Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter.

Objective: There is no consensus on the optimal management of recent-onset episodes of atrial fibrillation or flutter. The approach to these conditions is particularly relevant in the current era of emergency department (ED) overcrowding. We sought to examine the effectiveness and safety of the Ottawa Aggressive Protocol to perform rapid cardioversion and discharge patients with these arrhythmias.

The 5-HT 2A serotonin receptor enhances cell viability, affects cell cycle progression and activates MEK-ERK1/2 and JAK2-STAT3 signalling pathways in human choriocarcinoma cell lines.

Previous results from our group have demonstrated the expression of the 5-HT(2A) receptor and a mitogenic effect of serotonin in human trophoblast. The objectives of the present study were to investigate the role of the 5-HT(2A) receptor in trophoblast cells and to determine the signalling pathways activated by this receptor. We investigated the effect of (+/-)-2,5-dimethoxy-4-iodoamphetamine hydrochloride (DOI), a selective 5-HT(2A) agonist, on cell cycle progression and cell viability in BeWo and JEG-3 cells.

Out-of-hospital cardiac arrest surveillance in Canada: a survey of national resources.

Objective: The general objective of this study was to explore the challenges of establishing an out of hospital cardiac arrest (OOHCA) surveillance program in Canada. More specifically, we attempted to determine the organizational structure of the delivery of emergency medical services (EMS) in Canada, describe the cardiac arrest data collection infrastructure in each province and determine which OOHCA variables are being collected.

Methods: We conducted a national survey of 82 independent EMS health authorities in Canada.

A geospatial assessment of transport distance and survival to discharge in out of hospital cardiac arrest patients: Implications for resuscitation centers.

Objectives: National leaders have suggested that patients with an out of hospital cardiac arrest (OOHCA) may benefit from transport to specialized hospitals. We sought to assess the survival of OOHCA patients by transport distance and hospital proximity.

Methods: Prospective, cohort study of OOHCA patients in 11 Resuscitation Outcomes Consortium (ROC) sites across North America.

Can after-hours family medicine clinics represent an alternative to emergency departments? Survey of ambulatory patients seeking after-hours care.

Objective: To explore patients' motivations for seeking care in the emergency department (ED) after hours and their willingness to consult their family physicians instead, if their family physicians had been available.

Design: Survey using an 8-item questionnaire.

Setting: Two tertiary care hospital EDs in Ottawa, Ont, from June 4 to 22, 2007, between 5 pm and 9 pm.

Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation.

Background: Quality cardiopulmonary resuscitation contributes to cardiac arrest survival. The proportion of time in which chest compressions are performed in each minute of cardiopulmonary resuscitation is an important modifiable aspect of quality cardiopulmonary resuscitation. We sought to estimate the effect of an increasing proportion of time spent performing chest compressions during cardiac arrest on survival to hospital discharge in patients with out-of-hospital ventricular fibrillation or pulseless ventricular tachycardia.

Expression of placental serotonin transporter and 5-HT 2A receptor in normal and gestational diabetes mellitus pregnancies.

Recent studies reveal that serotonin (5-hydroxytryptamine, 5-HT) might play a role in the aetiology of gestational diabetes mellitus (GDM). The involvement of the serotonin transporter (SERT) and 5-HT(2A) receptor (5-HT(2A)R) in diabetes has also been suggested. However, placental SERT and 5-HT(2A)R have never been studied in GDM-complicated pregnancies.

A survey of factors associated with the successful recognition of agonal breathing and cardiac arrest by 9-1-1 call takers: design and methodology.

Background: Cardiac arrest victims most often collapse at home, where only a modest proportion receives life-saving bystander cardiopulmonary resuscitation. As many as 40% of all sudden cardiac arrest victims have agonal or abnormal breathing in the first minutes following cardiac arrest. 9-1-1 call takers may wrongly interpret agonal breathing as a sign of life, and not initiate telephone cardiopulmonary resuscitation instructions.

Involvement of MAPK signalling in human villous trophoblast differentiation.

Human villous trophoblast differentiation is a complex and highly regulated process essential for the well-being of the pregnancy and fetal development. In this review, we present an overview of the role of MAPKs signalling in morphological and functional differentiation of villous trophoblast.

Endocrinology and cell signaling in human villous trophoblast.

In humans, the placenta that forms by an implantation process in the maternal uterus allows the development of the embryo and the fetus by exchanging ions, metabolites, and wastes and by producing specific hormones (steroids and proteins) with the levels of secretion often surpassing the levels of other endocrine organs. The process of placental development involves two pathways of differentiation that lead to the formation of two distinct phenotypes: villous trophoblast (fusion phenotype) and extravillous trophoblast (proliferative/invasive phenotype). In this chapter we describe the current methods to study villous trophoblast differentiation and the cell-cell fusion of the cytotrophoblast cells.

Isolation and culture of term human cytotrophoblast cells and in vitro methods for studying human cytotrophoblast cells' calcium uptake.

Human primary cytotrophoblast cell culture is a very useful model to study the endocrine and immunological functions of syncytiotrophoblasts, as well as the ion exchange between the mother and her fetus, like calcium. In this chapter, we expose the procedure to (1) isolate and purify the cytotrophoblast cells from human term placenta and (2) study syncytiotrophoblast calcium uptake. First, the methodology is based on the enzymatic dissociation of villous placental tissue, followed by Percoll gradient separation.

Human embryogenesis: overview.

Over the past several decades, embryogenesis knowledge and research have progressed rapidly by taking advantage of the technical advances made in other fields. No field of contemporary biomedical science has been more revolutionized by the techniques of molecular biology than developmental embryology. Despite its inherent controversy, the exploration of the human embryo can unlock many of the answers to our deepest biological questions.

The out-of-hospital validation of the Canadian C-Spine Rule by paramedics.

Study Objective: We designed the Canadian C-Spine Rule for the clinical clearance of the cervical spine, without need for diagnostic imaging, in alert and stable trauma patients. Emergency physicians previously validated the Canadian C-Spine Rule in 8,283 patients. This study prospectively evaluates the performance characteristics, reliability, and clinical sensibility of the Canadian C-Spine Rule when used by paramedics in the out-of-hospital setting.

Environmental control of diatom community size structure varies across aquatic ecosystems.

Changes in the size structure of photoautotrophs influence food web structure and the biogeochemical cycling of carbon. Decreases in the median size of diatoms within communities, in concert with climate warming and water column stratification, have been observed over the Cenozoic in the ocean and over the last 50 years in Lake Tahoe. Decreases in the proportion of larger plankton are frequently observed in response to reduced concentrations of limiting nutrients in marine systems and large stratified lakes.

A survey of attitudes and factors associated with successful cardiopulmonary resuscitation (CPR) knowledge transfer in an older population most likely to witness cardiac arrest: design and methodology.

Background: Overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While bystander cardiopulmonary resuscitation (CPR) can increase survival for cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%). Most cardiac arrest victims are men in their sixties, they usually collapse in their own home (85%) and the event is witnessed 50% of the time.

An evaluation of 9-1-1 calls to assess the effectiveness of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions: design and methodology.

Background: Cardiac arrest is the leading cause of mortality in Canada, and the overall survival rate for out-of-hospital cardiac arrest rarely exceeds 5%. Bystander cardiopulmonary resuscitation (CPR) has been shown to increase survival for cardiac arrest victims. However, bystander CPR rates remain low in Canada, rarely exceeding 15%, despite various attempts to improve them.

Socioeconomic status influences bystander CPR and survival rates for out-of-hospital cardiac arrest victims.

Objectives: While lower socioeconomic status is associated with lower level of education and increased incidence of cardiovascular diseases, the impact of socioeconomic status on out-of-hospital cardiac arrest outcomes is unclear. We used residential property values as a proxy for socioeconomic status to determine if there was an association with: (1) bystander CPR rates and (2) survival to hospital discharge for out-of-hospital cardiac arrest.

Methods: We performed a secondary data analysis of cardiac arrest cases prospectively collected as part of the Ontario Prehospital Advanced Life Support study, conducted in 20 cities with ALS and BLS-D paramedics.

Human placental trophoblasts synthesize melatonin and express its receptors.

Although the role of melatonin on fetal development has been the subject of a number of studies, little is known about the function of melatonin in the placenta. We previously showed that melatonin receptors are expressed and are functional in JEG-3 and BeWo cell lines, both in vitro models of human trophoblast. Local synthesis of melatonin in placenta has been proposed, but the human placenta's ability to synthesize melatonin de novo has never been studied.

Understanding and improving low bystander CPR rates: a systematic review of the literature.

Objectives: Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training.

Methods: For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites.

Emergency department use of intravenous procainamide for patients with acute atrial fibrillation or flutter.

Objectives: Acute atrial fibrillation and flutter are very common arrhythmias seen in emergency department (ED) patients, but there is no consensus for their optimal management. The objective of this study was to examine the efficacy and safety of intravenous (IV) procainamide for acute atrial fibrillation or flutter.

Methods: This health records review included a consecutive cohort of ED patients with acute-onset atrial fibrillation or atrial flutter who received IV procainamide at one university hospital ED during a five-year period.

Evaluating the effectiveness of dispatch-assisted cardiopulmonary resuscitation instructions.

Objectives: To determine the frequency of agonal breathing during cardiac arrest (CA), its impact on the ability of 9-1-1 dispatchers to identify CA, and the impact of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions on bystander CPR rates.

Methods: A before-after observational study enrolling out-of-hospital adult CA patients where resuscitation was attempted in a single city with basic life support with defibrillation/advanced life support tiered emergency medical services. Victim, caller, and system characteristics were measured during two successive nine-month periods before (control group) and after (intervention group) the introduction of dispatch-assisted CPR instructions.

Quantifying delays in the recognition and management of acute compartment syndrome.

Objective: To identify where most efforts should be made to decrease ischemia time and necrosis in acute compartment syndrome (ACS) and to determine the causes for late interventions.

Methods: This was a multicentre, historical cohort study of patients who underwent fasciotomy for ACS within the McGill Teaching Hospitals between 1989 and 1997. Patients studied had a clinical diagnosis of ACS or compartment pressures greater than 30 mm Hg.

Acute compartment syndrome: how long before muscle necrosis occurs?

Objectives: Acute compartment syndrome (ACS) is a limb-threatening condition often first diagnosed by emergency physicians. Little is known about the rapidity with which permanent damage may occur. Our objective was to estimate the time to muscle necrosis in patients with ACS.