Base excess and lactate as prognostic indicators for patients treated by extra corporeal life support after out hospital cardiac arrest due to acute coronary syndrome

OBJECTIVE

To examine whether values of arterial base excess or lactate taken 3 h after starting ECLS indicate poor prognosis and if this can be used as a screening tool to follow Extra Corporeal Life Support after Out Hospital Cardiac Arrest due to acute coronary syndrome.

DESIGN

Single Centre retrospective observational study.

SETTING

University teaching hospital general adult intensive care unit.

PATIENTS

15 consecutive patients admitted to the intensive care unit after refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support.

INTERVENTIONS

Arterial base excess and lactate concentrations were measured immediately after starting ECLS and every 3 h after.

RESULTS

Both base excess and arterial lactate measured 3 h after starting ECLS effectively predict multi-organ failure occurrence and mortality in the following 21 h (area under the curve on receiver operating characteristic analysis of 0.97, 0.95 respectively). The best predictive values were obtained with a base excess level measured 3 h after starting ECLS of less than -10 mmol/l and lactate concentrations greater than 12 mmol/l. The combination of these two markers measured 3 h after starting ECLS predicted multiorgan failure occurrence and mortality in the following 21 h with a sensitivity of 70% and a specificity of 100%.

CONCLUSIONS

Combination of base excess and lactate, measured 3 h after starting ECLS, can be used to predict multiorgan failure occurrence and mortality in the following 21 h in patients admitted to an intensive care unit for refractory Out Hospital Cardiac Arrest due to acute coronary syndrome treated by Extra Corporeal Life Support. These parameters can be obtained simply and rapidly and help in the decision process to continue ECLS for refractory CA.

Extracting grain-orientation-dependent data fromin situtime-of-flight neutron diffraction. I. Inverse pole figures

The problem of calculating the inverse pole figure (IPF) is analyzed from the perspective of the application of time-of flight neutron diffraction toin situmonitoring of the thermomechanical behavior of engineering materials. On the basis of a quasi-Monte Carlo (QMC) method, a consistent set of grain orientations is generated and used to compute the weighting factors for IPF normalization. The weighting factors are instrument dependent and were calculated for the engineering materials diffractometer VULCAN (Spallation Neutron Source, Oak Ridge National Laboratory). The QMC method is applied to face-centered cubic structures and can be easily extended to other crystallographic symmetries. Examples include 316LN stainless steelin situloaded in tension at room temperature and an Al–2%Mg alloy, substantially deformed by cold rolling andin situannealed up to 653 K.

Design and implementation of a multiaxial loading capability during heating on an engineering neutron diffractometer

A gripping capability was designed, implemented, and tested for in situ neutron diffraction measurements during multiaxial loading and heating on the VULCAN engineering materials diffractometer at the spallation neutron source at Oak Ridge National Laboratory. The proposed capability allowed for the acquisition of neutron spectra during tension, compression, torsion, and/or complex loading paths at elevated temperatures. The design consisted of age-hardened, Inconel(®) 718 grips with direct attachment to the existing MTS load frame having axial and torsional capacities of 100 kN and 400 N·m, respectively. Internal cooling passages were incorporated into the gripping system for fast cooling rates during high temperature experiments up to ∼1000 K. The specimen mounting couplers combined a threaded and hexed end-connection for ease of sample installation/removal without introducing any unwanted loads. Instrumentation of this capability is documented in this work along with various performance parameters. The gripping system was utilized to investigate deformation in NiTi shape memory alloys under various loading/control modes (e.g., isothermal, isobaric, and cyclic), and preliminary results are presented. The measurements facilitated the quantification of the texture, internal strain, and phase fraction evolution in NiTi shape memory alloys under various loading/control modes.

Competitive Interactions between Immature Stages of Bactrocera cucurbitae (Coquillett) and Bactrocera tau (Walker) (Diptera: Tephritidae) under Laboratory Conditions

The melon fly, Bactrocera cucurbitae (Coquillett), and the pumpkin fly, Bactrocera tau (Walker), are economically important pests that attack mainly cucurbitacean fruits. The two fruit fly species have similar natural distributions, host ranges, and population growth capacities. This study was designed to assess the asymmetrical competitions through resource exploitation between the larvae of B. cucurbitae and B. tau at different density levels and temperatures, and on different hosts by comparing the relative effects of interspecific and intraspecific interactions on four life history parameters: survival rate, puparial mass, puparial duration, and developmental duration. Our results showed that intraspecific and interspecific competitions occurred under some laboratory conditions, and B. cucurbitae took advantage over B. tau at the high-density level and at low and high temperatures on pumpkin, bitter gourd, and bottle gourd when interspecific competition took place. Intraspecific and interspecific competitions mainly affected the puparial mass and the survival rate of the two fruit fly species but had no marked effect on the puparial duration or development duration.

Spinal protein kinase Mζ contributes to the maintenance of peripheral inflammation-primed persistent nociceptive sensitization after plantar incision

BACKGROUND

Previous studies suggest that persistent post-surgical pain (PPSP) is correlated with preoperative pain status and amplification of central sensitization. Protein kinase Mζ (PKMζ) is an essential substrate of the late long-term potentiation underlying central sensitization, which is one mechanism of pain memory formation. However, the potential contributions of spinal PKMζ to PPSP, a condition in which preoperative pain is prevalent, are not known.

METHODS

Here, a modified 'hyperalgesia priming' model was established to simulate the clinical situation. This model used intraplantar injections of carrageenan (Car) as priming stimuli to elicit persistent nociceptive sensitization after plantar incision in rats. Upon treatment with PKMζ inhibitor ZIP, Scr-ZIP or protein kinase Cs (PKCs) inhibitor NPC-15437, altered behaviour and spinal PKMζ/PKCs expression were observed.

RESULTS

A long-lasting hypersensitivity induced by Car-priming was identified and precipitated by subsequent plantar incision in this 'two-hit' paradigm. Post-treatment with ZIP, but not Scr-ZIP and NPC-15437, after the resolution of Car-priming selectively relieved hypersensitivity. In contrast, pre-priming NPC-15437 treatment only prevented Car-induced initial transient hyperalgesia. Immunoassays showed a significant decrease in spinal PKMζ expression after plantar incision with post-priming ZIP treatment as compared with Scr-ZIP and NPC-15437, but no notable differences in PKCs expression were observed.

CONCLUSIONS

Spinal PKCs solely contribute to the initial induction of persistent pain, whereas PKMζ plays an essential role in spinal plasticity storage. PKMζ is responsible for the maintenance of peripheral inflammation-primed PPSP. Therefore, spinal PKMζ may be a therapeutic target to prevent surgery-induced chronic pain in patients with preoperative pain.

Effects of zinc on interleukins and antioxidant enzyme values in psoriasis-induced mice

The effects of zinc chloride (ZnCl2), disodium zinc ethylenediamine tetraacetate (Zn-EDTA), and zinc gluconate (Zn-GLU) on the antioxidant enzyme activities and levels of interleukins (ILs) in psoriasis-induced mice were studied. One hundred twenty female mice were randomly divided into six groups with 20 mice in each group: the control, positive control (PC), methotrexate (MTX), ZnCl2, Zn-EDTA, and Zn-GLU groups. All animals except the control group were given diethylstilbestrol for three consecutive days. After successfully inducing psoriasis, the control and PC groups were given normal saline (i.g.) daily while the remaining groups were given MTX, ZnCl2, Zn-EDTA, and Zn-GLU, respectively. The results revealed that the zinc supplementation could significantly (p < 0.05) inhibit mitosis in the mouse vaginal epithelium as methotrexate did and the inhibiting efficacy had nothing to do with the zinc forms. After ZnCl2, Zn-EDTA, and Zn-GLU supplementation, the levels of liver superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) activities increased and the concentration of malondialdehyde (MDA) decreased significantly (p < 0.05) compared to the PC group. The levels of SOD, CAT activity, and MDA level between each zinc supplementation group and MTX group were insignificant (p > 0.05). The zinc treatments also caused a significant (p < 0.05) decrease in the raised IL-2 level of animal serum. The results obtained in the present work indicate the potential for zinc as a complementary pharmaceutical intervention for the treatment of topical psoriasis.

Spectrum of the cavity-QED microlaser: strong coupling effects in the frequency pulling at off resonance

We report the first experimental observation of the cavity-QED microlaser spectrum, specifically the unconventional frequency pulling brought by a strong atom-cavity coupling at off resonance. The pulling is enhanced quadratically by the atom-cavity coupling to result in a sensitive response to the number of pumping atoms (2.1 kHz per atom maximally). Periodic variation of the pulling due to the coherent Rabi oscillation is also observed as the number of pumping atoms is increased across multiple thresholds.

Strain incompatibility and residual strains in ferroelectric single crystals

Residual strains in ferroelectrics are known to adversely affect the material properties by aggravating crack growth and fatigue degradation. The primary cause for residual strains is strain incompatibility between different microstructural entities. For example, it was shown in polycrystalline ferroelectrics that residual strains are caused due to incompatibility between the electric-field-induced strains in grains with different crystallographic orientations. However, similar characterization of cause-effect in multidomain ferroelectric single crystals is lacking. In this article, we report on the development of plastic residual strains in [111]-oriented domain engineered BaTiO(3) single crystals. These internal strains are created due to strain incompatibility across 90° domain walls between the differently oriented domains. The average residual strains over a large crystal volume measured by in situ neutron diffraction is comparable to previous X-ray measurements of localized strains near domain boundaries, but are an order of magnitude lower than electric-field-induced residual strains in polycrystalline ferroelectrics.

Polarized neutron diffraction at a spallation source for magnetic studies

The availability of high-power spallation neutron sources, along with advances in the development of coupled moderators and neutron polarizers, has made it possible to use polarized neutrons on time-of-flight diffractometers forin situstudies of phenomena contributing to field-induced magnetization of a material. Different electronic and structural phenomena that contribute to the overall magnetization of a material can be studied and clearly identified with polarized neutron diffraction measurements. This article reports the first results from polarized neutron diffraction experiments on a time-of-flight instrument at a spallation source. Magnetic field-induced rotation of electron spins in an Ni–Mn–Ga single crystal was measured with polarized neutron diffraction at the MAGICS reflectometer at the Spallation Neutron Source at Oak Ridge National Laboratory. The difference in intensities measured with spin-up and spin-down polarized neutrons is proportional to the field-induced magnetization of the crystal. The polarized neutron measurements indicate that the magnetic form factor for the 3delectrons of Mn in Ni–Mn–Ga is lower than the value reported earlier for an ideal spherical symmetry of electronic distribution. Future experiments for studying field-induced magnetization in materials following the current methodology are outlined.

Prescribed nondegenerate high-order modes in an axial-asymmetric high-finesse Fabry-Perot microcavity

We report an axial-asymmetric high-Q Fabry-Perot cavity supporting nondegenerate Hermite-Gaussian modes of the same mode order. Axial asymmetry of mirror surface was introduced by mechanically grinding off one side of a cylindrical mirror substrate without degrading the original mirror quality. The bases of the resulting Hermite-Gaussian modes were aligned with respect to the direction of grinding, making it possible to prescribe the mirror principal axes.

Sign reversal of field-angle resolved heat capacity oscillations in a heavy Fermion superconductor CeCoIn5 and d{x{2}-y{2}} pairing symmetry

To identify the superconducting gap symmetry in CeCoIn5 (T{c}=2.3 K), we measured the angle-resolved specific heat (C{phi}) in a field rotated around the c axis down to a very low temperature, 0.05T{c}, and made detailed theoretical calculations. In a field of 1 T, a sign reversal of the fourfold angular oscillation in C{phi} was observed at T approximately 0.1T{c} upon entering a quasiclassical regime where the maximum of C{phi} corresponds to the antinodal direction, coinciding with the angle-resolved density of states (ADOS) calculation. The C{phi} behavior, which exhibits minima along the [110] directions, unambiguously allows us to conclude d{x{2}-y{2}} symmetry of this system. The ADOS-quasiclassical region is confined to a narrow T and H domain within T/T{c} approximately 0.1 and 1.5 T (0.13H{c2}).

[Epidemiology of SARS: mission of the emergency medical department of the French Hospital of Hanoi]

During the epidemic of severe acute respiratory syndrome (SARS) that occurred in Vietnam in March 2003, the French Ministries of Health and Foreign Affairs dispatched a mission composed of personnel from the emergency medical assistance department (French acronym, SAMU) and one virologist from the Pasteur Institute to the French hospital in Hanoi. The purpose of this mission was to reinforce the local medical staff, to bring medical equipment, and to assist in identifying the cause of the SARS epidemic. Most of the 39 cases observed involved health care personnel working at the hospital. Six including 5 who died presented severe manifestations. Application of strict empirical measures of isolation, hygiene, and personal protection allowed containment of the SARS outbreak in Hanoi.

Cavity-damping-induced transitions in a driven atom- cavity system

We investigate the fluorescence spectrum of a two-level atom in a cavity when the atom is driven by a classical field. We show that forbidden dipole transitions in the Jaynes-Cummings ladder structure are induced in the presence of cavity damping, which deteriorates the degree of otherwise perfect destructive interference among the transition channels. With the larger cavity decay, these transitions are more enhanced.

Mechanisms of female urinary continence under stress: frequency spectrum analysis

Intravesical and urethral pressure signals during cough and Valsalva maneuvers for 15 continent women were analyzed with frequency spectrum analysis. Clear modulation of the urethral pressure changes by the intravesical pressure rise during stress maneuvers was demonstrated in the frequency bands of 14 and 7 Hz for cough and Valsalva, respectively. The linearity between the urethral and intravesical pressure signals was strong for cough, but relatively weaker for Valsalva. The observed linearity lead to the formulation of a modified continence equation to mathematically quantify stress leak point pressure (sLPP): sLPP=MUCP/(1-alpha1)+RBP. This algebraic equation demonstrated that sLPP depends on pressure transmission, resting bladder pressure, and maximum urethral closure pressure. The equation was validated with excellent theoretical predictions for the 15 continent subjects (R(2)=0.98 and 0.97 for cough and Valsalva leak point pressure, respectively) and good but somewhat weaker predictions for 46 stress incontinent women (R(2)=0.79 and 0.48, respectively). It has been shown that pressure transmission plays the most important role in female continence function, while it may be attributable to passive structural origin as evidenced by the minimal time delay between the two pressure signals, in the order of a few milliseconds. It can be concluded that coughing seems to have a more mechanical, rather than neuromuscular basis for its signal dynamics. This study suggests that a complete assessment of female stress continence function requires comprehensive urodynamic information in terms of pressure transmission, maximum urethral closure pressure, and resting bladder pressure.

Training-related changes in the maximal rate of torque development and EMG activity

This study monitored the effects of a short-term elbow flexor training program on surface electromyographic (SEMG) spike activity. The experimental paradigm consisted of three test sessions separated by 2-week intervals. At the beginning of each session, participants (N=13) performed five maximal effort isometric contractions of the elbow flexors to serve as baseline. After 5 min of rest, the participants then engaged in a 30-trial isometric fatigue protocol during which maximal elbow flexion torque was measured with a load-cell, and the maximal rate of change in the torque (dtau/dt(max)) was obtained from the differentiated torque-time curve. Bipolar electrodes were used to monitor the SEMG spike activity of the biceps brachii. Mean spike amplitude (MSA) and mean spike frequency (MSF) were calculated for the torque development and constant-torque phases of the isometric contraction, termed Segment 1 and Segment 2, respectively. Mean power frequency (MPF) was also calculated for Segment 2. The five baseline contractions of the second and third sessions were compared with those of the first session and analyzed for training-related changes. Training increased dtau/dt(max) but failed to change maximal elbow flexion torque or MSA. However, there was an increase in the MSF during the torque development phase of the contraction (Segment 1). Both MSA and MSF were greatest during the constant-torque phase of the isometric contraction (Segment 2). There was a strong linear correlation (r=0.90, P<0.05) between MSF and MPF during (Segment 2). We hypothesize that the increase in dtau/dt(max) is due to enhanced motor-unit rate-coding. The demonstrated correlation between MSF and MPF measures will allow investigators to use spike analysis to examine the frequency content of the SEMG signal under non-stationary conditions.

CeReS-18, a cell regulatory sialoglycopeptide, inhibits proliferation and migration of rat vascular smooth muscle cells

CeReS-18, a cell regulatory sialoglycopeptide, has been shown to inhibit proliferation of a wide array of target cells. In the present study, the effect of CeReS-18 on vascular smooth muscle cell (SMC) proliferation was characterized in cultured rat aorta SMCs (A7r5). More extensively, the effect of CeReS-18 on platelet-derived growth factor (PDGF)-induced SMC migration was examined using a modified Boyden's chamber assay. CeReS-18 inhibits both SMC proliferation and migration in a concentration-dependent, calcium-sensitive, and reversible manner. Furthermore, cells preincubated with the inhibitor had an increased sensitivity to CeReS-18-mediated inhibition of SMC migration. Immunoprecipitation and in vitro phosphorylation assays demonstrated that MAP kinase activity was inhibited in the CeReS-18-treated cells and pretreatment with CeReS-18 suppressed the activation of MAP kinase stimulated by PDGF. However, it is not likely that the suppression of the MAP kinase pathway was directly responsible for the ability of CeReS-18 to inhibit migration of the rat aorta smooth muscle cells since a MEK-specific inhibitor, PD98059, did not influence A7r5 cell migration.

Cylindrical microcavity laser based on the evanescent-wave-coupled gain

A microcavity laser based on the gain only in the evanescent field region of whispering gallery modes has been demonstrated. A cylindrical microcavity of 125 microm diam was surrounded by rhodamine 6G dye molecules in an ethanol solution of lower refractive index such that whispering gallery modes of the microcavity underwent laser oscillation when the dye molecules in the evanescent field region outside the cavity were excited by a second harmonic of a Nd:YAG laser. For particular pumping spots, single-mode laser oscillation of a transverse magnetic mode was observed at about 600 nm with associated cavity Q of 3x10(7).