Does this comatose survivor of cardiac arrest have a poor prognosis?

Neurological prognostication in comatose survivors of cardiac arrest requires a multimodal approach combining clinical and diagnostic tests. Most patients with good outcomes recover consciousness within 72–120 h of arrest, and therefore the suggested timing for prognostication is 72 h from ROSC, or later. Results of earlier prognostic tests, such as status myoclonus and NSE levels, should also be considered at this time point. A careful clinical neurological examination is the cornerstone of prognostic assessment [and it should be performed after major confounders, (e.g. residual sedation,neuromuscular blockade, metabolic derangements) have been excluded.Although absent or extensormotor responses to pain are not specific for predicting a poor neurological outcome, they are highly sensitive for identifying those patients who require neurological prognostication

Quantum limits to center-of-mass measurements

We discuss the issue of measuring the mean position (center-of-mass) of a group of bosonic or fermionic quantum particles, including particle number fluctuations. We introduce a standard quantum limit for these measurements at ultra-low temperatures, and discuss this limit in the context of both photons and ultra-cold atoms. In the case of fermions, we present evidence that the Pauli exclusion principle has a strongly beneficial effect, giving rise to a 1/N scaling in the position standard-deviation -- as opposed to a $1/\sqrt{N}$ scaling for bosons. The difference between the actual mean-position fluctuation and this limit is evidence for quantum wave-packet spreading in the center-of-mass. This macroscopic quantum effect cannot be readily observed for non-interacting particles, due to classical pulse broadening. For this reason, we also study the evolution of photonic and matter-wave solitons, where classical dispersion is suppressed. In the photonic case, we show that the intrinsic quantum diffusion of the mean position can contribute significantly to uncertainties in soliton pulse arrival times. We also discuss ways in which the relatively long lifetimes of attractive bosons in matter-wave solitons may be used to demonstrate quantum interference between massive objects composed of thousands of particles.Comment: 12 pages, 6 figures. Submitted to PRA. Revised to include more references as well as a discussion of fermionic center-of-mas

Demonstration of extracellular peptidylarginine deiminase (PAD) activity in synovial fluid of patients with rheumatoid arthritis using a novel assay for citrullination of fibrinogen

INTRODUCTION: Members of the peptidylarginine deiminase (PAD) family catalyse the posttranslational conversion of peptidylarginine to peptidylcitrulline. Citrullination of proteins is well described in rheumatoid arthritis (RA), and hypercitrullination of proteins may be related to inflammation in general. PAD activity has been demonstrated in various cell lysates, but so far not in synovial fluid. We aimed to develop an assay for detection of PAD activity, if any, in synovial fluid from RA patients. METHODS: An enzyme-linked immunosorbent assay using human fibrinogen as the immobilized substrate for citrullination and anti-citrullinated fibrinogen antibody as the detecting agent were used for measurement of PAD activity in synovial fluid samples from five RA patients. The concentrations of PAD2 and calcium were also determined. RESULTS: Approximately 150 times lower levels of recombinant human PAD2 (rhPAD2) than of rhPAD4 were required for citrullination of fibrinogen. PAD activity was detected in four of five synovial fluid samples from RA patients and correlated with PAD2 concentrations in the samples (r = 0.98, P = 0.003). The calcium requirement for half-maximal activities of PAD2 and PAD4 were found in a range from 0.35 to 1.85 mM, and synovial fluid was found to contain sufficient calcium levels for the citrullination process to occur. CONCLUSIONS: We present an assay with high specificity for PAD2 activity and show that citrullination of fibrinogen can occur in cell-free synovial fluid from RA patients

The James Clerk Maxwell Telescope Spectral Legacy Survey

Original article can be found at: http://www.journals.uchicago.edu/loi/pasp Copyright University of Chicago Press / AAS. DOI: 10.1086/511161Stars form in the densest, coldest, most quiescent regions of molecular clouds. Molecules provide the only probes that can reveal the dynamics, physics, chemistry, and evolution of these regions, but our understanding of the molecular inventory of sources and how this is related to their physical state and evolution is rudimentary and incomplete. The Spectral Legacy Survey (SLS) is one of seven surveys recently approved by the James Clerk Maxwell Telescope (JCMT) Board of Directors. Beginning in 2007, the SLS will produce a spectral imaging survey of the content and distribution of all the molecules detected in the 345 GHz atmospheric window (between 332 and 373 GHz) toward a sample of five sources. Our intended targets are a low-mass core (NGC 1333 IRAS 4), three high-mass cores spanning a range of star-forming environments and evolutionary states (W49, AFGL 2591, and IRAS 20126), and a photodissociation region (the Orion Bar). The SLS will use the unique spectral imaging capabilities of HARP-B/ACSIS (Heterodyne Array Receiver Programme B/Auto- Correlation Spectrometer and Imaging System) to study the molecular inventory and the physical structure of these objects, which span different evolutionary stages and physical environments and to probe their evolution during the star formation process. As its name suggests, the SLS will provide a lasting data legacy from the JCMT that is intended to benefit the entire astronomical community. As such, the entire data set (including calibrated spectral data cubes, maps of molecular emission, line identifications, and calculations of the gas temperature and column density) will be publicly available.Peer reviewe

Neurocardiac risk stratification 6 hours after resuscitation from cardiac arrest

Introduction: • An increasing number of patients are resuscitated from out-ofhospital cardiac arrest. Triage to optimal treatment pathways could improve and increase the efficacy of post-resuscition care. • Despite great variability in etiology, duration, and patterns of injury from cardiac arrest, post-resuscitation treatment guidelines emphasize standard treatments. We hypothesize that by categorizing competing risks very early after resuscitation, it may be possible to improve the efficacy and efficiency of care. • When measured very early after resuscitation, suppression ratio (SR, the percentage of suppressed EEG), correlates with severity of brain injury and the likelihood of poor neurological outcome. • The CREST score2 is a validated model to predict circulatoryetiology death (CED) based on: Coronary artery disease, initial nonshockable Rhythm, Ejection fraction25 minutes

IRC+10216's Innermost Envelope -- The eSMA's View

We used the Extended Submillimeter Array (eSMA) in its most extended configuration to investigate the innermost (within a radius of 290 R* from the star) circumstellar envelope (CSE) of IRC+10216. We imaged the CSE using HCN and other molecular lines with a beam size of 0."22 x 0."46, deeply into the very inner edge (15 R*) of the envelope where the expansion velocity is only 3 km/s. The excitation mechanism of hot HCN and KCl maser lines is discussed. HCN maser components are spatially resolved for the first time on an astronomical object. We identified two discrete regions in the envelope: a region with a radius of . 15 R*, where molecular species have just formed and the gas has begun to be accelerated (region I) and a shell region (region II) with a radius of 23 R* and a thickness of 15 R*, whose expansion velocity has reached up to 13 km/s, nearly the terminal velocity of 15 km/s. The Si$^{34}$S line detected in region I shows a large expansion velocity of 16 km/s due to strong wing components, indicating that the emission may arise from a shock region in the innermost envelope. In region II, the P.A. of the most copious mass loss direction was found to be 120 +/- 10 degrees, which may correspond to the equatorial direction of the star. Region II contains a torus-like feature. These two regions may have emerged due to significant differences in the size distributions of the dust particles in the two regions.Comment: 26 pages, 8 figures, accepted for publication in The Astrophysical Journal. Please find the pdf at http://www.submm.caltech.edu/~hs/astroph/0904.0280.pdf and the ps file at http://www.submm.caltech.edu/~hs/astroph/0904.0280.p

The JCMT Legacy Survey of the Gould Belt: a first look at Orion B with HARP

‘The definitive version is available at www3.interscience.wiley.com '. Copyright Royal Astronomical Society.The Gould Belt Legacy Survey will survey nearby star-forming regions (within 500 pc), using Heterodyne Array Receiver Programme (HARP), Submillimetre Common-User Bolometer Array 2 and Polarimeter 2 on the James Clerk Maxwell Telescope. This paper describes the initial data obtained using HARP to observe 12CO, 13CO and C18O J= 3 → 2 towards two regions in Orion B, NGC 2024 and NGC 2071. We describe the physical characteristics of the two clouds, calculating temperatures and opacities utilizing all the three isotopologues. We find good agreement between temperatures calculated from CO and from dust emission in the dense, energetic regions. We determine the mass and energetics of the clouds, and of the high-velocity material seen in 12CO emission, and compare the relative energetics of the high- and low-velocity material in the two clouds. We present a clumpfind analysis of the 13CO condensations. The slope of the condensation mass functions, at the high-mass ends, is similar to the slope of the initial mass function.Peer reviewe

Electroencephalography (EEG) for neurological prognostication after cardiac arrest and targeted temperature management; rationale and study design.

BACKGROUND: Electroencephalography (EEG) is widely used to assess neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by inter-rater variability. The American Clinical Neurophysiology Society (ACNS) has recently proposed a standardized EEG-terminology for critical care to address these limitations. METHODS/DESIGN: In the TTM-trial, 399 post cardiac arrest patients who remained comatose after rewarming underwent a routine EEG. The presence of clinical seizures, use of sedatives and antiepileptic drugs during the EEG-registration were prospectively documented. DISCUSSION: A well-defined terminology for interpreting post cardiac arrest EEGs is critical for the use of EEG as a prognostic tool. TRIAL REGISTRATION: The TTM-trial is registered at ClinicalTrials.gov (NCT01020916)

Predicting neurological outcome after out-of-hospital cardiac arrest with cumulative information; development and internal validation of an artificial neural network algorithm

BACKGROUND: Prognostication of neurological outcome in patients who remain comatose after cardiac arrest resuscitation is complex. Clinical variables, as well as biomarkers of brain injury, cardiac injury, and systemic inflammation, all yield some prognostic value. We hypothesised that cumulative information obtained during the first three days of intensive care could produce a reliable model for predicting neurological outcome following out-of-hospital cardiac arrest (OHCA) using artificial neural network (ANN) with and without biomarkers. METHODS: We performed a post hoc analysis of 932 patients from the Target Temperature Management trial. We focused on comatose patients at 24, 48, and 72 h post-cardiac arrest and excluded patients who were awake or deceased at these time points. 80% of the patients were allocated for model development (training set) and 20% for internal validation (test set). To investigate the prognostic potential of different levels of biomarkers (clinically available and research-grade), patients' background information, and intensive care observation and treatment, we created three models for each time point: (1) clinical variables, (2) adding clinically accessible biomarkers, e.g., neuron-specific enolase (NSE) and (3) adding research-grade biomarkers, e.g., neurofilament light (NFL). Patient outcome was the dichotomised Cerebral Performance Category (CPC) at six months; a good outcome was defined as CPC 1-2 whilst a poor outcome was defined as CPC 3-5. The area under the receiver operating characteristic curve (AUROC) was calculated for all test sets. RESULTS: AUROC remained below 90% when using only clinical variables throughout the first three days in the ICU. Adding clinically accessible biomarkers such as NSE, AUROC increased from 82 to 94% (p < 0.01). The prognostic accuracy remained excellent from day 1 to day 3 with an AUROC at approximately 95% when adding research-grade biomarkers. The models which included NSE after 72 h and NFL on any of the three days had a low risk of false-positive predictions while retaining a low number of false-negative predictions. CONCLUSIONS: In this exploratory study, ANNs provided good to excellent prognostic accuracy in predicting neurological outcome in comatose patients post OHCA. The models which included NSE after 72 h and NFL on all days showed promising prognostic performance