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Although initial resuscitation from cardiac arrest (CA) has increased over the past years, long term survival rates remain dismal. Epinephrine is the vasopressor of choice in the treatment of CA. However, its efficacy has been questioned, as it has no apparent benefis for long-term survival or favorable neurologic outcome. Levosimendan is an inodilator with cardioprotective and neuroprotective effects. Several studies suggest that it is associated with increased rates of return of spontaneous circulation as well as improved post-resuscitation myocardial function and neurological outcome. The purpose of this article is to review the properties of Levosimendan during cardiopulmonary resuscitation (CPR) and also to summarize existing evidence regarding the use of Levosimendan in the treatment of CA. © 2014 Elsevier B.V. All rights reserved.

Objective: The evaluation of the expression of S100B protein, in the swine heart in an experimental model of hypoxia - reoxygenation. Methods: Normocapnic hypoxia was induced in 40 male Landrace/Large White neonatal piglets by decreasing the inspired concentration of oxygen to 6-8%. When animals developed bradycardia or severe hypotension, reoxygenation was initiated. Piglets were allocated in four groups of 10, according to the oxygen concentration they were reoxygenated with: Group 1, 2, 3 and 4 resuscitated with 18%, 21%, 40% and 100% oxygen, respectively. The animals were further classified into 4 groups according with the time required for reoxygenation: group A (60min); group D (deceased animals). Results: Immunostaining for S100B protein was detected in 14 out of the 40 heart samples (35%), both inside the cytoplasm of cardiomyocytes and as globular deposits in the interstitial spaces. Significant differences were observed among groups 1-4 regarding S100B expression. Reactivity for S100B in cardiac cells was detected in 50%, 50%, 10% and 33% of animals in groups 1 and 2, 3 and 4, respectively. Marked differences were also observed among groups A-D: 75%, 33%, 12% and 22% of the animals in group 1, 2, 3 and 4, respectively, showed reactivity for S100B in the heart. Conclusions: Expression of S100B protein occurred in the heart of some of newborn piglets following severe hypoxia. S100B storage in cardiomyocytes correlates with the different oxygen concentration used during reoxygenation, being higher in piglets reoxygenated with 18% and 21%, and lower in animals reoxygenated with 40% oxygen. Intermediate levels of S100B expression were found in 100% O2-treated animals. The finding of a higher percentage of S100B-immunoreactive hearts in piglets with a fast recovery and the detection of a decreased reactivity in animals with a slow and a very slow recovery clearly indicates S100B protein as an early protective factor with a positive prognostic value in asphyxiated newborn piglets. © 2013 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.

Acute kidney injury (AKI) refers to the rapid loss of renal function. In clinical practice, AKI is common among hospitalized patients of all age groups including neonates and remains an important cause of morbidity and mortality due to its late diagnosis and therefore delayed therapeutic intervention. Although the precise incidence of AKI in newborn is unknown, several studies have reported that 8 to 24% of all critically ill newborns in neonatal intensive care units may develop the condition. We aim at reviewing the existing literature on novel serum and urinary biomarkers and discuss their role in the early diagnosis and prognosis of AKI in newborns. Specifically, this review will focus on cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) in serum and on CysC, NGAL, kidney injury molecule-1, and IL-18 in urine. © 2013 by Thieme Medical Publishers, Inc.

Objective: Nurses are usually the first-responders in cases of in-hospital cardiac arrest. Their competence in Basic Life Support (BLS) is important in improving patient outcome. The purpose of this study was to evaluate the nurses' BLS knowledge in a small district hospital. Methods: Data was collected by an anonymous questionnaire, distributed to all nursing personnel in this hospital. Data/results: The failure rate of the BLS theoretical questionnaire was 84%. Regarding self-assessment 10.3% of the participants rated their BLS knowledge as very good, whereas 31.2%, 44.2% and 14.3% of them rated it as good, moderate or not good respectively. This self-assessment did not correlate significantly with the final performance in the written test. No difference regarding the performance in the written test was observed between nurses who had participated in a refresher BLS course after graduation and those who had not. The nurses without any previous personal experience in the BLS had a higher probability to pass the written test. Conclusions: Our results indicate a low level of BLS knowledge among the study participants. Having an occasional refresher BLS course, or prior experience in BLS, does not affect the level of knowledge. © 2010 Elsevier Ltd.

Objective: The aim of this study is to describe and evaluate an experimental model of neonatal normocapnic hypoxia and resuscitation. Methods: Ten male Landrace/Large White neonatal piglets were studied. Following anaesthesia and intubation, the animals were mechanically ventilated. Surgical procedures included catheterization of the right internal jugular vein and the carotid artery. After stabilization with 21% O2, normocapnic hypoxia was induced by decreasing the inspired O2 to 68%. When piglets developed bradycardia (heart rate < 60 beats/min), reoxygenation was initiated by administering 21% O2. Arterial blood samples were taken during baseline, hypoxia and reoxygenation in order to measure interleukine-6 and interleukine-8. Results: Nine out of ten animals were successfully resuscitated (one of these required chest compressions and a dose of adrenaline) and one died despite resuscitation efforts. After returning to baseline haemodynamic values, euthanasia was performed using thiopental overdose. Conclusions: Haemodynamic fluctuations at baseline, during normocapnic hypoxia and reoxygenation in Landrace/Large White piglets are comparable to that in human neonates, making the breed a favorable model of human neonatal hypoxia investigation. © 2012 Informa UK, Ltd.

OBJECTIVE: Evaluation of myocardial histological changes in an experimental animal model of neonatal hypoxiareoxygenation. METHODS: Normocapnic hypoxia was induced in 40 male Landrace/Large White piglets. Reoxygenation was initiated when the animals developed bradycardia (HR 90 min), and E: nine deceased piglets. RESULTS: Histology revealed changes in all heart specimens. Interstitial edema, a wavy arrangement, hypereosinophilia and coagulative necrosis of cardiomyocytes were observed frequently. No differences in the incidence of changes were observed among groups 1-4, whereas marked differences regarding the frequency and the degree of changes were found among groups A-E. Coagulative necrosis was correlated with increased recovery time: this condition was detected post-asphyxia in 14%, 57%, and 100% of piglets with fast, medium, and slow or very slow recovery rates, respectively. CONCLUSIONS: The significant myocardial histological changes observed suggest that this experimental model might be a reliable model for investigating human neonatal cardiac hypoxia-related injury. No correlation was observed between the severity of histological changes and the fiO2 used during reoxygenation. Severe myocardial changes correlated strictly with recovery time, suggesting an unreported individual susceptibility of myocardiocytes to hypoxia, possibly leading to death after the typical time-sequence of events. © 2012 CLINICS.

We hypothesized that because the view of the glottis is better with videolaryngoscopes, successful intubation in neonates would be accomplished in a shorter time with the GlideScope® (Verathon, Inc., Bothell, WA) videolaryngoscope (GVL). Forty-five students of the University of Athens, inexperienced in both techniques, participated in the study (21 medical students and 24 nursing students, crossover randomized study). Following a brief educational session, each participant practiced and attempted intubation on a neonatal manikin using conventional laryngoscope and GVL, as many times as required to secure the airway. The time required to successful intubation and the number of attempts with each device were recorded. No significant difference was observed between the number of attempts required for successful intubation with either laryngoscope. The time required for the first successful intubation with the conventional laryngoscope was significantly shorter compared with that required with the GVL (p = 0.0013). There was no difference regarding the time required for the successful intubation between medical and nursing students, using the conventional laryngoscope or the GVL. The number of attempts to successful intubation with either device did not differ. The time required for intubation with the GVL was longer, and this is probably due to a design flaw. Copyright © 2011 by Thieme Medical Publishers, Inc.

Perinatal asphyxia is one of the leading causes of morbidity and mortality in the neonatal period. Response to oxygen treatment is unpredictable and the optimum concentration of oxygen in neonatal resuscitation is still a matter of debate among neonatologists. A metabolomic approach was used to characterize the metabolic profiles of newborn hypoxic-reoxygenated piglets. Urine samples were collected from newborn piglets (n=40) undergoing hypoxia followed by resuscitation at different oxygen concentrations (ranging from 18% to 100%) and analyzed by 1H NMR spectroscopy. Despite reoxygenation 7 piglets, out of 10 which became asystolic, did not respond to resuscitation. Profiles of the 1H NMR spectra were submitted to unsupervised (principal component analysis) and supervised (partial least squares-discriminant analysis) multivariate analysis. The supervised analyses showed differences in the metabolic profile of the urine collected before the induction of hypoxia between survivors and deaths. Metabolic variations were observed in the urine of piglets treated with different oxygen concentrations comparing T0 (basal value) and end of the experiment (resuscitation). Some of the individual metabolites discriminating between these groups were urea, creatinine, malonate, methylguanidine, hydroxyisobutyric acid. The metabolomic approach appears a promising tool for investigating newborn hypoxia over time, for monitoring the response to the treatment with different oxygen concentrations, and might lead to a tailored management of the disorder. © 2010 Informa UK, Ltd.

Ketamine, the phencyclidine derivative described in 1965, is an intravenous anesthetic with a variety of applications. The enthusiasm following its initial release subsided due to side effects from the central nervous system. New anesthetics limited the role of ketamine in anesthetic practice. However, its hemodynamically stable profile, along with its beneficial respiratory properties and analgesic potency, rendered the drug invaluable in battlefield medicine, sedation of the uncooperative child, analgesia, and sedation in burn units. Reevaluation, though, of analgesic properties of ketamine resulted in new interest regarding its use in perioperative and chronic pain management. Moreover, recent studies in the effects of the substance on intracranial pressure and cerebral blood flow led to revising the recommendation against its use in brain injury. Furthermore, the bronchodilating effects of the substance led to increasing interest for potential use in asthma treatment. In addition, separation of the 2 enantiomers and subsequent separate studies indicated beneficial results of the S(+) one. Thus, new controlled multicentered clinical trials are to be conducted to justify approval for new uses of ketamine and take advantage of its unique range of applications. © 2009 the American College of Clinical Pharmacology.

The density and ultrasonic velocity of aqueous solutions of formamide (FA), N-methylformamide (NMF), N,N-dimethylformamide (DMF), N,N-dimethylacetamide (DMA), pyrrolidin-2-one (PYR), N-methyl-2-pyrrolidinone (NMP), and their pure phases have been measured at 298.15 K and atmospheric pressure. Densities and ultrasonic velocities in pure amides have been also measured at the temperature range 288.15 K to 308.15 K for the computation of their thermal expansivities. Isentropic compressibility, intermolecular free length, relative association, apparent molar compressibility, as well as the excess quantities, ultrasonic velocity, isentropic compressibility, intermolecular free length, have been evaluated and fitted to the Redlich-Kister type equation. The deviation from ideal mixing law in ultrasonic velocity is positive while the deviations in isentropic compressibility and intermolecular free length are negative for all (amide + water) mixtures. This behavior reveals the nature and the magnitude of intermolecular interactions between the amide-water molecules. The sequence of superimposed curves of various ultrasonic parameters vs. the amide mole fraction is related to the strength of interactions between the unlike molecules and the role of -CH3 substitution in amides. The comparison of ultrasonic to volumetric properties reveals differences on the position of the extrema and their relation with the degree of substitution while the interpretation of these differences is discussed. Two different approaches on the computation of excess functions, applied in this work, brought out a difference in the magnitude of deviations and a partial reversion to the sequence of amides curves suggesting a different estimation in terms of deviations from ideal mixing law and therefore of the relative molecular interactions. © 2007 Elsevier Ltd. All rights reserved.

The effect of binary aqueous mixtures of ethylene glycol (EG), formamide (FA), N-methylformamide (NMF), dimethylformamide (DMF), and their pure phase on the apparent molar volume φV of the bolaamphiphile decamethonium bromide (C10Me6) has been investigated at 298.15 K. The behavior of standard molar volumes V20 and transfer volumes ΔtφV of C10Me6 from water to solvent/water (S/W) binary mixtures, shows different minima and maxima depending on the composition of the solvent. This behavior is influenced by the nature of the cosolvent and on the type of the solute and more or less corresponds to volumetric changes in the S/W mixture. The investigation of the transfer volumes in different fixed concentrations reveals an inversion of Δ tφV values between the compositions, which suggests a differentiation of the effects of different volume contributions on the partial molar volume of ions. The correlation of ΔtφV with the dielectric constant of the aqueous amide mixtures shows that the behavior of ΔtφV vs xamide reflects the changes of εE vs xamide. © 2005 Elsevier Inc. All rights reserved.

We have studied the molecular dimensions of poly-2-vinylpyridine in solution in binary solvent mixtures consisting of a non polar and a polar component, viz. benzene-ethanol and benzene-chloroform. We have also studied the preferential solvation of the same polymer in the above mixtures using light scattering. We have observed a conformational transition of P2VP taking place in a composition region for each solvent mixture. This transition shows as a discontinuity in the unperturbed dimensions, in the long range interactions parameter and in the parameter of preferential solvation of the polymer. We think that this transition is related to the existence of two ordered structures of the polymer chain, one stable before and the other after the transition region. © 1974.