Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) is a serious complication that occurs several days or weeks after carbon monoxide (CO) intoxication. This study identified computed tomography (CT) findings in the prediction of DEACMP development. Adults with CO poisoning admitted to Beijing Chaoyang Hospital, Shenyang Ninth People's Hospital, Shanxi Second People's Hospital and Shandong Provincial Hospital in China from January 2013 to January 2016 were retrospectively analyzed. Baseline demographic and clinical characteristics were extracted from the medical records. Brain CT imaging was carried out within 24 h of admission, and an integrated CT score was calculated to semi-quantify lesion severity. Patients were followed-up for 6 months. Baseline characteristics and CT findings were compared among patients who developed DEACMP (DEACMP group) and those who did not (non-DEACMP group). The receiver operating characteristic (ROC) curve analysis was used to examine the utility of integrated CT score for predicting DEACMP. Among the 123 patients included in the analysis, 27 (22.0%) developed DEACMP. The DEACMP and non-DEACMP groups did not differ with regard to age, sex and carboxyhemoglobin (COHb) level at admission. However, compared with the non-DEACMP group, the patients in the DEACMP group had longer onset time of symptoms and duration of exposure to CO, higher acute physiology and chronic health evaluation-II (APACHE-II) score, lower Glasgow Coma Scale (GCS) score, and there was a higher proportion of patients with severe symptoms and brain CT abnormalities (81.5 vs. 51.0%; P<0.05). Integrated CT score in the DEACMP group was significantly higher than that in the non-DEACMP group (73.63 vs. 51.39; P<0.01). ROC curve was used to analyze the utility of integrated CT score in the prediction of DEACMP. The area under the ROC curve was 0.700 (95% confidence interval, 0.584-0.817; P<0.01). In conclusion, brain integrated CT score has the potential to identify DEACMP in patients.

2018年3月,伴随着国务院行政部门的职能调整,职业卫生的监管职能重新回到卫生行政部门,《中华人民共和国职业病防治法》面临再次修改.当前,我国职业病高发依然构成重大的公共卫生和社会问题,社会各界对于屡次修订《职业病防治法》以及政府部门职能调整寄予了很高的希望. 作为职业病诊断机构和职业病诊断医师,我们是否意识到在整个修法过程中,社会层面一度热议的职业病诊断问题,与职业病防治的实际需求和职业病学科建设及人才培养方面的发展方向存在一定的差异.大多数法定职业病可防而不能根治,职业病诊断工作只能在一定范围内服务于患病的劳动者,无法直接降低职业病的发病率.因而解决我国职业病的高发问题,关键在预防.

中毒性疾病的治疗在对症支持治疗的基础上,主要通过改变毒物代谢动力学和改变毒效学两条途径来实现.通过分别概述急性有机磷杀虫剂中毒、中毒性高铁血红蛋白血症、抗凝血杀鼠剂中毒、铅中毒、汞中毒的特效解毒剂治疗效果,对特效解毒剂的临床应用现况做了分析和探讨.

收集北京朝阳医院2003-2015年收治的34例急性氨气中毒患者的临床资料,对其发病情况、临床症状和体征、实验室检查指标和急救治疗措施及转归情况进行回顾性分析.

Objectives: To evaluate the efficacy of conservative treatment vs. hemoperfusion (HP) vs. HP + continuous veno-venous hemofiltration (CVVH) for acute Paraquat (PQ) poisoning. Methods: This was a multicenter retrospective study of patients with PQ poisoning between January 2013 and June 2014. Clinical data and PQ serum levels were collected at baseline and after 24, 48, and 72 h of treatment. Results: Seventy-five, 65, and 43 underwent conservative treatment only (conservative treatment group), conservative treatment + HP (HP group), and conservative treatment + HP + CVVH (HP + CVVH group), respectively. PQ serum levels decreased in all groups after 72 h of treatment (p < 0.001); meanwhile, these values decreased faster in the HP and HP + CVVH groups compared with the conservative treatment group. More importantly, PQ blood levels were significantly lower in the HP + CVVH group compared with the HP group at 24 h (p < 0.05). Sequential organ failure assessment (ΔSOFA) values in the HP and HP + CVVH groups were significantly lower compared with that obtained for the conservative treatment group (p < 0.05). The 60-day survival rates were 21.3, 43.1 and 46.5%, respectively. Multivariate analysis indicated that age, PQ dose, admission PQ levels, and admission SOFA score were independently associated with mortality. HP and HP + CVVH were protective factors. Conclusion: Early HP or HP + CVVH after PQ poisoning could decrease PQ blood levels, alleviate organ damage, and increase survival.

s are available online only, free of charge, at www.karger.com/doi/10.1159/000446616 Basel · Freiburg · Paris · London · New York · Chennai · New Delhi · Bangkok · Beijing · Shanghai · Tokyo · Kuala Lumpur · Singapore · Sydney Selected Abstracts from the 34th Vicenza Course on AKI & CRRT Vicenza, June 7–10, 2016

Objective To study the clinical value of hypokalemia to predicting the prognosis of acute paraquat poisoning in the early stage.Methods A total of 182 patients with paraquat poisoning were divided into survival group and death group according to the follow-up results.The clinical data were compared between two groups.The death factors were explored by binary logistic regression analysis.The patients were divided into hypokalemia group (n =83) and nonhypokalemia group (n=99) according to the serum potassium concentrations at admission,and the survival rates were compared between two groups.ROC curve was used to determine the sensitivity and specificity of serum potassium for predicting the survival,and Kaplan-Meier method was used to analyze the relationship between hypokalemia and death.Results In 182 patients,70 survived and 112 died,with the fatality of 61.53％.Significant differences were found between the survival and death groups in the age,the amount of ingested,white blood cell count,hemoglobin,plasma glucose,blood urea nitrogen,creatinine,serum potassium,CO2,anion gap and urine concentrations of paraquat (P＜ 0.05),among which the amount of ingested (OR=0.057,95％CI:0.916 to 0.975,P=0.016),urine concentration of paraquat (OR=1.937,95 ％ CI:0.039 to 0.536,P =0.004),serum potassium (OR =-1.725,95 ％ CI:1.259 to 24.995,P=0.024),creatinene (OR=0.048,95％CI:0.913 to 0.996,P=0.034) and anion gap (OR=0.225,95％CI:0.654 to 0.976,P =0.028) were the independent prognostic factors for death.When serum potassium concentration was 3.45 mmol/L,the sensitivity was 91.4％,and specificity was 68.7％ for predicting the survival of the patients with paraquat poisoning.Kaplan-Meier survival analysis showed the survival rate of hypokalemia group was significantly lower (7.23％) than that in non-hypokalemia group (64.65％) (P＜0.05).Hypokalemia was the high risk factor for death (OR=8.943,95％CI:4.082 to 19.593,P=0.000).Conclusion Hypokalemea might be one of distinguishing characteristics in the early stage of acute paraquat poisoning and can be used as a clinical marker for predicting the death of paraquat poisoning.

OBJECTIVE:To study the influences of carbon disulfide (CS2) exposureon fatty acid metabolism in apolipoprotein E (ApoE) knockout mice and C57BL/6J mice.METHODS:Twenty-four male ApoE knockout mice were randomly and equally divided into four groups: a CS2-exposed normal diet group, a CS2-unexposed normal diet group, a CS2-exposed high-fat diet group, and a CS2-unexposed high-fat diet group. Twenty-four C57BL/6J male mice were divided into four groups in the same way. The CS2-exposed groups were exposed to CS2 (1 g/m³) by static inhalation for 5 hours a day, 5 days a week. After two weeks, the whole blood of mice was collected. Methyl ester derivatization of fatty acids was performed using an acid-catalyzed method. Fatty acid contents before and after exposure were compared by gas chromatography-mass spectroscopy.RESULTS:There were significant differences in fatty acid contents of mice between the four groups. For the C57BL/6J mice, the arachidic acid contents in the CS2-exposed high-fat diet group were significantly lower than those in the CS2-unexposed high-fat diet group (P = 0.0450). For the ApoE knockout mice, the arachidonic acid contents in the CS2-exposed normal diet group were significantly lower than those in the CS2-unexposed control diet group (P = 0.0452). For the ApoE knockout mice, the γ-linolenic acid contents in the CS2-exposed high-fat diet group were significantly higher than those in the unexposed high-fat diet group (P = 0.0447).CONCLUSION:Exposure to CS2 can induce fatty acid metabolism disorder in mice, indicating that CS2 may increase the risk of atherosclerosis and other cardiovascular diseases.

对25例慢性正己烷中毒患者的神经肌电图进行随访观察.结果提示肌电图改变与临床症状体征相符,运动和感觉神经同时受损,运动神经受损下肢比上肢严重,而感觉神经受损上肢比下肢严重,神经传导的恢复慢于临床表现的恢复.

在临床医学、环境医学、职业医学研究工作中,生物样品(如血、尿等)是了解人体健康状况的重要指标之一.在评价机体的毒物负荷时,尿样因收集简便,对人体无创伤,且其分析前处理也较简单,在评价毒物内负荷及其对机体的影响方面,占有非常重要的地位.文献报道24 h尿中被测物浓度,多与接触程度有较好的正相关,能较准确地反映毒物在体内的蓄积状况,但是对于患者来说,收集24小时尿费时、费力,且对容器及存放条件要求严格,故此项多适用于住院患者.

Sodium 3,5,6-trichloropyridin-2-ol (STCP) is an important intermediate for synthesizing organophosphate insecticide chlorpyrifos. At present, chlorpyrifos is one of the world's largest species of pesticide products. Many studies have focused on the toxicity of chlorpyrifos, but few reports have looked at the toxicity mechanism of STCP. Even fewer studies have looked at STCP poisoning. With increasing production and usage of STCP, the chances of such poisoning will increase. In this study, we present a report on four workers who helped in the industrial manufacture of STCP and who were affected by exposure to it. We hope that these case studies will provide a foundation for further research into STCP.

在临床医学、环境医学、职业医学研究工作中,生物样品(如血、尿等)是了解人体健康状况的重要指标之一.在评价机体的毒物负荷时,尿样因收集简便,对人体无创伤,且其分析前处理也较简单,在评价毒物内负荷及其对机体的影响方面,占有非常重要的地位.文献报道24 h尿中被测物浓度,多与接触程度有较好的正相关,能较准确地反映毒物在体内的蓄积状况,但是对于患者来说,收集24小时尿费时、费力,且对容器及存放条件要求严格,故此项多适用于住院患者。

OBJECTIVE:To explore the prognostic value of the Acute Kidney Injury Network (AKIN) criteria in patients with acute paraquat (PQ) poisoning.METHODS:A retrospective study on 184 patients with acute PQ poisoning admitted to the Shandong Provincial Hospital from April 2010 to March 2013 was done. The clinical data and AKIN stage were compared between survivors and non-survivors, and multivariate analysis was done by Cox-proportional hazards regression model. Kaplan-Meier method was used to analyze survival rate of the patients in different stages of poisoning.RESULTS:The 60-day mortality was 42.93% (79/184). There were no significant differences between the survival and non-survival groups in respect of gender, simultaneous alcohol drinking, duration between ingestion and gastric lavage, duration between ingestion and first hemoperfusion, and number of hemoperfusion. Significant differences were found between two groups in age, quantity of ingestion, receiving hemoperfusion or not, AKIN stage, and initial laboratory data including white blood cell count, the percentage of neutrophil, blood glucose, blood urea nitrogen, creatinine, β2-microglobulin (β2-MG), serum K+, CO2, anion gap, and urinary concentration of PQ. The AKIN stage [odds ratio (OR)=3.242, 95% confidence interval (95%CI) 2.236-4.701, P=0.000], urinary concentrations of PQ (OR=1.773, 95%CI 1.008-3.116, P=0.047), the amount of ingestion (OR=1.003, 95%CI 1.000-1.006, P=0.040), and CO2 (OR=0.094, 95%CI 0.891-0.991, P=0.021) were independent prognostic factors for death among them. Kaplan-Meier survival analysis showed the survival rate of AKIN 3 group was significantly lower than that in AKIN 2 group (5.88% vs. 56.25%, χ2=16.149, P=0.000), AKIN 1 group (5.88% vs. 78.95%, χ2=62.444, P=0.000) and non-AKI group(5.88% vs. 100.0%, χ2=173.549, P=0.000).CONCLUSIONS:The AKIN staging is a reliable marker for mortality prediction in acute PQ poisoning patients. In cases without facilities to determine plasma PQ concentration, the staging of AKIN may be a simple and practical tool for assessing the severity of PQ poisoning.

有机磷农药广泛应用于农业生产活动中，其毒性较大，由其导致的急性中毒很常见。在本院统计的急性化学品中毒事件中，急性有机磷农药中毒（ Acute organophosphate pesticide poisoning ，AOPP）的发生占第1位［1］。本文将对AOPP发病机制及其实验室检测指标新进展作系统的介绍。

目的：介绍GBZ 11—2002《职业性急性磷化氢中毒诊断标准》修订的背景及主要修订内容依据。方法查阅国内外相关文献，收集急性磷化氢中毒病例资料并进行分析，对本次标准修订内容进行探讨。结果提出本次标准修订仍沿用原标准中以呼吸系统、中枢神经系统损害的临床表现和损害程度作为职业性磷化氢中毒主要诊断分级指标。分级由原标准的轻度、重度2级细化为轻度、中度和重度；将原标准的观察对象变更为接触反应；删除轻度中毒中的支气管周围炎指标；删除明显心肌损害和明显肝、肾损害条款；重度中毒增加“肺泡性肺水肿”、“急性呼吸窘迫综合征”和“猝死”条款。结论修订后的诊断标准适应职业性急性磷化氢中毒的临床特点。

OBJECTIVE:To investigate the relationship between semi-quantification of urine paraquat and the severity of acute paraquat poisoning, and to evaluate the prognostic value of the test in patients with acute paraquat poisoning.METHODS:A total of 179 patients with acute paraquat poisoning were categorized into four groups according to their semi-quantification results of urine paraquat: +group (n = 36), ++group (n = 23), +++ group (n = 25), and ++++group (n = 95). The clinical features, severity of hepatic and renal injuries, respiratory failure, and clinical classification were compared between these four groups. Kaplan-Meier analysis was used to evaluate the survival rate.RESULTS:The 60-day mortality was 45.25% (81/179). The amount of ingestion increased significantly from +group to ++++group (P < 0.05). No patient in +group was found to have serious complications, while most patients in ++++group suffered organ dysfunction or even organ failure. The incidence of acute respiratory failure, renal failure, and hepatic failure in ++++group was significantly higher than that in +group, ++group, and +++group (P < 0.05). The urine paraquat concentration was positively correlated with the clinical severity of acute paraquat poisoning (Spearman correlation coefficient = 0.720, P < 0.01). Kaplan-Meier survival analysis showed that the mortality of ++++group (73.7%) was significantly higher than that of +++group (40%), ++group (4.3%), and +group (0%) (P < 0.05).CONCLUSION:The semi-quantification of urine paraquat is a promising test in evaluating the severity of acute paraquat poisoning. This test can be used to guide therapy and to predict the outcomes of patients suffering acute paraquat poisoning.

The clinical data of 237 suicidal patients with acute paraquat poisoning from April 2010 to November 2012 were retrospectively analyzed.There were 122 males and 115 females with a mean age of 34.9 (11-83) years.The crude 60-day mortality was 59.1% (140/237). All patients with trace or clear blue results in their urine dithionite tests survived and 128/152 (84.2%) patients with dark blue results in their urine dithionite tests deceased.A significant correlation existed between urine paraquat concentrations and degrees of severity for paraquat poisoning following ingestion (Spearman correlation 0.720, P<0.01). The receiver operating characteristics area under the curve of the amount ingested was 0.887(0.845-0.928). Under a cutoff value of 36.5 ml, the amount ingested had a sensitivity of 81.4% and a specificity of 80.2% in predicting mortality.The prognosis of patients with paraquat poisoning was closely related with the amount ingested.And urine dithionite test might be a reliable indicator of the severity and prognosis of acute paraquat poisoning. Key words: Paraquat poisoning; Dithionite test

目的：探讨我国医疗机构救治急性甲醇中毒能力的现状。方法采用文献计量学法，在“中国知网”和“万方医学网”上，以“急性”、“中毒”和“甲醇”为主题词检索2000年1月1日至2013年6月30日在国内公开杂志上发表的急性甲醇中毒文献。自行设计调查表，收集省级中毒救治基地和省、市级非中毒救治基地医疗机构（简称“非中毒救治机构”）关于急性甲醇中毒的救治情况，评估其救治能力和资源配置情况。结果收集到国内公开杂志上发表的急性甲醇中毒患者592例，其中7例职业性中毒患者，585例生活性中毒患者。592例急性甲醇中毒患者中，有190例患者进行了血清甲醇检测，全部患者均未进行血清甲酸检测；19例患者行动脉血气分析。回收省级中毒救治基地有效问卷16份，非中毒救治机构有效问卷14份。调查结果显示，分别有31.25％和12.50％的省级中毒救治基地能够分别开展血清甲醇、甲酸检测，14家非中毒救治机构均不具备开展血清甲醇、甲酸检测能力；31.25％的省级中毒救治基地和7.14％非中毒救治机构具备开展血清乙醇检测的能力；87.50％的省级中毒救治基地和85.71％的非中毒救治机构具备开展动脉血气分析能力。结论血清甲醇检测可作为病因学依据，医疗机构应开展血清甲酸检测。需要进一步规范急性甲醇中毒代谢性酸中毒的治疗，普及动脉血气分析，更多地采用血液透析技术清除毒物。

OBJECTIVE:To establish a method for simultaneous determination of 17 common pesticides in whole blood by solid phase extraction-gas chromatography-mass spectrometry (SPE-GC-MS).METHODS:Whole blood samples were treated by extraction with acetonitrile, and the obtained extract was cleaned up using an Oasis HLB SPE cartridge; pesticides were separated by GC and quantitatively analyzed by MS with selected ion monitoring.RESULTS:The concentrations of 17 pesticides in whole blood were 1.0-5.0 mg/L, and the recovery rate was 41.3-102.1%, with a relative standard deviation of less than 10%in most pesticides. The 17 pesticides showed a good linear relationship between concentration and peak area within 0.5-5.0 mg/L, with a correlation coefficient of 0.9945-0.9994. The limit of detection and limit of quantification were 0.02-0.05 mg/L and 0.05-0.09 mg/L, respectively.CONCLUSION:With this method, 17 pesticides in whole blood can be well separated and determined. This method has high sensitivity, accuracy, and precision and can be used for identification and quantification of multiple pesticides in blood samples.

OBJECTIVE:To investigate the changes in expression of serum cytokines in patients with pneumoconiosis using cytokine antibody chips (CACs).METHODS:The CAC technology was applied to measure the serum levels of 60 cytokines in 12 patients with pneumoconiosis and 3 normal controls.RESULTS:In the patients with pneumoconiosis, the highly expressed serum cytokines included interleukin (IL)-1α, IL-1β, IL-2, ILs 4-16, macrophage colony-stimulating factor, interferon-γ, tumor necrosis factor (TNF)-α, TNF-β, human bone morphogenetic protein-6, fibroblast growth factor-7, neurotrophin-3, and stem cell factor, and the lowly expressed serum cytokines included recombinant human I-309, monocyte chemoattractant protein (MCP)-1, MCP-2, MCP-3, MCP-4, macrophage inflammatory protein (MIP)-1-δ, and MIP-3-α.CONCLUSION:Patients with pneumoconiosis have changes in the expression of most serum cytokines.