Exploring the heterogeneity of effects of corticosteroids on acute respiratory distress syndrome: a systematic review and meta-analysis

INTRODUCTION: The effectiveness of corticosteroid therapy on the mortality of acute respiratory distress syndrome (ARDS) remains under debate. We aimed to explore the grounds for the inconsistent results in previous studies and update the evidence. METHODS: We searched MEDLINE, Cochrane Central Register of Controlled Trials and Web of Science up to December 2013. Eligible studies included randomized clinical trials (RCTs) and cohort studies that reported mortality and that had corticosteroid nonusers for comparison. The effect of corticosteroids on ARDS mortality was assessed by relative risk (RR) and risk difference (RD) for ICU, hospital, and 60-day mortality using a random-effects model. RESULTS: Eight RCTs and 10 cohort studies were included for analysis. In RCTs, corticosteroids had a possible but statistically insignificant effect on ICU mortality (RD, −0.28; 95% confidence interval (CI), −0.53 to −0.03 and RR, 0.55; 95% CI, 0.24 to 1.25) but no effect on 60-day mortality (RD, −0.01; 95% CI, −0.12 to 0.10 and RR, 0.97; 95% CI, 0.75 to 1.26). In cohort studies, corticosteroids had no effect on ICU mortality (RR, 1.05; 95% CI, 0.74 to 1.49) but non-significantly increased 60-day mortality (RR, 1.30; 95% CI, 0.96 to 1.78). In the subgroup analysis by ARDS etiology, corticosteroids significantly increased mortality in influenza-related ARDS (three cohort studies, RR, 2.45, 95% CI, 1.40 to 4.27). CONCLUSIONS: The effects of corticosteroids on the mortality of ARDS differed by duration of outcome measures and etiologies. Corticosteroids did not improve longer-term outcomes and may cause harm in certain subgroups. Current data do not support routine use of corticosteroids in ARDS. More clinical trials are needed to specify the favorable and unfavorable subgroups for corticosteroid therapy

Work at home, home at work : building a bridge between private and public life

Thesis (M. Arch.)--Massachusetts Institute of Technology, Dept. of Architecture, 1992.Includes bibliographical references (p. 114).There is an increasing number of people who have chosen for one reason or another to work at home. The current trend toward working at home due to the advances of technology (computers, fax machines) and changing family structures (both parents working, single parenting) will change the architectural expression of a home and such a change will also affect the neighborhood the home resides in. The thesis work that has been undertaken during this semester is to determine just what those changes and effects might be. Three levels of design investigation were attempted: Single-Detached Unit, Duplex Unit, Multi-Unit Attached. These three were basic examples that represent the broad spectrum of existing housing types. The variation allowed the investigation to identify the differences and particular issues that went along with each type when it underwent the conversion to a home-office. Existing buildings on an existing site were used as the vehicle for the design investigations. The site is in Cambridgeport, MA on a residential block in a typical neighborhood setting. The three building types were clustered together to study what would happen when a substantial number of home-offices existed on the same block. Currently, home-offices are scattered throughout neighborhoods confined to their own property lines. The hypothesis was that the density of home-offices could help form a community-oriented space that would improve the quality of community life in the neighborhood.by Jennifer Jen-Huey Lin.M.Arch

The Components of Flemingia macrophylla Attenuate Amyloid β-Protein Accumulation by Regulating Amyloid β-Protein Metabolic Pathway

Flemingia macrophylla (Leguminosae) is a popular traditional remedy used in Taiwan as anti-inflammatory, promoting blood circulation and antidiabetes agent. Recent study also suggested its neuroprotective activity against Alzheimer's disease. Therefore, the effects of F. macrophylla on Aβ production and degradation were studied. The effect of F. macrophylla on Aβ metabolism was detected using the cultured mouse neuroblastoma cells N2a transfected with human Swedish mutant APP (swAPP-N2a cells). The effects on Aβ degradation were evaluated on a cell-free system. An ELISA assay was applied to detect the level of Aβ1-40 and Aβ1-42. Western blots assay was employed to measure the levels of soluble amyloid precursor protein and insulin degrading enzyme (IDE). Three fractions of F. macrophylla modified Aβ accumulation by both inhibiting β-secretase and activating IDE. Three flavonoids modified Aβ accumulation by activating IDE. The activated IDE pool by the flavonoids was distinctly regulated by bacitracin (an IDE inhibitor). Furthermore, flavonoid 94-18-13 also modulates Aβ accumulation by enhancing IDE expression. In conclusion, the components of F. macrophylla possess the potential for developing new therapeutic drugs for Alzheimer's disease

Multiple resistance-activating substances produced by Humicola phialophoroides isolated from soil for control of Phytophthora blight of pepper

Abstract Background Microorganisms capable of utilizing vegetable tissues for multiplication in soil were isolated, cultivated in liquid medium prepared from the same vegetable tissues, and tested for ability to activate resistance in pepper leaves against Phytophthora blight caused by Phytophthora capsici. Results Among the 121 microorganisms isolated, a fungus Humicola phialophoroides showed distinct ability to produce substances capable of activating resistance. The resistance-activating substances produced by H. phialophoroides were mostly retained in the mycelium, and were readily extracted from the mycelium powder with polar solvents. The extract was not inhibitory to zoospore germination or germ tube growth of P. capsici. In pepper leaves, the extract took only about 12 h to activate resistance against P. capsici. After activation, washing treated leaf surface with water did not have much effect on the resistance expression. In addition to being able to move from the upper leaf surface to lower leaf surface, the resistance-activating substances were capable of moving 5 mm acropetally and 10 mm basipetally in pepper leaves, Chromatography of the extract on silica gel column suggests that there are probably more than three components in the extract with resistance-activating ability. The resistance-activating activity of the mycelium extract was not affected by treatment with either cation or anion exchange resins, indicating that none of the active components have positive or negative charges on their molecules. Conclusion Results show that H. phialophoroides is capable of producing multiple resistance-activating substances which are mostly retained in the mycelium. The study also indicates that none of the active components have positive or negative charges on their molecules. </jats:sec

Liver Governs Tendon: A Theory from Traditional Chinese Medicine—Evidence from a Population-Based Matched Cohort Study in Taiwan for the Association of Chronic Liver Disease and Common Diseases in the Chiropractic Office

In traditional Chinese medicine (TCM) theory, the liver governs the tendons. This retrospective cohort study investigated the relationship between chronic liver disease and common orthopedic conditions by utilizing the National Health Insurance Research Database of Taiwan. The populations included within this study were chronic liver disease patients (International Classification of Diseases/ICD-9 code: 571) and a comparison group composed of patients with nonchronic liver disease. The medical event that was evaluated was internal derangement of joints (ICD-9 codes: 717-718). In comparison with the control group, patients with chronic liver disease were 1.29 times more likely to develop internal derangement of joints when major trauma had also occurred. We did not find the association of viral hepatitis with internal derangement of joints. Patients with chronic liver disease as well as anemia were 3.01 times more likely to develop joint derangements. Our study shows that patients with anemia in addition to chronic liver disease are more prone to develop joint derangements. This is the first documented research study that endorses “the liver governs the tendons which gives the body the ability to move” theory of TCM. The incidence rate of internal derangement of knee joints was higher in patients with chronic liver disease.</jats:p