Entwicklung der Qualitätsindikatoren nach der Einführung eines Qualitäts- und Informationsmanagementsystems an der Klinik für Herz- und Thoraxchirurgie der Otto-von-Guericke-Universität Magdeburg

Magdeburg, Univ., Medizin. Fakultät, Diss., 2009

Capacidad predictiva del euroscore II en una cohorte de pacientes de cirugía cardiovascular en una institución de cuarto nivel de Bogotá

El EuroSCORE II es una de las escalas más empleadas como predictor de riesgo de mortalidad en los servicios de cirugía cardiovascular. Esta ha sido validada en diferentes hospitales alrededor del mundo demostrando una adecuada capacidad de discriminación. El objetivo de este estudio fue evaluar el valor predictivo de la escala de riesgo EuroSCORE II en los pacientes sometidos a Cirugía Cardiovascular en una institución de cuarto nivel de Bogotá. Metodología: Estudio de prueba diagnóstica observacional y retrospectivo de la cohorte de pacientes en una institución de cuarto nivel durante los años 2012 a 2014. Se realizó el cálculo del EuroSCORE II para cada paciente, comparando la mortalidad predicha versus la observada, de forma global y por grupo de riesgo. Resultados: Del total de la población que tuvo intervención cardiaca mayor en una institución de cuarto nivel en la cohorte estudiada se presentaron 58 casos de muerte en los treinta días posteriores a la intervención, que corresponde al 7,46%. La mortalidad esperada calculada con el EuroSCORE II fue del 9,26%, lo cual indica un buen poder de predicción para esta población. Por otro lado, la curva ROC evidencia con un valor de 0.757 del área bajo la curva, que el modelo El EuroSCORE II es un buen modelo predictivo con un adecuado valor de discriminación. Se evidenció que las variables estado crítico preoperatorio y función del ventrículo izquierdo tienen mayor peso estadístico en nuestra población objeto, con una significancia del 0,001, seguido de infarto agudo de miocardio, sexo y peso de la intervención con una significancia del 0,01. Adicionalmente, el Euroscore II tiene mejor valor predictivo cuando se realiza un solo procedimiento o revascularización, en comparación a cuando se realiza procedimientos mixtos. Se recomienda realizar un estudio multicéntrico donde se incluyan pacientes con diferentes características demográficas

Bay 41-2272, A Soluble Guanylate Cyclase Stimulator, Relaxes Isolated Human Ureter In A Standardized In Vitro Model.

To characterize the relaxation induced by BAY 41-2272 in human ureteral segments. Ureter specimens (n = 17) from multiple organ human deceased donors (mean age 40 ± 3.2 years, male/female ratio 2:1) were used to characterize the relaxing response of BAY 41-2272. Immunohistochemical analysis for endothelial and neuronal nitric oxide synthase, guanylate cyclase stimulator (sGC) and type 5 phosphodiesterase was also performed. The potency values were determined as the negative log of the molar to produce 50% of the maximal relaxation in potassium chloride-precontracted specimens. The unpaired Student t test was used for the comparisons. Immunohistochemistry revealed the presence of endothelial nitric oxide synthase in vessel endothelia and neuronal nitric oxide synthase in urothelium and nerve structures. sGC was expressed in the smooth muscle and urothelium layer, and type 5 phosphodiesterase was present in the smooth muscle only. BAY 41-2272 (0.001-100 μM) relaxed the isolated ureter in a concentration dependent manner, with a potency and maximal relaxation value of 5.82 ± 0.14 and 84% ± 5%, respectively. The addition of nitric oxide synthase and sGC inhibitors reduced the maximal relaxation values by 21% and 45%, respectively. However, the presence of sildenafil (100 nM) significantly potentiated (6.47 ± 0.10, P <.05) this response. Neither glibenclamide or tetraethylammonium nor ureteral urothelium removal influenced the relaxation response by BAY 41-2272. BAY 41-2272 relaxes the human isolated ureter in a concentration-dependent manner, mainly by activating the sGC enzyme in smooth muscle cells rather than in the urothelium, although a cyclic guanosine monophosphate-independent mechanism might have a role. The potassium channels do not seem to be involved.

Bay 41-2272 Activates Host Defence Against Local And Disseminated Candida Albicans Infections.

In our previous study, we have found that 5-cyclopropyl-2-[1-(2-fluoro-benzyl)-1H-pyrazolo[3,4-b]pyridine-3-yl]-pyrimidin-4-ylamine (BAY 41-2272), a guanylate cyclase agonist, activates human monocytes and the THP-1 cell line to produce the superoxide anion, increasing in vitro microbicidal activity, suggesting that this drug can be used to modulate immune functioning in primary immunodeficiency patients. In the present work, we investigated the potential of the in vivo administration of BAY 41-2272 for the treatment of Candida albicans and Staphylococcus aureus infections introduced via intraperitoneal and subcutaneous inoculation. We found that intraperitoneal treatment with BAY 41-2272 markedly increased macrophage-dependent cell influx to the peritoneum in addition to macrophage functions, such as spreading, zymosan particle phagocytosis and nitric oxide and phorbol myristate acetate-stimulated hydrogen peroxide production. Treatment with BAY 41-2272 was highly effective in reducing the death rate due to intraperitoneal inoculation of C. albicans, but not S. aureus. However, we found that in vitro stimulation of peritoneal macrophages with BAY 41-2272 markedly increased microbicidal activities against both pathogens. Our results show that the prevention of death by the treatment of C. albicans-infected mice with BAY 41-2272 might occur primarily by the modulation of the host immune response through macrophage activation.

Comparison Between Single-Diode Low-Level Laser Therapy (LLLT) and LED Multi-Diode (Cluster) Therapy (LEDT) Applications Before High-Intensity Exercise

Background Data and Objective: There is anecdotal evidence that low-level laser therapy (LLLT) may affect the development of muscular fatigue, minor muscle damage, and recovery after heavy exercises. Although manufacturers claim that cluster probes (LEDT) maybe more effective than single-diode lasers in clinical settings, there is a lack of head-to-head comparisons in controlled trials. This study was designed to compare the effect of single-diode LLLT and cluster LEDT before heavy exercise. Materials and Methods: This was a randomized, placebo-controlled, double-blind cross-over study. Young male volleyball players (n = 8) were enrolled and asked to perform three Wingate cycle tests after 4 x 30 sec LLLT or LEDT pretreatment of the rectus femoris muscle with either (1) an active LEDT cluster-probe (660/850 nm, 10/30mW), (2) a placebo cluster-probe with no output, and (3) a single-diode 810-nm 200-mW laser. Results: The active LEDT group had significantly decreased post-exercise creatine kinase (CK) levels (-18.88 +/- 41.48U/L), compared to the placebo cluster group (26.88 +/- 15.18U/L) (p < 0.05) and the active single-diode laser group (43.38 +/- 32.90U/L) (p<0.01). None of the pre-exercise LLLT or LEDT protocols enhanced performance on the Wingate tests or reduced post-exercise blood lactate levels. However, a non-significant tendency toward lower post-exercise blood lactate levels in the treated groups should be explored further. Conclusion: In this experimental set-up, only the active LEDT probe decreased post-exercise CK levels after the Wingate cycle test. Neither performance nor blood lactate levels were significantly affected by this protocol of pre-exercise LEDT or LLLT.

Adsorption in mesopores: A molecular-continuum model with application to MCM-41

The classical model of surface layering followed by capillary condensation during adsorption in mesopores, is modified here by consideration of the adsorbate solid interaction potential. The new theory accurately predicts the capillary coexistence curve as well as pore criticality, matching that predicted by density functional theory. The model also satisfactorily predicts the isotherm for nitrogen adsorption at 77.4 K on MCM-41 material of various pore sizes, synthesized and characterized in our laboratory, including the multilayer region, using only data on the variation of condensation pressures with pore diameter. The results indicate a minimum mesopore diameter for the surface layering model to hold as 14.1 Å, below which size micropore filling must occur, and a minimum pore diameter for mechanical stability of the hemispherical meniscus during desorption as 34.2 Å. For pores in-between these two sizes reversible condensation is predicted to occur, in accord with the experimental data for nitrogen adsorption on MCM-41 at 77.4 K.

Modification of MCM-41 by surface silylation with trimethylchlorosilane and adsorption study

Siliceous MCM-41 samples were modified by silylation using trimethylchlorosilane (TMCS). The surface coverage of functional groups was studied systematically in this work. The role of surface silanol groups during modification was evaluated using techniques of FTIR and Si-29 CP/MAS NMR. Adsorption of water and benzene on samples of various hydrophobicities was measured and compared. It was found that the maximum degree of surface attachments of trimethylsilyl (TMS) groups was about 85%, corresponding to the density of TMS groups of 1.9 per nm(2). The degree of silylation is found to linearly increase with increasing pre-outgassing temperature prior to silylation. A few types of silanol groups exist on MCM-41 surfaces, among which both free and geminal ones are responsible for active silylation. Results of water adsorption show that aluminosilicate MCM-41 materials are more or less hydrophilic, giving a type IV isotherm, similar to that of nitrogen adsorption, whereas siliceous MCM-41 are hydrophobic, exhibiting a type V adsorption isotherm. The fully silylated Si-MCM-41 samples are more hydrophobic giving a type III adsorption isotherm. Benzene adsorption on all MCM-41 samples shows type IV isotherms regardless of the surface chemistry. Capillary condensation occurs at a higher relative pressure for the silylated MCM-41 than that for the unsilylated sample, though the pore diameter was found reduced markedly by silylation. This is thought attributed to the diffusion constriction posed by the attached TMS groups. The results show that the surface chemistry plays an important role in water adsorption, whereas benzene adsorption is predominantly determined by the pore geometry of MCM-41.

Irreversible change of pore structure of MCM-41 upon hydration at room temperature

The pore structure stability of MCM-41 materials upon hydration/dehydration was studied by XRD, Si-29 MAS NMR, and gravimetric adsorption techniques. Results demonstrated that collapses of the pore structure of MCM-41 occurred upon rehydration at room temperature due to the hydrolysis of the bare Si-O-Si(Al) bonds in the presence of water vapor. Full structure collapses of MCM-41 were found to occur when a MCM-41 sample was left in air for three months. It is also suggested that care must be taken when XRD is used to evaluate the structure property of MCM-41 materials to avoid the possible adverse effects of water vapor.

Experimental and theoretical investigations of adsorption hysteresis and criticality in MCM-41: Studies with O-2, Ar, and CO2

MCM-41 materials of six different pore diameters were prepared and characterized using X-ray diffraction, transmission electron microscopy, helium pycnometry, small-angle neutron scattering, and gas adsorption (argon at 77.4 and 87.4 K, nitrogen and oxygen at 77.4 K, and carbon dioxide at 194.6 K). A recent molecular continuum model of the authors, previously used for adsorption of nitrogen at 77.4 K, was applied here for adsorption of argon, oxygen, and carbon dioxide. While model predictions of single-pore adsorption isotherms for argon and oxygen are in satisfactory agreement with experimental data, significant deviation was found for carbon dioxide, most likely due to its high quadrupole moment. Predictions of critical pore diameter, below which reversible condensation occurs: were possible by the model and found to be consistent with experimental estimates, for the adsorption of the various gases. On the other hand, existing models such as the Barrett-Joyner-Halenda (BJH), Saito-Foley, and Dubinin-Astakhov models were found to be inadequate, either predicting an incorrect pore diameter or not correlating the isotherms adequately. The wall structure of MCM-41 appears to be close to that of amorphous silica, as inferred from our skeletal density measurements.

VOC removal: Comparison of MCM-41 with hydrophobic zeolites and activated carbon

The recently discovered mesoporous molecular sieve MCM-41 was tested as an adsorbent for VOC removal. Its adsorption/desorption properties were evaluated and compared with other hydrophobic zeolites (silicalite-1 and zeolite Y) and a commercial activated carbon, BPL. The adsorption isotherms of some typical VOCs (benzene, carbon tetrachloride, and n-hexane) on MCM-41 are of type IV according to the IUPAC classification, drastically different from the other microporous adsorbents, indicating that VOCs, in the gas phase, have to be at high partial pressures in order to make the most of the new mesoporous material as an adsorbent for VOC removal. However, a proper modification of the pore openings of MCM-41 can change the isotherm types from type IV to type I without remarkable loss of the accessible pare volumes and, therefore, significantly enhance the adsorption performance at low partial pressures. Adsorption isotherms of water on these adsorbents are all of type V, demonstrating that they possess a similar hydrophobicity. Desorption of VOCs from MCM-41 could be achieved at lower temperatures (50-60 degrees C), while this had to be conducted at higher temperatures (100-120 degrees C) for microporous adsorbents, zeolites, and activated carbons.

A novel method for tailoring the pore-opening size of MCM-41 materials

A novel pore tailoring method is proposed by which the pore-opening sizes of MCM-41 materials can be finely tuned without significant loss in pore volume and surface area.

Characterization of the structural and surface properties of chemically modified MCM-41 material

Mesoporous Mobil catalytic materials of number 41 (MCM-41) silica was chemically modified using both inorganic and organic precursors and characterized using the techniques, XRD, XPS, MAS NMR, FTIR, W-Vis, and physical adsorption of nitrogen, hydrocarbons (hexane, benzene, acetone, and methanol) and water vapor. Modification using organic reagents was found to result in a significant loss in porosity and a shape change of surface properties (increased hydrophobicity and decreased acidity). With inorganic modifying reagents, the decrease in porosity was also observed while the surface properties were not significantly altered as reflected by the adsorption isotherms of organics and water vapors. Chemical modifications can greatly improve the hydrothermal stability of MCM-41 material because of the enhanced surface hydrophobicity (with organic modifiers) or increased pore wall thickness (with inorganic modifiers). (C) 2000 Elsevier Science B.V. All rights reserved.

Comprehensive structural characterization of MCM-41: From mesopores to particles

In the present work the meso- and macro-structural characteristics of the mesoporous adsorbent MCM-41 have been estimated with the help of various techniques. The structure is found to comprise four different length scales: that of the mesopores, the crystallites, the grains and of the particles. It was found that the surface area estimated by the use of small angle scattering techniques is higher, while that estimated by mercury porosimetry is much lower, than that obtained from gas adsorption methods. Based on the macropore characterization by mercury porosimetry, and the considerable macropore area determined, it is seen that the actual mesopore area of MCM-41 may be significantly lower than the BET area. TEM studies indicated that MCM-41 does not have an ideal mesopore structure; however, it may still be treated as a model mesoporous material for gas adsorption studies because of the large radius of curvature of the channels.

Copper/MCM-41 as catalyst for the wet oxidation of phenol

A heterogeneous copper catalyst supported on mesoporous MCM-41 was developed. The parent MCM-41 has a large pore area of over 1400 m(2)/g. Copper was chosen as the active element of catalyst and loaded into MCM-41 by adsorption at ambient temperature. The prepared catalysts were evaluated in the catalytic wet oxidation of phenol solution with an initial concentration of 1,300 ppm at 150 and 200 degreesC. The catalyst was found to be of high catalytic activity. It is also shown that the catalyst with a higher copper loading exhibits higher ability of accelerating the catalytic reaction to certain extent but reaches its constant level afterwards. (C) 2001 Elsevier Science B.V. All rights reserved.