Cardiac arrest (CA) is an acute critical illness with the high occurrence in the world. The directions of cardiopulmonary resuscitation (CPR) development are to improve CA patients' survival rate and to decrease the poor prognosis. β-blockers can selectively block the neurotransmitter or receptor agonists. They offer beneficial pharmacological properties and have been widely used in the treatment of cardiovascular diseases. Based on the search result of the domestic and foreign medical databases, the usage of β-blockers including clinical research, animal experiments and clinical work of CPR patients was summarized. Finally, the CPR research progress of β-blockers in recent years was reviewed in the article.

Objective To investigate the epidemiological features of out-of-hospital cardiac arrest (OHCA) patients who are return of spontaneous circulation (ROSC) on scene. Methods According to Utstein style,we collected the clinical data of OHCA patients who are ROSC on scene from the pre-hospital on the call of 120 of Henan Provincial People ' s Hospital from January 2012 to December 2016. We analyzed the data by SPSS 20.0 software. Results Among a total of 29 patients were enrolled,9(31.03%)were ROSC ≥ 6h,and 20 (68.97%)were ROSC < 6 h. There were no significant difference in the two groups in patients' age,sex,arrest location,witnessed by bystander,bystander CPR,initial arrest rhythm,etiology,the use of epinephrine. None of patients were survival in the group of ROSC≥6 h. The average length of hospital stay was(44.15 ± 34.16)hours, while the shortest length of hospital stay was 12.08 hours and the longest length of hospital stay was 125.75 hours. The ratio of emergency response time to the return to hospital time were 4.55 min ± 2.46 min vs 6.45 min ± 3.60 min,P=0.014 in all patients. The emergency response time consumes more time. Conclusion The hospitalized survival rate of ROSC patients is low. The occurrence of OHCA needs early prevention. The short-term survival(6 h)is not affected by the patients' basic situation and the first-aid situation.

This paper introduces the perioperative nursing of 47 patients undergoing intraperitoneal parastomal hernia repair.After the surgery,two cases suffered from incision infection and two cases with subcutaneous hydrops.Three patients suffered from chronic pain or foreign bodies sensation,which disappeared at 3-6 months later.No recurrence occurred at 6-24 months after the surgery.It is suggested that the key points of perioperative nursing were careful preoperative symptom care and bowel preparation,as well as postoperative observation and correct discharge instruction.

Naphazoline,Diphenoxylate, Over-the-counter (OTC) cough and cold medications, widely used for the symptomatic relief of nasal obstruction, diarrhea or common cold symptoms. But these medicines might cause poisoning even if utilized in recommended doses for treatment. The side effects of these medicines were neglected when they were used much more commonly. The clinical manifestation of these medicine poisoning were delitescence and children' s parents couldn't provide the whole history, so these medicine poisoning were often misdiagnosis, even lead to treatment failure. We explore the toxicities of these medicines ,discuss their mechanisms and clinical manifestation, and suggest why physicians should be more vigilant in specifically inquiring about them when evaluating an ill child.

0 05) between the two procedures in incidence of anastomotic leakage (25 0% vs 10 7%), pulmonary infection rate (31 3% vs 32 1%), incide nce of thoracic cavity infection (0 vs 3 6%), proportion of re-thoracotomy (0 vs 3 6%), incidence of d elayed gastric emptying (3 1% vs 21 4%), postoperative SICU stay (4d?2 3d vs 5d ?3 6d), and peri-operative mortality (3 1% vs 7 1%). The incidence of recurr ent laryngeal nerve injuries (28 1% vs 7 1%, ? 2=4 391,P =0 036) and arr hythmia (43 8 % vs 17 9%, ? 2 =4 627, P =0 031) in the THE Group were significantly higher than those in the TTE Group, while the intra-operative blood loss in the THE Group was signif icantly less than that in the TTE Group ( t = -3 100, P =0 003).ConclusionsVideo- assisted THE is a safe procedure. With the increase of the experience, the incid ence of post- operative complications is subject to further decrease.

Objective To compare the histopathologic and immunohistochemical differences between primary renal cell carcinomas and paired bone metastases in order to discuss the significance in the selection of standard targeted therapies.Methods The clinical data of 19 patients who underwent nephrectomy and resection of bone metastases successively from January 2003 to September 2013 were analysed retrospectively.The paraffin-embedded surgical samples of all the patients were obtained for histopathologic and immunohistochemical analysis.The differences of Fuhrman grades,expression of Ki-67,CD34,vascular endothelial growth factor receptor 2 (VEGFR2),epidermal growth factor receptor (EGFR) and CXC subfamily receptor 4 (CXCR4) were compared between primary renal cell carcinomas and their paired bone metastases.Microvessel density (MVD) was evaluated by the CD34 immunostaining.Results The Fuhrman grades of samples from bone metastases were higher than that of primary tumors (36.8％,7/19) (P=0.008).The Ki-67 label index was (4.00±3.96)％ in primary tumors and (7.90±7.38)％ in bone metastases (P=0.033).The microvessel density (MVD) was 58.13±22.90 in primary tumors and 46.71±25.40 in the bone metastases (P=0.026).The immunohistochemistry scores of VEGFR2 were 4.68±1.20 in primary tumors and 4.05±1.58 in bone metastases (P=0.014).The immunohistochemistry scores of EGFR were 5.89±1.05 in primary tumors and 5.47± 1.12 in bone metastases (P=0.134).The immunohistochemistryscores of CXCR4 in cytomembrane and cytoplasm were 1.74±1.97 in primary tumors and 2.16± 1.64 in bone metastases (P=0.414).The inununohistochemistry scores of CXCR4 in cell nucleus were 2.52±2.09 in primary tumors and 3.42±1.95 in bone metastases (P=0.009).Conclusions The Fuhrman grades and the expression of Ki-67 and CXCR4 in cell nucleus were higher in bone metastases than that in the primary renal cell carcinomas.The MVD and the expression of VEGFR2 were lower in bone metastases than that in the primary tumors.The above alternations may contribute to the poor prognosis of bone metastasis and the poor result of angiosuppressive therapy.

Purpose　To investigate whether thoracotomy can induce lung injury in the operative side and the protection by ambroxol in this procedure.　Methods　24 patients with esophageal carcinoma who were performed esophagectomy with anastomosis over the arcus aortae were randomized into 2 groups:an ambroxol group (ambroxol 1 g iv gtt qd×3,preoperatively) and a controlled group without any respiratory medication.General anesthesia by tracheo-cannula combined with continuous epidual anesthesia were used in all the patients.Bilateral broncho-alveolar lavage(BAL) was carried out after intubation preoperatively and before removal of the cannula postoperatively.Total Phospholipid(TPL),Saturated Phosphaytidylcholine(SatPC) and Total protein(TP) in the BALF were measured.The ratio of SatPC/TPL and SatPC/TP represented the activity of PS.　Results　In the controlled group,SatPC/TPL and SatPC/TP of the left lung(operation side) showed significant difference(P<0.05),compared with the right side(non-operation side).In the ambroxol group,no significant difference of such ratio was showed.　Conclusions　Thoracotomy can induce lung injury and bring out the decrease of PS and increase of protein exudation in the operative side.Large dose of ambroxol can promote in synthesize and secretion of PS and protect those changes.

Objective: : To explore the effect of PD-1 gene knockout by CRISPR/Cas9 system on the proliferation and IFN-γ secretion in human T cells. Methods: : The sequence of sgRNA targeting PD-1 was designed. The PD-1-sgRNA and Cas9 mRNA were synthesized by T7 RNApolymerase in vitro, and then the mixture of PD-1-sgRNAand Cas9 mRNAwas delivered into activated T cells by nucleofection. The efficiency of gene knockout was confirmed by sequencing. The phenotypes of T lymphocytes and the expression of PD-1 after gene knockout were analyzed by Flow cytometry. The proliferation of T lymphocytes was calculated by trypan blue counting. The level of IFN-γ secreted by T lymphocytes was detected by ELISA. Results： ：PD-1-sgRNA and Cas9 mRNA were successfully synthesized in vitro and delivered into T cells by nucleofection. Sequencing technology confirmed that the PD-1 gene sequence was edited and the editing efficiency was 58.3%. The expression of PD-1 on T lymphocyte surface was down-regulated successfully by CRISPR/Cas9 system [(9.6±1.85)% vs (16.2±2.05)%, P<0.05]. The knockout of PD-1 gene did not affect the proliferation and phenotype of T lymphocytes(P<0.05); However, compared with the control group, the level of IFN-γ secreted by T lymphocytes in the PD-1sgRNA group was significantly increased (P<0.01). Conclusion: : CRISPR/Cas9 system can successfully ablate PD-1 gene in human T lymphocytes, which could block the negative regulation of PD-1／PD-L1 and further promote the IFN-γ secretion in T cells.

Objective Gastrointestinal dysfunction is closely correlated with the impairment of intestinal barrier caused by serious infection.We focused on the role of platelet activating factor(PAF)in the intestinal impairment caused by endotoxemia by studying on the morphology of intestinal epithelial ceils and diamine oxidase (DAO)levels with the application of Ginkgolide B(PAF receptor antagonist).Method Eighteen-day-old Wistar rats were randomized into lipopolysaccharide(LPS)(5 mg/kg),PAF receptor antagonist(pretreatment and treatment)and normal saline(Control)groups(n=8 at each time point).Ginkgolide B(PAF receptor antagonist BN52021)5 mg/kg was administered 30 minutes before(in pretreatment group)and after LPS injection(in treatment group).The ileum specimens(n=8)were harvested at 1.5,3,6,24,48 and 72 hours after LPS or NS injection.The ultrastructures of intestinal epithelial cells were studied by transmission electron microscopy (TEM)and with hematoxylin and erosin staining.The contents of DAO in ileum tissue and plasma were measured respectively with spectrophotometer.According to data Normality and Variance equality,ANOVA analysis and LSD (least significant difference)-t test were used for multiple group difference.The whole test Was performed in the animal laboratory,pathological laboratory,biochemical laboratory of our hospital and electron microscopy laboratory of Liao-ning University of Traditionary Chinese Medicine.Results Histologic examination of intestinal injury in LPS group showed the edema of intestinal villi,the capillary congestion in lamina propria,the dilation of interstitial lymphatic vessel.and the polymorphonuclear infiltration in enteric cavity in LPS group at 1.5,3,6,24 hours.The edema of the intestinal villi were shown in antagonist group.Ultrastructural study showed microvilli and tight junctions were intact in the control group.The tight junctions enlarged and the microvilli were thin,rare or disrupted in the experimental group.The pathological changes in PAF antagonist group were slightly lighter than that in the LPS group.The DAO content in the ileum tissue was obviously decreased in the LPS group compared with that in the control group.It reached to a nadir at 6 hrs[from(0.172±0.004)U/mg to(0.096±0.010)U/mg,F=13.372,P＜0.01).The DAO content in plasma was obviously higher in the LPS group than that in the control group.The patterns of DAO changes in the PAF antagonist group were as the same as that in the LPS group at each time point.Conclusions PAF may play a certain role in the injury of intestinal barrier in endotoxemia.Preventive and remedial administration of Ginkgolide B may relieve intestinal injury.The activity changes of DAO in plasma synchronized with that in ileum tissue.It may be deduced that the alterations of DAO in plasma may indicate the destruction of intestinal mucosa in the early stage sensitively.

Objective To investigate experience in nursing the patients with emergency traumatic injury combined with postoperative atelectasis. Method The clinical data of 11 patients with emergency traumatic injury combined with postoperative atelectasis were reviewed for summarizing the nursing experience. Result The clinical symptoms of all the 11 patients disappeared and the lungs reexpanded. Conclusion Careful observation of the disease conditions in order to prevent and treat atelectasis by airway humidification, sputum drainage and early exercises are effective for the cure of postoperative atelectasis.