Acquired heat acclimation in rats subjected to physical exercise under environmental heat stress alleviates brain injury caused by exertional heat stroke.

BACKGROUND: Exertional heatstroke (EHS) is an emergency with a high mortality rate, characterized by central nervous system dysfunctions. This study aims to establish a Heat acclimation/acclimatization (HA) rat model in locomotion to recapitulate the physical state of human in severe environment of high temperature and humidity, and investigate the mechanism of organism protection in HA. (2) Methods: Wistar rats were exposed to 36 °C and ran 2 h/d for 21 days, acquired thermal tolerance test was conducted to assess the thermotolerance and exercise ability. Core temperature and consumption of water and food were observed. Expression of HSP70 and HSP90 of different tissues were determined by WB. Pathological structure of brain tissue was detected with HE staining. Proteomics was used to identify the differently expressed proteins in cerebral cortex of different groups. And key molecules were identified by RT-PCR and WB. (3) Results: HA rats displayed stronger thermotolerance and exercised ability on acquired thermal tolerance test. Brain water content of HA + EHS group reduced compared with EHS group. HE staining revealed slighter brain injuries of HA + EHS group than that of EHS. Proteomics focused on cell death-related pathways and key molecules Aquaporin 4 (AQP4) related to cell edema. Identification results showed HA increased AQP4, Bcl-xl, ratio of p-Akt/AKT and Bcl-xl/Bax, down-regulated Cleaved Caspase-3. (4) Conclusions: This HA model can ameliorate brain injury of EHS by reducing cerebral edema and cell apoptosis, offering experimental evidence for EHS prophylaxis.

[Exploring the mechanisms of ferroptosis in non-obstructive azoospermia based on bioinformatics and machine learning].

OBJECTIVE: To explor the potential mechanisms of ferroptosis involvement in non-obstructive azoospermia based on bioinformatics and machine learning methods. METHODS: To obtain disease-related datasets and ferroptosis-related genes, we utilized the GEO database and FerrDb database, respectively. Using the R software, the disease dataset was subjected to normalization, differential analysis, and GO and KEGG enrichment analysis. The differentially expressed genes from the disease dataset were then intersected with the ferroptosis-related genes to identify common genes. Core genes were selected using three machine learning algorithms, namely LASSO, SVM-RFE, and random forest. Further analysis included exploring immune infiltration correlation, predicting target drugs, and conducting molecular docking simulations. RESULTS: The differential analysis of the GSE45885 dataset yielded 1751 differentially expressed genes, while the GSE145467 dataset yielded 4358 differentially expressed genes. The intersection of these two gene sets resulted in a disease-related gene set consisting of 508 genes. Taking the intersection of the disease-related gene set and the ferroptosis-related gene set, we obtained 17 disease-related ferroptosis genes. After machine learning-based screening, three core genes were identified: GPX4, HSF1, and KLHDC3. CONCLUSION: The mechanism underlying the involvement of ferroptosis in non-obstructive azoospermia may be linked to the downregulation of GPX4, HSF1, and KLHDC3 expression. This finding provides a basis for subsequent in-depth mechanistic and therapeutic studies.

3,4-Seco-Isopimarane Diterpenes from the Twigs and Leaves of Isodon Flavidus.

Three isopimarane diterpenes [fladins B (1), C (2), and D (3)] were isolated from the twigs and leaves of Chinese folk medicine, Isodon flavidus. The chemical structures were determined by the analysis of the comprehensive spectroscopic data, and the absolute configuration was confirmed by X-ray crystallographic analysis. The structures of 1-3 were formed from isopimaranes through the rearrangement of ring A by the bond break at C-3 and C-4 to form a new δ-lactone ring system between C-3 and C-9. This structure type represents the first discovery of a natural isopimarane diterpene with an unusual lactone moiety at C-9 and C-10. In the crystal of 1, molecules are linked to each other by intermolecular O-H···O bonds, forming chains along the b axis. Compounds 1-3 were evaluated for their bioactivities against different diseases. None of these compounds displayed cytotoxic activities against HCT116 and A549 cancer cell lines, antifungal activities against Trichophyton rubrum and T. mentagrophytes, or antiviral activities against HIV entry at 20 µg/mL (62.9-66.7) µM. Compounds 1 and 3 did not show antiviral activities against Ebola entry at 20 µg/mL either; only 2 was found to show an 81% inhibitory effect against Ebola entry activity at 20 µg/mL (66.7 µM). The bioactivity evidence suggested that this type of compound could be a valuable antiviral lead for further structure modification to improve the antiviral potential.

Cellular-Beacon-Mediated Counting for the Ultrasensitive Detection of Ebola Virus on an Integrated Micromagnetic Platform.

Ebola virus (EBOV) disease is a complex zoonosis that is highly virulent in humans and has caused many deaths. Highly sensitive detection of EBOV is of great importance for early-stage diagnosis for increasing the probability of survival. Herein, we established a cellular-beacon-mediated counting strategy for an ultrasensitive EBOV assay on a micromagnetic platform. The detection platform, which was assisted by on-demand magnetic-field manipulation, showed high integration and enhanced complex-sample pretreatment by magnetophoretic separation and continuous-flow washing. Cellular beacons (i.e., fluorescent cells) with superior optical properties were used as reporters, and each cellular beacon was used as a fluorescent tracking unit to quantify EBOV by counting the numbers of individual fluorescent signals on the micromagnetic platform. This method achieves high sensitivity with a detection limit as low as 2.6 pg/mL, and the detection limit shows little difference in a complex matrix. In addition, it has excellent specificity and good reproducibility. These results indicate that this method proposes an ultrasensitive detection strategy for early diagnosis of the disease.

Correlation between CO2 storage at the last minute of gas insufflation and area of retroperitoneal lacuna during retroperitoneal laparoscopic radical nephrectomy.

BACKGROUND: Adequate operation interspace is the premise of laparoscopy, and carbon dioxide (CO2) was an ideal gas for forming lacuna. A retroperitoneal space is used to form operation interspace in retroperitoneal laparoscopic radical nephrectomy by making ballooning, and the retroperitoneal space has no relative complete and airtight serous membrane, therefore CO2 absorption may be greater in retroperitoneal than transperitoneal laparoscopic radical nephrectomy. Excess CO2 absorption may induce hypercapnemia and further cause physiopathological change of respiratory and circulatory system. Therefore, exact evaluation of amount of CO2 which is eliminated from body via minute ventilation is important during retroperitoneal laparoscopic radical nephrectomy. The aim of the paper is to study the correlation between CO2 storage at the last minute of gas insufflation and area of retroperitoneal lacuna during retroperitoneal laparoscopic radical nephrectomy. METHODS: Forty ASA I/II patients undergoing retroperitoneal laparoscopic radical nephrectomy were enrolled. CO2 storage at the last minute of gas insufflation and area of a retroperitoneal lacuna were observed. Linear correlation and regression were performed to determine the correlation between them. RESULTS: There was positive correlation between CO2 storage at the last minute of gas insufflation and area of retroperitoneal lacuna (r = 0.880, P = 0.000), and the equation of linear regression was y = -83.097 + 0.925x (R(2) = 0.780, t = 11.610, P = 0.000). CONCLUSIONS: Amount of CO2 which is eliminated from body via mechanical ventilation could be calculated by measuring the area of retroperitoneal lacuna during retroperitoneal laparoscopic radical nephrectomy, and an anesthetist should be aware of the size of lacuna to predict high CO2 storage at the last minute of gas insufflation.

Discovery of antifungal constituents from the Miao medicinal plant Isodon flavidus.

ETHNOPHARMACOLOGICAL RELEVANCE: Leigong Mountain is an area in the Southwest of China where there is a high incidence rate of athlete's foot, but the Miao people, a Chinese minority who reside in this mountainous area have suffered less from this disease due to their use of the herbal medicine Isodon flavidus (Hand.-Mazz.) H. Hara. AIM OF THE STUDY: The present study is to identify the active chemical constituents responsible for antifungal effects of the folk medicine plant. MATERIALS AND METHODS: The natural compounds were separated from the methanol extract of the twigs and leaves of I. flavidus by phytochemical study using chromatographic methods, and their chemical structures were determined by analysis of the spectroscopic data including 1D and 2D NMR spectra. The absolute configuration of fladin A (1) was further confirmed by X-ray crystallographic analysis. The compounds were evaluated for their antifungal activity against the athlete's foot fungus Trichophyton rubrum. They were further evaluated for their antimicrobial and anti-biofilm activity against the dental pathogens Streptococcus mutans, Porphyromonas gingivalis and Candida albicans. RESULTS: Phytochemical and biological studies of I. flavidus led to the discovery of two antifungal compounds, fladin A (1) and lophanic acid (2). Fladin A (1) is a novel diterpene with an unprecedented cyclic ether group formed between C-4 and C-9. Lophanic acid (2) displayed inhibition activity against the athlete's foot fungus Trichophyton rubrum with an MIC value of 7.8µg/mL, and fladin A (1) also showed inhibition activity against the fungus with a MIC value of 62.5µg/mL. CONCLUSIONS: Our identification of two antifungal compounds provided strong evidence for the Miao people to use I. flavidus as a medicinal plant for treatment of athlete's foot disease. The very different chemical structures of the active compounds from those in the market presents them as potential antifungal lead compounds for follow-up study.

[Bushen Tiaojing Recipe Regulated Expressions of BMPR I[/ALK6-Smads in Mouse Oocytes Cul- ture in vitro].

Objective To observe the effects of Bushen Tiaojing Recipe (BTR) on the counts of survival preantral follicles and the bone morphogenetic protein receptor II (BMPR II )/activin receptor- like kinase 6-drosophila mothers against decapentaplegic proteins (ALK6-Smads) signal pathway in oocytes cultured in vitro, and to study its mechanism for improving the quality of oocytes. Methods Prean- tral follicles were mechanically isolated from 65 female 12-day old healthy Kunming mice, which were inoculated by normal rats' serum (as the control group) , high, medium, low dose BTR containing serums (as Shen-supplementing groups) , high dose BTR containing serum + K02288 (as the inhibitor group) , respectively. All were cultured by common method in vitro. On the 6th day the counts of survival preantral follicles were compared between each Shen-supplementing group and the control group respectively. mR- NA expressions of BMPR II, ALK6, Smad1 , Smad5, and Smad8 were detected by Real-time fluorescence quantitative PCR. The protein expressions of indices mentioned above and phospho-Smadl/5/8 (p- Smadl/5/8) were detected by cellular immunofluorescence test. Results Compared with the control group, the quantity of survival preantral follicles increased in the high dose BTR containing serum group; mRNA expressions of BMPR II, ALK6, Smad5, and Smad8 were elevated, protein expressions of indi- ces mentioned above and p-Smadl/5/8 were increased in the 3 Shen-supplementing groups (P <0. 05) ; mRNA and protein expressions of Smad1 were increased in high and medium dose BTR containing serum groups (P<0.05). Compared with the high dose BTR containing serum group, protein expressions of Smad1/5/8 were reduced in the inhibitor group (P <0.05). Conclusion BTR could elevate the quantity of survival preantral follicles cultured in vitroand improve the quality of oocytes, which might be possibly as- sociated to regulating the BMPR II/ALK6-Smads signal pathway in oocytes.

Elevated survivin mediated multidrug resistance and reduced apoptosis in breast cancer stem cells.

PURPOSE: Overexpression of survivin in breast cancer cells is associated with aberrant inhibition of apoptosis which leads to massive proliferation of cancer cells. Downregulation of survivin by the anticancer agent prodigiosin can efficiently induce apoptosis in cancer cells. METHODS: The levels of survivin expression in breast cancer stem like side population (SP) cells were assessed. Analyzed were also the rate of apoptosis, drug resistance and the efficiency of clone formation of breast cancer SP cells after treatment with progiosin. RESULTS: Breast cancer samples contained about 2.7% of cancer stem like SP cells which possessed elevated mRNA expression of stem cell proteins Oct-4, EpCAM and ABC transporter ABCG2, essential for the maintenance of SP cells. Furthermore, the SP cells displayed overexpression of survivin in conjunction with reduced apoptosis and increased multidrug resistance. After treatment with prodigiosin, the SP cells became more sensitive to apoptosis and to several chemotherapeutic agents. CONCLUSION: These data suggest that increased expression of survivin in SP cells is one of the major factors involved in apoptosis and resistance to chemotherapy.

S100A8 contributes to postoperative cognitive dysfunction in mice undergoing tibial fracture surgery by activating the TLR4/MyD88 pathway.

Neuro-inflammation plays a key role in the occurrence and development of postoperative cognitive dysfunction (POCD). Although S100A8 and Toll-like receptor 4 (TLR4) have been increasingly recognized to contribute to neuro-inflammation, little is known about the interaction between S100A8 and TLR4/MyD88 signaling in the process of systemic inflammation that leads to neuro-inflammation. Firstly, we demonstrated that C57BL/6 wide-type mice exhibit cognitive deficit 24h after the tibial fracture surgery. Subsequently, increased S100A8 and S100A9 expression was found in the peripheral blood mononuclear cells (PBMCs), spleen, and hippocampus of C57BL/6 wide-type mice within 48h after the surgery. Pre-operative administration of S100A8 antibody significantly inhibited hippocampal microgliosis and improved cognitive function 24h after the surgery. Secondly, we also observed TLR4/MyD88 activation in the PBMCs, spleen, and hippocampus after the surgery. Compared with those in their corresponding wide-type mice, TLR4(-/-) and MyD88(-/-) mice showed lower immunoreactive area of microglia in the hippocampal CA3 region after operation. TLR4 deficiency also led to reduction of CD45(hi)CD11b(+) cells in the brain and better performance in both Y maze and open field test after surgery, suggesting a new regulatory mechanism of TLR4-dependent POCD. At last, the co-location of S100A8 and TLR4 expression in spleen after operation suggested a close relationship between them. On the one hand, S100A8 could induce TLR4 activation of CD11b(+) cells in the blood and hippocampus via intraperitoneal or intracerebroventricular injection. On the other hand, TLR4 deficiency conversely alleviated S100A8 protein-induced hippocampal microgliosis. Furthermore, the increased expression of S100A8 protein in the hippocampus induced by surgery sharply decreased in both TLR4 and MyD88 genetically deficient mice. Taken together, these data suggest that S100A8 exerts pro-inflammatory effect on the occurrence and development of neuro-inflammation and POCD by activating TLR4/MyD88 signaling in the early pathological process of the postoperative stage.

[Medical rescue of China National Earthquake Disaster Emergency Search and Rescue Team in Lushan earthquake].

OBJECTIVE: To summarize and analyze the medical mission of China National Earthquake Disaster Emergency Search and Rescue Team (CNESAR) in Lushan earthquake, to promote the medical rescue effectiveness incorporated with search and rescue. METHODS: Retrospective analysis of medical work data by CNESAR from April 21th, 2013 to April 27th during Lushan earthquake rescue, including the medical staff dispatch and the wounded case been treated. RESULTS: The reasonable medical corps was composed by 22 members, including 2 administrators, 11 doctors [covering emergency medicine, orthopedics (joints and limbs, spinal), obstetrics and gynecology, gastroenterology, cardiology, ophthalmology, anesthesiology, medical rescue, health epidemic prevention, clinical laboratory of 11 specialties], 1 ultrasound technician, 5 nurses, 1 pharmacist, 1 medical instrument engineer and 1 office worker for propaganda. There were two members having psychological consultants qualifications. The medical work were carried out in seven aspects, including medical care assurance for the CNESAR members, first aid cooperation with search and rescue on site, clinical work in refugees' camp, medical round service for scattered village people, evacuation for the wounded, mental intervention, and the sanitary and anti-epidemic work. The medical work covered 24 small towns, and medical staff established 3 medical clinics at Taiping Town, Shuangshi Town of Lushan County and Baoxing County. Medical rescue, mental intervention for the old and kids, and sanitary and anti-epidemic were performed at the above sites. The medical corps had successful evacuated 2 severe wounded patients and treated the wounded over thousands. Most of the wounded were soft tissue injuries, external injury, respiratory tract infections, diarrhea, and heat stroke. CONCLUSIONS: Compared with the rescue action in 2008 Wenchuan earthquake, the aggregation and departure of rescue team in Lushan earthquake, the traffic control order in disaster area, the self-aid and buddy aid are better, which give rise to the casualties to the lowest. The medical mission incorporated with search and rescue work showed that the medical performance manner altered with stages, the medical staff match changed with the mission, and the focus related with rescue time.

[Discussion about health assessment and epidemic prevention mode for China National Earthquake Disaster Emergency Search and Rescue Team in Lushan earthquake].

OBJECTIVE: To discuss health assessment and epidemic prevention in earthquake rescue, to establish emergency health and epidemic prevention mode for the national earthquake emergency medical rescue team scientifically, and to provide references and consultations for emergency hygiene and epidemic prevention measures in disaster medicine. METHODS AND RESULTS: China National Earthquake Disaster Emergency Search and Rescue Team gathered and evaluated environment, food, drinking water and other health related information around more than 2000 earthquake victims in Baoxing County, Shuangshi Town and Qingren Township from 20th April 2013 to 27th by using methods such as field epidemiological investigations. The national earthquake emergency medical rescue team spread comprehensive evaluation focusing on the local epidemics, find out the starting point of epidemic prevention, and then built reporting system in disaster area. The team also formulated the emergency detection system of food and drinking water and carried out health education. CONCLUSION: After the golden 72 hours, by comprehensive evaluation the establishment of early response in disaster area and spreading epidemic prevention, this team achieved the full coverage of three in the earthquake area, the resettlement of residents and families in that area and gradually formed a disaster medical rescue hygiene and epidemic prevention mode.

[Protection of anisodamine on the mitochondrial injury induced by oxidative stress in swine with cardiac arrest].

OBJECTIVE: To investigate the protection of anisodamine on cardiac ischemia/reperfusion (I/R) injury by oxidative stress by observing the changes in oxidation and antioxidant markers in plasma and myocardium, and the damage of cardiac mitochondria structure in pigs with cardiac arrest (CA). METHODS: Twenty-three healthy male swine were divided into three groups using random digits table: sham group (n=5), epinephrine group (n=9), and anisodamine group (n=9). The CA model was reproduced by alternating current. Blood samples were collected before CA, 8 minutes after CA, and 0 minute, 30 minutes, 24 hours after recovery of spontaneous circulation (ROSC), and hearts were harvested at 24 hours after ROSC. The content of malondialdehyde (MDA) and the enzyme activity of superoxide dismutase (SOD) were analyzed by spectrophotography, the cardiac ATP content was assayed by high performance liquid chromatography, the generation of reactive oxygen species (ROS) was detected by laser confocal microscope, and the myocardial ultrastructures were observed with transmission electron microscope to assess mitochondrial damage score. RESULTS: At 30 minutes and 24 hours after ROSC, plasma MDA level of anisodamine group was lower than that of epinephrine group (30 minutes: 43.38±8.12 µmol/L vs. 55.47±10.97 µmol/L, 24 hours: 29.96±6.04 µmol/L vs. 37.87±7.85 µmol/L, both P<0.05). Compared with epinephrine group, the cardiac SOD activity and ATP content of anisodamine group were elevated (SOD: 1.35±0.50 U/mg vs. 0.54±0.19 U/mg, ATP: 4.17±1.06 µmol/g vs. 2.95±0.94 µmol/g, P<0.01 and P<0.05), and the mitochondrial ROS level (RFU) was lowered (88.00±17.67 vs. 107.00±21.35, P<0.05). Although the cardiac MDA content was also reduced, but the difference between two resuscitation groups showed no statistical significance (16.66±2.89 µmol/mg vs. 19.28±3.90 µmol/mg, P>0.05). Using electron microscope, in epinephrine group disordered arrangement of cardiac myocyte arrangement was observed, and the mitochondrial alignment and morphology were significantly different from the sham group (mitochondrial damage score: 0.41±0.08 vs. 0.12±0.01, P<0.01). The level of mitochondrial injury in anisodamine group was milder than that of epinephrine group (mitochondrial damage score: 0.21±0.05 vs. 0.41±0.08, P<0.05). CONCLUSION: Through regulating oxygen radical metabolism, anisodamine alleviates the injury to myocardial mitochondria structure and function injury as induced by oxidative stress.

[Protective effect of anisodamine against myocardial cell apoptosis through mitochondria impairment in cardiac arrest in pigs].

OBJECTIVE: To investigate the protective effect of anisodamine on myocardial mitochondrial damage in cardiac arrest (CA) in pigs. METHODS: Twenty-three male pigs were randomly divided into three groups, epinephrine group (n=9), anisodamine group (n=9) and control group (n=5). CA following ventricular fibrillation (VF) was induced by alternating current. The blood samples were collected before CA, 8 minutes after CA and instantly after recovery of spontaneous circulation (ROSC), and 30 minutes and 24 hours later. Hearts were obtained at 24 hours after ROSC. The changes in Cytochrome C (Cyt C) and caspase-3 in plasma and myocardium were analyzed by enzyme-linked immunosorbent assay (ELISA). The myocardial specimens were observed by transmission electron microscopy for ultrastructural changes, and apoptosis was assessed with Hoechst 33258 staining. RESULTS: The ROSC rate of the anisodamine group was elevated by 22.22% compared with the epinephrine group (77.78% vs. 55.56%, P>0.05). All animals with resumption of ROSC survived up to 24 hours. The plasma contents of Cyt C and caspase-3 in the epinephrine group and the anisodamine group gradually increased after ROSC, and were significantly higher than those in the control group. But the plasma Cyt C level in the anisodamine group was lower than that in the epinephrine group at 30 minutes and 24 hours after ROSC (48.68±19.50 nmol/L vs. 77.51±29.87 nmol/L, 48.98±20.26 nmol/L vs. 82.11±25.09 nmol/L, both P<0.05). There was no significant difference in protein contents of both Cyt C and caspase-3 in plasma and myocardium between two resuscitate groups. Both epinephrine and anisodamine could mitigate cardiac mitochondrial damage after CA, but the anisodamine showed better effect. The myocardium apoptosis ratio in the anisodamine group was lower than that of the epinephrine group [(0.15±0.04)% vs. (0.37±0.04)%, P<0.01]. CONCLUSION: By decreasing the protein content of Cyt C, and reducing the extent of damage to myocardial mitochondria, anisodamine can protect the myocardial ultrastructure, and restrain the mitochondria-induced cell apoptosis after resuscitation.

[The impact of interrupted abdominal aorta compression on resuscitation effects of cardiac arrest rabbit].

OBJECTIVE: To determine whether interrupted abdominal aorta compression-cardiopulmonary resuscitation (IAAC-CPR), as a new cardiopulmonary resuscitation (CPR) method, can improve resuscitation effects on rabbits with cardiac arrest (CA). METHODS: Twenty-eight New Zealand rabbits were randomly divided into two groups in equal number (n=14), and they were resuscitated either by standard CPR (STD-CPR, external chest compression) or by IAAC-CPR (abdominal aorta compression at intermission of external chest compression). CA model was reproduced by injection of iced-potassium chloride, and it was maintained for 3 minutes before resuscitation. Electrocardiogram (ECG), hemodynamic indexes were monitored continuously. Aortic systolic pressure and right atrial pressure at baseline and during resuscitation were recorded. Mean arterial pressure (MAP), coronary perfusion pressure (CPP) and recovery of spontaneous circulation (ROSC) indexes were compared between two groups. RESULTS: Compared with STD-CPR group, MAP within 2 minutes of resuscitation (without drugs intervention) in the IAAC-CPR group was significantly increased (30 s: 46.0±12.6 mm Hg vs. 30.0±12.2 mm Hg, 60 s: 57.0±15.6 mm Hg vs. 31.9±9.7 mm Hg, 90 s: 61.9±14.4 mm Hg vs. 36.0±9.8 mm Hg, 120 s: 63.1±12.6 mm Hg vs. 37.8±11.1 mm Hg, all P<0.05), and CPP was also significantly increased (30 s: 29.9±17.4 mm Hg vs. 14.1±11.0 mm Hg, 60 s: 43.1±22.4 mm Hg vs. 14.3±9.8 mm Hg, 90 s: 46.7±20.1 mm Hg vs. 15.9±7.7 mm Hg, 120 s: 50.5±21.0 mm Hg vs. 17.3±9.9 mm Hg, all P<0.05), the time of ROSC was earlier (212.1±43.4 s vs. 307.3±51.2 s, P<0.05), and successful resuscitation rate was significantly higher (85.7% vs. 42.8%, P<0.05). However, there were no statistical differences in ROSC rate and the survivor rate at 24 hours and 48 hours between the two groups, though they were increased. No abdominal organs injury was found in all animals by postmortem study. CONCLUSION: Abdominal aorta compression in the intermittent period of chest compression (IAAC-CPR) increases MAP, CPP and the successful rate of resuscitation, thus improves the outcome.

Effects of subdiaphragmatic cardiac compression on cardiac arrest during liver transplantation.

Cardiac arrest during upper abdominal surgery such as liver transplantation is a rare but very severe complication. Traditional external cardiac compression has been the mainstay of basic life support in general circumstances. Subdiaphragmatic cardiac compression (SDCC), with no incision in the diaphragm, may be a more effective measure. This maneuver can provide more effective and timely cardiac compression via the already open abdomen in surgery and not add extra trauma. This method can provide a quicker and more effective means of circulation support for intraoperative cardiac arrest patients without adding new injuries. Five cases are reported and all the patients had return of spontaneous circulation (ROSC). This is the first report of the SDCC method.

[An experimental study on the effects of rhythmic abdominal lifting and compression during cardiopulmonary resuscitation in a swine model of asphyxia].

OBJECTIVE: To compare the hemodynamic and respiratory influences of chest compression- cardiopulmonary resuscitation (CC-CPR) and rhythmic abdominal lifting and compression-cardiopulmonary resuscitation (ALC-CPR) in a swine model of asphyxia cardiac arrest (CA), and evaluate the effectiveness of rhythmic abdominal lifting and compression. METHODS: Thirty swines were randomly divided into two groups, with 15 swines in each group. CA model was reproduced by asphyxia as a result of clamping the trachea, and CC-CPR and ALC-CPR was conducted in two groups, respectively. Electrocardiogram (ECG), pulse oxygen saturation [SpO(2)], end-tidal partial pressure of carbon dioxide [P(ET)CO(2)], aorta systolic blood pressure (SBP), diastolic blood pressure (DBP), central venous pressure (CVP), and tidal volume (VT) were monitored continuously from 10 minutes before asphyxia to the end of experiment. The aorta mean arterial pressure (MAP), coronary perfusion pressure (CPP) and minute ventilation (MV) were calculated. Artery blood samples were collected to determine the blood gas analysis at 10 minutes before asphyxia, 10 minutes after asphyxia, and 5, 10, 20 minutes after resuscitation. The restoration of spontaneous circulation (ROSC) rate, 24-hour survival rate and 24-hour neurological function score were observed. RESULTS: There were no significant differences in all mentioned indexes between two groups at 10 minutes before and 10 minutes after asphyxia. At 2 minutes after the resuscitation, the MAP (mm Hg, 1 mm Hg = 0.133 kPa) and CPP (mm Hg) in CC-CPR group were significantly higher than those in ALC-CPR group (MAP: 43.60 ± 12.91 vs. 33.40 ± 6.59, P < 0.05; CPP: 21.67 ± 11.28 vs. 11.80 ± 4.16, P < 0.01), the VT (ml) and MV (L/min)in ALC-CPR group were significantly higher than those in CC-CPR group (VT: 111.67 ± 18.12 vs. 56.60 ± 7.76; MV: 11.17 ± 1.81 vs. 5.54 ± 0.79, both P < 0.01). At 5, 10, 20 minutes after resuscitation, in ALC-CPR group, pH value, arterial partial pressure of oxygen [PaO(2), mm Hg] and arterial oxygen saturation [SaO(2)] were increased, and HCO(3)(-) (mmol/L) and base excess (BE, mmol/L) were decreased, which significantly higher than those in CC-CPR group [pH at 20 minutes after resuscitation: 7.16 ± 0.16 vs. 7.01 ± 0.14; PaO(2): 82.73 ± 13.20 vs. 58.33 ± 17.77; HCO(3)(-): 27.71 ± 3.11 vs. 21.04 ± 3.62; BE: -4.78 ± 4.30 vs. -10.23 ± 2.12; SaO(2): 0.893 ± 0.088 vs. 0.764 ± 0.122], and arterial partial pressure of carbon dioxide [PaCO(2), mm Hg], K(+) (mmol/L) and lactic acid (Lac,mmol/L) were significantly lower than those in CC-CPR group [PaCO(2) at 20 minutes after resuscitation: 49.40 ± 15.60 vs. 79.80 ± 15.35; K(+): 7.18 ± 1.76 vs. 8.55 ± 1.02; Lac: 8.17 ± 1.46 vs. 10.39 ± 1.92], with statistical significant (P < 0.05 or P < 0.01). But the ROSC rate and 24-hour survival rate in ALC-CPR group were significantly higher than those in CC-CPR group (ROSC rate: 80.0% vs. 26.7%, P < 0.01; 24-hour survival rate: 60.0% vs. 13.3%, P < 0.05), and the 24-hour neurological function score was significantly lower than that in CC-CPR group (1.11 ± 0.33 vs. 3.50 ± 0.70, P < 0.01). CONCLUSION: In the incipient stage of cardiopulmonary resuscitation of the swine CA model of asphyxia, compared with CC-CPR, ALC-CPR can be more effective.