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Karlis G, Kotanidou A, Georgiopoulos G, Masi S, Magkas N, Xanthos T. Usefulness of F2-isoprostanes in early prognostication after cardiac arrest: a topical review of the literature and meta-analysis of preclinical data. Biomarkers 2020; 25:315-321. [PMID: 32274952 DOI: 10.1080/1354750x.2020.1754465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Prognostication after cardiac arrest (CA) represents a challenging issue, and several biomarkers have been proposed in the attempt to predict outcome. Among these, F2-isoprostanes stand out as potential biomarkers for early prognostication, providing information on the magnitude of global oxidative injury after return of spontaneous circulation (ROSC). We performed a topical review searching PubMed and Scopus databases to identify studies evaluating the modifications of F2-isoprostanes in the early period after CA, and a meta-analysis of studies providing curves of F2-isoprostanes plasma levels seeking to describe the biomarker's kinetics after CA. Evidence suggests that plasma levels of F2-isoprostanes increase in the early post-resuscitation period and seem well correlated with the burden of ischaemia-reperfusion injury. Our meta-analysis shows a possible increase as early as 5 minutes after ROSC, which persists at 2 hours and is attenuated at 4 hours. Clinical studies are warranted to evaluate the utility of this biomarker for prognostication purposes in CA survivors.
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Affiliation(s)
- George Karlis
- Intensive Care Unit, General Hospital of Rodos, "Andreas Papandreou", Rodos, Greece.,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Anastasia Kotanidou
- 1st Department of Intensive Care Medicine, National and Kapodistrian University of Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Nikolaos Magkas
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Theodoros Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.,School of Medicine, European University Cyprus, Nicosia, Cyprus
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2
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Autism-like behavior in the BTBR mouse model of autism is improved by propofol. Neuropharmacology 2017; 118:175-187. [PMID: 28341205 DOI: 10.1016/j.neuropharm.2017.03.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/28/2017] [Accepted: 03/20/2017] [Indexed: 01/01/2023]
Abstract
Autism spectrum disorder (ASD) is a developmental disorder that is characterized by symptoms of impaired social interactions, restricted interests and repetitive behaviors. Recent studies in humans and animal-models suggest that reduced GABAergic neurotransmission in the brain may underlie autism-related behavioral symptoms. It has been shown that propofol, a commonly used anesthetic, facilitates γ-aminobutyric acid-mediated inhibitory synaptic transmission. The present study investigated whether propofol improved autistic phenotypes in BTBR T + Itpr3tf/J (BTBR) mice, a model of idiopathic autism. We found that i.p. injection of propofol in BTBR mice significantly improved aspects of social approach and repetitive behaviors without affecting reciprocal social interactions and without any detrimental effects in C57BL/6J mice. The ability of propofol to improve autistic phenotypes in BTBR mice through GABAergic neurotransmission suggests a potential pharmacological target for interventions to treat symptoms of autism.
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Hoffmann U, Sheng H, Ayata C, Warner DS. Anesthesia in Experimental Stroke Research. Transl Stroke Res 2016; 7:358-67. [PMID: 27534542 PMCID: PMC5016251 DOI: 10.1007/s12975-016-0491-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Abstract
Anesthetics have enabled major advances in development of experimental models of human stroke. Yet, their profound pharmacologic effects on neural function can confound the interpretation of experimental stroke research. Anesthetics have species-, drug-, and dose-specific effects on cerebral blood flow and metabolism, neurovascular coupling, autoregulation, ischemic depolarizations, excitotoxicity, inflammation, neural networks, and numerous molecular pathways relevant for stroke outcome. Both preconditioning and postconditioning properties have been described. Anesthetics also modulate systemic arterial blood pressure, lung ventilation, and thermoregulation, all of which may interact with the ischemic insult as well as the therapeutic interventions. These confounds present a dilemma. Here, we provide an overview of the anesthetic mechanisms of action and molecular and physiologic effects on factors relevant to stroke outcomes that can guide the choice and optimization of the anesthetic regimen in experimental stroke.
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Affiliation(s)
- Ulrike Hoffmann
- Multidisciplinary Neuroprotection Laboratories, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA
| | - Huaxin Sheng
- Multidisciplinary Neuroprotection Laboratories, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - David S Warner
- Multidisciplinary Neuroprotection Laboratories, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA.
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Wong JK, Nikravan S, Maxwell BG, Marques MA, Pearl RG. Nocturnal Low-Dose Propofol Infusion for the Management of ICU Delirium: A Case Series in Nonintubated Cardiac Surgery Patients. J Cardiothorac Vasc Anesth 2016; 30:1340-3. [PMID: 27423473 DOI: 10.1053/j.jvca.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Jim K Wong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
| | - Sara Nikravan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bryan G Maxwell
- Department of Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael A Marques
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Ronald G Pearl
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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Yen HC, Chen TW, Yang TC, Wei HJ, Hsu JC, Lin CL. Levels of F2-isoprostanes, F4-neuroprostanes, and total nitrate/nitrite in plasma and cerebrospinal fluid of patients with traumatic brain injury. Free Radic Res 2015; 49:1419-30. [PMID: 26271312 DOI: 10.3109/10715762.2015.1080363] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Several events occurring during the secondary damage of traumatic brain injury (TBI) can cause oxidative stress. F(2)-isoprostanes (F(2)-IsoPs) and F(4)-neuroprostanes (F(4)-NPs) are specific lipid peroxidation markers generated from arachidonic acid and docosahexaenoic acid, respectively. In this study, we evaluated oxidative stress in patients with moderate and severe TBI. Since sedatives are routinely used to treat TBI patients and propofol has been considered an antioxidant, TBI patients were randomly treated with propofol or midazolam for 72 h postoperation. We postoperatively collected cerebrospinal fluid (CSF) and plasma from 15 TBI patients for 6-10 d and a single specimen of CSF or plasma from 11 controls. Compared with the controls, the TBI patients exhibited elevated levels of F(2)-IsoPs and F(4)-NPs in CSF throughout the postsurgery period regardless of the sedative used. Compared with the group of patients who received midazolam, those who received propofol exhibited markedly augmented levels of plasma F(2)-IsoPs, which were associated with higher F(4)-NPs levels and lower total nitrate/nitrite levels in CSF early in the postsurgery period. Furthermore, the higher CSF F(2)-IsoPs levels correlated with 6-month and 12-month worse outcomes, which were graded according to the Glasgow Outcome Scale. The results demonstrate enhanced oxidative damage in the brain of TBI patients and the association of higher CSF levels of F(2)-IsoPs with a poor outcome. Moreover, propofol treatment might promote lipid peroxidation in the circulation, despite possibly suppressing nitric oxide or peroxynitrite levels in CSF, because of the increased loading of the lipid components from the propofol infusion.
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Affiliation(s)
- H-C Yen
- a Graduate Institute and Department of Medical Biotechnology and Laboratory Science , College of Medicine, Chang Gung University , Taoyuan , Taiwan
| | - T-W Chen
- a Graduate Institute and Department of Medical Biotechnology and Laboratory Science , College of Medicine, Chang Gung University , Taoyuan , Taiwan
| | - T-C Yang
- b Department of Neurosurgery , Chang Gung Memorial Hospital and Chang Gung University , Taoyuan , Taiwan
| | - H-J Wei
- a Graduate Institute and Department of Medical Biotechnology and Laboratory Science , College of Medicine, Chang Gung University , Taoyuan , Taiwan
| | - J-C Hsu
- c Department of Anesthesiology , Chang Gung Memorial Hospital and Chang Gung University , Taoyuan , Taiwan
| | - C-L Lin
- b Department of Neurosurgery , Chang Gung Memorial Hospital and Chang Gung University , Taoyuan , Taiwan
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Propofol Attenuates Small Intestinal Ischemia Reperfusion Injury through Inhibiting NADPH Oxidase Mediated Mast Cell Activation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:167014. [PMID: 26246867 PMCID: PMC4515292 DOI: 10.1155/2015/167014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/07/2014] [Indexed: 12/14/2022]
Abstract
Both oxidative stress and mast cell (MC) degranulation participate in the process of small intestinal ischemia reperfusion (IIR) injury, and oxidative stress induces MC degranulation. Propofol, an anesthetic with antioxidant property, can attenuate IIR injury. We postulated that propofol can protect against IIR injury by inhibiting oxidative stress subsequent from NADPH oxidase mediated MC activation. Cultured RBL-2H3 cells were pretreated with antioxidant N-acetylcysteine (NAC) or propofol and subjected to hydrogen peroxide (H2O2) stimulation without or with MC degranulator compound 48/80 (CP). H2O2 significantly increased cells degranulation, which was abolished by NAC or propofol. MC degranulation by CP further aggravated H2O2 induced cell degranulation of small intestinal epithelial cell, IEC-6 cells, stimulated by tryptase. Rats subjected to IIR showed significant increases in cellular injury and elevations of NADPH oxidase subunits p47(phox) and gp91(phox) protein expression, increases of the specific lipid peroxidation product 15-F2t-Isoprostane and interleukin-6, and reductions in superoxide dismutase activity with concomitant enhancements in tryptase and β-hexosaminidase. MC degranulation by CP further aggravated IIR injury. And all these changes were attenuated by NAC or propofol pretreatment, which also abrogated CP-mediated exacerbation of IIR injury. It is concluded that pretreatment of propofol confers protection against IIR injury by suppressing NADPH oxidase mediated MC activation.
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Bókkon I, Mallick BN, Tuszynski JA. Near death experiences: a multidisciplinary hypothesis. Front Hum Neurosci 2013; 7:533. [PMID: 24062655 PMCID: PMC3769617 DOI: 10.3389/fnhum.2013.00533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 08/16/2013] [Indexed: 12/16/2022] Open
Abstract
Recently, we proposed a novel biophysical concept regarding on the appearance of brilliant lights during near death experiences (NDEs) (Bókkon and Salari, 2012). Specifically, perceiving brilliant light in NDEs has been proposed to arise due to the reperfusion that produces unregulated overproduction of free radicals and energetically excited molecules that can generate a transient enhancement of bioluminescent biophotons in different areas of the brain, including retinotopic visual areas. If this excess of bioluminescent photon emission exceeds a threshold in retinotopic visual areas, this can appear as (phosphene) lights because the brain interprets these intrinsic retinotopic bioluminescent photons as if they originated from the external physical world. Here, we review relevant literature that reported experimental studies (Imaizumi et al., 1984; Suzuki et al., 1985) that essentially support our previously published conception, i.e., that seeing lights in NDEs may be due to the transient enhancement of bioluminescent biophotons. Next, we briefly describe our biophysical visual representation model that may explain brilliant lights experienced during NDEs (by phosphenes as biophotons) and REM sleep associated dream-like intrinsic visual imageries through biophotons in NDEs. Finally, we link our biophysical visual representation notion to self-consciousness that may involve extremely low-energy quantum entanglements. This article is intended to introduce novel concepts for discussion and does not pretend to give the ultimate explanation for the currently unanswerable questions about matter, life and soul; their creation and their interrelationship.
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Affiliation(s)
- István Bókkon
- Neuroscience Department, Vision Research Institute Lowell, MA, USA
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Basu S, Nachat-Kappes R, Caldefie-Chézet F, Vasson MP. Eicosanoids and adipokines in breast cancer: from molecular mechanisms to clinical considerations. Antioxid Redox Signal 2013; 18:323-60. [PMID: 22746381 DOI: 10.1089/ars.2011.4408] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic inflammation is one of the foremost risk factors for different types of malignancies, including breast cancer. Additional risk factors of this pathology in postmenopausal women are weight gain, obesity, estrogen secretion, and an imbalance in the production of adipokines, such as leptin and adiponectin. Various signaling products of transcription factor, nuclear factor-kappaB, in particular inflammatory eicosanoids, reactive oxygen species (ROS), and cytokines, are thought to be involved in chronic inflammation-induced cancer. Together, these key components have an influence on inflammatory reactions in malignant tissue damage when their levels are deregulated endogenously. Prostaglandins (PGs) are well recognized in inflammation and cancer, and they are solely biosynthesized through cyclooxygenases (COXs) from arachidonic acid. Concurrently, ROS give rise to bioactive isoprostanes from arachidonic acid precursors that are also involved in acute and chronic inflammation, but their specific characteristics in breast cancer are less demonstrated. Higher aromatase activity, a cytochrome P-450 enzyme, is intimately connected to tumor growth in the breast through estrogen synthesis, and is interrelated to COXs that catalyze the formation of both inflammatory and anti-inflammatory PGs such as PGE(2), PGF(2α), PGD(2), and PGJ(2) synchronously under the influence of specific mediators and downstream enzymes. Some of the latter compounds upsurge the intracellular cyclic adenosine monophosphate concentration and appear to be associated with estrogen synthesis. This review discusses the role of COX- and ROS-catalyzed eicosanoids and adipokines in breast cancer, and therefore ranges from their molecular mechanisms to clinical aspects to understand the impact of inflammation.
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Affiliation(s)
- Samar Basu
- Biochemistry, Molecular Biology and Nutrition, University of Auvergne, Clermont-Ferrand, France.
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Dokken BB, Piermarini CV, Teachey MK, Gura MT, Dameff CJ, Heller BD, Krate J, Ashgar AM, Querin L, Mitchell JL, Hilwig RW, Kern KB. Glucagon-like peptide-1 preserves coronary microvascular endothelial function after cardiac arrest and resuscitation: potential antioxidant effects. Am J Physiol Heart Circ Physiol 2012; 304:H538-46. [PMID: 23241323 DOI: 10.1152/ajpheart.00282.2012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Glucagon-like peptide-1 (GLP-1) has protective effects in the heart. We hypothesized that GLP-1 would mitigate coronary microvascular and left ventricular (LV) dysfunction if administered after cardiac arrest and resuscitation (CAR). Eighteen swine were subjected to ventricular fibrillation followed by resuscitation. Swine surviving to return of spontaneous circulation (ROSC) were randomized to receive an intravenous infusion of either human rGLP-1 (10 pmol·kg(-1)·min(-1); n = 8) or 0.9% saline (n = 8) for 4 h, beginning 1 min after ROSC. CAR caused a decline in coronary flow reserve (CFR) in control animals (pre-arrest, 1.86 ± 0.20; 1 h post-ROSC, 1.3 ± 0.05; 4 h post-ROSC, 1.25 ± 0.06; P < 0.05). GLP-1 preserved CFR for up to 4 h after ROSC (pre-arrest, 1.31 ± 0.17; 1 h post-ROSC, 1.5 ± 0.01; 4 h post-ROSC, 1.55 ± 0.22). Although there was a trend toward improvement in LV relaxation in the GLP-1-treated animals, overall LV function was not consistently different between groups. 8-iso-PGF(2α), a measure of reactive oxygen species load, was decreased in post-ROSC GLP-1-treated animals [placebo, control (NS): 38.1 ± 1.54 pg/ml; GLP-1: 26.59 ± 1.56 pg/ml; P < 0.05]. Infusion of GLP-1 after CAR preserved coronary microvascular and LV diastolic function. These effects may be mediated through a reduction in oxidative stress.
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Affiliation(s)
- Betsy B Dokken
- Department of Medicine, University of Arizona, Tucson, AZ, USA.
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Nachat-Kappes R, Pinel A, Combe K, Lamas B, Farges MC, Rossary A, Goncalves-Mendes N, Caldefie-Chezet F, Vasson MP, Basu S. Effects of enriched environment on COX-2, leptin and eicosanoids in a mouse model of breast cancer. PLoS One 2012; 7:e51525. [PMID: 23272114 PMCID: PMC3521763 DOI: 10.1371/journal.pone.0051525] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/05/2012] [Indexed: 12/21/2022] Open
Abstract
Cyclooxygenase-2 (COX-2) and adipokines have been implicated in breast cancer. This study investigated a possible link between COX-2 and adipokines in the development of mammary tumors. A model of environmental enrichment (EE), known to reduce tumor growth was used for a syngeneic murine model of mammary carcinoma. 3-week-old, female C57BL/6 mice were housed in standard environment (SE) or EE cages for 9 weeks and transplanted orthotopically with syngeneic EO771 adenocarcinoma cells into the right inguinal mammary fat pad. EE housing influenced mammary gland development with a decrease in COX-2 expressing cells and enhanced side-branching and advanced development of alveolar structures of the mammary gland. Tumor volume and weight were decreased in EE housed mice and were associated with a reduction in COX-2 and Ki67 levels, and an increase in caspase-3 levels. In tumors of SE mice, high COX-2 expression correlated with enhanced leptin detection. Non-tumor-bearing EE mice showed a significant increase in adiponectin levels but no change in those of leptin, F(2)-isoprostanes, PGF(2α), IL-6, TNF-α, PAI-1, and MCP-1 levels. Both tumor-bearing groups (SE and EE housing) had increased resistin, IL-6, TNF-α, PAI-1 and MCP-1 levels irrespective of the different housing environment demonstrating higher inflammatory response due to the presence of the tumor. This study demonstrates that EE housing influenced normal mammary gland development and inhibited mammary tumor growth resulting in a marked decrease in intratumoral COX-2 activity and an increase in the plasma ratio of adiponectin/leptin levels.
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Affiliation(s)
- Rachida Nachat-Kappes
- Chaire d’Excellence Program, Biochemistry, Molecular Biology and Nutrition, Université d'Auvergne, Unité de Nutrition Humaine, Equipe ECRIN, CLARA, CRNH Auvergne; INRA, UMR, UNH, CRNH Auvergne, Clermont-Ferrand, France
| | - Alexandre Pinel
- Chaire d’Excellence Program, Biochemistry, Molecular Biology and Nutrition, Université d'Auvergne, Unité de Nutrition Humaine, Equipe ECRIN, CLARA, CRNH Auvergne; INRA, UMR, UNH, CRNH Auvergne, Clermont-Ferrand, France
| | - Kristell Combe
- Chaire d’Excellence Program, Biochemistry, Molecular Biology and Nutrition, Université d'Auvergne, Unité de Nutrition Humaine, Equipe ECRIN, CLARA, CRNH Auvergne; INRA, UMR, UNH, CRNH Auvergne, Clermont-Ferrand, France
| | - Bruno Lamas
- Chaire d’Excellence Program, Biochemistry, Molecular Biology and Nutrition, Université d'Auvergne, Unité de Nutrition Humaine, Equipe ECRIN, CLARA, CRNH Auvergne; INRA, UMR, UNH, CRNH Auvergne, Clermont-Ferrand, France
| | - Marie-Chantal Farges
- Chaire d’Excellence Program, Biochemistry, Molecular Biology and Nutrition, Université d'Auvergne, Unité de Nutrition Humaine, Equipe ECRIN, CLARA, CRNH Auvergne; INRA, UMR, UNH, CRNH Auvergne, Clermont-Ferrand, France
| | - Adrien Rossary
- Chaire d’Excellence Program, Biochemistry, Molecular Biology and Nutrition, Université d'Auvergne, Unité de Nutrition Humaine, Equipe ECRIN, CLARA, CRNH Auvergne; INRA, UMR, UNH, CRNH Auvergne, Clermont-Ferrand, France
| | - Nicolas Goncalves-Mendes
- Chaire d’Excellence Program, Biochemistry, Molecular Biology and Nutrition, Université d'Auvergne, Unité de Nutrition Humaine, Equipe ECRIN, CLARA, CRNH Auvergne; INRA, UMR, UNH, CRNH Auvergne, Clermont-Ferrand, France
| | - Florence Caldefie-Chezet
- Chaire d’Excellence Program, Biochemistry, Molecular Biology and Nutrition, Université d'Auvergne, Unité de Nutrition Humaine, Equipe ECRIN, CLARA, CRNH Auvergne; INRA, UMR, UNH, CRNH Auvergne, Clermont-Ferrand, France
| | - Marie-Paule Vasson
- Chaire d’Excellence Program, Biochemistry, Molecular Biology and Nutrition, Université d'Auvergne, Unité de Nutrition Humaine, Equipe ECRIN, CLARA, CRNH Auvergne; INRA, UMR, UNH, CRNH Auvergne, Clermont-Ferrand, France
- Centre de Lutte Contre le Cancer Jean Perrin, Unité de Nutrition, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service Nutrition, Clermont-Ferrand, France
| | - Samar Basu
- Chaire d’Excellence Program, Biochemistry, Molecular Biology and Nutrition, Université d'Auvergne, Unité de Nutrition Humaine, Equipe ECRIN, CLARA, CRNH Auvergne; INRA, UMR, UNH, CRNH Auvergne, Clermont-Ferrand, France
- Oxidative Stress and Inflammation, Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
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Orban JC, Cattet F, Lefrant JY, Leone M, Jaber S, Constantin JM, Allaouchiche B, Ichai C. The practice of therapeutic hypothermia after cardiac arrest in France: a national survey. PLoS One 2012; 7:e45284. [PMID: 23049783 PMCID: PMC3458038 DOI: 10.1371/journal.pone.0045284] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 08/14/2012] [Indexed: 11/18/2022] Open
Abstract
AIMS Cardiac arrest is a major health concern worldwide accounting for 375,000 cases per year in Europe with a survival rate of <10%. Therapeutic hypothermia has been shown to improve patients' neurological outcome and is recommended by scientific societies. Despite these guidelines, different surveys report a heterogeneous application of this treatment. The aim of the present study was to evaluate the clinical practice of therapeutic hypothermia in cardiac arrest patients. METHODS This self-declarative web based survey was proposed to all registered French adult intensive care units (ICUs) (n=357). Paediatrics and neurosurgery ICUs were excluded. The different questions addressed the structure, the practical modalities of therapeutic hypothermia and the use of prognostic factors in patients admitted after cardiac arrest. RESULTS One hundred and thirty-two out of 357 ICUs (37%) answered the questionnaire. Adherence to recommendations regarding the targeted temperature and hypothermia duration were 98% and 94% respectively. Both guidelines were followed in 92% ICUs. During therapeutic hypothermia, sedative drugs were given in 99% ICUs, mostly midazolam (77%) and sufentanil (59%). Neuromuscular blocking agents (NMBA) were used in 97% ICUs, mainly cisatracurium (77%). Numerous prognostic factors were used after cardiac arrest such as clinical factors (95%), biomarkers (53%), electroencephalography (78%) and evoked potentials (35%). CONCLUSIONS In France, adherence to recommendations for therapeutic hypothermia after cardiac arrest is higher than those previously reported in other countries. Numerous prognostic factors are widely used even if their reliability remains controversial.
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Affiliation(s)
- Jean-Christophe Orban
- Réanimation médico-chirurgicale, Hôpital Saint-Roch, Centre Hospitalier Universitaire de Nice, Nice, France.
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12
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Bókkon I, Salari V. Hypothesis about brilliant lights by bioluminescent photons in near death experiences. Med Hypotheses 2012; 79:47-9. [PMID: 22543076 DOI: 10.1016/j.mehy.2012.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 03/22/2012] [Accepted: 03/30/2012] [Indexed: 10/28/2022]
Abstract
In near death experiences (NDEs), seeing a brilliant light may arise in the recovery period following cardiac arrest, but the subjects can think that these experiences had happened during the actual period itself. Here we hypothesize a biophysical explanation about the encounter with a brilliant light in NDEs. Accordingly, meeting brilliant light in NDEs is due to the reperfusion that induces unregulated overproduction of free radicals and excited biomolecules among them in numerous parts in the visual system. Unregulated free radicals and excited species can produce a transient increase of bioluminescent photons in different areas of the visual system. If this excess of bioluminescent photon emission exceeds a threshold, they can appear as (phosphene) lights in our mind. In other words, seeing a brilliant light in NDEs may due to bioluminescent photons simultaneously generated in the recovery phase of numerous areas of the visual system and the brain interprets these intrinsic bioluminescent photons as if they were originated from the external visual world. Although our biophysical explanation about brilliant light phenomenon in NDEs can be promising, we do not reject further potential notions.
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Affiliation(s)
- István Bókkon
- Doctoral School of Pharmaceutical and Pharmacological Sciences, Semmelweis University, Hungary; Vision Research Institute, 25 Rita Street, Lowell, MA 01854, USA.
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