The prognostic role of fatigue,depression and anxiety on postoperative outcomes after pancreatectomy for pancreatic cancer. A prospective observational study (FAT-PRO study)

ObjectivesThis study aims to assess the prevalence of preoperative fatigue, depression and anxiety among patients undergoing pancreatic surgery for pancreatic cancer (PC), and possible relationship with postoperative outcomes.MethodsProspective data from 162 consecutive patients undergoing pancreatectomy for PC at a third-level referral centers for pancreatic surgery were collected. All patients preoperatively completed four questionnaires assessing depression (PHQ-9), anxiety (STAI-Y2), chronic illness fatigue (FACIT-F) and cancer therapy fatigue (FACT-G).ResultsForty patients (25%) where in the first quartile for chronic illness (FACIT-F ≤34) and/or cancer therapy (FACT-G ≤78) fatigue, 26 patients (16%) met the criteria for major depression (PHQ-9 ≥10) and 34 patients (21%) had anxiety symptoms (STAI-Y2 ≥40). Cancer therapy fatigue was significantly associated with higher rates of morbidity (70% vs 49%), major morbidity (Clavien-Dindo ≥3) (28% vs 11%), post-pancreatectomy hemorrhage (18% vs 4%), pulmonary complications (20% vs 9%) and mortality (8% vs null) (all P ≤ 0.01). Major depression was associated with higher rates of post-pancreatectomy hemorrhage and readmission (23% vs 5%). Multivariable logistic regression analysis of preoperative factors confirmed diabetes (OR 2.71, 95%CI 1.01–7.20; P = 0.04), ASA score ≥3 (OR 4.12, 95%CI 1.52–11.21; P < 0.01) and cancer therapy fatigue (OR 2.95, 95%CI 1.01–8.74; P = 0.04) to be independent predictors of major morbidity.ConclusionsHigher levels of fatigue (in particular cancer therapy fatigue) strongly correlates with worse postoperative outcomes.     

Functional pasta consumption in healthy volunteers modulates ABCG1-mediated cholesterol efflux capacity of HDL

Backgrounds and aimsPrevention of cardiovascular (CV) disease is considered a central issue in public health and great attention is payed to nutritional approaches, including consumption of functional foods to reduce CV risk in individuals without indications for anti-atherosclerotic drugs. Cholesterol efflux capacity (CEC) is an important anti-atherogenic property of HDL and a marker of CV risk. We evaluated the effect of a daily consumption of an innovative whole-wheat synbiotic pasta, compared to a control whole-wheat pasta, on serum ATP binding cassette G1 (ABCG1)-mediated CEC in healthy overweight or obese individuals.Methods and resultsStudy participants (n = 41) were randomly allocated to either innovative or control pasta, consumed daily for twelve weeks. Serum CEC was measured before and after the dietary intervention, by a well-established radioisotopic technique on Chinese Hamster Ovary Cells transfected with human ABCG1. The innovative synbiotic pasta consumption was associated to a significantly higher post treatment/baseline ratio of ABCG1-mediated CEC values with respect to control pasta (mean ratio 1.05 ± 0.037 and 0.95 ± 0.042 respectively, p < 0.05). Analysis of the relationship between ABCG1-mediated CEC and glycemia, homocysteine, total folates and interleukin-6 showed specific changes in the correlations between HDL function and glycemia, oxidative and inflammatory markers only after synbiotic pasta consumption.ConclusionThis is the first report on serum CEC improvement obtained by a new synbiotic functional pasta consumption, in absence of lipid profile modifications, in overweight/obese participants. This pilot study suggests that a simple dietary intervention can be a promising approach to CV preservation through improving of athero-protective HDL function.     

儿童严重急性呼吸综合征冠状病毒2 型感染药物治疗的快速循证评价

目的:采用循证评价和文献综述的方法,总结和分析目前已发表的儿童严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)感染病例、临床实践指南或专家共识以及儿童严重急性呼吸综合征(SARS)/中东呼吸综合征(MERS)感染药物治疗经验,以期为儿童SARS-CoV-2感染药物治疗方案的制定提供循证依据。方法:系统检索PubMed、EMBase、the Cochrane Library、CNKI(含新型冠状病毒肺炎专题知识库)、WanFang Data、SinoMed和中华医学会杂志社(新型冠状病毒防控和诊治专栏)等数据库,根据文献研究特点和需要,设置快速检索策略和时限,对符合纳入标准研究中的药物治疗部分进行总结和描述性分析。结果:最终纳入11篇报告儿童病例的研究或综述(共196例患儿)和8篇指南,对儿童SARS/MERS感染的药物治疗经验进行综述。截至目前,已报道儿童感染病例的药物治疗方案基本依从儿童SARS-CoV-2感染指南推荐,且与既往发表的儿童SARS/MERS的药物治疗经验基本一致。α-干扰素为最常应用和最多推荐的抗病毒药物,其他抗病毒药物的应用多参考成人用法,有效性和安全性需要临床研究进一步予以证实;糖皮质激素和人免疫球蛋白在重症患儿中的应用尚存在争议,需权衡利弊谨慎使用;抗菌药物治疗需严格把握用药指征;其他治疗(如中医药)同样需要更多数据予以支持。结论:目前对于儿童SARS-CoV-2感染,尚无确证有效的药物治疗方案,这与儿童SARS/MERS的药物治疗经验基本一致,药物治疗方案的制定仍需进一步临床试验证据和用药经验总结的支持。     

艾司洛尔治疗儿童重症手足口病疗效的系统评价和Meta分析

目的:系统评价艾司洛尔治疗儿童重症手足口病的临床疗效。方法：计算机检索中国学术期刊全文数据库、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、EMBase、the Cochrance Library数据库,收集从建库至2018年12月所有艾司洛尔治疗儿童重症手足口病的随机对照试验（对照组采用常规治疗,试验组在常规治疗基础上加用艾司洛尔）。提取符合纳入标准的文献并进行质量评价,运用RevMan 5.3进行Meta分析。结果：共纳入6项研究,包括700例患儿。Meta分析结果显示,实验组治疗后血清内乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、去甲肾上腺素（NE）均低于对照组（P<0.05）。结论：对于重症手足口病患儿,在常规治疗基础上加用艾司洛尔可提高疗效。     

Out-of-Pocket Costs of Insulin and Diabetes-Related Supplies Among Patients With Type 1 Diabetes

The cost of insulin has increased exponentially since its discovery in the 1920s, but the degree to which this financial burden has been transferred to patients is unknown. The present study is a retrospective analysis using claims data for privately insured patients with type 1 diabetes from 2005 to 2017. We quantify the mean annual out-of-pocket costs for insulin and diabetes-related supplies during the study period. It is imperative for health care professionals to be aware of this cost, and we hope that these findings serve as a call for legislation to cap the rising price of insulin.     

LncRNA 4344 promotes NLRP3-related neuroinflammation and cognitive impairment by targeting miR‐138-5p

ObjectiveCognitive impairment is a common neurological disease of which NLRP3-related neuroinflammation has been demonstrated to be an essential mediator. Previous studies have indicated that long non-coding RNAs (lncRNAs) are critical for the development of neurological disorders. However, the roles and functions of lncRNA 4344 in neuroinflammation during cognitive impairment are unknown and need to be further elucidated.MethodsLipopolysaccharide (LPS)-induced rat cognitive impairment and rat microglia (RM) cell inflammation models were established in vitro and in vivo. The Morris water maze test was used to evaluate the cognitive behavior of the rats. Gene expression was assessed using real-time quantitative polymerase chain reaction, and protein levels using enzyme-linked immunosorbent assay, or western blot analysis. The targeting relationship between lncRNA 4344, miR-138-5p, and NLRP3 was identified using bioinformatics analysis and a dual-luciferase reporter gene assay. Hematoxylin-Eosin and Nissl stainings, terminal deoxynucleotidyl transferase dUTP nick end labeling, or immunofluorescence staining assays were performed to detect pathological changes, neuronal apoptosis, or positive cells in hippocampal tissues, respectively.ResultsThe expression levels of lncRNA 4344 and NLRP3 were upregulated in the hippocampal tissues of LPS-treated rats and RM cells, and showed a strong positive correlation between each other. LncRNA 4344 overexpression further enhanced the expression of NLRP3 and its downstream genes (caspase-1, IL-1β, and IL-18), as well as neuronal apoptosis in LPS-stimulated RM cells, whereas lncRNA 4344 silencing attenuated the inflammatory injuries. Moreover, miR-138-5p was the direct target of lncRNA 4344 and was downregulated in the RM cell inflammation model. We also found that miR-138-5p directly reduced the expression of NLRP3 and its downstream genes. Subsequently, the results of the animal experiments showed that the lncRNA 4344/miR-138-5p/NLRP3 axis plays an essential role in regulating the cognitive behavior, pathological changes and apoptosis of hippocampal neurons, expression of inflammation-related factors (NLRP3, caspase-1, IL-1β, and IL-18), and microglial activation in LPS-induced cognitive impairment rats.ConclusionOur results demonstrated for the first time that lncRNA 4344 regulates NLRP3-related neuroinflammation and cognitive impairment by targeting miR-138-5p, providing a possible target for the treatment of diseases characterized by a cognitive deficit.     

P2Y12 receptor as a new target for electroacupuncture relieving comorbidity of visceral pain and depression of inflammatory bowel disease

Dried fruits of Psoralea corylifolia L. (Psoraleae Fructus) is one of the most popular traditional Chinese medicine with treatment for nephritis, spermatorrhea, pollakiuria, asthma, and various inflammatory diseases. Bakuchiol is main meroterpenoid with bioactive diversity from Psoraleae Fructus. This study was designed to seek structural diverse bakuchiol derivants with anti-inflammatory activities from this plant. Various column chromatography methods were used for isolation experiment. Structures and configurations of these compounds were determined by spectroscopic methods and single-crystal X-ray diffraction. Their inhibition on nitric oxide (NO) production in lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages were evaluated by the Griess reaction. Twelve unpresented bakuchiol dimmers, bisbakuchiols M–U (1–9) and bisbakuchiol ethers A–C (10–12), along with five known compounds (13–17), were isolated from the fruits of Psoralea corylifolia L. Compounds 1–3, 10–12, 16 and 17 exhibited inhibitory activities against LPS-induced NO production in RAW264.7 macrophages, and the inhibition of compound 1 (half maximal inhibitory concentration (IC50) value = 11.47 ± 1.57 μM) was equal to that of L-N(6)-(1-iminoethyl)-lysine (IC50 = 10.29 ± 1.10 μM) as a positive control. Some compounds exhibited inhibitory activities against NO production, and the study of structure–activity relationship suggested that uncyclized compounds with oxygen substitution at C-12/12′ showed strong inhibitory activities, and carbonyl units contributed to enhanced activities.     

Metabolomic profiling of Saposhnikoviae Radix from Mongolia by LC–IT–TOF–MS/MS and multivariate statistical analysis

Journal of Natural Medicines - Saposhnikoviae Radix (SR) is a commonly used crude drug that is obtained from the root and rhizome of Saposhnikovia divaricata which is distributed throughout China,...