Impact of CPR Quality and Adherence to Advanced Cardiac Life Support Guidelines on Patient Outcomes in In-Hospital Cardiac Arrest.

BACKGROUND: Sudden cardiac arrest is a major cause of death worldwide. Performance of prompt, high-quality cardiopulmonary resuscitation improves patient outcomes. OBJECTIVES: To evaluate the association between patient survival of in-hospital cardiac arrest and 2 independent variables: adherence to resuscitation guidelines and patient severity of illness, as indicated by the number of organ supportive therapies in use before cardiac arrest. METHODS: An observational study was conducted using prospectively collected data from a convenience sample. Cardiopulmonary arrest forms and medical records were evaluated at an academic medical center. Adherence to resuscitation guidelines was measured with the ZOLL R Series monitor/defibrillator using RescueNet Code Review software. The primary outcome was patient survival. RESULTS: Of 200 cases, 37% of compressions were in the recommended range for rate (100-120/min) and 63.9% were in range for depth. The average rate was above target 55.7% of the time. The average depth was above and below target 1.4% and 34.7% of the time, respectively. Of the 200 patients, 125 (62.5%) attained return of spontaneous circulation. Of those, 94 (47%) were alive 24 hours after resuscitation. Fifty patients (25%) were discharged from the intensive care unit alive and 47 (23.5%) were discharged from the hospital alive. CONCLUSIONS: These exploratory data reveal overall survival rates similar to those found in previous studies. The number of pauses greater than 10 seconds during resuscitation was the one consistent factor that impacted survival. Despite availability of an audiovisual feedback system, rescuers continue to perform compressions that are not at optimal rate and depth.

Vesicle-associated membrane protein 7-mediated eosinophil degranulation promotes allergic airway inflammation in mice.

Eosinophil degranulation is a determining factor in allergy-mediated airway pathology. Receptor-mediated degranulation in eosinophils requires vesicle-associated membrane protein 7 (VAMP-7), a principal component of the SNARE fusion machinery. The specific contribution of eosinophil degranulation to allergen-induced airway responses remains poorly understood. We generated mice with VAMP-7 gene deficiency exclusively in eosinophils (eoCRE/V7) from a cross using eosinophil-specific Cre recombinase-expressing mice crossed with VAMP-7 f/f mice. Eosinophils from eoCRE/V7 mice showed deficient degranulation responses in vitro, and responses continued to be decreased following ex vivo intratracheal adoptive transfer of eoCRE/V7 eosinophils into IL-5/hE2/EPX -/- mice. Consistent with diminished degranulation responses, reduced airway hyperresponsiveness was observed in ovalbumin-sensitized and challenged eoCRE/V7 mice following methacholine inhalation. Therefore, VAMP-7 mediates eosinophil degranulation both in vitro and ex vivo, and this event augments airway hyperresponsiveness.

Proteomic analysis of secretagogue-stimulated neutrophils implicates a role for actin and actin-interacting proteins in Rac2-mediated granule exocytosis.

BACKGROUND: Neutrophils are abundant leukocytes that play a primary role in defence against pathogens. Neutrophils enter sites of infection where they eliminate pathogens via phagocytosis and the release of antimicrobial mediators via degranulation. Rho GTPases, particularly Rac2, play a key role in neutrophil degranulation. The purpose of this study was to identify Rac2-dependent changes in protein abundance in stimulated neutrophils. METHODS: We performed a proteomic analysis on secretagogue-stimulated bone marrow neutrophils that were isolated from wild-type and Rac2-/- mice. Protein abundance was analyzed by 2-dimensional SDS-PAGE of fluorescently labelled samples which allowed the detection ~3500 proteins. RESULTS: We identified 22 proteins that showed significant changes in abundance after secretagogue-stimulation of wild-type neutrophils, which did not occur in neutrophils isolated from Rac2-/- mice. As expected, the abundance of several granule proteins was reduced in wild-type cells; this did not occur in Rac2-/- neutrophils which confirms the requirement for Rac2 in degranulation. We also found changes in abundance of many actin remodelling proteins including coronin-1A, ß-actin and the F-actin capping protein, (CapZ-ß). Coronin-1A showed elevated levels of several isoforms after stimulation of neutrophils from wild-type, but not from Rac2-/- mice. These isoforms were immunoreactive with anti-phospho-threonine antibodies, suggesting that neutrophil stimulation triggers a Rac2-dependent kinase cascade that results in the phosphorylation of coronin-1A. CONCLUSION: The control of Rac2-mediated degranulation in neutrophils likely functions through actin remodelling via activation of several actin-binding proteins. We found coronin-1A to be a novel downstream effector protein of this pathway that is threonine phosphorylated in response to secretagogue stimulation.

Agonist activation of f-actin-mediated eosinophil shape change and mediator release is dependent on Rac2.

BACKGROUND: Tissue recruitment and activation of eosinophils contribute to allergic symptoms by causing airway hyperresponsiveness and inflammation. Shape changes and mediator release in eosinophils may be regulated by mammalian Rho-related guanosine triphosphatases. Of these, Rac2 is essential for F-actin formation as a central process underlying cell motility, exocytosis, and respiratory burst in neutrophils, while the role of Rac2 in eosinophils is unknown.We set out to determine the role of Rac2 in eosinophil mediator release and F-actin-dependent shape change in response to chemotactic stimuli. METHODS: Rac2-deficient eosinophils from CD2-IL-5 transgenic mice crossed with rac2 gene knockout animals were examined for their ability to release superoxide through respiratory burst or eosinophil peroxidase by degranulation. Eosinophil shape change and actin polymerization were also assessed by flow cytometry and confocal microscopy following stimulation with eotaxin-2 or platelet-activating factor. RESULTS: Eosinophils from wild-type mice displayed inducible superoxide release, but at a small fraction (4-5%) of human eosinophils. Rac2-deficient eosinophils showed significantly less superoxide release (p < 0.05, 26% less than wild type). Eosinophils lacking Rac2 had diminished degranulation (p < 0.05, 62% less eosinophil peroxidase) and shape changes in response to eotaxin-2 or platelet-activating factor (with 68 and 49% less F-actin formation, respectively; p < 0.02) compared with wild-type cells. CONCLUSION: These results demonstrate that Rac2 is an important regulator of eosinophil function by contributing to superoxide production, granule protein release, and eosinophil shape change. Our findings suggest that Rho guanosine triphosphatases are key regulators of cellular inflammation in allergy and asthma.

Nanotechnology for regenerative medicine: nanomaterials for stem cell imaging.

Although stem cells hold great potential for the treatment of many injuries and degenerative diseases, several obstacles must be overcome before their therapeutic application can be realized. These include the development of advanced techniques to understand and control functions of microenvironmental signals and novel methods to track and guide transplanted stem cells. The application of nanotechnology to stem cell biology would be able to address those challenges. This review details the current challenges in regenerative medicine, the current applications of nanoparticles in stem cell biology and further potential of nanotechnology approaches towards regenerative medicine, focusing mainly on magnetic nanoparticle- and quantum dot-based applications in stem cell research.