The deployment of an RRT led by physician assistants with specialized skills was associated with significant decreases in rates of in-hospital cardiac arrest and unplanned intensive care unit admissions.

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Rationale: Cardiac function is under exquisite intrinsic cardiac neural control. Neuroablative techniques to modulate control of cardiac function are currently being studied in patients, albeit with variable and sometimes deleterious results. Objective: Recognizing the major gaps in our understanding of cardiac neural control, we sought to evaluate neural regulation of impulse initiation in the sinoatrial node as an initial discovery step. Methods and Results: We report an in-depth, multi-scale structural and functional characterization of the innervation of the sinoatrial node (SAN) by the right atrial ganglionated plexus (RAGP) in porcine and human hearts. Combining intersectional strategies including tissue clearing, immunohistochemical and ultrastructural techniques, we have delineated a comprehensive neuroanatomic atlas of the RAGP-SAN complex. The RAGP shows significant phenotypic diversity of neurons while maintaining predominant cholinergic innervation. Cellular and tissue-level electrophysiologic mapping and ablation studies demonstrate interconnected ganglia with synaptic convergence within the RAGP to modulate SAN automaticity, atrioventricular (AV) conduction and left ventricular (LV) contractility. Using this approach, we comprehensively demonstrate that intrinsic cardiac neurons influence the pacemaking site in the heart. Conclusions: This report provides an experimental demonstration of a discrete neuronal population controlling a specific geographic region of the heart (SAN) that can serve as a framework for further exploration of other parts of the intrinsic cardiac nervous system (ICNS) in mammalian hearts and for developing targeted therapies.

Adequate magnesium stores are vitally important for life. Critically ill patients will almost always have diminished levels of circulating magnesium, and this predisposes them to a variety of adverse effects, some life threatening. The causes of hypomagnesemia are many and varied, but in the critically ill, losses from the kidneys, often secondary to medications and from the gastrointestinal (GI) tract, predominate. The measurement of magnesium is not straightforward, although many clinicians are now switching to the use of ionized magnesium from ion selective electrodes. The use of supplemental magnesium in acute flares of asthma has some support in medical literature, especially for those patients with severe disease who fail traditional therapy. Magnesium holds the preeminent position in the treatment of pre-eclampsia and eclampsia in the minds of most obstetricians, who have decades of experience showing it to be both effective and safe. Magnesium is clearly useful for certain types of ventricular tachycardia, and probably assists in the treatment of several types of supraventricular tachycardia. Its role in acute myocardial ischemia is less certain, although there is no benefit once reperfusion therapy has already been carried out. Finally, the role of magnesium in the treatment of acute cerebral insults is an exciting area of active investigation with initial studies suggesting much promise.

Objectives: Although dislocation of the knee is rare, the high-energy nature of most injuries often results in high morbidity and sometimes limb-threatening injury. Literature regarding knee dislocations tends to focus upon management. There is a lack of research investigating quality of life for patients having undergone multi-ligament knee reconstruction. The purpose of our study was to review quality of life and functional outcomes as well as examine preoperative variables that may affect these outcomes for patients having undergone multi-ligament knee reconstruction. Methods: Retrospectively, we identified a total of 31 patients who underwent a standardized method of surgical reconstruction for multi-ligament knee injuries since 2006 at a single institution. A single surgeon performed all operations. A total of 28 knees (26 patients) were included in the final analysis. We contacted patients at a minimum of 12 months postoperatively (mean: 40.5 months; range: 12-111 months) and administered the Multi-ligament Quality of Life Questionnaire (ML-QOL), 2000 International Knee Documentation Committee Subjective Knee Form (IKDC), and Lysholm Knee Scoring Scale. We performed independent two-sample t-tests to examine the difference in quality of life and functional measures for the following factors: age (≤ 40 vs. > 40), sex, mechanism of injury, time to surgery ( 3 weeks), vascular injury, nerve injury, concomitant fracture, other injuries, Schenk classification for knee dislocation, manipulation, surgical release, previous knee ligament surgery, and subsequent revision. We then performed ageadjusted multivariable linear regression analysis, including factors that we found to be statistically significant in univariate analysis. A p-value of 0.05 was used for statistical significance and all analysis was performed using STATA (College Station, TX). Results: For ML-QOL, we found that patients who had undergone previous knee ligament surgery had significantly worse mean scores relative to patients who had not undergo previous knee ligament surgery (122.9 vs. 80.2; p = 0.001) (higher score indicates worse quality of life). All other differences in ML-QOL scores were not statistically significant. IKDC and Lysholm scores did not differ significantly with regards to the studied variables. After stratifying patients by history of previous knee ligament surgery (7 vs. 21), we found that patients with Schenk classifications of III or IV had significantly worse mean ML-QOL scores relative to patients with Schenk classifications of I or II (91.3 vs. 62.1; p = 0.0152). Conclusion: To our knowledge, our study is the first to investigate both quality of life and functional outcome measures for patients undergoing multi-ligament reconstruction after knee dislocation. We found that patients with a previous history of knee ligament surgery had a significantly worse quality of life relative to those with no history of knee ligament surgery. Among patients with no history of knee ligament surgery, higher Schenk classification was ass...