Etiological diagnostic value of cerebrospinal fluid metagenomic next-generation sequencing in central nervous system infection / 中华急诊医学杂志

Objective:To investigate the etiological diagnostic value of metagenomic sequencing in central nervous system (CNS) infectious diseases.Methods:A total of 170 patients with central nervous system infection admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2020 were selected as the study subjects according to inclusion and exclusion criteria. General clinical data and pathogen test results were collected. All included patients underwent routine examination and mNGS test, and were divided into the conventional method test group and mNGS test group according to the test results. The measurement data conforming to normal distribution were represented by ± s; The measurement data that did not conform to normal distribution were represented by median and interquartile range. The classification data were expressed by the number of cases and percentage( n,%), and were compared by χ2 test or Fisher's exact test. Consistency test was represented by Kappa value. The detection of pathogenic microorganisms by the two methods and the rule of pathogen spectrum were compared and analyzed. Results:The overall positive rate of mNGS in CNS infectious diseases was higher than that of conventional methods (58.23% vs. 18.82%), and the difference was statistically significant ( P<0.01). Among the 20 samples which were both positive by the two methods, 10 cases were completely pathogenic, 5 cases were partially consistent and 5 cases were completely inconsistent. In the detection of tuberculous nervous system infection, the positive rates were 66.7%, 53.8%, 44.0%, 40.0%, 4.0% in blood T-SPOT, cerebrospinal fluid mNGS, ADA, Mycobacterium tuberculosis DNA and tuberculous specific antibody, respectively. The positive rate of acid-fast staining was 0. The positive rate of mNGS combined with conventional method was 80.8%. Conclusions:The detection rate of mNGS in CNS infection is better than that of conventional methods. However, it does not show obvious superiority in the detection rate of Mycobacterium tuberculosis associated nervous system infection. In general, mNGS detection of pathogenic bacteria is more extensive, which is conducive to a thorough and comprehensive understanding of the bacterial characteristics of central nervous system infection. The combination of the two methods can make up for the deficiency of clinical routine detection to a certain extent, and can maximize the detection rate.

Clinical characteristics of 83 patients with acute glyphosate herbicide poisoning / 中华急诊医学杂志

Objective:To analyze the clinical characteristics of patients with acute glyphosate herbicide poisoning and the differences in the severity of poisoning.Methods:A retrospective analysis was performed on patients with acute glyphosate herbicide poisoning admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2020. The general information, exposure time, poisoning dose, poisoning cause, poisoning route, clinical manifestations, laboratory examination results during hospitalization, treatment measures, hospital stays and prognosis of the patients were collected. The patients were graded according to the poisoning severity scoring standard of Chinese Expert Consensus on Diagnosis and Treatment of Acute Poisoning in 2016. The highest severity score during hospitalization was used as the final grade. According to the final grade, asymptomatic and mild patients were included in the mild group, and moderate, severe and death patients were included in the severe group. The independent sample T test or Mann-Whitney U test was used for measurement data, and χ2 test or Fisher's exact test was used for counting data. The differences of general data and clinical data between the two groups were compared. Results:According to the inclusion and exclusion criteria, 83 patients with acute glyphosate herbicide poisoning were selected as the study subjects. All patients survived, mainly mild poisoning (56.6%), with a male to female ratio of 33∶50, and an average age of 39 years. The number of poisoning cases increased yearly (the highest in 2019), and most cases occurred in spring and summer. The main cause of poisoning was suicide (71.1%), direct oral administration (83.1%) was the primary route of poisoning, and the dominating clinical manifestations were digestive symptoms (71.1%). Laboratory tests showed increased white blood cell count (WBC), neutrophil percentage (NEUT %) and D-dimer, and decreased hemoglobin and potassium. Compared with the mild group, patients in the severe group were older [(51±17) years vs. (35±19) years], had a higher proportion of suicide and direct oral administration, a longer hospital stay [8.0 (4.8, 12.0) d vs. 3.0 (2.0, 5.5) d], a higher dose of poisoning [200.0 (50.0, 200.0) mL vs. 30.0 (11.3, 57.5) mL], and higher NEUT % within 24 h of admission [(83.4±10.4) vs. (73.2±12.8)]. The increase of WBC, NEUT %, aspartate aminotransferase, prothrombin time, D-dimer and the decrease of serum potassium were more common in the severe group than the mild group, with statistical significance (all P<0.05). Conclusions:The number of patients with acute glyphosate herbicide poisoning is increasing yearly. Generally, the condition is mild and the prognosis is satisfying. The severity is more serious in the middle-aged and elderly patients andthose with direct oral administration, high toxic dose, and high NEUT % within 24 h of admission. Severe poisoning is more likely to cause changes in laboratory indicators.

Influencing factors and prognosis of emphysematous urinary tract infection / 中华肾脏病杂志

Objective:To explore the influencing and prognosis factors of emphysematous urinary tract infection (EUTI).Methods:The baseline clinical data of the patients admitted to Shandong University Qilu Hospital (Qingdao) from December 2013 to June 2020 and diagnosed with EUTI were analyzed retrospectively. The patients with non-EUTI (NEUTI) during the same period were selected as the control group. The baseline characteristics between the two groups were compared. Logistic regression analysis method was used to analyze the influencing factors of EUTI.Results:(1) 24 EUTI patients and 53 NEUTI patients were included in the present study. Compared with the NEUTI group, the hemoglobin level was lower ( t=-5.245, P<0.001) and the levels of blood urine nitrogen ( Z=-4.361, P<0.001), serum creatinine (Scr, Z=-4.543, P<0.001), blood glucose ( Z=-2.608, P=0.009), and triacylglycerol ( Z=-2.408, P=0.016) were higher in the EUTI group. The proportions of diabetes mellitus ( χ2=13.453, P<0.001) and chronic kidney disease ( χ2=17.936, P<0.001) in the EUTI group were higher than those in the NEUTI group. Increasing Scr was the risk factor of EUTI in patients with urinary tract infection ( OR=1.011, 95% CI 1.001-1.020, P=0.025). (2) Escherichia coli ( E.coli, 14 cases, 58.3%) was the most common causative organism. The other causative organisms included Klebsiella pneumoniae (2 cases, 8.3%), Enterococcus faecium (1 case, 4.2%), Pantoea (1 case, 4.2%), and mixed bacteria of E.coli and Enterococcus faecium (1 case, 4.2%). Ten cases of E.coli were extended-spectrum β-lactamases (ESBL)-positive. (3) Of the 24 patients with EUTI, 4 patients had adverse outcomes. The length of stay ( Z=-2.457, P=0.014), blood urea nitrogen ( t=2.432, P=0.024), shock ( P=0.002), autoimmune disease ( P=0.022), and white blood cell count ( Z=-2.091, P=0.036) were statistically different between good prognosis group ( n=20) and poor prognosis group ( n=4). However, logistic regression analysis results showed that neither was the influencing factor of poor prognosis of EUTI. Conclusions:The elevated Scr level is the independent influencing factor of EUTI among urinary infection patients. E.coli is the most common pathogenic bacteria, and ESBL-positive bacteria are common.

Analysis of 43 cases of anti-NMDA receptor encephalitis misdiagnosed as mental disorder / 中华急诊医学杂志

Objective:To investigate the clinical features of patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis misdiagnosed as mental disorder, improve the early diagnosis rate and reduce misdiagnosis.Methods:The clinical data of patients with anti-NMDA receptor encephalitis diagnosed at the First Affiliated Hospital of Zhengzhou University from 2012 to 2018 were collected. Patients misdiagnosed as mental disorders were screened out. Their psychiatric symptom characteristics, disease course characteristics, imaging and laboratory findings, treatment and prognosis were retrospectively analyzed.Results:A total of 121 cases of anti-NMDA receptor encephalitis were collected, and 43 cases of mental disorders were screened out. Sixteen of the 43 patients (37.2%) had prodromal symptoms, and all the patients had psychiatric behavioral abnormalities (100%), including 32 cases (74.4%) of seizures, 13 cases (30.2%) of decreased level of consciousness, 21 cases (48.8%) of involuntary movements, 15 cases (34.9%) of decreased memory, 8 cases (18.6%) of speech dysfunction, and 8 cases (18.6%) of other neurological symptoms (central hyperventilation, autonomic dysfunction). Memory loss was observed in 15 cases (34.9%), speech dysfunction in 8 cases (18.6%), other neurological symptoms (central hypoventilation, autonomic dysfunction) in 8 cases (18.6%), and various symptoms may appear simultaneously or successively in the same patient. Thirty-eight cases had complete resolution of symptoms or only minor physical impairment, and 5 cases had recurrent admissions with mental abnormalities and seizures. The recurrence rate accounted for 11.6% (5/43).Conclusions:The clinical manifestations of anti-NMDA receptor encephalitis are complex and varied. Most of them have mental behavior abnormalities as the first symptom, which is easily misdiagnosed as mental disorder and delayed treatment will lead to prolonged disease course and poor prognosis.

The role of elevated blood amylase in the assessment of diabetic ketoacidosis / 中华急诊医学杂志

Objective:To investigate therole of serum amylase elevation in the evaluation of diabetic ketoacidosis (DKA) patients and the related factors affecting serum amylase (AMS) levels in patients with diabetic ketoacidosis.Methods:A total of 249 patients with DKA who were admitted to the First Affiliated Hospital of Zhengzhou University from November 2011 to August 2018 were selected for this retrospective study. The patients were divided into the normal group ( n=176) and the elevated group ( n=73) according to the AMS level measured by fasting venous blood samples. The enumeration data such as sex, type of DM, diabetic vascular complications, number of deaths, number of ICU monitoring, and number of acute pancreatitis (AP) after discharge were analyzed by chi-square test or Fisher test, and the measurement data such as age, pH, HbA1c, CO 2CP, Ca 2+, BUN, and Scr were analyzed by independent sample t test to compare the difference between the two groups. Results:The intensive care unit (ICU) monitoring rate was 50.7%, the median length of stay in ICU was 4 days, the median length of hospital stay was 14 days, and the median treatment cost was 28 000 yuan, which were higher in the elevated group than those in the normal group ( P<0.05). There were no significant differences in mortality, AP during hospitalization, and the probability of AP after discharge between the elevated group and the normal group ( P>0.05). The duration of diabetes, the number of previous DKA, the incidence of diabetic vascular complications, HbA1c, pH, BUN, and Scr in the elevated group were all higher than those in the normal group ( P<0.01 or P<0.05). Conclusions:DKA patients with elevated AMS are more likely to be admitted to ICU, and the length of stay in ICU, total length of hospital stay and total cost of treatment are all increased. Where as the overall mortality rate during hospitalization and the likelihood of AP after discharge are not increased.

A report on the follow-up of 14 patients with familial thallium poisoning after 9 years / 中华急诊医学杂志

Objective:To investigate the recovery of patients with acute thallium poisoning after 9 years.Methods:A group of 14 patients with familial thallium poisoning who were admitted to our hospital in 2010 were followed up for 9 years.Results:Among the 14 patients with acute thallium poisoning, one patient died on the 14th day after poisoning, and all the other survivors were followed up 9 years later. The general condition of all the patients was significantly better than that of poisoning 9 years ago. The alopecia of all cases disappeared, the newborn hair grew normally, without gastrointestinal symptoms, numbness, pain in the limbs and mental symptoms. All the patients returned to normal intelligence and physical strength and had a normal life. One patient (No. 5) gave birth to 2 children successively after discharge. The first child was 6 years old and the second child was 2 years old. Both growth and intelligence were not different from those of the same age. Currently, the third pregnancy was more than 7 months. No.6 and No.10 patients were poisoned in their teenage and were currently all studying in university. No.6 patient suffered from Hashimoto's thyroiditis 7 years after poisoning, and he has been taking thiamazole tablets for two years. Poisoned infants, No.7, 8 ,11 and 12, were school-age children with normal growth, mental development and excellent academic performance. Among the 13 surviving patients, blood and urine samples from No. 1, No. 3, and No. 4 patients were collected, and no thallium concentration was detected, and biochemical examina-tion and neurological examination were all normal.Conclusions:Patients with acute thallium poisoning have a favorable prognosis according to the follow-up after 9 years. All patients have no obvious sequelae and have normal labor ability. Young women have normal fertility, and children have normal growth and mental development.

Ethical thinking and effect research of multiple comprehensive psychological intervention measures used in intensive care unit / 中国中西医结合急救杂志

Objective To discuss the ethical necessity and feasibility of implementing multiple comprehensive psychological intervention measures in intensive care unit (ICU), and to investigate the effect of the measures on treatment compliance. Methods The conscious adult patients hospitalized in emergency ICU (EICU) of the Second Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2017 were enrolled, and divided into control group and intervention group according to random number table, with 40 patients in each group. Patients in control group were treated with routine care and routine diagnosis and treatment, and patients in intervention group were treated with the help of psychologists and with multiple comprehensive psychological intervention measures (including nursing care, medical treatment, family and management) based on routine care and routine diagnosis and treatment. After 5 days of intervention, the treatment compliance, the medical coping attitude and the mental health were assessed respectively using the Treatment Compliance Scale, the Medical Coping Modes Questionnaire (MCMQ) and the Symptom Checklist Scale (SCL-90), and then comparation were done between the two groups. Results After 5 days of intervention, 3 patients in the control group and 4 patients in the intervention group withdraw the study because of the change of illness, and at last 37 patients in the control group and 36 in the intervention group were enrolled. There was no significant difference in basic data such as gender, age, education level, disease, course of disease, the length of EICU stay, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score between the two groups. The scores of treatment compliance in intervention group was significantly higher than that in control group (2.89±0.67 vs. 2.32±0.91, P < 0.01). Compared with the control group, the "confrontation" dimension score of the MCMQ questionnaire in intervention group was significantly increased (19.75±2.08 vs. 18.62±2.65, P < 0.05), while the "avoidance" and"surrender" dimensions scores were significantly decreased (14.22±1.91 vs. 15.14±1.92, 8.83±1.54 vs. 9.73±2.10, both P < 0.05). In the SCL-90 scale, the scores of the 5 factors such as "somatization", "interpersonal sensitivity","depression", "anxiety" and "photic anxiety" in intervention group were significantly less than those in control group (1.59±0.38 vs. 1.81±0.37, 1.72±0.40 vs. 1.93±0.42, 1.76±0.32 vs. 1.92±0.29, 1.82±0.40 vs. 2.14±0.40, 1.44±0.30 vs. 1.60±0.38, all P < 0.05), while there was no significantly difference in the scores of the other 4 factors as "obsessive-compulsive symptoms", "hostile", "bigotry" and "psychoticism" between the two groups (all P > 0.05). Conclusion The multiple comprehensive psychological intervention measures used for ICU conscious patients could improve the treatment compliance, make the patients' medical coping attitude more active and improve the mental health of the patients, so it has ethical necessity and certain feasibility.

The usage of scene simulation combined with multiple-station mini-CEX evaluation for the teaching of standardized training of emergency medicine / 中华急诊医学杂志

Objective To investigate the feasibility and effect of scene simulation combined with multiple-station mini-CEX evaluation used for the teaching of standardized training of emergency medicine. Methods Sixty standard-trained doctors were randomly(random number) divided into two groups. Thirty standard-trained doctors in team A were taught using the traditional teaching modality of emergency medicine, and the rest in team B were trained using the method of scene simulation combined with multiple-station mini-CEX evaluation. At the end of standardized training, comparisons of the examination results of mini-CEX evaluation and the satisfaction of standard-trained doctors with the teaching mode were done between two groups. Results The scores of team B on medical interviewing skills, clinical judgment, counseling skills, proper presentation/efficiency and overall clinical competence were significantly higher than those of team A[(7.26±0.36),(7.63±0.39),(7.22±0.34),(7.26±0.45), (7.75±0.24) vs. (6.81±0.42),(7.24±0.39),(6.90±0.44),(6.97±0.50),(7.21±0.32)],while there were no significant differences in scores on physical examination skills and humanistic qualities/professionalism between two teams [(7.60±0.36),(7.92±0.35) vs. (7.42±0.30),(7.98±0.32)]. The satisfaction with the mini-CEX evaluation of both teachers and standard-trained doctors in team B were significantly higher than those in team A [(7.40±0.30), (7.46±0.28) vs. (7.06±0.38), (6.91±0.38)]. The satisfaction of standard-trained doctors in team B with the teaching mode and teaching effect were significantly higher than those in team A[(8.17±0.78),(8.59±0.66) (6.67±0.73), (6.80±0.72)]. Conclusions The scene simulation combined with multiple-station mini-CEX evaluation used for the teaching of standardized training of emergency medicine may improve some of the clinical skills of standard-trained doctors, and thus this teaching reform was feasible.

The application of HC visual laryngoscope as a visualization teaching method for the standardized training of endotracheal intubation in emergency department / 中华急诊医学杂志

Objective To investigate the feasibility and effect of visualization teaching method using HC visual laryngoscope for the standardized training of endotracheal intubation in emergency department.Methods Forty standard-trainee doctors were divided into two groups randomly.20 standard-trainee doctors in team N were taught using the conventional teaching method of emergency medicine for the standardized training of endotracheal intubation,and the other 20 standard-trainee doctors in team HC were taught by visualization teaching method using HC visual laryngoscope.After 1 month training,comparisons of the success rate of tracheal intubation in airway management simulator,the time consumed for intubation and the number of attempt on successful intubation cases,and the satisfaction score with the teaching mode scored by standard-trainee doctors between the two groups were done.Results The one-attempt success rate and the success rate of tracheal intubation in airway management simulator by the standard-trainee doctors in group HC were significantly higher than those in group N (40％ vs.10％,85％ vs.55％),while the number of attempt and the time consumed for successful intubation were significantly less than those in group N[(1.65±0.61) vs.(2.27±0.66),(79.00±8.35) s vs.(89.36±12.03) s).The satisfaction score with this teaching mode and teaching effect of standard-trainee doctors in group HC were significantly higher than those in group N (8.10±0.74 vs.6.55±1.05,8.15±0.80 vs.6.85±0.91).Conclusions The visualization teaching method with application of HC visual laryngoscope for standardized training of endotracheal intubation in emergency department could improve the success rate and efficiency of tracheal intubation in airway management simulator for standard-trainee doctors,and this teaching method may be better than the conventional teaching method on teaching mode presenting some feasibility.

Mutation analysis of 5 children with primary distal renal tubular acidosis / 中华肾脏病杂志

Objective To analyze the mutations of causal genes in 5 children with primary distal renal tubular acidosis (dRTA),and explore their association of genotype and phenotype,so as to raise the awareness of the disease.Methods The whole exome sequencing was used to identify mutations in these 5 children from 5 families.Results A total of 4 different mutations of ATP6V0A4 gene were found in 2 dRTA children,including a novel heterozygous intron mutation (c.639 + 1G＞ A),a reported heterozygous nonsense variant (c.580C ＞T,p.Arg194*) and 2 novel heterozygous duplications (c.1504dupT,p.Tyr502Leufs*22;c.2351dupT,p.Phe785Ilefs*28).Two novel heterozygous missense mutations of ATP6V 1B 1 gene (c.409C ＞ T,p.Pro 137Ser;c.904C ＞ T,p.Arg302Trp) were identified in the third child,and a heterozygous missense mutation of SLC4A1 gene (c.1765C ＞ A,p.Arg589Ser) previously reported was found in the fourth child.No mutation of the dRTA-related causal genes was found in the fifth child.Furthermore,the mutations of causal genes in each of the first three children were compound heterozygous,which were consistent with the autosomal recessive inheritance pattern,and the variant from the fourth child was de novo.Conclusions The present study has found 7 mutations,including 5 novel variants,which enriches the human gene mutation database (HGMD) and contributes to a better understanding of the disease mechanisms.

Gene analysis, treatment, and follow-up of sixteen Chinese patients with Bartter syndrome / 中华肾脏病杂志

Objective To analyze the mutations of causal genes in sixteen Chinese patients with suspicious Bartter syndrome,and follow up their treatment results.Methods Mutations were identified by the next generation sequencing and the multiplex ligation-dependent probe amplification (MLPA).Clinical and biochemical features at the first presentation as well as follow-up results were reviewed.Results 15 different CLCNKB gene mutations were identified in sixteen patients with BS,including 11 novel ones.A novel missense mutation and a novel small deletion were found from SLC12A1 gene.A novel gross deletion was found in CLCNKA gene.A recurrent missense mutation was identified from BSND gene.The whole gene deletion mutation of CLCNKB gene was the most frequent mutation (32％),and the rate of gross deletion was up to 50 percent in this group of Chinese patients.The most common clinical manifestations were development retardation (15/16),polydipsia and polyuria (15/16).All of the patients were detected with hypokalemia,hypochloremia and metabolic alkalosis.Indomethacin treatment had significant improvement to the stature and weight restoration.Conclusion The present study has found 19 mutations,including 14 novel ones,which enriches the human gene mutation database (HGMD) and provides valuable references to the genetic counseling and diagnosis of Chinese population.

Study on HPLC fingerprint of Ginseng Radix et Rhizoma Rubra / 药学实践杂志

Objective To establish the HPLC fingerprint of Ginseng Radix et Rhizoma Rubra for its quality control . Methods Sharpsil-T C18 column(4 .6 mm × 250 mm ,5 μm)was used with acetonitrile-water in gradient elution mode .The flow rate was 1 .0 ml/min ,the column temperature was maintained at 30 ℃ ,and the detective wavelength was 203 nm .Results 24 co-possessing peaks were selected as fingerprint peaks and the similarities between each of the ten areas and the standard chro-matographic fingerprints of Panax ginseng Rubra were calculated while Rb1 peak selected as the reference peak .The similarity was more than 0 .940 .Eleven chemical compounds were identified by comparing the reference substance .Conclusion The method could be used for the quality control of Panax ginseng Rubra with good precision ,stability ,and reproducibility .

Change of platelet parameters in septic shock patients / 中华危重病急救医学

Objective To observe the changes in platelet parameters including platelet volume distribution width (PDW),plateletcrit (PCT) and platelet large cell ratio (PLCR) in patients with septic shock,and to approach its predictive effect on prognosis to obtain the indexes predicting the prognosis quickly and conveniently.Methods A retrospective study was conducted.Data from septic shock patients admitted to Peking Union Medical College Hospital from January 1 to December 31,2012 were collected.The patients were divided into two groups according to prognosis.The general condition,laboratory parameters,infection,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,and platelet parameters at 5 days after admission and 2 days before discharge from hospital,such as platelet count (PLT),Mean platelet volume (MPV),PDW,PCT and PLCR were recorded.Receiver operating characteristic curve (ROC curve) was drawn for those parameters and the area under curve was compared.Results A total 124 septic shock patients were enrolled finally,88 of the patients died and 36 remained alive.PDW and PLCR were elevated with the progress of the disease,the PLT and PCT were declined,and MPV maintained at a high level.The control group showed an opposite trend.MPV in non-survivor group was significantly higher than that in survivor group [fl:11.2 (10.5,12.5) vs.10.3 (9.7,11.0),relative risk (RR)=3.362,P=0.009].There was no significant difference in PLT,PDW,PCT and PLCR between non-survivor group and survivor group [PLT(× 109/L):105.0(47.5,191.5) vs.164.0 (85.0,236.0),RR=1.004,P=0.441; PDW:0.14 (0.12,0.17) vs.0.12 (0.11,0.13),RR=1.053,P=0.795;PCT:0.13 (0.07,0.21)％vs.0.18 (0.09,0.24)％,RR=0.234,P=0.747; PLCR:33.7 (28.1,42.8)％vs.26.8 (23.2,32.0)％,RR=0.924,P=0.324].ROC curve showed the best cutoff value for PLT was ＞487.0 × 109/L,with AUC of 0.377,sensitivity of 1.14％,specificity of 100％,diagnosis accuracy of 29.27％ and Youden index of 0.011; the best cutoff value for MPV was ＞ 10.5 fl,with AUC of 0.812,sensitivity of 81.82％,specificity of 65.71％,diagnosis accuracy of 75.61％ and Youden index of 0.475; the best cutoff value for PLCR was ＞39.3％,with AUC of 0.758,sensitivity of 48.86％,specificity of 91.43％,diagnosis accuracy of 60.98％ and Youden index of 0.403;the best cutoff value for PCT was ＞0.33％,with AUC of 0.380,sensitivity of 7.96％,specificity of 97.14％,diagnosis accuracy of 32.52％ and Youden index of 0.051 ; the best cutoff value for PDW was ＞0.12,with AUC of 0.747,sensitivity of 82.96％,specificity of 57.14％,diagnosis accuracy of 74.80％ and Youden index of 0.401.Conclusions Different change trends of platelet parameters can be seen between the non-survivors and survivors of septic shock patients.If PDW,PLCR and MPV show increased trend while PLT and PCT show decreased trend,a poor prognosis maybe indicated.MPV may be most useful in prognosis forecast because of its biggest AUC.

Analysis of AGXT gene mutation in a primary hyperoxaluria type Ⅰ family / 中华肾脏病杂志

Objective To describe the clinical characteristics,and to analyze the AGXT gene mutation in three siblings with primary hyperoxaluria type I (PHI).Methods AGXT gene mutation was analyzed by direct sequencing analysis in this family,and the minor allele status was also tested.One hundred unrelated healthy subjects were also analyzed as controls.Results Three mutations in AGXT were identified in each of three patients including two novel heterozygous missense mutations and one previously reported variant.One mutation was a methionine to leucine substitution at position 49 (p.M49L,c.145A ＞ C) in exon 1,one was an asparagine to isoleucine transition at codon 72 (p.N72I,c.215A ＞ T) in exon 2,and another was a heterozygous nonsense mutation at codon 333 (p.R333*).Both p.M49L and p.R333* occured in cis configuration with the minor allele IVS1 +74 bp.Conclusions Two novel mutations are identified probably in association with PHI,however their pathogenicity and potential molecular mechanisms should be explored by further investigations.This is the first investigation on mutant gene analysis of PHI in China.

Mutation analysis of ATP6V0A4 and ATP6V1B1 gene in autosomal recessive distal renal tubular acidosis children / 中华肾脏病杂志

Objective To analyze and identify the mutations of ATP6V0A4 and ATP6V1B1 gene in autosomal recessive distal renal tubular acidosis (rdRTA) children,and study the association of genotype and phenotype. Methods Genome DNA was amplified by PCR.Mutations of ATP6V0A4 and ATP6V1B1 gene in 3 children from 3 families were examined by direct sequencing.One hundred unrelated healthy subjects were selected to evaluate all mutations found in this study. Results A novel homozygous nonsense mutation was identified in ATP6VOA4 gene in one child, and a novel heterozygous nonsense variant and a frame-shift alteration were found in another child.No mutation of both genes was found in the third child.Conclusions Study of mutant genes of rdRTA in Chinese patients is helpful to understand the association in genotype and phenotype and increase the level of cognition and treatment to this disease.

Titer Determination of Main Component in Kitasamycin Tablets and Acetylkitasamycin Dry Suspension by Turbidimetry / 中国药房

OBJECTIVE:To determine the titer of main component in kitasamycin tablets and acetylkitasamycin dry suspension.METHODS:Staphylococcus aureus was used as test organism and which were cultured at (37?0.5) ℃ for about 4～5 hours by adding 1.0%～1.5% kitasamycin and 2.0%～2.5% acetylkitasamycin,then the absorbance was determined at a wavelength of 530 nm.RESULTS:The linear range of kitasamycin was 0.5～4.0 IU?mL-1 and that of acetylkitasamycin was 0.45～6.3 IU?mL-1,and their recovery rates were 101.7%(RSD=1.9%,n=9) and 101.1%(RSD=2.1%,n=9),respectively.CONCLUSION:The established turbidimetry is sensitive,rapid yet with few influencing factors,thus it is applicable for the titer determination of main component in kitasamycin tablets and acetylkitasamycin dry suspension.

Determination of the Dissolution of Lovastatin Tablets / 中国药房

OBJECTIVE:To establish a method for determination of the dissolution of lovastatin tablets and to investigate the dissolution of it from different manufactures.METHODS:HPLC was employed for content determination with Alltima C18 chromatographic column,and the mobile phase consisted of acetonitrile-0.01% phosphoric acid(60∶40)with the detective wavelength set at 238 nm.The dissolution was determined by paddle method with 2% sodium lauryl sulphate-phosphate buffered solution(pH 7.0)as medium at a rotation speed of 50 r?min-1,and the sampling time was 30 min.The dissolution rates of 12 batches of samples from 6 manufacturers were determined.RESULTS:The linear range of lovastatin was 4.88～195.2 ?g?mL-1(r=0.999 9)and its average recovery rate was 97.7%(RSD=1.3%,n=9).Of the 12 batches of samples,3 batches from 2 manufacturers had dissolution rates of less than 80%,and the other batches stood at 80%～101%.CONCLUSION:The method is accurate,reproducible and simple,and it is effective in the quality control of lovastatin tablets.

Detection of Nifedipine,Nitrendipine and Nimodipine Added in Chinese Patent Medicine Illegally by LC-MS / 中国药房

OBJECTIVE: To develop a rapid, accurate and sensitive method for the determination of nifedipine, nitrendipine and nimodipine which were added into traditional patent medicine illegally. METHODS: The LC-MS method was used to detect the extractive of Chinese patent medicine for antihypertension in respects of relative molecular mass, tandem mass spectrometry fragment, retention time, UV spectrum. The compounds added into the Chinese patent medicine were identified by comparing with standard sample in terms of spectrum, chromatographic and mass spectrometric behavior. RESULTS: According to four aspects of determination, nifedipine, nitrendipine and nimodipine were found in three kinds of Chinese patent medicine for antihypertension. CONCLUSION: The method is selective and sensitive for the detection of nifedipine, nitrendipine and nimodipine which were added into traditional patent medicine illegally.

Determination of the Potencies of Oxytetracycline Crude Drug and Its Tablets by Turbidimetric Method / 中国药房

OBJECTIVE:To establish a turbidimetric method for the determination of the potency of the crude drugs and tablets of oxytetracycline. METHODS: By turbidimetric method in which Staphylococcus aureus was used as the test organism with biomass concentration of 1.0%～1.5% (V/V). The culture temperature was 37 ℃ and the culture time was about 4 h. The method was compared with the cup-plate method in potency. RESULTS: The linear range of oxytetracycline was 0.05～0.4 IU?mL-1. The average recovery of the crude drug of oxytetracycline was 99.59% (RSD=2.0%) and that of oxytetracycline tablets was 99.51% (RSD=1.91%), showing no significant difference as compared with the cup-plate method in contents. CONCLUSIONS: The method was sensitive and rapid yet with few influencing factors thus applicable for the determination of the potencies of oxytetracycline and its tablets.