Lurasidone for the treatment of delirium in critically ill patients did not differ in the time to delirium resolution when compared to quetiapine. Additionally, the incidence of QTc prolongation between agents does not appear to be different. Future randomized trials should evaluate dose escalation schemes and a larger proportion of patients to evaluate differences in mortality, efficacy, and life-threatening arrhythmias associated with atypical antipsychotic use.

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We compared clinical feature, risk factors, B-MRI patterns, and laboratory findings between patients with the cryptogenic (cancer-related stroke) and conventional stroke mechanism (CSM). Results: Over the study period, a total of 88 cancer patients underwent B-MRI scanning for suspicion of IS. 43 (49%) patients had a final diagnosis of IS. 27 (63%) patients had the cryptogenic mechanism and 16 (37%) patients had the CSM. The levels of D-dimer were higher in the cryptogenic group (median level of 10.00 [3.77-17.72] µg/dL) than CSM group (median level of 2.60 (1.50-3.74) µg/dL). The area under the curve for prediction of cryptogenic mechanism was 0.802 (95% CI, 0.652-0.908) for D-dimer. In multivariate analysis, D-dimer levels of > 3.9 µg/dL (adjusted OR 27.453; 95% CI, 1.382-545.322) and the diffusion-weighted imaging (DWI) lesion pattern of multiple vascular territories (adjusted OR 37.610; 95% CI, were significantly associated with the cryptogenic group in critically ill cancer patients. Conclusions: The levels of D-dimer and the DWI lesion pattern may be helpful to evaluate precise mechanism and treat IS in critically ill cancer patients.

Background: We previously have shown widespread occurrence of biphasic ventricular filling in several clades of fishes, which challenges the long‐held tenet that atrial contraction is the sole determinant of piscine ventricular filling. As in mammals, ventricular filling in fish consists of an early conduit filling event (E phase) followed shortly by atrial contraction (A phase). Unlike mammals, atrial contribution in fish dominates ventricular filling. In this study, we asked the question at which tetrapod lineage does atrial filling become a secondary contributor in ventricular filling. Methods: Doppler echocardiography was used to quantitate atrioventricular inflow pattern and the percent of blood‐flow peak velocity for the two filling phases in several representatives of fish, amphibian, reptile, and mammal under anesthesia (Figure). Results: Thus far, all species examined showed two filling phases. In cartilaginous and bony fishes (circles), the A phase dominates while in primitive air‐breathing fishes (squares), both phases contribute about equally. Among amphibians and reptiles, the E phase slightly dominates over the A phase, however, the E phase is the predominant filling agent in mammals (triangles). Conclusion: We speculate that air breathing, transition to land, and endothermy are three plausible factors that influence the diminished role of the vertebrate atrium as the major contributor of ventricular end‐diastolic volume.