Lower Chance Of Survival Research Articles

ECOLOGY. Living sentinels for climate change effects.

Migrating birds affected by climate change in the Arctic may have lower survival chances in their tropical habitats

Outcome of Encephalitis in Pediatric Intensive Care Unit.

To review pathogens, morbidity and mortality in pediatric intensive care unit (PICU) patients with viral and infectious encephalitis. Retrospective chart review of all patients with encephalitis admitted to the PICU between 2002 and 2014 was done. Encephalitis (n=46) accounted for 2.7% of PICU admissions, but 11.8% PICU mortality over a 12-y period. A microorganism (primarily virus) was identified in 59% of encephalitis patients in the PICU. Enteroviruses and herpes viruses were isolated from the cerebrospinal fluid (CSF). Respiratory viruses [such as respiratory syncytial virus (RSV) and influenza viruses] and enteric viruses (such as rotavirus and norovirus) were obtained in the nasopharyngeal aspirate and stool respectively, but undetectable from the CSF. More than one-fourth patients with encephalitis died in the PICU. Boys accounted for 85% of nonsurvivors and 52% survivors (p = 0.038). Mechanical ventilation, inotrope, intravenous immunoglobulin (IVIG) and corticosteroid usage were significantly higher among non-survivors (p 0.001-0.044). Binomial logistic regression showed that patients who received corticosteroid had a lower chance of survival than those who did not after adjusting for gender, IVIG and mechanical ventilation (adjusted odd ratio=0.071, 95% CI 0.006-0.881; p 0.039). Eighteen (55%) of the survivors had moderate-to-severe neurodevelopmental impairments. Encephalitis is associated with significant mortality despite intensive care. Over 25% case died and 55% of survivors had moderate-to-severe neurodevelopmental impairments. There appeared to be no emerging outbreaks of encephalitis during the 15-y study period.

Emergency Preservation and Resuscitation Trial: A Philosophical Justification for Non-Voluntary Enrollment.

In a current clinical trial for Emergency Preservation and Resuscitation (EPR), Dr. Samuel Tisherman of the University of Maryland aims to induce therapeutic hypothermia in order to 'buy time' for operating on victims of severe exsanguination. While recent publicity has framed this controversial procedure as 'killing a patient to save his life', the US Army and Acute Care Research appear to support the study on the grounds that such patients already face low chances of survival. Given that enrollment in the trial must be non-voluntary, the study has received an exemption from federal standards for obtaining informed consent. How exactly, if at all, is non-voluntary enrollment morally justifiable? In this essay, I appeal to the notable work of Hans Jonas in an effort to defend the EPR trial's use of non-voluntary enrollment. It is often thought and, as I show, it may appear that Jonas has called for the end of experimental medical practice. Still, I derive from Jonas a principle of double-effect upon which physicians may be seen as morally permitted to pursue innovations in emergency medicine but only as a byproduct of pursuing therapeutic success. With this position, I argue that the EPR trial can be granted a stronger philosophical justification than simply waiving the requirement of obtaining informed consent. The double-effect justification would obtain, perhaps regardless of the success of such innovative procedures as therapeutic hypothermia.

Abstract 3810: Leptomycin B sensitizes ovarian and endometrial cancer cells to TRAIL-induced apoptosis

Abstract One of our most important line of defense against cancer is the use of chemotherapy. Resistance to these drugs represents, however, a fundamental limitation in our ability to treat tumors, especially in ovarian cancer (OC) as well as in endometrial cancer (EC). Both of these cancers display high mortality rate due to the establishment of chemoresistance. It is thus of utmost importance that we develop new approaches to overcome this problem and restore chemosensitivity in cancer cells. Nuclear transport has been shown to be exceedingly important in cell fate dynamics. CRM1, also known as XPO1, is a nuclear export receptor that recognize leucine-rich domain known as “Nuclear Export Signal”. Indeed, substantial CRM1 enrichment is indicative of highly invasive and resistant tumors and is generally suggestive of lower chance of survival. On the other hand, Par-4, an exceptionally rarely mutated protein capable of inducing cell death only in transformed cells while sparing normal cells, is suggested to be activated upon nuclear localization; it is thus considered a powerful, cancer-specific, inducer of cell death. Recent findings suggest that reinstating the ability of Par-4 to accumulate in the nucleus could re-establish its capacity to induce apoptosis. Our hypothesis was that CRM1 nuclear exclusion of Par-4 could be an acquired resistance mechanism in cancer cells. To explore this hypothesis, we first treated various OC and EC cell types with Leptomycin B to observe whether Par-4 would accumulate to the nucleus; to this end, we performed immunofluorescence as well as subcellular protein fractionations. The obtained results suggested that Par-4 was enriched in the nucleus of cells following Leptomycin B treatments. We then treated multiple OC and EC cell lines with a combination of Leptomycin B, cisplatin and TRAIL recombinant protein to determine if Par-4 enrichment through CRM-1 inhibition could sensitizes tumor cells through either extrinsic or intrinsic death pathways. We then assessed cell death and Par-4 cleavage, an important event in Par-4 induced cell death, using western blot and confirmed the results pertaining to cell death by flow cytometry (Annexin V/PI). The obtained results suggested that the combination of Leptomycin B and TRAIL largely increased cell death and apoptosis when compared to their treatment alone. Taken together, these results suggest that CRM1 control export of various tumor suppressors including Par-4, and this could be a putative mechanism responsible for the establishment of chemoresistance in OC as well as EC. The use of CRM1 inhibitors in combination to chemotherapeutic drug treatments could be an attractive strategy to reverse chemoresistance in the context of gynecological cancer therapy. Citation Format: François Fabi, France-Hélène Joncas, Sophie Parent, Valérie Leblanc, Eric Asselin. Leptomycin B sensitizes ovarian and endometrial cancer cells to TRAIL-induced apoptosis. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3810. doi:10.1158/1538-7445.AM2015-3810

Very low birth weight piglets show improved cognitive performance in the spatial cognitive holeboard task.

Low birth weight (LBW) is common in humans and has been found to cause lasting cognitive and developmental deficits later in life. It is thought that the primary cause is intra-uterine growth restriction (IUGR) due to a shortage of oxygen and supply of nutrients to the fetus. Pigs appear to be a good model animal to investigate long-term cognitive effects of LBW, as LBW is common in commercially farmed breeds of pigs. Moreover, pigs are developmentally similar to humans and can be trained to perform complex tasks. In this study, we trained ten very low birth weight (vLBW) piglets and their ten normal birth weight (NBW) siblings in a spatial cognitive holeboard task in order to investigate long-term cognitive effects of LBW. In this task, four out of sixteen holes contain a hidden food reward, which allows measuring working memory (WM) (short-term memory) and reference memory (RM) (long-term memory) in parallel. Piglets were trained for 46–54 trials during the acquisition phase, followed by a 20-trial reversal phase in which a different set of four holes was baited. Both groups acquired the task and improved their performance over time. A mixed model repeated measures ANOVA revealed that vLBW piglets showed better RM performance than NBW piglets in both the acquisition and reversal phase. Additionally, WM scores in the vLBW were less disrupted than in the NBW animals when switched to the reversal phase. These findings are contrary to findings in humans. Moreover, vLBW pigs had lower hair cortisol concentrations (HCCs) than NBW pigs in flank hair at 12 weeks of age. These results could indicate that restricted intra-uterine growth causes compensatory mechanisms to arise in early development that result in beneficial effects for vLBW piglets, increasing their low survival chances in early-life competition.

Is epinephrine during cardiac arrest associated with worse outcomes in resuscitated patients?

Although epinephrine is essential for successful return of spontaneous circulation (ROSC), the influence of this drug on recovery during the post-cardiac arrest phase is debatable. This study sought to investigate the relationship between pre-hospital use of epinephrine and functional survival among patients with out-of-hospital cardiac arrest (OHCA) who achieved successful ROSC. We included all patients with OHCA who achieved successful ROSC admitted to a cardiac arrest center from January 2000 to August 2012. Use of epinephrine was coded as yes/no and by dose (none, 1 mg, 2 to 5 mg, >5 mg). A favorable discharge outcome was coded using a Cerebral Performance Category 1 or 2. Analyses incorporated multivariable logistic regression, propensity scoring, and matching methods. Of the 1,556 eligible patients, 1,134 (73%) received epinephrine; 194 (17%) of these patients had a good outcome versus 255 of 422 patients (63%) in the nontreated group (p < 0.001). This adverse association of epinephrine was observed regardless of length of resuscitation or in-hospital interventions performed. Compared with patients who did not receive epinephrine, the adjusted odds ratio of intact survival was 0.48 (95% confidence interval [CI]: 0.27 to 0.84) for 1 mg of epinephrine, 0.30 (95% CI: 0.20 to 0.47) for 2 to 5 mg of epinephrine, and 0.23 (95% CI: 0.14 to 0.37) for >5 mg of epinephrine. Delayed administration of epinephrine was associated with worse outcome. In this large cohort of patients who achieved ROSC, pre-hospital use of epinephrine was consistently associated with a lower chance of survival, an association that showed a dose effect and persisted despite post-resuscitation interventions. These findings suggest that additional studies to determine if and how epinephrine may provide long-term functional survival benefit are needed.

Abstract 262: Women Are Less Likely to Be Resuscitated than Men

Background: There is a gender disparity in utilization of and benefit from health care. In various fields of medicine, women underuse the health care system and seem to benefit less when accessing health care than men. We aimed to study whether access to and outcome after out-of-hospital cardiopulmonary resuscitation (CPR) differs between men and women. Methods: We performed a population-based cohort study of non-traumatic out-of-hospital cardiac arrest (OHCA) cases before EMS arrival between 2006 and 2012. By using death certificate data of the national statistics service, we identified all cardiac out-of hospital deaths in the same period. Persons aged &lt;20 years were excluded. First, we calculated the Mantel-Haenzel odds ratio (OR-MH) for gender and chance of a resuscitation attempt, while weighing the number of persons per age-category. Second, neurologically intact survival (NI-survival) after resuscitation attempt was regressed on gender in the total group and stratified according to score on resuscitation parameter. Third, multivariable logistic regression was used to assess the independent association between gender and shockable initial rhythm. Results: We identified 22,443 OHCAs (52.8% male), and recorded 6,038 CPR attempts after OHCA of cardiac cause (72.5% male). Men have a significantly higher chance of receiving a resuscitation attempt than women (pooled OR-MH 1.63, 95%CI 1.52-1.75, p&lt;0.001). Women benefited less from CPR than men; NI-survival was higher in men compared to women (20.4% vs. 13.0%, OR 1.71, 95%CI 1.46-2.01, p&lt;0.001). The gender gap in survival was explained by a lower incidence of a shockable initial rhythm in women (48.8% vs. 34.4%). Gender was independently associated with presence of a shockable initial rhythm (OR 1.83, 95%CI 1.60-2.09, p&lt;0;001); so were CPR parameters. Conclusions: Women are less likely than men to receive CPR by EMS in case of OHCA. When women do receive CPR, they have lower chance of survival. The survival disparity is gender related and can only partly be explained by CPR circumstances.

Survival costs of fast exploration during juvenile life in a small mammal

Animal personality is considered to be subject to natural selection, and measuring its fitness consequences is an important step in the study of the evolution of this phenomenon. The evolutionary costs and benefits of certain personality traits are frequently assumed to fluctuate across different life history stages. However, little is still known about survival consequences of personality during juvenile life. We predicted survival costs of exploration tendency in juvenile European rabbits (Oryctolagus cuniculus), which we studied under quasi-natural conditions. In addition, consistencies between exploration and the animal’s behavioral responses in other contexts were tested. Early exploratory behavior was assessed in two annual cohorts, either observationally by quantifying the time course of exploring the area around the nursery burrow shortly after emergence above ground or experimentally by conducting open-field tests shortly before emergence. In both years, the study revealed consistent results: more exploratory individuals had a lower chance of survival until the end of the vegetation period, presumably due to a higher predation risk. Fast explorers, as assessed by their exploration of the burrow environment, were also less sociable and tended to be more aggressive toward conspecifics as subadults. Sociability was repeatable across time. Furthermore, fast explorers, as assessed by their open-field behavior, were bolder in a handling test before emergence. These consistencies across context and time suggest the existence of personality. In conclusion, the results provide evidence for survival costs of fast exploration during juvenile life. The findings are in line with predictions on personality-related life history variation.

Characteristics of settling coral reef fish are related to recruitment timing and success.

Many marine populations exhibit high variability in the recruitment of young into the population. While environmental cycles and oceanography explain some patterns of replenishment, the role of other growth-related processes in influencing settlement and recruitment is less clear. Examination of a 65-mo. time series of recruitment of a common coral reef fish, Stegastes partitus, to the reefs of the upper Florida Keys revealed that during peak recruitment months, settlement stage larvae arriving during dark lunar phases grew faster as larvae and were larger at settlement compared to those settling during the light lunar phases. However, the strength and direction of early trait-mediated selective mortality also varied by settlement lunar phase such that the early life history traits of 2–4 week old recruit survivors that settled across the lunar cycle converged to more similar values. Similarly, within peak settlement periods, early life history traits of settling larvae and selective mortality of recruits varied by the magnitude of the settlement event: larvae settling in larger events had longer PLDs and consequently were larger at settlement than those settling in smaller pulses. Traits also varied by recruitment habitat: recruits surviving in live coral habitat (vs rubble) or areas with higher densities of adult conspecifics were those that were larger at settlement. Reef habitats, especially those with high densities of territorial conspecifics, are more challenging habitats for young fish to occupy and small settlers (due to lower larval growth and/or shorter PLDs) to these habitats have a lower chance of survival than they do in rubble habitats. Settling reef fish are not all equal and the time and location of settlement influences the likelihood that individuals will survive to contribute to the population.

The association between a quantitative computed tomography (CT) measurement of cerebral edema and outcomes in post-cardiac arrest—A validation study

AimPrevious studies have examined the association between quantitative head computed tomography (CT) measures of cerebral edema and patient outcomes reporting that a calculated gray matter to white matter attenuation ratio (GWR) of <1.2 indicates a near 100% non-survivable injury post-cardiac arrest. The objective of the current study was to validate whether a GWR <1.2 reliably indicates poor survival post-cardiac arrest. We also sought to determine the inter-rater variability among reviewers, and examine the utility of a novel GWR measurement to facilitate easier practical use. MethodsWe performed a retrospective analysis of post-cardiac arrest patients admitted to a single center from 2008 to 2012. Inclusion criteria were age ≥18 years, non-traumatic arrest, and available CT imaging within 24h after ROSC. Three independent physician reviewers from different specialties measured CT attenuation of pre-specified gray and white matter areas for GWR calculations. ResultsOut of 171 consecutive patients, 90 met the study inclusion criteria. Thirteen patients were excluded for technical reasons and/or significant additional pathology, leaving 77 head CT scans for evaluation. Median age was 66 years and 64% were male. In-hospital mortality was 65% and 70% of patients received therapeutic hypothermia. For the validation measurement, the intra-class correlation coefficient was 0.70. In our dataset, a GWR below 1.2 did not accurately predict mortality or poor neurological outcome (sensitivity 0.56–0.62 and specificity 0.63–0.81). A score below 1.1 predicted a near 100% mortality but was not a sensitive metric (sensitivity 0.14–0.20 and specificity 0.96–1.00). Similar results were found for the exploratory model. ConclusionA GWR <1.2 on CT imaging within 24h after cardiac arrest was moderately specific for poor neurologic outcome and mortality. Based on our data, a threshold GWR <1.1 may be a safer cut-off to identify patients with low chance of survival and good neurological outcome. Intra-class correlation among reviewers was moderately good.

Two's Company: Composition, Structure and Performance of Entrepreneurial Pairs

We explore the effects of diverse team composition on the survival and growth of new ventures using the Danish Linked Employer‐Employee database. To get cleaner measures of diverse team composition, we focus on entrepreneurial dyads, and also investigate the asymmetric hierarchical effects of team composition by distinguishing between the ‘primary’ and the ‘secondary’ member. We complement existing work by showing that heterogeneity in team composition is moderated by the asymmetric hierarchical structure within the team, and that a unidimensional diversity indicator (which is usually applied) fails to capture a number of performance effects of heterogeneous team composition. Pairs of younger individuals have lower survival chances but higher employment growth. Pairs led by a male tend toward ‘jobless growth’ in the sense that they have higher growth of profits and sales but not employment. Family firms have lower employment growth, especially when formed with one's mother.

Isolation, Identification and Growth Optimization of Microalgae Derived from Soft Coral Dendronephthya sp.

Despite its beauty in shape and color, soft coral Dendronephthya sp. is less interesting commercially as an ornamental coral commodity due to its low chances of survival in artificial habitats. Unlike other corals, this species is azooxhantellae, and thus, it depends on external feeding. The aim of this research is to isolate, identify, and cultivate the microalgae derived from Dendronephthya sp. The microalgae was isolated from digestive tract, followed by genomic DNA isolation and Polymerase Chain Reaction. The algae cultivation was conducted using the nitrogen sources as proven treatment. Five species of microalgae (Amphora sp., Navicula salinicola, Meyerella planktonica, Nannochloris sp., and Nitzschia inconspicua) were successfully isolated. The highest biomass of Amphora sp. was obtained when ammonium was added as nitrogen source. Meanwhile, the highest biomass of N. inconspicua was obtained through the addition of nitrate. Finally, the highest biomass of N. salinicola was acquired when a combination of ammonium and nitrate was used.

Careful Use of Science to Advance the Debate on the UK Cancer Drugs Fund

Careful Use of Science to Advance the Debate on the UK Cancer Drugs Fund

Ecological extinction of the Critically Endangered northern white-cheeked gibbon Nomascus leucogenys in China

AbstractWe conducted an interview survey around and within Mengla and Shangyong Nature Reserves, Mengla County, Yunnan, China, in December 2008 to ascertain whether gibbons were present in the area, and in December 2011 we surveyed two sites in the Reserves for the northern white-cheeked gibbon Nomascus leucogenys. We found no signs of the existence of gibbons during the survey. Illegal hunting was common at both sites. Only 36 individuals in nine groups were recorded in Mengla and Shangyong Nature Reserves in the 1980s, and this small and fragmented population was probably unable to survive the pressure of hunting. No white-cheeked gibbon was recorded in Huanglianshan Nature Reserve in a survey carried out by other researchers in 2003. Gibbons have a very low chance of survival in unprotected forest, and we conclude that the white-cheeked gibbon is extinct, or at least ecologically extinct, in China.

Validation of Clinical Prediction Scores in Patients with Primary Intracerebral Hemorrhage

Initial reports of the FUNC score suggest that it may accurately identify those patients suffering from intracerebral hemorrhage (ICH) with an ultra low chance of functional neurologic recovery. This study's aim is to validate the FUNC score and determine if it accurately identifies the cohort of patients with an ultra low chance of survival with good neurologic recovery. Retrospective review of 501 consecutive primary ICH patients admitted from the Emergency Department to a large healthcare system. Performance of the FUNC, ICH-GS, and oICH scores was determined by calculating areas under the receiver-operator-characteristic curves. Patients with a predicted 100 % chance of poor neurologic outcome (PNO) (FUNC <4 and ICH-GS >10) scores were evaluated to determine if DNR impacted 90 day survival or rate of survival with a Glasgow Outcome Score of <3. In 366 cases of primary ICH who presented during the study period, 222(61 %) survived to discharge. Both the FUNC (AUC: 0.873) and ICH-GS (AUC: 0.888) outperformed the oICH (AUC: 0.743) in predicting 90-day mortality (p = <0.001). Of 68 patients with a FUNC score <4, 67 (98.5 %) had PNO at discharge. The presence of DNR was not associated with a significant difference in the rate of PNO at discharge (40/40 = 100 % vs. 27/28 = 96.4 % p = 0.42) or 90-day mortality (40/40 = 100 % vs. 21/28 = 75 %, p = 0.06). The FUNC and ICH-GS appear superior to the oICH in predicting outcome in patients with primary ICH. In addition, the FUNC score appears to accurately identify patients with low chance of functional neurologic recovery at discharge.

Pre-arrest predictors of survival after resuscitation from out-of-hospital cardiac arrest in the elderly a systematic review

BackgroundTo enable older people to make decisions about the appropriateness of cardiopulmonary resuscitation (CPR), information is needed about the predictive value of pre-arrest factors such as comorbidity, functional and cognitive status on survival and quality of life of survivors. We systematically reviewed the literature to identify pre-arrest predictors for survival, quality of life and functional outcomes after out-of-hospital (OHC) CPR in the elderly.MethodsWe searched MEDLINE (through May 2011) and included studies that described adults aged 70 years and over needing CPR after OHC cardiac arrest. Prognostic factors associated with survival to discharge and quality of life of survivors were extracted. Two authors independently appraised the quality of each of the included studies. When possible a meta-analysis of odd’s ratios was performed.ResultsTwenty-three studies were included (n = 44,582). There was substantial clinical and statistical heterogeneity and reporting was often inadequate. The pooled survival to discharge in patients >70 years was 4.1% (95% CI 3.0-5.6%). Several studies showed that increasing age was significantly associated with worse survival, but the predictive value of comorbidity was investigated in only one study. In another study, nursing home residency was independently associated with decreased chances of survival. Only a few small studies showed that age is negatively associated with a good quality of life of survivors. We were unable to perform a meta-analysis of possible predictors due to a wide variety in reporting and statistical methods.ConclusionsAlthough older patients have a lower chance of survival after CPR in univariate analysis (i.e. 4.1%), older age alone does not seem to be a good criterion for denying patients CPR. Evidence for the predictive value of comorbidities and for the predictive value of age on quality of life of survivors is scarce. Future studies should use uniform methods for reporting data and pre-arrest factors to increase the available evidence about pre arrest factors on the chance of survival. Furthermore, patient-specific outcomes such as quality of life and post-arrest cognitive function should be investigated too.

Vehicle Submersion: A Review of the Problem, Associated Risks, and Survival Information

Of all drownings, 3 to 11% occur in submersed vehicles, yet scientific study of this topic seems limited. A search was made of digital medical, drowning, transportation, and rescue databases regarding vehicle submersion drownings. The major risk factors include driving on ice or roadways near water, flooding of roadways or bridges, slippery roads, curved roads, and darkness. A new definition of a Flotation Phase (from water impact until water rises to the bottom of side windows) defines a period when escape is easiest. Since survival probability is highest during this period (generally the first minute)--and then decreases rapidly--cell phones should not be used to call for help because this will only squander the optimal window for survival. It is virtually impossible to open a door until the vehicle is almost completely full of water. Since there is little or no trapped air, this period provides a very low chance of survival. Before exit, children should be released from their restraints. Breaking windows is difficult without a center punch or rescue hammer, which should be visibly mounted within reach of the driver. Prevention includes installing adequate guardrails, barriers, warning signs, and road markings, or placing roadways at a greater distance from water. Areas at high risk for flooding should have signs and public warning systems for flash flooding should be improved. Public education should also focus on the dangers of driving on flooded roads or bridges, and on ice roads.

The prognostic role of age in oral cancer. A clinical study

The problem of malignant tumors developing in a young age is a topic of special importance and subject of intensive research. The occurrence of oral cavity tumors shows a decreasing trend worldwide, while the incidences of oral squamous cell carcinoma diagnosed at young adulthood is increasing. The etiology of tumors developing in young age is not yet fully understood, however, it can be stated that the usual high-risk behavioral patterns (i.e. smoking and alcohol abuse) play only a minor role in this patient group, if any. Our own observations indicate a higher regional and locoregional relapse for these patients and, although they turn for help early, at an early stage of the disease, a lower chance of survival. The target of our research was to analyze the differences in certain etiological, pathological and clinical parameters of our own patient group consisting of both young and older patients. The data of 105 young (<50 years) and, as a control group, 105 older (>50 years) patients were analyzed. The patients have undergone surgery and, if necessary, radiotherapy and/or chemotherapy. The tumor-specific survival was determined at 36 months. Our study aimed at understanding the relationship between the clinical prognostic factors (stage, localization, anamnestic time), smoking habits, gender and age of the patients. Relationship between cancer occurrence (local, locoregional relapse) and survival rate, as well as age and survival rate were analyzed. We found that young patients report themselves for treatment at an early stage. Smoking and alcohol abuse were considerably less. When a relapse occurs, it occurs more frequently and earlier than at older patients. The most decisive correlation was observed between age and anamnestic time, age and number of cigarettes smoked, age and time elapsed until relapse, as well as age and cancer-specific survival. Moreover, cancer-specific survival of patients younger than 50 years of age was found significantly shorter than in the control group.

Abstract TMP79: The Accuracy of the FUNC score to Identify Poor Prognosis in Patients with Primary Intracerebral Hemorrhage

Background &amp; Purpose: Recent studies suggest that intracerebral hemorrhage (ICH) clinical prediction scores (CPS) are not accurate enough to identify the cohort of patients with an extremely low chance of survival who would not benefit from further care. The early withdrawal of aggressive care, even in those with the poorest prognosis according to several CPS, has been demonstrated to be associated with worsened outcomes. Initial reports of one recently developed CPS, the FUNC score, suggest that it may more accurately identify this patient population. The aim of this study is to determine if application of do-not-resuscitate orders (DNR) within in the first 24 hours of admission impacted the prognosis of patients with predicted poor outcome. Methods: We retrospectively reviewed 501 consecutive patients with ICH who were admitted from the Emergency Department to a large healthcare system in Dallas, TX between 6/1/2009 and 6/1/2011. Patients with a predicted 100% chance of poor neurologic outcome (PNO) according to FUNC (&lt;4) and ICH-GS(&gt;10) scores were evaluated to determine if early DNR impacted 90 day survival or rate of survival with PNO, defined as Glasgow Outcome Score of &lt;3. Results: Of the 501 patients with ICH, 104 were excluded due to a recognized etiology of their ICH. Data was not available in 31 patients. In the resultant 366 patients, the overall mortality at discharge was 114 (31%, 95% CI=27%-36%). Of the 68 patients who scored &lt;4 on the FUNC, 67 (98.5%, 95% CI=92%-100%) had a PNO at discharge. Of these 68 patients, early DNR were present in 40 patients. The presence of early DNR was not associated with a significant difference in the rate of PNO at discharge (40/40=100% v. 27/28=96.4% p:0.42) or 90 day mortality (40/40=100% v. 21/28=75%, p:0.06). Of the 92 patients who scored &gt;10 on the ICH-GS, 88 (95.6%, 95% CI=89.3-98.3) had a PNO at discharge. The presence of early DNR was associated with a significant difference in both the rate of PNO at discharge (48/48=100% v. 40/44=90.9%, p=0.048) and 90 day mortality (48/48=100% v. 34/44=77.3%, p:0.007). Conclusion: The FUNC score is able to accurately identify the subgroup of patients suffering from ICH with an extremely poor prognosis and little hope of survival to hospital discharge with good neurologic outcome.

Spawning behaviour and mating success in hybrids of silver bream (Blicca bjoerkna L.) and rudd (Scardinius erythrophthalmus L.) in an experimental environment

The egg-release, mating, courting and aggressive acts for the spawning behaviour as well as the survival rates after spawning at stages of eyed embryos, viable hatchlings, and larvae to dry food consumption for the mating success were studied in cultured silver bream Blicca bjoerkna × rudd Scardinius erythrophthalmus hybrids at their first sexual maturity. Experiments were conducted in experimental environments simulating natural reproductive conditions of the parental species. Spawning behaviour was analysed over 1 day from 8.00 to 18.00 hours using a remote-controlled video. Mating success was assessed from eggs and hatched embryos collected on the spawning ground. The results showed that these hybrids exhibited all the reproductive behaviours of the parental species with significantly more courtship than mating. Each egg-release act was accompanied by mating behaviour, involving all the experimental males. A surprising aggressive behaviour was observed in one male which attacked all other experimental fish. Successful mating resulted in the presence of fertilized eggs, the production of hatched embryos in experiments, and the survival of larvae at the dry food consumption stage. However, the low viable hatchling rate observed could indicate a very low chance of survival for these hybrids in rivers in which the occurrence of post-F1 individuals may be more possible by backcrossing.