Purpose
The aim of this study was to assess the neurologic outcome following extracorporeal cardiopulmonary resuscitation (ECPR) in five European centers.
Methods
Retrospective database analysis of ...prospective observational cohorts of patients undergoing ECPR (January 2012–December 2016) was performed. The primary outcome was 3-month favorable neurologic outcome (FO), defined as the cerebral performance categories of 1–2. Survival to ICU discharge and the number of patients undergoing organ donation were secondary outcomes. A subgroup of patients with stringent selection criteria (i.e., age ≤ 65 years, witnessed bystander CPR, no major co-morbidity and ECMO implemented within 1 h from arrest) was also analyzed.
Results
A total of 423 patients treated with ECPR were included (median age 57 48–65 years; male gender 78%); ECPR was initiated for OHCA in 258 (61%) patients. Time from arrest to ECMO implementation was 65 48–84 min. Eighty patients (19%) had favorable neurological outcome. ICU survival was 24% (
n
= 102); 23 (5%) non-survivors underwent organ donation procedures. Favorable neurological outcome rate was lower (9% vs. 34%,
p
< 0.01) in out-of-hospital than in-hospital cardiac arrest and was significantly associated with shorter time from collapse to ECMO. The application of stringent ECPR criteria (
n
= 105) resulted in 38% of patients with favorable neurologic outcome.
Conclusions
ECPR was associated with intact neurological recovery in 19% of unselected cardiac arrest victims, with 38% favorable outcome if stringent selection criteria would have been applied.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
IFN-stimulated gene 15 (ISG15) deficiency in humans leads to severe IFNopathies and mycobacterial disease, the latter being previously attributed to its extracellular cytokine-like activity. In this ...study, we demonstrate a novel role for secreted ISG15 as an IL-10 inducer, unique to primary human monocytes. A balanced ISG15-induced monocyte/IL-10 versus lymphoid/IFN-γ expression, correlating with p38 MAPK and PI3K signaling, was found using targeted in vitro and ex vivo systems analysis of human transcriptomic datasets. The specificity and MAPK/PI3K-dependence of ISG15-induced monocyte IL-10 production was confirmed in vitro using CRISPR/Cas9 knockout and pharmacological inhibitors. Moreover, this ISG15/IL-10 axis was amplified in leprosy but disrupted in human active tuberculosis (TB) patients. Importantly, ISG15 strongly correlated with inflammation and disease severity during active TB, suggesting its potential use as a biomarker, awaiting clinical validation. In conclusion, this study identifies a novel anti-inflammatory ISG15/IL-10 myeloid axis that is disrupted in active TB.
The potential benefit of extracorporeal cardiopulmonary resuscitation (ECPR) compared to conventional CPR (CCPR) for patients with refractory cardiac arrest (CA) remains unclear.
This study is a ...retrospective analysis of a prospective database of CA patients, which includes all consecutive adult patients admitted to the Department of Intensive Care after CA between January 2012 and December 2017. The decision to initiate ECPR was made by the attending physician and ECPR performed by the ECPR team, which is composed of ICU physicians. A propensity score was derived using a logistic regression model, including characteristics that varied between groups with a p < 0.10 and were potentially related to outcome. Primary outcomes were survival to ICU discharge and favorable 3-month neurologic outcome, assessed by a Cerebral Performance Category (CPC) score of 1-2.
From a total of 635 patients with CA during the study period (ECPR, n = 112), 80 ECPR patients were matched to 80 CCPR patients. The time from arrest to termination of CPR (i.e., return of spontaneous circulation ROSC, extracorporeal membrane oxygenation ECMO initiation, or death) was 54 ± 22 and 54 ± 19 min in the ECPR and CCPR groups, respectively. ROSC rates were 77/80 (96%) for ECPR and 30/80 (38%) for CCPR (p < 0.001). Survival to ICU discharge was 18/80 (23%) vs. 14/80 (18%) in the ECPR and CCPR groups, respectively (p = 0.42). At 3 months, 17/80 (21%) ECPR patients and 9/80 (11%) CCPR patients had a favorable outcome (p = 0.11). Cox regression analysis stratified by matched pairs showed a significantly higher neurologic outcome rate in the ECPR group than in the CCPR group (log-rank test p = 0.003).
ECPR after CA may be associated with improved long-term neurological outcome.
This paper addresses a forensic tool used to assess audio authenticity. The proposed method is based on detecting phase discontinuity of the power grid signal; this signal, referred to as electric ...network frequency (ENF), is sometimes embedded in audio signals when the recording is carried out with the equipment connected to an electrical outlet or when certain microphones are in an ENF magnetic field. After down-sampling and band-filtering the audio around the nominal value of the ENF, the result can be considered a single tone such that a high-precision Fourier analysis can be used to estimate its phase. The estimated phase provides a visual aid to locating editing points (signalled by abrupt phase changes) and inferring the type of audio editing (insertion or removal of audio segments). From the estimated values, a feature is used to quantify the discontinuity of the ENF phase, allowing an automatic decision concerning the authenticity of the audio evidence. The theoretical background is presented along with practical implementation issues related to the proposed technique, whose performance is evaluated on digitally edited audio signals.
Drug‐induced liver injury (DILI) is an important cause of acute liver failure, with limited therapeutic options. During DILI, oncotic necrosis with concomitant release and recognition of ...intracellular content amplifies liver inflammation and injury. Among these molecules, self‐DNA has been widely shown to trigger inflammatory and autoimmune diseases; however, whether DNA released from damaged hepatocytes accumulates into necrotic liver and the impact of its recognition by the immune system remains elusive. Here we show that treatment with two different hepatotoxic compounds (acetaminophen and thioacetamide) caused DNA release into the hepatocyte cytoplasm, which occurred in parallel with cell death in vitro. Administration of these compounds in vivo caused massive DNA deposition within liver necrotic areas, together with an intravascular DNA coating. Using confocal intravital microscopy, we revealed that liver injury due to acetaminophen overdose led to a directional migration of neutrophils to DNA‐rich areas, where they exhibit an active patrolling behavior. DNA removal by intravenous DNASE1 injection or ablation of Toll‐like receptor 9 (TLR9)‐mediated sensing significantly reduced systemic inflammation, liver neutrophil recruitment, and hepatotoxicity. Analysis of liver leukocytes by flow cytometry revealed that emigrated neutrophils up‐regulated TLR9 expression during acetaminophen‐mediated necrosis, and these cells sensed and reacted to extracellular DNA by activating the TLR9/NF‐κB pathway. Likewise, adoptive transfer of wild‐type neutrophils to TLR9−/− mice reversed the hepatoprotective phenotype otherwise observed in TLR9 absence. Conclusion: Hepatic DNA accumulation is a novel feature of DILI pathogenesis. Blockage of DNA recognition by the innate immune system may constitute a promising therapeutic venue. (Hepatology 2015;61:348–360)
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Monocyte counts are increased during human tuberculosis (TB) but it has not been determined whether
(
) directly regulates myeloid commitment. We demonstrated that exposure to
directs primary human ...CD34
cells to differentiate into monocytes/macrophages. In vitro myeloid conversion did not require type I or type II IFN signaling. In contrast,
enhanced IL-6 responses by CD34
cell cultures and IL-6R neutralization inhibited myeloid differentiation and decreased mycobacterial growth in vitro. Integrated systems biology analysis of transcriptomic, proteomic and genomic data of large data sets of healthy controls and TB patients established the existence of a myeloid
gene module associated with disease severity. Furthermore, genetic and functional analysis revealed the
gene module has undergone recent evolutionary selection, including Neanderthal introgression and human pathogen adaptation, connected to systemic monocyte counts. These results suggest
co-opts an evolutionary recent IFN-IL6-CEBP feed-forward loop, increasing myeloid differentiation linked to severe TB in humans.
Introducción: los hábitos de alimentación saludable y actividad física, han demostrado que son beneficiosos para la salud física y psicológica en adolescentes. Objetivo: analizar las barreras ...percibidas y los aspectos que motivan a los adolescentes de establecimientos educacionales, sobre alimentación saludable y la realización de actividad física de forma habitual. Material y método: investigación cualitativa de diseño fenomenológico explicativo. La información se obtuvo a través de la realización de 4 Grupos focales con adolescentes de ambos sexos (32 participantes) en la ciudad de Santiago, Chile. Resultados: se detectaron barreras percibidas y motivaciones sobre alimentación saludable y actividad física en todos los grupos de adolescentes, aportando un total de 96 unidades de análisis. Conclusión: se identificaron distintas barreras y motivaciones percibidas por adolescentes sobre alimentación saludable y actividad física, las que se destacan son el tiempo, la familia, amigos, componentes sociales y multiculturales.
Palabras claves: motivación, barreras, actividad física, alimentación saludable.
Abstract. Introduction: healthy eating habits and physical activity have been shown to be beneficial for physical and psychological health in adolescents. Objective: to describe the perceived barriers and the aspects that motivate adolescents from educational establishments on healthy eating and regular physical activity. Method: qualitative research of explanatory phenomenological design. The information was obtained through 4 focus groups with adolescents of both sexes (32 participants) in the city of Santiago. Results: perceived barriers and motivations regarding healthy eating and physical activity were detected in all groups of adolescents, providing a total of 96 units of analysis. Conclusion: different barriers and motivations perceived by adolescents regarding healthy eating and physical activity were identified, the ones that stand out are time, family, friends, social and multicultural components.
Keywords: motivation, barriers, physical activity, healthy eating.
This article explores the growing popularity of alternative presidential candidates — those from outside the two dominant coalitions — in Chile from 2009 to 2017. Following a theoretical discussion ...that focuses on the causes of voter discontent with the political establishment, we formulate four hypotheses. We view support for alternative presidential candidates as a function of ideological detachment, declining political engagement, the economic vote, and socio-demographic shifts in the electorate. We use three pre-electoral Centro de Estudios Públicos surveys to present probit models and predicted probabilities. Our findings suggest that a distinct segment of Chilean voters is behind the rise of alternative presidential candidates. Younger and more educated voters who identify less with the traditional left-right ideological scale and political parties and suffer from economic anxiety—viewing the economy as performing well nationally while remaining pessimistic about their financial prospects—comprise this subgroup.
La investigación tuvo como objetivo determinar la efectividad de la aplicación de Genially con alumnos de bachillerato de la Unidad Educativa “Carlos Lenin Ávila” en el asignatura de biología, ...mediante una investigación de tipo experimental considerando para el efecto la aplicación de un pretest y un postest, datos que fueron analizados mediante la estimación de medias aritméticas de los promedios obtenidos por los estudiantes en las evaluaciones con el uso de SPSS evidenciando un incremento en los promedios, lo cual demuestra los cambios evidentes en la consolidación de conocimientos a través de presentaciones interactivas y evaluaciones mediante Gamificación con lo que se concluye que la aplicación de la herramienta digital Genially en la transmisión de conocimientos científicos mejora el rendimiento académico de forma significativa.
The establishment of a virus infection is the result of the pathogen's ability to replicate in a hostile environment generated by the host's immune system. Here, we found that ISG15 restricts Dengue ...and Zika viruses' replication through the stabilization of its binding partner USP18. ISG15 expression was necessary to control DV replication driven by both autocrine and paracrine type one interferon (IFN-I) signaling. Moreover, USP18 competes with NS5-mediated STAT2 degradation, a major mechanism for establishment of flavivirus infection. Strikingly, reconstitution of USP18 in ISG15-deficient cells was sufficient to restore the STAT2's stability and restrict virus growth, suggesting that the IFNAR-mediated ISG15 activity is also antiviral. Our results add a novel layer of complexity in the virus/host interaction interface and suggest that NS5 has a narrow window of opportunity to degrade STAT2, therefore suppressing host's IFN-I mediated response and promoting virus replication.
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