Gaslighting in alleged assault ascertained as Munchausen syndrome transcending to malingering in highly counterintuitive self inflicted acid burns

A factitious disorder leading to the self-infliction of highly counter-intuitive burns was diagnosed in a middle-aged female. The injuries were otherwise alleged to have been sustained by assault inflicted upon her by an unknown person. The case was diagnosed by medico-legal interpretation of injuries, in spite of a highly deceptive and concocted history by the patient and her husband. The entity was unique in being associated with magnificent primary, secondary and tertiary gains. The exploitation of the morbid sequel to malinger by the patient, and the involvement of the husband for the prolongation of the illness of his wife for financial gains as gaslighting was highly unusual. The self-infliction of injuries over hands is seen in factitious disorder. However, a combination of a guarded self-immersion of the hands and feet in a corrosive by an illiterate female, followed by malingering to earn livelihood is unprecedented in factitious disorders. The delayed presentation which required amputation of all the limbs to save the life of the patient is a glaring highlight of this case.     

The role of urease in the acid stress response and fimbriae expression in Klebsiella pneumoniae CG43

Background/purposeTwo urease operons were identified in Klebsiella pneumoniae CG43, ure-1 and ure-2. This study investigates whether a differential regulation of the expression of ure-1 and ure-2 exists and how urease activity influences the acid stress response and expression of type 1 and type 3 fimbriae.MethodsThe ureA1 and ureA2 gene specific deletion mutants were constructed. Promoter activity was assessed using a LacZ reporter system. The sensitivity to acid stress was determined by assessing the survival after pH 2.5 treatment. The influence on type 1 and type 3 fimbriae expression was assessed using western blotting and mannose-sensitive yeast agglutination and biofilm formation assay, respectively.ResultsBacterial growth analysis in mM9-U or modified Stuart broth revealed that ure-1 was the principal urease system, and ure-2 had a negative effect on ure-1 activity. Deletion of the fur or nac gene had no apparent effect on the activity of P_ure1, P_ure2-1, and P_ure2-2. The P_ure2-2 activity was enhanced by deletion of the hns gene. ureA1 deletion increased acid stress sensitivity, whereas the deleting effect of ureA2 was notable without hns. Deletion of ureA1 or ureA2 significantly induced the expression of type 1 fimbriae but decreased MrkA production and biofilm formation.Conclusionure-1 is the primary expression system in K. pneumoniae CG43, while ure-2 is active in the absence of hns. Impairment of urease activity increases the sensitivity to acid stress, and the accumulation of urea induces the expression of type 1 fimbriae but represses type 3 fimbriae expression.     

丹青胶囊联合他扎罗汀倍他米松治疗银屑病的临床研究

目的 探讨丹青胶囊联合他扎罗汀倍他米松治疗银屑病的临床疗效.方法 选取2019年6月—2021年6月在天津市职业病防治院门诊皮肤科就诊治疗的114例银屑病患者,根据随机数字法分为对照组和治疗组,每组各57例.对照组患者给予他扎罗汀倍他米松乳膏,洗净患处,待皮肤干爽后,将适量本品均匀涂抹于患处,1次/d.治疗组患者在对照组治疗基础上口服丹青胶囊,4粒/次,3次/d.两组患者均连续治疗7 d.观察两组患者的临床疗效和临床症状好转时间,比较两组治疗前与治疗1、4、8周的皮损面积和严重程度指数(PASI)评分和血清炎性因子水平.结果 治疗后,治疗组总有效率是98.25％,显著高于对照组的82.46％(P<0.05).治疗后,治疗组患者皮损暗红、皮损肥厚、皮肤瘙痒、皮肤疼痛等症状好转时间均显著短于对照组(P<0.05).治疗后,两组PASI评分均较治疗前显著降低(P<0.05);治疗1、4、8周治疗组PASI评分显著低于对照组(P<0.05).治疗后,两组患者血清炎性因子白细胞介素6(IL-6)、白细胞介素17(IL-17)、肿瘤坏死因子α(TNF-α)、干扰素-γ(IFN-γ)水平均较治疗前显著降低(P<0.05);治疗后,治疗组血清炎性因子水平显著低于对照组(P<0.05).结论 丹青胶囊联合他扎罗汀倍他米松治疗银屑病效果明显,能显著降低炎性因子水平,并有助于改善皮损情况,值得临床推广应用.     

难治性胃食管反流病临证研究

难治性胃食管反流病是临床疑难病,症状反复,缠绵难愈,治疗棘手。中医药治疗“反酸”“吞酸”证历久源远,充分挖掘古籍,深研病机,提炼治法,发挥中医药特色,对治疗本病意义深远。     

Synaptic signals mediated by protons and acid‐sensing ion channels

Extracellular pH changes may constitute significant signals for neuronal communication. During synaptic transmission, changes in pH in the synaptic cleft take place. Its role in the regulation of presynaptic Ca²⁺ currents through multivesicular release in ribbon‐type synapses is a proven phenomenon. In recent years, protons have been recognized as neurotransmitters that participate in neuronal communication in synapses of several regions of the CNS such as amygdala, nucleus accumbens, and brainstem. Protons are released by nerve stimulation and activate postsynaptic acid‐sensing ion channels (ASICs). Several types of ASIC channels are expressed in the peripheral and central nervous system. The influx of Ca²⁺ through some subtypes of ASICs, as a result of synaptic transmission, agrees with the participation of ASICs in synaptic plasticity. Pharmacological and genetical inhibition of ASIC1a results in alterations in learning, memory, and phenomena like fear and cocaine‐seeking behavior. The recognition of endogenous molecules, such as arachidonic acid, cytokines, histamine, spermine, lactate, and neuropeptides, capable of inhibiting or potentiating ASICs suggests the existence of mechanisms of synaptic modulation that have not yet been fully identified and that could be tuned by new emerging pharmacological compounds with potential therapeutic benefits.     

刚果（金）维和任务区52例隐翅虫皮炎的调查和临床治疗

目的 调查研究刚果（金）维和任务区隐翅虫皮炎患者的发病特点、行为因素及临床治疗情况,为科学防控隐翅虫皮炎提供有效依据。方法 选择2018年5月—2020年4月在刚果（金）维和任务区中国二级医院临床诊断的52例隐翅虫皮炎患者为研究对象,对患者的一般资料、行为因素及临床特征进行流行病学调查,并分析药物的临床疗效。结果 刚果（金）任务区的隐翅虫皮炎具有明显的季节性,每年自10月起发病数逐渐增多,次年1—3月为高峰期。患者驻地主要分布在郊区,有50例（96.15%）,多见于户外工作者,为48例（92.3%）, 其中白天有明确隐翅虫接触史者21例（40.4%）,夜间开窗就寝者20例（38.5%）,夜间开荧光灯就寝者16例（30.8%）,未使用纱窗者18例（34.6%）,就寝时四肢裸露者15例（28.9%）,所有患者未使用蚊帐、驱蚊剂及防护服。颈部、前臂为最容易发生的部位;皮损主要呈斑片状红斑分布（80.77%）,并可见特征性条索状或“吻唇样”改变。患者自觉烧灼痛（88.46%）,少数为瘙痒感（11.54%）。常规予以5%碳酸氢钠溶液擦洗,口服抗组胺药、外用炉甘石洗剂、抗生素联合糖皮质激素软膏是有效治疗手段。对于眶周受累患者,口服强的松,用丁苯羟酸乳膏,获得良好效果。结论 掌握隐翅虫皮炎的流行病学特点,增强二级医院医护人员对隐翅虫皮炎的认识水平,准确识别临床特征,有助于早期诊断并选择合适的治疗方案。     

深圳地区HBV核酸检测反应性献血者两种归队模式风险评估研究

目的评估HBV核酸检测反应性献血者归队风险,为采供血机构制定献血者归队策略提供依据。方法对ELISA双试剂无反应性、HBV核酸检测反应性献血者进行跟踪检测。每次间隔3个月以上,两次直接静脉采样。归队后再跟踪两次以上献血检测结果。两家血站分别按无门槛自愿原则与增加献血10次以上要求进行采样,并对两种模式归队结果进行比对。结果无门槛自愿归队模式归队前检测3例酶免检测阴转阳(15.79%);增加献血次数门槛归队模式归队成功率88.46%;两种归队模式成功归队后再次出现不合格情况分别为20.00%、13.04%,统计无差异,但归队后人均年献血次数有较大差别。结论酶免检测无反应性而HBV核酸检测反应性被屏蔽献血者无门槛归队模式存在窗口期感染风险。建议将多次献血或固定献血、首次出现酶免检测无反应性而HBV核酸检测反应性被屏蔽的献血者列入归队目标人群。仅以HBsAg+HBV DNA作为HBV核酸检测反应性献血者的归队评价指标存在较大风险,应考虑增加化学发光法等补充试验。     

Inhibitory Role of Gamma-Aminobutyric Receptors in Paraventricular Nucleus on Ejaculatory Responses in Rats

BackgroundAlthough abnormal sympathetic nerve system (SNS) activity has been demonstrated in the pathogenesis of ejaculation disorders, few data are available on its underlying mechanism.AimTo investigate whether differences in ejaculatory behavior of rats were associated with the state of SNS activity and gamma-aminobutyric (GABA) receptor expressions in the paraventricular nucleus (PVN) of the hypothalamus and the effects of GABA receptors in the PVN on ejaculatory behavior.MethodsBased on ejaculatory performance, Sprague-Dawley rats were divided into “sluggish,” “normal,” and “rapid” ejaculators. PVN microinjection was performed to evaluate the role of GABA receptors on sexual behavior.OutcomesThe outcomes include differences in expression and distribution of GABA receptors and norepinephrine level among the 3 groups and changes in copulation behavior parameters after PVN microinjection.ResultsCompared with “normal” rats, the “rapid” group ejaculated more times with shorter latency (P < .001, P < .001) and had lower expression and distribution of both GABA-A and GABA-B receptors, while the opposed results appeared in the “sluggish” group. The norepinephrine level was successively increased among “sluggish,” “normal,” and “rapid” rats (P < .001) and correlated with ejaculation frequency (r = 0.896, P < .001) and ejaculation latency (r = −0.835, P < .001). In addition, bilateral microinjection of the GABA-A and GABA-B receptor agonist (isoguvacine and baclofen) into the PVN both significantly prolonged the intromission latency and inhibited ejaculation, which could be blocked by antagonist gabazine and CGP-35348, respectively. Vigabatrin, the GABA-transaminase inhibitor, caused a significantly reduced ejaculation frequency and extended ejaculation latency in rats, which could be offset by simultaneous injections of gabazine and CGP-35348.Clinical ImplicationsOur findings provide new understanding about GABA receptors in the PVN on sexual behavior and enhance the comprehension of neurobiological mechanisms involved in premature ejaculation.Strengths & LimitationsOur results have indicated that GABA receptors in the PVN may inhibit ejaculation through restraining the activity of SNS. However, our study did not analyze the changes of GABA receptors in other brain areas, which needs further study.ConclusionEjaculation behaviors in male rats are associated with SNS activity and could be regulated by GABA receptors in the PVN, which may be of assistance in the treatment of ejaculation disorders in the future.Zhang QJ, Yang BB, Yang J, et al. Inhibitory Role of Gamma-Aminobutyric Receptors in Paraventricular Nucleus on Ejaculatory Responses in Rats. J Sex Med 2020;17:614–622.