Nationales Reanimationsregister

Within the scope of the symposium “Rescue Medicine in Germany” (held at the Reisensburg near Ulm in 2002), the need for a standardized data acquisition set for prehospital cardiac arrest patients was identified. Therefore, the working group “Emergency Medicine” of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) created a nationwide data acquisition system for primary medical care in prehospital cardiac arrest patients treated with cardiopulmonary resuscitation procedures. The system is in full accordance with the “Utstein style.” Integration of this data acquisition system, for example into the “Dortmund protocol,” is providing a standardized data web base of all acquired prehospital data analyze and to compare processing and structural quality. As additional modules for this nationwide data web base system, an inhospital module “further clinical treatment” and a “long-term follow-up” module are currently in the developmental process.     

Mechanics of the anterior drawer and talar tilt tests: A cadaveric study of lateral ligament injuries of the ankle

We analyzed the changes in lateral ligament forces during anterior drawer and talar tilt testing and examined ankle joint motion during testing, following an isolated lesion of the anterior talofibular ligament (ATFL) or a combined lesion of the ATFL and calcaneofibular ligament (CFL). 8 cadaver specimens were held in a specially designed testing apparatus in which the ankle position (dorsiflexion-plantarflexion and supination-pronation) could be varied in a controlled manner. Ligament forces were measured with buckle transducers, and joint motion was measured with an instrumented spatial linkage. An anterior drawer test was performed using an 80 N anterior translating force, and a talar tilt test was performed using a 5.7 Nm supination torque with intact ligaments, after sectioning of the ATFL, and again after sectioning of the CFL. The tests were repeated at 10° dorsiflexion, neutral, and 10° and 20° plantarflexion. In the intact ankle, the largest increases in ATFL force were observed during testing in plantarflexion, whereas the largest increases in CFL force were observed in dorsiflexion. Isolated ATFL injury caused only small laxity changes, but a pronounced increase in laxity was observed after a combined CFL and ATFL injury.     

Recombinant human IL-16 inhibits HIV-1 replication and protects against activation-induced cell death (AICD)

The chemoattractant cytokine IL-16 has been reported to suppress lymphocyte activation and to inhibit HIV-1 replication in acutely infected T cells. We have cloned and expressed human IL-16 in Escherichia coli and investigated whether the recombinant protein could regulate the level of lymphocyte apoptosis from HIV-1-infected subjects. After purification and refolding, only 2–10% of the recombinant cytokine was present in a biologically active homotetrameric form. This could explain the need for high concentrations of the bacterially derived IL-16 to induce significant inhibition of HIV-1 replication. Addition of IL-16 to unstimulated peripheral blood mononuclear cell (PBMC) cultures from HIV-1-infected subjects did not modify the observed level of spontaneous lymphocyte apoptosis. In contrast, IL-16 added to PBMC cultures stimulated with anti-CD3, anti-CD95 or dexamethasone reduced significantly the percentage of lymphocytes undergoing AICD. This effect was found to correlate with the ability of the cytokine to decrease CD95 expression on activated CD4⁺ T cells. Comparative studies on PBMC from healthy individuals indicated that the regulation of apoptosis levels by IL-16 is a complex phenomenon and could depend on the nature of the activator used and/or the immune status of lymphocytes tested. The outcome of CD4 cross-linking on T cells by various ligands is discussed in the context of the observed beneficial activities of IL-16 and its potential role in the treatment of HIV disease.     

Different Regiospecificity in the Hydroxylation of the Antidepressant Desmethylimipramine Between Rat Brain and Liver

Abstract: Incubation of the tricyclic antidepressant desmethylimpramine (DMI) with rat liver or brain microsomes in the presence of NADPH or t-butyl-hydroperoxide (TBH) revealed different regiospecificities in the hydroxylation reactions between the tissues. In brain preparations 10-OH-DMI was formed in reactions supported by NADPH or TBH, whereas in the latter case also an unidentified metabolite could be detected. Inclusion of exogenous NADPH-cytochrome P450 reductase in the brain preparations caused a 10-fold higher rate of 10-hydroxylation but no 2-OH-DMI could be detected. By contrast, liver microsomal preparations in the presence of NADPH catalyzed formation of both 2- and 10-OH-DMI, whereas only 10-OH-DMI was formed in TBH-supported reactions. The results indicate that antidepressant drugs can be metabolized in brain with different stereospecificity as compared to liver.     

Laienreanimation im bundesdeutschen Rettungssystem

To bridge the time gap without therapeutic intervention until the EMS team arrives, lay rescuers should be trained in performing adequate cardiopulmonary resuscitation (CPR). About 2 million people attend CPR courses each year in Germany. However, it has been observed that the skills acquired by the attendees already begin to deteriorate shortly thereafter. As an alternative, efforts are currently underway to assess telephone-guided resuscitation performed by bystanders on site following instruction received via telephone. Use of automated external defibrillators by helpers first on the scene is considered to be another option. Initial experience has shown, however, that little use is made of the equipment located at heavily frequented areas (airports, railroad stations, etc.). At these locations it seems to make more sense to train the first responders (police force, fire department). Further measures need to be implemented to improve the actual assistance rendered in terms of quality and quantity.     

Identification of a Thymidylate Synthase Gene within the Genome of Chilo Iridescent Virus

The thymidylate synthase (TS, EC 2.1.1.45) is essential for the de novo synthesis of dTMP in pro- and eucaryotic organisms. Consequently it plays a major role in the replication of the DNA genome of a cell or a DNA virus. The gene encoding the TS of Chilo iridescent virus (CIV) was identified by nucleotide sequence analysis of the viral genome and was mapped within the EcoRI CIV DNA fragments G and R. Computer assisted analysis of the DNA nucleotide sequence between the genome coordinates 0.482 and 0.489 revealed an open reading frame (ORF) of 885 nucleotides. This ORF was found to encode a polypeptide of 295 amino acid residues (33.9 kDa) that showed significant homologies to known TS of different species including mammals, plants, fungi, protozoa, bacteria, and DNA viruses. The highest amino acid homologies were found between the CIV-TS and the TS of herpesvirus ateles (54.0%), Saccharomyces cerevisiae (51.8%), herpesvirus saimiri (51.0%), rhesus monkey rhadinovirus (50.7%), mouse (50.5%), rat (50.2%), varicella-zoster virus (50.2%), equine herpesvirus 2 (50.0%), and the human TS (48.4%). The CIV-TS contains six amino acid domains that are highly conserved in the TS of other species. Within these domains the major amino acid residues are present for which a functional role has been reported. The CIV-TS was found to be more closely related to the TS of eucaryotes than to the TS of procaryotes indicating the phylogenetic origin of the CIV-TS gene. The identification of a TS gene in the genome of CIV is the first report of a viral TS that is not encoded by a herpesvirus or a bacteriophage.     

Erratum: Sodium channel gene (SCN5A) mutations in 44 index patients with brugada syndrome: Different incidences in familial and sporadic disease

In supplementation of previously published cardiac sodium channel (SCN5A) gene mutations that were cited in the text, in Table 2 and in Figure 2 we here apply an updated gene mutation nomenclature (Human Genome Variation Society, 2005) to facilitate mutation annotation comparison (SCN5A cDNA reference: NM_198056.1 or GI: 37622906; amino acid reference sequence: SWISS‐PROT entry Q14524, long splice variant, 2,016 amino acids): Mutation: c.2602delC Amino acid change: p.Glu868X Mutation: c.2581_2582delTT Amino acid change: p.Phe861Trp fsX90 Mutation: c.4477_4479delAAG Amino acid change: p.Lys1493del Mutation: c.5425C>A Amino acid change: p.Ser1812X     

Residual effects of prior exercise and recovery on subsequent exercise-induced metabolic responses

Abstract Data on the metabolic responses to repeated endurance exercise sessions are limited. Thus, the aims of this study were to examine (1) the impact of prior exercise on metabolic responses to a subsequent exercise session and (2) the effect of different recovery periods between two daily exercise sessions on metabolic responses to the second bout of exercise. Nine male elite athletes participated in four 25-h trials: one bout of exercise (ONE), two bouts of exercise separated by 3 h of rest and one meal (SHORT), two bouts of exercise separated by 6 h of rest and two meals (LONG), and a trial with no exercise (REST). All exercise bouts consisted of 10 min cycling at 50% followed by 65 min at 75% of maximal O₂ uptake. Compared to no prior exercise (ONE), a previous bout of exercise (SHORT) was followed by higher mean O₂ uptake, heart rate (HR), rectal temperature (T_R), excess post-exercise oxygen consumption and lower respiratory exchange ratio (R) during and after a similar exercise session 3 h later. A longer rest interval between the two exercise bouts (6 h versus 3 h) and an additional meal resulted in a decrease in O₂ uptake, HR, T_R and an increase in R during the second bout of exercise, but no effects on post-exercise metabolism were found. Thus, augmented metabolic stress was observed when strenuous exercise was repeated after only 3 h of recovery, but this was attenuated when a longer recovery period including an additional meal was provided between the exercise sessions.