北京地区汉族年轻妇女钙敏感受体基因多态性分布及其与血钙水平相关性

目的了解北京地区汉族年轻妇女钙敏感受体（calcium-sensing receptor,CASR）基因多态性的分布,探索其与血钙、甲状旁腺素（PTH）水平的相关性。方法分别采用突变分离PCR和错配PCR-限制性片段长度多态性（RFLP）方法检测北京地区202例无亲缘关系的汉族年轻健康妇女（20—35岁）CASR基因A986S、G990R基因型,测定其血钙、经白蛋白校正后的血钙、磷及PTH水平,以及肝肾功能等指标。结果（1）北京地区汉族妇女中存在CASR基因A986S、G990R多态性,AA、AS基因型频率分别为95．0％和5．0％,等位基因A和S的频率分别为97．5％和2．5％;RR、GR及GG基因型频率分别为21．3％、51．0％和27．7％,等位基因R和G的频率分别为46．8％和53．2％。（2）AA、AS基因型组血钙分别为（2．46±0．09）、（2．45±0．08）mmol／L,经白蛋白校正后的血钙为（2．314±0．10）、（2．30±0．09）mmol／L,血磷为（1．23±0．14）、（1．24±0．11）mmol／L,血PTH为（41．6±18．6）、（50．0±25．1）ng／L,上述指标差异无统计学意义。（3）GG、GR及RR组的血钙分别为（2．44±0．10）、（2．46±0．08）及（2．48±0．08）mmol／L,经白蛋白校正后的血钙分别为（2．30±0．10）、（2．32±0．09）及（2．32±0．10）mmol／L,血磷分别为（1．22±0．13）、（1．24±0．15）及（1．20±0．15）mmol／L,血PTH分别为（37．6±16．0）、（42．1±20．2）及（45．9±18．1）ns／L,各组间血钙、校正后的血钙及咖水平间差异有统计学意义（P值分别为0．042、0．020及0．014）。结论（1）北京地区汉族妇女中CASR基因A986S、G990R多态性的分布频率,以A、G等位基因频率较高,初步显示其分布与高加索人群不同。（2）在健康人群中G990R多态性与血钙、PTH水平相关,R等位基因对应较高的血钙和PTH水平。未发现A986S多态性与血钙、PTH水平相关。     

北京地区汉族青年女性钙敏感受体基因多态性分布及其与骨密度相关性的研究

目的了解北京地区汉族青年女性钙敏感受体（Calcium-sensing ReceptOF,CaSR）基因多态性的分布,探索其与汉族妇女峰值骨密度的相关性。方法分别采用突变分离PCR和错配PCR-RFLP方法检测北京地区202名无亲缘关系的汉族青年健康女性（20～35岁）受试者CaSR基因A986S、G990R基因型,测定其血钙（Ca）、磷（P）及甲状旁腺素（PTH）水平,以及肝肾功能等指标,应用双能X线骨密度仪（DXA）测定腰椎、股骨上段部位的骨密度（BMD）。结果（1）北京地区汉族女性中存在CaSR基因A986S、G990R多态性,AA、AS基因型频率分别为95．0％和5．0％,等位基因A和s的频率分别为97．5％和2．5％;RR、GR及GG基因型频率分别为21．3％、51．0％和27．7％,等位基因R和G的频率分别为46．8％和53．2％。（2）校正年龄、身高、体重、BMI及血Ca、PTH水平后,多因素协方差分析显示AA、AS基因型组之间L2-4、股骨颈、ward＇s三角及大转子部位的BMD无显著差异（P=0J090～0．671）;GG、GR及RR基因型组之间L2。、股骨颈、ward＇s三角及大转子部位的BMD也无显著差异（P=0．089～0．493）。结论（1）北京地区汉族青年女性中CaSR基因A986S、G990R多态性的分布频率,以A、G等位基因频率较高。（2）未发现CaSR基因A986S、G990R多态性与北京地区汉族青年女性峰值骨密度相关。     

北京地区汉族青年女性钙敏感受体基因多态性分布及其与骨密度相关性的研究

目的 了解北京地区汉族青年女性钙敏感受体(Calcium-sensing Receptor,CaSR)基因多态性的分布,探索其与汉族妇女峰值骨密度的相关性.方 法分别采用突变分离PCR和错配PCR-RFLP方法检测北京地区202名无亲缘关系的汉族青年健康女性(20～35岁)受试者CaSR基因A986S、G990R基因型,测定其血钙(Ca)、磷(P)及甲状旁腺素(PTH)水平,以及肝肾功能等指标,应用双能X线骨密度仪(OXA)测定腰椎、股骨上段部位的骨密度(BMO).结果 (1)北京地区汉族女性中存在CaSR基因A986S、G990R多态性,从、AS基因型频率分别为95.0%和5.0%,等位基因A和S的频率分别为97.5%和2.5%;RR、GR及GG基因型频率分别为21.3%、51.0%和27.7%,等位基因R和G的频率分别为46.8%和53.2%.(2)校正年龄、身高、体重、BMI及血Ca、P、PTH水平后,多因素协方差分析显示从、AS基因型组之间L2-4、股骨颈、ward's三角及大转子部位的BMD无显著差异(P=01090～0.671);GG、GR及RR基因型组之间L2-4、股骨颈、ward's三角及大转子部位的BlVID也无显著差异(P=0.089～0.493).结论 (1)北京地区汉族青年女性中CaSR基因A986S、G990R多态性的分布频率,以A、G等位基因频率较高.(2)未发现CaSR基因A986S、G990R多态性与北京地区汉族青年女性峰值骨密度相关.     

甲状旁腺素基因多态性对正常女性骨密度的影响

目的 探讨正常女性人群甲状旁腺素（PTH）基因多态性对多部位骨密度的影响。方法 对596名平均年龄（46．3±13．7）岁女性志愿者基因组DNA作限制性内切酶BstBⅠ的PCR-RFLP检测以确定其基因型，存在Bst BⅠ限制性酶切位点用“B”表示，不存在则用“b”表示；采用Hologic QDR4500A DEXA骨密度仪测定不同骨骼部位的骨密度，即腰椎（L1～L4）正位总体（AP）和仰卧侧位总体（Lat）、股骨颈（FN）、髋部总体（T—hip）、Ward三角（Ward）、大转子（Troch）和前臂超远端（RUUD）及远端总体（RUT）的骨密度。结果 （1）596名健康女性PTH基因多态性符合Hardy—Weinberg平衡，BB、Bb和bb基因型分布频率分别为0．784、0．208和0．008；B、b等位基因频率为0．888和0．112。347名绝经后妇女PTH基因多态性频率调查结果显示BB、Bb和bb基因型分布频率分别为0．781，0．210和0．009，B、b等位基因频率为0．886和0．114；绝经前妇女PTH基因多态性频率与绝经后妇女差异无统计学意义。（2）方差分析显示女性BB和Bb基因型在AP、Lat、FN、T-hip、Ward、Troch、RUUD和RUT的骨密度差异无统计学意义。（3）Logistic分析结果显示PTH基因型不是骨量减少或骨质疏松的独立相关变量。结论 女性PTH基因多态性对骨密度的变异无明显影响。     

慢性肾功能不全患者血清甲状旁腺素、钙、磷之间的关系

为了解慢性肾功能不全患者血清中钙、磷、甲状旁腺素（PTH）水平变化,藉以推测继发性甲状腺腺亢进的原因,观察了92例不同阶段段功能不全患者的血清、钙、磷、PTH水平。结果显示,PTH与内生肌酐清除（Ccr)呈负相关（P＜0．05）,与血清磷水平呈正相关（P＜0．05）,与血清钙水平无相关必.性肾功能不全早期,随着Ccr降低,PTH逐渐升高,但血磷、血钙水平并无显著改变,慢性肾功能不全后期（肾功能衰竭期）血磷水平才明显升高,血钙水羡明显降低。     

Association between calcium sensing receptor gene polymorphisms and chronic pancreatitis in a US population： Role of serine protease inhibitor Kazal 1type and alcohol

AIM： To test the hypothesis that calcium sensing receptor （CASR） polymorphisms are associated with chronic pancreatitis （CP）, and to determine whether serine protease inhibitor Kazal 1type （SPINK1） N34S or alcohol are necessary co-factors in its etiology.
METHODS： Initially, 115 subjects with pancreatitis and 66 controls were evaluated, of whom 57 patients and 21 controls were predetermined to carry the high-risk SPINK1 N34S polymorphism. We sequenced CASR gene exons 2, 3, 4, 5 and 7, areas containing the majority of reported polymorphisms and novel mutations. Based on the initial results, we added 223 patients and 239 controls to analyze three common nonsynonymous single nucleotide polymorphisms （SNPs） in exon 7 （A986S, R990G, and Q1011E）.
RESULTS： The CASR exon 7 R990G polyrnorphism was significantly associated with CP （OR, 2.01; 95% CI, 1.12-3.59; P = 0.015）. The association between CASR R990G and CP was stronger in subjects who reported moderate or heavy alcohol consumption （OR, 3.12; 95% CI, 1.14-9.13; P = 0.018）. There was no association between the various CASR genotypes and SPINK1 N34S in pancreatitis. None of the novel CASR polymorphisms reported from Germany and India was detected.
CONCLUSION： Our United States-based study confirmed an association of CASR and CP and for the first time demonstrated that CASR R990G is a significant risk factor for CP. We also conclude that the risk of CP with CASR R990G is increased in subjects with moderate to heavy alcohol consumption.     

马来酸曲美布汀治疗功能性消化不良与腹泻型肠易激综合征重叠的随机对照研究

目的 观察马来酸曲美布汀片（曲美布汀）治疗功能性消化不良（FD）与腹泻型肠易激综合征（IBS—D）重叠的疗效和不良反应。方法 采用随机、病例对照的前瞻性研究,129例患者随机分为A组（曲美布汀和地衣芽孢杆菌）、B组（曲美布汀）和C组（地衣芽孢杆菌）。各症状采用分级记分进行描述,疗效评价参照症状积分的变化。结果 A、B组治疗前后的评分,分别为腹胀[A组（4．55±0．85）分,（1．26±0．52）分;B组（4．36±0．66）分,（1．48±0．61）分]、早饱[A组（4．05±0．96）分,（1．01±0．51）分;B组（3．89±0．81）分,（1．25±0．76）分]、腹痛[A组（9．26±0．68）分,（0．68±0．43）分;B组（9．57±1．60）分,（0．76±0．54）分],症状总积分[A组（20．00±1．25）分,（3．06±0．91）分;B组（19．05±2．28）分,（3．89±2．12）分],治疗后较治疗前均有显著下降（P〈0．05）,而C组治疗前后差异无统计学意义（P〉0．05）;3组治疗前后的腹泻评分[A组（4．78±0．76）,（0．65±0．53）;B组（4．13±0．65）,（1．25±0．62）;C组（4．65±0．88）,（1．45±0．70）]均有显著性下降（P〈0．05）。治疗4周后,腹胀、早饱、腹痛的评分和症状总积分,A、B组与C组比较,差异有统计学意义（P〈0．05）。A、B组的各症状的疗效和总疗效均优于C组（P〈0．05）。3组的费用一效果比（C／E）分别为4．07、1．19、6．65,以B组最佳。A、B组的不良反应发生率分别为22．9％和23．7％,主要为轻度的口干和便秘。结论 曲美布汀治疗FD与IBS—D重叠的患者,具有疗效高,价廉,不良反应少的特点。     

不同水平呼气末正压通气对肺内外源性急性呼吸窘迫综合征患者的影响

目的 观察不同水平呼气末正压（PEEP）通气对肺内、外源性急性呼吸窘迫综合征（ARDS）患者的影响。方法 以16例早期肺内源性ARDS（A组）和12例早期肺外源性ARDS（B组）患者为研究对象,调整PEEP水平,分别监测在PEEP通气前和PEEP为5、10、15cmH2O通气后30min时的氧合、呼吸力学和血流动力学的变化。结果 PEEP5cmH2O时与PEEP通气前比较,A、B两组患者的动脉血氧分压（PaO2）／吸入气氧浓度（FiO2）、气道峰压（Ppeak）、气道平台压（Pplat）、平均动脉压（MAP）以及B组患者的呼吸系统顺应性（Crs）差异均无统计学意义（P均〉0．05）;A组患者的Crs[PEEP5cmH2O时、PEEP通气前分别为（0．027±0．004）、（0．022±0．005）L／cmH2O]差异有统计学意义（P〈0．05）。PEEP10cmH2O时与PEEP通气前比较,A、B两组患者的PaO2／Fioz[PEEP10cmH2O时、PEEP通气前A组分别为（130．Off=30．6）、（81．6±26．7）,B组分别为（137．3±28．9）、（73．6±30．8）]、Crs[PEEP10cmH2O时、PEEP通气前A组分别为（0．032±0．005）、（0．022±0．005）L／cmH2O,B组分别为（0．033±0．005）、（0．022±0．004）L／cmH2O]、MAP[PEEP10cmH2O时、PEEP通气前A组分别为（68．9±8．4）、（79．3±9．2）mEHg,B组分别为（69．0±6．2）、（77．5±8．7）mEHg]以及A组患者的Ppeak[PEEP10cmH2O时、PEEP通气前分别为（33．0±6．O）、（25．0±5．8）mEHg]和PplatFPEEP10cmH20时、PEEP通气前分别为（30．5±5．6）、（22．1±4．8）mEHg]差异均有统计学意义（P〈0．05或P〈0．01）,其中B组患者PaO2／FiO2升高幅度、Crs增大幅度均较A组患者更显著（P均G0．05）。PEEP15cmHzO时与PEEP通气前比较,A、B两组患者的PaO2／FiO2[EEP15cmH2O时、PEEP通气前A组分别为（139．8±34．8）、（81．6±26．7）,B组分别为（178．7±35．4）、（73．6±30．8）]、Crs[PEEP15cmH2O时、PEEP通气前A组分别为（0．030±0．005）、（0．022±0．005）L／cmH20,B组分别为（0．036±0．007）、（0．022±0．004）L／cmH201、MAP[PEEP15cmH2O时、PEEP通气前A组分别为（66．9±9．1）、（79．3±9．2）mEHg,B组分别为（66．3±5．2）、（77．5±8．7）mEHg]、Ppeak[PEEP15cmH2O时、PEEP通气前A组分别为（40．3±6．7）、（25．0±5．8）cmH2O,B组分别为（35．7±8．5）、（22．2±7．8）cmH2O]和Pplat[PEEP15cmH2O时、PEEP通气前A组分别为（36．9±5．6）、（22．1±4．8）cmH2O,B组分别为（29．2±6．8）、（18．7±5．6）cmH2O]差异均有统计学意义（P均〈0．01）,其中B组患者PaO2／FiO2升高幅度、Crs增大幅度均较A组患者更显著（P均〈0．01）,A组患者Pplat增高幅度较B组患者更显著（P〈0．01）。A、B两组患者MAP下降幅度比较差异无统计学意义（P〉0．05）。机械通气24h后A组2例出现轻度纵隔气肿。结论 PEEP通气能改善部分ARDS患者的氧合和呼吸系统顺应性,而且对肺外源性ARDS患者的改善可能要优于肺内源性ARDS患者。但高PEEP可能使Ppeak和Pplat显著增高,而且肺内源性ARDS患者Pplat的增高幅度可能要更显著于肺外源性ARDS患者。     

痛风伴微量白蛋白尿患者胰岛素抵抗与红细胞膜胰岛素受体的关系

目的 探讨痛风伴微量白蛋白尿患者胰岛素抵抗与红细胞膜胰岛素受体的关系。方法 观察106例痛风患者，按是否合并微量白蛋白尿（MAU），将其分为MAU组和正常MAU组（NMAU），测定空腹、餐后2h血糖、胰岛素及空腹血脂、血尿酸（UA），并检测高、低亲和力红细胞膜胰岛素受体数目（R1、R2）和高、低亲和力常数（K1、K2），分析痛风伴MAU患者胰岛素抵抗与红细胞膜胰岛素受体的关系。结果 MAU组空腹胰岛素（FINS）、甘油三酯（TG）、低密度脂蛋白（LDL-c）及胰岛素抵抗指数（HOMA—IR），分别为：（16±4）mU／L、（2．5±0．6）mmol／L、（3．2±0．5）mmol／L和3．6±1．2，正常MAU组分别为（13±3）mU／L、（2．3±0．8）mmol／L、（3．0±0．5）mmol／L及3．0±0．4，上述指标两组间比较差异有统计学意义（P〈0．05）。痛风患者合并MAU红细胞膜胰岛素受体数目（R1）较正常MAU组明显减少，两组间比较差异有统计学意义（P〈0．05）。痛风患者合并MAU的Pearson相关分析结果示：HOMA—IR与年龄、体重指数（BMI）、TG、LDL—c、UA、UAER呈正相关（P〈0．05或P〈0．01），与R1、R2、K1、K2呈负相关（P〈0．05或P〈0．01）。多元线性逐步回归分析提示BMI、年龄、R1是影响痛风合并MAU患者胰岛素抵抗的独立危险因素。结论 痛风合并MAU时存在胰岛素抵抗，且与红细胞膜胰岛素受体数目减少密切相关。     

硫化氢在大鼠急性支气管哮喘模型中的变化及意义

目的观察卵白蛋白（OVA）诱导的大鼠急性支气管哮喘（简称哮喘）模型，内源性硫化氢（H2S）生成的变化以及应用外源性硫氢化钠（NaHS，H2S供体）处理对哮喘大鼠的影响，探讨气体信号分子H2S在哮喘发病中的作用。方法24只健康SD大鼠按随机数字表法分为正常对照组、哮喘组和NaHS干预组，每组8只。致敏后28d测定所有大鼠肺功能并观察大鼠支气管周围炎性细胞浸润程度并进行评分；采用敏感硫电极测定血浆及肺组织H2S的生成量；采用酶促反应法测定大鼠肺组织匀浆中胱硫醚-γ-裂解酶（CSE）活性；用Western blot法测定大鼠肺组织中CSE蛋白含量（每组3只）。结果哮喘组大鼠呼气峰流量（PEF）、血浆及肺组织中H2S分别为（2．90±0．70）L／s、（10±3）、（4．9±1．3）μmoL／L，对照组分别为（6．50±0．10）L／s、（54±10）、（24．1±8．0）μmoL／L，NaHS干预组大鼠分别为（5．70±0．50）L／s、（17±4）、（15．3±4．0）μmol／L，3组间比较差异有统计学意义（F值分别为112．13、110．10、27．34，P均〈0．01）；哮喘组大鼠肺组织匀浆每毫克蛋白中CSE活性和肺组织匀浆中CSE蛋白含量[用相对吸光度（A）值表示]分别为（1．00±0．10）nmol·min^-1·mg^-1、0．20±0．10，正常对照组分别为（1．80±0．10）nmo]·min^-1·mg^-1、0．90±0．30，NaHS干预组大鼠分别为（1．60±0．20）nmo]·min^-1·mg^-1、1．10±0．20，3组间比较差异有统计学意义（F值分别为79．39、12．28，P均〈0．05）；光镜下支气管周围炎性细胞浸润程度评分[用中位数（四分位数）]表示，正常对照组为1（0～1）分，哮喘组为3（2～4）分，NaHS干预组为1（1～2）分，3组间比较差异有统计学意义（H=16．93，P〈0．01）；哮喘组肺组织H2S含量与PEF呈正相关（r=0．74，P〈0．01）；与光镜下支气管周围炎性细胞浸润程度评分呈负相关（r=-0．64，P〈0．01）。结论内源性H2S参与了大鼠急性哮喘发病过程，外源性NaHS可以减轻哮喘气道炎症，对哮喘急性发病起到保护作用。     

Beta blocker overdose with propranolol and with atenolol

During a one-month period, two cases of beta-adrenergic blocker overdose were treated by the emergency staff at our hospital. One case of propranolol intoxication demonstrated profound cardiovascular collapse and generalized tonic-clonic seizures. The condition failed to respond to high-dose intravenous pressor agents, but did improve significantly with IV glucagon infusion. The second overdose involved atenolol. Although the blood levels reported were very high, the patient showed no cardiovascular compromise and required only inhaled bronchodilators for an exacerbation of her asthma.     

Colitis associated with biological agents

In the past, there has been considerable focus on a host of drugs and chemicals that may produce colonic toxicity. Now, a variety of new biological monoclonal antibody agents, usually administered by infusion, have appeared in the clinical realm over the last decade or so to treat different chronic inflammatory or malignant disorders.For some of these agents, adverse effects have been documented, including apparently new forms of immune-mediated inflammatory bowel disease. In some, only limited symptoms have been recorded, but in others, severe colitis with serious complications, such as bowel perforation has been recorded. In others, adverse effects may have a direct vascular or ischemic basis, while other intestinal effects may be related to a superimposed infection. Some new onset cases of ulcerative colitis or Crohn's disease may also be attributed to the same agents used to treat these diseases, or be responsible for disease exacerbation. Dramatic and well documented side effects have been observed with ipilimumab, a humanized monoclonal antibody developed to reduce and overcome cytotoxic T-lymphocyte antigen 4, a key negative feedback regulator of the T-cell anti-tumor response. This agent has frequently been used in the treatment of different malignancies, notably, malignant melanoma. Side effects with this agent occur in up to 40% and these are believed to be largely immune-mediated. One of these is a form of enterocolitis that may be severe, and occasionally, fatal. Other agents include rituximab (an anti-CD20 monoclonal antibody), bevacizumab (a monoclonal antibody against the vascular endothelial growth factor) and anti-tumor necrosis factor agents, including infliximab, adalimumab and etanercept.     

Water intoxication with seizures

Presented is the case of a normal two-month-old girl who developed seizures secondary to water intoxication. The infant had been fed 20 to 30 oz of water daily for three days, while her usual formula was withheld because of vomiting and diarrhea. On the day of admission, the infant exhibited signs of water intoxication in the form of lethargy, vomiting, and seizures. Hyponatremia, hypothermia, and hyperglycemia were noted on admission, and are common features of the syndrome. The patient responded well to fluid restriction and salt replacement. Previous reports have attributed water intoxication to feeding mismanagement, vigorous hydration, dilute formulas, and swimming lessons.     

Weber-Christian disease with ileocolonic involvement successfully treated with infliximab

Weber-Christian disease(WCD) is an inflammatory disease whose main histological feature is lobular panniculitis of adipose tissue. The location of panniculitis determines the clinical presentation,being the subcutaneous adipose tissue the most frequent one,followed by liver,spleen,bone marrow and mesenteric adipose tissue.Systemic corticosteroids are first line treatment,but other options should be considered if systemic symptoms are observed or in case of refractory clinical situation.We report herein a case with WCD showing orbital,mesenteric and ileocolonic involvement,which required surgical treatment and also developed postoperative recurrence.Symptoms were resolved by administration of thalidomide and,afterwards,infliximab.To our knowledge,this is the first report of Weber-Christian disease with luminal ileocolonic involvement,treated with infliximab.     

Anticoagulation with Bivalirudin during Deep Hypothermic Circulatory Arrest in a Patient with Heparin-Induced Thrombocytopenia

Heparin-induced thrombocytopenia is a well-recognized complication of anticoagulation with heparin. We present the case of a patient with recent heparin-induced thrombocytopenia who subsequently needed surgery on an emergency basis for acute type A aortic dissection. This article reports the successful use of bivalirudin, a direct thrombin inhibitor, as an alternative to heparin throughout cardiopulmonary bypass and deep hypothermic circulatory arrest. We contend that bivalirudin is a safe alternative to heparin when performing surgery for aortic dissection and should be considered as an option for use in patients who present with heparin-induced thrombocytopenia.     

Curing Cats with Feline Infectious Peritonitis with an Oral Multi-Component Drug Containing GS-441524

Feline infectious peritonitis (FIP) caused by feline coronavirus (FCoV) is a common dis-ease in cats, fatal if untreated, and no effective treatment is currently legally available. The aim of this study was to evaluate efficacy and toxicity of the multi-component drug Xraphconn^® in vitro and as oral treatment in cats with spontaneous FIP by examining survival rate, development of clinical and laboratory parameters, viral loads, anti-FCoV antibodies, and adverse effects. Mass spectrometry and nuclear magnetic resonance identified GS-441524 as an active component of Xraphconn^®. Eighteen cats with FIP were prospectively followed up while being treated orally for 84 days. Values of key parameters on each examination day were compared to values before treatment initiation using linear mixed-effect models. Xraphconn^® displayed high virucidal activity in cell culture. All cats recovered with dramatic improvement of clinical and laboratory parameters and massive reduction in viral loads within the first few days of treatment without serious adverse effects. Oral treatment with Xraphconn^® containing GS-441524 was highly effective for FIP without causing serious adverse effects. This drug is an excellent option for the oral treatment of FIP and should be trialed as potential effective treatment option for other severe coronavirus-associated diseases across species.     

Serum metabolome profiles characterized by patients with hepatocellular carcinoma associated with hepatitis B and C

AIM: To clarify the characteristics of metabolite profiles in virus-related hepatocellular carcinoma(HCC) patients using serum metabolome analysis. METHODS: The serum levels of low-molecular-weight metabolites in 68 patients with HCC were quantified using capillary electrophoresis chromatography and mass spectrometry. Thirty and 38 of the patients suffered from hepatitis B virus-related HCC(HCC-B) and hepatitis C virus-related HCC(HCC-C), respectively.RESULTS: The main metabolites characteristic of HCC were those associated with glutathione metabolism, notably 13 γ-glutamyl peptides, which are by-products of glutathione induction. Two major profiles, i.e., concentration patterns, of metabolites were identified in HCC patients, and these were classified into two groups: an HCC-B group and an HCC-C group including some of the HCC-B cases. The receiver operating characteristic curve for the multiple logistic regressionmodel discriminating HCC-B from HCC-C incorporating the concentrations of glutamic acid, methionine and γ-glutamyl-glycine-glycine showed a highly significant area under the curve value of 0.94(95%CI: 0.89-1.0, P 0.0001).CONCLUSION: The serum levels of γ-glutamyl peptides, as well as their concentration patterns, contribute to the development of potential biomarkers for virus-related HCC. The difference in metabolite profiles between HCC-B and HCC-C may reflect the respective metabolic reactions that underlie the different pathogeneses of these two types of HCC.     

Management of a child with acute thyroxine ingestion

We report a case of thyroxine overdose in a child. Despite extremely high thyroxine (T4RIA) levels on admission, the patient's only symptoms were mild hypertension and tachycardia. Both symptoms responded to propranolol, with a drop in pulse rate and a decrease in blood pressure to normal levels. After four days of cardiac monitoring, the patient was released and received propranolol for five additional days as an outpatient.     

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus简

The incidence of esophageal adenocarcinoma, a poor prognosis neoplasia, has risen dramatically in recent decades. Barrett’s esophagus represents the best-known risk factor for esophageal adenocarcinoma development. Non-steroidal anti-inflammatory drugs through cyclooxygenase-2 inhibition and prostaglandin metabolism regulation could control cell proliferation, increase cell apoptosis and regulate the expression of growth and angiogenic factors. Statins can achieve equivalent effects through prenylation and subsequently control of cellular signaling cascades. At present, epidemiological studies are small and underpowered. Their data could not justify either medication as a chemo-preventive agent. Population based studies have shown a 43% reduction of the odds of developing an esophageal adenocarcinoma, leaving out or stating a 25% reduction in patients consuming non-aspirin nonsteroidal anti-inflammatory drugs and a 50% reduction in those patients consuming aspirin. They have also stated a 19% reduction of esophageal cancer incidence when statins have been used. Observational studies have shown that non-steroidal anti-inflammatory drugs could reduce the adenocarcinoma incidence in patients with Barrett’s esophagus by 41%, while statins could reduce the risk by 43%. The cancer preventive effect has been enhanced in those patients taking a combination of non-steroidal anti-inflammatory drugs and statins (a 74% decrease). Observational data are equivocal concerning the efficacy of non-steroidal anti-inflammatory drug subclasses. Non-steroidal anti-inflammatory drugs clearly have substantial potential for toxicity, while statins are rather safe drugs. In conclusion, both non-steroidal anti-inflammatory drugs and statins are promising chemopreventive agents and deserve further exploration with interventional studies. In the meanwhile, their use is justified only in patients with cardiovascular disease.