Metabolic and Behavioral Patterns in a Pre-Menstrual Syndrome Animal Model with Liver-qi Invasion and Their Reversal by a Chinese Traditional Formula

This work successfully used model rats with Pre-Menstrual Syndrome (PMS) liver-qi invasion in the early de-velopment days to detect the Metabolic and Behavioral Patterns and their reversal by a Chinese traditional for-mula. Our aim is to verify the reliability of PMS liver-qi invasion rat model and explore some micro- mecha-nism of the syndrome of the liver failing to maintain the normal flow of qi. 30 rats with estrous cycles not in accepting time were selected and divided randomly into three groups: the normal control group, PMS liver-qi invasion model group and PMS liver-qi invasion medication-administered group. Emotional stimulation and multiple factors combination were used to prepare the PMS liver-qi invasion model. Baixiangdan Capsules (a Chinese traditional formula) were administered to rats to interfere with the PMS liver-qi invasion mode. Open-field test was used to explore behavioral aspects of the model. Urine samples, from the three groups, were collected and analyzed with UPLC-Q-TOF method to detect changes in metabolites related to liver func-tions. In the open-field experiment, the crossing scores, rearing scores and open-field experiment total scores of rats in the PMS liver-qi invasion model group increased remarkably (P < 0.05) compared with the scores of the normal control group, the tendency was retrieved remarkably after medications (P < 0.05). Metabolic finger-prints between the PMS liver-qi invasion model group and the normal control group had also distinguished changes through principal component analysis, and an evident restoration trend occurred after Baixiangdan Capsules administration. Taken together, behavioral and metabolic patterns can differentiate the PMS liver-qi invasion rat models from the normal rats. Our results identified potential biological markers that might reflect metabolic pathologies associated with PMS liver-qi invasion.

Leukopenia-a rare complication secondary to invasive liver abscess syndrome in a patient with diabetes mellitus:A case report

BACKGROUND Thrombocytopenia is a common complication of invasive liver abscess syndrome(ILAS)by Klebsiella pneumoniae(K.pneumoniae)infection,which indicates severe infection and a poor prognosis.However,the presence of leukopenia is rare.There are rare reports on leukopenia and its clinical significance for ILAS,and there is currently no recognized treatment plan.Early and broad-spectrum antimi-crobial therapy may be an effective therapy for treating ILAS and improving its prognosis.CASE SUMMARY A 55-year-old male patient who developed fever,chills,and abdominal distension without an obvious cause presented to the hospital for treatment.Laboratory tests revealed thrombocytopenia,leukopenia,and multiple organ dysfunction.Imaging examinations revealed an abscess in the right lobe of the liver and thromboph-lebitis,and K.pneumoniae was detected in the blood cultures.Since the patient was diabetic and had multi-system involvement,he was diagnosed with ILAS accom-panied by leukopenia and thrombocytopenia.After antibiotic treatment and sys-temic supportive therapy,the symptoms disappeared,and the patient’s condition almost completely resolved.CONCLUSION Leukopenia is a rare complication of ILAS,which serves as an indicator of adverse prognostic outcomes and the severity of infection.

Klebsiella pneumoniae invasive liver abscess syndrome with purulent meningitis and septic shock: A case from China's Mainland

We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient&#x02019;s condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in China's Mainland. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.

Successful treatment of invasive liver abscess syndrome caused by Klebsiella variicola with intracranial infection and septic shock:A case report

BACKGROUND Klebsiella variicola(K.variicola)is a member of the Klebsiella genus and is often misidentied as Klebsiella pneumoniae.In this report,we present a rare case of invasive liver abscess caused by K.variicola.CASE SUMMARY We report a rare case of liver abscess due to K.variicola.A 57-year-old female patient presented with back pain for a month.She developed a high-grade fever associated with chills,and went into a coma and developed shock.The clinical examinations and tests after admission confirmed a diagnosis of primary liver abscess caused by K.variicola complicated by intracranial infection and septic shock.The patient successfully recovered following early percutaneous drainage of the abscess,prompt appropriate antibiotic administration,and timely open surgical drainage.CONCLUSION This is a case of successful treatment of invasive liver abscess syndrome caused by K.variicola,which has rarely been reported.The findings of this report point to the need for further study of this disease.

Biological basis of “depression with liver-qi stagnation and spleen deficiency syndrome”: A digital gene expression profiling study

Objective:To investigate the biological basis of“depression with liver-qi stagnation and spleen deficiency syndrome”.Methods:A digital gene expression profiling method was conducted to explore global changes in the mRNA transcriptome in a rat model of depression with liver-qi stagnation and spleen deficiency syndrome.Real-time quantitative polymerase chain reaction(q-PCR)was performed to verify the five genes most interest based on the Kyoto Encyclopedia of Genes and Genome(KEGG)analysis.Sini San,which disperses stagnated liver qi and strengthens the spleen,was administered to the model rats to observe whether it could reverse these genetic changes in the liver.Results:Forty-six differentially expressed genes were identified.Three of the five genes of most interestdHnf4a,Hnf4g and Cyp1a1dbased on KEGG analysis,were confirmed by realtime q-PCR.Sini San reduced the gene expression changes of Hnf4a,Hnf4g and Cyp1a1 in the rat model.Conclusions:Hnf4a,Hnf4g and Cyp1a1 are involved in“depression with liver-qi stagnation and spleen deficiency syndrome”.These findings indicate that depressed rats with liver-qi stagnation and spleen deficiency syndrome are at risk of liver diseases.Furthermore,our results will inform exploration of the etiology of depression and help in the development of effective therapeutic strategies.

OUTCOMES OF INVASIVE STRATEGY TO PATIENTS WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROMES

Objective To compare the outcomes of an invasive with a conservative strategy in the manage-ment of patients with non-ST-elevation acute coronary syndromes. Methods From January 2000 to June 2001, 505 patients presenting with unstable angina or non-Q wave myocardial infarction were divided into two groups (conservative vs. invasive) according to management strategy. Patients assigned to an early invasive strategy underwent coronary angiography within 7d of enrollment after intensive antiplatelet, antithrombotic and antiangina therapy and revascularization as appropriate. All patients were followed up at least 6 months. The primary endpoints were cardiac death and acute myocardial infarction. Recurrence angina and readmission were the secondary end-point. Results There were 194 patients in conservative group and311 patients in invasive group. Overall, coronary angiography was performed in 100% and 56% , and revascularization in 93% and 52% in the invasive and conservative groups, respectively. During a mean of 11±5.7 months (range 6 ~ 24 months) of follow-up, the occurrence of primary endpoint was significantly lower in the invasive group than that in the conservative group (3.9% vs 8. 2% , P =0. 036). The rate of recurrent angina (48% vs 17% , P =0. 001) , readmission (41% vs 13% , P = 0. 001) and revascularization (12% vs 35% , P =0. 001) was also significantly lower in patients assigned to invasive strategy. Conclusion The study indicates that the early invasive approach may be the preferred strategy in patients with unstable angina or non-Q wave myocardial infarction.

Effects of IGF-Ⅱand TGF-β1 on invasiveness of placental trophoblast cells in patients with pregnancy-induced hypertension syndrome

Objective: This study was to investigate the invasiveness of pregnancy-induced hypertension (PIH) trophoblast cells and evaluate the effects of IGF-Ⅱand TGF-β1 on cytotrophoblast invasion.Methods: Cytotrophoblast cells from normal and PIH placenta were separated and purified. Cytotrophoblast invasiveness of normal and PIH placenta was measured by in vitro invasion assay. Effects of IGF-Ⅱand TGF-β1 on cytotrophoblast invasion were also studied.Results: In PIH group, cytotrophoblast invasiveness was dramatically decreased. In normal group, trophoblast invasiveness was significantly enhanced by IGF-Ⅱ but inhibited by TGF-β1. Neither IGF-Ⅱ nor TGF-β1 had statistically significant effects on PIH trophoblast invasion.Conclusions: PIH cytotrophoblast invasiveness dramatically decreases as compared to the normal level. IGF-Ⅱand TGF-β1 may play an important role in shallow trophoblast invasion on PIH.

Coronary artery disease in women:From the yentl syndrome to contemporary treatment

In recent years attention has been raised to the fact of increased morbidity and mortality between women who suffer from coronary disease. The identification of the so called Yentl Syndrome has emerged the deeper investigation of the true incidence of coronary disease in women and its outcomes. In this review an effort has been undertaken to understand the interaction of coronary disease and female gender after the implementation of newer therapeutic interventional and pharmaceutics' approaches of the modern era.

Robotic Transthoracic First Rib Resection for Neurogenic Thoracic Outlet Syndrome

Purpose: Neurogenic Thoracic Outlet Syndrome accounts for over 95% of patients with TOS. We report a single institution experience with robotic first rib resection in patients with Neurogenic TOS. Methods: The diagnosis of NTOS was made in patients in whom all specific localizing and diagnostic orthopedic and neurologic conditions were ruled out. Preoperative diagnostic tests included a comprehensive history and physical exam, Chest X-ray, Chest CT, MRI if the cervical spine, Nerve conduction studies, and Magnetic Resonance angiography of the Thoracic outlet with arm maneuvers (MRA). Patients with NTOS who underwent robotic first rib resection with disarticulation of the costosternal joint and scalenectomy. Results: There were 137 patients (47 men and 90 women). Mean age was 34 ± 9.5 years. Operative time was 93 minutes ± 10.3 minutes. There were no intraoperative complications. There was no injury to the subclavian vessels during the dissection. There were no neurovascular complications. There was no 30 or 90 day mortality. Quick DASH Scores (Mean ± SEM) decreased from 60.3+/2.1 preoperatively to 5 ± 2.3 in the immediate postoperative period, and 3.5+/1.1 at 6 months. (P < 0.01) Immediate relief of symptoms was seen in all patients (100%). Complete relief of symptoms was seen in 133/137 (97%) of patients. Conclusions: Robotic resection of the medial aspect of the first rib with disarticulation of the costo-sternal joint is associated with excellent relief of neurologic symptoms in patients with Neurogenic Thoracic Outlet Syndrome.

Nutrient drink test: A promising new tool for irritable bowel syndrome diagnosis

BACKGROUND Irritable bowel syndrome(IBS) is a highly prevalent condition. It is diagnosed on the basis of chronic symptoms after the clinical and/or investigative exclusion of organic diseases that can cause similar symptoms. There is no reproducible noninvasive test for the diagnosis of IBS, and this raises diagnostic uncertainty among physicians and hinders acceptance of the diagnosis by patients.Functional gastrointestinal(GI) syndromes often present with overlapping upper and lower GI tract symptoms, now believed to be generated by visceral hypersensitivity. This study examines the possibility that, in IBS, a nutrient drink test(NDT) provokes GI symptoms that allow a positive differentiation of these patients from healthy subjects.AIM To evaluate the NDT for the diagnosis of IBS.METHODS This prospective case-control study compared the effect of two different nutrient drinks on GI symptoms in 10 IBS patients(patients) and 10 healthy controls(controls). The 500 kcal high nutrient drink and the low nutrient 250 kcal drink were given in randomized order on separate days. Symptoms were assessed just before and at several time points after drink ingestion. Global dyspepsia and abdominal scores were derived from individual symptom data recorded by two questionnaires designed by our group, the upper and the general GI symptomquestionnaires, respectively. Psycho-social morbidity and quality of life were also formally assessed. The scores of patients and controls were compared using single factor analysis of variance test.RESULTS At baseline, IBS patients compared to controls had significantly higher levels of GI symptoms such as gastro-esophageal reflux(P = 0.05), abdominal pain(P =0.001), dyspepsia(P = 0.001), diarrhea(P = 0.001), and constipation(P = 0.001) as well as higher psycho-social morbidity and lower quality of life. The very low incidence of GI symptoms reported by control subjects did not differ significantly for the two test drinks. Compared with the low nutrient drink, IBS patients with the high nutrient drink had significantly more dyspeptic symptoms at 30(P =0.014), 45(P = 0.002), 60(P = 0.001), and 120 min(P = 0.011). Dyspeptic symptoms triggered by the high nutrient drink during the first 120 min gave the best differentiation between healthy controls and patients(area under receiver operating curve of 0.915 at 45 min for the dyspepsia score). Continued symptom monitoring for 24 h did not enhance separation of patients from controls.CONCLUSION A high NDT merits further evaluation as a diagnostic tool for IBS.

Current approach for Boerhaaves syndrome:A systematic review of case reports

There is no consensus on the appropriate therapeutic strategy for Boerhaave syndrome due to its rarity and changing therapeutic approaches.We conducted a systematic review of case reports documenting Boerhaave syndrome.AIM To assess the therapeutic methods and clinical outcomes and discuss the current trends in the management of Boerhaave syndrome.METHODS We searched PubMed,Google scholar,MEDLINE,and The Cochrane Library for studies concerning Boerhaave syndrome published between 2017 and 2022.RESULTS Of the included studies,49 were case reports,including a total of 56 cases.The mean age was 55.8±16 years old.Initial conservative treatment was performed in 25 cases,while operation was performed in 31 cases.The rate of conservative treatment was significantly higher than that of operation in cases of shock vital on admission(9.7%vs 44.0%;P=0.005).Seventeen out of 25 conservative cases(68.0%)were initially treated endoscopic esophageal stenting;2 of those 17 cases subsequently underwent operation due to poor infection control.Twelve cases developed postoperative leakage(38.7%),and 4 of those 12 cases underwent endoscopic esophageal stenting to stop the leakage.The length of the hospital stay was not significantly different between the conservative treatment and operation cases(operation vs conservation:33.52±22.69 vs 38.81±35.28 days;P=0.553).CONCLUSION In the treatment of Boerhaave syndrome,it is most important to diagnose the issue immediately.Primary repair with reinforcement is the gold-standard procedure.The indication of endoscopic esophageal stenting or endoluminal vacuum-assisted therapy should always be considered for patients in a poor general condition and who continue to have leakage after repair.

Clinical Trial Demonstrates Efficacy of Transcranial Direct Current Stimulation (tDCS) in Improving Pain Management from Post-Laminectomy Syndrome

Chronic pain, a multidimensional experience affecting individuals’ sensory, cognitive, and emotional aspects, significantly impacts their quality of life. Post-laminectomy syndrome, a condition characterized by persistent back pain following spinal surgery, often leads to disability and increased healthcare utilization. Methods: This randomized, controlled, blind clinical trial aimed to investigate the efficacy of Transcranial Direct Current Stimulation (tDCS) in managing pain from post-laminectomy syndrome in patients. Twenty-four participants were assigned to three groups: sham stimulation, active stimulation over primary motor cortex (M1), or stimulation over dorsolateral prefrontal cortex (DLPFC). Stimulation was administered for five consecutive days, 20 minutes per session, using a current of 1.5 mA through 25 cm2 electrodes. Pain intensity was assessed using Visual Analog Scale (VAS) before, during, and after intervention. Results: An ANOVA model demonstrates significant reduction in pain intensity compared to baseline in VAS, (F(7, 285) = 12.292;p 0.001;Power = 1.000;η2p = 0.534), in tDCS applied to M1, after five days of intervention. After stimulation, a significant improvement was observed in WHOQoL-Bref Quality of life item 1 (p = 0.04), considering statistical significant difference p 0.05. Correlation between the variables: quality of life, depression, anxiety and pain also demonstrates reduction in depression and anxiety according to Beck’s Depression and Anxiety Inventories (BDI and BAI), p 0.05. This effect was not observed in DLPFC stimulation group. Patients who believed they received active stimulation, in sham group, demonstrated potential for effective blinding. Conclusion: The tDCS applied to primary motor cortex effectively improved pain management and psychiatry symptoms in post-laminectomy syndrome patients. The technique’s low cost, ease of use, and high tolerability make it a promising adjuvant therapy for chronic pain conditions like post-laminectomy syndrome.

Minimally invasive liver resection in metabolic syndrome: insights and future directions

Hepatocellular carcinoma(HCC)has emerged as a formidable global health challenge since it ranks the sixth most common malignant tumor and the third most common cause of cancer-related death(1).One of the most important factors in the creation of the increased incidence of HCC is the increasing rate of metabolic syndrome(MS),which is a complex interaction of metabolic abnormalities represented by obesity,insulin resistance,dyslipidemia,and hypertension.It was believed that chronic hepatitis B and C were one of the major etiologies of HCC,but additionally,the changed landscape of etiology now points toward MS and its comorbidities,such as non-alcoholic fatty liver disease,as major contributors in promotion of development and progress of HCC(2,3).

Invasive versus non-invasive ventilation in patients with COVID-19 pneumonia:A retrospective study

Objective:To compare the survival and length of stay of invasive ventilation(IV)with those of non-invasive ventilation(NIV)in patients with COVID-19 acute respiratory distress syndrome in a single hospital from May 2020 to March 2021.Methods:After obtaining approval from the Hospital Director,the data of COVID-19 patients including demographics,type of respiratory support(non-invasive ventilation or invasive ventilation),duration of ventilation,length of stay,discharge,and death were collected and analyzed.Results:Out of the 152 patients identified,134 patients were analyzed.The median intubation days were 10.0(Q1:3.5,Q3:13.5)in the IV group and 0.0(Q1:0.0,Q3:0.0)days in the NIV-only group.Out of the 101 patients who received NIV,43 patients were subsequently intubated due to failure of NIV.Of the 63 patients(47.01%)who died,22(66.66%)were from the IV group and 40(92.02%)were from the NIV-followed-by-intubation group,and 1(1.72%)were from the NIV-only group.Multivariate analysis showed that the presence of a respiratory comorbidity(OR=16.56,95%CI=1.56-175.48,P=0.02)was an independent predictor of survival.Conclusions:Respiratory co-morbidity is a significant adverse predictor of survival outcome.The decision on the type of respiratory support should be made on a patient-to-patient basis.

猪繁殖与呼吸综合征病毒入侵宿主细胞途径研究进展

病毒入侵宿主细胞是其完成自身复制周期的首要步骤。全面解析病毒入侵宿主细胞途径可深入揭示病毒感染及其致病机制,有助于制定更为有效的抗病毒策略。猪繁殖与呼吸综合征病毒(PRRSV)是具有囊膜的单股正链RNA病毒,对全球养猪业造成巨大的经济损失。以往研究报道PRRSV主要通过网格蛋白介导的内吞途径(CME)入侵宿主细胞。近年来研究发现,除CME外,PRRSV还会采取其他途径入侵宿主细胞。本文通过总结PRRSV入侵宿主细胞途径的最新研究进展,以期加深人们对PRRSV的认识,并为防控该病毒提供新的思路。

Forearm Loss Caused by Automated Non-Invasive Blood Pressure Cuff Malfunction: A Hearsay Report

Failure of an automated blood pressure cuff to deflate when a patient is under general anesthesia can lead to catastrophic consequences if unnoticed for more than three hours [1]. We present this as a hearsay case in which an automated blood pressure cuff of the Spacelabs Ultraview Clinical Workstation monitor (model No. 90385) applied pressure for about five hours resulting in limb thrombosis. In order to analyze this catastrophe, simulation scenarios were tested to elucidate the possible errors and malfunctions that may have led to this injury. We present the analysis of the advantages and validity of the hearsay case report. We also include our proposed criteria that should be required when a hearsay case is considered for publication.

1例心源性脑梗死后出血转化合并心肾综合征病人应用无创呼吸机治疗的护理

总结1例心源性脑梗死后出血转化合并心肾综合征病人应用无创呼吸机治疗的护理经验。护理要点:无创呼吸机辅助通气治疗的护理、液体及营养支持管理、静脉血栓的预防及处理、预防和控制感染、联合康复科制订渐进式康复方案、出院指导与随访。经过21 d的精心治疗和护理,病人病情稳定,顺利转回当地医院继续康复治疗。

LISA技术与INSURE技术治疗早产儿呼吸窘迫综合征的效果比较

目的:探讨微创注入肺表面活性物质(less invasive surfactant administration,LISA)与气管插管-肺表面活性物质-拔管(intubation-surfactant-extubate,INSURE)两种不同给药方法在早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)中的应用效果。方法:选取2019年1月1日—2022年8月31日江西省儿童医院收治的55例NRDS患儿,运用随机数字表法,分为LISA组(给予LISA技术,n=29)和INSURE组(给予INSURE技术,n=26)。比较两组治疗相关指标、并发症发生情况。结果:两组二次牛肺表面活性剂(CPS)使用率比较,差异无统计学意义(P>0.05);LISA组72 h内有创机械通气治疗率低于INSURE组,机械通气时间、总用氧时间及住院时间均短于INSURE组,差异均有统计学意义(P<0.05)。LISA组支气管肺发育不良(BPD)和早产儿视网膜病变(ROP)发生率均低于INSUR组,差异均有统计学意义(P<0.05),但两组其他并发症发生率比较,差异均无统计学意义(P>0.05)。结论:与INSURE技术相比,LISA技术治疗早产儿RDS,能有效降低有创机械通气率,缩短用氧时间,并减少BPD及ROP的发生。

侵袭性肺炎克雷伯菌肝脓肿综合征1例并文献复习

目的探讨侵袭性肺炎克雷伯菌肝脓肿综合征的临床特点。方法分析1例确诊为侵袭性肺炎克雷伯菌肝脓肿综合征病人的病历资料,并进行相关文献检索及复习。结果共检索到国内外文献48篇,除临床资料不完整和非英文文献外,获取病例报道文献26篇,加该研究病例共纳入38例病人。合并糖尿病病人23例(60.5%),肝脓肿位于右肝23例,单发脓肿20例,多发脓肿16例;病原学主要来源于血液和肝脓液培养,分别为26例和16例;侵袭部位主要为肺和血流,分别为26例和28例;38例病人培养鉴定的肺炎克雷伯菌多为敏感菌株,仅2例出现多耐药和泛耐药,总体耐药率相对较低。所有病人经抗感染治疗,其中19例行肝脓肿穿刺引流。32例病人经敏感抗生素治疗好转,6例死亡,其中5例出现颅内感染。结论侵袭性肺炎克雷伯菌肝脓肿综合征是一种严重的多部位感染的疾病,多见于糖尿病病人,容易导致败血症,合并颅内感染者病死率高。早期、充分、全程抗菌治疗或肝脓肿穿刺引流,可改善临床预后。

微创表面活性物质注射技术联合无创通气在早产儿轻中度新生儿呼吸窘迫综合征中的应用

目的探讨微创表面活性物质注射(LISA)技术联合无创通气(NIPPV)在早产儿轻中度新生儿呼吸窘迫综合征(NRDS)中的应用效果。方法选取2022年3月至2023年3月江西省妇幼保健院收治的80例NRDS患儿为研究对象,采用随机数字表法分为常规组与研究组,每组各40例。其中常规组传统技术联合NIPPV进行治疗,研究组使用LISA技术联合NIPPV进行治疗,比较两组患儿疗效、血气指标[pH值、血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))及氧合指数(OI)]、临床指标[再次肺表面活性物质(PS)治疗例数、72 h内机械通气例数、机械通气时间、住院时间]及并发症发生情况。结果研究组总有效率(97.50%)高于常规组(80.00%),差异有统计学意义(P<0.05);治疗后,研究组pH、PaO_(2)及OI值均高于常规组,PaCO_(2)低于常规组,差异有统计学意义(P<0.05)。两组患儿再次PS发生率比较,差异无统计学意义(P>0.05)。研究组72 h内机械通气发生率低于常规组,机械通气时间及住院时间短于常规组,差异有统计学意义(P<0.05)。研究组并发症总发生率(5.00%)低于常规组(22.50%),差异有统计学意义(P<0.05)。结论在治疗早产儿轻中度NRDS患儿方面,LISA技术疗效确切,相较于传统技术其改善患儿血气指标的效果更加明显,同时可显著减少患儿机械通气次数及时间,缩短住院时间,并显著减少并发症的发生。