Obesity has been one of the most serious challenges for public health and is purported to cause over 100,000 deaths every year in the United States alone. Moreover, obesity has increased worldwide by 75% since 1980, and consequently it has been defined as a global epidemic by WHO. Therefore, there is an urgent medical need to develop the effective and safe treatment of obesity [1]. The discovery of the endocannabinoid system provides a promising target for obesity therapy and intense research efforts in the past two decades have led to the discovery of several CB1 antagonists including rimonabant and taranabant. Recently they were not approved for the treatment of obesity because of severe psychiatric side effects [2]. Whether side effect of these compounds results from the mechanism of action themselves or if these are specific and selective compounds remains a mystery. It is therefore important and urgent to identify and develop novel and selective CB1 antagonists that may exhibit a distinct and attractive therapeutic profile. One fungal species UK-143 was found to exhibit >50% inhibition at 100 nM in a CB1 competitive binding assay and was further followed by bioassay-guided isolation. The most potent compound has a CB1 Ki of 22 nM and >10-fold selectivity against the CB2 receptor. References: [1] Bray GA (2006) Journal of Medicinal Chemistry 49: 4001–4007. [2] Wu CH, Huang MS, et al. (2009) Journal of Medicinal Chemistry 52: 4496–4510.
To the editor: The prognosis of in-hospital and out-of-hospital cardiac arrest (CA) is awfully poor. Most causes are reported to thromboembolism diseases, i.e. massive pulmonary embolism (MPE) and acute myocardial infarction (AMI). Systemic thrombolysis during cardiopulmonary resuscitation (CPR) is still controversial, for fear of potentially lethal hemorrhage. A 23-year-old woman presented to our emergency room (ER) with chill and fever for 2 days, along with two times of emesis and melena, chest distress and light headedness. She had also been troubled with autoimmune hemolytic anemia (AIHA) for more than 10 years and bronchial asthma for 3 years. Ultrasound of both the upper and lower extremities where done in ER showed no evidence of deep vein thrombosis, and a moderate risk was achieved by Well's criteria for PE. Then she was admitted to intensive care unit. About 4 hours later, a sudden CA occurred. A 12-lead electrocardiogram briefly before CA revealed sinus tachycardia, incomplete right bundle-branch block as well as T inversion in leads V1-4 compared with that at admission just showing sinus tachycardia. Echocardiography during CPR displayed right ventricular dilatation and moderate pulmonary hypertension, compared to that at admission nearly normal state. However, refractory pulseless electrical activity appeared after 20-minute consistent CPR. MPE was potentially considered. The drug recombinant tissue plasminogen activator (rt-PA) therefore was prescribed. The resuscitation was continued for next 55 minutes until the return of spontaneous circulation (ROSC) was achieved. Chest computed tomographic pulmonary angiography (CTPA) and cerebral CT were therefore implemented after 4 hour-observation. Apparent bilateral pulmonary embolism was discovered (Figure 1), while without obvious intracranial hemorrhage. She regained her consciousness 6 hours later after recovery of ROSC, without evident neurological deficits.Figure 1.: Chest computed tomographic pulmonary angiography demonstrating bilateral arterial embolism (→).Debate existed whether or not using thrombolysis during CPR, while the subgroup of patients with MPE or AMI might benefit from it.1 When to start it was another key factor, as longer-CPR could induce potentially greater hemorrhage complication and mortality. Two large retrospective studies had revealed that autoimmune diseases including AIHA, pertaining to blood hypercoagulation, increased the risk of subsequent venous thromboembolism (VTE) and PE.2,3 Coagulation disturbance was always complicating from severe sepsis. Both AIHA and severe sepsis occurred in the case, indicating high risk of VTE. Subcutaneous low-molecular weight heparin or unfractionated heparin could be prescribed for prophylaxis or treatment of VTE. However, a dilemma of thrombotic and bleeding risk might coexist. Antithrombotic therapy was not initiated at admission in the case, considering the gastrointestinal and urinary bleeding. In summary, any new intervention has to be studied and evaluated carefully in view of the poor prognosis of CA. Since AIHA, as other autoimmune disorders presented hypercoagulability feature, unexpected thromboembolism event has to be prevented intentionally. Thrombolysis with rt-PA during CPR after CA, caused by presumed MPE, should be started early. This case also indicated the strategy might be effective and safe even within prolonged CPR, though which should be evaluated by further large randomized controlled trial. Jianping Gao Konghan Pan Kejing Ying Critical Care Department (Gao JP and Pan KH), Respiratory Department (Ying KJ), Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China Correspondence to: Dr. Ying Kejing, Respiratory Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China (Tel: 86-571-86006606. Fax: 86-571-86044817. Email: [email protected])
OBJECTIVE To analyse different factors related to the occurrence of bladder neck contracture (BNC) and to find possible ways of reducing this complication. METHODS All putative factors and the numbers of BNC cases were studied with statistical analyses in 1,017 cases that had undergone transurethral resection of the prostate (TURP). RESULTS The morbidity of BNC after TURP was significantly higher than that of open operations. Small size of the prostate, longer time of operation, higher power in resection and prostatitis were factors of BNC. CONCLUSION Properties of the prostate and electrical current injuries of resection are the primary factors of BNC. The selection of patients and techniques of TURP are most important in decreasing the morbidity of BNC.
Objective To investigate the iodine deficiency disorders (IDD) prevention in Qujing City and to assess its present situation. To find out many existing problems and put forward corresponding plan. Methods In this paper, random sampling was used to detect goiter rate, urinary iodine of children of 8-10 years, and to investigate qualified rate of iodized salt and healthy education of students. Results Goiter rate was 5.21%,median of urinary iodine was 177.7μg/L, qualified rate of iodized salt was 87.41%, the three main indices have been achieved the national eliminating standard goal. Conclusions The prevention and cure of IDD in Qujing City has a good achievement. The routine monitoring of salt iodine should be continued.
To investigate the effect of hyperbaric oxygen (HBO) on paroxysmal sympathetic hyperexcitation (PSH) after brain injury. A multicenter retrospective study was conducted. Fifty-six patients with PSH who received HBO treatment from four hospitals in Henan Province from January 2021 to September 2023 were selected as the HBO group, and 36 patients with PSH who did not receive HBO treatment from Zhengzhou People's Hospital from May 2018 to December 2020 were selected as the control group. PSH assessment measure (PSH-AM) score [clinical feature scale (CFS) score+diagnostic likelihood tool (DLT) score] and Glasgow coma scale (GCS) were compared before and after HBO treatment, and between HBO group and control group to evaluate the effect of HBO treatment on prognosis of PSH patients. There were no statistically significant differences in age, gender, PSH etiology, GCS score, time from onset to occurrence of PSH, CFS score, CFS+DLT score and frequency of PSH episodes between the two groups, indicating comparability. The duration of HBO treatment ranged from 3 to 11 days for 56 patients receiving HBO treatment, and the duration of HBO treatment ranged from 3 to 5 courses. Compared with before treatment, after HBO treatment, PSH symptoms in HBO patients were significantly relieved (body temperature increase: 14.29% vs. 64.29%, heart rate increase: 25.00% vs. 98.21%, shortness of breath: 14.29% vs. 76.79%, blood pressure increase: 8.93% vs. 85.71%, sweating: 10.71% vs. 85.71%, muscle tone increased: 19.64% vs. 75.00%, all P < 0.05), CFS+DLT score decreased significantly (16.90±4.81 vs. 22.12±3.12, P < 0.01), GCS score improved (12.31±5.34 vs. 5.95±2.18, P < 0.01). After 30 days of hospitalization, compared with the control group, PSH symptoms in the HBO group were improved (body temperature increase: 14.29% vs. 19.44%, heart rate increase: 19.64% vs. 25.00%, shortness of breath: 10.71% vs. 27.78%, blood pressure increase: 7.14% vs. 22.22%, sweating: 8.93% vs. 25.00%, muscle tone increased: 19.64% vs. 38.89%, all P < 0.05 except body temperature increase), CFS+DLT score decreased (16.90±3.81 vs. 19.98±4.89, P < 0.05), GCS score increased (14.12±4.12 vs. 12.31±4.14, P < 0.01), the length of intensive care unit (ICU) stay was shortened (days: 18.01±5.67 vs. 24.93±8.33, P < 0.01). HBO treatment can significantly relieve the symptoms of patients with PSH after brain injury and provide a new idea for the treatment of PSH patients.
Introduction:The outbreak of coronavirus disease 2019 (COVID-19) has exerted a heavy burden on public health worldwide.We aimed to investigate the epidemiological and clinical characteristics of patients with COVID-19 in a designated hospital in Hangzhou, China. Methods:This was a retrospective study that included laboratory-confirmed cases of COVID-19 in XiXi Hospital of Hangzhou from 15 January 2020 to 30 March 2020.We reviewed and analysed the epidemiological, demographic, clinical, radiological, and laboratory features involving these cases.Agestratification analysis was also implemented. Results:We analysed 96 confirmed cases.The patients had mean age 43 years, with six patients aged <18 years and 14 patients aged >60 years.No significant gender difference was discovered.Comorbidities were commonly observed in patients aged >40 years.Twenty-eight of the patients had travelled from Wuhan City, and 51 patients were infected through close contact.Familial clusters accounted for 48 of the cases.The mean incubation time was 7 days, and the symptoms were mainly fever, cough, fatigue, and sore throat.Lymphocytopenia was observed predominantly in patients aged >60 years.Fifty-five patients presented with bilateral pulmonary lesions.The radiological Epidemiological and clinical characteristics of patients with COVID-19 from a designated hospital in Hangzhou City: a retrospective observational study
Objective To evaluate whether the gastroesophageal reflux disease (GERD) questionnaire (GerdQ) symptom score could reflect the acid exposure indicated by 24-hour esophageal pH monitoring in patients with GERD, and to further validate the clinical application value of GerdQ.Methods From November 2008 to March 2010, 134 GERD patients from outpatient department with heartburn and acid reflux symptoms were enrolled.All the patients had undergone endoscopy examination, 24-hour esophageal pH monitoring and GerdQ scoring.According to 24-hour esophageal pH monitoring result, acid exposure group and none acid exposure group was divided by the percentage of time that pH was lower than 4 over 4.2% or DeMeester score over 14.72, the difference of GerdQ score was assessed.The receiver operating characteristic (ROC) curve of GerdQ score was drawn according to DeMeester score and the percentage of time that pH was lower than 4 as the gold standard.With SPSS 17.0 statistical software, the ratio was compared with the u test and Chi-square test, comparison between groups with t test.Results The BMI of acid exposure group was higher than that of none acid exposure group(t= 2.365, P= 0.019).The GerdQ score of acid exposure group (8.51± 2.34) was significantly higher than that of none acid exposure group (6.67 ± 2.79), the difference was statistically significant (t = 4.002, P = 0.000) .ROC curve was drawn according to DeMeester score over 14.72 as gold standard; the area under curve (AUC) was 0.70.When the critical value of GerdQ score was 7.5, Youden index was up to 0.3365, the sensitivity of diagnosis was 0.6909 and specificity was 0.6454.The percentage of time that PH was lower than 4 over 4.2% as the gold standard, the AUC of GerdQ score was 0.663.When the critical value of GerdQ score was 7.5, Youden index was up to 0.2790, the sensitivity of diagnosis was 0.6600 and specificity was 0.6190.Conclusions GerdQ score greater than 7.5 can better reflect acid exposure at the lower esophageal.There is stronger association between GerdQ score with the DeMeester acid exposure score over 14.72 than with the percentage of time that pH lower than 4 over 4.2% as the critical value for acid exposure.Obesity may aggravate the transient lower esophageal sphincter relaxation leading to occurrence of GERD symptoms.
Key words:
Gastroesophageal reflux; Questionaire; Monitoring, physiologic; Hydrogen-Ion concentration; Obesity
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