Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients.

OBJECTIVES: To determine the association between spontaneous hypothermia (SH), defined as initial post-resuscitation core body temperature less than 34°C, and diffuse anoxic brain injury (DABI) on initial CT scan of the head (CTH) in post-cardiac arrest patients. DESIGN SETTING AND PARTICIPANTS: This was a retrospective, observational cohort study. This study was performed at the University of Rochester Medical Center Strong Memorial Hospital. All in-hospital and out-of-hospital cardiac arrest patients with return of spontaneous circulation admitted between January 1, 2022, and October 31, 2022, were included. MAIN OUTCOMES AND MEASURES: The primary outcomes were the odds of DABI on initial CTH for patients with SH compared with patients without SH post-cardiac arrest using a multivariable logistic regression controlling for patient covariates including basic demographics and arrest features. DABI on initial CTH was measured qualitatively and quantitatively using neuroradiologist interpretation and calculated gray-white matter ratio of the basal ganglia, respectively. Secondary outcome measures included length of stay (LOS), inpatient mortality, and those who underwent withdrawal of life-sustaining therapy (WOLST) or progression to brain death. RESULTS: Out of the observed 150 cases of cardiac arrest, 31 patients (21%) had SH. Of the 128 patients who had an initial CTH performed, 27 (21%) had DABI. The adjusted odds ratio of DABI on initial CTH associated with SH was 3.55 (95% CI, 1.08-11.64; p = 0.036) and 2.18 (95% CI, 0.69-6.91; p = 0.182) when DABI was measured qualitatively and quantitatively, respectively, after controlling for multiple covariates. There was a difference observed in LOS between the groups (3 vs. 10 d; p = 0.0005) and this was driven by early WOLST. CONCLUSIONS AND REVELANCE: Patients presenting with SH after cardiac arrest may be at greater risk of early DABI on initial CTH compared with those with higher body temperatures in the post-arrest period. Recognition of early SH may help to risk stratify post-cardiac arrest patients at highest risk of DABI.

Transitions of Care Coordination Intervention Identifies Barriers to Discharge in Hospitalized Stroke Patients.

Background: Prolonged hospital lengths of stay increase costs, delay rehabilitation, and expose acute ischemic stroke patients to hospital-acquired infections. We designed and implemented a nurse-driven transitions of care coordinator (TOCC) program to facilitate the transition of care from the acute care hospital setting to rehabilitation centers and home. Methods: This was a single-blinded, prospective, randomized pilot study of 40 participants to evaluate the feasibility of implementing a TOCC program led by a stroke nurse navigator in hospitalized acute ischemic stroke patients. The intervention consisted of a stroke nurse navigator completing eight specific tasks, including meeting with stroke patients and their families, facilitating communication between team members at multi-disciplinary rounds, assisting with referrals to rehabilitation facilities, providing stroke education, and arranging stroke clinic follow-up appointments, which were confirmed to be completed by independent study personnel. The primary outcome was to assess the feasibility of the program. The secondary outcomes included comparing hospital length of stay (LOS) and patient satisfaction between the TOCC and usual care groups. We also explored the association between patient-level variables and LOS. Results: The TOCC program was feasible with all pre-specified components completed in 84.2% (95% CI: 60.4-96.6%) and was not significantly different from the assumed completion rate of 75% (p = 0.438). There was no significant difference in median LOS between the two groups [TOCC 5.95 days (4.02, 9.57) vs. usual care 4.01 days (2.00, 10.45), false discovery rate (FDR)-adjusted p = 0.138]. There was a trend toward higher patient median satisfaction in the TOCC group [TOCC 35.00 (33.00, 35.00) vs. usual care 30 (26.00, 35.00), FDR-adjusted p = 0.1] as assessed by a questionnaire at 30 days after discharge. The TOCC study allowed us to identify patient variables (gender, insurance, stroke severity, and discharge disposition) that were significantly associated with longer hospital LOS. Conclusion: A TOCC program is feasible and can serve as a guide for future allocation of resources to facilitate transitions of care and avoid prolonged hospital stays.

Plant phloem sterol content: forms, putative functions, and implications for phloem-feeding insects.

All eukaryotes contain sterols, which serve as structural components in cell membranes, and as precursors for important hormones. Plant vegetative tissues are known to contain mixtures of sterols, but very little is known about the sterol composition of phloem. Plants are food for many animals, but plant-feeding arthropods (including phloem-feeding insets) are unique among animals in that they have lost the ability to synthesize sterols, and must therefore acquire these essential nutrients from their food, or via endosymbionts. Our paper starts by providing a very brief overview of variation in plant sterol content, and how different sterols can affect insect herbivores, including those specializing on phloem. We then describe an experiment, where we bulk collected phloem sap exudate from bean and tobacco, and analyzed its sterol content. This approach revealed two significant observations concerning phloem sterols. First, the phloem exudate from each plant was found to contain sterols in three different fractions - free sterols, sterols conjugated to lipids (acylated), and sterols conjugated to carbohydrates (glycosylated). Second, for both plants, cholesterol was identified as the dominant sterol in each phloem exudate fraction; the remaining sterols in each fraction were a mixture of common phytosterols. We discuss our phloem exudate sterol profiles in a plant physiology/biochemistry context, and how it relates to the nutritional physiology/ecology of phloem-feeding insects. We close by proposing important next steps that will advance our knowledge concerning plant phloem sterol biology, and how phloem-sterol content might affect phloem-feeding insects.