Background: Therapeutic hypothermia (TH) after cardiac arrest protects from neurological sequels and death and is recommended in guidelines. The Hypothermia Registry was founded to the monitor outcome, performance and complications of TH. Methods: Data on out-of-hospital cardiac arrest (OHCA) patients admitted to intensive care for TH were registered. Hospital survival and long-term outcome (6-12 months) were documented using the Cerebral Performance Category (CPC) scale, CPC 1-2 representing a good outcome and 3-5 a bad outcome. Half of the patients underwent coronary angiography and one-third underwent percutaneous coronary intervention

BackgroundHumeral fractures are common, but the association between the patho-anatomical fracture pattern and patient characteristics has been inadequately studied and epidemiological knowledge is scarce. Following the introduction of the Swedish Fracture Register (SFR), risk factors for various fractures can be studied, as well as the outcome of different treatments. The objective of this study was to analyse adult humeral fractures in Gothenburg from a descriptive epidemiological perspective.MethodsAll humeral fractures registered in the SFR at Sahlgrenska University Hospital in 2011–2013 in patients aged ≥ 16 years were included. The fractures were divided into humeral segments (proximal, shaft and distal humerus) and analysed according to patient characteristics and patho-anatomical pattern. Furthermore, overall and age-specific incidence rates were calculated.ResultsA total of 2,011 humeral fractures were registered in the SFR, of which 79 % were proximal, 13 % shaft and 8 % distal humeral fractures. The mean age was 66.8 years and women ran a higher risk of humeral fractures than men (female/male ratio 2.4:1). On average, women were older than men at the time of fracture (mean age 70.1 years for women vs. 58.9 years for men). The overall incidence of humeral fractures was 104.7 per 100,000 inhabitants per year, with a segment-specific incidence of 83.0 for proximal fractures, 13.4 for shaft fractures and 8.3 per 100,000 person-years for distal fractures. There was a distinct increase in the age-specific incidence from the fifth decade and onwards, regardless of fracture site. Most fractures occurred in older patients (83 % > 50 years) as a result of a simple or an unspecified fall (79 % > 50 years). Only 1.2 % of all fractures were open injuries and 1.3 % were pathological.ConclusionThis population-based study provides updated epidemiological data on humeral fractures in a Western-European setting. Most humeral fractures occur as the result of low-energy falls in the elderly population, indicating the influence of age-related risk factors in these fractures. The SFR will be a useful tool for providing continuous information on fracture epidemiology, risk factors and treatment outcome and these population-based data are essential in the planning of future fracture prevention and management.

URL: https://www.clinicaltrials.gov. Unique identifier: NCT01946932.

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Three-dimensional brain organoids have emerged as a valuable model system for studies of human brain development and pathology. Here we establish a midbrain organoid culture system to study the developmental trajectory from pluripotent stem cells to mature dopamine neurons. Using single cell RNA sequencing, we identify the presence of three molecularly distinct subtypes of human dopamine neurons with high similarity to those in developing and adult human midbrain. However, despite significant advancements in the field, the use of brain organoids can be limited by issues of reproducibility and incomplete maturation which was also observed in this study. We therefore designed bioengineered ventral midbrain organoids supported by recombinant spider-silk microfibers functionalized with full-length human laminin. We show that silk organoids reproduce key molecular aspects of dopamine neurogenesis and reduce inter-organoid variability in terms of cell type composition and dopamine neuron formation.

IMPORTANCE Electroconvulsive therapy (ECT) is indicated for severe depression, including depression with psychosis, catatonia, and/or an elevated suicide risk. However, the association of ECT with suicide risk is uncertain.OBJECTIVE To determine the association between ECT and the risk of suicide in patients with unipolar major depressive disorder. DESIGN, SETTING, AND PARTICIPANTSThis registry-based cohort study used patient data from Swedish national registers. Patients with a record of inpatient care between January 1, 2012, and October 31, 2018, for moderate depression, severe depression, or severe depression with psychosis were included in the study. Propensity score matching (1:1) was used to balance risk factors for suicide at baseline between patients treated with and without ECT during the inpatient episode.EXPOSURES Data from the Swedish National Quality Register for ECT and the Swedish National Inpatient Register were combined to identify patients who had received ECT during the inpatient episode. National registers were used to identify risk factors for suicide. MAIN OUTCOMES AND MEASURESSuicide within 3 and 12 months of admission to inpatient care was analyzed. Cox regression analyses were used to adjust for confounders. RESULTSThe study included 28 557 patients (mean [SD] age, ECT group, 55.9 [18.4] years; non-ECT group, 45.2 [19.2] years; 15 856 women [55.5%]). In the matched sample of 5525 patients in each group, 62 patients (1.1%) in the ECT group and 90 patients (1.6%) in the non-ECT group died of suicide within 12 months (hazard ratio [HR], 0.72; 95% CI, 0.52-0.99). Electroconvulsive therapy was significantly associated with a decreased risk of suicide in patients with psychotic features (HR, 0.20; 95% CI, 0.08-0.54) and those aged 45 to 64 years (HR, 0.54; 95% CI, 0.30-0.99) or 65 years or older (HR, 0.30; 95% CI, 0.15-0.59), but not in patients aged 44 years or younger (HR, 1.22; 95% CI, 0.68-2.16). CONCLUSIONS AND RELEVANCEThe results of this cohort study support the continued use of ECT to reduce suicide risk in hospitalized patients who are severely depressed, especially those who are older than 45 years and those with a psychotic subtype.

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