Post-cardiac arrest syndrome (PCAS) is one of the most common medical emergencies in children.The fatality rate and disability rate are extremely high.Pathogenesis of PCAS remains incompletely clear,and clinical manifestation is complicated.The treatment is mainly limited to supportive care.In recent years,the phases of PCAS are defined according to the pathophysiological changes and clinical prognosis.Investigators also made some advances in the fields of pathophysiological changes and clinical treatment of brain damage and myocardial damage.For the treatment of PCAS,early therapeutic hypothermia,glucose control and seizure control,and reasonable cardiopulmonary support are promoted.In this article,we reviewed the advances in the above fields and the latest advance on the management of PCAS in foreign countries.

Objective To analyze and evaluate neoadjuvant chemotherapy's value and significance in combining with surgical treatment for limited small cell lung cancer(LD-SCLC).Methods A total of 94 LD-SCLC patients underwent complete resections combined with chemotherapy between January 2000 and January 2011 in Shanghai Pulmonary Hospital.Among these cases,initial two cycles of neoadjuvant chemotherapies were performed for all pathologically confirmed patients (Group A),and initial operations followed by adjuvant chemotherapy were administered to patients without pathology (Group B).The survival rate was analyzed by log-rank test and Kaplan-Meier method.Multivariate analysis of the prognostic factors was performed using Cox's regression model.Results Group A included 43 cases and Group B included 51 cases.The mean age was (56.37 ± 10.18) years.According to the 6th edition of Tumor,Node,Metastasis(TNM) classification of lung cancer,54 cases were at stage Ⅰ or Ⅱ,40 cases were at stage Ⅲ.Overall 5-year survival(5-YS) was 27％.The 5-YS for patients with stage Ⅰ-Ⅱ was notably better than that of stage Ⅲ (34％ vs 20％,P =0.033).For patients with stage Ⅲ,the 5-YS of Group A was significantly better than that of Group B(34％ vs 12％,P =0.020),besides median overall survival for Group A and Group B were 46 and 15 months(P =0.009).Furthermore,the results of multivariate analysis showed that neoadjuvant chemotherapy,surgery and histopathology of SCLC were independent factors that strongly affected survival and prognosis.Conclusion In combined surgical treatment for LD-SCLC,neoadjuvant chemotherapy obviously improved the prognosis of patients with stage Ⅲ.Therefore,it was very important and necessary that pre-surgical neoadjuvant chemotherapy was administered to resectable stage Ⅲ LD-SCLC patients.

BACKGROUND:Airway epithelial regeneration can effectively inhibit submucosal hyperblastosis and the occurrence of obliteration. Studies demonstrated that ventilation could accelerate the regeneration of airway epithelium. OBJECTIVE:To establish and improve an orthotopic tracheal transplantation model and to further observe the effects of ventilation on trachea in alogeneic mice. METHODS:C57BL/6 mouse's tracheal served as donor, and BALB/c mouse's tracheal as recipient. This experiment contained two groups. In the experimental group, the membranous part of trachea was longitudinaly dissected in two donors and sutured into an enlarged trachea, which was implanted in the recipient. In the control group, donor's trachea was implanted into the recipient in situ. Samples were obtained and detected at 28 days after surgery. RESULTS AND CONCLUSION: Hematoxylin-eosin staining results demonstrated that compared with the control group, wel-differentiated ciliated epithelium was visible in the epithelial lamina of tracheal lumen, accompanying a few non-ciliated single or stratified squamous epithelium, mild submucosal fibrosis and inflammatory cel infiltration. Morphological analysis revealed that ciliated epithelial proportion in the experimental group was higher than in the control group (P < 0.05). The ratio of lamina propria to the tracheal cartilage, submucous fibrous tissuearea and the degree of lymphocyte infiltration were lower in the experimental group than in the control group (P < 0.05). Immunohistochemical staining demonstrated that the transplanted tracheal epithelium in both groups was recipient epithelial phenotype. Results verified that a modified orthotopic tracheal transplantation model was successfuly established. The increased ventilation of the tracheal alografts can accelerate the differentiation of tracheal epithelium. The wel-differentiated airway epithelium inhibited the proliferation of fibroblast.

OBJECTIVETo discuss the anti-tumor effect of Xihuang pill on tumor-bearing rats and its effect on the immune clearance function of tumor-bearing organisms.

METHODWalker256 tumor cells were adopted to establish the tumor-bearing rat model. The rats were randomly divided into five groups: the normal control group, the model control group, the lentinan group and Xihuang pill low dose, middle dose and high dose groups, with 10 rats in each group, and continuously treated and given drugs for 14 d after modeling. Blood and tumors were collected from abdominal aorta to calculate the tumor inhibition rate. The content of CD3+, CD4+, CD8+ T cells and adhesion molecule B7-1 (CD80) in peripheral blood were detected by flow cytometry (FCM). The expressions of IL-2 and IFN-gamma in were determined by ELISA.

RESULTThe tumor inhibition rate of the Xihuang pill high dose group was 33. 1 percent. Compared with the model group, the Xihuang pill large dose group showed significantly low IL-2, IFN-gamma, CD3+, CD4+, B7-1 in peripheral blood, with statistical significance in their differences (P < 0.05).

CONCLUSIONXihuang pill could show its anti-tumor effect by enhancing the immune clearance function and increasing IL-2, IFN-gamma, CD3+ T, CD4+ T, B7-1 in peripheral blood.

Animals ; Antineoplastic Agents ; administration & dosage ; B7-1 Antigen ; genetics ; immunology ; Breast Neoplasms ; drug therapy ; genetics ; immunology ; CD4-Positive T-Lymphocytes ; drug effects ; immunology ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Flow Cytometry ; Humans ; Immune System ; drug effects ; Immunologic Factors ; administration & dosage ; Interferon-gamma ; genetics ; immunology ; Interleukin-2 ; genetics ; immunology ; Rats ; Rats, Wistar ; Tumor Burden ; drug effects

OBJECTIVETo explore the mechanism of prevention and treatment of post-PTCA restenosis with Xinmaitong (XMT).

METHODSRabbit carotid endothelial injury model was established using Fishman air drying method. Effect of XMT on model rabbits wild-type p53 gene expression was observed by tissue in situ hybridization.

RESULTSp53 gene expression appeared on the 3 days after operation, enhanced on the 7 days, reached the peak on the 14th day, weakened on the 21th, and still showed on the 28th day. The strongest expression was shown in rabbits treated by XMT, second in those treated by Warfarin, and the weakest in the operated control group.

CONCLUSIONXMT could promote the high expression of wild-type p53 gene expression in rabbit with carotid endothelial injury, which is possibly one of the important mechanism of XMT in preventing and treating arterial restenosis.

Animals ; Carotid Arteries ; pathology ; Coronary Restenosis ; prevention & control ; Drugs, Chinese Herbal ; pharmacology ; Endothelium, Vascular ; metabolism ; pathology ; Phytotherapy ; Rabbits ; Tumor Suppressor Protein p53 ; biosynthesis ; genetics

Objective To explore the expressions and significance of miRNA - 101,enhancer of ZESTE homo-log 2(EZH2)and transforming growth factor(TGF)- β1 in the kidneys with complete uniateral ureteral obstruction (CUUO). Methods Thirty male SD rats,(6 ± 1)weeks old,weighted(150 ± 10)g,were divided into sham group, 7 - day group with CUUO and 14 - day group with CUUO by using random number table method,10 rats in each group. The obstructed kidney samples were collected in 7 and 14 days,respectively,for detecting the expression of miRNA -101 by real time - polymerase chain reaction(RT - PCR)and TGF - β1 and EZH2 protein by Western blot,immuno-histochemistry and hematoxylin - eosin staining. Their correlated expressions were analyzed. Results RT - PCR results showed that the expressions of miRNA - 101 in sham group and 7 - day group with CUUO were(12. 69 ± 1. 60)times and(3. 74 ± 1. 24)times which were higher than those of 14 - day group with CUUO,respectively,there was a signifi-cant difference among these 3 groups(P ﹤ 0. 05). The expressions of TGF - β1 and EZH2 proteins were 1. 14 ± 0. 12, 1. 04 ± 0. 14,0. 76 ± 0. 18 and 1. 04 ± 0. 04,0. 89 ± 0. 03,0. 73 ± 0. 02 in 14 - day group with CUUO,7 - day group with CUUO and sham group,respectively. There was a negative correlation between miRNA - 101 with EZH2( r =- 0. 92,P ﹤ 0. 05),and negative correlation with TGF - β1(r = - 0. 63,P ﹤ 0. 05),and positive correlation between EZH2 and TGF - β1(r = 0. 67,P ﹤ 0. 05);the expressions of miRNA - 101,EZH2 and TGF - β1 were associated with each other in obstruction renal in different time periods. Conclusions With the extension of obstruction time, miRNA - 101 expression decreased,EZH2 and TGF - β1 expression increased,evidently,which indicates that the de-velopment of renal interstitial fibrosis may be affected through regulating EZH2 expression of renal obstruction through miRNA - 101 in the young rats.

BACKGROUND:The bispectral (BIS) index is a processed electroencephalogram (EEG) parameter with extensive validation and demonstrated clinical utility. The study aimed to investigate the correlation between the BIS index and the prognosis of patients with coma in the ICU. METHODS:A total of 208 patients with coma in the ICU were enrolled in this study. According to the BIS value, the patients were divided into four groups:group I, BIS value 0 to 20; group Ⅱ, BIS value 21 to 40; group Ⅲ, BIS value 41 to 60; and group IV, BIS value greater than 60. The difference in BIS values with the differences in prognosis of patients with coma was compared between the four groups, and the prognosis of patients with coma was stratified into consciousness, coma, vegetative state, and brain death. Subsequently, the best cut-off score of BIS values calculated for determining the correlation between BIS value and mental state was proposed. RESULTS:There are no significant differences in the age and APACHE Ⅱ scores between the four groups (P>0.05). An inverse correlation was observed between BIS value and mental state (r=–0.749, P=0.00). According to the ROC curve, as BIS value was greater than 42.5, there were higher sensitivity and specificity in conscious-coma patients. CONCLUSION:BIS value is correlated with the prognosis of patients with coma in ICU, and BIS value can be a useful marker for estimating the prognosis of comatose patients.

ObjectiveTo investigate the effect of whole-period psychiatric rehabilitation on outpatients with schizophrenia.Methods90 outpatients with schizophrenia were randomly divided into the study group and control group with 45 cases in each group. All cases in two groups received pharmacotherapy, but cases of study group were added with whole-period psychiatric rehabilitation. Assessments were performed before and after study. All subjects were evaluated with the Brief Psychiatric Rating Scale (BPRS) and Social Disability Screening Schedule (SDSS).ResultsThe outcome of the study group was significantly superior to the control group on overall improvement according to the reductions of BPRS score, Anergia factor score, thought disturbance factor score, suspiciousness factor score and SDSS score(P<0.05-0.01).ConclusionThe whole-period psychiatric rehabilitation may play an important role in controlling symptoms and improving social function to outpatients with schizophrenia.

OBJECTIVETo verify the efficacy of Jianpi Tiaogan Wenshen Recipe (JTWR) in treating diarrhea-predominant irritable bowel syndrome (IBS-D) and to analyze its therapeutic mechanism through observing the effect of JTWR on clinical symptoms and rectal sensibility in patients.

METHODSWith a prospective, randomized controlled trial adopted, 80 patients with IBS-D were assigned randomly equally and to two groups. The treatment group was treated with JTWR, and the control group was treated with pinaverium bromide tablet (PVB), all for four weeks. Patients' symptoms, such as abdominal discomfort, pain, and distension; frequency of defecation; appearance of stool; and occurrence of tenesmus were recorded before and after treatment by scoring, and the rectal sensitivity was detected as well. Patients with therapeutic effect of cured and markly effective were followed up four weeks after withdrawal of medication.

RESULTSThree cases in the treatment group and four cases in the control group were dropped. Except the appearing of mucus stool, no statistically significant difference was shown between the two group in all other symptoms, either at before or after treatment; but the end point scores of individual symptoms between pre- and post-treatment were different statistically in both groups (P<0.05). Per-protocol population set (PPS) analysis on comprehensive effect showed that the total effective rate and the cure rate in the treatment group was 81.1% (30/37) and 24.3% (9/37), and those in the control group, 80.6% (29/36) and 19.4% (7/36) respectively; while the full analysis set (FAS) showed a result of 80.0% (32/40) and 22.5% (9/40) vs 77.5% (31/40) and 17.5% (7/40) respectively, all with insignificant difference between groups (P>0.05). Follow-up study showed that relapse or aggravation of disease occurred in four cases in the treatment group and 12 in the control group respectively, showing significant difference between groups (P<0.01). Rectal sensitivity examination showed that the rectal thresholds of sensation, defecation, and maximum tolerable volume were improved in both groups after treatment (P<0.05), but showed no significant difference between groups (P>0.05).

CONCLUSIONSJTWR is effective in treating IBS-D, with the effect better than PVB in improving mucus stool, also in the remote effect. Its therapeutic mechanism is possibly by way of adjusting the sensitivity of rectum.

Adolescent ; Adult ; Diarrhea ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Irritable Bowel Syndrome ; drug therapy ; Male ; Middle Aged ; Morpholines ; therapeutic use ; Phytotherapy ; Prospective Studies ; Young Adult

OBJECTIVETo compare the indications and therapeutic effects of several invasive interventions in treating postoperative sputum retention.

METHODSBronchoscopy, cricothyroidotomy, intubation or tracheotomy was performed in 112 patients with postoperative sputum retention from January 2002 to December 2006. There were 95 male and 17 female patients. The age ranged from 14- to 81-years-old with a mean of (65.2 +/- 11.1) years old. Their clinical data were collected to prove the improvement of PaO2, SpO2, and pulmonary atelectasis. Sputum clearance results of these invasive methods were compared as well.

RESULTSBronchoscopies were effective in 24 out of 60 cases (40.0%), while the rest 36 cases called for multiple bronchoscopies or other maneuvers. Tracheal intubations were effective in 31.2% (15/48) patients, among whom 11 patients required further cricothyroidotomies, and 22 patients required tracheotomies. Intubations and bronchoscopies resulted shorter intervention durations and efficacy durations, comparing with the other two methods.

CONCLUSIONSPersonalized risk analysis helps decision making in invasive interventions for postoperative sputum clearance. Tracheal intubations and bronchoscopic clearance are helpful in short-term symptomatic relief and recommended the first choice in cases of postoperative sputum retentions.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bronchoscopy ; Female ; Humans ; Intubation, Intratracheal ; Male ; Middle Aged ; Postoperative Care ; Retrospective Studies ; Sputum ; Thoracic Surgical Procedures ; Tracheotomy ; Young Adult