Coma post-anoxique après arrêt cardiaque et hypothermie, peut-on encore prédire le pronostic en 2014 ?

L'encéphalopathie post-anoxique après arrêt cardiaque (AC) est une cause féquente d'admission pour coma en réanimation. Depuis les recommandations de 2003, l'hypothermie thérapeutique (HT) est devenue un standard de traitement après AC et est à l'origine de l'amélioration du pronostic au cours de cette derniere décennie. Les élements prédicteurs de pronostic validés par l'Académie Américaine de Neurologie avant l'ère de l'HT sont devenus moins précis. En effet, l'HT et la sédation retardent la reprise de la réponse motrice et peuvent altérer la valeur prédictive des réflexes du tronc cérébral. Une nouvelle approche est nécessaire pour établir un pronostic après AC et HT. L'enregistrement (pendant l'HTou peu après) d'une activité électroencéphalographique réactive et/ou continue est un bon prédicteur de récupération neurologique favorable après AC. Au contraire, la présence d'un tracé non réactif ou discontinu de type burst-suppression, avec une réponse N20 absente bilatérale aux potentiels évoqués somatosensoriels, sont presqu'à 100 % prédictifs d'un coma irréversible déjà à 48 heures après AC. L'HT modifie aussi la valeur prédictive de l'énolase neuronale spécifique (NSE), principal biomarqueur sérique de la lésion cérébrale post-anoxique. Un réveil avec bonne récupération neurologique a été récemment observé par plusieurs groupes chez des patients présentant des valeurs de NSE>33 μg/L à 48-72 heures : ce seuil ne doit pas être utilisé seul pour guider le traitement. L'imagerie par résonance magnétique de diffusion peut aider à prédire les séquelles neurologiques à long terme. Un réveil chez les patients en coma post-anoxique est de plus en plus observé, malgré l'absence précoce de signes moteurs et une élévation franche des biomarqueurs neuronaux. En 2014, une nouvelle approche multimodale du pronostic est donc nécessaire, pour optimiser la prédiction d'une évolution clinique favorable après AC. Hypoxic-ischemic encephalopathy after cardiac arrest (CA) is a frequent cause of intensive care unit (ICU) admission. Incorporated in all recent guidelines, therapeutic hypothermia (TH) has become a standard of care and has contributed to improve prognosis after CA during the past decade. The accuracy of prognostic predictors validated in 2006 by the American Academy of Neurology before the era of TH is less accurate. Indeed, TH and sedation may delay the recovery of motor response and alter the predictive value of brainstem reflexes. A new approach is needed to accurately establish prognosis after CA and TH. A reactive and/or continuous electroencephalogram background (during TH or shortly thereafter) strongly predicts good outcome. On the contrary, unreactive/spontaneous burst-suppression electroencephalogram pattern, together with absent N20 on somatosensory evoked potentials, is almost 100% predictive of irreversible coma. TH also affects the predictive value of neuronspecific enolase (NSE), the main serum biomarker of postanoxic injury. A good outcome can occur despite NSE levels >33 μg/L, so this cutoff value should not be used alone to guide treatment. Diffusion magnetic resonance imagery may help predict long-term neurological sequelae. Awakening from postanoxic coma is increasingly observed, despite the absence of early motor signs and pathological elevation of NSE. In 2014, a multimodal approach to prognosis is recommended to optimize the prediction of outcome after CA.

Mass for the poor

Soitinnus: Kuoro, urut.

Reciclagem de cobre proveniente de analisador automático de carbono e nitrogênio

Isotopic and elemental analysis of N, C and S in liquid and solid samples has been simplified with the advent of automated systems. The simplest method of automation for this kind of analysis involves an elemental analyzer interfaced directly to the ion source of an IRMS (Isotope Ratio Mass Spectrometry). In the analyzer reduction system, an expressive amount of oxidized copper is generated as solid residue. This material is normally imported and the price is very high. A methodology was proposed for the recovery of metallic copper in order to recycle this reagent in the reduction system of a GC-IRMS, using the hydrogen gas in the vacuum line. Results show that it is possible to obtain a recycle of about 95 % of the initial metallic copper used in the reduction system.

Procedimentos para recuperação de Ag de resíduos líquidos e sólidos

A simple procedure for recovering Ag, generated as residual solutions, from three different analytical methods, is presented. Based on the rate of the total Ag mass recovered, to the initial one in the initial residual solutions, efficiency as high as 97,9 ± 2,9% was obtained in the process. The purity of Ag, as Ag2O, was verified by employing this reagent in the determination of S in plant tissue. This leads to the generation of a solid metallic Ag as waste. In this situation, an 88,7 ± 0,6% Ag recovery was acquired, when a HNO3 solution was employed as solvent.

Gerenciamento de resíduos químicos e águas servidas no laboratório de isótopos estáveis do CENA/USP

A system for disposal and recovery of the main effluents and chemical waist from isotope separation plants and enriched compounds-15N and 34S production has been carried out at the Stable Isotope Laboratory (LIE) of the CENA/USP. Around four hundred thousand liters of effluents has been recovered yearly. Among the recovered chemical wastes, the more relevant are: ammonia; brome; ammonium and sodium sulfate; sodium hydroxide; sulfur dioxide; and hydrochloric acid. Chemical wastes containg recoverable heavy metals (Ag, Cr and Cu) and solvents (methanol, ethanol and acetone) are processed and recovered. Gaseous emissions, mainly H2S are used for recovery of heavy metals solutions. The minimization of the residues waters, as well the reduction of electric energy consume was established using a water deionization system. A cost/effect balance of the process is reported.

Recuperação de bromo em soluções aquosas residuais

A laboratory procedure was devised to recover bromine from waste alkaline aqueous solutions used in the isotopic determination of N-15. The laboratory apparatus comprises two round bottom flasks (1 and 2 L), a dropping funnel, a gas bubbler, a gas regulator and glass fittings. The waste solution is acidified with sulfuric acid forming molecular bromine that is stripped out by a flow of nitrogen gas bubbled through the solution. This gas is then bubbled through a solution of lithium hydroxide generating lithium bromide and lithium hypobromite. The efficiency of bromine recovery was estimated to be 82±2%. This resulting solution was successfully reused in the isotopic determination of N-15. The procedure can recycle most of the bromine used in the laboratory saving resources and preserving the environment. The procedure can be adapted to recover bromine of other laboratory waste streams.

Chaotic dynamics of electric-field domains in periodically driven superlattices

Self-sustained time-dependent current oscillations under dc voltage bias have been observed in recent experiments on n-doped semiconductor superlattices with sequential resonant tunneling. The current oscillations are caused by the motion and recycling of the domain wall separating low- and high-electric-field regions of the superlattice, as the analysis of a discrete drift model shows and experimental evidence supports. Numerical simulation shows that different nonlinear dynamical regimes of the domain wall appear when an external microwave signal is superimposed on the dc bias and its driving frequency and driving amplitude vary. On the frequency-amplitude parameter plane, there are regions of entrainment and quasiperiodicity forming Arnold tongues. Chaos is demonstrated to appear at the boundaries of the tongues and in the regions where they overlap. Coexistence of up to four electric-field domains randomly nucleated in space is detected under ac+dc driving.

Implantação de um programa de gerenciamento de resíduos químicos e águas servidas nos laboratórios de ensino e pesquisa no CENA/USP

The aim of this work is to establish a program for the treatment of chemical residues and waste waters at the Centro de Energia Nuclear na Agricultura (CENA/USP), for environmental preservation and training of staff. Five tons of stored residues and the ones currently generated in the laboratories have to be treated. Rational use of water is also part of the program. The traditional purification by distillation has been replaced by purification with ion exchange resins. Lower energy consumption and better water quality were achieved.

Revisió de la recerca educativa sobre les variables explicatives del rendiment acadèmic:Apunts per a l'ús del criteri de "modificabilitat pedagògica" de les variables.

La conceptualització del concepte de rendiment acadèmic ha variat al llarg de lahistòria des de definicions que es basaven en un únic criteri fins a les més actuals concepcionsmultidimensionals. Aquestes darreres apareixen com a resultat del desenvolupamentd'aquest concepte, paral.lel a l'evolució històrica d'un fenomen més ampli:el fracàs escolar

Centres diürns d'atenció a la gent gran: grau de satisfacció dels usuaris i familiars

Estudi descriptiu sobre els centres de dia i centres de serveis per a la gent gran, dos recursos que ofereixen atenció diürna, i sobre la satisfacció que comporta assistir a un o a l’altre. OBJECTIUS. Descriure i comparar dos models d’atenció diürna per a la gent gran, i els graus de satisfacció d’aquells que els utilitzen. MÈTODES. Estudi multicèntric descriptiu, de disseny és transversal. Portat a terme entre els mesos d’abril i juny de 2011, en set centres de serveis i un centre de dia, ha inclòs un total de 296 persones. S’ha fet una valoració del grau de satisfacció d’usuaris i familiars mitjançant una enquesta de disseny propi. RESULTATS. Els centres de dia, que es troben situats en zones urbanes, ofereixen un únic servei (servei d’estada), on el 41,94% de les persones tenen una elevada dependència. Els centres de serveis, que estan situats en zones rurals, ofereixen serveis d’estada, ambulatoris, tallers i atenció a domicili, i el 25,58% de les persones mostra una dependència elevada. El grau de satisfacció en els dos tipus de centres és elevada tant en famílies 87,63%, com en usuaris 96.5% . CONCLUSIÓ. Són dos models que tenen similituds, però ofereixen diferents tipus de serveis. Creats amb més de 15 anys de diferència, és possible que el centre de serveis acabi sent l’evolució natural del centre de dia.

Avaliação das técnicas de precipitação química e encapsulamento no tratamento e destinação conjunta de resíduos líquidos contendo cromo e vidrarias de laboratório

In this paper, we present procedures for the treatment and final disposal of residual solutions containing chromium, in order to evaluate the effectiveness of chemical precipitation of the metal and the potential of the glass encapsulation technique, using broken laboratory glassware. The results demonstrated that pH-values convenient for chemical precipitation are between 10 - 11. With regard to Cr(OH)3 encapsulation, the leaching and solubilization tests allowed to classify the waste as non-dangerous and non-inert. Finally, it is pointed out that the adoption of waste management practices in universities should be encouraged, helping to train professionals skilled in good laboratory practices.

Theses miscellaneae

Invocatio: Q.B.V.

De fortitudine

Invocatio: I.N.N.I.

De magnitudine Romana

Invocatio: D.D.