In November 2019, the American Heart Association updated guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care. This update is not a comprehensive revision of the 2015 version. The updates for children and newborns mainly include three aspects: ① Pediatric basic life support: A. It is recommended that emergency medical dispatch centers offer dispatcher-assisted CPR instructions for presumed pediatric cardiac arrest. B. It is recommended that emergency dispatchers provide CPR instructions for pediatric cardiac arrest when no bystander CPR is in progress. ② Pediatric advanced life support: A. The bag-mask ventilation is reasonable compared with advanced airway interventions (endotracheal intubation or supraglottic airway) in the management of children during out-of-hospital cardiac arrest (OHCA). B. The extracorporeal CPR may be considered for pediatric patients with cardiac diagnoses who have in-hospital cardiac arrest (IHCA) in settings with existing extracorporeal membrane oxygenation protocols, expertise, and equipment. C. Continuous measurement of core temperature during targeted temperature management is recommended; for infants or children between 24 hours and 18 years of age who remain comatose after OHCA or IHCA, targeted temperature management is recommened. ③ Neonatal resuscitation: A. In term and late-preterm newborns (≥35 weeks of gestation) receiving respiratory support at birth, the initial use of 21% oxygen is reasonable. B. One hundred percent oxygen should not be used to initiate resuscitation because it is associated with excess mortality. C. In preterm newborns (<35 weeks of gestation) receiving respiratory support at birth, it may be reasonable to begin with 21% to 30% oxygen.
Periodontal disease is a common chronic infectious disease targeting the connective tissue supporting the dentition. In recent years, the research on periodontal disease and cerebral infarction has been increasing. However, the causal relationship between periodontal disease and cerebral infarction remains unclear. Periodontal disease may be associated with atherosclerosis, which is one of the major causes of cerebral infarction. Regular dental care can reduce the risk of cardiovascular disease. Therefore, investigating the above association and its underlying mechanisms is of great clinical significance, which may help clinicians to make appropriate treatment and prevention measures. In this paper, the research progress and possible mechanism of the relationship between periodontal disease and cerebral infarction were reviewed.
American Heart Association (AHA) updated the advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest in the AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care in November 2018. Based on the latest progress of relative evidence-based clinical evidence and 2015 AHA guidelines for cardiopulmonary resuscitation and cardiovascular emergency cardiovascular care. This update gave recommends on the use of antiarrhythmic drugs during resuscitation from adult shock-refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) cardiac arrest and immediately after restoration of spontaneous circulation following shock-refractory VF/pVT cardiac arrest, respectively. This review aims to interpret this update by reviewing the literature and comparing the recommends in this update with other guidelines.
ObjectiveTo analyze the association between the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (syndrome of phlegm-heat obstructing lung) and clinical indicators related to COPD. MethodAECOPD in-patients and out-patients were enrolled from the Third People's Hospital of Chengdu from January 2013 to January 2014. The patients were grouped to Tanre Syndrome and non-Tanre Syndrome according to their clinical symptoms, signs and tongue, pulse. All patients underwent the following tests including routine blood test, erythrocyte sedimentation rate, lung function, blood gas analysis, C-reaction protein (CRP), procalcitonin (PCT) and other clinically relevant indicators. The association between AECOPD and clinically relevant indicators were analyzed by using SPSS 19.0 software. ResultsA total of 194 AECOPD patients were included, of which 88 patients were syndrome of phlegm-heat obstructing lung and 106 were non syndrome of phlegm-heat obstructing lung according to the traditional Chinese medicine (TCM) classifications. The results of single factor analysis showed that age (Z=-4.848, P=0.000) and course of disease (Z=-2.455, P=0.014) were associated with syndrome of phlegm-heat obstructing lung. While further logistic regression analysis showed that age (r=0.090, P=0.000) and the level of CRP (r=-0.008, P=0.000) were associated with syndrome of phlegm-heat obstructing lung. ConclusionSyndrome of phlegm-heat obstructing lung is the major clinical TCM syndrome of AECOPD. Syndrome of phlegm-heat obstructing lung is associated with age and level of CRP.
In the American Heart Association’s Scientific Sessions 2021, the results of six clinical trials related to cardiovascular surgery were revealed. The PALACS trial demonstrated that posterior left pericardiotomy during open heart surgery was associated with a significant reduction in postoperative atrial fibrillation; the EPICCURE study found that injection of mRNA encoding vascular endothelial growth factor (VEGF-A mRNA) directly into the myocardium of patients undergoing elective coronary artery bypass grafting (CABG) improved patients’ heart function; the VEST trial once again proved the safety and potential value of external stent for vein graft. This article will interpret the above-mentioned three studies.
Objective To reveal the association between the single nucleotide polymorphism (SNP) of v-maf musculoaponeurotic fibrosarcoma oncogene homolog B (MAFB) gene rs17820943 locus and non-syndromic cleft l ip with or without cleft palate (NSCL/P) in the southern Chinese Han population. Methods Genotyping of MAFB gene rs17820943 polymorphism was carried out in 300 patients with NSCL/P, 354 normal controls, and an additional 168 case-parent trios with matrix-assisted laser desorption/ionisation time-of-fl ight (MALDI-TOF) mass spectrometry. Then based on the genotypingresults, both a case-control association study and a case-parent trio association study were performed. Results Significant differences were found in the allele and genotype frequencies of rs17820943 locus between case and control groups (Pallele=0.001 and Pgenotype=0.002, respectively). To be specific, the odds radio (OR) values and 95% confidence interval (95%CI) of allele T (frequencies of cases ∶ controls = 0.358 ∶ 0.448) and genotype TT (frequencies of cases ∶ controls = 0.110 ∶ 0.195) were ORT = 0.69 (95%CI: 0.55-0.86) and ORTT = 0.43 (95%CI: 0.26-0.70), respectively. Subsequent case-parent trio analysis also indicated an association between MAFB rs17820943 variant and the risk of NSCL/P (ORT vs. C = 0.55, 95%CI: 0.41-0.75, P value of transmission disequilibrium test was 0.000). Conclusion Polymorphism of MAFB gene rs17820943 locus is associated with NSCL/P in the southern Chinese Han population; MAFB rs17820943 variant may be a susceptible gene of NSCL/P.
ObjectiveTo explore the association between free fatty acid (FFA) and extent of severity of acute coronary syndrome (ACS). MethodsWe analyzed the clinical data of 93 ACS in-patients treated between July 2014 and May 2015, including 35 with acute ST-elevation myocardial infarction (STEMI), 34 with acute non STEMI (NSTEMI), and 24 with unstable angina (UA). Another 29 in-patients during the same period without coronary heart disease and heart failure and with normal results of electrocardiogram and myocardial damage markers were selected as the control. The statistical analysis of FFA collected within 24 hours after admission was conducted. ResultsThe FFA in the ACS group[(1.08±0.41) mmol/L] was significantly higher than that in control group[(0.51±0.15) mmol/L] (P < 0.01). The FFA in patients with STEMI, NSTEMI, and UA in ACS group was (1.32±0.38), (1.12±0.35, and (0.67±0.10) mmol/L, respectively; the FFA in STEMI and NSTEMI patients was much higher than that in the UA patients (P < 0.05), and the difference between STEMI and NSTEMI patients was not significant (P > 0.05). There were 58 NSTEMI and UA patients evaluated by Grace risk score, in whom 30 had Grace score≥140 with the FFA of (1.12±0.37) mmol/L and 28 had < 140 with the FFA of (0.73±0.17) mmol/L; the difference was significant (P < 0.05). There were 35 STEMI patients evaluated by Killip grade, in whom 16 were Killip I-II with the FFA of (1.17±0.37) mmol/L, and 19 were Killip III-IV with the FFA of (1.45±0.35) mmol/L; the difference was significant (P < 0.05). ConclusionElevated plasma FFA could be associated with ischemic risk and extent of severity of ACS.
The TNM staging of lung cancer which is now widely used in clinic was formally proposed in 1997. It has played quite an important role in directing the diagnosis and treatment of lung cancer as well as the clinical research in the past decade. However, at the same time, there are some insufficiencies which are emerging gradually. By collecting the clinical information from 100 869 patients, in 2007, International Association for the Study of Lung Cancer(IASLC) made a deep analysis on the relativity between TNM staging and prognosis, and put forward the suggestions to revise the Seventh Edition of the TNM staging of lung cancer: (1) According to the size of tumor, the primary T staging is divide into T1a (the maximum tumor diameter≤2 cm), T1b (3 cm≥the maximum tumor diameter＞2 cm), T2a (5 cm≥the maximum tumor diameter＞3 cm) and T2b (7 cm≥the maximum tumor diameter＞5 cm); (2) T 2c (the maximum tumor diameter gt;7 cm) and additional nodules in the same lobe are classified as T3, while nodules in the ipsilateral nonprimary lobe are classified as T4;(3) Cancerous hydrothorax, pericardial effusion and the additional nodules in the contralateral lung are classified as M1a, while the extrapulmonary metastases are classified as M1b. It is believed that the new revised edition will has higher international authority and identification degree, and it will play a more meticulous and accurate guiding role in the treatment of lung cancer and its predicting prognosis in the future. At the same time, it will provide a new starting point to the research of lung cancer.
In November 2018, the American Heart Association (AHA) updated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Rather than a comprehensive revision of the 2015 edition guidelines, the 2018 AHA guidelines update was updated again according to the rule " the update of the guideline is whenever new evidence is available”, providing the evidence review and treatment recommendation for antiarrhythmic drug therapy in pediatric shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. The Pediatric Task Force of the International Liaison Committee on Resuscitation updated the guideline, reaffirming the 2015 pediatric advanced life support guideline recommendation that either lidocaine or amiodarone may be used to treat pediatric patients with shock-refractory ventricular fibrillation or pulseless ventricular tachycardia.
With the increasing popularity of chest spiral CT screening, the detection rate of lung cancer in China is increasing. According to the characteristics of lung cancer in China and the progress of lung cancer researches at home and abroad, Chinese Medical Association guidelines for clinical diagnosis and treatment of lung cancer are updated once a year. It is of great guiding significance to standardize and improve the clinical diagnosis and treatment of lung cancer for thoracic surgeons. The surgical diagnosis and treatment of lung cancer in the guidelines mainly include: (1) surgical treatment of stage Ⅰ-Ⅱ non-small cell lung cancer (NSCLC); (2) surgical treatment of resectable stage Ⅲ NSCLC; (3) surgical treatment of multiple primary lung cancer; and (4) surgical treatment of locally resectable small cell lung cancer. Based on the Chinese Medical Association guidelines for clinical diagnosis and treatment of lung cancer (2019 edition), this paper interprets the hot issues related to the surgical treatment of lung cancer.