The abdomen is an indispensable site of cardiopulmonary resuscitation,and combination with the chest for sustaining artificial circulation is the future research direction for precision medicine.This paper elaborates on the importance of abdomen in cardiopulmonary resuscitation,and analyzes the resuscitation mechanism of the chest,abdomen and thoracic abdominal combination for heart and lung recovery.The respective advantages and complementary points of chest and abdomen compression for cardiopulmonary resuscitation were also discussed.

Objective To investigate the effect of external abdominal aorta compression on circulation during anesthetic induction in elderly patients. Methods A prospective randomized controlled trial was conducted. Patients with age of 60-75 years old, requiring a general anesthesia for non-abdominal surgery, and with Ⅱ-Ⅲ class of American Society of Anesthesiologists (ASA) physical status classification, and admitted to General Hospital of Chinese People's Armed Police Forces from January to April in 2017 were enrolled. They were divided into abdominal aorta pressure group and control group according to random number method, with 20 patients in each group. In both groups, anesthesia was induced with midazolam, propofol, fentanyl and cisatracurium, and was maintained with propofol, remifentanil and cisatracurium. After successful intubation, the anesthesia machine was changed into mechanical ventilation. The patients in abdominal aorta pressure group were given abdominal aorta pressure 1 minute after induction of general anesthesia with midazolam till 5 minutes after intubation. The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO2) were observed before anesthesia induction, immediately after anesthesia induction, immediately after intubation, 5 minutes and 10 minutes after intubation, respectively. The incidence of hypotension or bradycardia, and usage of ephedrine or atropine were recorded. Results There were no significant differences in MAP [mmHg (1 mmHg = 0.133 kPa): 83.6±4.7 vs. 82.9±4.7], HR (bpm: 67.3±5.9 vs. 65.9±5.7) and SpO2 (0.962±0.007 vs. 0.960±0.009) before anesthesia induction between abdominal aorta pressure group and control group (all P > 0.05). Immediately after anesthesia induction, the MAP and HR in control group were significantly decreased as compared with those before anesthesia induction [MAP (mmHg): 70.0±8.7 vs. 82.9±4.7, HR (bpm): 60.7±6.7 vs. 65.9±5.7, both P < 0.05], and they were also significantly lower than those of abdominal aorta pressure group [MAP (mmHg): 83.1±3.9, HR (bpm): 66.8±4.9, both P < 0.05]. Immediately after intubation, the MAP and HR in control group were significantly increased as compared with those immediately after anesthesia induction [MAP (mmHg): 78.9±7.9 vs. 70.0±8.7, HR (bpm): 67.3±2.7 vs. 60.7±6.7, both P < 0.05], but the changes in MAP and HR in abdominal aorta pressure group were not obvious. During the anesthesia induction period, there was no statistical difference in SpO2 change between the two groups. During induction of anesthesia, no adverse reaction was found in the abdominal aorta pressure group, but 4 patients with hypotension and 2 patients with bradycardia were found in the control group. Two patients with hypotension were treated with ephedrine, and 2 patients with bradycardia were treated with atropine. Conclusion Anesthesia induction of elderly patients with abdominal aorta pressure can help maintain hemodynamic stability.

Objective To investigate the expression of VEGF-C in breast cancer and its relationship with lymph node metastasis. Methods VEGF-C expression was assessed by immunohistochemistry in 78 cases of breast cancer. The relationship between expression of VEGF-C and lymph node status and clinicopathological features in breast cancer was analyzed. 20 cases of breast fibroadenoma was taken as control group. Results The expression of VEGF-C was significantly higher in breast cancer group than that in fibroadenoma group(P<0.01). VEGF-C was significantly higher in axillary lymph node-positive group than that in axillary lymph node-negative group(P<0.05). No relativity was found between VEGF-C and patient age, tumor size, estrogen receptor status, progesterone receptor status, and clinical stage. Conclusion The high expression of VEGF-C has a relativity with lymph node metastasis of breast cancer and may be important for the breast cancer's prognosis.

Objective To compare the effect of lymph node dissection by VATS lung cancer resection surgery and conventional lung cancer surgery.Metnods 120 patients with non-small cell lung cancer were selected and randomly divided into observation group (n =60) and control group (n =60) according to the digital table.The control group was given conventional resection of lung cancer treatment,the observation group was assisted thoracoscopic lung resection treatment.The postoperative drainage,postoperative ambulation time,postoperative hospital stay,the number of lymph node metastasis and incidence rate of postoperative complications were observed.Results The time of postoperative drainage,get out of bed and postoperative hospital stay of the observation group were all shorter than those of the control group [(2.43 ± 0.54) d vs.(5.82 ± 1.35) d,(1.23 ± 0.29) d vs.(3.87 ± 0.75) d,(2.59 ± 0.63) d vs.(6.92 ± 1.27) d;t =18.059,25.430,23.658,all P ＜ 0.05)].The lymph node dissection number of the two groups had no statistically significant difference(x2 =1.008,P ＞ 0.05).The positive rate of lymph node metastasis in the observation group was lower than that in the control group(x2 =7.033,P ＜ 0.05).The incidence rate of postoperative complication of the observation group was lower than that of the control group (x2 =6.708,P ＜ 0.05).Conclusion Video-assisted thoracoscopic lung resection for non-small cell lung cancer patients with lymph node dissection is better than conventional lung surgery,and it is worthy of studying.

Mechanical ventilation is regarded as an effective means of replacing artificial ventilation during cardiopulmonary resuscitation (CPR), and has been widely used in the treatment of cardiac arrest (CA) patients. However, there are still some controversial issues remaining to be settled, such as the assessmentof the effectiveness of mechanical ventilation, the selection of the optimal oxygen concentration (FiO2), tidal volume (VT), respiratory frequency, and mode of ventilation during the CPR process. The pros and cons of positive pressure ventilation are also inconclusive. We reviewed and summarized the related research in recent years, and recommended that the intermittent positive pressure ventilation (IPPV) of volume controlled with small VT (6-7 mL/kg), low ventilation rates (10 times/min), and pure oxygen could be applied during the mechanical ventilation of CPR. The best mechanical ventilation strategy still needs further experimental researches to discover and explore.

To promote the technical training and scientific popularization of cardiopulmonary resuscitation (CPR) in China, the Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association combined with the Science Popularization Branch of the Chinese Medical Association wrote "2018 National consensus on cardiopulmonary resuscitation training in China". The formation was based on the general outline about "2016 National consensus on cardiopulmonary resuscitation in China", and to implement the important strategies included the "three pre" policy, prevention, precognition, and pre-warning, before the cardiac arrest (CA); the "three modernization" methods, standardized, diversified and individualized, during the CA; and the "three life" strategies, the rebirth, the extra and the extended, after the CA; and also combined with the concrete National conditions and clinical practice of China area. The document summarized the evidence of published science about CPR training till now, and recommend the establishment of "the CPR Training Triangle" according to the Chinese National conditions. The bases of the triangle were system, training and person, the core of which was CPR science. The main contents were: (1) The "three training" policy for CPR training: the cultivation of a sound system, which included professional credibility, extensive mobilization and continuous driving force, and the participation of the whole people and continuous improvement; the cultivation of scientific guidelines, which included scientific content, methods and thinking; and the cultivation of a healthy culture, which included the enhancement of civic quality, education of rescue scientifically, and advocate of healthy life. (2) The "three training" program of CPR training: training professional skills, which included standard, multiple, and individual skills; training multidimensional, which included time, space, and human; and training flexible, including problem, time, and innovation oriented. (3) The "three party" direction of CPR training, the application for achievement translation, which included scientific translations, skill propagators, and cultural advocates; the precision disseminators, which included accurate communication sources, channels, and dissemination of the audience; and theoretical innovation guides, which included scientific, popular science and communication theory. That integrated the wisdom of scholars, melt the thought of genius, and created the act of envoy for Chinese and foreign CPR training. The training program should be suitable for different trainee, no matter who is trainer or trainee. The release of the expert consensus on the 2018 CPR training will make the National CPR education into the new training era with definite direction, clear target and fully standard of China.
Cardiopulmonary Resuscitation ; China ; Consensus ; Heart Arrest ; Humans

Objective To observe the effect of cardiac massage by subdiaphragmatic compression (D-CPR) on the length of time required from cardiac arrest (CA) to restoration of spontaneous circulation (ROSC),hemodynamics,rate of ROSC,survival rate of 6 h,level of Caspase3 in myocardial cells and apoptosis index (AI) of myocardial cells and compare the effect of standard cardiac massage by chest compression (S-CPR) on those variables in order to choose the more effective resuscitation method for the patient with CA during abdomen operations.Methods A total of 32 healthy New Zealand rabbit were randomly (random number) divided into two groups,namely S-CPR group and D-CPR group (n =16 in each group).All of rabbits were anesthetized with ketamine and Shumianxin (a kind of hypnotics) by intraperitoneal injection,subsequently tracheotomy was made for endotracheal intubation,and right internal jugular vein was catheterized for monitoring central venous pressure (CVP) and left common carotid artery was for indwelling cannula to monitor arterial blood pressure.Lead-2 of ECG was placed.After laparotomy and vital signs of rabbits stabilized for 5 minutes,the endotracheal tube was clamped at the end expiration for 8 minutes to make asphyxial cardiac arrest model.The effects of two different methods were observed and compared in respects of changes in hemodynamics、length of time elapsed from CA to ROSC、ROSC rate and the survival rate in 6 h.The level of Caspase3 in myocardial cells and AI of myocardial cells were detected by using immunohistochemistry staining method and TUNEL,respectively 6 hours after successful resuscitation.Results ①The length of time consumed fiom CA to ROSC in D-CPR group was shorter than that in S-CPR group (P ＜0.05) ②Coronary perfusion pressure (CPP) and MAP 15 minutes after CPR were higher in D-CPR group than those in S-CPR group (P ＜ 0.05).③SBP and DBP after ROSC were higher in D-CPR group than those in S-CPR group.④ROSC rate in D-CPR group was significantly higher than that in S-CPR group (81％ vs.43％,P ＜0.05).⑤Survival rate in 6h in D-CPR group was substantially higher than that in S-CPR group (75％ vs.25％,P ＜ 0.05).⑥HE staining showed that severe myocardial damage manifesting in edema of myocardial cell,indistinguishable cell boundary,and patchy necrosis with infiltration of scanty inflammatory cells were found in S-CPR group.While in D-CPR group,mild myocardial damage in form of slight cellular edema and distinctive cell boundary was observed.⑦Level of Caspase3 in myocardial cells in terms of integrated optical density (IOD) of postive Caspase3 cells was substantially lower in D-CPR group than that in S-CPR group (P ＜ 0.05).⑧Apoptosis index (AI) of cells was lower in D-CPR group than that in S-CPR group (P ＜ 0.05).Conclusions ①The hemodynamics in D-CPR group was more stable than that in S-CPR.group,and D-CPR increased CPP,MAP,ROSC rate and survival rate in 6h,improving achievement of successful resuscitation.②D-CPR was more effective in terms of shortening the length of time for restoration of spontaneous circulation、decreasing level of Caspase3 in myocardial cells、decreasing apoptosis index of myocardial cells and ameliotating myocardial damage from ischemic repeffusion injury.

OBJECTIVE:To optimize the preparation process of Naringin liposome gel,and to establish the quality control method of the gel. METHODS:The preparation method of Naringin liposome was investigated by single factor test with encapsula-tion percentage as index. The phosphatide concentration,the proportion of phosphatide to cholesterol and the proportion of phospha-tide to drug in the liposomes were optimized by orthogonal design. Using formability,spread performance and stability as compre-hensive evaluation indicator,the dosage of carbopol and triethanolamine and drug-loading amount in the gels were optimized by or-thogonal design. The quality control method of the gel was established preliminarily. RESULTS:Naringin liposomes were prepared by the method of ethanol injection;the optimal formulation of the liposomes was as follows as phosphatide 30 mg/ml,the propor-tion of phosphatide to cholesterol 3∶1,the proportion of phosphatide to drug 10∶1;that of the gels was as follows as carbopol 0.30 g,triethanolamine 1.0 g,drug-loading amount 1.0 g/20 g. Average encapsulation efficiency of validation test was 40.19% for Lipo-some(RSD=0.10%,n=3);comprehensive score was 9.8,average content of naringin was 0.58%(accounting for 96.67% of la-bel amount)for gels. The quality control method of the preparation was established,i.g. identification,content determination. CON-CLUSIONS:The optimal preparation formulation is feasible,and the preparation is controllable in quality.

Objective To explore the impact of a“one-week”staged multivessel percutaneous coronary intervention (PCI) versus culprit-only PCI on deaths and major adverse cardiac events (MACE). Methods We retrospectively analyzed 447 patients with multivessel disease who experienced a ST-segment elevation myocardial infarction (STEMI) within 12 h before undergoing PCI between July 26, 2008 and Septem-ber 25, 2011. After completion of PCI in the infarct artery, 201 patients still in the hospital agreed to undergo PCI in non-infarct arteries with more than 70%stenosis for a“one-week”staged multivessel PCI. A total of 246 patients only received intervention for the culprit vessel. Follow-up ended on September 9, 2014. This study examined the differences in deaths from any cause (i.e., cardiac and noncardiac) and MACE between the two treatment groups. Results Compared to a culprit-only PCI treatment approach, the“one-week”staged multivessel PCI was strongly associated with greater benefits for 55-month all cause death [41 (16.7%) vs.13 (6.5%), P=0.004] and MACE [82 (33.3%) vs. 40 (19.9%), P=0.002] rates. In addition, there were significant differences in the number of myocardial infarctions [43 (17.5%) vs. 20 (10.0%), P=0.023], coronary-artery bypass grafting [CABG;20 (8.1%) vs. 6 (3.0%), P=0.021], and PCI [31 (12.6%) vs. 12 (6.0%), P=0.018]. Patients undergoing culprit-only PCI compared to“one-week”PCI had the same number of stent thrombosis events [7 (2.8%) vs. 3 (1.5%), P=0.522]. Conclusions Compared to a culprit-only PCI treatment approach,“one-week”staged multi-vessel PCI was a safe and effective selection for STEMI and multi-vessel PCI.

Objective To compare the efficacy and resistance between S?1 combined with radiotherapy and S?1 alone in the treatment of elderly patients with locally advanced gastric cancer. Methods Fifty?eight elderly patients with unresectable locally advanced ( stage Ⅲ) gastric cancer were randomly and equally divided into S?1 combined with concurrent radiotherapy group ( experimental group ) and S?1 alone group ( control group ) . The experimental group received 4 cycles of S?1 treatment with each cycle containing two?week oral administration of S?1 at a dose of 40 mg/m2 twice a day followed by one?week drug withdrawal. Gastric intensity?modulated radiotherapy was performed concurrently with a dose of 45 Gy ( 1. 8 Gy per fraction) . The control group received the same dose of S?1 alone. Short?term outcomes and adverse reactions were evaluated in the two groups. Comparison was made by chi?square test. Results All patients completed the planning treatment. The experimental group had significantly higher objective response, disease control, and symptom remission rates than the control group ( 52% vs. 24%, P=0. 03;76% vs. 45%, P=0. 016;86% vs. 48%, P=0. 005) . There were no significant differences in the incidence of nausea and vomiting, anorexia, leukopenia, diarrhea, or thrombocytopenia between the two groups ( all P>0. 05) . Conclusions S?1 treatment combined with concurrent radiotherapy improves the short?term outcomes and causes tolerable toxicities in the treatment of elderly patients with locally advanced gastric cancer.