NT-proBNP in patients with out-of-hospital cardiac arrest: Results from the FINNRESUSCI Study

AIM To assess whether the established cardiovascular biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) provides prognostic information in patients with out-of-hospital cardiac arrest due to ventricular tachycardia or fibrillation (OHCA-VT/VF). METHODS We measured NT-proBNP levels in 155 patients with OHCA-VT/VF enrolled into a prospective multicenter observational study in 21 ICUs in Finland. Blood samples were drawn <6h of OHCA-VT/VF and later after 24h, 48h, and 96h. The end-points were mortality and neurological outcome classified according to Cerebral Performance Category (CPC) after one year. NT-proBNP levels were compared to high-sensitivity troponin T (hs-TnT) levels and established risk scores. RESULTS NT-proBNP levels were higher in non-survivors compared to survivors on study inclusion (median 1003 [quartile (Q) 1-3 502-2457] vs. 527 [179-1284]ng/L, p=0.001) and after 24h (1913 [1012-4573] vs. 1080 [519-2210]ng/L, p<0.001). NT-proBNP levels increased from baseline to 96h after ICU admission (p<0.001). NT-proBNP levels were significantly correlated to hs-TnT levels after 24h (rho=0.27, p=0.001), but not to hs-TnT levels on study inclusion (rho=0.05, p=0.67). NT-proBNP levels at all time points were associated with clinical outcome, but only NT-proBNP levels after 24h predicted mortality and poor neurological outcome, defined as CPC 3-5, in models that adjusted for SAPS II and SOFA scores. hs-TnT levels did not add prognostic information to NT-proBNP measurements alone. CONCLUSION NT-proBNP levels at 24h improved risk assessment for poor outcome after one year on top of established risk indices, while hs-TnT measurements did not further add to risk prediction.

Prognostic Value of Secretoneurin in Critically Ill Patients With Infections.

OBJECTIVES Secretoneurin is produced in neuroendocrine cells, and the myocardium and circulating secretoneurin levels provide incremental prognostic information to established risk indices in cardiovascular disease. As myocardial dysfunction contributes to poor outcome in critically ill patients, we wanted to assess the prognostic value of secretoneurin in two cohorts of critically ill patients with infections. DESIGN Two prospective, observational studies. SETTING Twenty-four and twenty-five ICUs in Finland. PATIENTS A total of 232 patients with severe sepsis (cohort #1) and 94 patients with infections and respiratory failure (cohort #2). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We measured secretoneurin levels by radioimmunoassay in samples obtained early after ICU admission and compared secretoneurin with other risk indices. In patients with severe sepsis, admission secretoneurin levels (logarithmically transformed) were associated with hospital mortality (odds ratio, 3.17 [95% CI, 1.12-9.00]; p = 0.030) and shock during the hospitalization (odds ratio, 2.17 [1.06-4.46]; p = 0.034) in analyses that adjusted for other risk factors available on ICU admission. Adding secretoneurin levels to age, which was also associated with hospital mortality in the multivariate model, improved the risk prediction as assessed by the category-free net reclassification index: 0.35 (95% CI, 0.06-0.64) (p = 0.02). In contrast, N-terminal pro-B-type natriuretic peptide levels were not associated with mortality in the multivariate model that included secretoneurin measurements, and N-terminal pro-B-type natriuretic peptide did not improve patient classification on top of age. Secretoneurin levels were also associated with hospital mortality after adjusting for other risk factors and improved patient classification in cohort #2. In both cohorts, the optimal cutoff for secretoneurin levels at ICU admission to predict hospital mortality was ≈ 175 pmol/L, and higher levels were associated with mortality also when adjusting for Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores. CONCLUSIONS Secretoneurin levels provide incremental information to established risk indices for the prediction of mortality and shock in critically ill patients with severe infections.

Bibliotheca historica sueo-gothica, af C.G. Warmholtz. 1782-9.

Preface signed: Aksel Andersson.

Skandinaviens växter,

Also issued in a Latin edition: Plantae Scandinaviae.

La dénomination égyptienne des boeufs sans cornes,

"Extrait du Sphinx, vol. XVI:5."

Plantae vasculares circa Quickjock Lapponiae Lulensis.

Mode of access: Internet.

Specimen academicum de curiositate naturali ... /

in Linné's Amoenitates academicae, v. 1 [ed. 1] 1749, p. 429-453; [ed. 2] 1749, p.540-563; ed. 3, 1787. p. 541-563. For other reprints and translations see T.O.B.N. Krok, Bibliotheca botanica suecana (1925) : Linné. 129.

Lake Ngami; or, Exploration and discoveries during four years' wanderings in the wilds of south western Africa.

Mode of access: Internet.

Om en kvantitativ bestamning af varmevariationerna vid metalltraders dilatation och kompression.

Thesis (doctoral)--Upsala.

Uber die Stratigraphie und Tektonik der Bären Insel.

Thesis (doctoral)--Upsala.

Notes on the birds of Damara Land and the adjacent countries of South-west Africa.

Bibliography: p. [xxxi]-xxxv.

Ausgewahlte Bemerkungen uber den bohairischen Dialect im Pentateuch Koptisch.

Thesis (doctoral)--Upsala.

Verbal contents of repetitions in Swedish child-directed speech

Repetitions in child-directed speech (CDS) have been shown to vary over time, and are suggested to affect first language acquisition. Correlations between verbal contents of repetitions in CDS and children’s language development have been suggested. The verbal contents of repetitions in Swedish CDS have not yet been investigated. The aim of this study was to examine the verbal contents of repetitions in Swedish CDS during the child’s first 2 years and possible changes in proportions of repetitions during the same time span. Verbal contents of repetitions in parents’ speech in 10 parent-child dyads as the children were 3, 6, 9, 12 and 24 months old were investigated focusing on word classes, sentence types and whole-constituent change. The results were compared to the children’s productive vocabularies at the age of 30 months. Possible occurrences of item-based constructions and frequent frames in the repetitions were also examined. The overall results revealed patterns concerning change in verbal contents in repetitions over time and correlations between verbal contents in repetitions and child language development. Two proposals were made: parents adjust the complexity of their speech to linguistic developmental stages of their children, and linguistic variation in the input increases as the child grows older.

Identifying mobility in populations with mixed marine/terrestrial diets : strontium isotope analysis of skeletal material from a passage grave in Resmo, Öland, Sweden

Strontium isotope analysis of skeletal material as a means to reconstruct prehistoric residential patterns has previously mainly been applied to populations with terrestrial diets. Here we present a model for populations with mixed marine/terrestrial diets, which is based on two-component mixing of strontium isotopes. Applying this model, we can estimate the original strontium isotope value of the terrestrial component of the diet. Accordingly it is possible to identify non-local individuals even if they had a mixed marine/terrestrial diet. The model is applied to tooth enamel samples representing nine individuals recovered from a passage grave in Resmo, on the island of Öland in the Baltic Sea, where at least five non-local individuals, representing at least two different geographical regions of origin, were identified. Non-local individuals were more frequent during the Bronze Age than during previous phases.