2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research

Overexpression of the catalytic subunit of DNA polymerase γ results in depletion of mitochondrial DNA in Drosophila melanogaster

El pdf es el borrador del artículo.The mechanisms involved in the regulation of mitochondrial DNA (mtDNA) replication, a process that is crucial for mitochondrial biogenesis, are not well understood. In this study, we evaluate the role of DNA polymerase γ (pol γ), the key enzyme in mtDNA replication, in both Drosophila cell culture and in developing flies. We report that overexpression of the pol γ catalytic subunit (pol γ-α) in cultured Schneider cells does not alter either the amount of mtDNA or the growth rate of the culture. The polypeptide is properly targeted to mitochondria, yet the large excess of pol γ-α does not interfere with mtDNA replication under these conditions where the endogenous polypeptide is apparently present in amounts that exceed of the demand for its function in the cell. In striking contrast, overexpression of pol γ-α at the same level in transgenic flies interferes with the mtDNA replication process, presumably by altering the mechanism of DNA synthesis, suggesting differential requirements for, and/or regulation of, mtDNA replication in Drosophila cell culture versus the developing organism. Overexpression of pol γ-α in transgenic flies produces a significant depletion of mtDNA that causes a broad variety of phenotypic effects. These alterations range from pupal lethality to moderate morphological abnormalities in adults, depending on the level and temporal pattern of overexpression. Our results demonstrate that although cells may tolerate a variable amount of the pol γ catalytic subunit under some conditions, its level may be critical in the context of the whole organism.This work was supported by grants PB97-0034 from the DGICYT (Ministerio de Educación y Ciencia, Spain) to R.G. and from the National Institutes of Health (GM45295) to L.S.K. Etienne Lefai was a recipient of a European Union fellowship from theMarie Curie program.Peer Reviewe

Helmet use and bicycle-related trauma injury outcomes

Background: It is essential to identify factors that predict helmet use, so as to mitigate the injury and mortality from bicycle accidents.Objective: To examine the relationship between helmet use and the bicycle-related trauma injury outcomes among bicyclists with head/neck injury in the US.Methods: Data from the 2002-2012 National Trauma Data Bank were used, including all trauma bicycle riders involved in bicycle-related accidents whose primary reason for the hospital or Intensive Care Unit stay was head or neck injury. Using multiple logistic regression, the association between helmet use, Injury severity score (ISS), length of stay in hospital (HLOS) and Intensive Care Unit (ICULOS), and mortality was examined.Results: Of the 76,032 bicyclists with head/neck injury, 22% worn helmets. The lowest was among Blacks, Hispanics, and <17 years old. Wearing a helmet significantly reduces injury severity, HLOS, ICULOS, and mortality (i.e total and in-hospital). Males had a severe injury, longer HLOS, ICULOS, and higher mortality than female. Blacks and Hispanics had longer HLOS and ICULOS and higher total mortality than Whites, but had a similar chance for in-hospital mortality.Conclusions: More effort is needed to enhance helmet use among at-risk bicycle riders, which may reduce injury severity, HLOS, ICULOS, and mortality

Helmet use and bicycle-related trauma injury outcomes

Background: It is essential to identify factors that predict helmet use, so as to mitigate the injury and mortality from bicycle accidents.Objective: To examine the relationship between helmet use and the bicycle-related trauma injury outcomes among bicyclists with head/neck injury in the US.Methods: Data from the 2002-2012 National Trauma Data Bank were used, including all trauma bicycle riders involved in bicycle-related accidents whose primary reason for the hospital or Intensive Care Unit stay was head or neck injury. Using multiple logistic regression, the association between helmet use, Injury severity score (ISS), length of stay in hospital (HLOS) and Intensive Care Unit (ICULOS), and mortality was examined.Results: Of the 76,032 bicyclists with head/neck injury, 22% worn helmets. The lowest was among Blacks, Hispanics, and <17 years old. Wearing a helmet significantly reduces injury severity, HLOS, ICULOS, and mortality (i.e total and in-hospital). Males had a severe injury, longer HLOS, ICULOS, and higher mortality than female. Blacks and Hispanics had longer HLOS and ICULOS and higher total mortality than Whites, but had a similar chance for in-hospital mortality.Conclusions: More effort is needed to enhance helmet use among at-risk bicycle riders, which may reduce injury severity, HLOS, ICULOS, and mortality

Standardizing emergency department hyperkalemia management: The PLATINUM study

Background and Objectives: Although hyperkalemia (HK) is common and potentially life-threatening, there is limited data defining an ED standard of care (SoC). ED treatment is mostly based on small studies, anecdotal experience, and historical standards. The lack of a SoC has resulted in wide practice variability and created challenges for the control arm of any investigation. The PLATINUM (Patiromer utiLity as an Adjunct Treatment In patients Needing Urgent hyperkalemia Management) study has proposed an ED SoC HK treatment regimen. Methods: This is a multicenter, randomized, double-blind, placebo-controlled, parallel group study. After informed consent, ED subjects ≥18 years old with potassium (K) ≥ 5.8 mEq/L are enrolled. Exclusions are clinically significant arrhythmia, hemodynamic instability, overdose on K, known bowel obstruction, K binder use within 7 days, expected dialysis within 6 hours of enrollment, hypersensitivity to patiromer, participation in another studyprior, inability to take study drug, life expectancy of \u3c6 \u3emonths, or pregnant/breastfeeding. No more than 50% will be current hemodialysis recipients. Upon enrollment, subjects are randomized to treatment or control in a 1:1 ratio, and all receive SoC therapy defined as regular insulin 5U IV plus dextrose 25 g IV plus albuterol 10 mg nebulized. Controls receive blinded placebo and the treatment group receives blinded patiromer 25.2 g by mouth. Serum K is drawn at baseline and every 2 hours up to 10 hours or until ED discharge. Efficacy will be evaluated by comparing Net Clinical Benefit (NCB) at 6 hours between study arms as defined by the mean change in number of interventions less mean change in serum K. Safety analysis will include frequency and severity of adverse events, ECG changes, hypokalemia and hypomagnesemia. Results: A total of 300 subjects will be enrolled from 30 sites across the United States. A modified intention to treat analysis will be used for the primary endpoint. Proportions will be analyzed using Cochran-Mantel- Haenszel methods while continuous variables will be analyzed using analysis of covariance. Conclusion: The Platinum study is the first randomized controlled trial to evaluate the efficacy and safety of a standard combination of insulin, dextrose, and albuterol with or without an oral K binder for treatment of HK. In addition, the 150-patient control arm may help define the optimal ED HK SoC management