Narratiivisuus folkloristiikassa

Teemanumero 2007

Erään ihmeen anatomia

Kirja-arvio

Tiedettä rajoista

Kirja-arvio

Kansanrunoudentutkimuksen synty

Kirja-arvio

Kertomisen kaipuu!

Pääkirjoitus

Muistitietotutkimuksen käsikirja

Kirja-arvio

Onnelliset haapajärviset Eskilstunassa

Kirja-arvio

Tissue oxygenation and hemodynamic response to NO synthase inhibition in septic shock.

The objective of the study was to evaluate the tissue oxygenation and hemodynamic effects of NOS inhibition in clinical severe septic shock. Eight patients with septic shock refractory to volume loading and high level of adrenergic support were prospectively enrolled in the study. Increasing doses of NOS inhibitors [N(G)-nitro-L-arginine-methyl ester (L-NAME) or N(G)-monomethyl-L-arginine (L-NMMA)] were administered as i.v. bolus until a peak effect = 10 mmHg on mean blood pressure was obtained or until side effects occurred. If deemed clinically appropriate, a continuous infusion of L-NAME was instituted and adrenergic support weaning attempted. The bolus administration of NOS inhibitors transiently increased mean blood pressure by 10 mm Hg in all patients. Seven out of eight patients received an L-NAME infusion, associated over 24 h with a progressive decline in cardiac index (P < 0.001) and an increase in systemic vascular resistance (P < 0.01). Partial or total adrenergic support weaning was rapidly possible in 6/8 patients. Oxygen transport decreased (P < 0.001), but oxygen consumption remained unchanged in those patients in whom it could be measured by indirect calorimetry (5/8). Blood lactate and the difference between tonometric gastric and arterial PCO2 remained unchanged. There were 4/8 ICU survivors. We conclude that nitric oxide synthase inhibition in severe septic shock was followed with a progressive correction of the vasoplegic hemodynamic disturbances with finally normalization of cardiac output and systemic vascular resistances without any demonstrable deterioration in tissue oxygenation.

Esimodernin yksilön rakentuminen suomalaisessa taikaperinteessä

Kirja-arvio

Runomatkalla Tartossa : regilaulu müüdid ja ideoloogiad 22 ja 23 novembril 2006 Tartus, Eesti Kirjandusmuuseumis

Ajankohtaista

Viron perinteentutkijoiden ja uskontotieteilijöiden seurat

Ajankohtaista

Narratiivisuus uskomusperinteessä

Abstract: Narrativity in belief tradition

Superior diagnostic performance of perfusion-cardiovascular magnetic resonance versus SPECT to detect coronary artery disease: The secondary endpoints of the multicenter multivendor MR-IMPACT II (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial).

ABSTRACT: BACKGROUND: Perfusion-cardiovascular magnetic resonance (CMR) is generally accepted as an alternative to SPECT to assess myocardial ischemia non-invasively. However its performance vs gated-SPECT and in sub-populations is not fully established. The goal was to compare in a multicenter setting the diagnostic performance of perfusion-CMR and gated-SPECT for the detection of CAD in various populations using conventional x-ray coronary angiography (CXA) as the standard of reference. METHODS: In 33 centers (in US and Europe) 533 patients, eligible for CXA or SPECT, were enrolled in this multivendor trial. SPECT and CXA were performed within 4̴1;weeks before or after CMR in all patients. Prevalence of CAD in the sample was 49% and 515 patients received MR contrast medium. Drop-out rates for CMR and SPECT were 5.6% and 3.7%, respectively (ns). The study was powered for the primary endpoint of non-inferiority of CMR vs SPECT for both, sensitivity and specificity for the detection of CAD (using a single-threshold reading), the results for the primary endpoint were reported elsewhere. In this article secondary endpoints are presented, i.e. the diagnostic performance of CMR versus SPECT in subpopulations such as multi-vessel disease (MVD), in men, in women, and in patients without prior myocardial infarction (MI). For diagnostic performance assessment the area under the receiver-operator-characteristics-curve (AUC) was calculated. Readers were blinded versus clinical data, CXA, and imaging results. RESULTS: The diagnostic performance (= area under ROC̴1;=̴1;AUC) of CMR was superior to SPECT (p̴1;=̴1;0.0004, n̴1;=̴1;425) and to gated-SPECT (p̴1;=̴1;0.018, n̴1;=̴1;253). CMR performed better than SPECT in MVD (p̴1;=̴1;0.003 vs all SPECT, p̴1;=̴1;0.04 vs gated-SPECT), in men (p̴1;=̴1;0.004, n̴1;=̴1;313) and in women (p̴1;=̴1;0.03, n̴1;=̴1;112) as well as in the non-infarct patients (p̴1;=̴1;0.005, n̴1;=̴1;186 in 1-3 vessel disease and p̴1;=̴1;0.015, n̴1;=̴1;140 in MVD). CONCLUSION: In this large multicenter, multivendor study the diagnostic performance of perfusion-CMR to detect CAD was superior to perfusion SPECT in the entire population and in sub-groups. Perfusion-CMR can be recommended as an alternative for SPECT imaging. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT00977093.

Usko ja kerronta : arkitodellisuuden narratiivinen rakentuminen uskonliikkeessä

Ajankohtaista