Objective To explore the time of application of hemoperfusion (HP) for the treatment of acute serious organophosphorus pesticide (ASOPP). Methods One hundred and four patients with ASOPP were randomly divided into two groups, 46 patients accepted traditional treatment(control group), 58 patients were treated with traditional treatment and HP (HP group). The patients in HP group were again divided into three groups according the different time of treatment (time of beginning HP after poisoning), the 4-8 hours group (HP-1 group, 27 patients), the 9-16 hours group (HP-2 group, 19 patients), the 17-32 hours group (HP-3 group, 12 pafients).Tbe coma period, the dosage of atropine, the time of regaining the vitality of cholinesterase, the time of hospitalization and the rate of fatality and curing among groups were observed. Results The coma period, the dosage of atropine, the time of regaining the vitality of cholinesterase, the time of hospitalization and the rate of fatality of the HP group were less than those of the control group (P<0.05). Compared with HP-1 group, the eoma period, the dosage of atropine, the time of regaining the vitality of eholinesterase and the time of hospitalization of the HP-2 group and the HP-3 group were higher (P<0.05), but the difference of the rate of fatality and curing between the HP-1 group and the other HP groups was not statistically significant (P>0.05). The difference of all of the above indicators between HP-2 group and HP-3 group was not statistically significant (P>0.05). Conclusion Application of hemoperfusion among 4-32 hours after poisoning for the treatment of ASOPP can improve the efficacy of therapy, and the efficacy of application of hemoperfusion among 4-8 hours is the best.

Objective To analyze the risk factors for the failure of noninvasive mechanical ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and to help the clinical risk assessment and decision making.Methods A retrospective case control study was conducted.The patients with AECOPD undergoing NIV admitted to Kaifeng Emergency Center from June 2011 to March 2016 were enrolled,and they were divided into two groups according to whether NIV was successful or not within 12 hours.The nutritional status,blood gas analysis,serum electrolytes,D-dimer,renal function,serum pre-albumin,as well as kinetic vital signs,Glasgow coma scale (GCS) score,expression of respiratory distress,and spontaneous expectoration were recorded.Logistic forward stepwise regression analysis was used to analyze the factors for failure of NIV.Results 122 patients.with the initial NIV were enrolled,with NIV failure in 41 patients within 12 hours,accounted for 33.6％.Compared with NIV success group,the percents of respiratory rate ≥ 25 breaths/min (75.6％ vs.17.3％),expectoration disorders (78.0％ vs.19.8％),circulatory disorders (61.0％ vs.18.5％),malnutrition (61.0％ vs.11.1％),decreased serum pre-albumin (58.5％ vs.17.3％),and GCS score ＜ 12 (75.6％ vs.28.4％) in NIV failure group were significantly increased (all P ＜ 0.05).But there were no significant differences in gender,age,body temperature,blood gas analysis,D-dimer,serum creatinine between two groups.It was shown by the results of binary logistic regression analysis that respiratory rate,expectoration disorders,circulatory disorders,malnutrition,serum pre-albumin,and GCS score were the factors of NIV failure [odds ratio (OR) values were 10.879,6.338,9.860,23.273,8.862,6.774,and P values were 0.011,0.038,0.024,0.003,0.015,0.041,respectively].It was shown by the results of logistic stepwise regression analysis that respiratory rate ≥ 25 breaths/min,expectoration disorders,circulatory disorders,malnutrition,decreased serum pre-albumin,and GCS score ＜ 12 were independent risk factors of NIV failure (OR values were 6.610,5.403,5.138,8.153,4.979,5.100,and P values were 0.007,0.013,0.023,0.007,0.027,0.023,respectively).Conclusions The multiple independent risk factors can induce NIV failure within 12 hours in emergency patients with AECOPD,i.e.increased respiratory rate,expectoration dysfunction,circulatory disorders,malnutrition,decreased serum pre-albumin,and decreased GCS score.Emergency physicians should pay attention to these early risk factors in AECOPD patients,which can be taken as correct judgment and guide.

Objective To analyze the influence of ionizing radiation on the lymphocytes and its regulatory T cells in mice.Methods Mice were administered with whole body irradiation of γ-rays at different doses,and lymphocytes were separated from thymus and spleen,then the number of total cells were counted and the percentages of CD4 + T and CD4 + FOXP3 + CD25 + Treg lymphocytes were analyzed by using FACS.Results The lymphocyte numbers in thymus and spleen decreased in dosedependent manner and reached to the minimum at 4 d after irradiation (F =118.08,144.01,P ＜ 0.05).Exposure to higher dose(more than 1 Gy) decreased Treg number time-dependently in thymus,however increased it in spleen.On the contrary,exposure to lower dose (less than 0.75 Gy) increased Treg number in thymus.Besides,the percentage of Treg cells increased dose-dependently(in thymus,F =5.16,89.44,3.01,P ＜ 0.05 ; in spleen,F =52.02,32.13,27.45,P ＜ 0.05).Conclusions The radiation responses of lymphocytes and their Treg subpopulation vary with the different doses.Treg cells are resistant to high dose irradiation,however,their differentiation could be induced by low dose irradiation.In addition,the different time-dependent responses of lymphocytes and their subpopulation to ionizing radiation indicate the difference of lymphocyte maturation,differentiation and emigration.

Objective Compare the complications between laparoscopic and abdominal cervical cancer surgery, and investigate the safety of laparoscopic cervical cancer surgery and complications classified by Clavien-Dindo classification, then analyze the risk factors. Method Clinical data of 215 cases of cervical cancer received surgery from March 2011 to October 2014 was collected, which include intraoperative, postoperative and postoperative fol﹣low-up data. All the cases were divided into two groups: LRH group (n= 116) and ARH group (n= 88), then ana﹣lyze and compare the difference of intraoperative, postoperative complications and postoperative follow-up data be﹣tween the two groups, assess the safety of the two groups, and statistically concluded related independent risk factors. Results The complications of 204 patients were classified into 4 grades. The criticality and morbidity of intraopera﹣tive and postoperative complications have no significant difference between the two groups (P> 0.05). Logistic re﹣gression analysis show that over criticality grade Ⅱ of LRH intraoperative complication related to operating time, over criticality grade Ⅱ of ARH intraoperative complication related to aged over 50 yr, over criticality grade Ⅱ of ARH intraoperative complication related to BMI> 25. Conclusions Through the analysis of laparoscopic operation and the criticality of complications, the safety of the two groups were no difference. The patients with high risk fac﹣tors should be evaluated comprehensively. And strictly grasp the contraindication and indication.

Background:Colorectal polyps,especially adenomatous polyps are the precusor of colorectal cancer. Screening and polypectomy by using colonoscopy is an important approach for prevention of colorectal cancer. Aims:To conduct a retrospective analysis among 1 613 cases of patients with colorectal polyps in Jiading District,Shanghai,China for guiding the management of colonoscopy surveillance of colorectal polyps. Methods:A total of 2 652 colorectal polyps detected by colonoscopy from Jan. 2013 to Aug. 2014 in the Endoscopy Center of Shanghai Ruijin Hospital Northern Branch were recruited in the study. Clinicopathological features of the polyps,coincidence rate of biopsy pathology and polypectomy pathology,and the re-detected polyps in colonoscopic follow-up were analyzed. Results:In 2 652 colorectal polyps,1 996 (75. 3% )were located in distal colon;adenomatous polyps accounted for 77. 5%(2 056 / 2 652)of the polyps detected by colonoscopy,of which 804(39. 1% )were found to have intraepithelial neoplasia. Both biopsy pathology and polypectomy pathology were obtained in 447 polyps,with an overall coincidence rate of 60. 4% ;as for adenomas,the coincidence rate was 68. 1% . Two hundred and eighteen pathologically proved polyps were found in a 1. 5-year colonoscopic follow-up, among which 74. 3% were adenomatous polyps;the re-detection rate of polyps located in proximal colon or less than 1. 0 cm in diameter was significantly higher than polyps located in distal colon and more than 1. 0 cm in diameter, respectively(12. 3% vs. 6. 9% and 9. 0% vs. 4. 5% ,P all < 0. 01). Conclusions:Adenomatous polyps account for high proportion of colorectal polyps detected by colonoscopy. Pathological examination of resection specimens and periodical follow-up are important for patients with colorectal polyps after endoscopic polypectomy.

Objective To analyze the application value of uterine artery flow and cerebral placental rate(CPR)in diagnosing fetal growth restriction(FGR).Methods A total of 114 pregnant women with clinically diagnosed late-onset FGR who were hospitalized in Jiangxi Maternal and Child Health Hospital from January 2021 to June 2022 were assigned to study group,and 122 pregnant women with normal intrauterine development were assigned to control group.The blood flow parameters of uterine artery(UtA),umbilical artery(UA)and middle cerebral artery(MCA)in two groups were determined by ultrasound,and CPR in two groups was calculated.The blood flow difference and pregnancy outcome of two groups were compared.Receiver operating characteristic(ROC)curve was used to analyze the application value of UtA and CPR alone and combined in the clinical diagnosis of FGR.Results The UtA resistance index(RI)of pregnant women in study group was higher than that of control group,the fetal UA blood flow parameter was higher than that of control group,the MCA blood flow parameter and the CPR value were both lower than those of control group,the differences were statistically significant(P<0.05).The birth weight and 1min Apgar score of study group were lower than those of control group(P<0.001).In addition,the incidence of emergency cesarean section operation,premature delivery and neonates transferred to neonatal intensive care unit(NICU)due to various complications in study group were significantly higher than those in control group(P<0.05).ROC curve showed that in predicting FGR,the area under the curve(AUC)of UtA-RI was 0.82(95%CI:0.77-0.88).The predictive efficiency of CPR was 0.75(95%CI:0.69-0.81).The combination of UtA-RI and CPR parameters had the highest efficiency in predicting FGR,with an AUC of 0.92(95%CI:0.89-0.95).Conclusion CPR combined with UtA-RI monitoring has clinical application value for early detection of FGR,guiding intervention,and improving adverse perinatal outcomes.

Objective To discuss the shielding calculation method for proton therapy room, and to provide a scientific basis for shielding design of proton therapy room and improvement of existing national standards. Methods Using the calculation formula and key characteristic parameters from national standards and Chinese and foreign literature, combining with the FLUKA Monte Carlo method, empirical formula calculation and Monte Carlo simulation were conducted for the neutron ambient dose equivalent rates of the focuses outside the shielding of proton therapy room. The estimation results of the two methods were analyzed. Results Relative to the calculation results of the single exponential formula in the two directions of 0° and 50° in the beam loss point of divergence slit (0.13 and 12.4), the calculation results of the double exponential formula (0.40 and 17.9) were more consistent with the Monte Carlo simulation results (0.32 ± 0.19 and 18.2 ± 4.98). The Monte Carlo simulation results of copper target and nickel target were similar, suggesting that the key characteristic parameters of concrete shielding for copper target could be well applied to the calculation of nickel target, but the neutron ambient dose equivalent rates were underestimated when applied to tantalum target, with a difference of 5.7 times and 1.3 times in the two directions of 0° and 40°, respectively. Conclusion The dose rate estimates based on the calculation formula and key characteristic parameters from Chinese and foreign literature are consistent with FLUKA simulation results, and this method can be used in the shielding design of proton therapy room as a supplement and improvement to the existing national standards.

Objective To compare H_p(3) calibration with a homemade (A) thermoluminescent dosimeter (TLD) and an imported (B) TLD in a standard X-ray RQR radiation field, to explore the different responses of A and B, and to provide foundation for the calibration of H_p(3). Methods A column mode was selected. H_p(3) calibration was performed using A and B in a standard X-ray RQR radiation field in the Secondary Standard Dosimetry Laboratory, National Institute for Radiological Protection, China Center for Disease Control and Prevention. Angle response, energy response, and linear response were calibrated with RQR4 (60 kV), RQR7 (90 kV), and RQR9 (120 kV), respectively. Results In terms of angle response, the calibration results of A were relatively high, while the calibration results of B were relatively low. In terms of energy response, the calibration results showed a similar pattern to angle response. In terms of linear response, the calibration results of both A and B were satisfactory. Conclusion Both A and B can be used for normal calibration of H_p(3) in a standard X-ray RQR radiation field. However, in actual monitoring, attention should be paid to the energy and angle response values of TLDs.