996 resultados para late potential


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Background: Heart transplant rejection originates slow and fragmented conduction. Signal-averaged ECG (SAECG) is a stratification method in the risk of rejection. Objective: To develop a risk score for rejection, using SAECG variables. Methods: We studied 28 transplant patients. First, we divided the sample into two groups based on the occurrence of acute rejection (5 with rejection and 23 without). In a second phase, we divided the sample considering the existence or not of rejection in at least one biopsy performed on the follow-up period (rejection pm1: 18 with rejection and 10 without). Results: On conventional ECG, the presence of fibrosis was the only criterion associated with acute rejection (OR = 19; 95% CI = 1.65-218.47; p = 0.02). Considering the rejection pm1, an association was found with the SAECG variables, mainly with RMS40 (OR = 0.97; 95% CI = 0.87-0.99; p = 0.03) and LAS40 (OR = 1.06; 95% IC = 1.01-1.11; p = 0.03). We formulated a risk score including those variables, and evaluated its discriminative performance in our sample. The presence of fibrosis with increasing of LAS40 and decreasing of RMS40 showed a good ability to distinguish between patients with and without rejection (AUC = 0.82; p < 0.01), assuming a cutoff point of sensitivity = 83.3% and specificity = 60%. Conclusion: The SAECG distinguished between patients with and without rejection. The usefulness of the proposed risk score must be demonstrated in larger follow-up studies.

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Abstract Background: The revascularization strategy of the left main disease is determinant for clinical outcomes. Objective: We sought to 1) validate and compare the performance of the SYNTAX Score 1 and 2 for predicting major cardiovascular events at 4 years in patients who underwent unprotected left main angioplasty and 2) evaluate the long-term outcome according to the SYNTAX score 2-recommended revascularization strategy. Methods: We retrospectively studied 132 patients from a single-centre registry who underwent unprotected left main angioplasty between March 1999 and December 2010. Discrimination and calibration of both models were assessed by ROC curve analysis, calibration curves and the Hosmer-Lemeshow test. Results: Total event rate was 26.5% at 4 years.The AUC for the SYNTAX Score 1 and SYNTAX Score 2 for percutaneous coronary intervention, was 0.61 (95% CI: 0.49-0.73) and 0.67 (95% CI: 0.57-0.78), respectively. Despite a good overall adjustment for both models, the SYNTAX Score 2 tended to underpredict risk. In the 47 patients (36%) who should have undergone surgery according to the SYNTAX Score 2, event rate was numerically higher (30% vs. 25%; p=0.54), and for those with a higher difference between the two SYNTAX Score 2 scores (Percutaneous coronary intervention vs. Coronary artery by-pass graft risk estimation greater than 5.7%), event rate was almost double (40% vs. 22%; p=0.2). Conclusion: The SYNTAX Score 2 may allow a better and individualized risk stratification of patients who need revascularization of an unprotected left main coronary artery. Prospective studies are needed for further validation.

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Magdeburg, Univ., Fak. für Naturwiss., Diss., 2010

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Magdeburg, Univ., Fak. für Verfahrens- und Systemtechnik, Diss., 2010

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Magdeburg, Univ., Fak. für Verfahrens- und Systemtechnik, Diss., 2010

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Die aus Schichtarbeit resultierende Verschiebung der zeitlichen Lage von Arbeit und Schlaf führt zu einer Belastung für den menschlichen Organismus. Inwieweit diese Belastung für ein Individuum zur Beanspruchung wird, ist neben anderen Faktoren auch vom Ausmaß dieser Verschiebung abhängig. Die individuelle Zeitstruktur eines Menschen findet dabei Ausdruck in seinem Chronotypus (ugs. "Eulen" und "Lerchen"). Ziel dieser Arbeit ist es, zu ermitteln, inwieweit eine betriebliche Berücksichtigung individueller Chronotypen bei Schichtarbeitenden zu deren Gesunderhaltung beitragen kann. Hierfür wurde eine systematische Literaturrecherche für den Zeitraum 2000 bis 2013 durchgeführt. Es kann aufgezeigt werden, dass die Belastung der Schichtarbeit nicht für alle Chronotypen identisch ist. Vielmehr ist die Adaptionsfähigkeit an konkret zu leistende Schichten, z.B. eine Nachtschicht, vom Chronotyp abhängig. Aus dem Zusammenhang zwischen Chronotyp, Schicht und Schlaf resultiert die Empfehlung einer zukünftigen Berücksichtigung in der Gestaltung von Schichtplänen. Eine engmaschige arbeitsmedizinische Begleitung extremer Chronotypen und die individuelle Schlafberatungen aller Früh- und Spättypen sind zusätzlich angeratene Maßnahmen betrieblicher Gesundheitsförderung mit vermutlich kurzfristiger Wirksamkeit.