4482例住院儿童损伤和中毒的外部原因分析

目的:总结分析某院住院患儿损伤、中毒的特点及相关原因分析,为预防儿童损伤和中毒提供科学依据。方法:按照ICD-10标准分类,统计分析2019年主要诊断编码在S00-T99(剔除T80-T98手术和医疗操作的并发症和后遗症)的住院患儿资料,对这些住院患儿的年龄、性别、损伤原因进行分析。结果:在4482例住院儿童损伤中毒病例中,男童2861例,女童1621例,男女之比为1.76∶1,6~11岁组所占比重最大(31.9%),排在前五位的损伤中毒原因分别是跌倒/坠落、异物、交通事故、烧烫伤、砸伤(撞伤)。结论:政府、家庭、学校应通力合作、多管齐下,针对各类损伤中毒的年龄分布规律,采取有针对性的预防措施,可有效降低儿童损伤中毒的发生率。

Venous diethylene glycol poisoning in patients with preexisting severe liver disease in China

AIM: To analyze the clinical presentation of venous diethylene glycol (DEG) poisoning in patients with preexisting severe liver disease and factors that correlate with DEG poisoning. METHODS: Retrospective chart review was performed to analyze the epidemiology, clinical presentation, hepatorenal functions, hemodynamics and pathological characteristics of 64 patients with severe liver disease who received intravenous armillarisin-A, the solvent of which was DEG. Comparative analyses of correlating factors and causes for poisoning were based on the presence or absence of poisoning. RESULTS: Of the 64 patients who received armillarisin-A, 15 were found to have DEG poisoning. Twelve poisoned patients died. After a mean of 5 d, the poisoned patients displayed acute renal failure. Metabolic acidosis occurred in 13 cases. BUN, Cr, and CO2 values were significantly elevated and exacerbation of digestive tract symptoms and/or symptom was noted in 11 cases. Neurological system impairment was observed in 10 cases after 2 wk. Compared to the 49 non-poisoned patients, the poisoned patients exhibited significantly lower RBC and Hb values and higher WBC count. Renal biopsy from the poisoned patientsrevealed acute tubular necrosis and interstitial nephritis. Significant differences in preexisting severe hepatitis, ascites, renal disease, and diuretic therapy were found between groups. Prior to diethylene glycol injections, the mean values for neutral granular cells, BUN, Cr, calcium and phosphorous ions differed significantly between groups. CONCLUSION: Venous diethylene glycol poisoning is characterized by oliguric acute renal failure, metabolic acidosis, digestive symptoms, nervous system impairment, and a high probability of anemia and WBC proliferation. Mortality is high. Correlative factors include preexisting severe liver disease, renal disease, and infection.

CYP2E1-dependent hepatotoxicity and oxidative damage after ethanol administration in human primary hepatocytes

AIM： To observe the relationship between ethanol-induced oxidative damage in human primary cultured hepatocytes and cytochrome P450 2E1 （CYP2E1） activity, in order to address if inhibition of CYP2E1 could attenuate ethanol- induced cellular damage. METHODS： The dose-dependent （25-100 mmol/L） and time-dependent （0-24 h） exposures of primary human cultured hepatocytes to ethanol were carried out. CYP2E1 activity and protein expression were detected by spectrophotometer and Western blot analysis respectively. Hepatotoxicity was investigated by determination of lactate dehydrogenase （LDH） and aspartate transaminase （AST） level in hepatocyte culture supernatants, as well as the intracellular formation of malondialdehyde （MDA）. RESULTS： A dose-and time-dependent response between ethanol exposure and CYP2E1 activity in human hepatocytes was demonstrated. Moreover, there was a time-dependent increase of CYP2E1 protein after 100 mmol/L ethanol exposure. Meanwhile, ethanol exposure of hepatocytes caused a time-dependent increase of cellular MDA level, LDH, and AST activities in supernatants. Furthermore, the inhibitor of CYP2E1, diallyl sulfide （DAS） could partly attenuate the increases of MDA, LDH, and AST in human hepatocytes. CONCLUSION： A positive relationship between ethanolinduced oxidative damage in human primary cultured hepatocytes and CYP2E1 activity was exhibited, and the inhibition of CYP2E1 could partly attenuate ethanol-induced oxidative damage.

Dosage of L-arginine Preventing Acute High-dose PDD Nephrotoxicity

Objective： To explore the optimal dose of L-arginine to prevent acute high-dose （HD）-PDD nephrotoxicity. Methods： 128 cases using PDD with the dosage of 100 mg/m^2 within two days （D1, 2） in combination with L-arginine were randomly divided into 3 groups of A, B and C. The dosages of L- arginine in the 3 groups were 5 g/（m^2·d）, 10 g/（m^2·d） and 15 g/（m^2·d）, respectively. Each patient received 2 cycles chemotherapy to form self control： 1 cycle combined with L-arginine, while 1 cycle chemotherapy alone, β2-MG in urine, BUN, Cr and uric acid in blood were detected just 24 h before and after using PDD. The changes of each index in the three groups were observed in the presence or absence, and the therapeutic effects were compared among the three groups. Results： There was no significant difference in BUN, Cr and uric acid in blood before and after chemotherapy in the presence or absence, showing these indexes could not be used as markers of early acute nephrotoxicity. Urine β2-MG values in the presence and absence were 0.9120±0.6618 vs 1.5167±0.7908 （P〈0.05）, 0.5404±0.5810 vs 1.4616±0.8120 （P〈0.01）, 0.4998±0.6210 vs 1.5210±0.7710 （P〈0.01） in the groups A, B and C respectively. The excellent effective rate and total effective rate in groups A, B and C were 40.9% and 59.1%, 68.2% and 90.9%, and 77.5% and 97.5%, respectively. There was significant difference in the excellent effective rate and total effective rate between groups A and B, but not between groups B and C. Conclusion： The optimal dose of L- arginine to prevent acute HD-PDD nephrotoxicity is 10 g/（m^2·d）. Increased dosage can＇t improve the effect accordingly.

α_1-ANTITRYPSIN ATTENUATES ENDOTOXIN-INDUCED ACUTE LUNG INJURY IN RABBITS

Objective To investigate whether pretreatment with α 1-AT can attenuate acute lung injury (ALI) in rabbits induced with endotoxin. Methods Thirty-two New Zealand rabbits were randomly assigned to four groups(n=8):1.Infusion of endotoxin(Lipopolysaccharide,LPS 500μg/kg)without α 1-AT (group LPS).2.Infusion α 1-AT 120mg/kg at 15min before challenge with LPS(group LAV).3.Infusion of α 1-AT 120mg/kg(group AAT).4 Infusion of saline 4ml/kg as control (group NS).Arterial blood gases,peripheral leukocyte counts and airway pressure were recorded every 1h.Physiologic intrapulmonary shunting (Qs/Qt) was measured every 4h.After 8h the bloods were collected for measurement of plasma concentration and activity of α 1-AT.Then bronchoalveolar lavage fluid (BALF)was collected for measurement of concentrations of total protein (TP),interleukin-8(IL-8),tumor necrosis factor(TNF-α),the activities of elastase-like and α 1-AT,total phospholipids(TPL) and disaturated phosphatidylcholine (DSPC).In addition,the wet-to-dry lung weight ratio(W/D) was measured. Results After infusion of endotoxin,it was observed that PaO 2,peripheral luekocyte counts,total respiratory compliance progressively decreased and P peak and Qs/Qt increased comparing with the baseline values.In contrast to group NS,the increased plasma concentration but reduced activity of α 1-AT was found in group LPS.In the BALF,the activity of α 1-AT,TPL,DSPC/TPL were lower,but the concentrations of albumin,IL-8,TNF-α,and the activity of NE were higher.The ratio of W/D also increased.The pretreatment of α 1-AT attenuated the deterioration of oxygenation,the reduction of compliance and the deterioration of other physiological,biochemical parameters mentioned above. Conclusion Pretreatment with α 1-AT could attenuate endotoxin-induced lung injury in rabbits.Those beneficial effects of α 1-AT might be due in part to the inhibitory effect on neutrophil elastase.

The analysis of injured and poisoned patients during the construction of urbanization and industrialization from 1998 to 2002

Objective: To analyze the causes of injury and poisoning during construction of urbanization and industrialization and to explore proper measures. Methods: The data of the patients with injury and poisoning during construction of urbanization and industrialization treated in out hospital from 1998 to 2002 were retrospectively analyzed. Results: The number of discharged patients of injury and poisoning accounted for (29.2)% of the total number ((49 800)) of discharged patients in the corresponding period in our hospital, which was greater than that of other city and county hospitals, and accounted for (94.3)% of the total number ((15 411)) of discharged patients of the Surgery Department in the corresponding period in our hospital. Injuries caused by motor vehicle traffic accidents, cutting and piercing instruments or objects, homicide and injury purposely inflicted by other persons and accidental falls held (78.9)%. The number of the inpatients in 2002 increased by (83.3)% compared with that of 1998, the number of injured and poisoned inpatients increased by (76.1)% and these patients aged mainly at age of 15-39 years, holding (80.1)%. In a year, the peak period of trauma patients was in summer because of hot weather; the fewest in February for the floating people went home for Spring Festival holidays. Conclusions: During construction of rural urbanization and industrialization, injuries and poisoning increase evidently and are the main tasks of surgical management. So to raise its treatment level and therapeutic effect is a key point.