Propofol in bronchoalveolar lavage during anaesthesia

BackgroundThe lung protecting effect of propofol requires methods to measure the propofol concentration of the epithelial line fluid covering the alveolar surface.We hypothesized that (1) propofol can be determined in bronchoalveolar lavage (BAL) by reversed phase high performance liquid chromatography with fluorescence detection. (2) Positive end-expiratory pressure (PEEP) ventilation may have an effect on propofol concentration in BAL (cpB).Methods76 surgical patients were investigated after institutional review board approval. After criteria-based exclusion 45 samples were included. For group I (n = 15) BAL was performed directly after induction, for group Z (n = 15, PEEP = 0 cm H₂O) and P (n = 15, PEEP = 10 cm H₂O) at the end of anaesthesia. BAL and plasma samples were analysed for propofol by reversed phase high performance liquid chromatography with fluorescence detection. Data from all groups were compared by non-parametric Mann–Whitney U-test.ResultsPropofol can be detected in BAL. CpB varied between 23 and 167 μg l^? 1 in all groups. Patients ventilated with PEEP (group P) showed significantly higher cpB (median 74.5 μg l^? 1) compared to those immediately after induction of anaesthesia (median 42.0 μg l^? 1) (group I), but not to those ventilated without PEEP in group Z (median 52.5 μg l^? 1).ConclusionEpithelial line fluid, sampled by BAL, can be used to determine cpB by reversed phase high performance liquid chromatography with fluorescence detection. Continuous propofol infusion and PEEP ventilation may have an effect on cpB.     

Impaired capsular polysaccharide is relevant to enhanced biofilm formation and lower virulence in Streptococcus pneumoniae

Streptococcus pneumoniae has been reported to form biofilms. Many different surface molecules, including capsular polysaccharide (CPS), may play a fundamental role in pneumococcal biofilm development. We designed a CPS mutant, TIGR4cps4D^?, from the TIGR4 strain and detected enhanced biofilm formation. The pathogenic diversities of the mutant were also investigated with the in vitro expression levels of pavA, lytA, IgA1, piaA, psaA, ply, and spxB. The mean OD₅₉₅ of TIGR4cps4D^? biofilm was 1.77 and 1.74, whereas that of TIGR4 was 0.76 and 0.33 on day 1 and day 2, respectively. Scanning electron microscopy and confocal laser scanning microscopy showed TIGR4cps4D^? formed a biofilm that was significantly thicker than that formed by TIGR4 (~12.22 vs. ~6.29 μm). Compared to TIGR4, the gene expression of lytA, IgA1, and, psaA in TIGR4cps4D^? was 1.9 × 10^?5-, 2.4 × 10^?5-, and 3.2 × 10^?3 fold lower under the planktonic condition, and 1.9 × 10^?5- and 9.7 × 10^?5 fold lower in biofilms, respectively. Furthermore, TIGR4cps4D^? seemed to induce less cell death, compared to the results of TIGR4 (21.38 vs. 33.47 %, after a 5-h exposure; P < 0.05). Our data indicate that impaired pneumococcal CPS may increase biofilm formation and be involved in inhibition of virulence, possibly by influencing the gene expression.     

Comparative study on the pharmacodynamics of cisatracurium: continuous infusion or intermittent bolus injection

ObjectiveTo explore a better administration way through comparison of the pharmacodynamics of cisatracurium administered by continuous infusion or intermittent bolus injection.MethodsThirty patients (ASAI-II) who had no neuromuscular disease and underwent selective surgery under general anesthesia were randomly divided into group I and II (each group with 15 patients). In group I, patients received cisatracurium by continuous infusion and in group II, by intermittent bolus injection. The responses of adductor pollicis to train-of-four (TOF) stimulation were monitored. The duration of neuromuscular blockade, recovery index and total dose of cisatracurium consumption were recorded in the two groups. Intravenous anesthesia was used for anesthesia induction and sevoflurane inhalation for maintenance of anesthesia.ResultsThe mean infusion rate was significantly lower in group I (0.78 ± 0.15 μg.kg^? 1.min^? 1) than in group II (1.09 ± 0.33 μg.kg^? 1.min^? 1) (P < 0.05). There was no significant difference in duration of neuromuscular blockade between the two groups (P > 0.05). The recovery index was 13.13 ± 3.36 min in group I and 14.38 ± 4.48 min in group II, which indicated that the recovery was faster in group I than in group II, but without statistical significance (P > 0.05). During the duration of neuromuscular blockade, 8 patients had T₁ < 3%, 4 T₁ of 3%–7% and 3 T₁ of 7%–10% in group I; T₁ was maintained between 0 and 20% in group II.ConclusionsAlthough cisatracurium consumption was significantly lower in continuous infusion than in intermittent bolus injection, continuous infusion can obtain more stable neuromuscular blockade than intermittent bolus injection.     

The influence of smoking on semen quality, seminal microelements and Ca2+-ATPase activity among infertile and fertile men

ObjectiveTobacco smoking is now increasing rapidly throughout the developing world and is one of the biggest threats to current and future world health. Several studies have addressed the role of cigarette smoking on semen quality, but the exact mechanisms remain inconclusive. In order to evaluate the detrimental effects of smoking on semen quality among Saudi subjects, the levels of different seminal parameters in smokers were compared to non-smokers.Patients and methodsA total of 159 semen samples (61 smokers and 98 non-smokers) from men attending an infertility clinic for routine infertility workup were sub-grouped into fertile or infertile and were compared based on standard semen analysis (according to WHO guidelines), content of metals (magnesium, zinc and cadmium) and plasma membrane Ca²⁺-ATPase activity of sperms.ResultsCadmium concentration was found significantly higher in smokers than in non-smokers either in fertile or infertile group (2.9 ± 0.4 vs 1.4 ± 0.7; 2.9 ± 0.5 vs 1.3 ± 0.7 μg L^? 1; respectively). Together with this increase in seminal Cd a significant decrease in Ca²⁺-ATPase activity (21.5 ± 2.8 vs 33.71 ± 1.2; 20.7 ± 1.5 vs 35.07 ± 2.9 mmol min^? 1 mg^? 1 protein, p < 0.05), decrease in seminal zinc (109.8 ± 8.1 vs 189.7 ± 9.9 mg L^? 1, p < 0.01) and decrease in sperm motility (41.9% ± 2.9 vs 46.01% ± 2.5; 9.8% ± 2.4 vs 15.3% ± 2.7, p < 0.05) were found.ConclusionOur data demonstrate that cigarette smoking affects both Ca²⁺-ATPase activity and motility of the spermatozoa. These effects may be attributed to increased seminal cadmium and reduced zinc concentrations.     

Mitochondrial depolarisation and oxidative stress in rheumatoid arthritis patients

ObjectivesTo investigate mitochondrial membrane integrity, lipid peroxidation and cytotoxicity in peripheral lymphocytes (PL) from rheumatoid arthritis (RA) patients.Design and methodsSouth African black RA patients (HIV^?) were recruited into the study. Mitochondrial membrane potential (Δψ_m) was analysed in PL using the JC-1 dye distribution assay and flow cytometry. Correlations between Δψ_m and clinical parameters were tested for statistical significance. Cytotoxicity (LDH) and lipid peroxidation (thiobarbituric acid reactive substances (TBARS)) was also determined.ResultsOur findings show significantly elevated levels of cytotoxicity (p = 0.0029) and lipid peroxidation (p = 0.0030) in RA. A significantly higher percentage of circulating PL contained depolarised mitochondria (p = 0.0003) which correlated with disease activity and C-reactive protein levels in patients. Collapse of Δψ_m also negatively correlated to absolute lymphocyte counts (r = ? 0.4041; p = 0.0197).ConclusionThese findings suggest a possible role for mitochondrial membrane alterations in the pathology of RA.     

Diagnostic accuracy, reproducibility and robustness of fibrosis blood tests in chronic hepatitis C: a meta-analysis with individual data

ObjectivesTo evaluate the diagnostic accuracy of liver fibrosis tests and its influencing factors in a meta-analysis with individual data.Design and methodsFour independent centers provided four blood tests and Metavir staging from 825 patients with chronic hepatitis C.ResultsFibroMeter AUROC (0.840) for significant fibrosis was superior to those of Fibrotest (0.803, p = 0.049), APRI (0.789, p = 0.001) and Hepascore (0.781, p < 0.001). The misclassification rate was lower for FibroMeter (23%) than for Fibrotest and Hepascore (both 28%, p < 0.001). The variation in the diagnostic cut-offs of tests among centers, reflecting the overall reproducibility, was: FibroMeter: 4.2%, APRI: 24.0%, Fibrotest: 24.2%, Hepascore: 35.0%. Accordingly, the proportion of patients diagnosed with significant fibrosis changed: FibroMeter: 0.8%, Hepascore: 2.4% (p = 0.02 vs FibroMeter), Fibrotest: 5.8% (p < 10^? 3), APRI: 18.2% (p < 10^? 3).ConclusionsThis study on clinical applicability shows significant differences in diagnostic accuracy, inter-center reproducibility, and robustness of biomarkers to changes in population characteristics between blood tests.     

Coenzyme Q10 in salivary cells correlate with blood cells in Fibromyalgia: improvement in clinical and biochemical parameter after oral treatment

ObjectiveWe have determined Coenzyme Q₁₀ (CoQ₁₀) levels in salivary cells (SCs) and mononuclear blood cells (BMCs) from Fibromyalgia (FM), and we study the influence of oral CoQ₁₀ supplementation on cells levels and clinical symptoms.MethodsCoQ₁₀ was determined by high-performance liquid chromatography (HPLC). Ten patients were supplemented daily with 300 mg of CoQ₁₀ during 3 months.ResultsCoQ₁₀ were reduced in both cell models. Oral supplementation showed an improvement in clinical symptoms and restored levels.ConclusionsPatients with FM showed an important dysfunction in CoQ₁₀ levels and might benefit from oral supplementation.     

Postoperative analgesia and early rehabilitation after total knee replacement: A comparison of continuous low‐dose intravenous ketamine versus nefopam

The effects of nefopam and ketamine on pain control and rehabilitation after total knee replacement were compared in a prospective, double blinded study.Seventy-five patients were randomly assigned to receive a 0.2 mg kg^?1 bolus of nefopam or ketamine, followed by a 120 μg kg^?1 h^?1 continuous infusion until the end of surgery, and 60 μg kg^?1 h^?1 until the second postoperative day, or an equal volume of saline considered as placebo. Pain scores measured on a visual analog scale at rest and on mobilization, and patient-controlled intravenous morphine consumption, were assessed during 48 h. We measured the maximal knee flexion on the third postoperative day, and the delay to obtain a 90° flexion.Ketamine and nefopam reduced morphine consumption (p < 0.0001). Pain scores, were lower at rest and on mobilization in the ketamine group compared to the two other groups at all times of measurement. Pain score were lower in patients receiving nefopam compared to placebo, on arrival in the recovery room and at 2 h. Ketamine improved knee flexion on post operative day 3 (59° [33–63] vs. 50° [47–55] and 50° [44–55] in ketamine, placebo and nefopam groups, respectively, p < 0.0002) and decreased the delay to flex the knee at 90° (9.1 ± 4.2 vs. 12.3 ± 4.0 days, in ketamine and placebo groups, respectively, p = 0.01).Ketamine produces opioid-sparing, decreases pain intensity, and improves mobilization after total knee replacement. Nefopam achieves less significant results in that circumstances.     

Evaluation of quantitative debriefing after pediatric cardiac arrest

AimOur primary objective was to describe and determine the feasibility of implementing a care environment targeted pediatric post-cardiac arrest debriefing program. A secondary objective was to evaluate the usefulness of debriefing content items. We hypothesized that a care environment targeted post-cardiac arrest debriefing program would be feasible, well-received, and result in improved self-reported knowledge, confidence and performance of pediatric providers.MethodsPhysician-led multidisciplinary pediatric post-cardiac arrest debriefings were conducted using data from CPR recording defibrillators/central monitors followed by a semi-quantitative survey. Eight debriefing content elements divided, a priori, into physical skill (PS) related and cognitive skill (CS) related categories were evaluated on a 5-point Likert scale to determine those most useful (5-point Likert scale: 1 = very useful/5 = not useful). Summary scores evaluated the impact on providers’ knowledge, confidence, and performance.ResultsBetween June 2010 and May 2011, 6 debriefings were completed. Thirty-four of 50 (68%) front line care providers attended the debriefings and completed surveys. All eight content elements were rated between useful to very useful (Median 1; IQR 1–2). PS items scored higher than CS items to improve knowledge (Median: 2 (IQR 1–3) vs. 1 (IQR 0–2); p < 0.02) and performance (Median: 2 (IQR 1–3) vs. 1 (IQR 0-1); p < 0.01).ConclusionsA novel care environment targeted pediatric post-cardiac arrest pediatric debriefing program is feasible and useful for providers regardless of their participation in the resuscitation. Physical skill related elements were rated more useful than cognitive skill related elements for knowledge and performance.     

Proatherogenic disturbances in lipoprotein profile,associated enzymes and transfer proteins in women with iron deficiency anaemia

ObjectiveTo characterize the lipid-related atherogenic risk factors in iron deficiency anaemia (IDA) patients.Design and methodsTwenty IDA women were compared to healthy age-matched controls. Lipoprotein profile, cholesteryl ester transfer protein (CETP), paraoxonase (PON) 1 and lipoprotein-associated phospholipase A₂ (LpPLA₂) activities and plasma levels of oxidized-LDL were evaluated.ResultsTriglycerides were higher (median [range]) (1.0 [0.5–1.9] vs. 0.7 [0.5–1.5] mmol/L, p < 0.05) and HDL-C lower (mean ± SD) (1.3 ± 0.3 vs. 1.6 ± 0.4 mmol/L, p < 0.01) in the patients group. CETP (197 ± 29% vs. 151 ± 29% mL^? 1 h^? 1, p < 0.001), PON 1 (122 ± 17 vs. 140 ± 33 μmol mL^? 1 min^? 1, p < 0.05) and LpPLA₂ (9.6 ± 2.0 vs. 8.1 ± 1.7 μmol mL^? 1 h^? 1, p < 0.05) activities were different in IDA women. No difference was observed in oxidized-LDL. Haemoglobin correlated negatively with triglycerides (r = ? 0.35, p < 0.05), CETP (r =  ?  0.62, p < 0.001) and LpPLA₂ (r =  ?  0.34, p < 0.05), while ferritin was positively associated with HDL-C (r =  0.39, p < 0.05) and inversely with CETP (r =  ?  0.49, p < 0.005).ConclusionThe alterations in lipoprotein profile, CETP, PON 1 and LpPLA₂ activities described in the present study indicate that non-treated IDA might represent a proatherogenic state.     

Effects of AED device features on performance by untrained laypersons

ObjectiveOur study evaluates the impact of features of automated external defibrillators (AEDs) on the performance and speed of untrained laypersons to deliver a shock and initiate CPR after a shock.MethodsThis was a randomized trial of volunteer laypersons without AED or advanced medical training. Subjects were assigned to use one of six different models of AEDs on a manikin in simulated cardiac arrest. No instructions on AED operation were provided. Primary endpoints were shock delivery and elapsed time from start to shock. Secondary endpoints included time to power-on, initiation of CPR, adequacy of pad placement and subjects’ ratings of ease of use (1 = very easy, 5 = very difficult).ResultsMost subjects (109/120; 91%) were able to deliver a shock. Median time from start of scenario to shock delivery was 79 s (IQR: 67–99). Of the 11 participants who did not deliver shock, eight never powered on the device. Time to power-on was shorter in devices with open lid (median 12 s, IQR 8–27 s) and pull handle (17 s, IQR 9–20 s) mechanisms than with a push button (37 s, IQR 18–69 s; p = 0.000). Pad position on the manikin was judged adequate for 86 (77%) of the 111 subjects who placed pads. Devices which gave more detailed voice instruction for pad placement had higher rates of adequate pad position [38/39 (97%) versus 50/73 (68%), p = 0.001]. With AEDs that provided step-by-step CPR instruction, 49/58 (84%) subjects began CPR compared to 26/51 (51%) with AEDs that only prompted to start CPR (p = 0.01). Participants rated all the models easy to use (overall mean 1.48; individual device means 1.28–1.71).ConclusionsMost untrained laypersons were successful in delivering a shock. Device features had the most impact on these functions: ability and time to power-on device, adequacy of pad position and initiation of CPR.     

Increased clopidogrel response is associated with ABCC3 expression: a pilot study

BackgroundThe aim of this study was investigate the relationship between ABCB1 and ABCC3 gene expressions in peripheral blood cells (PBC) and the response to clopidogrel in patients with coronary arterial disease (CAD).MethodsTwenty-six male CAD patients (50–70 years) under treatment with clopidogrel (75 mg/day) for at least 5 days were selected. Blood samples were obtained to evaluate platelet reactivity and ABCB1 and ABCC3 mRNA expression. Platelet reactivity was measured in P2Y12 Reaction Units (PRU) using VerifyNow. RNA was extracted from PBC and mRNA levels were measured by qPCR, using GAPD as a reference gene.ResultsPlatelet response to clopidogrel was categorized in to PRU quartiles. Individuals with PRU values within the first quartile (Q1, < 151 units) were considered good responders, while those who had PRU within the fourth quartile (Q4, PRU > 260) were considered non-responders. ABCC3 was 1.7 times more expressed in Q4 than in Q1 PRU group (p = 0.048). Moreover, CAD patients with low ABCC3 expression (Qe1, < 2.5 × 10^? 3) had higher probability to have a good response to clopidogrel (OR: 18.00, 95%CI: 1.90–169.99, p = 0.001). Univariate linear regression analysis demonstrated that low ABCC3 mRNA expression contributed with a reduction of 73 PRU in relation to the patients with expression value higher than 2.5 × 10^? 3 (p = 0.027). Neither ABCB1 mRNA levels nor clinical variables studied influenced PRU values.ConclusionsLow ABCC3 mRNA expression in peripheral blood cells is associated with increased clopidogrel response, but further studies are needed to describe the functional relationship of clopidogrel with the ABCC3.     

Matrix metalloproteinase-1 promoter genotypes and haplotypes are associated with carotid plaque presence

ObjectivesMatrix metalloproteinase (MMP)-1 degrades fibrillar collagens suggesting important role in vascular remodeling. Data about MMP-1 promoter polymorphisms and carotid atherosclerosis (CA) are scarce. The aim of this study was to evaluate association of MMP-1 genotypes/haplotypes with carotid plaque (CP) presence in Serbian population.Design and methodsStudy enrolled a total of 702 participants: 274 controls and 428 consecutive patients with CA who underwent carotid endarterectomy. MMP-1 polymorphisms ? 1607 1G/2G, ? 519 A/G and ? 340 T/C were genotyped by PCR and RFLP methods.ResultsIndividuals carrying MMP-1 ? 1607 2G allele had significantly increased allele dose-dependent risk for CP presence (1G1G vs. 1G2G vs. 2G2G; OR = 1; OR = 1.87 95% CI 1.29–2.07; OR = 3.49 95% CI 1.67–7.30, p = 0.0009, respectively). Compared to the referent haplotype 2G_? 1607-T_? 340-A_? 519, the haplotypes 1G_? 1607-T_? 340-A_? 519, 1G_? 1607-T_? 340-G_? 519 and 2G_? 1607-C_? 340-A_? 519 had statistically significant protective effect on CP presence (OR = 0.41, 95% CI 0.29–0.81, p = 0.01; OR = 0.56, 95% CI 0.44–0.89, p = 0.01; OR = 0.43, 95% CI 0.27–0.86, p = 0.02, respectively).ConclusionsMMP-1 ? 1607 G/2G polymorphism solely and specific haplotypes of three analyzed promoter polymorphisms are significantly and independently associated with occurrence of CP. Replication studies in other populations are needed.     

Effect of somatostatin analogue octreotide on pain relief after major abdominal surgery

BackgroundOctreotide acetate is an 8-amino-acids synthetic octapeptide analogue of somatostatin with much-enhanced duration of action and lower incidence of side effects. We assessed the utility of using intravenous octreotide as an adjuvant to opioid analgesia that might exert a post-operative opioid-sparing effect.MethodsForty-four patients were randomly allocated, to receive either a placebo or intraoperative octreotide 0.33 μg kg^?1 h^?1 intravenous infusion that was maintained in the post-operative period. Patients received for post-operative analgesia an intravenous piritramide patient controlled analgesia (PCA), set to deliver a piritramide 0.02 mg kg^?1 dose.ResultsTwo-way ANOVA revealed significantly fewer (P = 0.0003) mean ± SD weighted piritramide dose requirements in the octreotide group (19.5 ± 6.3 μg kg^?1 h^?1) than in the control group (35.7 ± 8.2 μg kg^?1 h^?1). Dunnett’s two-sided multiple-comparison post hoc test revealed a significant difference between the two groups during the first 22 post-operative hours, following which there were no differences between the two groups. There were no significant differences over time in the mean arterial pressure (P = 0.722), heart rate (P = 0.579) and respiratory rate (P = 0.823) between the octreotide group (80 ± 10 mm Hg, 74 ± 12, 14 ± 2) and the control group (82 ± 9 mm Hg, 76 ± 11, 15 ± 3), respectively.ConclusionWe demonstrated that perioperative octreotide intravenous infusion could be an adjuvant to opioid analgesia as it exerted a piritramide opioid-sparing effect. We encountered more systemic side effects such as nausea, abdominal discomfort, and diarrhea in the octreotide group than in the control group. Our findings could be beneficial to patients who cannot tolerate the adverse effects of opioids.     

Are preservatives necessary in 24-hour urine measurements?

Background24-h urine measurements are used in the routine diagnosis and follow-up of many diseases in the clinical laboratory. Calcium (Ca²⁺), magnesium (Mg²⁺), phosphate (PO₄^3?) and uric acid are frequently requested markers in 24-h urine samples. Because of the different solubilities of these parameters, different urine collection conditions – urine in base for uric acid and urine in acid for Ca²⁺, PO₄^3? and Mg²⁺ measurements – are recommended.MethodsWe aimed to test the effect of addition of preservatives and heating of the urine specimen on the results obtained for Ca²⁺, Mg²⁺, PO₄^3? and uric acid by comparison with untreated samples results. Spot (n = 20) and 24-h urine (n = 50) samples were obtained from patients for routine urine analysis. A single spot urine sample was divided into five aliquots of 10 mL each: one containing 200 µL of HCl (6 N), another containing 200 µL of sodium bicarbonate, NaHCO₃ (5 g/L), two others in which the same preservative agents were added 24 h after the collection, and one without any preservative (untreated). Ca²⁺, PO₄^3?, uric acid and Mg²⁺ were measured in triplicate and at three different time points during the study: at the time of sampling (0 h), 24 h after sampling, and after heating the samples. The 24-h urine samples were collected without preservatives and analytes were measured promptly before and after acidification/alkalinization.ResultsThere was no statistically significant difference between untreated and treated samples (p > 0.05). Heating also failed to show any difference in the results (p > 0.05).ConclusionAccording to our results, addition of preservatives is not necessary for measurement of Ca²⁺, Mg²⁺, PO₄^3? and uric acid in promptly assayed 24-h urine samples.     

Isotope dilution ultra performance liquid chromatography-tandem mass spectrometry method for simultaneous measurement of 25-hydroxyvitamin D2, 25-hydroxyvitamin D3 and 3-epi-25-hydroxyvitamin D3 in human serum

BackgroundAn ultra performance liquid chromatography-tandem mass spectrometry method with calibration traceable to NIST SRM was developed and validated to measure concentrations of 25-hydroxyvitamin D₂ (25OHD₂), 25-hydroxyvitamin D₃ (25OHD₃) and the C-3 epimer of 25OHD₃ (epi-25OHD₃) in human serum.MethodsTri- and hexa-deuterated internal standards were added to serum (100 μl) to monitor recovery. Liquid–liquid extraction was used to extract the hexane-soluble materials. Calibration solutions [8–100 nmol/L 25OHD_2, 12–150 nmol/L 25OHD₃, and 4–50 nmol/L epi-25OHD₃] prepared in phosphate-buffered saline containing 4% albumin were similarly processed. Using a pentafluorophenyl column (2.1 × 100 mm) and isocratic methanol/water (72/28, v/v) flowing at 0.4 ml/min, run time was 14 min per sample; 25OHD₃ and epi-25OHD₃ were baseline separated. Atmospheric pressure chemical ionization in the positive ion mode with selected reaction monitoring captured the following transitions: 25OHD₂, m/z 395.3 > 377.3 (209.1 qualifier); (epi-)25OHD₃, m/z 383.3 > 365.3 (105.1 qualifier); d₃-25OHD₂, m/z 398.3 > 380.3; and d₆-25OHD₃, m/z 389.3 > 371.3.ResultsRecovery averaged ≥ 98%. Total imprecision was ≤ 10% when concentrations were ≥ 20 nmol/l. Bias averaged < 5%. Detection limits were < 5 nmol/l. Median (nmol/l) 25OHD₂, 25OHD₃ and epi-25OHD₃ were quantitated in 98 blood donors (< LOD, 56.0, < LOD) and 35 pregnant women (< LOD, 87.6, 3.70).ConclusionsThis method is highly accurate, precise and specific.     

The influence of rewarming after therapeutic hypothermia on outcome after cardiac arrest

IntroductionTreatment with hypothermia has been shown to improve outcome after cardiac arrest (CA). Current consensus is to rewarm at 0.25–0.5 °C/h and avoid fever. The aim of this study was to investigate whether active rewarming, the rate of rewarming or development of fever after treatment with hypothermia after CA was correlated with poor outcome.MethodsThis retrospective cohort study included adult patients treated with hypothermia after CA and admitted to the intensive care unit between January 2006 and January 2009. The average rewarming rate from end of hypothermia treatment (passive rewarming) or start active rewarming until 36 °C was dichotomized in a high (≥0.5 °C/h) or normal rate (<0.5 °C/h). Fever was defined as > 38 °C within 72 h after admission. Poor outcome was defined as death, vegetative state, or severe disability after 6 months.ResultsFrom 128 included patients, 56% had a poor outcome. Actively rewarmed patients (38%) had a higher risk for poor outcome, OR 2.14 (1.01–4.57), p < 0.05. However, this effect disappeared after adjustment for the confounders age and initial rhythm, OR 1.51 (0.64–3.58). A poor outcome was found in 15/21 patients (71%) with a high rewarming rate, compared to 54/103 patients (52%) with a normal rewarming rate, OR 2.61 (0.88–7.73), p = 0.08. Fever was not associated with outcome, OR 0.64 (0.31–1.30), p = 0.22.ConclusionsThis study showed that patients who needed active rewarming after therapeutic hypothermia after CA did not have a higher risk for a poor outcome. In addition, neither speed of rewarming, nor development of fever had an effect on outcome.     

Potential negative effects of epinephrine on carotid blood flow and ETCO2 during active compression-decompression CPR utilizing an impedance threshold device

ObjectivesThis study examines the effects of IV epinephrine administration on carotid blood flow (CBF) and end tidal CO₂ (ETCO₂) production in a swine model of active compression–decompression CPR with an impedance threshold device (ACD-CPR + ITD).MethodsSix female swine (32 ± 1 kg) were anesthetized, intubated and ventilated. Intracranial, thoracic aorta and right atrial pressures were measured via indwelling catheters. CBF was recorded. ETCO₂, SpO₂ and EKG were monitored. V-fib was induced and went untreated for 6 min. Three minutes each of standard CPR (STD), STD-CPR + impedance threshold device (ITD) and active compression–decompression (ACD)-CPR + ITD were performed. At minute 9 of the resuscitation, 40 μg/kg of IV Epinephrine was administered and ACD-CPR + ITD was continued for 1 min. Statistical analysis was performed with a paired t-test. p values of <0.05 were considered statistically significant and all values are reported in mmHg unless otherwise noted.ResultsAortic pressure, cerebral and coronary perfusion pressures increased from STD < STD + ITD < ACD-CPR + ITD (p <0.001). Epinepherine administered during ACD-CPR + ITD signficantly increased mean aortic pressure (29 ± 5 vs 42 ± 12, p = 0.01), cerebral perfusion pressure (12 ± 5 vs 22 ± 10, p = 0.01), and coronary perfusion pressure (8 ± 7 vs 17 ± 4, p = 0.02); however, mean CBF and ETCO₂ decreased (respectively 29 ± 15 vs 14 ± 7.0 ml/min, p = 0.03; 20 ± 7 vs 18 ± 6, p = 0.04).ConclusionsIn this model, administration of epinepherine during ACD-CPR + ITD signficantly increased markers of macrocirculation, while significantly decreasing carotid blood flow and ETCO₂. This calls into question the ability of calculated perfusion pressures to accurately reflect oxygen delivery to end organs. The administration of epinepherine during ACD-CPR + ITD does not improve cerebral tissue perfusion.     

Gingival crevicular fluid PGE2, IL-1beta, t-PA, PAI-2 levels in type 2 diabetes and relationship with periodontal disease

ObjectivesTo evaluate if type 2 diabetes mellitus increase gingival crevicular fluid (GCF) levels of prostaglandin E₂ (PGE₂), interleukin-1beta (IL-1ß), tissue-type plasminogen activator (t-PA), and plasminogen activator inhibitor-2 (PAI-2).Design and methodsSeventeen type 2 diabetic patients with periodontal disease (DM), 17 otherwise healthy periodontally diseased patients (PD) and 17 systemically and periodontally healthy control subjects (H) were enrolled. Clinical periodontal measurements were recorded at six sites/tooth. GCF samples were analyzed by ELISA. Data were tested by statistical tests.ResultsDM group revealed lower IL-1ß levels than PD group (p < 0.01). PGE₂, t-PA and PAI-2 levels were similar in DM and PD groups (p > 0.05). PGE₂, t-PA levels were higher in DM and PD groups than H group (p < 0.05). PAI-2 level was higher in DM group than H group (p < 0.05). GCF total amount of PGE₂ in DM group exhibited significant correlations with all clinical periodontal measurements (p < 0.05).ConclusionType 2 diabetes in this study seems not to increase GCF levels of the evaluated inflammatory mediators.     

Influence of diabetes on homocysteine-lowering therapy in chronic hemodialysis patients

IntroductionThe effect of homocysteine (Hcy)-lowering therapy may be different in hemodialysis (HD) patients with and without diabetes mellitus (DM).MethodsStable HD patients with uremia were administered folic acid and vitamin B for 3 months. The impact of treatment was compared in patients with and without DM.ResultsA total of 61 patients (31 men and 30 women) aged 56 ± 13 y completed the study. Among these, 44 patients (72%) did not have DM and 17 (28%) had DM. At baseline, total Hcy and high-sensitivity C-reactive protein (hsCRP) levels were similar. After treatment, the levels of total Hcy and hsCRP were significantly decreased in the nondiabetic group (total Hcy level decreased from 33.63 ± 14.13 μmol/l to 18.94 ± 8.46 μmol/l, p < 0.001; hsCRP level decreased from 0.58 mg/dl [range, 0.21–1.05 mg/dl] to 0.22 mg/dl [range, 0.11–0.53 mg/dl], p < 0.001) but not in the diabetic group (total Hcy level decreased from 34.97 ± 17.12 μmol/l to 29.53 ± 11.36 μmol/l, p = 0.057; hsCRP level decreased from 0.80 mg/dl [range, 0.24–1.47 mg/dl] to 0.49 mg/dl [range, 0.45–0.98 mg/dl], p = 0.28). Serial monitoring of total Hcy level showed a more sustained effect of therapy on patients without DM.ConclusionFolic acid and vitamin B administration significantly lower total Hcy and hsCRP levels in HD patients without DM but not in those with DM.