Early prognostication of neurological outcome in comatose survives after cardiopulmonary resuscitation,an essential component of post-cardiac arrest care is significantly meaningful in both clinical and economic fields.From the perspectives of predictors based on neurological examination,electroencephalogram,evoked potentials,neuroimaging and blood biomarkers and taking advantage of therapeutic hypothermia into consideration,this article reviews the development in evaluation of neurological outcome in comatose survives after cardiac arrest.

At present,nutrition therapy plays a very important role in critically ill children,which can impact on the development and outcome of the disease by the process of metabolism and immunity.Immune-modulating nutrients,such as glutamine,which is a current hot topic,but now there is a little research in it in critically ill children,and this paper summarizes the approach,the dose and the efficacy of glutamine in critically ill children,aiming to offer reference in clinics.

Objective To analyze the epidemic characteristics of mushroom poisoning incident in order to find the regularity of outbreak and provide the fundamental guidelines of prophylaxis,control,diagnosis and treatment.Methods According to the reported information from the Management Information System of Public Health Emergency in China mainland,the area-time distribution of mushroom poisoning incidents from 2004 to 2014 was analyzed,and the descriptive analysis of mushrooms poisoning incidents including causes,places,occupation of victims and incidents identification were made from 2010 to 2014.Results In China (excluding Hong Kong,Macao and Taiwan),the top five provinces of mushroom poisoning incidents were Yunnan,Guizhou,Sichuan,Guangxi and Hunan.The epidemic peak was reached in summer-autumn season.The major and significant incidents accounted for 76.56％ of overall mushroom poisoning incidents,and the fatality rate of 3 701 patients accounted for 21.24％ (786 deaths).The causes were mistaking poisonous mushrooms as edible mushrooms or purchasing poisonous mushrooms in the market by accident.About 87.50％ incidents happened at home.Farmers,workers,children and students were easily subjected to mushroom poisoning because of their large range of activities,strong curiosity and lacking related ability for distinguishing edible mushroom from poisonous mushrooms.No identification was done in 200 mushroom poisoning incidents from 2010 to 2014,which accounted for 92.59％ of mushroom poisoning incidents in the corresponding period.Standard species identification was carried out only in two poisonous mushroom incidents.Conclusions Mushroom poisoning incident was one of the most important causes of death in per-oral poisoning incidents.It should to cope with surveillance and meticulous management during high prevalence season and in high-risk provinces.At the same time,it should be strengthened to train doctors and health professionals with the knowledge of identification of mushroom poisoning in key areas as well as to develop the health promotion of mushrooms poisoning prevention.

Objective To study the establishment of rat model of asphyxia-cardiac arrest and efficacy of CPR in order to find the length of optimum time of asphyxia to cause injury.Methods One hundred and twenty-six male Sprague-Dawley rats were randomly (random number) divided into sham operation group and experimental groups.Cardiac arrest was induced by asphyxiation after intravenous injection of vecuronium bromide.The experimental groups were assigned into AP4 (four-minute asphyxia period),AP6 and AP8 subgroups in accordance with different lengths of time of asphyxia subjected to.In these groups,CPR,including pre-cordial compression and synchronized mechanical ventilation,was initiated 4,6 and 8 min after asphyxia-induced cardiac arrest,respectively.The successful ratio of resuscitation and hemodynamic variables were recorded.Brain water content,neural deficit scores (NDS),imaging changes on MR,pathological changes of brain tissue and neuronal apoptosis were evaluated at 1 d,3 d and 7 days after ROSC.All the data were analyzed by single-factor analysis of variance or Chi-square test.P ＜ 0.05 was considered statistically significant.Result The lowest NDS occurred at 1 d after ROSC,brain water content and imaging changes on MR were most obvious at 3 d after ROSC,while pathological changes of brain tissue and neuronal apoptosis increased and reached the peak at 7d after ROSC.The survival rates after 24 hours of AP4,AP6 and AP8 groups were 85％,75％ and 45％,respectively.The rate of ROSC and survival rate of AP8 group were significantly lower than those of other groups (P ＜0.01).The longer time of asphyxia the severer pathological changes of brain tissue,brain edema,neural deficit,and magnetic resonance imaging changes in all experimental groups.As compared to other groups,the brain damage index of AP8 group was most serious,while that of AP6 group was moderate.Conclusions The rat model following asphyxia-induced cardiac arrest and cardiopulmonary resuscitation was established successfully.From the evidence of survival rate and damage grade of brain tissue,asphyxia for 6 min may be the rational length of ischemic time in this model.

Objective To investigate a reproducible model of severe crush injury (CI) in rats.Methods A total of 50 clean grade male SD rats were randomly (random number) divided into 5 groups.Both hindlimbs of anesthetized rats were compressed by blocks weighing 3.5 kg,for 6 hours and followed by 3 hours of reperfusion on a specially notched device (group SP,n =10),ordinary compression (group NM,n =10) and simple control (group SHAM,n =10).Arterial tension,serum lactate,and potassium (K+),serum myoglobin (MB),aspartate transferase (AST) and alanine transferase (ALT),BUN and Cr were measured at 10 minutes after cannulaton,and 3 hours after release from compression.Muscles and kidneys were evaluated morphologically.Group D and E were treated in the same way and were observed for 72 h to get the survival rate of the NM group and the specially notched compression group.The SPSS 17.0 statistical software was used for statistical analysis,repeated-measures ANOVA analysis for the differences between groups,Kaplan Meier-estimator for survival analysis.Results The Specially notched compression produced a greater increase in serum lactate (F =39.626,P ＜ 0.05),AST (F =24.965,P ＜ 0.05),ALT (F =19.096,P＜0.05),BUN (F=7.938,P＜0.05),CR (F=14.787,P＜0.05) and MB (F=16.840,P ＜0.05) by the end of experiment than NM group and simple control group.The direct cellular damage and ischemia-reperfusion injury were found under microscope.In crush injury caused by specially notched compression there was acute tubular necrosis found at 24 hours after injury.Mortality rate in the NM group was 20％,whereas mortality rate reached 90％ in rats with specially notched compression (P ＜0.05).Conclusions It successfully developed a severe crush injury model in experimental rats,suggesting it is worthwhile to popularization.

Objective To observe the impact of hypoxia/reoxygenation on myocardial cytoskeletal proteins (α-actinin protein,tubulin protein,desmin protein) and to investigate EPO lessening the damage of myocardial cytoskeleton proteins in rats proved by culturing hypoxia/reoxygenation injured myocardial cells in presence of EPO.Methods The rat model of asphyxia-induced cardiac arrest was performed by turning-off the ventilator and clamping the endotracheal tube.After asphyxia for 8 minutes,CPR was carried out.A total of 24 rats were divided into normal group,ischemia/resuscitation (I/R) group and the EPO group (n =8).The model of myocardial dysfunction was determined 2 hours after restoration of spontaneous circulation (ROSC).The rats of EPO group were given EPO 5000 U/kg after ROSC.The rat heart specimens were collected.Actinin,Tubulin and Desmin protein were observed by SABC immunohistochemistry.The cultured cardiomyocytes were taken from neonatal rats and were divided into three groups:the normal group,the hypoxia/reoxygenation (H/R) group (hypoxia 10 h/reoxygenate 4h),the EPO group (hypoxia 10 h/reoxygenate 4 h,plus 10 U/mL EPO).The changes of tubulin and actinin in cultured cardiomyocytes were observe by Immunofluorescence.Results From immunohistochemistry,there were no significant difference in the optical density of actinin,tubulin and desmin among the normal,I/Rand EPO groups.After H/R injury,the structures of the actinin,tubulin protein were destroyed,the network structure of both protein were unclear in cultured myocardial cells.The grades of fluorescence intensity of actinin and tubulin in H/R group were significant lower than those in normal group,but there was no significant difference between H/R group and EPO group.Conclusions The damage of cytoskeleton during ischemia/reperfusion may be time-dependent.EPO has no beneficial effect on the cytoskeleton after I/R injury.

Objective To study the clinical significance of early changes in cerebral oxygen and glucose metabolism in patients with cerebral hemorrhage and with Glasgow coma score (GCS) of 5-8 caused by acute hypertension in order to find relationship between those changes and prognosis.Methods From January 1,2011 to June 30,2012,a cohort of 43 patients with cerebral hemorrhage caused by acute hypertension were enrolled for retrospective study.Radial artery and internal jugular vein were separately cannulated retrogradely for collecting blood for blood gas analysis and blood glucose tests carried out 24 hours after the onset of the cerebral hemorrhage and then every 6-8 hours and as any major changes in physical signs of patients occurred.And this monitoring kept for consecutive 3 days.The data of these laboratory findings were analyzed and calculated to determine internal jugular vein oxygen saturation (SjVO2),cerebral oxygen utilization rate (CEO2),cerebral arterio-venous oxygen difference (AVDO2),arterio-venous blood glucose difference (V-Aglu),arterio-venous lactic acid difference (V-Alac) and absolute value of carbon dioxide pressure difference between jugular vein and artery (V-APCO2).All patients met the diagnostic criteria of hypertensive cerebral hemorrhage revised by the 4th National Academic Conference on cerebrovascular disease in 1995 requiring diagnosis confirmed by brain CT,admitted within 24 hours of onset,Glasgow coma score (GCS) 5-8 and a history of hypertension.Exclusion criteria were:cerebral hemorrhage caused by traumatic intracranial hematoma,spontaneous subarachnoid hemorrhage,arteriovenous malformation and Moyamoya disease,intracranial tumor apoplexy,cerebral bleeding derived from the disturbance of blood coagulation system,and cerebral hemorrhagic infarction.According to the short-term prognosis,the patients were divided into the death group and the survival group.Then the differences in biomarkers mentioned above between two groups were compared to find the relationship between levels of those biomarkers and outcomes of patients.Thereafter,the results of this retrospective study inspired us to carry out a prospective and double blind study in another 23 patients from July 2012 to January 2013 for further confirming the validity of these biomarkers to predict the short-term outcomes of patients.The statistical analysis was performed with SPSS 16.0 software (SPSS,USA) and a P ＜ 0.05 was considered significant.Numerical values were given as means ± SD unless stated otherwise.For statistical analyses,normality was assessed before choosing the relevant comparative test and nonparametric tests was used in cases as the normality test failed.Results Of 43 patients with cerebral hemorrhage for retrospective analysis,there were 27 male and 16 female with M/F ratio =1.7:1,aged from 49 to 81 with mean 66.2 ± 15.3 years and their GCS scores were 5-8.of them,there were 28 patients suffered from basal ganglia hemorrhage,6 cerebella hemorrhage,5 pons cerebelli hemorrhage and 4 lobe hemorrhage.There were 25 patients with supratentorial hematoma in volume of no less than 30 mL and 10 infratentorial hematoma in volume of no less than 10 mL of them,11 patients were treated with craniotomy and evacuation of hematoma or decompression craniotomy and rest were treated with conservative strategy.Compared with the death group,the CEO2,AVDO2,V-AGlu,V-ALac in the survival group decreased significantly (P ＜ 0.05),while V-APCO2 and SjvO2 increased significantly (P ＜ 0.05).In the subsequent prospective study,the accuracy rate of the levels of SjvO2 ＜ 52％,AVDO2 ＞ 83％ for predicting prognosis was 78.3％.Conclusions The cerebral oxygen and glucose metabolism was obviously abnormal in hypertensive cerebral hemorrhagic patients with GCS score of 5-8 among the death group,and especially the anaerobic metabolism was apparently increased.It was also found that the risk threshold (SjvO2 ＜ 52％,AVDO2 ＞83％) was in close relationship with patients'death expectation.

Objective To investigate the effects of aggressive dosing of atorvastatin on the expression of SOCS1 in CD4 + Tlymphocytes from patients with unstable angina pectoris during peri-operative period of PCI.Methods A cohort of 50 patients with unstable angina pectoris were randomized (random number) to give pretreatment with either an aggressive dose (80 mg/d,n =25) or a routine dose (20 mg/d,n =25)of atorvastatin.Circulating CD4 +T cells were subsequently obtained prior to PCI,and also 18 h to 24 hours after PCI,using a magnetic cell sorting system (MACS).Fluorescence-based quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure expressions of SOCSI mRNA in the isolated CD4 + Tlymphocytes,and western blot analysis was used to detect levels of SOCS1 protein.Serum levels of IFN-γwere quantified using enzyme-linked immunosorbent assays (ELISAs).Results Compared with routine dose group,the expressions of SOCS1 mRNA and protein levels were dramatically increased and those were higher in aggressive dose group following PCI (P ＜ 0.05).In contrast,serum levels of IFN-γsignificantly increased following PCI in both groups,but it was higher in routine dose group than in aggressive dose group (P ＜ 0.05).Conclusions Treatment with aggressive dosing of atorvastatin reduced the post-PCI myocardial inflammatory response in patients with unstable angina pectoris,possibly modulating by up-regulating SOCS1 expression in CD4 + Tlymphocytes.

Objective To compare the clinical efficacy and safety of sublingual nifedipine,intravenous urapidil and micropump nitroglycerin in the treatment of APH (acute postoperative hypertension).Methods A retrospective study was conducted to analyze clinical data of 497 patients with AHP undergoing tumor resection from July 2007 through December 2010.Patients received antihypertensive treatment for APH; hypertension occurred within 24 hours after surgery; patients received no long-acting antihypertensive agents within 24 hours.Patients with a previous history of coronary heart disease,arrhythmia,stroke and incomplete clinical data were excluded.All patients were divided into three groups.Nifedipine group,10 mg nifedipine tablet was administered sublingually; urapidil group,12.5 mg of urapidil was diluted in 20 ml normal saline and administered by intravenous injection; nitroglycerin group,25 mg of nitroglycerin was diluted in 40ml normal saline and infused intravenously by a micropump.The x2 test was employed to compare the efficacy and safety among different treatment.Results Treatment with sublingual nifedipine caused a reduction of the systolic blood pressure by 5.8％,and diastolic blood pressure by 4.7％.Treatment with intravenous urapidil caused a reduction of the systolic blood pressure by 11.1％,and diastolic blood pressure by 8.4％.Treatment with micropump nitroglycerin caused a reduction of the systolic blood pressure by 13.1％,and diastolic blood pressure by 10.2％.There is not different between intravenous urapidil and micropump nitroglycerin (63.4％ vs 57.8％,P =0.506).Intravenous urapidil and micropump nitroglycerin were associated with a significantly higher rate of blood pressure control than sublingual nifedipine (63.4％ vs 33.3％,P =0.000; 57.8％ vs 33.3％,P =0.001).The frequency of cardio-cerebrovascular events in intravenous urapidil group was similar to that in sublingual nifedipine group (6.9％ vs 4.7％,P =0.345),but it was significantly higher in micropump nitroglycerin group compared with intravenous urapidil group and sublingual nifedipine group.(24.4％ vs 6.9％,P =0.001 ; 24.4％ vs 4.7％,P =0.000).Conclusions Considering therapeutic effect and safety,we concluded that intravenous administration of urapidil was more suitable for the treatment of APH compared with sublingual nifedipine and micropump nitroglycerin.

Objective To study the effects of large dose anisodamine (654-2) combined with ulinastain on severe acute pancreatitis (SAP).Methods 100 healthy adult SD rats which were fasted 12 hours before experiment and were allowed drinking water freely,were divided to 5 groups randomly (random number):normal control group,SAPgroup,SAP + Ulinastain group,SAP + Anisodamine group,SAP +Ulinastain + Anisodamine,there were 20 rats in every group.To observe the levels of diastase,phospholipase A2 (PLA2) and endotoxin and pathology of rats in every group.Another cohort of 60 SD rats were divided into 3 groups:SAP group,SAP + Ulinastain group,SAP + Ulinastain + large dose Anisodamine group,survival periods were observed.Results The levels of diastase,PLA2 and endotoxin in SAP rats were higher than those in 3 SAP with treatment groups (P ＜ 0.05).The histopathological changes were most severe in SAP group.All of 3 markers in 3 SAP with treatment groups decreased obviously,and anisodamine alone was effective to treat SAP,but the effect of UTI + 654-2 was better than UTI or 654-2 alone,and histopathological changes were mild in this group treated with UTI + 654-2.Conclusions Anisodamine could effectively relax the Oddi sphincter thereby decreasing the hydrostatic pressure inside the bile duct and pancreatic duct.Ulinastain is a kind of proteinase inhibitor suppressing many kinds of enzymes and in tern to stabilize lysosomal membrane and inhibit the release of lysosomal enzyme.Combination of the large dose Anisodamine with Ulinastain could inhibit the overexpression of inflammationarv factors in SAP,thereby lessening the severity of viscera injury.