[Diaphragmatic dysfunction post-COVID-19 infection: report of two cases]

Following the global outbreak of COVID-19, many patients have suffered from multi-system complications and long-term sequelae caused by the virus. Diaphragm dysfunction is an obscure post-COVID-19 symptom. Although a few cases of diaphragm dysfunction caused by COVID-19 infection have been reported abroad, there are no relevant reports in China. Herein, we present two cases of patients with respiratory distress after COVID-19 infection. On admission, dynamic chest radiographs revealed diaphragm dysfunction in these patients. Further investigations including diaphragm ultrasound, neurophysiological examinations, transdiaphragmatic pressure measurements cranial MRI, and antibody testing for autoimmune diseases, were conducted. The final diagnoses were severe myasthenia gravis induced by COVID-19 infection and diaphragmatic nerve and muscle involvement caused by COVID-19 infection. Both patients showed improvement in symptoms after treatment. Therefore, we summarized our case, with a review of the relevant literature to improve the understanding of the disease and to provide clinical evidence for future diagnosis and treatment.

Synergistically homogeneous-heterogeneous Fenton catalysis of trace copper ion and g-C3N4 for degradation of organic pollutants

Using the bulk g-C₃N₄ as a precursor, four g-C₃N₄ nanosheets were further prepared by ultrasonic, thermal, acid, and alkali exfoliation. The structures of these materials were characterized by various techniques such as X-ray powder diffraction, Fourier transform infrared spectroscopy, scanning electron microscopy, energy dispersive X-ray spectroscopy, transmission electron microscopy, and X-ray photoelectron spectroscopy. The synergistical Fenton catalysis of these materials with Cu²⁺ was evaluated by using rhodamine B as a simulated organic pollutant. The results showed that there existed a significant synergistical Fenton catalysis between Cu²⁺ and g-C₃N₄. This synergistic effect can be observed even when the concentration of Cu²⁺ was as low as 0.064 mg L^-1. The properties of g-C₃N₄ strongly influenced the catalytic activity of the Cu²⁺/g-C₃N₄ system. The coexistent of Cu²⁺ and the alkali exfoliated g-C₃N₄ showed the best catalytic activity. Hydroxyl radicals as oxidizing species were confirmed in the Cu²⁺/g-C₃N₄ system by electron paramagnetic resonance spectra. The synergistic catalysis may be attributed to the easier reduction of Cu²⁺ adsorbed on the g-C₃N₄. This study provided an excellent Fenton catalytic system, and partly solved the rapid deactivation of heterogeneous Fenton catalysts caused by the leaching of metal ions.

Clinical observation and preliminary study of mechanism of daphnetin in improving therapeutic effects for colitis

BACKGROUND

Daphnein is the first new drug in China. In addition to the treatment of cardiovascular diseases and coronary heart disease, daphnein also has anti-inflammatory, anti-apoptosis, analgesia, and immunity-enhancing activities. Some studies have reported that daphnetin may inhibit the activities of cyclooxygenase and 5-ester oxidase and produce anti-inflammatory and anti-allergic reactions by inhibiting the synthesis of prostaglandin and leukotriene.

AIM

To explore the efficacy of daphnetin in the treatment of colitis, and observe its effect on the composition of microbiota and the balance of regulatory T cells (Treg)/helper Th17 cells (Th17).

METHODS

One hundred and eight patients with ulcerative colitis (UC) admitted to our hospital from June 2017 to November 2019 were selected and randomly divided into either a control group or an observation group, with 54 cases in each group. Both groups were given conventional Western medicine treatment, and the observation group was additionally given daphnetin. The total effective rate, Baron endoscopic score, Geboes mucosal histology score, modified Mayo activity index, intestinal flora distribution, Treg/Th17 balance changes [CD4⁺CD25⁺Foxp3⁺ Treg, interleukin-10 (IL-10), transforming growth factor β (TGF-β), CD3⁺CD4⁺IL-17A⁺ Th17, interleukin-17 (IL-17), and interleukin-21 (IL-21)], the simplified Chinese version of the Inflammatory Bowel Disease Quality of Life Scale (IBDQ) score, and adverse reactions of the two groups were compared.

RESULTS

The total effective rate of the observation group was 90.74%, which was higher than that of the control group (70.37%; P < 0.05). Baron endoscopy score, Geboes mucosal histology score, and modified Mayo activity index of the observation group after treatment were significantly lower than those of the control group (P < 0.05). The numbers of E. coli, Bacteroides, and Enterococcus in the observation group were significantly lower and those of Lactobacillus and Bifidobacterium were significantly higher in the observation group than in the control group (P < 0.05). CD4⁺CD25⁺Foxp3⁺ Treg, IL-10, and TGF-β were significantly higher and CD3⁺CD4⁺IL-17A⁺ Th17, IL-17, and IL-21 were significantly lower in the observation group than in the control group (P < 0.05). The scores of emotional ability, intestinal symptoms, social ability, and systemic symptoms on the IBDQ scale were significantly higher in the observation group than in the control group (P < 0.05).

CONCLUSION

Daphnetin can promote the healing of the intestinal mucosa of UC patients by modulating the microbiome composition and Treg/Th17 balance and effectively improve the patient's condition and quality of life, which is safe and reliable.

Graphitic carbon nitride (g-C3N4) as an efficient metal-free Fenton-like catalyst for degrading organic pollutants: the overlooked non-photocatalytic activity

Graphitic carbon nitride (g-C₃N₄) has attracted a large amount of research, mainly being used as a photocatalyst, but its Fenton-like catalytic performance has been overlooked. In this paper, the dark Fenton-like catalytic performance of g-C₃N₄ was evaluated by degrading rhodamine B over a wide pH range. The results showed that the g-C₃N₄, which was synthesized by conventional urea pyrolysis without any modification, was an efficient metal-free heterogeneous Fenton-like catalyst. The highest activity occurred under a weakly alkaline condition of about pH 10. The experiment of catalyst recycling indicated that g-C₃N₄ had long-term stability. The reactive oxidizing species of HO·, generated by the g-C₃N₄ activating H₂O₂, was identified by EPR and further supported by a scavenging experiment of HO· using isopropanol as the scavenger. The HNO₃ oxidation of g-C₃N₄ resulted in catalytic deactivation, implying the catalytic activity originated from the surface reduced groups of g-C₃N₄. The structure of synthesized g-C₃N₄ before and after the HNO₃ oxidation was characterized by X-ray diffraction, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy, and a possible catalytic mechanism was proposed.

[FABP5 promotes cell growth, invasion and metastasis in cervical cancer]

Objective: To investigate the functions of FABP5 in the carcinogenesis and development of cervical cancer. Methods: The expression of FABP5 was detected in several cervical cancer cell lines (C33A, Siha, Caski, HeLa and HCC94), 206 cases of cervical cancer tissues with stage Ⅰa2-Ⅱa2 and 40 cases of normal cervical tissues by real-time PCR and Western blotting. Then, the cells were infected with lentivirus-mediated siRNA-targeting FABP5. CCK-8 cell proliferation, colony formation, wound healing and transwell assays were used to investigate the effects of FABP5 on in vitro cell proliferation, migration and invasion. And in vivo xenograft model and lung metastasis model were used to observe the transplanted tumor growth and metastasis in female athymic nude mice. Furthermore, the total protein and RNA were extracted from the primary xenografts to determine the expression levels of FABP5, metalloproteinase-2 and metalloproteinase-9 using Enzyme linked immunosorbent assay (ELISA), real-time PCR and Western blotting. Results: FABP5 expression was found to be significantly unregulated in cervical cancer tissues than that in normal cervical tissues (P<0.05). Compared with the Siha-NC group and uninfected group, the expression of FABP5 mRNA and protein in Siha-FABP5-RNAi group was significantly inhibited along with the decrease of cell proliferation, colony formation, wound healing and invasion ability. The clone formation rates of Siha cells in uninfected group, Siha-NC group and Siha-FABP5-RNAi group were (84.6±4.5)%, (84.6±5.1)% and (21.2±2.6)%, respectively. Moreover, the transwell assay showed that invasive cells in three groups were (72.8±4.7)/HPF, (72.6±3.3)/HPF and (21.4±2.3)/HPF, respectively. All of the difference was statistically significant (P<0.05). Furthermore, FABP5 silencing significantly reduced tumor growth and lung metastases in nude mice in vivo (P<0.001). The subcutaneously xenografted volume in uninfected group, Siha-NC group and Siha-FABP5-RNAi group was (921.4±63.0) mm(3,) (1 021.4±56.0) mm(3) and (139.6±36.0) mm(3,) respectively. The real-time quantitative PCR results showed that the relative expression levels of MMP-2 and MMP-9 mRNA were 1.00±0.10 and 1.00±0.10, 1.00±0.10 and 1.00±0.10 as well as 0.34±0.13 and 0.38±0.17 in xenografted tumor tissues of uninfected group, Siha-NC group and Siha-FABP5-RNAi group, respectively. MMP-2 and MMP-9 was significantly downregulated after FABP5 inhibition(P<0.05). Additionally, the protein expression trend of MMP-2 and MMP-9 in three groups was consistent with the mRNA levels. Conclusion: FABP5 might promote the carcinogenesis and metastasis of cervical cancer via up-regulating MMP-2 and MMP-9.

Different serum motilin, gastrin, and pepsinogen levels in patients with different chronic gastric diseases associated with H. pylori infection

AIM

To investigate the differences in the number of mast cells (MCs) and plasma motilin (MTL), gastrin, and pepsinogen (PG) levels in the gastric mucosa of patients with Helicobacter pylori (H. pylori) infection related chronic gastric disease.

METHODS

From January 2015 to January 2017, 74 patients with H. pylori associated gastric ulcer (GU), 68 patients with H. pylori associated duodenal ulcer (DU), and 76 patients with chronic atrophic gastritis (CAG) treated at the Qixian Hospital of Keqiao District and Shaoxing Central Hospital were included in this study. Eighty healthy people who underwent medical examination in the same period at the Qixian Hospital of Keqiao District and Shaoxing Central Hospital were included as a control group (without H. pylori infection). The number of MCs and serum levels of motilin (MTL), gastrin, and PG were compared among the four groups.

RESULTS

The number of MCs was significantly higher and serum level of MTL was significantly lower in the CAG, GU, and DU groups than in the control group (P < 0.05). The DU group had the highest gastrin-17 level, followed by the GU, CAG, and control groups. PG I, PG II, and PG 1/2 ratio were significantly higher in the GU and DU groups than in the control group (199.74 mg/L ± 80.53 mg/L, 13.72 mg/L ± 5.75 mg/L vs 14.53 ± 5.42), while PG I and PG 1/2 ratio were significantly lower in the CAG group than in the control group (P < 0.05).

CONCLUSION

H. pylori infection may promote the development of GU, DU, and CAG by regulating serum levels of MTL, gastrin, and PG.

Effect of Helicobacter pylori eradication therapy on degree of antral inflammation and inflammatory mediators in patients with Helicobacter pylori infection and duodenal ulcer

AIM

To investigate the effect of Helicobacter pylori (H. pylori) eradication therapy on the degree of antral inflammation and inflammatory mediators in patients with H. pylori infection and duodenal ulcer (DU).

METHODS

From September 2014 to September 2016, 100 patients with H. pylori infection and DU treated at the Qixian Hospital of Keqiao District and Shaoxing Central Hospital were included in this study. All the patients underwent H. pylori radical quadruple therapy. The degree of inflammation in the gastric antrum and the contents of inflammatory mediators were compared between before and after treatment.

RESULTS

The degree of chronic and acute inflammation in the gastric antrum was positively correlated with H. pylori infection (r = 0.267, P < 0.05). The levels of malonaldehyde (MDA), interleukin-8 (IL-8), superoxide dismutase (SOD), and tumor necrosis factor-α (TNF-α) were significantly higher in H. pylori positive patients than in H. pylori negative patients (P < 0.05). As the degree of inflammation increased, the levels of MDA, IL-8, SOD, and TNF-α were also gradually increased, and there was a positive relationship between the degree of inflammation and the levels of inflammatory mediators (r = 0.941, P < 0.05). After treatment, both the degree of inflammation and the levels of inflammatory mediators were improved significantly (P < 0.05).

CONCLUSION

H. pylori eradication therapy can obviously improve the degree of inflammation and the contents of inflammatory mediators in H. pylori infected patients with DU.

Effect of Changningfang enema combined with mesalazine on inflammatory factors and coagulation function in patients with ulcerative proctitis

AIM

To investigate the effect of Changningfang enema combined with mesalazine on clinical efficacy, inflammatory factors, and coagulation function in patients with ulcerative proctitis.

METHODS

Seventy-seven patients with ulcerative proctitis were randomly divided into an observation group (38 cases) and a control group (39 cases). The control group was treated with mesalazine alone, and the observation group was treated with Changningfang enema combined with mesalazine. After one month of treatment, the clinical efficacy, inflammatory factors, and coagulation function of the two groups were compared.

RESULTS

The total effective rate was 86.8% in the observation group and 60.0% in the control group, and there was a significant difference between the two groups (P < 0.05). After one month of treatment, the levels of serum tumor necrosis factor-α, interleukin (IL)-8, IL-6 and IL-1β were significantly lower than those before treatment in both groups (P < 0.05), and the observation group had a more significant decrease (P < 0.05). Prothrombin time and mean platelet volume in both groups were significantly higher than those before treatment (P < 0.05), but fibrinogen and platelet levels were significantly lower than those before treatment (P < 0.05); these parameters were improved more significantly in the observation group (P < 0.05). No serious adverse reactions occurred in either group. The relapse rate in the observation group was significantly lower than that in the control group (13.2% vs 35.9%, P < 0.05).

CONCLUSION

The clinical efficacy of mesalazine combined with Changningfang enema in the treatment of ulcerative proctitis is superior to that of mesalazine alone, and it can significantly improve the coagulation function, reduce the degree of inflammatory response, and decrease the recurrence rate, without serious adverse reactions.

[The indications for glucocorticoids in treating community-acquired pneumonia in adults: a meta-analysis]

OBJECTIVE

Community acquired pneumonia (CAP) is a common pulmonary infectious disease. Glucocorticoids (GCS) as one of the most powerful anti-inflammation drugs, are still the most controversial adjuvant therapy in treating CAP. Which sub-groups of CAP patients would benefit from GCS is a debating topic. Our aim of this study is to find the indications for GCS in treating adult CAP patients by using meta-analysis.

METHOD

"Steroids, glucocorticoids, corticosteroids, hydrocortisone, prednisone, cortisol, methylprednisolone, dexamethasone"and"community-acquired pneumonia"were used as key words both in Chinese and English to search all published literature in Pubmed, EMBASE MEDLINE, Cochrane, CNKI and Wanfang Database until March 2015.

RESULTS

All 840 articles were reviewed, and 11 high quality randomized clinical trials involving 1942 adult CAP patients were included in this meta-analysis. Using GCS did not significantly reduce mortality in all CAP patients (OR=0.68, 95%CI 0.46-0.99, P=0.04). But in the subgroup analysis, patients with severe CAP benefited from GCS treatment (OR=0.35, 95%CI 0.17-0.75, P=0.007). GCS also increased the risk of hyperglycemia (OR=1.99, 95%CI 1.50-2.65, P<0.000 01).

CONCLUSION

RESULTS from this meta-analysis suggested that GCS should only be rigorously used in severe CAP patients.

A novel angiogenesis inhibitor impairs lovo cell survival via targeting against human VEGFR and its signaling pathway of phosphorylation

Colorectal cancer represents the fourth commonest malignancy, and constitutes a major cause of significant morbidity and mortality among other diseases. However, the chemical therapy is still under development. Angiogenesis plays an important role in colon cancer development. We developed HMQ18–22 (a novel analog of taspine) with the aim to target angiogenesis. We found that HMQ18–22 significantly reduced angiogenesis of chicken chorioallantoic membrane (CAM) and mouse colon tissue, and inhibited cell migration and tube formation as well. Then, we verified the interaction between HMQ18–22 and VEGFR2 by AlphaScreen P-VEGFR assay, screened the targets on angiogenesis by VEGF Phospho Antibody Array, validated the target by western blot and RNAi in lovo cells. We found HMQ18–22 could decrease phosphorylation of VEGFR2(Tyr¹²¹⁴), VEGFR1(Tyr¹³³³), Akt(Tyr³²⁶), protein kinase Cα (PKCα) (Tyr⁶⁵⁷) and phospholipase-Cγ-1 (PLCγ-1) (Tyr⁷⁷¹). Most importantly, HMQ18–22 inhibited proliferation of lovo cell and tumor growth in a human colon tumor xenografted model of athymic mice. Compared with normal lovo cells proliferation, the inhibition on proliferation of knockdown cells (VEGFR2, VEGFR1, Akt, PKCα and PLCγ-1) by HMQ18–22 decreased. These results suggested that HMQ18–22 is a novel angiogenesis inhibitor and can be a useful therapeutic candidate for colon cancer intervention.