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Objective:To investigate the predictive value of early indicators changes in blood test on the prognosis of patients with acute paraquat poisoning.Methods:The clinical data of patients with acute paraquat poisoning admitted to emergency department of Shengjing Hospital of China Medical University from January 2012 to June 2019 were retrospectively analyzed. The changes of blood test indexes within 24 hours after admission were collected, including white blood cell count (ΔWBC), neutrophils count (ΔNE), lymphocytes count (ΔLY), monocytes count (ΔMO), arterial partial pressure of oxygen (ΔPaO 2), arterial partial pressure of carbon dioxide (ΔPaCO 2), arterial blood pH (ΔpH), bicarbonate radical (ΔHCO 3-), base excess (ΔBE), lactate (ΔLac), total protein (ΔTP), albumin (ΔALB), alanine aminotransferase (ΔALT), aspartate aminotransferase (ΔAST), total bilirubin (ΔTBil), direct bilirubin (ΔDBil), blood urea nitrogen (ΔBUN), serum creatinine (ΔSCr), serum calcium concentration (ΔCa 2+), and serum potassium concentration (ΔK +). Multivariate Logistic regression was used to analyze the risk factors of prognosis in patients with acute paraquat poisoning, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of ROC curve for the death of patients with paraquat poisoning. Results:A total of 251 patients with acute paraquat poisoning were included, with 99 cases dead, and the mortality was 39.4%. The increase of the markers including ΔWBC, ΔLac, ΔALT, ΔAST, ΔTBil, ΔDBil, ΔBUN, ΔSCr and ΔK + within 24 hours of admission in the death group were significantly higher than that in the survival group; the decrease of the markers including ΔPaCO 2, ΔHCO 3-, ΔBE, ΔTP, and ΔALB in the death group were significantly greater than those in the survival group. The variables with statistical significance in the above single factor analysis were included in the multivariate Logistic regression analysis. The results showed that ΔLac, ΔSCr and ΔK + were independent risk factors for the prognosis of patients with acute paraquat poisoning [odds ratio ( OR) and 95% confidence interval (95% CI) were 1.662 (0.997-2.772), 1.045 (1.010-1.083) and 4.555 (1.190-17.429), respectively, all P < 0.05]. The area under the ROC curve (AUC) of ΔLac, ΔSCr and ΔK + for predicting death of patients with acute paraquat poisoning was 0.639 (95% CI was 0.505-0773), 0.811 (95% CI was 0.704-0.917), and 0.649 (95% CI was 0.519-0.779), respectively. When the cut-off of ΔLac was 1.85 mmol/L, the sensitivity was 87.9%, the specificity was 47.7%, and the diagnostic accuracy was 70.2%; when the cut-off of ΔSCr was 37.75 μmol/L, the sensitivity was 84.4%, the specificity was 77.9%, and the diagnostic accuracy was 80.5%; when the cut-off of ΔK + was 0.42 mmol/L, the sensitivity was 36.6%, the specificity was 90.7%, and the diagnostic accuracy was 68.3%. The efficiency of combination of ΔLac, ΔSCr, and ΔK + was greater than a single indicator in predicting death of patients with acute paraquat poisoning, with AUC of 0.911, and 95% CI of 0.834-0.989. Conclusions:ΔLac, ΔSCr, ΔK + within 24 hours of admission were all independent risk factors for the prognosis of patients with acute paraquat poisoning. ΔSCr > 37.75 μmol/L within 24 hours of admission would predict a poor prognosis in the patients with acute paraquat poisoning. Combined analysis of ΔLac, ΔSCr, and ΔK + can predict the prognosis of paraquat poisoning patients more accurately than single index.
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Objective To improve the first-aid ability of emergency residents by using simulated clinical practice skills training combined with scenario analysis in standardized residency training. Methods 218 residents who participated in standardized residency training in Shengjing Hospital of China Medical University were randomly distributed to two groups. The experimental group (n=134) was trained with the teaching methods of simulated clinical practice skills training combined with scenario analysis; the control group (n=84) was trained with traditional teaching methods combined with teaching video. The theoretical test scores and clinical practice skills results of the two groups were compared, and a questionnaire survey was also conducted after comparing the two teaching modes. T test and rank-sum test were performed by using SPSS 19.0. Results There was no significant difference in the theoretical test scores between the experimental group (85.27 ±5.59) and the control group (84.11 ±7.43) (P>0.05). However, the clinical practice skills scores of the experimental group (89.42±6.63) were significantly higher than those of the control group (71.36±4.41) (P<0.05), which showed the statistical significance. Student's satisfactions with teachers and teaching methods in the experimental group were 70.90% and 80.60%, respectively, which were extremely higher than those in the control group (23.81% and 33.33%). Student's satisfaction with self-learning in the experimental group (64.93%) was significantly higher than that in the control group (39.29%). Conclusions The application of simulated clinical practice skills training combined with scenario analysis could improve the first-aid ability of emergency residents. This teaching method is expected to be applied in standardized residency training in emergency medicine in the future.
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Objective@#The aim was to investigate the genotype distribution of two major epitopes of large surface protein (PreS1) of hepatitis B in Chinese patients and to explore the association between the genotypes of these two epitopes, and to determine whether PreS1 full-length genotype could be revealed according to the polypeptide sequence of key epitopes. @*Methods@#HBV DNA was extracted from the serum of patients for PCR amplification. 278 samples amplified successfully were sequenced and compared with the known HBV sequences in Genbank to determine the two key epitopes of HBV PreS1 genotype (amino acid epitope 21-47 and 94-117, abbreviated as P21 and P94) and PreS1 full-length genotypes. The correlation among three genotyping approaches was analyzed by Cohen’s kappa coefficient to verify the consistency between the key-epitope genotyping and the full-length preS1 genotyping. @*Results@#232 samples were successfully sequenced. The genotyping based on the kind of P21 epitope protein sequence, 201 cases for genotype C, 23 cases for genotype B and 8 cases for uncertain genotypes and genotyping based on the form of P94 epitope protein sequence, 199 cases for genotype C, 25 cases for genotype B and 8 cases for indeterminate genotypes. Lastly, the genotyping based on sequence of the full-length PreS1 sequence, 207 and 25 cases for genotype C and B. P21 or P94 epitope genotyping and PreS1 full length genotyping were highly consistent, respectively, 96.55% and 96.12%, and the two epitopes (P21and P94) genotyping have parallel consistency (93.10%). @*Conclusion@#In this study, an innovatively genotyping method based on the amino acid sequence of key epitopes was proposed. The genotypes of HBV in china were mainly B and C genotypes, and the genotypes of key conserved epitopes of HBV PreS1 were highly consistent with the full-length genotyping ( > 96%). Moreover, genotyping with one or two key epitopes can be used in place of the full-length genotyping.
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AIM: To study the effects of taurine at different doses on renal oxidative stress and inflammation induced by paraquat in rats.METHODS: Male SD rats (n=48) were randomly divided into 4 groups: negative control group, paraquat group, paraquat + low-dose taurine group, and paraquat + high-dose taurine group.The serum levels of creatinine and urea nitrogen were detected by a biochemical analyzer.The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were measured by colorimetry.The plasma concentrations of IL-6 and intercellular adhesion molecule (ICAM)-1 were detected by ELISA.Renal reactive oxygen species (ROS) was checked by fluorescence probe dihydroethidium (DHE).The protein levels of renal p-P38 MAPK, p-ERK1/2 and p-JNK were determined by Western blot.The mRNA expression of TNF-α, IL-6 and TGF-β1 was detected by real-time PCR.RESULTS: Serum creatinine and urea nitrogen increased after paraquat poisoning, and decreased after feeding with taurine in poisoned rats, with better result in high-dose taurine group.Taurine reduced the oxidative stress and inflammation in the renal tissue, and also reduced the protein levels of p-JNK, p-ERK1/2 and p-P38 in the kidney of paraquat-poisoned rats.CONCLUSION: Taurine attenuates renal injury induced by paraquat poisoning in rats.The mechanism may be related to reducing renal MAPK activity, oxidative stress and inflammatory response.
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BACKGROUND:Growth differentiation factor-5 can induce adipose-derived stem cels into chondrocytes in our previous studies, but it has not been reported that the adipose-derived stem cels induced by growth differentiation factor-5 can differentiate into chondrocytes on the type I colagen scaffold. OBJECTIVE:To investigate the chondrogenic differentiation ability of adipose-derived stem cels induced by growth differentiation factor-5 cultured on the type I colagen scaffold. METHODS:Adipose derived stem cels were isolated from rabbit adipose tissue, the cels morphology was observed using inverted phase contrast microscope and the phenotypes were identified using immunofluorescence. The exogenous growth differentiation factor-5 was added to the cultural media with the type I colagen scaffold so as to induce the chondrogenic differentiation. The cels morphology was observed using hematoxylin-eosin staining and scanning electron microscope after the induction by growth differentiation factor-5 for 14 days. Meanwhile, the type II colagen and aggrecan mRNA expressions of the induced cels were measured using RT-PCR after the induction by growth differentiation factor-5 for 7, 14, and 21 days.RESULTS AND CONCLUSION:The primary cultured adipose-derived stem cels proliferated adherently with the fusiform and polygonal distribution under inverted phase contrast microscope. The positive CD44, CD49d and negative CD106 were detected by immunofluorescence. The adipose-derived stem cels induced by growth differentiation factor-5 were wel adhered to the type I colagen scaffold and strongly proliferated. The large amounts of extracelular matrix existed on the surface of the induced cels under scanning electron microscope. RT-PCR agarose gel electrophoresis indicated that the type II colagen and aggrecan mRNA expressions of the adipose-derived stem cels induced by growth differentiation factor-5 with the type I colagen scaffold were significantly increased. Growth differentiation factor-5 can successfuly induce the chondrogenic differentiation of adipose-derived stem cels cultured on the type I colagen scaffold.
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Objective To study inhibition effect of rosiglitazone on lung injury induced by paraquat. Methods 72 male SD rats were randomly divided into three groups ( n=24 ): model control group, paraquat ( PQ ) was administered intraperitoneally at the dose of 20 mg·kg-1;rosiglitazone group, rosiglitazone (10 mg·kg-1 , ip) was administered 1 h before PQ administration; blank control group, 1 mL 0. 9% sodium chloride solution was administered intraperitoneally. The concentration of TNF-α and IL-1β in serum was measured by ELISA at 4, 8 h and 1, 3 day(s) after PQ exposure. The lung injury scores and nuclear factor-kappa B( NF-κB) positive signal were investigated 3 days after PQ exposure by HE staining and immunohistochemistry, respectively. Protein expression levels of NF-κB and activating protein-1(AP-1) were also determined by using Western blotting. Results The levels of IL-1β and TNF-α in serum of PQ-treated rats were significantly increased as compared with blank control group. Rosiglitazone pretreatment reduced the degree of lung tissue injury, the levels of IL-1β and TNF-α in serum, and the protien expression levels of NF-κB and AP-1 as compared with the model control group. Conclusion Rosiglitazone can inhibit NF-κB and AP-1 protein expression in lung tissue, reduce the levels of IL-1β and TNF-α in serum after PQ exposure, and exert an inhibition effect on inflammation in PQ-induced lung injury of rats.
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[ ABSTRACT] AIM: To study the protective effects of cannabinoid CB2 receptor agonist JWH133 on rat acute lung injury induced by paraquat (PQ).METHODS: Male Sprague-Dawley rats (n=72) were randomly divided into 4 groups.PQ group:PQ was administered intraperitoneally at the dose of 20 mg/kg;Low-dose JWH133 pretreatment group ( L-JWH133 group):JWH133 (5 mg/kg, ip) was administered 1 h before PQ exposure;high-dose JWH133 pretreatment group ( H-JWH133 group):JWH133 (20 mg/kg, ip) was administered 1 h before PQ exposure;control group:1 mL sa-line was administered intraperitoneally.Arterial blood, bronchoalveolar lavage fluid (BALF) and lung tissue samples were collected at 8 h, 1 d and 3 d after PQ exposure.PaO2 and the levels of TNF-αand IL-1βin BALF were measured via blood gas analyzer and ELISA, respectively.The pathological changes and lung injury scores were assessed at 3 d after PQ expo-sure.NF-κB and AP-1 protein levels were also determined by Western blotting.RESULTS:The decrease in PaO2 , struc-tural injury of the lung tissues, interstitial pulmonary edema, and the increase in IL-1βand TNF-αin BALF were observed in PQ-treated rats compared with control group.JWH133 pretreatment reduced the degree of lung tissue injury, decreased the levels of IL-1βand TNF-αin BALF and the NF-κB and AP-1 protein expression in the lung tissue compared with PQ group, especially in H-JWH133 group.CONCLUSION:CB2 receptor agonist JWH133 inhibits NF-κB and AP-1 protein expression in the lung tissues, and reduces the secretion of IL-1βand TNF-αin BALF after paraquat exposure, thus atten-uating paraquat-induced acute lung injury.
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Objective To evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of intertrochanteric hip fractures in elderly patients. Methods Between 2004 and 2009,10 patients were treated with hip arthroplasty after the failed treatment of intertrochanteric fracture.There were six females and four males,at mean age of 75.7 years ( range,68-84 years).The initial treatment of fractures included dynamic hip screw (DHS) fixation in three cases,dynamic condyle screw (DCS) fixation in one,proximal femur fixation with reconstruction interlocking nail in three and conservative treatment without internal fixation in three.The failed procedures included avascular necrosis in four cases,cephalic implant cutting in three,nonunion in two and malunion associated with osteoarthritis in one.Joint hip replacement was performed except for pre-operative infection.Harris score at follow-up was recorded and prosthesis position was evaluated by imaging. Results Six patients were treated with total hip arthroplasty with a cemented cup (three patients) and an uncemented cup ( three patients) and four with a bipolar hemiarthroplasty.A long-stem implant was used in 5 of the 10 hips.The average duration of follow-up was 4.6 years (2-7 years).The mean duration of surgery was 128 minutes and mean blood loss was 764 ml.The mean Harris hip score increased from 37 preoperatively to 85 postoperatively.The functional results were satisfactory.One 84-year-old patient with the implant intact died 2 years postoperatively from a brain hemorrhage. Conclusions Hip arthroplasty is an effective salvage procedure after the failed treatment of intertrochanteric fractures in elderly patient.Most patients have better pain relief and functional improvements in spite of technical difficulties than primary arthroplasty.In the meantime,attention should be paid to patients with poor bone quality,bone loss,or articular cartilage damage.
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Objective To investigate the role of hybrid bone grafting using autograft and freezedried allograft bone in restoration of acetabular bone defect,as well as to evaluate the clinical results of this grafting technique combined with acetabular scaffold in dealing with massive acetabular deficiency.Methods Between April 1999 to December 2007,18 patients (19 hips) underwent acetabular revision by using a mixture of autograft and allogenic freeze-dried cancellous bone particles plus acetabular scaffold.There were 8males and 10 females,aged from 33 to 76 years (average,64.7 years).The acetabular defects were caused by aseptic loosening of primary total hip arthroplasty in 17 patients and osteoarthritis secondary to osteotomy in 1 case of acetabular dysplasia.There were 5 cases of Paprosky Ⅱ B defect,2 Paprosky Ⅱ C defect,6 Paprosky ⅢA defect and 6 Paprosky ⅢB defect.Results All patients were followed up for 3.6 to 12.3 years (average,6.5 years).Harris hip score improved from preoperative 38.7±9.6 to 87.6±7.8 at final follow-up.According to X-rays,bone incorporation evidenced by trabecular bridging of the host-donor interface was found at 3to 6 months postoperatively,and effective bone incorporation was achieved in all cases one year postoperatively.Polyethylene wear occurred in one case.Acetabular component loosening was not found at final follow up.Conclusion Impacted bone grafting using a mixture of autograft and freeze-dried allograft bone can efficiently restore acetabular bone defect.Adding autograft bone to freeze-dried allograft bone is a highly effective way of achieving graft incorporation.Hybrid bone grafting technique with acetabulum scaffold is an attractive option for the treatment of extensive acetabular deficiency.
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Objective To summarize the perioperative characters of femoral neck fractures in patients aged at over 80 years by analyzing the surgical treatment procedures. Methods A retrospective study was done on data of patients with femoral neck fractures treated surgically from June 2000 and June 2008. There were 25 males and 36 females, at average age of 83.4 years (80-94 years). Of all, there were 53 patients with fresh fractures including six with type Garden Ⅰ or Ⅱ fractures and 47 with type Garden Ⅲ or Ⅳ fractures, eight with old fractures ( all type Garden Ⅳ). Fifty-one patients (84%) were accompanied with preexisted internal medical or neurological diseases. Six patients with type Garden Ⅰ or Ⅱ fractures were treated with cannulated screw fixation (CSF). Among 55 patients with type Garden Ⅲ or Ⅳ fractures inclu-ding 47 fresh fractures and 8 old ones, 53 patients were treated by hip hemiarthroplasty (HHA) but the other two by cemented total hip arthroplasty (THA) because of preexisting hip osteoarthritis. Results The average operation duration and blood loss were 51 minutes and 50 ml in CSF group, 81 minutes and 180 ml in HHA group, 105 minutes and 350 ml in THA group. Fifteen patients (25%) had postoperative com-plications, mostly hypotension, cardiac insufficiency and atrial fibrillation, accounting for 12%. Postoperative hemoglobin was decreased by 11.9%, 17.1% and 18. 1% on average respectively in CSF group, HHA group and THA group, and postoperative albumin decreased by 10.8%, 18. 1% and 20.2% on average respectively in CSF group, HHA group and THA group. There were 17 patients (28%) with hemoglobin below 100 g/L and four (7%) with albumin below 30 g/L after operation. Conclusions The patients aged ≥80 years with femoral neck fractures are usually accompanied with preexisted internal medical or neurological diseases and have high risk in operation. Adequate preoperative preparation and active prevention and treatment of perioperative complications are important for successful operation and good postoperative results.
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[Objective] To evaluate clinical effect of total hip arthroplasty(THA)with a short-neck and straight stem in patients with osteoarthritis secondary to developmental dysplastic hip with high dislocation.[Methods]From June 2002 to October 2007,total hip arthroplasties with a short-neck and straight stem were performed for 11 patients(12 hips)with osteoarthritis secondary to developmental dysplastic hip with high dislocation.All were females with an average age of 51 years(range from 41 to 68 years).The operations were performed through a posterolateral approach.All the acetabular cups were reconstructed at the original anatomic location,and structural autogenous bone-grafting was performed if the cup was not covered enough by host bone.Short-neck and straight femoral stems were used with cement fixation.During operation,the soft tissue around hip was released extensively.[Results]After surgery,the center of the hip had an average distal translation of 4.5cm(range from 3.8 to 4.8 cm)and the limb length had an average increase of 3.9cm(range from 3.6 to 4.3 cm).All the patients were followed up for a mean time of 36 months(range from 10 to 66 months).All structural autografts united and none of acetabular and femoral components showed loosening.No radiolucent line was observed at the bone-cement and at the implant-cement interface around femoral stem.No patient had sciatic or femoral nerve palsy.The mean Harris score increased from preoperative 41.8 points to postoperative 86.2 points.[Conclusion]THA with a short-neck and straight stem for treatment of osteoarthritis secondary to developmental dysplastic hip with high dislocation avoids femoral shortening osteotomy and greater trochanter osteotomy when the center of hip had a distal translation less than 5cm in preoperative plan,and this choice provides satisfactory results at early-term follow-up.