Early ICD implantation following out-of-hospital cardiac arrest: a retrospective cohort study from the Swedish Registry for Cardiopulmonary Resuscitation

BACKGROUND

It is unclear whether an implantable cardioverter-defibrillator (ICD) is generally beneficial in survivors of out-of-hospital cardiac arrest (OHCA).

OBJECTIVE

We studied the association between ICD implantation prior to discharge and survival in patients with cardiac aetiology or initial shockable rhythm in OHCA.

DESIGN

We conducted a retrospective cohort study in the Swedish Registry for Cardiopulmonary Resuscitation. Treatment associations were estimated using propensity scores. We used gradient boosting, Bayesian additive regression trees, neural networks, extreme gradient boosting and logistic regression to generate multiple propensity scores. We selected the model yielding maximum covariate balance to obtain weights, which were used in a Cox regression to calculate HRs for death or recurrent cardiac arrest.

PARTICIPANTS

All cases discharged alive during 2010 to 2020 with a cardiac aetiology or initial shockable rhythm were included. A total of 959 individuals were discharged with an ICD, and 2046 were discharged without one.

RESULTS

Among those experiencing events, 25% did so within 90 days in the ICD group, compared with 52% in the other group. All HRs favoured ICD implantation. The overall HR (95% CI) for ICD versus no ICD was 0.38 (0.26 to 0.56). The HR was 0.42 (0.28 to 0.63) in cases with initial shockable rhythm; 0.18 (0.06 to 0.58) in non-shockable rhythm; 0.32 (0.20 to 0.53) in cases with a history of coronary artery disease; 0.36 (0.22 to 0.61) in heart failure and 0.30 (0.13 to 0.69) in those with diabetes. Similar associations were noted in all subgroups.

CONCLUSION

Among survivors of OHCA, those discharged with an ICD had approximately 60% lower risk of death or recurrent cardiac arrest. A randomised trial is warranted to study this further.

Extracting Mutual Interaction Rules Using Fuzzy Structured Agent-based Model of Tumor-Immune System Interactions

Background:

There are many studies to investigate the effects of each interacting component of tumor-immune system interactions. In all these studies, the distinct effect of each component was investigated. As the interaction of tumor-immune system has feedback and is complex, the alternation of each component may affect other components indirectly.

Objective:

Because of the complexities of tumor-immune system interactions, it is important to determine the mutual behavior of such components. We need a careful observation to extract these mutual interactions. Achieving these observations using experiments is costly and time-consuming.

Material and Methods:

In this experimental and based on mathematical modeling study, to achieve these observations, we presented a fuzzy structured agent-based model of tumor-immune system interactions. In this study, we consider the confronting of the effector cells of the adaptive immune system in the presence of the cytokines of interleukin-2 (IL-2) and transforming growth factor-beta (TGF-β) as a fuzzy structured model. Using the experimental data of murine models of B16F10 cell line of melanoma cancer cells, we optimized the parameters of the model.

Results:

Using the output of this model, we determined the rules which could occur. As we optimized the parameters of the model using escape state of the tumor and then the rules which we obtained, are the rules of tumor escape.

Conclusion:

The results showed that using fuzzy structured agent-based model, we are able to show different output of the tumor-immune system interactions, which are caused by the stochastic behavior of each cell. But different output of the model just follow the predetermined behavior, and using this behavior, we can achieve the rules of interactions.

Determining Changes in Electromyography Indices when Measuring Maximum Acceptable Weight of Lift in Iranian Male Students

BACKGROUND

In spite of the increasing degree of automation in industry, manual material handling (MMH) is still performed in many occupational settings. The aim of the current study was to determine the maximum acceptable weight of lift using psychophysical and electromyography indices.

METHODS

This experimental study was conducted among 15 male students recruited from Tehran University of Medical Sciences. Each participant performed 18 different lifting tasks which involved three lifting frequencies, three lifting heights and two box sizes. Each set of experiments was conducted during the 20 min work period using free-style lifting technique and subjective as well as objective assessment methodologies. SPSS version 18 software was used for descriptive and analytical analyses by Friedman, Wilcoxon and Spearman correlation techniques.

RESULTS

The results demonstrated that muscle activity increased with increasing frequency, height of lift and box size (P<0.05). Meanwhile, MAWLs obtained in this study are lower than those in Snook table (P<0.05). In this study, the level of muscle activity in percent MVC in relation to the erector spine muscles in L3 and T9 regions as well as left and right abdominal external oblique muscles were at 38.89%, 27.78%, 11.11% and 5.55% in terms of muscle activity is more than 70% MVC, respectively. The results of Wilcoxon test revealed that for both small and large boxes under all conditions, significant differences were detected between the beginning and end of the test values for MPF of erector spine in L3 and T9 regions, and left and right abdominal external oblique muscles (P<0.05). The results of Spearman correlation test showed that there was a significant relation between the MAWL, RMS and MPF of the muscles in all test conditions (P<0.05).

CONCLUSION

Based on the results of this study, it was concluded if muscle activity is more than 70% of MVC, the values of Snook tables should be revisited. Furthermore, the biomechanical perspective should receive special attention in determining the standards for MMH.