Kyoung Min You

Enhanced reduction of nitrate by supported nanoscale zero‐valent iron prepared in ethanol‐water solution

Nanoscale zero‐valent iron is famous for its high reactivity originating from its high surface area, and has emerged as an extension of granular zero‐valent iron technology. Due to its extremely small size, nanosized iron cannot be used as a medium in a permeable reactive barrier system, which is the most popular application of granular iron. To overcome this shortcoming, supported nanoscale zero‐valent iron was created. In addition to this, the preparation solution was modified to enhance the reactivity. An ethanol/water solvent containing a dispersant of polyethylene glycol was used to synthesize nanoscale iron. This preparation was done in the presence of an ion‐exchange resin as a supporting material. Nanoscale zero‐valent iron was formed and bound to the granular resin at the same time through the borohydride reduction of an iron salt, and the resulting product was compared with that prepared in a conventional way of using water only. Switching the preparation solution increased the supported nanoscale iron’s BET surface area and Fe content from 31.63 m2 g−1 and 18.19 mg Fe g−1 to 38.10 m2 g−1 and 22.44 mg Fe g−1, respectively. Kinetic analysis from batch tests revealed that a higher denitrification rate was achieved by the supported nanoscale zero‐valent iron prepared in the modified way. The pseudo‐first‐order reaction constant of 0.462 h−1 suggested that the reactivity of the supported iron, prepared in ethanol/water, increased by 61% compared with the one prepared in water. The higher rates of reaction, based on higher specific area and iron content, suggest that this new supported nanoscale iron can be used successfully for permeable reactive barriers.

Long-term survival of out-of-hospital cardiac arrest patients with malignancy

Background: The aim of this study was to investigate whether the 1‐year survival rate of out‐of‐hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy. Methods: All adult OHCA patients were retrospectively analyzed in a single institution for 6 years. The primary outcome was 1‐year survival, and secondary outcomes were sustained return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and discharge with a good neurological outcome (CPC 1 or 2). Kaplan‐Meier survival analysis and Cox proportional hazard regression analysis were performed to test the effect of malignancy. Results: Among 341 OHCA patients, 59 patients had malignancy (17.3%). Sustained ROSC, survival to admission, survival to discharge and discharge with a good CPC were not different between the two groups. The 1‐year survival rate was lower in patients with malignancy (1.7% vs 11.4%; P = 0.026). Kaplan‐Meier survival analysis revealed that patients with malignancy had a significantly lower 1‐year survival rate when including all patients (n = 341; P = 0.028), patients with survival to admission (n = 172, P = 0.002), patients with discharge CPC 1 or 2 (n = 18, P = 0.010) and patients with discharge CPC 3 or 4 (n = 57, P = 0.008). Malignancy was an independent risk factor for 1‐year mortality in the Cox proportional hazard regression analysis performed in patients with survival to admission and survival to discharge. Conclusions: Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1‐year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy.

Niacin and Selenium Attenuate Sepsis-Induced Lung Injury by Up-Regulating Nuclear Factor Erythroid 2-Related Factor 2 Signaling.

Objectives:To determine whether the combination therapy of niacin and selenium attenuates lung injury and improves survival during sepsis in rats and whether its benefits are associated with the activation of the glutathione redox cycle and up-regulation of nuclear factor erythroid 2–related factor 2. Design:Prospective laboratory study. Setting:University laboratory. Subjects:Human lung microvascular endothelial cells and male Sprague-Dawley rats (n = 291). Intervention:In lipopolysaccharide-exposed cells, the dose-related effects of niacin and selenium were assessed, and the therapeutic effects of the combination therapy of niacin (0.9 mM) and selenium (1.5 &mgr;M) were evaluated. The role of nuclear factor erythroid 2–related factor 2 was determined using nuclear factor erythroid 2–related factor 2 knockdown cells. In endotoxemic and cecal ligation and puncture with antibiotics rats, the therapeutic effects of the posttreatments of clinically relevant doses of niacin (360 mg/kg) and selenium (60 &mgr;g/kg) were evaluated. Measurements and Main Results:Combination therapy reduced the hydrogen peroxide level via the synergistic activation of the glutathione redox cycle, which involves niacin-induced increases in glutathione reductase activity, and reduced the glutathione level and a selenium-induced increase in glutathione peroxidase activity. Combination therapy contributed to the up-regulation of nuclear factor erythroid 2–related factor 2, enhancement of glutathione synthesis, and down-regulation of nuclear factor &kgr;B signaling, but nuclear factor erythroid 2–related factor 2 knockdown inhibited the enhancement of glutathione synthesis and down-regulation of the nuclear factor &kgr;B pathway. The therapeutic effects of combination therapy on endotoxemic rats were consistent with those on lipopolysaccharide-exposed cells. In addition, the posttreatment of combination therapy attenuated lung injury and improved survival in endotoxemic and cecal ligation and puncture with antibiotics rats. However, individual therapies of niacin or selenium failed to achieve these benefits. Conclusions:The combination therapy of niacin and selenium attenuated lung injury and improved survival during sepsis. Its therapeutic benefits were associated with the synergistic activation of the glutathione redox cycle, reduction of hydrogen peroxide level, and up-regulation of nuclear factor erythroid 2–related factor 2.

Epileptiform discharge detection with the 4-channel frontal electroencephalography during post-resuscitation care

INTRODUCTION We performed this study to investigate whether the SEDline system, a 4-channel-processed electroencephalography (EEG) monitoring device in the frontal area, can detect epileptiform discharges accurately during post-resuscitation care in comatose cardiac arrest survivors. METHODS Adult comatose cardiac arrest survivors, who were admitted to the intensive care unit (ICU) for post-resuscitation care including TTM, were enrolled. Within 72h post-return of spontaneous circulation (ROSC), conventional EEG was conducted for 30min. The SEDline system data were recorded with a video camera simultaneously with conventional EEG. Data retrieved from conventional EEG were interpreted by a neurologist and data from the SEDline system were interpreted by three emergency physicians blinded to the conventional EEG data. Then, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the SEDline system to detect epileptiform discharges were calculated. RESULTS Thirty-nine patients were enrolled in this study. Epileptiform discharges were confirmed in 6 patients (15.4%) who had the same patterns of generalized periodic epileptiform discharges in both conventional EEG and the concurrent SEDline system. The SEDline system showed 100.0% (95% confidence interval (CI), 54.1-100.0%) of sensitivity, 100.0% (95% CI, 89.4-100.0%) of specificity, 100.0% (95% CI, 54.1-100.0%) of PPV, and 100.0% (95% CI, 89.4-100.0%) of NPV. The overall classification accuracy of the SEDline system to detect epileptiform discharges was 100.0%. CONCLUSION The SEDline system detected epileptiform discharges accurately in comatose cardiac arrest survivors during post-resuscitation care.

End-tidal CO 2 -guided automated robot CPR system in the pig. Preliminary communication

BACKGROUND Our aim was to compare the efficacy of the end-tidal CO2-guided automated robot CPR (robot CPR) system with manual CPR and mechanical device CPR. METHODS We developed the algorithm of the robot CPR system which automatically finds the optimal compression position under the guidance of end-tidal CO2 feedback in swine models of cardiac arrest. Then, 18 pigs after 11 min of cardiac arrest were randomly assigned to one of three groups, robot CPR, LUCAS CPR, and manual CPR groups (n = 6 each group). Return of spontaneous circulation (ROSC) and Neurological Deficit Score 48 h after ROSC were compared. RESULTS A ROSC was achieved in 5 pigs, 4 pigs, and 3 pigs in the robot CPR, LUCAS CPR, and manual CPR groups, respectively (p = 0.47). Robot CPR showed a significant difference in Neurological Deficit Score 48 h after ROSC compared to manual CPR, whereas LUCAS CPR showed no significant difference over manual CPR. (p = 0.01; Robot versus Manual adjusted p = 0.04, Robot versus LUCAS adjusted p = 0.07, Manual versus LUCAS adjusted p = 1.00). CONCLUSIONS The end-tidal CO2-guided automated robot CPR system did not significantly improve ROSC rate in a swine model of cardiac arrest. However, robot CPR showed significant improvement of Neurological Deficit Score 48 h after ROSC compared to Manual CPR while LUCAS CPR showed no significant improvement compared to Manual CPR.

Prediction of neurological outcomes following the return of spontaneous circulation in patients with out-of-hospital cardiac arrest: Retrospective fast-and-frugal tree analysis

AIM Although various quantitative methods have been developed for predicting neurological prognosis in patients with out-of-hospital cardiac arrest (OHCA), they are too complex for use in clinical practice. We aimed to develop a simple decision rule for predicting neurological outcomes following the return of spontaneous circulation (ROSC) in patients with OHCA using fast-and-frugal tree (FFT) analysis. METHODS We performed a retrospective analysis of prospectively collected data archived in a multi-centre registry. Good neurological outcomes were defined as cerebral performance category (CPC) values of 1 or 2 at 28-day. Variables used for FFT analysis included age, sex, witnessed cardiac arrest, bystander cardiopulmonary resuscitation, initial shockable rhythm, prehospital defibrillation, prehospital ROSC, no flow time, low flow time, cause of arrest (cardiac or non-cardiac), pupillary light reflex, and Glasgow Coma Scale score after ROSC. RESULTS Among the 456 patients enrolled, 86 (18.9%) experienced good neurological outcomes. Prehospital ROSC (true = good), prompt or sluggish light reflex response after ROSC (true = good), and presumed cardiac cause (true = good, false = poor) were selected as nodes for the decision tree. Sensitivity, specificity, positive predictive value, and negative predictive value of the decision tree for predicting good neurological outcomes were 100% (42/42), 64.0% (119/186), 38.5% (42/109), and 100% (119/119) in the training set and 95.5% (42/44), 57.6% (106/184), 35.0% (42/120), and 98.1% (106/108) in the test set, respectively. CONCLUSION A simple decision rule developed via FFT analysis can aid clinicians in predicting neurological outcomes following ROSC in patients with OHCA.

Clinical Effects of Activated Charcoal Unavailability on Treatment Outcomes for Oral Drug Poisoned Patients

Background Activated charcoal is the most frequently and widely used oral decontaminating agent in emergency departments (EDs). However, there is some debate about its clinical benefits and risks. In Korea, activated charcoal with sorbitol was unavailable as of the mid-2015, and our hospital had been unable to use it from September 2015. This study examined the differences of clinical features and outcomes of patients during the periods charcoal was and was not available. Methods We retrospectively reviewed the electronic medical records of patients who had visited an urban tertiary academic ED for oral drug poisoning between January 2013 and January 2017. Results For the charcoal-available period, 413 patients were identified and for the charcoal-unavailable period, 221. Activated charcoal was used in the treatment of 141 patients (34%) during the available period. The mortality rates during the available and unavailable periods were 1.9 and 0.9%, respectively (p = 0.507). There was also no interperiod difference in the development of aspiration pneumonia (9.9 versus 9.5%, p = 0.864), the endotracheal intubation rate (8.4 versus 7.2%, p = 0.586), and vasopressor use (5.3 versus 5.0%, p = 0.85). Intensive care unit (ICU) admission was higher in the unavailable period (5.8 versus 13.6%, p = 0.001). ICU days were lower in the unavailable period (10 [4.5-19] versus 4 [3-9], p = 0.01). Hospital admission (43.3 versus 29.9%, p = 0.001) was lower in the unavailable period. Conclusions In this single center study, there appeared to be no difference in mortality, intubation rates, or vasopressor use between the charcoal-available and charcoal-unavailable periods.

975: PLASMA GLUTATHIONE REDUCTASE ACTIVITY IS ASSOCIATED WITH THE PROGNOSIS OF SEPTIC SHOCK

p=0.004), but TNF did not change after CLP in alcohol fed mice. At 72h, TNF production decreased due to alcohol in the sham groups, and also decreased due to sepsis in the water-fed groups; TNF production in alcohol septic mice was further decreased below the water septic group (H2O CLP vs EtOH CLP mean diff 13.6 ± 3.8%, p=0.004). There were no significant differences between water and alcohol septic groups in frequency of CD44HI, CD69+, CD44HICD69+, or CD44HICD43+ populations at 24h or 72h. Conclusions: Increased mortality due to sepsis in the setting of chronic alcohol ingestion is not associated with changes in CD4 activation at 24h or 72h, but is associated with alterations in capacity for inflammatory cytokine production. Decreased TNF production at 72h in alcohol septic mice below water septic mice suggests an additive change specific to sepsis following alcohol ingestion.