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Objective:To investigate the effect of continuous hemoperfusion (HP) on the levels of soluble CD14 isoform (sCD14-st) and neutrophil gelatinase-associated lipocalin (NGAL) on patients with diquat (DQ) poisoning and its significance.Methods:A total of 86 patients with acute DQ poisoning admitted to the department of emergency medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to August 2021 were enrolled and divided into the intermittent HP group (40 cases) and the continuous HP group (46 cases) according to the random number table method. All patients received basic treatment and continuous veno-venous hemofiltration (CVVH) within 24 hours after admission. On this basis, the intermittent HP group received HP treatment within 2 hours, lasting 2 hours each time for every 8 hours, 3 times in all; the continuous HP group received continued HP treatment until there was no DQ component in urine samples. Serum NGAL levels were detected in all patients before treatment and at 3 hours, 12 hours, 24 hours, 2 days, 3 days, 5 days, and 7 days after treatment. At the same time, serum sCD14-st, blood lactate (Lac), arterial partial pressure of oxygen (PaO 2), serum creatinine (SCr), MB isoenzyme of creatine kinase (CK-MB) and interleukin-18 (IL-18) levels were detected before treatment and at 24 hours, 3 days, and 7 days after treatment. Kaplan-Meier survival curve was drawn to analyze the 28-day survival of patients. Results:Before treatment, there was no significant difference in serum NGAL, sCD14-st, Lac, PaO 2, SCr, CK-MB and IL-18 levels between the two groups. With the prolongation of treatment, the serum levels of NGAL, sCD14-st, Lac, SCr, CK-MB and IL-18 in the intermittent HP group increased at first and then decreased. Serum levels of NGAL, sCD14-st, CK-MB and IL-18 reached their peaks at 24 hours after treatment, and the Lac and SCr levels reached their peaks at 3 days after treatment. In addition, the levels of the above indexes at each time point in the continuous HP group were all significantly lower than those in the intermittent HP group [after 24 hours of treatment: NGAL (μg/L) was 345.90±30.75 vs. 404.24±38.79, sCD14-st (ng/L) was 1 941.88±298.02 vs. 2 656.35±347.93, CK-MB (U/L) was 30.67±9.11 vs. 43.28±8.06, IL-18 (ng/L) was 139.49±16.29 vs. 177.98±27.85; 3 days of treatment: Lac (mmol/L) was 2.98±0.26 vs. 3.72±0.49, SCr (μmol/L) was 125.01±24.24 vs. 156.74±28.88; all P < 0.05]. However, there was no significant difference in PaO 2 levels between the two groups at each time point after treatment. The Kaplan-Meier survival curve showed that the 28-day mortality of patients in the continuous HP group was significantly lower than that in the intermittent HP group [26.09% (12/46) vs. 52.50% (21/40); Log-Rank test: χ2 = 7.288, P = 0.007]. Conclusion:Continuous HP could effectively reduce serum sCD14-st, NGAL levels and 28-day mortality in patients with DQ poisoning, with good curative effect.
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Objective:To explore the value of neutrophil gelatinase-associated lipocalin(NGAL)and neutrophil-to-lymphocyte and platelet ratio(NLPR)for early prediction of kidney injury with Diquat(DQ)poisoning in elderly patients.Methods:In this retrospective study, a total of 106 elderly patients with DQ poisoning treated in the Emergency Intensive Care Unit(EICU)of Harrison International Peace Hospital Affiliated to Hebei Medical University between October 2019 and October 2021 were divided into an acute kidney injury group(AKI group, n=62)and a non-acute kidney injury group(NAKI group, n=44). Meanwhile, 40 non-elderly patients with DQ poisoning served as the control group.Samples of 5 ml venous blood were collected from patients admitted to the EICU to measure NGAL and NLPR levels and Logistic regression analysis was conducted to analyze independent risk factors for AKI in elderly DQ poisoning patients.The area under the curve(AUC)was calculated via the receiver operating characteristic(ROC)curve, and the value of NGAL and NLPR for early prediction of AKI in elderly patients with DQ poisoning and patient prognosis was assessed.Results:Blood NGAL and NLPR levels in the AKI group were significantly higher than in the NAKI group[(387.1±46.6)μg/L vs.(103.5±18.6)μg/L, (13.5±3.4) vs.(5.3±1.1), t=38.243, 15.608, P<0.001 for both]. Logistic regression analysis results showed that elevated levels of NGAL( OR=1.009, 95% CI: 1.003-1.015, P<0.001)and NLPR( OR=1.263, 95% CI: 1.039-1.536, P<0.001)were risk factors for AKI in elderly patients with DQ poisoning.The areas under the ROC curves of NGAL, NLPR and NGAL+ NLPR for AKI prediction were 0.834, 0.803 and 0.873 respectively.The predictive power of NGAL and NLPR for the death of elderly patients with DQ poisoning was higher than that of creatinine clearance(Ccr). The sensitivity of the combination of the two to predict the risk of death was 0.850, the specificity was 0.828, and the AUC was 0.887. Conclusions:NGAL and NLPR are independent risk factors for the occurrence of AKI in elderly patients with DQ poisoning.Combined detection of NGAL and NLPR improves AKI prediction and prognosis assessment in elderly patients with DQ poisoning.
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In order to explore the effect of peptidoglycan hydrolase on the viable cell counts of Bacillus amyloliquefaciens and the yield of alkaline protease, five peptidoglycan hydrolase genes (lytC, lytD, lytE, lytF and lytG) of B. amyloliquefaciens TCCC111018 were knocked out individually. The viable cell counts of the bacteria and their alkaline protease activities before and after gene deletion were determined. The viable cell counts of the knockout mutants BA ΔlytC and BA ΔlytE achieved 1.67×106 CFU/mL and 1.44×106 CFU/mL respectively after cultivation for 60 h, which were 32.5% and 14.3% higher than that of the control strain BA Δupp. Their alkaline protease activities reached 20 264 U/mL and 17 265 U/mL, respectively, which were 43.1% and 27.3% higher than that of the control strain. The results showed that deleting some of the peptidoglycan hydrolase genes effectively maintained the viable cell counts of bacteria and increased the activity of extracellular enzymes, which may provide a new idea for optimization of the microbial host for production of industrial enzymes.
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Bacillus amyloliquefaciens/genetics , Bacterial Proteins , Cell Count , Endopeptidases/genetics , N-Acetylmuramoyl-L-alanine Amidase/geneticsABSTRACT
Objective:To investigate the predictive neutrophil/lymphocyte ratio (NLR) combined with soluble growth stimulating expression gene 2 protein (sST2) on in-hospital major adverse cardiovascular events (MACE) in patients with myocardial injury following moderate-severe acute carbon monoxide poisoning (ACOP).Methods:A single-cente prospective observational approach was conducted. Moderate-severe ACOP patients with myocardial damage from November 2016 to February 2020 in department of emergency medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University were enrolled. The baseline data of the patients, NLR and sST2 (T0 sST2) on admission, sST2 at 3 days after admission (T3 d sST2), and the other myocardial injury and biochemical indicators were collected. According to whether MACE occurred, the patients were divided into MACE group and non-MACE group. The clinical data of the two groups were compared. Pearson correlation analysis was used to analyze the correlation of each index. Binary Logistic regression was used to analyze the independent risk factors of in-hospital MACE in patients with moderate-severe ACOP myocardial injury. The receiver operator characteristic curve (ROC curve) was drawn and area under ROC curve (AUC) was calculated to analyze the predictive value of NLR, sST2, and NLR combined with sST2 for the occurrence of in-hospital MACE in patients with moderate-severe ACOP myocardial injury.Results:A total of 278 patients with moderate-severe ACOP myocardial injury were included in the final analysis, and the incidence of MACE was 11.51% (32/278). Cardiac troponin I (cTnI), lactic acid (Lac), NLR, and T3 d sST2 in the MACE group were significantly higher than those in the non-MACE group [cTnI (μg/L): 0.83±0.15 vs. 0.46±0.37, Lac (mmol/L): 2.96±1.14 vs. 2.43±1.35, NLR: 13.14±4.37 vs. 9.49±4.21, T3 d sST2 (μg/L): 59.88±23.42 vs. 39.83±12.60, all P < 0.05], there was no significant difference in T0 sST2 between the MACE group and the non-MACE group (μg/L: 269.09±90.89 vs. 240.14±113.02, P > 0.05). Pearson correlation analysis showed that there were significantly positive correlations in NLR with acute physiology and chronic health evaluationⅡ(APACHEⅡ), T3 d sST2 with APACHEⅡ, and NLR with T3 d sST2 ( r values were 0.226, 0.209, 0.193, all P < 0.01). Binary Logistic regression analysis showed that T3 d sST2 and NLR were both independent risk factors for MACE in moderate-severe ACOP patients with myocardial injury [odds ratio ( OR) and 95% confidence interval (95% CI) respectively was 1.064 (1.039-1.090), 1.176 (1.066-1.298), both P < 0.01]. ROC curve analysis showed that the predictive efficacy of NLR combined with T3 d sST2 for the occurrence of in-hospital MACE in patients with ACOP myocardial injury (AUC = 0.876) was better than that of NLR (AUC = 0.754) and T3 d sST2 (AUC = 0.813). When the optimal critical value of NLR was 10.02 and that of T3 d sST2 was 43.50 μg/L, the sensitivity of predicting the occurrence of MACE in patients with moderate-severe ACOP myocardial injury was 69.8% and 86.2% respectively, and the specificity was 74.3% and 70.4%, respectively. The specificity and sensitivity of the combined detection was 83.4% and 79.8%, respectively. Conclusions:NLR and T3 d sST2 were independent predictors of in-hospital MACE in moderate-severe ACOP patients with myocardial injury, and combined application of NLR and T3 d sST2 had good predictive value. For patients with moderate-severe ACOP myocardial injury with NLR > 10.02 and T3 d sST2 > 43.50 μg/L, the occurrence of in-hospital MACE should be alert.
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Objective:To investigate the clinical significance of soluble growth stimulating expression gene 2 protein (sST2) combined with neutrophil/lymphocyte ratio (NLR) in the prediction of nosocomial cardiovascular adverse events in patients with acute carbon monoxide poisoning (ACOP) myocardial injury.Methods:Patients with ACOP myocardial injury from January 2017 to December 2019 in Emergency Ward and EICU of Harrson International Peace Hospital, Hebei Medical University were enrolled. NLR was calculated by routine blood examination on admission, and sST2 (T 0sST2, T 3dsST2) was detected by ELISA on admission and at 3 days after admission. According to the occurrence of cardiovascular adverse events, the patients were divided into the event group and the non-event group. Logistic regression was used to analyze the risk factors of in-hospital cardiovascular adverse events. ROC curve was used to analyze the value of sST2, NLR, sST2 and NLR combined in predicting the occurrence of in-hospital cardiovascular adverse events in patients with ACOP myocardial injury. Results:Totally 255 patients with ACOP myocardial injury were included in the final analysis. NLR was (13.38±4.33) in the event group and (9.57±4.22) in the non-event group, T 3dsST2 was (61.59±22.67) ng/mL in the event group and (40.52±13.14) ng/mL in the non-event group, with statistically significant differences (all P<0.01). T 0sST2 was (265.34±89.95) ng/mL in the event group and (242.43±93.09) ng/mL in the non-event group, with no statistically significant difference ( P=0.333). Logistic regression analysis showed that NLR ( OR=1.270, 95% CI: 1.125-1.434, P<0.01) and T 3dsST2 ( OR=1.082, 95% CI: 1.052-1.114, P<0.01) were independent risk factors for nosocomial cardiovascular adverse events in patients with ACOP myocardial injury. The optimal cutoff value of T 3dsST2 was 44.5 ng/mL, and of NLR was 12.08. The sensitivity and specificity of dual T 3dsST2 and NLR in predicting nosocomial cardiovascular adverse events was 79.3% and 82.7%, respectively (AUC 0.857, Youden index 0.620). Conclusions:T 3dsST2 and NLR are independent risk factors for the nosocomial cardiovascular adverse events in patients with ACOP myocardial injury. The predictive cutoff values are 44.5 ng/mL for T 3dsST2 and 12.08 for NLR. Combination of T 3dsST2 and NLR has a practical predictive value for nosocomial cardiovascular adverse events in patients with ACOP myocardial injury.
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Objective:To investigate the effect of clinical factors on the short-term prognosis of patients with acute carbon monoxide toxic heart disease.Methods:From October 2017 to December 2019, 92 patients with acute carbon monoxide poisoning (ACOP) and toxic heart disease admitted to the Department of Emergency of our hospital were enrolled in this study. The duration from poisoning to hospital admission, duration of coma, length of hospital stay, endotracheal intubation or not, admission to ICU ward or not, acute physiology and chronic health evaluation (APACHEⅡscore) at admission were recorded. The heart rate-corrected QT dispersion (QTcd) calculated based on electrocardiography results, as well as levels of serum trocalin I (cTnI) and creatine kinase isoenzyme (CK-MB) were recorded at admission, day 2, day 3, and hospital discharge. According to the diagnostic criteria of occupational cute toxic cardiopathy caused by chemicals, the patients were divided into three groups: 45 cases in the mild heart disease group (mild group), 35 cases in the moderate heart disease group (moderate group) and 12 cases in the severe heart disease group (severe group). The variables data of each group were presented as Mean±SD, and analyzed using one-way anova test. LSD- t test was used for pairwise comparison between the groups. Attributes data were compared using χ 2 comparisontest, and correlations were analyzed using Spearman correlation method and binary logistic regression analysis. Results:APACHE II score was significantly higher, and the durations of coma, and hospitalization time of severe heart disease group were significantly higher longer in the severe heart disease group than those ofin the mild and moderate groups, and the proportions of patients with early tracheal intubation to protect airway and admission in ICU ward were both significantly lower in the severe heart disease group than those ofin the mild and moderate moderate groups (all P < 0.05). The levels of CTnI and QTcd in each group increased immediately after admission, which was statistically different from that in the normal control group ( P < 0.05), while cTnI and QTcd at admission in the severe group were significantly higher than those in the mild and moderateother two groups ( P < 0.05). The levels of CK-MB in the severe group wereas significantly different from thoseat of the mild to and moderate groups at day 2 and day 3 after admission ( P < 0.05). The correlation between serum cTnI and APACHE II score at admission was R1 = 1.000 and R2 = 0.458. The correlation between QTcd and APACHE II score at admission was R1 = 1.000 and R2 = 0.765. Both of them were positively correlationsed with statistical difference ( P < 0.01). Conclusions:Patients with ACOP should admit to hospital as early as possible. For patients with severe hypoxia and no airway protection ability, an artificial airway should be established as soon as possible, and the patients should admit to the ICU at the early stage of poisoning to stabilize their condition. Changes of QTcd, serum cTnI, CK-MB and other related indicators should be monitored to detect cardiac injury in time and protect heart.
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Objective@#To investigate the predictive values of the acute physiology and chronic health evaluation II (APACHE.II) score and disseminated intravascular coagulation (DIC) score on death in patients with heat stroke.@*Methods@#A total of 76 patients with heat stroke who were treated in Emergency Department of Harrison International Peace Hospital from June 2013 to September 2017 were studied. According to the outcome of patients, we distributed the patients to death group and survival group. APACHE.II score and DIC score were calculated according to the clinical data and the test results at admission. Evaluate the correlation between the two indicators associated with death.@*Results@#There were 76 patients, with 23 deaths (30.3%) and 53 survivors (69.7%) . The APACHE-II score and DIC score were 26.26±6.48 and 4.00±1.38 in the death group.significantly higher than 20.74±4.17 and 2.28±1.21 in the survival group, and there were significant difference (P< 0.01) . The APACHE. II score was positively correlated with the DIC score, and the higher the score, the higher the mortality rate.Both indicators are significant for the Logitic regression analysis of death (P<0.01) .The sensitivity and specificity of the APACHE.II score were 65.2% and 81.1% in prediction of mortality, The sensitivity and specificity of DIC score were 65.2% and 84.9% in prediction of mortality. The specificity of the APACHE II score plus DIC score were higher than that of single APACHE. II score or DIC score in prediction of mortality (P<0.05) .@*Conclusion@#The APACHE.II score and DIC score are significantly increased in the early stage of the patients with heat stroke, and the APACHE. II score combined with DIC score may improve the value in prediction of mortality with heat stroke.
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Objective To investigate the clinical value of Rheum officinale Ball.as a main agent in a tra-ditional Chinese medicine recipe combined with continuous hemoperfusion in patients with acute paraquat poison-ing(APP). Methods A total of 124 patients with APP were divided into three groups:A group(40 cases),B group(42 cases)and C group(42 cases). Before,3 days and 7 days after treatment,PⅢNP,CⅣ,TGF-β1, MDA,SOD and SOFA scores were observed. The correlation between PⅢNP and the concentration of paraquat were analyzed,and the outcomes in 28 days were compared.Results In admission,there were no differences in PⅢNP,CⅣ,TGF-β1,MDA,SOD and SOFA scores among three groups(P>0.05).After treatment for 3 days, MDA and SOFA scores were elevated in three groups compared with these three scores in the three groups at admis-sion. Group A was increased significantly;the activity of SOD were decreased,especially in A group decreased most significantly(P<0.05);After 7 days'treatment,MDA and SOFA scores were lower than those of 3 days af-ter treatment in three groups,especially in C group decreased most significantly(P < 0.05),the activity of SOD were higher than 3 days after treatment,especially in C group increased most significantly(P<0.05);After 3,7 days treatment,PⅢNP,CⅣ,TGF-β1 were increased gradually,C group increased slowly(P<0.05).PⅢNP in patients with APP was positively correlated with the concentration of paraquat(P < 0.05). The mortality rate of three groups were 65.00%,45.24%and 23.81%,there were significant difference among three groups(P<0.05). Conclusions Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe combined with con-tinuous hemoperfusion in patients with APP could decrease PⅢNP,CⅣ,TGF-β1 and MDA. The can enhance the expression of SOD and reduce the mortality rate of patients.
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Objective To investigate the clinical values of continuous hemoperfusion on the level of inter-leukin-18(IL-18)and prognosis in patients with acute paraquat poisoning(APP). Methods A total of 112 pa-tients with APP treated in our hospital from Jun 2013 to Jul 2017 were divided into two groups:control group(56 cases,routine drug and single hemoperfusion)and therapy group(56 cases,treated by continuous hemoperfusion based on control group).All APP patients were treated with continuous veno venous hemofiltration(CVVH)at 24 hours after treatment.Within admission 24 hours,3 days and 7 days after treatment,IL-18,lactic acid(Lac),ar-terial oxygen partial pressure(PaO2),alanine aminotransferase(ALT),creatinine(Cr)and creatine kinase(CK-MB)of patients were detected,28-day survival was recorded.Pearson correlation test was used to analyze the corre-lation between IL-18 in patients with APP and the survival rate. Results In admission,there were no differences in the levels of IL-18,Lac,PaO2,ALT,Cr and CK-MB between the two groups(P>0.05).At 3 days after treat-ment,the levels of IL-18,Lac,ALT,Cr and CK-MB were higher than those before treatment,and the therapy group was lower than the control group,while PaO2was lower than those before treatment,and the therapy group was higher than the control group(P<0.05);At 7 days after treatment,the two groups both had lower levels of IL-18,Lac,ALT,Cr and CK-MB than those after 3 days treatment,and the therapy group was lower than the con-trol group,while PaO2was lower than those after 3 days treatment,and the therapy group was higher than the con-trol group(P<0.05);There were 39 deaths in the therapy group and 49 deaths in the control group,the therapy group had a lower 28-day mortality rate than control group,the difference was statistically significant(69.64% vs 87.50%,χ2=5.303,P=0.021). The level of serum IL-18 in patients with APP was negatively correlated with the survival rate(r =-0.209,P = 0.027).Conclusions Therapeutic effect of continuous hemoperfusion in APP pa-tients is superior to single hemoperfusion. It could decrease the levels of IL-18,Lac,ALT,Cr and CK-MB,im-prove PaO2 and reduce the mortality rate of patients.The clinical curative effect is distinct.
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Objective@#To observe the effects of extract of Ginkgo biloba (Ginaton) on magnetic resonance imaging (MRI) and electroencephalography (EEG) in patients with delayed encephalopathy after acute carbon monoxide poisoning.@*Methods@#The 84 patients with delayed encephalopathy after acute carbon monoxide poisoning treated in our hospital from Jan. 2011 to Apr. 2016 were randomly divied into therapy group and observation group. The therapy group received routine treatments of hyperbaric oxygen, cure cerebral edema and promote brain cell metabolism, and observation group was given intravenous injection (intravenous drip) Ginaton 70 mg (adding 0.9% sodium chloride injection 250 ml) , once a day, 2 weeks for one therapeutic course. The changes of MRI and EEG before and after treatment between therapy group and observation group were observed.@*Results@#In the observation group, the white matter and globus pallidus lesions of 14 d after treatment were smaller than those in the treatment group, and the abnormal signal intensity was decreased. At 14 days after treatment the improvement of EEG in observation group were better than therapy group (P<0.05) .@*Conclusion@#Early treatment of extract of Ginkgo biloba (Ginaton) in delayed encephalopathy after acute carbon monoxide poisoning can effectively improve lesion and signal on MRI and abnormal rate on EEG. It has a certain therapeutic effect in clinical.
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Objective@#To observe the effects of Ginaton on blood nitric oxide (NO) and nitric oxide synthase (NOS) in patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP).@*Methods@#A total of 116 patients with DEACMP who were treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2012 to April 2016 were enrolled and ran-domly divided into control group and treatment group using a random number table, with 58 patients in each group. The patients in the control group were given conventional treatment including hyperbaric oxygen, preven-tion and treatment of cerebral edema, and promotion of brain cell metabolism, and those in the treatment group were given Ginaton in addition to the conventional treatment. The course of treatment was 2 weeks for both groups. The levels of neuron-specific enolase (NSE) , NO, NOS, and inducible nitric oxide synthase (iNOS) were measured before treatment and at 2 weeks after treatment, and the change in Mini-Mental State Examina-tion (MMSE) score and clinical outcome were observed in both groups. The correlation between the blood NO level on admission and the MMSE score was analyzed.@*Results@#There was a significant difference in the overall response rate between the treatment group and the control group (81.03% vs 62.07%, χ2 = 5.124, P=0.024). Be-fore treatment, there were no significant differences in the levels of NO and NSE, the activity of NOS and iN-OS, and MMSE score between the two groups (P>0.05). After treatment, both groups showed reductions in the levels of NO and NSE and the activity of NOS and iNOS, but the treatment group had significantly greater reduc-tions compared with the control group (P<0.05). Both groups showed a significant increase in the MMSE score after treatment, while the treatment group had a significantly greater increase compared with the control group (P<0.05). In the patients with DEACMP, the blood NO level on admission was negatively correlated with the MMSE score (r=-0.268, P=0.004).@*Conclusion@#In the treatment of patients with DEACMP, Ginaton can effectively reduce the levels of NO and NSE and the activity of NOS and iNOS, increase the MMSE score, and promote the recovery of neurological function.
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Objective To investigate the clinical value of type Ⅲ procollagen peptide (P Ⅲ P) in sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe in patients with acute paraquat poisoning (APP).Methods A total of 104 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from March 2013 to December 2016 were divied into three groups:A group (n =30,routine therapeutic agents coupled with a single hemoperfusion),B group (n =34,treated by Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe coupled with a single hemoperfusion),C group (n =40,treated by Rheum officinale Ball.as a predominant agent in a traditional Chinese medicine recipe and sequential continuous hemoperfusion).Before and 3 days and 7 days after treatment,tumor necrosis factor t (TNF-α),interleukin-18 (IL-18),maleic dialdehyde (MDA),superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) of patients were detected,and the change of sequential organ failure assessment (SOFA) scores were observed.Before and 3 days,7 days,10 days and 14 days after treatment,PⅢP were detected,and the changes of lung CT in three groups were observed before and 7 days,14 days after treatment.Pearson correlation test was used to analyze the correlation between P Ⅲ P in patients with APP and the concentration of paraquat,and the outcomes in 28 days were compared with chi square test.Results At admission,there were no differences in the levels of plasma TNF-α,IL-18,MDA,P Ⅲ P,SOD,GSHPX and SOFA scores among three groups (P ＞ 0.05).At 3 days after treatment,the levels of plasma TNF-α,IL-18,MDA and SOFA scores were elevated in three groups compared with those at admission,especially in group A were increased significantly,whereas the activity of plasma SOD and GSH-PX were decreased in thress groups,especially in group A decreased most significantly (P ＜ 0.05).At 7 days after treatment,the levels of plasma TNF-α,IL-18,MDA and SOFA scores were lower than those at 3 days after treatment in three groups especially those in group C decreased most significantly (P ＜ 0.05),whereas the activities of plasma SOD and GSH-PX were higher than those at 3 days after treatment especially in group C decreased most significantly (P ＜0.05).At 3 days,7 days,10 days,14 days after treatment,the level of P Ⅲ P were increased gradually in three groups,especially in group C increased most slowly with statistically significant difference between the groups (P ＜ 0.05).At admission,there were no statistically significant difference in the features of lung CT among three groups (P ＞ 0.05).At 7 days after treatment,lung CT mainly manifested ground glass lesions in C group.At 14 days after treatment,lung CT mainly manifested small size of the exudative changes and the irregular line of pleura in C group with higher proportion of those changes than that in A,B group,while pulmonary interstitial changes were found in the lung CT of A and B groups with higher proportion of these changes than that in C group,and those A group was higher than those in B group (P ＜ O.05).The level of serum P Ⅲ P in patients with APP was positively correlated with the concentration of paraquat (r =0.310,P =0.001).The mortality rate of three groups were 53.33％,44.12％ and 25.00％,respectively,with significant difference among three groups (P ＜ 0.05).Conclusion The clinically therapeutic effect of sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine in patients with APP was distinct.It could decrease the levels of PⅢ P,TNF-α,IL-18 and MDA,enhance the expression of SOD and GSH-PX,reduce pulmonary fibrosis in patients and the mortality rate of patients.The P Ⅲ P is the evaluation index of pulmonary fibrosis and can provide useful clinical value for the treatment of patients with APP.
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Objective To observe the impact of ginkgo biloba extract(Ginaton) on nerve functioninpa-tients withdelayed encephalopathy after acute carbon monoxide poisoning(DEACMP). Methods 96 patients with DEACMP treated in our hospital from April 2011 to February 2017 were randomly divided into a control group and a study group. The control group received hyperbaric oxygen ,control of intracranial pressure ,and improvement of brain cell metabolism;while the study group receivedintravenous injection of Ginaton 70 mg(adding into 250 mL of 0.9% sodium chloride) once daily fora 2-week therapeutic course. MRIand EEGwere used forexamination in DEACMP patients within 24 h after onset and 14 days after treatment. Changes in MRI and EEG examination , clinical symptoms ,mini-mental state examination (MMSE) score ,Barthel index (BI),and Montreal cognitive assessment(MoCA)were assessed before and after treatment between the two groups. Results The therapy wasef-fective in 39 patients in the study group,with a total effectiveness rate of 81.25%;and in 29 patients in the control group,with a total effectiveness rate of 60.42%. There was significant difference between the two groups (χ2 =5.042,P = 0.025). Inadmission,there were no differences between the two groups in the abnormal signals of MRI,abnormal rate of EEG,and the scores on MMSE,BI,andMoCA(P>0.05). After a 14-day treatment,the abnormal signals of MRI,abnormal rate of EEG,andthe scores on MMSE,BI,and MoCA score were improved better in the study than in the control group(P < 0.05). The MMSE score was negatively correlated with disease severity in DEACMP patients(r=-0.832,P=0.000). Conclusions Early treatment with Ginaton can effectively improvethe cerebral lesions on MR,the abnormal rate of EEG,andthe scores on MMSE,BI,and MoCA. It has certain clinical efficacy.
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Objective To investigate the clinical effect of paraquat (PQ) detoxification recipe combined with continuous hemoperfusion (HP) in the treatment of patients with acute paraquat poisoning (APP) and clinical significance of soluble CD14 subtype (sCD14-st, Presepsin). Methods A prospective randomized controlled trial was conducted. 152 patients with moderate APP admitted to Department of Emergency Medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University from July 2013 to June 2017 were enrolled, and they were randomly divided into three groups. The patients in HP group (group A, n = 35) only received 2-hour HP for 3 times, 8 hours each time, those in PQ detoxification recipe combined with HP group (group B, n = 50) received PQ detoxification recipe 1 (once per 2 hours until no PQ component was found in faeces) and 2 (3 times a day for 14 days) beside HP. The others in PQ detoxification recipe combined with persistent HP group (group C, n = 67) received continuous HP until the PQ component in serum was not detected. The parameters of organ function and inflammatory factor, and blood Presepsin and PQ contents were determined before and after treatment. The curative effect and 28-day mortality were recorded. The correlations between serum Presepsin level and PQ content as well as 28-day mortality were analyzed with Pearson correlation analysis. Receiver operating characteristic curve (ROC) was plotted to analyze the predictive value of Presepsin on prognosis. Results The total effective rate of group C was significantly higher than that of groups A and B [70.1% (47/67) vs. 34.3% (12/35), 54.0% (27/50)], and 28-day mortality was significantly lowered [29.8% (20/67) vs. 65.7% (23/35), 46.0% (23/50), both P < 0.05]. There was no significant difference in alanine aminotransferase (ALT), MB isoenzyme of creatine kinase (CK-MB), serum creatinine (SCr), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukins (IL-6 and IL-10) before treatment among the three groups. Five days after treatment, the above parameters in the three groups were increased as compared with those before treatment, but the increase degree in group C was the lowest. At 7 days after treatment, the parameters were decreased, especially in group C. There was no significant difference in serum Presepsin and PQ levels before treatment among the three groups. With the prolongation of treatment time, the Prespsin levels in groups A, B, and C were increased, and peaked at 12 hours (μg/L: 4.28±0.20, 3.87±0.25, 3.53±0.23), then gradually decreased,and the PQ contents were lower than those before treatment from 8 hours (mg/L: 1.76±0.12 vs. 2.12±0.17, 1.57±0.08 vs. 2.24±0.16, 1.25±0.10 vs. 2.14±0.18), with a time dependence pattern, especially in group C (all P < 0.05) . Correlation analysis showed that blood Presepsin level was positively correlated with PQ content and 28-day mortality (r1= 0.917, r2= 0.864, both P = 0.001), suggesting that the higher the PQ content was, the higher the Presepsin level, and the higher the 28-day mortality was. ROC curve analysis showed that the area under ROC curve (AUC) of Presepsin predicting 28-day mortality was 0.863; when the cut-off value was 1.22 μg/L, the sensitivity was 83.3%, the specificity was 81.4%, the positive predictive value was 77.46%, and the negative predictive value was 86.42%. Conclusions Early administration of PQ detoxification recipe combined with continuous HP treatment can effectively reduce Presepsin level, decrease the mortality of patients with moderate APP, improve the prognosis. Presepsin can assess the prognosis of patients with APP.
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Objective To investigate the clinical efficacy of sequential hemoperfusion combined with rhu-barb as the main treatment for patients with acute paraquat poisoning(acute,paraquat,poisoning,APP). Meth-ods 16 moderate APP patients in our hospital were randomly divided into group A(hemoperfusion group,31 cas-es),group B(hemoperfusion combined with rhubarb as the main prescription group,40 cases)and group C(con-tinuous hemoperfusion combined with rhubarb as the main prescription group,45 cases),respectively.Levels of C-reactive protein(CRP),alanine aminotransferase(ALT),creatine kinase(CK-MB),creatinine(Cr),tumor ne-crosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10(IL-10)were determined before treatment and at 5 d,7 d post-treatment. At 8 h,12 h and 24 h post-treatment,serum paraquat level was determined. Results After treatment,the total effective rate of group C(68.89%)was significantly higher than that of group A (35.48%),group B(52.5%),with significant differences among groups(χ2= 8.335,P=0.015). Levels of ALT,CK-MB,Cr,CRP,TNF-α,IL-6 and IL-10 were significantly increased at 5 d post-treatment in group A, but were significantly decreased at 7d post-treatment in group C,with significant differences among groups(P<0.05).The serum paraquat content in group B and C was lower than that in group A at 8 h post-treatment.The se-rum paraquat content was the lowest in group C at 12h post-treatment(P < 0.05). However,the serum paraquat content decreased significantly in each group at 24 h post-treatment,with no significant differences among three groups. Conclusions The early continuous hemoperfusion combined with rhubarb-based sequential treatment of APP can effectively reduce the fatality rate and improve prognosis of APP patients.
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Objective To investigate the relationship between soluble CD14-st (Presepsin)and assessment,prognosis in patients with acute paraquat poisoning (APP).Methods A total of 82 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2013 to January 2016 were divied into three groups:mild poisoning group (n =20),moderate poisoning group (n =36)and severe poisoning group (n =26).According to the outcomes,patients were divided into survivor group (n =28)and non-survivor group (n =54).Another 50 healthy subjects were selected as control group.In control group,samples of 3 mL venous blood from 50 healthy subjects were collected for laboratory examination.Samoles of 10 mL venous blood from all patients were collected before and 72 hours,7 days after treatment to detect presepsin,C reactive protein (CRP), tumor necrosis factor α(TNF-α),interleukin-6 (IL-6)and interleukin-10 (IL-10).Before and 72 hours, 7 days after treatment,the change of Acute physiology and chronic health evaluation (APACHE)Ⅱscore and the outcomes in 28 days were observed.The variance analysis of repeated measures was used for comparison among multiple groups,and the t test was used to compare changes of detected biomarkers between two groups,and the outcomes in 28 days between two groups were compared with chi square test. Pearson correlation test was used to analyze the correlation between Presepsin in patients with APP and the survival rate.Results APACHE Ⅱ scores and the serum level of prespsin,CRP,TNF-α,IL-6 at admission and 72 hours,7 days after treatment in three poisoning groups were significantly increased compared with control group,IL-10 were decreased compared with control group (P <0.05 ),and there were significant differences in those biomarkers between moderate group and mild group,and between severe group and mild group,moderate group (P <0.05).At admission,72 h,7 d after admission,APACHEⅡscore and the serum levels of presepsin,CRP,TNF-α,IL-6 in non-survivor group were higher than those in survivor group,and IL-10 in non-survivor was lower than that in survivor group (P <0.05).The mortality rates of these 3 groups were 25.00%,69.44% and 92.31%,demonstrating significant differences among three groups (P <0.05).The AUCs were 0.862 and 0.731 for presepsin and APACHEⅡscore respectively at admission.The predictive capability of presepsin for 28-day mortality was superior over that of APACHEⅡscore (P <0.05).The level of serum presepsin in patients with APP was negatively correlated with the survival rate (r =-0.285,P =0.009).Conclusions The detection of prespsin has important clinical value in the severity assessment and prognosis in patients with APP.It is an important guidance for early therapeutic strategy.
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Objective To study the value of copeptin and APACHE Ⅱ used for assessing acute paraquat poisoning (APP). Methods One hundred and twenty six APP patients were divided into survival group (n = 58) and death group (n = 68), with clinical death as the endpoint of observation. 3 mL blood was obtained from each subject at 2 h , 24 h and 7 d after admission for detecting the levels of copeptin , and APACHE Ⅱ scores were recorded at the same time. Results There was significant difference in dosages of paraquat taken in the death group and the survival group , but the differences were significant in the rescue time , the first time for hemoperfusion and the times for hemoperfusion. 2 h after admission , the death group and survival group had significant difference in elevated copeptin but no significant difference in scores by APACHE Ⅱ. 24 h after admission copeptin decreased to normal level in the survival group but maintained at a higher level in the death group, while the scores by APACHE Ⅱ had insignificant difference between two groups. 7 d after admission, copeptin kept at a higher level and the scores by APACHE Ⅱwere significantly increased in the death group , with significant differences compared to the survival group. The oral doses of pesticides the patients took were positively correlated with copeptin level and scores by APACHE Ⅱ. Conclusion Repeated detection of copeptin and APACHE Ⅱ score are of clinical importance for the assessment of prognosis of APP patients and reasonable distribution of medical resources.
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Objective To investigate the clinical value of copeptin and ischemia modified albumin combined determination in the early diagnosis and clinical significance in myocardial damage of acute organic phosphorus pesticide poisoning .Methods Eighty‐six cases of AOPP patients were divided into two groups :the myocardial injury group (50 cases) and non myocardial injury group (36 cases) ;30 healthy people were selected as the control group .3 mL of venous blood were collected for all subjects involved within one hour in admission ,and their cTnI ,IMA and copeptin levels were detected .Results Compared with the control group ,the copep‐tin levels of non myocardial injury group and myocardial injury group were elevated and there was significant difference (P< 0 .05) ;the difference between myocardial injury group and non myocardial injury groups was also significantly different (P< 0 .05) .Among them ,the comparison between severe and mild to moderate group revealed that the IMA and copeptin levels reduced obviously ,there was significant difference (P< 0 .05) ;in myocardial injury group ,the IMA and copeptin levels of patients in different poisoning de‐gree were negatively correlated .Conclusion Early determination of IMA and copeptin level has important significance in the early diagnosis of myocardial injury in patients with poisoning in AOPP ,and could provide guidance for clinical medication .
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Objective To investigate the application value of early lactate clearance rate and acute physiology and chronic health evaluation (APACHE) Ⅱ score in patients with acute carbon monoxide poisoning encephalopathy.Methods One hundred and forty-six patients with acute severe carbon monoxide poisoning were divided into control group (60 cases) and case group (86 cases) according to the occurrence of toxic encephalopathy.All the patients were extracting 1 ml arterial blood under the condition of air before treatment and 6,24,72 h after treatment,arterial blood lactic acid level was detected,and the lactate clearance rate was calculated.The initial level of blood lactic acid,lactic acid clearance rate and APACHE Ⅱ score 6,24,72 h after treatment,complication rate and mortality rate were compared between the two groups.Results Compared with control group,the initial level of blood lactic acid in case group was higher [(3.30 ± 0.55) mmol/L vs.(2.64 ± 0.24) mmol/L],the lactate clearance rate 6,24 h after treatment was lower [(8.22 ± 1.20)％ vs.(12.83 ± 5.31)％,(12.00 ± 2.40)％ vs.(15.17 ± 2.99)％],the APACHE Ⅱ score 6,24,72 h after treatment was higher [(16.78 ±2.82) scores vs.(12.33 ±2.16) scores,(14.11 ± 1.54) scores vs.(10.17 ±0.98) scores,(10.56 ± 1.51) scores vs.(7.83 ± 1.17) scores],the complication rate and mortality rate were higher,and there were statistical differences (P ＜ 0.05).There was no statistical difference in lactate clearance rate 72 h after treatment between the two groups (P ＞ 0.05).In acute carbon monoxide poisoning encephalopathy patients,the lactate clearance rate 6 h after treatment was negatively correlated with APACHE Ⅱ score and mortality rate (r =-0.616,P =0.015;r =-0.606,P =0.017).Conclusion Early lactate clearance rate and APACHE Ⅱ score can help to assessment the severity,guide treatment and judging prognosis in patients with acute carbon monoxide poisoning encephalopathy.