Comparison of extracorporeal and conventional cardiopulmonary resuscitation:A meta-analysis of 2 260 patients with cardiac arrest

BACKGROUND: This meta-analysis aimed to determine whether extracorporeal cardiopulmonary resuscitation(ECPR), compared with conventional cardiopulmonary resuscitation(CCPR), improves outcomes in adult patients with cardiac arrest(CA).DATA RESOURCES: Pub Med, EMBASE, Web of Science, and China Biological Medicine Database were searched for relevant articles. The baseline information and outcome data(survival, good neurological outcome at discharge, at 3–6 months, and at 1 year after CA) were collected and extracted by two authors. Pooled risk ratios(RRs) and 95% confidence intervals(CIs) were calculated using Review Manager 5.3.RESULTS: In six studies 2 260 patients were enrolled to study the survival rate to discharge and longterm neurological outcome published since 2000. A signi? cant effect of ECPR was observed on survival rate to discharge compared to CCPR in CA patients(RR 2.37, 95%CI 1.63–3.45, P<0.001), and patients who underwent ECPR had a better long-term neurological outcome than those who received CCPR(RR 2.79, 95%CI 1.96–3.97, P<0.001). In subgroup analysis, there was a significant difference in survival to discharge favoring ECPR over CCPR group in OHCA patients(RR 2.69, 95%CI 1.48–4.91, P=0.001). However, no signi? cant difference was found in IHCA patients(RR 1.84, 95%CI 0.91–3.73, P=0.09).CONCLUSION: ECPR showed a bene? cial effect on survival rate to discharge and long-term neurological outcome over CCPR in adult patients with CA.

Video versus direct laryngoscopy on successful firstpass endotracheal intubation in ICU patients

BACKGROUND: Airway management in intensive care unit(ICU) patients is challenging. The aim of this study was to compare the rate of successful first-pass intubation in the ICU by using the direct laryngoscopy(DL) and that by using the video laryngoscopy(VL).METHODS: A randomized, non-blinded trial comparing first-pass success rate of intubation between VL and DL was performed. Patients were recruited in the period from August 2014 to August 2016. All physicians working at ICU received hands-on training in the use of the video and direct laryngoscope. The primary outcome measure was the first-pass intubation success. RESULTS: A total of 163 ICU patients underwent intubation during the study period(81 patients in VL group and 82 in DL group). The rate of successful first-pass intubation was not significantly different between the VL and the DL group(67.9% vs. 69.5%, P=0.824). Moreover, the overall intubation success and total number of attempts to achieve intubation success did not differ between the two groups. In patients with successful first-pass intubation, the median duration of the intubation procedure did not differ between the two groups. The Cormack-Lehane grades and the percentage of glottic opening score were similar, and no significant differences were found between the two groups. There were no statistical differences between the VL and the DL group in intubation complications(all P>0.05). CONCLUSION: Among ICU patients requiring intubation, there was no significant difference in the rate of successful first-pass intubation between VL and DL.

Effects of ulinastatin on immune function, oxidative stress and related factors in patients with acute pancreatitis

Objective: To investigate the effects of ulinastatin on immune function, oxidative stress and related factors in patients with acute pancreatitis. Methods: 120 patients with acute pancreatitis admitted to digestive department of our hospital from May 2016 to May 2018 were randomly divided into control group and observation group, 60 cases in each group. Patients in the control group were given routine treatment, while patients in the observation group were given ulinastatin on the basis of the treatment of patients in the control group. The levels of Kim-1, Cys C, BUN, IgA, IgM, IgG, SOD, NO, TAC, PCT and CRP of patients in the two groups were detected and compared before and after treatment. Results: After treatment, the serum levels of Kim-1, Cys C, BUN, NO, PCT and CRP of patients in the control group and the observation group decreased significantly and the serum levels of IgA, IgG, IgM, SOD and TAC increased significantly. The change trend of these indexes in the serum of patients in the observation group was more obvious than those of patients in the control group (P<0.05). Conclusion: Ulinastatin in the treatment of acute pancreatitis can significantly alleviate kidney injury, enhance immune function and antioxidant capacity of patients, alleviate inflammation.

Potential therapeutic effect of epigenetic therapy on Ireatment-induced neuroendocrine prostate cancer

Although adenocarcinomas of the prostate are relatively indolent, some patients with advanced adenocarcinomas show recurrence of treatment-induced neuroendocrine prostate cancer, which is highly aggressive and lethal. Detailed biological features of treatment-induced neuroendocrine prostate cancer have not been characterized owing to limited biopsies/resections and the lack of a cellular model. In this study, we used a unique cellular model （LNCaP/NE1.8） to investigate the potential role of cancer stem cells in treatment-induced neuroendocrine prostate cancer with acquired resistance to hormonal therapy and chemotherapy. We also studied the role of cancer stem cells in enhancing invasion in treatment-induced neuroendocrine prostate cancer cells that recurred after long-term androgen-ablation treatment. Using an in vitro system mimicking clinical androgen-ablation, our results showed that the neuroendocrine-like subclone NE1.8 cells were enriched with cancer stem cells. Compared to parental prostate adenocarcinoma LNCaP cells, NE1.8 cells are more resistant to androgen deprivation therapy and chemotherapeutic agents and show increased cancer cell invasiveness. Results from this study also suggest a potential epigenetic therapeutic strategy using suberoylanilide hydroxamic acid, a histone deacetylase inhibitor, as a chemotherapeutic agent for therapy-resistant treatment-induced neuroendocrine prostate cancer cells to minimize the risk of prostate cancer recurrence and metastasis.