901 resultados para death certification


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We examined the degeneration of post-mitotic ganglion cells in ex-vivo neonatal retinal explants following axon damage. Ultrastructural features of both apoptosis and autophagy were detected. Degenerating cells reacted with antibodies specific for activated caspase-3 or -9, consistent with the presence of caspase activity. Furthermore, peptidic inhibitors of caspase-9, -6 or -3 prevented cell death (100 µM Ac-LEDH-CHO, 50 µM Ac-VEID-CHO and 10 µM Z-DEVD-fmk, respectively). Interestingly, inhibition of autophagy by 7-10 mM 3-methyl-adenine increased the rate of cell death. Immunohistochemistry data, caspase activation and caspase inhibition data suggest that axotomy of neonatal retinal ganglion cells triggers the intrinsic apoptotic pathway, which, in turn, is counteracted by a pro-survival autophagic response, demonstrated by electron microscopy profiles and pharmacological autophagy inhibitor.

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The SEARCH-RIO study prospectively investigated electrocardiogram (ECG)-derived variables in chronic Chagas disease (CCD) as predictors of cardiac death and new onset ventricular tachycardia (VT). Cardiac arrhythmia is a major cause of death in CCD, and electrical markers may play a significant role in risk stratification. One hundred clinically stable outpatients with CCD were enrolled in this study. They initially underwent a 12-lead resting ECG, signal-averaged ECG, and 24-h ambulatory ECG. Abnormal Q-waves, filtered QRS duration, intraventricular electrical transients (IVET), 24-h standard deviation of normal RR intervals (SDNN), and VT were assessed. Echocardiograms assessed left ventricular ejection fraction. Predictors of cardiac death and new onset VT were identified in a Cox proportional hazard model. During a mean follow-up of 95.3 months, 36 patients had adverse events: 22 new onset VT (mean±SD, 18.4±4‰/year) and 20 deaths (26.4±1.8‰/year). In multivariate analysis, only Q-wave (hazard ratio, HR=6.7; P<0.001), VT (HR=5.3; P<0.001), SDNN<100 ms (HR=4.0; P=0.006), and IVET+ (HR=3.0; P=0.04) were independent predictors of the composite endpoint of cardiac death and new onset VT. A prognostic score was developed by weighting points proportional to beta coefficients and summing-up: Q-wave=2; VT=2; SDNN<100 ms=1; IVET+=1. Receiver operating characteristic curve analysis optimized the cutoff value at >1. In 10,000 bootstraps, the C-statistic of this novel score was non-inferior to a previously validated (Rassi) score (0.89±0.03 and 0.80±0.05, respectively; test for non-inferiority: P<0.001). In CCD, surface ECG-derived variables are predictors of cardiac death and new onset VT.

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Cardiovascular disease is one of the leading causes of death worldwide, and evidence indicates a correlation between the inflammatory process and cardiac dysfunction. Selective inhibitors of cyclooxygenase-2 (COX-2) enzyme are not recommended for long-term use because of potentially severe side effects to the heart. Considering this and the frequent prescribing of commercial celecoxib, the present study analyzed cellular and molecular effects of 1 and 10 µM celecoxib in a cell culture model. After a 24-h incubation, celecoxib reduced cell viability in a dose-dependent manner as also demonstrated in MTT assays. Furthermore, reverse transcription-polymerase chain reaction analysis showed that the drug modulated the expression level of genes related to death pathways, and Western blot analyses demonstrated a modulatory effect of the drug on COX-2 protein levels in cardiac cells. In addition, the results demonstrated a downregulation of prostaglandin E2 production by the cardiac cells incubated with celecoxib, in a dose-specific manner. These results are consistent with the decrease in cell viability and the presence of necrotic processes shown by Fourier transform infrared analysis, suggesting a direct correlation of prostanoids in cellular homeostasis and survival.

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Community-acquired pneumonia (CAP) is amongst the leading causes of death worldwide. As inflammatory markers, cytokines can predict outcomes, if interpreted together with clinical data and scoring systems such as CURB-65, CRB, and Acute Physiology and Chronic Health Evaluation II (APACHE II). The aim of this study was to determine the impact of inflammatory biomarkers on the early mortality of hospitalized CAP patients. Twenty-seven CAP patients needing hospitalization were enrolled for the study and samples of interleukin-1 (IL-1) and interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and homocystein were collected at the time of admission (day 1) as well as on the seventh day of the treatment. There was a significant reduction in the levels of IL-6 between the first and the second collections. Median IL-6 values decreased from 24 pg/mL (day 1) to 8 pg/mL (day 7) (P=0.016). The median levels of TNF-α were higher in patients: i) with acute kidney injury (AKI) (P=0.045), ii) requiring mechanical ventilation (P=0.040), iii) with short hospital stays (P=0.009), iv) admitted to the intensive care unit (ICU) (P=0.040), v) who died early (P=0.003), and vi) with worse CRB scores (P=0.013). In summary, IL-6 and TNF-α levels were associated with early mortality of CAP patients. Longer admission levels demonstrated greater likelihood of early death and overall mortality, necessity of mechanical ventilation, and AKI.

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After a traumatic injury to the central nervous system, the distal stumps of axons undergo Wallerian degeneration (WD), an event that comprises cytoskeleton and myelin breakdown, astrocytic gliosis, and overexpression of proteins that inhibit axonal regrowth. By contrast, injured neuronal cell bodies show features characteristic of attempts to initiate the regenerative process of elongating their axons. The main molecular event that leads to WD is an increase in the intracellular calcium concentration, which activates calpains, calcium-dependent proteases that degrade cytoskeleton proteins. The aim of our study was to investigate whether preventing axonal degeneration would impact the survival of retinal ganglion cells (RGCs) after crushing the optic nerve. We observed that male Wistar rats (weighing 200-400 g; n=18) treated with an exogenous calpain inhibitor (20 mM) administered via direct application of the inhibitor embedded within the copolymer resin Evlax immediately following optic nerve crush showed a delay in the onset of WD. This delayed onset was characterized by a decrease in the number of degenerated fibers (P<0.05) and an increase in the number of preserved fibers (P<0.05) 4 days after injury. Additionally, most preserved fibers showed a normal G-ratio. These results indicated that calpain inhibition prevented the degeneration of optic nerve fibers, rescuing axons from the process of axonal degeneration. However, analysis of retinal ganglion cell survival demonstrated no difference between the calpain inhibitor- and vehicle-treated groups, suggesting that although the calpain inhibitor prevented axonal degeneration, it had no effect on RGC survival after optic nerve damage.

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This study aims to explore the effect of microRNA-21 (miR-21) on the proliferation of human degenerated nucleus pulposus (NP) by targeting programmed cell death 4 (PDCD4) tumor suppressor. NP tissues were collected from 20 intervertebral disc degeneration (IDD) patients, and from 5 patients with traumatic spine fracture. MiR-21 expressions were tested. NP cells from IDD patients were collected and divided into blank control group, negative control group (transfected with miR-21 negative sequences), miR-21 inhibitor group (transfected with miR-21 inhibitors), miR-21 mimics group (transfected with miR-21 mimics) and PDCD4 siRNA group (transfected with PDCD4 siRNAs). Cell growth was estimated by Cell Counting Kit-8; PDCD4, MMP-2,MMP-9 mRNA expressions were evaluated by qRT-PCR; PDCD4, c-Jun and p-c-Jun expressions were tested using western blot. In IDD patients, the expressions of miR-21 and PDCD4 mRNA were respectively elevated and decreased (both P<0.05). The miR-21 expressions were positively correlated with Pfirrmann grades, but negatively correlated with PDCD4 mRNA (both P<0.001). In miR-21 inhibitor group, cell growth, MMP-2 and MMP-9 mRNA expressions, and p-c-Jun protein expressions were significantly lower, while PDCD4 mRNA and protein expressions were higher than the other groups (all P<0.05). These expressions in the PDCD4 siRNA and miR-21 mimics groups was inverted compared to that in the miR-21 inhibitor group (all P<0.05). MiR-21 could promote the proliferation of human degenerated NP cells by targeting PDCD4, increasing phosphorylation of c-Jun protein, and activating AP-1-dependent transcription of MMPs, indicating that miR-21 may be a crucial biomarker in the pathogenesis of IDD.

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Työn teoriaosuudessa tutkittiin prosessien uudelleen suunnittelua, prosessien mallintamista sekä prosessimittariston rakentamista. Työn tavoitteena oli uudelleen suunnitella organisaation sertifiointiprosessi. Tämän tavoitteen saavuttamiseksi piti mallintaa nykyinen ja uusi prosessi sekä rakentaa mittaristo, joka antaisi organisaatiolle arvokasta tietoa siitä, kuinka tehokkaasti uusi prosessi toimii. Työ suoritettiin osallistuvana toimintatutkimuksena. Diplomityön tekijä oli toiminut kohdeorganisaatiossa työntekijänä jo useita vuosia ja pystyi näinollen hyödyntämään omaa tietämystään sekä nykyisen prosessin mallintamisessa, että uuden prosessin suunnittelussa. Työn tuloksena syntyi uusi sertifiointiprosessi, joka on karsitumpi ja tehokkaampi kuin edeltäjänsä. Uusi mittaristojärjestelmä rakennettiin, jota organisaation johto kykenisi seuraamaan prosessin sidosryhmien tehokkuutta sekä tuotteiden laadun kehitystä. Sivutuotteena organisaatio sai käyttöönsä yksityiskohtaiset prosessikuvaukset, joita voidaan hyödyntää koulutusmateriaalina uutta henkilöstöä rekrytoitaessa sekä informatiivisena työkaluna esiteltäessä prosessia virallisille sertifiointitahoille.

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One of the merits of contemporary economic analysis is its capacity to offer accounts of choice behavior that dispense with details of the complex decision machinery. The starting point of this paper is the concern with the important methodological debate about whether economics might offer accurate predictions and explanations of actual behavior without any reference to psychological presuppositions. Inspired by an exercise of rational reconstruction of ideas, I aim to offer an interpretation of the process of freeing economic analysis from psychology at the end of the 19th century and the contemporary resurrection of behavioral approaches in the late 1980s.

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Gestión del conocimiento

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Gestión del conocimiento

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This study investigated loss, death and dying, reminiscing, coping and the process of adaptation from the sUbjective perspective. A number of theories and models of death and dying were reviewed in the background literature search with the focus on reminiscing as a coping phenomenon. The format of the study was audio-taped interviews with ten sUbjects and the recording of their memories and reminiscing of life stories. The sUbjects were required to complete an initial questionnaire in a demographic data collection process. Two separate interviews consisted of a primary data collecting interview and a verification interview four to eight weeks later. An independent chart review completed the data collecting process. Data analysis was by the examination of the emerging themes in the subjects' personal narratives which revealed the sUb-categories of reminiscing, loss (including death and dying), acceptance, hope, love, despair and belief. Belief was shown to be the foundation and the base for living and reminiscing. Reminiscing was found to be a coping phenomenon, within the foundation of a belief system. Both living and reminiscing revealed the existence of a central belief or value with a great deal of importance attached to it. Whether the belief was of a spiritual nature, a value of marriage, tradition, a work ethic or belief in an abstract value such as fate,it gave support and control to the individuals' living and reminiscing process. That which caused despair or allowed acceptance indicated the sUbjects' basic belief and was identified in the story narrations. The findings were significant to health care in terms of education, increased dignity for the elderly and better understanding by society. The profiles represented an average age of 86.3 years with age showing no bearing on the life experiences associated with the emerging themes. Overwhelmingly, belief was shown to be the foundation in reminiscing. A Judeo-Christian cultural value base supported the belief in 90% of the sUbjects; however, different beliefs were clearly shown indicating that belief is central to all thinking beings, in everyday life and in reminiscing. Belief was not necessarily spiritual or a practised or verbalized religion. It was shown to be a way of understanding, a fundamental and single thread tying the individual's life and stories together. The benefits were the outcomes, in that knowledge of an individual's belief can optimize care planning for any age group, and/or setting. The strength of the study was the open question format and the feedback process of data verification. The unrestricted outcomes and non-specificity were significant in a world where dying is everybody's business.