Early diagnosis, treatment, and outcomes of five patients with acute thallium poisoning

BACKGROUND Thallium poisoning is rare and difficult to recognize.Early diagnosis and treatment of thallium-poisoned patients are essential to prevent morbidity and mortality.AIM To evaluate the efficacy of treatments and outcomes of five patients with early diagnosis of acute thallium poisoning.METHODS Five patients who consumed a thallium-contaminated meal were hospitalized in succession,and underwent clinical examinations such as blood tests and electromyography tests.Urine and blood tests confirmed the diagnosis of thallotoxicosis,revealing the occurrence of food poisoning.All patients underwent detoxification treatment,including hemoperfusion(HP)and treatment with Prussian blue(PB).A 24-mo follow-up was performed to evaluate the long-term outcomes on the patients after discharge.RESULTS Initially,the patients presented with symptoms of acute thallium poisoning including hyperalgesia of the limbs and abdominalgia,which may differ from common peripheral neuropathy.Accompanying symptoms such as hepatic damage and alopecia were observed in all the patients,which further confirmed the diagnosis of poisoning.Treatment with chelating agents was ineffective,while HP and treatment with PB drastically decreased the thallium concentration in the urine and blood.With early diagnosis and intervention,four patients had a good prognosis and no permanent sequelae.One patient developed blindness and disability during the 24-mo follow-up period.CONCLUSION Identification of incident cluster and characteristic symptoms is extremely important for early diagnosis of acute thallium poisoning.HP plus PB is essential to improve the prognosis of thallium-poisoned patients.

Diagnostic value of transbronchial lung biopsy in peripheral lung cancer

Objective: The purpose of this study was to evaluate the diagnostic value of transbronchial lung biopsy (TBLB) in peripheral lung cancer. Methods: 78 cases of peripheral lung cancer which could not be observed by bronchoscope were selected from the Second Affiliated Hospital of Sun Yat-sen University (China), of which 42 cases were diagnosed by TBLB. Among the 36 cases of peripheral lung cancer that could not be able to be diagnosed by TBLB, 22 cases were diagnosed by percutaneous lung biopsy (PNLB) and 14 cases being left were diagnosed by surgical specimens biopsy, lymphadenopathy biopsy, pleural biopsy or pleural effusion cytology. Results: The positive rates produced by TBLB and transbronchial brush biopsy were 53.8% and 8.9%, respectively, and the combined positive rate was 57.7%. The positive rate produced by TBLB was higher than that of transbronchial brush biopsy (P < 0.01). As the tumor’s diameter increased, the positive rate of the biopsy was higher (P < 0.05). The positive rate of biopsy of the right lung was not significantly higher than that of the left lung (P > 0.05). The positive rate of biopsy of the inferior lobes was not significantly higher than that of the upper lobes of the lung (P > 0.05). The lesions of the tumors which were nearer to the infield and hilar of the lung got a higher positive rate (P < 0.01). The incidence of complications in PNLB was much higher than that in TBLB (P < 0.05). Conclusion: TBLB is an important method in the diagnosis of peripheral lung cancer. Combination of TBLB and other methods can increase the positive rate in the diagnosis of peripheral lung cancer.

中国传统建筑的先进性

中国传统建筑是中华民族的先人在“天人合一”的宇宙认知的指引下,在顺应自然、师法自然、巧妙利用自然为人类谋福祉的不懈努力中创造出的充满东方智慧和创造力的特殊建筑,有优于世界其他体系建筑的先进性。本文从建筑选址、材料选择、营建理念、构造方式、资源节约、抗震减灾等方面论证了中国传统建筑的先进性,澄清了某些人对中国传统建筑的错误认知。

Consensus on the application of negative pressure wound therapy of diabetic foot wounds

Because China is becoming an aging society,the incidence of diabetes and diabetic foot have been increasing.Diabetic foot has become one of the main health-related killers due to its high disability and mortality rates.Negative pressure wound therapy(NPWT)is one of the most effective techniques for the treatment of diabetic foot wounds and great progress,both in terms of research and its clinical application,has been made in the last 20 years of its development.However,due to the complex pathogenesis and management of diabetic foot,irregular application of NPWT often leads to complications,such as infection,bleeding and necrosis,that seriously affect its treatment outcomes.In 2020,under the leadership of Burns,Trauma and Tissue Repair Committee of the Cross-Straits Medicine Exchange Association,the writing group for‘Consensus on the application of negative pressure wound therapy of diabetic foot wounds’was established with the participation of scholars from the specialized areas of burns,endocrinology,vascular surgery,orthopedics and wound repair.Drawing on evidence-based practice suggested by the latest clinical research,this consensus proposes the best clinical practice guidelines for the application and prognostic evaluation of NPWT for diabetic foot.The consensus aims to support the formation of standardized treatment schemes that clinicians can refer to when treating cases of diabetic foot.

P300/CBP-associated factor(PCAF)-mediated acetylation of Fascin at lysine 471 inhibits its actin-bundling activity and tumor metastasis in esophageal cancer

Background:Fascin is crucial for cancer cell filopodium formation and tumor metastasis,and is functionally regulated by post-translational modifications.However,whether and how Fascin is regulated by acetylation remains unclear.This study explored the regulation of Fascin acetylation and its corresponding roles in filopodium formation and tumor metastasis.Methods:Immunoprecipitation and glutathione-S-transferase pull-down assays were performed to examine the interaction between Fascin and acetyltransferase P300/CBP-associated factor(PCAF),and immunofluorescence was used to investigate their colocalization.An in vitro acetylation assay was performed to identify Fascin acetylation sites by using mass spectrometry.A specific antibody against acetylated Fascin was generated and used to detect the PCAF-mediated Fascin acetylation in esophageal squamous cell carcinoma(ESCC)cells using Western blotting by overexpressing and knocking down PCAF expression.An in vitro cell migration assay was performed,and a xenograft model was established to study in vivo tumor metastasis.Live-cell imaging and fluorescence recovery after photobleaching were used to evaluate the function and dynamics of acetylated Fascin in filopodium formation.The clinical significance of acetylated Fascin and PCAF in ESCC was evaluated using immunohistochemistry.Results:Fascin directly interacted and colocalized with PCAF in the cytoplasm and was acetylated at lysine 471(K471)by PCAF.Using the specific antiAcK471-Fascin antibody,Fascin was found to be acetylated in ESCC cells,and the acetylation level was consequently increased after PCAF overexpression and decreased after PCAF knockdown.Functionally,Fascin-K471 acetylation markedly suppressed in vitro ESCC cell migration and in vivo tumor metastasis,whereas Fascin-K471 deacetylation exhibited a potent oncogenic function.Moreover,Fascin-K471 acetylation reduced filopodial length and density,and lifespan of ESCC cells,while its deacetylation produced the opposite effect.In the filipodium shaft,K471-acetylated Fascin displayed rapid dynamic exchange,suggesting that it remained in its monomeric form owing to its weakened actinbundling activity.Clinically,high levels of AcK471-Fascin in ESCC tissues were strongly associated with prolonged overall survival and disease-free survival of ESCC patients.Conclusions:Fascin interacts directly with PCAF and is acetylated at lysine 471 in ESCC cells.Fascin-K471 acetylation suppressed ESCC cell migration and tumor metastasis by reducing filopodium formation through the impairment of its actin-bundling activity.