ABSTRACT
Purpose@#We investigated the association between defoliant exposure and survival to discharge after out-of-hospital cardiac arrest. @*Methods@#This is a retrospective case-control study based on the cardiopulmonary resuscitation (CPR) registry. The electronic medical records of out-of-hospital cardiac arrest victims from 6/9/2008 to 12/31/2016 were analyzed statistically. The case patients group had a history of defoliant exposure while the control group did not. Among the 401 victims studied, a total of 110 patients were male out-of-hospital cardiac arrest patients. Baseline characteristics and the parameters involved in cardiac arrest were analyzed and compared between the two groups after propensity score matching. The primary outcome was survival to discharge, and secondary outcomes were sustained return of spontaneous circulation (ROSC) and survival to admission. @*Results@#After propensity score matching a total of 50 patients (case=25, control=25) were analyzed. Primary outcome (survival to discharge) was not significantly different between case and control groups [(OR, 1.759; 95% C.I., 0.491-6.309) and (OR, 1.842;95% C.I., 0.515-6.593), respectively]. In the subgroup analysis, there were also no significant differences between the control group and subgroups in primary and secondary outcomes according to defoliant exposure severity. @*Conclusion@#There is no statistically significant association between defoliant exposure and survival of out-of-hospital cardiac arrest.
ABSTRACT
Purpose@#Agent Orange (AO) is a herbicide and defoliant used by the United States and its military allies during the Vietnam War. Pneumonia is a common cause of death among Vietnam veterans in our hospital. There have been no previous studies researching any association between AO exposure and the prognosis for pneumonia. The primary objective of this study was to investigate associations between AO exposure and 30-day mortality due to pneumonia. The secondary objective was to examine the clinical factors associated with therapeutic outcomes in veterans with pneumonia, and to assess the prevalence of combined diseases in AO-exposed veterans. @*Methods@#This study retrospectively included veteran patients diagnosed with pneumonia in the emergency department and hospitalized between February 2014 and March 2018. The enrolled patients were grouped according to their defoliant exposure history, and the clinical information of defoliant-exposed and non-defoliant-exposed groups were compared. Patients were divided according to 30-day mortality, and significant factors influencing mortality were evaluated by using univariate analysis and multivariate analysis. The final multivariate model revealed the effect of AO exposure on therapeutic outcomes of pneumonia. @*Results@#A total of 1006 patients were analyzed. Of these, 276 patients had a history of AO exposure, whereas 730 patients had not been exposed. Factors positively associated with 30-day mortality were malignancy, respiratory rate, blood urea nitrogen, and albumin which was negatively associated with mortality. @*Conclusion@#Exposure to defoliant is not associated with 30-day mortality in patients with pneumonia. However, veterans with defoliant exposure are associated with a high prevalence of diabetes mellitus, hypertension, cerebrovascular accident, malignancy, and chronic kidney disease.
ABSTRACT
PURPOSE: To investigate the change in mitogen-activated protein kinase pathways in the brain tissue after therapeutic hypothermia in the swine cardiac arrest model. METHODS: After the return of spontaneous circulation by cardiopulmonary resuscitation, following a 6 min of no-flow time induced by ventricular fibrillation, pigs (n=24) were randomly assigned to one of four groups (sham, normothermia, 24 hr of therapeutic hypothermia, 48 hr of therapeutic hypothermia). After 24 or 48 hr of therapeutic hypothermia (core temperature 32-34℃), the pigs were then rewarmed to 36℃ for a period of 8 hr. At 60 hr upon the return of spontaneous circulation, the pigs were sacrificed and brain tissues were harvested. RESULTS: We measured the tissue levels of p38, JNK, and ERK pathway expressions from the hippocampus of the swine brain in all four groups. The phosphorylated p38-to-p38 ratio and phosphorylated JNK-to-JNK ratio were significantly increased in all of the intervention groups compared with the sham group. The phosphorylated ERK-to-ERK ratio was increased only in the therapeutic hypothermia groups (p-value=0.026 in the 24 hr of therapeutic hypothermia group and p-value=0.002 in the 48 hr of therapeutic hypothermia group, compared with the sham group). CONCLUSION: The p38 and JNK pathways were also activated during therapeutic hypothermia and normothermia. However, the ERK pathway was activated only in therapeutic hypothermia. Therapeutic hypothermia activated the ERK pathway in ischemia-reperfusion injury of the brain tissue after cardiac arrest, which seemed to be dependent on the duration of therapeutic hypothermia.