Reflections on the aconitine poisoning.

Aconitine is a natural toxic substance belonging to the family of aconitum alkaloids, which is used in small doses by Traditional Chinese practitioners. We present a case of accidental death due to acute aconitine poisoning. A 65-year-old Chinese man presented to a medical clinic with fever and shoulder pain. Soon after administration of intravenous ceftriaxone, a bottle of Chinese medicinal wine was administered. The man rapidly experienced headache, hearing loss and tinnitus, nausea, diarrhea, numbness of the lips, tongue, face, and the upper and lower extremities, cold sweat, fall of blood pressure, and discomfort of the entire body, and he died on the same day. Postmortem examination showed cyanosis of the nail beds, severe congestion in lungs and other organs, bilateral pleural effusions, and infiltration of basophils in the intestinal submucosa. No significant increase of IgE was found in the blood. Toxicological analysis detected aconitine in the medicinal wine, blood, and stomach contents by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Aconitine was quantified in cardiac blood as 16.4 ng/ml, and in stomach contents (63.8 ng/ml) and wine sample (10.1 ug/ml). The cause of death was aconitine poisoning. This case report highlights the danger of aconitine. LC-MS/MS has the advantages of high analytic speed, sensitivity, and accuracy. It would be desirable for the government to control the use of aconitine-containing herbal extracts.

DNA methylation at CpG island shore and RXRα regulate NR2F2 in heart tissues of tetralogy of Fallot patients.

The nuclear receptor subfamily 2 group F member 2 (NR2F2) gene encodes a ligand-inducible transcription factor involved in angiogenesis and heart development. This study aimed to elucidate the molecular mechanism of epigenetic regulation of NR2F2 in tetralogy of Fallot (TOF) development. In the present study, immunohistochemical staining showed that NR2F2 protein expression was significantly higher in the right ventricular outflow tract (RVOT) tissues of TOF cases compared with controls. The methylation status of the CpG island shore (CGIS) of the NR2F2 gene was decreased in TOF cases, and the CpG site 3 in the CGIS region of NR2F2 promoter was a differential methylation site. Furthermore, the methylation level of the CpG site 3 and the NR2F2 protein expression were significantly negatively correlated in TOF patients. In vitro functional analysis revealed that RXRα could upregulate the NR2F2 gene by directly binding to the CGIS in the NR2F2 promoter, while hypomethylation of the NR2F2 promoter via treatment with 5-azacytidine influenced the affinity of RXRα to its binding sites, as shown by ChIP-qPCR. These findings suggest that promoter hypomethylation activates NR2F2 by enhancing RXRα binding to NR2F2 CGIS in the development of TOF.

Effects of sensory integration therapy on cognitive function and self-care ability in patients with mild cognitive impairment after stroke / 中国实用护理杂志

Objective:To investigate the changes of cognitive function and self-care ability in patients with mild cognitive impairment after stroke after sensory integration therapy.Methods:One hundred patients with mild cognitive impairment after stroke were divided into control group and intervention group according to the random number table method. The control group was given the routine health education path and rehabilitation training, and the intervention group was given the cognitive rehabilitation through sensory integration therapy on the basis of the control group. The cognitive function and self-care ability of the patients were evaluated by the Montreal cognitive assessment(MoCA) and daily self-care ability scale(ADL) before and after intervention.Results:After intervention, the total MoCA score, visual space, nominalization, language, abstraction and memory scores of the intervention group were 26.02±1.15, 3.50±0.76, 2.98±0.14, 2.90±0.30, 2.84±0.37 and 3.18±0.69, respectively, while those of the control group were 23.32±1.90, 2.86±1.20, 2.78±0.42, 2.82±0.39, 1.58±0.54 and 2.82±0.94, respectively. The difference between the two groups was statistically significant ( t value was -18.296--2.064, all P<0.05). The scores of attention and directional force in the intervention group were 5.44±0.67 and 5.18±0.85, respectively, while those in the control group were 5.32±0.84 and 5.14±0.78, respectively. There was no statistically significant difference between the two groups ( t value was -1.288, -0.704, P>0.05).After intervention, the total ADL score, stool, urine, toilet, eating, dressing and bathing scores of the intervention group were 65.00±5.98, 5.90±2.19, 6.40±2.27, 7.40±2.72, 7.80±2.70, 7.50±2.53 and 5.50±1.52, respectively, The control group was 53.60±10.20, 3.50±3.23, 5.00±3.50, 5.50±3.23, 5.40±3.76, 5.90±3.45, and 4.40±2.79, respectively. The difference between the two groups was statistically significant ( t value was -7.573~-2.615, all P<0.05). Conclusions:Sensory integration therapy can improve the cognitive function and self-care ability of patients with mild cognitive impairment after stroke.

Cardiac angiosarcoma: A case report and review of current treatment.

RATIONALE: Primary cardiac angiosarcoma is a rare malignant cardiac neoplasm with early metastasis and poor prognosis. As there are currently no guidelines or effective therapeutic strategies, management of this condition depends on previous experiences of the clinician treating and the consideration of reported cases. PATIENT CONCERNS: A 65-year-old male presented to our department with a 4-day history of chest tightness, dyspnea, lower extremity weakness and occasional dizziness, and a transthoracic echo (TTE) revealed a right atrium occupying mass. DIAGNOSES: TTE showed right atrium occupation, and the post-operative histopathology showed the tumor to be a primary cardiac angiosarcoma. INTERVENTIONS: Right atrium tumor resection and right atrium reconstruction with a bovine pericardium were performed. OUTCOMES: The patient recovered from surgery and discharged but died 10 months after surgery because of complete resection was impossible and adjuvant therapy was not performed. LESSONS: Resection of primary cardiac angiosarcomas should be integrated with a combination of chemotherapy, radiotherapy, and targeted therapy based on tumor cell gene mutation and altered expression.

The impacts of the green aerobics to the homocysteine level in blood and the morning surge in blood pressure of patients who suffer from H-type hypertension as well as ischemic stroke / 中国实用护理杂志

Objective@#To analyze the effects of green aerobics on serum homocysteine concentration and the morning surge in blood pressure in H-type hypertension patients with ischemic stroke.@*Methods@#The 125 patients who suffer from H-type hypertension as well as ischemic stroke were divided into two groups by random digital table method. The control group (60 cases) accepted neurology normal nursing, while the intervention group (65 cases) accepted green aerobics intervention except the neurology normal nursing. The patients′ homocysteine level and the morning surge in blood pressure were assessed in two groups.@*Results@#Two weeks later, the homocysteine level in the control group was (9.44±2.07) mmol/L, while the intervention group was (11.62±3.03) mmol/L. The difference between the two groups had statistics significance(t=-5.257, P <0.05). The morning surge in blood pressure was (18.75±7.51) mmHg(1 mmHg=0.133 kPa), while the control group was (34.07±2.91) mmHg. The difference between the two groups had statistics significance (t=15.761, P <0.05).@*Conclusions@#The green aerobics could effectively lower the homocysteine level and the morning surge in blood pressure of patients who suffer from H-type hypertension as well as ischemic stroke. It was an alternative therapy or assistant therapy without side effects.

The impacts of the green aerobics to the homocysteine level in blood and the morning surge in blood pressure of patients who suffer from H-type hypertension as well as ischemic stroke / 中国实用护理杂志

Objective To analyze the effects of green aerobics on serum homocysteine concentration and the morning surge in blood pressure in H-type hypertension patients with ischemic stroke. Methods The 125 patients who suffer from H-type hypertension as well as ischemic stroke were divided into two groups by random digital table method. The control group (60 cases) accepted neurology normal nursing, while the intervention group (65 cases) accepted green aerobics intervention except the neurology normal nursing. The patients′homocysteine level and the morning surge in blood pressure were assessed in two groups. Results Two weeks later, the homocysteine level in the control group was (9.44± 2.07) mmol/L, while the intervention group was (11.62 ± 3.03) mmol/L. The difference between the two groups had statistics significance(t=-5.257, P<0.05). The morning surge in blood pressure was (18.75± 7.51) mmHg(1 mmHg=0.133 kPa), while the control group was (34.07 ± 2.91) mmHg. The difference between the two groups had statistics significance (t =15.761, P <0.05). Conclusions The green aerobics could effectively lower the homocysteine level and the morning surge in blood pressure of patients who suffer from H-type hypertension as well as ischemic stroke. It was an alternative therapy or assistant therapy without side effects.

The effects of isometric resistance training conducted using handgrip exercise on blood pressure variability in hypertensive patients with minor ischemic stroke / 中国实用护理杂志

Objective The present study aimed to evaluate the effects of isometric resistance training(IRT)conducted using handgrip exercise on blood pressure variability (BPV) and heart rate variability (HRV) in hypertensive patients with minor ischemic stroke (MIS).Methods One hundred and twenty-five hypertensive patients with MIS were included in the present study. Patients were randomized into two groups with random number table. Patients in the control group (n=60) were nursed in the routine care in department of neurology, while patients in the experimental group (n=65) received the IRT.The 24-hour ambulatory blood pressure-monitoring assessment was performed using validated oscillometric recorders (A&D TM- 2430, A&D Inc.,Tokyo,Japan).The 24- hour ambulatory electrocardiography measurement was performed using electrocardiocorder(PI200A-A, QunTian Inc.,Shanghai,China).The BPV ratio and the HRV ratio were assessed in the two groups. Results 24 hours after the intervention, intervention group 24 hours systolic blood pressure variation coefficient and diastolic blood pressure variation coefficient were(10.16 ± 1.95)％,(12.6 ± 7.15)％,the control group, respectively (12.92 ± 2.79)％, (17.38±4.49)％, two groups compare the difference was statistically significant (t=6.450, 4.435, P<0.05). Intervention group of normal sinus R- R period between the standard deviation, to the phase difference between adjacent R- R , root mean square value of the whole difference in more than 50 ms continuous period of percentage between normal R-R and triangle Index were (173.3±58.5) ms, (115.9±74.4), (54.8± 24.1)％, (53.3 ± 15.1).The control group was(128.7 ± 40.2)ms, (82.1 ± 35.2),(39.9 ± 17.1)％, (30.6 ± 14.9), and the difference between the two groups was statistically significant(t=-8.439--3.207, all P<0.05). Conclusions Isometric resistance training conducted using handgrip exercise could increase the HRV and decrease the BPV in hypertensive patients with MIS. These results indicated that the IRT may improve the life quality of hypertensive patients with MIS.

The efficacy and safety of insulin degludec versus insulin glargine in insulin-naive subjects with type 2 diabetes: results of a Chinese cohort from a multinational randomized controlled trial / 中华内科杂志

Objective To compare the safety and efficacy of insulin degludec (IDeg) with those of insulin glargine (IGlar) in insulin-naive subjects with type 2 diabetes (T2DM).Methods This was a 26-week,randomized,open-label,parallel-group,treat-to-target trial in 560 Chinese subjects with T2DM (men/women:274/263,mean age 56 years,mean diabetes duration 7 years) inadequately controlled on oral antidiabetic drugs (OADs).Subjects were randomized 2:1 to once-daily IDeg (373 subjects) or IGlar(187 subjects),both in combination with metformin.The primary endpoint was changes from baseline in glycosylated hemoglobin(HbA1c) after 26 weeks.Results Mean HbA1c decreased from 8.2％ in both groups to 6.9％ in IDeg and 7.0％ in IGlar,respectively.Estimated treatment difference (ETD) of IDegIGlar in change from baseline was-0.10％ points (95％ CI-0.25-0.05).The proportion of subjects achieving HbA1c ＜ 7.0％ was 56.3％ and 49.7％ with IDeg and IGlar,respectively [estimated odds ratio of IDeg/IGlar:1.26 (95 ％ CI 0.88-1.82)].Numerically lower rateof overall confirmed hypoglycaemia and statistically significantly lower nocturnal confirmed hypoglycemia were associated with IDeg compared with IGlar,respectively [estimated rateratio of IDeg/IGlar 0.69 (95％ CI 0.46-1.03),and 0.43 (95％ CI 0.19-0.97)].No differences in other safety parameters were found between the two groups.Conclusions IDeg was non-inferior to IGlar in terms of glycaemic control,and was associated with a statistically significantly lower rate of nocturnal confirmed hypoglycaemia.IDeg is considered to be suitable for initiating insulin therapy in Chinese T2DM patients on OADs requiring intensified treatment.Clinical trail registration Clinicaltrials.gov,NCT01849289.

Histopathological and ultrastructural observation of the supraspinal ligaments in ankylosing spondylitis / 中华风湿病学杂志

Objective To observe the histopathological and ultrastructural changes of the supraspinal ligaments in ankylosing spondylitis (AS).Methods The supraspinal ligaments were stained with HE,Sirius Red/saturated carbazotic acid and then observed nuder microscope,electyonic scanning microscope and transmission electron microscope respectively.The density of blood vessel and collagen fibril were analy-zed.Statistical analysis was carried out by using t test.Results In the AS group,under the microscope,the arrangement of in collagen fibers was in chaos,and hyalinosis,fatty infiltration could be seen.Vascular proliferation was predominant.Collagen-Ⅲ expression could be detected in this group.Under electron microscope,the distribution of collagen fibril was sparse,and the periodic strita was indistinct,the matrix was degraded,and some matrix vesicle could be seen.While in the control group,orderly arrangd collagen fibrils could be seen,and no change of blood vessels could be seen.The density of vascular structures in the AS group was (6.8±0.7)/HP,and (1.0±0.4)/HP of the control group.The density of collagen fibrils in the AS group was (122±22)/μm2,and that of the control group was (218±10)/μm2,the difference between the two groups was statistically significant (P＜0.05).Conclusion A series of histopathological changes have occurred in the supraspinal ligaments in AS patients.