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Yadav RK, Gurung S, Karki S, Lama S, Tamang S, Poudel M. Acute paraquat poisoning complicated by acute kidney injury and lung fibrosis: a case report from Nepal. Ann Med Surg (Lond) 2023; 85:5117-5119. [PMID: 37811118 PMCID: PMC10553043 DOI: 10.1097/ms9.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and importance While incidents are rare elsewhere, paraquat herbicide poisoning is a serious medical issue in some parts of Asia. It can cause the failure of various organs, including the heart, kidneys, liver, adrenal glands, central nervous system, muscles, and spleen. Due to its inherent toxicity and lack of available therapies, paraquat has a very high case fatality rate. Case presentation The authors discuss a case of a 15-year-old female with an alleged history of paraquat ingestion who presented with complaints of vomiting, abdominal pain, and loose stools. Initially, she had gastrointestinal symptoms, but she developed renal failure and respiratory symptoms and died of multiple organ failure. Clinical discussion Acute gastrointestinal tract necrosis and multiorgan failure are the initial effects of paraquat intake, and among those who survive the immediate post-ingestion interval, the lung is the target organ for poisoning. Ingestion of large amounts of liquid concentrates results in fulminant organ failure: pulmonary edema, cardiac, renal, and hepatic failure, and convulsions. The course of treatment can range from supportive care alone to various integration of immune modulation, antioxidant therapy, hemoperfusion, and hemodialysis. Conclusion Patients presenting to the emergency department with an alleged history of ingestion of paraquat poisoning should be admitted even if they have mild symptoms initially. There is no specific antidote available. Early renal failure, along with progressive pulmonary fibrosis, can lead to death.
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Affiliation(s)
| | | | - Saurab Karki
- Nepalese Army Institute of Health Sciences, Kathmandu
| | - Susan Lama
- Nepalese Army Institute of Health Sciences, Kathmandu
| | | | - Manish Poudel
- Nepalese Army Institute of Health Sciences, Kathmandu
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Guo H, Yuan Y, Ma Y, Shi J, Gu H. Effects of early repeated hemoperfusion combined with hemodialysis on the prognosis of patients with paraquat poisoning. Am J Transl Res 2023; 15:5613-5623. [PMID: 37854212 PMCID: PMC10579036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/29/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To investigate the effect of early, repeated hemoperfusion in conjunction with hemodialysis on the health status, blood-gas indices, and prognosis of patients with paraquat (PQ) poisoning. METHODS In this retrospective study, clinical data of 149 PQ-poisoned patients treated at Xianyang First People's Hospital between January 2019 and January 2022 were analysed. Sixty-two patients who received conventional treatment coupled with early, repeated hemoperfusion were designated as the control group. The remaining 87 patients, who were subjected to additional hemodialysis on the basis of the control group, were designated in the experimental group. A comparison was made between the two groups regarding the changes in liver function, renal function, and blood-gas indices before and after the treatment. Three-month survival outcomes of both groups were analyzed using Cox regression, with survival curves drawn for different prognostic factors. RESULTS The experimental group exhibited significantly lower levels of indirect bilirubin (IBiL) and glutamic-pyruvic transaminase (ALT) after the treatment compared to the control group (all P < 0.05), as well as markedly lower levels of total bilirubin (TBil), direct bilirubin (DBil), glutamic-oxaloacetic transaminase (AST), alkaline phosphatase (ALP), urea nitrogen (BUN), and creatinine (Cr) (all P < 0.01). The experimental group also demonstrated significantly improved arterial partial pressure of oxygen (PaO2) and PaO2/inspired oxygen (FIO2) ratios, along with reduced arterial carbon dioxide partial pressure (PaCO2) after the treatment (all P < 0.05). Moreover, a significantly higher three-month survival rate was observed in the experimental group compared to the control group (P < 0.001). According to Cox regression analysis, blood purification mode, age, urine PQ concentration upon admission, the timing of initial gastric lavage and bowl cleanse, and the timing of initial blood purification were identified as independent factors affecting the patients' 90-day prognosis. CONCLUSION Early, repeated hemoperfusion coupled with hemodialysis significantly improves the blood-gas indices and liver and kidney function in patients with PQ poisoning, while also extending their short-term survival.
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Affiliation(s)
- Hao Guo
- Department of Critical Care Medicine, Xianyang First People’s HospitalXianyang 712000, Shaanxi, China
| | - Yaying Yuan
- Department of Critical Care Medicine, Xianyang First People’s HospitalXianyang 712000, Shaanxi, China
| | - Yanan Ma
- Emergency Department, Gansu Gem Flower HospitalLanzhou 730060, Gansu, China
| | - Jianling Shi
- Emergency Department, Gansu Gem Flower HospitalLanzhou 730060, Gansu, China
| | - Hua Gu
- Emergency Department, Gansu Gem Flower HospitalLanzhou 730060, Gansu, China
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Maezawa T, Tsutsui T. Green serum-A sign of paraquat poisoning. Acute Med Surg 2023; 10:e826. [PMID: 36936743 PMCID: PMC10014420 DOI: 10.1002/ams2.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/08/2023] [Indexed: 03/17/2023] Open
Affiliation(s)
- Toshinori Maezawa
- Department of Emergency and Intensive Care MedicineJA Hiroshima General HospitalHiroshimaJapan
| | - Toru Tsutsui
- Department of Emergency and Intensive Care MedicineJA Hiroshima General HospitalHiroshimaJapan
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Fan L, Wang X, Lv T, Xue F, Wu B, Ma A, Lu M. Follow-up of patients with a 5-year survival after paraquat poisoning using computed tomography images and spirometry. Hum Exp Toxicol 2023; 42:9603271221150243. [PMID: 36622665 DOI: 10.1177/09603271221150243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The study aimed to examine long-term survival of patients with acute paraquat poisoning using computed tomography (CT) images and spirometry. METHODS A total of 36 patients with long-term survival after paraquat poisoning were followed-up and divided into mild (11 patients), moderate (17 patients), and severe (8 patients) paraquat poisoning groups. Differences among the groups were compared using clinical indicators, such as peripheral capillary oxygen saturation, arterial partial pressure of oxygen and 6-min walk test (6-MWT), chest CT, spirometry, and serum immunoglobulin E (IgE). RESULTS The 6-MWT distance was significantly shorter in the severe paraquat poisoning group than that in the mild and moderate paraquat poisoning groups. In the mild paraquat poisoning group, CT revealed no obvious lung injury, and spirometry showed normal lung function in most patients. In moderate or severe paraquat poisoning group, CT images showed fibrotic lesions as cord-like high-density shadows, reticulations, and honeycombs. In addition, other pulmonary changes, including bronchiectasis, increased lung transparency, and pulmonary bullae, were discovered. In moderate or severe paraquat poisoning group, obvious obstructive ventilation dysfunction with slight restrictive and diffuse impairment were observed in some patients, with positive bronchial relaxation test and high serum IgE level. CONCLUSION In the long-term follow-up, patients with severe paraquat poisoning showed the lowest exercise endurance. In moderate or severe paraquat poisoning group, CT images revealed diversified changes, not only dynamic evolution of pulmonary fibrosis process, but also signs of bronchiectasis, and chronic obstructive pulmonary disease. Some patients with moderate or severe paraquat poisoning developed obstructive ventilatory dysfunction with airway hyperresponsiveness.
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Affiliation(s)
- Lu Fan
- Clinical Medical College, 38043Yangzhou University, Yangzhou, P. R. China
| | - Xuejie Wang
- Clinical Medical College, 38043Yangzhou University, Yangzhou, P. R. China
| | - Tianyi Lv
- Clinical Medical College, 38043Yangzhou University, Yangzhou, P. R. China
| | - Fei Xue
- Clinical Medical College, 38043Yangzhou University, Yangzhou, P. R. China
| | - Benhe Wu
- Clinical Medical College, 38043Yangzhou University, Yangzhou, P. R. China
| | - Aiwen Ma
- Clinical Medical College, 38043Yangzhou University, Yangzhou, P. R. China
| | - Mingfeng Lu
- Clinical Medical College, 38043Yangzhou University, Yangzhou, P. R. China
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Wu Y, Li N, Li S, Song S. Lung transplantation in a woman with paraquat poisoning that led to pulmonary fibrosis-Widely reported by the media: A case report. Medicine (Baltimore) 2022; 101:e32263. [PMID: 36626514 PMCID: PMC9750538 DOI: 10.1097/md.0000000000032263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Paraquat is an extremely toxic herbicide with a high mortality rate on poisoning. It can damage vital organs, such as the lungs, liver, heart, and kidneys. In this study, we report a case of pulmonary fibrosis after paraquat poisoning in a patient who underwent a lung transplant procedure after preoperative administration of corticosteroids and immunosuppressive agents and continuous noninvasive ventilation support therapy. PATIENT CONCERNS An 18-year-old student was hospitalized owing to diarrhea, chest pain, and gradually evolving dyspnea. DIAGNOSES Owing to the inability to estimate the intake concentration and dose, paraquat was only detected in the urine on the 13th day, resulting in rapid progression of the disease and severe pulmonary fibrosis. INTERVENTIONS Extensive media coverage has attracted the attention of all sectors of society. The patient received financial assistance; thus, she could receive a double-lung transplant with extracorporeal membrane oxygenation (ECMO) support on the 34th day after the poisoning. OUTCOMES Postoperatively, the girl was actively rehabilitated, adhered to anti-rejection medication, followed up regularly, and had a good prognosis. LESSONS Lung transplantation is currently the most effective treatment for pulmonary fibrosis, and mass media campaigns can provide economic support, influence potential organ donation, and provide such patients more chances to survive.
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Affiliation(s)
- Yunxiao Wu
- Department of General Medical, Hebei General Hospital, Shijiazhuang, China
- Graduate School of Hebei Medical University, Shijiazhuang, China
| | - Ning Li
- Department of General Medical, Hebei General Hospital, Shijiazhuang, China
| | - Suyan Li
- Department of General Medical, Hebei General Hospital, Shijiazhuang, China
- * Correspondence: Suyan Li, Department of General Medical, Hebei General Hospital, Shijiazhuang 050057, China (e-mail: )
| | - Shumei Song
- Graduate School of Hebei Medical University, Shijiazhuang, China
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Ding M, Zhang Y, Xu W, Fang C, Zhang K. MicroRNA-200b-3p as a biomarker for diagnosis and survival prognosis of multiple organ dysfunction syndrome caused by acute paraquat poisoning. Hum Exp Toxicol 2022; 41:9603271221094008. [PMID: 35442113 DOI: 10.1177/09603271221094008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute paraquat poisoning-induced multiple organ dysfunction syndrome (MODS) leads to the high mortality. This study aimed to investigate the clinical significance of microRNA-200b-3p (miR-200b-3p), an upstream inhibitor of high-mobility group box 1 (HMGB1), in acute paraquat poisoning patients for the prediction of MODS and survival. METHODS This study enrolled 80 patients with MODS induced by paraquat and 94 healthy volunteers. The interaction between miR-200b-3p and HMGB1 was identified by luciferase reporter assay. miR-200b-3p levels were measured by quantitative real-time (QRT) PCR. High-mobility group box 1 levels were measured by enzyme-linked immune sorbent assay (ELISA). Receiver operating characteristic analysis was used to evaluate the diagnostic value of miR-200b-3p in screening MODS patients. The relationship between miR-200b-3p and the 28-day survival of MODS patients was evaluated by Kaplan-Meier curves and log-rank test. Cox regression analysis was used to assess the prognostic value of miR-200b-3p. Correlation between miR-200b-3p and HMGB1 was confirmed by Pearson's correlation analysis. RESULTS miR-200b-3p directly target HMGB1. miR-200b-3p, decreased in MODS patients, had high diagnostic value to screen MODS patients from healthy controls. Additionally, serum miR-200b-3p was decreased in non-survivors, and patients with low miR-200b-3p level had poor 28-day survival. Serum miR-200b-3p could independently predict the survival prognosis. Moreover, serum HMGB1 level was increased in MODS patients, and was negatively correlated with miR-200b-3p level. CONCLUSION Decreased miR-200b-3p may function as a biomarker for the diagnosis and survival prognosis of MODS patients, and miR-200b-3p may be involved in the progression of acute paraquat-induced MODS via regulating inflammatory responses by targeting HMGB1.
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Affiliation(s)
- Minggang Ding
- Emergency Department, 155177Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, Shandong, China
| | - Yi Zhang
- Emergency Department, 155177Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, Shandong, China
| | - Weijun Xu
- Emergency Department, 155177Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, Shandong, China
| | - Chongtao Fang
- Emergency Department, 155177Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, Shandong, China
| | - Kaitai Zhang
- Emergency Department, 155177Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, Shandong, China
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Dai Y, Liu X, Gao Y. Aberrant miR-219-5p is correlated with TLR4 and serves as a novel biomarker in patients with multiple organ dysfunction syndrome caused by acute paraquat poisoning. Int J Immunopathol Pharmacol 2021; 34:2058738420974888. [PMID: 33233960 PMCID: PMC7691899 DOI: 10.1177/2058738420974888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This study aimed to investigate the clinical significance of serum
microRNA-219-5p (miR-219-5p) in patients with multiple organ dysfunction
syndrome (MODS) caused by acute paraquat (PQ) poisoning, and its correlation
with Toll-like Receptor 4 (TLR4). Luciferase reporter assay was used to
investigate in vitro the correlation of miR-219-5p with TLR4. Serum miR-219-5p
levels were evaluated by quantitative real-time polymerase chain reaction. Serum
levels of TLR4, IL-1β, and TNF-α were measured by Enzyme-linked immune sorbent
assay (ELISA). ROC analysis was performed to assess the diagnostic significance,
Kaplan-Meier survival curves and Cox regression analysis were used to evaluate
the prognostic value of miR-219-5p in MODS patients. TLR4 was a target gene of
miR-219-5p and was increased in MODS patients. Serum miR-219-5p level was
decreased and negatively correlated with TLR4 level in MODS patients
(r = −0.660, P < 0.001), which had
important diagnostic value and negatively correlated with APACHE II score in
MODS patients. The miR-219-5p expression was markedly associated with the WBC,
ALT, AST, PaCO2, Lac, and APACHE II score. Non-survivals had more
patients with low miR-219-5p expression. Patients with low miR-219-5p expression
had shorter survival time. MiR-219-5p and APACHE II score were two independently
prognostic factors for 28-day survival. MiR-219-5p was negatively correlated
with, while TLR4 was positively correlated with the levels of IL-1β and TNF-α.
The serum miR-219-5p level may be a potential biomarker for acute PQ-induced
MODS diagnosis and prognosis. Furthermore, miR-219-5p may be associated with the
progression of MODS by regulating TLR4-related inflammatory response.
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Affiliation(s)
- Yunxiang Dai
- Emergency Department, Qingdao Jiaozhou Central Hospital, Qingdao, Shandong, China
| | - Xia Liu
- Radiology Department, Qingdao Jiaozhou Central Hospital, Qingdao, Shandong, China
| | - Yuming Gao
- Emergency Department, Qingdao Jiaozhou Central Hospital, Qingdao, Shandong, China
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Panda PK, Manna S, Bhasi A, Singh SS, Maneesh VS. Paraquat poisoning in Andaman and Nicobar Islands - Government must intervene. J Family Med Prim Care 2021; 10:1780-1784. [PMID: 34123928 PMCID: PMC8144775 DOI: 10.4103/jfmpc.jfmpc_2020_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/02/2020] [Accepted: 01/05/2021] [Indexed: 11/04/2022] Open
Abstract
Paraquat poisoning is a grave public health problem in the Andaman and Nicobar islands of India. To evaluate various aspects of paraquat poisoning that influence the outcome, a retrospective study was planned. In this case series study, the information about all cases of acute paraquat poisoning who were admitted to GB Pant Hospital, Port-Blair, in a 12-year period (January 2007–December 2018) were evaluated. A total of 29 referred patients were evaluated with the majority from the early productive age of 16–30 years (68.97%). The case fatality rate was 100%. Most of the incidents took place in South Andaman district (68.97%) and during the rainy season (55.17%). Initially, they presented with local symptoms like mouth and throat pain with ulceration (48.27%), vomiting (44.82%), breathlessness (34.48%), epigastric and abdominal pain (31.03%), hematemesis (27.58%), and oliguria (20.68%). Later on, major organ dysfunctions like a respiratory failure (65.51%), acute kidney injury (62.08%), acute liver failure (55.17%), cardiac dysfunction (31.03%), and multiorgan failure (58.62%) ensued. Patients who were referred early had a significantly longer hospital stay. Few received advanced care, like, methyl prednisolone (24.12%), cyclophosphamide (10.34%), Mesna/NAC (06.89%), charcoal tablets (10.34%), mechanical ventilation (06.89%), and hemodialysis (10.34%). Apart from hemodialysis in acute kidney injury patients and steroid pulse, no other modalities showed improved hospital survival duration. Primary prevention especially government laws, public awareness, and education of health professionals regarding the seriousness of this problem are the keys to get rid of this incurable poisoning in these islands. The government should prioritize preventive works in the south Andaman district and during the rainy season to avoid catastrophe each year and if possible should ban it. Methyl prednisolone therapy and hemodialysis might be advocated to have a better outcome.
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Affiliation(s)
- Prasan Kumar Panda
- Department of Medicine, ANIIMS, Port Blair, Andaman and Nicobar Islands, India
| | - Sukdev Manna
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Ankith Bhasi
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - S S Singh
- Department of Medicine, ANIIMS, Port Blair, Andaman and Nicobar Islands, India
| | - V S Maneesh
- Department of Medicine, ANIIMS, Port Blair, Andaman and Nicobar Islands, India
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Gao Y, Hou L, Wang Y, Zhang Y, Zhang S, Li Y, Jiang Y, Zhu C, Sun T, Duan G, Yuan D. Comparison of Pancreatic Damage in Rats for Two Methods of Paraquat Administration. Front Pharmacol 2021; 12:611433. [PMID: 33967752 PMCID: PMC8099104 DOI: 10.3389/fphar.2021.611433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/01/2021] [Indexed: 01/09/2023] Open
Abstract
It is noted that elevated serum amylase levels suggesting pancreatic damage has an association with prognosis in PQ patients. This study aimed to determine whether PQ can cause pancreatic damage. The two conventional models (intragastric infusion (iG) and intraperitoneal injection (iP)) may exhibit different effects on the pancreas depending on whether or not they pass through the digestive tract. In this study, the rats were divided into four groups: the intragastric infusion group (PQ-iG, n = 45), intraperitoneal injection group (PQ-iP, n = 53), normal control group 1 (NC-iG, n = 6) and normal control group 2 (NC-iP, n = 6). Pancreatic damage was compared between groups using serum amylase activity assay, hematoxylin and eosin (H&E) staining, TUNEL assay, and transmission electron microscopy (TEM). Serum amylase levels in group PQ-iG were significantly higher than in group PQ-iP (p < 0.05). Examination of the H&E sections showed damage to the pancreas. Both experimental groups were displayed inflammatory infiltration within 9 h of PQ treatment. After 9 h, patchy necrosis was observed in group PQ-iP, when inflammatory infiltration was still the dominant pathology. Necrosis appeared and gradually worsened in group PQ-iG, in which necrosis was the dominant pathology. The TUNEL assay showed significantly higher numbers of apoptotic cells in the pancreas of PQ-groups than in the control NC- groups (p < 0.05). TEM showed expansive endoplasmic reticulum lumens and mitochondria swelling in the pancreas of the PQ-groups. It is concluded that both methods of modeling could cause pancreatic damage and the type and degree of damage would change over time. Note that pancreatic damage in group PQ-iG was more severe than that in group PQ-iP. Therefore, clinical practitioners should pay close attention to pancreatic damage caused by PQ, especially when the route of PQ administration was oral.
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Affiliation(s)
- Yanxia Gao
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linlin Hou
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yibo Wang
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zhang
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shoutao Zhang
- Henan Key Laboratory of Bioactive Macromolecules, School of Life Sciences, Zhengzhou, China
| | - Yi Li
- Emergency Department, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yanan Jiang
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Changju Zhu
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tongwen Sun
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoyu Duan
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ding Yuan
- Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Deng G, Li L, Ouyang Y. Modeling paraquat-induced lung fibrosis in C. elegans reveals KRIT1 as a key regulator of collagen gene transcription. Aging (Albany NY) 2021; 13:4452-4467. [PMID: 33495402 PMCID: PMC7906160 DOI: 10.18632/aging.202406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/18/2020] [Indexed: 02/01/2023]
Abstract
Paraquat poisoning causes lung fibrosis, which often results in long-term pulmonary dysfunction. Lung fibrosis has been attributed to collagens accumulation, but the underlying regulatory pathway remains unclear. Here we use the genetically tractable C. elegans as a model to study collagen gene transcription in response to paraquat. We find that paraquat robustly up-regulates collagen gene transcription, which is dependent on KRI-1, a poorly studied protein homologous to human KRIT1/CCM1. KRI-1 knockdown prevents paraquat from activating the oxidative stress response transcription factor SKN-1/Nrf2, resulting in reduced collagen transcription and increased paraquat sensitivity. Using human lung fibroblasts (MRC-5), we confirm that both KRIT1 and Nrf2 are required for collagen transcription in response to paraquat. Nrf2 hyper-activation by KEAP1 knockdown bypasses KRIT1 to up-regulate collagen transcription. Our findings on the regulation of collagen gene transcription by paraquat could suggest potential strategies to treat pulmonary fibrosis caused by paraquat poisoning.
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Affiliation(s)
- Gongping Deng
- Department of Emergency, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan, China
| | - Le Li
- Hunan Yuantai Biotechnology Co., Ltd, Changsha 410000, Hunan, China
| | - Yanhong Ouyang
- Department of Emergency, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan, China
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Wang TY, Lee YT, Chen HY, Ko CH, Hong CT, Wen JW, Yen TH, Cheng CM. A Paper-Based Analytical Device for Analysis of Paraquat in Urine and Its Validation with Optical-Based Approaches. Diagnostics (Basel) 2020; 11:E6. [PMID: 33375112 DOI: 10.3390/diagnostics11010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 01/04/2023] Open
Abstract
Paraquat is a highly toxic herbicide. Paraquat poisoning is often fatal and is an important public health threat in many places. The quick identification and timely initiation of treatment based on timely analysis of the paraquat concentration in urine/serum could improve the prognosis for patients. However, current paraquat concentration measurements are time-consuming and difficult to implement due to the expensive and bulky equipment required. To address these practical challenges, paper-based devices have emerged as alternative diagnostic tools for improving point-of-care testing. In this study, we demonstrate the successful use of a paper-based analytical device for the accurate detection of urine paraquat concentration. The developed paper-based analytical device employs colorimetric paraquat concentration measurements. The R2 value for the urine paraquat standard curve was 0.9989, with a dynamic range of 0–100 ppm. The limit of detection was 3.01 ppm. Two other optical-based approaches, Spectrochip and NanoDrop, were used for comparison. The results suggest that the developed paper-based analytical device is comparable to other colorimetric measurements, as determined by Bland–Altman analysis. The device was clinically validated using urine from six paraquat-poisoned patients. The results prove that the developed paper-based analytical device is accurate, easy-to-use, and efficient for urine paraquat concentration measurement, and may enable physicians to improve clinical management.
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Sun Z, Yang Z, Wang M, Huang C, Ren Y, Zhang W, Gao F, Cao L, Li L, Nie S. Paraquat induces pulmonary fibrosis through Wnt/β-catenin signaling pathway and myofibroblast differentiation. Toxicol Lett 2020; 333:170-183. [PMID: 32795487 DOI: 10.1016/j.toxlet.2020.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/22/2022]
Abstract
Paraquat (PQ) poisoning-induced pulmonary fibrosis always results in fatal harm to patients. Our study aimed to investigate the functions of the Wnt/β-catenin pathway in PQ-induced pulmonary fibrosis. By comparing the proteomic profiles of rat lung tissues using protein array in the absence or presence of PQ, the Wnt/β-catenin signaling, as a fibrosis-related pathway, was discovered to be profoundly activated by PQ. The protein levels of Wnt/β-catenin signaling components including MMP-2, β-catenin, Wnt3a, Wnt10b, Cyclin D1, and WISP1 were increased in PQ-treated rat lung tissues. Surprisingly, PQ was found to be able to promote lung epithelial cells and fibroblasts differentiating into myofibroblasts by activating Wnt/β-catenin signaling pathway. Dickkopf-1 (DKK1), an antagonist of Wnt/β-catenin signaling pathway, could inhibit the myofibroblast differentiation and attenuate PQ-induced pulmonary fibrogenesis in vitro and in vivo. The expression levels of fibroblasts markers Vimentin, α-smooth muscle actin (α-SMA) and Collagen I was detected and found to be increased when PQ treated and restored with additional DKK1 treatment. In summary, these assays indicated that Wnt/β-catenin signaling pathway played a regulatory role in the differentiation of lung epithelial cells and fibroblasts, and the pathogenesis of pulmonary fibrosis related to PQ. Inhibition of the Wnt/β-catenin signaling pathway may be investigated further as a potential fibrosis suppressor for pulmonary fibrosis therapy.
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Affiliation(s)
- Zhaorui Sun
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China.
| | - Zhizhou Yang
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China; Department of Emergency Medicine, Jinling Hospital, Southern Medical University, Nanjing, 210002, PR China.
| | - Mengmeng Wang
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China.
| | - Changbao Huang
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China.
| | - Yi Ren
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China.
| | - Wei Zhang
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China.
| | - Fei Gao
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China.
| | - Liping Cao
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China.
| | - Liang Li
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China.
| | - Shinan Nie
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China; Department of Emergency Medicine, Jinling Hospital, Southern Medical University, Nanjing, 210002, PR China.
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Dai H, Zhang H, Zu X, Wang H, Wang L. Clinical significance of serum levels of microRNA-27a and its correlation with interleukin-10 in patients with multiple organ dysfunction syndrome caused by acute paraquat poisoning. Exp Ther Med 2020; 19:1961-1968. [PMID: 32104255 DOI: 10.3892/etm.2020.8409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/06/2019] [Indexed: 02/06/2023] Open
Abstract
The aims of the present study were to examine the clinical significance of serum microRNA-27a (miR-27a) levels in patients with multiple organ dysfunction syndrome (MODS) caused by acute paraquat poisoning and to investigate the correlation between miR-27a and interleukin (IL)-10. A total of 82 patients with MODS induced by acute paraquat poisoning and 88 healthy controls were recruited in the present study. Reverse transcription-quantitative PCR was used to measure serum miR-27a expression levels in patients with MODS and the control group. IL-10 serum levels were determined using ELISA. Decreased serum miR-27a level and increased IL-10 expression levels were detected in patients with paraquat poisoning compared with healthy controls (P<0.001). A moderately negative correlation was identified between the serum expression levels of miR-27a and IL-10 (r=-0.5225; P<0.001). miR-27a expression level was found to be associated with blood urea nitrogen, partial pressure of carbon dioxide, arterial blood lactic acid, and the acute physiology and chronic health evaluation II score (APACHE II; P<0.05). The area under the curve for miR-27a was 0.946, with a sensitivity of 86.6% and specificity of 87.5% at a cutoff value of 2.10. The non-survival patient group had lower miR-27a expression levels compared with the survival group (P<0.01). Multivariate Cox regression analyses suggested miR-27a expression level and APACHE II score were independent prognostic factors for 30-day mortality (P<0.01). The present results suggested that serum miR-27a level may be a potential novel diagnostic and prognostic factor for MODS caused by paraquat poisoning. Collectively, miR-27a may be involved in the process of MODS induced by paraquat poisoning by regulating the inflammatory response.
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Affiliation(s)
- Huizhen Dai
- Department of Emergency, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
| | - Huan Zhang
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
| | - Xinxia Zu
- Department of Obstetrics, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
| | - Hongyan Wang
- Comprehensive Ward, Hetan Hospital in Hanting District of Weifang, Weifang, Shandong 261031, P.R. China
| | - Lili Wang
- Operation Room, Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
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Abstract
RATIONALE Despite the fact that treatment of paraquat poisoning in pregnant women and their fetuses is challenging and raises ethical issues, it is rarely reported in the literature. We report the case of a pregnant woman who took paraquat intentionally. PATIENT CONCERNS A 36-year-old woman at 38 weeks gestational age, in an apparent suicide attempt, drank 1 mouthful (about 20 ml) of paraquat solution. Ten hours later, her urine dithionate test showed light blue color with a plasma paraquat concentration of 0.547 μg/ml. Six hours after admission, a male infant, whose plasma paraquat concentration was 0.761 μg/ml, together with 0.673 μg/ml in the amniotic fluid measured by high-performance liquid chromatography, was delivered but the woman's lung, liver, and kidney function declined rapidly. DIAGNOSIS INTERVENTIONS:: Because of placenta previa and multiple organ failure, emergency cesarean section, and panhysterectomy were performed for the pregnant woman. Intravenous injection of antibiotic to prevent infection and dexamethasone 30 mg once a day were administered. Mechanical ventilation was performed for the infant and meropenem and penicillin injection was administered. OUTCOMES The infant died 33 hours after birth while the mother died on the 3rd day after ingestion. LESSONS Paraquat can enter the fetus through the placenta and the amniotic fluid via fluid exchange. The pathological changes of fetal organs may relate to gestational age, and the prognosis was very poor in both the mother and the fetus.
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Affiliation(s)
- Jianshi Chen
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong
- Department of Intensive Care Unite, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Xiangdong Jian
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong
| | - Guangcai Yu
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong
| | - Min Si
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong
| | - Baotian Kan
- Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong University, Jinan, Shandong
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Marashi SM, Hosseini SF, Hosseinzadeh M, Qadir MF, Khodaei F. Ameliorative role of aspirin in paraquat-induced lung toxicity via mitochondrial mechanisms. J Biochem Mol Toxicol 2019; 33:e22370. [PMID: 31348582 DOI: 10.1002/jbt.22370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/23/2019] [Accepted: 06/17/2019] [Indexed: 12/12/2022]
Abstract
Paraquat (PQ) has accounted for numerous suicide attempts in developing countries. Aspirin (ASA) as an adjuvant treatment in PQ poisoning has an ameliorative role. And, it's uncoupling of mitochondrial oxidative phosphorylation role has been well established. The current study aimed at examining the aspirin mechanism on lung mitochondria of rats exposed to PQ. Male rats were randomly allocated in five groups: Control group, PQ group (50 mg/kg; orally, only on the first day), and PQ + ASA (100, 200, and 400 mg/kg; i.p.) groups for 3 weeks. Mitochondrial indices and respiratory chain-complex activities were determined. PQ induced lung interstitial fibrosis; however, ASA (400 mg/kg) led to decrease in this abnormal alteration. In comparison with PQ group, complex II and IV activity, and adenosine triphosphate content in ASA groups had significantly increased; however, reactive oxygen species production, mitochondrial membrane permeabilization, and mitochondrial swelling were significantly reduced. In conclusion, aspirin can alleviate lung injury induced by PQ poisoning by improving mitochondrial dynamics.
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Affiliation(s)
- Sayed Mahdi Marashi
- Forensic Medicine and Clinical Toxicology, Shiraz University of Medical Sciences, Shiraz, Iran.,Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.,Tehran Blood Transfusion Center, Tehran, Iran
| | - Seyede Fatemeh Hosseini
- Department of Anatomy, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Massood Hosseinzadeh
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Muhammad Farhan Qadir
- College of Animal Science and Veterinary Medicine, Shanxi Agricultural University, Taigu, China
| | - Forouzan Khodaei
- Department of Pharmacology and Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.,College of Animal Science and Veterinary Medicine, Shanxi Agricultural University, Taigu, China
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Zhang L, Li Q, Liu Z, Wang Y, Zhao M. The protective effects of bone mesenchymal stem cells on paraquat-induced acute lung injury via the muc5b and ERK/MAPK signaling pathways. Am J Transl Res 2019; 11:3707-3721. [PMID: 31312382 PMCID: PMC6614636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/17/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the protective effect of bone mesenchymal stem cells (BMSCs) on paraquat (PQ)-induced acute lung injury (ALI) and investigate the possible underlying mechanisms. METHODS Male Sprague Dawley rats were treated with BMSCs (3 × 106) 1 h after intraperitoneal injection of PQ. The cell apoptosis rate and mitochondrial membrane potential in rat pulmonary alveolar type II epithelial (ATII) cells were quantitated by flow cytometry. IL-17, IL-6, and MUC5B levels in bronchoalveolar lavage fluid (BALF) and ATII culture medium were measured. Lung tissues were collected to determine the wet-to-dry (W/D) ratios and lung injury scores, in addition to the protein and mRNA expression levels of ERK1/2, Bcl-2, Bax, and muc5b. RESULTS BMSCs had decreased mRNA expression of Muc5b in lung tissue of rats with PQ-induced ALI as shown by RNA-seq. Treatment with BMSCs also alleviated the PQ-induced increases in protein expression in the BALF and reduced the concentration of IL-17, IL-6, and Muc5b in both the BALF and ATII culture medium. In addition, the ATII cell apoptosis rate and mitochondrial membrane potential, as well as the W/D ratios, were decreased by BMSC treatment. Moreover, BMSCs ameliorated the expression levels of Bax mRNA and active caspase-3 proteins and increased Bcl-2 mRNA expression. Furthermore, BMSCs attenuated ERK1/2 activation upon PQ-induced ALI in lung tissue. CONCLUSION BMSC therapy can protect against PQ-induced ALI in rats. A possible mechanism is the suppression of the muc5b and ERK/MAPK signaling pathways, resulting in an improvement in the endothelial permeability and a decrease in inflammation and cell apoptosis.
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Affiliation(s)
- Lichun Zhang
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China
| | - Qiuhe Li
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China
| | - Zhenning Liu
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China
| | - Yu Wang
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China
| | - Min Zhao
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China
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Abstract
To observe whether edaravone can protect organs and inhibit pulmonary fibrosis in patients with paraquat poisoning and to provide a method for clinical intervention for paraquat poisoning.Forty-four cases of paraquat poisoning were collected from March 2011 to December 2017 in our hospital. Eighteen cases from March 2011 to November 2013 did not receive edaravone treatment and were considered the control group, and 26 cases from January 2014 to December 2017 were treated with edaravone and were considered the observation group. Injuries to the central nervous system, heart, liver, kidney, and digestive system were evaluated on at 24 hours, 3 days, and 7 days after hospitalization. The expression of serum inflammatory factors (interleukin [IL]-6, IL-10, tumor necrosis factor-α [TNF-α]) and oxidative stress correlation (superoxide dismutase [SOD] and malondialdehyde [MDA]) were assayed at 24 hours, 3 days, and 7 days after being hospitalized. After 7, 14, and 30 days, the changes in pathological lung characteristics in the 2 groups were assessed, and survival rates were calculated.Edaravone significantly increased the serum levels of SOD and obviously markedly reduce the serum levels of IL-6, IL-10, TNF-α, and MDA in patients poisoned with paraquat (P < .05). Edaravone significantly protected the liver (P = .021), cardiovascular (P = .031), and renal (P = .028) organs of patients from paraquat poisoning-induced injury after 7 days but had no significant protection or improvement on respiratory and digestive tract damage. Edaravone delayed the occurrence of pulmonary fibrosis and increase the survival time of patients at 7 and 14 days (P < .05). However, the 1-month follow-up found that edaravone did not reduce pulmonary fibrosis (77.8% vs 73.1%, P = .615) and did not increase the survival rate of the patients (61.1% vs 65.3%, P = .853).Edaravone is beneficial for protecting the kidneys and liver from paraquat poisoning through reducing oxidative stress and inhibiting inflammatory response. It can also inhibit the pulmonary fibrosis process and prolong the survival time of the patients. However, no significant improvements were seen in the probability of pulmonary fibrosis and the survival rate.
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Chen H, Yang R, Tang Y, Fu X. Effects of curcumin on artery blood gas index of rats with pulmonary fibrosis caused by paraquat poisoning and the expression of Smad 4, Smurf 2, interleukin-4 and interferon-γ. Exp Ther Med 2019; 17:3664-3670. [PMID: 30988750 PMCID: PMC6447781 DOI: 10.3892/etm.2019.7341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/21/2019] [Indexed: 12/14/2022] Open
Abstract
Effects of curcumin on artery blood gas index of rats with pulmonary fibrosis caused by paraquat poisoning and the expression of Mothers against decapentaplegic homolog 4 (Smad4), Smad ubiquitination regulatory factor 2 (Smurf2), interleukin-4 (IL-4) and interferon-γ (IFN-γ) were explored. A total of 54 Wistar rats were randomly selected, of which 36 rats were selected for paraquat poisoning pulmonary fibrosis modeling, and 18 were used in the control group for normal feeding. Then, 18 rats were randomly selected from the modeled groups and injected with curcumin and classified as the curcumin group. The remaining 18 rats were not processed and 17 were successfully modeled as the paraquat group. The expression of SMAD4, Smurf2, IL-4 and INF-γ was detected by enzyme-linked immunosorbent assay. Abdominal aortic blood was taken for determination of pH, arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2). The artery blood PaO2 and serum INF-γ of the curcumin and paraquat groups were significantly higher on day 1 than those on day 5 (P<0.05). The artery blood PaO2 and serum INF-γ in the curcumin group were higher than those in the paraquat group (P<0.05). The artery blood PaCO2, serum Smad4, Smurf2 and IL-4 in the curcumin group were significantly lower on day 1 than those on day 5 (P<0.05). The artery blood PaCO2, serum Smad4, Smurf2 and IL-4 in the paraquat group were significantly lower on day 1 than those on day 5 (P<0.05). The PaCO2, serum Smad4, Smurf2 and IL-4 in the curcumin group were lower than those in the paraquat group (P<0.05). In conclusion, curcumin can effectively improve pulmonary fibrosis in rats after treatment with paraquat poisoning. The results show that it is expected to be an effective drug for the treatment of paraquat, and provide effective reference and guidance for clinical treatment.
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Affiliation(s)
- Honggang Chen
- Department of Emergency, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Rongjia Yang
- Department of Emergency, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Yan Tang
- Department of Emergency, The Second People's Hospital of Lanzhou City, Lanzhou, Gansu 730000, P.R. China
| | - Xiaoyan Fu
- Department of Nursing, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P.R. China
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Hu S, Qiao C, Yuan Z, Li M, Ye J, Ma H, Wang J, Xin S, Zhang J. Therapy with high-dose long-term antioxidant free radicals for severe paraquat poisoning: A pilot study. Exp Ther Med 2018; 16:5149-5155. [PMID: 30542470 PMCID: PMC6257550 DOI: 10.3892/etm.2018.6823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/06/2018] [Indexed: 12/18/2022] Open
Abstract
This study investigated the effects of high-dose long-term antioxidant free radicals on the mortality rate, creatinine (Cr) value, partial pressure of oxygen (PaO2), alanine aminotransferase (ALT), as well as the incidence rates of lung fibrosis and dysfunction in the treatment of patients with severe paraquat (PQ) poisoning [toxic dose, 20 ml stock solution (20% w/v)]. A total of 23 cases of severe PQ poisoning treated in Xiangyang First People's Hospital, Hubei University of Medicine were collected (group 1), and they received conventional treatments such as immunosuppressive agents and/or hemoperfusion. Six patients were given high-dose long-term antioxidant therapy on the basis of conventional treatments (group 2). After treatment, 6 out of the 23 patients in group 1 survived, and all the 6 patients in group 2 survived, with the survival rate of 26.1 vs. 100% (p<0.01). The lowest PaO2 value in group 1 was lower than that in group 2 (70.26±16.38 vs. 91.17±3.43 mmHg, p<0.01). The highest ALT value in group 1 was higher than that in group 2 (216.74±126.23 vs. 52.50±24.83 U/l, p<0.01). There was no significant difference in the incidence rate of lung fibrosis between the two groups of survived patients, but there were 6 patients that died of severe lung fibrosis in group 1. Besides, the incidence rate of lung dysfunction in patients in group 2 was significantly lower than that in survived patients in group 1 (p<0.01). High-dose long-term antioxidants are the most critical treatment option to improve the survival rate of high-dose PQ poisoning, they increase the patient's PaO2, enhance liver function, reduce lung fibrosis and refine lung dysfunction.
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Affiliation(s)
- Shunlin Hu
- Department of Gastroenterology, Xiangyang First People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Chuanhu Qiao
- Department of Gastroenterology, Xiangyang First People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Zhengli Yuan
- Department of Gastroenterology, Xiangyang First People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Min Li
- Department of Gastroenterology, Xiangyang First People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Jiangfeng Ye
- Department of Gastroenterology, Xiangyang First People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Huimin Ma
- Department of Gastroenterology, Xiangyang First People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Jinghui Wang
- Department of Gastroenterology, Xiangyang First People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Siyi Xin
- Department of Gastroenterology, Xiangyang First People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Jing Zhang
- Department of Gastroenterology, Xiangyang First People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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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Wu W, Li Y. Lung injury caused by paraquat poisoning results in increased interleukin-6 and decreased microRNA-146a levels. Exp Ther Med 2018; 16:406-412. [PMID: 29896267 DOI: 10.3892/etm.2018.6153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 01/03/2018] [Indexed: 12/29/2022] Open
Abstract
The aim of the present study was to investigate the expression of microRNA (miR)-146a in the pulmonary macrophages, peripheral blood mononuclear cells and serum of patients with lung injury caused by paraquat poisoning, as well as the underlying mechanism of its regulation in the disease. A total of 26 patients with lung injury caused by paraquat poisoning were included in the present study. In addition, 33 healthy subjects were included as the control group. The expression levels of interleukin (IL)-6 mRNA and miR-146a was determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Western blotting was used to measure IL-6 protein expression, while enzyme-linked immunosorbent assay was also performed to determine the secretion of IL-6 protein. A dual-luciferase reporter assay was conducted to examine whether IL-6 mRNA is a direct target of miR-146a. Patients with lung injury caused by paraquat poisoning exhibited higher IL-6 mRNA and protein levels as compared with those in healthy subjects. In addition, miR-146a expression in patients with paraquat poisoning-induced lung injury was significantly reduced in comparison with that in healthy subjects. Notably, the overexpression of miR-146a by mimic transfection downregulated the expression of IL-6 in pulmonary macrophages. The results of dual-luciferase reporter assay demonstrated that IL-6 mRNA was a direct target of miR-146a. Therefore, the present study demonstrated that increased expression of IL-6 in patients with lung injury caused by paraquat poisoning is associated with decreased expression of miR-146a. Furthermore, miR-146a may regulate the occurrence and immune response of lung injury caused by paraquat poisoning and this process is possibly achieved via IL-6, an important cytokine that mediates inflammation.
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Affiliation(s)
- Wei Wu
- Department of Respiratory Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Yong Li
- Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
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Elenga N, Merlin C, Le Guern R, Kom-Tchameni R, Ducrot YM, Pradier M, Ntab B, Dinh-Van KA, Sobesky M, Mathieu D, Dueymes JM, Egmann G, Kallel H, Mathieu-Nolf M. Clinical features and prognosis of paraquat poisoning in French Guiana: A review of 62 cases. Medicine (Baltimore) 2018; 97:e9621. [PMID: 29642226 PMCID: PMC5908553 DOI: 10.1097/md.0000000000009621] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates. Because of its high toxicity, the European Union withdrew it from its market in 2007. The aim of this study is to analyze all cases of paraquat poisoning hospitalized in French Guiana in order to assess their incidence and main characteristics.Medical records of all paraquat intoxicated patients hospitalized from 2008 until 2015 were reviewed in this retrospective study.Demographics, clinical presentation, and laboratory data were evaluated.A total of 62 cases were reviewed. The incidence of paraquat poisoning was 3.8/100,000 inhabitants/year. There were 44 adults and 18 children younger than 16 years of age. The median ages were 31 years [18.08-75.25] in adults and 13.4 years [0.75-15.08] in children, respectively. The median duration of hospitalization was longer in children [15.5 days (1-24)] than in adults [2 days (1-30)], P < .01. The majority of cases was due to self-poisoning (84%).Children had ingested a lower quantity of paraquat [48.8 mg/kg (10-571.1)] than adults [595.8 mg/kg (6-3636.4), P = .03]. There were more deaths among adults (65%) than in children (22%), P = .004. The severity and outcome was determined primarily by the amount of paraquat ingested.In conclusion, French Guiana has the largest cohort of paraquat poisonings in the European Union. The major factor affecting the prognosis of patients was the ingested amount of paraquat. The administration of activated charcoal or Pemba, in situ, within the first hour after ingestion of paraquat is essential.
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Affiliation(s)
- Narcisse Elenga
- Service de Médecine et Chirurgie Pédiatrique, Centre Hospitalier de Cayenne, Rue des flamboyants, Cayenne Cedex, Guyane Française
| | - Caroline Merlin
- Service de Médecine et Chirurgie Pédiatrique, Centre Hospitalier de Cayenne, Rue des flamboyants, Cayenne Cedex, Guyane Française
| | - Rémi Le Guern
- Université de Lille, UFR Médecine
- CHU Lille, Infection Control
- EA 7366, Pseudomonas aeruginosa Host-Pathogen Translational Research Group, Lille
| | - Rémi Kom-Tchameni
- Service de Médecine et Chirurgie Pédiatrique, Centre Hospitalier de Cayenne, Rue des flamboyants, Cayenne Cedex, Guyane Française
| | - Yves-Marie Ducrot
- Département des centres délocalisés de prévention et de soins, Rue des flamboyants, Cayenne Cedex, Guyane Française
| | - Maxime Pradier
- Service de maladies infctieueses et du voyageur, Centre Hospitalier de Tourcoing-Hôpital Gustave Dron - 135, Tourcoing
| | - Balthazar Ntab
- Département de l’information médicale, Centre Hospitalier de l’Ouest Guyane “Franck Joly”16 avenue du Général de Gaulle, Saint-Laurent-du-Maroni
| | - Kim-Anh Dinh-Van
- Département de l’information médicale, Centre Médico-chirurgical de Kourou, Kourou
| | - Milko Sobesky
- Département de l’information médicale, Centre Hospitalier de Cayenne, Rue des flamboyants, Cayenne Cedex, Guyane Française
| | - Daniel Mathieu
- Service de Réanimation Médicale et Médecine Hyperbare, Hôpital Albert Calmette, Lille Cedex
| | | | | | - Hatem Kallel
- Service de réanimation polyvalente, Centre Hospitalier de Cayenne, Rue des flamboyants, Cayenne Cedex, Guyane Française
| | - Monique Mathieu-Nolf
- Centre anti pison, Centre Hospitalier Régional Universitaire de Lille, 2, Lille Cedex, France
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Zhu Y, Deng G, Ji A, Yao J, Meng X, Wang J, Wang Q, Wang Q, Wang R. Porous Se@SiO 2 nanospheres treated paraquat-induced acute lung injury by resisting oxidative stress. Int J Nanomedicine 2017; 12:7143-7152. [PMID: 29026307 PMCID: PMC5627737 DOI: 10.2147/ijn.s143192] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Acute paraquat (PQ) poisoning is one of the most common forms of pesticide poisoning. Oxidative stress and inflammation are thought to be important mechanisms in PQ-induced acute lung injury (ALI). Selenium (Se) can scavenge intracellular free radicals directly or indirectly. In this study, we investigated whether porous Se@SiO2 nanospheres could alleviate oxidative stress and inflammation in PQ-induced ALI. Male Sprague Dawley rats and RLE-6TN cells were used in this study. Rats were categorized into 3 groups: control (n=6), PQ (n=18), and PQ + Se@SiO2 (n=18). The PQ and PQ + Se@SiO2 groups were randomly and evenly divided into 3 sub-groups according to different time points (24, 48 and 72 h) after PQ treatment. Porous Se@SiO2 nanospheres 1 mg/kg (in the PQ + Se@SiO2 group) were administered via intraperitoneal injection every 24 h. Expression levels of reduced glutathione, malondialdehyde, superoxide dismutase, reactive oxygen species (ROS), nuclear factor-κB (NF-κB), phosphorylated NF-κB (p-NF-κB), tumor necrosis factor-α and interleukin-1β were detected, and a histological analysis of rat lung tissues was performed. The results showed that the levels of ROS, malondialdehyde, NF-κB, p-NF-κB, tumor necrosis factor-α and interleukin-1β were markedly increased after PQ treatment. Glutathione and superoxide dismutase levels were reduced. However, treatment with porous Se@SiO2 nanospheres markedly alleviated PQ-induced oxidative stress and inflammation. Additionally, the results from histological examinations and wet-to-dry weight ratios of rat lung tissues showed that lung damage was reduced after porous Se@SiO2 nanosphere treatment. These data indicate that porous Se@SiO2 nanospheres may reduce NF-κB, p-NF-κB and inflammatory cytokine levels by inhibiting ROS in PQ-induced ALI. This study demonstrates that porous Se@SiO2 nanospheres may be a therapeutic method for use in the future for PQ poisoning.
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Affiliation(s)
- Yong Zhu
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine
| | - Guoying Deng
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Anqi Ji
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Jiayi Yao
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine
| | - Xiaoxiao Meng
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine
| | - Jinfeng Wang
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine
| | - Qian Wang
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Qiugen Wang
- Trauma Center, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Ruilan Wang
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine
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Zhu Y, Wang J, Meng X, Xie H, Tan J, Guo X, Han P, Wang R. A positive feedback loop promotes HIF-1α stability through miR-210-mediated suppression of RUNX3 in paraquat-induced EMT. J Cell Mol Med 2017; 21:3529-3539. [PMID: 28699703 PMCID: PMC5706527 DOI: 10.1111/jcmm.13264] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 04/28/2017] [Indexed: 01/06/2023] Open
Abstract
Irreversible pulmonary fibrosis induced by paraquat (PQ) poisoning is the major cause of death in patients with PQ poisoning. The epithelial–mesenchymal transition (EMT) is postulated to be one of the main mechanisms of pulmonary fibrosis. Here, we investigated the role of miR‐210 in PQ‐induced EMT and its relationship with hypoxia‐inducible factor‐1α (HIF‐1α). Western blotting, immunofluorescence, immunoprecipitation and other methods were used in this study. We found that miR‐210 expression was significantly increased after PQ poisoning, and it may be regulated by HIF‐1α. Overexpression of miR‐210 further increased the HIF‐1α protein level and promoted EMT. Moreover, miR‐210 knock‐down reduced the HIF‐1α protein level and decreased the degree of EMT. Runt‐related transcription factor‐3 (RUNX3), a direct target of miR‐210, was inhibited by miR‐210 in response to PQ poisoning. RUNX3 increased the hydroxylation ability of prolyl hydroxylase domain‐containing protein 2 (PHD2), a key enzyme that promotes HIF‐1α degradation. PHD2 immunoprecipitated with RUNX3 and its level changed similarly to that of RUNX3. The expression of the HIF‐1α protein was significantly reduced when RUNX3 was overexpressed. HIF‐1α protein levels were markedly increased when RUNX3 was silenced. Based on these results, a positive feedback loop may exist between miR‐210 and HIF‐1α. The mechanism may function through miR‐210‐mediated repression of RUNX3, which further decreases the hydroxylation activity of PHD2, enhances the stability of HIF‐1α, and promotes PQ‐induced EMT, aggravating the progression of pulmonary fibrosis. This study further elucidates the mechanism of PQ‐induced pulmonary fibrosis and may provide a new perspective for the future development of therapies.
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Affiliation(s)
- Yong Zhu
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Jinfeng Wang
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Xiaoxiao Meng
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Hui Xie
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Jiuting Tan
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Xinkun Guo
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Peng Han
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Ruilan Wang
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
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Liu XW, Ma T, Li LL, Qu B, Liu Z. Predictive values of urine paraquat concentration, dose of poison, arterial blood lactate and APACHE II score in the prognosis of patients with acute paraquat poisoning. Exp Ther Med 2017; 14:79-86. [PMID: 28672896 PMCID: PMC5488431 DOI: 10.3892/etm.2017.4463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 02/14/2017] [Indexed: 12/12/2022] Open
Abstract
The present study investigated the predictive values of urine paraquat (PQ) concentration, dose of poison, arterial blood lactate and Acute Physiology and Chronic Health Evaluation (APACHE) II score in the prognosis of patients with acute PQ poisoning. A total of 194 patients with acute PQ poisoning, hospitalized between April 2012 and January 2014 at the First Affiliated Hospital of P.R. China Medical University (Shenyang, China), were selected and divided into survival and mortality groups. Logistic regression analysis, receiver operator characteristic (ROC) curve analysis and Kaplan-Meier curve were applied to evaluate the values of urine paraquat (PQ) concentration, dose of poison, arterial blood lactate and (APACHE) II score for predicting the prognosis of patients with acute PQ poisoning. Initial urine PQ concentration (C0), dose of poison, arterial blood lactate and APACHE II score of patients in the mortality group were significantly higher compared with the survival group (all P<0.05). Logistic regression analysis revealed that C0, dose of poison and arterial blood lactate correlated with mortality risk of acute PQ poisoning (all P<0.05). ROC curve analysis suggested that the areas under the curve (AUC) values of C0, dose of poison, arterial blood lactate and APACHE II score in predicting the mortality of patients within 28 days were 0.921, 0.887, 0.808 and 0.648, respectively. The AUC of C0 for predicting early and delayed mortality were 0.890 and 0.764, respectively. The AUC values of urine paraquat concentration the day after poisoning (Csec) and the rebound rate of urine paraquat concentration in predicting the mortality of patients within 28 days were 0.919 and 0.805, respectively. The 28-day survival rate of patients with C0 ≤32.2 µg/ml (42/71; 59.2%) was significantly higher when compared with patients with C0 >32.2 µg/ml (38/123; 30.9%). These results suggest that the initial urine PQ concentration may be the optimal index for predicting the prognosis of patients with acute PQ poisoning. Additionally, dose of poison, arterial blood lactate, Csec and rebound rate also have referential significance.
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Affiliation(s)
- Xiao-Wei Liu
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Tao Ma
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Lu-Lu Li
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Bo Qu
- Department of Biostatistics, School of Public Health, China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Zhi Liu
- Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Lin CC, Liao SC, Shih CP, Hsu KH. QTc prolongation as a useful prognostic factor in acute paraquat poisoning. J Emerg Med 2014; 47:401-7. [PMID: 25060011 DOI: 10.1016/j.jemermed.2014.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/10/2013] [Accepted: 02/08/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Acute paraquat poisoning has a high mortality rate. Several prognostic factors have been proposed to predict the mortality risk of paraquat-poisoned patients. However, these prognostic factors are complex and some require a laboratory. Corrected QT (QTc) has been used as a prognostic factor in several clinical conditions, such as acute organophosphate poisoning. In addition, the measurement can be obtained in a reasonable amount of time. STUDY OBJECTIVES This study's objective was to investigate whether QTc can predict mortality in paraquat-poisoned patients. METHODS This was a retrospective study. Potential prognostic factors such as QTc, vital signs at admission, and certain biochemistry variables were analyzed with Cox regression analyses for their ability to predict a patient's survival from paraquat poisoning. RESULTS Sixty acute paraquat-poisoned patients were admitted to the emergency department during the study period. The QTc of the survival group ranged from 0.35 to 0.48 s, whereas the nonsurvivor group ranged from 0.32 to 0.63 s. The nonsurvivor group contained a higher percentage of patients with QTc prolongation (≥0.45 s) compared with the survivor group (p = 0.04). The hazard ratio of QTc prolongation for a patient's death was found to be 2.47 (95% confidence interval [CI] 1.68-5.67) in patients with a lower potassium level (<3.2 mEq/L) and 3.71 (95% CI 1.53-8.97) in patients with a higher potassium level (≥3.2 mEq/L). In addition, hyperdynamic circulation was observed upon admission of these poisoned patients. CONCLUSION QTc prolongation is a useful prognostic factor for predicting death in acute paraquat-poisoned patients. Cardiovascular collapse may occur in some paraquat-poisoned patients. Physicians can use QTc as an indicator of a patient's severity of poisoning and mortality risk.
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