Objective To compare the changes of physiological parameters after cardiac arrest caused by asphyxia with that of cardiac arrest induced by ventricular fibrillation in rats and assess the values of the parameters on predicting ROSC and 24 h survival rate. Method Two groups of Sprague-Dwaley rats, which randomly (ramdom number) included 30 animals in each group, were investigated. Cardiac arrest were induced by asphyxia (AS group) or ventricular fibrillation(VF group). PETCO2, aortic pressure, left ventricular pressure and ECG of limb lead Ⅱ were recorded continuously, dP/dt4o was calculated with the windaq software. The parameters were compared between the two groups at baseline, precordial compression(PC) 10 s, PC 1 min, PC 3 min, ROSC 1 h and ROSC 2 h. The relations were explored between the parameters and ROSC/24 h survival rate. Results PETCO2,aortic pressure, left ventricular pressure and ECG have distinctive changes in the two groups. In group VF, PETCO2 of ROSC rats at BL, PC 1 min and PC 3 min were higher than those of Non-ROSC rats (P ＜ 0.05); PETCO2of 24 h survival rats at ROSC 1 h and ROSC 2 h were higher than those of 24 h death rats (P ＜ 0.05), which were not observed in the group AS. dP/dt40 and - dP/dt40 at ROSC 1 h and ROSC 2 h in group VF were higher than those in group AS (P ＜ 0.05). Conclusions Physiological parameters after cardiac arrest caused by asphyxia or that of cardiac arrest induced by ventricular fibrillation in rats have unique features respectively. PETCO2 in cardiac arrest caused by ventricular fibrillation may predict ROSC and 24 h survival rate. Researchers have to select the appropriate cardiac arrest model according their research purposes and clinical requirments.

Objective To study the procoagulant activity of microparticles (MP) in patients with acute in-tracerebral hemorrhage (ICH) and to evaluate the correlation between procoagulant activity of MPs and disease out-come. Method From August 2006 through August 2008, 83 consecutive patients with history of hypertension ad-mitted for spontaneous basal ganglia hemorrhage including 54 male and 29 female, aged (60.9±9.7) years ranged from 41 to 79 years, were enrolled into this study. The control group was consisted of 30 age- and sex-matched (P= 0.429; P = 0.415) patients admitted for mild soft tissue injury. Patients with history of head trauma or previ-ous stroke, under the antiplatelet or anticoagulant medication, severe infection, or presence of previous cerebrovas-cttlar disease were excluded. Venous blood sample was kaken within the first 24 hours after disease onset. The MPs procoaulant potential was measured with a prothrombinase assay, and the levels of IL-6,TNF-α, D-dimer (DD)and thrombin-antithrombin Ⅲ complex (TAT) in plasma were measured with enzyme-linked immunosorbent assay. The multivariate analysis was made with forward stepwise logistic regression to determined the predictors of one. month mortality. The plasma levels of MPs were compared between ICH group and control group, between patients with intraventricular hemorrhage (IVH) and those without IVH,and between survivors and non-survivors with the Mann-Whitney U-test. The Spearman' s rank correlation coefficient was used to analyze the correlations between the plasma levels of MPs and ICH volume, Glasgow coma scale (GCS), and plasma levels of IL-6, TNF-α, DD and TAT. A receiver operating characteristic curve (ROC curve) identified the plasma MPs cutoff levels that predicted one-month mortality of patients. Under ROC curve, z statistic analysis was used to compare the area under curves (AUCs) between plasma IMPs and Glasgow coma scale, ICH volumes, and plasma levels of IL-6, TNF-α, DD and TAT for one-month mortality. Results Thirty-six patients (43.4%) died of ICH in a month. The multivariate analyses sorted out the GCS (odds ratio = 0.558, 95%CI:0.367-0.850, P = 0.007), Hematoma volume (odds ratio= 1.061, 95%C1:1.012- 1.113, P = 0.015) and IVH (odds ratio= 5.537, 95%CI:1.035-29.629, P = 0.045) as the independent pcedictors for one-week mortality. The MPs procoagulant activity in the ICH group (6.72±3.26 U/mL) was significantly higher than that in control group (1.84±0.82) U/mL (P = 0.000). The IMPs procoagulant activity in the non-survival group (8.51±3.45) U/mL was significantly higher than that in the survival group (5.35±2.33) U/mL (P = 0.000). The MPs procoagulant activity in the IVH group (7.66±3.39) U/mL was significantly higher than that in the non-lVH group (5.36±2.53) U/mL (P = 0.001). The MPs procoagulant activity was highly associated with GCS scores (r = -0.690, P = 0.000), ICH volumes (r =0.590, P = 0.000), and plasma IL-6 (r = 0.465, P = 0.015), TNF-α (r = 0.464, P = 0.016), DD(r= 0.567, P = 0.001) and TAT(r = 0.469, P = 0.014) in ICH. The ROC curve identified cutoff levels of MPs procoagulant activity to be 7.47 U/mL that predicted one-month mortality of patients with high sensitivity (77.8%) and specificity values (76.6%). Areas under curves (AUCs) of MPs procoagulant activity (AUC =0.825±0.048) were significantly larger than those of plasma IL-6 (AUC = 0.685±0.060, P = 0.042), TNF-α(AUC = 0.681±0.060, P =0.036) and TAT (AUC = 0.644±0.062, P =0.008).The AUCs ofMPs procoag-ulant activity were larger than those of plasma DD (AUC = 0.743±0.056), but this difference was not statistical significance (p = 0.226). Conclusions The procoagulant activity of MPs may contribute to the pathophysiology of ICH. The propcoagulant activity of MPs after spontaneous onset of ICH seems to correlate with clinical outcome in these patients. Its procoagulant activity can be used as an useful clinical marker for evaluating the prognosis of ICH.

Objective To investigate the levels of peripheral blood CD8+ CD28- regulatory lymphocytes and their clinical values in the patients with multiple sclerosis (MS). Method From October 2005 to August 2008, 51 patients with active rehpsing-remitting MS were enrrolled from Department of Neurology of the First Affil-iated Hospital of Wenzliou Medical College. The diagnostic criteria for MS were the 2005 revisions to the "McDon-ald criteria". All the admitted patients received 1 g of methylprednisoione per day intravenously for 5 days, fol-lowed by 60 mg prednisone per day orally for 12 days,and tapered in 6 weeks. Fourteen patients were reevaluated after corticosteroid therapy. Twenty healthy individuals ,as normal controls,matched for age and sex with the MS patients were also enrolled in this study. The percentages of peripheral blood T cells (CD8+ CD28-, CD8+CD28+, CD8+, CD4+ CD8-) were measured by flow cytometric analysis. Parametric statistical analysis were per-formed using standard methods, and linear regression analysis was conducted using Pearson correlation test. Re-sults (1)Compared with controls,the patients with active MS had significantly lower percentage of CD8+ CD28-T cells [(18.48±9.89)% vs. (24.48±4.86)%, P <0.01], and higher percentage of CD8+ CD28+ T cells [(12.23±4.31) % vs. (8.55±3.49) %, P <0.01]. (2)The percentage of CD8+ CD28- T cells was negative-ly correlated with that of CD4+ CDS- T cells (r = -0.488, P < 0.01). (3) After corticosteroid therapy, the per-eentage of peripheral blood CD8+ CD28- / CD8+ CD28+ T cells didn' t significantly decrease or increase in 14 ac-tive MS patients (P > 0.05). Conclusions The decrease of peripheral blood CD8+ CD28- regulatory T cells might be associated with the pathogenesis of MS, and CD8+ CD28- regulatory T cells perhaps played their roles through CD4+ T cells. Corticosteroid therapy could not reverse the levels of CD8+ CD28- T cells.

Objective To investigate the effects of limited resuscitation on hepatic ischernia-reperfusion in-jury in rots with hemorrhagic shock. Method Uncontrolled hemorrhagic shock was induced in 54 rats by transect-ing the middle branch of the splenic artery to produce standardized massive splenic injury. Resuscitation started when the mean arterial pressure (MAP) reached 40 mmHg. The rats were randomly divided (n = 9per group) in-to sham-operated group (SS), or one of five treatment groups in which infusion of Ringer' s solution was continually administrated to maintain MAP at 40 (RS40), 50 (RS50), 60 (RS60), 80 (RS80) or 100 mmHg (RS100) for 45 minutes (T45 point). After the bleeding was controlled, resuscitation was continued with Ringer's solution and whole blood (2:1) to increase the MAP to 100 mmHg for 120 minutes (T165 point), which was followed by obser-vation for 240 minutes (T405 point). All animals were observed for 240 minutes or until death. Blood specimens were collected at TO, T45, T165 and T405 for determination of blood lactate levels. At the end of the experiment,a small amount of hepatic tissue was collected to measure tissue blood perfusion, total antioxidative capacity (TAOC), Na+K+ ATPase activity and malondialdehyde (MDA) levels. Results At T405, the blood lactate lev-els in the RS80 and RS100 groups [(3.60±0.68) and (3.84 ± 1.09) mmol/L, respectively] were significantly higher than those in the SS, RS40, RS50 and RS60 groups [(2.00±0.66),(2.74±1.45),(2.43 +0.94) and (2.07±0.95) mmol/L, respectively;all:P < 0.05]. The MDA levels were significantly higher in the RS80 and RS100[(7.32±0.31) and (7.71±0.23) nmol/mg,respectively] than those in the SS, RS40, RS50 and RS60 groups[(4.95±0.80),(6.14±0.94),(6.42±0.48) and (6.84±0.36) nmol/mg, respeetively;all: P <0.05]. The Na+ K+ ATPase and TAOC levels were significantly lower in all of the RS groups than those in the SS group (all: P < 0.05), and those in the RS80 and RS100 groups was significantly lower than those in the RS40,RS50 and RS60 groups (all: P <0.05). Blood perfusion in the RS80 and RS100 groups was significantly lower than that in the other groups (all: P < 0.05). Conclusions If hemorrhage is uncontrolled, limited resuscitation appears to balance the needs for organ perfusion, improve the microcircttlation and decrease lactate levels. Fur-thermore, limited resuscitation could decrease ischemia-reperfusion injury in liver tissue.

Objective To investigate the modulation of EPCs by interleukin 1β (IL-1β) and p38 mitogen activated protein kinase (p38MAPK) and the pathogenesis resulting from their dysdifferenfiation after trauma.Method Thirty pigs were divided into a control group (n = 15) and a multiple organ dysfimction syndrome (MODS) group (n = 15), the latter of which were subjected to a "two-hit" injury including hemon'hagic shock and endotoxemia. Phosphorylation of p38MAPK in peripheral blood mononuclear cells was monitored by western blotting. The concentration of IL-1β in peripheral blood plasma was determined by ELISA and the numbers of EPCs with FCM in peripheral blood plasma were monitored. The morbidity rates in the two groups were compared by chi square test. The levels of phosphorylation of p38MAPK in peripheral blood mononuclear cells, the concentmtions of IL-1β in peripheral blood plasma and the numbers of EPCs in the peripheral blood were compared between groups using with Student's t lest. Results The level of p38MAPK phosphorylation was more augmented and the concen-tration of IL-1β higher in peripheral blood mononuelear cells and plasma from MODS pigs compared with those from control pigs; nevertheless the mauler of EPC conspicuously decreased in the peripheral blood (P <0.01). The morbidity rate in the MODS group was much higher than that in the control group (P < 0.01). There were fewer EPCs in the peripheral blood of animals in group M than in the peripheral blood of animals in group C (P <0.01). Conclusions p38MAPK phosphorylation is important for the pathogenesis of MODS. p38MAPK phospho-rylation might cause the concentration of IL-1β in the peripheral blood plasma to rise and could cause a drop in the numbers of EPCs, thereby aggravating the inflanmmatory reaction in MODS.

Objective To study the pulmonary functions of pediatric ALI/ARDS(acute lung injury/acute respiratory distress syndrome) survivors. Method A prospective cohort study of all survivors of ALI/ARDS in the PICU of Beijing Children's Hospital was performed. Patients were divided into three groups(0-3 years of age,3 ～ 7 years of age, and over 7 years of age) and followed up three months after diagnosis. Results There were 36 survivors in total of 44 ALl patients, three patients lost follow-up, 12 died and 21 survived. Five survivors refused to participate in the study because of asymptomatic, and one was unable to participate because of lymphoma com-bined with sepsis. A total of 15 children completed the whole survey (11 patients were less than 3 years old, andfour were over 7 years of age). Twelve patients had no discomfort in their respiratory tracts. Three months after be-ing enrolled, the pulmonary functions of all children improved, especially in terms of tidal volume and respiratory compliance (P<0.05). Conclusions The abnormal respiratory symptoms and signs in most children disap-peared three months after discharge. Most survivors still have pulmonary dysfunction at 3 monthes after discharge, but better than discharge.

Objective To observe the changes of nitric oxide (NO) levels in plasma during cardiopul-monary resuscitation (CPR) and to compare the effects of aminoguanidine (AG) and NG-nitro-L-arginine methyl ester (L-NAME) on CPR. Method This was a prospective, randomized animal study performed at the Function Laboratory of Lanzhou University. Cardiac arrest was electrically induced and was left untreated for 5 min. After performing chest compression for 1 min, 40 domestic rabbits were divided into four groups (n = 10) to receive ei-ther 20 mg/kg AG, 25 mg/kg L-NAME, 0.02 mg/kg epinephrine or 2 ml saline placebo before defibrillation. Successfully resuscitated rabbits were observed for a further 4 h. Hernodynamics variables and cardiac functions were monitored with appropriate instrumentation. Arterial blood NO levels were examined at baseline, at the end of 1 min chest compression and at 15, 30, 60 and 120 min after survival. Repeated measures analysis of variance was used to determine statistical significance between groups. Results During chest compression, the mean + stan-dard deviation coronary perfusion pressure was higher in the AG group (40±10 mmHg) than in the L-NAME group (34±8 mmHg; P =0.001) and was higher in both groups with the control group (20±5 mmHg; both P =0.000). Left ventricular + dp/dtmax and- dp/dtmax were higher in the AG group than in the L-NAME group. In the surviving rabbits, the left ventricular + dp/dtmax and - dp/dtmax were higher in the AG and L-NAME groups than in the epinephrine and control groups and were higher in the AG group (4783±912, 4409±827 mmHg/s)than in the b-NAME group (3554±847, 3398±764 mmHg/s; P = 0.001 and 0.023, respectively). Conclu-sions Both AG and L-NAME increased the coronary perfusion pressure, and improved left ventricular systolic and diastolic function during CPR and prevented post-resuscitation myocardial dysfunction. However, AG was signifi-canfly superior to L-NAME.

Objective To investigate the effects of exogenous IGF- Ⅰon apoptosis, bax,bcl-2 and caspase-3 gene mRNA transcription in intestinal mucosal epithelial cell of SAP rats. Method Seventy-two male Wistar rats were randomly divided into sham operation group (SO),SAP group(SAP) and IGF-Ⅰ treatment (SAP + IGF-Ⅰ) group.Every group was randomly divided into 3 time units (6,12,24 h),8 rats as each time unit. SAP was induced in the rats by injecting adversely 5.0 % sodium taurocholate into biliary-pancreafic duct. The SO rats were infused with NS by the same way. The rats in IGF-Ⅰgroup were injected with IGF-Ⅰ by subcutano at half an hour before operation and three hours after operation,respectively. Animals in each group were killed separately at 6,12 and 24 hours after operation.The apoptosis in mucesal cells of small intestine was detected by TUNEL, and histo pathological changes of the small intestine was observed. The expressions of bax and bcl-2 and caspase-3 mR-NA gene in small intestine were measured by reverse transcription polymerase chain reaction(RT-PCR). Results Compared with the SAP group,the serum amylase were lower in IGF-Ⅰ group,and there existed significant at 12 h and24 h (P < 0.05).The pathological score of small intestinal was significantly reduced in IGF-Ⅰ group com-pared with SAP group,and there were statistical differences at 12 h and 24 h.ln IGFo-Ⅰ group,the apoptosis index of intestinal epithelial decreased significantly compared with SAP group[6 h: (13.88±1.73) vs. (19.00±2.78) ;12h:(10.13±1.55) vs. (17.63±.60);24 h:(9.50±1.07) vs. (17.25±2.76)] (P <0.05); the histopathdogical changes were more improved compared wit SAP group under the electronic microscope; the expres-sion of bax mRNA [6 h:(1.35±0.18) vs.(0.85±0.12);12 h:(1.21±0.21) vs. (0.86±0.24);24 h:(1.14±0.24) vs. (0.95±0.22)] and caspese-3 mRNA[6 h:(0.78±0.01) vs. (0.55±0.04);12 h:(0.79±0.04) vs. (0.57±0.05) ;24 h: (0.81±0.06) vs. (0.55±0.01) (P < 0.01)] were higher in three time units in SAP group than those in SO group (P < 0.01) ,and in IGF-1 group it was weakened significantly compared with the SAP group at each time point (P <0.05). bcl-2 mRNA expression was weak and have no difference between the SO group and SAP group (P > 0.05), but increased signifycantly in the IGF-± group at each time point [6 h:(0.65±0.07) vs. (0.54±0.04) vs. (0.57±0.06);12 h:(0.69±0.04) vs. (0.56±0.05) vs. (0.53±0.05);24h:(0.72±0.05) vs. (0.54±0.07) vs. (0.58±0.08)] (P <0.05). Conclusions Exogenous IGF-Ⅰ could rivalry SAP induced apoptosis to mucosal cells of small intestine , then could alleviate SAP induced injury to intestinal mucosal, It may be associated with the mechanisms that IGF-Ⅰ could improve the expression of bcl-2 mRNA and inhibit the expression of bax,caspase-3 mRNA.

Objective To study the change of CD4+ CD25+ Foxp3high regulatory T cells (Treg cells) and the molecules associated with Treg cells in different immune status in infant with sepsis, and to further clarity the pathogenesis of disturbed immune function in infant with sepsis. Method Totally 36 sepsis infants admitted in In-tensive Care Unit of Shenzhen Children' s Hospital from May 2007 to November 2007 and 16 age-matched healthy infants were collected for prospective study, after excluding autoimmune disease, immunodeficiency, inherited metabolic disorders, tumor, and drug-treatment that could affect immune function during lately 6 months. The study was approved by Ethics Committee of Shenzhen Children's Hospital. The 36 infants with sepsis were divided into two groups according to expression levels of HLA-DR in CD14-positive cells: DR-H group was defined as patients with HLA-DR > 30%, while DR-L group was defined as patients with HLA-DR < 30%. Expression levels of HLA-DR in CD14-positive cells and the proportion of Treg cells were analyzed by flow cytometry. Real-time PCR were used to evaluate the mRNA levels of Foxp3, CTLA-4,GITR, and IL-10 in CD4-posidve ceils. Statistical analysis was performed by one-way Anova. There was statistical difference with P < 0.05. Results The proportion of Treg cells in DR-L group was found to be significantly higher than that in healthy control or DR-H group (P <0.05).Compared with healthy control group or DR-H group, transcriptional levels of Foxp3, CTLA-4 and IL-10were significantly increased in DR-L group (P <0.05). The levels of GITR mRNA in DR-L group were detected to be higher than those in DR-H group (P < 0.05). Conclusions Aberrant increased proportion of Treg cells may be associated with suppressed immune status in infant with sepsis.

Objective To evaluate protective effects of hypothermic pulmonary protective solution with uli-nastatin on lung function during cardiopulmouary bypass (CPB) in the patients with congenital heart disease(CHD) and pulmonary hypertenion. Method Fifty-four children,who had CHD of left-to-fight shunts with moderate-se-rious pulmonary hypertension, were enrolled. They had been performed with the radical operation under CPB from September 2005 to December 2006 in the Department of Cardiovascular Surgery, Children' s Hospital of Zhejiang University. Moderate-serious pulmonary hypertension was defined as pulmonary-to-systolic pressure ratio > 0.45(Pp/Ps > 0.45). Fifty-four children were randomly divided into three groups. Patients in group A (n = 18)didn't receive pulmonary protective solution, and scrved as control; patients in group B (n = 18) were adminis-tered with pulmonary protective solution without ulinastatin;patients in group C (n = 18) were administered with pulmonary protective solution with ulinastatin. The serum concentrations of MDA and MPO were measured at five different time points:pre-operation, 0 h, 3 h, 6 h and 24 h in the intensive care unit (ICU) (T1～5). Patients'lung functions were monitored at T1 - T4. The time of mechanical ventilation was recorded. Results No one died in this study. The mean time of mechanical ventilation was shorter in the group B and group C than that in the group A. The MDA and MPO levels were lower in group B compared with group A at T4. The MDA level at T3-T5 and the MPO level at T4 was lower in group C than those in group A. There were no significant in MDA and MPO levels between group B and group C at five time point.A-aDO2 was lower in groups B and C than those in group A at T3 and T4, whereas at T4, A-aDO2 was lower in group C than that in group B. Cdyn was higher in group B at T3and group C at T3 - T4 than those in group A. Cdyn was lower in groups C than that in group B at T4.Condusions Lung perfusion with hypothermic protective solution during CPB can all lung injury and promote recovery after operation, especialy with ulinastatin.