AIM: Determination of total alkaloids in Dendrobium nobile Lindl.METHODS: Dried materials were subjected to exhaustive extraction with ethanol: water (9:1,v/v) under reflux.Following filtration and condensation,the residue was dissolved in 3% hydrochloric acid and filtered.The solution was refined using a strongly acidic cation exchange resin column through sequential elution.After elution of deionized H2O,the eluent with 50% of alcoholic plus 5% of ammonia was collected until alkaloids were completely desorbed and evaporated under reduced pressure.The test sample was obtained.The test sample was dissolved in glacial acetic acid and titrated with perchloric acid titrand(0.1 mol/L) with automatic titrator.The herb should contain alkaloids,calculated as dendrobium(per 1ml of perchloric acid titrand is equivalent to 26.3 mg dendrobium).RESULTS: The results of three batches of material were 0.85% ,0.63% ,1.03% respectively.CONCLUSION: The method is convenient,fast,effective and reliable.Automatic potentiometric titration can be used for determination of alkaloids in Dendrobium nobile Lindl.

Objective To establish a swine model of 10 min prolonged cardiac arrest (CA) induced by electrically triggered ventricular fibrillation,and then evaluate the quality of the model and the value in the establishment of post-cardiac arrest syndrome.Methods Fourteen domestic healthy swine weighing 38 ±3 kg were selected for study.Ventricular fibrillation was induced for 10 min,and then cardiopulmonary resuscitation (CPR) was initiated and continued for 5 min.The resuscitated animals were observed for 72 h after resuscitation.The resuscitation outcomes and survival rate were recorded.The functions of heart,lung and brain,and systemic inflammatory response and tissue perfusion were regularly evaluated for 72 h post-resuscitation.Results Eleven of the fourteen swine obtained restoration of spontaneous circulation (ROSC),and the rate of successful resuscitation and 72 h survival were both 78.6％.Significantly worse post-resuscitation myocardial function was found in all animals compared to the value prior to CA and the myocardial function was evaluated by decreased stroke volume and global ejection fraction,and increased levels of serum cardiac troponin-Ⅰ and n-terminal pro brain natriuretic peptide.Postresuscitation extra-vascular lung water index and pulmonary vascular permeability index were significantly increased accompanied with significantly decreased oxygenation index compared with the values before CA,indicating the occurrence of acute lung injury.In addition,post-resuscitation systemic inflammatory response and tissue low perfusion evidenced by significantly higher levels of serum tumor necrosis factor-α and interleukin-6 and arterial blood lactate were observed.Consequently,severe neurological deficit with significantly higher levels of serum neuron-specific enolase and S-100B was observed following 72 h postresuscitation.Conclusions This swine model of prolonged cardiac arrest induced by electrically triggered ventricular fibrillation was a well established model with high success rate of resuscitation,significant vital organ injury and relatively long duration of survival;it is an excellent model for the study of post-cardiac arrest syndrome.

Objective To investigate the effects of limb ischemic post-conditioning (LIpostC) alone or its combination with therapeutic hypothermia (TH) on systemic inflammatory response and lung injury after cardiac arrest (CA) and resuscitation. Methods Twenty-one healthy male pigs weighing (37±2) kg were randomly divided into 3 groups (n = 7 each): control group, LIpostC group, and LIpostC+TH group. The animal model was established by 10 minutes of untreated CA and then 5 minutes of cardiopulmonary resuscitation (CPR).Coincident with the start of CPR, LIpostC was induced by four cycles of 5 minutes of limb ischemia followed by 5 minutes of reperfusion in the LIpostC and LIpostC+TH groups. After successful resuscitation, TH was implemented by surface cooling to reach a temperature of 32-34℃ until 4 hours post-resuscitation, followed by a re-warming rate of 1 ℃/h for 4 hours in the LIpostC+TH group. Normal temperature was maintained in the control and LIpostC groups. The resuscitation outcomes in each group were recorded during CPR. At 15 minutes prior to CA (baseline) and during 4 hours post-resuscitation, the level of arterial lactate was measured and PaO2/FiO2 was calculated, and extra-vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were measured meanwhile by a PiCCO monitor. At 15 minutes prior to CA (baseline) and during 24 hours post-resuscitation, the levels of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured by enzyme linked immunosorbent assay (ELISA). Results Six animals in each group were successfully resuscitated. Coronary perfusion pressure (CPP), duration of resuscitation, number of shocks and epinephrine dosage during CPR were not statistically significant among the three groups. The baseline of arterial lactate, PaO2/FiO2, EVLWI, PVPI and cytokines prior to CA were also not statistically significant among the three groups. The levels of serum TNF-α and IL-6 after resuscitation were gradually increased in all the three groups; however, the values of TNF-αand IL-6 were significantly lower in the LIpostC and LIpostC+TH groups than that in the control group, and they were further decreased in the LIpostC+TH group when compared to the LIpostC group [TNF-α (ng/L): 305±22 vs. 343±26 at 4 hours, 350±29 vs. 389±18 at 24 hours; IL-6 (ng/L): 239±14 vs. 263±19 at 24 hours, all P < 0.05]. The levels of lactate reached the peak at 2 hours post-resuscitation and then gradually decreased in all the three groups; it finally returned to the baseline in the LIpostC and LIpostC+TH groups, which was markedly lower than that in the control group (mmol/L: 1.4±0.7, 1.2±0.3 vs. 3.1±1.7, both P < 0.05). During 4 hours post-resuscitation, PaO2/FiO2 was significantly higher and EVLWI and PVPI were markedly lower in the LIpostC and LIpostC+TH groups than that in the control group; additionally, PaO2/FiO2 and EVLWI were further improved in the LIpostC+TH group than the LIpostC group [4-hour PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 391±26 vs. 361±20; 4-hour EVLWI (mL/kg): 10.1±1.5 vs. 12.1±1.2, both P < 0.05]. Conclusion LIpostC can be used to alleviate systemic inflammatory response and lung injury after porcine CA and CPR, and its combination with TH further enhanced its protective effects.

Objective To explore the role of resolvin D1 in reducing brain injury after porcine cardiopulmonary resuscitation and its potential mechanisms.Methods Twenty-eight male domestic pigs weighing (36 ±3)kg were utilized.The animals were randomly divided into 4 groups (n =7 each):sham operation group (group S),cardiopulmonary resuscitation group (group CPR),low-dose resolvin D1 gToup (group LRD),and high-dose resolvin D1 group (group HRD).The animals in group S only got the general preparation without the procedure of cardiac arrest and resuscitation.The pig model was established by 8 mins of untreated ventricular fibrillation and then 5 mins of cardiopulmonary resuscitation.At 5 min post-resuscitation,the doses of resolvin D10.3 μg/kg,and 0.6 μg/kg were correspondingly injected via the femoral vein in LRD and HRD groups,and meanwhile the same amount of vehicle was given into the animals inthe other two groups.At 3 h,6 h and 24 h post-resuscitation,the concentrations of neuron specific enolase (NSE) and S100B protein (S100B) in serum was measured.At 24 h post-resuscitation,neurological deficit score (NDS) was evaluated;thereafter the pigs were sacrificed,and cerebral cortex was obtained for the determination of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6),and malondialdehyde (MDA) contents,and superoxide dismutase (SOD) activity.Results Compared to group S,post-resuscitation brain injury was observed in the other three groups,which was indicated by significantly increased NDS score,and markedly elevated concentrations of serum NSE and S100B.Compared to group CPR,the NDS was significantly decreased at 24 h post-resuscitation,and the concentrations of serum NSE and S100B were significantly reduced at 6 h and 24 h post-resuscitation in LRD and HRD groups.Compared to group LRD,the NDS score and its serum markers were further significantly decreased in group HRD.The inflammatory response and oxidative stress in brain tissue were observed in all the animals experiencing cardiac arrest and resuscitation,which were indicated by increased contents of TNF-α,IL-6 and MDA and decreased SOD activity.Compared to group CPR,the contents of TNF-α,IL-6 and MDA were significantly decreasedwhile SOD activity was significantly increased in LRD and HRD groups.The indicators of inflammatory response and oxidative stress in brain tissue were further significantly improved in group HRD when compared to group LRD.Conclusions Resolvin D1 can reduce post-resuscitation brain injury in a dose-dependent manner in swine,and the mechanism is related to the inhibition of inflammatory response and oxidative stress.

OBJECTIVE: To investigate the change of pathogen distribution and antibiotic resistance of pathogens isolated from in-patients with hospital acquired pneumonia (HAP) in the Department of Respiratory Medicine Intensive Care Unit (RICU) of Xiangya Hospital in 2005 and in 2011, and to provide reasonable anti-infectious strategy. METHODS: The positive susceptibility test of sputum (bronchial secretions) culture was done in patients with HAP in RICU of Xiangya Hospital in 2005 and in 2011, and the distribution feature and antibiotic resistance were compared. RESULTS: 1) In the two years, the main pathogen in HAP patients was Gram negative bacteria (infection rate was 68.07% and 65.21% in 2005 and in2011 respectively). The primary pathogenic bacteria were changed, and Acinetobacter baumanii became the most common Gram negative bacterium which replaced Pseudomonas aeruginosa, with infection rate 6.81% in 2005 to 40.87% in 2011. The infection rate of Pseudomonas aeruginosa reduced from 20.42% in 2005 to 15.60% in 2011. Haemophilus influenzae was rare. Staphylococcus aureus became the primary Gram positive bacteria, and its infection rate increased from 1.57% in 2005 to 4.83% in 2011, all of which were methicillin-resistant Staphylococcus aureus (MRSA). Saccharomyces albicans' positive culture rate increased significantly. 2) Compared with in 2005, the antibiotic resistance of pathogen isolated from the HAP pationts changed a lot in 2011: increased antibiotic resistance rate and decreased sensitivity to many antibiotics. Pseudomonas aeruginosa was only relatively susceptible to meropenem, cefoperazone sulbactam, ceftazidime, cefpodoxime, and andamicaxin in 2011. The resistance rate of Pseudomonas aeruginosa to levofloxacin, cyclopropane, amicacin, gentamicin, meropenem, cematrixone, and piperacilintazobactam increased obviously (P<0.05). Compared with 2005, Acinetobacter baumanii was totally susceptible to polymyxin and relatively susceptible to sulbactam, but it was almost completely resistant to Aminoglycoside antibiotics in 2011, with significant difference (P<0.01). CONCLUSION The main pathogen of HAP patients in RICU was Gram negative bacteria, with increased infection rate of Staphylococcus aureus and fungus. There is change pathogen distribution and antibiotic resistance, and the clinical initial experimental antibiotic therapy may be influenced. It is important to use antibiotics more rationally to delay the antibiotic resistance.
Acinetobacter baumannii ; drug effects ; isolation & purification ; Cross Infection ; microbiology ; Drug Resistance, Bacterial ; Female ; Gram-Negative Bacteria ; drug effects ; isolation & purification ; Humans ; Intensive Care Units ; Male ; Methicillin-Resistant Staphylococcus aureus ; drug effects ; isolation & purification ; Pneumonia ; etiology ; microbiology ; Respiratory Tract Diseases ; complications ; Saccharomyces ; drug effects ; isolation & purification ; Staphylococcus aureus ; drug effects ; isolation & purification

Objective To observe the effect of optimized nursing procedure on the emer-gency treatment of patients with acute myocardial infarction(AMI).Methods A total of 35 AMI patients in the observation group implemented optimized nursing procedure to conduct rescue and nursing.Delicacy Management was optimized and the nurses were conducted optimized nursing procedure.Afterwards,it was continuously improved according to the efficacy evaluation.And du-ration of stay in emergency department,satisfaction of patients towards nurses as well as satisfac-tion of doctors towards nurses in the control group implemented traditional nursing process with 35 patients and the observation group were analyzed.Results Length of emergency stay of the obser-vation group was significantly shorter than that in the control group and the doctors’satisfaction towards nurses was significantly higher than that in the control group(P <0.05).Conclusion Optimized nursing procedure in emergency treatment of AMI patients can standardize nursing and improve the nursing efficiency and nursing quality.

Objective To observe the effect of optimized nursing procedure on the emer-gency treatment of patients with acute myocardial infarction(AMI).Methods A total of 35 AMI patients in the observation group implemented optimized nursing procedure to conduct rescue and nursing.Delicacy Management was optimized and the nurses were conducted optimized nursing procedure.Afterwards,it was continuously improved according to the efficacy evaluation.And du-ration of stay in emergency department,satisfaction of patients towards nurses as well as satisfac-tion of doctors towards nurses in the control group implemented traditional nursing process with 35 patients and the observation group were analyzed.Results Length of emergency stay of the obser-vation group was significantly shorter than that in the control group and the doctors’satisfaction towards nurses was significantly higher than that in the control group(P <0.05).Conclusion Optimized nursing procedure in emergency treatment of AMI patients can standardize nursing and improve the nursing efficiency and nursing quality.

OBJECTIVETo assess the value of stent-assistant angioplasty for intracranial vascular diseases.

METHODSThirteen patients with intracranial vascular diseases were treated consecutively by stent-assistant angioplasty for different purposes. Of these patients 7 had symptomatic intracranial artery stenosis, 3 intracranial wide-neck aneurysms, 2 intracranial pseudoaneurysms, and 1 bilateral transverse sinus stenosis. Clinical procedures and technical data of the patients were retrospectively analyzed.

RESULTSIn the 7 patients, the degree of intracranial artery stenosis reduced from 83% to 5%. Three months after the operation they exhibited good patency of stented lesions. Intracranial wide neck aneurysms (with 2 pseudoaneurysms) were successfully embolized with GDC in 5 patients. The patients with bilateral transverse sinus stenosis were implanted a self-expanded stent in the right transverse sinus. One patient failed because of the tortuous configuration of the left jugular bulb, but the patient's symptoms were improved quickly after the procedure.

CONCLUSIONStent-assistant angioplasty is a useful technique for selected intracranial vascular diseases, and it needs further investigation.

Adult ; Angioplasty, Balloon ; methods ; Cerebrovascular Disorders ; therapy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

Objective To explore the application of work shop in health education in the rehabilitation period of cerebral infarction. Methods A total of 44 patients with cerebral infarction from January to June 2016 were selected as the observation group, they were given work shop in health education. Then 40 patients with cerebral infarction from July to December 2015 were selected as the control group,and they were given routine health education.The health knowledge mastery,rehabilitation and health education satisfaction were compared between two groups. Results The knowledge rate of health education knowledge in knowledge of disease medicine, placement of good limb position, limb function training,medication was respectively 97.37%(43/44),93.18%(41/44),95.45%(42/44),95.45%(42/44) in the observation group and 82.50%(33/40), 77.50%(31/40), 77.50%(31/40), 77.50%(31/40) in the control group, and the difference was statistically significant (χ2=4.01-5.94, P<0.05). The satisfaction of health education in health education skills,communication skills,service attitude was respectively 97.73% (43/44), 100.00%(44/44), 97.73%(43/44) in the observation group and 82.50%(33/40), 82.50%(33/40), 82.50%(33/40)in the control group,and the difference was statistically significant(χ2=4.01,6.27,4.01,P<0.05). The level of compliance, demand, compatibility score was (8.32 ± 1.34), (8.45 ± 1.21), (8.38 ± 1.29) points in the observation group and(5.89±1.74),(5.64±1.53),(5.76±1.35)points in the control group,the difference was statistically significant (t=2.42, 2.74, 2.35, P<0.05). Conclusions Work shop in health education can increase the health knowledge of patients in rehabilitation period of cerebral infarction,and improve the enthusiasm of health education and rehabilitation training satisfaction.

Objective To investigate the effects of therapeutic hypothermia (TH) on myocardial Ca2+/calmodulin-dependent protein kinase Ⅱ (CaMK Ⅱ) and cell autophagy after cardiopulmonary resuscitation (CPR) in swine.Methods Twenty healthy male domestic swine weighing 33-40 kg were randomly (random number) divided into 3 groups:sham group (n=4),CPR group (n=8) and TH group (n=8).Sham animals only underwent general preparation without experiencing cardiac arrest and resuscitation.The animal model was established by 8 min of electrically induced ventricular fibrillation and then 5 min CPR in the CPR and TH groups.Successful resuscitation was regarded as an organized rhythm with a mean arterial pressure of greater than 50 mmHg for 5 min or more.After successful resuscitation,body temperature was decreased to 33 ℃ by a cooling blanket and then maintained until 24 h post-resuscitation,and followed by a rewarming at a rate of 1 ℃/h for 5 h in the TH group.A normal temperature was maintained by the blanket throughout the experiment in the sham and CPR groups.At 6,12,24 and 30 h after resuscitation,the values of stroke volume (SV) and global ejection fraction (GEF) were measured by PiCCO,and meanwhile the serum concentrations of cardiac troponin Ⅰ (cTnI) were measured by ELISA assay and the serum activities of creatine kinase-MB (CK-MB) were evaluated by an automatic biochemical analyzer.At 30 h after resuscitation,the animals were sacrificed and left ventricular myocardium was obtained for the determination ofCaMK Ⅱ,microtubule-associated protein light chain 3 Ⅱ (LC3 Ⅱ) and p62 expressions by Western blot.The variables were compared with One way analysis of variance and then the Bonferroni test among the three groups.Results Compared with the sham group,myocardial dysfunction and injury after resuscitation were observed in the CPR and TH groups,which were indicated by decreased SV and GEF and also increased cTnI concentration and CK-MB activity in serum (all P＜0.05).Compared with the CPR group,the values of SV and GEF were significantly increased at 6 h after resuscitation,and serum cTnI concentration and CK-MB activity were significantly decreased starting 12 h after resuscitation in the TH group [SV (mL):25.0±6.9 vs 31.9±3.3 at 6 h,26.7±5.1 vs 34.6±3.7 at 12 h,28.8±3.3 vs 35.7±3.2 at 24 h,29.2±5.2 vs 36.7±3.3 at 30 h;GEF (％):17.1±2.7 vs 19.9±1.8 at 6 h,18.7±1.9 vs 21.6±1.8 at 12 h,19.3±2.3 vs 23.0±2.4 at 24 h,21.0±1.7 vs 23.7±1.7 at 30 h;cTnI (pg/mL):564±51 vs 466±56 at 12 h,534±38 vs 427±60 at 24 h,476±55 vs 375±46 at 30 h;CK-MB (U/L):803±164 vs 652±76 at 12 h,693±96 vs 557±54 at 24 h,633±91 vs 480±77 at 30 h,all P＜0.05].Tissue detection indicated that the expression of CaMK Ⅱ and LC3 Ⅱ were increased while the expression of p62 was decreased in post-resuscitation myocardium in the CPR and TH groups compared with the sham group (all P＜0.05).However,the expression of CaMK Ⅱ and LC3 Ⅱ were decreased and the expression of p62 was increased in postresuscitation myocardium in the TH group compared to the CPR group (CaMK Ⅱ:0.73±0.06 vs 0.58±0.05;LC3 Ⅱ:0.69±0.09 vs 0.50±0.07;p62:0.40±0.07 vs 0.68±0.14,all P＜0.05).Conclusion The mechanism of TH alleviating post-resuscitation myocardial dysfunction and injury may be related to the inhibition of CaMK Ⅱ expression and cell autophagy.