Structural analysis of the factors pertaining to attitudes toward and consciousness of organ donation : Comparison between Japanese and Americans

The purpose of this study is to analyze the background factors relating to opinions on organ donation through factorial and structural comparisons between Japanese and Americans. The data were obtained from responses to a questionnaire (371 Japanese and 41 Americans). The main findings are as follows: 1. Most of the factors, ‘a will for organ donation depending on a recipient’, ‘view of remains’, ‘understanding of brain death’ and so on showed significant differences between Japanese and Americans. 2. Japanese had a better understanding of brain death. On the other hand, the ratio of Americans who were willing to donate an organ was higher than that of Japanese. 3. It was revealed that “the approval of organ donation for the third person, not only for one's family” had an impact for having donor card showing the approval for organ donation. Furthermore, as underlying factors generating differences on organ transplant opinions, differences were found among Japanese between “approval of organ transplant” and the attitude assuming that oneself or a member of one's family was the person concerned with organ transplantation. There were also differences between Japanese and Americans on ideas about a view for life and death such as soul existence or view of remains. The argument for transplantation in Japan should consider these structural differences

Neurological prognostication after cardiac arrest

Purpose of review Prediction of neurological prognosis in patients who are comatose after successful resuscitation from cardiac arrest remains difficult. Previous guidelines recommended ocular reflexes, somatosensory evoked potentials and serum biomarkers for predicting poor outcome within 72 h from cardiac arrest. However, these guidelines were based on patients not treated with targeted temperature management and did not appropriately address important biases in literature. Recent findings Recent evidence reviews detected important limitations in prognostication studies, such as low precision and, most importantly, lack of blinding, which may have caused a self-fulfilling prophecy and overestimated the specificity of index tests. Maintenance of targeted temperature using sedatives and muscle relaxants may interfere with clinical examination, making assessment of neurological status before 72 h or more after cardiac arrest unreliable. Summary No index predicts poor neurological outcome after cardiac arrest with absolute certainty. Prognostic evaluation should start not earlier than 72 h after ROSC and only after major confounders have been excluded so that reliable clinical examination can be made. Multimodality appears to be the most reasonable approach for prognostication after cardiac arrest

Time jitter of somatosensory evoked potentials in recovery from hypoxic-ischemic brain injury

Impaired neural conductivity shown by delayed latency and reduced amplitude of characteristic peaks in somatosensory evoked potentials (SSEPs), has been used to monitor hypoxic-ischemic brain injury after cardiac arrest (CA). However, rather than characteristic peak deferral and suppression, the time jitter of the peak in SSEP related with time-variant neurological abnormalities is diminished by the commonly used ensemble average method. This paper utilizes the second order blind identification (SOBI) technique to extract characteristic peak information from one trial of SSEPs. Sixteen male Wistar rats were subjected to 7 or 9. min of asphyxial CA (n= 8 per group). The SSEPs from median nerve stimulation were recorded for 4. h after CA and then for 15. min periods at 24, 48 and 72. h. Neurological outcomes were evaluated by neurologic deficit score (NDS) at 72. h post-CA. The SSEP signal was analyzed offline with SOBI processing in Matlab. The N10 feature of SSEP was compared between good (NDS ≥ 50) and bad (NDS < 50) outcomes. After processed by SOBI, the N10 detection rate was significantly increased (p< 0.001) from 90. min post-CA. Statistical difference of the latency variance of the N10 between good and bad outcome groups existed at 24, 48 and 72. h post-CA (p≤ 0.001). Our study is the first application using SOBI detecting variance in neural signals like SSEP. N10 latency variance, related with neurophysiological dysfunction, increased after hypoxic-ischemic injury. The SOBI technique is an efficient method in the identification of peak detection and offers a favorable alternative to reveal the neural transmission variation. © 2011 Elsevier B.V.link_to_subscribed_fulltex