OBJECTIVETo explore the clinical efficacy of early application of sequential gastrointestinal lavage in patients with acute paraquat poisoning by analyzing the clinical data of 97 patients.

METHODSA total of 97 eligible patients with acute paraquat poisoning were divided into conventional treatment group (n = 48) and sequential treatment group (n = 49). The conventional treatment group received routine gastric lavage with water. Then 30 g of montmorillonite powder, 30 g of activated charcoal, and mannitol were given to remove intestinal toxins once a day for five days. The sequential treatment group received 60 g of montmorillonite powder for oral administration, followed by small-volume low-pressure manual gastric lavage with 2.5%bicarbonate liquid. Then 30 g of activated charcoal, 30 g of montmorillonite powder, and polyethylene glycol electrolyte lavage solution were given one after another for gastrointestinal lavage once a day for five days. Both groups received large doses of corticosteroids, blood perfusion, and anti-oxidation treatment. The levels of serum potassium, serum amylase (AMY) alanine aminotransferase (ALT), total bilirubin (TBIL), blood urea nitrogen (BUN), creatinine (Cr), lactate (Lac), and PaO₂of patients were determined at 1, 3, 5, 7, and 10 days. Laxative time, mortality, and survival time of dead cases were evaluated in the two groups.

RESULTSThe incidence rates of hypokalemia (<3.5 mmol/L) and AMY (>110 U/L) were significantly lower in the sequential treatment group than in the conventional treatment group (P < 0.05). There were no significant differences in the incidence of ALT (>80 U/L), TBIL (>34.2 µmol/L), BUN (>7.2 mmol/L), and Cr (>177 µmol/L) between the two groups (P>0.05). However, the highest levels of ALT, TBIL, BUN, Cr, and Lac were significantly lower in the sequential treatment group than in the conventional treatment group (P < 0.05). Moreover, the sequential treatment group had significantly lower incidence of PaO₂(<60 mmHg), shorter average laxative time, lower mortality, and longer survival time of dead cases than the conventional treatment group (P < 0.05).

CONCLUSIONThe early application of sequential gastrointestinal lavage can shorten laxative time, alleviate organ damage in the liver, kidney, lung, and pancreas, reduce mortality, and prolong the survival time of dead cases in patients with acute paraquat poisoning.

Acute Disease ; Bentonite ; administration & dosage ; Bilirubin ; Blood Urea Nitrogen ; Charcoal ; Combined Modality Therapy ; Creatinine ; Gastric Lavage ; methods ; Humans ; Liver ; Paraquat ; poisoning ; Poisoning ; therapy ; Treatment Outcome

Objective: To evaluate the predictive value of cervical size change rate and morphological distribution detected by ultrasound in the second trimester of pregnancy for preterm delivery. Methods: From June 2016 to June 2018, 300 pregnant women who underwent antenatal testing and gave birth in , the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected in this research.The length, width and shape of cervix were measured by transvaginal color doppler ultrasonography at 14 and 28 weeks respectively.According to whether or not premature delivery occurred, they were divided into premature delivery group and full-term delivery group.The differences of cervical length, cervical inner mouth width, cervical length shortening rate, cervical inner mouth width increasing rate and cervical shape distribution between preterm and full-term pregnant women were compared, and the correlation between the above indicators and the occurrence of premature delivery were analyzed. Results: The length of cervix in the preterm delivery group [(21.41±6.28)mm] was significantly shorter than that in the full-term delivery group at 28 weeks of gestation [(34.17±5.76)mm](t=10.295, P=0.000), and the width of cervical inner mouth in the preterm delivery group [(9.54±2.57) mm] was significantly longer than that in the full-term delivery group [(4.06±0.91)mm] (t=25.416, P=0.000). The shortening rate of cervical length [(39.28±8.65)%] and the increasing rate of cervical width [(149.74±15.09)%] in the preterm pregnant women during the second trimester were significantly higher than those in the full-term pregnant women [(10.15±5.29)% and (16.33±3.84)%] (t=21.471, 39.420; P=0.000, 0.000). The proportion of T-type cervix in the preterm delivery group (77.17%) was significantly higher than that in the full-term delivery group (63.28%) (χ²=10.935, P=0.001). According to the correlation analysis, the length of cervix was negatively correlated with premature birth (r=-0.612, P=0.035), and the width of cervical inner mouth, the shortening rate of cervical length in the second trimester and the increasing rate of cervical inner mouth width in the second trimester were positively correlated with premature birth (r=0.743, 0.665, 0.807; P=0.013, 0.026, 0.004). Conclusion Ultrasound monitoring of cervical size change rate and cervical morphology during the second trimester of pregnancy is helpful to the early prediction of preterm labor, which should be paid attention to clinically.

Objective:To investigate the value of abdominal ultrasound in the diagnosis of postpartum diastasis of the rectus abdominis muscle (DRA).Methods:A total of 300 pregnant women who received prenatal examination and finally gave birth in Wenzhou Hospital of Integrated traditional Chinese and Western Medicine between October 2018 and October 2020 were included in this study. All of them underwent finger test and high-frequency ultrasound to determine the degree of DRA. The occurrence of DRA was recorded. The efficacy of abdominal high-frequency ultrasound versus finger test in the diagnosis of DRA was analyzed. The high-frequency ultrasound outcomes regarding DRA distance at different positions and at different phases were compared between women with DRA and those without DRA. Results:The overall incidence of DRA among all women included in this study was 57.67% (173/300). The incidence of DRA in multiparae was significantly higher than that in primipara [73.38% (102/139) vs. 44.10% (71/160), χ2 = 26.20, P = 0.001). The incidence of DRA in women subjected to cesarean section was significantly higher than that in women subjected to vaginal delivery [68.52% (74/108) vs. 51.56% (99/192), χ2 = 8.14, P = 0.004). The sensitivity, specificity and accuracy of abdominal ultrasound in the diagnosis of DRA were 99.42%, 98.42% and 99.00%, respectively, which were significantly higher than those of finger test [80.35%,85.04%, 82.33%, χ2 = 34.61, 15.00, 49.23, all P < 0.01]. The DRA distances at different positions measured at 36 weeks of gestation and 2 weeks postpartum were significantly shorter in women with DRA than those without DRA ( t = 5.17-7.46, P < 0.001). Conclusion:Abdominal ultrasound is of high clinical application value in the early diagnosis and rehabilitation treatment of postpartum DRA.

Lateral epicondylitis is a common clinical disease with characteristics of lateral elbow pain, insidious onset and easy recurrence, which can cause forearm pain and decreased wrist strength, seriously affecting patients′ daily life and work. Although there are various treatment methods for lateral epicondylitis with different effects, standard treatments are still lacking nowadays. Platelet-rich plasma (PRP) has good effects on bone and tendon repair, and is now widely used in the treatment of lateral epicondylitis. However, there is a lack of a unified understanding of the technology and specifications of PRP in the treatment of lateral epicondylitis. Therefore, the Sports Medicine Branch of the Chinese Medical Association and Physical Medicine and Rehabilitation Branch of the Chinese Medical Association organized experts in the fields of sports medicine and rehabilitation medicine in China to formulate the "clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version)", and proposed suggestions based on evidence-based medicine mainly from the concept, epidemiology and pathophysiology of lateral epicondylitis, symptoms, signs and imaging manifestations of lateral epicondylitis, PRP concept and application component requirements, quality control of PRP preparation technology, indications and contraindications of PRP in the treatment of lateral epicondylitis, PRP injection in the treatment of lateral epicondylitis, application of PRP in the operation of lateral epicondylitis, related problems after PRP treatment of lateral epicondylitis, evaluation of the results after PRP treatment of lateral epicondylitis, and health and economic evaluation of PRP treatment of lateral epicondylitis, so as to provide guidance for clinical diagnosis and treatment.