Evaluation of efficacy of resin hemoperfusion in patients with acute 2,4-dinitrophenol poisoning by dynamic monitoring of plasma toxin concentration

Objective: The intoxications caused by 2,4-dinitrophenol (2,4-DNP), even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and explore the clinical value of resin hemoperfusion (HP) in the treatment of patients with acute 2,4-DNP poisoning. Methods: We reported 16 cases of acute 2,4-DNP poisoning through occupational exposure due to ignoring the risk of poisoning. The blood samples were collected from the 14 survivors. According to the different treatments of resin HP, the survivors were divided into routine HP (n=5) and intensive HP (n=9) groups. Ultra high performance liquid chromatography/tandem mass spectroscopy (UPLC-MS/MS) was used to detect the 2,4-DNP concentration in plasma in this study. Results: The 14 survivors recovered very well after treatment. The initial plasma 2,4-DNP concentrations (C ₁) of survivors ranged from 0.25 to 41.88 µg/ml (mean (12.56±13.93) µg/ml). A positive correlation existed between initial plasma 2,4-DNP concentration (C ₁) and temperature. The elimination of 2,4-DNP was slow and persistent, and the total clearance rates of plasma toxin from the 1st to 3rd day (R ₃), the 3rd to 7th day (R _3–7), and the 1st to 7th day (R ₇), were only (53.03±14.04)%, (55.25±10.50)%, and (78.29±10.22)%, respectively. The plasma toxin was cleared up to 25 d after poisoning in most of the patients. The R ₃, R _3–7, and R ₇ in the intensive HP group were all apparently higher than those in the routine HP group, with statistical significance (P<0.05). Simultaneously, the elimination half-life (t _1/2) of 2,4-DNP in the intensive HP group was apparently shorter than that in the routine HP group, with statistical significance (P<0.05). Conclusions: The clinicians should be aware of this slow and persistent process in the elimination of plasma 2,4-DNP. Higher initial plasma toxin concentration resulted in a more severe fever for the patient. According to the limited data, longer and more frequent resin HP may accelerate to eliminate the poison.     

Successful treatment of patients with paraquat intoxication: three case reports and review of the literature

Objective  

To report on three patients with paraquat (PQ) intoxication surviving after combined therapy with hemoperfusion (HP), cyclophosphamide (CTX), and glucocorticoid.     

2，4-D在明胶／壳聚糖微球中的包埋与释放

以明胶／壳聚糖复合物为水相,液体石蜡为连续油相,农药2,4-二氯苯氧乙酸（2,4-D）为芯材,Span80为乳化剂,通过醛交联,采用反相乳液法制备了2,4-D-明胶／壳聚糖微球．考察了制备条件对微球形貌及包封率的影响,并研究了2,4-D在微球中的释放性能．结果表明：当Span80为1mL,油水比为4：1,用一定量甲醛与戊二醛的混合物为交联剂,芯壁材比大于1：14时,制备的微球形态圆整,表面光滑,分散性较好．该复合微球中2,4-D的包封率为70．8％,具有良好的缓释性能,作为一种新型农药剂型可望在农业领域得到应用．     

Diagnosis and treatment of pheochromocytoma in urinary bladder

Objective： To study the diagnosis and treatment ofpheochromocytoma in urinary bladder. Methods： Six cases of bladder pheochromocytoma were studied. Four cases showed hypertension, 3 of which were paroxysmal hypertension during urination. Catecholamine （CA） was increased in a case, and vanillymandelic acid （VMA） was increased in 2 cases. Bladder submucosal mass was detected by B-ultrasound in 5 cases （5/5）, computerized tomography （CT） in 3 cases （3/3）, cystoscopy in 5 cases （5/6）. Four cases took a-receptor blocker for 2 weeks, 1 case took β-receptor blocker to decrease heart rate. All patients were treated with surgical operation including 4 partial cystectomies, 2 excavations. Results： Three cases had manifestations including headache, excessive perspiration and hypertension during cystoscopy. Four cases were confirmed before operation. Two cases showed hypertension during operation. All patients were pathologically diagnosed as pheochromocytoma post- operatively. In five cases followed up, blood pressure returned to normal. No patient had relapse and malignancy. Conclusions： Typical hypertension during urination comprised the main symptoms. We should highly suspect bladder pheochromocytoma if a submucosal mass was discovered with B-ultrasound, CT, ^131I-M1BG （methyliodobenzylguanidine） and cystoscopy. The determination of CA in urine is valuable for qualitative diagnosis. The preoperative management of controlling blood pressure and expansion of the blood volume are very important. Surgical operation is a good method for effective treatment. Postoperative long-time followed up is necessary.     

Case Report:Diagnosis and treatment of pheochromocytoma in urinary bladder

Objective: To study the diagnosis and treatment of pheochromocytoma in urinary bladder. Methods: Six cases of bladder pheochromocytoma were studied. Four cases showed hypertension, 3 of which were paroxysmal hypertension during urination. Catecholamine (CA) was increased in a case, and vanillymandelic acid (VMA) was increased in 2 cases. Bladder sub- mucosal mass was detected by B-ultrasound in 5 cases (5/5), computerized tomography (CT) in 3 cases (3/3), cystoscopy in 5 cases (5/6). Four cases took α-receptor blocker for 2 weeks, 1 case took β-receptor blocker to decrease heart rate. All patients were treated with surgical operation including 4 partial cystectomies, 2 excavations. Results: Three cases had manifestations including headache, excessive perspiration and hypertension during cystoscopy. Four cases were confirmed before operation. Two cases showed hypertension during operation. All patients were pathologically diagnosed as pheochromocytoma post- operatively. In five cases followed up, blood pressure returned to normal. No patient had relapse and malignancy. Conclusions: Typical hypertension during urination comprised the main symptoms. We should highly suspect bladder pheochromocytoma if a submucosal mass was discovered with B-ultrasound, CT, 131I-MIBG (methyliodobenzylguanidine) and cystoscopy. The deter- mination of CA in urine is valuable for qualitative diagnosis. The preoperative management of controlling blood pressure and expansion of the blood volume are very important. Surgical operation is a good method for effective treatment. Postoperative long-time followed up is necessary.     

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Objective

Coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease. We sought to determine which clinical and angiographic variables are associated with collateral development in patients with stable angina and chronic total coronary occlusion.

Methods

Demographic variables, biochemical measurements, and angiographic findings were collected from 478 patients with stable angina and chronic total coronary occlusion. The presence and extent of collaterals supplying the distal aspect of a total coronary occlusion from the contra-lateral vessel were graded from 0 to 3 according to the Rentrop scoring system.

Results

Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralizations were detected in 186 and 292 patients, respectively. Despite similar age, cigarette smoking, and medical treatment, patients with low collateralization were female in a higher proportion and less hypertensive, and had higher rates of type 2 diabetes and dyslipidemia than those with high collateralization (for all comparisons, P<0.05). In addition, patients with low collateralization exhibited more single-vessel disease, less right coronary artery occlusion, more impaired renal function, and higher serum levels of high-sensitivity C-reactive protein (hsCRP) compared with those with high collateralization. Multivariate analysis revealed that age of ≥65 years, female gender, diabetes, no history of hypertension, dyslipidemia, moderate to severe renal dysfunction, single-vessel disease, and elevated hsCRP levels were independently associated with low coronary collateralization.

Conclusions

Coronary collateralization was reduced in almost 40% of stable angina patients with chronic total occlusion, which was related to clinical and angiographic factors. The impact of coronary collateralization on outcomes after revascularization needs further investigation.     

Clinical features of chronic hepatitis B patients with YMDD mutation after lamivudine therapy

INTRODUCTION Chronic hepatitis B(CHB)remains a major public health problem,affecting more than350mil-lion people worldwide.Cirrhosis,liver failure,or hepatocellular carcinoma will develop in approxi-mately15to40percent of infected patients(Ganem and Prince,2004).Lamivudine,an oral nucleoside analogue,inhibits HBV replication(de Clercq,2001;2004;Lai et al.,1997;1998;Marcellin et al.,2004).It can markedly reduce serum HBV DNA levels and normalize alanine aminotransferase(ALT)levels …     

真皮下血管网皮瓣血流量与皮瓣成活关系

目的:通过对兔背部真皮下血管网皮瓣断蒂时及断蒂后10d血流量的监测,分析血流量变化与皮瓣成活的关系,探求皮瓣断蒂指征,提出皮瓣成活的客观标准,为临床治疗提供依据。方法:以兔为实验动物,行背部真皮下血管网皮瓣成形术,术后7d断蒂,断蒂前使用激光多普勒血流仪(Laser Doppler flowmetry,LDF)测定皮瓣阻断实验前后皮瓣血流灌注量(Perfuse unit,PU),并对皮瓣断蒂后10d的PU进行连续监测并与周围正常皮区PU值进行比较,10d后处死动物取皮瓣组织行病理检查,按坏死与否将皮瓣分为两组:成活组与坏死组。分析两组皮瓣血流量变化情况并得出结论。结果:成活组断蒂时阻断试验前后PU比值(阻断比值)明显高于坏死组,且成活组PU值在断蒂后1~10d均显著高于坏死组(P<0.01);成活组与坏死组断蒂后10d周边皮区的PU值无统计学差异(P>0.05);成活组断蒂后10d皮瓣与周围正常皮区PU比值(瓣周比值)为70.1±11.2。结论:真皮下血管网皮瓣断蒂后皮瓣血流灌注量随皮瓣断蒂时阻断实验前后PU比值增高而增高;皮瓣的最佳断蒂时机为:①皮瓣成形术后7d以上。②肉眼观察皮瓣存活。③LDF测量阻断比值大于44.6%。皮瓣成活的标准为:断蒂术后10d肉眼观察成活且皮瓣与周围正常皮区灌注量比值大于58.9%。     

老年性消化性溃疡并出血患者胃镜下止血治疗的临床疗效分析

目的:探讨胃镜下止血治疗老年性消化性溃疡并出血的临床疗效。方法:选择144例老年性消化性溃疡并出血的患者,随机分为2组:甲组80例采用胃镜下喷洒和或注射止血治疗;乙组64例予以每天2次静脉滴注奥美拉唑40mg,疗程5天。治疗期间记录病人的72h治疗成功率、再出血率、止血时间、住院天数作为疗效判断指标。结果:72h治疗成功率分别为87.5%(70)、50.0%(32);再出血率分别为6.25%(5)、26.6%(17);止血时间(h)分别为46.2±14.5、86.8±19.4;住院天数(d)分别为15.8±2.0、24.1±4.2,甲乙两组比较均有显著性差异(P<0.05)。结论:胃镜下止血治疗老年出血性消化性溃疡的临床疗效较内科治疗更满意,值得临床推广应用。     

Comparative features of colorectal and gastric cancers with microsatellite instability in Chinese patients

Objective  

The purpose of this study was to determine the unique and universal features of microsatellite instability-high (MSI-H) colorectal cancer (CRC) and MSI-H gastric cancer (GC) in the Chinese population.     

Changes of oxidative and lipoperoxidative metabolism in patients with acute viral myocarditis

Objective: To study the changes of oxidative metabolism and lipoperoxidative metabolism in patients with acute viral myocarditis (AVM), and to research pathological chain reactions of a series of free radicals, and oxidative damage and lipoperoxidative damage in AVM patients' bodies. Methods: A random paired control design was used to investigate 70 cases of AVM patients and 70 cases of healthy adult volunteers (HAV) on the basis of contents of nitric oxide (NO), lipoperoxide (LPO) in plasma, and LPO in red blood cell (RBC) as well as activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) in RBC as revealed by spectrophotometric assays. Results: Compared with the average values (AV) of the above biochemical parameters (BP) in the HAV group, the AV of NO in plasma, and LPO in plasma and in RBC in the AVM group were significantly increased (P=0.0001), while the AV of SOD, CAT and GSH-Px in the AVM group were significantly decreased (P=0.0001). Conclusion: The findings in this study suggested that in the AVM patients bodies the metabolism of NO was disturbed, and the pathological chain reactions of a series of free radicals were so severely aggravated, as to cause the oxidative damage and lipoperoxidative damage in the AVM patients' bodies.     

Infliximab treatment in two Chinese patients with psoriatic arthritis

Psoriatic arthritis (PsA) is a rheumatoid factor (RF)-seronegative systemic inflammatory disorder associated with psoriasis. Current treatment for PsA in China is still focused on disease modifying anti-rheumatic drugs (DMARDs). In this paper, we report two Chinese patients with active longstanding PsA treated with infliximab, a human-mouse chimeric monoclonal antibody against tumor necrosis factor alpha (TNF-α). The results show that infliximab acted quickly and effectively in relieving peripheral and axial symptoms and refractory skin lesions, even in recombinant human TNF-α receptor (rhTNFR)-resistant case. The take-home message from our cases is that infliximab is a useful therapeutic option for refractory PsA, especially when a patient has a combination of psoriasis and psoriatic arthritis. Further local evidence and experience must be accumulated in order to make anti-TNF-α therapy more accessible to PsA patients in China.     

Chaiqin Chengqi Decoction decreases IL-6 levels in patients with acute pancreatitis

Objective  

In this paper, we investigated the effect of the traditional Chinese medicine Chaiqin Chengqi Decoction (CQCQD) on serum cytokines in acute pancreatitis (AP) patients.     

Clinical characteristics and treatment of thyroid cancer in children and adolescents: a retrospective analysis of 83 patients

Objective

To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents.

Methods

We performed a retrospective analysis of clinical data from 83 cases of thyroid cancer in children and adolescents from January 1990 to December 2010. We compared extra-thyroid extension, lymph node metastasis, distant metastasis, and prognosis between pediatric patients ≤12 years of age (27 cases) and those >12 years of age (56 cases). All the patients agreed to undergo thyroidectomy and endocrine therapy, and the consent was obtained from parents or guardians.

Results

Histopathology included papillary carcinoma in 67 cases, papillary carcinoma with partial follicular growth pattern in 1 case, papillary carcinoma with squamous metaplasia in 4 cases, follicular carcinoma in 7 cases, medullary carcinoma in 3 cases, and poorly differentiated carcinoma in 1 case. The total lymph node metastasis rate was 78.31%. Patients ≤12 years of age showed a higher rate of lymph node metastasis than the older group (92.59% vs. 71.43%, P=0.028). The incidence rate in females in the older group was higher than that in the younger group (80.36% vs. 59.26%, P=0.041). There were no significant differences in extra-thyroid extension, distant metastasis, survival rate, or recurrent disease between the two groups.

Conclusions

The lymph node metastasis of thyroid cancer is higher in patients ≤12 years of age than in those >12 years of age; the incidence rate is higher in females than in males. Childhood thyroid cancer has a good prognosis, surgery being the most effective treatment. Choosing a reasonable surgery method and comprehensive postoperative treatment can achieve a cure and satisfactory survival rate.

     

Comparison of the effects of acute and chronic psychological stress on metabolic features in rats

This study was aimed to compare the effects of acute and chronic psychological stress on metabolic factors. Forty-two male Wistar rats were divided into control and stressed groups. Stress was applied by a communication box acutely (1 d) and chronically (15 and 30 d). Blood sampling was carried out by retro-orbital-puncture method. The plasma levels of glucose, cholesterol, triglyceride, insulin, and corticosterone were measured. In addition, feed and water intake, latency to eat and drink, adrenal and body weights were determined. Acute and chronic psychological stress did not significantly change basal plasma corticosterone levels. However, immediately (1 min) after acute exposure to stress, plasma corticosterone level increased compared to that before stress exposure. Acute stress increased plasma insulin levels significantly. Fifteen days of stress exposure resulted in plasma glucose increase. Chronic stress significantly increased feed intake, latency to eat, and adrenal weight compared to acute stress. The body weights of both control and stressed groups increased markedly during the experiment. Homeostasis model assessment of insulin resistance (HOMA-IR) index did not change significantly in the stressed group. In conclusion, application of acute and chronic psychological stress leads to different metabolic and/or behavioral changes but the metabolic changes resulting from acute exposure to stress seem to be more pronounced.     

FLT3 and NPM1 mutations in Chinese patients with acute myeloid leukemia and normal cytogenetics

Mutations of fms-like tyrosine kinase 3 (FLT3) and nucleophosmin (NPM1) exon 12 genes are the most common abnormalities in adult acute myeloid leukemia (AML) with normal cytogenetics. To assess the prognostic impact of the two gene mutations in Chinese AML patients, we used multiplex polymerase chain reaction (PCR) and capillary electrophoresis to screen 76 AML patients with normal cytogenetics for mutations in FLT3 internal tandem duplication (FLT3/ITD) and exon 12 of the NPM1 gene. FLT3/ITD mutation was detected in 15 (19.7%) of 76 subjects, and NPM1 mutation in 20 (26.3%) subjects. Seven (9.2%) cases were positive for both FLT3/ITD and NPM1 mutations. Significantly more FLT3/ITD aberration was detected in subjects with French-American-British (FAB) M1 (42.8%). NPM1 mutation was frequently detected in subjects with M5 (47.1%) and infrequently in subjects with M2 (11.1%). FLT3 and NPM1 mutations were significantly associated with a higher white blood cell count in peripheral blood and a lower CD34 antigen expression, but not age, sex, or platelet count. Statistical analysis revealed that the FLT3/ITDpositive group had a lower complete remission (CR) rate (53.3% vs. 83.6%). Survival analysis showed that the FLT3/ITD-positive/NPM1 mutation-negative group had worse overall survival (OS) and relapse-free survival (RFS). The FLT3/ITD-positive/NPM1 mutation-positive group showed a trend towards favorable survival compared with the FLT3/ITD-positive/NPM1 mutation-negative group (P=0.069). Our results indicate that the FLT3/ITD mutation might be a prognostic factor for an unfavorable outcome in Chinese AML subjects with normal cytogenetics, while NPM1 mutation may be a favorable prognostic factor for OS and RFS in the presence of FLT3/ITD.     

评分法在救治急性有机磷农药中毒中的应用

目的：探讨在治疗急性有机磷农药中毒时阿托品用量的评价方法，方法：用心率快慢、瞳孔大小，皮肤干湿程度进行评分，评价阿托品化及维持用药的多少。结果：331例急性有机磷农药中毒患者，无一例因托品不足或过量或病情反跳死亡。结论：评分法是阿托品用量客观的评价方法，，可避免阿托品用量不足和过量，防止过早减量或停药，为救治急性有机磷农药中毒提出了一个新的评价阿托品用量的方法。     

Clinical heterogeneity in patients with early-stage Parkinson's disease: a cluster analysis

The aim of this study was to investigate the clinical heterogeneity of Parkinson’s disease (PD) among a cohort of Chinese patients in early stages. Clinical data on demographics, motor variables, motor phenotypes, disease progression, global cognitive function, depression, apathy, sleep quality, constipation, fatigue, and L-dopa complications were collected from 138 Chinese PD subjects in early stages (Hoehn and Yahr stages 1–3). The PD subject subtypes were classified using k-means cluster analysis according to the clinical data from five- to three-cluster consecutively. Kappa statistical analysis was performed to evaluate the consistency among different subtype solutions. The cluster analysis indicated four main subtypes: the non-tremor dominant subtype (NTD, n=28, 20.3%), rapid disease progression subtype (RDP, n=7, 5.1%), young-onset subtype (YO, n=50, 36.2%), and tremor dominant subtype (TD, n=53, 38.4%). Overall, 78.3% (108/138) of subjects were always classified between the same three groups (52 always in TD, 7 in RDP, and 49 in NTD), and 98.6% (136/138) between five- and four-cluster solutions. However, subjects classified as NTD in the four-cluster analysis were dispersed into different subtypes in the three-cluster analysis, with low concordance between four- and three-cluster solutions (kappa value=−0.139, P=0.001). This study defines clinical heterogeneity of PD patients in early stages using a data-driven approach. The subtypes generated by the four-cluster solution appear to exhibit ideal internal cohesion and external isolation.     

Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma

Objective  

To assess the clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma (EOC).     

关于免疫抑制冲击治疗百草枯中毒的安全性和有效性评价系统回顾和荟萃分析（英文）

目的:评估免疫抑制冲击治疗百草枯中毒患者的安全性和有效性.创新点:报告了在百草枯中毒的患者中,使用免疫抑制冲击治疗的效果,确定了其是否会增加患者发生肝炎和肾衰的风险.方法:我们检索了截止于2018年6月,发表在PubMed,EMBASE和Cochrane三个数据库中关于免疫抑制冲击治疗百草枯中毒患者的文献.经过筛选,最终有7篇文献符合纳入标准,总共426位病人,并采用RevMan软件进行数据分析.结论:对纳入的7篇文献进行荟萃分析,发现使用免疫抑制冲击治疗能够有效的降低百草枯中毒患者的死亡率,而且是相对安全的,不会增加患者发生肝炎或者肾衰的发生率.部分文献报道一些患者出现了白细胞减少,但都在停药后1~2周内恢复正常.另外,文献还报道了两例非致死性的脓毒症,这可能是免疫抑制治疗造成的免疫功能低下引起的.