Intravenous glucose after out-of-hospital cardiopulmonary arrest: a community-based randomized trial

Question: Does the common practice of infusing small amounts of glucose after cardiopulmonary arrest worsen neurologic outcome? Design and setting: A community-based randomized trial in Seattle, WA. Paramedics treated all patients with out-of-hospital cardiac arrest in a standard fashion except that the intravenous infusion did or did not contain glucose; ie, patients received either usual treatment, with 5% dextrose in water (D5W), or alternative, with half normal saline (0.45S). Outcomes: The main outcome was awakening, defined as the patient having comprehensible speech or following commands as determined by chart review. Other outcomes were survival to hospital admission and to discharge. Results: Over 2 years, paramedics randomized 748 patients. The type of fluid administered was not significantly related to awakening (16.7% for D5W versus 14.6% for 0.45S), admission (38.0% for D5W versus 39.8% for 0.45S), or discharge (15.1% for D5W versus 13.3% for 0.45S). As in previous studies, patients whose arrest had likely been on a cardiac basis with initial rhythms of ventricular fibrillation or asystole had admission blood glucose levels significantly related to awakening: mean = 309 mg/dl for never awakening and 251 mg/dl for awakening. Of note, the relation between glucose and awakening was reversed in the remaining patients, who had electromechanical dissociation or noncardiac mechanisms of arrest. Conclusion: Current practices of using limited amounts of glucose-containing solutions after cardiopulmonary arrest do not need to be changed. Blood glucose level on admission is a prognostic indicator but depends on the type of arrest.     

Retrovirus-mediated transfer of an angiotensin type I receptor (AT1-R) antisense sequence decreases AT1-Rs and angiotensin II action in astroglial and neuronal cells in primary cultures from the brain

The AT1-R has been implicated in many cellular and physiological actions of angiotensin II (AII) in the brain. A retrovirus vector (LNSV) containing an AT1B-R antisense sequence (AT1B-AS) (termed LNSV-AT1B-AS) was constructed and used to determine the feasibility of using viral-mediated gene transfer to control AT1-Rs and AII actions in astroglial and neuronal cells in primary cultures from rat brain. Briefly, a 1.26-kb antisense sequence corresponding to nt -132 to +1128 of AT1-R cDNA was cloned into the LNSV vector, the vector was transfected into PA317 cells, and transfected cells were selected in G418. Incubation of brain cells with culture medium containing LNSV-AT1B-AS viral particles showed that AT1B-AS was integrated into the genome and transcribed in brain cells. This was associated with a significant decrease in AT1-Rs and in the AII-stimulated increase of c-fos mRNA, a measure of AT1-R function. These observations show that the AT1B-AS gene can be transferred into astroglial cells in culture by LNSV and that such a transfer inhibits AT1-Rs and the AII stimulation of cellular activities. In addition, the usefulness of this approach to study AII-dependent pathophysiology in primary neuronal cultures from brain, in particular, is established.     

Antibody and cell-mediated immune responses to booster immunization with a new acellular pertussis vaccine in school children

235 healthy 10-12 years old school children were randomly immunized with either a booster dose of diphtheria-tetanus-acellular pertussis (dTap) or diphtheria-tetanus (dT) vaccine. For this booster immunization designed for school children and adults, the quantities of Bordetella pertussis antigens in the dTap vaccine had been reduced to one third of those of the Infanrix vaccine (SmithKline Beecham) commonly used for infants. IgG antibodies and cell-mediated immune (CMI) responses to pertussis toxin (PT), pertactin (PRN) and filamentous hemagglutinin (FHA) were assessed by an enzyme immunosorbent assay and in vitro proliferation of peripheral blood mononuclear cells, respectively. Before immunization, 55%, 80% and 99% of children had detectable serum IgG antibodies to PT, PRN and FHA, whereas CMI response was found in 35%, 27% and 50% of children, respectively. After immunization, a 20-30-fold increase in geometric mean level (GML) of antibodies to the pertussis antigens occurred and CMI response to PT, PRN and FHA was seen in 88%, 94% and 100% of children, respectively. Adverse reactions following the immunization were rare. The results show that booster immunization with an acellular pertussis vaccine with reduced concentrations of antigens induces both antibody and CMI responses and support further studies of this pertussis vaccine in school children.     

The regional Monte Carlo method: a dose calculation method based on accuracy requirement

In this work we propose the regional Monte Carlo (RMC) method of dose calculation. This method combines the Monte Carlo (MC) algorithm and a non-MC algorithm (such as the convolution method) for optimal speed and accuracy in dose calculation for both photon and electron beams and for various irradiation and patient geometries. For specific regions in the geometry where high accuracy is required but difficult to obtain with analytical or empirical calculations, such as critical organs surrounded by complicated inhomogeneities, the MC algorithm is used. For regions with simple geometries, or where a high degree of dose accuracy is not critical, the non-MC algorithm is used to increase speed. There are two aspects of the RMC method. The first one involves determining critical regions and boundaries, and the other involves the actual implementation and mixing of the two computational algorithms. Two examples of different geometries are used to illustrate the different ways to apply the RMC method. The possibility to extend the method to more complicated geometries and inhomogeneities, as well as the ability of the method to incorporate different calculation algorithms, are also discussed.     

The role and properties of the iron-sulfur cluster in Escherichia coli dihydroxy-acid dehydratase

Dihydroxy-acid dehydratase has been purified from Escherichia coli and characterized as a homodimer with a subunit molecular weight of 66,000. The combination of UV visible absorption, EPR, magnetic circular dichroism, and resonance Raman spectroscopies indicates that the native enzyme contains a [4Fe-4S]2+,+ cluster, in contrast to spinach dihydroxy-acid dehydratase which contains a [2Fe-2S]2+,+ cluster (Flint, D. H., and Emptage, M. H. (1988) J. Biol. Chem. 263, 3558-3564). In frozen solution, the reduced [4Fe-4S]+ cluster has a S = 3/2 ground state with minor contributions from forms with S = 1/2 and possibly S = 5/2 ground states. Resonance Raman studies of the [4Fe-4S]2+ cluster in E. coli dihydroxy-acid dehydratase indicate non-cysteinyl coordination of a specific iron, which suggests that it is likely to be directly involved in catalysis as is the case with aconitase (Emptage, M. H., Kent, T. A., Kennedy, M. C., Beinert, H., and Münck, E. (1983) Proc. Natl. Acad. Sci. U.S.A. 80, 4674-4678). Dihydroxy-acid dehydratase from E. coli is inactivated by O2 in vitro and in vivo as a result of oxidative degradation of the [4Fe-4S]cluster. Compared to aconitase, the oxidized cluster of E. coli dihydroxy-acid dehydratase appears to be less stable as either a cubic or linear [3Fe-4S] cluster or a [2Fe-2S] cluster. Oxidative degradation appears to lead to a complete breakdown of the Fe-S cluster, and the resulting protein cannot be reactivated with Fe2+ and thiol reducing agents.     

Immunological assessment of exposure to Echinococcus granulosus in a rural dog population in Uruguay

An ELISA was used to screen a dog population in Uruguay (Sarandi Del Yi, Durazno District) for the prevalence of specific serum antibodies (IgG, IgA and IgE) to Echinococcus granulosus. The sensitivity (61%) and specificity (97%) of the ELISA were determined using well-defined serum groups. A total of 408 dogs from Sarandi del Yi and environs were screened serologically, and 29.7% (8.6-13.8% for each antibody class) of dogs had positive levels of antibody to E. granulosus. This antibody prevalence (exposure) was significantly higher than the percentage of dogs found to be positive for E. granulosus worms by arecoline purgation (7.6%). This level of exposure to E. granulosus determined by ELISA is considered unacceptable from a public health perspective. Measures will now focus on obtaining data on the true prevalence of current infection in this dog population and on determining the transmission patterns of the disease in this endemic region.     

Human chagasic disease is not associated with an antiheart humoral response

An inflammatory cardiomyopathy occurs in humans with chronic Trypanosoma cruzi infection (Chagas' disease). This study finds that T. cruzi infection is not associated with the production of cardiac-specific autoantibodies in humans with cardiac manifestations.     

Chronic GABA treatment downregulates the GABAA receptor alpha 2 and alpha 3 subunit mRNAS as well as polypeptide expression in primary cultured cerebral cortical neurons

Chronic GABA exposure of mammalian primary cultured cortical neurons results in a downregulation of the GABA-benzodiazepine receptor complex. In the present study, the mRNA levels, as well as polypeptide expression, for the GABAA receptor alpha 2 and alpha 3 subunits in cultured embryonic mouse cerebral cortical neurons (7 day old) were examined using northern analysis and immunoblotting techniques following chronic GABA treatment. The alpha 1 subunit mRNA or polypeptide could not be detected in these neurons. The steady state levels of mRNA for the GABAA receptor alpha 2 and alpha 3 subunits showed a decrease in comparison with untreated neurons. There was no change in the level of the beta actin or poly(A)+ RNA under the same experimental conditions. This agonist-induced reduction in the GABAA receptor alpha 2 and alpha 3 subunit mRNA was blocked by the concomitant exposure of neurons to R 5135, an antagonist of GABAA receptor. The polypeptide expression for the GABAA receptor alpha 2 and alpha 3 subunits in chronically GABA-treated neurons also showed a decline and this change was also blocked by the concomitant exposure of cells to GABA and R 5135. These results indicate that the chronic exposure of the GABAA receptor complex to agonist downregulates the expression of the alpha subunits of the receptor complex, which may be related to an observed decreases in the number of binding sites and GABA-induced 36Cl-influx in the cortical neurons.