Relationship between onset-to-door time and door-to-thrombolysis time: a pooled analysis of 10 dedicated stroke centers

BACKGROUND AND PURPOSE Inverse relationship between onset-to-door time (ODT) and door-to-needle time (DNT) in stroke thrombolysis was reported from various registries. We analyzed this relationship and other determinants of DNT in dedicated stroke centers. METHODS Prospectively collected data of consecutive ischemic stroke patients from 10 centers who received IV thrombolysis within 4.5 hours from symptom onset were merged (n=7106). DNT was analyzed as a function of demographic and prehospital variables using regression analyses, and change over time was considered. RESULTS In 6348 eligible patients with known treatment delays, median DNT was 42 minutes and kept decreasing steeply every year (P<0.001). Median DNT of 55 minutes was observed in patients with ODT ≤30 minutes, whereas it declined for patients presenting within the last 30 minutes of the 3-hour time window (median, 33 minutes) and of the 4.5-hour time window (20 minutes). For ODT within the first 30 minutes of the extended time window (181-210 minutes), DNT increased to 42 minutes. DNT was stable for ODT for 30 to 150 minutes (40-45 minutes). We found a weak inverse overall correlation between ODT and DNT (R(2)=-0.12; P<0.001), but it was strong in patients treated between 3 and 4.5 hours (R(2)=-0.75; P<0.001). ODT was independently inversely associated with DNT (P<0.001) in regression analysis. Octogenarians and women tended to have longer DNT. CONCLUSIONS DNT was decreasing steeply over the last years in dedicated stroke centers; however, significant oscillations of in-hospital treatment delays occurred at both ends of the time window. This suggests that further improvements can be achieved, particularly in the elderly.

VEGF-B-induced vascular growth leads to metabolic reprogramming and ischemia resistance in the heart

Angiogenic growth factors have recently been linked to tissue metabolism. We have used genetic gain- and loss-of function models to elucidate the effects and mechanisms of action of vascular endothelial growth factor-B (VEGF-B) in the heart. A cardiomyocyte-specific VEGF-B transgene induced an expanded coronary arterial tree and reprogramming of cardiomyocyte metabolism. This was associated with protection against myocardial infarction and preservation of mitochondrial complex I function upon ischemia-reperfusion. VEGF-B increased VEGF signals via VEGF receptor-2 to activate Erk1/2, which resulted in vascular growth. Akt and mTORC1 pathways were upregulated and AMPK downregulated, readjusting cardiomyocyte metabolic pathways to favor glucose oxidation and macromolecular biosynthesis. However, contrasting with a previous theory, there was no difference in fatty acid uptake by the heart between the VEGF-B transgenic, gene-targeted or wildtype rats. Importantly, we also show that VEGF-B expression is reduced in human heart disease. Our data indicate that VEGF-B could be used to increase the coronary vasculature and to reprogram myocardial metabolism to improve cardiac function in ischemic heart disease.

Clave para la identificación del segundo estadío larval de algunos trips comunes (Thysanoptera: Thripidae) : Mendoza, Argentina

Existen pocas publicaciones sobre claves de identificación de larvas de trips. Sin embargo, el tema es de interés básico para detectar el rango de hospedantes de los trips. Algunas especies son capaces de transmitir Tospovirus, agentes causales de la peste negra y otras enfermedades. El insecto adquiere el virus sólo como larva. Una clave de larvas será una herramienta útil para estudios epidemiológicos. La identificación de larvas es difícil porque tienen menos caracteres distintivos que los adultos; además, los individuos crecen constantemente. Las larvas obtenidas para este trabajo se recolectaron del campo sobre varias malezas y algunas plantas nativas y cultivadas. También se criaron en chauchas de poroto o polen y miel diluida a partir de adultos identificados. En este trabajo se presenta una descripción breve del segundo estadío larval de Frankliniella australis Morgan, F. gemina Bagnall, F. occidentalis Pergande, F. schultzei Trybom, F. valdiviana Sakimura et O'Neil y Thrips tabaci Lindeman y una clave para separar estas especies. Estación Experimental Agropecuaria INTA Mendoza.

Efecto de la incusion de hidrolizado de mucosa digestiva porcina (palbio 50 rd®) y del nivel de lisina del pienso sobre los parametros productivos en pollos de 1 a 21 dias de edad

El hidrolizado de mucosa digestiva de porcino (Palbio 50 RD ® , Bioiéerica, S.A., PAL) se utiliza con resultados óptimos en la alimentación de lechones recién destetados (Lindeman el al. 2000; Corassa et al. 2007). En un trabajo reciente, Mohiti-Asli et al. (2011) observaron que la inclusión de PAL mejoraba los resultados productivos en pollos de engorde a cualquier edad. En este trabajo se demostró que los niveles más recomendables de utilización de PAL teniendo en cuenta razones productivas y económicas, era el 2,5%. En esta investigación se estudio el efecto de la inclusión de 2,5% de PAL en piensos para pollos con niveles crecientes de lisina total (LYS, 1,1 a 1,4%). El objetivo fue estudiar si los efectos beneficiosos del PAL sobre la productividad de los pollos eran independientes o no del nivel de LYS del pienso.

Efecto de la inclusión de un hidrolizado de mucosa digestiva porcina (palbio 50 rd®) en piensos de broilers con niveles diferentes de lisina

La alimentación del pollo broiler durante la primera semana de vida es de creciente importancia debido a que la edad de sacrificio ha disminuido de forma constante en los últimos años. Además, consumos elevados durante la primera semana de vida mejoran el desarrollo del aparato digestivo de las aves, favoreciendo el crecimiento de las vellosidades intestinales y la eficiencia alimenticia (Lilburn, 1998, Noy et al., 2005). En los últimos años, el mercado dispone de nuevos productos de origen animal obtenidos durante el proceso de obtención de la heparina para uso farmacéutico. Uno de estos productos comerciales (Palbio 50 RD, Bioibérica S.A., Palafolls, Barcelona) está formado por la proteína hidrolizada de la mucosa digestiva de porcino limpia de contenidos intestinales, secada mediante un procedimiento especial que incluye la utilización de harina de soja como excipiente. Recientes estudios han demostrado de forma fehaciente el interés de utilizar este ingrediente en piensos de lechones de primera edad (Lindeman, et al., 2000; Corassa et al., 2007) pero los datos existentes en aves son más limitados. El objetivo de esta investigación fue evaluar los efectos de niveles crecientes de este hidrolizado proteico (PAL) sobre la productividad de pollos que recibían piensos con dos niveles diferentes de lisina total (Lys)

WEBJORNALISMO COLABORATIVO - A PRESENÇA DOS USUÁRIOS NO CONTEÚDO INFORMATIVO DO PORTAL R7

Este estudo procura verificar como ocorre a colaboração dos usuários no conteúdo informativo do Portal R7, a partir da nova configuração da internet, a web 2.0, criada em 2004. O termo web 2.0 surgiu para qualificar uma segunda geração de comunidades e serviços, em um ambiente de interação e participação que engloba diversas linguagens. Com o crescimento da adesão à tecnologia digital, algumas barreiras que limitavam a colaboração nos conteúdos informativos foram superadas e o ambiente comunicacional tornou-se um espaço de intercâmbio para experiências e práticas do cotidiano. Nesse cenário, os internautas passam a ter uma relação mais aproximativa nos processos midiáticos presentes no suporte digital, no qual o cidadão pode se expressar, ter maior visibilidade e se relacionar a partir do momento em que ele produz, publica e compartilha qualquer tipo de conteúdo, seja de caráter informativo ou de entretenimento. A revisão bibliográfica abrangeu autores como Ciro Marcondes Filho, José Marques de Melo, Nelson Traquina, Alex Primo, Ana Brambilla, Marcelo Träsel, Raquel Recuero, Polyana Ferrari, Squirra, entre outros. O método de investigação utilizado é o qualitativo, por meio de uma pesquisa exploratória descritiva, do tipo estudo de caso. Os instrumentos para a investigação foram a observação direta assistemática e a entrevista semiestruturada (ou semiaberta). O principal resultado obtido é que o webjornalismo colaborativo no Portal R7 é prioritariamente induzido pelas redes sociais, especialmente o Facebook e o Twitter, inspirado no “call for action”, como estratégia para chamar à colaboração. As práticas jornalísticas estão intrinsicamente dependentes da ação do usuário, sendo que o jornalista agrega às práticas de checagem uma nova etapa, a de relacionamento com o usuário do Portal, para agregar e fidelizar a audiência, valorizando a colaboração em todas as etapas de produção.

The subcellular localization of E2F-4 is cell-cycle dependent

The E2F family of transcription factors plays a crucial role in cell cycle progression. E2F activity is tightly regulated by a number of mechanisms, which include the timely synthesis and degradation of E2F, interaction with retinoblastoma protein family members (“pocket proteins”), association with DP heterodimeric partner proteins, and phosphorylation of the E2F/DP complex. Here we report that another mechanism, subcellular localization, is important for the regulation of E2F activity. Unlike E2F-1, -2, or -3, which are constitutively nuclear, ectopic E2F-4 and -5 were predominantly cytoplasmic. Cotransfection of expression vectors encoding p107, p130, or DP-2, but not DP-1, resulted in the nuclear localization of E2F-4 and -5. Moreover, the transcriptional activity of E2F-4 was markedly enhanced when it was invariably nuclear. Conversely, it was reduced when the protein was excluded from the nucleus, implying that E2F-4 transcription function depends upon its cytological location. In keeping with this, the nuclear/cytoplasmic ratios of endogenous E2F-4 changed as cells exited G0, with high ratios in G0 and early G1 and a progressive increase in cytoplasmic E2F-4 as cells approached S phase. Thus, the subcellular location of E2F-4 is regulated in a cell cycle-dependent manner, providing another potential mechanism for its functional regulation.

Plasma Heme Oxygenase-1 in Patients Resuscitated from out-of-Hospital Cardiac Arrest

Heme oxygenase-1 (HO-1) is an enzyme induced by hypoxia and reperfusion injury, and is associated with organ dysfunction in critically ill patients. Patients resuscitated from out-of-hospital cardiac arrest (OHCA) are subjected to hypoxemia, brain injury, and organ dysfunction. Accordingly, we studied HO-1 among these patients. A total of 143 OHCA patients resuscitated from a shockable initial rhythm and admitted to an ICU were included, with plasma HO-1 measured at ICU admission and at 24 h. We analyzed the associations between plasma HO-1 and time to return of spontaneous circulation (ROSC), 90-day mortality, and 12-month Cerebral Performance Category (CPC). HO-1 plasma concentrations were higher after OHCA compared with controls. HO-1 concentrations at admission and on day 1 associated with ROSC (P = 0.002 to P = 0.003). Admission and day 1 HO-1 plasma concentrations were higher in 90-day non-survivors than in survivors (P = 0.017, 0.026). In addition, poor neurological outcome (CPC 3-5) was associated with higher HO-1 plasma levels at admission (P = 0.024). Admission plasma HO-1 levels had an AUC of 0.623 to predict 90-day mortality and an AUC of 0.611 to predict CPC 3 to 5. In conclusion, we found that higher HO-1 plasma levels are associated with longer ROSC and poor long-term outcome.

NT-proBNP in patients with out-of-hospital cardiac arrest: Results from the FINNRESUSCI Study

AIM To assess whether the established cardiovascular biomarker N-terminal pro-B-type natriuretic peptide (NT-proBNP) provides prognostic information in patients with out-of-hospital cardiac arrest due to ventricular tachycardia or fibrillation (OHCA-VT/VF). METHODS We measured NT-proBNP levels in 155 patients with OHCA-VT/VF enrolled into a prospective multicenter observational study in 21 ICUs in Finland. Blood samples were drawn <6h of OHCA-VT/VF and later after 24h, 48h, and 96h. The end-points were mortality and neurological outcome classified according to Cerebral Performance Category (CPC) after one year. NT-proBNP levels were compared to high-sensitivity troponin T (hs-TnT) levels and established risk scores. RESULTS NT-proBNP levels were higher in non-survivors compared to survivors on study inclusion (median 1003 [quartile (Q) 1-3 502-2457] vs. 527 [179-1284]ng/L, p=0.001) and after 24h (1913 [1012-4573] vs. 1080 [519-2210]ng/L, p<0.001). NT-proBNP levels increased from baseline to 96h after ICU admission (p<0.001). NT-proBNP levels were significantly correlated to hs-TnT levels after 24h (rho=0.27, p=0.001), but not to hs-TnT levels on study inclusion (rho=0.05, p=0.67). NT-proBNP levels at all time points were associated with clinical outcome, but only NT-proBNP levels after 24h predicted mortality and poor neurological outcome, defined as CPC 3-5, in models that adjusted for SAPS II and SOFA scores. hs-TnT levels did not add prognostic information to NT-proBNP measurements alone. CONCLUSION NT-proBNP levels at 24h improved risk assessment for poor outcome after one year on top of established risk indices, while hs-TnT measurements did not further add to risk prediction.

Mean arterial pressure and vasopressor load after out-of-hospital cardiac arrest: Associations with one-year neurologic outcome

THE AIM OF THE STUDY There are limited data on blood pressure targets and vasopressor use following cardiac arrest. We hypothesized that hypotension and high vasopressor load are associated with poor neurological outcome following out-of-hospital cardiac arrest (OHCA). METHODS We included 412 patients with OHCA included in FINNRESUSCI study conducted between 2010 and 2011. Hemodynamic data and vasopressor doses were collected electronically in one, two or five minute intervals. We evaluated thresholds for time-weighted (TW) mean arterial pressure (MAP) and outcome by receiver operating characteristic (ROC) curve analysis, and used multivariable analysis adjusting for co-morbidities, factors at resuscitation, an illness severity score, TW MAP and total vasopressor load (VL) to test associations with one-year neurologic outcome, dichotomized into either good (1-2) or poor (3-5) according to the cerebral performance category scale. RESULTS Of 412 patients, 169 patients had good and 243 patients had poor one-year outcomes. The lowest MAP during the first six hours was 58 (inter-quartile range [IQR] 56-61) mmHg in those with a poor outcome and 61 (59-63) mmHg in those with a good outcome (p<0.01), and lowest MAP was independently associated with poor outcome (OR 1.02 per mmHg, 95% CI 1.00-1.04, p=0.03). During the first 48h the median (IQR) of the TW mean MAP was 80 (78-82) mmHg in patients with poor, and 82 (81-83) mmHg in those with good outcomes (p=0.03) but in multivariable analysis TWA MAP was not associated with outcome. Vasopressor load did not predict one-year neurologic outcome. CONCLUSIONS Hypotension occurring during the first six hours after cardiac arrest is an independent predictor of poor one-year neurologic outcome. High vasopressor load was not associated with poor outcome and further randomized trials are needed to define optimal MAP targets in OHCA patients.

Ældre og nyere norske fjeldmelodier /

Arr. for piano, in part with words.

Deutsche geographische Blätter,

Editors: 1877-95, M. Linderman (1881, M. Lindeman and W. Wolkenhauer).--1896-<1921> A. Oppel and W. Wolkenhauer.

Pi︠e︡snʹ o vi︠e︡shchem Olegi︠e︡. Tochnai︠a︡ kopīi︠a︡ rukopisi poėta.

Part of Rimsky-Korsakov's music to Pi︠e︡snʹ o vi︠e︡shchem Olegi︠e︡: p. [127-128].

The Creole Petroleum Corporation in Venezuela /

Mode of access: Internet.

Die arktische fischerei der deutschen seestädte 1620-1868.

With this is bound Payer, Julius. Die südlichen Ortler-Alpen; Koldewey, Karl. Die erste deutsche nordpolar-expedition im jahre 1868; Petermann, August. Australien nach dem stande der geographischen Kenntniss in 1871.