Objective To investigate the application value of early lactate clearance rate and acute physiology and chronic health evaluation (APACHE) Ⅱ score in patients with acute carbon monoxide poisoning encephalopathy.Methods One hundred and forty-six patients with acute severe carbon monoxide poisoning were divided into control group (60 cases) and case group (86 cases) according to the occurrence of toxic encephalopathy.All the patients were extracting 1 ml arterial blood under the condition of air before treatment and 6,24,72 h after treatment,arterial blood lactic acid level was detected,and the lactate clearance rate was calculated.The initial level of blood lactic acid,lactic acid clearance rate and APACHE Ⅱ score 6,24,72 h after treatment,complication rate and mortality rate were compared between the two groups.Results Compared with control group,the initial level of blood lactic acid in case group was higher [(3.30 ± 0.55) mmol/L vs.(2.64 ± 0.24) mmol/L],the lactate clearance rate 6,24 h after treatment was lower [(8.22 ± 1.20)％ vs.(12.83 ± 5.31)％,(12.00 ± 2.40)％ vs.(15.17 ± 2.99)％],the APACHE Ⅱ score 6,24,72 h after treatment was higher [(16.78 ±2.82) scores vs.(12.33 ±2.16) scores,(14.11 ± 1.54) scores vs.(10.17 ±0.98) scores,(10.56 ± 1.51) scores vs.(7.83 ± 1.17) scores],the complication rate and mortality rate were higher,and there were statistical differences (P ＜ 0.05).There was no statistical difference in lactate clearance rate 72 h after treatment between the two groups (P ＞ 0.05).In acute carbon monoxide poisoning encephalopathy patients,the lactate clearance rate 6 h after treatment was negatively correlated with APACHE Ⅱ score and mortality rate (r =-0.616,P =0.015;r =-0.606,P =0.017).Conclusion Early lactate clearance rate and APACHE Ⅱ score can help to assessment the severity,guide treatment and judging prognosis in patients with acute carbon monoxide poisoning encephalopathy.

OBJECTIVE To investigate the expression of transcription factors Snail,Slug and cell adhesion molecule E-cadherin in nasopharyngeal carcinoma(NPC)and evaluate their relationship with clinical pathological features and metastases.METHODS Immunohistochemistry and quantitative polymerase chain reaction were carried out to detect the expression of Snail,Slug and E-cadherin in 65 NPC samples and normal nasopharyngeal mucosa(18 cases).The expression of Snail and Ecadherin in distinct differentiation nasopharyngeal carcinoma was analyzed and the relationship of them with clinical pathological features was discussed.RESULTS Real-time PCR analysis and immunohistochemistry showed that Slug was elevated with increasing tumor grade.E-cadherin expression was reduced corresponding with prognostic indices and tumor.Snail showed no obvious change.The relative expression levels of E-cadherin mRNA were significantly different between lymph node metastasis group and nometastasis group(P

In this study, we prepared various matrices of hydrogel patches and studied their cross-linking mechanism by observing their rheological properties, which could provide theoretical basis and deep technical support for further industrial development of hydrogel patch. Rheology method was used to do the amplitude scanning and single-frequency scanning for various hydrogel matrix, under the condition of oscillation mode of the rheometer. Then the linear viscoelastic region, composite modulus value, as well as changes in slope with time of the composite modulus and phase angle of various hydrogel matrix were analyzed in detail. The results showed that the stability of matrix was mainly determined by hydrogel frame; only in acidic environment, the cross-linking reaction between cross-linker and hydrogel frame can occur; elasticity of matrix can be decreased by organic acid and the effect level was related to the ratio of the number of carboxyl and hydroxyl (-COO(-)/-OH) in adjusters: if the ratio was not equal, the higher -COO(-)/-OH in adjusters would be the less elasticity of matrix decreased; the cross-linking speed of matrix was determined by adjuster, the cross-linking speed of matrix contain different adjusters was ranged in following order: matrix containing tartaric acid > matrix containing lactic acid > matrix containing malic acid > matrix containing citric acid; the cross-linking speed of matrix was not uniform in the whole cross-linking process.

Objective To investigate the clinical value of copeptin and ischemia modified albumin combined determination in the early diagnosis and clinical significance in myocardial damage of acute organic phosphorus pesticide poisoning .Methods Eighty‐six cases of AOPP patients were divided into two groups :the myocardial injury group (50 cases) and non myocardial injury group (36 cases) ;30 healthy people were selected as the control group .3 mL of venous blood were collected for all subjects involved within one hour in admission ,and their cTnI ,IMA and copeptin levels were detected .Results Compared with the control group ,the copep‐tin levels of non myocardial injury group and myocardial injury group were elevated and there was significant difference (P< 0 .05) ;the difference between myocardial injury group and non myocardial injury groups was also significantly different (P< 0 .05) .Among them ,the comparison between severe and mild to moderate group revealed that the IMA and copeptin levels reduced obviously ,there was significant difference (P< 0 .05) ;in myocardial injury group ,the IMA and copeptin levels of patients in different poisoning de‐gree were negatively correlated .Conclusion Early determination of IMA and copeptin level has important significance in the early diagnosis of myocardial injury in patients with poisoning in AOPP ,and could provide guidance for clinical medication .

Objective To study the value of copeptin and APACHE Ⅱ used for assessing acute paraquat poisoning (APP). Methods One hundred and twenty six APP patients were divided into survival group (n = 58) and death group (n = 68), with clinical death as the endpoint of observation. 3 mL blood was obtained from each subject at 2 h , 24 h and 7 d after admission for detecting the levels of copeptin , and APACHE Ⅱ scores were recorded at the same time. Results There was significant difference in dosages of paraquat taken in the death group and the survival group , but the differences were significant in the rescue time , the first time for hemoperfusion and the times for hemoperfusion. 2 h after admission , the death group and survival group had significant difference in elevated copeptin but no significant difference in scores by APACHE Ⅱ. 24 h after admission copeptin decreased to normal level in the survival group but maintained at a higher level in the death group, while the scores by APACHE Ⅱ had insignificant difference between two groups. 7 d after admission, copeptin kept at a higher level and the scores by APACHE Ⅱwere significantly increased in the death group , with significant differences compared to the survival group. The oral doses of pesticides the patients took were positively correlated with copeptin level and scores by APACHE Ⅱ. Conclusion Repeated detection of copeptin and APACHE Ⅱ score are of clinical importance for the assessment of prognosis of APP patients and reasonable distribution of medical resources.

Objective:To investigate the clinical significance of soluble growth stimulating expression gene 2 protein (sST2) combined with neutrophil/lymphocyte ratio (NLR) in the prediction of nosocomial cardiovascular adverse events in patients with acute carbon monoxide poisoning (ACOP) myocardial injury.Methods:Patients with ACOP myocardial injury from January 2017 to December 2019 in Emergency Ward and EICU of Harrson International Peace Hospital, Hebei Medical University were enrolled. NLR was calculated by routine blood examination on admission, and sST2 (T 0sST2, T 3dsST2) was detected by ELISA on admission and at 3 days after admission. According to the occurrence of cardiovascular adverse events, the patients were divided into the event group and the non-event group. Logistic regression was used to analyze the risk factors of in-hospital cardiovascular adverse events. ROC curve was used to analyze the value of sST2, NLR, sST2 and NLR combined in predicting the occurrence of in-hospital cardiovascular adverse events in patients with ACOP myocardial injury. Results:Totally 255 patients with ACOP myocardial injury were included in the final analysis. NLR was (13.38±4.33) in the event group and (9.57±4.22) in the non-event group, T 3dsST2 was (61.59±22.67) ng/mL in the event group and (40.52±13.14) ng/mL in the non-event group, with statistically significant differences (all P<0.01). T 0sST2 was (265.34±89.95) ng/mL in the event group and (242.43±93.09) ng/mL in the non-event group, with no statistically significant difference ( P=0.333). Logistic regression analysis showed that NLR ( OR=1.270, 95% CI: 1.125-1.434, P<0.01) and T 3dsST2 ( OR=1.082, 95% CI: 1.052-1.114, P<0.01) were independent risk factors for nosocomial cardiovascular adverse events in patients with ACOP myocardial injury. The optimal cutoff value of T 3dsST2 was 44.5 ng/mL, and of NLR was 12.08. The sensitivity and specificity of dual T 3dsST2 and NLR in predicting nosocomial cardiovascular adverse events was 79.3% and 82.7%, respectively (AUC 0.857, Youden index 0.620). Conclusions:T 3dsST2 and NLR are independent risk factors for the nosocomial cardiovascular adverse events in patients with ACOP myocardial injury. The predictive cutoff values are 44.5 ng/mL for T 3dsST2 and 12.08 for NLR. Combination of T 3dsST2 and NLR has a practical predictive value for nosocomial cardiovascular adverse events in patients with ACOP myocardial injury.

Objective To investigate the relationship between soluble CD14-st (Presepsin)and assessment,prognosis in patients with acute paraquat poisoning (APP).Methods A total of 82 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2013 to January 2016 were divied into three groups:mild poisoning group (n =20),moderate poisoning group (n =36)and severe poisoning group (n =26).According to the outcomes,patients were divided into survivor group (n =28)and non-survivor group (n =54).Another 50 healthy subjects were selected as control group.In control group,samples of 3 mL venous blood from 50 healthy subjects were collected for laboratory examination.Samoles of 10 mL venous blood from all patients were collected before and 72 hours,7 days after treatment to detect presepsin,C reactive protein (CRP), tumor necrosis factor α(TNF-α),interleukin-6 (IL-6)and interleukin-10 (IL-10).Before and 72 hours, 7 days after treatment,the change of Acute physiology and chronic health evaluation (APACHE)Ⅱscore and the outcomes in 28 days were observed.The variance analysis of repeated measures was used for comparison among multiple groups,and the t test was used to compare changes of detected biomarkers between two groups,and the outcomes in 28 days between two groups were compared with chi square test. Pearson correlation test was used to analyze the correlation between Presepsin in patients with APP and the survival rate.Results APACHE Ⅱ scores and the serum level of prespsin,CRP,TNF-α,IL-6 at admission and 72 hours,7 days after treatment in three poisoning groups were significantly increased compared with control group,IL-10 were decreased compared with control group (P <0.05 ),and there were significant differences in those biomarkers between moderate group and mild group,and between severe group and mild group,moderate group (P <0.05).At admission,72 h,7 d after admission,APACHEⅡscore and the serum levels of presepsin,CRP,TNF-α,IL-6 in non-survivor group were higher than those in survivor group,and IL-10 in non-survivor was lower than that in survivor group (P <0.05).The mortality rates of these 3 groups were 25.00%,69.44% and 92.31%,demonstrating significant differences among three groups (P <0.05).The AUCs were 0.862 and 0.731 for presepsin and APACHEⅡscore respectively at admission.The predictive capability of presepsin for 28-day mortality was superior over that of APACHEⅡscore (P <0.05).The level of serum presepsin in patients with APP was negatively correlated with the survival rate (r =-0.285,P =0.009).Conclusions The detection of prespsin has important clinical value in the severity assessment and prognosis in patients with APP.It is an important guidance for early therapeutic strategy.

Objective To observe the impact of ginkgo biloba extract(Ginaton) on nerve functioninpa-tients withdelayed encephalopathy after acute carbon monoxide poisoning(DEACMP). Methods 96 patients with DEACMP treated in our hospital from April 2011 to February 2017 were randomly divided into a control group and a study group. The control group received hyperbaric oxygen ,control of intracranial pressure ,and improvement of brain cell metabolism;while the study group receivedintravenous injection of Ginaton 70 mg(adding into 250 mL of 0.9% sodium chloride) once daily fora 2-week therapeutic course. MRIand EEGwere used forexamination in DEACMP patients within 24 h after onset and 14 days after treatment. Changes in MRI and EEG examination , clinical symptoms ,mini-mental state examination (MMSE) score ,Barthel index (BI),and Montreal cognitive assessment(MoCA)were assessed before and after treatment between the two groups. Results The therapy wasef-fective in 39 patients in the study group,with a total effectiveness rate of 81.25%;and in 29 patients in the control group,with a total effectiveness rate of 60.42%. There was significant difference between the two groups (χ2 =5.042,P = 0.025). Inadmission,there were no differences between the two groups in the abnormal signals of MRI,abnormal rate of EEG,and the scores on MMSE,BI,andMoCA(P>0.05). After a 14-day treatment,the abnormal signals of MRI,abnormal rate of EEG,andthe scores on MMSE,BI,and MoCA score were improved better in the study than in the control group(P < 0.05). The MMSE score was negatively correlated with disease severity in DEACMP patients(r=-0.832,P=0.000). Conclusions Early treatment with Ginaton can effectively improvethe cerebral lesions on MR,the abnormal rate of EEG,andthe scores on MMSE,BI,and MoCA. It has certain clinical efficacy.

Objective To investigate the clinical value of type Ⅲ procollagen peptide (P Ⅲ P) in sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe in patients with acute paraquat poisoning (APP).Methods A total of 104 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from March 2013 to December 2016 were divied into three groups:A group (n =30,routine therapeutic agents coupled with a single hemoperfusion),B group (n =34,treated by Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe coupled with a single hemoperfusion),C group (n =40,treated by Rheum officinale Ball.as a predominant agent in a traditional Chinese medicine recipe and sequential continuous hemoperfusion).Before and 3 days and 7 days after treatment,tumor necrosis factor t (TNF-α),interleukin-18 (IL-18),maleic dialdehyde (MDA),superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) of patients were detected,and the change of sequential organ failure assessment (SOFA) scores were observed.Before and 3 days,7 days,10 days and 14 days after treatment,PⅢP were detected,and the changes of lung CT in three groups were observed before and 7 days,14 days after treatment.Pearson correlation test was used to analyze the correlation between P Ⅲ P in patients with APP and the concentration of paraquat,and the outcomes in 28 days were compared with chi square test.Results At admission,there were no differences in the levels of plasma TNF-α,IL-18,MDA,P Ⅲ P,SOD,GSHPX and SOFA scores among three groups (P ＞ 0.05).At 3 days after treatment,the levels of plasma TNF-α,IL-18,MDA and SOFA scores were elevated in three groups compared with those at admission,especially in group A were increased significantly,whereas the activity of plasma SOD and GSH-PX were decreased in thress groups,especially in group A decreased most significantly (P ＜ 0.05).At 7 days after treatment,the levels of plasma TNF-α,IL-18,MDA and SOFA scores were lower than those at 3 days after treatment in three groups especially those in group C decreased most significantly (P ＜ 0.05),whereas the activities of plasma SOD and GSH-PX were higher than those at 3 days after treatment especially in group C decreased most significantly (P ＜0.05).At 3 days,7 days,10 days,14 days after treatment,the level of P Ⅲ P were increased gradually in three groups,especially in group C increased most slowly with statistically significant difference between the groups (P ＜ 0.05).At admission,there were no statistically significant difference in the features of lung CT among three groups (P ＞ 0.05).At 7 days after treatment,lung CT mainly manifested ground glass lesions in C group.At 14 days after treatment,lung CT mainly manifested small size of the exudative changes and the irregular line of pleura in C group with higher proportion of those changes than that in A,B group,while pulmonary interstitial changes were found in the lung CT of A and B groups with higher proportion of these changes than that in C group,and those A group was higher than those in B group (P ＜ O.05).The level of serum P Ⅲ P in patients with APP was positively correlated with the concentration of paraquat (r =0.310,P =0.001).The mortality rate of three groups were 53.33％,44.12％ and 25.00％,respectively,with significant difference among three groups (P ＜ 0.05).Conclusion The clinically therapeutic effect of sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine in patients with APP was distinct.It could decrease the levels of PⅢ P,TNF-α,IL-18 and MDA,enhance the expression of SOD and GSH-PX,reduce pulmonary fibrosis in patients and the mortality rate of patients.The P Ⅲ P is the evaluation index of pulmonary fibrosis and can provide useful clinical value for the treatment of patients with APP.

Objective To investigate the clinical efficacy of sequential hemoperfusion combined with rhu-barb as the main treatment for patients with acute paraquat poisoning(acute,paraquat,poisoning,APP). Meth-ods 16 moderate APP patients in our hospital were randomly divided into group A(hemoperfusion group,31 cas-es),group B(hemoperfusion combined with rhubarb as the main prescription group,40 cases)and group C(con-tinuous hemoperfusion combined with rhubarb as the main prescription group,45 cases),respectively.Levels of C-reactive protein(CRP),alanine aminotransferase(ALT),creatine kinase(CK-MB),creatinine(Cr),tumor ne-crosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10(IL-10)were determined before treatment and at 5 d,7 d post-treatment. At 8 h,12 h and 24 h post-treatment,serum paraquat level was determined. Results After treatment,the total effective rate of group C(68.89%)was significantly higher than that of group A (35.48%),group B(52.5%),with significant differences among groups(χ2= 8.335,P=0.015). Levels of ALT,CK-MB,Cr,CRP,TNF-α,IL-6 and IL-10 were significantly increased at 5 d post-treatment in group A, but were significantly decreased at 7d post-treatment in group C,with significant differences among groups(P<0.05).The serum paraquat content in group B and C was lower than that in group A at 8 h post-treatment.The se-rum paraquat content was the lowest in group C at 12h post-treatment(P < 0.05). However,the serum paraquat content decreased significantly in each group at 24 h post-treatment,with no significant differences among three groups. Conclusions The early continuous hemoperfusion combined with rhubarb-based sequential treatment of APP can effectively reduce the fatality rate and improve prognosis of APP patients.