Background and Purpose-The aim of our study was to assess the use of S-100 protein (S-100) and neuron-specific enolase (NSE) in serum and cerebrospinal fluid (CSF) for the prediction of patients' regaining consciousness after acute global cerebral ischemia. Methods-Sixty-four unconscious patients were followed until the return of consciousness or until death/vegetative state.Serum and CSF samples for measurement of S-100 and NSE using an immunoradiometric assay technique were obtained 24 hours (serum) and 48 hours (CSF) after the acute event and correlated with patient outcome. Results-Values for serum S-100 protein, serum NSE, CSF S-100, and CSF NSE were significantly different in the 2 outcome groups. A serum S-100 value of Ͼ0.7 g/L was found to be a predictor of not regaining consciousness, with a high positive predictive value (95%) and high specificity (96%). Conclusions-S-100 protein used as serum marker 24 hours after acute global cerebral ischemia gives reliable and independent information on the outcome of the patient that is comparable or superior to that obtained with CSF markers. Therefore, S-100 may be a serum marker of brain cell damage useful for clinical assessment of these patients.

Background-In the present study, we compared an automatic external defibrillator (AED) that delivers 150-J biphasic shocks with traditional high-energy (200-to 360-J) monophasic AEDs. Methods and Results-AEDs were prospectively randomized according to defibrillation waveform on a daily basis in 4 emergency medical services systems. Defibrillation efficacy, survival to hospital admission and discharge, return of spontaneous circulation, and neurological status at discharge (cerebral performance category) were compared. Of 338 patients with out-of-hospital cardiac arrest, 115 had a cardiac etiology, presented with ventricular fibrillation, and were shocked with an AED. The time from the emergency call to the first shock was 8.9Ϯ3.0 (meanϮSD) minutes. Conclusions-The 150-J biphasic waveform defibrillated at higher rates, resulting in more patients who achieved a return of spontaneous circulation. Although survival rates to hospital admission and discharge did not differ, discharged patients who had been resuscitated with biphasic shocks were more likely to have good cerebral performance.

No abstract

No abstract

No abstract

No abstract

We conducted a randomized, controlled trial to evaluate different strategies of offering an HPV-self sampling program, and compared this with two control groups. All total of 35,354 women who did not participate in the Flemish cancer screening program were included in the study: 9,118 received a HPV self-collection brush (RIATOL qPCR HPV genotyping test (qPCR [E6/E7]); 9,098 were offered the opportunity to order an HPV-selfsampling brush, 8,830 received the recall letter; 8,849 received no intervention. Within 12 months after the mailing, 18.7% of the women who had received the brush, participated by returning a self-sample sample, while 10.6% women allocated to the opt- in group did so. 10.5% women who received the standard recall letter, had a PAP smear taken within a period of 12 months; while 8% women did so without receiving an intervention at all. Participation in postmenopausal women was higher than in women younger than 50 in both self-sampling arms. Screening by means of the self-sample kit increased by age, contradictory when screening is performed by a PAP smear. Of those testing hrHPV positive (9.5%), 88.9% attended for follow up cytology. The mean DNA concentration, found in the self-sampler, decreased by age, causing a higher number of inconclusive results. Our results support the efficacy of a self-sampling strategy to increase participation in the Flemish screening program. Self-sampling seems particularly acceptable to postmenopausal non-responders. Future research should focus on the performance of different self-sampling devices in post-menopausal women as low DNA concentrations exponentially increased over age.

Objective: To assess the use of serum neuron-specific enolase (S-NSE) level as a noninvasive predictor of CNS injury irreversibility in comatose cardiac arrest survivors.Methods: An observational, prospective clinical study was performed in a community hospital ED and intensive care unit. All cardiac arrest survivors ( n = 52) with impaired neurologic status admitted between February 1994 and May 1995 were followed until return of consciousness (1) or death due to CNS failure (0). Serum samples for S-NSE determination (ng/mL) using the radioimmunoassay technique were obtained 24 hours after cardiac arrest. Data were analyzed using stepwise logistic regression with dichotomized predictors to validate the correlation between S-NSE (X) and outcome (Y), where X = 0 if 5 median and 1 if > median S-NSE level. Adjustment was made for the following variables: glucose level on admission, total epinephrine dose used before return of spontaneous circulation, and best Glasgow Coma Scale score on admission. These data were all available in 34 cases. In 16 cases, CSF enzymes at 48 hours postarrest were obtained and compared with S-NSE. Results:The logistic equation determining the influence of S-NSE (X) on outcome (Y) was: Y = 0.606 -1.785X (odds ratio = 6; p = 0.020). There was no confounding effect of the other variables related to survival. The mean S-NSE value for all the patients was 34 (7.9-188). All the patients recovering consciousness (n = 15) had an S-NSE mean ? SEM value of 17.5 t 2.4, with a maximum of 47. Conclusion:These data support the conclusion that measurement of S-NSE at 24 hours post-cardiac arrest may supplement clinical assessment of hypoxic-ischemic encephalopathy after cardiac arrest.