ABSTRACT
Objective To study the impact of interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) for patients with cardiac arrest (CA). Methods A prospective study was conducted. A total of 122 CA patients admitted to Department of Emergency of Shandong Provincial Mining Industry Group Company Central Hospital from July 2013 to December 2017 were enrolled. They were divided into standard cardiopulmonary resuscitation (S-CPR) group (n = 62) and IAPP-CPR group (n = 60) according to order of admission. The patients in S-CPR group received external cardiac compression, open airway, endotracheal intubation, mechanical ventilation, routine drug rescue, and defibrillation when ventricular fibrillation was found. And the patients in IAPP-CPR group received the IAPP-CPR on the basis of the routine chest compression. During the relaxation period, the patients were subjected to abdominal lifting and compressing with amplitude of 4-5 cm, frequency of 100 times/min, and the time ratio of lifting to compressing was 1:1. The data of demographics and clinical signs of patients were collected. The markers of respiratory and circulatory performance of all patients after CPR were determined. The rates of restoration of spontaneous circulation (ROSC), successful resuscitation, and the prognosis were recorded. With the success of CRP as the dependent variable, the factors with statistical significance showed by univariate analysis were used as the independent variable to carry out two classification Logistic regression analysis for screening the influence factors of CPR success. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of various factors on the success of CPR. Results 122 patients were enrolled in the analysis. Compared with the S-CPR group, heart rate (HR), mean arterial pressure (MAP), arterial partial pressure of oxygen (PaO2), and end-tidal carbon dioxide partial pressure (PETCO2) were significantly increased at 30 minutes after CPR in IAPP-CPR group [HR (bpm): 66.3±11.5 vs. 53.1±12.6, MAP (mmHg, 1 mmHg = 0.133 kPa): 65.4±6.5 vs. 53.2±5.4, PaO2(mmHg): 77.7±11.8 vs. 61.8±14.3, PETCO2(mmHg):45.5±9.6 vs. 31.8±8.2, all P < 0.05], and arterial partial pressure of carbon dioxide (PaCO2) and lactic acid (Lac) were significantly lowered [PaCO2(mmHg): 46.7±6.2 vs. 57.9±9.5, Lac (mmol/L): 2.1±1.5 vs. 4.4±2.2, both P < 0.05]. The time of CA to ROSC in IAPP-CPR group was significantly shorter than that in S-CPR group (minutes: 6.3±1.8 vs. 11.2±1.4, P < 0.05), the ROSC rate and CPR success rate were significantly higher than those in S-CPR group [ROSC rate: 61.7% (37/60) vs. 43.5% (27/62), CPR success rate: 40.0% (24/60) vs. 21.0% (13/62), both P < 0.05], and 24-hour survival rate and survival and discharge rate of patients were significantly higher than those in the S-CPR group [24-hour survival rate: 46.7% (28/60) vs. 29.0% (18/62), survival and discharge rate: 20.0% (12/60) vs. 11.3% (7/62), both P < 0.05]. Logistic regression analysis showed that PaO2, PaCO2 and PETCO2 were the factors that affect the success of CPR [PaO2: β= -3.76, odds ratio (OR) = 0.23, 95% confidence interval (95%CI) = 0.12-0.86, P = 0.031; PaCO2:β=1.41,OR=4.09,95%CI=1.70-9.82,P=0.002,PETCO2:β=0.78,OR=2.18,95%CI=1.42-3.35,P=0.000]. ROC curve analysis showed that the above three factors had good predictive value for the success of CPR. The predictive value of PaCO2 and PETCO2 were better, the area under ROC curve (AUC) was 0.93 and 0.92, respectively, when the cut-off values was 46.7 mmHg and 48.8 mmHg, the sensitivity was 92.0%, 88.0%, respectively, and the specificity was both 94.3%. Conclusions PaO2, PaCO2 and PETCO2 are the factors that influence the success of CPR. PaCO2 and PETCO2 have great value in predicting the success of CPR. Compared with the S-CPR group, IAPP-CPR group results in better hemodynamic and pulmonary ventilation effects, and remarkably improve ROSC and successful resuscitation. IAPP-CPR has obvious clinical value for CA patients.
ABSTRACT
Objective To study the expression of early growth response gene-1(Egr-1)in esophageal carcinoma tissue,and to explore the relationship between Egr-1 and the survival time of the patients with esophageal carcinoma.Methods RT-PCR was performed to detect the expression of Egr-1 mRNA in68 cases of esophageal carcinoma.The relationship between survival time and prognosis was analyzed.Results The expression of Egr-1 mRNA was the lowest(0.567±0.404),(0.945±0.336)and(1.201±0.347)in esophageal carcinoma tissue,para-cancerous tissue and normal esophageal mucosa tissue,respectively(F=12.709,P＜0.05,P＜0.00).21 cases showed the positive expression of Egr-1 mRNA of both the esophageal carcinoma tissue and the para-cancerous tissue.21 cases showed the positive expression of Egr-1 mRNA in a single esophageal carcinoma tissue or the para-cancerous tissue.26 cases showed the negative expression of Egr-1 mRNA both in the esophageal carcinoma tissue and the paracancerous tissue.The positive rate of Egr-1mRNA expression was 65.71%and 30.00%in the groups of the survival time for three years and the groups of the survival time for one year(P＜0.05).The survival rates in the two groups with positive expression of Egr-1 mRNA were 94.44%and 86.96%,respectively(P＞0.05).Conclusion Decreased level of EGR1 expression may be related to esophageal carcinogenesis.The expression level of Egr-1 mRNA might be associated with the survival time of the patients with esophageal carcinoma.Egr-1 expression in esophageal carcinoma tissue may be of great value for determining prognosis of esophageal carcinoma.
ABSTRACT
Objective To explore the relationship between the apoptosis of esophageal carcinoma tissue and its adjacent tissues with the survival time of patients with esophageal carcinoma by examining the apoptosis in esophageal carcinoma tissue and its adjacent tissues.Methods FCM Wag performed to detect the rates of apoptosis in 68 cases of esophageal carcinoma and their adjacent tissues and 28 cases of normal esophageal mucosae tissue.Sixty-three patients with esophageal carcinoma had been followed up and noted the survival time of every patient from the operated day to the deadline.Results The rate of apoptosis was the highest in the normal esophageal mucosae tissue(12.78±1.32)%,(7.79±1.48)% in adjacent tissue,and(4.16±2.06)% in esophageal carcinoma tissue,respectively.To follow the survival time after operation of 63 cases with esophageal carcinoma showed 60 cases in one year survival time and 35 cases in three years survival time.The rate of apoptosis in the esophageal carcinoma and its adjacent tissues wag(3.45±1.51)% and (3.96±0.94)% in the patients of one year survival time,(3.90±2.53)% and (7.89±2.27)% in the patients of three years survival time,respectively,P<0.05.Conclusions There is the phenomenon of apoptosis-escape in the esophageal carcinogenesis.There is close relationship between the apoptosis of esophageal carcinoma tissue and the survival time after operation.The apoptosis in the adjacent tissue is more important than that in the esophageal carcinoma tissue for evaluating the survival time after operation of patients with esophageal carcinoma.