An observational study on survival rates of patients with out-of-hospital cardiac arrest in the Netherlands after improving the 'chain of survival'.

OBJECTIVES: To evaluate the impact of implemented procedures for out-of-hospital cardiac arrests (OHCAs) by determining patient outcome defined as the percentage return of spontaneous circulation at arrival at the emergency department, and 3-month and 1-year-survival rates. DESIGN: Observational study. SETTING: Primary emergency medical care consisting of Advanced Life Support is given by ambulance nurses and secondary care by hospitals within the mid-western part of the Netherlands covering 750 000 inhabitants. PARTICIPANTS: 433 of 500 consecutive patients with OHCA were included in the study over a 1.5 -year period. OUTCOME MEASURES: Analysis included number of patients with return of spontaneous circulation (ROSC) when handed over to the emergency department, survival at 3 months and 1 year including a comparison with global outcome rates. We further considered the influence of gender, delays, bystander Basic Life Support, use of an automated external defibrillator, initial rhythm and mechanical thorax compression in combination with Boussignac tube ventilation. RESULTS: 13% (67/500) of the initial patient population was excluded from the analysis as reanimation in these patients was aborted due to expressed wish not to be resuscitated. Resuscitation was started by bystanders, police and/or first responders in 312/433 (72%) cases. An automated external defibrillator was used in 198 of these 312 cases (63%) of which it defibrillated 108 times. Mechanical thorax compression in combination with Boussignac tube ventilation was necessary in 277/433 patients (64%). Spontaneous circulation returned in 96/277 (35%) patients of this group. In the overall studied population, ROSC percentage at arrival at the hospital was 214/433 (49%). The 3-month and 12-month-survival rates were 123/433 (28%) and 119/433 (27%), respectively. CONCLUSIONS: Optimised 'chain of survival' for patients with OHCA resulted in ROSC in 49% of the cases and a 1-year-survival rate of 27% in the studied population.

Learning-related neuronal activation in the zebra finch song system nucleus HVC in response to the bird's own song.

Like many other songbird species, male zebra finches learn their song from a tutor early in life. Song learning in birds has strong parallels with speech acquisition in human infants at both the behavioral and neural levels. Forebrain nuclei in the 'song system' are important for the sensorimotor acquisition and production of song, while caudomedial pallial brain regions outside the song system are thought to contain the neural substrate of tutor song memory. Here, we exposed three groups of adult zebra finch males to either tutor song, to their own song, or to novel conspecific song. Expression of the immediate early gene protein product Zenk was measured in the song system nuclei HVC, robust nucleus of the arcopallium (RA) and Area X. There were no significant differences in overall Zenk expression between the three groups. However, Zenk expression in the HVC was significantly positively correlated with the strength of song learning only in the group that was exposed to the bird's own song, not in the other two groups. These results suggest that the song system nucleus HVC may contain a neural representation of a memory of the bird's own song. Such a representation may be formed during juvenile song learning and guide the bird's vocal output.

Localized brain activation specific to auditory memory in a female songbird.

Song acquisition in songbird males is a prominent model system for the study of the brain mechanisms of memory. Male zebra finches (Taeniopygia guttata) learn their songs from an adult conspecific tutor early in life. Previous work has shown that exposure of males to their tutor song leads to increased expression of immediate early genes (IEGs) in the caudomedial nidopallium (NCM) and in the caudomedial mesopallium (CMM). In addition, IEG expression in the NCM correlates significantly with the strength of song learning. Interpretation of these findings is complicated, as males both learn the characteristics of tutor song and learn to produce a similar own song. Female zebra finches do not sing, but nevertheless they learn the characteristics of a song to which they were exposed when young, and form a preference for it. Here, adult zebra finch females reared with their fathers showed a significant preference for their father's song. Females that were later reexposed to their father's song showed significantly greater expression of Zenk, the protein product of the IEG ZENK, than controls that were exposed to a novel song, in the CMM, but not in the NCM or hippocampus. These results suggest that in female zebra finches the CMM may be (part of) the neural substrate for the representation of the memory of their father's song.

Neuronal activation related to auditory perception in the brain of a non-songbird, the ring dove.

In songbirds, parrots, and hummingbirds, which need to learn their songs, exposure to conspecific song leads to increased expression of the immediate early gene (IEG) ZENK in a number of forebrain regions, including the caudomedial nidopallium (NCM) and the caudomedial mesopallium (CMM). Here we investigated the pattern of IEG expression in response to auditory stimulation in the brain of the ring dove (Streptopelia risoria), a non-songbird that does not need to learn its vocalizations. Ring dove males were exposed to conspecific vocalizations (coos), to heterospecific vocalizations (zebra finch song) or they were kept in silence. IEG expression was investigated by means of immunocytochemical analysis of the distribution of the ZENK protein product Zenk. In all three groups there was Zenk expression in several forebrain regions including the NCM and the CMM, similar to earlier findings in song-learning species. Quantitative analysis of the NCM, the CMM, and the hippocampus revealed significantly greater Zenk expression in birds exposed to conspecific vocalizations than in birds kept in silence, in the CMM only. These results show that there is substantial Zenk expression in the forebrain of a non-song-learning bird, comparable to that in avian song-learning taxa. These findings suggest that there is IEG expression specific to conspecific auditory stimulation in the CMM in both songbirds and non-songbirds.

An analysis of the neural representation of birdsong memory.

Songbirds, such as zebra finches, learn their song from a tutor early in life. Forebrain nuclei in the "song system" are important for the acquisition and production of song. Brain regions [including the caudomedial part of the neostriatum (NCM) and of the hyperstriatum ventrale (CMHV)] outside the song system show increased neuronal activation, measured as expression of immediate early genes (IEGs), when zebra finch males are exposed to song. IEG expression in the NCM in response to tutor song is significantly positively correlated with the strength of song learning (i.e., the number of elements copied). Here, we exposed three groups of adult zebra finch males to tutor song, to their own song, or to novel conspecific song. The two control groups were included to examine an alternative explanation of our previous results in terms of variation in predisposed levels of attentiveness. Expression of Zenk, the protein product of the IEG ZENK, was measured in the NCM, CMHV, and hippocampus. There were no significant differences in overall Zenk expression between the three experimental groups. However, there was a significant positive correlation between Zenk expression in the NCM (but not in the other two regions) and strength of song learning in the males that were exposed to the tutor song. There was no such correlation in the other two groups. These results suggest that experience-related neuronal activation is specific to the tutor song and thus unlikely to be a result of differences in attention.

Sexual equality in zebra finch song preference: evidence for a dissociation between song recognition and production learning.

Song in oscine birds is a culturally inherited mating signal and sexually dimorphic. From differences in song production learning, sex differences in song recognition learning have been inferred but rarely put to a stringent test. In zebra finches, Taeniopygia guttata, females never sing and the species has one of the greatest neuroanatomical differences in song-related brain nuclei reported for songbirds. Preference tests with sibling groups for which exposure to song had been identical during the sensitive phase for song learning in males, revealed equally strong influence of the tutor's song (here the father) on males' and females' adult song preferences. Both sexes significantly preferred the father's over unfamiliar song when having free control over exposure to playbacks via an operant task. The sibling comparisons suggest that this preference developed independently of the song's absolute quality: variation between siblings was as great as between nests. The results show that early exposure has an equally strong influence on males' and females' song preferences despite the sexual asymmetry in song production learning. This suggests that the trajectory for song recognition learning is independent of the one for song production learning.