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.

Objective To describe the clinical characteristics of acute dichlorvos poisoning and analyzed the risk factors affecting patient prognosis,in order to provide important treatment guidance and theoretical reference for reducing the mortality of patients with acute dichlorvos poisoning.Methods A retrospective study method was conduct to collect the clinical data of patients admitted to the department of emergency of Fuyang People's Hospital from November 2019 to November 2023 and analyze the clinical poisoning characteristics.The patients were divided into death group and survival group according to the prognosis to compare the differences in the clinical characteristics of patients with different outcomes.This study conducted binary multifactor Logistic regression analysis of statistically significant indicators to select the independent risk factors affecting the prognosis of patients,and drew the receiver operator characteristic(ROC)curve to predict value of the risk factors on the prognosis.Results In 82 patients,22(26.83%)died,39(47.56%)developed capillary leak syndrome(CLS),31(37.80%)had acute respiratory failure,and 35(42.68%)had shock.Compared with the survival group,patients in the death group were older(years:57.73±17.67 vs.44.25±13.74),the proportion of gastric lavage,cholinesterase activity,Glasgow coma scale(GCS),albumin,pH value were all significantly decreased[proportion of gastric lavage:81.82%(18/22)vs.100.00%(60/60),cholinesterase activity(U/L):235.96(200.00,401.67)vs.450.00(240.26,739.25),GCS scores:4.00(3.00,6.00)vs.12.00(4.00,15.00),albumin(g/L):39.35±12.02 vs.45.21±4.51,pH value:7.14(7.04,7.26)vs.7.38(7.28,7.40)],dichlorvos concentration,dipterex concentration,sequential organ failure assessment(SOFA),acute physiology and chronic health evaluationⅡ(APACHEⅡ),alanine transaminase(ALT),blood urea nitrogen(BUN),serum creatinine(SCr),MB isoenzyme of creatine kinase(CK-MB),blood lactate acid(Lac),and concurrent acute respiratory failure,shock,CLS ratio were significantly increased[dichlorvos concentration(μg/L):271.00(49.25,908.25)vs.64.00(16.75,211.00),dipterex concentration(μg/L):1 337.50(397.25,3 614.00)vs.494.00(71.00,1 679.80),SOFA score:12.50(9.00,15.50)vs.2.00(0.00,6.75),APACHEⅡscore:28.50(23.00,32.50)vs.6.50(2.25,19.00),ALT(U/L):40.40(17.28,66.33)vs.19.65(13.70,34.68),BUN(mmol/L):6.30±2.78 vs.5.05±1.48,SCr(μmol/L):87.59±39.67 vs.58.87±14.85,CK-MB(U/L):164.80(86.13,284.85)vs.116.05(81.65,160.60),Lac(mmol/L):3.00(1.68,9.15)vs.1.20(1.00,2.40),the proportion of concurrent acute respiratory failure:95.45%(21/22)vs.33.33%(20/60),proportion of concurrent shock:100.00%(22/22)vs.21.67%(13/60),proportion of concurrent CLS:95.45%(21/22)vs.30.00%(18/60)],the differences were statistically significant(all P<0.05).The binary multivariate Logistic regression analysis showed that age,SOFA score,and CLS were independent risk factors affecting the prognosis of dichlorvos poisoning[age:odds ratio(OR)=1.090,95%credibility interval(95%CI)was 1.019-1.167;SOFA score:OR=1.454,95%CI was 1.159-1.825;CLS:OR=122.473,95%CI was 7.954-1 885.787,all P<0.05].The ROC curve analysis shows that the age,SOFA score and CLS had a certain predictive value for the prognosis of patients with acute dichlorvos poisoning[area under the curve(AUC)were 0.752,0.864,0.827,95%CI were 0.622-0.881,0.767-0.960,0.735-0.919,the Youden index were 0.453,0.681,0.655,sensitivity were 63.6%,86.4%,95.5%,specific features were 81.7%,81.6%,70.0%,all P<0.05].Conclusions Age,SOFA score,and CLS are independent risk factors affecting the prognosis of patients with acute dichlorvos poisoning.In particular,CLS is the most important risk factor affecting the prognosis of patients.When managing acute dichlorvos poisoning,it is crucial to closely monitor the occurrence of CLS and administer prompt,proactive treatment.

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.

Pancreatic cancer is a malignant and gastrointestinal tumor.The five year survival for pancreatic cancer is very low.The pathogenic factors for pancreatic cancer are not yet clear.However,more and more studies have showed that lncRNAcontributed to pancreatic cancer proliferation and metastasis through genomic imprinting,chromatin modification,transcriptional activation and inhibition,nuclear transport,and protein function regulation.In recent years,with the continuous deepening of basic researches of pancreatic cancer,there were many long non-coding RNA deregulated in pancreatic cancer,which played an important role in tumororigenesis and metastasis.In this article,we reviewed the relevant researches on the mechanism of lncRNA in the occurrence and metastasis of pancreatic cancer.

Objective To investigate the significances of monitoring urine neutrophil gelatinase -associated apolipoprotein (NGAL)and kidney injury molecule -1 (KIM-1)levels before and after coronary intervention in early predication of contrast -induced nephropathy.Methods The clinical data of 249 patients with coronary heart disease undergoing percutaneous coronary intervention were collected.All patients were divided into contrast -induced nephropathy group(n =21 )and non -contrast -induced nephropathy group(n =228)according to whether had contrast -induced nephropathy.Before surgery and 4h,12h,24h,48h,72h after surgery,the levels of serum creatinine were tested.Before surgery and 4h,12h,24h,48h after surgery,the levels of urinary NGAL and KIM-1 were detected by using enzyme -linked immunosorbent assay(ELISA).Results Compared with before surgery,the serum creati-nine level of contrast -induced nephropathy patients after surgery 48h[(101.7 ±20.3)μmol/L]was elevated,the difference was statistically significant(t =15.972,P <0.05).Compared with before surgery,the urinary NGAL levels of contrast -induced nephropathy patients after surgery 4h ~48h were (12.3 ±1.6)μg/L,(14.5 ±1.5 )μg/L, (14.1 ±1.2)μg/L and (14.3 ±1.4)μg/L,which were significantly elevated(t =8.672,11.817,15.942 and 17.641,all P <0.05),and the urinary KIM-1 levels after surgery 24h and 48h were (5.1 ±0.9)μg/L and (5.5 ± 1.3)μg/L,which were elevated,the differences were statistically significant(t =9.672,14.381,all P <0.05).The urinary NGAL levels of contrast -induced nephropathy patients after surgery 4h ~48h were higher than non -contrast-induced nephropathy patients,and the urinary KIM-1 levels after surgery 24h and 48h were higher than non -contrast -induced nephropathy patients,the differences were statistically significant(t =17.838,19.370,13.996, 18.172,2.792,3.307,all P <0.05).Pearson correlation analysis showed that the urinary NGAL levels after 4h and urinary KIM-1 levels after 24h were positively correlated with serum creatinine levels after surgery 48h(r =0.698, 0.576,all P <0.05).ROC curve analysis showed that urinary NGAL levels in predicting contrast -induced nephrop-athy,the area under the curve was 0.963 (95% CI:0.931 ~0.995 ),sensitivity was 85.7%,and specificity was 94.3%,for urinary KIM-1 levels,those were 0.839 (95%CI:0.768 ~0.909),81.0% and 72.8%.Conclusion The urinary NGAL levels of contrast -induced nephropathy patients after interventional treatment 4h were increased, and the urinary KIM-1 levels appeared increased after surgery 24h,which were earlier than serum creatinine.They were expected to be early indicators for determining acute kidney injury and predicting contrast -induced nephropathy after intervention treatment.

Objective To study the risk factors associated with death of patients suffered from acute exacerbation of interstitial pneumonia (AE-IP) with very high mortality and very difficult to handle so as to find the most suitable treatment strategy for these patients.Methods The data of 26 patients with AE-IP admitted to Emergency Intensive Care Unit in Peking Union Medical College Hospital from September 2010 to September 2013 were restrospectively analyzed.Comparison of general condition of patients,treatment strategy and response to non-invasive ventilation of patients was made between survival group and death group.Results There was no significant difference in general condition of patients between death group and survival group.But compared with idiopathic pulmonary fibrosis (IPF),connective tissue disease-related interstitial pneumonia had a tendency to accounting for higher proportion in the survival group.The rats of endotracheal intubation and invasive ventilation were significantly increased in death group (14％ vs.84％,P ＜ 0.05).There was significant improvement in PaO2/FiO2 after non-invasive ventilation for 2 hours in the survival group (176 ± i10 vs.218 ±64,P ＜0.05) while the death group had no significant improvement.Conclusions In patients with AE-IP,connective tissue disease associated interstitial pneumonia might have better outcome than IPF.AE-IP patients have a very high mortality rate once patients intubated,thus the decision of intubation in such patients needs to be very cautious.The patients with negligible improvement in PaO2/FiO2 after non-invasive ventilation for 2 hours may have a poor prognosis.

Objective Respiratory variations in the pulse oximetry plethysmographic waveform amplitude (△POP) have been popularly studied as a dynamic indicators for fluid responsiveness assessment.The authors hypothesized that △POP can indicate fluid responsiveness in septic shock patient in emergency department.Methods A prospective study of 28 patients with septic shock was carried out in Emergency Room and Emergency Intensive Care Unit from 1 October,2010 to 30 September,2011.Hemodynamic data including cardiac index,stroke volume Variation (SVV) and △POP were recorded before and after volume expansion treatment.Fluid responsiveness was defined as an increase in cardiac index of 15％ or greater.Results Changes in △POP after volume expansion were greater in responders than that in non-responders (P ＜ 0.01).There was a significant relation between △POP and SVV before volume expansion (r =0.900,P ＜ 0.0001).Conclusions △POPcan indicate fluid responsiveness non-invasively in septic shock patient in emergency department.This marker has potential clinical application with high sensitivity and reliability.

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

Objective To explore the impact of ischemic stroke on intestinal barrier changes in dogs.Methods Totally 20 mongrel dogs were divided into 2 groups by random number table with 10 in each.Double silicone cylinders measuring 1.1 mm in diameter and 8 mm in length were placed into their internal carotid arteries in all dogs of group A.Group B served as a control group and received sham operation.Light microscopy was performed for morphological measurement of intestinal epithelial cell.Immunohistochemistry was used to analysis the changes of protein zonula occludens-1(ZO-1)localizing at tight junction of intestinal epithelial cells.Results Ischemic stroke was confirmed by cranial CT scanning in all dogs of group A.Compared with the test results in group B,the occludin and Zo-1 protein levels in group A were significantly lower than those in group B(occludin:0.20 ±0.01 vs 0.22 ±0.01,P =0.007; ZO-1:0.20 ±0.01 vs 0.22 ±0.02,P =0.008).The apoptotic index in group A was significantly higher than in group B(29.04 ± 3.79 vs 6.44 ± 1.24,P =0.002).There was a positive correlation between occludin and ZO-1(R =0.71,P =0.02),and the apoptotic index was negatively correlated with levels of occludin,ZO-1(R =-0.91,P =0.00; R =-0.77,P =0.01).Light microscopy showed that the dogs in group A had intestinal mucousal injuries while no obvious change was detected in group B.Conclusions Dogs with ischemic stroke tend to develop intestinal barrier dysfunction,during which the destruction of tight junction plays a key role.The up-regulated apoptosis of intestinal epithelial cell constitutes one of the cellular bases of intestine injury.