- ISSN 1008-5734
- CN 11-4015/R
- 1999年创刊
- 主管: 中国科学技术协会
- 主办: 中华医学会
ObjectiveTo evaluate the efficiency of the three molecular marker techniques for identification of plant genus in order to select the most suitable molecular technique to rapidly identify a poisonous plant at the scene of the poisoning accident.MethodsNineteen samples of leaves in 18 species of common poisonous plants of Ranunculaceae and Euphorbiaceaec were selected. Genomic DNA of these samples were extracted using improved hexadecyltrimethylammonium bromide (CTAB) method, species identification (genus level) were performed using random amplified polymorphic DNA (RAPD), inter-simple sequences repeats (ISSR) and DNA barcoding, cluster analysis were performed using NYSTS, SPSS, PAUP, and MEGA software. Accuracy, reliability, timeliness, and operability were compared between the 3 molecular marker techniques.ResultsAccuracy: genus level of samples failed to be identified using RAPD; and the accuracy rates in genus level of identification using ISSR and DNA barcoding were 68% and 100%, respectively. Reliability: the subjective influence rates and the repetitive rates in RAPD and ISSR were 47% and 26% as well as 47% and 45%, respectively; the success rates of amplification and sequencing of trnH-psbA fragment using DNA barcoding both were 100%. Timeliness: the time from extraction of DNA to accomplishment of identification in the 3 molecular marker techniques were 8.5, 9.0, and 42.2 h, respectively. Operability: species identification using RAPD and ISSR could be done in a common laboratory; special sequencing equipment was needed when using DNA barcoding technique in the identification of poisonous plants.ConclusionThe preliminary study results show that DNA barcoding is a molecular identification technique more suitable for rapid determination of the poisonous plant at the scene of the sudden poisoning accident.
ObjectiveTo validate the effects of the etiological judgment model for poisoning event in a poisoning event caused by Aconitum in Tacheng District, Xinjiang Uygur Autonomous Region. Methods The main point of the etiological judgment model for poisoning event was synthesized determination according to the results of the scene, cases and laboratory research. After receiving the report of poisoning event, the specialists in local Center for Disease Control and Prevention (CDC) hastened to the scene to conduct epidemiological investigation, to obtain the clinical features of the poisoning patients, and to collect the specimen of blood and vomitus of patients and the fresh sample of suspicious poisonous plants. Chinese Center for Disease Control and Prevention organized the relevant institutes to conduct morphological and DNA molecular identification of the poisonous plant, toxin detection of the blood and vomitus specimen. The above-mentioned results were synthesized to determine the poisoning reason and provide guidance for clinical diagnosis and treatment.ResultsOn May 30, 2010, 13 staffs in a metal company in Tacheng District picked and ate the “wild celery” which grew in nearby mountain. Within 15 to 30 minutes after eating the “wild celery”, they successively developed numbness in mouth, lips, and limbs, as well as asthenia, nausea and vomiting. They were sent to a local hospital, 4 patients died on the way to the hospital，other 9 patients received rescue therapy in the hospital, 2 of them died about 4 hours after poisoning despite resuscitation attemempts. The morphological identification of fresh sample of suspected poisonous plants was demonstrated as Aconitum, Raunnculaceae. Aconitine was detected in a vomitus specimen and 3 blood specimens. The aconitine content in blood specimens were 0.17, 0.25 and 0.48 μg/L, respectively. The result of DNA molecular identification showed that the fresh leaves of suspected poisonous plants collected from the scene belonged to the same species of Acontium. This event was determined as a sudden poisoning event caused by picking and eating Acontium stems and leaves by mistaken.ConclusionThe etiological judgment model for poisoning event might play an important guiding role in the determination of the cause of poisoning events.
ObjectiveTo report the epidemiological investigation of a poisonous mushroom poisoning event occurring in Tengchong County, Yunnan Province in order to provide reference for preventing and controlling similar poisonous mushroom poisoning.MethodsAfter receiving the report of poisoning event, the specialists in local Center for Disease Control and Prevention (CDC) hastened to the scene and they conducted epidemiological investigations, identification of poison and analysis of the results.ResultsAround 3 o′clock in the afternoon on June 30,2012, six members of a family comprising a grandfather (case 1, 56-year-old), a grandmother (case 2, 47-year-old), and four granddaughters (case 3, 4, 5, and 6 aged 8, 8, 7, and 1.5 years, respectively) ate a dish containing “malijun” for lunch, which was picked by the grandfather at that day. Around 4-6 o′clock the next morning, two granddaughters (cases 3 and 5) and the grandparents developed nausea, vomiting, and diarrhea successively and then presented to a local health center. They were treated with symptomatic therapy and then returned home. Case 4 experienced diarrhea only without seeking medical advice and case 6 just drank a little juice of the dish and she had no marked symptoms. On July 2, cases 3 and 5 developed lethargy and coma. All the six patients presented to the People′s Hospital of Tengchong County and were diagnosed with group poisonous mushroom poisoning which was reported to local CDC. Case 3 died despite resuscitation attempts in the emergency department. Case 1 was admitted to hospital and case 2 was staying treatment in emergency department and both of them recovered on days 26 and 19 after poisoning, respectively. The other three kids were transferred to provincial medical institutions in the same day and recovered on days 10 to 13 after poisoning. The fresh sample of “malijun”, which was picked by specialists of CDC at the location, was identified as Galerina sulciceps rather than the edible mushroom Laccaria vinaceoavellanea which was commonly called “malijun” by local people. This event was determined as a sudden acute poisonous mushroom poisoning event caused by picking and eating Galerina sulciceps by mistaken.ConclusionsThe appearance of Galerina sulciceps may be easily confused with that of Laccaria vinaceoavellanea, thus, the poisoning may occur due to picking and eating by mistaken. Management of the information on poisoning should be enhanced, and the spectrum of poisonous mushrooms in different districts should be controlled by professional institutes. Medical staff should be trained to reinforce knowledge of diagnosis and treatment of poisonous mushrooms, and popular science education in the prevention of common poisonous mushrooms poisoning to general public should be conducted.
ObjectiveTo investigate the safety of a loading dose of IV antiepileptic drugs (AED) in the treatment of adult patients with generalized convulsive status epilepticus (GCSE).MethodsA method for the analysis of pooled data was adopted. The results from the two prospective randomized controlled trials (RCTs) performed by Xuanwu Hospital from January 2007 to January 2010 and from June 2010 to May 2012 were collected. The clinical data were analyzed and compared among the patients in the diazepam group，the diazepam and subsequent valproate group,and the diazepam and subsequent phenobarbital group. A loading dose of IV diazepam (0.2 mg/kg, 5 mg/min) was as first-line AED treatment for all patients in the 3 groups. Second-line AED treatment were as follows: in the diazepam group, a loading dose of IV diazepam (0.2 mg/kg, 5mg/min) was given, then a maintenance dose of IV diazepam (4.0 mg/h, increase by 1.0 μg/kg every 3 minutes) was given via a pump. In the diazepam subsequent valproate group,a loading dose of IV diazepam ［30 mg/kg , 6 mg/(kg·min)］ was given, then a maintenance dose of IV valproate 1-2 mg/(kg·h)was given via a pump. In the diazepam subsequent phenobarbital group, a loading dose of IV phenobarbital (20 mg/kg，50 mg/min)was given, then a maintenance dose of IV phenobarbital (100 mg/6 h, 50 mg/min) was given. The second-line AED treatment should be continued until 24 hours after epileptic seizure stopped, then the dosage was gradually reduced. The patients should be closely monitored for reactions after drug administration.ResultsA total of 101 patients were enrolled in the study. They comprised 53 male and 48 female with mean age of (42±16) years. The diazepam group comprised 20 male and 18 female with mean age of (41±19)years. The diazepam and subsequent valproate group comprised 22 male and 18 female with mean age of (45±15)years. The diazepam and subsequent phenobarbital group comprised 11 male and 12 female with mean age of (41±14)years. There was no statistically significant difference among the baseline data of patients in the three groups. The termination rate of GCSE in the diazepam，diazepam and subsequent valproate, and diazepam and subsequent phenobarbital groups were 63.2% (24/38), 57.5% (23/40)and 60.9% (14/23), respectively. The difference was not statistically significant (P=0.902). There were 6 cases(158%) of adverse reactions in the diazepam group. The number of cases of respiratory depression, circulatory depression,and bone marrow depression were 2, 3, and 1, respectively. There were 11 cases (27.5%) of adverse reactions in the diazepam and subsequent valproate group. The number of cases of slight hyperammonemia without hyperammonemia encephalopathy, mild abnormal liver function, and bone marrow depression were 8, 2, and 1, respectively. There were 11 cases (47.8%) of adverse reactions in the diazepam and subsequent phenobarbital group. The number of cases of respiratory depression, circulation depression, mild abnormal liver function, and bone marrow depression were 3, 2, 5, and 1, respectively. The incidence of adverse reactions in the diazepam group was markedly lower than that in the diazepam and subsequent phenobarbital group (P=0.033). The above-mentioned adverse symptoms could resolve after drug withdrawal and symptomatic treatment.ConclusionsA loading dose of IV diazepam or IV valproate or IV phenobarbital are effective and safe in the treatment of adult patients with GCSE. The patient should be closely monitored for adverse reactions during the antiepileptic treatment, especially in the patients receiving diazepam combined with phenobarbital. Once adverse reactions developed, the drug should be stopped and symptomatic treatment should be given.
ObjectiveTo study the effects of intracoronary pre-injection of tirofiban before primary percutaneous coronary intervention (PPCI) on coronary forward blood flow and myocardial tissue perfusion in patients with acute ST-segment elevation myocardial infarction(STEMI). MethodsThe STEMI patients who were scheduled for PPCI from January 2010 to December 2011 in Beijing Anzhen Hospital were enrolled in the study as the subjects and were divided into the tirofiban group and the control group by random number table. The patients in both groups chewed aspirin 300mg and clopidogrel 300-600 mg before coronary angiography, and received heparin at the standard dosage (100 U/kg)during the operation. The patients in the tirofiban group were given a slow IV push of tirofiban(10 μg/kg)within three minutes through a guiding catheter after coronary angiography, followed by a continuous IV infusion of tirofiban 0.15 μg/kg per minute for 36 hours via a mini pump, while the patients in the control group did not received any drugs. The patients in both groups received the same routine anticoagulant treatment after PPCI. The data including baseline characteristics of patients features of coronary angiogram, clinical prognosis，incidences of mild, moderate and severe hemorrhage, thrombocytopenia and in hospital mortality were collected and compared between the 2 groups. The efficacy and safety of intracoronary pre-injection of tirofiban were analyzed.ResultsA total of 737 patients enrolled in the study. There were 324 patiens in the tirofiban group comprising 233 male and 91 female with average age of (62±10)years. There were 413 patients in the control group comprising 301 male and 112 female with average age of (60±11)years. The differences in sex and age distribution, cases complicated with hypertension and diabetes mellitus, smoking status, percentage of anterior myocardial infarction, the time from disease onset to treatment, the percentage of patients with thrombolysis in myocardial infarction (TIMI) grade 0 flow before PPCI, utilization rate of thrombus aspiration catheter during PPCI, incidence of moderate hemorrhage and thrombocytopenia between the 2 groups were not statistically significant (all P>0.05). No severe hemorrhage occurred in both groups. The percentage of patients with TIMI grade 3 flow after PPCI, percentage of grade 3 myocardial blush grade (MBG), rate of ST-segment decline and rate of mild hemorrhage were significantly higher in the tirofiban group than in the control group, they were 96.0%(311/324)vs 91.3%(377/413)，92.3%(299/324)vs 87.2%(360/413)，91.4%(296/324)vs 85.7%(354/413)，6.8%(22/324)vs 2.7%(11/413), respectively, but the in hospital mortality was lower than that in the control group ［0.9%(3/324)vs 3.1% (13/413)］(all P＜0.05). Logistic regression analysis indicated that intracoronary pre-injection of tirofiban was the independent factor affecting TIMI grade 3 flow after PPCI(OR=1.947，95%CI：1.156-4.022，P=0.036).ConclusionsIntracoronary pre-injection of tirofiban before PPCI may improve the coronary forward blood flow and myocardial tissue perfusion, and it may also increase the mild haemorrhage rate, but there is no need for clinical intervention. It has better efficacy and safety to patients with STEMI.
A 53-year-old woman self-medicated with 4 Lingzhiyishou capsules thrice daily to improve physical strength and vitality. Two months later, the patient developed dark urine. About four months later, she presented with jaundiced skin and sclera, upper abdominal discomfort, accompanied by nausea, fatigue, and lassitude. Laboratory tests revealed the following levels: alanine aminotransferase (ALT) 1114 U/L, aspartate aminotransferase (AST) 611 U/L, γ-glutamyl transferase (γ-GT) 235 U/L, alkaline phosphatase (ALP) 158 U/L, total bilirubin (TBil) 104.5 μmol/L, direct bilirubin (DBil) 63.2 μmol/L, indirect bilirubin (IBil) 41.3 μmol/L, total bile acid (TBA) 165.3 μmol/L. She was diagnosed with drug-induced liver injury. Lingzhiyishou capsules were stopped and she was given reduced glutathione, magnesium isoglycyrrhizinate, and ademetionine 1, 4-butanedisulfonate. Two week later, repeat liver function tests showed the following levels: ALT 69 U /L, AST 35 U/L, γ-GT 100 U/L, ALP 137 U/L, TBil 30.1 μmol/L, DBil 14.4 μmol/L, IBil 15.7 μmol/L, TBA 70.2 μmol/L.
A 54-year-old female patient with rheumatoid arthritis, osteoarthropathy received leflunomide 20 mg，once daily. After 5 months of therapy, 4 Yuxuebi capsules thrice daily was added to her regimen. About five hours after took the second dose of Yuxuebi, the patient′s body temperature rose to 38.8 ℃, red rashes appeared on her palm and rapidly progressed to involve her entire body, accompanied by pharyngeal pain, dizziness, chest distress, asthenia, abnormal vision. Her blood pressure was 86/47 mm Hg. He received anti-allergic treatment such as calcium gluconate, vitamin C, hydrocortisone sodium succinate, and loratadine combined with Chinese herbal decoction. On day 2 of admission, laboratory tests showed the following values: white blood cell count 18.3×1012/L, neutrophils 0.96, C-reactive protein 148 mg/L, procalcitonin 2.16 ng/ml, alanine aminotransferase 54 U/L, aspartate aminotransferase 55 U/L, direct bilirubin 7.8 μmol/L, urea 11.2 mmol/L, and creatinine 209 μmol/L. X-ray showed lung infection. An IV infusion of cefoxitin sodium was given. On day 3 of admission, the patient′s body temperature returned to normal, and she developed allergic stomatitis. She was treated with oral Kangfuxin Ye (康复新液) and gargled with compound chlorhexidine gluconate gargle. On day 8 of admission, her anaphylactic symptoms disappeared.
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