Objective: To analyze the correlation between changes in the concentration of glyphosate (GLY) and its metabolites (AMPA) in patients with acute glyphosate poisoning and clinical symptoms, and to provide reference for the study of glyphosate toxicity. Methods: Urine samples from 5 patients with oral glyphosate poisoning admitted to the Emergency Department of Yangzhou Third Class A General Hospital from February to July 2021 were collected. Urine concentrations of GLY and AMPA were measured using derivatization gas chromatography-mass spectrometry, and analyzed based on the patient's clinical manifestations and treatment process. Results: The main symptoms of the patient after poisoning were acute gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, etc. The concentration of GLY in the patient's urine reached its maximum on the first day and gradually decreased over time. On the day of discharge, the final concentration of GLY was 10% lower than the initial concentration. At discharge, the clearance rates of GLY in cases 1, 2, 3, and 4 were 96.97%, 95.91%, 96.87% and 92.87%, respectively. Conclusion: The glyphosate has a shorter maintenance time after entering the human body; There is no correlation between the concentration of glyphosate and its metabolites admitted to the hospital, the dose of poisoning, and clinical symptoms in poisoned patients.

Sepsis-associated acute lung injury (ALI) is a life-threatening condition in intensive care units with high mortality. LncRNAs have been confirmed to participate in the underlying pathogenesis of septic ALI. This study investigated the biological functions of lncRNA CDKN2B-AS1 in septic ALI and its potential mechanism.BEAS-2B cells were challenged with lipopolysaccharide (LPS) and mice were subjected to caecal ligation and puncture (CLP) to induce septic ALI in vitro and in vivo. The expression levels of CDKN2B-AS1, LIN28B, HIF-1α, and pyroptosis-related molecules were assessed by qRT-PCR or Western blotting. The production of IL-1β and IL-18 was detected by ELISA. BEAS-2B cell pyroptosis was examined by flow cytometry. The interaction between LIN28B and CDKN2B-AS1/HIF-1α was validated by RIP and RNA pull-down assays. Colocalization of CDKN2B-AS1 and LIN28B was observed by FISH. ALI was determined by HE staining, the lung wet-to-dry (W/D) weight ratio, inflammatory cell numbers, and total protein concentration in bronchoalveolar lavage fluid (BALF). Caspase-1 expression in the lung tissues was examined by immunohistochemical staining.CDKN2B-AS1 was upregulated in BEAS-2B cells after LPS stimulation. CDKN2B-AS1 knockdown inhibited pyroptosis in LPS-exposed BEAS-2B cells in vitro and the lung tissues of septic mice in vivo. Mechanistically, CDKN2B-AS1 interacted with LIN28B to enhance HIF-1α stability. Rescue experiments showed that HIF-1α overexpression counteracted the inhibitory effect of sh-CDKN2B-AS1 on LPS-induced pyroptosis. CDKN2B-AS1 bound to LIN28B to trigger NLRP3-mediated pyroptosis by stabilizing HIF-1α, which promoted sepsis-induced ALI. CDKN2B-AS1 might be a novel therapeutic target for this disease.

An analytical method for the determination of glyphosate (GLY) and aminomethylphosphoric acid (AMPA) in biological fluid samples (serum and urine) from poisoning patients using liquid chromatography-tandem mass spectrometry (LC-MS/MS) is established. After the sample pretreatment, including protein precipitation and a modified liquid-liquid extraction method, the chromatographic separation was conducted on a trifunctional modified hydrophilic column. The mobile phases in the gradient program were 2.5% formic acid aqueous solution and acetonitrile. The multiple reaction monitoring (MRM) models and the isotope-labeled internal standards were used in the acquisition process. Good linearities and satisfying recovery rates were obtained in two sample matrices with good RSDs. The detection limits of GLY and AMPA were <2 μg L-1, which were close to those obtained in our previous research. The established method was applied to biological samples from five patients with glyphosate intoxication. The analysis of the trend for the concentration of GLY and AMPA in two biological samples was investigated, and the difference in the downward trend of AMPA in urine was found in patients with a relatively higher concentration of GLY in serum.

Sepsis is an infection-induced systemic inflammatory response syndrome accompanied by multiple organ injury and failure. MCC950, an inhibitor of NLR family pyrin domain containing 3 (NLRP3), can alleviate the inflammatory response and relieve inflammation-induced injury. The aim of the present study was to explore the efficacy of MCC950 in lipopolysaccharide (LPS)-induced inflammation and elucidate the underlying mechanisms. Based on a prior study, C57BL/6 mice were divided into three groups: Control, LPS, and LPS + MCC950. The mice were administered 10 mg/kg LPS to induce sepsis and 10 mg/kg MCC950 to treat sepsis 6 h before and after LPS injection. Histopathological imaging revealed organ morphology and damage during inflammation, and MCC950 alleviated organ damage and dysfunction. MCC950 prevented LPS-induced inflammatory responses by reducing inflammatory cytokine levels in the blood. To explore the mechanism by which MCC950 functions, blood neutrophils were isolated and a series of tests were performed. As revealed by measuring reactive oxygen species levels and Annexin V/PI staining of neutrophils, MCC950 reduced oxidative stress and programmed death induced by LPS. Western blotting was used to assess the protein levels of pyroptosis-related markers, including GSDMD, NLRP3, and caspase-1, in neutrophils to further explore the form of death. MCC950 reduced LPS-induced pyroptosis in neutrophils. The results of the survival analysis revealed that MCC950 increased the survival rates of mice within 72 h of LPS injection. MCC950 may be an effective treatment for sepsis that targets neutrophil pyroptosis.

Objective: To analyze the concentrations of glyphosate and its metabolites in occupational exposed workers and their possible effects on human health, so as to provide a reference for improving the safe use of glyphosate and toxicity research. Methods: From April to December 2020, 247 workers directly exposed to glyphosate in 5 enterprises were selected as the contact group, and 237 workers who were not exposed to glyphosate and other pesticides in the same enterprise were selected as the control group. Questionnaire survey and occupational health examination were conducted on objects, and the concentrations of glyphosate and its metabolites in the air of workplaces and biological samples were detected. The correlation between the concentrations and the difference of health examination between the two groups were analyzed. Results: The urine glyphosate concentration (0.022-47.668 mg/L), the rate of exceeding the standard (60.32%, 149/247) and the urine aminomethyl phosphonic acid concentration (<0.010-1.624 mg/L) in the contact group were higher than those in the control group [urine glyphosate concentration (<0.020-4.482 mg/L), the rate of exceeding the standard (2.53%, 6/237) and the urine aminomethyl phosphonic acid concentration (<0.010-0.524 mg/L) ], respectively (P<0.001). The exceeding standard rate of glyphosate concentration in the workplace was 33.67% (33/98). The concentration of glyphosate in the workplace was positively correlated with the concentrations of glyphosate and aminomethylphosphonic acid in urine (r(s)=0.804, 0.238, P<0.001), and the concentration of glyphosate in urine was positively correlated with the concentration of aminomethylphosphonic acid in urine (r(s)=0.549, P<0.001). The alanine aminotransferase (ALT), white cell ratio, creatinine, uric acid, the abnormal rates of ALT and total protein (TP) in the contact group were higher than those in the control group, and TP was lower than that in the control group, the differences were statistically different (P<0.05). The abnormal rates of overall liver function, overall renal function, blood routine test, urine routine test, electrocardiogram, liver B ultrasound and blood lipid in the contact group were significantly higher than those in the control group (P<0.05) . Conclusion: The concentration of glyphosate in the workplace is related to the concentrations of glyphosate and aminomethyl phosphonic acid in the urine of workers, and exposure to glyphosate may have some harmful effects on human health.

Objective:To investigate the related factors that affect the timing and prognosis of early tracheostomy in patients with multiple rib fractures.Methods:A retrospective case series study was conducted on medical data of 222 patients with multiple rib fractures who underwent tracheostomy in Affiliated Hospital of Yangzhou University from February 2013 to October 2019，including 160 males and 66 females，with the age of 18 to 85 years ［（49.5 ± 16.3）years］. According to the practice management guidelines for tracheostomy timing and the use of propensity score matching technology，there were 118 patients with tracheostomy within 7 days of tracheal intubation （early group） and 104 patients with tracheostomy after 7 days of tracheal intubation （late group） before matching，and there were 87 patients in early group and 87 patients in late group after matching. Data were compared between groups including the gender，age，underlying disease，injury severity score （ISS），Glasgow coma score （GCS），number of fractured ribs，total number of rib fractures （NTRF），first rib fracture，flail chest，traumatic brain injury，combined injuries （spine，maxillofacial，sternum），acute respiratory distress syndrome （ARDS），volume fraction of pulmonary contusion（VPC），blood lactic acid （within 24 hours of admission），hemothorax，pneumothorax，mechanical ventilation time，duration of tracheostomy，time from tracheal intubation to incision，length of hospital stay，length of stay in ICU，closed thoracic drainage，number of fiberoptic bronchoscopy，multi-drug resistant bacteria infection，ventilator-associated pneumonia，antibiotic use time，duration of sedative and analgesic drugs used and 28-day mortality. The multivariate Logistic regression analysis was used to predict independent risk factors for early tracheostomy. The Pearson method was used to compare the relationship between multiple factors. The receiver operating characteristic （ROC） curve was used to predict indicators that affect the prognosis of patients with early tracheostomy，and calculate the best cut-off value. The Kaplan-Meier single factor and COX multivariate survival were used to analyze the relevant factors affecting the 28-day mortality of patients.Results:（1） In early group，the NTRF，ARDS and VPC were higher than those in late group，and the time from tracheal intubation to incision and 28-day mortality rate were lower than those in late group （ P < 0.05），while the two groups showed no significant differences in the gender，age，underlying diseases and ISS （ P > 0.05）. （2） The multivariate Logistic regression analysis showed that there was statistical significance in NTRF （ OR = 1.775，95% CI 1.439-2.188），ARDS（ OR = 3.740，95% CI 1.441-9.711），VPC （ OR = 1.087，95% CI 1.052-1.124） （ P < 0.05）； the Pearson method analysis showed a significant correlation between VPC and NTRF （ r = 0.369， P < 0.05） and a low degree of correlation between ARDS and VPC （ r = 0.179， P < 0.05），but there was no significant correlation between ARDS and NTRF （ r = 0.132， P > 0.05）. （3） The ROC curve analysis showed that the area under the curve （AUC） of the VPC and NTRF ［AUC = 0.832 （95% CI 0.770-0.893），AUC = 0.804 （95% CI 0.740-0.868）］ were significantly higher than those of the number of rib fractures ［AUC = 0.437（95% CI 0.352-0.523），GCS ［AUC = 0.519 （95% CI 0.432-0.605）］ and ISS ［AUC = 0.484 （95% CI 0.398-0.571）］ （ P < 0.05）. After calculating the Yorden index，the best cut-off value for VPC was 23.9，and the best cut-off value for NTRF was 8.5. （4） The Kaplan-Meier single factor and multivariate COX model survival analysis showed that the 28-day survival ratio of patients with early tracheostomy was significantly better than that of late tracheostomy （ P < 0.05）. Conclusions:The NTRF，ADRS and VPC are independent risk factors for the timing and prognosis of early tracheostomy. There is a significant correlation between VPC and NTRF. The VPC ≥ 23.9% and or NTRF ≥ 8.5 can be used to predict early tracheostomy in patients with multiple rib fractures. Early tracheostomy may benefit the 28-day survival of patients with multiple rib fractures.

Objective: To explore the clinical characteristics and prognostic factors of patients with acute glyphosate poisoning, and to provide reference for the comprehensive treatment and prognosis judgment of acute glyphosate poisoning. Methods: The complete hospitalized medical records data of 40 patients with acute glyphosate poisoning who were treated in the emergency department of Affiliated Hospital of Yangzhou University from 2014 to 2019 were collected in August 2020. According to the outcome during the follow-up period of 90 d after discharge from hospital, patients were divided into survival group (n=33) and treatment failure group (n=7) . The clinical characteristics of the two groups were analyzed. The influencing factors of prognosis were analyzed by binary logistic regression, and the receiver operating characteristic (ROC) curve was used to evaluate the value of white blood cell count level at admission to the prognosis of patients with acute glyphosate poisoning. Results: The average age of the 40 glyphosate poisoning patients was (57.70±19.72) years old, the oral dose was 100 (50, 200) ml, the hospital stay was 4.0 (1.0, 5.0) d, and the fatality rate was 17.5% (7/40) . The main clinical manifestations were the symptoms of the digestive tract, respiratory tract, cardiovascular system and nervous system. Logistic regression showed that white blood cell level at admission was an influencing factor for the prognosis of patients with acute glyphosate poisoning (OR=1.148, 95%CI: 1.124-1.791, P=0.003) . The ROC curve showed that the best diagnostic cut-off value of white blood cell level at admission to the prognosis of acute glyphosate poisoning was 14.65×10(9)/L, the area under the curve (AUC) was 0.9351. The sensitivity was 100.00%, and the specificity was 84.85%. Conclusion: High level of white blood cell at admission is a risk factor for the prognosis of acute glyphosate poisoning, and white blood cell level at admission has a certain predictive value for the prognosis of acute glyphosate poisoning.

目的 通过改良早期预警评分(modified early warning score,MEWS)、格拉斯昏迷评分(glasgow coma scale,GCS)和营养风险筛查评分(Nutritional risk screening 2002,NRS2002),分析急诊医学规培学员对危重症评估工具的认知、掌握与运用能力,并评估急诊医学培训在提升学员急诊能力建设中的作用.方法 选取2015年7月至2017年12月参加本院急诊医学规范化培训的学员72名为研究对象,依据规培时是否具备执业资格,分成非执业医师组(n=36)与执业医师组(n=36),主要考察培训学员对改良早期预警评分(MEWS)、格拉斯哥昏迷评分(GCS)、NRS2002营养风险筛查评分(NRS2002)的认知、掌握与运用情况.培训前对学员进行摸底考查,了解学员对评估工具的一般认知;专项培训后进行相应考核,了解学员对评估工具理论知识的掌握程度;通过对门急诊病历及住院病历的随机调取,回顾性分析学员培训后临床实践工作中评估工具的主动运用.采用SPSS 13.0统计软件进行统计学分析,组间计数资料采用χ2检验,不满足χ2检验的使用Fisher确切概率法,以P<0.05为差异有统计学意义.结果 培训前,执业医师组GSC正确率高于非执业医师组,MEWS、NRS2002评分工具比较差异无统计学意义;培训后,两组对MEWS、GSC、NRS2002评估工具的掌握程度比较差异无统计学意义;培训后,两组达到较好掌握的人员比例提高,执业医师组和非执业医师组培训前后在MEWS、GSC、NRS2002评估工具掌握程度组内比较差异有统计学意义(P<0.05).结论 培训前执业医师组与非执业医师组对在危重症评价工具认知程度相当,培训后两组人员对评估工具掌握程度大大提高.执业医师组在GCS及NRS2002评估工具运用合格率高于非执业医师组,执业医师组较非执业医师组具有较高的执业风险意识,但临床实践中主动运用评估工具的能动性上仍有待加强.

Pulmonary ground-glass nodules is a special type of pulmonary nodules,it is more likely to malignant transformation of solid nodules,its appearance and lung adenocarcinoma are closely related. With the progress of imaging technology, the detection rate of pulmonary ground-glass nodules increases year by year,however,there is still no guideline for the diagnosis and treatment of pulmonary ground-glass nodules in our country at present. Scientific management,follow-up and treatment of pulmonary ground-glass nodules can early detect malignant lesions,which is conducive to better improve the prognosis of patients and improve the survival rate of patients with lung cancer. The components of pulmonary ground-glass nodules and their natural history determine the benign and malignant,molecular pathological features and invasiveness. Liquid biopsy or radiomics may replace the current invasive biopsy,and wedge resection may reduce the patient's loss of lung function and reduces patient's pain. The surgical treatment of multiple pulmonary ground-glass nodules still need to be further explored.

Objective To analyze the effect of N-acetylcysteine on pulmonary function and inflammatory factors of pa-tients with pulmonary emphysema.Methods The clinical data of 80 cases of COPD patients with pulmonary emphysema in the emergency department and Department of respiration in Affiliated Hospital of Yangzhou University, from January 2015 to January 2017 were retrospectively analyzed.These patients were divided into conventional treatment group(n=40)and the conventional treatment with N-acetylcysteine treatment group(combined treatment group,n=40).According to the treatment methods,the pulmonary function indexes,serum CRP,IL-18,IL-12 levels of the two groups were analyzed.Results The se-rum CRP,IL-18,IL-12 levels of the observation group(1.97 ±0.51),mg/L(101.86 ±16.64), mg/L(89.78 ±10.20) pg/L were lower than the control group(3.22 ±1.25), mg/L(113.47 ±20.17), mg/L(109.35 ±10.24)pg/L(t=3.355,t=3.250,t=3.169,P=0.025,P=0.021,P=0.035);Analysis of the differences between the 2 groups were not significant for blood 0 h,1 h(P>0.05);After treatment,in the observation group,6 h and 24 h blood gas analysis of PaO2 and SpO2were significantly higher than the control group(P<0.05), PaCO2was significantly lower than the control group (P<0.05),but the difference between the value of pH were not significant(P>0.05); The FEV1, FVC, FEV1/FVC of the observation group(2.64 ±0.41)L,(4.01 ±0.24)L,(78.84 ±4.64)were higher than the control group(1.98 ± 0.35)L,(3 ±0.34)L,(69.63 ±5.24)(t=6.965,t=4.541,t=3.747,P=0.020,P=0.034,P=0.021).Conclu-sion N acetyl cysteine can effectively reduce the serum IL-12 level of patients with pulmonary inflammatory reaction,so as to reduce the lung inflammation and improve the lung function of patients.

Objective To investigate the influence of early enteral nutrition(EEN)on the nutritional status and immune function in the patients with acute severe pancreatitis(SAP).Methods Seventy patients with SAP were equally divided into two groups.On the basis of routine therapy, group EEN was given enteral nutrition within 72 hours and group DEN was given enteral nutrition on the 5thday after the onset of illness.The immunity indicators,nutritional status,inflammatory cytokine and clinical symptoms were compared between two groups.Results The levels of CD3+,CD4+, CD4+/CD8+,NK cells,B lymphocyte,IgA,IgG,IgM,prealbumin,albumin and transferrin were higher after treatment than those before(P<0.05),which were higher in group EEN than those in group DEN(P<0.05 or P<0.01).The levels of TNF-α,IL-6,endotoxin and amylase were lower after treatment than those before(P<0.05),which were lower in group EEN than those in group DEN (P<0.01).The acute physiology and chronic health evaluation Ⅱ score were lower and the improvement time of systemic inflammatory response syndrome and hospital stay were shorter in group EEN than those in group DEN(P<0.01).The incidences of sepsis and multiple organ failure syndrome were lower in group EEN than those in group DEN(P<0.05).Conclusion EEN can improve the nutritional status and immune function in SAP patients,and reduce the risk of infectious complications.

Objective:To investigate the effect of noninvasive positive pressure ventilation combined with nikethamide in the treatment of AECOPD (acute exacerbation of chronic obstructive pulmonary disease) with type Ⅱ respiratory failure.Method:110 cases of AECOPD with type Ⅱ respiratory failure patients were randomly divided into two groups.All patients were given conventional expectorant,antiasthma and anti-infection treatment.On the basis of routine treatment,control group patients accepted noninvasive positive pressure ventilation,and the treatment group patients were given noninvasive positive pressure ventilation and nikethamide.PaO2,PaCO2 and pH value were observed before and after treatment in the two groups.FEV1 ％,respiratory rate and mMRC were detected before treatment and 7 d after treatment in the two groups.Tracheal intubation condition,average hospital stay and curative effect were compared between the two groups.Results:The PaCO2 value of the treatment group was significantly lower than that of the control group at 4 h,24 h and 48 h after treatment (P ＜ O.05).The respiratory rate and mMRC in the treatment group were significantly lower than those in the control group in 7 days after treatment (P ＜ 0.05).The rate of tracheal intubation was 7.27％ in the treatment group,which was significantly lower than that in the control group (18.18％).The average hospital stay in the treatment group was shorter than control group (P ＜ O.05).The total effective rate was 90.91％ in the treatment group and 76.36％ in the control group,there was significant difference between the two groups (P ＜ 0.05).Conclusion:Nikethamide combine with noninvasive positive pressure ventilation in the treatment of AECOPD with type Ⅱ respiratory failure can effectively improve the arterial blood gas index,clinical efficacy is remarkable.

目的:探讨中西医结合治疗急性重度有机磷农药中毒的临床疗效,为相关临床治疗提供参考依据.方法:选取我院收治的90例急性重度有机磷农药中毒患者,随机分成研究组和对照组,对照组采用常规西医手段进行抢救治疗,研究组在对照组治疗基础上采用中西医结合的模式进行治疗,对比两组患者治疗后的临床疗效、卫生经济学指标及并发症情况.结果:研究组和对照组的治疗总有效率分别为95.6％和80.0％,两组差异具有统计学意义(P＜0.05);研究组在阿托品用量、患者住院时间、胆碱酯酶活性恢复时间等卫生经济学指标,以及并发症发生情况,均显著优于对照组(P＜0.05).结论:中西医结合治疗急性重度有机磷农药中毒疗效显著,有助于胆碱酯酶活性恢复,促进患者早日康复,减少并发症,值得临床推广使用.

目的:探讨氟伐他汀治疗颈动脉粥样硬化斑块的临床疗效。方法:收集我院门诊和住院颈动脉斑块患者,随机分成治疗组和对照组:对照组患者给予常规治疗方案并服用其他非他汀类降脂药物进行治疗;治疗组在给予常规治疗方案的同时,每晚睡前加服氟伐他汀40mg,两组连续治疗12个月。治疗结束后,比较两组患者血脂及斑块大小变化。结果:经过治疗后,治疗组患者TC、TG、LDL-C指标水平均较治疗前降低,HDL-C较治疗前增加(P<0.05);而对照组患者各指标在治疗前后均无显著性变化;治疗组患者斑块长度和厚度均较治疗前降低(P<0.05);而对照组患者斑块长度和厚度在治疗后有增加的趋势;结论:氟伐他汀能稳定并明显逆转颈动脉粥样硬化斑块,减缓颈动脉粥样硬化的进展。

Objective: To investigate the role of video laryngoscope in establishment of emergency airway.Methods:Eighty-six cases in need of emergency airway establishment were randomly divided into two video laryngoscope and laryngoscope group.Success rate of tube insertion,time for insertion of tube,and times of insertion,changes in heart rates before and after the establishment of airway,side effects and complications were recorded and compared.Results:Time for insertion of tube in the video laryngoscopes group was significant shorter than that of the laryngoscope group,it also took less time for the heart beat to restore normal rate.Status of side effects and complications were better than the laryngoscope group.Conclusion:Video laryngoscopes can significantly improve the success rate of intubation,shorten the intubation time,reduce incidence of adverse reactions and complications.