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Background Despite controversies, epinephrine remains a mainstay of cardiopulmonary resuscitation (CPR). Recent animal studies have suggested that epinephrine may decrease cerebral blood flow (CBF) and cerebral oxygenation, possibly potentiating neurological injury during CPR. We investigated the cerebrovascular effects of intravenous epinephrine in a swine model of pediatric in-hospital cardiac arrest. The primary objectives of this study were to determine if (1) epinephrine doses have a significant acute effect on CBF and cerebral tissue oxygenation during CPR and (2) if the effect of each subsequent dose of epinephrine differs significantly from that of the first. Methods One-month-old piglets ( n  = 20) underwent asphyxia for 7 min, ventricular fibrillation, and CPR for 10–20 min. Epinephrine (20 mcg/kg) was administered at 2, 6, 10, 14, and 18 min of CPR. Invasive (laser Doppler, brain tissue oxygen tension [PbtO 2 ]) and noninvasive (diffuse correlation spectroscopy and diffuse optical spectroscopy) measurements of CBF and cerebral tissue oxygenation were simultaneously recorded. Effects of subsequent epinephrine doses were compared to the first. Results With the first epinephrine dose during CPR, CBF and cerebral tissue oxygenation increased by > 10%, as measured by each of the invasive and noninvasive measures ( p  < 0.001). The effects of epinephrine on CBF and cerebral tissue oxygenation decreased with subsequent doses. By the fifth dose of epinephrine, there were no demonstrable increases in CBF of cerebral tissue oxygenation. Invasive and noninvasive CBF measurements were highly correlated during asphyxia (slope effect 1.3, p  < 0.001) and CPR (slope effect 0.20, p  < 0.001). Conclusions This model suggests that epinephrine increases CBF and cerebral tissue oxygenation, but that effects wane following the third dose. Noninvasive measurements of neurological health parameters hold promise for developing and directing resuscitation strategies.

Background: To assess the utility of urinary prostate cancer antigen 3 (PCA3) as both a one-time and longitudinal measure in men on active surveillance (AS). Methods: The Johns Hopkins AS program monitors men with favorable-risk prostate cancer with serial PSA, digital rectal examination (DRE), prostate magnetic resonance imaging and prostate biopsy. Since 2007, post-DRE urinary specimens have also been routinely obtained. Men with multiple PCA3 measures obtained over ⩾3 years of monitoring were included. Utility of first PCA3 score (fPCA3), subsequent PCA3 (sPCA3) and change in PCA3 were assessed for prediction of Gleason grade reclassification (GR, Gleason score >6) during follow-up. Results: In total, 260 men met study criteria. Median time from enrollment to fPCA3 was 2 years (interquartile range (IQR) 1–3) and from fPCA3 to sPCA3 was 5 years (IQR 4–6). During median follow-up of 6 years (IQR 5–8), 28 men (11%) underwent GR. Men with GR had higher median fPCA3 (48.0 vs 24.5, P =0.007) and sPCA3 (63.5 vs 36.0, P =0.002) than those without GR, while longitudinal change in PCA3 did not differ by GR status (log-normalized rate 0.07 vs 0.06, P =0.53). In a multivariable model including age, risk classification and PSA density, fPCA3 remained significantly associated with GR (log(fPCA3) odds ratio=1.77, P =0.04). Conclusions: PCA3 scores obtained during AS were higher in men who underwent GR, but the rate of change in PCA3 over time did not differ by GR status. PCA3 was a significant predictor of GR in a multivariable model including conventional risk factors, suggesting that PCA3 provides incremental prognostic information in the AS setting.

Pediatric neurological injury and disease is a critical public health issue due to increasing rates of survival from primary injuries (e.g., cardiac arrest, traumatic brain injury) and a lack of monitoring technologies and therapeutics for treatment of secondary neurological injury. Translational, preclinical research facilitates the development of solutions to address this growing issue but is hindered by a lack of available data frameworks and standards for the management, processing, and analysis of multimodal datasets. Here, we present a generalizable data framework that was implemented for large animal research at the Children’s Hospital of Philadelphia to address this technological gap. The presented framework culminates in a custom, interactive dashboard for exploratory analysis and filtered dataset download. Compared with existing clinical and preclinical data management solutions, the presented framework better enables management of various data types (single measure, repeated measures, time series, and imaging), integration of datasets for comparison across experimental models, cohorts, and groups, and facilitation of predictive modeling from integrated datasets. Further, a predictive model development use case demonstrated utilization and value of the data framework. The general outline of a preclinical data framework presented here can serve as a template for other translational research labs that generate heterogeneous datasets and require a dynamic platform that can easily evolve alongside their research.

Neurologic injury is a leading cause of morbidity and mortality following pediatric cardiac arrest. In this study, we assess the feasibility of quantitative, non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) neuromonitoring during cardiopulmonary resuscitation (CPR), and its predictive utility for return of spontaneous circulation (ROSC) in an established pediatric swine model of cardiac arrest. Cerebral tissue optical properties, oxy- and deoxy-hemoglobin concentration ([HbO 2 ], [Hb]), oxygen saturation (StO 2 ) and total hemoglobin concentration (THC) were measured by a FD-DOS probe placed on the forehead in 1-month-old swine (8–11 kg; n = 52) during seven minutes of asphyxiation followed by twenty minutes of CPR. ROSC prediction and time-dependent performance of prediction throughout early CPR (< 10 min), were assessed by the weighted Youden index (J w , w = 0.1) with tenfold cross-validation. FD-DOS CPR data was successfully acquired in 48/52 animals; 37/48 achieved ROSC. Changes in scattering coefficient (785 nm), [HbO 2 ], StO 2 and THC from baseline were significantly different in ROSC versus No-ROSC subjects ( p  < 0.01) after 10 min of CPR. Change in [HbO 2 ] of + 1.3 µmol/L from 1-min of CPR achieved the highest weighted Youden index (0.96) for ROSC prediction. We demonstrate feasibility of quantitative, non-invasive FD-DOS neuromonitoring, and stable, specific, early ROSC prediction from the third minute of CPR.

Many in-hospital cardiac arrests are precipitated by hypotension, often associated with systemic inflammation. These patients are less likely to be successfully resuscitated, and novel approaches to their treatment are needed. To determine if the addition of inhaled nitric oxide (iNO) to hemodynamic-directed cardiopulmonary resuscitation (HD-CPR) would improve short-term survival from cardiac arrest associated with shock and systemic inflammation. In 3-month-old swine (n = 21), LPS was intravenously infused, inducing systemic hypotension. Ventricular fibrillation was induced, and animals were randomized to blinded treatment with either: 1) HD-CPR with iNO, or 2) HD-CPR without iNO. During HD-CPR, chest compression depth was titrated to peak aortic compression pressure of 100 mm Hg, and vasopressor administration was titrated to coronary perfusion pressure greater than or equal to 20 mm Hg. Defibrillation attempts began after 10 minutes of resuscitation. The primary outcome was 45-minute survival. The iNO group had higher rates of 45-minute survival (10 of 10 vs. 3 of 11; P = 0.001). During cardiopulmonary resuscitation, the iNO group had lower pulmonary artery relaxation pressure (mean ± SEM, 10.9 ± 2.4 vs. 18.4 ± 2.4 mm Hg; P = 0.03), higher coronary perfusion pressure (21.1 ± 1.5 vs. 16.9 ± 1.0 mm Hg; P = 0.005), and higher aortic relaxation pressure (36.6 ± 1.6 vs. 30.4 ± 1.1 mm Hg; P < 0.001) despite shallower chest compressions (5.88 ± 0.25 vs. 6.46 ± 0.40 cm; P = 0.02) and fewer vasopressor doses in the first 10 minutes (median, 4 [interquartile range, 3-4] vs. 5 [interquartile range, 5-6], P = 0.03). The addition of iNO to HD-CPR in LPS-induced shock-associated cardiac arrest improved short-term survival and intraarrest hemodynamics.

Although hoary bats (Lasiurus cinereus) are presumed to be migratory and capable of long-distance dispersal, traditional marking techniques have failed to provide direct evidence of migratory movements by individuals. We measured the stable hydrogen isotope ratios of bat hair (δDh) and determined how these values relate to stable hydrogen isotope ratios of precipitation (δDp). Our results indicate that the major assumptions of stable isotope migration studies hold true for hoary bats and that the methodology provides a viable means of determining their migratory movements. We present evidence that a single annual molt occurs in L. cinereus prior to migration and that there is a strong relationship between δDh and δDp during the molt period. This presumably reflects the incorporation of local δDp into newly grown hair. Furthermore, we present evidence that individual hoary bats are capable of traveling distances in excess of 2,000 km and that hair is grown at a wide range of latitudes and elevations. Stable hydrogen isotope analysis offers a promising new tool for the study of bat migration.

Porphyry and epithermal deposits are important sources of base and precious metals. Most actively mined deposits have been exhumed such that ore bodies are relatively close to the surface and are therefore locatable and economic to extract. Identifying and characterizing concealed deposits, particularly more deeply buried porphyry deposits, represents a far greater challenge for mineral exploration, and will become progressively more important as near-surface resources are gradually exhausted over time. We report high-precision 40Ar/39Ar dates for coarsely crystalline alunite that precipitated from magmatic steam in open fractures in Oligocene dacitic volcanic rocks, and a SHRIMP 206Pb/238U zircon date for one of several rhyolite dikes present at Alunite Ridge and Deer Trail Mountain, Utah. Both the magmatic-steam alunite and rhyolite dikes are related to concealed intrusions. The rhyolite dike yielded an age of 30.72 ± 0.36 Ma, which is older than a commonly cited 27.1 Ma age estimate for the Three Creeks Tuff Member of the Bullion Canyon Volcanics that is cut by the dike. 40Ar/39Ar data for samples of magmatic-steam alunite and sericite from six mines and prospects provide evidence for at least two periods of episodic hydrothermal activity at ca. 15.7–15.1 Ma and ca. 14.7–13.8 Ma, with the older and younger pulses of activity recorded at the more eastern and western sites, respectively. These two periods of hydrothermal activity are consistent with previous interpretations that Alunite Ridge and Deer Trail Mountain are underlain by two concealed porphyry stocks. 40Ar/39Ar analyses of individual bands in a sample of massive, centimeter-scale banded vein alunite yield indistinguishable ages with a weighted mean of 13.98 ± 0.12 Ma, consistent with a short-lived (≲250 ka) magmatic event with episodic vapor discharge recurring on short timescales (≲36 ka). 40Ar/39Ar geochronology of magmatic-steam alunite is a valuable tool to constrain the timing and duration of magmatic hydrothermal activity associated with unexposed intrusions and potentially porphyry deposits, and therefore may be useful in exploration.

To assess the utility of urinary prostate cancer antigen 3 (PCA3) as both a one-time and longitudinal measure in men on active surveillance (AS). The Johns Hopkins AS program monitors men with favorable-risk prostate cancer with serial PSA, digital rectal examination (DRE), prostate magnetic resonance imaging and prostate biopsy. Since 2007, post-DRE urinary specimens have also been routinely obtained. Men with multiple PCA3 measures obtained over [greater-than or slanted equal to]3 years of monitoring were included. Utility of first PCA3 score (fPCA3), subsequent PCA3 (sPCA3) and change in PCA3 were assessed for prediction of Gleason grade reclassification (GR, Gleason score >6) during follow-up. In total, 260 men met study criteria. Median time from enrollment to fPCA3 was 2 years (interquartile range (IQR) 1-3) and from fPCA3 to sPCA3 was 5 years (IQR 4-6). During median follow-up of 6 years (IQR 5-8), 28 men (11%) underwent GR. Men with GR had higher median fPCA3 (48.0 vs 24.5, P=0.007) and sPCA3 (63.5 vs 36.0, P=0.002) than those without GR, while longitudinal change in PCA3 did not differ by GR status (log-normalized rate 0.07 vs 0.06, P=0.53). In a multivariable model including age, risk classification and PSA density, fPCA3 remained significantly associated with GR (log(fPCA3) odds ratio=1.77, P=0.04). PCA3 scores obtained during AS were higher in men who underwent GR, but the rate of change in PCA3 over time did not differ by GR status. PCA3 was a significant predictor of GR in a multivariable model including conventional risk factors, suggesting that PCA3 provides incremental prognostic information in the AS setting.

Antioxidants, such as vitamin C, are hypothesized to prevent prostate carcinogenesis by protecting the DNA from oxidative damage. We assessed whether higher prediagnostic plasma concentrations of vitamin C were associated with a lower risk of prostate cancer in a well-nourished cohort of men. Plasma concentrations of ascorbic acid (vitamin C) were previously determined in blood specimens collected between 1984 and 1990 in men participating in the Baltimore Longitudinal Study of Aging. Total plasma ascorbic acid ( l-ascorbic acid plus dehydro- l-ascorbic acid) levels were measured by using a modification of the 2,4-dinitrophenylhydrazine method. Among the 498 male participants with measured plasma vitamin C levels, 62 men were subsequently diagnosed with prostate cancer during their lifetime. Cox proportional hazards regression models were used to estimate relative risks and 95% confidence intervals for prostate cancer. The median plasma concentration of vitamin C for the cohort was 1.17 mg/dL, which is in the normal to high range for older men. The age-adjusted relative risk of prostate cancer for the highest quartile (median = 1.47 mg/dL, range = 1.36–2.58) compared with the lowest quartile (median = 0.83 mg/dL, range = 0.15–0.98) of plasma vitamin C concentration was 1.31 (95% confidence interval 0.63 to 2.70, P for trend = 0.29). Adjustment for cigarette smoking status, body mass index, or plasma cholesterol concentration did not attenuate the results. This small but prospective study suggests that higher plasma vitamin C concentrations within the normal physiologic range are not associated with a lower risk of prostate cancer in well-nourished men.

Gases trapped in Miocene to Upper Cretaceous amber were released by gently crushing the amber under vacuum and were analyzed by quadrupole mass spectrometry. After discounting the possibility that the major gases N$_{2}$, O$_{2}$, and CO$_{2}$ underwent appreciable diffusion and diagenetic exchange with their surroundings or reaction with the amber, it has been concluded that in primary bubbles (gas released during initial breakage) these gases represent mainly original ancient air modified by the aerobic respiration of microorganisms. Values of N$_{2}$/(CO$_{2}$ + O$_{2}$) for each time period give consistent results despite varying O$_{2}$/CO$_{2}$ ratios that presumably were due to varying degrees of respiration. This allows calculation of original oxygen concentrations, which, on the basis of these preliminary results, appear to have changed from greater than 30 percent O$_{2}$ during one part of the Late Cretaceous (between 75 and 95 million years ago) to 21 percent during the Eocene-Oligocene and for present-day samples, with possibly lower values during the Oligocene-Early Miocene. Variable O$_{2}$ levels over time in general confirm theoretical isotope-mass balance calculations and suggest that the atmosphere has evolved over Phanerozoic time.