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.

Objective:To investigate the clinical value of transjugular liver biopsy (TJLB) in patients with unexplained liver disease complicated with massive ascites or coagulopathy.Methods:A retrospective analysis was performed from patients underwent TJLB in the First Affiliated Hospital of Zhengzhou University, Zhoukou Central Hospital, Shangqiu First People's Hospital and Jincheng People's Hospital from March 2015 to January 2022 due to unexplained liver disease complicated with massive ascites or coagulopathy. A total of 37 patients were included, including 21 males and 16 females, aged (53.5±11.9) years. According to different puncture points, the patients were divided into two groups: transhepatic right vein TJBL and transhepatic middle vein TJBL. The obtained liver tissue sampling effect, puncture times, complications were analyzed.Results:The success rate of TJLB was 97.3%(36/37). Thirty-six patients were able to obtain more than three segments of liver tissue and obtain histological diagnosis, and the pathological diagnosis rate was 100.0%(36/36). The number of puncture times, the amount of hepatic tissue and the number of portal areas in the right hepatic vein group (21 cases) were (3.7±0.9), (3.7±0.7) and (6.5±0.9) respectively, and those in the middle hepatic vein group (15 cases) were (3.7±0.7), (3.7±0.7) and (6.3±0.8) respectively. There were no significant differences between the two groups (all P>0.05). Conclusion:TJLB is safe and feasible for patients with unexplained liver disease complicated with massive peritoneal effusion and coagulopathy. Good liver tissue specimens can be obtained by TJLB from both right hepatic vein and middle hepatic vein.

Objective To investigate the effect of continuous quality improvement on subjective well-being quality of life and satisfaction of esophageal cancer patients. Methods A total of 120 esophageal cancer patients in our hospital were randomly divided into two groups, 60 cases in the observation group treated with continuous quality improvement while the other 60 cases in the control group treated with routine care. The two groups were compared in terms of subjective well-being,quality of life and nursing satisfaction. Results Before the intervention, there were no significant differences between the two groups in view of the quality of life scale score and subjective well-being score (P>0.05). After the intervention, in view of symptoms, the scores on all the items in the boservation group were significantly lower than those in the control group (P<0.05), except constipation, economic difficulty and diarrhea and the function items were higher. The subjective satisfaction of the observation group was significantly better than that of the control group (P<0.05). Conclusion Continuous quality improvement care can promote the improvement of subjective well-being, improve the quality of life and satisfaction of patients with esophageal cancer.

Objective To investigate antimicrobial resistance of Escherichia coli (E.coli)and Klebsiella pneumoniae (K.pneumoniae),antimicrobial use density(AUD),as well as relation between antimicrobial resistance and AUD in a ter-tiary first-class hospital.Methods Antimicrobial resistance rates of clinically-isolated E.coli and K.pneumoniae,AUD of carbapenems and quinolones,as well as relation between resistance and AUD in 2013-2015 were statistically analyzed. Results Correlation analysis of antimicrobial resistance of bacteria and AUD showed that the decrease in resistance rate of E.coli to levofloxacin was related to the decrease in the use density of quinolones(r=0.61,P=0.03);increase in resist-ance rate of K.pneumoniae to imipenem was related to the increase in the use density of carbapenems(r=0.78,P<0.01). Conclusion Antimicrobial use is one of the causes of bacterial resistance,management on antimicrobial use needs to be strengthened to reduce the threat of bacterial resistance to human health.

Objective To evaluate the effect of a protein kinase CK2 inhibitor on intracellular levels of reactive oxygen species and DNA double?stand break in human non?small cell lung cancer H460 cells. Methods H460 cells were exposed to 0, 12?5, 25.0, and 50.0μmol/L quinalizarin, a specific inhibitor of protein kinase CK2, for 24 hours. The changes in protein and mRNA levels of CK2 subunits were measured. Flow cytometry was used to measure changes in the intracellular levels of reactive oxygen species in H460 cells after 4 or 24 hours of quinalizarin treatment. Immunofluorescence assays were performed to determine the effect of the CK2 inhibitor onγ?H2 AX expression and the average fluorescent number ofγ?H2 AX foci in H460 cells. Comparison was made by analysis of variance and t test. Results There were no significant differences in protein or mRNA levels of CK2 subunits in H460 cells after quinalizarin treatment ( CK2α,0μmol vs. 12?5 μmol/L, P=0?966;0 μmol/L vs. 25 μmol/L, P=0?355;0 μmol/L vs. 50 μmol/L, P=0?864, CK2α’ , 0 μmol/L vs. 12?5μmol/L,P=0?409;0μmol/L vs. 25μmol/L,P=0?833;0μmol/L vs. 50 μmol/L, P=0?0. 746, CK2β, 0 μmol/L vs. 12?5 μmol/L, P=0?532;0 μmol/L vs. 25 μmol/L, P=0?830;0 μmol/L vs. 50 μmol/L, P= 0?061 ) . The intracellular levels of reactive oxygen species were substantially elevated in H460 cells with the increase in quinalizarin concentration and treatment time. Different concentrations of quinalizarin resulted in dose?and time?dependent increases in the numbers of γ?H2 AX foci after 4 and 24 hours of treatment ( treated by Quianlizarin for 4 or 24 h, 0 μmol/L vs. 12?5μmol/L,12?5 μmol/L vs. 25 μmol/L, 25 μmol/L vs. 50 μmol/L, all P=0?000, concentration is 12?5μmol/L,25 μmol/L or 50 μmol/L, 4 h vs. 24 h, all all P=0?000 ) . Conclusions Quinalizarin can increase the intracellular levels of reactive oxygen species and DNA double?stand break in H460 cells by inhibition of protein kinase CK2 activity. This study provides a theoretical basis for using quinalizarin as a potential radiosensitizer for lung cancer.

Objective To evaluate the direct economic loss due to surgical site infection(SSI)from a medical eco-nomics perspective,and provide basis for health administrative departments to make strategies.Methods SSI in pa-tients undergoing breast,stomach and colorectal operation between March 2008 and February 2010 were selected for 1∶1 case-control study,patients with SSI were as SSI group,without SSI during the same period were as control group,difference in medical expense and length of stay between two groups were compared,economic loss due to SSI was evaluated.Results A total of 1 523 operation cases were investigated,75(4.92%)developed SSI.69 effec-tive pairings were obtained.Wilcoxon signed rank test revealed that difference in medical expense between two groups was statistically significant(Z =6.586,P <0.001),the median of average medical expense of SSI group was 6 828.60 yuan higher than control group,all kinds of medical expense in SSI group were all higher than control group;the median length of stay of SSI group was 10 days longer than that of control group (Z = 5.939,P <0.001).Conclusion SSI can prolong hospitalization,increase medical expense,decrease bed turnover rate,and in-fluence economic income and medical quality.

Objective To evaluate the effect of bundle intervention measures on preventing ventilator-associated pneumonia (VAP).Methods Patients who were admitted to an intensive care unit(ICU)of a hospital from January 2012 to December 2013 were monitored,patients from January to December 2012 were as control group,while from January to December 2013 were as intervention group (bundle intervention measures were implemented).Usage rate of ventilators and incidence of VAP between two groups were compared.Results A total of 4 560 patients were mo-nitored,2 608 in intervention group and 1 952 in control group.Usage rate of ventilators in intervention group was lower than control group (53.95% vs 61 .17%;χ2 =65.756,P <0.01).Incidence of VAP per 1 000 ventilator days in intervention group was lower than control group (13.00‰ vs 19.56‰;χ2 =4.649,P =0.031 ).Percentage of late-onset VAP per 1 000 ventilator days in tervention group was higher than control group(41 .82‰ vs 24.59‰). Conclusion Bundle intervention measures are helpful for reducing the incidence of VAP in ICU patients.

[Abstr act] Objective To explore whether quninalizarin, an specific inhibitor of protein kinase CK2, could sensitize icotinib in EGFR-TKIs (epithelial growth factor receptor-tyrosine kinase inhibitor)-resistant cell lines and uncover the underlying mechanisms.Methods MTT assay was performed to evaluate the inhibitory effect of quninalizarin, icotinib or the combination of both on cell proliferation in several lung adenocarcinoma cell lines.Western blot assay was used to assess if combined inhibition of EGFR and protein kinase CK2 by icotinib and quninalizarin, exerts effect on the expression and phosphorylation of major proteins of EGFR signaling pathways.Results The IC50 of HCC827, H1650 , H1975 and A549 cells for icotinib were (8.07±2.00) μmol/L, (66.01±6.64) μmol/L, (265.60±9.47) μmol/L and( 87.88±6.8)μmol/L, respectively, indicating that HCC827 cells are sensitive to icotinib, and the H1650, H1975 and A549 cells are relatively resistant to icotinib.When treated with both quninalizarin and icotinib in the concentration of 50 μmol/L, the viability of H1650, H1975 and A549 cells was (40.64±3.73)%, (65.74± 3.27)% and (44.96±0.48)%, respectively, significantly lower than that of H1650 , H1975 and A549 cells treated with 50 μmol/L icotinib alone (55.05±1.22)%, (71.98±1.60)% and (61.74±6.18)%, respectively (P<0.01 for all).When treated with both 100 μmol/L quninalizarin and 100 μmol/L icotinib, the viability of H1650, H1975and A 549 ells were (23.35±0.81)%, (55.70±1.03)%, (33.42±1.33)%,respectively, significantly lower than the viability of H1650, H1975 and A549 cells treated with 100 μmol/L icotinib alone (40.57±2.65)%, (62.40±2.05)% and (44.97±8.20)%, respectively, (P<0.01 for all).The two-way ANOVA analysis showed that compared with the viability of EGFR-TKIs-resistant cells ( H1650, H1975, A549) treated with 50 μmol/L and 100 μmol/L icotinib alone, the viability of cells treated with icotinib and quinalizarin were significantly suppressed, and the differences were statistically significant (P<0.01).In addition, the phosphorylation form of Akt and ERK (namely p-Akt and p-ERK) were significantly down-regulated by treating with quninalizarin and icotinib together in the H1650 cells while the expression of Akt and ERK changed little.Conclusions Quinalizarin, as a specific CK2 inhibitor, may overcome icotinib resistance by inhibiting proliferation mediated by Akt and ERK in human lung adenocarcinoma cell lines, and enhances the suppressive effect of icotinib on the proliferation of EGFR-TKIs-resistant human lung adenocarcinoma cells.

[Abstr act] Objective To explore whether quninalizarin, an specific inhibitor of protein kinase CK2, could sensitize icotinib in EGFR-TKIs (epithelial growth factor receptor-tyrosine kinase inhibitor)-resistant cell lines and uncover the underlying mechanisms.Methods MTT assay was performed to evaluate the inhibitory effect of quninalizarin, icotinib or the combination of both on cell proliferation in several lung adenocarcinoma cell lines.Western blot assay was used to assess if combined inhibition of EGFR and protein kinase CK2 by icotinib and quninalizarin, exerts effect on the expression and phosphorylation of major proteins of EGFR signaling pathways.Results The IC50 of HCC827, H1650 , H1975 and A549 cells for icotinib were (8.07±2.00) μmol/L, (66.01±6.64) μmol/L, (265.60±9.47) μmol/L and( 87.88±6.8)μmol/L, respectively, indicating that HCC827 cells are sensitive to icotinib, and the H1650, H1975 and A549 cells are relatively resistant to icotinib.When treated with both quninalizarin and icotinib in the concentration of 50 μmol/L, the viability of H1650, H1975 and A549 cells was (40.64±3.73)%, (65.74± 3.27)% and (44.96±0.48)%, respectively, significantly lower than that of H1650 , H1975 and A549 cells treated with 50 μmol/L icotinib alone (55.05±1.22)%, (71.98±1.60)% and (61.74±6.18)%, respectively (P<0.01 for all).When treated with both 100 μmol/L quninalizarin and 100 μmol/L icotinib, the viability of H1650, H1975and A 549 ells were (23.35±0.81)%, (55.70±1.03)%, (33.42±1.33)%,respectively, significantly lower than the viability of H1650, H1975 and A549 cells treated with 100 μmol/L icotinib alone (40.57±2.65)%, (62.40±2.05)% and (44.97±8.20)%, respectively, (P<0.01 for all).The two-way ANOVA analysis showed that compared with the viability of EGFR-TKIs-resistant cells ( H1650, H1975, A549) treated with 50 μmol/L and 100 μmol/L icotinib alone, the viability of cells treated with icotinib and quinalizarin were significantly suppressed, and the differences were statistically significant (P<0.01).In addition, the phosphorylation form of Akt and ERK (namely p-Akt and p-ERK) were significantly down-regulated by treating with quninalizarin and icotinib together in the H1650 cells while the expression of Akt and ERK changed little.Conclusions Quinalizarin, as a specific CK2 inhibitor, may overcome icotinib resistance by inhibiting proliferation mediated by Akt and ERK in human lung adenocarcinoma cell lines, and enhances the suppressive effect of icotinib on the proliferation of EGFR-TKIs-resistant human lung adenocarcinoma cells.

OBJECTIVE To analyze the bacterial distribution and drug resistance in lower respiratory tract nosocomial infection(NI).METHODS To investigate 351 patients suffered from lower respiratory tract NI using the prospective monitoring methods,and doing the pathogenic bacterium cultivation for sputums of 351 patients and then taking the susceptibility test.RESULTS Totally 346 pathogenic bacteria were found in sputums of 351 patients.The major pathogenic bacteria were Pseudomonas aeruginosa,Escherichia coli,Klebsiella and Staphylococcus aureus.ESBLs were 36.0% and 40.0%,respectively in E.coli and Klebsiella,and MRSA were 82.1% in S.aureus.Drug resistances were common in Gram-negative bacilli(GNB) and Gram-positive cocci.Piperacillin/tazobactam and cefoperazone/sulbactam and imipenem were the most sensitive for GNB,S.aureus,S.epidermidis and Enterococcus were all sensitive to vancomycin.CONCLUSIONS Drug resistance of the pathogenic bacteria in lower respiratory tract NI is common,so it′s necessary to emphasize pathogenic bacterium monitoring and use the antibacterials exactly.