CRIMINOLOGY, Issue 2 2008
DEBORAH M. CAPALDI
Female romantic partners' influence on official crime occurrence for men across a 12-year period in early adulthood was examined within a comprehensive dynamic prediction model, including both social learning and social control predictors. We hypothesized that relationship stability, rather than attachment to partner, would be associated with reduced likelihood of crime, whereas women's antisocial behavior would be a risk factor, along with deviant peer association. Models were tested on a sample of at-risk men [the Oregon Youth Study (OYS)] using zero-inflated Poisson (ZIP) modeling predicting 1) arrest persistence (class and count) and 2) arrest onset class. The findings indicated that women's antisocial behavior was predictive of both onset and persistence of arrests for men and that deviant peer association was predictive of persistence. Relationship stability was protective against persistence. [source]

SUCCESSFUL REPAIR OF AORTOBRONCHIAL FISTULA USING CIRCULATORY ARREST

ANZ JOURNAL OF SURGERY, Issue 5 2007
Ritwick R. Bhuyan MS
No abstract is available for this article. [source]

THE NARROWING GENDER GAP IN ARRESTS: ASSESSING COMPETING EXPLANATIONS USING SELF-REPORT, TRAFFIC FATALITY, AND OFFICIAL DATA ON DRUNK DRIVING, 1980,2004,

CRIMINOLOGY, Issue 3 2008
JENNIFER SCHWARTZ
We evaluate two alternative explanations for the converging gender gap in arrest,changes in women's behavior versus changes in mechanisms of social control. Using the offense of drunk driving and three methodologically diverse data sets, we explore trends in the DUI gender gap. We probe for change across various age groups and across measures tapping DUI prevalence and chronicity. Augmented Dickey-Fuller time-series techniques are used to assess changes in the gender gap and levels of drunk driving from 1980 to 2004. Analyses show women of all ages making arrest gains on men,a converging gender gap. In contrast, self-report and traffic data indicate little or no systematic change in the DUI gender gap. Findings support the conclusion that mechanisms of social control have shifted to target female offending patterns disproportionately. Little support exists for the contention that increased strain and liberalized gender roles have altered the gender gap or female drunk-driving patterns. [source]

MENTAL HEALTH AND JUVENILE ARRESTS: CRIMINALITY, CRIMINALIZATION, OR COMPASSION?,

CRIMINOLOGY, Issue 3 2006
PAUL HIRSCHFIELD
Juveniles in secure confinement allegedly suffer from more mental health problems than their peers. This may reflect background and behavioral characteristics commonly found in clients of both mental health and juvenile justice systems. Another explanation is that mental disorders increase the risk of arrest. These interpretations were tested on a sample of Pittsburgh boys (n = 736). Findings indicate that arrested youth exhibit more attention deficit hyperactivity (ADH) problems, oppositional defiant (OD) problems, and nondelinquent externalizing symptoms prior to their first arrests compared to their never-arrested peers. However, arrested and nonarrested youth score similarly on prior affective and anxiety problems and internalizing symptoms. Net of delinquency, substance use, and other selection factors, internalizing problems lower the risk of subsequent arrest, whereas OD problems and nondelinquent externalizing symptoms increase it. ADH problems have no effect on arrest net of delinquency and substance use. These findings lend only partial support to the criminalization hypothesis. Whereas some mental health symptoms increase the risk of arrest, others elicit more cautious or compassionate official responses. [source]

Mediastinal Lymphoma Presenting as Asystolic Arrest

ECHOCARDIOGRAPHY, Issue 3 2004
Amgad N. Makaryus M.D.
(ECHOCARDIOGRAPHY, Volume 21, April 2004) [source]

Out-of-hospital Care of Critical Drug Overdoses Involving Cardiac Arrest

ACADEMIC EMERGENCY MEDICINE, Issue 1 2004
Valentine L. Paredes MD
Objectives: Death from acute drug poisoning, also termed drug overdose, is a substantial public health problem. Little is known regarding the role of emergency medical services (EMS) in critical drug poisonings. This study investigates the involvement and potential mortality benefit of EMS for critical drug poisonings, characterized by cardiovascular collapse requiring cardiopulmonary resuscitation (CPR). Methods: The study population was composed of death events caused by acute drug poisoning, defined as poisoning deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in King County, Washington, during the year 2000. Results: Eleven persons were successfully resuscitated and 234 persons died from cardiac arrest caused by acute drug poisoning, for a total of 245 cardiac events. The EMS responded to 79.6% (195/245), attempted resuscitation in 34.7% (85/245), and successfully resuscitated 4.5% (11/245) of all events. Among the 85 persons for whom EMS attempted resuscitation, opioids, cocaine, and alcohol were the predominant drugs involved, although over half involved multiple drug classes. Among the 11 persons successfully resuscitated, return of circulation was achieved in six following EMS cardiopulmonary resuscitation alone, in one following CPR and defibrillation, and in the remaining four after additional advanced life support. Conclusions: In this community, EMS was involved in the majority of acute drug poisonings characterized by cardiovascular collapse and may potentially lower total mortality by approximately 4.5%. The results show that, in some survivors, return of spontaneous circulation may be achieved with CPR alone, suggesting a different pathophysiology in drug poisoning compared with cardiac arrest due to heart disease. [source]

The Accuracy of Predicting Cardiac Arrest by Emergency Medical Services Dispatchers: The Calling Party Effect

ACADEMIC EMERGENCY MEDICINE, Issue 9 2003
Alex G. Garza MD
Abstract Objectives: To analyze the accuracy of paramedic emergency medical services (EMS) dispatchers in predicting cardiac arrest and to assess the effect of the caller party on dispatcher accuracy in an advanced life support, public utility model EMS system, with greater than 90,000 calls and greater than 60,000 transports per year. Methods: This was a retrospective analysis from January 1, 2000, through June 30, 2000, of 911 calls with dispatcher-assigned presumptive patient condition (PPC) or field diagnosis of cardiac arrest. Sensitivity and positive predictive value (PPV) of the PPC code for cardiac arrest by calling parties were calculated. Homogeneity of sensitivity and PPV of the PPC code for cardiac arrest by calling parties was studied with chi-square analysis. Relevant proportions, relative risk ratios, and associated 95% confidence intervals (95% CIs) were calculated. Student's t-test was used to compare quality assurance scores between calling parties. Results: There were 506 patients included in the study. Overall sensitivity for dispatcher-assigned PPC of cardiac arrest was 68.3% (95% CI = 63.3% to 73.0%) with a PPV of 65.0% (95% CI = 60.0% to 69.7%). There was a significant difference in the PPV for the EMS dispatcher diagnosis of cardiac arrest depending on the type of caller (,2= 17.34, p < 0.001). Conclusions: A higher level of medical training may improve dispatch accuracy for predicting cardiac arrest. The type of calling party influenced the PPV of dispatcher-assigned condition. [source]

Surface Cooling for Rapid Induction of Mild Hypothermia After Cardiac Arrest: Design Determines Efficacy

ACADEMIC EMERGENCY MEDICINE, Issue 4 2010
Thomas Uray MD
Abstract Objectives:, Recently, a novel cooling pad was developed for rapid induction of mild hypothermia after cardiac arrest. The aim of this study was to evaluate the cooling efficacy of three different pad designs for in-hospital cooling. Methods:, Included in this prospective interventional study were patients with esophageal temperature (Tes) > 34°C on admission. The cooling pad consists of multiple cooling units, filled with a combination of graphite and water, which is precooled to ,18°C (design A) or to ,9°C (designs B and C) before use. The designs of the cooling pad differed in number, shape, and thickness of the cooling units, with weights of 9.7 kg (design A), 5.3 kg (design B), and 6.2 kg (design C). All three designs were tested in sequential order and were changed according to the results found in the previous trial. Cooling was started after admission until Tes = 34°C, when the cooling pad was removed. The target temperature of Tes = 32,34°C was maintained for 24 hours. Data are presented as medians and interquartile ranges (IQRs = 25%,75%) or proportions. Results:, Cooling rates were 3.4°C/hour (IQR = 2.5,3.7) with design A (n = 12), 2.8°C/hour (IQR = 1.6,3.3) with design B (n = 7), and 2.9°C/hour (IQR = 1.9,3.6) with design C (n = 10; p = 0.5). To reach 34°C, the cooling pad had to be exchanged with a new one due to melting and therefore depleting cooling capacity in three patients with design A, in five patients with design B, and in no patient with design C (p = 0.004). Conclusions:, With adequate design and storage temperature, the cooling pad proved to be efficient for rapid in-hospital cooling of patients resuscitated from cardiac arrest. ACADEMIC EMERGENCY MEDICINE 2010; 17:360,367 © 2010 by the Society for Academic Emergency Medicine [source]

Out-of-hospital Cardiac Arrest in Denver, Colorado: Epidemiology and Outcomes

ACADEMIC EMERGENCY MEDICINE, Issue 4 2010
Jason S. Haukoos MD
Abstract Objectives:, The annual incidence of out-of-hospital cardiac arrest (OOHCA) in the United States is approximately 6 per 10,000 population and survival remains low. Relatively little is known about the performance characteristics of a two-tiered emergency medical services (EMS) system split between fire-based basic life support (BLS) dispersed from fixed locations and hospital-based advanced life support (ALS) dispersed from nonfixed locations. The objectives of this study were to describe the incidence of OOHCA in Denver, Colorado, and to define the prevalence of survival with good neurologic function in the context of this particular EMS system. Methods:, This was a retrospective cohort study using standardized abstraction methodology. A two-tiered hospital-based EMS system for the County of Denver and 10 receiving hospitals were studied. Consecutive adult patients who experienced nontraumatic OOHCA from January 1, 2003, through December 31, 2004, were enrolled. Demographic, prehospital arrest characteristics, treatment data, and survival data using the Utstein template were collected. Good neurologic survival was defined by a Cerebral Performance Categories (CPC) score of 1 or 2. Results:, During the study period, 1,985 arrests occurred. Of these, 715 (36%) had attempted resuscitation by paramedics and constitute our study sample. The median age was 65 years (interquartile range = 52,78 years), 69% were male, 41% had witnessed arrest, 25% had bystander cardiopulmonary resuscitation (CPR) performed, and 30% had ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as their initial rhythm. Of the 715 patients, 545 (76%) were transported to a hospital, 223 (31%) had return of spontaneous circulation (ROSC), 175 (25%) survived to hospital admission, 58 (8%) survived to hospital discharge, and 42 (6%, 95% confidence interval [CI] = 4% to 8%) had a good neurologic outcome. Conclusions:, Out-of-hospital cardiac arrest survival in Denver, Colorado, is similar to that of other United States communities. This finding provides the basis for future epidemiologic and health services research in the out-of-hospital and ED settings in our community. ACADEMIC EMERGENCY MEDICINE,2010; 17:391,398 © 2010 by the Society for Academic Emergency Medicine [source]

Indentation of a free-falling lance penetrometer into a poroelastic seabed

INTERNATIONAL JOURNAL FOR NUMERICAL AND ANALYTICAL METHODS IN GEOMECHANICS, Issue 2 2005
Derek Elsworth
Abstract A solution is developed for the build-up, steady and post-arrest dissipative pore fluid pressure fields that develop around a blunt penetrometer that self-embeds from freefall into the seabed. Arrest from freefall considers deceleration under undrained conditions in a purely cohesive soil, with constant shear strength with depth. The resulting decelerating velocity field is controlled by soil strength, geometric bearing capacity factors, and inertial components. At low impact velocities the embedment process is controlled by soil strength, and at high velocities by inertia. With the deceleration defined, a solution is evaluated for a point normal dislocation penetrating in a poroelastic medium with a prescribed decelerating velocity. Dynamic steady pressures, PD, develop relative to the penetrating tip geometry with their distribution conditioned by the non-dimensional penetration rate, UD, incorporating impacting penetration rate, consolidation coefficient and penetrometer radius, and the non-dimensional strength, ND, additionally incorporating undrained shear strength of the sediment. Pore pressures develop to a steady peak magnitude at the penetrometer tip, and drop as PD=1/xD with distance xD behind the tip and along the shaft. Peak induced pressure magnitudes may be correlated with sediment permeabilities, post-arrest dissipation rates may be correlated with consolidation coefficients, and depths of penetration may be correlated with shear strengths. Together, these records enable strength and transport parameters to be recovered from lance penetrometer data. Penetrometer data recorded off La Palma in the Canary Islands (J. Volcanol. Geotherm. Res. 2000; 101:253) are used to recover permeabilities and consolidation coefficients from peak pressure and dissipation response, respectively. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Cardiocerebral Resuscitation Is Associated With Improved Survival and Neurologic Outcome from Out-of-hospital Cardiac Arrest in Elders

ACADEMIC EMERGENCY MEDICINE, Issue 3 2010
Jarrod Mosier MD
Abstract Background:, Recent studies have shown that a new emergency medical services (EMS) protocol for treating patients who suffer out-of-hospital cardiac arrest (OHCA), cardiocerebral resuscitation (CCR), significantly improves survival compared to standard advanced life support (ALS). However, due to their different physiology, it is unclear if all elders, or any subsets of elders who are OHCA victims, would benefit from the CCR protocol. Objectives:, The objectives of this analysis were to compare survival by age group for patients receiving CCR and ALS, to evaluate their neurologic outcome, and to determine what other factors affect survival in the subset of patients who do receive CCR. Methods:, An analysis was performed of 3,515 OHCAs occurring between January 2005 and September 2008 in the Save Hearts in Arizona Registry. A total of 1,024 of these patients received CCR. Pediatric patients and arrests due to drowning, respiratory, or traumatic causes were excluded. The registry included data from 62 EMS agencies, some of which instituted CCR. Outcome measures included survival to hospital discharge and cerebral performance category (CPC) scores. Logistic regression evaluated outcomes in patients who received CCR versus standard ALS across age groups, adjusted for known potential confounders, including bystander cardiopulmonary resuscitation (CPR), witnessed arrest, EMS dispatch-to-arrival time, ventricular fibrillation (Vfib), and agonal respirations on EMS arrival. Predictors of survival evaluated included age, sex, location, bystander CPR, witnessed arrest, Vfib/ventricular tachycardia (Vtach), response time, and agonal breathing, based on bivariate results. Backward stepwise selection was used to confirm predictors of survival. These predictors were then analyzed with logistic regression by age category per 10 years of age. Results:, Individuals who received CCR had better outcomes across age groups. The increase in survival for the subgroup with a witnessed Vfib was most prominent on those <40 years of age (3.7% for standard ALS patients vs. 19% for CCR patients, odds ratio [OR] = 5.94, 95% confidence interval [CI] = 1.82 to 19.26). This mortality benefit declined with age until the ,80 years age group, which regained the benefit (1.8% vs. 4.6%, OR = 2.56, 95% CI = 1.10 to 5.97). Neurologic outcomes were also better in the patients who received CCR (OR = 6.64, 95% CI = 1.31 to 32.8). Within the subgroup that received CCR, the factors most predictive of improved survival included witnessed arrest, initial rhythm of Vfib/Vtach, agonal respirations upon arrival, EMS response time, and age. Neurologic outcome was not adversely affected by age. Conclusions:, Cardiocerebral resuscitation is associated with better survival from OHCA in most age groups. The majority of patients in all age groups who survived to hospital discharge and who could be reached for follow-up had good neurologic outcome. Among patients receiving CCR for OHCA, witnessed arrest, Vfib/Vtach, agonal respirations, and early response time are significant predictors of survival, and these do not change significantly based on age. ACADEMIC EMERGENCY MEDICINE 2010; 17:269,275 © 2010 by the Society for Academic Emergency Medicine [source]

PTHrP Signaling Targets Cyclin D1 and Induces Osteoblastic Cell Growth Arrest,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2005
Nabanita S Datta PhD
Abstract PTHrP control of the MC3T3-E1 cell cycle machinery showed that, during differentiation, PTHrP induced G1 growth arrest. Cyclin D1 was a critical mediator as a downstream effector of cAMP, PKC, and MAPK signaling, and the process was PKA-independent. The involvement of JunB has been found critical for PTHrP effects. Introduction: PTH-related protein (PTHrP) has been implicated in the control of bone cell turnover, but the mechanisms underlying its effect on osteoblast proliferation and differentiation have not been clearly defined. The mechanisms by which PTHrP impacts cell cycle proteins and the role of signaling pathways in differentiated osteoblasts were studied. Materials and Methods: To elucidate the role of PTHrP, flow cytometric analyses were performed using MC3T3-E1 and primary mouse calvarial cells. Relative protein abundance (Western blot), physical association of partners (immunoprecipitation), and kinase activities (in vitro kinase assays using either GST-Rb or H1-histone as substrates) of cell cycle-associated proteins in vehicle and PTHrP-treated 7-day differentiated cells were determined. ELISA and/or Northern blot analyses were done to evaluate JunB and cyclin D1 expression. SiRNA-mediated gene silencing experiments were performed to silence JunB protein. Finally, inhibitors of cAMP, protein kinase A (PKA), protein kinase C (PKC), and mitogen-activated protein kinase (MAPK) were used to determine involvement of different signaling pathways. Results: PTHrP inhibited cyclin D1 protein expression 7-fold in a dose- and time-dependent manner and increased the level of p16 protein in differentiated osteoblasts. Additionally, PTHrP reduced cyclin D1-CDK4/CDK6 and CDK1 kinase activities. Forskolin, a cAMP agonist, mimicked PTHrP action, and the PKC inhibitor, GF109203X, slightly blocked downregulation of cyclin D1, implying involvement of both cAMP and PKC. U0126, a MAPK inhibitor, alone decreased cyclin D1 protein, suggesting that the basal cyclin D1 protein is MAPK dependent. H-89, a PKA inhibitor, did not alter the effect of PTHrP on cyclin D1, suggesting a PKA-independent mechanism. Finally, expression of JunB, an activating protein-1 transcription factor, was significantly upregulated, and silencing JunB (siRNA) partially reversed the cyclin D1 response, implying involvement of JunB in the PTHrP-mediated growth arrest of MC3T3-E1 cells. Conclusion: PTHrP upregulates JunB and reduces cyclin D1 expression while inducing G1 cell cycle arrest in differentiated osteoblasts. Such regulation could be an important determinant of the life span and bone-forming activity of osteoblasts. [source]

Giant Aneurysm After Aortic Coarctation: Repair without Circulatory Arrest

JOURNAL OF CARDIAC SURGERY, Issue 5 2010
D.E.S.A., Gabor Erdoes M.D.
Using the hemi-clamshell approach, the entire aortic arch was replaced and the supraaortic branches were reimplanted. The applied surgical technique using hypothermic extracorporeal circulation without cardiac arrest allowed an uninterrupted cerebral and spinal cord perfusion due to stepwise clamping of the aortic arch during reconstruction and resulted in an excellent neurologic outcome at six-month follow-up.,(J Card Surg 2010;25:560-562) [source]

Deep Hypothermia and Circulatory Arrest in the Surgical Management of Renal Tumors with Cavoatrial Extension

JOURNAL OF CARDIAC SURGERY, Issue 6 2009
Panagiotis Dedeilias M.D.
Their intraluminar extension to the cardiac cavities occurs with a tumor-thrombus formation at a percentage of 1%. The aim of this study is to present the principles of "radical" management that should be targeted to excision of the kidney together with the cavoatrial tumor-thrombus. Material: From 2003 through 2008, we treated six patients with renal-cell carcinoma involving the IVC and/or the right cardiac chambers. The main symptoms leading to the diagnosis were hematuria, dyspnea, or lower limb edema. The extension of the tumor was type IV in three cases, type III in two, and type II in one case. Method: Extracorporeal circulation combined with a short period of hypothermic circulatory arrest was the method used. Radical nephrectomy combined with cavotomy and atriotomy was performed to an "en-block" extirpation of the tumor-thrombus and allowed oncologic surgical clearance of the disease. Results: There was no operative death. The mean postoperative course duration was 11 days, apart from one obese patient who presented postoperative pancreatitis and died on the 44th postoperative day due to respiratory failure. During the cumulative postoperative follow-up of 171 months the patients remain free of recurrence. Conclusions: The use of extracorporeal circulation and deep hypothermic circulatory arrest provides a good method for radical excision of renal carcinomas involving the IVC with satisfactory morbidity and long-term survival results. Cooperation of urologists and cardiac surgeons is necessary for this type of operation. [source]

Immediate Clinical Outcome after Prolonged Periods of Brain Protection: Retrospective Comparison of Hypothermic Circulatory Arrest, Retrograde, and Antegrade Perfusion

JOURNAL OF CARDIAC SURGERY, Issue 5 2009
Anil Z. Apaydin M.D.
Methods: Between 1993 and 2006, 339 patients underwent proximal aortic operations using a period of cerebral protection. Among these, 161 patients (mean age of 55 ± 12 years) who required cerebral protection longer than 25 minutes were included in the analysis. Ascending aorta with or without root was replaced in all patients. In addition, total arch replacement was performed in 36 patients. All patients were cooled to rectal temperature of 16 °C. Hypothermic circulatory arrest without adjunctive perfusion was used in 48 patients. Retrograde or antegrade cerebral perfusion was added in 94 and 19 patients, respectively. The mean duration of total cerebral protection was 42 ± 17 minutes. Results: Overall mortality was 15.5% (25/161) and did not differ among the perfusion groups. There was no difference in the incidence of overall neurological events, temporary neurological dysfunction, or major stroke among the groups. Multivariate analysis revealed that transfusion of >3 units of blood (p < 0.03) was an incremental risk factor for mortality. History of hypertension (p < 0.03), coexisting systemic diseases (p < 0.005), and transfusion of >3 units of blood (p < 0.04) were predictors of temporary neurological dysfunction. Conclusion: In proximal aortic operations requiring prolonged periods of cerebral protection, the mortality and neurological morbidity are not determined by the type of cerebral protection method only. Factors like hypertension and diabetes may play a role in the development of temporary neurological dysfunction. [source]

Results of Treatment Methods in Cardiac Arrest Following Coronary Artery Bypass Grafting

JOURNAL OF CARDIAC SURGERY, Issue 3 2009
Mehmet R. Guney M.D.
We evaluated the short- and long-term consequences of these two methods and discussed the indications for re-revascularization. Methods: Between 1998 and 2004, a total of 148 CABG patients, who were complicated with cardiac arrest, were treated with emergency re-revascularization (n = 36, group R) and ICU procedures (n = 112, group ICU). Re-revascularizations are mostly blind operations depending on clinical/hemodynamic criteria. These are: no response to resuscitation, recurrent tachycardia/fibrillation, and severe hemodynamic instability after resuscitation. Re-angiography could only be performed in 3.3% of the patients. Event-free survival of the groups was calculated by the Kaplan-Meier method. Events are: death, recurrent angina, myocardial infarction, functional capacity, and reintervention. Results: Seventy percent of patients, who were complicated with cardiac arrest, had perioperative myocardial infarction (PMI). This rate was significantly higher in group R (p = 0.013). The major finding in group R was graft occlusion (91.6%). During in-hospital period, no difference was observed in mortality rates between the two groups. However, hemodynamic stabilization time (p = 0.012), duration of hospitalization (p = 0.00006), and mechanical support use (p = 0.003) significantly decreased by re-revascularization. During the mean 37.1 ± 25.1 months of follow-up period, long-term mortality (p = 0.03) and event-free survival (p = 0.029) rates were significantly in favor of group R. Conclusion: Better short- and long-term results were observed in the re-revascularization group. [source]

Surgery for Cardiac Valves and Aortic Root Without Cardioplegic Arrest ("Beating Heart"): Experience with a New Method of Myocardial Perfusion

JOURNAL OF CARDIAC SURGERY, Issue 6 2007
Tomas A. Salerno M.D.
Similarly, beating heart mitral valve surgery via the trans-septal approach with the aorta unclamped, is a novel technique. We, herein, report a series of 346 patients with a variety of cardiac pathologies who were operated upon utilizing a new modality of myocardial perfusion. Among this group of patients, there were 55 patients who were diagnosed with endocarditis of one or more valves. These patients were excluded from this series of patients. Mean age was 59 ± 12, and there were 196 (67.3%) males and 95 (32.7%) females. There were six aortic root procedures, 90 mitral valve replacements (MVR), 46 mitral valve repairs, 20 MVR+ coronary artery bypass grafting (CABG), 28 tricuspid valve repairs, 106 aortic valve replacements (AVR), 17 AVR+CABG, and 8 AVR/MVR. Crude mortality for the group was 20 of 291 (6.8%). Intra-aortic balloon pump utilization at time of weaning from cardiopulmonary bypass was 6/291 (2.06%), and re-operation for bleeding was needed in 12 of 291 (4.1%) patients. Postoperative stroke occurred in 4 of 291 (1.3%) patients. In these patients, the clinical diagnosis of stroke was made prior to surgery. This initial experience with this new method of myocardial perfusion indicates that results are at least comparable, if not superior, to conventional techniques utilizing intermittent cold blood cardioplegia. [source]

Case Report of Cardiac Arrest, Abdominal Compartment Syndrome, and Thoracic Aortic Injury with Endovascular Repair of Thoracic Aortic Tear

JOURNAL OF CARDIAC SURGERY, Issue 4 2007
Randy M. Stevens M.D.
Currently, endografts are not FDA-approved for treating thoracic aortic injury (TAI). We report a case of TAI who presented in hemorrhagic shock and preoperative cardiac arrest who was successfully treated with large volume resuscitation, closed chest cardiac massage, exploratory laparotomy, and thoracic endografting. [source]

Deep Hypothermic Circulatory Arrest and Bivalirudin Use in a Patient With Heparin-Induced Thrombocytopenia and Antiphospholipid Syndrome

JOURNAL OF CARDIAC SURGERY, Issue 1 2007
Kay B. Leissner M.D.
Methods: Bivalirudin was used during CPB and deep hypothermic circulatory arrest (DHCA) for resection of multiple right atrial masses in a patient with HIT II and antiphospholipid antibodies syndrome (APS). Anticoagulation was monitored with the activated clotting time (ACT) and a target ACT of 450 seconds or greater was maintained. Results: Surgical removal of multiple right atrial masses was successful and there was no evidence of thromboembolic events. Clot was noticed in the cardiotomy and venous reservoir after CPB was discontinued and the system flushed. The postoperative course was uneventful. Conclusions: Anticoagulation was successfully managed with bivalirudin, a new short-acting, and direct thrombin inhibitor. Further studies are necessary to evaluate the safety of bivalirudin during DHCA. [source]

Long-Term Incidence of Malignant Ventricular Arrhythmia and Shock Therapy in Patients with Primary Defibrillator Implantation Does Not Differ from Event Rates in Patients Treated for Survived Cardiac Arrest

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2005
ULRICH BACKENKÖHLER M.D.
Introduction: Recent trials have demonstrated benefit of prophylactic defibrillator (ICD) implantation compared to conventional treatment in high-risk patients. However, many patients have rare or no sustained arrhythmias following implantation. Our study addresses the question, whether patients with prophylactic defibrillator implantation have a lower risk for life-threatening ventricular tachycardia (VT) or ventricular fibrillation (VF) compared to sudden cardiac death (SCD) survivors. Methods and Results: Over 7 years we enrolled 245 patients. Occurrence of spontaneous sustained VT/VF resulting in adequate ICD treatment was the endpoint. Incidence, type, and treatment of sustained arrhythmia in 43 previously asymptomatic ICD recipients (group B) were compared to data of 202 survivors of imminent SCD (group A). All patients had severely impaired left ventricular ejection fraction (<45%). Group B patients had long runs (>6 cycles, <30 s) of VT during Holter monitoring and inducible sustained arrhythmia. Incidence of rapid VT and VF (cycle length <240 ms/heart rate >250 bpm) after 4 years (35% in both groups, P = ns) and adequate defibrillator therapies (57% vs 55%, P = ns) were similar in both groups after univariate and multivariate analysis. Cumulative mortality tended to be lower in group B compared to group A, but the difference was not statistically significant. Conclusion: During long-term follow-up, incidence of sustained rapid ventricular arrhythmia in prophylactically treated patients is as high as that of SCD survivors. Benefit from defibrillator implantation for primary prevention (group B) appears to be comparable to that for survived cardiac arrest (group A). [source]

Role of ,4,1 Integrins in Chemokine-Induced Monocyte Arrest under Conditions of Shear Stress

MICROCIRCULATION, Issue 1 2009
SHARON J. HYDUK
ABSTRACT Monocyte recruitment or emigration to tissues is an essential component of host defense in both acute and chronic inflammatory responses. Sequential molecular interactions mediate a cascade of tethering, rolling, arrest, stable adhesion, and intravascular crawling that culminates in monocyte diapedesis across the vascular endothelium and migration through the basement membrane of postcapillary venules. Integrins are complex adhesion and signaling molecules. Dynamic alterations in their conformation and distribution on the monocyte cell surface are required for many steps of monocyte emigration. Intracellular signaling initiated by chemokine receptors induces conformational changes in integrins that upregulate their affinity for ligands, and this is essential for monocyte arrest. This review focuses on the activation of monocyte ,4,1 integrins by endothelial chemokines, which is required for the arrest of monocytes rolling on vascular cell adhesion molecule 1 under shear flow. Using soluble ligand-binding assays and adhesion assays in parallel-plate flow chambers, critical signaling mediators in chemokine-induced ,4,1 integrin affinity upregulation and monocyte arrest have been identified, including phospholipase C, calcium, and calmodulin. [source]

Long-Term Outcomes of a Telephone Intervention After an ICD

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2005
CYNTHIA M. DOUGHERTY
Background: The purpose of this study was to determine the long-term benefits of participating in a structured, 8-week educational telephone intervention delivered by expert cardiovascular nurses post-ICD. The intervention was aimed to (1) increase physical functioning, (2) increase psychological adjustment, (3) improve self-efficacy in managing the challenges of ICD recovery, and (4) lower levels of health care utilization over usual care in the first 12 months post-ICD. This article reports on the 6- and 12-month outcomes of the nursing intervention trial. Methods and Results: A two-group (N = 168) randomized control group design was used to evaluate intervention efficacy with persons receiving an ICD for the secondary prevention of sudden cardiac arrest. Measures were obtained at baseline, 6 and 12 months post hospitalization. Outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI], Centers for Epidemiologic Studies,Depression [CES-D], fear of dying), (3) self-efficacy (Sudden Cardiac Arrest,Self-Efficacy [SCA-SE], Sudden Cardiac Arrest,Behavior [SCA-B], Sudden Cardiac Arrest,Knowledge [SCA-K]), and (4) health care utilization (emergency room [ER] visits, outpatient visits, hospitalizations). Using repeated measures ANOVA, the 6- and 12-month benefits of the intervention over usual care were in reductions in physical concerns (P = 0.006), anxiety (P = 0.04), and fear of dying (P = 0.01), with enhanced self-confidence (P = 0.04) and knowledge (P = 0.001) to manage ICD recovery. There were no statistically significant differences between the groups on total outpatient visits, hospitalizations, or ER visits over 12 months. Conclusion: A structured 8-week post-hospital telephone nursing intervention after an ICD had sustained 12-month improvements on patient concerns, anxiety, fear of dying, self-efficacy, and knowledge. Results may not apply to individuals with congestive heart failure who receive an ICD for primary prevention of sudden cardiac arrest. [source]

Technical note: Standardized and semiautomated Harris lines detection

AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 3 2008
S. Suter
Abstract Arrest in long bone growth and the subsequent resumption of growth may be visible as radiopaque transverse lines in radiographs (Harris lines, HL; Harris, HA. 1933. Bone growth in health and disease. London: Oxford University Press). The assessment of individual age at occurrence of such lines, as part of paleopathological skeletal studies, is time-consuming and shows large intra- and interobserver variability. Thus, a standardized, automated detection algorithm would help to increase the validity of such paleopathological research. We present an image analysis application facilitating automatic detection of HL. On the basis of established age calculation methods, the individual age-at-formation can be automatically assessed with the tool presented. Additional user input to confirm the automatic result is possible via an intuitive graphical user interface. Automated detection of HL from digital radiographs of a sample of late Medieval Swiss tibiae was compared to the consensus of manual assessment by two blinded expert observers. The intra- and interobserver variability was high. The quality of the observer result improved when standardized detection criteria were defined and applied. The newly developed algorithm detected two-thirds of the HL that were identified as consensus lines between the observers. It was, however, necessary to validate the last one-third by manual editing. The lack of a large test series must be noted. The application is freely available for further testing by any interested researcher. Am J Phys Anthropol, 2008. © 2008 Wiley-Liss, Inc. [source]

Arrest of flagellum morphogenesis with fibrous sheath immaturity of human spermatozoa

ANDROLOGIA, Issue 2 2006
D. Escalier
Summary Morphogenesis of the mammalian sperm flagellum is characterized by the assembly of axonemal and peri-axonemal structures. The incorporation of mitochondria into the flagellum results from complex cellular events, including flagellum compartmentalization and membrane and organelle reorganization. These events are striking in the annulus, which progressively relocates from the neck to the principal piece of the flagellum. This study presents a human sperm phenotype with failure of the annulus relocation, absence of mitochondrial sheath and a fibrous sheath at intermediate step of assembly. The sperm nucleus was fully condensed but with deep invaginations engulfing the acrosome. The distal pole of some mitochondria exhibited an unusual dense substance. This rare human sperm phenotype was found in a consanguineous patient, suggesting a genetic origin. These anomalies raise the question of the mechanisms that lead to impairment of both the annulus relocation and the deposit of proteins on the fibrous sheath during spermiogenesis. [source]

Cell Cycle Arrest and Apoptosis Induction by an Anticancer Chalcone Epoxide

ARCHIV DER PHARMAZIE, Issue 8 2010
Haiyong Han
Abstract Safe and effective chemotherapeutic agents for the treatment of pancreatic cancer remain elusive. We found that chalcone epoxides (1,3-diaryl-2,3-epoxypropanones) inhibited growth in two pancreatic cancer cell lines, BxPC-3 and MIA PaCa-2. Three compounds were active, with GI50 values of 5.6 to 15.8,µM. Compound 4a, 1,3-bis-(3,4,5-trimethoxyphenyl)-2,3-epoxypropanone, had an average GI50 of 14.1,µM in the NCI 60-cell-line panel. To investigate the mode of action, cell cycle analyses of BxPC-3 cells were carried out. Treatment of cells with 50,µM 4a resulted in dramatic accumulation at G2/M (61% after 12,h for 4avs. 15% for untreated cells). The cells rapidly entered apoptosis. After 12,h, 26% of cells treated with 50,µM 4a had entered apoptosis vs. 4% for cells treated with 100,µM etoposide and 2% for untreated cells. Compound 4a interfered with paclitaxel enhancement of tubulin polymerization, suggesting microtubules as the site of action. Reaction of thiol nucleophiles with 4a under basic conditions resulted in epoxide ring-opening and retroaldol fragmentation, yielding alkylated thiol. MALDI mass spectrometry showed that retroaldol reaction occurred upon treatment of ,-tubulin with 4a. The site of alkylation was identified as Cys354. Chalcone epoxides warrant further study as potential agents for treatment of cancer. [source]

Mesenteric Complications After Hypothermic Cardiopulmonary Bypass with Cardiac Arrest: Underlying Mechanisms

ARTIFICIAL ORGANS, Issue 11 2002
Terézia Bogdana Andrási
Abstract: The aim of this study was to determine the pathophysiological mechanisms of postcardiopulmonary bypass (CPB) intestinal dysfunction using an in vivo canine model of extracorporeal circulation. Six dogs underwent a 90 min hypothermic CPB with continuous monitoring of mean arterial blood pressure (MAP) and mesenteric blood flow (MBF). Reactive hyperemia and vasodilator responses of the superior mesenteric artery to acetylcholine and sodium nitroprusside were determined before and after CPB. Mesenteric lactate production, glucose consumption, creatine kinase (CK) release and venous free radicals were determined. CPB induced a significant fall (p < 0.05) in MAP and MBF. After CPB, reactive hyperemia (,26 ± 15% versus ,53 ± 2%, p < 0.05) and the response to acetylcholine (,42 ± 9 versus ,55 ± 6%, p < 0.05) were significantly decreased. Reperfusion increased lactate production (0.8 ± 0.09 mmol/L versus 0.4 ± 0.18, p < 0.05) and the CK release (446 ± 98 U/L versus 5 ± 19 U/L, p < 0.01). Endothelial dysfunction, conversion from aerobic to anaerobic metabolism, and intestinal cell necrosis seem to be responsible for intestinal complications associated with CPB. [source]

Rosiglitazone Inhibits Cell Proliferation by Inducing G1 Cell Cycle Arrest and Apoptosis in ADPKD Cyst-Lining Epithelia Cells

BASIC AND CLINICAL PHARMACOLOGY & TOXICOLOGY, Issue 6 2010
Yawei Liu
Many drugs inhibiting cell proliferation have been proved to be effective in slowing the disease progression in ADPKD. Recent evidence has suggested that peroxisome proliferator-activated receptor , (PPAR,) ligands have anti-neoplasm effects through inhibiting cell growth and inducing cell apoptosis in various cancer cells. In the present study, we examined the expression of PPAR, in human ADPKD kidney tissues and cyst-lining epithelial cell line, and found that the expression of PPAR, was greater in ADPKD kidney tissues and cyst-lining epithelial cell line than in normal kidney tissues and human kidney cortex (HKC) cell line. Rosiglitazone inhibited significantly proliferation of cyst-lining epithelial cells in a concentration- and time-dependent manner. These effects were diminished by GW9662, a specific PPAR, antagonist. Cell cycle analysis showed a G0/G1 arrest in human ADPKD cyst-lining epithelial cells with rosiglitazone treatment. Analysis of cell cycle regulatory proteins revealed that rosiglitazone decreased the protein levels of proliferating cell nuclear antigen, pRb, cyclin D1, cyclin D2 and Cdk4 but increased the levels of p21 and p27 in a dose-dependent manner. Rosiglitazone also induced apoptosis in cyst-lining epithelial cells, which was correlated with increased bax expression and decreased bcl-2 expression. These results suggest PPAR, agonist might serve as a promising drug for the treatment of ADPKD. [source]

Electrophysiology and Hemodynamics of Open Chest Resuscitation from Cardiac Arrest in a Swine

ACADEMIC EMERGENCY MEDICINE, Issue 1 2009
Bphil, David D. Salcido BS
First page of article [source]

Use of a Standardized Order Set for Achieving Target Temperature in the Implementation of Therapeutic Hypothermia after Cardiac Arrest: A Feasibility Study

ACADEMIC EMERGENCY MEDICINE, Issue 6 2008
J. Hope Kilgannon MD
Abstract Objectives:, Induced hypothermia (HT) after cardiac arrest improved outcomes in randomized trials. Current post,cardiac arrest treatment guidelines advocate HT; however, utilization in practice remains low. One reported barrier to adoption is clinician concern over potential technical difficulty of HT. We hypothesized that using a standardized order set, clinicians could achieve HT target temperature in routine practice with equal or better efficiency than that observed in randomized trials. Methods:, After a multidisciplinary HT education program, we implemented a standardized order set for HT induction and maintenance including sedation and paralysis, intravenous cold saline infusion, and an external cooling apparatus, with a target temperature range of 33,34°C. We performed a retrospective analysis of a prospectively compiled and maintained registry of cardiac arrest patients with HT attempted (intent-to-treat) over the first year of implementation. The primary outcome measures were defined a priori by extrapolating treatment arm data from the largest and most efficacious randomized trial: 1) successful achievement of target temperature for ,85% of patients in the cohort and 2) median time from return of spontaneous circulation (ROSC) to achieving target temperature <8 hours. Results:, Clinicians attempted HT on 23 post,cardiac arrest patients (arrest location: 78% out-of-hospital, 22% in-hospital; initial rhythm: 26% ventricular fibrillation/tachycardia, 70% pulseless electrical activity or asystole) and achieved the target temperature in 22/23 (96%) cases. Median time from ROSC to target temperature was 4.4 (interquartile range 2.8,7.2) hours. Complication rates were low. Conclusions:, Using a standardized order set, clinicians can achieve HT target temperature in routine practice. [source]

Hypothermia after Cardiac Arrest: We Can Do This

ACADEMIC EMERGENCY MEDICINE, Issue 6 2008
Alan E. Jones MD
No abstract is available for this article. [source]