基于糖脂代谢研究筋疽（糖尿病足非缺血性坏疽）湿热毒盛证

[目的] 通过现代检验技术研究筋疽（糖尿病足非缺血性坏疽）湿热毒盛证的糖脂代谢指标。[方法] 收集136例筋疽（糖尿病足非缺血性坏疽）患者进行不同证型间指标的比较。[结果] 湿热毒盛证患者空腹血糖（FBG）、糖化血红蛋白（HbA1c）、餐后2 h血糖（2 hPBG）、晚期糖基化终末产物（AGEs）、白蛋白（ALB）、总胆固醇（TC）、高密度脂蛋白（HDL-C）与其他证型比较存在统计学差异（P<0.05）。湿热毒盛证患者C-反应蛋白（CRP）、人可溶性血管细胞黏附分子1（sVCAM-1）与其他证型组间比较存在统计学差异（P<0.01）。[结论] 筋疽（糖尿病足非缺血性坏疽）湿热毒盛证形成的原因与低营养状态下糖脂代谢紊乱引起的高血糖及持续炎症反应相关。     

浅谈新型冠状病毒肺炎

新型冠状病毒肺炎是一种由新型冠状病毒引发的炎症,患者感染后出现发烧、咳嗽、乏力、舌胖大、苔厚腻等症状。中医认为新型冠状病毒肺炎属于瘟疫范畴,病性为湿毒,病位在肺脾,病机为"湿、热、瘀、毒、虚"。发病后传染速度极快,根据疾病传变规律,可分急性期、中期、极期、恢复期4个时期,治则治法以清热解毒、祛湿化瘀、扶正固本为主,早期中药介入治疗对疾病的转归发展起到关键作用。     

Accreditation in Belgium: a 10 Years’ Experience

Purpose : Toxic adenoma is one of the main causes of hyperthyroidism. We investigated the efficacy of surgery in the treatment of toxic adenoma.

Methods : Serum thyroid stimulating hormone (TSH) measurement, ultrasound and scintigraphy of the thyroid were made for diagnostic purpose. The safety of surgery was evaluated by postoperative clinical course of patients. The efficacy of surgery was determined by the function of the remaining thyroid tissue.

Results : The incidence of hyperthyroidism was 53% in surgically treated patients with nodular goitre in our iodine deficient region. The cause of thyrotoxicosis was toxic adenoma in 15 patients (14%). Suppressed serum TSH levels indicated the hyperthyroidism in all of 15 patients. Solitary solid adenoma was found by ultrasonographic examination, and solitary autonomous hot nodule by thyroid scintigraphy. Surgical treatment consisted of unilateral total lobectomy. It was the primary treatment in 13 patients. Two patients had surgery as secondary treatment after unsuccessful primary radioactive iodine application. The early postoperative clinical course of all patients was uneventful. Thirteen patients who had surgery as primary treatment had normal thyroid function postoperatively contrary to other two patients who became hypothyroid after having unsuccessful radioiodine therapy, and surgery as the secondary treatment. Conclusions : The incidence of hyperthyroidism and toxic adenoma is high in our surgically treated patients with nodular goitre. The diagnosis of toxic adenoma is not difficult by serum TSH measurements, and ultrasound and nuclear imaging of the thyroid. Surgery is effective and safe, and the treatment of choice for patients with toxic adenoma in order to control radically the hyperthyroidism and to achieve the goal of providing the euthyroid status.     

T-cell receptor and carbamazepine-induced Stevens–Johnson syndrome and toxic epidermal necrolysis: understanding a hypersensitivity reaction

Ample evidence exists to support the view that drug hypersensitivity is mediated by adaptive immunity, which involves MHC-restricted drug presentation, activation and clonal expansion of T cells. The specific MHC molecules implicated in hypersensitivity have been identified; for example, HLA-B*5701 in abacavir-induced drug hypersensitivity and HLA-B*1502 in carbamazepine-induced Stevens–Johnson syndrome. However, little is known about the role of drug-specific T cells and their T-cell receptors (TCRs) in the pathogenesis of drug hypersensitivity. Using the combination of a strong HLA-B*1502 predisposition in carbamazepine-induced Stevens–Johnson syndrome and applying global analysis of the TCR repertoire, restricted and common TCR usage in the development of severe drug hypersensitivity have recently been documented. This article reviews recent advances in the understanding of the pathogenic role of drug-specific T cells and their TCRs in the development of drug hypersensitivity and provides an analysis of their potential clinical implications.     

Immunological aspects of nonimmediate reactions to β-lactam antibiotics

β-lactam antibiotics are the agents most frequently implied in immune drug adverse reactions. These can be classified as immediate or nonimmediate according to the time interval between the last drug administration and their onset. Mechanisms of immediate IgE-mediated reactions are widely studied and are therefore better understood. Nonimmediate reactions include a broad number of clinical entities like mild maculopapular exanthemas, the most common, and other less frequent but more severe reactions such as Stevens–Johnson syndrome, toxic epidermal necrolysis, acute exanthematic pustulosis or cytopenias. These nonimmediate reactions are mainly mediated by T cells but the precise underlying mechanisms are not well elucidated. This fact complicates the allergological evaluation of patients with this type of reaction and available tests have demonstrated poor sensitivity and specificity.     

蚊虫的摄糖习性及其在蚊虫控制中应用的研究进展

多个蚊种的雌雄成蚊均需通过摄取自然界中的糖分以获得维持其正常生理活动所需的能量,针对该习性研制的带毒糖诱剂(ATSB)初步应用显示,其可明显减少蚊虫种群数量。本文对近年蚊虫摄糖习性及其在蚊虫控制中的应用研究进展作简要介绍。     

Endoscopic visualization-assisted corneal bee sting removal

Purpose:Deeply embedded corneal foreign bodies and intrastromal foreign body removal can often be a challenge. The aim of this report was to describe the utility of endoscopy in visualization and removal of an embedded corneal bee stinger.Methods:A 44-year-old male patient developed toxic keratopathy after injury from a bee stinger. On examination, the bee stinger was noted to be deeply embedded in the corneal stroma. A superficial keratectomy was initially attempted; however, the stinger was noted to be intrastromal and protruding into the anterior chamber and could not be removed. An Endoscopy-assisted visualization was used to remove the stinger.Results:The bee stinger was successfully removed and the patient''s vision improved to 20/100 from an initial CFCF (counting fingers close to face) at time of presentation. At the end of 3 months follow-up, there was residual corneal edema along with cataractous changes in the lens as a sequelae of the initial bee sting injury. The patient subsequently underwent an endothelial keratoplasty along with phacoemulsification with intraocular lens implantation and the final BCVA improved to 20/40.Conclusion:Endoscopyassisted visualisation of anterior chamber and angle structures can be valuable in removal of retained and deeply embedded corneal or intracameral foreign bodies.     

Utility of the lymphocyte transformation test in the diagnosis of drug sensitivity: dependence on its timing and the type of drug eruption

BACKGROUND: Lymphocyte transformation test (LTT) is a safety and reproducible test to assess activation of drug-specific T cells in vitro; however, there are several practical concerns such as the time of testing and the influence of treatment. Our aim was to define the right timing to perform LTT for determining the causative agent in various types of drug reactions. METHODS: Lymphocyte transformation test was performed at different time points during the evolution of three types of drug reactions, maculo-papular type of drug eruptions (MP), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and drug-induced hypersensitivity syndrome/drug rash and eosinophilia with systemic symptoms (DIHS/DRESS). RESULTS: Positive LTT reactions were obtained when the test was performed at the acute stage but not the recovery stage in MP and SJS/TEN, while positive LTT reactions were obtained at the recovery stage but not the acute stage in DIHS/DRESS, regardless of treatment with systemic prednisolone. CONCLUSIONS: Lymphocyte transformation test is a reliable method to define the causative agent, when LTT is performed at the right timing depending on the type of drug reactions. Lymphocyte transformation test should be performed within 1 week after the onset of skin rashes in patients with MP and SJS/TEN; and 5-8 weeks after in patients with DIHS/DRESS, respectively.     

The Pharmacokinetics and Pharmacodynamics of Carfentanil After Recreational Exposure: A Case Report

Carfentanil and related fentanyl analogs have been linked to a number of overdose deaths from drug users in several cities across North America. Diagnosis of carfentanil exposure requires a very high index of clinical suspicion, especially because available laboratory narcotic screens do not detect this agent. We describe a 34‐year‐old man admitted with depressed level of consciousness and in respiratory failure after recreational exposure to a white powder later inferred to contain carfentanil. Urine and whole blood samples were obtained for conventional preliminary drug screen immunoassays for unknown exposures, in addition to utilizing a high‐pressure liquid chromatography–tandem mass spectrometry assay for quantification of carfentanil and its metabolite. The patient was intubated and required mechanically assisted ventilation for 31 hours until he was able to breathe safely on his own. Pharmacokinetic modeling of three timed blood samples identified the elimination half‐life as 5.7 hours for carfentanil and 11.8 hours for the norcarfentanil metabolite. Awakening and breathing spontaneously corresponded to an interpolated blood carfentanil concentration of 0.52 ng/ml. This is the first pharmacokinetic and pharmacodynamic case report on the recreational use of carfentanil. Critical care clinicians should anticipate long periods of ventilatory support in the care of patients exposed to carfentanil.     

Determination of toxic element levels (lead and cadmium) in commonly used cosmetic products in Iran

Toxic elements are commonly used in cosmetic products for many reasons like coloring pigments or blocking ultraviolet light; however, the level of some metals exceed specific concentration which can cause serious safety issues. This study aims to evaluate the content of lead and cadmium in samples of sunscreen and foundation creams, most frequently used brands of cosmetic products, in Iran. Concentration of lead in the sunscreens and foundation creams was lower than that of USFDA standards. The content of cadmium was higher than Europe Union standard. Effort must be made to inform the users about the harmful consequences of cosmetics.