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1.
Nat Commun ; 10(1): 3771, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31434889

RESUMO

Experimental techniques to manipulate cold molecules have seen great development in recent years. The precision measurements of cold molecules are expected to give insights into fundamental physics. Here we use a rovibrationally pure sample of ultracold KRb molecules to improve the measurement on the stability of electron-to-proton mass ratio [Formula: see text]. The measurement is based upon a large sensitivity coefficient of the molecular spectroscopy, which utilizes a transition between a nearly degenerate pair of vibrational levels each associated with a different electronic potential. Observed limit on temporal variation of µ is [Formula: see text], which is better by a factor of five compared with the most stringent laboratory molecular limits to date. Further improvements should be straightforward, because our measurement was only limited by statistical errors.

2.
Phys Rev Lett ; 118(16): 163401, 2017 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-28474928

RESUMO

Multichannel Efimov physics is investigated in ultracold heteronuclear admixtures of K and Rb atoms. We observe a shift in the scattering length where the first atom-dimer resonance appears in the ^{41}K-^{87}Rb system relative to the position of the previously observed atom-dimer resonance in the ^{40}K-^{87}Rb system. This shift is well explained by our calculations with a three-body model including van der Waals interactions, and, more importantly, multichannel spinor physics. With only minor differences in the atomic masses of the admixtures, the shift in the atom-dimer resonance positions can be cleanly ascribed to the isolated and overlapping Feshbach resonances in the ^{40}K-^{87}Rb and ^{41}K-^{87}Rb systems, respectively. Our study demonstrates the role of multichannel Feshbach physics in determining Efimov resonances in heteronuclear three-body systems.

3.
BMJ Open ; 6(6): e011505, 2016 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-27311914

RESUMO

INTRODUCTION: Postoperative delirium, arbitrarily defined as occurring within 5 days of surgery, affects up to 50% of patients older than 60 after a major operation. This geriatric syndrome is associated with longer intensive care unit and hospital stay, readmission, persistent cognitive deterioration and mortality. No effective preventive methods have been identified, but preliminary evidence suggests that EEG monitoring during general anaesthesia, by facilitating reduced anaesthetic exposure and EEG suppression, might decrease incident postoperative delirium. This study hypothesises that EEG-guidance of anaesthetic administration prevents postoperative delirium and downstream sequelae, including falls and decreased quality of life. METHODS AND ANALYSIS: This is a 1232 patient, block-randomised, double-blinded, comparative effectiveness trial. Patients older than 60, undergoing volatile agent-based general anaesthesia for major surgery, are eligible. Patients are randomised to 1 of 2 anaesthetic approaches. One group receives general anaesthesia with clinicians blinded to EEG monitoring. The other group receives EEG-guidance of anaesthetic agent administration. The outcomes of postoperative delirium (≤5 days), falls at 1 and 12 months and health-related quality of life at 1 and 12 months will be compared between groups. Postoperative delirium is assessed with the confusion assessment method, falls with ProFaNE consensus questions and quality of life with the Veteran's RAND 12-item Health Survey. The intention-to-treat principle will be followed for all analyses. Differences between groups will be presented with 95% CIs and will be considered statistically significant at a two-sided p<0.05. ETHICS AND DISSEMINATION: Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) is approved by the ethics board at Washington University. Recruitment began in January 2015. Dissemination plans include presentations at scientific conferences, scientific publications, internet-based educational materials and mass media. TRIAL REGISTRATION NUMBER: NCT02241655; Pre-results.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Anestesia Geral/efeitos adversos , Delírio/epidemiologia , Eletroencefalografia/métodos , Complicações Pós-Operatórias/prevenção & controle , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Delírio/prevenção & controle , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Qualidade de Vida , Análise de Regressão , Projetos de Pesquisa , Estados Unidos
4.
J Clin Neurosci ; 31: 133-6, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27068011

RESUMO

Use of the pulmonary artery catheter (PAC) has been controversial since the late 1980s. Multi-center observational and randomized controlled trials (RCTs) have concluded that PACs fail to decrease mortality. Subsequently, studies have looked for a decline in PAC use that corresponds to the literature and have indeed found that it exists. However, none to date have looked primarily at trends in the aneurysmal subarachnoid hemorrhage (aSAH) population. This study uses the Nationwide Inpatient Sample (NIS) from 2000-2010 to identify trends in PAC use among patients with aSAH. Trend analysis was assessed using a multivariable regression model with a calculation of slope of PAC frequency over time for pre-2005 and post-2005. Trends in mortality and routine discharge were also assessed for the same time period. 363,096 SAH patients were extrapolated using survey weights, of whom 6,988 had a PAC. Over time, PAC use declined, with a significant downward shift in the year 2005. Analyses also showed a decrease in mortality over the same time period. Our results show that PAC use among patients with aSAH decreased from 2000 to 2010. Similar to other studies, the decline appears to be temporally related to RCTs that showed a lack of benefit from PAC. Studies such as these have the potential to influence clinical practice through illumination of shifting opinions and approaches.


Assuntos
Cateterismo de Swan-Ganz/tendências , Hemorragia Subaracnóidea/terapia , Adulto , Aneurisma Roto/complicações , Feminino , Humanos , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/mortalidade
5.
Opt Express ; 19(15): 14479-86, 2011 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-21934810

RESUMO

We describe a tunable two-color CW light source sufficient for realizing a coherent Raman transfer between two molecular states that are more than 0.5 eV (120 THz) apart. The simultaneous frequency stabilization of 901 nm and 655 nm light was achieved by locking diode lasers to a single ultralow expansion cavity with dual wavelengths coating. By utilizing offset-locking and optical phase-locked loop (OPLL), we ensured a large mode-hop free tuning range (> 2 GHz). The obtained short term linewidth (<10 Hz) and the linear drift of frequency (65 mHz/s) were both sufficient to eliminate the influence of laser linewidths on the efficiency of coherent Raman transition.

6.
Drug Discov Ther ; 5(5): 238-45, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22466370

RESUMO

Essential oils of young and mature rhizomes, air-dried and steamed rhizomes, and seed rhizomes of Zingiber officinale Roscoe (ginger) were prepared, and their inhibition of filamentation by Candida albicans was examined. Ginger essential oils, and particularly those from seed and air-dried rhizomes, had potent inhibitory activity compared to ginger oleoresins obtained by ethanol and hypercritical carbon dioxide extraction and essential oils of 5 other plants in the family Zingiberaceae. Of the constituents, [6]-shogaol was most active against filament formation and growth of C. albicans, followed by citral and [6]-gingerol. Ginger oleoresin, and especially that obtained by ethanol extraction, with a high [6]-gingerol content exhibited potent scavenging activity against 1,1-diphenyl-2-picrylhydrazyl radicals in comparison to essential oils of ginger and other Zingiberaceae plants.

7.
Insect Mol Biol ; 19(6): 737-43, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20609019

RESUMO

We isolated a luciferase gene (LbLuc) from the non-luminous diurnal firefly, Lucidina biplagiata, with high similarity to that from the nocturnal firefly, Photinus pyralis. The recombinant LbLuc showed luminescence activity comparable to that of the luciferases from P. pyralis and Luciola cruciata. To understand the non-luminosity of L. biplagiata, we determined the amount of luciferase in the adult specimen using the luciferin-luciferase reaction and found that the content of luciferase in L. biplagiata was estimated to be only 0.1% of that in L. cruciata. As previously reported, the content of luciferin in L. biplagiata was less than 0.1% of that in L. cruciata. Thus, the non-luminosity of L. biplagiata might be explained by low levels of both luciferase and luciferin.


Assuntos
Vaga-Lumes/enzimologia , Vaga-Lumes/genética , Luciferases de Vaga-Lume/genética , Luciferases de Vaga-Lume/metabolismo , Sequência de Aminoácidos , Animais , Vaga-Lumes/química , Vaga-Lumes/classificação , Luciferina de Vaga-Lumes/metabolismo , Luciferases de Vaga-Lume/análise , Masculino , Dados de Sequência Molecular , Filogenia , Alinhamento de Sequência
8.
Phys Rev Lett ; 105(20): 203001, 2010 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-21231225

RESUMO

We report on the direct conversion of laser-cooled 41K and 87Rb atoms into ultracold 41K87Rb molecules in the rovibrational ground state via photoassociation followed by stimulated Raman adiabatic passage. High-resolution spectroscopy based on the coherent transfer revealed the hyperfine structure of weakly bound molecules in an unexplored region. Our results show that a rovibrationally pure sample of ultracold ground-state molecules is achieved via the all-optical association of laser-cooled atoms, opening possibilities to coherently manipulate a wide variety of molecules.

9.
Neurology ; 72(18): 1570-5, 2009 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-19414723

RESUMO

OBJECTIVE: To examine the impact of delirium on the trajectory of cognitive function in a cohort of patients with Alzheimer disease (AD). METHODS: A secondary analysis of data collected from a large prospective cohort, the Massachusetts Alzheimer's Disease Research Center's patient registry, examined cognitive performance over time in patients who developed (n = 72) or did not develop (n = 336) delirium during the course of their illnesses. Cognitive performance was measured by change in score on the Information-Memory-Concentration (IMC) subtest of the Blessed Dementia Rating Scale. Delirium was identified using a previously validated chart review method. Using linear mixed regression models, rates of cognitive change were calculated, controlling for age, sex, education, comorbid medical diagnoses, family history of dementia, dementia severity score, and duration of symptoms before diagnosis. RESULTS: A significant acceleration in the slope of cognitive decline occurs following an episode of delirium. Among patients who developed delirium, the average decline at baseline for performance on the IMC was 2.5 points per year, but after an episode of delirium there was further decline to an average of 4.9 points per year (p = 0.001). Across groups, the rate of change in IMC score occurred about three times faster in those who had delirium compared to those who did not. CONCLUSIONS: Delirium can accelerate the trajectory of cognitive decline in patients with Alzheimer disease (AD). The information from this study provides the foundation for future randomized intervention studies to determine whether prevention of delirium might ameliorate or delay cognitive decline in patients with AD.


Assuntos
Doença de Alzheimer/epidemiologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Delírio/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/psicologia , Estudos de Coortes , Comorbidade , Delírio/prevenção & controle , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Massachusetts , Testes Neuropsicológicos , Estudos Prospectivos , Sistema de Registros , Caracteres Sexuais , Fatores de Tempo
10.
Anaesthesia ; 63(9): 941-7, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18547292

RESUMO

The purpose of this analysis was to determine if postoperative delirium was associated with early postoperative cognitive dysfunction (at 7 days) and long-term postoperative cognitive dysfunction (at 3 months). The International Study of Postoperative Cognitive Dysfunction recruited 1218 subjects >or= 60 years old undergoing elective, non-cardiac surgery. Postoperatively, subjects were evaluated for delirium using the criteria of the Diagnostic and Statistical Manual. Subjects underwent neuropsychological testing pre-operatively and postoperatively at 7 days (n = 1018) and 3 months (n = 946). Postoperative cognitive dysfunction was defined as a composite Z-score > 2 across tests or at least two individual test Z-scores > 2. Subjects with delirium were significantly less likely to participate in postoperative testing. Delirium was associated with an increased incidence of early postoperative cognitive dysfunction (adjusted risk ratio 1.6, 95% CI 1.1-2.1), but not long-term postoperative cognitive dysfunction (adjusted risk ratio 1.3, 95% CI 0.6-2.4). Delirium was associated with early postoperative cognitive dysfunction, but the relationship of delirium to long-term postoperative cognitive dysfunction remains unclear.


Assuntos
Transtornos Cognitivos/etiologia , Delírio/etiologia , Complicações Pós-Operatórias , Idoso , Transtornos Cognitivos/epidemiologia , Delírio/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Prognóstico , Medição de Risco
11.
Insect Mol Biol ; 15(3): 293-9, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16756548

RESUMO

Three homologous genes of firefly luciferase were cloned from the non-luminous beetle Tenebrio molitor. Three gene products for homologues, TmLL-1, TmLL-2 and TmLL-3, showed fatty acyl-coenzyme A (acyl-CoA) synthetic activity, but not luciferase activity with firefly luciferin. The transcripts were detected through the developmental stages in T. molitor. These results suggested that firefly luciferase was evolved from a fatty acyl-coenzyme A synthetase by gene duplications in the insect.


Assuntos
Genes de Insetos , Tenebrio/genética , Sequência de Aminoácidos , Animais , Evolução Biológica , Coenzima A Ligases/metabolismo , Regulação da Expressão Gênica no Desenvolvimento , Larva/metabolismo , Luciferases de Vaga-Lume/genética , Luminescência , Dados de Sequência Molecular , Análise de Sequência de DNA , Homologia de Sequência , Tenebrio/enzimologia
12.
Phys Rev Lett ; 95(5): 050401, 2005 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-16090852

RESUMO

Polarization-dependent phase-contrast imaging is used to resolve the spatial magnetization profile of an optically trapped ultracold gas. This probe is applied to Larmor precession of degenerate and nondegenerate spin-1 87Rb gases. Transverse magnetization of the Bose-Einstein condensate persists for the condensate lifetime, with a spatial response to magnetic field inhomogeneities consistent with a mean-field model of interactions. In comparison, the magnetization of the non-condensed gas decoheres rapidly. Rotational symmetry implies that the Larmor frequency of a spinor condensate be density independent, and thus suitable for precise magnetometry with high spatial resolution.

13.
Cytogenet Genome Res ; 110(1-4): 491-9, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16093702

RESUMO

Retrons are distinct DNA sequences that code for a reverse transcriptase (RT) similar to the RTs produced by retroviruses and other types of retroelements. Retron DNAs are commonly associated with prophage DNA and are found in the genomes of a wide variety of different bacteria. The retron RT is used to synthesize a strange satellite DNA known as msDNA. msDNA is actually a complex of DNA, RNA, and probably protein. It is composed of a small, single-stranded DNA, linked to a small, single-stranded RNA molecule. The 5' end of the DNA molecule is joined to an internal guanosine residue of the RNA molecule by a unique 2'-5' phosphodiester bond. msDNA is produced in many hundreds of copies per cell, but its function remains unknown. Although retrons are absent from the genome of most members of a population of related bacteria, retrons may not be entirely benign DNAs. Evidence is beginning to suggest that retron elements may produce small but potentially significant effects on the host cell. This includes the generation of repeated copies of the msDNA sequence in the genome, and increasing the frequency of spontaneous mutations. Because these events involve the retron RT, this may represent a source of reverse transcription in the bacterial cell. Thus, the process of reverse transcription, a force that has profoundly affected the content and structure of most eukaryotic genomes, may likewise be responsible for changes in some prokaryotic genomes.


Assuntos
DNA Bacteriano/genética , Genoma Bacteriano , Retroelementos/genética , Elementos de DNA Transponíveis , Conformação de Ácido Nucleico , RNA Bacteriano/química , RNA Bacteriano/genética , Sequências Repetitivas de Ácido Nucleico
14.
Phys Rev Lett ; 93(18): 183201, 2004 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-15525160

RESUMO

Three magnetic-field induced heteronuclear Feshbach resonances were identified in collisions between bosonic 87Rb and fermionic 40K atoms in their absolute ground states. Strong inelastic loss from an optically trapped mixture was observed at the resonance positions of 492, 512, and 543+/-2 G. The magnetic-field locations of these resonances place a tight constraint on the triplet and singlet cross-species scattering lengths, yielding (-281+/-15)a(0) and (-54+/-12)a(0), respectively. The width of the loss feature at 543 G is 3.7+/-1.5 G wide; this broad Feshbach resonance should enable experimental control of the interspecies interactions.

15.
Phys Rev Lett ; 90(9): 090401, 2003 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-12689206

RESUMO

We have investigated the properties of Bose-Einstein condensates of sodium atoms in the upper hyperfine ground state. Condensates in the high-field seeking [F=2, m(F)=-2> state were created in a large volume optical trap from initially prepared [F=1, m(F)=-1> condensates using a microwave transition at 1.77 GHz. We found condensates in the stretched state [F=2, m(F)=-2> to be stable for several seconds at densities in the range of 10(14) atoms/cm(3). In addition, we studied the clock transition [F=1, m(F)=0> --> [F=2, m(F)=0> in a sodium Bose-Einstein condensate and determined a density-dependent frequency shift of (2.44+/-0.25+/-0.5) x 10(-12) Hz cm(3).

16.
Clin Exp Allergy ; 33(2): 211-7, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12580914

RESUMO

BACKGROUND: Japanese cedar (Cryptomeria japonica; CJ) pollinosis has been reported to occur naturally in Japanese monkeys (Macaca fuscata) as well as in humans. Most human patients and monkeys with pollinosis have specific IgE for Cry j 2, a major allergen of CJ pollen. OBJECTIVE: The main purpose of this study was to identify IgE B cell epitopes of Cry j 2 using a synthetic peptide in humans, monkeys and mice. METHODS: We synthesized 38 overlapping peptides that span the entire length of Cry j 2. We examined the B cell epitopes of Cry j 2 that are recognized by IgE in the sera of human patients and monkeys with pollinosis and immunized mice using synthetic peptides of Cry j 2. We also examined the reaction of Cry j 2-specific mouse monoclonal IgG antibodies to the peptides. Furthermore, we conducted a histamine release assay with leucocytes from a pollinosis patient using human serum albumin (HSA) conjugated with the peptides as a B cell epitope. RESULTS: We found that 16 of the 20 pollinosis patients who had specific IgE to Cry j 2 also exhibited IgE reaction with some Cry j 2 peptides. Of these 16 patients, 10 exhibited IgE reaction with Cry j 2 peptide no. 13 (121GQCKWVNGREICNDRDRPTA140). Five of the seven monkeys with CJ pollinosis exhibited a reaction with peptide no. 13. Furthermore, IgE in mice immunized with Cry j 2 and two mouse monoclonal IgG antibodies reacted with peptide no. 13. Peptide no. 13-conjugated HSA showed the release of histamine from basophils. Furthermore, to determine the minimum epitope in peptide no. 13, we conducted an enzyme-linked immunosorbent assay inhibition test. The core of the epitope in humans, monkeys and mice was 124KWVNGREI131. CONCLUSION: We found that 124KWVNGREI131 is an important B cell epitope recognized by IgE in humans, monkeys and mice.


Assuntos
Epitopos de Linfócito B/metabolismo , Imunoglobulina E/metabolismo , Proteínas de Plantas/imunologia , Pólen/imunologia , Rinite Alérgica Sazonal/imunologia , Animais , Anticorpos Monoclonais/metabolismo , Especificidade de Anticorpos , Feminino , Liberação de Histamina/imunologia , Humanos , Macaca/imunologia , Camundongos , Camundongos Endogâmicos , Fragmentos de Peptídeos/imunologia , Testes Cutâneos/métodos , Especificidade da Espécie
17.
Tissue Antigens ; 59(5): 412-6, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12144625

RESUMO

Systemic immediate reactions including anaphylaxis to gelatin in vaccines have been reported. However, the number of such reports is very small compared with the number of children exposed to gelatin. The present study was designed to investigate whether susceptibility or resistance to gelatin allergy is associated with human leukocyte antigen (HLA) class II gene. Blood samples were obtained from 49 patients with gelatin allergy and specific IgE to gelatin. DNA-based HLA class II typing was performed to determine the DRB1, DQB1 and DPB1 alleles. Genotype frequencies were compared with those found in 240 unrelated controls. The frequency of DQB1*0303 (55.1%) was significantly higher in the patients than in the control subjects (32.1%). The frequency of DPB1*0402 was also significantly higher in the patients (32.7%) than in the control subjects (15.4%). On the other hand, the frequency of subjects carrying DRB1*15 (DRB1*1501 and DRB1*1502) was significantly lower among the patients group (18.4%) than among the controls (40.8%). We found that DQB1*0303 and DPB1*0402 were positively associated with the IgE response for gelatin, while DRB1*15 was negatively associated with it.


Assuntos
Gelatina/imunologia , Teste de Histocompatibilidade , Hipersensibilidade/genética , Hipersensibilidade/imunologia , Criança , Frequência do Gene , Antígenos HLA-DP/genética , Cadeias beta de HLA-DP , Antígenos HLA-DQ/genética , Cadeias beta de HLA-DQ , Antígenos HLA-DR/genética , Cadeias HLA-DRB1 , Humanos , Imunoglobulina E/imunologia , Vacinas/imunologia
18.
Biol Bull ; 201(3): 339-47, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11751246

RESUMO

Bioluminescence of the medusa Periphylla is based on the oxidation of coelenterazine catalyzed by luciferase. Periphylla has two types of luciferase: the soluble form luciferase L, which causes the exumbrellar bioluminescence display of the medusa, and the insoluble aggregated form, which is stored as particulate material in the ovary, in an amount over 100 times that of luciferase L. The eggs are especially rich in the insoluble luciferase, which drastically decreases upon fertilization. The insoluble form could be solubilized by 2-mercaptoethanol, yielding a mixture of luciferase oligomers with molecular masses in multiples of approximately 20 kDa. Those having the molecular masses of 20 kDa, 40 kDa, and 80 kDa were isolated and designated, respectively, as luciferase A, luciferase B, and luciferase C. The luminescence activities of Periphylla luciferases A, B, and C were 1.2 approximately 4.1 x 10(16) photon/mg. s, significantly higher than any coelenterazine luciferase known, and the quantum yields of coelenterazine catalyzed by these luciferases (about 0.30 at 24 degrees C) are comparable to that catalyzed by Oplophorus luciferase (0.34 at 22 degrees C), which has been considered the most efficient coelenterazine luciferase until now. Luciferase L (32 kDa) could also be split by 2-mercaptoethanol into luciferase A and an accessory protein (approx. 12 kDa), as yet uncharacterized. Luciferases A, B, and C are highly resistant to inactivation: their luminescence activities are only slightly diminished at pH 1 and pH 11 and are enhanced in the presence of 1 approximately 2 M guanidine hydrochloride; but they are less stable to heating than luciferase L, which is practically unaffected by boiling.


Assuntos
Imidazóis , Luciferases/isolamento & purificação , Ovário/enzimologia , Cifozoários/enzimologia , Animais , Cromatografia em Gel , Cromatografia por Troca Iônica , Eletroforese em Gel de Poliacrilamida , Feminino , Guanidina/química , Temperatura Alta , Concentração de Íons de Hidrogênio , Luciferases/química , Luciferases/metabolismo , Medições Luminescentes , Mercaptoetanol/química , Peso Molecular , Pirazinas/metabolismo , Cifozoários/metabolismo
19.
J Allergy Clin Immunol ; 108(6): 1033-4, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11742284

RESUMO

BACKGROUND: Some children--though the number is few-have been sensitized with gelatin. OBJECTIVE: To investigate the relationship between the presence of antigelatin IgE and anaphylaxis to gelatin-containing rectal suppository, we measured antigelatin IgE in the sera of the children with anaphylaxis. METHODS: Ten children showed systemic allergic reactions, including anaphylaxis, to a chloral hydrate rectal suppository containing gelatin (231 mg/dose) that had been used as a sedative. These children's clinical histories and serum samples were submitted from physicians to the National Institute of Infectious Diseases during a 2-year period from 1996 to 1997. RESULTS: Of the 10 children, 5 showed apparent anaphylaxis, including hypotension and/or cyanosis, along with urticaria or wheezing; 2 showed both urticaria and wheezing without hypotension or cyanosis; the other 3 showed only urticaria. All of the children had antigelatin IgE (mean value +/- SD, 7.9 +/- 8.4 Ua/mL). As a control, samples from 250 randomly selected children had no antigelatin IgE. These findings suggest that the 10 children's systemic allergic reactions to this suppository were caused by the gelatin component. CONCLUSION: Gelatin-containing suppositories must be used with the same caution as gelatin-containing vaccines and other medications.


Assuntos
Anafilaxia/etiologia , Gelatina/efeitos adversos , Supositórios/efeitos adversos , Pré-Escolar , Feminino , Gelatina/administração & dosagem , Humanos , Lactente , Masculino
20.
Arch Intern Med ; 161(20): 2467-73, 2001 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-11700159

RESUMO

BACKGROUND: Nurses play a key role in recognition of delirium, yet delirium is often unrecognized by nurses. Our goals were to compare nurse ratings for delirium using the Confusion Assessment Method based on routine clinical observations with researcher ratings based on cognitive testing and to identify factors associated with underrecognition by nurses. METHODS: In a prospective study, 797 patients 70 years and older underwent 2721 paired delirium ratings by nurses and researchers. Patient-related factors associated with underrecognition of delirium by nurses were examined. RESULTS: Delirium occurred in 239 (9%) of 2721 observations or 131 (16%) of 797 patients. Nurses identified delirium in only 19% of observations and 31% of patients compared with researchers. Sensitivities of nurses' ratings for delirium and its key features were generally low (15%-31%); however, specificities were high (91%-99%). Nearly all disagreements between nurse and researcher ratings were because of underrecognition of delirium by the nurses. Four independent risk factors for underrecognition by nurses were identified: hypoactive delirium (adjusted odds ratio [OR], 7.4; 95% confidence interval [CI], 4.2-12.9), age 80 years and older (OR, 2.8; 95% CI, 1.7-4.7), vision impairment (OR, 2.2; 95% CI, 1.2-4.0), and dementia (OR, 2.1; 95% CI, 1.2-3.7). The risk for underrecognition by nurses increased with the number of risk factors present from 2% (0 risk factors) to 6% (1 risk factor), 15% (2 risk factors), and 44% (3 or 4 risk factors; P(trend)<.001). Patients with 3 or 4 risk factors had a 20-fold risk for underrecognition of delirium by nurses. CONCLUSIONS: Nurses often missed delirium when present, but rarely identified delirium when absent. Recognition of delirium can be enhanced with education of nurses in delirium features, cognitive assessment, and factors associated with poor recognition.


Assuntos
Delírio/diagnóstico , Delírio/enfermagem , Avaliação em Enfermagem/normas , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Competência Clínica/normas , Delírio/epidemiologia , Delírio/etiologia , Demência/complicações , Análise Fatorial , Feminino , Avaliação Geriátrica , Humanos , Masculino , Entrevista Psiquiátrica Padronizada/normas , Avaliação em Enfermagem/métodos , Pesquisa em Avaliação de Enfermagem , Variações Dependentes do Observador , Estudos Prospectivos , Escalas de Graduação Psiquiátrica/normas , Fatores de Risco , Sensibilidade e Especificidade , Transtornos da Visão/complicações
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