Circulating cardio-enriched microRNAs are associated with long-term prognosis following myocardial infarction.

Increased levels of cardio-enriched microRNAs (miRNAs) have been described in patients with myocardial infarction (MI). We wanted to evaluate the diagnostic and prognostic potential of cardio-enriched miRNAs in patients presenting with a suspected acute coronary syndrome (ACS)

Controversial significance of early S100B levels after cardiac surgery

BACKGROUND: The brain-derived protein S100B has been shown to be a useful marker of brain injury of different etiologies. Cognitive dysfunction after cardiac surgery using cardiopulmonary bypass has been reported to occur in up to 70% of patients. In this study we tried to evaluate S100B as a marker for cognitive dysfunction after coronary bypass surgery with cardiopulmonary bypass in a model where the inflow of S100B from shed mediastinal blood was corrected for. METHODS: 56 patients scheduled for coronary artery bypass grafting underwent prospective neuropsychological testing. The test scores were standardized and an impairment index was constructed. S100B was sampled at the end of surgery, hourly for the first 6 hours, and then 8, 10, 15, 24 and 48 hours after surgery. None of the patients received autotransfusion. RESULTS: In simple linear analysis, no significant relation was found between S100B levels and neuropsychological outcome. In a backwards stepwise regression analysis the three variables, S100B levels at the end of cardiopulmonary bypass, S100B levels 1 hour later and the age of the patients were found to explain part of the neuropsychological deterioration (r = 0.49, p < 0.005). CONCLUSIONS: In this study we found that S100B levels 1 hour after surgery seem to be the most informative. Our attempt to control the increased levels of S100B caused by contamination from the surgical field did not yield different results. We conclude that the clinical value of S100B as a predictive measurement of postoperative cognitive dysfunction after cardiac surgery is limited

En studie om pedagogers bemötande av skilsmässobarn

Bakgrund: I Sverige är kärnfamiljen än så länge den vanligaste familjeformen men det blir allt vanligare med separationer och därmed bildas nya familjekonstellationer. Familjer bryter upp och nya par flyttar samman. Hur påverkar de nya strukturerna barnen?I samtal med pedagoger i verksamheten har det kommit till vår kännedom att ämnet skilsmässa är ”tabubelagt”. Pedagogerna vet inte riktigt hur man ska närma sig problemet, personalen vill vara ett stöd men är rädd för att ”lägga sig i”. Syfte: Studiens syfte är att undersöka hur pedagoger anser att barn, vars föräldrar skilt sig, borde bemötas samt att se om det finns någon skillnad i synen på bemötandet, pedagogkategorier emellan. Metod: För att uppnå syftet har vi valt att göra en kvantitativ enkätundersökning med 13 påståenden med fasta svarsalternativ, varav sju stycken redovisas i uppsatsen, samt en öppen fråga. Resultat: Vi har kommit fram till att pedagogerna anser att det är viktigt att föräldrarna meddelar om att de ska separera för att enklare kunna anpassa elevens individuella planering. Vi har också kommit fram till att fritidspedagoger/förskollärare i högre utsträckning än lärarna vill ha en bättre kunskap om hur man bör bemöta skilsmässobarn.

Substance P relaxes rat bronchial smooth muscle via epithelial prostanoid synthesis

BACKGROUND: Substance P is present in bronchial nerve fibres. The physiological actions of substance P are mediated via tachykinin NK(1) receptors. Immunochemical studies have demonstrated tachykinin NK(1) receptors in the rat airway epithelium. OBJECTIVE: To elucidate how epithelial tachykinin NK(1) receptors affect smooth muscle response to substance P. METHODS: Contractile response of isolated rat bronchial trunk with or without epithelium was recorded. RESULTS: In intact segments precontracted by 5-hydroxytryptamine, relaxation was induced by substance P and the nitric oxide donor, sodium nitroprusside. Removal of the epithelium abolished relaxation induced by substance P but did not affect relaxation induced by sodium nitroprusside. The cyclo-oxygenase inhibitor, indomethacin, but not the nitric oxide synthase inhibitor, L-N(G)-monomethylarginine, reduced the relaxation in response to substance P. CONCLUSIONS: Epithelial tachykinin NK(1) receptors mediate substance-P-induced relaxation of rat bronchial smooth muscle via release of prostanoids but not nitric oxide

Clinical experience with a novel endotoxin adsorbtion device in patients undergoing cardiac surgery.

Endotoxaemia is thought to occur in cardiac surgery using extracorporeal circulation (ECC) and a positive correlation has been proposed between the magnitude of endotoxaemia and risk for postoperative complications. We studied the effects of a new endotoxin adsorber device (Alteco(R) LPS adsorber) in patients undergoing cardiac surgery with ECC, with special reference to safety and ease of use. Fifteen patients undergoing coronary artery bypass and/or valvular surgery were studied. In 9 patients, the LPS Adsorber was included in the bypass circuit between the arterial filter and the venous reservoir. Flow through the adsorber was started when the aorta was clamped and stopped at the end of perfusion. Flow rate was kept at 150 ml/min. Six patients served as controls with no adsorber in the circuit. Samples were taken for analysis of endotoxin, TNFalpha, IL-1ss and IL-6 as well as complement factors C3, C4 and C1q. Whole blood coagulation status was evaluated using thromboelastograpy (TEG) and platelet count. No adverse events were encountered when the adsorber was used in the circuit. Blood flow through the device was easily monitored and kept at the desired level. Platelet count decreased in both groups during surgery. TEG data revealed a decrease in whole blood clot strength in the control group while it was preserved in the adsorber group. Endotoxin was detected in only 2 patients and IL-1ss in 4 patients. IL-6 decreased in both groups whereas no change in TNF concentrations was found. C3 fell in both groups, but no changes wer found in C4 and C1q. The Alteco(R) LPS adsorber can be used safely and is easy to handle in the bypass circuit. No complications related to the use of the adsorber were noted. The intended effects of the adsorber, i.e. removal of endotoxin from the blood stream could not be evaluated in this study, presumably due to the small number of patients and the relatively short perfusion times

Early posttraumatic pulmonary platelet trapping and its potentiation by oral pretreatment with alcohol

Soft tissue trauma is associated with platelet aggregation and sequestration in the lungs. This is believed to be an early step in the later development of adult respiratory distress syndrome. In the present experiment using a new method for in vivo dynamic studies of platelet sequestration, we wanted to evaluate the effect of soft tissue trauma on pulmonary platelet trapping in pigs and the influence of acute alcohol intoxication. The results show that significant pulmonary platelet trapping is registered within minutes of trauma and that alcohol significantly increases platelet sequestration in the lungs. This indicates an increased risk for posttraumatic pulmonary problems in alcohol-intoxicated trauma victim

Prevention of posttraumatic pulmonary platelet trapping by portacaval transposition

Significant soft-tissue trauma induces platelet activation, aggregation, and sequestration in the lungs. This pulmonary trapping is due either to the size of the platelet aggregates or to changes in the pulmonary microvasculature. To evaluate which one of these mechanisms is responsible for the trapping, we performed portacaval transposition in one group of pigs, making the liver the first receiving capillary bed for blood from the trauma sites in the lower extremities. One week after the operation, the platelets were labeled with indium oxine and reinfused, and the operated animals and a group of six control animals were subjected to standardized soft-tissue trauma to the lower extremities. Sequestration of platelets in the lungs and in the liver was registered dynamically before and for 90 minutes after the trauma. Soft-tissue trauma induced platelet sequestration in the liver in the operated group (p less than 0.01) and in the lungs in the control group (p less than 0.01). Trapping was paralleled by a decrease in the number of circulating platelets. This study has indicated that posttraumatic pulmonary platelet trapping is caused by platelet activation at the trauma sites and not by changes in the pulmonary microvasculature

Lung mechanics, gas exchange and central circulation during treatment of intra-abdominal hemorrhage with pneumatic anti-shock garment and intra-aortic balloon occlusion. An experimental study in pigs

Standardized intra-abdominal hemorrhage was induced in 7 anesthetized pigs. The resulting hypovolemic shock was treated with pneumatic anti-shock garment (PASG) followed by intra-aortic balloon occlusion. The effects of this treatment on circulation, lung mechanics and gas exchange were studied. Hemorrhage was induced by pulling out sutures introduced in the inferior caval vein. We found that the use of PASG partially restored mean arterial blood pressure from 44 +/- 6 to 66 +/- 6 mm Hg. When intraaortic balloon occlusion was added, the arterial pressure returned to basal levels. Cardiac output fell severely due to the hemorrhage from 3.7 +/- 0.2 to 1.3 +/- 0.2 liters/min and could not be restored during the treatment. A severe fall in total lung compliance was recorded after inflation of the PASG from 18.6 +/- 0.9 to 10 +/- 0.7 ml/cm H2O, this was accompanied by a fall in alveolar ventilation. These findings emphasize the severe restriction in lung function that occurred during treatment with PASG. Both parameters returned to near normal values when the PASG was deflated and the intra-aortic balloon was inflated. Pulmonary vascular resistance increased by more than 400% and remained high during the study period. There was no change in arterial PO2, however the fall in mixed venous PO2 caused by hemorrhage was reversed at the end of the treatment. Indirect monitoring of cerebral function by continuous EEG showed a decreased voltage during the hemorrhage, this was reversed by the combined treatment. We conclude that the outlined treatment makes it possible to restore central hemodynamics and preserve cerebral function at least for a short period of time until definite surgical treatment can be performed. However, severe restriction on lung mechanics, especially when PASG was inflated, makes it probable that ventilatory support can be necessary in such cases