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Objective To explore the clinic efficacy on early repeated hemoperfusion in patients with acute paraquat (PQ) poisoning by analyzing the clinical data of 168 patients.Methods A total of 168 patients with acute paraquat poisoning,admitted to our emergency intensive care unit (EICU) from January 2008 to February 2011 were retrospectively analyzed.The PQ poisoning patients were divided into HP group (n =81,group A) and non-HP group (n =87,group B).The early repeated HP was carried out for at least 2 times within 24 hours after poisoning.The chi-square test and t test were used to detect the difference in outcome between groups.Results There were 52 patients (64.2％) in group A died and 68 fatalities (78.2％) in group B (x2 =4.01,P =0.042).The first HP was carried out in patients of group A within (3.6 ± 3.3) h after poisoning,and the patients in the group A received HP for (2.9 ± 1.4) times.On the second day after poisoning,sequential organ failure assessment (SOFA) scores of 168 patients were higher than those at admission (P ＜ 0.05).SOFA scores of patients in the group A were higher than that in the group B on the third day and on the forth day (P ＜ 0.05).In the group B,alanine aminotransferase (ALT)＞ 80 U/L and total bilirubin (TBIL) ＞ 34.2 μmol/L occurred earlier than those in group A (P ＜ 0.05)and there were more patients with abnormal creatinine and arterial oxygen and those abnormalities occurred earlier than those in group A (P ＜0.05).The maximum value of ALT,TBIL,creatinine,amylase (AMS)and CK-MB in the group B were higher than those in group A (P ＜ 0.05),the lowest value of PaO2 (＜ 60mm Hg) in group B were lower than that in group A (P ＜ 0.05).Conclusions The early repeated HP can delay organ injury after acute paraquat poisoning and reduce the extent of injure,giving ample time to get advanced treatment measures to improve the prognosis of patients.
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Objective To explore the early predictors of patients with 2009 H1N1 pneumonia by analyzing the clinical features.Methods The 2009 H1 N1 pneumonia patients,admitted to our emergency intensive care unit (EICU) from October 2009 to January 2010,were retrospectively analyzed. The 86patients were divided into died and survival groups. The chi-square test and T test were used to examine the difference between groups.Results Of the 86 patients we studied,15 ( 17.4％ ) cases died and 12 cases received mechanical ventilation. All patients underwent chest radiography on admission and the findings were consistent with pneumonia in all cases.The median duration of symptoms before admission was 3.2 days.The first laboratory test results indicated the average total number of white blood cell (WBC) was (6358 ±483) /mm3.Of the 86 patients,47 (54.7％ ) showed a reduction in WBC.Of the 71 patients who survived,35 (49.3％) had leucopenia and12 (80％) in died group (x2 =4.71,P ＜ 0.05).In survival group,39 (54.9％) had lymphopenia and 13 (86.7％) in died group (x2 =5.22,P ＜0.05).Of 72 patients had T-lymphocyte subsets results,CD4 + T cell counts on average was (424.8 ±231.6 ) /mm3 in57 survival cases and (242.5 ±99.1) /mm3 in 15 died cases (t=2.14,P ＜ 0.05).On admission,serum creatine kinase (CK) in died group was (794.5 ± 85.1 ) U/L,higher than (632.3 ±47.9) U/L in survival group (t =2.25,P ＜ 0.05).Elevated CK was found in 14 (93.3％)of 15 died cases and 50 (70.4％) in survival group (x2 =5.87,P ＜ 0.05). Serum lactate dehydrogenase (LDH) in died group was (1028.6 ± 97.3) U/L,higher than (832.3 ± 56.1 ) U/L in survival group (t =2.31,P ＜ 0.05). According to the criterion of body mass index (BMI) ≥25 kg/m2,33 (38.4％) cases were obesity,in which 13 (86.7％ ) in died group and 20 (28.2％) in survival group ( x2 =17.92,P ＜ 0.01 ),The mortality was increasing along with the BMI was increasing ( r =0.37,P =0.048). Conclusions SOFA,MEDS,CURB-65 score used in emergency room as the risk stratification methods can not effectively predict the 2009 H1N1 pneumonia patients. Peripheral blood lymphocyte counts,serum creatine kinase and lactate dehydrogenase,body mass index in the early course may be factors associated with outcomes of 2009 H1N1 pneumonia patients.
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Objective To study the changes of transforming growth factor-β1(TGF-β1) in pulmonary fibrosis induced by paraquat (PQ) with immunohistochemistry method. MethodsA total of 58 C57BL/6J male mice were randomly (random number) divided into the experimental group and control group. Pulmonary fibrosis was induced by intra-peritoneal injection of PQ in dose of 10 mg/kg into the mice of experimental group (n = 48), while physiological saline was used instead in mice of control group (n = 10). The mice of experimental group were sacrificed 2, 5, 7 and 14 days after PQ poisoning and the mice of control group were sacrificed on the 7th day after saline administration. Lungs of mice were taken and histological changes in lungs were evaluated by haematoxylin-eosin stain, and TGF-β1 was determined with immunohistochemistry method. The integrated optical density (iOD) value of TGF-β1 was measured and analyzed. ResultsThe TGF-β1 was markedly increased in macrophages during the genesis of pulmonary fibrosis induced by PQ. As the course of fibrosis progressed, the positive staining of TGF-B1 was mainly seen in macrophages and neutrophil's cytoplasm. On the 14th day after PQ poisoning, TGF-β1-positive cells were also detected in the fibroblast and myo-fibroblast inside the fibroblastic foci. Compared with the control group, the iOD value of TGF-β1 increased in experimental group (P ＜ 0. 01 ) and it gradually upgraded during the course of fibrosis. Conclusions The TGF-β1 significantly increased during the course of pulmonary fibrosis induced by PQ and played an important role in the pathogenesis of the disease.