Which anesthetic should be used in the treatment of refractory status epilepticus?

While the treatment of refractory status epilepticus (SE) relies on the use of anesthetic agents, mostly barbiturates, propofol, or midazolam, the study of the available literature discloses that the evidence level is low. Therapeutic coma induction appears straightforward for generalized convulsive or subtle SE, but this approach is debated for complex partial SE. Each anesthetic has its own advocates, and specific advantages and risks; furthermore, several different protocols have been reported regarding the duration and depth of sedation. However, it seems that the biological background of the patient (especially the etiology) remains the main prognostic determinant in SE. There is a clear need of controlled trials regarding this topic.

Termination of Atrial Fibrillation by Catheter Ablation can be Successfully Predicted from Baseline ECG

Purpose Multiple organization indices (OIs) have been used to predict the outcome of stepwise catheter ablation (step-CA) in long-standing persistent AF (pers-AF), however with limited success. Our study aims at developing innovative OIs from baseline (BL, before ablation) ECG in order to predict the outcome of step-CA. Methods Fourteen consecutive patients (pts) (60±5 y, AF duration 21±9 m) underwent a step-CA consisting in pulmonary veins isolation, left atrial (LA) defragmentation and linear ablations, and right atrial (RA) ablations if non terminated. Chest lead V6 was placed in the back (V6b). After QRST cancellation from chest leads V1 to V6b, two OIs were computed to quantify the harmonic components of ECG atrial activity: 1) phase difference variance (PD) between the AF harmonic components as a measure of AF regularity, and 2) adaptive OI (AOI) evaluating the time evolution of the AF harmonic components. Both indices were compared to classical ones: a spectrum-based OI (SOI) and ECG AF cycle length (AFCL). Results Pers-AF was terminated into sinus rhythm or atrial tachycardia in 10/14 pts during step-CA, 8 during LA (LT), 2 during RA (RT) ablation, and 4 were non terminated (NT). The figure shows that LT was best separated from RT/NT before ablation by AOI computed on lead V1 (A) and PD from lead V6b (B) as compared to SOI and AFCL respectively. Conclusion Our results suggest that adaptive OIs computed before ablation perform better than classical OIs for separating LT from RT/NT pts. These findings are indicative of a higher baseline organization in LT pts that could be used to select candidates for the restoration of sinus rhythm by step-CA.

Consumer Advisory Bulletin, Be Wary of Online Payday Loans, July 2011

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High-pressure ultrasonic study of vibrational anharmonicity in bcc Cu-Al-Be alloys

To quantify the vibrational anharmonicity of the long-wavelength acoustic modes of bcc Cu74.1Al23.1Be2.8 near its martensitic transition temperature Ms (261 K), the hydrostatic pressure derivatives (¿CIJ/¿P)P=0 of the elastic stiffness moduli have been measured. The Grüneisen parameters at 268 K (just above Ms), especially of longitudinal modes, which become smaller than those of the shear modes, are quite different from those at 295 K: the anharmonicity changes markedly in the vicinity of the transition. Similar trends are noted for Cu66.5Al12.7Zn20.8. Experimental data near Ms are used to estimate cubic invariants in the strain order parameters in a Landau formalism.

Lattice-dynamical study of the premartensitic state of the Cu-Al-Be alloys

Neutron-scattering techniques have been used to study the premartensitic state of a family of Cu-Al-Be alloys, which transform from the bcc phase to an 18R martensitic structure. We find that the phonon modes of the TA2[110] branch have very low energies with anomalous temperature dependence. A slight anomaly at q=2/3 was observed; this anomaly, however, does not change significantly with temperature. No elastic peaks, related to the martensite structure, were found in the premartensitic state of these alloys. The results are compared with measurements, performed under the same instrumental conditions, on two Cu-Al-Ni and a Cu-Zn-Al martensitic alloy.

Aging behavior in Cu-Al-Be shape memory alloy

This article reports positron annihilation spectroscopy and calorimetric measurements of the aging behavior in a Cu¿Al¿Be shape memory alloy. An excess of single vacancies is retained in the alloy as a result of a quench. All vacancies in excess disappear after long aging time, and a migration energy EM = 1.0±0.1 eV for this process has been found to be larger than in other Cu-based shape memory alloys. The good correlation found for the concentration of vacancies and the shift in the martensitic transition temperature demonstrates that, in Cu¿Al¿Be, changes in the transition after a quench are deeply related to the excess of vacancies.

Measurement Errors Should Always Be Incorporated in Phylogenetic Comparative Analysis

The evolution of continuous traits is the central component of comparative analyses in phylogenetics, and the comparison of alternative models of trait evolution has greatly improved our understanding of the mechanisms driving phenotypic differentiation. Several factors influence the comparison of models, and we explore the effects of random errors in trait measurement on the accuracy of model selection. We simulate trait data under a Brownian motion model (BM) and introduce different magnitudes of random measurement error. We then evaluate the resulting statistical support for this model against two alternative models: Ornstein-Uhlenbeck (OU) and accelerating/decelerating rates (ACDC). Our analyses show that even small measurement errors (10%) consistently bias model selection towards erroneous rejection of BM in favour of more parameter-rich models (most frequently the OU model). Fortunately, methods that explicitly incorporate measurement errors in phylogenetic analyses considerably improve the accuracy of model selection. Our results call for caution in interpreting the results of model selection in comparative analyses, especially when complex models garner only modest additional support. Importantly, as measurement errors occur in most trait data sets, we suggest that estimation of measurement errors should always be performed during comparative analysis to reduce chances of misidentification of evolutionary processes.

An overview of how rubisco and carbohydrate metabolism may be regulated at elevated atmospheric [CO2] and temperature

Selostus: Hiilihydraatti- ja proteiiniaineenvaihdunnan säätely kohonneen hiilidioksidipitoisuuden ja lämpötilan vallitessa