With the rapid advancement of society and technology， the threat posed by acute poisoning accidents to public health safety has become increasingly significant.The traditional health emergency response system for acute poisoning accidents is struggling to adequately address the complex and changeable emergencies.Therefore， it is imperative to establish a scientific and efficient response system.The swift development of digitalization and artificial intelligence （AI） technologies offers new opportunities for constructing such a system.Based on the experience of establishing the Chemical Intoxication Treatment Base of Zhejiang Province， this paper explores the development direction of a scientifically sound and efficient health emergency response system for poisoning emergencies.It highlights how digitalization and AI enhance the system's capabilities in monitoring and early warning， resource allocation，information sharing， and decision support， thereby addressing the limitations of the traditional system in information acquisition， decision-making assistance， and resource management.A scientifically robust and efficient health emergency response system， augmented by digitalization and AI， is not only crucial for safeguarding people's lives and health， but also represents an inevitable trend in the modernization of public health emergency management.
To analyze the detection results of antipsychotic drugs in blood among national medical emergency toxicology testing laboratories in 2023， and to evaluate the poison detection capabilities of participating laboratories.
Methods
Clozapine， fluphenazine and haloperidol were used as comparative detection compounds.Male New Zealand rabbits were poisoned by oral gavage in four doses， each containing two drugs， namely low-dose clozapine +haloperidol， low-dose fluphenazine + clozapine， high-dose fluphenazine + clozapine and high-dose clodiapine + haloperidol.Plasma was collected as comparative samples 1 h after exposure and sent to 64 participating laboratories via the cold chain transportation.Based on the evaluation of qualitative results， quantitative results， original records， integrity of submitted materials and sample testing time， the comparison results among laboratories were divided into excellent，qualified， basically qualified and unqualified.
Results
Among the 64 participating laboratories，60 gave feedback on the detection results， with a feedback rate of 93.75%.Among the 60 participating laboratories， 7 were excellent， 42 were qualified， 7 were basically qualified and 4 were unqualified， with an excellence rate of 11.67% and a passing rate （including excellent，qualified and basically qualified） of 93.33%.The passing rates of general hospitals， disease control and prevention centers and occupational disease prevention and control institutes were 13 / 15，92.59% （25/27） and 17/17 respectively.
Conclusion
The qualitative and quantitative testing of antipsychotic drugs in blood is generally good， but the standardized and normative construction of medical emergency poison detection and its quality control system should be strengthened.
To preliminarily analyze the risk factors of Enterococcus faecium infections and drug resistance of Enterococcus faecium， and to provide clinical basis for empirical coverage of Enterococcus faecium in patients with critical abdominal infections.
Methods
A retrospective analysis was performed on 112 patients with critical abdominal infections in the Department of Critical Care Medicine in three districts of Tongji Hospital， Tongji Medical College of Huazhong University of Science and Technology from January 2016 to August 2021.According to whether they were infected with Enterococcus faecium， patients were divided into an infection group （24 cases） and a non-infection group （88 cases）， and factors that may be associated with Enterococcus faecium infections were statistically analyzed.
Results
A total of 112 patients with intra-abdominal infections were studied， yielding 188 non-repetitive pathogenic strains through abdominal drainage and / or blood cultures， including 24 strains of Enterococcus faecium （12.8%）.No vancomycin-resistant Enterococcus faecium （VREfm） was isolated.Comparisons between the two groups showed no statistically significant differences in terms of sex， age， ICU length of stay， sequential organ failure assessment scores ≥13， acute physiology and chronic health evaluation II scores ≥25， comorbidities， and prognosis （all P ＞0.05）.Multivariate logistic regression analysis indicated that intestinal mechanical barrier disruption ［odds ratio = 3.314， 95% confidence interval （1.147， 9.573）， P = 0.027］ was an independent risk factor for Enterococcus faecium infections in critically ill patients with intraabdominal infections.
Conclusions
Unlike previous studies， the use of third-generation cephalosporins and carbapenems in the ICU is not associated with Enterococcus faecium infections and does not promote VREfm infections.Intestinal mechanical barrier damage is an independent risk factor for Enterococcus faecium infections in patients with critical intraabdominal infections.
To analyze the risk factors of central nervous system （CNS） infections in acute herpes zoster patients， and to provide reference for the prevention and early diagnosis and treatment of varicella-zoster virus （VZV） related CNS infections.
Methods
A total of 1 059 patients with acute herpes zoster admitted to the Hangzhou Third People's Hospital from January 2021 to December 2022 were prospectively included.They were divided into a herpes zoster group （1 020 cases） and a herpes zoster-CNS infection group （39 cases） based on whether they had concurrent CNS infections.The differences in clinical characteristics and serum marker levels between the two groups were analyzed.Multiple logistic regression analysis was applied to screen independent risk factors for concurrent CNS infections in herpes zoster patients.
Results
Compared with the herpes zoster group， patients in the herpes zoster-CNS infection group had a longer interval from onset to treatment， younger age， lower blood chloride and total protein levels，and higher C-reactive protein （CRP） and glutamyltranspeptidase levels， with herpes mainly located in the head and neck and infection prevailing in males （all P ＜0.05）.Using the concurrent CNS infection as the dependent variable， binary logistic regression analysis found that the interval from onset to treatment ［odds ratio （OR）=1.165， 95% confidence interval （CI） （1.012， 1.341）， P=0.034］， herpes site （head and neck） ［OR=2.059， 95%CI （1.192， 3.555）， P=0.010］， and CRP［OR = 1.017， 95%CI （1.001， 1.033）， P = 0.041］ were independent risk factors for acute herpes zoster patients complicating CNS infections， while the total protein content ［OR = 0.947， 95%CI（0.900， 0.995）， P = 0.032］ was a protective factor.
Conclusions
Identifying the risk factors for CNS infections caused by reactivation of VZV is helpful for early screening of intracranial infections.Clinicians should pay attention to the acute herpes zoster patients who experience herpes in the head and neck and have elevated CRP levels and decreased total protein levels.Early intervention may reduce the incidence of CNS infections.
To explore the association between venous excess ultrasound score（VExUS） and acute kidney injury （AKI） in patients with sepsis.
Methods
A prospective study was conducted on 54 sepsis patients admitted to the ICU of Zhejiang Hospital from October 2022 to December 2023.Based on whether AKI occurred during their stay in the ICU， all patients were divided into an AKI group （25 cases） and a non-AKI group （29 cases）.The general clinical data， hemodynamic indicators， laboratory indicators， venous congestion， and cardiac ultrasound indicators were compared， and the generalized estimating equation （GEE） was used to evaluate the correlation between VExUS and AKI in sepsis patients.
Results
The sequential organ failure assessment （SOFA） score， acute physiology and chronic health evaluation（APACHE） II score， creatinine， urea nitrogen， procalcitonin （PCT）， brain natriuretic peptide （BNP），and 72-h fluid balance in the AKI group were higher than those in the non-AKI group， while the glomerular filtration rate （eGFR）， hemoglobin， and 72-h total urine output were lower （all P ＜0.05）.The VExUS of the AKI group on the first day ［1.0 （0.0， 2.2） vs.0.0 （0.0， 1.0）］， third day ［2.0 （1.0， 3.0） vs.1.0 （0.0， 2.0）］， and fifth day ［1.0 （0.0， 2.0） vs.0.0 （0.0， 1.0）］ was higher than that of the non-AKI group （U=2.349， 2.441， 2.536； P=0.019， 0.015， 0.011）.VExUS was positively correlated with the fluid balance， peripheral sign score， and BNP （r = 0.314， 0.287，0.351； all P ＜0.05）.GEE analysis found that VExUS ［odds ratio = 1.661， 95% confidence interval （1.180， 2.339）， P = 0.004］ was an independent risk factor for AKI in sepsis patients.
Conclusions
VExUS is associated with the occurrence of AKI during ICU stay for sepsis patients.Bedside ultrasound is helpful in evaluating venous congestion and guiding volume management strategies.
To evaluate the effectiveness of endoscopic endonasal optic canal decompression （EEOCD） and microsurgical transcranial optic canal decompression （MTOCD） in treating traumatic optic neuropathy （TON） and to explore the risk factors of postoperative visual non-improvement.
Methods
The clinical data of 47 TON patients who underwent surgery in the Department of Neurosurgery of the First Affiliated Hospital， Zhejiang University School of Medicine from August 2015 to July 2023 were retrospectively reviewed.Patients were divided into an EEOCD group （26 cases） and a MTOCD group （21 cases） based on the surgical approach.The baseline data， surgical duration， intraoperative blood loss， hospital stay， and postoperative visual recovery were compared between the two groups.Logistic regression was used to analyze risk factors for postoperative visual non-improvement in TON patients.
Results
The EEOCD group had a shorter operation time ［（136 ±13）min vs.（183±21）min， t=9.361， P ＜0.001］， less intraoperative blood loss ［（153 ±32）mL vs.（205 ±54）mL， t=4.112， P ＜0.001］， and a shorter hospital stay ［（7.9±1.5）days vs.（11.0±1.2）days， t=7.494， P ＜0.001］ compared to the MTOCD group.The visual improvement rates were 57.7% （15 / 26） for the EEOCD group and 42.9% （9 / 21） for the MTOCD group， with no significant difference （ χ2 = 1.023， P = 0.312）.Multivariate logistic regression identified a delay of more than seven days from injury to surgery as a risk factor for poor visual recovery in TON patients ［odds ratio = 8.515， 95% confidence interval （1.647， 44.032）， P=0.011］.Other factors， including age， gender， orbital and optic canal fractures， ethmoid / sphenoid sinus hemorrhage， surgical approach， and optic nerve sheath fenestration， did not significantly correlate with visual outcomes （all P ＞0.05）.
Conclusions
Endoscopic endonasal and microsurgical transcranial approaches are equally effective in improving visual acuity in TON patients.However， the endoscopic endonasal approach offers a distinct advantage in terms of minimal invasiveness.Early surgical intervention is important for TON patients who meet surgical indications.
