Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 8 de 8
Filtrar
Mais filtros










Base de dados
Tipo de estudo
Intervalo de ano de publicação
1.
Int J Cardiol ; 269: 114-121, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30224031

RESUMO

BACKGROUND: Various scores have been derived for the assessment of syncope patients in the emergency department (ED) but stay inconsistently validated. We aim to compare their performance to the one of a common, easy-to-use CHADS2 score. METHODS: We prospectively enrolled patients ≥ 40 years old presenting with syncope to the ED in a multicenter study. Early clinical judgment (ECJ) of the treating ED-physician regarding the probability of cardiac syncope was quantified. Two independent physicians adjudicated the final diagnosis after 1-year follow-up. Major cardiovascular events (MACE) and death were recorded during 2 years of follow-up. Nine scores were compared by their area under the receiver-operator characteristics curve (AUC) for death, MACE or the diagnosis of cardiac syncope. RESULTS: 1490 patients were available for score validation. The CHADS2-score presented a higher or equally high accuracy for death in the long- and short-term follow-up than other syncope-specific risk scores. This score also performed well for the prediction of MACE in the long- and short-term evaluation and stratified patients with accuracy comparative to OESIL, one of the best performing syncope-specific risk score. All scores performed poorly for diagnosing cardiac syncope when compared to the ECJ. CONCLUSIONS: The CHADS2-score performed comparably to more complicated syncope-specific risk scores in the prediction of death and MACE in ED syncope patients. While better tools incorporating biochemical and electrocardiographic markers are needed, this study suggests that the CHADS2-score is currently a good option to stratify risk in syncope patients in the ED. TRIAL REGISTRATION: NCT01548352.

2.
Eur Heart J ; 35(34): 2303-11, 2014 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-24842285

RESUMO

AIM: It is unknown whether cardiac troponin (cTn) I or cTnT is the preferred biomarker in the early diagnosis of acute myocardial infarction without ST segment elevation (NSTEMI). METHODS AND RESULTS: In a prospective multicentre study, we measured cTnI and cTnT using clinically available high-sensitivity assays (hs-cTnI Abbott and hs-cTnT Roche) and compared their diagnostic and prognostic accuracies in consecutive patients presenting to the emergency department with acute chest pain. The final diagnosis was adjudicated by two independent cardiologists using all information pertaining to the individual patient. The mean follow-up was 24 months. Among 2226 consecutive patients, 18% had an adjudicated final diagnosis of NSTEMI. Diagnostic accuracy at presentation as quantified by the area under the receiver-operating-characteristics curve (AUC) for NSTEMI was very high and similar for hs-cTnI [AUC: 0.93, 95% confidence interval (CI) 0.92-0.94] and hs-cTnT (0.94, 95% CI: 0.92-0.94) P = 0.62. In early presenters (<3 h since chest pain onset) hs-cTnI showed a higher diagnostic accuracy (AUC: 0.92, 95% CI: 0.89-0.94) when compared with hs-cTnT AUC (0.89, 95% CI: 0.86-0.91) (P = 0.019), while hs-cTnT was superior in late presenters [AUC hs-cTnT 0.96 (95% CI: 0.94-0.96)  vs. hs-cTnI 0.94 (95% CI: 0.93-0.95); P = 0.007]. The prognostic accuracy for all-cause mortality, quantified by AUC, was significantly higher for hs-cTnT (AUC: 0.80; 95% CI: 0.78-0.82) when compared with hs-cTnI (AUC: 0.75; 95% CI: 0.73-0.77; P < 0.001). CONCLUSION: Both hs-cTnI and hs-cTnT provided high diagnostic and prognostic accuracy. The direct comparison revealed small but potentially important differences that might help to further improve the clinical use of hs-cTn.


Assuntos
Infarto do Miocárdio/diagnóstico , Troponina I/metabolismo , Troponina T/metabolismo , Idoso , Área Sob a Curva , Biomarcadores/metabolismo , Diagnóstico Precoce , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade
3.
Can J Cardiol ; 30(2): 195-203, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24461921

RESUMO

BACKGROUND: Endothelial dysfunction plays a major role in cardiovascular diseases, including acute myocardial infarction (AMI). However, its quantification has not been available as a clinical tool. METHODS: In a prospective international multicentre study, we analyzed the diagnostic and prognostic utility of endothelial dysfunction as quantified by C-terminal proendothelin-1 (CT-proET-1) in 658 consecutive patients presenting with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists. Patients were followed long-term for mortality. RESULTS: The adjudicated final diagnosis was AMI in 145 patients (22%). The diagnostic performance of CT-proET-1 for AMI was moderate; its area under the receiver operating characteristic (ROC) curve amounted to 0.66 (95% confidence interval [CI], 0.61-0.72; P < 0.001). There was no significant increase in the AUC when CT-proET-1 was added to either cardiac troponin T (cTnT) or high-sensitivity cTnT (hs-cTnT). Seventy four percent of patients who died during the first 24 months (n = 50) were in the fourth quartile of the CT-proET-1 presentation value (>82 pmol/L). The prognostic accuracy of CT-proET-1 regarding mortality was tantamount to that of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and outperformed cTnT and hs-cTnT both in patients with AMI and in patients without acute coronary syndrome. CT-proET-1 at presentation yielded high prognostic accuracy that was similar to that of the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores. The TIMI risk score could be significantly improved by adding CT-proET-1 (integrated discriminatory improvement [IDI] of 0.074 P = 0.004). CONCLUSIONS: Use of CT-proET-1 improves risk stratification of unselected patients with suspected AMI. CT-proET-1 did not provide additional diagnostic value.


Assuntos
Diagnóstico Precoce , Endotelina-1/sangue , Infarto do Miocárdio/diagnóstico , Fragmentos de Peptídeos/sangue , Medição de Risco/métodos , Idoso , Eletrocardiografia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/epidemiologia , Prognóstico , Estudos Prospectivos , Curva ROC , Fatores de Risco , Taxa de Sobrevida/tendências , Suíça/epidemiologia
4.
Heart ; 99(21): 1567-72, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23604180

RESUMO

OBJECTIVE: To analyse whether levels of high-sensitivity cardiac troponin (hs-cTn) below their respective 99th percentile can be used as a single parameter to rule out acute myocardial infarction (AMI) at presentation. DESIGN: Prospective, multicentre study. MAIN OUTCOME MEASURES: We measured hs-cTn using four different methods (hs-cTnT Roche, hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting to the emergency department with acute chest pain. Two independent cardiologists adjudicated the final diagnosis. Patients were followed for death or AMI during a mean period of 24 months. RESULTS: Among 2072 consecutive patients with hs-cTnT measurements available, 21.4% had an adjudicated diagnosis of AMI (sensitivity 89.6%, 95% CI 86.4% to 92.3%, negative predictive value (NPV): 96.5%, 95% CI 95.4% to 97.4%). Among 1180 consecutive patients with hs-cTnI Siemens measurements available, 20.0% had AMI (sensitivity 94.1%, 95% CI 90.3% to 96.7%, NPV: 98.0%, 95% CI: 96.6% to 98.9%). Among 1151 consecutive patients with hs-cTnI Beckman Coulter measurements available, 19.7% had AMI (sensitivity 92.1%, 95% CI 87.8% to 95.2%, NPV: 97.5%, 95% CI 96.0% to 98.5%). Among 1567 consecutive patients with hs-cTnI Abbott measurements available, 20.0% had AMI (sensitivity 77.2%, 95% CI 72.1% to 81.7%, NPV: 94.3%, 95% CI 92.8% to 95.5%). CONCLUSIONS: Normal hs-cTn levels at presentation should not be used as a single parameter to rule out AMI as 6%-23% of adjudicated AMI cases had normal levels of hs-cTn levels at presentation. Our data highlight the lack of standardisation among hs-cTnI assays resulting in substantial differences in sensitivity and NPV at the 99th percentile.


Assuntos
Infarto do Miocárdio/sangue , Troponina I/sangue , Troponina T/sangue , Idoso , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Europa (Continente) , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Valores de Referência , Fatores de Tempo
5.
Development ; 137(21): 3687-95, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20940227

RESUMO

In Drosophila, the cephalic gap gene empty spiracles plays key roles in embryonic patterning of the peripheral and central nervous system. During postembryonic development, it is involved in the development of central olfactory circuitry in the antennal lobe of the adult. However, its possible role in the postembryonic development of peripheral olfactory sense organs has not been investigated. Here, we show that empty spiracles acts in a subset of precursors that generate the olfactory sense organs of the adult antenna. All empty spiracles-expressing precursor cells co-express the proneural gene amos and the early patterning gene lozenge. Moreover, the expression of empty spiracles in these precursor cells is dependent on both amos and lozenge. Functional analysis reveals two distinct roles of empty spiracles in the development of olfactory sense organs. Genetic interaction studies in a lozenge-sensitized background uncover a requirement of empty spiracles in the formation of trichoid and basiconic olfactory sensilla. MARCM-based clonal mutant analysis reveals an additional role during axonal targeting of olfactory sensory neurons to glomeruli within the antennal lobe. Our findings on empty spiracles action in olfactory sense organ development complement previous studies that demonstrate its requirement in olfactory interneurons and, taken together with studies on the murine homologs of empty spiracles, suggest that conserved molecular genetic programs might be responsible for the formation of both peripheral and central olfactory circuitry in insects and mammals.


Assuntos
Proteínas de Drosophila/genética , Proteínas de Drosophila/fisiologia , Drosophila melanogaster/embriologia , Drosophila melanogaster/genética , Proteínas de Homeodomínio/genética , Proteínas de Homeodomínio/fisiologia , Condutos Olfatórios/embriologia , Animais , Animais Geneticamente Modificados , Padronização Corporal/genética , Padronização Corporal/fisiologia , Proteínas de Drosophila/metabolismo , Drosophila melanogaster/crescimento & desenvolvimento , Embrião não Mamífero , Feminino , Regulação da Expressão Gênica no Desenvolvimento , Proteínas de Homeodomínio/metabolismo , Masculino , Modelos Biológicos , Condutos Olfatórios/crescimento & desenvolvimento , Condutos Olfatórios/metabolismo , Neurônios Receptores Olfatórios/embriologia , Neurônios Receptores Olfatórios/metabolismo , Órgãos dos Sentidos/embriologia , Órgãos dos Sentidos/metabolismo , Olfato/genética , Células-Tronco/metabolismo , Células-Tronco/fisiologia
6.
Dev Biol ; 340(1): 125-33, 2010 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-20045685

RESUMO

The ems/Emx genes encode homeodomain transcription factors that have conserved actions in anterior embryonic patterning in bilaterian animals ranging from insects to mammals. Recently, genes of the ems/Emx family have been identified in cnidarians raising the possibility that some of their developmental functions might be conserved throughout the Eumetazoa. To determine to what extent functions of a cnidarian ems/Emx protein have been retained across phyla, we carried out cross-phylum rescue expression experiments in which the coral Acropora emx-Am gene was misexpressed in Drosophila ems mutants. Our findings demonstrate that coral emx-Am can substitute for fly ems in embryonic head development and rescue the open head defect and the loss of segmental engrailed expression domains in Drosophila ems mutants. In contrast, the coral emx-Am gene can not substitute for fly ems in embryonic brain development. Even when a hexapeptide motif of the type present in the Drosophila ems gene is inserted into the coral emx-Am gene, rescue of the developmental brain defects in fly ems mutants fails. These findings have implications for understanding the evolutionary origins of head versus brain patterning mechanisms.


Assuntos
Drosophila/embriologia , Regulação da Expressão Gênica no Desenvolvimento , Proteínas de Homeodomínio/genética , Fatores de Transcrição/genética , Animais , Antozoários/genética , Antozoários/metabolismo , Padronização Corporal/genética , Drosophila/metabolismo , Proteínas de Drosophila/genética , Proteínas de Drosophila/metabolismo , Embrião não Mamífero/metabolismo , Proteínas de Homeodomínio/metabolismo , Microscopia Confocal , Fatores de Transcrição/metabolismo
7.
J Agric Food Chem ; 58(3): 1850-9, 2010 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-20058867

RESUMO

Due to certain off-flavor problems and lacking bitter masking effects with Yerba Santa (Eriodictyon angustifolium and E. californicum) extracts, which are also described as bitter, herbal, medicinal, phenolic, or astringent, methanolic extracts were fractionated and evaluated for their taste properties using a high temperature liquid chromatography (HTLC)-based approach. The taste-guided fractionation led to the identification of a series of novel bisprenylated benzoic acids (erionic acids A (1), B (2), C (3), D (4), E (5), and F (6) and eriolic acids A (7), B (8), C (9), and D (10), respectively), along with the known flavonoids eriodictyol, homoeriodictyol, hesperetin, and chrysoeriol. The new compounds were isolated in larger amounts for characterization from Narrow Leaf Yerba Santa (E. angustifolium) and California Yerba Santa (E. californicum), respectively, using fast centrifugal partition chromatography (FCPC) and HTLC. The structures were elucidated using one and two-dimensional NMR spectroscopy and high resolution mass spectrometry (HR-MS). For E. californicum, data regarding seasonal and climatic variation of the eriolic acid contents and of the flavonoids were collected. The flavor properties of some of the isolated new compounds were evaluated; they showed strong off-flavor characteristics, such as bitter, astringent, phenolic, or woody, and may contribute to the sensory effects observed for crude Yerba Santa extracts. Erionic acid C (3) was not only able to increase the absolute bitterness but also to extinguish the bitter masking effect of homoeriodictyol in a caffeine solution.


Assuntos
Ácido Benzoico/química , Ácido Benzoico/isolamento & purificação , Eriodictyon/química , Extratos Vegetais/química , Extratos Vegetais/isolamento & purificação , Paladar , Fracionamento Químico , Cromatografia Líquida , Humanos , Estrutura Molecular
8.
J Agric Food Chem ; 54(2): 274-8, 2006 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-16417279

RESUMO

Liquid chromatography/mass spectrometry and liquid chromatography/nuclear magnetic resonance techniques with ultraviolet/diode array detection were used as complementary analytical tools for the reliable identification of polymethoxylated flavones in residues from molecular distillation of cold-pressed peel oils of Citrus sinensis. After development of a liquid chromatographic separation procedure, the presence of several polymethoxy flavones such as sinensetin, nobiletin, tangeretin, quercetogetin, heptamethoxyflavone, and other derivatives was unambiguously confirmed. In addition, proceranone, an acetylated tetranortriterpenoid with limonoid structure, was identified for the first time in citrus.


Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Citrus sinensis/química , Flavonas/análise , Espectroscopia de Ressonância Magnética , Espectrometria de Massas , Óleos Vegetais/química , Flavonas/química , Frutas/química , Cromatografia Gasosa-Espectrometria de Massas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA