Objective:To study the difference of the development between mandibular condylar cartilage and femoral head cartilage in vitro.Methods:Mandibular condyles and femoral heads were sampled from 1 2 neonatal mice and cultured in vitro.The samples before culture and after 6-week culture were examined by gross observation,HE staining,Alizarin Red staining and PCNA immunohistochem-istry respectively.Results:After in vitro culture,abnormal changes were observed in condyle cartilage,but the surface area of condyle cartilage was not changed(P >0.05).HE staining showed partial cartilage layer structure disappearance and the Alizarin Red staining confirmed calcification in the cartilage matrix.However,calcification was not found in femoral head cartilage,and the surface area of femoral head cartilage increased(P <0.05).HE staining showed the hypertrophied layer was thicker after culture than before and the Alizarin Red staining showed there was no calcification in the femoral cartilage matrix.The immunohistochemistry displayed PCNA posi-tive expression in both cartilage after culture.Conclusion:In vitro,the mandibular condylar cartilage matrix can be spontaneously cal-cificated.

Objective To investigate the effects of Erlong Zuoci Pills on AQP4 expression in cochlear tissue of mice with elderly kidney deficiency deafness;To discuss the action mechanism. Methods Intraperitoneal injection of hydrocortisone method was used to duplicate mice models with kidney deficiency except the normal control group. After the models were established, mice were divided into model group and TCM group, 16 mice in each group. TCM group was gavaged by Erlong Zuoci Pills, model group and normal control group were gavaged by normal saline for 22 d. Cochlear stretched preparation technology was used to observe morphological changes in cochlear inner and outer hair cells, and supporting cells. Immunohistochemistry and Western bolt were used to detect protein expression of AQP4. Results Compared with normal control group, mice in model group missed inner and outer hair cells and supporting cells of the cochlea. Compared with model group, arrangement of cochlear inner and outer hair cells and supporting cells was neat and boundary was clear in TCM group. Compared with model group, protein expression of AQP4 in cochlear tissues in TCM group increased (P<0.01). There was no difference between TCM group and normal control group. Conclusion Erlong Zuoci Pills have significant therapeutic effect for elderly kidney deficiency deafness, and the treatment is related to the upregulation of protein expression of AQP4 in cochlear tissues.

Objective:To study the effects of hyaluronic acid(HA) and TGF-β1 on the growth of mandibular condylar cartilage and the hyperthophic differentiation of the condylar chondrocyts.Methods:60 condyle samples from newborn mice were in vitro cultured and treated with HA(0.5 mg/ml),TGF-beta 1 (5 ng/ml) and without additional agent(the control) respectively.The Morphological observation,Alizarin Red Staining,Alkaline phosphatase staining and condylar cartilage surface area measurement were conducted after 1,2,4,6 and 8 weeks of culture respectively.Results:High-density photoresist area was observed in the condylar cartilage of the control group after 4 weeks of culture.Alizarin Red Staining and Alkaline phosphatase staining showed condylar cartilage matrix production and calcification.The HA group showed no high-density photoresist area at all time points,however,the cartilage area was significantly increased (P ＜ 0.05);the TGF-beta 1 group showed high-density photoresist area after 2 weeks of culture.but the cartilage area were not significantly changed(P ＞ 0.05).Conclusion:HA can promote the growth of condylar cartilage in vitro,but have an inhibitory effect on chondrocyte differentiation.TGF-β1 plays a role in mandibular condylar chondrocyte hypertrophic differentiation in the early days of in vitro culture.

Objective To summarize the efficacy of extracorporeal membrane oxygenation (ECMO)utilization in Emergency Department (ED),as well as the establishment of emergency ECMO team.Methods A retrospective analysis was carried out in 16 patients treated with ECMO between April 2015 to December 2016 in ED.The clinical data including demographics,diagnosis,initiating ECMO timing,place of ECMO establishment,intubation approaches,duration of ECMO,complications and outcomes were collected and analyzed.Results Eight patients were successfully weaned from ECMO,and 7 of them survived to discharge from hospital.The duration of ECMO support was 4 to 384 hours.The emergency ECMO team was set up.Conclusions Emergency medical team can successfully operate the ECMO process.The emergency medical team-initiated ECMO can provide effectively adjuvant measures to support patients with respiratory failure,circulatory failure and cardiac arrest.

Objective:To analyze the effectiveness and annual cost-effectiveness of extracorporeal cardiopulmonary resuscitation, ECPR) in adults.Methods:Totally 60 patients received ECPR from April 2015 to March 2020 in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The patients were grouped by discharge survival/hospital death and shockable/unshockable initial rhythm. Age, gender, initial rhythm, survival rate, ECMO treatment time, time-to-death, length of stay and hospitalization costs were analyzed. All discharged survivors were followed up for 1 year, then cost-effectiveness analysis was performed using total cost of ECPR as the cost and 1-year survival rate as the effect.Results:Fifty-four adult patients with ECPR were enrolled, and 17 (31.5%) patients survived and discharged, of whom 15 (88.2%) patients had good neurological outcomes and survived at 1-year follow-up. The median ECMO time was 5 ( IQR 1-8) d, time-to-death was 4 ( IQR 1-9) d, length of stay was 10 ( IQR 3-18) d, total hospitalization cost was 209 122 ( IQR 121 431-303 822) RMB, and the daily cost was 23 587 ( IQR 13 439-38 217) RMB. The rate of shockable initial rhythm was significantly higher in the discharge survival group than the hospital death group. The survival rate of ECPR patients with shockable initial rhythm was significantly higher than that of patients with unshockable initial rhythm, and there was no difference in cost. Conclusions:ECPR is a resource-intensive treatment with a total cost of about 200 000 RMB. Moreover, the effectiveness and annual cost-effectiveness are superior for patients with shockable initial rhythm.

Objective:To investigate the prognostic value of early lactate in patients with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:A retrospective analysis was performed on the clinical data of patients with ECPR in the Emergency Medicine Department of The First Affiliated Hospital of Nanjing Medical University from March 2015 to August 2021. The age, sex, etiology, initial rhythm, prognosis, blood lactate and pH of patients with ECPR were collected, and their difference between the deceased and survived patients was compared.Results:Totally 95 patients were enrolled, with an average age of 47 years; male accounted for 69.5%, and the survival rate was 29.5%. There was no significant difference in age and sex ratio between the deceased and survived patients. However, the deceased patients had a significant lower rate of shockable rhythms (31.3% vs. 60.8%), a higher level of lactate [16.4 (11.2, 19.1) vs. 9.2 (3.2, 15.0), mmol/L], and a lower pH [7.01 (6.88, 7.23) vs. 7.37 (7.10, 7.43)] than the survived patients. Multivariate binary logistic regression analysis showed that shockable rhythm [odds ratio ( OR) = 0.295, 95% confidence interval ( CI): 0.118-0.739), lactate ( OR=1.159, 95% CI: 1.068-1.258) and pH ( OR= 0.017, 95% CI: 0.002-0.157) were independent risk factors for poor prognosis. Furthermore, a lactate level >24 mmol/L was the best threshold to predict mortality with a specificity of 100%. Combined application, the cutoff point was lactate level>16 mmol/L and pH <6.828. Conclusions:Shockable rhythm, higher early lactate and lower pH value are independent risk factors for prognosis in patients with ECPR. Early lactate > 24 mmol/L or lactate > 16 mmol/L companied with pH < 6.828 are novel indicators of the termination of ECPR.

Objective:To investigate the predictive value of platelet dynamics on the prognosis of 28-day in patients with extracorporeal membrane oxygenation (ECMO).Methods:From January 2017 to December 2020, 60 patients from the Emergency Medicine Center of the First Affiliated Hospital of Nanjing Medical University received ECMO for life support. The baseline data of the patients were collected, the minimum value of platelets on day 1-7 of the machine was calculated, and the platelet change value and change rate were calculated. The patients were divided into the survival group and death group according to the 28-day survival status after ECMO was installed, and the receiver operating curve (ROC) was drawn based on the platelet change value and change rate to evaluate its predictive value for prognosis.Results:Among patients receiving VV-ECMO, the platelet change value and change rate on day 7 had the best prediction effect on the patient's 28-day outcome ( AUCΔPLT7=0.772, P=0.016; AUCΔPLT7%=0.764, P=0.020), when the platelet change value was 4×10 9/L as the critical value, the sensitivity was 0.857, the specificity was 0.615, and when the platelet change rate was -28.99% as the critical value, the sensitivity was 0.857, the specificity was 0.615, and when the platelet change rate was -28.99%. The sensitivity was 0.643 with a specificity of 0.846. In patients receiving VA-ECMO, the platelet change rate on day 6 predicted the best effect on the patient's 28-day outcome ( AUCΔPLT6%= 0.707, P = 0.045). When the platelet change rate was -26.19% as the critical value, the sensitivity was 0.842 and the specificity was 0.643. Conclusions:Platelet dynamic changes of platelets are correlated with the 28-day prognosis of patients receiving ECMO, and the combination of platelet change value and the critical value of change rate can better predict the poor prognosis of patients in both ECMO modes.

Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) in the treatment of out-of-hospital cardiac arrest (OHCA) in adults.Methods:The data of 40 adults with OHCA-ECPR in Emergency Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2022 were retrospectively analyzed. The patients were grouped by discharge survival/in-hospital death, with/without bystander resuscitation, and with/without interhospital transport. Age, sex, Charlson comorbidity index, initial rhythm, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO evacuation success rate, survival rate, ECMO treatment time, time-to-death, and length of hospital stay were analyzed.Results:①Among the 40 patients with OHCA-ECPR, 9 patients (22.5%) survived upon discharge, 7 (77.8%) of whom had good neurological outcomes.②The no-flow time in the survival group was significantly shorter than that in the death group, and the proportion of shockable initial rhythm was higher.③Bystander resuscitation greatly shortened the no-flow time.④The regional OHCA-ECPR interhospital transport extended the CA-Pump On time, without affecting patients’ prognosis.Conclusions:ECPR improves the prognosis of patients with OHCA. Bystander resuscitation greatly shortens the no-flow time. ECPR is significantly effective in patients with short no-flow time and shockable initial rhythm. Regional interhospital transport ECPR is recommended to benefit more patients with OHCA.

Objective:To explore the prognostic value of survival after veno-arterial ECMO (SAVE) score combined with 24-h lactate on the machine in patients with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:Totally 59 patients treated with ECPR in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from April 2017 to June 2021 were retrospectively analyzed. According to the 28-day prognosis, the patients were divided into the death group ( n=36) and the survival group ( n=23). The differences in baseline data were analyzed, and multivariate logistic regression was performed to identify the influencing factors of 28-day mortality in patients with ECPR. The receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of SAVE score, 24-h lactate and their combined detection for predicting 28-day mortality risk in patients with ECPR. Results:The 28-day survival rate of patients with ECPR was 39% (23/59). SAVE score of the death group was significantly lower than that of the survival group (-11.67±4.60 vs. -2.43±4.77, P<0.001), and the 24-h lactate in the death group was significantly higher than that in the survival group [5.94 (3.37, 12.40) mmol/L vs. 1.65 (1.07, 3.15) mmol/L, P<0.001]. Multivariate logistic regression analysis showed that SAVE score ( OR=0.703, 95% CI: 0.566-0.873, P=0.001) and 24-h lactate ( OR=1.608, 95% CI: 1.025-2.523, P=0.039) were independent influencing factors of 28-day mortality in ECPR patients. ROC curve analysis showed that the best cut-off value of SAVE score was -6, the sensitivity was 78.30% and specificity was 91.70%. The best cutoff value of 24-h lactate was 4.7 mmol/L, the sensitivity was 63.90% and specificity was 100.00%. The sensitivity and specificity of the combined detection of SAVE score and 24-h lactate were 82.60% and 100.00%, respectively. The area under the curve (AUC) of SAVE score combined with 24-h lactate for predicting the 28-day mortality risk in patients with ECPR was larger than that of SAVE score and 24-h lactate alone (0.952 vs. 0.917; 0.952 vs. 0.847). Conclusions:Lower SAVE score and higher 24-h lactate are independently risk factors of 28-day mortality in patients with ECPR, and SAVE score combined with 24-h lactate on the machine has a good predictive value for the prognosis of patients with ECPR.

Objective:To study the application of blood products in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and evaluate its effect on the prognosis.Methods:A total of 83 adult patients treated with VA-ECMO in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from January 2017 to January 2020 were grouped by survival to explore the risk factors of 28-day mortality using binary logistic regression, and the threshold was calculated by ROC curve.Results:Platelet transfusion ( OR=2.506, 95% CI: 1.142-5.499) and non-myocarditis disease ( OR=6.881, 95% CI: 1.615-29.316) were the risk factors of 28-day mortality in adult VA-ECMO patients. The threshold of platelet transfusion was 0.427 mL/(kg·d) (sensitivity 78.4%, specificity 69.6% , AUC 0.735). Conclusions:The increased platelet transfusion is related to the poor prognosis of adult patients with VA-ECMO. Refractory myocarditis patients are better treated with VA-ECMO.