Anesthesia-related and perioperative cardiac arrest in low- and high-income countries: a systematic review with meta-regression and proportional meta-analysis

The anesthesia-related cardiac arrest (CA) rate is a quality indicator to improve patient safety in the perioperative period. A systematic review with meta-analysis of the worldwide literature related to anesthesia-related CA rate has not yet been performed.This study aimed to analyze global data on anesthesia-related and perioperative CA rates according to country's Human Development Index (HDI) and by time. In addition, we compared the anesthesia-related and perioperative CA rates in low- and high-income countries in 2 time periods.A systematic review was performed using electronic databases to identify studies in which patients underwent anesthesia with anesthesia-related and/or perioperative CA rates. Meta-regression and proportional meta-analysis were performed with 95% confidence intervals (CIs) to evaluate global data on anesthesia-related and perioperative CA rates according to country's HDI and by time, and to compare the anesthesia-related and perioperative CA rates by country's HDI status (low HDI vs high HDI) and by time period (pre-1990s vs 1990s-2010s), respectively.Fifty-three studies from 21 countries assessing 11.9 million anesthetic administrations were included. Meta-regression showed that anesthesia-related (slope: -3.5729; 95% CI: -6.6306 to -0.5152; P = 0.024) and perioperative (slope: -2.4071; 95% CI: -4.0482 to -0.7659; P = 0.005) CA rates decreased with increasing HDI, but not with time. Meta-analysis showed per 10,000 anesthetics that anesthesia-related and perioperative CA rates declined in high HDI (2.3 [95% CI: 1.2-3.7] before the 1990s to 0.7 [95% CI: 0.5-1.0] in the 1990s-2010s, P < 0.001; and 8.1 [95% CI: 5.1-11.9] before the 1990s to 6.2 [95% CI: 5.1-7.4] in the 1990s-2010s, P < 0.001, respectively). In low-HDI countries, anesthesia-related CA rates did not alter significantly (9.2 [95% CI: 2.0-21.7] before the 1990s to 4.5 [95% CI: 2.4-7.2] in the 1990s-2010s, P = 0.14), whereas perioperative CA rates increased significantly (16.4 [95% CI: 1.5-47.1] before the 1990s to 19.9 [95% CI: 10.9-31.7] in the 1990s-2010s, P = 0.03).Both anesthesia-related and perioperative CA rates decrease with increasing HDI but not with time. There is a clear and consistent reduction in anesthesia-related and perioperative CA rates in high-HDI countries, but an increase in perioperative CA rates without significant alteration in the anesthesia-related CA rates in low-HDI countries comparing the 2 time periods.

Uma nova estratégia na determinação de macroelementos :'K', 'Ca', e 'Mg em plantas medicinais empregando espectrometria de absorção atômica com fonte contínua e alta resolução

A simple and fast method to determine Ca, K and Mg in a single aliquot of medicinal plants by HR-CS FAAS is proposed. The secondary lines for Ca (239.856 nm) and K (404.414 nm), and the alternate line measured at wing of the secondary line for Mg at (202.588 nm) allowed calibration within the 20 - 500 mg.L-1 Ca and K, and 1.0 - 80 mg.L-1 Mg. Twenty samples and three plant certified materials were analyzed. Results were in agreement at a 95% confidence level with reference values. Limits of detection were 2.4 mg.L-1 Ca, 1.9 mg.L-1 K and 0.3 mg.L-1 Mg. The RSD (n=12) were ≤ 5.1% and recoveries were between 83 and 108% for all analytes.

Parada cardíaca perioperatória e relacionada à anestesia: revisão sistemática com meta-análise proporcional e análise de metarregressão

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Growth hormone pharmacogenetics: the interactive effect of a microsatellite in the IGF1 promoter region with the GHR-exon 3 and-202 A/C IGFBP3 variants on treatment outcomes of children with severe GH deficiency

Insulin-like growth factor type 1 (IGF1) is a mediator of growth hormone (GH) action, and therefore, IGF1 is a candidate gene for recombinant human GH (rhGH) pharmacogenetics. Lower serum IGF1 levels were found in adults homozygous for 19 cytosine-adenosine (CA) repeats in the IGF1 promoter. The aim of this study was to evaluate the influence of (CA)n IGF1 polymorphism, alone or in combination with GH receptor (GHR)-exon 3 and -202 A/C insulin-like growth factor binding protein-3 (IGFBP3) polymorphisms, on the growth response to rhGH therapy in GH-deficient (GHD) patients. Eighty-four severe GHD patients were genotyped for (CA) n IGF1, -202 A/C IGFBP3 and GHR-exon 3 polymorphisms. Multiple linear regressions were performed to estimate the effect of each genotype, after adjustment for other influential factors. We assessed the influence of genotypes on the first year growth velocity (1st y GV) (n = 84) and adult height standard deviation score (SDS) adjusted for target-height SDS (AH-TH SDS) after rhGH therapy (n = 37). Homozygosity for the IGF1 19CA repeat allele was negatively correlated with 1st y GV (P = 0.03) and AH-TH SDS (P = 0.002) in multiple linear regression analysis. In conjunction with clinical factors, IGF1 and IGFBP3 genotypes explain 29% of the 1st y GV variability, whereas IGF1 and GHR polymorphisms explain 59% of final height-target-height SDS variability. We conclude that homozygosity for IGF1 (CA) 19 allele is associated with less favorable short-and long-term growth outcomes after rhGH treatment in patients with severe GHD. Furthermore, this polymorphism exhibits a non-additive interaction with -202 A/C IGFBP3 genotype on the 1st y GV and with GHR-exon 3 genotype on adult height. The Pharmacogenomics Journal (2012) 12, 439-445; doi:10.1038/tpj.2011.13; published online 5 April 2011

Chemical and isotope compositions of thermal and surficial waters from the Chukotka Peninsula

Twenty three groups of thermomineral springs in the eastern Chukotka with discharge temperature from 2 to 97°C and mineralization from 1.47 to 37.14 g/l are studied and compared with surface freshwater from their localities. dD and d18O values in surface waters vary from -121.4 to -89.5 per mil and from -16.4 to -11.1 per mil, respectively, while respective values in thermomineral waters range from -134.2 to -92.5 per mil and from -17.6 to -10.5 per mil. dD value in surface waters decreases from the east to the west, i.e. toward interior areas of the peninsula. Hydrothermal springs most depleted in deuterium (dD < -120 per mil) are localized in the geodynamically active Kolyuchinskaya-Mechigmen Depression. According to the proposed formation model of Chukotka thermomineral waters their observed chemical and isotopic characteristics could result from mixing (in different proportions) of surface waters with the deep-sourced isotopically light mineralized component (dD = ca. -138 per mil, d18O = ca. -19 per mil, ? = from 9.5 to 14.7 g/l). The latter originates most likely from subpermafrost waters subjected to slight cryogenic metamorphism.

Isotopic analyses of DSDP Hole 45-395A samples from veins containing gypsum (Table 1)

Gypsum and halite crystals, together with saponite and phillipsite, were found in a vein in a basalt sill 625 m below the sea floor at DSDP Site 395A, located 190 km west of the crest of the Mid-Atlantic Ridge. The delta34S value of the gypsum (+19.4?) indicates a seawater source for the sulfate. The delta18O values of the saponite (+19.9?) and phillipsite (+18.1?) indicate either formation from normal seawater at about 55°C or formation from delta18O-depleted seawater at a lower temperature. The gypsum (which could be secondary after anhydrite) was formed by reaction between Ca[2+] released from basalt and SO4[2-] in circulating seawater. The halite could have formed when water was consumed by hydration of basalt under conditions of extremely restricted circulation. A more probable mechanism is that the gypsum was originally precipitated as anhydrite at temperatures above 60°C. As the temperature dropped the anhydrite converted to gypsum. The conversion would consume water, which could cause halite precipitation, and would cause an increase in the volume of solids, which would plug the vein and prevent subsequent dissolution of the halite.

Grazing under experimental hypercapnia and elevated temperature does not affect the radula of a chiton (Mollusca, Polyplacophora, Lepidopleurida)

Chitons (class Polyplacophora) are benthic grazing molluscs with an eight-part aragonitic shell armature. The radula, a serial tooth ribbon that extends internally more than half the length of the body, is mineralised on the active feeding teeth with iron magnetite apparently as an adaptation to constant grazing on rocky substrates. As the anterior feeding teeth are eroded they are shed and replaced with a new row. The efficient mineralisation and function of the radula could hypothetically be affected by changing oceans in two ways: changes in seawater chemistry (pH and pCO2) may impact the biomineralisation pathway, potentially leading to a weaker or altered density of the feeding teeth; rising temperatures could increase activity levels in these ectothermic animals, and higher feeding rates could increase wear on the feeding teeth beyond the animals' ability to synthesise, mineralise, and replace radular rows. We therefore examined the effects of pH and temperature on growth and integrity in the radula of the chiton Leptochiton asellus. Our experiment implemented three temperature (10, 15, 20 °C) and two pCO2 treatments (400 µatm, pH 8.0; 2000 µatm, pH 7.5) for six treatment groups. Animals (n = 50) were acclimated to the treatment conditions for a period of 4 weeks. This is sufficient time for growth of ca. 7-9 new tooth rows or 20% turnover of the mineralised portion. There was no significant difference in the number of new (non-mineralised) teeth or total tooth row count in any treatment. Examination of the radulae via SEM revealed no differences in microwear or breakage on the feeding cusps correlating to treatment groups. The shell valves also showed no signs of dissolution. As a lineage, chitons have survived repeated shifts in Earth's climate through geological time, and at least their radulae may be robust to future perturbations.

Census of calcareous nannofossil taxa expressed as percent of total number of individuals counted, ODP Legs 113, 114, 119, 120

Quantitative analysis of upper Eocene-upper Oligocene calcareous nannofossil assemblages from five Ocean Drilling Program sites in the Atlantic and Indian Ocean sectors of the Southern Ocean reveals an abrupt increase in cool-water taxa at the top of magnetic Subchron C13R ca. 35.9 Ma, coincident with an enrichment of ~1? d18O in the planktonic foraminifers at these sites. The synchrony of the abrupt increase in cool-water taxa in the Southern Ocean renders this event a useful biostratigraphic datum at southern high latitudes. This earliest Oligocene cool-water taxa increase was the sharpest and largest during the late Eocene-late Oligocene interval and indicates a drop in surface-water temperature of more than 3°C in the Southern Ocean. This suggests that the earliest Oligocene d18O shift represents primarily a temperature signal; a small portion (~0.2?) is attributable to a global ice-volume increase.

Mn/Ca and Fe/Ca systematics in benthic foraminifera from the Peruvian OMZ

In this study we present an initial dataset of Mn/Ca and Fe/Ca ratios in tests of benthic foraminifera from the Peruvian oxygen minimum zone (OMZ) determined with SIMS. These results are a contribution to a better understanding of the proxy potential of these elemental ratios for ambient redox conditions. Foraminiferal tests are often contaminated by diagenetic coatings, like Mn rich carbonate- or Fe and Mn rich (oxyhydr)oxide coatings. Thus, it is substantial to assure that the cleaning protocols are efficient or that spots chosen for microanalyses are free of contaminants. Prior to the determination of the element/Ca ratios, the distributions of several elements (Ca, Mn, Fe, Mg, Ba, Al, Si, P and S) in tests of the shallow infaunal species Uvigerina peregrina and Bolivina spissa were mapped with an electron microprobe (EMP). To visualize the effects of cleaning protocols uncleaned and cleaned specimens were compared. The cleaning protocol included an oxidative cleaning step. An Fe rich phase was found on the inner test surface of uncleaned U. peregrina specimens. This phase was also enriched in Al, Si, P and S. A similar Fe rich phase was found at the inner test surface of B. spissa. Specimens of both species treated with oxidative cleaning show the absence of this phase. Neither in B. spissa nor in U. peregrina were any hints found for diagenetic (oxyhydr)oxide or carbonate coatings. Mn/Ca and Fe/Ca ratios of single specimens of B. spissa from different locations have been determined by secondary ion mass spectrometry (SIMS). Bulk analyses using solution ICP-MS of several samples were compared to the SIMS data. The difference between SIMS analyses and ICP-MS bulk analyses from the same sampling sites was 14.0-134.8 µmol mol-1 for the Fe/Ca and 1.68(±0.41) µmol mol-1 for the Mn/Ca ratios. This is in the same order of magnitude as the variability inside single specimens determined with SIMS at these sampling sites (1sigma[Mn/Ca] = 0.35-2.07 µmol mol-1; 1sigma[Fe/Ca] = 93.9-188.4 µmol mol-1). The Mn/Ca ratios in the calcite were generally relatively low (2.21-9.93 µmol mol-1) but in the same magnitude and proportional to the surrounding pore waters (1.37-6.67 µmol mol-1). However, the Fe/Ca ratios in B. spissa show a negative correlation to the concentrations in the surrounding pore waters. Lowest foraminiferal Fe/Ca ratios (87.0-101.0 µmol mol-1) were found at 465 m water depth, a location with a strong sharp Fe peak in the pore water next to the sediment surface and respectively, high Fe concentrations in the surrounding pore waters. Previous studies found no living specimens of B. spissa at this location. All these facts hint that the analysed specimens already were dead before the Fe flux started and the sampling site just recently turned anoxic due to fluctuations of the lower boundary of the OMZ near the sampling site (465 m water depth). Summarized Mn/Ca and Fe/Ca ratios are potential proxies for redox conditions, if cleaning protocols are carefully applied. The data presented here may be rated as base for the still pending detailed calibration.

Red Sea Region, North Africa, ca. 1730 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Carte de l'Egypte, de la Nubie, de l'Abyssinie &c., par Guillaume de l'Isle, de l'Academie Royal a Paris. It was published by Chez Henri de Leth, a l'enseigne du Pecheur ca. 1730. Scale [ca. 1:9,250,000]. Covers the Red Sea region, North Africa including portions of the Middle East and Europe. Map in French.The image inside the map neatline is georeferenced to the surface of the earth and fit to the Africa Sinusoidal projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, major roads, cities and other human settlements, territorial boundaries, shoreline features, and more. Relief shown pictorially. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

Martinsburg, West Virginia and vicinity, ca. 1864 (Raster Image)

This layer is a georeferenced raster image of the historic paper manuscript map entitled: Plan of Martinsburg and vicinity. "This map was drawn by that noble officer Capt. C.L. Chandler and was much prized by our late Col. Geo. D. Wells, Chas. H. Howland, 1st Lt. & B. Gen., 34th Mass. Inf."-verso. It was sketched ca. 1864. Scale [ca. 1:9,250]. The image inside the map neatline is georeferenced to the surface of the earth and fit to the West Virginia State Plane North Coordinate System (in Meters) (Fipszone 4701). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, or other information associated with the principal map. This map shows features such as roads, railroads, selected dwellings with names of inhabitants, lines of pickets, troop location and camps, drainage, and more. Relief shown by form lines. This layer is part of a selection of digitally scanned and georeferenced historic maps of the Civil War from the Harvard Map Collection. Many items from this selection are from a collection of maps deposited by the Military Order of the Loyal Legion of the United States Commandery of the State of Massachusetts (MOLLUS) in the Harvard Map Collection in 1938. These maps typically portray both natural and manmade features, in particular showing places of military importance. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

Ottoman Empire, ca. 1790 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Empire de la Porte ottomane en Europe, en Asie et en Afrique avec les pays qui lui sont tributaires, dressé par les Frères Lotter. It was published by Frères Lotter ca. 1790. Scale [ca. 1:9,000,000]. Covers the Ottoman Empire. Map in French. The image inside the map neatline is georeferenced to the surface of the earth and fit to a modified 'Europe Lambert Conformal Conic' projection with a central meridian of 38 degrees East projection. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, territorial and provincial boundaries, shoreline features, and more. Relief shown pictorially. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection as part of the Open Collections Program at Harvard University project: Islamic Heritage Project. Maps selected for the project represent a range of regions, originators, ground condition dates, scales, and purposes. The Islamic Heritage Project consists of over 100,000 digitized pages from Harvard's collections of Islamic manuscripts and published materials. Supported by Prince Alwaleed Bin Talal and developed in association with the Prince Alwaleed Bin Talal Islamic Studies Program at Harvard University.

West & North Africa, ca. 1710 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Carte de la Barbarie, le [sic] la Nigritie et del la Guinée, par Guillaume de l'Isle de l'Academie Royale des Sciences. It was published by ex officina Nicolai Visscher, ca. 1710. Scale [ca.1:9,000,000]. Covers West and North Africa. Map in French.The image inside the map neatline is georeferenced to the surface of the earth and fit to the Africa Sinusoidal projected coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, routes and roads, territorial boundaries, shoreline features, and more. Relief shown pictorially. Includes notes.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.