Reperfusion after cardioplegic cardiac arrest--effects on intracoronary leucocyte elastase release and oxygen free radical mediated lipid peroxidation

Immunological responses to overreaching in cyclists

INTRODUCTION

Acute bouts of prolonged strenuous exercise are often associated with immune suppression and an increased risk of infection. However, few studies have examined immunological responses to intensified training that results in overreaching or overtraining. We investigated the effects of intensified training on plasma cytokines, glutamine, glutamate, and other related immunological variables in endurance-trained cyclists.

METHODS

Eight male subjects (age 27.0 +/- 3.0 yr, [OV0312]O(2max) 58.0 +/- 1.7 mL.kg-1.min-1, mass 73.7 +/- 2.1 kg) completed 6 wk of training: 2 wk each of normal training (N, 7 +/- 2 h.wk-1), intensified training (ITP, 14 +/- 5 h.wk-1) and recovery training (R, 3.5 +/- 2.5 h.wk-1). During the study period, subjects completed six graded cycle ergometer tests to exhaustion (MT), six simulated time trial tests (TT), and eight 2 x 10-min maximal effort bouts (IT). Subjects also completed questionnaires to assess mood state. Plasma concentrations of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), salivary IgA, plasma glutamine, glutamate, ammonia, urea, creatine kinase activity, and routine hematological measures were determined once per week.

RESULTS

ITP resulted in overreaching in all subjects identified by a significant decline in performance and disturbances of mood state. Significant increases during the ITP were observed in creatine kinase activity and glutamate, whereas the glutamine/glutamate ratio (Gln/Glu ratio), red blood cell numbers (RBC), hemoglobin concentration (Hb), and packed cell volume (PCV) declined after ITP. No significant changes were observed in TNF-alpha, IL-6, salivary IgA, glutamine, ammonia, urea and various routine hematological measures.

CONCLUSION

Alterations in plasma cytokines do not appear to be related to the decline in performance and increased mood state characteristic of overreaching; however, the Gln/Glu ratio may be of use as a marker of overreaching and/or overtraining.

Does aprotinin reduce lung reperfusion damage after cardiopulmonary bypass?

OBJECTIVE

The role of aprotinin in the prevention of lung reperfusion injury was investigated in the patients undergoing cardio-pulmonary bypass (CPB) for coronary artery bypass grafting (CABG) operations.

METHODS

The study was planned randomly and prospectively. Two hundred milliliters of physiological saline solution was added to the prime solution of patients in group I (n=10) whereas, 200 ml aprotinin (Trasylol, Bayer AG) was given to patients in group II (n=10). In order to measure lung tissue malondialdehyde (MDA) levels, glutathion peroxidase (GSH-Px) activity levels and polymorphonuclear leukocytes (PMNs) numbers, lung tissue samples were taken before CPB and 5 min after removing the cross clamp. In addition, alveolo-arterial oxygen difference (AaDO(2)) for tissue oxygenation was calculated by obtaining arterial blood gas samples.

RESULTS

MDA levels before CPB increased from 41.72+/-21.00 nmol/g tissue to 66.71+/-13.44 nmol/g tissue in group I and from 43.44+/-5.16 nmol MDA/g tissue to 53.22+/-10.95 nmol MDA/g tissue in group II after cross clamp removal (P=0.001 and P=0.021, respectively). The increase in group II was found to be significantly lower than group I (P=0.048). With the initiation of reperfusion, GSH-Px activity decreased in group I from 3.05+/-0.97 to 2.31+/-0.46 U/mg protein (P=0.015) whereas GSH-Px activity in group II decreased from 3.18+/-1.01 to 2.74+/-0.81 U/mg protein (P=0. 055). This decrease in the group II was less than group I (P=0.049). AaDO(2) significantly increased in the group I and II (P=0.012 and P=0.020, respectively), but elevation in the group I was significant than in the Group II (P=0.049). In histopathological examination, it was observed that neutrophil counts in the lung parenchyma rose significantly following removal of cross clamp in both groups (P=0. 001). The increase in group I was significantly larger than in group II (P=0.050).

CONCLUSION

Results represented in our study indicate that addition of aprotinin (2 million units) into the prime solution during CPB can reduce lung reperfusion injury.

Narrow-pore flow behavior of blood cells in cardioplegic suspension

Cardioplegia alters the ionic composition of the myocardium and also the blood in a way that may influence the cellular capillary flow behavior. We measured changes in RBC volume and narrow-pore flow resistance of blood cardioplegia versus crystalloid medium. Potassium, magnesium and sodium as osmotic control caused an expected cell shrinkage and reduced the flow resistance through 3 microm pores; however, stressing the osmosis further resulted in increased resistance. No major effects were seen with the 5 microm filters. Twenty percent blood cells in the cardioplegic medium caused a 360% increase in 5 microm pore resistance. There were no obvious additional filterability effects of the cardioplegic additives other than their osmotic patterns. There may be a theoretical advantage in having a cell-free medium in terms of flow resistance. Using blood cardioplegia, a limited hypertonicity may be beneficial in reducing the capillary flow resistance of RBC.