982 resultados para critical condition
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The aim of this study was to evaluate the venous blood lactate concentration in sheep and newborn lambs immediately after normal delivery. We used 14 ewes, nine and four Suffolk crossbred lambs and 20 healthy newborns (males and females). The effect of gender, race and number of lambs per birth was investigated, as well as the possible correlation between the concentration of maternal and newborn lactate. There was no difference between males and females or in relation to race (and Suffolk crossbred); however the concentration of lactate was higher in twin or triplet lambs when compared to single lambs. There was a positive correlation between the maternal and newborn concentration and the higher the concentration of lactate, the greater the concentration in the lamb immediately after normal delivery. The results of this study provide a base from which to compare the blood lactate levels in lambs in critical condition.
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Pós-graduação em Geografia - IGCE
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The acute obstruction of pulmonary vessels by venous thrombi is a critical condition named acute pulmonary embolism (APE). During massive APE, severe pulmonary hypertension may lead to death secondary to right heart failure and circulatory shock. APE-induced pulmonary hypertension is aggravated by active pulmonary vasoconstriction. While blocking the effects of some vasoconstrictors exerts beneficial effects, no previous study has examined whether angiotensin II receptor blockers protect against the hemodynamic changes associated with APE. We examined the effects exerted by losartan on APE-induced hemodynamic changes. Hemodynamic evaluations were performed in non-embolized lambs treated with saline (n = 4) and in lambs that were embolized with silicon microspheres and treated with losartan (30 mg/kg followed by 1 mg/kg/h, n = 5) or saline (n = 7) infusions. The plasma and lung angiotensin-converting enzyme (ACE) activity were assessed using a fluorometric method. APE increased mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance index (PVRI) by 21 +/- 2 mmHg and 375 +/- 20 dyn s cm(-5) m(-2), respectively (P < 0.05). Losartan decreased MPAP significantly (by approximately 15%), without significant changes in PVRI and tended to decrease cardiac index (P > 0.05). Lung and plasma ACE activity were similar in both embolized and non-embolized animals. Our findings show evidence of lack of activation of the renin-angiotensin system during APE. The lack of significant effects of losartan on the pulmonary vascular resistance suggests that losartan does not protect against the hemodynamic changes found during APE.
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[ES]En el presente ensayo se reflexiona sobre la dimensión sagrada del lenguaje (y cómo debe enterderse tal dimensión) haciendo un breve recorrido por alguno de sus aspectos más notorios. Mostramos cómo esta sacralidad sin la cual la palabra no es ya palabra, expuesta siempre a todo tipo de negaciones, se encuentra en situación crítica en la modernidad.
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Recent advances in the field of statistical learning have established that learners are able to track regularities of multimodal stimuli, yet it is unknown whether the statistical computations are performed on integrated representations or on separate, unimodal representations. In the present study, we investigated the ability of adults to integrate audio and visual input during statistical learning. We presented learners with a speech stream synchronized with a video of a speaker's face. In the critical condition, the visual (e.g., /gi/) and auditory (e.g., /mi/) signals were occasionally incongruent, which we predicted would produce the McGurk illusion, resulting in the perception of an audiovisual syllable (e.g., /ni/). In this way, we used the McGurk illusion to manipulate the underlying statistical structure of the speech streams, such that perception of these illusory syllables facilitated participants' ability to segment the speech stream. Our results therefore demonstrate that participants can integrate audio and visual input to perceive the McGurk illusion during statistical learning. We interpret our findings as support for modality-interactive accounts of statistical learning.
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Os acessos venosos são indispensáveis para assistência do paciente em situação crítica. O cateter venoso central (CVC) é um acesso que viabiliza a terapêutica dessa clientela, mas o seu uso pode levar à infecções. Estas infecções ocasionam maior permanência hospitalar, elevam os custos totais das instituições e aumentam a morbidade e a mortalidade do paciente. O uso de curativos como cobertura do sítio de saída do CVC é eficaz na prevenção das infecções relacionadas a estes cateteres, em particular, o uso de curativos impregnados com antissépticos como o curativo gel de clorexidina. Este estudo teve como objetivo comparar a efetividade do curativo gel de clorexidina com a do filme transparente de poliuretano na prevenção da colonização do cateter venoso central em pacientes adultos críticos. Trata-se de estudo experimental, do tipo ensaio clínico randomizado, com tratamentos em paralelo, prospectivo e monocêntrico, realizado de acordo com as recomendações do Consolidated Standards of Reporting Trials (CONSORT). O estudo foi realizado na Unidade de Terapia Intensiva e na Unidade Coronariana de um hospital de ensino do interior do Estado de São Paulo. Participaram do estudo 102 indivíduos hospitalizados nestes locais, divididos aleatoriamente em dois grupos: grupo intervenção, no qual o tipo de cobertura utilizada foi o curativo de gel de clorexidina e grupo controle, que utilizou como cobertura o filme transparente de poliuretano. O desfecho primário mensurado foi a colonização do cateter e os desfechos secundários foram a infecção clínica do sítio de saída, a infecção microbiológica do sítio de saída e a infecção da corrente sanguínea relacionada ao cateter. Para a coleta de dados foi elaborado um instrumento, e este validado quanto ao seu conteúdo e forma por 13 enfermeiros pertencentes aos locais do estudo. Estes profissionais foram treinados para a realização dos curativos e coleta das pontas dos cateteres centrais, swabs dos sítios de saída e hemoculturas. Análises descritivas foram usadas para todas as variáveis do estudo. O teste Exato de Fisher foi utilizado para comparar as proporções de cada desfecho nos grupos de intervenção e controle, e a regressão logística para explorar se a colonização no CVC poderia ser associada com o tempo de uso do cateter e com o Acute Physiology and Chronic Health Evaluation II (APACHE II) dos pacientes do estudo. De acordo com os resultados não houve diferença estatisticamente significante entre a colonização nos dois grupos (p valor = 1.00), para a infecção microbiológica do sítio de saída (p valor = 0.08), para a infecção clínica do sítio de saída (p valor = 0.77) e para as infecções da corrente sanguínea relacionadas ao cateter (p valor = 1,00). Conclui-se que o presente estudo pode contribuir para que as unidades de saúde tenham subsídios para realizar a escolha do tipo de curativo baseado em suas necessidades institucionais e no desenvolvimento de protocolos relacionados à medidas de inserção e manutenção do cateter, bem como medidas educativas permanentes
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In examining the long-awaited opinion given January 22nd by the CJEU in the case concerning the European Securities and Markets Authority (ESMA), this Commentary argues that the ruling is important for the insights it yields into the modern understanding of the Meroni non-delegation doctrine. The authors, Jacques Pelkmans and Marta Simoncini, aim to extract the potential implications of the ESMA case for the place and significance of the Meroni doctrine in building up the single market. They demonstrate that the ESMA case is yet another manifestation of a slow process of “mellowing Meroni’, which is a critical condition for a new single market strategy aiming to end the remaining fragmentation of the single market – not only in financial markets but also in network industries – and to ensure its ‘proper functioning’.
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Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico-cirúrgica
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O artigo apresenta os resultados da análise das questões éticas identificadas por enfermeiros perante usuários em situação crítica, de risco iminente de morte, e cuja sobrevivência depende de métodos avançados de vigilância, monitorização e terapêutica. As principais preocupações éticas dizem respeito à informação ao cliente, ao acompanhamento em fim de vida, à responsabilidade profissional em intervenções interdependentes; as temáticas reportam à decisão da pessoa (consentimento/recusa de proposta terapêutica), dilemas na informação, atuação nos processos de morrer e decisão de não tentar reanimar, respeito pelos direitos humanos em contextos desfavoráveis. Destacamos as dimensões do sentido de responsabilidade, da influência da consciência moral nas decisões, da deliberação de proteger o Outro em risco e da vivência de episódios profissionais de superação; finalmente, identificamos fatores mediadores na gestão das dificuldades éticas.
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The convective instability of pore-fluid flow in inclined and fluid-saturated three-dimensional fault zones has been theoretically investigated in this paper. Due to the consideration of the inclined three-dimensional fault zone with any values of the inclined angle, it is impossible to use the conventional linear stability analysis method for deriving the critical condition (i.e., the critical Rayleigh number) which can be used to investigate the convective instability of the pore-fluid flow in an inclined three-dimensional fault zone system. To overcome this mathematical difficulty, a combination of the variable separation method and the integration elimination method has been used to derive the characteristic equation, which depends on the Rayleigh number and the inclined angle of the inclined three-dimensional fault zone. Using this characteristic equation, the critical Rayleigh number of the system can be numerically found as a function of the inclined angle of the three-dimensional fault zone. For a vertically oriented three-dimensional fault zone system, the critical Rayleigh number of the system can be explicitly derived from the characteristic equation. Comparison of the resulting critical Rayleigh number of the system with that previously derived in a vertically oriented three-dimensional fault zone has demonstrated that the characteristic equation of the Rayleigh number is correct and useful for investigating the convective instability of pore-fluid flow in the inclined three-dimensional fault zone system. The related numerical results from this investigation have indicated that: (1) the convective pore-fluid flow may take place in the inclined three-dimensional fault zone; (2) if the height of the fault zone is used as the characteristic length of the system, a decrease in the inclined angle of the inclined fault zone stabilizes the three-dimensional fundamental convective flow in the inclined three-dimensional fault zone system; (3) if the thickness of the stratum is used as the characteristic length of the system, a decrease in the inclined angle of the inclined fault zone destabilizes the three-dimensional fundamental convective flow in the inclined three-dimensional fault zone system; and that (4) the shape of the inclined three-dimensional fault zone may affect the convective instability of pore-fluid flow in the system. (C) 2004 Published by Elsevier B.V.
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The uncontrolled growth of most Brazilian cities is not accompanied by the development of urban infrastructure. With increasing soil sealing, runoff and decreased infiltration volume, impacts on water resources and on population of the areas affected by urban growth are inevitable. This study aims to evaluate the use and occupation of a watershed and analyze the drainage system in order to control the impact using tools to integrate urban development with the drainage of rainwater in an important watershed in the Natal City, Rio Grande do Norte State. The study involved the characterization of the basin XII.4 on the land use and occupation, for the years 2005 and 2014. With the application of SWMM model was possible to analyze the impacts caused by the urbanization process in the existing drainage system, showing the two years analyzed have their areas very close to percentage saturation of impervious areas. Although the region is still predominantly single family residential, suffers increasing verticalization of mainly commercial buildings. The drainage system is inefficient for the area's needs by the year 2005. The drainage system was also tested for four variations of land use by developing scenarios. Scenario 1 is related to the year 2014, considered current. Scenario 2 was adopted the maximum rate of 80% for land use, allowed for the Natal City. Scenario 3 gives the critical condition of land use, with the area 100% impervious. Scenario 4 is applied to the existence of LID (Low Impact Device). The scenarios analysis showed that all indicate deficiency at some point of the drainage system as a result of the high degree of occupation of the area that generate higher flows than the initial drainage system capacity. With the study it became clear that the adoption of non-structural tools are effective in reducing flooding and improving the drainage system capacity.
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The uncontrolled growth of most Brazilian cities is not accompanied by the development of urban infrastructure. With increasing soil sealing, runoff and decreased infiltration volume, impacts on water resources and on population of the areas affected by urban growth are inevitable. This study aims to evaluate the use and occupation of a watershed and analyze the drainage system in order to control the impact using tools to integrate urban development with the drainage of rainwater in an important watershed in the Natal City, Rio Grande do Norte State. The study involved the characterization of the basin XII.4 on the land use and occupation, for the years 2005 and 2014. With the application of SWMM model was possible to analyze the impacts caused by the urbanization process in the existing drainage system, showing the two years analyzed have their areas very close to percentage saturation of impervious areas. Although the region is still predominantly single family residential, suffers increasing verticalization of mainly commercial buildings. The drainage system is inefficient for the area's needs by the year 2005. The drainage system was also tested for four variations of land use by developing scenarios. Scenario 1 is related to the year 2014, considered current. Scenario 2 was adopted the maximum rate of 80% for land use, allowed for the Natal City. Scenario 3 gives the critical condition of land use, with the area 100% impervious. Scenario 4 is applied to the existence of LID (Low Impact Device). The scenarios analysis showed that all indicate deficiency at some point of the drainage system as a result of the high degree of occupation of the area that generate higher flows than the initial drainage system capacity. With the study it became clear that the adoption of non-structural tools are effective in reducing flooding and improving the drainage system capacity.
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Tissue engineering of biomimetic skeletal muscle may lead to development of new therapies for myogenic repair and generation of improved in vitro models for studies of muscle function, regeneration, and disease. For the optimal therapeutic and in vitro results, engineered muscle should recreate the force-generating and regenerative capacities of native muscle, enabled respectively by its two main cellular constituents, the mature myofibers and satellite cells (SCs). Still, after 20 years of research, engineered muscle tissues fall short of mimicking contractile function and self-repair capacity of native skeletal muscle. To overcome this limitation, we set the thesis goals to: 1) generate a highly functional, self-regenerative engineered skeletal muscle and 2) explore mechanisms governing its formation and regeneration in vitro and survival and vascularization in vivo.
By studying myogenic progenitors isolated from neonatal rats, we first discovered advantages of using an adherent cell fraction for engineering of skeletal muscles with robust structure and function and the formation of a SC pool. Specifically, when synergized with dynamic culture conditions, the use of adherent cells yielded muscle constructs capable of replicating the contractile output of native neonatal muscle, generating >40 mN/mm2 of specific force. Moreover, tissue structure and cellular heterogeneity of engineered muscle constructs closely resembled those of native muscle, consisting of aligned, striated myofibers embedded in a matrix of basal lamina proteins and SCs that resided in native-like niches. Importantly, we identified rapid formation of myofibers early during engineered muscle culture as a critical condition leading to SC homing and conversion to a quiescent, non-proliferative state. The SCs retained natural regenerative capacity and activated, proliferated, and differentiated to rebuild damaged myofibers and recover contractile function within 10 days after the muscle was injured by cardiotoxin (CTX). The resulting regenerative response was directly dependent on the abundance of SCs in the engineered muscle that we varied by expanding starting cell population under different levels of basic fibroblast growth factor (bFGF), an inhibitor of myogenic differentiation. Using a dorsal skinfold window chamber model in nude mice, we further demonstrated that within 2 weeks after implantation, initially avascular engineered muscle underwent robust vascularization and perfusion and exhibited improved structure and contractile function beyond what was achievable in vitro.
To enhance translational value of our approach, we transitioned to use of adult rat myogenic cells, but found that despite similar function to that of neonatal constructs, adult-derived muscle lacked regenerative capacity. Using a novel platform for live monitoring of calcium transients during construct culture, we rapidly screened for potential enhancers of regeneration to establish that many known pro-regenerative soluble factors were ineffective in stimulating in vitro engineered muscle recovery from CTX injury. This led us to introduce bone marrow-derived macrophages (BMDMs), an established non-myogenic contributor to muscle repair, to the adult-derived constructs and to demonstrate remarkable recovery of force generation (>80%) and muscle mass (>70%) following CTX injury. Mechanistically, while similar patterns of early SC activation and proliferation upon injury were observed in engineered muscles with and without BMDMs, a significant decrease in injury-induced apoptosis occurred only in the presence of BMDMs. The importance of preventing apoptosis was further demonstrated by showing that application of caspase inhibitor (Q-VD-OPh) yielded myofiber regrowth and functional recovery post-injury. Gene expression analysis suggested muscle-secreted tumor necrosis factor-α (TNFα) as a potential inducer of apoptosis as common for muscle degeneration in diseases and aging in vivo. Finally, we showed that BMDM incorporation in engineered muscle enhanced its growth, angiogenesis, and function following implantation in the dorsal window chambers in nude mice.
In summary, this thesis describes novel strategies to engineer highly contractile and regenerative skeletal muscle tissues starting from neonatal or adult rat myogenic cells. We find that age-dependent differences of myogenic cells distinctly affect the self-repair capacity but not contractile function of engineered muscle. Adult, but not neonatal, myogenic progenitors appear to require co-culture with other cells, such as bone marrow-derived macrophages, to allow robust muscle regeneration in vitro and rapid vascularization in vivo. Regarding the established roles of immune system cells in the repair of various muscle and non-muscle tissues, we expect that our work will stimulate the future applications of immune cells as pro-regenerative or anti-inflammatory constituents of engineered tissue grafts. Furthermore, we expect that rodent studies in this thesis will inspire successful engineering of biomimetic human muscle tissues for use in regenerative therapy and drug discovery applications.
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O presente trabalho pretende descrever o percurso de estágio realizado na Unidade de Acidentes Vasculares Cerebrais no Hospital do Espirito Santo de Évora, EPE sob orientação pedagógica do Professor Doutor Raul Cordeiro, que decorreu no período compreendido entre 1 de Novembro de 2015 a 30 de Abril de 2016. A metodologia utilizada para a concretização do relatório foi a metodologia descritiva, analítica e reflexiva que me permitiu, através de um carácter narrativo, de forma detalhada e objetiva, descrever as experiências vividas, as situações-problema encontradas, as soluções propostas e as dificuldades sentidas durante a concretização do Estágio. Este documento tem como finalidade relatar e descrever as experiências vividas na prática de cuidados, as atividades desenvolvidas e os contextos em que estas foram praticadas, analisá-las e refletir de que forma contribuíram para o desenvolvimento de saberes e competências especializadas em Enfermagem Médico-Cirúrgica nos cuidados à pessoa em situação crítica com o diagnóstico de AVC na área de Gestão de Unidades de Saúde. Os ganhos em saúde foram obtidos pela concretização do estágio repercutindo-se ao nível das equipas multidisciplinares com as quais tive contacto, através da partilha e troca de experiências e saberes, aquisição e aperfeiçoamento de competências, objetivando-se a melhoria dos cuidados de enfermagem prestados
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The Glenelg spiny freshwater crayfish Euastacus bispinosus is a large endangered freshwater invertebrate of southeastern Australia that has suffered major population declines over the last century. Disjunct populations in the state of South Australia are in a particularly critical condition, restricted to a few isolated rising-spring habitats and in an ongoing state of decline. We assessed genetic diversity and gene flow within E. bispinosus across its current range using allele frequencies from 11 nuclear microsatellite loci and DNA sequence data from a single mitochon -drial locus (cytochrome oxidase subunit I). Populations were characterized by low levels of genetic diversity and found to be highly structured, with gene flow restricted both within and across catchments, highlighting the species' vulnerability to further habitat fragmentation and the importance of managing environmental threats on local scales across its current natural range. South Australian populations were characterized by critically low levels of genetic diversity generally, highlighting their potential vulnerability to localized extinction. Holistic conservation efforts are necessary to conserve populations, including local habitat management and, potentially, translocations to increase genetic diversity and evolutionary potential, and reduce possible inbreeding effects and the threat of extinction.