Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statement.

Cardiac arrest (CA) is associated with a low rate of survival with favourable neurologic recovery. The most common mechanism of death after successful resuscitation from CA is withdrawal of life-sustaining measures on the basis of perceived poor neurologic prognosis due to underlying hypoxic-ischemic brain injury. Neuroprognostication is an important component of the care pathway for CA patients admitted to hospital but is complex, challenging, and often guided by limited evidence. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to evaluate the evidence underlying factors or diagnostic modalities available to determine prognosis, recommendations were generated in the following domains: (1) circumstances immediately after CA; (2) focused neurologic exam; (3) myoclonus and seizures; (4) serum biomarkers; (5) neuroimaging; (6) neurophysiologic testing; and (7) multimodal neuroprognostication. This position statement aims to serve as a practical guide to enhance in-hospital care of CA patients and emphasizes the adoption of a systematic, multimodal approach to neuroprognostication. It also highlights evidence gaps.

The Native Bees of Texas: Evaluating the Benefits of a Public Engagement Course.

Declines in native bee communities due to forces of global change have become an increasing public concern. Despite this heightened interest, there are few publicly available courses on native bees, and little understanding of how participants might benefit from such courses. In October of 2018 and 2019, we taught the 'Native Bees of Texas' course to the public at The University of Texas at Austin Lady Bird Johnson Wildflower Center botanical gardens in an active learning environment with slide-based presentations, printed photo-illustrated resources, and direct insect observations. In this study, we evaluated course efficacy and learning outcomes with a pre/post-course test, a survey, and open-ended feedback, focused on quality improvement findings. Overall, participants' test scores increased significantly, from 60% to 87% correct answers in 2018 and from 64% to 87% in 2019, with greater post-course differences in ecological knowledge than in identification skills. Post-course, the mean of participants' bee knowledge self-ratings was 4.56 on a five-point scale. The mean of participants' ratings of the degree to which they attained the course learning objectives was 4.43 on a five-point scale. Assessment results provided evidence that the course enriched participants' knowledge of native bee ecology and conservation and gave participants a basic foundation in bee identification. This highlights the utility of systematic course evaluations in public engagement efforts related to biodiversity conservation.

Just the facts: Hypertonic saline is just as good as (and probably better than) mannitol.

A 27-year-old female is brought to the emergency department (ED) by ambulance following a motor vehicle collision at highway speed. She was the belted driver. She has no significant past medical history and is on no medications. Following a prolonged extrication, she is intubated due to decreased level of consciousness before transport.

Comparison of the king vision video laryngoscope with the macintosh laryngoscope.

BACKGROUND: Endotracheal intubation is a common procedure in the emergency department, and new devices may improve intubation time, success, or view. OBJECTIVE: We compared the King Vision video laryngoscope (KVVL; King Systems, Noblesville, IN) to the Macintosh direct laryngoscope (DL) in simulated normal and difficult airways. METHODS: Using manikins and clinical-grade cadavers, difficult airway scenarios were simulated using head movement restriction or a cervical spine collar. Four scenarios were studied using the KVVL and DL: normal manikin airway, difficult manikin airway, normal cadaver airway, and difficult cadaver airway. Primary outcomes were time to intubation and rate of successful intubation. Secondary outcomes were the percent of glottic opening and Cormack-Lehane grade visualized. RESULTS: Thirty-two paramedics participated in the study. In the normal manikin airway scenario, time to intubation was 3.4 s (99% confidence interval [CI] 0.1-6.6) faster with the KVVL compared with DL. Time to intubation was 11.3 s (99% CI 2.4-20.2) faster with the KVVL in the difficult cadaver airway scenario. There was no difference in time to intubation in the other 2 scenarios. In the difficult cadaver airway, 10 of 32 participants failed to successfully intubate the trachea using DL, whereas all KVVL intubations were successful. All scenarios found a lower Cormack-Lehane grade and higher percentage of glottic opening with the KVVL compared to DL. CONCLUSION: The KVVL was slightly faster than Macintosh DL in two of four studied airway scenarios, and had a higher success rate in the difficult cadaver airway scenario. Further study is required in the clinical setting.

A case of commotio cordis treated with therapeutic hypothermia.

BACKGROUND: Therapeutic hypothermia is used as a neuroprotective strategy for patients who have persistent neurologic compromise after return of spontaneous circulation from cardiac arrest. The 2010 American Heart Association Guidelines recommend the use of therapeutic hypothermia in adult cardiac arrest patients when the initial rhythm is ventricular fibrillation. These recommendations are based on primary research in patients with a cardiac cause of their ventricular fibrillation. CASE REPORT: A 43-year-old male was brought to our emergency department (ED) with commotio cordis. He was struck in the chest with a baseball bat, after which he collapsed at the scene and was pulseless. Return of spontaneous circulation was achieved after defibrillation by treating paramedics, and the patient remained comatose on arrival to the ED. He was transferred to the intensive care unit and treated with therapeutic hypothermia at target temperature of 32-34°C. He was extubated on day 3, and discharged home on day 8 with good neurologic function. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We report a case of commotio cordis in which the adult patient was treated with therapeutic hypothermia and had a favorable outcome. To our knowledge, this is the first reported case of its kind. Evidence for the use of therapeutic hypothermia is incomplete in patients with a traumatic cause of cardiac arrest, such as commotio cordis, despite probable similarities in the pathophysiology of anoxic brain injury. Our case illustrates that there may be benefit from use of therapeutic hypothermia for a broader population than is currently recommended.

Folate and vitamin B12 in idiopathic male infertility.

Although methylenetetrahydrofolate reductase, a folate enzyme gene, has been associated with idiopathic male infertility, few studies have examined other folate-related metabolites and genes. We investigated whether idiopathic male infertility is associated with variants in folate, vitamin B(12) (B12) and total homocysteine (tHcy)-related genes and measured these metabolites in blood. We conducted a case-control study that included 153 men with idiopathic infertility and 184 fertile male controls recruited at the Fertility Center and Antenatal Care Center, University Hospital, Malmö and Lund, Sweden. Serum folate, red cell folate (RCF), serum B12, plasma tHcy and semen quality were measured. Subjects were genotyped for 20 common variants in 12 genes related to folate/B12/homocysteine metabolism. Metabolite concentrations and genotype distributions were compared between cases and controls using linear and logistic regression with adjustment for covariates. The phosphatidylethanolamine N-methyltransferase (PEMT) M175V and TCblR rs173665 polymorphisms were significantly associated with infertility (P=0.01 and P=0.009, respectively), but not with semen quality. Among non-users of supplements, infertile men had lower serum folate concentrations than fertile men (12.89 vs. 14.73 nmol l(-1); P=0.02), but there were no significant differences in RCF, B12 or tHcy. Folate, B12 and tHcy concentrations were not correlated with any semen parameters. This study provides little support for low folate or B12 status in the pathogenesis of idiopathic male infertility. Although additional data are needed to confirm these initial findings, our results suggest that PEMT and TCblR, genes involved in choline and B12 metabolism, merit further investigation in idiopathic male infertility.

Maternal serum preconception polychlorinated biphenyl concentrations and infant birth weight.

BACKGROUND: Prenatal and postnatal polychlorinated biphenyl (PCBs) exposure has been associated with decrements in fetal and infant growth and development, although exposures during the preconception window have not been examined despite recent evidence suggesting that this window may correspond with the highest serum concentrations. OBJECTIVES: We assessed maternal serum PCB concentrations at two sensitive developmental windows in relation to birth weight. METHODS: Serum samples were collected from 99 women as they began trying to become pregnant (preconception) and after a positive pregnancy test (prenatal); 52 (53%) women gave birth and represent the study cohort. Using daily diaries, women recorded sexual intercourse, menstruation, and home pregnancy test results until pregnant or up to 12 menstrual cycles with intercourse during the estimated fertile window. With gas chromatography with electron capture, 76 PCB congeners were quantified (nanograms per gram serum) and subsequently categorized by purported biologic activity. Serum PCBs were log-transformed and entered both as continuous and categorized exposures along with birth weight (grams) and covariates [smoking (yes/no), height (inches), and infant sex (male/female)] into linear regression. RESULTS: A substantial reduction in birth weight (grams) was observed for women in the highest versus the lowest tertile of preconception antiestrogenic PCB concentration (beta; = 429.3 g, p = 0.038) even after adjusting for covariates (beta; = 470.8, p = 0.04). CONCLUSIONS: These data reflect the potential developmental toxicity of antiestrogenic PCBs, particularly during the sensitive preconception critical window among women with environmentally relevant chemical exposures, and underscore the importance of PCB congener-specific investigation.

Fluorescence-based comparative binding studies of the supramolecular host properties of PAMAM dendrimers using anilinonaphthalene sulfonates: unusual host-dependent fluorescence titration behavior.

This work describes the fluorescence enhancement of the anilinonaphthalene sulfonate probes 1,8-ANS, 2,6-ANS, and 2,6-TNS via complexation with PAMAM dendrimer hosts of Generation 4, 5 and 6. The use of this set of three very closely related probes allows for comparative binding studies, with specific pairs of probes differing only in shape (1,8-ANS and 2,6-ANS), or in the presence of a methyl substituent (2,6-TNS vs. 2,6-ANS). The fluorescence of all three probes was significantly enhanced upon binding with PAMAM dendrimers, however in all cases except one, a very unusual spike was consistently observed in the host fluorescence titration plots (fluorescence enhancement vs. host concentration) at low dendrimer concentration. This unprecedented fluorescence titration curve shape makes fitting the data to a simple model such as 1:1 or 2:1 host: guest complexation very difficult; thus only qualitative comparisons of the relative binding of the three guests could be made based on host titrations. In the case of G4 and G5 dendrimers, the order of binding strength was qualitatively determined to be 1,8-ANS<2,6-ANS indicating that the more streamlined 2,6-substituted probes are a better match for the dendrimer cavity shape than the bulkier 1,8-substituted probe. This order of binding strength was also indicated by double fluorometric titration experiments, involving both host and guest titrations. Further double fluorometric titration experiments on 2,6-ANS in G4 dendrimer revealed a host concentration-dependent change in the nature of the host: guest complexation, with multiple guests complexed per host molecule at very low host concentrations, but less than one guest per host at higher concentrations.

Friends, porn, and punk: sensation seeking in personal relationships, internet activities, and music preference among college students.

One hundred thirty-eight college students completed a questionnaire assessing level of sensation seeking, number of close and casual friends, Internet usage, liking certain styles of music, and genre of music listened to most often. It was found that the number of casual and close friends was positively associated with sensation seeking. Individuals who reported using the Internet to get sex-oriented material, download or play music, play games, and chat/instant message with friends in the previous 24 hours had higher levels of sensation seeking. Liking punk, heavy metal, and reggae music were related to higher levels of sensation seeking. Higher sensation seeking was also associated with spending more time listening to punk music.