Favorable neurological outcomes by early epinephrine administration within 19 minutes after EMS call for out-of-hospital cardiac arrest patients.

OBJECTIVE: To evaluate the time-independent effect of the early administration of epinephrine (EPI) on favorable neurological outcome (as CPC [cerebral performance category] 1-2) at 1 month in patients with out-of-hospital cardiac arrest. MATERIALS AND METHODS: A total of 119 639 witnessed cardiac arrest patients from 2008 to 2012 were eligible for this nationwide, prospective, population-based observational study. Patients were divided into EPI group (n = 20 420) and non-EPI group (n = 99 219). To determine the time-dependent effects of EPI, EPI-administered patients were divided into 4 groups as follows: early EPI (5-18 min), intermediate EPI (19-23 min), late EPI (24-29 min), and very late EPI (30-62 min), respectively. Multiple logistic regression analyses and adjusted odds ratios (AORs) were determined for CPC 1-2 at 1 month (primary outcome) and field return of spontaneous circulation (as secondary outcome) among the groups. RESULTS: The EPI and non-EPI group had identical background, but EPI group shows higher incidence public access defibrillation and emergency medical technician defibrillation delivered than the non-EPI group. The differences were clinically negligible. Higher return of spontaneous circulation rate (18.0%) and lower CPC 1-2 (2.9%) shown in the EPI group than in the non-EPI group (9.4% and 5.2%). In the time dependent analysis, CPC 1 to 2 was greatest in the early EPI group (AOR, 2.49; 95% confidence interval [CI], 1.90-3.27), followed by the intermediate EPI group (AOR, 1.53; 95% CI, 1.14-2.05) then the late EPI group (AOR, 0.71; 95% CI, 0.47-1.08) as reference. CONCLUSION: Early EPI administration within 19 minutes after emergency medical service call independently improved the neurological outcome compared with late EPI (24-29 minutes) administration in patients with out-of-hospital cardiac arrest.

[Skinallograft and skin bank].

The skin (homogeneous skin) hervested from the human (corpse) is called cryopreserved skin or Arograft (freezing homogeneous preservation skin) without decreasing physiological (viability) of the skin. This homogeneous skin is recognized by a living body material and world Monkey that is the nearest the ideal. It came for the skin bank network system of the multi facilities participation type to be constructed in our country in 1990's, for 53 facilities to participate now, and to grow up as a skin bank network where the main burn facilities in our country were able to be covered. Moreover, the coordinator who belonged exclusively to the skin bank was set up, and system construction with a high quality or more became possible from communications with the skin offer family by doing the collection, preservation, and the supply work. It adopted with the Kinki skin bank last year, and it started newly as Japan skin bank network (JSBN). After the establishment in 1994, the offer of the skin was received from 214 people every 11 years until 2004 in Japanese skin bank network (JSBN). Moreover, the skin of 472 times every 295 burn patients has been supplied 2004 in Japanese skin bank network (Figure 1). Fcatassei that remains epidermal element when clinical result that transplants homogeneous skin is considered? It was a good adjustment to the burn at each Unit, and even burn index 40-80 came to admit the improvement of the mortality rate of 10-20% in the cooking stove with the highest lifesaving effect. Even if the fault of the rejection is considered, a clinical effect of freezing the homogeneous skin is high.

[Simple quantitation of arsenic by energy dispersive fluorescence X-ray spectrometer using Reinsch's test].

We examined the clinical usefulness of the Reinsch's test for the detection of the small amounts of the heavy metals such as arsenic and mercury using the fluorescence X-ray spectrometry. We tried t o measure various kinds of biological samples, including serum, urine, and gastric contents using this method. 0.4 ml or 1 ml of hydrochloric acid were added to 2 ml of serum or 6 ml urine and gastric content, respectively, and a copper plate (5.0x 0.8 cm) was immersed into this solution. The mixture heated at 90 degrees C by a heating block for 30 minutes. After heating, the copper plate was washed with water and dried. The copper arsenide that stuck to the copper plate due to Reinsch's test dissolved by methanol/ammonia (8:2) solution at 60 degrees C for 15 minutes. A drop gave the solution to a filter paper fluorescence X-ray analysis and completely dried the filter paper, and applied to the fluorescence X-ray spectrometer. As a result, this method showed about 20 times high sensitivity in comparison with the measurement with condition of solution. The minimal detectable limits of rsenic was 0.4 ppm in serum and were 0.2 ppm in rine and gastric content. The calibration curve could be made for 0.5 to 50 ppm. It will take about 90 min for the measurement using this method for the detection of arsenic in biological samples. We showed the usefulness of the Reinsch's test using the fluorescence X-ray spectrometry in the clinical toxicology.

Bone marrow-derived myofibroblasts recruited to the upper dermis appear beneath regenerating epidermis after deep dermal burn injury.

Fibroblasts and myofibroblasts migrating to sites of tissue repair after injury may not only be locally recruited but could also be recruited from the bone marrow. However, the characteristics and functional roles, if any, of these cells in wound healing are poorly understood. Here, we show unequivocally that bone marrow-derived fibroblasts do contribute to deep dermal burn wound healing. Bone-marrow stromal cells were collected from femurs of male Lewis rats, cultured for a week, and then the adherent cells were labeled with the fluorescent marker PKH-26. These cells stained positive for alpha-smooth muscle actin and prolyl 4-hydroxylase, but did not express RM-4 (a macrophage marker), CD34, or cytokeratin, characteristic of myofibroblastic differentiation. When injected intravenously into Lewis rats, they homed to the bone marrow. Five days after transplantation, a deep dermal burn was made on the back of the rat, and biopsies were taken 7, 10, and 14 days later. PKH-positive cells were not found at day 7, but by day 10, they were easily detected mainly in the upper dermis close beneath the regenerating epidermis. These PKH-positive cells still stained for alpha-SMA and prolyl 4-hydroxylase, but not RM4. Thus, it is suggested that myofibroblasts originating in the bone marrow contribute not only to promotion of granulation but also enhancement of dermal-epidermal interaction after thermal injury.

Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.

BACKGROUND: We compared the clinical efficacy of surgical stabilization and internal pneumatic stabilization in severe flail chest patients who required prolonged ventilatory support. METHODS: Thirty-seven consecutive severe flail chest patients who required mechanical ventilation were enrolled in this study. All the patients received identical respiratory management, including end-tracheal intubation, mechanical ventilation, continuous epidural anesthesia, analgesia, bronchoscopic aspiration, postural drainage, and pulmonary hygiene. At 5 days after injury, surgical stabilization with Judet struts (S group, n = 18) or internal pneumatic stabilization (I group, n = 19) was randomly assigned. Most respiratory management was identical between the two groups except the surgical procedure. Statistical analysis using two-way analysis of variance and Tukey's test was used to compare the groups. RESULTS: Age, sex, Injury Severity Score, chest Abbreviated Injury Score, number of rib fractures, severity of lung contusion, and Pao2/Fio2 ratio at admission were all equivalent in the two groups. The S group showed a shorter ventilatory period (10.8 +/- 3.4 days) than the I group (18.3 +/- 7.4 days) (p < 0.05), shorter intensive care unit stay (S group, 16.5 +/- 7.4 days; I group, 26.8 +/- 13.2 days; p < 0.05), and lower incidence of pneumonia (S group, 24%; I group, 77%; p < 0.05). Percent forced vital capacity was higher in the S group at 1 month and thereafter (p < 0.05). The percentage of patients who had returned to full-time employment at 6 months was significantly higher in the S group (11 of 18) than in the I group (1 of 19). CONCLUSION: This study proved that in severe flail chest patients, surgical stabilization using Judet struts has beneficial effects with respect to less ventilatory support, lower incidence of pneumonia, shorter trauma intensive care unit stay, and reduced medical cost than internal fixation. Moreover, surgical stabilization with Judet struts improved percent forced vital capacity from the early phase after surgical fixation. Also, patients with surgical stabilization could return to their previous employment quicker than those with internal pneumatic stabilization, even in those with the same severity of flail chest. We therefore concluded that surgical stabilization with Judet struts may be preferably applied to patients with severe flail chest who need ventilator support.