Determination of Traditional Chinese Medicine Syndrome of Rat Model of Follicular Dysplasia Induced by Tripterygium Glycosides Based on Prescriptions via AMPK/mTOR/HIF-1/VEGF Pathway / 中国实验方剂学杂志

ObjectiveTo determine the syndrome of a rat model of follicular dysplasia induced by Tripterygium glycosides based on prescriptions and investigate the mechanism of traditional Chinese medicine intervention via the adenosine monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin （mTOR）/hypoxia-inducible factor-1 （HIF-1）/vascular endothelial growth factor （VEGF） pathway. MethodForty-eight rats with regular estrous cycles were randomly assigned into a normal group （n=8） and a modeling group （n=40）. The rats in the modeling group were administrated with Tripterygium glycoside suspension （75 mL·kg-1） by gavage for 30 days. The modeled rats were assigned into model， Siwutang （3.69 g·kg-1）， Youguiyin （3.11 g·kg-1）， Zuoguiyin （7.29 g·kg-1）， and Guishenwan （10.35 g·kg-1） groups， with 8 rats in each group. The drug intervention lasted for 14 days. The changes of estrous cycle were detected by Pap staining， and a stereoscope was used to observe the morphology of the ovarian tissue. Hematoxylin-eosin staining was employed to observe the pathological changes and follicle count in the ovarian tissue. Enzyme-related immunosorbent assay （ELISA） was used to measure the levels of follicle-stimulating hormone （FSH）， luteinizing hormone （LH）， and estradiol （E2） in the serum. Real-time fluorescence quantitative polymerase chain reaction and Western blot were employed to determine the mRNA and protein levels， respectively， of AMPK， mTOR， HIF-1， and VEGF in the ovarian tissue. ResultCompared with the normal group， the model group had a disordered estrous cycle， reduced secondary and mature follicles， increased atretic follicles， elevated FSH and LH levels， lowered E2 level， up-regulated mRNA and protein levels of AMPK， and down-regulated mRNA and protein levels of mTOR， HIF-1， and VEGF （P<0.01）. Compared with the model group， Guishenwan increased secondary and mature follicles， decreased atretic follicles， lowered the FSH and LH levels， elevated the E2 level， down-regulated the mRNA and protein levels of AMPK， and up-regulated the mRNA and protein levels of mTOR， HIF-1， and VEGF （P<0.01）. Compared with Guishenwan group， Siwutang， Youguiyin， and Zuoguiyin decreased mature follicles， increased atretic follicles （P<0.01）， elevated the LH （P<0.01） and FSH （P<0.05） levels， and lowered the E2 level （P<0.05）. In addition， Youguiyin up-regulated the protein level of AMPK （P<0.05） and down-regulated the mRNA levels of mTOR and HIF-1 （P<0.01） as well as the mRNA and protein levels of VEGF （P<0.01）. Siwutang down-regulated the mRNA levels of mTOR and HIF-1 as well as the mRNA and protein levels of VEGF （P<0.05）. Zuoguiyin down-regulated the mRNA level of mTOR and the protein and mRNA levels of VEGF （P<0.05）. ConclusionGuishenwan may improve the ovarian function and promote follicle maturation in a rat model of follicular dysplasia by inhibiting the AMPK/mTOR/HIF-1/VEGF pathway， with the therapeutic effect superior to Zuoguiyin， Youguiyin， and Siwutang. It was hypothesized that this model presented the syndrome of kidney-essence deficiency.

Comparison of Direct and Extraction Immunoassay Methods With Liquid Chromatography-Tandem Mass Spectrometry Measurement of Urinary Free Cortisol for the Diagnosis of Cushing’s Syndrome

Background@#Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS. @*Methods@#Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis. @*Results@#Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively. @*Conclusions@#Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.

Impact of half-dose 18F-FDG on the image quality of total-body PET/CT in infants and toddlers / 中华核医学与分子影像杂志

Objective:To explore the impact of half-dose 18F-FDG on the image quality in infants and toddlers undergoing total-body PET/CT. Methods:From January 2021 to August 2023, 59 infants and toddlers undergoing total-body 18F-FDG PET/CT scans at Sun Yat-Sen University Cancer Center were retrospectively enrolled. Of these, 21 patients (11 males, 10 females; age: 22.0(7.5, 34.5) months) were given a full dose of 18F-FDG (3.70 MBq/kg), and the other 38 patients (24 males, 14 females; age: 20.0(9.3, 33.3) months) received half dosage (1.85 MBq/kg) both with 10-minute scans. The differences of image quality scores and quantitative parameters including SUV, standard deviation (SD) of SUV, signal-to-noise ratio (SNR), and the normalized SNR for administered activity and scan time (SNR norm) were compared between the two groups by Mann-Whitney U test. The correlations between age, body weight and image quality were analyzed by Spearman rank correlation analysis. Results:The injected dosage of 18F-FDG for the full-dose group was 46.99(27.75, 50.42) MBq, while for the half-dose group was 21.83(18.13, 28.86) MBq. Compared to the full-dose group, the half-dose group had higher SD in the mediastinal blood pool (0.04(0.03, 0.05) vs 0.05(0.04, 0.08); z=-2.32, P=0.021). No statistically significant differences were observed between the two groups in terms of other SUV parameters ( z values: from -1.92 to -0.48, all P>0.05). In terms of image quality, the liver SNR of full-dose group was 29.5(25.3, 39.9), while that of half-dose group was 25.8(22.0, 30.4), with no significant difference ( z=1.66, P=0.096). The SNR values of mediastinal blood pool showed the same comparing result (20.0(11.4, 31.0) vs 19.0(11.4, 31.0); z=0.02, P=0.981). The correlation analysis revealed that SNR norm decreased with increasing age and body weight ( rs values: -0.704, -0.647, both P<0.001). Conclusions:In infants and toddlers, half-dose 18F-FDG total-body PET/CT with 10-minute scan can still achieve good performance. There is an observed decline in image quality with increasing age and body weight.

Neotuberostemonine and tuberostemonine ameliorate pulmonary fibrosis through suppressing TGF-β and SDF-1 secreted by macrophages and fibroblasts via the PI3K-dependent AKT and ERK pathways / 中国天然药物

Activated fibroblasts and M2-polarized macrophages may contribute to the progression of pulmonary fibrosis by forming a positive feedback loop. This study was aimed to investigate whether fibroblasts and macrophages form this loop by secreting SDF-1 and TGF-β and the impacts of neotuberostemonine (NTS) and tuberostemonine (TS). Mice were intratracheally injected with 3 U·kg-1 bleomycin and orally administered with 30 mg·kg-1 NTS or TS. Primary pulmonary fibroblasts (PFBs) and MH-S cells (alveolar macrophages) were used in vitro. The animal experiments showed that NTS and TS improved fibrosis related indicators, inhibited fibroblast activation and macrophage M2 polarization, and reduced the levels of TGF-β and SDF-1 in alveolar lavage fluid. Cell experiments showed that TGF-β1 may activated fibroblasts into myofibroblasts secreting SDF-1 by activating the PI3K/AKT/HIF-1α and PI3K/PAK/RAF/ERK/HIF-1α pathways. It was also found for the first time that SDF-1 was able to directly polarize macrophages into M2 phenotype secreting TGF-β through the same pathways as mentioned above. Moreover, the results of the cell coculture confirmed that fibroblasts and macrophages actually developed a feedback loop to promote fibrosis, and the secretion of TGF-β and SDF-1 was crucial for maintaining this loop. NTS and TS may disturb this loop through inhibiting both the PI3K/AKT/HIF-1α and PI3K/PAK/RAF/ERK/HIF-1α pathways to improve pulmonary fibrosis. NTS and TS are stereoisomeric alkaloids with pyrrole[1,2-a]azapine skeleton, and their effect on improving pulmonary fibrosis may be largely attributed to their parent nucleus. Moreover, this study found that inhibition of both the AKT and ERK pathways is essential for maximizing the improvement of pulmonary fibrosis.

Mycoplasmahominis meningitis in an extremely preterm infant: a case report and literature review / 中华围产医学杂志

Objective:To summarize the clinical characteristics, diagnosis, treatment, and prognosis of neonatal meningitis caused by Mycoplasma hominis. Methods:We present the clinical data, diagnosis and treatment of a premature infant with Mycoplasma hominis meningitis who was admitted to the Department of Neonatology, the Second Affiliated Hospital of Wenzhou Medical University in June 2020. Relevant literature up to May 2021 was retrieved with the strategy of "( Mycoplasma hominis) AND (meningitis OR central nervous system OR cerebrospinal fluid) AND (newborn)" from CNKI, Wanfang, and PubMed database. The clinical manifestations, examinations, diagnosis, treatments and prognosis of cases with complete clinical data were summarized using two-sample rank sum test. Results:A premature female infant at gestational age of 27 +4 weeks presented with repeated low-grade fever and apnea since the 7 days of life. Cerebrospinal fluid testing in a local hospital showed neutrophil-based leukocytosis, which indicated purulent meningitis. However, empiric antibiotic treatment did not improve the infant's condition. The patient was transferred to our hospital due to dyspnea for 32 days and repeated fever for 25 days. Mycoplasma hominis was detected from the cerebrospinal fluid samples using metagenomic next generation sequencing (NGS). Treatment with erythromycin was ineffective, but the patient improved and discharged after changing to chloramphenicol for 18 d without any side effects. A total of 21 English articles were retrieved, and no Chinese literature was retrieved, involving 22 infants. Of the 23 cases including the present case, 14 were preterm, eight were term and one with no available data; 19 were born by vaginal delivery; the median age of onset was 11.0 d ( P25- P75: 7.0-18.0 d). The initial symptoms included fever, convulsions, irritability, and apnea. Blood routine examination showed elevated white blood cell count in ten cases and elevated C-reactive protein in seven cases. In the cerebrospinal fluid testing, white blood cell count increased in 19 cases, protein increased in 20 cases, and glucose decreased in 13 cases. Eight cases were confirmed by 16S RNA polymerase chain reaction amplification technology, seven by serum antibodies test, two cases by culture and microscopic findings, two cases by culture alone, one case by Mycoplasma kit, and one by NGS. The main treatment was the administration of tetracyclines, quinolones, chloramphenicol, lincosamides, etc. (alone or in combination). Two cases improved without using special anti- Mycoplasma drugs. Of the 23 patients, 15 had hydrocephalus, eight had intracranial hemorrhage, four had cerebral ischemic infarction, and two had cerebral abscess. Four cases had good prognosis,16 cases had adverse prognosis, and other three without available data. The median time to start sensitive antibiotic therapy in children with good prognosis was 4.5 d(3.6-5.0 d) after diagnosis, which was earlier than that in children with adverse prognosis [16.8 d (7.0-25.0 d)]( Z=－2.27, P=0.023). Conclusions:Mycoplasma hominis infection has non-specific clinical manifestations and should be considered for infants with intracranial infection that is not responding to empirical antibiotic treatment. NGS is helpful in detecting Mycoplasma hominis and chloramphenicol can be an option for the treatment.

Clinical analysis of 33 cases with purulent meningitis complicated with hydrocephalus in neonates / 中华传染病杂志

Objective:To study the clinical characteristics of purulent meningitis complicated with hydrocephalus in neonates, and to analyze the risk factors of the disease.Methods:Neonates diagnosed with purulent meningitis complicated with hydrocephalus who hospitalized in the department of neonatology of the Second Affiliated Hospital of Wenzhou Medical University from January 2002 to August 2021 were selected as the case group. Neonates with positive pathogen cultures but no hydrocephalus during the same period were assigned by random number table method as the control group. The ratio of the control group and the case group was 2 ∶1. The clinical data such as bacteria distribution, cranial imaging, therapy and prognosis were compared between the two groups. The risk factors for hydrocephalus were predicted. Statistical analysis was conducted using chi-square test and multiple logistic regression analysis.Results:There were 33 cases in the case group and 66 cases in the control group. A total of 27 cases had confirmed pathogen results, of which 20 cases (74.1%) were Gram-negative bacteria and seven cases (25.9%) were Gram-positive bacteria. The time of diagnosis for hydrocephalus were 13.0(5.5, 28.5) days after the onset. Twenty-six cases received non-surgical treatment, while seven cases received surgery. The cure rate of case group was 42.4%(14/33), which was lower than that of control group (72.7%, 48/66), and the difference was statistically significant ( χ2=8.63, P=0.003). Univariate analysis showed that the incidences of protein>3 g/L in cerebrospinal fluid, glucose<2 mmol/L in cerebrospinal fluid, convulsions, central respiratory failure, intracranial hemorrhage and encephalomalacia in the case group were all higher than those in the control group, with statistical significance ( χ2=19.72, 12.04, 19.04, 5.73, 11.85 and 17.48, respectively, all P<0.050). Multivariate logistic regression analysis showed that convulsions (odds ratio ( OR)=4.476, 95% confidence interval ( CI) 1.091 to 18.363, P=0.037), intracranial hemorrhage ( OR=8.031, 95% CI 1.894 to 34.059, P=0.005) and encephalomalacia ( OR=35.189, 95% CI 2.954 to 419.150, P=0.005) were risk factors for neonatal purulent meningitis complicated with hydrocephalus. Conclusions:Gram-negative bacteria are common pathogen of neonatal purulent meningitis complicated with hydrocephalus. Convulsions, intracranial hemorrhage and encephalomalacia are important predictors for neonatal purulent meningitis complicated with hydrocephalus.

Reference Intervals for Thyroid-Associated Hormones and the Prevalence of Thyroid Diseases in the Chinese Population

Background@#Thyroid diseases are highly prevalent worldwide, but their diagnosis remains a challenge. We established reference intervals (RIs) for thyroid-associated hormones and evaluated the prevalence of thyroid diseases in China. @*Methods@#After excluding outliers based on the results of ultrasound screening, thyroid antibody tests, and the Tukey method, the medical records of 20,303 euthyroid adults, who visited the Department of Health Care at Peking Union Medical College Hospital from January 2014 to December 2018, were analyzed. Thyroid-associated hormones were measured by the Siemens Advia Centaur XP analyzer. The RIs for thyroid-associated hormones were calculated according to the CLSI C28-A3 guidelines, and were compared with the RIs provided by Siemens. The prevalence of thyroid diseases over the five years was evaluated and compared using the chi-square test. @*Results@#The RIs for thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), and total triiodothyronine (TT3) were 0.71–4.92 mIU/L, 12.2–20.1 pmol/L, 3.9–6.0 pmol/L, 65.6–135.1 nmol/L, and 1.2–2.2 nmol/L, respectively. The RIs of all hormones except TT4 differed significantly between males and females. The RIs of TSH increased with increasing age. The prevalence of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism was 0.5% and 0.8%, 0.2% and 0.6%, 3.8% and 6.1%, and 3.3% and 4.7% in males and females, respectively, which differed from those provided by Siemens. @*Conclusions@#Sex-specific RIs were established for thyroid-associated hormones, and the prevalence of thyroid diseases was determined in the Chinese population.

Follow-up testing of viral nucleic acid in discharged patients with moderate type of COVID-19 / 浙江大学学报·医学版

OBJECTIVE@#To investigate the clinical outcome of patients with moderate type of coronavirus disease 2019 (COVID-19) after discharge by retesting viral nucleic acid.@*METHODS@#Seven patients with moderate COVID-19 met the discharge criteria enacted by National Health Commission were quarantined in hospital for 7 days, then continuously quarantined at home for 4 weeks after discharged. During the quarantined period, the symptoms and signs were documented, and sputum or nasal swab and feces samples were collected to test SARS-CoV-2 nucleic acid by RT-PCR method.@*RESULTS@#There was no symptoms and signs during the quarantine period in all 7 patients. However, respiratory swabs from 3 patients were confirmed positive of SARS-CoV-2 nucleic acid at 5 to 7 days after they met the discharge criteria.@*CONCLUSIONS@#There is a relatively high incidence of positive viral nucleic acid in patients met the discharge criteria, and it is suggested that patients met the current discharge criteria should be quarantined in hospital for another 7 days and the follow-up viral testing is necessary.

Follow-up testing of viral nucleic acid in discharged patients with moderate type of 2019 coronavirus disease (COVID-19) / 浙江大学学报·医学版

OBJECTIVE@#To investigate the clinical outcome of patients with moderate type of corona virus disease 2019 (COVID-19) after discharge by retesting viral nucleic acid.@*METHODS@#Seven patients with moderate COVID-19 met the discharge criteria enacted by National Health Commission were quarantine in hospital for 7 days, then continuously quarantined at home for 4 weeks after discharged. During the three weeks of quarantined period, the symptoms and signs were documented; and sputum or nasal swab and feces samples were collected to test SARS-COV-2 nucleic acid by RT-PCR method.@*RESULTS@#There were no symptoms and signs during the quarantine period in all 7 patients. However, respiratory swabs from 3 patients were confirmed positive of SARS-COV-2 nucleic acid at 5 to 7 days after they met the discharge criteria.@*CONCLUSIONS@#The study indicates that there is a relatively high incidence of positive viral nucleic acid in patients met the discharge criteria, and it is suggested that patients met the current discharge criteria should be quarantined in hospital for another 7 days and the follow-up viral testing is necessary.

Pathogenic bacteria analysis of lower respiratory tract infection in patients after craniocerebral operation and nursing countermeasures / 中国中西医结合急救杂志

Objective To analyze the characteristics of lower respiratory tract infection occurring in patients after craniocerebral surgery in Intensive Care Unit (ICU) and explore its nursing countermeasures. Methods Sixty-eight patients with lower respiratory tract infection after craniocerebral surgery in the ICU of the First Affiliated Hospital of Wenzhou Medical University from January 2015 to March 2016 were selected as the study subjects. All patients were treated with dehydration to reduce intracranial pressure, hemostasis, anti-infection, anti-epilepsy, mild hypothermia, hypoglycemia and other symptomatic supportive treatments, and the corresponding nursing measures were given. The patients' primary diseases and etiological examination results were analyzed. Results Of the 68 patients complicated with lower respiratory tract infection after craniocerebral surgery, the majority of primary disease was craniocerebral injury, accounting for 45.59% (31/68). A total of 127 strains of pathogenic bacteria were isolated, mainly Gram-negative (G-) bacteria [92 strains (accounting for 72.44% )];followed by Gram-positive (G+) bacteria [19 strains (accounting for 14.96%)] and fungi [16 strains (accounting for 12.60%)]. The main pathogens of G- were Acinetobacter baumannii 21 strains (accounting for 23.14%), Klebsiella pneumoniae 13 strains (accounting for 14.94%), Burkholderia cepacia 10 strains (accounting for 11.49%), Pseudomonas aeruginosa 8 strains (accounting for 11.49%); the main pathogens of G+ was Staphylococcus aureus 6 strains (accounting for 5.89%). Conclusion The incidence of lower respiratory tract infection in ICU patients after craniocerebral surgery is high. It is necessary to prevent and control the related risk factors as soon as possible, and take energetic and effective nursing measures to reduce the incidence of lower respiratory tract infection.

Prognostic factors of multi-drug resistant organism infection in infected pancreatic necrosis patients / 中华外科杂志

Objective@#To investigate the prognostic factors of multi-drug resistant organism (MDRO) infection in patients with infected pancreatic necrosis(IPN).@*Methods@#A retrospective study was performed to assess the MDRO in IPN patients. The clinical data of 104 IPN patients admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from June 2013 to January 2019 were analyzed. Fifty-six patients were allocated in the MDRO group and 48 patients in the non-MDRO group depended on drug sensitivity test. There were 37 males and 19 females in the MDRO group with age of 40 (23) years. The duration time was 3(5) days between onset and admission. In the non-MDRO group, 34 males and 14 females were included with age of (42±14) years. The duration time was 3(4) days between onset and admission. Normally distributed quantitative variables was represented by ±s, non-normally distributed quantitative variables was represented by M(QR). Wilcoxon rank-sum test and χ2 test were used to analyze the data. Univariate and multivariable Logistic regression analytic model were used to figure out the risk factors associated with MDRO infection.@*Results@#The mean duration of hospital stay was 29.5(31.8) days and hospitalization expenses were CNY 166 991(270 692), which were much higher than those in non-MDRO group (16.5(15.7) days, CNY 56 789(62 354)) (W=1 889, 2 019, both P<0.01). Gram-negative isolates(67.2%, 80/119) were commonly detected in IPN patients.Acinetobacter baumannii was the most common MDRO(27.0%,20/74). Initial use of carbapenem(OR=2.22, 95%CI: 1.02-4.96, P=0.047) and open necrosectomy(OR=10.00, 95%CI: 3.14-44.77, P<0.01) were the potential risk factors for MDRO-induced infections in IPN. Furthermore, the Logistic regression analysis revealed that open necrosectomy was the independent variable for MDRO infections(OR=9.42, 95%CI: 2.92-42.42, P<0.01).@*Conclusion@#Open necrosectomy is the independent risk factor for the infection of MDRO.

The changes of content and proportion of main components in glycyrrhiza ura-lensis Fisch under different processing and extraction conditions / 药学实践杂志

Objective To explore the licorice herbs principal component isomer content and percentage change in differ-ent processing and extracting conditions.Methods RP-HPLC method were used with 18 beta glycyrrhizic acid(18β-Gly)and 18 alpha glycyrrhizic acid(18α-Gly)as the basis of evaluation,determination of main components and impurities of licorice pieces,effects of processing temperature and processing time on licorice pieces and standard mixture of principal components andimpuritiesthecontentof18-Glyand18α-Glyand18β-Glyratiochange.Results Duringtheprocessof Glycyrrhizauralen-sis Fisch,increasing the processing temperature and prolonging the processing time caused the decomposition of 18β-Gly and 18α-Gly,which was the main component isomer of licorice root,and the total content of licorice root was slightly decreased. During the processing,the main components did not change the conformation,and had no effect on the proportion of the two. The content of 18β-Gly and 18α-Gly content of glycyrrhizic acid in Glycyrrhiza uralensis Fisch after processing were lower than those before processing in 18β-Gly and 18α-Gly.Conclusion The processing time of licorice pieces could not be too long,the temperature could not be too high,so as to avoid excessive loss of active ingredients.Baking conditions suitable for baking tem-perature was 65 ℃,time was 1-2 h.The processing condition was convenient,the time and the temperature were controllable, and the sample quality was stable.

Profile and outcome of cardiopulmonary resuscitation after sudden cardiac arrests in the emergency department: a multicenter prospective observational study / 中华危重病急救医学

Objective To investigate the status of cardiopulmonary resuscitation (CPR) in patients with sudden cardiac arrest (CA) in the emergency department. Methods A multicenter prospective observational study was conducted. The patients with CA admitted to 13 hospitals from 6 provinces in four different regions, including North China, Southern China, East China, Southwest China, from July 1st, 2015 to July 31st, 2017 were enrolled. A modified Utstein template was applied to collect clinical data, including general data, CA related data and prognosis, and primary outcome indicator was the return of spontaneous circulation (ROSC) rate, and the secondary outcome indicator was 28-day survival rate. The influence factors of ROSC were screened by Logistic regression analysis. Results The data of 613 patients with CA in 13 hospitals were enrolled. The ROSC rate in Beijing and Guangdong Province was higher, but there was no significant difference in 28-day survival rate among hospitals from different provinces. ① In 613 patients with CA, there were 413 patients suffering from in-hospital cardiac arrest (IHCA, 67.4%), and 200 suffering from out-hospital cardiac arrest (OHCA, 32.6%). 208 patients had ROSC at least once (33.9%), only 20 patients survived within 28 days (3.3%). ROSC rate in IHCA patients was significantly higher than that in OHCA patients [37.3% (154/413) vs. 27.0% (54/200), P < 0.01]. There was no statistic difference in 28-day survival rate between patients with IHCA and OHCA. The patients received manual chest compression, electric defibrillation, or epinephrine ≤ 4 mg had higher ROSC rate, but 28-day survival rate showed no significant difference. Multivariate Logistic regression analysis showed that IHCA [odds ratio (OR) = 1.893, 95% confidence interval (95%CI) = 1.253-2.858, P = 0.002], manual chest compression (OR = 0.506, 95%CI = 0.348-0.736, P = 0.000), electric defibrillation (OR = 0.458, 95%CI = 0.300-0.699, P = 0.000), and total adrenalin ≤ 4 mg (OR = 0.317, 95%CI = 0.216-0.464, P = 0.000) were the protective factors of ROSC in CA patients. ② In 200 OHCA patients, there were 49 patients had ROSC (24.5%), only 5 patients survived (2.5%). The patients aging < 65 years, with witnesses of CPR, received manual chest compression, electric defibrillation, or epinephrine ≤ 4 mg had higher ROSC rate, and the ROSC rate was higher in ambulances than that at home and in public sites, but 28-day survival rate showed no significant difference. Multivariable Logistic regression analysis showed that age < 65 years old (OR = 2.749, 95%CI = 1.192-6.336, P = 0.018), manual chest compressions (OR = 0.196, 95%CI =0.072-0.535, P = 0.001), electric defibrillation (OR = 0.263, 95%CI = 0.108-0.641, P = 0.003), total adrenaline dose ≤4 mg (OR = 0.122, 95%CI = 0.049-0.303, P = 0.000) and the ambulance CA (OR = 2.441, 95%CI = 1.334-4.468, P = 0.004) were protective factors of ROSC in OHCA patients. Conclusions The survival of sudden CA in emergency department was still poor. Early electric defibrillation, manual chest compression, CA occurred in hospital or in ambulance, and witness CPR can improve the ROSC rate of CA patients. Excessive use of adrenaline is not beneficial to patients with CA. Clinical Trial Registration Clinical Trials, NCT01987245.

Rhythm analysis in CPR / 中华危重病急救医学

It's necessary to interrupt cardiopulmonary resuscitation (CPR) for a reliable automatic external defibrillator (AED) rhythm analysis, because the mechanical activity from the chest compressions introduces artifacts in the electrocardiogram (ECG) that substantially lower the capacity of an AED to judge cardio-electric rhythm. However, repeated interruptions of compression will reduce the quality of CPR, which in turn affect the prognosis of patients with cardiac arrest (CA). In order to improve the quality of CPR, reduce the interruptions of chest compression and implement accurate defibrillation, people have made many efforts on identifying ECG rhythm in CPR. The studies can be grouped into two broad categories: those based on the artificial mixture of ECG data and CPR artifacts and those based on CA data recorded during CPR. This article introduced researches for rhythm recognition in CPR, including sources and characteristics of CPR artifacts, methods of rhythm analysis, and provided a basis for the study of how to improve the accuracy of cardio-electric rhythm recognition.

Rhythm analysis in CPR / 中华危重病急救医学

It's necessary to interrupt cardiopulmonary resuscitation (CPR) for a reliable automatic external defibrillator (AED) rhythm analysis, because the mechanical activity from the chest compressions introduces artifacts in the electrocardiogram (ECG) that substantially lower the capacity of an AED to judge cardio-electric rhythm. However, repeated interruptions of compression will reduce the quality of CPR, which in turn affect the prognosis of patients with cardiac arrest (CA). In order to improve the quality of CPR, reduce the interruptions of chest compression and implement accurate defibrillation, people have made many efforts on identifying ECG rhythm in CPR. The studies can be grouped into two broad categories: those based on the artificial mixture of ECG data and CPR artifacts and those based on CA data recorded during CPR. This article introduced researches for rhythm recognition in CPR, including sources and characteristics of CPR artifacts, methods of rhythm analysis, and provided a basis for the study of how to improve the accuracy of cardio-electric rhythm recognition.

Study on the role of NALP3 inflammasome in Porphyromonas gingivalis lipopolysaccharide induced RAW264.7 / 中华口腔医学杂志

Objective@#To illuminate the effect of NALP3 inflammasome on regulating the expression of cytokines of macrophages in periodontitis.@*Methods@#RAW264.7 cells were cultured and divided into three groups. The first group stayed normal as control, the second group was stimulated by 1 mg/L Porphyromonas gingivalis (Pg) lipopolysaccharide (LPS), the third group was pretreated with AC-YVAD-CMK (caspase-1 inhibitor) before stimulated with 1 mg/L Pg LPS. RAW264.7 cells pretreated with various concentrations (0, 5, 10, 25, 50, 75, 100, 200 μmol/L) of AC-YVAD-CMK for 2 h, and stimulated by 1 mg/L Pg LPS for 24 h in the third group. After that, cell survival rate were detected by cell counting kit-8. Every group cells gene transcription of NALP3 and interleukin-1β (IL-1β) were detected by quantitative real-time PCR (qPCR) after 6 h, protein expression of NALP3 and IL-1β were separately detected by Western blotting and enzyme linked immunosorbent assay (ELISA) after 24 h, respectively.@*Results@#It is observed that treatment with 5, 10, 25, 50, 75, 100, 200 μmol/L AC-YVAD-CMK did not significantly affect the viability of RAW264.7 cells. qPCR showed that mRNA expression of IL-1β level (1.03±0.08, 5.48±0.22, 4.31±0.20) and NALP3 level (0.96±0.05, 2.62±0.44, 1.73±0.09). Western blotting showed that protein expression of NALP3 level (1.00±0.10, 2.34±0.04, 1.64±0.04), ELISA showed protein secretion of IL-1β level ([40.20±0.25], [61.50±1.81], [52.40±1.91] ng/L). After stimulated by Pg LPS, mRNA and protein expression of IL-1β (P<0.01, P<0.01) and NALP3 (P<0.01, P<0.01) significantly increased; but the expression of IL-1β (P=0.002, P=0.027) and NALP3 (P<0.01, P<0.01) were decreased when pretreated with AC-YVAD-CMK.@*Conclusions@#NALP3 inflammasome signal pathway can be activated by Pg LPS in RAW264.7. Block of the pathway can inhibit Pg LPS-induced secretion of cytokines.

Value of 18 F-FDG PET/CT for prognosis evaluation in small cell lung cancer with normal serum lac-tate dehydrogenase / 中华核医学与分子影像杂志

Objective To evaluate the value of 18 F-FDG PET/CT imaging in predicting the progno-sis of newly diagnosed SCLC with normal serum LDH ( SCLC-nsLDH) . Methods A total of 68 SCLC pa-tients (59 males, 9 females, median age:58.5 years) proved by pathology between June 2005 and Decem-ber 2016 were retrospectively analyzed. All patients underwent 18 F-FDG PET/CT. The general information of patients, including LDH, NSE, OS, PFS and SUVmax , were recorded. SUVmax differences were analyzed with Mann-Whitney u test. Life-table method and Kaplan-Meier analysis were used to estimate the survival rate and median survival time. The survival function curve was drawn. Log-rank test was used to analyze whether there existed statistical differences in survival period among different groups. Cox regression analysis was used for screening the influencing factors of prognosis. Results ( 1) In 68 SCLC patients, there were 38 cases with limited disease ( LD) and 30 cases with extensive disease ( ED) . There were 3 cases in stageⅠ, 7 cases in stage Ⅱ, 29 cases in stage Ⅲ, 29 cases in stage Ⅳ. The median SUVmax of the primary tumor was 11.35 (9.90, 13.90). There was no significant difference between the median SUVmax of LD group and that of ED group:11.05(9.72, 13.60) vs 12.25(10. 05, 14.12)months;z=-0.797, P=0.426. The median serum LDH was 195.15(171.00, 220.80) U/L. (2) The median follow-up time was 18(range:2-101) months. The disease developed in 46 patients and 35 patients died. The median OS was 23 (95%CI:13.3-32.7) months and median PFS was 17 (95% CI: 11.4-22.6) months. (3) ROC curve showed the optimal SUVmax cutoff value was 10.85. The OS of patients with SUVmax≤10.85 ( n=25) and with SUVmax>10.85 (n=43) were 40.0(95% CI:2.5-77.5) months and 18.0(95% CI:13.3-22.7) months(χ2=8.956, P=0.003), respectively. (4)Weight loss, VALG stage and primary tumor SUVmax were independent prog-nostic factors for OS (all P<0.05). Only VALG stage was an independent prognostic factor for PFS (P<0. 001) . Conclusion 18 F-FDG PET/CT can help to differentiate the different prognosis of SCLC-nsLDH patients, and provide more evidence for the choice of individual treatment strategy.

Value of 18 F-FDG PET/CT for prognosis evaluation in small cell lung cancer with normal serum lac-tate dehydrogenase / 中华核医学与分子影像杂志

Objective To evaluate the value of 18 F-FDG PET/CT imaging in predicting the progno-sis of newly diagnosed SCLC with normal serum LDH ( SCLC-nsLDH) . Methods A total of 68 SCLC pa-tients (59 males, 9 females, median age:58.5 years) proved by pathology between June 2005 and Decem-ber 2016 were retrospectively analyzed. All patients underwent 18 F-FDG PET/CT. The general information of patients, including LDH, NSE, OS, PFS and SUVmax , were recorded. SUVmax differences were analyzed with Mann-Whitney u test. Life-table method and Kaplan-Meier analysis were used to estimate the survival rate and median survival time. The survival function curve was drawn. Log-rank test was used to analyze whether there existed statistical differences in survival period among different groups. Cox regression analysis was used for screening the influencing factors of prognosis. Results ( 1) In 68 SCLC patients, there were 38 cases with limited disease ( LD) and 30 cases with extensive disease ( ED) . There were 3 cases in stageⅠ, 7 cases in stage Ⅱ, 29 cases in stage Ⅲ, 29 cases in stage Ⅳ. The median SUVmax of the primary tumor was 11.35 (9.90, 13.90). There was no significant difference between the median SUVmax of LD group and that of ED group:11.05(9.72, 13.60) vs 12.25(10. 05, 14.12)months;z=-0.797, P=0.426. The median serum LDH was 195.15(171.00, 220.80) U/L. (2) The median follow-up time was 18(range:2-101) months. The disease developed in 46 patients and 35 patients died. The median OS was 23 (95%CI:13.3-32.7) months and median PFS was 17 (95% CI: 11.4-22.6) months. (3) ROC curve showed the optimal SUVmax cutoff value was 10.85. The OS of patients with SUVmax≤10.85 ( n=25) and with SUVmax>10.85 (n=43) were 40.0(95% CI:2.5-77.5) months and 18.0(95% CI:13.3-22.7) months(χ2=8.956, P=0.003), respectively. (4)Weight loss, VALG stage and primary tumor SUVmax were independent prog-nostic factors for OS (all P<0.05). Only VALG stage was an independent prognostic factor for PFS (P<0. 001) . Conclusion 18 F-FDG PET/CT can help to differentiate the different prognosis of SCLC-nsLDH patients, and provide more evidence for the choice of individual treatment strategy.

Value of 18F-FDG PET/CT with Volume Metabolic Parameters for Prognosis Evaluation in Limited-Disease Small Cell Lung Cancer / 中山大学学报(医学科学版)

[Objective]To investigate the prognostic value of 18F-FDG PET/CT with different metabolic parameters in newly diagnosed limited-disease(LD)small cell lung cancer(SCLC).[Methods]Retrospective analysis was carried out in the patients between June 2005 to December 2016 in our hospital confirmed of LD SCLC by pathology or cytology and comprehensive imaging. Fifty-four patients were recruited. Record the general characteristics of patients,pre-treatment KPS score,smoking status,weight loss,serum LDH,NSE,OS,PFS. All lesions(primary lesions + metastases)were sketched out within one VOI,and the SUVmax, SUVmean and SUVpeak in the VOI were automatically measured and recorded. The automatic measurement was performed by the fixed threshold method. The thresholds of tumor of MTV and TLG were 40% and 50% of SUVmax. The TLG and MTV were identified as TLG40%,TLG50%,MTV40% and MTV50% respectively. Kaplan-Meier method was used for survival analysis. All the prognostic factors were analyzed by Cox model.[Result]The median SUVmax was 13.92(2.61~43.28),the median of SUVmean was 8.31(1.71~26.85) and the median of SUVpeak was 10.51(1.49 ~ 27.48). The median of TLG40% was 340.22(16.58 ~ 2827.26),the median of TLG50%was 215.645(1.70 ~ 2270.36),the median of MTV40% was 36.71(1.15 ~ 259.47 cm3),the median of MTV50% was 19.65(0.93 ~1900.00)cm3. Univariate and multivariate analysis of metabolic index and prognosis showed that TLG50% was the prognostic factor of OS(P = 0.013),but not of PFS(P > 0.05). The SUVmax,SUVmean and SUVpeak were not the prognostic factors of OS and PFS(P >0.05).[Conclusion]The volume metabolic parameters TLG50%was the independent prognostic factor of the overall survival time of the LD SCLC. The volume metabolic parameters (TLG and MTV) of 18F-FDG PET/CT were related to the prognosis of SCLC ,which could provide the basis for individual chemotherapy.