The possible roles of CD23 molecule on B cells were analyzed through cross—linking CD23 molecules on tonsillar B lymphocytes with CD23 natural ligands IgE and anti—CD23 McAb.After cross—linking CD23 molecules on activated B cells,the change of B cell proliferation and second messengers were observed.The results showed:(1)Double—valence anti—CD23 McAb and multi—valence IgE immune complex(IgEIC)had a two—way effect on B cellsproliferation,on high concentrations,they inhibited the proliferation of a etivated B cells by sAo In con trast with a certain lower concentration,they promoted the proliferation of activted B cells.The two—way effect depended on IL—4 which functions to up—regulate CD23;(2)mono —valence IgE had no observeable effects on B cells proliferation;(3)IgEIC and antl—CD23 McAb at the same concentration as stimulating B cell proliferation increased the intracellularCAMP levls,but not cGMP levels.(4)Anti—CD23 McAb provoked the transent increase of in tracellular free(Ca~(2+)).

The paper defines the quality of emergency medical care and analyzes its influencing factors from such angles as policy assurance, hospital support, organizational structure, cultivation of professional personnel, scientific management, interdisciplinary coordination, emergency care equipment, and the system of technological access. The goal is to improve the quality of emergency medical care so as to meet the needs of the broad masses of people for emergency medical care.

The Lazarus phenomenon is defined as delayed ROSC,or ROSC after failure of CPR and cessation of all the emergency medical care,including the cessation of chest compression,mechanical ventilation,and venous fluid resuscitation.It was first reported in 1982 and 53 cases of Lazarus phenomenon have been reported in the medical literature so far.Even though Lazarus phenomenon is rare and the pathophysiological mechanisms are poorly understood,several possible mechanisms are still proposed,which could be rational to explain this phenomenon,such as auto-PEEP,hyperkalemia,alkalosis,delayed action of drugs,etc.In most cases,it was reported that ROSC occurred within 10 minutes after cessation of medical effort.Therefore,before the announcement of death of patient,it is mandatory to monitor those patients for at least 10 minutes after the cessation of CPR.However,more explicit studies seem to be necessary to gain a better understanding of this phenomenon.

Objective To study the utility of inferior vena cava-collapse index (IVC-CI) for assessing fluid resuscitation for hypovolemic shock in order to look for better echocardiographic markers to assess patients' condition with hypovolemic shock,also to look for optimal guidance for the adjustment of the treatment for these patients.Methods A total of 40 patients with hypovolemic shock admitted to Emergency Department were enrolled for study.All patients were treated with 500 mL normal saline iutravenously as fluid resuscitation.The vital signs and echocardiographic findings before and after the treatment were documented.Comparison of data between pre-treatment and post-treatment was carried out.Results Of 40 patients,there were 23 male and 17 female with average age (50.00 ± 17.71) years.The time consumed for echocardiography examination was (8.68 ± 5.73) min,time required for establishing central line was (29.32 ± 8.06) min.Collapse index of inferior vena cava (IVC-CI) before and after treatment were (0.43 ± 0.16) and (0.38 ± 0.13),respectively.In hypovolemic shock group,the relationship of the peak velocity (Vpeak) of left ventricular outflow between before and after treatment was r =0.75,P =0.001.The relationship of the peak velocity of left ventricular outflow with left ventricular end diastolic volume (LEDV) before treatment was P =0.03 and after treatment was P =0.05.Conclusions (1) Between IVC-CI and the effectiveness of fluid resuscitation,there was no relationship.It was inappropriate to take IVC-CI as a marker for assessment.(2) Vpeak increased apparently after the fluid resuscitation.(3) Vpeak was proved to be associated with LEDV which supported that Vpeak is the indicator of left ventricular contractility.(4) Time consumed for echocardiography examination was shorter than that for establishing the central line in the group.

Ontology alignment technology is a knowledge engineering method to realize the concept and relationship integration of different ontologies.In view of the same scope of ontology,such as disease ontology,developed by researchers from a number of different areas or institutions of independent research and development,there is a big difference between the term expression and the concept of the relationship.Thus,how to achieve the integration of multi-source ontology through alignment processing has been recognized as a significant methodological problem.In this paper,the concept,technology,method and corresponding tool of ontology alignment were expounded at full length.The technique of ontology alignment based on linguistic features and structural features was emphasized.Combined with the two international disease ontology:Disease Ontology and Orphanet,the experiment and analysis of the technique of ontology alignment were carried out and detailed the application of alignment technology.Furthermore,for the existing multi-source problems on TCM ontology database,the necessity and application of ontology alignment were discussed.

Objective To evaluate the effects of aminoguandine(AG) used as a selective inhibitor of the inducible isoform of nitric oxide synthase(iNOS) and L NAME used as a non selective inhibitor of nitric oxide synthase(NOS) on severe hemorrhagic shock Methods Forty rabbits were bled to mean arterial pressure of 4 4 66 kPa via femoral artery Hypotention was maintained for 120 min, the shed blood was then returned, followed by an infusion with Ringer′s solutions Animals were randomly divided into three groups: hemorrhagic shock group (n=14), AG group (AG 20mg/kg was infused intravenously ,n=14), L NAME group (L NAME 30mg/kg was infused intravenously with ,n=12) Plasma levels of endotoxin, tumor necrosis factor(TNF?) and nitric oxide (NO) were determined before and after shock, immediately after resuscitation and 0 5h, 2h, 4h after resuscitation The 24h and 48h survival rates were recorded Lung, intestine, liver and kidney tissues were obtained 48 h after shock for microscopic examination Results The plasma endotoxin, TNF? and NO levels markedly increased and were kept at high levels after shock Lower plasma levels of endotoxin TNF? and NO, less tissue damages and high survival rates were observed in AG group as compared with those in L NAME group and shock group Conclusions The endotoxin,TNF? and NO play an important role in the development of irreversible shock AG is beneficial in the treatment of hemorrhagic shock, while L NAME does not improve the outcome of shock

Objeetive To investigate protective effect of trimetazidine on myocardial ischemia/reperfusion injury (MIRI) in rats.Methods Forty Wistar rats were randomly divided into MIRI group (n =10 rats),trimetazidine high-dosage group (n =10 rats; 20 mg/kg),trimetazidine low-dosage group (n=10 rats; 10 mg/kg),and the normal control group (n =10 rats).After MIRI,hemodynamic changes were observed,the concentration of IL-6 and TNF-α was determined,and the cardiac muscle histology under the microscope was observed.Results Hemodynamic studies:Compared to the indices LVSP(198 ±35.5) mmHg,LVEDP (17 ±9.18) mmHg,+ dp/dt max (11050 ± 1517.4) mmHg/s,and-dp/dtmax (9175± 1900) mmHg/s] in the sham-operated group,the indices [LVSP (143 ± 24.5) mmHg,LVEDP (37.5 ±7.16)mmHg,+ dp/dtmax (7450 ± 1755.1) mmHg/s,and-dp/dtmax (6075 ± 1641) Hg/S] in the MIRI group,the indices [LVSP (154.5 ± 31.1) mmHg,LVEDP (31.3 ± 12.6) mmHg,± dp/dtmax (8527.7 ±2251.5) mmHg/s,and-dp/dtmax (6694 ± 2242.2) mmHg/s] in the trimetazidine low-dosage (10 mg/kg)group,the indices[LVSP (168.3 ± 17.6) mmHg,LVEDP (28 ± 10.05) mmHg,+ dp/dtmax (9213.6 ±1747) mmHg/s,and-dp/dtmax (7568 ± 1462.4) mmHg/s] in the trimetazidine high-dosage (20 mg/kg)group,left ventricular remodeling end diastolic pressure (LVEDP),left ventricular systolic pressure (LVSP),and left ventricular pressure maxial rate of rise and fall (± dp/dtmax) were significantly decreased.Compared to the MIRI group,LVSP and ± dp/dtmax in the trimetazidine high-dosage (20 mg/kg)group were significantly increased (P ＜ 0.01),and myocardial damage of MIRI group was more severe in microscope.Compared to the sham-operated group [IL-6 (2556.5 ± 662.9) ng/ml,and TNF-α (134 ± 73.7)ng/ml],the corresponding indices [IL-6 (3664.0 ± 995.7) ng/ml,and TNF-α (443 ± 22.1) ng/ml] in the MIRI group,[IL-6 (3692.8 1545.2) ng/ml,and TNF-α (295 ± 24.2) ng/ml] in the trimetazidiue low-dosage (10 mg/kg) group,and[IL-6(2654.8 ±681.7) ng/ml,and TNF-α(230 ±7.8) ng/ml]in the trimetazidine high-dosage (20 mg/kg) group,the levels of IL-6 and TNF-α were significantly increased.Compared to the MIRI group,the levels of IL-6 and TNF-α were significantly decreased in the trimetazidine high-dosage (20 mg/kg) group (P ＜ 0.01).Conclusions The high-dosage (20 mg/kg) of trimetazidine had a protective effect on myocardial ischemia-reperfusion injury.

Cardiopulmonary resuscitation is the most comonly used method facing cardiac arrest.The 2010 CPR guidelines emphasized high quality chest compressions and recommended continuous compression for 2 minutes after defibrillation to minimize interruptions in compressions.However,starting chest compressions immediately after a defibrillation shock may be harmful,if the heart is providing spontaneous beats and being subjected to external compressions at the same time.So it is very important to recognize ROSC during CPR,the methods of which include touching the pulse,amplitude spectral area,partial pressure end-tidal carbon dioxide,coronary perfusion pressure,central venous oxygen saturation,chest compression fraction,regional cerebral oxygen saturation,photoplethysmography,conjunctival oxygen tension,transthoracic-impedance plethysmography and echocardiography.This paper gives a review of the ROSC prognosis and recognition methods during CPR.

As one of the cornerstones of modern cardiopulmonary resuscitation (CPR), ventilation received controversy and challenges in the past two decades. From 2000 to 2015, the changes in CPR guidelines of American Heart Association (AHA) showed that the position of ventilation declined gradually as compared to chest compressions. Chest compressions only CPR has been strongly advocated in recent years, especially in witnessed cardiogenic cardiac arrest (CA). Passive oxygenation and cardiocerebral resuscitation (CCR) also showed good effect in the early stage of cardiogenic CA. However, clinical validation in a larger context is still needed. An impedance threshold device (ITD) transiently blocks air from entering the lungs during recoil, decreases the intrathoracic pressure, facilitates venous return to the chest and increases coronary blood flow. However, the relevant research findings are not consistent, and the guidelines do not recommend routine use of ITD. Positive-pressure ventilation, which can increases intrathoracic pressure, affects the coronary perfusion pressure (CPP) and cerebral perfusion, is thought to be not only useless, but also has adverse effects within the first few minutes of CPR. This view is accepted by many scholars, however, ventilation is essential in late-start CPR, prolonged CPR and non-cardiogenic CA. Mechanical ventilation, especially special ventilation modes for CPR showed some prospects. Positive-pressure ventilation remains the gold standard in CPR in clinical practice at present. It was shown by existing research that hyperventilation significantly reduce the success rate of resuscitation, thus a consensus had been reached about avoiding hyperventilation. Currently, the number of studies on ventilation during CPR is very limited, and many of the conclusions are not consistent among studies. Therefore, more high-quality studies are needed in future to further clarify the application of ventilation during CPR.

Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy.Methods According to whether the patients accepted the invasive rescue therapy or not,2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR).There were 2 147 cases in group R and 526 case in group DNR.The rescue consent form or do not rescue consent form was required to sign by patient self,patient' s family member or relatives.The patient' s basic information,underlying disease,payment of medical expenses,personnel who signed the consent form,treatment and prognosis in both groups were investigated.Results There was no significant gender deference in both groups (x2 =1.86,P =0.173).The mean age of patients in group DNR was much higher than that in group R (69.5 ±-12.5 vs.58.6 ± 19.2 years,F =28.92,P =0.000).The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90％ vs.44.01％,x2 =10.59,P =0.001).The ratios of chronic heart failure,chronic respiratory failure,chronic hepatic encephalopathy,chronic renal failure,malignant tumor in group DNR were significantly higher than that of group R (8.17％ vs.3.03％,8.17％ vs.2.61％,3.80％ vs.1.16％,5.32％ vs.1.44％,11.98％ vs.2.28％,all P=0.000).The proportion of patients without insurance in group DNR was higher than that of group R (52.09％ vs.41.08％,x2 =20.87,P =0.000).Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04％ vs.0.42％,x2 =64.40,P =0.000),there were no significant deference in other people who signed the consent form such as patient's offspring,spouse,parents,siblings and others.Univariate and multivariate logistic regression analyses showed older age,non Beijing patients,chronic underlying diseases,without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy.The mortality rate of group DNR was much higher than that of group R (19.39％ vs.7.68％,x2=64.40,P=0.000).Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease.The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain.