BACKGROUND:Early identification of patients requiring ventilator support will be beneficial for the outcomes of botulism.The present study aimed to establish a new scoring system to predict mechanical ventilation(MV)for botulism patients. METHODS:A single-center retrospective study was conducted to identify risk factors associated with MV in botulism patients from 2007 to 2022.Univariate analysis and multivariate logistic regression analysis were used to screen out risk factors for constructing a prognostic scoring system.The area under the receiver operating characteristic(ROC)curve was calculated. RESULTS:A total of 153 patients with botulism(66 males and 87 females,with an average age of 43 years)were included.Of these,49 patients(32.0%)required MV,including 21(13.7%)with invasive ventilation and 28(18.3%)with non-invasive ventilation.Multivariate analysis revealed that botulinum toxin type,pneumonia,incubation period,degree of hypoxia,and severity of muscle involvement were independent risk factors for MV.These risk factors were incorporated into a multivariate logistic regression analysis to establish a prognostic scoring system.Each risk factor was scored by allocating a weight based on its regression coefficient and rounded to whole numbers for practical utilization([botulinum toxin type A:1],[pneumonia:2],[incubation period≤1 day:2],[hypoxia<90%:2],[severity of muscle involvement:grade II,3;grade III,7;grade IV,11]).The scoring system achieved an area under the ROC curve of 0.82(95%CI 0.75-0.89,P<0.001).At the optimal threshold of 9,the scoring system achieved a sensitivity of 83.7%and a specificity of 70.2%. CONCLUSION:Our study identified botulinum toxin type,pneumonia,incubation period,degree of hypoxia,and severity of muscle involvement as independent risk factors for MV in botulism patients.A score≥9 in our scoring system is associated with a higher likelihood of requiring MV in botulism patients.This scoring system needs to be validated externally before it can be applied in clinical settings.

Chlorfenapyr,an emerging synthetic pesticide,has been linked to a growing number of poisoning incidents,attributed to heightened human exposure as its application becomes more widespread.However,the toxicokinetics and toxicology of chlorfenapyr remain incompletely understood.Research since the 1990s,including animal experiments,has illuminated the absorption,distribution,excretion,and metabolism of chlorfenapyr.Toxicological investigations have revealed that the primary toxicity of chlorfenapyr is the uncoupling of oxidative phosphorylation.Chlorfenapyr exposure in humans and other animals can lead to various toxic effects,including neurotoxicity,cardiotoxicity,skeletal muscle toxicity,genotoxicity,reproductive and developmental toxicity,renal toxicity,splenic toxicity,and hematotoxicity.This article presents a comprehensive review of the toxicokinetics and toxicology of chlorfenapyr,integrating data from animal experiments,human cell line studies,clinical reports,and human autopsy.Its objective is to raise clinical awareness regarding chlorfenapyr poisoning and offer valuable references for its treatment and management.

This paper analyzed the clinical data of a patient with acute oral emamectin·chlorfenapyr poisoning, and discussed the effect of blood purification therapy on chlorfenapyr poisoning. Chlorfenapyr was detected in the blood, urine, ultrafiltrate and plasma exchange fluid of the patient, and the concentrations of chlorfenapyr poison gradually decreased with time. Blood purification has a certain effect on chlorfenapyr, and early blood purification may be an effective measure to treat chlorfenapyr poisoning.

This paper analyzed the clinical data of a patient with acute oral emamectin·chlorfenapyr poisoning, and discussed the effect of blood purification therapy on chlorfenapyr poisoning. Chlorfenapyr was detected in the blood, urine, ultrafiltrate and plasma exchange fluid of the patient, and the concentrations of chlorfenapyr poison gradually decreased with time. Blood purification has a certain effect on chlorfenapyr, and early blood purification may be an effective measure to treat chlorfenapyr poisoning.

In order to improve the clinical attention to the poisoning of chlorfenapyr, the diagnosis and treatment strategy of chlorfenapyr poisoning were discussed. This paper collected 4 cases of chlorfenapyr in the emergency department of the Second Hospital of Hebei Medical University and 4 cases of literature review, summarized the clinical characteristics of pesticide poisoning cases containing chlorfenapyr in China, and summarized and analyzed the clinical data of the cases. Seven of the 8 patients died from poisoning by chlorfenapyr. Exposure to chlorfenapyr through respiratory tract and digestive tract showed high mortality. Fever, hyperhidrosis, elevated muscle enzymes and progressive central nerve damage were its prominent clinical characteristics. Most of the initial symptoms of exposure were not serious. Some patients, especially those with low exposure dose, had a relatively stable stage with or without clinical diagnosis and treatment. In case of sweating, obvious fever and disturbance of consciousness, the condition would deteriorate rapidly, respiratory and circulatory failure and eventually die. With the increase of production capacity and market launch, people have more opportunities to be exposed to chlorfenapyr. It is urgent to strengthen the basic and clinical research of chlorfenapyr poisoning; Attention should be paid to the observation and treatment in the initial stable stage of poisoning, which can be used as a reference for the treatment of oxidative phosphoric acid dissolving coupling agent (sodium pentachlorophenol) poisoning.

In order to improve the clinical attention to the poisoning of chlorfenapyr, the diagnosis and treatment strategy of chlorfenapyr poisoning were discussed. This paper collected 4 cases of chlorfenapyr in the emergency department of the Second Hospital of Hebei Medical University and 4 cases of literature review, summarized the clinical characteristics of pesticide poisoning cases containing chlorfenapyr in China, and summarized and analyzed the clinical data of the cases. Seven of the 8 patients died from poisoning by chlorfenapyr. Exposure to chlorfenapyr through respiratory tract and digestive tract showed high mortality. Fever, hyperhidrosis, elevated muscle enzymes and progressive central nerve damage were its prominent clinical characteristics. Most of the initial symptoms of exposure were not serious. Some patients, especially those with low exposure dose, had a relatively stable stage with or without clinical diagnosis and treatment. In case of sweating, obvious fever and disturbance of consciousness, the condition would deteriorate rapidly, respiratory and circulatory failure and eventually die. With the increase of production capacity and market launch, people have more opportunities to be exposed to chlorfenapyr. It is urgent to strengthen the basic and clinical research of chlorfenapyr poisoning; Attention should be paid to the observation and treatment in the initial stable stage of poisoning, which can be used as a reference for the treatment of oxidative phosphoric acid dissolving coupling agent (sodium pentachlorophenol) poisoning.

Ultraviolet light hardening therapy is an effective method for the treatment of polymorphic light eruption (PLE) . Recent studies have shown that narrow-band ultraviolet B (NB-UVB) is effective and safe for the prevention of recurrence of PLE. However, its treatment mechanisms still need further elucidation, and clinical studies with large sample size are needed for long-term tracking and assessment of initial dose of photohardening, dose-addition principle, treatment frequency and maintenance treatment protocols, in order to confirm the clinical application value of ultraviolet light photohardening therapy.

BACKGROUNDVulvodynia, or vulvar pain, is a common condition in women; however, there are few evidence-based clinical trials evaluating nonpharmacological therapies for this condition. Acupuncture is one complementary and integrative medicine therapy used by some patients with vulvodynia. This study evaluates two different acupuncture strategies for the treatment of vulvodynia and aims to evaluate whether either of the acupuncture protocols reduces vulvar pain, pain duration or pain with intercourse. The study also examines how long the effect of acupuncture lasts in women with vulvodynia.

METHODS/DESIGNThe study is designed as a randomized controlled trial, focused on two acupuncture protocols. Fifty-one patients who have had vulvodynia for more than 3 months will be recruited. Among them, 34 patients will be randomized into Groups 1a and 1b; those who are unwilling to receive acupuncture will be recruited into the standard care group (Group 2). Patients in Group 1a will have acupuncture focused on the points in the pudendal nerve distribution area, while patients in Group 1b will receive acupuncture focused on traditional (distal) meridian points. Patients in Group 2 will receive routine conventional treatments, such as using pain medications, local injections and physical therapies or other nonsurgical procedures. Acupuncture will last 45 min per session, once or twice a week for 6 weeks. The primary outcome measurement will be objective pain intensity, using the cotton swab test. The secondary outcome measurement will be subjective patient self-reported pain intensity, which will be conducted before cotton swab test. Pain intensities will be measured by an 11-point Numeric Pain Rating Scale. Pain duration and pain score during intercourse are recorded. Local muscle tension, tenderness and trigger points (Ashi points) are also recorded. All measurements will be recorded at baseline (before the treatment), at the end of each week during treatment and at the end of the 6 weeks. Follow-up will be done 6 weeks following the last treatment.

DISCUSSIONResults of this trial will provide preliminary data on whether acupuncture provides better outcomes than nonacupuncture treatments, i.e., standard care, and whether acupuncture focused on the points in pudendal nerve distribution, near the pain area, has better results than traditional acupuncture focused on distal meridian points for vulvodynia.

TRIAL REGISTRATIONClinicaltrials.gov: NCT03481621. Register: March 29, 2018.

Objective To observe the nutritional biochemical indicators of paraquat poisoning patients, analyze and compare the nutritional status of patients and understand the changing trend of each indicator. Methods A total of 104 patients with acute paraquat poisoning who were admitted to the emergency department of the Second Hospital of Hebei Medical University from December 2015 to December 2017 were enrolled, and divided into the cure group (patients who survived >30 days) and the death group. Nutritional biochemical indicators including serum protein (ALB, PA, TP) and serum lipids (TCh, TG, LDL) were selected for dynamic observation. The observation time points were set as follows: immediate treatment of poisoned patients (day 1 on admission), on day 4, 7, 10, 13 and 16 after admission, and on day 30 after follow-up. The nutritional biochemical indicators of the two groups on day 1 and 4 were statistically analyzed and compared by t test. The nutritional status of the patients in the cure group was analyzed, and the Repeated Measures Anova was performed to understand the trend of each indicator over time. Results In the cure group, the TP level decreased from (73.34±5.75)g/L on day 1 to (51.95±6.05)g/L on day 4, t=20.34, P<0.01; and the TCh level decreased from (4.37±0.98) mmol/L on day 1 to (3.03±1.01)mmol/L on day 4, t=7.56, P<0.01. In the death group, the TP level decreased from (72.25±8.80)g/L on day 1 to (49.07±5.48)g/L on day 4, t=12.38, P<0.01, and the TCh level decreased from (4.38±0.88)mmol/L on day 1 to (2.51±1.07) mmol/L on day 4, t=7.94, P<0.01. Compared with the cure group, serum levels of ALB, TP and TCh in the death group decreased greater from day 1 to day 4 (all P<0.05). In addition, dynamic observation of the indicators in the cure group within 16 days after admission showed that, after treatment, the levels of ALB and TP recovered slowly and were still lower than normal . While the levels of PA and lipid rose rapidly after 10 days of admission. Conclusions Paraquat poisoning seriously affects the nutritional status of patients, and the serum protein levels decline significantly and can not be recovered easily. Therefore, sufficient attention should be paid to the treatment, and timely and appropriate nutritional support should be provided.

Objective To study the mechanism of paraquat (PQ)-induced renal injury in rats,the expression changes of ICAM-1 to assess the protective effect of Melatonin in PQ poisoning.Methods Ninety adult healthy Sprague-Dawley (SD) rats were divided into three groups at random.Control group:30 rats;Poisoned group:30 rats;Melatonin group:30 rats.Control group and Poisoned group were treated intragastrically with 1 ml of PQ (50 mg/kg) diluted with normal saline.Control groupwere treated with the same dose of normal saline as Poisoned group and Melatonin group.Melatonin group were given 1 ml of Melatonin at a dose of 10 mg/kg diluted with normal saline (once daily,intraperitoneally) Control and Poisoned group were treated with the same dose of normal saline (once daily,intraperitoneally) as Melatonin group.Pathology of renal tissue were oberserved by HE staining,and electron microscope.The histopathological changes and the expression of ICAM-1 were observed with mmunohistochemistry (IHC).Results (1) There were no obvious pathological changes in Control group.Poisoned group Renal glomerulus had hyperemia and distension.Renal tubule epithelial cell had edema and vacuolar degeneration and renal tubule lumina was narrowing on day 1,There were serious edema exudation and necrosis on day 5,which gradually lessened furthermore;Compared with Poisoned group,the aforementioned pathological lesion was more palliative in Melatonin group.(2) No obvious abnomal changes in ultrastructure of renal tissues in Control group.There were swelling of mitochondrion and rupture of renal tubule epithelial cell and endoplasmic reticulum had extension,lysosome was mult and had much phagocytosis in Poisoned group.(3)There was a very weak expression of ICAM-1 in Control group.while in Poisoned group,there was already a significant higher expression of ICAM-1 of renal tubule on day 1 after PQ poisoning,Immunohistochemistry score (IHS) of Poisoned group on day 1,3,5,7,14 were (0.1561 ±0.0295、0.2572±0.0259、0.3028±0.0153、0.2083 ±0.0227、0.9309 ±0.0059),compared with Control group (P＜0.01);Melatonin group were (0.1259±0.0061、0.2109±0.0280、0.2679±0.0233、0.1771 ±0.0186、0.0791 ±0.0135),compared with Control group (P＜0.01),compared with Poisoned group (P＜0.05);Conclusion ICAM-1 was involved in the procedures of renal injury;MT surely had a protective effect,which might be mediated by ICAM-1 in the paraquat-induced renal injury,but its regulation path still need a further exploration.