Cardiac arrhythmia triggered by diuretic-induced hyponatremia.

Diuretics have a long and distinguished history in the treatment of hypertension and heart failure. Clinical practice guidelines recommend that diuretics should be considered to be as suitable as other antihypertensive agents for the initiation and maintenance of antihypertensive treatment. However, diuretics may potentially cause electrolyte disturbances and metabolic side effects. Diuretic-induced hyponatremia is probably more prevalent than generally acknowledged. We present an unusual case of indapamide-induced hyponatremia and hypokalemia complicated by cardiac arrhythmia. The adverse drug reaction was reversible and non-life-threatening, but this case serves as a reminder that careful evaluation and constant monitoring are necessary when prescribing diuretics.

[The value of DCE-MRI in predicting IDH gene mutation of high-grade gliomas].

Objective: To investigate the value of quantitative and semiquantitative parameters of DCE-MRI in predicting IDH gene mutation of high-grade gliomas before the operation. Methods: Twenty-six individuals with surgically and pathologically proved WHO Ⅲ-Ⅳ gliomas collected from April 2016 to June 2019 in First People's Hospital of Changzhou, were divided into two groups, IDH mutation group (7 cases, 27-67 years, 3 males and 4 females,) and IDH gene wild group (19 cases, 42-75 years, 12 males and 7 females) according to the results of molecular pathology. All individuals underwent conventional plain (T(1)WI, T(2)WI), enhanced MR scanning (T(1)WI) and dynamic contrast enhancement (DCE). Four quantitative parameters:volume transfer constant (K(trans)), ratio constant of back flux (Kep), extravascular extracellular space fractional volume (Ve), and blood plasma fractional volume (Vp), and four semiquantitative parameters: time to peak (TTP), maximum concentration (MAX Conc), initial area under the gadolinium concentration-time curve (IAUC) and maximum slope of decrease (MAX Slope) were measured. The independent samples t test (normal distribution and homogeneity of variance) or Mann-Whitney rank sum test (abnormal distribution or heterogeneity of variance) were used to compare the differences of quantitative and semiquantitative parameters between IDH gene mutation group and IDH gene wild type group. Receiver operating characteristic (ROC) curve was used to evaluate the efficiency of quantitative and semiquantitative parameters in predicting IDH gene mutation of high-grade gliomas. Results: The value of K(trans),TTP in IDH mutated group were 0.096 (0.080,0.135)/min and (3.95±0.34) s, respectively. The value of K(trans), TTP in IDH wild type group were 0.168 (0.132, 0.337)/min and (2.58±1.15) s, respectively. The value of K(trans) in IDH mutated group was significantly less than the value of K(trans) in IDH gene wild type group (Z value was -2.168, P value was 0.030). The value of K(trans) in IDH mutated group was significantly greater than the value of K(trans) in IDH gene wild type (Z value was -2.630, P value was 0.007). The area under the ROC curve (AUC) of K(trans) and TTP in predicting IDH gene mutation of high-grade gliomas was 0.782 and 0.842, respectively. The specificity of K(trans) was higher (73.7%), The sensitivity of TTP was the higher (100.0%). Combined K(trans)and TTP were the best for predicting IDH gene mutation of high-grade gliomas, AUC was 0.865. Conclusion: Quantitative and semiquantitative parameters of DCE-MRI can help to predict IDH gene mutation of high-grade gliomas before the operation.

Diagnostic value of electrocardiogram in cardiac tamponade.

INTRODUCTION: We aim to study the diagnostic value of electrocardiogram (ECG) in cardiac tamponade. METHODS: This study was a single centre, retrospective casecontrol study. We recruited 42 patients diagnosed with cardiac tamponade of various aetiologies confirmed by transthoracic echocardiography and 100 controls between January 2011 and December 2015. The ECG criteria of cardiac tamponade we adopted was as follows: 1) Low QRS voltage in a) the limb leads alone, b) in the precordial leads alone or, c) in all leads, 2) PR segment depression, 3) Electrical alternans, and 4) Sinus tachycardia. RESULTS: Malignancy was the most common causes of cardiac tamponade, the two groups were of similar proportion of gender and ethnicity. We calculated the sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of each ECG criteria. Among the ECG abnormalities, we noted the SN of 'low voltage in all chest leads' (69%), 'low voltage in all limb leads' (67%) and 'sinus tachycardia' (69%) were higher as compared to 'PR depression' (12%) and 'electrical alternan' (5%). On the other hand, 'low voltage in all chest leads' (98%), 'low voltage in all leads' (99%), 'PR depression' (100%) and 'electrical alternans' (100%) has highest SP. CONCLUSION: Our study reaffirmed the findings of previous studies that electrocardiography cannot be used as a screening tool for diagnosing cardiac tamponade due to its low sensitivity. However, with clinical correlation, electrocardiography is a valuable adjuvant test to 'rule in' cardiac tamponade because of its high specificity.

Acute myocarditis mimicking ST-elevation myocardial infarction: A diagnostic challenge for frontline clinicians.

The clinical presentation of acute myocarditis is highly variable ranging from no symptoms to cardiogenic shock. Despite considerable progress, it remains a challenge for frontline physicians to discriminate between acute myocarditis and myocardial infarction, especially in the early phase. Our case serves as a reminder that acute presentation of myocarditis could resemble ST elevation myocardial infarction potentially misdirecting the therapeutic decision. The clinical presentation, electrocardiographic and laboratory findings of the patient are not specific enough to distinguish acute myocarditis from myocardial infarction. The gold standard tests such coronary angiography and cardiovascular magnetic resonance (CMR) can reliably differentiate the two entities.

Assessment of mismatch negativity and P300 response in patients with disorders of consciousness.

OBJECTIVE: To evaluate changes in mismatch negativity (MMN) and P300 response in vegetative state (VS) and minimally conscious state (MCS) patients before and after treatment, and their value for prediction of prognosis. PATIENTS AND METHODS: Event-related potentials (ERPs), performed on 11 patients classified as VS (n = 6) or MCS (n = 5), and five healthy participants (i.e., control group). We performed a six months telephone follow-up to monitor changes in consciousness recovery. RESULTS: Comparison of the three groups showed significantly higher MMN latency elicited by salient stimuli and P300 elicited by the subject's own name for the VS group, as well as significant difference in amplitudes of MMN elicited by frequent stimuli and P300 elicited by other first names for this group. The source of MMN and P300 responses was the frontal lobe for the control group, and temporal lobe for the VS and MCS groups. CONCLUSIONS: The sudden increase in MMN amplitude and latency shortening may indicate an improvement in the state of consciousness. Neurophysiological evaluations suggest that patients with vegetative state (VS) and minimally conscious state (MCS) may preserve patterns of higher-order cerebral processing similar to those observed in conscious patients.

Dynamic contrast-enhanced magnetic resonance angiography for the localization of spinal dural arteriovenous fistulas at 3T.

OBJECTIVE: This study was undertaken to evaluate the accuracy of dynamic contrast-enhanced magnetic resonance angiography (DCE-MRA) in the precise location and demonstration of fistulous points in spinal dural arteriovenous fistulas (SDAVFs). METHODS: Fifteen patients (14 men, 1 woman; age range: 40-78 years; mean: 55.5 years) harboring SDAVF who underwent preoperative DCE-MRA and spinal digital subtraction angiography (DSA) between January 2012 and January 2015 were evaluated retrospectively. Two reviewers independently evaluated the level and side of the arteriovenous fistula and feeding artery on 3T DCE-MRA and DSA images. The accuracy of DCE-MRA was assessed by comparing its findings with those from DSA and surgery in each case. RESULTS: All 15 patients underwent DCE-MRA and DSA. DSA was unsuccessful in two patients due to technical difficulties. All cases were explored surgically, guided by the DCE-MRA. Surgery confirmed that 14 AVF sites were located in the thoracic spine, 5 in the lumbar spine, and 1 in the cervical spine. The origin of the fistulas and feeding arteries was accurately shown by DCE-MRA in 11 of the 15 patients. DCE-MRA also detected dilated perimedullary veins in all 15 patients. Overall, DCE-MRA facilitated DSA catheterization in 10 cases. In six patients, the artery of Adamkiewicz could be observed. In 15 out of 20 fistulas (75%), both readers agreed on the location on DCE-MRA images, and the κ coefficient of the interobserver agreement was 0.67 (95% confidence interval [CI], 0.16-0.87). In 13 of 16 shunts (75%), the DCE-MRA consensus findings and DSA findings coincided. The intermodality agreement was 0.77 (95% CI: 0.35-0.92). CONCLUSIONS: Our DCE-MRA studies benefited from the use of a high-field 3T MR imaging unit and reliably detected and localized the SDAVF and feeding arteries. As experience with this technique grows, it may be possible to replace DSA with DCE-MRA if surgery is the planned treatment.

[Study on Indole-3-carbinol inhibits nasopharyngeal carcinoma cells growth in vitra and in vivo].

Objective:The aim of this study is to investigate the inhibition of nasopharyngeal carcinoma cells by indole-3-carbinol in vitro and in vivo.Method:The human nasopharyngeal carcinoma cell line CNE2 was treated in different concentrations 0,100,200,300 µmol/L of indole-3-carbinol. Then we detected cell proliferation after 0,24,48 and 72 h, apoptosis after 48 h and the levels of PI3K/Akt pathway-related proteins in vitro. The BALB/c nude mice were divided into three groups: prevention group, treatment group and control group. In vivo, the nude mice in every group were inoculated with nasopharyngeal carcinoma cells CNE2, and mice in prevention and treatment groups were given feed containing 0.5% indole-3-carbinol. We investigated the tumoricidal effect of I3C in nude mice , and eight weeks later, the PI3K/Akt pathway-related proteins expressions in tumors from nude mice of each group were detected.Result:With the indole-3-carbinol concentration increased, cell proliferation decreased and apoptosis increased significantly.The levels of PI3K/Akt pathway-related proteins were decreased.In animal experiments, the prevention and treatment group developed smaller tumors, and the expression of PI3K/Akt pathway-related proteins in prevention and treatment groups PI3K/Akt pathway also reduced, compared to control group. Meanwhile, nearly no changes of heart, liver and kidney tissues in all groups were seen in HE staining.Conclusion:Indole-3-carbinol inhibited the growth of nasopharyngeal carcinoma cells and induced apoptosis effectively in vivo and in vitro. The mechanism might be that indole-3-carbinol could suppress PI3K/Akt pathway.

Establishment of a neuroblastoma mouse model by subcutaneous xenograft transplantation and its use to study metastatic neuroblastoma.

The aim of this study was to establish a metastatic human neuroblastoma (NB) mouse model by xenograft in order to study the metastatic mechanisms of NB. A human NB cell line was obtained from a 5-year-old patient and cultured in vitro. A suspension of these cells was subcutaneously inoculated into nude mice at the right flank next to the forelimb. The biological characteristics of the developed subcutaneous and metastatic tumors were analyzed by hematoxylin and eosin staining. The expression of the tumor marker neuron-specific enolase was determined by immunohistochemistry, and the invasive ability of metastatic tumors was examined by a Matrigel invasion assay. DNA microarray analyses were performed to examine the metastasis-related gene expression. Our results showed that tumors grew in 75% of the mice injected with NB cells and the rate of metastasis was 21%. The xenograft tumors retained the morphological and biological characteristics of the NB specimen from the pediatric patient. Neuron-specific enolase was highly expressed in both subcutaneous and metastatic tumors. The metastatic tumor cells possessed a higher invasive capability than the primary NB cells. The expression of 25 metastasis-related genes was found to be significantly altered in metastatic tumors compared to primary tumors, including RECK, MMP2, VEGF, MMP3, and CXCL12. In conclusion, we successfully established a human NB xenograft model with high tumor-bearing and metastatic rates in nude mice, providing an ideal animal model for the in vivo study of NB.

Elevated TrkA receptor expression is associated with all-trans retinoic acid-induced neuroblastoma differentiation.

Neuroblastoma is the most common and one of the deadliest among pediatric tumors; however, a subset of infants with neuroblastoma display spontaneous regression. The mechanism of spontaneous regression remains to be elucidated. TrkA plays an essential role in the differentiation and functionality of neurons; abundant TrkA expression is associated with favorable prognosis of neuroblastoma. All-trans retinoic acid (ATRA), a first-line drug for acute promyelocytic leukemia (APL) treatment, has been shown to induce differentiation and inhibit cell growth. Neuroblastoma tissues in our hospital inpatient were collected, primary cell culture was performed, and the cells were separated and purified to be cell line. Trypan blue exclusion was used to count the numbers of cells alive, morphological changes were observed under the phase-contrast microscope. RT-PCR was used to determine the expression level of TrkA. In this study, a human neuroblastoma cell line was successfully established; in addition, we demonstrated that ATRA induces growth arrest and promotes the differentiation of neuroblastoma cells. In addition, ATRA was shown to significantly increase the levels of TrkA mRNA expression. Therefore, we concluded that the elevated expression of the TrkA receptor is associated with ATRA-induced growth arrest and differentiation o neuroblastoma cells. The results of this study provide a theoretical basis for the clinical application of differentiation-inducing ATRA for neuroblastoma therapy.

Involvement of T helper type 17 and regulatory T cell activity in tumour immunology of bladder carcinoma.

T helper type 17 (Th17) and regulatory T cells (T(reg) ) play an important role in the pathogenesis of inflammation and autoimmune disorders. Recent studies have suggested that they also had an impact on tumour immunology. However, the relationship between Th17 and T(reg) cells in the pathogenesis of bladder carcinoma is still unclear. Flow cytometry was used to analyse the numbers, phenotype and cytokine production of Th17 cells in peripheral blood and tumour tissue from bladder carcinoma patients, in parallel with analysis of T(reg) cells. The suppressor capacity of T(reg) and the potential effects of interleukin (IL)-2 on the differentiation of Th17 and T(reg) cells in vitro were studied in a T cell stimulation and suppression assays. The results were as follows: Th17 cells were enriched in the tumours of patients with bladder carcinoma compared with the peripheral blood of patients and controls; patients with bladder carcinoma had a higher proportion of T(reg) cells in peripheral blood compared with healthy controls and nearly all patients examined showed a relative enrichment of tumour-infiltrating T(reg) with respect to peripheral blood; there appeared to be an inverse relationship between tumour-infiltrating Th17 and T(reg) cells; IL-2 could convert tumour-infiltrating T(reg) cells cultured in the presence of the autologous irradiated CD3(-) fraction into Th17 cells, down-regulate forkhead box P2 expression and suppressive capacity of T(reg) cells. This study is the first to define the frequency and characteristics of Th17 cells in bladder carcinoma. We suggest that the balance between Th17 and T(reg) cells may be involved in the development or progression of bladder carcinoma.

Establishment of the long-term in vitro culture system for chicken primordial germ cells.

The objective of this study was to establish the long-term in vitro culture system for chicken gonadal primordial germ cells (gPGCs). Primitive gonads collected from 5.5-day-old chicken embryos were dissociated and explanted onto plates pre-coated with 0.1% gelatin. Each of the four different conditioned media from proliferating and mitotically inactivated chicken embryonic fibroblast (CEF) cells and murine embryonic fibroblasts (STO cells, CRL-1053, ATCC, USA), respectively, was supplemented with growth factors and used to support the growth of gPGCs. The result showed that all the conditioned media could promote the growth and colony formation of gPGCs in vitro, in particular the medium conditioned by inactivated CEF cells. The gPGC-derived colonies maintained in inactivated CEF cells-conditioned medium up to 281 days were positively stained by periodic acid Schiff reaction and antibodies specific to anti-SSEA-1, SSEA-3, SSEA-4, integrin alpha6 and integrin beta1. Their capacities of migration via vascular system and taking up residence in the primary gonadal ridge were further demonstrated by transferring to the dorsal aorta of stage 17 recipient embryos. These results suggested that our culture system is able to maintain chicken gPGCs for long-term in vitro culture without losing their capacity to express pluripotent markers and to integrate into the gonads.

In vitro susceptibility of 10 clinical isolates of SARS coronavirus to selected antiviral compounds.

Effective antiviral agents are urgently needed to combat the possible return of severe acute respiratory syndrome (SARS). Commercial antiviral agents and pure chemical compounds extracted from traditional Chinese medicinal herbs were screened against 10 clinical isolates of SARS coronavirus by neutralisation tests with confirmation by plaque reduction assays. Interferon-beta-1a, leukocytic interferon-alpha, ribavirin, lopinavir, rimantadine, baicalin and glycyrrhizin showed antiviral activity. The two interferons were only active if the cell lines were pre-incubated with the drugs 16 h before viral inoculation. Results were confirmed by plaque reduction assays. Antiviral activity varied with the use of different cell lines. Checkerboard assays for synergy were performed showing combinations of interferon beta-1a or leukocytic interferon-alpha with ribavirin are synergistic. Since the clinical and toxicity profiles of these agents are well known, they should be considered either singly or in combination for prophylaxis or treatment of SARS in randomised placebo controlled trials in future epidemics.

Variables affecting simulated use determination of residual ethylene oxide in medical devices.

In autumn 1993, AAMI/ST/WG 63, Sterilization Residuals Working Group undertook the task of studying factors involved in determining the amount of residual ethylene oxide in medical devices after sterilization and developing a protocol for controlling the relevant variables. The protocol was evaluated by conducting a round robin study consisting of 8 participating laboratories from around the country. Results of this round robin study demonstrated the range over which results may vary despite controls placed on the time and temperature at which determinations were conducted. The data from the study suggest that small, random variations in technique during short sample extraction times can lead to variability in the results. Variables such as initial water temperature, oven temperature, weighing of sample, and length of extraction should be carefully controlled. Inherent variations in the material composition of similar devices are possible contributing factors. The efforts of this working group and the subsequent evaluation and discussion of its findings are presented.

[Effect of combined treatment of Shuanghuanglian and recombinant interferon alpha 2a on coxsackievirus B3 replication in vitro].

OBJECTIVE: To investigate the effect of combined treatment of Shanghanglian (SHHL) and recombinant interferon alpha 2a on Coxsackie virus B3 replication. METHODS: Microdose cytopathogenic inhibition effect assay was used in Wish and Vero cultured cells. rIFN-alpha 2a was applied 12 hours before Coxsackievirus B3 inoculation and SHHL was applied 1 hour after Coxsackievirus B3 inoculation. RESULTS: 0.125 mg.ml-1 SHHL has a synergism with rIFN-alpha 2a to inhibit CPE caused by Coxsackievirus B3 on the Wish and Vero cells. The anti-cox-sackievirus activity of combined treatment was 2.58 times higher than that of rIFN-alpha 2a treatment. CONCLUSION: This combined treatment of drugs may be useful in preventing and treating Coxsackie B3 Virus infection.