How to assess prognosis after cardiac arrest and therapeutic hypothermia.

The prognosis of patients who are admitted in a comatose state following successful resuscitation after cardiac arrest remains uncertain. Although the introduction of therapeutic hypothermia (TH) and improvements in post-resuscitation care have significantly increased the number of patients who are discharged home with minimal brain damage, short-term assessment of neurological outcome remains a challenge. The need for early and accurate prognostic predictors is crucial, especially since sedation and TH may alter the neurological examination and delay the recovery of motor response for several days. The development of additional tools, including electrophysiological examinations (electroencephalography and somatosensory evoked potentials), neuroimaging and chemical biomarkers, may help to evaluate the extent of brain injury in these patients. Given the extensive literature existing on this topic and the confounding effects of TH on the strength of these tools in outcome prognostication after cardiac arrest, the aim of this narrative review is to provide a practical approach to post-anoxic brain injury when TH is used. We also discuss when and how these tools could be combined with the neurological examination in a multimodal approach to improve outcome prediction in this population.

Growth arrest-specific gene 6 (GAS6) as an intra-hospital mortality predictor for patients in septic shock

Aim: Gas6 is known to be elevated in sepsis, correlating with the severity of infection and organ failure. We aimed to investigate the performance of Gas6 plasma levels at admission to predict the risk of mortality in a cohort of septic patients.Methods: We used prospectively collected data and plasma samples from the 'Sepsis Cohorte Romande'. Gas6 level was measured by ELISA at admission and expressed in percentage relative to its level in a pool of normal plasma.Results: Non-survivors (n = 19) presented higher Gas6 levels than survivors (n = 78; median 287% vs. 158%, IQR 182 and 119 respectively; P = 0.0003). Gas6 correlated positively with different cytokine and was the best mortality predictor, as shown by the ROC curves area (Fig. 1). In patients with septic shock (n = 67), using 249% as a cut-off value, Gas6 measurement had a specificity of 81% and a sensitivity of 68% for predicting mortality. ROC curve area was 0.76. Positive and negative predictive values were 59% and 87%, respectively.Conclusion: Thus, Gas6 plasma level at admission might be a useful tool to predict mortality in patients with septic shock. Nevertheless, independent association of Gas6 level with mortality still needs to be assessed. Although Gas6 hold promise as an early sepsis marker, its precise implication in sepsis remains to be elucidated.

Arrest du Conseil d'Etat du Roy. Du 12 octobre 1700. Concernant les sucres bruts & non raffinez, provenants de l'isle de Cayenne, qui seront déchargez à Nantes & voiturez sans séjour à droiture par le bureau d'Ingrande...

[Acte. 1700-10-12. Fontainebleau]

Arrest du conseil d'Etat du Roy, pour la seureté des sommes dûës à ceux qui sont compris dans les brevets d'assurance accordezs par le Roy sur les charges de sa Maison, & autres charges de cette nature ou gouvernemens . Du vingt-cinquiéme janvier 1694

[Acte. 1694-01-25. Versailles]

The short arm of the law: judicial institutions and local governance in Brazil

This paper estimates the effect of judicial institutions on governance at the local level in Brazil. Our estimation strategy exploits a unique institutional feature of state judiciary branches which assigns prosecutors and judges to the most populous among contiguous counties forming a judiciary district. As a result of this assignment mechanism there are counties with nearly identical populations, some with and some without local judicial presence, which we exploit to impute counterfactual outcomes. Conditional on observable county characteristics, offenses per civil servant are about 35% lower in counties that have a local seat of the state judiciary. The lower incidence of infractions stems mostly from fewer violations of financial management regulations by local administrators, fewer instances of problems in project execution and project managment, fewer cases of non-existent or ineffective civil society oversight and fewer cases of improper handling of remittances to local residents.

VOLUMES RELIES du Cabinet des titres : recherches de noblesse, armoriaux, preuves, histoires généalogiques. « État de la noblesse de la Généralité d'Alençon, suivant l'arrest du Conseil du 22 mars 1666... », par M. de Marle.

Il y a une table alphabétique des noms à la fin du volume.

VOLUMES RELIES du Cabinet des titres : recherches de noblesse, armoriaux, preuves, histoires généalogiques. « Cathalogue des gentilshommes des provinces de Touraine, Anjou et Mayne, qui ont représenté, en exécution de l'arrest du Conseil du 22 mars 1666, leurs titres de noblesse ; ... ensemble le blazon de leurs armes ».

Il y a une table alphabétique des noms à la fin du volume.

Advantages of a cohort study on cardiac arrest conducted by nurses

AbstractOBJECTIVEIdentifying factors associated to survival after cardiac arrest.METHODAn experience report of a cohort study conducted in a university hospital, with a consecutive sample comprised of 285 patients. Data were collected for a year by trained nurses. The training strategy was conducted through an expository dialogue lecture. Collection monitoring was carried out by nurses via telephone calls, visits to the emergency room and by medical record searches. The neurological status of survivors was evaluated at discharge, after six months and one year.RESULTSOf the 285 patients, 16 survived until hospital discharge, and 13 remained alive after one year, making possible to identify factors associated with survival. There were no losses in the process.CONCLUSIONCohort studies help identify risks and disease outcomes. Considering cardiac arrest, they can subsidize public policies, encourage future studies and training programs for CPR, thereby improving the prognosis of patients.

Automated auditory mismatch negativity paradigm improves coma prognostic accuracy after cardiac arrest and therapeutic hypothermia.

PURPOSE: EEG and somatosensory evoked potential are highly predictive of poor outcome after cardiac arrest; their accuracy for good recovery is however low. We evaluated whether addition of an automated mismatch negativity-based auditory discrimination paradigm (ADP) to EEG and somatosensory evoked potential improves prediction of awakening. METHODS: EEG and ADP were prospectively recorded in 30 adults during therapeutic hypothermia and in normothermia. We studied the progression of auditory discrimination on single-trial multivariate analyses from therapeutic hypothermia to normothermia, and its correlation to outcome at 3 months, assessed with cerebral performance categories. RESULTS: At 3 months, 18 of 30 patients (60%) survived; 5 had severe neurologic impairment (cerebral performance categories = 3) and 13 had good recovery (cerebral performance categories = 1-2). All 10 subjects showing improvements of auditory discrimination from therapeutic hypothermia to normothermia regained consciousness: ADP was 100% predictive for awakening. The addition of ADP significantly improved mortality prediction (area under the curve, 0.77 for standard model including clinical examination, EEG, somatosensory evoked potential, versus 0.86 after adding ADP, P = 0.02). CONCLUSIONS: This automated ADP significantly improves early coma prognostic accuracy after cardiac arrest and therapeutic hypothermia. The progression of auditory discrimination is strongly predictive of favorable recovery and appears complementary to existing prognosticators of poor outcome. Before routine implementation, validation on larger cohorts is warranted.

Arrest du Conseil d'Etat du Roy, du quatorze septembre 1700. qui ordonne que conformément à l'arrêt du conseil du 3 février 1670, l'or & l'argent faux, battu, trait & filé venant de Genève en France, sera tenu de passer par Lyon, & d'y payer les droits de tiers-sur-taux, & de quarantième de la douane au fermier desdits droits...

[Acte. 1700-09-14. Marly]

Sentence de mort confirmee par Arrest de la Cour de Parlement de Paris, contre Manuel Magnan compagnon cordonnier, executé, à mort, Pour avoir pris & derobé le sainct Sacrement de l'Autel, en l'Eglise Commandataire de S. Iean de Lattran le 14 Féburier, 1620. Ensemble tout le contenu du Procès, Informations, et confessions, faicte par ledict Magnã, sur ledict larrecin & Sacrilege

[Acte. 1620-02-14]

Arrest du Conseil d'Etat du Roi, qui ordonne que les biens, droits et revenus dépendans du monastère des célestins de Paris seront régis et administrés par le sieur Bollioud de Saint-Julien, receveur général du clergé, jusqu'à ce qu'il en ait été autrement ordonné. Du 29 mars 1776...

[Acte. 1776-03-29]

Arrest de la cour de parlement du dixième juin 1693, portant l'omologation du règlement fait par M. l'archevêque pour l'honoraire des curez et des ecclésiastiques de la ville et fauxbourgs de Paris, avec les droits, salaires et vacations attribuez aux jurés crieurs de corps et de vins de Paris

[Acte. 1693-06-10]

Arrest de la cour du parlement du 3 février 1755 [condamnant le clergé de St-Etienne-du Mont à Paris pour refus d'administrer les sacrements.]

[Acte. 1755-02-03]