Objective:To explore the clinical characteristics and prognostic factors of patients with acute glyphosate poisoning, and to provide reference for the comprehensive treatment and prognosis judgment of acute glyphosate poisoning.Methods:The complete hospitalized medical records data of 40 patients with acute glyphosate poisoning who were treated in the emergency department of Affiliated Hospital of Yangzhou University from 2014 to 2019 were collected in August 2020. According to the outcome during the follow-up period of 90 d after discharge from hospital, patients were divided into survival group ( n=33) and treatment failure group ( n=7) . The clinical characteristics of the two groups were analyzed. The influencing factors of prognosis were analyzed by binary logistic regression, and the receiver operating characteristic (ROC) curve was used to evaluate the value of white blood cell count level at admission to the prognosis of patients with acute glyphosate poisoning. Results:The average age of the 40 glyphosate poisoning patients was (57.70±19.72) years old, the oral dose was 100 (50, 200) ml, the hospital stay was 4.0 (1.0, 5.0) d, and the fatality rate was 17.5% (7/40) . The main clinical manifestations were the symptoms of the digestive tract, respiratory tract, cardiovascular system and nervous system. Logistic regression showed that white blood cell level at admission was an influencing factor for the prognosis of patients with acute glyphosate poisoning ( OR=1.148, 95% CI: 1.124-1.791, P=0.003) . The ROC curve showed that the best diagnostic cut-off value of white blood cell level at admission to the prognosis of acute glyphosate poisoning was 14.65×10 9/L, the area under the curve (AUC) was 0.9351. The sensitivity was 100.00%, and the specificity was 84.85%. Conclusion:High level of white blood cell at admission is a risk factor for the prognosis of acute glyphosate poisoning, and white blood cell level at admission has a certain predictive value for the prognosis of acute glyphosate poisoning.

Objective:To explore the clinical characteristics and prognostic factors of patients with acute glyphosate poisoning, and to provide reference for the comprehensive treatment and prognosis judgment of acute glyphosate poisoning.Methods:The complete hospitalized medical records data of 40 patients with acute glyphosate poisoning who were treated in the emergency department of Affiliated Hospital of Yangzhou University from 2014 to 2019 were collected in August 2020. According to the outcome during the follow-up period of 90 d after discharge from hospital, patients were divided into survival group ( n=33) and treatment failure group ( n=7) . The clinical characteristics of the two groups were analyzed. The influencing factors of prognosis were analyzed by binary logistic regression, and the receiver operating characteristic (ROC) curve was used to evaluate the value of white blood cell count level at admission to the prognosis of patients with acute glyphosate poisoning. Results:The average age of the 40 glyphosate poisoning patients was (57.70±19.72) years old, the oral dose was 100 (50, 200) ml, the hospital stay was 4.0 (1.0, 5.0) d, and the fatality rate was 17.5% (7/40) . The main clinical manifestations were the symptoms of the digestive tract, respiratory tract, cardiovascular system and nervous system. Logistic regression showed that white blood cell level at admission was an influencing factor for the prognosis of patients with acute glyphosate poisoning ( OR=1.148, 95% CI: 1.124-1.791, P=0.003) . The ROC curve showed that the best diagnostic cut-off value of white blood cell level at admission to the prognosis of acute glyphosate poisoning was 14.65×10 9/L, the area under the curve (AUC) was 0.9351. The sensitivity was 100.00%, and the specificity was 84.85%. Conclusion:High level of white blood cell at admission is a risk factor for the prognosis of acute glyphosate poisoning, and white blood cell level at admission has a certain predictive value for the prognosis of acute glyphosate poisoning.

Objective:To investigate the related factors that affect the timing and prognosis of early tracheostomy in patients with multiple rib fractures.Methods:A retrospective case series study was conducted on medical data of 222 patients with multiple rib fractures who underwent tracheostomy in Affiliated Hospital of Yangzhou University from February 2013 to October 2019，including 160 males and 66 females，with the age of 18 to 85 years ［（49.5 ± 16.3）years］. According to the practice management guidelines for tracheostomy timing and the use of propensity score matching technology，there were 118 patients with tracheostomy within 7 days of tracheal intubation （early group） and 104 patients with tracheostomy after 7 days of tracheal intubation （late group） before matching，and there were 87 patients in early group and 87 patients in late group after matching. Data were compared between groups including the gender，age，underlying disease，injury severity score （ISS），Glasgow coma score （GCS），number of fractured ribs，total number of rib fractures （NTRF），first rib fracture，flail chest，traumatic brain injury，combined injuries （spine，maxillofacial，sternum），acute respiratory distress syndrome （ARDS），volume fraction of pulmonary contusion（VPC），blood lactic acid （within 24 hours of admission），hemothorax，pneumothorax，mechanical ventilation time，duration of tracheostomy，time from tracheal intubation to incision，length of hospital stay，length of stay in ICU，closed thoracic drainage，number of fiberoptic bronchoscopy，multi-drug resistant bacteria infection，ventilator-associated pneumonia，antibiotic use time，duration of sedative and analgesic drugs used and 28-day mortality. The multivariate Logistic regression analysis was used to predict independent risk factors for early tracheostomy. The Pearson method was used to compare the relationship between multiple factors. The receiver operating characteristic （ROC） curve was used to predict indicators that affect the prognosis of patients with early tracheostomy，and calculate the best cut-off value. The Kaplan-Meier single factor and COX multivariate survival were used to analyze the relevant factors affecting the 28-day mortality of patients.Results:（1） In early group，the NTRF，ARDS and VPC were higher than those in late group，and the time from tracheal intubation to incision and 28-day mortality rate were lower than those in late group （ P < 0.05），while the two groups showed no significant differences in the gender，age，underlying diseases and ISS （ P > 0.05）. （2） The multivariate Logistic regression analysis showed that there was statistical significance in NTRF （ OR = 1.775，95% CI 1.439-2.188），ARDS（ OR = 3.740，95% CI 1.441-9.711），VPC （ OR = 1.087，95% CI 1.052-1.124） （ P < 0.05）； the Pearson method analysis showed a significant correlation between VPC and NTRF （ r = 0.369， P < 0.05） and a low degree of correlation between ARDS and VPC （ r = 0.179， P < 0.05），but there was no significant correlation between ARDS and NTRF （ r = 0.132， P > 0.05）. （3） The ROC curve analysis showed that the area under the curve （AUC） of the VPC and NTRF ［AUC = 0.832 （95% CI 0.770-0.893），AUC = 0.804 （95% CI 0.740-0.868）］ were significantly higher than those of the number of rib fractures ［AUC = 0.437（95% CI 0.352-0.523），GCS ［AUC = 0.519 （95% CI 0.432-0.605）］ and ISS ［AUC = 0.484 （95% CI 0.398-0.571）］ （ P < 0.05）. After calculating the Yorden index，the best cut-off value for VPC was 23.9，and the best cut-off value for NTRF was 8.5. （4） The Kaplan-Meier single factor and multivariate COX model survival analysis showed that the 28-day survival ratio of patients with early tracheostomy was significantly better than that of late tracheostomy （ P < 0.05）. Conclusions:The NTRF，ADRS and VPC are independent risk factors for the timing and prognosis of early tracheostomy. There is a significant correlation between VPC and NTRF. The VPC ≥ 23.9% and or NTRF ≥ 8.5 can be used to predict early tracheostomy in patients with multiple rib fractures. Early tracheostomy may benefit the 28-day survival of patients with multiple rib fractures.

Objective:To analyze the correlation between changes in the concentration of glyphosate (GLY) and its metabolites (AMPA) in patients with acute glyphosate poisoning and clinical symptoms, and to provide reference for the study of glyphosate toxicity.Methods:Urine samples from 5 patients with oral glyphosate poisoning admitted to the Emergency Department of Yangzhou Third Class A General Hospital from February to July 2021 were collected. Urine concentrations of GLY and AMPA were measured using derivatization gas chromatography-mass spectrometry, and analyzed based on the patient's clinical manifestations and treatment process.Results:The main symptoms of the patient after poisoning were acute gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, etc. The concentration of GLY in the patient's urine reached its maximum on the first day and gradually decreased over time. On the day of discharge, the final concentration of GLY was 10% lower than the initial concentration. At discharge, the clearance rates of GLY in cases 1, 2, 3, and 4 were 96.97%, 95.91%, 96.87% and 92.87%, respectively.Conclusion:The glyphosate has a shorter maintenance time after entering the human body; There is no correlation between the concentration of glyphosate and its metabolites admitted to the hospital, the dose of poisoning, and clinical symptoms in poisoned patients.

Objective:To analyze the correlation between changes in the concentration of glyphosate (GLY) and its metabolites (AMPA) in patients with acute glyphosate poisoning and clinical symptoms, and to provide reference for the study of glyphosate toxicity.Methods:Urine samples from 5 patients with oral glyphosate poisoning admitted to the Emergency Department of Yangzhou Third Class A General Hospital from February to July 2021 were collected. Urine concentrations of GLY and AMPA were measured using derivatization gas chromatography-mass spectrometry, and analyzed based on the patient's clinical manifestations and treatment process.Results:The main symptoms of the patient after poisoning were acute gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, etc. The concentration of GLY in the patient's urine reached its maximum on the first day and gradually decreased over time. On the day of discharge, the final concentration of GLY was 10% lower than the initial concentration. At discharge, the clearance rates of GLY in cases 1, 2, 3, and 4 were 96.97%, 95.91%, 96.87% and 92.87%, respectively.Conclusion:The glyphosate has a shorter maintenance time after entering the human body; There is no correlation between the concentration of glyphosate and its metabolites admitted to the hospital, the dose of poisoning, and clinical symptoms in poisoned patients.