Effects of cardiopulmonary resuscitation instructions on the outcomes of out-of-hospital cardiac arrest: An analysis of the JAAM-OHCA registry

Aim

To determine whether dispatcher-provided cardiopulmonary resuscitation (CPR) instructions improve the outcomes of out-of-hospital cardiac arrest (OHCA).

Methods

Cases registered in the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest (JAAM-OHCA) Registry between June 2014 and December 2019 were included. Cases in which the dispatcher provided CPR instructions to the bystander were included in the "Instructions" group", and cases without CPR instructions were included in the "No Instructions" group. The primary outcome was the proportion of patients with a favorable neurological outcome, defined as a Glasgow-Pittsburgh cerebral performance category scale of 1 to 2 at 1 month after OHCA.

Results

Overall, 51,199 patients with OHCA were registered in the JAAM-OHCA Registry during the study period. Of these, 33,745 were eligible for the study, with 16,509 in the Instructions group and 17,236 in the No Instructions group. The proportion of patients with a favorable neurological outcome at 1 month after OHCA was inferior in the Instructions group than in the No Instructions group (2.3% versus 3.0%, p < 0.001). After adjustment for patient background characteristics, no association was found between CPR instructions provided by a dispatcher and favorable neurological outcomes at 1 month after OHCA (adjusted odds ratio, 1.000; 95% confidence interval, 0.869-1.151, p = 0.996).

Conclusion

The present study found no clear clinical benefit of dispatcher-provided CPR instructions on the neurological outcomes of cases with OHCA.

Citrullinated inter-alpha-trypsin inhibitor heavy chain 4 in arthritic joints and its potential effect in the neutrophil migration

The citrullinated inter-alpha-trypsin inhibitor heavy chain 4 (cit-ITIH4) was identified as its blood level was associated with the arthritis score in peptide glucose-6-phosphate-isomerase-induced arthritis (pGIA) mice and the disease activity in patients with rheumatoid arthritis (RA). This study aimed to clarify its citrullination pathway and function as related to neutrophils. In pGIA-afflicted joints, ITIH4 and cit-ITIH4 levels were examined by immunohistochemistry (IHC), immunoprecipitation (IP) and Western blotting (WB), while peptidylarginine deiminase (PAD) expression was measured by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), IHC and immunofluorescent methods. The pGIA mice received anti-lymphocyte antigen 6 complex locus G6D (Ly6G) antibodies to deplete neutrophils and the expression of cit-ITIH4 was investigated by WB. The amounts of ITIH4 and cit-ITIH4 in synovial fluid (SF) from RA and osteoarthritis (OA) patients were examined by I.P. and W.B. Recombinant ITIH4 and cit-ITIH4 were incubated with sera from healthy volunteers before its chemotactic ability and C5a level were evaluated using Boyden's chamber assay and enzyme-linked immunosorbent assay (ELISA). During peak arthritic phase, ITIH4 and cit-ITIH4 were increased in joints while PAD4 was over-expressed, especially in the infiltrating neutrophils of pGIA mice. Levels of cit-ITIH4 in plasma and joints significantly decreased upon neutrophil depletion. ITIH4 was specifically citrullinated in SF from RA patients compared with OA patients. Native ITIH4 inhibited neutrophilic migration and decreased C5a levels, while cit-ITIH4 increased its migration and C5a levels significantly. Cit-ITIH4 is generated mainly in inflamed joints by neutrophils via PAD4. Citrullination of ITIH4 may change its function to up-regulate neutrophilic migration by activating the complement cascade, exacerbating arthritis.

Three cases of small hepatocellular carcinoma presenting as obstructive jaundice

BACKGROUND

Despite improved diagnostic tools, it is often difficult to make a correct diagnosis of small hepatocellular carcinoma (HCC) in patients with obstructive jaundice.

CASE OUTLINES

Three cases of small HCC (<2 cm diameter) presenting as obstructive jaundice are reported. All tumours were initially diagnosed as hilar cholangiocarcinoma based on ultrasonography, computed tomography, cholangiography and angiography. Because of insufficient hepatic function, none of the patients underwent hepatic resection. One patient died 8 months after first admission to our hospital, another died of disseminated intravascular coagulation I month after admission, and the third was treated with hepatic arterial infusion chemotherapy and survived >36 months.

CONCLUSION

It is important to consider HCC in the diagnosis of obstructive jaundice in patients who are predisposed to HCC because of liver cirrhosis and/or chronic viral hepatitis, and have elevated serum alpha-fetoprotein.

"Ordered" structure in ionic dilute solutions: dendrimers with univalent and bivalent counterions

As an intermediate sample of ionic solutes between colloidal particles (macroions) and simple electrolyte ions, we made small-angle x-ray scattering (SAXS) measurements for aqueous solutions of poly(amido amine) dendrimers of three generations (G4, G7, and G10). The SAXS curves of univalent acid solutions showed a single scattering peak, as observed for synthetic macroions. The peak position was dependent on the dendrimer concentration but independent not only of the acid concentration (degree of protonation) but also of the counterion species. The effective charge density of the dendrimer determined by conductivity measurements was found to be insensitive to the acid concentration and the counterion species. The nearest neighbor interparticle distance 2D(exp) calculated from the peak position of the structure factor of G7 and G10 was obviously smaller, though slightly, than the average interparticle distance 2D(0) calculated from molecular weights and concentrations of dendrimers, implying that acid solutions of dendrimers formed the two-state structures by the attractive force. The ultra-small-angle x-ray scattering curve for the hydrochloric acid solution did not show an upturn, which indicates the existence of large scale structural inhomogeneities such as localized ordered structures, probably due to the weak attraction and hence less clear distinction of the ordered and disordered regions. For sulfuric acid solutions, clear scattering peaks were not observed. The bivalent counterions were more strongly associated with the dendrimer ions than the univalent ones. The resulting low charge number of the dendrimers with the bivalent counterion was confirmed directly by the conductivity measurements. These observations confirm that the counterion-mediated attraction does exist even with the univalent counterions and point out that the frequently advanced claim that the effective potential is essentially repulsive with univalent counterions while attraction appears with bivalent counterions is not necessarily correct. It is noted that the intensity of the counterion-mediated attraction in dendrimer solutions is dictated by both the effective charge density and the effective charge number, in contrast with macroionic solutions or colloidal dispersions in which only the effective charge density appeared to be important.

Small bowel perforation caused by metastasis from an extra-abdominal malignancy: report of three cases

Small bowel perforation is rarely caused by metastasis from an extra-abdominal malignancy. This report describes three cases of small bowel perforation that occurred secondary to a metastatic tumor. The first case involved a 72-year-old man with malignant lymphoma of the larynx that had been treated with chemo- and radiation therapy; the second involved a 70-year-old man with rhabdomyosarcoma of the mediastinum that had been treated with radiation therapy; and the third involved a 41-year-old man with lung carcinoma that had been treated with surgery 10 months prior to perforation. Each patient presented with acute abdominal pain, had X-ray findings of free air in the abdomen, and underwent limited emergency surgery. Wedge resection and closure of the ileum was performed for the first patient and partial bowel resection with the creation of an intestinal stoma was performed for the second and third patients. In each case, the histologic findings of the resected specimens were consistent with the extra-abdominal primary tumors. Although the patients recovered sufficiently to begin eating and moving about, all three died of cancer or cancer-related complications within 45 days of surgery. We conclude that surgeons should be aware of the poor prognosis of such patients and perform only the minimal surgery required.

Reply to "Comment on 'Monte carlo study of structural ordering in charged colloids using a long-range attractive interaction' "

In the Comment by Grier and Crocker (preceding paper) the authors tried to refute our criticism [Phys. Rev. E 58, 2237 (1998)] on their work [J. C. Crocker and D. G. Grier, Phys. Rev. Lett. 77, 1897 (1996)] by simply fitting once again their old experimental data. Grier and Crocker claim that their pair-potential measurements on aqueous dilute suspension of charged colloidal particles confined between charged glass walls at gap of about 8 &mgr;m provide evidence for the failure of Sogami-Ise (SI) theory and demonstrate the applicability of the Dejaguin, Landau, Vervey, and Overbeek (DLVO) theory. Grier and Crocker do not provide additional experimental proof to counter our criticism. We continue to claim here based on our conductivity and conductometric titration measurements, which allow estimating the effective charge and determining the number and nature of the dissociable sites respectively, that their measurements using not well-characterized samples cannot provide clear evidence for the failure of SI theory. With the evidences available in literature, we refute all of the Grier and Crocker comments, including the effect of charged wall confinement on the measured colloidal interactions.

Reactivity of recombinant Treponema pallidum (r-Tp) antigens with anti-Tp antibodies in human syphilitic sera evaluated by ELISA

We evaluated the immunoreactivity of recombinant Treponema pallidum (r-Tp) antigens with human sera by indirect enzyme-linked immunoabsorbant assay (ELISA). We expressed antigens with a molecular weight (MW) of 17KDa, 15KDa, 47KDa, and 42KDa, which are believed to be major immunoreactive membrane proteins of Tp cells. The expressed proteins were described by adding the prefix M, S, and G to the corresponding Tp antigens, namely, mature antigens, signal sequence containing antigens, and glutathione s-transferase (GST)-fused antigen in this report. A rather high expression occurred for M47 and S42 proteins in the Escherichia coli system, whereas for M15 and M17 proteins, a poor expression was observed. However, a fairly high expression occurred for G15 and G17. Thus expressed proteins were purified by means of chromatographies to a level of > 95%, and the purified proteins were found to be reactive with TPHA positive serum by Western blotting (WB). An ELISA performed with a serum of 1/1000 dilution using these purified antigens for coating on the solid phase showed that G17 antigen was more effective in detecting syphilis antibodies in human serum than M47, S42, and G15. There was a good consistency between ELISA and TPHA, whereby the cutoff indexes (CI) on ELISA showed a correlation coefficient of 0.7276 in logarithmic TPHA titers.

Construction of a Two-Dimensional Ultra-Small-Angle X-ray Scattering Apparatus

A two-dimensional ultra-small-angle X-ray scattering (USAXS) apparatus was constructed using a rotating-anode X-ray generator and a Bonse–Hart camera. In this camera, two sets of two channel-cut single crystals were used to collimate the X-ray beam in both the horizontal and the vertical planes. The measured intensity profile of the direct beam showed a high small-angle resolution in all directions on the detector plane. The full width at half-maximum was 17′′, indicating that the apparatus can be applied to structural analysis in the range up to 2 μm, even for directionally oriented samples. One- and two-dimensional USAXS profiles from colloidal silica powder agreed well with each other, showing that the desmearing procedure adopted in the previous one-dimensional USAXS experiments were justified.

An analysis of users' preference on keyboards through ergonomic comparison among four keyboards

The usability of four kinds of keyboards as regards touch and feel was evaluated by measuring the performance and eliciting the preferences of a total of 24 Japanese participants in a test that consisted of typing English text. It was found that quiet keyboards with an indistinct tactile feedback tend to give higher uncorrected error rates than keyboards with a distinct tactile feedback and clicking sound, while no significant difference in throughput was found among the four keyboards. As regards preference, the test participants were divided into two groups: those who preferred keyboards with a distinct tactile feedback and clicking sound, and those who preferred keyboards with an indistinct tactile feedback and no sound. Analysis revealed that these two groups also showed different sensations and preferences with respect to several aspects of the touch and feel of keyboards. This result suggests that suppliers of computer keyboards should provide two kinds of keyboards, with distinct and indistinct tactile key switches, in order to satisfy as many users as possible.

Void Structure in Colloidal Dispersions

The time evolution of void structures in highly purified polymer latex dispersions was studied with a confocal laser scanning microscope. In such dispersions, which were initially homogeneous, the voids grew with time when the dispersions were kept standing and formed more quickly in the internal material than in material close to the glass-dispersion interface. Void formation is thus not an artifact arising from the presence of the interface. A similar structural inhomogeneity, in apparently homogeneous systems, is discussed for simple ionic solutions, ionic polymer solutions, and Langmuir-Blodgett films.

Mutual recognition between polymerized liposomes. IV. Polysaccharide-lectin system

As a model of cell-cell recognition processes, the association processes of a polysaccharide (mannan)-carrying liposome with a lectin (Concanavalin A, Con A)-carrying polymerized liposome were followed by turbidimetry. The association process was strongly inhibited by the addition of a low molecular weight sugar, methyl-alpha-D-mannopyranoside, which shows that the association between the liposomes is due to the specific interaction between Con A and mannan. The association rate constant obtained was much smaller than the theoretical value for a diffusion-controlled binary association process. This implies that the association rate of liposomes is limited by the recognition between complementary ligands bound on the liposome surfaces. Another reason for the smaller association rate constant in the liposome-liposome system is the repulsive hydration effect. The effect of the surface density of the lectin immobilized on the liposome on the recognition was also examined.

Mutual recognition between polymerized liposomes. III. Association processes between avidin and biotin on polymerized liposome surfaces

Association processes between avidin and biotin in various liposome systems were studied. By incorporating biotin onto the polymerized liposome surface, association processes with free avidin were largely decelerated. When the number of binding sites on the liposome surface was taken into account, the corrected association rate constant was 4.3% of the theoretical value for binary collision. The association rate constant between avidin- and biotin-carrying polymerized liposomes was much smaller than those for both the free avidin-free biotin system and the free avidin/biotin-liposome system, probably due to the repulsive hydration phenomenon. The results are discussed both in terms of our understanding of cell-cell recognition phenomena and for the development of drug delivery systems.

Ultra-small-angle x-ray-scattering study: preliminary experiments in colloidal suspensions

We report here a multiple-reflection type ultra-small-angle x-ray-scattering apparatus constructed according to the principle proposed by Bonse and Hart. The ultra-small-angle x-ray scattering technique enables us to investigate the distribution of solutes or particles in turbid systems, which could not be studied by the conventional light-scattering and microscopic methods. By this method, the density fluctuation from an order of several thousand angstroms to several micrometers is now detectable. In this paper, the ultra-small-angle x-ray scattering apparatus was calibrated by using well-defined latex particles.

[Metastasis of uterine cervical cancer to the biceps muscle of right upper arm; report of a case]

A hematogenic metastasis to the biceps muscle of right upper arm was reported in a 48-year-old women with recurrent uterine cervical cancer who had undergone radiotherapy. Cancer metastasis to the limb skeletal muscle is very rare. We have not known the similar case report in uterine cervical cancer.

Direct examination of chemical kinetic laws by visual imagery. IV. Association processes between antigen- and fragmented antibody carrying fluorescent latex particles

The binary association process was further examined by direct visual observation using a fluorescence microscope connected to an image-processing system and by a spectrophotometric method. In the present paper, we used human serum albumin (HSA)- and fragmented anti-HSA antibody-carrying fluorescent latex particles in order to attain higher sensitivities and exclude complexities that might be caused by dissociation of the association product. The rate constant of the binary association process was estimated to be 6.0 x 10(8) M-1 s-1 at 30 degrees C and pH 7.6. The activation parameters of the association process were evaluated. The effects of pH and viscosity of the suspension on the association process were also examined.

Mutual recognition between polymerized liposomes: enzyme and enzyme inhibitor system

In order to examine the usefulness of polymerized liposomes as a model for cell membranes, a mutual recognition phenomenon between different liposomes on which complementary ligands were attached was examined. We used trypsin- and soybean trypsin inhibitor (STI)-carrying polymerized liposomes to attain high sensitivities. The STI which was immobilized on the polymerized mono-dienoylphosphatidylcholine liposome showed a definite inhibitory effect on the catalytic activity of the trypsin which was immobilized on another polymerized liposome, whereas the inhibitory effect of the STI which was immobilized on the di-dienoylphosphatidylcholine liposome was much smaller than that of the mono-dienoylphosphatidylcholine system because of the larger rigity of the di-dienoylphosphatidylcholine liposome. These results suggest that the mutual recognition between complementary ligands can be realized by using polymerized liposomes with a physical stability and moderate deformability as their carriers.

Functional properties of proteins immobilized on albumin microspheres

Bovine serum albumin (BSA) microspheres with an average diameter of 12.5 micron were prepared by crosslinking of BSA molecules with glutaraldehyde in the presence of polymethylmethacrylate dissolved in chloroform-toluene. Trypsin and anti-human IgG antibody were immobilized onto their surfaces by the glutaraldehyde-activation method. The catalytic activity and storage stability of the immobilized trypsin were satisfactorily high. The enzyme immunoassay (EIA) method using BSA-microspheres as a solid phase has a high sensitivity (the minimum concentration of detectable antigen in the sample: 0.2 ng/ml) and a wide concentration range (final concentration 0.027-3000 ng/ml) for the detection of human IgG.

Pulse injection analysis of the binding of serum proteins to porous polymer gels modified with formyl groups

Highly porous spherical polymer gels were modified with formyl groups by a modified Friedel-Crafts reaction and the interaction of serum proteins with the modified gels were examined by pulse injection analysis. The introduction of formyl groups into the polymer greatly increases its protein-binding capacity, and the protein bound to the gel is not eluted by washing with acid, alkali or urea solution. The effects of temperature and the percentage of formyl group substitution on the binding capacity indicate that the binding process can be interpreted as initial approach of the protein to the polymer surface, caused by the hydrophobic interaction, followed by formation of a stable Schiff base between the polymer gel and the protein. Theoretical treatment of the elution behaviour of the protein from the polymer-packed column is also examined, with the assumption that there are three kinds of binding site in the polymer gel: surface, macropore and micropore regions. These polymers are shown to be useful for the removal of proteins from biological samples in clinical assays using immobilized enzymes.

pH dependence of the formation of dimeric alpha-chymotrypsin and its catalytic activity

The dimerization of alpha-chymotrypsin (alpha-CT) has been known to involve a specific interaction between the Tyr-146 alpha-carboxyl of one molecule and the His-57 imidazole, which is a member of the catalytic triad in the active site, of the other. This interaction determines the pH dependences of the dimerization constant and of the catalytic activities of the monomeric and dimeric enzymes. We compared the pKa values for catalytic activities with known pKa values for the dimerization constant in order to assign pKa values to residues of the enzyme. In the monomeric enzyme, the catalytic triad has a pKa value of 3.6 at the site between the Asp-102 carboxyl and His-57 N delta 1, and the Tyr-146 alpha-carboxyl has a pKa value of 4.6. In the dimeric enzyme, the site between the Asp-102 carboxyl and His-57 N delta 1 has a pKa value of around 5.5 and the site between His-57 N epsilon 2 and the Tyr-146 alpha-carboxyl has a pKa value around 2.4. Protonation at the site between the Asp-102 carboxyl and His-57 N delta 1 reduced the catalytic activity of the dimeric enzyme for p-nitrophenyl propionate, indicating that the Asp-102 carboxyl plays an important role in the monomeric alpha-CT-catalyzed reactions.