Two cases of asystolic cardiac arrests managed with therapeutic hypothermia

Poor neurological outcome is a common sequel of prolonged cardiac arrest. Although Therapeutic Hypothermia (TH) for neuroprotection has been a subject for research for over Half a century, its use has been limited because of many controversies and lack of clear guidelines. However for over two decades there has been a revival of interest in mild therapeutic hypothermia (32-34°C) for neuroprotection. However its use after primary asystolic cardiac arrest has been questioned.Herein presenting two cases of prolonged asystolic arrest (39 minutes and 25 minutes); where therapeutic hypothermia was successfully used in following prolonged cardio pulmonary resuscitation. On patients who were in deep coma after resuscitation, TH was applied for 24 hours as per institutional protocol with full neurological recovery in both the cases. Therapeutic hypothermia might have a potential role in even in non-shockable arrests and should be considered in every successful cardiopulmonary resuscitation with poor neurological status.     

Investigation of the structural,optical and gas sensing properties of PANI coated Cu–ZnS microsphere composite

Polyaniline (PANI)/Cu–ZnS composites with porous microspheres are prepared by a hydrothermal and in situ polymerization method. The structural, optical, and morphological properties are characterized by X-ray powder diffraction, FTIR, UV-vis, scanning electron microscope, transmission electron microscope. The XRD results confirmed that the PANI/Cu–ZnS composite is formed. The morphological analyses exhibited that the PANI/Cu–ZnS composite comprises the porous microspherical structures. The emission peaks obtained in photoluminescence spectra confirm the presence of surface defects in the prepared composite. The UV-DRS study shows that the bandgap of the samples is found to decrease for the PANI/Cu–ZnS composite compared to the pure Cu–ZnS sample. The calculated band gap (E_g) value of PANI/Cu–ZnS composite is 2.47 eV. Furthermore, the fabricated gas sensor based on PANI/Cu–ZnS can perform at room temperature and exhibits good gas sensing performance toward CO₂ gas. In particular, PANI/Cu–ZnS sensor shows good response (31 s) and recovery time (23 s) upon exposure to CO₂ gas. The p/n heterojunction, surface defects, and porous nature of the PANI/Cu–ZnS composite microsphere enhanced sensor performance.

Polyaniline (PANI)/Cu–ZnS composites with porous microspheres are prepared by a hydrothermal and in situ polymerization method.     

Nocturnal Medications Dosing: Does It Really Make a Difference in Blood Pressure Control Among Patients with Chronic Kidney Disease?

Ambulatory blood pressure (BP) monitoring is superior to clinic BP monitoring in predicting long-term consequences of hypertension. This has raised interest in diurnal variation in BP and elevation in nighttime BP as a prognostic and therapeutic target. Several studies have identified prevalence of nocturnal hypertension in patients with accelerated progression of chronic kidney disease and target organ damage. Some studies suggest that nocturnal BP can be lowered by changing administration of antihypertensive medication to bed time; whether that results in retarding kidney disease progression is not very clear. Further research is needed to determine if certain classes of medications or interventions are superior in controlling nocturnal hypertension, and protocols need to be developed to screen patients for monitoring nocturnal BP. Further studies are needed to evaluate long-term renal outcomes of evening dosing in patients with nocturnal hypertension and chronic kidney disease.     

Lymphocyte proliferation in mice congenitally deficient in T-cell receptor alpha beta + cells.

In mice and humans, T cells are characterized on the basis of T-cell receptor (TcR) expression and divided into the major TcR alpha beta + and minor TcR gamma delta + populations. TcR alpha beta + cells are considered to be the primary regulators of the immune response, whereas the function of TcR gamma delta + cells is unclear. Mice congenitally deficient in TcR alpha beta-expressing cells provide an ideal model for analyzing the independent in vivo function of TcR gamma delta + cells in the absence of TcR alpha beta + cells. Here we report that lymphoid organs in TcR alpha mutant mice undergo substantial enlargement after being challenged by environmental antigens. This organ expansion can be attributed in part to increases in the relative proportions and absolute numbers of TcR gamma delta + cells, but an expansion of the recently described TcR beta + alpha - population also has a role. The expansion of the TcR gamma delta + population is polyclonal, as evidenced by the usage of multiple gamma and delta variable chain segments. Furthermore, a substantial proportion of the cells appears to be activated and these activated cells express surface activation markers. The results clearly demonstrate that TcR gamma delta + cells proliferate independently in response to a broad spectrum of challenges. Moreover, since the expansion of the lymphoid tissues and the TcR gamma delta + cell population is excessive relative to that seen in wild-type animals, one role of TcR alpha beta + cells is directly or indirectly to limit the responses of the other lymphoid components.     

Poststroke acute dysexecutive syndrome,a disorder resulting from minor stroke due to disruption of network dynamics

Stroke patients with small central nervous system infarcts often demonstrate an acute dysexecutive syndrome characterized by difficulty with attention, concentration, and processing speed, independent of lesion size or location. We use magnetoencephalography (MEG) to show that disruption of network dynamics may be responsible. Nine patients with recent minor strokes and eight age-similar controls underwent cognitive screening using the Montreal cognitive assessment (MoCA) and MEG to evaluate differences in cerebral activation patterns. During MEG, subjects participated in a visual picture–word matching task. Task complexity was increased as testing progressed. Cluster-based permutation tests determined differences in activation patterns within the visual cortex, fusiform gyrus, and lateral temporal lobe. At visit 1, MoCA scores were significantly lower for patients than controls (median [interquartile range] = 26.0 [4] versus 29.5 [3], P = 0.005), and patient reaction times were increased. The amplitude of activation was significantly lower after infarct and demonstrated a pattern of temporal dispersion independent of stroke location. Differences were prominent in the fusiform gyrus and lateral temporal lobe. The pattern suggests that distributed network dysfunction may be responsible. Additionally, controls were able to modulate their cerebral activity based on task difficulty. In contrast, stroke patients exhibited the same low-amplitude response to all stimuli. Group differences remained, to a lesser degree, 6 mo later; while MoCA scores and reaction times improved for patients. This study suggests that function is a globally distributed property beyond area-specific functionality and illustrates the need for longer-term follow-up studies to determine whether abnormal activation patterns ultimately resolve or another mechanism underlies continued recovery.

Advances in acute stroke treatment have significantly reduced motor and language deficits, converting highly morbid large hemispheric lesions into smaller infarcts with better overall long-term outcomes (1, 2). Prior work has shown that the majority of individuals presenting for follow-up 4- to 6-wk postinfarct now exhibit what would be classified as “minor symptoms,” (3) with low stroke severity measured by the NIH Stroke Scale (NIHSS) (4) and modified Rankin Scale (mRS) (5) scores. Although these individuals lack a dense hemiparesis or aphasia, over half endorse some degree of cognitive impairment that significantly impacts their recovery. Interestingly, these symptoms are typically found to be independent of stroke size, location, or coexisting depression (6, 7).Poststroke cognitive decline has a substantial presence in the literature (8–13). However, we find that rather than memory impairment or confusion, patients without prior cognitive disability report immediate difficulty with executive function, focus, concentration, and attention after a minor stroke, hereafter referred to as poststroke acute dysexecutive syndrome (PSADES) (3). Dysexecutive syndrome has been previously described in individuals with anatomic lesions (14) as well as disorders, such as schizophrenia (15) and Alzheimer’s disease (14), affecting the frontal lobes. When mild, the syndrome can be hard for others to appreciate, particularly, in previously high-functioning individuals, but poststroke, these deficits are detectable on screening tests, such as the Montreal cognitive assessment (MoCA) (16) and other scales of activities of daily living compared to age-matched controls (3). Despite the fact that following stroke, symptoms typically improve over the first 3–6 mo of recovery, PSADES impedes many successful well-educated individuals from returning to cognitively driven professions given the uncertainty of their prognosis. These decisions affect lifestyle and quality of life, resulting in lasting long-term consequences.The pathophysiology underlying PSADES is poorly understood, as many times the inciting infarct is small and does not involve an area of the brain classically thought to be important for cognitive processing. Cognitive change due to deep white matter lesions (in multiplicity) has been well described (17), but there is no clear unifying physiological explanation regarding how a single small cortical or subcortical lesion may cause significant generalized cortical dysfunction. Some posit a “network” hypothesis suggesting that an individual requires an extensive system of neuronal connectivity, involving numerous cortical and subcortical regions, in order to complete a task (18). We propose that the cognitive dysfunction of PSADES may be the result of a disruption of general network dynamics due to lesions of the subcortical white matter tracts, which would, in turn, interfere with basic network function.This study was designed as a first step in evaluating the role of network dynamics during tasks requiring attention, concentration, speed, and accuracy; all skills difficult for patients poststroke. We used magnetoencephalography (MEG) to determine the differences in cerebral activation patterns in nine individuals with small strokes versus a group of eight age-similar controls by measuring the amplitude and latency of cerebral responses during a visual comprehension task at two time points: ∼1- and 6-mo postinfarct. Our analysis focused on the early visual, M170, and M400 components of the event-related potential from the occipital lobe, fusiform gyrus, and lateral temporal lobe given their importance in visual recognition and language processing (19–22).