[Evidence summary for postoperative hypothermia rewarming in adults with severe burns]

Objective: To retrieve, evaluate, and summarize the best evidence for postoperative hypothermia rewarming in adults with severe burns. Methods: Foreign language databases including Cochrane Library, Joanna Briggs Institute Evidence-Based Health Care Center Database, PubMed, Ovid-Medline, BMJ Best Practice, and Web of Science were retrieved with the search terms of " severe burn/major burn/severe degree burn" , " hypothermia/warming intervention/hypothermia/temperature/body temperature change" , and " postoperative /perioperative/peri-operative/post-operative" and Chinese databases including Chinese Journal Full-Text Database, Wanfang Database, and VIP Database were retrieved with the search terms of "//" , "/" , and "" to obtain all the publicly published evidence for postoperative hypothermia rewarming in adults with severe burns from the establishment of each database to April 2018, including systematic evaluations, guidelines, expert consensus, evidence summary, and original research closely related to the evidence. The literatures were screened and evaluated for their quality, the evidences were extracted from them, evaluated, classified in order to summarize the best evidences. Results: A total of 8 literatures were included, including one systematic evaluation, three guidelines, one expert consensus, and three evidence summaries. Finally, the best evidences in 8 aspects including the body temperature monitoring site, body temperature monitoring frequency, surface heating, in vivo heating, rewarming start, multi-strategy rewarming, equipment, and personnel training were summarized. Conclusions: Based in the evidence-based nursing method, this study retrieves and evaluates the literature, summarizes the evidence analysis and evaluation, and obtains the best evidences of postoperative hypothermia rewarming in adult patients with severe burns, which provides a strong reference for the clinical implementation of rewarming.

[Treatment and nursing of one patient with burns on perineal region and complicated by secondary multiple organ injuries by exposing to paraquat fluid]

On March 18, 2016, one 53 years old man with burns on perineal region and complicated by secondary multiple organ injuries by exposing to paraquat fluid was admitted to our department. Comprehensive treatment measures including protective mechanical ventilation, intensive care, vacuum sealing drainage, anti-infection, and organ protection were conducted sequentially. Through 33 days of comprehensive treatment and nursing, the patient's condition substantially improved and he left hospital. This case presents that paraquat fluid absorption through skin and mucosa can also lead to severe systemic poisoning, and multiple organ protection is the key to improve the prognosis of this patient.

[Robotic versus laparoscopic distal pancreatectomy: a retrospective single-center study]

Objective: To compare the short-term clinical outcomes and cost differences of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). Methods: The retrospective descriptive study was adopted.The clinical data of 158 patients underwent minimally invasive distal pancreatectomy who were admitted to Fujian Medical University Union Hospital between January 2016 and July 2018 were collected.A 1∶1 matched propensity score (PSM) analysis was performed for the RDP group and the LDP group.Observed indexes included operative time, blood loss, spleen-preserving rate, postoperative hospital stay, morbidity, incidence of pancreatic fistula and hospital costs. T test or rank sum test was used to compare measurement data, χ(2) test or Fisher exact test was used to compare count data. Results: A well-balanced cohort of 41 patients was analyzed.There were 14 males and 27 females in the RDP group, aged (45.2±16.4)years. There were 15 males and 26 females in the LDP group, aged (47.4±14.9) years.The operation time was (209.7±52.9) minutes for the RDP group and (186.5±56.7) minutes for the LDP group (P=0.073). Median blood loss was less in RDP (50(15-175)ml) compared with LDP (100(50-350)ml) (Z=-2.689, P=0.007). Thirty-eight cases of non-malignant diseases were observed in each group and spleen-preserving rate was higher in RDP (76.3%) compared to LDP(44.7%) (χ(2)=7.930, P=0.005).Postoperative hospital stay was similar in the RDP group and the LDP group (RDP: 9.4 days vs. LDP: 10.6 days; P=0.372). The overall morbidity and incidence of pancreatic fistula major complication rates (RDP: 12.2% vs. LDP: 14.6%, P=0.746; RDP: 7.3% vs. LDP: 9.8%, P=1.000) were similar.Total cost of RDP group was higher than that of LDP group ((80 563.7±10 641.8) yuan vs. (57 792.8±8 943.0) yuan, t=4.515, P<0.01). Conclusions: Both RDP and LDP are safe and feasible procedures. RDP is more expensive, but RDP is associated with significantly less blood loss and higher spleen-preserving rate, which is more suitable for the non-malignant diseases of pancreatic body and tail with an expectation of splenic preservation.

[Expression and potential clinical significance of cytidine triphosphate: phosphocholine cytidylyltransferase-α in oral squamous cell carcinoma]

Objective: To examine the expression and potential clinical significance of CCT (cytidine triphosphate: phosphocholine cytidylyltransferase)-α in oral squamous cell carcinoma (OSCC). Methods: Fifty-eight OSCC and paired adjacent non-malignant epithelia samples (between May 2016 and July 2016) were obtained from dental center, Second Xiangya Hospital, Central South University. CCT-α expression was examined by immunohistochemistry. The relationship between CCT-α and clinicopathological features of OSCC patients was analyzed. Quantitative real-time PCR and Western blot were performed to measure the expression of CCT-α mRNA and protein level in several OSCC cell line and two normal oral epithelial cell line. Results: Immunohistochemistry showed that CCT-α positive staining was found in cell nuclear of OSCC cells and adjacent epithelial cells. CCT-α was positively expressed in OSCC, which was significantly higher than that adjacent to carcinoma tissues (P=0.000). The expression of CCT-α in oral squamous cell carcinoma was correlated with smoking, alcohol consumption, tumor size, differentiation degree and lymph node metastasis. The expression level of CCT-α protein was significantly increased in patients with a history of smoking and alcohol consumption (P=0.001, P=0.004). With the increase of tumor diameter, the expression of CCT-α protein was significantly increased (P=0.005). According to histopathological grade, the lower the degree of tumor differentiation, the higher the expression level of CCT-α protein (P=0.000). The expression of CCT-α protein was significantly higher in patients with lymph node metastasis compared with no lymph node metastasis (P=0.000). Quantitative real-time PCR results showed the CCT-α mRNA expression level was significantly higher in OSCC cells than that in normal oral epithelial cells (P=0.016). The protein expression level of CCT-α was significantly higher in OSCC cells than that in normal oral epithelial cells. Conclusions: CCT-α may play a critical role in the carcinogenesis and development of OSCC.

[Choices of methods in dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy]

Objective: To discuss the methods, skills and experiences of dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy(LPD). Methods: The clinical data of 58 patients with periampullary tumors who received LPD at the Union Hospital of Fujian Medical University from December 2014 to January 2017 were retrospectively analyzed.There were 26 males and 32 females, ranged from 18 to 65 years, with a mean age of (46±12)years. Results: All of the 58 patients underwent operation smoothly.Three cases underwent open anastomosis via an auxiliary incision after the total resection of specimen laparoscopically, due to the early learning curve of LPD.Two cases transformed into open operation as a result of tumor vascular invasion to portal vein(PV) or superior mesenteric vein(SMV). Fifty-three cases underwent laparoscopic or laparoscopic combined with robotic pancreaticoduodenectomy completely.Forty-two cases ligated gastroduodenal artery(GDA), fully penetrated the interspace between rear of pancreatic neck and SMV, suspended the pancreas and then divided the neck of pancreas from inferior to superior. Thirteen cases fully dissected the interspace between rear of pancreatic neck and SMV, divided the neck of pancreas from inferior to superior and then ligated GDA.Three cases ligated GDA, dissected PV and SMV at the superior and inferior margin of the neck of pancreas separately, and then divided pancreas from anterior to posterior.Mean time of dividing pancreas was (34.9±9.7)minutes, mean volume of blood loss while dividing pancreas was (30.1±8.2)ml.The main postoperative complications included pancreatic fistula(7 cases, Biochemical leak 2 cases, B grade 3 cases, C grade 2 cases), biliary fistula(3 cases), gastric fistula(1 case), delayed gastric emptying(1 case, C grade), abdominal infection(5 cases), hepatic failure (1 case), intra-abdominal hemorrhage(2 cases), reoperation(2 cases). One case died at the perioperative period while others recovered.The mean duration of postoperative stay was (14.2±5.1)days. Conclusions: Dividing the neck of pancreas is one of the most important steps in LPD, which deserved sufficient attention.At the meantime, a suitable method of dividing the neck of pancreas should be chosen according to intraoperative exploration and preoperative imageological examinations.

The Development of Tolerance to Morphine in Rats Concurrently Treated with Chlorpromazine

Using a modified hot plate method for measuring analgesia in rats, the analgesic dose of morphine was estimated to be about 5 mg./kg. This dose increased by 50 per cent the time the animals withstood exposure before reacting to the thermal stimulation. When chlor-promazine 1.5 mg./kg. was given simultaneously with morphine, a similar degree of analgesia was obtained with about 2 mg./kg. of the narcotic. The sensitivity decreased markedly in rats receiving daily injections of analgesic doses of morphine. Chlorpromazine did not retard the development of tolerance to morphine in these rats. Some of the toxic effects of morphine, however, were less marked in the rats treated with both drugs than those treated with morphine alone.

Comparative study of SPORL and dilute-acid pretreatments of spruce for cellulosic ethanol production

The performance of two pretreatment methods, sulfite pretreatment to overcome recalcitrance of lignocellulose (SPORL) and dilute acid (DA), was compared in pretreating softwood (spruce) for fuel ethanol production at 180 degrees Celsius for 30 min with a sulfuric acid loading of 5% on oven-dry wood and a 5:1 liquor-to-wood ratio. SPORL was supplemented with 9% sodium sulfite (w/w of wood). The recoveries of total saccharides (hexoses and pentoses) were 87.9% (SPORL) and 56.7% (DA), while those of cellulose were 92.5% (SPORL) and 77.7% (DA). The total of known inhibitors (furfural, 5-hydroxymethylfurfural, and formic, acetic and levulinic acids) formed in SPORL were only 35% of those formed in DA pretreatment. SPORL pretreatment dissolved approximately 32% of the lignin as lignosulfonate, which is a potential high-value co-product. With an enzyme loading of 15 FPU (filter paper units) per gram of cellulose, the cellulose-to-glucose conversion yields were 91% at 24h for the SPORL substrate and 55% at 48 h for the DA substrate, respectively.

Recent advances in studies on selenium: an overview of a symposium held in China

Selenium is an essential nutrient as well as a toxicant. To ensure that the intake is neither deficient nor excessive, much work has been done in many parts of the world. International symposia have been held to facilitate exchange of up-to-date information. The 6th International Symposium on Selenium in Biology and Medicine was held in August 1996 in Beijing, China. Selected papers have been published in Biomedical and Environmental Sciences. Some highlights are summarized in this overview.

Safety assessment based on irrelevant toxicologic data: an extraordinary case of bromomethane used as a fumigant

Bromomethane (BM) is a fumigant used in agriculture; it readily breaks down to bromide ion. WHO assessed the ADI of BM, at 1 mg/kg, using data on the toxicity of bromide. On the other hand, U.S. EPA used the observation of hyperplasia in the forestomach of rats given BM by gavage and arrived at a value of 0.0014 mg/kg. The validity of EPA's assessment is thus subject to question because of the data involved by (1) direct introduction of this volatile and reactive chemical to the GI by gavage and (2) using lesions in the rat forestomach which is absent in humans.

A review of the acceptable daily intakes of pesticides assessed by WHO

Over the past three decades, WHO has evaluated and reevaluated, through the Joint FAO/WHO Meeting on Pesticide Residues, 230 pesticides. The acceptable daily intakes (ADIs) of these pesticides are analyzed along with their scientific bases. In most cases, the evaluation process was consistent with the stated general principles and procedures of JMPR. However, the safety factors used in allocating the ADIs of several pesticides seem to be inconsistent with the severity of the toxicity, and thus, may require further consideration. These chemicals are abamectin, dinocap, procymidone, chlormequat, ethion, glyphosate, fentin hydroxide, and fentin compounds. In addition, pesticides that were evaluated many years ago, e.g., bromomethane, might merit a reevaluation in light of any relevant recent data.

Safety/risk assessment of chemicals compared for different expert groups

Two sets of 65 risk/safety assessments are compared. These assessments, mostly for pesticide chemicals, were developed by the World Health Organization (WHO) and the U.S. Environmental Protection Agency (EPA) at different times, often with different toxicity data, and with slightly different methods. Despite these differences, 38 sets of assessments give values that are within a 3-fold range of each other, 18 of these 38 are essentially identical (when rounded to one digit of precision), although not always for the same reasons. An additional 20 sets give values that lie within a 30-fold range; 6 sets lie within a 300-fold range; and the bromomethane ADI and RfD are 700-fold apart. In addition, on average the EPA values are lower than the WHO numbers. These comparisons are discussed in relationship to a developing world-wide consensus that the methods for evaluating the safety/risks from various chemicals should be more consistent and the resulting assessments should be more comparable. Moreover, we argue that an established assessment and associated information from one expert group should be routinely discussed in the ongoing evaluation of a chemical by another expert group. A procedure for effecting more consistency among such expert groups is proposed.

Safety/risk assessment of pesticides: principles, procedures and examples

The principles and procedures for the assessment of the safety/risk of chemical used by the relevant WHO and EPA expert groups are outlined. The assessment in terms of acceptable daily intakes (ADIs) and reference doses (RfDs) of 25 pesticides is listed. The pesticides assessed are acephate, alachlor, amitrole, azinphos-methyl, benomyl, biphenthrin, bromophos, chlordane, chlorthalonil, cyhalothrin, DDT, EPTC, ethion, folpet, fosetyl-al, glyphosate, isofenphos, methomyl, methyl mercury, paraquat, phosphamidon, systhane, terbutyn, tribultyltin oxide, and vinclozin. In addition, their critical effects, the no-observed-effect levels and the size of the safety/uncertainty factors used are also listed to illustrate the diversity of the toxic effects and the resulting assessments. Furthermore, the enormous amount of data reviewed and the complex scientific judgement involved are also indicated. Considering the various uncertainties existing, the ADIs and RfDs do not differ appreciably in most instances. However, marked differences exist between the ADIs and RfDs of DDT and chlordane. It is suggested that re-evaluation be done on these, and perhaps other, chemicals.

Assessment of safety/risk of chemicals: inception and evolution of the ADI and dose-response modeling procedures

This article reviews the procedures for the assessment of safety/risk of chemicals to human health. Because the nature and severity of toxicity and the extent of the database vary from chemical to chemical, the assessment is done on a case by case basis. Essentially 5 steps are involved in the assessment: (a) identification of hazards based on appropriate human and animal data; (b) determination of the dose-response relationship of the adverse effects of the chemical; (c) extrapolation of the dose-response data from test subjects to human populations; (d) estimation of the exposure; and (e) assessment of the safety/risk of the chemical under a specified exposure. Emphasis in this article, however, is placed on the extrapolation of the dose-response data to the human situation. The extrapolation is done by the identification of a no-observed-adverse-effect level (NOAEL) and the application of a safety factor, thereby arriving at an acceptable daily intake (ADI). The safety factor is selected on the basis of, inter alia, the severity of the adverse effect and the adequacy of the database. On the other hand, with genotoxic carcinogens, mathematical modeling is used for extrapolation. This is because the effects of genotoxic carcinogens are generally believed to have no threshold. The ADI approach, which involves the identification of a NOAEL, is therefore not applicable. A number of mathematical models have been developed to assess, from the dose-response data, either the risks that may be associated with a specified dose, or the 'virtually safe dose' at a specified risk level. The evolution, application and shortcomings of these procedures and the potential improvements in the ADI approach and in the dose-response characterization based on these mathematical models are also discussed.

Acceptable daily intake: inception, evolution, and application

The acceptable daily intake (ADI) approach to toxicological evaluation was initiated by the Joint FAO/WHO Expert Committee on Food Additives in 1961. The procedure involves collecting all relevant data, ascertaining the completeness of the available data, determining the no-effect level using the most sensitive indicator of the toxicity, and applying an appropriate safety factor to arrive at the ADI for man. This procedure was also adopted by the Joint FAO/WHO Meeting of Experts on Pesticide Residues later in 1961. In the ensuing years, hundreds of food additives and pesticide residues have been evaluated and reevaluated by these two international expert groups. The ADIs, used nationally and internationally in the elaboration of food standards, have proved satisfactory in permitting the judicious use of these chemicals and in protecting the health of the consumer. The success of this endeavor over the years can be attributed to the dedication and hard work of the many international experts involved as well as to the cooperation of the chemical industry in submitting all relevant published and unpublished data. It is envisaged that this approach will continue to be followed in evaluating and reevaluating additives, pesticides, and contaminants, and that it will likely be extended to other situations where toxicological evaluation forms the scientific basis of control measures.

Safety assessments of chemicals with thresholded effects

Toxicological evaluation of chemicals with thresholded effects involves the estimation of their acceptable daily intakes (ADI). The following steps are involved in the evaluation: judging the completeness of the available chemical and biological data, determination of the no-effect level (NEL), selection of an appropriate safety factor, and extrapolation of the NEL to the ADI using the selected safety factor. The relative insignificance of the sample size on the NEL, the advantages of body weight (compared to the body surface) as a basis for interspecies extrapolation, the size of the safety factor as a function of the nature of the toxic effects, and the multiplicity of the toxicological investigations, in addition to the conventional short-term and long-term toxicity studies, are described. In addition, the possible inadvisability of overemphasizing the importance of dose-response relationship at the expense of in-depth, relevant studies is discussed.

Toxicological evaluations of carcinogens and noncarcinogens: pros and cons of different approaches

Toxicological evaluations are performed to provide estimates of the safety/risk entailed in specified exposures to chemicals. This paper presents the two common approaches to toxicological evaluations. One of these assumes the presence of threshold doses. It involves determination of no-effect levels and extrapolation to acceptable daily intakes in man. This procedure has been widely and successfully used for noncarcinogens. For carcinogens, a number of mathematical models have been proposed for estimating the level of risk associated with a specified exposure level or the dose that is considered virtually safe, e.g., with a risk level of 10(-6). Variations of these major approaches are also outlined. Examples are included to indicate that a deficiency of significant biological data, such as an unexpected toxic effect and the marked influence of modifying factors, can invalidate a toxicological evaluation. It is also pointed out that such deficiencies cannot be overcome by any mathematical manipulation of the available dose-response data.

DEPRESSED DIURESIS CAUSED BY ETHANOL AFTER A WATER LOAD IN RATS

Ethanol at 5% and 10% depresses the absorption and excretion of a water load in rats. This depression of diuresis is probably caused by the ethanol-induced acidity, since it was not observed when the gastric acidity was neutralized by administration of aluminium hydroxide concomitant with the ethanol.

THE MECHANISM OF THE RESERPINE-INDUCED ANTIDIURESIS IN THE RAT

The delay of diuresis caused by reserpine in hydrated rats was not consistently prevented by prior administration of dibenamine or a potent anti-5-hydroxytryptamine substance (Methysergide), to the rats at the time of hydration. Carotid blood from rats under ethanol anaesthesia did not contain detectable antidiuretic activity. After administration of an intravenous dose of reserpine (50 μg/100 g) carotid blood collected at the time of maximum antidiuresis contained a detectable amount of antidiuretic activity which, in four experiments out of five, was destroyed by sodium thioglycollate. This, together with the finding that reserpine prolongs the time to the maximum rate of excretion of urine in hydrated rats, suggests that reserpine releases antidiuretic hormone from the neurohypophysis.

THE MECHANISM OF THE RESERPINE-INDUCED ANTIDIURESIS IN THE RAT

The delay of diuresis caused by reserpine in hydrated rats was not consistently prevented by prior administration of dibenamine or a potent anti-5-hydroxytryptamine substance (Methysergide), to the rats at the time of hydration. Carotid blood from rats under ethanol anaesthesia did not contain detectable antidiuretic activity. After administration of an intravenous dose of reserpine (50 μg/100 g) carotid blood collected at the time of maximum antidiuresis contained a detectable amount of antidiuretic activity which, in four experiments out of five, was destroyed by sodium thioglycollate. This, together with the finding that reserpine prolongs the time to the maximum rate of excretion of urine in hydrated rats, suggests that reserpine releases antidiuretic hormone from the neurohypophysis.