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1.
Environ Monit Assess ; 191(11): 641, 2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586255

RESUMO

The aim of this study was to determine concentrations of antimony and barium in air quality samples and assess the potential suitability of these metals as tracer elements for non-exhaust traffic emissions sources. Air quality filters sampled at monitoring sites around the UK for the purposes of the UK Heavy Metals Monitoring Network were subjected to microwave digestion in hydrogen peroxide and nitric acid, then analysed by ICP-MS for a suite of metals including antimony and barium. The average antimony concentration found across all the network sites was 1.84 ng m-3; the average barium concentration was 6.33 ng m-3. The range of antimony concentrations observed was 0.13-8.02 ng m-3; barium concentrations ranged from levels below the detection limit of 0.18 to 39.9 ng m-3. There are no legislative limits for antimony and barium in ambient air, but the maximum concentrations found are well below the Workplace Exposure Limits specified by the UK Health and Safety Executive. The highest concentrations were found at roadside sites situated to monitor traffic environments, supporting the suitability of antimony and barium to be considered tracer elements for traffic emissions sources. Strong correlations were observed between antimony, barium and copper, indicating they share a common traffic-related source. Based on the strong correlation with copper at urban and traffic locations, indicative annual UK atmospheric emission estimates for antimony and barium in brake and tyre wear were calculated as 6 and 19 tonnes respectively.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Antimônio/análise , Bário/análise , Monitoramento Ambiental/métodos , Emissões de Veículos/análise , Reino Unido
2.
J Fish Biol ; 92(4): 1065-1081, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29479698

RESUMO

Thirteen microsatellite loci were used to address three hypotheses regarding genetic diversity in the humpback whitefish Coregonus clupeaformis complex in Alaska. The test results provided further insight into the factors influencing C. clupeaformis complex population structure and level of genetic variation. First, the microsatellite data did not provide evidence of two spatially distinct Beringian and Eurasian refugial groups as revealed in previous phylogeographic analyses of mitochondrial DNA variation. Rather, the population structure inferred from the microsatellite variation appears to reveal the influence of factors on a more recent time scale, including gene flow among the refugial groups and isolation of some anadromous and freshwater resident populations. Second, anadromous C. clupeaformis complex collections exhibited higher intra-population genetic diversity than freshwater resident collections. This outcome is consistent with previous meta analyses suggesting that freshwater resident populations probably have smaller historical effective population sizes and less conspecific gene flow because the habitat tends to be smaller and supports fewer and smaller populations. Finally, the analysis of contemporary immigration rates was consistent with, but did not provide statistical support for, the hypothesis that gene flow among anadromous C. clupeaformis complex populations along coastal Alaska is influenced by the Alaska Coastal Current. Further studies are needed to evaluate gene flow among coastal Alaska C. clupeaformis complex populations.


Assuntos
Fluxo Gênico , Variação Genética , Genética Populacional , Salmonidae/genética , Alaska , Animais , DNA Mitocondrial/genética , Ecossistema , Água Doce , Repetições de Microssatélites , Filogeografia
3.
Soft Matter ; 10(29): 5249-68, 2014 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-24740612

RESUMO

Fundamental understanding on microscopic physical changes of plant materials is vital to optimize product quality and processing techniques, particularly in food engineering. Although grid-based numerical modelling can assist in this regard, it becomes quite challenging to overcome the inherited complexities of these biological materials especially when such materials undergo critical processing conditions such as drying, where the cellular structure undergoes extreme deformations. In this context, a meshfree particle based model was developed which is fundamentally capable of handling extreme deformations of plant tissues during drying. The model is built by coupling a particle based meshfree technique: Smoothed Particle Hydrodynamics (SPH) and a Discrete Element Method (DEM). Plant cells were initiated as hexagons and aggregated to form a tissue which also accounts for the characteristics of the middle lamella. In each cell, SPH was used to model cell protoplasm and DEM was used to model the cell wall. Drying was incorporated by varying the moisture content, the turgor pressure, and cell wall contraction effects. Compared to the state of the art grid-based microscale plant tissue drying models, the proposed model can be used to simulate tissues under excessive moisture content reductions incorporating cell wall wrinkling. Also, compared to the state of the art SPH-DEM tissue models, the proposed model better replicates real tissues and the cell-cell interactions used ensure efficient computations. Model predictions showed good agreement both qualitatively and quantitatively with experimental findings on dried plant tissues. The proposed modelling approach is fundamentally flexible to study different cellular structures for their microscale morphological changes at dehydration.


Assuntos
Malus/citologia , Modelos Biológicos , Células Vegetais , Parede Celular , Simulação por Computador , Citoplasma , Dessecação , Frutas/citologia , Hidrodinâmica , Fenômenos Mecânicos , Reprodutibilidade dos Testes
4.
Environ Sci Technol ; 48(21): 12577-85, 2014 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-25322332

RESUMO

We have studied the effect of chemical composition of biodiesel fuel on the physical (volatility) and chemical (reactive oxygenated species concentration) properties of nano particles emitted from a modern common-rail diesel engine. Particle emissions from the combustion of four biodiesels with controlled chemical compositions and different varying unsaturation degrees and carbon-chain lengths, together with a commercial diesel, were tested and compared in terms of volatility of particles and the amount of reactive oxygenated species carried by particles. Different blends of biodiesel and petro diesel were tested at several engine loads and speeds. We have observed that more saturated fuels with shorter carbon chain lengths result in lower particle mass but produce particles that are more volatile and also have higher levels of Reactive Oxygen Species. This highlights the importance of taking into account metrics that are relevant from the health effects point of view when assessing emissions from new fuel types.


Assuntos
Biocombustíveis/análise , Material Particulado/análise , Emissões de Veículos/análise , Estrutura Molecular , Oxirredução , Material Particulado/química , Volatilização
5.
Clin Exp Immunol ; 174(2): 265-73, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23841802

RESUMO

Mannan binding lectin (MBL)-associated serine protease type 1 (MASP-1) has a central role in the lectin pathway of complement activation and is required for the formation of C3 convertase. The activity of MASP-1 in the peripheral blood has been identified previously as a highly significant predictor of the severity of liver fibrosis in hepatitis C virus (HCV) infection, but not in liver disease of other aetiologies. In this study we tested the hypotheses that expression of MASP-1 may promote disease progression in HCV disease by direct activation of hepatic stellate cells (HSCs) and may additionally be up-regulated by HCV. In order to do so, we utilized a model for the maintenance of primary human HSC in the quiescent state by culture on basement membrane substrate prior to stimulation. In comparison to controls, recombinant MASP-1 stimulated quiescent human HSCs to differentiate to the activated state as assessed by both morphology and up-regulation of HSC activation markers α-smooth muscle actin and tissue inhibitor of metalloproteinase 1. Further, the expression of MASP-1 was up-regulated significantly by HCV infection in hepatocyte cell lines. These observations suggest a new role for MASP-1 and provide a possible mechanistic link between high levels of MASP-1 and the severity of disease in HCV infection. Taken together with previous clinical observations, our new findings suggest that the balance of MASP-1 activity may be proinflammatory and act to accelerate fibrosis progression in HCV liver disease.


Assuntos
Hepacivirus/imunologia , Células Estreladas do Fígado/imunologia , Hepatite C/imunologia , Cirrose Hepática/imunologia , Serina Proteases Associadas a Proteína de Ligação a Manose/metabolismo , Actinas/genética , Actinas/metabolismo , Diferenciação Celular , Células Cultivadas , Lectina de Ligação a Manose da Via do Complemento/imunologia , Progressão da Doença , Hepatite C/complicações , Humanos , Cirrose Hepática/etiologia , Lectina de Ligação a Manose/metabolismo , Serina Proteases Associadas a Proteína de Ligação a Manose/genética , Serina Proteases Associadas a Proteína de Ligação a Manose/imunologia , Proteínas Recombinantes/imunologia , Inibidor Tecidual de Metaloproteinase-1/genética , Inibidor Tecidual de Metaloproteinase-1/metabolismo , Regulação para Cima
6.
Nature ; 450(7172): E21; discussion E22, 2007 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-18075522

RESUMO

Wilson and Head model kimberlite ascent and eruption by considering the propagation of a volatile-rich dyke. Wilson and Head's model has features in common with Sparks et al., but it is inconsistent with geological observations and constraints on volatile solubility. Here we show that this may be due to erroneous physical assumptions.

7.
BMJ Mil Health ; 169(2): 127-132, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33243763

RESUMO

INTRODUCTION: There is little systematic tracking or detailed analysis of investments in research and development for blast injury to support decision-making around research future funding. METHODS: This study examined global investments into blast injury-related research from public and philanthropic funders across 2000-2019. Research databases were searched using keywords, and open data were extracted from funder websites. Data collected included study title, abstract, award amount, funder and year. Individual awards were categorised to compare amounts invested into different blast injuries, the scientific approaches taken and analysis of research investment into blast traumatic brain injury (TBI). RESULTS: A total of 806 awards were identified into blast injury-related research globally, equating to US$902.1 million (m, £565.9m GBP). There was a general increase in year-on-year investment between 2003 and 2009 followed by a consistent decline in annual funding since 2010. Pre-clinical research received $671.3 m (74.4%) of investment. Brain-related injury research received $427.7 m (47.4%), orthopaedic injury $138.6 m (15.4%), eye injury $63.7 m (7.0%) and ear injury $60.5m (6.7%). Blast TBI research received a total investment of $384.3 m, representing 42.6% of all blast injury-related research. The U.S. Department of Defense funded $719.3 m (80%). CONCLUSIONS: Investment data suggest that blast TBI research has received greater funding than other blast injury health areas. The funding pattern observed can be seen as reactive, driven by the response to the War on Terror, the rising profile of blast TBI and congressionally mandated research.


Assuntos
Pesquisa Biomédica , Traumatismos por Explosões , Lesões Encefálicas Traumáticas , Obtenção de Fundos , Humanos , Traumatismos por Explosões/epidemiologia , Investimentos em Saúde , Lesões Encefálicas Traumáticas/epidemiologia
8.
Epilepsy Behav ; 25(4): 676-81, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23168089

RESUMO

We previously described a communication strategy for the delivery of the diagnosis of psychogenic non-epileptic seizures (PNES) that was acceptable and effective at communicating the psychological cause of PNES. This prospective multicenter study describes the short-term seizure and psychosocial outcomes after the communication of the diagnosis and with no additional treatment. Participants completed self-report measures at baseline, two and six months after the diagnosis (seizure frequency, HRQoL, health care utilization, activity levels, symptom attributions and levels of functioning). Thirty-six participants completed the self-report questionnaires. A further eight provided seizure frequency data. After six months, the median seizure frequency had dropped from 10 to 7.5 per month (p=0.9), 7/44 participants (16%) were seizure-free, and an additional 10/44 (23%) showed greater than 50% improvement in seizure frequency. Baseline questionnaire measures demonstrated high levels of impairment, which had not improved at follow-up. The lack of change in self-report measures illustrates the need for further interventions in this patient group.


Assuntos
Convulsões/diagnóstico , Adulto , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Qualidade de Vida/psicologia , Recidiva , Convulsões/psicologia , Inquéritos e Questionários
9.
J Endocrinol Invest ; 35(5): 541-6, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22572768

RESUMO

Approximately 215,000 people younger than 20 yr of age, or 1 in 500 children and adolescents, had diabetes in the United States in 2010--and the incidence is rising. We still have insufficient knowledge about the precise mechanisms leading to the autoimmune mediated ß-cell destruction in Type 1 diabetes, and the ß-cell failure associated with insulin resistance in Type 2 diabetes. Long-term complications are similar: micro- and macrovascular disease occurs prematurely and presents an enormous burden on affected individuals, often as early as in middle age. In Type 1 diabetes, technological advances have clearly improved blood glucose management, but chronic peripheral over-insulinization remains a problem even with the most advanced systems. Thus, in Type 1 diabetes our research must focus on 1) finding the stimulus that ignites the immune response and 2) developing treatments that avoid hyperinsulinemia. In Type 2 diabetes in youth, the challenges start much earlier: most young patients do not even benefit from existing therapies due to non-compliance. Therefore, prevention of Type 2 diabetes and improvement of compliance, especially with non-pharmacological interventions, are the greatest challenges.


Assuntos
Diabetes Mellitus/epidemiologia , Diabetes Mellitus/fisiopatologia , Adolescente , Criança , Humanos , Incidência , Estados Unidos/epidemiologia
10.
Nanotechnology ; 22(10): 105303, 2011 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-21289393

RESUMO

Engineered gold nanostructured arrays with feature separation in the sub-10-nm range were fabricated and used for highly sensitive surface enhanced Raman scattering (SERS) detection of biomarkers. Nanostructuring is achieved by combining electron beam lithography with the so-called shadow evaporation technique which involves a two-step Au vapor deposition through a suspended Ge mask while the substrate is tilted in opposite directions. This results in a regular triangular surface pattern with extremely small gap distances that allow positive enhancement of the local electric fields by enabling improvements in the electromagnetic coupling between adjacent nanoparticles. The resulting SERS active surfaces are suitable for the realization of reference procedures for quantifying marker molecules like urea or creatinine at physiologically relevant concentrations.


Assuntos
Biomarcadores/química , Análise em Microsséries/instrumentação , Nanotecnologia/métodos , Análise Espectral Raman/instrumentação , Benzoatos/química , Creatinina/química , Desenho de Equipamento , Ouro/química , Análise em Microsséries/métodos , Análise Espectral Raman/métodos , Compostos de Sulfidrila/química , Propriedades de Superfície , Ureia/química
11.
J Neurol ; 268(12): 4882-4889, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34537867

RESUMO

BACKGROUND: Functional Neurological Disorder (FND) is a complex neuropsychiatric condition with a multifactorial aetiology. The heterogeneity of patients with FND is rarely considered in psychotherapy trials, which may contribute to variable outcomes. Shared Individual Formulation Therapy (SIFT) is a new, brief (four session) psychotherapy that aims to accommodate heterogeneity by providing a personalised, trans-theoretical formulation of the person's difficulties and accompanying management plan. METHODS: An open-label, prospective trial of outpatient SIFT for adults with FND was conducted, using health-related quality of life (SF-12) as the principal outcome measure, with secondary measures of mental health, dissociation, health care use and attitude to the FND diagnosis. Measures were collected at baseline, end of treatment and 6- and 12-month follow-ups. RESULTS: Twenty-nine participants with various FND symptoms enrolled. Twenty-four completed all four sessions and 25 completed follow-up measures at 12 months. SF-12 scores improved significantly at end of treatment and were sustained throughout follow-up with moderate effect sizes (0.39-0.47; all p < 0.001). Most secondary outcomes also improved significantly at all time points. The intervention was highly acceptable and tolerable to patients and perceived as beneficial. CONCLUSION: This trial provides preliminary evidence for initial and sustained benefit from SIFT for adults with FND. Further study is needed to validate these findings.


Assuntos
Doenças do Sistema Nervoso , Qualidade de Vida , Adulto , Humanos , Doenças do Sistema Nervoso/terapia , Estudos Prospectivos , Psicoterapia
12.
Water Sci Technol ; 59(6): 1117-27, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19342807

RESUMO

Flow through a gross pollutant trap (GPT) with fully blocked screens is investigated experimentally and theoretically using computational fluid dynamics (CFD). Due to the wide range of possible flow regimes, an experimental approach is developed which uses a downstream weir arrangement to control the nature of the flow and the variation in free surface height. To determine the overall flow structure, measurements are taken at a fixed depth throughout the trap with an Acoustic Doppler Velocimeter (ADV), including velocity profile data across three cross sections of the GPT suitable for more detailed comparison with simulations. Observations of the near-wall flow features at the free surface are also taken, due to their likely importance for understanding litter capture and retention in the GPT. Complementary CFD modelling (using Fluent 6.3) is performed using a two-dimensional k-epsilon turbulence model along with either standard wall law boundary conditions or enhanced near-wall modelling approaches. Comparison with experiments suggest that neither CFD modelling approach could be considered as clearly superior to the other, despite the significant difference in near-wall mesh refinement and modelling that is involved. The experimental approach taken here is found useful to control the flow regime in the GPT and further experiments are recommended to study a greater range of flow conditions.


Assuntos
Eliminação de Resíduos Líquidos/instrumentação , Eliminação de Resíduos Líquidos/métodos , Poluentes Químicos da Água/isolamento & purificação , Modelos Teóricos
13.
Obes Sci Pract ; 5(1): 75-82, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30847226

RESUMO

OBJECTIVES: Lipodystrophies are characterized by regional or generalized loss of adipose tissue and severe metabolic complications. The role of visceral adipose tissue (VAT) in the development of metabolic derangements in lipodystrophy is unknown. The study aim was to investigate VAT contribution to metabolic disease in lipodystrophy versus healthy controls. METHODS: Analysis of correlations between VAT volume and biomarkers of metabolic disease in 93 patients and 93 age/sex-matched healthy controls. RESULTS: Patients with generalized lipodystrophy (n = 43) had lower VAT compared with matched controls, while those with partial lipodystrophy (n = 50) had higher VAT versus controls. Both groups with lipodystrophy had lower leg fat mass versus controls (p < 0.05 for all; unpaired t-test). In both generalized and partial lipodystrophy, there was no correlation between VAT and glucose, triglycerides or high-density lipoprotein cholesterol (p > 0.05 for all; Spearman correlation). In controls matched to patients with generalized or partial lipodystrophy, VAT correlated with glucose (R = 0.42 and 0.36), triglycerides (R = 0.36 and 0.60) and high-density lipoprotein cholesterol (R = -0.34 and -0.64) (p < 0.05 for all; Spearman correlation). CONCLUSIONS: In contrast to healthy controls, metabolic derangements in lipodystrophy did not correlate with VAT volume. These data suggest that, in lipodystrophy, impaired peripheral subcutaneous fat deposition may exert a larger effect than VAT accumulation on the development of metabolic complications. Interventions aimed at increasing functional subcutaneous adipose tissue may provide metabolic benefit.

14.
Acta Psychiatr Scand ; 117(3): 232-5, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18028249

RESUMO

OBJECTIVE: High suggestibility is widely regarded as an important feature of patients with medically unexplained symptoms (MUS), particularly those with multiple MUS [i.e. somatization disorder (SD)], although there are few empirical data attesting to this assumption. A study was therefore conducted to compare levels of non-hypnotic suggestibility in patients with SD and medical controls. METHOD: A modified version of the Barber Suggestibility Scale was administered to 19 patients with SD and 17 controls with an established organic dystonia. RESULTS: Patients with SD were no more suggestible than control patients. Dystonia controls were more likely to deliberately comply with suggestions than the SD patients. CONCLUSION: Contrary to popular belief, high suggestibility is not necessarily a feature of SD.


Assuntos
Transtornos Somatoformes/psicologia , Sugestão , Adulto , Distonia/psicologia , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Valores de Referência , Papel do Doente , Transtornos Somatoformes/diagnóstico
15.
Lab Chip ; 7(11): 1434-41, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17960268

RESUMO

We describe an autonomous 'black-box' system for the controlled synthesis of fluorescent nanoparticles. The system uses a microfluidic reactor to carry out the synthesis and an in-line spectrometer to monitor the emission spectra of the emergent particles. The acquired data is fed into a control algorithm which reduces each spectrum to a scalar 'dissatisfaction coefficient' and then intelligently updates the reaction conditions in an effort to minimise this coefficient and so drive the system towards a desired goal. In the tests reported here, CdSe nanoparticles were prepared by separately injecting solutions of CdO and Se into the two inlets of a heated y-shaped microfluidic reactor. A noise-tolerant global search algorithm was then used to efficiently identify-without any human intervention-the injection rates and temperature that yielded the optimum intensity for a chosen emission wavelength.

16.
J Mol Endocrinol ; 36(1): 1-7, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16461922

RESUMO

It has been 75 years since Evans and Long identified a somatic growth-promoting substance in pituitary extracts, yet it is only in the last 20 years that the molecular basis for this action has been established. Three key elements in this elucidation were the cloning of the GH receptor, the identification of Janus kinase (JAK) 2 as the receptor-associated tyrosine kinase, and the delineation of signal transduction and activators of transcription (STAT) 5a/b as the key transcription factor(s) activated by JAK2. The interaction between these three elements results in enhanced postnatal growth and is the subject of this review. We describe a new model for GH receptor activation based on subunit rotation within a constitutive dimer, together with the phenotype and hepatic transcript profile of mice with targeted knockins to the receptor cytoplasmic domain. These support a central role for STAT5a/b in postnatal growth.


Assuntos
Hormônio do Crescimento/fisiologia , Sequência de Aminoácidos , Animais , Clonagem Molecular , Hormônio do Crescimento/genética , Hormônio do Crescimento/metabolismo , Humanos , Janus Quinase 2 , Camundongos , Modelos Moleculares , Dados de Sequência Molecular , Conformação Proteica , Proteínas Tirosina Quinases/química , Proteínas Tirosina Quinases/metabolismo , Proteínas Proto-Oncogênicas/química , Proteínas Proto-Oncogênicas/metabolismo , Fator de Transcrição STAT5/fisiologia , Fator de Transcrição STAT6/fisiologia
17.
Handb Clin Neurol ; 139: 85-94, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27719880

RESUMO

Dissociation has been cited as a possible psychologic mechanism underpinning functional neurologic disorders (FND) since the 19th century. Since that time, changes in psychiatric classification have created confusion about what the term dissociation actually means. The available evidence suggests that it now refers to at least two qualitatively distinct types of phenomena: detachment (an altered state of consciousness characterized by a sense of separation from the self or world) and compartmentalization (a reversible loss of voluntary control over apparently intact processes and functions), as well as their underlying mechanisms. This chapter considers some of the problems with conflating these phenomena under a single heading as well as the relationship between detachment, compartmentalization, and FND. It is argued that FNDs are fundamentally compartmentalization disorders, but that detachment is often part of the clinical picture and may contribute to the development and maintenance of functional symptoms in many cases. By this view, understanding compartmentalization requires an appreciation of the mechanisms involved in controlling and accessing mental processes and contents. Two possible mechanisms in this regard are described and the evidence for these is considered, followed by a discussion of clinical and empiric implications.


Assuntos
Transtornos Dissociativos/psicologia , Doenças do Sistema Nervoso/psicologia , Humanos
19.
Sci Total Environ ; 545-546: 381-8, 2016 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26748002

RESUMO

Oxidative potential (OP) is related to the organic phase, specifically to its oxygenated organic fraction (OOA). Furthermore, the oxygen content of fuel molecules has significant influence on particulate OP. Thus, this study aimed to explore the actual dependency of the OOA and ROS to the oxygen content of the fuel. In order to reach the goal, different biodiesels blends, with various ranges of oxygen content; have been employed. The compact time of flight aerosol mass spectrometer (c-ToF AMS) enabled better identification of OOA. ROS monitored by using two assays: DTT and BPEA-nit. Despite emitting lower mass, both assays agreed that oxygen content of a biodiesel is directly correlated with its OOA, and highly related to its OP. Hence, the more oxygen included in the considered biodiesels, the higher the OP of PM emissions. This highlights the importance of taking oxygen content into account while assessing emissions from new fuel types, which is relevant from a health effects standpoint.


Assuntos
Poluentes Atmosféricos/análise , Biocombustíveis/análise , Oxigênio/análise , Material Particulado/análise , Monitoramento Ambiental , Oxirredução , Emissões de Veículos/análise
20.
J Am Coll Cardiol ; 36(3 Suppl A): 1117-22, 2000 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10985714

RESUMO

OBJECTIVES: We sought to compare the characteristics and outcomes of patients with acute myocardial infarction (MI) and cardiogenic shock (CS) caused by rupture of the ventricular free wall or tamponade versus shock from other causes. BACKGROUND: Free-wall rupture is a recognized cause of mortality in patients with acute MI. Some of these patients present subacutely, which provides an opportunity for intervention. Recognition of factors that distinguish them from the overall shock cohort would be beneficial. METHODS: The international SHOCK Trial Registry enrolled patients concurrently with the randomized SHOCK Trial. Thirty-six centers consecutively enrolled all patients with suspected CS after MI, regardless of trial eligibility. RESULTS: Of the 1,048 patients studied, 28 (2.7%) had free-wall rupture or tamponade. These patients had less pulmonary edema, less diabetes, less prior MI, and less prior congestive heart failure (all p < 0.05). They more often had new Q waves in two or more leads (51.9% vs. 31.5%, p < 0.04), but MI location and time to shock onset after MI did not differ. Of patients with rupture or tamponade, 75% had pericardial effusions. No hemodynamic characteristics identified patients with rupture/tamponade. Most patients with rupture/tamponade had surgery and/or pericardiocentesis (27/28); their in-hospital survival rate was identical to that of the group overall (39.3%). Women and older patients with rupture/tamponade tended to survive intervention less often. CONCLUSIONS: Free-wall rupture and tamponade may present as CS after MI, and survival after intervention is similar to that of the overall shock cohort. All patients with CS after MI should have echocardiography in order to detect subacute rupture or tamponade and initiate appropriate interventions.


Assuntos
Tamponamento Cardíaco/complicações , Ruptura Cardíaca Pós-Infarto/complicações , Sistema de Registros , Choque Cardiogênico/etiologia , Idoso , Procedimentos Cirúrgicos Cardíacos , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/mortalidade , Tamponamento Cardíaco/cirurgia , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/mortalidade , Ruptura Cardíaca Pós-Infarto/cirurgia , Mortalidade Hospitalar , Humanos , Masculino , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Estudos Prospectivos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/mortalidade , Choque Cardiogênico/cirurgia
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