Preliminary application of CPC/PMMA composite bone cement in kyphoplasty for the elderly / 中国骨伤

OBJECTIVE@#From the perspective of clinical application to analyze the effectiveness and reliability of CPC/PMMA bone cement in percutaneous kyphoplasty (PKP) for the treatment of elderly patients with osteoporotic thoracolumbar fractures.@*METHODS@#A retrospective analysis was performed on 62 patients with osteoporotic compression fracture of single-vertebral thoracic or lumbar segment who underwent PKP surgery and had a bone density less than or equal to -3.0 SD from February 2016 to December 2016. Among them, 23 patients were in CPC/PMMA group, with an average age of (77.6±2.2) years old, 39 patients in PMMA group, with an average age of (77.1±1.1) years old. The indexes between two groups were compared, including the visual analogue scale (VAS), height ratio of anterior vertebra (AVHR), local Cobb angle, cement leakage, new adjacent vertebral fracture(NAVF).@*RESULTS@#There were no significant difference in gender, age, follow-up time and preoperative VAS, AVHR, local Cobb angle between two groups (>0.05), at the 1 day after operation, VAS, AVHR, local Cobb angle in all patients got obvious improvement (0.05). At the same time, there was no statistically significant difference in the incidence of new adjacent vertebral fracture and cement leakage (>0.05). The pain in both groups continued to improve at follow up after operation (<0.05), the local Cobb angle increased (<0.05) and AVHR decreased slightly (<0.05). However, the images of conventional methods (X-ray or CT) could not find signs about CPC degeneration and new bone ingrowth.@*CONCLUSION@#CPC/PMMA composite bone cement is safe and reliablein PKP for treatment of elderly patients with osteoporotic thoracolumbar fractures, which can effectively relieve pain and maintain vertebral body stability. It has the same curative effect as PMMA bone cement. It was worthy to research more in future, although no direct evidences support the CPC/PMMA composite bone cement can reduce the incidence of adjacent vertebral fracture, CPC degeneration or new bone ingrowth.

Cloning, expression, and purification of c-di-AMP metabolism-related genes from Porphyromonas gingivalis / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To clone, express, and purify cyclic diadenosine monophosphate (c-di-AMP) metabolism-related genes from Porphyromonas gingivalis (P. gingivalis) ATCC33277.</p><p><b>METHODS</b>Polymerase chain reaction (PCR) from the genome of P. gingivalis ATCC33277 amplified, the coding regions of pgn0523, pgn1187, and pgn2003 genes. The amplified DNA fragments were ligated with a prokaryotic expression vector pET28a to construct the recombinant expression plasmids pET-pgn0523, pET-pgn1187, and pET-pgn2003. These recombinant plasmids were transformed into Escherichia coli (E. coli) BL21 (DE3) competent cells. The expression of recombinant proteins was induced by isopropyl-β-D-thiogalactoside and detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Proteins were purified using a Ni²⁺ matrix column, and their concentrations were determined by a BCA Protein Quantitative Kit.</p><p><b>RESULTS</b>The c-di-AMP metabolism-related genes from P. gingivalis ATCC33277 were amplified successfully with the correct molecular size. The recombinant expression vectors were constructed by ligating enzyme-digested PCR products and pET28a vector, and verified by PCR and sequencing. After induction and purification, recombinant proteins were expressed successfully and obtained with the correct molecular size (19.5 x 10³, 39.9 x 10³, 66.0 x 10³). The final protein concentrations were 0.708, 0.523, and 0.861 mg · mL⁻¹ after dialysis.</p><p><b>CONCLUSION</b>The c-di-AMP metabolism-related genes from P. gingivalis ATCC33277 are cloned successfully, and their coding products are expressed correctly in E. coli. High-purity proteins are finally obtained. The cloning and purification of these important proteins will help us to further investigate the physiological function and regulatory mechanism of c-di-AMP signaling system in P. gingivalis.</p>

The different contraction between rat gastric longitudinal and circular smooth muscle induced by extracellular nucleotides / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To test the different contrctile responses of extracellular nucleotides, such as ATP, UTP and nucleotide uridine adenosine tetraphosphate (Up4A) in gastric longitudinal muscle (LM) and circular muscle (CM). Examined the effect of P2X and P2Y receptor antagonists (in this study, we used IP5I and suramin) and cyclooxygenase inhibitor (indomethacin) on Up4A induced contractile responses in LM and CM.</p><p><b>METHODS</b>The rats were sacrificed and the stomachs were opened to gain LM and CM. Using organ bath system to assess contrctile responses of smooth muscle.</p><p><b>RESULTS</b>Up4A could induce contractile responses in both CM and LM, which were similar with ATP and UTP. IP5 did not attenuate Up4A could induce contractions in both LM and CM, but suramin and indomethacin significantly inhibited Up4A contraction in CM, but not in LM.</p><p><b>CONCLUSION</b>Our results suggest that extracellular nucleosides and their inhibitors induce different responses between LM and CM.</p>

Evaluation of Korean Version of the Beliefs about Papanicolau Test and Cervical Cancer in Unmarried University Students

PURPOSE: This study was conducted to evaluate Korean version of the beliefs about Papanicolau (Pap) test and cervical cancer [CPC-28] in unmarried university students. METHODS: The Korean version of CPC-28 (K-CPC-28) was developed through forward-backward translation techniques. A reliability, confirmatory factor analysis and correlations coefficients were evaluated. Data were collected from 303 unmarried female students attending university using a questionnaire that included28 items of CPC, 5 items of susceptibility of cervicalcancer and 8 items of HPV knowledge. RESULTS: K-CPC-28 had reliable internal consistency with Cronbach's alpha=.74 of six subscales ranged from .66 to .80. Factor loadings of the 28 items of subscales ranged from .31 to .86. Six factors in this study explained 55% of the total variance. In convergent validity of the K-CPC-28, the subscales of K-CPC-28 were significantly correlated with susceptibility scale of cervical cancer and HPV knowledge scale. CONCLUSION: K-CPC-28has satisfactory construct validity and reliability. It seems to be an acceptable tool to assess the attitudes toward cervical cancer prevention and Pap smear in unmarried women. This tool would be also applicable to screen the risk group in cervical cancer prevention and to identify its association with actual Pap test or cervical cancer prevention behaviors.

Long-term Prognosis and Neuro-psychosocial Deficits in Post-cardiac arrest Patients

PURPOSE: Anoxic neurologic deficits are an important cause of morbidity and mortality in post-cardiac arrest patients. Cardiopulmonary resuscitation (CPR), a series of life-saving actions, improve the chance of survival following cardiac arrest; however, there are few reports on neuropsychiatric function in patients successfully resuscitated after cardiac arrest. We conducted this study to evaluate the long-term neurologic, psychiatric, and social deficits in post-cardiac arrest patients. METHODS: We reviewed medical records from eight university hospitals from January 2009 to December 2009. Patients, older than 14 years old, successfully resuscitated after cardiac arrest and with a cerebral performance category scale (CPC) 1 or 2 were enrolled. Among 56 included patients, the mean age was 57 years old and 37 patients were male. Forty-two cases were presumed to have cardiac etiology and 14 were considered to have a non-cardiac etiology. The initially recorded rhythms, in 50% of patients, were ventricular fibrillation and pulse-less ventricular tachycardia. The mean length of a hospital stay was 30 days. RESULTS: At hospital discharge, 51 patients (91.1%) with successful resuscitation showed CPC 1 and 5 patients (8.9%) showed CPC 2. Twenty-four (42.9%) patients suffered from a variety of neuro-psychosocial deficits, such as memory disturbances, attention deficits, post-traumatic stress disorder, and difficulty initiating exercise. CONCLUSION: Despite successful resuscitation, a considerable number of patients complained of various neuro-psychiatric deficits. The most common neuro-psychosocial deficits were disturbances in short-term memory.

Early Initiation of Therapeutic Hypothermia after Sudden Out-of-Hospital Cardiac Arrest

PURPOSE: Therapeutic hypothermia (TH) improves the probability of survival and neurologic recovery after resuscitation from out-of-hospital cardiac arrest (OHCA). However, the best time to initiate TH after the return of spontaneous circulation (ROSC) remains unknown. METHODS: The aim of this study was to evaluate the correlation between TH initiation time after ROSC and the resulting neurological outcome. Methods: A retrospective analysis was performed on 122 OHCA patients enrolled between January 2008 and December 2011. Therapeutic hypothermia (32~34degrees C) was induced immediately after ROSC. The primary measure of outcome was neurological function at hospital discharge, as determined by a cerebral performance category (CPC) scale. RESULTS: Out of the 122 patients, 34 patients (27.9%) had a good neurological outcome at hospital discharge. The initiation time following ROSC was shorter, although not statistically significant, in patients with good neurological outcomes compared to those with poor outcomes. Based on subgroup analysis, only the shockable rhythm group showed a significant difference, in the time after ROSC to TH initiation, between good and poor neurological outcome groups. Receiver operator characteristic analysis suggested that an initiation time of 250 min after ROSC was most predictive of CPC 1-2 outcomes compared to other time points. Furthermore, the 250 min initiation time after ROSC correlated with neurological outcome in patients with OHCA undergoing TH treatment. CONCLUSION: Compared to late initiation, early initiation (within 250 min) with TH had neurologic benefits for patients with OHCA.

Management of Perioperative Antiplatelet Therapy / 대한내과학회지

Drug-eluting stent (DES) implatation was the major method of coronary revascularization and marked reduction in target-lesion revascularization. Stent thrombosis (ST) is a severe complication that is associated with a high incidence of acute myocardial infarction and death. To prevent ST, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended for at least 12 months. The premature discontinuation of DAPT is the single most significant predictor of perioperative ST. The risk of surgical bleeding is increased approximately 20% by aspirin or clopidogrel alone, and 50% by DAPT. But the increased risk of perioperative bleeding is not necessarily associated with increased mortality or surgical outcome. Usually, the risk of a cardiovascular event when stopping antiplatelet agents preoperatively is higher than the risk of surgical bleeding when continuing these drugs, except during high risk surgery in a closed space. We remember that DES are never low risk situation for ST and aspirin must never be stopped in all patients with DES.

Efficacies of Somatosensory Evoked Potential and Diffusion-Weighted Magnetic Resonance Imaging as Predictors of Prognosis for Patients Experiencing Coma after Cardiac Arrest / 대한구급학회지

BACKGROUND: The aim of this study was to examine the efficacies of somatosensory evoked potential (SEP) and diffusion-weighted magnetic resonance imaging (DWI) in predicting the clinical prognosis of comatose patients following cardiac arrest. METHODS: Forty-one patients resuscitated from out-of hospital cardiac arrest (OHCA) were retrospectively studied. After return of spontaneous circulation (ROSC), SEP was conducted between one and three days after resuscitation, and DWI was conducted within five days of resuscitation. SEP was classified into three grades: normal, delayed conduction or unilateral loss of the N20 peak, and bilateral loss of the N20 peak. Bilateral loss of the N20 peak was considered a predictor of poor prognosis. For DWI, diffuse signal intensity (SI) abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex was taken as a predictor of poor prognosis. For patient clinical prognosis, the Glasgow-Pittsburgh Cerebral Performance Category (CPC) was used to evaluate neurological results at the time of discharge. Resulting CPC scores of 1 and 2 were considered as a favorable prognosis, and scores of 3, 4, and 5 were considered as a poor prognosis. Sensitivity, specificity, positive predictive value, and negative predictive value for the prediction of poor prognosis were analyzed for each test individually and for the combination of the two tests. RESULTS: Among the 41 subject patients, 31 underwent SEP, 30 underwent DWI, and 20 underwent both tests. The prognosis predictor of SEP (bilateral loss of the N20 peak) predicted poor prognosis with 56.5% sensitivity, 100% specificity, 100% positive predictive value, and 44.4% negative predictive value. The prognosis predictor of DWI (diffuse SI abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex) predicted poor prognosis with 85% sensitivity, 100% specificity, 100% predictive value, and 76.9% predictive value. For patients who underwent both tests, the sensitivity and negative predictive value for the prediction of poor prognosis increased to 92.3% and 87.5%, respectively, and the specificity and positive predictive value were maintained at 100%. CONCLUSIONS: The accuracy of poor prognosis prediction for patients in prolonged comas after resuscitation is enhanced by combining the results of SEP and DWI along with the individual results of each test.

Relevance of Seizure with Mortality and Neurologic Prognosis of Out of Hospital Cardiopulmonary Arrest (OHCA) Patients Who had Treated with Therapeutic Hypothermia after Return of Spontaneous Circulation

PURPOSE: The purpose of this study is to evaluate relevance of postanoxic seizure with prognosis in cases of out-of hospital cardiac arrest (OHCA) patients treated with TH and to research the prognostic role of portable electroencephalography (EEG). METHODS: A total of 180 OHCA patients arrived during July of 2008 and June of 2011, and 144 patients who had been treated with therapeutic hypothermia were included in this study. Portable EEG was taken 24 hours after induction of TH and classified by the attending neurologist. As an outcome variable, overall mortality and neurological outcome after six months from discharge were evaluated (Good neurological outcome; Cerebral performance category (CPC) scale 1, 2, Poor neurological outcome; CPC scale 3~5). RESULTS: Among 144 patients, 93 patients (63.9%) were male, and mean age was 51. Eighty two patients (56.9%) survived and almost 30% (43/144) of patients had a good neurological outcome. Sixty five patients (45.1%) had seizures, and, among this group, 19 patients (29.2%) were discharged with a good neurological outcome. No statistical difference was observed between the seizure group and the non-seizure group. Initial rhythm, APACHI II score, and time from basic life support to return of spontaneous circulation (OR, 2.169; 95% CI, 1.158~4.063, OR 1.107; 95% CI 1.064~1.152, OR 1.014; 95% CI 1.006~1.022, respectively) showed statistical importance, however, the seizure group (OR, 0.67, 95% CI, 0.356~1.032, p=0.065) had no statistical relevance with mortality. Grading of EEG by the neurologist showed a positive association with neurological outcomes (p<0.001). Factors associated with good neurological outcome were VF/VT initial rhythm (p=0.005), cardiac cause of arrest (p=0.001), high initial body temperature (p<0.001), low APACHI II score (p=0.010), and shorter time interval between arrest from basic life support (p=0.005). CONCLUSION: In our study, the seizure group showed no relevance with mortality and prognosis. In hope of achieving a better outcome, careful treatment should be provided in cases of OHCA patients with seizure. Conduct of larger, prospective studies is needed.

Neurologic Outcomes and Factors Related to Outcomes in Patients Transferred for Specialized Post-cardiac Arrest care after Successful Resuscitation at other Facilities: One-year Experience in a Regional Emergency Center in Seoul, Republic of Korea

PURPOSE: We report on neurologic outcomes and experience with specialized post-cardiac arrest (PCA) care of transferred patients at a regional emergency center in Seoul over a one-year period, and we evaluate factors related to neurologic outcomes by analyzing the characteristics of the patients, transport processes, and therapeutic interventions. METHODS: We conducted a retrospective review of patients who were transferred to our facility after successful resuscitation at another hospital. The variables evaluated included clinical variables, whether there was the presence of any critical event on arrival, the transport time, the transport distance, the PCA care delay, and whether or not specialized PCA care was administered. RESULTS: A total of 31 cardiac arrest patients were included in this study. Of these, 27 patients (87.1%) were treated with therapeutic hypothermia. Thirteen patients (41.9%) were ultimately included in the good outcome group (discharge CPC 1, 2), and 18 were included in the poor outcome group (discharge CPC 3-5). During transport, occurrence of re-arrest was uncommon (n=1, 3.2%). Conversely, other critical events were common (11 patients, 35.5%). Transport time, distance, and PCA care delay were not statistically relevant to occurrence of critical events during inter-facility transport. A critical event was more likely to occur in patients who were on vasopressors (p=0.045), and it was an independent risk factor of poor outcome (odds ratio 12.28 [95% confidence interval, 1.44-104.83]). CONCLUSION: The transfer of resuscitated patients is reasonable for specialized PCA care. Because critical events were common during transport and showed correlation with poor neurologic outcomes, a critical care transport team must be used with these patients.

Vertebroplasty Using Calcium Phosphate Cement for Osteoporotic Vertebral Fractures: Study of Outcomes at a Minimum Follow-up of Two Years

STUDY DESIGN: A case-series study. PURPOSE: To assess the long-term clinical and radiographic outcomes after vertebroplasty using calcium phosphate cement (CPC) for treatment of osteoporotic vertebral fractures (OVF). OVERVIEW OF LITERATURE: Vertebroplasty has become common for the treatment of OVF. However, few studies have reported the clinical application of CPC to vertebroplasty. METHODS: We reviewed 86 consecutive patients undergoing 99 vertebroplasties using CPC. Following repositioning and curettage of the pathological soft tissue of the vertebral body (VB), vertebroplasty using CPC was performed in patients with osteoporotic burst fracture and pseudoarthrosis (procedure A). Vertebroplasty was also performed in patients with osteoporotic compression fractures (procedure B). Back pain and lower back pain were evaluated using the visual analogue scale (VAS). The VB deformity index was measured in a lateral radiograph as the ratio of the VB's height to its longitudinal diameter. RESULTS: The mean age at time of surgery was 77 years old. The mean duration of follow-up was forty-four months. All patients reported decreased pain according to the VAS immediately after vertebroplasty, and pain relief was maintained at the last follow-up in all patients without new OVFs. Complete bone union was observed in all cases by six months after surgery. The mean recovery rate of deformity index was 5.9% in procedure A and 0.02% in procedure B at the final follow-up visit. CONCLUSIONS: Vertebroplasty using CPC gave a satisfactory outcome and no delayed complications in elderly patients with osteoporotic vertebral fractures at follow-up times of at least two years.

Antiplaque and antigingivitis effects of a mouthrinse containing cetylpyridinium chloride, triclosan and dipotassium glycyrrhizinate

PURPOSE: The goal of this study was to evaluate the clinical anitplaque and antigingivitis effects of a mouthrinse containing cetylpyridinium chloride (CPC), triclosan and dipotassium glycyrrhizinate (DPZ) in patients with gingivitis and mild periodontitis. METHODS: Thirty-two subjects were randomized into 2 groups. The test group used a mouthrinse containing 0.05% CPC, 0.02% triclosan and 0.02% DPZ, while the control group used a placebo mouthrinse. At baseline, 2 weeks and 4 weeks, the papillary bleeding index (PBI), Turesky-Quigley-Hein plaque index (PI) and Loe-Silness gingival index (GI) were assessed. During the experimental period, the patients used the mouthrinse for 30 seconds, 4 to 5 times/day (10 mL/time) within 30 minutes after toothbrushing. RESULTS: No adverse effects appeared in either the experimental or the control group. Regarding PBI, PI and GI values, statistical significance was detected between values at baseline and 2 weeks for both groups (P<0.05). In the experimental group, statistically significantly lower values were detected at 4 weeks compared to at 2 weeks. However, in the control group, no statistically significant difference was detected between the values at 2 weeks and 4 weeks. Additionally, the mean value after 4 weeks for the control group was slightly higher than the mean value after 2 weeks for the control group. CONCLUSIONS: This study for 4 weeks demonstrated that mouthrinses containing CPC, triclosan and DPZ may contribute to the reduction of supragingival plaque and gingivitis.

Antiplaque and antigingivitis effects of a mouthrinse containing cetylpyridinium chloride, triclosan and dipotassium glycyrrhizinate

PURPOSE: The goal of this study was to evaluate the clinical anitplaque and antigingivitis effects of a mouthrinse containing cetylpyridinium chloride (CPC), triclosan and dipotassium glycyrrhizinate (DPZ) in patients with gingivitis and mild periodontitis. METHODS: Thirty-two subjects were randomized into 2 groups. The test group used a mouthrinse containing 0.05% CPC, 0.02% triclosan and 0.02% DPZ, while the control group used a placebo mouthrinse. At baseline, 2 weeks and 4 weeks, the papillary bleeding index (PBI), Turesky-Quigley-Hein plaque index (PI) and Loe-Silness gingival index (GI) were assessed. During the experimental period, the patients used the mouthrinse for 30 seconds, 4 to 5 times/day (10 mL/time) within 30 minutes after toothbrushing. RESULTS: No adverse effects appeared in either the experimental or the control group. Regarding PBI, PI and GI values, statistical significance was detected between values at baseline and 2 weeks for both groups (P<0.05). In the experimental group, statistically significantly lower values were detected at 4 weeks compared to at 2 weeks. However, in the control group, no statistically significant difference was detected between the values at 2 weeks and 4 weeks. Additionally, the mean value after 4 weeks for the control group was slightly higher than the mean value after 2 weeks for the control group. CONCLUSIONS: This study for 4 weeks demonstrated that mouthrinses containing CPC, triclosan and DPZ may contribute to the reduction of supragingival plaque and gingivitis.

Neuron Specific Enolase as a Biomarker Predicting Neurological Outcome after Cardiac Arrest in Patients Treated by Therapeutic Hypothermia

PURPOSE: Neurological outcome prediction is an important aspect of post-resuscitation care in cardiac arrest survivors. The appearance of high serum neuron specific enolase (NSE) is known to be associated with ischemic brain injury and poor neurological outcome. The application of therapeutic hypothermia to cardiac arrest survivors has been shown to improve neurological outcomes. As such, we investigated the predictive value of serial serum NSE levels in patients who were resuscitated from cardiac arrest. METHODS: This study included 123 cardiac arrest survivors who were treated by therapeutic hypothermia from January 2008 to June 2011. Blood samples used for evaluating NSE were collected at return of spontaneous circulation (ROSC) at 6, 24 and 48 hours after initiation of therapeutic hypothermia. Neurological outcome was graded as 'good' or 'poor' at discharge and assessed according to the Cerebral Performance Category scale (CPC). A poor outcome was defined as a CPC value of 3-5. RESULTS: Receiver operating characteristic (ROC) analysis revealed NSE cut-off values of 53.9 microg/L (sensitivity 14.6%), 48.5 microg/L (sensitivity 30.6%), 80.0 microg/L (sensitivity 40.0%), and 52.7 microg/L (sensitivity 55.5%) for poor outcomes with a specificity of 100%, measured at ROSC of 6, 24 and 48 hours after initiation of therapeutic hypothermia, respectively. The poor outcome group showed significant change in NSE concentration over time (p=0.002), while the good outcome group did not. CONCLUSION: Detection of NSE at the cut-off value, 48 hr after initiation of therapeutic hypothermia was a specific but moderately sensitive marker of poor outcome at discharge. Single measurements of NSE should be cautiously interpreted, but NSE change over time was helpful in predicting the neurologic outcome.

Neuron Specific Enolase as a Biomarker Predicting Neurological Outcome after Cardiac Arrest in Patients Treated by Therapeutic Hypothermia

PURPOSE: Neurological outcome prediction is an important aspect of post-resuscitation care in cardiac arrest survivors. The appearance of high serum neuron specific enolase (NSE) is known to be associated with ischemic brain injury and poor neurological outcome. The application of therapeutic hypothermia to cardiac arrest survivors has been shown to improve neurological outcomes. As such, we investigated the predictive value of serial serum NSE levels in patients who were resuscitated from cardiac arrest. METHODS: This study included 123 cardiac arrest survivors who were treated by therapeutic hypothermia from January 2008 to June 2011. Blood samples used for evaluating NSE were collected at return of spontaneous circulation (ROSC) at 6, 24 and 48 hours after initiation of therapeutic hypothermia. Neurological outcome was graded as 'good' or 'poor' at discharge and assessed according to the Cerebral Performance Category scale (CPC). A poor outcome was defined as a CPC value of 3-5. RESULTS: Receiver operating characteristic (ROC) analysis revealed NSE cut-off values of 53.9 microg/L (sensitivity 14.6%), 48.5 microg/L (sensitivity 30.6%), 80.0 microg/L (sensitivity 40.0%), and 52.7 microg/L (sensitivity 55.5%) for poor outcomes with a specificity of 100%, measured at ROSC of 6, 24 and 48 hours after initiation of therapeutic hypothermia, respectively. The poor outcome group showed significant change in NSE concentration over time (p=0.002), while the good outcome group did not. CONCLUSION: Detection of NSE at the cut-off value, 48 hr after initiation of therapeutic hypothermia was a specific but moderately sensitive marker of poor outcome at discharge. Single measurements of NSE should be cautiously interpreted, but NSE change over time was helpful in predicting the neurologic outcome.

Gray/White Matter Ratio as an Outcome Predictor for Cardiac Arrest Patients Treated by Therapeutic Hypothermia

PURPOSE: Ischemic brain injury following cardiac arrest presents as cerebral edema. Cerebral edema can be diagnosed using computed tomography (CT) by evidence of difference in the ratio between gray and white matter density. The prognostic value of CT scan use in determining neurologic outcomes remains unclear for cardiac arrest survivors treated with therapeutic hypothermia. We investigated the density of gray and white matter and found that their ratio was associated with neurologic outcome. METHODS: Our study data included 93 cardiac arrest survivors treated with therapeutic hypothermia from January 2008 to June 2011. Cranial CT was performed after the return of spontaneous circulation. Circular regions of CT measurement (9.4 mm2) evaluated locations of interest including the caudate nucleus, putamen, posterior limb of the internal capsule, and the corpus callosum. The average attenuation in Hounsfield Units (HU) for each region was recorded. Neurological outcome was ranked as good or poor at discharge with neurological outcome assessed according to the Cerebral Performance Category scale (CPC) with a poor outcome defined as a CPC of 3-5. RESULTS: Gray matter attenuation was found to be significantly different between the good and poor outcome cases while white matter attenuation was insignificant. All types of gray/white matter ratio were significantly different between two groups. Receiver operating characteristics analysis determined a cut-off value of gray/white matter ratio at less than 1.11 (sensitivity 29.8%) which results in a poor outcome with a specificity of 100%. CONCLUSION: A low gray/white matter ratio (<1.11), as evaluated by CT scan, is associated with poor outcome after cardiac arrest and therapeutic hypothermia. However, the results of a CT scan should be interpreted with caution as the gray/white matter ratio is a low sensitivity marker.

Serial Measured Glucose Level and Neurological Outcome in Out of Hospital Cardiac Arrest Survivors Who Received Therapeutic Hypothermia

PURPOSE: In patients resuscitated from out-of-hospital cardiac arrest (OHCA), the influences of serial serum glucose and variability on neurological outcome are not well understood. We investigated the influence of serum glucose and variability on neurological outcome in OHCA survivors. METHODS: Records of 105 OHCA survivors who received therapeutic hypothermia (TH) between April, 2007 and January, 2010 were retrospectively reviewed. By neurological prognosis at 6 months after restoration of spontaneous circulation, patients were divided to two groups based on cerebral performance category (CPC) score; 1-2 (good) and 3-5 (poor). The serial measured glucose level and glucose variability during 72 hours were compared between the groups. RESULTS: The poor CPC group had statistically higher mean, median and maximum glucose level, but not minimal glucose, compared to the good CPC group. The poor CPC group also comparatively displayed higher standard deviation and time-glucose variability index (TGVI) of glucose level during 72 hours. Multiple logistic regression demonstrated that increased TGVI was significantly associated with poor neurological outcome (odds ratio 1.304, 95% confidence interval 1.078-1.578) CONCLUSION: Serial glucose level and variability are strongly related with neurological outcome in post-resuscitated patients who received TH after OHCA. Further randomized controlled studies are needed.

The Effect of Cefazolin on Mechanical Properties and Antibacterial Reactions of Calcium Phosphate Cement / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the change of mechanical properties and the effect of antibacterial reactions in calcium phosphate cement (CPC) mixed with cefazolin. MATERIALS AND METHODS: We made CPC and a sodium alginate solution and we mixed in variable dosages of cefazolin and then we made a standard sized cement mold. With that we performed compression stress tests, drug releasing tests and antibacterial tests. RESULTS: We found the typical appearance of hydroxyapatite (HA) in the cement mixed with cefazolin. The compressive strength of the cement mixed with cefazolin was higher than that of the cement not mixed with cefazolin and the higher strength cement had a smaller pore size and less porosity. The sodium alginate solution showed the maximum compressive strength at 2 & 4 wt%, but this was decreased at 6 wt%. Cefazolin was released in proportion to the concentration for the first 8 days on the drug releasing test and then a similar amount was released until the tenth day. An antibacterial effect was detected at all dosages of cefazolin on the antibacterial test. CONCLUSION: The compressive strength of the cement mixed with cefazolin was higher than that of the cement not mixed with cefazolin. The drug was released from the cement in a proper fashion and the antibacterial effect was preserved.

Response of Odontoblast to the Bio-Calcium Phosphate Cement

Outcome after Admission to Intensive Care Unit Following Out-of-Hospital Cardiac Arrest: Comparison between Cardiac Etiology and Non-Cardiac Etiology / 대한구급학회지

BACKGROUND: To evaluate the post-resuscitation intensive care unit outcome of patients who initially survived out-of-hospital cardiac arrest (OHCA). METHODS: We retrospectively analyzed patients who were admitted to the ICU after OHCA in a tertiary hospital between January, 2005 and December, 2009. We compared the patients' clinical data, the factors associated with admission and the prognosis of patients in cardiac and non-cardiac groups. RESULTS: Sixty-four patients were included in this study. Thirty-four patients were in the cardiac group and thirty patients were in the non-cardiac group. The mean age was 57.3 +/- 15.1 years of age in the cardiac group and 61.9 +/- 15.7 years of age in the non-cardiac group (p = 0.235). The collapse-to-start of the CPR interval was 5.9 +/- 3.8 min in the cardiac group and 6.0 +/- 3.2 min in the non-cardiac group (p = 0.851). The complaint of chest pain occurred in 12 patients (35.3%) in the cardiac group and 1 patient (3.3%) in the non-cardiac group (p = 0.011). The time duration for making a decision for admission was 285.2 +/- 202.2 min in the cardiac group and 327.7 +/- 264.1 min in the non-cardiac group (p = 0.471). The regional wall motion abnormality and ejection fraction decrease were significant in the cardiac group (p = 0.002, 0.030). Grade 5 CPC was present in 8 patients (23.5%) in the cardiac group and 14 patients (46.7%) in the non-cardiac group. CONCLUSIONS: The key symptom that could initially differentiate the two groups was chest pain. The time duration for making an admission decision was long in both groups. The CPC score of the cardiac group was lower than that for the non-cardiac group.