[Analysis of factors affecting the return of spontaneous circulation in elderly patients with out-of-hospital cardiac arrest].

OBJECTIVE: To investigate the factors that influence the return of spontaneous circulation (ROSC) in elderly patients suffering from out-of-hospital cardiac arrest (OHCA). METHODS: A retrospective study was used to collect the clinical data of OHCA patients admitted to the emergency center of Zhengzhou People's Hospital from July 2016 to July 2019 based on the pre-hospital emergency database of Utstein model. Patients' gender, age, cardiac arrest (CA) etiology, presence or absence of bystander cardiopulmonary resuscitation (CPR), emergency response time, initial cardiac rhythm, ventilation method, use of epinephrine, defibrillation and ROSC were included. The patients were divided into elderly and young groups according to whether age ≥ 60 years old, and the differences in various indicators between the two groups were compared. Univariate Logistic regression analysis was used to analyze the relationship between emergency response time and ROSC in elderly patients and multivariate Logistic regression analysis was used to identify factors influencing ROSC in elderly patients. RESULTS: A total of 3 429 adult OHCA patients were enrolled in this study, including 2 105 elderly patients (61.39%), and 1 324 young and middle-aged patients (38.61%). Compared to the young group, the proportion of females, non-cardiac causes and asystole as the initial rhythm was higher in the elderly group, the emergency response time was shorter, the rate of defibrillation and tracheal intubation, and the success rate of ROSC were lower (all P < 0.05). Among them, the proportion of cardiac arrest as the initial rhythm in elderly male patients was significantly higher than that of young male patients (P < 0.05); the proportion of non-cardiac causes in elderly female patients was significantly higher than that of young female patients, and the proportion of defibrillation was significantly lower than that of young female patients (all P < 0.05). Multivariate Logistic regression analysis showed that cardiac arrest as the initial rhythm was strongly associated with ROSC in elderly male patients [odds ratio (OR) = 0.126, 95% confidence interval (95%CI) was 0.045-0.352, P < 0.05]. Univariate Logistic regression analysis of the relationship between emergency response time and ROSC in elderly patients showed that although there was no significant difference in the ROSC success rate among elderly patients with various emergency response times, an emergency response time within 10 minutes was beneficial for ROSC in elderly patients. CONCLUSIONS: The success rate of ROSC is very low in elderly OHCA patients aged ≥60 years. Although the CPR-related indicators of elderly patients are significantly different from those of young patients, there are gender differences. The association between the elderly male patients and cardiac arrest as the initial rhythm is stronger, while OHCA caused by non-cardiac diseases is more common and defibrillable rhythm is less common in elderly female patients. It may be more beneficial for elderly patients to shorten the emergency response time and increase bystander CPR.

COMPARISON BETWEEN ACTIVE ABDOMINAL COMPRESSION-DECOMPRESSION CARDIOPULMONARY RESUSCITATION AND STANDARD CARDIOPULMONARY RESUSCITATION IN ASPHYCTIC CARDIAC ARREST RATS WITH MULTIPLE RIB FRACTURES.

ABSTRACT: Background: Active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) is potentially more effective for cardiac arrest (CA) with multiple rib fractures. However, its effect on survival rates and neurological outcomes remains unknown. This study aimed to assess if AACD-CPR improves survival rates and neurological outcomes in a rat model of asphyctic CA with multiple rib fractures. Methods: Adult male Sprague-Dawley rats were randomized into three groups-AACD group (n = 15), standard cardiopulmonary resuscitation (STD-CPR) group (n = 15), and sham group (n = 10)-after bilateral rib fractures were surgically created and endotracheal intubation was performed. AACD-CPR and STD-CPR groups underwent 8 min of asphyxia followed by different CPR techniques. The sham group had venous catheterization only. Physiological variables and arterial blood gases were recorded at baseline and during a 4-h monitoring period. Neurological deficit scores (NDSs) and cumulative survival rates were assessed at 24, 48, and 72 h. NDS, serum biomarkers, and hippocampal neuron analysis were used to evaluate neurological outcomes. Results: No statistical differences were observed in the return of spontaneous circulation (ROSC), 24-, 48-, and 72-h survival rates between the AACD-CPR and STD-CPR groups. AACD-CPR rats had lower serum levels of neuron-specific enolase and S100B at 72 h post-ROSC, and higher NDS at 72 h post-ROSC compared with STD-CPR animals. Cellular morphology analysis, hematoxylin and eosin staining, and TUNEL/DAPI assays showed more viable neurons and fewer apoptotic neurons in the AACD-CPR group than in the STD-CPR group. Conclusions: AACD-CPR can achieve similar survival rates and better neurological outcome after asphyxial CA in rats with multiple rib fractures when compared with STD-CPR.

Platforms of graphene/MXene heterostructure for electrochemical monitoring of rutin in drug and Tartary buckwheat tea.

The use of two-dimensional heterostructure composite as electrode modification material has become a new strategy to improve the electrocatalytic activity and electroactive sites of electrochemical sensor. Herein, a soluble heterostructure, namely rGO-PSS@MXene, was designed and synthesized by integrating poly (sodium p-styrenesulfonate)-functionalized reduced graphene oxide into MXene nanosheets via ultrasonic method. The interactive heterostructure can effectively alleviate the self-stacking of MXene and rGO, endowing them with superior electron transfer capacity and large specific surface area, thereby producing prominent synergistic electrocatalytic effect towards rutin. In addition, the excellent enrichment effect of rGO-PSS@MXene for rutin also plays an important role through the electrostatic and π-π stacking interactions. The electrochemical characteristics of rutin on the sensor were examined in detail and a sensitive sensing method was proposed. Under optimized conditions, the method showed satisfactory linear relationship for rutin in the concentration range of 0.005-10.0 µM, with limit of detection of 1.8 nM (S/N = 3). The quantitative validation results in herbal medicine and commercial Tartary buckwheat tea were highly consistent with the labeled quantity and the results of HPLC determination, respectively, suggesting the sensor possessed excellent selectivity and accuracy. This proposed strategy for rutin determination is expected to expand the application of MXene heterostructure in electrochemical sensors, and is envisioned as a promising candidate for quality monitoring of drugs and foods.

Mulberry fruit repairs alcoholic liver injury by modulating lipid metabolism and the expression of miR-155 and PPARα in rats.

As alcohol consumption increases, alcoholic liver disease (ALD) has become more popular and is threating our human life. In this study, we found mulberry fruit extract (MFE) repaired alcohol-caused liver diseases by regulating hepatic lipid biosynthesis pathway and oxidative singling in alcoholically liver injured (ALI) rats. MFE administration inhibited hepatic lipid accumulation and improved liver steatosis in ALI rats. MFE also enhanced the antioxidant capacity and alleviated the inflammatory response by increasing the activities of antioxidant enzymes and decreasing the contents of interleukin (IL)-1ß and tumor necrosis factor (TNF)-α. Additionally, MFE regulated the expression of miRNA-155 and lipid metabolism-related PPARα protein in rats. Both miR-155 and PPARα play important roles in liver function. The results indicate that MFE has hepatoprotective effects against ALI in rats.

COX7B Is a New Prognostic Biomarker and Correlates with Tumor Immunity in Esophageal Carcinoma.

Esophageal carcinoma (ESCA) refers to the most common type of malignant tumor, which reveals that it occurs often all over the world. ESCA is also correlated with an advanced stage and low survival rates. Thus, the development of new prognostic biomarkers is an absolute necessity. In this study, the aim was to investigate the potential of COX7B as a brand-new predictive biomarker for ESCA patients. COX7B expression in pancancer was examined using TIMER2. The statistical significance of the predictive value of COX7B expression was explored. The relationship between COX7B expression and tumor-infiltrating immune cells in ESCA was analyzed by using ssGSEA. In this study, the result indicated that several types of cancers had an abnormally high amount of COX7B. COX7B expression in samples from patients with ESCA was considerably higher than in nontumor tissues. A more advanced clinical stage may be anticipated from higher COX7B expression. According to the findings of Kaplan-Meier survival curves, patients with low COX7B levels had a more favorable prognosis than those with high COX7B levels. The result of multivariate analysis suggested that COX7B expression was a standalone prognostic factor for the overall survival of ESCA patients. A prognostic nomogram including gender, clinical stage, and COX7B expression was constructed, and TCGA-based calibration plots indicated its excellent predictive performance. An analysis of immune infiltration revealed that COX7B expression has a negative correlation with TFH, Tcm, NK cells, and mast cells. COX7B may serve as an immunotherapy target and as a biomarker for ESCA diagnosis and prognosis.

Characteristics, polarization and targeted therapy of mononuclear macrophages in rheumatoid arthritis.

Macrophages are the core of the pathophysiology of rheumatoid arthritis (RA). They participate in specific and non-specific immunological responses, have phagocytosis, chemotaxis and immune regulatory functions, and are involved in the onset and progression of RA. In recent years, research on the pathophysiology of RA has focused on the polarization and functions of classically activated M1 and selectively activated M2 macrophage subtypes. M1 macrophages release different proinflammatory cytokines, thus driving the chronic proinflammatory, tissue destruction and pain response in RA. M2 macrophages play an anti-inflammatory role. Because of the important role of monocyte-macrophage in RA, drug research targeting monocyte-macrophage can bring us more hope for treatment of RA. This study reviewed the characteristics, plasticity, molecular activation mechanism and relationship of RA with mononuclear macrophages, as well as the transformative potential of macrophages in developing new therapeutic drugs for clinical practice.

Comprehensive Molecular Analyses of Notch Pathway-Related Genes to Predict Prognosis and Immunotherapy Response in Patients with Gastric Cancer.

Gastric cancer (GC) is a highly molecular heterogeneous tumor with unfavorable outcomes. The Notch signaling pathway is an important regulator of immune cell differentiation and has been associated with autoimmune disorders, the development of tumors, and immunomodulation caused by tumors. In this study, by developing a gene signature based on genes relevant to the Notch pathway, we could improve our ability to predict the outcome of patients with GC. From the TCGA database, RNA sequencing data of GC tumors and associated normal tissues were obtained. Microarray data were collected from GEO datasets. The Molecular Signature Database (MSigDB) was accessed in order to retrieve sets of human Notch pathway-related genes (NPRGs). The LASSO analysis performed on the TCGA cohort was used to generate a multigene signature based on prognostic NPRGs. In order to validate the gene signature, the GEO cohort was utilized. Using the CIBERSORT method, we were able to determine the amounts of immune cell infiltration in the GC. In this study, a total of 21 differentially expressed NPRGs were obtained between GC specimens and nontumor specimens. The construction of a prognostic prediction model for patients with GC involved the identification and selection of three different NPRGs. According to the appropriate cutoff value, the patients with GC were divided into two groups: those with a low risk and those with a high risk. The time-dependent ROC curves demonstrated that the new model had satisfactory performance when it came to prognostic prediction. Multivariate assays confirmed that the risk score was an independent marker that may be used to predict the outcome of GC. In addition, the generated nomogram demonstrated a high level of predictive usefulness. Moreover, the scores of immunological infiltration of the majority of immune cells were distinctly different between the two groups, and the low-risk group responded to immunotherapy in a significantly greater degree. According to the results of a functional enrichment study of candidate genes, there are multiple pathways and processes associated with cancer. Taken together, a new gene model associated with the Notch pathway may be utilized for the purpose of predicting the prognosis of GC. One potential method of treatment for GC is to focus on NPRGs.

Effects of NCSTN Mutation on Hair Follicle Components in Mice.

BACKGROUND AND OBJECTIVES: Hidradenitis suppurativa (HS)/acne inversa is an intractable skin disease that is characterized by destructive lesions - primarily on the flexural areas. Although its etiology is unknown, genetics is considered to be a factor of its pathology - mutations in γ-secretase genes have been identified in certain familial HS patients, and follicular occlusion is widely accepted as the primary cause of HS. But, no relationship between these mutations and the components of hair follicles has been reported. Thus, we examined changes in these components in mice with a mutation in NCSTN (a γ-secretase gene). METHODS: We generated C57BL/6 mice with an NCSTN mutation and examined their expression of hair cortex cytokeratin and trichohyalin by Western blot and immunohistochemistry, in addition to nicastrin, the product of NCSTN, and NICD compared with wild-type mice. The structure of hair follicles was analyzed by hematoxylin-eosin staining and transmission electron microscopy. RESULTS: In mice with an NCSTN mutation, HS-like skin lesions appeared after age 6 months, the pathological manifestations of which were consistent with the features of human HS. The structure of hair follicles was abnormal in mice with an NCSTN mutation versus wild-type mice, and hair cortex cytokeratin, trichohyalin, nicastrin, and NICD were downregulated in these mice. CONCLUSIONS: This NCSTN mutant mouse model could be an improved model to study early lesion development aspects of human HS pathogenesis and could perhaps be a better alternative for evaluating early-acting and preventive therapeutics for HS experimentally before clinical trials in HS patients. NCSTN mutations disrupt the development of hair follicles, leading to abnormal hair follicle structures, perhaps resulting in the onset of HS.

SnO2 quantum dots-functionalized Ti3C2 MXene nanosheets for electrochemical determination of dopamine in body fluids.

A novel SnO2 quantum dots (SnO2QDs)-functionalized Ti3C2 MXene nanocomposite was prepared via in situ synthesis method, resulting in well-regulated the nucleation and growth of SnO2QDs to evenly distribute onto MXene nanosheets. Ultra-small size SnO2QDs decorated on the surface of Ti3C2 MXene nanosheets can effectively prevent the restacking of MXene and remarkably increase the electroactive surface area of the electrode, which can further increase electrocatalytic activity toward dopamine. Then, an ultrasensitive electroanalytical method based on SnO2QDs-functionalized Ti3C2 MXene nanocomposite for dopamine monitoring was developed, and the effects of experimental condition were investigated systematically. Under optimized conditions, the prepared sensor presented a linear dependence for dopamine in the concentration range from 0.004 to 8.0 µM with the detection limit of 2.0 nM (S/N = 3). Moreover, it selectively perceived dopamine in presence of physiological interferents in urine and serum samples with excellent linearities (correlation coefficients higher than 0.9920). The relative recoveries were in the range 97.67-105.3% and 103.0-106.8%, while the limits of quantitation were 10.12 nM and 9.62 nM in urine and serum sample, respectively, demonstrating the method suitability for dopamine sensing and being envisioned as a promising candidate for neurotransmitter monitoring in biological diagnosis.

Next-generation sequencing and targeted quantitative real-time polymerase chain reaction for detection of Akebiae Caulis in the traditional Chinese medical formula Longdan Xiegan Wan.

Background: Akebiae Caulis (Mu Tong) is commonly misused by Aristolochiae Manshuriensis Caulis (Guan Mutong) and Clematidis Armandii Caulis (Chuan Mutong), which are nephrotoxic and carcinogenic. However, in the Pharmacopoeia of the People's Republic of China (2015 Edition), the method for determining Akebiae Caulis remains undefined. Methods: We used DNA barcode-based next-generation sequencing (NGS) combined with quantitative real-time polymerase chain reaction (qPCR) to detect Akebiae Caulis in Longdan Xiegan Wan (LDXGW) for the first time. Compared with chromatographic studies, NGS enables better evaluation of the ingredient components of traditional Chinese medicine (TCM) preparations. The feasibility of qPCR using species-specific primers to determine the authenticity of species has been validated. In this study, the constituents of Akebiae Caulis in LDXGW from three different manufacturers were scanned by NGS. The independently developed qPCR detection primers of Akebiae Caulis, Aristolochiae Manshuriensis Caulis, and Clematidis Armandii Caulis were specifically used to analyze the LDXGW mentioned above. Results: The results showed that qPCR detected Clematidis Armandii Caulis in all commercial samples. Meanwhile, NGS detected the counterfeit species Clematis peterae (Tie-Xian Lian) in all samples. We found that qPCR shows a difference in detecting Akebiae Caulis, but it was not able to identify the unknown additives and adulterants for the primer pairs of Clematidis Armandii Caulis. Conclusions: Hence, it is sensitive and rapid, qPCR is not suitable for detection alone. The NGS approaches offer important novel insights that complement the qPCR method. The combination of NGS and qPCR will be a powerful complement to traditional identification methods of TCM substances.

Application of Extracorporeal Membrane Oxygenation in Patients With Severe Acute Respiratory Distress Syndrome Caused by Pneumocystis jirovecii Pneumonia Following Kidney Transplantation: A Case Series.

Objective: To investigate the application effect of extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) caused by Pneumocystis jirovecii pneumonia (PJP) after kidney transplantation. Methods: This is a case series on 10 kidney transplant recipients with severe ARDS caused by PJP at the People's Hospital of Zhengzhou, who were enrolled as the case group. A total of 17 cases of PJP diagnosed with severe ARDS without ECMO were selected as the control group. The timing and mode of ECMO support and treatment complications were summarized. The primary aim of this study was mortality and secondary was imaging and complications. Results: The enrolled patients' oxygenation index before the start of ECMO ranged from 25 to 92, and the time from admission to the start of ECMO was 1-17 days, with an average of 5.56 days. In the case group, one patient died of hemorrhagic shock due to abdominal hemorrhage, but the other nine patients were successfully weaned from ECMO. Of these patients, one died due to sepsis following weaning. The survival rate in the case group was 80.0% (8/10), and the survival rate in the control group was 35.29% (6/17). The vein-vein ECMO support time in the nine successfully weaned patients in the case group ranged from 131 to 288 h, with an average of 215.5 h. Of the eight patients who survived, deterioration of renal function after transplantation occurred in two patients, but no fatal complications occurred. Conclusion: Overall, Patients with severe ARDS caused by postoperative PJP infection following kidney transplantation have a poor prognosis. The mortality was lower in patients who were treated with ECMO compared to standard care.

Overexpression of Foxc1 ameliorates sepsis­associated encephalopathy by inhibiting microglial migration and neuroinflammation through the IκBα/NF­κB pathway.

Sepsis­associated encephalopathy (SAE) is a common and severe complication of sepsis. The cognitive dysfunction that ensues during SAE has been reported to be caused by impairments of the hippocampus. Microglia serves a key role in neuroinflammation during SAE through migration. Forkhead box C1 (Foxc1) is a member of the forkhead transcription factor family that has been found to regulate in cell migration. However, the role of Foxc1 in neuroinflammation during SAE remains unknown. In the present study, the mechanistic role of Foxc1 on microglial migration, neuroinflammation and neuronal apoptosis during the occurrence of cognitive dysfunction in SAE was investigated. A microglia­mediated inflammation model was induced by LPS in BV­2 microglial cells in vitro, whilst a SAE­related cognitive impairment model was established in mice using cecal ligation and perforation (CLP) surgery. Cognitive function in mice was evaluated using the Morris Water Maze (MWM) trial. Lipopolysaccharide (LPS) treatment was found to trigger BV­2 cell migration, inflammation and neuronal apoptosis. In addition, CLP surgery induced cognitive injury, which was indicated by longer latencies and shorter dwell times in the goal quadrant compared with those in the Sham group in the MWM trial. LPS treatment or CLP induction decreased the expression of Foxc1 and inhibitor of NF­κB (IκΒα) whilst increasing that of p65, IL­1ß and TNF­α. After Foxc1 was overexpressed, the cognitive dysfunction of mice that underwent CLP surgery was improved, with the expression of IκBα also increased, microglial cell migration, the expression of p65, IL­1ß and TNF­α and neuronal apoptosis were all decreased in vivo and in vitro, which were in turn reversed by the inhibition of IκBα in vitro. Overall, these results suggest that the overexpression of Foxc1 inhibited microglial migration whilst suppressing the inflammatory response and neuronal apoptosis by regulating the IκBα/NF­κB pathway, thereby improving cognitive dysfunction during SAE.

SENP1 modulates microglia-mediated neuroinflammation toward intermittent hypoxia-induced cognitive decline through the de-SUMOylation of NEMO.

Intermittent hypoxia (IH)-induced cognition decline is related to the neuroinflammation in microglia. SUMOylation is associated with multiple human diseases, which can be reversed by sentrin/SUMO-specific proteases 1 (SENP1). Herein, we investigated the role of SENP1 in IH-induced inflammation and cognition decline. BV-2 microglial cells and mice were used for inflammatory response and cognition function evaluation following IH treatment. Biochemical analysis and Morris water maze methods were used to elaborate the mechanism of SENP1 in IH impairment. Molecular results revealed that IH induced the inflammatory response, as evidenced by the up-regulation of NF-κB activation, IL-1ß and TNF-α in vitro and in vivo. Moreover, IH decreased the expression of SENP1, and increased the SUMOylation of NEMO, not NF-κB P65. Moreover, SENP1 overexpression inhibited IH-induced inflammatory response and SUMOylation of NEMO. However, the inhibitions were abolished by siRNA-NEMO. In contrast, SENP1 depletion enhanced IH-induced inflammatory response and SUMOylation of NEMO, accompanying with increased latency and reduced dwell time in mice. Overall, the results demonstrated that SENP1 regulated IH-induced neuroinflammation by modulating the SUMOylation of NEMO, thus activating the NF-κB pathway, revealing that targeting SENP1 in microglia may represent a novel therapeutic strategy for IH-induced cognitive decline.

Depletion of SENP1-mediated PPARγ SUMOylation exaggerates intermittent hypoxia-induced cognitive decline by aggravating microglia-mediated neuroinflammation.

Intermittent hypoxia (IH)-associated cognition decline is related to the neuroinflammation of microglia. SUMOylation is a post-translational modification related to multiple human diseases, which can be reversed by SENP1. Studies showed that SENP1 and PPARγ play essential roles in restricting inflammation by blocking NF-κB activation. However, the mechanism remains unclear. Herein, we investigated the precise mechanism underlying SENP1 and PPARγ in cognitive decline after IH insult. Biochemical analysis results revealed that IH triggered the inflammatory response and neuronal apoptosis, increased the SUMOylation of PPARγ, and decreased the level of PPARγ compared to that in the normoxia group. After SENP1 downregulation, the inflammatory response, neuronal apoptosis and the SUMOylation of PPARγ were enhanced, and the level of PPARγ was further decreased in vitro and in vivo. However, the application of PPARγ agonist, GW1929, abolished the enhancement of inflammation and neuronal apoptosis in vitro. The Morris Water Maze results showed that both IH groups mice exhibited longer latency and shorter dwell-time in the goal quadrant than normoxia groups. Notably, SENP1 downregulation aggravated these alterations. Overall, these results showed that SENP1 played an essential role in IH-associated cognitive dysfunction. SENP1 depletion aggravated neuroinflammation and neuronal apoptosis via promoting the SUMOylation of PPARγ, reducing the level of PPARγ, thus exaggerating IH-induced cognitive decline.

[Investigation of out-of-hospital cardiac arrest in Zhengzhou City and the risk factors of prognosis of cardiopulmonary resuscitation: case analysis for 2016-2018].

OBJECTIVE: To analyze the first aid situation of patients with out-of-hospital cardiac arrest (OHCA) in Zhengzhou City, and to explore the related factors affecting the prognosis of cardiopulmonary resuscitation (CPR) in patients with OHCA. METHODS: Retrospective analysis of patients with OHCA admitted to Zhengzhou Emergency Medical Rescue Center from June 2016 to June 2018 was performed. General information of patients, such as gender, age, bystander, the quality of bystander CPR (medical personnel, non-medical personnel), 120 reception time (day/night), location (family, public place, hotel, other), emergency medical service (EMS) response time, duration of CPR, first detected heart rhythm, defibrillation, mode of ventilation (balloon mask, laryngeal mask, endotracheal intubation), epinephrine dose, cause of cardiac arrest, outcome of resuscitation [restoration of spontaneous circulation (ROSC) or death] were collected. The risk factors of CPR prognosis were analyzed with univariate and multivariate Logistic regression analysis. RESULTS: (1) The result of general investigation: 7 728 cases with OHCA in the past two years, among whom 3 891 were clinically dead upon arrival, 1 413 were not rescued, 2 424 were actively rescued, and only 51 got ROSC. There were 73.71% (5 696/7 728) patients calling "120" during 07:01-23:00 and 26.29% (2 032/7 728) patients during 23:01-07:00. The response time of EMS was (9.36±6.75) minutes. Cardiac arrest mostly occurred at home, which accounting for 61.61% (4 761/7 728), followed by public places, which accounting for 16.19% (1 251/7 728). The incidence of cardiac arrest was higher in males than in females [63.11% (4 877/7 728) vs. 36.89% (2 851/7 728)]. 54.94% (4 246/7 728) of patients were over 60 years old. Cardiogenic factors were the most important etiology, which accounting 38.63% (2 985/7 728), followed by trauma, which accounting 19.16% (1 481/7 728). (2) The risk factors of prognosis of CPR: univariate Logistic regression analysis showed that age, bystander CPR, 120 reception time, duration of CPR, first detected heart rhythm, epinephrine dose and the cause of cardiac arrest were related to the ROSC in OHCA patients [age: odds ratio (OR) = 0.450, 95% confidence interval (95%CI) = 0.257-0.787; bystander CPR: OR = 6.446, 95%CI = 4.695-8.851; 120 reception time: OR = 1.941, 95%CI = 1.114-3.382; duration of CPR: OR = 0.163, 95%CI = 0.074-0.360; first detected heart rhythm: OR = 0.080, 95%CI = 0.042-0.155; epinephrine dose: OR = 0.423, 95%CI = 0.241-0.740; cause of cardiac arrest: OR = 1.901, 95%CI = 1.091-3.314; all P < 0.05]. Multivariate Logistic regression analysis showed that non-medical personnel, medical personnel, shockable rhythm, duration of CPR < 10 minutes and epinephrine dose < 5 mg were favorable factors for ROSC in OHCA patients (non-medical personnel: OR = 24.552, 95%CI = 10.192-59.144; medical personnel: OR = 36.960, 95%CI = 17.572-77.740; shockable rhythm: OR = 0.036, 95%CI = 0.015-0.087; duration of CPR < 10 minutes: OR = 0.191, 95%CI = 0.069-0.526; epinephrine dose < 5 mg: OR = 0.259, 95%CI = 0.125-0.537; all P < 0.01). CONCLUSIONS: (1) Male patients with OHCA in Zhengzhou City were more than female patients, and the age of most patients was older than 60 years old. OHCA often happened at home, followed by public places. The etiology was mainly cardiogenic, followed by trauma. EMS response time was a little long, the success rate of recovery was low, and pre-hospital emergency treatment needs to be further improved. (2) Bystander CPR, shockable rhythm, duration of CPR < 10 minutes and epinephrine dose < 5 mg were beneficial to ROSC.

[Feasible study of carotid artery Doppler ultrasound blood flow measurement during chest compression cardiopulmonary resuscitation].

OBJECTIVE: To determine the feasibility of ultrasound to measure blood flow on patients with chest compression cardiopulmonary resuscitation (CPR), and to find out a real-time, noninvasive hemodynamic evaluation method. METHODS: A prospective study was conducted. All adult patients undergoing CPR admitted to Department of Emergency and intensive care unit (ICU) of Zhengzhou People's Hospital from May 2016 to November 2018 were enrolled. The blood flow over the right carotid arteries during chest compressions was recorded with a bedside ultrasound machine. The peak systolic flow velocity (PSV) and end diastolic flow velocity (EDV) of carotid artery were recorded at 1 minute after the start of CPR and 1 minute before the end of CPR. The mean compression frequency during the whole recovery period was recorded, the rate of compression reaching the standard was evaluated by ultrasound (the rate of compression 100-120 times/min was defined as up to standard), and the interruption time of compression was calculated retrospectively according to the ultrasound image data recorded during CPR. RESULTS: Thirty-nine patients were enrolled, and 21 patients were successfully rescued, with a successful rate of 53.8%, the time of restoration of spontaneous circulation (ROSC) was (10.9±5.3) minutes. The time from CPR to retrieve an ultrasound image was 1.1-4.9 minutes, with an average of (2.5±1.2) minutes. Satisfactory ultra-sonographic images were obtained in 28 patients during the whole course of chest compression. The acquisition rate was 71.8% (28/39). In the process of compression, if the frequency of compression was less than 100 times/min or the velocity of carotid artery dropped (PSV < 30 cm/s), the chest compressors should be reminded and corrected in time. The PSV at 1 minute after CPR start of 28 patients with satisfactory ultrasound images was (62.9±18.5) cm/s, and the EDV was (13.9±3.5) cm/s, the PSV at 1 minute before the end of CPR was (55.4±18.4) cm/s, and the EDV was (12.9±3.7) cm/s. There was no significant difference in above parameters between the two time points (both P > 0.05), suggesting that satisfactory resuscitation effect was achieved in the whole process of CPR. The compression frequency of 28 patients was 100-149 times/min with an average of (117±47) times/min. The rate of compression with standard was 85.7% (24/28), and the total interruption time of compression accounted for 4.4% of all compression time (25.9 minutes/587.2 minutes). CONCLUSIONS: Ultrasound measurement of common carotid artery blood flow during CPR has the advantage of real-time and non-invasive, and it is feasible in clinical work.

SOFA Score Can Effectively Predict the Incidence of Sepsis and 30-Day Mortality in Liver Transplant Patients: A Retrospective Study.

INTRODUCTION: This study aims to evaluate the early predictive value for postoperative sepsis and 30-day mortality in liver transplant patients using sequential organ failure assessment (SOFA). METHODS: A total of 96 liver transplant patients were enrolled into this study from February 2015 to June 2018. The general information, biochemical findings, and postoperative 30-day mortality of these patients were statistically analyzed. RESULTS: The SOFA scores, C-reactive protein (CRP), and procalcitonin (PCT) at postoperative day (POD) 3, 5, and 7 were significantly higher in the sepsis group than in the non-sepsis group, and the differences were statistically significant. Receiver operating characteristic (ROC) curve showed that SOFA scores at POD 1, 3, 5, and 7 had higher sensitivity and specificity in predicting the incidence of sepsis within 30 days. The difference in 30-day survival rate between patients with SOFA scores of > 5 and patients with SOFA scores of ≤ 5 at POD 1-7 was statistically significant (P < 0.05). CONCLUSION: SOFA scores at POD 1-7 can effectively predict the incidence of sepsis and 30-day mortality in liver transplant patients on the basis of CRP and PCT.

[Comparison of neurologic outcome between active abdominal compression-decompression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation in asphyxia cardiac arrest].

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). CONCLUSIONS: After suffering asphyxia CA, patients who accepted AACD-CPR had better neurologic outcome than STD-CPR.