BACKGROUND: Preclinical studies have indicated that Angong Niuhuang Pills (ANP) reduce cerebral infarct and edema volumes. This study aimed to investigate whether ANP safely reduces cerebral infarct and edema volumes in patients with moderate to severe acute ischemic stroke. METHODS: This randomized, double-blind, placebo-controlled pilot trial included patients with acute ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores ranging from 10 to 20 in 17 centers in China between April 2021 and July 2022. Patients were allocated within 36 h after onset via block randomization to receive ANP or placebo (3 g/day for 5 days). The primary outcomes were changes in cerebral infarct and edema volumes after 14 days of treatment. The primary safety outcome was severe adverse events (SAEs) for 90 days. RESULTS: There were 57 and 60 patients finally included in the ANP and placebo groups, respectively for modified intention-to-treat analysis. The median age was 66.0 years, and the median NIHSS score at baseline was 12.0. The changes in cerebral infarct volume at day 14 were 0.3 mL and 0.4 mL in the ANP and placebo groups, respectively (median difference: -7.1 mL; interquartile range [IQR]: -18.3 to 2.3 mL, P = 0.30). The changes in cerebral edema volume of the ANP and placebo groups on day 14 were 11.4 mL and 4.0 mL, respectively ( median difference: 3.0 mL, IQR: -1.3 to 9.9 mL, P = 0.15). The rates of SAE within 90 days were similar in the ANP (3/57, 5%) and placebo (7/60, 12%) groups ( P = 0.36). Changes in serum mercury and arsenic concentrations were comparable. In patients with large artery atherosclerosis, ANP reduced the cerebral infarct volume at 14 days (median difference: -12.3 mL; IQR: -27.7 to -0.3 mL, P = 0.03). CONCLUSIONS: ANP showed a similar safety profile to placebo and non-significant tendency to reduce cerebral infarct volume in patients with moderate-to-severe stroke. Further studies are warranted to assess the efficacy of ANP in reducing cerebral infarcts and improving clinical prognosis. TRAIL REGISTRATION Clinicaltrials.gov , No. NCT04475328.
Aged ; Female ; Humans ; Male ; Middle Aged ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Ischemic Stroke/drug therapy* ; Pilot Projects ; Stroke/drug therapy* ; Treatment Outcome

ObjectiveTo explore the syndrome elements and evolving patterns of patients with hepatitis B virus-related acute on chronic liver failure （HBV-ACLF） at different stages. MethodsClinical information of 1,058 hospitalized HBV-ACLF patients， including 618 in the early stage， 355 in the middle stage， and 85 in the late stage， were collected from 18 clinical centers across 12 regions nationwide from January 1， 2012 to February 28， 2015. The “Hepatitis B-related Chronic and Acute Liver Failure Chinese Medicine Clinical Questionnaire” were designed to investigate the basic information of the patients， like the four diagnostic information （including symptoms， tongue， pulse） of traditional Chinese medicine （TCM）， and to count the frequency of the appearance of the four diagnostic information. Factor analysis and cluster analysis were employed to determine and statistically analyze the syndrome elements and patterns of HBV-ACLF patients at different stages. ResultsThere were 76 four diagnostic information from 1058 HBV-ACLF patients， and 53 four diagnostic information with a frequency of occurrence ≥ 5% were used as factor analysis entries， including 36 symptom information， 12 tongue information， and 5 pulse information. Four types of TCM patterns were identified in HBV-ACLF， which were liver-gallbladder damp-heat pattern， qi deficiency and blood stasis pattern， liver-kidney yin deficiency pattern， and spleen-kidney yang-deficiency pattern. In the early stage， heat （39.4%， 359/912） and dampness （27.5%， 251/912） were most common， and the pattern of the disease was dominated by liver-gallbladder damp-heat pattern （74.6%， 461/618）； in the middle stage， dampness （30.2%， 187/619） and blood stasis （20.7%， 128/619） were most common， and the patterns of the disease were dominated by liver-gallbladder damp-heat pattern （53.2%， 189/355）， and qi deficiency and blood stasis pattern （27.6%， 98/355）； and in the late stage， the pattern of the disease was dominated by qi deficiency （26.3%， 40/152） and yin deficiency （20.4%， 31/152）， and the patterns were dominated by qi deficiency and blood stasis pattern （36.5%， 31/85）， and liver-gallbladder damp-heat pattern （25.9%， 22/85）. ConclusionThere are significant differences in the distribution of syndrome elements and patterns at different stages of HBV-ACLF， presenting an overall trend of evolving patterns as "from excess to deficiency， transforming from excess to deficiency"， which is damp-heat → blood stasis → qi-blood yin-yang deficiency.

Objective: To evaluate the effectiveness of varicella vaccine in varicella outbreaks and to analyze the influencing factors, and to provide a reference for making the targeted prevention and controlling measures. Methods: A total of 3 888 students with no history of varicella were selected from 2 schools with varicella outbreak in Guangdong Province in 2021, a retrospective cohort study was conducted by using questionnaire survey, rate ratio ( RR ) and vaccine effectiveness ( VE ) values were calculated and Logistic regression was uses to analyze the factors influencing the protective effect of varicella. Results: There were 138 confirmed cases of varicella among the participants. There was no significant sex difference in the vaccination rate( χ 2=1.36, P =0.51), but there was significant difference in the vaccinattion rate of different age groups( χ 2=555.82, P <0.01). The overall protective effect of VarV was 66.94%(95% CI =56.17%-77.71%), and the protective effect of 2 doses of vaccine( VE = 90.02% , 95% CI =83.13%-96.90%) was higher than that of 1 dose( VE =49.40%, 95% CI =32.36%-66.44%)( χ 2=24.93, P < 0.01 ). The high fever rates in the vaccinated and unvaccinated groups were 7.69% and 25.81%, with significant difference( χ 2= 6.29 , P <0.05). The rates of moderate and severe skin lesions of vaccinated and unvaccinated groups was 20.00% and 50.00%, respectively, and the difference was statistically significant( χ 2=11.32, P <0.01). The protective effects of varicella vaccine against high fever and moderate to severe rash were 70.19%(95% CI =42.11%-98.27%) and 60.00%(95% CI =38.15%-81.85%). Stratified analysis showed that there were significant differences in different years of vaccination( χ 2=37.87, P <0.05), while there were no significant differences in age of vaccination and vaccine manufacturer ( P >0.05). Conclusion Varicella vaccination can prevent chickenpox infection and reduce the severity of the disease. However, the efficacy of varicella vaccine was affected by vaccination years. It is recommended to improve the vaccination coverage of varicella vaccine to prevent the outbreak of the epidemic.

Objective To test the inhabiting effect of Lactobacillus acidophilus on E.coli O157: H7 in intestinal colonization and explore its mechanism. Methods The suppressive effects of Lactobacillus acidophilus against E.coli O157:H7 adhering to Ht29 cells were carried out by competition , exclusion and replacement as-says. Furthermore, we evaluated the cytokine levels of IL-4, IL-12, and INF-γ in serum of mice. In addition, E.coli O157:H7 fecal shedding was monitored and the pathological changes of intestines were observed in mice. Results The competition, exclusion and replacement assays showed Lactobacillus acidophilus inhibited E.coli O157:H7 adhering to Ht29 cells. In vivo, the mice of treatment group were induced significantly higher level of IL-4, IL-12, and INF-γ, though prevention group induced IL-12 only. Fifteen days after E.coli O157:H7 infec-tion, there were 8 mice (80%) in prevention group and 5 mice (50%) in treatment group stopped shedding. Moreover, the pathological changes of intestines of both prevention group and treatment group appeared normal , but control groups showed seriously damaged in intestinal villus. Conclusion Lactobacillus acidophilus inhibits E.coli O157:H7 in intestinal colonization and the preventative effect was better than treatment effect. Thus , Lac-tobacillus acidophilus can be used for E.coli O157:H7 in prevention and treatment infection as probiotics.

Objective To analyze the epidemiologic features of hand-foot-mouth disease (HFMD) in Haikou city from 2008 to 2015.Methods Descriptive methods on epidemiology and detection on pathogens were conducted in Haikou city from 2008 to 2015.Results A total of 71 611 patients were diagnosed as HFMD in Haikou city from 2008 to 2015,including 728 severe cases,accounting for 1.02％ among all the cases.The average annual incidence was 458.89/100 000.A total of 11 deaths were caused by the disease,with the average annual mortality rate as 0.07/100 000.Two peaks of incidence were seen,from April to July and from September to November.Age of the patients mainly fell in children aged 5 and below,taking up 95.78％ of the total cases.Among all the patients,1-year-olds presented the highest incidence as 12 881.24/100 000.The reported incidence for males was higher than that in females.There were 4 districts in Haikou city that reported the disease.Residential areas of the patients were scattered around,with a percentage of 79.89％.Spectrums of pathogens that causing the prevalence of HFMD were EV71 type,Cox A16 type and other enteroviruses,which prevailing in turns,since 2011.Conclusions Haikou city had been an area with high incidence of HFMD.The incidence started to show a rising trend recently.It is suggested that programs as surveillance,case management,health education and comprehensive prevention and control of disease on HFMD targeting on key population should be intensively implemented to reduce the mortality of the disease.

OBJECTIVETo investigate the inhibitory effect of Lactobacillus rhamnosus GG ( LGG) against Cronobacter-induced meningitis in neonatal rats.

METHODSThe cell adhesion and invasion capacities of Cronobacter were assayed in Caco-2 cells, and the optimal time length and concentration of the bacterium for infection were determined. The suppressive effects of LGG on the adhesion and invasion of Cronobacter in caco-2 cells were tested by competitive and exclusion experiments, and its inhibitory effect against Cronobacter-induced meningitis was evaluated in neonatal rats.

RESULTSCronobacter showed aggressive adhesion to caco-2 cells with an optimal infection time of 3 h. LGG produced a concentration-dependent inhibition of Cronobacter adhesion and invasion by competing with and excluding the latter for cell adhesion. In neonatal rats, LGG showed an obvious preventive effect and also a moderate therapeutic effect against Cronobacter-induced meningitis.

CONCLUSIONLGG can inhibit Cronobacter entry across the intestinal barrier to achieve preventive and therapeutic effects against Cronobacter-induced meningitis.

Animals ; Animals, Newborn ; Bacterial Adhesion ; Caco-2 Cells ; Cronobacter ; pathogenicity ; Enterobacteriaceae Infections ; therapy ; Humans ; Intestines ; microbiology ; Lactobacillus rhamnosus ; Meningitis, Bacterial ; therapy ; Probiotics ; Rats

OBJECTIVETo investigate the incidence and trends of thyroid cancer in urban areas of Guangzhou, 2000-2011.

METHODSTotal of 2 957 new cases with a coverage population of 45 699 522 person-years diagnosed as thyroid cancer in 2000-2011 in urban areas of Guangzhou were extracted from the population-based data base of Guangzhou cancer registry, among which 649 were males and 2 308 were females with a coverage population of 23 391 743 person-years and 22 307 779 person-years, respectively. The crude incidence, Chinese age-adjusted incidence rate and world age-adjusted incidence rate were calculated. Time trends of different gender and age groups were examined using Joinpoint Regression Program.

RESULTSThere were a total of 2 957 cases diagnosed as thyroid cancer during 2000-2011 with a sex ratio of 1: 3.56. World age adjusted incidence rates of thyroid cancer in urban areas of Guangzhou increased dramatically from 2.99/100 000 in 2000 to 9.13/100 000 in 2011 with an increase rate of 204.73%. Annual percentage change (APC) was 10.5% (P < 0.001). The APC in world age adjusted incidence rates of thyroid cancer were 8.6% (P < 0.001) for male and 10.9% (P < 0.001) for female, resulting in a total increase of 169.45% (from 1.32/100 000 to 3.54/100 000) for male and 214.64% for female (from 4.73/100 000 to 14.87/100 000). The mean age of onset of thyroid cancer was significantly different between the males and females. The incidence rate of thyroid cancer in females aged 45-59 group (19.56/100 000) reached the highest one.While in males, it was increasing gradually with the age, the incidence increased from 0.74/100 000 in aged 15-19 to 9.48/10 000 in aged of 85 years above. The APC was significant in 20-59 age groups in both males (12.2%) and females (13.4%) (P < 0.001).

CONCLUSIONSThe incidence rate of thyroid cancer increased rapidly in urban areas of Guangzhou. The prevention and treatment of thyroid cancer should be focused on 20-59 age groups.

Adolescent ; Adult ; Asian Continental Ancestry Group ; China ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Thyroid Neoplasms ; Urban Population ; Young Adult