Sequential Organ Failure Assessment Score Can Predict Mortality in Patients with Paraquat Intoxication

Introduction

Paraquat poisoning is characterized by multi-organ failure and pulmonary fibrosis with respiratory failure, resulting in high mortality and morbidity. The objective of this study was to identify predictors of mortality in cases of paraquat poisoning. Furthermore, we sought to determine the association between these parameters.

Methods

A total of 187 patients were referred for management of intentional paraquat ingestion between January 2000 and December 2010. Demographic, clinical, and laboratory data were recorded. Sequential organ failure assessment (SOFA) and acute kidney injury network (AKIN) scores were collected, and predictors of mortality were analyzed.

Results

Overall hospital mortality for the entire population was 54% (101/187). Using a multivariate logistic regression model, it was found that age, time to hospitalization, blood paraquat level, estimated glomerular filtration rate at admission (eGFR _{first day}), and the SOFA_48-h score, but not the AKIN_48-h score, were significant predictors of mortality. For predicting the in-hospital mortality, SOFA_48-h scores displayed a good area under the receiver operating characteristic curve (AUROC) (0.795±0.033, P<0.001). The cumulative survival rate differed significantly between patients with SOFA_48-h scores <3 and those ≥3 (P<0.001). A modified SOFA (mSOFA) score was further developed by using the blood paraquat level, and this new score also demonstrated a better AUROC (0.848±0.029, P<0.001) than the original SOFA score. Finally, the cumulative survival rate also differed significantly between patients with mSOFA scores <4 and ≥4 (P<0.001).

Conclusion

The analytical data demonstrate that SOFA and mSOFA scores, which are based on the extent of organ function or rate of organ failure, help to predict mortality after intentional paraquat poisoning.     

Predictors of Acute Respiratory Distress Syndrome in Patients with Paraquat Intoxication

Introduction

Paraquat poisoning is characterized by acute lung injury, pulmonary fibrosis, respiratory failure, and multi-organ failure, resulting in a high rate of mortality and morbidity. The objectives of this study were to identify predictors of acute respiratory distress syndrome (ARDS) in cases of paraquat poisoning and determine the association between these parameters.

Materials and Methods

In total, 187 patients were referred for management of intentional paraquat ingestion between 2000 and 2010. Demographic, clinical, and laboratory data were recorded. Sequential organ failure assessment (SOFA) and Acute Kidney Injury Network (AKIN) scores were collected, and predictors of ARDS were analyzed.

Results

The overall mortality rate for the entire population was 54% (101/187). Furthermore, the mortality rate was higher in the ARDS patients than in the non-ARDS patients (80% vs. 43.80%, P<0.001). Additionally, the ARDS patients not only had higher AKIN_48-h scores (P<0.009), SOFA_48-h scores (P<0.001), and time to ARDS/nadir PaO₂ (P=0.008) but also suffered from lower nadir PaO₂ (P<0.001), nadir AaDO₂ (P<0.001), and nadir eGFR (P=0.001) compared to those in the non-ARDS patients. Moreover, pneumomediastinum episodes were more frequent in the ARDS patients than in the non-ARDS patients (P<0.001). A multivariate Cox regression model revealed that blood paraquat concentrations (P<0.001), SOFA_48-h scores (P=0.001), and steroid and cyclophosphamide pulse therapies (P=0.024) were significant predictors of ARDS. The cumulative survival rates differed significantly (P<0.001) between patients with SOFA_48-h scores <3 and SOFA_48-h scores ≥3, with a sensitivity of 95.8%, specificity of 58.4%, and overall correctness of 67.6%. Finally, the area under the receiver operating characteristic (AUROC) analysis showed that SOFA_48-h scores (P<0.001) had a better discriminatory power than blood paraquat concentrations (P=0.01) for predicting ARDS.

Conclusions

The analytical results indicate that SOFA_48-h scores, blood paraquat concentrations, and steroid and cyclophosphamide pulse therapies are significantly associated with ARDS complications after paraquat intoxication.     

血浆置换联合血液灌流治疗急性重度有机磷农药中毒的疗效及对患者肝功能的影响

目的:探讨血浆置换联合血液灌流治疗急性重度有机磷农药中毒的临床疗效及对患者肝功能的影响。方法:选择我院于2014年1月至2017年9月收治的66例急性重度有机磷农药中毒患者,按照随机原则分为血液灌流组(n=30)、联合治疗组(n=36),两组均接受急性重度有机磷农药中毒常规治疗,在此基础上血液灌流组和联合治疗组分别接受血液灌流、血浆置换联合血液灌流治疗。观察两组治疗效果,治疗前、治疗1周后血浆丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素水平。观察治疗过程中的不良反应发生情况。结果:与血液灌流组比较,联合治疗组胆碱酯酶(CHE)恢复时间较短,而长托宁用量较少,住院时间较短,且抢救成功率较高(P0.05)。治疗1周后联合治疗组血浆ALT、AST、总胆红素显著低于血液灌流组(P0.05)。治疗过程联合治疗组出现1例皮疹,不良反应发生率为2.78%,血流灌注组无不良反应发生,两组不良反应发生率比较无差异(P0.05)。结论:血浆置换联合血液灌流能明显提高急性重度有机磷中毒患者的抢救成功率,同时改善患者肝功能,且安全性良好,值得临床推广。     

Evaluation of treatments with hCG and carprofen at embryo transfer in a demi-embryo and recipient virgin heifer model

An in vivo model, combining a low developmental competence embryo (demi-embryo) and a high-fertility recipient (virgin dairy heifer) was used to evaluate the effects of treatment with human chorionic gonadotropin (hCG) and carprofen at embryo transfer (ET) on plasma progesterone (P₄) concentrations of recipients and on embryonic growth and survival. Embryos were bisected and each demi-embryo was transferred to a recipient on Day 7 of the estrous cycle. At ET, heifers (n = 163) were randomly allocated to treatment with hCG (2500 IU im), carprofen (500 mg iv), hCG plus carprofen or to untreated controls. Plasma P₄ concentrations were measured on Days 0, 7, 14 and 21 of all recipients plus on Days 28, 42 and 63 of pregnant recipients. Pregnancy was presumed to be present in recipients with luteal plasma P₄ concentrations until Day 21 and confirmed by using transrectal ultrasonography on Days 28, 42 and 63. Embryonic measurements (crown–rump length and width) were obtained on Day 42. Treatment with hCG induced formation of secondary corpora lutea (CL) in 97% of heifers and increased (P < 0.01) mean plasma P₄ concentrations of non-pregnant recipients on Day 14 and of pregnant heifers on Days 14 to 63. This was associated to a significant decrease in early embryonic mortality. In contrast, subsequent embryonic losses resulted in a non-significant numerical increase by 8% of pregnancies maintained to Day 63. Therefore, treatment with hCG significantly rescued embryos through the maternal recognition of pregnancy window but was not able to support development thereafter. Treatment with carprofen at ET had no significant effects on plasma P₄ concentrations and rate of embryo mortality. Treatment with hCG plus carprofen at ET induced formation of secondary CL in 90% of heifers but decreased the luteotrophic effect of hCG, resulting in no effect on embryo survival. Low developmental competence embryos showed an intrinsic deficiency in overcoming the maternal recognition of pregnancy challenge and in proceeding to further development until Day 28 of pregnancy, whereas mortality beyond this point was residual. Results on pregnancy rates should be confirmed in further experiments involving a larger sample size.     

Effects of High Dose of Anisodamine on the Respiratory Function of Patients with Traumatic Acute Lung Injury

The objective of this study is to observe the effects of high dose of anisodamine in the respiratory function of patients with acute lung injury (ALI) induced by trauma. Fifty cases of patients with complicated ALI after trauma were randomly divided into the anisodamine treatment group (n = 26) and the conventional treatment group (n = 24). Intravenous injection of high dose of anisodamine was administrated in the anisodamine treatment group on the basis of conventional treatment. Acute lung injury scores, oxygenation index, PaO₂, respiratory mechanic index, mechanical ventilation time, and the occurrence of adverse reactions in the two groups were observed. Acute lung injury scores and respiratory parameters were all significantly improved in the two groups of patients after the treatment (P < 0.05); compared with the conventional treatment group, the improvements of respiratory function in the anisodamine treatment group were more obvious (P < 0.05), the mechanical ventilation time was shorter (P < 0.05), and there was no significant adverse reaction. In conclusion, high dose of anisodamine contributed to improve the respiratory function of the patients with traumatic ALI.     

Psychiatric Comorbidity and Its Impact on Mortality in Patients Who Attempted Suicide by Paraquat Poisoning during 2000–2010

Background

Paraquat poisoning is a lethal method of suicide used around the world. Although restricting its accessibility had been widely discussed, the underlying psychopathological mechanism of paraquat self-poisoning and its association with mortality have not yet been explicitly evaluated.

Methods

We included all patients admitted to a tertiary general hospital in Taiwan between 2000 and 2010 following a suicide attempt by paraquat self-administration. Diagnoses were made upon psychiatric consultation based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The risk of mortality was calculated by logistic regression with various psychiatric or medical covariates.

Results

The consultation-liaison psychiatry team assessed 157 patients who attempted suicide by paraquat poisoning. Mood disorders (54.0%), including dysthymic (26.7%) and major depressive disorders (24.7%), were the most common psychiatric diagnoses among the self-poisoning patients. Among those who attempted suicide, 87 patients (58.0%) died and dysthymic disorder (OR = 5.58, 95% CI: 1.13–27.69; p<0.05) significantly increased the mortality risk after adjustment for relevant medical variables, including age, gender, severity index of paraquat poisoning (SIPP), and risk for respiratory failure.

Conclusions

Awareness of comorbid psychiatric illnesses, especially dysthymic disorder, is vital in the prevention and treatment of suicide by paraquat poisoning.     

An Increase in Mean Platelet Volume from Baseline Is Associated with Mortality in Patients with Severe Sepsis or Septic Shock

Introduction

Mean platelet volume (MPV) is suggested as an index of inflammation, disease activity, and anti-inflammatory treatment efficacy in chronic inflammatory disorders; however, the effect of MPV on sepsis mortality remains unclear. Therefore, we investigated whether the change in MPV between hospital admission and 72 hours (ΔMPV_72h-adm) predicts 28-day mortality in severe sepsis and/or septic shock.

Methods

We prospectively enrolled 345 patients admitted to the emergency department (ED) who received standardized resuscitation (early goal-directed therapy) for severe sepsis and/or septic shock between November 2007 and December 2011. Changes in platelet indices, including ΔMPV_72h-adm, were compared between survivors and non-survivors by linear mixed model analysis. The prognostic value of ΔMPV_72h-adm for 28-day mortality was ascertained by Cox proportional hazards model analysis.

Results

Thirty-five (10.1%) patients died within 28 days after ED admission. MPV increased significantly during the first 72 hours in non-survivors (P = 0.001) and survivors (P < 0.001); however, the rate of MPV increase was significantly higher in non-survivors (P = 0.003). Nonetheless, the difference in the platelet decline rate over the first 72 hours did not differ significantly between groups (P = 0.360). In multivariate analysis, ΔMPV_72h-adm was an independent predictor of 28-day mortality, after adjusting for plausible confounders (hazard ratio, 1.44; 95% confidence interval, 1.01–2.06; P = 0.044).

Conclusions

An increase in MPV during the first 72 hours of hospitalization is an independent risk factor for adverse clinical outcomes. Therefore, continuous monitoring of MPV may be useful to stratify mortality risk in patients with severe sepsis and/or septic shock.     

Using Bosentan to Treat Paraquat Poisoning-Induced Acute Lung Injury in Rats

Background

Paraquat poisoning is well known for causing multiple organ function failure (MODS) and high mortality. Acute lung injury and advanced pulmonary fibrosis are the most serious complications. Bosentan is a dual endothelin receptor antagonist. It plays an important role in treating PF. There is no related literature on the use of bosentan therapy for paraquat poisoning.

Objective

To study the use of bosentan to treat acute lung injury and pulmonary fibrosis as induced by paraquat.

Method

A total of 120 adult Wister male rats were randomly assigned to three groups: the paraquat poisoning group (rats were intragastrically administered with paraquat at 50 mg/kg body weight once at the beginning); the bosentan therapy group (rats were administered bosentan at 100 mg/kg body weight by intragastric administration half an hour after paraquat was administered, then the same dose was administered once a day); and a control group (rats were administered intragastric physiological saline). On the 3rd, 7th, 14th, and 21st days following paraquat exposure, rats were sacrificed, and samples of lung tissue and venous blood were collected. The levels of transforming growth factor-β1 (TGF-β1), endothelin-1 (ET-1), and hydroxyproline (HYP) in the plasma and lung homogenate were determined. Optical and electronic microscopes were used to examine pathological changes.

Result

The TGF-β1, ET-1, and HYP of the paraquat poisoning group were significantly higher than in the control group, and they were significantly lower in the 21st day therapy group than in the paraquat poisoning group on the same day. Under the optical and electronic microscopes, lung tissue damage was observed to be more severe but was then reduced after bosentan was administered.

Conclusion

Bosentan can reduce inflammation factor release. It has a therapeutic effect on acute lung injury as induced by paraquat.     

氯吡格雷强化治疗对老年急性心肌梗死患者炎性反应及氧化-抗氧化水平影响

目的:探讨氯吡格雷强化治疗对老年急性心肌梗死患者炎性反应及氧化-抗氧化水平的影响。方法:选择我院2012年1月至2016年12月收治的400例老年急性心肌梗死患者,根据随机数字表法分为观察组及对照组。对照组给予常规治疗,观察组给予氯吡格雷强化治疗,对比两组患者的疗效,治疗期间的不良心血管事件及不良反应的发生情况,治疗前后的血清白介素1 (interleukin-1,IL-1)、白介素2 (interleukin-2,IL-2)、白介素6 (interleukin-6,IL-6)、白介素10 (interleukin-10,IL-10)水平及超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)、过氧化酶(catalase,CAT)及谷胱甘肽氧化物酶(glutathione peroxidase,GSHPX protein)水平。结果:治疗后,观察组的总有效率为92.50%,明显高于对照组(72%,P0.05);观察组的心血管不良事件发生率明显低于对照组(P0.05);两组的不良反应发生率对比差异无统计学意义(P0.05)。两组治疗后的血清IL-1、IL-2、IL-6、IL-10、MDA水平均较治疗前明显下降,且观察组以上指标水平均明显低于对照组(P0.05),而两组治疗后的血清SOD、CAT、GSHPX水平均较治疗前明显上升,且观察组以上指标水平均明显高于对照组(P0.05)。结论:与常规治疗相比,氯吡格雷强化治疗可显著提高老年急性心肌梗死患者的临床疗效,这可能与有效减轻患者的炎症反应,增强抗氧化作用有关。     

血必净联合利奈唑胺注射液对老年重症肺炎患者血清肺表面活性蛋白、基质金属蛋白酶及其组织抑制剂水平的影响

目的:探讨血必净联合利奈唑胺注射液治疗老年重症肺炎患者的临床疗效及对患者血清肺表面活性蛋白(Pulmonary surfactant protein,SP)、基质金属蛋白酶(Matrix metalloproteinases,MMPs)及其组织抑制剂(Matrix metalloproteinases tissue inhibitor,TIMPs)水平的影响。方法:选择我院2015年6月～2017年12月收治的101例老年重症肺炎患者,按随机数字表法分为对照组(n=48)和研究组(n=53)。对照组采用利奈唑胺注射液治疗,研究组在对照组基础上采用血必净治疗。比较两组临床疗效,细菌清除情况,症状缓解时间,治疗前后血清SP、MMPs、TIMPs水平的变化,动脉血气,肺功能,不良反应的发生情况和28天内病死率。结果:治疗后,研究组有效率、细菌清除率均显著高于对照组(均P0.05),发热消失、血常规恢复、痰液颜色改变及胸部影像明显吸收时间均明显短于对照组(P0.05);两组血清SP-A、SP-B、SP-C、SP-D、MMP-2、MMP-9及TIMP-1及TIMP-2、血氧饱和度(blood oxygen saturation,SaO_2)、动脉血二氧化碳分压(arterial blood,PaCO_2)、动脉血二氧化碳分压(arterial blood CO_2 partial pressure of CO_2 partial pressure,PaCO_2)、峰流速(peak velocity of flow,PEF)水平均较治疗前显著下降,而血氧饱和度(blood oxygen saturation,SaO_2)、氧分压(oxygen partial pressure,PaO2)、最大呼气中段流量(maximum tidal midexpiratory flow,MMF)、用力肺活量(forced vital capacity,FVC)均较治疗前明显上升,且研究组以上指标变化较对照组更明显(均P0.05)。两组不良反应的发生情况比较差异无统计学意义(P0.05),而研究组在28天内病死率显著低于对照组(P0.05)。结论:血必净联合利奈唑胺注射液对老年重症肺炎患者的疗效优于单用利奈唑胺注射液治疗,可能与其显著降低患者血清SP、MMPs及TIMPs水平,改善肺功能,降低病死率有关。     

Aidi injection,a traditional Chinese biomedical preparation for gynecologic tumors: a systematic review and PRISMA-compliant meta-analysis

Aidi injection (ADI), a traditional Chinese biomedical preparation, is a promising adjuvant therapy for gynecologic tumors (GTs), including cervical cancer (CC), endometrial cancer (EC), and ovarian cancer (OC). Although studies have reported positively on ADI therapy, its exact effects and safety in GT patients remain controversial. Therefore, a wide-ranging systematic search of electronic databases was performed for this meta-analysis. Data from 38 trials including 3309 GT patients were analyzed. The results indicated that the combination of conventional treatment and ADI markedly improved the patients’ overall response rate (P<0.00001), disease control rate (P<0.00001), and quality of life (P<0.05) compared with conventional treatment alone. Furthermore, patient immunity was enhanced with combined treatment, as indicated by significantly increased percentages of CD3⁺ (P=0.005) and CD4⁺ (P<0.00001) and increased CD4⁺/CD8⁺ ratio (P=0.001). Most of the adverse events caused by radiochemotherapy such as gastrointestinal issues, leukopenia, thrombocytopenia, and hepatotoxicity, (P<0.05 for all) were significantly alleviated when ADI was used in the GT patients. However, other adverse events such as nephrotoxicity, diarrhea, alopecia, and neurotoxicity did not significantly differ between the two groups. Overall, these results suggest that the combination of conventional and ADI treatment is more effective than conventional treatment alone.     

Progesterone enhances in vitro development of bovine embryos

Increased pregnancy rates in cattle given progesterone (P₄) prior to 5 d after breeding have recently been reported. The objective was to determine if this increase in pregnancy rate could be attributed to a direct positive effect of P₄ on the developing embryo. In Experiment 1, 280 bovine oocytes were inseminated in vitro and at Day 3 (insemination = Day 0), good quality 8 cell embryos (n = 206) were randomly allocated to be cultured in either CR1aa+serum with 0 or ∼15 ng/mL (n = 102 and n = 104, respectively). In Experiment 2, 881 bovine oocytes were used; on Day 3, good quality 8 cell embryos (n = 511) were randomly allocated to either the control (CR1aa+FCS, n = 168), vehicle (CR1aa + FCS + ethanol, n = 170), or P₄ treatment (CR1aa + FCS + ∼15 ng/mL P₄ in ethanol, n = 173). On Day 7, in both experiments, there were increased numbers of blastocysts developing in the P₄ group (Experiment 1, 59% and Experiment 2, 71%) compared to the vehicle (Experiment 2, 53%) or control (40 and 62% in Experiments 1 and 2, respectively). The addition of P₄ (8%) stimulated the rate of embryo development (early blastocysts or more advanced stages on Day 6) compared to vehicle (3%) and control (0%) and the P₄ group had more hatched or hatching blastocysts (33%) on Day 9 compared to the control or vehicle group (21 or 22%). Additionally, the P₄ group had greater embryo diameter and significantly more Grade 1 blastocysts on Day 7. In conclusion, P₄ had a direct, positive effect on developing bovine embryos cultured in vitro.     

Effects of human chorionic gonadotropin combined with clomiphene on Serum E2, FSH,LH and PRL levels in patients with polycystic ovarian syndrome

ObjectiveEffects of human chorionic gonadotropin combined with clomiphene on serum E₂, FSH, LH and PRL levels in patients with polycystic ovarian syndrome were analyzed.Methods90 patients with polycystic ovarian syndrome treated from January 2015 to March 2016 were randomly and evenly divided into control group and observation group. Patients in the control group were only treated with clomiphene. On the basis of the treatment in control group, human chorionic gonadotropin was added in the treatment of observation group. The changes of E₂, FSH, LH, PRL levels were compared between two groups before and after the treatment. Clinical curative effects of patients in the two groups was evaluated. Adverse reactions during treatment in two groups were observed and recorded. The incidence of adverse reactions was calculated.ResultsSerum E₂, FSH, LH and PRL levels in the two groups decreased significantly after treatment compared with that before treatment. The difference is statistical significant (P < 0.05). After the treatment, E₂, FSH, LH and PRL levels in the observation group were lower than that in the control group and the difference is statistical significant (P < 0.05). Total effective rate was 64.44% in the control group and 93.33% in the observation group. There were statistically significant difference in clinical curative effects in the two groups (P < 0.05). Different degrees of adverse reactions were found in both groups during treatment, such as nausea, vomiting, anorexia, liver dysfunction. There were 2 cases of nausea, 2 cases of vomiting, 3 cases of anorexia and 1 case of liver dysfunction from the 45 patients in control group. The total incidence of adverse reactions was 17.78% (8/45). There were 1 case of nausea, 1 case of vomiting, 1 case of anorexia and no liver dysfunction from the 45 patients in observation group. The total incidence of adverse reactions was 6.67% (3/45). The total incidence of adverse reactions in the observation group was significantly higher than that in the control group and the difference was not statistically significant (P > 0.05).ConclusionCombined use of human chorionic gonadotropin can significantly reduce serum E₂, FSH, LH and PRL levels, improve clinical curative effects and reduce the incidence of adverse reactions. Human chorionic gonadotropin has high application value on the treatment of polycystic ovary syndrome.     

Inhibition of NAD biosynthesis by paraquat in Escherichia coli

Niacin significantly reduced the bacteristatic effect of 1 mM paraquat for Escherichia coli. Without niacin (an intermediate in the salvage pathway for pyridine nucleotide coenzyme biosynthesis), the NAD concentration was decreased rapidly and significantly in E. coli during paraquat poisoning. Niacin prevented the decline in NAD in paraquat-poisoned cells; quinolinate (an intermediate in de novo NAD biosynthesis prior to the entry point of niacin) did not. These data suggest that paraquat poisons the de novo pathway of pyridine nucleotide coenzyme biosynthesis. Similar consequences have been reported to result from hyperbaric oxygen poisoning of E. coli; thus, there is growing evidence for a common mechanism of toxicity for hyperoxia and paraquat.     

Delayed treatment with GnRH agonist,hCG and progesterone and reduced embryonic mortality in buffaloes

The present study examined the effect of delayed treatment with tropic hormones and progesterone (P₄) on embryonic mortality in buffaloes. Buffaloes with a conceptus on Day 25 after AI were assigned to the following treatments: Control (n = 41), i.m. physiological saline; GnRH agonist (n = 36), i.m. 12 μg buserelin acetate; hCG (n = 33), i.m. 1500 IU hCG; P₄ (n = 38), i.m. 341 mg P₄ every 4 days on three occasions. Control buffaloes had an embryonic mortality of 41.4% (17/41) between Days 25 and 45, and this was reduced (P < 0.01) by treatment with GnRH agonist (11.1%, 4/36), hCG (9.0%, 3/33) and P₄ (13.1%, 5/38). On Day 45, buffaloes treated with hCG and which ovulated had greater (P < 0.05) concentrations of P₄ in whey (453 ± 41 pg/ml) than buffaloes in the same treatment that did not ovulate (297 ± 32 pg/ml). A similar but non-significant trend was observed for buffaloes treated with GnRH agonist. It was concluded from the findings that the treatment of buffaloes on Day 25 after AI with tropic hormones or P₄ is beneficial to processes associated with embryonic implantation.     

The value of plasma paraquat concentration in predicting therapeutic effects of haemoperfusion in patients with acute paraquat poisoning

Objective

This study was aimed to analyze the scavenging effect of haemoperfusion on plasma paraquat (PQ) and to evaluate the clinical significance of PQ examination in the treatment of patients with acute paraquat poisoning.

Methods

85 patients with acute paraquat intoxication by oral ingestion were admitted in West China Hospital from Jun, 2010 to Mar, 2011. A standardized therapeutic regimen including emergency haemoperfusion was given on all subjects. A total of 91 whole blood samples were taken before (0h), underway (1h after haemoperfusion beginning) and at the end (2h) of the haemoperfusion therapy. The clearance rate was calculated and related factors were analyzed.

Results

As heamoperfusion was going on, the plasma paraquat concentration of the patients kept falling down. After 1 hour of haemoperfusion, the average clearance rate (R₁) was 37.06±21.81%. After 2 hours of haemoperfusion, the average clearance rate (R₂) was 45.99±23.13%. The average of R₁/R₂ ratio was 76.61±22.80%. In the high paraquat concentration group (plasma paraquat concentration (C₀) >300 ng/mL), both the averages of R₁ and R₂ were significantly higher than those of the low paraquat concentration group (C₀≤200 ng/mL) (p<0.05), and there was no significant difference of R₁/R₂ between these two groups (p>0.05).

Conclusions

The dynamic monitoring of plasma PQ concentration was not only critical in the clinical evaluation but also helpful in guiding the treatment of patients with acute PQ intoxication. Haemoperfusion can effectively eliminate paraquat from the plasma in patients with high initial plasma PQ concentration, while in patients with low initial plasma PQ concentration (<200 ng/ml), the clearance effect of harmoperfusion was very limited. Increasing HP time might improve the overall clearance rate of HP on plasma PQ yet decrease the elimination efficiency of HP, while repeated HP treatment was helpful against the rebound phenomena.     

Absolute Lymphocyte Count as a Predictor of Mortality in Emergency Department Patients with Paraquat Poisoning

Background

Paraquat (PQ) is a potent, highly toxic and widely used herbicide. The major medical problems associated with PQ are accidental or suicidal ingestion. There are several prognostic markers of PQ poisoning, with the serum PQ concentration considered to be the best indicator of outcome. However, the measurement of such markers is limited in many hospitals.

Objective

The present study was conducted to investigate the association of absolute lymphocyte count (ALC) and the 30-day mortality rate in patients with PQ poisoning.

Methods

We performed a retrospective analysis of patients admitted to the emergency department after paraquat poisoning between January 2010 and April 2013. Independent risk factors including ALC for 30-day mortality were determined. The ALC was categorized in quartiles as ≤1700, 1700 to 3200, 3200 to 5000, and >5000. Univariate and multivariate Cox proportional hazard analysis were performed to determine the independent risk factors for mortality.

Results

A total of 136 patients were included in the study, and the 30-day mortality was 73.5%. ALC was significantly higher in nonsurvivors than in survivors. The highest ALC quartile (ALC>5000; hazard ratio, 2.58; 95% CI, 1.08–6.21) was associated with increased mortality in multivariate analysis. In addition, old age, lower arterial PaCO₂, increased peripheral neutrophil count, and high serum levels of creatinine were associated with mortality.

Conclusion

The absolute lymphocyte count is associated with the 30-day mortality rate in patients with paraquat poisoning.     

Improved Glycemic Control with Insulin Glargine Versus Pioglitazone as Add-On Therapy to Sulfonylurea or Metformin in Patients with Uncontrolled Type 2 Diabetes Mellitus

ObjectiveTo compare glycemic control with add-on insulin glargine versus pioglitazone treatment in patients with type 2 diabetes.MethodsThis 48-week, multicenter, parallel-group, open-label study randomized 389 adults with poorly controlled type 2 diabetes (glycated hemoglobin A1c [A1C], 8.0% to 12.0%), despite ≥ 3 months of sulfonylurea or metformin monotherapy, to receive add-on therapy with insulin glargine or pioglitazone. Outcomes included A1C change from baseline to end point (primary), percentage of patients achieving A1C levels ≤ 7.0%, and changes from baseline in fasting plasma glucose, body mass index, weight, and serum lipids. The safety analysis included incidence of adverse events and rates of hypoglycemia.ResultsAt end point, insulin glargine yielded a significantly greater reduction in A1C in comparison with pioglitazone (-2.48% versus -1.86%, respectively; 95% confidence interval, -0.93 to -0.31; P = .0001, 48-week modified intent-to-treat population). Insulin glargine also yielded significantly greater reductions in fasting plasma glucose at all time points (end point difference, -34.9 mg/ dL; 95% confidence interval, -47.6 to -22.2; P < .0001). In comparison with pioglitazone, insulin glargine resulted in a lower overall incidence of possibly related treatmentemergent adverse events (12.0% versus 20.7%) and fewer study discontinuations (2.2% versus 9.1%), but a higher rate (per patient-year) of confirmed clinically relevant hypoglycemic episodes (blood glucose < 70 mg/dL and all severe hypoglycemia) (4.97 versus 1.04; P <.0001) and severe hypoglycemia (0.07 versus 0.01; P = .0309). Weight and body mass index changes were similar between the 2 treatment groups.ConclusionThe addition of insulin glargine early in the diabetes treatment paradigm in patients for whom sulfonylurea or metformin monotherapy had failed resulted in significantly greater improvements in glycemic control in comparison with the addition of pioglitazone. Although severe hypoglycemia was more frequent in patients with insulin glargine therapy, hypoglycemic events occurred in < 5% of patients in the insulin glargine treatment group. (Endocr Pract. 2010;16:588-599)     

无创正压通气治疗重症社区获得性肺炎临床疗效和预后影响

摘要 目的：考察无创正压机械通气(noninvasive positive-presure ventilation,NIPPV)对重症社区获得性肺炎(Severe community acquired Pneumonia,SCAP)的治疗效果和预后的影响。方法：以2018年7月-2020年2月我院收治的80例SCAP患者为研究对象,采用随机数字法分为无创组和常规组,各40例。两组患者均在在入院后均接受常规治疗,无创组在常规治疗的基础上进行NIPPV治疗。详细记录患者治疗前和治疗后1 h、24 h的体温、呼吸、血压、心率、血二氧化碳分压(arterial partial pressure of CO₂,PaCO₂)、氧合指数(PaO₂/FIO₂)、气管插管率、病死率、ICU住院天数,对患者入院的第1、3、7 d的血清可溶性尿激酶型纤溶酶原激活物受体(soluble urokinase-plasminogen activator receptor,suPAR)、降钙素原(procalcitonin,PCT)及C反应蛋白(C-reactive protein,CRP)的水平进行检测。结果：治疗后1 h和24 h,无创组患者呼吸、心率、PaCO₂、PaO₂/FIO₂和PH均显著的改善（P＜0.05）,显示NIPPV可明显改善患者肺部气体交换,减慢呼吸频率、提高氧和指数,降低二氧化碳分压;第1 d两组患者的PCT、CRP和suPAR的水平无明显差异（P＞0.05）,相对于第1 d,两组患者第3 d和第7 d的PCT、CRP和suPAR水平均明显的降低（P＜0.05）;相对于常规组,第3 d和第7 d无创组患者的PCT、CRP和suPAR水平有显著的降低（P＜0.05）;与常规组相比,无创组患者的插管率、ICU住院天数和死亡率统计学上无显著差异（P＞0.05）,但均有一定程度上的降低。结论：NIPPV能显著改善SCAP患者的呼气情况,降低血清PCT、CRP和suPAR水平,对降低气管插管率、缩短ICU住院天数,降低患者死亡率有一定的效果。     

Prediction of Patient Survival in Cases of Acute Paraquat Poisoning

Paraquat concentration-time data have been used to predict the clinical outcome following ingestion. However, these studies have included only small populations, although paraquat poisoning has a very high mortality rate. The purpose of this study was to develop a simple and reliable model to predict survival according to the time interval post-ingestion in patients with acute paraquat poisoning. Data were retrospectively collected for patients who were admitted with paraquat poisoning to Soonchunhyang University Choenan Hospital between January 2005 and December 2012. Plasma paraquat levels were measured using high-performance liquid chromatography. To validate the model we developed, we used external data from 788 subjects admitted to the Presbyterian Medical Center, Jeonju, Korea, between January 2007 and December 2012. Two thousand one hundred thirty six patients were included in this study. The overall survival rate was 44% (939/2136). The probability of survival for any specified time and concentration could be predicted as (exp(logit))/(1+exp(logit)), where logit = 1.3544+[−3.4688×log10(plasma paraquat μg/M)]+[−2.3169×log10(hours since ingestion)]. The external validation study showed that our model was highly accurate for the prediction of survival (C statics 0.964; 95% CI [0.952–0.975]). We have developed a model that is effective for predicting survival after paraquat intoxication.