Effect of empiric antiarrhythmic therapy in resuscitated out-of-hospital cardiac arrest victims with coronary artery disease

The effect of empiric antiarrhythmic therapy with quinidine and procainamide on long-term mortality was examined in 209 patients with coronary artery disease resuscitated after out-of-hospital cardiac arrest. The antiarrhythmic agent used was determined by the patient's private physician without knowledge of the study ambulatory electrocardiogram. Of the 209 patients, procainamide was prescribed in 45 (22%), quinidine in 48 (23%) and no antiarrhythmic therapy in 116 (55%). Digoxin therapy was initiated in 101 patients. The 2-year total survival rate for the quinidine, procainamide and nontreated patients was 61, 57 and 71% (p less than 0.05), and for sudden death was 69, 69 and 89% (p less than 0.01), respectively. These observations suggest that empiric antiarrhythmic therapy in survivors of out-of-hospital cardiac arrest did not affect total mortality and was associated with an increased frequency of sudden death.     

Bilingual deep dysphasia

We report B.R.B., a bilingual Turkish–English speaker with deep dysphasia. B.R.B. shows the typical pattern of semantic errors in repetition with effects of lexicality and imageability on performance in both languages. The question we asked is whether language type (Turkish or English) or language status—that is, first acquired (L1) or second acquired (L2)—has a greater impact on performance. Results showed that repetition in L1 (Turkish) was better than that in L2 (English). We also observed effects of language status on oral reading, writing to dictation, and naming (spoken and written) with greater impairment to repetition than other tasks in both languages. An additional finding was that spoken-word translation in both directions was worse than written-word translation, and word class had an effect on translation from L1 to L2. We argue that interactive activation models of deep dysphasia could explain deep dysphasia in bilingual speakers and interactions between task and language, if the weighted connections that support language processing in L2 are assumed to be weaker, thus causing rapid phonological decay to have more impact on task performance in L2. Implications of the results for models of bilingual language processing are also considered.     

Brain bases of recovery following cognitive rehabilitation for traumatic brain injury: a preliminary study

Brain Imaging and Behavior - Many patients with traumatic brain injury (TBI) have persistent cognitive deficits, including decreased attention and working memory. This preliminary study examined...     

Regional Intraosseous Administration of Prophylactic Antibiotics is More Effective Than Systemic Administration in a Mouse Model of TKA

Background

In human TKA studies, intraosseous regional administration (IORA) of prophylactic antibiotics achieves local tissue antibiotic concentrations 10 times greater than systemic administration. However, it is unclear if such high concentrations provide more effective prophylaxis.

Questions/purposes

We asked: (1) What prophylaxis dosage and route (intravenous [IV] versus IORA of prophylactic antibiotics) produce less in vivo bacterial burden compared with no-antibiotic controls? (2) Compared with controls, what prophylaxis dosage and route yield fewer colony-forming units (CFUs) in euthanized animals in a model of TKA? (3) Is prophylactic IORA of antibiotics more effective than same-dose IV antibiotic administration in reducing CFUs?

Methods

Mice (six to nine per group) were block randomized to one of six prophylaxis regimens: control, systemic cefazolin (C100_IV), IORA of cefazolin (C100_IORA), systemic vancomycin (V110_IV), low-dose systemic vancomycin (V25_IV), and low-dose IORA of vancomycin (V25_IORA). Surgery involved placement of an intraarticular knee prosthesis, followed by an inoculum of bioluminescent Staphylococcus aureus strain Xen36. Biophotonic imaging assessed in vivo bacterial loads, and after 4 days bacterial load was quantified using culture-based techniques. Comparisons were made for each prophylactic regimen to controls and between same-dose IV and IORA of prophylactic antibiotic regimens.

Results

Mice treated with systemic high-dose vancomycin, IORA of vancomycin, or IORA of cefazolin had lower in vivo Staphylococcus aureus burdens (median area under curve, Control: 5.0 × 10⁶; V110_IV: 1.5 × 10⁶, difference of medians 3.5 × 10⁶, p = 0.003; V25_IV: 1.94 × 10⁶, difference 3.07 × 10⁶, p = 0.49; V25_IORA: 1.51 × 10⁶, difference 3.5 × 10⁶, p = 0.0011; C100_IORA: 1.55 × 10⁶, difference 3.46 × 10⁶, p = 0.0016; C100_IV: 2.35 × 10⁶, difference 2.66 × 10⁶, p = 0.23.) Similar findings were seen with culture-based techniques on recovered implants. IORA of prophylactic antibiotics was more effective than same-dose IV administration in reducing bacterial load on recovered implants (median CFUs < 7.0 × 10⁰ vs 2.83 × 10², p = 0.0183).

Conclusions

IORA of prophylactic cefazolin and vancomycin was more effective than the same dose of antibiotic given systemically. The effectiveness of vancomycin in particular was enhanced by IORA of prophylactic antibiotics despite using a lower dose.

Clinical relevance

Our study supports previous studies of IORA of prophylactic antibiotics in humans and suggests this novel form of administration has the potential to enhance the effectiveness of prophylaxis in TKA. Because of concerns regarding antibiotic stewardship, IORA of prophylactic vancomycin may be more appropriately restricted to patients having TKA who are at greater risk of infection, and clinical trials are in progress.     

Three-dimensional,three-vector-component velocimetry of cilia-driven fluid flow using correlation-based approaches in optical coherence tomography

Microscale quantification of cilia-driven fluid flow is an emerging area in medical physiology, including pulmonary and central nervous system physiology. Cilia-driven fluid flow is most completely described by a three-dimensional, three-component (3D3C) vector field. Here, we generate 3D3C velocimetry measurements by synthesizing higher dimensional data from lower dimensional measurements obtained using two separate optical coherence tomography (OCT)-based approaches: digital particle image velocimetry (DPIV) and dynamic light scattering (DLS)-OCT. Building on previous work, we first demonstrate directional DLS-OCT for 1D2C velocimetry measurements in the sub-1 mm/s regime (sub-2.5 inch/minute regime) of cilia-driven fluid flow in Xenopus epithelium, an important animal model of the ciliated respiratory tract. We then extend our analysis toward 3D3C measurements in Xenopus using both DLS-OCT and DPIV. We demonstrate the use of DPIV-based approaches towards flow imaging of Xenopus cerebrospinal fluid and mouse trachea, two other important ciliary systems. Both of these flows typically fall in the sub-100 μm/s regime (sub-0.25 inch/minute regime). Lastly, we develop a framework for optimizing the signal-to-noise ratio of 3D3C flow velocity measurements synthesized from 2D2C measures in non-orthogonal planes. In all, 3D3C OCT-based velocimetry has the potential to comprehensively characterize the flow performance of biological ciliated surfaces.OCIS codes: (110.4500) Optical coherence tomography, (120.7250) Velocimetry, (170.3340) Laser Doppler velocimetry, (170.6480) Spectroscopy, speckle