[Construction of early warning indicators of in-hospital cardiac arrest in adult inpatients].

OBJECTIVE: To establish early warning indicators for Chinese nurses to recognize in-hospital cardiac arrest (IHCA) of adult inpatients. METHODS: Computer retrieval of Chinese and English databases such as CNKI, Wanfang Database, VIP, National Medical Library of the United States PubMed Database, Web of Science, Embase Database of the Netherlands Medical Abstracts, Cochrane Library Database and other international guidelines collaboration network (GIN), National Institute for Health and Clinical Optimization (NICE), Scottish Intercollegiate Guidelines Network (SIGN), BMJ best clinical practice and other guidelines was performed. The retrieval time limit for respiratory and cardiac arrest early warning indicators or risk identification related content of the adult inpatient in the professional website was until June 30, 2020. After literature research and expert group analysis, the research group drew up an expert correspondence questionnaire, and selected 32 medical and nursing experts from Beijing, Tianjin, Jilin, Shandong, Shaanxi, Sichuan, Zhejiang and other grade three first-class general hospitals from July to September 2022. The Delphi method was used to conduct two rounds of expert correspondence, forming the final version of the early warning index of cardiac arrest in adult inpatients. RESULTS: Five first-level indicators, 23 second-level indicators and 41 third-level indicators including vital signs, consciousness and pupils, postoperative blood drainage volume, lab results and other five aspects were initially formed. The effective response rates of the two rounds of expert correspondence were 100% (32/32) and 93.75% (30/32), respectively, the Kendall coordination coefficients W of the first round and the second round were 0.340 and 0.462, respectively, the expert authority coefficients Cr were 0.88 and 0.89, respectively, the mean value of importance assignment was 3.94-5.00, 4.07-5.00, and the coefficient of variation was 0-0.16, 0-0.14, with statistically significant differences (all P < 0.05). Finally, 5 primary indicators, 23 secondary indicators and 43 tertiary indicators were formed, including five aspects of vital signs, consciousness and pupils, postoperative blood drainage, lab results, symptoms and chief complaints. CONCLUSIONS: The expert consultation on the early warning indicators of IHCA for adult patients tends to be consistent and scientific, which is applicable to help nurses detect the changes of patients' condition as early as possible.

The retention characteristics for water-soluble and water-insoluble particulate matter of five tree species along an air pollution gradient in Beijing, China.

The air purification potential of plants has been widely studied and recognized. However, their specific capacities in retaining water-soluble (WSPM) and water-insoluble (WIPM) atmospheric particulate matter (PM) are still unclear. In order to recommend tree species with high air phytoremediation ability, the retention characteristics for WSPM and WIPM of five tree species under different haze pollution levels and PM retention durations in Beijing were evaluated after introducing ultrasonic cleaning procedure to the conventional leaf cleaning methods. The daily PM amount retained these species in the six central districts in Beijing (SCBD) was roughly estimated based on the field tree survey data in 171 plots randomly distributed within the Fifth Ring Road. The updated leaf cleaning method improved the evaluation accuracy for WSPM and WIPM by 54% and 31%, respectively. The particles retained by the broadleaf and coniferous species were mainly composed of WSPM (71%) and WIPM (64%), respectively. The diameter distribution of PM varied markedly with species, PM retention duration, and pollution level. However, it always showed a unimodal pattern for WSPM and no uniform patterns for WIPM. The average relative capacities of different species in retaining WSPM of TSP (PM ≤ 100 µm) were more stable with time, and the corresponding rank was Sophora japonica > Salix babylonica > Ginkgo biloba > Pinus tabuliformis > Sabina chinensis. Whereas, as to the WIPM of TSP, their order changed to S. japonica > P. tabuliformis > S. babylonica > G. biloba > S. chinensis. During the study period, the TPM (WIPM+WSPM) of TSP retained by these species per day in the SCBD reached 132.6 t (76.1 t WSPM + 56.5 t WIPM), accounting for a considerable proportion of the daily dust-fall amount. These findings can contribute to selecting greening tree species and managing the urban forest to improve urban air quality.

Effect of activated charcoal hemoperfusion on renal function in patients with paraquat poisoning.

The present study retrospectively analyzed 19 patients diagnosed with paraquat (PQ) poisoning with the aim to investigate the effect of activated charcoal hemoperfusion on renal function and PQ elimination. The results indicated that 7 patients died and 12 survived. Non-oliguric renal failure occurred in all of the 7 patients who died. Among the 12 surviving patients, 10 had normal renal function and 2 developed non-oliguric renal failure. There was a linear correlation between plasma and urine paraquat concentration prior to and during activated charcoal hemoperfusion. The equation parameters together with the correlation coefficient on admission were as follows: Y=0.5820+1.7348X (R2=0.678; F=35.768; P<0.0001). The equation parameters together with the correlation coefficient were as follows during activated charcoal hemoperfusion: Y=0.6827+1.2649X (R2=0.626; F=50.308; P<0.0001). Therefore, it was concluded that in patients with normal renal function, the elimination kinetics of PQ by the kidneys were only associated with the plasma PQ concentration. Activated charcoal hemoperfusion had little effect on avoiding acute kidney injury in patients with severe PQ poisoning.

The potential impact of invasive woody oil plants on protected areas in China under future climate conditions.

Biodiesel produced from woody oil plants is considered a green substitute for fossil fuels. However, a potential negative impact of growing woody oil plants on a large scale is the introduction of highly invasive species into susceptible regions. In this study, we examined the potential invasion risk of woody oil plants in China's protected areas under future climate conditions. We simulated the current and future potential distributions of three invasive woody oil plants, Jatropha curcas, Ricinus communis, and Aleurites moluccana, under two climate change scenarios (RCP2.6 and RCP8.5) up to 2050 using species distribution models. Protected areas in China that will become susceptible to these species were then identified using a spatial overlay analysis. Our results showed that by 2050, 26 and 41 protected areas would be threatened by these invasive woody oil plants under scenarios RCP2.6 and RCP8.5, respectively. A total of 10 unique forest ecosystems and 17 rare plant species could be potentially affected. We recommend that the invasive potential of woody oil plants be fully accounted for when developing forest-based biodiesel, especially around protected areas.

Continuous plasma perfusion of dual cartridges in series: rationale and early clinical experience.

To improve the efficiency of plasma perfusion on eliminating plasma paraquat (PQ), we designed continuous plasma perfusion of dual cartridges in series (CPPDCS) on Diapact Braun CRRT machine. The goals of this study were to evaluate the effective of CPPDCS on paraquat removal in patients with acute paraquat intoxication. Our results show that the PQ clearance rate of dual cartridges was significantly higher than that of single cartridge at 1st, 2nd, 3rd, and 4th plasma perfusion. Compared with single-cartridge plasma perfusion, CPPDCS significantly reduced the frequency of cartridge replacement, shorten the time of perfusion. These results indicate that CPPDCS is effective than plasma perfusion of single cartridge on PQ clearance rate and may provide an effective treatment for PQ poisoning.

Clinical management of organophosphate poisoning in pregnancy.

BACKGROUND: Acute organophosphorus pesticide poisoning during pregnancy may lead to spontaneous abortion. Now, there is no definite strategy focused on maintaining pregnancy. METHOD: This is a retrospective analysis of 2 cases of organophosphorus poisoning during pregnancy. All patients received penehyclidine hydrochloride injection,until the tracheobronchial tree is cleared of the secretions, and most secretions were dried. In addition, magnesium sulfate was used in one woman for the correction of hyperdynamic uterine activity. RESULTS: Two women all survived, one fetus died of spontaneous abortion, and one fetus died of incoordinate uterine action. The 2 women had no significant complications during postpartum period. CONCLUSION: Penehyclidine hydrochloride and magnesium sulfate may be used to treat organophosphorus during pregnancy. However, futher study and new experimental need to be designed.

A descriptive analysis of injury triage, surge of medical demand, and resource use in an university hospital after 8.12 Tianjin Port Explosion, China.

OBJECTIVE: The 8.12 Tianjin Port Explosion in 2015 caused heavy casualties. Pingjin Hospital, an affiliated college hospital in Tianjin, China participated in the rescue activities. This study aims to analyze the emergency medical response to this event and share experience with trauma physicians to optimize the use of medical resource and reduce mortality of critical patients. METHODS: As a trauma centre at the accident city, our hospital treated 298 patients. We retrospectively analyzed the data of emergency medical response, including injury triage, injury type, ICU patient flow, and medical resource use. RESULTS: There were totally 165 deaths, 8 missing, and 797 non-fatal injuries in this explosion. Our hospital treated 298 casualties in two surges of medical demand. The first one appeared at 1 h after explosion when 147 wounded were received and the second one at 4 h when 31 seriously injured patients were received, among whom 29 were transferred from Tianjin Emergency Center which was responsible for the scene injury triage. After reexamination and triage, only 11 cases were defined as critical ill patients. The over-triage rate reached as high as 62.07%. Seventeen patients underwent surgery and 17 patients were admitted to the intensive care unit. CONCLUSIONS: The present pre-hospital system is incomplete and may induce two surges of medical demand. The first one has a much larger number of casualties than predicted but the injury level is mild; while the second one has less wounded but almost all of them are critical patients. The over-triage rate is high. The hospital emergency response can be improved by an effective re-triage and implementation of a hospital-wide damage control.

[Analysis of prognostic value of initial serum paraquat concentration in patients with paraquat poisoning].

OBJECTIVE: To investigate the prognostic values of initial serum paraquat (PQ) concentration and time lag after PQ ingestion in patients with PQ poisoning. METHODS: A retrospective analysis was performed on 189 patients who ingested PQ between 2.5 and 48 h before admission. The values of initial serum PQ concentration and time lag after PQ ingestion for the prognosis after poisoning were analyzed by the receiver operating characteristic (ROC) curve and multiple logistic regression analysis. RESULTS: The serum PQ concentration of non-survivors was significantly higher than that of survivors (P<0.01) , and the time lag after PQ ingestion of non-survivors was significantly longer than that of survivors (P<0.01). The ROC curve analysis showed that the area under the ROC curve (AUC) showed no significant difference between initial serum PQ concentration and serum PQ concentration-time data when the time lag after PQ ingestion was between 2.5 and 48 h (z=0.563, P=0.574) ; the AUC showed a significant difference between initial serum PQ concentration and serum PQ concentration-time data when the time lag after PQ ingestion was between 2.5 and 6 h (z=2.199, P=0.034) and between 6 and 48 h (z=2.525, P=0.012). CONCLUSION: Initial serum PQ concentration has a better predictive power than serum PQ concentration-time data in evaluating the prognosis of patients when the time lag after PQ ingestion is within 6 h. However, serum PQ concentration-time data has a better predictive power than PQ concentration alone in evaluating the prognosis of patients when the time lag after PQ ingestion is between 6 and 48 h.

Prediction of outcome following paraquat poisoning by arterial lactate concentration-time data.

The present study retrospectively analyzed 170 patients diagnosed with paraquat (PQ) poisoning with the aim of clarifying whether the arterial lactate-time (arterial lactate concentration × time between ingestion and arterial lactate measurement) was a good predictor of mortality in patients with acute PQ poisoning. The results indicated that there was a positive correlation between the arterial lactate-time and PQ concentration-time (ρ=0.485). In addition, the arterial lactate-time data exhibited a similar discriminative power to the plasma PQ concentration-time data (z=0.712; P=0.864). For the receiver operating characteristic curve analysis, the lactate-time data had an area of 0.782 with a cut-off value of 11.95 mmol/l.h (sensitivity, 64.52%; specificity, 84.42%). To calculate the predicted probability of survival for any specified time and initial arterial lactate concentration, the following formula was derived based on the logistic regression coefficients: Logit(p) = 3.066 - 0.139 × (time lag following PQ ingestion) - 0.177 × (initial arterial lactate concentration); where the probability of survivors = 1/1 + e-logit(p). Therefore, the arterial lactate-time data exhibited a good predictive power for evaluating the prognosis of patients with acute PQ poisoning.

[Paraquat (PQ) clearance through continuous plasma perfusion in PQ poisoning patients: a clinical study].

OBJECTIVE: To examine the impact of continuous plasma perfusion on plasma PQ concentration (PPQ) in acute PQ-poisoning patients for the estimation of its PQ clearance effect. METHODS: 21 PQ-poisoned patients admitted to our poisoning center within 24 hours after the ingestion were prospectively enrolled. Continuous plasma perfusion (flow rate 180 ml/min) was performed, with plasma/blood separation at 40 ml/min and routine cartridges change every 3 hours. Urinary PQ (UPQ), urine flow rate (UFR), and PPQ level at inlet/outlet of the cartridge were obtained right before, and 1.5 hours after the start of each perfusion session for calculation of renal and plasma PQ excretion. RESULTS: In all 8 rounds (108 sessions) of plasma perfusion on the 21 patients, PQ elimination rate (ml/min) by plasma perfusion was found always higher than the renal value: [1st (21 cases) 11.14±6.13 vs. 5.33±4.33; 2nd (21 cases) 18.36±11.32 vs. 4.85±3.15; 3rd (21 cases) 16.13±10.05 vs. 0.84±0.80; 4th (17 cases) 12.86 (6.72, 17.47) vs. 0.28 (0.09, 0.60); 5th (11 cases) 14.12 (10.48, 35.20) vs. 0.10 (0.03, 0.73); 6th (7 cases) 16.47 (11.82; 20.69) vs. 0.13 (0.03, 0.40); 7th (5 cases) 13.33 (9.71, 18.75) vs. 0.33 (0.24, 0.47); 8th (5 cases) 11.27 (9.21, 16.02) vs. 0.32 (0.10, 1.22), P< 0.05 or P< 0.01]. In the study, PPQ was found negatively correlated to PQ elimination by plasma perfusion (r = - 0.4799, P< 0.0001), and positively correlated to the renal elimination ( r = 0.5060, P< 0.0001). The survivors (10 cases) showed a higher PPQ reduction rate (mg×L(-1)×h(-1)) than the non-survivors (11 cases, 0.57± 0.03 vs. 0.47±0.06,P< 0.05). CONCLUSION: Continuous plasma perfusion may be a promising therapeutic tool for its significant PPQ reduction effect, and plasma perfusion should be made available early for patients with acute PQ intoxication.