The effect of blood pressure on mortality following out-of-hospital cardiac arrest : a retrospective cohort study of the United Kingdom Intensive Care National Audit and Research Centre database

Correction: Volume27, Issue 1 Article Number:169 DOI: 10.1186/s13054-023-04458-x Published: MAY 4 2023Background: Hypotension following out-of-hospital cardiac arrest (OHCA) may cause secondary brain injury and increase mortality rates. Current guidelines recommend avoiding hypotension. However, the optimal blood pressure following OHCA is unknown. We hypothesised that exposure to hypotension and hypertension in the first 24 h in ICU would be associated with mortality following OHCA. Methods: We conducted a retrospective analysis of OHCA patients included in the Intensive Care National Audit and Research Centre Case Mix Programme from 1 January 2010 to 31 December 2019. Restricted cubic splines were created following adjustment for important prognostic variables. We report the adjusted odds ratio for associations between lowest and highest mean arterial pressure (MAP) and systolic blood pressure (SBP) in the first 24 h of ICU care and hospital mortality. Results: A total of 32,349 patients were included in the analysis. Hospital mortality was 56.2%. The median lowest and highest MAP and SBP were similar in survivors and non-survivors. Both hypotension and hypertension were associated with increased mortality. Patients who had a lowest recorded MAP in the range 60-63 mmHg had the lowest associated mortality. Patients who had a highest recorded MAP in the range 95-104 mmHg had the lowest associated mortality. The association between SBP and mortality followed a similar pattern to MAP. Conclusions: We found an association between hypotension and hypertension in the first 24 h in ICU and mortality following OHCA. The inability to distinguish between the median blood pressure of survivors and non-survivors indicates the need for research into individualised blood pressure targets for survivors following OHCA.Peer reviewe

The association between time of in hospital cardiac arrest and mortality:a retrospective analysis of two UK databases

Aims: The incidence of in hospital cardiac arrest (IHCA) varies throughout the day. This study aimed to report the variation in incidence of IHCA, presenting rhythm and outcome based on the hour in which IHCA occurred. Methods: We conducted a retrospective analysis of the National Cardiac Arrest Audit (NCAA) including patients who suffered an IHCA from 1st April 2011 to 31st December 2019. We then linked the NCAA and intensive care Case Mix Programme databases to explore the effect of time of IHCA on hospital survival in the subgroup of patients admitted to intensive care following IHCA. Results: We identified 115,690 eligible patients in the NCAA database. Pulseless electrical activity was the commonest presenting rhythm (54.8%). 66,885 patients died in the immediate post resuscitation period. Overall, hospital survival in the NCAA cohort was 21.3%. We identified 13,858 patients with linked ICU admissions in the Case Mix Programme database; 37.0% survived to hospital discharge. The incidence of IHCA peaked at 06.00. Rates of return of spontaneous circulation, survival to hospital discharge and good neurological outcome were lowest between 05.00 and 07.00. Among those admitted to ICU, no clear diurnal variation in hospital survival was seen in the unadjusted or adjusted analysis. This pattern was consistent across all presenting rhythms. Conclusions: We observed higher rates of IHCA, and poorer outcomes at night. However, in those admitted to ICU, this variation was absent. This suggests patient factors and processes of care issues contribute to the variation in IHCA seen throughout the day

Selective and Contagious Prosocial Resource Donation in Capuchin Monkeys, Chimpanzees and Humans

Prosocial acts benefitting others are widespread amongst humans. By contrast, chimpanzees have failed to demonstrate such a disposition in several studies, leading some authors to conclude that the forms of prosociality studied evolved in humans since our common ancestry. However, similar prosocial behavior has since been documented in other primates, such as capuchin monkeys. Here, applying the same methodology to humans, chimpanzees, and capuchins, we provide evidence that all three species will display prosocial behavior, but only in certain conditions. Fundamental forms of prosociality were age-dependent in children, conditional on self-beneficial resource distributions even at age seven, and conditional on social or resource configurations in chimpanzees and capuchins. We provide the first evidence that experience of conspecific companions’ prosocial behavior facilitates prosocial behavior in children and chimpanzees. Prosocial actions were manifested in all three species following rules of contingency that may reflect strategically adaptive responses

Dimensional reduction of 4d heterotic string black holes

We perform the spherical symmetric dimensional reduction $4d\to2d$ of heterotic string theory. We find a class of two-dimensional (2d) dilaton gravity models that gives a general description of the near-horizon, near-extremal behavior of four-dimensional (4d) heterotic string black holes. We show that the duality group of the 4d theory is realized in two dimensions in terms of Weyl transformations of the metric. We use the 2d dilaton gravity theory to compute the statistical entropy of the near-extremal 4d, $a=1/\sqrt3$, black hole.Comment: 12 pages, LaTex fil

Cell Encapsulation in Sub-mm Sized Gel Modules Using Replica Molding

For many types of cells, behavior in two-dimensional (2D) culture differs from that in three-dimensional (3D) culture. Among biologists, 2D culture on treated plastic surfaces is currently the most popular method for cell culture. In 3D, no analogous standard method—one that is similarly convenient, flexible, and reproducible—exists. This paper describes a soft-lithographic method to encapsulate cells in 3D gel objects (modules) in a variety of simple shapes (cylinders, crosses, rectangular prisms) with lateral dimensions between 40 and 1000 μm, cell densities of 105 – 108 cells/cm3, and total volumes between 1×10−7 and 8×10−4 cm3. By varying (i) the initial density of cells at seeding, and (ii) the dimensions of the modules, the number of cells per module ranged from 1 to 2500 cells. Modules were formed from a range of standard biopolymers, including collagen, Matrigel™, and agarose, without the complex equipment often used in encapsulation. The small dimensions of the modules allowed rapid transport of nutrients by diffusion to cells at any location in the module, and therefore allowed generation of modules with cell densities near to those of dense tissues (108 – 109 cells/cm3). This modular method is based on soft lithography and requires little special equipment; the method is therefore accessible, flexible, and well suited to (i) understanding the behavior of cells in 3D environments at high densities of cells, as in dense tissues, and (ii) developing applications in tissue engineering

Classical Open String Models in 4-Dim Minkowski Spacetime

Classical bosonic open string models in fourdimensional Minkowski spacetime are discussed. A special attention is paid to the choice of edge conditions, which can follow consistently from the action principle. We consider lagrangians that can depend on second order derivatives of worldsheet coordinates. A revised interpretation of the variational problem for such theories is given. We derive a general form of a boundary term that can be added to the open string action to control edge conditions and modify conservation laws. An extended boundary problem for minimal surfaces is examined. Following the treatment of this model in the geometric approach, we obtain that classical open string states correspond to solutions of a complex Liouville equation. In contrast to the Nambu-Goto case, the Liouville potential is finite and constant at worldsheet boundaries. The phase part of the potential defines topological sectors of solutions.Comment: 25 pages, LaTeX, preprint TPJU-28-93 (the previous version was truncated by ftp...

Long Distance Contribution to s→dγs \to d\gamma and Implications for Ω−→Ξ−γ,Bs→Bd∗γ\Omega^-\to \Xi ^-\gamma, B_s \to B_d^*\gamma and b→sγb \to s\gamma

We estimate the long distance (LD) contribution to the magnetic part of the $s \to d\gamma$ transition using the Vector Meson Dominance approximation $(V=\rho,\omega,\psi_i)$. We find that this contribution may be significantly larger than the short distance (SD) contribution to $s \to d\gamma$ and could possibly saturate the present experimental upper bound on the $\Omega^-\to \Xi^-\gamma$ decay rate, $\Gamma^{\rm MAX}_{\Omega^-\to \Xi^-\gamma} \simeq 3.7\times10^{-9}$eV. For the decay $B_s \to B^*_d\gamma$, which is driven by $s \to d\gamma$ as well, we obtain an upper bound on the branching ratio $BR(B_s \to B_d^*\gamma)<3\times10^{-8}$ from $\Gamma^{\rm MAX}_{\Omega^-\to \Xi^-\gamma}$. Barring the possibility that the Quantum Chromodynamics coefficient $a_2(m_s)$ be much smaller than 1, $\Gamma^{\rm MAX}_{\Omega^-\to \Xi^-\gamma}$ also implies the approximate relation $\frac{2}{3} \sum_i \frac{g^2_{\psi_i}(0)}{m^2_{\psi_i}} \simeq \frac{1}{2} \frac{g^2_\rho(0)}{m^2_\rho} + \frac{1}{6}\frac{g^2_\omega(0)}{m^2_\omega}$. This relation agrees quantitatively with a recent independent estimate of the l.h.s. by Deshpande et al., confirming that the LD contributions to $b \to s\gamma$ are small. We find that these amount to an increase of $(4\pm2)\%$ in the magnitude of the $b \to s \gamma$ transition amplitude, relative to the SD contribution alone.Comment: 16 pages, LaTeX fil

Beyond the Singularity of the 2-D Charged Black Hole

Two dimensional charged black holes in string theory can be obtained as exact (SL(2,R)xU(1))/U(1) quotient CFTs. The geometry of the quotient is induced from that of the group, and in particular includes regions beyond the black hole singularities. Moreover, wavefunctions in such black holes are obtained from gauge invariant vertex operators in the SL(2,R) CFT, hence their behavior beyond the singularity is determined. When the black hole is charged we find that the wavefunctions are smooth at the singularities. Unlike the uncharged case, scattering waves prepared beyond the singularity are not fully reflected; part of the wave is transmitted through the singularity. Hence, the physics outside the horizon of a charged black hole is sensitive to conditions set behind the past singularity.Comment: 19 pages, 5 figures; v2: refs added, minor typos corrected; v3: references on the infinite blue shift at the inner horizon and minor corrections adde

High-dose etoposide with granulocyte colony-stimulating factor for mobilization of peripheral blood progenitor cells: efficacy and toxicity at three dose levels.

High-dose etoposide (2.0-2.4 g m(-2)) with granulocyte colony-stimulating factor (G-CSF) is an effective strategy to mobilize peripheral blood progenitor cells (PBPCs), although in some patients this is associated with significant toxicity. Sixty-three patients with malignancy were enrolled into this non-randomized sequential study. The majority (55/63, 87%) had received at least two prior regimens of chemotherapy, and seven patients had previously failed to mobilize following high-dose cyclophosphamide with G-CSF. Consecutive patient groups received etoposide at three dose levels [2.0 g m(-2) (n = 22), 1.8 g m(-2) (n = 20) and 1.6 g m(-2) (n = 21)] followed by daily G-CSF. Subsequent leukaphereses were assayed for CD34+ cell content, with a target total collection of 2.0 x 10(6) CD34+ cells kg(-1). Toxicity was assessed by the development of significant mucositis, the requirement for parenteral antibiotics or blood component support and rehospitalization incidence. Ten patients (16%) had less than the minimum target yield collected. Median collections in the three groups were 4.7 (2 g m(-2)), 5.7 (1.8 g m(-2)) and 6.5 (1.6 g m(-2)) x 10(6) CD34+ cells kg(-1). Five of the seven patients who had previously failed cyclophosphamide mobilization achieved more than the target yield. Rehospitalization incidence was significantly lower in patients receiving 1.6 g m(-2) etoposide than in those receiving 2.0 g m(-2) (P = 0.03). These data suggest that high-dose etoposide with G-CSF is an efficient mobilization regimen in the majority of heavily pretreated patients, including those who have previously failed on high-dose cyclophosphamide with G-CSF. An etoposide dose of 1.6 g m(-2) appears to be as effective as higher doses but less toxic