Imbalance between plasma double-stranded DNA and deoxyribonuclease activity predicts mortality after out-of-hospital cardiac arrest

AIM

Despite an increased rate of return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients, almost half of patients do not survive up to hospital discharge. Understanding pathophysiological mechanisms of post-cardiac arrest syndrome is essential for developing novel therapeutic strategies. During systemic inflammatory responses and concomitant cell death, double-stranded (ds) DNA is released into circulation, exerting pro-inflammatory effects. Deoxyribonuclease (DNase) degrades dsDNA. The role of DNase activity in OHCA survivors and impact on clinical outcome has not been analyzed yet.

METHODS

In a prospective, single-center study, dsDNA and DNase activity were determined at hospital admission (acute phase) and 24 h (subacute phase) after ROSC. The ratio between dsDNA levels and DNase activity was calculated to determine the extent of dsDNA release in relation to the patients' capacity of degradation. Thirty-day mortality was defined as study end point.

RESULTS

We enrolled 64 OHCA survivors, of whom 26.6% (n = 17) died within 30 days. A peak of circulating dsDNA was observed at admission which decreased within 24 h. DNase activity did not differ between acute and subacute phase, while dsDNA load per DNase activity significantly decreased. The ratio between dsDNA levels and DNase activity in the subacute phase was the strongest predictor of 30-day mortality with an adjusted HR per 1 SD of 3.59 (95% CI, 1.80-7.18, p < 0.001).

CONCLUSION

Disproportionally increased dsDNA levels uncompensated by DNase activity are a strong predictor of mortality in OHCA survivors. This pilot study points to a potentially protective effect of DNase activity in patients undergoing cardiac arrest.

European hospitals as a source for platinum in the environment in comparison with other sources

The concentration of platinum in the sewage of five European hospitals originating from excreted antineoplastic drugs, cisplatin and carboplatin, was analyzed in a short term study to provide an order of magnitude of Pt emissions from hospitals into aquatic environments. These emissions were compared with a rough estimation of emissions by cars. The average daily concentrations in the hospital effluents were approximately < 10-601 ng l-1 Pt (20-3580 ng l-1 in 2-h mixed samples). As expected from consumption data, the daily average concentrations should range from < 10-710 ng l-1 Pt. Platinum emitted by hospitals is 3.3-12.3% (1.3-14.3 kg per year) the estimated amount emitted by cars equipped with catalytic converters in the different European countries. Compared to platinum emissions from other sources, the effluents of hospitals are a minor source of platinum in municipal sewage, but they should not to be disregarded. Other possible sources for the emission of platinum into the environment should be considered in further investigations.

[Systems analysis of colour music corrective effect]

In the context of P. K. Anokhin's theory of functional systems, the corrective effects of various combinations of medical therapeutical resonance music (MTRM) and dynamic colour exposure were analyzed. As compared to rehabilitative music programmes, MRTM was shown to have a more pronounced relaxing effect as manifested both in the optimization of emotion and in the activity of autonomic regulation of cardiovascular functions. On combined MRTM and dynamic colour flow exposures, the relaxing effect is most marked. In the examinees, the personality and situation anxieties diminish, mood improves, cardiovascular parameters become normal, the rate of metabolic processes and muscular rigidity reduce, the spectral power of alpha-rhythm increases, these occurring predominantly in the anterior region of the brain. The findings suggest the high efficiency of the chosen way of normalizing the functional status of man.

Analysis of benzalkonium chloride in the effluent from European hospitals by solid-phase extraction and high-performance liquid chromatography with post-column ion-pairing and fluorescence detection

A highly reproducible and specific method for the analysis of the quaternary ammonium compound, benzalkonium chloride, in effluents from European hospitals is presented. Benzalkonium chloride was extracted with end-capped RP-18 solid-phase cartridges and was selectively eluted. The resulting solution was analyzed by high-performance liquid chromatography (HPLC). After elution from the analytical column of the HPLC system, 9,10-dimethoxyanthracene-2-sulfonate was added continuously as a fluorescence marker, forming a hydrophobic ion-pair with benzalkonium chloride. The ion-pair was analyzed by fluorescence detection. The method was applied to highly complex effluent samples from different sized European hospitals. The measured concentrations were between 0.05 and 6.03 mg/l. The amounts emitted per bed and year were 4.5-362 g and did not correlate with the size of the hospital. The total amounts were 2.6-909 kg/year.

Evaluation of changes in myocardial perfusion and function on exercise in patients with coronary artery disease by gated MIBI scintigraphy

OBJECTIVE

To investigate the ability of gated methoxy-isobutylisonitrile (MIBI) scintigraphy to measure changes in myocardial function as well as perfusion with exercise.

SETTING

Regional cardiothoracic centre.

PATIENTS

43 presenting with chest pain, 28 with coronary artery disease on angiography, and 15 with normal coronary arteriograms.

RESULTS

Gated perfusion images showed an improvement in detecting regions with stenosed arteries compared with non-gated images (38/55 v 31/55, p < or = 0.01)). Functional analysis showed an increase in fractional shortening of 4.11% in subjects with normal coronary arteries, whereas in those with coronary disease a fall of 0.57% was found (p < or = 0.01). Both perfusion and function imaging showed an improved sensitivity compared with standard exercise testing (p < or = 0.01). When both function and perfusion imaging were analysed all patients with coronary disease were detected. There was agreement in abnormal regions in 33/55 territories supplied by a stenosed artery. Combined perfusion and function detected 49/55 (89%) of abnormal regions, thus improving the overall sensitivity from 38/55 (69%) by perfusion imaging alone (p < or = 0.01).

CONCLUSIONS

Gated methoxy-isobutylisonitrile scintigraphy can successfully evaluate perfusion and function on exercise, so improving the diagnostic usefulness of this agent.

Value of vectorcardiogram in diagnosis of posterior and inferior myocardial infarctions

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