Search

BACKGROUND: Coronary artery disease remains the largest contributor to cardiac arrests worldwide; yet, long-term outcomes are often driven by neurological status after resuscitation. We examined the association between pre–percutaneous coronary intervention (PCI) level of consciousness (LOC) and outcomes among patients with cardiac arrest who underwent PCI. METHODS: The study cohort included patients undergoing PCI after cardiac arrest between April 2018 and March 2022 at 48 hospitals in the state of Michigan. Pre-PCI LOC was categorized as mentally alert, partially responsive, unresponsive, and unable to assess. In-hospital outcomes included mortality, bleeding, and acute kidney injury. RESULTS: Among 3021 patients who underwent PCI after cardiac arrest, 1394 (49%) were mentally alert, 132 (5%) were partially responsive, 698 (24%) were unresponsive, and 631 (22%) were unable to assess. The mentally alert cohort had lower mortality (4.59%) compared with the partially responsive (17.42%), unresponsive (50.14%), and unable to assess cohorts (38.03%; P<0.001). After adjusting for baseline differences, compared with mentally alert patients, the odds of mortality were markedly elevated in patients who were partially responsive (adjusted odds ratio, 4.63 [95% CI, 2.67–8.04]; P<0.001), unable to assess (adjusted odds ratio, 13.95 [95% CI, 9.97–19.51]; P<0.001), and unresponsive (adjusted odds ratio, 24.36 [17.34–34.23]; P<0.001). After adjustment, patients with impaired LOC also had higher risks of acute kidney injury and bleeding compared with mentally alert patients. CONCLUSIONS: Pre-PCI LOC is a strong predictor of in-hospital outcomes after PCI among cardiac arrest patients. A patient’s pre-PCI LOC should be considered an important factor when weighing treatment options, designing clinical trials, and counseling patients and their families regarding prognosis after PCI. [ABSTRACT FROM AUTHOR]

A neck lump is a common presenting sign in both the paediatric and adult population and may represent a broad range of benign or malignant diagnoses. The appropriate initial assessment, investigation and management is key to delivering appropriate treatments and to avoid missing potentially serious diagnoses. There is a range of imaging modalities available to the treating clinician and huge variability in the appropriate surgical or non-surgical management of disease. In this article we discuss the approach to the assessment of patients with a neck lump, including the history and examinations which should take place. We discuss the imaging modalities which are most appropriate for each condition and the range of management options available. Both common and rarer diagnoses are discussed through the course of the review. [ABSTRACT FROM AUTHOR]

This study combined a catchment model and one-dimensional lake model (GLM-AED) to simulate the response of hydrodynamics and water quality of subtropical Advancetown Lake (South-East Queensland, Australia) to future changing climates from 2040 to 2069 and 2070 to 2099 under Representative Concentration Pathway (RCP) 4.5 and 8.5 and increased water demand from a 50% increase in population over current levels. The simulation adequately reproduced water temperature (RMSE of 0.6 °C), dissolved oxygen (DO) (RMSE of 2 mg/L), and other water quality variables, such as nitrogen, phosphorus, and chlorophyll a (Chl-a). Warming temperatures dominated the change in thermal structure and hydrodynamic status of the lake under future climate change conditions. Projected changes in precipitation and hydrological response from the upstream catchment might, however, partly offset the warming temperatures under future climate change. Increased water withdrawal due to population growth, which involved water extraction from the epilimnion, showed antagonistic effects on water stability compared to those from climate change. Under a high emission scenario of RCP8.5 during the 2080s, there is an increased likelihood of winter turnover failure in Advancetown Lake. Nutrient concentrations were simulated to decrease from reduced catchment loads under future climate change conditions. However, Chl-a concentrations were simulated to increase, especially during the period after winter turnover, under these future conditions. The depth of the hypoxia front during stratification is expected to decrease and move towards the water surface, attributable to the warming water temperatures and prolonged thermal stratification, which might affect biogeochemical processes and exchange fluxes between the hypolimnion and bottom sediments. These potential changes may present challenges for water resource management under future conditions of climate change and population growth. [ABSTRACT FROM AUTHOR]

• Spinal cord hypoperfusion undermines recovery following spinal cord injury. • Cord perfusion pressure is managed via reactive or empiric CSF drainage strategies. • Patients managed with reactive drainage were more likely to exhibit hypoperfusion. Spinal cord hypoperfusion undermines clinical recovery in acute traumatic spinal cord injuries. New guidelines suggest cerebrospinal fluid (CSF) drainage is an important strategy for preventing spinal cord hypoperfusion in the acute post-injury phase. This study included participants presenting to a single level 1 trauma center between 2018 and 2022 with cervical or thoracic traumatic spinal cord injury severity grade A–C, as evaluated by the American spinal injury association impairment scale (AIS). The primary objective of this study was to compare the efficacy of two CSF drainage protocols in preventing spinal cord hypoperfusion; 1) draining CSF only when spinal cord perfusion pressure (SCPP) drops below 65 mmHg (i.e. reactive) versus 2) empiric CSF drainage of 5–10 mL every hour. Intrathecal pressure, spinal cord perfusion pressure (SCPP), mean arterial pressure (MAP), and vasopressor utilization were compared using univariate T-test statistical analysis. While there was no difference in the incidence of sub-optimal SCPP (<65 mmHg; p = 0.1658), reactively drained participants were more likely to exhibit critical hypoperfusion (<50 mmHg; p = 0.0030) despite also having lower average intrathecal pressures (p < 0.001). There were no differences in average SCPP, mean arterial pressure (MAP), or vasopressor utilization between the two groups (p > 0.05). Empiric (vs reactive) CSF drainage resulted in fewer incidences of critical spinal cord hypoperfusion for patients with acute traumatic spinal cord injuries. [ABSTRACT FROM AUTHOR]

Decision makers are often confronted with inadequate information to predict nutrient loads and yields in freshwater ecosystems at large spatial scales. We evaluate the potential of using data mapped at large spatial scales (regional to global) and often coarse resolution to predict nitrogen yields at varying smaller scales (e.g., at the catchment and stream reach level). We applied the SPAtially Referenced Regression On Watershed attributes (SPARROW) model in three regions: the Upper Midwest part of the United States, New Zealand, and the Grande River Basin in southeastern Brazil. For each region, we compared predictions of nitrogen delivery between models developed using novel large-scale datasets and those developed using local-scale datasets. Large-scale models tended to underperform the local-scale models in poorly monitored areas. Despite this, large-scale models are well suited to generate hypotheses about relative effects of different nutrient source categories (point and urban, agricultural, native vegetation) and to identify knowledge gaps across spatial scales when data are scarce. Regardless of the spatial resolution of the predictors used in the models, a representative network of water quality monitoring stations is key to improve the performance of large-scale models used to estimate loads and yields. We discuss avenues of research to understand how this large-scale modelling approach can improve decision making for managing catchments at local scales, particularly in data poor regions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)