急性有机磷中毒患者晚期氧化蛋白产物动态变化的临床研究

目的探讨晚期氧化蛋白（AOPP）在急性有机磷农药中毒（AOPP）患者中的临床意义。方法采用酶联免疫分析法（ELISA）动态检测90例有机磷农药中毒患者和30例健康对照者血清晚期氧化蛋白的含量，并探讨其与病情的相关性。结果AOPP患者血浆中晚期氧化蛋白含量发病后的第1天〉第3天〉第7天与健康对照组比较，P均〈0．01。血清CRP的含量在患者中毒后的第1天〉第3天〉第7天与健康对照组比较，P均〈0．01。在发病的第1天，AOPP患者血清晚期氧化蛋白和CRP的含量重度中毒组〉中度中毒组〉轻度中毒组与健康对照组比较，P均〈0．01。在第1天，AOPP患者的病情程度即MODS的评分值与血清晚期氧化蛋白和CRP的含量均呈明显的正相关性（r1=0．590和r2=0．627，P均〈O．01），而血清晚期氧化蛋白和CRP的含量之间也呈明显的正相关性（r3=0．792，P〈0．01）。结论晚期氧化蛋白的含量随急性有机磷农药中毒患者的病情和炎症反应加重而升高。晚期氧化蛋白可能参与了有机磷农药中毒患者发生多脏器功能障碍的病理生理过程。     

The relationship between exposure duration,carboxyhemoglobin, blood glucose,pyruvate and lactate and the severity of intoxication in 39 cases of acute carbon monoxide poisoning in man

The relationship between exposure duration, COHb, blood glucose, pyruvate and lactate and the severity of intoxication was investigated in a group of 39 cases of acute CO poisoning treated in the Clinical Toxicology Center in ód, Poland.On the basis of clinical criteria the patients were classified into cases of mild, moderate, severe and very severe CO poisoning. COHb and carbohydrate metabolites were estimated in venous blood taken immediately after admission of the patient to hospital prior to treatment.The severity of intoxication did not correlate with blood COHb; variation in exposure duration seems to be responsible for this phenomenon. Severe and very severe poisonings were associated with longer exposures and were accompanied by a markedly higher blood lactate level, compared to mild and moderate cases. Blood pyruvate depended less than lactate on the severity of intoxication. Blood glucose depended neither on exposure duration nor on the severity of intoxication.Among the carbohydrate metabolic parameters studied, blood lactate determination can be helpful in the evaluation of the severity of CO poisoning in man.     

Recreational gasoline sniffing: acute gasoline intoxication and latent organolead poisoning. Case reports and literature review

Gasoline is a readily obtainable intoxicant that unfortunately lends itself to habitual abuse by sniffing, a practice found particularly among children and adolescents. The concerted effects of the multiple hydrocarbon and other constituents of gasoline result in a predictable acute toxic syndrome. Organoleads, primarily tetraethyl lead (TEL), cause a separate toxicologic symptom-sign complex that overlaps with the initial acute toxic syndrome. The different clinical symptomatology, effects on hemoglobin synthesis, and response to chelation therapy are all in keeping with the view that organolead poisoning is a separate and distinct toxicologic entity from that of classical elemental lead poisoning or "plumbism".     

Formation of cyanide after i. v. administration of the oxime HI 6 to dogs

HI6(pyridinium, 1-[[[4-(aminocarbonyl)pyridinio] methoxy]methyl]-2-[(hydroxyimino)methyl]-dichloride belongs to a series of bisquaternary pyridinium oximes that are effective against poisoning with extremely toxic organophosphates. Since HI6 has been shown to be unstable at pH 7.4 and to release significant amounts of cyanide, a study was undertaken to determine the degree of cyanide formation from HI 6 in vivo. When HI 6 (100 mol/kg) was administered i. v. to dogs, the animals showed no signs of cyanide toxicity but exhibited some cholinomimetic symptoms, including retching, hypersalivation and enhanced intestinal motility. Cyanide content in whole blood was monitored after production of methemoglobinemia (30%) by 4-dimethylaminophenol in order to sequester cyanide within red cells. Maximal cyanide contents of 20 mol/l were found in blood after 90 min. Calculation of the area under the concentration versus time curve for blood cyanide indicates that about 4% of HI 6 produced cyanide. Determination of the pharmacokinetic parameters of HI 6 (V_D=0.31 l/kg; k_el=0.76 h^–1) and of cyanide (V_D=0.086 l/kg; k_el=0.52 h^–1) together with the apparent first order rate constant of cyanide formation from HI 6 in vitro (0.174 h^–1, pH 7.4, 37°) allowed the simulation of a cyanide concentration curve that fitted with the experimental data points, indicating that cyanide formation in vivo was not bio-catalyzed. It is concluded that cyanide formation from HI 6 may not be regarded as a potential hazard, since cyanide elimination exceeded markedly its formation. Whether this conclusion also holds true for man has to be established.     

2010—2020年云南省学校食源性疾病暴发事件流行病学分析

目的 了解云南省学校食源性疾病暴发事件流行病学特征和趋势。 方法 收集2010—2020年云南省各地报告的学校食源性疾病暴发资料,并进行描述性流行病学分析。 结果 2010—2020年共发生学校食源性疾病暴发260起,发病6 600人,死亡2人,总体呈下降趋势。学校食源性疾病暴发高峰期为第二、四季度,占总起数的66.54%(173/260);暴发场所多发生在小学,占总起数的58.08%(151/260)。报告明确或可疑致病因子的185起事件中由微生物或可疑微生物引起的占40.00%(74/185),毒素引起的占46.49%(86/185);明确致病因子的118起暴发事件中,60.17%(71/118)是由4种致病因子引起的,其中蓖麻毒素导致的最多,达22起(18.64%),发病人数428人,其次是蜡样芽孢杆菌20起(16.95%),原因食品被归因为一类食品植物类,主要是大米、三明治、面包。导致暴发污染环节最多的是生产加工环节(50.77%,132/260)。 结论 关注学校食源性疾病暴发事件流行特征,在学生开学季时,加强对小学食堂植物类食品的生产加工环节管理和监督。微生物、毒素感染是学校食源性疾病主要的致病因素,且原因查明率低,进一步强化医疗机构食源性疾病微生物、毒素检测能力,提高原因查明率,最大限度地降低学校食源性疾病的发病率。     

一起赤潮后海产品麻痹性贝类毒素衰减结果分析

目的 以2017年漳州沿海一起赤潮引起的麻痹性贝类毒素(paralytic shellfish poisoning,PSP)中毒事件为研究起点,研究贝类海产品中的PSP在自然条件下的衰减情况。方法 在漳浦佛昙和龙海港尾海域采集牡蛎和贻贝进行PSP检测。结果 2017年6月8日相关海域海产品最大毒素总毒力为21 056.7 μg/kg,2017年6月26日海产品PSP总毒力值衰减86%以上,2017年7月20日海产品PSP总毒力值衰减97%以上,2018年12月所有海产品中PSP均未检出。结论 本次赤潮发生后,漳浦佛昙和龙海港尾两个海域贝类海产品约需45天净化周期方可食用,相关海域约需18个月净化至贝类毒素完全消失。     

Association of Opioid Use Disorder With 2016 Presidential Voting Patterns: Cross-sectional Study in New York State at Census Tract Level

BackgroundOpioid overdose-related deaths have increased dramatically in recent years. Combating the opioid epidemic requires better understanding of the epidemiology of opioid poisoning (OP) and opioid use disorder (OUD).ObjectiveWe aimed to discover geospatial patterns in nonmedical opioid use and its correlations with demographic features related to despair and economic hardship, most notably the US presidential voting patterns in 2016 at census tract level in New York State.MethodsThis cross-sectional analysis used data from New York Statewide Planning and Research Cooperative System claims data and the presidential voting results of 2016 in New York State from the Harvard Election Data Archive. We included 63,958 patients who had at least one OUD diagnosis between 2010 and 2016 and 36,004 patients with at least one OP diagnosis between 2012 and 2016. Geospatial mappings were created to compare areas of New York in OUD rates and presidential voting patterns. A multiple regression model examines the extent that certain factors explain OUD rate variation.ResultsSeveral areas shared similar patterns of OUD rates and Republican vote: census tracts in western New York, central New York, and Suffolk County. The correlation between OUD rates and the Republican vote was .38 (P<.001). The regression model with census tract level of demographic and socioeconomic factors explains 30% of the variance in OUD rates, with disability and Republican vote as the most significant predictors.ConclusionsAt the census tract level, OUD rates were positively correlated with Republican support in the 2016 presidential election, disability, unemployment, and unmarried status. Socioeconomic and demographic despair-related features explain a large portion of the association between the Republican vote and OUD. Together, these findings underscore the importance of socioeconomic interventions in combating the opioid epidemic.     

乳酸及降钙素原对一氧化碳中毒后迟发性脑病的预测价值

目的探讨检测血乳酸、降钙素原和联合检测对急性一氧化碳中毒后迟发性脑病(DEACMP)的预测价值。 方法随机抽取我院在急诊科收住院的ACMP患者70例,随访3个月,以其中发生DEACMP患者10例为DEACMP组,其余60例为非DEACMP组,随机抽取同期笔者医院40例健康体检者为对照组。对患者立即行动脉血Lac和血清PCT检测,并计算Lac和PCT诊断DEACMP的灵敏度、特异度。 结果DEACMP组血Lac和PCT检测值均明显高于非DEACMP和对照组,差异有统计学意义(采用秩和检验,P<0.05);检测异常率亦明显高于非DEACMP组及对照组,差异有统计学意义(采用χ²检验,P<0.05)。Lac和PCT升高预测DEACMP的敏感度均为90.0% ,特异度分别为50.0%和65.0% ,准确性分别为55.7%和68.6%。联合检测时若其中1个指标为阳性时即预测DEACMP发病,则联合检测的敏感度为100.0%,特异度为41.7%,阳性预测值为21.7%,阴性预测值为100.0%,准确性为71.4%。 结论DEACMP患者早期动脉血Lac和PCT均明显升高,PCT诊断价值优于Lac,联合检测较单项指标检测对DEACMP发病预测价值更理想。     

血液透析与血液灌流联合应用治疗急性中毒50例临床分析

目的 :探索、验证、实践血液透析 (HD)与血液灌流 (HP)联合运用治疗急性中毒的有效性、安全性。方法 :对我院 1998-2 0 0 1年间共收治 5 0例急性中毒的病例资料进行统计分析。结果 :本组 5 0例急性中毒的病例中 ,男 2 7例 ,女 2 3例 ,治愈 4 7例(94 % ) ,死亡 1例 (2 % )。结论 :血液透析与血液灌流联合运用治疗急性中毒 ,临床效果满意 ,操作简便、安全。     

46例急性有机磷农药中毒死亡原因分析

目的 :探讨急性有机磷中毒 (AOPP)死亡。方法 :回顾分析 1998年至 2 0 0 0年 8月死亡病例 4 6例 ,占同期中AOPP5 0 8例的 9.0 6 %。结果 :洗胃不彻底 15例 (32 .6 % ) ,阿托品用量不足 12例(2 6 .1% ) ;中间综合征 (IMS) 7例 (15 .2 % )阿托品中毒 5例 (10 .9% ) ;混合性中毒 3例 (6 .5 % ) ,其余存在严重并发症。结论 :表明洗胃不彻底 ,阿托品用量不足及中毒、IMS、混合性中毒是AOPP死亡的主要原因。对AOPP并发的紧急凶险症状未及时控制也是其死亡原因之一。