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Objective To study the early diagnostic value of high-sensitivity cardiac troponin Ⅰ(hs-cTnI) and soluble growth stimulating gene 2 protein (soluble suppression of tumorigenicity 2,sST2) in myocardial injury of acute organophosphorus pesticide poisoning (AOPP).Methods Totally 168 AOPP patients hospitalized from March 2014 to October 2018 were divided into the mild group (n=45),moderate group (n=55) and severe group (n=68).Another 30 healthy persons were served as the control group.The levels of cTnI,hs-cTnI,N-terminal B-type natriuretic peptide(NT-proBNP) and sST2 were detected at 4 h and 12 h after admission.SPSS 21.0 was used for statistical analysis.The measurement data were expressed by mean±standard deviation,two groups were compared by LSD-t test,and the multigroup comparison was made by single factor analysis of variance (ANOVA).The correlation analysis by Spearman correlation test (P＜0.05).Results At 1 h after admission,the hs-cTnI of AOPP patients with different degrees of poisoning was higher than that of control group,and that of severe group was higher than that of mild to moderate group.Comparison between groups was statistically significant (P＜0.05).However,there was no significant difference in the cTnI level (P＞0.05).At 4 h and 12 h after admission,the levels of cTnI and hs-cTnI increased with the increase of poisoning degree and the extension of time,and their level at 12 h after admission were significantly higher than those at 4 h after admission,with statistically significant difference between the two groups (P＜0.05).At 1 h after admission,the level of sST2 in the poisoned patients was higher than that in the control group,and the level in the severe group was higher than that in the mild to moderate groups.At 4 h and 12 h after admission,the level of sST2 was increased significantly,especially in the severe group.The level of sST2 at 12 h after admission was significantly higher than that at 4 h after admission (P＜0.05).The concentration of NT-proBNP was in normal range 1 h after admission,increased gradually at 12 h after admission,and the level of NT-proBNP in the severe group was significantly higher than that in the other groups (P＜0.05),and comparison between the groups was significantly different (P＜0.05).The correlation analysis showed that there was a positive correlation between hs-TnI and sST2 in AOPP patients (r=0.776,P＜0.01).hs-TnI and sST2 was positively correlated with the severity of AOPP (r=0.958,P＜0.01;r=0.844,P＜0.01).That is,the more severe the patient,the higher the concentration of hs-TnI and sST2,and the more serious myocardial injury.Conclusions Early detection ofhs-cTnI and sST2 levels in AOPP patients can identify early myocardial damage and objectively evaluate the extent of myocardial damage.
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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 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 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 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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ObjectiveTo observe the effects of extract of Ginkgo biloba, Ginaton, on cerebral oxygen utilization coefficients (O2UCc) and lactate clearance rate (LCR) in patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP).Methods The 196 patients with DEACMP admitted to Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2011 to March 2016 were enrolled, and they were randomly divided into a control group and an observation group, 98 cases in each groups. The control group received routine treatments such as hyperbaric oxygen, measures to prevent and treat cerebral edema, and promote brain cell metabolism, etc routine therapies: while in the observation group, besides the above routine treatments, additionally intravenous drip of Ginaton 70 mg (with 0.9% sodium chloride injection 250 mL added), once a day, for consecutive 2 weeks to complete one therapeutic course. At ambient air, before treatment and 6, 24 and 72 hours after treatment, the O2UCc and LCR and the changes of mini-mental state examination (MMSE) score, clinical efficacy and hospital mortality were observed and compared between two groups. Pearson correlation test was used to analyze the correlations between O2UCc, LCR and MMSE score.Results On the day of admission before treatment, there were no differences in O2UCc, lactate and MMSE score between the two groups (allP > 0.05). At 6 hours, 24 hours after treatment, the levels of O2UCc in observation group were obviously lower than those in control group [6 hours: (40.64±9.50)% vs. (45.78±7.94)%, P = 0.000; 24 hours: (30.51±6.76)% vs. (33.34±8.19)%,P = 0.009], while the levels of LCR were significantly higher than those in control group [6 hours: (14.93±2.27)% vs. (11.45±1.88)%,P = 0.000; 24 hours: (19.86±3.42)% vs. (13.73±2.35)%,P = 0.009]. There were no statistical significant differences in O2UCc and LCR at 72 hours after treatment between the two groups (P > 0.05). The MMSE scores at 6, 24 and 72 hours after treatment in observation group were higher than those in control group (6 hours: 15.52±3.61 vs. 11.60±2.49, 24 hours: 20.05±5.79 vs. 14.85±5.71,72 hours: 23.87±5.96 vs. 18.07±6.97, allP < 0.05). The total effective rate in observation group was significantly higher [77.55% (76/98) vs. 61.22% (60/98),P < 0.05], and the mortality [3.06% (3/98) vs. 10.20% (10/98),P < 0.05] was obviously lower than their own counterparts in control group. The correlation analysis showed that at different time points, the levels of O2UCc were negatively correlated to the corresponding MMSE scores (r6 h = -0.153,r24 h = -0.158, P6 h = 0.032,P24 h = 0.027), and there were positive correlations between the levels of LCR and MMSE scores (r6 h = 0.473, r24 h = 0.242,P6 h = 0.000,P24 h = 0.001) in patients with DEACMP.Conclusions The treatment of Ginaton in patients with DEACMP can effectively elevate the LCR and MMSE score, reduce O2UCc, decrease mortality and improve the prognosis, thus the clinical curative effect is distinct.
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ObjectiveTo observe the effect of rhubarb as the main composition in the therapy for patients with acute paraquat poisoning (APP).MethodsA prospective randomized controlled trial was conducted. 128 patients with APP admitted to Harrison International Peace Hospital from March 2011 to December 2013 were randomly divided into western medicine control group (n = 64) and western medicine and traditional Chinese medicine (TCM) combination group (n = 64). All the patients were treated with repeated gastric lavage and oral kaolin. The patients in western medicine control group were given 20% mannitol and (or) magnesium sulfate for catharsis, early (within 8 hours of admission) hemoperfusion (HP), and also given the routine combined therapy. In TCM combination group, in addition to the above treatment patients were given oral paraquat poisoning detoxification prescription No.1 every 2 hours for catharsis, which was composed of rhubarb 10 g, glauber salt 12 g, agrimony 12 g, and licorice 6 g. When green stool disappeared, detoxification therapy was changed to No. 2 compound once a day for 14 days, which was consisted of rhubarb 10 g, ginseng 6 g, agrimony 15 g, rhizoma chuanxiong 10 g, licorice 6 g. The poison volume, first dose of oral drug, time for the first HP, time of the first defecation, the time of last green stool, decontamination time, white blood cell count (WBC), C-reactive protein (CRP), arterial blood gas analysis, blood lactic acid (Lac), liver and kidney functions, myocardial enzyme spectrum, chest CT, adverse reaction, days of hospitalization, and mortality rate were observed in both groups. The levels of paraquat in plasma and urine were determined before treatment and 12 hours after poisoning in both groups. Sixty days after discharge, chest CT was taken for observation of pulmonary fibrosis. ResultsThere were no significant differences in the poison volume, ingestion time and the time for the first HP between the two groups. Compared with western medicine control group, the first defecation time (hours: 3.94±1.14 vs. 6.17±1.52), the last time of green stool (hours: 36.90±4.10 vs. 51.63±4.91), and poison clean-up time from plasma (hours: 19.48±3.63 vs. 23.84±3.29) in combination with TCM group were significantly earlier (allP< 0.01). WBC, CRP, alanine aminotransferase (ALT), blood urea nitrogen (BUN), and serum creatinine (SCr) levels were gradually increased after admission in combination with TCM group, and they peaked on 5th day [WBC (×109/L): 15.35±2.17 vs. 17.47±2.09, CRP (mg/L): 32.62±2.76 vs. 39.51±2.45, ALT (U/L): 270.88±11.06 vs. 334.67±7.85, BUN (mmol/L): 13.29±1.90 vs. 17.63±1.42, SCr (μmol/L): 203.54±18.40 vs. 251.53±14.38, allP< 0.05], and then they declined; Lac after admission was gradually increased, and peaked at 7 days (mmol/L: 3.53±0.21 vs. 3.82±0.14, P< 0.05), and then it was decreased. Myocardial enzyme spectrum was increased after admission, and peaked on 3rd day [creatine kinase (CK, U/L): 192.09±16.26 vs. 216.20±11.96, creatine kinase isoenzyme enzyme (CK-MB, U/L):39.03±3.75 vs. 47.22±5.84, bothP< 0.05), and then they declined gradually. Arterial partial pressure of oxygen (PaO2) and base excess (BE) were gradually decreased after admission, down to trough on the 7th day after admission [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 87.04±2.37 vs. 84.93±2.44, BE (mmol/L): -7.31±2.31 vs. -9.18±2.49, bothP< 0.05], and then they were increased. At 12 hours after poisoning, paraquat contents in plasma and urine in combination with TCM group were significantly lower than those of the western medicine control group [plasma (ng/L):0.83±0.08 vs. 0.96±0.10, urine (ng/L): 0.88±0.09 vs. 0.97±011, bothP< 0.05]. The injury to lung tissue was significantly improved in combination with TCM group compared with that in the western medicine control group, and no serious adverse reactions was found, and the hospital stay time (days: 20.46±6.07 vs. 29.73±9.16) was significantly shortened (P< 0.01), and the mortality rate [35.9% (23/64) vs. 45.3% (29/64)] was significantly lowered compared with western medicine control group (P< 0.05). In the combination with TCM group pulmonary fibrosis was lighter than that in the western medicine control group during the 60-day follow-up. ConclusionThe sequential treatment of No. 1 and No. 2 detoxification of APP, using rhubarb as the main drug, can effectively eliminate paraquat, reduce absorption of the toxin, prevent the development of multiple organ dysfunction syndrome (MODS) induced by the toxin, shorten the hospital stay days, and improve the prognosis of APP.
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Objective:To statistics and analyze the detection rate of 5 kinds of common respiratory virus specific IgM in children with respiratory tract infection to guide the clinical.Methods: 1 609 cases of children with respiratory tract infection in department of Pediatrics in our hospital were collected in 2012 from 1 to 12 months.Serum was collected to detect the specific IgM of respiratory syncytial virus (RSV),adenovirus (ADV),influenza A virus (IVA),influenza B virus (IVB) and parainfluenza virus ( PIV) by method of indirect immunofluorescence.Results:263 positive cases were detected from 1 609 cases ( 16.35%) , and the positive rates of IVB was the highest (8.45%) with a total of 136 cases,followed by the rest of IVA 63 cases(3.92%),PIV 62 cases (3.85%),ADV 44 cases(2.73%) and RSV 42 cases(2.61%).The positive detection rate was different in children of different age groups,and the difference was statistical significant (χ2=134.822,P<0.01).Positive detection rate was gradually increased along with the age growth,and the detection rate of school-age children was the highest (34.55%);The comparison differences of IVB ,PIV,IVA positive detection rate between different age stages were significant (χ2=102.660 ,86.145 ,39.791 ,P<0.05 ).The detection rate of IVB and IVA was the highest in school-age children,20.00%and 8.64%respectively.The detection rate of PIV was the highest (12.07%) in preschool children.The positive rates of different respiratory virus specific IgM had their own characteristics in different months .IVB appeared two positive peaks in March and October with the rate of 20.15%and 11.11%respectively;IVA appeared two positive peaks in March and May with the rate of 10.27% and 11.81% respectively;PIV and RSV , the detection rate of which was the highest ( 7.98%and 6.46 respectively ) in March increased gently from January to June ,and then declined steadily.The detection rate of ADV was the highest (6.19%) during three months of March ,April and May.Conclusion:The positive rate of 5 kinds of respiratory virus specific IgM was 16.35%,especially the detection rate of IVB was the highest.Positive detection rate of respiratory virus specific IgM was gradually increased along with the age growth;The detection rate of IVB and IVA was the highest in school-age children ,while PIV in preschool children.5 kinds of respiratory tract virus own respectively prevalent characteristics in 2012.
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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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A total of 11 200 subjects from urban and rural areas of Taocheng of Hebei Province were surveyed for cardiopulmonary resuscitation (CPR) knowledge with self-made questionnaire. Our results showed that of the 11200 participants, there were 3708 subjects (33.11%) knew CPR; 6105 subjects (54.51%) knew but couldnt put it into practice; and 1387 subjects (12.38%) didn't know CPR. There was a significant difference in CPR awareness rate among people with different education level and profession (P <0.01). Awareness of emergency treatment and therapeutic technique was proved to be low among urban and rural residents, especially those living at poor-educated small towns. We suggest that more attention should be paid to increased awareness of CPR and its technique to improve to outcome of the treatment.