Роль сугаммадекса при эндоваскулярных вмешательствах на сосудах головного мозга

Highlights. The article discusses the features of general anesthesia in patients with cerebrovascular diseases using the relaxant binding agent sugammadex.Aim. To evaluate the effectiveness of sugammadex in endovascular management of cerebrovascular diseases.Methods. The study included 57 patients who underwent endovascular treatment of cerebrovascular disease under general anesthesia. The experimental group included 29 patients who were injected with sugammadex - a selective relaxant binding agent for reversal of neuromuscular block induced by rocuronium. The comparison group included 28 patients who did not undergo decurarization (n = 13), or it was performed with neostigmine (n = 15). Acceleromyography was used to monitor the state of neuromuscular function.Result. Onset of action and duration of action of rocuronium at a dose of 0.9 mg/kg did not differ between the groups. The neuromuscular recovery time was 2.14 [1.67; 2.59] minutes after administration of sugammadex, compared with spontaneous 35.8 [31.5; 40.4] minutes and neostigmine-induced 22.1 [16.8; 27.3] minutes (p<0.001). No adverse or allergic reactions were noted after administration of the relaxant binding agent.Conclusion. Using a specific antidote sugammadex to eliminate the effect of rocuronium helps to restore neuromuscular function within 2–3 minutes and assess the neurological status of patients immediately after the endovascular treatment of cerebrovascular disease.Основные положения. В статье обсуждаются особенности проведения общей анестезии пациентам с сосудистыми заболеваниями головного мозга с использованием релаксант-связывающего агента сугаммадекса.Цель. Оценка эффективности сугаммадекса при эндоваскулярных вмешательствах на сосудах головного мозга.Материалы и методы. В исследование включены 57 пациентов, которым выполнено рентгенэндоваскулярное вмешательство на сосудах головного мозга в условиях общей анестезии. В исследуемую группу вошли 29 больных, которым вводили сугаммадекс – релаксант-связывающий агент рокурония. Группу сравнения составили 28 пациентов, которым декураризация не выполнена (n = 13) или проведена с помощью неостигмина (n = 15). Для контроля состояния нейромышечной функции использован метод акcелерометрического мониторинга.Результаты. Время начала действия и клиническая продолжительность действия рокурония в дозе 0,9 мг/кг не различались в группах. Время восстановления нейромышечной проводимости после введения сугаммадекса составило 2,14 [1,67; 2,59] мин в сравнении с 35,8 [31,5; 40,4] мин при спонтанном восстановлении и 22,1 [16,8; 27,3] мин при восстановлении, индуцированным неостигмином (p<0,001). Не зафиксировано каких-либо побочных и аллергических реакций после введения релаксант-связывающего агента.Заключение. Использование специфического антидота сугаммадекса для устранения эффекта рокурония позволяет в течение 2–3 мин полностью восстановить нейромышечное проведение и оценить неврологический статус пациентов сразу после окончания эндоваскулярного вмешательства на сосудах головного мозга

A Belief System's Organization Based on a Computational Model of the Dynamic Context: First Approximation

In this article we present a model of organization of a belief system based on a set of binary recursive functions that characterize the dynamic context that modifies the beliefs. The initial beliefs are modeled by a set of two-bit words that grow, update, and generate other beliefs as the different experiences of the dynamic context appear. Reason is presented as an emergent effect of the experience on the beliefs. The system presents a layered structure that allows a functional organization of the belief system. Our approach seems suitable to model different ways of thinking and to apply to different realistic scenarios such as ideologies

Response and resilience of Spartina alterniflora to sudden dieback

We measured an array of biophysical and spectral variables to evaluate the response and recovery of Spartina alterniflora to a sudden dieback event in spring and summer 2004 within a low marsh in coastal Virginia, USA. S. alterniflora is a foundation species, whose loss decreases ecosystem services and potentiates ecosystem state change. Long-term records of the potential environmental drivers of dieback such as precipitation and tidal inundation did not evidence any particular anomalies, although Hurricane Isabel in fall 2003 may have been related to dieback. Transects were established across the interface between the dieback area and apparently healthy areas of marsh. Plant condition was classified based on ground cover within transects as dieback, intermediate and healthy. Numerous characteristics of S. alterniflora culms within each condition class were assessed including biomass, morphology and spectral attributes associated with photosynthetic pigments. Plants demonstrated evidence of stress in 2004 and 2005 beyond areas of obvious dieback and resilience at a multi-year scale. Resilience of the plants was evident in recovery of ground cover and biomass largely within 3 y, although a small remnant of dieback persisted for 8 y. Culms surviving within the dieback and areas of intermediate impact had modified morphological traits and spectral response that reflected stress. These morphometric and spectral differences among plant cover condition classes serve as guidelines for monitoring of dieback initiation, effects and subsequent recovery. Although a number of environmental and biotic parameters were assessed relative to causation, the reason for this particular dieback remains largely unknown, however

Эффективность персонализированной антитромботической терапии при стентировании коронарных артерий: мета-анализ

Background. Prevention of complications in patients after coronary stenting by selection of personalized antiplatelet therapy (PAPT) based on platelet function test and genetic analysis have been actively studied. However, it is still an issue of concern. The article presents a meta-analysis of the recent PAPT studies.Aim. To evaluate the effectiveness of personalized antiplatelet therapy in patients undergoing coronary stenting.Methods             Fifteen studies with the total of 9,497 patients were included in the meta-analysis. The PAPT studies were searched using the PubMed, Embase and Cochrane Library.Results. PAPT reduces the risk of major adverse cardiovascular events (RR 0.58, 95% CI 0.42-0.80, p = 0.001), stent thrombosis (RR 0.60, 95% CI 0.41-0.87, p = 0.008) and myocardial infarction (RR 0.43, 95% CI 0.21-0.88, p = 0.02) compared with patients without PAPT. However, no significant differences were found in cardiovascular mortality (RR 0.77, 95% CI 0.51-1.16, p = 0.21), bleeding (RR 0.96, 95% CI 0.81-1.13, p = 0.59) and ischemic stroke (RR 0.81, 95% CI 0.39-1.66, p = 0.57). The effectiveness of PAPT in reducing major adverse cardiovascular events was mainly in patients with high platelet reactivity during dual antiplatelet therapy (RR 0.46, 95% CI 0.27-0.80, p = 0.006).Conclusion. Personalized antiplatelet therapy significantly reduces the risk of stent thrombosis, myocardial infarction and other major adverse cardiovascular events in patients with coronary artery stenting.Основные положения. На основании данных рандомизированных контролируемых исследований получены доказательства эффективности персонализированной антитромботической терапии в снижении риска развития тромбоза стента, инфаркта миокарда и других серьезных кардиальных событий.Актуальность. Активно изучается профилактика развития осложнений после стентирования коронарных артерий, путем подбора персонализированной антитромботической терапии (ПАТ) на основании оценки функции тромбоцитов и генетического анализа. Однако имеются разногласия по этой проблеме. В данной статье представлен метаанализ наиболее значимых исследований ПАТ.Цель. Оценить эффективность персонализированной антитромботической терапии при стентировании коронарных артерий.Материалы и методы               . Использовались данные рандомизированных контролируемых исследований из баз данных PubMed, Embase и CochraneLibrary.Результаты. Изучено пятнадцать исследований, всего 9 497 пациентов. По результатам метаанализа ПАТ снижает риск серьезных кардиальных событий (относительный риск (ОР) 0,58, 95% доверительный интервал (ДИ) 0,42-0,80, p = 0,001), тромбоза стента (ОР 0,60, 95% ДИ 0,41-0,87, p = 0,008) и инфаркта миокарда (ОР 0,43, 95% ДИ 0,21-0,88, p = 0,02) по сравнению с группой пациентов без ПАТ. Тем не менее, не было обнаружено значимого различия по сердечно-сосудистой смертности (ОР 0,77, 95% ДИ 0,51-1,16, p = 0,21), кровотечениям (ОР 0,96, 95% ДИ 0,81-1,13, p = 0,59) и ишемическому инсульту (ОР 0,81, 95% ДИ 0,39-1,66, p = 0,57). Эффективность ПАТ в снижении серьезных кардиальных событий проявлялась в основном у пациентов с высокой реактивностью тромбоцитов на фоне двойной антитромботической терапии (ОР 0,46, 95% ДИ 0,27-0,80, p = 0,006).Заключение. Персонализированная антитромботическая терапия статистически значимо снижает риск развития тромбоза стента, инфаркта миокарда и других серьезных кардиальных событий при стентировании ко онарных артерий

Optical types of inland and coastal waters

Inland and coastal waterbodies are critical components of the global biosphere. Timely monitoring is necessary to enhance our understanding of their functions, the drivers impacting on these functions and to deliver more effective management. The ability to observe waterbodies from space has led to Earth observation (EO) becoming established as an important source of information on water quality and ecosystem condition. However, progress toward a globally valid EO approach is still largely hampered by inconsistences over temporally and spatially variable in‐water optical conditions. In this study, a comprehensive dataset from more than 250 aquatic systems, representing a wide range of conditions, was analyzed in order to develop a typology of optical water types (OWTs) for inland and coastal waters. We introduce a novel approach for clustering in situ hyperspectral water reflectance measurements (n = 4045) from multiple sources based on a functional data analysis. The resulting classification algorithm identified 13 spectrally distinct clusters of measurements in inland waters, and a further nine clusters from the marine environment. The distinction and characterization of OWTs was supported by the availability of a wide range of coincident data on biogeochemical and inherent optical properties from inland waters. Phylogenetic trees based on the shapes of cluster means were constructed to identify similarities among the derived clusters with respect to spectral diversity. This typification provides a valuable framework for a globally applicable EO scheme and the design of future EO missions

Синдром Мэя - Тернера: современные методы диагностики и лечения

May-Turner syndrome is a condition where the left common iliac vein is compressed between the lumbar spine and the overlying right common iliac artery. Left iliac vein compression is common (up to 24%) in the general population, but clinical manifestations occur in a few patients. This syndrome should be considered in case of unexplained edema of the left lower extremity since routine duplex ultrasound does not possess optimal sensitivity and specificity in the study of the iliac veins and the inferior vena cava. Intravascular ultrasound is the most accurate diagnostic method. However, the advent of computed tomography angiography and magnetic resonance angiography providing high-quality images of the vasculature have become a promising alternative to invasive intravascular ultrasound. Treatment for May-Turner syndrome usually involves stenting of the left common iliac vein along with medical therapy, including antithrombotic (anticoagulant and antiplatelet) therapy combined with phlebotonics. Our review reports modern methods of diagnosis and treatment of May-Turner syndrome.Синдром Мэя - Тернера (СМТ) является симптомокомплексом, который возникает при сдавлении левой общей подвздошной вены между поясничным отделом позвоночника и правой общей подвздошной артерией. Компрессия левой общей подвздошной вены распространена в общей популяции (24%), однако клинические проявления наступают у значительно меньшего количества пациентов. Заподозрить данный синдром следует при необъяснимом отеке левой нижней конечности, так как классическое ультразвуковое дуплексное сканирование не обладает необходимыми чувствительностью и специфичностью при исследовании подвздошных вен и нижней полой вены. Внутрисосудистое ультразвуковое исследование (ВСУЗИ) является наиболее точным методом диагностики, однако компьютерная томографическая и магнитно-резонансная ангиографии с высоким качеством изображения представляют эффективную альтернативу инвазивному ВСУЗИ. Основным методом лечения СМТ является стентирование левой общей подвздошной вены на фоне приема медикаментозной терапии, включающей антитромбо-тическую (антикоагулянтную и антиагрегантную) терапию в комбинации с флеботонизирующими препаратами. Цель данного обзора состоит в описании современных методов диагностики и лечения синдрома Мэя - Тернера

The behaviour of repeat visitors to museums: Review and empirical findings

This study presents a theoretical and operational framework for analysing repeat visit to museums. Starting from the literature on repeat visit in tourism, the specificities of these cultural attractions are made explicit through a review of theoretical and applied works. Consistently with previous contributors, the paper suggests that the analysis of actual past behaviours has to be preferred to the one of attitudes. The application of proper econometric models is also remarked in order to put into account individual profiles. Information coming from three techniques is then used in an integrated way in order to provide a more comprehensive view of the phenomenon. Evidence from an ad hoc survey suggests the necessity to give a greater attention to perceived cultural value during the visit, promoting cultural events during the week and addressed to children, and taking care of those visitors that come from far places also through an integrated tourist supply. © 2013 Springer Science+Business Media Dordrecht

DELINEAMENTO AMOSTRAL EM RESERVATÓRIOS UTILIZANDO IMAGENS LANDSAT-8/OLI: UM ESTUDO DE CASO NO RESERVATÓRIO DE NOVA AVANHANDAVA (ESTADO DE SÃO PAULO, BRASIL)

O uso do sensoriamento remoto voltado para a determinação de amostras de campo é de grande valia para estudos ambientais, uma vez que as imagens de satélite apresentam atributos capazes de avaliar a variabilidade espectral da superfície da água considerando uma área extensa. Desse modo, a abordagem deste trabalho objetiva definir um método de seleção estratificada de amostras baseada na variabilidade de imagens no espectro do visível e infravermelho oriundos do sensor Landsat-8/OLI. O método conta com a utilização de dados raster que representam o desvio padrão de uma série temporal de imagens Landsat-8/OLI e em seguida a definição automática de pontos de campo apoiada na técnica de amostragem estratificada aleatória. A escolha da imagem que deu origem a seleção dos pontos foi baseada na componente de maior variabilidade espectral por meio da técnica de Principal Componente. Como resultado foram obtidos vinte pontos representativos de um total de seis classes espectralmente semelhantes