Severe liver injury and clinical characteristics of occupational exposure to 2-amino-5-chloro-N,3-dimethylbenzamide: A case series

Background:The 2-amino-5-chloro-N,3-dimethylbenzamide is a key intermediate in the synthesis of pesticides and pharmaceuticals.However,no literature currently exists on 2-amino-5-chloro-N,3-dimethylbenzamide poisoning in humans.This study aimed to reveal the health hazard of this chemical for humans and summarize the clinical characteristics of patients with occupational 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.Methods:This observational study included four patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning from June 2022 to July 2022.The entire course of the incidents was described in detail.Blood 2-amino-5-chloro-N,3-dimethylbenzamide concentrations were detected by a mass spectrometer.Hema-toxylin and eosin staining was performed to assess liver injury,and immunofluorescence was used to evaluate hepatic mitophagy.Results:The 2-amino-5-chloro-N,3-dimethylbenzamide powder(99%purity)entered the human body mainly via the skin and respiratory tract due to poor personal protective measures.The typical course of 2-amino-5-chloro-N,3-dimethylbenzamide poisoning was divided into latency,rash,fever,organic dam-age,and recovery phases in accordance with the clinical evolution.Rash and fever may be the important premonitory symptoms for further organ injuries.The chemical was detected in the blood of all patients and caused multiple organ injuries,predominantly liver injury,including kidney,myocardium,and micro-circulation.Three patients recovered smoothly after comprehensive treatments,including artificial liver therapy,continuous renal replacement therapy,glucocorticoids,and other symptomatic and supportive treatments.One patient survived by liver transplantation.The postoperative pathological findings of the removed liver showed acute liver failure,and immunofluorescence staining confirmed the abundance of mitophagy in residual hepatocytes.Conclusions:This study is the first to elaborate the clinical characteristics of patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.The chemical enters the body through the respiratory tract and skin during industrial production.The 2-amino-5-chloro-N,3-dimethylbenzamide poisoning causes multiple-organ dysfunction with a predominance of liver injury.Liver transplantation may be an effective option for patients with severe liver failure.The mechanisms of liver injury induced by 2-amino-5-chloro-N,3-dimethylbenzamide might involve abnormal mitochondrial function and mitophagy.

The characteristics of liver injury induced by Amanita and clinical value of α-amanitin detection

Background:Amanita poisoning as a foodborne disease has raised concerning mortality issues.Reducing the interval between mushroom ingestion and medical intervention could greatly influence the outcomes of Amanita poisoning patients,while treatment is highly dependent on a confirmed diagnosis.To this end,we developed an early detection-guided intervention strategy by optimizing diagnostic process with performingα-amanitin detection,and further explored whether this strategy influenced the progression of Amanita poisoning.Methods:This study was a retrospective analysis of 25 Amanita poisoning patients.Thirteen patients in the detection group were diagnosed mainly based onα-amanitin detection,and 12 patients were diagnosed essentially on the basis of mushroom consumption history,typical clinical patterns and mushroom identification(conventional group).Amanita poisoning patients received uniform therapy,in which plasmapheresis was executed once confirming the diagnosis of Amanita poisoning.We compared the demographic baseline,clinical and laboratory data,treatment and outcomes between the two groups,and further explored the predictive value ofα-amanitin concentration in serum.Results:Liver injury induced by Amanita appeared worst at the fourth day and alanine aminotransferase(ALT)rose higher than aspartate aminotransferase(AST).The mortality rate was 7.7%(1/13)in the detection group and 50.0%(6/12)in the conventional group(P=0.030),since patients in the detection group arrived hospital much earlier and received plasmapheresis at the early stage of disease.The early detection-guided intervention helped alleviate liver impairment caused by Amanita and decreased the peak AST as well as ALT.However,the predictive value ofα-amanitin concentration in serum was still considered limited.Conclusions:In the management of mushroom poisoning,consideration should be given to the rapid detection ofα-amanitin in suspected Amanita poisoning patients and the immediate initiation of medical treatment upon a positive toxin screening result.

Comparison of clinical and immunological profiles in coronavirus disease 2019 and influenza patients:a case control study

The pandemic caused by the SARS-CoV-2 coronavirus is still looming worldwide,and the pandemic has challenged health care delivery and health care systems internationally.[1]The epidemic of seasonal influenza would occur in the winter months.Since coronavirus disease 2019(COVID-19)and influenza share many clinical symptoms,[2]it is difficult to distinguish these two respiratory infections in the early stage.[3]Although nucleic acid testing was the gold standard to identify different virus infected diseases,false-negative nucleic acid results were reported frequently in COVID-19,[4]and its diagnostic sensitivity is less optimal.Therefore,the aim of our study is to explore and compare the clinical characteristics of COVID-19 and influenza,which could deepen the understanding of these two diseases and provide some guidance for clinicians to make a differential diagnosis.

Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

BACKGROUND:Traumatic aortic dissection(TAD)has a low incidence but extremely high mortality.It always presents atypical clinical manifestations that are easily missed or misdiagnosed.This study mainly aims to describe the imaging characteristics and management of TAD patients.METHODS:A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020.Demographic features,imaging characteristics,and management were analyzed.RESULTS:Twenty-seven patients with type B aortic dissection(age 56.04±16.07 years,20 men)were included.Aortic intimal tears were mostly initiated from the aortic isthmus.The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature(1.78±0.56 cm vs.1.24±0.52 cm,P=0.031).Compared with those in the control group,the maximum diameters of the aortic arch,thoracic aorta,and abdominal aorta in the TAD patients were all significantly widened(all P<0.050).Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD,with a predictive value with an area under the receiver operating characteristic curve(AUC)of 0.673.Finally,26 patients successfully underwent delayed thoracic endovascular aortic repair(TEVAR),and the remaining one patient was treated conservatively.No progression of aortic dissection or death occurred during the six-month follow-up period.CONCLUSIONS:In blunt trauma,the aortic isthmus is the most common site of proximal intimal tears.An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics.Delayed TEVAR might be an eff ective therapeutic option for TAD.

Development and validation of a predictive model for the assessment of potassium-lowering treatment among hyperkalemia patients

BACKGROUND:Hyperkalemia is common among patients in emergency department and is associated with mortality.While,there is a lack of good evaluation and prediction methods for the effi cacy of potassium-lowering treatment,making the drug dosage adjustment quite diffi cult.We aimed to develop a predictive model to provide early forecasting of treating eff ects for hyperkalemia patients.METHODS:Around 80%of hyperkalemia patients(n=818)were randomly selected as the training dataset and the remaining 20%(n=196)as the validating dataset.According to the serum potassium(K+)levels after the fi rst round of potassium-lowering treatment,patients were classifi ed into the eff ective and ineff ective groups.Multivariate logistic regression analyses were performed to develop a prediction model.The receiver operating characteristic(ROC)curve and calibration curve analysis were used for model validation.RESULTS:In the training dataset,429 patients had favorable eff ects after treatment(eff ective group),and 389 had poor therapeutic outcomes(ineff ective group).Patients in the ineff ective group had a higher percentage of renal disease(P=0.007),peripheral edema(P<0.001),oliguria(P=0.001),or higher initial serum K+level(P<0.001).The percentage of insulin usage was higher in the effective group than in the ineff ective group(P=0.005).After multivariate logistic regression analysis,we found age,peripheral edema,oliguria,history of kidney transplantation,end-stage renal disease,insulin,and initial serum K+were all independently associated with favorable treatment eff ects.CONCLUSION:The predictive model could provide early forecasting of therapeutic outcomes for hyperkalemia patients after drug treatment,which could help clinicians to identify hyperkalemia patients with high risk and adjust the dosage of medication for potassium-lowering.

Hypertonic saline resuscitation reduces apoptosis of intestinal mucosa in a rat model of hemorrhagic shock

Objective: To investigate the early effects of hypertonic and isotonic saline solutions on apoptosis of intestinal mucosa in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was established in 21 Sprague-Dawley (SD) rats. The rats were randomly divided into the sham group, normal saline resuscitation (NS) group, and hypertonic saline resuscitation (HTS) group, with 7 in each group. We detected and compared the apoptosis in small intestinal mucosa of rats after hemorrhagic shock and resuscitation by terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL), FITC (fluo- rescein-iso-thiocyanate)-Annexin V/PI (propidium iodide) double staining method, and flow cytometry. Results: In the early stage of hemorrhagic shock and resuscitation, marked apoptosis of small intestinal mucosa in the rats of both NS and HTS groups was observed. The numbers of apoptotic cells in these two groups were significantly greater than that in the sham group (P<0.01). In the HTS group, the apoptic cells significantly decreased, compared with the NS group (P<0.01). Conclusion: In this rat model of severe hemorrhagic shock, the HTS resuscitation of small volume is more effective than the NS resuscitation in reducing apoptosis of intestinal mucosa in rats, which may improve the prognosis of trauma.

The life-saving emergency thoracic endovascular aorta repair management on suspected aortoesophageal foreign body injury

BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.

Performance of extracorporeal membrane oxygenation in patients with fatal paraquat poisoning:grasp for straws?

Dear editor,Paraquat(PQ)can cause acute lung injury and irreversible pulmonary fibrosis,without specific antidotes.Respiratory failure is the main cause of death among patients with PQ poisoning.Currently,the treatment involves the use of adsorbents,intensive hemoperfusion,antioxidants,immunosuppressive therapy,respiratory support by mechanical ventilation,and other symptomatic and supportive treatments.[1-3]The mortality of patients with severe PQ poisoning remains high.More eff ective and safer therapies remain to be explored.Few studies reported performing extracorporeal membrane oxygenation(ECMO)and subsequent lung transplantation with either successful or poor clinical outcome in extremely critical patients with PQ poisoning.[4,5]This study aims to summarize the clinical experience and refl ect on the therapeutic prospect of ECMO in respiratory failure or cardiopulmonary failure caused by fatal PQ poisoning.

Hepatic abscess resulted from a toothpick piercing the gastric wall into the liver

Foreign bodies’ingestion is a common phenomenon,and most of the ingested foreign bodies pass through the gut uneventfully.In clinical practice,less than 1%of these patients develop complications such as gut wall penetration or perforation[1–3].We present a rare complication of hepatic abscess secondary to the toothpick piercing the gastric wall into the liver.The abscess was successfully treated by endoscopic retrieval of the foreign body and empirical antibiotic therapy,without drainage or laparotomy.

Role of routine check-up in the prognosis of patients with pancreatic cancer:A puzzling phenomenon

Background:The high coverage of annual routine health check-up in China is a unique phenomenon throughout the world.However,its clinical value is controversial.In this cohort study,we chose pancreatic cancer as a disease model to explore the role of routine check-up in the prognosis of patients with pancreatic cancer.Methods:Data from 157 patients who were diagnosed with pancreatic cancer between January 2010 and April 2014 were collected.Patients were divided into two groups depending on how their disease was detected.Group A(n=85):Patients were diagnosed with pancreatic cancer in clinic visits.Group B(n=72):Patients were diagnosed with pancreatic cancer in routine check-ups.We compared their prognosis.Results:The tumor stage in group B was earlier than that in group A.The 1-year survival rate in group B was significantly higher than that in group A(74.6%vs.42.4%,P<0.001),while the 3-and 5-year survival rates of the two groups showed no significant difference(P>0.05).The difference of overall survival time between the two groups was not significant(22.0 vs.9.0 months,P=0.078).Conclusions:The stage of pancreatic cancer diagnosed in routine check-ups was earlier and therefore,the intervention was earlier which improved short-term survival rate.However,early intervention did not improve overall survival in the long-term.

Acute generalized exanthematous pustulosis with airway mucosa involvement:A case report

BACKGROUND Acute generalized exanthematous pustulosis(AGEP)is a severe cutaneous adverse reaction characterized by sterile pustules on erythematous skin associated with fever and leukocytosis.The annual incidence of AGEP is estimated to be 1-5 cases per million.Cases of AGEP with oral mucosa involvement have been reported.However,reports of AGEP involving airway mucosa are limited.CASE SUMMARY We report a 42-year-old woman with serious AGEP involving the airway mucosa.The patient initially developed fever and a small rash on her forehead and face.Over the next 2 d,she developed a diffuse,pustular rash over her trunk and legs.In addition,she complained of a cough with white foam-like sputum,chest tightness and dyspnea.Four days later,due to dyspnea,her mental status started to gradually deteriorate.She became more and more drowsy.Biopsies of the skin and airway mucosa suggested the diagnosis of AGEP.According to the European study of severe cutaneous adverse reactions group’s scoring system,the patient scored+6 indicating a probable diagnosis of AGEP.She received intravenous methylprednisolone 120 mg/12 h for 3 d,and was eventually discharged in good condition.This patient had already experienced respiratory failure and airway mucosa involvement on admission;however,the clinicians had an insufficient understanding of AGEP.Glucocorticoid was administered for more than 10 d following onset of the disease,and her overall prognosis was satisfactory.CONCLUSION This case represents a rare clinical feature of AGEP and an important finding for clinicians.

Adult patients with allied disorders of Hirschsprung’s disease in emergency department:An 11-year retrospective study

BACKGROUND In the past years,only a few studies with a limited number of adult patients analyzed clinical features of allied disorders of Hirschsprung’s disease(ADHD),most of which were individual case reports or lacked detailed clinical information.Although many studies have reported patients presenting to the emergency department(ED)with recurrent abdominal symptoms for a number of disorders,there are few data involving ADHD.However,owing to a lack of awareness of the disease,misdiagnoses and mistreatments are common.Severe complications such as perforation,bleeding,malabsorption,and even death in ADHD had been reported by many studies.AIM To assist ED clinicians in having a more comprehensive understanding of this disease and making an early suspected diagnosis of ADHD more effectively.METHODS We enrolled 53 patients who visited the ED and were eventually diagnosed with ADHD over the past 11 years in our hospital.Their basic information,clinical manifestations,and imaging findings were analyzed.Blood indices were compared between the ADHD and irritable bowel syndrome(IBS)groups.RESULTS Adult patients with ADHD had a mean age of 48.8±14.3 years,and 77.4%had been treated before admission.The transverse colon was the most common dilated part(73.6%),and constipation(67.9%)was the most common symptom.ADHD patients can present with uncommon symptoms and false-negative imaging findings.Logistic regression analysis indicated that body mass index(BMI)[odds ratio(OR)=0.786,P=0.013],cholinesterase(per 1000 units;OR=0.693,P=0.008),and blood chlorine(OR=0.816,P=0.022)were determined to be independent related factors between the ADHD and IBS groups.The area under the receiver operating characteristics curve of these three indices combined was 0.812(P<0.001).CONCLUSION Emergency physicians should be vigilant regarding patients with chronic constipation,abdominal pain,or abdominal distension,and consider the possibility of ADHD despite its rarity.Abdominal computed tomography examination is recommended as a useful tool in the suspected diagnosis of ADHD.BMI,cholinesterase,and blood chlorine have good discriminative abilities between ADHD and IBS.The nutritional status of adult patients with ADHD is worthy of further attention.Surgical treatment for adult patients with ADHD is important and inevitable.

Clinical characteristics and outcomes of patients with hepatic veno-occlusive disease induced by Gynura segetum: A retrospective study

Objective: Hepatic veno-occlusive disease(HVOD) has attracted increasing attention in recent years due to its relationship with ingestion of Gynura segetum. The mortality of severe HVOD remains high due to the lack of specific therapies. The aim of the study was to delineate the clinical characteristics and outcomes and explore the potential prognostic factors of HVOD.Methods: This was a single-center retrospective study. Eighty-nine HVOD patients were screened from the First Affiliated Hospital of Zhejiang University with an ingestion history of G. segetum before developing symptoms from January 2009 to May 2018. The enrolled patients were divided into the survivor and death groups according to the clinical follow-up that ended on September 1, 2019. The demographic variables and clinical data of the patients were recorded. A binary logistic regression analysis and receiver operating characteristic curve were conducted to identify the prognostic factors and assess the prognostic value for predicting death, and a survival analysis was performed to evaluate the clinical outcomes.Results: Sixty-four patients were eligible for further analysis. Most patients showed abdominal distension and were positive for migrating dullness in the abdomen(P = 0.740 and P = 0.732, respectively). The patients who died had higher levels of model for end-stage liver disease score, and higher prothrombin time than those who survived(both P < 0.001). All HVOD patients in both the survival and death groups showed ascites with abnormal imaging presentations of the liver parenchyma and hepatic blood vessels.Unexpectedly, we found that hydrothorax was detected in 21(65.63%) patients in the death group and 19(59.38%) patients in the survivor group during hospitalization, which was rarely mentioned in previous studies. Furthermore, international normalized ratio(INR) and creatinine are found to be potential independent prognostic factors for predicting death. Six severe patients achieved clinical improvements and survived after liver transplantation.Conclusion: HVOD can be induced by the ingestion of G. segetum, and INR combined with creatinine has prognostic value for predicting death. Liver transplantation may be an effective treatment option for severe HVOD patients.

Circulating Vitamin D and Risk of Cerebrovascular Disease:A Meta-analysis

Objective:This scoping review aims to perform a meta-analysis to harmonize the existing results on circulating vitamin D and cerebrovascular disease.Methods:Three scientific databases,PubMed,the Cochrane Library and EMBASE,were systematically searched.The overall relative risk(RR)and the corresponding 95%confidence interval(CI)were calculated using a random-effects model,and sensitivity analysis and publication bias tests were performed.Results:Of the 4,138 articles retrieved,28 studies were included in our analysis,with a cumulative sample size of 284,840.Subsequent random-effects meta-analysis showed an association between low levels of vitamin D and cerebrovascular disease:RR=1.39,95%CI:1.26,1.53.In subgroup analyses,low levels of vitamin D were associated with both ischemic stroke(RR=1.35,95%CI:1.17,1.55)and hemorrhagic stroke(RR=1.70,95%CI:1.03,2.79).The funnel plot was asymmetric.Sensitivity analysis showed that one literature article had a significant impact on the results.There was a statistically significant correlation between low levels of vitamin D and cerebrovascular disease.Conclusion:Vitamin D levels are associated with both ischemic and hemorrhagic stroke.

Successful treatment of patients with paraquat intoxication:three case reports and review of the literature

Objective: To report on three patients with paraquat (PQ) intoxication surviving after combined therapy with hemoperfusion (HP), cyclophosphamide (CTX), and glucocorticoid. Methods: Three patients suffered acute renal failure in a few days after ingesting a lethal amount of PQ. Chest computed tomography (CT) scans revealed obvious pulmonary inflammation, pleural effusion, and fibrous lesions several days after ingestion. HP was performed immediately, followed by large doses of glucocorticoid (methylprednisolone, 500 g/d) and CTX (approximately 4 g). Results: After 50 d of treatments, all three patients were discharged in healthy condition, with chest CT showing small fibrous lesions, exuda- tion, and both lungs clear of auscultation. Conclusions: The protective effect of the lungs may have been due to timely treatment at adequate doses.

雷公藤在免疫介导的炎症疾病中的应用:研究进展及展望

雷公藤作为中国传统药材的瑰宝,具有较强的抗炎及免疫抑制作用,临床上广泛应用于类风湿性关节炎、系统性红斑狼疮、肾脏疾病等自身免疫性及炎症性疾病。由于雷公藤对于自身免疫疾病疗效显著,且没有激素的副作用,近年来备受国内外研究者关注,大量研究开始探究其抗炎及免疫抑制的潜在机制。而雷公藤本身也存在毒副作用,限制了其在临床更广泛的应用。本文总结了近年来雷公藤在免疫相关炎性疾病临床应用情况,雷公藤抗炎和免疫调节的机制以及目前雷公藤减毒的方法,旨在更好地帮助临床医生及科研工作者理解雷公藤的生物特性及作用机制,为临床应用及推广提供参考依据。

关于免疫抑制冲击治疗百草枯中毒的安全性和有效性评价系统回顾和荟萃分析（英文）

目的:评估免疫抑制冲击治疗百草枯中毒患者的安全性和有效性.创新点:报告了在百草枯中毒的患者中,使用免疫抑制冲击治疗的效果,确定了其是否会增加患者发生肝炎和肾衰的风险.方法:我们检索了截止于2018年6月,发表在PubMed,EMBASE和Cochrane三个数据库中关于免疫抑制冲击治疗百草枯中毒患者的文献.经过筛选,最终有7篇文献符合纳入标准,总共426位病人,并采用RevMan软件进行数据分析.结论:对纳入的7篇文献进行荟萃分析,发现使用免疫抑制冲击治疗能够有效的降低百草枯中毒患者的死亡率,而且是相对安全的,不会增加患者发生肝炎或者肾衰的发生率.部分文献报道一些患者出现了白细胞减少,但都在停药后1~2周内恢复正常.另外,文献还报道了两例非致死性的脓毒症,这可能是免疫抑制治疗造成的免疫功能低下引起的.

A Review of Compression, Ventilation, Defibrillation, Drug Treatment, and Targeted Temperature Management in Cardiopulmonary Resuscitation

Objective：Important studies of cardiopulmonary resuscitation （CPR） techniques influence the development of new guidelines.We systematically reviewed the efficacy of some important studies of CPR.Data Sources：The data analyzed in this review are mainly from articles included in PubMed and EMBAS E,published from 1964 to 2014.Study Selection：Original articles and critical reviews about CPR techniques were selected for review.Results：The survival rate after out-of-hospital cardiac arrest （OHCA） is improving.This improvement is associated with the performance of uninterrupted chest compressions and simple airway management procedures during bystander CPR.Real-time feedback devices can be used to improve the quality of CPR.The recommended dose,timing,and indications for adrenaline （epinephrine） use may change.The appropriate target temperature for targeted temperature management is still unclear.Conclusions：New studies over the past 5 years have evaluated various aspects of CPR in OHCA.Some of these studies were high-quality randomized controlled trials,which may help to improve the scientific understanding of resuscitation techniques and result in changes to CPR guidelines.

血液灌流对急性2,4-二硝基苯酚中毒患者的毒物清除疗效评估（英文）

目的：本研究通过监测急性2,4-二硝基苯酚中毒患者治疗前后血浆毒物浓度的动态变化,从而探讨血液灌流治疗对急性2,4-二硝基苯酚中毒患者的毒物清除疗效及其临床价值。创新点：由于急性2,4-二硝基苯酚中毒患者在临床中较为罕见,其相关毒物代谢动力学资料十分缺乏,且尚未有规范的临床救治方案。本研究创新点主要有：（1）对2,4-二硝基苯酚的毒物代谢动力学进行了必需的探讨和研究;（2）为临床上形成规范的救治方案,提供了科学的实践资料。方法：回顾性分析了16例急性2,4-二硝基苯酚中毒患者的救治经过,其中14例幸存者根据救治中实施树脂-血液灌流治疗的强度和频度差异,分为常规血液灌流组（5例）和强化血液灌流组（9例）。同时,本研究使用超高效液相色谱串联质谱方法对患者救治过程中的血浆毒物浓度进行了动态监测。结论：14例幸存患者的初始血浆2,4-二硝基苯酚浓度为0.25-41.88μg/ml不等,且初始血浆毒物浓度与患者体温高低呈正相关。研究发现,机体对于2,4-二硝基苯酚的清除是缓慢而持久的。根据血浆2,4-二硝基苯酚浓度动态变化计算而得,患者血浆毒物总清除率R3（中毒后第1日至第3日）、R3–7（中毒后第3日至第7日）和R7（中毒后第1日至第7日）分别为（53.03±14.04）%、（55.25±10.50）%和（78.29±10.22）%。其中,强化血液灌流组患者的血浆毒物总清除率R3、R3–7和R7均显著高于常规血液灌流组,差异有统计学意义（P〈0.05）。此外,强化血液灌流组患者的2,4-二硝基苯酚清除半衰期（t1/2）明显短于常规血液灌流组,差异有统计学意义（P〈0.05）。因而,本研究显示高强度、高频度地实施血液灌流治疗有利于急性2,4-二硝基苯酚中毒患者清除毒物。

严重失血性休克大鼠液体复苏后的免疫修复（英文）

目的:严重失血性休克大鼠模型早期阶段使用不同的液体复苏,比较脾脏组织中调节性T细胞(Tregs)、辅助性T细胞1(Th1)/Th2以及细胞毒性T细胞1(Tc1)/Tc2的不同变化,初步探讨其免疫修复机制。创新点:(1)脾脏为机体重要免疫器官,检测其中的免疫细胞变化,比外周血更具敏感性和特异性;(2)将免疫反应中多环节的免疫细胞变化进行协同分析,结果更具创新性和科学性,为临床上形成规范的救治方案提供了科学的实践资料。方法:将SD雄性大鼠随机分成5组,其中对照组和Sham组(假手术)仅作为比较,其余三组在建立严重失血性休克大鼠模型后,采用不同的液体复苏:等渗盐水(NS组)、高渗盐水(HTS组)和羟乙基淀粉(HES组)。然后再灌注30分钟,并持续监测血液动力学120分钟,最后心脏穿刺,取脾脏组织,通过三色荧光标记流式细胞术进一步分析CD4^+CD25^+Foxp3^+Treg细胞含量,以及Th1/Th2和Tc1/Tc2的比值。结论:液体复苏后大鼠脾脏中CD4^+CD25^+Foxp3^+Tregs细胞含量、Th1/Th2和Tc1/Tc2的比值在对照组、Sham组和HTS组中无差异,并都显著高于NS组和HES组。与Sham组比较,HTS组中Tc1水平明显升高,而NS组、HES组和HTS组中Tc2水平均有升高,且三组之间Tc2水平无差别。因此,对于维持脾脏中Treg细胞含量、Th1/Th2和Tc1/Tc2平衡的作用上,HTS液体复苏对免疫系统的影响大于NS和HES。综上所述,在失血性休克后的早期阶段HTS复苏可提供潜在的免疫修复作用。