Annual improvement trends in resuscitation outcome of patients defibrillated by laypersons after out-of-hospital cardiac arrests and compression-only resuscitation of laypersons.

AIM: We aimed to investigate the effect of compression-only cardiopulmonary resuscitation (CPR) with conventional CPR in patients who were defibrillated by laypersons. METHODS: This is a population-based, nationwide observational study. Adult and children who sustained a witnessed out-of-hospital cardiac arrest and defibrillated by laypersons between 2005 to 2019 were identified on the national database. The study used trend analyses, multivariate logistic regression, and inverse probability weighting using propensity score to explore changes in one-month survival and survival with a good neurological outcome over time and the influence of compression-only CPR compared with conventional CPR. RESULTS: In total, 11,402 patients defibrillated by laypersons were enrolled in this study. The percentages of compression-only resuscitation increased dramatically and more than 50% from 2012 (P < 0.001). The percentages of cases with favorable resuscitation outcomes also increased annually (P < 0.001). By regression analysis, favorable outcomes were associated with recent years, male sex, younger age, and shorter resuscitation start time. In addition, the adjusted odds ratio of compression-only CPR to conventional CPR was 1.23 with a 95% confident interval 1.13-1.34. By inverse probability weighting, compression-only CPR was superior to conventional CPR for the favorable outcomes (P < 0.001). The adjusted outcomes in each year were better in compression-only resuscitation in most of the years. The overall relative risk reduction and the number needed to treat for compression-only resuscitation compared with conventional resuscitation were 7.6% and 22.1, respectively. CONCLUSIONS: In Japan, the outcomes of out-of-hospital cardiac arrest patients who were defibrillated by laypersons were considerably better in compression-only resuscitation of laypersons every year.

Altered consciousness with transient abnormal signals in the hippocampus: A case report.

Hippocampal infarction is relatively rare. Many different diseases can mimic hippocampal infarction including transient global amnesia, Alzheimer's disease, epilepsy, encephalitis, and encephalopathies. An 89-year-old man was transported to our hospital for altered consciousness. Diffusion-weighted magnetic resonance imaging revealed slightly intense signals in the hippocampus with a mildly decreased apparent diffusion coefficient. Serial magnetic resonance imaging revealed features of hippocampal infarction. Symptoms and cognitive function gradually improved with rehabilitation, and he was transferred to a rehabilitation facility on Hospital Day 38. Hippocampal infarction is rare in patients with altered mental status, but should be considered when magnetic resonance imaging shows findings suggestive of this condition. Other differential diseases should be ruled out by serial magnetic resonance imaging and observation of the clinical course.

Tachyarrhythmia improved by management of low back pain in a patient with delayed diagnosis of infective spondylodiscitis: A case report.

A 77-year-old man presented to the emergency room with a 1-month history of persistent low back pain with the absence of vital sign abnormalities. On several previous orthopedic surgery clinic visits, pathological back pain had not been considered and pain killers had been prescribed because he had low back pain due to lumbar spinal canal stenosis. He was admitted to the intensive care unit for infectious spondylodiscitis and infective endocarditis with disseminated abscess caused by methicillin-resistant Staphylococcus aureus. Shock refractory tachyarrhythmia could not be managed with antiarrhythmic agent in the intensive care unit. Intractable low back pain and persistent tachyarrhythmia were adequately managed by pain control with fentanyl in the intensive care unit. Infectious spondylodiscitis and infective endocarditis were effectively managed with anti-methicillin-resistant Staphylococcus aureus drugs, initially in rotational usage, but the patient died of extended-spectrum beta-lactamase-producing Escherichia coli pneumonia on day 50 of hospitalization. Infectious spondylodiscitis should have been considered for persistent low back pain with hemodialysis, fever, and a history of device implantation. Pain management may be necessary for persistent tachycardia that proves unresponsive to usual antiarrhythmic medications.

Type A fulminant Clostridium perfringens sepsis indicated RBC/Hb discrepancy; a case report.

BACKGROUND: Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. C. perfringens septicemia is rare, but is a known cause of hemolysis by damaging red blood cell, and often proves rapidly fatal in emergency department (ED) situations. CASE PRESENTATION: A previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. Laboratory examination revealed a large discrepancy between the red blood cell count of 1.91 × 106/mm3 and the hemoglobin level of 10.3 g/dL, suggesting massive intravascular hemolysis. Computed tomography revealed liver abscesses with gas. During ED treatment, the state of the patient rapidly deteriorated and he entered cardiopulmonary arrest. Blood cultures finally identified C. perfringens. CONCLUSION: Intravascular hemolysis and red blood cell (RBC) / hemoglobin (Hb) discrepancy in the presence of infection should prompt ED physicians to consider C. perfringens septicemia and to act quickly to provide appropriate treatment.

Nickel-Catalyzed Propylene/Polar Monomer Copolymerization.

Nickel complexes bearing bidentate alkylphophine-phenolate ligands were synthesized and applied to the polymerization of propylene and the copolymerization of propylene and polar monomers. Therein, the use of bulky alkyl substituents on the phosphorus atom was crucial for the formation of highly regioregular polypropylenes. Theoretical calculations suggested that the 1,2-insertion of propylene is favored over the 2,1-insertion in these nickel-catalyzed (co)polymerization reactions. The substituent at the ortho position relative to the oxido group greatly influences the polymerization activity, the molecular weight, and stereoregularity of the polypropylenes. This method delivers moderately isotactic ([mm] ≤ 68%) crystalline polypropylenes. The present system represents the first example for a nickel-catalyzed regiocontrolled copolymerization of propylene and polar monomers such as but-3-en-1-ol, but-3-en-1-yl acetate, and tert-butyl allylcarbamate.

Nickel Catalyzed Copolymerization of Ethylene and Alkyl Acrylates.

Ni(II) complexes bearing an o-bis(aryl)phosphinophenolate ligand were synthesized as catalysts for copolymerization of ethylene and alkyl acrylates. When the P-bound aryl group was 2,6-dimethoxyphenyl group, one of the oxygen atoms in the methoxy groups coordinated to the nickel center on its apical position. This complex was a highly active catalyst without any activators to give highly linear and high molecular weight copolymers. The structures of the copolymers were determined by 1H and 13C NMR to clarify that the alkyl acrylate comonomers were incorporated in the main chain and that the structures of the copolymers were significantly influenced by the structure of the aryl group in the ligand.

Mechanisms of the Cycloaddition Reaction of Methylenecyclopropane-Palladium and Oxa- and Azatrimethylenemethane-Palladium Complexes with Olefins.

Mechanisms of palladium-catalyzed cycloaddition reactions of methylenecyclopropane with olefins and those of oxatrimethylenemethane (OTMM) and azatrimethylenemethane (ATMM) complexes with olefins have been studied by applying the ab initio molecular orbital method. Assuming an intramolecular coupling mechanism, we have examined some model complexes, Pd(eta(2)-methylenecyclopropane)(ethylene)(PH(3)) and Pd(eta(3)-OTMM or eta(3)-ATMM)(ethylene)(PH(3)), to determine the transition state structures. The coupling of methylenecyclopropane, OTMM, and ATMM with ethylene on the metal center takes place in two steps. In the reaction of methylenecyclopropane, the first step involves an opening of the cyclopropane ring promoted by an attack of ethylene. The methylenecyclopropane moiety has a pi-allylic form at the first transition state which leads to a metallacyclic intermediate. The first transition state of the reactions of OTMM and ATMM complexes looks very similar to that of the methylenecyclopropane complex, having pi-allylic coordinations. The two paths are separated in the second step. A [3 + 2] addition product is obtained by a reductive elimination from the intermediate metallacycle, whereas a prototropic shift followed by a reductive elimination affords a [2 + 1] addition product. It is the energetics of the second stage starting from the metallacycles that differentiates the reactions of the OTMM and ATMM complexes from the reaction of the methylenecyclopropane complex. The relative stabilities of various isomeric forms of these complexes have also been studied.