目的 探讨血浆置换(PE)联合连续性肾脏替代治疗(CRRT)在秋水仙碱中毒患者中的疗效及护理要点.方法 采用观察性研究方法,选择2017年12月至2022年8月在温州医科大学附属第一医院急诊重症监护病房(EICU)救治的19例秋水仙碱中毒患者,分析其临床资料,观察PE联合CRRT治疗后的疗效及护理要点.结果 19例秋水仙碱中毒患者中男性15例(78.9％),女性4例(21.1％);平均年龄(50.31±22.22)岁;?口服毒物剂量为30～180片(0.5～1.0?mg/片);服药后出现恶心、呕吐、腹痛、腹泻等消化道症状,并发多器官功能障碍、骨髓抑制和红细胞、白细胞、血小板三系下降现象.所有患者行PE联合CRRT治疗后,秋水仙碱浓度从血液净化前最高53.6?μg/L下降至<1.0?μg/L,17例患者在2周内好转,平均住院天数为9～11?d;最终治愈17例,自动出院2例.结论 秋水仙碱中毒患者首发症状以恶心、呕吐、腹痛、腹泻等消化道表现为主;进行床旁PE联合CRRT综合急救与护理,能有效降低患者体内的秋水仙碱浓度,维持循环及内环境稳定,减轻患者的多器官功能损害;同时提供有效的护理干预措施,对患者预后具有非常重要的意义.

Objective To explore the teaching methods to improve clinical thinking ability of emergency department resident doctors based on clinical cases.Methods A total of 104 resident physicians from 2017 to 2022 who were trained in the professional base of the emergency department of the First Affiliated Hospital of Wenzhou Medical University were selected and divided into the untrained group（n=63） and the trained group（n=41） according to whether they were trained by the clinical case teaching method. The independent learning ability, writing ability, clinical thinking ability, annual assessment and final examination results of resident physicians in the two groups were analyzed. Results At the end of the first year of residential training and after the completion of residential training, the self-perception self-learning ability, writing ability, medical history collection ability, physical examination ability and skill operation ability of residential training physicians were improved, and the differences were statistically significant（t values were 18.19, 14.68, 11.61, 20.82, 19.59,P＜0.001）. The self-perception self-learning ability, writing ability, medical history collection ability, physical examination ability and skill operation ability of the completed residential training physicians without the clinical case teaching method were worse than those with the clinical case teaching method. The results of clinical thinking ability in the annual assessment of the second year of training were better than those in the annual assessment of the first year（scores: 82.23±1.69 vs. 80.70±1.52, t=2.71, P=0.016）, and the results of clinical thinking ability in the assessment of completion were better than those in the annual assessment of the second year（scores: 84.20±2.60 vs. 82.23±1.69,t=2.22, P=0.043）. Conclusions The clinical case-oriented teaching method can help to improve the clinical thinking ability of emergency department resident doctors to a certain extent, provide the references for the continuous improvement of standardized training for emergency department residents in China, and promote the continuous progress of resident training in China.

Objective:To explore the clinical characteristics of patients with paraquat mixed with diquat poisoning.Methods:The clinical data of 145 patients with paraquat mixed with diquat poisoning admitted to the Department of Emergency of the First Affiliated Hospital of Wenzhou Medical University from January 20, 2016 to March 31, 2022 were retrospectively analyzed. According to the detection results of plasma toxicants in patients with poisoning, the patients were divided into the paraquat diquat mixed group (mixed group), paraquat group (PQ group) and diquat group (DQ group). The clinical indexes, organ dysfunction, different poisoning doses and prognosis of the three groups were compared. Patients in the mixed group were divided into the survival group and death group according to their 90-day survival, and the differences of each index between the two groups were compared. Kaplan-Meier survival analysis was conducted for each index. After Log-rank test, multivariate Cox regression was used to analyze the risk factors of death in the mixed group.Results:A total of 31 patients were included in the mixed group, 92 patients in the PQ group, and 22 patients in the DQ group. There were significant differences in age, toxic dose, number of organ dysfunction, PSS score and APACHE II score among the three groups ( P<0.05). The main injured organs of the mixed group were gastrointestinal tract, kidney, liver, lung and nervous system. The proportion of organ damage in the mixed group was higher than that in the PQ group and DQ group. The white blood cell count, neutrophil count, HB, creatinine, AST, lactic acid, PT and APTT were statistically significant among the three groups ( P<0.05). In the mixed group, patients taking oral administration of < 20 mL all survived; 8 patients taking oral administration of 20 -50 mL died; 11 patients took oral administration of 51-100 mL and 8 (72.7%) died; and 10 patients took oral administration of more than 100 mL and 9 patients (90%) died. In the mixed group, patients with the concentration of diquat > 5000 ng/mL died. Among 31 patients with mixed poisoning, 30 patients (96.78%) had significantly higher concentrations of diquat than paraquat. There were no significant differences in sex, age, time from poisoning to hospitalization, ingestion amount, lymphocyte count, Hb, BNU, CK, total bilirubin, PH, and PT between the survival group and the death group ( P>0.05). Multivariate Cox regression analysis showed that the ingestion amount, plasma PQ concentration at admission, plasma DQ concentration at admission, and lactic acid were independent risk factors for death ( P<0.05). Conclusions:Paraquat mixed with diquat can cause multiple organ function damage. The main damaged organs are gastrointestinal tract, kidney, liver, lung and nervous system. Compared with PQ or DQ poisoning, mixed poisoning has a higher incidence of organ damage, a more serious condition, and a higher mortality rate. Ingestion amount, plasma PQ concentration at admission, plasma DQ concentration at admission and lactic acid were independent factors influencing the prognosis of mixed poisoning.

课程思政强调"立德树人",培养医学人才需要旗帜鲜明地把"医学科学性与人文性结合和融通".该文以急诊医学为例,探讨急诊医学开展思政教育的必要性,针对该课程特点,从建设路径方面进行探索,提炼教学理念和设计,切实提升课程思政的育人效果,为其他专业和其他高校提供参考.

Objective:To investigate the clinical effect of early bronchoalveolar lavage on patients with aspiration pneumonia.Methods:A retrospective study was conducted on 55 patients with aspiration pneumonia who met inclusion criteria but not exclusion criteria in the Intensive Care Department of our hospital from January 2020 to April 2021. The patients were divided into the control group (32 cases) and the bronchoscopic lavage group (23 cases) according to whether they received bronchoscopic lavage within 24 h after aspiration. Basic information (sex, age, body mass index, chest X-ray score, oxidation index, temperature, heart rate, respiratory rate, white blood cells, PCT, IL-6, CPR and APACHE Ⅱ score), etiology changes at the early stage (≤ 3 d) and later stage (4-7 d after admission), and changes in prognostic indexes (mechanical ventilation time, length of ICU stay, length of stay and mortality) were compared between the two groups. The clinical efficacy of early endoscopy lavage for aspiration pneumonia was evaluated.Results:The positive rate of early etiological culture was 85.2%, the bacterial positive rate was 72.9% and the fungal positive rate was 14.6%. Pseudomonas aeruginosa accounted for 20.8%, Klebsiella pneumoniae accounted for 14.6%, Staphylococcus aureus and Streptococcus accounted for 12.5%, and there was no significant difference in the distribution between the bronchoscopic lavage group and the control group (all P>0.05). The positive rate of late etiological culture was 88.6%, the bacterial positive rate was 85.7% and the fungal positive rate was 2.9%. The positive rate of late bacterial culture was significantly decreased in the bronchoscopic lavage group ( P < 0.05), and the other results were not significantly different from the control group (all P>0.05). After early bronchoscopic lavage, the duration of mechanical ventilation, length of ICU stay and length of stay were significantly shortened, and the fifth day CPIS score was significantly decreased (all P< 0.05). Conclusions:Early endotracheal lavage can reduce mechanical ventilation time, length of ICU stay and length of stay of aspiration pneumonia, and reduce the positive rate of bacterial culture in the lung at the later stage, which needs to be further verified by a large randomized controlled study.

Objective: To investigate the value of serum mitochondrial ATP synthase C subunit level in the evaluation of cardiac functional status and prognosis in patients with sepsis. Methods: A total of 165 sepsis patients admitted to the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University from January 1, 2017 to December 31, 2018 were included, there were 103 males (62.4%) and 62 females (37.6%) with an age of (63±14) years. Human ATP synthase lipid binding protein (ATP5G1) ELISA kit was used to detect the level of serum ATP synthase C subunit within 24 h after admission to EICU, and compared with that in 45 healthy subjects. Clinical data of patients were collected and divided into groups according to different left ventricular ejection fraction (LVEF) and clinical outcomes. The differences in clinical indicators among each group were compared to evaluate the value of serum ATP synthase C subunit level in the evaluation of cardiac functional state and prognosis of patients with sepsis, and the independent risk factors for cardiac functional state and prognosis of patients with sepsis were analyzed. Results: Compared with the control group, the level of serum ATP synthase C subunit in the sepsis group was higher ((116±62) μg/L vs (77±34) μg/L, P<0.001). Compared with normal cardiac function group, the level of serum ATP synthase C subunit in septic cardiac dysfunction group was higher (P<0.001). Compared with the survival group, the level of serum ATP synthase C subunit in the death group was higher (P<0.05). The receiver operating curve (ROC) was drawn to analyze the value of ATP synthase C subunit, creatine kinase isoenzyme (CK-MB), B-type natriuretic peptide (BNP), troponin I (cTnI), left atrial end diastolic diameter, left ventricular end systolic diameter, left ventricular end diastolic volume, left ventricular end systolic volume in evaluating the cardiac function in patients with sepsis, and the area under the curve (AUC) was 0.928, 0.661, 0.837, 0.814, 0.703, 0.831, 0.794 and 0.765, respectively. The cut-off value, sensitivity and specificity of ATP synthase C subunit in it was 139.44 ng/L, 100% and 75.2%, respectively. ROC was drawn to analyze the prognostic value of age, urea nitrogen (BUN), ATP synthase C subunit, APACHEⅡ score and SAPSⅡ score in patients with sepsis, and the AUC was 0.719, 0.772, 0.656, 0.868 and 0.884, respectively. The cut-off value, sensitivity and specificity of ATP synthase C subunit in it was 131.24 ng/L, 61.9% and 68.7%, respectively. Logistic regression analysis showed that age, BUN, ATP synthase C subunit, cardiac dysfunction, APACHEⅡ score and SAPS Ⅱ score were independent risk factors for the prognosis of patients with sepsis. Conclusion: The level of serum ATP synthase C subunit is closely related to cardiac dysfunction in patients with sepsis, and can effectively predict the prognosis of patients with sepsis.

毒蛇咬伤是急诊科临床常见急症之一,严重者可导致死亡.被具有血液毒性的毒蛇咬伤可引起溶血,但迟发性急性溶血病例目前鲜有文献报道.临床上早期症状较轻的毒蛇咬伤患者,亦有发生迟发性急症的可能,甚至危及生命.温州医科大学附属第一医院2018年5月收治1例不明蛇种毒蛇咬伤致迟发急性溶血患者,该患者早期以血小板计数(PLT)减少为主要表现,至当地医院常规治疗后第10日突发急性溶血,转至本院经血液净化治疗、激素抗炎等治疗措施后得以成功救治.

目的 分析热性惊厥患儿呼吸道病原的分布特点及呼吸道病原感染与热性惊厥的关系.方法 收集2017年1月一2019年12月249例热性惊厥患儿的临床资料,通过咽拭子检测呼吸道病原体抗原和(或)血清检测IgM抗体,分析不同病原体与热性惊厥的发作类型、复发、年龄、家族史等临床特征的关系.结果 249例热性惊厥患儿完成了呼吸道病原学检测,病原检出率为76.7％(191/249),其中检出率最高的病原分别是乙型流感病毒49.80％(124/249),肺炎支原体31.73％(79/249)和甲型流感病毒30.12％(75/249).甲型流感病毒在复杂型热性惊厥中的检出率(42.4％)比在单纯型热性惊厥中的检出率(22.9％)高(P＜0.05),发生复杂型热性惊厥的比值比(OR值)为1.707(1.25,2.33)(P＜0.05).呼吸道病原检出数量在热性惊厥临床特点(包括再次发作、临床发作类型、家族史)的差别无统计学意义(P＞0.05).所检测病原与热性惊厥的再发、家族史、年龄无统计学意义(P＞0.05).结论 流感病毒(包括甲型和乙型流感病毒)是热性惊厥儿童中检出率最高的呼吸道病原,复杂型热性惊厥儿童中甲型流感病毒的阳性率最高.开展流感病毒疫苗接种能降低流感的发病率,可能减少儿童热性惊厥发生.

Objective To analyze the characteristics of lower respiratory tract infection occurring in patients after craniocerebral surgery in Intensive Care Unit (ICU) and explore its nursing countermeasures. Methods Sixty-eight patients with lower respiratory tract infection after craniocerebral surgery in the ICU of the First Affiliated Hospital of Wenzhou Medical University from January 2015 to March 2016 were selected as the study subjects. All patients were treated with dehydration to reduce intracranial pressure, hemostasis, anti-infection, anti-epilepsy, mild hypothermia, hypoglycemia and other symptomatic supportive treatments, and the corresponding nursing measures were given. The patients' primary diseases and etiological examination results were analyzed. Results Of the 68 patients complicated with lower respiratory tract infection after craniocerebral surgery, the majority of primary disease was craniocerebral injury, accounting for 45.59% (31/68). A total of 127 strains of pathogenic bacteria were isolated, mainly Gram-negative (G-) bacteria [92 strains (accounting for 72.44% )];followed by Gram-positive (G+) bacteria [19 strains (accounting for 14.96%)] and fungi [16 strains (accounting for 12.60%)]. The main pathogens of G- were Acinetobacter baumannii 21 strains (accounting for 23.14%), Klebsiella pneumoniae 13 strains (accounting for 14.94%), Burkholderia cepacia 10 strains (accounting for 11.49%), Pseudomonas aeruginosa 8 strains (accounting for 11.49%); the main pathogens of G+ was Staphylococcus aureus 6 strains (accounting for 5.89%). Conclusion The incidence of lower respiratory tract infection in ICU patients after craniocerebral surgery is high. It is necessary to prevent and control the related risk factors as soon as possible, and take energetic and effective nursing measures to reduce the incidence of lower respiratory tract infection.

Objective To investigate the incidence of nutritional risk in infants with lower respiratory tract infection, and to compare the effects of different nutritional risks on clinical outcomes, and to provide evi-dence for clinical nutritional management of infantile lower respiratory tract infection. Methods Infants and young children with lower respiratory tract infection who were hospitalized in our hospital from January 2013 to March 2016 were selected as subjects. Nutritional risk screening was performed using the Nutritional Status and Growth Risk Screening Tool ( STRONGkids) . Results A total of 957 infants with lower respiratory tract infec-tions were included in the study. The incidence of high nutrition risk and low and medium nutritional risk were 17. 6％ and 82. 4％, respectively. The clinical cure rate was 68. 5％ and 71. 4％ respectively. The children with pneumonia and bronchitis had high nutritional risk. The incidence rates were 20. 60％ and 4. 87％, respectively, and the difference was statistically significant (χ2=25. 52, P=0. 000) . Time-effect single factor analysis ( Kaplan-Meier method):The hospitalization time for infants with low nutritional risk and high nutri-tional risk was 9. 3 ( 0. 3) d and 13. 3 ( 1. 0) d, respectively. The difference between the two groups was sta-tistically significant. (χ2=28. 33, P=0. 000) , the total hospitalization expenses were 5653. 5 ( 224. 8) yuan and 10079. 5 ( 1755. 8) yuan respectively. The difference between the two groups was statistically significant (χ2=4. 47, P=0. 034) . Multivariate COX regression analysis:High nutritional risk was a risk factor for hospi-talization of hospitalized infants with lower respiratory tract infection ( RR=1. 57, P=0. 024 ) . Conclusion There is a high incidence of high nutritional risk in infants with lower respiratory tract infection. Compared with children with low and moderate nutritional risk, the hospitalization time is longer, the hospitalization cost is in-creased, and the clinical cure rate is lower, which is the risk of clinical outcome. factor. Therefore, it is neces-sary to conduct nutrition risk screening for infants with lower respiratory tract infections, and provide a theoreti-cal basis for clinical nutrition evaluation and nutritional intervention.

创伤弧菌脓毒症是由创伤弧菌(vibrio vulnificus)感染导致的急重症,起病急、进展凶猛,救治困难,约 50％～70％的患者在48 h内死于脓毒性休克及多脏器功能衰竭.该疾病散发少见,多数临床医师对该病的诊治缺乏相应的经验,由此造成延误诊治的案例时有发生.2008年,笔者根据自己多年的实践经验,结合国内外文献,编写并发表了《创伤弧菌脓毒症诊治方案(草案)》用以指导创伤弧菌脓毒症的诊治.十年来,创伤弧菌微生物检测技术取得长足进步,影像学在坏死性筋膜炎诊断中也积累不少了经验,更为重要的是新版的严重脓毒症及脓毒性休克诊治指南的颁布、坏死性筋膜炎治疗指南的修订为创伤弧菌脓毒症的诊疗提供了新指导意见.同时,在创伤弧菌脓毒症外科手术治疗、流程建设与管理实践中也取得新进展.因此,为进一步规范创伤弧菌脓毒症的诊疗,提高患者救治成功率,我们再次组织专家对《创伤弧菌脓毒症诊疗方案(草案)》进行修订.修订后的方案不仅体现了最新进展,而且提出了多学科协作的临床救治流程,使其对临床实践具有更好的指导性和操作性.

创伤弧菌脓毒症是由创伤弧菌(Vibrio vulnificus)感染导致的急重症,起病急、进展凶猛,救治困难,50％ ～ 70％的患者在48 h内死于感染性休克及多脏器衰竭.该疾病散发,相对少见,多数临床医师对该病的诊治缺乏相应的经验,由此造成延误诊治的案例时有发生.2008年,我们根据自己多年的实践经验,结合国内外文献,编写并发表了《创伤弧菌脓毒症诊治方案(草案)》用以指导创伤弧菌脓毒症的诊治[1].该方案提出创伤弧菌脓毒症早期临床诊断标准、早期足量联合应用抗菌药物、尽早外科处理感染灶等核心治疗理念,明显降低了患者病死率,使患者病死率由原先的75％下降至26.3％ [2-4].

草乌,其主要成分乌头碱,具有祛湿止痛功效,民间常用于治疗风湿关节等,但因煎煮、炮制、使用不当,易引起急性中毒,主要表现为为恶心呕吐、口舌发麻、共济失调、心律失常等〔1〕。其中,快速进展的紊乱性心律失常是中毒患者死亡的主要原因〔2〕。急性草乌中毒常呈现散发特点,群体性发病少见。由于草乌中毒起病急骤,进展快速,缺乏特效的解毒药物,因此群体性草乌中毒救治复杂、困难。本文报道9例群体性急性草乌中毒的紧急救治及管理,为突发群体性急性中毒事件的医疗援救提供经验。

Objective:To investigate the effect of curcumin on oxidative stress of acute renal injury in rats induced by paraquat and the mechanism underlying its effect. Methods:Sixty rats were randomly divided into 4 groups:control group (n=15), curcumin control group (curcumin 50 mg/kg) (n=15), PQ poisoned group (2%paraquat solution 100 mg/kg) (n=15), and curcumin intervention group (intraperitoneal injection of curcumin 50 mg/kg at 15 min, 24 h, or 48 h after paraquat exposure) (n=15). On days l, 3 and 7 after the treatment and renal tissue was collected. The content of malonaldehyde (MDA) and glutathione (GSH), the activities of superoxide dismutase activity (SOD) and catalase (CAT) in the renal tissue were determined with chemical colorimetry. The activities of heme oxygenase-1 (HO-1) and inducible nitric oxide synthase (iNOS) in the renal tissue were determined with ELISA. The mRNA and protein levels of nuclear related factor 2 (Nrf2) were determined with RT-PCR and Western Blot, respectively. The pathological changes of renal tissue were examined under optical microscopy. Results:Both PQ group and curcumin intervention group with each time showed increase in MDA content, decrease in GSH content, decrease in SOD and CAT activities, increase in iNOS activities, increase in the protein and mRNA levels of Nrf2, increase in HO-1 activities at day 1, 3, in comparison with the control group (P<0.05). In comparison with the PQ group on the same day, the curcumin intervention group showed de-crease in MDA content, increase in the activities of GSH, SOD, CAT, decrease in iNOS activities, and increase in the mRNA and protein levels of Nrf2 on days l, 3 and 7, increase in HO-1 on days 1, 3 (P<0.05). In the PQ group, the clearance of glomerulus saccules was increased, arranged in disorder, renal tubular epithelial cell ap-peared glassy degeneration and vacuolar degeneration with time expanding, but compared with PQ group, the pathological manifestations was relieved obviously with the same time in the curcumin intervention group. Con-clusion:Curcumin plays a protective role in paraquat poisoning with oxidative stress of acute renal injury, which may depend on inducing the expression of Nrf2, increasing the HO-1, SOD and other antioxidant enzyme levels, and increasing the ability of resistance to oxidative stress in renal tissue.

目的:分析我国综合性医院急性中毒的流行病学特点,为今后制定急性中毒控制规划提供依据.方法:Meta分析2008-01-2015-05发表在中国知网、万方、维普数据库上的有关我国急性中毒流行病学文献.结果:有44篇文献进行Meta分析,共有52 666例中毒患者;男女比例1.08∶1.中毒高发于20～39岁(59.07％).前4位急性中毒患者的职业依次为农民(29.19％)、员工(18.04％)、无业者(16.22％)、学生(11.24％).中毒途径以消化道为主(78.59％),地点主要在家中(53.01％).中毒原因以无意接触毒物为主(53.90％),其中有意中毒以自杀为主.毒物种类依次为药物(26.90％)、酒精(25.05％)、农药(22.03％)、一氧化碳(9.46％)、食物(7.08％)、其他毒物(6.32％)、鼠药(3.16％).急性中毒病死率2.36％,死亡患者中以农药(57.41％)、一氧化碳(12.78％)、药物(11.24％)为主.结论:药物及农药中毒是急性中毒的重点,应加强对高发人群健康宣教,加强毒物监管及自我防护意识,并重视广大群众身心健康(尤其青壮年).同时应完善中毒数据库,成立中毒控制中心,提高医务人员抢救水平,制定、完善各种中毒抢救流程,完善救治设备.

目的 评价心肌肌钙蛋白Ⅰ(cTnⅠ)对严重脓毒症及感染性休克患者预后的预测价值.方法 回顾性分析2013-01-01～2014-12-31入住我院EICU、ICU的严重脓毒症、感染性休克患者86例的临床资料.按照cTnⅠ是否大于0.08 ng/mL分为Ⅰ组(cTnⅠ≤0.08 ng/mL)和Ⅱ组(cTnⅠ＞0.08 ng/mL),比较两组总住院病死率、ICU病死率、总住院天数及ICU住院天数.按照入院28d是否存活分为存活组和死亡组,比较两组cTnⅠ是否有差异及其对预后的预测价值.结果 一共纳入研究的患者为86例,Ⅰ组与Ⅱ组比较总住院病死率(12.5％vs.50.9％)、ICU病死率(12.5％vs.42.6％)差异有统计学意义(P＜0.01),总住院天数[10(7,17)d vs.11(6,20)d]、ICU住院天数[4(2,9)d vs.6(3,9)d]差异无统计学意义(P＞0.05);存活组体温、呼吸、心率、cTnⅠ、乳酸、器官受累数量及APACHEⅡ评分均较死亡组明显下降(均P＜0.01),而年龄、性别、血压、白细胞、血小板等指标两组比较差异无统计学意义(均P＞0.05).Logistic回归分析显示,cTnⅠ＞ 0.08 ng/mL、体温、乳酸及器官受累数量对预后有预测价值.结论 cTnⅠ＞ 0.08 ng/mL的严重脓毒症及感染性休克患者的总住院病死率、ICU病死率较cTnⅠ≤0.08 ng/mL的患者增加,且cTnI可作为预测患者病死率的独立指标.

Objective To explore nursing methods and characteristics of patients with sepsis and acute kidney injury to improve the success rate of treatment. Methods Clinical data of 90 patients with sepsis and acute kidney injury was collected from December 2006 to October 2011 in EICU. Treatments included correcting shock and treating primary disease positively, using antimicrobial drugs rationally, correcting acid-base imbalance and water electrolyte disorders, continuous renal replacement therapy and so on. Nursing interventions included paying attention to early fluid resuscitation, observing symptoms changes and treating complications in time, strengthening the hemodynamic monitoring and nursing for blood vessel channel. Results There were 45 patients whose renal functions recovered to normal and 45 patients who developed renal failure and died in 90 patients. Conclusions Since the mortality was high in patients with sepsis and acute kidney injury, it is important to observe the serial changes of condition closely and provide nursing effectively for the recovery of renal functions. It is helpful to improve success rate of treatment for patients with sepsis and acute kidney injury.

Objective To investigate the effect of over expression of paraoxonase 1 gene(PON1) on inflammation and liver injury induced by dichlorvos (DDVP) poisoning in mice. Methods Ninety six Balb/c mice were randomly divided into 4 groups:normal control group, the dichlorvos poisoning group (9 mg/kg dichlorvos), blank lentivirus group (Lv- GFP + dichlorvos) and PON1 recombinant lentivirus group (Lv- PON1+dichlorvos) with 24 mice in each group. The Lv- GFP, Lv- PON1 were transfected to mice via tail vein in Lv- GFP and Lv- PON1 groups and 9 mg/kg dichlorvos solution were intraperitoneal injected to mice 3 days after transfection, while same amount of saline solution was given to normal control group. At 6 h, 12 h, 24 h, 48 h after dichlorvos injection, 6 mice were sacrificed in batch. Serum acetylcholinesterase (AChE), alanine aminotransferase (ALT) and aspartate transaminase (AST) were measured with chemical colorimetry. The levels of tumor necrosis- α(TNF- α) and interleukin 1β(IL-1β) in liver tissue were determined by enzyme- linked immunosorbent (ELISA). The expression of NF- κBp65 in liver tissue was detected by Western blot. The pathological changes of liver tissue were observed with HE staining. Results Compared with normal control group, the AChE activity decreased and ALT, AST activity increased at 6 h, 12 h, 24 h after dichlorvos injection (P<0.05). Compared to dichlorvos group at corresponding time points, the AChE activity of Lv- PON1+dichlorvos group was significantly increased, and ALT, AST activity significantly decreased(P<0.05). Compared with normal control group, the TNF- α, IL- 1β, and NF- κBp656 levels in dichlorvos group at 6 h, 12 h, 24 h, 48 h were elevated (P<0.05). Compared with dichlorvos group at corresponding time points, the TNF- α, IL- 1βlevels and NF- κBp65 expression in Lv- PON1+dichlorvos group were significantly decreased (P<0.05), expect the IL- 1β expression in 48h. Compared with the Lv- PON1+dichlorvos group, liver injury in dichlorvos group at 12h were significantly severe. Conclusion Over expression of PON1 can reduce inflammation and protect the liver injury induced by acute dichlorvos poisoning in mice, which is associated with down- regulation of NF- κBp65 expression and reduced TNF- α, IL- 1βlevels.

Objective To observe the protective effect of melatonin (MT) on paraquat (PQ)-induced acute liver injury in mice and its possible mechanism.Methods A total of 48 male BALB/c mice were randomly divided into normal group (n =6),MT control group (n =6),PQ poisoning group (n =18),and MT treatment group (n =18,1 hour-PQ poisoning ± MT).The drugs were intraperitoneally injected,MT 15 mg/kg,PQ 30 mg/kg.The mice in the later two groups were subdivided into 12,24,72 hours subgroups according to different time points after administration,with 6 mice in each subgroup.Blood from medial angle of eye and liver tissue were collected at different time points after intervention to determine the serum levels of alanine transaminase (ALT) and aspartate aminotransferase (AST) with iodine colorimetry.The levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1 β) in liver tissue were determined with double-antibody sandwich enzyme linked immunosorbent assay (ELISA).The protein expression of nuclear factor-κB p65 (NF-κB p65) in liver nuclei was determined by Western Blot.The pathological changes in liver tissue were observed with light microscope using hematoxylin and eosin (HE) staining.Results Compared with the normal group,the levels of serum ALT and AST,and TNF-α in liver tissue were significantly increased from 12 hours after poisoning,and peaked at 24 hours [ALT (U/L):417.88±76.16 vs.41.76±3.63,AST (U/L):469.79±69.81 vs.53.19±6.31,TNF-α (pg/mg):46.39±9.81 vs.13.01 ±3.19,all P ＜ 0.05],then they were gradually decreased;the levels of IL-1β in liver tissue and NF-κB p65 in nucleus were continuously rose with time prolongation,peaked at 72 hours [IL-1β (pg/mg):30.74±5.81 vs.3.81±0.71,NF-κB p65 protein (gray value):1.70±0.14 vs.0.85 ±0.08,both P ＜ 0.05].MT intervention could significantly inhibit the above parameters with abnormal increase induced by PQ poisoning.Compared with the PQ poisoning group,the levels of AST in serum and TNF-α and IL-1 β in liver tissue were significantly decreased from 12 hours [AST (U/L):269.35± 11.34 vs.391.11±8.71,TNF-α (pg/mg):15.10±5.03 vs.28.77±5.96,IL-1β (pg/mg):6.23± 1.03 vs.10.89±3.02,all P ＜ 0.05],and the levels of serum ALT and NF-κB p65 in nucleus were significantly decreased from 24 hours [ALT (U/L):249.38±21.71 vs.417.88 ± 76.16,NF-κB p65 protein expression (gray value):1.13 ± 0.07 vs.1.45 ± 0.09,both P ＜ 0.05].It was shown by light microscope that no pathological changes in hepatocyte were found in normal group.The pathological changes in hepatocyte were obvious in PQ poisoning group as following:inflammatory cell infiltrates,central venous and blood sinus dilation,hyperemia,and necrosis of liver cells.The pathological changes in hepatocyte in MT treatment group were lessened as compared with those of PQ poisoning group.No significant differences were found in above parameters between normal group and MT control group.Conclusion MT can lessen the necrosis of hepatocyte induced by PQ poisoning via inhibiting the excessive activity of NF-κB p65 and decreasing the TNF-α releasing,and play a role of liver protection.