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INTRODUCTION@#Nursing home (NH) residents with out-of-hospital cardiac arrests (OHCA) have unique resuscitation priorities. This study aimed to describe OHCA characteristics in NH residents and identify independent predictors of survival.@*MATERIALS AND METHODS@#OHCA cases between 2010-16 in the Pan-Asian Resuscitation Outcomes Study were retrospectively analysed. Patients aged <18 years old and non-emergency cases were excluded. Primary outcome was survival at discharge or 30 days. Good neurological outcome was defined as a cerebral performance score between 1-2.@*RESULTS@#A total of 12,112 cases were included. Of these, 449 (3.7%) were NH residents who were older (median age 79 years, range 69-87 years) and more likely to have a history of stroke, heart and respiratory diseases. Fewer NH OHCA had presumed cardiac aetiology (62% vs 70%, <0.01) and initial shockable rhythm (8.9% vs 18%, <0.01), but had higher incidence of bystander cardiopulmonary resuscitation (74% vs 43%, <0.01) and defibrillator use (8.5% vs 2.8%, <0.01). Non-NH (2.8%) residents had better neurological outcomes than NH (0.9%) residents ( <0.05). Factors associated with survival for cardiac aetiology included age <65 years old, witnessed arrest, bystander defibrillator use and initial shockable rhythm; for non-cardiac aetiology, these included witnessed arrest (adjusted odds ratio [AOR] 3.8, <0.001) and initial shockable rhythm (AOR 5.7, <0.001).@*CONCLUSION@#Neurological outcomes were poorer in NH survivors of OHCA. These findings should inform health policies on termination of resuscitation, advance care directives and do-not-resuscitate orders in this population.
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BACKGROUND:A mass of debris particles that can lead to cytotoxicity exist in commercial large-inner-diameter multi-walled carbon nanotubes (LID-MWCNTs).Because of the high hydrophobicity on the surface of the tube wall,the carbon tubes can be twisted and agglomerated,resulting in the low dispersion and poor biocompatibility.Therefore,to explore the effective methods of purifying and modifying LID-MWCNTs is the primary problem to develop its potency in the biomedical application.OBJECTIVE:To explore the effects of different mixed acid reflux time on LID-MWCNTs purification and biocompatibility.METHODS:After pretreatment with high temperature calcinations and hydrochloric acid pickling,LID-MWCNTs were purified under different time of mixed acid reflux time (1,2,4 hours).The mixed acid reflux time for best purification was chosen based on surface morphology and dispersibility,so as to optimize preparation technology and observe the characterization.The L929 cells and CAL-27 cells were treated with different concentrations of raw LID-MWCNTs (5,10,20,40,80 mg/L) and purified LID-MWCNTs by mixed acid reflux (5,10,20,40,80 mg/L).After 72 hours,cell counting kit-8 assay was employed to test the proliferation of L929 cells and CAL-27 cells.RESULTS AND CONCLUSION:(1) With the time of mixed acid reflux,the length of LID-MWCNTs was decreased,and the dispersion was improved.However,the external surface of the tubes after mixed acid reflux 2 and 4 hours were destroyed obviously.Especially after mixed acid reflux 4 hours,the tubes were destroyed seriously and the diameter of tubes was not uniform.However,after mixed acid reflux 1 hour,the fundamental structure and morphology of the tubes were not changed,the debris particles were undetected on the tube wall surface,and the tubes had the good dispersion.(2) Under the same concentration,the survival rate of L929 cells in the raw LID-MWCNTs group was lower than that in the purified LID-MWCNTs group.At the concentration of 10-80 mg/L,the survival rate of L929 cells in the group of mixed acids reflux 1 hour was up to 90％,higher than that in the other groups (P ＜ 0.05).(3) Under the same concentration,the survival rate of CAL-27 cells in the raw LID-MWCNTs group was lower than that in the purified LID-MWCNTs.At the concentration of 20-80 mg/L,the survival rate of CAL-27 cells in the group of mixed acids reflux 1 hour was up to 90％,higher than that in the other groups (P ＜ 0.05).These results revealed that the raw LID-MWCNTs were purified effectively after mixed acid reflux 1 hour,and the cytotoxicity was decreased.
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Morphine is a widely used opioid analgesic, but great individual differences in response to morphine such as sensitivity to analgesia and susceptibility to tolerance, which due to chronic morphine treatment, are great challenges for clinicians to optimize treatment strategy. Genetic factors play an important role in individual variability to morphine treatment. Individual responses to morphine are influenced by various gene-encoded-proteins implied in pharmacokinetics and pharmacodynamics. Variants of P-glycoprotein encoding gene ABCB1 regulate transportation and distribution of morphine and affect analgesic effect. Diversity in UDP-glucuronosyl transferase encoding gene UGT2B7, whose encoding product catalyzing morphine to glycosylated metabolites contribute to different response to morphine in a pharmacokinetic way. Nevertheless, variants in μ-opioid receptor encoding gene OPRM1 and catechol-O-methyltransferase encoding gene COMT regulate morphine-induced downstream signaling and influence morphine analgesia in a pharmacodynamic way. It is necessary to employ individuals with more complex genetic diversity and screen in a larger scope through a more comprehensive system to find the key genes involved in individual differences of morphine analgesia in future research. Elucidating the association between genetic variability and individual differences will help to figure out the mechanism of pharmacogenetic regulation in morphine analgesia. It will provide basis for personalized and accurate utility of morphine or even combining with gene therapy to improve the analgesic effect.
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Morphine is a widely used opioid analgesic, but great individual differences in response to morphine such as sensitivity to analgesia and susceptibility to tolerance, which due to chronic morphine treatment, are great challenges for clinicians to optimize treatment strategy. Genetic factors play an important role in individual variability to morphine treatment. Individual responses to morphine are influenced by various gene-encoded-proteins implied in pharmacokinetics and pharmacodynamics. Variants of P-glycoprotein encoding gene ABCB1 regulate transportation and distribution of morphine and affect analgesic effect. Diversity in UDP-glucuronosyl transferase encoding gene UGT2B7, whose encoding product catalyzing morphine to glycosylated metabolites contribute to different response to morphine in a pharmacokinetic way. Nevertheless, variants in μ-opioid receptor encoding gene OPRM1 and catechol-O-methyltransferase encoding gene COMT regulate morphine-induced downstream signaling and influence morphine analgesia in a pharmacodynamic way. It is necessary to employ individuals with more complex genetic diversity and screen in a larger scope through a more comprehensive system to find the key genes involved in individual differences of morphine analgesia in future research. Elucidating the association between genetic variability and individual differences will help to figure out the mechanism of pharmacogenetic regulation in morphine analgesia. It will provide basis for personalized and accurate utility of morphine or even combining with gene therapy to improve the analgesic effect.
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Objective To prepare a targeted antitumor drug delivery system using large-inner-diameter multi-walled carbon nanotubes (LID-MWCNTs) for sustained release and to study its performance. Methods LID-MWCNTs were puri?fied and oxidized,then use nanocarriers and USTs as homologous blockers. Folic acid and fluorescent labels were conjugat?ed onto the external surfaces of nanocarriers. CDDP (cisplatin) was encapsulated and ultrashort tubes (USTs) were employed to block the drug entry/exit paths. The microstructure of resulted drug delivery system (DDS) was observed, while drug load?ing efficiency and drug release profile in vitro were determined. The tumor-targeting property and cytotoxicity of DDS were also assessed. Results LID-MWCNT based sustained release targeted drug delivery system was established. Drug loading efficiency of CDDP@UST-FA-LID-MWCNTs was as high as 70.97%. A typical biphasic sustained release pattern was dem?onstrated, and the accumulating release time was 18 h. DDS exhibited a certain kind of tumor-targeting property, and inhibit?ed proliferation of tumor cells in a dose-dependent manner. Conclusion CDDP@UST-FA-LID-MWCNT drug delivery system exhibited an improved drug loading efficiency and a sustained drug release profile. It could specifically target the tu?mor cells and had a significant antitumor effect.