Pancreatite aguda biliar: um estudo de coorte prospectivo

OBJECTIVE: Acute biliary pancreatitis (ABP) is a disease with high morbidity and mortality rates but poorly studied in Brazil. Our objective was to describe the differential  diagnosis for the etiology of ABP and assess the severity and treatment of the disease at the Hospital de Clínicas de Porto Alegre, in 1999. MATERIALS AND METHODS: We carried out a cohort, prospective study in 65 (78.4%) patients who presented amylase greater than 440 mg/dl and acute biliary pancreatitis (ABP). We assessed biliary Ranson scores, modified Glasgow scores, APACHE-II and APACHE-O of our population in order to determine the severity of the disease. These scores and values were followed-up during the evolution of the disease. RESULTS: Twelve patients presented clinical evolution of the disease. The systemic complications were kidney failure (n=4), respiratory failure (n=3), shock (n=3), and sepsis associated with cholangitis (n=1). The local complications, in turn, were peripancreatic fluid collection (n=3), pancreatic necroses (n=3), pancreatic pseudocyst (n=1), and pancreatic fistula (n=1). There was only one case of death, which occurred due to acute myocardial infarction and refractory hypocalcemia. The prognostic criteria, according to the number of positive parameters, indicated relative risk (RR) from 4.7 to 11.2, sensitivity from 33.3% to 83.3%, specificity from 79.2% to 98.1%, positive predictive value from 45.0% to 83.3%, negative predictive value from 86.4% to 95.5%, and accuracy from 78.5% to 89.6%. The parameters that presented a separate correlation with severity were white blood cell count >18,000/mm3 , LDH >400 UI/l, 10% decrease in hematocrit levels, serum calcium levels <8 mg/dl, increase in urea nitrogen levels >2 mg/dl, AST >200 mg/dl, LDH >600 UI/l, white cell count >15,000/mm3 , urea >45 mg/dl, arterial pH £7.33 or ³7.49, creatinine levels £0.6 or ³1.4, hematocrit levels £30 or ³45,9, white cell count £3,000 or ³14,900. CONCLUSION: biliary Ranson scores, modified Glasgow scores, APACHE-II and APACHE-O presented good sensitivity and specificity. Multidisciplinary protocols should be implemented in order to achieve optimal treatment results. OBJETIVO: A pancreatite aguda biliar (PAB) é uma doença com morbidade e mortalidade elevadas mas pouco estudada no Brasil. O objetivo deste trabalho é detalhar o diagnóstico diferencial etiológico, a gravidade e o tratamento da PAB no Hospital de Clínicas de Porto Alegre em 1999. MATERIAIS E MÉTODOS: Foram avaliados em estudo de coorte, prospectivo, todos os pacientes com amilase superior a 440 mg/dl e incluídos 65 (78,4%) que apresentavam PAB. Esta amostra foi submetida à determinação de gravidade pelos critérios de Ranson biliar, Glasgow modificado, APACHE-II e APACHE-O e acompanhada durante a evolução da doença. RESULTADOS: Doze pacientes (18,5%) apresentaram evolução clínica com 19 complicações. As sistêmicas foram: falência renal (n = 4), insuficiência respiratória (n = 3), choque (n = 3) e sepse por colangite (n = 1). As complicações locais foram: coleções líquidas peripancreáticas (n = 3), necroses pancreáticas (n = 3), pseudocisto pancreático (n = 1), fístula pancreática (n = 1). Houve apenas uma morte relacionada a infarto agudo do miocárdio e hipocalcemia refratária. Os critérios prognósticos, conforme o número de parâmetros positivos, apresentaram um risco relativo que variou de 4,7 a 11,2, sensibilidade de 33,3% a 83,3%, especificidade de 79,2% a 98,1%, valor preditivo positivo de 45,0% a 83,3%, valor preditivo negativo de 86,4% a 95,5% e acurácia de 78,5% a 89,6%. Isoladamente, os parâmetros que apresentaram correlação com a gravidade foram leucograma >18000/mm3 , LDH >400 UI/L, queda ³10% hematócrito, cálcio sérico <8 mg/dL, aumento do nitrogênio uréico >2 mg/dL, AST >200 mg/dL, LDH >600 UI/L, leucograma >15000 mm3 , uréia >45 mg/dL, pH arterial £7,33 ou ³7,49, creatinina £0,6 ou ³1,4, Ht £30 ou ³45,9, leucócitos £ 3 ou ³14,9 (mil). CONCLUSÕES: Os critérios de Ranson, Glasgow, APACHE-II e APACHE-O apresentam boa sensibilidade e especificidade. O manejo da PAB deve ser revisto a partir de protocolos institucionais multidisciplinares

Directed flow of antiprotons in Au+Au collisions at AGS

Directed flow of antiprotons is studied in Au+Au collisions at a beam momentum of 11.5A GeV/c. It is shown that antiproton directed flow is anti-correlated to proton flow. The measured transverse momentum dependence of the antiproton flow is compared with predictions of the RQMD event generator.Comment: 16 pages, 6 figure

Proton and Pion Production in Au+Au Collisions at 10.8A GeV/c

We present proton and pion tranverse momentum spectra and rapidity distributions for Au+Au collisions at 10.8A GeV/c. The proton spectra exhibit collective transverse flow effects. Evidence of the influence of the Coulomb interaction from the fireball is found in the pion transverse momentum spectra. The data are compared with the predictions of the RQMD event generator.Comment: plain tex (revtex), 24 pages Submitted to Phys. Rev.

Two-pion correlations in Au+Au collisions at 10.8 GeV/c per nucleon

Two-particle correlation functions for positive and negative pions have been measured in Au+Au collisions at 10.8~GeV/c per nucleon. The data were analyzed using one- and three-dimensional correlation functions. From the results of the three-dimensional fit the phase space density of pions was calculated. It is consistent with local thermal equilibrium.Comment: 5 pages RevTeX (including 3 Figures

Proton and Pion Production Relative to the Reaction Plane in Au + Au Collisions at AGS Energies

Results are presented of an analysis of proton and charged pion azimuthal distributions measured with respect to the reaction plane in Au + Au collisions at a beam momentum of about 11 AGeV/c. The azimuthal anisotropy is studied as a function of particle rapidity and transverse momentum for different centralities of the collisions. The triple differential (in rapidity, transverse momentum, and azimuthal angle) distributions are reconstructed. A comparison of the results with a previous analysis of charged particle and transverse energy flow as well as with model predictions is presented.Comment: 23 pages (LaTeX), 12 figure

Hadron yields and spectra in Au+Au collisions at the AGS

Inclusive double differential multiplicities and rapidity density distributions of hadrons are presented for 10.8 A GeV/c Au+Au collisions as measured at the AGS by the E877 collaboration. The results indicate that large amounts of stopping and collective transverse flow effects are present. The data are also compared to the results from the lighter Si+Al system.Comment: 12 pages, latex, 10 figures, submitted to Nuclear Physics A (Quark Matter 1996 Proceedings

Two-Proton Correlations from 14.6A GeV/c Si+Pb and 11.5A GeV/c Au+Au Central Collisions

Two-proton correlation functions have been measured in Si+Pb collisions at 14.6A GeV/c and Au+Au collisions at 11.5A GeV/c by the E814/E877 collaboration. Data are compared with predictions of the transport model RQMD and the source size is inferred from this comparison. Our analysis shows that, for both reactions, the characteristic size of the system at freeze-out exceeds the size of the projectile, suggesting that the fireball created in the collision has expanded. For Au+Au reactions, the observed centrality dependence of the two-proton correlation function implies that more central collisions lead to a larger source sizes.Comment: RevTex, 12 pages, 5 figure

Rapid circulation of warm subtropical waters in a major glacial fjord in East Greenland

Author Posting. © The Authors, 2009. This is the author's version of the work. It is posted here by permission of Nature Publishing Group for personal use, not for redistribution. The definitive version was published in Nature Geoscience 3 (2010): 182-186, doi:10.1038/ngeo764.The recent rapid increase in mass loss from the Greenland Ice Sheet is primarily attributed to an acceleration of outlet glaciers. One possible cause is increased melting at the ice/ocean interface driven by the synchronous warming of subtropical waters offshore of Greenland. This hypothesis is largely untested, however, because of the lack of observations from Greenland’s glacial fjords and our limited understanding of their dynamics. Here, we present new ship-based and moored oceanographic data, collected in Sermilik Fjord, a large glacial fjord in East Greenland, showing that subtropical waters are present throughout the fjord and are continuously replenished via a wind-driven exchange with the shelf, where they occur year-round. The temperature and rapid renewal of these waters suggest that, at present, they drive enhanced submarine melting at the terminus. Key controls on the melting rate are the volume and properties of subtropical waters on the shelf and the patterns of the along-shore winds, suggesting the glaciers’ acceleration was triggered by a combination of atmospheric and oceanic changes. These measurements provide evidence of rapid advective pathway for the transmission of oceanic variability to the ice-sheet margins and highlight an important process that is missing from prognostic ice-sheet models.F.S. acknowledges support from WHOI’s Ocean and Climate Change Institute’s Arctic Research Initiative and from NSF OCE 0751896, and G.S.H and L.A.S from NASA’s Cryospheric Sciences Program. Funding for the hooded seal deployments was obtained from the International Governance and Atlantic Seal Research Program, Fisheries and Oceans, Canada, to G. B. S. and to the Greenland Institute of Natural Resources to A. R. A

Heterogeneous 2.5D integration on through silicon interposer

© 2015 AIP Publishing LLC. Driven by the need to reduce the power consumption of mobile devices, and servers/data centers, and yet continue to deliver improved performance and experience by the end consumer of digital data, the semiconductor industry is looking for new technologies for manufacturing integrated circuits (ICs). In this quest, power consumed in transferring data over copper interconnects is a sizeable portion that needs to be addressed now and continuing over the next few decades. 2.5D Through-Si-Interposer (TSI) is a strong candidate to deliver improved performance while consuming lower power than in previous generations of servers/data centers and mobile devices. These low-power/high-performance advantages are realized through achievement of high interconnect densities on the TSI (higher than ever seen on Printed Circuit Boards (PCBs) or organic substrates), and enabling heterogeneous integration on the TSI platform where individual ICs are assembled at close proximity