Daily FOUR score assessment provides accurate prognosis of long-term outcome in out-of-hospital cardiac arrest.

BACKGROUND: The accurate prediction of outcome after out-of-hospital cardiac arrest (OHCA) is of major importance. The recently described Full Outline of UnResponsiveness (FOUR) is well adapted to mechanically ventilated patients and does not depend on verbal response. OBJECTIVE: To evaluate the ability of FOUR assessed by intensivists to accurately predict outcome in OHCA. METHODS: We prospectively identified patients admitted for OHCA with a Glasgow Coma Scale below 8. Neurological assessment was performed daily. Outcome was evaluated at 6 months using Glasgow-Pittsburgh Cerebral Performance Categories (GP-CPC). RESULTS: Eighty-five patients were included. At 6 months, 19 patients (22%) had a favorable outcome, GP-CPC 1-2, and 66 (78%) had an unfavorable outcome, GP-CPC 3-5. Compared to both brainstem responses at day 3 and evolution of Glasgow Coma Scale, evolution of FOUR score over the three first days was able to predict unfavorable outcome more precisely. Thus, absence of improvement or worsening from day 1 to day 3 of FOUR had 0.88 (0.79-0.97) specificity, 0.71 (0.66-0.76) sensitivity, 0.94 (0.84-1.00) PPV and 0.54 (0.49-0.59) NPV to predict unfavorable outcome. Similarly, the brainstem response of FOUR score at 0 evaluated at day 3 had 0.94 (0.89-0.99) specificity, 0.60 (0.50-0.70) sensitivity, 0.96 (0.92-1.00) PPV and 0.47 (0.37-0.57) NPV to predict unfavorable outcome. CONCLUSION: The absence of improvement or worsening from day 1 to day 3 of FOUR evaluated by intensivists provides an accurate prognosis of poor neurological outcome in OHCA.

Erectile function preservation after radiotherapy using a dose-optimization approach on sexual structures for localized prostate cancer.

PURPOSE: Erectile function preservation is an important quality of life factor in patients treated for prostate cancer. A dose-optimization approach on sexual structures was developed and evaluated to limit erectile dysfunction after radiotherapy. MATERIALS AND METHODS: Twenty-three men with localized prostate cancer and no erectile dysfunction were enrolled in the study. All patients received a prescription dose between 76 and 78Gy. Computed tomography/magnetic resonance image registration was used to delineate the prostatic volume and the sexual structures: internal pudendal arteries (IPA), penile bulb and corpus cavernosum. Erectile function was evaluated using the 5-items International Index of Erectile Function (IIEF-5) score every 6 months during the 2 years after radiotherapy and once a year afterwards. No erectile dysfunction, mild erectile dysfunction and severe erectile dysfunction were defined if the IIEF-5 scores were 20-25, 17-19 and < 17, respectively. RESULTS: The mean follow-up was 4.5 years. The mean age of the patients was 66.3 years. At 2 years, 67% of the patients had no erectile dysfunction, 11% had mild erectile dysfunction and 22% had severe erectile dysfunction. No significant difference was found between the patients with and without erectile dysfunction (IIEF-5≥20 and IIEF-5<20, respectively) for any of the parameters: dosimetric values (internal pudendal arteries, penile bulb, corpus cavernosum), age, comorbidity and smoking status. The biochemical-relapse free survival was 100% at 2 years. CONCLUSION: This approach with dose-optimization on sexual structures for localized prostate cancer found excellent results on erectile function preservation after radiotherapy, with 78% of the patients with no or mild erectile dysfunction at 2 years.

Coma as a complication of total parenteral nutrition. Clinical case.

We report a case of coma occurring during the onset of anabolism and which was concomitant of the perfusion of an aminoacids solution. The neurological problem vanished when we stopped aminoacids perfusion. It is stressed that the perfusion of a non-physiological aminoacids spectrum distribution might lead to metabolic abnormalities resembling hepatic comas.

[Ambulance transportation time of obstetrical patients]. / Duur van ambulancevervoer van verloskundige patiënten.

OBJECTIVE: To examine the time the ambulance needs to transfer women in labour, or immediately after delivery, from home to hospital. DESIGN: Descriptive. SETTING: Amsterdam, the Netherlands. METHOD: Ambulance data from the 'Centrale Post Ambulancevervoer', region Amsterdam, were analysed over a period of one year (1992/1993). RESULTS: Of the 287 women who were transported during labour with urgency code A1 (critical condition) 244 (85%) arrived within 0.5 h in hospital, of 124 who were not in a critical condition (urgency code A2) 66 (53%) (chi 2 = 47.2; p < 0.00001). The average duration for A1 transport of the 51 women who were transferred immediately after delivery, was 32 min. Of those who went by ambulance with urgency code A2 (n = 86) the average duration was 37 min. For A1 transport the ambulance is legally bound to arrive within 15 min. In 7 women (2%) the transport time exceeded 15 min. This was not associated with time of day or distance to hospital. Factors that influenced the duration of ambulance transport included the allocated emergency code, the timing of transport in relation to parturition and the distance between the home and hospital. CONCLUSION: In the municipality of Amsterdam transportation by ambulance of obstetrical patients from home to hospital can in most cases be realised within 0.5 h. The difference in average total time between A1 and A2 transport during labour is only 7 min, but the likelihood of arriving at the hospital within 0.5 h is much greater with A1 than with A2 transport.

Determination of UVA protection factors using the persistent pigment darkening (PPD) as the end point. (Part 1). Calibration of the method.

BACKGROUND/AIMS: The accuracy and reliability of any method to assess the UVA protection effectiveness of sunscreens needs to be demonstrated. The aim of the present study was to calibrate the effectiveness of a biological end point (Persistent Pigment Darkening, PPD) to assess UVA photoprotection, METHODS: Persistent Pigment Darkening was selected as the end point because its action spectrum extends across the UVA. A broad UVA source was chosen to challenge all UVA wavelengths. Attenuation of UVA was performed with neutral density filters (equally absorbing at all wavelengths). Human subjects were tested with a series of UVA beams attenuated by the neutral density filters. The UVA protection effectiveness of a standard sunscreen was also tested with four panels of volunteers to assess the reproducibility of the method. RESULTS: The attenuation factors of the neutral density filters were found to correspond to the UVA protection factors arrived at with PPD as the end point. The repetitive tests showed a good internal consistency of the method. CONCLUSIONS: The calibration procedure proposed shows threshold PPD, used as an end point in a UVA-PF test method, to be a reliable endogenous dosimeter for UVA radiation that enters the skin.

UVA protection efficacy of sunscreens can be determined by the persistent pigment darkening (PPD) method. (Part 2).

BACKGROUND: The UVA-induced Persistent Pigment Darkening (PPD) in vivo has been proposed as an end point for the evaluation of UVA protection. AIMS: This study was designed to determine whether PPD can be used to correctly evaluate the in vivo effectiveness of UVA filters such as oxybenzone, avobenzone, ecamsule and zinc oxide concentrated and together with UVB filters. METHODS: The UVA protection effectiveness of a number of commercial sunscreen products with either SPF 15 or SPF 30 was determined. RESULTS: The UVA protection increased closely with the concentration of the UVA filters and was independent of UVB filters. The PPD method proved sensitive to all UVA filters irrespective of their range of absorbance within the UVA range. CONCLUSION: The results show PPD to be a stable end point inducible by all the UVA wavelengths, not affected by fluence rate, i.e. a reliable endogenous UVA dosimeter in the skin.

Skin colour typology and suntanning pathways.

Synopsis The evaluation of sun-product efficacy, with laboratory solar simulators or in actual sun, implicates clinical and subjective assessment of the various skin responses in terms of wavelengths constitutive of solar light. These photobiological responses vary according to skin types and particularly to basic skin melanic content, i.e. with skin colour. Now, the instrumental measurement of live skin colour has become easier to perform, fast and reliable. Based on the standard CIE-L*a*b* colour system and correlated with the human eye, this technique was used to define the skin colour domain of the caucasian population, to propose a skin colour classification, and then to objectively follow, over a three week period, the dynamics and kinetics of tanning induced by UVB, UVA and UVB +/- A multi-exposures on the three skin categories. The specific directions in the three-dimensional L*a*b* colour space of the tanning components, i.e. erythema, immediate pigmentation and constitutional melanization, as well as the resulting tanning pathways, were analysed and defined in the three-dimensional colour space, using a vectorial method. The UVB, UVA and UVB +/- A tannings were differentiated by their intensity, their hue and especially their lasting capacity: UVA tanning clearly appeared more lasting than UVB. In addition, the UVA*UVB interaction on tanning intensity was not found to be significant. With the skin colour classification and the tanning models, this comprehensive study supplies a basic tool for the colorimetric interpretation of the skin phenomena involved, provided that this interpretation is always considered in the three dimensions of the colour space. It also suggests some useful practical applications for sun product formulation and evaluation.

High-protection sunscreen formulation prevents UVB-induced sunburn cell formation.

A human sunburn cell (SBC) count is used to evaluate the reduction in UV-induced skin damage achieved by a highly protective sunscreen formulation containing 3 filters and reflective pigments (sun protection factor 34). Results indicate that, for the same minimal erythema level, SBC counts do not significantly differ between protected and unprotected skin, showing that the very high efficacy demonstrated against actinic erythema also extends to UV-induced skin damage.

A non-invasive technique for the control of intestinal parasites in rhesus macaques (Macaca mulatta).

Control of intestinal parasites is a major concern in maintaining the health and well-being of captive primates. This study established that percutaneous application of ivermectin was as effective as subcutaneous administration for the control of nematodes in captive rhesus macaques. The method is less intrusive than the standard subcutaneous or oral delivery routes and did not adversely affect the health of any of the study subjects.

Compact diode-pumped passively Q-switched tunable Er-Yb double-clad fiber laser.

Efficient repetitive passive Q switching of a cladding-pumped Er-Yb fiber laser has been demonstrated by use of an external-cavity configuration containing a Co(2+): ZnS crystal as a saturable absorber. Energies of as much as 60muJ in pulses of durations as short as 3.5 ns (FWHM), corresponding to a peak power of >10kW, have been generated, and the maximum slope efficiency with respect to the absorbed pump power was 13%. Using a bulk diffraction grating in the Littrow configuration to provide wavelength-selective feedback, we tuned the passively Q -switched fiber laser over 31 nm from 1532 to 1563 nm. The prospects for further improvement in performance are discussed.

Collaborative development of a sun protection factor test method: a proposed European Standard. COLIPA Task Force 'Sun Protection Measurement', Europe.

Synopsis Standardization of the method to determine sun protection factors (SPF) is fundamental to uniform labelling of SPF values on sun products. The COLIPA Task Force 'Sun Protection Measurement'(SPM), including representatives of major European sun-product manufacturers and contract testing laboratories, was established in 1990 to define methods for sun products testing. The process involved in developing the COLlPA SPF Test Method started with a critical appraisal of previously existing methods, and identification of areas for improvement. Experiments were performed by the participating laboratories to establish the new recommended test protocol which was then confirmed in two multicentred ring tests. Improvements to test methodology included the number and selection of volunteers and skin types, the application of the product, the definition of W output from solar simulators, and the method for assessing erythemal response (MED) including an option to use colorimetry to define objectively the 'erythemal threshold' of skin and to predetermine MED prior to exposure. Four cosmetic formulations and neutral density physical filters (SPF from 4 to 20) were tested in two ring tests. Results showed that variations in SPF of the cosmetic products were, on average, directly proportional to SPF value. An excellent correlation was found between visual and colorimetric SPF assessments (r = 0.99). An acceptable range of values for low and high SPF standard products was also established. The COLIPA SPF test method is now fully defined and supported by experimental data. Its use will harmonize SPF testing throughout Europe and help in the quest for global harmonization in testing sun products.