Modified Tongqiao Huoxuetang Down-regulates PI3K/Akt Pathway to Treat Basilar Artery Dolichoectasia / 中国实验方剂学杂志

ObjectiveTo establish a mouse model of basilar artery dolichoectasia （BAD） and explore the mechanism of modified Tongqiao Huoxuetang （JTQHX） in regulating BAD via phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt） pathway. MethodSixty C57/BL6 female mice were randomized into sham operation （injected with 10 U·mL-1 inactivate elastase）， model， atorvastatin calcium tablets （2.6 mg·kg·d-1）， and low- and high-dose （crude drug 3.4， 17 g·kg-1·d-1， respectively） JTQHX groups. The mouse model of BAD was established by injection with 10 U·mL-1 elastase. After 14 days of modeling， the sham operation group and model group were administrated with equal volumes of pure water by gavage， and other groups with corresponding drugs for 2 months. The levels of interleukin-6 （IL-6） and calpain （LpA） in the serum were measured by enzyme-linked immunosorbent assay （ELISA）. Verhoeff 's Van Gieson （EVG） staining was employed to observe the pathological changes of blood vessels. Terminal-deoxynucleotidyl transferase mediated nick end labeling （TUNEL） was employed to examine the apoptosis rate of vascular smooth muscle cells （VSMCs）. Image Pro Plus was used to observe and calculate the curvature index， elongation length， percentage increase in vessel diameter， and curvature angle of the basilar artery vessels in mice. Western blot was employed to determine the expression levels of PI3K and Akt in the vascular tissue. ResultCompared with the sham operation group， the model group showed lowered IL-6 level （P<0.01）， no significant change in LpA level， increased apoptosis of VSMCs （P<0.01）， and increased curvature index， elongation length， percentage increase in vessel diameter， and curvature angle （P<0.01）. Furthermore， the modeling up-regulated the protein levels of PI3K and Akt in blood vessels （P<0.01） and aggravated the destruction of the inner elastic layer， atrophy of the muscular layer， and hyaline changes in the connective tissue of the medial membrane of the basilar artery wall. Compared with the model group， 2 months of treatment with JTQHX elevated the IL-6 level （P<0.01）， reduced the apoptosis of VSMCs （P<0.01）， decreased the curvature index， elongation length， percentage increase in vessel diameter， and curvature angle （P<0.05， P<0.01）， and down-regulated the protein levels of PI3K and Akt in blood vessels （P<0.01）. In addition， the treatment alleviated the destruction of the inner elastic layer， atrophy of the muscular layer， and hyaline changes in the connective tissue of the medial membrane of the basilar artery wall. ConclusionJTQHX inhibits the elongation， expansion， and curvature of basilar artery vessels and alleviates the pathological changes by reducing the apoptosis of VSMCs and down-regulating the expression of PI3K/Akt pathway.

Chinese consensus of cardiopulmonary resuscitation guides prevention, treatment and rescue of cardiac arrest in pregnancy / 中华危重病急救医学

Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.

Current status and future prospects of the model integrating medicine with health regimens for elderly care under the multilevel referral healthcare system / 中华老年医学杂志

Along with population aging in China, the spectrum of chronic diseases in the elderly is constantly evolving, and the demand for different types of elderly care is increasing steadily.The healthcare infrastructure constitutes the cornerstone of elderly care.In order to further improve the elderly care system and the medical service model, this paper analyzes the current status of the model integrating medicine with health regimens for elderly care under the multilevel referral healthcare system and puts forward suggestions for future development.

Expression and function of HLA-G in human T-cell leukemia virus type 1-positive T cells / 中华微生物学和免疫学杂志

Objective:To analyze the expression of human leukocyte antigen G (HLA-G) in human T-cell leukemia virus type 1 (HTLV-1)-positive T cells, and to investigate its role in the occurrence and development of HTLV-1 infection.Methods:The expression of HLA-G in HTLV-1-positive T cell lines (MT2 and MT4) was detected by Western blot and real-time PCR. HLA-G gene in MT2 and MT4 cells was knocked down by siRNA, and the effects of HLA-G on the expression of HTLV-1 Tax and P19 at mRNA and protein levels were detected by Western blot and real-time PCR. Moreover, the changes in cytokine expression in MT2 and MT4 cells were monitored at RNA level after HLA-G gene silencing. The proliferation ability of MT2 and MT4 cells was analyzed by CCK8. Signal transducer and activator of transcription 3 (STAT3) pathway-related proteins were detected by Western blot.Results:Compared with HTLV-1-negative T cells (Jurkat and MOLT4), the expression of HLA-G increased significantly in MT2 and MT4 cells. After knocking down the HLA-G gene with siRNA in MT2 and MT4 cells, the expression of HTLV-1 Tax and P19 at mRNA and protein levels was decreased, and the expression of antiviral cytokines IFN-γ and TNF-α was increased. The proliferation of MT2 and MT4 cells and STAT3 phosphorylation in these cells were decreased.Conclusions:HTLV-1 could induce T cells to overexpress the immune tolerance molecule HLA-G. Silencing HLA-G gene in HTLV-1-positive T cells could promote the production of antiviral cytokines and reduce IL-6 expression and STAT3 phosphorylation, thereby effectively inhibiting the replication of HTLV-1.

Effect of HLA-G expressed in platelets on Tax protein of human T lymphocyte leukemia type 1 virus / 中国输血杂志

【Objective】 To investigate the effect of HLA-G expressed in platelets on Tax protein of human T cell leukemia type 1 virus (HTLV-1). 【Methods】 Platelets were isolated from anticoagulant whole blood, and HLA-G molecule on platelet membrane was detected by flow cytometry. The content of secretory HLA-G before and after platelet lysis was detected by ELISA, HTLV-1 human lymphoma cells MT2 were cultured with platelet lysate (PL). The effect of HLA-G in platelets on the expression of HTLV-1 protein Tax was evaluated by Western blot (WB). 【Results】 Membrane type mHLA-G was highly expressed on the surface of platelet membrane. The expression of secretory sHLA-G (ng/mL) increased after platelet lysis (15.73±1.01) vs (6.65±0.47), the expression of sHLA-G increased with the increase of platelet concentration in a dose-dependent manner. Compared with fetal bovine serum, PL significantly promoted the high expression of HLA-G protein and HTLV-1 virus tax protein in MT2 cells, and the addition of anti-HLA-G antibody to PL could effectively inhibit the expression of Tax and HLA-G protein. 【Conclusion】 High expression of immune tolerance molecule HLA-G on platelets can induce high expression of HTLV-1 protein Tax in human lymphoma cell MT2, which contributes to viral infection.

Practice of medical care and rescue Amne Machin extreme cross-country challenge / 中华危重病急救医学

Objective:To share the practice of medical care and rescue in the 2017-2019 Amne Machin extreme cross-country challenge.Methods:At the invitation of the Organizing Committee of Amne Machin extreme cross-country challenge of Maqin County of Qinghai Province. More than 150 medical personnel were sent to make the rescue plan and implement the medical security for three consecutive years. The support was divided into leading command group, expert consulting group, on-site medical support group, rear medical support group, and medical material support group. The on-site medical support group was equipped with the ambulance, corresponding emergency medical equipments and medicines to provide medical support at eight medical stations from the starting point to the endpoint and along the route between each station.Results:There were no cardiac arrest and sudden death cases during the three competitions. A total of 56 patients (5 cases of combined injuries) were received, including 21 cases of mild altitude reaction, 8 cases of abrasions, 13 cases of muscle spasm and strain, 11 cases of hypoglycemia, and 3 cases of abdominal pain. All the injured were treated and observed in time. Each patient achieved a complete remission.Conclusions:To achieve the success of medical security of the highest average altitude cross-country race certified by International Trail Running Association (ITRA), we must formulate a scientific and perfect medical security work plan in the first place: pre competition physical examination, especially the application of sports cardiopulmonary function test, screen out athletes who may have medical accidents; during the competition, focus on monitoring and tracking the players who may have problems; each support point is closely connected with the support vehicle; do a good job of first aid training for all kinds of personnel, so that medical accidents can be found, aided, and transferred at the first time. The medical care and rescue of Amne Machin extreme cross-country challenge have played a good role in the security of the international plateau sports events, which provides a reference for the security of similar events.

Repair of medial plantar wound with posterior tibial artery perforator combined with saphenous nerve nutrient vessel fascial flap / 中华显微外科杂志

Objective:To investigate the surgical technique and its clinical efficacy of the flaps with double blood supply through posterior tibial artery perforators and saphenous nerve nutrient vessels for the secondary stage repair of medial plantar defects.Methods:Thirteen patients with medial plantar tissue defects, who were repaired by posterior tibial artery perforator flaps combined with saphenous nerve nutrient vascular fascia flaps from January, 2016 to December, 2018, were studied. The patients were 9 males and 4 females, aged 23-69 (mean age 36.9) years. All defects were near the tarsometatarsal joints in the medial planta, and the soft tissue defects were 4.5 cm× 5.0 cm-8.0 cm×14.0 cm in size. The donor sites were directly sutured or repaired with free graft of ipsilateral thigh full-thickness skin. All patients in this study were followed-up for 6-12 months to observe the function of affected limbs and the recovery of flap donor and recipient sites through outpatient visits and telephone reviews.Results:All the 13 flaps survived successfully. One flap developed a small area of necrosis at the distal end, which was healed after partial stitch removal, decompression and dressing change. Another flap had shown purple bruises and tension blisters, surgical exploration was then performed to remove local hematoma and the flap survived after pedicle stitch removal and decompression. One flap received flap thinning and shaping at 8 months after surgery. All flaps showed normal in color, temperature, capillary reaction, soft in texture and without swollen appearance. The affected feet were not apparently restricted when walking, and the functions had satisfactory recovery.Conclusion:Posterior tibial artery perforator flap carrying saphenous nerve and great saphenous vein is able to achieve higher and reliable flap survival and better blood supply. Anastomosis of the saphenous nerve carried by flap with cutaneous nerve of the recipient site helps to reconstruct the protective sensation of the flap, which is an effective approach in clinically repairing of the medial plantar defects.

Effects of refinement of clinical pathways on the rational use of antimicrobial drugs in hospitalized elderly patients with community-acquired pneumonia / 中华老年医学杂志

Objective:To explore the effects and value of implementing clinical pathway refinement on the rational use of antimicrobial drugs in elderly inpatients with community-acquired pneumonia(CAP)in secondary care hospitals.Methods:A total of 122 elderly patients with CAP admitted to the respiratory department of our hospital from April 1, 2018 to October 31, 2019 were enrolled as the subjects, and they were randomly divided into two groups: the study group(n=61, receiving management of refined clinical pathways)and the control group(n=61, the selection of management types and duration determined by clinical experience). The rates of sample submission and positive sputum pathogens, the intensity of antibiotic use, course of treatment, drug costs, combined drug use, length of stay and costs of hospitalization were analyzed and compared between the two groups.Results:The sample submission rate and the positive rate of sputum pathogens were higher in the study group than in the control group(95.1% or 58/61 vs.73.8% or 45/61, 27.6% or 16/58 vs.13.3% or 6/45, χ2=10.536 and 5.545, P=0.001 and 0.019). There was no significance in the cumulative defined daily use(DDD), duration of all antibiotic administration and cumulative administration time between the study and control groups(41.8 or 46.5 vs.78.3 or 111.0, 41 d or 61 d vs.50 d or 131 d, 6 or 7 vs.9 or 15, Z=-0.526, -0.559 and-0.429, all P>0.05). The rate of combined antibiotic therapy was lower in the study group than in the control group(16.4% or 10/61 vs.65.5% or 40/61, χ2=30.500, P=0.000). The duration of antibiotic use, drug costs, length of stay and hospitalization expenses were lower in the study group than in the control group[(8.98±2.05)d vs.(11.75±3.16)d, (1 928.03±1 156.47)yuan vs.(2 335.92±1 038.56)yuan, (11.00±3.16)d vs.(13.90±3.72)d, (12 172.94±3 934.52)yuan vs.(14 036.85±5 591.11)yuan, t=5.748, 2.050, 4.643 and 2.129, P<0.05]. There was no significant difference in the cure rate and 30-day mortality between the study and control groups(95.1% or 58/61 vs.88.5% or 54/61, 4.9% or 3/61 vs.8.2% or 5/61, χ2=1.743 and 0.535, both P>0.05). Conclusions:The application of refinement of clinical pathways in elderly patients with CAP can effectively improve sample submission and detection rates of pathogenic bacteria in sputum, reduce the intensity of antibiotic use, duration, cost and rates of combined antibiotic therapy, decrease the in-hospital time and hospitalization expenses, and help promote rational use of antimicrobial drugs and control of medical expenses.

Prevention strategies for traumatic cardiac arrest / 中华危重病急救医学

The fatality rate of traumatic cardiac arrest (TCA) is extremely high, and it is very different from that of non-traumatic cardiac arrest (NTCA) in resuscitation strategy. Only when the standard resuscitation process is combined with rapid treatment of various reversible causes can the mortality rate of patients be decreased. In this paper, the key factors leading to TCA are reviewed, such as hypovolemic shock, asphyxia, tension pneumothorax, pericardial tamponade, crush syndrome, craniocerebral injury, cerebral hernia, and the control measures are elaborated respectively, so as to provide references for clinical treatment of patients with severe trauma, and reduce TCA incidence and mortality.

Effects of interposed abdominal pulling-pressing cardiopulmonary resuscitation on hemodynamics and oxygen metabolism in patients with cardiac arrest / 中华危重病急救医学

To analyze the effect of interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) and standard cardiopulmonary resuscitation (S-CPR) on hemodynamics and oxygen metabolism in patients with cardiac arrest, and to evaluate the treatment effect of IAPP-CPR. Methods The patients with cardiac arrest, cardiac arrest time less than 30 minutes, and with S-CPR indications admitted to intensive care unit (ICU) of the First People's Hospital of Lianyungang from January 2017 to January 2019 were enrolled. The patients were divided into IAPP-CPR group and S-CPR group according to whether the patients had IAPP-CPR indication or not. The patients in the S-CPR group were operated according to the 2015 American Heart Association (AHA) CPR guidelines; and the patients in the IAPP-CPR group received the IAPP-CPR on the basis of the S-CRP. During the relaxation period, the patients were subjected to abdominal lifting and compressing with amplitude of 4-5 cm, frequency of 100-120 times/min, and the time ratio of lifting to compressing was 1∶1. Hemodynamic changes during resuscitation were recorded in the two groups. Hemodynamics, oxygen metabolism, arterial blood gas analysis and prognostic indicators were recorded at 30 minutes after successful resuscitation. Results During the study period, 77 patients were selected, 24 patients were excluded from giving up treatment and quitting, 53 patients were enrolled in the analysis finally, with 28 patients in the S-CPR group and 25 in the IAPP-CPR group. ① The heart rate (HR), mean arterial pressure (MAP) and coronary perfusion pressure (CPP) showed an upward trend during resuscitation, and a more significant increase was shown in the IAPP-CPR group. ② Hemodynamics after successful resuscitation:there were 16 patients with successful resuscitation in the IAPP-CPR group and 13 in the S-CPR group. The MAP, CPP, global ejection fraction (GEF) and stroke volume (SV) of patients with successful resuscitation at 30 minutes after resuscitation in the IAPP-CPR group were significantly higher than those in the S-CPR group [MAP mmHg (1 mmHg =0.133 kPa): 52.88±3.11 vs. 39.39±4.62, CPP (mmHg): 36.56±6.89 vs. 29.61±6.92, GEF: 0.217±0.036 vs. 0.178±0.027, SV (mL): 38.43±5.25 vs. 32.92±8.28, all P < 0.05], but there was no significant difference in central venous pressure (CVP) or HR between the two groups. ③ Oxygen metabolism after successful resuscitation: the cardiac output (CO), arterial oxygen content (CaO2), oxygen transport (DO2) and oxygen consumption (VO2) of patients with successful resuscitation at 30 minutes after resuscitation in the IAPP-CPR group were significantly higher than those in the S-CPR group [CO (L/min): 2.23±0.38 vs. 1.99±0.29, CaO2 (mL/L): 158.0±11.8 vs. 141.4±8.2, DO2 (mL/L):245.8±29.9 vs. 209.1±28.0, VO2 (mL/L): 138.2±24.9 vs. 112.8±18.1, all P < 0.05]. ④ Arterial blood gas after successful resuscitation: the values of the pH, arterial oxygen partial pressure (PaO2), arterial partial pressure of carbon dioxide (PaCO2), oxygenation index (PaO2/FiO2) and central venous oxygen saturation (ScvO2) of patients with successful resuscitation at 30 minutes after resuscitation in the IAPP-CPR were significantly higher than those in the S-CPR group [pH value: 7.13±0.22 vs. 7.00±0.23, PaO2 (mmHg): 73.68±13.80 vs. 65.32±15.32, PaCO2 (mmHg): 36.24±11.77 vs. 29.12±7.82, PaO2/FiO2 (mmHg): 73.68±13.80 vs. 65.32±15.32, ScvO2: 0.628±0.074 vs. 0.589±0.066, all P < 0.05], and the blood lactic acid (Lac) level was significantly lower than that in the S-CPR group (mmoL/L: 9.80±4.28 vs. 12.18±3.63, P < 0.05). ⑤ The patients in the IAPP-CPR group had a shorter time for cardiac arrest to restoration of spontaneous circulation (ROSC) than that in the S-CPR group (minutes: 10.63±2.94 vs. 14.54±3.84, P < 0.01), and the rate of ROSC, CPR successful rate and 28-day survival rate were significantly higher than those in the S-CPR group [64.0% (16/25) vs. 46.4% (13/28), 60.0% (15/25) vs. 28.6% (8/28), 52.0% (13/25) vs. 21.4% (6/28), all P < 0.05]. There was no significant difference in incidence of rib fracture between the IAPP-CPR and S-CPR groups [92.0% (23/25) vs. 89.3% (25/28), P > 0.05], and no abdominal bleeding was found in both group. Conclusion IAPP-CPR can produce better hemodynamic effect during and after resuscitation than S-CPR, and oxygen metabolism and arterial blood gas analysis parameters at 30 minutes after resuscitation were better than S-CPR, with higher ROSC rate, CPR successful rate and 28-day survival rate, and no significant difference in complications between the two resuscitation methods.

Effects of interposed abdominal pulling-pressing cardiopulmonary resuscitation on hemodynamics and oxygen metabolism in patients with cardiac arrest / 中华危重病急救医学

Objective@#To analyze the effect of interposed abdominal pulling-pressing cardiopulmonary resuscitation (IAPP-CPR) and standard cardiopulmonary resuscitation (S-CPR) on hemodynamics and oxygen metabolism in patients with cardiac arrest, and to evaluate the treatment effect of IAPP-CPR.@*Methods@#The patients with cardiac arrest, cardiac arrest time less than 30 minutes, and with S-CPR indications admitted to intensive care unit (ICU) of the First People's Hospital of Lianyungang from January 2017 to January 2019 were enrolled. The patients were divided into IAPP-CPR group and S-CPR group according to whether the patients had IAPP-CPR indication or not. The patients in the S-CPR group were operated according to the 2015 American Heart Association (AHA) CPR guidelines; and the patients in the IAPP-CPR group received the IAPP-CPR on the basis of the S-CRP. During the relaxation period, the patients were subjected to abdominal lifting and compressing with amplitude of 4-5 cm, frequency of 100-120 times/min, and the time ratio of lifting to compressing was 1∶1. Hemodynamic changes during resuscitation were recorded in the two groups. Hemodynamics, oxygen metabolism, arterial blood gas analysis and prognostic indicators were recorded at 30 minutes after successful resuscitation.@*Results@#During the study period, 77 patients were selected, 24 patients were excluded from giving up treatment and quitting, 53 patients were enrolled in the analysis finally, with 28 patients in the S-CPR group and 25 in the IAPP-CPR group. ① The heart rate (HR), mean arterial pressure (MAP) and coronary perfusion pressure (CPP) showed an upward trend during resuscitation, and a more significant increase was shown in the IAPP-CPR group. ② Hemodynamics after successful resuscitation: there were 16 patients with successful resuscitation in the IAPP-CPR group and 13 in the S-CPR group. The MAP, CPP, global ejection fraction (GEF) and stroke volume (SV) of patients with successful resuscitation at 30 minutes after resuscitation in the IAPP-CPR group were significantly higher than those in the S-CPR group [MAP mmHg (1 mmHg = 0.133 kPa): 52.88±3.11 vs. 39.39±4.62, CPP (mmHg): 36.56±6.89 vs. 29.61±6.92, GEF: 0.217±0.036 vs. 0.178±0.027, SV (mL): 38.43±5.25 vs. 32.92±8.28, all P < 0.05], but there was no significant difference in central venous pressure (CVP) or HR between the two groups. ③ Oxygen metabolism after successful resuscitation: the cardiac output (CO), arterial oxygen content (CaO2), oxygen transport (DO2) and oxygen consumption (VO2) of patients with successful resuscitation at 30 minutes after resuscitation in the IAPP-CPR group were significantly higher than those in the S-CPR group [CO (L/min): 2.23±0.38 vs. 1.99±0.29, CaO2 (mL/L): 158.0±11.8 vs. 141.4±8.2, DO2 (mL/L): 245.8±29.9 vs. 209.1±28.0, VO2 (mL/L): 138.2±24.9 vs. 112.8±18.1, all P < 0.05]. ④ Arterial blood gas after successful resuscitation: the values of the pH, arterial oxygen partial pressure (PaO2), arterial partial pressure of carbon dioxide (PaCO2), oxygenation index (PaO2/FiO2) and central venous oxygen saturation (ScvO2) of patients with successful resuscitation at 30 minutes after resuscitation in the IAPP-CPR were significantly higher than those in the S-CPR group [pH value: 7.13±0.22 vs. 7.00±0.23, PaO2 (mmHg): 73.68±13.80 vs. 65.32±15.32, PaCO2 (mmHg): 36.24±11.77 vs. 29.12±7.82, PaO2/FiO2 (mmHg): 73.68±13.80 vs. 65.32±15.32, ScvO2: 0.628±0.074 vs. 0.589±0.066, all P < 0.05], and the blood lactic acid (Lac) level was significantly lower than that in the S-CPR group (mmoL/L: 9.80±4.28 vs. 12.18±3.63, P < 0.05). ⑤ The patients in the IAPP-CPR group had a shorter time for cardiac arrest to restoration of spontaneous circulation (ROSC) than that in the S-CPR group (minutes: 10.63±2.94 vs. 14.54±3.84, P < 0.01), and the rate of ROSC, CPR successful rate and 28-day survival rate were significantly higher than those in the S-CPR group [64.0% (16/25) vs. 46.4% (13/28), 60.0% (15/25) vs. 28.6% (8/28), 52.0% (13/25) vs. 21.4% (6/28), all P < 0.05]. There was no significant difference in incidence of rib fracture between the IAPP-CPR and S-CPR groups [92.0% (23/25) vs. 89.3% (25/28), P > 0.05], and no abdominal bleeding was found in both group.@*Conclusion@#IAPP-CPR can produce better hemodynamic effect during and after resuscitation than S-CPR, and oxygen metabolism and arterial blood gas analysis parameters at 30 minutes after resuscitation were better than S-CPR, with higher ROSC rate, CPR successful rate and 28-day survival rate, and no significant difference in complications between the two resuscitation methods.

Stereoscopic cardiopulmonary resuscitation, stereoscopic health and stereoscopic number: a "three-in-one" concept / 中华危重病急救医学

Each person in the era has its corresponding mission and responsibility.Based on the thinking and practice of life health and data age,the author puts forward the "three-in-one" concept of "stereoscopic cardiopulmonary resuscitation","stereoscopic health" and "stereoscopic number".According to the common cognition from enlarged cardiopulmonary resuscitation to stereoscopic cardiopulmonary resuscitation,from enlarged health to stereoscopic health,and from big data to stereoscopic number,we try to figure out the internal relations and rules of them,and endow new cultural connotations to cure lives with safe healthy,and digital life.

Compose the splendid passages of "heart" for the age of health: theory and practice of "three construction"strategy of cardiopulmonary resuscitation in China / 中华危重病急救医学

Cardiac arrest is an emergency that threatens the safety of human life. Cardiopulmonary resuscitation, as the key technology, has always attracted much attention. Based on the practice on the health of life, the Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association, Cardiopulmonary Resuscitation Specialized Committee of Chinese Aging Well Association, Health Culture Committee of Chinese Health Association, the 10th Science Popularization Branch of the Chinese Medical Association, is facing the life of the people's "to die in an old age". From the force "to bring back to life" of the cardiopulmonary resuscitation, the author constructs the scientific theory of cardiopulmonary resuscitation, the base of the scientific and technical personnel of the cardiopulmonary resuscitation, and the mass of the popularization of the cardiopulmonary resuscitation. The scientific theory system, the technological team, and the benefit to the people are focused. It has promoted the popularization and promotion of the cardiopulmonary resuscitation science and technology, and obtained the great achievements of the scientific and technological innovation and the scientific popularization of the cardiopulmonary resuscitation, which arethe cultural connotations of the "heart" of the life and health.

Survival cycle of Chinese cardiopulmonary resuscitation / 中华危重病急救医学

To explore the occurrence and development of cardiac arrest guided by the needs of patients with cardiac arrest. We improved the survival chain promulgated by American Heart Association, and made it run through the whole life cycle of cardiopulmonary resuscitation (CPR). The concept of survival cycle of CPR in China was launched. Considering from the whole cycle of it, moved forward or delayed, the cardiac arrest line was divided into pre-arrest phase, intra-arrest phase and post-resuscitation phase. The main content is "three-prevention" policies (precaution, pre-warning and early identification), "three-ways" strategies (standardization, diversification and individuation) and"three lives" general plans (demutation, transcending and extension). Survival cycle of CPR with Chinese characteristics was constructed with prevention, curation and relieve in cardiac arrest line.

Abdomen is the second "home" of the heart / 中华危重病急救医学

The heart locates in the chest. When the cardiac arrest is caused by various internal and external factors, it is necessary to establish an artificial circulation for the heart, including external compression. But when the integrity of the chest is destroyed, the "home" of the chest cannot effectively carry out high-quality cardiopulmonary resuscitation (CPR). The abdomen not only possesses 1/4 body blood volume, but also is the abdominal respiratory basis mainly through diaphragm. Through the "abdominal pump" mechanism, intrathoracic pressure is changed by moving the diaphragm up and down, and then exert the effect of indirect "chest pump", "heart pump" and "lung pump". So by using abdomen as the second "home", the purpose of establishing artificial circulation and respiration can be successfully achieved.

Comparison of neurologic outcome between active abdominal compression-decompression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation in asphyxia cardiac arrest / 中华危重病急救医学

Objective To compare the neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and chest compression cardiopulmonary resuscitation (STD-CPR) in asphyxia cardiac arrest (CA). Methods A prospective multicenter randomized controlled trial (RCT) was conducted. Adult patients with CA because of asphyxia such as drowning, airway obstruction admitted to Zhengzhou People's Hospital and Sanmenxia Central Hospital from June 2014 to December 2017 were enrolled. With the informed consent of patients' families, patients were divided into AACD-CPR group and STD-CPR group according to random number table method. The blood from median cubital vein or basilic vein were extracted at 1, 6, 12, 24 and 48 hours after the return of spontaneous circulation (ROSC), and the levels of S100B protein and neuron-specific enolase (NSE) were detected by enzyme linked immunosorbent assay. Neurological outcome was classified according to cerebral performance classification (CPC) after 3 months. Results A total of 183 patients were selected, including 78 ROSC patients after CPR. Patients with CA > 8 minutes and rescue time > 1 hour were excluded, 69 ROSC patients (36 in STD-CPR group and 33 in AACD-CPR group) were finally included. After ROSC, the levels of S100B protein and NSE in blood of two groups were increased gradually, reaching the peak at 6 hours, and then decreased gradually. The levels of S100B protein and NSE in AACD-CPR group at different time points after ROSC were significantly lower than those in STD-CPR group [S100B protein (μg/L): 1.62±0.52 vs. 1.88±0.46 at 1 hour, 1.71±0.41 vs. 2.02±0.58 at 6 hours, 1.24±0.37 vs. 1.52±0.59 at 12 hours, 1.05±0.23 vs. 1.28±0.37 at 24 hours, 0.82±0.29 vs. 1.05±0.36 at 48 hours; NSE (μg/L):24.76±3.02 vs. 26.78±4.29 at 1 hour, 58.78±5.58 vs. 61.68±5.44 at 6 hours, 53.87±4.84 vs. 56.78±5.68 at 12 hours, 40.96±3.52 vs. 43.13±4.50 at 24 hours, 33.23±2.89 vs. 35.54±3.44 at 48 hours; all P < 0.05]. 3 months after ROSC, the CPC classification of AACD-CPR group was lower than that of the STD-CPR group (average rank: 28.86 vs. 42.46, Z = -3.375, P < 0.001). Conclusion After suffering asphyxia CA, patients who accepted AACD-CPR had better neurologic outcome than STD-CPR.

Predictive value of partial pressure of end-tidal carbon dioxide on the effect of active abdominal compression-decompression cardiopulmonary resuscitation and serum S100B protein on cerebral function / 中华危重病急救医学

Objective To explore the predictive value of partial pressure of end-tidal carbon dioxide (PETCO2) on the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and serum S100B protein on cerebral function. Methods 142 adult patients with in-hospital cardiac arrest (IHCA) AACD-CPR in Zhengzhou People's Hospital, Affiliated Southern Medical University from September 2014 to December 2017 were enrolled. Patients were divided into successful group and failure group according to restoration of spontaneous circulation (ROSC) or not; and then according to Glasgow-Pittsburgh cerebral performance categories (CPC) one month after ROSC, the successful group was divided into good prognosis group (CPC 1-2) and poor prognosis group (CPC 3-5) further. The variations of hemodynamic, arterial blood gas index, PETCO2and serum S100B protein level (25 healthy subjects as normal S100B protein level reference value) during the recovery were analyzed. The predictive value of PETCO2on the effect of AACD-CPR and serum S100B protein on cerebral function of successful resuscitation patients were analyzed by receiver operating characteristic curve (ROC). Results ① According to the traditional qualitative indexes, such as pulsation of the large artery, redness of lips and extremities, spontaneous fluctuation of chest, narrowing of pupil, existence of shallow reflex, etc, 54 in 142 patients with IHCA were successfully resuscitated; 57 cases were successfully resuscitated through the guidance of PETCO2, there was no significant difference between the two groups (χ2= 0.133, 1 = 0.715). With the AACD-CPR, 142 CA patients' arterial partial pressure of oxygen (PaO2), arterial blood carbon dioxide partial pressure (PaCO2) were all improved with different degrees; heart rate (HR), mean arterial pressure (MAP), PaO2and PaCO2were further improved at 20 minutes after ROSC. At beginning of AACD-CPR, PETCO2of both groups were about 10 mmHg (1 mmHg = 0.133 kPa). PETCO2was gradually rising to above 20 mmHg in successful group during AACD-CPR process; the failed group increased slightly within 2-5 minutes, then gradually decreased to below 20 mmHg, there was a significant difference in PETCO2between the two groups at each time. The area under the ROC (AUC) of PETCO2at CPR 20 minutes in predicting the outcome of the resuscitation was 0.969, 95% confidence interval (95%CI) was 0.943-0.995 (1 = 0.000), when the cut-off value of PETCO2was 24.25 mmHg, the sensitivity was 90.7%, and the specificity was 96.6%. ② The level of serum S100B protein at 0.5 hour after ROSC in the good prognosis group and the poor prognosis group were significant higher than that of the normal control group; there was no significant difference between poor prognosis group and good prognosis group. S100B protein concentration of the poor prognosis group reached the peak within 3-6 hours, then gradually decreased, and was higher than that of the normal control group at ROSC 72 hours; the good prognosis was gradually decreased and recovered to normal control group within ROSC 72 hours. The AUC of S100B at 3 hours after ROSC on cerebral function prognosis prediction was 0.925, 95%CI was 0.867-0.984 (1 = 0.000), when the cut-off value of S100B protein was 1.215 μg/L, the sensitivity was 85.2%, and the specificity was 85.5%. Conclusion The variation of PETCO2can be used as an objective index to predict the success of AACD-CPR, and serum S100B protein can be used as an objective clinical index to predict cerebral function after AACD-CPR, both of which have some reference and guiding significance for clinical treatment.

Compose a new chapter of cardiopulmonary resuscitation training with Chinese characteristics / 中华危重病急救医学

China's cardiopulmonary resuscitation (CPR) training in the form of a Chinese tutor classes for the training of CPR has spread across the country. It is supported by three Chinese original theoretical systems: "2016 Chinese cardiopulmonary resuscitation expert consensus", "2018 China cardiopulmonary resuscitation training expert consensus", and "Chinese public health guidelines for cardiopulmonary resuscitation". There are five characteristics in the classes, such as the "three analysis" "three-prevention" (precaution, prewarning and early identification),"three-ways" (standardization, diversification and individuation), "three lives" (demutation, transcending and extension),"three dimensional" (time, space and society). Highlighting the Chinese CPR training of the "three training" policy for CPR training (the cultivation of a sound system, the cultivation of scientific guidelines and the cultivation of a healthy culture), the "three training" program of CPR training (training professional skills, training multidimensional and training flexible ), the "three party" direction of CPR training (the application for achievement translation, the precision disseminators and theoretical innovation guides) under the new era background. A new chapter of CPR training with Chinese characteristics was composed.

Chinese consensus on CPR and American guidelines on CPR / 中华危重病急救医学

In the article, we compared "2016 national consensus on cardiopulmonary resuscitation in China"and "2015 American Heart Association guidelines on cardiopulmonary resuscitation and emergency cardiovascular care"with their definition, orientation, characterization, quantifying and thinking mode. Chinese consensus on cardiopulmonary resuscitation (CPR) emphasizes the concept of "survival cycle" and focuses on the victim, it defines the rate of survival in its broad sense, and the thinking mode of the document is typically oriental style. However, American guidelines on CPR emphasize the concept of "survival chain" and the rescuer, it defines the rate of survival in its narrow sense, and the thinking mode is western style. The Chinese consensus cited American guidelines as part of references, and specialized them locally according to the current situation in China. In Chinese consensus, the cycle of survival covers three periods, pre-arrest phase, intra-arrest phase and post-resuscitation phase. In the pre-arrest phase, "three-prevention" policies should be adopted, which are precaution, pre-identification and early warning. During intra-arrest phase, CPR should be carried out with "three-ways" strategies, which are standardization, diversification and individuation. The "three lives" general plans should be considered during the post-resuscitation phase, which are demutation, transcending and extension. Chinese consensus on CPR has provided an omnibearing, overall-process and three-dimensional program with Chinese wisdom.

Effect of external abdominal aorta compression on circulation during anesthesia induction in elderly patients / 中华危重病急救医学

Objective To investigate the effect of external abdominal aorta compression on circulation during anesthetic induction in elderly patients. Methods A prospective randomized controlled trial was conducted. Patients with age of 60-75 years old, requiring a general anesthesia for non-abdominal surgery, and with Ⅱ-Ⅲ class of American Society of Anesthesiologists (ASA) physical status classification, and admitted to General Hospital of Chinese People's Armed Police Forces from January to April in 2017 were enrolled. They were divided into abdominal aorta pressure group and control group according to random number method, with 20 patients in each group. In both groups, anesthesia was induced with midazolam, propofol, fentanyl and cisatracurium, and was maintained with propofol, remifentanil and cisatracurium. After successful intubation, the anesthesia machine was changed into mechanical ventilation. The patients in abdominal aorta pressure group were given abdominal aorta pressure 1 minute after induction of general anesthesia with midazolam till 5 minutes after intubation. The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO2) were observed before anesthesia induction, immediately after anesthesia induction, immediately after intubation, 5 minutes and 10 minutes after intubation, respectively. The incidence of hypotension or bradycardia, and usage of ephedrine or atropine were recorded. Results There were no significant differences in MAP [mmHg (1 mmHg = 0.133 kPa): 83.6±4.7 vs. 82.9±4.7], HR (bpm: 67.3±5.9 vs. 65.9±5.7) and SpO2 (0.962±0.007 vs. 0.960±0.009) before anesthesia induction between abdominal aorta pressure group and control group (all P > 0.05). Immediately after anesthesia induction, the MAP and HR in control group were significantly decreased as compared with those before anesthesia induction [MAP (mmHg): 70.0±8.7 vs. 82.9±4.7, HR (bpm): 60.7±6.7 vs. 65.9±5.7, both P < 0.05], and they were also significantly lower than those of abdominal aorta pressure group [MAP (mmHg): 83.1±3.9, HR (bpm): 66.8±4.9, both P < 0.05]. Immediately after intubation, the MAP and HR in control group were significantly increased as compared with those immediately after anesthesia induction [MAP (mmHg): 78.9±7.9 vs. 70.0±8.7, HR (bpm): 67.3±2.7 vs. 60.7±6.7, both P < 0.05], but the changes in MAP and HR in abdominal aorta pressure group were not obvious. During the anesthesia induction period, there was no statistical difference in SpO2 change between the two groups. During induction of anesthesia, no adverse reaction was found in the abdominal aorta pressure group, but 4 patients with hypotension and 2 patients with bradycardia were found in the control group. Two patients with hypotension were treated with ephedrine, and 2 patients with bradycardia were treated with atropine. Conclusion Anesthesia induction of elderly patients with abdominal aorta pressure can help maintain hemodynamic stability.