Objective To establish a stabile normal model of cardiac arrest (CA) by programmed electrical stimulation(PES). Method Eighteen healthy domestic swine were anesthesiased with propofol. Ventrieular fibril-lation (VF) was induced by PES through right ventricle after tracheal intubation. The PES mode is S1S2 (300/200 ms), 40 V, and-10 ms step length. Results VF was successfully induced in 16 of eighteen swine with the method of PES. The extent of coupling interval of S1S2 was between 110 and 190 ms (168±23) ms. VF occurred in 2 swines when S1S1 (350 ms) stimulus was used to decide if the electrede was placed in right ventricle. All the swine were successfully defibrillated after 3 minutes of untreated VF. Conclusions This swine model of VF is easy to repeat and orerase, and has little injury on the heart. Therefore PES is a good method to make animal car-diac arrest model.

Objective To investigate the therapeutic effects of injectio xuebijing (Chinese herb prepara-tions) on coagulat factors in dogs with septic shock. Method Eighteen dogs infected and shocked by intravenous endotoxin(LPS) were randomly divided into three groups: control group (n=6) treated with sodium chloride, dopamine group (n=6) treated with dopanfine, and dopamine plus xuebijing group (n=6) treated with dopamine and xuebijing. The therapeutic effects were assessed by comparison of the changes in VCAM (vascular cell adhe-sion molecule) ,ICAM (inter-cell adhesion molecule), VWF (yon willibrand factor) and PAI-I (plasminogen acti-vator inhibitor-1) at different indexes including the basic status, the dog being shocked without therapy, 3 and 7 hours after treatment.Analysis was made by SPSS 13.0 software. Results In xuebijing group, VCAM, ICAM, VWF and PAI-1 were signifieanfly changed 3 or 7 hours later after xuebijing administered rather than in control group and dopamine group (P<0.01 or P<0.05 ).In dopamine group, ICAM,VWF and PAI-1 were signiti-eanfly changed 3 or 7 hours after dopamine given rather than in control group (P<0.01 or P <0.05). Conclu-sions Injectio xuebijing obviously decreases the levels of coagulat factors in dogs with septic shock. Therfore, the injectio xuebijing can be used to treat the septic shock.

Objective To investigate the relationship between the colloid osmotic pressure (COP) as well asosmolality and the outcomes of critical patients. Method Totally 1568 critical patients were chosen from emergen-cy intensive care unit and surgical intensive care unit in Chaoyang Hospital Affiliated to Capital Medical Universityfrom January 2002 to December 2005, and divided into different groups according to levels of COP and osmolality.In group program Ⅰ, all patients were divided into 2 subgroups based on COP (the critical value was 20 mmHg =1.2 mOsm/kg H2O)on the day of admission. In group program Ⅱ, the same patients were divided into 3 sub-groups based on osmolality (the critical value was in the range from 280 mOsm/kg H2O aad 310 mOsm/kgH2O)which was also measured on the day of admission. The mortality of patients was calculated. Chi-square test wasused. Results Compared with patients of normal colloid osmotic pressure group, patients of lower colloid osmoticpressure group had higher mortality(24.5% vs. 17.7%, P = 0.001). Compared with the patients of normal os-molality group, the patients of lower total osmotic pressure group had lower mortality(17.0% vs. 24.5%, P =0.000). Conclusions Compared with the normal osmolality, the normal colloid osmotic pressure had the moreclosely relationship with the outcomes of critical patients, and it maybe a predictor of prognosis of the critical pa-tients.

Objective To explore the clinical significance of carrying out fast blood B-type natriuretic peptide ( BNP) detection together with noninvasive hemodynamic monitoring for pathogenic diagnosis in patients with dyspnea and to assess further the application value of noninvasive cardiac output monitoring in emergency room.Methods 354 patients were diagnosed as dyspnea in the Emergency Department of Chaoyang Hospital, being Affiliated to Capital Medical University during a period from May 2007 to January 2008 by using USCOM noninvasive ultrasonic cardiac output monitor to measure cardiac output ( CO).If CO was less than 4 L/min, cardiac dyspnea will be diagnosed.Meanwhile, certain amount of venous blood was kept for rapid measuring of BNP concentration.If BNP concentration was higher than 100 pg/ml, cardiac dyspnea would be diagnosed.After diagnosis was made clearly, all the 354 patients were divided in two groups according to Framingham standards whether they had cardiac dyspnea or not and then comparison was carried out between the patients with the diagnosis of cardiac dyspnea with CO and BNP.The relationship between CO and BNP was studied as well.Results In a group of 127 patients with cardiac dyspnea, there was no difference in terms of the number of patients showing positive results with CO or BNP as judging criteria (122 vs 119, P =0.393) and CO and BNP had negative correlation; while the results were opposite in a group of 227 patients with non-cardiac dyspnea (102 vs 11, showing negative CO or BNP P = 0.000) and there was no correlation between BNP and CO.Conclusions For patients with dyspnea in the emergency room, the value of BNP concentration of blood plasma to determine cardiac dyspnea is somewhat limited.Appling non-invasive ultrasonic cardiac output monitor in the emergency room to detect CO for identifying the cause of dyspnea is clinically valuable.

Objective To investigate the efficiency and safety of the automated external defibrillator (AED); and to compare the defibrillating efficacy between the domestic AED and the imported AED. Method Fourteen Peking white swine weighed (30 ± 1 ) kg, were anaesthetized and arterial cannula was inserted into the left femoral artery for collecting blood samples and measuring artery blood pressure, cardiac output (CO) and external vascular lung water index (EVWI) by using PiCCO monitor, and another cannula was inserted into the left femoral vein to place an electrode as a temporary pace maker, and then ventricular fibrillation (VF) was induced by using a programmed electrical stimulation instrument. The swine were divided into two groups randomly ( random number) after VF was confirmed by electrocardio-monitor,and the domestic made AED (M group, n = 7) or imported AED (Z group, n = 7) were used respectively in 7 swine of each group. The electrodes of defibrillator were stuck to the precordium and sternum separately, and defibrillation was delivered by the AED signal. The entire procedure of defibrillation was repeated four times. The number of defibrillation delivery required to get normal cardiac rhythm was recorded. Twenty minutes after restoration of spontaneous circulation (ROSC), blood sample was taken to measure myocardial enzyme. The CO and EVWI were measured too. Measurement data was analyzed by repeated ANOVA and enumeration data was analyzed by Chi-square test. A value of P ＜0.05 was regarded as being significant statistical difference. Results There were 54 episodes of VF induced in 14 swine and only one swine in Z group was dead after 2nd episode of VF, resulting in 98.1% success rate of resuscitation. There were 37 defibrillation deliveries given to swine of M group, and 75.0% produced normal cardiac rhythm after the first delivery of defibrillation,whereas 80.0% in Z group after 32 defibrillation deliveries. The length of time from AED turned on to the recognition of ECG signal of VF was (29 ± 1 ) s. There were 2 occasions in both groups that the AEDs failed to recognize the VF signal emerged on ECG after the first induction of VF by electrical shock. Similarly, there were 2 occasions in Z group that the AED incorrectly recognized the signal of ventricular tachycardia as that of VF, but no harm was done after defibrillation delivery given following the signal of AED. During the entire course of experiment, heart rate,blood pressure and CO of all survived swine were stable,but the EVWI and myoglobin (MYO) gradually increased as time elapsed until the 3rd or 4th episode of VF leading to significant differences from the original ones. There were no significant differences in all biomarkers between two groups. Conclusions The VF can be ceased by AED safely and efficiently. There are no significant differences in signal recognition, efficacy of defibrillation and myocardial injury found between the domestic made AED and imported AED; but AED may not be good to be recommended to the professional staff of resuscitation because of its incorrect reorganization of ECG owing to over-automation.

Objective Amiodarone was diluted to release the side effect of hypotension in clinic, but this maybe unsuitable during cardiopulmonary resuscitation (CPR). This study was designed to observe the effects of undiluted amiodarone, diluted amiodarone, and CPR alone on ventricular fibrillation (VF) in a pig model. MethodsVF was induced in 21 pigs. The animals were randomly (random mumber) divided into 3 groups after VF 3 min.① CPR group ( n= 7): standard CPR; ② undiluted amiodarone group ( n= 7): undiluted amiodarone (5 mg/kg)bolus within 3 s, then 20 mL saline flush into the peripheral vein, CPR was started after observed 30 s; ③ diluted amiodarone group ( n = 7): amiodarone was dissolved in 20 mL saline and bolus with 30 s. Defibrillation was attempted at VF 5 min. Results The restoration of spontaneous circulation (ROSC) of CPR and undiluted amiodarone groups were higher than diluted group (85.7％ vs. 71.4％ vs. 42.9％), but the differences were not significant (all P ＞0.05). The defibrillation energy and timesof CPR group were higher than that of undiluted amiodarone (P= 0.009) and diluted group ( P = 0. 170). The mean arterial pressure of undiluted amiodarone were lower than diluted and CPR groups at ROSC 10 min (all P ＜0.05), but the differences of undiluted and diluted groups were not significant after ROSC 0.5 h. Conclusions In this study, undiluted amiodaronecan effectively reduced the defibrillation times and energy. Although diluted amiodaronecan release the side effect of hypotension which was transient, it didn't significantly improved cardiac electric activity and delayed to start CPR.

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Objective To investigate the role of underlying diseases in predicting the length of stay for observation in emergency department of internal medicine by the Charlson weighted index of comorbidities (WIC).Methods A single-center retrospective analysis of clinical data of 2 836 patients admitted in emergency observation room of the Beijing Chaoyang Hospital from January 1 to June 30 in 2013 was carried out.The patients were divided into two groups according to the length of observation time:Group A (time of observation ≥72 h,n =1908) and Group B (time of observation ＜ 72 h,n =928).The data of the length of observation time were recorded,and the WIC and the APACHE Ⅱ score were calculated.Logistic regression analysis was used to determine the independent predictors for 72-hour observation.Receiver operating characteristics (ROC) curve was used to evaluate the value of WIC in predicting 72-hour observation.Results Of 2836 patients,1176 (41.5％) suffered from respiratory disease,709 (25.0％) had cardiovascular and cerebrovascular diseases,423 (14.9％) were contracted digestive system disease,251 (8.8％) had renal and endocrinology system diseases and 277 (9.8％) had diseases arisen from physicochemical factor and miscellaneous causes.Compared with patients in Group B,the average age,the number of elderly patients residing in apartment exclusively for elderly,the WIC and the APACHE Ⅱ score were higher in patients in Group A.The one-variable and multi-variable Logistic regression analyses showed that age,the WIC score,the APACHE Ⅱ score and residing in apartment for elderly people were related with 72-hour observation in emergency observation room.The area under the ROC curve in predicting 72-hour observation was 0.701 for the WIC score,0.788 for APACHE Ⅱ score and 0.853 for their combination.Conclusions The WIC scoring system can be a good predicting method for 72-hour observation in patients in emergency observation room.

Objective Two different transthoracic impedances were made with an adjustable impedance instrument to compare the success rate of defibrillation,heart and skin damage in a porcine model.Methods A total of sixteen pigs were randomly (random number) divided into two groups:low impedance group (about 50 Ω,n =8) and high impedance group (about 100 Ω,n =8).Defibrillation (recommended 150 J) was first attempted at 15 s after induction of ventricular fibrillation (VF).If spontaneous circulation was not recovered,2-minute chest compression and subsequent defibrillation attempts (maximum 200 J) were attempted.Model animal kept stabilization for 30 min after return of spontaneous circulation before induction of the next episode of VF,which was induced five episodes in each pig.Results In the low impedance group,VF was induced 39 times,39 of 43 attempted defibrillations were successful.In the high impedance group,VF was induced 40 times,40 of 70 attempted defibrillations were successful.The current and success rate of the first defibrillation were (34.9 ±3.2) A and 94.9％ respectively in the low impedance group,while those of the high impedance group were (19.1 ±2.1) A and 50％ respectively (both P ＜ 0.05).There were no significant differences in skin damage between two groups,but myocardial injury was lighter in the high impedance group.Conclusions Success rate of the first defibrillation with recommend 150 J obviously decreases with the increase of transthoracic impedance.The main factor of myocardial injury is current instead of the numbers of defibrillation.

Objective To investigate effect on telomerase activity of Hep-2 cells treated by anticancer drugs(hydroxycamptothecine, cisplatin and cytoxan).Methods By MTT method,we measured the 50% inhibitory concentration(IC 50 ) at 72h,and compared to untreated control cells. Telomerase activity of Hep-2 cells treated by the drugs in different concentration based on IC 50 for different time was observed by Telomeric Repeat Amplification Protocol with ELISA(TRAP-ELISA).Results Hydroxycamptothecine and cytoxan could inhibit proliferation of Hep-2 and down-regulate telomerase activity of Hep-2 cell. However, cisplatin promoted proliferation of Hep-2 and up-regulated telomerase activity of Hep-2 cell.Conclusions Hydroxycamptothecine and cytoxan could down-regulate telomerase activity of Hep-2 cell by direct or indirect pattern, which may correlate with drug concentration and time-dependent pattern.Cisplatin could up-regulate telomerase activity of Hep-2 cell, which mechanism is not clear.