5'-DMT-dC(Ac)-Suc-CPG; 1000 Å

Aconitine (AC) is well-known as the main toxic ingredient and active compound of Aconitum species, of which several aconites are essential herbal medicines of Traditional Chinese Medicine (TCM) and widely applied to treat diverse diseases for their excellent anti-inflammatory, analgesic, and cardiotonic effects. However, the cardiotoxicity and neurotoxicity of AC attracted a lot of attention and made it a favorite botanic poison in history. Nowadays, the narrow therapeutic window of AC limits the clinical application of AC-containing herbal medicines; overdosing on AC always induces ventricular tachyarrhythmia and heart arrest, both of which are potentially lethal. But the underlying cardiotoxic mechanisms remained chaos. Recently, beyond its cardiotoxic effects, emerging evidence shows that low doses of AC or its metabolites could generate cardioprotective effects and are necessary to aconite's clinical efficacy. Consistent with TCM's theory that even toxic substances are powerful medicines, AC thus could not be simply identified as a toxicant or a drug. To prevent cardiotoxicity while digging the unique value of AC in cardiac pharmacology, there exists a huge urge to better know the characteristic of AC being a cardiotoxic agent or a potential heart drug. Here, this article reviews the advances of AC metabolism and focuses on the latest mechanistic findings of cardiac efficacy and toxicity of this aconite alkaloid or its metabolites. We also discuss how to prevent AC-related cardiotoxicity, as well as the issues before the development of AC-based medicines that should be solved, to provide new insight into the paradoxical nature of this ancient poison.

Acute calculous cholecystitis (AC) is one of the most frequent surgical emergencies in our field. Laparoscopic cholecystectomy is considered the treatment of choice, although not sufficiently widespread. To analyze the application of the Tokyo Guidelines in the management of AC and to determine the influence of the degree of severity on management and prognosis. Prospective, observational study of patients with a primary diagnosis of AC between 2010 and 2015.. Exclusion criteria: AC recurrence; AC as a secondary diagnosis; acalculous cholecystitis; concurrent biliary pathology. Severity was classified according Tokyo 2013 Guidelines. 998 patients were included: 338 (33.9%) mild AC, 567 (56.8%) moderate AC, and 93 (9.3%) severe AC. A total of 582 (58.3%) patients were operated on. Postoperative complications Dindo-Clavien grade ≥ II 12.6%: mild AC 3.6%; moderate AC 12.2%; severe AC 49.0% (p < 0.001). Overall mortality 2%: mild AC 0%; moderate AC 0.5%; severe AC 18.0% (p < 0.001). Urgent laparoscopic cholecystectomy remains the treatment of choice for mild and moderate AC. In patients with severe AC, the risks and benefits of surgery should be assessed, given the high degree of complications and associated mortality.

Facing a lack of high accuracy current standards in the calibration of AC (Alternating Current) + DC (Direct Current) measurement devices that function to measure DC and AC simultaneously, a measurement method with high accuracy is proposed based on zero-flux self-oscillating fluxgate. An iron core and two windings are added onto the single-iron-core double-winding structure of the traditional self-oscillating fluxgate. The added iron core and its upper winding are used to weaken the influence of ripple on the sensor's accuracy. The other one of the added windings is used for the feedback from the AC+DC magnetic potential, allowing the sensor to work in a zero-flux state and to measure AC+DC simultaneously. An AC+DC transducer prototype with an AC ranging from 0-500 A and DC 0-300 A is developed by selecting the core parameters and an optimized design of the circuit. The test results of the prototype show that the prototype can measure the AC and DC simultaneously, and the measurement accuracy reaches class 0.05 level in the nominal current range. This transducer can be used as a calibration standard of measurement devices for AC only, DC only, or AC and DC simultaneously. Compared with the AC+DC current transducer with the same accuracy level, the proposed transducer has fewer cores and simpler measuring circuit.