Kounis syndrome is an acute coronary syndrome triggered by an allergic reaction, which is clinically rare and frequently subject to misdiagnosis or missed diagnosis. This article presents a case report of a 70-year-old male patient who developed a rash, pruritus, and chest pain following colon polyp resection. Coronary angiography revealed occlusion of the left anterior descending artery, and blood flow was restored after stent implantation. However, the patient experienced recurrent symptoms accompanied by loss of consciousness. Drug skin tests confirmed positive reactions to chlorhexidine and fondaparinux sodium, leading to a diagnosis of type Ⅱ Kounis syndrome. By avoiding allergenic drugs and combining antihistamines with symptomatic treatment to correct myocardial ischemia, the patient′s clinical symptoms significantly improved, and he eventually recovered and was discharged from the hospital. This case underscores the importance of maintaining vigilance for this syndrome in patients with allergies accompanied by chest pain and promptly identifying and avoiding allergens.

Endosomal TLRs (TLR3/7/8/9) are highly analogous innate immunity sensors for various viral or bacterial RNA/DNA molecular patterns. Among them, TLR7, in particular, has been suggested to be a target for various inflammatory disorders and autoimmune diseases including systemic lupus erythematosus (SLE); but few small-molecule inhibitors with elaborated mechanism have been reported in literature. Here, we reported a well-characterized human TLR7-specific small-molecule inhibitor, TH-407b, with promising potency and negligible cytotoxicity through a novel binding mechanism. Notably, TH-407b not only effectively inhibited TLR7-mediated pro-inflammatory signaling in a variety of cultured cell lines but also demonstrated potent inflammation suppressing activities in primary peripheral blood mononuclear cells (PBMCs) derived from SLE patients. Furthermore, TH-407b showed prominent efficacy in vivo, improved survival rate and ameliorated symptoms of SLE model mice. To obtain molecular insights into the TH-407b derivatives' inhibition mechanism, we performed the structural analysis of TLR7/TH-407b complex using cryogenic electron microscopy (cryo-EM) method. As an atomistic resolution cryo-EM structure of the TLR family, it not only of value to facilitate structure-based drug design, but also shed light to methodology development of small proteins using EM. Significantly, TH-407b has unveiled an inhibition strategy for TLR7 via stabilizing its resting/inactivated state. Such a resting state could be generally applicable to all TLRs, rendering a useful method for targeting this group of important immunological receptors.

Renal artery thrombosis can cause acute occlusion of unilateral or bilateral renal arteries,and kidney failure would be induced if it is not diagnosed and treated in time.Therefore,rapid and correct treatment is especially important for renal artery thrombosis.Due to the lack of specificity of clinical manifestations,this disease in commonly misdiagnosed or missed and thus has a low early diagnosis rate.Here we report a case of acute renal artery thrombosis to improve the diagnosis and treatment.
Acute Disease ; Diagnostic Errors/adverse effects* ; Humans ; Renal Artery ; Renal Artery Obstruction/diagnosis* ; Thrombosis/etiology*

Objective: To investigate the clinical efficacy of long-segment pedicle screw reduction and internal fixation combined with kyphoplasty in the treatment of stage Ⅲ reducible Kummell disease. Methods: The clinical data of 32 patients with stage Ⅲ reducible Kummell disease treated at the Department of Orthopedics, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine from January 2012 to March 2017 were analyzed retrospectively.There were 7 males and 25 females,aged (71.8±6.7)years(range:61 to 86 years).The injured segment was T₁₀ in 1 patient,T₁₁ in 8 patients,T₁₂ in 13 patients,L₁ in 7 patients,L₂ in 2 patients and L₃ in 1 patient.Preoperative American spinal injury association(ASIA) classification of patients all showed grade D.Bone mineral density (BMD),spinal X-ray,CT and MRI were examined before operation.All patients were treated with postural reduction, long-segment pedicle screw reduction and internal fixation combined with kyphoplasty.The operation time,intraoperative blood loss,length of stay and postoperative complications were recorded.The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) as well as the BMD of hip were collected before and after operation.The Cobb angle of involved segment kyphosis and the height of anterior edge of diseased vertebrae were measured before operation,3 days and 12 months after operation.CT-related parameters were measured before and 3 days after operation,including sagittal anterior and posterior diameter of spinal canal,cross-sectional anterior and posterior diameter of spinal canal and cross-sectional spinal canal area.Paired sample t test and repeated measures were used to compare the data before and after operation. Results: All patients received the operation successfully.The operation time was (131.3±16.9) minutes (range:95 to 180 minutes),the blood loss was (82.5±27.1) ml (range:50 to 150 ml),and the length of stay was (8.3±2.4) days (range:5 to 14 days).All patients were followed up for more than 12 months.The VAS decreased gradually at 3 days,3 months,6 months and 12 months after operation,and the differences were statistically significant compared with the VAS before surgery (all P<0.01).ODI at 3,6 and 12 months after surgery was significantly improved compared with that before surgery(All P<0.01).The CT-related parameters at 3 days after operation were significantly higher than those before operation (All P<0.05).At 12 months after surgery,the Cobb angle decreased from (35.2±7.6) ° preoperatively to (4.3±1.7) ° (t=22.630,P<0.01),the height of anterior edge of diseased vertebrae increased from (4.3±1.0) mm preoperatively to (16.9±2.5) mm(t=-25.845,P<0.01),the bone mineral density of hip increased from -(2.2±0.6) preoperatively to -(2.8±0.6)(t=-0.040,P<0.01).Up to the last follow-up,2 patients had distal pedicle screw loosening, 1 patient had proximal junctional kyphosis,and there was no new vertebral fracture. Conclusions: Based on postural reduction,long-segment pedicle screw reduction and internal fixation combined with kyphoplasty is a safe and effective treatment method for stage Ⅲ reducible Kummell disease,which can reconstruct the stability of the diseased vertebrae.Postoperative standard anti-osteoporosis treatment is the basis to ensure the efficacy.
Aged ; Cross-Sectional Studies ; Female ; Fracture Fixation, Internal ; Humans ; Kyphoplasty ; Lumbar Vertebrae/surgery* ; Male ; Pedicle Screws ; Retrospective Studies ; Spinal Fractures/surgery* ; Thoracic Vertebrae/surgery* ; Treatment Outcome

Purpose To investigate the expression of lipocalin-2 (LCN2) and plateled derived growth factor-BB (PDGF-BB) in serum,carcinoma and bone metastases of lung cancer patients. Methods Protein chip were used to screen the differential expression of cytokines in serum of 19 lung cancer patients (9 patients with bone metastasis and 10 patients freedistant metastasis) . Immunohistochemistry was performed to assess the differential expression of LCN2 and PDGF-BB cytokines in 12 cases of primary lung cancer without distant metastasis and 12 cases of primary lung cancer with only bone metastasis. Results Serum level of lipid transport factor (LCN2) and PDGFBB in non-small cell lung cancer patients with bone metastasis were significantly higher than that without distant metastasis(P< 0. 05) . There was no difference cytokines between small cell lung cancer patients with bone metastasis and without metastasis group (P > 0. 05) . The results of immunohistochemistry showed that high expression of LCN2 and PDGF-BB in bone metastasis tissues was significantly higher than that in primary lung cancer tissues. Conclusions High expression of LCN2 and PDGF-BB in serum and bone metastasis tissue of patients with non-small cell lung cancer might be involved in the occurrence,development of bone metastasis of lung cancer in the bone marrow,may be an important biomarker and potential therapeutic target for bone metastasis of lung cancer.

Objective: To analyze relevant preoperative risk factors for microvascular invasion (MVI) in patients with small hepatocellular carcinoma and establish a prediction model. Methods: A retrospective analysis of 157 cases of singlehepatocellular carcinoma with tumor diameter ≤5 cm undergoing hepatectomy at the First Affiliated Hospital of Fujian Medical University from Dec 2012 to Mar 2019 was conducted. There were 59 cases with MVI and 98 cases without MVI.According to different time periods, the enrolled cases were divided into modeling group (n=137) and validation group (n=20). The independent risk factors of small hepatocellular carcinoma with MVI were discussed and a prediction model was established by using preoperative specific imaging characteristics and clinical data. Results: Multivariate Logistic regression analysis showed that AFP, imaging tumor maximum diameter and tumor margin status were independent risk factors for small hepatocellular carcinoma complicated by microvascular invasion. Preoperative prediction model was established according to the above factors : P=1/1+ [e^(2.751-1.090X1-1.778X2-1.147X3)]. (X1-X3 represent the assignment of AFP, maximum tumor diameter and tumor margin state, respectively). The area under curve (AUC) and the receiver operating characteristic curve (ROC) of the model is 0.786. Conclusion Based on three preoperative clinical data, including AFP, tumor maximum diameter and tumor margin, the preoperative prediction model of small hepatocellular carcinoma complicated with MVI was successfully established with clinical value.

Objective To explore the treatment methods and prognosis of early infection and delayed infection after intramedullary nail fixation.Methods Data of 22 cases of postoperative infections after intramedullary nail from January 2013 to August 2017 were retrospectively analyzed.There were 18 males and 4 females aged from 20 to 72 years old,with an average age of 46.8 years.14 cases were tibias and 8 cases were femurs.In the early infection group,6 cases showed swelling,heat and pain in the affected area with drainage and pus.In the late infection group,12 cases showed sinus formation and 4 cases showed no sinus tract.According to whether the infection occurred within six weeks,it was divided into early infection and delayed infection groups.Of 6 patients in early infection group,there was 1 case of septic shock which underwent removal of intramedullary nails,debridement and antibiotic bone cement stick implantation.5 cases were retained intramedullary nail and underwent local debridement treatment.Late infection occurred in 16 patients.One patient with tibia infection was given partial dressing to heal the fracture.Then the intramedullary nail was removed and intramedullary debridement was performed.Two patients with poor general condition,the intramedullary nails were removed and debridement was performed.Calcium sulphate cement was implanted and fixed with external fixation.The remaining 13 cases were treated with debridement and antibiotic cement stick implantation.We compared the differences between early and late infections of internal fixation,infection control,fracture healing,and secondary fracture fixation.Results Of the 6 patients with early infection,1 patient with septic shock removed intramedullary nails to control infection.After infection controlled,the fracture was treated with intramedullary nailing.Of the 5 patients with retained intramedullary nails,2 patients' infection were controlled and 3 were uncontrolled.After removal of the intramedullary nails the infection was control.The success rate of retaining intramedullary nails was 33.3％ (2/6).Late infection occurred in 16 cases and infection was all controlled.The fractures healed in 22 patients.The fracture healing time of 6 patients with early infection was 2-6 months,with an average of 3.67±2.08 months.The fracture healing time of 16 patients with late infection was 2-4 months (average 3.2±0.79) months.Conclusion Patients with early bone infections after femoral and tibial intramedullary nail surgery may attempt debridement therapy with retained intramedullary nails,but the failure rate is high.If the intramedullary nail fails to remain,follow the treatment of patients with delayed bone infection.For patients with delayed bone infection,because the fracture has not yet healed,thorough debridement is used after the removal of internal fixation,then calcium sulfate or antibiotic bone cement stick should be implanted and fixed with external fixation.For the second phase,we may choose plate,intramedullary nail or external fixation to fix the fractures according to the soft tissue condition.All of the fixation methods could provide good fracture healing.

Bone defects,a challenge in orthopedics,are mostly caused by severe trauma,bone tumor and bone infection.Their chief treatments include bone graft,distraction osteogenesis and Masquelet technique.Compared with other treatments,Masquelet technique is simpler and causes fewer complications,especially for infectious defects.In the first stage of Masquelet technique,a bone defect is filled with bone cement.The spacer most commonly used is polymethylmethacrylate(PMMA).PMMA can form induced membrane rich in blood vessels and bioactive components promoting osteogenesis,but it is not biodegradable,lacks bone conductibility,has an obvious thermal effect during operation,and is hard to remove in the second phase of Masquelet technique.Calcium sulfate and calcium phosphate bone cement are biodegradable materials which overcome the defects of PMMA due to their biological absorbability,bone conduction and bone inducement.It is possible for them to replace PMMA in Masquelet technique,but their poor mechanical strength limits their application.There is clinical evidence showing that calcium sulfate bone cement can form obvious induced membrane.As calcium silicate cement can also form a layer of fibrous tissue around the shell,it may be applied in orthopaedic surgery after improvement as a potential filling agent.A structure like induced membrane can form around a silicone prosthesis,and it functions similarly as induced membrane around PMMA and is more resistant to a radiation environment.Silicone has obvious advantages over PMMA after resection of bone tumor.Spacers used in the first stage of Masquelet technique have important effects on formation process and quality of induced membranes.By comparing membranes induced by different types of spacer,we can know more about the effects of spacers on induced membranes in the first stage of Masquelet technique and thus discover the most suitable spacers good for fracture healing and membrane formation.

BACKGROUND: Adipocytes in the tumor microenvironment may provide the metabolic fuel or signal transduction through media and other means to promote a variety of malignant proliferation and invasion, of tumor cells, but their role in lung cancer progression is still unclear. The purpose of this study was to investigate the effect of adipocytes on lung cancer cell biology. METHODS: 3T3-L1 pre-adipocytes were induced into mature adipocytes. The cell morphology was observed by microscopy and Oil Red O staining. MTT assay, colony formation assay, wound-healing and Transwell methods were used to detect lung cancer cell proliferation, migration and invasion ability. The content of triglyceride in cells was determined by colorimetry. RESULTS: The morphology of lung adenocarcinoma A549 cells became more slender after co-culture with mature adipocytes, and the proliferation and cloning ability were significantly enhanced (P<0.05). In addition, mature adipocytes can also promote the migration ability (P<0.05), invasion ability (P<0.01) and accumulation of intracellular lipid (P<0.05) of A549 cells. CONCLUSIONS These findings suggested that adipocytes in tumor microenvironment can promote the proliferation, migration and invasion of lung adenocarcinoma A549 cells, which may be related to lipid metabolism.
A549 Cells ; Adenocarcinoma ; metabolism ; pathology ; physiopathology ; Adenocarcinoma of Lung ; Adipocytes ; cytology ; metabolism ; Animals ; Cell Movement ; Cell Proliferation ; Humans ; Lung Neoplasms ; metabolism ; pathology ; physiopathology ; Mice ; NIH 3T3 Cells ; Triglycerides ; metabolism ; Tumor Microenvironment

OBJECTIVEMany metals, some of which have been classified as environmental endocrine disruptors, are used extensively in everyday consumer products and are ubiquitous in our living environment. In the present study, we aimed to explore the associations between the prevalence risk of type 2 diabetes and plasma levels of 20 trace elements as well as those of heavy metals in a Han Chinese population.

METHODSWe conducted a case-control study to investigate the associations between plasma concentrations of 20 metals and diabetes in Jiangsu province. A total of 122 newly diagnosed cases of type 2 diabetes and 429 matched controls were recruited from community physical examinations in Suzhou City of Jiangsu Province. Plasma metal levels were measured by inductively-coupled plasma mass spectrometry.

RESULTSAfter adjusting for confounders, plasma vanadium, chromium, manganese, copper, zinc, arsenic, selenium, strontium, palladium, cadmium, cesium, and barium were associated with diabetes risk (P < 0.05). The adjusted OR increased with increasing concentration of vanadium, manganese, copper, zinc, and cesium.

CONCLUSIONMany metals, including manganese, copper, zinc, arsenic, selenium, and cadmium in plasma, are associated with the morbidity of diabetes. Monitoring of environmental metal levels and further studies are urgently needed.

Aged ; Case-Control Studies ; Diabetes Mellitus ; blood ; etiology ; Environmental Pollutants ; blood ; toxicity ; Female ; Humans ; Male ; Metals ; blood ; Middle Aged ; Risk Factors