A systematic review of the management and outcome of toxic epidermal necrolysis treated in burns centres

IntroductionToxic epidermal necrolysis (TEN) is a rare condition characterised by mucocutaneous exfoliation of greater than 30% total body surface area (%TBSA), increasingly being treated in burns centres. The rate of mortality varies significantly in the literature, with recent prospective studies in non-burns centres reporting percentage mortality of approximately 45%. We undertook a systematic review of published studies that included TEN patients treated specifically in burns centres to determine a cumulative mortality rate.MethodsElectronic searches of MEDLINE, EMBASE and The Cochrane Library (Issue 4, 2010) databases from 1966 onwards were used to identify English articles related to the treatment of TEN in burns centres.ResultsThe systematic literature search identified 20 studies which specifically described patients with TEN grater than 30% %TBSA. Treatment regimens varied amongst studies, as did mortality. The overall percentage mortality of the combined populations was 30%. Risk factors commonly described as associated with mortality included age, %TBSA and delay to definitive treatment.ConclusionThe review highlights the variation between principles of treatment and mortality amongst burns centres. It offers a standard that burns centre can use to internationally compare their mortality rates. The review supports the ongoing reporting of outcomes in TEN patients with epidermal detachment greater than 30%.     

Regional Pharmaceutical Preparation for Biological and Chemical Terrorism

Background: The United States National Office of Domestic Preparedness has determined that the threat of a biological or chemical attack is very real. As an active participant of a 13-county regional task force, one of the roles of the poison center was to determine the pharmaceutical needs of the community in the event of a terrorist action and develop a financially responsible method of acquisition and storage. Methods: Working with local health officials, an extensive literature review was conducted to identify possible biological and chemical poisons. Treatment recommendations were identified and an estimated amount to treat 5,000 people for 24 hrs was determined. Instead of purchasing the medications, a unique solution utilizing a regional pharmacy wholesaler was used. Discussion: An important element in a biological or chemical terrorist event is the availability of the pharmaceuticals and the capability of delivering them rapidly. The poison center is the ideal agency to help coordinate this endeavor since it is familiar with contemporary therapy and will be aware of the number, location, and status of casualties. Based on the expense involved in the purchase and storage of a large quantity of medications, utilizing a local pharmaceutical distribution company is fiscally responsible. Rotation through normal stock and being readily accessible is another benefit. Conclusion: The poison center serves a number of roles in the surveillance, recognition, and treatment of biological and chemical terrorism. Assisting in the development, implementation, and procurement of a pharmaceutical cache is yet another role.     

The content of selected minerals and vitamin C for potatoes (Solanum tuberosum L.) from the high Tiber Valley area,southeast Tuscany

Potatoes (Solanum tuberosum L.) from the high Tiber valley area (TVA; Tuscany, Italy), have been sampled and analyzed for selected mineral content (Na, Mg, K, Ca, and Mn, Fe, Cu and Zn) and vitamin C, the year 2012; some samples from 2011 and 2013 crops were also collected and analyzed. The varieties were Daytona (DAY), Kennebec (KEN), Sifra (SIF) and Volare (VOL). Control samples consisted of mixed commercial varieties from the local market, namely C1, C2 and C3. The low content of sodium, especially for KEN (46 ± 3 mg/kg FD (freeze dry), year 2012) and SIF (47 ± 3) (VOL (55 ± 3) and DAY (61 ± 3) have a little higher values) is worth of note and in agreement with the scarce concentration of Na in the soil (291 ± 12 mg/kg DM). Magnesium was abundant in KEN (1434 ± 75 mg/kg FD, year 2012) and VOL (1334 ± 70). The content of K for DAY and KEN (13,147 ± 900 and 13,185 ± 900 mg/kg FD) was higher than for VOL and SIF; whereas Ca was in the range 340 ± 16–490 ± 28 mg/kg FD. The contents of Cu and Zn were higher in KEN (8.1 ± 0.3 and 25 ± 1 mg/kg FD) when compared to the other varieties and controls. The content of vitamin C is high for KEN and SIF and decreased significantly upon cooking (50% for KEN).     

Toxic trace elements at gastrointestinal level

Many trace elements are considered essential [iron (Fe), zinc (Zn), copper (Cu)], whereas others may be harmful [lead (Pb), cadmium (Cd), mercury (Hg), arsenic (As)], depending on their concentration and chemical form. In most cases, the diet is the main pathway by which they enter our organism. The presence of toxic trace elements in food has been known for a long time, and many of the food matrices that carry them have been identified. This has led to the appearance of legislation and recommendations concerning consumption. Given that the main route of exposure is oral, passage through the gastrointestinal tract plays a fundamental role in their entry into the organism, where they exert their toxic effect. Although the digestive system can be considered to be of crucial importance in their toxicity, in most cases we do not know the events that occur during the passage of these elements through the gastrointestinal tract and of ascertaining whether they may have some kind of toxic effect on it. The aim of this review is to summarize available information on this subject, concentrating on the toxic trace elements that are of greatest interest for organizations concerned with food safety and health: Pb, Cd, Hg and As.     

TSHR第三胞内袢基因突变与毒性多结节性甲状腺肿发病的相关研究

目的探讨促甲状腺激素受体(TSHR)第三胞内袢基因突变在毒性多结节性甲状腺肿(TMG)自主高功能性形成中的作用。方法将16例TMG患者手术切除标本及其作为对照的甲状腺正常组织,用酚-氯仿-异戊醇法提取基因组DNA,对目的基因片断进行聚合酶链反应(PCR)及行DNA测序。结果在16例TMG 标本中,发现3例为622位密码子的点突变。异亮氨酸被苯丙氨酸置换(I622F,ATT→TTT),2例为单碱基插入性突变,在1928位和1929位核酸之间播入了一个鸟嘌呤核苷酸(G),使该密码子609位以后氨基酸发生了移码突变。在对照组中,未发现TSHR基因突变。结论 TSHR第三胞内袢基因突变,可能在TMG发病中起重要作用。     

Real-time toxicity prediction of Aconitum stewing system using extractive electrospray ionization mass spectrometry

Due to numerous obstacles such as complex matrices, real-time monitoring of complex reaction systems (e.g., medicinal herb stewing system) has always been a challenge though great values for safe and rational use of drugs. Herein, facilitated by the potential ability on the tolerance of complex matrices of extractive electrospray ionization mass spectrometry, a device was established to realize continuous sampling and real-time quantitative analysis of herb stewing system for the first time. A complete analytical strategy, including data acquisition, data mining, and data evaluation was proposed and implemented with overcoming the usual difficulties in real-time mass spectrometry quantification. The complex Fuzi (the lateral root of Aconitum)–meat stewing systems were real-timely monitored in 150 min by qualitative and quantitative analysis of the nine key alkaloids accurately. The results showed that the strategy worked perfectly and the toxicity of the systems were evaluated and predicated accordingly. Stewing with trotters effectively accelerated the detoxification of Fuzi soup and reduced the overall toxicity to 68%, which was recommended to be used practically for treating rheumatic arthritis and enhancing immunity. The established strategy was versatile, simple, and accurate, which would have a wide application prospect in real-time analysis and evaluation of various complex reaction systems.