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Características sociodemográficas y clínicas relacionadas con la condición final de pacientes intoxicados por paraquat en un hospital del suroccidente de Colombia. BIOMÉDICA 2022; 42:479-491. [PMID: 36122288 PMCID: PMC9552748 DOI: 10.7705/biomedica.6361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Introducción. El herbicida paraquat constituye la primera causa de decesos por intoxicaciones en distintos países. Objetivo. Relacionar las características sociodemográficas y clínicas con la condición final de pacientes intoxicados por paraquat atendidos en un hospital del suroccidente de Colombia. Materiales y métodos. En este estudio observacional, descriptivo, analítico, transversal y retrospectivo, se revisaron las historias clínicas de pacientes atendidos por intoxicación con paraquat en una institución de tercer nivel de complejidad en Pasto (Colombia) entre el 2013 y el 2018. Se recolectó la información sobre la condición final (vivo o fallecido) de cada paciente, así como los datos sociodemográficos, clínicos y de los exámenes paraclínicos. Se establecieron comparaciones por grupos y se diseñó un modelo de regresión logística binaria. Resultados. Se filtró la información de 299 registros y se analizaron finalmente 160 casos. Las características relacionadas con la condición final de los pacientes fueron el tiempo de estancia (OR=0,124; IC95% 0,03-0,6; p=0,009), la frecuencia cardiaca (OR=35,65; IC95% 1,44-884,78; p=0,029) y la creatinina inicial (OR=1,73; IC95% 1,23-2,44; p=0,002). Conclusiones. La proporción de la letalidad fue mayor entre los pacientes con estancia hospitalaria corta, taquicardia y elevación de la concentración sérica de creatinina al ingreso. Este reporte puede ser útil como fundamento de una escala de gravedad para detectar a los pacientes con resultados adversos en la fase temprana para que puedan recibir una intervención oportuna.
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Anthrahydroquinone-2-6-disulfonate is a novel, powerful antidote for paraquat poisoning. Sci Rep 2021; 11:20159. [PMID: 34635711 PMCID: PMC8505516 DOI: 10.1038/s41598-021-99591-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
Paraquat (PQ) is a widely used fast-acting pyridine herbicide. Accidental ingestion or self-administration via various routes can cause severe organ damage. Currently, no effective antidote is available commercially, and the mortality rate of poisoned patients is exceptionally high. Here, the efficacy of anthrahydroquinone-2-6-disulfonate (AH2QDS) was observed in treating PQ poisoning by constructing in vivo and ex vivo models. We then explored the detoxification mechanism of AH2QDS. We demonstrated that, in a rat model, the PQ concentration in the PQ + AH2QDS group significantly decreased compared to the PQ only group. Additionally, AH2QDS protected the mitochondria of rats and A549 cells and decreased oxidative stress damage, thus improving animal survival and cell viability. Finally, the differentially expressed genes were analysed in the PQ + AH2QDS group and the PQ group by NextGen sequencing, and we verified that Nrf2's expression in the PQ + AH2QDS group was significantly higher than that in the PQ group. Our work identified that AH2QDS can detoxify PQ by reducing PQ uptake and protecting mitochondria while enhancing the body's antioxidant activity.
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Chen CK, Chen YC, Mégarbane B, Yeh YT, Chaou CH, Chang CH, Lin CC. The acute paraquat poisoning mortality (APPM) score to predict the risk of death in paraquat-poisoned patients. Clin Toxicol (Phila) 2021; 60:446-450. [PMID: 34543159 DOI: 10.1080/15563650.2021.1979234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONTEXT Mortality prediction in paraquat poisoning is a major issue since most prediction rules are inapplicable if the exact ingestion time cannot be determined and/or the serum paraquat concentration is not readily available, as in most countries. Therefore, we aimed to develop and validate a new prediction rule not requiring these two parameters. METHODS We designed a 10-year observational cohort study including all consecutive paraquat-poisoned patients managed in two Taiwanese hospitals. We built one cohort to define and one cohort to validate this prediction rule. Parameters independently related to mortality determined using a multivariate analysis were used to formulate the Acute Paraquat Poisoning Mortality (APPM) score. RESULTS Overall, 321 paraquat-poisoned patients were included, 156 in the derivation and 165 in the validation cohort. Mortality rates in the derivation and validation cohorts were 73% and 81%, respectively (p = 0.20). The three parameters chosen of 28-day mortality at presentation were urine paraquat level >10 ppm (using a colorimetric sodium dithionite-based test; odds ratio (OR), 12.70; 95% confidence interval (CI), 2.64-61.24), white blood cells >13.0 G/L (OR, 5.50; CI, 1.41-21.48) and blood glucose >140 mg/dL [7.8 mmol/L] (OR, 7.45; CI, 1.70-32.86). In the derivation cohort, the area under the ROC curve (AUC-ROC) of the APPM score did not significantly differ from AUC-ROCs of serum paraquat (0.95, p = 0.25) and the Severity Index of Paraquat Poisoning (0.95, p = 0.33). AUC-ROCs of the APPM score in the derivation and validation cohorts were 0.91 and 0.94, respectively. CONCLUSION We built and validated a reliable score to predict 28-day mortality in paraquat-poisoned patients at presentation, independently from the ingestion time and serum paraquat measurement.
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Affiliation(s)
- Chun-Kuei Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical and Toxicological Critical Care, Lariboisière Hospital, AP-HP, Paris University, Paris, France
| | - Yen-Chia Chen
- Department of Emergency medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, AP-HP, Paris University, Paris, France
| | - Ying-Tse Yeh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Yuli branch, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsun Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chuan Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Wang T, Li S, Wu Y, Yan X, Zhu Y, Jiang Y, Jiang F, Liu W. Mechanistic Investigation of Xuebijing for Treatment of Paraquat-Induced Pulmonary Fibrosis by Metabolomics and Network Pharmacology. ACS OMEGA 2021; 6:19717-19730. [PMID: 34368559 PMCID: PMC8340419 DOI: 10.1021/acsomega.1c02370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
After paraquat (PQ) poisoning, it is difficult to accurately diagnose patients' condition by only measuring their blood PQ concentration. Therefore, it is important to establish an accurate method to assist in the diagnosis of PQ poisoning, especially in the early stages. In this study, a gas chromatography-mass spectrometry (GC-MS) metabonomics strategy was established to obtain metabolite information. A random forest algorithm was used to search for potential biomarkers of PQ poisoning, and data mining and network pharmacological analysis were used to evaluate the active components, drug-disease targets, and key pathways of Xuebijing (XBJ) injection in the treatment of PQ-induced pulmonary fibrosis. Targets from the network pharmacology analysis and metabolites from plasma metabolomics were jointly analyzed to select crucial metabolic pathways. Finally, molecular docking technology and in vitro experiments were used to verify the pathway targets to further reveal the potential mechanisms underlying the antipulmonary fibrosis effect of XBJ. Metabonomics studies showed that l-valine, glycine, citric acid, d-mannose, d-galactose, maltose, l-tryptophan, and arachidonic acid contributed more to the differentiation of different groups than other metabolites. Compared with the control group, the PQ poisoning group had higher levels of l-valine, glycine, citric acid, l-tryptophan, and arachidonic acid, and lower levels of d-mannose, d-galactose, and maltose. After treatment with XBJ injection, the relative levels of these metabolites were reversed. The network pharmacological analysis screened a total of 180 targets, mainly involving multiple signaling pathways and metabolic pathways, which jointly played an antipulmonary fibrosis effect. Based on the combined analysis of 180 targets and 8 different metabolites, arachidonic acid metabolism was selected as the key metabolic pathway. Molecular docking analysis showed that the XBJ compound had strong binding activity with the target protein. Western blot results showed that XBJ injection could reduce the inflammatory response by downregulating the expressions of p-p65, p-IKBα, and p-IKKβ, thus inhibiting the development of PQ-induced pulmonary fibrosis. In summary, the combined results from metabolomics and network pharmacology studies showed that Xuebijing has the characteristics of multitarget, multichannel, and multicomponent action in the treatment of pulmonary fibrosis caused by PQ.
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Affiliation(s)
- Tongtong Wang
- Department
of Pharmacy, The First Affiliate Hospital
of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, China
| | - Sha Li
- Department
of Pharmacy, Changsha Stomatological Hospital, Changsha 410005, China
| | - Yangke Wu
- Department
of Pharmacy, The First Affiliate Hospital
of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, China
| | - Xiao Yan
- Department
of Pharmacy, The First Affiliate Hospital
of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, China
| | - Yiming Zhu
- Department
of Pharmacy, The First Affiliate Hospital
of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, China
| | - Yu Jiang
- Hunan
Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Changsha 410005, China
| | - Feiya Jiang
- Department
of Pharmacy, The First Affiliate Hospital
of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, China
| | - Wen Liu
- Department
of Pharmacy, The First Affiliate Hospital
of Hunan Normal University (Hunan Provincial People’s Hospital), Changsha 410005, China
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Li Y, Zhong X, Ye J, Guo H, Long Y. Proteome of Saccharomyces cerevisiae under paraquat stress regulated by therapeutic concentration of copper ions. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 217:112245. [PMID: 33894630 DOI: 10.1016/j.ecoenv.2021.112245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
Paraquat (PQ) is a non-selective herbicide with strong toxicity to humans and mammals. However, the proteome regulation of cells by PQ is still unclear, limiting the development of effective antidotes. Studies have shown that a slight excess of intracellular copper levels could be beneficial to the survival under exposure to PQ. In this study, Saccharomyces cerevisiae was used as a model to explore the regulation effect of copper ions on PQ poisoning by the approach of date independent acquisition proteomics. The results showed that toxic effect of PQ was primarily induced by oxidative damage in the mitochondria and the disorder of gene expression. The addition of Cu2+ involved a series of favorable reactions to cell survival under PQ stress, including activation of the mitogen-activated protein kinase signaling pathway, regulation of processes such as sulfur metabolism, carbon metabolism and gene expression in cells. The generation of glutathione, heme and steroids advantageous to cell growth under stress was also increased. These findings inferred that therapeutic concentration of copper ions could prolong the survival of cells under PQ stress.
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Affiliation(s)
- Yani Li
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 510632, China
| | - Xing Zhong
- Department of Ultrasound, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Jinshao Ye
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 510632, China.
| | - Huiying Guo
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 510632, China
| | - Yan Long
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 510632, China
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Gao Y, Liu L, Li T, Yuan D, Wang Y, Xu Z, Hou L, Zhang Y, Duan G, Sun C, Che L, Li S, Sun P, Li Y, Ren Z. A novel simple risk model to predict the prognosis of patients with paraquat poisoning. Sci Rep 2021; 11:237. [PMID: 33420265 PMCID: PMC7794476 DOI: 10.1038/s41598-020-80371-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Yanxia Gao
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Liwen Liu
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.,Gene Hospital of Henan Province, Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Tiegang Li
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110001, China
| | - Ding Yuan
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yibo Wang
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Zhigao Xu
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Linlin Hou
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yan Zhang
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Guoyu Duan
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Changhua Sun
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Lu Che
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Sujuan Li
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Pei Sun
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yi Li
- Emergency Department, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Zhigang Ren
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China. .,Gene Hospital of Henan Province, Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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7
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Li C, Xie Z, Chen Q, Zhang Y, Chu Y, Guo Q, Zhou W, Zhang Y, Liu P, Chen H, Jiang C, Sun K, Sun T. Supramolecular Hunter Stationed on Red Blood Cells for Detoxification Based on Specific Molecular Recognition. ACS NANO 2020; 14:4950-4962. [PMID: 32203660 DOI: 10.1021/acsnano.0c01119] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Efficient removal of deadly toxicants by blood purification remains predominant in poisoning treatment. Current strategies mainly rely on absorptive scavengers that normally have no selectivity to the adsorbates, which could result poor clinical outcomes to certain toxic species due to the passivity and inaccuracy of the detoxification procedure. Herein, a positive, accurate, and customized detoxification strategy was proposed. Based on the sophisticated molecule design and thoughtful structure analysis of the aimed toxicant paraquat, a supramolecular hunter stationed on red blood cells (RBC) is developed to continuously track paraquat in the blood. In this construct, a Janus dendrimer amphiphile (JDA) molecule was synthesized with the aim of facilely anchoring onto RBC membranes while bridging to load the antidote WP6 that could precisely recognize paraquat. In vitro and in vivo results demonstrate the effective toxicant-hunting and harm-neutralizing capability of the system through a guest-exchange reaction. This strategy provides a different insight in designing scavengers that can actively, precisely, and continuously hunt toxicants through a supramolecular approach.
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Affiliation(s)
- Chao Li
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Zichen Xie
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Qinjun Chen
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Yujie Zhang
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Yongchao Chu
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Qin Guo
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Wenxi Zhou
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Yiwen Zhang
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Peixin Liu
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Hongyi Chen
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Chen Jiang
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Keyu Sun
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
| | - Tao Sun
- Key Laboratory of Smart Drug Delivery (Ministry of Education), Minhang Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Department of Pharmaceutics, School of Pharmacy, Research Center on Aging and Medicine, Fudan University, Shanghai 201203, P.R. China
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Reisinger A, Rabensteiner J, Hackl G. Diagnosis of acute intoxications in critically ill patients: focus on biomarkers - part 2: markers for specific intoxications. Biomarkers 2020; 25:112-125. [PMID: 32011177 DOI: 10.1080/1354750x.2020.1725787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In medical intensive care units, acute intoxications contribute to a large proportion of all patients. Epidemiology and a basic overview on this topic were presented in part one. The purpose of this second part regarding toxicological biomarkers in the ICU setting focuses on specific poisons and toxins. Following the introduction of anion and osmol gap in part one, it's relevance in toxic alcohols and other biomarkers for these poisonings are presented within this publication. Furthermore, the role of markers in the blood, urine and cerebrospinal fluid for several intoxications is evaluated. Specific details are presented, amongst others, for cardiovascular drug poisoning, paracetamol (acetaminophen), ethanol, pesticides, ricin and yew tree intoxications. Detailed biomarkers and therapeutic decision tools are shown for carbon monoxide (CO) and cyanide (CN-) poisoning. Also, biomarkers in environmental toxicological situations such as mushroom poisoning and scorpion stings are presented.
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Affiliation(s)
- Alexander Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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9
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Li H, Zhu Q, Wang S, Huang T, Li X, Ni C, Fang Y, Li L, Lian Q, Ge RS. Paraquat exposure delays stem/progenitor Leydig cell regeneration in the adult rat testis. CHEMOSPHERE 2019; 231:60-71. [PMID: 31128353 DOI: 10.1016/j.chemosphere.2019.05.104] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/15/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
Paraquat, a widely used nonselective herbicide, is a serious hazard to human health. However, the effects of paraquat on the male reproductive system remain unclear. In this study, adult male Sprague Dawley rats were intraperitoneally injected ethane dimethane sulfonate (EDS, 75 mg/kg) to initiate a regeneration of Leydig cells. EDS-treated rats were orally exposed to paraquat (0.5, 2, 8 mg/kg/day) from post-EDS day 17 to day 28 and effects of paraquat on Leydig and Sertoli cell functions on post-EDS day 35 and day 56 were investigated. Paraquat significantly decreased serum testosterone levels at 2 and 8 mg/kg. Paraquat lowered Leydig cell Hsd17b3, Srd5a1, and Hsd11b1 mRNA levels but increased Hsd3b1 on post-EDS day 35. Paraquat lowered Cyp11a1, Cyp17a1, and Hsd11b1 but increased Srd5a1 on post-EDS day 56. However, paraquat did not alter Leydig cell number and PCNA labeling index. Epididymal staining showed that few sperms were observed in paraquat-treated rats. Primary culture of adult Leydig cells showed that paraquat diminished testosterone output and induced reactive oxygen species generation at 1 and 10 μM and apoptosis rate at 10 μM. In conclusion, a short-term exposure to paraquat delays Leydig cell regeneration from stem/progenitor Leydig cells, causing low production of testosterone and an arrest of spermatogenesis.
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Affiliation(s)
- Huitao Li
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China
| | - Qiqi Zhu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China
| | - Songxue Wang
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China
| | - Tongliang Huang
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China
| | - Xiaoheng Li
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China
| | - Chaobo Ni
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China
| | - Yinghui Fang
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China
| | - Linxi Li
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China
| | - Qingquan Lian
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China.
| | - Ren-Shan Ge
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, Zhejiang, 325027, China.
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10
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Implementation and outcomes of suicide-prevention strategies by restricting access to lethal suicide methods in Korea. J Public Health Policy 2019; 40:91-102. [PMID: 30478435 DOI: 10.1057/s41271-018-0152-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
For more than 10 years, the suicide rate in South Korea has been the highest among members of the Organization for Economic Cooperation and Development. Suicide-prevention strategies, such as restricting access to lethal suicide methods, have been implemented in Korea. In this paper, we discuss suicide-prevention strategies that restrict access to the five leading methods for committing suicide: pesticide ingestion, inhalation of charcoal fumes, jumping from heights, placing oneself in front of moving subway trains, and hanging oneself by the neck. Of the five suicide-prevention strategies outlined in our study, prohibition of the herbicide paraquat and installation of screen doors were proven to be effective, while others need further assessments. Yet, the overall decline in suicide rate from 31.7 per 100,000 people in 2011 to 27.3 per 100,000 people in 2014 suggests that these suicide-prevention strategies have successfully decreased the suicide rate in Korea.
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11
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A retrospective analysis of leucocyte count as a strong predictor of survival for patients with acute paraquat poisoning. PLoS One 2018; 13:e0201200. [PMID: 30044873 PMCID: PMC6059481 DOI: 10.1371/journal.pone.0201200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 07/10/2018] [Indexed: 12/27/2022] Open
Abstract
The aim of this study is the identification of a reliable predictor of prognosis to optimize the treatment of acute paraquat (PQ) poisoning patients. We performed a retrospective analysis on 96 patients with acute PQ poisoning to evaluate leucocyte count as a predictor of 90-day survival. These patients were admitted to the emergency department from May 2012 to February 2017. Kaplan–Meier method was used to compare the 90-day survival. Cox proportional hazard models were utilized to estimate the hazard ratios (HR) and 95% confidence intervals (CI). Receiver operating characteristic (ROC) analysis was conducted to analyze the discriminatory potential of leucocyte with respect to 90-day survival. Result showed that leucocyte was significantly higher among nonsurvivors than that among survivors (p<0.001). Leukocyte was also an independent predictor of survival according to the multivariate Cox analysis (HR 1.103; 95%CI: 1.062–1.146; p<0.001). The area under the curve (AUC) for leucocyte (AUC 0.911; 95%CI: 0.855–0.966; p<0.001) showed a discriminatory potential similar to that of the plasma PQ concentration (AUC 0.961; 95%CI: 0.926–0.997; p<0.001) in predicting 90-day survival. The leucocyte count is a strong predictor of survival in patients with acute PQ poisoning.
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12
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Cui JW, Xu Y, Wang Y, Gao YX, Guo S, Wang M, Lu X, Yu S, Ma Y, Yuan D, Che L, Sun P, Yu X, Zhu H, Li Y. Efficacy of initial haemopurification strategy for acute paraquat poisoning in adults: study protocol for a randomised controlled trial (HeSAPP). BMJ Open 2018; 8:e021964. [PMID: 29934393 PMCID: PMC6020939 DOI: 10.1136/bmjopen-2018-021964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/12/2018] [Accepted: 04/18/2018] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Paraquat (PQ) is a widely used herbicide which is inexpensive and easily accessible for people in rural areas. A small amount of PQ ingestion could be lethal, yet currently, the optimal treatment is still controversial. Extracorporeal therapies (ECTR) have been practised in PQ poisoning management, though limited evidence could be obtained to suggest its superiority over conservative therapy. Haemodialysis (HD) and haemoperfusion (HP) are most commonly used, while some institutions also choose HP-HD concurrent therapy. The object of the present trial is to investigate whether haemopurification therapy can reduce mortality compared with conservative therapy. METHODS AND ANALYSIS This is a planned single-centre, non-blinded, randomised controlled trial. Acute PQ poisoned adults who have orally ingested PQ within 24 hours would be recruited. A total of 360 patients would be recruited and randomly assigned to four groups, that is, HP, HD, concurrent HP-HD and control, at a 1:1:1:1 ratio. Subjects would be also stratified by their urine dithionite test results. Primary outcome is 28-day all-cause mortality. Secondary outcomes include survival time, all-cause mortality at the 3rd, 7th and 60th day, rate of major complications, Acute Physiologic and Chronic Health Evaluation score and Poisoning Severity Score, etc. ETHICS AND DISSEMINATION: The protocol and informed consent documents have been approved by the Ethics Committee of The First Affiliated Hospital of Zhengzhou University in September 2017 (approval number: 2017-KY-10). The result of this trial would be submitted to peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03314909; Pre-results.
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Affiliation(s)
- Jian-Wei Cui
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Yinyan Xu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yibo Wang
- Emergency department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan-Xia Gao
- Emergency department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shigong Guo
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
| | - Meng Wang
- Department of Science and Technology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Lu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Shiyuan Yu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Yong Ma
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Ding Yuan
- Emergency department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lu Che
- Emergency department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pei Sun
- Emergency department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - Yi Li
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
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13
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Zyoud SH. Investigating global trends in paraquat intoxication research from 1962 to 2015 using bibliometric analysis. Am J Ind Med 2018. [PMID: 29537078 DOI: 10.1002/ajim.22835] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Paraquat is considered to be the main pesticide involved in accidental and intentional poisoning, and is responsible for a high rate of morbidity and mortality. The aim of this study is to present a comprehensive bibliometric analysis of paraquat intoxication-related research. METHODS Data was retrieved in March 2017 from the Scopus database. An overview of the research on paraquat intoxication was presented alongside the information related to several bibliometric indicators, such as research trends, countries with their h-index, collaboration, hot issues, top-cited publications, journals, and institutions. RESULTS There were 1971 publications related to paraquat intoxication in the Scopus database that were published between 1966 and 2015. There was increasing research output in the field of paraquat intoxication during the period 2006-2015. The USA published the highest number of publications (n = 338), followed by Japan with 228 publications, and China with 159 publications. The USA and the UK achieved the greatest h-index values (h-index values of 49 and 31, respectively). The USA also achieved the highest number of publications involving international collaboration, with 55 publications, followed by the UK, with 18 publications. The most prevalent topics in this field were "acute paraquat intoxication," "toxic effects of paraquat to the lung," and "mechanism of paraquat toxicity." CONCLUSIONS Although a substantial amount of research has been produced on paraquat intoxication for most developed countries, there are research gaps regarding the international research agenda in this research area. The findings could be applied for prioritizing and organizing future research efforts related to paraquat toxicity.
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Affiliation(s)
- Sa'ed H Zyoud
- College of Medicine and Health Sciences, An-Najah National University, Poison Control and Drug Information Center (PCDIC), Nablus, Palestine
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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14
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Wei TY, Yen TH, Cheng CM. Point-of-care testing in the early diagnosis of acute pesticide intoxication: The example of paraquat. BIOMICROFLUIDICS 2018; 12:011501. [PMID: 29430271 PMCID: PMC5775096 DOI: 10.1063/1.5003848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/04/2018] [Indexed: 05/09/2023]
Abstract
Acute pesticide intoxication is a common method of suicide globally. This article reviews current diagnostic methods and makes suggestions for future development. In the case of paraquat intoxication, it is characterized by multi-organ failure, causing substantial mortality and morbidity. Early diagnosis may save the life of a paraquat intoxication patient. Conventional paraquat intoxication diagnostic methods, such as symptom review and urine sodium dithionite assay, are time-consuming and impractical in resource-scarce areas where most intoxication cases occur. Several experimental and clinical studies have shown the potential of portable Surface Enhanced Raman Scattering (SERS), paper-based devices, and machine learning for paraquat intoxication diagnosis. Portable SERS and new SERS substrates maintain the sensitivity of SERS while being less costly and more convenient than conventional SERS. Paper-based devices provide the advantages of price and portability. Machine learning algorithms can be implemented as a mobile phone application and facilitate diagnosis in resource-limited areas. Although these methods have not yet met all features of an ideal diagnostic method, the combination and development of these methods offer much promise.
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Affiliation(s)
- Ting-Yen Wei
- Interdisciplinary Program of Life Science, National Tsing Hua University, Hsinchu 300, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and Chang Gung University, Linkou 333, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan
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15
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Reczek CR, Birsoy K, Kong H, Martínez-Reyes I, Wang T, Gao P, Sabatini DM, Chandel NS. A CRISPR screen identifies a pathway required for paraquat-induced cell death. Nat Chem Biol 2017; 13:1274-1279. [PMID: 29058724 PMCID: PMC5698099 DOI: 10.1038/nchembio.2499] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 09/18/2017] [Indexed: 02/06/2023]
Abstract
Paraquat, a herbicide linked to Parkinson's disease, generates reactive oxygen species (ROS), which causes cell death. Because the source of paraquat-induced ROS production remains unknown, we conducted a CRISPR-based positive-selection screen to identify metabolic genes essential for paraquat-induced cell death. Our screen uncovered three genes, POR (cytochrome P450 oxidoreductase), ATP7A (copper transporter), and SLC45A4 (sucrose transporter), required for paraquat-induced cell death. Furthermore, our results revealed POR as the source of paraquat-induced ROS production. Thus, our study highlights the use of functional genomic screens for uncovering redox biology.
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Affiliation(s)
- Colleen R Reczek
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kıvanç Birsoy
- Laboratory of Metabolic Regulation and Genetics, The Rockefeller University, New York, New York, USA
| | - Hyewon Kong
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Tim Wang
- Whitehead Institute for Biomedical Research, Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Howard Hughes Medical Institute, Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Peng Gao
- Metabolomics Core Facility, Northwestern University Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
| | - David M Sabatini
- Whitehead Institute for Biomedical Research, Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Howard Hughes Medical Institute, Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Navdeep S Chandel
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Kim HJ, Kim HK, Kwon JT, Lee SH, El Park S, Gil HW, Song HY, Hong SY. Effect of MDR1 gene polymorphisms on mortality in paraquat intoxicated patients. Sci Rep 2016; 6:31765. [PMID: 27545861 PMCID: PMC4992846 DOI: 10.1038/srep31765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/27/2016] [Indexed: 01/11/2023] Open
Abstract
Paraquat is a fatal herbicide following acute exposure. Previous studies have suggested that multidrug resistance protein 1 (MDR1) might help remove paraquat from the lungs and the kidney. MDR1 single-nucleotide polymorphisms (SNPs) are involved in the pharmacokinetics of many drugs. The purpose of this study was to determine whether MDR1 SNPs were associated with the mortality in paraquat intoxicated patients. We recruited 109 patients admitted with acute paraquat poisoning. They were genotyped for C1236T, G2677T/A, and C3435T single-nucleotide polymorphisms (SNPs) of MDR1 gene. Their effects on mortality of paraquat intoxicated patients were evaluated. Overall mortality rate was 66.1%. Regarding the C1236T of the MDR1 gene polymorphism, 21 (19.3%) had the wild type MDR1 while 88 (80.7%) had homozygous mutation. Regarding the C3435T MDR1 gene polymorphism, 37(33.9%) patients had the wild type, 23 (21.1%) had heterozygous mutation, and 49 (45.0%) had homozygous mutation. Regarding the G2677T/A MDR1 gene polymorphism, 38 (34.9%) patients had the wild type, 57 (52.3%) had heterozygous mutation, and 14 (12.8%) had homozygous mutation. None of the individual mutations or combination of mutations (two or three) of MDR1 SNP genotypes altered the morality rate. The mortality rate was not significantly different among SNP groups of patients with <4.0 μg/mL paraquat. In conclusion, MDR1 SNPs have no effect on the mortality rate of paraquat intoxicated patients.
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Affiliation(s)
- Hak Jae Kim
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Choongcheongnam-do 330-930, Republic of Korea
| | - Hyung-Ki Kim
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Choongcheongnam-do 330-930, Republic of Korea
| | - Jun-Tack Kwon
- Department of Clinical Pharmacology, College of Medicine, Soonchunhyang University, Cheonan, Choongcheongnam-do 330-930, Republic of Korea
| | - Sun-Hyo Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Sam El Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Hyo-Wook Gil
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Ho-Yeon Song
- Department of Microbiology, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Sae-Yong Hong
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
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17
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Hong G, Hu L, Tang Y, Zhang T, Kang X, Zhao G, Lu Z. Prognosis and survival analysis of paraquat poisoned patients based on improved HPLC-UV method. J Pharmacol Toxicol Methods 2016; 80:75-81. [PMID: 27216136 DOI: 10.1016/j.vascn.2016.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/29/2016] [Accepted: 05/18/2016] [Indexed: 02/08/2023]
Abstract
UNLABELLED Paraquat (PQ) has caused deaths of numerous people around the world. In order to assess the lethal plasma concentration, the patients who acquired acute PQ intoxication were analyzed by plasma concentration monitoring. The plasma PQ concentrations were determined by high performance liquid chromatography (HPLC) which used 5-bromopyrimidine as internal standard and trichloroacetic acid-methanol (1:9) as protein precipitant. The liver, kidney and coagulation function were determined by automatic biochemical analyzer. According to plasma PQ concentration, 90 patients were divided into four groups: trace PQ group (<50ng/mL), low PQ group (<1000ng/mL), medium PQ group (1000-5000ng/mL) and high PQ group (>5000ng/mL). The clinical data from the four groups was statistically analyzed. The results showed the developed HPLC methods exhibited a high degree of accuracy and good linearity within 50-25000ng/mL (R=0.9998). The Spearman's correlation analysis showed PQ concentration had a strong relationship to total bilirubin, direct bilirubin, aspartic transaminase, urea nitrogen, prothrombin time, prothrombin activity, and international normalized ratio (P<0.01). The cured or survival PQ poisoned patients among the trace PQ group, the low PQ group, the medium PQ group, and the high PQ group were 19/19 (100%), 19/21 (90.47%), 11/25 (44.0%), and 0/25 (0%) respectively. The mean hospital days were (10.37±8.04), (18.76±12.06), (16.76±14.44), and (4.04±5.41) days respectively. The Cox regression analysis indicated that plasma PQ concentration was highly related to prognosis (P<0.05). In conclusion, no patient presenting with a PQ concentration over 5000ng/mL survived. The plasma PQ level is related to liver, kidney and coagulation function, which can be used as an important clinical index to judge the prognosis of PQ poisoned patients. CHEMICAL COMPOUNDS Paraquat (PubChem CID: 15938), 5-bromopyrimidine (PubChem CID: 78344), acetonitrile (PubChem CID: 6342), sodium dihydrogen phosphate (PubChem CID: 23672064), sodium heptanesulfonate (PubChem CID: 23672332), methylprednisolone (PubChem CID: 6741), cyclophosphamide (PubChem CID: 2907).
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Affiliation(s)
- Guangliang Hong
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Lufeng Hu
- Department of Pharmacy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yahui Tang
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Tao Zhang
- Department of Intensive Care Unit, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China
| | - Xiaowen Kang
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Guangju Zhao
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Zhongqiu Lu
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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18
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Abnormal pancreatic enzymes and their prognostic role after acute paraquat poisoning. Sci Rep 2015; 5:17299. [PMID: 26603772 PMCID: PMC4658566 DOI: 10.1038/srep17299] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/26/2015] [Indexed: 02/07/2023] Open
Abstract
Ingestion of paraquat causes multi-organ failure. Prognosis is best estimated through
measurement of blood paraquat concentrations but this facility is not available in
most hospitals. We studied the prognostic significance of abnormal pancreatic
enzymes for survival. Patients with acute paraquat poisoning were recruited. An
extensive series of blood tests including serum amylase were serially checked.
Patients were sorted according to their serum amylase activity (normal
[<220 U/L], mildly elevated [220 to 660 U/L],
elevated [>660 U/L]), and survival compared between groups. 177
patients were enrolled to the study, of whom 67 died and 110 survived. 122 (70.62%),
27 (15.25%) and 25 (14.13%) patients were in the normal, mildly elevated and
elevated amylase activity groups, respectively. The case fatality in the elevated
group was 100% compared to 17% in the normal group
(P < 0.001). We found four independent factors for
paraquat death prediction: amylase, PaCO2, leukocyte number, and
neutrophil percentage. Models using pancreatic enzyme activity showed good
prediction power. We have found that abnormal pancreatic enzymes are useful
prognostic marker of death after acute paraquat poisoning. Including serum amylase
activity into a prognostic model provides a good prognostication.
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Lee JW, Hwang IW, Kim JW, Moon HJ, Kim KH, Park S, Gil HW, Hong SY. Common Pesticides Used in Suicide Attempts Following the 2012 Paraquat Ban in Korea. J Korean Med Sci 2015; 30:1517-21. [PMID: 26425052 PMCID: PMC4575944 DOI: 10.3346/jkms.2015.30.10.1517] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/10/2015] [Indexed: 01/07/2023] Open
Abstract
To determine the change in pesticides used during suicide attempts after the 2012 paraquat (PQ) ban, we evaluated the annual number of suicide attempts by pesticide ingestion between 2011 and 2014. We extracted demographic, clinical outcome, and pesticide class data from the medical records of 1,331 patients that attempted suicide by pesticide ingestion. Pesticides were sorted into 5 groups: herbicides, insecticides, fungicides, other pesticides, and combined pesticides. Each group was subdivided into various classes based on publications by the respective Resistance Action Committees. The chi-square test for trends was used to compare the annual incidence of categorical variables. The total number of suicide attempts decreased each year, from 399 in 2011 to 245 in 2014. Simultaneously, PQ ingestion decreased from 253 patients in 2011 to 60 in 2014. The proportion of PQ to pesticides also decreased from 63.4% in 2011 to 24.5% in 2014. Furthermore, the rate of decrease in the proportion of PQ to all herbicide categories increased by calendar year. In conclusion, there is a significant trend in increased annual number of suicides and proportion of suicides using glyphosates and glufosinates versus total herbicides. However, the number of suicide attempts using glyphosate and glufosinate is lower than that using PQ. The ratio of persons completing suicide to those attempting suicide after pesticide ingestion has decreased every year after the PQ ban.
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Affiliation(s)
- Jung-Won Lee
- Department of Emergency Medicine, Soonchunhyang University Hospital, Cheonan, Korea
| | - Il-Woong Hwang
- Department of Emergency Medicine, Soonchunhyang University Hospital, Cheonan, Korea
| | - Jae-Wook Kim
- Department of Emergency Medicine, Soonchunhyang University Hospital, Cheonan, Korea
| | - Hyung-Jun Moon
- Department of Emergency Medicine, Soonchunhyang University Hospital, Cheonan, Korea
| | - Ki-Hwan Kim
- Department of Emergency Medicine, Soonchunhyang University Hospital, Cheonan, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Hospital, Cheonan, Korea
| | - Hyo-Wook Gil
- Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea
| | - Sae-Yong Hong
- Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea
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