The cerebral resuscitation is the most important aim in advanced cardiopulmonary cerebral resuscitation (CPCR). Cerebral function protection after cardiac arrest (CA) is important to improve survival rates including those after the discharge. Therapeutic mild hypothermia maybe the only method that can improve neurological function of patients following resuscitation after CA, which was recommended as one of treatment strategies for unconscious patients after successful resuscitation in 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Although there are many cooling methods of inducing hypothermia, each has some advantages or shortcomings. There were many controversies on the choice, which need further research. We make a summary and analysis about the mechanism of therapeutic mild hypothermia, the possible complications at different stages and the clinical application of mild hypothermia, such as the evaluation before therapeutic mild hypothermia and the choice of hypothermia protocol and cooling methods, to provide guidance for clinical mild hypothermia therapy.

Adolescent ; Anemia, Aplastic ; complications ; therapy ; Anemia, Hemolytic ; chemically induced ; complications ; Antilymphocyte Serum ; adverse effects ; therapeutic use ; Female ; Humans

BACKGROUND:Methicil in-resistant Staphylococcus aureus has been a primary pathogen of nosocomial infections worldwide. To construct a quick and easy knockout method is an important technique of studying virulence and resistance of methicil in-resistant Staphylococcus aureus. OBJECTIVE:To construct the Staphylococcus aureus gene knockout plasmid for understanding the antibiotic resistance and virulence of Staphylococcus aureus. METHODS:pUC19 was considered as a basic skeleton of construction. pLE194Ts temperature-sensitive replicon and tetracycline resistance gene fragment pHY300PLK plasmid in pCL52.1 were bound to EcoR I site in pUC19 by high assurance amplification. Al multiple clone sites in pUC19 were reserved. The Escherichia coli-Staphylococcus aureus shuttle plasmid was obtained. The N315 dapB gene knockout plasmid was obtained through gene knockout technology. This strain was eventual y identified by multiplex-PCR. RESULTS AND CONCLUSION:The Escherichia coli-Staphylococcus aureus shuttle plasmid, pYZ1 and pYZ8, was successful y constructed, and had been used in Staphylococcus aureus gene knockout. Homologous recombinant plasmid pYZ-ΔdapB was constructed by restriction enzyme digestion and overlap technique. After genetical y modification in RN4220, the constructed gene knockout plasmid pYZ-ΔdapB was introduced to N315 to be screened in the low culture temperature. The deletion strain was successful y obtained after being identified by multiplex-PCR. Above data suggested that pYZ1 and pYZ8 can be successful y used for Staphylococcus aureus gene detection, which provides a tool to study resistance and virulence of clinical Staphylococcus aureus strains.

Objective To evaluate the efficacy of fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in treatment of twin-twin transfusion syndrome (TTTS) and to investigate the incidence of TTTS complicated with selective intrauterine growth restriction (sIUGR) for better understanding the effects of sIUGR as a complication of TTTS on pregnancy outcomes. Methods A retrospective study was performed on 116 gravidas who were diagnosed with TTTS of Quintero stage Ⅰ - Ⅳ in Peking University Third Hospital from September 2008 to September 2014. Among them, 44 cases received FLOC therapy. The incidences of sIUGR in each Quintero stage of TTTS were analyzed. Pregnancy outcomes of those 44 cases treated with FLOC were observed and the differences among four stage groups were analyzed. Chi-square or Fisher exact test was performed for statistical analysis. Results (1) The survival rates of both twins from stage Ⅰ to Ⅳ groups were 4/7, 10/14, 5/19 and 3/4, respectively, with statistically significant difference (χ2=7.840, P=0.038), but that in stage Ⅲ group was lower than in stage Ⅱ group without significant difference (P'=0.008). Differences in the total fetal survival rate among the four groups were statistically significant [8/14, 75% (21/28), 32% (12/38) and 6/8, χ2=14.016, P=0.002]. The total fetal survival rate in stage Ⅲ group was significantly lower than that in stageⅡ group (P'<0.008). In patients with stage Ⅲ TTTS, those complicated with sIUGR, after receiving FLOC therapy, showed a lower total fetal survival rate than those without sIUGR [21% (6/28) vs 6/10, P<0.05]. (2) Among the 116 TTTS patients, there were 63 cases (54%) with sIUGR complication. Patients with sIUGR complication in TTTS stages Ⅰ to Ⅳ groups accounted for 40% (14/35), 48% (11/23), 78% (28/36) and 46% (10/22), respectively, and the differences were significant (χ2=11.963,P=0.007). The incidence of sIUGR in stage Ⅲ group was greater than that in stage Ⅰ group (χ2=10.482, P'=0.002), and those in both stage Ⅲ and Ⅱ groups were higher than in stage Ⅰgroup without significant difference. Conclusions TTTS patients in stage Ⅲ have lower survival rate of both twins and total fetal survival rates after FLOC therapy, which may be related to a higher incidence of concurrent sIUGR.

Objective To investigate the clinical outcome and placental characteristics of spontaneous twin anemia-polycythemia sequence (sTAPS). Methods Twelve cases with sTAPS delivered in Peking University Third Hospital from May 2013 to August 2016. The data of ultrasound characteristics, gestational age at delivery, and 1 minute Apgar score were analyzed,retrospectively. Placental superficial vascular anastomoses, placental territory discordance and the ratio of umbilical cords insertion distance to the longest placental diameter were also analyzed. Results (1) Only 1 case of sTAPS was diagnosed prenatally, the others were diagnosed postnatally because the fetal middle cerebral artery(MCA) doppler was not measured regularly. Five cases were complicated with selective intrauterine growth restriction (sIUGR). The median gestational age at delivery was 32.8 weeks(31-37 weeks). The pregnancies were terminated because 3 cases were sIUGR typeⅠ, 1 case was sIUGR type Ⅱ, 1 case was sIUGR type Ⅲ, 2 cases were fetal distress, 2 cases were severe pre-eclampsia, 2 cases were premature rupture of membrane, 1 case was fetal hydrops with abnormal doppler waveforms of ductus venouses. (2) When 5 sIUGR cases were excluded, there was no difference between the twins in birth weight [1797 g(940-2620 g),1648 g(980-2500 g);P=0.688]. The hemoglobin (Hb) level in all donor was significantly lower than recipient(P=0.000)and the inter-twin Hb difference was 147.6 g/L (84.0-216.0 g/L). While the reticulocyte percentage in donor was significantly higher than recipient (P=0.013) and reticulocyte percentage ratio was 3.60 (1.04-7.50). Five donor newborns had neonatal asphyxia, including 1 severe asphyxia, while no asphyxia happened in the recipient twins. (3) Arterio-arterial (A-A) anastomoses, veno-venous (V-V) anastomoses, arterio-venous (A-V) anastomoses were found in 3, 1 and 11 placentas, respectively. The total number of anastomoses was 2 (1-5) and the total diameter was 1.1 mm (0.4-2.1 mm), including 0 (0-1) A-A anastomoses with 0.2 mm (0.0-0.9 mm) in diameter and 2 (0-5) A-V anastomoses with 0.7 mm (0.0-2.1 mm) in diameter. The placental territory discordance was 0.17 (0.02-0.40) and the ratio of umbilical cords insertion to the longest placental diameter was 0.82 (0.34-0.99). Conclusions The pathogenesis of sTAPS might result from slow and chronic blood transfusion from donor to recipient through a few minuscule vascular anastomoses in the placenta. In all monochorionic twins, especially sIUGR cases, MCA doppler should be monitored closely in the second and third trimester, in order to diagnose and manage sTAPS in time.

OBJECTIVE:To compare the difference of the information about smoking affecting pharmacodynamics and pharma-cokinetics in prescription drug instructions between US and China. METHODS:The US and Chinese guidance for drug R&D and drug instructions editing,prescription drug instructions were collected;the information about smoking affecting pharmacodynamics and pharmacokinetics were retrieved from FDA drug instruction official website DailyMed and Yaozhi Network in China up to Jun. 19th,2014. The difference in related regulations and drug instruction were compared between US and China. RESULTS & CON-CLUSIONS:The guidance issued by US and China require that great importance should be attached to the effects of smoking on pharmacodynamics and pharmacokinetics,and it must be noted in drug instructions. Of 62 857 drugs recorded,smoking affected pharmacodynamics and pharmcokinetics of 34 drugs in US drug instructions,among which 9 drugs needed dose modifications;for above drugs,Chinese drug instructions pointed out great importance should be attached to the effect of smoking on pharmacodynam-ics and pharmacokinetics of 6 drugs,and only one drug(erlotinid hydrochloride)needed to be modified. The label rate of smoking affecting pharmacodynamics and pharmacokinetics was relatively low in Chinese drug instructions compared to US. It is suggested that the regulatory agent should standardize and improve related description in drug instruction,correct unsuitable content,revise the items which may result in severe consequence,and set up official website which can provide all drug instructions as soon as possible. Drug manufacturers should standardize clinical study of drugs before marketing,focus on the scientificity,completeness and normalization of drug instructions.

Follicular lymphoma (FL) is a kind of indolent non-Hodgkin lymphoma (iNHL), which origins from follicle germinal center. Multiple researches reported the latest development about treatment of FL in the 58th American Society of Hematology (ASH) Annual Meeting. The outcomes of clinical trials in which GAl01 combined with chemotherapy and bendamustine in combination with 90Y-ibritumomab tiuxetan for the advanced stage FL were exciting. Relapsed/refractory FL patients who receive tandem autologous followed by nonmyeloablative allogeneic transplantation could acquire preferable remissions. With the emerging of novel drugs including inhibitor of bcl-2 or PI3K and antibody drug conjugate, more and more improvements of efficacy and remission were made in the treatment of relapsed/refractory FL therapy and remission.

Objective To compare the antineoplastic immunological effects of nanoemulsion-encapsulated MAGE1-HSP70 and SEA(the ratio of MAGE1-HSP70 fusion protein to SEA superantigen was 100∶1)as NE(MHS)vaccine as given in different routes,and try to look for a novel and effective immune route.Methods NE(MHS)was prepared using magnetic ultrasound methods,and the size,the encapsulation rate and the stability of the nanoemulsion vaccine were evaluated.C57BL/6 mice were immunized via p.o.,subcut.,i.v.,or i.p.route.The cellular immunocompetence was detected by ELISpot assay and LDH release assay.The therapeutic and tumor challenge assay were examined too.Results When the vaccine was given orally,the tumor masses formed 28 days after B16-MAGE1 inoculation in mice were markedly bigger than that formed in the mice of the other groups(P

[Objective]To modify posterior lumbar interbody fusion for improvement of convenient manipulation and safety in the operation,and solid fusion. [Methods]After total decompression of the spinal nerve through posterior medline approach,discectomy of the slipping segment was performed with a circular saw with diameter of 1.0 centmeter.Under direct visualization through the hole of the circular saw,the disc tissue including cartilage of upper and lower end plates was removed with a long handle curette.After pedicle screw and rod system was placed,a bone block harvested from the posterosuperior iliac with a circular saw with diameter of 1.2 centmeter was implanted into the intervertebral space.Then compression of the intervertebral space to catch the bone lock firmly was conducted by regulating and fixing the the pedicle screw and rod system.[Results]Forty-eight patients in this report were followed up from 6 to 24 months.Based on JOA low back pain score,there were 36 patients was in excellent result,8 in good and 4 in fair,the satisfactory rate was 91.67% and effective rate was 100%.[Conclusion]Using circular saws in posterior lumbar interbody fusion has advantagas of good visualization profit removing disc tissue,preventing neurovascular injuries,and making good bone grafting bed.Convenient and secure bone harvesting decrease blood loss,time consume during the operation and prevent donor site complication.Futhermore,follow up results of the patients in this report demonstrate that posterior interbody fusion with circular saw for treatment of lumbar spondylolisthesis have satisfactory outcome and high fusion rate.

Objective Two different transthoracic impedances were made with an adjustable impedance instrument to compare the success rate of defibrillation,heart and skin damage in a porcine model.Methods A total of sixteen pigs were randomly (random number) divided into two groups:low impedance group (about 50 Ω,n =8) and high impedance group (about 100 Ω,n =8).Defibrillation (recommended 150 J) was first attempted at 15 s after induction of ventricular fibrillation (VF).If spontaneous circulation was not recovered,2-minute chest compression and subsequent defibrillation attempts (maximum 200 J) were attempted.Model animal kept stabilization for 30 min after return of spontaneous circulation before induction of the next episode of VF,which was induced five episodes in each pig.Results In the low impedance group,VF was induced 39 times,39 of 43 attempted defibrillations were successful.In the high impedance group,VF was induced 40 times,40 of 70 attempted defibrillations were successful.The current and success rate of the first defibrillation were (34.9 ±3.2) A and 94.9％ respectively in the low impedance group,while those of the high impedance group were (19.1 ±2.1) A and 50％ respectively (both P ＜ 0.05).There were no significant differences in skin damage between two groups,but myocardial injury was lighter in the high impedance group.Conclusions Success rate of the first defibrillation with recommend 150 J obviously decreases with the increase of transthoracic impedance.The main factor of myocardial injury is current instead of the numbers of defibrillation.