Successful treatment of 4 patients with severe acute organic fluorine poisoning using extracorporeal membrane oxygenation / 中华急诊医学杂志

Objective:To summarize the clinical experience of treating patients with severe acute organic fluorine poisoning using extracorporeal membrane oxygenation (ECMO).Methods:In January 2021, an acute mass organic fluorine gas poisoning incident occurred in Quzhou, Zhejiang Province. The clinical data of 4 severe patients with acute poisoning of organic fluorine treated by ECMO in our hospital were retrospectively analyzed, and the epidemiological characteristics, clinical symptoms, signs, the abnormal laboratory studies/examinations, and treatments of this kind poisoning patients, especially, the treatment pattern, support time, complications, and outcomes of ECMO were collected and analyzed.Results:All the 4 patients were male, with an average age of (52±9) years, and all of them came to the emergency department complaining chest tightness, cough and pharyngeal discomfort 6 h after exposure by inhalation. The patient’s condition progressed rapidly with severe acute respiratory failure and circulatory failure as the prominent manifestations. The mechanical ventilations were performed (13.0±4.8) h after poisoning, and ECMO treatment was performed (15.5±5.3) h after poisoning. Among them, 2 patients were treated using venoarterial (VA) ECMO, and 2 patients using venovenous (VV) ECMO, but 1 patient was converted to VA-ECMO 8 h later. The duration of ECMO support for the patients was (8.8±3.6) d. The duration of mechanical ventilation was (23.0±28.7) d and stay in intensive care unit was (42.0±55.4) d. Among them, one patient was transferred to a specialized rehabilitation hospital after the amputation surgery due to lower limb necrosis after VA-ECMO support, and the remaining 3 patients were discharged after recovery.Conclusions:ECMO support might have the irreplaceable value in the treatment of patients with severe acute organic fluorine poisoning, and should be considered as one of the reserves of regional health care system in dealing with public health emergencies.

Relationship between screen time and myopia in children aged 11-14 years in China / 中国学校卫生

Objective@#To explore relationship between screen time and myopia in children aged 11-14 years in China.@*Methods@#The data were extracted from "National Nutrition and Health Systematic Survey and Application for 0-18 Years Old Children". A total of 12 397 children aged 11-14 years old from 14 provinces and 28 districts/counties in seven regions of China were surveyed by using multi stage stratified random sampling method. Daily screen time and visual acuity information were collected through a questionnaire.@*Results@#The myopia rate of 11-14 years old children in China was 45.0%, among which the rate of girls was higher than that of boys, and the rate of urban was higher than that of rural, and it increased with age ( χ 2=178.82,79.25, 495.96 , P <0.01). The daily screen time median of 12 397 children was 40.0 minutes, with boys(40.0 min) longer than girls( 35.0 min ) and urban children(40 min) longer than rural children(33.0 min) ( χ 2=20.86，102.68， P <0.01). The myopia rate of boys ( 42.5 %) with daily screen time greater than or equal to 60 minutes was higher than that of boys (36.4%) with daily screen time less than 60 minutes, and the myopia rate of girls (55.6%) with daily screen time greater than or equal to 60 minutes was higher than that of girls (48.0%)( χ 2=23.62，34.15， P <0.01). After adjusting for age, gender, region, time of medium and high intensity physical activity, intake of sugary food and sugary beverages, daily sleep time, multivariable Logistic regression model showed that girls with daily screen time greater than or equal to 60 minutes ( OR=1.14, 95%CI =1.03-1.27) had a higher risk of myopia than those with less than 60 minutes. After adjusting for confounding factors, there was no correlation between daily screen time and the degree of myopia in boys or girls( P >0.05).@*Conclusion@#Daily screen time greater than or equal to 60 minutes may be a risk factor for myopia in girls aged 11 to 14 years old. Given the complexity of the factors that affect vision, researches are needed to examine the relationship between screen time and myopia.

Relationship between adenosine diphosphate pathway-induced platelet dysfunction monitoring by thrombelastography with hospital mortality in patients with traumatic brain injury / 中国医师进修杂志

Objective:To investigate the relationship between adenosine diphosphate (ADP) pathway-induced platelet dysfunction monitoring by thrombelastography with hospital mortality in patients with traumatic brain injury.Methods:The clinical data of 180 patients with traumatic brain injury in Zhejiang Quhua Hospital from January 2016 to December 2018 were retrospectively analyzed. The patients underwent thrombelastography examination. Among them, the ADP pathway-induced platelet inhibition rate (ADP inhibition rate) ≤ 60% was in 74 cases (non-ADP dysfunction group), and ADP inhibition rate > 60% was in 106 cases (ADP dysfunction group). Multiple Logistic regression analysis was used to analyze the independent influencing factors of patients′ hospital mortality. Logistic regression model was used to analyze the threshold of ADP inhibition rate to predict hospital mortality.Results:There were no statistical differences in the gender composition, age, prothrombin time, international standardized ratio, activated partial thromboplastin time, platelet count, systolic blood pressure, pulse, admission to thrombelastography examination time, Glasgow coma score, trauma severity score, simple trauma grading criteria and using of antiplatelet drugs before admission between 2 groups ( P>0.05). The intubation rate and in-hospital mortality in ADP dysfunction group were significantly higher than those in non-ADP dysfunction group: 69.8% (74/106) vs. 37.8% (28/74) and 32.1% (34/106) vs. 8.1% (6/74), and there were statistical differences ( P<0.01 or <0.05). The maximum amplitude and G value in ADP dysfunction group were significantly lower than those in non-ADP dysfunction group: (61 ± 9) mm vs. (65 ± 6) mm and (9 ± 4) kD/cm2 vs. (11 ± 3) kD/cm2, the ADP inhibition rate and arachidonic acid pathway-induced platelet inhibition rate were significantly higher than those in non-ADP dysfunction group: (76 ± 22)% vs. (45 ± 18)% and (75 ± 28)% vs. (35 ± 22)%, and there were statistical differences ( P<0.05). There were no statistical difference in the reaction time, blood clot formation time and angle between 2 groups ( P>0.05). Multiple Logistic regression analysis result showed that ADP inhibition rate >60% and trauma severity score were independent predictors of increased hospital mortality in patients with traumatic brain injury ( OR = 6.21 and 1.13, 95% CI 1.21 to 31.27 and 1.05 to 1.22, P<0.05). Logistic regression model analysis result showed that ADP inhibition rate >60% was the threshold for predicting the hospital mortality rate ( OR = 6.18, 95% CI 1.2 to 33.3). Conclusions:ADP inhibition rate of thrombelastography is related to the hospital mortality in patients with traumatic brain injury.

Effects of Xingnaojing injection on PCT, CRP and WBC in elderly patients with severe pneumonia / 中国基层医药

Objective To investigate the effect of Xingnaojing injection combined with ambroxol hydrochloride on precalcitonin (PCT),C-reactive protein (CRP) and white blood cell count (WBC) in the elderly patients with severe pneumonia,and to observe the clinical effect.Methods From December 2013 to March 2015,94 cases of severe pneumonia in Zhejiang Quhua Hospital were selected and divided into treatment group and control group according to the random digital table method,with 47 cases in each group.The control group was treated with ambroxol hydrochloride,while the treatment group was treated with Xingnaojing injection on the basis of the control group.The main symptom scores,blood gas analysis indicators,PCT,CRP and WBC changes and therapeutic effects were compared between the two groups before and after treatment.Results After treatment,the fever score and cough score in the treatment group [(1.03 ± 0.25) points,(1.12 ± 0.29) points] were significanly lower than those in the control group [(2.17 ± 0.42) points,(2.34 ± 0.71) points] (t =15.989,10.905,all P ＜ 0.05).After treatment,the PaO2 of the treatment group [(89.47 ± 8.41) mmHg] was higher than that of the control group [(76.39 ± 5.63) mmHg],while PaCO2 [(48.37 ± 7.19) mmHg] was lower than that in the control group [(63.27 ± 3.48) mmHg],the differences were statistically significant (t =8.860,12.780,all P ＜ 0.05).After treatment,the serum levels of PCT,CRP and WBC in the treatment group were (5.41 ± 0.97) ng/L,(48.98 ± 8.97) mg/L,(7.82 ± 1.23) × 109/L,respectively,which were significanly lower than those in the control group [(7.98 ± 1.47) ng/L,(76.45 ± 12.54) mg/L and (12.56 ± 1.89) × 109/L] (t =10.004,12.214,14.410,all P ＜ 0.05).The total effective rate in the treatment group(91.49％) was higher than that in the control group (72.34％),and there was statistically significant difference (x2 =5.817,P ＜ 0.05).Conclusion Xingnaojing injection combined with ambroxol can reduce the changes of serum PCT,CRP and WBC in the elderly patients with severe pneumonia,and the curative effect is significant.It is worthy of clinical study.

Curative effect of Sandplay therapy on attention deficit hyperactivity disorder in preschool children co - mor-bid sleep disorder / 中华实用儿科临床杂志

Objective To investigate the curative effect of Sandplay therapy on attention deficit hyperactivity disorder (ADHD)preschool children co - morbid sleep disorder. Methods According to the random number generated by EXCEL software's RAND function,a total of 62 ADHD children co - morbid sleep disorder were randomly divi-ded into experimental group(n = 31)and control group (n = 31). The control group was treated with family behavior therapy and the experimental group was treated with sandplay therapy based on the family behavior therapy. With the Achenbach Child Behavior Check List (CBCL),Conners Parent Symptom Questionnaire (PSQ),Conner Concise Questionnaire (Conners Abbreviated Symptom Questionnaire,ASQ)and Children′s Sleep Habit Questionnaire(CSHQ),the overall curative effect was evaluated before and after treatment by their scores. Results The results of independent - samples t test showed that the scores of PSQ′s all factors,ASQ′s and CBCL′s total score,CSHQ′s total score and all factors had no significant difference between the two groups before the intervention (t conduct problem = - 0. 847,t learning problems =0. 504,t psychosomatic disorder = - 1. 008,t hyperactivity/ impulsion = - 0. 331,t anxiety = 0. 690,t hyperactivity index = 0. 757,t CBCL′s total score =- 0. 532,t ASQ′s total score = 0. 514,t CSHQ′s total score = 1. 132,t sleep impedance = - 0. 767,t sleep latency = - 0. 634,t sleep duration = 0. 150, tsleep anxiety = 0. 149,t sleep wake = 0. 417,t sleep disorder = 0. 709,t sleep apnea = 0. 950,t daytime sleepiness = 1. 530,all P > 0. 05). The scores of PSQ′s all factors,ASQ′s and CBCL′s total score,sleep impedance,sleep latency,sleep duration,sleep wake, daytime sleepiness and CSHQ′s total score all had significant differences between the two groups after the intervention(t conduct problem = - 3. 982,t learning problems = - 2. 258,t psychosomatic disorder = - 2. 470,t hyperactivity/ impulsion = - 4. 377,t anxiety =- 2. 684,t hyperactivity index = - 4. 249,t CBCL′s total score = - 3. 982,t ASQ′s total score = - 5. 576,t sleep impedance = - 3. 712,t sleep latency =- 2. 947,t sleep duration = - 2. 332,t sleep wake = - 6. 031,t daytime sleepiness = - 6. 256,t CSHQ′s total score = - 6. 706,all P < 0. 05). The results of analysis of variance of repeated measurement showed that PSQ behaviour problem,psychosomatic disor-der,hyperactivity and hyperactivity index scores of the main effects of intervention had significant difference (F conduct problem = 4. 966,F psychosomatic disorder = 5. 176,F hyperactivity/ impulsion = 4. 949,F hyperactivity index = 4. 926,all P < 0. 05);the main intervention effects of ASQ and CBCL′s total score had statistical difference (F CBCL = 4. 398,F ASQ = 4. 814,all P < 0. 05);the main intervention effects of sleep impedance,sleep duration,sleep wake and CSHQ′s total score had statistical difference (F sleep impedance = 5. 697,F sleep duration = 4. 467,F sleep wake = 6. 610,F CSHQ′s total score = 6. 016,all P <0. 05). There were significant differences in the characteristics of the initial sand table and the final sand table in the experimental group [traumatic subject:(4. 48 ± 1. 55)cases vs. (1. 23 ± 0. 81)cases,t = 8. 247;curing subject:(1. 77 ± 1. 09)cases vs. (4. 55 ± 1. 46)cases,t = 11. 274,all P < 0. 05]. Conclusion Sandplay therapy can effectively improve the core symptoms of preschool ADHD children co - morbid sleep disorders,which can be used as an early in-tervention.

Preliminary study of evaluation criterion for continuing health education in parents of very low birth weight premature infants / 中华行为医学与脑科学杂志

Objective To develop and evaluate the reliability and validity of evaluation criterion for continuing health education in very low birth weight premature infants.Methods The literature review,theoretical analysis,qualitative research and Delphi technique were conducted to identify the evaluation criterion for continuing health education.The reliability and validity of evaluation criterion was tested in 112 parents of very low birth weight premature infants.Results The evaluation criterion which was based on the frame of KABP Model and Nursing Outcomes Classification as well as Nursing Interventions Classification consisted of 3 projects with 29 specific items.The content validity index for the scale was 0.950.Three common factors were extracted by the principal components extraction analysis and the cumulative contribution rate was 49.70％,73.25％ and 46.90％ respectively.The Cronbach' s alpha coefficient was 0.934,the retest reliability was 0.865 and the ICC was 0.940 for the total scale.Conclusion The evaluation criterion for continuing health education in very low birth weight premnature infants has good reliability and validity and can be used as a measurement tool for health education effect of continuing health education.The design of the scale provides basis for making transitional care model as well.

Human pregnane X receptor-mediated transcriptional regulation of CYP3A4 by extracts of 7 traditional Chinese medicines / 中国中药杂志

<p><b>OBJECTIVE</b>To test whether 7 herbs stimulate human pregnane X receptor (PXR)-mediated CYP3A4 transcription.</p><p><b>METHOD</b>Transient cotransfection reporter gene assays were performed with human PXR expression plasmids and a reporter plasmid containing the XRES in the CYP3A4 gene promoter in HepG2 cells.</p><p><b>RESULT</b>The aqueous extracts of Chrysanthemi Flos, Lycii Fructus, and Salviae Miltiorrhizae Radix et Rhizoma, and the methanol extracts of Chrysanthemi Flos, Crataegi Fructus, Lycii Fructus, Lonicerae Japonicae Flos, Dioscoreae Rhizoma,and Salviae Miltiorrhizae Radix et Rhizoma, activated human PXR-mediated transcription.</p><p><b>CONCLUSION</b>The aqueous extracts of Chrysanthemi Flos, Lycii Fructus, and Salviae Miltiorrhizae Radix et Rhizoma, and the methanol extracts of Chrysanthemi Flos, Crataegi Fructus, Lycii Fructus, Lonicerae Japonicae Flos, Dioscoreae Rhizoma, and Salviae Miltiorrhizae Radix et Rhizoma are inducers of CYP3A4 by activating PXR, and thus may influence the metabolism of other substrates on CYP3A4.</p>

Observation of bathing posture in neonates / 中华护理杂志

Objective:To explore the best bathing posture in neo nates.Methods:Normal mature neonates 664 total were randomly seperated into two groups .The bathing posture was the traditional upwards from face to back in the control group,but upwards from back to face in the experimental group .The noise and comfort levels of the neonates were observed.Results:Uncomfortableness in the experimental gr oup was markedly lowerthan in the control group(χ2=45.78，P<0.0001).Bathing style,i.e.in basin or in shower,did not have an effect on the postures (P> 0.05).Conc lusion:The bathing posture of upwards from back to face is better than upwards from face to back.In this position,the neonates feel safer and more comfortable,and can be stroked while being bathed by the neonates' parents.