Objective:To study and analyze the epidemiological regularity of acute poisoning in Tianjin-Hebei region from 2020 to 2022, and to provide reference for the treatment and prevention of related patients.Methods:In December 2023, the analysis results and clinical data of 4695 patients with drug poisoning from January 2020 to December 2022 in multiple centers of Tianjin-Hebei region were collected as research objects. Gender, age, type of drug poisoning, season and poisoning route of the research objects were analyzed, and statistical analysis was conducted as well.Results:The sex ratio of men and women was 1∶1.16 (2173/2522). The poisoning of antidepressants and benzodiazepines were the most common drug poisonings, accounting for 1550 and 1274 cases respectively (33%, 27.1%). Paraquat poisoning has decreased year by year, while the poisonings of herbicides with low toxicity such as diquat, glyphosate and cremart have increased. The number of cases reached a peak during May to August which was the poisoning season, while was relatively fewer during October to December.Conclusion:Effective intervention measures should be taken according to the age of high incidence of poisoning, different seasons and populations. Essential drug poisoning prevention measures should be established and improved. The systems of sedative drug management and use should be established, and pesticide management and storage need to be strengthened.

Objective:To study and analyze the epidemiological regularity of acute poisoning in Tianjin-Hebei region from 2020 to 2022, and to provide reference for the treatment and prevention of related patients.Methods:In December 2023, the analysis results and clinical data of 4695 patients with drug poisoning from January 2020 to December 2022 in multiple centers of Tianjin-Hebei region were collected as research objects. Gender, age, type of drug poisoning, season and poisoning route of the research objects were analyzed, and statistical analysis was conducted as well.Results:The sex ratio of men and women was 1∶1.16 (2173/2522). The poisoning of antidepressants and benzodiazepines were the most common drug poisonings, accounting for 1550 and 1274 cases respectively (33%, 27.1%). Paraquat poisoning has decreased year by year, while the poisonings of herbicides with low toxicity such as diquat, glyphosate and cremart have increased. The number of cases reached a peak during May to August which was the poisoning season, while was relatively fewer during October to December.Conclusion:Effective intervention measures should be taken according to the age of high incidence of poisoning, different seasons and populations. Essential drug poisoning prevention measures should be established and improved. The systems of sedative drug management and use should be established, and pesticide management and storage need to be strengthened.

Objective To evaluate clinical efficacy and safety of Bizheng Granules combined with basic therapy in the treatment of liver and kidney insufficiency and phlegm-dampness cross-blocking syndrome of nerve root type cervical spondylosis radiculopathy.Methods Totally 108 patients with nerve root type cervical spondylosis radiculopathy were selected and divided into Bizheng Granules group,Jingfukang Granules group,and Bizheng Granules placebo group according to random number table method,with 36 cases in each group.The three groups were treated with the basic treatment(oral methylcobalamin tablets of 0.5 mg,three times a day,and cervical spine intermittent traction once a day,each time for 15 min),and Bizheng Granules were given in the Bizheng Granules group,and Jingfukang Granules in the Jingfukang Granules group,and Bizheng Granules placebo in the Bizheng Granules placebo group,twice a day after meals.All three groups were treated continuously for 2 weeks and followed up at 4 and 12 weeks after treatment.Visual analog scale(VAS),cervical dysfunction index(NDI),and 36-items short form survey(SF-36)score were recorded in the 3 groups before and after treatment and 4 and 12 weeks after treatment,respectively.Adverse reactions during treatment and follow-up were recorded in the 3 groups.Results 3 cases lost in the Bizheng Granules group,3 cases in the Jingfukang Granules group,and 1 case in the Bizheng Granules placebo group.Compared with the pre-treatment period,the differences in VAS score,NDI score,and SF-36 score among the three groups of patients at all time points of treatment and follow-up were statistically significant(P<0.05).At 12 weeks after treatment,the VAS score and NDI score of the Bizheng Granules group and the Jingfukang Granules group were lower than those of the Bizheng Granules placebo group,but the differences in VAS score and NDI score between Bizheng Granules group and Jingfukang Granules group were not statistically significant(P>0.05).12 weeks after treatment,the SF-36 score of Bizheng Granules group were higher than those of Bizheng Granules placebo group,but the difference in SF-36 score between Bizheng Granules group and Jingfukang Granules group was not statistically significant(P>0.05).The total effective rate of Bizheng Granules group was better than that of the Jingfukang Granules group and Bizheng Granules placebo group(P<0.05).The incidence of adverse reactions in the three groups was not statistically significant(P>0.05).There were no serious adverse events in the three groups.Conclusion Bizheng Granules combined with basic therapy has a definite therapeutic effect in improving pain,restoring cervical dysfunction,and improving quality of life in the treatment of liver and kidney insufficiency and phlegm-dampness cross-blocking syndrome of nerve root type cervical spondylosis radiculopathy,with good safety.

At present, some "5+3" integration students have different levels of understanding and application problems in various stages, such as role transformation, professional knowledge and technology, communication ability and humanistic care ability, clinical thinking and evidence-based medicine concepts, clinical research thinking, learning and work attitude. This research will permeate and run through the training of "5+3" integrated students' diagnostic and therapeutic operation ability through the training of modern clinical thinking oriented by post competency, and integrate humanistic care, evidence-based medicine, learning attitude, working attitude, and attitude towards patients in the whole process to gradually complete the comprehensive training goal of clinical thinking oriented by post competency + diagnostic and therapeutic operation ability.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective To report the clinical outcomes of latissimus dorsus flap used to reconstruct severe trauma on lower leg.Methods From May 2011 to September 2016,12 patients were treated for severe trauma on lower leg at Orthopaedic Department,General Hospital of Rocket Force.They were 10 men and 2 women,aged from 22 to 54 years (average,37.5 years).According to the Gustilo classification,their open fractures were of type ⅢA in 2 cases and of type ⅢB in 10.The areas of soft tissue defect ranged from 15 cm × 8 cm to 35 cm × 12 cm.Their wounds were covered with latissimus dorsus flaps;the dorsal expansion of the ankle joint was reconstructed after their bone infection was controlled.Two flaps were anastomosed directly to the anterior tibial vessels and one flap to the femoral vessels.The other 9 flaps were anatomosed to the lateral circumflex femoral artery,bridging with the greater saphenous vein (average length:32 cm).Ten flaps were neuroanatomosed with the motor branch of common peroneal nerve and 2 with the motor branch of vastus lateralis.The therapeutic outcomes were evaluated in terms of repair of soft tissue defects,control of infection and range of active dorsal flexion of the ankle at neutral position.Results The 12 patients were followed up for an average of 3.5 years (from 1 to 6 years).All the 12 flaps survived and infections were eradicated.The fractures were healed with muscle strength of grade 3 to grade 4.Their ankle extension was reconstructed.Their limbs were preserved with satisfactory limb function.The bone exposures of 5 cm × 3 cm and 6 cm × 3 cm in area after debridement respectively in 2 cases of Gustilo type ⅢA were covered with latissimus dorsus flaps.The range of active dorsal flexion of the ankle at neutral position increased from preoperative 10.5° to postoperative 19.1° on average.Conclusion In treatment of severe trauma on lower leg,latissimus dorsus flaps can be used to repair skin wound,control infection and reconstruct ankle function simultaneously,with advantages of reduced operative procedures,a high rate of limb preservation,and better function recovery.

Objective To evaluate the feasibility of T2 *mapping T2 *value combined with DWI ADC value in quantitative assessment of the activity of sacroiliitis.Methods 30 patients diagnosed with ankylosing spondylitis (AS)were divided into 2 groups as acute group (n=17)and chronic group (n=13)according to the BASDAI scores of the clinical severity of disease.And 20 healthy adults were recruited as control group.All groups were examined by MR with traditional sequence,T2 *mapping and DWI in the sacroiliac joint.The T2 *value and ADC value of the bone marrow edema region and normal region were measured.Furthermore,the imaging data and the clinical scores were statistical analysis and compared among three groups.Results T2 *values and ADC values in acute group of AS patients were higher than chronic group (P<0.05),as well as compared with healthy volunteers (P<0.05).There was no statistically significant difference between the chronic group of AS patients and control group (P>0.05).Positive correlation between ADC value and BASDAI was observed in patients group.Conclusion T2 *mapping combined with DWI imaging in AS is beneficial for early diagnosis and quantitative analysis of the activity of sacroiliitis.

Objective To investigate the method for the measurement of chlorpyrifos in serum by gas chromatography,and to provide a basis for emergency treatment of poisoning in clinical practice.Methods Venous blood (3.0 ml) was collected from patients.After coagulation,the blood samples were centrifuged at 4 000 r/min for 5 minutes,and 0.5 ml of serum was placed in a glass test tube with a cork;4.0 ml of ethyl acetate was then added and mixed rapidly,and this solution was subjected to extraction for 5 minutes and centrifuged at 4 000 r/min for 10 minutes.The ethyl acetate layer was placed in a conical tube and extracted twice with the same method.The extract was mixed and blow-dried with nitrogen,and the residue was dissolved with 50.0 μl ethanol.Gas chromatography was used for measurement,with a sample size of 1 μl and a retention time of 9.609 minutes.Results The linear range of this method was 0.2～20.0 μg/ml,and the regression equation was y =2 372.6x+357.2 (r=0.999 6).The detection limit of chlorpyrifos in serum was 0.05 μg/ml,and the recovery rate was 84.6％～102.4％.The relative standard deviation was 3.6％～4.8％,and the intra-day and inter-day relative standard deviations were 3.62％～5.10％ and 3.77％～4.98％,respectively.Conclusion This detection method is accurate,simple,and convenient,and can be used for the clinical diagnosis of chlorpyrifos poisoning.

Objective To investigate the method for the measurement of chlorpyrifos in serum by gas chromatography,and to provide a basis for emergency treatment of poisoning in clinical practice.Methods Venous blood (3.0 ml) was collected from patients.After coagulation,the blood samples were centrifuged at 4 000 r/min for 5 minutes,and 0.5 ml of serum was placed in a glass test tube with a cork;4.0 ml of ethyl acetate was then added and mixed rapidly,and this solution was subjected to extraction for 5 minutes and centrifuged at 4 000 r/min for 10 minutes.The ethyl acetate layer was placed in a conical tube and extracted twice with the same method.The extract was mixed and blow-dried with nitrogen,and the residue was dissolved with 50.0 μl ethanol.Gas chromatography was used for measurement,with a sample size of 1 μl and a retention time of 9.609 minutes.Results The linear range of this method was 0.2～20.0 μg/ml,and the regression equation was y =2 372.6x+357.2 (r=0.999 6).The detection limit of chlorpyrifos in serum was 0.05 μg/ml,and the recovery rate was 84.6％～102.4％.The relative standard deviation was 3.6％～4.8％,and the intra-day and inter-day relative standard deviations were 3.62％～5.10％ and 3.77％～4.98％,respectively.Conclusion This detection method is accurate,simple,and convenient,and can be used for the clinical diagnosis of chlorpyrifos poisoning.

Objective To explore the application of knowledge-attitude-practice theory in Operating Room nurses to improve the prevention management of deep venous thrombosis ( DVT ) . Methods A total of 114 nurses participated in operations in Operating Room were randomly divided into control group (57 cases) and intervention group ( 57 cases ) . Nurses of two groups accepted training of routine knowledge, operation training and guidance, while nurses in intervention group also accepted knowledge-attitude-practice intervention. Cognition situation and implementation situation on prevention of lower limb venous thrombosis were compared among nurses between two groups. Results The score of cognition situation on prevention of lower limb venous thrombosis was (9. 41 ± 2. 26) in control group and (17. 27 ± 2. 03) in intervention group with a significant difference (P<0. 01). The score of implementation situation on prevention of lower limb venous thrombosis was (4. 60 ± 1. 83) in control group and (7. 52 ± 1. 69) in intervention group with a significant difference ( P<0. 01). There were statistically significant differences in score of each dimension (P<0. 01). Conclusions The intervention of knowledge-attitude-practice can effectively improve cognition situation and implementationsituation on prevention of lower limb venous thrombosis so as to reduce the incidence rate of lower limb venous thrombosis.