In Taiwan, traditional herbal medication was included in Taiwan's National Health Insurance (NHI) system since 1996 and in 9 out of 10 hospitals have developed their own departments of traditional medicine. This study aims to address the herb-induced liver injury (HILI) after using herbal medicine on the relationship between age, gender, epidemiology, laboratory data, pathogenesis, mobility, and mortality. We searched the PubMed database with “hepatitis after herbal medicine” and “in human” till 2018 April and returned 163 articles in a systemic review manner. Two cases reports describing in-vitro liver injury were excluded. Reviews and articles without the detailed report, laboratory data and history were excluded from this study. In the end, there were 53 articles enrolled in this study. These enrolled literatures are from France (n = 13), Germany (n = 12), Switzerland (n = 5) United States of America (n = 4), Korea (n = 4), Hong Kong (n = 4), Greece (n = 3), China (n = 2), Canada (n = 1), Italy (n = 1), Thailand (n = 1), Finland (n = 1), Taiwan (n = 1), and Japan (n = 1). The data were analyzed with a commercial statistical software Stata/SE 12.0 program Stata Corporation, College Station, TX, USA. Statistical χ 2 tests were performed and the significance was set at a P value of less than .05 (2-tailed). The ages are ranged from 15 to 78 years with the mean ± SD (standard deviation) of 48.3 ± 16.2 years old. The majority of cases are female (n = 37). In elderly, man is more commonly seen than female in HILI (37.5% vs 10.5%, P = .02). Female is vulnerable to cholestatic type of HILI than male (21.1% vs 0.0%, P = .04). Of all the cases in HILI, using pure substance are more commonly seen than mixed substance ( P = .02). In gender, male patients have higher alanine aminotransferase (GPT) (IU/L) level in HILI than female ones (1560 ± 819 vs 1047 ± 706, P = .03). In HILI, the female is more commonly seen than male, but less than male in the elderly. The pure substance more often happens to HILI than mixture substance. Female is predominant in the cholestatic type of HILI. The major prevalence of HILI is in Europe rather than Asia. HILI cases in Europe is 2.75-fold than in Asia. This could be due to fewer reports of the herb induced liver injury in Asia compared to Europe. Prevention of HILI is the best policy because it needs to take 78 ± 59 days to recover.

We previously demonstrated that IL-3 stimulates transcription of the antiapoptotic gene mcl-1 via two promoter elements designated as the SIE and CRE-2 sites. To further study the functional role of these two DNA elements, mutant mice with targeted mutations of both SIE and CRE-2 sites (SC mutants) were generated. Homozygous SC mutants manifested a markedly reduced level of Mcl-1 in thymus but not in other major organs such as spleen, liver, lung, or heart. Reduced expression of Mcl-1 in SC mutant thymus resulted in attenuated positive selection of double-positive thymocytes into both CD4 and CD8 lineages, a result likely due to reduced survival of SC mutant double-positive thymocytes that were supposed to be positively selected. In contrast, in the peripheral lymphoid organs, only CD8؉ but not CD4 ؉ T cells were significantly reduced in homozygous SC mutant mice, a result consistent with a more dramatic decrease both of Mcl-1 expression and cell viability in mutant CD8؉ compared with mutant CD4؉ T cells. Impaired T cell development and peripheral CD8 ؉ lymphopenia in homozygous SC mutant mice were both cell autonomous and could be rescued by enforced expression of human Mcl-1. Together, the promoter-knock-in mouse model generated in this study not only revealed a Mcl-1, a member of the Bcl-2 family protein, was originally identified in the ML-1 human myeloid leukemia cell line that underwent phorbol ester-induced differentiation (1). Mcl-1 is widely expressed in various tissues and cell lineages, and a great number of studies indicate that Mcl-1 plays an apical role in many cell survival and death pathways (2). Mcl-1 deficiency results in embryonic lethality at the peri-implantation stage (3). Conditional knock-out approaches have thus been used to assess Mcl-1 functions in other tissues. Using this approach, Mcl-1 has been shown to be essential for the survival of many cell types in the hematopoietic system, including hematopoietic stem cells, lymphoid precursors, mature T and B lymphocytes, and neutrophils (4 -6).T cell progenitors arise from the bone marrow and migrate into the thymus to become early committed T cells that lack expression of TCR, CD4, and CD8. These cells are termed double-negative (DN) 3 thymocytes (7). DN thymocytes then develop in an ordered progression and mature into the CD4 ϩ CD8 ϩ double-positive (DP) stage (8). At this stage, immature DP thymocytes expressing unique TCRs are tested individually by two selection processes that eliminate cells whose TCRs either cannot recognize self peptide/MHC complex (positive selection) or react too strongly (negative selection). These two selection processes ensure that most DP thymocytes selected to differentiate into CD4 single-positive (SP) or CD8SP thymocytes, and eventually peripheral T cells, can respond properly when encountering foreign peptides in the context of self MHC in the periphery (8 -10). Many Bcl-2 family members have been shown to play a role in T cell development. Deletion of Bcl-2 resulted in rapid loss of thymocytes and naive...

Introduction Meningitis is a commonly seen disease in the daily practice of emergency departments. Cerebrospinal fluid (CSF) examination including Gram stain and culture are crucial for identifying between bacterial and viral meningitis and should be completed prior to antibiotic administration. Hypoglycorrhachia is one of the certain independent predictors of bacterial meningitis.Case report A 69-year-old male having a past medical history of alcoholism and liver cirrhosis presented to the emergency department with intermittent fever and chills for one day. Sudden onset of a tonic-clonic seizure for a few minutes with agitation, and neck stiffness on physical examination were noted. Lumbar puncture was performed and xanthochromic turbid cerebrospinal fluid (CSF) was retrieved. CSF analysis showed pleocytosis with a white blood cell count of 4608/cm 2 ; the neutrophil-tolymphocyte ratio was 96:4. The CSF also showed extreme hypoglycorrhachia (4 mg/dL) and high protein levels (865 mg/dL) were noted. Bacterial meningitis was diagnosed. The CSF yielded Klebsiella pneumoniae on the third day of admission. After 4 weeks of meropenem complete treatment, the patient recovered uneventfully without any neurological deficit and was discharged one1 month later.Discussion Hypoglycorrhachia is one of the certain independent predictors of bacterial meningitis. Elevated CSF protein over 150 mg/dL may turn normal crystal-clear CSF into yellowish or turbid CSF. Aerobic Gram-negative bacteria like Klebsiella species are uncommon community-acquired pathogens and are more likely to occur after neurosurgical procedures complicated with pyogenic liver abscess and septic endophthalmitis. The appropriate antibiotic should be monitored and adjusted clinically.Conclusions In febrile patients, epileptic episodes may hint towards an inflammatory process in the central nervous system. Grossly turbid and xanthochromic CSF with hypoglycorrhachia raise the concern for bacterial meningitis. Adequate antibiotic adjustment according to CSF culture results can also lead to the successful outcome without neurologic deficits.

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Background: pulmonary edema results from the shift of excessive fluid into the alveoli space and can be clinically classified into cardiogenic or non-cardiogenic by pathophysiology. This study aimed to elucidate the mechanism, outcomes, and prevention of poisoning induced non-cardiogenic pulmonary edema (PINCPE). Materials and methods: we conducted a study on etiology, epidemiology, mechanism, risk, and length of hospital stay in PINCPE. A PubMed search using terms: poisoning and non-cardiogenic pulmonary edema. From 1986 to 2017, a total of 15 articles with 16 cases (2 cases in one article) were included. Cut-off value of mean age was used for classification of subjects into younger group and older group, and length of stay (LOS) was compared between the two groups. Results: the age range of the patients was 7 to 72 years, and the average age (mean ± SD [standard deviation]) was 35.7±19.5 years. Among the reported substances in PINCPE, calcium channel blockers (CCBs) were most frequently used (n=8; 50%). In electrocardiogram (ECG), sinus tachycardia (n=8; 50%) was the most common finding. The overall rate of intubation with mechanical ventilator support was 81.3%. The mortality rate was 12.5%. Among patients with PINCPE, LOS was significantly shorter in the younger group aged <35.7 years than in the older group (5.7 vs. 8.9; p=.022). Conclusion: CCB was the most common etiologic agent in PINCPE. Up to 81.3% of PINCPE cases required intubation with ventilator support due to respiratory failure. LOS may increase 3.2 days if the case is complicated with extra-pulmonary organ failure.