Prognostic value of systemic immune-inflammation index and monocyte-to-HDL-cholesterol ratio in early cardio-cerebral complications in elderly patients with acute severe carbon monoxide poisoning.

To investigate how effectively systemic immune-inflammation index (SII) and Monocyte-to-HDL-cholesterol ratio (MHR) predict the development of early cardio-cerebral complications in elderly patients who have experienced acute severe carbon monoxide poisoning (ASCMP). A retrospective analysis was conducted on 77 elderly patients with ASCMP admitted to the emergency department of Harrison International Peace Hospital from November 2020 to March 2022. The prevalence of early-onset complications among the 77 individuals was 38.96%. Binary Logistics regression analysis showed that SII and MHR were independent influencing factors of early cardio-cerebral complications in elderly patients with ASCMP. The complication group had a longer length of stay, a greater mortality rate, and a higher incidence of delayed encephalopathy after acute carbon monoxide poisoning (p < .05) than the non-complication group. The area under the curve (AUC) of SII and MHR in predicting early cardio-cerebral complications in elderly patients with ASCMP were 0.724 and 0.796, respectively, with 80.0% and 63.3% sensitivity, and 61.7% and 87.2% specificity. The incidence of early cardio-cerebral complications in elderly patients who had ASCMP is high and the prognosis is poor. SII and MHR can be utilized as independent predictors of early cardio-cerebral complications in elderly patients with ASCMP, allowing doctors to diagnose and treat cardio-cerebral complications earlier and improve prognosis.

Evaluation of Lac and NGAL on the Condition and Prognosis of Patients with Diquat Poisoning.

AIM: This study aims to explore the evaluation of lactic acid (Lac) and neutrophil gelatinase-associated lipocalin (NGAL) on the condition and prognosis of patients with diquat (DQ) poisoning. METHODS: A total of 79 cases of DQ poisoning treated in one hospital from January 2019 through February 2023 were included: 10 cases of mild poisoning, 49 cases of moderate to severe poisoning, and 20 cases of fulminant poisoning. According to the Kidney Disease: Improving Global Outcomes-acute kidney injury (KDIGO-AKI) criteria, the patients were divided into 60 cases in the AKI group and 19 cases in the non-acute kidney injury (NAKI) group. According to the AKI diagnostic indicators, AKI patients were divided into Grade I, Grade II, and Grade III. According to prognosis, the patients were divided into survivor group and non-survivor group. During the same period, 30 healthy subjects were selected as the healthy group. The changes of blood Lac, NGAL, cystatin C (CysC), and serum creatinine (Scr) levels of patients were detected, the 28-day survival of patients was recorded, and the correlation between blood Lac, NGAL levels, and renal injury grade in patients with AKI caused by DQ poisoning was analyzed. The receiver operator characteristic (ROC) curve was used to evaluate the predictive value and prognostic value of Lac, NGAL, and their combination in patients with AKI caused by DQ poisoning. RESULTS: There were significant differences in AKI grade, Lac, NGAL, CysC, and Scr levels among different degrees of poisoning groups (P < .05). There were significant differences in the levels of Lac, NGAL, CysC, and Scr among patients with different AKI grades (P < .05). The levels of Lac, NGAL, CysC, and Scr in the survivor group were significantly lower than those in the non-survivor group (P < .05). The blood Lac and NGAL levels were positively correlated with AKI grades in patients with DQ poisoning (r = 0.752, 0.836; P = .000, .000). The combined detection of blood Lac and NGAL had higher predictive value for AKI and assessed value for death in DQ poisoning than either of them alone. CONCLUSION: The combined detection of Lac and NGAL have a certain clinical value in AKI grading and evaluating AKI prognosis caused by DQ poisoning.

Multicenter, randomized controlled, open label evaluation of the efficacy and safety of arbidol hydrochloride tablets in the treatment of influenza-like cases.

OBJECTIVE: To study the efficacy and safety of arbidol hydrochloride tablets as a treatment for influenza-like diseases. METHODS: In this multicenter, randomized, controlled, open label study, a total of 412 influenza-like cases were collected from 14 hospitals in seven regions of Hebei Province from September 2021 to March 2022. Patients were randomly divided into two groups. The control group (n = 207) were administered oseltamivir phosphate capsules for five days and the experimental group (n = 205) were administered arbidol hydrochloride tablets for five days. The primary endpoint was the time to normal body temperature, and the secondary endpoints included the time to remission of influenza symptoms, incidence of influenza-like complications, and incidence of adverse reactions. RESULTS: Before treatment, there was no significant difference between the two groups in general conditions, blood routine, body temperature, or symptom severity. After treatment, there was no significant difference between the groups in the mean time to fever remission (59.24 h ± 25.21 vs. 61.05 h ± 29.47) or the mean time to remission of influenza symptoms (57.31 h ± 30.19 vs. 62.02 h ± 32.08). Survival analyses using Log-rank and Wilcoxon bilateral tests showed that there was no significant difference in fever relief time or influenza symptom relief time between the two groups. Regarding the incidence of complications and adverse events, there was only one case of tracheitis, one case of nausea, one case of vomiting, and one case of dizziness in the control group. In the experimental group, there was one case of nausea, one case of vomiting, and one case of drowsiness. In addition, one patient in the control group was hospitalized for urinary calculi. CONCLUSION: There was no significant difference between the patients with influenza-like cases treated with arbidol hydrochloride tablets and those treated with oseltamivir phosphate capsules. Further, the patients treated with arbidol hydrochloride tablets had fewer adverse reactions, and thus, the tablets were safe to use.

Clinical application of BIS combined with LCR in assessing brain function and prognosis of patients with severe carbon monoxide poisoning.

BACKGROUND: This study investigated the value of the bispectral index (BIS) and lactate clearance rate (LCR) in the assessment of cerebral neurological injury and prognosis in acute severe carbon monoxide poisoning (ASCOP) patients. METHODS: A retrospective study was conducted on 86 ASCOP patients admitted to our hospital from November 2019 to March 2021. The patients' prognosis neurological function of the brain after 3 months of treatment was observed. The patients were divided into good (48) and poor (38) groups according to the different prognoses. The GCS-Pittsburgh score (G-P score) was performed on the patients after admission. BIS and LCR were recorded at admission, 6 h, 24 h, 48 h, and 72 h after admission. We conducted correlation and multivariate regression analysis for each factor. ROC curves were used to assess the diagnostic efficacy of each index on prognosis. RESULTS: The two different prognosis groups showed that there were no significant differences for gender, age, treatment-free period, and APACHE II score at admission (P > 0.05); the G-P score, the BIS, and LCR at different times of admission was significantly higher in the good group than in the poor group (all P < 0.05). Both the 24 h of BIS and the LCR were diagnostically superior to the G-P score (P < 0.05); the diagnostic efficacy of the two combined was not superior to that of the individual factors (AUC=0.787), but had a high specificity (93.8 %). CONCLUSION: BIS monitoring and LCR have clinical value in the assessment of neurological damage and prognostic in ASCOP patients.

[Effects and significance of continuous hemoperfusion on patients with diquat poisoning].

OBJECTIVE: To investigate the effect of continuous hemoperfusion (HP) on the levels of soluble CD14 isoform (sCD14-st) and neutrophil gelatinase-associated lipocalin (NGAL) on patients with diquat (DQ) poisoning and its significance. METHODS: A total of 86 patients with acute DQ poisoning admitted to the department of emergency medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to August 2021 were enrolled and divided into the intermittent HP group (40 cases) and the continuous HP group (46 cases) according to the random number table method. All patients received basic treatment and continuous veno-venous hemofiltration (CVVH) within 24 hours after admission. On this basis, the intermittent HP group received HP treatment within 2 hours, lasting 2 hours each time for every 8 hours, 3 times in all; the continuous HP group received continued HP treatment until there was no DQ component in urine samples. Serum NGAL levels were detected in all patients before treatment and at 3 hours, 12 hours, 24 hours, 2 days, 3 days, 5 days, and 7 days after treatment. At the same time, serum sCD14-st, blood lactate (Lac), arterial partial pressure of oxygen (PaO2), serum creatinine (SCr), MB isoenzyme of creatine kinase (CK-MB) and interleukin-18 (IL-18) levels were detected before treatment and at 24 hours, 3 days, and 7 days after treatment. Kaplan-Meier survival curve was drawn to analyze the 28-day survival of patients. RESULTS: Before treatment, there was no significant difference in serum NGAL, sCD14-st, Lac, PaO2, SCr, CK-MB and IL-18 levels between the two groups. With the prolongation of treatment, the serum levels of NGAL, sCD14-st, Lac, SCr, CK-MB and IL-18 in the intermittent HP group increased at first and then decreased. Serum levels of NGAL, sCD14-st, CK-MB and IL-18 reached their peaks at 24 hours after treatment, and the Lac and SCr levels reached their peaks at 3 days after treatment. In addition, the levels of the above indexes at each time point in the continuous HP group were all significantly lower than those in the intermittent HP group [after 24 hours of treatment: NGAL (µg/L) was 345.90±30.75 vs. 404.24±38.79, sCD14-st (ng/L) was 1 941.88±298.02 vs. 2 656.35±347.93, CK-MB (U/L) was 30.67±9.11 vs. 43.28±8.06, IL-18 (ng/L) was 139.49±16.29 vs. 177.98±27.85; 3 days of treatment: Lac (mmol/L) was 2.98±0.26 vs. 3.72±0.49, SCr (µmol/L) was 125.01±24.24 vs. 156.74±28.88; all P < 0.05]. However, there was no significant difference in PaO2 levels between the two groups at each time point after treatment. The Kaplan-Meier survival curve showed that the 28-day mortality of patients in the continuous HP group was significantly lower than that in the intermittent HP group [26.09% (12/46) vs. 52.50% (21/40); Log-Rank test: χ 2 = 7.288, P = 0.007]. CONCLUSIONS: Continuous HP could effectively reduce serum sCD14-st, NGAL levels and 28-day mortality in patients with DQ poisoning, with good curative effect.

Effect of Recombinant Human Brain Natriuretic Peptide on Acute Carbon Monoxide Poisoning Complicated with Heart Failure with Reduced Ejection Fraction.

This paper aims to observe the effect of recombinant human brain natriuretic peptide (rhBNP) on treatment of acute carbon monoxide poisoning (ACMP) complicated with heart failure with reduced ejection fraction (HFREF).A total of 103 patients with ACMP complicated with HFREF admitted to our department from October 2016 to March 2020 were observed. Patients were divided into control group (50 cases) and experimental group (53 cases). The control group was given diuretic, vasodilator, and digitalis treatment, and the experimental group was supplemented with rhBNP treatment based on the control group. Patients' general information was collected. The levels of myocardial injury-associated indicators of patients were detected at and after admission.No significant differences were observed in the general data of patients compared with control group. The acute physiology and chronic health enquiry II score of patients was positively correlated with left ventricular ejection fraction (LVEF). At admission, the levels of myocardial injury indicators, N-terminal B-type brain natriuretic peptide, and cardiac ultrasound indexes had no significant difference between the control group and experimental group. However, after admission, the LVEF and stroke output levels were elevated, while the other indicators were all decreased compared with the control group.The rhBNP exerts a protective effect on ACMP-induced cardiomyocyte injury to improve cardiac function, shorten the length of hospital stay, and reduce the incidence and mortality of delayed encephalopathy after carbon monoxide poisoning.

Study of Impact Characteristics of ZrO2 Ceramic Composite Projectiles on Ceramic Composite Armor.

Exploring new armor-piercing materials is crucial for improving the penetrative ability of projectiles. Based on the process of in situ solidification injection molding through ceramic dispersant hydrolytic degradation, a ZrO2 ceramic material suitable for use as the tip of a 12.7 mm kinetic energy (KE) projectile was prepared. The ZrO2 ceramic tip can be matched with the metal core of a conventional projectile to form a ceramic composite projectile, increasing the damage to the Al2O3 ceramic composite armor. Specifically, the ZrO2 ceramic tip can increase the impact load on the Al2O3 ceramic panel, prolonging the pre-damage phase and reducing the stable penetration phase, shortening the mass erosion time of the metal core compared with a 12.7 mm metal KE projectile tip. The ceramic composite projectile with the ZrO2 ceramic tip has a lower critical penetration velocity than a 12.7 mm metal KE projectile for Al2O3 ceramic composite armor. Furthermore, the residual velocity, residual length, and residual mass of the metal core of the ceramic composite projectile that penetrated the Al2O3 ceramic composite armor are greater than those of a 12.7 mm metal KE projectile.

Expression of Hypersensitive Troponin I and Soluble ST2 in Acute Organophosphorus Pesticide Poisoning.

The role of soluble growth stimulating gene 2 protein and highly sensitive cardiac troponin in the diagnosis of early myocardial injury caused by acute organophosphorus pesticide poisoning was studied. 171 inpatients with AOPP were divided into three experimental groups according to their mild, moderate, and severe conditions. 20 healthy people were selected as the control group. The levels of cTnI, HS-CTNI, NT proBNP, and ST2 were measured at the 4th and 12th hours after the experiment. The measured data were expressed by mean standard deviation. The independent sample t-test was used for the detection between the two groups, and one-way ANOVA was used for the analysis and comparison between multiple groups. The relevant data were analyzed by Spearman correlation test (P < 0.05). The levels of cTnI and HS cTnI in the experimental group increased with the extension of time and the deepening of poisoning degree; four hours after admission, ST2 and NT proBNP water in the control group and the experimental group increased significantly on average. According to the analysis of the data, there was a positive correlation between HS TnI and ST2 in patients with AOPP (r = 0.938, P < 0.001, r = 0.827, P < 0.001). The more serious the disease, the higher the concentrations of HS TnI and ST2, and the more serious the myocardial injury.

Effect of early intervention on short-term prognosis of patients with myocardial injury induced by acute carbon monoxide poisoning.

AIM: This study aimed to investigate the effect of early intervention on the short-term prognosis of patients with myocardial injury induced by acute carbon monoxide poisoning (ACOP). METHODS AND RESULTS: We performed a retrospective cohort study of 139 patients admitted to the hospital for ACOP-induced acute toxic cardiopathy. Compared with the mild and moderate toxic cardiopathy group, the severe toxic cardiopathy group has significantly increased coma time, acute physiology and chronic health status (APACHE) II score, and the length of hospital stay and significantly reduced proportion of patients with immediate endotracheal intubation and early admission to intensive care unit (ICU) (all P < 0.05). The cardiac troponin I (cTnI) levels and corrected QT dispersion (QTcd) duration in three patient groups were significantly higher (all P < 0.05) than those in the control group, with the highest in the severely toxic heart disease group. Serum cTnI level and QTcd duration were two independent predictors of myocardial injury in ACOP patients. There was a positive correlation between the APACHE II score and serum cTnI level/QTcd duration at admission. The sensitivities of cTnI and QTcd at admission to diagnose serious cardiovascular events were 78.6% and 85.7%, respectively, and the specificities were both 75%. CONCLUSIONS: Acute carbon monoxide poisoning patients with myocardial injury need to be admitted to the hospital as early as possible. For patients with severe hypoxia, an artificial airway should be established as early as possible, and patients should be admitted to the monitoring ward to stabilize their condition at the early stage of poisoning. Meanwhile, changes in QTcd, serum cTnI, and creatine kinase-MB (CK-MB) should be closely observed.

[Predictive value of neutrophil/lymphocyte ratio combined with soluble growth stimulating expression gene 2 protein on the occurrence of in-hospital major adverse cardiaovascular events in patients with myocardial injury from moderate-severe acute carbon monoxide poisoning: a single-center prospective observational study].

OBJECTIVE: To investigate the predictive neutrophil/lymphocyte ratio (NLR) combined with soluble growth stimulating expression gene 2 protein (sST2) on in-hospital major adverse cardiovascular events (MACE) in patients with myocardial injury following moderate-severe acute carbon monoxide poisoning (ACOP). METHODS: A single-cente prospective observational approach was conducted. Moderate-severe ACOP patients with myocardial damage from November 2016 to February 2020 in department of emergency medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University were enrolled. The baseline data of the patients, NLR and sST2 (T0 sST2) on admission, sST2 at 3 days after admission (T3 d sST2), and the other myocardial injury and biochemical indicators were collected. According to whether MACE occurred, the patients were divided into MACE group and non-MACE group. The clinical data of the two groups were compared. Pearson correlation analysis was used to analyze the correlation of each index. Binary Logistic regression was used to analyze the independent risk factors of in-hospital MACE in patients with moderate-severe ACOP myocardial injury. The receiver operator characteristic curve (ROC curve) was drawn and area under ROC curve (AUC) was calculated to analyze the predictive value of NLR, sST2, and NLR combined with sST2 for the occurrence of in-hospital MACE in patients with moderate-severe ACOP myocardial injury. RESULTS: A total of 278 patients with moderate-severe ACOP myocardial injury were included in the final analysis, and the incidence of MACE was 11.51% (32/278). Cardiac troponin I (cTnI), lactic acid (Lac), NLR, and T3 d sST2 in the MACE group were significantly higher than those in the non-MACE group [cTnI (µg/L): 0.83±0.15 vs. 0.46±0.37, Lac (mmol/L): 2.96±1.14 vs. 2.43±1.35, NLR: 13.14±4.37 vs. 9.49±4.21, T3 d sST2 (µg/L): 59.88±23.42 vs. 39.83±12.60, all P < 0.05], there was no significant difference in T0 sST2 between the MACE group and the non-MACE group (µg/L: 269.09±90.89 vs. 240.14±113.02, P > 0.05). Pearson correlation analysis showed that there were significantly positive correlations in NLR with acute physiology and chronic health evaluation II (APACHE II), T3 d sST2 with APACHE II, and NLR with T3 d sST2 (r values were 0.226, 0.209, 0.193, all P < 0.01). Binary Logistic regression analysis showed that T3 d sST2 and NLR were both independent risk factors for MACE in moderate-severe ACOP patients with myocardial injury [odds ratio (OR) and 95% confidence interval (95%CI) respectively was 1.064 (1.039-1.090), 1.176 (1.066-1.298), both P < 0.01]. ROC curve analysis showed that the predictive efficacy of NLR combined with T3 d sST2 for the occurrence of in-hospital MACE in patients with ACOP myocardial injury (AUC = 0.876) was better than that of NLR (AUC = 0.754) and T3 d sST2 (AUC = 0.813). When the optimal critical value of NLR was 10.02 and that of T3 d sST2 was 43.50 µg/L, the sensitivity of predicting the occurrence of MACE in patients with moderate-severe ACOP myocardial injury was 69.8% and 86.2% respectively, and the specificity was 74.3% and 70.4%, respectively. The specificity and sensitivity of the combined detection was 83.4% and 79.8%, respectively. CONCLUSIONS: NLR and T3 d sST2 were independent predictors of in-hospital MACE in moderate-severe ACOP patients with myocardial injury, and combined application of NLR and T3 d sST2 had good predictive value. For patients with moderate-severe ACOP myocardial injury with NLR > 10.02 and T3 d sST2 > 43.50 µg/L, the occurrence of in-hospital MACE should be alert.

Multislice Spiral CT Image Analysis and Meta-Analysis of Inspiratory Muscle Training on Respiratory Muscle Function.

Respiratory muscle function has a significant effect on stroke. Stroke is one of the most common cardiovascular and cerebrovascular diseases in the clinic and has a significant impact on the quality of life of patients. Hemiplegia, cerebral hemorrhage, and even death can occur, mainly in the elderly. In this paper, we meta-analyzed the effect of inspiratory muscle training on respiratory muscle function. In this article, we used a topic search method to search for relevant literature on respiratory muscle training and obtained 58 and 32 literature studies from CNKI and Wanfang Data, respectively. As a result of the screening, 36 and 28 documents were obtained. In this paper, 64 selected articles were studied. The authors make statistics on the literature of designing serum content index and multislice spiral CT (Member of the Society of Cardiological Technicians) image of patients, so as to analyze the influence of CT image and inspiratory muscle training on respiratory muscle function. The study showed that FVC, FEV1, MIP, and diaphragm mobility of the experimental group were significantly improved after treatment in more than 85% of the studies (P < 0.05), while those of the control group were not significantly improved (P > 0.05). The comparison between the two groups after treatment showed that FVC, FEV1, MIP, and diaphragm mobility of the experimental group were higher than those of the control group (P < 0.05). The application of multislice spiral CT image analysis technology can effectively evaluate the effect of inspiratory muscle training on respiratory dysfunction in stroke patients, the mechanism of which regulates the expression of related pathways, suppresses the inflammatory response, and can reduce oxidative stress damage. Therefore, respiratory muscle training can improve the function of respiratory muscle and reduce the death rate of cerebellar hemorrhage in patients with stroke and other vascular diseases.

Correlation Between QTc Dispersion and Soluble Growth-stimulating Gene 2 Protein on the Early Prognosis of Acute Carbon Monoxide Poisoning Heart Disease.

ABSTRACT: This study aimed to explore the correlation between QTc dispersion (QTcd) and soluble growth-stimulating gene 2 protein (sST2) after heart rate correction in patients with acute carbon monoxide poisoning heart disease. Among the 150 patients, 35 cases had severe toxic heart disease. The concentrations of sST2, cardiac troponin I, and creatine kinase-MB in the severe group began to increase from admission, 24 hours, and 2 days, respectively, and their detected values were all higher than those in the nonsevere group and the normal control group. There were statistically significant differences in sST2 and QTcd between the poisoning, nonsevere, and normal control groups before the treatment. There was a statistically significant difference between the indexes of the poisoning groups at different degrees 2 and 3 days after poisoning. Receiver operating characteristic curve analysis confirmed the sensitivity and specificity of sST2 and QTcd. The correlation analysis showed that sST2 and QTcd levels were positively correlated with the incidence of severe heart disease at admission. Generally, the combined observation of sST2 and QTcd improved the prediction sensitivity and were early predictor indexes of toxic heart disease.

A combination of NLR and sST2 is associated with adverse cardiovascular events in patients with myocardial injury induced by moderate to severe acute carbon monoxide poisoning.

BACKGROUND: Indicators of adverse cardiovascular events in patients with acute carbon monoxide (CO) poisoning-induced myocardial injury have not yet been elucidated. HYPOTHESIS: This study aimed at determining the risk factors for adverse cardiovascular events in patients with acute CO poisoning-induced myocardial injury. METHODS: We enrolled patients with moderate-to-severe acute CO poisoning-induced myocardial injury. Based on the occurrence of adverse cardiovascular events, the patients were assigned into event and non-event group. Binary logistic regression analysis was performed to analyze the potential risk factors for cardiovascular adverse events. RESULTS: A total of 413 eligible patients were enrolled. Among them, 61 (14.8%) patients presented adverse cardiovascular events and were assigned to the event group while 352 patients were assigned to the non-event group. Univariate analysis revealed that cTnI, Lac, and NLR levels at admission and sST2 at day 3 in the event group were significantly higher compared to those in the non-event group. Subsequent multivariate analysis revealed that sST2 at day 3 and NLR at admission were independent risk factors for adverse cardiovascular events in patients with acute CO poisoning-induced myocardial injury. Finally, the sensitivity, specificity, and AUC of sST2 at day 3 combined with NLR for event prediction were 79.5%, 82.8%, and 0.858, respectively. CONCLUSION: A combination of sST2 at day 3 and NLR is a potential predictor for the occurrence of adverse cardiovascular events in patients with acute CO poisoning-induced myocardial injury. Therefore, cardiovascular risk stratification should be taken into consideration, especially in patients with acute CO poisoning-induced myocardial injury.

Protective effects of recombinant human brain natriuretic peptide on the myocardial injury induced by acute carbon monoxide poisoning.

BACKGROUND: To investigate the protective effect of recombinant human brain natriuretic peptide (rhBNP) on myocardial injury after acute carbon monoxide poisoning (ACOP). METHODS: We retrospectively reviewed medical records of patients with ACOP and high risk of cardiac events admitted to our hospital, and grouped them into rhBNP group and control group according treatments they received. Patients in control group received conventional treatment while those in rhBNP group were treated with rhBNP intravenously for 72 hours on the basis of conventional treatment. Levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), serum creatine kinase MB fraction (CK-MB), aldosterone (ALD), angiotensin II (AT II), and endothelin-1 (ET-1) prior to and after treatment of rhBNP or conventional treatment were collected. Corrected QT dispersion (QTcd) results were calculated based on the electrocardiography data. The left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVS), left ventricular ejection fraction (LVEF), and stroke output (SV) were measured using color Doppler echocardiography. Major adverse cardiovascular events (MACEs) that occurred within 1 month after treatment were recorded. RESULTS: A total of 135 patients in the rhBNP group and 136 patients in the control group were enrolled. Baseline characteristics between the two groups were similar at admission. Levels of cTnI, CK-MB, and ET-1 in the rhBNP group were significantly lower than those in the control group at day 1, 2 and 3 after treatment (P<0.05). Compared with the control group, levels of QTcd, ALD and AT II in the rhBNP group were significantly lower at day 3 after treatment (P<0.05). After 7 days of treatment, the reduction of NT-proBNP in the rhBNP group was significantly greater than that in the control group at each day (P<0.05), and LVEF, SV and LVEDD in the rhBNP group were all greater than those in the control group. After 1 month of treatment, the incidence of MACEs in the rhBNP group was significantly lower than that in the control group. CONCLUSIONS: For patients with ACOP and high risk of cardiac events, early treatment of rhBNP can protect injured cardiomyocytes, prevent the injury of carbon monoxide on heart, and reduce the incidence of MACE.

Continuous hemoperfusion relieves pulmonary fibrosis in patients with acute mild and moderate paraquat poisoning.

Acute paraquat poisoning (APP) is a serious public health problem with a high mortality rate and there is no specific antidote for APP in clinical. Early haemoperfusion (HP) treatment is effective in APP rescue. In this study, we compared the influence of routine HP and continuous HP on the survival rate and the treatment of pulmonary fibrosis in mild and moderate APP patients. Eighty-two cases of mild and moderate APP patients who were admitted to our hospital from January of 2017 to December of 2018 were selected. All patients were randomly divided into a routine haemoperfusion (HP) group (n = 40) and a continuous haemoperfusion (CHP) group (n = 42). Compared with the HP group, the 28-day survival rate of mild and moderate APP patients was elevated in the CHP group. Blood N-terminal procollagen Ш propeptide (PIIINP) levels in APP patients were positively related with paraquat (PQ) concentration (r = 0.309, P = 0.000). There were statistically significant differences in the levels of PIIINP, Collage TypeIV (CIV), transforming growth factor-beta 1 (TGF-ß1), malondialdehyde (MDA), superoxide dismutase (SOD) activity and sequential organ failure assessment (SOFA) score between the two groups both on the third and seventh days after treatment, and the treatment effect of the CHP group on pulmonary fibrosis in APP patients was better than that of the HP group. In conclusion, CHP treatment had a significant therapeutic effect on mild and moderate APP patients, which could effectively improve the survival rate and relieve pulmonary fibrosis.

Effect of CeO2 on Impact Toughness and Corrosion Resistance of WC Reinforced Al-Based Coating by Laser Cladding.

WC reinforced Al-based coating with added CeO2 was prepared on the surface of S420 steel by laser cladding. The microstructure and structure of the coatings were analyzed by scanning electron microscope, X-ray diffractometer and optical profiler. The mechanical properties and corrosion properties of the coatings were studied by microhardness tester, friction and wear tester, Charpy impact tester, and electrochemical workstation. The results show that the coating is mainly composed of Al-phase, continuous-phase, and hard reinforced-phase WC, and the coating and substrate show good metallurgical bonding. When the content of CeO2 is 1%, the fine grain strengthening effect is obvious, and the impact toughness of the coating is obviously improved. Appropriate amount of rare earth CeO2 can significantly improve the hardness of the coating. When the content of CeO2 is more than 1%, the wear resistance of the coating decreases. The coating prepared with different CeO2 content has higher impedance and corrosion resistance than that of the substrate. At 1% CeO2 content, the coating has the best corrosion resistance.

[Curative effect of paraquat detoxification recipe combined with continuous hemoperfusion in the treatment of patients with APP and clinical value of Presepsin].

OBJECTIVE: To investigate the clinical effect of paraquat (PQ) detoxification recipe combined with continuous hemoperfusion (HP) in the treatment of patients with acute paraquat poisoning (APP) and clinical significance of soluble CD14 subtype (sCD14-st, Presepsin). METHODS: A prospective randomized controlled trial was conducted. 152 patients with moderate APP admitted to Department of Emergency Medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University from July 2013 to June 2017 were enrolled, and they were randomly divided into three groups. The patients in HP group (group A, n = 35) only received 2-hour HP for 3 times, 8 hours each time, those in PQ detoxification recipe combined with HP group (group B, n = 50) received PQ detoxification recipe 1 (once per 2 hours until no PQ component was found in faeces) and 2 (3 times a day for 14 days) beside HP. The others in PQ detoxification recipe combined with persistent HP group (group C, n = 67) received continuous HP until the PQ component in serum was not detected. The parameters of organ function and inflammatory factor, and blood Presepsin and PQ contents were determined before and after treatment. The curative effect and 28-day mortality were recorded. The correlations between serum Presepsin level and PQ content as well as 28-day mortality were analyzed with Pearson correlation analysis. Receiver operating characteristic curve (ROC) was plotted to analyze the predictive value of Presepsin on prognosis. RESULTS: The total effective rate of group C was significantly higher than that of groups A and B [70.1% (47/67) vs. 34.3% (12/35), 54.0% (27/50)], and 28-day mortality was significantly lowered [29.8% (20/67) vs. 65.7% (23/35), 46.0% (23/50), both P < 0.05]. There was no significant difference in alanine aminotransferase (ALT), MB isoenzyme of creatine kinase (CK-MB), serum creatinine (SCr), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukins (IL-6 and IL-10) before treatment among the three groups. Five days after treatment, the above parameters in the three groups were increased as compared with those before treatment, but the increase degree in group C was the lowest. At 7 days after treatment, the parameters were decreased, especially in group C. There was no significant difference in serum Presepsin and PQ levels before treatment among the three groups. With the prolongation of treatment time, the Prespsin levels in groups A, B, and C were increased, and peaked at 12 hours (µg/L: 4.28±0.20, 3.87±0.25, 3.53±0.23), then gradually decreased,and the PQ contents were lower than those before treatment from 8 hours (mg/L: 1.76±0.12 vs. 2.12±0.17, 1.57±0.08 vs. 2.24±0.16, 1.25±0.10 vs. 2.14±0.18), with a time dependence pattern, especially in group C (all P < 0.05) . Correlation analysis showed that blood Presepsin level was positively correlated with PQ content and 28-day mortality (r1 = 0.917, r2 = 0.864, both P = 0.001), suggesting that the higher the PQ content was, the higher the Presepsin level, and the higher the 28-day mortality was. ROC curve analysis showed that the area under ROC curve (AUC) of Presepsin predicting 28-day mortality was 0.863; when the cut-off value was 1.22 µg/L, the sensitivity was 83.3%, the specificity was 81.4%, the positive predictive value was 77.46%, and the negative predictive value was 86.42%. CONCLUSIONS: Early administration of PQ detoxification recipe combined with continuous HP treatment can effectively reduce Presepsin level, decrease the mortality of patients with moderate APP, improve the prognosis. Presepsin can assess the prognosis of patients with APP.

Effect of soluble CD14 subtype on the prognosis evaluation of acute paraquat poisoning patients.

OBJECTIVE: To study the relationship between soluble CD14 subtype (also named presepsin) and the prognosis of acute paraquat poisoning (APP) patients. METHODS: We studied 85 APP patients who were divided into three groups: light (21 cases), moderate (37 cases) and heavy poisoning (27 cases) groups. Fifty healthy subjects were as control group. According to the conditions of prognosis, they were divided into two groups: survive group (28 cases) and death group (57 cases). We measured the concentration of presepsin in serum and the levels of CRP, TNF-α, IL-6 and IL-10 in venous blood. APACHE II scores were observed before treatment, 72 h and 7 d after treatment. RESULTS: The levels of presepsin, CRP, TNF-α, IL-6 and the scores of APACHE II in patients of three poisoning groups were increased at three different time points compared with control group, while the level of IL-10 was decreased. And there were significant differences between each poisoning groups (P<0.05). The levels of prespsin, CRP, TNF-α, IL-6 and the scores of APACHE II in patients of death group were higher than survive group at three different time points, while the level of IL-10 was lower (P<0.05). The mortality rates of three poisoning groups were 28.57%, 70.27% and 92.59%, and there were significant differences between each poisoning groups (P<0.05). The area under curve (AUC) of presepsin level and APACHE II scores of APP patients on admission were 0.862 and 0.731, respectively. Presepsin had a better predictive ability than APACHE II score for 28-day mortality rate in APP patients (P<0.05). The level of presepsin was negatively correlated with survival rates (r=0.291, P=0.007). CONCLUSION: Monitoring the level of presepsin in serum has an important role in assessing the severity of APP patients, guiding treatment and predicting prognosis.

[Effect of rhubarb as the main composition of sequential treatment in patients with acute paraquat poisoning: a prospective clinical research].

OBJECTIVE: To observe the effect of rhubarb as the main composition in the therapy for patients with acute paraquat poisoning (AP). METHODS: A prospective randomized controlled trial was conducted. 128 patients with APP admitted to Harrison International Peace Hospital from March 2011 to December 2013 were randomly divided into western medicine control group (n = 64) and western medicine and traditional Chinese medicine (TCM) combination group (n = 64). All the patients were treated with repeated gastric lavage and oral kaolin. The patients in western medicine control group were given 20% mannitol and (or) magnesium sulfate for catharsis, early ( within 8 hours of admission ) hemoperfusion HP), and also given the routine combined therapy. In TCM combination group, in addition to the above treatment patients were given oral paraquat poisoning detoxification prescription No.1 every 2 hours for catharsis, which was composed of rhubarb 10 g, glauber salt 12 g, agrimony 12 g, and licorice 6 g. When green stool disappeared, detoxification therapy was changed to No. 2 compound once a day for 14 days, which was consisted of rhubarb 10 g, ginseng 6 g, agrimony 15 g, rhizoma chuanxiong 10 g, licorice 6 g. The poison volume, first dose of oral drug, time for the first HP, time of the first defecation, the time of last green stool, decontamination time, white blood cell count ( WBC ), C-reactive protein ( CRP ), arterial blood gas analysis, blood lactic acid ( Lac ), liver and kidney functions, myocardial enzyme spectrum, chest CT, adverse reaction, days of hospitalization, and mortality rate were observed in both groups. The levels of paraquat in plasma and urine were determined before treatment and 12 hours after poisoning in both groups. Sixty days after discharge, chest CT was taken for observation of pulmonary fibrosis. RESULTS: There were no significant differences in the poison volume, ingestion time and the time for the first HP between the two groups. Compared with western medicine control group, the first defecation time (hours: 3.94 ± 1.14 vs. 6.17 ± 1.52), the last time of green stool (hours: 36.90 ± 4.10 vs. 51.6 3 ± 4.91), and poison clean-up time from plasma (hours: 19.48 ± 3.63 vs. 23.84 ± 3.29) in combination with TCM group were significantly earlier (all P < 0.01). WBC, CRP, alanine aminotransferase (ALT), blood urea nitrogen (BUN), and serum creatinine (SCr) levels were gradually increased after admission in combination with TCM group, and they peaked on 5th day [WBC ( × 109/L) : 15.35 ± 2.17 vs. 17.47 ± 2.09, CRP (mg/L): 32.62 ± 2.76 vs. 39.51 ± 2.45, ALT (U/L): 270.88 ± 11.06 vs. 334.67 ± 7.85, BUN (mmol/L): 13.29 ± 1.90 vs. 17.63 ± 1.42, SCr (µmol/L): 203.54 ± 18.40 vs. 251.53 ± 14.38, all P < 0.05 ], and then they declined; Lac after admission was gradually increased, and peaked at 7 days (mmol/L: 3.53 ± 0.21 vs. 3.82 ± 0.14, P < 0.05 ), and then it was decreased. Myocardial enzyme spectrum was increased after admission, and peaked on 3rd day [creatine kinase (CK, U/L): 192.09 ± 16.26 vs. 216.20 ± 11.96, creatine kinase isoenzyme enzyme ( K-MB, U/L): 39.03 ± 3.75 vs. 47.22 ± 5.84, both P < 0.05 ), and then they declined gradually. Arterial partial pressure of oxygen (PaO2) and base excess (E) were gradually decreased after admission, down to trough on the 7th day after admission [PaO2(mmHg, 1 mmHg = 0.133 kPa): 87.04 ± 2.37 vs. 84.93 ± 2.44, BE (mmol/L): -7.31 ± 2.31 vs. -9.18 ± 2.49, both P < 0.05 ], and then they were increased. At 12 hours after poisoning, paraquat contents in plasma and urine in combination with TCM group were significantly lower than those of the western medicine control group [plasma (ng/L): 0.83 ± 0.08 vs. 0.96 ± 0.10, urine (ng/L): 0.88 ± 0.09 vs. 0.97 ± 011, both P < 0.05]. The injury to lung tissue was significantly improved in combination with TCM group compared with that in the western medicine control group, and no serious adverse reactions was found, and the hospital stay time (days: 20.46 ± 6.07 vs. 29.73 ± 9.16) was significantly shortened (P < 0.01), and the mortality rate [ 35.9% (23/64) vs. 45.3% (29/64) ] was significantly lowered compared with western medicine control group (P < 0.05). In the combination with TCM group pulmonary fibrosis was lighter than that in the western medicine control group during the 60-day follow-up. CONCLUSIONS: The sequential treatment of No. 1 and No. 2 detoxification of APP, using rhubarb as the main drug, can effectively eliminate paraquat, reduce absorption of the toxin, prevent the development of multiple organ dysfunction syndrome (MODS) induced by the toxin, shorten the hospital stay days, and improve the prognosis of APP.