Anti-inflammatory effect and antihepatoma mechanism of carrimycin

BACKGROUND New drugs are urgently needed for the treatment of liver cancer, a feat that could be feasibly accomplished by finding new therapeutic purposes for marketed drugs to save time and costs. As a new class of national anti-infective drugs, carrimycin(CAM) has strong activity against gram-positive bacteria and no cross resistance with similar drugs. Studies have shown that the components of CAM have anticancer effects.AIM To obtain a deeper understanding of CAM, its distribution, metabolism and antiinflammatory effects were assessed in the organs of mice, and its mechanism of action against liver cancer was predicted by a network pharmacology method.METHODS In this paper, the content of isovaleryl spiramycin Ⅲ was used as an index to assess the distribution and metabolism of CAM and its effect on inflammatory factors in various mouse tissues and organs. Reverse molecular docking technology was utilized to determine the target of CAM, identify each target protein based on disease type, and establish a target protein-disease type network to ascertain the effect of CAM in liver cancer. Then, the key action targets of CAM in liver cancer were screened by a network pharmacology method, and the core targets were verified by molecular docking and visual analyses.RESULTS The maximum CAM concentration was reached in the liver, kidney, lung and spleen 2.5 h after intragastric administration. In the intestine, the maximum drug concentration was reached 0.5 h after administration. In addition, CAM significantly reduced the interleukin-4(IL-4) levels in the lung and kidney and especially the liver and spleen;moreover, CAM significantly reduced the IL-1β levels in the spleen, liver, and kidney and particularly the small intestine and lung. CAM is predicted to regulate related pathways by acting on many targets,such as albumin, estrogen receptor 1, epidermal growth factor receptor and caspase 3, to treat cancer, inflammation and other diseases.CONCLUSION We determined that CAM inhibited inflammation. We also predicted the complex multitargeted effects of CAM that involve multiple pathways and the diversity of these effects in the treatment of liver cancer, which provides a basis and direction for further clinical research.

Clostridium perfringens infection after transarterial chemoembolization for large hepatocellular carcinoma

We report an unusual case of Clostridium perfringens liver abscess formation after transcatheter arterialchemoembolization(TACE) for large hepatocellular carcinoma.Severe deterioration in liver and renal function accompanied with hemocytolysis was found on the 2nd day after TACE.Blood culture found Clostridium perfringens and abdominal computed tomography revealed a gas-containing abscess in the liver.Following antibiotics administration and support care, the infection was controlled and the liver and renal function turned normal.The 2nd TACE procedure was performed 1.5 mo later and no recurrent Clostridium perfringens infection was found.

Oxaliplatin and 5-fluorouracil hepatic infusion with lipiodolized chemoembolization in large hepatocellular carcinoma

AIM: To investigate transarterial chemoembolization(TACE) with hepatic infusion of oxaliplatin and 5-fluorouracil and Lipiodol chemoembolization in large hepatocellular carcinoma(HCC).METHODS: In this retrospective study, 132 patients with unresectable HCCs larger than 10 cm were treated with hepatic infusion of oxaliplatin and 5-fluorouracil followed by Lipiodol chemoembolization. The primary endpoint was overall survival(OS). Sixteen-week disease-control rate, time to progression(TTP), and major complications were also studied. Univariate and multivariate analyses were performed to identify prognostic factors affecting OS and TTP.RESULTS: A total of 319 procedures were performed in the 132 patients. Eleven(8.3%) patients received radical resection following TACE treatment(median time to initial TACE 4.3 ± 2.3 mo). The median OS and TTP were 10.3 and 3.0 mo respectively, with a 50.0% 16-wk disease-control rate. Major complications were encountered in 6.0%(8/132) of patients following TACE and included serious jaundice in 1.5%(2/132) patients, aleukia in 1.5%(2/132), and hepatic failure in 3.0%(4/132). One patient died within one month due to serious hepatic failure and severe sepsis after receiving the second TACE. The risk factor associated with TTP was baseline alpha-fetoprotein level, and vascular invasion was an independent factor related to OS.CONCLUSION: Hepatic infusion of oxaliplatin and 5-fluorouracil followed by lipiodolized-chemoembolization is a safe and promising treatment for patients with HCCs larger than 10 cm in diameter.

Evaluation of Impact of Major Causes of Death on Life Expectancy Changes in China,1990-2005

Objective To evaluate the impact of major causes of death on changes of life expectancy in China. Methods Life expectancy was calculated by standard life table techniques using mortality data from the national censuses in 1990 and 2000 and the 1% National Population Sampling Surveys in 1995 and 2005, Mortality data about the major causes of death from VR-MOH were used as reference values to estimate their death proportions of the specific age groups by sex and regions, as well as all-cause mortality and age-specific mortality rates of major causes of death. Decomposition method was used to quantitatively evaluate the impact. Results Three key findings were identified in our study. First, China's health challenge was shifted from diseases related to living conditions to those related to behavior and lifestyle, with rural areas relatively lagged behind urban areas, Second, the impacts of cardiovascular diseases and neoplasm on the middle aged and elderly population were stressed. Third, compared to the urban population, the rural population tended to have increasing mortality of neoplasm and cardiovascular diseases, especially in adults at the age of 15-39 years. Conclusion Further efforts should be made to reduce the incidence of neoplasm and cardiovascular diseases, especially in rural areas, by promoting healthy behavior and lifestyle and providing appropriate therapies for all patients in need.

Metastatic infection caused by hypervirulent Klebsiella pneumonia and co-infection with Cryptococcus meningitis: A case report

BACKGROUND Klebsiella pneumoniae(K.pneumoniae)used to affect mainly people with compromised immunity or weakened by other infections,but recent emergence of hypervirulent strains has increased infections even in healthy individuals.These infections include liver abscess,pneumonia,bacteremia,meningitis,necrotizing fasciitis,and endophthalmitis.Although metastatic infection by hypervirulent K.pneumoniae(hvKP)is increasingly recognized,co-infection with Cryptococcus neoformans(C.neoformans)meningitis in immunocompetent hosts is rare but fatal.So,it is necessary to determine the risk factors,complications,and comorbidity of this disease.CASE SUMMARY This report describes a 58-year-old man with hvKP pulmonary abscess,bacteremia,and meningitis,accompanied by fatal Cryptococcus meningitis.This patient presented with fever for 1 wk and drowsiness for 3 d.Laboratory findings revealed pulmonary abscess and bacteremia of K.pneumoniae.He was given intravenous antibiotic therapy,and the infection was under control for about 1 wk.However,his condition deteriorated rapidly because of metastatic purulent meningitis.Although hvKP and C.neoformans were isolated and confirmed,the patient died of spontaneous respiratory and cardiac arrest caused by cerebral hernia.CONCLUSION HvKP has emerged as a cause of metastatic infections in immunocompetent hosts.polymicrobial co-infections should be taken into consideration when metastatic infection is present.

TDZ-Induced High Frequency Plant Regeneration through Direct Shoot Organogenesis in <i>Stevia rebaudiana</i>Bertoni: An Important Medicinal Plant and a Natural Sweetener

An efficient high frequency plant regeneration protocol through direct organogenesis was developed for Sevia rebaudiana Bert. Nodal segments containing axillary buds were used as an explant and inoculated on Murashige and Skoog’s (MS) medium containing 3% (w/v) sucrose, 0.8% (w/v) agar supplemented with various concentrations of benzyladenine (BA), kinetin (Kn) and thidiazuron (TDZ) ranging from 1.00 to 9.00 μM. Maximum multiple shoots (96%) were obtained in MS medium supplemented with 1.0 μM TDZ with an average of 60 shoots per culture, having an average shoot length of 6.0 cm. The best in vitro root induction (89%) was achieved on half strength MS medium without any growth regulator with an average of 24 roots per culture and root length of7 cm. The rooted plantlets were successfully established in soil and grown to maturity at the survival rate of 95% in the indoor grow room. High-performance liquid chromatography was used to assess the stability in chemical profile and quantification of stevioside and rebaudioside A content of in vitro propagated S. rebaudiana plants and compared with their mother plant at the peak vegetative stage. Our results show no significant differences (p in vitro propagated plants. Furthermore, fully developed in vitro propagated S. rebaudiana plants were also compared with mother plant for their gas and water vapour exchange characteristics and leaf anatomy. The results show that in vitro propagated and hardened plants of S. rebaudiana are morphologically as well as functionally comparable to each other and to their mother plant.

Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure:A case report

BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.

Scale-up synthesis and characterization of 2,6-diamino-3,5-dinitropyrazine-1-oxide

2,6-diamino-3,5-dinitropyrazine-1-oxide(ANPZO), as an insensitive high explosive, with a high yield and excellent purity has been prepared at pilot plant scale by an improved method. The synthesized ANPZO is characterized by IR, laser granularity measurement, SEM and HPLC.The particle analysis revealed that the improved method could offer desired product with average particle size of 40 mm and high purity(>98.45%). The experimental parameters exhibited that the detonation velocity of the formulation based on ANPZO was higher than that of the corresponding TATB formulation. The DSC curve showed that the exothermic decomposition of the product occurred at the temperature between300.5 C and 360.4 C. Furthermore, the sensitivity test suggests its safe nature towards mechanical stimulus.

In vivo evaluation and mechanism prediction of anti-diabetic foot ulcer based on component analysis of Ruyi Jinhuang powder

BACKGROUND Diabetes is a metabolic disease with a high complication rate.Diabetic foot ulcers(DFUs)seriously affect the quality of life of patients.A total of 15%-20%of diabetic patients develop DFUs,which heal with difficulty over a long time and can result in amputation and disability.Traditional Chinese medicine has a unique effect in the treatment of skin ulcerative diseases.Ruyi Jinhuang powder(RHP)is one of the classic prescriptions in traditional Chinese medicine and is widely used in clinical practice.AIM To verify the ability of RHP to promote wound healing by electron microscopy analysis in animal models and hematoxylin-eosin(HE)staining.The effective components of RHP were extracted and identified by gas chromatography-mass spectrometry(GC-MS),and the obtained chemical components were analyzed by network pharmacology methods to predict its therapeutic mechanism.METHODS Sprague Dawley rats were injected with streptozotocin to establish the DFU model.HE staining was used to observe the wound tissue under an electron microscope.The chemical constituents of RHP were extracted first by supercritical fluid extraction and alcohol extraction,and then,GC-MS and ultra-performance liquid chromatography–MS were used to separately identify the chemical constituents.In addition,the"herb-component-target"link was established through the Traditional Chinese Medicine Systems Pharmacology database to obtain the target information,and the molecular docking of important components and key targets was performed in Discovery Studio software.Cytoscape software was used to visualize and analyze the relationship between the chemical composition,targets and Traditional Chinese Medicine network.RESULTS RHP promoted DFU healing in rats by affecting fibroblasts and nerve cells.A total of 89 chemical components were obtained by GC-MS.Network pharmacological analysis revealed that RHP was associated with 36 targets and 27 pathways in the treatment of DFU,of which the important components were luteolin,trans caryophyllene,ar-turmerone,palmitic acid,methyl palmitate,gallic acid,demethoxycurcumin,berberine,and rheic acid.The key targets were posttranscriptional silencing,topoisomerase II alpha,muscarinic acetylcholine receptor M2,interleukin 6,tumor necrosis factor and retinoic X receptor alpha,and the key pathways were the phosphoinositide 3-kinase-protein kinase B signaling pathway,neuroactive ligand–receptor interactions,and the forkhead box O signaling pathway.CONCLUSION Our results indicated that RHP may play a role in the treatment of DFU through these target pathways by affecting insulin resistance,altering the nervous system and immune system,participating in inflammatory responses and regulating cell proliferation,differentiation and apoptosis through other specific mechanisms.

Metal-organic framework IRMOFs coated with a temperaturesensitive gel delivering norcantharidin to treat liver cancer

BACKGROUND Norcantharidin(NCTD)is suitable for the treatment of primary liver cancer,especially early and middle primary liver cancer.This compound can reduce tumors and improve immune function.However,the side effects of NCTD have limited its application.There is a marked need to reduce the side effects and increase the efficacy of NCTD.AIM To develop a nanomaterial carrier,NCTD-loaded metal-organic framework IRMOF-3 coated with a temperature-sensitive gel(NCTD-IRMOF-3-Gel),aiming to improve the anticancer activity of NCTD and reduce the drug dose.METHODS NCTD-IRMOF-3-Gel was obtained by a coordination reaction.The apparent characteristics and in vitro release of NCTD-IRMOF-3-Gel were investigated.Cell cytotoxicity assays,flow cytometry,and apoptosis experiments in mouse hepatoma(Hepa1-6)cells were used to determine the anti-liver cancer activity of NCTD-IRMOF-3-Gel in in vitro models.RESULTS The particle size of NCTD-IRMOF-3-Gel was 50-100 nm,and the particle size distribution was uniform.The release curve showed that NCTD-IRMOF-3-Gel had an obvious sustained-release effect.The cytotoxicity assays showed that the free drug NCTD and NCTD-IRMOF-3-Gel treatments markedly inhibited Hepa1-6 cell proliferation,and the inhibition rate increased with increasing drug concentration.By flow cytometry,NCTD-IRMOF-3-Gel was observed to block the Hepa1-6 cell cycle in the S and G2/M phases,and the thermosensitive gel nanoparticles may inhibit cell proliferation by inducing cell cycle arrest.Apoptosis experiments showed that NCTD-IRMOF-3-Gel induced the apoptosis of Hepa1-6 cells.CONCLUSION Our results indicated that the NCTD-IRMOF-3-Gel may be beneficial for liver cancer disease treatment.

Management of the palato-radicular groove with a periodontal regenerative procedure and prosthodontic treatment:A case report

BACKGROUND Palato-radicular groove(PRG)is defined as an anomalous formation of teeth.The etiology of PRG remains unclear.The prognosis of a tooth with a PRG is unfavorable.The treatment of combined periodontal-endodontic lesions requires multidisciplinary management to control the progression of bone defects.Some researchers reported cases that had short-term observations.The management of teeth with PRGs is of great clinical significance.However,to date,no case reports have been documented on the use of bone regeneration and prosthodontic treatment for PRGs.CASE SUMMARY This case reported the management of a 40-year-old male patient with the chief complaint of slight mobility and abscess in the upper right anterior tooth for 15 d and was diagnosed with type II PRG of tooth 12 with combined endodonticperiodontal lesions.The accumulation of plaque and calculus caused primary periodontitis and a secondary endodontic infection.A multidisciplinary management approach was designed that included root canal therapy,groove sealing,a periodontal regenerative procedure,and prosthodontic treatment.During a 2-year follow-up period,a good prognosis was observed.CONCLUSION This report indicates that bone regeneration and prosthodontic treatment may contribute to the long-term favorable prognosis of teeth with PRGs.

Energy-efficient methods for production methane from natural gas hydrates

Gas hydrates now are expected to be one of the most important future unconventional energy resources. In this paper, researches on gas hydrate exploitation in laboratory and field were reviewed and discussed from the aspects of energy efficiency. Different exploiting methods and different types of hydrate reservoir were selected to study their effects on energy efficiencies. Both laboratory studies and field tests have shown that the improved technologies can help to increase efficiency for gas hydrate exploitation. And it also showed the trend that gas hydrate exploitation started to change from permafrost to marine. Energy efficiency ratio （EER） and energy return on energy invested （EROI） were introduced as an indicator of efficiency for natural gas hydrate exploitation. An energy-efficient hydrate production process, called ＂Hydrate Chain Energy System （HCES）＂, including treatment of flue gas, replacement of CH4 with CO2, separation of CO2 from CH4, and storage and transportation of CH4 in hydrate form, was proposed for future natural gas hydrate exploitation. In the meanwhile, some problems, such as mechanism of C02 replacement, mechanism of CO2 separation, CH4 storage and transportation are also needed to be solved for increasing the energy efficiency of gas hydrate exploitation.

Treatment of radiation-induced hemorrhagic gastritis with prednisolone:A case report

Radiation-induced gastritis is an infrequent cause of gastrointestinal bleeding.It is a serious complication arising from radiation therapy,and the standard treatment method has not been established.The initial injury is characteristically acute inflammation of gastric mucosa.We presented a 46-year-old male patient with hemorrhagic gastritis induced by external radiotherapy for metastatic retroperitoneal lymph node of hepatocellular carcinoma.The endoscopic examination showed diffuse edematous hyperemicmucosa with telangiectasias in the whole muscosa of the stomach and duodenal bulb.Multiple hemorrhagic patches with active oozing were found over the antrum.Anti-secretary therapy was initiated for hemostasis,but melena still occurred off and on.Finally,he was successfully treated by prednisolone therapy.We therefore strongly argue in favor of perdnisolone therapy to effectively treat patients with radiation-induced hemorrhagic gastritis.

Sequence stratigraphic framework and sedimentary model of Shanxi Formation in northeast Zhoukou Depression of the North China Plate

The sequence stratigraphic framework of Shanxi Formation in the northeast Zhoukou Depression was established based on detailed sequence stratigraphical and sedimentological analysis by utilizing the logging and core data of six wells drilled in the eastern tectonic unit of Zhoukou Depression.It was divided into three third-order sequences,namely SQs1,SQs2,and SQs3 from bottom to top.Each sequence can be divided into a transgressive system tract(TST)and a highstand system tract(HST).Furthermore,four sequence boundaries and three maximum flooding surfaces were identified,and they are the bottom interface SBs and maximum flooding surface mfss1 of SQs1,the bottom interface SBs1 and maximum flooding surface mfss2 of SQs2,the bottom interface SBs3 and maximum flooding surface mfss3 of SQs3,and the top interface SBx from bottom to top.Carbonate tidal flat–clastic tidal flat sedimentary system developed in Shanxi Formation in the northeast Zhoukou Depression(also referred to as the study area)under the control of regression.Meanwhile,four sedimentary microfacies were identified in the sedimentary system,which are lime-mud flats,sand flats,mixed flats,and mud flats.The transgression in the study area occurred from the southeast to the northwest.Therefore,the northwestern part is the seaward side,and the southeastern part is the landward side.As revealed by relevant drilling data,SQs1 of the Shanxi Formation is characterized by the development of limestone and carbonaceous mudstone,with limestone,dark mudstone,and carbonaceous mudstone mainly developing.Meanwhile,lime-mud flats were mainly deposited in it.During the periods of SQs2 and SQs3,the sedimentary environment of the study area changed from the carbonate tidal flats to clastic tidal flats as the coastline migrated towards the sea.In these periods,sand flats mainly developed near the maximum flooding surfaces and were relatively continuous in the eastern and southern parts of the transgressive system tract;mixed flats were relatively continuous in the western and northern parts of the transgressive system tract as well as the eastern and southern parts of the highstand system tract;mud flats widely developed in the highstand system tract.Peat flats mainly developed in the period of HSTs2,with coal seams relatively developing in the southeastern part of the study area as revealed by drilling data.The peat flats in SQs2 are favorable hydrocarbon source layers,the lime-mud flats in SQs1 and sand flats formed in the transgression periods of SQs2 and SQs3 constitute favorable hydrocarbon reservoirs,and the mud flats form in the transgressions periods serve as favorable cap rocks.Therefore,the study area features a reservoir-cap assemblage for self-generating and self-storing of hydrocarbon,and the southeastern part of the study area can be taken as a favorable exploration area.

Editorial

2,6-diamino-3,5-dinitropyrazine-1-oxide(ANPZO), as an insensitive high explosive, with a high yield and excellent purity has been prepared at pilot plant scale by an improved method. The synthesized ANPZO is characterized by IR, laser granularity measurement, SEM and HPLC.The particle analysis revealed that the improved method could offer desired product with average particle size of 40 mm and high purity(>98.45%). The experimental parameters exhibited that the detonation velocity of the formulation based on ANPZO was higher than that of the corresponding TATB formulation. The DSC curve showed that the exothermic decomposition of the product occurred at the temperature between300.5 C and 360.4 C. Furthermore, the sensitivity test suggests its safe nature towards mechanical stimulus.

Molecular Analysis of Genetic Fidelity in Micropropagated Plants of <i>Stevia rebaudiana</i>Bert. Using ISSR Marker

Inter-simple sequence repeat (ISSR) markers were used to evaluate the genetic fidelity of in vitro propagated and hardened plants of Stevia rebaudiana Bert. Nodal segments containing axillary buds were used as explant and inoculated on Murashige and Skoog’s (MS) medium containing 3% (w/v) sucrose, 0.8% (w/v) agar supplemented with various concentrations of benzyladenine (BA), kinetin (Kn) and thidiazuron (TDZ) ranging from 0.20 to 2.00 mg·L-1. Maximum multiple shoots (93%) were obtained in MS medium supplemented with 0.20 mg L-1 TDZ. The best in vitro root induction (87%) was achieved on half strength MS medium without any growth regulator. The rooted plantlets were successfully established in soil and grown to maturity at the survival rate of 96% in the indoor grow room. For ISSR analysis, total genomic DNA was extracted from 20 mg fresh leaves of mother and randomly selected in vitro propagated plants. Out of? fifteen arbitrary primers tested, each produced clear and scorable amplification products ranged in size from about 216 bp in UBC 811 to 1917 bp in (GGGGT)3M with an average of 4.5 products per primer. A total of 45 bands (number of plantlets analyzed multiplied by number of bands with all primers) were generated by the ISSR method. All the ISSR profiles from micropropagated plants were monomorphic and comparable to mother plants, confirming the genetic stability among micropropagated plants and mother plant. Chemical analysis, using high-performance liquid chromatography (HPLC), was done to further confirm the existence of qualitative and quantitative differences in the major secondary metabolites (rebaudioside A, stevioside and steviolbioside) between the mother plant and in vitro propagated plants. Our results clearly show similar chemical profiles and insignificant differences in the major secondary metabolites between the two types of plants. These results suggest that the micropropagation protocol followed in this study is appropriate and applicable for clonal mass propagation of true-to-type elite Stevia rebaudiana plants.

Chinese registry of rheumatoid arthritis: IV. Correlation and consistency of rheumatoid arthritis disease activity indices in China

Background:Disease activity indices(DAIs)including disease activity score 28(DAS28),simplified disease activity index(SDAI),and clinical disease activity index(CDAI)have been widely used in clinical practice and research studies of rheumatoid arthritis(RA).The objective of our study was to evaluate the correlation and concordance among different DAIs in Chinese patients with RA.Methods:A cross-sectional study,including patients enrolled in the Chinese registry of rheumatoid arthritis from November 2016 to August 2018,was conducted.The correlations were evaluated using Spearman correlation coefficient and concordance with Bland-Altman plots,quadratic weighted kappa,and discordance rates in the crosstab.For other indices,the optimal cutoff points corresponding to SDAI remission were explored through receiver operating characteristic curve analysis.Results:A total of 30,501 patients were included,of whom 80.46%were women.Most individuals were with moderate disease activity or high disease activity.High correlations among DAS28-erythrocyte sedimentation rate(ESR)and DAS28-C-reactive protein(CRP),SDAI and CDAI were observed.Similarly,the weighted kappa value among the indices was high.In Bland-Altman plots,a positive difference between DAS28-ESR and DAS28-CRP was observed,with an absolute difference of>1.2 in 3079(10.09%)patients.In crosstab,approximately 30%of the patients were classified into different groups.Concordance values between SDAI remission and the optimal cutoff points of DAS28-ESR,DAS28-CRP,and CDAI were 3.06,2.37,and 3.20,respectively.Conclusions:Although DAIs had high correlations and weighted kappa values,the discordance between DAIs was significant in Chinese patients with RA.The four DAIs are not interchangeable.

Out-of-pocket payments and economic consequences from tuberculosis care in eastern China:income inequality

Background:Despite the availability of free tuberculosis(TB)diagnosis and treatment,TB care still generates substantial costs that push people into poverty.We investigated out-of-pocket(OOP)payments for TB care and assessed the resulting economic burden and economic consequences for those with varying levels of household income in eastern China.Methods:A cross-sectional study was conducted among TB patients in the national TB programme networks in eastern China.TB-related direct OOP costs,time loss,and coping strategies were investigated across households in different economic strata.Analysis of Variance was used to examine the differences in various costs,and Kruskal-Wallis tests were used to compare the difference in total costs as a percentage of annual household income.Results:Among 435 patients,the mean OOP total costs of TB care were USD 2389.5.In the lower-income quartile,OOP payments were lower,but costs as a percentage of reported annual household income were higher.Medical costs and costs prior to treatment accounted for 66.4 and 48.9%of the total costs,respectively.The lower the household income was,the higher the proportion of medical costs to total costs before TB treatment,but the lower the proportion of medical costs patients spent in the intensive phase.TB care caused 25.8%of TB-affected households to fall below the poverty line and caused the poverty gap(PG)to increase by United States Dollar(USD)145.6.Patients in the poorest households had the highest poverty headcount ratio(70.2%)and PG(USD 236.1),but those in moderately poor households had the largest increase in the poverty headcount ratio(36.2%)and PG(USD 177.8)due to TB care.Patients from poor households were more likely to borrow money to cope with the costs of TB care;however,there were fewer social consequences,except for food insecurity,in poor households.Conclusions:Medical and pretreatment costs lead to high costs of TB care,especially among patients from the poorest households.It is necessary to train health system staff in general hospitals to promptly identify and refer TB patients.Pro-poor programmes are also needed to protect TB patients from the medical poverty trap.

Anaphylaxis effect and substance basis of honeysuckle extract

Objective:To explore the anaphylaxis effect and anaphylaxis substances of honeysuckle.Methods:Rat peritoneal mast cells(PMC)were separated and purified,the cells were incubated with compound 48/80(0.02 g/L),physiological saline and honeysuckle extract(120 g/L)at 37°C for 0,15,30,45 and 60 min.Degranulation were observed by optical microscope and transmission electron microscope.Annexin V positive cell rate was detected by flow cytometry to reflect the degranulation rate of PMC.SD rats were supplied with honeysuckle extract by intravenous injection at a dose of 2.25 g/L.After administration,different parameters were analyzed,including the symptoms,histamine(HIS)and tryptase(MCT)levels,which were determined to explore the effect of anaphylaxis.Regression analysis was used to calculate the relationships between the peaks and the pharmacological effects to explore potentially anaphylactoid components.Results:The percentage of Annxin V positive cells and the degranulation ratio were markedly elevated in PMC treated with honeysuckle extract for more than 15 min(P<0.05).HIS and MCT level were significantly elevated after injection of honeysuckle extract for more than 15 min.Morphology of PMC and systemic symptoms were also changed compared with the controlled group(P<0.05).Regression analysis was used to calculate the relationship between peaks and pharmacological effects,and to determine peaks 7,10 and 13 as possible anaphylactoid ingredients.Conclusion:This study established a prospective method to clarify the anaphylactoid components of honeysuckle extract,which would provide guidance for screening anaphylactoid components in traditional Chinese medicine injections containing honeysuckle in the prescription.

A guinea pig model of Ciwujia Injection-induced anaphylaxis for allergic substance screening

Objective: Though especially efficient for cardiovascular and cerebrovascular diseases treatment, many serious anaphylactic diseases could be induced by Ciwujia Injection(CWJI). However, study of the mechanism and detection of allergies have been investigated by the unknown sources of allergenic substances.In this study, a guinea pig model which could mimic the symptoms of anaphylactic reactions induced by Ciwujia Injection(CWJI) was modeled and used to screen the allergenic substance of CWJI.Methods: Guinea pigs were sensitized three times every other day with CWJI and excitated 14 d after the last sensitization administration. Then, the histamine, trypsin, IL-4 and IFN-γ levels, and the Annexin V positive rate of peritoneal mast cells(PMC) were detected, the numbers of B lymphocyte and the pathological changes were also analyzed to verify the guinea pig allergy model, PCA test and Ig E antibody levels were determined to study the mechanism.Results: The levels of total IgE, histamine, and trypsin were significantly increased after CWJI sensitization, IL-4 level was elevated, Annexin V positive of PMC cell rate, local skin reactions, and declined IFN-γwere observed after excitation. Histological examination showed that mild pathological changes in lungs were found.Conclusion: This guinea pig model may provide a powerful tool to study the mechanism in CWJI induced anaphylaxis and screen the allergic source of CWJI.