Objective:To analyze clinical characteristics of drug-induced hypersensitivity syndrome (DIHS) , and to compare the European, Japanese and Chinese diagnostic criteria.Methods:A total of 45 patients confirmedly diagnosed with DIHS according to the DIHS criteria originally proposed by Bocquet, were collected from the First Affiliated Hospital (Southwest Hospital) of Army Medical University between January 2009 and January 2019. Clinical data on the 45 patients were retrospectively analyzed, clinical characteristics were summarized and re-evaluated according to the European, Japanese and Chinese diagnostic criteria separately, and differences were analyzed in terms of the latency period, time to rash regression, eosinophil count, liver function indices, etc. One-way analysis of variance was used to compare means among multiple groups, and t test to compare means between two groups. Results:Of the 45 patients, 38 presented with eruptive drug eruptions, and 44 were accompanied by liver damage, 40 by elevated counts of peripheral white blood cells, 38 by eosinophilia, 21 by lymphadenectasis, and 4 by mucosal damage. Common culprit drugs included allopurinol (10 cases) , anti-tuberculosis drugs (7 cases) , cephalosporins (7 cases) , and Chinese medicine (4 cases) . Forty patients were treated with glucocorticoids, and 17 with glucocorticoids and intravenous gamma globulin. After treatment, 44 patients received improvement and 1 died. According to the European diagnostic criteria, there were 29 patients with suspected DIHS and 16 with confirmed DIHS; according to the Japanese diagnostic criteria, 37 patients could be confirmedly diagnosed with DIHS, but 8 could not be confirmedly diagnosed; according to the Chinese diagnostic criteria, 17 patients could be confirmedly diagnosed, but 28 could not be confirmedly diagnosed. According to the Japanese diagnostic criteria, the latency period was significantly longer in the patients with a confirmed diagnosis (36.91 ± 21.73 d) than in those without (20.00 ± 20.82 d, P = 0.04) . Conclusions:Common culprit drugs for DIHS include allopurinol, anti-tuberculosis drugs and cephalosporins. Most patients with DIHS are accompanied by liver damage, and the European diagnostic criteria are preferentially recommended for DIHS.

The content of SO2 in Paeoniae Radix Alba (RPA) was determined by the method documented in Chinese Pharmacopoeia (CP) 2010 edition to validate the repeatability of the method for evaluating RPA, and the contents of paeoniflorin sulfonate in both the residual material and distilled solution of RPA were determined by HPLC to study the transformation of paeoniflorin sulfonate to SO2 by HCl. It was found that the repeatability of the method in CP for evaluating RPA is unacceptable, and paeoniflorin sulfonate was detectable in both the residual material and distilled solution of RPA even at "the end point" of SO2 determination, merely about 50% of paeoniflorin sulfonate was transformed to SO2 by HCl, indicating that the current SO2 determination method in CP is not able to accurately quantify SO2 in RPA. It is recommended that more special method for determining SO2 content in RPA should be developed regarding the chemical characteristics of sulfur-fumigated RPA.
Chemistry Techniques, Analytical ; methods ; Chemistry, Pharmaceutical ; Drugs, Chinese Herbal ; analysis ; Fumigation ; Glucosides ; analysis ; Monoterpenes ; analysis ; Paeonia ; chemistry ; Pharmacopoeias as Topic ; standards ; Sulfur Dioxide ; chemistry

An ultra-performance liquid chromatography-quadrupole/time of flight mass spectrometry (UPLC-Q-TOF-MS/MS) combined with reference herb method was developed to rapidly screen commercial sulfur-fumigated ginseng. Sufur-fumigated ginseng reference herb was prepared using genuine ginseng by conventional procedure. Then the reference sulfur-fumigated ginseng sample was analyzed by UPLC-Q-TOF-MS/MS to identify characteristic marker components. 25-hydroxyl-Re sulfate with higher abundance was se- lected as marker compound from 8 characteristic components identified in sulfur-fumigated ginseng reference herb. The fragmentation of 25-hydroxyl-Re sulfate was extensively investigated, fragment ion m/z 879.44 with higher intensity was chosen as the characteristic ion of sulfur-fumigated ginseng. The response of ion m/z 879. 44 was improved by optimizing the MS conditions so that this ion could be used as the characteristic marker ion for screening purpose in ion extracting screening mode. The established approach was successfully applied to inspect 21 commercial ginseng samples collected from different cities in China It was found that the chemical profiles of 9 samples were similar to that of sulfur-fumigated ginseng reference herb, and the characteristic ion m/z 879. 44 of 25-hydroxyl-Re sulfate was also detected in these samples, suggesting that there were nearly 43% ginseng samples analyzed being sulfur-fumigated. This findng agreed well with the results of sulfur dioxide residues of these 21 commercial ginseng samples determined with the method documented in Chinese Pharmacopeia Compared with the method documented in Chinese Pharmacopeia, the proposed approach is more rapid and specific for screening sulfur-fumigated ginseng. SFDA of China should strengthen the enforcement to prohibit ginseng being sulfur-fumigated, so that ginseng and it preparations could be effectively and safely benefit to the health of human beings.
Chromatography, High Pressure Liquid ; methods ; standards ; Drug Contamination ; Drugs, Chinese Herbal ; chemistry ; Fumigation ; Panax ; chemistry ; Quality Control ; Reference Standards ; Sulfur ; chemistry ; Sulfur Dioxide ; analysis ; Tandem Mass Spectrometry ; methods ; standards ; Time Factors

Objective To systematically evaluate the clinical efficacy of bariatric surgery for elderly (age ≥ 60 years) or nonelderly (age ＜60 years) obese patients.Methods Literatures were researched using PubMed,Embase,Cochrane Library from January 2006 to June 2016 with the key words including bariatric surgery,metabolic surgery,gastric bypass,gastric band,sleeve gastrectomy,biliopancreatic diversion,elderly,aged,over 60 years.The cohort study about clinical efficacy of bariatric surgery for elderly or nonelderly obese patients were received and enrolled,and surgical procedures were unrestricted.Patients with age ≥ 60 years and with age ＜60 years were respectively allocated into the elderly group and nonelderly group.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as odds ratio (OR) and 95％ confidence interval (CI).The heterogeneity of the studies was analyzed using the I2 test.Results Eleven retrospective studies were enrolled in the Meta analysis,and the total sample size was 9 913 patients,including 792 in the elderly group and 9121 in the nonelderly group.The results of Meta analysis showed that there were no statistically significant differences in the early mortality,incidence of postoperative early complication,remission rates of postoperative diabetes,postoperative hypertension,dyslipidemia and obstructive sleep apnea syndrome between elderly group and nonelderly group (OR =3.31,1.94,1.00,0.61,0.99,1.40,95 ％ CI:0.86-12.77,1.01-3.74,0.66-1.50,0.34-1.10,0.42-2.29,0.72-2.72,P＞0.05).Conclusion The safety and clinical efficacy of bariatric surgery in the elderly obese patients are equivalent to that of nonelderly patients.

Objective To assess the value of 64-slice computer tomography used in the preoperative evaluation of rectal cancer to predict the operative procedures. Methods There were 51 pathologically proven rectal cancer patients recruited, undergoing multi-slice computer tomagraphy (MSCT) assessment preoperatively. Preoperative MSCT stage and predictive operative procedures were recorded to compare with postoperative pathological stage and practical operative procedures. Kappa Coefficient for Diagnosis Coherence and Spearman correlation analysis were performed. Results The overall accuracy of CT-TNM stages were 74.5% which led to high coherence to pathological TNM stage ( Kappa value = 0.658,P=0.000). The univariate analysis showed that distance from tumor to dentate line (F = 3.386, P =0.042 ) and tumor thickness (F = 4.542, P = 0.016) was a statistically risk factor for operative procedures. Moreover, the significant correlation between tumor thickness (cc =0.319, P =0.023 ), as well as CT-M stage (cc = 0.369, P = 0.008) and CT-TNM stage ( cc = 0.365, P = 0. 008), and operative procedures was observed, by means of conducting Spearman correlation. The possibility of developing palliative stoma was 75%, when sufficing both CT-MI stage and tumor thickness ≥20 mm; The possibility of performing sphincter sparing radical operation reached 86% when both CT-T stage < 4 and distance from tumor to dentate line were referred by MSCT. Conclusion The objective parameters influencing development of operative procedures, involving tumor thickness, CT-M stage and CT-T stage, can be rendered by MSCT preoperative assessment, which served as valuable reference for clinical decision of operative procedures in retal cancer.

Objective To investigate the value of model for end-stage liver disease (MELD) score, MELD with in-corporation of serum sodium (MELD-Na) score and integrated MELD (iMELD) score for evaluation of prognosis of chronic liver failure. Methods A total of 159 consecutive patients with chronic liver failure were included in the study and divided into two groups (death group and survival group) according to the prognosis. The levels of total bilirubin (TBIL), serum creati-nine (Cr), prothrombin time (PT), PT international normalized ratio (INR), serum sodium (Na+), age, MELD, MELD-Na and iMELD were calculated respectively and the comparative analysis was performed. Areas under the receiver operating charac-teristic curve (AUC-ROC) of MELD, MELD-Na and iMELD were used to assess the prognosis in patients with chronic liver failure. Results The values of TBIL (μmol/L:330.9±181.9 vs 245.5±127.7),Cr (μmol/L:84.9±63.8 vs 81.2±49.3),INR (2.50±1.01 vs 2.09±0.57),MELD (26.2±6.5 vs 22.0±5.8),MELD-Na (35.9±31.5 vs 25.3±8.7) and iMELD (49.5±17.4 vs 42.4±10.9) were significantly higher in death group than those in survival group (P < 0.01). The serum level of Na+ was signif- icantly lower in death group than that of survival group (P < 0.01). The mortality of liver failure was higher in patients with the increased scores of MELD, MELD-Na and iMELD. The area under curve (AUC) values generated by the ROC curves was no difference respectively (P > 0.05) for MELD score (AUC=0.691), MELD-Na score (AUC=0.690) and iMELD score (AUC= 0.674) . The cut-off scores of three systems were 25.8 (MELD), 31.0 (MELD-Na) and 53.5 (iMELD) respectively, which could discriminate higher and lower mortality accurately. Conclusion MELD, MELD-Na and iMELD scores can predict short-term clinical outcomes of liver failure patients undergoing artificial liver comprehensive medical treatment.

Objective To investigate the presence and significance of Th9 cells and the related transcription factor ( PU.1 ) and cytokine ( IL-9 ) in peripheral blood of patents with hashimoto thyroiditis ( HT) .Methods Thirty patients with HT and thirty age/gender matched healthy subjects were recruited in this study.The peripheral blood and serum samples were collected from each subject.The percentages of Th9 cells and the transcriptional levels of PU.1 in peripheral blood mononuclear cells ( PBMCs) were meas-ured by flow cytometry analysis and real-time RT-PCR.The concentrations of IL-9, the functions of thyroid and the titers of thyroid-specific autoantibodies ( TPOAb and TgAb) in serum samples were detected by using enzyme-linked immunosorbent assay ( ELISA ) and electrochemiluminescence immunoassay analysis ( ECLIA) .Results Compared with healthy subjects, the percentages of Th9 cells and the expression of PU.1 at mRNA level in PBMCs and the concentrations of IL-9 in serum samples were all significantly in-creased in patients with HT [(1.49±0.68)%vs (0.87±0.24)%], 4.91±2.14 vs 1.66±0.52, (26.90± 7.74) pg/ml vs (16.71±5.87) pg/ml, all P<0.01).Serum concentrations of IL-9 were positively correla-ted with the percentages of Th9 cells (r=0.419, P=0.021).Moreover, the percentages of Th9 cells were positively correlated with the titers of TPOAb and TgAb in serum samples (r=0.394, P=0.032;r=0.457, P=0.011) of patients with HT.Conclusion The levels of Th9 cells and the related cytokine IL-9 were in-creased in the peripheral blood of patients with HT.A positive correlation was found between the percentage of Th9 cells and the titers of thyroid-specific autoantibodies.This study indicated that Th9 cells might be in-volved in the pathogenesis of autoimmune damage in thyroid.

A management window model for patients with atrial fibrillation (AF) was established in Tilanqiao Community Health Service Center cooperated with tertiary hospitals.Patients were screened and treated in the community health service center,and a comprehensive management plan was conducted and patients were followed-up.A total of 105 patients with atrial fibrillation (97.2％) were effectively managed with an average follow-up of 10.6 months.The CHADS2 score ≥ 2 in 78 cases,including 11 cases with administration of warfarin (14.1％) and 26 cases with paroxysmal AF without transition to persistent atrial fibrillation.Compared to the data before management,the rate of taking aspirin and warfarin in managed patients was increased (all P ＜ 0.05),the international normalized ratio (INR) of patients receiving warfarin was improved (P ＜ 0.05) ; the ratio of receiving comprehensive treatment program,standardized treatment and health education were significantly increased (P ＜ 0.05) ; the awareness of the disease,treatment compliance and satisfaction of patients were improved significantly (all P ＜ 0.05).The results suggest that the management widow model is feasible and effective for management of patients with atrial fibrillation in community health service centers.

Objective To investigate the side effects of a new supramolecular drug-platinum compound CCP on the cardiovascular system,respiratory system and neuropsychological system of healthy rat.Methods After abdominal anaesthesia with 4.0 ml/kg of 10%chloral hydrate.the rats were injected with10,20,40 ms/ks CCP respectively,and then the life indexes,including blood pressure,heart rate,electrocardiogram,respiratory rate and depth were recorded through single femoral and tracheal intubations and so to non-anaesthesia rats.Glucose injection was chosen as negative control and carboplatin(15 mg/kg)as positive control.Results After venous injection with CCP,glucose injection and carboplatin as the dosages as above respectively,the blood pressures of the tested rats are from(57.8±14.1)mm Hg to(86.2±8.1)mm Hg,heart rates are from(250.9±95.4)times/min to(356.7±47.7)times/min,respiratory rates are from(59.3±17.7)times/min to(95.7±26.0)times/min.No obvious changes of blood pressure,heart rate and respiration were observed after drug injection,t values are(0.02～1.96),(P＞0.05).Once of sporadically ventrieular premature beat was recorded in one rat of CCP and earboplatin groups and it is not dosage-dependent.There is no side effect of 40 ms/ks CCP in neuropsychological system and daily activity of non-anaesthesia rats.Conclusion CCP injection is safe in rat and there is no obvious change observed in the cardiovascular system,respiratory system,neuropsyehological system of healthy rat.

Objective:To construct the lentiviral vector over-expressing Staphylococcus aureus enterotoxin C3 and detect the expression of target gene in vitro.Methods:SEC3 gene were amplificatied by polymerase chain rcaction( PCR).The GV365 lentiviral vectors were digested by AgeⅠenzyme,which was linked to SEC3 gene and then constructed the GV365-SEC3 lentiviral vetor.Positive clones of vectors were identificd by PCR.Then the positive lentiviral vectors were transfected into 293T cells for lentivirus package.The expression of lentiviral vectors was tested by observating cell fluorescence and Western blot.The virus titer was determined by HIV-1 p24 ELISA.Results: SEC3 gene was amplified and successfully bound to the GV365 lentivirus vectors.The sequences of the recombinant plasmid were confirmed correct by PCR and DNA scqucncing.A large mass of green fluorescent cells were observed after transfecting.And the resulting size of 29 kD protein band of protein electrophoresis, which was consistent with the target gene protein.Viral vector titer was 5×108 TU/ml by ELISA detection.Conclusion: Lentiviral vector over-expressing Staphylococcus aureus enterotoxin C3 was successfully constructed,laid the foundation of observing its effect and mechanism against to tumor in vivo and in vitro for later research.