Pulmonaaliatresiapotilaiden pitkäaikaisennuste

Tausta Pulmonaaliatresia on yksi harvinaisimpia ja vakavimmista synnynnäistä sydänvioista, jonka esiintyvyys maailmanlaajuisesti vaihtelee 4–10/100 000 elävänä syntynyttä lasta kohti. Vian hoidotta jättäminen johtaa merkittävällä osalla varhaiseen kuolemaan ja ainoa parantava hoito on leikkaushoito. Nykyään suurin osa pulmonaaliatresioista diagnosoidaan jo varhain raskaudessa, jonka seurauksesta synnytys voidaan etukäteen suunnitella ja hoitoon pääsy nopeutuu huomattavasti. Pulmonaaliatresian perustana on keuhkovaltimoläpän kehityksellinen vika. Pulmonaaliatresia voidaan jakaa alatyyppeihin kammioväliseinärakenteen mukaan. Pulmonaaliatresiapotilaiden pitkäaikaisennusteet vaihtelevat eri keskusten välillä ja tutkimukset, joissa potilaiden seuranta-aika on pitkä on harvassa. Kirjallisuuskatsauksessa pyritään selvittämään pulmonaaliatresiapotilaiden pitkäaikaisennustetta. Aineisto ja menetelmät Kirjallisuuskatsaus tehtiin PubMed ja OVID Medline -tietokannoista käyttämällä hakusanoja ”pulmonary atresia”, ”intact ventricular septum”, ”VSD”, ”MAPCAs”, ”outcome”, ja ”survival” sekä niiden yhdistelmiä. Haku rajoitettiin 1993–2021 julkaistuihin artikkeleihin. Löydökset Tutkimuksessa verrattiin eri aineistoissa julkaistujen potilaiden pitkäaikaisia elossaolo-osuuksia keskenään. Vuoden 2010 jälkeen julkaistuissa aineistoissa potilaiden elossaolo-osuudet olivat korkeammat kuin ennen vuotta 2010 julkaistuissa aineistoissa. Potilaiden keskimääräiset NYHA-luokat olivat I- tai II tutkimusten lopussa kaikissa alaryhmissä. Pohdinta Yhdessä varhaisen diagnostiikan, varhaisen konservatiivisen ja kehittyneen leikkaushoidon kanssa, pulmonaaliatresiapotilaiden pitkäaikaisennusteet ja elämänlaatu ovat parantuneet vuosikymmenten aikana. Vaikkakin pitkäaikaisennusteet ovat selkeästi parantuneet, pitkäaikaisennusteesta tarvitaan lisää tutkimuksia, sillä tutkimuksia pitkillä seuranta-ajoilla on harvakseltaan ja leikkaushoidot vaihtelevat eri keskusten välillä vaikeuttaen pitkäaikaisennusteiden vertailua keskenään

Gender differences in parasympathetic reactivation during recovery from Wingate anaerobic test

Background and Purpose: We wanted to investigate gender differences in parasympathetic reactivation from supramaximal exercise. Materials and methods: Parasympathetic reactivation from a Wingate anaerobic test was investigated in 16 male and 15 female volunteers. Heart rate recovery was assessed as the difference between peak exercise heart rate and heart rate recorded following 60 seconds of recovery (HRR60 ). The time constant of the first 30 s post-exercise HR (T30) was determined as a negative reciprocal of the slope of the regression line. Another time constant decay (T) was obtained by fitting the 5 minute post-exercise HRR into a first-order exponential curve. Measures of heart rate variability (HRV) were used to describe the changes in autonomic cardiac regulation following exercise. Results: Post exercise heart rate recovery was faster in male participants, demonstrated through HRR60 (29.5±8.9 vs. 23.4±9.8 seconds respectively) and T30 (292.4±88.7 vs. 409.2±138.3 seconds respectively), but the time constant of the exponential heart rate decay (T) did not differ between the two genders (140.4±55.7 in males and 130.3±49.7seconds in females). The present study demonstrated similar RMSSD, lnHF and HFnu at rest in male and female participants. The time course of RMSSD30 recovery was impaired immediately after exercise. None of the observed vagal HRV indices have restored after five minutes of recovery following the 30-s Wingate test, but the post-exercise lnHF2-5min was significantly smaller in females (3.3±0.9 ms 2 in males vs. 2.5±1.0 ms 2 in females). Conclusion: The immediate HRR and parasympathetic reactivation was affected by gender and was attenuated in female participants

Orexin neurons track temporal features of blood glucose in behaving mice

Does the brain track how fast our blood glucose is changing? Knowing such a rate of change would enable the prediction of an upcoming state and a timelier response to this new state. Hypothalamic arousal-orchestrating hypocretin/orexin neurons (HONs) have been proposed to be glucose sensors, yet whether they track glucose concentration (proportional tracking) or rate of change (derivative tracking) is unknown. Using simultaneous recordings of HONs and blood glucose in behaving male mice, we found that maximal HON responses occur in considerable temporal anticipation (minutes) of glucose peaks due to derivative tracking. Analysis of >900 individual HONs revealed glucose tracking in most HONs (98%), with derivative and proportional trackers working in parallel, and many (65%) HONs multiplexed glucose and locomotion information. Finally, we found that HON activity is important for glucose-evoked locomotor suppression. These findings reveal a temporal dimension of brain glucose sensing and link neurobiological and algorithmic views of blood glucose perception in the brain's arousal orchestrators

Predictive value of serum bicarbonate, arterial base deficit/excess and SAPS III score in critically ill patients

Abstract. Arterial base deficit/excess (BD/E) is commonly used marker of metabolic acidosis in critically ill patients, but requires an arterial puncture and blood gas analysis. We hypothesized that serum bicarbonate (HCO 3 ), which can be routinely obtained, strongly correlates with arterial BD/E and provides equivalent predictive information. In addition, we evaluated predictive value of simplified acute physiology score III (SAPS III). Total of 152 critically ill surgical patients were included in retrospective analysis. On admission to intensive care unit sets of simultaneously obtained paired laboratory data, including an arterial blood gas and serum chemistry panel with serum HCO 3 were obtained. Very strong correlation between BD/E and simultaneously measured serum HCO 3 levels was found (r = 0.857, R 2 = 0.732, p < 0.01). The serum HCO 3 level reliably identified a significant metabolic acidosis (AUC = 0.761, p < 0.05). BD and SAPS III were good predictors of mortality (AUCs 0.70 and 0.74, respectively). Serum HCO 3 may be used as substitute to detect severe metabolic acidosis. BD and SAPS III score were good predictors of mortality

A checklist of springtails (Hexapoda, Collembola) from Kosovo and Metohija province, Republic of Serbia

View on Scopus The knowledge of Collembola diversity is far from complete, especially on the territory of the Republic of Serbia. This paper presents a summary of all identified species of springtails in the area of Kosovo and Metohija. The list of species includes a total of 119 species of springtails classified into 65 genera, 16 families, and 4 orders. Representatives of all four recent orders of Collembola are present in this checklist. The order with the greatest number of species is Entomobryomorpha with 55 determined species, while the order Neelipleona is present with only one endemic cave species Neelus klisurensis Kovác & Papác, 2010, which is found in the aphotic zone of the cave in Velika Klisura at the foot of Prokletije mountains. The family with the most number of species is Entomobryidae Schäffer, 1896 with 21 species, while the most scarce families are Poduridae, Paronellidae and Neelidae, each with one representative. The family with the most genera is Isotomidae with a total of 11 genera. The genus Entomobrya Rondani, 1861 is the genus with the most species, with a total of 11 species. The fauna of the springtails of Kosovo and Metohija has not been properly and sufficiently investigated, although great diversity and high endemism can be expected in this territory, especially in the unexplored caves and gorges. The importance of springtail research is manifold. This paper is a contribution to add knowledge to the existing fauna of Kosovo and Metohija and the starting point for further research of springtails in this area

Rational inattention in mice

Behavior exhibited by humans and other organisms is generally inconsistent and biased and, thus, is often labeled irrational. However, the origins of this seemingly suboptimal behavior remain elusive. We developed a behavioral task and normative framework to reveal how organisms should allocate their limited processing resources such that sensory precision and its related metabolic investment are balanced to guarantee maximal utility. We found that mice act as rational inattentive agents by adaptively allocating their sensory resources in a way that maximizes reward consumption in previously unexperienced stimulus-reward association environments. Unexpectedly, perception of commonly occurring stimuli was relatively imprecise; however, this apparent statistical fallacy implies "awareness" and efficient adaptation to their neurocognitive limitations. Arousal systems carry reward distribution information of sensory signals, and distributional reinforcement learning mechanisms regulate sensory precision via top-down normalization. These findings reveal how organisms efficiently perceive and adapt to previously unexperienced environmental contexts within the constraints imposed by neurobiology.ISSN:2375-254

Glass-ceramic enamels derived from the Li2O-Na2O-Al2O3-TiO2-SiO2 system

The results of research on the conditions for obtaining model glass-ceramic enamels, derived from the basic Li2O-Na2O-Al2O3-TiO2-SiO2 system, by varying the initial composition and thermal treatment conditions, are presented in this paper. Segregation of the crystal phases in the glassy-matrix was carried out during subsequent thermal treatment. The formation of different crystal phases was evidenced through the results of differential-thermal analysis and X-ray powder diffraction analysis

MAXIMAL OXIGEN UPTAKE (VO2 MAX) AS THE INDICATOR OF PHYSICAL WORKING CAPACITY IN SPORTSMEN

The term “aerobic capacity” represents the sum of aerobic metabolic processes in human organism. It is the basis of the physical working capacity. Value of the maximal oxygen uptake (VO2max) is the best indicator for the aerobic capacity evaluation.The purpose of this study was to check the possibility of using VO2max as the indicator of aerobic capacity in sportsmen and to check differences in VO2max values in regard to non-sportsmen.The goals were: 1.Analyses of the VO2max values in sportsmen of various sports 2. Comparison of values of sportsmen with the values of non-sportsmen.This study included 67 sportsmen (rowers, football players and judoists) and 28 nonsportsmen. VO2max was measured by using a direct method.The results obtained show statistically higher VO2max values in rowers (4,52 L/min - 55,8 mL/kg/min) in regard to football players (4,2 L/min – 53,6 mL/kg/min), judoists (3,58 L/min - 47,2 mL/ kg/min) and non-sportsmen (3,28 L/min – 42,3 mL/kg/min). Successful rowing requires high anaerobic capacity and, therefore, high VO2max.These results show higher values of VO2max in sportsmen in regard to non-sportsmen, which is the result of training only