A case of multiple ART intolerance responds to Albuvirtide and Dolutegravir: Case report and literature review.

Upon confirming an HIV diagnosis, patients need to start life-long antiretroviral therapy (ART) as soon as possible. During HIV treatment, ART drugs can cause intolerable adverse reactions, leading to poor medication compliance, treatment failure, and advancement of the HIV stage. Herein, we report a case of AIDS intolerant to multiple antiviral drugs due to side effects that we finally stabilized with the Albuvirtide (ABT) and Dolutegravir (DTG) combination. A 48 -year-old woman developed intractable nausea, vomiting and abdominal discomfort within one month of starting ART. Over the course of four years, she was switched to four different ART regimens due to her intolerance of severe adverse effects, mainly gastrointestinal symptoms, rash, and lethargy. Over four years, she failed to attain viral suppression due to poor drug compliance. After several ART changes, we started her on the Long-acting antiretroviral therapy (LA ART), Albuvirtide, combined with Dolutegravir, which she tolerated well. The patient's general condition improved significantly and attained marked virologic suppression. The patient's condition has been well controlled for nearly two years with good adherence. This case emphasizes the influence of ART treatment options on medication compliance and the outcome of HIV infection.

The effect of incentives on intertemporal choice: Choice, confidence, and eye movements.

Despite various studies examining intertemporal choice with hypothetical rewards due to problematic real reward delivery, there remains no substantial evidence on the effect of the incentives on the decision confidence and cognitive process in intertemporal choice and no comprehensive exploration on the loss domain. Hence, this study conducts an eye-tracking experiment to examine the effect of incentive approach and measure participants' decision confidence using a between-subject design in both gain and loss domains. Results replicated previous findings which show incentives do not affect intertemporal choice in the gain domain. In contrast, in the loss domain, participants in the incentivized group were more likely to choose the larger-later options than those in the non-incentivized group. Furthermore, the decision confidence and the mean fixation duration differed between the incentivized and non-incentivized groups in both gain and loss domains. These findings allow for a better understanding of the effect of incentives on intertemporal choice and provide valuable information for the design of incentives in future intertemporal experiments.

Assessment of knowledge and perceptions of medical radiation among caregivers and adolescent patients in the paediatric emergency department

INTRODUCTION@#This study aimed to assess understanding of the potential risks associated with medical imaging among caregivers and adolescent patients in a paediatric emergency department (PED) in Singapore.@*METHODS@#A prospective convenience sample survey was performed involving adolescents and caregivers presenting to our PED from December 2015 to May 2016. The questionnaire examined demographic data, knowledge of imaging procedures and radiation risks, and expectations regarding information provided about medical radiation.@*RESULTS@#A total of 349 questionnaires were returned (caregivers 82.5%, adolescents 17.5%). A mean of 6.2 ± 2.4 (out of 11) questions were correctly answered. Those who had tertiary education fared better than those who did not (36.4% vs. 17.2% scoring above the mean, p = 0.001). Age, gender, history of previous imaging and imaging performed during the visit did not affect the score. Two-thirds of the participants did not associate medical radiation with any negative lifetime risk of cancers or know that different scans entailed differing amounts of radiation. Most were unaware that the radiation dose in medical imaging is adjusted to a child's size. Among patients who underwent imaging, 90.1% received explanations on the need for scans, and 26.5% were informed of the risks involved. Almost all participants wished to be informed of imaging indications and risks. More preferred to learn this from physicians (75.6%) or technicians (51.6%) rather than through educational pamphlets (34.4%) or Internet resources (22.9%).@*CONCLUSION@#Awareness regarding medical radiation needs to be improved in our patient population. A mismatch exists between caregiver expectations and the actual procedure of disclosure of the risk associated with radiation.

Artesunate-Based Multifunctional Nanoplatform for Photothermal/Photoinduced Thermodynamic Synergistic Anticancer Therapy.

Thermodynamic therapy (TDT), one that uses heat to activate thermosensitizers and produce reactive oxygen species (ROS), has recently emerged as an attractive approach for cancer therapy. However, the development of safe and efficient thermosensitizers for TDT remains a big challenge. Here, we have found that artesunate (ARS) could produce ROS upon heating. Based on this interesting result, we have designed and prepared a pH-sensitive liposomal nanoplatform (ICG-ARS@NPs) composed of indocyanine green (ICG) and ARS for photoinduced TDT as well as photothermal therapy (PTT). Under the slightly acidic conditions in tumor tissues, the pH-sensitive liposomal ICG-ARS@NPs were able to release their drug cargos. Upon near-infrared irradiation, the photothermal agent ICG generated in situ hyperthermia and triggered the thermal sensitizing activity of ARS to produce ROS, resulting in damage to cancer cells and tumor tissues. The heat-induced ROS generation of ARS was also confirmed both in vitro and in vivo. In addition, because of their specific tumor targeting and synergistic photothermal and thermodynamic effects, ICG-ARS@NPs exhibited highly efficient anticancer therapeutic efficacy in H22 tumor-bearing mice. We believe that this work will promote the exploration of TDT for cancer therapy as well as the application of the old drug, artemisinin.

Simultaneous determination of eight constituents in Shenmai Zhisou Syrup by HPLC-ELSD / 中成药

AIM To establish an HPLC-ELSD method for the simultaneous content determination of euscaphic acid,tormentic acid,crategolic acid,corosolic acid,ophiopogonin D,ophiopogonin D',methylophiopogonanone A and methylophiopogonanone B in Shenmai Zhisou Syrup (Eriobotryae Folium,Ophiopogonis Radix,Glehniae Radix,etc.).METHODS The analysis of methanol extract of this drug was performed on a 35 ℃ Alltima C18 column (4.6 mm × 250 mm,5 μm),with the mobile phase comprising of (acetonitrile-methanol)-0.5％ ammonium acetate flowing at 0.7 mL/min in a gradient elution manner.RESULTS Eight constituents showed good linear relationships within their own ranges (r ＞ 0.999 0),whose average recoveries were 96.85％-99.43％ with the RSDs of 0.57％-1.33％.CONCLUSION This simple and accurate method can be used for the rapid quality control of Shenmai Zhisou Syrup.

Simultaneous determination of eight constituents in Wuli Huichun Pills by HPLC / 中成药

AIM To establish an HPLC method for the simultaneous content determination of arctiin,arctigenin,forsythoside A,narirutin,naringin,rhoifolin,prim-O-glucosylcimifugin and 5-O-methylvisammioside in Wuli Huichun Pills (Saposhnikoviae Radix,Arctii Fructus,Forsythiae Fructus,etc.).METHODS The analysis of 70％ methanol extract of this drug was performed on a 25 ℃ thermostatic Agilent TC-C18 column (4.6 mm ×250 mm,5 μm),with the mobile phase comprising of methanol-0.4％ glacial acetic acid flowing at 0.9 mL/min in a gradient elution manner.RESULTS Eight constituents showed good linear relationships within their own ranges (r ＞ 0.999 0),whose average recoveries were 96.55％-99.50％ with the RSDs of 0.54％-1.72％.CONCLUSION This accurate,reliable and reproducible method can be used for the quality control of Wuli Huichun Pills.

Application of Doctor-nurse Integrative Medical Care in Analgesia at Home for Cancer Patients / 昆明医科大学学报

Objecctive To explore the construction and effect of the Doctor-nurse integrative medical care mode for domestic analgesia in middle and late stage cancer patients.Me thods From september 2016 to February 2017, 120 Cancer patients in The People's hospitalof Du Jiang Yan were included, and randomly divided into experimental group (n=60) and observation group (n=60). The observation group received routine outpatient follow-up after discharge.The experimental group was treated with the Doctor-nurse integrative medical care mode.The analgesic modes included psychological support, immediate morphine and morphine sustained release tablets for personalized home titration. The Net bottom-hospitals were responsible for the follow-up and intervention, the training and guidance were bore by Hub hospitals. The patients were followed up at the first and twelfth weeks, followed by telephone follow-up at fourth and eighthweek, after discharge. The quality of life, the degree of depression and the degree of anxiety of caregiver were compared between the two groups at the beginning of the study and the twelfth weeks after discharge. Re s ults In experimental group, the scores of in the life quality of patints before and after intervention were (62.43±12.83) and (50.33 ±9.04), respectively, the scores of depression before and after intervention were (50.33± 6.59) and (47.37±4.97), respectively, the scores of anxiety before and after intervention were (55.05 ±8.82) and (52.22 ±5.37). There was statistically significant difference between the two groups (P＜0.05). Conclus ions Doctor-nurse integrative medical care mode can improve the quality of life of patients with advanced cancer, reduce the degree of depression, and reduce the degree of anxiety of patients.

Gelatin-functionalized mesoporous silica nanoparticles with sustained release properties for intracameral pharmacotherapy of glaucoma.

Herein, pilocarpine-loaded gelatin-covered mesoporous silica nanoparticles (denoted as p/GM) were intracamerally administrated into the anterior chamber for the reduction of intraocular pressure (IOP). The in vitro release profile shows that p/GM demostrates a high release percentage (50%) with a long-lasting release profile (36 days). The in vivo studies showed the maintenance of IOP in eye with ocular hypertension for 21 days.

Reducing the door-to-needle time for patients with acute ischemic stroke based on the quality improvement program of PDCA cycle / 国际脑血管病杂志

ObjectiveTo investigate the role of reducing the door-to-needle time for patients with acute ischemic stroke based on the quality improvement program of PDCA cycle.MethodsConsecutive patients with acute ischemic stroke admitted to hospital were registered prospectively from January 1, 2016 to September 30, 2016.Questionnaires and time tracking method were used to investigate the door-to-needle (DNT) and its influencing factors.PDCA cycle method was used to improve the stroke channel workflow and the changing trend of DNT was analyzed.ResultsA total of 71 patients with acute ischemic stroke were enrolled.After 3 PDCA cycles, DNT (median, interquartile range) from 100.0 min (65.5-127.0 min) reduced to58.0 min (45.5-80.0 min) (Z=11.689, P<0.001), the proportion of the patients with DNT ≤60 min increased from 19.05% to 60.00% (χ2=7.893, P=0.019).Conclusions The quality improvement program of PDCA cycle may effectively reduce the time of DNT in patients with acute ischemic stroke.

Comparison of Measurement Methods of Exophthalmos and Its Forensic Significance / 法医学杂志

Objective To compare the differences between Hertel exophthalmometry and CT on exophthalmos measurement,and explore its practical application value in forensic medicine.Methods Fifty-six normal individuals without eye injuries or diseases were selected as the control group.The absolute values of exophthalmos were measured in the standardized CT image workstation.The difference of binocular exophthalmos was compared in normal group.Forty-seven cases with unilateral orbital fracture were divided into injured eye group and normal eye group according to the presence of binocular orbital fractures.The differences of the absolute values of eophthalmos from the same eye and the relative values of eophthalmos between two eyes for same person measured by Hertel exophthalmometry and CT were analyzed.Results There was no statistical difference of exophthalmos between the normal eyes measured by CT method.In the normal eye group,the absolute value of exophthalmos measured by CT method was (16.66±5.41) rm,which was (16.16±4.45)mm when measured by the Hertel exophthalmometry method.There was no statistical difference between two groups (P＞0.05).In the injured eye group,there was statistical difference between the absolute values of exophthalmos measured by two measurement methods (P＜0.05).There was no statistical difference of the relative values of exophthalmos between the injured eyes and the normal eyes by two measurement methods (P＞0.05).Conclusion CT method has a good consistency with Hertel exophthalmometry,which can be applied into the practice of medicolegal expertise.

Stabilization of collagen nanofibers with L-lysine improves the ability of carbodiimide cross-linked amniotic membranes to preserve limbal epithelial progenitor cells.

To overcome the drawbacks associated with limited cross-linking efficiency of carbodiimide modified amniotic membrane, this study investigated the use of L-lysine as an additional amino acid bridge to enhance the stability of a nanofibrous tissue matrix for a limbal epithelial cell culture platform. Results of ninhydrin assays and zeta potential measurements showed that the amount of positively charged amino acid residues incorporated into the tissue collagen chains is highly correlated with the L-lysine-pretreated concentration. The cross-linked structure and hydrophilicity of amniotic membrane scaffolding materials affected by the lysine molecular bridging effects were determined. With an increase in the L-lysine-pretreated concentration from 1 to 30 mM, the cross-linking density was significantly increased and water content was markedly decreased. The variations in resistance to thermal denaturation and enzymatic degradation were in accordance with the number of cross-links per unit mass of amniotic membrane, indicating L-lysine-modulated stabilization of collagen molecules. It was also noteworthy that the carbodiimide cross-linked tissue samples prepared using a relatively high L-lysine-pretreated concentration (ie, 30 mM) appeared to have decreased light transmittance and biocompatibility, probably due to the influence of a large nanofiber size and a high charge density. The rise in stemness gene and protein expression levels was dependent on improved cross-link formation, suggesting the crucial role of amino acid bridges in constructing suitable scaffolds to preserve limbal progenitor cells. It is concluded that mild to moderate pretreatment conditions (ie, 3-10 mM L-lysine) can provide a useful strategy to assist in the development of carbodiimide cross-linked amniotic membrane as a stable stem cell niche for corneal epithelial tissue engineering.

Simvastatin inhibits apoptosis of endothelial cells induced by sepsis through upregulating the expression of Bcl-2 and downregulating Bax / 世界急诊医学杂志（英文）

@#BACKGROUND: Many studies have showed that apoptosis of endothelial cells plays a curial role in the progress of sepsis. But the role of simvastatin in apoptosis of endothelial cells induced by sepsis is not clear. The present study aimed to investigate the role of simvastatin in apoptosis of endothelial cells induced by sepsis and its mechanism. METHODS: Human umbilical vein endothelial cells (HUVECs) were randomly divided into three groups: control group, sepsis serum intervention group (sepsis group) and simvastatin+sepsis serum intervention group (simvastatin group). After 24-hour incubation with corresponding culture medium, the relative growth rate of HUVECS in different groups was detected by MTT assay; the apoptosis of HUVECs was detected by Hoechst33258 assay and flow cytometry; and the expression of the Bcl-2 and Bax genes of HUVECs was detected by PCR. RESULTS: Compared with the sepsis group, HUVECs in the simvastatin group had a higher relative growth rate. Apoptotic HUVECs decreased significantly in the simvastatin group in comparison with the sepsis group. Expression of the Bcl-2 gene in HUVECs decreased obviously, but the expression of the Bax gene increased obviously after 24-hour incubation with sepsis serum;however, the expression of the Bcl-2 and Bax genes was just the opposite in the simvastatin group. CONCLUSIONS: Our study suggests that simvastatin can inhibit apoptosis of endothelial cells induced by sepsis through upregulating the expression of Bcl-2 and downregulating Bax. It may be one of the mechanisms for simvastatin to treat sepsis.

A survey on the periodontal status in type 2 diabetic patients / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the type 2 diabetic patient's periodontal condition and to analyze the influencing factors of periodontitis.</p><p><b>METHODS</b>A total of 182 type 2 diabetic patients were included in the survey and requested to fill out a questionnaire, and their periodontal status was evaluated by measuring probing depth (PD), attachment level (AL), sulcus bleeding index (SBI), simplified oral hygiene index (OHI-S).</p><p><b>RESULTS</b>The prevalence of periodontitis in this group of patients was 96.7% (176/182), including 20 patients with mild periodontitis, 156 with moderate to advanced periodontitis. The mean PD and AL of the 182 patients were (2.92 +/- 0.67) mm and (2.87 +/- 1.31) mm. At least one tooth was lost in 57.1% (104/182) of the patients. The factors related to periodontitis were age, gender, smoking, living in town or country, and 2 h plasma glucose of oral glucose tolerance test (OGTT). There was no relationship between the severity of periodontitis and education level. The majority of patients did not receive any periodontal therapy.</p><p><b>CONCLUSIONS</b>Periodontal status was bad in patients with type 2 diabetes. It is important to develop an education program on oral health for type 2 diabetic patients.</p>