A simple ABCD score to stratify patients with respect to the probability of survival following in-hospital cardiopulmonary resuscitation.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is occurring more frequently at community hospitals but most patients undergoing CPR do not survive to discharge. Tools to predict CPR survival can be improved by the identification of high-yield clinical indicators. OBJECTIVE: To identify variables associated with survival to discharge following in-hospital cardiac arrest. METHODS: Retrospective cohort study of 463,530 hospital admissions from the Nationwide Inpatient Sample (2012-2016). The analysis includes adults (age ≥50) who underwent in-hospital CPR at US community hospitals. RESULTS: Overall survival to discharge was 29.8% (95% CI: 29.5-30.1%). Age was the strongest predictor of survival and had greater prognostic value than the Charlson comorbidity index. Obesity was associated with improved survival (35.9%, 95% CI: 35.1-36.7%), whereas underweight patients had decreased survival (24.0%, 95% CI: 22.2-25.7%). Acute indicators of poor survival included hyperkalemia, hypercalcemia, and sepsis. We generated an ABCD index based upon four high-yield variables (age, body habitus, comorbidity, day of hospital admission). An ABCD score of 2 or less was a sensitive but non-specific predictor of post-CPR survival (96.8% sensitivity, 95% CI: 96.6-97.0), and those with extreme scores differed 3.8-fold with respect to post-CPR survival probability (46.0% versus 12.1%). CONCLUSION: Age is the strongest predictor of post-CPR survival, but body habitus is also an important indicator that may currently be underutilized. Our results support improved post-CPR survival of obese patients, consistent with an 'obesity paradox'. The ABCD score provides an efficient means of risk-stratifying patients and can be calculated in less than 1 minute.

Light chain deposition disease presenting as an atrial mass: a case report and review of literature.

Light chain deposition disease (LCDD) also known as nonamyloidotic immunoglobulin deposition disease is a rare systemic disorder due to the abnormal deposition of immunoglobulin in multiple organs caused by the clonal proliferation of B lymphocytes and plasma cells. Renal involvement is the most common with cardiac manifestations being the most common extra renal presentation of the disease. Renal involvement is not always associated with LCDD. Isolated cardiac involvement can manifest in a wide variety of ways: heart failure, cardiomyopathy, arrhythmias, angina, myocardial infarction, etc. We hereby present an unusual case of 59-year-old female who presented to clinic for routine follow up. A murmur on physical exam was evaluated with echocardiogram which led to the discovery of an incidental right atrial mass. Cardiac magnetic resonance imaging was completed 6 months later for follow up which showed increasing size of the mass. The mass was excised and found to be consistent with LCDD. To the best of our knowledge, this is the first reported case of LCDD manifesting as an atrial mass. Through this case report and review of literature we would like to generate awareness among our fellow pathologists and clinicians to maintain a high level of suspicion for LCDD as it can manifest in many unusual ways, with or without kidney involvement.

Coccygeal Polypoid Eccrine Nevus Presenting as a Skin Tag: Case Report and Review of the Literature.

Coccygeal polypoid eccrine nevi (CPEN) are rare, benign, cutaneous polypoid lesions localized to the coccyx region that are characterized by areas of hyperplastic eccrine ducts without hyperhidrosis. We present the case of an asymptomatic 16-month-old female with a congenital lesion in the lower sacral area and review the literature and the differential diagnosis for CPEN.

Characterizing constraining forces in the alignment phase of orthodontic treatment.

OBJECTIVES: To describe the frictional forces (FF) that constrain wire sliding in the initial alignment phase of treatment using a new term, the "constraining force" (CF), and to hypothesize that CF is dependent on two factors: the hyperelastic behavior of archwires and the specific type of tooth geometric malalignment present. MATERIALS AND METHODS: A laboratory device that simulates the four distinct malalignment types (in-out, rotation, tipping, and vertical step) was used to couple with an Instron testing apparatus. Incremental CF data for the four types of malalignment were recorded. Each type had five trials per increment of severity, from which the CF was averaged using 0.016-inch copper-nickel-titanium (CuNiTi) archwires. RESULTS: Two types of friction curves were obtained: a traditional step function response and a power regression response. For all malalignment types, increasing degrees of irregularity increased power regression responses and CF. A severity turning point, displayed as a sudden increase in CF, occurred for each malalignment. The rotation type of malalignment yielded the lowest CF, while the vertical step type resulted in the highest CF. CONCLUSIONS: The data infer a hypothesis that malrotation type having weak CF might act as a limiting factor in the alignment phase to unravel the neighboring teeth. Future investigations to compare clinical and bench data can help explain more fully the constraints impeding alignment resolution and the factors governing the ability to bring malaligned teeth into alignment.

Dentin bonding of an etch-and-rinse adhesive using self- and light-cured composites.

PURPOSE: To evaluate the dentin shear bond strength (SBS) of a new two-step etch-and-rinse adhesive system (MPa Direct) using self- and light-cured composites. METHODS: The dentin of 160 bovine teeth was ground to 600 grit. Self- (Bisfil 2B) or light-cured (Filtek Supreme Plus) composite was bonded to dentin using MPa Direct, Adper Single Bond Plus, One-Step Plus, OptiBond Solo Plus, or Prime & Bond NT. For the light-cured composite, MPa Direct was used both with and without the HEMA/glutaraldehyde desensitizer (G5) supplied in the kit. For the self-cured composite, OptiBond Solo Plus and Prime & Bond NT were used with and without their respective self-cure activators. Those two adhesives and MPa Direct also were used with the self-cured composite after removal of the oxygen-inhibited layer from the adhesive. Following storage in water for 24 hours, shear bond strengths were determined using a universal testing machine. The data were subjected to factorial ANOVA and Tukey's test. RESULTS: With the light-cured composite, the mean SBS of MPa Direct was 41.1 MPa. Use of G5 did not significantly affect mean SBS (35.7 MPa). Mean SBS of MPa Direct when used with the self-cured composite was significantly lower (16.6 MPa). However, removal of the oxygen-inhibited layer returned the bond strength (38.9 MPa) to the level obtained using light-cured composite. Both OptiBond Solo Plus and Prime & Bond NT had significantly lower bond strengths when used with the self-cured composite than with the light-cured composite, regardless of whether their self-cure activators were used. Removal of the oxygen-inhibited layer improved the bond strengths of these two adhesives, but the improvement was less than that observed for MPa Direct. Bond strengths of One-Step Plus and Adper Single Bond Plus were not affected by the type of composite resin used.