Objective To investigate The effect of early intravenous of glucocorticoid application in children with asthmatic pneumonia. Methods 120 cases of asthmatic pneumonia treated in our hospital were divided into the study group and the control group according to the order in the hospital, 60 cases in each group. The control group was treated with conventional therapy, and patients in the study group were treated with intravenous infusion of glucocorticoid(Jia Bo nylon)3 times daily, 1.5 mg / kg on the basis of conventional therapy for 5 consecutive days. Results Dyspnea and wheezing time and hospitalization time of the study group was significantly lower than those of the control group(P 0.05). The cure rate and the total effective rate in the study group were 73.3% and 98.3%, respectively, and were significantly higher than those in control group(P 0.05). Conclusion The early use of glucocorticoid such asmethyl prednisolone infusion for treatment of children with asthmatic pneumonia can rapidly relieve respiratory tract obstruction,reduce wheezing, shorten the breath and other symptoms of the respiratory tract.
Endomorphins (EMs) have important roles in the body with regards to analgesia, feeding behavior, gastrointestinal movement and inflammatory reaction. Recent studies have reported that EMs may also participate in chronic hypoxia in the protection of rat myocardial ischemia/reperfusion; however, the mediator and underlying mechanisms remain to be elucidated. The aim of the present study was to investigate the effects of EM‑1 postconditioning on myocardial ischemia/reperfusion injury (MIRI) and myocardial cell apoptosis in a rat model, and to assess its likely mechanisms. A total of 48 male Sprague Dawley rats were randomly divided into four groups: Sham group, ischemia/reperfusion group (IR group), ischemic postconditioning group (IPO group) and EM‑1 postconditioning group (EM50 group). A MIRI model was established via occlusion of the left anterior descending branch of the coronary artery for 30 min, followed by reperfusion for 120 min in vivo. Hemodynamic indexes were recorded and analyzed. Following reperfusion, plasma lactate dehydrogenase (LDH), creatine kinase‑MB (CK‑MB), malondialdehyde (MDA), superoxide dismutase (SOD), interleukin‑6 (IL‑6) and tumor necrosis factor‑α (TNF‑α) contents or activities were measured, infarct size was determined, and the expression levels of B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax) mRNA and cleaved caspase‑3 protein were assessed. In the IR group, mean arterial pressure (MAP) and heart rate (HR) were decreased compared with in the sham group. In addition, LDH and CK‑MB levels were increased; IL‑6, TNF‑α and MDA content was increased; SOD activity was decreased; the Bcl‑2/Bax ratio was decreased; and cleaved caspase‑3 protein expression levels were increased in the IR group. Compared with in the IR group, in the IPO and EM50 groups, MAP and heart rate (HR) were recovered to various extents post‑reperfusion; LDH and CK‑MB levels were decreased; IL‑6, TNF‑α and MDA content was decreased; SOD activity was increased; infarct size was reduced; the Bcl‑2/Bax ratio was increased; and cleaved caspase‑3 protein expression levels were decreased. In conclusion, EM‑1 postconditioning was revealed to reduce I/R injury and inhibit myocardial cell apoptosis, which may be associated with reductions in oxidative stress and inflammatory reactions.
Through a field experiment in the greenhouse,different irrigation quota in the case of a fixed irrigation cycle impact on green peppers growth,yield and water productivity in both autumn and winter were studied,to determine the suitability of irrigation regime.The results showed that when irrigation quota within a certain range,the height and stem diameter of green pepper with the increase of irrigation quota;but when irrigation quota was too large to reach 280 mm,irrigation would inhibit the reproductive growth of green pepper,cause peppers lower production,reduce water use efficiency;when irrigation quota was 260 mm,yield and water use efficiency were the highest,could be used as indicators of appropriate irrigation for drip irrigation of green peppers.
As China's aging population trend, gastric cancer patients in the proportion of elderly patients with a gradual increase. So the older the clinical features of patients with gastric cancer, and postoperative complications and other issues of increasing concern. In this paper, 106 cases of gastric cancer patients with clinical data analysis, to explore the impact of elderly patients with gastric cancer risk factors of postoperative complications,
Dear Editor, The dramatic rise in confirmed coronavirus disease 2019 (COVID-19) cases poses a rigorous challenge to the global healthcare system. Previous studies have indicated that the cytokine storm plays a major role in the progression and death of patients diagnosed with COVID-19.1, 2 Therefore, glucocorticoids as an immunomodulatory therapy may be beneficial.3, 4 However, evidence concerning glucocorticoids for patients with COVID-19 is controversial and limited by small sample sizes or flawed study designs.5-9 A recent randomized controlled trial (RCT) showed that 6 mg of dexamethasone once per day for ten days reduced deaths by one-third in ventilated COVID-19 patients.10 However, the practical application of glucocorticoids in clinical treatment has not been clearly stated. Considering the gap between RCT participants and actual clinical users, we believe it is of great value to explore the application of glucocorticoids and their effectiveness on patient prognosis in the real world based on elaborated information from electronic medical records. Herein, we implemented a real-world, multicenter study with comprehensively detailed clinical data of 2044 patients with COVID-19 who had been discharged or died from January 27 to March 21, 2020 in the Sino-French New City campus and the Optical Valley Campus of Tongji Hospital in Wuhan, China. All patients were classified into the noncritical group or critical group based on their most severe condition during the entire course of disease (Supporting Information Methods). The flowchart is shown in Figure S1. We aimed to depict the administration of glucocorticoids in a large population. We employed multivariate logistic regression and Cox regression to explore whether glucocorticoids affect the prognosis of patients with COVID-19. The detailed demographic and clinical characteristics of patients with different severities are shown in Tables S1 and S2. The use of glucocorticoids was heterogeneous in patients in the two groups. Glucocorticoids were especially widely used in critical patients compared with noncritical patients (83.6% vs 24.9%, P < .001). The critical patients received glucocorticoid therapy earlier after illness onset (1.0, IQR [interquartile range]: 1.0-3.0 vs 2.0, IQR: 1.0-4.0, P = .002), and the treatment duration was shorter (5.0, IQR: 3.0-10.0 vs 8.0, IQR: 5.0-12.0, P < .001). The recommended days of glucocorticoid use and the timepoint at which to initiate use remain inconclusive. A further comparison between glucocorticoid users and nonusers is presented in Table 1. In the noncritical patients, the instability of vital signs in users was noticeable, including higher temperature (P < .001), faster respiratory rate (P < .001), lower mean arterial pressure (P = .009), and reduced SpO2 (P < .001). More antibiotics and intravenous immunoglobin were received by users than by nonusers (P < .001; P < .001, respectively). The mortality rates of the users and nonusers were similar (0.7% vs 0.2%, P = .168). However, the incidence of various complications of the users was significantly higher. The median hospital length of stay was significantly prolonged by nearly one week in users (24.0, IQR: 19.0-32.0 vs 18.0, IQR: 12.0-25.0, P < .001), as well as the time from illness onset to discharge or death (36.0, IQR: 29.0-43.0 vs 35.0, IQR: 27.0-43.0, P = .003). In the critical patients, the mortality rates were 84.8% for users and 88.6% for nonusers. Similar to noncritical patients, more users received intravenous immunoglobin treatment (P = .001). This finding suggested that immunomodulatory therapy may be an important method to treat COVID-19. The users among critical patients also experienced a remarkably prolonged hospital length of stay (12.0, IQR: 6.5-21.5 vs 5.5, IQR: 4.0-17.0, P = .001), especially for survivors (34.0, IQR: 28.5-39.5 vs 21.0, IQR: 20.5-25.5, P = .003). Some potential factors were found to influence the effectiveness of glucocorticoids in critical patients. The detailed results are displayed in Table 2. A total of 190 of the 224 glucocorticoid users in the critical patients died, while only 34 recovered. The nonsurvivors presented with older age (70.0, IQR: 64.0-78.0 vs 65.0, IQR: 54.0-73.0, P = .010), lower SpO2 (84.0, IQR: 74.0-91.0 vs 91.5, IQR: 84.5-94.0, P < .001), and higher SOFA score at admission (5.0, IQR: 4.0-7.0 vs 4.0, IQR: 3.0-4.0, P = .002). The lymphocyte and platelet counts were both significantly lower in nonsurvivors than in survivors (0.56, IQR: 0.39-0.80 vs 0.74, IQR: 0.56-1.06, P = .003; 159.0, IQR: 106.3-224.7 vs 223.5, IQR: 148.5-316.5, P = .002). The level of albumin among nonsurvivors was lower (30.8, IQR: 27.9-33.6 vs 33.2, IQR: 29.4-36.8, P = .020), and the levels of blood urea nitrogen, creatinine, prothrombin time, D-dimer, high-sensitivity cardiac troponin I and NT-proBNP were all higher in nonsurvivors (P < .050). This suggested that abnormal metabolism and coagulation function are related to adverse outcomes of glucocorticoid treatment. The initial levels of C reactive protein, ferritin, procalcitonin, interleukin-2R, interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α were remarkably higher in nonsurvivors (P < .050), which revealed that the release of excessive inflammatory factors may also influence the effectiveness of glucocorticoids. More research is needed to explore the underlying mechanism and the interaction between cytokines and glucocorticoids. In summary, highly heterogeneous individuals vary in their response to glucocorticoid treatment. Even for patients with the same disease severity, physicians should fully grasp the auxiliary examination results of COVID-19 patients before the administration of glucocorticoids. We found no association between glucocorticoids and death, the incidence of complications, the incidence of more than one complication, or the use of invasive mechanical ventilation/extracorporeal membrane oxygenation (ECMO) in the multivariate logistic regression analysis (Table S3). In the multivariable Cox regression model, glucocorticoid therapy failed to affect the survival time of patients in the noncritical group (P = .558,Table S4) or critical group (P = .113, Table S4; log-rank P = .15, Figure S2). Incredibly, glucocorticoid treatment prolonged the hospital length of stay of both noncritical patients (HR [hazard ratio]= 0.563, 95% CI [confidence interval]: 0.504-0.628, P < .001, after adjusting for age) and critical patients (HR = 0.080, 95% CI: 0.024-0.262, P < .001). Kaplan-Meier curves with log-rank tests drew consistent conclusions (log-rank P < .0001 for noncritical patients; log-rank P < .0001 for critical patients) (Figure 1A,B). Furthermore, delayed viral shedding time in noncritical patients (HR = 0.892, 95% CI: 0.798-0.997, P = .043) was observed after adjusting for age and time from illness onset to admission (Table S4). However, the Kaplan-Meier curve showed no correlation between glucocorticoids and viral shedding time in either noncritical (log-rank P = .49, Figure 1C) or critical patients (log-rank P = .57, Figure 1D). Our research has several limitations. First, retrospective research has inherent limitations. However, compared with RCT, this study covered a wider population, including all confirmed patients. Second, all patients were located in Wuhan, China. Therefore, national or worldwide experience in treating COVID-19 with glucocorticoids is needed to support our findings. In conclusion, we conducted a real-world study of the early administration of glucocorticoids in patients with COVID-19 in Wuhan, China. Glucocorticoids were used in noncritically ill patients with unstable vital signs and the majority of critically ill patients. The use of glucocorticoids was related to prolonged hospitalization time of patients with different disease severities and prolonged viral shedding time of patients in the noncritical group. Glucocorticoids should be used with caution, especially in noncritical patients with older age and delayed admission. Physicians should prudently prescribe glucocorticoids according to the clinical guidelines and the actual situation of individual patients. We sincerely thank all individuals and communities involved in fighting against COVID-19. The study was supported by the National Science and Technology Major Sub-Project (grant number: 2018ZX10301402-002), the Technical Innovation Special Project of Hubei Province (grant number: 2018ACA138), the National Key Basic Research Program of China (grant number: 2015CB553903), the National Natural Science Foundation of China (grant numbers: 81572570, 81974405, 31822030, 31771458, 81772787, and 81873452), the Fundamental Research Funds for the Central Universities (grant number: 2019kfyXMBZ024), and the Wuhan Municipal Health Commission (grant number: WX18Q16). This study was approved by the Research Ethics Commission of Tongji Hospital of Huazhong University of Science and Technology (TJ-IRB20200406) with written informed consent waived. The trial has been registered in Chinese Clinical Trial Registry (ChiCTR2000032161). Chunrui Li and Qinglei Gao had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Xiaofei Jiao, Ya Wang, Dan Liu, and Shaoqing Zeng equally contributed to this work. Dan Liu and Qinglei Gao designed the study. Jianhua Chi, Ruyuan Li, Yang Yu, Shaoqing Zeng, Ruidi Yu, Siyuan Wang, Yuan Yuan, Yue Gao, and Sen Xu acquired, analyzed, and interpreted the data. Xiaofei Jiao, Ya Wang, Dan Liu, and Shaoqing Zeng analyzed and interpreted data, and wrote the paper. Chunrui Li and Qinglei Gao provided critical revision of the manuscript for important intellectual content and administrative, technical, or material support. Chunrui Li and Qinglei Gao supervised this work. All authors vouch for the respective data and analysis, approved the final version, and agreed to publish the manuscript. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. Data supporting the findings of this study are available from the corresponding author upon reasonable request. The data containing information that could compromise research participant privacy, and so are not publicly available. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Purpose:To study the clinical characteristics of primary colorectal non Hodgkin's lymphoma, analyze the prognostic factors, and assess the results of treatment with adjuvant chemotherapy and radiotherapy. Methods:Ninety four patients were restrospectively studied at our institution between 1971 and 1995, and all of them underwent operation and were confirmed primary colorectal non Hodgkin's lymphoma pathologically. Adjuvant chemotherapy and radiotherapy were administered to 77 and 83 patients respectively. The univariate and multivariate analysis were used to estimate the prognostic factors.Results:The 3 , 5 , and 10 year survival rate was 62.5%, 61.0%, and 58.9% respectively. By univariate analysis, the operation type, lymph node metastasis, postoperative chemotherapy, postoperative radiotherapy, clinical stage were the significant prognostic factors for survival ( P 0.05), and by multivariate analysis the factors of age, operation type, postoperative chemotherapy, postoperative radiotherapy, clinical stage had significant effects on survival.Conclusions:Radical resection of primary tumor with adjuvant chemotherapy and radiotherapy significantly improve survival in patients with primary colorectal non Hodgkin′s lymphoma.
This study was aimed to investigate the safety and effectiveness of tumor-ablative Chemotherapy combined with low intensity conditioning regiment BUCy/TBICy for patients with hematologic malignancies receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT). The clinical data of 30 patients with hematologic malignancies received above-mentioned therapeutic method from January 2012 to January 2013 was analyzed retrospectively, and the engraftment, GVHD, infection, conditioning-related toxicity, relapse and survival rates were evaluated. All the patients signed the informed consent before transplantation. The median follow-up duration was 20.5 (16.3-27.3) months. The results indicated that all the patients had been engrafted successfully. One year overall survival (OS) and disease-free survival (DFS) rates were 93.3% and 83.3% respectively. No conditioning-related toxicity occurred. The incidences of II-IV grade aGVHD was 37.9%, among which incidence of III-IV grade aGVHD was 3.4%; incidence of extensive cGVHD was 13.8%. So far, 1 case relapsed, 1 case displayed graft rejection, and poor function of graft occurred in 1 case, death occurred in 2 cases(6.7%). It is concluded that tumor-ablative chemotherapy combined with low intensity-modified BUCy/TBICy is safe and effective in allogeneic hematopoietic stem cell transplantation for hematologic malignancies, and it is useful to reduce relapse of hematologic malignancies after transplantation.
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