目的:探讨CD4+/CD8+比值降钙素原(Procallcitonin,PCT)、C反应蛋白(C-reactiveprotein,CRP)水平变化与感染性休克(Septicshock,SS)患者疾病转归的相关性.方法:选取我院2020年4月-2022年2月收治的135例SS患者为研究对象,根据患者28d疾病转归分为生存组(91例)和病死组(44例).比较两组一般临床资料,比较两组治疗前、治疗3d、7d后CD4+/CD8+比值、PCT、CRP水平,分析治疗3d、7d后CD4+/CD8+比值、PCT、CRP水平与急性生理与慢性健康评估(AcutephysiologyandchronichealthevaluationⅡ,APCHEⅡ)评分、序贯器官衰竭(Sepsis-relatedorganfailureassessment,SOFA)评分及疾病转归的相关性,偏回归分析影响SS患者疾病转归的危险因素.结果:病死组年龄、治疗3d后、7d后APACHEⅡ评分、SOFA评分较生存组高(P<0.05);病死组治疗3d、7d后CD4+/CD8+比值低于生存组,PCT、CRP水平高于生存组(P<0.05);治疗3d、7d后,CD4+/CD8+比值与SOFA评分、APCHEⅡ评分、疾病转归呈负相关,PCT、CRP水平与SOFA评分、APCHEⅡ评分、疾病转归呈正相关(P<0.05);Logistic回归分析显示,治疗3d后CD4+/CD8+比值≤1.10、PCT>19.18μg/L、CRP>122.98mg/L,治疗7d后CD4+/CD8+比值≤1.18、PCT>18.03μg/L、CRP>111.65mg/mL是SS患者病死的危险因素(P<0.05).结论:CD4+/CD8+比值、PCT、CRP水平与SS患者疾病转归密切相关,检测其水平对临床预测患者疾病转归具有指导意义.

目的:探索在射血分数中间值的心力衰竭(heart failure with mid-range ejection fraction,HFmrEF)合并糖尿病患者中,沙库巴曲缬沙坦(angiotensin receptor-neprilysin inhibitor,ARNI)和钠-葡萄糖协同转运蛋白-2(sodium-dependent glucose transporters 2,SGLT2)抑制剂联合用药治疗对患者预后的影响.方法:回顾性研究2020年3月至2021年2月,于郑州大学第一附属医院诊断为HFmrEF合并糖尿病的患者593例.所有患者根据是否服用ARNI和SGLT2抑制剂分为四组:对照组(n=234),ARNI组(n=111),SGLT2抑制剂组(n=136)和联合用药组(n=103).主要结局:心力衰竭(HF)再住院、心源性死亡.随访2年.采用生存分析明确不同用药方案与HF再住院结局间的关系.通过多元Cox回归分析探索不同用药方案对HF再住院风险的影响.结果:在四个组别中,联合用药组HF再住院发生率显著降低(61.7％vs.46.8％vs.45.6％vs.30.1％,P＜0.001).而心源性死亡发生率四组间差异无统计学意义(P＞0.05).生存分析表明,联合用药组HF再住院率显著低于其他三组(Log-rankP均＜0.05).多元Cox回归分析表明:相比于对照组,ARNI(HR=0.70,95％CI:0.51～0.97,P=0.033)、SGLT2抑制剂(HR=0.71,95％CI:0.53～0.96,P=0.028)及联合用药治疗(HR=0.40,95％CI:0.27～0.60,P＜0.001)患者HF再住院风险显著降低.其中,联合用药的保护作用显著优于单用ARNI(HR=0.58,95％CI:0.37～0.92,P=0.021)或 SGLT2 抑制剂(HR=0.59,95％CI:0.37～0.94,P=0.026).结论:在HFmrEF合并糖尿病的患者中,ARNI和SGLT2抑制剂联合治疗可显著降低HF再住院的发生风险,从而改善患者的预后.

患者，男，64岁，2020-08-19因"胸闷4 d，加重11 h"入院。患者4 d前受凉后出现活动后胸闷、气喘，间断咳嗽、咳痰，于家中自行静脉应用抗感染、舒张支气管、化痰等药物治疗。11 h前误将石蜡油20 mL静脉注射，立即出现持续性胸闷、气喘，剧烈咳嗽，持续约20 min后症状较前稍减轻，至"漯河市中心医院"就诊，给予对症治疗（具体不详），症状无明显减轻，遂来本院。入院查体：体温36.5℃，脉搏86次/min，呼吸20次/min，血压122/80 mmHg（1 mmHg=0.133 kPa），呼吸室内空气氧饱和度88%，左肺吸气相可闻及湿啰音。动脉血气分析（室内静息状态未吸氧）：PO 2 57.9 mmHg，PCO 2 45 mmHg。白细胞13.23×10 9/L，中性粒细胞10.88×10 9/L，中性粒细胞百分数82.2%，C反应蛋白16.28 g/L，PCT 0.117 ng/mL。胸部CT（2020-08-19，图1A）示双肺支气管扩张并感染，左肺为著；双肺胸膜下微小炎性结节考虑。肺动脉CTA，肠系膜动脉CTA及头颅MRA未见动脉栓塞。立即给予吸氧、莫西沙星抗感染、甲强龙抗炎、低分子肝素抗凝、脂肪乳、舒张支气管、化痰等治疗，并分别于入院后16 h、48 h行2次血浆置换。治疗后患者自觉症状减轻，鼻导管吸氧2 L/min，氧饱和度持续>94%。入院第3天患者胸闷气喘较前加重，鼻导管吸氧4 L/min，动脉血气分析：PO 2 57.8 mmHg，PCO 2 58.7 mmHg。给予面罩给氧，增大氧流量，吸氧6 L/min，氧饱和度可维持>94%。复查胸部CT（2020-08-25，图1B）示双上肺絮状高密度影，局部呈磨玻璃样改变。支气管镜示：主气管见大量陈旧性血性粘痰，右上叶、中叶段支气管见大量陈旧性血性分泌物，左上叶可见中等量稀薄分泌物、左下叶段支气管见大量稀薄分泌物。右上叶支气管毛刷涂片细胞学示：镜下见中等量纤毛柱状上皮细胞（图2A）。右上叶肺泡灌洗液涂片细胞学示：镜下见少量上皮细胞、吞噬细胞及炎细胞（图2B、图2C）。肺功能示：重度阻塞性为主的混合型通气功能障碍，肺总量降低，肺活量降低，残气/肺总量%增高，支气管舒张试验阳性。继续给予抗感染、抗炎、抗凝及对症治疗，患者症状逐渐减轻，复查肺部CT较前好转（2020-08-30，图1C），激素逐渐减量，好转出院。于出院后1个月（2020-09-23，图1D），3个月（2020-11-17，图1E）复查胸部CT，双肺病灶逐渐好转，随访1年，患者恢复良好。

Objective:To analyze the clinical characteristics of patients with acute glyphosate herbicide poisoning and the differences in the severity of poisoning.Methods:A retrospective analysis was performed on patients with acute glyphosate herbicide poisoning admitted to the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2020. The general information, exposure time, poisoning dose, poisoning cause, poisoning route, clinical manifestations, laboratory examination results during hospitalization, treatment measures, hospital stays and prognosis of the patients were collected. The patients were graded according to the poisoning severity scoring standard of Chinese Expert Consensus on Diagnosis and Treatment of Acute Poisoning in 2016. The highest severity score during hospitalization was used as the final grade. According to the final grade, asymptomatic and mild patients were included in the mild group, and moderate, severe and death patients were included in the severe group. The independent sample T test or Mann-Whitney U test was used for measurement data, and χ2 test or Fisher's exact test was used for counting data. The differences of general data and clinical data between the two groups were compared. Results:According to the inclusion and exclusion criteria, 83 patients with acute glyphosate herbicide poisoning were selected as the study subjects. All patients survived, mainly mild poisoning (56.6%), with a male to female ratio of 33∶50, and an average age of 39 years. The number of poisoning cases increased yearly (the highest in 2019), and most cases occurred in spring and summer. The main cause of poisoning was suicide (71.1%), direct oral administration (83.1%) was the primary route of poisoning, and the dominating clinical manifestations were digestive symptoms (71.1%). Laboratory tests showed increased white blood cell count (WBC), neutrophil percentage (NEUT %) and D-dimer, and decreased hemoglobin and potassium. Compared with the mild group, patients in the severe group were older [(51±17) years vs. (35±19) years], had a higher proportion of suicide and direct oral administration, a longer hospital stay [8.0 (4.8, 12.0) d vs. 3.0 (2.0, 5.5) d], a higher dose of poisoning [200.0 (50.0, 200.0) mL vs. 30.0 (11.3, 57.5) mL], and higher NEUT % within 24 h of admission [(83.4±10.4) vs. (73.2±12.8)]. The increase of WBC, NEUT %, aspartate aminotransferase, prothrombin time, D-dimer and the decrease of serum potassium were more common in the severe group than the mild group, with statistical significance (all P<0.05). Conclusions:The number of patients with acute glyphosate herbicide poisoning is increasing yearly. Generally, the condition is mild and the prognosis is satisfying. The severity is more serious in the middle-aged and elderly patients andthose with direct oral administration, high toxic dose, and high NEUT % within 24 h of admission. Severe poisoning is more likely to cause changes in laboratory indicators.

Lung damage is a characteristic feature of paraquat intoxication; most deaths resulting from ingesting paraquat are due to progressive respiratory failure. Liver failure caused by paraquat intoxication is rare. A case of orally ingested paraquat intoxication is reported in which serious liver injury and toxic encephalopathy were observed, but little lung damage was found. The principal systemic symptom was severe liver injury, characterized by cholestasis, that gradually became aggravated. In addition to standard treatment, aggressive treatment through liver protection and cholestasis was administered. Finally, liver function returned to normal and central nervous system symptoms were controlled. The patient was successfully discharged. This case suggests that the hepatotoxicity of paraquat intoxication is possibly characterized by cholestasis, and the treatment of cholestasis promotes recovery of severe hepatocyte damage.

This study explored the role of metformin (MET) in regulating the polarization of alveolar macrophages to protect against acute lung injury (ALI) in rats caused by paraquat (PQ) poisoning. The in vivo studies showed that the 35 mg/kg dose of MET increased the survival rate of rats, alleviated pathological damages to the lungs and their systemic inflammation, promoted the reduction of the pro-inflammatory factors interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels, and increased the anti-inflammatory factor IL-10 levels in the rat serum. At the same time, the MET intervention decreased the expression of M1 macrophage marker iNOS in the lungs of the PQ-poisoned rats while increasing the M2 macrophage marker, Arg1, expression. In vitro, the concentration of MET > 10 mmol/L affected NR8383 viability adversely and was concentration-dependent; however, no adverse impact on NR8383 viability was observed at MET ≤ 10 mmol/L concentration, resisting the reducing effect of PQ on NR8383 vitality. The PQ-induced NR8383 model with MET intervention showed significantly reduced secretions of IL-6 and TNF-α in NR8383, and lowered expressions of M1 macrophage markers iNOS and CD86. Additionally, MET increased IL-10 secretion and the M2 macrophage markers, Arg1 and Mrcl, expressions. Therefore, we speculate that MET could regulate alveolar macrophage polarization to protect against PQ-poisoning caused ALI.

目的 分析总结非重症与重危症新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者早期临床特征和实验室检查等特点,以便临床及时评估与识别危重信号.方法 回顾性收集2020年1月16日至2020年3月1日郑州大学第一附属医院收治的COVID-19病例的临床特征、实验室检查等资料,分析非重症型与重危症型之间的差异.结果 共纳入67例确诊患者,其中非重症组22例,重危症组45例.重危症组患者年龄及基础病比例均高于非重症组(P<0.05).初发症状按发生率前五位依次为发热、咳嗽、胸闷、乏力、咳痰,重危症组胸闷症状及肺部啰音比例均高于非重症组,但差异无统计学意义(P>0.05),余症状体征均无统计学意义.入院时重危症组白细胞总数、中性粒细胞比例、D-二聚体及乳酸脱氢酶均高于非重症组,淋巴细胞计数低于非重症组,差异具有统计学意义(P<0.05);首诊于郑州大学第一附属医院的重危症组患者自发病至转为重危症的中位时间为10天,病情加重时较入院时白细胞总数、D-二聚体升高,淋巴细胞计数降低(P<0.05).结论 高龄、有无基础病、初始白细胞总数、中性粒细胞比例、D-二聚体、乳酸脱氢酶及淋巴细胞计数均与COVID-19病情程度有关.白细胞总数和D-二聚体逐渐升高、淋巴细胞绝对值逐渐降低等动态变化提示病情有转为重危症的风险;发病后第10天可能是病情转为重危症的重要时间点,建议及时复查.

目的 将案例导入式教学法(case-based learning,CBL)应用于全科住院医师岗位胜任力培养中,分析并评价其应用效果.方法 选取2020年6月—2021年3月在郑州大学第一附属医院全科医学科进行全科住院医师规范化培训的学员192名随机分为CBL教学组(95名)和传统教学组(97名).培训结束后进行全科医学理论和技能考核、岗位胜任力评价,并进行教学效果的问卷调查,比较两组间差异.结果 192位学员中位年龄24岁,男性占46.4％,学员类型包括订单定向(40.1％),委培(24.0％)和社会人(35.9％).两组间学员在性别、年龄、学员类型构成方面均具有可比性(P>0.05).相比于传统教学方法,CBL教学组学员全科医学理论考核和技能考核成绩均明显提高,差异有统计学意义(P<0.05),基本医疗服务能力、公共卫生服务能力、人文执业能力、教育学习能力等全科医学岗位胜任力指标均显著提升,差异有统计学意义(P<0.05),且学员对CBL教学法的效果评价和认可度明显高于传统教学法,差异有统计学意义(P<0.05).结论 CBL教学法在全科住院医师岗位胜任力培养中的应用效果优于传统带教方法.

It is noted that elevated serum amylase levels suggesting pancreatic damage has an association with prognosis in PQ patients. This study aimed to determine whether PQ can cause pancreatic damage. The two conventional models (intragastric infusion (iG) and intraperitoneal injection (iP)) may exhibit different effects on the pancreas depending on whether or not they pass through the digestive tract. In this study, the rats were divided into four groups: the intragastric infusion group (PQ-iG, n = 45), intraperitoneal injection group (PQ-iP, n = 53), normal control group 1 (NC-iG, n = 6) and normal control group 2 (NC-iP, n = 6). Pancreatic damage was compared between groups using serum amylase activity assay, hematoxylin and eosin (H&E) staining, TUNEL assay, and transmission electron microscopy (TEM). Serum amylase levels in group PQ-iG were significantly higher than in group PQ-iP (p < 0.05). Examination of the H&E sections showed damage to the pancreas. Both experimental groups were displayed inflammatory infiltration within 9 h of PQ treatment. After 9 h, patchy necrosis was observed in group PQ-iP, when inflammatory infiltration was still the dominant pathology. Necrosis appeared and gradually worsened in group PQ-iG, in which necrosis was the dominant pathology. The TUNEL assay showed significantly higher numbers of apoptotic cells in the pancreas of PQ-groups than in the control NC- groups (p < 0.05). TEM showed expansive endoplasmic reticulum lumens and mitochondria swelling in the pancreas of the PQ-groups. It is concluded that both methods of modeling could cause pancreatic damage and the type and degree of damage would change over time. Note that pancreatic damage in group PQ-iG was more severe than that in group PQ-iP. Therefore, clinical practitioners should pay close attention to pancreatic damage caused by PQ, especially when the route of PQ administration was oral.

目的 探讨分析基于虚拟仿真技术的医学模拟教学法在急诊与灾难医学临床教学中的应用效果及价值.方法 纳入郑州大学临床医学系2017级五年制本科临床专业2个班级共60名学生为研究对象,按班级分为对照组与研究组.对照组(n=30)采用传统教学方法,研究组采用基于虚拟仿真技术的医学模拟教学方法.教学结束后考核两组学生的理论知识与技能操作,通过发放问卷调查学生对自我表现的评价,以及对教学方法的认可度.结果 研究组学生理论考核与技能考核成绩均优于对照组学生,且研究组学生自我评分均显著高于对照组学生,差异有统计学意义(P<0.05);研究组在教学内容与形式、教学氛围、学生参与度、学习兴趣提高度、喜爱度等方面的评分显著高于对照组,差异有统计学意义(P<0.05),而在教学模式适应度方面,两组学生评分差异无统计学意义(P>0.05),且对照组评分稍高于研究组(6.3±1.7)分vs(5.6±2.2)分.结论 在急诊与灾难医学教学中应用基于虚拟仿真技术的医学模拟教学法可有效提高教学效果,较传统教学方法具有更高的认可度.

The present study investigates whether paraquat (PQ) regulates polarization of alveolar macrophages through glycolysis and promotes the occurrence of acute lung injury in rats. In vivo, the PQ intraperitoneal injection was used to construct a model of acute lung injury in rats. In vitro, the study measured the effect of different concentrations of PQ on the viability of the alveolar macrophages, and explored the polarization and glycolysis metabolism of alveolar macrophages at different time points after PQ intervention. Compared with the normal control (NC) group, the lung pathological damage in rats increased gradually after PQ poisoning, reaching a significant degree at 48 h after poisoning. The PQ-poisoned rat serum showed increased expressions of interleukin-6 (IL-6), tumor necrosis factor- α (TNF-α), and M1 macrophage marker, iNOS, while the expression of interleukin-10 (IL-10) and M2 macrophage marker, Arg1, decreased. The toxic effect of PQ on alveolar macrophages was dose- and time-dependent. Compared with the NC group, IL-6 and TNF-α in the cell supernatant gradually increased after PQ intervention, while the IL-10 content gradually decreased. The PQ intervention in alveolar macrophages increased the expression of intracellular glycolysis rate-limiting enzyme pyruvate kinase isozymes M1/M2 (PKM1/M2), lactate, lactate/pyruvate ratio, and the polarization of alveolar macrophage towards M1. Inhibition of cellular glycolysis significantly reduced the PQ-induced alveolar macrophage polarization to M1 type. Thus, PQ induced increased polarization of lung macrophages toward M1 and decreased polarization toward M2, promoting acute lung injury. Therefore, it can be concluded that PQ regulates the polarization of alveolar macrophages through glycolysis.

To identify risk factors and develop a simple model to predict early prognosis of acute paraquat (PQ) poisoning patients, we performed a retrospective cohort study of acute PQ poisoning patients (n = 1199). Patients (n = 913) with PQ poisoning from 2011 to 2018 were randomly divided into training (n = 609) and test (n = 304) samples. Another two independent cohorts were used as validation samples for a different time (n = 207) and site (n = 79). Risk factors were identified using a logistic model with Markov Chain Monte Carlo (MCMC) simulation and further evaluated using a latent class analysis. The prediction score was developed based on the training sample and was evaluated using the testing and validation samples. Eight factors, including age, ingestion volume, creatine kinase-MB [CK-MB], platelet [PLT], white blood cell [WBC], neutrophil counts [N], gamma-glutamyl transferase [GGT], and serum creatinine [Cr] were identified as independent risk indicators of in-hospital death events. The risk model had C statistics of 0.895 (95% CI 0.855–0.928), 0.891 (95% CI 0.848–0.932), and 0.829 (95% CI 0.455–1.000), and predictive ranges of 4.6–98.2%, 2.3–94.9%, and 0–12.5% for the test, validation_time, and validation_site samples, respectively. In the training sample, the risk model classified 18.4%, 59.9%, and 21.7% of patients into the high-, average-, and low-risk groups, with corresponding probabilities of 0.985, 0.365, and 0.03 for in-hospital death events. We developed and evaluated a simple risk model to predict the prognosis of patients with acute PQ poisoning. This risk scoring system could be helpful for identifying high-risk patients and reducing mortality due to PQ poisoning.

Objective:To investigate the clinical features of patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis misdiagnosed as mental disorder, improve the early diagnosis rate and reduce misdiagnosis.Methods:The clinical data of patients with anti-NMDA receptor encephalitis diagnosed at the First Affiliated Hospital of Zhengzhou University from 2012 to 2018 were collected. Patients misdiagnosed as mental disorders were screened out. Their psychiatric symptom characteristics, disease course characteristics, imaging and laboratory findings, treatment and prognosis were retrospectively analyzed.Results:A total of 121 cases of anti-NMDA receptor encephalitis were collected, and 43 cases of mental disorders were screened out. Sixteen of the 43 patients (37.2%) had prodromal symptoms, and all the patients had psychiatric behavioral abnormalities (100%), including 32 cases (74.4%) of seizures, 13 cases (30.2%) of decreased level of consciousness, 21 cases (48.8%) of involuntary movements, 15 cases (34.9%) of decreased memory, 8 cases (18.6%) of speech dysfunction, and 8 cases (18.6%) of other neurological symptoms (central hyperventilation, autonomic dysfunction). Memory loss was observed in 15 cases (34.9%), speech dysfunction in 8 cases (18.6%), other neurological symptoms (central hypoventilation, autonomic dysfunction) in 8 cases (18.6%), and various symptoms may appear simultaneously or successively in the same patient. Thirty-eight cases had complete resolution of symptoms or only minor physical impairment, and 5 cases had recurrent admissions with mental abnormalities and seizures. The recurrence rate accounted for 11.6% (5/43).Conclusions:The clinical manifestations of anti-NMDA receptor encephalitis are complex and varied. Most of them have mental behavior abnormalities as the first symptom, which is easily misdiagnosed as mental disorder and delayed treatment will lead to prolonged disease course and poor prognosis.

百草枯(paraquat)是一种有效和广泛使用的除草剂,其对动物和人均有很强的致毒性,因意外或自杀摄入引起的百草枯中毒,死亡率高达50％～90％[1].经消化道是百草枯最常见的中毒途径,常因自杀或误服、误食引起.皮肤接触途径的中毒多为职业暴露导致,也有通过皮肤接触谋杀的案例报道[2],而静脉途径多见于自杀或药物滥用患者.目前临床多关注口服引起的百草枯中毒,其他途径导致的中毒比较少见.本研究对2例非消化道途径百草枯中毒患者的临床资料进行总结,并结合文献对其临床特点进行探讨,以拓展对该病的认识.

目的 分析新型冠状病毒肺炎(以下简称新冠肺炎)流行期间,疑似病例中经新型冠状病毒核酸检测阴性患者的流行病学史、临床表现、实验室检查及影像学等特点.方法 选取2020年1月22日至2020年4月4日郑州大学第一附属医院收治的新冠肺炎疑似病例核酸检测阴性者共70例,收集其一般资料、流行病学史、临床表现、实验室检查、影像学检查及诊治情况等资料.结果 70例核酸检测阴性患者中有明确流行病学史39例(55.8％);发生率前5位的早期临床症状为发热(78.6％)、咳嗽(64.3％)、乏力(35.7％)、咳痰(31.4％)、胸闷(31.4％),其中体温正常15例(21.4％),低热28例(40％),中等度热21例(30％),高热6例(8.6％),无超高热病例;从隔离至转入普通发热病房的中位时间为5(3,8)d,住院日中位数8(5,13)d;丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)和肌酸激酶(CK)多在正常范围内;10例(14.2％)胸部CT正常,56例(80.0％)胸部CT有不同程度絮状、斑片状、条索状改变;有基础疾病组(n=29)累及双肺情况多于无基础疾病组(n=41),且差异有统计学意义(x2=10.516,P=0.001).结论 有明确疫区流行病学史的疑似患者核酸检测并非均为阳性,5d左右可能最终判断是否为确诊病例,核酸检测阴性的患者体温多为中低热或正常,较少发生肝功能及心肌损伤,影像学多符合病毒性肺炎表现,有基础疾病者多累及双肺,病程较短,预后好.

Background: Acute paraquat (PQ) poisoning is characterized by multi-organ failure and lacking effective therapies. Therefore, identifying risk factors and developing model that could predict early prognosis for patients with PQ poisoning is of great importance. Methods: This was a retrospective cohort study employed with patients suffered from acute PQ poisoning (n=1199). Patients (n=913) with PQ poisoning from 2011 to 2018 were randomly divided into 2 mutually exclusive groups: training (609 patients) and test (304 patients). Another 2 external cohorts containing 207 cases from Zhengzhou 2019 were used as validation from different time and 79 from Shenyang as validation from different site. Risk factors were identified by a logistic model with Markov Chain Monte Carlo (MCMC) simulation and further evaluated by a latent class analysis. The prediction score of this model was developed based on the training sample and was further evaluated using the testing and validation samples. Results: Eight risk factors including age, ingestion volume, CK-MB, platelet (PLT), white blood cell (WBC), neutrophil counts (N), gamma-glutamyl transferase (GGT) and serum creatinine (Cr) were identified as in dependent risk indicators of in-hospital death events. The risk model had a C statistic of 0.895 (95% CI 0.855-0.928), 0.891 (95% CI 0.848-0.932) and 0.829 (95% CI 0.455-1.000) and a predictive range of 4.6%-98.2%, 2.3%-94.9% and 0%-12.5% for the test, validation_time and validation_site group, respectively. In the training group, the risk model classified 18.4%, 59.9% and 21.7% of patients into the high, average and low-risk groups, with corresponding probabilities of 0.985, 0.365, and 0.03 for in-hospital death events. Conclusion: Eight risk factors were identified in this study. And we developed and evaluated a simple risk model to predict the prognosis of patients with acute PQ poisoning. This simple and reliable risk score system could be helpful in recognizing high-risk patients and reducing in-hospital death rate due to PQ poisoning.

Objective:To investigate therole of serum amylase elevation in the evaluation of diabetic ketoacidosis (DKA) patients and the related factors affecting serum amylase (AMS) levels in patients with diabetic ketoacidosis.Methods:A total of 249 patients with DKA who were admitted to the First Affiliated Hospital of Zhengzhou University from November 2011 to August 2018 were selected for this retrospective study. The patients were divided into the normal group ( n=176) and the elevated group ( n=73) according to the AMS level measured by fasting venous blood samples. The enumeration data such as sex, type of DM, diabetic vascular complications, number of deaths, number of ICU monitoring, and number of acute pancreatitis (AP) after discharge were analyzed by chi-square test or Fisher test, and the measurement data such as age, pH, HbA1c, CO 2CP, Ca 2+, BUN, and Scr were analyzed by independent sample t test to compare the difference between the two groups. Results:The intensive care unit (ICU) monitoring rate was 50.7%, the median length of stay in ICU was 4 days, the median length of hospital stay was 14 days, and the median treatment cost was 28 000 yuan, which were higher in the elevated group than those in the normal group ( P<0.05). There were no significant differences in mortality, AP during hospitalization, and the probability of AP after discharge between the elevated group and the normal group ( P>0.05). The duration of diabetes, the number of previous DKA, the incidence of diabetic vascular complications, HbA1c, pH, BUN, and Scr in the elevated group were all higher than those in the normal group ( P<0.01 or P<0.05). Conclusions:DKA patients with elevated AMS are more likely to be admitted to ICU, and the length of stay in ICU, total length of hospital stay and total cost of treatment are all increased. Where as the overall mortality rate during hospitalization and the likelihood of AP after discharge are not increased.

Objective:To explore the risk factors of prognosis and develop a nomogram to predict the risk of short-term mortality in patients with acute respiratory failure (ARF).Methods:The clinical data of 827 ARF patients in MIMIC-III database and 296 ARF patients in the Second Affiliated Hospital of Wenzhou Medical University from January 2010 to December 2019 were collected and analyzed by the univariate and multivariable logistic regression analysis. A nomogram was developed to predict 30-day mortality in ARF patients according to the risk factors.Results:Multivariate logistic regression analysis showed that the lowest systolic blood pressure, the highest respiratory rate, the lowest fingertip oxygen saturation, the highest bilirubin, the lowest albumin and 24 h urine volume were independent risk factors of ARF ( OR=0.988, 1.028, 0.980, 0.750, 1.059 and 0.999, all P<0.05). Combined with the clinical situation, mechanical ventilation, the highest heart rate and age were also included in the nomogram model. The AUC of ROC curve in this model was 0.752 (95% CI: 0.719-0.784), the AUC of ROC curve in external validation set was 0.666 (95% CI: 0.621-0.711). The calibration curves both in the primary cohort and validation cohort were close to the standard curve. Conclusions:This nomogram has good differentiation and generalization, which is helpful for clinicians to accurately evaluate the mortality risk of ARF.

Objective:To investigate the recovery of patients with acute thallium poisoning after 9 years.Methods:A group of 14 patients with familial thallium poisoning who were admitted to our hospital in 2010 were followed up for 9 years.Results:Among the 14 patients with acute thallium poisoning, one patient died on the 14th day after poisoning, and all the other survivors were followed up 9 years later. The general condition of all the patients was significantly better than that of poisoning 9 years ago. The alopecia of all cases disappeared, the newborn hair grew normally, without gastrointestinal symptoms, numbness, pain in the limbs and mental symptoms. All the patients returned to normal intelligence and physical strength and had a normal life. One patient (No. 5) gave birth to 2 children successively after discharge. The first child was 6 years old and the second child was 2 years old. Both growth and intelligence were not different from those of the same age. Currently, the third pregnancy was more than 7 months. No.6 and No.10 patients were poisoned in their teenage and were currently all studying in university. No.6 patient suffered from Hashimoto's thyroiditis 7 years after poisoning, and he has been taking thiamazole tablets for two years. Poisoned infants, No.7, 8 ,11 and 12, were school-age children with normal growth, mental development and excellent academic performance. Among the 13 surviving patients, blood and urine samples from No. 1, No. 3, and No. 4 patients were collected, and no thallium concentration was detected, and biochemical examina-tion and neurological examination were all normal.Conclusions:Patients with acute thallium poisoning have a favorable prognosis according to the follow-up after 9 years. All patients have no obvious sequelae and have normal labor ability. Young women have normal fertility, and children have normal growth and mental development.

The benefits and adverse effects of immunosuppressive drugs (ISDs) in patients with paraquat (PQ) poisoning have not been thoroughly assessed. This meta-analysis study aims to evaluate the effect of ISDs in patients with moderate to severe PQ poisoning. We searched PubMed, Embase, Cochrane Library, Ovid Medline, CNKI and Wanfang Data from inception to January 2019. The Mantel-Haenszel method with a random-effects model was used to calculate the pooled relative risks (RRs) and 95% Confidence Intervals (CIs) as described by DerSimonian and Laird. An L'Abbé plot was drawn to explore the relationship between the degree of poisoning and mortality. Four randomized controlled trials, two prospective and seven retrospective studies were identified. ISDs were significantly associated with reduced mortality (RR 0.76; 95% CI, 0.58-0.99) and the incidence rate of multiple-organ dysfunction syndrome (MODS) (RR 0.63; 95% CI, 0.48-0.83) in patients with moderate to severe PQ poisoning. They were not associated with an increased incidence rate of hepatitis and reduced incidence rate of acute renal failure and hypoxia. The L'Abbé plot results showed a slight increase in mortality rate in the ISD group with increased mortality in the placebo group. This indicates a possible advantage of ISDs in most of the patients with severe PQ poisoning. These findings suggest that ISDs may reduce the mortality and incidence rate of MODS in moderate to severe PQ poisoning patients, and severe PQ poisoning patients might benefit more from ISDs.