P21CIP_1/WAF_1、CD_(44)V_6在恶性卵巢上皮性肿瘤的表达及与淋巴结转移相关研究

目的 :探讨细胞周期调控蛋白 P2 1CIP1 / WAF1 和细胞粘附分子 CD44 V6 在恶性卵巢上皮性肿瘤中的增殖、浸润、转移过程中的作用及相互关系。方法 :采用免疫组化方法 (im munohistochemical assay IHCA)检测 5 5例恶性卵巢上皮性肿瘤组织中 P2 1CIP1 / WAF1 蛋白和 CD44 V6 的表达。结果 :(1)恶性卵巢上皮性肿瘤中 P2 1CIP1 / WAF1总体阳性率为 5 5 .5 4% ,其中 期的阳性率为 2 1.43%低于 至 期的阳性率 6 5 .85 % (P<0 .0 5 ) ,伴有淋巴结转移的原发灶中的阳性率 31.5 7%明显低于无淋巴结转移的原发灶中的阳性率 6 6 .6 7% (P<0 .0 5 )。 (2 ) CD44 V6 在 到 期癌组织中表达阳性率差别无显著性 (P>0 .0 5 ) ,而在 、 期中强阳性 ( 、 )率 5 3.13%明显高于 、 期 13.0 4%(P<0 .0 5 ) ,在有淋巴结转移的原发灶中的强阳性率 (6 8.42 % )高于无淋巴结转移组 19.44 % (P<0 .0 1)。 (3) P2 1CIP1/ WAF1与 CD44 V6 在有淋巴结转移的原发灶中的表达呈负相关 (P<0 .0 5 )。结论 :P2 1CIP1 / WAF1 抑制恶性卵巢上皮性肿瘤增殖、浸润、转移 ,而 CD44 V6 作用相反     

Association between body mass index and clinical outcomes of patients after cardiac arrest and resuscitation: A meta-analysis

Background

Obesity as one of the risk factors for cardiovascular diseases increases mortality in general population. Several clinical studies investigated clinical outcomes in patients with different body mass index (BMI) after cardiac arrest (CA). Controversial data regarding BMI on clinical outcomes in those patients exist in those studies. Therefore, we conducted a meta-analysis to evaluate the effect of BMI on survival condition and neurological prognosis in those patients.

A rapid, safe, and low-cost technique for the induction of mild therapeutic hypothermia in post-cardiac arrest patients

Aim of study

The benefits of inducing mild therapeutic hypothermia (MTH) in cardiac arrest patients are well established. Timing and speed of induction have been related to improved outcomes in several animal trials and one human study. We report the results of an easily implemented, rapid, safe, and low-cost protocol for the induction of MTH.

Methods

All in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients admitted to an intensive care unit meeting inclusion criteria were cooled using a combination modality of rapid, cold saline infusion (CSI), evaporative surface cooling, and ice water gastric lavage. Cooling tasks were performed with a primary emphasis on speed. The main endpoints were the time intervals between return of spontaneous circulation (ROSC), initiation of hypothermia (IH), and achievement of target temperature (TT).

Results

65 patients underwent MTH during a 3-year period. All patients reached target temperature. Median ROSC-TT was 134 min. Median ROSC-IH was 68 min. Median IH-TT was 60 min. IH-TT cooling rate was 2.6 °C/h. Complications were similar to that of other large trials. 31% of this mixed population of IHCA and OHCA patients recovered to a Pittsburgh cerebral performance score (CPC) of 1 or 2.

Conclusion

A protocol using a combination of core and surface cooling modalities was rapid, safe, and low cost in achieving MTH. The cooling rate of 2.6 °C/h was superior to most published protocols. This method uses readily available equipment and reduces the need for costly commercial devices.     

Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends

Background

Survival after in-hospital cardiac arrest (IHCA) is lower during nights and weekends (off-hours) compared with daytime during weekdays (on-hours). As overall IHCA survival has improved over time, it remains unknown whether survival differences between on-hours and off-hours have changed.

The incidence and significance of bacteremia in out of hospital cardiac arrest

Background

The most common etiology of cardiac arrest is presumed of myocardial origin. Recent retrospective studies indicate that preexisting pneumonia, a form of sepsis, is frequent in patients who decompensate with abrupt cardiac arrest without preceding signs of septic shock, respiratory failure or severe metabolic disorders shortly after hospitalization. The contribution of pre-existing infection on pre and post cardiac arrest events remains unknown and has not been studied in a prospective fashion. We sought to examine the incidence of pre-existing infection in out-of hospital cardiac arrest (OHCA) and assess characteristics associated with bacteremia, the goal standard for presence of infection.

Methods and results

We prospectively observed 250 OHCA adult patients who presented to the Emergency Department (ED) between 2007 and 2009 to an urban academic teaching institution. Bacteremia was defined as one positive blood culture with non-skin flora bacteria or two positive blood cultures with skin flora bacteria. 77 met pre-defined exclusion criteria. Of the 173 OHCA adults, 65 (38%) were found to be bacteremic with asystole and PEA as the most common presenting rhythms. Mortality in the ED was significantly higher in bacteremic OHCA (75.4%) compared to non-bacteremic OHCA (60.2%, p < 0.05). After adjustment for potential confounders, predictive factors associated with bacteremic OHCA were lower initial arterial pH, higher lactate, WBC, BUN and creatinine.

Conclusions

Over one-third of OHCA adults were bacteremic upon presentation. These patients have greater hemodynamic instability and significantly increased short-term mortality. Further studies are warranted to address the epidemiology of infection as possible cause of cardiac arrest.     

Is there a difference in survival between men and women suffering in-hospital cardiac arrest?

ObjectivesTo describe in-hospital cardiac arrest (CA) events with regard to sex and to investigate if sex is associated with survival.BackgroundPrevious studies exploring differences between sexes are incongruent with regard to clinical outcomes. In order to provide equality and improve care, further investigations into these aspects are warranted.MethodsThis registry study included 286 CAs. To investigate if sex was associated with survival, logistic regression analyses were performed.ResultsThe proportion of CA with a resuscitation attempt compared to CA without resuscitation was higher among men. There were no associations between sex and survival when controlling for previously known predictors and interaction effects.ConclusionsSex does not appear to be a predictor for survival among patients suffering CA where resuscitation is attempted. The difference regarding proportion of resuscitation attempts requires more attention. It is important to consider possible interaction effects when studying the sex perspective.