How to diagnose the cause of sudden cardiac arrest

Sudden cardiac death or sudden cardiac arrest (SCA) is defined as natural death that occurs within an hour of the onset of acute symptoms or during sleep due to a primary cardiac cause. Most cases of SCA are attributable to coronary artery disease, with occult cardiomyopathy or inheritable arrhythmic syndromes accounting for a minority of SCA. Diagnosing the cause of SCA has potential implications for the patient and the family, and demands a comprehensive approach. This review summarizes the potential causes of SCA and outlines a systematic diagnostic approach to the SCA survivor. (Cardiol J 2011; 18, 2: 210-216

Progression to chronic atrial fibrillation after pacing: the Canadian Trial of Physiologic Pacing

AbstractOBJECTIVESThis study examined the effect of physiologic pacing on the development of chronic atrial fibrillation (CAF) in the Canadian Trial Of Physiologic Pacing (CTOPP).BACKGROUNDThe role of physiologic pacing to prevent CAF remains unclear. Small randomized studies have suggested a benefit for patients with sick sinus syndrome. No data from a large randomized trial are available.METHODSThe CTOPP randomized patients undergoing first pacemaker implant to ventricular-based or physiologic pacing (AAI or DDD). Patients who were prospectively found to have persistent atrial fibrillation (AF) lasting greater than or equal to one week were defined as having CAF. Kaplan-Meier plots for the development of CAF were compared by log-rank test. The effect of baseline variables on the benefit of physiologic pacing was evaluated by Cox proportional hazards modeling.RESULTSPhysiologic pacing reduced the development of CAF by 27.1%, from 3.84% per year to 2.8% per year (p = 0.016). Three clinical factors predicted the development of CAF: age ≥74 years (p = 0.057), sinoatrial (SA) node disease (p < 0.001) and prior AF (p < 0.001). Subgroup analysis demonstrated a trend for patients with no history of myocardial infarction or coronary disease (p = 0.09) as well as apparently normal left ventricular function (p = 0.11) to derive greatest benefit.CONCLUSIONSPhysiologic pacing reduces the annual rate of development of chronic AF in patients undergoing first pacemaker implant. Age ≥74 years, SA node disease and prior AF predicted the development of CAF. Patients with structurally normal hearts appear to derive greatest benefits

Separation and enrichment of enantiopure from racemic compounds using magnetic levitation

Crystallization of a solution with high enantiomeric excess can generate a mixture of crystals of the desired enantiomer and the racemic compound. Using a mixture of S-/RS-ibuprofen crystals as a model, we demonstrated that magnetic levitation (MagLev) is a useful technique for analysis, separation and enantioenrichment of chiral/racemic products.Chemistry and Chemical Biolog

OGLE-2009-BLG-092/MOA-2009-BLG-137: A Dramatic Repeating Event With the Second Perturbation Predicted by Real-Time Analysis

We report the result of the analysis of a dramatic repeating gravitational microlensing event OGLE-2009-BLG-092/MOA-2009-BLG-137, for which the light curve is characterized by two distinct peaks with perturbations near both peaks. We find that the event is produced by the passage of the source trajectory over the central perturbation regions associated with the individual components of a wide-separation binary. The event is special in the sense that the second perturbation, occurring $\sim 100$ days after the first, was predicted by the real-time analysis conducted after the first peak, demonstrating that real-time modeling can be routinely done for binary and planetary events. With the data obtained from follow-up observations covering the second peak, we are able to uniquely determine the physical parameters of the lens system. We find that the event occurred on a bulge clump giant and it was produced by a binary lens composed of a K and M-type main-sequence stars. The estimated masses of the binary components are $M_1=0.69 \pm 0.11\ M_\odot$ and $M_2=0.36\pm 0.06\ M_\odot$, respectively, and they are separated in projection by $r_\perp=10.9\pm 1.3\ {\rm AU}$. The measured distance to the lens is $D_{\rm L}=5.6 \pm 0.7\ {\rm kpc}$. We also detect the orbital motion of the lens system.Comment: 18 pages, 5 figures, 1 tabl

Binary microlensing event OGLE-2009-BLG-020 gives a verifiable mass, distance and orbit predictions

We present the first example of binary microlensing for which the parameter measurements can be verified (or contradicted) by future Doppler observations. This test is made possible by a confluence of two relatively unusual circumstances. First, the binary lens is bright enough (I=15.6) to permit Doppler measurements. Second, we measure not only the usual 7 binary-lens parameters, but also the 'microlens parallax' (which yields the binary mass) and two components of the instantaneous orbital velocity. Thus we measure, effectively, 6 'Kepler+1' parameters (two instantaneous positions, two instantaneous velocities, the binary total mass, and the mass ratio). Since Doppler observations of the brighter binary component determine 5 Kepler parameters (period, velocity amplitude, eccentricity, phase, and position of periapsis), while the same spectroscopy yields the mass of the primary, the combined Doppler + microlensing observations would be overconstrained by 6 + (5 + 1) - (7 + 1) = 4 degrees of freedom. This makes possible an extremely strong test of the microlensing solution. We also introduce a uniform microlensing notation for single and binary lenses, we define conventions, summarize all known microlensing degeneracies and extend a set of parameters to describe full Keplerian motion of the binary lenses.Comment: 51 pages, 8 figures, 2 appendices. Submitted to ApJ. Fortran codes for Appendix B are attached to this astro-ph submission and are also available at http://www.astronomy.ohio-state.edu/~jskowron/OGLE-2009-BLG-020

Frequency of Solar-Like Systems and of Ice and Gas Giants Beyond the Snow Line from High-Magnification Microlensing Events in 2005-2008

We present the first measurement of planet frequency beyond the "snow line" for planet/star mass-ratios[-4.5<log q<-2]: d^2 N/dlog q/dlog s=(0.36+-0.15)/dex^2 at mean mass ratio q=5e-4, and consistent with being flat in log projected separation, s. Our result is based on a sample of 6 planets detected from intensive follow-up of high-mag (A>200) microlensing events during 2005-8. The sample host stars have typical mass M_host 0.5 Msun, and detection is sensitive to planets over a range of projected separations (R_E/s_max,R_E*s_max), where R_E 3.5 AU sqrt(M_host/Msun) is the Einstein radius and s_max (q/5e-5)^{2/3}, corresponding to deprojected separations ~3 times the "snow line". Though frenetic, the observations constitute a "controlled experiment", which permits measurement of absolute planet frequency. High-mag events are rare, but the high-mag channel is efficient: half of high-mag events were successfully monitored and half of these yielded planet detections. The planet frequency derived from microlensing is a factor 7 larger than from RV studies at factor ~25 smaller separations [2<P<2000 days]. However, this difference is basically consistent with the gradient derived from RV studies (when extrapolated well beyond the separations from which it is measured). This suggests a universal separation distribution across 2 dex in semi-major axis, 2 dex in mass ratio, and 0.3 dex in host mass. Finally, if all planetary systems were "analogs" of the Solar System, our sample would have yielded 18.2 planets (11.4 "Jupiters", 6.4 "Saturns", 0.3 "Uranuses", 0.2 "Neptunes") including 6.1 systems with 2 or more planet detections. This compares to 6 planets including one 2-planet system in the actual sample, implying a first estimate of 1/6 for the frequency of solar-like systems.Comment: 42 pages, 10 figure

MOA-2009-BLG-387Lb: A massive planet orbiting an M dwarf

We report the discovery of a planet with a high planet-to-star mass ratio in the microlensing event MOA-2009-BLG-387, which exhibited pronounced deviations over a 12-day interval, one of the longest for any planetary event. The host is an M dwarf, with a mass in the range 0.07 M_sun < M_host < 0.49M_sun at 90% confidence. The planet-star mass ratio q = 0.0132 +- 0.003 has been measured extremely well, so at the best-estimated host mass, the planet mass is m_p = 2.6 Jupiter masses for the median host mass, M = 0.19 M_sun. The host mass is determined from two "higher order" microlensing parameters. One of these, the angular Einstein radius \theta_E = 0.31 +- 0.03 mas, is very well measured, but the other (the microlens parallax \pi_E, which is due to the Earth's orbital motion) is highly degenate with the orbital motion of the planet. We statistically resolve the degeneracy between Earth and planet orbital effects by imposing priors from a Galactic model that specifies the positions and velocities of lenses and sources and a Kepler model of orbits. The 90% confidence intervals for the distance, semi-major axis, and period of the planet are 3.5 kpc < D_L < 7.9 kpc, 1.1 AU < a < 2.7AU, and 3.8 yr < P < 7.6 yr, respectively.Comment: 20 pages including 8 figures. A&A 529 102 (2011

A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the use of methylprednisolone sodium succinate

Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest." Results: The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) "We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI"; (2) "We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option"; and (3) "We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI." Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients

A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (<= 24 hours versus > 24 hours) of decompressive surgery

Objective: To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. Methods: A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as "we recommend," whereas a weak recommendation is presented as "we suggest." Results: Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation; (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery; and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: "We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome" and "We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level." Quality of evidence for both recommendations was considered low. Conclusions: These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions