[A case of severe rhabdomyolysis after γ-butyrolactone withdrawal].

γ-butyrolactone is a colorless transparent liquid used in the production of drugs such as cyclopropylamine and pyrrolidone, and is also used as an industrial solvent, diluent, curing agent, etc., and is listed as the third category of precursor chemicals control. There is less clinical exposure to γ-butyrolactone and insufficient studies on its withdrawal response. This article reports a case of severe life-threatening rhabdomyolysis in a patient with γ-butyrolactone withdrawal. After active treatment, the patient eventually recovered. The clinical characteristics and treatment methods of γ-butyrolactone withdrawal reaction were summarized, suggesting that severe withdrawal reaction may occur in γ-butyrolactone.

Effects of 10-hydroxycamptothecin on differentiation of RAW264.7 cells into osteoclasts.

This study was designed to investigate the effect of 10-hydroxycamptothecin (10-HCPT) on osteoclast formation. RAW264.7 cells were cultured in vitro with 100 ng/ml receptor activator for nuclear factor-κ B ligand (RANKL) and 30 ng/ml recombinant macrophage colony stimulating factor (M-CSF), and 10-HCPT with different solubilities were added. After five-day cultivation, tartrate-resistant acid phosphatase (TRAP) staining was used to observe the number of osteoclasts. mRNA expression of osteoclast-specific genes, such as TRAP, cathepsin K (CTSK) and matrix metalloproteinase protease 9 (MMP-9), was detected by real-time Polymerase Chain Reaction (PCR). The effect of 10-HCPT on the proliferation activity of RAW264.7 cells was detected using Cell Counting Kit-8 (CCK-8). CCK-8 detection showed that 10-HCPT with a certain concentration (1 ng/ml to 5 ng/ml) had no effect on cell proliferation (P>0.05); 10-HCPT could inhibit the generation of osteoclasts. With the increase of the concentration of 10-HCPT, the number of osteoclasts generated from cells cultured with 10-HCPT [1 ng/ml (86±11.14), 2 ng/ml (66.67±7.51), 5ng/ml (27.67±6.51)] was much lower than that of the control group (145±8.19), and the difference was statistically significant (all P=0, P less than 0.05); mRNA expression of osteoclast-specific gene TRAP [1 ng/ml (24.38±0.68), 2 ng/ml (20.09±1.86), 5 ng/ml (6.23±0.53)], CTSK [1 ng/ml (10.08±0.81), 2 ng/ml (7.30±0.30), 5 ng/ml (3.20±0.56)] and MMP-9 [1 ng/ml (43.54±6.96), 2 ng/ml (28.28±5.83), 5 ng/ml (11.07±2.53)] was much lower than that of the groups added with RANKL and M-CSF only (all P=0, P less than 0.05), and with the increase of concentration of 10-HCPT, the expression of osteoclast-specific genes showed a decreasing tendency. All the findings suggest that 10-HCPT can inhibit the formation of osteoclasts by reducing the expression of osteoclast-specific genes such as TRAP, CTSK and MMP-9.

A novel HLA-A allele, HLA-A*02:441, identified by sequence-based typing in Chinese individuals.

HLA-A*02:441 differs from HLA-A*02:01:01:01 by one nucleotide exchange at position 91(T>C) with an amino acid exchange.

A prospective study of drug-drug interaction between antiepileptic drugs and meropenem in patients in a tertiary hospital in China from January 2020 to March 2023.

OBJECTIVE: This study aimed to determine the minimum interaction between different antiepileptic drugs (AEDs) and meropenem (MEPM) for clinical treatment. PATIENTS AND METHODS: The data of 91 patients enrolled in the neurology department from January 2020 to March 2023 for clinical trials were measured and observed. Self-controlled studies were conducted to monitor the trough concentrations of valproic acid (VPA), carbamazepine (CBZ) and levotiracetam (LEV) before and after MEPM usage. Relevant indicators of liver and kidney function were also monitored. RESULTS: The serum VPA trough concentrations were 36.25±8.22 µg/ml at 24±12 h and 34.99±11.17 µg/ml at 96±12 h after MEPM use; the difference was significant (p<0.05). Decreased CBZ trough concentrations were also identified after MEPM usage (96±12 h), whereas LEV trough concentrations were not affected. An increased liver injury rate (χ2 =8.744, p<0.05) and a decreased kidney injury rate (χ2 =5.393, p<0.05) were found in the VPA group only. CONCLUSIONS: The interaction between VPA and MEPM decreased serum VPA concentrations, increased liver injury rates, and decreased kidney injury rates. In addition, the co-administration of MEPM and CBZ reduced serum CBZ concentrations. Clinicians should be aware of this potential interaction and closely monitor the relevant biochemical indices and number of seizures.

Expression of FOXP3 in esophageal squamous cell carcinoma relating to the clinical data.

Forkhead box protein 3 (FOXP3) has been studied as a biomarker in many human malignancies recently. But in esophageal squamous cell carcinoma (ESCC) the studies are limited. In this study, expression of FOXP3 in ESCC tissue was evaluated in relation to the clinical data. Detection of FOXP3 mRNA was made by using quantitative real-time PCR while protein expression was assessed by immunocytochemistry (n = 112). The results were correlated to the clinical data including age, gender, carcinoma size, carcinoma differentiation, lymphatic invasion and pathological stage. A significantly higher FOXP3 expression in tumors was confirmed than in normal-appearing mucosa. The FOXP3 mRNA and protein expressions were higher in advanced stages (stage II B and III) than in early stages (stage I and stage II A). A significantly higher FOXP3 expression in tumors with lymph node metastasis was also confirmed than in those without lymph node metastasis. No significant correlation was found in age, gender, carcinoma size, or carcinoma differentiation. These results suggest that expression of FOXP3 was higher in ESCC tissue and was closely correlated to lymphatic invasion and pathological stage. It may imply that FOXP3 might play an important role in esophageal carcinoma progression.

[A case of cerebral infarction after deep burn tangential excision and skin grafting].

A female patient aged 42 years with deep burn on right lower limb was admitted to Affiliated Hospital of Jining Medical University on January 25, 2019. The patient previously had cerebral infarction, hypertension, and hysteria, with long-term use of aspirin and risperidone. After admission, the patient underwent tangential excision twice. On the third day after the second tangential excision and skin grafting, the muscle strength of the right limb gradually decreased, and the patient was treated with emergency craniocerebral magnetic resonance imaging, which suggested acute cerebral infarction. Improvement of cerebral circulation and vasodilatation were given immediately. The limb muscle strength of the patient gradually recovered on the fifth day after the operation, and no sequela was left when the patient was discharged. After the case was discussed, we think that postoperative decreased blood volume and blood concentration resulting from tangential excision bleeding of deep burn and wound exudate as well as inadequate fluid infusion are the main causes of hemodynamic change, the patient had the basis of multiple cerebral artery stenosis, and superposition of multiple factors led to the occurrence of postoperative acute cerebral infarction. Appropriate increase in the fluid infusion volume during and after surgery and transfusion if necessary to increase blood and oxygen supply to the brain can reduce the occurrence of cerebral infarction.

A decrease of human leucocyte antigen-DR expression on monocytes in peripheral blood predicts stroke-associated infection in critically-ill patients with acute stroke.

BACKGROUND AND PURPOSE: To investigate changes in human leucocyte antigen (HLA)-DR expression on peripheral monocytes, determine the value of predicting the development of stroke-associated infection (SAI), and determine the correlation with other conditions in critically-ill patients in the neurological intensive care unit (NICU) who suffered an acute stroke. METHODS: All patients were enrolled consecutively and admitted to NICU within 24 h after the onset of symptoms. Patients were followed in order to identify whether infection developed and determine survival status within 2 weeks after the stroke. Patients were divided into stroke or control group by study design, infection or non-infection group by whether or not they had an infection, survival or death group by prognosis and cerebral infarction or cerebral haemorrhage group by stroke type. Patients in which acute stroke was excluded by head CT or MRI were admitted to general ward and were used as a control group. Blood samples were collected serially on days 1, 2, 4, 6 and 14 after stroke, then monocyte human leucocyte antigen-DR (HLA-DR) expression was determined by flow cytometry. The National Institute of Health Stroke Scale (NIHSS), Acute Physiology and Chronic Health Evaluation II (APACHEII) and Glasgow Coma Scale (GCS) scores were recorded over the course of observation. RESULTS: Fifty-three subjects and 39 controls were enrolled in the study. On days 1, 2, 4, 6 and 14, there was a significant difference in monocyte HLA-DR expression between stroke group and control group (all P < 0.001), but no difference was found between ischaemic stroke group and haemorrhagic stroke group (all P > 0.05). The infection group compared with non-infection group did not exhibit a significant difference in HLA-DR expression on days 1 and 2 (all P > 0.05), but significant differences emerged on days 4, 6 and 14 (all P < 0.01). On days 1 and 2 the HLA-DR expression in the survival group compared with death group, was not significantly different (all P > 0.05), but differences became significant on days 4 and 6 (P < 0.01). On day 1, HLA-DR expression <62.80% had the predictive value to SAI (sensitivity 83.3%, specificity 55.2%, AUC = 0.661, P = 0.031) and on day 2, HLA-DR expression <57.83% had the predictive value to SAI (sensitivity 95.8%, specificity 79.3%, AUC = 0.907, P = 0.000) in acute stroke patients. A statistically significant inverse correlation was found between NIHSS and HLA-DR on days 2 and 4 during the observation period (all P < 0.01), but there was no statistically significant negative correlation on days 1, 6 or 14 (all P > 0.05). HLA-DR expression did not correlate with APACHEII (all P > 0.05) or GCS (all P > 0.05) during the measurement period. CONCLUSIONS: Human leucocyte antigen-DR (HLA-DR) expression decreases and sustains a dynamic change and it also relates to the severity of patient's condition in the critically-ill patients with stroke. Progressively persistent low monocyte HLA-DR expression is associated with a poor prognosis. The decline in HLA-DR expression contributes to infection in critically-acute stroke patients. Monitoring of monocyte HLA-DR expression may be useful for identifying patients suffering from acute stroke who are at high risk for infection.

Evaluation of the efficacy and safety of olopatadine and fexofenadine compared with placebo in Japanese cedar pollinosis using an environmental exposure unit.

BACKGROUND: Second-generation oral H1-antihistamines have become a mainstay of treatment for the symptoms of seasonal allergic rhinitis; however, the effect of olopatadine has not been widely reported to date. OBJECTIVES: To evaluate the efficacy of 2 oral H1-antihistamines, olopatadine and fexofenadine, in the treatment of the nasal symptoms of Japanese cedar pollinosis and their possible side effects. METHODS: This was a randomized, double-blind, placebo-controlled, crossover study conducted in an environmental exposure unit (EEU). Twenty volunteers suffering from Japanese cedar pollinosis were randomly divided into 3 groups and exposed to cedar pollen in the EEU with oral administration of olopatadine hydrochloride (5 mg), fexofenadine hydrochloride (60 mg), or placebo 1 hour prior to pollen exposure. Nasal symptoms, activity impairment, and subjective sleepiness were self-assessed during the study period. Attention was measured using the digit cancellation test. The trial was repeated after 4 and 7 weeks. RESULTS: Compared with placebo, olopatadine significantly improved nasal symptoms and activity impairment during pollen exposure (P < .05). There was no significant relief of nasal discharge or nasal congestion with fexofenadine throughout the 5-hour exposure to cedar pollen. Furthermore, olopatadine significantly reduced nasal congestion during the first 2 hours, as well as sneezing and nasal discharge 4 hours after admission to the EEU compared with fexofenadine (P < .05). There was no significant difference in the effect on subjective sleepiness among the 3 groups, and all 3 agents had little effect on attention. CONCLUSIONS: These findings suggest that olopatadine is more effective than placebo and fexofenadine in improving nasal symptoms of Japanese cedar pollinosis.

Photodynamic therapy and anti-vascular endothelial growth factor for acute central serous chorioretinopathy: a systematic review and meta-analysis.

This systematic review aims to update current evidence on the efficacy and safety of photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF) injections for acute central serous chorioretinopathy (CSC). A comprehensive literature search was conducted in PubMed, EMBASE, and Cochrane Library. Studies comparing (1) PDT versus placebo, (2) anti-VEGF versus placebo, and (3) PDT versus anti-VEGF were included and meta-analyzes were performed when appropriate. Ocular and systemic adverse effects were also summarized. Literature search yielded six comparative studies, among which five were included for this review. Meta-analysis with three studies indicated that eyes treated with PDT achieved better best-corrected visual acuity (BCVA) and central macular thickness (CMT) than the placebo group throughout a follow-up of 12 months. Meta-analysis with another two studies comparing anti-VEGF injections and placebo showed that BCVA at first month was better in anti-VEGF group than in placebo group, though the differences of BCVA and CMT no longer existed at 3 and 6 months after injection. There was no report directly comparing PDT and anti-VEGF for acute CSC. No severe complications was reported in included studies. In this review, current evidence suggested that early treatment of acute CSC by PDT is valuable in improving visual acuity, reducing subretinal fluid, and maintaining long term effectiveness. Anti-VEGF injection could shorten the duration of symptoms and accelerate visual improvement at early stage of disease. Direct comparison between these two treatment will be needed in the future.

Suppression of the proliferation and migration of oncogenic ras-dependent cell lines, cultured in a three-dimensional collagen matrix, by flavonoid-structured molecules.

The effects of 7-hydroxycoumarin, genistein and quercetin on two ras-oncogene-driven tumour cells (rat breast adenocarcinoma and human bladder carcinoma) were investigated using cellular (proliferation and migration) and molecular targets (p21ras GTPase activity and intracellular amount of p21ras protein). All three compounds inhibited the growth of both cell lines. Genistein was the most effective substance. Furthermore, 7-hydroxycoumarin and genistein affected the motile machinery of both cell lines because major fractions of the cells were slowed down or stopped locomotion. The phorbol ester, phorbol 12-myristate 13-acetate (PMA), a well-known tumour promoter, increased the locomotion behaviour of the cells; the time of migration, the velocity and the distance of migration increased under the control of PMA. 7-Hydroxycoumarin decreased the relative amount of intracellular p21ras, and concomitantly a PMA-induced decrease of p21ras GTPase activity could be partially antagonized by 7-hydroxycoumarin. Because of the low toxicity and the mode of action evaluated, it is likely that the best role for these substances may be adjuvant therapy of some malignancies following surgery. Profiles directed to migration and proliferation inhibition make these drugs exceptional candidates for chemopreventive strategies in tumours diagnosed as having increased ras oncogene levels.

Women's health in the People's Republic of China: some challenges of modernization.

OBJECTIVE: To identify aspects of the health of Chinese women throughout their lifespan which may paradoxically be threatened by modernization and to suggest relevant interventions through medical practice, education and research to meet these challenges. DATA SOURCES: Six risk areas were selected as examples: infant sex ratios; tobacco use by girls; respiratory illness plus anemia; psychosocial stress; osteoporosis; and dementia. Articles and other databases, through article citations, and through consultations with Chinese medical professionals. DATA SELECTION: Studies were selected which described clinical investigations, health care policy, or conditions of women in the People's Republic of China (PRC). Preference (but not exclusivity) was given to articles in internationally available publications, in English, and to authors working in the PRC. DATA EXTRACTION: Study quality, specific descriptive information concerning population, samples, and outcome measures were evaluated. DATA SYNTHESIS: Data documenting the present and future significance of these health threats are described, and current and potential interventions to address these problems through medical practice, education and research are outlined. CONCLUSION: Important issues in women's health are currently recognized in the PRC; problems occur in assigning priorities in the face of a large population and limited resources. The Chinese medical community plays a central role in developing and carrying out interventions to protect and promote women's health.

Effects of hyperbaric oxygen on S-180 sarcoma in mice.

The contents of oxygen free radicals (OFRs) and malondialdehyde (MDA) in S-180 sarcoma tissues were measured in four groups of mice: an untreated normoxic group, a normoxic hyperbaric group, a hyperbaric oxygen group, and an HBO group treated with superoxide dismutase (SOD). Measurements were done by electron resonance and spectrophotometry, and observations were made on the volume, weight, necrosis incidence rate of sarcoma tissues, and mortality in all groups. The OFR and MDA content in sarcoma tissues in the HBO group was significantly higher than those of the control groups (P < 0.001); necrosis incidence of sarcoma tissues and the survival rate of mice were higher; the time required for necrosis was shorter, and the volume and weight of sarcoma tissues were smaller and lighter than those of the control groups (P < 0.01). The results suggest that SOD cannot completely eliminate OFRs produced by hyperbaric exposure, although the role of HBO in producing more OFRs can be counterbalanced by SOD to a certain degree. Apparently HBO can check the growth rate of sarcoma and accelerate the necrosis of S-180 sarcoma cells.

Increased expression of Toll like receptor 4 on peripheral-blood mononuclear cells in patients with coronary arteriosclerosis disease.

The family of Toll-like receptors (TLRs) initiates innate immune responses, and Toll-like receptor 4 (TLR4) was considered to be an important player in the initiation and progression of atherosclerotic disease. The aim of the study was to investigate the expression of TLR4 on peripheral-blood mononuclear cells (PBMCs) in patients with coronary arteriosclerosis disease (CAD). We have examined the expression of TLR4 protein and mRNA by flow cytometry (FCM) and real-time quantitative reverse transcription polymerase chain reaction (RT-PCR). In addition, the levels of plasma lipids were determined by automatic biochemistry analyzer. The results showed that the positive rates and the mean mRNA copy number of TLR4 in CAD group were significantly higher than that in controls. But no significant difference was found in the positive rate and the mean mRNA copy number of TLR4 between CAD group with normal level of plasma lipids and the CAD group with abnormal level of plasma lipids. We suggest that expression level of TLR4 on peripheral-blood mononuclear cells is increased in atherosclerotic, but the differential expression of TLR4 has no correlation with the level of plasma lipids.