Insulin is an important protein hormone that participates in multiple metabolic pathways.Biosynthetic insulin has been widely used in the treatment of type 1 and type 2 diabetes.Currently,the number of reported cases of insulin overdose both at home and abroad is gradually increasing,and insulin homicide is no longer a means of"committing murder without leaving a trace".At present,there are no systematic protocols for the identification of insulin overdose in the field of forensic medi-cine in China.This article introduces the causes,toxicological characteristics,forensic examination,labo-ratory testing methods and indicator reference of insulin overdose.Based on the identification practice and research results and referring to relevant studies on insulin overdose at home and abroad,this pa-per aims to provide recommendations and references for the formulation of forensic identification guide-lines for insulin overdose cases.

The limited treatment options for advanced prostate cancer (PCa) lead to the urgent need to discover new anticancer drugs. Mannose, an isomer of glucose, has been reported to have an anticancer effect on various tumors. However, the anticancer effect of mannose in PCa remains unclear. In this study, we demonstrated that mannose inhibits the proliferation and promotes the apoptosis of PCa cells in vitro, and mannose was observed to have an anticancer effect in mice without harming their health. Accumulation of intracellular mannose simultaneously decreased the mitochondrial membrane potential, increased mitochondrial and cellular reactive oxygen species (ROS) levels, and reduced adenosine triphosphate (ATP) production in PCa cells. Mannose treatment of PCa cells induced changes in mitochondrial morphology, caused dysregulated expression of the fission protein, such as fission, mitochondrial 1 (FIS1), and enhanced the expression of proapoptotic factors, such as BCL2-associated X (Bax) and BCL2-antagonist/killer 1 (Bak). Furthermore, lower expression of mannose phosphate isomerase (MPI), the key enzyme in mannose metabolism, indicated poorer prognosis in PCa patients, and downregulation of MPI expression in PCa cells enhanced the anticancer effect of mannose. This study reveals the anticancer effect of mannose in PCa and its clinical significance in PCa patients.
Animals ; Apoptosis ; Cell Line, Tumor ; Humans ; Male ; Mannose ; Membrane Potential, Mitochondrial ; Mice ; Mitochondria ; Prostatic Neoplasms ; Reactive Oxygen Species

The outbreak of coronavirus disease 2019 (COVID-19) was declared a global public health emergency on 31 January 2020. Emergency medicine procedures in Emergency Department should be optimized to cope with the current COVID-19 pandemic by providing subspecialty services, reducing the spread of nosocomial infections, and promoting its capabilities to handle emerging diseases. Thus, the Chinese Society of Emergency Medicine and Wuhan Society of Emergency Medicine drafted this consensus together to address concerns of medical staffs who work in Emergency Department. Based on in-depth review of COVID-19 diagnosis and treatment plans, literatures, as well as management approval, this consensus proposes recommendations for improving the rationalization and efficiency of emergency processes, reducing the risk of nosocomial infections, preventing hospital viral transmission, and ensuring patient safety.

Objective To learn the epidemiological characteristics of foodborne disease outbreak in 2015,Zhejiang Province,and to provide evidences for the prevention and control of foodborne disease outbreak.Methods Descriptive epidemiological analysis using ArcGIS 10.2 and SPSS 19.0 was conducted on geographical country data,information of permanent resident population and the incidence data of foodborne disease outbreak reported through foodborne disease outbreak reporting information system in 2015.Results There were 116 foodborne disease events reported in Zhejiang in 2015,resulting in 1 009 persons attacked,115 hospitalization and 10 deaths.The proportion of unknown pathogenic factor for events was 29.31%.The events appearance sporadic,there were some local hotspots in Jiaxing.The vibrio parahaemolyticus was the most common pathogen (32.76%),and poisonous mushrooms(8.62%)come the second.Most foodborne disease incidents occurred during June to November.Restaurants ,family and rural feasts were the major places where the foodborne disease occurred.The proportion of family foodborne disease events because of mistaken and misuse poisonous substances increased,and the hospitalization rate and mortality of events of which were the highest (33.9% and 7.63% respectively).Conclusion The food safety management and of restaurants and rural feasts should be strengthened in summer and autumn,as well as foodborne disease prediction and forewarning to reduce the foodborne disease incidents caused by microorganism contamination and poisonous muchnooms.It is necessary to conduct public risk cognition research for foodborne disease in Zhejiang,which could provide evidence for preventing and controlling family foodborne disease.

Objective To investigate the effects of flight environmental factors,such as hypobaric hypoxia or +Gz exposure on the formation of kidney stone. Methods Forty-eight adult male Wistar rats were randomly and averagely assigned into control,hypobaric hypoxia, + Gz exposure and stone formation group.The rats of hypobaric hypoxia group were tested in 5000 m equivalent hypoxia environment for 1 h per 3 times a week for 4 weeks.+ Gz exposure group was exposed in +9 Gz for 25 s,5 times/d (with 5 min interval) by centrifuge.The frequency of +Gz exposure was 3 times a week for 4 weeks.The stone formation group was fed with water with 1％ ethylene glycol and poured with 2％ ammonium chloride by the dose of 2 ml/d for each.The serum blood urea nitrogen (BUN),creatinine (Scr),phosphorus(Pi),Ca2+,24 h urine volume,urinary excretion of Ca2+,oxalare (Ox),uric acid and urine pH value were detected.All rats' kidneys were removed and stained with hematoxylin-eosin (HE),and then examined by microscope to check the possible calculi crystals and tubular dilatation. Results ① The concentrations of BUN in + Gz exposure group and stone formation group were higher than that of control group (P＜0.05).Other data showed no difference among all groups. ② 24 h urine volume and Ca2+ of urine were no significant difference among groups but the uric acid (F=33.064,P＜0.01).Uric acid of urine of +Gz exposure group and stone formation group was significantly higher than that of control group (P＜0.01).Significant difference on oxalate of urine was observed among all groups (F=4.877,P＜0.01).Oxalate of urine of +Gz exposure group and stone formation group was higher than that of control group (P＜0.05).Urine pH value of hypobaric hypoxia group was lower than that of control group (t=3.099,P＜0.05).③ Renal tubules were normal and no calculi crystal was found in control group.Renal tubules were normal and only slight amount of calculi crystals were found in hypobaric hypoxia group.In +Gz exposure group,transparent scattered crystals could be seen and the tubules were slightly dilated.Big amount of transparent crystals could be seen in lumen of the evidently dilated tubules in stone formation group. Conclusions Acceleration would be one of the risk factors contributed to kidney stone formation.But the effect of hypobaric hypoxia on the formation of kidney stone is not obvious.

Objective To investigate the effects of flight environmental factors,such as hypobaric hypoxia or +Gz exposure on the formation of kidney stone. Methods Forty-eight adult male Wistar rats were randomly and averagely assigned into control,hypobaric hypoxia, + Gz exposure and stone formation group.The rats of hypobaric hypoxia group were tested in 5000 m equivalent hypoxia environment for 1 h per 3 times a week for 4 weeks.+ Gz exposure group was exposed in +9 Gz for 25 s,5 times/d (with 5 min interval) by centrifuge.The frequency of +Gz exposure was 3 times a week for 4 weeks.The stone formation group was fed with water with 1％ ethylene glycol and poured with 2％ ammonium chloride by the dose of 2 ml/d for each.The serum blood urea nitrogen (BUN),creatinine (Scr),phosphorus(Pi),Ca2+,24 h urine volume,urinary excretion of Ca2+,oxalare (Ox),uric acid and urine pH value were detected.All rats' kidneys were removed and stained with hematoxylin-eosin (HE),and then examined by microscope to check the possible calculi crystals and tubular dilatation. Results ① The concentrations of BUN in + Gz exposure group and stone formation group were higher than that of control group (P＜0.05).Other data showed no difference among all groups. ② 24 h urine volume and Ca2+ of urine were no significant difference among groups but the uric acid (F=33.064,P＜0.01).Uric acid of urine of +Gz exposure group and stone formation group was significantly higher than that of control group (P＜0.01).Significant difference on oxalate of urine was observed among all groups (F=4.877,P＜0.01).Oxalate of urine of +Gz exposure group and stone formation group was higher than that of control group (P＜0.05).Urine pH value of hypobaric hypoxia group was lower than that of control group (t=3.099,P＜0.05).③ Renal tubules were normal and no calculi crystal was found in control group.Renal tubules were normal and only slight amount of calculi crystals were found in hypobaric hypoxia group.In +Gz exposure group,transparent scattered crystals could be seen and the tubules were slightly dilated.Big amount of transparent crystals could be seen in lumen of the evidently dilated tubules in stone formation group. Conclusions Acceleration would be one of the risk factors contributed to kidney stone formation.But the effect of hypobaric hypoxia on the formation of kidney stone is not obvious.

Objective To explore the clinical treatment experience and medical evaluation method for the aircrew with renal cell carcinoma. Methods The medical records of 6 cases of the aircrew with renal cell carcinoma dated from Mar. 2002 to Dec. 2008 were analyzed and related literatures were reviewed. Results Six male aircrew's average age was 47.3(43-54) years.Four tumors were in left kidney and 2 in right.The mean diameter of the tumors was 3.6(1.8-5.2) cm.Five patients didn't show any symptom in annual general health checkup but ultrasound examination indicated.One patient complained flank pain and gross hematuria was observed and renal cell carcinoma was diagnosed by imaging examination. All patients received ultrasound,plain film of kidneys,ureter and bladder (KUB) + intravenous urography (IVU) and CT scan to confirm the final diagnosis.Clinical stage was T1 N0 M0 for all cases and all patients received operations. Radical nephrectomy was performed on 3 cases while nephron-sparing surgery on 1 case and laparoscopic radical nephrectomy on 2 cases.All surgeries were successful and all patients recovered well.The pathological examination showed that all cases were clear cell carcinoma.Three patients got flying qualification and 1 was still in observation.Two patients retired after surgery.By 2-5 years follow-up,no recurrence and metastasis were found. Conclusions Surgery is effective for the aircrew with pristine localized renal cell carcinoma.And it enables the aircrew with satisfied recovery and would be helpful to let them return flying.

Objective To explore the clinical treatment experience and medical evaluation method for the aircrew with renal cell carcinoma. Methods The medical records of 6 cases of the aircrew with renal cell carcinoma dated from Mar. 2002 to Dec. 2008 were analyzed and related literatures were reviewed. Results Six male aircrew's average age was 47.3(43-54) years.Four tumors were in left kidney and 2 in right.The mean diameter of the tumors was 3.6(1.8-5.2) cm.Five patients didn't show any symptom in annual general health checkup but ultrasound examination indicated.One patient complained flank pain and gross hematuria was observed and renal cell carcinoma was diagnosed by imaging examination. All patients received ultrasound,plain film of kidneys,ureter and bladder (KUB) + intravenous urography (IVU) and CT scan to confirm the final diagnosis.Clinical stage was T1 N0 M0 for all cases and all patients received operations. Radical nephrectomy was performed on 3 cases while nephron-sparing surgery on 1 case and laparoscopic radical nephrectomy on 2 cases.All surgeries were successful and all patients recovered well.The pathological examination showed that all cases were clear cell carcinoma.Three patients got flying qualification and 1 was still in observation.Two patients retired after surgery.By 2-5 years follow-up,no recurrence and metastasis were found. Conclusions Surgery is effective for the aircrew with pristine localized renal cell carcinoma.And it enables the aircrew with satisfied recovery and would be helpful to let them return flying.

Adult ; Arnold-Chiari Malformation ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged