991 resultados para 1995_03301658 MOC-26


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The evolution of the Atlantic Meridional Overturning Circulation (MOC) in 30 models of varying complexity is examined under four distinct Representative Concentration Pathways. The models include 25 Atmosphere-Ocean General Circulation Models (AOGCMs) or Earth System Models (ESMs) that submitted simulations in support of the 5th phase of the Coupled Model Intercomparison Project (CMIP5) and 5 Earth System Models of Intermediate Complexity (EMICs). While none of the models incorporated the additional effects of ice sheet melting, they all projected very similar behaviour during the 21st century. Over this period the strength of MOC reduced by a best estimate of 22% (18%–25%; 5%–95% confidence limits) for RCP2.6, 26% (23%–30%) for RCP4.5, 29% (23%–35%) for RCP6.0 and 40% (36%–44%) for RCP8.5. Two of the models eventually realized a slow shutdown of the MOC under RCP8.5, although no model exhibited an abrupt change of the MOC. Through analysis of the freshwater flux across 30°–32°S into the Atlantic, it was found that 40% of the CMIP5 models were in a bistable regime of the MOC for the duration of their RCP integrations. The results support previous assessments that it is very unlikely that the MOC will undergo an abrupt change to an off state as a consequence of global warming.

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INTRODUCTION AND OBJECTIVES There is continued debate about the routine use of aspiration thrombectomy in patients with ST-segment elevation myocardial infarction. Our aim was to evaluate clinical and procedural outcomes of aspiration thrombectomy-assisted primary percutaneous coronary intervention compared with conventional primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. METHODS We performed a meta-analysis of 26 randomized controlled trials with a total of 11 943 patients. Clinical outcomes were extracted up to maximum follow-up and random effect models were used to assess differences in outcomes. RESULTS We observed no difference in the risk of all-cause death (pooled risk ratio = 0.88; 95% confidence interval, 0.74-1.04; P = .124), reinfarction (pooled risk ratio = 0.85; 95% confidence interval, 0.67-1.08; P = .176), target vessel revascularization (pooled risk ratio = 0.86; 95% confidence interval, 0.73-1.00; P = .052), or definite stent thrombosis (pooled risk ratio = 0.76; 95% confidence interval, 0.49-1.16; P = .202) between the 2 groups at a mean weighted follow-up time of 10.4 months. There were significant reductions in failure to reach Thrombolysis In Myocardial Infarction 3 flow (pooled risk ratio = 0.70; 95% confidence interval, 0.60-0.81; P < .001) or myocardial blush grade 3 (pooled risk ratio = 0.76; 95% confidence interval, 0.65-0.89; P = .001), incomplete ST-segment resolution (pooled risk ratio = 0.72; 95% confidence interval, 0.62-0.84; P < .001), and evidence of distal embolization (pooled risk ratio = 0.61; 95% confidence interval, 0.46-0.81; P = .001) with aspiration thrombectomy but estimates were heterogeneous between trials. CONCLUSIONS Among unselected patients with ST-segment elevation myocardial infarction, aspiration thrombectomy-assisted primary percutaneous coronary intervention does not improve clinical outcomes, despite improved epicardial and myocardial parameters of reperfusion. Full English text available from:www.revespcardiol.org/en.

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