Post resuscitation care: what are the therapeutic alternatives and what do we know?

A large proportion of deaths in the Western World are caused by ischaemic heart disease. Among these patients a majority die outside hospital due to sudden cardiac death. The prognosis among these patients is in general, poor.

Remnant epitopes, autoimmunity and glycosylation.

The role of extracellular proteolysis in innate and adaptive immunity and the interplay between cytokines, chemokines and proteinases are gradually becoming recognized as critical factors in autoimmune processes. Many of the involved proteinases, including those of the plasminogen activator and matrix metalloproteinase cascades, and also several cytokines and chemokines, are glycoproteins. The stability, interactions with inhibitors or receptors, and activities of these molecules are fine-controlled by glycosylation.

Advanced cardiac life support before and after tracheal intubation--direct measurements of quality.

Study Hypothesis: Tracheal intubation should improve the quality of cardiopulmonary resuscitation (CPR) by enabling adequate ventilation without pauses in external chest compressions.

Methods: Out-of-hospital cardiac arrests of all causes were sampled in this non-randomized, observational study of advanced cardiac life support in three ambulance services (Akershus, London and Stockholm). Prototype defibrillators (Heartstart 4000SP, Philips Medical Systems, Andover, MA, USA and Laerdal Medical AS, Stavanger, Norway) registered all chest compressions via an extra chest pad with an accelerometer mounted over the lower part of sternum and ventilations from changes in transthoracic impedance between the standard defibrillator pads.

Practical issues in the evaluation of methods for the prediction of shock outcome success in out-of-hospital cardiac arrest patients.

There is a need for robust, effective predictors of the outcome from shock for out-of-hospital cardiac arrest patients. Such technology would enable the emergency responder to provide a therapy tailored to the patient's needs. Here we report our most recent findings while dwelling intentionally on the rationale behind the decisions taken during system development.

A phase II trial of a combination of pemetrexed and gemcitabine in patients with metastatic breast cancer: an NCCTG study.

Purpose: This phase II study was undertaken to define the efficacy and toxicity of pemetrexed in combination with gemcitabine in patients with metastatic breast cancer.

Patients And Methods: Patients with measurable metastatic breast cancer who had previously received an anthracycline and a taxane in either the adjuvant or metastatic setting were treated with gemcitabine 1250 mg/m2 (intravenous; days 1 and 8) and pemetrexed 500 mg/m2 (intravenous; day 8) every 21 days.

Results: Fifty-nine patients received a median of five cycles (range one to 22) of treatment and were followed until death or for a median of 28 months (range 19.

Independent evaluation of a defibrillation outcome predictor for out-of-hospital cardiac arrested patients.

We evaluated the ability of a previously derived outcome predictor to discriminate between ECG segments corresponding to return of spontaneous circulation (ROSC) or not in validation data from 136 patients with cardiac arrest. The new data used for validation were totally independent from the predictor derivation data used in the original study. Features corresponding to those used in the development of the original outcome predictor, centroid frequency, peak power frequency, spectral flatness and energy, were computed following which a second decorrelated feature set was generated.

Reducing no flow times during automated external defibrillation.

There has recently been an increased attention focused on the importance of reducing time without blood flow from chest compressions (no flow time, NFT) during cardiopulmonary resuscitation (CPR). In this study we have analyzed and quantified the NFTs during external automatic defibrillation in 105 cardiac arrest patients. We found that for around half of the time (about 10 min), these patients were not perfused.

Recommended guidelines for reviewing, reporting, and conducting research on post-resuscitation care: the Utstein style.

The aim of this report is to establish recommendations for reviewing, reporting, and conducting research during the post-resuscitation period in hospital. It defines data that are needed for research and more specialised registries and therefore supplements the recently updated Utstein template for resuscitation registries. The updated Utstein template and the out-of-hospital "Chain of Survival" describe factors of importance for successful resuscitation up until return of spontaneous circulation (ROSC).

The electroosmotic droplet switch: countering capillarity with electrokinetics.

Electroosmosis, originating in the double-layer of a small liquid-filled pore (size R) and driven by a voltage V, is shown to be effective in pumping against the capillary pressure of a larger liquid droplet (size B) provided the dimensionless parameter sigmaR(2)/epsilon|zeta|VB is small enough. Here sigma is surface tension of the droplet liquid/gas interface, epsilon is the liquid dielectric constant, and zeta is the zeta potential of the solid/liquid pair. As droplet size diminishes, the voltage required to pump electroosmotically scales as V approximately R(2)/B.

PS-341 and gemcitabine in patients with metastatic pancreatic adenocarcinoma: a North Central Cancer Treatment Group (NCCTG) randomized phase II study.

Background: PS-341 is a proteasome inhibitor with preclinical activity in pancreatic cancer tumor models and synergistic activity with gemcitabine. This randomized phase II study determined the tumor response rate (RR) for PS-341 alone and the 6-month survival and RR for the combination of gemcitabine and PS-341 in patients with metastatic pancreatic adenocarcinoma.

Patients And Methods: Patients were randomized to receive 3-week cycles of either arm A: PS-341 1.

Twelve-month retention of CPR skills with automatic correcting verbal feedback.

Aim: To evaluate the retention of CPR skills 12 months after initial training, using a manikin equipped with a computer-based voice advisory feedback system.

Methods: Thirty-five volunteers had individual 20 min training sessions without an instructor on a manikin with computer-based voice advisory feedback. The feedback depended on the performance as measured by the manikin computer system versus set limits for ventilation and compression variables.

Targeting neutrophil collagenase/matrix metalloproteinase-8 and gelatinase B/matrix metalloproteinase-9 with a peptidomimetic inhibitor protects against endotoxin shock.

Gram-negative sepsis, bacterial meningitis and endotoxin shock are life-threatening disorders, associated with the rapid release of neutrophil enzymes. Neutrophil collagenase/matrix metalloproteinase-8 (MMP-8) and gelatinase B/matrix metalloproteinase-9 (MMP-9) are contained in granules, are quickly exocytosed upon granulocyte activation and efficiently cleave intact and denatured collagens, respectively. Genetic ablation of gelatinase B protects against endotoxin-induced mortality.

International Resuscitation Network Registry: design, rationale and preliminary results.

There is a lack of high-quality information about the effectiveness of resuscitation interventions and international differences in structure, process and outcome after out-of-hospital cardiac arrest and cardiopulmonary resuscitation because data are not collected uniformly. An internet-based international registry could make such evaluations possible, and enable the conduct of large randomized controlled trials of resuscitation therapies. A prospective international cohort study was performed that included 571 infants, children and adults (a) who experienced cardiac arrest requiring chest compressions or external defibrillation, (b) outside the hospital in the study communities and (c) upon whom resuscitation was attempted by EMS personnel.

Simulation of evolution-selected propeptide by high-throughput selection of a peptidomimetic inhibitor on a capillary DNA sequencer platform.

Many proteinases, including gelatinase B/MMP-9, fulfill crucial regulatory or effector functions in disease states and may be pharmacologically targeted by specific inhibitors. Denatured collagen type II provides one of the best gelatinase B substrates, and the characteristics of its cleavage were employed to define the requirements of a novel optimal substrate probe. A synthetic fluorescent derivative was used for the development of a new high-throughput technology for the selection of inhibitors on the principles of sensitivity of confocal fluorescence detection, resolution capacity of capillary electrophoresis, and multichannel power of DNA sequencers.

Have the implementation of a new specialised emergency medical service influenced the pattern of general practitioners involvement in pre-hospital medical emergencies? A study of geographic variations in alerting, dispatch, and response.

Objectives: Emergency medical service systems in Norway are based on equity and equality. A toll free number (113) and criteria based dispatch are crucial components. The establishment of an emergency medical system (EMS) manned by an air and ground emergency physician (EP) has challenged the role of the general practitioner (GP) in emergency medical care.

Large-scale changes in dendritic structure during reorganization of adult somatosensory cortex.

In adult rat somatosensory cortex (S1), neurons are biased and have less dendritic arbor close to the border between the forepaw and lower jaw representations. Changes in sensory experience cause changes in the functional organization of the neocortex. Therefore, we examined the morphology of neurons in the reorganized region of S1 after forepaw denervation.

Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest.

Context: Cardiopulmonary resuscitation (CPR) guidelines recommend target values for compressions, ventilations, and CPR-free intervals allowed for rhythm analysis and defibrillation. There is little information on adherence to these guidelines during advanced cardiac life support in the field.

Objective: To measure the quality of out-of-hospital CPR performed by ambulance personnel, as measured by adherence to CPR guidelines.

Performing procedures on the newly deceased for teaching purposes: what if we were to ask?

Background: Performance of procedures on the recently dead for physician training is controversial. It has been suggested that permission be obtained. We investigated whether patients and family members would grant such permission or if even this request might anger the recently bereaved.