Monkeypox presenting as a chancre-like rash: A case report.

BACKGROUND: Since May 2022, outbreaks of monkeypox have occurred in many countries around the world, and several cases have been reported in China. CASE SUMMARY: A 38-year-old man presented with a small, painless, shallow ulcer on the coronary groove for 8 d. One day after the rash appeared, the patient developed inguinal lymphadenopathy with fever. The patient had a history of male-male sexual activity and denied a recent history of travel abroad. Monkeypox virus was detected by quantitative polymerase chain reaction from the rash site and throat swab. Based on the epidemiological history, clinical manifestations and nucleic acid test results, the patient was diagnosed with monkeypox. CONCLUSION: Monkeypox is an emerging infectious disease in China. Monkeypox presenting as a chancre-like rash is easily misdiagnosed. Diagnosis can be made based on exposure history, clinical manifestations and nucleic acid test results.

Simultaneous Detection of Multiple Plant Growth Regulator Residues in Cabbage and Grape Using an Optimal QuEChERS Sample Preparation and UHPLC-MS/MS Method.

BACKGROUND: At present, plant growth regulators (PGRs) are widely used in agricultural and forestry production. PGRs, like traditional pesticides, have certain toxicities. Naively excessively applying them will cause the acute and chronic poisoning of humans and animals and potentially harm human health. OBJECTIVE: In order to assess, prevent, and control the residues of PGRs in fruits and vegetables, a set of quick, easy, cheap, effective, rugged, and safe (QuEChERS) analytical methods that simultaneously detect multiple PGR residues are urgently needed for quality and safety inspection of agricultural product. METHODS: In this study, grapes (representative of fruits) and cabbages (representative of vegetables) were used as the detected objects. The 30 commercial product residues of PGRs were detected in both with an ultra-high performance liquid chromatography (UHPLC)-tandem mass spectrometry (MS/MS) method, based on optimized chromatographic, MS, and preparation conditions (extraction solvent and cleanup conditions). Grape and cabbage samples were extracted with acetonitrile containing 5% (v/v) acetic acid, dehydrated using a salt package, purified using the QuEChERS method, ionized using electrospray ionization under positive and negative ion switching mode, detected using multi-reaction monitoring, and quantification using an external standard method of matrix matching standard curve. RESULTS: Methanol was selected as the strong elution phase. A methanol-0.1% formic acid-5 mmol/L ammonium acetate solution was selected as the best mobile phase. The optimal extraction solvent was acetonitrile containing 5% acetic acid. Primary secondary amine cleanup could met the determination requirements of PGR residues. The developed method for determination of 30 commercial products of PGR, such as betaine, showed excellent linearity in 1-500, 10-1000, ∼500, ∼2000, and 100-10 000 µg/kg (R ≥ 0.98). At the 0.001 (0.01), 0.05, 0.20, and 1.00 mg/kg additive concentrations, the average addition standard recovery of 30 commercial products of PGR were 61-132% with the relative standard deviations of 1-14% and the LOQs were confirmed to be 1.0-100 µg/kg through the actual addition values of samples. CONCLUSION: The set of optimized QuEChERS UHPLC-MS/MS methods simultaneously detect residues of PGRs in fruits and vegetables with one-time sample preparation for high-throughput, rapid quantitative screening, and confirmation. The methods cover a wide range of PGRs with simple and convenient preparation and small amounts of solvent, and can provide technical support for the supervision of PGR residues in fruits and vegetables. HIGHLIGHTS: The optimizations of extraction solvent screening, different ratios of various purification packages in the QuEChERS method, and UPLC-MS conditions were conducted and the precision, sensitivity, and recovery rates of the methods were investigated in order to establish a QuEChERS UPLC-MS/MS method for simultaneously detecting 30 kinds of PGR residues in fruits and vegetables. The methods allow high-throughput determination of multiple PGR residues in fruits and vegetables and can also provide technical references for related compound residue detection of other matrixes.

Drug-induced erythroderma in patients with acquired immunodeficiency syndrome.

BACKGROUND: To explore the clinical manifestations, diagnosis, and treatment of patients with acquired immunodeficiency syndrome (AIDS) complicated with drug-induced erythroderma. METHODS: The clinical data of 12 AIDS patients with drug-induced erythroderma in our hospital were retrospectively analyzed. The general information, offending medications, complications, modified severity-of-illness score for toxic epidermal necrolysis (SCORTEN) scores, and disease outcome spectrums were analyzed. RESULTS: Drug-induced erythroderma was mostly caused by antiviral drugs, antituberculosis drugs, antibiotics, traditional Chinese medicine, and immune checkpoint inhibitors. The spectrum of sensitizing drugs was broad, the clinical situation was complex, and infections were common. The affected areas were greater than 40% body surface area in all patients. The modified SCOTERN score averaged 3.01±0.99. All patients were treated with glucocorticoids, and nine patients were treated with intravenous immunoglobulin (IVIG) pulse therapy at the same time. The average time to effectiveness was 7.08±2.23 days, and the average hospital stay was 17.92±8.46 days. Eleven patients were cured, and one patient died of secondary multiple infections, who had a modified SCORTEN score of 5 points. The mortality rate in this study was 8.3%. CONCLUSIONS: The clinical situation of AIDS patients with drug-induced erythroderma in hospitalized patients is complex and the co-infection rate is high. The use of modified SCORTEN score may objectively and accurately assess the conditions, and the use of glucocorticoid combined with IVIG therapy may improve the prognosis.

RBBP4 promotes colon cancer malignant progression via regulating Wnt/ß-catenin pathway.

BACKGROUND: Our previous study demonstrated that RBBP4 was upregulated in colon cancer and correlated with poor prognosis of colon cancer and hepatic metastasis. However, the potential biological function of RBBP4 in colon cancer is still unknown. AIM: To investigate the biological role and the potential mechanisms of RBBP4 in colon cancer progression. METHODS: Real-time polymerase chain reaction and western blot analysis were used to detect the expression of RBBP4 in colon cancer cell lines. The cell proliferation and viability of SW620 and HCT116 cells with RBBP4 knockdown was detected by Cell Counting Kit-8 and 5-ethynyl-2'-deoxyuridine staining. The transwell assay was used to detect the invasion and migration capabilities of colon cancer cells with RBBP4 knockdown. Flow cytometry apoptosis assay was used to detect the apoptosis of colon cancer cells. Western blotting analysis was used to detect the expression of epithelial-mesenchymal transition and apoptosis related markers in colon cancer. The nuclear translocation of ß-catenin was examined by Western blotting analysis in colon cancer cells with RBBP4 knockdown. The TOPFlash luciferase assay was used to detect the effect of RBBP4 on Wnt/ß-catenin activation. The rescue experiments were performed in colon cancer cells treated with Wnt/ß-catenin activator LiCl and RBBP4 knockdown. RESULTS: We found that RBBP4 was highly expressed in colon cancer cell lines. The 5-ethynyl-2'-deoxyuridine assay showed that knockdown of RBBP4 significantly inhibited cell proliferation. RBBP4 inhibition reduced cell invasion and migration via regulating proteins related to epithelial-mesenchymal transition. Knockdown of RBBP4 significantly inhibited survivin-mediated apoptosis. Mechanistically, the TOPFlash assay showed that RBBP4 knockdown increased activity of the Wnt/ß-catenin pathway. Meanwhile, RBBP4 knockdown suppressed nuclear translocation of ß-catenin. With Wnt/ß-catenin activator, rescue experiments suggested that the role of RBBP4 in colon cancer progression was dependent on Wnt/ß-catenin pathway. CONCLUSION: RBBP4 promotes colon cancer development via increasing activity of the Wnt/ß-catenin pathway. RBBP4 may serve as a novel therapeutic target in colon cancer.

Correlation between invasive microbiota in margin-surrounding mucosa and anastomotic healing in patients with colorectal cancer.

BACKGROUND: Impaired anastomotic healing is one of the major complications resulting from radical resection in colorectal cancer (CRC). Accumulating evidence suggests that intestinal microbiota is correlated with anastomotic healing. AIM: To explore the microbiota structural shift in margin-surrounding mucosa and evaluate the predictive ability of selected bacterial taxa for impaired anastomotic healing. METHODS: Margin-surrounding mucosa samples derived from 37 patients were collected to characterize the microbial community structure by 16s rRNA gene sequencing. The patients were divided into two groups according to the healing status of anastomoses: well-healing group (n = 30) and impaired-healing group (n = 7). Statistic differences in bacteria taxa were compared by Wilcoxon test and chi-squared test. The predictive ability of the selected bacterial taxa for the healing status of anastomoses was evaluated by the area under the receiver operator characteristic curve. RESULTS: Community structure shifts were observed in the impaired-healing group and well-healing group. Six bacterial species were found to be significantly correlated with anastomotic healing, and among these species, Alistipes shahii, Dialister pneumosintes, and Corynebacterium suicordis were considered as the predictive factors. Taking the known risk factor age into consideration, Alistipes shahii, Dialister pneumosintes, and Corynebacterium suicordis improved predictive ability for the healing status of anastomoses. CONCLUSION: These data show that Alistipes shahii, Dialister pneumosintes, and Corynebacterium suicordis could be considered as supplementary factors in the prediction of anastomosis healing status in patients after CRC radical resection.

Application of 4% formaldehyde under electronic colonoscope as a minimally invasive treatment of chronic hemorrhagic radiation proctitis.

BACKGROUND: To investigate the effectiveness of topical application of 4% formaldehyde as a minimally invasive treatment of rectal bleeding due to chronic radiation proctitis (CRP) under direct vision of electronic colonoscope. METHODS: The clinical data of 13 CRP patients complicated with ≥ grade II bleeding admitted to our hospital between January 2003 and December 2018 were retrospectively analyzed. Under the guidance of electronic colonoscope, 4% formaldehyde combined with 5-aminosalicylic acid (5-ASA) suppositories was topically applied. Patients were followed up for two months after treatment, and the therapeutic effectiveness was observed and analyzed. RESULTS: The rectal bleeding due to CRP was markedly reduced after topical application of 4% formaldehyde under colonoscope in all 13 patients. The bleeding stopped after one treatment session in 11 patients and after the second session in 2 patients. 5-ASA was also applied along with the use of 4% formaldehyde. The therapeutic effectiveness was satisfactory during the 1- and 2-month follow-up period. CONCLUSION: Topical application of 4% formaldehyde under the direct vision of colonoscope as a minimally invasive treatment for CRB-induced bleeding is a simple, effective, affordable, and repeatable technique without obvious complications, which deserves further exploration and promotion.

An emerging trend of equal authorship credit in major public health journals.

BACKGROUND: This study aimed to identify the longitudinal trends and characteristics of the practice of explicitly giving equal credit to multiple authors of publications in public health journals. Manual searches were conducted to identify original research articles, published in five public health journals with the highest IFs according to the "2012 JCR Science Edition" between January 1, 2004 and December 31, 2013, which awarded equal credit to multiple authors (Epidemiologic Reviews, Environmental Health Perspectives, the International Journal of Epidemiology, Epidemiology, and the Annual Review of Public Health). The Instructions to Authors in the five journals were also examined with regard to information about giving equal credit to multiple authors. FINDINGS: Statistically significant differences were noted in the annual prevalence in Environmental Health Perspectives, International Journal of Epidemiology, and Epidemiology (r = 0.753, P = 0.012; r = 0.894, P = 0.000; r = 0.522, P = 0.122, respectively). The first two authors listed in the by-line received equal credit in the majority of articles, but this practice was also extended to authors in nearly every position on the by-line in some publications. The authors given equal credit in articles appearing in Environmental Health Perspectives, International Journal of Epidemiology, and Epidemiology were primarily from European and North American countries. Finally, none of the journals provided specific guidance regarding this practice in their Instructions to Authors. CONCLUSIONS: An emerging trend of giving equal credit to multiple authors is observed in the public health journals. This practice should be better addressed in the guidance provided by journals to authors.

Enterostomy can decrease the mortality of patients with Fournier gangrene.

AIM: To determine the significance of enterostomy in the emergency management of Fournier gangrene. METHODS: The clinical data of 51 patients (49 men and 2 women) with Fournier gangrene who were treated at our hospital over the past 12 years were retrospectively analyzed. The patients were divided into two groups according the surgical technique performed: enterostomy combined with debridement (the enterostomy group, n = 28) or debridement alone (the control group, n = 23). Patients in the enterostomy group received thorough debridement during surgery and adequate local drainage after surgery, as well as administration of broad-spectrum antibiotics. The clinical data and outcomes in both groups were analyzed. RESULTS: The surgical procedures were successful in both patient groups. In the enterostomy group, 10 (35.8%) patients required skin grafting with a total of six debridement procedures. While in the control group, six (26.1%) patients required four debridement procedures. However, this difference was not statistically significant. Following surgery, the time to normal body temperature (6 d vs 8 d, P < 0.05) and average length of hospital stay (14.3 ± 7.8 d vs 20.1 ± 8.9 d, P < 0.05) were shorter in the enterostomy group. The case fatality rate was lower in the enterostomy group than that in the control group (3.6% vs 21.7%, P < 0.05). CONCLUSION: Enterostomy can decrease the case fatality rate of patients with Fournier gangrene.

Excisional hemorrhoidal surgery and its effect on anal continence.

AIM: To investigate the role of anal cushions in hemorrhoidectomy and its effect on anal continence of the patients. METHODS: Seventy-six consecutive patients (33 men and 43 women) with a mean age of 44 years were included. They underwent Milligan-Morgan hemorrhoidectomy because of symptomatic third- and fourth-degree hemorrhoids and failure in conservative treatment for years. Wexner score was recorded and liquid continence test was performed for each patient before and two months after operation using the techniques described in our previous work. The speed-constant rectal lavage apparatus was prepared in our laboratory. The device could output a pulsed and speed-constant saline stream with a high pressure, which is capable of overcoming any rectal resistance change. The patients were divided into three groups, group A (< 900 mL), group B (900-1200 mL) and group C (> 1200 mL) according to the results of the preoperative liquid continence test. RESULTS: All the patients completed the study. The average number of hemorrhoidal masses excised was 2.4. Most patients presented with hemorrhoidal symptoms for more than one year, including a mean duration of incontinence of 5.2 years. The most common symptoms before surgery were anal bleeding (n = 55), prolapsed lesion (n = 34), anal pain (n = 12) and constipation (n = 17). There were grade III hemorrhoids in 39 (51.3%) patients, and grade IV in 37 (48.7%) patients according to Goligher classification. Five patients had experienced hemorrhoid surgery at least once. Compared with postoperative results, the retained volume in the preoperative liquid continence test was higher in 40 patients, lower in 27 patients, and similar in the other 9 patients. The overall preoperative retained volume in the liquid continence test was 1130.61 ± 78.35 mL, and postoperative volume was slightly decreased (991.27 ± 42.77 mL), but there was no significant difference (P = 0.057). Difference was significant in the test value before and after hemorrhoidectomy in group A (858.24 ± 32.01 mL vs 574.18 ± 60.28 mL, P = 0.011), but no obvious difference was noted in group B or group C. There was no significant difference in Wexner score before and after operation (1.68 ± 0.13 vs 2.10 ± 0.17, P = 0.064). By further stratified analysis, there was significant difference before and 2 months after operation in group A (2.71 ± 0.30 vs 3.58 ± 0.40, P = 0.003). In contrast, there were no significant differences in group B or group C (1.89 ± 0.15 vs 2.11 ± 0.19, P = 0.179; 0.98 ± 0.11 vs 1.34 ± 0.19, P = 0.123). CONCLUSION: There is no difference in the continence status of patients before and after Milligan-Morgan hemorrhoidectomy. However, patients with preoperative compromised continence may have further deterioration of their continence, hence Milligan-Morgan hemorrhoidectomy should be avoided in such patients.

Hepatitis C virus infection and biological false-positive syphilis test: a single-center experience.

BACKGROUND: Rapid plasma regain positive and/or treponema pallidum hemagglutination negative [RPR(+)/TPHA(-)] results were designated as biologic false-positive (BFP). There are limited data about BFP reactions against syphilis in patients with hepatitis C virus (HCV) infection. This study aimed to determine the prevalence of BFP reactions for syphilis in patients with HCV infection in a large sample and assess the relationship between BFP reactions and HCV infection. METHODS: A total of 2656 patients with positive anti-HCV and 5600 healthy control subjects were enrolled in this study. Hepatitis C serology was determined by a second generation ELISA test for HCV antibody. Syphilis serology was determined by the RPR test. Those subjects with reactive RPR positive underwent the TPHA test. Demographics and laboratory data were collected by trained clinicians. RESULTS: Among 2656 patients, 111 (4.2%) had a reactive RPR test. Of the 111 patients who were subjected to reactive RPR test, 30 (27.0%) showed HCV(+)/RPR(+). Of 5600 healthy controls, 80 (1.4%) had a reactive RPR test. Fourteen (17.5%) controls with HCV(-)/RPR(+) had a non-reactive TPHA test. These represented 1.1% of all HCV-positive and 0.3% of all HCV-negative subjects (P<0.001). A significantly increased prevalence shown by false-positive tests for syphilis was observed in elderly HCV-seropositive patients. BFP-HCV positive group had a higher prevalence of eosinophilia. The eosinophil abnormality was compared between the patients and controls (66.7% vs 21.4%, P=0.0043). No significant results were observed in antinuclear antibodies, antiphospholipid and complement (C3, C4) (P>0.05). CONCLUSIONS: The data of this study demonstrate that HCV infection is associated with a false-positive RPR test. In this study BFPs were significantly more common in HCV positive patients compared to HCV-negative ones. Eosinophil abnormality can be considered as a predictor for BFP. Excessive BFPs must be considered in assessing the frequency of syphilis in a HCV-positive population and the importance of the treponemal specific serologic test should be emphasized for a diagnosis of syphilis in such population.

[Observation on therapeutic effect of dog-day acupuncture and moxibustion combined with pelvic floor muscle exercises for treatment of female stress urinary incontinence].

OBJECTIVE: To observe the clinical effect of dog-day acupuncture and tortoise-shell moxibustion combined with pelvic floor muscle exercises for treatment of female stress urinary incontinence. METHODS: Seventy one cases were randomly divided into two groups. Thirty six cases in the observation group were treated with acupuncture on Zhongji (CV 3), Zigong (EX-CA 1), Chize (LU 5) etc. and tortoise-shell moxibustion on Shenque (CV 8) combined with pelvic floor muscle exercises; while thirty five cases in the control group were treated with only pelvic floor muscle exercises. The scores of the International Consultation Committee on Incontinence Questionnaire Short Form (ICI-Q-SF) and the Medical Outcomes Survey Short Form-36 (SF-36) were evaluated before and after treatment, and the scores of SF-36 were also compared with 35 cases in normal group. RESULTS: The total effective rate of 91.7% in the observation group was higher than that of 77.1% in the control group (P < 0.05). The dimensions of SF-36 of stress urinary incontinence patients were remarkably lower than those of normal group (all P < 0.05). The scores of ICI-Q-SF were decreased while the scores of SF-36 were increased obviously after treatment in both the observation group and the control group, there were pronounced improvements on physiological function, pain, physical activity, social function and affection function in the observation group (all P < 0.05). CONCLUSION: The quality of life for female stress urinary incontinence patients may be poor, however the dog-day acupuncture and tortoise-shell moxibustion combined with pelvic floor muscle exercises can improve the symptoms of urinary incontinence and increase the quality of life of patients.

[Clinical observation on electroacupuncture combined with catgut implantation at acupoints for treatment of simple obesity of heart and spleen deficiency type].

OBJECTIVE: To observe the interventional effect of electroacupuncture combined with catgut implantation at acupoints for treatment of simple obesity of heart and spleen deficiency type. METHODS: Sixty five cases were randomly divided into an observation group (33 cases) and a control group (32 cases). The observation group was treated with electroacupuncture combined with catgut implantation at acupoint therapy, the electroacupuncture was applied at Zhongwan (CV 12), Xiawan (CV 10), Guanyuan (CV 4), Tianshu (ST 25), ect. and catgut implantation was given at Zhongwan (CV 12), Tianshu (ST 25), Qihai (CV 6), etc. The control group was treated with electroacupuncture only. The body weight, body mass index (BMI), waistline, waist hip ratio (WHR), Pittsburgh sleep quality index (PSQI), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD, 17 items) were evaluated before and after treatment, and these were also compared with those of 35 nomal cases. RESULTS: The total effective rate of 93.9% in the observation group was higher than that of 84.4% in the control group (P < 0.05); the body weight, BMI, waistline, WHR, PSQI, HAMD and HAMA of simple obesity cases were obviously higher than those of normal cases (all P < 0.05). The scores of above indexes were all obviously decreased in both groups after treatment (all P < 0.05), and the improvement was more significant in observation group (P < 0.05). CONCLUSION: The sleep quality reduction and mental and psychology disorder exist in simple obesity patients, and electroacupuncture combined with catgut implantation at acupoints can reduce weight effectively, and at the same time improve the sleep quality and regulate psychological state.

Genome-wide association study in a Chinese Han population identifies nine new susceptibility loci for systemic lupus erythematosus.

We performed a genome-wide association study (GWAS) of systemic lupus erythematosus (SLE) in a Chinese Han population by genotyping 1,047 cases and 1,205 controls using Illumina Human610-Quad BeadChips and replicating 78 SNPs in two additional cohorts (3,152 cases and 7,050 controls). We identified nine new susceptibility loci (ETS1, IKZF1, RASGRP3, SLC15A4, TNIP1, 7q11.23, 10q11.22, 11q23.3 and 16p11.2; 1.77 x 10(-25) < or = P(combined) < or = 2.77 x 10(-8)) and confirmed seven previously reported loci (BLK, IRF5, STAT4, TNFAIP3, TNFSF4, 6q21 and 22q11.21; 5.17 x 10(-42) < or = P(combined) < or = 5.18 x 10(-12)). Comparison with previous GWAS findings highlighted the genetic heterogeneity of SLE susceptibility between Chinese Han and European populations. This study not only advances our understanding of the genetic basis of SLE but also highlights the value of performing GWAS in diverse ancestral populations.

Bortezomib in treatment of extramedullary plasmacytoma of the pancreas.

BACKGROUND: Extramedullary pancreatic plasmacytoma treated with bortezomib is rarely reported. METHODS: We admitted a 53-year-old woman with an asymptomatic mass above the left clavicle for over three months, then an asymptomatic swelling of the pancreas was found. A biopsy on the mass and a fine needle aspiration of the pancreas were performed. The diagnosis of extramedullary plasmacytoma (EMP) was made. The patient was initially treated with combination chemotherapy consisting of vincristine, doxorubicin and dexamethasone (VAD regimen). She progressed to painless jaundice during the chemotherapy. Then she was treated with bortezomib and hyper-dose dexamethasone. As a result, she had a near complete remission. RESULTS: The data demonstrated that the diagnosis was EMP of the pancreas. The patient responded very well to bortezomib, while failing to respond to the traditional chemotherapy regimen of VAD. CONCLUSION: EMP of the pancreas is rare. This case gives evidence for an excellent response of EMP of the pancreas to bortezomib.

Survey on skin aging status and related influential factors in Southeast China.

OBJECTIVE: To investigate cutaneous aging patterns of residents in Hangzhou, Zhejiang, China, and their contributing factors. METHODS: Eight hundred and forty-eight Hangzhou residents received the survey between March 2004 and September 2004. RESULTS: Facial wrinkling first occurred at 21 years of age and skin elasticity began to lose at 22 years of age. In middle-aged and old people, facial wrinkling and looseness escalated with the increase of ultraviolet (UV)-exposure time, indicating the accelerating effect of a higher accumulative dose of UV radiation on skin aging. Only Fitzpatrick types II, III and IV were found in the skin phototypes of residents in Hangzhou area, and Fitzpatrick type II seemed to be much more subject to severe wrinkling, elasticity destruction and skin tumors than types III and IV. The oily skin was more protected against wrinkling and facial looseness than dry skin. However, as to concomitant cutaneous diseases, no difference was found among different skin types. CONCLUSION: Age, solar-exposure time, Fitzpatrick type and skin type are the associated forces in promoting skin aging, and emotional factor seems to be another independent risk factor. The age of 49 years and 2 h/d of solar-exposure time seem to be the turning points responsible for dramatic changes of cutaneous appearance in the process of skin aging in Southeast China.