Background:The 2-amino-5-chloro-N,3-dimethylbenzamide is a key intermediate in the synthesis of pesticides and pharmaceuticals.However,no literature currently exists on 2-amino-5-chloro-N,3-dimethylbenzamide poisoning...Background:The 2-amino-5-chloro-N,3-dimethylbenzamide is a key intermediate in the synthesis of pesticides and pharmaceuticals.However,no literature currently exists on 2-amino-5-chloro-N,3-dimethylbenzamide poisoning in humans.This study aimed to reveal the health hazard of this chemical for humans and summarize the clinical characteristics of patients with occupational 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.Methods:This observational study included four patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning from June 2022 to July 2022.The entire course of the incidents was described in detail.Blood 2-amino-5-chloro-N,3-dimethylbenzamide concentrations were detected by a mass spectrometer.Hema-toxylin and eosin staining was performed to assess liver injury,and immunofluorescence was used to evaluate hepatic mitophagy.Results:The 2-amino-5-chloro-N,3-dimethylbenzamide powder(99%purity)entered the human body mainly via the skin and respiratory tract due to poor personal protective measures.The typical course of 2-amino-5-chloro-N,3-dimethylbenzamide poisoning was divided into latency,rash,fever,organic dam-age,and recovery phases in accordance with the clinical evolution.Rash and fever may be the important premonitory symptoms for further organ injuries.The chemical was detected in the blood of all patients and caused multiple organ injuries,predominantly liver injury,including kidney,myocardium,and micro-circulation.Three patients recovered smoothly after comprehensive treatments,including artificial liver therapy,continuous renal replacement therapy,glucocorticoids,and other symptomatic and supportive treatments.One patient survived by liver transplantation.The postoperative pathological findings of the removed liver showed acute liver failure,and immunofluorescence staining confirmed the abundance of mitophagy in residual hepatocytes.Conclusions:This study is the first to elaborate the clinical characteristics of patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.The chemical enters the body through the respiratory tract and skin during industrial production.The 2-amino-5-chloro-N,3-dimethylbenzamide poisoning causes multiple-organ dysfunction with a predominance of liver injury.Liver transplantation may be an effective option for patients with severe liver failure.The mechanisms of liver injury induced by 2-amino-5-chloro-N,3-dimethylbenzamide might involve abnormal mitochondrial function and mitophagy.展开更多
Background:Amanita poisoning as a foodborne disease has raised concerning mortality issues.Reducing the interval between mushroom ingestion and medical intervention could greatly influence the outcomes of Amanita pois...Background:Amanita poisoning as a foodborne disease has raised concerning mortality issues.Reducing the interval between mushroom ingestion and medical intervention could greatly influence the outcomes of Amanita poisoning patients,while treatment is highly dependent on a confirmed diagnosis.To this end,we developed an early detection-guided intervention strategy by optimizing diagnostic process with performingα-amanitin detection,and further explored whether this strategy influenced the progression of Amanita poisoning.Methods:This study was a retrospective analysis of 25 Amanita poisoning patients.Thirteen patients in the detection group were diagnosed mainly based onα-amanitin detection,and 12 patients were diagnosed essentially on the basis of mushroom consumption history,typical clinical patterns and mushroom identification(conventional group).Amanita poisoning patients received uniform therapy,in which plasmapheresis was executed once confirming the diagnosis of Amanita poisoning.We compared the demographic baseline,clinical and laboratory data,treatment and outcomes between the two groups,and further explored the predictive value ofα-amanitin concentration in serum.Results:Liver injury induced by Amanita appeared worst at the fourth day and alanine aminotransferase(ALT)rose higher than aspartate aminotransferase(AST).The mortality rate was 7.7%(1/13)in the detection group and 50.0%(6/12)in the conventional group(P=0.030),since patients in the detection group arrived hospital much earlier and received plasmapheresis at the early stage of disease.The early detection-guided intervention helped alleviate liver impairment caused by Amanita and decreased the peak AST as well as ALT.However,the predictive value ofα-amanitin concentration in serum was still considered limited.Conclusions:In the management of mushroom poisoning,consideration should be given to the rapid detection ofα-amanitin in suspected Amanita poisoning patients and the immediate initiation of medical treatment upon a positive toxin screening result.展开更多
The pandemic caused by the SARS-CoV-2 coronavirus is still looming worldwide,and the pandemic has challenged health care delivery and health care systems internationally.[1]The epidemic of seasonal influenza would occ...The pandemic caused by the SARS-CoV-2 coronavirus is still looming worldwide,and the pandemic has challenged health care delivery and health care systems internationally.[1]The epidemic of seasonal influenza would occur in the winter months.Since coronavirus disease 2019(COVID-19)and influenza share many clinical symptoms,[2]it is difficult to distinguish these two respiratory infections in the early stage.[3]Although nucleic acid testing was the gold standard to identify different virus infected diseases,false-negative nucleic acid results were reported frequently in COVID-19,[4]and its diagnostic sensitivity is less optimal.Therefore,the aim of our study is to explore and compare the clinical characteristics of COVID-19 and influenza,which could deepen the understanding of these two diseases and provide some guidance for clinicians to make a differential diagnosis.展开更多
BACKGROUND:Traumatic aortic dissection(TAD)has a low incidence but extremely high mortality.It always presents atypical clinical manifestations that are easily missed or misdiagnosed.This study mainly aims to describe...BACKGROUND:Traumatic aortic dissection(TAD)has a low incidence but extremely high mortality.It always presents atypical clinical manifestations that are easily missed or misdiagnosed.This study mainly aims to describe the imaging characteristics and management of TAD patients.METHODS:A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020.Demographic features,imaging characteristics,and management were analyzed.RESULTS:Twenty-seven patients with type B aortic dissection(age 56.04±16.07 years,20 men)were included.Aortic intimal tears were mostly initiated from the aortic isthmus.The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature(1.78±0.56 cm vs.1.24±0.52 cm,P=0.031).Compared with those in the control group,the maximum diameters of the aortic arch,thoracic aorta,and abdominal aorta in the TAD patients were all significantly widened(all P<0.050).Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD,with a predictive value with an area under the receiver operating characteristic curve(AUC)of 0.673.Finally,26 patients successfully underwent delayed thoracic endovascular aortic repair(TEVAR),and the remaining one patient was treated conservatively.No progression of aortic dissection or death occurred during the six-month follow-up period.CONCLUSIONS:In blunt trauma,the aortic isthmus is the most common site of proximal intimal tears.An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics.Delayed TEVAR might be an eff ective therapeutic option for TAD.展开更多
BACKGROUND:Hyperkalemia is common among patients in emergency department and is associated with mortality.While,there is a lack of good evaluation and prediction methods for the effi cacy of potassium-lowering treatme...BACKGROUND:Hyperkalemia is common among patients in emergency department and is associated with mortality.While,there is a lack of good evaluation and prediction methods for the effi cacy of potassium-lowering treatment,making the drug dosage adjustment quite diffi cult.We aimed to develop a predictive model to provide early forecasting of treating eff ects for hyperkalemia patients.METHODS:Around 80%of hyperkalemia patients(n=818)were randomly selected as the training dataset and the remaining 20%(n=196)as the validating dataset.According to the serum potassium(K+)levels after the fi rst round of potassium-lowering treatment,patients were classifi ed into the eff ective and ineff ective groups.Multivariate logistic regression analyses were performed to develop a prediction model.The receiver operating characteristic(ROC)curve and calibration curve analysis were used for model validation.RESULTS:In the training dataset,429 patients had favorable eff ects after treatment(eff ective group),and 389 had poor therapeutic outcomes(ineff ective group).Patients in the ineff ective group had a higher percentage of renal disease(P=0.007),peripheral edema(P<0.001),oliguria(P=0.001),or higher initial serum K+level(P<0.001).The percentage of insulin usage was higher in the effective group than in the ineff ective group(P=0.005).After multivariate logistic regression analysis,we found age,peripheral edema,oliguria,history of kidney transplantation,end-stage renal disease,insulin,and initial serum K+were all independently associated with favorable treatment eff ects.CONCLUSION:The predictive model could provide early forecasting of therapeutic outcomes for hyperkalemia patients after drug treatment,which could help clinicians to identify hyperkalemia patients with high risk and adjust the dosage of medication for potassium-lowering.展开更多
Objective: To investigate the early effects of hypertonic and isotonic saline solutions on apoptosis of intestinal mucosa in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was estab...Objective: To investigate the early effects of hypertonic and isotonic saline solutions on apoptosis of intestinal mucosa in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was established in 21 Sprague-Dawley (SD) rats. The rats were randomly divided into the sham group, normal saline resuscitation (NS) group, and hypertonic saline resuscitation (HTS) group, with 7 in each group. We detected and compared the apoptosis in small intestinal mucosa of rats after hemorrhagic shock and resuscitation by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), FITC (fluo- rescein-iso-thiocyanate)-Annexin V/PI (propidium iodide) double staining method, and flow cytometry. Results: In the early stage of hemorrhagic shock and resuscitation, marked apoptosis of small intestinal mucosa in the rats of both NS and HTS groups was observed. The numbers of apoptotic cells in these two groups were significantly greater than that in the sham group (P<0.01). In the HTS group, the apoptic cells significantly decreased, compared with the NS group (P<0.01). Conclusion: In this rat model of severe hemorrhagic shock, the HTS resuscitation of small volume is more effective than the NS resuscitation in reducing apoptosis of intestinal mucosa in rats, which may improve the prognosis of trauma.展开更多
BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology imp...BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.展开更多
Dear editor,Paraquat(PQ)can cause acute lung injury and irreversible pulmonary fibrosis,without specific antidotes.Respiratory failure is the main cause of death among patients with PQ poisoning.Currently,the treatmen...Dear editor,Paraquat(PQ)can cause acute lung injury and irreversible pulmonary fibrosis,without specific antidotes.Respiratory failure is the main cause of death among patients with PQ poisoning.Currently,the treatment involves the use of adsorbents,intensive hemoperfusion,antioxidants,immunosuppressive therapy,respiratory support by mechanical ventilation,and other symptomatic and supportive treatments.[1-3]The mortality of patients with severe PQ poisoning remains high.More eff ective and safer therapies remain to be explored.Few studies reported performing extracorporeal membrane oxygenation(ECMO)and subsequent lung transplantation with either successful or poor clinical outcome in extremely critical patients with PQ poisoning.[4,5]This study aims to summarize the clinical experience and refl ect on the therapeutic prospect of ECMO in respiratory failure or cardiopulmonary failure caused by fatal PQ poisoning.展开更多
Foreign bodies’ingestion is a common phenomenon,and most of the ingested foreign bodies pass through the gut uneventfully.In clinical practice,less than 1%of these patients develop complications such as gut wall pene...Foreign bodies’ingestion is a common phenomenon,and most of the ingested foreign bodies pass through the gut uneventfully.In clinical practice,less than 1%of these patients develop complications such as gut wall penetration or perforation[1–3].We present a rare complication of hepatic abscess secondary to the toothpick piercing the gastric wall into the liver.The abscess was successfully treated by endoscopic retrieval of the foreign body and empirical antibiotic therapy,without drainage or laparotomy.展开更多
Background:The high coverage of annual routine health check-up in China is a unique phenomenon throughout the world.However,its clinical value is controversial.In this cohort study,we chose pancreatic cancer as a dise...Background:The high coverage of annual routine health check-up in China is a unique phenomenon throughout the world.However,its clinical value is controversial.In this cohort study,we chose pancreatic cancer as a disease model to explore the role of routine check-up in the prognosis of patients with pancreatic cancer.Methods:Data from 157 patients who were diagnosed with pancreatic cancer between January 2010 and April 2014 were collected.Patients were divided into two groups depending on how their disease was detected.Group A(n=85):Patients were diagnosed with pancreatic cancer in clinic visits.Group B(n=72):Patients were diagnosed with pancreatic cancer in routine check-ups.We compared their prognosis.Results:The tumor stage in group B was earlier than that in group A.The 1-year survival rate in group B was significantly higher than that in group A(74.6%vs.42.4%,P<0.001),while the 3-and 5-year survival rates of the two groups showed no significant difference(P>0.05).The difference of overall survival time between the two groups was not significant(22.0 vs.9.0 months,P=0.078).Conclusions:The stage of pancreatic cancer diagnosed in routine check-ups was earlier and therefore,the intervention was earlier which improved short-term survival rate.However,early intervention did not improve overall survival in the long-term.展开更多
BACKGROUND Acute generalized exanthematous pustulosis(AGEP)is a severe cutaneous adverse reaction characterized by sterile pustules on erythematous skin associated with fever and leukocytosis.The annual incidence of A...BACKGROUND Acute generalized exanthematous pustulosis(AGEP)is a severe cutaneous adverse reaction characterized by sterile pustules on erythematous skin associated with fever and leukocytosis.The annual incidence of AGEP is estimated to be 1-5 cases per million.Cases of AGEP with oral mucosa involvement have been reported.However,reports of AGEP involving airway mucosa are limited.CASE SUMMARY We report a 42-year-old woman with serious AGEP involving the airway mucosa.The patient initially developed fever and a small rash on her forehead and face.Over the next 2 d,she developed a diffuse,pustular rash over her trunk and legs.In addition,she complained of a cough with white foam-like sputum,chest tightness and dyspnea.Four days later,due to dyspnea,her mental status started to gradually deteriorate.She became more and more drowsy.Biopsies of the skin and airway mucosa suggested the diagnosis of AGEP.According to the European study of severe cutaneous adverse reactions group’s scoring system,the patient scored+6 indicating a probable diagnosis of AGEP.She received intravenous methylprednisolone 120 mg/12 h for 3 d,and was eventually discharged in good condition.This patient had already experienced respiratory failure and airway mucosa involvement on admission;however,the clinicians had an insufficient understanding of AGEP.Glucocorticoid was administered for more than 10 d following onset of the disease,and her overall prognosis was satisfactory.CONCLUSION This case represents a rare clinical feature of AGEP and an important finding for clinicians.展开更多
BACKGROUND In the past years,only a few studies with a limited number of adult patients analyzed clinical features of allied disorders of Hirschsprung’s disease(ADHD),most of which were individual case reports or lac...BACKGROUND In the past years,only a few studies with a limited number of adult patients analyzed clinical features of allied disorders of Hirschsprung’s disease(ADHD),most of which were individual case reports or lacked detailed clinical information.Although many studies have reported patients presenting to the emergency department(ED)with recurrent abdominal symptoms for a number of disorders,there are few data involving ADHD.However,owing to a lack of awareness of the disease,misdiagnoses and mistreatments are common.Severe complications such as perforation,bleeding,malabsorption,and even death in ADHD had been reported by many studies.AIM To assist ED clinicians in having a more comprehensive understanding of this disease and making an early suspected diagnosis of ADHD more effectively.METHODS We enrolled 53 patients who visited the ED and were eventually diagnosed with ADHD over the past 11 years in our hospital.Their basic information,clinical manifestations,and imaging findings were analyzed.Blood indices were compared between the ADHD and irritable bowel syndrome(IBS)groups.RESULTS Adult patients with ADHD had a mean age of 48.8±14.3 years,and 77.4%had been treated before admission.The transverse colon was the most common dilated part(73.6%),and constipation(67.9%)was the most common symptom.ADHD patients can present with uncommon symptoms and false-negative imaging findings.Logistic regression analysis indicated that body mass index(BMI)[odds ratio(OR)=0.786,P=0.013],cholinesterase(per 1000 units;OR=0.693,P=0.008),and blood chlorine(OR=0.816,P=0.022)were determined to be independent related factors between the ADHD and IBS groups.The area under the receiver operating characteristics curve of these three indices combined was 0.812(P<0.001).CONCLUSION Emergency physicians should be vigilant regarding patients with chronic constipation,abdominal pain,or abdominal distension,and consider the possibility of ADHD despite its rarity.Abdominal computed tomography examination is recommended as a useful tool in the suspected diagnosis of ADHD.BMI,cholinesterase,and blood chlorine have good discriminative abilities between ADHD and IBS.The nutritional status of adult patients with ADHD is worthy of further attention.Surgical treatment for adult patients with ADHD is important and inevitable.展开更多
Objective： The intoxications caused by 2,4-dinitrophenol （2,4-DNP）, even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and ex...Objective： The intoxications caused by 2,4-dinitrophenol （2,4-DNP）, even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and explore the clinical value of resin hemoperfusion （HP） in the treatment of patients with acute 2,4-DNP poisoning. Methods We reported 16 cases of acute 2,4-DNP poisoning through occupational exposure due to ignoring the risk of poisoning. The blood samples were collected from the 14 survivors. According to the different treatments of resin HP, the survivors were divided into routine HP （n=5） and intensive HP （n=9） groups. Ultra high performance liquid chromatography/ tandem mass spectroscopy （UPLC-MS/MS） was used to detect the 2,4-DNP concentration in plasma in this study. Results： The 14 survivors recovered very well after treatment. The initial plasma 2,4-DNP concentrations （C1） of survivors ranged from 0.25 to 41.88 pg/ml （mean （12.56＋13.93） pg/ml）. A positive correlation existed between initial plasma 2,4-DNP concentration （C1） and temperature. The elimination of 2,4-DNP was slow and persistent, and the total clearance rates of plasma toxin from the 1st to 3rd day （R3）, the 3rd to 7th day （R3-7）, and the 1st to 7th day （RT）, were only （53.03±14.04）%, （55.25±10.50）%, and （78.29±10.22）%, respectively. The plasma toxin was cleared up to 25 d after poisoning in most of the patients. The R3, R3-7, and R7 in the intensive HP group were all apparently higher than those in the routine HP group, with statistical significance （P〈0.05）. Simultaneously, the elimination half-life （tl/2） of 2,4-DNP in the intensive HP group was apparently shorter than that in the routine HP group, with statistical significance （P〈0.05）. Conclusions： The clinicians should be aware of this slow and persistent process in the elimination of plasma 2,4-DNP. Higher initial plasma toxin concentration resulted in a more severe fever for the patient. According to the limited data, longer and more frequent resin HP may accelerate to eliminate the poison.展开更多
Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of...Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.Methods: This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.Results: Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen(P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived(both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels.Unexpectedly, we found that hydrothorax was detected in 21(65.63%) patients in the death group and 19(59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio(INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.Conclusion: HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.展开更多
Objective： To investigate the effects of resuscitation with normal saline（NS）, hypertonic saline（HTS）, and hydroxyethyl starch（HES） on regulatory T cells（Tregs）, helper T 1（Th1）/Th2 and cytotoxic T 1（Tc1）...Objective： To investigate the effects of resuscitation with normal saline（NS）, hypertonic saline（HTS）, and hydroxyethyl starch（HES） on regulatory T cells（Tregs）, helper T 1（Th1）/Th2 and cytotoxic T 1（Tc1）/Tc2 profiles in the treatment of hemorrhagic shock. Methods： Rats subjected to severe hemorrhagic shock were resuscitated for 30 min with NS（n=8）, HTS（n=8）, or HES（n=8）; sham（n=8） and naive control（n=8） groups were used for comparison. Following fluid resuscitation, the whole shed blood was reinfused for 30 min, and the rats were observed with continuous hemodynamic monitoring for 120 min. CD4^＋CD25^＋Foxp3^＋ Treg proportions, Th1/Th2 and Tc1/Tc2 profiles in spleen were analyzed by three-color flow cytometry. Results： The proportion of CD4^＋CD25^＋Foxp3^＋ Tregs and ratios of Th1/Th2 and Tc1/Tc2 did not differ among control, sham, and HTS groups, but were significantly lower in NS and HES groups（both P0.05 vs. sham）; NS and HES levels were similar. The level of Tc1 was significantly increased in HTS（P0.05 vs. sham）, and levels of Tc2 were increased in NS, HES, and HTS groups compared to sham（all P0.05）, but did not differ from each other. Conclusions： HTS resuscitation has a greater impact on immune system recovery than NS or HES by preserving the proportion of Tregs and maintaining the balance between Th1/Th2 and Tc1/Tc2 cells in the spleen. Thus, HTS resuscitation provides potential immunomodulatory activity in the early stage after hemorrhagic shock.展开更多
We have read with great interest the recent article “Cellular mechanism of cardiac alternans： an unresolved chicken or egg problem” by Zang and Xia （2014）, published in Journal of Zhejiang University- SCIENCE B ...We have read with great interest the recent article “Cellular mechanism of cardiac alternans： an unresolved chicken or egg problem” by Zang and Xia （2014）, published in Journal of Zhejiang University- SCIENCE B （Biomedicine ＆ Biotechnology）. The authors proposed that both calcium handling and electrical components of cardiac cells could be the cellular mechanism of cardiac alternans, and identifying the main mechanism of cardiac alternans could help to cure targeted patients with heart failure. Here,展开更多
Objective： To investigate the distribution and differentiation of myeloid-derived suppressor cells （MDSCs） in hemorrhagic shock mice, which are resuscitated with normal saline （NS）, hypertonic saline （HTS）, and...Objective： To investigate the distribution and differentiation of myeloid-derived suppressor cells （MDSCs） in hemorrhagic shock mice, which are resuscitated with normal saline （NS）, hypertonic saline （HTS）, and hydroxyethyl starch （HES）. Methods： BALB/c mice were randomly divided into control, NS, HTS, and HES resuscitation groups. Three subgroups （n=8） in each resuscitation group were marked as 2, 24, and 72 h. Flow cytometry was used to detect the MDSCs, monocytic MDSCs （M-MDSCs）, and granulocytic/neutrophilic MDSCs （G-MDSCs） in peripheral blood nucleated cells （PBNCs）, spleen single-cell suspension, and bone marrow nucleated cells （BMNCs）. Results： The MDSCs in BMNCs among three resuscitation groups were lower 2 h after shock, in PBNCs of the HTS group were higher, and in spleen of the NS group were lower （all P〈0.05 vs. control）. The M-MDSC/G-MDSC ratios in PBNCs of the HTS and HES groups were lower （both ,P〈0.05 vs. control）. At 24 h, the MDSCs in PBNCs of the NS and HTS groups were higher, while the spleen MDSCs in the HTS group were higher （all P〈0.05 vs. control）. The M-MDSC/ G-MDSC ratios were all less in PBNCs, spleen, and BMNCs of the NS and HTS groups, and were lower in BMNCs of the HES group （all P〈0.05 vs. control）. At 72 h, the elevated MDSCs in PBNCs were presented in the HTS and HES groups, and in spleen the augment turned up in three resuscitation groups （all P〈0.05 vs. control）. The inclined ratios to M-MDSC were exhibited in spleen of the NS and HTS groups, and in PBNCs of the NS group; the inclination to G-MDSC in BMNCs was shown in the HES group （all P〈0.05 vs. control）. Conclusions： HTS induces the earlier ele- vation of MDSCs in peripheral blood and spleen, and influences its distribution and differentiation, while HES has a less effect on the distribution but a stronger impact on the differentiation of MDSCs, especially in bone marrow.展开更多
Objective:This scoping review aims to perform a meta-analysis to harmonize the existing results on circulating vitamin D and cerebrovascular disease.Methods:Three scientific databases,PubMed,the Cochrane Library and E...Objective:This scoping review aims to perform a meta-analysis to harmonize the existing results on circulating vitamin D and cerebrovascular disease.Methods:Three scientific databases,PubMed,the Cochrane Library and EMBASE,were systematically searched.The overall relative risk(RR)and the corresponding 95%confidence interval(CI)were calculated using a random-effects model,and sensitivity analysis and publication bias tests were performed.Results:Of the 4,138 articles retrieved,28 studies were included in our analysis,with a cumulative sample size of 284,840.Subsequent random-effects meta-analysis showed an association between low levels of vitamin D and cerebrovascular disease:RR=1.39,95%CI:1.26,1.53.In subgroup analyses,low levels of vitamin D were associated with both ischemic stroke(RR=1.35,95%CI:1.17,1.55)and hemorrhagic stroke(RR=1.70,95%CI:1.03,2.79).The funnel plot was asymmetric.Sensitivity analysis showed that one literature article had a significant impact on the results.There was a statistically significant correlation between low levels of vitamin D and cerebrovascular disease.Conclusion:Vitamin D levels are associated with both ischemic and hemorrhagic stroke.展开更多
Objective: To report on three patients with paraquat (PQ) intoxication surviving after combined therapy with hemoperfusion (HP), cyclophosphamide (CTX), and glucocorticoid. Methods: Three patients suffered acute renal...Objective: To report on three patients with paraquat (PQ) intoxication surviving after combined therapy with hemoperfusion (HP), cyclophosphamide (CTX), and glucocorticoid. Methods: Three patients suffered acute renal failure in a few days after ingesting a lethal amount of PQ. Chest computed tomography (CT) scans revealed obvious pulmonary inflammation, pleural effusion, and fibrous lesions several days after ingestion. HP was performed immediately, followed by large doses of glucocorticoid (methylprednisolone, 500 g/d) and CTX (approximately 4 g). Results: After 50 d of treatments, all three patients were discharged in healthy condition, with chest CT showing small fibrous lesions, exuda- tion, and both lungs clear of auscultation. Conclusions: The protective effect of the lungs may have been due to timely treatment at adequate doses.展开更多
基金This work was supported by grants from the Key Research and Development Program of Zhejiang Province(2019C03076)the Fundamental Research Funds for the Central Universities(226-2022-00088).
文摘Background:The 2-amino-5-chloro-N,3-dimethylbenzamide is a key intermediate in the synthesis of pesticides and pharmaceuticals.However,no literature currently exists on 2-amino-5-chloro-N,3-dimethylbenzamide poisoning in humans.This study aimed to reveal the health hazard of this chemical for humans and summarize the clinical characteristics of patients with occupational 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.Methods:This observational study included four patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning from June 2022 to July 2022.The entire course of the incidents was described in detail.Blood 2-amino-5-chloro-N,3-dimethylbenzamide concentrations were detected by a mass spectrometer.Hema-toxylin and eosin staining was performed to assess liver injury,and immunofluorescence was used to evaluate hepatic mitophagy.Results:The 2-amino-5-chloro-N,3-dimethylbenzamide powder(99%purity)entered the human body mainly via the skin and respiratory tract due to poor personal protective measures.The typical course of 2-amino-5-chloro-N,3-dimethylbenzamide poisoning was divided into latency,rash,fever,organic dam-age,and recovery phases in accordance with the clinical evolution.Rash and fever may be the important premonitory symptoms for further organ injuries.The chemical was detected in the blood of all patients and caused multiple organ injuries,predominantly liver injury,including kidney,myocardium,and micro-circulation.Three patients recovered smoothly after comprehensive treatments,including artificial liver therapy,continuous renal replacement therapy,glucocorticoids,and other symptomatic and supportive treatments.One patient survived by liver transplantation.The postoperative pathological findings of the removed liver showed acute liver failure,and immunofluorescence staining confirmed the abundance of mitophagy in residual hepatocytes.Conclusions:This study is the first to elaborate the clinical characteristics of patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.The chemical enters the body through the respiratory tract and skin during industrial production.The 2-amino-5-chloro-N,3-dimethylbenzamide poisoning causes multiple-organ dysfunction with a predominance of liver injury.Liver transplantation may be an effective option for patients with severe liver failure.The mechanisms of liver injury induced by 2-amino-5-chloro-N,3-dimethylbenzamide might involve abnormal mitochondrial function and mitophagy.
基金This project was supported by a grant from the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine (2017-XKA36).
文摘Background:Amanita poisoning as a foodborne disease has raised concerning mortality issues.Reducing the interval between mushroom ingestion and medical intervention could greatly influence the outcomes of Amanita poisoning patients,while treatment is highly dependent on a confirmed diagnosis.To this end,we developed an early detection-guided intervention strategy by optimizing diagnostic process with performingα-amanitin detection,and further explored whether this strategy influenced the progression of Amanita poisoning.Methods:This study was a retrospective analysis of 25 Amanita poisoning patients.Thirteen patients in the detection group were diagnosed mainly based onα-amanitin detection,and 12 patients were diagnosed essentially on the basis of mushroom consumption history,typical clinical patterns and mushroom identification(conventional group).Amanita poisoning patients received uniform therapy,in which plasmapheresis was executed once confirming the diagnosis of Amanita poisoning.We compared the demographic baseline,clinical and laboratory data,treatment and outcomes between the two groups,and further explored the predictive value ofα-amanitin concentration in serum.Results:Liver injury induced by Amanita appeared worst at the fourth day and alanine aminotransferase(ALT)rose higher than aspartate aminotransferase(AST).The mortality rate was 7.7%(1/13)in the detection group and 50.0%(6/12)in the conventional group(P=0.030),since patients in the detection group arrived hospital much earlier and received plasmapheresis at the early stage of disease.The early detection-guided intervention helped alleviate liver impairment caused by Amanita and decreased the peak AST as well as ALT.However,the predictive value ofα-amanitin concentration in serum was still considered limited.Conclusions:In the management of mushroom poisoning,consideration should be given to the rapid detection ofα-amanitin in suspected Amanita poisoning patients and the immediate initiation of medical treatment upon a positive toxin screening result.
基金This research was supported by a grant from the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(2017XK-A3)National Key R&D Program of China(2018YFC2001405).
文摘The pandemic caused by the SARS-CoV-2 coronavirus is still looming worldwide,and the pandemic has challenged health care delivery and health care systems internationally.[1]The epidemic of seasonal influenza would occur in the winter months.Since coronavirus disease 2019(COVID-19)and influenza share many clinical symptoms,[2]it is difficult to distinguish these two respiratory infections in the early stage.[3]Although nucleic acid testing was the gold standard to identify different virus infected diseases,false-negative nucleic acid results were reported frequently in COVID-19,[4]and its diagnostic sensitivity is less optimal.Therefore,the aim of our study is to explore and compare the clinical characteristics of COVID-19 and influenza,which could deepen the understanding of these two diseases and provide some guidance for clinicians to make a differential diagnosis.
基金This study was supported by the National Natural Science Foundation of China(81272075 and 81801572)the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(2017-XK-A36).
文摘BACKGROUND:Traumatic aortic dissection(TAD)has a low incidence but extremely high mortality.It always presents atypical clinical manifestations that are easily missed or misdiagnosed.This study mainly aims to describe the imaging characteristics and management of TAD patients.METHODS:A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020.Demographic features,imaging characteristics,and management were analyzed.RESULTS:Twenty-seven patients with type B aortic dissection(age 56.04±16.07 years,20 men)were included.Aortic intimal tears were mostly initiated from the aortic isthmus.The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature(1.78±0.56 cm vs.1.24±0.52 cm,P=0.031).Compared with those in the control group,the maximum diameters of the aortic arch,thoracic aorta,and abdominal aorta in the TAD patients were all significantly widened(all P<0.050).Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD,with a predictive value with an area under the receiver operating characteristic curve(AUC)of 0.673.Finally,26 patients successfully underwent delayed thoracic endovascular aortic repair(TEVAR),and the remaining one patient was treated conservatively.No progression of aortic dissection or death occurred during the six-month follow-up period.CONCLUSIONS:In blunt trauma,the aortic isthmus is the most common site of proximal intimal tears.An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics.Delayed TEVAR might be an eff ective therapeutic option for TAD.
基金supported by the Key Research and Development Program of Zhejiang Province(2019C03076).
文摘BACKGROUND:Hyperkalemia is common among patients in emergency department and is associated with mortality.While,there is a lack of good evaluation and prediction methods for the effi cacy of potassium-lowering treatment,making the drug dosage adjustment quite diffi cult.We aimed to develop a predictive model to provide early forecasting of treating eff ects for hyperkalemia patients.METHODS:Around 80%of hyperkalemia patients(n=818)were randomly selected as the training dataset and the remaining 20%(n=196)as the validating dataset.According to the serum potassium(K+)levels after the fi rst round of potassium-lowering treatment,patients were classifi ed into the eff ective and ineff ective groups.Multivariate logistic regression analyses were performed to develop a prediction model.The receiver operating characteristic(ROC)curve and calibration curve analysis were used for model validation.RESULTS:In the training dataset,429 patients had favorable eff ects after treatment(eff ective group),and 389 had poor therapeutic outcomes(ineff ective group).Patients in the ineff ective group had a higher percentage of renal disease(P=0.007),peripheral edema(P<0.001),oliguria(P=0.001),or higher initial serum K+level(P<0.001).The percentage of insulin usage was higher in the effective group than in the ineff ective group(P=0.005).After multivariate logistic regression analysis,we found age,peripheral edema,oliguria,history of kidney transplantation,end-stage renal disease,insulin,and initial serum K+were all independently associated with favorable treatment eff ects.CONCLUSION:The predictive model could provide early forecasting of therapeutic outcomes for hyperkalemia patients after drug treatment,which could help clinicians to identify hyperkalemia patients with high risk and adjust the dosage of medication for potassium-lowering.
基金Project (No. 20061420) supported by the Education and Research Foundation of Zhejiang Province, China
文摘Objective: To investigate the early effects of hypertonic and isotonic saline solutions on apoptosis of intestinal mucosa in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was established in 21 Sprague-Dawley (SD) rats. The rats were randomly divided into the sham group, normal saline resuscitation (NS) group, and hypertonic saline resuscitation (HTS) group, with 7 in each group. We detected and compared the apoptosis in small intestinal mucosa of rats after hemorrhagic shock and resuscitation by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), FITC (fluo- rescein-iso-thiocyanate)-Annexin V/PI (propidium iodide) double staining method, and flow cytometry. Results: In the early stage of hemorrhagic shock and resuscitation, marked apoptosis of small intestinal mucosa in the rats of both NS and HTS groups was observed. The numbers of apoptotic cells in these two groups were significantly greater than that in the sham group (P<0.01). In the HTS group, the apoptic cells significantly decreased, compared with the NS group (P<0.01). Conclusion: In this rat model of severe hemorrhagic shock, the HTS resuscitation of small volume is more effective than the NS resuscitation in reducing apoptosis of intestinal mucosa in rats, which may improve the prognosis of trauma.
基金the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine (2017-XK-A36)the Key Research and Development Program of Zhejiang Province (2019C03076).
文摘BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.
基金the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(2017-XK-A36)the Medical and Health Science Foundation of Zhejiang Province(2019327552).
文摘Dear editor,Paraquat(PQ)can cause acute lung injury and irreversible pulmonary fibrosis,without specific antidotes.Respiratory failure is the main cause of death among patients with PQ poisoning.Currently,the treatment involves the use of adsorbents,intensive hemoperfusion,antioxidants,immunosuppressive therapy,respiratory support by mechanical ventilation,and other symptomatic and supportive treatments.[1-3]The mortality of patients with severe PQ poisoning remains high.More eff ective and safer therapies remain to be explored.Few studies reported performing extracorporeal membrane oxygenation(ECMO)and subsequent lung transplantation with either successful or poor clinical outcome in extremely critical patients with PQ poisoning.[4,5]This study aims to summarize the clinical experience and refl ect on the therapeutic prospect of ECMO in respiratory failure or cardiopulmonary failure caused by fatal PQ poisoning.
基金This study was supported by a grant from the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(2017-XK-A36).
文摘Foreign bodies’ingestion is a common phenomenon,and most of the ingested foreign bodies pass through the gut uneventfully.In clinical practice,less than 1%of these patients develop complications such as gut wall penetration or perforation[1–3].We present a rare complication of hepatic abscess secondary to the toothpick piercing the gastric wall into the liver.The abscess was successfully treated by endoscopic retrieval of the foreign body and empirical antibiotic therapy,without drainage or laparotomy.
基金the National Natural Science Foundation of China(81272075 and 81801572)the Medical and Health Science Foundation of Zhejiang Province(2019327552)+1 种基金the Foundation of Key Research Project of Zhejiang Province for Traditional Chinese Medicine(2019ZZ014)the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(2017-XKA36).
文摘Background:The high coverage of annual routine health check-up in China is a unique phenomenon throughout the world.However,its clinical value is controversial.In this cohort study,we chose pancreatic cancer as a disease model to explore the role of routine check-up in the prognosis of patients with pancreatic cancer.Methods:Data from 157 patients who were diagnosed with pancreatic cancer between January 2010 and April 2014 were collected.Patients were divided into two groups depending on how their disease was detected.Group A(n=85):Patients were diagnosed with pancreatic cancer in clinic visits.Group B(n=72):Patients were diagnosed with pancreatic cancer in routine check-ups.We compared their prognosis.Results:The tumor stage in group B was earlier than that in group A.The 1-year survival rate in group B was significantly higher than that in group A(74.6%vs.42.4%,P<0.001),while the 3-and 5-year survival rates of the two groups showed no significant difference(P>0.05).The difference of overall survival time between the two groups was not significant(22.0 vs.9.0 months,P=0.078).Conclusions:The stage of pancreatic cancer diagnosed in routine check-ups was earlier and therefore,the intervention was earlier which improved short-term survival rate.However,early intervention did not improve overall survival in the long-term.
文摘BACKGROUND Acute generalized exanthematous pustulosis(AGEP)is a severe cutaneous adverse reaction characterized by sterile pustules on erythematous skin associated with fever and leukocytosis.The annual incidence of AGEP is estimated to be 1-5 cases per million.Cases of AGEP with oral mucosa involvement have been reported.However,reports of AGEP involving airway mucosa are limited.CASE SUMMARY We report a 42-year-old woman with serious AGEP involving the airway mucosa.The patient initially developed fever and a small rash on her forehead and face.Over the next 2 d,she developed a diffuse,pustular rash over her trunk and legs.In addition,she complained of a cough with white foam-like sputum,chest tightness and dyspnea.Four days later,due to dyspnea,her mental status started to gradually deteriorate.She became more and more drowsy.Biopsies of the skin and airway mucosa suggested the diagnosis of AGEP.According to the European study of severe cutaneous adverse reactions group’s scoring system,the patient scored+6 indicating a probable diagnosis of AGEP.She received intravenous methylprednisolone 120 mg/12 h for 3 d,and was eventually discharged in good condition.This patient had already experienced respiratory failure and airway mucosa involvement on admission;however,the clinicians had an insufficient understanding of AGEP.Glucocorticoid was administered for more than 10 d following onset of the disease,and her overall prognosis was satisfactory.CONCLUSION This case represents a rare clinical feature of AGEP and an important finding for clinicians.
基金the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine,No. 2017-XK-A36
文摘BACKGROUND In the past years,only a few studies with a limited number of adult patients analyzed clinical features of allied disorders of Hirschsprung’s disease(ADHD),most of which were individual case reports or lacked detailed clinical information.Although many studies have reported patients presenting to the emergency department(ED)with recurrent abdominal symptoms for a number of disorders,there are few data involving ADHD.However,owing to a lack of awareness of the disease,misdiagnoses and mistreatments are common.Severe complications such as perforation,bleeding,malabsorption,and even death in ADHD had been reported by many studies.AIM To assist ED clinicians in having a more comprehensive understanding of this disease and making an early suspected diagnosis of ADHD more effectively.METHODS We enrolled 53 patients who visited the ED and were eventually diagnosed with ADHD over the past 11 years in our hospital.Their basic information,clinical manifestations,and imaging findings were analyzed.Blood indices were compared between the ADHD and irritable bowel syndrome(IBS)groups.RESULTS Adult patients with ADHD had a mean age of 48.8±14.3 years,and 77.4%had been treated before admission.The transverse colon was the most common dilated part(73.6%),and constipation(67.9%)was the most common symptom.ADHD patients can present with uncommon symptoms and false-negative imaging findings.Logistic regression analysis indicated that body mass index(BMI)[odds ratio(OR)=0.786,P=0.013],cholinesterase(per 1000 units;OR=0.693,P=0.008),and blood chlorine(OR=0.816,P=0.022)were determined to be independent related factors between the ADHD and IBS groups.The area under the receiver operating characteristics curve of these three indices combined was 0.812(P<0.001).CONCLUSION Emergency physicians should be vigilant regarding patients with chronic constipation,abdominal pain,or abdominal distension,and consider the possibility of ADHD despite its rarity.Abdominal computed tomography examination is recommended as a useful tool in the suspected diagnosis of ADHD.BMI,cholinesterase,and blood chlorine have good discriminative abilities between ADHD and IBS.The nutritional status of adult patients with ADHD is worthy of further attention.Surgical treatment for adult patients with ADHD is important and inevitable.
文摘Objective： The intoxications caused by 2,4-dinitrophenol （2,4-DNP）, even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and explore the clinical value of resin hemoperfusion （HP） in the treatment of patients with acute 2,4-DNP poisoning. Methods We reported 16 cases of acute 2,4-DNP poisoning through occupational exposure due to ignoring the risk of poisoning. The blood samples were collected from the 14 survivors. According to the different treatments of resin HP, the survivors were divided into routine HP （n=5） and intensive HP （n=9） groups. Ultra high performance liquid chromatography/ tandem mass spectroscopy （UPLC-MS/MS） was used to detect the 2,4-DNP concentration in plasma in this study. Results： The 14 survivors recovered very well after treatment. The initial plasma 2,4-DNP concentrations （C1） of survivors ranged from 0.25 to 41.88 pg/ml （mean （12.56＋13.93） pg/ml）. A positive correlation existed between initial plasma 2,4-DNP concentration （C1） and temperature. The elimination of 2,4-DNP was slow and persistent, and the total clearance rates of plasma toxin from the 1st to 3rd day （R3）, the 3rd to 7th day （R3-7）, and the 1st to 7th day （RT）, were only （53.03±14.04）%, （55.25±10.50）%, and （78.29±10.22）%, respectively. The plasma toxin was cleared up to 25 d after poisoning in most of the patients. The R3, R3-7, and R7 in the intensive HP group were all apparently higher than those in the routine HP group, with statistical significance （P〈0.05）. Simultaneously, the elimination half-life （tl/2） of 2,4-DNP in the intensive HP group was apparently shorter than that in the routine HP group, with statistical significance （P〈0.05）. Conclusions： The clinicians should be aware of this slow and persistent process in the elimination of plasma 2,4-DNP. Higher initial plasma toxin concentration resulted in a more severe fever for the patient. According to the limited data, longer and more frequent resin HP may accelerate to eliminate the poison.
基金supported by the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(Grant No. 2017-XK-A36)the Foundation of Key Research Project of Zhejiang Province for Traditional Chinese Medicine (Grant No. 2019ZZ014)。
文摘Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.Methods: This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.Results: Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen(P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived(both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels.Unexpectedly, we found that hydrothorax was detected in 21(65.63%) patients in the death group and 19(59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio(INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.Conclusion: HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.
基金supported by the National Natural Science Foundation of China(No.81272075)
文摘Objective： To investigate the effects of resuscitation with normal saline（NS）, hypertonic saline（HTS）, and hydroxyethyl starch（HES） on regulatory T cells（Tregs）, helper T 1（Th1）/Th2 and cytotoxic T 1（Tc1）/Tc2 profiles in the treatment of hemorrhagic shock. Methods： Rats subjected to severe hemorrhagic shock were resuscitated for 30 min with NS（n=8）, HTS（n=8）, or HES（n=8）; sham（n=8） and naive control（n=8） groups were used for comparison. Following fluid resuscitation, the whole shed blood was reinfused for 30 min, and the rats were observed with continuous hemodynamic monitoring for 120 min. CD4^＋CD25^＋Foxp3^＋ Treg proportions, Th1/Th2 and Tc1/Tc2 profiles in spleen were analyzed by three-color flow cytometry. Results： The proportion of CD4^＋CD25^＋Foxp3^＋ Tregs and ratios of Th1/Th2 and Tc1/Tc2 did not differ among control, sham, and HTS groups, but were significantly lower in NS and HES groups（both P0.05 vs. sham）; NS and HES levels were similar. The level of Tc1 was significantly increased in HTS（P0.05 vs. sham）, and levels of Tc2 were increased in NS, HES, and HTS groups compared to sham（all P0.05）, but did not differ from each other. Conclusions： HTS resuscitation has a greater impact on immune system recovery than NS or HES by preserving the proportion of Tregs and maintaining the balance between Th1/Th2 and Tc1/Tc2 cells in the spleen. Thus, HTS resuscitation provides potential immunomodulatory activity in the early stage after hemorrhagic shock.
文摘We have read with great interest the recent article “Cellular mechanism of cardiac alternans： an unresolved chicken or egg problem” by Zang and Xia （2014）, published in Journal of Zhejiang University- SCIENCE B （Biomedicine ＆ Biotechnology）. The authors proposed that both calcium handling and electrical components of cardiac cells could be the cellular mechanism of cardiac alternans, and identifying the main mechanism of cardiac alternans could help to cure targeted patients with heart failure. Here,
基金Project supported by the National Natural Science Foundation of China(No.81272075)
文摘Objective： To investigate the distribution and differentiation of myeloid-derived suppressor cells （MDSCs） in hemorrhagic shock mice, which are resuscitated with normal saline （NS）, hypertonic saline （HTS）, and hydroxyethyl starch （HES）. Methods： BALB/c mice were randomly divided into control, NS, HTS, and HES resuscitation groups. Three subgroups （n=8） in each resuscitation group were marked as 2, 24, and 72 h. Flow cytometry was used to detect the MDSCs, monocytic MDSCs （M-MDSCs）, and granulocytic/neutrophilic MDSCs （G-MDSCs） in peripheral blood nucleated cells （PBNCs）, spleen single-cell suspension, and bone marrow nucleated cells （BMNCs）. Results： The MDSCs in BMNCs among three resuscitation groups were lower 2 h after shock, in PBNCs of the HTS group were higher, and in spleen of the NS group were lower （all P〈0.05 vs. control）. The M-MDSC/G-MDSC ratios in PBNCs of the HTS and HES groups were lower （both ,P〈0.05 vs. control）. At 24 h, the MDSCs in PBNCs of the NS and HTS groups were higher, while the spleen MDSCs in the HTS group were higher （all P〈0.05 vs. control）. The M-MDSC/ G-MDSC ratios were all less in PBNCs, spleen, and BMNCs of the NS and HTS groups, and were lower in BMNCs of the HES group （all P〈0.05 vs. control）. At 72 h, the elevated MDSCs in PBNCs were presented in the HTS and HES groups, and in spleen the augment turned up in three resuscitation groups （all P〈0.05 vs. control）. The inclined ratios to M-MDSC were exhibited in spleen of the NS and HTS groups, and in PBNCs of the NS group; the inclination to G-MDSC in BMNCs was shown in the HES group （all P〈0.05 vs. control）. Conclusions： HTS induces the earlier ele- vation of MDSCs in peripheral blood and spleen, and influences its distribution and differentiation, while HES has a less effect on the distribution but a stronger impact on the differentiation of MDSCs, especially in bone marrow.
基金supported by the Key Research and Development Program of Zhejiang Province[No.2019C03076].
文摘Objective:This scoping review aims to perform a meta-analysis to harmonize the existing results on circulating vitamin D and cerebrovascular disease.Methods:Three scientific databases,PubMed,the Cochrane Library and EMBASE,were systematically searched.The overall relative risk(RR)and the corresponding 95%confidence interval(CI)were calculated using a random-effects model,and sensitivity analysis and publication bias tests were performed.Results:Of the 4,138 articles retrieved,28 studies were included in our analysis,with a cumulative sample size of 284,840.Subsequent random-effects meta-analysis showed an association between low levels of vitamin D and cerebrovascular disease:RR=1.39,95%CI:1.26,1.53.In subgroup analyses,low levels of vitamin D were associated with both ischemic stroke(RR=1.35,95%CI:1.17,1.55)and hemorrhagic stroke(RR=1.70,95%CI:1.03,2.79).The funnel plot was asymmetric.Sensitivity analysis showed that one literature article had a significant impact on the results.There was a statistically significant correlation between low levels of vitamin D and cerebrovascular disease.Conclusion:Vitamin D levels are associated with both ischemic and hemorrhagic stroke.
文摘Objective: To report on three patients with paraquat (PQ) intoxication surviving after combined therapy with hemoperfusion (HP), cyclophosphamide (CTX), and glucocorticoid. Methods: Three patients suffered acute renal failure in a few days after ingesting a lethal amount of PQ. Chest computed tomography (CT) scans revealed obvious pulmonary inflammation, pleural effusion, and fibrous lesions several days after ingestion. HP was performed immediately, followed by large doses of glucocorticoid (methylprednisolone, 500 g/d) and CTX (approximately 4 g). Results: After 50 d of treatments, all three patients were discharged in healthy condition, with chest CT showing small fibrous lesions, exuda- tion, and both lungs clear of auscultation. Conclusions: The protective effect of the lungs may have been due to timely treatment at adequate doses.
