Hypothermia is associated with a low ETCO2 and low pH-stat PaCO2 in refractory cardiac arrest.

AIMS: The end-tidal carbon dioxide (ETCO2) is frequently measured in cardiac arrest (CA) patients, for management and for predicting survival. Our goal was to study the PaCO2 and ETCO2 in hypothermic cardiac arrest patients. METHODS: We included patients with refractory CA assessed for extracorporeal cardiopulmonary resuscitation. Hypothermic patients were identified from previously prospectively collected data from Poland, France and Switzerland. The non-hypothermic CA patients were identified from two French cohort studies. The primary parameters of interest were ETCO2 and PaCO2 at hospital admission. We analysed the data according to both alpha-stat and pH-stat strategies. RESULTS: We included 131 CA patients (39 hypothermic and 92 non-hypothermic). Both ETCO2 (p < 0.001) and pH-stat PaCO2 (p < 0.001) were significantly lower in hypothermic compared to non-hypothermic patients, which was not the case for alpha-stat PaCO2 (p = 0.15). The median PaCO2-ETCO2 gradient was greater for hypothermic compared to non-hypothermic patients when using the alpha-stat method (46 mmHg vs 30 mmHg, p = 0.007), but not when using the pH-stat method (p = 0.10). Temperature was positively correlated with ETCO2 (p < 0.01) and pH-stat PaCO2 (p < 0.01) but not with alpha-stat PaCO2 (p = 0.5). The ETCO2 decreased by 0.5 mmHg and the pH-stat PaCO2 by 1.1 mmHg for every decrease of 1° C of the temperature. The proportion of survivors with an ETCO2 ≤ 10 mmHg at hospital admission was 45% (9/25) for hypothermic and 12% (2/17) for non-hypothermic CA patients. CONCLUSIONS: Hypothermic CA is associated with a decrease of the ETCO2 and pH-stat PaCO2 compared with non-hypothermic CA. ETCO2 should not be used in hypothermic CA for predicting outcome.

Cost-utility of extracorporeal membrane oxygenation rewarming in accidentally hypothermic patients-A single-centre retrospective study.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has become the treatment of choice for severely hypothermic patients in cardiac arrest or acute cardiac failure. Highly specialized ECMO centres have been established, however, no centre has ever reported the costs of extracorporeal rewarming. The aim of this study was to assess the costs of the treatment of patients in Swiss Stage III and IV rewarmed with veno-arterial ECMO. METHODS: A retrospective exploratory cohort study analysed twenty-nine consecutive patients treated for hypothermia in the Severe Accidental Hypothermia Centre in Cracow, Poland. The main outcome parameters were the overall and specific costs of the ICU treatment of patients rewarmed with veno-arterial ECMO. The secondary outcome parameter was cost utility, determined by the costs involved for every year of life gained. Costs were processed using the bottom-up method and classified into six categories. Survivors were followed up after 1 year. RESULTS: The mean cost of VA-ECMO was $5133 USD, which equalled 35% of all ICU expenditures ($14 668 USD). One year after discharge, 13 of 29 patients were still alive (45%). The overall gain of life of the thirteen 1-year survivors was 28 years, while the mean cost related to treatment with VA-ECMO for each year of life gained was 1138 USD. CONCLUSIONS: In this study, the costs of VA-ECMO rewarming and intensive care treatment per patient were substantially lower than in other studies reporting ECMO and intensive care treatment of other causes.

Beta2-ADR haplotypes/polymorphisms associate with bronchodilator response and total IgE in grass allergy.

Association and linkage studies of beta2-adrenergic receptor (beta2-ADR) polymorphisms in relation to the expression of asthmatic phenotypes and immune regulatory mechanisms have shown inconsistent results. In order to analyse the relevance of particular combinations of single nucleotide polymorphisms (SNPs) or haplotypes of beta2-ADR gene to bronchial asthma, bronchodilator response and total immunoglobulin E (IgE) we determined by direct DNA sequencing five SNPs (in positions: -47, -20, 46, 79, 252) in a group of 180 Caucasian subjects (110 patients with grass allergy and 70 nonatopic controls). The eight different beta2-ADR haplotypes were identified, with three the most common of them representing 92% of the studied cohort. Significantly higher (pcor = 0.0045) bronchodilator response was observed in patients with homozygotic genotype 46A/A in comparison with respective homo- and hetero-zygotes. There was no significant difference in bronchodilator response when beta2-ADR haplotypes were analysed. Significantly higher (pcor = 0.0005) total IgE levels were found in patients with beta2-ADR haplotype -47T/-20T/46A/79C/252G and homozygotic carriers of 46A (pcor = 0.0015) and 79C (pcor = 0.003) genotypes. No significant associations were found in regards to asthmatic phenotype and atopy. These results indicate that depending on phenotype studied, either an individual beta2-ADR SNP or beta2-ADR haplotype might affect disease manifestation.

Soliton self-frequency shift in a short tapered air-silica microstructure fiber.

We report a soliton self-frequency shift of more than 20% of the optical frequency in a tapered air-silica microstructure fiber that exhibits a widely flattened large anomalous dispersion in the near infrared. Remarkably, the large frequency shift was realized in a fiber of length as short as 15 cm, 2 orders of magnitude shorter than those reported previously with similar input pulse duration and pulse energies, owing to the small mode size and the large and uniform dispersion in the tapered fiber. By varying the power of the input pulses, we generated compressed sub-100-fs soliton pulses of ~1-nJ pulse energy tunable from 1.3 to 1.65 mum with greater than 60% conversion efficiency.

[Psychogenic laryngeal dysfunction--pseudo-asthmatic syndrome]. / Psychogenne zaburzenia motoryki krtani--zespól pseudoastmatyczny.

Laryngeal dysfunction occurs as periodical narrowing or closing of the glottis which does not depend on respiratory phase. Mechanism of this disorder is unknown. It is believed that it is caused by psychological factors or disturbed neural transmission from the respiratory tract. It results in disfunction of vocal cords and presents as episodes of airways obstruction misdiagnosed as asthma attacks. Authors present five cases mostly treated as severe bronchial asthma in which disfunction of vocal cords has been diagnosed on confirmed. In most of observed patients the psychological factor connected with family conflicts were the most probably background of the illness.

Birefringence reduction in side-written photoinduced fiber devices by a dual-exposure method.

An in situ birefringence measurement in conjunction with an atomic force microscope study shows that the geometric asymmetry of the side-writing process is a major cause of the induced birefringence in grating-based fiber devices. Measured refractive-index profiles of UV-exposed fibers clearly show the asymmetry in the induced index change. We demonstrate the use of a dual-exposure technique for producing low-birefringence devices.

Alteration of brain stem auditory evoked potentials after intracerebroventricular administration of met-enkephalin in rabbits.

Brainstem auditory evoked potentials (BAEPs) were elicited by binaural click stimulation and recorded from the rabbits with chronically implanted electrodes and a cannula for intracerebroventricular injection (i.c.v.). 400 BAEPs were averaged off line. The registration was carried out before and after i.c.v. injection of met-enkephalin (2.5 or 25 nmol), naloxone (20 micrograms), or i.v. injection of morphine (1.0, 2.0, 5.0 mg/kg b.w.). Enkephalin caused shortening of interpeak latency time, naloxone caused its lengthening, while the effect of morphine was not unidirectional. Enkephalin caused increase in the surface area below the negative peaks located in the range of 4.5-7.5 ms from the first positive peak, naloxone caused its decrease while the effect of morphine was also in this respect not unidirectional. It is concluded that opiate receptors are involved in the modulation of the auditory brainstem responses.

Delta-sleep inducing peptide (DSIP) and its fragments as the modulators of neural transmission in the central nervous system.

The present study is a continuation of our previous experiments on DSIP activity which have revealed that nonapeptide DSIP inhibits hippocampal electrical activity of the 4-7 c/s frequency band. The aim of the present study was to find which of the known DSIP fragments is responsible for its activity, i.e. to find the active site of the molecule. The experiments were carried out with the entire DSIP molecule and its three different fragments. The method of threshold continuous arousal pattern (TCAP) monitoring was used as the indicator of DSIP activity. It was found that the entire DSIP molecule increased TCAP, while its 1-5 fragment decreased it 1-4 and 5-9 fragments had no noticeable effect.

[Role of fungi in house dust allergy in patients with bronchial asthma]. / Rola grzybów w uczuleniu na kurz domowy u chorych na astme oskrzelowa.

The aim of the study was to evaluate the contribution of skin hyperreactivity to fungi in patients with bronchial asthma and demonstrating skin sensitivity to house dust. In 50 patients skin tests with 24 allergen solutions of fungi found most often in house dust. Positive skin tests were found in 92% of the evaluated patients. Reactions to fungi allergens were seen more often than to Dermatophagoides pteronyssimus. Most often skin reactivity toward the following fungal allergens were seen: Candida albicans, Aspergillus fumigatus, Fusarium culmorum and Aureobasidium pullulans. It seems that skin hypersensitivity to fungi is very common in patients with bronchial asthma and sensitive to house dust. Clinical verification of this hypersensitivity should be studied further.

A supertypic HLA class II determinant shared by DR1 and DRw9, and crossreactive with DR2, defined by human monoclonal antibody.

A human monoclonal antibody Pez.2F5, produced by a lymphoblastoid cell line, has been established in vitro by Epstein-Barr virus (EBV) transformation of B lymphocytes isolated from the blood of a volunteer immunized with allogeneic peripheral blood leukocytes (PBLs). The antibody reacted with a new supertypic determinant expressed on all lymphoblastoid cell lines homozygous for HLA-DR1, -2, and -w9. The genetic linkage of the Pez.2F5 determinant to the HLA region was demonstrated by family segregation studies. Quantitative absorption studies indicated that DR2-positive cells required more Pez.2F5 antibody for lysis, and since their absorption capacity was significantly lower than that of DR1- or DRw9-positive cells, it is likely that the Pez.2F5 determinant of the DR2 haplotype is crossreactive but not identical with the determinant found on the latter haplotypes. In addition, on a test panel of HLA-typed B lymphocytes, Pez.2F5 showed perfect correlation with DR1 and DRw9, but reacted with only a fraction of DR2-positive cells. The Pez.2F5 determinant was found to be absent from resting T lymphocytes, but its expression could be identified on IL-2-dependent T-cell lines by cytotoxicity and flow cytofluorometric analysis. By sequential immunoprecipitation and SDS gel analysis of antigens of DR1 cells it was determined that the Pez.2F5 determinant is carried by HLA class II DR molecules. Thus, the Pez.2F5 is the first described human monoclonal antibody able to immunoprecipitate HLA class II-related molecules.

A human monoclonal antibody against HLA-A25.

We are reporting the production and characterization of a human monoclonal antibody recognizing antigen HLA-25. The antibody was developed by a line transformed in vitro by the Epstein-Barr virus. The immune B lymphocytes for transformation were generated by planned immunization of a volunteer with repeated doses of allogenic peripheral blood lymphocytes of one donor over the course of 7 years. The antibody showed correlation with A25 antigen on a panel of 244 individuals tested by microcytotoxicity. The antibody showed neither cytotoxic reactivity nor CYNAP phenomenon with antigens of HLA-10 CREG.

A new cloning method for antibody-forming lymphoblastoid cells. Increase in cloning efficiency by inclusion of human fibroblasts into semisolid agarose growth layer.

We report the development of a method for cloning human EBV-transformed cells which has greater efficiency than techniques used presently. In this new method lymphoblastoid cells are cultured in semisolid agarose in close physical association with human fibroblasts. The results indicate a 10-fold increase in the cloning efficiencies. The average cloning efficiency, depending on the age of cell lines, was from 1 to 14%, and colonies appeared 7-9 days sooner than in the traditional soft agarose method. The new method has allowed us to develop several stable lymphoblastoid cell lines producing antibody cytotoxic to human B lymphocytes. This method may make it more practical to obtain monoclonal human antibodies from lymphoblastoid cell lines which had previously been unstable due to heterogeneity.

A human monoclonal antibody to an HLA-DRw53 (MT3)-like epitope on class II antigens.

We report the production of a lymphoblastoid human B cell line, which secretes monoclonal antibody with HLA-DRw53-like specificity. The immune lymphocytes were obtained from a patient who had been undergoing immunotherapy at Memorial Hospital with allogeneic cultured melanoma cells. The antibody producing cell line was established by transformation of immune B cells with Epstein-Barr virus and stabilized by serial selection of antibody-positive cell clusters. The cell line (R39.14) has been producing a cytotoxic antibody of IgM, kappa type during nearly two years of continuous culture. The specificity pattern was determined on a panel of HLA-DR-typed lymphoblastoid cell lines, and resembled the HLA-DRw53 specificity closely. In studies of informative families the R39.14 specificity segregated with DRw53-bearing haplotypes, which included DR-4, 7 and DRw9 antigens. The R39.14 specificity was found to be expressed in similar quantities on all antibody positive homozygous cell lines tested. Blocking experiments with monoclonal class II specific antibodies revealed R39.14 to reside on a DR molecule in close association with the determinant detected by the 109d6 mouse monoclonal antibody.

Effects of intracerebroventricular administration of vasopressin and oxytocin on the extinction of hippocampal theta rhythm in rabbits.

Vasopressin and oxytocin were administered intracerebro-ventriculary to rabbits in order to test their effects on the brain electrical activity. The effects were manifested by an increase or decrease in the amount of energy of electrical pulse trains required to produce habituation which is known to occur after repetitive stimulation of the midbrain reticular - formation. Vasopressin inhibited the extinction of hippocampal theta rhythm, while oxytocin facilitated it.

[A case of migraine associated with paralysis of the hypoglossal nerve]. / Przypadek migreny skojarzonej z porazeniem nerwu podjezykowego.

The authors report a 52-year-old woman with migraine in whom transient hypoglossal nerve paralysis developed during an attack. Similar cases published in the literature, including those of Rushton et al. 1978 and Domzal et al. 1982 are analysed.

The effect of intracerebroventricular administration of substance P fragment and met-enkephalin on the transmission of nervous impulses between the midbrain reticular formation and two generators of the hippocampal theta rhythm in rabbits.

The effect of intracerebroventricular administration of Substance P fragment and met-enkephalin on the excitability of two generators of hippocampal theta rhythm was investigated in the experiments performed on chronic rabbits. Substance P had a strong facilitatory effect on the threshold of the generator of the hippocampal theta rhythm of the frequency 4-7 c/s and an inhibitory effect on the threshold of the generator of the 7-12 c/s frequency evoked by stimulation of the midbrain reticular formation. These effects were dose dependent. The effects of met-enkephalin were opposite. They increased the threshold of the 4-7 c/s hippocampal generator and decreased the threshold of the other generator. The effect of these two compounds was evaluated according to the energy of electrical trains of pulses maintaining the continuous arousal pattern in the hippocampus.