Preditores de fibrilação atrial de novo em unidade de cuidados intensivos não cardíaca

OBJECTIVE: To assess the predictors of de novo atrial fibrillation in patients in a non-cardiac intensive care unit. METHODS: A total of 418 hospitalized patients were analyzed between January and September 2016 in a non-cardiac intensive care unit. Clinical characteristics, interventions, and biochemical markers were recorded during hospitalization. In-hospital mortality and length of hospital stay in the intensive care unit were also evaluated. RESULTS: A total of 310 patients were included. The mean age of the patients was 61.0 ± 18.3 years, 49.4% were male, and 23.5% presented de novo atrial fibrillation. The multivariate model identified previous stroke (OR = 10.09; p = 0.016) and elevated levels of pro-B type natriuretic peptide (proBNP, OR = 1.28 for each 1,000pg/mL increment; p = 0.004) as independent predictors of de novo atrial fibrillation. Analysis of the proBNP receiver operating characteristic curve for prediction of de novo atrial fibrillation revealed an area under the curve of 0.816 (p 5,666pg/mL. There were no differences in mortality (p = 0.370), but the lengths of hospital stay (p = 0.002) and stay in the intensive care unit (p = 0.031) were higher in patients with de novo atrial fibrillation. CONCLUSIONS: A history of previous stroke and elevated proBNP during hospitalization were independent predictors of de novo atrial fibrillation in the polyvalent intensive care unit. The proBNP is a useful and easy- and quick-access tool in the stratification of atrial fibrillation risk.Objetivo: Avaliar quais os preditores de fibrilação atrial de novo em doentes de uma unidade de cuidados intensivos não cardíaca. Métodos: Foram analisados 418 doentes internados entre janeiro e setembro de 2016 em uma unidade de cuidados intensivos não cardíaca. Registaram-se as características clínicas, as intervenções efetuadas e os marcadores bioquímicos durante a internação. Avaliaram-se ainda a mortalidade hospitalar e o tempo de internação hospitalar e na unidade de cuidados intensivos. Resultados: Foram incluídos 310 doentes, com média de idades de 61,0 ± 18,3 anos, 49,4% do sexo masculino, 23,5% com fibrilação atrial de novo. O modelo multivariável identificou acidente vascular cerebral prévio (OR de 10,09; p = 0,016) e valores aumentados de proBNP (OR de 1,28 por cada aumento em 1.000pg/mL; p = 0,004) como preditores independentes de fibrilação atrial de novo. A análise por curva Característica de Operação do Receptor do proBNP para predição de fibrilação atrial de novo revelou área sob a curva de 0,816 (p 5.666pg/mL. Não se verificaram diferenças na mortalidade (p = 0,370), porém a duração da internação hospitalar (p = 0,002) e na unidade de cuidados intensivos (p = 0,031) foi superior nos doentes com fibrilação atrial de novo. Conclusões: História de acidente vascular cerebral prévio e proBNP elevado em internação constituíram preditores independentes de fibrilação atrial de novo na unidade de cuidados intensivos polivalente. O proBNP pode constituir ferramenta útil, de fácil e rápido acesso na estratificação do risco de fibrilação atrial.info:eu-repo/semantics/publishedVersio

Regulation of arginine transport by GCN2 eIF2 kinase is important for replication of the intracellular parasite Toxoplasma gondii

Toxoplasma gondii is a prevalent protozoan parasite that can infect any nucleated cell but cannot replicate outside of its host cell. Toxoplasma is auxotrophic for several nutrients including arginine, tryptophan, and purines, which it must acquire from its host cell. The demands of parasite replication rapidly deplete the host cell of these essential nutrients, yet Toxoplasma successfully manages to proliferate until it lyses the host cell. In eukaryotic cells, nutrient starvation can induce the integrated stress response (ISR) through phosphorylation of an essential translation factor eIF2. Phosphorylation of eIF2 lowers global protein synthesis coincident with preferential translation of gene transcripts involved in stress adaptation, such as that encoding the transcription factor ATF4 (CREB2), which activates genes that modulate amino acid metabolism and uptake. Here, we discovered that the ISR is induced in host cells infected with Toxoplasma. Our results show that as Toxoplasma depletes host cell arginine, the host cell phosphorylates eIF2 via protein kinase GCN2 (EIF2AK4), leading to induced ATF4. Increased ATF4 then enhances expression of the cationic amino acid transporter CAT1 (SLC7A1), resulting in increased uptake of arginine in Toxoplasma-infected cells. Deletion of host GCN2, or its downstream effectors ATF4 and CAT1, lowers arginine levels in the host, impairing proliferation of the parasite. Our findings establish that Toxoplasma usurps the host cell ISR to help secure nutrients that it needs for parasite replication

Perspectives on engineering more usable context-aware systems

The expectations of the abilities of context-aware systems (C-AS) often differ from reality. It becomes difficult to program contextual services that react adequately to the circumstantial needs of users as developers need to know, beforehand: the set of contextual states that may exist, what information could accurately determine a contextual state within that set, and what appropriate action should be taken in that particular state. Although there exist many frameworks and tools which support the design and implementation of C-AS, there is less conceptual help for developers to inform them of what contextual situations and services are appropriate (or feasible) to be implemented. This report reviews the state-of-the-art conceptualisation of context, which is more focused on the representational interpretation of the concept, to introduce a perspective that also acknowledges its interactional interpretation. A combination of revised and new definitions is introduced, which give key insights for the development of more useful C-AS. By acknowledging situations as a dynamic phenomenon that arises from action (interaction), and needs to be understood by the developers, it facilitates the analysis of these subjective interpretations into programming constructs (representation). The conceptualisation is also complemented with a set of guidelines for developers, an illustration of their usage, and a further discussion on the future directions for the engineering of more usable C-AS. The introduced conceptualisation is targeted towards the creation of an open-source tool supported framework for the engineering of C-AS

Context-aware systems testing and validation

Newer systems are still tested and validated following techniques which have been developed decades ago when systems were of a different nature. We report on an attempt to define a new method which is practical and focus on the concept of ‘context’ as a system aspect which have become more relevant in the development of the subsystem category called Intelligent Environments

Engineering intelligent environments: preliminary findings of a systematic review

Intelligent environments are complex systems that may require a diverse set of hardware devices, software libraries, networking and human computer interactions. New tools and techniques that can facilitate the engineering of such systems are thus critical. However, given the size and heterogeneity of the literature and in the light of, to our knowledge, there being only informal surveys restricted to specific issues have been conducted, we have seen the need to organise and synthesise the existent research corpus to obtain a clear idea on the main approaches that have been utilised for the development of IEs. To address this research gap, this systematic literature review was carried out. This paper presents the review’s preliminary findings that are expected to provide avenues for further research in this area. We find that there are different approaches for developing IEs and the development cycle consists of several phases. However, not all phases have received equal consideration. An evaluation framework which could offer guidance on the choice of the most suitable techniques per phase should also be the target of research efforts

Requirements engineering for intelligent environments

The field of Intelligent Environments (IE) is maturing to a level at which a range of sophisticated applications are emerging. Such systems aim to be context-aware, especially being adaptable to possibly unpredictable circumstances. An area of significant potential is that of ‘ambient assisted living’, with significant advances in fields such as smart spaces, classrooms, and assisted living space for the elderly or people with disabilities. In recent years, however, it has been recognised that numerous IE systems have been developed without adopting best practises from software engineering. The work presented here focuses on the requirements engineering stage and presents a framework for IE systems in which an intrinsic component is context-awareness. Whilst the framework is intended as a general IE model, we are currently applying it to the specific area of ambient assisted living and it is being employed on the POSEIDON project. It is anticipated that such real world application of the model will help endorse its conception and facilitate further refinement of the framework

Progenitor cells, bone marrow–derived fibrocytes and endothelial-to-mesenchymal transition: new players in vascular fibrosis

No abstract available