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2.
Int Heart J ; 2020 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-32173714

RESUMO

The effect of post-cardiac arrest care in children with out-of-hospital cardiac arrest (OHCA) has not been adequately established, and the long-term outcome after pediatric OHCA has not been sufficiently investigated. We describe here detailed in-hospital characteristics, actual management, and survival, including neurological status, 90 days after OHCA occurrence in children with OHCA transported to critical care medical centers (CCMCs).We analyzed the database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study, which is a multicenter, prospective observational data registry designed to accumulate both pre- and in-hospital data on OHCA treatments. We enrolled all consecutive pediatric patients aged <18 years who had an OHCA and for whom resuscitation was attempted and who were transported to CCMCs between 2012 and 2016.A total of 263 pediatric patients with OHCA were enrolled. The average age of the patients was 6.3 years, 38.0% were aged < 1 year, and 60.8% were male. After hospital arrival, 4.9% of these pediatric patients received defibrillation; 1.9%, extracorporeal life support; 6.5%, target temperature management; and 88.2% adrenaline administration. The proportions of patients with 90-day survival and a pediatric cerebral performance category (PCPC) score of 1 or 2 were 6.1% and 1.9%, respectively. The proportion of patients with a PCPC score of 1 or 2 at 90 days after OHCA occurrence did not significantly improve during the study period.The proportion of pediatric patients with a 90-day PCPC score of 1 or 2 transported to CCMCs was extremely low, and no significant improvements were observed during the study period.

3.
Geriatr Gerontol Int ; 19(11): 1088-1095, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31622019

RESUMO

AIM: The purpose of this study was to evaluate the out-of-hospital cardiac arrest (OHCA) characteristics of patients stratified by age who had resuscitation attempted and were transported to tertiary emergency medical institutions in Osaka Prefecture, Japan; especially those of advanced age. METHODS: A prospective, population-based, observational review was carried out of consecutive OHCA patients with emergency responder resuscitation attempts from July 2012 to December 2016 in Osaka, Japan. Patients were classified into four groups: (i) 18-64 years; (ii) 65-74 years; (iii) 75-84 years; and (iv) ≥85 years. Patient, event and treatment characteristics were examined for patients with presumed cardiac etiology of OHCA. The primary outcome was the 1-month survival with a neurologically favorable outcome. RESULTS: A total of 4636 patients with OHCA of presumed cardiac origin were transported to tertiary emergency medical institutions. The number of patients in the four groups was as follows: (i) 1290 (27.8%); (ii) 1102 (23.8%); (iii) 1420 (30.6%); and (iv) 824 (17.8%). The 1-month survival with a neurologically favorable outcome was: (i) 207 (16.0%); (ii) 96 (8.7%); (iii) 60 (4.2%); and (iv) seven (0.85%). In a multivariate analysis for 1-month survival with a neurologically favorable outcome, increased age was a significant prognostic factor (≥85 years; adjusted odds ratio 0.08, 95% confidence interval 0.03-0.23) for poor outcomes. CONCLUSIONS: In this population, advanced age (≥85 years) was strongly associated with poor outcomes. Further discussion of policies directed at resuscitation of very elderly OHCA patients is required, considering limited medical resources and the rapidly aging population in Japan. Geriatr Gerontol Int 2019; 19: 1088-1095.

4.
Resuscitation ; 143: 165-172, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302105

RESUMO

OBJECTIVES: This study aimed to evaluate whether intra-aortic balloon pump (IABP) use in nontraumatic out-of-hospital cardiac arrest (OHCA) patients who achieved return of spontaneous circulation (ROSC) is associated with favorable neurological outcome after OHCA. BACKGROUND: The association between the IABP use in OHCA patients and favorable neurological outcome has not been extensively evaluated. METHODS: The Comprehensive Registry of Intensive Cares for OHCA Survival (CRITICAL) study, a multicenter, prospective observational registry in Osaka, Japan, included consecutive nontraumatic OHCA patients aged ≥18 years who achieved ROSC from July 2012 to December 2016. The primary outcome was 1-month survival with favorable neurological outcome. Logistic regression analysis was used to evaluate the association between the IABP use or non-IABP use and favorable neurological outcome using one-to-one propensity score (PS) matching analysis. RESULTS: Among the 2894 eligible patients, 10.4% used IABP, and 89.6% did not use IABP. In all patients, the proportion of 1-month survival with favorable neurological outcome was higher in the IABP use group than in the non-IABP use group (30.7% [92/300] vs. 13.2% [342/2594]). However, in PS-matched patients, the proportions of 1-month survival with favorable neurological outcome were almost consistent, and there were no significant differences between the IABP use group and the non-IABP use group (37.3% [59/158] vs. 41.1% [65/158]; adjusted odds ratio, 0.97; 95% confidence interval, 0.48-1.96). CONCLUSIONS: In this population, the current PS matching analysis did not reveal any association between the IABP use and 1-month survival with favorable neurological outcome among adult patients with ROSC after OHCA.

5.
Eur Heart J Acute Cardiovasc Care ; : 2048872619848883, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31081678

RESUMO

BACKGROUND: Little is known about the association between serum potassium level on hospital arrival and neurological outcome after out-of-hospital cardiac arrest (OHCA). We investigated whether the serum potassium level on hospital arrival had prognostic indications for patients with OHCA. METHODS: This prospective, multicenter observational study conducted in Osaka, Japan (CRITICAL study) enrolled consecutive patients with OHCA transported to 14 participating institutions from 2012 to 2016. We included adult patients aged ⩾18 years with OHCA of cardiac origin who achieved return of spontaneous circulation and whose serum potassium level on hospital arrival was available. Based on the serum potassium level, patients were divided into four quartiles: Q1 (K ⩽3.8 mEq/L), Q2 (3.8< K⩽4.5 mEq/L), Q3 (4.5< K⩽5.6 mEq/L) and Q4 (K >5.6 mEq/L). The primary outcome was one-month survival with favorable neurological outcome, defined as cerebral performance category scale 1 or 2. RESULTS: A total of 9822 patients were registered, and 1516 of these were eligible for analyses. The highest proportion of favorable neurological outcome was 44.8% (189/422) in Q1 group, followed by 30.3% (103/340), 11.7% (44/375) and 4.5% (17/379) in the Q2, Q3 and Q4 groups, respectively ( p<0.001). In the multivariable analysis, the proportion of favorable neurological outcome decreased as the serum potassium level increased ( p<0.001). CONCLUSIONS: High serum potassium level was significantly and dose-dependently associated with poor neurological outcome. Serum potassium on hospital arrival would be one of the effective prognostic indications for OHCA achieving return of spontaneous circulation.

6.
Resuscitation ; 133: 82-87, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30316953

RESUMO

BACKGROUND: It has been insufficiently investigated whether neurological function after out-of-hospital cardiac arrest (OHCA) would differ by 1 °C change in ordered target temperature of 33-36 °C among patients undergoing targeted temperature management (TTM) in the real-world setting. METHODS: This nationwide hospital-based observational study (The Japanese Association for Acute Medicine-OHCA Registry) conducted between June 2014 and December 2015 in Japan included OHCA patients aged ≥18 years who were treated with TTM. The primary outcome was one-month survival with neurologically favorable outcomes defined by cerebral performance category 1 or 2. To investigate the effect of TTM by 1 °C change in ordered target temperature of 33-36 °C on each outcome, random effects logistic regression analyses were performed. RESULTS: The final analysis included 738 patients. The proportion of patients with neurologically favorable outcome was 30.4% (7/23), 31.7% (175/552), 28.9% (11/38), and 30.4% (38/125) in the 33 °C, 34 °C, 35 °C, and 36 °C groups, respectively. In the multivariable logistic regression analysis, no group had a higher proportion of neurologically favorable outcome compared with the 34 °C group (vs. 33 °C group, adjusted odds ratio [AOR] 0.90; 95% confidence interval [CI] 0.25-3.12, vs. 35 °C group, AOR 1.17; 95% CI 0.44-3.13, vs. 36 °C group, AOR 1.26; 95% CI 0.78-2.02). CONCLUSIONS: In this population, we evaluated the difference in outcomes after adult OHCA patients received TTM by 1 °C change in ordered target temperature of 33-36 °C and demonstrated that there was no statistically significant difference in neurologically favorable outcomes after OHCA irrespective of target temperature.


Assuntos
Hipotermia Induzida/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Temperatura Ambiente , Adulto , Idoso , Reanimação Cardiopulmonar/métodos , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/epidemiologia , Sistema de Registros , Estudos Retrospectivos
7.
Crit Care ; 22(1): 239, 2018 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30261905

RESUMO

BACKGROUND: Commensal microbiota deteriorate in critically ill patients. The preventive effects of probiotic/synbiotic therapy on microbiota and septic complications have not been thoroughly clarified in patients with sepsis. The objective of this study was to evaluate whether synbiotics have effects on gut microbiota and reduce complications in mechanically ventilated patients with sepsis. METHODS: Sepsis patients who were mechanically ventilated in the intensive care unit (ICU) were included in this randomized controlled study. Patients receiving daily synbiotics (Bifidobacterium breve strain Yakult, Lactobacillus casei strain Shirota, and galactooligosaccharides) initiated within 3 days after admission (the Synbiotics group) were compared with patients who did not receive synbiotics (the No-Synbiotics group). The primary outcome was infectious complications including enteritis, ventilator-associated pneumonia (VAP), and bacteremia within 4 weeks from admission. The secondary outcomes included mortality within 4 weeks, fecal bacterial counts, and organic acid concentration. Enteritis was defined as the acute onset of continuous liquid stools for more than 12 h. RESULTS: Seventy-two patients completed this trial; 35 patients received synbiotics and 37 patients did not receive synbiotics. The incidence of enteritis was significantly lower in the Synbiotics than the No-Synbiotics group (6.3% vs. 27.0%; p < 0.05). The incidence of VAP was also significantly lower in the Synbiotics than the No-Synbiotics group (14.3% vs. 48.6%; p < 0.05). The incidence of bacteremia and mortality did not differ significantly between the two groups. In the analysis of fecal bacteria, the number of Bifidobacterium and Lactobacillus in the Synbiotics group was significantly higher than that in the No-Synbiotics group. In the analysis of fecal organic acids, total organic acid concentration, especially the amounts of acetate, were significantly greater in the Synbiotics group than in the No-Synbiotics group at the first week (p < 0.05). CONCLUSIONS: Prophylactic synbiotics could modulate the gut microbiota and environment and may have preventive effects on the incidence of enteritis and VAP in patients with sepsis. TRIAL REGISTRATION: UMIN, R000007633 . Registered on 29 September 2011.


Assuntos
Enterite/prevenção & controle , Microbioma Gastrointestinal/efeitos dos fármacos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Simbióticos/administração & dosagem , APACHE , Idoso , Idoso de 80 Anos ou mais , Bifidobacterium bifidum , Estado Terminal/terapia , Enterite/tratamento farmacológico , Feminino , Microbioma Gastrointestinal/fisiologia , Humanos , Incidência , Lactobacillus casei , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Probióticos/farmacologia , Probióticos/uso terapêutico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sepse/complicações , Sepse/tratamento farmacológico
8.
Org Lett ; 20(4): 938-941, 2018 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-29412679

RESUMO

Organophosphorus compounds with a phosphorus atom attached to a phenyl group and two organothio/organoseleno groups were synthesized using the rhodium-catalyzed insertion reaction of the PhP group of pentaphenylcyclopentaphosphine (PhP)5 with acyclic disulfides and diselenides. The method was applied to the synthesis of heterocyclic compounds containing the S-P-S group by the reaction of (PhP)5 and cyclic disulfides such as 1,2-dithietes, 1,2-dithiocane, 1,4,5-dithiopane, and 1,2-dithiolanes.

9.
Ther Hypothermia Temp Manag ; 8(3): 165-172, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29364051

RESUMO

To assess whether serum albumin concentration measured upon hospital arrival was useful as an early prognostic biomarker for neurologically favorable outcome in out-of-hospital cardiac arrest (OHCA) patients treated with target temperature management (TTM). This prospective, multicenter observational study (The CRITICAL Study) carried out between July 1, 2012 and December 31, 2014 in Osaka Prefecture, Japan involving 13 critical care medical centers (CCMCs) and one non-CCMC with an emergency department. This study included patients ≥18 years of age who underwent an OHCA, for whom resuscitation was attempted by Emergency Medical Services personnel and were then transported to participating institutions, and who were then treated with TTM. Based on the serum albumin concentration upon hospital arrival, involved patients were divided into four quartiles (Q1-Q4) defined as Q1 (<3.0 g/dL), Q2 (≥3.0, <3.4 g/dL), Q3 (≥3.4, <3.8 g/dL), and Q4 (≥3.8 g/dL). The primary outcome of this study was 1-month survival with neurologically favorable outcome defined by cerebral performance category 1 or 2. During the study period, a total of 327 were eligible for our analysis. The overall proportion of neurologically favorable outcome was 33.0% (108/327). The Q4 group had the highest proportion of neurologically favorable outcome (52.5% [48/91]), followed by Q3 (34.5% [30/87]), Q2 (27.3% [21/77]), and Q1 (12.5% [9/72]). The multivariable logistic regression analysis demonstrated that the proportion of neurologically favorable outcome was significantly higher in the Q4 group than that in the Q1 group (adjusted odds ratio 10.39; 95% confidence interval 3.36-32.17). The adjusted proportion of neurologically favorable outcome increased in a stepwise fashion across increasing quartiles (p < 0.001). In this study, higher serum albumin concentration upon hospital arrival had a positive association with neurologically favorable outcome after OHCA in a dose-dependent manner.


Assuntos
Albuminas/metabolismo , Hipotermia Induzida , Doenças do Sistema Nervoso/sangue , Parada Cardíaca Extra-Hospitalar/complicações , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Parada Cardíaca Extra-Hospitalar/sangue , Parada Cardíaca Extra-Hospitalar/mortalidade , Prognóstico , Estudos Prospectivos
10.
Am J Cardiol ; 121(2): 156-161, 2018 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-29146024

RESUMO

The aim of this study was to assess whether serum albumin concentration upon hospital arrival had prognostic indications on out-of-hospital cardiac arrest (OHCA). This prospective, multicenter observational study conducted in Osaka, Japan (the CRITICAL [Comprehensive Registry of Intensive Cares for OHCA Survival] study), enrolled all patients with consecutive OHCA transported to 14 participating institutions. We included adult patients aged ≥18 years with nontraumatic OHCA who achieved return of spontaneous circulation and whose serum albumin concentration was available from July 2012 to December 2014. Based on the serum albumin concentration upon hospital arrival, patients were divided into quartiles (Q1 to Q4), namely, Q1 (<2.7 g/dl), Q2 (2.7 to 3.1 g/dl), Q3 (3.1 to 3.6 g/dl), and Q4 (≥3.6 g/dl). The primary outcome was 1-month survival with favorable neurological outcome (cerebral performance category scale 1 or 2). During the study period, a total of 1,269 patients with OHCA were eligible for our analyses. The highest proportion of favorable neurological outcome was 33.5% (109 of 325) in the Q4 group, followed by 13.2% (48 of 365), 5.0% (13 of 261), and 3.5% (11 of 318) in the Q3, Q2, and Q1 groups, respectively. In the multivariable logistic regression analysis, the proportion of favorable neurological outcome in the Q4 group was significantly higher, compared with that in the Q1 group (adjusted odds ratio 8.61; 95% confidence interval 4.28 to 17.33). The adjusted proportion of favorable neurological outcome increased in a stepwise manner across increasing quartiles (p for trend <0.001). Higher serum albumin concentration was significantly and independently associated with favorable neurological outcome in a dose-dependent manner.


Assuntos
Hipoalbuminemia/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Sistema de Registros , Albumina Sérica/metabolismo , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar , Feminino , Humanos , Hipoalbuminemia/metabolismo , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Parada Cardíaca Extra-Hospitalar/metabolismo , Parada Cardíaca Extra-Hospitalar/mortalidade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos
11.
J Affect Disord ; 225: 460-465, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-28863298

RESUMO

BACKGROUND: Self-harm is an important risk factor for subsequent suicide and repetition of self-harm, and a common cause of emergency department presentations. However, there still remains limited evidence on intervention in emergency department settings for individuals who self-harm. METHODS: This multicentre, randomised controlled trial was conducted at 17 general hospitals in Japan. In total, 914 adult patients admitted to emergency departments for a suicide attempt and had a DSM-IV-TR axis I disorder were randomly assigned to two groups, to receive either assertive case management (intervention) or enhanced usual care (control). Assertive case management was introduced by the case manager during emergency department admissions for suicide attempts, and continued after discharge. Interventions were provided until the end of the study period (for at least 18 months and up to 5 years). RESULTS: The number of overall self-harm episodes per person-year was significantly lower in the intervention group (adjusted incidence risk ratio (IRR) 0.88, 95%CI 0.80-0.96, p=0.0031). Subgroup analysis showed a greater reduction of overall self-harm episodes among patients with no previous suicide attempt at baseline (adjusted IRR 0.73, 95% CI 0.53-0.98, p=0.037). LIMITATIONS: Patients younger than 20 years and patients who self-harmed but were not admitted to an emergency department were excluded. CONCLUSIONS: The present study showed that assertive case management following emergency admission for a suicide attempt reduced the incident rate of repeat overall self-harm.


Assuntos
Administração de Caso/organização & administração , Intervenção na Crise/métodos , Comportamento Autodestrutivo/terapia , Tentativa de Suicídio/prevenção & controle , Suicídio/prevenção & controle , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Suicídio/psicologia
12.
Intern Med ; 57(4): 507-510, 2018 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-29151499

RESUMO

Intestinal dysmotility is a major problem in critically ill patients. This report describes the successful treatment of intestinal dysmotility with rhubarb as a laxative in six critically ill patients on mechanical ventilation. Bowel movement and defecation occurred in all patients an average of 1.8 days after the administration of powdered rhubarb. In 4 patients who also had gastric reflux, the reflux volume via nasal tube was decreased an average of 3.5 days after the initiation of rhubarb treatment, and enteral nutrition was able to be started. Rhubarb may be useful for the treatment of incompetent gastric and intestinal motility in critically ill patients.


Assuntos
Constipação Intestinal/tratamento farmacológico , Estado Terminal/terapia , Defecação/efeitos dos fármacos , Motilidade Gastrointestinal/efeitos dos fármacos , Laxantes/farmacologia , Extratos Vegetais/uso terapêutico , Rheum/química , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
J Biol Chem ; 292(51): 21128-21136, 2017 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-29046357

RESUMO

Before entering host cells, herpes simplex virus-1 uses its envelope glycoprotein B to bind paired immunoglobulin-like type 2 receptor α (PILRα) on immune cells. PILRα belongs to the Siglec (sialic acid (SA)-binding immunoglobulin-like lectin)-like family, members of which bind SA. PILRα is the only Siglec member to recognize not only the sialylated O-linked sugar T antigen (sTn) but also its attached peptide region. We previously determined the crystal structure of PILRα complexed with the sTn-linked glycopeptide of glycoprotein B, revealing the simultaneous recognition of sTn and peptide by the receptor. However, the contribution of each glycopeptide component to PILRα binding was largely unclear. Here, we chemically synthesized glycopeptide derivatives and determined the thermodynamic parameters of their interaction with PILRα. We show that glycopeptides with different sugar units linking SA and peptides (i.e. "GlcNAc-type" and "deoxy-GlcNAc-type" glycopeptides) have lower affinity and more enthalpy-driven binding than the wild type (i.e. GalNAc-type glycopeptide). The crystal structures of PILRα complexed with these glycopeptides highlighted the importance of stereochemical positioning of the O4 atom of the sugar moiety. These results provide insights both for understanding the unique O-glycosylated peptide recognition by the PILRα and for the rational design of herpes simplex virus-1 entry inhibitors.


Assuntos
Glicoproteínas de Membrana/metabolismo , Modelos Moleculares , Fragmentos de Peptídeos/metabolismo , Receptores Imunológicos/metabolismo , Proteínas do Envelope Viral/metabolismo , Acetilgalactosamina/análogos & derivados , Acetilgalactosamina/química , Acetilgalactosamina/metabolismo , Sítios de Ligação , Calorimetria , Cristalografia por Raios X , Escherichia coli/metabolismo , Humanos , Cinética , Ligantes , Glicoproteínas de Membrana/química , Glicoproteínas de Membrana/genética , Fragmentos de Peptídeos/síntese química , Fragmentos de Peptídeos/química , Fragmentos de Peptídeos/genética , Polissacarídeos/síntese química , Polissacarídeos/química , Polissacarídeos/metabolismo , Conformação Proteica , Domínios e Motivos de Interação entre Proteínas , Receptores Imunológicos/química , Receptores Imunológicos/genética , Proteínas Recombinantes , Estereoisomerismo , Termodinâmica , Proteínas do Envelope Viral/síntese química , Proteínas do Envelope Viral/química
14.
Sci Rep ; 7(1): 12255, 2017 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-28947744

RESUMO

Crush injury patients often have systemic inflammatory response syndrome that leads to multiple organ failure. Receptor for advanced glycation endproducts (RAGE) functions as a pattern recognition receptor that regulates inflammation. We evaluated the effects of anti-RAGE antibody in a crush injury model. Pressure was applied to both hindlimbs of rats for 6 h by 3.0-kg blocks and then released. Animals were randomly divided into the sham (RAGE-Sh) group, crush (RAGE-Ctrl) group or anti-RAGE antibody-treated crush (RAGE-Tx) group. Samples were collected at 3, 6 and 24 h after releasing pressure. In the RAGE-Ctrl group, fluorescent immunostaining in the lung showed upregulated RAGE expression at 3 h. The serum soluble RAGE (sRAGE) level, which reflects the amount of RAGE expression in systemic tissue, increased at 6 h. Serum interleukin 6 (IL-6; systemic inflammation marker) increased immediately at 3 h. Histological analysis revealed lung injury at 6 and 24 h. Administration of anti-RAGE antibody before releasing compression inhibited upregulated RAGE expression in the lung alveoli, suppressed RAGE-associated mediators sRAGE and IL6, attenuated the lung damage and improved the 7-day survival rate. Collectively, our results indicated that the use of anti-RAGE antibody before releasing compression is associated with a favourable prognosis following crush injury.


Assuntos
Anticorpos/administração & dosagem , Lesões por Esmagamento/complicações , Fatores Imunológicos/administração & dosagem , Receptor para Produtos Finais de Glicação Avançada/antagonistas & inibidores , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Animais , Modelos Animais de Doenças , Pulmão/patologia , Ratos , Soro/química , Resultado do Tratamento
15.
Chem Commun (Camb) ; 52(93): 13580-13583, 2016 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-27805182

RESUMO

A rhodium-catalyzed exchange reaction of diphosphine disulfides, a diphosphine oxide, and a diphosphine is developed. Various symmetric diphosphine disulfides containing alkyl and phenyl groups are exchanged, giving equilibrium mixtures, from which unsymmetric diphosphine disulfides are readily separated by silica gel chromatography. The resulting unsymmetric diphosphine disulfide is regioselectively added to an aldehyde.

16.
Angew Chem Int Ed Engl ; 55(40): 12311-5, 2016 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-27610949

RESUMO

A phosphole-fused porphyrin dimer, as a representative of a new class of porphyrins with a phosphorus atom, was synthesized for the first time. The porphyrin dimer exhibits remarkably broadened absorption, indicating effective π-conjugation over the two porphyrins through the phosphole moiety. The porphyrin dimer possesses excellent electron-accepting character, which is comparable to that of a representative electron-accepting material, [60]PCBM. These results provide access to a new class of phosphorus-containing porphyrins with unique optoelectronic properties.

17.
Shock ; 46(6): 681-687, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27355403

RESUMO

Crush syndrome is a devastating condition leading to multiple organ failure. The mechanisms by which local traumatic injuries affect distant organs remain unknown. ETS-GS is a novel water-soluble, stable anti-oxidative agent composed of vitamin E derivative. Given that one of the main pathophysiological effects in crush syndrome is massive ischemia-reperfusion, reactive oxygen species (ROS) generated from the injured extremities would be systemically involved in distant organ damage. We investigated whether ETS-GS could suppress inflammatory response and improve mortality in a rat model of crush injury. Crush injury was induced by compression of bilateral hindlimbs for 6 h followed by release of compression. Seven-day survival was significantly improved by ETS-GS treatment. To estimate anti-oxidative and anti-inflammatory effects of ETS-GS, serum was collected 6 and 20 h after the injury. ETS-GS treatment significantly dampened the up-regulation of malondialdehyde and reduction of superoxide dismutase in the serum, which were induced by crush injury. Serum levels of interleukin 6 and high mobility group box 1 were significantly decreased in the ETS-GS group compared with those in the control group. Lung damage shown by hematoxylin-eosin staining at 20 h after the injury was ameliorated by the treatment. Ex vivo imaging confirmed that ETS-GS treatment reduced ROS generation in both the lung and the muscle following crush injury. The administration of ETS-GS could suppress ROS generation, systemic inflammation, and the subsequent organ damage, thus improving survival in a rat model of crush injury. These findings suggest that ETS-GS can become a novel therapeutic agent against crush injury.


Assuntos
Síndrome de Esmagamento/sangue , Síndrome de Esmagamento/tratamento farmacológico , Oligopeptídeos/uso terapêutico , Vitamina E/análogos & derivados , Animais , Modelos Animais de Doenças , Proteína HMGB1/sangue , Interleucina-6/sangue , Pulmão/efeitos dos fármacos , Pulmão/metabolismo , Pulmão/patologia , Masculino , Malondialdeído/sangue , Ratos , Ratos Wistar , Espécies Reativas de Oxigênio/metabolismo , Superóxido Dismutase/metabolismo
18.
Australas Phys Eng Sci Med ; 39(2): 571-81, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27052439

RESUMO

Myocardial perfusion single photon emission computed tomography (SPECT) is typically subject to a variation in image quality due to the use of different acquisition protocols, image reconstruction parameters and image display settings by each institution. One of the principal image reconstruction parameters is the Butterworth filter cut-off frequency, a parameter strongly affecting the quality of myocardial images. The objective of this study was to formulate a flowchart for the determination of the optimal parameters of the Butterworth filter for filtered back projection (FBP), ordered subset expectation maximization (OSEM) and collimator-detector response compensation OSEM (CDR-OSEM) methods using the evaluation system of the myocardial image based on technical grounds phantom. SPECT studies were acquired for seven simulated defects where the average counts of the normal myocardial components of 45° left anterior oblique projections were approximately 10-120 counts/pixel. These SPECT images were then reconstructed by FBP, OSEM and CDR-OSEM methods. Visual and quantitative assessment of short axis images were performed for the defect and normal parts. Finally, we formulated a flowchart indicating the optimal image processing procedure for SPECT images. Correlation between normal myocardial counts and the optimal cut-off frequency could be represented as a regression expression, which had high or medium coefficient of determination. We formulated the flowchart in order to optimize the image reconstruction parameters based on a comprehensive assessment, which enabled us to perform objectively processing. Furthermore, the usefulness of image reconstruction using the flowchart was demonstrated by a clinical case.


Assuntos
Imagem de Perfusão do Miocárdio , Tecnécio/química , Tomografia Computadorizada de Emissão de Fóton Único , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imagens de Fantasmas
19.
J Intensive Care ; 4: 10, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26819708

RESUMO

BACKGROUND: We established a multi-center, prospective cohort that could provide appropriate therapeutic strategies such as criteria for the introduction and the effectiveness of in-hospital advanced treatments, including percutaneous coronary intervention (PCI), target temperature management, and extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) patients. METHODS: In Osaka Prefecture, Japan, we registered all consecutive patients who were suffering from an OHCA for whom resuscitation was attempted and who were then transported to institutions participating in this registry since July 1, 2012. A total of 11 critical care medical centers and one hospital with an emergency care department participated in this registry. The primary outcome was neurological status after OHCA, defined as cerebral performance category (CPC) scale. RESULTS: A total of 688 OHCA patients were documented between July 2012 and December 2012. Of them, 657 were eligible for our analysis. Patients' average age was 66.2 years old, and male patients accounted for 66.2 %. The proportion of OHCAs having a cardiac origin was 50.4 %. The proportion as first documented rhythm of ventricular fibrillation/pulseless ventricular tachycardia was 11.6 %, pulseless electrical activity 23.4 %, and asystole 54.5 %. After hospital arrival, 10.5 % received defibrillation, 90.8 % tracheal intubation, 3.0 % ECPR, 3.5 % PCI, and 83.1 % adrenaline administration. The proportions of 90-day survival and CPC 1/2 at 90 days after OHCAs were 5.9 and 3.0 %, respectively. CONCLUSIONS: The Comprehensive Registry of In-hospital Intensive Care for OHCA Survival (CRITICAL) study will enroll over 2000 OHCA patients every year. It is still ongoing without a set termination date in order to provide valuable information regarding appropriate therapeutic strategies for OHCA patients (UMIN000007528).

20.
Angew Chem Int Ed Engl ; 55(2): 629-33, 2016 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-26610285

RESUMO

The unprecedented dependence of final charge separation efficiency as a function of donor-acceptor interaction in covalently-linked molecules with a rectilinear rigid oligo-p-xylene bridge has been observed. Optimization of the donor-acceptor electronic coupling remarkably inhibits the undesirable rapid decay of the singlet charge-separated state to the ground state, yielding the final long-lived, triplet charge-separated state with circa 100% efficiency. This finding is extremely useful for the rational design of artificial photosynthesis and organic photovoltaic cells toward efficient solar energy conversion.

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