Objective To investigate the predictive value of extra pulmonary multiple factors including creatine kinase-isoenzyme MB (CK-MB) for the prognosis of patients with acute paraquat poisoning.Methods A retrospectively analysis were conducted on 641 patients who were treated at the First Affiliated Hospital of Zhengzhou University due to oral paraquat poisoning from October 2002 to April 2017.The observation end point was that the patients died from paraquat poisoning within 3 months after admission or were still alive within 3 months after paraquat poisoning.The patients' data were retrieved,including general information,the dose of poison,urinary paraquat concentration,arterial blood gas analysis,alanine transaminase (ALT),total bilirubin (TBIL),uric acid (UA),aspartate transaminase (AST),creatine kinase (CK),CK-MB,B type natriuretic peptide (BNP),lactic dehydrogenase (LDH),high sensitivity troponin T (hsTnT),C-reaction protein (CRP) and procaicitonin (PCT).According to the patient's prognosis within 3 months,the patients were divided into a survival group and a non-survival group.The above indicators were compared between the two groups and the diagnostic value of CK-MB for acute paraquat poisoning was analyzed according to the receiver operating characteristics (ROC) curve.Collect the last arterial blood gas analysis,and laboratory test results were analyzed by binary logistic regression analysis to determine the risk factors for death in patients with acute paraquat poisoning.Results Among the 641 patients with acute paraquat poisoning,315 (49.1％) patients survived and 326 (50.9％) died.Compared with the survival group,patients in the non-survival groupthere were older,had a shorter hospital stay,and had a higher oral paraquat dose and urinary paraquat concentration;Lac,TBIL,UA,AST,CK,CK-MB,BNP,LDH,CRP and PCT were higher,while blood gas analysis index were lower in the non-survival group (P＜0.05).Binary logistic regression analysis showed that the dose of paraquat,CK-MB and AST were closely related to the prognosis of patients with acute paraquat poisoning.The optimal cut-off value of ingestion dose,the first urinary paraquat concentration on admission and CK-MB in predicting the prognosis of patients with acute paraquat poisoning were 7 g (AUC=0.918,sensitivity 80.6％,specificity 87.5％,Yoden index 0.681,P＜0.01),5.16 μg/mL (AUC=0.879,sensitivity 93.8％,specificity 70.1％,Yoden index 0.639,P＜0.01),and 18.2 U/L (AUC=0.846,sensitivity 83.9％,specificity 71.9％,Yoden index 0.558,P＜0.01),respectively.Binary logistic regression analysis of the last biochemical indicators of paraquat poisoning showed that the dose of poison,the last CK-MB,the last SCr,urinary paraquat concentration,and the last blood Na+ were closely related to the prognosis of patients with acute paraquat poisoning.Among them,the last CK-MB＞18.05 U/L often indicated poor prognosis (AUC=0.808,sensitivity 79.7％,specificity 65.8％,Yoden index 0.455,P＜0.01).Conclusions In the treatment of patients with acute paraquat poisoning,there are significant differences in extra pulmonary factors such as heart,liver,kidney,electrolytes and inflammatory markers in patients with different prognosis,so the monitoring and follow-up should be improved,in addition to focusing on the presence and treatment of pulmonary fibrosis.In particular,CK-MB is an independent risk factor for the prognosis of acute paraquat poisoning.In the late stage of poisoning,CK-MB,SCr,and blood Na+ have a strong predictive value for the prognosis of the patients,and we should pay attention to the regular follow-up of the above mentioned laboratory items.

Objective To comprehensively evaluate the clinical efficacy of hemoperfusion (HP) combined with continuous veno-venous hemofiltration (CVVH) on acute paraquat poisoning (APP).Methods Literatures of Chinese and English randomized controlled trials (RCTs), case control and cohort study on HP combined with CVVH in the treatment of APP from the PubMed, Embase, Wanfang, and CNKI up to November 2017 were enrolled (the subjects were > 16 years old). The obtained literatures were strictly screened and evaluated in quality, and data such as mortality, the life time of dead patients, inefficiency rate, incidence of multiple organ dysfunction syndrome (MODS) and acute respiratory distress syndrome (ARDS) were extracted. Meta-analysis was performed by RevMan 5.3. Results Twenty-one studies were included with 2222 subjects, among whom 976 subjects were in HP combined with CVVH group (experimental group) and 1246 subjects in HP group (control group). Compared with control group, the mortality in experimental group were significantly decreased [43.77％ (362/827) vs. 55.26％ (604/1093), odds ratio (OR) =0.68, 95％ confidential interval (95％CI) = 0.56-0.82,P = 0.0001], the life time of death patients was significantly prolonged [mean difference (MD) = 4.63, 95％CI = 2.60-6.66,P < 0.00001], incidence of MODS [25.93％ (70/270) vs. 55.36％ (155/280),OR = 0.26, 95％CI = 0.14-0.49,P< 0.0001], and incidence of ARDS [30.37％ (82/270) vs. 51.07％(143/280),OR = 0.42, 95％CI = 0.30-0.61,P < 0.00001], and inefficiency rate [8.72％ (13/149) vs. 34.64％ (53/153),OR=0.17, 95％CI = 0.09-0.34, P < 0.00001] were significantly reduced. Funnel chart showed that except the publication bias of mortality rate, there were less publication bias about other indicators among studies.Conclusion HP combined with CVVH can significantly reduce the mortality of patients with APP compared with HP alone on the whole, prolong the life time and reduce the occurrence of MODS and ARDS, thus improving the treatment efficiency.

The effective exploitation of natural products is of great significance. Herein the essential oil from Herba Artimisiae Sieversianae in growth period and flower/ fruit bearing period was extracted by ethanol extraction method. The optimal extraction condition was determined by orthogonal experiment, including extracting 3 times, soaking for 90 min, and the ratios of liquid to solid for Herba Artimisiae Sieversianae in growth period and flower/ fruit bearing period were 10 mL : 1 g and 8 mL : 1 g, respectively. The main components of the products were confirmed by FT-IR and GC-MS, which were cineole, camphor, d-borneol, caryophyllene, cadina-1, 4-diene, calamenene, ethyl palmitate, etc. in herba artimisiae sieversianae in growth period, and camphor, caryophyllene, borneol, neryl formate, etc. in Herba Artimisiae Sieversianae in flower/ fruit bearing period. The radical scavenging activity of the products was determined. The results showed that the IC50 values of the essential oil from Herba Artimisiae Sieversianae in growth period and flower/fruit bearing period for 0. 05 mmol/ L DPPH solution were 0. 40 mg / mL and 1. 66 mg / mL, respectively. The essential oil extracted by ethanol from Herba Artimisiae Sieversianae was confirmed to possess good antioxidant activity.

Objective:To define the definition and connotation of nursing shame by using Walker-Avant classical conceptual analysis.Methods:Literature was systematically searched from CNKI, Wanfang, VIP, PubMed, Web of Science, Wiley Online Library, ScienceDirect and CINAHL, and articles were screened according to inclusion and exclusion criteria. Based on Walker-Avant classical conceptual analysis, the concept of nursing shame was analyzed from the aspects of defining attribute, antecedent factors and post factors.Results:The three defining attributes of nursing shame included negative self-evaluation, avoidance and withdrawal and self-breakthrough. Antecedent factors included non-compliance with self-expectations and clinical bullying. Post-effects included physical and mental impairment and departure of nurses, increased patient burden and hindered expression. However, nursing shame could also be positive by cultivating shame resilience and become a psychological motivation for nurses to reflect and adjust themselves.Conclusions:The conceptual attribute of nursing shame is clarified through conceptual analysis, which lays a theoretical foundation for the future development or localization of targeted measurement tools to effectively identify and deal with nursing shame.

Objective To evaluate the efficacy,safety of rigid gas permeable contact lens (RGPCL) wearing for over 5 years in different degrees of keratoconus eyes.Methods A retrospective case study was performed.The clinical data of 217 eyes with different degree of keratoconus from 126 keratoconus patients who fitted with RGPCL in Beijing Tongren Hospital from 2000-2010 over 5 years were analyzed.The eyes were divided into mild keratoconus group (Ks≤45.0 D),moderate keratoconus group (45.0 D＜ Ks ＜ 52.0 D) and severe keratoconus group (Ks ≥52.0 D) according to the severity.Uncorrected visual acuity (UCVA,LogMAR),spectacle corrected visual acuity (SCVA) and RGP corrected visual acuity (RGPVA) was examined before RGPCL wearing and the end of followingup after RGPCL wearing.The refraction,corneal curvature,corneal astigmatism were measured with auto-refractomer/keratometer and keratoconus screening analysis system of computer-assisted corneal topography.Comparisons of the changes of corrected visual acuity and corneal parameters were assessed.Results The RGPVA was 0.09±0.17,0.05±0.07 and 0.07 ±0.07 in the mild,moderate and severe keratoconus group,respectively,showing a significant difference among the three groups (F=0.522,P=0.594);The △Ks was (2.25±5.42),(0.26±3.44) and (-4.52±3.44)D,and △Kf was (2.06±4.98),(1.02±3.41) and (-2.03±5.05)D,and the change value of corneal astigmatism was (0.19±2.87),(-0.78±2.84) and (-2.44±3.77)D in the mild,moderate and severe keratoconus group(all at P＜ 0.05),respectively,with the minimum amount of change in the severe keratoconus group.The variation of differential sector index (△DSI) was-0.33 ± 1.64,0.14±3.01 and-2.11 ±4.28;the variation of center/ surround index (△CSI) was-0.41 ± 1.07,0.03±2.22 and-2.49±4.15;the variation of standard deviation of power (△SDP) was-0.43 ±0.64,-0.02 ±0.89 and-1.67 ± 1.68;the variation of keratoconus prediction index (△KPI)was 0.00±0.07,0.03±0.09 and-0.05±0.11 in the mild,moderate and severe keratoconus group,respectively,and the reduced amount in above parameters was much more in the severe keratoconus group than that in the mild and moderate keratoconus group (all at P＜0.01).Mild conjunctivitis and corneal affection occurred in 12 eyes (5.5％)during the follow-up.Conclusions Long-term wearing RGPCL can improve the visual acuity and slow the tendency of corneal curvature increase in keratoconus eyes,and this procedure is safe and effective for the correction of different degree of keratoconus.

In order to prevent the canceration of gallbladder polyps or avoid the misdiagnosis of gallbladder cancer,the mainstream practice is cholecystectomy for polyps larger than 1 cm,while gallbladder polyps larger than 0.5 cm as an indication of gallbladder preserving surgery.The reasons for this result is that we put the diameter of more than 1 cm of gallbladder polyps as high risk factors for prediction of gallbladder carcinoma,and we ignored the characteristics of gallbladder polyps that most of them are not gallbladder cancer or are not cancerous even larger than 1 cm.We analysed the high risk factors for gallbladder cancer on the basis of variety of clinical data,and we believe that the most valuable indicator of gallbladder cancer are the growth time of gallbladder polyps,the age of the patients,the combination of gallstones,the single polyps,and the sex.Polyps diameter greater than 1 cm are not a high risk factor for gallbladder cancer.We can use these five high risk factors to manage gallbladder polyps and reduce unnecessary cholecystectomy and gallbladder preserving surgery.

Dermatofibrosarcoma ; Fibroma ; Humans ; Skin Neoplasms

Objective:Explore the predictive value of the C-reactive protein to albumin ratio (CAR) and combined indicators for the prognosis of cardiac arrest (CA) patients.Methods:Retrospective analysis was conducted on patients who recovered spontaneous circulation after cardiopulmonary resuscitation (CPR) admitted to the First Affiliated Hospital of Zhengzhou University from January 2021 to May 2023. Patients were divided into survival and non-survival groups based on their status at discharge. Baseline characteristics, CPR data, and laboratory indicators were compared between the two groups. Statistically significant indicators were further analyzed using multivariate logistic regression to identify independent risk factors affecting the prognosis of CA patients. Receiver operating characteristic (ROC) curves were constructed to assess the predictive value of each independent factor and combined indicators for the prognosis of CA patients.Results:A total of 145 patients were included in the study, including 33 patients in the survival group and 112 patients in the non-survival group. There were statistically significant differences between the survival group and the non-survival group in terms of CPR duration, the dosage of vasopressor drugs used, ICU length of stay, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score at ICU admission, lactate, fibrinogen, aspartate aminotransferase, albumin, procalcitonin, C-reactive protein, CAR, myoglobin, and creatine kinase isoenzyme (all P < 0.05). Multivariate logistic regression analysis revealed that CAR and CPR duration were independent risk factors affecting the prognosis of CA patients (CAR: OR=2.372, 95% CI: 1.094~5.146, P=0.029; CPR duration: OR=1.170, 95% CI: 1.020~1.342, P=0.025). ROC curve analysis showed that the areas under the curve for CAR, CPR duration, and their combination in predicting patient prognosis were 0.792, 0.731, and 0.859, respectively. The cut-off values for CAR and CPR duration were 1.455 and 11.5 minutes, respectively. Conclusions:The CAR and CPR duration are independent risk factors affecting the prognosis of CA patients, and the predictive value is higher when both CAR and CPR duration are combined. A CAR greater than 1.455 and a CPR duration longer than 11.5 minutes suggest a poorer prognosis for the patients.

Objective To investigate the correlation between the level of N-terminal pro-Brain natriuretic peptide(NT-proBNP)and cardiorespiratory fitness following acute exposure to high altitude.Methods Forty-six subjects were recruited from the Second Affiliated Hospital of Army Medical University in June 2022,including 19 males and 27 females.After completing cardiopulmonary exercise test(CPET),serological detection of myocardial cell-related markers,and multiple metabolites at a plain altitude(300 meters above sea level),all subjects flew to a high-altitude location(3900 meters above sea level).Biomarker testing and CPET were repeated on the second and third days after arrival at high altitude.Changes in serum biomarker and key CPET indicators before and after rapid ascent to high altitude were compared,and the correlation between serum levels of various myocardial cell-related markers and metabolites and high altitude cardiorespiratory fitness was analyzed.Results Compared with the plain altitude,there was a significant decrease in maximal oxygen uptake after rapid ascent to high altitude[(25.41±6.20)ml/(kg.min)vs.(30.17±5.01)ml/(kg.min),P<0.001].Serum levels of NT-proBNP,Epinephrine(E),plasma renin activity(PRA),angiotensin Ⅱ(Ang Ⅱ),angiotensin-converting enzyme 2(ACE2)and leptin(LEP)significantly increased,with all differences being statistically significant(P<0.05)after acute high altitude exposure.In contrast,no statistically significant differences were observed for creatine kinase MB(CK-MB),cardiac troponin I(cTnI),myoglobin(Myo)and norepinephrine(NE)(P>0.05).Correlation analysis showed a significant negative correlation between NT-proBNP at plain altitude(r=-0.768,P<0.001)and at high altitude(r=-0.791,P<0.001)with maximal oxygen uptake at high altitude.Multivariate linear regression analysis indicated that maximal oxygen uptake at plain altitude(t=2.069,P=0.045),NT-proBNP at plain altitude(t=-2.436,P=0.020)and at high altitude(t=-3.578,P=0.001)were independent influencing factors of cardiorespiratory fitness at high altitude.Conclusion Cardiorespiratory fitness significantly decreases after rapid ascent to high altitude,and the baseline NT-proBNP level at plain altitude is closely related to cardiorespiratory fitness at high altitude,making it a potential predictor indicator for high altitude cardiorespiratory fitness.

Objective:To investigate the effects of curdione on the proliferation， apoptosis and cell cycle of triple negative breast cancer cell line MDA-MB-231. Method:MDA-MB-231 cells were cultured in vitro with capecitabine （positive control） and curdione at different concentrations （125， 250， 500， 1 000， and 2 000 μmol·L^-1）， respectively， for detecting their viability using the cell counting kit-8 （CCK-8） at 24 and 48 h. Three effective inhibitory concentrations （250， 500， and 1 000 μmol·L^-1） against cell proliferation were selected for subsequent experiments. The effect of curdione on cell cycle was determined by flow cytometry combined with propidium iodide （PI） staining. After the set-up of high-concentration （2 000 μmol·L^-1） group， the effect of curdione on cell mitochondrial membrane potential was measured by JC-1（5，5，6，6-tetrachloro-1，1，3，3-tetraethylbenzimidazolylcarbocyanine iodide） staining， followed by the detection of cell apoptosis by flow cytometry combined with Annexin V-FITC/PI double staining. The changes in cell cycle status and apoptosis-related protein expression following curdione intervention were assayed by Western blot. Result:Compared with the blank control， curdione at 250， 500， 1 000， and 2 000 μmol·L^-1 significantly inhibited the proliferation of MDA-MB-231 cells （P<0.01）， exhibiting a concentration- and time-response relationship. The half maximal inhibitory concentration （IC₅₀） values at 24 and 48 h were 1 607 and 1 401 μmol·L^-1， respectively. Curdione at 250， 500， and 1 000 μmol·L^-1 arrested cells in G₁ phase. Curdione at 250 μmol·L^-1 had no effect on cell mitochondrial membrane potential， which， however， declined significantly in the 500， 1 000， and 2 000 μmol·L^-1 groups （P<0.05， P<0.01）. Curdione at 250， 500， and 1 000 μmol·L^-1 obviously increased the proportion of apoptotic cells （P<0.05， P<0.01）. Curdione at each concentration elevated the Bcl-2-associated X protein （Bax）/B-cell lymphoma 2 （Bcl-2） ratio （P<0.05， P<0.01）， but did not change the cysteinyl aspartate-specific protease-3 （Caspase-3） expression. The protein expression levels of Caspase-9， cleaved Caspase-9， cleaved Caspase-3， p53， and p21 were up-regulated （P<0.05）. Conclusion:A certain concentration of curdione inhibits the proliferation of MDA-MB-231 cells， which may be related to its efficacy in arresting cell cycle and inducing apoptosis.