To Tube or Not to Tube? The Role of Intubation during Stroke Thrombectomy.

In the 10 years since the FDA first cleared the use of endovascular devices for the treatment of acute stroke, definitive evidence that such therapy improves outcomes remains lacking. The decision to intubate patients undergoing stroke thrombectomy impacts multiple variables that may influence outcomes after stroke. Three main areas where intubation may deleteriously affect acute stroke management include the introduction of delays in revascularization, fluctuations in peri-procedural blood pressure, and hypocapnia, resulting in cerebral vasoconstriction. In this mini-review, we discuss the evidence supporting these limitations of intubation during stroke thrombectomy and encourage neurohospitalists, neurocritical care specialists, and neurointerventionalists to carefully consider the decision to intubate during thrombectomy and provide strategies to avoid potential complications associated with its use in acute stroke

Lipid rescue of massive verapamil overdose: a case report

<p>Abstract</p> <p>Introduction</p> <p>Massive intentional verapamil overdose is a toxic ingestion which can cause multiorgan system failure and has no currently known antidote.</p> <p>Case Presentation</p> <p>The patient is a 41-year-old Caucasian woman who ingested 19.2 g of sustained release verapamil in a suicide attempt. Our patient became hypotensive requiring three high-dose vasopressors to maintain arterial pressure. She also developed acute respiratory failure, bradycardic ventricular rhythm necessitating continuous transvenous pacing, and anuric renal failure. Our patient was treated with intravenous calcium, bicarbonate, hyperinsulinemic euglycemic therapy and continuous venovenous hemodialysis without success. On the fourth day after hospital admission continuous intravenous lipid therapy was initiated. Within three hours of beginning lipid therapy, our patient's vasopressor requirement decreased by half. Within 24 hours, she was on minimal vasopressor support and regained an underlying junctional rhythm. After three days of lipid infusion, she no longer required inotropic agents to maintain blood pressure or pacing to maintain stable hemodynamics.</p> <p>Conclusions</p> <p>Intravenous fat emulsion therapy may be an effective antidote for massive verapamil toxicity.</p

Dendritic Hold and Read: A Gated Mechanism for Short Term Information Storage and Retrieval

Two contrasting theories have been proposed to explain the mechanistic basis of short term memory. One theory posits that short term memory is represented by persistent neural activity supported by reverberating feedback networks. An alternate, more recent theory posits that short term memory can be supported by feedforward networks. While feedback driven memory can be implemented by well described mechanisms of synaptic plasticity, little is known of possible molecular and cellular mechanisms that can implement feedforward driven memory. Here we report such a mechanism in which the memory trace exists in the form of glutamate-bound but Mg2+-blocked NMDA receptors on the thin terminal dendrites of CA1 pyramidal neurons. Because glutamate dissociates from subsets of NMDA receptors very slowly, excitatory synaptic transmission can leave a silent residual trace that outlasts the electrical activity by hundreds of milliseconds. Read-out of the memory trace is possible if a critical level of these bound-but-blocked receptors accumulates on a dendritic branch that will allow these quasi-stable receptors to sustain a regenerative depolarization when triggered by an independent gating signal. This process is referred to here as dendritic hold and read (DHR). Because the read-out of the input is not dependent on repetition of the input and information flows in a single-pass manner, DHR can potentially support a feedforward memory architecture

Cyanobacteria in motion

This work was supported by a grant from the DFG (WI 2014/7-1) to A.W

A point-of-care clinical trial comparing insulin administered using a sliding scale versus a weight-based regimen

Background Clinical trials are widely considered the gold standard in comparative effectiveness research (CER) but the high cost and complexity of traditional trials and concerns about generalizability to broad patient populations and general clinical practice limit their appeal. Unsuccessful implementation of CER results limits the value of even the highest quality trials. Planning for a trial comparing two standard strategies of insulin administration for hospitalized patients led us to develop a new method for a clinical trial designed to be embedded directly into the clinical care setting thereby lowering the cost, increasing the pragmatic nature of the overall trial, strengthening implementation, and creating an integrated environment of research-based care

Cosmogenic background simulations for the DARWIN observatory at different underground locations

Xenon dual-phase time projections chambers (TPCs) have proven to be a successful technology in studying physical phenomena that require low-background conditions. With 40t of liquid xenon (LXe) in the TPC baseline design, DARWIN will have a high sensitivity for the detection of particle dark matter, neutrinoless double beta decay ($0\nu\beta\beta$), and axion-like particles (ALPs). Although cosmic muons are a source of background that cannot be entirely eliminated, they may be greatly diminished by placing the detector deep underground. In this study, we used Monte Carlo simulations to model the cosmogenic background expected for the DARWIN observatory at four underground laboratories: Laboratori Nazionali del Gran Sasso (LNGS), Sanford Underground Research Facility (SURF), Laboratoire Souterrain de Modane (LSM) and SNOLAB. We determine the production rates of unstable xenon isotopes and tritium due to muon-included neutron fluxes and muon-induced spallation. These are expected to represent the dominant contributions to cosmogenic backgrounds and thus the most relevant for site selection

Search for Coherent Elastic Scattering of Solar ⁸B Neutrinos in the XENON1T Dark Matter Experiment

We report on a search for nuclear recoil signals from solar 8B neutrinos elastically scattering off xenon nuclei in XENON1T data, lowering the energy threshold from 2.6 to 1.6  keV. We develop a variety of novel techniques to limit the resulting increase in backgrounds near the threshold. No significant 8B neutrinolike excess is found in an exposure of 0.6  t×y. For the first time, we use the nondetection of solar neutrinos to constrain the light yield from 1–2 keV nuclear recoils in liquid xenon, as well as nonstandard neutrino-quark interactions. Finally, we improve upon world-leading constraints on dark matter-nucleus interactions for dark matter masses between 3 and 11  GeV c−2 by as much as an order of magnitude

Search for inelastic scattering of WIMP dark matter in XENON1T

We report the results of a search for the inelastic scattering of weakly interacting massive particles (WIMPs) in the XENON1T dark matter experiment. Scattering off 129Xe is the most sensitive probe of inelastic WIMP interactions, with a signature of a 39.6 keV deexcitation photon detected simultaneously with the nuclear recoil. Using an exposure of 0.83 tonne-years, we find no evidence of inelastic WIMP scattering with a significance of more than 2σ. A profile-likelihood ratio analysis is used to set upper limits on the cross section of WIMP-nucleus interactions. We exclude new parameter space for WIMPs heavier than 100  GeV/c2, with the strongest upper limit of 3.3×10−39  cm2 for 130  GeV/c2 WIMPs at 90% confidence level

Low-energy Calibration of XENON1T with an Internal 37^{37}Ar Source

A low-energy electronic recoil calibration of XENON1T, a dual-phase xenontime projection chamber, with an internal $^{37}$Ar source was performed. Thiscalibration source features a 35-day half-life and provides two mono-energeticlines at 2.82 keV and 0.27 keV. The photon yield and electron yield at 2.82 keVare measured to be (32.3$\pm$0.3) photons/keV and (40.6$\pm$0.5) electrons/keV,respectively, in agreement with other measurements and with NEST predictions.The electron yield at 0.27 keV is also measured and it is(68.0$^{+6.3}_{-3.7}$) electrons/keV. The $^{37}$Ar calibration confirms thatthe detector is well-understood in the energy region close to the detectionthreshold, with the 2.82 keV line reconstructed at (2.83$\pm$0.02) keV, whichfurther validates the model used to interpret the low-energy electronic recoilexcess previously reported by XENON1T. The ability to efficiently remove argonwith cryogenic distillation after the calibration proves that $^{37}$Ar can beconsidered as a regular calibration source for multi-tonne xenon detectors.<br