Elevated D-Dimer Combined with Persistent Acupuncture-like Chest Pain in An Elderly Patient Misdiagnosed as Pulmonary Embolism Finally Proved as Lung Hamartoma with Secondary Lung Infection by Bronchoscopy Biopsy: a Case Report and Literature Review.

BACKGROUND: Pulmonary hamartoma is one of the most common benign tumors of the lung, the symptoms are often atypical, so its diagnosis is not so easy. We presented an elderly man with elevated D-dimer combined persistent acupuncture-like chest pain misdiagnosed as pulmonary embolism finally proved as lung hamartoma with secondary lung infection by bronchoscopy biopsy. METHODS: Appropriate laboratory tests were carried out. The chest computed tomography (CT) scan and bronchoscopy were performed for diagnosis. RESULTS: Laboratory tests showed D-dimer was 2,615.88 ng/mL, the chest CT scan showed the right lung portal occupying lesions accompanied by obstructive changes in the middle of the right lung and mediastinal lymphade-nopathy with partial calcification. Bronchoscopy showed the new spherical neoplasm in the middle of the right lung completely blocked the opening of the bronchus, the surface of the neoplasm was smooth and blood vessels were abundant, pathological result was lung hamartoma. CONCLUSIONS: Elevated D-dimer is not a specific index of pulmonary embolism. When a patient's D-dimer rise combined with severe chest pain, the physician should be wary of pulmonary embolism, myocardial infarction, aortic dissection, and other emergencies, and should also take into account serious infections, tumors, and other diseases. Diagnosis needs further related examination. Chest CT scan has guidance function, and when the chest CT scan suggests the occupying lesion, the pathology examination is the key to identify the benign tumor.

Effect of Ginkgo biloba extract on matrix metalloproteinase-3 expression in a rat model of chondrocyte injury.

A rat model with cartilage chondrocyte injury was established using interleukin-1ß (IL-1ß) to investigate the effect of Ginkgo biloba extract (EGb) on matrix metalloproteinase-3 (MMP-3) expression. Rat chondrocytes were extracted and randomly divided into six groups: control group, IL-1ß (model) group, IL-1ß + dexamethasone group, and IL-1ß + EGb group (both high and low dose groups). Reverse transcriptase polymerase chain reaction and enzyme-linked immunosorbent assay were used to detect MMP-3 expression. Compared to the MMP-3 mRNA level in the control group, MMP-3 mRNA level significantly increased in the model group (P < 0.05). The application of dexamethasone or EGb significantly decreased the MMP-3 mRNA level (P < 0.05). MMP-3 mRNA and protein levels decreased in the EGb-treated group, especially in the high-dose group, compared to those in the dexamethasone group (P < 0.05). EGb may reduce MMP-3 production during IL-1ß-induced chondrocyte damage and protect chondrocytes to some extent, with better efficacy at high doses.

Protective effects of sodium p-aminosalicylic acid on learning and memory via increasing the number of basal forebrain choline acetyltransferase neurons in manganese-exposed rats.

This study was conducted to investigate the protective effects of sodium p-aminosalicylic acid (PAS-Na) on learning and memory via increasing the number of basal forebrain choline acetyltransferase (ChAT) neurons in manganese (Mn)-exposed rats. Male Sprague Dawley rats were divided into following groups: the normal control I, II, and III groups, the model I, II, and III groups, low- and high-dose PAS-Na treatment (L- and H-PAS) group, PAS-Na prevention (PAS-P) group, and PAS-Na treatment (PAS-T) group. The model I, II, and III groups, L- and H-PAS, and PAS-T groups received intraperitoneal (i.p.) injection of 15 mg/kg manganese chloride tetrahydrate (MnCl2·4H2O) for 3 or 12 weeks, while the normal control I, II, and III groups received i.p. injection of an equal volume of saline; L- and H-PAS and PAS-T groups received back subcutaneous (s.c.) injection of PAS-Na (100 and 200 mg/kg) for the next 5 or 6 weeks, whereas model I and II group received back s.c. injection of an equal volume of saline. However, PAS-P group received back s.c. injection of 200 mg/kg PAS-Na + i.p. injection of 15 mg/kg MnCl2·4H2O for 12 weeks. Mn exposure significantly reduced the ability of spatial learning and memory capability, while PAS-Na prevention recovered it. Mn decreased the number of ChAT-positive neurons in vertical limb nucleus of the basal forebrain diagonal band/horizontal limb nucleus of the basal forebrain diagonal band and ChAT protein activity and treatment or prevention with PAS-Na restored those comparable with control. In brief, our results showed that PAS-Na may have protective effects on learning and memory against Mn via increasing the number of ChAT-positive neurons and activity of ChAT protein.

Nutritional status of the elderly in rural North China: a cross-sectional study.

OBJECTIVES: This study aimed to describe the nutritional status of elderly people living in a rural area of North China. DESIGN: Community-based, cross-sectional prevalence survey. SETTING: 3 rural towns of Lvliang City, Shanxi Province, China. PARTICIPANTS: A sample of 1845 community residents (29.1% of those eligible) 55 years or older (birth before 1958-01-01). MEASUREMENTS: The participants were assessed regarding demographic characteristics, height, weight, as well as having a physical examination and blood sampling for serum cholesterol, total homocysteine (tHcy), folate, and vitamin B12 levels. RESULTS: 991 (53.7%) were female and 139 (7.5%) did not complete the anthropometric measurement. Prevalence of underweight and obesity was 3.5% and 24.9% in men and 6.7% and 31.0% in women (P = 0.003, P = 0.005, respectively). Prevalence of hypercholesterolemia and hypocholesterolemia was 13.5% and 52.6% in men and 25.0% and 34.3% in women (P < 0.001, P < 0.001, respectively). Prevalence of high LDL-c concentrations was 8.8% in men and 16.8% in women (P < 0.001). The mean serum tHcy in men (28.8 ± 20.1 µmmol/l) was significantly higher than in women (21.0 ± 15.1 µmmol/L, P < 0.001). Prevalence of hyperhomocysteinemia (defined as > 15µmmol/L) was 79.7% in men and 65.5% in women (P < 0.001). Prevalence of low folate (defined as < 11 nmol/L) and vitamin B12 levels (defiend as < 185 pmol/L) was 70.8 % and 76.8% in men and 56.5% and 72.6% in women (P < 0.001, P = 0.036, respectively). Correlation coefficients between tHcy, folate, and vitamin B12 indicated an inverse linear correlation (r = -0.21, P < 0.001, r = -0.35, P < 0.001, respectively). CONCLUSIONS: As China's economic climate has developed, the nutritional status of elderly people in the rural parts of the country has improved in some aspects. However, the trend toward obesity will lead to a shift in the burden of obesity-related chronic diseases. In addition, rurally-located elderly people are at high risk of death that may be associated with abnormal serum cholesterol. The data also suggest that severe deficiencies in folate and vitamin B12 levels exist, as well as there being a high prevalence of hyperhomocysteinemia. Folate and vitamin B12 supplementation are necessary to prevent related diseases.

In vitro induction of tetraploid garlic with trifluralin.

Garlic (Allium sativum) is propagated asexually. Since sexual cross breeding is almost impossible, means for effective breeding are not currently available and the available production cultivars are seriously aged and degenerated. A possible alternative for breeding is chemical induction. Trifluralin, a type of herbicide, has been reported to provoke chromosome doubling. However, this chemical had not been tested on garlic. We tested various trifluralin concentrations and treatment durations for efficiency in the induction of tetraploid garlic. A clove base of garlic with a stem cv. Gailiang was used as the ex-plant to induce calluses on Murashige and Skoog (MS) medium; the calluses were then inoculated onto MS medium containing different levels of trifluralin and cultured to induce chromosome number variation in vitro. Garlic calluses were effectively induced via the ex-plant and both shoots and roots differentiated well on MS medium containing 6-benzylaminopurine at 3.0 mg/L and indole-3-acetic acid at 0.1 mg/L. However, increases in trifluralin concentration and treatment duration reduced the survival rate and differentiation rate of calluses. Garlic callus cultured for 15 days on medium containing 100 µM trifluralin gave the highest rate of chromosome doubling. Through observation of chromosome number in the root apical cells and the morphology of guard cells on the leaf epidermis of the regenerated plantlets, it was clear that chromosome number variation was induced and tetraploids were produced in vitro by trifluralin treatment.

Photobiomodulation partially rescues visual cortical neurons from cyanide-induced apoptosis.

Near-infrared light via light-emitting diode treatment has documented therapeutic effects on neurons functionally inactivated by tetrodotoxin or methanol intoxication. Light-emitting diode pretreatment also reduced potassium cyanide-induced cell death, but the mode of death via the apoptotic or necrotic pathway was unclear. The current study tested our hypothesis that light-emitting diode rescues neurons from apoptotic cell death. Primary neuronal cultures from postnatal rat visual cortex were pretreated with light-emitting diode for 10 min at a total energy density of 30 J/cm2 before exposing to potassium cyanide for 28 h. With 100 or 300 microM potassium cyanide, neurons died mainly via the apoptotic pathway, as confirmed by electron microscopy, Hoechst 33258, single-stranded DNA, Bax, and active caspase-3. In the presence of caspase inhibitor I, the percentage of apoptotic cells in 300microM potassium cyanide was significantly decreased. Light-emitting diode pretreatment reduced apoptosis from 36% to 17.9% (100 microM potassium cyanide) and from 58.9% to 39.6% (300 microM potassium cyanide), representing a 50.3% and 32.8% reduction, respectively. Light-emitting diode pretreatment significantly decreased the expression of caspase-3 elicited by potassium cyanide. It also reversed the potassium cyanide-induced increased expression of Bax and decreased expression of Bcl-2 to control levels. Moreover, light-emitting diode decreased the intensity of 5-(and -6) chloromethy-2', 7-dichlorodihydrofluorescein diacetate acetyl ester, a marker of reactive oxygen species, in neurons exposed to 300 microM potassium cyanide. These results indicate that light-emitting diode pretreatment partially protects neurons against cyanide-induced caspase-mediated apoptosis, most likely by decreasing reactive oxygen species production, down-regulating pro-apoptotic proteins and activating anti-apoptotic proteins, as well as increasing energy metabolism in neurons as reported previously.

Immune reponses in human mesangial cells regulated by emodin from Polygonum hypoleucum Ohwi.

In the hope of identifying agents of therapeutic value in glomerulonephritis from Chinese herbs, we found that methanolic extracts of Polygonum hypoleucum Ohwi (P. hypoleucum Ohwi) inhibit human mesangial cells proliferation activated with interleukin-1beta (IL-1beta) and interleukin-6 (IL-6) previously. This study was designed to identify bioactive components from P. hypoleucum Ohwi and elucidate their action mechanisms. We tested four anthraquinones emodin, emodin 1-O-beta-D-glucoside (49A), physcion (62A), and physcion 1-O-beta-D-glucoside (50A) purified from P. hypoleucum Ohwi for their effects on human mesangial cell proliferation and cytokines production in vitro. On a percentage basis, emodin had the highest suppressing activity on the human mesangial cells proliferation activated by IL-1beta and IL-6. The IC50 of emodin on human mesangial cells proliferation were 17.9+/-1.2 microM. In contrast to 49A, 50A, and 62A, emodin also decreased IL-1beta, IL-6 and tumor necrosis factor-alpha (TNF-alpha) production in human mesangial cells activated with IL-1beta and IL-6. The IC50 of emodin on IL-1beta, IL-6 and TNF-alpha production in activated human mesangial cells were 16.6+/-1.8 microM, 8.2+/-1.3 microM, and 9.5+/-1.6 microM, respectively. Moreover, IL-1beta and TNF-alpha mRNA expression in activated human mesangial cells was impaired by emodin. The intracellular free Ca2+ concentration ([Ca2+]i) in IL-1beta and IL-6 activated human mesangial cells was decreased by emodin. It is unlikely that cytotoxicity was involved because no cell deaths were observable. We hypothesize that the inhibitory mechanisms of emodin on activated human mesangial cells proliferation may be related to the impairments of gene expression and production of cytokines and [Ca2+]i in the cells.

Otolith-activated vestibulothalamic neurons in cats.

The components of the vestibular ascending pathway that transmit otolith information to the thalamus were studied electrophysiologically in anesthetized cats. Thalamic-projecting vestibular neurons (confirmed antidromically) were recorded extracellularly in the various vestibular nuclei. Otolith inputs to these neurons were examined with selective stimulation of the utricular (UT) or the saccular (SAC) nerves. Vestibular nerve branches other than the tested nerve were transected. Of 40 UT-activated vestibulothalamic neurons, 40% (16/40) were activated by UT nerve stimulation with latencies ranging between 0.9-1.4 ms, suggesting they were second-order neurons from the UT nerve. UT-activated vestibulothalamic neurons were recorded in the medial vestibular nucleus (MVN; 24/40), the lateral vestibular nucleus (LVN; 9/40), the descending vestibular nucleus (DVN; 6/40), and the superior vestibular nucleus (SVN; 1/40). Most of the neurons (38/40) were antidromically activated by focal stimulation of the ventral part of the ipsilateral thalamus. Antidromic stimulation of the pontine area revealed that trajectories of the ascending axons (14 of 38 neurons) to the ipsilateral thalamus passed through the pontine reticular formation, ventral to the ascending tract of Deiters (ATD) and the medial longitudinal fasciculus (MLF). Only three SAC-activated vestibulothalamic neurons were encountered in the LVN. All these neurons were second-order neurons from the SAC nerve and were antidromically activated by stimulation of the contralateral thalamus, in marked contrast to the UT-activated vestibulothalamic neurons. Only three UT-activated and two SAC-activated neurons sent descending collaterals to the spinal cord.

[Study on effect of jinshui liujun jian oral liquid on serum superoxide dismutase activity and malonyldialdehyde content in mice with chronic bronchitis].

OBJECTIVE: To study the effect of Jinshui Liujun Jian Oral Liquid (JLJOL) on serum superoxide dismutase (SOD) activity and malonyldialdehyde (MDA) content in mice with chronic bronchitis. METHODS: JLJOL was given to the chronic bronchitis mice model (induced by smoking) through gastrogavage, and then SOD activity and MDA content were tested. RESULTS: SOD activity in model mice after JLJOL treatment was 0.67 +/- 0.15 NU/L, which was significantly higher than that in the untreated model (0.39 +/- 0.13 NU/L, P < 0.01). But the MDA content in treated mice was significantly lower than that in untreated one (9.26 +/- 2.90 nmol/L vs 16.07 +/- 5.62 nmol/L, P < 0.01). CONCLUSION: JLJOL could scavenge the injury of free radical on organism.

[Clinical and experimental study on jinshui liujun decoction in treating chronic bronchitis].

OBJECTIVE: To assess the effect of Jinshui Liujun decoction (JSL) in treating chronic bronchitis. METHODS: The effect of JSL on expelling the phlegm and strengthening the body resistance were observed. RESULTS: JSL was proved to be efficacious in improving immune function of the body and pulmonary ventilatory function (P < 0.01). JSL could not only increase the secretion of rats' trachea mucosa and dilute sputum, but also increase the motion speed of the pigeons' trachea cilia, thus facilitate the removal of sputum. Compared with the normal saline control group, both animal experiments displayed significant statistical difference (P < 0.01), but without significant difference when compared the JSL group with the positive drug Juhong Tanke Ye control group. CONCLUSION: JSL has the effect of resolving phlegm as well as improving human immunological and pulmonary ventilatory functions.

[Anti-inflammatory and anti-bacterial functions of bezoar antipyretic tablets].

Bezoar Antipyretic Tablets can inhibit markedly acute exudative inflammation. It can also inhibit markedly drug-resistant Staphylococcus aureus, etc. It has no influence on Bacillus pyocyaneus, etc.

Comparison of the clinical and biochemical effect of increased alpha-linolenic acid in a safflower oil intravenous fat emulsion.

We report the results of a randomized comparison of two intravenous safflower oil (fat) emulsions in neonates who required total parenteral nutrition. The fat emulsions differed only in their content of alpha-linolenic acid: in one emulsion the alpha-linolenic acid content of the oil was 0.1% of fatty acids, while in the other emulsion the alpha-linolenic acid content of the oil was 3.0 +/- 1.5% (SD) of fatty acids. Group 1 and 2 patients received the "low" and "high" alpha-linolenic acid emulsions, respectively. Ten patients were studied in each group. The mean daily fat dosage was 1.70 g/kg in patients of Group 1 and 1.56 g/kg in those of Group 2. No significant difference in the clinical effects of either fat emulsion could be detected between the two study groups. Both emulsions prevented or corrected biochemical signs of essential fatty acid deficiency. The major statistically significant difference between study groups was in the level of alpha-linolenic acid and its metabolite, eicosapentaenoic acid. After 2 weeks of fat therapy, these fatty acids were increased in the high alpha-linolenic acid group; however, another metabolite of linolenic acid, docosahexaenoic acid, decreased during intravenous fat therapy in both study groups. Both study groups had significantly decreased arachidonic acid levels and increased linoleic to arachidonic acid ratios.

Parenteral safflower oil emulsion (Liposyn 10%): safety and effectiveness in treating or preventing essential fatty acid deficiency in surgical patients.

The safety and effectiveness of a 10% safflower oil emulsion in treating or preventing essential fatty acid deficiency was tested in a prospective study of 15 surgical patients requiring total parenteral nutrition for two to four weeks. Three dosage regimens were evaluated including: Group I: 4% of calories as linoleate daily (five patients), Group II: 4% of calories as linoleate every other day (two patients), and Group III: 8% of calories every other day (eight patients). Patients were monitored for laboratory changes from baseline specifically in those areas where previous fat emulsions have caused serious deviations. No significant changes were noted in hematologic parameters, coagulation studies, cholesterol and triglyceride serum levels. Although there were sporadic mild deviations in liver function changes in several patients, no clinically significant adverse effects could be directly attributed to infusion of the fat emulsion. Three patients had baseline triene/tetraene ratios of 0.4 or greater, indicative of essential fatty/acid deficiency, and these ratios dropped to less than 0.4 within eight days of beginning therapy with the parenteral fat emulsion. The remaining 12 patients maintained a normal triene/tetraene ratio of less than 0.4 throughout the 28 day study period. All three dosage regimens were considered effective for treatment and prevention of essential fatty acid deficiency.

Vitamin requirements in patients receiving total parenteral nutrition.

This study represents an initial attempt to define intravenous vitamin requirements in adult patients receiving total parenteral nutrition (TPN). We have investigated two different vitamin formulations for their ability to maintain normal circulating blood levels of vitamins A, C, E, B12, folic acid and riboflavin. Administration of 1.1 ml of Multi-Vitamin Infusion (MVI) solution supplemented with 100 microgram of folic acid, 10 microgram of vitamin b12, and 100 mg of vitamin C, per liter of TPN infusate (patients received an average of about 3 liters/day), maintained normal or higher than normal levels of vitamins C, B12, and riboflavin, but resulted in less-than-normal levels of vitamins A, E, and folic acid. Increasing the amount of MVI to 1.4 ml and the folic acid to 200 microgram, and decreasing the ascorbic acid to 70 mg and vitamin B12 to 5 microgram/liter of TPN infusate, resulted in normal blood levels of all tested vitamins within two weeks after initiating TPN therapy, and normal blood levels were then maintained at this dosage for additional periods of time up to three weeks.

The use of a crystalline amino acid mixture for parenteral nutrition in low-birth-weight infants.

Thirty-six preterm, sick, low-birth-weight neonates were given either total or partial parenteral nutrition. The patients were divided into three groups according to their birth weights: group A -less than 1,000 gm, 12 patients: group B--between 1,000 and 1,500 gm, 15 patients: group C--more than 1,500 gm, 9 patients. The solution for total parenteral nutrition contained 20% glucose and 2.6% crystalline amino acids plus appropriate amounts of vitamins and minerals. The volume of infusate given was usually 125 ml/kg/day, but varied depending on the clinical condition of the patient; occasionally it was as high as 150 to 175 ml/kg/day. Infusate of one-half strength was administered initially; its concentrations of glucose and amino acids were increased to three quarters and full strength gradually, if tolerated. The solution for total parenteral nutrition was infused into the superior vena cava via a central venous catheter; that for partial parenteral nutrition was given into a peripheral vein to supplement inadequate oral feedings. The period of parenteral nutrition lasted from 5 to 49 days, with an average of 13.2 days. The intake of 500 mg of nitrogen as crystalline amino acids and 100 kcal as glucose was capable of achieving body weight gain. Positive nitrogen balance of various degrees was also observed. Hyperglycemia of a slight to moderate degree was observed in nine patients; only three required insulin therapy. Two patients had thrombotic occlusion of the central venous catheter. The conclusion was reached that total parenteral nutrition or partial parenteral nutrition, when properly managed, is a safe procedure in small, premature infants. The amino acid solution given as a nitrogen source along with adequate calories was effective in promoting weight gain and nitrogen balance; it was apparently well tolerated by low-birth-weight neonates.

Essential fatty acid deficiency in surgical patients.

Parenteral nutrition may protect patients unable to eat from malnutrition almost indefinitely. If fat is not also given EFAD will occur. This outlines a prospective study of 28 surgical patients on total intravenous fat-free nutrition to determine the developmental course of EFAD and the response to therapy. Twenty-eight patients ranging from newborn to 66 years receiving parenteral nutrition without fat had regular determinations of the composition of total plasma fatty acids and the triene/tetraene ratio using gas liquid chromatography. Physical signs of EFAD were looked for also. Patients found to have evidence of EFAD were treated with 10% Intralipid. Topical safflower oil was used in three infants. Total plasma fatty acid composition was restudied following therapy. In general, infants on fat-free intravenous nutrition developed biochemical EFAD within two weeks, but dermatitis took longer to become evident. Older individuals took over four weeks to develop a diagnostic triene/tetraene ratio (greater than 0.4; range 0.4 to 3.75). Therapeutic correction of biochemical EFAD took 7 to 10 days but dermatitis took longer to correct. Cutaneous application of safflower oil alleviated the cutaneous manifestations but did not correct the triene/tetraene ratio of total plasma fatty acids. These studies indicate that surgical patients who are unable to eat for two to four weeks, depending upon age and expected fat stores, should receive fat as a part of their intravenous regimen.