OBJECTIVES: To study the mechanism mediating the protective effect of asiaticoside (AS) against myocardial ischemia-reperfusion injury (MIRI) in rats. METHODS: Fifty SD rats were randomized into sham-operated group, MIRI model group and AS treatment group. AS treatment was administered at low, moderate and high doses by daily gavage for 2 weeks before MIRI modeling (n=10). Serum levels of lactate dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB), interleukin-18 (IL-18) and IL-1β, the volume of myocardial infarction and ischemia, and myocardial pathologies of the rats were determined or observed. The protein expression levels of NLRP3, ASC, caspase-1, GSDMD, GSDMD-N, IL-1β and IL-18 in the myocardial tissues were detected using Western blotting. The changes in the expression levels of these proteins were also detected in H9C2 cells with AS pretreatment prior to hypoxia-reoxygenation (H/R) injury. RESULTS: The rats models of MIRI exhibited significant myocardial infarction and ischemia with increased serum levels of LDH and CK-MB and myocardial expressions of NLRP3, ASC, caspase-1, GSDMD, GSDMD-N, IL-1β and IL-18. AS pretreatment effectively reduced myocardial infarction volume in the rat models and significantly reduced serum LDH and CK-MB levels and the protein levels in the myocardial tissue in a dose-dependent manner. In the H9C2 cell model of H/R injury, AS pretreatment significantly suppressed the elevation of the protein expressions of NLRP3, ASC, caspase-1, GSDMD, GSDMD-N, IL-1β and IL-18. Molecular docking studies showed that AS had a strong binding affinity with NLRP3. CONCLUSIONS Asiaticoside can alleviate MIRI in rats possibly by inhibiting NLRP3 inflammasome-mediated pyroptosis.
Animals ; Myocardial Reperfusion Injury/metabolism* ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism* ; Pyroptosis/drug effects* ; Rats, Sprague-Dawley ; Rats ; Inflammasomes/metabolism* ; Triterpenes/pharmacology* ; Interleukin-18/metabolism* ; Male ; Interleukin-1beta/metabolism* ; Caspase 1/metabolism*

Objective:To analyze the causes of out-of-hospital cardiac arrest (OHCA) and the differences in outcomes of pre-hospital first-aid measures and cardiopulmonary resuscitation for different etiologies, improved the success rate of rescue.Methods:A retrospective study was conducted on OHCA patients admitted to Beijing Emergency Medical Centre from January to December 2021. The pre-hospital emergency medical records and rescue results within medical institutions were collected. Compared the basic situation between patients with cardiogenic and non-cardiogenic cardiac arrest, the differences of rescue measures and CPR outcomes between the groups were compared by non-parametric test and χ 2 test. Results:A total of 7 517 patients were included in this study. Cardiogenic arrest patients were older, more underlying diseases (84.2%), and cardiac arrest mainly occurred at home. The cause of non-cardiogenic arrest included disease (85.1%), trauma (2.9%), suicide (5.0%), traffic accidents (1.7%), poisoning (1.1%), and so on. In terms of first-aid measures, after the emergency doctor arrived at the scene, the proportion of first-aid measures used for cardiogenic patients was high (22.3%), and the first aid measures include cardiopulmonary resuscitation, tracheal intubation, defibrillation, oxygen inhalation, injection of adrenaline and use of other drugs. All the proportions of first-aid measures for cardiogenic patients were significantly higher than non-cardiogenic patients (all P<0.001). In terms of clinical outcomes, there were no statistical differences in return of spontaneous circulation ( P=0.072) and 24-hour survival ( P=0.093) between cardiogenic and non-cardiogenic patients. Conclusions:Cardiogenic cardiac arrest was the main cause of OHCA. Cardiogenic arrest patients were more underlying diseases, and older in age, the main clinical feature was onset at home. The comprehensive treatment measures for pre-hospital first-aid cardiac arrest should continue to be strengthened to improve the success rate of rescue for OHCA.

Objective:To explore the epidemiological factors of patients with OHCA who did not attempt CPR, and analyze the reasons and clinical features of non resuscitation.Methods:Data from OHCA patients who did not undergo CPR were collected from January 2020 to December 2020 at Beijing Emergency Medical Center. The registration form was designed according to the Utstein model, and the data were analyzed retrospectively by the chi-square test.Results:A total of 5 977 patients were enrolled and divided into two groups according to age: 2 349 patients aged ≤ 80 years old and 3 628 patients aged ≥ 81 years old. Compared with the younger group, the proportion of patients in the older group who did not undergo CPR due to disease (97.0%) and family desertion (99.4%) were higher, and the difference was statistically significant (both P<0.01). Conclusions:Elderly people over 80 years old with underlying diseases have a high probability of developing OHCA at home. Most of the witnesses at the scene were family members and could not implement CPR in time. After the emergency personnel arrived at the scene, they found that the patient had been in cardiac arrest for too long and had apparently died. Family members would choose to give up treatment.

Objective:To analyze the clinical characteristics of patients with cardiac arrest caused by poisoning, explore the differences in the corresponding emergency measures and emergency effects under different causes of poisoning, and improve the success rate of out-of-hospital cardiac arrest rescue.Methods:All out-of-hospital toxic cardiac arrest patients admitted to Beijing Emergency Medical Center from January 2021 to December 2021 were retrospectively included.Results:A total of 38 patients with a median age of 43 years, including 26(68.4%) were male. There were 20 cases of acute alcoholism (52.6%), and 9 (23.7%) cases of carbon monoxide and drug poisoning respectively. In 38 cases, only 2 cases achieved return of spontaneous circulation, and no cases survived more than 24 hours.Conclusions:Poisoning induced cardiac arrest is one of the non-cardiac causes of out-of-hospital cardiac arrest, responsible for 1.7%. Alcoholism is the main poisoning cause of noncardiac out-of-hospital cardiac arrest in Beijing, prevent the poisoning and quickly identify the cause of the poisoning and give the correct rescue measures is very important for cardiac arrest.

Objective:To investigate the current situation of telephone cardiopulmonary resuscitation (T-CPR) in China, and analyze the reasons for the low implementation rate of T-CPR.Methods:This was a multicenter cross-sectional survey. Twenty cities were selected from six geographical regions of China by convenient sampling method. Anonymous online electronic questionnaires were sent to emergency medical service staffs in each city. All respondents were divided into the routine T-CPR group and control group. Student's t test and Chi-square test were used to analyze the difference between groups. Multivariate logistic regression was used to analyze the influencing factors of T-CPR. Results:⑴A total of 1 191 questionnaires were collected. 80.94% of respondents knew T-CPR. Nine hundred and sixty respondents, who knew T-CPR and completed the questionnaires, were included in the study, and were divided into the routine T-CPR group ( n=401) and control group ( n=559). Nine hundred and thirty-nine (97.81%) responders believed that T-CPR should be implemented for cardiac arrest patients that could be confirmed by telephone.⑵Four hundred and one (41.77%) responders routinely implemented T-CPR. Among them, 237 (24.68%) responders always did and 164 (17.08%) responders often did. ⑶Multivariate logistic regression analysis showed that male ( OR=1.787, 95% CI: 1.235-2.587, P=0.002), age ( OR=1.025, 95% CI: 1.004-1.047, P=0.020), clinical medicine background ( OR=2.926, 95% CI: 1.387-6.171, P =0.005), dispatcher ( OR=5.305, 95% CI: 3.463-8.126, P<0.01), using medical priority dispatch system (MPDS) system ( OR=1.941, 95% CI: 1.418-2.656, P<0.01), and T-CPR policy or procedure ( OR=3.879, 95% CI: 2.652-5.674, P<0.01) were favorable factors for T-CPR. ⑷The top three reasons for implementing T-CPR in the routine T-CPR group were that they had received T-CPR training (67.08%), believed that T-CPR could improve survival rate (63.59%), and had standard T-CPR process (63.09%). The top three reasons for not implementing T-CPR in the control group were that worrying about bystander compliance (42.04%), worrying about the quality of bystander cardiopulmonary resuscitation (CPR) (38.28%), and worrying about medical dispute (36.14%). Conclusions:The awareness and implementation of T-CPR among emergency medical service staffs need to be improved. The implementation of T-CPR depend on telephone dispatchers with clinical medicine background, clear T-CPR policy, standardized operation procedure, and professional assistant tools. To improve the public's awareness of cardiac arrest and cardiopulmonary resuscitation, and to improve the supporting legal system are also conducive to the implementation of T-CPR.

Objectives To investigate the cognition of dispatcher-initiated telephone cardiopulmonary resuscitation (TCPR) among emergency medical system(EMS) personnel and compare the cognition of TCPR among EMS personnel in different economic status,and to understand the current situation of TCPR cognition of EMS personnel in China.Methods This study is a multicenter crosssectional survey.The method of multi-level convenient sampling was adopted,and the test reliability and split half reliability of the questionnaire was tested.Questionnaire survey and data collection were conducted from December 2018 to June 2019.The ethical approval number is M2018264.SPSS 20.0 was used for analysis.x2 test was used to analyze the differences between groups.Results A total of 1191 electronic questionnaires were collected.Of them,80.94％ respondents knew TCPR,97.82％ respondents thought that TCPR should be implemented in cardiac arrest,36.62％ respondents thought that bystander cardiopulmonary resuscitation quality monitoring was needed in TCPR,and TCPR training courses were set up in the emergency department which recruited 25.83％ respondents.Emergency personnel in developed areas had a better understanding of the criteria for judging patients' breathlessness (11.69％ vs 7.89％,P=0.048),of TCPR need ncluding guidance of chest compression (92.45％ vs 87.49％,P=0.012) and of bystander cardiopulmonary resuscitation (BCPR) quality monitoring including the frequency of artificial respiration (84.42％ vs 74.87％,P=0.029) than those in underdeveloped areas,but there was no significant difference in other indicators (P＞0.05).Conclusions TCPR knowledge of EMS personnel in China is unsatisfactory.Further training is needed to improve their understanding of the criteria for judging cardiac arrest in out-of-hospital cardiac arrest patients via telephone,TCPR content and bystander cardiopulmonary resuscitation quality monitoring.There is difference in TCPR knowledge between the EMS personnel in developed and undeveloped areas in China.

Objective:To investigate the clinical efficacy of Yunke(99TC-MDP) combined with strontium 89SrCl2 in the treatment of bone pain in patients with multiple bone metastases.Methods:The clinical data of 95 patients with multiple bone metastases admitted to the General Hospital of Datong Coal Group from August 2014 to July 2019 were retrospectively analyzed.According to the different treatment methods, they were divided into three groups: 37 patients in Yunke group were treated with Yunke alone, 29 patients in 89SrCl2 group were treated with 89SrCl2 alone, 29 patients in combination group were treated with Yunke combined with 89SrCl2.All patients were treated for 5 days, with a course of treatment per month.The clinical efficacy, analgesic time and adverse reactions of the three groups were compared.Results:After treatment, the pain relief rates of the Yunke group, the 89SrCl2 group and the combination group were 67.6%(25/37), 69.0%(20/29) and 79.3%(23/29), respectively.The pain relief rate of the combined group was higher than that of the Yunke group(χ 2=4.25, P<0.05). The effective rate of bone metastases in the combined group was 41.4%(12/29), which was higher than that in the Yunke group[0.0%(0/37)], the 89SrCl2 group[17.2%(5/29)], the differences were statistically significant(χ 2=13.09, 10.54, all P<0.01). No serious adverse reactions were found in the three groups. Conclusion:Yunke combined with 89SrCl2 is superior to 89SrCl2 alone, and it is safe in the treatment of bone metastases.

Objective To report the treatment of type A3 distal tibiofibular fractures with the fibular posterolateral approach and minimally invasive percutaneous plate osteosynthesis (MIPPO).Methods We reviewed 61 patients with type A3 distal tibiofibular fracture (observation group) who had been treated with MIPPO and the fibular posterolateral approach from June 2011 to May 2015.Our control group included 78 patients with type A3 distal tibiofibular fracture who had been treated by traditional open reduction and internal fixation from April 2009 to September 2013.Interval between injury and surgery,surgical time,intraoperative bleeding,hospital stay,postoperative complications,X-ray Lane-Sandhu osteotylus score and limb weight-bearing score one year after operation were compared between the 2 groups.Results All the 139 patients were followed up for more than one year.There were significant differences between the 2 groups in terms of interval between injury and surgery (8.0 ± 3.5 h versus 140.7 ± 52.4 h),surgical time (66.2 ± 7.2 min versus 92.1 ±6.6 min),intraoperative bleeding (59.8 ± 12.8 mL versus 209.5 ±50.4 mL),hospital stay (9.4 ± 1.9 d versus 26.1 ± 15.7 d),postoperative complications,X-ray Lane-Sandhu osteotylus score (3.9 ±0.2 points versus 3.0 ±0.6 points) and limb weight-bearing score (3.9 ±0.1 points versus 3.0 ±0.7 points) one year after operation,favoring the observation group(P ＜ 0.001).Conclusions In the treatment of type A3 tibiofibular fractures,MIPPO plus the fibular posterolateral approach is superior to the traditional open reduction and internal fixation because it can benefit fracture healing by shortening the time for preoperative preparation,surgery and hospitalization,and decreasing the amount of intraoperative bleeding and the incidence of postoperative complications.

Gut microbiota-mediated deglycosylationplays an important role in the metabolism of ginsenoside Rb1. Thus, a lincomycin-induced gut microbiota dysbiosis rat model was selected to explored the pharmacokinetics and deglycosylation metabolism of ginsenoside Rb1. An UPLC-MS/MS analytical method was developed to detect ginsenoside Rb1 and its deglycosylated metabolite, Rd in rat plasma. The triple quadruple mass spectrometer was set in negative electrospray ionization mode by multiple reaction monitoring. The method was validated to meet the requirements of biological applications, by evaluating specificity, linearity, lower limits of quantification(LLOQ), precision, accuracy, matrix effect, recovery and stability. Gut microbiota dysbiosis rats were induced by oral administration of lincomycin(5 000 mg/kg)for 7 continuous days. The in vitro and in vivo results reveal that the reduced β-D-glucosidase activity significantly decreases the Rd formation rate in lincomycin-induced gut microbiota dysbiosis rats, leading to the pharmacokinetic alteration of ginsenoside Rb1 and Rd in gut microbiota dysbiosis rats.