Role of penehyclidine in acute organophosphorus pesticide poisoning

BACKGROUND:Penehyclidine is a newly developed anticholinergic agent.We aimed to investigate the role of penehyclidine in acute organophosphorus pesticide poisoning(OP)patients.METHODS:We searched the Pubmed,Cochrane library,EMBASE,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical literature(CBM)and Wanfang databases.Randomized controlled trials(RCTs)recruiting acute OP patients were identifi ed for meta-analysis.Main outcomes included cure rate,mortality rate,time to atropinization,time to 60%normal acetylcholinesterase(AchE)level,rate of intermediate syndrome(IMS)and rate of adverse drug reactions(ADR).RESULTS:Sixteen RCTs involving 1,334 patients were identifi ed.Compared with the atropineor penehyclidine-alone groups,atropine combined with penehyclidine significantly increased the cure rate(penehyclidine+atropine vs.atropine,0.97 vs.0.86,RR 1.13,95%CI[1.07–1.19];penehyclidine+atropine vs.penehyclidine,0.93 vs.0.80,RR 1.08,95%CI[1.01–1.15])and reduced the mortality rate(penehyclidine+atropine vs.atropine,0.015 vs.0.11,RR 0.17,95%CI[0.06–0.49];penehyclidine+atropine vs.penehyclidine,0.13 vs.0.08,RR 0.23,95%CI[0.04–1.28]).Atropine combined with penehyclidine in OP patients also helped reduce the time to atropinization and AchE recovery,the rate of IMS and the rate of ADR.Compared with a single dose of atropine,a single dose of penehyclidine also signifi cantly elevated the cure rate,reduced times to atropinization,AchE recovery,and rate of IMS.CONCLUSION:Atropine combined with penehyclidine benefi ts OP patients by enhancing the cure rate,mortality rate,time to atropinization,AchE recovery,IMS rate,total ADR and duration of hospitalization.Penehyclidine combined with atropine is likely a better initial therapy for OP patients than atropine alone.

Speckle-tracking echocardiography for detecting myocardial dysfunction in sepsis and septic shock patients:A single emergency department study

BACKGROUND:Septic cardiomyopathy(SCM)occurs in the early stage of sepsis and septic shock,which has implications for treatment strategies and prognosis.Additionally,myocardial involvement in the early stages of sepsis is difficult to identify.Here,we assess subclinical myocardial function using laboratory tests and speckle-tracking echocardiography(STE).METHODS:Emergency department patients diagnosed with sepsis or septic shock were included for analysis.Those with other causes of acute or pre-existing cardiac dysfunction were excluded.Transthoracic echocardiography(TTE),including conventional echocardiography and STE,were performed for all patients three hours after initial resuscitation.Samples for laboratory tests were taken around the time of TTE.RESULTS:Left ventricular functions of 60 patients were analyzed,including 21 septic shock patients and 39 sepsis patients.There was no significant difference in global longitudinal strain(GLS),global circumferential strain(GCS),or global radical strain(GRS)between patients with sepsis and septic shock(all with P>0.05).However,GLS and GCS were significantly less negative in patients with abnormal troponin levels or in patients with abnormal left ventricular ejection fraction(LVEF)values(all with P<0.05).There were also moderate correlations between GLS and levels of cTnI(r=0.40,P=0.002)or N-terminal pro-B-type natriuretic peptide(NT-proBNP)(r=0.44,P=0.001)in sepsis and septic shock patients.CONCLUSION:Myocardial dysfunction,e.g.,lower LVEF or less negative GLS in patients with sepsis or septic shock,is more affected by myocardial injury.GLS could be incorporated into mainstream clinical practice as a supplementary LVEF parameter,especially for those with elevated troponin levels.

(±)-Zanthonitidine A,a Pair of Enantiomeric Furoquinoline Alkaloids from Zanthoxylum nitidum with Antibacterial Activity

A pair of new enantiomeric furoquinoline alkaloids,(±)-zanthonitidine A(1),together with nine known ones(2-10)were isolated from the radix of Zanthoxylum nitidum.Their chemical structures were elucidated based on the extensive spectroscopic analysis.The racemic mixture of 1 was separated by chiral column chromatography,and the absolute configurations of (+)-1 and(-)-1 were determined by the comparison of experimental and calculated electronic circular dichroism spectra.Antibacterial activities of compounds 1-9 were evaluated,and compounds(+)-1,(-)-1,3,7 and 8 showed antibacterial activities against Bacillus subtilis,Enterococcus faecalis or Staphylococcus aureus.

The clinical effect of frontotemporal rhytidectomy combined with botulinum toxin type A injection facial rejuvenation treatment

Objective To investigate the effect of frontotemporal rhytidectomy combined with botulinum toxin A type injection on lifting upper facial skin,improving upper facial skin aging,removing peri-orbital,glabellar and forehead wrinkles a nd strengthening the effect of rhytidectomy.Methods 20 patients with upper facial wrinkle plastic surgery,female,were designed with incision marking line along forehead and temporal hairline for dissection.The forehead was stripped along the superficial layer of periosteum,and the temporal part was stripped against the superficial surface of superficial temporal fascia.Then the suspension was used to tight the skin,the redundant skin tissue was removed,the cosmetic incision was sutured,the drainage device was placed routinely after the operation,and the pressure dressing is applied for 72 hours.The stitches were removed 7 days after the operation,at the same time,the appropriate dose of botulinum toxin type A was injected into the glabella,the outer corner of both eyes and the forehead to remove wrinkles and to rejuvenate the upper facial skin.Results 20 patients were followed up for 1-12 months,the results were all satisfactory.The upper skin relaxation was obviously improved,the forehead,glabellar and periorbital wrinkles were significantly reduced,the skin was plump and lustrous,the scar was hidden,not obvious and without complications after the incision was healed,and the upper facial skin showed obvious rejuvenation ef fect.Conclusion Frontotemporal rhytidectomy combined with botulinum toxin type A injection facial rejuvenation treatment is safe,effective,and has less complications as well as quick recovery,which is a feasible and good treatment.

Development of an intensive simulating training program in emergency medicine for medical students in China

BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulating training program in EM, based on a tight schedule, is anticipated to enhance the competency of medical students.METHODS: A 3-day intensive EM training program, consisting of four procedural skills and 8-hour case-based learning(CBL), was developed by experienced physicians from the EM department in Peking Union Medical College Hospital(PUMCH). Medical students from Peking Union Medical College(PUMC) and Tsinghua University(THU) participated in the training. Three written tests were cautiously designed to examine the short-term(immediately after the program) and long-term(6 months after the program) efficacy of the training. After completion of the training program, an online personal appraisal questionnaire was distributed to the students on WeChat(a mobile messaging App commonly used in China) to achieve anonymous self-evaluation.RESULTS: Ninety-seven out of 101 students completed the intensive training and took all required tests. There was a significant increase in the average score after the intensive simulating training program(pre-training 13.84 vs. 15.57 post-training, P<0.001). Compared with the pre-training test, 63(64.9%) students made progress. There was no significant difference in scores between the tests taken immediately after the program and 6 months later(15.57±2.22 vs. 15.38±2.37, P=0.157). Students rated a higher score in all diseases and procedural skills, and felt that their learning was fruitful.CONCLUSIONS: The introduction of a standardized intensive training program in EM focusing on key competencies can improve clinical confidence, knowledge, and skills of medical students toward the specialty. In addition, having such a program can also enhance student’s interest in EM as a career choice which may enhance recruitment into the specialty and workplace planning.

Effect of electroacupuncture "Shenmen" on the expression of cAMP and cGMP in the myocardium, hippocampus and serum of rats with acute myocardial ischemia

Objective:Discussion on the protectiion of electroacupuncture"Shenmen"on heart and brain injury induced by acute myocardial ischemia in rats from the perspective of the expression of cyclic adenosine monophosphate(cAMP)and cyclic guanosine monophosphate(cGMP).Methods:Thirty male SD rats were randomly divided into normal group,model group,and electroacupuncture group.The electrocardiogram was recorded by the Powerlab 8-lead physiological recording system.The left anterior descending coronary artery was ligated to replicate the rat myocardial ischemia model.The acupuncture group was treated with electroacupuncture on the second day after the model was replicated.After the last electroacupuncture treatment,rat myocardium,hippocampus tissue and abdominal aortic blood were collected,and enzyme-linked immunosorbent assay was used to detect the levels of cAMP and cGMP in myocardium,hippocampus tissue and serum content.Results:Compared with the normal group,the cAMP content in the myocardial tissue of the model group was significantly increased,and the cAMP content in the hippocampus tissue and serum was significantly reduced;compared with the model group,the cAMP content in the myocardial tissue of the electroacupuncture group was decreased,and the hippocampus tissue Compared with the normal group,the content of cGMP in the myocardial tissue and serum of the model group increased,and the content of cGMP in the hippocampus decreased.Compared with the model group,the content of cGMP in the hippocampus of the electroacupuncture group was increased.The cGMP content increased,the serum cGMP content was significantly reduced,and the difference in the cGMP content in myocardial tissue was not statistically significant.Conclusion:Electroacupuncture at"Shenmen"acupoint can significantly improve the expression of cAMP,cGMP and myocardial cAMP in the serum and hippocampus of model rats with acute myocardial ischemia-induced heart and brain injury,but has a lower effect on myocardial cGMP content.

Moxibustion Treatment for Knee Osteoarthritis: A Meta-Analysis

Objective:To systematically evaluate the efficacy of Moxibustion in the treatment of knee osteoarthritis, and to provide a reasonable supplementary scheme for clinical medical treatment by analyzing the results of Moxibustion in the treatment of knee osteoarthritis and related experimental studies.Methods:Computerized retrieval of CNKI, Wanfang, PubMed and other databases from January 2009 to June 2019, published clinical controlled trials of Moxibustion in the treatment of knee osteoarthritis, and retrospective references of the required literature to improve the relevant literature retrieval, if there are documents that can not be downloaded, Manual search was carried out and the literature was included after quality evaluation. Meta-analysis was carried out with Review Manager 5.3 software.Results:A total of 1207 patients with knee osteoarthritis were included in 15pieces of literature. (1) In terms of total effective rate, moxibustion was superior to conventional Western drugs. Meta-analysis showed that RR=1.21,95%CI [1.14,1.28],Z=6.44,P < 0.00001;(2) In VAS score, moxibustion was superior to conventional Western drugs, meta-analysis of two groups: WMD=-2.71, 95% CI [-4.90, -0.52], Z=2.43,P < 0.05;(3) In WOMAC score, moxibustion was superior to conventional Western drugs, meta-analysis of two groups: WMD=-6.79,95%CI [-12.35,-1.23],Z=2.39,P < 0.05;(4) WOMAC pain. In terms of pain score, moxibustion was superior to conventional Western drugs. Meta-analysis showed that WMD=-1.34,95%CI [-2.50,-0.17],Z=2.25,P < 0.05;(5) knee joint function. On the contrary, moxibustion was superior to conventional Western drugs. Meta-analysis showed that WMD = 12.54, 95% CI [6.93, 18.15], Z = 4.28,P < 0.01;(6) In Lysholm index, moxibustion was superior to conventional Western drugs. Meta-analysis showed that WMD = 12.13, 95% CI [6.87, 17.39], Z = 4.52,P < 0.01;(7) In Lequesne index, moxibustion was superior to conventional Western drugs. Routine western drugs, meta-analysis: WMD =-4.22, 95% CI [-5.74, -2.70], Z = 5.45,P < 0.01.Conclusions: The efficacy of Moxibustion in the treatment of knee osteoarthritis is better than that of conventional western drug therapy, but a large sample size and high quality randomized controlled trials are still needed to verify and analyze.

Progress in ceramic materials and structure design toward advanced thermal barrier coatings

Thermal barrier coatings(TBCs)can effectively protect the alloy substrate of hot components in aeroengines or land-based gas turbines by the thermal insulation and corrosion/erosion resistance of the ceramic top coat.However,the continuous pursuit of a higher operating temperature leads to degradation,delamination,and premature failure of the top coat.Both new ceramic materials and new coating structures must be developed to meet the demand for future advanced TBC systems.In this paper,the latest progress of some new ceramic materials is first reviewed.Then,a comprehensive spalling mechanism of the ceramic top coat is summarized to understand the dependence of lifetime on various factors such as oxidation scale growth,ceramic sintering,erosion,and calcium–magnesium–aluminium–silicate(CMAS)molten salt corrosion.Finally,new structural design methods for high-performance TBCs are discussed from the perspectives of lamellar,columnar,and nanostructure inclusions.The latest developments of ceramic top coat will be presented in terms of material selection,structural design,and failure mechanism,and the comprehensive guidance will be provided for the development of next-generation advanced TBCs with higher temperature resistance,better thermal insulation,and longer lifetime.

Brittleness and fracture mechanism of sintered Dy-doped NdFeB magnets

The brittleness and fracture behaviors of the sintered and the two-stage aged Dy-doped NdFeB magnets were studied by a unique method of acoustic emission testing and Vickers hardness indentation method in this paper.A detailed analysis on the crack propagation mechanism along the grain boundary of the main grain phase(Nd,Dy)_(2)Fe_(14)B was done.By comparing the acoustic emission energy count value(E_(n))with the Vickers hardness indentation load(P),it is shown that there is a linear relationship between En and P for both the sintered and the two-stage aged Dy-doped NdFeB magnets.According to the slope of En versus P linear lines,it can be found that the two-stage aged Dy-doped NdFeB magnet is more brittle than the sintered one.It is due to that the Ndrich grain boundary phase of the two-stage aged Dy-doped NdFeB magnet is formed as thin film and uniformly distributes around the main grain phase,which plays a significant role in increasing the intrinsic coercive force of the magnet,but decreasing its interface binding strength.Therefore,the resistance of crack propagation along the grain boundary decreases and the brittleness increases.

Ganoderma lucidum protease hydrolyzate on lipid metabolism and gut microbiota in high-fat diet fed rats

In this study,we aimed to evaluate the effect of Ganoderma lucidum protease hydrolysate (GLPH) on lipid metabolism and intestinal flora in rats fed on a high-fat diet.Our research shows that GLPH reduces triglycerides,total cholesterol,low-density lipoprotein cholesterol,alanine aminotransferase and aspartate aminotransferase levels,but increases high-density lipoprotein cholesterol in the serum and liver.Besides,GLPH has hypolipidemic effects,such as sterol regulatory element-binding transcription factor 1C,acetyl-coenzyme A carboxylase at the liver mRNA level were down-regulated,5′-adenosine monophosphate (AMP)-activated protein kinase,acyl-CoA oxidase,farnesoid X receptor and peroxisome proliferator-activated receptor α at the liver mRNA level was upregulated.GLPH treatment changes the composition of the intestinal flora and reduces the relative abundance of potentially harmful bacteria,such as Alistipes,Clostridium.Spearman's correlation analysis showed that changes in faecal microbiota are related to biochemical indicators.In summary,our research indicates that GLPH can improve lipid metabolism disorders,regulate the structure of intestinal microbes,and can be used as a lipid-lowering functional food.

Research Progress on Processing and Processing Methods in Salvia miltiorrhiza Production Areas

Salvia miltiorrhiza is one of the 40 most commonly used traditional Chinese medicinal materials in clinics.It is effective in activating blood circulation,removing blood stasis,relieving pain through the meridian,clearing the heart and removing irritations,and cooling blood and eliminating blemishes.Each main production area has developed a unique production method and processing technology,in accordance with local conditions.The processed products included in Chinese Pharmacopoeia are purified and wine-fried S.miltiorrhiza.In addition,the Chinese province’s standards include the vinegar-fried and wine-fried types.S.miltiorrhiza is produced in more areas and is more extensively processed,with large variations in specifications.The challenge in establishing a uniform quality standard affects the clinical application of decoction pieces.This review has explored the books of the past dynasties,summarized the relevant literature published in the past three decades,discussed the processing methods of S.miltiorrhiza,and provided a basis for further research on the processing method of the original sample.In particular,we integrate fresh cut processing as the starting point for in-depth research,discuss the processing technology specifications,and formulate quality product standards.