[A case of aconitum kusnezoffii intoxication with severe arrhythmia].

Aconitum kusnezoffii is a traditional Chinese medicine of Ranunculaceae family. Its toxicity is relatively strong, and its dosage is similar to that of poisoning. In clinical practice, poisoning events are often caused by excessive dosage or improper use. There is no specific antidote for kusnezoff root poisoning. Severe kusnezoff root poisoning can cause malignant arrhythmia and even death.A case of severe kusnezoff monkshood poisoning was reported in January 2021, which was treated with nificaran hydrochloride for injection in the emergency medicine department of the First Hospital of Handan City. The patient developed ventricular tachycardia, ventricular fibrillation and AS syndrome. In addition to conventional treatment, the patient did not have arrhythmia again after intravenous injection of 25 mg of nifekalan load and continuous pumping of 0.4 mg/kg/h for 7 hours, and did not relapse after discontinuation of nifekalan 24 hours later. It is suggested that the malignant arrhythmia caused by clinical severe kusnezoff monkshood poisoning can be controlled by nifekalan. Whether nifekalan is superior to conventional antiarrhythmic drugs still needs more accumulation and verification of clinical application data.

[Preliminary clinical analysis of direct renin inhibitor aliskiren in the treatment of severe coronavirus disease 2019 patients with hypertension].

Objective: To explore the feasibility of direct renin inhibitor aliskiren for the treatment of severe or critical coronavirus disease 2019 (COVID-19) patients with hypertension. Methods: The antihypertensive effects and safety of aliskiren was retrospectively analyzed in three severe and one critical COVID-19 patients with hypertension. Results: Four patients, two males and two females, with an average age of 78 years (66-87 years), were referred to hospital mainly because of respiratory symptoms. Three were diagnosed by positive novel coronavirus 2019 (2019-nCoV) nucleic acid or antibody, and the critical patient with cardiac insufficiency was clinically determined. Two patients were treated with calcium channel antagonist (CCB), one with angiotensin converting enzyme inhibitor (ACEI), and one with angiotensin Ⅱ receptor antagonist (ARB). After admission, ACEI and ARB were discontinued, one patient with heart failure was treated by aliskiren combined with diuretic.Three patients were treated with aliskiren combined with CCB among whom two withdrew CCB due to low blood pressure after 1 to 2 weeks. Based on comprehensive treatment including antiviral and oxygenation treatment, blood pressure was satisfactorily controlled by aliskiren after three to four weeks without serious adverse events. All patients were finally discharged. Conclusion: Our preliminary clinical data shows that antihypertensive effect of aliskiren is satisfactory and safe for severe COVID-19 patients complicated with hypertension.

[Analysis of disease spectrum of biliary surgery among 30 years in a single center].

OBJECTIVE: To explore the changing trend and clinical significance of disease spectrum of biliary surgery among 30 years in PLA General Hospital. METHODS: We retrospectively analyzed the clinical data of 21 189 consecutive patients with biliary diseases in PLA General Hospital between January 1985 and December 2014 according to the inclusion criteria. Taking 5 years as a research group, all patients were divided into 6 groups, and then the 30 years of the disease spectrum of biliary surgery was described. RESULTS: (1) From January 1985 to December 2014, the PLA General Hospital performed 21 189 cases of patients with biliary surgery diseases, including 9 460 cases of male, 11 729 cases of female (female∶male=1.24∶1). The average age was 52.1±13.5 years old (6-98 years). (2) Of the all cases, the most patients was cholelithiasis, accounting for 65.26%, and gallbladder stones accounting for 53.61%. The following disease was cholangiocarcinoma, accounting for 12.79%, and hilar cholangiocarcinoma accounting for 5.95%. (3) From the perspective of disease spectrum changing trend, the proportion of patients with cholelithiasis were decreased gradually, from 74.9% to 65.2%, while the proportion of patients with cholangiocarcinoma showed a gradual upward trend, rising from 6% to 14% (P<0.05); and the proportion of bile duct cystic dilatation and gallbladder carcinoma shared a gradual increase(P<0.05), however, the variation of proportion of gallbladder polyps and biliary stricture were not statistically significant (P>0.05). (4) In patients with cholelithiasis, the proportion of patients with gallbladder stones increased gradually from 71.9% to 82%, while the proportion of patients with bile duct stones decreased gradually from 28.1% to 18%. There was no statistical significance in the proportion of different types of cholangiocarcinoma patients (P>0.05) (40% of the patients with hilar cholangiocarcinoma, 25% of the intrahepatic cholangiocarcinoma, and 35% of the extrahepatic cholangiocarcinoma). CONCLUSION: With the time changing, the disease spectrum of biliary surgery has also changed. The proportion of patients with cholelithiasis, especially the patients with bile duct stones, was declining gradually, and the proportion of patients with cholangiocarcinoma was increasing gradually.

Surgical management of biliary cystadenoma and cystadenocarcinoma of the liver.

Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare biliary duct neoplasms. This study investigated reasonable management strategies of cystic neoplasms in the liver. Charts of 39 BCA/BCAC patients (9 males, 30 female; median age 53.74 ± 14.50 years) who underwent surgery from January 1999 to December 2009 were reviewed retrospectively. Cyst fluid samples of 32 BCA/BCAC patients and 40 simple hepatic cyst patients were examined for the tumor markers carbohydrate associated antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). The most frequent symptoms were abdominal pain (N = 10), abdominal mass (N = 7), abdominal distension (N = 4), jaundice (N = 2), and fever (N = 3); the remaining patients showed no clinical symptoms. Liver resection (N = 17) or enucleation (N = 22) was performed in the 39 patients. Ultimately, 35 patients were diagnosed with intrahepatic BCA and four patients were diagnosed with BCAC. The median CA19-9 level was significantly higher in BCA/BCAC patients than in simple hepatic cyst patients. The median CEA levels in BCA/BCAC patients and controls were 6.83 ± 2.43 and 4.21 ± 2.91 mg/L, respectively. All symptoms were resolved after surgery, and only one BCAC patient showed recurrence. The incidence of intrahepatic cystic lesions was 1.7%. Increased CA19-9 levels in the cyst fluid is a helpful marker for distinguishing BCA/BCAC from common simple cysts. The presence of coarse calcifications is suggestive of BCAC. Complete surgical removal of these lesions yielded satisfying long-term outcomes with a very low recurrence rate.

IMPACT OF AGE AND AUTOANTIBODY STATUS ON THE GENE EXPRESSION OF SCLERODERMA FIBROBLASTS IN RESPONSE TO SILICA STIMULATION.

Environmental factors are believed to play an important role in the pathogenesis of systemic sclerosis (SSc). Silica exposure has been implicated as potentially hazardous in epidemiological studies of SSc. It can activate fibroblasts to express profibrotic genes at certain conditions. The aim of this study is to examine whether the fibroblasts of SSc patients respond to silica particles with specific gene expressions differentially from normal control fibroblasts. The fibroblasts obtained from skin biopsies of 96 SSc patients and 104 controls were examined. Silica particles were used to perturb the cultures of the fibroblasts in time-course and dose-response assays. The transcript levels of COL1A2, COL3A1, MIVIP1, MMP3, TIMP3 and CTGF genes of the fibroblasts were measured with quantitative RT-PCR. The results showed that the expressions of all six genes in SSc fibroblasts under silica perturbation appeared significantly different from normal control fibroblasts. In age stratified analysis, compared to control fibroblasts, SSc fibroblasts from patients at age 30-40 years and 50-60 years displayed significantly decreased expressions of MMP1 gene in all dosage assays and increased expression of COL3A1 genes started at low dosages perturbation of silica particles, respectively. In autoantibody stratified analysis, specific gene expression patterns were significantly associated with autoantibody-subgroups of fibroblasts. A common feature of SSc fibroblasts was unstable and a wide range of gene expression changes in response to silica perturbation. Our studies may suggest an altered intrinsic dynamic control in SSc fibroblasts. In addition, sensitivity and specificity of SSc fibroblasts to potentially hazardous environmental trigger is age and autoantibody-subgroup-dependent. The fibroblasts of SSc patients at age 30-60 years may be more sensitive to silica perturbation toward a profibrotic gene expression.

Near room-temperature formation of a skyrmion crystal in thin-films of the helimagnet FeGe.

The skyrmion, a vortex-like spin-swirling object, is anticipated to play a vital role in quantum magneto-transport processes such as the quantum Hall and topological Hall effects. The existence of the magnetic skyrmion crystal (SkX) state was recently verified experimentally for MnSi and Fe(0.5)Co(0.5)Si by means of small-angle neutron scattering and Lorentz transmission electron microscopy. However, to enable the application of such a SkX for spintronic function, materials problems such as a low crystallization temperature and low stability of SkX have to be overcome. Here we report the formation of SkX close to room temperature in thin-films of the helimagnet FeGe. In addition to the magnetic twin structure, we found a magnetic chirality inversion of the SkX across lattice twin boundaries. Furthermore, for thin crystal plates with thicknesses much smaller than the SkX lattice constant (as) the two-dimensional SkX is quite stable over a wide range of temperatures and magnetic fields, whereas for quasi-three-dimensional films with thicknesses over as the SkX is relatively unstable and observed only around the helical transition temperature. The room-temperature stable SkX state as promised by this study will pave a new path to designing quantum-effect devices based on the controllable skyrmion dynamics.

[One case of severely scalded patient with pneumonia and sepsis].

In February 2018, one 54-year-old male patient with severe scald complicated with pneumonia and sepsis was transferred to Qingdao Municipal Hospital from other hospital. Drugs including cephalosporin, vancomycin, and imipenem/cilastatin combined with ciprofloxacin were used successively for anti-infective treatment, with no obvious effect. Multiple bacterial culture results of sputum, blood, and wound exudate showed infection of extensively drug resistant Pseudomonas aeruginosa. On the 4th day of admission, the anti-infective treatment plan was adjusted, and plasma, red blood cell, and albumin were supplemented and nutritional support and symptomatic treatment were performed. At the same time, medication and drug-related adverse reaction were monitored. After treatment for more than 10 days, infection of the patient was effectively controlled and the condition gradually improved. The case suggests that severely burned patients are prone to have serious and fatal systemic infection, irregular use of antibiotics increases the risk of infection of extensively drug resistant bacteria, clear anti-infection idea and effective application of antibacterial drug can help to improve the success rate of infection treatment and are of important value in improving the prognosis of patients with severe burn.

[Standardization and application on ribotyping library of Clostridioides difficile in China].

Objective: To establish a standard operation procedure (SOP) for ribosome genotyping (ribotyping) on Clostridioides (C.) difficile, supplement and verify ribotyping typing library, so as to improve the comparability of data between different laboratories and to develop surveillance network of C. difficil in China. Methods: Molecular typing of 54 reference strains from the United States and Europe of C. difficile were performed by using the SOP referencing correspondence from abroad and from our laboratory with a BioNumerics 7.6 software to estimate the reference library of types of C. difficile. Identification of 374 clinical and animal isolates of C. difficile from 13 cities in China between 2010 and 2018, to supplement the library information. Kappa test was used to evaluate the consistency. Results: Results of capillary electrophoresis of reference strains appeared clear and stable, which guaranteed the clustering results being fast and accurate. Results from the supplementary typing showed that there were 84 types of isolates, of which 25 RT types were consistent with reference strains from abroad, while 58 RT types were different from referenced types. In the 40 referenced types, 15 RT types were not found in this study. In the consistency evaluation, the Kappa value was 0.891 and (P<0.01), showing the two Molecular typing as consistent and with close resemblance. Conclusions: The result of capillary electrophoresis by applying SOP for ribotyping on C. difficile base on QIAxcel capillary electrophoresis system, appeared clear and stable. The standardized library seemed more easily used for comparability and data sharing between the laboratories.

Study on the effect of different doses of rosuvastatin on ventricular remodeling in patients with acute coronary syndrome after emergency percutaneous coronary intervention.

OBJECTIVE: The objective of the present study was to observe the effects of different doses of rosuvastatin on cardiac protection in patients with acute coronary syndrome (ACS) after stent implantation. PATIENTS AND METHODS: A total of 137 patients with ACS were selected from March 2014 to January 2015 and randomly divided into: 1. The conventional treatment group: 45 patients were treated with conventional drugs such as aspirin, clopidogrel, nitrates, and a ß-blocker; 2. The conventional rosuvastatin dose group: 45 patients received 10 mg/d rosuvastatin before sleep in addition to routine therapy; 3. The large rosuvastatin dose group: 47 patients received 20 mg/d rosuvastatin before sleep in addition to routine therapy. The course of treatment was 12 weeks. At 1, 6, and 12 week, ultrasound echocardiography, electrocardiogram (ECG), high-sensitivity C-reactive protein (hs-CRP), and pro-brain natriuretic peptide (pro-BNP) levels were tested to evaluate the therapeutic effects. The ultrasonic imaging criteria included left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), and left ventricular ejection fraction (LVEF). RESULTS: After 1 week, hs-CRP, pro-BNP, and echocardiography of the patients in the three groups showed no significant differences (p>0.05); after 6 and 12 weeks, the levels of hs-CRP, MMP-9, and pro-BNP in the large rosuvastatin dose group were significantly lower than in the conventional rosuvastatin dose group and conventional treatment group (p<0.05), and ultrasonic indexes changed significantly after 12 weeks (p<0.05). There were no significant differences in ultrasonic indexes after 6 weeks (p>0.05). No thrombosis or restenosis occurred during the follow-up period in each group. CONCLUSIONS: Three months after emergency percutaneous coronary intervention, a high-dose of rosuvastatin can delay ventricular remodeling, effectively inhibit malignant remodeling of the heart, improve left ventricular systolic function, reduce the prevalence of adverse events, and significantly improve the long-term prognosis.

[Comparative study of core needle biopsy and fine needle aspiration cytology in the diagnosis of neck lymph node diseases with contrast-enhanced ultrasound].

OBJECTIVE: To compare the efficacies of core needle biopsy and fine needle aspiration cytology in the diagnosis of neck lymph node diseases with contrast-enhanced ultrasound. METHODS: A total of 105 patients with enlargement cervical lymph nodes were randomly divided into two groups, 49 in group A and 56 in group B. All patients were firstly examined with contrast-enhanced ultrasound to determine the targeted lymph node and the puncture point. Core needle biopsy was performed in Group A and tissues were fixed by with 10% formaldehyde; Fine needle aspiration cytology was performed in Group B and extracts were smeared and fixed with 95% alcohol. RESULTS: The success rates of sampling were 100.0% in group A and 96.4% in group B. The positive rates of pathological examinations were 97.9% in group A; and 82.1% in group B, with a significant difference between two groups (χ(2) = 6.97, P<0.05). CONCLUSION: The pathologically positive rates of core needle biopsy is higher than that of fine needle aspiration cytology for the diagnosis of neck lymph node diseases with contrast-enhanced ultrasound.

Randomized study of chemoembolization as an adjuvant therapy for primary liver carcinoma after hepatectomy.

From April 1990 to December 1993, 140 patients were recruited to a randomized study to evaluate transcatheter hepatic arterial chemoembolization (TACE) as an adjuvant therapy for primary liver carcinoma after hepatectomy. This study investigated the principle, techniques and results of TACE. The results showed that the intrahepatic recurrence rate was 48.9% in the patients who underwent radical resection only, but only 21.3% in the patients who also underwent TACE 3-4 weeks after hepatectomy (P < 0.01). The 1-, 2-, 3-, and 4-year survival rates were 72.3%, 52.7%, 35.1%, and 35.1% respectively for the patients who underwent radical resection only, and were 97.9%, 85.5%, 69.5%, and 56.9% for the patients who also underwent TACE 3-4 weeks after radical resection (P < 0.001). The 1-, 2-, 3-, and 4-year survival rates were 38.9%, 0%, 0%, and 0% for the patients who underwent palliative resection only, and were 68.3%, 32.3%, 21.5%, and 21.5% respectively for the patients undergoing TACE 3-4 weeks after palliative hepatectomy (P < 0.001).

Loss of pigment epithelium derived factor expression in glioma progression.

BACKGROUND: Pigment epithelium derived factor (PEDF) was first isolated from medium conditioned by human fetal retinal pigment epithelial cells. PEDF was detected in a broad range of human fetal and adult tissues including almost all brain areas. It can also inhibit the proliferation of cultured rat astrocytes. Recent studies have implicated PEDF in activities that are inhibitory to angiogenesis. AIMS: To investigate the expression of PEDF in gliomas to assess its "gliastatic" effects and its role in anti-angiogenesis. METHODS: PEDF mRNA values were measured by quantitative real time reverse transcription polymerase chain reaction (RT-PCR) analysis of normal brain tissue and tumour specimens from both low and high grade gliomas. In addition, immunohistochemical staining for PEDF and vascular endothelial growth factor (VEGF) was performed on 32 paraffin wax embedded glioma samples, 10 of them grade IV, 10 grade III, seven grade II, and five grade I. RESULTS: RT-PCR showed that PEDF mRNA values were 5.0 (p < 0.001) and 15.4 (p < 0.001) times higher in normal human brain specimens (n = 5) than in tumour tissue specimens of low grade glioma (grades I and II; n = 15) and high grade glioma (grades III and IV; n = 10), respectively. VEGF was strongly positive in 90% of grade IV, 70% of grade III, 43% of grade II, and 20% of grade I cases. In contrast, PEDF was positive in none of grade IV, 20% of grade III, 43% of grade II, and 60% of grade I tumours. There was an inverse correlation between VEGF and PEDF expression, and a lack of PEDF in advanced grade gliomas. CONCLUSIONS: It is possible that the absence of PEDF expression is a potent factor for the enhancement of angiogenesis in glioma.

Genetic polymorphism of the accessory gene regulator (agr) locus in Staphylococcus epidermidis and its association with pathogenicity.

Staphylococcus epidermidis has become one of the most important causes of nosocomial infections in recent years. The staphylococcal accessory gene regulator (agr) is the most important locus responsible for the regulation of virulence factors, and it has been shown to be polymorphic. The aim of this study was to investigate the agr locus and its genetic polymorphisms in different Chinese S. epidermidis isolates and the relationship between genetic polymorphisms and pathogenicity. Specific PCR was used to amplify the different agr groups. Results were confirmed by restriction enzyme digestion and sequence analysis. agr mutations were detected and three agr groups of S. epidermidis were determined. Of the isolates, 12 % were pathogenic S. epidermidis and 17 % had naturally occurring agr mutations (P > 0.05). Pathogenic S. epidermidis isolates comprised 68.2 % agr group I, 19.3 % group II and 12.5 % group III, while isolates from healthy controls comprised 39 % agr group I, 51 % group II and 10 % group III (P < 0.01). The percentages of agr locus mutants and the three agr groups in different hospitals showed no significant differences (P > 0.05). The percentage of agr group I S. epidermidis isolated from catheters and blood was higher than that isolated from the other clinical specimens. This is the first study to investigate the genetic polymorphism of agr in S. epidermidis in China. The mean percentage of agr locus mutants was 14.9 % (12 % in clinical specimens; 17.7 % in controls). Genetic polymorphism of agr in S. epidermidis was linked to its pathogenicity; group I was associated with pathogenicity, while most isolates from healthy subjects were group II. The mechanism is to be investigated.

On the interaction of alpha-crystallin with membranes.

The interaction of human and bovine alpha-crystallins with bovine lens membranes was evaluated using binding curves and Scatchard plots constructed from scans of SDS-PAGE gels and/or from the association of [14C]-leu alpha-crystallin with the membranes. No differences were observed for total bovine, normal human 19 and 88 year old and cataractous alpha-crystallins. In each case, interaction takes place through two distinct processes, a) a high affinity (Kd = 1 x 10(-8) M) binding with low capacity (25 mg alpha-crystallin/g membrane protein) and b) partitioning (Kp = 0.25 l/g membrane protein). Loss of the high-affinity binding component was observed for bovine nuclear alpha-crystallin. Contrary to previous reports, it is concluded that cataract formation does not affect the ability of human alpha-crystallins to interact with bovine lens membranes. Reanalysis of previously published data supports this conclusion.

Effects of calcitonin gene-related peptide on bone resorption mediated by interleukin-1.

We examined the effects of calcitonin gene-related peptide CGRP on the bone resorption stimulated by IL-1 alpha after neonatal mouse calvaria were cultured in vitro and bone resorption was determined by measuring the release of calcium into the medium after alpha 48-hour incubation. CGRP (10(-9)-10(-8) M) blocked completely the IL1 alpha-mediated increase in bone resorption and inhibited the basal bone resorption. In accordance with the effects of calcitonin on osteoclasts, CGRP caused cessation of lamellipodia activity and gradual retraction of lamellipodia when added into the culture medium. Quantitative analysis showed that CGRP (10(-6) M) caused a gradual reduction of osteoclastic surface area and convex perineum. These data show that CGRP inhibits IL1 alpha mediated bone resorption because of its direct regulation of osteoclast activity.

Effects of parathyroid hormone and estradiol on proliferation and function of human osteoblasts from fetal long bone. An in vitro study.

The effect of parathyroid hormone (PTH) (0.01 nM-10 nM) and 17 beta-estradiol (E2, 1 nmol-10 nM) alone or in combination on 3H-thymidine incorporation, alkaline phosphatase and adenylate cyclase activities were investigated in human fetal osteoblasts using serum-free monolayer primary cultures. The results showed that PTH inhibited cell proliferation while E2 promoted it. On alkaline phosphatase activity, PTH showed a complex results while E2 were slightly inhibitory. PHT-E2 combination suggested that E2 could alter the effect of PTH alone, also potentiated the anabolic and antagonize the catabolic effects of PTH on bone formation.

[Nuclear morphometry and DNA cytometry in the grading of malignant tumors of the salivary gland].

Nuclear morphometry and DNA cytometry were performed in 6 normal salivary glands and 37 malignant tumors of the salivary gland. Multivariate discrimination analysis was used to grade the malignant salivary gland tumors. The discrimination rate was 100% for normal salivary gland, benign tumor, high malignant carcinoma and low malignant carcinoma. It was 66.7% for borderline malignancies. These results indicate that quantitative cytological analysis is effective and reproducible in the grading of salivary gland tumors. Stepwise multivariate regression analysis showed that there was a very complicated correlation between DNA content and nuclear morphometric parameters of salivary gland tumors.

[Evaluation of chemoembolization as an adjuvant therapy for primary liver carcinoma after surgical resection].

In order to decrease the intrahepatic recurrence rate after surgical resection of hepatoma, from October 1989 to December 1992, 219 patients were recruited to a prospective trial to evaluate transcatheter hepatic arterial chemo-embolization (TCE) as a postoperative adjuvant therapy for primary liver carcinoma. These patients who underwent radical or palliative resection were divided into 3 groups: (1) Resection of tumor; (2) TCE three to four weeks after resection; (3) Relapse after resection plus TCE. This study presented the principle, techniques and results of TCE. The intrahepatic recurrence rate was 58.6% in group I and 9.5% in group II (P < 0.001). The 1-, 2-, 3-year-survival rates were 67.2%, 52.0%, 42.8% of the patients in group I, while 95.2%, 84.7%, 67.7% in the patients in group II (P < 0.05). The 1-, 2-, 3-year-survival rates were 21.5%, 0%, 0% of the patients who underwent palliative. resection only, while 66.7%, 41.7% of the patients in group III (P < 0.001). Taken together, adjuvaut chemoembolization helps decrease the recurrence rate and increase the survival rate in patients with primary liver cancer treated with surgical resection.