ABSTRACT
OBJECTIVE: To analyze the usage of glucocorticoid in patients who were treated with occupational medicamentose-like dermatitis due to trichloroethylene( OMDT),in order to provide a reference for regulating the glucocorticoid treatment of the disease. METHODS: Using a retrospective survey method,144 OMDT cases of patients who were diagnosed and cured by Guangdong Province Hospital for Occupational Disease Prevention and Treatment from 2001 to2013 were selected. The general information,clinical data and the use of glucocorticoid were collected and analyzed.RESULTS: i) The usage of glucocorticoid. The median and the 0th to 100 th percentile [M( P_0-P_(100)) ] of first dose of methylprednisolone was 100. 00( 40. 00-1 000. 00) mg / d; 58 patients( 40. 3%) using the first dose of treatment were ineffective. The dosage of glucocorticoid was increased one week after admission,the M( P_0-P_(100)) to an initial dose of120. 00( 40. 00-1 000. 00) mg / d; The M( P_0-P_(100)) of maintenance time of initial dose was 5. 5( 1. 0-14. 0) days. After treating effectively,should the decrement to stop using gradually the first glucocorticoid. The dose was gradually cut down to 20-50 mg every 1 to 3 days if the glucocorticoid dose was more than 100 mg / d; it was cut down to 10 mg every 2 to 3days if the glucocorticoid dose was less than 100 mg / d. The M( P_0-P_(100)) of glucocorticoid using time was 66. 0( 22. 0-229. 0) days. The M( P_0-P_(100)) of total amount of glucocorticoid was 3 510. 0( 420. 0 ~ 27 336. 3) mg. ii) The first dose of glucocorticoid in patients of erythema multiforme group were less than those of exfoliative dermatitis group and bullous epidermal necrolysis group( P < 0. 05),the initial dose and total amount of glucocorticoid were less than the other 3 types of rash( P < 0. 05). iii) Compared with the patients with severe impaired liver function,the first dose,the initial dose and the total amount of glucocorticoid were significantly higher than those in mild impaired liver function( P < 0. 05),and the time of using glucocorticoid was longer than that in mild impaired liver function( P < 0. 05). iv) The first dose and the initial dose of glucocorticoid in patients were positively correlated with the total amount of glucocorticoid [Spearmen correlation coefficient( r_S) were 0. 73 and 0. 78 respectively,P < 0. 01). The maintenance time of the initial dose of glucocorticoid was not correlation with the time of patients who were out of contact with trichloroethylene or the urinary level of trichloroacetic acid at admission( r_Swere- 0. 14 and 0. 10 respectively,P > 0. 05). v) Binary Logistic regression analysis showed that,if the patients who had no erythema multiforme,the more severe the degree of liver dysfunction or the white blood cell count higher than 9. 5 × 10~9/ L,the first dose of glucocorticoid used should be more than 120 mg / d( P <0. 05). CONCLUSION: Liver function and type of rash are important factors that affect the usage of glucocorticoid in patients with OMDT. Glucocorticoid therapy should be prescribed in reference to the liver function and skin lesion of patients with OMDT.
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OBJECTIVE: To establish the clinical pathway of chronic mild occupational cadmium poisoning,and to promote the application of clinical pathway in the treatment of occupational diseases. METHODS: Chronic mild occupational cadmium poisoning was selected as a disease for a pilot study based on GBZ 17-2015 Diagnosis of Occupational Cadmium Poisoning. The diagnosis and treatment scheme and the clinical pathway were developed based on the theory of evidencebased medicine and expert consultation. It was then used and evaluated in clinical practice in several hospitals. RESULTS: The content of clinical pathway of chronic mild occupational cadmium poisoning included the standard in-hospital treatment process protocol,the clinical pathway forms and the consent document for patients. The clinical application of the pathway significantly improved the outcome of treatment,shortened hospital stays and effectively control hospitalization expenses.CONCLUSION: The clinical pathway for chronic mild occupational cadmium poisoning is rational and feasible. The result confirms that the clinical pathway may have good application prospect for the treatment of occupational diseases.
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OBJECTIVE: To gain insight into the effect associated with cadmium toxicity in placenta and explore the reproductive toxicity of low level cadmium exposure. METHODS: Thirty-two specific pathogen free healthy female SD rats were randomly divided into 4 groups with 8 rats in each group. These were a control group and low-,medium- and highcadmium treated groups. Rats were treated with 0,1,3,9 mg / kg body weigh( bw) cadmium chloride by intragastric administration respectively. The treatment was once a day for 43 consecutive days as the one-generation reproductive toxicity experiment. On gestation day 20,the parental females were euthanized or delivered. The numbers of corpus luteum,implantations,live or dead fetuses,resorptions were all recorded and represented as reproductive toxicity index.Some placentas were prepared for proteomic analysis with difference gel electrophoresis method, some for histological analysis,some were analyzed by Western blot and immunohistochemistry methods. RESULTS: There was no statistical significance between low-cadmium treated group and control group in the changes of the body weights and reproductive toxicity index( P > 0. 05). The female rats showed different degrees of slow body weights gain from gavages day 19 in medium-and high-cadmium treated groups. According to the proteomic screening criteria in placenta,15 protein spots with a 1. 5-fold change relative to the controls in medium- and high-cadmium treated groups were identified. To validate the proteomics results,ATP-binding cassette,sub-family B,member 4( ABCB4) was examined by Western blot. The result showed that the expression of ABCB4 was significantly down-regulated in the cadmium treated groups( P < 0. 05).Moreover,there was a dose-response relationship between cadmium exposure and ABCB4 protein expressions( P < 0. 05).The histological analysis of placenta showed an increasing tendency towards degradation of cytotrophoblastic cells,hyperemia and decreased glycogen cells with increasing cadmium exposure. The subcellular localization of ABCB4 protein was mainly in the nucleus or cytoplasm in placenta. CONCLUSION: The above results demonstrated that the exposure to 1mg / kg· bw · d cadmium had not significant reproductive toxicity. The placenta is a target organ of cadmium toxicity.ABCB4 protein maybe involved in mediating the toxicity of cadmium in placenta.