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??Diagnosis and treatment of hyperparathyroid crisis??a report of 4 cases BAI Yan-xia*, MA Qing-yong, YAN Li-ying, et al . *Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital, Medical College of Xi’an Jiaotong University??Xi’an 710061??China Corresponding Author?? MA Qing-yong, E-mail: qyma56@xjtu.edu.cn Abstract Objective To explore the diagnostic and therapeutic method of hyperparathyroid crisis. Methods The clinical data, the operative technique, the therapeutic effect of 4 cases which were treated in First Affiliated Hospital of Xi’an Jiaotong University from January 2005 to May 2007 were presented. Through reviewing pertinent literature, we discuss the qualitative diagnosis??level diagnosis and operative juncture of primary hyperparathyroidism complicating hyperparathyroid crisis. Results The three patients were healed by promptly exploratory parathyroidectomy and medical treatment. One patient died for complicating of multiple organ dysfunction. Conclusions Promptly exploratory parathyroidectomy after temporal medical treatment is an effective method to rescue the patient of primary hyperparathyroidism complicating hyperparathyroid crisis??The exploratory parathyroidectomy can be successed on preoperative definite diagnosis and accurate localization??frozen section and quickly PTH determination in the operation.     

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??Clinical efficacy and safety of moxifloxacin for acute cholangitis of severe type--A prospective multi-centric study YIN Da-long*, LU Zhao-yang, LIU Lian-xin, et al. *The First Affiliated Hospital,Haerbin Medical University ,Haerbin 150001,China Corresponding author: LIU Lian-xin,E-mail:liulianxin@medmail.com.cn Abstract Objective To investigate the clinical efficacy and safety of moxifloxacin for acute cholangitis of severe type(ACST). Methods In this prospective, single-blind, multi-centric study a total of 50 consecutive patients from January 2008 to June 2008 with ACST were included the current clinical trial. The efficacy and safety of moxifloxacin 400 mg by intravenous infusion once daily were evaluated to treat ACST accompanying surgery or endoscopy. The clinical and bacteriologic response at different intervals after administration were observed, as well as body temperature, leucocytes, alanine aminotransferase, total bilirubin, alkaline phosphate andγ-glutamyltransferase. Results The temperature and leucocytes of 42 in 49 patients were markedly decreased at 3 days after treatment compared to those at admission . There were significant decrease (P<0.01) in alanine aminotransferase, total bilirubin, alkaline phosphate and γ-glutamyltransferase at 3 days comparable with those at admission, respectively. Clinical success rates at test-of-cure were 85.7% (42 of 49) for moxifloxacin. Pathogens were isolated from bile or blood cultures in all patients. Thirty out of 49 patients had positive bile and/or blood cultures, including 11(36.7%) patients with mixed infection with several species. The predominant strains were E.coli (22/49), Klebsiella species (8/49) and Enterococcus species (5/49). Bacterial eradication rates were 83.3%(35/42) for moxifloxacin at 7 days after administration.Conclusion E.coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with ACST and a mixed infection with several species was observed. Moxifloxacin evidently showed high clinical and bacteriological efficacies and safety in the hospitalized patients with ACST.     

Addition of a defibrillation electrode in the low right atrium to a right ventricular lead does not reduce ventricular defibrillation thresholds

Transvenous unipolar active can defibrillation systems have proven to be effective in treating ventricular tachyarrhythmias. However, a further reduction of ventricular defibrillation thresholds (V-DFT) would increase the longevity, reduce the size of pulse generators, and help to avoid additional leads in patients with inacceptable high V-DFTs. In a finite difference computer model, the extension of the right ventricular (RV) defibrillation coil into the low right atrium led to a 40% reduction of unipolar V-DFT. To evaluate this finding, we conducted a prospective, randomized study in 11 patients receiving an ICD. Extension of the RV electrode was simulated by adding a second coil placed in the low right atrium with the same polarity. Using a binary search protocol, V-DFT was determined with and without the additional electrode in each patient. Total shock impedance was significantly lower in the two coil (low RA) configuration, compared to the single coil (RV) configuration. Corresponding values were 49.9 +/- 6.7 Ohm and 61.1 +/- 9.3 Ohm, respectively (P < 0.01, paired t-test). However, there was no reduction, but even a nonsignificant increase in V-DFTs. Mean V-DFT in the RV configuration was 12.0 +/- 5.6 J and 16.3 +/- 7.8 J in the low RA configuration (P = 0.09, paired t-test). Despite a reduction in total impedance, the addition of a defibrillation coil in the low right atrium does not reduce ventricular defibrillation thresholds.     

Sesquiterpene lactones of Aucklandia lappa: Pharmacology,pharmacokinetics, toxicity,and structure–activity relationship

The medicinal part of Aucklandia lappa(Asteraceae) is its dried root,which is one of the commonly used Chinese medicinal materials.Here we reviewed sesquiterpene lactones isolated from A.lappa over the past ten years in the following aspects of pharmacological activities,pharmacokinetics,toxicology,structure-activity relationship.Pharmacological activities consist of anti-cancer,anti-inflammatory activity,anti-immunity activity,anti-oxidant activity,antimicrobial activity,spasmolytic activity and so on.The extractive,showing similar pharmacokinetics parameters,may exert their various biological activities by the interaction of their α-methylene-γ-butyrolactone moiety with the thiol groups of biomacromolecules through Michael-addition.However,the poor aqueous solubility,non-selective binding as a Michael acceptor at undesired targets limited clinical translation of this class.In order to evaluate the potential effect of the extractive applied in clinical trial,the present review outlines information on pharmacological activities,pharmacokinetics,toxicology,and structure-activity relationship,as well as the future research directions of the extractive for further development and utilization of A.lappa.     

肾损伤螺旋CT扫描时相的选择

螺旋CT增强扫描是显示肾脏病变最佳手段之一,常规时相选择为双期或三期法[1],少有对肾脏增强扫描最佳时相特别是对肾损伤扫描最佳时相选择的研究.由于使用的机型不同,可能各项指标不尽相同.现将作者对时相选择方法介绍如下.     

Evidence of active efflux in resistance to ciprofloxacin and to ethidium bromide by Mycoplasma hominis

The uptake of fluoroquinolones was characterized for the fluoroquinolone-susceptible strain PG21 of Mycoplasma hominis. Accumulation of fluoroquinolones appeared to occur by passive diffusion. Addition of arginine as the energizer significantly reduced the uptake of fluoroquinolones, suggesting the presence of an energy-dependent efflux process. Reserpine and orthovanadate, two multidrug pump inhibitors, increased significantly the ciprofloxacin (CIP) uptake. In contrast, such a strong effect was not observed for moxifloxacin and pefloxacin uptakes. Two ethidium bromide (EtBr)-resistant strains, selected in vitro, showed a resistance profile compatible with a multidrug-resistant phenotype, with increased MICs for the hydrophilic fluoroquinolones, CIP and norfloxacin, EtBr, and acriflavine. Taking the EtBr-resistant strain RB1La as a model, a significant decrease of the CIP and EtBr uptakes was observed compared to the reference strain PG21. In the presence of reserpine and orthovanadate, both inhibitors of ATP-dependent efflux pumps, the CIP uptake increased significantly, reaching approximately the same level as that of the susceptible strain. Similar results were obtained with EtBr uptake and efflux experiments. Our data suggest the presence of an active efflux system, possibly an ABC-type efflux pump, implicated in the resistance to CIP and unrelated compounds like EtBr in the human mycoplasma M. hominis.     

RNA versus DNA (NucliSENS EasyQ HIV-1 v1.2 versus Amplicor HIV-1 DNA test v1.5) for early diagnosis of HIV-1 infection in infants in Senegal

The objective of this study was to compare the performance of the NucliSENS EasyQ HIV-1 v1.2 platform (bioMérieux, France) to the Amplicor HIV-1 DNA test v1.5 (Roche Molecular Systems, Switzerland) in detecting HIV-1 infection in infants using venipuncture-derived whole blood in tubes and dried blood spots. A total of 149 dried blood spots and 43 EDTA-anticoagulated peripheral blood samples were collected throughout Dakar and other areas in Senegal from infants and children aged 3 weeks to 24 months who were born to HIV-1-infected mothers. Samples were tested using the NucliSENS and Amplicor technologies. The NucliSENS and Amplicor results were 100% concordant using either EDTA-anticoagulated peripheral blood or dried blood spots. Compared to Amplicor, the sensitivity and specificity of the NucliSENS test were 100%. The NucliSENS EasyQ HIV-1 RNA assay performed as well as the Amplicor HIV-1 DNA test in detecting HIV-1 infection in infants. In addition, this platform can give an indication of the viral load baseline. The NucliSENS EasyQ platform is a good alternative for early infant diagnosis of HIV-1 infection.     

Expression of decorin and collagens I and III in different layers of human skin in vivo: a laser capture microdissection study

Extracellular matrix (ECM) organization is a complex process that requires the coordinated efforts of many molecules. For the regulation of collagen fiber diameter, the proteoglycan decorin appears to be of major relevance. To investigate the role of decorin in the process of (photo-)aging in more detail, full-thickness punch biopsies were isolated from human buttock skin. Single exposure with two minimal erythemal doses of solar simulated irradiation caused down-regulation of decorin mRNA in young (n = 5) and old subjects (n = 5) after 24 h. Interestingly, decorin mRNA was elevated with age. To test the hypothesis that a decreased collagen-to-decorin-ratio impairs collagen structure we also investigated collagens I and III gene expression. Both were down-regulated with increasing age and after single UV-irradiation. As determined by laser capture microdissection-quantitative real time-Polymerase chain reaction (n = 11), decorin is mostly present in the reticular dermis while being absent from the papillary dermis. Minor expression was also observed in the epidermis. However, in contrast to full-thickness skin biopsies age-dependent changes in collagens I, III, and decorin expression could not be observed with this methodology indicating technical limitations. Together with our finding that collagens I and III mRNA are similarly expressed in the reticular and papillary dermis and are down-regulated by UV, our studies support the idea of a major role of decorin in ECM organization. Altered expression of decorin mRNA in the different dermal strata and a decrease in the collagen-to-decorin ratio inflicted by both age and ultraviolet irradiation possibly affect collagen bundle diameter and subsequently the mechanical properties of human skin.