Objective To investigate the correlation of the initial arterial lactate (Lac) and 6-h lactate clearance rate (LCR) with prognosis in patients with acute paraquat poisoning (APP).Methods The included 132 APP patients (70 males and 62 females,age ranging 15-71,30 (18) [M (IQR)]treated at a single center between January 2009 and December 2013.Patients were divided into two groups:group A,survivors ＞ 28 days after admission (n =64); and group B,those died ≤ 28 days after admission (n =68).The prognostic values of arterial Lac and 6-h LCR during the acute stage of poisoning were evaluated.Results Paraquat dose ranged from 5-200 mL,20 mL (37.25 mL) [M (IQR)].The average time from poisoning to arrival at the emergency department was ranging 4-312 h,6 h (8.75h) [M (IQR)].Total mortality was 51.51％.There were no differences in age,gender,and length of time elapsed from poisoning to diagnosis between two groups.Survivors had a significantly lower dose of paraquat ingested compared with nonsurvivors (P ＜ 0.05).An ROC curve analysis determined that the dose had an area of 0.86 (95％ CI:0.80-0.92) and the volume cut-off point was 27.5 mL to predict the prognosis in patients with acute paraquat poisoning (75％ sensitivity,85.9％ specificity,Youden index 0.609).The initial arterial lactate level was higher in nonsurvivors than that in survivors.The ROC curve analysis indicated that the initial arterial lactate level had an area of 0.99 (95％ CI:0.99-1.00) and the concentration cut-off point was 5.050 mmoL/L to predicti prognosis in patients with acute paraquat poisoning (sensitivity 98.5％,specificity 100％,Youden index 0.985).The 6 h LCR was lower in nonsurvivors than that in survivors.ROC curve analysis showed that the 6-h LCR had an area of 0.99 (95 ％ CI:0.97-1.00) and the concentration cut-off point was 17.28％ to predict prognosis in APP patients (sensitivity 100％,specificity 97.1％,Youden index 0.971).Conclusions In the early stages of APP,initial arterial Lac and 6-h LCR are closely related to prognosis and may serve as prognostic factors.

Objective To investigate the characteristics of pathogens and risk factors of the catheterassociated infection (CAI) in emergency ICU (EICU) in order to design an appropriately therapeutic strategy for the future.Methods From January 2008 to December 2010,a total of 1363 patients were enrolled for this retrospective study.Blood sample taken from the vein with indwelling catheterization and the tips of catheters cut in 5 cm after withdrawn from the veins in 1363 patients were collected for bacterial culture.Results Of 1363 catheters,pathogens were found in 147 (10.79％) after venous catheterization.The daily occurrences of CAI were 3.05 ones per 1000 catheters.Of 147 cases of infection,46.94％ pathogens were gram-negative bacilli,40.14％ gram-positive cocci,and 12.92％ fungi.Unconditional Logistic regression analysis suggested that repeated catheterization,femoral vein catheterization,the application of multi-lumen catheter and long-term indwelling catheterization were the independent risk factors responsible for CAI.Conclusions The risk factors responsible for catheter related infections should be controlled to prevent the occurrence of nosocomial infection.

Objective To explore the protective effect and possible mechanism of bone marrow mesenchymal stem cells (BMSCs) on pulmonary fibrosis induced by paraquat (PQ) in rats.Methods A total of 54 male SD rats were randomly (random number) divided into 3 groups (n =18 in each).Group A (normal control group),group B [PQ + phosphate buffer solution (PBS)],group C (PQ + BMSCs group).Rats in group B and C were induced to get pulmonary fibrosis by intragastric administration of PQ in a dosage of 120 mg/kg.In addition,BMSCs was given to rats in group C by injection in a dose of 1 × 106/mL via the vena caudalis,whereas an equal volume of PBS (1 mL) was given to rats in group B by injection instead.The survival rats in each groups were sacrificed separately at 7 days,14 days and 28 days after administration of PQ.The lower lobe of left lung were taken to observe histopathological changes with HE staining and Masson staining,and the pulmonary fibrosis was scored by using the Szapiel classification of alveolitis.At the same time,the lower lobe of right lung was harvested to detect the hydroxyproline (HYP),TGF-β1 and HGF in lung tissue by using immunohistochemistry.Results The pathological changes in lung tissue of rats were inflammatory change in alveoli space filled with massive amount of exudate obviously in group B at 7 days after exposure to PQ,but in group C,the inflammatory changes were much milder than those in group B.The exudation and edema in lunge alveoli were mitigated in group B at 14 days after exposure to PQ,but pulmonary interstitial fibers were increased.The degree of pulmonary interstitial fibrosis in group C was milder than that in group B.In group B,there were obvious pathological changes including destroyed alveoli septum,enlarged alveoli,thickened alveoli septum and the deposition of collagen fibers,disarranged alveolar structure at 28 days after exposure to PQ.The deposition off collagen fiber was slighter with well observed basic alveolar structure in group C than that in group B.The levels of HYP in lung tissue at different intervals in B group were escalating with time after exposure to PQ,and reached a peak at 28 day,which were significantly higher than those in group A (P ＜ 0.01).The levels of HYP in lung tissue at different intervals in C group were increasing with time after exposure to PQ,and reached a peak at 28 day,which were significantly lower than those in group B (P ＜ 0.01).The levels of TGF-β1 from different intervals in B group were increased greatly with wider distribution over large portion of lung structure than those in group A,and reached a peak at 7 days,then declined with time,which were significantly higher than those in group A (P ＜ 0.05).The levels of TGF-β1 at different intervals in group C were significantly lower than those in group B (P ＜ 0.05).The levels of HGF at different intervals in B group increased with time,but there was no significant difference among those at different intervals (P ＞0.05).The levels of HGF at different intervals in group B were little bit higher than those in group A,but there was no significant difference between them (P ＞ 0.05).The levels of HGF at different intervals in group C increased with time with significant differences among different intervals (P ＜ 0.05).The levels of HGF at 3 intervals in group C were significantly different from those of group A and group B group (P ＜0.05).Conclusions BMSCs can alleviate pulmonary fibrosis induced by PQ,and increase the survival rate,which may be attributed to decreasing the level of TGF-β1 and increasing the level of HGF.