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Background: Administration of terlipressin can reverse hypotension in potential organ donors with norepinephrine-resistance. The aim of this study was to determine the effects of terlipressin on the hemodynamics, liver function, and renal function of hypotensive brain-dead patients who were potential organ donors.Methods: A retrospective study was conducted by using the ICU database of one hospital. 18 patients in a total of 294 brain-dead cases were enrolled and administered terlipressin intravenously. All physiological parameters of recruited patients were obtained at baseline, 24 and 72 h after administration, and immediately before organ procurement.Results: Terlipressin induced significant increases in mean arterial pressure (MAP) from 69.56 ± 10.68 mm Hg (baseline) to 101.82 ± 19.27 mm Hg (immediately before organ procurement) and systolic blood pressure (SBP) from 89.78 ± 8.53 mm Hg (baseline) to 133.42 ± 26.11 mm Hg (immediately before organ procurement) in all patients. The increases in MAP were accompanied by significant decreases in heart rate (HR) from 113.56 ± 28.43 bpm (baseline) to 83.89 ± 11.70 bpm (immediately before organ procurement), which resulted in the decrease of norepinephrine dose over time from 0.8 ± 0.2 μg/kg/min (baseline) to 0.09 ± 0.02 μg/kg/min (immediately before organ procurement). There were no changes in central venous pressure, liver function including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin. Renal function, assessed by serum creatinine (SCr), urine output (UOP), creatinine clearance rate (CCr), and estimated glomerular filtration rate (eGFR), improved significantly.Conclusion: Our analysis of brain-dead patients with hypotension indicates that administration of terlipressin can significantly increases MAP, SBP, UOP, CCr, and eGFR, while decreases HR and Scr. Terlipressin appears to help maintain hemodynamic stability, reduce vasoactive support, and improve renal function.

Astragalin, a bioactive component of medicinal plants such as Rosa agrestis, has anti-inflammatory and antioxidant features. Induction of heme oxygenase (HO)-1 is an effective strategy to reduce excessive generated oxidants during the pathogenesis of acute lung injury (ALI). The aim of the present study is to investigate that whether the anti-inflammatory and antioxidant features of astragalin is HO-1 dependent in lipopolysaccharide (LPS)-induced ALI. Sprague-Dawley rats were used in animal study. Intratracheal LPS was performed to induce experimental ALI model. Astragalin was administrated 1 h after LPS challenge. Human lung epithelial cells were used in cell study. Samples from rats were harvested at 24 h post LPS challenge. Astragalin treatment inhibited LPS-induced inflammatory cells infiltration in the lung and pulmonary edema. Astragalin treatment markedly enhanced the activity of HO-1 compared with vehicle-treated group at 24 h post LPS challenge. Levels of lipid hydroperoxide, a marker for oxidative stress, were decreased in astragalin-treated animals compared with vehicle-treated group. However, the protective effect of astragalin on LPS-induced ALI was abolished in an inhibitor of HO-1-treated animals. Moreover, the astragalin-induced the upregulation of HO-1 in human lung epithelial cells was inhibited when nuclear factor erythroid-2-related factor 2 (Nrf2) was silenced by small interfering RNA. Astragalin reduces LPS-induced ALI via activation of Nrf2/HO-1 pathway.

Purpose:To investigate the clinical significance of serum procalcitonin (PCT) concentrations and related indicators of infection in the early diagnosis and prognosis of severe surgical patients with infection. Methods: This study included 77 critically ill patients taken from the Surgery Department to the Intensive Care unit between June 2015 and July 2017. Patients were divided into control, sepsis and septic shock groups, and their serum concentrations of PCT and related indicators of infection were compared. Results: PCT levels increased significantly from the control to the sepsis group and from the sepsis to the septic shock group (P0.05). Receiver operating curve (ROC) analysis showed that the areas under the curve (AUC) for PCT, WBC count, neutrophil percentage and body temperature were 0.949, 0.657, 0.640 and 0.656, respectively. PCT, with 0.52 µg/L as the cut-off concentration, had the highest performance in the diagnosis of severe surgical sepsis, with a sensitivity of 96.1%, a specificity of 92.3% and a Youden index of 0.884. Conclusion: PCT concentration is diagnostic of infection in severe surgical patients, has high specificity in the early diagnosis of sepsis, and can reflect the severity of infection.

BackgroundThe world is under serious threat with the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19). However, there is no effective drug for the treatment of COVID-19. Based on analyses of available data, we deduced that the excessive prostaglandins E2(PGE2) accumulation mediated by cyclooxygenase-2 (COX-2) was the key pathological basis of COVID-19.MethodsThe urine PGE2levels were measured by mass spectrometry. An experimental study about Celebrex to treat COVID-19 was conducted based on routine treatment. A total of 44 confirmed COVID-19 patients were enrolled (Experimental group n=37, Control group n=7). Patients in experimental group were given Celebrex once or twice a day (0.2 g/time) for 7–14 days. The dosage or duration was modified for individuals. Clinical outcomes of Celebrex adjuvant therapy were evaluated by vital signs, laboratory tests, and computed tomography upon the discontinuance of Celebrex.ResultsWe found that the concentrations of PGE2in urine samples of COVID-19 patients were significantly higher than that of healthy individuals (mean value is 170 ng/mlvs18.8 ng/ml,p2levels and promoted recovery of ordinary or severe COVID-19.ConclusionOur study suggests that Celebrex adjuvant treatment may be helpful for the therapy of COVID-19.

Background: Tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) are recent promising markers for identification of cardiac surgery-associated acute kidney injury (CSA-AKI). The aim of this study was systematically and quantitatively to evaluate the accuracy of urinary TIMP-2 and IGFBP7 for the diagnosis of CSA-AKI. Methods: Three databases including PubMed, ISI web of knowledge, and Embase were systematically searched from inception to March 2018. Two investigators conducted the processes of literature search study selection, data extraction, and quality evaluation independently. Meta-DiSc and STATA were used for all statistical analyses. Results: A total of 8 studies comprising 552 patients were included in this meta-analysis. Pooled sensitivity and specificity with corresponding 95% confidence intervals (CIs) were 0.79 (95% CI, 0.71-0.86, I 2 = 74.2%) and 0.76 (95% CI, 0.72-0.80, I 2 = 80.8%), respectively. Pooled positive likelihood ratio (LR), negative LR, and diagnostic odds ratio were 3.49 (95% CI, 2.44-5.00, I 2 = 61.5%), 0.31(95% CI, 0.19-0.51, I 2 = 51.8%), and 14.89 (95% CI, 7.31-30.32, I 2 = 27.9%), respectively. The area under curve estimated by summary receiver operating characteristic was 0.868 (standard error [SE] 0.032) with a Q* value of 0.799 (SE 0.032). Sensitivity analysis demonstrated that one study notably affected the stability of pooled results. One of the subgroups investigated—AKI threshold—could account for partial heterogeneity. Conclusion: Urinary TIMP-2 and IGFBP7 is a helpful biomarker for early diagnosis of CSA-AKI. And, the potential of this biomarker with a broader spectrum of clinical settings may be the focus of future studies.

Hepatocellular carcinoma (HCC) is a common malignant tumor usually resistant to chemotherapy. MicroRNAs play important roles in modulation of carcinogenesis and chemoresistance, which miR-16 has been reported to mediate chemoresistance in many types of cancers. However, the role of miR-16 in HCC remains unknown. The aim of this study was to investigate whether miR-16 is participated in chemoresistance in HCC and shed light on the underlying molecular mechanisms. The findings of the current study discover that miR-16 is down-regulated in HCC tissue and cell lines. The results demonstrate that the inhibition of miR-16 renders resistance to paclitaxel in vitro and in vivo by targeting IKBKB via NF-κB signaling pathway, suggesting that miR-16 may be a meaningful therapeutic potential to overcome drug resistance in HCC.

In order to monitor the fatigue state of the face, a state detection algorithm based on a variety of facial fatigue parameters is proposed. Firstly, convolution neural network is used to enhance the edge information of eyes and mouth for accurate positioning. Then, a rotation invariant LBP pyramid feature is used to describe the eyes, and a linear SVM classifier is trained to distinguish the open and closed state of eyes. The open and closed state of mouth is judged according to the open area and aspect ratio of mouth. At the same time, the vertical movement of eyes is counted Determine changes in head position. Finally, based on the state of eyes and mouth and the position of head, four fatigue parameters which can describe the state are calculated, and the final fatigue state is obtained by convolution neural network. The experimental results show that the detection and state discrimination algorithms have high accuracy.

Objectives. Driving pressure (DP) has recently become a promising mediator for the identification of the effects of mechanical ventilation on outcomes in acute respiratory distress syndrome (ARDS). The aim of this study was to systematically and quantitatively update and assess the association between DP and mortality among ventilated patients with ARDS. Methods. PubMed, the Cochrane Library, ISI Web of Knowledge, and Embase were systematically searched from inception to June 2018. Two investigators conducted the literature search study selection, data extraction, and quality evaluation independently. RevMan 5.3 software was used for all statistical analyses. Results. A total of seven studies comprising 8010 patients were included in this meta-analysis. Higher DP showed a significant association with higher mortality (pooled risk ratio, 1.10; 95% [CI], 1.05–1.16; I2 =58%). Sensitivity analysis indicated that one study significantly affected the stability of pooled results. One of the subgroups investigated, ARDS severity, could account for the heterogeneity. An exploratory post hoc subgroup analysis and higher DP significantly increased mortality in the mild to severe ARDS subgroup (RR 1.28; 95% [CI], 1.14–1.43; I2 =0), but not in the moderate to severe ARDS subgroup (RR 1.18; 95% [CI], 0.95–1.46; I2 =52%). Conclusion. Higher DP was significantly associated with an increased risk of death among ventilated patients with ARDS. But it did not seem to predict prognosis to moderate to severe ARDS. Future prospective randomized clinical trials are needed to verify the results of this meta-analysis and address the unresolved questions about optimum cutoff values for DP. Trial Registration. This trial is registered with PROSPERO (CRD42018102146), on 11 August 2018.

Background: To investigate the occurrence and risk factors of acute kidney injury (AKI) in organ donors. Methods: Clinical data of 153 donor patients who donated organs in our hospital from January 2016 to July 2018 were collected. Patients were divided into AKI group and non-AKI group according to AKI diagnostic criteria. Clinical indicators of patients in the two groups were compared, and the related risk factors were analyzed by unifactorial and multivariate logistic regression. Results: The incidence of donor patients complicated with AKI was 48.37%. Unifactorial analysis suggested that the SOFA score, positive rate of blood culture, hypothermia incidence and vasoactive drug dose in donor AKI group were larger than those in non-AKI group. Multivariate Logistic regression analysis showed that the dose of booster drugs (P=0.02, OR=3.53) and the positive rate of blood culture (P=0.01, OR=6.64) were independent risk factors for donor patients complicated with AKI. Conclusion: The incidence of acute kidney injury in organ donors is high, with the dose of booster drugs and the positive rate of blood culture as independent risk factors for evaluation basis to assess the incidence rate of donor patients complicated with AKI.

Virus-induced gene silencing (VIGS) is a valuable reverse genetics tool to study gene function in a broad range of plants. As the efficiency of apple stable transformation is very low and it is still not easy to produce a large number of apple transgenic plants for most laboratories. Here, we developed an easy and effective transient transformation method of agro-inoculation for virus-induced gene silencing based on vacuum infiltration in genus of apples, the crabapple. The entire young tissue cultured crabapple plantlets were used as the plant material for infiltration, and a −90 kPa vacuum pressure and 19 °C day/18 °C night cultivation temperature were shown to result in highest VIGS efficiency. Infiltration with tobacco rattle virus containing a fragment of the transcription factor gene McMYB10, which regulates the synthesis of anthocyanin pigments, resulted in low levels of McMYB10 transcripts and characteristic faded red leaves. In addition, the expression of several anthocyanin biosynthetic genes was down-regulated in the transformed leaves. The results of this study indicate that the MYB10 gene represents a useful reporter gene for VIGS in crabapple and that the VIGS technique can be successfully applied to crabapple, thereby providing a platform for functional genetic studies in this and likely other Malus species.

The promotion of tumor development by Dickkopf 4 (DKK4) is receiving increased attention. However, the association between DKK4 and pancreatic cancer remains unclear. DKK4 expression was measured in pancreatic ductal adenocarcinoma tissues using qRT-PCR and immunohistochemistry. A DKK4-overexpressing pancreatic cancer cell line was established, and the differentially expressed genes (DEGs) that were induced by DKK4 were identified using transcriptome sequencing. The association between the identified DEGs and pancreatic cancer was assessed using gene ontology (GO), pathway analysis, pathway interaction networks, differentially expressed gene interaction network analysis, and co-expression gene networks. Finally, the accuracy of the analyses was validated using serial paraffin and frozen sections of clinical samples. DKK4 is highly expressed in pancreatic cancer tissues. DEGs of overexpression DKK4 of PANC-1 are mostly upregulated. GO and pathway analysis showed that DKK4 are associated with tumor and organ development and immune inflammation. The mitogen-activated protein kinase (MAPK) signaling pathway was the main signal transduction pathway that showed significant enrichment in overexpression DKK4 of PANC-1. The results of GO, pathway analyses, and differentially expressed gene interaction network identified genes that are closely associated with tumor development, including MAPK3, PIK3R3, VAV3, JAG1, and Notch3. The immunohistochemistry and immunofluorescence results suggested that DKK4 is co-expressed with MAPK3 and VAV3 in pancreatic cancer tissues. The results presented here show for the first time that DKK4 is highly expressed in pancreatic cancer tissues. Bioinformatics analysis of a DKK4-overexpressing of PANC-1 identified several oncogenes that are closely associated with tumors, and the MAPK signaling pathway is the core signal transduction pathway. DKK4 can be co-expressed with MAPK3 and VAV3 in pancreatic ductal adenocarcinoma tissues. Thus, DKK4 may have function on the development and progression of pancreatic cancer.

Introduction Toll-like receptor (TLR) 7 is an important mediator in inflammation. However, its role in hyperoxia-induced acute lung injury (HALI) remains to be elucidated. Methods C57BL/6 wild-type and C57BL/6 background TLR 7 deficiency mice were exposed to hyperoxia to stimulate HALI in airtight cages. Animals were sacrificed at 72 h post hyperoxia or room air exposure. Lung injury indicators were measured. Moreover, soluble epoxide hydrolase (sEH) activity was detected by a 14, 15-EET/DHET ELISA kit. Activation of activator protein (AP)-1 and nuclear factor kappa-B (NF-κB) was detected with enzyme linked immunosorbent assay kits. Results Our data revealed that pulmonary histological assay and wet to dry weight ratio, myeloperoxidase and malondialdehyde activity were reduced in TLR 7 deficiency mice compared with wild-type mice. Moreover, hyperoxia–caused elevation of sEH activity was reduced in TLR 7 deficiency mice. Transcription factors AP-1 activation was significantly inhibited in TLR 7 deficiency mice compared with wild-type mice. Similarly, the activation of NF-κB was reduced in TLR 7 deficiency mice. Tumor necrosis factor-α and interleukin-1β, potent proinflammatory cytokines, were reduced in TLR 7 deficiency mice. Conclusion TLR 7 deficiency is associated with inhibition of inflammation in HALI in mice.

Objectives Patients with myasthenia gravis (MG) often benefit from thymectomy, but the optimal timing of extubation following thymectomy in these patients remains unknown. This study of MG patients compared the effect of early and late extubation following thymectomy on clinical outcome. Methods We performed a study of data from 96 patients with MG who received thymectomy procedures, followed by early ( 6 h) extubation, at our institution between October 2011 and November 2017. Patient clinical and demographic characteristics, preoperative data, and postoperative clinical outcomes were analyzed. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Results The patients in the early extubation group (n = 53) and late extubation group (n = 43) had similar preoperative clinical and demographic characteristics. However, the early extubation group had a significantly longer duration of MG (24 months vs. 12 months, P

Summary Background Paediatric liver allografts sometimes are allocated to adult recipients when there are no suitable paediatric recipients on the waiting list. However, debate exits regarding the reported outcomes of liver transplants using such small grafts. Methods Records from adult patients undergoing liver transplantation between February 2010 and January 2016 who received whole grafts from paediatric (≤ 13 years) donors or ideal deceased adult (18–35 years) donors were reviewed. Patient and graft survival, post-transplant liver function, and complications between the two groups were compared. Results The baseline characteristics were comparable, except that the paediatric donor allografts had smaller size. The 3-month, 1-year, and 3-year rates of patient survival were 91.3%, 85.2%, and 85.2% in the paediatric donor group and 93.4%, 88.9%, and 85.0% in the adult donor group (P = 0.947), respectively. One patient receiving a paediatric allograft developed small-for-size liver syndrome post-transplantation. There was no difference in primary non-function, early allograft dysfunction, biliary complications, vascular complications, or infection between the two groups. Conclusion Our study indicates that using paediatric donor livers in well-selected adult recipients is a safe procedure, considering there was no suitable paediatric recipient. However, the risk of portal hyperperfusion should be considered in clinical cases such as size-mismatched transplants.

The structural substitution effects of different intramolecular π-stacking molecules at 9-position of diarylfluorenes were analyzed. Ground (excited-state) geometric conformations were optimized at B97-D/TZVP (TD-B97D/6-31+G ∗ ) level and their intramolecular π–π interactions were investigated by non-covalent interactions (NCI) theory. UV– vis and photoluminescence (PL) spectra were obtained on the optimized structures at TD-B97D/TZVP level. The results show that the strong π–π interactions mainly focus on the middle area of substituent groups, whereas the outer is the weak π–π interactions. The π–π stacking interactions have different effect on the HOMOs and LUMOs in the diarylfluorenes and diaryldiazafluorenes, resulting in the distinct optical properties.

Objective To evaluate the safety and efficacy of steroid-minimization therapy in liver transplantation (LT) recipients with hepatitis B virus-related diseases in China. Methods From March 2000 to June 2007, 502 adult LT recipients, mostly with hepatitis B (HBV)-related diseases, were enrolled in our study. Four study groups were setup according to the steroid-minimization protocols: tacrolimus (TAC) with 6 months steroids withdrawal (6M SW), TAC with 3 months SW (3M SW), TAC with 14 days SW (14d SW), and TAC with basiliximab induction and steroids avoidance (Bas SA). All patients were followed up for at least 36 months after LT. Results There were no significant differences in the overall 3-year survival rates of the patients and graft, and chronic rejection among the four groups (P = 0.092, P = 0.113 and P = 0.684, respectively). There was also no difference in acute rejection within 12 months after LT (P = 0.514). The 3-year recurrence rates of HBV infection and hepatocellular carcinoma (HCC) after LT were significantly different among all the groups (lowest in TAC/Bas SA group; P = 0.037 and P = 0.029, respectively). The overall incidence of infection was significantly higher in the 6M SW group (62.2% vs 56.1% in 3M SW, 30.5% in 14d SW, 20.5% in Bas SA; P