RESUMO
Responses to sexually antagonistic selection are thought to be constrained by the shared genetic architecture of homologous male and female traits. Accordingly, adaptive sexual dimorphism depends on mechanisms such as genotype-by-sex interaction (G×S) and sex-specific plasticity to alleviate this constraint. We tested these mechanisms in a population of Xiphophorus birchmanni (sheepshead swordtail), where the intensity of male competition is expected to mediate intersexual conflict over age and size at maturity. Combining quantitative genetics with density manipulations and analysis of sex ratio variation, we confirm that maturation traits are dimorphic and heritable, but also subject to large G×S. Although cross-sex genetic correlations are close to zero, suggesting sex-linked genes with important effects on growth and maturation are likely segregating in this population, we found less evidence of sex-specific adaptive plasticity. At high density, there was a weak trend towards later and smaller maturation in both sexes. Effects of sex ratio were stronger and putatively adaptive in males but not in females. Males delay maturation in the presence of mature rivals, resulting in larger adult size with subsequent benefit to competitive ability. However, females also delay maturation in male-biased groups, incurring a loss of reproductive lifespan without apparent benefit. Thus, in highly competitive environments, female fitness may be limited by the lack of sex-specific plasticity. More generally, assuming that selection does act antagonistically on male and female maturation traits in the wild, our results demonstrate that genetic architecture of homologous traits can ease a major constraint on the evolution of adaptive dimorphism.
Assuntos
Ciprinodontiformes/fisiologia , Modelos Genéticos , Comportamento Sexual Animal , Fatores Etários , Animais , Tamanho Corporal/genética , Comportamento Competitivo , Ciprinodontiformes/genética , Feminino , Variação Genética , Genótipo , Masculino , Fenótipo , Reprodução/fisiologia , Caracteres Sexuais , Razão de MasculinidadeRESUMO
PURPOSE: Toxic reactions to local anesthetics are rare but potentially lethal. In fact, animal studies and case reports demonstrate that the administration of lipid emulsions after initializing cardiopulmonary resuscitation is a promising treatment option. The aim of this study was to determine how many hospitals in Germany are prepared to treat toxic reactions to local anesthetics with lipid infusion and to identify how often and what type of toxic reactions occur and if treatment was successful. Further, we aimed to elucidate if current guidelines lead to more immediate availability of lipid emulsions in direct proximity to the room where regional anesthesia is performed. METHODS: A standardized survey was sent to 1,305 German hospitals. The main question was whether lipid emulsions are readily available and if published guidelines contributed to this availability. Additionally, we asked whether local anesthetic toxicity had already successfully been treated by lipid emulsions and what type of symptoms were treated. RESULTS: We received replies from n = 509 (39%) hospitals. In 338 (66%) of the responding hospitals, lipid emulsions are readily available. Hospitals with standard operating procedures (SOPs) implemented according to published guidelines have lipids significantly more often immediately available than hospitals with just SOPs (chi-square test of independence, p-value < 0.01). Of all responding hospitals 287 (56%) have implemented a SOP for the treatment of toxic reactions to local anesthetics and 196 (39%) of the hospitals introduced the SOP because of the guidelines. In 28 (6%) of the hospitals, local anesthetic toxicity had already caused cardiac arrest with subsequent cardiopulmonary resuscitation in at least one patient. In 132 (26%) hospitals, local anesthetic toxicity had already been treated by infusing lipid emulsions. Of these hospitals 128 (96%) state this therapeutic approach was successful. Treatment with lipid emulsions was performed frequently after prodromal symptoms 83 (63%) were witnessed. CONCLUSIONS: The majority of surveyed German hospitals are prepared to treat toxic reactions to local anesthetics and published guidelines contributed to this preparedness. The infusion of lipid emulsions is a promising measure to deal with toxic reactions to local anesthetics. Since toxic reactions to local anesthetics are potentially lethal, it seems desirable that lipid emulsions are generally available in routine clinical practice. Currently, the treatment of toxic reactions to local anesthetics is mostly performed in situations (e.g. treatment of prodromal symptoms) that are not recommended by current guidelines. Further research is necessary to better define the future use of lipid emulsions in routine clinical practice.
Assuntos
Anestésicos Locais/efeitos adversos , Antídotos/uso terapêutico , Emulsões Gordurosas Intravenosas/uso terapêutico , Hospitais/estatística & dados numéricos , Ressuscitação/estatística & dados numéricos , Reanimação Cardiopulmonar/métodos , Alemanha/epidemiologia , Guias como Assunto , Pesquisas sobre Atenção à Saúde , Parada Cardíaca/induzido quimicamente , Parada Cardíaca/terapia , Humanos , Ressuscitação/métodosRESUMO
Local adaptation is often invoked to explain hybrid zone structure, but empirical evidence of this is generally rare. Hybrid zones between two poeciliid fishes, Xiphophorus birchmanni and X. malinche, occur in multiple tributaries with independent replication of upstream-to-downstream gradients in morphology and allele frequencies. Ecological niche modelling revealed that temperature is a central predictive factor in the spatial distribution of pure parental species and their hybrids and explains spatial and temporal variation in the frequency of neutral genetic markers in hybrid populations. Among populations of parentals and hybrids, both thermal tolerance and heat-shock protein expression vary strongly, indicating that spatial and temporal structure is likely driven by adaptation to local thermal environments. Therefore, hybrid zone structure is strongly influenced by interspecific differences in physiological mechanisms for coping with the thermal environment.
Assuntos
Adaptação Fisiológica , Ciprinodontiformes/fisiologia , Meio Ambiente , Hibridização Genética , Alelos , Animais , Ciprinodontiformes/genética , Feminino , Regulação da Expressão Gênica , Frequência do Gene , Genética Populacional/métodos , Proteínas de Choque Térmico/análise , Proteínas de Choque Térmico/genética , Temperatura Alta , Masculino , Polimorfismo de Nucleotídeo Único , Dinâmica Populacional , Estações do Ano , Especificidade da Espécie , Estresse Fisiológico , Fatores de Tempo , Viviparidade não MamíferaRESUMO
Natural hybrid zones provide opportunities to study a range of evolutionary phenomena from speciation to the genetic basis of fitness-related traits. We show that widespread hybridization has occurred between two neo-tropical stream fishes with partial reproductive isolation. Phylogenetic analyses of mitochondrial sequence data showed that the swordtail fish Xiphophorus birchmanni is monophyletic and that X. malinche is part of an independent monophyletic clade with other species. Using informative single nucleotide polymorphisms in one mitochondrial and three nuclear intron loci, we genotyped 776 specimens collected from twenty-three sites along seven separate stream reaches. Hybrid zones occurred in replicated fashion in all stream reaches along a gradient from high to low elevation. Genotyping revealed substantial variation in parental and hybrid frequencies among localities. Tests of F(IS) and linkage disequilibrium (LD) revealed generally low F(IS) and LD except in five populations where both parental species and hybrids were found suggesting incomplete reproductive isolation. In these locations, heterozygote deficiency and LD were high, which suggests either selection against early generation hybrids or assortative mating. These data lay the foundation to study the adaptive basis of the replicated hybrid zone structure and for future integration of behaviour and genetics to determine the processes that lead to the population genetic patterns observed in these hybrid zones.
Assuntos
Evolução Biológica , Ciprinodontiformes/classificação , Ciprinodontiformes/genética , Especiação Genética , Hibridização Genética , Animais , Sequência de Bases , Ciprinodontiformes/fisiologia , DNA Mitocondrial/genética , Feminino , Variação Genética , Genótipo , Geografia , Desequilíbrio de Ligação , Masculino , México , Filogenia , Polimorfismo de Nucleotídeo Único , Reprodução/genética , Análise de Sequência de DNARESUMO
Human-induced environmental change can affect the evolutionary trajectory of populations. In Mexico, indigenous Zoque people annually introduce barbasco, a fish toxicant, into the Cueva del Azufre to harvest fish during a religious ceremony. Here, we investigated tolerance to barbasco in fish from sites exposed and unexposed to the ritual. We found that barbasco tolerance increases with body size and differs between the sexes. Furthermore, fish from sites exposed to the ceremony had a significantly higher tolerance. Consequently, the annual ceremony may not only affect population structure and gene flow among habitat types, but the increased tolerance in exposed fish may indicate adaptation to human cultural practices in a natural population on a very small spatial scale.
Assuntos
Adaptação Fisiológica , Comportamento Ritualístico , Paullinia/toxicidade , Poecilia/fisiologia , Animais , Tamanho Corporal , Tolerância a Medicamentos , Feminino , Humanos , Masculino , Poecilia/anatomia & histologia , Religião , Fatores Sexuais , Testes de ToxicidadeRESUMO
The establishment and survival of seedlings are critical stages in the life cycle of plants and therefore usually well timed to humid and favourable conditions. Climate projections suggest that the threatened mountain grassland species Arnica montana may be increasingly exposed to drought stress. However, studies that focus on the species' early development are missing. We evaluated impacts of drought-induced stress on A. montana seedlings in their early establishment phase and identified traits that could cause the species' fitness to decline. In a greenhouse experiment, we tested the response of A. montana seedlings to different drought levels (moderate, strong, extreme). To assess their fitness under increasing drought, we evaluated survival of the seedlings based on four senescence stages and measured the performance of above- and belowground morphological and physiological functional traits. Arnica montana seedlings showed high resistance to drought. Senescence accelerated and survival declined only under strong and extreme drought conditions. However, the seedlings' vegetative performance decreased even with moderate drought, as indicated by smaller values of most leaf traits and some root traits. Physiological trait response was less sensitive. Drought stress hinders the establishment and survival of A. montana seedlings. Following the functional trait responses to drought and their association with survival, we suggest declining leaf length, leaf width, and leaf number are sensitive traits that can lead to a decline in performance.
Assuntos
Arnica , Plântula , Clima , Secas , Folhas de PlantaRESUMO
Development consists of growth and differentiation, which can be partially decoupled and can be affected by environmental factors to different extents. In amphibians, variation in the larval environment influences development and causes changes in post-metamorphic shape. We examined post-metamorphic consequences, both morphological and locomotory, of alterations in growth and development. We reared tadpoles of two phylogenetically and ecologically distant frog species (the red-eyed treefrog Agalychnis callidryas and the African clawed frog Xenopus laevis) under different temperatures with ad libitum food supply and under different food levels at a constant temperature. Low temperature and low food levels both resulted in similarly extended larval periods. However, low temperature yielded relatively long-legged frogs with a lower degree of ossification than warm temperature, whereas low food yielded relatively short-legged frogs with a higher degree of ossification than high food levels. Such allometric differences had no effect on locomotor performance of juveniles. Our results provide a basis for understanding the relationship between growth, differentiation and post-metamorphic shape in anurans and help explain many of the discrepancies reported in previous studies.
Assuntos
Anuros/crescimento & desenvolvimento , Meio Ambiente , Membro Posterior/crescimento & desenvolvimento , Animais , Anuros/anatomia & histologia , Dieta , Membro Posterior/anatomia & histologia , Larva/crescimento & desenvolvimento , Locomoção/fisiologia , Osteogênese/fisiologia , Especificidade da Espécie , Temperatura , Fatores de TempoRESUMO
The seeds of the Neotropical legume, Dioclea megacarpa, the sole food source for developing larvae of the bruchid beetle, Caryedes brasiliensis, contain about 13 percent L-canavanine (dry weight). Canavanine detoxification and utilization produces L-canaline, a potent neurotoxic and insecticidal amino acid. This seed predator has developed a unique biochemical mechanism for degrading canaline by reductive deamination to form homoserine and ammonia. In this way, canaline is detoxified; canavanine's stored nitrogen is more fully utilized and its carbon skeleton is conserved.
RESUMO
L-canavanine is a highly toxic L-arginine analog found in some leguminous seeds. Larvae of the bruchid beetle Caryedes brasiliensis, collected in Costa Rica, subsist solely on tissues of the mature seed of Dioclea megacarpa, which contains more than 8 percent L-canavanine by dry weight. The arginyl-tRNA synthetase of the bruchid beetle larvae discriminates between L-arginine and L-canavanine, and canavanyl proteins are not synthesized. In this way, bruchid beetle larvae avoid an adverse biochemical effect of L-canavanine.
Assuntos
Canavanina/metabolismo , Besouros/metabolismo , Animais , Biossíntese de ProteínasRESUMO
Larvae of the bruchid beetle Caryedes brasiliensis feed exclusively on seeds of the Neotropical legume Dioclea megacarpa, which contains 13 percent L-canavanine by dry weight. L-Canavanine, a nonprotein amino acid analog of L-arginine, exhibits potent insecticidal properties. Most of the seed nitrogen is sequestered in canavanine, and bruchid beetle larvae do not simply excrete this toxic compound. Instead, these larvae possess extraordinarily high urease activity, which facilitates the conversion of canavanine to ammonia through urea. In this way, canavanine is effectively detoxified and a supply of nitrogen for fixation into organic linkage is ensured.
Assuntos
Canavanina/metabolismo , Besouros/metabolismo , Animais , Arginase/metabolismo , Besouros/enzimologia , Larva , Urease/metabolismoRESUMO
Larvae of the bruchid beetle Caryedes brasiliensis (Bruchidae) develop entirely within the seed of the neotropical legume Dioclea megacarpa. The seed contains an appreciable concentration of L-canavanine, a potent antimetabolite and structural analog of L-arginine. This bruchid beetle uses the nitrogen stored in this toxic allelochemical as an effective dietary nitrogen source for amino acid biosynthesis.
RESUMO
BACKGROUND: Emergency treatment of ischemic stroke should ideally be mechanism specific, but acute subtype diagnosis is problematic. Since different subtypes often are associated with specific patterns of neurological deficits, we hypothesize that scores on baseline NIH stroke scale (NIHSS) items may help emergently stratify patients by their probability of having a particular stroke subtype. METHODS: We performed multivariate polytomous logistic regression analyses on 1,281 patients enrolled in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST). We tested the predictive value of individual items to the baseline NIHSS exam, and syndromic combinations of those items, in anticipating the TOAST stroke subtype at 3 months adjusting for atrial fibrillation. We then used the most significant NIHSS items to construct a predictive model. RESULTS: The NIHSS items that discriminate between stroke subtypes are language, neglect, visual field and brachial predominance of weakness. Among patients without atrial fibrillation, a normal score for these 4 variables conveys a 46% chance of lacunar stroke, 12% of atherothrombotic stroke and 10% of cardioembolism. This pattern gradually reverses with increased numbers of abnormal responses. Those with abnormalities in all 4 items have a 0.1% chance of lacunar stroke, 50% of atherothrombotic stroke and 39% of cardioembolism. CONCLUSIONS: Language, neglect, visual fields and brachial predominance of weakness in the baseline NIHSS help discriminate between subtypes, particularly between lacunar and nonlacunar strokes. Clinical trials testing interventions aimed to particular stroke mechanisms may use these NIHSS items to emergently stratify patients based on their probability of having a particular stroke subtype.
Assuntos
Índice de Gravidade de Doença , Acidente Vascular Cerebral/classificação , Afasia/etiologia , Braço , Fibrilação Atrial/complicações , Infarto Encefálico/diagnóstico , Infarto Encefálico/epidemiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Estudos de Coortes , Método Duplo-Cego , Hemianopsia/etiologia , Humanos , Arteriosclerose Intracraniana/complicações , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/epidemiologia , Modelos Logísticos , Debilidade Muscular/etiologia , Paresia/etiologia , Transtornos da Percepção/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologiaRESUMO
BACKGROUND: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians' attitudes and practices regarding error discussions with colleagues. METHODS: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables. RESULTS: Responses were received from 338 participants (response rate = 74%). In all, 73% of respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision (91%), wanting colleagues to learn from the mistake (80%) and wanting to receive support (79%). Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm (77%), minor harm (87%) or major harm (94%). Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion (OR 4.17, CI 2.34 to 7.42). CONCLUSIONS: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners.
Assuntos
Atitude do Pessoal de Saúde , Docentes de Medicina , Internato e Residência , Erros Médicos/psicologia , Revelação da Verdade/ética , Competência Clínica , Feminino , Humanos , Masculino , Erros Médicos/ética , Estatística como Assunto , Inquéritos e QuestionáriosRESUMO
The effects of L-canavanine, a higher plant nonprotein amino acid, on the growth of a rat colon carcinoma were assessed. The 1 and 10% lethal dose values following a single s.c. injection in Fischer rats were 4.75 and 5.57 g/kg, respectively. Rats received s.c. injections of a 10% (w/v) tumor cell suspension. When the tumors reached a size of 500 to 1000 mm3, the rats received canavanine, 2.0 g/kg or 3.0 g/kg s.c. daily for 5 or daily for 9 days. Control animals received a 0.9% NaCl solution. Administration of canavanine, 2.0 g/kg for 5 days produced a treated versus control of 23%; the treated versus control for 9 days was 14%. The 3.0-g/kg dosing regimen resulted in a treated versus control value of -13% after 5 days and -8% after 9 days. The negative values indicated regression of the tumor. The reduction in tumor volume, expressed as the percentage of regression, was 22% in animals receiving canavanine, 3.0 g/kg daily for 5 days and 60% in the 3.0-g/kg-daily-for-9-days treatment group. Cumulative toxicity caused death in 2 of 5 animals in the 3.0-g/kg-for-9-days treatment group; the average weight loss was 31%. The 3.0-g/kg-for-5-days treatment also produced undesirable cumulative toxicity as indicated by a weight loss of 19%. Cumulative toxicity was reduced greatly when canavanine was administered at a dose level of 2.0 g/kg for 5 days (weight loss of 13%). Analysis of the relationship of caloric deprivation to tumor growth reduction established that canavanine-mediated curtailment of tumor growth was not caused by reduced food intake and its associated loss in body weight. Histological examination of tissues from rats receiving canavanine, 2.0 or 3.0 g/kg daily for 5 or 9 days failed to reveal lesions in any of the examined tissues, except for varying degrees of pancreatic acinar atrophy. All other tissues appeared normal. The white and red blood cell values of canavanine-treated rats were also normal following 1, 3, or 6 injections of canavanine, 2.0 or 3.0 g/kg. The results indicated that canavanine induced marked growth inhibition of the rat colon carcinoma. Our experiments also disclosed that further studies must be conducted to optimize the dosing schedule to enhance drug efficacy and to reduce its cumulative toxicity.
Assuntos
Canavanina/uso terapêutico , Neoplasias do Colo/tratamento farmacológico , Animais , Canavanina/administração & dosagem , Canavanina/toxicidade , Linhagem Celular , Neoplasias do Colo/patologia , Ingestão de Energia , Masculino , Ratos , Ratos Endogâmicos F344 , Fatores de TempoRESUMO
L-Canavanine (CAV), the L-2-amino-4-guanidinooxy structural analogue of L-arginine (ARG), is a potent ARG antagonist which occurs in the jack bean, Canavalia ensiformis. This ARG antimetabolite is active against L1210 murine leukemia and a solid colonic tumor in the rat. Our initial studies using a microtiter assay show that CAV exhibits a 50% inhibitory concentration of approximately 2 mM against the human pancreatic adenocarcinoma cell line, MIA PaCa-2, when these cells are grown in Dulbecco's modified Eagle's medium containing 0.4 mM ARG. When the ARG concentration is reduced to 0.4 microM, the 50% inhibitory concentration for CAV falls precipitously to 0.01 mM. The pronounced increase in the ability of CAV to inhibit MIA PaCa-2 cell growth at the lower ARG concentration may result from enhanced CAV competition with ARG for incorporation into newly synthesized cellular proteins. At 0.4 microM ARG, 30 mM CAV almost completely inhibits cell growth by 6 h. In contrast, with 0.4 mM ARG, complete inhibition does not occur until after 48 h. A dramatic reversal of growth inhibition caused by a very high concentration of CAV was observed when cells treated with CAV were replenished with a high concentration of ARG. Our results suggest that CAV has real potential as a lead compound for the development of analogues with enhanced activity against human pancreatic cancer.
Assuntos
Canavanina/farmacologia , Neoplasias Pancreáticas/patologia , Arginina/farmacologia , Divisão Celular/efeitos dos fármacos , Humanos , Células Tumorais CultivadasRESUMO
Protein kinase C (PKC) has been implicated in the proliferation and apoptosis of glial tumors, but the role of specific PKC isoforms remains unresolved. Comparing brain tumors differing in degree of malignancy, we found that malignant gliomas expressed higher levels of PKCalpha and lower levels of PKCdelta as compared with low-grade astrocytomas. Consistent with a mechanistic role for these differences, overexpression of PKCalpha in the human U87 glioma cell line resulted in enhanced cell proliferation and decreased glial fibrillary acidic protein (GFAP) expression as compared with controls. Reciprocally, overexpression of PKCdelta inhibited cell proliferation and enhanced GFAP expression. Using PKC chimeras, we found that the regulatory domains of PKCalpha and PKCdelta mediated their effects on cell proliferation and GFAP expression. PKCalpha and delta have been implicated as potential signaling molecules in apoptosis. Therefore, we examined the role of these isoforms in the resistance of glioma cells to apoptotic stimuli. In U87 cells, manipulation of PKCalpha levels had little effect on apoptosis in response to etoposide. In contrast, overexpression of PKCdelta rendered the U87 cells more sensitive to the apoptotic effect of etoposide, and PKCdelta was cleaved in these cells by a caspase-dependent process. Furthermore, the glioma cell line U373, which expresses endogenous PKCdelta, underwent apoptosis in response to etoposide, and the apoptotic response was blocked by the PKCdelta inhibitor rottlerin. Our results suggest that PKCalpha and PKCdelta play opposite roles in the proliferation and apoptosis of glioma cells.
Assuntos
Apoptose/fisiologia , Astrocitoma/enzimologia , Neoplasias Encefálicas/enzimologia , Glioblastoma/enzimologia , Isoenzimas/fisiologia , Proteína Quinase C/fisiologia , Antineoplásicos Fitogênicos/farmacologia , Apoptose/efeitos dos fármacos , Astrocitoma/patologia , Neoplasias Encefálicas/patologia , Caspases/metabolismo , Divisão Celular/fisiologia , Resistencia a Medicamentos Antineoplásicos , Etoposídeo/farmacologia , Proteína Glial Fibrilar Ácida/biossíntese , Glioblastoma/patologia , Humanos , Isoenzimas/biossíntese , Isoenzimas/metabolismo , Pessoa de Meia-Idade , Proteína Quinase C/biossíntese , Proteína Quinase C/metabolismo , Proteína Quinase C-alfa , Proteína Quinase C-delta , Estrutura Terciária de Proteína , Proteínas Recombinantes de Fusão/metabolismo , Transdução de Sinais/fisiologia , Células Tumorais CultivadasRESUMO
BACKGROUND: Infectious respiratory disorders are important causes of childhood morbidity and mortality. Viral causes are common and may lead to rapid deterioration, requiring mechanical ventilation; myocardial dysfunction may accompany respiratory decompensation. The etiologic viral diagnosis may be difficult with classic methods. The purpose of this study was to evaluate polymerase chain reaction (PCR) as a diagnostic method for identification of causative agents. METHODS AND RESULTS: PCR was used to amplify sequences of viruses known to cause childhood viral pneumonia and myocarditis. Oligonucleotide primers were designed to amplify specific sequences of DNA virus (adenovirus, cytomegalovirus, herpes simplex virus, and Epstein-Barr virus) and RNA virus (enterovirus, respiratory syncytial virus, influenza A, and influenza B) genomes. Tracheal aspirate samples were obtained from 32 intubated patients and nucleic acid extracted before PCR. PCR results were compared with results of culture, serology, and antigen detection methods when available. In cases of myocarditis (n=7), endomyocardial biopsy samples were analyzed by PCR and compared with tracheal aspirate studies. PCR amplification of viral genome occurred in 18 of 32 samples (56%), with 3 samples PCR positive for 2 viral genomes. Amplified viral sequences included RSV (n=3), enterovirus (n=5), cytomegalovirus (n=4), adenovirus (n=3), herpes simplex virus (n=2), Epstein-Barr virus (n=1), influenza A (n=2), and influenza B (n=1). All 7 cases of myocarditis amplified the same viral genome from heart as found by tracheal aspirate. CONCLUSIONS: PCR is a rapid and sensitive diagnostic tool in cases of viral pneumonia with or without myocarditis, and tracheal aspirate appears to be excellent for analysis.
Assuntos
Infecções por Adenoviridae/virologia , Líquidos Corporais/virologia , DNA Viral/isolamento & purificação , Infecções por Enterovirus/virologia , Infecções por Herpesviridae/virologia , Herpesviridae/isolamento & purificação , Influenza Humana/virologia , Miocardite/virologia , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase , RNA Viral/isolamento & purificação , Infecções por Vírus Respiratório Sincicial/virologia , Traqueia/virologia , Infecções por Adenoviridae/diagnóstico , Adenovírus Humanos/genética , Adenovírus Humanos/isolamento & purificação , Adolescente , Sequência de Bases , Biópsia , Criança , Pré-Escolar , Citomegalovirus/genética , Citomegalovirus/isolamento & purificação , Endocárdio/virologia , Enterovirus/genética , Enterovirus/isolamento & purificação , Infecções por Enterovirus/diagnóstico , Ensaio de Imunoadsorção Enzimática , Herpesviridae/genética , Infecções por Herpesviridae/diagnóstico , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/isolamento & purificação , Humanos , Lactente , Recém-Nascido , Vírus da Influenza A/genética , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/genética , Vírus da Influenza B/isolamento & purificação , Influenza Humana/diagnóstico , Dados de Sequência Molecular , Miocardite/diagnóstico , Pneumonia Viral/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/virologia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Vírus Sinciciais Respiratórios/genética , Vírus Sinciciais Respiratórios/isolamento & purificação , Simplexvirus/genética , Simplexvirus/isolamento & purificação , Sucção , Cultura de VírusRESUMO
BACKGROUND: Use of automatic external defibrillators (AEDs) in children aged <8 years is not recommended. The purpose of this study was to develop an ECG database of shockable and nonshockable rhythms from a broad age range of pediatric patients and to test the accuracy of the Agilent Heartstream FR2 Patient Analysis System for sensitivity and specificity. METHODS AND RESULTS: Children aged =12 years who either developed arrhythmias or were at risk for developing arrhythmias were studied. Two sources were used for the database: children whose rhythms were recorded prospectively via a modified AED and children who had arrhythmias captured on paper and digitized for subsequent analysis. The rhythms were divided into 5-second strips, classified by 3 reviewers, and then assessed by the AED analysis algorithm. A total of 696 five-second rhythm strips from 191 children (81 female and 110 male) aged 1 day to 12 years (median 3.0 years) were analyzed. There was 100% specificity for nonshockable rhythms. Sensitivity for ventricular fibrillation was 96%. CONCLUSIONS: There was excellent AED rhythm analysis sensitivity and specificity in all age groups for ventricular fibrillation and nonshockable rhythms. The high specificity and sensitivity indicate that there is a very low risk of an inappropriate shock and that the AED correctly identifies shockable rhythms, making the algorithm both safe and effective for children.
Assuntos
Arritmias Cardíacas/prevenção & controle , Cardioversão Elétrica/instrumentação , Adulto , Algoritmos , Arritmias Cardíacas/diagnóstico , Criança , Pré-Escolar , Bases de Dados como Assunto , Feminino , Coração/fisiopatologia , Humanos , Lactente , Masculino , Sistema de RegistrosRESUMO
OBJECTIVES: The purpose of this study was to identify echocardiographic hemodynamic and morphometric factors that would predict which infants with critical aortic stenosis could undergo relief of left ventricular outflow obstruction as opposed to the Norwood procedure. BACKGROUND: Echocardiographic predictors of survival in infants with critical aortic stenosis after two-ventricle repair have been mainly limited to morphometric factors, which have limitations. Echocardiographic hemodynamic predictors of survival in these patients have not previously been studied. METHODS: Doppler color flow mapping and pulsed Doppler techniques were used to obtain hemodynamic measurements of flow in the ascending, transverse and descending aorta, the ductus arteriosus, and across the aortic and mitral valves in infants with critical aortic stenosis. Morphometric measurements of the left heart structures were obtained, and comparisons were made between survivors and nonsurvivors for the hemodynamic and morphometric factors. RESULTS: Twenty-eight infants (mean age 1 +/- .6 days, mean weight 3.6 +/- .6 kg) with critical aortic stenosis were evaluated. Nineteen had a two-ventricle repair initially attempted, and nine had a Norwood operation. Among the patients with a two-ventricle repair, the hemodynamic factors associated with survival after two-ventricle repair included predominant or total antegrade flow in the ascending (p < 0.01) and transverse aorta (p < 0.05). Aortic valve gradient, mitral valve inflow and direction of flow in the ductus arteriosus and descending aorta were unrelated to outcome. The morphometric factors associated with survival after two-ventricle repair included the indexed aortic annulus (p < 0.0002), aortic root (p < 0.003), ascending aorta (p < 0.008) and left ventricular long-axis length (p < 0.01). Left ventricular volume, mass, ejection fraction and mitral valve area were not related to outcome after two-ventricle repair. CONCLUSIONS: In infants with critical aortic stenosis, predominant or total antegrade flow in the ascending and transverse aorta was associated with survival after two-ventricle repair. Determination of a one- versus two-ventricle repair remains a complex issue in infants with critical aortic stenosis. In addition to established morphometric predictors, hemodynamic information on the direction of flow in the aorta may help to define candidates for the Norwood operation.