O Doente Cirrótico na Unidade de Cuidados Intensivos: Avaliação do Prognóstico

INTRODUÇÃO: Os doentes com cirrose hepática admitidos em Unidades de Cuidados Intensivos (UCI) têm um prognóstico particularmente reservado. O prognóstico destes doentes pode ser avaliado com scores gerais (SOFA, APACHE, SAPS) ou com scores específicos de cirrose hepática (MELD, Child-Pugh). OBJECTIVOS: Avaliar o valor prognóstico dos scores gerais (SOFA, APACHE e SAPS) e dos scores específicos de cirrose hepática (MELD e Child-Pugh) em doentes com cirrose hepática admitidos em UCI polivalentes ou em Unidades de Cuidados Intensivos de Gastrenterologia (UCIGE). MATERIAL E MÉTODOS: Os autores fazem uma revisão da literatura sobre a avaliação do prognóstico de doentes com cirrose hepática admitidos em ICUs e relatam também a sua experiência sobre esta temática no contexto duma UCIGE incluindo a análise de 124 internamentos. RESULTADOS: Nos diversos estudos efectuados em doentes com cirrose hepática admitidos em UCI polivalentes, os diferentes scores gerais e específicos revelaram um bom poder discriminativo, ou seja, com uma área sob a curva ROC (AUC) > 0,7. Considerando os seis estudos mais representativos, o valor médio da AUC dos scores SOFA, APACHE II, APACHE III, MELD e Child-Pugh foi 0,86, 0,74, 0,81, 0,79 e 0,77, respectivamente. O estudo de 124 internamentos consecutivos na UCIGE de doentes com cirrose hepática revelou que os doentes que faleceram pertenciam todos à classe C de Child-Pugh e tinham valores médios dos scores SOFA, APACHE II, SAPS II e MELD significativamente superiores aos dos doentes que não faleceram (10,1, 22,0, 47,5 e 30,7 nos que faleceram e 3,5, 13,6, 25,4 e 18,0 nos que não faleceram, respectivamente; p >< 0,05). Conclusões: Tanto os scores gerais como os específicos de cirrose hepática têm valor prognóstico na avaliação do risco de doentes com cirrose hepática internados em UCI polivalentes ou em UCIGE. Nas UCI polivalentes os scores gerais, e em particular o SOFA, apresentam melhor capacidade prognóstica do que os scores específicos de cirrose hepátic

Prognostic scores in a gastroenterology intensive care unit

BACKGROUND: Several prognostic systems have been developed and validated in general Intensive Care Units (ICUs). No assessment of these scores was performed in specialized Gastroenterology Intensive Care Units (GICUs). AIM: To assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores systems to predict mortality in a GICU. METHODS: Retrospective study of 300 consecutively admissions in a GICU. Demographics, indication for admission, APACHE II, SAPS II and SOFA scores and survival at GICU discharge were recorded. Discrimination was evaluated using receiver operations characteristic (ROC) curves and area under a ROC curve (AUC). Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Overall GICU mortality was 5.3%. APACHE II, SAPS II and SOFA mean scores of nonsurvivors (21.9, 46.2 and 9.3, respectively) were found to be significantly higher than those of survivors (11.9, 26.7 and 2.2, respectively) (p < 0.001). Discrimination was excellent for all the prognostic systems, with AUC = 0.900, 0.903 and 0.965 for APACHE II, SAPS II and SOFA, respectively. Similarly, APACHE II, SAPS II and SOFA scores achieved good calibration, with p = 0.671, 0.928 and 0.775, respectively. Among the three scores, SOFA showed the best performance, with overall correctness of prediction of 94.0%, while it was 86.2% for APACHE II and 82.7% for SAPS II. CONCLUSIONS: in GICU, APACHE II, SAPS II and SOFA scores have excellent prognostic accuracy and, among the three scores, SOFA has the greatest overall correctness of prediction

Analysis of the resolution of split-ring metamaterial lenses with application in parallel magnetic resonance imaging

In this work, we experimentally determine the resolution of split-ring metamaterials lenses with emphasis in magnetic resonance imaging applications. Two small sources are used to determine the minimal resolution of the lens, which is compared with previous theoretical predictions. Taking into account this minimal resolution, a second experiment is designed in order to study the ability of a split-ring lens to improve the localization of the field produced by two closely spaced coils. This ability could find application in parallel magnetic resonance imaging, which take advantage of the distinct coil sensitivities in order to reduce the image acquisition time. © 2011 American Institute of Physics

Component digestibility of lupin (Lupinus angustifolius) and pea (Pisum sativum) seeds and effects on the small intestine and body organs in anastomosed and intact growing pigs.

Thirty-six male growing pigs were used to compare the component digestibility of legume seeds and the impact of diets and ileo-rectal anastomosis (IRA) on the morphology and enzyme activities of intestinal mucosa. The pigs were fed a control (C) diet based on casein or a diet in which 60% of crude protein (CP) was supplied by blue lupin (Lupinus angustifolius) (L) or pea (Pisum sativum) (P) seeds. Coefficient of total tract apparent digestibility (CTTAD) of organic matter (OM), CP and gross energy (GE) was lower in the L diet compared to the control diet. The pea-based diet presented intermediate CTTAD values of OM and GE. Coefficient of ileal apparent digestibility (CIAD) of OM and GE was lower in the legume-containing diets than with C. No significant differences were found for the CIAD of CP There was a significant interaction between diet and IRA for villus height in the jejunum and crypt width in the ileum. Duodenal and jejunal crypt width was lower in the pigs fed the legume-containing diets compared to controls. The diet influenced the specific activity of most intestinal enzymes at various sites along the small intestine. Anastomosed pigs had higher spleen and small intestine weights and lower large intestine weights as compared to intact pigs. IRA influenced intestinal villus and crypt architecture but it had no significant effect on the activities of intestinal enzymes. (Résumé d'auteur

Bioorthogonal Strategy for Bioprocessing of Specific-Site-Functionalized Enveloped Influenza-Virus-Like Particles

Virus-like particles (VLPs) constitute a promising platform in vaccine development and targeted drug delivery. To date, most applications use simple nonenveloped VLPs as human papillomavirus or hepatitis B vaccines, even though the envelope is known to be critical to retain the native protein folding and biological function. Here, we present tagged enveloped VLPs (TagE-VLPs) as a valuable strategy for the downstream processing and monitoring of the in vivo production of specific-site-functionalized enveloped influenza VLPs. This two-step procedure allows bioorthogonal functionalization of azide-tagged nascent influenza type A hemagglutinin proteins in the envelope of VLPs through a strain-promoted [3 + 2] alkyne-azide cycloaddition reaction. Importantly, labeling does not influence VLP production and allows for construction of functionalized VLPs without deleterious effects on their biological function. Refined discrimination and separation between VLP and baculovirus, the major impurity of the process, is achieved when this technique is combined with flow cytometry analysis, as demonstrated by atomic force microscopy. TagE-VLPs is a versatile tool broadly applicable to the production, monitoring, and purification of functionalized enveloped VLPs for vaccine design trial runs, targeted drug delivery, and molecular imaging.The authors acknowledge funding from the European Union (EDUFLUVAC project FP7-HEALTH-2013-INNOVATION), the Fundação para a Ciência e Tecnologia (FCT, Portugal; project HIVERA/0002/2013 and FCT Investigator to G.J.L.B.), EPSRC (to G.J.L.B.), the European Commission, Marie Skłodowska-Curie Actions (MSCA), and RISE project grant 644167. S. B. C., J. M. F., F. M., and D. G. acknowledge FCT for fellowships SFRH/BD/52302/2013, SFRH/BD/70423/2010, SFRH/BD/70139/2010, and SFRH/BPD/73500/2010, respectively. The authors acknowledge Ricardo Silva for all his help in fluorescence analysis implementation and fruitful discussions. The authors also acknowledge Patrícia Gomes-Alves for her help for mass spectrometry analysis. Mass spectrometry data was obtained by the Mass Spectrometry Unit (UniMS), ITQB/iBET, Oeiras, Portugal. G. J. L. B. is a Royal Society University Research Fellow and the recipient of a European Research Council Starting Grant (TagIt)

Introduction to the functional RG and applications to gauge theories

These lectures contain an introduction to modern renormalization group (RG) methods as well as functional RG approaches to gauge theories. In the first lecture, the functional renormalization group is introduced with a focus on the flow equation for the effective average action. The second lecture is devoted to a discussion of flow equations and symmetries in general, and flow equations and gauge symmetries in particular. The third lecture deals with the flow equation in the background formalism which is particularly convenient for analytical computations of truncated flows. The fourth lecture concentrates on the transition from microscopic to macroscopic degrees of freedom; even though this is discussed here in the language and the context of QCD, the developed formalism is much more general and will be useful also for other systems.Comment: 60 pages, 14 figures, Lectures held at the 2006 ECT* School "Renormalization Group and Effective Field Theory Approaches to Many-Body Systems", Trento, Ital

Functional renormalization group with a compactly supported smooth regulator function

The functional renormalization group equation with a compactly supported smooth (CSS) regulator function is considered. It is demonstrated that in an appropriate limit the CSS regulator recovers the optimized one and it has derivatives of all orders. The more generalized form of the CSS regulator is shown to reduce to all major type of regulator functions (exponential, power-law) in appropriate limits. The CSS regulator function is tested by studying the critical behavior of the bosonized two-dimensional quantum electrodynamics in the local potential approximation and the sine-Gordon scalar theory for d<2 dimensions beyond the local potential approximation. It is shown that a similar smoothing problem in nuclear physics has already been solved by introducing the so called Salamon-Vertse potential which can be related to the CSS regulator.Comment: JHEP style, 11 pages, 2 figures, proofs corrected, accepted for publication by JHE