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A 58-year-old male patient with diabetic foot ulcer was admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine on December 11, 2018. The patient was treated with local debridement, vacuum sealing drainage treatment, and dressing change and discharged after basic wound healing. On January 15, 2019, the patient was hospitalized again due to local infection and rupture of wound surface. He underwent a surgical debridement on the third day after second admission and was given intravenous infusion of 0.4 g teicoplanin twice daily. Histopathological examination after surgery showed keratinizing squamous-cell carcinoma. An extended squamous-cell carcinoma resection plus autologous split-thickness skin grafting and vacuum sealing drainage treatment was carried out on the 10th day after second admission. The patient's whole body turned red after surgery with rash, recurrent fever over 39 ℃, leucopenia, and thrombocytopenia. A multi-disciplinary consultation of physicians attributed these symptoms to teicoplanin-induced hypersensitivity syndrome. After withdrawal of teicoplanin and administration of hormone, the patient's temperature returned to normal, and the leucocyte count and platelet count recovered gradually. The patient was cured and discharged on the 49th day after second admission. The case presented reminds us of need to strictly follow the indications of teicoplanin prior to medication, be resolute to the administration and withdrawal, and be alert to adverse drug reactions when above-mentioned abnormalities occur, meanwhile, infection and rheumatic diseases are excluded.

Objective: To compare plasma asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, and cystatin C levels in patients with or without coronary artery disease (CAD)., Methods: We recruited 87 CAD patients (39 with acute myocardial infarction and 48 with unstable angina pectoris) and 51 non-CAD controls. Plasma ADMA was measured by HPLC, cystatin C by particle-enhanced immunonephelometric assay (N Latex cystatin C, Dade Behring) with nephelometer (BNII, Dade Behring). CAD patients were further divided into low cystatin C group (< 1.0 mg/L, 36 cases) and high cystatin C group (> 1.0 mg/L, 51 cases)., Results: (1) The plasma levels of ADMA [(0.47 ± 0.15) µmol/L vs. (0.37 ± 0.15) µmol/L], SDMA [(0.39 ± 0.19) µmol/L vs. (0.28 ± 0.12) µmol/L] and cystatin C [(1.16 ± 0.32) mg/L vs. (0.73 ± 0.16) mg/L] were significantly higher in CAD patients than in controls (all P < 0.05). The plasma L-Arg was significantly lower in CAD patients than in controls [(59.4 ± 19.4) µmol/L vs. (83.7 ± 19.6) µmol/L, P < 0.05]. (2) Plasma ADMA was similar in CAD patients with low cystatin C level and controls [(0.42 ± 0.12) µmol/L vs. (0.39 ± 0.15) µmol/L, P = 0.251] and Plasma ADMA was significantly higher in CAD patients with high cystatin C level than in controls [(0.50 ± 0.17) µmol/L vs. (0.39 ± 0.15) µmol/L, P < 0.05]., Conclusion: ADMA levels were significantly increased only in CAD patients with elevated cystatin C levels but not in CAD patients with normal renal function. The reported relationship between coronary heart disease and ADMA may not be direct, but could be secondary due to reduced renal function.

Epidermal growth factor receptor (EGFR) is a classic protein tyrosine kinase receptor, which plays an important role in cell proliferation, survival, adhesion, differentiation and apoptosis. Abnormality of EGFR and its signaling are closely associated with tumor initiation and development. Many environmental physical and chemical agents can interfere with EGFR and its signal transduction pathways via affecting its phosphorylation, conformation and function, or distribution on cell membrane, finally influencing gene expression and cell fate. This review focuses on the recent progress of above aspects for further understanding of epigenetic mechanisms of cellular stress and carcinogenesis related with environmental agents.

Objective: To screen primary aldosteronism cases with ARR (aldosterone/plasma renin activity, ARR) from patients with hypertension, and to evaluate the diagnosis value of ARR in primary aldosteronism cases and analysis the clinical characters of primary aldosteronism cases., Methods: Nine hundred and two patients with hypertension were collected, the plasma aldosterone concentration to plasma renin activity ratio were detected by radio-immunity method, after that, ARR were calculated. Retrospective analysis was made of clinical data in 126 primary aldosteronism cases, which ARR were over 25., Results: One hundred and twenty-six cases (14%) were diagnosed as primary aldosteronism, and of them, 49 cases had hypokalemia. 25 patients received surgical operation and the rate of efficiency and cure of surgery treatment were 100% and 48%, respectively. The rate of efficiency and cure of drug treatment was 89% and 24% respectively., Conclusions: Primary aldosteronism affects over 10% of patients with hypertension in China. Patients with hypertension and most patients with treatment-resistant hypertension should undergo screening for primary aldosteronism with ARR. A high ARR is a positive screening test result, a finding that warrants confirmatory testing.

Objective: To study the serum homocysteine (Hcy) distribution and characteristics in different sex and age groups in the community residents in Wuhan, and to analyse its associated factors with multi-stepwise regression analysis., Methods: The population under study was from three community areas in Wuhan. Demographic distribution and the correlation with other risk factors of serum Hcy were analyzed statistically., Results: (1) Geometric mean of serum Hcy was 14.43 micromol/L in males and 10.89 micromol/L in females with P <0.001. (2) Hcy of per age level in males was also higher (P <0.001). (3) The prevalence rate of hyperhomocysteinemia was 23.94% in the general population in Wuhan. The prevalence rate of hyperhomocysteinemia in males was 2.62 times higher than in females. (4) Multi-stepwise regression analysis showed that Hcy had different affecting factors in males and females. The affecting factors of Hcy in males were daily cigarettes smoking, urine micro-albumin (UMALB) and times of exercise per week. The affecting factors of Hcy in females were duration of exercise each time, weight, triglyceride (TG), high-density lipoprotein (HDL), urine micro-albumin (UMALB) and age., Conclusions: (1) Hcy at the population level was significantly different by sex and age. (2) Population living in the community in Wuhan had a higher serum level and prevalence rate of Hcy comparing to some other cities in China and even in developed countries. (3) The important affecting factors of Hcy in population also showed sex difference, unlike the reports from other countries or other areas in China. Serum Hcy seemed to be affected by environmental and other factors.

Objective: To study relationship between acute dipterex poisoning and oxidative stress and free radical damage., Methods: Eighty-two patients with acute dipterex poisoning (ADPP) and ninety-two healthy adult volunteers (HAV) were enrolled in the study with randomized controlled trial design. Plasma levels of vitamin C (VC) and vitamin E (VE), as well as level of lipoperoxide (LPO) and activities of superoxide dismutase (SOD) and acetylcholinesterase (AChE) in the red blood cells (RBC), were determined by spectrophotometry., Results: Levels of VC and VE, and activities of SOD and AChE were (37.35 +/- 9.98) micromol/L, (16.57 +/- 4.54) micromol/L, (1 785 +/- 154) U/g Hb and (213.1 +/- 57.6) U/g Hb, respectively, in the ADPP group, significantly lower than those in the HAV group, (55.34 +/- 15.98) micromol/L, (25.66 +/- 7.24) micromol/L, (2 124 +/- 185) U/g Hb and (305.3 +/- 83.6) U/g Hb, respectively. Plasma level of LPO was (35.20 +/- 5.29) nmol/g Hb in the ADPP group, significantly higher than that in the HAV group, (27.87 +/- 4.66) nmol/g Hb. Partial correlation analysis suggested that there existed negative correlation between activity of AChE in the RBC and plasma level of LPO (r = -0.274, P = 0.013) and positive correlation between activity of AChE in the RBC and plasma levels of VC and VE, and activity of SOD in the RBC (r = 0.333, P = 0.002, r = 0.269, P = 0.015 and r = 0.248, P = 0.026, respectively) in the ADPP, adjusted for age. Coefficient of reliability alpha was 0.682 (P < 0.001), with a standardized alpha of 0.868 (P < 0.001)., Conclusion: There exist severe oxidative stress and free radical damage in patients with acute dipterex poisoning.

Objective: To study the relationship of stroke and plasma homocysteine (Hcy) level and the mutation of methylenetetrahydrofolate reductase (MTHFR) gene., Methods: Three hundred patients with stroke were included as the case group in this study while 300 subjects without stroke matched with the case group for sex and age were collected as the control group. Plasma Hcy level was measured using HPLC and MTHFR 667C-->T mutant was determined by polymerase chain reaction and restriction fragment analysis. The relationship of stroke and plasma Hcy level and the mutation of MTHFR gene was then analysed., Results: The plasma Hcy level of the case group was significantly higher than that of the control group (16.92 +/- 3.43 micromol/L vs. 14.57 +/- 2.59 micromol/L, P <0.05). There was no significant difference in mutation rate of MTHFR C677T between stroke group and control group (P >0.05), as well as between ischemic stroke group and homorrhagic stroke group (P >0.05). The mutation of MTHFR C677T had no significant influence on the Hcy level (15.28 +/- 2.17 micromol/L vs. 15.11 +/- 3.81 micromol/L, P >0.05)., Conclusion: Increased plasma Hcy level played an important role in the occurrence of stroke in Chinese people, and the mutation of MTHFR C677T was not associated with Hcy level or stroke which led to the speculation that plasma Hcy level was important in the prevention of cardio-cerebro-vascular diseases among Chinese people.

Objective: To study psychologic features of accidentally injured children to provide basis for application of psychologic intervening measures., Methods: Eysenck personality questionnaire (EPQ) and Achenback child behavior capacity list (CBCL) (list for parents) were used to test accidentally injured children 7 - 11 years of age who were hospitalized (injury group) and healthy children (control group). Each group was composed of 81 cases., Results: (1) Scores of P, E and N branch capacity lists in EPQ of injury group were all higher than those of control group (P < 0.05 or < 0.001). But the score of L branch capacity of control group was higher than that of injury group (P < 0.001). (2) Boys of injury group in seven factors of restlessness, violation of discipline, attack, harmful contact, schizoid anxiety, depression and body complaint and girls of injury group in seven factors of restlessness, cruelty, attack, depression, body complaint, social flinching and violation of discipline had higher scores than those in control group did (P < 0.01). (3) Detectable rate of behavior problems of injury group was 32.09% (26/81), higher than that of control group [11.11% (9/81), P < 0.001]. The odds ratio (OR) was 3.78, 95% CI was 1.66 approximately 8.59 (P < 0.01). The behavior factor had a lower sensitivity (32.1%) and a higher specificity (88.9%) and lower positive result value (74.3%). (4) Average CBCL score of boys in injury group (39.84 +/- 10.99) was higher than that of girl in injury group (34.26 +/- 10.43, P < 0.05). Boys in two factors of violation of discipline and attack, girls in factor of depression factor M had higher score than the opposite sex subjects did (P < 0.05 or 0.01). (5) Average CBCL score (37.62 +/- 11.03) of injury group was higher than that of control group (17.77 +/- 12.12, P < 0.001). Logistic multiple factor analysis showed that boys' accidentally injured factors were attack, restlessness, violation of discipline, and girls' accidentally injured factors were attack, violation of discipline and depression., Conclusion: Accidentally injured children have more psychologic problems in character and behavior. Psychologic education should be given to reduce incidence of accidental injury to children.

Among 4,950 advanced schistosomiasis patients examined, 709 (14.3%) had upper gastrointestinal bleeding, and in patients who had been treated with splenectomy, 532 presented history of bleeding. Of the 338 cases with a history of bleeding, 268 (79.3%) ceased bleeding after operation and 70 cases (20.7%) bled again. In 194 cases (7%) who had no history of bleeding before operation, bleeding occurred, suggesting that simple splenectomy has certain effect in preventing upper gastrointestinal bleeding, but the incidence of bleeding is higher in those who had a history of bleeding before operation. Gastrofibroscopic examinations in 50 cases who bled recently indicated that 74% of the patients had gastro-duodenal lesion as a concomitant disease. Prevention and treatment of upper gastrointestinal bleeding of advanced schistosomiasis patients are discussed.