Two patients who developed typical skin eruptions 24 hours after consumption of shiitake mushrooms are reported.Case 1:a 56-year-old woman suddenly developed widespread itching eruptions one day after intake of shiitake mushrooms.On examination,there were erythematous and edematous linear streaks (flagellate erythema) over the neck,trunk and limbs.Case 2:a 60-year-old man presented with edematous flagellate erythema over the trunk and limbs for four days.He reported intake of shiitake mushroom several days prior to the presentation.Pathological examination revealed focal parakeratosis,intracellular and intercellular edema in the prickle cell layer,severe edema of papillary dermis,evident widening of interfibrous spaces,dilation and congestion of capillaries in the superficial dermis with a mixed perivascular infiltrate of massive lymphocytes and sparse neutrophils.Both patients were diagnosed with shiitake dermatitis,and treated with prednisone and antihistamines.The lesions subsided after 3 and 4 days of treatment in patient 1 and 2 respectively.

Objective To compare the difference in pharmacokinetics characteristics of vancomycin in cerebrospinal fluid between administration by continuous infusion and interim infusion.Methods Twenty postoperative patients in the Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University admitted into intensive care unit (ICU) to receive vancomycin for prophylaxis of intracranial infection were enrolled, and they were randomly distributed to a continuous intravenous infusion group and a interim intravenous infusion group, each group 10 cases. In continuous intravenous infusion group, the patients received a loading dose of vancomycin (15 mg/kg) by continuous intravenous pump infusion for 1 - 2 hours followed by 30 mg/kg vancomycin in a constant pump infusion rate for 24 hours; while in interim intravenous infusion group, the patients received 15 mg/kg vancomycin administered by intravenous pump infusion for 1 - 2 hours, once every 12 hours. The concentration of vancomycin in the cerebrospinal fluid at different time points was measured by two-dimensional liquid chromatography (2D-LC) method, the parameters of pharmacokinetics were calculated in the two groups, and the adverse reaction was observed.Results The comparison between the ratio of areas under the concentration-time curves (AUC) and minimum inhibitory concentration (MIC) of the continuous and interim groups showed no significant difference (19.7±14.0 vs. 16.1±6.4,P > 0.05). However, in the continuous intravenous infusion group, the drug concentration reached the peak value (0.96± 0.77)μg/mL at 12 hours, and later revealed a plateau concentration 0.91-0.93μg/mL for 12 hours; while in the intravenous infusion interim group, the drug concentration reached the peak value (0.92±0.47)μg/mL at 16 hours, in the later 2 hours declined to (0.84±0.45)μg/mL, and afterwards still had a tendency of persistent declination. In all the patients, no any adverse reaction related to the drug occurred.Conclusion Continuous intravenous infusion and interim intravenous infusion of vancomycin for the postoperative neurosurgical patients without intracranial infection have the similar efficacy of medication, but the former can achieve the peak concentration faster and later the fluctuation of drug concentration in cerebrospinal fluid is smaller than those in the latter.

Objective To evaluate the features of pelvic lymph node metastasis and the significance of lymph node dissection in bladder cancer patients treated with radical cystcetomy. Methods The data of 77 bladder cancer patients(58 males and 19 females with mean age of 57 yrs)treated with radical eystectomy and pelvic lymph node dissection from Jan. 1990 to Dec.2008 were analyzed retrospectively.Preoperative TNM staging showed stage T1 tumor of 9 cases,stage T2 of 24 cases,stage T3 of 39 eases and stage T4 of 5 cases.The pelvic lymph nodes were divided into 5 groups according to the anatomic sites.The metastatic rate and dissected lymph node positive rate in these patients were compared. Results The metastatic rate and dissected lymph node positive rate were 27.3%(21/77)and 14.8%(233/1576),respectively.The metastatic rate in these patients from higher to lower were as follows:obturator group 19.5%(15/77),internal iliac group 19.3%(11/57),external iliac group 13.7%(10/73),common iliac group 5.3%(3/57)and presacral group 3.8%(1/26),with a significant difference in those groups,P<0.01.The dissected lymph node positive rates from higher to lower were as follows:external iliac group 23.0%(83/361),obturator group 22.1% (103/467),common iliac group 9.5%(17/179),internal iliac group 6.8%(28/411)and presacral group 1.3 % (2/158), with a significant difference in those groups, P<0.01. There was no metastasis in 9 eases with stage T, tumor. Conclusions In the radical cystectomy for the treatment of bladder cancer, it is suggested that the regional lymph nodes with higher metastatic rate should he resected accordingly, and the group with a higher metastatic rate should be dissected completely. The operation extent may be adjusted according to the result of sentinel lymph node biopsy in the obturator or presacral groups. The pelvic lymphadenectomy is not suggested in the cases of stage T1 tumor.

Objective:To combine the detection of serum levels of adenosine deaminase (ADA) and T-cell spot test (T-spot.TB),and to explore their significances in diagnosis of pulmonary tuberculosis.Methods:159 patients suspected with pulmonary tuberculosis were selected and divided into pulmonary tuberculosis group and non-tuberculosis group (n=68);80 healthy people were randonly selected as healthy control group.The serum ADA levels and number of T-spot of the subjects in three groups were detected.Ther serum ADA levels and the positive rates of T-spot.TB in various groups and their sensitivities and specifities were compared. Results:The serum ADA level of the patients in pulmonary tuberculosis gruop was (22.10±6.60)U·L-1;those in non-tuberculosis group and healthy control group were (16.90±6.35)and (8.70±5.98)U·L-1;the serum ADA level in pulmonary tuberculosis group was significantly higher than those in non-tuberculosis group and heathy control group (P<0.05).The positive rate of serum ADA level in diagnosis of pulmonary tuberculosis was 56% and the T-spot.TB positive rate in diagnosis of pulmonary tuberculosis was 87.9%. Combined use of parallel test, the detection sensitivity was 91.2%;using the series of joint tests,the specificity was 94.6%.Conclusion:Combined detection of serum level of ADA and T-spot.TB can significantly improve the clinical diagnosis efficacy of pulmonary tuberculosis.

This study was aimed to establish a rapid detection method for timosaponin BⅡ in Anemarrhenae Rhizoma in order to determine its concentration quickly,conveniently and efficiently.The concentration of timosaponin BⅡ in A.Rhizomadetected by HPLC in the Chinese Pharmacopeia was used as the actual measured value.The near-infrared spectroscopy (NIRS) was used to collect the spectrogram of A.Rhizomasamples.The partial least squares (PLS) of TQ Analyst 8.0 were used in the data analysis.Through the pretreatment,wavelength range and principal component number selection,the actual measured value and NIRS information were associated for the establishment of the optimal quantitative analysis model of timosaponin BⅡ.The results showed that the correlation coefficients (R2),root-mean-square error of calibration (RMSEC),root-mean-square error of prediction (RMSEP),root-mean-square error of cross-validation (RMSECV) and the performance index (PI) of the established model were 0.975 15,0.094 2,0.080 0,0.369 20,and 91.0,respectively.It was concluded that the established quantitative analysis model by NIRS with HPLC was able to determine the concentration of timosaponin BⅡ in A.Rhizomaquickly and accurately.

Objective To investigate the antidepressant effect of DS-1226, a hydrolysate of ginsenosides, on a mouse model of depression induced by chronic sleep interruption, and provide scientific evidence for the research and de?velopment of antidepressant drugs. Methods 72 male ICR mice were divided into control group, model group, positive control group (paroxetine hydrochloride, 10 mg/kg) and 3 treatment groups (20 mg/kg, 40 mg/kg, 80 mg/kg of DS?1226). Except the control group, the other mice were put into a rotary roller (parameter settings:1 min/rev;rest 2 min af?ter 1 rev) for 3 days of drum adaptation, 3 h/d. Then making model for 14 days in the roller( parameter settings:1 min/rev;rest 2 min after 1 rev) . The antidepressant effects of DS?1226 were evaluated by weight monitoring, open?field test, tail suspension test, and forced swimming test. Results After 14 d sleep disturbance, compared with the control group,the body weight, immobility time in tail suspension test and forced swimming test were significantly decreased in the model group. Compared with the model group, DS?1226(40 mg/kg)significantly reversed the weight loss caused by sleep disturb?ance. Paroxetine significantly reduced the immobility time of tail suspension test. DS?1226 (40 mg/kg, 80 mg/kg)signifi?cantly decreased the immobility time of tail suspension test, and DS?1226 (80 mg/kg) significantly decreased the immobil?ity time of forced swimming test. Conclusion The hydrolysate of ginsenosides DS?1226 shows antidepressant effect on mouse model of depression induced by chronic sleep interruption.

Objective To explore the feasibility and safety of uniportal video-assisted thoracoscopic surgery under non-intubated anesthesia with spontaneous respiration.Methods The clinical data in 35 cases of uniportal video-assisted thoracoscopic surgery under non-intubated anesthesia with spontaneous respiration implemented by same doctor and team in the Affiliated Nanjing Chest Hospital of Medical College,Southeast University from June 2016 to January 2017 were retrospectively analyzed.Results The operations were successfully completed in 35 cases,including 23 cases of lung bullae resection,6 cases of lung wedge resection,5 cases of pulmonary lobectomy and lymph nodes clearance,and 1 case of bilateral sympathectomy.The operative time was 20-106min,average(38.79 ± 26.45) min,intraoperative bleeding volume was 20-350 mL,average(57.14 ± 56.50) mL.No perioperative serious complications or death occurred.Conclusion Uniportal video-assisted thoracoscopic surgery technique under non-intubated anesthesia with spontaneous respiration is safe and feasible,and can be selectively used in partial patients.

Liver fibrosis can progress to liver cirrhosis and end-stage liver disease, which may lead to poor prognosis. In addition to pathological angiogenesis and hepatic sinusoid remodeling, hepatic lymphangiogenesis also plays an important role in the progression of liver fibrosis. This article briefly describes lymphatic vessel markers and their expression in the liver, introduces the role of lymphangiogenesis in liver fibrosis, and reviews the role of liver macrophages (Kupffer cells) and lymphatic endothelial cells in lymphangiogenesis. It is pointed out lymphangiogenesis may become a potential target for the intervention of liver fibrosis, which plays an important role in the early treatment and reversal of liver fibrosis and the prevention of liver cirrhosis and end-stage liver disease.

Objective To evaluate the diagnostic validity of application of brainstem auditory evoked potential (BAEP) as an ancillary test in patients with brain death.Methods A prospective observational study was conducted. Adult patients (≥ 18 years) with brain death were consecutively admitted to the Department of Intensive Care Unit (ICU) of Beijing Tiantan Hospital Affiliated to Capital Medical University from July 2015 to June 2017, and they further underwent BAEP monitoring. The following findings: absence of all waveforms at bilateral sides, absence of all waveforms except wave-Ⅰonly present at bilateral orunilateral side were set as the positive criteria of BAEP for the diagnosis of brain death, and its diagnostic sensitivity (SEN), positive predictive value (PPV) and false negative rate (FNR) were further assessed.Results A total of 47 patients were enrolled in the study, and the 43 complete BAEP results were analyzed. The SEN, PPV and FNR of the above 3 types of diagnostic criteria (absence of all waveforms, and unilateral or bilateral presence of wave-Ⅰ only) were 100% [95% confidence interval (95%CI) 90-100], 100% (95%CI 89-100), and 0% (95%CI 0-9), respectively.Conclusion As an ancillary test, BAEP has extremely high validity for the diagnosis of patients with brain death, thus it should be used more extensively in clinical practice.

Objective To compare the safety and efficacy of directly thrombectomy and bridging therapy in patients with acute large vessel occlusion stroke within 4.5 h of onset.Methods From April 2014 to September 2017, patients with acute large vessel occlusion stroke treated with emergency mechanical thrombectomy in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School were collected. The patients who were eligible for intravenous thrombolysis and whose onset time was ≤4.5 h were selected. The propensity score matching analysis and McNemar test were used to compare the safety and efficacy of direct mechanical thrombectomy and bridging therapy. Results A total of 41 patients with acute large vessel occlusion stroke were enrolled.The final propensity score matching was 12 pairs.In the direct thrombectomy group, the time from door to femoral artery sheath placement was significantly reduced (P=0.03), but there was no significant difference in the good functional outcome rate, mortality rate, and incidence of symptomatic intracranial hemorrhage between the two groups of patients at 90 d(P>0.05).Conclusion It is safe and effective to start direct mechanical thrombectomy within 4.5 h of onset in patients with acute large vessel occlusion stroke and can significantly shorten the time of vascular recanalization.