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Acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure caused by infection, trauma, shock, aspiration or drug reaction. The pathogenesis of ARDS is characterized as an unregulated inflammatory storm, which causes endothelial and epithelial layer damage, leading to alveolar fluid accumulation and pulmonary edema. Previous studies have shown the potential role of mesenchymal stem cells (MSC) in combating the inflammatory cascade by increasing the anti-inflammatory mediator interleukin-10 (IL-10). However, the involved mechanisms are unclear. Here we investigated whether a key immunomodulatory regulator, stanniocalcin-1 (STC-1), was secreted by MSC to activate phosphoinositide 3-kinase/protein kinase B (PI3K/AKT)/ mammalian target of rapamycin (mTOR) signaling pathway to increase IL-10 expression in alveolar macrophages. Lipopolysaccharide (LPS)-stimulated alveolar macrophages co-cultured with human umbilical mesenchymal stem cells (HUMSC) secreted high levels of IL-10. HUMSC co-cultured with alveolar macrophages expressed high STC-1 levels and increased PI3K, AKT and mTOR phosphorylation after LPS activation in alveolar macrophages. STC-1 knockdown in HUMSC decreased the phosphorylation of PI3K, AKT and mTOR and suppressed IL-10 expression in alveolar macrophages. Rapamycin (an mTOR inhibitor) reduced IL-10 secretion in alveolar macrophages. These results, together with our previous study and others, indicate that the PI3K/AKT/mTOR pathway is involved in the regulation of IL-10 production by STC-1 secreted by HUMSC in alveolar macrophages.

To date, the efficacy of glucocorticoid therapy to reduce mortality in patients with acute respiratory distress syndrome (ARDS) has remained controversial among the studies available. The present meta-analysis study aimed to further clarify the impact of glucocorticoid therapy on mortality in patients with ARDS by performing a pooled analysis of the previous data. The PubMed, Chinese Knowledge Infrastructure, Wanfang and Cochrane trials databases were searched for relevant studies published between 1966 and 2016. Randomized controlled trials (RCTs) that included the use of glucocorticoids in patients with ARDS and had reported on mortality were included. Odds ratios (OR) and 95% confidence intervals (CI) for mortality were calculated. A total of 10 RCTs were included in the meta-analysis. Of these, 4 studies used high-dose glucocorticoid therapy, while 6 used low-dose glucocorticoid therapy. In the pooled analysis, glucocorticoids were indicated to significantly reduce ARDS-associated mortality (OR=0.64, 95% CI: 0.48–0.85, P=0.002). Further subgroup analysis indicated the following: i) Long-term low-dose glucocorticoid therapy reduced ARDS-associated mortality compared with that in the control group (OR=0.60, 95% CI: 0.44–0.82, P=0.001), whereas high-dose short-term glucocorticoid therapy did not reduce mortality (OR=0.82, 95% CI: 0.43–1.57, P=0.55). ii) Early initiation of glucocorticoid therapy was associated with reduced mortality compared with that in the control group (OR=0.60, 95% CI: 0.44–0.83, P=0.002); however, late initiation did not reduce mortality (OR=0.36, 95% CI: 0.03–3.76, P=0.39). iii) Therapeutic rather than preventive use of glucocorticoids reduced mortality (OR=0.65, 95% CI: 0.49–0.86, P=0.003). Overall, the present meta-analysis suggests that early initiation of long-term low-dose glucocorticoid therapy reduces mortality of patients with ARDS.

Coronavirus disease 2019 (COVID-19) becomes a global pandemic in 2020. Early identification of severe ill patients is a top priority for clinicians. We aimed to describe clinical features and risk factors of severe-critically ill patients with COVID-19 in Jiangsu Province.This multi-centered retrospective study collected the information of 631 laboratory-confirmed COVID-19 patients hospitalized at 28 authorized hospitals in Jiangsu province from January 23, 2019 to March 13, 2020.A total of 583 adult patients with laboratory-confirmed COVID-19 were enrolled for final analysis, including 84 severe-critically ill patients and 499 mild-moderate patients. Median age of the severe-critically ill patients was 57.0 years old (interquartile range, 49.0-65.8), and 50 (59.5%) were males. Multisystemic laboratory abnormalities were observed on admission for severe-critically ill patients. These patients showed more noticeable radiologic abnormalities and more coexisting health issues as compared to the mild-moderate patients. Most of the severe-critically ill COVID-19 patients became deteriorated in 2 weeks after diagnosis. Age, D-dimer, and lymphocytes were independently associated with the progression of severe-critically illness.Older age, higher D-dimer levels and less lymphocyte counts on admission are potential risk factors for COVID-19 patients to develop into severe and critically illness.

Subunit 1 is the scaffold protein of the carbon catabolite repressor protein 4 (CCR4)‑negative on TATA (NOT) complex (CNOT1). In our previous study, it was reported that tristetraprolin (TTP) could recruit subunit 7 of the CCR4‑NOT complex (CNOT7) to induce the degradation of intercellular adhesion molecule‑1 (ICAM‑1) and interleukin‑8 (IL‑8) mRNA in human pulmonary microvascular endothelial cells (HPMECs). It was additionally demonstrated that TTP, CNOT7 and CNOT1 formed a complex in HPMECs. However, whether CNOT1 is involved in TTP‑mediated ICAM‑1 and IL‑8 mRNA decay remains unclear. The present study demonstrated that CNOT1 knockdown improved ICAM‑1 and IL‑8 mRNA stabilization and protein expression levels. The immunofluorescence results demonstrated that CNOT1, CNOT7 and TTP are co‑localized in the cytoplasm. CNOT1 silencing abolished CNOT7 and TTP coimmunoprecipitation. However, CNOT7 silencing did not influence CNOT1 and TTP coimmunoprecipitation, and TTP silencing additionally did not influence CNOT1 and CNOT7 coimmunoprecipitation. These results together with the authors' previous study, have identified that CNOT1 provides a platform for the recruitment of TTP and CNOT7, and is involved in TTP‑mediated ICAM‑1 and IL‑8 mRNA decay.

To design a product with the given product requirement and design objective, there can be alternative ways to propose the detailed design specifications of the product. In the design modeling stage, alternative design cases with detailed specifications can be modeled to fulfill the product requirement and design objective. Therefore, in the design evaluation stage, it is required to perform an evaluation of the alternative design cases for deciding the final design. The purpose of this research is to develop a product evaluation model for evaluating the alternative design cases by integrated evaluating the criteria of functional design, Kansei design, and design for supply chain. The criteria in the functional design group include primary function, expansion function, improved function, and new function. The criteria in the Kansei group include geometric shape, dimension, surface finish, and layout. The criteria in the design for supply chain group include material, manufacturing process, assembly, and supply chain operation. From the point of view of value and cost, the criteria in the functional design group and Kansei design group represent the design value of the product. The criteria in the design for supply chain group represent the supply chain and manufacturing cost of the product. It is required to evaluate the design value and the supply chain cost to determine the final design. For the purpose of evaluating the criteria in the three criteria groups, a fuzzy analytic network process (FANP) method is presented to evaluate a weighted index by calculating the total relational values among the three groups. A method using the technique for order preference by similarity to ideal solution (TOPSIS) is used to compare and rank the design alternative cases according to the weighted index using the total relational values of the criteria. The final decision of a design case can be determined by using the ordered ranking. For example, the design case with the top ranking can be selected as the final design case. Based on the criteria in the evaluation, the design objective can be achieved with a combined and weighted effect of the design value and manufacturing cost. An example product is demonstrated and illustrated in the presentation. It shows that the design evaluation model is useful for integrated evaluation of functional design, Kansei design, and design for supply chain to determine the best design case and achieve the design objective., {"references":["Y. J. Tseng, and Y-S. Chen, \"A Closed-loop Design Model for Sustainable Manufacturing by Integrating Forward Design and Reverse Design,\" International Journal of Social, Behavioral, Educational, Economic and Management Engineering, Vol. 9, No. 7, 2015, pp. 2217-2213.","Y.-J. Tseng, and Y-J Wang, \"A Product Development for Green Logistics Model by Integrated Evaluation of Design and Manufacturing and Green Supply Chain\", ICIME 2013 International Conference on Industrial and Mechanical Engineering (World Academy of Science, Engineering and Technology), London, UK, July 08-09, 2013, vol. 7, no. 7, pp. 420-425.","C. A. Weber, J. R. Current, and W. C. Benton, \"Vendor Selection Criteria and Methods,\" European Journal of Operational Research, vol. 50, pp. 2-18, 1991.","R. G. Kasilingam, and C. P. Lee, \"Selection of Vendors: A Mixed-Integer Programming Approach,\" Computers and Industrial Engineering, vol. 31, no. 1-2, pp. 347-350, 1996.","P. K. Humphreys, Y. K., Wong, and F. T. S. Chan, \"Integrating environmental criteria into the supplier selection process,\" Journal of Materials Processing Technology, vol. 138, pp.349-356, 2003.","G. Akyuz, and E., T. Erman, \"Supply chain performance measurement: a literature review,\" International Journal of Production Research, vol. 48, no. 17, pp. 5137-5155, 2010.","T. L. Saaty, \"Decision Making with Dependence and Feedback: The Analytic Network Process,\" Pittsburgh, PA: RWS Publications, 1996.","C. L. Hwang, and K. Yoon,\"Multiple Attribute Decision Making: Methods and Applications, \" New York: Springer-Verlag, 1981."]}

Jia-Xin Shi,1 Jia-Shu Li,1 Rong Hu,1 Xiao-Min Li,2 Hong Wang3 1Department of Respiratory Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical University, Affiliated Hospital of the Clinical Medical School of Nanjing Medical University, Clinical Medical School of Jiangsu University, Lianyungang, 2Department of Critical Care Medicine, Lianyungang First People’s Hospital, Affiliated Hospital of Xuzhou Medical University, Affiliated Hospital of the Clinical Medical School of Nanjing Medical University, Clinical Medical School of Jiangsu University, Lianyungang, 3Department of Respiratory Medicine, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China Abstract: The carbon catabolite repressor protein 4 (CCR4)–negative on TATA (NOT) complex includes multiple subunits and is conserved in the eukaryotic cells. The CCR4–NOT complex can regulate gene expression at different levels. Two subunits of the CCR4–NOT complex, CCR4 and CCR4-associated factor 1 (CAF1), possess deadenylase activity. In yeast, the deadenylase activity is mainly provided by the CCR4 subunit; however, the deadenylase activity is provided by both CCR4 and CAF1 in other eukaryotes. A previous study reported that CAF1 but not CCR4 is required for the decay of a reporter mRNA with AU-rich elements. Our previous study showed that CAF1 is involved in the regulation of intercellular adhesion molecule-1 (ICAM-1) and interleukin-8 (IL-8) expression. Both ICAM-1 and IL-8 play crucial roles in acute lung injury. In the present study, we examined the effects of CAF1 deficiency on IL-8 and ICAM-1 expression and acute lung injury in mice. Here we showed that there were no differences between the wild-type and CAF1-knockout mice on phenotypes. The lung histology and protein and mRNA levels of IL-8 and ICAM-1 in unstimulated wild-type mice were comparable to those in unstimulated CAF1-knockout mice. However, lipopolysaccharide stimulation led to more severe lung histological injury and greatly higher IL-8 and ICAM-1 expression in CAF1-knockout mice compared to the wild-type mice. These results, together with our previous study, suggest that CAF1 is involved in the regulation of lipopolysaccharide-stimulated IL-8 and ICAM-1 expression in vivo and affects the progression of acute lung injury. Keywords: CAF1, knockout, mice, acute lung injury, IL-8, ICAM-1