Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room

PURPOSE: To evaluate the efficacy of a systematic model of care for patients with chest pain and no ST segment elevation in the emergency room. METHODS: From 1003 patients submitted to an algorithm diagnostic investigation by probability of acute ischemic syndrome. We analyzed 600 ones with no elevation of ST segment, then enrolled to diagnostic routes of median (route 2) and low probability (route 3) to ischemic syndrome. RESULTS: In route 2 we found 17% acute myocardial infarction and 43% unstable angina, whereas in route 3 the rates were 2% and 7%, respectively. Patients with normal/non--specific ECG had 6% probability of AMI whereas in those with negative first CKMB it was 7%; the association of the 2 data only reduced it to 4%. In patients in route 2 the diagnosis of AMI could only be ruled out with serial CKMB measurement up to 9 hours, while in route 3 it could be done in up to 3 hours. Thus, sensitivity and negative predictive value of admission CKMB for AMI were 52% and 93%, respectively. About one-half of patients with unstable angina did not disclose objective ischemic changes on admission. CONCLUSION: The use of a systematic model of care in patients with chest pain offers the opportunity of hindering inappropriate release of patients with ACI and reduces unnecessary admissions. However some patients even with normal ECG should not be released based on a negative first CKMB. Serial measurement of CKMB up to 9 hours is necessary in patients with medium probability of AMI.

The Brugada syndrome. Outcome of one case

The Brugada syndrome is a rare condition, and due to its mutating manner of presentation it may be difficult to diagnose. We report one case and discuss the diagnostic aspects and the clinical outcome of one patient with characteristic findings of this syndrome. These findings are especially defined by J-ST elevation in the right leads of serial electrocardiographic records, wide oscillations of J points and ST segments during 24-hour Holter monitoring, and nocturnal sudden death. We stress the importance of the Holter monitor findings for diagnostic complementation. Through this method it is possible to establish a correlation between vigil activities and sleep and the variability of the degree of impairment in ventricular repolarization.

Cytokines and troponin-I in cardiac dysfunction after coronary artery grafting with cardiopulmonary bypass

OBJECTIVE: The association between cytokines and troponin-I with cardiac function after cardiac surgery with cardiopulmonary bypass remains a topic of continued investigation. METHODS: Serial measurements, within 24h following surgery, of tumor necrosis factor-alpha, its soluble receptors, and troponin-I were performed in patients with normal ejection fraction undergoing coronary artery bypass grafting. Ejection fraction was measured by radioisotopic ventriculography preoperatively, at 24h and at day 7 postoperatively. RESULTS: Of 19 patients studied (59±8.5 years), 10 (group 1) showed no changes in ejection fraction, 53±8% to 55±7%, and 9 (group 2) had a decrease in ejection fraction, 60±11% to 47±11% (p=0.015) before and 24h after coronary artery bypass grafting, respectively. All immunological variables, except tumor necrosis factor-alpha soluble receptor I at 3h postoperation (5.5± 0.5 in group 1 versus 5.9±0.2 pg/ml in group 2; p=0.048), were similar between groups. Postoperative troponin-I had an inverse correlation with ejection fraction at 24h (r= -0.44). CONCLUSIONS: Inflammatory activity, assessed based on tumor necrosis factor-alpha and its receptors, appears to play a minor role in cardiac dysfunction after cardiac surgery. Troponin I levels are inversely associated with early postoperative ejection fraction.

Morphofunctional study of the junction between the left atrium and the pulmonary veins in patient with pulmonary hypertension

OBJECTIVE: To study the arrangement of the myocardial fiber bundles at the pulmonary venous left atrial junction in patients with pulmonary hypertension, and to discuss the pathophysiological importance of this element in the etiology of acute pulmonary edema. METHODS: We obtained 12 hearts and their pulmonary vein extremities from postmortem examinations of patients with the anatomicopathological diagnosis of acute pulmonary edema. The specimens, which had no grossly visible morphological cardiac alterations, were fixed in 10% formalin, and the muscular arrangement of the pulmonary venous left atrial junctions was analyzed. This material was then isolated, embedded in paraffin, underwent serial cutting (50 µm of thickness), and was stained with Azam's trichrome. RESULTS: We observed in our specimens that: a) the myocardial fiber bundles that originate in the atrial wall and involve the openings of the pulmonary veins were fewer than those observed in healthy material; b) the myocardial fiber bundles that extend into the pulmonary veins were shorter than those found in material originating from individuals with no pulmonary hypertension. CONCLUSION: Anatomical changes that result in a reduction in the amount of myocardial fiber bundles in the pulmonary venous left atrial junction, isolated or associated with other factors, may be the cause of disorders in pulmonary circulation, leading to an increase in pulmonary venous pressure, and, consequently, to acute pulmonary edema.

Does a Role Exist for Tilting-Guided Therapy in the Management of Neurocardiogenic Syncope?

PURPOSE: Upright tilt-table testing (UTT) is an useful method for identifying patients with neurocardiogenic syncope, but its role in the evaluation of therapeutic efficacy is controversial. The aim of this study was to determine the correlation between negative UTT after therapy introduction (acute efficacy) and symptom recurrence during follow-up (chronic efficacy). METHODS: We studied 56 severely symptomatic patients (age 27±19 years) with recurrent (7±12 episodes) neurocardiogenic syncope (positive UTT). Once empirical pharmacological therapy was initiated, all patients underwent another UTT (therapeutic evaluation test - TET). Therapy was not modified after TET results. The probability of symptom recurrence was analyzed with the Kaplan-Meier method and compared by log-rank test in patients with negative and positive TET. RESULTS: Negative UTT after therapy was related to a significantly lower probability of recurrence during follow-up (4.9 versus 52.4% in 12 months, P<0.0001). CONCLUSION: A good correlation exists between acute and long-term efficacy of pharmacological therapy for neurocardiogenic syncope, so that serial UTT may be considered a good method for identifying an effective therapeutic strategy.

Comparison between tilt-table testing results performed during different periods of the day

OBJECTIVE: To evaluate the influences of circadian variations on tilt-table testing (TTT) results by comparing the positivity rate of the test performed during the morning with that of the test performed in the afternoon and to evaluate the reproducibility of the results in different periods of the day. METHODS: One hundred twenty-three patients with recurrent unexplained syncope or near-syncope referred for TTT were randomized into 2 groups. In group I, 68 patients, TTT was performed first in the afternoon and then in the morning. In group II, 55 patients, the test was performed first in the morning and then in the afternoon. RESULTS: The TTT protocol was the prolonged passive test, without drug sensitization. Twenty-nine (23.5%) patients had a positive result in at least one of the periods. The positivity rate for each period was similar: 20 (16.2%) patients in the afternoon and 19 (15.4%) in the morning (p=1.000). Total reproducibility (positive/positive and negative/negative) was observed in 49 (89%) patients in group I and in 55 (81%) in group II. Reproducibility of the results was obtained in 94 (90.4%) patients with first negative tests but in 10 (34%) patients with first positive tests. CONCLUSION: TTT could be performed during any period of the day, and even in the 2 periods to enhance positivity. Considering the low reproducibility rate of the positive tests, serial TTT to evaluate therapeutic efficacy should be performed during the same period of the day.

Verfahren zur direkten Implementierung von Algorithmen auf Gatterebene

Bit serial, processing, digital signal processing, transmission, time division, linear programming, linear optimization

Neural correlates of target detection in the attentional blink

Attention, attentional blink, rapid serial visual presentation, RSVP, ERP, EEG, fMRI, gammaband, oscillatiory activity

Ansteuerkonzept für piezoelektrische Aktoren

Piezoelectric actuator, electric drive, switching amplifier, charge pump, energy recovery, model of the piezoelectric actuator, mixed-mode-simulation, FPGA, voltage control, bit serial implementation

Changes in Medical Management after Coronary CT Angiography

AbstractIntroduction:Coronary computed tomography angiography (CCTA) allows for non-invasive coronary artery disease (CAD) phenotyping. There are still some uncertainties regarding the impact this knowledge has on the clinical care of patients.Objective:To determine whether CAD phenotyping by CCTA influences clinical decision making by the prescription of cardiovascular drugs and their impact on non-LDL cholesterol (NLDLC) levels.Methods:We analysed consecutive patients from 2008 to 2011 submitted to CCTA without previous diagnosis of CAD that had two serial measures of NLDLC, one up to 3 months before CCTA and the second from 3 to 6 months after.Results:A total of 97 patients were included, of which 69% were men, mean age 64 ± 12 years. CCTA revealed that 18 (18%) patients had no CAD, 38 (39%) had non-obstructive (< 50%) lesions and 41 (42%) had at least one obstructive ≥ 50% lesion. NLDLC was similar at baseline between the grups (138 ± 52 mg/dL vs. 135 ± 42 mg/dL vs. 131 ± 44 mg/dL, respectively, p = 0.32). We found significative reduction in NLDLC among patients with obstrctive lesions (-18%, p = 0.001). We also found a positive relationship between clinical treatment intensification with aspirin and cholesterol reducing drugs and the severity of CAD.Conclusion:Our data suggest that CCTA results were used for cardiovascular clinical treatment titration, with especial intensification seen in patients with obstructive ≥50% CAD.

Estudos sôbre Ascia monuste orseis (GODART, 1818) (Lep., Pierididae)

A biologia de Ascia monuste orseis (Godart, 1818) (Lep., Pierididae) foi estudada. O material utilizado foi coligido em Campinas e Piracicaba (Estado de São Paulo), durante os meses de dezembro de 1951 e janeiro de 1952 e constituiu-se principalmente de posturas do inseto. O número máximo de ovos, obtido de uma fêmea, em condições de laboratório, foi de 202, sendo registradas algumas observações sobre o comportamento da borboleta durante a oviposição na natureza. Os ovos e as posturas são descritos. A incubação exigiu cerca de 4 dias. Durante a vida larvária, a espécie passa por 5 estádios, sofrendo, portanto, 4 ecdises. São descritas as lagartas em tôdas essas idades. O ciclo completo, de ôvo a imago, andou ao redor de 22 dias. O 5º. estádio larval mostrou-se, de todos, o mais longo, consumindo 3 até 6 dias. O período de crisálida abrangeu 6 a 7 dias. Os adultos viveram, em insetário, 5 a 9 dias, quer em presença ou em ausência de uma mecha de algodão hidrófilo em-bebida de uma mistura de água e mel. Unicamente um caso de parasitismo foi verificado, os Autores concluindo que, nestas regiões de São Paulo, na época em que as observações foram feitas, a espécie é muito pouco perseguida por agentes naturais de controle. O parasito foi identificado pelo Professor Luis De Santis, da Universidade de La Plata (Rep. Argentina), como Pteromalus caridei Brèthes, 1913, interessante Hymenoptera da família Pteromalidae. Os Autores procuraram esclarecer a ação do pardal - Passer domesticus domesticus (L.) - com relação às lagartas de A. m. orseis, uma vez que há, entre olericultures, a crença de que o referido Ploceidae constitui inimigo do Lepidoptera em estudo. As observações colhidas não permitiram uma conclusão, sendo, contudo, de molde a negar a ação do pássaro como devorador das lagartas.

Parallel Architecture Prototype for 60 GHz High Data Rate Wireless Single Carrier Receiver

Nowadays a huge attention of the academia and research teams is attracted to the potential of the usage of the 60 GHz frequency band in the wireless communications. The use of the 60GHz frequency band offers great possibilities for wide variety of applications that are yet to be implemented. These applications also imply huge implementation challenges. Such example is building a high data rate transceiver which at the same time would have very low power consumption. In this paper we present a prototype of Single Carrier -SC transceiver system, illustrating a brief overview of the baseband design, emphasizing the most important decisions that need to be done. A brief overview of the possible approaches when implementing the equalizer, as the most complex module in the SC transceiver, is also presented. The main focus of this paper is to suggest a parallel architecture for the receiver in a Single Carrier communication system. This would provide higher data rates that the communication system canachieve, for a price of higher power consumption. The suggested architecture of such receiver is illustrated in this paper,giving the results of its implementation in comparison with its corresponding serial implementation.

The Research of Increase of Channel Efficiency for IP Traffic Transmission over Digital Power Line Carrier Channels

This article is devoted to the research of channel efficiency for IP-traffic transmission over Digital Power Line Carrier channels. The application of serial WAN connections and header compression as methods to increase channel efficiency is considered. According to the results of the research an effective solution for network traffic transmission in DPLC networks was proposed.

Nutrição mineral das plantas ornamentais: II - absorção de macronutrientes pelo craveiro

Plantas de cravo (Dianthus caryophyllus L.) das variedades "Evening Grown", "White Sim", "Yellow Sim", "Red Sim" e "Dust" foram coletadas na época do transplante, aos 15, 30, 35, 75 e 115 dias em uma plantação comercial na região de Atibaia, S. Paulo. As plantas foram divididas em caule, fôlhas, flores e analisadas para nitrogênio, fósforo, potássio, cálcio, magnésio e enxofre. Observou-se que o craveiro cresce em altura até aos 115 dias e em peso até aos 75 dias estabilizando o pêso após este estádio. O teor porcentual dos nutrientes, na matéria sêca oscilou em torno de 2% para nitrogênio, 0,2% a 0,8% para o fósforo, 2%a 4% para o potássio, 1% para o cálcio, 0,3% para o magnésio e 0,2% para o enxofre. Uma planta de cravo aos 115 dias de idade contém: 581 mg de nitrogênio, 82 mg de fósforo, 1026 mg de potássio, 348 mg de cálcio, 90 mg de magnésio, 55 mg de enxofre.

Variação do regime de umidade do solo durante o ciclo fenológico de plantas de batata

Neste trabalho foram analisadas as relações entre a produção, o desenvolvimento vegetativo e a evapotranspiração de uma cultura de batata (Solanum tuberosum L.) submetida à três regimes de umidade, definidos pelos valores assumidos pelo potencial matricial da água do solo antes de se proceder as irrigações (-0,5; -1,0 e -5,0 bares) em três estádios de desenvolvimento das plantas. Com respeito à produção de tubérculos, ficou evidenciado que por ocasião da tuberização e desenvolvimento de um grande número de tubérculos, as plantas revelaram uma maior sensibilidade à redução da umidade do solo. Assim, ocorrendo deficits moderados (-1,0 bar) no período inicial de desenvolvimento, a produção não foi significativamente afetada. Isto foi atribuído, em parte, à recuperação parcial do crescimento vegetativo no estádio subseqüente, quando foram restabelecidas condições mais adequadas de umidade no solo. O mesmo não se verificou no tratamento submetido a deficits mais severos (-5,0 bares) no estádio inicial. Neste caso, o crescimento foi quase irreversivelmente reduzido, contribuindo para diminuir a produção e a eficiência de utilização de água pelas plantas. A redução da umidade do solo, a partir dos 60 dias após a emergência das plantas, não afetou a produção de tubérculos. Este procedimento concorreu para aumentar significativamente a eficiência de utilização de água. Além disso, havendo suspensão total da irrigação neste período, a senescência foi antecipada em 16 dias, em relação aos tratamentos submetidos a níveis de umidade mais elevados. O desenvolvimento vegetativo e a produção não foram igualmente afetados pela redução da umidade do solo. Conseqüentemente, o crescimento das plantas não parece se constituir em um índice absoluto da produção de tubérculos de batata.