A systematic review of neuroprotective strategies after cardiac arrest: from bench to bedside (Part I - Protection via specific pathways).

Neurocognitive deficits are a major source of morbidity in survivors of cardiac arrest. Treatment options that could be implemented either during cardiopulmonary resuscitation or after return of spontaneous circulation to improve these neurological deficits are limited. We conducted a literature review of treatment protocols designed to evaluate neurologic outcome and survival following cardiac arrest with associated global cerebral ischemia. The search was limited to investigational therapies that were utilized to treat global cerebral ischemia associated with cardiac arrest. In this review we discuss potential mechanisms of neurologic protection following cardiac arrest including actions of several medical gases such as xenon, argon, and nitric oxide. The 3 included mechanisms are: 1. Modulation of neuronal cell death; 2. Alteration of oxygen free radicals; and 3. Improving cerebral hemodynamics. Only a few approaches have been evaluated in limited fashion in cardiac arrest patients and results show inconclusive neuroprotective effects. Future research focusing on combined neuroprotective strategies that target multiple pathways are compelling in the setting of global brain ischemia resulting from cardiac arrest

Comparison of web-based and face-to-face interviews for application to an anesthesiology training program: a pilot study.

ObjectiveThis study compared admission rates to a United States anesthesiology residency program for applicants completing face-to-face versus web-based interviews during the admissions process. We also explored factors driving applicants to select each interview type.MethodsThe 211 applicants invited to interview for admission to our anesthesiology residency program during the 2014-2015 application cycle were participants in this pilot observational study. Of these, 141 applicants selected face-to-face interviews, 53 applicants selected web-based interviews, and 17 applicants declined to interview. Data regarding applicants' reasons for selecting a particular interview type were gathered using an anonymous online survey after interview completion. Residency program admission rates and survey answers were compared between applicants completing face-to-face versus web-based interviews.ResultsOne hundred twenty-seven (75.1%) applicants completed face-to-face and 42 (24.9%) completed web-based interviews. The admission rate to our residency program was not significantly different between applicants completing face-to-face versus web-based interviews. One hundred eleven applicants completed post-interview surveys. The most common reasons for selecting web-based interviews were conflict of interview dates between programs, travel concerns, or financial limitations. Applicants selected face-to-face interviews due to a desire to interact with current residents, or geographic proximity to the residency program.ConclusionsThese results suggest that completion of web-based interviews is a viable alternative to completion of face-to-face interviews, and that choice of interview type does not affect the rate of applicant admission to the residency program. Web-based interviews may be of particular interest to applicants applying to a large number of programs, or with financial limitations

X-ray Bright Active Galactic Nuclei in Massive Galaxy Clusters II: The Fraction of Galaxies Hosting Active Nuclei

We present a measurement of the fraction of cluster galaxies hosting X-ray bright Active Galactic Nuclei (AGN) as a function of clustercentric distance scaled in units of $r_{500}$. Our analysis employs high quality Chandra X-ray and Subaru optical imaging for 42 massive X-ray selected galaxy cluster fields spanning the redshift range of $0.2 < z < 0.7$. In total, our study involves 176 AGN with bright ($R <23$) optical counterparts above a $0.5-8.0$ keV flux limit of $10^{-14} \rm{erg} \ \rm{cm}^{-2} \ \rm{s}^{-1}$. When excluding central dominant galaxies from the calculation, we measure a cluster-galaxy AGN fraction in the central regions of the clusters that is $\sim 3$ times lower that the field value. This fraction increases with clustercentric distance before becoming consistent with the field at $\sim 2.5 r_{500}$. Our data exhibit similar radial trends to those observed for star formation and optically selected AGN in cluster member galaxies, both of which are also suppressed near cluster centers to a comparable extent. These results strongly support the idea that X-ray AGN activity and strong star formation are linked through their common dependence on available reservoirs of cold gas.Comment: 9 Pages, 4 Figures, accepted for publication in MNRAS, please contact Steven Ehlert ([email protected]) with any querie

Cosmology and Astrophysics from Relaxed Galaxy Clusters II: Cosmological Constraints

We present cosmological constraints from measurements of the gas mass fraction, $f_{gas}$, for massive, dynamically relaxed galaxy clusters. Our data set consists of Chandra observations of 40 such clusters, identified in a comprehensive search of the Chandra archive, as well as high-quality weak gravitational lensing data for a subset of these clusters. Incorporating a robust gravitational lensing calibration of the X-ray mass estimates, and restricting our measurements to the most self-similar and accurately measured regions of clusters, significantly reduces systematic uncertainties compared to previous work. Our data for the first time constrain the intrinsic scatter in $f_{gas}$, $(7.4\pm2.3)$% in a spherical shell at radii 0.8-1.2 $r_{2500}$, consistent with the expected variation in gas depletion and non-thermal pressure for relaxed clusters. From the lowest-redshift data in our sample we obtain a constraint on a combination of the Hubble parameter and cosmic baryon fraction, $h^{3/2}\Omega_b/\Omega_m=0.089\pm0.012$, that is insensitive to the nature of dark energy. Combined with standard priors on $h$ and $\Omega_b h^2$, this provides a tight constraint on the cosmic matter density, $\Omega_m=0.27\pm0.04$, which is similarly insensitive to dark energy. Using the entire cluster sample, extending to $z>1$, we obtain consistent results for $\Omega_m$ and interesting constraints on dark energy: $\Omega_\Lambda=0.65^{+0.17}_{-0.22}$ for non-flat $\Lambda$CDM models, and $w=-0.98\pm0.26$ for flat constant-$w$ models. Our results are both competitive and consistent with those from recent CMB, SNIa and BAO data. We present constraints on models of evolving dark energy from the combination of $f_{gas}$ data with these external data sets, and comment on the possibilities for improved $f_{gas}$ constraints using current and next-generation X-ray observatories and lensing data. (Abridged)Comment: 25 pages, 14 figures, 8 tables. Accepted by MNRAS. Code and data can be downloaded from http://www.slac.stanford.edu/~amantz/work/fgas14/ . v2: minor fix to table 1, updated bibliograph

Human Fetal Progenitor Tenocytes for Regenerative Medicine.

Tendon injuries are very frequent and affect a wide and heterogeneous population. Unfortunately, the healing process is long with outcomes that are not often satisfactory due to fibrotic tissue appearance, which leads to scar and adhesion development. Tissue engineering and cell therapies emerge as interesting alternatives to classical treatments. In this study, we evaluated human fetal progenitor tenocytes (hFPTs) as a potential cell source for treatment of tendon afflictions, as fetal cells are known to promote healing in a scarless regenerative process. hFPTs presented a rapid and stable growth up to passage 9, allowing to create a large cell bank for off-the-shelf availability. hFPTs showed a strong tenogenic phenotype with an excellent stability, even when placed in conditions normally inducing cells to differentiate. The karyotype also indicated a good stability up to passage 12, which is far beyond that necessary for clinical application (passage 6). When placed in coculture, hFPTs had the capacity to stimulate human adult tenocytes (hATs), which are responsible for the deposition of a new extracellular matrix during tendon healing. Finally, it was possible to distribute cells in porous or gel scaffolds with an excellent survival, thus permitting a large variety of applications (from simple injections to grafts acting as filling material). All of these results are encouraging in the development of an off-the-shelf cell source capable of stimulating tendon regeneration for the treatment of tendon injuries

Cosmology and astrophysics from relaxed galaxy clusters - IV: Robustly calibrating hydrostatic masses with weak lensing

This is the fourth in a series of papers studying the astrophysics and cosmology of massive, dynamically relaxed galaxy clusters. Here, we use measurements of weak gravitational lensing from the Weighing the Giants project to calibrate Chandra X-ray measurements of total mass that rely on the assumption of hydrostatic equilibrium. This comparison of X-ray and lensing masses provides a measurement of the combined bias of X-ray hydrostatic masses due to both astrophysical and instrumental sources. Assuming a fixed cosmology, and within a characteristic radius (r_2500) determined from the X-ray data, we measure a lensing to X-ray mass ratio of 0.96 +/- 9% (stat) +/- 9% (sys). We find no significant trends of this ratio with mass, redshift or the morphological indicators used to select the sample. In accordance with predictions from hydro simulations for the most massive, relaxed clusters, our results disfavor strong, tens-of-percent departures from hydrostatic equilibrium at these radii. In addition, we find a mean concentration of the sample measured from lensing data of c_200 = $3.0_{-1.8}^{+4.4}$. Anticipated short-term improvements in lensing systematics, and a modest expansion of the relaxed lensing sample, can easily increase the measurement precision by 30--50%, leading to similar improvements in cosmological constraints that employ X-ray hydrostatic mass estimates, such as on Omega_m from the cluster gas mass fraction.Comment: 13 pages. Submitted to MNRAS. Comments welcom

Autologous keratinocyte suspension in platelet concentrate accelerates and enhances wound healing - a prospective randomized clinical trial on skin graft donor sites: platelet concentrate and keratinocytes on donor sites.

BACKGROUND: Wound healing involves complex mechanisms, which, if properly chaperoned, can enhance patient recovery. The abilities of platelets and keratinocytes may be harnessed in order to stimulate wound healing through the formation of platelet clots, the release of several growth factors and cytokines, and cell proliferation. The aim of the study was to test whether autologous keratinocyte suspensions in platelet concentrate would improve wound healing. The study was conducted at the Lausanne University Hospital, Switzerland in 45 patients, randomized to three different topical treatment groups: standard treatment serving as control, autologous platelet concentrate (PC) and keratinocytes suspended in autologous platelet concentrate (PC + K). Split thickness skin graft donor sites were chosen on the anterolateral thighs of patients undergoing plastic surgery for a variety of defects. Wound healing was assessed by the duration and quality of the healing process. Pain intensity was evaluated at day five. RESULTS: Healing time was reduced from 13.9 ± 0.5 days (mean ± SEM) in the control group to 7.2 ± 0.2 days in the PC group (P &lt; 0.01). An addition of keratinocytes in suspension further reduced the healing time to 5.7 ± 0.2 days. Pain was reduced in both the PC and PC + K groups. Data showed a statistically detectable advantage of using PC + K over PC alone (P &lt; 0.01). CONCLUSION: The results demonstrate the positive contribution of autologous platelets combined with keratinocytes in stimulating wound healing and reducing pain. This strikingly simple approach could have a significant impact on patient care, especially critically burned victims for whom time is of the essence. CLINICAL TRIAL REGISTRY INFORMATION: Protocol Record Identification Number: 132/03Registry URL: http://www.clinicaltrials.gov