Heparin-binding epidermal growth factor expression in KATO-III cells after Helicobacter pylori stimulation under the influence of strychnos Nux vomica and Calendula officinalis.

INTRODUCTION: Previous studies have shown the stimulating effect of Helicobacter pylori on the gene expression of heparin-binding epidermal growth factor (HB-EGF) using the gastric epithelial cell line KATO-III. Strychnos Nux vomica (Nux vomica) and Calendula officinalis are used in highly diluted form in homeopathic medicine to treat patients suffering from gastritis and gastric ulcers. AIM AND METHOD: To investigate the influence of Nux vomica and Calendula officinalis on HB-EGF-like growth factor gene expression in KATO-III cells under the stimulation of H. pylori strain N6 using real-time PCR with and without addition of Nux vomica and Calendula officinalis as a 10c or 12c potency. RESULTS: Baseline expression and stimulation were similar to previous experiments, addition of Nux vomica 10c and Calendula officinalis 10c in a 43% ethanolic solution led to a significant reduction of H. pylori induced increase in gene expression of HB-EGF (reduced to 53.12+/-0.95% and 75.32+/-1.16% vs. control; p<0.05), respectively. Nux vomica 12c reduced HB-EGF gene expression even in dilutions beyond Avogadro's number (55.77+/-1.09%; p<0.05). Nux vomica 12c in a 21.5% ethanol showed a smaller effect (71.80+/-3.91%, p<0.05). This effect was only be observed when the drugs were primarily prepared in ethanol, not in aqueous solutions. The data suggest that both drugs prepared in ethanolic solution are potent inhibitors of H. pylori induced gene expression.

Evaluation of interleukin-6 and interleukin-10 in lung transplant patients with human cytomegalovirus infection.

We hypothesized that interleukin-6 (IL-6) in plasma and bronchoalveolar lavage (BAL) might serve as additional diagnostic parameter in lung transplant patients with human cytomegalovirus (HCMV) infection. Therefore, we compared IL-6 levels in HCMV-positive vs. HCMV-negative patients. IL-6 was measured by ELISA in plasma and BAL in 111 patients. Furthermore, we investigated the influence of IL-10 on IL-6 production in HCMV-positive patients. For HCMV-DNA detection in plasma and BAL a quantitative polymerase chain reaction (PCR) assay was used. IL-6 levels were significantly higher in the HCMV-positive group (n = 39; BAL p = 0.045; plasma p = 0.017) in comparison to the HCMV-negative group (n = 72). IL-10 did not correlate with IL-6 concentration (p = 0.146). Donor (D) or recipient (R) HCMV-constellation did not influence IL-6 concentration. IL-6 levels were not influenced by elevated levels of HCMV copies. Our data suggest that IL-6 does not serve as a good diagnostic parameter for existence of HCMV infection in lung transplant patients. Because of the wide range of the IL-6 levels in both groups, we were not able to find a breakpoint differentiating between infected and not-infected patients. Another important finding was that IL-6 production is not dependent of the HCMV status of D/R.

Thiocyanate catalyzes myeloperoxidase-initiated lipid oxidation in LDL.

There is evidence that LDL oxidation may render the lipoprotein atherogenic. The myeloperoxidase-hydrogen peroxide (MPO/H2O2) system of activated phagocytes may be involved in this process. Chloride is supposed to be the major substrate for MPO, generating reactive hypochlorous acid (HOCl), modifying LDL. The pseudo-halide thiocyanate (SCN-) has been shown to be a suitable substrate for MPO, forming reactive HOSCN/SCN*. As relatively abundant levels of SCN- are found in plasma of smokers--a well-known risk group for cardiovascular disease--the ability of SCN- to act as a catalyst of LDL atherogenic modification by MPO/H2O2 was tested. Measurement of conjugated diene and lipid hydroperoxide formation in LDL preparations exposed to MPO/H2O2 revealed that SCN- catalyzed lipid oxidation in LDL. Chloride did not diminish the effect of SCN- on lipid oxidation. Surprisingly, SCN inhibited the HOCl-mediated apoprotein modification in LDL. Nitrite--recently found to be a substrate for MPO--showed some competing properties. MPO-mediated lipid oxidation was inhibited by heme poisons (azide, cyanide) and catalase. Ascorbic acid was the most effective compound in inhibiting the SCN- -catalyzed reaction. Bilirubin showed some action, whereas tocopherol was ineffective. When LDL oxidation was performed with activated human neutrophils, which employ the MPO pathway, SCN- catalyzed the cell-mediated LDL oxidation. The MPO/H2O2/SCN- system may have the potential to play a significant role in the oxidative modification of LDL--an observation further pointing to the link between the long-recognized risk factors of atherosclerosis: elevated levels of LDL and smoking.

Free and peptide-bound DOPA can inhibit initiation of low density lipoprotein oxidation.

Hydroxyl radicals have been shown to convert free tyrosine to 3,4-dihydroxyphenyl-alanine (DOPA) which has reducing properties. During protein or peptide oxidation such reducing species are also formed from tyrosine residues. Free DOPA or peptide-bound DOPA (PB-DOPA) is able to promote radical-generating events, facilitating the damage of biomolecules such as nucleic acids. Radical induced lipid oxidation in low density lipoprotein (LDL) transforms the lipoprotein into an atherogenic particle. As PB-DOPA has been found in atherosclerotic plaques, we tested the ability of free and PB-DOPA to influence LDL oxidation. Free DOPA, in contrast to tyrosine had strong inhibitory action on both, the copper-ion initiated and metal ion independent (AAPH-induced) lipid oxidation. Free DOPA also inhibited LDL oxidation induced by the copper transport protein ceruloplasmin. To test if PB-DOPA was also able to inhibit LDL oxidation, DOPA residues were generated enzymatically in the model peptides insulin and tyr-tyr-tyr, respectively. PB-DOPA formation substantially increased the ability of both molecules to inhibit LDL oxidation by copper or AAPH. We hypothesize that DOPA-peptides and -proteins may have the potential to act as efficacious antioxidants in the atherosclerotic plaque.

Comparison of a conventional tracheal airway with the Combitube in an urban emergency medical services system run by physicians.

This prospective randomised study was performed to compare the use of the Esophageal-Tracheal Combitube(R) (ETC; Tyco Healthcare, Mansfield, MA; http://www.combitube.org) with a conventional tracheal airway (ETA) for airway management by experienced physicians of the Emergency Medical Services System of the City of Vienna in the prehospital setting. Access to the patient's head, time of arrival of the ambulance, ease of insertion, time of insertion, potential substitution by the alternate airway, efficacy of adrenaline (epinephrine) administered via the airway, survival to the intensive care unit (ICU) ward and survival to discharge from the hospital were evaluated. One hundred and seventy-two non-traumatic cardiac arrest patients (131 males, 41 females) were enrolled in this study during a 12 months period. In 83 patients (48.3%), the conventional ETA (group 1) was used for the initial intubation attempt which was successful in 78 patients (94%). The remaining five patients of group 1 could not be intubated with an ETA, but were successfully managed with the ETC. Eighty-nine patients (51.7%) were intubated with the ETC (group 2) as first choice (79 in oesophageal position (89%); eight in tracheal position: (9%)), which was successful in 87 (98%) patients. The remaining two patients in group 2 (2%) were successfully managed with the ETA. Success of intubation and ventilation with ETC was comparable to the ETA. Recorded time of insertion was shorter with the ETC versus ETA (P<0.05). The Combitube worked well in cases of difficult access to the patient's head and in bleeding and vomiting patients. Both devices served as successful substitutes for each other. Adrenaline (epinephrine) applied via ETC with a 10-fold dosage was as effective as via the conventional ETA. To our knowledge this is the first study using physicians comparing ETC and ETA in the prehospital setting.

Furosemide and spironolactone reduce transmigration of leukocytes through endothelial cell monolayers.

Furosemide and spironolactone reduce transmigration of leukocytes through endothelial cell monolayers. Leukocytes play a tremendous role during inflammation. Leukocytes migrate from intravascular space into the tissue to attack microorganisms. Various agents are able to influence leukocyte recruitment. The influence of diuretics, such as furosemide and spironolactone, on inflammatory processes is not well known. The aim of our study was to examine the influence of furosemide and spironolactone on leukocyte migration through endothelial cell monolayers (ECM). Human umbilical vein endothelial cells were cultured on microporous membranes achieving a monolayer. Polymorphonuclear leukocytes (PMNL) were used in a currently described migration assay. PMNL and/or ECM were pretreated with furosemide and spironolactone using therapeutic, as well as higher and lower, concentrations. Furosemide (76 +/- 7.2%) and spironolactone (70 +/- 7.7%) were able to inhibit PMNL migration through ECM significantly, when both cell types were treated simulating the situation after an iv injection. Furosemide and spironolactone were identified as potent inhibitors of leukocyte migration through ECM.

Evaluation of the oesophageal-tracheal double-lumen tube (Combitube) during general anaesthesia.

OBJECTIVES: Evaluation of safety and effectiveness of the Combitube during general anaesthesia. PATIENTS AND METHODS: 250 patients undergoing general anaesthesia were enrolled in the study. The respective types and duration of surgery, ease of insertion of the Combitube, and potential complications were recorded. Maximum ventilatory pressures and leak fraction were also evaluated in this study. RESULTS: Duration of surgery varied between 20 and 410 min. More than 96% of the blind Combitube insertions were successful at the first attempt, with a mean time of less than 18 +/- 5 seconds (range 12-24 seconds). In 99% of patients the Combitube worked well, and adequate oxygenation and ventilation was possible. All patients were haemodynamically stable during the entire duration of surgery. In all patients, pulse oximetry showed an oxygen saturation of 97 +/- 2% and an end-tidal carbon dioxide of 38 +/- 6 mmHg. Leak fraction, calculated as a fraction of the inspired volume, did not increase to more than 5% up to a ventilation pressure of 40 cm H2O. Superficial laceration occurred in 18 patients (7.2%) without further sequelae. No severe injuries were observed during the study period. CONCLUSION: Ventilation via the Combitube appears to be safe and effective during general anaesthesia. Practice in elective cases is a requirement for successful use in an emergency situation.

Nutraceuticals: potential roles and potential risks for pain management.

Over the past 2 decades, the world health market has been flooded with over the counter herbal products, also known as nutraceuticals. Although many of these products are neither recommended nor prescribed by conventional medical practitioners, an increasing number of people are taking these products on a daily basis. A recent survey at Texas Tech University School of Medicine in Lubbock, Texas concluded that 32% of patients scheduled for elective surgery or pain procedures were taking one or more herbal supplements; however, 70% did not disclose these during a routine anesthetic assessment.(1) Pain physicians are also increasingly needed in the care of these patients. As many of these agents carry a potential to cause bleeding problems, we have reviewed here briefly, the basic mechanisms of coagulation and correlated the role of commonly used herbs known to possess side effects, which can cause excessive bleeding. In addition, we have reviewed a number of potential useful herbal derived agents for pain management.

Evaluation of Seldinger technique emergency cricothyroidotomy versus standard surgical cricothyroidotomy in 200 cadavers.

BACKGROUND: Percutaneous cricothyroidotomy is a lifesaving procedure for airway obstruction in trauma victims who need airway establishment and cannot be intubated or in whom intubation has failed. METHODS: The purpose of this study was to examine whether there is a training effect using Seldinger technique emergency cricothyroidotomy (group 1; Arndt Emergency Cricothyroidotomy Catheter Set; Cook Critical Care, Bloomington, IN) versus standard surgical cricothyroidotomy (group 2). Twenty emergency physicians performed five cricothyroidotomies with each method in a total of 200 human cadavers, comparing efficacy and safety (speed, success rate, and injuries). RESULTS: Seven attempts in group 1 and six in group 2 had to be aborted. Time intervals from the start of the procedure to location of the cricothyroid membrane were not significantly different between the groups. However, time to tracheal puncture (P < 0.01) and time to first ventilation (P < 0.001) were significantly longer in group 2. No time effect could be observed in both groups. The airway was accurately placed into the trachea through the cricothyroid membrane in 88.2% (82 of 93) of the cadavers in group 1 and in 84.0% (79 of 94) in group 2 (not significant). No injuries were observed in group 1, whereas there were six punctures of the thyroid vessels in group 2 (P < 0.05). CONCLUSIONS: With respect to time needed for the procedure, the participants performed Seldinger technique emergency cricothyroidotomy significantly faster as compared with standard surgical cricothyroidotomy. Even if no training effect had been observed, the authors believe that it is important to train residents in different methods of cricothyroidotomy in cadavers in addition to training in mannequins to achieve a higher level of efficacy in real-life situations. The shorter time to first ventilation and the fact that no injuries could be observed favor the Seldinger technique.

A scanning electron microscopic study on thrombogenicity of intraarterial catheters for chemotherapeutic treatment in head and neck cancer.

BACKGROUND: The purpose of this study was to assess the impact of standard anticoagulation and intermittent catheter irrigation on clot formation on intraarterial chemotherapeutical catheters. METHODS: Sixteen nonheparinized catheters were placed in the carotid vessels of 10 patients. Ten catheters were perfused with chemotherapeutic drugs; six catheters were not perfused. Patients received LMWH anticoagulation; catheters were irrigated with boluses of heparinized saline daily. Catheters were retrieved for SEM evaluation after a mean intravessel placement interval of 21 days. RESULTS: All samples demonstrated accumulation of thrombotic debris on luminal sides and outsides of catheters. Obliteration was seen in three samples. Detachment of thrombus fragments was present in several specimens. No significant dependence of clot formation on placement interval and chemotherapeutic perfusion was calculated. CONCLUSIONS: Standard anticoagulation was ineffective in clot prevention. Heparinized catheters might potentially reduce the risk of clot formation. A delivery system should be engaged for continuous irrigation of catheters with heparinized saline.

Evaluation of an end-tidal portable ETCO2 colorimetric breath indicator (COLIBRI).

Evaluation of tube position is important after in-hospital and prehospital emergency intubation. Colorimetric breath indicators are devices for immediate control of tube positioning by showing a color change according to end-tidal CO2 (ETCO2) concentrations. We hypothesized that colorimetric breath indicators can yield reliable results for confirmation of tube position. The aim of this study was to evaluate the effectiveness and safety of a new colorimetric breath indicator (Colibri, ICOR AB, Bromma, Sweden) in 147 patients during general anesthesia, in critically ill patients, during transport to in-hospital interventions, and in a study design after insertion of a second tube into the esophagus in long-term ventilated patients. The Colibri was attached between the respective airway and ventilatory tubing. Seventy-three patients were investigated during general anesthesia, 39 patients were observed during long-term ventilation with an average duration of 33 hours, in 15 patients during transport to an intervention for up to 4 hours, and in 20 long-term ventilated patients at the medical intensive-care unit after insertion of a second tube intentionally into the esophagus with the help of a laryngoscope. The Colibri worked well in all groups investigated and showed no false results in the group with tubes inserted into the trachea and esophagus. Data suggest that the Colibri might serve as a valuable tool for evaluating and controlling tube position. This device is independent of power supply or electronic equipment, portable, small, and immediately ready for use.