Neutrophilic urticarial dermatosis as a presenting feature of systemic juvenile idiopathic arthritis

This report describes a case of chronic neutrophilic urticarial dermatosis as a presenting feature of systemic juvenile idiopathic arthritis. When encountered in children, neutrophilic urticarial dermatosis should raise suspicion of autoimmune or autoinflammatory disease.     

Detecting the developmental toxicity of bFGF in the embryonic stem cell test using differential gene expression of differentiation-related genes

Basic fibroblast growth factor (bFGF) is a mitogenic cytokine that can stimulate mesoderm-and neuroectoderm-originated cell proliferation. This study was performed to investigate the effects of bFGF on cell differentiation and the expression of specific markers at different embryonic developmental stages. We firstly evaluated the embryotoxic potential of bFGF in vitro using a modified EST protocol. Sequentially, we further investigated how bFGF impact the different tissue-special genes and proteins expressions during the differentiation of murine ES cells in vitro and attempt to reveal the effects of bFGF on differentiation processes. This analysis was focused on key tissue- and stage-specific genes involved in ectodermal, mesodermal, and endodermal differentiation, including ectodermal-specific gene Nestin, Oligo2 and Syn, mesodermal-specific gene MHC and MyoD, and endodermal-specific gene GATA6, TTR and ALB, as well as undifferentiated gene Sox-2 and Oct-4. The results demonstrate that bFGF could promote expression of ectodermal-specific genes and protein, but suppress the expressions of endoderm-specific and some mesoderm-specific gene and protein. A conclusion can be drawn that bFGF exhibits weak embryotoxicity and mainly promotes ES cell differentiation towards the ectodermal lineages but suppress differentiation into endoderm lineages. These opposing effects of bFGF on the embryonic development of the three germ layers may be related to its weak embryotoxic potential. More specifically, inhibition of expression of the endodermal-specific markers transthyretin (TTR), and albumin (ALB) by bFGF may be of more value in detecting the embryotoxic potential of bFGF.     

提高医用化学理论大课质量的教学实践和探索

理论大课能直接反映教师的教学水平和学生的学习质量。为了提高医学院校医用基础化学大课的教学质量，教师采取一系列措施和方法，从备课、上课、课后答疑、辅导、考试等各个环节入手，进行教学实践和探索，以期学生的成绩和能力有明显提高，经过多年的实践和探索，收到了良好的效果，达到了教学目的。     

Clinical tests for confirming tracheal intubation or excluding oesophageal intubation: a diagnostic test accuracy systematic review and meta-analysis

Unrecognised oesophageal intubation causes preventable serious harm to patients undergoing tracheal intubation. When capnography is unavailable or doubted, clinicians still use clinical findings to confirm tracheal intubation, or exclude oesophageal intubation, and false reassurance from clinical examination is a recurring theme in fatal cases of unrecognised oesophageal intubation. We conducted a systematic review and meta-analysis of the diagnostic accuracy of five clinical examination tests and the oesophageal detector device when used to confirm tracheal intubation. We searched four databases for studies reporting index clinical tests against a reference standard, from inception to 28 February 2023. We included 49 studies involving 10,654 participants. Methodological quality was overall moderate to high. We looked at misting (three studies, 115 participants); lung auscultation (three studies, 217 participants); combined lung and epigastric auscultation (four studies, 506 participants); the oesophageal detector device (25 studies, 3024 participants); ‘hang-up’ (two non-human studies); and chest rise (one non-human study). The reference standards used were capnography (22 studies); direct vision (10 studies); and bronchoscopy (three studies). When used to confirm tracheal intubation, misting has a false positive rate (95%CI) of 0.69 (0.43–0.87); lung auscultation 0.14 (0.08–0.23); five-point auscultation 0.18 (0.08–0.36); and the oesophageal detector device 0.05 (0.02–0.09). Tests to exclude events that invariably lead to severe damage or death must have a negligible false positive rate. Misting or auscultation have too high a false positive rate to reliably exclude oesophageal intubation and there is insufficient evidence to support the use of ‘hang-up’ or chest rise. The oesophageal detector device may be considered where other more reliable means are not available, though waveform capnography remains the reference standard for confirmation of tracheal intubation.     

七味通痹口服液联合甲氨蝶呤治疗类风湿关节炎的疗效观察及其对血清疼痛介质和炎症因子的影响

目的 探讨七味通痹口服液联合甲氨蝶呤治疗类风湿关节炎的疗效观察及其对血清疼痛介质和炎症因子的影响。方法 选取2019年5月—2020年11月海南省中医院收治的84例类风湿关节炎患者作为研究对象，按照治疗方法将84例患者分为对照组和观察组，每组各42例。对照组口服甲氨蝶呤片，10 mg/次，1次/周。观察组在对照组基础上口服七味通痹口服液，10 mL/次，3次/d。两组连续治疗3个月。观察两组患者的临床疗效，比较两组治疗前后的关节压痛数、肿胀数、晨僵持续时间，同时比较两组视觉模拟评分法（VAS）、血清前列腺素E₂（PGE₂）、血浆P物质（SP）、白细胞介素-17（IL-17）、抗链球菌溶血素O（ASO）、类风湿因子（RF）、C反应蛋白（CRP）和血沉（ESR）水平。结果 治疗后，观察组总有效率为85.71%，显著高于对照组的66.67%，两组间对比差异有统计学意义（P<0.05）。两组治疗后的压痛数、肿胀数、晨僵持续时间、疼痛程度评分显著降低（P<0.05）；治疗后，观察组的压痛数、肿胀数、晨僵持续时间、疼痛程度评分显著低于对照组，差异有统计学意义（P<0.05）。两组治疗后的PGE₂、SP、IL-17水平显著降低（P<0.05）；治疗后，观察组的PGE₂、SP、IL-17水平显著低于对照组，差异有统计学意义（P<0.05）。两组治疗后的ASO、RF、CRP、ESR水平显著降低（P<0.05）；治疗后，观察组的ASO、RF、CRP、ESR水平显著低于对照组，差异有统计学意义（P<0.05）。结论 七味通痹口服液联合甲氨蝶呤可提高类风湿关节炎的疗效，降低患者血清疼痛介质和炎症因子的水平，进一步减轻临床症状体征，具有一定临床研究价值。