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 analyze the projects funded by National Natural Science Foundation of China(NSFC) in the field of liver diseases during 2010 to 2014.Methods The projects in the field of liver disease were statistically analyzed regarding the subordinate branches and distribution of the applicants and registered institutions.Results 1.There were 624.4 projects and 321,839,200 yuans annual funded in the field of liver diseases; 2.The percentage of the key/major projects was lower than the average level; 3.Nearly half of the projects funded focus on the liver cancer; 4.19.03％ of registered institution got 80％ of funded projects.Conclusions With the continuous funding aid from NSFC,the fundamental research in this field has progressed significantly,especially in immunology.However,the overall research capacity still need to be further improved and the research direction need to be connected more closely to the clinical requirement to meet the translational medicine demand.

ObjectiveTo investigate the effect of anisodamine on the expression of connexin 43 (Cx43) in swine ventricular myocardium after resuscitation from cardiac arrest.Methods The experiment was conducted on healthy pigs, and they were randomly divided into three groups, namely sham group, epinephrine group (control group) and anisodamine group (experimental group, animals were resuscitated combined with injection of 0.4 mg/kg of anisodamine), with 5 pigs in each group. Model of ventricular fibrillation was reproduced by alternating current challenge, and cardiopulmonary resuscitation (CPR) was performed 8 minutes after cardiac arrest. Left ventricular myocardium was harvested at 24 hours after restoration of spontaneous circulation. The expression and distribution of Cx43 were observed by immunofluorescence, Cx43 mRNA expression was assessed with reverse transcription-polymerase chain reaction (RT-PCR), and the protein expressions of Cx43 and phosphorylation of Cx43 (p-Cx43) were analyzed by Western Blot.Results The positive expression of Cx43 in ventricular muscle was distributed uniformly, mostly at the end-to-end linkage of myocardial cells, with a few side-to-side linkage in sham group. The positive expression of Cx43 in control group was significantly weaker than that in the sham group, and the signal intensity was significantly declined (4.35±2.10 vs. 10.02±3.66,P< 0.01). The positive expression of Cx43 at the end-to-end linkage and side-to-side linkage was irregular in experimental group, and the signal intensity was obviously higher than that in the control group (7.91±2.54 vs. 4.35±2.10,P< 0.05), but it was significantly weaker than that in the sham group (7.91±2.54 vs. 10.02±3.66,P< 0.05). For control group and experimental group, the Cx43 mRNA and protein expressions were significantly lower than those of the sham group [Cx43 mRNA (A value): 0.32±0.05, 0.32±0.03 vs. 0.48±0.07; Cx43 protein (A value): 0.43±0.03, 0.50±0.07 vs. 0.65±0.04, allP< 0.01], and there were no significant differences between experimental group and control group (allP> 0.05). The p-Cx43 protein expression of control group was significantly lower than that of the sham group (A value: 0.22±0.03 vs. 0.37±0.06,P< 0.01), and it was significantly higher in the experiment group than that in the control group (A value: 0.29±0.07 vs. 0.22±0.03, P< 0.01), but there was no significant difference with the sham group (P> 0.05). No significant difference in p-Cx43/Cx43 was found among sham, control, and experiment groups (0.57±0.09, 0.51±0.05, 0.58±0.06, all P> 0.05).ConclusionAnisodamine can improve the abnormal expression of Cx43 in ventricular muscle of pigs with cardiac arrest, which may be related to the protection effect of anisodamine on cardiac conduction.

This paper presented the practice of performance evaluation at public hospitals in Wuhu.The performance evaluation system at public hospitals should emphasize public benefits,present a true picture of work and management performance,and help build the incentive and constraint mechanism.In addition,it should encourage public hospitals to strengthen management,improve quality of care and control health care costs.The system is designed for providing a safe,effective,convenient and inexpensive medical and health services for the people.