Xiao-Jin Li

Four undescribed sulfoxide-containing derivatives, sinkiangenoxides A and B, (2Z, 4E)-sinkiangenoxide C, and (2E, 4E)-sinkiangenoxide C (1 – 4), and one known compound, 1-(methylthio)propyl (E)-1-propenyl disulfide (5), were isolated from the resin of Ferula sinkiangensis. Their structures were determined based on spectroscopic methods, including IR, UV, HRESIMS, NMR, and CD analysis. Compounds 2 – 4 showed moderate cytotoxic activities against four human cancer cell lines with IC₅₀ values ranging from 15.0 to 40.3 µM. Sinkiangenoxide B (2) was shown to induce apoptosis in HepG2 cells. In addition, compound 5 effectively attenuated lipopolysaccharide-induced nitric oxide release and TNF-α, IL-1β, IL-6, and IL-10 expression. Received: 20 September 2020 Accepted after revision: 19 April 2021 Article published online: 20 May 2021 © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Background Antibiotic‐resistant bacteria, especially multidrug‐resistant strains, play a key role in impeding critical patients from survival and recovery. The effectiveness of the empiric use of antibiotics in the circling manner in intensive care units (ICUs) has not been analyzed in detail and remains controversial. Therefore, this systematic review and meta‐analysis were conducted to evaluate antibiotic‐cycling effect on the incidence of antibiotic‐resistant bacteria. Methods We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science for studies focusing on whether a cycling strategy of empiric use of antibiotics could curb the prevalence of antibiotic‐resistant bacteria in ICUs. The major outcomes were risk ratios (RRs) of antibiotic‐resistant infections or colonization per 1,000 patient days before and after the implementation of antibiotic cycling. A random‐effects model was adopted to estimate results in consideration of clinical heterogeneity among studies. The registration number of the meta‐analysis is CRD42018094464. Results Twelve studies, involving 2,261 episodes of resistant infections or colonization and 160,129 patient days, were included in the final analysis. Based on the available evidence, the antibiotic‐cycling strategy did not reduce the overall incidence of infections or colonization with resistant bacteria (RR = 0.823, 95% CI 0.655–1.035, p = .095). In subgroup analyses, the cycling strategy cut down the incidence of resistant bacteria more significantly than baseline period (p = .028) but showed no difference in comparison with mixing strategy (p = .758). Linking Evidence to Action Although the cycling strategy performed better than relatively free usage of antibiotics in the baseline period on reducing resistant bacteria, the cycling strategy did not show advantage when compared with the mixing strategy in subgroup analyses. In addition, these viewpoints still need more evidence to confirm.

Background and Objective: Since the outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in Wuhan, Hubei Province, China, it has spread throughout the world and become a global public health emergency. It is important to distinguish COVID-19 from other viral pneumonias to properly screen and diagnose patients, reduce nosocomial infections, and complement the inadequacy of nucleic acid testing. In this study, we retrospectively analysed the clinical data of COVID-19 versus non-COVID-19 patients treated at our hospital between January 17 and February 27, 2020 to summarize our clinical experience in the differential diagnosis of COVID-19. Methods: In this retrospective cohort study, 23 confirmed COVID-19 patients were consecutively enrolled from January 17 to February 27, 2020, and 29 confirmed non-COVID-19 patients were enrolled in the West China Hospital of Sichuan University. We collected baseline data, epidemiological data, clinical characteristics, imaging findings, viral nucleic acid test results, and survival data. SPSS v22.0 was used for the statistical analysis. Outcomes were followed-up until March 25. Results: A total of 52 patients were included in this study, including 23 COVID-19 patients and 29 non-COVID-19 patients. No significant between-group differences were observed for age, sex, primary signs or symptoms, cellular immunity, or platelet count. Significant between-group differences were observed in clinical characteristics such as dry cough, contact with individuals from Wuhan, some underlying diseases, nucleated cell count, chest imaging findings, viral nucleic acid test results, 28-day mortality, and 28-day survival. Conclusion: Epidemiological data, clinical symptoms, nucleic acid test results for COVID-19 and chest CT manifestation may help distinguish COVID-19 from non-COVID-19 cases, prevent imported cases and nosocomial infections.

Background. The high prevalence of delirium among postoperative patients has increased morbidity and mortality. The kind of drug that can effectively reduce the incidence of delirium has become the focus of discussion in recent years. However, a consensus in this respect has yet to be reached. Methods. Randomized controlled trials (RCTs) were retrieved from the PubMed, Cochrane Library, ClinicalTrials.gov, and Embase databases from their inception through October 12, 2018. We included RCTs of pharmacological prevention for postoperative delirium in adults (at least 18 years), and the Cochrane risk of bias tool was used to evaluate the methodological quality of trials. The primary outcomes were the risk ratios (RRs) of incidence of postoperative delirium, and the secondary outcomes were the RRs of mortality and adverse events in the intervention and control groups. Results. Thirty-eight trials, which comprised 20302 patients and 18 different drugs, were included in the analysis. Of the 38 studies, 17 were rated as low risk with respect to methodological quality. Dexmedetomidine administration (RR 0.58, 95%CI 0.44-0.76, P Conclusion. Among the pharmacological prophylactic measures for postoperative delirium, dexmedetomidine, olanzapine, and risperidone showed higher efficacy than other drugs. However, more high-quality evidence is needed to confirm these results.

Objectives. To evaluate the efficacy of safflower yellow in the acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods. In a prospective, randomized, controlled trial, 127 patients who met the inclusion criteria were enrolled and were randomly divided into two groups. The control group included 64 patients treated according to the global strategy for diagnosis, management, and prevention of COPD (www.goldcopd.org, updated 2011). The intervention group included 63 patients who received intravenous infusions of safflower yellow (100 mg of safflower yellow dissolved in 250 ml 0.9% saline) once daily for 14 consecutive days in addition to standard diagnosis and treatment. The difference in the average length of the hospital stay between the two groups of patients was determined. The follow-up period was 28 days; the differences in symptoms, clinical indicators, and 28-day mortality in the two groups were compared. Statistical analysis was conducted using SPSS 22.0 software to determine whether there were statistically significant differences (P Results. There were no statistically significant differences between the intervention group and the control group in changes in secondary indicators. There were no statistically significant differences in the 28-day mortality or in the survival curves of the two groups (P=0.496 and P=0.075, respectively). Safflower yellow treatment of AECOPD may relieve the patient’s clinical symptoms, such as dyspnoea, shorten the average length of hospital stay (P=0.006, respectively), and decrease the duration of mechanical ventilation. Conclusion. Safflower yellow in the treatment of AECOPD has a degree of clinical value. This trial is registered under the identifier ChiCTR-IPR-17014176.

To investigate the correlation between subjective scoring and bispectral index (BIS) monitoring, and to study the feasibility of BIS monitor in assessing the depth of sedation for mechanically ventilated patients. A prospective randomized controlled trial was conducted. The sedation target was sedation-agitation scale (SAS) 3-4. A total of 83 patients in the intensive care unit were assigned to receive the sedation based on BIS monitor (42 cases) or the sedation based on subjective scale SAS (41 cases). The parameters of respiration, circulation, and the depth of sedation (BIS, SAS, Ramsay) were recorded. The difference between the two groups was compared. The correlation index and significance were calculated. A total of 83 patients of two groups reached the sedation target. Statistically significant difference was found between two groups in respiratory rate, fraction of inspiratory oxygen, and pulse saturation of oxygen before and after sedation (all P<0.05). After sedation, respiratory rate and fraction of inspiratory oxygen declined in all patients, while pulse saturation of oxygen rose obviously (all P<0.05). Statistically significant difference was also found in different correlation index. There was positive correlation index between BIS and SAS (r=0.626, P<0.05), a negative correlation index between BIS and Ramsay (r=-0.650, P<0.05), and also a negative correlation index between SAS and Ramsay (r=-0.908, P<0.05). Statistically significant difference was not found in the parameters of respiration and circulation between the two groups. BIS monitor is feasible for assessing the depth of sedation in mechanically ventilated patients.