Diagnosis and treatment of 4 cases imported severe malaria and COVID-19 co-infection / 中国热带医学

@#Abstract: To explore the clinical characteristics, diagnosis and treatment of imported severe malaria and COVID-19 co-infection cases, and to provide scientific basis for epidemic prevention and control measures. The epidemiological characteristics, clinical manifestations, laboratory tests, treatment process and prognosis of 4 cases of severe malaria and COVID-19 co-infection with confirmed diagnosis were analyzed retrospectively. Four cases of severe malaria were African returnees of the same batch, male, aged 40-54 years old, with the same journey track. They all had African work and life history and acute onset. The main clinical manifestations were fever (4/4), chills (3/4), chills (3/4), nausea and vomiting (3/4), diarrhea (4/4), fatigue and anorexia (4/4). Two cases had headache and dizziness, confusion, muscle aches, two cases had cough, one cases had sputum, sore throat and runny urine. All 4 cases were confirmed by positive nucleic acid detection of the new coronavirus (2019-nCOV) in throat swabs. Plasmodium falciparum was found by microscopic examination of peripheral blood smears of all patients, and all of them were consistent with high altitude helminthiasis. All cases were accompanied by abnormal liver function and severe hypoproteinemia, two cases were hyperbilirubinemia, three cases were dyslipidemia, three cases were involved in abnormal tertiary hemogram with different degrees of elevation of procalcitonin, two cases were lactic acid poisoning, and one case was hypoglycemia. One case showed viral pneumonia on chest CT. All cases were treated individually according to the different conditions and were discharged after improvement, and were rechecked for 2019-nCOV nucleic acid and microscopic examination of blood smear negative for Plasmodium.During the global COVID-19 epidemic, the emergence of coinfection cases of con-infection of imported malaria parasites and severe acuterespiratory syndrome coronavirus 2 (SARS-CoV-2) makes the clinical diagnosis and treatment more complicated. It is important to establish the awareness of simultaneous prevention and diagnosis of COVID-19 and malaria for local prevention and control and early warning of severe cases, and timely and effective formulation of treatment plan to improve the comprehensive treatment efficiency.

Research advances in the role of ferroptosis in neonatal hypoxic-ischemic brain damage / 中国当代儿科杂志

Neonatal hypoxic-ischemic brain damage (HIBD) remains an important cause of neonatal death and disability in infants and young children, but it has a complex mechanism and lacks specific treatment methods. As a new type of programmed cell death, ferroptosis has gradually attracted more and more attention as a new therapeutic target. This article reviews the research advances in abnormal iron metabolism, glutamate antiporter dysfunction, and abnormal lipid peroxide regulation which are closely associated with ferroptosis and HIBD.

Nation-Wide Observational Study of Cardiac Arrests Occurring in Nursing Homes and Nursing Facilities in Singapore

INTRODUCTION@#Nursing home (NH) residents with out-of-hospital cardiac arrests (OHCA) have unique resuscitation priorities. This study aimed to describe OHCA characteristics in NH residents and identify independent predictors of survival.@*MATERIALS AND METHODS@#OHCA cases between 2010-16 in the Pan-Asian Resuscitation Outcomes Study were retrospectively analysed. Patients aged <18 years old and non-emergency cases were excluded. Primary outcome was survival at discharge or 30 days. Good neurological outcome was defined as a cerebral performance score between 1-2.@*RESULTS@#A total of 12,112 cases were included. Of these, 449 (3.7%) were NH residents who were older (median age 79 years, range 69-87 years) and more likely to have a history of stroke, heart and respiratory diseases. Fewer NH OHCA had presumed cardiac aetiology (62% vs 70%, <0.01) and initial shockable rhythm (8.9% vs 18%, <0.01), but had higher incidence of bystander cardiopulmonary resuscitation (74% vs 43%, <0.01) and defibrillator use (8.5% vs 2.8%, <0.01). Non-NH (2.8%) residents had better neurological outcomes than NH (0.9%) residents ( <0.05). Factors associated with survival for cardiac aetiology included age <65 years old, witnessed arrest, bystander defibrillator use and initial shockable rhythm; for non-cardiac aetiology, these included witnessed arrest (adjusted odds ratio [AOR] 3.8, <0.001) and initial shockable rhythm (AOR 5.7, <0.001).@*CONCLUSION@#Neurological outcomes were poorer in NH survivors of OHCA. These findings should inform health policies on termination of resuscitation, advance care directives and do-not-resuscitate orders in this population.

Systematic efficacy study and mechanism prediction of Chaihu Plus Mangxiao Decoction in treatment of constipation based on network pharmacology model / 中草药

Objective: To investigate the function network and potential mechanisms of effects of Chaihu Plus Mangxiao Decoction in the treatment of functional constipation by using network pharmacology methods. Methods: TCMSP, TCMID, and Swiss Target Prediction online prediction databases were used to screen the components and their potential targets of Chaihu Plus Mangxiao Decoction using oral availability (OB) and drug-like (DL) as the qualification conditions. PubMed, CTD, TTD, and DrugBank were used to search functional constipation-related targets. STRING and Cytoscape were used to make targets network visualization, screen the key components and core targets with high a degree of the node; Finally, relevant software was applied to analyze core targets and predict the mechanism. Results: A number of 206 total components of Chaihu Plus Mangxiao Decoction were screened, and there were 998 corresponding targets, which were contained 295 targets associated with functional constipation. According to the analysis, there were 64 key components and 30 core targets involving the Chaihu Plus Mangxiao Decoction-induced treatment of functional constipation. After enrichment analysis and KEGG pathway analysis of 30 core targets, it was found that SCN9A, CFTR, HTR2A, OPRD1, PTGS1, and FGFR1 were involved in regulating biological processes including opioid receptor activity, water balance of the organism, terpenoids and biological receptors and subsequent mediating the function of serotonin receptors, arachidonic acid metabolism, transcriptional regulation of MECP2, cytochrome P450, biogenic amine-binding receptors, PI3K the aberrant expression, tyrosine-protein kinase signaling pathway, and exogenous foreign body stimulation. These biological targets and molecular signaling pathways may play a therapeutic role in the treatment of functional constipation. Conclusion: The mechanism of effect of Chaihu Plus Mangxiao Decoction in the treatment of functional constipation is characterized by multiple targets and pathways. Saponins, flavonoids, and sterols may be the material basis for core functions, and serotonin receptors, opioid receptors and chloride channel-regulated receptors may be key targets of Chaihu Plus Mangxiao Decoction.

Identification of Ophiocordyceps sinensis and its adulterants based on portable and CFX96 real-time fluorescent PCR systems / 药学学报

The molecular identification of Ophiocordyceps sinensis and its adulterants was carried out by real-time fluorescent PCR with TaqMan probe. Genomic DNA was extracted from 100 samples of Ophiocordyceps sinensis and its adulterants. MEGA 7.0 software was used for comparative analysis to define the variable sites between Ophiocordyceps sinensis and its adulterants according to the internal transcribed spacer (ITS) region of ribosomal DNA (rDNA). A set of specific primers and TaqMan probe were designed using Primer Premier 6.0 software, and sensitivity and specificity studies were performed on two different real-time fluorescent PCR systems (Genesig q16 and Bio-Rad CFX96). The sensitivity study showed that the detectable DNA template concentration of Ophiocordyceps sinensis for the real-time fluorescent PCR was 0.016 ng·μL-1 in the Bio-Rad CFX96 system and 15.527 ng·μL-1 in the Genesig q16 system, respectively. Meanwhile, this method had good specificity for Ophiocordyceps sinensis on Genesig q16 and Bio-Rad CFX96 systems, so Ophiocordyceps sinensis could be clearly distinguished from Ophiocordyceps nutans, Cordyceps gunnii, Cordyceps militaris, Cordyceps cicadae, Cordyceps liangshanensis, Cordyceps gracilis. Our results indicate that real-time fluorescent PCR with TaqMan probe can be used to accurately identify Ophiocordyceps sinensis from its adulterants. This provides a technical method that has wide applications for market management and quality control of Chinese materia medica.

Simultaneous Determination of Stilbene Glycosides, Ferulic Acid and Paeonol in Qubai Granules by a Dual-wavelength HPLC Method / 中国药师

Objective: To establish an HPLC determination method for the quantitative indicators in Qubai granules( stilbene gly-cosides, ferulic acid and paeonol). Methods: A dual-wavelength HPLC assay was used with the following conditions: a chromatogra-phy column ODS (150 mm×4. 6 mm, 5 μm) was used, the mobile phase was methanol: 0. 1% phosphoric acid with gradient elution, the column temperature was 35℃, and the injection volume was 10 μl. Results: The linear ranges of the three active constituents were 1.56-156.00 μg·ml-1(r stilbeneglycoside=0.999 8)、1.00~100.00 μg·ml-1(rferulicacid=0.999 8),1.61~161.00 μg·ml-1(rpaeonol=0. 999 7), respectively, and the average recoveries of the three constituents were between 100. 33% and 100. 76% with the RSDS less than 2% (n=6). Conclusion: The method is simple, stable and reliable, which can be used for the quality control of Qubai granules.

Rapid determination of nine components in the first extraction process of Xingnaojing injection by using ultraviolet spectroscopy / 中国中药杂志

In this study, an analytical method based on ultraviolet spectroscopy was established for the rapid determination of nine components including isophorone, 4-methylene-isophorone, curcumenone, curcumenol, curdione, curzerenone, furanodienone, curcumol and germacrone in the first extraction process of Xingnaojing injection. 166 distillate samples of Gardeniae Fructus and Radix Curcumae were collected in the first extraction process of Xingnaojing injection. The ultraviolet spectra of these samples were collected, and the contents of the nine components in these samples were determined by high performance liquid chromatography. Least squares support vector machine and radial basis function artificial neural network were used to establish the multivariate calibration models between the ultraviolet spectra and the contents of the nine components. The results showed that the established ultraviolet spectrum analysis method can determine the contents of the nine components in the distillates accurately, with root mean square error of prediction of 0.068, 0.147, 0.215, 0.319, 1.01, 1.27, 0.764, 0.147, 0.610 mg•L⁻¹, respectively. This proposed method is a rapid, simple and low-cost tool for the monitoring and endpoint determination of the extraction process of Xingnaojing injection to reduce quality defects and variations.

A modified closed-loop double-endobutton technique for the treatment of Rockwood type Ⅲ acromioclavic-ular joint dislocation / 医学研究生学报

Objective Double-endobutton technique , as a widely accepted strategy for the treatment of acromioclavicular joint dislocation ( ACD ) , is undergoing constant improvement .This study was to assess the clinical effect of a modified closed-loop double-endobutton technique ( CDT) in the fixation of Rockwood type Ⅲ ACD . Methods This retrospective study included 60 cases of Rockwood type Ⅲ ACD treated between January 2010 and December 2015, 30 by modified CDT (MCDT) and the other 30 by conventional CDT (CCDT).We recorded and compared the operation time, incision length , intraoperative blood loss , pre-and post-opera-tive scores in the Constant-Murley Scale ( CMS ) , UCLA Shoulder Rating Scale ( SRS) , American Shoulder and Elbow Surgeons Rating Scale ( ARS) and Oxford Shoulder Score ( OSS), and the vertical distance from the supraclavian to subcoracoid plane ( CC-Dist ) be-tween the two groups of patients . Results Compared with the CCDT group, the MCDT group showed a significantly shorter operation time ([78.33±11.47] vs [52.33±8.48] min, P<0.05) and less intraoperative blood loss ([103.00±7.38] vs [79.17±9.75] mL, P<0.05).In comparison with the baseline, the patients of MCDT group achieved markedly improved scores at 12 months after surgery in CMS (46.60±2.09 vs 97.67±0.88, P<0.05), SRS (14.70±1.24 vs 32.17±1.21, P<0.05), ARS (44.23±2.40 vs 91.83±1.62, P<0.05), OSS (45.07±3.10 vs 15.80±1.81, P<0.05), and CC-Dist ([16.76±0.88] vs [7.57±0.73] mm, P<0.05). Conclusion MCDT, with the advantages of easier , tighter, and fas-ter reduction and fixation , is obviously superior to CCDT in the treatment of Rockwood type Ⅲ ACD .

A modified closed-loop double-endobutton technique for the treatment of Rockwood type Ⅲ acromioclavic-ular joint dislocation / 医学研究生学报

Objective Double-endobutton technique , as a widely accepted strategy for the treatment of acromioclavicular joint dislocation ( ACD ) , is undergoing constant improvement .This study was to assess the clinical effect of a modified closed-loop double-endobutton technique ( CDT) in the fixation of Rockwood type Ⅲ ACD . Methods This retrospective study included 60 cases of Rockwood type Ⅲ ACD treated between January 2010 and December 2015, 30 by modified CDT (MCDT) and the other 30 by conventional CDT (CCDT).We recorded and compared the operation time, incision length , intraoperative blood loss , pre-and post-opera-tive scores in the Constant-Murley Scale ( CMS ) , UCLA Shoulder Rating Scale ( SRS) , American Shoulder and Elbow Surgeons Rating Scale ( ARS) and Oxford Shoulder Score ( OSS), and the vertical distance from the supraclavian to subcoracoid plane ( CC-Dist ) be-tween the two groups of patients . Results Compared with the CCDT group, the MCDT group showed a significantly shorter operation time ([78.33±11.47] vs [52.33±8.48] min, P<0.05) and less intraoperative blood loss ([103.00±7.38] vs [79.17±9.75] mL, P<0.05).In comparison with the baseline, the patients of MCDT group achieved markedly improved scores at 12 months after surgery in CMS (46.60±2.09 vs 97.67±0.88, P<0.05), SRS (14.70±1.24 vs 32.17±1.21, P<0.05), ARS (44.23±2.40 vs 91.83±1.62, P<0.05), OSS (45.07±3.10 vs 15.80±1.81, P<0.05), and CC-Dist ([16.76±0.88] vs [7.57±0.73] mm, P<0.05). Conclusion MCDT, with the advantages of easier , tighter, and fas-ter reduction and fixation , is obviously superior to CCDT in the treatment of Rockwood type Ⅲ ACD .

Study on Water Extraction Process of Traditional Chinese Medicine Qubai Granule by Orthogonal Test / 中国药师

Objective:To optimize the water extraction process of traditional Chinese medicine ( TMC) Qubai granule. Methods:The orthogonal test was used to study four influencing factors including water amount, soaking time, extraction time and extraction times with dry extract yielding rate and the content of ferulic acid as the evaluation indices. Results:The optimum extraction process was as follows:A2 B1 C2 D2 , namely adding 10-fold amount of water, without soaking in advance, extracting twice with 2 h for each time. Con-clusion:The process is simple, stable and reproducible, which provides basis for the industrial production.

Long-term outcome of patients undergoing recanalization procedures for chronic total coronary occlusion / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the long-term outcomes of patients receiving percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy for treatment of chronic total coronary occlusion (CTO).</p><p><b>METHODS</b>The patients with CTO were selected from a consecutive cohort of patients who underwent coronary angiography (CAG) between 2008 and 2009. The patients with multiple CAG were excluded. The patients received treatments with PCI, CABG, or conservative medication therapy and were followed for major adverse cardiovascular events (MACE) within 5 years.</p><p><b>RESULTS</b>A total of 253 patients were enrolled in this study, including 192 receiving PCI, 48 receiving CABG, and 13 treated conservatively with medications. The baseline clinical characteristics were similar among the 3 groups except for increased low-density lipoprotein (LDL) and total cholesterol (TC) in the medication group, and increased Syndax score in CABG group. During the follow-up, the incidences of MACE, AMI, death, stroke or heart failure did not differ significantly among the 3 groups (P>0.05). However, CABG group showed a higher incidence of the stroke than the other two groups although this difference did not reach a statistically significantly level (P=0.06).</p><p><b>CONCLUSION</b>Our study did not demonstrate that recanalization offers greater long-term benefits than medications for treatment of CTO, and the patients receiving CABG appeared to have a higher incidence of stroke.</p>

Clinincal application of self-made eccentric traction belt in the treatment of distal radial fractures / 中国骨伤

<p><b>OBJECTIVE</b>To observe the curative effect of self-made eccentric traction belt as a manipulative reduction tool in the treatment of the distal radial fracture.</p><p><b>METHODS</b>From February 2011 to June 2012,62 patients with distal radial closed fractures were treated by manipulative reduction with self-made wristlet-eccentric traction belt and combined with the small splint and plaster external fixation. Among them, 59 cases were Colles fractures, 2 were Smith fractures, 1 was Barton fracture. After the reduction, lateral X-ray imaging was used to evaluate curative effect immediately.</p><p><b>RESULTS</b>All the patients obtained excellent and good reduction in standard of fractures, only 1 case didn't. According to functonal assessment of Dienst, the results were excellent in 49 cases, good in 11, fair in 1, and poor in 1.</p><p><b>CONCLUSION</b>Self-made wristlet-eccentric traction belt as a manipulative reduction tool to treat distal radius fractures, can make fractures close to the anatomic reduction, and can significantly improve the manual reduction success rate.</p>

Effect of growth and differentiation factor 6 on the tenogenic differentiation of bone marrow-derived mesenchymal stem cells / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recent studies showed that bone marrow-derived mesenchymal stem cells (BMSCs) had risk of ectopic bone formation. In this study, we aimed to investigate the effect of growth and differentiation factor 6 (GDF-6) on the tenogenic differentiation of BMSCs in vitro, and then combined with small intestine submucous (SIS) to promote tendon regeneration in vivo.</p><p><b>METHODS</b>The BMSCs were isolated from the green fluorescent protein (GFP) rats, and were characterized by multi-differentiation assays following our previous study protocol. BMSCs cultured with different concentrations of GDF-6, without growth factors served as control. After 2 weeks, mRNA expression and protein expression of tendon specific markers were examined by qRT-PCR and Western blotting to define an optimal concentration of GDF-6. Mann-Whitney U-test was used to compare the difference in relative mRNA expression among all groups; P ≤ 0.05 was regarded as statistically significant. The GDF-6 treated BMSCs combined with SIS were implanted in nude mice and SD rat acute patellar tendon injury model, the BMSCs combined with SIS served as control. After 12 and 4 weeks in nude mice and tendon injury model, the samples were collected for histology.</p><p><b>RESULTS</b>After the BMSCs were treated with different concentration of GDF-6 for 2 weeks, the fold changes of the specific markers (Tenomodulin and Scleraxis) mRNA expression were significantly higher in GDF-6 (20 ng/ml) group (P ≤ 0.05), which was also confirmed by Western blotting result. The BMSCs became parallel in orientation after GDF-6 (20 ng/ml) treatment, but the BMSCs in control group were randomly oriented. The GDF-6 (20 ng/ml) treated BMSCs were combined with SIS, and were implanted in nude mice for 12 weeks, the histology showed neo-tendon formation. In the SD rat patellar tendon window injury model, the histology also indicated the GDF-6 (20 ng/ml) treated BMSCs combined with SIS could promote tendon regeneration.</p><p><b>CONCLUSIONS</b>GDF-6 has tenogenic effect on the tenogenic differentiation of BMSCs, and GDF-6 (20 ng/ml) has better tenogenic effect compared to other concentrations. The GDF-6 (20 ng/ml) treated BMSCs combined with SIS can form neo-tendons and promote tendon regeneration.</p>

Four-year clinical outcome in asymptomatic patients undergoing coronary computed tomography angiography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Percutaneous coronary intervention (PCI) is indicated for angina with coronary stenosis. However, PCI for asymptomatic coronary stenosis remains controversial. We prospectively followed a group of patients for four years who underwent coronary computed tomography angiography (CCTA) for major adverse cardiac events (MACE). We hypothesized that the results of this trial would reliably reflect the natural outcome of the coronary disease.</p><p><b>METHODS</b>Consecutive patients who underwent CCTA from June 2008 to May 2009 were selected. Those who could not be reached by telephone, had significant angina, had CT images that were not interpretable, or poor kidney and left ventricular (LV) function were excluded. The patients were divided into five groups: group A normal CCTA without stenosis, group B mild stenosis (1% - 49%), group C moderate stenosis (50% - 74%), group D severe stenosis (= 75%) and they were treated with optimal medical therapy (OMT) or PCI. The group E had PCI before the CCTA examination. The patients were then followed for MACE after different treatments. MACE included acute myocardial infarction (MI), heart failure (HF) and death.</p><p><b>RESULTS</b>The patient population consisted of 419 patients. The follow-up time was (51 ± 5) months. The age was (60 ± 31) years. Male made up 67.78% of the population (n = 284). A total of 51 cases of MACE occurred including 25 MI, eight HF and 18 all-cause deaths. There was no MACE in group A. Although MACE occurred in two patients in group B, they were not attributed to cardiac death. We further compared the MACE in groups C-E and no significant difference was found (P > 0.05). However, a difference was detected among patients with unstable angina pectoris (UAP), stable angina pectoris (SAP), re-hospitalization, and cerebrovascular events from groups A-E (P < 0.05). The plaque scores were used to predict MACE. The scores progressively increased significantly with lesion severity (P < 0.05). Receiver operating curve (ROC) was performed to determine the sensitivity and specificity in predicting MACE. Our scores predicted MI with area of 0.76, predicted HF with area of 0.77, and predicted death with area of 0.70.</p><p><b>CONCLUSIONS</b>Normal and mild lesions had very few events. With increased stenosis the MACE rate increased progressively. PCI did not significantly reduce the MACE in comparison with OMT in asymptomatic patients. Furthermore, UAP, re-hospitalization, and re-PCI were significantly increased in patients who were treated with PCI.</p>