[A case of severe acute respiratory distress syndrome caused by inhalation injury].

A 54-year-old male patient with severe acute respiratory distress syndrome caused by inhalation injury was admitted to the First People's Hospital of Lianyungang City on June 26th, 2022. After admission, the patient received invasive mechanical ventilation (driving pressure-guided ventilator parameter setting) combined with prone position treatment immediately, but his condition continued to deteriorate. Five hours after admission, the patient received veno-venous extracorporeal membrane oxygenation (VV-ECMO) supporting treatment, treatment based on ultra-protective lung ventilation strategy combined with prone position ventilation for more than 12 hours per day. At the same time, pulse contour cardiac output monitoring technology was used to monitor cardiac index and extravascular lung water index to guide volume management, and fiberoptic bronchoalveolar lavage was performed for several times. After that, the patient was successfully weaned from VV-ECMO and ventilator, and then discharged from hospital successfully. During follow-up of one year after the injury, the patient showed no obvious respiratory symptoms, and his lung function was basically normal.

[Value of base excess in predicting the prognosis of patients with paraquat poisoning].

Objective: To explore prognostic factors of acute paraquat poisoning (APP) , analyze the correlation between base excess (BE) and plasma concentration of paraquat (C-PQ) and discuss BE level in evalua-tion of prognosis of acute paraquat poisoning patients. Methods: We retrospectively selected 84 APP patients who admitted to Emergency Intensive Care Unit (EICU) of our hospital from 2009.9.1 to 2015.8.31.Clinical data from 84 APP patients were analyzed. BE、C-PQ、time of gastric lavagesince ingestion、time of hemoperfusion since ingestion、severity index of paraquat poisoning (SIPP) 、white blood cell (WBC) 、percentage of neutrophils (N%) 、hemoglobin (HB) 、creatinine (Cr) 、alanine aminotransferase (ALT) 、aspartate aminotransferase (AST) 、partial pressure of oxygen (PaO(2)) 、partial pressure of carbon dioxide (PaCO(2)) and other laboratory parameters were measured. A total of 41 patients in non-survivors died during the 30 days after admission and 43 patients in survivors survived during the 30 days. The factors of prognosis in paraquat poisoining and the role of BE in evalu-ating prognosis was analyzed, as well as the correlation between BE and C-PQ. Results: 1.Logistic regression analyses showed BE、C-PQ、ALT、AST、Cr was of prognostic significance[odds ratio (OR) of BE: 0.511, 95%CI 0.267, 0.978; C-PQ:-=0.999, 95%CI 0.999, 1.000; both P<0.05] ; 2.The area under the receiver operating characteristic curve (ROC curve) of BE、C-PQ and prognosis were 0.775、0.927 respectively, BE≤-1.7 mmol/L was the best cut-off value, the sensitivity、specificity for predicting were 82.9%、62.8%, the evaluation value was lower to C-PQ>3 273.935 ng/ml (AUC 0.927, 78.0%、95.3%) ; 3.BE negative correlated with C-PQ[-1.100 (-4.100, -0.200) , -5.900(-8.650, -2.500) , both P<0.05]. (r=-0.4, P<0.01). Conclusion: These results suggest that BE may be useful for the prediction of prognosis in PQ poisoning and BE negative correlated with C-PQ.

[An analysis of the clinical and epidemiological characteristics of acute poisoning patients in a general hospital].

Objective: To analyze the clinical and epidemiological characteristics of acute poisoning patients in a general hospital, then to provide a reference for the prevention and treatment of acute poisoning in the future. Methods: A retrospective analysis was made on the clinical data of 660 patients with acute poisoning admitted in emergency medical center of the First Affiliated Hospital of Wenzhou Medical University from July 2009 to May 2015. Results: More men than women in 660 cases with acute poisoning(the ratio of male to female was 1.36∶1) ; ≥30 years old was the high incidence age (78.79%) ; The top occupation was farmers (39.70%) ; Most were life poisoning (88.18%) , suicide was the main reason (62.42%) especially happened in women, and the main cause of suicide was family conflicts; Toxic species dominated by pesticide (67.58%) , most were severe poisoning (81.82%) ; The top two pesticide poisoning were organic phosphorus and paraquat, and the proportion of blood purification in paraquat was significantly higher (χ2=105.21, P=0.00) ; There were 212 cases with organ dysfunction, main were pesticide poisoning patients, and the proportionof organ dysfunction in paraquat was significantly higher than the rest allpesticide poisoning (χ2=45.09, P=0.00) ; The general fatal rate of acute poisoning was 2.27%, and the proportion in paraquat poisoning was .higher than the rest pesticide poisoning who were death and give up when discharged (χ2=56.83, P=0.00) . Conclusion: The focus of acute poisoning in the general hospital is still pesticide (especially organic phosphorus and paraquat) , and most were severe poisoning.

Effectiveness of muscle basal lamina carrying neural stem cells and olfactory ensheathing cells in spinal cord repair.

We examined the effect of muscle basal lamina (MBL) with neural stem cells (NSCs) and olfactory ensheathing cells (OECs) on spinal cord injury repair. Seventy-two Sprague-Dawley rats were subjected to spinal cord hemisection and divided into 6 groups. In blank control group (group A), the ends of the spinal cord hemisection model were flushed with physiological saline. In NSC transplantation group (B), OEC transplantation group (C), MBL with NSC transplantation group (D), MBL with OEC transplantation group (E), and MBL with NSC and OEC transplantation group (F), NSCs, OECs, MBL with NSCs, MBL with OECs, and MBL with NSCs and OECs were implanted into the ends of the hemisection model. Survival and migration of transplanted cells were detected by immunohistochemistry and immunofluorescence after 4 and 8 weeks. Hind limb function repair was evaluated by Bundle branch block score at various time points before and after surgery. MBL could promote NSC growth along its lumen and promote host cell advancement in the lumen, reducing local inflammatory responses. Using MBL with NSCs and/or OECs for spinal cord repair shows advantages over simple cell transplantation. Group F contained more nerve cells in muscle basal lamina than group E. This method is useful for forming more axons, synaptic connections, and signal transduction pathways. However, these new axons showed nerve demyelination, which may greatly limit nerve signal conduction. In group F, OECs could induce neural stem cells, axonal growth, and synaptic connection formation, but its role is limited.