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Concept: Hebrew numerals

343

Background Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited. Methods In a trial conducted at 37 children’s hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest. Results The trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse events, as well as 28-day mortality, did not differ significantly between groups. Conclusions Among comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087 .).

Concepts: Drowning, Relative risk, Hebrew numerals, Heart, Harshad number, Asystole, Therapeutic hypothermia, Cardiac arrest

91

Background Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients. Recurrences are common after antibiotic therapy. Actoxumab and bezlotoxumab are human monoclonal antibodies against C. difficile toxins A and B, respectively. Methods We conducted two double-blind, randomized, placebo-controlled, phase 3 trials, MODIFY I and MODIFY II, involving 2655 adults receiving oral standard-of-care antibiotics for primary or recurrent C. difficile infection. Participants received an infusion of bezlotoxumab (10 mg per kilogram of body weight), actoxumab plus bezlotoxumab (10 mg per kilogram each), or placebo; actoxumab alone (10 mg per kilogram) was given in MODIFY I but discontinued after a planned interim analysis. The primary end point was recurrent infection (new episode after initial clinical cure) within 12 weeks after infusion in the modified intention-to-treat population. Results In both trials, the rate of recurrent C. difficile infection was significantly lower with bezlotoxumab alone than with placebo (MODIFY I: 17% [67 of 386] vs. 28% [109 of 395]; adjusted difference, -10.1 percentage points; 95% confidence interval [CI], -15.9 to -4.3; P<0.001; MODIFY II: 16% [62 of 395] vs. 26% [97 of 378]; adjusted difference, -9.9 percentage points; 95% CI, -15.5 to -4.3; P<0.001) and was significantly lower with actoxumab plus bezlotoxumab than with placebo (MODIFY I: 16% [61 of 383] vs. 28% [109 of 395]; adjusted difference, -11.6 percentage points; 95% CI, -17.4 to -5.9; P<0.001; MODIFY II: 15% [58 of 390] vs. 26% [97 of 378]; adjusted difference, -10.7 percentage points; 95% CI, -16.4 to -5.1; P<0.001). In prespecified subgroup analyses (combined data set), rates of recurrent infection were lower in both groups that received bezlotoxumab than in the placebo group in subpopulations at high risk for recurrent infection or for an adverse outcome. The rates of initial clinical cure were 80% with bezlotoxumab alone, 73% with actoxumab plus bezlotoxumab, and 80% with placebo; the rates of sustained cure (initial clinical cure without recurrent infection in 12 weeks) were 64%, 58%, and 54%, respectively. The rates of adverse events were similar among these groups; the most common events were diarrhea and nausea. Conclusions Among participants receiving antibiotic treatment for primary or recurrent C. difficile infection, bezlotoxumab was associated with a substantially lower rate of recurrent infection than placebo and had a safety profile similar to that of placebo. The addition of actoxumab did not improve efficacy. (Funded by Merck; MODIFY I and MODIFY II ClinicalTrials.gov numbers, NCT01241552 and NCT01513239 .).

Concepts: Hebrew numerals, Infection, Placebo, Probiotic, Antibiotic resistance, Clinical trial, Antibiotic, Clostridium difficile

5

Our previously presented method for high throughput computational screening of mutant activity (Hediger et al., 2012) is benchmarked against experimentally measured amidase activity for 22 mutants of Candida antarctica lipase B (CalB). Using an appropriate cutoff criterion for the computed barriers, the qualitative activity of 15 out of 22 mutants is correctly predicted. The method identifies four of the six most active mutants with ≥3-fold wild type activity and seven out of the eight least active mutants with ≤0.5-fold wild type activity. The method is further used to screen all sterically possible (386) double-, triple- and quadruple-mutants constructed from the most active single mutants. Based on the benchmark test at least 20 new promising mutants are identified.

Concepts: Scientific method, Enzymes, Hebrew numerals, Test method, Benchmark, Enzyme

2

Our hypothesis is that there are no difference in the injury incidence on artificial turf and natural grass. During the 2011/2012 season, we recorded injuries which occurred to two Italian stadiums equipped with third-generation artificial turf during 36 games (391 players). Data were compared with the injuries which occurred in the same season in two stadiums equipped with natural grass (372 players). We recorded 43 injuries during the playing time (16.7 per 1000 h). About 23 (18.1 per 1000 h) injuries occurred on artificial turf, while 20 (15.2 per 1000 h) on the natural grass with no statistical differences P > 0.05. We recorded 10 (7.87 per 1000 h) contact and 13 (10.23 per 1000 h) non-contact injuries on artificial turf, while 5 (3.8 per 1000 h) contact and 15 (11.4 per 1000 h) non-contact injuries on natural grass P > 0.05. The overall relative risk was 1.15; 95% CI: 0.64-2.07). Our study demonstrates a substantial equivalence in injury risk on natural grass and artificial turf in elite professional soccer athletes during official matches.

Concepts: Injury, Hebrew numerals, Prime number, Major League Baseball, Substantial equivalence, Association football, Grass, Artificial turf

1

When ingested alone, beetroot juice and sodium bicarbonate are ergogenic for high-intensity exercise performance. This study sought to determine the independent and combined effects of these supplements. Eight endurance trained (V̇O2max 65 mL·kg·min(-1)) male cyclists completed four x 4-km time trials (TT) in a double-blind Latin square design supplementing with beetroot crystals (BC) for 3 days (15 g.day(-1) + 15 g 1 h prior to TT, containing 300 mg nitrate per 15 g), bicarbonate (Bi 0.3 g·kg(-1) body mass [BM] in 5 doses every 15 min from 2.5 h prior to TT); BC+Bi or placebo (PLA). Subjects completed TTs on a Velotron cycle ergometer under standardized lab conditions. Plasma nitrite concentrations were significantly elevated only in the BC+Bi trial prior to the TT (1520 ± 786 nmol.L(-1)) compared to baseline (665 ± 535 nmol.L(-1), p = 0.02) and the Bi and PLA conditions (Bi: 593 ± 203 nmol.L(-1), p < 0.01; PLA: 543 ± 369 nmol.L(-1), p< 0.01). Plasma nitrite concentrations were not elevated in the BC trial prior to the TT (1102 ± 218 nmol.L(-1)) compared to baseline (975 ± 607 nmol.L(-1), p > 0.05). Blood bicarbonate concentrations were increased in the BC+Bi and Bi trials prior to the TT (BC+Bi: 30.9 ± 2.8 mmol.L(-1); Bi: 31.7 ± 1.1 mmol.L(-1)). There were no differences in mean power output (386 - 394 W) or the time taken to complete the TT (335.8 - 338.1 s) between any conditions. Under the conditions of this study, supplementation was not ergogenic for 4-km TT performance.

Concepts: Ammonia, Carbonate, Hebrew numerals, Chemistry, Time trial, Isle of Man TT, Nitrate, Individual time trial

0

A hierarchically structured Bi2S3/graphene aerogel composite is constructed that shows excellent sodium storage properties. Specifically, the composite delivers a stable reversible capacity of 397 mA h g(-1) at 100 mA g(-1) after 50 cycles and 348 mA h g(-1) at 1 A g(-1) after 120 cycles. Furthermore, even at a high current density of 2 A g(-1), a reversible capacity of 336 mA h g(-1) is achieved.

Concepts: Hebrew numerals

0

Exposure to humid O2 or ambient air affords a 5-order-of-magnitude increase in electronic conductivity of a new Prussian blue analogue incorporating Co(II) and V(IV)-oxo units. Oxidation produces a mixed-valence framework, where the O2 exposure time controls the V(IV)/V(V) ratio and thereby the material’s conductivity. The oxidized framework shows an intervalence charge-transfer band at ca. 4200 cm(-1), consistent with mixed valence. The mixed-valence frameworks show semiconducting behavior with conductivity values of 10(-5) S·cm(-1) at room temperature and 10(-4) S·cm(-1) at 100 °C and activation energies of ca. 0.3 eV. N2 adsorption measurements at 77 K show that these materials possess permanent porosity before and after oxidation with Brunauer-Emmett-Teller surface areas of 340 and 370 m(2)·g(-1), respectively.

Concepts: Shutter speed, Hebrew numerals, Oxidation state, Materials science, Physical chemistry, Iron, Nitrogen

0

Activity concentrations of (238)U, (226)Ra, (228)Ra, (137)Cs and (40)K in 64 mushroom samples collected in China from Yunnan, Fujian and Heilongjiang Provinces, were measured. Gamma-ray emissions were determined by using high-purity germanium (HPGe) γ spectrometry. The range of concentrations (Bq kg(-1) dry weight) for (238)U, (226)Ra, (228)Ra, (137)Cs and (40)K in all investigated mushroom samples were from 0.12 to 12, 0.05 to 7.5, 0.14 to 14, MDC(<0.01) to 339, and 396 to 1880, respectively. Activity concentrations of (137)Cs in mushrooms showed some variation between species sampled at the same site. To calculate soil to mushroom transfer factors, levels of radionuclide in 15 paired soil samples and mushrooms were also investigated. The median transfer factors for (238)U, (226)Ra, (228)Ra, (137)Cs and (40)K were 8.32 × 10(-2), 3.03 × 10(-2), 6.69 × 10(-2), 0.40 and 1.19, respectively. The results were compared with values of other areas.

Concepts: Hebrew numerals, Species, Radioactivity, Radioactive decay, Radioactive contamination, Radionuclide, Nuclear medicine, Ionizing radiation

0

The purpose of this study was to assess the noninferiority of dual-source high-pitch CT angiography (CTA) performed with high-concentration (iopamidol 370) low-volume (60 mL) iodinated contrast material at low voltage (100 kVp) in comparison with dual-source high-pitch CTA with standard-of-care low-concentration (iopamidol 300) standard-volume (75 mL) iodinated contrast material at high voltage (120 kVp) to determine whether use of the high-concentration low-volume method would afford a reduction in radiation dose and contrast volume without negatively affecting vascular opacification.

Concepts: Angiography, Hebrew numerals, Harshad number, Medical imaging, High voltage, Radiocontrast

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