ObjectiveTo detect the development of retinal neovascularization (NV) induced by metabolic acidosis in neonatal rats and investigate the relationship between the occurrence of NV and vascular endothelial growth factor (VEGF). MethodsA total of 425 newborn Sprague-Dawley rats in experimental group underwent tubal feeding of NH4Cl (535 mg/kg) with the concentration of (50 mg/ml) (twice per day) from the 2nd day after the birth for 6 days and followed by a period of recovery. Additional 150 neonatal rats were in the control group without the tubal feeding. The rats were executed at the 3rd, 5th, 8th, 10th, 13th, 20th day after birth respectively. The retinal vessels were evaluated through retinal stretched preparation andadenosine diphosphatase (ADPase) staining; VEGF in retina was detected by enzymelinked immunosorbent assay(ELISA).ResultsIn the experimental group, the incidence of retinal NV at the 3rd, 5th, 8th, 10th, 13th, 20th day after birth was 0%，9%，26%，55%，19%, and 0% respectively. At the 3rd day, the expression of VEGF protein was lower in experimental group ［（101.1±14.2 ）pg/mg］ than that in the control group ［（133.2±15.9） pg/mg］（P＝0.004）, while at the 8th day it was higher in experimental group［(98.4±19.2) pg/mg］than that in the control group［（78.1±8.7） pg/mg］（P=0.028). There was no significant difference between the two groups at the 5th, 10th, 13th, and 20th day (Pgt;0.05). ConclusionsMetabolic acidosis may induce NV by injuring the developing retinal vessels. Retinal NV induced by acidosis relates to VEGF. (Chin J Ocul Fundus Dis, 2005,21:296-299)
Acute poisoning is characterized by a sudden and rapid onset, most poisons lack specific antidotes. Even with the full use of blood purification, mechanical ventilation, and various drugs, it is often difficult to change the fatal outcome of critically ill patients. In recent years, extracorporeal membrane oxygenation (ECMO) has gradually gained attention and exploratory application in the treatment of acute poisoning due to its significant cardiopulmonary function support, veno-venous ECMO is used for severe lung injury after poisoning, acute respiratory distress syndrome and respiratory failure due to ineffective mechanical ventilation, and it can also be used to assist the removal of residual poisons in the lungs. Veno-arterial ECMO is commonly employed in patients with circulatory failure following poisoning, fatal cardiac arrhythmias, and arrest of cardiac and respiratory. The application of veno-arterio-venous ECMO has also been reported. The mode of ECMO necessitates timely adjustments according to the evolving illness, while ongoing exploration of additional clinical indications is underway. This review analyzes and evaluates the application scope and effectiveness of ECMO in acute poisoning in recent years, with a view to better exploring and rationalizing the use of this technology.
ObjectiveTo establish paraquat (PQ)-induced acute respiratory distress syndrome (ARDS) mice model via gavage, in order to simulate oral adminitration in clinical situations.MethodsSeventy-eight 6-8-week-old, specific pathogen free female C57 mice were chosen in this study. The mice were randomly divided into the control group (n=6) and the PQ model group(n=36); the mice in the latter group were randomly divided into 6 poisoning model subgroups further, with 6 mice in each, to find out the suitable concentration of PQ to establish stable ARDS model. The mice in the control group were given phosphatebuffer saline (PBS) by gavage, 200 μL per mouse; while the mice in the 6 poisoning model subgroups were given PQ with varies doses of 3, 10, 30, 100, 150, 300 mg/kg respectively by gavage. The clinical manifestations were observed for 7 days, and the ratio of lung wet/dry (W/D) was measured. After the suitable concentration of PQ for stable ARDS mice model was found, the other 36 mice were randomly divided into the controlgroup and the poisoning model group, both were divided into 4 subgroups, according to different observation point in time (1 day and 2, 3, 4 days after PQ gavage). The mice in the 4 control subgroups (n=3) were given PBS by gavage, 200 μL per mouse; while the mice in the 4 poisoning model subgroups (n=6) were given PQ with the suitable concentration for ARDS mice model by gavage. Pathological manifestations by Haematoxylin-Eosin staining and lung injury score were observed and analyzed.ResultsThe mice began to die at the PQ dosage of 150 mg/kg; while the death rate was stable at 300 mg/kg. On the 2nd and 4th day after PQ gavage, lung W/D was 5.335, 6.113, and 5.525, and 6.403, respectively in the mice in 150 and 300 mg/kg subgroup, which differed much from those in the control group (P<0.001). Congestion, edema, hemorrhage, alveolar structure damage, inflammation cells infiltration of lung tissue were observed, and lung injury score increased.ConclusionPQ-induced ARDS mice model by gavage is established successfully.
Objective To summarize the genotypes associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) induced by methazolamide and to provide references for the diagnosis and treatment of SJS and TEN induced by methazolamide. Methods Databases including PubMed, EMbase, CNKI, and WanFang Data were electronically searched from database inception to September 2021. Two reviewers independently screened literature and extracted data, and then a systematic review was performed. Results A total of 18 studies involving 49 patients were included. HLA genetic testing was performed on 37 patients. HLA-B*59:01 was detected in 27 patients, HLA-C*01:02 was detected in 15 patients, and 14 patients carried both genes. Statistical analysis showed that the positive rate of HLA-B*59:01 was 73% (95% CI 0.58 to 0.88) and that of HLA-C*01:02 was 40.5% (95%CI 0.24 to 0.57). The latent time until the symptoms were observed was 14.08 ± 8.77 days, and the mean dosage of methazolamide administered was 88.95±39.45 mg/d. Glucocorticoid and immunoglobulin were the main treatments prescribed. Conclusion Methazolamide can cause SJS and TEN. As the presence of HLA-B*59:01 or HLA-C*01:02 has been reported as a genetic risk factor for these adverse drug reactions, the implementation of genetic screening can effectively reduce their occurrence. Glucocorticoid and immunoglobulin, anti-infectives, should be administered to control the symptoms.
ObjectiveTo observe the prognosis index in acute arsenic trihydride poisoning patients in order to provide references for early clinical treatment. MethodsWe retrospectively analyzed the clinical data of 20 acute arsenic trihydride poisoning patients treated between July 2010 and January 2014. The patients were divided into death group and survival group according to survival situation 90 days later. The length of time from onset to treatment, urine arsenic concentration, blood routine, hepatic and renal function, electrolyte, myocardial enzyme, arterial blood gas analysis were observed by single factor analysis, and the positive indexes were analyzed by logistic regression analysis to seek the potential influencing factors for survival. ResultsCompared with the survival group, the length of time from onset to treatment, urine arsenic, serum total bilirubin, creatinine, creatine kinase of the death group were significantly higher (P<0.05), while the value of pH, HCO3-, BE of the survival group were significantly lower (P<0.05). Logistic regression analysis revealed that these indexes remarkably affected patients' survival rate. ConclusionTherapeutic time window, extent of damage of heart, liver, kidney and acid-base imbalance are closely associated with the survival rate of arsenic trihydride poisoning patients, and timely treatment for above factors can be useful for improving prognosis.
【摘要】 目的 总结非器质性呼吸困难患者的急诊诊治经验，提高急诊医生对心理-生理性疾病的认识。 方法 对2005年-2009年急诊科32例非器质性呼吸困难患者的诊治经过进行回顾性分析。 结果 32例患者发病前均有精神创伤或过度劳累、精神紧张、或应急等心因性诱因；有典型的临床症状；过度通气激发试验阳性；血气分析提示呼吸性碱中毒；Nijmegen问卷积分≤23分者18例（56.2%）；辅助检查未见其他原发性疾病。 结论 随着现代社会身心压力的增大，非器质性呼吸困难患者明显增加，临床医生应加强对社会心理-生理性疾病的认识，提高诊断率，对减轻患者的精神压力及避免过度医疗具有重要的临床意义。【Abstract】 Objective To summarize the medical experiences of treating nonorganic dyspnea in the emergency department and raise physicians’ awareness of psychological-physiological diseases. Methods The clinical data of 32 patients with nonorganic dyspnea between 2005 and 2009 in the emergency department of our hospital were analyzed retrospectively. Results All the 32 patients had psychogenic incentives before onset of the disease, such as mental injury, over-exhaustion, nervousness or emergency. All of them had typical clinical manifestations. The results of hyperventilation provocation test were positive. Arterial blood gas analysis implied respiratory alkalosis. Eighteen of them (56.2%) had a mark ≤23 on the Nijmegen questionnaire. Auxiliary examinations showed no other primary diseases. Conclusions With the increase of emotional stress in the modern society, the number of patients with nonorganic dyspnea have markedly increased. Clinicians should strengthen the awareness of social psychology-physiological diseases, and improve diagnostic accuracy, which will have an obvious clinical value in relieving patients’ mental stress and avoiding excessive medical treatment.