BACKGROUND:Acute pulmonary embolism(APE)with cardiac arrest(CA)is characterized by high mortality in emergency due to pulmonary arterial hypertension(PAH).This study aims to determine whether early pulmonary artery re...BACKGROUND:Acute pulmonary embolism(APE)with cardiac arrest(CA)is characterized by high mortality in emergency due to pulmonary arterial hypertension(PAH).This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme(ACE)2-angiotensin(Ang)(1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor(AT1)axis(ACE2/ACE axes)ratio on pulmonary artery lesion after return of spontaneous circulation(ROSC).METHODS:To establish a porcine massive APE with CA model,autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg(1 mmHg=0.133 kPa).Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation.Pigs were divided into four groups of five pigs each:control group,APE-CA group,ROSC-saline group,and ROSC-captopril group,to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril.RESULTS:Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells.Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor(VEGF)in the APE-CA group compared with the control group.Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC.Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax)ratio and decreasing cleaved caspase-3 expression.CONCLUSION:Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.展开更多
BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsi...BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsis and 20 age-matched healthy controls were enrolled in the study.Patients with sepsis were further subdivided into a sepsis group and a septic shock group.nCD64 expression,serum procalcitonin(PCT)level,C-reactive protein(CRP)level,and white blood cell(WBC)count were obtained for each patient,and Sequential Organ Failure Assessment(SOFA)scores were calculated.RESULTS:nCD64 expression was higher in the sepsis group with confirmed infection than in the control group.The receiver operating characteristic(ROC)curve of nCD64 was higher than those of SOFA score,PCT,CRP and WBC for diagnosing infection.The area under the curve(AUC)of nCD64 combined with SOFA score was the highest for all parameters.The AUC of nCD64 for predicting 28-day mortality in sepsis was signifi cantly higher than those of PCT,CRP,and WBC,but slightly lower than that of SOFA score.The AUC of nCD64 or PCT combined with SOFA score was signifi cantly higher than that of any single parameter for predicting 28-day mortality.CONCLUSION:nCD64 expression and SOFA score are valuable parameters for early diagnosis of infection and prognostic evaluation of sepsis patients.展开更多
Zn-air batteries with high energy density and safety have acquired enormous attention,while the practical application is hindered by the sluggish kinetics of the oxygen evolution reaction(OER)and the oxygen reduction ...Zn-air batteries with high energy density and safety have acquired enormous attention,while the practical application is hindered by the sluggish kinetics of the oxygen evolution reaction(OER)and the oxygen reduction reaction(ORR).In this work,a threedimensional(3D)defect-rich bifunctional electrocatalyst(CoFe/N CNFs)comprising irregular hollow CoFe nanospheres in Ndoped carbon nanofibers is presented,which is fabricated from CoFe ZIFs-derived(ZIF:zeolitic-imidazolate framework)polymer nanofibers precursor.The CoFe ZIFs with tunable particle size and composition are constructed using a confined synthesis strategy.Moreover,the Kirkendall diffusion process is available for forming the irregular hollow CoFe nanospheres,and the decomposition of polyvinylpyrrolidone(PVP)results in forming the defective carbon nanofibers,which provide more efficient active sites and enhance the electrocatalytic properties toward both OER and ORR.The optimized CoFe/N CNFs exhibit superior bifunctional activities,outperforming that of the benchmark Pt/C+RuO_(2) catalyst.As a result,the CoFe/N CNFs as an air-cathode endow the rechargeable Zn-air battery with an excellent power density of 149 mW·cm^(−2),energy density of 875 Wh·kg^(−1),and cycling stability.This work provides a new strategy to develop bifunctional electrocatalysts with desired nanostructure and regulated performance toward energy applications.展开更多
Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with ou...Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with out-of-hospital cardiac arrest(OHCA)after return of spontaneous circulation(ROSC)by observing the changes in circulating CD14^(+)monocytes and the expression of human leukocyte antigen D–related(HLA-DR)and programmed cell death ligand 1(PD-L1)in CD14^(+)monocytes.Methods:Adult patients admitted to the emergency department of Beijing Chao-Yang Hospital after OHCA between January 2017 and March 2018 were included in this study.Thirty control subjects,10 patients with OHCA,and 37 patients with OHCA who received 72 hours of TTM therapy were enrolled.Peripheral blood samples of patients in the OHCA and TTM groups were collected on Days 1 and 3(D1 and D3)after ROSC and evaluated for HLA-DR and PD-L1 expression on CD14^(+)monocytes using flow cytometry.Results:Compared with control subjects,the percentage of circulating CD14^(+)monocytes,HLA-DR+/CD14^(+)monocyte ratios,and mean fluorescence intensity were significantly decreased in patients with OHCA.After ROSC,HLA-DR expression in CD14^(+)monocytes in the TTM group was lower than that in patients with OHCA.However,there were no significant differences in the percentage of PD-L1+/CD14^(+)monocytes or the mean fluorescence intensity between patients with OHCA and healthy volunteers.Conclusion:After ROSC,circulating CD14^(+)monocytes and HLA-DR+/CD14^(+)monocyte ratios decreased significantly in patients with OHCA.Human leukocyte antigen D–related expression in CD14^(+)monocytes was lower in patients treated with TTM.展开更多
With an annual incidence of 0.5 to 1.5/1000,cardiac arrest(CA)has emerged as a major global public health concern.[1]Although the American Heart Association(AHA)-International Liaison Committee on Resuscitation update...With an annual incidence of 0.5 to 1.5/1000,cardiac arrest(CA)has emerged as a major global public health concern.[1]Although the American Heart Association(AHA)-International Liaison Committee on Resuscitation updates the cardiopulmonary resuscitation(CPR)guidelines every 5 years,the survival rate and percentage of patients with good neurologic outcomes post-CA after hospital discharge have been relatively low.Therefore,the AHA 2010 CPR guidelines mention the treatment of post-cardiac arrest syndrome(PCAS)in the intensive care unit(ICU)as the fifth link in the CA survival chain.PCAS is a pathophysiological process that includes(1)brain injury,(2)myocardial dysfunction leading to hemodynamic instability,and(3)systemic ischemia/reperfusion response leading to lactate accumulation.[2]These key factors affect the survival and neurological prognosis of CA patients in the early stages.We assessed the effects of early hemodynamics,oxygen metabolism,and lactate dynamics during PCAS on a 28-day survival rate and neurological outcomes.展开更多
To the Editor:Regulatory T-cells(Tregs),a subset of CD4+T-cells,have the capacity to actively suppress immune responses and play a pivotal role in sepsis-induced immunosuppression.B-and T-lymphocyte attenuator(BTLA)is...To the Editor:Regulatory T-cells(Tregs),a subset of CD4+T-cells,have the capacity to actively suppress immune responses and play a pivotal role in sepsis-induced immunosuppression.B-and T-lymphocyte attenuator(BTLA)is a co-inhibitory receptor that is known to potently inhibit CD4+T-cell function and to block prosurvival signaling in CD4+T-cells.展开更多
Background： The success rate of resuscitation in cardiac arrest （CA） caused by pulmonary thromboembolism （PTE） is low. Furthermore, there are no large animal models that simulate clinical CA. The aim of this stud...Background： The success rate of resuscitation in cardiac arrest （CA） caused by pulmonary thromboembolism （PTE） is low. Furthermore, there are no large animal models that simulate clinical CA. The aim of this study was to establish a porcine CA model caused by PTE and to investigate the pathophysio[ogy of CA and postresuscitation. Methods： This model was induced in castrated male pigs （30 ± 2 kg; n = 21 ） by injecting thrombi （10-15 ml） via the left external jugular vein. Computed tomographic pulmonary angiography （CTPA） was performed at baseline, CA, and return of spontaneous circulation （ROSC）. After CTPA during CA, cardiopulmonary resuscitation （CPR） with thrombolysis （recombinant tissue plasminogen activator 50 mg） was initiated. Hemodynamic, respiratory, and blood gas data were monitored. Cardiac troponins T, cardiac troponin I, creatine kinase-MB, myoglobin, and brain natriuretic peptide （BNP） were measured by enzymeqinked immunosorbent assay. Data were compared between baseline and CA with paired-sample t-test and compared among different time points for survival animals with repeated measures analysis of variance. Results： Seventeen animals achieved CA after emboli injection, while four achieved CA after 5-8 ml more thrombi. Nine animals survived 6 h after CPR. CTPA showed obstruction of the pulmonary arteries. Mean aortic pressure data showed occurrence of CA caused by PTE （Z = -2.803, P = 0.002）. The maximal rate of mean increase of left ventricular pressure （dp/dtmax） was statistically decreased （t = 6,315, P = 0.000, variation coefficient = 0.25）, and end-tidal carbon dioxide partial pressure （PetCO2） decreased to the lowest value （t - 27.240, P = 0.000）. After ROSC （n = 9）, heart rate （HR） and mean right ventricular pressure （MRVP） remained different versus baseline until 2 h after ROSC （HR, P = 0.036; MRVP, P - 0.027）. Myoglobin was statistically increased from CA to 1 h after ROSC （P - 0.036, 0.026, 0,009, respectively）, and BNP was increased from 2 h to 6 h after ROSC （P 0.012, 0.014, 0.039, respectively）. Conclusions： We established a porcine model of CA caused by PTE. The dp/dtmax and PetCO2 may be important for the occurrence of CA, while MRVP may be more important in postresuscitation.展开更多
Background:Cardiac arrest(CA)is a terminal event that results in a range of pathophysiological changes in the body,most notably,systemic ischemia-reperfusion injury.The hypothalamic-pituitary-adrenal(HPA)axis is an im...Background:Cardiac arrest(CA)is a terminal event that results in a range of pathophysiological changes in the body,most notably,systemic ischemia-reperfusion injury.The hypothalamic-pituitary-adrenal(HPA)axis is an important neuroendocrine system that modulates adrenocortical hormone release.This study was designed to investigate the changes in HPA-related hormone levels after successful cardiopulmonary resuscitation(CPR)and to explore possible etiologies to provide a basis for relevant clinical research.Methods:We collected the clinical data of 96 patients with CA admitted to the Emergency Department of Beijing Chaoyang Hospital,Capital Medical University,between January 2016 and May 2017.Serum samples were collected 6,24,and 72 hours after restoring spontaneous circulation(ROSC).The data were compared with those of the healthy control group(n=50).An enzyme-linked immunosorbent assay(ELISA)was performed to measure copeptin,adrenocorticotropic hormone(ACTH),corticotropin-releasing hormone(CRH),and total cortisol.Demographic data were collected for both groups.For the CPR group,clinical data and the end-of-study cerebral performance category(CPC)were analyzed.Patients were followed up through day 28.Death or survival after day 28 was used as the study endpoint.Simple values were expressed as medians and quartiles or ratios(%)for statistical analysis.Continuous variables are expressed as mean±standard deviation.Categorical variables were expressed as frequencies and percentages.The mean values of normally distributed measurement data were analyzed using 1-way analysis of variance(ANOVA)for among-group comparisons and the least significant difference(LSD)test for between-group comparisons.SPSS v17(SPSS,Chicago,IL,USA)was used for statistical analysis,and P<0.05 was considered statistically significant.Results:No significant between-group differences were observed in terms of age or sex.The 28-day mortality rate in the CPR group was 71%.ACTH and CRH levels were significantly lower in the CPR group than in the healthy control group(P<0.001).Copeptin and cortisol levels 6 hours after ROSC were significantly higher in the CPR group than in the healthy control group(P<0.001).No significant changes in any indicator were observed over time(6,24,and 72 hours after ROSC)(P>0.05).The CPC score was 1–2(good cerebral performance group)in 13 patients,3–4(poor cerebral performance group)in 17 patients,and 5(brain death or clinical death)in 66 patients.Patients with significantly declining ACTH and CRH levels had higher CPC scores(P<0.05);however,no significant differences were found in other indicators(P>0.05).Conclusion:After post-CA ROSC,ischemia-reperfusion injury may cause brain damage and HPA axis damage and dysfunction,the severity of which is associated with CPC score.展开更多
Background:Study of lung function in survivor from cardiac arrest(CA)caused by pulmonary thromboembolism(PTE)was rare.The aim of this study was to investigate the variations ofpostresuscitation lung function after thr...Background:Study of lung function in survivor from cardiac arrest(CA)caused by pulmonary thromboembolism(PTE)was rare.The aim of this study was to investigate the variations ofpostresuscitation lung function after thrombolysis treatment in a CA porcine model caused by PTE.Methods:After 2 min of untreated CA,pigs of 10-12 weeks with a weight of 30±2 kg(n=24)were treated with recombinant human tissue plasminogen activator(50 mg).Cardiopulmonary resuscitation(CPR)and ventilation were initiated after drug administration.Pulmonary function and arterial blood gas parameters were measured at baseline,return of spontaneous circulation(ROSC)immediately,and 1 h,2 h,4 h,and 6 h after ROSC.Results:The dynamic lung compliance decreased significantly at ROSC immediately and 1 h after ROSC compared to baseline(21.86±2.00 vs.26.72±2.20 ml/mmHg and 20.38±1.31 vs.26.72±2.20 ml/mmHg,respectively;P〈0.05;1 mmHg=0.133 kPa).Compared with baseline,airway resistance increased significantly at ROSC immediately and 1 h after ROSC(P〈0.05).Respiratory index also increased after ROSC and showed significant differences among baseline,ROSC immediately,and 2 h after ROSC(P〈0.05).Oxygen delivery decreased at ROSC immediately compared to baseline(P〈0.05).The oxygenation index decreased significantly at any time after ROSC compared to baseline(P〈0.05).Extravascular lung water index and pulmonary vascular permeability index(PVP1)showed significant differences at ROSC immediately compared to baseline and 1 h after ROSC(P〈0.05);PVPI at ROSC inamediately was also different from 6 h after ROSC(P〈0.05).Ventilation/perfusion ratios increased after ROSC(P〈0.05).Histopathology showed fibrin effusion,bleeding in alveoli,and hemagglutinatiun in pulmonary artery.Conclusions:Lung function remains abnormal even after CPR with thrombolysis therapy;it is essential to continue anticoagulation and symptomatic treatment after ROSC.展开更多
According to the official website of China’s National Equities Exchange and Quotations,the Beijing Stock Exchange formally came into being on September 3.The Beijing bourse may provide a fundraising avenue with easie...According to the official website of China’s National Equities Exchange and Quotations,the Beijing Stock Exchange formally came into being on September 3.The Beijing bourse may provide a fundraising avenue with easier listing rules closer to home,stockbrokers said.展开更多
The cash amount that should be reserved for Chinese financial institutions,or the reserve requirement ratio(RRR),was lowered by 50 basis points starting July 15,excluding those that have already held the ratio at a lo...The cash amount that should be reserved for Chinese financial institutions,or the reserve requirement ratio(RRR),was lowered by 50 basis points starting July 15,excluding those that have already held the ratio at a low level of 5 percent. The measure,part of the financial sector's efforts to support the real economy,would release about 1 trillion yuan($154.24 billion) in long-term liquidity,the People's Bank of China(PBC),the central bank,said.展开更多
The State Council Information Office released a white paper on August 12 titled Moderate Prosperity in All Respects:Another Milestone Achieved in China’s Human Rights.Chiiia’s realization of moderate prosperity for ...The State Council Information Office released a white paper on August 12 titled Moderate Prosperity in All Respects:Another Milestone Achieved in China’s Human Rights.Chiiia’s realization of moderate prosperity for all serves as a solid foundation for human rights,according to the white paper.It represents the comprehensive progress made in China,and a new contnbution to the world’s human rights cause."China’s approach and experience have provided a distinctive path forward for human progress,"it says.The Chinese people completed a historic transformation over the past decades,moving from poverty to secure access to food and clothing,to a decent life,and finally to moderate prosperity,mirroring the true meaning of human rights.展开更多
基金supported by grants from the National Natural Science Foundation of China(81773931 and 81374004)the Beijing Municipal Administration of Hospitals’Youth Program(QML20170105)+1 种基金the Natural Science Foundation of Beijing Municipality(7173253)the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support“Yangfan”Project(ZYLX201802)。
文摘BACKGROUND:Acute pulmonary embolism(APE)with cardiac arrest(CA)is characterized by high mortality in emergency due to pulmonary arterial hypertension(PAH).This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme(ACE)2-angiotensin(Ang)(1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor(AT1)axis(ACE2/ACE axes)ratio on pulmonary artery lesion after return of spontaneous circulation(ROSC).METHODS:To establish a porcine massive APE with CA model,autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg(1 mmHg=0.133 kPa).Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation.Pigs were divided into four groups of five pigs each:control group,APE-CA group,ROSC-saline group,and ROSC-captopril group,to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril.RESULTS:Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells.Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor(VEGF)in the APE-CA group compared with the control group.Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC.Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax)ratio and decreasing cleaved caspase-3 expression.CONCLUSION:Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.
文摘BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsis and 20 age-matched healthy controls were enrolled in the study.Patients with sepsis were further subdivided into a sepsis group and a septic shock group.nCD64 expression,serum procalcitonin(PCT)level,C-reactive protein(CRP)level,and white blood cell(WBC)count were obtained for each patient,and Sequential Organ Failure Assessment(SOFA)scores were calculated.RESULTS:nCD64 expression was higher in the sepsis group with confirmed infection than in the control group.The receiver operating characteristic(ROC)curve of nCD64 was higher than those of SOFA score,PCT,CRP and WBC for diagnosing infection.The area under the curve(AUC)of nCD64 combined with SOFA score was the highest for all parameters.The AUC of nCD64 for predicting 28-day mortality in sepsis was signifi cantly higher than those of PCT,CRP,and WBC,but slightly lower than that of SOFA score.The AUC of nCD64 or PCT combined with SOFA score was signifi cantly higher than that of any single parameter for predicting 28-day mortality.CONCLUSION:nCD64 expression and SOFA score are valuable parameters for early diagnosis of infection and prognostic evaluation of sepsis patients.
基金supported by the National Natural Science Foundation of China(Nos.11902256 and 51573148)the Natural Science Basic Research Program of Shaanxi(No.2019JQ-479)+2 种基金the Key Research and Development Program of Shaanxi Province(No.2020ZDGY01-01)the Fundamental Research Funds for the Central Universities(No.D5000220202)the China Scholarship Council and thanks eceshi(www.eceshi.com)for the Raman analysis.
文摘Zn-air batteries with high energy density and safety have acquired enormous attention,while the practical application is hindered by the sluggish kinetics of the oxygen evolution reaction(OER)and the oxygen reduction reaction(ORR).In this work,a threedimensional(3D)defect-rich bifunctional electrocatalyst(CoFe/N CNFs)comprising irregular hollow CoFe nanospheres in Ndoped carbon nanofibers is presented,which is fabricated from CoFe ZIFs-derived(ZIF:zeolitic-imidazolate framework)polymer nanofibers precursor.The CoFe ZIFs with tunable particle size and composition are constructed using a confined synthesis strategy.Moreover,the Kirkendall diffusion process is available for forming the irregular hollow CoFe nanospheres,and the decomposition of polyvinylpyrrolidone(PVP)results in forming the defective carbon nanofibers,which provide more efficient active sites and enhance the electrocatalytic properties toward both OER and ORR.The optimized CoFe/N CNFs exhibit superior bifunctional activities,outperforming that of the benchmark Pt/C+RuO_(2) catalyst.As a result,the CoFe/N CNFs as an air-cathode endow the rechargeable Zn-air battery with an excellent power density of 149 mW·cm^(−2),energy density of 875 Wh·kg^(−1),and cycling stability.This work provides a new strategy to develop bifunctional electrocatalysts with desired nanostructure and regulated performance toward energy applications.
基金the National Natural Science Foundation of China(Grant No.81372025).
文摘Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with out-of-hospital cardiac arrest(OHCA)after return of spontaneous circulation(ROSC)by observing the changes in circulating CD14^(+)monocytes and the expression of human leukocyte antigen D–related(HLA-DR)and programmed cell death ligand 1(PD-L1)in CD14^(+)monocytes.Methods:Adult patients admitted to the emergency department of Beijing Chao-Yang Hospital after OHCA between January 2017 and March 2018 were included in this study.Thirty control subjects,10 patients with OHCA,and 37 patients with OHCA who received 72 hours of TTM therapy were enrolled.Peripheral blood samples of patients in the OHCA and TTM groups were collected on Days 1 and 3(D1 and D3)after ROSC and evaluated for HLA-DR and PD-L1 expression on CD14^(+)monocytes using flow cytometry.Results:Compared with control subjects,the percentage of circulating CD14^(+)monocytes,HLA-DR+/CD14^(+)monocyte ratios,and mean fluorescence intensity were significantly decreased in patients with OHCA.After ROSC,HLA-DR expression in CD14^(+)monocytes in the TTM group was lower than that in patients with OHCA.However,there were no significant differences in the percentage of PD-L1+/CD14^(+)monocytes or the mean fluorescence intensity between patients with OHCA and healthy volunteers.Conclusion:After ROSC,circulating CD14^(+)monocytes and HLA-DR+/CD14^(+)monocyte ratios decreased significantly in patients with OHCA.Human leukocyte antigen D–related expression in CD14^(+)monocytes was lower in patients treated with TTM.
文摘With an annual incidence of 0.5 to 1.5/1000,cardiac arrest(CA)has emerged as a major global public health concern.[1]Although the American Heart Association(AHA)-International Liaison Committee on Resuscitation updates the cardiopulmonary resuscitation(CPR)guidelines every 5 years,the survival rate and percentage of patients with good neurologic outcomes post-CA after hospital discharge have been relatively low.Therefore,the AHA 2010 CPR guidelines mention the treatment of post-cardiac arrest syndrome(PCAS)in the intensive care unit(ICU)as the fifth link in the CA survival chain.PCAS is a pathophysiological process that includes(1)brain injury,(2)myocardial dysfunction leading to hemodynamic instability,and(3)systemic ischemia/reperfusion response leading to lactate accumulation.[2]These key factors affect the survival and neurological prognosis of CA patients in the early stages.We assessed the effects of early hemodynamics,oxygen metabolism,and lactate dynamics during PCAS on a 28-day survival rate and neurological outcomes.
文摘To the Editor:Regulatory T-cells(Tregs),a subset of CD4+T-cells,have the capacity to actively suppress immune responses and play a pivotal role in sepsis-induced immunosuppression.B-and T-lymphocyte attenuator(BTLA)is a co-inhibitory receptor that is known to potently inhibit CD4+T-cell function and to block prosurvival signaling in CD4+T-cells.
基金grants from the National Natural Science Foundation of China，the 2015 Annual Special Cultivation and Development Project for Technology Innovation Base of Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation
文摘Background： The success rate of resuscitation in cardiac arrest （CA） caused by pulmonary thromboembolism （PTE） is low. Furthermore, there are no large animal models that simulate clinical CA. The aim of this study was to establish a porcine CA model caused by PTE and to investigate the pathophysio[ogy of CA and postresuscitation. Methods： This model was induced in castrated male pigs （30 ± 2 kg; n = 21 ） by injecting thrombi （10-15 ml） via the left external jugular vein. Computed tomographic pulmonary angiography （CTPA） was performed at baseline, CA, and return of spontaneous circulation （ROSC）. After CTPA during CA, cardiopulmonary resuscitation （CPR） with thrombolysis （recombinant tissue plasminogen activator 50 mg） was initiated. Hemodynamic, respiratory, and blood gas data were monitored. Cardiac troponins T, cardiac troponin I, creatine kinase-MB, myoglobin, and brain natriuretic peptide （BNP） were measured by enzymeqinked immunosorbent assay. Data were compared between baseline and CA with paired-sample t-test and compared among different time points for survival animals with repeated measures analysis of variance. Results： Seventeen animals achieved CA after emboli injection, while four achieved CA after 5-8 ml more thrombi. Nine animals survived 6 h after CPR. CTPA showed obstruction of the pulmonary arteries. Mean aortic pressure data showed occurrence of CA caused by PTE （Z = -2.803, P = 0.002）. The maximal rate of mean increase of left ventricular pressure （dp/dtmax） was statistically decreased （t = 6,315, P = 0.000, variation coefficient = 0.25）, and end-tidal carbon dioxide partial pressure （PetCO2） decreased to the lowest value （t - 27.240, P = 0.000）. After ROSC （n = 9）, heart rate （HR） and mean right ventricular pressure （MRVP） remained different versus baseline until 2 h after ROSC （HR, P = 0.036; MRVP, P - 0.027）. Myoglobin was statistically increased from CA to 1 h after ROSC （P - 0.036, 0.026, 0,009, respectively）, and BNP was increased from 2 h to 6 h after ROSC （P 0.012, 0.014, 0.039, respectively）. Conclusions： We established a porcine model of CA caused by PTE. The dp/dtmax and PetCO2 may be important for the occurrence of CA, while MRVP may be more important in postresuscitation.
基金supported by the National Natural Science Foundation of China(no.81372025).
文摘Background:Cardiac arrest(CA)is a terminal event that results in a range of pathophysiological changes in the body,most notably,systemic ischemia-reperfusion injury.The hypothalamic-pituitary-adrenal(HPA)axis is an important neuroendocrine system that modulates adrenocortical hormone release.This study was designed to investigate the changes in HPA-related hormone levels after successful cardiopulmonary resuscitation(CPR)and to explore possible etiologies to provide a basis for relevant clinical research.Methods:We collected the clinical data of 96 patients with CA admitted to the Emergency Department of Beijing Chaoyang Hospital,Capital Medical University,between January 2016 and May 2017.Serum samples were collected 6,24,and 72 hours after restoring spontaneous circulation(ROSC).The data were compared with those of the healthy control group(n=50).An enzyme-linked immunosorbent assay(ELISA)was performed to measure copeptin,adrenocorticotropic hormone(ACTH),corticotropin-releasing hormone(CRH),and total cortisol.Demographic data were collected for both groups.For the CPR group,clinical data and the end-of-study cerebral performance category(CPC)were analyzed.Patients were followed up through day 28.Death or survival after day 28 was used as the study endpoint.Simple values were expressed as medians and quartiles or ratios(%)for statistical analysis.Continuous variables are expressed as mean±standard deviation.Categorical variables were expressed as frequencies and percentages.The mean values of normally distributed measurement data were analyzed using 1-way analysis of variance(ANOVA)for among-group comparisons and the least significant difference(LSD)test for between-group comparisons.SPSS v17(SPSS,Chicago,IL,USA)was used for statistical analysis,and P<0.05 was considered statistically significant.Results:No significant between-group differences were observed in terms of age or sex.The 28-day mortality rate in the CPR group was 71%.ACTH and CRH levels were significantly lower in the CPR group than in the healthy control group(P<0.001).Copeptin and cortisol levels 6 hours after ROSC were significantly higher in the CPR group than in the healthy control group(P<0.001).No significant changes in any indicator were observed over time(6,24,and 72 hours after ROSC)(P>0.05).The CPC score was 1–2(good cerebral performance group)in 13 patients,3–4(poor cerebral performance group)in 17 patients,and 5(brain death or clinical death)in 66 patients.Patients with significantly declining ACTH and CRH levels had higher CPC scores(P<0.05);however,no significant differences were found in other indicators(P>0.05).Conclusion:After post-CA ROSC,ischemia-reperfusion injury may cause brain damage and HPA axis damage and dysfunction,the severity of which is associated with CPC score.
基金This work supported by grants from the National Natural Science Foundation of China(No.81372025)the 2015 Annual Special Cultivation and Development Project for Technology Innovation Base of Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation(No.Z 151100001615056).
文摘Background:Study of lung function in survivor from cardiac arrest(CA)caused by pulmonary thromboembolism(PTE)was rare.The aim of this study was to investigate the variations ofpostresuscitation lung function after thrombolysis treatment in a CA porcine model caused by PTE.Methods:After 2 min of untreated CA,pigs of 10-12 weeks with a weight of 30±2 kg(n=24)were treated with recombinant human tissue plasminogen activator(50 mg).Cardiopulmonary resuscitation(CPR)and ventilation were initiated after drug administration.Pulmonary function and arterial blood gas parameters were measured at baseline,return of spontaneous circulation(ROSC)immediately,and 1 h,2 h,4 h,and 6 h after ROSC.Results:The dynamic lung compliance decreased significantly at ROSC immediately and 1 h after ROSC compared to baseline(21.86±2.00 vs.26.72±2.20 ml/mmHg and 20.38±1.31 vs.26.72±2.20 ml/mmHg,respectively;P〈0.05;1 mmHg=0.133 kPa).Compared with baseline,airway resistance increased significantly at ROSC immediately and 1 h after ROSC(P〈0.05).Respiratory index also increased after ROSC and showed significant differences among baseline,ROSC immediately,and 2 h after ROSC(P〈0.05).Oxygen delivery decreased at ROSC immediately compared to baseline(P〈0.05).The oxygenation index decreased significantly at any time after ROSC compared to baseline(P〈0.05).Extravascular lung water index and pulmonary vascular permeability index(PVP1)showed significant differences at ROSC immediately compared to baseline and 1 h after ROSC(P〈0.05);PVPI at ROSC inamediately was also different from 6 h after ROSC(P〈0.05).Ventilation/perfusion ratios increased after ROSC(P〈0.05).Histopathology showed fibrin effusion,bleeding in alveoli,and hemagglutinatiun in pulmonary artery.Conclusions:Lung function remains abnormal even after CPR with thrombolysis therapy;it is essential to continue anticoagulation and symptomatic treatment after ROSC.
文摘According to the official website of China’s National Equities Exchange and Quotations,the Beijing Stock Exchange formally came into being on September 3.The Beijing bourse may provide a fundraising avenue with easier listing rules closer to home,stockbrokers said.
文摘The cash amount that should be reserved for Chinese financial institutions,or the reserve requirement ratio(RRR),was lowered by 50 basis points starting July 15,excluding those that have already held the ratio at a low level of 5 percent. The measure,part of the financial sector's efforts to support the real economy,would release about 1 trillion yuan($154.24 billion) in long-term liquidity,the People's Bank of China(PBC),the central bank,said.
文摘The State Council Information Office released a white paper on August 12 titled Moderate Prosperity in All Respects:Another Milestone Achieved in China’s Human Rights.Chiiia’s realization of moderate prosperity for all serves as a solid foundation for human rights,according to the white paper.It represents the comprehensive progress made in China,and a new contnbution to the world’s human rights cause."China’s approach and experience have provided a distinctive path forward for human progress,"it says.The Chinese people completed a historic transformation over the past decades,moving from poverty to secure access to food and clothing,to a decent life,and finally to moderate prosperity,mirroring the true meaning of human rights.
