Gastric Lavage in Acute Organophosphorus Pesticide poisoning (GLAOP) – a randomised controlled trial of multiple vs. single gastric lavage in unselected acute organophosphorus pesticide poisoning

BACKGROUND: Organophosphorus (OP) pesticide poisoning is the most common form of pesticide poisoning in many Asian countries. Guidelines in western countries for management of poisoning indicate that gastric lavage should be performed only if two criteria are met: within one hour of poison ingestion and substantial ingested amount. But the evidence on which these guidelines are based is from medicine overdoses in developed countries and may be irrelevant to OP poisoning in Asia. Chinese clinical experience suggests that OP remains in the stomach for several hours or even days after ingestion. Thus, there may be reasons for doing single or multiple gastric lavages for OP poisoning. There have been no randomised controlled trials (RCTs) to assess this practice of multiple lavages. Since it is currently standard therapy in China, we cannot perform a RCT of no lavage vs. a single lavage vs. multiple lavages. We will compare a single gastric lavage with three gastric lavages as the first stage to assess the role of gastric lavage in OP poisoning. METHODS/DESIGN: We have designed an RCT assessing the effectiveness of multiple gastric lavages in adult OP self-poisoning patients admitted to three Chinese hospitals within 12 hrs of ingestion. Patients will be randomised to standard treatment plus either a single gastric lavage on admission or three gastric lavages at four hour intervals. The primary outcome is in-hospital mortality. Analysis will be on an intention-to-treat basis. On the basis of the historical incidence of OP at the study sites, we expect to enroll 908 patients over three years. This projected sample size provides sufficient power to evaluate the death rate; and a variety of other exposure and outcome variables, including particular OPs and ingestion time. Changes of OP level will be analyzed in order to provide some toxic kinetic data. DISCUSSION: the GLAOP study is a novel, prospective cohort study that will explore to the toxic kinetics of OP and effects of gastric lavage on it. Given the poor information about the impact of gastric lavage on clinical outcomes for OP patients, this study can provide important information to inform clinical practice

Nanomechanical properties of Mg–Al intermetallic compounds produced by packed powder diffusion coating (PPDC) on the surface of AZ91E

A packed powder diffusion coating (PPDC) treatment produced two intermetallic layers on the surface of the commercial magnesium alloy AZ91E. The beta-phase (Mg17Al12) was immediately on top of the AZ91E, on top of which was the tau-phase (Mg-32(Al,Zn)(49)). Nanoindentation showed that the elastic modulus and hardness of each of the intermetallic compounds was significantly greater than that of the AZ91E substrate. Staircase displacement bursts occurred during nanoindentation of the intermetallic compounds, attributed to the combination of incipient plasticity at low loads, and the development of dislocation networks due to dislocation pile ups around the indentation at higher loads. Crystallographic analysis of beta phase orientations using EBSD showed that the nanomechanical properties of the intermetallic compound produced through PPDC treatment were isotropic. (C) 2013 Elsevier B.V. All rights reserved

Gastric Lavage in Acute Organophosphorus Pesticide poisoning (GLAOP) – a randomised controlled trial of multiple vs. single gastric lavage in unselected acute organophosphorus pesticide poisoning

Abstract Background Organophosphorus (OP) pesticide poisoning is the most common form of pesticide poisoning in many Asian countries. Guidelines in western countries for management of poisoning indicate that gastric lavage should be performed only if two criteria are met: within one hour of poison ingestion and substantial ingested amount. But the evidence on which these guidelines are based is from medicine overdoses in developed countries and may be irrelevant to OP poisoning in Asia. Chinese clinical experience suggests that OP remains in the stomach for several hours or even days after ingestion. Thus, there may be reasons for doing single or multiple gastric lavages for OP poisoning. There have been no randomised controlled trials (RCTs) to assess this practice of multiple lavages. Since it is currently standard therapy in China, we cannot perform a RCT of no lavage vs. a single lavage vs. multiple lavages. We will compare a single gastric lavage with three gastric lavages as the first stage to assess the role of gastric lavage in OP poisoning. Methods/Design We have designed an RCT assessing the effectiveness of multiple gastric lavages in adult OP self-poisoning patients admitted to three Chinese hospitals within 12 hrs of ingestion. Patients will be randomised to standard treatment plus either a single gastric lavage on admission or three gastric lavages at four hour intervals. The primary outcome is in-hospital mortality. Analysis will be on an intention-to-treat basis. On the basis of the historical incidence of OP at the study sites, we expect to enroll 908 patients over three years. This projected sample size provides sufficient power to evaluate the death rate; and a variety of other exposure and outcome variables, including particular OPs and ingestion time. Changes of OP level will be analyzed in order to provide some toxic kinetic data. Discussion the GLAOP study is a novel, prospective cohort study that will explore to the toxic kinetics of OP and effects of gastric lavage on it. Given the poor information about the impact of gastric lavage on clinical outcomes for OP patients, this study can provide important information to inform clinical practice.</p

Transport pathway and depocenter of anthropogenic heavy metals off the Shandong Peninsula, China

© 2016 Surface sediment grain size as well as the spatial distribution, sources and geochemical baseline levels of heavy metals in the south Shandong Peninsula clinoform were analyzed to determine the transport pathway and main depocenter of anthropogenic heavy metals off the peninsula. Results showed that the surface sediments were primarily silt-sized components, and the fine grain matter mainly originated from the Yellow River and rivers around Laizhou Bay. Heavy metals Cu, Pb, Zn, Cr, and Cd were predominantly from natural sources and their spatial distributions were controlled by grain size; conversely, anthropogenic As (concentration above geochemical baseline level 10.9 mg/kg) was principally derived from human activities, and its transportation from the Yellow River and Laizhou Bay was controlled by the Shandong Coastal Current off the Shandong Peninsula. Furthermore, the anthropogenic As was deposited in three main areas, that is, the Yellow River estuary, Laizhou Bay, and south Shandong Peninsula clinoform