Calomel is a common traditional Chinese medicine (TCM) containing mercury in clinical external application. Although the toxicity of calomel has attracted concern, there is no unified standard yet in clinical external application. Risk assessment is used for evaluating the potential health effects of hazardous substances. The purpose of this article was to evaluate the health risk of calomel in clinical external application on the basis of toxicity data, to ensure safe and rational application of TCM containing calomel. The toxicity data of transdermal administration of calomel or mercurous chloride were collected by searching the literature. The daily maximum exposure dosage of calomel in clinical external application was estimated by following the four procedures of risk assessment, and Margin of Safety (MOS) as an evaluation indicator was then calculated to evaluate the safety of calomel on clinical application. It has been reported that the adult in single transdermal administration of calomel at 1. 5 g was lethal. Based on the LOAEL of calomel for long-term transdermal exposure (1 month) in rats was 0.096 g · kg(-1) · d(-1), the NOAEL of calomel for patients (about 60 kg) by external application within 2 weeks was estimated to be 1.46 mg · kg(-1) · d(-1). When MOS value equals to 1, the daily maximum exposure of calomel in clinical external application within 2 weeks was calculated to be 1.1 g. The results suggest that daily single dose of calomel in clinical external application should be lower than 1.5 g for adults, and more attention should be paid to changes in hepatic and renal function of patients when repeated dose more than 1.1 g within 2 weeks. The approach of risk assessment could be helpful in rational application of TCM containing mercury.
Animals ; Humans ; Medicine, Chinese Traditional ; Mercury Compounds ; toxicity ; No-Observed-Adverse-Effect Level ; Rats ; Risk Assessment

ObjectiveTo observe the clinical efficacy of superficial needling in treating senile intractable constipation.Method The recruited patients were randomized into a treatment group and a control group, 40 in each group. The treatment group was intervenedby superficial needling, while the control group was by oral administration of Phenolphthalein tablets. The two groups both received the treatments for 4 weeks.ResultThe therapeutic efficacy increased with the treatment; patients showed improvements indefecation frequency, stool constitution, and effort in defecation (P<0.05); there was a significant difference between the treatment group and the control group (P<0.05); the residual marker counts of 48 h and 72 h after treatment were significantly lowered in both groups compared to that before treatment (P<0.05).ConclusionSuperficial needling can obviously improve the symptoms of senile intractable constipation, promoting the gastrointestinal transit motility.

Objective To investigate the changes of serum and pleural effusion inflammatory indexes in chil-dren with mycoplasma pneumoniae complicated with pleural effusion.Methods Enzyme linked immunosorbent assay (ELISA)double antibody sandwich method was used in the three of pleural effusion group,mycoplasma pneumonia group,control group and other groups to detect serum and pleural effusion human interleukin 6 (IL -6).human inter-leukin 2 (IL -2)and TNF -(human tumor necrosis factor alpha)etc.Inflammation index levels were detected and compared.Results The group of patients with mycoplasma pneumonia mycoplasma pneumonia patients was (9.93 ± 1.05)pg/mL for the IL -6 level,IL -2 levels for (4.93 ±0.55)μg/mL,(1.45 ±0.17)ng/mL for the TNF alpha level,which were significantly higher than those of the control group,the IL -2 was significantly lower than that of the control group,with statistically significant difference (t =6.25,5.88,4.63,5.95,3.69,5.95,all P <0.05).Compa-ring pleural effusion group and mycoplasma pneumonia group,we found serum IL -6,TNF alpha levels of pleural effu-sion group were significantly higher than that of mycoplasma pneumonia group,while IL -2 was lower than that in group mycoplasma pneumonia,with statistically significant difference (t =4.02,3.06,3.06 and 2.88,all P <0.05). The levels of serum IL -6,IL -2 and TNF -in the serum of patients with different effusion levels were significantly different from the other two groups (all P <0.05).Pleural effusion IL -6 and TNF level of pleural effusion group and mycoplasma pneumonia patients was significantly higher than those of the control group and IL -2 were significantly lower than that of the control group,the difference had statistical significance (t =5.69,3.69,602,4.11,2.94,3.67, all P <0.05).Pleural effusion pleural effusion IL -6 and TNF levels were significantly higher than those in the myco-plasma pneumonia group and IL -2 were significantly lower than that in mycoplasma pneumonia group,the difference had statistical significance (t =3.58,4.13,3.21,all P <0.05).The inflammatory indexes of patients with different effusion volume could be found in the pleural effusion,in patients with a large number of pleural effusion,the IL -2, IL -6 and TNF -levels compared with the other two groups showed significantly different (t =6.11、5.44、4.82,all P <0.05).Conclusion IL -6,IL -2 and TNF alpha in the occurrence and development of mycoplasma pneumoniae pneumonia play an important role.Suffering from mycoplasma pneumonia in patients with pleural effusion,whoseTNF-and IL -6 inflammatory index and serum indexes are abnormal,is of certain clinical practical value for clinical diagnosis,treatment and prognosis,as the indicator of the development and prognosis of pneumonia and pleural effusion.

Chronic lymphocytic leukemia (CLL) remains an incurable disease.Rituximab and fludarabine are two of the most effective agents in CLL update.Despite the widespread use of highly effective chemoimmunotherapy,fludarabine-refractory CLL remains a challenging problem associated with poor overall survival.Approved therapeutic options for these patients remain limited.Fortunately,allogenetic stem cell transplantation (allo-SCT) and several novel targeted therapeutics in clinical trails hold promise of significant benefit for these patients' population.This review discusses the activity of available and novel targeted therapeutics besides allo-SCT in fludarabine-refractory or fludarabine-resistant CLL.

The phenomenon of perineural invasion in pancreatic cancer occurs more easily.It can cause pain and tumor recurrence,and result in poor prognosis.The perineural invasion of pancreas cancer is closely related to the anatomical basis of pancreas and nerve tissue as well as the changes in the tumor microenvironment.Multiple factors in the microenvironment take part in the development of perineural invasion,meanwhile,the tumor tissue itself can also change the microenvironment.This article is to overview the research on the anatomy and molecular biology of perineural invasion of pancreas cancer.

ObjectiveTo detect the mRNA expression levels of RORγt and Foxp3 genes in peripheral blood mononuclear cells(PBMCs) of children with atopic dermatitis(AD),and to explore their possible roles in the development of AD.MethodsSixty-three children with AD and 54 age-matched normal children were eligible for this study.Real-time fluorescence-based quantitative PCR was carried out to measure the mRNA expressions of RORγt and Foxp3 genes in PBMCs of these subjects.ResultsThe relative expression levels of Foxp3 and RORγt mRNA were significantly higher in children with AD compared with the normal controls (2.4060 ± 0.3355 vs.1.1852 ± 0.4189,t =17.50,P＜ 0.01; 6.9130 ± 0.2046 vs.2.7501 ± 0.2518,t =98.63,P ＜ 0.01 ).A statistical increase was observed in the level of RORγt mRNA in children with severe AD compared with children with mild and moderate AD(7.1203 ± 0.1056 vs.6.8046 ± 0.1731 and 6.8655 ± 0.3671,t =6.61,5.23,both P ＜ 0.01).No significant difference was noted in the expression of RORγt mRNA between children with mild and moderate AD,or in the Foxp3 mRNA expression among children with mild,moderate and severe AD.The severity of AD was positively correlated with the level of RORγt mRNA (r =0.62,P ＜ 0.01 ),but uncorrelated with the level of Foxp3 mRNA(r =0.04,P ＞ 0.05).ConclusionsThe high expressions of RORγt and Foxp3 genes may be involved in the pathogenesis of AD,and the severity of AD is positively correlated with the expression intensity of RORγt gene.

Objective To investigate the anatomical characteristics and clinical application of the distal musculocutaneous perforators derived from the descending branch of lateral circumflex femoral artery in the anterolateral thigh flap transplantation. Methods From July 2007 to December 2009, the anatomic variations of musculocutaneous perforator were investigated in 96 cases who received anterolateral thigh flap and 10 preserved cadavers. Thirty-five cases who received the anterolateral thigh flap using the distal musculocutaneous perforators were included in the study. There were 19 males and 16 females. The age ranged from 28-55 years old, with an average of 38.5 years old. Single flap was used in 20 cases while lobulated flap in 15 cases. Single flap area ranged from 7 cm×15 cm to 9 cm×25 cm, lobulated flap ranged from 5 cm×7 cm to 8 cm×20 cm. Results The cadaver study found that the most musculocutaneous perforators were concentrated in the far fourth of the anterolateral thigh region. The musculocutaneous perforators commonly arose from the the lateral femoral circumflex artery. The perforator arose directly from the femoral artery or the deep femoral artery in one case separately. In the clinical study, 2-5 musculocutaneous perforators were found in 94 cases but not in the other 2 cases. The descending branch of lateral circumflex femoral artery became the direct m musculocutaneous perforator. The proximal intermuscularseptum perforator was found in 2 cases. Postoperative follow-up time ranged from 6-11 months. All flaps survived in the follow-up.Marginal necrosis was found in 3 cases. Only 1 case had complained of knee joint instability. Conclusion The results of this study suggest that the vascular anatomy of the distal musculocutaneous perforator was reliable. The perforator may serve as an option for proximal one in anterolateral thigh flap transplantation.

The problems, such as non-full utilization of media, low interesting and participation of users, in read-ing extension service provided by the WeChat public platform in Library of China Medical University were summa-rized by literature analysis and comparative analysis with the reading extension service provided by the WeChat plat-form in other academic libraries as examples, and suggestions were proposed for the application WeChat public plat-form in future reading extension service.

Objective To compare the effects of general anesthesia and epidural anesthesia on short -term cognitive function in elderly patients after orthopedic surgery.Methods According to the digital table,90 elderly orthopedic patients were divided into the control group and observation group,45 cases in each group.The control group was given general anesthesia,and the observation group was given epidural anesthesia.Before anesthesia and 6h,12h,12h,72h after anesthesia,cognitive function was detected according to MMSE,and before anesthesia and operation,30min after operation,postoperation heart rate (HR)and blood pressure (BP)were measured.Results Before anesthesia,before operation,30 min intraoperation and after operation,the HR between the two groups had no significant differences(t =0.094,0.113,0.188,0.348,all P >0.05),and BP between the two groups also had no significant differences (t =0.190,0.179,0.181,0.271,all P >0.05).Compared with the scores of MMSE in the control group at postoperative 24h,the scores of MMSE in the observation group was significantly higher (t =37.947, P <0.01).Compared with pre -induction of anesthesia,the scores of MMSE in the observation group at postoperative 6h and 12h were relatively lower(t =37.210,65.118,all P <0.01),but there was no significant difference at 24h and 72h(t =1.861,P >0.05).Compared with pre -induction,the scores of MMSE in the control group at postopera-tive 6h,12h and 24h were significantly lower(t =29.912,41.000,39.528,all P <0.01),while the score of MMSE in the control group at postoperative 72h had no significant difference compared with before anesthesia(t =1.861,P >0.05).Conclusion Compared with general anesthesia,epidural anesthesia has less impact on short -term cognitive function.and the anesthetic effect is better.

Objective To analyze the application of non-protective midwifery in China so as to provide a theoretic basis for the develop-ment of this technique. Methods The full-text literatures of non-protective midwifery published in China during January 2004 and January 2014 were searched and obtained in China National Knowledge Infrastructure ( CNKI) ,Wanfang Database and VIP Database via computer. All searched literatures were analyzed with the literature study method. Results Totally 21 literatures were obtained by search. They were centrally from the coastal areas and mainly the controlled studies,and focused on the comparison of non-protective midwifery vs. protective midwifery in perineal laceration,second birth course and intrapartum bleeding volume. Conclusion The literatures show that non-protective midwifery is significantly beneficial for patients,though it develops later and concentrates at partial areas. Such midwifery technique shall be popularized all around the country.