Volatile metabolites in the exhaled breath of healthy volunteers: their levels and distributions
The data obtained for the concentration distributions of the most abundant volatile metabolites in exhaled breath determined in two independent studies are reviewed, the first limited study involving five healthy volunteers providing daily breath samples over a month, and the subsequent study involving 30 healthy volunteers providing breath samples weekly over six months. Both studies were carried out using selected ion flow tube mass spectrometry, SIFT-MS, to obtain on-line, real-time analyses of single breath exhalations, avoiding the complications associated with sample collection. The distributions of the metabolites from the larger more comprehensive study are mostly seen to be log normal with the median values (in parts per billion, ppb) being ammonia (833), acetone (477), methanol (461), ethanol (112), propanol (18), acetaldehyde (22), isoprene (106) with the geometric standard deviation being typically 1.6, except for ethanol which was larger (3.24) due to the obvious increase of breath ethanol following the ingestion of sugar. These were the first well-defined concentration distributions of breath metabolites obtained and they are the essential requirement for recognizing abnormally high levels that are associated with particular diseases. The associations of each metabolite with known diseased states are alluded to. These SIFT-MS studies reveal the promise of breath analysis as a valuable addition to the tools for clinical diagnosis and therapeutic monitoring.
A Multicenter Study Involving the Use of a Human Acellular Dermal Regenerative Tissue Matrix for the Treatment of Diabetic Lower Extremity Wounds
This multicenter, retrospective study presents the use of a human acellular dermal regenerative tissue matrix as an alternative treatment for 100 chronic, full-thickness wounds of the lower extremity in 75 diabetic patients. Comorbidities included cardiac disease (86.0%), neuropathy (86.0%), peripheral vascular disease (82.0%), infection (54.0%), obesity (51.0%), and osteomyelitis (37.0%). Wound locations included the foot (86.0%), ankle (8.0%), and lower extremity (6.0%). Mean wound age was 20.4 weeks (1.3-191.4 weeks). University of Texas (UT) wound classifications included 15 (15.0%) 1A, 1 (1.0%) 1B, 1 (1.0%) 1C, 2 (2.0%) 1D, 18 (18.0%) 2A, 8 (8.0%) 2B, 5 (5.0%) 2C, 3 (3.0%) 2D, 3 (3.0%) 3A, 7 (7.0%) 3B, 3 (3.0%) 3C, and 34 (34.0%) 3D. The mean time to matrix incorporation, 100% granulation, and complete healing was 1.5 weeks (0.43-4.4 weeks), 5.1 weeks (0.43-16.7 weeks), and 13.8 weeks (1.7-57.8 weeks), respectively. The overall matrix success rate, as defined by full epithelialization, was 90.0%. One failed wound subsequently healed approximately 7 weeks after matrix reapplication. The healing rate was 91.0%, as 91 of the 100 wounds healed. No statistically significant differences were observed between UT classifications and time to matrix incorporation, 100% granulation, and complete healing. Absence of matrix-related complications and high rates of closure in a wide array of diabetic wounds suggest that this matrix is a viable treatment for complex lower extremity wounds. Lack of any statistically significant differences between UT grades and wound outcome end points lends further support to the universal applicability of this matrix, with successful results in both superficial diabetic wounds and in wounds penetrating to the bone or joint.
Stroke in Relation to Cardiac Procedures in Patients With Non–ST-Elevation Acute Coronary Syndrome: A Study Involving >18 000 Patients
Background—There are few published data on risk factors for stroke in patients with non–ST-elevation acute coronary syndrome (ACS). We investigated prognostic factors for stroke in 2 large cohorts of patients from the Organization to Assess Strategies for Ischemic Syndromes (OASIS) registry (8010) and the OASIS-2 trial (10 141) Methods and Results—A total of 18 151 patients with non–ST-elevation ACS were enrolled in the OASIS program. Data from these 2 studies were pooled (a test for heterogeneity was nonsignificant, P =0.34). Overall, 238 patients (1.3%) had a stroke over a 6-month follow-up. Those who experienced stroke had a 4-fold increase in 6-month mortality (27.0% versus 6.3%, P <0.001). A Cox multivariate regression analysis identified CABG surgery as the most important predictor of stroke (hazard ratio [HR], 4.6), followed by history of stroke (HR, 2.3), diabetes mellitus (HR, 1.7), older age (HR, 1.6 per 10-year increase), higher heart rate (HR, 1.1 per 10-bpm increase), and on-site catheterization facility (HR, 1.4). There was no significant excess in stroke in patients undergoing percutaneous coronary intervention (P =0.21). Patients who underwent early CABG surgery were at a substantially increased risk compared with those who had later CABG (3.3% versus 1.6%; HR, 2.1;P =0.003) or who had no surgery (3.3% versus 1.1%; HR, 3.95;P =0.0001). Conclusions—In this large cohort of patients with ACS, stroke was an uncommon but serious event associated with high mortality. The performance of early CABG surgery was a powerful independent predictor of stroke.
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