U.S. Department of Health and Human Services
NATIONAL INSTITUTES OF HEALTH NIH News
National Heart, Lung, and Blood Institute (NHLBI)

Embargoed for Release: Wednesday, January 26, 2011

Comprehensive NIH study helps explain discrepancy in survival rates between cardiac arrests in public and at home

Cardiac arrests that can be treated by electric stimulation, also known as shockable arrests, were found at a higher frequency in public settings than in the home, according to a National Institutes of Health-funded study appearing in the Jan. 27 issue of the New England Journal of Medicine.

The study compared home and public cardiac arrests under various scenarios. For example, the study considered whether bystanders or emergency medical services (EMS) personnel witnessed the cardiac arrest, and whether the person experiencing the arrest received treatment with an automatic external defibrillator (AED).

In every scenario, a higher percentage of public cardiac arrests were classified as ventricular tachycardia (VT) or ventricular fibrillation (VF), the types of abnormal heart rhythms that can be treated by electric shock.

More than one-third of the people who had a cardiac arrest in public and were treated with an AED survived. This is a significant improvement over the roughly 8 percent national average of cardiac arrest survival. In comparison, the overall survival for home-occurring cardiac arrests treated with an AED was 12 percent.

“To improve the overall disappointing outcome for persons experiencing cardiac arrest, we must know the best immediate treatment,” said Susan Shurin, M.D., acting director of the National Heart, Lung, and Blood Institute (NHLBI), part of the NIH and the major funding agency of this study. “This study provides rich data which indicate the need for further evidence to guide clinical practice and public policy.”

The study is based on data from the world’s largest data registry of pre-hospital cardiac arrest and life-threatening trauma, which is part of the Resuscitation Outcomes Consortium (ROC). The researchers collected cardiac arrest data for over 14,000 people between Dec. 2005 and April 2007. The data spanned over 200 EMS agencies and their receiving hospitals across the United States and Canada.

Among the key findings were that 79 percent of documented cardiac arrests in high-traffic public places where AEDs were available and administered, such as airports or office buildings, were VT or VF.  An AED can automatically diagnose an arrhythmia and shock an arrest victim if necessary. In contrast, only 36 percent of home cardiac arrests in which an AED was applied were VT/VF.

Previous studies have found that home-based cardiac arrests have far lower survival rates than arrests that occur in public locations. This study found that only a third of arrests which occurred in homes were witnessed, while over half of those in public locations had witnesses who could immediately call 911 and provide assistance.

The importance of having someone who can provide or call for help does not exclude the possibility that the types of cardiac arrests occurring in home may differ from those occurring in public settings, or that those occurring in public may be more likely to be effectively treated with electrical stimulation.

The study noted that this significant contrast in prevalence could be due to the fact that individuals who spend more time in public places typically are younger, more active, and have fewer chronic diseases, thus predisposing them to a different class of arrest.

However, according to Dr. Shurin, more work is needed to know whether the differences in rates of rhythms and in outcome are due to underlying differences in severity of disease or in how rapidly responders provide effective therapy.

“These survival results affirm the value of putting AEDs in public locales,” said Myron Weisfeldt, M.D., a cardiologist at Johns Hopkins University in Baltimore and lead author of the study. “Even though the overall frequency of VT/VF arrests has declined over the past few decades, they are still a fairly common occurrence in public settings.”

George Sopko, M.D., ROC project officer and program director in the NHLBI’s Heart Failure and Arrhythmias Branch, added that public awareness and education are still important. The best chance of surviving a cardiac arrest, he noted, involves using AEDs in conjunction with cardiopulmonary resuscitation and immediately calling for medical help.

ROC was funded in 2004, with renewed funding in 2010, to conduct clinical research on treatments for life-threatening traumatic injury or cardiac arrest in real-world settings, typically where patients collapse or are critically injured, before they reach the hospital. ROC consists of 10 regional clinical centers in the United States and Canada.  In addition to contributing to the ROC database, these sites conduct multiple collaborative trials and studies aimed at optimizing first-line resuscitation management strategies to improve patient outcomes.

The study was supported by the NHLBI in partnership with the National Institute of Neurological Disorders and Stroke, the U.S. Army Medical Research & Materiel Command, the Canadian Institutes of Health Research-Institute of Circulatory and Respiratory Health, Defence Research and Development Canada, the American Heart Association, and the Heart and Stroke Foundation of Canada.

GoogleNews.com, FORBES.com, January 26, 2011, WASHINGTON — Federal health officials are investigating a possible link between breast implants and a very rare form of cancer after reviewing a handful of cases reported over the last 13 years.

The cancer, known as anaplastic large cell lymphoma, attacks the lymph nodes and skin and has been reported in the scar tissue which grows around the implant after it is inserted. The Food and Drug Administration is asking doctors to report all cases of the cancer so the agency can better understand the association.

The agency is aware of just 60 cases of the disease worldwide among the estimated 5 million to 10 million women with breast implants.

GoogleNews.com, FORBES.com, By RAMIT PLUSHNICK-MASTI , 01.26.11,

HOUSTON — Police stood guard as an ambulance took Rep. Gabrielle Giffords from intensive care to a rehabilitation hospital in Houston on Wednesday, an encouraging step that came after doctors upgraded her condition from serious to good.

Doctors at Memorial Hermann Texas Medical Center Hospital determined the Arizona congresswoman was healthy enough to move to nearby TIRR Memorial Hermann, where she will continue her rehabilitation work.

Helicopters buzzed overhead and police stopped traffic and blocked the road as an ambulance took Giffords and her husband, astronaut Mark Kelly, a short way to TIRR, which stands for The Institute for Rehabilitation and Research.

Video from a news helicopter showed a gurney wheeled into the building.

Giffords had been in intensive care since her arrival Friday from Tucson, Ariz.

Last week doctors placed a tube in her head to drain excess cerebrospinal fluid. A backup of the fluid can cause pressure and swelling within the brain.

Doctors said Friday that Giffords would stay in the ICU until the tube was taken out because of a risk of infection. Her move Wednesday suggests that the tube might have been removed, which would be another good sign in her recovery.

Giffords was shot in the head Jan. 8 in a rampage that killed six people and injured her and 12 others. The three-term Democratic congresswoman was hit in the forehead while meeting with constituents outside a Tucson supermarket.

The alleged assassination attempt cast a somber mood over President Barack Obama’s State of the Union speech on Tuesday night, where many lawmakers in both parties wore black-and-white lapel ribbons to signify the deaths and the hopes of the survivors. Giffords’ husband watched the speech from her bedside in Texas, as he held her hand.

The 22-year-old suspect in the shootings, Jared Loughner, pleaded not guilty Monday to federal charges of trying to assassinate the congresswoman and two of her aides. He also faces federal murder charges in the deaths of a federal judge and a Giffords aide, and more charges were expected.

A male Acmon blue butterfly (Icaricia acmon). Vladimir Nabokov described the Icaricia genus in 1944.  Photo by Kathy Keatley Garvey

The New York Times, January 26, 2011, by Carl Zimmer  —  Vladimir Nabokov may be known to most people as the author of classic novels like “Lolita” and “Pale Fire.” But even as he was writing those books, Nabokov had a parallel existence as a self-taught expert on butterflies.

He was the curator of lepidoptera at the Museum of Comparative Zoology at Harvard University, and collected the insects across the United States. He published detailed descriptions of hundreds of species. And in a speculative moment in 1945, he came up with a sweeping hypothesis for the evolution of the butterflies he studied, a group known as the Polyommatus blues. He envisioned them coming to the New World from Asia over millions of years in a series of waves.

Few professional lepidopterists took these ideas seriously during Nabokov’s lifetime. But in the years since his death in 1977, his scientific reputation has grown. And over the past 10 years, a team of scientists has been applying gene-sequencing technology to his hypothesis about how Polyommatus blues evolved. On Tuesday in the Proceedings of the Royal Society of London, they reported that Nabokov was absolutely right.

“It’s really quite a marvel,” said Naomi Pierce of Harvard, a co-author of the paper.

Nabokov inherited his passion for butterflies from his parents. When his father was imprisoned by the Russian authorities for his political activities, the 8-year-old Vladimir brought a butterfly to his cell as a gift. As a teenager, Nabokov went on butterfly-hunting expeditions and carefully described the specimens he caught, imitating the scientific journals he read in his spare time. Had it not been for the Russian Revolution, which forced his family into exile in 1919, Nabokov said that he might have become a full-time lepidopterist.

In his European exile, Nabokov visited butterfly collections in museums. He used the proceeds of his second novel, “King, Queen, Knave,” to finance an expedition to the Pyrenees, where he and his wife, Vera, netted over a hundred species. The rise of the Nazis drove Nabokov into exile once more in 1940, this time to the United States. It was there that Nabokov found his greatest fame as a novelist. It was also there that he delved deepest into the science of butterflies.

Nabokov spent much of the 1940s dissecting a confusing group of species called Polyommatus blues. He developed forward-thinking ways to classify the butterflies based on differences in their genitalia. He argued that what were thought to be closely related species were actually only distantly related.

At the end of a 1945 paper on the group, he mused on how they had evolved. He speculated that they originated in Asia, moved over the Bering Strait, and moved south all the way to Chile.

Allowing himself a few literary flourishes, Nabokov invited his readers to imagine “a modern taxonomist straddling a Wellsian time machine.” Going back millions of years, he would end up at a time when only Asian forms of the butterflies existed. Then, moving forward again, the taxonomist would see five waves of butterflies arriving in the New World.

Nabokov conceded that the thought of butterflies making a trip from Siberia to Alaska and then all the way down into South America might sound far-fetched. But it made more sense to him than an unknown land bridge spanning the Pacific. “I find it easier to give a friendly little push to some of the forms and hang my distributional horseshoes on the nail of Nome rather than postulate transoceanic land-bridges in other parts of the world,” he wrote.

When “Lolita” made Nabokov a star in 1958, journalists were delighted to discover his hidden life as a butterfly expert. A famous photograph of Nabokov that appeared in The Saturday Evening Post when he was 66 is from a butterfly’s perspective. The looming Russian author swings a net with rapt concentration. But despite the fact that he was the best-known butterfly expert of his day and a Harvard museum curator, other lepidopterists considered Nabokov a dutiful but undistinguished researcher. He could describe details well, they granted, but did not produce scientifically important ideas.

Only in the 1990s did a team of scientists systematically review his work and recognize the strength of his classifications. Dr. Pierce, who became a Harvard biology professor and curator of lepidoptera in 1990, began looking closely at Nabokov’s work while preparing an exhibit to celebrate his 100th birthday in 1999. She was captivated by his idea of butterflies coming from Asia. “It was an amazing, bold hypothesis,” she said. “And I thought, ‘Oh, my God, we could test this.’ ”

To do so, she would need to reconstruct the evolutionary tree of blues, and estimate when the branches split. It would have been impossible for Nabokov to do such a study on the anatomy of butterflies alone. Dr. Pierce would need their DNA, which could provide more detail about their evolutionary history.

Working with American and European lepidopterists, Dr. Pierce organized four separate expeditions into the Andes in search of blues. Back at her lab at Harvard, she and her colleagues sequenced the genes of the butterflies and used a computer to calculate the most likely relationships between them. They also compared the number of mutations each species had acquired to determine how long ago they had diverged from one another.

There were several plausible hypotheses for how the butterflies might have evolved. They might have evolved in the Amazon, with the rising Andes fragmenting their populations. If that were true, the species would be closely related to one another.

But that is not what Dr. Pierce found. Instead, she and her colleagues found that the New World species shared a common ancestor that lived about 10 million years ago. But many New World species were more closely related to Old World butterflies than to their neighbors. Dr. Pierce and her colleagues concluded that five waves of butterflies came from Asia to the New World — just as Nabokov had speculated.

“By God, he got every one right,” Dr. Pierce said. “I couldn’t get over it — I was blown away.”

Dr. Pierce and her colleagues also investigated Nabokov’s idea that the butterflies had come over the Bering Strait. The land surrounding the strait was relatively warm 10 million years ago, and has been chilling steadily ever since. Dr. Pierce and her colleagues found that the first lineage of Polyommatus blues that made the journey could survive a temperature range that matched the Bering climate of 10 million years ago. The lineages that came later are more cold-hardy, each with a temperature range matching the falling temperatures.

Nabokov’s taxonomic horseshoes turn out to belong in Nome after all.

“What a great paper,” said James Mallet, an expert on butterfly evolution at University College London. “It’s a fitting tribute to the great man to see that the most modern methods that technology can deliver now largely support his systematic arrangement.”

Dr. Pierce says she believes Nabokov would have been greatly pleased to be so vindicated, and points to one of his most famous poems, “On Discovering a Butterfly.” The 1943 poem begins:

I found it and I named it, being versed

in taxonomic Latin; thus became

godfather to an insect and its first

describer — and I want no other fame.

“He felt that his scientific work was standing for all time, and that he was just a player in a much bigger enterprise,” said Dr. Pierce. “He was not known as a scientist, but this certainly indicates to me that he knew what it’s all about.”

Acmon Blue