Disturbance of consciousness caused by dyclonine hydrochloride mucilage: a case report.

BACKGROUND: Dyclonine hydrochloride mucilage is a topical anaesthetic formulated for mucosal surfaces. It is employed frequently for topical anaesthesia of the pharynx prior to endoscopic examinations such as electronic gastroscopy, and few adverse reactions have been reported. This article describes a patient who experienced a transient but severe disturbance of consciousness following oral dyclonine hydrochloride mucilage administration. CASE PRESENTATION: A 75-year-old female presenting with gastrointestinal bleeding was examined by electronic gastroscopy. Six minutes after oral dyclonine hydrochloride mucilage administration, the patient entered a comatose-like state accompanied by loss of limb muscle tone and profuse perspiration. This response was not accompanied by changes in cardiac rhythm, blood pressure, or respiration rate, suggesting an effect on higher brain centres. After ten minutes, the patient's symptoms were alleviated. CONCLUSION: We suggest that sites of dyclonine hydrochloride mucilage use be equipped with appropriate rescue devices for these rare events.

Application value of double-layer spectral detector CT in differentiating central lung cancer from atelectasis.

BACKGROUND: Central lung cancer with obstructive atelectasis is very common in clinical practice. Determination of the tumor borderline is important. Conventional computed tomography (CT) alone may not be sufficiently accurate to distinguish central lung cancer from obstructive atelectasis. Spectral CT can improve the soft-tissue resolution greatly. In this study, we evaluated the application value of double-layer spectral detector CT in differentiating central lung cancer from atelectasis. METHODS: A total of 51 patients (37 males) with pathologically confirmed central lung cancer accompanied by atelectasis were enrolled. The rates of differentiation between tumors and atelectasis were retrospectively analyzed using conventional CT and three types of spectral images (40 keV virtual monoenergetic imaging, iodine density map, and their fusion image) of unenhanced scans as well as arterial and venous phases. Cochran's Q test and Friedman test were used to compare the differentiation rates and the maximal diameters of the tumors in each image. RESULTS: Among the 51 cases, conventional CT, 40 keV monoenergetic, iodine density, and their fusion images of the venous phase were successful in differentiating tumors from atelectasis in 17 (33.33%), 35 (68.63%), 39 (76.47%), and 38 (74.51%) cases, respectively. The differentiation rates of the 40 keV monoenergetic, iodine density, and fusion images were significantly higher than those of conventional images (χ2=-0.35, -0.43, and -0.41, respectively, all P<0.001). There were no significant differences in the differentiation rates among the 40 keV monoenergetic, iodine density, and fusion images (χ2=-0.06, -0.08, 0.02, respectively, all P=1.00). The maximal tumor diameters in the four images did not significantly differ (χ2=3.61, P=0.31). Conventional and spectral images of unenhanced and arterial phases could not/barely identify the tumor borderlines. CONCLUSIONS: Venous-phase spectral images of double-layer spectral detector CT can differentiate most central lung cancers from atelectasis, and the maximal diameter measurement of the tumor is reliable. Double-layer spectral detector CT can accurately identify the borderlines of most central lung cancers through spectral images during routine CT examinations without requiring other imaging modalities. Therefore, this method has considerable clinical value for applications in tumor staging, efficacy evaluation, and radiotherapy.

Predictive model for the probability of malignancy in solitary pulmonary nodules: a meta-analysis.

BACKGROUND: To date, multiple predictive models have been developed with the goal of reliably differentiating between solitary pulmonary nodules (SPNs) that are malignant and those that are benign. The present meta-analysis was conducted to assess the diagnostic utility of these predictive models in the context of SPN differential diagnosis. METHODS: The PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP databases were searched for relevant studies published through August 31, 2021. Pooled data analyses were conducted using Stata v12.0. RESULTS: In total, 20 retrospective studies that included 5171 SPNs (malignant/benign: 3662/1509) were incorporated into this meta-analysis. Respective pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic score values were 88% (95CI%: 0.84-0.91), 78% (95CI%: 0.74-0.80), 3.91 (95CI%: 3.42-4.46), 0.16 (95CI%: 0.12-0.21), and 3.21 (95CI%: 2.87-3.55), with an area under the summary receiver operating characteristic curve value of 86% (95CI%: 0.83-0.89). Significant heterogeneity among studies was detected with respect to sensitivity (I2 = 89.07%), NLR (I2 = 87.29%), and diagnostic score (I2 = 72.28%). In a meta-regression analysis, sensitivity was found to be impacted by the standard reference in a given study (surgery and biopsy vs. surgery only, P = 0.02), while specificity was impacted by whether studies were blinded (yes vs. unclear, P = 0.01). Sensitivity values were higher when surgery and biopsy samples were used as a standard reference, while unclear blinding status was associated with increased specificity. No significant evidence of publication bias was detected for the present meta-analysis (P = 0.539). CONCLUSIONS: The results of this meta-analysis demonstrate that predictive models can offer significant diagnostic utility when establishing whether SPNs are malignant or benign.

Co-Delivery of Curcumin and Paclitaxel by "Core-Shell" Targeting Amphiphilic Copolymer to Reverse Resistance in the Treatment of Ovarian Cancer.

BACKGROUND: Ovarian cancer is a common malignancy in the female reproductive system with a high mortality rate. The most important reason is multidrug resistance (MDR) of cancer chemotherapy. To reduce side effects, reverse resistance and improve efficacy for the treatment of ovarian cancer, a "core-shell" polymeric nanoparticle-mediated curcumin and paclitaxel co-delivery platform was designed. METHODS: Nuclear magnetic resonance confirmed the successful grafting of polyethylenimine (PEI) and stearic acid (SA) (PEI-SA), which is designed as a mother core for transport carrier. Then, PEI-SA was modified with hyaluronic acid (HA) and physicochemical properties were examined. To understand the regulatory mechanism of resistance and measure the anti-tumor efficacy of the treatments, cytotoxicity assay, cellular uptake, P-glycoprotein (P-gp) expression and migration experiment of ovarian cancer cells were performed. In addition, adverse reactions of nanoformulation to the reproductive system were examined. RESULTS: HA-modified drug-loaded PEI-SA had a narrow size of about 189 nm in diameters, and the particle size was suitable for endocytosis. The nanocarrier could target specifically to CD44 receptor on the ovarian cancer cell membrane. Co-delivery of curcumin and paclitaxel by the nanocarriers exerts synergistic anti-ovarian cancer effects on chemosensitive human ovarian cancer cells (SKOV3) and multi-drug resistant variant (SKOV3-TR30) in vitro, and it also shows a good anti-tumor effect in ovarian tumor-bearing nude mice. The mechanism of reversing drug resistance may be that the nanoparticles inhibit the efflux of P-gp, inhibit the migration of tumor cells, and curcumin synergistically reverses the resistance of PTX to increase antitumor activity. It is worth noting that the treatment did not cause significant toxicity to the uterus and ovaries with the observation of macroscopic and microscopic. CONCLUSION: This special structure of targeting nanoparticles co-delivery with the curcumin and paclitaxel can increase the anti-tumor efficacy without increasing the adverse reactions as a promising strategy for therapy ovarian cancer.

Potassium iodide catalyzed simultaneous C3-formylation and N-aminomethylation of indoles with 4-substituted-N,N-dimethylanilines.

A one-pot dual functionalization of indoles has been developed. The simultaneous C3-formylation and N-aminomethylation of indoles can be achieved using readily available potassium iodide as a catalyst and tert-butyl peroxybenzoate as a co-oxidant.

nBu4NI-catalyzed C3-formylation of indoles with N-methylaniline.

nBu(4)NI-catalyzed C3-selective formylation of N-H and N-substituted indoles by using N-methylaniline as a formylating reagent was first successfully demonstrated.

A preliminary study of apparent diffusion coefficient in chemotherapy-induced liver damage.

OBJECTIVES: To investigate changes in the hepatic apparent diffusion coefficient (ADC) in patients undergoing chemotherapy. METHODS: We enrolled 54 patients (25 women; mean age 57.0±13.1 years, range 29-89 years) undergoing chemotherapy for tumor and 10 controls (7 women; mean age 55.1±17.5 years, range 23-81 years). The patients were tested for serum alanine aminotransferase (ALT) activity (abnormal, normal) and fatty liver. Hepatic ADC values were compared among controls, patients and subgroups. Pearson correlation coefficient was used to assess the correlation between ADC and ALT activity. RESULTS: Hepatic ADC0,850 (×10(-3) mm2/s) was lower for patients than controls (1.14±0.18 vs. 1.28±0.12, P=0.02) and was lower for patients with than without fatty liver and controls (1.01±0.06 vs. 1.18±0.18 and 1.28±0.12, respectively, all P<0.01), with no significant difference between patients without fatty liver and controls (P=0.07). ADC0,850 was lower for patients with abnormal ALT than normal ALT activity and controls (0.99±0.06 vs. 1.17±0.18 and 1.28±0.12, respectively, all P<0.05), with a significant difference also being seen between patients with normal ALT activity and controls (P=0.04). Hepatic ADC0,850 was not correlated with ALT activity in patients (r=-0.24, P=0.08). CONCLUSIONS: Although ADC did not correlate with ALT values, it did distinguish patient likely to have chemotherapy-induced liver damage as indicated by abnormal ALT values or fatty liver. These mechanisms need to be disentangled.

Immunization with recombinant Lactobacillus casei strains producing K99, K88 fimbrial protein protects mice against enterotoxigenic Escherichia coli.

To exploit a safe and effective vaccine for the prevention against K99 or K88 infections of enterotoxigenic Escherichia coli (ETEC), we have developed a mucosal delivery vehicle based on Lactobacillus casei CICC 6105 using poly-γ-glutamate synthetase A (PgsA) as an anchoring matrix. To evaluate the immunization effect of the recombinant strains (harboring plasmids pLA-K99-K88-LTB, pLA-K99, and pLA-K88), anti-ETEC K99 or K88 antibody responses, T-cell proliferation, and cytokines by intracellular staining (ICS) were investigated after specific pathogen-free (SPF) C57BL/6 mice orally inoculated with these recombinant strains. After oral vaccination into C57BL/6 mice, all recombinant strains were proved to be immunogenic and able to elicit high levels of mucosal immunoglobulin A (IgA) titers in bronchoalveolar lavage fluids, intestinal fluids and prominent systemic immunoglobulin G and IgG subclasses (IgG1, IgG2b, and IgG2a) responses in sera. Using the T-cell proliferation assay, the stimulation index (SI) of groups immunized with pLA-K99/L. casei and pLA-K88/L. casei reached to 2.73 and 2.64, respectively, versus 2.56 in a group immunized with pLA-K99-K88-LTB/L. casei. A detailed analysis of the cell-mediated immune responses by ICS showed the number of specific CD8(+) T cells expressing cytokines (IFN-γ, TNF-α, and IL-2) and granule-associated proteins (CD107a) was higher than that of specific CD4(+) T cells secreted by immune spleen cells upon restimulation in vitro with peptides. Next, the results showed that DCs activated in vitro with recombinant L. casei enhance specific T-cell proliferation and promote T cells to produce both Th1 and Th2 cytokines. More than 80% of the vaccinated mice were protected after challenge with a lethal dose of standard strains C83912 and C83902. These results demonstrate that recombinant L. casei can induce specific humoral and mucosal antibodies and cellular immune response against protective antigens upon oral administration.