Anesthesia-related mortality in pediatric patients: a systematic review

This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics) and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesiarelated mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.

A história do intemperismo na Província Borborema Oriental, Nordeste do Brasil: implicações paleoclimáticas e tectônicas

Until some years ago, weathering geochronology was primarily based on the K-Ar and 40Ar/39Ar dating of supergene minerals. Recent advances in the analysis of supergene goethite by the (U-Th)/He method expanded the number of suitable minerals for such purpose, as well as the time of application for weathering geochronology. This study represents the first systematic approach in Brazil, combining both the 40Ar/39Ar e (U-Th)/He methodologies to improve the knowledge on the weathering and the age of nonfossiliferous sediments. Supported by geologic and geomorphologic correlations, we identified different types of weathering profiles occurring in the interior and coastal areas of northeastern Brazil. These profiles were correlated to main regional geomorphological domains: the Borborema Plateau , the Sertaneja Depression , and the Coastal Cuestas and Plains, and respective planation surfaces, which study is fundamental to understand the landscape evolution of the northern portion of the eastern Borborema Province. The depth and stratigraphic organization of the weathering profiles in each of the geomorphological domains permitted to establish that: (i) the profiles on the highlands that cap the Borborema Surface are deeper (up to 100 m) and can be considered as typical lateritic profiles; (ii) on the lowlands that form the Sertaneja Surface , the weathering profiles are shallow and poorly developed (2-5 m deep); (iii) the profiles along the coastal area are moderately developed (up to 25 m deep), and are characterized by thick saprolites and mottle zones. Aiming to establish the timing of the evolution of northeastern Brazil, we studied 29 weathering profiles representing distinct topographic levels of the Borborema Province, from the highlands to the coast, through the analysis of 248 grains of supergene manganese oxides using laser step-heating 40Ar/39Ar geochronology. Additionally, we applied the (U-Th)/He method in 20 weathering profiles, by dating 171 grains of supergene iron oxides and hydroxides. Geochronological results for 248 grains of manganese oxides analyzed by the 40Ar/39Ar method indicate that the weathering profiles in the study area record the history of weathering from the Oligocene to the Pleistocene, with ages in the order of 31.4 ± 1.0 Ma to 0.8 ± 0.4 Ma. Dating of 171 grains of goethite by the (U-Th)/He method yielded ages ranging from 43.2 ± 4.3 Ma to 0.8 ± 0.1 Ma, suggesting the weathering processes last from the Eocene to the Pleistocene. The precipitation of supergene goethite in this interval confirms the age of the weathering processes identified from the manganese oxides record. 105 goethite grains from 8 different occurrences of the Barreiras Formation were dated by the (U-Th)/He method. Five grains collected from the cement in the Barreiras Formation sandstones, in the Lagoa Salgada and Rio do Fogo coastal cuestas, yielded ages of 17.6 ± 1.8 Ma, 17.3 ± 1.7 Ma, 16.3 ± 1.6 Ma, 16.2 ± 1.6 Ma and 13.6 ± 1.4 Ma. Results of 69 goethite grains from authigenic pisoliths collected in 7 different localities also yielded concordant ages, varying from 17.8 ± 1.8 to 7.5 ± 0.8 Ma. Results obtained from 31 detrital grains are concordant in 3 distinct localities (Lagoa Salgada, Praia da Garças e Ponta Grossa); they vary in the range of 43.2 ± 4.3 to 21.6 ± 2.2 Ma, and indicate that the maximum age for the Barreiras Formation deposition is around 22 Ma. 40Ar/39Ar results for 15 manganese oxides grains associated with the Barreiras Formation weathering profiles, in 3 different localities, vary from 13.1 ± 0.9 to 7.7 ± 0.4 Ma, in the same range of ages obtained by the (U-Th)/He method. The systematic application of the 40Ar/39Ar and (U-Th)/He methods, respectively for manganese oxides and goethites, show that the Barreiras Formation sediments were already deposited since ca. 17 Ma, and that the weathering processes were active until ca. 7 Ma ago. The ages obtained from manganese oxides collected in the Cenozoic basalts (Macau Formation) also reveal a weathering history between 19 and 7 Ma, pointing to hot and humid conditions during most of the Miocene. 40Ar/39Ar ages yielded by manganese oxides associated with the Serra do Martins Formation vary from 14.1 ± 0.4 to 10.5 ± 0.3 Ma. On the other hand, (U-Th)/He ages from iron oxides/hydroxides collected in the Serra do Martins Formation mesas vary from 20.0 ± 2.0 to 5.5 ± 0.6 Ma, indicating that those sediments are older than 20 Ma. 40Ar/39Ar and (U-Th)/He results produced in this study are in agreement with paleoclimatic interpretations based on stable isotopes and clay index values measured in the Atlantic Ocean sediments, validating the use of weathering geochronology to investigate paleoclimatic variations. The direct dating of the Barreiras Formation permitted, for the first time, confident inferences on the age of the brittle deformation recorded by this sedimentary unit in the Rio Grande do Norte and Ceará states. The first event, syn-deposition, occurred during the early Miocene; an younger event, related to the post-depositional deformation of the Barreiras Formation, is associated with tectonic activity from the very early Miocene to the Holocene. In agreement with data from other areas, results obtained in this study reveal that the depth and complexity of the weathering profiles reflect the time of exposition of such areas to the weathering agents close to the surface. However, there is no clear relationship between ages vs. altitude. The depth and the stratigraphic organization of weathering profiles in northeastern Brazil, contrary to the southeastern Brazil pattern, do not vary toward the coast. In our study area, field observations reveal the presence of ancient, thick and complex lateritic profiles preserved in the sedimentary mesas on the Borborema Plateau, as younger, narrow and incipient ones occur in the dissected areas. Geochronological results obtained for these profiles yielded older ages on the high altitudes, and younger ages in the lowlands, suggesting the scarp retreatment is the most reliable model to explain the regional landscape evolution. However, in the coastal lowlands, the relatively older ages obtained indicate that more complexes processes were involved in the modeling of the local relief

Efeito da via de parto sobre a força muscular do assoalho pélvico

OBJETIVO: analisar a influência da via de parto sobre a força muscular do assoalho pélvico (FM-AP). MÉTODOS: estudo clínico de corte transversal, para avaliar a FM-AP pelo teste da avaliação da força do assoalho pélvico (AFA) e uso do perineômetro em primíparas, entre 20-30 anos de idade, 4-6 meses pós-parto. A contração, medida pelos dois testes, foi classificada em: zero - ausência, um - leve, dois - moderada e três - normal, sustentada por 6 segundos. Avaliaram-se 94 mulheres, entre 20 e 30 anos, divididas em três grupos: pós-parto vaginal (n=32); pós-cesárea (n=32) e nulíparas (n=30). A variável independente foi a via de parto e a dependente, a FM-AP. A comparação entre os graus de contração foi realizada pelo teste de Kruskal-Wallis e o teste de Dunn para comparações múltiplas; a influência da via de parto pelo teste chi2, o risco relativo (RR) para alteração da FM-AP e o coeficiente kappa para avaliar equivalência entre os testes. RESULTADOS: a mediana e 1º e 3º quartil da FM-AP foram menores (p=0,01) pós-parto vaginal (2,0;1-2) e intermediários pós-cesárea (2,0; 2-3) em relação às nulíparas (3,0;2-3), tanto analisadas pelo AFA como pelo perineômetro. Aumentou o RR de exame alterado pós-parto vaginal (RR=2,5; IC 95%: 1,3-5,0; p=0,002); (RR=2,3; IC 95%: 1,2-4,3; p=0,005) e pós-cesárea (RR=1,5; IC 95%: 0,94-2,57; p=0,12); (RR=1,3; IC 95%: 0,85-2,23; p=0,29) pelo PFSE e perineômetro, respectivamente. CONCLUSÕES: o parto vaginal diminuiu a força muscular do AP de primíparas quando comparado com os casos submetidos à cesárea e com as nulíparas.

Desenvolvimento e produção de Costus productus Maas como planta de vaso em função de doses de nitrogênio

Pós-graduação em Agronomia (Produção Vegetal) - FCAV

Ação sonoquímica e influência das condições de tratamento térmico na preparação de cimentos do sistema binário CaO-Al2O3

Foram preparados cimentos do sistema binário CaO-Al₂O₃ por meio de uma rota que emprega o processo sonoquímico seguido de tratamento térmico. Convencionalmente estes compostos são fabricados a partir da fusão ou da sinterização de uma mistura de calcário com bauxito ou com alumina. O maior inconveniente associado a este tipo de síntese é a necessidade de temperaturas elevadas e o grande consumo de energia. Na rota sonoquímica a cálcia, juntamente com a alumina em suspensão aquosa, são introduzidas num banho de ultra-som por tempo determinado. Em seguida, após a evaporação da água, o material resultante é tratado termicamente. Quando um sistema é submetido ao processo sonoquímico, alterações na morfologia superficial das partículas podem ser induzidas pelas ondas ultra-sônicas, incluindo a redução do tamanho dessas partículas. Como conseqüência, estes materiais tornam-se mais reativos, facilitando a síntese final dos aluminatos de cálcio durante o tratamento térmico. Foi estudada a ação das ondas ultra-sônicas e a influência das condições de tratamento térmico em duas composições molares de cálcia:alumina de 1:1 e 1:2. As temperaturas empregadas foram 1000 ºC, 1200 ºC e 1300 ºC com patamares de 1 e 6 h. O material obtido foi caracterizado por microscopia eletrônica de varredura, difração de raios X e as fases presentes foram semi-quantificadas pelo método de Rietveld. Também foram realizados ensaios de compressão diametral para avaliar a resistência mecânica dos produtos da síntese. Foram preparadas pastas constituídas de cimento, alumina e água, utilizando como cimento os aluminatos de cálcio preparados pelo processo sonoquímico e um cimento comercial, como referência.

Crescimento de leguminosas utilizadas na adubação verde em diferentes níveis de sais na água de irrigação

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Manejo da fertirrigação para melancia em função da condutividade elétrica da solução do solo

Pós-graduação em Agronomia (Horticultura) - FCA

Thermal, spectroscopic and DFT studies of solid benzamide

Thermogravimetry (TG), differential thermal analysis (DTA), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), and DFT theoretical calculations were used to study benzamide. The TG-DTA and DSC curves provided information concerning the melting point, evaporation and thermal stability of the compound. Using the FTIR technique it was possible to confirm the evaporation of the compound with no degradation. Density functional theory (DFT) at the 6-311++G (3df, 3dp) level, provided information regarding the energies involved in HOMO-LUMO transitions and the chemical stability of the compound.

Trachoma epidemiological school survey in the city of Embu das Artes - SP

Purpose: To estimate the trachoma prevalence in school children in Embu das Artes - SP, aiming the implementation of the disease epidemiological surveillance. Methods: The city of Embu das Artes - SP, is 25 km far from the capital of the State. In the years of 2003-2004, a trachoma survey was conducted in a cluster sample of school children with the same methodology of the national trachoma student's survey of the Ministry of Health. Previously to the trachoma active search, activities of health education were performed in all schools. External ocular examinations were done in all students to detect trachoma according to the WHO criteria. All cases of trachoma were notified and their families were submitted to an external ocular examination. The cases were treated with 1% tetracycline ointment or systemic azithromycin. Results: 2,374 students from nine sampled selected public schools were examined. The prevalence of follicular inflammatory trachoma (TF) was 3.1% (IC 95%: 2.4-3.9), varying from 0.5% to 4.2% in the examined schools. The prevalence for males was 3.2% and for females was 3.0%. The greater prevalence (8.6%) was found in 6 year-old children. Conclusion: The disease showed a mild behavior in this city, because no cases of intense inflammatory trachoma or cicatricial trachoma were detected. However, the prevalence was greater than the one found in the city of Sao Paulo. Epidemiological surveillance activities of trachoma must be continuous, mainly in places where the greater prevalence had been found.

The Effects of Oxybutynin on Urinary Symptoms in Children with Williams-Beuren Syndrome

Purpose: Williams-Beuren syndrome is a genomic disorder caused by a hemizygous contiguous gene deletion on chromosome 7q11.23. Lower urinary tract symptoms are common in children with Williams-Beuren syndrome. However, there are few data on the management of voiding symptoms in this population. We report our experience using oxybutynin to treat urinary symptoms in children with Williams-Beuren syndrome. Materials and Methods: We prospectively analyzed 42 patients with Williams-Beuren syndrome and significant lower urinary tract symptoms due to detrusor overactivity diagnosed on urodynamics in a 12-week, open-label study. Urological assessment included symptomatic evaluation, the impact of lower urinary tract symptoms on quality of life, frequency-volume chart, urodynamics and urinary tract sonography. After 12 weeks of treatment with 0.6 mg/kg oxybutynin per day given in 3 daily doses, patients were assessed for treatment efficacy and side effects. Results: A total of 17 girls and 19 boys completed medical therapy and were assessed at 12 weeks. Mean +/- SD patient age was 9.2 +/- 4.3 years (range 3 to 18). The most common urinary complaint was urgency, which occurred in 31 patients (86.1%), followed by urge incontinence, which was seen in 29 (80.5%). Compared to baseline, urinary symptoms were substantially improved. The negative impact of storage symptoms on quality of life was significantly decreased from a mean +/- SD of 3.3 +/- 1.7 to 0.5 +/- 0.9 (p <0.001). Mean +/- SD maximum urinary flow improved from 14.2 +/- 15.0 to 20.5 +/- 6.4 ml per second (p <0.001). Conclusions: A total of 12 weeks of therapy with 0.6 mg/kg oxybutynin daily resulted in improvement of lower urinary tract symptoms, quality of life and maximum flow rate in most patients with Williams-Beuren syndrome.

Renal GLUT1 reduction depends on angiotensin-converting enzyme inhibition in diabetic hypertensive rats

Aims: Angiotensin-converting enzyme (ACE) inhibitors are used in diabetic kidney disease to reduce systemic/intra-glomerular pressure. The objective of this study was to investigate whether reducing blood pressure (BP) could modulate renal glucose transporter expression, and urinary markers of diabetic nephropathy in diabetic hypertensive rats treated with ramipril or amlodipine. Main methods: Diabetes was induced in spontaneously-hypertensive rats (~210 g) by streptozotocin (50 mg/kg). Thirty days later, animals received ramipril 15 μg/kg/day (R, n =10), or amlodipine 10 mg/kg/day (A, n= 8,) or water (C, n = 10) by gavage. After 30-day treatment, body weight, glycaemia, urinary albumin and TGF-β1 (enzyme-linked immunosorbent assay) and BP (tail-cuff pressure method) were evaluated. Kidneys were removed for evaluation of renal cortex glucose transporters (Western blotting) and renal tissue ACE activity (fluorometric assay). Key findings: After treatments, body weight (p = 0.77) and glycaemia (p = 0.22) were similar among the groups. Systolic BP was similarly reduced (p < 0.001) in A and R vs. C (172.4 ± 3.2; 186.7 ± 3.7 and 202.2 ± 4.3 mm Hg; respectively). ACE activity (C: 0.903 ± 0.086; A: 0.654 ± 0.025, and R: 0.389 ± 0.057 mU/mg), albuminuria (C: 264.8 ± 15.4; A: 140.8 ± 13.5 and R: 102.8 ± 6.7 mg/24 h), and renal cortex GLUT1 content (C: 46.81 ± 4.54; A: 40.30 ± 5.39 and R: 26.89 ± 0.79 AU) decreased only in R (p < 0.001, p < 0.05 and p < 0.001; respectively). Significance:We concluded that the blockade of the renin–angiotensin systemwith ramipril reduced earlymarkers of diabetic nephropathy, a phenomenon that cannot be specifically related to decreased BP levels.

Experimentelle Untersuchungen zur embryonalen Entwicklung identifizierter Vorläuferzellen des zentralen Nervensystems von Drosophila melanogaster

Zusammenfassung Das ventrale Nervensystem (vNS) von Drosophila melanogaster entsteht aus zwei verschiedenen Populationen von Vorläufern, den mesektodermalen oder Mittellinien (ML)-Vorläufern und den neuroektodermalen Vorläufern oder Neuroblasten (NBs). Beide Populationen unterscheiden sich in vielen Aspekten, wie z.B. Genexpression, Teilungsverhalten und Zellstammbaum. Die ca. 30 NBs pro Hemisegment delaminieren als Einzelzellen aus dem Neuroektoderm und bilden ein invariantes subepidermales Muster in der neu entstandenen neuralen Zellschicht aus. Sie sind dort aufgrund ihrer Lage und der Expression spezifischer molekularer Marker individuell identifizierbar. Um die Mechanismen zu verstehen, die zur Determination und Differenzierung von ZNS Zellen führen, ist es eine Grundvoraussetzung, die Zellstammbäume aller Vorläufer zu kennen. Unter Verwendung des lipophilen in vivo Fluoreszenzfarbstoffs DiI wurden in früheren Arbeiten die Zellstammbäume der ML-Vorläufer und von 17 NBs, die aus der ventralen Hälfte des Neuroektoderms stammten, beschrieben. In der hier vorgelegten Arbeit wurden die Zellstammbäume von 13 NBs, die aus dem dorsalen Teil des Neuroektoderms delaminierten, beschrieben und 12 davon identifizierten Vorläufern zugeordnet. Darüber hinaus wurde ein bisher nicht beschriebener NB (NB 1-3) identifiziert und anhand morphologischer und molekularer Kriterien charakterisiert. Insgesamt produzierten die NBs ca. 120 Neurone und 22 bis 27 Gliazellen pro Hemineuromer, die in eine systematische Terminologie eingefügt wurden. Insgesamt besteht damit ein Neuromer des embryonalen vNS von Drosophila aus ca. 700 Neuronen (350 pro Hemineuromer) und 60 Gliazellen (30 pro Hemineuromer), die von NBs abstammen. Hinzu kommen ca. 12 ML-Neurone und 2 bis 4 ML-Glia pro Neuromer. Damit stammten die meisten Gliazellen im embryonalen vNS von Drosophila von NBs ab, die aus dem dorsalen Neuroektoderm hervorgingen. Zwei dieser NBs hatten ausschließlich gliale Nachkommen (NB 6-4A, GP) und fünf generierten sowohl Glia als auch Neurone (NBs 1-3, 2-5, 5-6, 6-4T, 7-4). Die übrigen sieben Zellstammbäume (NBs 2-4, 3-3, 3-5, 4-3, 4-4, 5-4, Klon y) waren rein neuronal. Es war ferner möglich, das bereits bekannte laterale Cluster von even-skipped exprimierenden Zellen (EL) dem Stammbaum von NB 3-3 zuzuordnen. Zusammen mit den zuvor beschriebenen Klonen sind damit mehr als 90% der thorakalen und abdominalen Zellstammbäume im embryonalen vNS von Drosophila bekannt. Darüber hinaus sind zuvor identifizierte Neurone und die meisten Gliazellen einem bestimmten Stammbaum zugeordnet und damit mit einer ontogenetischen Geschichte versehen. Dieser komplette Datensatz liefert eine Grundlage für die Interpretation mutanter Phänotypen und für zukünftige Untersuchungen über die Festlegung von Zellschicksalen und die Differenzierung von Zellen. Dies könnte dazu beitragen, das Verhältnis zwischen Herkunft der Zelle, Genexpression und Zellfunktion besser zu verstehen. Die wesentliche Funktion neuronaler Zellen ist die Integration und Weiterleitung von elektrischen Signalen. Mithin ist die Ausbildung elektrischer Eigenschaften (Elektrogenese) ein wesentlicher Aspekt der neuronalen Entwicklung. Um dabei zelltypspezifische Unterschiede zu finden, ist die Arbeit an definierten Zellpopulationen eine zwingende Voraussetzung. Es wurde daher hier ein in vitro System verwendet, das die selektive Kultivierung identifizierter embryonaler Vorläufer unter verschiedenen Bedingungen erlaubt. Da die Zellstammbäume der ML-Vorläufer besonders einfach sind und die ML-Zellen zudem in vielen Aspekten von den neuroektodermalen Zellen verschieden sind (s.o.), wurden die ML-Neurone als erstes Modellsystem ausgewählt. Unter Verwendung der Patch-clamp Technik wurden die in dieser definierten Zellpopulation auftretenden Ionenströme detailliert beschrieben. ML-Neurone exprimierten zumindest zwei verschiedene Typen von spannungsgesteuerten K+-Strömen (IA und IK), einen spannungsabhängigen Na+-Strom und zwei spannungsgesteuerte Ca(Ba)2+-Ströme. Darüber hinaus reagierten sie auf die Neurotransmitter ACh und GABA. Die meisten Ionenströme in den ML-Neuronen waren, trotz ihrer ontogenetischen Besonderheit, annähernd identisch mit denen, die in anderen Drosophila-Neuronen gefunden wurden. Ihnen fehlte allerdings eine anhaltende Komponente des Na+-Stroms, und sie waren homogen in ihrer Aktivität. Selbst bei anhaltender elektrischer Stimulation generierten sie immer nur ein Aktionspotential. Sie sind daher möglicherweise spezifisch hinsichtlich ihrer Signalleitungseigenschaften. Interessanterweise zeigte sich durch Verwendung verschiedener Kulturbedingungen, daß die Expression der spannungsgesteuerten K+-Kanäle weitgehend zellautonom erfolgte, während die Expression der anderen Ströme stark durch das Vohandensein von Neuritenkontakten beeinflußt wurde. Vorläufige Untersuchungen lassen darauf schließen, daß der involvierte molekulare Mechanismus unabhängig von synaptischer Transmission ist. In einer Art 'Ausblick' wurde schließlich die Validität von in vitro Ableitungen durch Analyse spannungsgesteuerter K+-Ströme in einer neuen in situ Präparation geprüft, die verschiedene Bereiche des Drosophila-ZNS für elektrophysiologische Untersuchungen zugänglich macht. Damit ist ein experimentelles System etabliert, daß den direkten Vergleich von in vitro und in situ Daten an definierten Zellpopulationen ermöglichen sollte.

Lowered microvascular vessel wall oxygen consumption augments tissue pO2 during PgE1-induced vasodilation

Continuous infusion of intravenous prostaglandin E1 (PgE1, 2.5 mug/kg/min) was used to determine how vasodilation affects oxygen consumption of the microvascular wall and tissue pO(2) in the hamster window chamber model. While systemic measurements (mean arterial pressure and heart rate) and central blood gas measurements were not affected, PgE1 treatment caused arteriolar (64.6 +/- 25.1 microm) and venular diameter (71.9 +/- 29.5 microm) to rise to 1.15 +/- 0.21 and 1.06 +/- 0.19, respectively, relative to baseline. Arteriolar (3.2 x 10(-2) +/- 4.3 x 10(-2) nl/s) and venular flow (7.8 x 10(-3) +/- 1.1 x 10(-2)/s) increased to 1.65 +/- 0.93 and 1.32 +/- 0.72 relative to baseline. Interstitial tissue pO(2) was increased significantly from baseline (21 +/- 8 to 28 +/- 7 mmHg; P < 0.001). The arteriolar vessel wall gradient, a measure of oxygen consumption by the microvascular wall decreased from 20 +/- 6 to 16 +/- 3 mmHg (P < 0.001). The arteriolar vessel wall gradient, a measure of oxygen consumption by the vascular wall, decreased from 20 +/- 6 to 16 +/- 3 mmHg (P < 0.001). This reduction reflects a 20% decrease in oxygen consumption by the vessel wall and up to 50% when cylindrical geometry is considered. The venular vessel wall gradient decreased from 12 +/- 4 to 9 +/- 4 mmHg (P < 0.001). Thus PgE1-mediated vasodilation has a positive microvascular effect: enhancement of tissue perfusion by increasing flow and then augmentation of tissue oxygenation by reducing oxygen consumption by the microvascular wall.

Comparison of intraarterial and intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign

BACKGROUND AND PURPOSE: It is unclear whether intraarterial (IAT) or intravenous (IVT) thrombolysis is more effective for ischemic stroke with hyperdense middle cerebral artery sign (HMCAS) on computed tomography (CT). The aim of this study was to compare IAT and IVT in stroke patients with HMCAS. METHODS: Comparison of data from 2 stroke units with similar management of stroke associated with HMCAS, except that 1 unit performed IAT with urokinase and the other IVT with plasminogen activator. Time to treatment was up to 6 hours for IAT and up to 3 hours for IVT. Outcome was measured by mortality and the modified Rankin Scale (mRS), dichotomized at 3 months into favorable (mRS 0 to 2) and unfavorable (mRS 3 to 6). RESULTS: One hundred twelve patients exhibited a HMCAS, 55 of 268 patients treated with IAT and 57 of 249 patients who underwent IVT. Stroke severity at baseline and patient age were similar in both groups. Mean time to treatment was longer in the IAT group (244+/-63 minutes) than in the IVT group (156+/-21 minutes; P=0.0001). However, favorable outcome was more frequent after IAT (n=29, 53%) than after IVT (n=13, 23%; P=0.001), and mortality was lower after IAT (n=4, 7%) than after IVT (n=13, 23%; P=0.022). After multiple regression analysis IAT was associated with a more favorable outcome than IVT (P=0.003) but similar mortality (P=0.192). CONCLUSIONS: In this observational study intraarterial thrombolysis was more beneficial than IVT in the specific group of stroke patients presenting with HMCAS on CT, even though IAT was started later. Our results indicate that a randomized trial comparing both thrombolytic treatments in patients with middle cerebral artery occlusion is warranted.