Research progress on emergency management and rescue in sudden chemical poisoning accidents / 中国职业医学

Sudden chemical poisoning accidents have the characteristics of suddenness, groups, complexity and difficulty in rescue. It usually brings serious harm and far-reaching social impact. Establishing a good emergency management and rescue system from the four stages of prevention, response, rescue and recovery can reduce the adverse effects of accidents, casualties, and social burden. The prevention of sudden chemical poisoning accidents focuses on finding the cause and putting forward effective preventive measures. Emergency response can be carried out from three aspects: response and acceptation, hazard assessment and operation of corresponding emergency plans. Emergency rescue of sudden chemical poisoning accidents should fully consider both rescue technology and emergency management. The former includes pre-hospital patient screening and pre-hospital detoxification, while the latter includes dealing with the uncertainty of rescue process, allocation of medical resources and health care for emergency rescuers. In the recovery stage of the accidents, attention should be paid to long-term post-disaster monitoring of the population and emergency rescuers. Using the treatment time and development sequence as the framework, we can more comprehensively describe the characteristics of sudden chemical poisoning accidents, which is helpful in finding the key points of prevention and treatment of such accidents, and provide a basis for exploring the emergency managing methods of such accidents.

Analysis of the on-site quality inspection results of occupational medical examination institutions in Guangdong Province in 2020 / 中国职业医学

OBJECTIVE: To analyze the problems existing in the on-site quality inspection of occupational medical examination(OME) institutions in Guangdong Province. METHODS: A total of 96 OME institutions in Guangdong Province were selected as the research subjects using the random number table method. On-site quality inspections were carried out and the results were analyzed. RESULTS: The OME institutions participating in the on-site quality inspection in 2020 accounted for 49.0%(96/196) of total OME institutions in Guangdong Province. Among them, occupational disease prevention and control hospitals/institutions, Centers for Disease Control and Prevention(CDC), public hospitals, and private hospitals accounted for 8.3%, 9.4%, 42.7% and 39.6%, respectively. They were distributed in 17 prefecture-level cities. The registered OME qualifications include dust, chemical factors, physical factors, radiological factors and other categories. Some institutions have registered two or more OME qualifications. The non-qualified rate of the on-site quality inspections in six assessment modules of the 96 OME institutions from high to low were quality management work, equipment(instruments and vehicles) allocation, quality management system, medical and health technical personnel allocation, information report, and on-site professional assessment module, with the non-qualified rate of 24.1%, 22.4%, 20.7%, 15.9%, 15.6% and 1.1% respectively(P<0.01). The problems were mostly concentrated in the CDC, public and private hospitals, and rarely in occupational disease prevention and treatment hospitals/institutes. In addition to the on-site professional assessment module, a total of 696 non-qualified items were detected in the remaining five modules of the 96 OME institutions, with an average of seven items per institution. Occupational disease prevention and treatment hospitals/institutions, CDC, public hospitals, and private hospitals had an average of 2, 9, 8, 7 non-qualified items respectively. CONCLUSION: In the on-site quality assessment of OME institutions in Guangdong Province, there are relatively few problems in all aspects of occupational disease prevention and treatment hospitals/institutes. CDC has certain inadequacies. The public and private hospitals have more prominent problems in aspects of equipment(instruments and vehicles) allocation, quality management system and quality management work.

Clinical Analysis of Preoperative Neoadjuvant Chemotherapy by Thalidomide Combined with Gefitinib for Non-small Cell Lung Cancer / 昆明医科大学学报

Objective To investigate the clinical effect of preoperative neoadjuvant chemotherapy by thalidomide combined with gefitinib for non-small cell lung cancer (NSCLC) patients and provide clinical basis for NSCLC therapy.Methods From 2011/1 to 2013/1,we collected 160 NSCLC cases in our hospital and divided them into 2 groups randomly,80 cases in control group and 80 cases in observation group.The patients in the control group were treated with conventional surgical treatment and patients in the observation group were treated with preoperative neoadjuvant chemotherapy by thalidomide combined with gefitinib before surgery.The clinical effects,the 6 months and 1 year survival rates,and the toxicity effects were observed,and the clinical effects and survival rates between the 2 groups were compared.Results The observation group had a therapeutic efficiency ratio (TER) of 80.0％ which was significantly higher than the control group (50.0％),and the difference was statistically significant (P＜0.05).The 6 months survival rate and 1 year survival rate were 97.5％ and 92.5％,which were both significantly higher than those of control group (87.5％ and 77.5％),and all differences were statistically significant (P＜0.05).The toxicity effects of observation group were lower.Conclusions Preoperative neoadjuvant chemotherapy by thalidomide combined with gefitinib for NSCLC therapy is effective and safe,which is worthy of study and further application in clinical treatment..

Investigation on the awareness of the residents around a nuclear power plant in Guangdong province / 中国职业医学

OBJECTIVE: To understand the general awareness of the residents around a newly built nuclear power,to evaluate the safety and the attitude on the construction of nuclear power. METHODS: By the stratified random sampling method,1 029 general publics and 260 representatives were selected for investigation. The participants were from 30 km range around the nuclear power plant,each 5 km was assigned as 1 layer and there were total 6 layers. RESULTS: 74. 9%( 965 /1 289) interviewees were not aware of nuclear power,3. 1%( 40 /1 289) interviewees were well or very-well understand nuclear power. The awareness score of the general publics was lower than that of the representatives( 1. 0 vs3. 0,P < 0. 01); male,younger people,higher educational level,higher family income,religious people and living close to the nuclear power plant had higher awareness( P < 0. 05). A total of 28. 4%( 366 /1 289) interviewees considered the nuclear power was very safe or safe. The evaluation of nuclear power safety of the general publics was inferior to the representatives( P < 0. 05). The representatives,older people and those living far away from the nuclear power have better evaluation on the nuclear power safety than the general publics( P < 0. 05). Only 13. 0%( 167 /1 289) interviewees supported building the nuclear power in their residence construction; male,people with family members working in nuclear power plant,people with high degree of awareness on nuclear power,considered highly safety of the nuclear power had higher support for the local nuclear power construction( P < 0. 05). The interviewees who mostly believe about nuclear energy sources were experts,government officials,plant management and domestic media. CONCLUSION: Residents around the nuclear power plant had low awareness of the knowledge about nuclear power. Therefore,it is necessary to enhance the awareness of residents on nuclear power and the trust on the government.

Mechanism of 1,2-dichloroethane-induced toxicity in SH-SY5Y Cells / 中国职业医学

OBJECTIVE: To establish the cell model of human neuroblastoma cell( SH-SY5Y cell) exposed to1,2-dichloroethane( 1,2-DCE) in vitro and to explore the mechanism of 1,2-DCE-induced toxicity in SH-SY5Y cells.METHODS: SH-SY5Y cells were collected in their logarithmic growth phase and cultured in complete medium that had final concentrations of 1,2-DCE in 0,10,20,30,40,50,60,70 and 80 mmol / L for 24 hours. Cell morphology was observed and cell survival rate was examined by CCK-8 assay. Using chemical colorimetric method, the activity of lactic dehydrogenase( LDH) in the cell culture supernatant,and the intracellular level of malondialdehyde( MDA),the intracellular activities of superoxide dismutase( SOD) and adenosine triphosphate( ATP) enzymes were detected. RESULTS: With the increasing exposure concentrations of 1,2-DCE,the cell density of SH-SY5Y cells gradually decreased,the synapse became shorter,the membrane ruptured,cytoplasm condensed and cytoplasmic contents overflowed increased.With the increasing concentration of 1,2-DCE,the cell survival rate decreased( P < 0. 01),the activity of LDH in the cell culture supernatant increased( P < 0. 01). These changes had a dose-effect correlation. Intracellular MDA level,and activities of SOD,Na~+-K~+-ATP enzyme,Ca~(2+)-Mg~(2+)-ATP enzyme and total ATP enzyme increased at first and then decreased. The activity of LDH in the cell culture supernatant and cell survival rate was negatively correlated( the correlation coefficient is- 0. 907,P < 0. 01). CONCLUSION: 1,2-DCE could inhibit the proliferation of SH-SY5Y cells.The mechanism may be related to the permeability change of cell membrane,cellular damage from excessive free radicals,the decrease of free radical scavenging capacity,ATP enzyme activity and calcium overloading. SH-SY5Y cells can be used as a common cell line for 1,2-DCE cytotoxicity analysis.

Comparison of therapeutic effects between comprehensive therapy and routine therapy in treatment of occupational chronic n-hexane poisoning / 中国职业医学

OBJECTIVE: To evaluate the therapeutic effects between comprehensive therapy and routine therapy in treatment of occupational chronic n-hexane poisoning. METHODS: By randomized controlled trial,116 cases with occupational chronic n-hexane poisoning were divided into two groups: the control group( n = 58) and the treatment group( n = 58). Subjects in the control group were given vitamin B_(12) and vitamin B_1 for neural nutrition; and Danshen and deproteinized calf blood extractive injection for activating blood circulation to dissipate blood stasis. Subjects in the treatment group were treated with comprehensive treatment including traditional Chinese and Western medicine,which including mouse nerve growth factor,acupuncture,physical therapy( infraredtherapy,microwave irradiation therapy),Chinese medicine steamingwashing and comprehensive rehabilitation therapy for a period of 12 weeks in addition to the conventional treatment. The curative effect and adverse reactions of both groups were observed after 12 weeks,and the treatment results and hospital stay were followed up. RESULTS: Before treatment,no significant differences( P > 0. 05) were noted in both groups in scores of neurological symptoms,signs,activities of daily living and neurogenic damage indexes of electroneuromyography[including motor digital latency( MDL),motor nerve conduction velocity( MCV),sense nerve conduction velocity( SCV) of median nerve,ulnar nerve,sural nerve or common peroneal nerve; and the detection of lengthen MDL,shorten MCV and SCV]. After treatment,patients in both groups got better in terms of the above indicators( P < 0. 05),with larger extend of improvement noted in the treatment group than in the control group( P < 0. 05). No obvious adverse reactions were noted in the 2 groups. Hospital stay of patients in the treatment group was about 2 months shorter than that in the control group( P < 0. 05). CONCLUSION: The therapeutic effects of comprehensive therapy on occupational chronic n-hexane poisoning are obviously better than routine therapy,which is an effective and safe therapeutic method.

The influence of 1,2-dichloroethane on the plasma level of MBP,NSE and S100 protein in rats / 中国职业医学

OBJECTIVE: To investigate the effects of 1,2-dichloroethane( 1,2-DCE) on myelin basic protein( MBP),neuron specific enolase( NSE) and S100 protein in the plasma of SD rats. METHODS: Forty-eight specific pathogen free adult SD rats were randomly divided into control group,low-dose group and high-dose group,with 8 females and 8 males in each group. Rats were given 1,2-DCE orally at the dose of 0,27 and 79 mg / kg body weight every other day( every Wednesday,Monday and Friday) for 4 weeks. After 1,2-DCE administration,8 survived rats( half male and female) were randomly selected in each group. The plasma levels of MBP,NSE and S100 protein were measured using enzyme-linked immunosorbent assay. The blood and urinary samples were collected to assess the concentration of 1,2-DCE and its main metabolites( 2-chlorideacetic acid, 2-chlorideacetaldehyde and 2-chlorideethanol) by gas chromatography. The pathological changes of cerebrum and cerebellum were observed through optical microscope,and the expression of MBP was detected by immunohistochemistry. RESULTS: Rats in high-dose group showed abnormal behavior from the third day of1,2-DCE exposure and 6 rats( 2 females,4 males) died from 1,2-DCE intoxication. Rats in low-dose group and control group appeared normal and no death was observed. MBP level in the plasma of high-dose group was higher than that in the control group( P < 0. 05),but the levels of NSE and S100 protein in each group did not show significant statisticaldifference( P > 0. 05). 1,2-DCE and 2-chloroethanol in the urine were detected in the high-dose group,and were below detection limit in the other two groups. 2-Chloroacetic acid level in high dose-group was significantly higher than that in the low-dose group( P < 0. 05),and was below detection limit in the control group. 2-Chloroacetaldehyde in the urine of each group was below detection limit. 1,2-DCE and its 3 kinds of metabolites were not detected in the plasma of all rats. There was no obvious structural damage,bleeding,edema or necrosis found in the cortex and white matter of cerebrum and cerebellum. The expression of MBP in the choroid plexus epithelial cells were significantly enhanced in the lateral ventricle and the fourth ventricle of rats in the high-dose group,and slight enhanced in rats in the low-dose group. CONCLUSION: MBP may play a role in the toxic effect of 1,2-DCE.

Clinical analysis on occupational chronic n-hexane poisoning cases / 中国职业医学

OBJECTIVE: To collect,analyze and summarize the clinical characteristics of occupational chronic n-hexane poisoning cases reported in the literatures published in domestic open public periodicals in order to provide evidence for the revision of GBZ 84 Diagnostic Criteria of Occupational Chronic n-Hexane Poisoning. METHODS: By the bibliometrics method,the databases of CNKI,VIP and WANFANG were used to retrieve literatures on the occupational chronic n-hexane poisoning published from 1990 to 2014. The literatures with detailed clinical data were screened and selected for summary and analysis. RESULTS: A total of 68 reference literatures meeting the inclusion criteria were chosen in 25 years of domestic publication. These literatures reported 1 027 cases of occupational n-hexane poisoning,including 165 males and 862 females. The median of age was 28. 3( 13. 0-59. 0) years. Most of the cases had a disease incubation period of 2. 0-10. 0months. The diagnostic classification was made in 817 cases( 79. 6%),with mild,moderate and severe chronic n-hexane poisoning in 418,241 and 158 cases,respectively. The n-hexane levels in workplace air were reported in 736 cases( 71. 7%),91. 8%( 676 /736) of which had exceeded the national occupational exposure limit. Chronic n-hexane poisoning was mainly characterized by peripheral nerve damage,626 cases( 61. 0%) had feeling and movement disorders,256 cases( 24. 9%) had movement disorder and 145 cases( 14. 1%) had feeling disorders. The clinical characteristics of these disorders were bilaterally symmetric feeling or movement disorders in distal limbs. The nerve-electromyography examination showed the neurogenic damage,which was parallel with the severity of patients' condition and could be detected at early stage of illness. The gas chromatography was used to detect the 2,5-hexanedione level of 156 cases( 15. 2%) of patients and the positive detection rate was 50. 6%( 70 /156). Currently,there was no specific medication or other therapy for treatment of chronic n-hexane poisoning. The comprehensive therapy which mainly include nerve restoration was the general therapy method. Addition of mouse nerve growth factor to the conventional therapy had significant treatment effects. The therapeutic effect was reported in 954 cases with the recovery rate of 83. 6%( 798 /954),and the complication in nervous system was observed in 156 cases who were not cured. CONCLUSION: The main clinical manifestation of chronic n-hexane poisoning is peripheral neuropathy. The nerve-electromyography is the most important diagnostic method. Currently,comprehensive therapy is used with good prognosis in the patients.

Imaging assessment of neonatal necrotizing enterocolitis / 中华儿科杂志

<p><b>OBJECTIVE</b>To improve the understanding of recognizing and diagnosis of neonatal necrotizing enterocolitis (NEC), imaging assessment of neonates with NEC was analyzed retrospectively.</p><p><b>METHOD</b>Data of 211 cases of NEC were retrospectively collected from the Department of Neonatology, Children's Hospital of Chongqing Medical University between Jan.1(st) 2006-Dec.31(st) 2011.</p><p><b>RESULT</b>Analysis of abdominal X-ray of 211 cases showed that there were 40 cases (19.0%) who had no changes on each X-ray, 47 cases (22.3%) had improvement and 23 cases (10.9%) became worse. In the group of no changes, positive rate with good prognosis was 97.5% and with poor prognosis, it was 2.5%. In the group of improvement, positive rate with good prognosis was 97.9%, and the contrary was 2.1%. Positive rate with good prognosis was 56.5%, and the contrary was 43.5% in worse group. Chi-square analysis of the three groups showed χ(2) = 31.742, P < 0.01. Comparison of detection rate of pneumoperitoneum on abdominal X-ray (16.0%, 12/75) and Doppler US (1.3%, 1/75), χ(2) = 10.191, P < 0.05, portal pneumatosis on abdominal X-ray(1.3%, 1/75) versus Doppler US (12.0%,9/75), χ(2) = 6.857, P < 0.05. Surgical timing mostly corresponded to pneumoperitoneum (OR = 19.543) and intestinal obstruction (OR = 19.527) of abdominal X-ray. The logistic regression equation is y = -2.915-1.588x1+2.972x4+2.973x7 + 1.711x9 (χ(2) = 101.705, P < 0.01).</p><p><b>CONCLUSION</b>Abdominal X-ray is the most important method of diagnosis of NEC, the group of deterioration of abdominal X-ray has obvious bad prognosis differ from no change group and better group. Comparison with abdominal X-ray and Doppler US, the former in pneumoperitoneum positive rate was higher than the latter, at the same time, portal pneumatosis on Doppler US is more sensitive to abdominal X-ray, the value of two imaging assessments both supplement each other. Surgical timing mostly corresponds to pneumoperitoneum and intestinal obstruction.</p>

Ultrasound diagnosis and differential diagnosis of renal arteriovenous fistula / 第二军医大学学报

Objective:To summarize the ultrasound features of renal arteriovenous fistula(RAVF)under various ultrasound imaging modes,so as to avoid missed diagnosis of RAVF on initial ultrasound examination.Methods:The clinical data of 6 patients with RAVF,including the ultrasound evidence,the timing of ultrasound diagnosis,the modes of ultrasound diagnosis, and the agreement between ultrasound diagnosis and selective renal arterial angiography,were retrospectively analyzed.Results: 2D ultrasound had 1 case of correct diagnosis,1 case of misdiagnosis and 4 cases of missed diagnosis.Color Doppler and spectral Doppler both had all the 6 cases correctly diagnosed.Ultrasound angiography in 3 cases demonstrated that the contrast agent reached the renal veins earlier than reached the renal parenchyma;large fistula lumen was associated with ischemia of downstream areas.3D ultrasound vividly reflected the structure of fistula lumen volume,and provided us with the profiles of blood signal in fistula at different planes and angles,improving our knowledge of blood flow on the fistula.Conclusion: Ultrasound is the first line screening method for RAVF.Color Doppler plays a decisive role in the diagnosis of RAVF and pulsed spectral Doppler plays a synergetic role and contributes to differential diagnosis.Contrast-enhanced ultrasound may help to discover the abnormality of venous circulation and the ischemic parenehyma area due to shunting.2D ultrasound has a poor diagnostic value and is liable to lead to misdiagnosis and missed diagnosis.