The Curse Of An Aching Heart

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Association of blood-based brain injury biomarker concentrations with outcomes after pediatric cardiac arrest

Importance: Families and clinicians have limited validated tools available to assist in estimating long-term outcomes early after pediatric cardiac arrest. Blood-based brain-specific biomarkers may be helpful tools to aid in outcome assessment. Objective: To analyze the association of blood-based brain injury biomarker concentrations with outcomes 1 year after pediatric cardiac arrest. Design, Setting, and Participants: The Personalizing Outcomes After Child Cardiac Arrest multicenter prospective cohort study was conducted in pediatric intensive care units at 14 academic referral centers in the US between May 16, 2017, and August 19, 2020, with the primary investigators blinded to 1-year outcomes. The study included 120 children aged 48 hours to 17 years who were resuscitated after cardiac arrest, had pre-cardiac arrest Pediatric Cerebral Performance Category scores of 1 to 3 points, and were admitted to an intensive care unit after cardiac arrest. Exposure: Cardiac arrest. Main Outcomes and Measures: The primary outcome was an unfavorable outcome (death or survival with a Vineland Adaptive Behavior Scales, third edition, score of \u3c70 points) at 1 year after cardiac arrest. Glial fibrillary acidic protein (GFAP), ubiquitin carboxyl-terminal esterase L1 (UCH-L1), neurofilament light (NfL), and tau concentrations were measured in blood samples from days 1 to 3 after cardiac arrest. Multivariate logistic regression and area under the receiver operating characteristic curve (AUROC) analyses were performed to examine the association of each biomarker with outcomes on days 1 to 3. Results: Among 120 children with primary outcome data available, the median (IQR) age was 1.0 (0-8.5) year; 71 children (59.2%) were male. A total of 5 children (4.2%) were Asian, 19 (15.8%) were Black, 81 (67.5%) were White, and 15 (12.5%) were of unknown race; among 110 children with data on ethnicity, 11 (10.0%) were Hispanic, and 99 (90.0%) were non-Hispanic. Overall, 70 children (58.3%) had a favorable outcome, and 50 children (41.7%) had an unfavorable outcome, including 43 deaths. On days 1 to 3 after cardiac arrest, concentrations of all 4 measured biomarkers were higher in children with an unfavorable vs a favorable outcome at 1 year. After covariate adjustment, NfL concentrations on day 1 (adjusted odds ratio [aOR], 5.91; 95% CI, 1.82-19.19), day 2 (aOR, 11.88; 95% CI, 3.82-36.92), and day 3 (aOR, 10.22; 95% CI, 3.14-33.33); UCH-L1 concentrations on day 2 (aOR, 11.27; 95% CI, 3.00-42.36) and day 3 (aOR, 7.56; 95% CI, 2.11-27.09); GFAP concentrations on day 2 (aOR, 2.31; 95% CI, 1.19-4.48) and day 3 (aOR, 2.19; 95% CI, 1.19-4.03); and tau concentrations on day 1 (aOR, 2.44; 95% CI, 1.14-5.25), day 2 (aOR, 2.28; 95% CI, 1.31-3.97), and day 3 (aOR, 2.04; 95% CI, 1.16-3.57) were associated with an unfavorable outcome. The AUROC models were significantly higher with vs without the addition of NfL on day 2 (AUROC, 0.932 [95% CI, 0.877-0.987] vs 0.871 [95% CI, 0.793-0.949]; P = .02) and day 3 (AUROC, 0.921 [95% CI, 0.857-0.986] vs 0.870 [95% CI, 0.786-0.953]; P = .03). Conclusions and Relevance: In this cohort study, blood-based brain injury biomarkers, especially NfL, were associated with an unfavorable outcome at 1 year after pediatric cardiac arrest. Additional evaluation of the accuracy of the association between biomarkers and neurodevelopmental outcomes beyond 1 year is needed

Assessment of brain magnetic resonance and spectroscopy imaging findings and outcomes after pediatric cardiac arrest

IMPORTANCE: Morbidity and mortality after pediatric cardiac arrest are chiefly due to hypoxic-ischemic brain injury. Brain features seen on magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) after arrest may identify injury and aid in outcome assessments. OBJECTIVE: To analyze the association of brain lesions seen on T2-weighted MRI and diffusion-weighted imaging and N-acetylaspartate (NAA) and lactate concentrations seen on MRS with 1-year outcomes after pediatric cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study took place in pediatric intensive care units at 14 US hospitals between May 16, 2017, and August 19, 2020. Children aged 48 hours to 17 years who were resuscitated from in-hospital or out-of-hospital cardiac arrest and who had a clinical brain MRI or MRS performed within 14 days postarrest were included in the study. Data were analyzed from January 2022 to February 2023. EXPOSURE: Brain MRI or MRS. MAIN OUTCOMES AND MEASURES: The primary outcome was an unfavorable outcome (either death or survival with a Vineland Adaptive Behavior Scales, Third Edition, score of \u3c70) at 1 year after cardiac arrest. MRI brain lesions were scored according to region and severity (0 = none, 1 = mild, 2 = moderate, 3 = severe) by 2 blinded pediatric neuroradiologists. MRI Injury Score was a sum of T2-weighted and diffusion-weighted imaging lesions in gray and white matter (maximum score, 34). MRS lactate and NAA concentrations in the basal ganglia, thalamus, and occipital-parietal white and gray matter were quantified. Logistic regression was performed to determine the association of MRI and MRS features with patient outcomes. RESULTS: A total of 98 children, including 66 children who underwent brain MRI (median [IQR] age, 1.0 [0.0-3.0] years; 28 girls [42.4%]; 46 White children [69.7%]) and 32 children who underwent brain MRS (median [IQR] age, 1.0 [0.0-9.5] years; 13 girls [40.6%]; 21 White children [65.6%]) were included in the study. In the MRI group, 23 children (34.8%) had an unfavorable outcome, and in the MRS group, 12 children (37.5%) had an unfavorable outcome. MRI Injury Scores were higher among children with an unfavorable outcome (median [IQR] score, 22 [7-32]) than children with a favorable outcome (median [IQR] score, 1 [0-8]). Increased lactate and decreased NAA in all 4 regions of interest were associated with an unfavorable outcome. In a multivariable logistic regression adjusted for clinical characteristics, increased MRI Injury Score (odds ratio, 1.12; 95% CI, 1.04-1.20) was associated with an unfavorable outcome. CONCLUSIONS AND RELEVANCE: In this cohort study of children with cardiac arrest, brain features seen on MRI and MRS performed within 2 weeks after arrest were associated with 1-year outcomes, suggesting the utility of these imaging modalities to identify injury and assess outcomes

On the Sum Secrecy Rate of Multi-User Holographic MIMO Networks

The emerging concept of extremely-large holographic multiple-input multiple-output (HMIMO), beneficial from compactly and densely packed cost-efficient radiating meta-atoms, has been demonstrated for enhanced degrees of freedom even in pure line-of-sight conditions, enabling tremendous multiplexing gain for the next-generation communication systems. Most of the reported works focus on energy and spectrum efficiency, path loss analyses, and channel modeling. The extension to secure communications remains unexplored. In this paper, we theoretically characterize the secrecy capacity of the HMIMO network with multiple legitimate users and one eavesdropper while taking into consideration artificial noise and max-min fairness. We formulate the power allocation (PA) problem and address it by following successive convex approximation and Taylor expansion. We further study the effect of fixed PA coefficients, imperfect channel state information, inter-element spacing, and the number of Eve's antennas on the sum secrecy rate. Simulation results show that significant performance gain with more than 100\% increment in the high signal-to-noise ratio (SNR) regime for the two-user case is obtained by exploiting adaptive/flexible PA compared to the case with fixed PA coefficients.Comment: 7 pages, 7 figures, submitted to IEEE ICC 202

The aggregation of cytochrome C may be linked to its flexibility during refolding

Large-scale expression of biopharmaceutical proteins in cellular hosts results in production of large insoluble mass aggregates. In order to generate functional product, these aggregates require further processing through refolding with denaturant, a process in itself that can result in aggregation. Using a model folding protein, cytochrome C, we show how an increase in final denaturant concentration decreases the propensity of the protein to aggregate during refolding. Using polarised fluorescence anisotropy, we show how reduced levels of aggregation can be achieved by increasing the period of time the protein remains flexible during refolding, mediated through dilution ratios. This highlights the relationship between the flexibility of a protein and its propensity to aggregate. We attribute this behaviour to the preferential urea-residue interaction, over self-association between molecules

Debilitating floods in the Sahel are becoming frequent

Despite the long-lasting and widespread drought in the Sahel, flood events did punctuate in the past. The concern about floods remains dwarf on the international research and policy agenda compared to droughts. In this paper, we elucidate that floods in the Sahel are now becoming more frequent, widespread, and more devastating. We analyzed gridded daily rainfall data over the period 1981–2020, used photographs and satellite images to depict flood areas and threats, compiled and studied flood-related statistics over the past two decades, and supported the results with peer-reviewed literature. Our analysis revealed that the timing of the maximum daily rainfall occurs from the last week of July to mid-August in the Eastern Sahel, but from the last week of July to the end of August in the Western Sahel. In 2019 and 2020, flash and riverine floods took their toll in Sudan and elsewhere in the region in terms of the number of affected people, direct deaths, destroyed and damaged houses and croplands, contaminated water resources, and disease outbreaks and deaths. Changes in rainfall intensity, human interventions in the physical environment, and poor urban planning play a major role in driving catastrophic floods. Emphasis should be put on understanding flood causes and impacts on vulnerable societies, controlling water-borne diseases, and recognizing the importance of compiling relevant and reliable flood information. Extreme rainfall in this dry region could be an asset for attenuating the regional water scarcity status if well harvested and managed. We hope this paper will induce the hydroclimate scholars to carry out more flood studies for the Sahel. It is only then encumbered meaningful opportunities for flood risk management can start to unveil

Taurolidine Sensitivity of Eryptosis, the Suicidal Erythrocyte Death

Background/Aims: The taurine derivative Taurolidine is effective against diverse bacteria and tumor growth. In the treatment of cancer, the substance is effective in part by triggering suicidal death or apoptosis of tumor cells. The Taurolidine-induced apoptosis involves mitochondria. Erythrocytes lack mitochondria but are nevertheless able to enter suicidal erythrocyte death or eryptosis, which is characterized by cell shrinkage and cell membrane scrambling with phosphatidylserine translocation to the erythrocyte surface. Signaling of eryptosis includes increase of cytosolic Ca2+ activity ([Ca2+]i), oxidative stress and ceramide. The present study explores, whether Taurolidine induces eryptosis and, if so, which cellular mechanisms are involved. Methods: Phosphatidylserine exposure at the cell surface was estimated using annexin-V-binding, cell volume using forward scatter, [Ca2+]i using Fluo3-fuorescence, reactive oxygen species (ROS) formation using 2’,7’-dichlorodihydrofuorescein (DCF)-dependent fluorescence, and ceramide abundance using specific antibodies. Results: A 48 hours exposure of human erythrocytes to Taurolidine (60 µg/ml) significantly enhanced the percentage of annexin-V-binding cells, significantly decreased forward scatter and significantly increased Fluo3-fluorescence and ceramide abundance, but not DCF-fluorescence. The effect of Taurolidine on annexin-V-binding was virtually abrogated by removal of extracellular Ca2+. Conclusion: Taurolidine triggers cell shrinkage and phospholipid scrambling of the erythrocyte cell membrane, an effect at least in part due to Ca2+ entry and paralleled by increase of ceramide abundance

Stimulation of Eryptosis, the Suicidal Erythrocyte Death, by Costunolide

Background/Aims: The sesquiterpene lactone Costunolide is effective against various disorders including inflammation and malignancy. The substance is effective in part by triggering suicidal death or apoptosis of tumor cells. Mechanisms involved include altered function of transcription factors and mitochondria. Erythrocytes lack nuclei and mitochondria but are – in analogy to apoptosis of nucleated cells – able to enter suicidal erythrocyte death or eryptosis, characterized by cell shrinkage and cell membrane scrambling with phosphatidylserine translocation to the erythrocyte surface. Triggers of eryptosis include increase of cytosolic Ca2+ activity ([Ca2+]i), oxidative stress and ceramide. The present study explored, whether Costunolide induces eryptosis and, if so, to shed light on the mechanisms involved. Methods: Phosphatidylserine exposure at the cell surface was estimated from annexin-V-binding, cell volume from forward scatter, [Ca2+]i from Fluo3-fluorescence, reactive oxygen species (ROS) formation from 2’,7’-dichlorodihydrofluorescein (DCF)-dependent fluorescence, and ceramide abundance utilizing specific antibodies. Results: A 48 hours exposure of human erythrocytes to Costunolide (15 µg/ml) significantly enhanced the percentage of annexin-V-binding cells, significantly decreased forward scatter and significantly increased Fluo3-fluorescence, DCF-fluorescence, and ceramide abundance. The effect of Costunolide on annexin-V-binding was significantly blunted by removal of extracellular Ca2+. Conclusion: Costunolide triggers cell shrinkage and phospholipid scrambling of the erythrocyte cell membrane, an effect at least in part due to Ca2+ entry and paralleled by oxidative stress and ceramide formation

Guiding structures with multiply connected cross-sections: evolution of propagation in external fields at complex Robin parameters

Properties of the two-dimensional ring and three-dimensional infinitely long straight hollow waveguide with unit width and inner radius $\rho_0$ in the superposition of the longitudinal uniform magnetic field $\bf B$ and Aharonov-Bohm flux are analyzed within the framework of the scalar Helmholtz equation under the assumption that the Robin boundary conditions at the inner and outer confining walls contain extrapolation lengths $\Lambda_{in}$ and $\Lambda_{out}$, respectively, with nonzero imaginary parts. It is shown that, compared to the disk geometry, the annulus opens up additional possibilities of varying magnetization and currents by tuning imaginary components of the Robin parameters on each confining circumference; in particular, the possibility of restoring a lossless longitudinal flux by zeroing imaginary part $E_i$ of the total transverse energy $E$ is discussed. The energy $E$ turns real under special correlation between the imaginary parts of $\Lambda_{in}$ and $\Lambda_{out}$ with the opposite signs what physically corresponds to the equal transverse fluxes through the inner and outer interfaces of the annulus. In the asymptotic case of the very large radius, simple expressions are derived and applied to the analysis of the dependence of the real energy $E$ on $\Lambda_{in}$ and $\Lambda_{out}$. New features also emerge in the magnetic field influence; for example, if, for the quantum disk, the imaginary energy $E_i$ is quenched by the strong intensities $B$, then for the annulus this takes place only when the inner Robin distance $\Lambda_{in}$ is real; otherwise, it almost quadratically depends on $B$ with the corresponding enhancement of the reactive scattering. Closely related problem of the hole in the otherwise uniform medium is also addressed for real and complex extrapolation lengths with the emphasis on the comparative analysis with its dot counterpart.Comment: 37 pages, 9 figure