EEG for good outcome prediction after cardiac arrest: a multicentre cohort study.

AIM: Assess the prognostic ability of a non-highly malignant and reactive EEG to predict good outcome after cardiac arrest (CA). METHODS: Prospective observational multicentre substudy of the "Targeted Hypothermia versus Targeted Normothermia after Out-of-hospital Cardiac Arrest Trial", also known as the TTM2-trial. Presence or absence of highly malignant EEG patterns and EEG reactivity to external stimuli were prospectively assessed and reported by the trial sites. Highly malignant patterns were defined as burst-suppression or suppression with or without superimposed periodic discharges. Multimodal prognostication was performed 96 hours after CA. Good outcome at 6 months was defined as a modified Rankin Scale score of 0-3. RESULTS: 873 comatose patients at 59 sites had an EEG assessment during the hospital stay. Of these, 283 (32%) had good outcome. EEG was recorded at a median of 69 hours (IQR 47-91) after CA. Absence of highly malignant EEG patterns was seen in 543 patients of whom 255 (29% of the cohort) had preserved EEG reactivity. A non-highly malignant and reactive EEG had 56% (CI 50-61) sensitivity and 83% (CI 80-86) specificity to predict good outcome. Presence of EEG reactivity contributed (p<0.001) to the specificity of EEG to predict good outcome compared to only assessing background pattern without taking reactivity into account. CONCLUSION: Nearly one-third of comatose patients resuscitated after CA had a non-highly malignant and reactive EEG that was associated with a good long-term outcome. Reactivity testing should be routinely performed since preserved EEG reactivity contributed to prognostic performance.

Lactate, lactate clearance and outcome after cardiac arrest: A post-hoc analysis of the TTM-Trial.

BACKGROUND: Admission lactate and lactate clearance are implemented for risk stratification in sepsis and trauma. In out-of-hospital cardiac arrest, results regarding outcome and lactate are conflicting. METHODS: This is a post-hoc analysis of the Target Temperature Management trial in which 950 unconscious patents after out-of-hospital cardiac arrest were randomized to a temperature intervention of 33°C or 36°C. Serial lactate samples during the first 36 hours were collected. Admission lactate, 12-hour lactate, and the clearance of lactate within 12 hours after admission were analyzed and the association with 30-day mortality assessed. RESULTS: Samples from 877 patients were analyzed. In univariate logistic regression analysis, the odds ratio for death by day 30 for each mmol/L was 1.12 (1.08-1.16) for admission lactate, P < .01, 1.21 (1.12-1.31) for 12-hour lactate, P < .01, and 1.003 (1.00-1.01) for each percentage point increase in 12-hour lactate clearance, P = .03. Only admission lactate and 12-hour lactate levels remained significant after adjusting for known predictors of outcome. The area under the receiver operating characteristic curve was 0.65 (0.61-0.69), P < .001, 0.61 (0.57-0.65), P < .001, and 0.53 (0.49-0.57), P = .15 for admission lactate, 12-hour lactate, and 12-hour lactate clearance, respectively. CONCLUSIONS: Admission lactate and 12-hour lactate values were independently associated with 30-day mortality after out-of-hospital cardiac arrest while 12-hour lactate clearance was not. The clinical value of lactate as the sole predictor of outcome after out-of-hospital cardiac arrest is, however, limited.

Filamentous supramolecular structures with polyelectrolyte and cadmium sulfide.

In this study, a new type of filamentous structures consisting of a generation 9 poly(amido amine) dendrimer (G9) and CdS is reported. The linearity of the interconnected dendrimers is a result of the electrostatic repulsion between the multiply charged dendrimer macroions. Structures have been investigated by dynamic light scattering (DLS) and transmission electron microscopy (TEM). The internal structure of the CdS-fibers reveals information on the mechanism of the fiber formation. In contrast to previous systems with smaller generation poly(propylene imine)-dendrimers, Cd(2+) is here found to be responsible for the interconnection of G9. Furthermore, more complex supramolecular structures were built by associating the CdS-dendrimer hybrid fibers with different ionic dyes, displaying the versatility of this system for future nanotechnology applications such as optoelectronics or energy conversion.

[Painful ischemia of the extremities with T-cell lymphoma]. / Schmerzhafte akrale Durchblutungsstörungen bei T-Zellymphomen.

Two years after the diagnosis of Sézary syndrome, a 50-year old female patient experienced attacks of painful ischemia of both hands and feet, leading to acral necrosis. Another 59-year old patient presented with severe pain in his feet, secondary to ischemia. This was the first symptom of a T-cell-chronic lymphocytic leukemia. Similar cases have only occasionally been described. The relationship between acral ischemia and T-cell-lymphoma is not clear but is discussed in this article.

Toward standards for posture. Postural characteristics of the lower back system in normal and pathologic conditions.

On theoretic grounds it can be assumed that aberrations of posture may play a role in the generation of low-back pain by creating concentrations of stress. However, this assumption remains speculative because of the absence of criteria for normal posture. This study considers some of these criteria, especially as they are related to the lumbar spine and pelvis. The relations between the angle of declivity of the sacrum and radius and inclination of the lordotic curvature of the lumbar spine show good correlation. Mean values of postural parameters in the group of spondylolysis patients differ significantly from those in the group of healthy volunteers.

Recordings of the movement at the intervertebral segment L5-S1: a technique for the determination of the movement in the L5-S1 spinal segment by using three specified postural positions.

The pathomechanism of low-back pain generation is not understood very well. Functional disturbances of motion at the individual segmental level appear to play a role in many cases. In this study a technique of numeric analysis of radiographic observations of the lumbar spine is developed by which the authors are able to assess the displacement of the two components of the L5-S1 motion segment in the sagittal plane when the subject assumes three specified standard postural positions.