Serotonin syndrome (SS), also known as serotonin toxicity, is a rare but life-threatening drug reaction syndrome. This case involves a 17-year-old female patient who developed tremors, fatigue, and tachycardia after taking fluoxetine combined with bupropion and tandospirone for five days. SS was highly suspected, and her symptoms improved following treatment targeted at serotonin syndrome. This case is reported to raise awareness among clinicians about the potential adverse reactions of drug combinations, the importance of early identification of SS symptoms, and precautions when prescribing combined medications to avoid serious consequences.

Serotonin syndrome (SS), also known as serotonin toxicity, is a rare but life-threatening drug reaction syndrome. This case involves a 17-year-old female patient who developed tremors, fatigue, and tachycardia after taking fluoxetine combined with bupropion and tandospirone for five days. SS was highly suspected, and her symptoms improved following treatment targeted at serotonin syndrome. This case is reported to raise awareness among clinicians about the potential adverse reactions of drug combinations, the importance of early identification of SS symptoms, and precautions when prescribing combined medications to avoid serious consequences.

Background: Inflammation indices are emerging predictors of diseases. Monoclonal gammopathy of undetermined significance (MGUS) is a precancerous state and chronic inflammation may drive MGUS progression. This study aimed to evaluate the association between inflammatory markers and MGUS. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) III and 1999–2004 were collected from 6,383 participants. MGUS subtypes were identified using immunofixation electrophoresis. Seven inflammatory indices [lymphocyte count (LC), neutrophil count (NC), platelet-neutrophil product (PPN), systemic immune inflammation index (SII), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP)] were calculated. Weighted multivariate regression and subgroup analyses assessed the relationships, reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results: Of the 6383 patients included in the study, 157 (2.45%) underwent MGUS. There was a significant correlation trend between ln PPN level and the development of MGUS, especially at low levels (OR: 2.62, 95% CI: 1.54–4.75, p-trend = 0.001), while the correlation between PLR level and MGUS was not obvious. In the subgroup analysis, a significant association between PPN level and MGUS was mainly found in the overall population, female sex, nonHispanic black, non-hypercholesterolemia, non-type 2 diabetes (T2D), high school education or above, and divorced or widowed; however, there was no significant interaction between PPN level and MGUS in each subgroup. Conclusion PPN levels were significantly associated with MGUS development. Our study identified PPN as a novel and convenient inflammatory marker with potential clinical relevance. Although preliminary, the observed associations highlight the need for validation through longitudinal studies before considering their clinical applications.

Objective:The study aimed to analyze the risk variables influencing the prognosis of patients with sepsis-associated delirium (SAD) in the Intensive Care Unit (ICU) and build a prediction nomogram.Methods:This was a retrospective cohort study that includes patients with SAD in the Medical Information Mart for Intensive CareⅢ database (MIMIC-Ⅲ) database as training cohort, and patients who were hospitalized in the First Hospital of Jiaxing from January 2021 to September 2022 as validation cohort. Inclusion criteria: (1) age≥18 years old; (2) being admitted to the ICU for the first time; (3) the length of ICU stay≥24 h; (4) consistent with the diagnosis of sepsis; (5) the diagnosis of delirium was identified by CAM-ICU questionnaire. The general information, vital signs, past medical history and laboratory examination results of the patients were collected, and the outcome was 28-day mortality. Multiple logistic regression was used to identify independent influencing factors and the nomogram was constructed. The validity of the prediction model was determined using multiple indicators, including calibration curve, the area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA), and Hosmer-Lemeshow test.Results:A total of 250 patients were included in the training cohort and 154 patients were in the validation cohort. The multiple logistic regression demonstrated that age ( OR=1.057, 95% CI: 1.030-1.084, P<0.001), respiratory frequency ( OR=1.117, 95% CI: 1.037-1.202, P=0.003), lactic acid ( OR=1.137, 95% CI:1.011-1.279, P=0,032), hemoglobin ( OR=0.983, 95% CI: 0.970-0.997, P=0.020), SOFA score ( OR=1.184, 95% CI: 1.070-1.309, P=0.001) were independent risk factors associated with the 28-day mortality of patients with SAD. The AUC of the nomogram created by the five factors above was 0.773 (95% CI: 0.705-0.841), and the Hosmer-Lemeshow test showed that the model was a good fit ( P=0.875). The DCA curve indicates that the model has potential net benefit. The AUC was 0.864 (95% CI: 0.799-0.928) in the validation cohort, and the Hosmer-Lemeshow test showed that the model was a good fit ( P=0.488). The DCA curve indicates that the model of the validation cohort had potential net benefit. Conclusion:The prediction model based on age, respiratory frequency, lactate, hemoglobin, and SOFA scores shows valuable capability of predicting the prognosis of patients with SAD, which could help clinicians identify risk factors at first time and make earlier intervention.

China has entered an aging society,fall in the elderly often causes their physical and mental damage and even be life-threatening.Literature reviews studying on fall prevention in the elderly discovered that the improvement of the lower-extremity muscle strength can reduce the fall incidence in the elderly.This paper summarized the current researches on the methods for elderly people's lower-extremity muscle strength improvement.In addition,this paper also gave an analysis of both advantages and disadvantages of these methods,in order to provide a theoretical evidence and reference for the future study in improving the lower-extremity muscle strength.

Objective: To investigate the effect of different mechanisms of liver-protection drugs in clinic and compare which one is best for the proliferation of irradiated HL-7702, laying the basis of liver-protection drugs choose in clinic on theory and practice. Methods: Human liver parenchyma cells HL-7702 were given single 6 MV X ray irradiation at a dose of 10Gy, the cells’ morphology were detected under an inverted microscope at 24h, 48h and 72h. Then, MTT was used to assess the survival rate of the cells to evaluate the effect of the X ray. The representive medicines which mechanism may relate to RILD were chosen and diluted into various concentrations with culture medium according to clinical and relative reports. Different concentrations of medicines were used to protect the cells damaged by the X ray. Comparing the effect with MTT and measure SOD, MDA for the best one. Further research on its protection of oxidative damage. T-test, F test and non- paramiter test were used for statistical analysis. Results: 2.5 mg/ml and 1 mg/ml of magnesium isoglycyrrhizinate both have an effect on the proliferation of liver cells, especially the concentration of 1 mg/ml. The injection of polyene phosphatidyl choline show trivial effect at the concentrations of 250 μmol/L and reduced glutathione(GSH) did not demonstrate relative functions. Further research on the magnesium isoglycyrrhizinate, found its protection at 48h to oxidative damage (P < 0.05), but the effect is weak at 24h and 48h. Conclusions In three kinds of representing medicines, magnesium isoglycyrrhizinate has preferable effects on liver parenchyma cells and show a bright future in the treatment of RILD.

Objective To investigate the incidence and influencing factors of aldosterone escape in patients with non-diabetic nephropathy by RASI-therapy. Methods A total of 104 patients with non-diabetic nephropathy were treated with ARB or combination therapy of ACEI and ARB in a mean follow-up period of 12 months. Aldosterone escape was determined according to the change of plasma aldosterone concentration before and after treatment during 6-month and 12-month ACEI/ARB treatment, while the influencing factors of aldosterone escape in patients with non-diabetic nephropathy was also analyzed after therapy with RASI . Results In 12 months, the incidence of aldosterone escape was significantly higher than that in 6 months (26.92% vs. 14.42%, P = 0.007). After 12-month treatment, the difference was statistically significant in incidence of aldosterone escape among different stages of CKD (P = 0.027). Compared with 6-month incidence of aldosterone escape in the losartan group, 12-month incidence increased evidently (P = 0.020). The Ald level was positively correlated with urinary protein excretion and the Scr level (r = 0.431, P = 0.003 and r = 0.336, P = 0.009, respectively), and negetively correlated with levels of the eGFR (r = -0.275, P = 0.006). Univariate Logistic regression demonstrated that risk factors of aldosterone escape included pre-treatment values of the urinary protein excretion (OR = 3.671, P = 0.028) and the eGFR (OR = 0.972, P = 0.019). Multivariate Logistic model revealed pre-treatment values of the eGFR was positively associated with aldosterone escape (OR = 0.970, P = 0.012). Conclusion The incidence of the aldosterone escape increases along with the time of treatment. Renal function has correlated with aldosterone escape and pre-treatment value of the eGFR is an independent risk factor of aldosterone escape.

Objective To compase laparoscopic vs open appendectomy in the treatment of appendicitis.Methods The clinical data of 1 716 appendicitis patients are studied in the form of retrospective summary,who were hospitalized in Jilin University China-Japan Union Hospital from 2009 to 2014.Patients were divided into laparoscopic appendectomy group and open appendectomy group.Duration of operation,surgical complications and postoperative recovery were evaluated.The chi-test and the student t test were used for statistics.Results More patients in open group with chronic lung disease,or a history of previous abdominal surgery than in the laparoscopic group (x2 =3.527,22.804,P ＜ 0.05);the postoperative deep vein thrombosis,intestinal obstruction,abdominal abscess and infection of incision in open group were more often seen than in laparoscopic group (x2 =4.179,4.71,7.351,8.766,P ＜ 0.05);Open group scored higher than laparoscopic group on the index of 24 hours of postoperative pain (t =-3.163,P =0.004);duration of surgery was similar (t =1.754,P =0.092 2);the laparoscopic group was better in recovery time of postoperative intestinal peristalsis,average length of scar and the average hospital stay (t =3.460,-15.335,-3.629,P ＜ 0.05).While the average hospitalization cost in open group is less than in the laparoscopic group (t =5.763,P =0.001).Conclusions Both laparoscopic appendectomy and open appendectomy were effective for the treatment of appendicitis,while laparoscopic appendectomy is superior to open procedure in reducing postoperative pain,postoperative complications promoting rapid recovery,shortening hospital stay and more cosmetic.

OBJECTIVETo explore the effect of folate on cell proliferation and apoptosis as well as on DNA methylation, expression of mRNA and protein of fragile histidine triad (FHIT)gene in cervical cancer cells.

METHODSCervical cancer cell lines including CaSki (HPV16-positive) and C33A (HPV-negative)were cultured in vitro with different folate concentrations. Cell proliferation and apoptosis were determined by viable cell counting and flow cytometry while FHIT gene DNA methylation was used with methylation specific PCR (MSP). Both gene expression of FHIT protein and mRNA were detected by Western blot and Real-time PCR, respectively.

RESULTSFolate could inhibit the proliferation and promote the apoptosis in two kinds of cervical cancer cells. The number of viable cells decreased (C33A:r = 0.98, P < 0.001; CaSki:r = 0.98, P < 0.001) and the apoptosis rate increased (C33A:r = 0.98, P < 0.001; CaSki:r = 0.99, P < 0.001) along with the increase of folate concentration. FHIT gene DNA methylation showed all positive at the folate concentration levels of 1 µg/ml and 10 µg/ml, partially positive at 100 µg/ml and 250 µg/ml, but negative at 500 µg/ml and 1 000 µg/ml in both C33A and CaSki cells. Comparing with the control group, the mRNA or protein relative expression levels of FHIT gene in different folate concentrations were statistically significant in two kinds of cells, and showing that the FHIT gene mRNA expression (C33A:r = 0.96, P < 0.001; CaSki:r = 0.94, P < 0.001) and protein expression (C33A:r = 0.96, P < 0.001; CaSki:r = 0.97, P < 0.001) both increased along with the increase of folate concentration.

CONCLUSIONOur findings indicated that adequate folate seemed to be able to effectively inhibit the proliferation of cervical cancer cells and facilitate their apoptosis in vitro, so would reverse the aberration mRNA and protein expression of FHIT gene.

Acid Anhydride Hydrolases ; genetics ; metabolism ; Apoptosis ; Cell Line, Tumor ; Cell Proliferation ; Culture Media ; chemistry ; DNA Methylation ; Female ; Folic Acid ; pharmacology ; Humans ; Neoplasm Proteins ; genetics ; metabolism ; Uterine Cervical Neoplasms ; genetics ; pathology

Objective To explore the effect of folate on cell proliferation and apoptosis as well as on DNA methylation,expression of mRNA and protein of fragile histidine triad(FHIT)gene in cervical cancer cells. Methods Cervical cancer cell lines including CaSki(HPV16-positive)and C33A(HPV-negative)were cultured in vitro with different folate concentrations. Cell proliferation and apoptosis were determined by viable cell counting and flow cytometry while FHIT gene DNA methylation was used with methylation specific PCR(MSP). Both gene expression of FHIT protein and mRNA were detected by Western blot and Real-time PCR,respectively. Results Folate could inhibit the proliferation and promote the apoptosis in two kinds of cervical cancer cells. The number of viable cells decreased (C33A:r=0.98,P<0.001;CaSki:r=0.98,P<0.001) and the apoptosis rate increased(C33A:r=0.98,P<0.001;CaSki:r=0.99,P<0.001)along with the increase of folate concentration. FHIT gene DNA methylation showed all positive at the folate concentration levels of 1μg/ml and 10μg/ml,partially positive at 100μg/ml and 250μg/ml,but negative at 500μg/ml and 1 000μg/ml in both C33A and CaSki cells. Comparing with the control group,the mRNA or protein relative expression levels of FHIT gene in different folate concentrations were statistically significant in two kinds of cells,and showing that the FHIT gene mRNA expression(C33A:r=0.96,P<0.001;CaSki:r=0.94,P<0.001)and protein expression (C33A:r=0.96,P<0.001;CaSki:r=0.97,P<0.001) both increased along with the increase of folate concentration. Conclusion Our findings indicated that adequate folate seemed to be able to effectively inhibit the proliferation of cervical cancer cells and facilitate their apoptosis in vitro,so would reverse the aberration mRNA and protein expression of FHIT gene.