Assessing Variability in End-of-Life Intensity of Care After Out-of-Hospital Cardiac Arrest

Out of hospital cardiac arrest (OHCA) affects over 300,000 Americans per year.1 Many factors affect the outcomes and overall OHCA survival in a community; some of these include an individual’s characteristics such as age, co-morbid conditions, availability of an AED on scene, time to CPR, and the characteristics of the hospital they are treated at.1,2 Directly following resuscitation from cardiac arrest, the individual is at risk of developing numerous problems caused by sequelae of ischemic injury sustained during the arrest. The national average rate of survival to discharge is only 10%.2,3 Many of these factors are modifiable and provide an opportunity to improve outcomes. In our project, we focus on lifesustaining procedures administered by hospitals upon receiving and admitting individuals experiencing OHCA. We used previously validated measures as defined by Barnato et al as “life sustaining end of life (EOL) measures”:4 • Intubation and mechanical ventilation • Tracheostomy • Gastrostomy tube insertion • Hemodialysis • Enteral/parenteral nutrition • CPRhttps://jdc.jefferson.edu/cwicposters/1035/thumbnail.jp

I-LEEP Newsletter Volume 1, Issue 1

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The Energy Landscape, Folding Pathways and the Kinetics of a Knotted Protein

The folding pathway and rate coefficients of the folding of a knotted protein are calculated for a potential energy function with minimal energetic frustration. A kinetic transition network is constructed using the discrete path sampling approach, and the resulting potential energy surface is visualized by constructing disconnectivity graphs. Owing to topological constraints, the low-lying portion of the landscape consists of three distinct regions, corresponding to the native knotted state and to configurations where either the N- or C-terminus is not yet folded into the knot. The fastest folding pathways from denatured states exhibit early formation of the N-terminus portion of the knot and a rate-determining step where the C-terminus is incorporated. The low-lying minima with the N-terminus knotted and the C-terminus free therefore constitute an off-pathway intermediate for this model. The insertion of both the N- and C-termini into the knot occur late in the folding process, creating large energy barriers that are the rate limiting steps in the folding process. When compared to other protein folding proteins of a similar length, this system folds over six orders of magnitude more slowly.Comment: 19 page

Using Single loxP Sites to Enhance Homologous Recombination: ts Mutants in Sec1 of Dictyostelium discoideum

Dictyostelium discoideum amoebae are haploid and, as they share many features with animal cells, should be an ideal creature for studying basic processes such as cell locomotion. Isolation of mutants in this amoeba has largely been limited to non-essential genes: nsfA-the gene for NEM-sensitive factor-remains the only essential gene for which conditional (ts) mutants exist. These ts mutants were generated by gene replacement using a library of mutagenised nsfA containing a selectable marker: transformants were then screened for temperature sensitivity. The success of this approach depended on the high level of homologous recombination prevailing at this locus: approximately 95% of selected clones were homologous recombinants. This is unusually high for Dictyostelium: homologous recombination at other loci is usually much less, usually between 0-30%, making the isolation of ts mutants much more tedious.In trying to make ts mutants in sec1A, homologous recombination was found to be only approximately 25%. A new approach, involving single loxP sites, was investigated. LoxP sites are 34 bp sequences recognised by Cre recombinase and between which this enzyme catalyses recombination. A Dictyostelium line containing a single loxP site adjacent to the 3' end of the sec1A gene was engineered. A sec1A replacement DNA also containing a single loxP site in a homologous position was then introduced into this cell line. In the presence of CRE recombinase, homologous recombination increased to approximately 80% at this locus, presumably largely driven by intermolecular recombination between the two single loxP sites.A route to increase the rate of homologous recombination at a specific locus, sec1A, is described which enabled the isolation of 30 ts mutants in sec1A. One of these, sec1Ats1,has been studied and found to cease moving at the restrictive temperature. The approach described here may be valuable for enhancing homologous recombination at specified loci and thus for introducing mutations into specific genes in Dictyostelium and other creatures

Association of plasma neurofilament light chain with disease activity in chronic inflammatory demyelinating polyradiculoneuropathy

BACKGROUND AND PURPOSE: This study was undertaken to explore associations between plasma neurofilament light chain (pNfL) concentration (pg/ml) and disease activity in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and examine the usefulness of pNfL concentrations in determining disease remission. METHODS: We examined pNfL concentrations in treatment-naïve CIDP patients (n = 10) before and after intravenous immunoglobulin (IVIg) induction treatment, in pNfL concentrations in patients on maintenance IVIg treatment who had stable (n = 15) versus unstable disease (n = 9), and in clinically stable IVIg-treated patients (n = 10) in whom we suspended IVIg to determine disease activity and ongoing need for maintenance IVIg. pNfL concentrations in an age-matched healthy control group were measured for comparison. RESULTS: Among treatment-naïve patients, pNfL concentration was higher in patients before IVIg treatment than healthy controls and subsequently reduced to be comparable to control group values after IVIg induction. Among CIDP patients on IVIg treatment, pNfL concentration was significantly higher in unstable patients than stable patients. A pNFL concentration > 16.6 pg/ml distinguished unstable treated CIDP from stable treated CIDP (sensitivity = 86.7%, specificity = 66.7%, area under receiver operating characteristic curve = 0.73). Among the treatment withdrawal group, there was a statistically significant correlation between pNfL concentration at time of IVIg withdrawal and the likelihood of relapse (r = 0.72, p < 0.05), suggesting an association of higher pNfL concentration with active disease. CONCLUSIONS: pNfL concentrations may be a sensitive, clinically useful biomarker in assessing subclinical disease activity

Schlieren Studies of Compressibility Effects on Dynamic Stall of Airfoils in Transient Pitching Motion

Compressibility effects on the flowfield of an airfoil executing rapid transient pitching motion from 0 - 60 degrees over a wide range of Mach numbers and pitching rates were studied using a stroboscopic schlieren flow visualization technique. The studies have led to the first direct experiments] documentation of multiple shocks on the airfoil upper surface flow for certain conditions. Also, at low Mach numbers, additional coherent vortical structures were found to be present along with the dynamic stall vortex, whereas at higher Mach numbers, the flow was dominated by a single vortex. The delineating Mach number for significant compressibility effects was 0.3 and the dynamic stall process was accelerated by increasing the Mach number above that value. Increasing the pitch rate monotonically delayed stall to angles of attack as large as 27 degrees.AFOSR-MIPR-87-0029 and 88-0010NAVAIRAR

I-LEEP Newsletter Volume 2, Issue 2

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Vitamins C and E and the risks of preeclampsia and perinatal complications

Copyright © 2006 Massachusetts Medical Society.Background: Supplementation with antioxidant vitamins has been proposed to reduce the risk of preeclampsia and perinatal complications, but the effects of this intervention are uncertain. Methods: We conducted a multicenter, randomized trial of nulliparous women between 14 and 22 weeks of gestation. Women were assigned to daily supplementation with 1000 mg of vitamin C and 400 IU of vitamin E or placebo (microcrystalline cellulose) until delivery. Primary outcomes were the risks of maternal preeclampsia, death or serious outcomes in the infants (on the basis of definitions used by the Australian and New Zealand Neonatal Network), and delivering an infant whose birth weight was below the 10th percentile for gestational age. Results: Of the 1877 women enrolled in the study, 935 were randomly assigned to the vitamin group and 942 to the placebo group. Baseline characteristics of the two groups were similar. There were no significant differences between the vitamin and placebo groups in the risk of preeclampsia (6.0 percent and 5.0 percent, respectively; relative risk, 1.20; 95 percent confidence interval, 0.82 to 1.75), death or serious outcomes in the infant (9.5 percent and 12.1 percent; relative risk, 0.79; 95 percent confidence interval, 0.61 to 1.02), or having an infant with a birth weight below the 10th percentile for gestational age (8.7 percent and 9.9 percent; relative risk, 0.87; 95 percent confidence interval, 0.66 to 1.16). Conclusions: Supplementation with vitamins C and E during pregnancy does not reduce the risk of preeclampsia in nulliparous women, the risk of intrauterine growth restriction, or the risk of death or other serious outcomes in their infants. (Controlledtrials.com number, ISRCTN00416244 [controlled-trials.com] .)Alice R. Rumbold, Caroline A. Crowther, Ross R. Haslam, Gustaaf A. Dekker and Jeffrey S. Robinso