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Objective:To collect the Internet news about "sudden death", analyze its characteristics and resuscitation effects, so as to provide reference for formulating intervention strategies.Methods:The Internet was used to search for "sudden death" and "cardiac arrest" on "Baidu" and "360" websites. Reports of sudden death events were collected from January 2013 to December 2022. The age, gender, characteristics of sudden death, implementation characteristics of cardiopulmonary resuscitation (CPR), and pre-hospital and final clinical outcomes of sudden death patients were recorded and analyzed. Subgroup analyses were performed for pre-hospital and final clinical outcomes. Unconditional multivariate Logistic regression analysis was used to screen the related factors affecting the pre-hospital and final clinical outcomes in patients with sudden death.Results:177 news reports were finally confirmed, involving 177 sudden death patients, including 152 males (85.9%) and 25 females (14.1%), aged (37.27±16.82) years old, and 53.1% in the 16-45 years old group. Triggering factors included strenuous exercise (29.9%), heart disease history (7.9%), overwork (6.2%), staying up late and insomnia (4.0%), activation of emotion (2.8%), and no obvious inducement (48.0%). After on-site first aid, 104 cases (58.8%) achieved restoration of spontaneous circulation (ROSC) before hospital admission, and 18 cases (10.2%) recovered consciousness. After clinical treatment, 109 cases (61.6%) achieved ROSC, 86 cases (48.6%) recovered consciousness, and 22 cases (12.4%) did not report the final outcome. Subgroup analysis showed that compared with patients who achieved pre-hospital ROSC ( n = 104), sudden death in non-ROSC patients ( n = 73) mainly occurred during sleep, in residence and without immediate CPR, full CPR, or automated external defibrillator (AED); and patients who ultimately did not recover consciousness clinically ( n = 91) showed similar characteristics compared with patients who recovered consciousness ( n = 86). Multifactorial Logistic regression analysis showed that immediate CPR [pre-hospital ROSC: odds ratio ( OR) = 8.06, 95% confidence interval (95% CI) was 2.36-27.46; final recovery of consciousness: OR = 9.10, 95% CI was 2.46-33.68] and AED defibrillation (pre-hospital ROSC: OR = 36.31, 95% CI was 4.53-291.19; final recovery of consciousness: OR = 3.53, 95% CI was 1.45-8.61) facilitated pre-hospital achievement of sudden death patients ROSC and final recovery of consciousness. Conclusions:Out-of-hospital sudden death mainly occurs in young people, and vigorous exercise is one of the potential factors for out-of-hospital sudden death, with nearly half having no obvious cause. Immediate and rapid CPR and defibrillation are the simplest and most effective on-site first aid methods. Strengthening public CPR and defibrillation education and training, and advocating healthy lifestyle are effective ways to improve the survival rate of sudden death and reduce the occurrence of sudden death. Based on practical clinical rescue experience, the implementation of bystander CPR by medical personnel is also a factor that cannot be ignored in affecting the clinical outcomes of sudden death patients.
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Objective:To survey the knowledge levels about diagnosis and management of asthma among general practitioners in community health centers in Shanghai and to analyze influencing factors.Methods:A questionnaire survey was conducted from May to June 2022 among general practitioners from 80 community health care centers in Shanghai. The questionnaire contained the basic information of the responders; knowledge about the diagnosis of asthma (symptoms, diagnostic methods, interpretation of bronchodilation and fractional exhaled nitric oxide, FeNO tests); and treatment of asthma (choosing and usage of therapeutic drugs). Logistic regression was used to analyze.Results:A total 324 general practitioners completed the questionnaire survey. Among them 221 (68.21%) had bachelor degree; 200 (61.73%) were attending doctors; the median working duration was 11 years; 174 (53.70%) had training on asthma knowledge in last 3 years. The survey results showed that 55 (16.98%) responders misinterpreted results of bronchodilation test, and 90(5.86%)misinterpreted results of FeNO test for diagnosis of asthma; 244 responders (75.31%) suspected implication of long-term cough for diagnosis of asthma; 277(85.49%)would order bronchodilation text to suspected patients; 273(84.26%)prescribed inhaled corticosteroid plus long-acting beta-2 agonist to asthma patients. For mild asthma patients, 144 responders(44.44%)suggested to use budesonide formoterol as needed; for moderate to severe asthma, 174(53.70%)suggested to use budesonide formoterol regularly and as needed, 100(30.86%)suggested to use salmeterol fluticasone regularly and salbutamol as needed. Logistic analysis showed that longer working duration was correlated with higher misinterpretation rate of bronchodilation and FeNO tests( OR=0.798,95% CI:0.694-0.918, P=0.002; OR=0.859,95% CI:0.739-0.998, P=0.047). The accuracy rate of all the questions was significantly higher in general practitioners who had training on asthma knowledge than those who didn′t receive training in last 3 years(all P<0.05). Conclusions:Most general practitioners in community health service centers in Shanghai have relatively high levels of knowledge about diagnosis and treatment of asthma. Years of work experience and training experience can affect the levels of asthma knowledge among community general practitioners.
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AIM:To establish a mouse model of immuno-inflammation in central nervous system (CNS) associated with cognitive dysfunction.METHODS:C57BL/6J male mice were divided into 3 groups.Lipopolysaccharide (LPS) was intraperitoneally injected into the mice to induce cognitive impairment.Morris water maze test, passive avoidance test and pole test were used to observe the behavioral changes of mice.The histomorphology was analyzed by the method of immunofluorescence.The detailed molecular mechanism was determined by Western blot.RESULTS:Compared with saline group, LPS induced mouse sickness behavior and memory loss.Microglia activation and neuronal loss in the hippocampus were observed.The expression of neuroinflammatory proteins COX-2 and iNOS in the brain of LPS-induced mice was increased.CONCLUSION:Intraperitoneal injection of LPS induces cognitive dysfunction in mice.
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AIM:To investigate the protective effect of lycopene on primary mouse cerebrocortical neurons ex -posed to tert-butyl hydroperoxide ( t-BHP) and its mechanisms of in vitro.METHODS:Primary cerebrocortical neurons of newborn C57 mice were extracted and divided into normal group , t-BHP group, lycopene +t-BHP group and lycopene group.The neuronal damage was induced by t-BHP exposure for 24 h, and the cell viability was examined by MTT assay . ROS content was measured by flow cytometry , and the protein levels of Bax , Bcl-2, caspase-3, cleaved caspase-3 and cyto-chrome C were examined by Western blot .RESULTS:The primary mouse cortical neurons expressed MAP-2 protein.Ly-copene at concentration of 4μmol/L reversed the decrease in cell viability .Flow cytometry revealed that lycopene treatment attenuated ROS content under the condition of t-BHP exposure.In addition, the protein level of Bcl-2 was increased, and the expression of Bax , cleaved caspase-3 and cytochrome-C was suppressed in lycopene +t-BHP group.CONCLUSION:The protective effect of lycopene on cortical neurons with t-BHP-induced injury may be involved in the mechanism of neuro-nal antioxidative response by down-regulating caspase-3 and Bax/Bcl-2 through the mitochondrial apoptotic pathway .
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Objective To explore the role of spinal monocyte chemoattractant protein?1 ( MCP?1) ?extracellular signal?regulated protein kinase ( ERK)?kinesin superfamily motor protein 17 ( KIF17)∕N?methyl?D?aspartate receptor subunit 2B ( NR2B) signaling pathway in the maintenance of type 2 diabetic neuropathic pain (DNP) in rats. Methods Type 2 diabetes mellitus was induced by a high?fat and high?sucrose diet and intraperitoneal streptozotocin ( STZ) 35 mg∕kg, and confirmed by fasting blood glucose level≥16?7 mmol∕L 3 days later in male Sprague?Dawley rats aged 6 weeks. Type 2 DNP was confirmed when the mechanical paw withdrawal threshold ( MWT ) and thermal paw withdrawl latency ( TWL ) measured on day 14 after STZ administration decreased to< 80% of the baseline value. The rats with type 2 DNP were randomly divided into 4 groups ( n=36 each) using a random number table: type 2 DNP group (group DNP), type 2 DNP +MCP?1 neutralizing antibody group (group DM), type 2 DNP +ERK inhibi?tor group (group DE) and type 2 DNP + dimethyl sulfoxide group ( group DD). In DM, DE and DD groups, 0?1 ng∕μl MCP?1 neutralizing antibody 10 μl, 0?5 μg∕μl U0126 10 μl and 5 % dimethyl sulfoxide 10 μl were injected intrathecally, respectively, once a day for 14 consecutive days starting from 14 days after administration of STZ. Another 36 normal rats fed a common forage diet were adopted as con?trol group ( group C) . MWT and TWL were measured before STZ injection and at 1, 3, 7 and 14 days after STZ injection ( T0-4 ) . Nine rats were sacrificed after measurement of pain thresholds at T1-4 , and the lumbar segments ( L4-6 ) of the spinal cord were removed for determination of the expression of phosphoryla?ted ERK (p?ERK), KIF17 and phosphorylated NR2B (p?NR2B) by Western blot. Results Compared with group C, the MWT was significantly decreased, the TWL was shortened, and the expression of p?ERK, KIF17 and p?NR2B was up?regulated at T1-4 in DNP, DM, DE and DD groups. Compared with group DNP, the MWT at T3-4 in group DM and at T2-4 in group DE was significantly increased, the TWL at T3-4 in group DM and at T2-4 in group DE was prolonged, and the expression of p?ERK, KIF17 and p?NR2B was down?regulated at T2-4 in DM and DE groups, and no significant changes were found in the pa?rameters mentioned above in group DD. Conclusion Spinal MCP?1?ERK?KIF17∕NR2B signaling pathway is involved in the maintenance of type 2 DNP in rats.
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Objective To evaluate the clinical results of arthroscopic reconstruction of posterior cruciate ligament (PCL) via posteromedial,posterolateral and posterior trans-septal portals with the preservation of intact meniscofemoral ligaments and remnant PCL fibers.Methods Nine patients with PCL injuries were treated with autogenous hamstring tendons arthroscopically through routine arthroscopic portal,posteromedial portal,posterolateral portal and posterior trans-septal portal with preservation of intact meniscofemoral ligaments and remnant PCL fibers.Tibial tunnel of 1-1.5 cm was made below the lateral articular surface of PCL tibial attachment via arthroscopic posterolateral approach.Femoral tunnel of 1 cm was made posterior to the articular cartilage of the medial femoral condyle through anterolateral approach.Autogenous tendon graft was positioned in the knee joint through the navigation of tibial and femoral double-folded silk loops that traversed the bone tunnels and was fixed with bioabsorbable interface screws at both ends.Knee function was evaluated with Lysholm scale six months postoperatively.Results All patients were followed up for average 8.6 months (range,7-14 months).None of the patients had knee extension limitation six months postoperatively,but there were two patients with 10°-15° flexion limitation and one withⅠ degree positive result in posterior drawer test.Lysholm knee score was increased from preoperative (47.6 ± 14.9)points to (92.9 ±4.6) points at six months postoperatively (P ＜0.01).Conclusion PCL reconstruction via posteromedial,posterolateral and posterior trans-septal portals can obtain clear vision (with no blind area),safe operation,accurate positioning of tibial attachment and affirmative short term treatment results.
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Objective To evaluate the significance of arthroscopy in diagnosis and treatment of acute posterior dislocation of the hip. Methods From August 2005 to April 2009, 32 patients with acute posterior hip dislocation underwent hip arthroscopy in our hospital. All patients were confirmed by symptoms, signs, X-ray examination and CT scan. There were 26 males and 6 females, at mean age of 38.5 years (range 23-55 years). An arthroscope was introduced to evaluate the intraarticular lesions routinely. Then, arthroscopic debridement was performed. Eight patients with acetabular fractures were treated by open reduction and internal fixation after arthroscopy. The Sanders scores were employed to evaluate the postoperative hip functions. Results Among 32 patients, there were 29 patients with loose bodies, three with tear of the ligamentum, 12 with labrum injuries and eight with acetabulum fractures that required a second stage open reduction and internal fixation. There were no complications of vessel or nerve injuries peri- or post-operatively. An average period of follow-up for 10 months (range, 5-24months) were available for all patients, which showed excellent results in 23 patients, good in five and fair in four according to the Sanders scores. Conclusion Hip intraarticular lesions can be evaluated and confirmed by the arthroscope, under which the loose bodies, tear of the ligamentum teres and labrum injuries can be cleared effectively.