Objective To study the effect of oral administration of activated charcoal and mannitol on removing toxicant after acute organophosphorus pesticide poisoning (AOPP). Method A total of 41 patients with severe AOPP were randomly divided into experiment group (activated charcoal used as adsorbent and mannitol used as cathartics, n =21)and control group (without adsorbent and cathartics, n = 20). Patients of both groups received routine treatment for AOPP after admission to hospital. The differences in duration of atropinization, the length of hospitalization and the success rate of treatment were compared between two groups. Results There were significant differences in duration of atropinization, the success rate of treatment and hospitalization time between the two groups. Conclusions The combination of activated charcoal and mannitol is more effective than the conventional gastric lavage on removal of organophosphorus pesticides from G-I tract, shorting the duration of atropinization time and hospital stays, and enhancing the success rate of rescue as well as improving the outcome of patients after organophosphorus pesticide poisoning.

Objective To study the value of focused abdominal sonography for trauma (FAST) used by emergency doctor in emergency department. Method It's a prospective,double-blinded and controlled study from June 2008 to October 2009. A total of 97 casualties with severe multiple trauma, 72 male and 25 female aged from 14 to 88 years old with average age of (41 ± 16) ,admitted to emergency department were enrolled, and the bedside focused abdominal sonography for trauma was performed by emergency doctor. It was diagnosed as positive if free fluid was detected in abdomen or pericardium. The severe injury scores (ISS) were from 14 to 38 with average score of (23.2±9.3). The criteria of inclusion were age over 14 years old, injury happened within 12 hours and casualties admitted directly into emergency room. The criteria of exclusion were death of patients within 2 days without CT scanning of abdomen and exploration of abdomen with laporotomy, and operations directly determined by using FAST without conventinal sonographic examination. The FAST was compared with CT and conventional sonography judged by the findings observed during operation. Results The examination with FAST was completed in (3.18±0.79) min, whereas that with conventional sonography was (16.63t4.62) min(t = 28.61,P ＜0.001). The FAST was positive in 11 cases and negative in 86 cases, whereas the conventional sonography was positive in 13 cases and negative in 84 cases ( P = 0.5). There were 4 false negative findings in FAST resulting in 73% sensitivity, 100% specificity, 95.3% negative predictive value, 4.6% false negative rate, 100% positive predictive value, 0% false positive rate and 95.9% accuracy. Conclusions The emergency doctors are able to operate the FAST well for casualties with multiple trauma in emergency department after proper training.

Objective To evaluate clinical features, therapeutic regimen and prognosis of unexplained rhabdomyolysis. Method Clinical manifestations, therapeutic regimen and prognosis were recorded in 23 patients,who were admitted to The First Affiliated Hospital of Nanjing Medical University 13 to 27 August,2010.The 23 patients were diagnozed as unexplained rhabdomyolysis. Results The patients all presented myalgia of upper body,like neck,waist and back,maybe with asthenia, nausea,dyspnea,abdominal pain, red urine or changed color of urine. Laboratory examination: obviously step-up of creatine kinase [CK: (4655 ± 2556) U/L( normal: 25 ～ 190U/L) AST:(141 ±78) U/L(normal:10～45 U/L),LDH:(348± 127) U/L(normal: 110～ 250 U/L)]and myoglobin[( Mb ＞ 1000 μg/L (normal: 0 ～ 50 μg/L)]. Therapeutic regimen included treatment of the underlying diseases, volume repletion, alkalization and dealing with the complications. No patients developed acute renal failure.All the patients recovered. Conclusions Rhabdomyolysis is a syndrome with different clinical manifestations.However, early diagnosis, proper treatment could prevent serious complications,and prognosis is good.

Objective To explore the effects of 7.5% hypertonic saline (HS) and pentoxifylline (PTX) on the pulmonary inflammation in rats with hemorrhagic shock. Method Controlled hemorrhagic shock in rats was induced to 40 mmHg MAP by blood withdrawal and maintained for 60 min. Animals were randomly (random number) divided into 3 groups. In sham shock group ( n = 8), rats underwent cannulation without exsanquination or resuscitation and served as negative controls. In RL-resuscitated animals group ( n = 8), rats received 32 mL/kg RL (Ringers'lactate solution). In HSPTX group, rats received 4 mL/kg of 7.5% NaCl + 25 mg/kg of PTX.PaO2,pH,PaCO2, lung wet/dry weight ratio (W/D) and lung penetrating index were determined, and the percentages of neutrophil in bronchoalveolar lavage fluid (BALF) were detected. The levels of malondialdehyde (MDA) and superoxide dismutase(SOD)were measured. The tumor necrosis factor-α(TNF-α) and interleukin 1β(IL-1β) in BALF supernatant were determined by using ELISA method. Results Compared with RL group, PaO2 and pH of arterial blood more increased and PaCO2 of arterial blood more decreased in HSPTX group ( P ＜ 0. 01).The wet/dry lung weight ratio and the percertages of neutrophil in BALF were reduced in HSPTX group. The level of tumor necrosis factor-αand interleukin 1β in HSPTX group were both more significantly decreased than those in RL group ( P ＜0.01). Conclusions Compared with RL group, the more attenuation of pulmonary inflammation in HSPTX group after shock is associated with less neutrophil activation and decrease in production of the irlammatory cytokines.

Objective A new type adsorbent for removal of bacterial ET was prepared by immobilizing L-serine covalently onto polyvinylidene difluoride membrane (PVDF-Ser) to study the effect of hemoperfusion on sepsis induced lung injuries in a pig model. Method Endotoxemia were induced in thirteen pigs by injecting endotoxin (1 μg/(kg·h) ) intravenously for 2 h. One hour later, the pigs were treated with absorber of PVDF-Ser volumn (group hemoperfusion) or empty adsorber (group control) for 2 h. Extravascular lung water indexed to body weight and alveolar capillary permeability, levels of serum endotoxin, tumor necrosis factor-α, interleukin-6, malondialdehyde, glutathione, myeloperoxidase activity, and lung histological changes and myeloperoxidase immunohistochemical analysis were measured. Results Hemoperfusion treatment with PVDF-Ser volumn significantly improved extravascular lung water, pulmonary alveolar capillary permeability and lung injuries ( P ＜ 0. 05). In addition, hemoperfusion attenuated both serum and pulmonary cytokines, and decreased lung malondialdehyde and myeloperoxidase levels ( P ＜ 0. 05). Conclusions Hemoperfusion with the adsorber of PVDF-Ser volumn effectively reduced inflammatory responses and improved lung injuries and oxidative stress in endotoxemia. It has a high potential of clinical application for treatment of patients with severe sepsis.

Objective Amiodarone was diluted to release the side effect of hypotension in clinic, but this maybe unsuitable during cardiopulmonary resuscitation (CPR). This study was designed to observe the effects of undiluted amiodarone, diluted amiodarone, and CPR alone on ventricular fibrillation (VF) in a pig model. MethodsVF was induced in 21 pigs. The animals were randomly (random mumber) divided into 3 groups after VF 3 min.① CPR group ( n= 7): standard CPR; ② undiluted amiodarone group ( n= 7): undiluted amiodarone (5 mg/kg)bolus within 3 s, then 20 mL saline flush into the peripheral vein, CPR was started after observed 30 s; ③ diluted amiodarone group ( n = 7): amiodarone was dissolved in 20 mL saline and bolus with 30 s. Defibrillation was attempted at VF 5 min. Results The restoration of spontaneous circulation (ROSC) of CPR and undiluted amiodarone groups were higher than diluted group (85.7％ vs. 71.4％ vs. 42.9％), but the differences were not significant (all P ＞0.05). The defibrillation energy and timesof CPR group were higher than that of undiluted amiodarone (P= 0.009) and diluted group ( P = 0. 170). The mean arterial pressure of undiluted amiodarone were lower than diluted and CPR groups at ROSC 10 min (all P ＜0.05), but the differences of undiluted and diluted groups were not significant after ROSC 0.5 h. Conclusions In this study, undiluted amiodaronecan effectively reduced the defibrillation times and energy. Although diluted amiodaronecan release the side effect of hypotension which was transient, it didn't significantly improved cardiac electric activity and delayed to start CPR.

Objective To observe the myocardial injury attributed to cardiopulmonary resuscitation, and to evaluate the impact of 4 ℃ saline perfusion on the ultra structure of myocardium. Method Twelve Pekimg white swine were induced to make models of ventricular fibrillation by direct current shock. Cardiopulmonary resuscitation was initiated 4 minutes after ventricular fibrillation established, and 10 swine survived from resuscitation. These swine were randomly(random number ) divided into hypothermia group ( n = 5) ( 4 ℃ saline infusion to lower the temperature) and control group ( n = 5). Haemodynamics were monitored. And ultra structure of myocardium was observed under electron microscope 24 hours later. The Mann-Whitney test was used to compare the consecutive variables of 2 samples. Results The damage to the ultra structure of myocardium, myofilaments and mitochondria, was found in the control group, while that to a much lesser extent in the hypothermia group was observed. Conclusions After cardiopulmonary resuscitation, 4 ℃ saline infusion has a protective effect on myocardium.

Objective To investigate the microstructure and ultrastructure changes of cardiac muscle, pallium, lung, liver and kidney tissue and hemodynamic effects after the success of cardiac arrest (CA)-cardiopulmonary resuscitation(CPR) of swine. Method A total of 16 Beijing swine(weight 29 ～ 35 kg)were randomly (random number) divided into normal-control group ( n = 8) and standard CPR group ( n = 8). The swine of the former group were only given anesthetized and intubated, without ventricular fibrillation and CPR. The swine of the latter group were given standard CPR after 4 min of untreated VF, from 10 min after restoration of spontaneous cirkg) and keep for 6 h. And cardiac output (CO), left ventricular maximal rate of systolic pressure ( + dp/dtmax),maximum reduction of left ventricular diastolic velocity ( - dp/dtmax), heart rate (HR) and mean arterial pressure (MAP) of these animals before ventricular fibrillation and 0.5 h, 2 h, 4 h, 6 h after ROSC have been monitored.All swine were put to death after 6 h,and got their cardiac apex, pallium, left lung, right lobe of liver and upper pole of left kidney quickly for microstructure and ultrastructure studies. Statistical analysis was performed using two paired samples t test. Results At different time points after restoration of spontaneous circulation, the cardiac output (CO),left ventricular maximal rate of systolic pressure ( + dp/dtmax), maximum reduction of left ventricular diastolic velocity (- dp/dtmax) were significantly lower than before ventricular fibrillation, with significant difference ( P ＜ 0.05). And HR of different time points were increased significantly ( P ＜ 0.05), with no significantly difference between MAP of each time points ( P ＞ 0.05). Compared with the normal-control group, the cardiac muscle, pallium, lung, liver and kidney tissue of the swine in standard CPR group were found different degree of damages in their microstructure and ultrastructure sections. The damages of the cardiac muscle, pallium, and lung tissue were more obviously. Conclusions Sudden cardiac arrest(CA)-cardiopulmonary resuscitation(CPR) could cause different degree of damages and hemodynamic effects on the body, through our ROSC 6 h model, the damages of the cardiac muscle, pallium and lung were more severity, the damages of liver and kidney were lighter.

Objective To investigate the effects of angiotensin Ⅱ on nuclear transcription factor-кB(NF-кB)and interleukin-8(A549 cells),and to explore the underlying mechanisms of ventilator-induced lung injure. MethodA549 cells were maintained in Dulbecco' s modified Eagle's culture medium at 37℃ with 5 ％ CO2 incubator. The cells were randomly (random number) divided into 4 groups (n =24 in each). The group A was control group. The group B,C and D had A549 cells co-incubated with Angiotensin Ⅱ 10-6 mmol/L (final concentration) for 1 h,2 h and 4 h, respectively. The samples of cell culture supematant,total cellular RNA and nuclear proteins were collected or extracted after culture of cells. The II-8 contents in cell culture supernatant were detected with enzyme linked immunosorbent assay(FLISA) .The expressions of IL-8 mRNA were measured by reverse ttanscription-polymerase chain reaction (RT-PCR).The NF-κB activities were assayed with electrophoretic mobility shift assay (EMSA). The levels of NF-κB p65 subunit were detected with Western blot. The overall differences were compared by using analysis of variance(ANOVA). Differences between two groups were assessed by q tests. ResultsThe levels of IL-8 content in cell culture supematant in groups A, B, C and D were (29.59+8.36) pg/mL,(135.35 + 28.93) pg/mL,(357.12+ 57.21) pg/mL,and (1732.13+ 261.73) pg/mL,respectively(group A vs. group B, P ＜0.01; group B vs group C, P ＜0.01;group C vs. group D, P ＜ 0.01 ) The overall differences between gtoups were statistically significant ( F =58.41,P ＜ 0.05). The expressions of IL-8 mRNA in groups A, B, C and D were (0.13±0.03)Au·nm,(0.49+0.08) Au·mm,(0.71 ±0.10) Au·mm and (0.88±0.11) Au·mm,respectively (group A vs. group B, P ＜0.01; group B vs. group C, P ＜ 0.01; group C vs. group D, P ＜ 0.05. The overall differences between groups were statistically significant (F = 19.08, P ＜ 0.05). The NF-κB activities in groups A, B, C and D were (70.37±6.57) Au·mm,(139.76± 11.72) Au·mm,(198.90± 18.95)Au·mm and (388.73±26.27) Au·mm, respectively (group A vs. group B, P ＜0.01,group B vs. groupC, P ＜0.05; group C vs. group D, P ＜ 0.01 ). The overall differences between groups were statistically significant ( F = 23.15, P ＜ 0.05). The levels of NF-κB p65 subunit in groups A, B＜ C and D were (33.05±6.23) Au·mm, (73.97 ± 5.34) Au·mm,(168.72± 8.40)Au·mm and (254.63 + 12.2) Au·mm, respectively (group A vs. group B, P ＜0.01; group B vs. group C, P ＜0.01; group C vs. group D, P ＜0.01). The overall differences between groups were statistically significant (F = 16.33,P ＜ 0.05). Conclusions The Ang Ⅱ can significantly activate the NF-κB system and up-regulate the expression of IL-8 in human lung adenocarcinoma cell line, which cause neutrophil infiltration and activation. This effect is time-dependent and induces acute lung injure, playing an important role in the underlying mechanisms of ventilator-induced lung injure.

Objective As members of CNEDERT, we were trusted to take the mission of medical rescue in April of this year in Yushu area of Qinghai province. As soon as we heard of the news of earthquake with shock of 7.1 on Richter scale happened on 14th April 2010, our team of 32 members from the General Hospital of Armed Police Force rapidly rushed to get there at 19 o'clock on 14th April. It is a cold plateau with 4000 meters in average above sea level. Of course, they would face many difficult problems and some of them could not be figured out in advance. It was really a new and big challenge. First of all, we had to bear the very low barometric pressure,threatening lives of team members. In order to fulfill the mission of medical rescue, and to prevent the acute mountain sickness (AMS) ,we monitored the physiological changes of every member. Method A total of 32 members aged from 27 - 42 years old with average age of (33.26 + 12.54) years, 6 male and 6 female, gathered at Peking, 50 meters above sea level, 6 hours ahead of getting to Yushu and received physical examination with measurements of SaO2, HR, Hb and breath holding test. The team worked in Yushu area for 13 days and returned back to Peking on 27th April at 13 o'clock. The measurements of SaO2, HR and He were kept on from 14th April to 4th May, 21 days in total. The occurrence of AMS was surveyed by questionnaire from 18 to 48 hours after arrival,and the AMSA was diagnosed and scored according to the Lake Louise consensus on the definition and quantification of altitude illness. When the score was equal or above 3, it was considered to be AMS. Our work activities included searching the victims under the collapsed building, carrying out treatment and operation as soon as possible in the mobile hospital, doing medical round visiting, public health and disease prevention, work of joint rescue of multiple professions and psychological counseling. Results Of them 26 (81.25%) members suffered from AMS of various severities and few of them had pulmonary edema and hematuria, and those with SaO2 below 60% were sent down to the plain of low level above sea. The average level of SaO2 at Peking was ( 98.21 + 2.63) %, and it suddenly dropped to (66.31 ± 4.24)% on the first day of entering Yushu area, and from the 2nd day on, it gradually increased to (84.80 ± 4.20)% on the 13th day of stay in Yushu. On the 14th day, we returned back to Peking, the average SaO2 gradually went up from ( 85.57 + 2.73) % to (85.70 + 3.11 ) % on the 15th day,(87.93±2.63)% on the 17th day, (92.21 ±3.62)% on the 18th day, and (98.2333 ± 1.78)% On the 21st day (5th May ). At plain the average HR was (78 ± 11 ) beats/min, and it went up abruptly to ( 121 ± 18) beats/min on the first day of arrival to Yushu, and from the 2nd day on, it slowly lowered down to (99± 12) beats/min at the end day of stay in Yushu area. When we got back to Peking, the average HR gradually normalized from (91± 18) beats/min to (77 + 16) beats on the 5th May. The average Hb in Peking was ( 118 ± 32) g/L, and it gradually increased to ( 137 ± 18) g/L on the 5th day and to ( 161 ± 27) g/L on the 11th day after arrival, and it gradually dropped to (127:± 13) g/L on the 17th day and to (120± 13) g/L on the 21st day. Various measures were taken to treat and prevent the AMS with Chinese herbal medicines such as hongjingtian (Rholiola sacra [Prain ex Hamet] Fu), droplet-sized pill of danshen (salva miltiorrhiza Bge), slice of xiyangshen (Panax quinquefolium L)for lozenge which had some effect of minimizing the symptoms of AMS, and with easily digestible diet catered for in less amount of food in each meal and more meals every day, and diet was composed of mainly carbohydrate and vitamins. Large amount of fluid was required at least 4000 - 6000 mL daily guided by the number of urination at least once or twice a day. For the severe case with shortness of breath and sense of oppression over chest, the oxygen inhalation and intravenous glucose saline with small dose of hydrocortisone were given. Conclusions There were great changes in SaO2, HR and Hb of individuals rushed into high altitude area from plain of low level above sea in a short length of time. But those individuals had the capability of adaptation to ameliorate bit by bit those changes day by day until 13 days of stay, the end of stay at high altitude. On that day, the levels of SaO2, HR and He were still far away from normal. And those changes took 6 days to resume the original levels after the members retumed to the plain. Of them, 81.25% (26/32) members suffered from AMS of various severities. Various measures taken to treat and prevent the AMS are very important. In addition, working at high altitude area, the medical equipment and facilities should be miniaturized for easy portability on the rugged and narrow footpath in order to preserve the energy of medical members.