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OBJECTIVE@#To observe the toxicokinetic parameters, absorption characteristics and pathomorphological damage in different parts of the gastrointestinal tract of rats poisoned with different doses of diquat (DQ).@*METHODS@#Ninety-six healthy male Wistar rats were randomly divided into a control group (six rats) and low (115.5 mg/kg), medium (231.0 mg/kg) and high (346.5 mg/kg) dose DQ poisoning groups (thirty rats in each dose group), and then the poisoning groups were randomly divided into 5 subgroups according to the time after exposure (15 minutes and 1, 3, 12, 36 hours; six rats in each subgroup). All rats in the exposure groups were given a single dose of DQ by gavage. Rats in the control group was given the same amount of saline by gavage. The general condition of the rats was recorded. Blood was collected from the inner canthus of the eye at 3 time points in each subgroup, and rats were sacrificed after the third blood collection to obtain gastrointestinal specimens. DQ concentrations in plasma and tissues were determined by ultra-high performance liquid chromatography and mass spectrometry (UPHLC-MS), and the toxic concentration-time curves were plotted to calculate the toxicokinetic parameters; the morphological structure of the intestine was observed under light microscopy, and the villi height and crypt depth were determined and the ratio (V/C) was calculated.@*RESULTS@#DQ was detected in the plasma of the rats in the low, medium and high dose groups 5 minutes after exposure. The time to maximum plasma concentration (Tmax) was (0.85±0.22), (0.75±0.25) and (0.25±0.00) hours, respectively. The trend of plasma DQ concentration over time was similar in the three dose groups, but the plasma DQ concentration increased again at 36 hours in the high dose group. In terms of DQ concentration in gastrointestinal tissues, the highest concentrations of DQ were found in the stomach and small intestine from 15 minutes to 1 hour and in the colon at 3 hours. By 36 hours after poisoning, the concentrations of DQ in all parts of the stomach and intestine in the low and medium dose groups had decreased to lower levels. Gastrointestinal tissue (except jejunum) DQ concentrations in the high dose group tended to increase from 12 hours. Higher doses of DQ were still detectable [gastric, duodenal, ileal and colonic DQ concentrations of 6 400.0 (1 232.5), 4 889.0 (6 070.5), 10 300.0 (3 565.0) and 1 835.0 (202.5) mg/kg respectively]. Light microscopic observation of morphological and histopathological changes in the intestine shows that acute damage to the stomach, duodenum and jejunum of rats was observed 15 minutes after each dose of DQ, pathological lesions were observed in the ileum and colon 1 hour after exposure, the most severe gastrointestinal injury occurred at 12 hours, significant reduction in villi height, significant increase in crypt depth and lowest V/C ratio in all segments of the small intestine, damage begins to diminish by 36-hour post-intoxication. At the same time, morphological and histopathological damage to the intestine of rats at all time points increased significantly with increasing doses of the toxin.@*CONCLUSIONS@#The absorption of DQ in the digestive tract is rapid, and all segments of the gastrointestinal tract may absorb DQ. The toxicokinetics of DQ-tainted rats at different times and doses have different characteristics. In terms of timing, gastrointestinal damage was seen at 15 minutes after DQ, and began to diminish at 36 hours. In terms of dose, Tmax was advanced with the increase of dose and the peak time was shorter. The damage to the digestive system of DQ is closely related to the dose and retention time of the poison exposure.
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Animais , Masculino , Ratos , Diquat/toxicidade , Gastroenteropatias , Intestinos , Venenos , Ratos Wistar , ToxicocinéticaRESUMO
Objective:To explore the clinical features of acute diquat (DQ) poisoning, and further improve the awareness of acute DQ poisoning.Methods:A retrospective analysis was performed on the clinical data of patients with acute DQ poisoning diagnosed in the emergency department of the Second Hospital of Hebei Medical University from January 1, 2019 to December 31, 2021. The clinical data included age, gender, exposure routes, presence of pesticides (drugs) mixture poisoning, dosage of poison, the time from taking poisoning to admitting in the emergency department, clinical manifestations, laboratory data, treatment, hospital days, prognosis and survival days.Results:The number of cases who firstly complained of acute DQ poisoning in the past three years were 19 cases in 2019, 28 cases in 2020, and 51 cases in 2021. A total of 12 patients were excluded due to being diagnosed paraquat (PQ) poisoning by toxicology detection. Finally, 86 cases of acute DQ poisoning were included, including 80 cases of oral DQ poisoning, 1 case of intramuscular injection, 1 case of binocular contact and 4 cases of dermal exposure. In 80 cases of oral DQ poisoning, there were 70 cases of diquat poisoning alone (42 cases survived, 28 cases died) and 10 cases of pesticide mixture poisoning (6 cases survived, 4 cases died). The time from oral poisoning to admitting in the emergency department was 0.5-96.0 hours, with an average of (8.6±5.8) hours. The time of intramuscular injection poisoning to admitting in the emergency department was 3 hours. The time of dermal exposure to admitting in the emergency department was relatively long, with an average of 66.1 hours. The time from oral simple DQ poisoning to death was 12.0-108.0 hours, and the time from oral mixed DQ poisoning to death was 24.0-576.0 hours. A total of 70 patients with oral diquat poisoning alone presented various degrees of multiple organ injuries. All patients presented gastrointestinal symptoms such as nausea and vomiting. Renal injury and central nervous system injury were the most significant and closely related to the prognosis.Conclusions:Acute oral DQ poisoning can cause to multiple organ injuries, and the clinical manifestations are related to the dose of the poison. In severe cases, acute renal failure and refractory circulatory failure occur within 24 hours after poisoning, and severe central nervous system injury with disturbance of consciousness as the primary manifestation occurs within 36 hours, followed by multiple organ failure until death.
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Objective:To explore the selection of strategies for early reperfusion therapy and its impact on prognosis in patients with acute ST segment elevation myocardial infarction (STEMI).Methods:The treatment data and 3-year follow-up results of acute myocardial infarction (AMI) patients in 49 hospitals in Hebei Province from January to December 2016 were collected. Patients with STEMI who received either intravenous thrombolytic therapy (ITT) or primary percutaneous coronary intervention (PPCI) within 12 hours of onset were enrolled. Baseline data, the time from the first diagnosis to the start of reperfusion (FMC2N for ITT patients and FMC2B for PPCI patients), vascular recanalization rate, in-hospital mortality, 1-year mortality, and 3-year mortality were compared between ITT and PPCI groups. The efficacy and prognosis of ITT and PPCI at different starting time of reperfusion (FMC2N≤30 minutes, FMC2N > 30 minutes, FMC2B≤120 minutes, FMC2B > 120 minutes) were analyzed.Results:A total of 1 371 STEMI patients treated with ITT or PPCI were selected, including 300 patients in the ITT group and 1 071 patients in the PPCI group. 1 055 patients were actually followed up (205 patients in the ITT group and 850 patients in the PPCI group), with a rate of 79.4%. There were no significant differences in age, gender, and previous history between the two groups. The time from the first diagnosis to the start of reperfusion in the ITT group was shorter than that in the PPCI group [minutes: 63 (38, 95) vs. 95 (60, 150), U = -9.286, P = 0.000], but was significantly longer than the guideline standard. Compared with the ITT group, the vascular recanalization rate in the PPCI group was higher [95.5% (1 023/1 071) vs. 88.3% (265/300), P < 0.01], and in-hospital mortality was lower [2.1% (22/1 071) vs. 6.7% (20/300), P < 0.01], but there were no significant differences in the 1-year mortality and 3-year mortality [5.3% (45/850) vs. 4.4% (9/205), 9.5% (81/850) vs. 9.3% (19/205), both P > 0.05]. Between ITT group and PPCI group with different reperfusion starting time, the FMC2N > 30 minutes group had the lowest vascular recanalization rate and the highest in-hospital mortality. Pairwise comparison showed that the vascular recanalization rate of the FMC2B ≤ 120 minutes group and the FMC2B > 120 minutes group were significantly higher than those of the FMC2N > 30 minutes group [95.5% (654/685), 95.6% (369/386) vs. 88.0% (220/250), both P < 0.008], the in-hospital mortality was significantly lower than that of the FMC2N > 30 minutes group [2.0% (14/685), 2.1% (8/386) vs. 7.6% (19/250), both P < 0.008]. There was no significant difference in 1-year mortality (χ 2 = 2.507, P = 0.443) and 3-year mortality (χ 2 = 2.204, P = 0.522) among the four groups. Conclusions:For STEMI patients within 12 hours of onset, reperfusion therapy should be performed as soon as possible. PPCI showed higher infarct related artery opening rate and lower in-hospital mortality compared with ITT, and had no effect on 1-year and 3-year mortality.
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Objective:To investigate the in-hospital diagnosis and treatment time for patients with acute ischemic stroke in Hebei Province.Methods:The data of in-hospital diagnosis and treatment of acute ischemic stroke in Hebei Province were collected and analyzed, and then compared with the NINDS recommended time. Methods The data of in-hospital diagnosis and treatment of acute ischemic stroke in Hebei Province were collected and analyzed, and then compared with the NINDS recommended time.Results:The median time in hospital diagnosis and treatment was significantly longer than the NINDS recommended time (104 min vs. 60 min, P<0.001). The median time from completing the cranial CT scan to getting the CT report differed significantly to the NINDS recommended time (30 min vs. 20 min, P<0.001). The median time from getting the CT report to obtaining treatment was 43 min, which was significantly longer than the NINDS recommended 15 min ( P<0.001). The median time of in-hospital diagnosis and treatment for emergency service system (EMS) patients was 101 min, which was shorter than that for non-EMS patients (104 min, P=0.01). The median time of in-hospital diagnosis and treatment in Tertiary Hospital was 105 min, which was significantly longer than that in Secondary Hospital 99 min, ( P<0.05). Conclusions:The in-hospital emergency treatment delay in Hebei Province was relatively serious for patients with acute ischemic stroke. The time between obtaining the head CT report to beginning thrombolytic therapy is the most important factor in hospital delay. EMS can shorten in-hospital delay for acute ischemic stroke. Compared with the tertiary hospital, the secondary hospital has shorter in-hospital delay time.
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Objective:To investigate the current situation of emergency medical service (EMS) system and its effect on treatment of the acute stage and short- and long-term prognosis in patients with acute myocardial infarction in Hebei province.Methods:Totally 2 961 patients with acute myocardial infarction who were admitted to major tertiary and some representative secondary hospitals in Hebei province from January 2016 to December 2016 were collected. According to the pattern of arriving hospital, all the patients were divided into the EMS group and self-transport group. The general conditions, time from onset to treatment, treatment methods, in-hospital mortality rate and 3-year mortality rate were compared between the two groups.Results:Of the included 2 961 patients, 33.13% of them were transported through EMS and 66.87% of them by private transport. Patients with a history of hypertension and ST-segment elevation myocardial infarction were more likely to choose EMS, and the difference was statistically significant ( P<0.05). Moreover, patients in the EMS group were more likely to go to tertiary hospitals for treatment (88.58% vs 85.76%, P=0.033). The time from onset to treatment of the EMS group was significantly shorter than that of the self-transport group (160 min vs 185 min, P<0.01), and the proportion of patients in the EMS group from onset-to-door time in <3 h and 3-6 h was higher than that of the self-transport group (55.76% vs 49.14%, 21.41% vs 19.09%, P<0.01). Compared with the self-transport group, the EMS group has a higher rate of reperfusion therapy (67.48% vs 61.67%, P=0.002). Patients in the EMS group had a higher in-hospital mortality rate in the acute stage (7.03% vs 4.44%, P=0.003), but its 3-year mortality rate was lower than that of the self-transport group (17.31% vs 20.77%, P<0.05). Conclusions:EMS can shorten symptom-onset-to-arrival time, increase the rate of reperfusion therapy and improve long-term prognosis of patients with acute myocardial infarction.
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Objective:To evaluate the efficacy of hemoperfusion (HP) combined with continuous veno-venous hemofiltration (CVVH) on the treatment of acute paraquat (PQ) poisoning.Methods:Prospective randomized controlled trials and retrospective studies on the efficacy of HP combined CVVH in patients with oral PQ poisoning (poisoning time ≤ 24 hours) were found by searching from PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI and Wanfang databases before November 1st, 2019. The experimental group was treated with HP+CVVH, and the control group was treated with HP. Data included the general information of the literature, mortality, survival time, the incidence of respiratory failure and circulatory failure. The bias risk and the data were analyzed using the RevMan 5.3 software.Results:A total of 1 041 literatures were retrieved, and 7 literatures were finally enrolled, including 1 199 patients, with 735 patients in the control group and 464 patients in experimental group. Meta-analysis showed that compared with HP alone, HP+CVVH could significantly reduce the short-term mortality [4-day mortality: hazard ratio ( HR) = 0.52, 95% confidence interval (95% CI) was 0.38-0.71, P < 0.000 1], but no significant improvement in long-term mortality was found (28-day or 30-day mortality: HR = 0.68, 95% CI was 0.39-1.21, P = 0.19; 90-day mortality: HR = 1.13, 95% CI was 0.61-2.10, P = 0.07; total mortality: HR = 0.96, 95% CI was 0.72-1.29, P = 0.78). The survival time of patients treated with HP+CVVH was significantly longer than that of HP patients [mean difference ( MD) = 2.02, 95% CI was 0.81-3.22, P = 0.001], but the heterogeneity between studies was large. According to the type of literature, a subgroup analysis showed that the survival time of patients treated with HP+CVVH in prospective randomized controlled trials and retrospective studies were significantly longer than that of HP patients (prospective studies: MD = 1.53, 95% CI was 0.94-2.12, P < 0.000 01; retrospective studies: MD = 2.40, 95% CI was 0.08-4.73, P = 0.04). Compared with HP group, HP+CVVH could significantly reduce the incidence of circulatory failure [relative risk ( RR) = 0.40, 95% CI was 0.30-0.52, P < 0.000 01], but the incidence of respiratory failure significantly increased ( RR = 2.75, 95% CI was 2.18-3.48, P < 0.000 01). Conclusion:HP combined with CVVH can reduce the short-term mortality and the incidence of circulatory failure, prolong the survival time, and save time for further rescue, but it can't improve the long-term prognosis of patients.
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Norepinephrine (NE) can raise blood pressure and speed up heart rate. However, because its effect of raising heart rate is less than that of reflex reduction of heart rate caused by the increase of blood pressure, NE causes more heart rate decrease in patients. A case of tachyarrhythmia caused by low dose NE was admitted to department of intensive care unit (ICU) of Shijiazhuang Third Hospital. The heart rate of the patient increased with the elevation of NE application dose. A variety of antiarrhythmic drugs was invalid. The related examination was prescribed to eliminate the cause of arrhythmia caused by the disorder of electrolysis and thyroid function, and found that heart rate decreased as the dose of NE tapered. After NE was stopped, the patient recovered sinus rhythm. During one month of follow-up, the patient's heart rhythm was normal. Therefore, the occurrence of tachyarrhythmia is related to NE.
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Objective To investigate the application of emergency medical service (EMS) of Hebei Province and preliminarily analyze its value in the treatment of acute stroke patients.Methods We collected data of 4 147 acute stroke patients admitted to the Emergency Department between January 2016 and December 2016 in 49 hospitals of Hebei Province.Patients were divided into the EMS group and non-EMS group according to the pattern of arriving hospital.The general data,the onset-to-door time,doorto-treatment time,thrombolytic rate,length of hospital stay and prognosis were compared between the two groups.LSD-t test,Mann-Whitney U or Chi-squared test or Fisher exact test was used for statistical analysis as appropriate.Results A total of 4 147 acute stroke patients were enrolled,including 589 patients (14.2％) with hemorrhagic stroke and 3 558 patients (85.8％) with ischemic stroke.A total of 750 patients (18.1％) were admitted to the hospital by EMS.The proportion of patients with hemorrhagic stroke who used EMS was higher than that of ischemic stroke (33.4％ vs 15.5％,P＜0.01).The median onset-to-foor time in the EMS group was less than that in the non-EMS group (1.75 h vs 4.57 h,P＜0.01).The median time of onset-to-door time within 1 h in the EMS group was longer than that of the non-EMS group (0.67 h vs 0.53 h,P＜0.01).There was no significant difference between the two groups in 1-＜2 h period and 2-＜3 h period.The median time of onset-to-door time of ≥ 3 h in the EMS group was shorter than that of the non-EMS group (5.0 h vs 9.47 h,P＜0.01).In the EMS group,the proportion of patients with onset-to-door time ＜3 h was higher than that of the non-EMS group (66.13％ vs 57.44％,P＜0.01).Compared with the non-EMS group,the time of door-to-treatment time was much shorter in the EMS group (87 min vs 101 min,P＜0.01).The length of hospital stay in the EMS group was shorter than that of the non-EMS group [11 (7,14) days vs 12 (6,16) days,P＜0.01].In the EMS group,15.9％ patients received thrombolytic therapy,whereas only 11.0％ patients in the non-EMS group received this therapy (P=0.001).In the EMS group,88.8％ patients achieved more favorable outcomes at discharge,which was higher than that in the non-EMS group (85.5％,P=0.02).Conclusions EMS is considered as effective in shortening onset-to-door time,reducing door-to-treatment time,improving thrombolytic rate,reducing hospitalization days,and enhancing the prognosis of acute stroke patients.
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Objective@#To establish the Wistar rat model of acute diquat poisoning and observe the pathological damage of main target organs.@*Methods@#Thirty-six Wistar rats were randomly divided into six groups (n=6) , including one normal saline control group and five treatment groups which were separately given single-dose of intragastric administration at the doses of 46.2 mg/kg, 77.0 mg/kg, 115.5 mg/kg, 231.0 mg/kg and 346.5 mg/kg. The pathological changes of lung, liver and kidney were observed by hematoxylin and eosin (HE) and Masson staining. The optimal dose was determined according to the general situation and pathological changes. Thirty-six Wistar rats were randomly divided into five treatment groups and one normal saline control group. Treatment groups were given single-dose of intragastric administration according to the optimal dose. The rats were sacrificed at 1st, 3rd, 7th, 11th and 14th day after exposed, respectively. The activity of serum glutamic-pyruvic transaminase (ALT) and glutamic-oxalacetic transaminase (AST) were measured by chemical colorimetry. The pathological changes of lung, liver and kidney were observed by HE and Masson staining.@*Results@#According to 14 d survival rate, the toxic symptoms and pathological changes, 115.50 mg/kg was determined the best dose. Given single-dose of intragastric administration at the doses of 115.50 mg/kg, it was found that the serum AST and ALT activity of rats on the first and third day of exposure was significant higher than those in control group. The results of pathological examination exhibited that in 115.50 mg/kg group, the pathological changes of lung, liver and kidney began to appear on the first day of exposure, the pathological changes were the most serious on the third day, and then gradually alleviated. On the 14th day, the alveolar septum was slightly widened, with inflammatory cell infiltration, local alveolar cavity became narrow, atrophy, peripheral alveolar compensation, bronchi and alveolar septum collagen fiber proliferation; The local renal tubular epithelial cells were enlarged and necrotic; the central vein surrounding hepatic cells showed vacuolar degeneration with punctate necrosis.@*Conclusion@#The rat model of acute diquat poisoning can be successfully induced by single-dose of intragastric administration. The condition of wistar rats and the pathological damage of the main target organs could be observed during the whole course of 115.50 mg/kg administration.
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Objective@#To investigate the application of emergency medical service (EMS) of Hebei Province and preliminarily analyze its value in the treatment of acute stroke patients.@*Methods@#We collected data of 4 147 acute stroke patients admitted to the Emergency Department between January 2016 and December 2016 in 49 hospitals of Hebei Province. Patients were divided into the EMS group and non-EMS group according to the pattern of arriving hospital. The general data, the onset-to-door time, door-to-treatment time, thrombolytic rate, length of hospital stay and prognosis were compared between the two groups. LSD-t test, Mann-Whitney U or Chi-squared test or Fisher exact test was used for statistical analysis as appropriate.@*Results@#A total of 4 147 acute stroke patients were enrolled, including 589 patients (14.2%) with hemorrhagic stroke and 3 558 patients (85.8%) with ischemic stroke. A total of 750 patients (18.1%) were admitted to the hospital by EMS. The proportion of patients with hemorrhagic stroke who used EMS was higher than that of ischemic stroke (33.4% vs 15.5%, P<0.01). The median onset-to-foor time in the EMS group was less than that in the non-EMS group (1.75 h vs 4.57 h, P<0.01). The median time of onset-to-door time within 1 h in the EMS group was longer than that of the non-EMS group (0.67 h vs 0.53 h, P<0.01). There was no significant difference between the two groups in 1-<2 h period and 2-<3 h period. The median time of onset-to-door time of ≥3 h in the EMS group was shorter than that of the non-EMS group (5.0 h vs 9.47 h, P<0.01). In the EMS group, the proportion of patients with onset-to-door time <3 h was higher than that of the non-EMS group (66.13% vs 57.44%, P<0.01). Compared with the non-EMS group, the time of door-to-treatment time was much shorter in the EMS group (87 min vs 101 min, P<0.01). The length of hospital stay in the EMS group was shorter than that of the non-EMS group [11 (7,14) days vs 12 (6,16) days, P<0.01]. In the EMS group, 15.9% patients received thrombolytic therapy, whereas only 11.0% patients in the non-EMS group received this therapy (P=0.001). In the EMS group, 88.8% patients achieved more favorable outcomes at discharge, which was higher than that in the non-EMS group (85.5%, P=0.02).@*Conclusions@#EMS is considered as effective in shortening onset-to-door time, reducing door-to-treatment time, improving thrombolytic rate, reducing hospitalization days, and enhancing the prognosis of acute stroke patients.
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Objective To observe the nutritional biochemical indicators of paraquat poisoning patients, analyze and compare the nutritional status of patients and understand the changing trend of each indicator. Methods A total of 104 patients with acute paraquat poisoning who were admitted to the emergency department of the Second Hospital of Hebei Medical University from December 2015 to December 2017 were enrolled, and divided into the cure group (patients who survived >30 days) and the death group. Nutritional biochemical indicators including serum protein (ALB, PA, TP) and serum lipids (TCh, TG, LDL) were selected for dynamic observation. The observation time points were set as follows: immediate treatment of poisoned patients (day 1 on admission), on day 4, 7, 10, 13 and 16 after admission, and on day 30 after follow-up. The nutritional biochemical indicators of the two groups on day 1 and 4 were statistically analyzed and compared by t test. The nutritional status of the patients in the cure group was analyzed, and the Repeated Measures Anova was performed to understand the trend of each indicator over time. Results In the cure group, the TP level decreased from (73.34±5.75)g/L on day 1 to (51.95±6.05)g/L on day 4, t=20.34, P<0.01; and the TCh level decreased from (4.37±0.98) mmol/L on day 1 to (3.03±1.01)mmol/L on day 4, t=7.56, P<0.01. In the death group, the TP level decreased from (72.25±8.80)g/L on day 1 to (49.07±5.48)g/L on day 4, t=12.38, P<0.01, and the TCh level decreased from (4.38±0.88)mmol/L on day 1 to (2.51±1.07) mmol/L on day 4, t=7.94, P<0.01. Compared with the cure group, serum levels of ALB, TP and TCh in the death group decreased greater from day 1 to day 4 (all P<0.05). In addition, dynamic observation of the indicators in the cure group within 16 days after admission showed that, after treatment, the levels of ALB and TP recovered slowly and were still lower than normal . While the levels of PA and lipid rose rapidly after 10 days of admission. Conclusions Paraquat poisoning seriously affects the nutritional status of patients, and the serum protein levels decline significantly and can not be recovered easily. Therefore, sufficient attention should be paid to the treatment, and timely and appropriate nutritional support should be provided.
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Objective@#To investigate the coping styles and subjective well-being of nurses in the emergency treatment room of grade A tertiary hospitals in a province of China, and to explore the relationship between coping styles and subjective well-being.@*Methods@#In January 2016, 189 nurses in the emergency treatment room were selected from 9 grade A tertiary hospitals in a province of China by random sampling. The general data, coping styles, and subjective well-being of these nurses were analyzed using the general questionnaire, coping style questionnaire, and Campbell index of well-being scale, respectively.@*Results@#The total score of subjective well-being of nurses in the emergency treatment room was 7.54, and the subjective well-being was significantly different between the nurses with different professional titles and between those with different education levels (F=3.46 and 3.47, both P<0.05). The score of illusion coping style differed significantly across the nurses of different ages (F=5.17, P<0.05) , the scores of self-reproach, illusion, and withdrawal coping styles differed significantly across the nurses with different nursing years (F=3.99, 5.30, and 4.97, all P<0.05) , and the score of illusion coping style differed significantly across the nurses with different education levels (F=5.09, P<0.05). Most (71.9%) of the nurses in the emergency treatment room adopted the mature coping style. Subjective well-being was positively correlated with problem-solving, help-seeking, and rationalization (r=0.232, 0.018, and 0.167, all P<0.05) and negatively correlated with withdrawal (r=-0.146, P<0.05) .@*Conclusion@#Most nurses in the emergency treatment room adopt the mature coping style. Their subjective well-being and coping style vary with different ages, nursing years, professional titles, and education levels, and the subjective well-being is relatively low.
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Objective To Pulse oximetry saturation has been wildly used clinically.It has been reported that pulse oximetry plethysmographic waveform (POP) reflected the peripheral tissue perfusion.In this study,we parameterized POP,observed the value of POP parameters in normal adults,and established the normal reference value range.Methods A multi-center prospective descriptive study.Total of 1 019 adult volunteers with normovolemia from 7 cities were enrolled in this study.Sex,age,height,weight and pulse oximetry data in awake and spontaneous breathing under in quiet conditions in the room temperature were collected.POP parameters and perfusion index were analyzed using MATLAB 2012a software.The normal reference value ranges of POP parameters,including the amplitude of POP (Amp) and the area under the curve of POP (AUC),were formulated.Results Statistical differences of POP parameters were detected between men and women in the normal adult.The 95％ confidence reference value of POP parameters in normal population was as follows:Amp (104.8-2298.7) PVA and AUC (3265.8-6028.5) PVPGin total,Amp (129.4-2433.6) PVA and AUC (3319.0-5862.2) PVPG in male;Amp (89.5-2138.2) PVA and AUC (3163.9-5929.9) PVPG in female.Conclusions POP,including the amplitude of POP (Amp) and the area under the curve of POP (AUC),had normal reference value ranges in normal adults.
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<p><b>OBJECTIVE</b>To investigate the expressions of P38 mitogen-activated protein kinases (P38 MAPK), JNK mitogen-activated protein kinases (JNK MAPK) and the therapeutical effects of melatonin in the renal tissue of acute acuteparaquat-induced rats.</p><p><b>METHODS</b>Seventy-eight healthy adult Sprague-Dawley (SD) rats (39 male, 39 female) were randomly divided into three groups: (1) Control group (group A): 6 rats, (2) Poisoned group (group B): 36 rats, (3) Therapeutical group (group C): 36 rats. At 1, 3, 5, 7, 10 and 14 days after poisoning, six rats in Group B and group C were used to assess renal pathological changes and the expression of P38 MAPK, JNK MAPK in kidney were evaluated by immunohistochemistry.</p><p><b>RESULTS</b>Compared with control group, the expression of P38MAPK in renal tissue of poisoned group significantly rose at the first day, reached the peak at the 10th day and afterwards decreased slowly. Expression of JNK MAPK reached the peak at the first day, and kept at relatively high levels up to the 14th day. Melatonin weakened markedly the expressions of P38 MAPK and JNK MAPK in renal tissue of acute acuteparaquat-induced rats.</p><p><b>CONCLUSION</b>P38 MAPK and JNK MAPK play an important role in renal injury of acute paraquat -poisoning rats. Melatonin takes a significant effect on the activation of them.</p>
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Animais , Feminino , Masculino , Ratos , Proteínas Quinases JNK Ativadas por Mitógeno , Metabolismo , Rim , Metabolismo , Melatonina , Usos Terapêuticos , Paraquat , Intoxicação , Ratos Sprague-Dawley , Proteínas Quinases p38 Ativadas por Mitógeno , MetabolismoRESUMO
<p><b>OBJECTIVE</b>To observe the effect of different doses of acetamide on the histopathology in the cerebral cortex of rats with tetramine (TET) poisoning and to provide a basis for the treatment of fluoroacetamide poisoning with acetamide.</p><p><b>METHODS</b>Eighty clean Sprague-Dawley rats were randomly divided into five groups: saline control group,dimethylsulfoxide water solution control group,TET poisoning group, acetamide (2.88 g/kg/d) treatment group, and acetamide (5.68 g/kg/d) treatment group, with 16 rats in each group. Rats in the poisoning group and treatment groups were poisoned with TET by intragastric administration after fasting; then, saline was injected intramuscularly into rats of the poisoning group, and different doses of acetamide were injected intramuscularly into rats of treatment groups; the course of treatment was 5 d. At 3 h, 12 h, 48 h, and 7 d after treatment, the cerebral cortex was harvested from rats in each group, and the histopathological changes in the cerebral cortex were evaluated under light and electron microscopes.</p><p><b>RESULTS</b>The light microscopy showed that the TET poisoning group had hypoxia changes in the cerebral cortex, which worsened over time; the treatment groups had reduced hypoxia changes, and the acetamide (2.88 g/kg/d) treatment group had more reduction than the acetamide (5.68 g/kg/d) treatment group. The electron microscopy showed that the apoptosis of neuronal cells were the main pathological changes in the TET poisoning group; the treatment groups had reduced apoptotic changes, and the acetamide (2.88 g/kg/d) treatment group had more reduction than the acetamide (5.68 g/kg/d) treatment group.</p><p><b>CONCLUSION</b>No pathological changes associated with the synergistic toxic effect of acetamide and TET are found in the cerebral cortex. Acetamide (2.88 g/kg/d) could reduce central nervous lesions, but the efficacy is not improved after increasing the dose. For patients who cannot be identified with TET or fluoroacetamide poisoning, acetamide could be considered for treatment.</p>
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Animais , Masculino , Ratos , Acetamidas , Farmacologia , Hidrocarbonetos Aromáticos com Pontes , Toxicidade , Córtex Cerebral , Patologia , Modelos Animais de Doenças , Ratos Sprague-DawleyRESUMO
<p><b>OBJECTIVE</b>To investigate the effects of acetamide at different doses on the expression of inhibitory amino acids (gamma-aminobutyric acid, GABA) and excitatory amino acid (glutamate, Glu) in the cerebral cortex of rats with acute tetramine (TET) poisoning.</p><p><b>METHODS</b>Eighty Sprague-Dawley rats (SPF) were randomly divided into five groups, with 16 rats in each group: saline control group, dimethyl sulfoxide (DMSO) control group, TET exposure group, high-dose (2.8 g/kg/d) acetamide treatment group, and super-high-dose (5.6 g/kg/d) acetamide treatment group. Rats in the exposure group and treatment groups were exposed to TET by intragastric administration after fasting, and were then intramuscularly injected with saline or different doses of acetamide in the following 5 days. The cortex of the temporal lobe was collected at 3 h, 12 h, 48 h, or 7 d after treatment. The expression levels of GABA and Glu in the cortex of the temporal lobe were determined by average optical density (OD) values in immunohistochemistry.</p><p><b>RESULTS</b>1) Expression of GABA: The OD value of GABA in TET exposure group started to increase at 12 h after treatment, reached the peak at 48 h, and decreased to the normal level at 7 d. In the high-dose acetamide treatment group, the increase in OD at 12 h was not so significant as that in the TET exposure group, OD value decreased to the normal level at 48 h and was lower than that in the exposure group, and the changes were more like those in the control groups. In the super-high-dose acetamide treatment group, OD value began to increase significantly at 3 h and was significantly higher than that in the TET exposure group (P < 0.01), it reached the peak at 12 h, and was restored to the normal value at 48 h. 2) Expression of Glu: The OD value of Glu in TET exposure group at 3 h after treatment was significantly lower than those in the two control groups, it increased gradually from 12 h to 48 h, and recovered to the normal level at the 7th d. The changes in the high-dose acetamide treatment group were similar to those in the TET exposure group, but became more like those in the control groups after 48 h; the OD value in super-high-dose acetamide treatment group was significantly higher than that in the TET exposure group at 3 h after treatment (P < 0.01), while no significant difference was found at 12 h; it was significantly lower than those of all other groups at 48 h and 7 d (P < 0.01).</p><p><b>CONCLUSIONS</b>Treatment with high dose of acetamide has some curative effect on TET poisoning-induced central nervous lesion, while the effect of super-high-dose acetamide on expression of neurotransmitters is too complex to evaluate.</p>
Assuntos
Animais , Feminino , Masculino , Ratos , Acetamidas , Farmacologia , Hidrocarbonetos Aromáticos com Pontes , Intoxicação , Córtex Cerebral , Metabolismo , Ácido Glutâmico , Metabolismo , Ratos Sprague-Dawley , Ácido gama-Aminobutírico , MetabolismoRESUMO
Objective To evaluate clinical significance of the grade of ischemia by QRS complex on the admission electrocardiogram(ECG)to predict severe arrithmia in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Patients with acute ST-segment elevation myocardial infarction(STEMI)admitted to emergency department from July 2003 to April 2008 were enrolled.A total of 223 patients met the criteria(ischemic chest pain ≥ 30 min,2 or more adjacent leads of ST segment elevation and onset time within 12 h).Exclusion criteria were bundle branch block and left ventricular hypertrophy.All enrolled patients were divided into two groups based on the enrollment electrocardiogram:grade 2 ischemia(ST elevation without terminal QRS distortion; n =134)and grade 3 ischemia(ST elevation with terminal QRS distortion; n =89).Patients of the two groups had comparable genderproportion,average age and coronary heart disease risk factors etc.All patients received thrombolytic therapy.The incidence rate of ST segment resolution(STR)and severe arrithmia in hospital stay were observed.Numerical variables were expressed mean ± standard deviation and compared by unpaired Student't test,Categorical variables were expressed percentage and compared by chi square test.Multiple logistic regression analysis was used to determine independent predictors of severe arrithmia.Results Patients with grade 3 ischemia had greater Σ ST on admission and 2 h after thrombolysis ECGs(P ＜ 0.01),the incidence rate of STR in patients with grade 3 ischemia was lower than that in patients with grade 2 ischemia(P ＜0.01).The peak creatine kinase MB fraction was higher in patients with grade 3 ischemia than that in patients with grade 2 ischemia(P ＜ 0.01).There was no significant difference of the incidence of severe arrithmia,such as ventricular premature beat,ventricular tachycardia or fibrillation,second-degree or third-degree atrioventricular block,and sinus arrest between the two groups(P ＞ 0.05),but there was a trend of higher incidence of severe arrithmia in patients with grade 3 ischemia compared with that in patients with grade 2 ischemia.Multiple logistic regression analysis demonstrated that the independent predictors of severe arrithmia were duration from symptom to thrombolysis and initial.Σ ST,whereas grade 3 ischemia remained a strong predictor of severe arrithmia.Conclusions Grade 3 ischemia on admission is associated with lower incidence of STR in patients with ST-segment elevation myocardial infarction(STEMI)after thrombolysis and a strong predictor of severe arrithmia.
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Objective To investigate the effects of N - acetylcysteine (NAC) on apoptosis and the expressions of Fas/FasL mRNA in lung tissue of rats with paraquat - induced acute lung injury.Methods Forty five male SD rats were randomly (random number) divided into normal control group,paraquat (PQ) group,and NAC treatment group.The rat model of acute lung injury was made with 2％ PQ induction in dose of 25 mg/kg injected,and NAC was injected into the PQ poisoning rats (200 mg/kg) 30 minutes after PQ administration in NAC treatment group.In the control group,equal amount of saline instead was injected into the rats.Apoptosis was detected by using TUNEL method and the expressions of Fas/FasL mRNA were evaluated by using reverse transcription polymerase chain reaction (RT- PCR),and the levels of Fas/FasL protein were detected by using western blot analysis.Results Compared with control group,cell apoptosis and expressions Fas/FasL mRNA in PQ group were significantly different ( P ＜ 0.05 ).Compared with PQ group,cell apoptosis and expressions Fas/FasL mRNA in NAC group were significantly decreased,were significant lower (P ＜ 0.05).Conclusions NAC inhibited apoptosis in lung tissue of rats with paraquat induction by regulating the activation of Fas/FasL systems.
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Objective To observe the expression of tumor necrosis factor-α(TNF-α)in acute lung injury caused by paraquat(PQ)in rats,and investigate the mechanism of the rhubarb in respect of pmteetive effects.Method PQ intragastrically poisoning at the dose of 50 mg/kg made a model of the acute lung injury in Sprague-Dawley(SD)rats.Totally 144 adult healthy SD rats(72 female,72male)were randomly divided into control group (group A,n=24),poisoned group(group B,n=48),rhubarb treated group(group C,n=48)and the shaln poisoning group(group D,n=24).Rats of group B and group C were poisoned intmgastrically with PQ(50 mg/kg).and rats of group C and group D were intervened intragastrieally with 300 mg/(kg·d)of rhubarb in 15 min-utes.The white blood cells and total cells in bronchoalveolar lavage fluid(BALF)were counted by using a blood cell counting plate and the protein content of BALF was measured by using the way of Lowry in order to calculate the neutmphiks pereentage and lung permeability index.A small portion of left lung was stained with HE to observe the pathological changes and the expression oftumor necrosis factor-α in the rest of the left lung was observed with immunohistochemistry.The data were handled by the analysis of variance and NK method using SPSS 14.0.Re-suits Compared with group A,the lungs of rats mainly showed congestion,edema and leukocytes infiltration in group B,and fibrosis was found onlyt in a few rats.And the rate neutrophils percentage,protein content and lung permeability index in BALF increased(P＜0.01).The expression of TNF-α were obviously inereased at 12 hours after PQ poisoning,and immtmohistochemistry score (IHS)was higher,and peaked at 24 hours later(P＜0.05),then remained on a high level for a while and sluggishly declined.Compared with group B,the changes of above mentioned were alleviated obviously,and the expression of TNF-α delayed with the less magnitude of increasing an an obvious tendency of less expression.Compared with group B,delayed,lower increasing extent,obviously re-ducing tendency in group C with statistical difference in IHS(P＜0.05).Conclusions Rhubarb ameliorates a-cute lung injury caused by PQ poisoning in rats by means of inhibiting the expression of TNF-α in turn to alleviate inflammatory reaction.
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Objective To investigate the effects of melatonin (MT) on rats with acute paraquat (PQ) poisoning. Method Fifty-four Sprague-Dawley (SD) rats were randomly divided into three groups (each group 18 rats) and given the following treatment: intragastric injection of PQ at 50 mg/kg (PQ); intragastric injection of paraquat followed by intraperitoneal injection of MT at 10mg/kg once a day (MT); intragastric injection of normal saline (Control). Serum assays for malondialdehyde (MDA) levels and superoxide dismutase (SOD) and glu tathione peroxidase (GSH-Px) activities were determined on the 1st, 3rd and 7th day post treatment. Clinical manifestations of poisoning and pathological changes in the lungs were also observed. Results Serum MDA levels were significantly increased (P ＜ 0.01), and SOD and GSH-Px activities significantly decreased (P ＜ 0.05) in the PQ group compared to the control group. Serum MDA levels were significantly decreased, and serum SOD and GSH-Px activities increased in MT group compared to the PQ group (P ＜ 0.05). Clinical manifestations of intoxication and pathological lung changes were also ameliorated in poisoned rats treated with MT. Condutions Administration of MT alleviates clinical manifestations of acute paraquat poisoning in rats by Limiting the damage from lipid peroxidation.