Inhibitory effects of Ganoderma lucidum triterpenoid on the growth and metastasis of hepatocellular carcinoma.

OBJECTIVE: To investigate the inhibitory effects and mechanisms of triterpenoids from Ganoderma lucidum (G. lucidum triterpenoids) on the growth and metastasis of hepatocellular carcinoma (HCC) both in vitro and in vivo. METHODS: In in-vitro experiments, the inhibitory effects of G. lucidum triterpenoids on human HCC SMMC-7721 cell lines were investigated by observing the proliferation, apoptosis, migration and invasion phenotypes of the cell line and assessing the cell cycles as well as the cell apoptosis and proliferation. In in-vivo experiments, nude mouse SMMC-7721 tumor models were established and divided into control group, treatment group A (low concentration group) and treatment group B (high concentration group) according to the treatment models received. Magnetic resonance imaging (MRI) was performed 3 times on each mouse model to calculate their tumor volumes. The liver and kidney functions of the models were evaluated. Tissues harvested from their solid organs were subjected to HE staining, and the tumor tissues were subjected to HE staining and immunohistochemical staining (E-cad, Ki-67, and Tunel), respectively. RESULTS: i. In in-vitro experiments, G. lucidum triterpenoids could inhibit the growth of human HCC SMMC-7721 cell lines via regulating their proliferation and apoptosis phenotype. ii. In in-vivo experiments, the comparison of tumor volumes of mouse models obtained from the second and third MIR scanning was found to be statistically significant between the control group and treatment group A (P<0.05); and statistically significant differences were also found in the tumor volumes from the second and third MRI scanning between the control group and treatment group B (P<0.05). iii. No significant acute injuries or adverse effects were observed in the liver or kidney of the nude mice. CONCLUSION: G. lucidum triterpenoids could inhibit the growth of tumor cells via blocking their proliferation, accelerating apoptosis, and inhibiting migration and invasion, without marked toxic effects on normal organs and tissues in the body.

The seasonality of acute coronary syndrome and its relations with climatic parameters.

BACKGROUND: Most research on the seasonality of acute coronary syndrome (ACS) has been were reported from hospital-based data. We aimed to investigate the seasonal distribution of ACS in Beijing and to elucidate the relations between ACS occurrence and climatic parameters in a prehospital setting. METHODS: We retrospectively reviewed the electronic prehospital medical records from the Beijing's emergency medical service system spanning August 1, 2005, to July 31, 2007. Case data were analyzed by month and season with χ² test. The effects of climatic factors on the occurrence of ACS were analyzed by Poisson regression with generalized linear model. RESULTS: During the 2-year study period, a total of 7037 ACS events were identified, including 4135 male patients (58.8%) and 2902 female patients (41.2%). Significant variations were observed in the monthly (P < .001) and seasonal (P < .001) distribution of ACS. The highest seasonal incidence occurred in winter and lowest in autumn. Significant negative correlations were noticed between the number of ACS events and daily mean temperature (P < .001) and between the number of ACS events and barometric pressure (P < .001). Comparing to the baseline level (temperature of 25°C to approximately 31°C; barometric pressure of 1026 to approximately 1048 hectopascal (hPa)), an increase of 41.3% of daily ACS incidence was associated with temperature lower than 2°C (-10.0°C to approximately 2.0°C), and an increase of 19.8% was associated with barometric pressure under 1006 hPa (991.0 to approximately 1006 hPa). CONCLUSIONS: There are clear monthly and seasonal rhythms of ACS in Beijing metropolitan area. Temperature and barometric pressure are negatively related with the occurrence of ACS.

Domicile-related carbon monoxide poisoning in cold months and its relation with climatic factors.

BACKGROUND: Many studies have identified strong correlations between winter months and acute, unintentional carbon monoxide (CO) poisoning. In this study, we aimed to investigate the incidence pattern of acute domicile-related CO poisoning in Beijing and its relation with climatic factors. METHODS: Data on CO poisoning were collected from the emergency medical service system during August 1, 2005, to July 31, 2007, in Beijing. Variations of the monthly and seasonal distribution of CO poisoning occurrences were examined with χ(2) testing. Climatic data including temperature, barometric pressure, humidity, wind speed, and visibility were obtained from the Beijing Meteorological Bureau. Correlations between the occurrence of CO poisoning and mean of each meteorological parameter spanning 3 days were analyzed with partial correlation test, with related parameters controlled. RESULTS: Significant differences were found among the cases occurring each month of the year (P < .001). The monthly caseload reached the peak and the nadir in January and in September, respectively. During the cold period, 3331 patients were recorded, accounting for 88.4% of the total cases of the 2-year study period. Among the 5 climatic parameters, only temperature had a significant inverse correlation with the occurrence of CO poisoning (P < .001, r = -0.467). CONCLUSIONS: The incidences of CO poisoning were highest during winter, particularly during the time period when charcoal or coal use for indoor heating would be most prevalent in Beijing.

Circadian, day-of-week, and age patterns of the occurrence of acute coronary syndrome in Beijing's emergency medical services system.

BACKGROUND: Previous in-hospital studies suggest that there are significant circadian rhythms associated with the incidence of acute coronary syndromes (ACSs). No study to date has examined the presentation of ACS in the prehospital setting. Our goal was to examine circadian, day-of-week, and age patterns of occurrence in ACS in a large, urban emergency medical services (EMS) system. METHODS: We retrospectively reviewed the electronic prehospital medical records from the Beijing's EMS system spanning August 1, 2005, to July 31, 2007. Data were analyzed by hour of the day and day of the week. chi(2) tests were performed to compare the difference. RESULTS: Seven thousand thirty-two cases of ACS were identified by the EMS system physicians during the 2-year study period, including 536 cases of acute myocardial infarction. A significant variation of circadian distribution of ACS was observed in both 24-hour (P < .001) and 2-hour (P < .001) interval time course. Two peaks were observed in the morning from 0800 to 1000 and approaching midnight from 2200 to 2400. Increases of 50% and 60.8% in the morning and evening peaks were found, respectively, when compared with the early morning baseline (nadir). No significant difference was found among the accumulated cases in 2 years on each day in a week (P = .203). CONCLUSIONS: Our study shows that, in the Beijing metropolitan area, the presentation of ACS has significant circadian rhythm characterized by 2 peaks within 24 hours, the morning peak is 0800 to 1000, and the late evening peak is 2200 to 2400. No significant weekly rhythm was observed in the present study.

Circadian and seasonal rhythms of acute upper gastrointestinal bleeding in Beijing.

OBJECTIVE: To investigate the circadian and seasonal patterns in the presentation of acute upper gastrointestinal bleeding (AUGIB) in Beijing, China. METHODS: Medical records of the Beijing Emergency Medical Service System (EMSS) for 1 August 2005 to 31 July 2007 were reviewed; all patients diagnosed with AUGIB were included in the study. RESULTS: 2580 patients were recorded in the EMSS system with a diagnosis of AUGIB during the study period. 1888 (73%) were male and 692 (27%) were female. Mean age was 53+/-20 years for male patients and 63+/-21 years for female patients. Significant differences in the presentation of AUGIB were noticed between seasons (p<0.001) and months (p<0.001). The number of cases in cold months (from December to April) was significantly higher than that in warm months (June to September). There was a significant circadian rhythm; there were fewer cases during daytime hours compared with night-time hours (p<0.001). CONCLUSIONS: The presentation of AUGIB in Beijing has a clear seasonal and circadian rhythm. Circadian and seasonal rhythms associated with AUGIB may aid in identifying modifiable risk factors in individuals and populations.

[Circadian variation of the incidence of upper gastrointestinal bleeding and its relationship with climatic factors].

OBJECTIVE: To study the circadian patterns of the incidence of upper gastrointestinal bleeding (UGIB) and its relationship with climatic factors in Beijing. METHODS: We searched all UGIB records from August 1, 2005 to July 31, 2007 from Beijing Emergency Center and tracked the meteorological data during the same period. The variation of the incidence of UGIB was compared based on day, month, and season. The relation between climatic factors and the incidence of UGIB was also analyzed. RESULTS: Totally 2 580 patients, including 1 888 males (73.2%) and 692 females (26.8%) were included in the study. The mean age was significantly different between males and females [(53.3 +/- 20.4) years vs. (63.3 +/- 20.7) years, P < 0.05]. The occurrence of UGIB were significantly different among different seasons (chi2 = 49.82, P < 0.01), months (chi2 = 83.43, P < 0.01), and hours (chi2 = 126.79, P < 0.01). UGIB cases were presented more frequently in winter and spring, especially in January. More UGIB cases were presented at night, especially from 8 pm to midnight. Partial correlation test showed that the incidence of UGIB significantly correlated with temperature (r = -0.3785, P = 0.001) and barametric pressure (r = -0.3002, P = 0.011). No correlation was found between UGIB incidence and wind speed (P = 0.086) and relative humidity (P = 0.971). CONCLUSIONS: The incidence of UGIB varies in different months and seasons in Beijing. Its climate-related risk factors may include temperature and barametric pressure, but not include relative humidity and wind speed.

Early recognition of myxedematous respiratory failure in the elderly.

OBJECTIVE: To report the clinical characteristics of myxedematous respiratory failure in the elderly and to facilitate early recognition of hypothyroidism in critically ill old patients. METHODS: Clinical characteristics of our reported 4 patients and that of 17 patients with myxedematous respiratory failure reported previously were reviewed. Demographic information, vital signs, basic laboratory studies, and blood gas analysis were compared. RESULTS: All 4 patients were older than 60 years and were hypoxic and hypercarbic upon presentation. All were found to have either anemia or marked electrolyte abnormalities and markedly elevated levels of thyroid-stimulating hormone once these levels were evaluated. Three of the 4 patients presented with profound lethargy and/or constipation, slowed intellectual ability, and dry skin. CONCLUSIONS: Early recognition of hypothyroidism in elderly patients with myxedematous respiratory failure is crucial to prognosis. Whereas hypothermia, myxedema, and a history of thyroid disease mandate the thyroid function tests in patients with type 2 respiratory failure, the following 5 elements also warrant the thyroid function tests: bradycardia, anemia, hyponatremia, pleural or pericardial effusion, and a history of weight gain. Where mechanical ventilation has been applied, patients with difficult weaning from ventilator support should also be evaluated and screened for hypothyroidism.

Future possibilities for the treatment of septic shock with herbal components.

The treatment of septic shock remains challenging even with the armamentarium of modern antibiotics and intensive care technologies. Reliance on antibiotics and other methods targeting modulation of the systemic inflammatory response such as steroids, hemofiltration, and cytokine antagonists has not led to reliable successful treatment for inflammation and infection-related shock. In part, this is attributable to the continuous evolution of antibacterial drug resistance. Herbal medicine has been used in treating infections and shock, worldwide, for thousands of years. The active components contained in these naturally occurring products usually have one or more of the following properties: (1) direct attack or suppression on bacterial pathogens, (2) modulation of the host's immune system resulting in suppression of inflammation and overproduction of inflammatory mediators, and (3) neutralization of toxic free-radicals. In vitro and in vivo animal and human clinical studies of herbal medicines' effectiveness in the treatment of septic shock are needed. Their pharmacological mechanisms need to be elucidated at molecular level to investigate and improve targeted therapy using heretofore unexplored uses for traditional herbal remedies. Herein, we discuss historical examples of herbal remedies used to fight infection. In addition, we discuss the use of herbal and traditional medicines as potential adjuncts in the ongoing battle against septic shock and systemic infections.

Ethanol poisoning together with organophosphate exposure: a difficult clinical diagnosis because of physician anchoring.

AIMS: Organophosphorus pesticide poisoning occurs frequently in China and can be diagnosed easily based on the history of ingestion and the cholinergic toxic syndrome. Yet, when combined with other toxins, organophosphorus poisoning may appear different. METHODS: Here, we present a case of acute ethanol poisoning together with a dermal organophosphorus exposure. RESULTS: Based on the history and a misinterpretation of the physical examination, the patient was treated as an organophosphorus poisoning. Ultimately, serum analysis helped clarify the diagnosis. CONCLUSIONS: Toxicologist should be aware of the error known as anchoring and take appropriate precautions to limit its occurrence.

The cytokine storm and factors determining the sequence and severity of organ dysfunction in multiple organ dysfunction syndrome.

Multiple organ dysfunction syndrome (MODS) is a major cause of morbidity and mortality in intensive care units. It is being encountered frequently in critically ill patients owing to advancements in organ-specific supportive technologies to survive the acute phase of severe sepsis and shock. It is now believed that MODS is the result of an inappropriate generalized inflammatory response of the host to a variety of acute insults. The pathologic mechanisms of MODS were reviewed, and factors determining the sequence and severity of organ dysfunction were discussed in depth. In the early phase of MODS, circulating cytokines cause universal endothelium injury in organs. In the later phase of MODS, overexpression of inflammatory mediators in the interstitial space of various organs is considered a main mechanism of parenchyma injury. The difference in constitutive expression and the upregulation of adhesion molecules in vascular beds and the density and potency of intrinsic inflammatory cells in different organs are the key factors determining the sequence and severity of organ dysfunction. By activating the intrinsic inflammatory cell in a distant organ, organ dysfunctions are linked in a positive feedback loop through circulating inflammatory mediators. Antagonists targeted at adhesion molecules may alleviate the severity of endothelial damage. And nonsteroidial anti-inflammatory drugs or steroids administered judiciously in the early phase of MODS may retard the progress of multiple organ failure.

[Effects of methylene blue on refractory hemorrhagic shock].

OBJECTIVE: To evaluate the effects of methylene blue (MB) on refractory hemorrhagic shock. METHODS: Totally 24 rabbits subjected to prolonged hemorrhagic shock and resuscitation were randomly divided into hemorrhagic shock group (12 rabbits) and MB group (12 rabbits; MB was administered immediately after resuscitation was performed). The plasma levels of tumor necrosis factor alpha (TNFalpha) , interleukin (IL)-6, IL-8, nitric oxide (NO), lactic acid (LA) , and mean arterial pressure (MAP) were detected before shock, immediately after resuscitation, and 0.5, 2, and 4 hours after resuscitation. The 12-hour survival rates were observed. RESULTS: The plasma levels of TNFalpha, IL-6, IL-8, NO and LA after shock were significantly higher than before shock (P <0.01), and maintained at high levels. Compared with the shock group, higher MAP and lower plasma levels of TNFalpha, IL-6, IL-8, NO, and LA were observed in the MB group after resuscitation (P<0.01). The 12-hour survival rates were not significantly different between shock group and MB group. CONCLUSION: Although MB can not improve the prognosis of refractory hemorrhagic shock, it can increase and maintain the MAP and thus play a beneficial role in the treatment of hemorrhagic shock.

[Apoptosis of gastric mucosa and gastric barrier dysfunction in acute ischemic stroke].

OBJECTIVE: To evaluate the role of gastric mucosa apoptosis in the stress of ischemic stroke, and to discuss the relationship between gastric mucosa apoptosis and gastric barrier. METHODS: Ten dogs were artificially made ischemic stroke by operation (IS group), and another 10 shamly-operated dogs were served as control group. Sucrose permeability were measured after the operation. All dogs were sacrificed 24 hours after operation to measure the gastric mucosal apoptosis index, gastric gross classification, and histological score. RESULTS: The gastric mucosal apoptosis index in the IS group were significantly higher than in the control group (14.83 +/- 4.41 vs. 5.60 +/- 2.61, P < 0.05). The gastric mucosal apoptosis index were correlated with the sucrose permeability (r = 0. 89, P < 0.05) , gastric gross classification (r = 0. 87, P < 0.05), and histological score (r = 0.92, P < 0.05). CONCLUSIONS: Although ischemic stroke will not cause the obvious damage in the respiratory and circulatory system, it is responsible for the apoptosis of epithelial cell in the gastric mucosa and gastric barrier dysfunction. The apoptosis index is closely correlated with the damage of the function and morphology of the gastric barrier, indicating that the epithelial cell apoptosis acceleration in the gastric mucosa may result in the damage of gastric barrier function.

[Clinical features of respiratory failure secondary to hypothyroidism].

OBJECTIVE: To explore the clinical features of respiratory failure secondary to hypothyroidism. METHOD: We retrospectively analyzed the clinical data of 4 patients with respiratory failure secondary to hypothyroidism. RESULTS: Respiratory failure secondary to hypothyroidism usually happened in the aged patients, presenting as myxedema, disturbance of consciousness, anemia, and hyponatrium. Respiratory symptoms were rare. Type II respiratory failure might occur as disease progressed. The clinical presentation of hypothyroidism was atypical and easily neglected. The hypoxia and hypercapnia ameliorated after thyroid hormone therapy. CONCLUSION: Hypothyroidism is a rare reason of respiratory failure. The prognosis is good after hormone therapy and mechanical ventilation.

[Functional hemodynamic monitoring].

Hemodynamic monitoring is important for critically ill patients in emergency medicine. While the conventional static hemodynamic monitoring may not accurately reflect the hemodynamic status, functional hemodynamic monitoring can dynamicly and individually monitor the hemodynamic status, and thus becomes a valuable supplementation for conventional static hemodynamic monitoring. This article reviews the limitations of conventional hemodynamic monitoring and introduces the methodology of functional hemodynamic monitoring.

[Gastrointestinal dysfunction/failure and critical care medicine].

This article reviews the recent advances in gastrointestinal function research, especially the gastrointestinal dysfunction/failure in critical care medicine.

[An analysis of the early diagnostic criteria for tuberculosis meningitis].

OBJECTIVE: To find a method for the early diagnosis of tuberculous meningitis (TM). METHODS: Cases with the discharge diagnosis of TM during 1995 - 2004 ten years in the Peking Union Medical College Hospital were analyzed retrospectively. History of tuberculosis other sites of tuberculous infection, the findings of cerebrospinal fluid (CSF) and CSF culture result were studied. RESULTS: 16 of the 68 patients had past history of tuberculosis. During hospitalization 20 had pulmonary tuberculosis, while 9 had other sites of tuberculous infection. The rate of tuberculous infection aside from neurological system was 43%. The top 7 clinical manifestations were: coma, onset of the disease more than 5 days, lymphocyte predominant in CSF, glucose level in CSF 50% lower than that of blood, abnormal CT findings. Abnormal ocular fundi and proved tuberculosis of other sites. CONCLUSIONS: TM is often accompanied with tuberculous infection of other sites. Its diagnosis can not be relied mainly on the culture result of CSf. When 4 of the 7 above mentioned criteria are present, TM should be diagnosed and anti-tuberculosis therapy started.