[Internal carotid artery pseudoaneurysm caused by parapharyngeal abscess: A case report].

Pseudoaneurysms of the neck are seldom, and those caused by neck infections especially parapharyngeal abscess are even rarer. However, it is life-threatening and may bring sudden death due to the obstruction of airway and the pseudoaneurysms rupture. We analyzed the clinical features, diagnosis and treatment of the disease through a case summary and literature review in order to guide clinical diagnosis and treatment of pseudoaneurysms. The patient, whom we presented was an 87-year-old male and admitted in emergency of our hospital with the chief complaint of neck swelling for 7 days and shortness of breath for 2 days. Cervical ultrasound examination showed that there was an liquid dark area next to the left common carotid artery which was approximately 8.0 cm × 5.0 cm, consideration of formation of left carotid artery pseudoaneurysm, and the liquid dark area which was visible on the right considered of pseudoaneurysm or infection. Angiography of neck showed a clustered high-density shadow around the bifurcation of the left carotid artery, with an overall range of approximately 65 mm × 52 mm × 72 mm, the pseudoaneurysms for sure, while on the right side of the lesion, mixed low density shadows with air could be seen, the parapharyngeal abscess for sure.Then he was diagnosed as the pseudoaneurysm of left internal carotid artery which was caused by parapharyngeal abscess. After tracheal intubation and anti-infection treatment, the patient died due to hemorrhagic shock of the ruptured of the pseudoaneurysm. Morever we performed literature search on PubMed, Wanfang database and CNKI with keywords of "neck pseudoaneurysm, neck infection, parapharyngeal abscess" and enrolled 10 cases. Then we summarized the clinical characteristics and treatment. We analyzed and summarized the 10 case reports, in which the number of male was 7. Among them, there were 4 pediatric, and 6 adults were enrolled overall. Most of the symptoms were neck swelling, and the diseased blood vessel was mainly the right internal carotid artery which accounted for half overall. All the patients underwent surgical intervention, and recovered well. So we draw the conclusion that the clinical incidence of cervical pseudoaneurysms is low and can be caused by a variety of factors, especially caused by infectious factors. When a patient has a progressive pulsating mass in the neck, the preliminary diagnosis should be made by ultrasound as soon as possible, and the aortic enhancement CT should be used to further confirm.For a patient with cervical pseudo-aneurysms caused by parapharyngeal infections, he should take operation timely combined with antibiotic treatment in time.

Liquid chromatographic separation of alkaloids in herbal medicines: Current status and perspectives.

Alkaloids are a widespread group of basic compounds in herbal medicines and have attracted great interest due to various pharmaceutical activities and desirable druggability. Their distinctive structures make chromatographic separation fairly difficult. Peak tailing, poor resolution, and inferior column-to-column reproducibility are common obstacles to overcome. In order to provide a valuable reference, the methodologies and/or strategies on liquid chromatographic separation of alkaloids in herbal medicines proposed from 2012 to 2019 are thoroughly summarized.

Revealing active components and action mechanism of Fritillariae Bulbus against non-small cell lung cancer through spectrum-effect relationship and proteomics.

BACKGROUND: Fritillariae Bulbus (FB) is widely used as a traditional medicine for the treatment of lung meridian diseases. It has been proved that FB has good anti-non-small cell lung cancer (NSCLC) activity. However, the active components and potential mechanism are still not clear. PURPOSE: To reveal the bioactive components of FB against NSCLC and potential mechanism through spectrum-effect relationship and proteomics. METHOD: First, the FB extract was chemically profiled by UHPLC-QTOF-MS and the inhibitory effect of FB extract on A549 cell viability was evaluated by Cell Counting Kit-8 assay. Second, orthogonal-partial least squares-regression analysis was applied to screen potential active compounds through correlating the chemical profile with corresponding inhibitory effect. Third, the anti-NSCLC activities of potential active components were further investigated in terms of cell proliferation, cell cycle and cell apoptosis in vitro and tumor growth in vivo. Finally, proteomics was utilized to reveal the underlying anti-NSCLC mechanism. RESULTS: Six potential active components including verticine, verticinone, zhebeirine, ebeiedinone, yibeissine and peimisine were screened out by spectrum-effect relationship. Among them, zhebeirine showed higher inhibitory effect on A549 cell viability with IC50 value of 36.93 µM and dosage-dependent inhibition of A549 xenograft tumor growth in nude mice. Proteomics and western blotting assays indicated that zhebeirine could arrest cell cycle by down-regulating the expressions of CDK1, CDK2, Cyclin A2, Cyclin B2 and inhibiting the phosphorylation of p53. Moreover, the proteins participating in p53 signaling pathway including PCNA, 14-3-3σ, CHEK1 were significantly decreased, which suggested that zhebeirine affected cell cycle progression through p53 signaling pathway. CONCLUSION: This study not only provides scientific evidence to support the clinical application of FB against NSCLC, but also demonstrates that zhebeirine is a promising anti-NSCLC lead compound deserving further studies.

An integrated strategy combining network toxicology and feature-based molecular networking for exploring hepatotoxic constituents and mechanism of Epimedii Folium-induced hepatotoxicity in vitro.

Epimedii Folium (EF), a commonly used herbal medicine to treat osteoporosis, has caused serious concern due to potential hepatotoxicity. Until now, its intrinsic hepatotoxic mechanism and hepatotoxic ingredients remain unclear. Here, a novel high-throughput approach was designed to investigate the intrinsic hepatotoxic of EF. High-content screen imaging (HCS) and biochemical tests were first performed to obtain the cytotoxicity parameter matrix of 17 batch EF samples. EF-treated alpha mouse liver 12 (AML12) cells showed increased reactive oxygen species (ROS), reduced glutathione (GSH) and mitochondrial membrane potential (MMP), and apoptosis and cholestasis were further observed. Network toxicology predicted that EF-triggered hepatotoxiciy was involved in transcription factor (TF) activity. The FXR expression, screened by a TF PCR array, exhibited down-regulation following EF extract administration. Moreover, EF inhibited bile acid (BA) metabolism pathway in an FXR-dependent manner. Pearson correlation between the cytotoxicity parameter matrix and quantification feature table obtained from UHPLC-QTOF data of EF suggested 7 prenylated flavonoids possessed potent hepatotoxicities and their cytotoxicity order was further summarized. The transcriptional repression effects of them on FXR were also verified. Collectively, our findings indicate that FXR is probably responsible for EF-induced hepatotoxicity and prenylated flavonoids may be a major class of hepatotoxic constituents in EF.

Klebsiella pneumoniae invasion syndrome: a case of liver abscess combined with lung abscess, endophthalmitis, and brain abscess.

Klebsiella pneumoniae invasion syndrome (KPIS) is a critical multi-site infection that is usually caused by highly virulent Klebsiella pneumonia. It is relatively common in Asian patients with diabetes and leads to sepsis, which has a high mortality rate. We report the case of a man in his early 40s who presented to the hospital with blurred vision in his left eye of 7 days' duration and fever of 1 day's duration. After a complete examination, he was diagnosed with KPIS on the basis of his liver abscessation, lung abscessation, endophthalmitis of the left eye and brain abscessation. After needle puncture and drainage of the left eye and liver abscess and anti-bacterial treatment with meropenem, the patient recovered well. When KPIS is suspected, attention should be paid to the sites of infection and the selection of the most appropriate antibiotics, but the most important aim should be to drain the lesions in a timely manner to improve the patient's prognosis.

Simultaneous Presentation of Multiple Myeloma and Lung Cancer: Case Report and Gene Bioinformatics Analysis.

Patients diagnosed with more than one cancer generally develop the individual tumors sequentially. There are a few cases of co-occurring multiple myeloma and lung cancer reported in the literature. Here, we report two cases of co-occurring multiple myeloma and lung cancer in patients who presented with the chief complaint of pain. The diagnoses of multiple myeloma and lung cancer were supported by hematologic and biochemical investigations, as well as bone marrow and lung histopathologic examination. We provided suitable interventions for both two patients. The patients are still currently undergoing treatment and followed up closely. We first performed a bioinformatic analysis to determine commonly shared genes and pathways in the two types of cancer types. Fortunately, we identified the hub gene mitochondrial trans-2-enoyl-CoA reductase (MECR), which was overexpressed in both tumors. Survival analysis correlated higher MECR expression with poorer overall survival. Signaling pathway analysis suggested possible transduction pathways implicated in the co-occurrence of both tumors. The clinical cases combined with bioinformatic analysis may provide insight for the pathogenesis of synchronous tumors.

Chemometrics integrated with in silico pharmacology to reveal antioxidative and anti-inflammatory markers of dandelion for its quality control.

BACKGROUND: Dandelion is an herb with high nutritional and medicinal values, which has been listed in Chinese Pharmacopeia, European Pharmacopoeia and British Pharmacopoeia, gaining increasing acceptance around the world. However, the current quality control of dandelion is lagging behind. Only in Chinese Pharmacopeia, cichoric acid is used as a marker compound for its quality evaluation, whereas, it can not comprehensively reflect the bioactivity of dandelion. METHODS: This study developed a strategy by integrating chemometrics with in silico pharmacology to reveal the bioactive markers of dandelion for its quality control. Firstly, the major chemicals in dandelion were characterized using HPLC-DAD-MS/MS, and the corresponding antioxidant and anti-inflammatory activities were evaluated in vitro. Subsequently, the active components were screened by relating the chemicals and bioactivity of dandelion via grey relational assay and partial least squares regression analysis. The potential active components were then subjected to a validation for their activities. Moreover, in silico pharmacology was utilized to evaluate the contribution of active components to efficacy. RESULTS: A total of 22 phenolic compounds were characterized. Among them, cichoric acid, caffeic acid and luteolin were identified as quality markers owing to their good correlations with the bioactivities of dandelion. These three markers were quantified in frequently-used dandelion species, viz. Taraxacum mongolicum Hand.-Mazz. (TAM) and T. officinale F. H. Wigg. (TAO). TAM, with acceptably higher content of cichoric acid and caffeic acid, showed better antioxidant activity than TAO. While TAO included higher content of luteolin, presenting slightly more effective in anti-inflammation. CONCLUSION: An useful strategy for the quality marker discovery was successfully designed. And the results provided more knowledge for the quality evaluation of dandelion.

Brucellosis of unknown origin with haemophagocytic syndrome: A case report.

BACKGROUND: Brucellosis is a contagious bacterial disease caused by Brucella species, which is a leading zoonotic disease worldwide. Most patients with brucellosis have a clear infection source; however, our case had a rare presentation of secondary haemophagocytic lymphohistiocytosis without any epidemiological history. CASE SUMMARY: A 50-year-old man was admitted to our hospital with a fever of unknown origin. After laboratory examinations, such as blood culture and bone marrow biopsy, the patient was diagnosed with brucellosis and secondary haemophagocytic lymphohistiocytosis. After antibiotic therapy, the patient was afebrile, and his haemogram recovered to normal, after which he was discharged. CONCLUSION: Brucellosis cannot be excluded in patients with clinically unexplained fever, even in those without epidemiologic history.

Treatment for CD57-negative γδ T-cell large granular lymphocytic leukemia with pure red cell aplasia: A case report.

BACKGROUND: T-cell large granular lymphocytic leukemia (T-LGLL) is a rare type of aplastic anemia with diverse clinical manifestations. Concomitant diseases are often present at the first manifestation. We describe the treatment of a patient with CD57-negative γδT-LGLL with pure red cell aplasia (PRCA). CASE SUMMARY: A 34-year-old woman with a 20-year history of anemia visited our hospital owing to severe dizziness and was admitted. Her condition was diagnosed as CD57-negative γδT-LGLL with PRCA through bone marrow cytology, bone marrow pathology, bone marrow flow cytometry, bone marrow multiplex polymerase chain reaction combined with fluorescent fragment analysis, and other tests. Treatment with prednisone, methotrexate, and subcutaneous erythropoietin did not significantly change her hemoglobin level. After treatment with oral cyclophosphamide for 3 mo, her hemoglobin level increased to approximately 100 g/L. After 5 mo of treatment, the patient could perform activities of daily living independently. CONCLUSION: The treatment of CD57-negative γδT-LGLL with PRCA with cyclophosphamide helps to improve prognosis.

Klebsiella pneumoniae infection secondary to spontaneous renal rupture that presents only as fever: A case report.

BACKGROUND: Spontaneous renal rupture is a rare disease in the clinic. The causes of spontaneous renal rupture include extrarenal factors, intrarenal factors, and idiopathic factors. Reports on infection secondary to spontaneous renal rupture and the complications of spontaneous renal rupture are scarce. Furthermore, there are few patients with spontaneous renal rupture who present only with fever. CASE SUMMARY: We present the case of a 52-year-old female patient who was admitted to our hospital. She presented only with fever, and the cause of the disease was unclear. She underwent a contrast-enhanced computed tomography (CT) scan, which showed that the left renal capsule had a crescent-shaped, low-density shadow; the perirenal fat was blurred, and exudation was visible with no sign of calculi, malignancies, instrumentation, or trauma. Under ultrasound guidance, a pigtail catheter was inserted into the hematoma, and fluid was drained and used for the bacterial test, which proved the presence of Klebsiella pneumoniae. Two months later, abdominal CT showed that the hematoma was absorbed, so the drainage tube was removed. The abdominal CT was normal after 4 mo. CONCLUSION: Spontaneous renal rupture due to intrarenal factors causes a higher proportion of shock and is more likely to cause anemia.

[Evaluation and Comparison of Thromboelastography and Conventional Coagulation Tests for Blood Coagulation Function in Children with Henoch-Schönlein Purpura].

OBJECTIVE: To investigate the efficacy of disease control, survival time and safely in treatment of newly diagnosed multiple mycloma patients with different dose of tenalidomide regimens. METHODS: The clinical data of 116 patients with multiple myeloma from June 2011 to June 2015 were collected and analyzed retrospectively. According to doses of used lenalidomide based on dexamethasone plus lenalidomide regimen 116 patients were divided into 2 groups: conventional dose group (58 cases) and low dose group (58 cases). The ORR, PFS rate and OS rate during followed-up for 3 years, KPS score, RNS score and immunophenotypic index before and after treatment and drug toxicity incidence were compared between 2 groups. RESULTS: The ORR for 2 treatment courses of low dose group was significantly lower than that in conventienal dose group (P＜0.05). The ORR for 4 and 6 treatment courses was not significantly different between 2 groups (P＞0.05). The PFS rate and OS rate during followed-up for 3 years was no significantly different between 2 groups (P＞0.05). The KPS score and RNS score after treatment of low dose group were significantly better than those in conventional dose group and before treatment (P＜0.05). The levels of immunophenotypic index after treatment of both groups were significantly better than those before treatment (P＜0.05). The incidence of III-IV grade hematological toxicity, pulmonary infection and herpes were not significantly different between 2 groups (P＞0.05). The incidence of peripheral neuropathy and gastrointestinal reactions in the low dose group were significantly lower than that in conventional dose group (P＜0.05). CONCLUSION: Conventional and low doses of lenalidomide possess the same control effects and survival time for treatment of newly dingnosed patients with multiple myeloma; Despite, the initiation of effects from the low dose lenalidomide is relatively slower, it contributes to raise the overall quality of life and reduce the risk of drug toxicity.

[Changes and clinical significance of serum Apelin in patients with severe sepsis and septic shock].

OBJECTIVE: To explore the changes and clinical significance of serum Apelin in patients with severe sepsis and septic shock. METHOD: We measured the serum level of Apelin with ELISA on different observation days (the 1st, 3rd, and 10th day obtaining the diagnosis) in 26 patients with severe sepsis and septic shock. RESULTS: Serum Apelin significantly increased in sepsis patients when compared with the normal control group (P<0.01); The serum Apelin levels significantly changed among different observation days (P< 0.01). Serum Apelin level was significantly higher in patients with septic shock than those with severe sepsis (P<0.01). CONCLUSION: Serum Apelin level changes in patients with severe sepsis and septic shock, which may provide clues in diagnosis and prognosis.

Myeloperoxidase polymorphism and coronary artery disease risk: A meta-analysis.

The myeloperoxidase (MPO) gene 463G/A and 129G/A polymorphisms have been reported to be associated with coronary artery disease (CAD), but the results remain inconclusive. This meta-analysis was designed to clarify these controversies.PubMed, EMBASE, and the Cochrane Library were used to retrieve the relevant literature up to March 2015 according to keywords. A total of 8 case-control studies, including 3491 cases and 7293 controls, were included in this meta-analysis. Summary odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated.There was strong evidence of an association between the MPO 463G/A polymorphism and CAD. The data revealed that only the dominant model was associated with CAD (dominant model: OR = 0.872, 95% CI = 0.77-0.99). Regarding the 129G/A gene polymorphism, the pooled OR for the genotype AA + AG versus GG was 0.906 (95% CI = 0.74-1.10).This meta-analysis suggested an association between the MPO 463G/A polymorphism and the risk of CAD, but there is no significant association between the MPO 129G/A gene polymorphism and CAD risk.

A multicentre, randomized, controlled trial of oseltamivir in the treatment of influenza in a high-risk Chinese population.

OBJECTIVE: To evaluate the efficacy and safety of oseltamivir treatment in a population at high risk for influenza. RESEARCH DESIGN AND METHODS: This was a randomized, open-label, controlled trial involving Chinese patients with chronic respiratory diseases (chronic bronchitis, obstructive emphysema, bronchial asthma or bronchiectasis) or chronic cardiac disease. Patients showing symptoms of influenza were randomly assigned to receive oral oseltamivir 75 mg twice daily for 5 days (oseltamivir group), or symptomatic treatment (control group) within 48 h after symptom onset. MAIN OUTCOME MEASURES: The main outcome measures were duration and severity of illness in influenza-infected patients. Other outcome measures included incidence of complications, antibiotic use, hospitalization and total medical cost. RESULTS: Of the 118 recruited patients, 56 were identified as influenza-infected through laboratory tests (oseltamivir, N = 27; control, N = 29). Relative to symptomatic treatment, oseltamivir significantly reduced the duration of influenza symptoms by 36.8% (p = 0.0479), and the severity by 43.1% (p = 0.0002). In addition, oseltamivir significantly reduced the duration of fever by 45.2% (p = 0.0051), and the time to return to baseline health status by 5 days (p = 0.0011). The incidence of complications (11% vs. 45%, p = 0.0053) and antibiotic use (37% vs. 69%, p = 0.0167) were also significantly lower in the oseltamivir group compared with the control group. The cost of treating influenza and its complications was comparable between the two groups (p = 0.2462). CONCLUSIONS: Oseltamivir is effective and well tolerated in high-risk patients with chronic respiratory or cardiac diseases. It can reduce the duration and severity of influenza symptoms and decrease the incidence of secondary complications and antibiotic use, without increasing the total medical cost.

[Inhibitory effects of protease inhibitor on endotoxin-induced acute lung injury in rats].

OBJECTIVE: To investigate the effects of protease inhibitor on lipopolysaccharide-induced acute lung injury in rats and its possible mechanisms. METHODS: Thirty-two male Wister rats, weighting 250-270 g, were divided into four groups randomly. C, normal controls (n=8); A: acute lung injury group (n=8), receiving intravenous endotoxin (lipopolysaccharide O55:B5, LPS 5 mg/kg); V, low-dose group (n=8), U, high-dose intervention group (n=8, receiving Ulinastatin 50,000 U/kg and 100,000 U/kg respectively and LPS 5 mg/kg). The specimens were collected 2 hours later, We observed the following changes: blood gas analysis, the lung wet/dry weight ratio, the pulmonary vascular permeability, histological manifestations, lung tissue myeloperoxidase activity, plasma endothelin-1, lung tissue malonaldehyde and conjugated-diene. RESULTS: Compared with Group C, the lungs of the rats in Group A had significant hyperemia and spotted hemorrhage. The inflammatory granulocyte infiltrating, diffused alveolar septum thickening and spotted hemorrhage were observed in pathological examinations. The lung wet/dry weight ratio and Evans Blue content (per gram) increased significantly in group A [(5.41+/-0.06), (27.64+/-2.48) microg] compared with group C [(4.95+/-0.08), (12.99+/-2.83) microg], in the intervention groups (U: 5.0+/-0.05, 19.47+/- 2.09; V: 4.98+/-0.06, 21.44+/-3.12) however the difference was not significant between the intervention groups; The plasma endothelin-1 and lung tissue myeloperoxidase activity increased significantly in group A [(948.23+/-103.45) u/g, (152.90+/-8.41) u/g] compared with group C [(729.38+/-88.64) u/g ], [(54.62+/-15.49) u/g] but intervention groups [U: (633.27+/-93.27) u/g, (119.40+/-11.32) u/g; V: (671.87+/-105.45) u/g, (129.55+/-9.57) u/g] decreased significantly compared with group A, no significant difference between intervention groups; lung tissue Lipid-peroxide (malonaldehyde, MDA and conjugated-diene, C-diene) increased significantly in group A [MDA: (73.95+/-4.62) nmol/g; C-diene: (10.96+/-0.81) nmol/g] compared with group C [MDA: (39.65+/-6.21) nmol/g; C-diene: (3.34+/-0.51) nmol/g], intervention groups [U: MDA: (51.26+/-5.56) nmol/g, C-diene: (7.59+/-0.84) nmol/g; V: MDA: (59.87+/-4.62) nmol/g, C-diene: (8.79+/-0.45) nmol/g] decreased significantly compared with group A. MDA decreased significantly in group U compared with group V. CONCLUSION: The protease inhibitor, Ulinastatin, may decrease inflammatory reaction and further decrease lung damage induced by LPS in rats, all indicating protection of protease inhibitor against acute lung injury.

[Protective effect of protease inhibitor on renal function of rat challenged by lipopolysaccharide].

OBJECTIVE: To investigate the protective effects of protease inhibitor on lipopolysaccharide (LPS)-induced kidney injury in rats and its possible mechanism. METHODS: Thirty-two male Wistar rats were divided into four groups randomly: normal control (n=6); LPS group (n=10), receiving intravenous endotoxin (LPS, O55:B5, 5 mg/kg); low-dose ulinastatin (UT) intervention group (n=8), receiving intraperitoneal UT 50 000 U/kg and LPS 5 mg/kg as above; high-dose UT intervention group (n=8), UT 100,000 U/kg and LPS 5 mg/kg. The following examinations were carried out: blood gas analysis, kidney pathological changes, plasma endothelin-1, plasma lactic acid, N-acetylglucosaminidase (NAG) in urine, and plasma creatinine (Cr) level. RESULTS: Blood gas analysis showed that pH, partial pressure of oxygen in artery (PaO(2)) and base excess (BE) lowered significantly (all P<0.01) in LPS group compared with normal control group, and elevated in low-dose and large dose UT intervention groups compared with LPS group, the differences were statistically significant (P<0.01). The plasma endothelin-1 increased significantly (P<0.01) in LPS group compared with normal control group and intervention groups. Plasma lactate increased significantly in LPS group compared with normal control group (P<0.001), decreased significantly in intervention groups compared with LPS group (P<0.01). No significant difference was found between two intervention groups (P>0.05). Plasma Cr and urine NAG level increased in LPS groups, and the difference was significant compared with normal control groups and intervention groups (P<0.01). Pathohistologic examination revealed normal glomeruli but vacuolar degeneration of tubular epithelial cells, and part of them disrupted and desquamated, and also tubular dilatation. Only mild pathological changes were seen in the intervention groups. There was no obvious difference in morphology between two intervention groups. CONCLUSION: The protease inhibitor, UT, may alleviate LPS-induced inflammatory reaction and damage to kidney in rats.

[Clinical analysis of 5 cases with acute intravascular hemolysis caused by puerarin].

OBJECTIVE: To explore the clinical characteristics of acute intravascular hemolysis caused by puerarin so as to help our prevention, diagnosis and treatment. METHODS: Analysis of 5 cases of acute intravascular hemolysis caused by puerarin was made and literature review conducted. RESULTS: All patients had the history of administering puerarin, with the pre-symptoms of acute hemolysis; the clinical characteristics of acute intravascular hemolysis were observed:sudden attacks of lumber and abdominal pain, chill, fever dyspnea, temporary conciousness loss, dark urine or hematuria, low hemoglobin, high reticular red blood cell, positive of Coombs' test. CONCLUSION: When sudden attacks of the above symptoms appear, the acute intravascular hemolysis should be taken into consideration first and the giving of the puerarin intravenously be immediately stopped Active and proper treatment should be made.

[MHC and its application in the population and conservation genetics].

The major histocompatibility complex (MHC),with the highest genetic polymorphism,is a cluster of genes involved in immune response regulation in the vertebrates.MHC can provide information such as population genetic diversity,evolutionary history and population dynamics,and population genetic structure etc. It can also be applied in the captive breeding programme for endangered vertebrate species.

[A multicenter randomized controlled study of the efficacy and safety of oseltamivir in the treatment of influenza in a high risk population].

OBJECTIVE: To evaluate the efficacy and safety of oseltamivir in the treatment of influenza in a high risk population. METHODS: A randomized, open, control trial was conducted from Nov. 2002 to Feb. 2003. Patients with chronic respiratory disease, such as chronic bronchitis, obstructive emphysema, bronchial asthma, bronchiectasis or chronic cardiac disease, and with symptoms of influenza were enrolled. They should satisfy the following criteria: Fever > or = 37.8 degrees C plus at least two of the following influenza symptoms: coryza/nasal congestion, sore throat, cough, myalgia/muscle aches and pain, fatigue, headache and chills/sweats. Within 48 h after the onset of the symptoms, the patients were randomly assigned to oseltamivir group (oseltamivir 75 mg, twice daily for 5 days) or control group (symptom relief medicine only). RESULTS: Fifty-six of the 108 recruited patients were identified as influenza-infected through laboratory test. They were defined as intent-to-treat infected population (ITTI) (27 oseltamivir, 29 control). The duration of influenza symptom was 64 h shorter (36.7%) and AUC score of the influenza symptom was decreased by 618 (43.1%) in the oseltamivir group as compared with those in the control group. The fever duration was 46.8 h (45.0%) less in the oseltamivir group than that in the control group. It took 6 d for the oseltamivir group and 11 days for the control group to recover to the basic health status. Secondary complications such as bronchitis, sinusitis and pneumonia occurred 11% (3/27) in the oseltamivir group and 45% (13/29) in the control group. The treatment expense for influenza and its complication was 587.4 RMB in the oseltamivir group and 786.5 RMB in the control group, which showed no significant difference (P = 0.246). CONCLUSIONS: It is suggested that oseltamivir is effective and well tolerated in patients with chronic respiratory or cardiac diseases. It can reduce the fever duration and severity of influenza symptom, and decrease the incidence of secondary complications and antibiotic use, while does not increase the total medical cost.

A New Runge-Kutta Discontinuous Galerkin Method with Conservation Constraint to Improve CFL Condition for Solving Conservation Laws.

We present a new formulation of the Runge-Kutta discontinuous Galerkin (RKDG) method [9, 8, 7, 6] for solving conservation Laws with increased CFL numbers. The new formulation requires the computed RKDG solution in a cell to satisfy additional conservation constraint in adjacent cells and does not increase the complexity or change the compactness of the RKDG method. Numerical computations for solving one-dimensional and two-dimensional scalar and systems of nonlinear hyperbolic conservation laws are performed with approximate solutions represented by piecewise quadratic and cubic polynomials, respectively. The hierarchical reconstruction [17, 33] is applied as a limiter to eliminate spurious oscillations in discontinuous solutions. From both numerical experiments and the analytic estimate of the CFL number of the newly formulated method, we find that: 1) this new formulation improves the CFL number over the original RKDG formulation by at least three times or more and thus reduces the overall computational cost; and 2) the new formulation essentially does not compromise the resolution of the numerical solutions of shock wave problems compared with ones computed by the RKDG method.