To investigate the efficacy of amiodarone and lidocaine in cardiac arrest patients.

We searched the PubMed, Embase, Cochrane Library, and Web of Science databases through to January 1, 2024. All studies comparing lidocaine, amiodarone, and placebo for cardiac arrest were included. Meta-analysis was performed, and the primary outcome was survival to hospital discharge. Secondary outcomes was survival to 24 h or hospital admission.

Three RCTs and seven non-randomized intervention studies were included. Compared with placebo, amiodarone can improve the likelihood of survival to 24 h/hospital admission (OR=1.32, 95% CI: 1.12-1.54) in RCTs, while this significance was not found in non-randomized intervention studies (OR=0.79, 95% CI: 0.39-1.61). In both RCTs and non-randomized intervention studies, amiodarone did not significantly improve discharge survival rate compared with placebo (OR=1.19, 95% CI: 0.98-1.44 and OR=1.14, 95% CI: 0.44-2.99). Lidocaine was more effective than placebo in improving both survival to 24 h/hospital admission (OR=2.36, 95% CI: 1.47-3.80) and discharge from hospital (OR=2.10, 95% CI: 1.21-3.64) in non-randomized intervention studies. Amiodarone showed no significant difference in improving survival to 24 h/admission to hospital compared with lidocaine in RCTs, while amidoraone was inferior to lidocaine in improving 24 h/admission survival rate (OR=0.72, 95% CI: 0.53-0.98) and discharge survival rate (OR=0.81, 95% CI: 0.76-0.87)in non-randomized intervention study.

Limited RCTs directly compared amiodarone and lidocaine. No significant difference was found between amiodarone and lidocaine in improving 24 h/admission survival rate in RCTs. While compared to amiodarone and placebo, lidocaine can improve 24 h/admission survival rate and discharge survival rate in non-randomized intervention studies.

BACKGROUND:Sepsis is one of the main causes of mortality in intensive care units(ICUs).Early prediction is critical for reducing injury.As approximately 36%of sepsis occur within 24 h after emergency department(ED)admission in Medical Information Mart for Intensive Care(MIMIC-IV),a prediction system for the ED triage stage would be helpful.Previous methods such as the quick Sequential Organ Failure Assessment(qSOFA)are more suitable for screening than for prediction in the ED,and we aimed to find a light-weight,convenient prediction method through machine learning. METHODS:We accessed the MIMIC-IV for sepsis patient data in the EDs.Our dataset comprised demographic information,vital signs,and synthetic features.Extreme Gradient Boosting(XGBoost)was used to predict the risk of developing sepsis within 24 h after ED admission.Additionally,SHapley Additive exPlanations(SHAP)was employed to provide a comprehensive interpretation of the model's results.Ten percent of the patients were randomly selected as the testing set,while the remaining patients were used for training with 10-fold cross-validation. RESULTS:For 10-fold cross-validation on 14,957 samples,we reached an accuracy of 84.1%±0.3%and an area under the receiver operating characteristic(ROC)curve of 0.92±0.02.The model achieved similar performance on the testing set of 1,662 patients.SHAP values showed that the five most important features were acuity,arrival transportation,age,shock index,and respiratory rate. CONCLUSION:Machine learning models such as XGBoost may be used for sepsis prediction using only a small amount of data conveniently collected in the ED triage stage.This may help reduce workload in the ED and warn medical workers against the risk of sepsis in advance.

OBJECTIVE: To explore the genetic etiology of a child with D bifunctional protein deficiency (DBPD) born to a consanguineous pedigree. METHODS: A child with DBPD who was admitted to the First Affiliated Hospital of Hainan Medical College on January 6, 2022 due to hypotonia and global developmental delay was selected as the study subject. Clinical data of her pedigree members were collected. Peripheral blood samples of the child, her parents and elder sisters were collected and subjected to whole exome sequencing. Candidate variant was validated by Sanger sequencing and bioinformatic analysis. RESULTS: The child, a 2-year-and-9-month-old female, had featured hypotonia, growth retardation, unstable head lift, and sensorineural deafness. Serum long-chain fatty acids were elevated, and auditory brainstem evoked potentials had failed to elicit V waves in both ears with 90 dBnHL stimulation. Brain MRI revealed thinning of corpus callosum and white matter hypoplasia. The child's parents were secondary cousins. Their elder daughter had a normal phenotype and no clinical symptoms related to DBPD. Elder son had frequent convulsions, hypotonia and feeding difficulties after birth, and had died one and a half month later. Genetic testing revealed that the child had harbored homozygous c.483G>T (p.Gln161His) variants of the HSD17B4 gene, for which both of her parents and elder sisters were carriers. Based on the guidelines from the American College of Medical Genetics and Genomics, the c.483G>T (p.Gln161His) was rated as a pathogenic variant (PM1+PM2_Supporting+PP1+PP3+PP4). CONCLUSION The homozygous c.483G>T (p.Gln161His) variants of the HSD17B4 gene caused by the consanguineous marriage probably underlay the DBPD in this child.
Female ; Humans ; Pedigree ; Muscle Hypotonia ; Hearing Loss, Sensorineural ; Protein Deficiency ; Mutation

Objective:To analyse the changes in color Doppler and contrast-enhanced ultrasound (CEUS) blood flow parameters in patients with septic acute kidney injury (AKI) from the perspective of macroscopic circulation and microscopic circulation perfusion, in order to explore the value of clinical application of ultrasound in this disease.Methods:A total of 53 ICU-admitted patients diagnosed with septic AKI at the Second Affiliated Hospital of Soochow University from January 2021 to May 2022 were selected.Patients with septic AKI were classified into stages 1-3 according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI diagnostic criteria, with stage 1 being the mild group(17 cases), stages 2 and 3 being the severe group(21 cases), and septic patients without AKI in the same period being the control group(15 cases). The ultrasound parameters such as the relative blood flow(RBF) and time-averaged velocity(TAV) of the renal artery as well as the cardiac output (CO) and cardiac index (CI) in the macroscopic circulation were measured, and the time-intensity curve was analysed by the CEUS analysis software to calculate the microscopic parameters such as time to peak(TTP), rise time(RT), fall half time(FHT) and mean transit time(MTT), and the cardiac output and cardiac index were also measured. The differences in ultrasound Doppler and CEUS parameters among the various groups were compared. The diagnostic effectiveness of each parameter for severe AKI was assessed using ROC curve analysis.Results:①In macrocirculation, the renal blood flow (RBF) and time-averaged velocity (TAV) gradually decreased ( P=0.004, P<0.001) as the disease progressed in AKI patients. But the difference of CO and CI among the three groups were not statistically significant in each group ( P=0.17, 0.12). ②In microcirculation, the renal interlobar artery Doppler parameters pulsatility index (PI), resistance index (RI), and systolic/diastolic flow ratio (S/D) gradually increase in patients with septic AKI ( P<0.05) and the CEUS parameters TTP, RT, FHT and MTT were prolonged ( P<0.001, P=0.003, P=0.004, P=0.009). ③The combined diagnosis of RI and TTP was more beneficial in diagnosing septic AKI in critically ill patients [AUC=0.93(0.85-1.00)]. Conclusions:Color Doppler ultrasound combined with CEUS can detect reduced macroscopic and microscopic circulation in patients with septic AKI, especially in those with severe AKI, and this is independent of changes in CO or CI.

A 77-years-old female patient presented gross hematuria for one week, and CT showed a mass in the left kidney. Ureteroscopy detected a left renal mass. Laparoscopic nephroureterectomy was performed and pathology showed the tumor was mainly located in the renal parenchyma, with glomeruli around the tumor cells. Urothelium showed no obvious dysplasia or clear migration of tumor cells. Considering both the clinical symptoms, and squamous cell carcinoma not detecting in other locations of the patient, primary renal parenchyma was confirmed. Three months after surgery, CT detected recurrence in the operating area, with metastasis to the adjacent abdominal cavity and aorta lymph node.

Objective To investigate the clinicopathological characteristics and prognosis of patients with Borrmann type Ⅳ gastric cancer. Methods A cohort retrospective analysis of 2386 patients with gastric cancer who underwent radical surgery was used to screen out Borrmann type Ⅳ patients, and analyze their clinical features and prognostic factors. Results Among 2386 patients with gastric cancer, 363 cases (15.21%) were Borrmann type Ⅳ. Compared with non-Borrmann type Ⅳ gastric cancer patients, Borrmann type Ⅳ patients had higher rates of simultaneous liver metastasis, metachronous liver metastasis, lymph node metastasis and vascular infiltration. Moreover, the age of onset tended to be younger and the pathological type tended to be poorly differentiated-undifferentiated (all P < 0.05). The 5-year OS of the entire group was 49.32% and the 5-year DFS was 44.61%. There were significant differences in 5-year OS and DFS between Borrmann type Ⅳ and non-Borrmann type Ⅳpatients (all P < 0.001). The subgroup analyses showed that there were statistically significant differences in 5-year OS and DFS of gastric cancer patients between Borrmann type Ⅳ and non-Borrmann type Ⅳ in pT2-pT4a and pN0-pN3a stages (all P < 0.005). Multivariate analysis showed that the poorly differentiated-undifferentiated tumor, the T4a-pT4b stage of tumor invasion depth, lymph node metastasis, the ⅢA-ⅢC pTNM stage of the tumor, postoperative liver metastasis and peritoneal metastasis were independent risk factors affecting the prognosis of Borrmann type Ⅳ gastric cancer patients (all P < 0.05). Conclusion Borrmann type Ⅳ gastric cancer is prone to liver metastasis, lymph node metastasis, peritoneal metastasis and poor prognosis, and it's prognosis is affected by a variety of independent risk factors.

The coronavirus disease 2019 (COVID-19) pandemic is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is spread primary via respiratory droplets and infects the lungs. Currently widely used cell lines and animals are unable to accurately mimic human physiological conditions because of the abnormal status of cell lines (transformed or cancer cells) and species differences between animals and humans. Organoids are stem cell-derived self-organized three-dimensional culture in vitro and model the physiological conditions of natural organs. Here we showed that SARS-CoV-2 infected and extensively replicated in human embryonic stem cells (hESCs)-derived lung organoids, including airway and alveolar organoids which covered the complete infection and spread route for SARS-CoV-2 within lungs. The infected cells were ciliated, club, and alveolar type 2 (AT2) cells, which were sequentially located from the proximal to the distal airway and terminal alveoli, respectively. Additionally, RNA-seq revealed early cell response to virus infection including an unexpected downregulation of the metabolic processes, especially lipid metabolism, in addition to the well-known upregulation of immune response. Further, Remdesivir and a human neutralizing antibody potently inhibited SARS-CoV-2 replication in lung organoids. Therefore, human lung organoids can serve as a pathophysiological model to investigate the underlying mechanism of SARS-CoV-2 infection and to discover and test therapeutic drugs for COVID-19.
Adenosine Monophosphate/therapeutic use* ; Alanine/therapeutic use* ; Alveolar Epithelial Cells/virology* ; Antibodies, Neutralizing/therapeutic use* ; COVID-19/virology* ; Down-Regulation ; Drug Discovery ; Human Embryonic Stem Cells/metabolism* ; Humans ; Immunity ; Lipid Metabolism ; Lung/virology* ; RNA, Viral/metabolism* ; SARS-CoV-2/physiology* ; Virus Replication/drug effects*

Objective To research the role of hypothalamocerebellar histaminergic projections in somatic‐visceral integration of rats .Methods A total of 120 SD rats were randomly divided to 6 groups :group A - F ;which separately microinjected saline (group A) ,triprolidine(selective antagonist of H1 receptor ,group B) ,2‐PyEA(selective agonist of H1 receptor ,group C) ,ranitidine (selective antagonist of H2 receptor ,group D) ,dimaprit (selective agonist of H2 receptor ,group E) and histamine (group F) to the deep nuclei of rats .The abilities of rats somatic‐visceral integration were observed when hypothalamocerebellar histaminergic pro‐jections were obstructed or enhanced compared to group A .Results The somatic‐visceral integration of rats were obstructed obvi‐ously in group D and enhanced in group E & group F compared to group A ,while group B and group C had no differences compared to group A .Conclusion Hypothalamocerebellar histaminergic projections play a key role in somatic‐visceral integration through the way of H2 receptors .

OBJECTIVETo explore the effect of prophylaxis on youth's chronic mountain sickness(CMS) who moved to an altitude of above 5 000 meters by long-term oxygen therapy (LTOT).

METHODSNinety-six male youth stationed at 5 070 m, 5 200 m and 5 380 m took oxygen continuously by nasal cannula (LTOT group) every body per day. One year later, epidemiological survey were carried out according to the international CMS diagnostic criteria consist of examining right ventricle end-diastolic dimension (RVED), right ventricular anterior wall (RVAW), right ventricular outflow tract (RVOT), main pulmonary artery (MPA), left ventricular end systolic diameter (LVSD) by ultrasonic diagnostic apparatus, and blood test of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (gamma-GT), creatine kinase (CK), lactate dehydrogenase (LDH), superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO), nitric-oxide synthase (NOS) blood oxygen saturation (SaQ2). Then, they were compared with 91 males in the same group stationed at the same altitude (without any interventions, control group).

RESULTS(1) The epidemiological survey showed that, SaO2 were increased significantly (P < 0.05) and the prevalence rate of CMS were decreased compared with that of control group (P < 0.05). (2) Echocardiography showed that SOD, NO, NOS were increased (P < 0.05 or 0.01) and LVSD, MPA had no significant difference compared with that of control group (P > 0.05). (3) Biochemical index showed that, SOD, NO, NOS were increased (P < 0.05 or 0.01), MDA, ALT, AST, LDH were decreased (P < 0.05 or 0.01) and gamma-GT, CK had no significant difference compared with that of the control group.

CONCLUSIONAt high altitude, LTOT can reduce lipid peroxidation, improve the important organ injuries caused by hypoxia and protect the mitochondria respiratory function and play an important role on the prevention of chronic mountain sickness.

Adolescent ; Adult ; Altitude Sickness ; blood ; prevention & control ; Humans ; Male ; Oxygen ; administration & dosage ; therapeutic use ; Oxygen Inhalation Therapy ; Young Adult

OBJECTIVETo explore the effects of iptkalim on myocardial enzymes and free radicals metabolism with hypoxic pulmonary hypertension (HPH), in order to provide evidence for the mechanism of iptkalim on clinical treat.

METHODS110 young men stayed at high altitude above 5 000 m were divided into iptkalim group (n = 74) and placebo group (n = 36), aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (gamma-GT), creatine kinase (CK), lactate dehydrogenase (LDH), superoxide dismutase (SOD), malonaldehyde (MDA), nitric oxide(NO) and nitric oxide synthase(NOS) were detected before and after took medicines for 6 mouths.

RESULTSAfter took medication for 6 mouths, ALT, AST, gamma-GT, CK and LDH were reduced, SOD, NO, and NOS were increased, MDA were reduced, there were very significant difference (P < 0.05).

CONCLUSIONOxygen free radicals have taken part in the process of HPH, iptkalim have the effect of anti-peroxidation of lipid and protect myocardial cells stress injured by hypoxia which related with mitochondrial membrane and cell membrane's K(ATP) channel activation.

Adolescent ; Adult ; Altitude ; Creatine Kinase ; blood ; Free Radicals ; metabolism ; Humans ; Hypertension, Pulmonary ; blood ; etiology ; metabolism ; Hypoxia ; complications ; L-Lactate Dehydrogenase ; blood ; Male ; Myocardium ; enzymology ; Potassium Channels ; agonists ; Propylamines ; pharmacology ; Young Adult