Vasopressor requirement during targeted temperature management for out-of-hospital cardiac arrest caused by acute myocardial infarction without cardiogenic shock

OBJECTIVE: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) due to an acute myocardial infarction without cardiogenic shock required higher doses of vasopressors with low targeted temperature management (TTM) after return of spontaneous circulation. METHODS: We included consecutive comatose patients resuscitated from OHCA between January 2011 and December 2013. Patients with return of spontaneous circulation, regional wall motion abnormality on echocardiography, and coronary artery stenosis of ≥70% on percutaneous coronary artery angiography were enrolled. These patients received 36°C TTM or 33°C TTM following approval of TTM by patients’ next-of-kin (36°C and 33°C TTM groups, respectively). The cumulative vasopressor index was compared between groups. RESULTS: During induction phase, dose of vasopressors did not differ between groups. In the maintenance phase, the norepinephrine dose was 0.37±0.57 and 0.26±0.91 µg·kg⁻¹·min⁻¹ in the 33°C and 36°C TTM groups, respectively (P<0.01). During the rewarming phase, the norepinephrine and dopamine doses were 0.49±0.60 and 9.67±9.60 mcg·kg⁻¹·min⁻¹ in the 33°C TTM group and 0.14±0.46 and 3.13±7.19 mcg·kg⁻¹·min⁻¹ in the 36°C TTM group, respectively (P<0.01). The median cumulative vasopressor index was 8 (interquartile range, 3 to 8) and 4 (interquartile range, 0 to 8) in the 33°C and 36°C TTM groups, respectively (P=0.03). CONCLUSION: In this study, patients with OHCA due to acute myocardial infarction without cardiogenic shock had an elevated vasopressor requirement with 33°C TTM compared to 36°C TTM during the maintenance and rewarming phases.

Serum Zinc Level and Its Related Dietary Factors in Male Patients with Coronary Heart Disease

Zinc is an antioxidant trace mineral, scavenging free radicals and known to be involved in inflammatory reactions. The prevalence of atherogenic diseases such as coronary heart disease (CHD) are increasing in Korean adults of middle age and elderly. The increased cell damage from free radicals and inflammation have been implicated in etiology of CHD, and the evidence is accumulating that low zinc status is involved in the prevalence of this inflammatory atherogenic disease. However, little is known about the zinc status of Korean CHD and its relationship with dietary zinc intake and zinc bioavailabilty. In this study the serum zinc levels of male patients with CHD over 40 yrs. were compared with that of healthy adult males and its associations with dietary zinc intake and zinc bioavailabilty affecting factors were examined. Serum zinc level was measured by HANARO research reactor using neutron activation analysis (NAA) method. The overall proportion of patients with zinc deficiency, serum zinc concentrations below 74.0 microgram/dL was 32.8% compared to the 10.3% in healthy group. The average serum zinc levels were 80.7 microgram/dL and 88.3 microgram/dL in patients and healthy group, respectively, showing significantly low zinc status in CHD patients compared to healthy group. The intake of nutrients such as energy, carbohydrate, iron, and copper of CHD patients was significantly higher compared to that of the healthy group. In addition, the intake of calcium, iron, and protein from vegetable foods was significantly higher in CHD patients than that of healthy group. The dietary zinc intake was 12.7+/-4.5 mg and 11.5+/-6.9 mg in CHD patients and control group, respectively, which showed no difference. The phytate intake of patients group, which is 1389.0 mg, was significantly higher than the control group which showed 1104.8 mg. However, the ratio of phytate :zinc or phytate *calcium :zinc per 1000 kcal energy intake did not show any difference between two groups. The serum zinc levels did not show any correlation with zinc or factors that affect the bioavailability of zinc. The dietary factors influencing the zinc status were not found in CHD patients.

A Study for The Relationship between Steroid Receptor Expression and Histologic Findings in Breast Diseases / 한국유방암학회지

The role of steroid receptor has been widely studied and well established in the field of breast cancer. In contrast of breast cancer, the clinicopathological roles of steroid receptors in benign breast diseases were not established clearly until now. Authors evaluated steroid receptor expressions of benign breast diseases using the immuno-histochemical staining and analyzed their relationship with pathologic types and the correlation between the positivity of steroid receptor expression and the proliferative activity of ductal epithelial cells. The results were follows; 1) The assayed tissue specimens were 93 cases which consisted with fibrocystic disease, 39 cases and fibroadenoma, 54 cases. 2) The positivity rate of steroid receptor expression in fibroadenoma (ER: 59.2%, PR: 75.9%) seemed to be more higher than in fibrecystic diseases (ER: 46.1%, PR: 55.5%) without a statistical significance. 3) The positivity rate of ER expression of fibrocystic diseases developed in premenopausal women (54.8%) was significantly higher than in postmenopausal women (2.5%). 4) Any significant correlation was not noted between the positivity of steroid receptor expression in the tissue and ductal epithelial proliferative activity. In conclusion, fibrocystic disease and fibroadenomas possessed a significant amount of steroid receptor positive cells in their tissues. However, the positivity of steroid receptor expression in the tissues seemed to have few correlation with the ductal epithelial cellular proliferation.