Chenghong Yin

An outbreak of Angiostrongyliasis cantonensis in Beijing

Abstract An outbreak of 81 cases of angiostrongyliasis cantonensis (AC) occurred in Beijing, China, during June through September 2006. Epidemiological characteristics, clinical signs and symptoms, laboratory tests, imaging, and treatment data from the 81 AC patients were collected and analyzed. All cases had a history of eating raw freshwater snails, and acquired Angiostrongylus cantonensis as a result. The incubation period ranged from 1 to 36 days. The main symptoms were fever, severe headache, neck stiffness, and skin paresthesia. A significant increase in eosinophilia occurred in the peripheral blood of 62 cases and in cerebrospinal fluid of 64 cases; 36 patients presented a linearly enhanced abnormal signal of the leptomeninges site during a cranial MRI examination, indicative of meningitis; 18 cases had a significant nodule shadow and spot flaky ground-glass shadow on chest computerized tomography. All patients were relieved of their illness with a 7-day treatment of albendazole.

Telmisartan attenuates hepatic fibrosis in bile duct-ligated rats

Aim:To evaluate the antifibrotic effect of telmisartan, an angiotensin II receptor blocker, in bile duct-ligated rats.Methods:Adult Sprague-Dawley rats were allocated to 3 groups: sham-operated rats, model rats underwent common bile duct ligation (BDL), and BDL rats treated with telmisartan (8 mg/kg, po, for 4 weeks). The animals were sacrificed on d 29, and liver histology was examined, the Knodell and Ishak scores were assigned, and the expression of angiotensin-converting enzyme (ACE) and ACE2 was evaluated with immunohistochemical staining. The mRNAs and proteins associated with liver fibrosis were evaluated using RTQ-PCR and Western blot, respectively.Results:The mean fibrosis score of BDL rats treated with telmisartan was significantly lower than that of the model rats (1.66±0.87 vs 2.13±0.35, P=0.015). However, there was no significant difference in inflammation between the two groups, both of which showed moderate inflammation. Histologically, treatment with telmisartan significantly ameliorated BDL-caused the hepatic fibrosis. Treatment with telmisartan significantly upregulated the mRNA levels of ACE2 and MAS, and decreased the mRNA levels of ACE, angiotensin II type 1 receptor (AT1-R), collagen type III, and transforming growth factor β1 (TGF-β1). Moreover, treatment with telmisartan significantly increased the expression levels of ACE2 and MAS proteins, and inhibited the expression levels of ACE and AT1-R protein.Conclusion:Telmisartan attenuates liver fibrosis in bile duct-ligated rats via increasing ACE2 expression level.

Human ocular angiostrongyliasis: a literature review.

Human ocular angiostrongyliasis caused by Angiostrongylus cantonensis infection in the eye is a very rare condition. Until now, there has been no comprehensive analysis of this disease. We searched and analysed the references found on the Internet that refer to human ocular angiostrongyliasis and reviewed the aetiology, clinical manifestations, diagnosis, epidemiology and treatment of the condition. Twenty-six references were found reporting 35 patients from 10 countries that were diagnosed with human ocular angiostrongyliasis. People are usually infected by eating raw or undercooked intermediate hosts of the parasite such as snails or contaminated vegetables. The most common symptom was visual loss. Although several treatments have been used, ocular angiostrongyliasis can still result in permanent visual impairment and may even cause blindness. As the eye is the site of infection and direct visualization is possible, ocular examination is crucial for diagnosis. The therapeutic success depended on early and complete surgical removal.

Angiostrongylus cantonensis: effect of combination therapy with albendazole and dexamethasone on Th cytokine gene expression in PBMC from patients with eosinophilic meningitis.

To determine how combination therapy with albendazole and dexamethasone changed cytokine responses in peripheral blood mononuclear cells (PBMC) in patients with eosinophilic meningitis caused by Angiostrongylus cantonensis (EOMA), we measured mRNA levels of Th2 (IL-5, IL-4 and IL-10) and Th1 (IL-2 and IFN-gamma) cytokines with reverse transcription polymerase chain reaction (RT-PCR). Forty-three patients were divided into three groups: group 1 (pre-treatment, 13 patients), group 2 (7 days post-treatment, 14 patients), and group 3 (30 days post-treatment, 16 patients). Peripheral eosinophil counts were also measured. EOMA patients showed higher levels of Th2 cytokines, including IL-5 and IL-10, and peripheral eosinophil counts, but no changes in IL-4 or Th1 cytokines. Combination therapy reduced IL-5 mRNA expression and peripheral eosinophil counts to control levels, but increased IL-10, IL-2, and IFN-gamma mRNA expression, and did not change IL-4 levels. These data suggest that systemic Th2 cytokine responses, especially IL-5, and peripheral eosinophil counts increased in EOMA patients. Combination therapy with albendazole and dexamethasone can shift the cytokine responses from Th2 to Th1 dominance, which may be a therapeutic mechanism.

Ulinastatin activates the renin–angiotensin system to ameliorate the pathophysiology of severe acute pancreatitis

Ulinastatin is a drug used effectively to alleviate symptoms and improve the pathophysiology of various types of pancreatitis. However, the molecular mechanism responsible for its action remains unknown. Therefore, we further explore the therapeutic effects of ulinastatin and investigate possible molecular pathways modulated by this drug in the development of severe acute pancreatitis (SAP).

Angiotensin‐converting enzyme (ACE and ACE2) imbalance correlates with the severity of cerulein‐induced acute pancreatitis in mice

What is the central question of this study? Angiotensin‐converting enzyme 2 (ACE2) degrades angiotensin II to angiotensin‐(1–7) and has recently been described to have an antagonistic effect on angiotensin‐converting enzyme (ACE) signalling. However, the specific underlying role of ACE2 in the pathogenesis of severe acute pancreatitis (SAP) is unclear. What is the main finding and its importance? Using wild‐type, ACE2 knock‐out and ACE2 transgenic mice, we show that ACE2–ACE imbalance plays an important role in the pathogenesis of SAP and that pancreatic ACE2 is an important factor in determining the severity of SAP.

The Ace2-angiotensin-(1–7)-mas Axis Protects Against Pancreatic Cell Damage in Cell Culture

Objective Angiotensin-converting enzyme 2 (ACE2), its product angiotensin-(1–7), and its receptor Mas have been shown to moderate the adverse effects of the ACE-angiotensin II-AT1 axis in many diseases. The aim of this study was to determine whether the ACE2-Ang-(1–7)-Mas axis could have similar effects in a cell culture model of pancreatic damage. Methods AR42J cells were stimulated with 10 nmol/L cerulein to simulate acute pancreatitis. ACE2, Ang-(1–7), Mas receptor, and PI3K/AKT pathway were measured by quantitative real-time polymerase chain reaction and Western blot analysis. Results ACE2 and Mas receptor protein levels in AR42J cells were significantly increased (P < 0.05) between 30 minutes and 6 hours postdisease induction compared with the control group. Mas receptor gene expression was significantly increased (P < 0.05) at 2 hours postdisease induction, and Ang-(1–7) was increased at 6 hours. Treatment with Ang-(1–7) in AR42J cells increased IL-10, decreased IL-6 and IL-8, and reduced the damage to pancreatic cells. Levels of IL-6 and IL-8 in AR42J cell culture were increased significantly after treatment with A779. Moreover, Ang-(1–7) increased the concentration of PI3K/AKT pathway and eNOSin AR42J cells. Conclusions ACE2-angiotensin-(1–7)-Mas axis significantly inhibits pancreatitis in response to decreased inflammatory factors by the activation of endothelial nitric oxide synthase and NO signaling pathways.

Angiostrongylus cantonensis: lesions in brain and spinal cord.

A 13-year-old boy had a one-month history of left upper limb numbness and headache, and a 20-day history of intermittent fever. He had eaten an inadequately cooked Pomacea canaliculata, an intermediate host of Angiostrongylus cantonensis, 35 days earlier. Blood count analysis showed 7.52 × 109 leukocytes/L with 18.3% eosinophils (0.5–5%). A lumbar puncture showed clear cerebrospinal fluid without erythrocytes (80 × 106 cells/L), 45% lymphocytes and 54% eosinophils; the opening pressure was 150 mm of H2O. Results of tests for circulating antigens of Angiostrongylus cantonensis were positive. Magnetic resonance imaging of the brain showed an enhancement in sagittal T1-weighted images (Figure 1). Magnetic resonance imaging of the spine showed a contrast-enhanced nodule in sagittal T1-weighted images after administration of gadolinilum (Figure 2). Consequently, a diagnosis of angiostrongyliasis was made, and the patient was treated with albendazole and dexamethasone. Symptoms of headache and intermittent fever resolved within 20 days, but left upper limb numbness remained. This symptom disappeared with time. Brain and spinal cord lesions were completely resolved at a one-year follow-up. Figure 1. Magnetic resonance imaging of the brain of the patient, showing multiple lesions in sagittal T1-weighted images after administration of gadolinilum. Figure 2. Spinal magnetic resonance imaging of the spine of the patient, showing a contrast-enhanced nodule in sagittal T1-weighted images after administration of gadolinilum.

Treatment of angiostrongyliasis using a combination of albendazole and dexamethasone: the results of a retrospective and comparative study

Abstract As the information available on the treatment of angiostrongyliasis with a combination of albendazole and dexamethasone is limited, the efficacy of such therapy was assessed using data collected during the 2006 outbreak of angiostrongyliasis in Beijing. In a retrospective and controlled study, 35 patients treated with albendazole–dexamethasone (given 20 mg albendazole/kg and 3 mg dexamethasone daily for 7 days) were compared with 34 controls who were treated only symptomatically (with acetaminophen or other drugs). Compared with the controls, the patients given the combination were less likely to have headaches after 7 days (P = 0·038), tended to have headaches that cleared quicker (P = 0·010), and received fewer doses of acetaminophen (P = 0·036). Since no serious adverse effects were observed, a 1‐week treatment with a combination of albendazole and dexamethasone appears both safe and beneficial in the treatment of angiostrongyliasis.

A scoring system for assessing the severity of acute diarrhea of adult patients

BACKGROUND Diarrhea is frequently seen in developed and developing countries, and severe diarrhea is characterized by the high risk of death. Thus, it is very important to assess the severity of diarrhea early. We conducted a multi-center study to identify risk factors for the severity of diarrhea in adult patients and formulate an adult diarrhea state score (ADSS) for out-patient clinicians. METHODS A total of 219 adult patients with acute diarrhea were divided into two groups: 132 patients with mild diarrhea and 87 with severe diarrhea. Logistic regression was used to determine risk factors for the severity of diarrhea. The risk factors were assessed and an ADSS was formulated. Receiver operating characteristic (ROC) analysis was made to evaluate the diagnostic accuracy of ADSS, and the Kappa test was used to confirm the diagnostic reliability. RESULTS Five risk factors for evaluating the severity of diarrhea in adults included age (P<0.05), axillary temperature (P<0.01), mean arterial pressure (P<0.01), white blood cell count (WBC; P<0.01), and WBC in stool (P<0.01). The area under the ROC curve for ADSS was 0.958 when the cut off value was 4 (a sensitivity of 0.909; a specificity of 0.874), and the Kappa value was 0.781 (P<0.05). CONCLUSION The risk factors associated with the pathogenic condition of diarrhea were identified, quantified and formulated into an ADSS, which has high diagnostic accuracy and reliability for the early identification of patients with severe acute diarrhea.