Safety assessment of Acori Tatarinowii Rhizoma: acute and subacute oral toxicity.

Introduction: Acori Tatarinowii Rhizoma (ATR) is a well-known traditional Chinese medicine that is used for treating neuropathic diseases. However, there is little information about the safety of ATR. Methods: The present study evaluated the acute and subacute oral toxicity of a water extract of ATR in Institute of Cancer Research (ICR) mice. In acute trials, a single administration of extract at a dose 5,000 mg/kg body weight led to no clinical signs of toxicity or mortality, indicating that the lethal dose (LD50) exceeded 5,000 mg/kg. A subacute toxicity test was done using daily doses of 1,250, 2,500, and 5,000 mg/kg of the ATR extract for 28 days, which did not show any adverse clinical symptoms or mortality. However, the male renal organ index and urea level in mice given 5,000 mg/kg was obviously abnormal, which was consistent with pathological results and suggested that this dose might cause kidney injury. Results: Doses of ATR lower than 2,500 mg/kg could be regarded as safe, although the potential cumulative effects of long-term use of high doses of ATR need to be considered. Discussion: The study highlights the function of ATR in reducing blood lipids and provides a new idea for its widespread clinical use in the future.

Association of carbohydrate intake from different sources with all-cause and cardiovascular mortality among chronic kidney disease populations: assessment of 1999-2018 National Health and Nutrition Examination Survey participation.

This study analysed the data from the NHANES (1999-2018) to examine how different sources of carbohydrate intake affected the all-cause and cardiovascular mortality of 11,302 chronic kidney disease (CKD) patients. The data were adjusted for other factors using various methods. The results showed that CKD patients (stages 1-2 and 3-5) who consumed more carbohydrates from whole grains, fruits, vegetables and less carbohydrates from fruit juice or sauces had lower mortality rates. Replacing fat intake with carbohydrates from whole grains (HR = 0.86[0.78-0.95]), fruits (raw) (HR = 0.79[0.70-0.88]) and non-starchy vegetables (HR = 0.82[0.70-0.96]), but not protein intake, was linked to lower all-cause mortality. The fibre content in carbohydrates might partly account for the benefits of selected carbohydrate intake. This study provided practical recommendations for optimising the carbohydrate sources in CKD patients.

Pollution characteristics and health risk assessment of phthalate esters in agricultural soil of the Yellow River Delta, China.

A total of 100 agricultural soil samples, collected in the Yellow River Delta, China, were analyzed for six U.S. Environmental Protection Agency priority phthalate esters (PAEs), focusing on the characteristics of PAEs contamination and potential health risks. The detection frequencies of ∑6PAEs were 100%, where the concentration ranged from 1.087 to 14.391 mg·kg-1, with a mean value of 4.149 mg·kg-1. The most abundant PAEs were di(2-ethylhexyl) phthalate (DEHP) and di-n-butyl phthalate (DnBP). The areas with higher contents of ∑6PAEs are distributed in the western and central parts of the Yellow River Delta region and around Laizhou Bay. PAEs in the Yellow River Delta agricultural soil were attributed to pollutant emissions from petrochemical industries, plasticizers or additives, fertilizers, and pesticides. The non-carcinogenic risk of human exposure to PAEs in agricultural soils is relatively low, but the non-carcinogenic risk is higher in children than in adults, and children are a sensitive group. Under the dietary route, both DEHP and ∑2PAEs (BBP, and DEHP) pose some degree of carcinogenic risk to both local adults and children. Efforts must be made to enhance the prevention and control of PAEs contamination of agricultural soils in the Yellow River Delta region to reduce the potential risk to humans.

The burden of the current curative expenditure of injury in Dalian, China-a study based on the "system of health accounts 2011".

BACKGROUND: Injury is one of the major public health problems and causes more than 5 million deaths in the world annually. Cases of specific types of injury are life-threatening and heavily-burdened to individuals and society. This study was aimed to assess the financial burden of injury on patients. METHODS: A total of 565 medical institutions were selected with multistage stratified cluster random sampling, containing 152,553 valid samples. Subsequently, the distribution of injury current curative expenditure (CCE) in different dimensions (including age and site of injury) was analyzed under the framework of System of Health Accounts 2011 (SHA 2011) using the established database. RESULTS: In China, both urban and rural injury mortality rates showed an upward trend of more than 5 percentage points from 2006 to 2016. In Dalian, the CCE of injury reached 1572.73 million RMB, accounting for 7.45% of the total CCE. Those aged 15-24 reported larger proportion of CCE than the other age groups. As for the injuries in body parts, injuries occurred to the spine, lower limb, head and foreign body cost most. CONCLUSIONS: Dalian has a relatively serious burden of injury costs. The essential and primary goal is to reduce the cost. Young people should pay attention to protect their head and limbs from injury, and related government sectors should implement preventive and educative measures.

[Distribution, Sources, and Risk Assessment of Polycyclic Aromatic Hydrocarbons (PAHs) in Tributary Waters of the Lower Reaches of the Yangtze River, China].

The lower reaches of the Yangtze River are a typical gathering place of chemical industrial parks in China. Polycyclic aromatic hydrocarbons (PAHs) emitted in the production process of chemical enterprises enter the tributary water body through atmospheric deposition and surface runoff, and finally merge into the Yangtze River. In this study, the distribution characteristics, source analysis, and ecological risk assessment of PAHs in a series of typical water samples collected in the tributary waters of the Yangtze River were studied. PAH monomers in the samples were mainly low-ring. The total concentration of PAHs was in the range of 37.27 to 285.88 ng·L-1 with a mean value of 78.31 ng·L-1, while the monomer concentration of PAHs ranged from 0 to 61.35 ng·L-1. The lowest detection rate was benzo[k] fluoranthene and benzo[a] pyrene at 75%. As a toxic PAH monomer, the concentration of benzo[a] pyrene ranged from 0 to 11.08 ng·L-1. According to "Water Quality Standards for Drinking Water Sources (CJ 3020-1993)" of China, the concentration of benzo[a] pyrene in a water sample (S12) located near Wuxi City exceeded the limit of drinking water standards (10 ng·L-1). Compared with the total concentration of PAHs in rivers in some typical regions of the world, the concentration of PAHs in this study was generally at low to moderate levels. According to the source analysis results of the ratio method and principal component analysis, the concentration of PAHs in water was mainly affected by fossil combustion, automobile exhaust, and chemical emissions. To assess the potential ecosystem risk of PAHs in the investigated area, the risk quotient (RQ) was used. In addition to the DBA monomer, the relative quantities (RQs) (replication) of the remaining monomers were greater than 1, and the RQ (MPCs) values in all the monomers were less than 1, indicating that the ecological risk of water samples was at a medium level. From the perspective of long-term environmental exposure, appropriate control measures should be considered to prevent further pollution. The results can provide reference for PAH risk assessment and pollution control of chemical industrial parks in the lower reaches of the Yangtze River.

Performance of a machine learning-based decision model to help clinicians decide the extent of lymphadenectomy (D1 vs. D2) in gastric cancer before surgical resection.

BACKGROUND: Controversy still exists on the optimal surgical resection for potentially curable gastric cancer (GC). Use of radiologic evaluation and machine learning algorithms might predict extent of lymphadenectomy to limit unnecessary surgical treatment. We purposed to design a machine learning-based clinical decision-support model for predicting extent of lymphadenectomy (D1 vs. D2) in local advanced GC. METHODS: Clinicoradiologic features available from routine clinical assignments in 557 patients with GCs were retrospectively interpreted by an expert panel blinded to all histopathologic information. All patients underwent surgery using standard D2 resection. Decision models were developed with a logistic regression (LR), support vector machine (SVM) and auto-encoder (AE) algorithm in 371 training and tested in 186 test data, respectively. The primary end point was to measure diagnostic performance of decision model and a Japanese gastric cancer treatment guideline version 4th (JPN 4th) criteria for discriminate D1 (pT1 + pN0) versus D2 (≥ pT1 + ≥ pN1) lymphadenectomy. RESULTS: The decision model with AE analysis produced highest area under ROC curve (train: 0.965, 95% confidence interval (CI) 0.948-0.978; test: 0.946, 95% CI 0.925-0.978), followed by SVM (train: 0.925, 95% CI 0.902-0.944; test: 0.942, 95% CI 0.922-0.973) and LR (train: 0.886, 95% CI 0.858-0.910; test: 0.891, 95% CI 0.891-0.952). By this improvement, overtreatment was reduced from 21.7% (121/557) by treat-all pattern, to 15.1% (84/557) by JPN 4th criteria, and to 0.7-0.9% (4-5/557) by the new approach. CONCLUSIONS: The decision model with machine learning analysis demonstrates high accuracy for identifying patients who are candidates for D1 versus D2 resection. Its approximate 14-20% improvements in overtreatment compared to treat-all pattern and JPN 4th criteria potentially increase the number of patients with local advanced GCs who can safely avoid unnecessary lymphadenectomy.

Serological Assessment of the Quality of Wound Healing Processes in Crohn's Disease.

BACKGROUND AND AIMS: Crohn's disease (CD) is a chronic inflammatory condition characterized by continuous mucosal damage and ongoing wound healing of the intestines. The fibrinolytic system is involved in early parts of the wound healing process. Fibrin is a key mediator of primary blood clot formation and is formed by cross-linking of fibrinogen. To gain insights into the dynamics of wound healing in CD patients we investigated the conversion of fibrinogen into fibrin by the pro-peptide FPA, the amount of factor XIII cross-linked fibrin and total fibrin clot. METHODS: Serum samples of 35 CD patients, 15 non-inflammatory bowel disease (non-IBD) patients and 39 age-matched healthy controls were analyzed for three novel neo-epitope markers: D-fragment and D-dimer, reflecting the degradation of total fibrin clot and factor XIII cross-linked fibrin, as well as FPA, reflecting synthesis of fibrin. RESULTS: Crohn's disease patients had a significantly lower D-dimer level (p=0.0001) compared to healthy controls. Crohn's disease and non-IBD patients had a significantly higher level of FPA (p<0.0001) and D-fragment/D-dimer ratio (p<0.0001 and p=0.02). FPA, D-dimer and D-fragment/D-dimer ratio could distinguish CD patients from healthy controls with area under the curve of 0.92 (95% CI 0.83-0.97), 0.78 (95% CI 0.67-0.87) and 0.85 (95% CI 0.75-0.93), respectively. CONCLUSION: Wound healing parameters were clearly changed in CD patients. FPA levels were higher in CD patients as compared to healthy controls, indicating more ongoing wound healing. D-dimer levels were lower in CD patients than in healthy controls, indicating impaired wound healing due to poor quality of factor XIII cross-linked fibrin and clot resolution.

An evaluation of clinical pharmacist service on a neurology care unit.

BACKGROUND: Medications used to treat neurological diseases may result in adverse effects. Research is needed to demonstrate pharmacist value and their roles in patient care. OBJECTIVE: To categorize the types and severities of the prescribing errors intercepted and to describe clinical activities conducted by neurology ward pharmacists. METHOD: Pharmacists prospectively reviewed medication orders over an 18-month period with inventions documented and categorized. RESULTS: A total of 341 prescribing errors in 1183 patients were intercepted. The most common error types were dosing frequency (35.8 %) and medication selection (21.5 %). The top five most detected error medications were those indicated for hyperhomocysteinemia (22.0 %), stress ulcer prophylaxis (12.3 %), poor circulation (10.9 %), hyperglycemia (6.5 %), and infections (5.9 %). Although 67.5 % of the detected errors having the potential causing no harm, 26.4 % of the errors may require intervention, and 6.2 % may increase the length of stay. The number of errors decreased from 19 to 10 per month during the study period. Clinical pharmacists also actively engaged in medication use evaluation, clinical decision support system optimization, and education to patients and providers. CONCLUSION: Presence of clinical pharmacists at the neurology unit may help in early detection of prescribing errors with increased patient safety.

Toxicity reduction in an industrial nitro-aromatic wastewater plant: an assessment and a proposed improvement.

In this study, the performance of a typical Chinese industrial nitro-aromatic wastewater project (operational capacity: 3,000 m(3)d(-1)) was evaluated using chemical properties and toxicity data. Additionally, the relationship between the removal of organic pollutants and toxicity reduction was investigated throughout the whole-process wastewater treatment. Current advanced treatment reduced the dissolved organic carbon by 40% compared with biologically treated wastewater effluent (BTWE), but the acute toxicity and early life-stage toxicity increased significantly. For instance, the acute toxicity of the current advanced treated wastewater was 450% greater than that of the untreated BTWE. With the aim of effectively decreasing the toxicity of the effluent, several efficient adsorption technologies were assessed and compared for further treatment of BTWE. Coagulation and/or oxidation coupled with activated carbon adsorption, hypercrosslinked resin adsorption, or MIEX(®) technology was helpful for improving chemical indices and reducing toxicity. Among these adsorption treatment technologies, hypercrosslinked resin adsorption was more effective at removing most of the toxicants than MIEX(®) technology, and it also had better regeneration efficiency and mechanical properties compared with activated carbon. Therefore, hypercrosslinked resin adsorption may be a promising technology for enhancing organic pollutant removal and toxicity reduction of BTWE from nitro-aromatic factories.

Clinical features and mismatch repair genes analyses of Chinese suspected hereditary non-polyposis colorectal cancer: a cost-effective screening strategy proposal.

China has the largest numbers of hereditary non-polyposis colorectal cancer (HNPCC) patients based on its population of 1.4 billion. However, the clinical data and mismatch repair (MMR) gene analyses have been limited. Here we performed microsatellite instability (MSI) and immunohistochemistry (IHC) analyses on a series of patients with a high-risk for HNPCC: 61 patients with family histories fulfilling Amsterdam criteria II (ACII-HNPCC) or suspected HNPCC criteria (S-HNPCC), and 106 early onset colorectal cancer (CRC) patients. Sixty late-onset CRC patients were used as control. Methylation of the hMLH1 promoter was analyzed on tumors lacking hMLH1 expression. MMR germ-line mutations were screened on patients with tumors classified as MSI-H/L or negative for IHC. We identified 27 germ-line MMR variants in the 167 patients with a high-risk for HNPCC while only one germ-line mutation in hMSH6 was found in the late-onset CRC group. Of those, 23 were pathogenic mutations. The high incidence of gastric and hepatobiliary cancers coupled with the increasing number of small families in China reduces the sensitivity (43.5%, 30.4%) and positive predictive value (PPV) (45.5%, 17.9%) of the ACII- or S-HNPCC criteria. MSI or IHC testing are highly sensitive in detecting pathogenic mutations (sensitivities = 91.3% and 95.6%, respectively), but the PPVs are quite low (25.6% and 27.8%, respectively). Considering that all 12 tumors with pathogenic mutations in hMLH1 also showed promoter unmethylation, the sensitivity of IHC in conjunction with hMLH1 promoter methylation analysis is not reduced, but the PPV was increased from 27.8% to 61.1%, and the total cost was greatly reduced.

A novel, cheap and effective fusion expression system for the production of recombinant proteins.

To develop faster, less expensive methods for expression and purification of proteins, the annexin B1-intein fusion expression system was constructed. The interest proteins fused to the annexin B1-intein tag were purified in a single-step method based on the Ca(2+)-binding activity of annexin B1, and the annexin B1-intein fusion tag was removed based on the self-cleaving activity of the intein. Moreover, we found that in some cases, fusion to annexin B1 can promote the solubility of heterologous proteins. The production of soluble and highly active of interleukin-2 and low-molecular single-chain urokinase in our results proved that the system was a novel, cheap and effective fusion expression system for the production of valuable soluble recombinant proteins in Escherichia coli.