Treatment of cardiac patients and complications on the ICU

In het afgelopen decennium zijn er vele verbeteringen in de behandeling van patiënten na een hartstilstand geweest. Dit proefschrift onderzocht wat deze veranderingen waren en wat hun effect op de uitkomst was voor alle patiënten na een hartstilstand. De de hemodynamische effecten van koeling therapie toonden een verminderd hartminuutvolume en verhoogde lactaat niveaus aan. De gemengde veneuze zuurstofgehaltes waren echter normaal. Hyperlactatiëmie zou verband kunnen houden met onderkoeling en heeft geen schadelijke effecten. De lactaat niveaus direct na een hartstilstand daalden veel sneller dan de 10% / uur reductie gemeld bij septische patiënten en welke ook werd voorgesteld in de setting van een hartstilstand. De overleving en neurologische uitkomst bij patiënten gereanimeerd na initieel VF en behandeld met een PCI binnen dit STEMI netwerk was opmerkelijk goed. Deze waarnemingen onderstrepen het feit dat de huidige keten van behandeling optimale is. Een ruimere toepassing van angiografie en coronaire interventie ervaren acute cardiale verwijzingscentra kan worden overwogen. De uitkomsten na reanimatie voor ouderen zijn veel slechter. De meeste ouderen die overleefden hadden echter wel een goede neurologische uitkomst en een levensduur die redelijk overeenkomt in vergelijking met de algemene populatie van deze leeftijd

Bromination Pattern of Hydroxylated Metabolites of BDE-47 Affects Their Potency to Release Calcium from Intracellular Stores in PC12 Cells

BACKGROUND: Brominated flame retardants, including the widely used polybrominated diphenyl ethers (PBDEs), have been detected in humans, raising concern about possible neurotoxicity. Recent research demonstrated that the hydroxylated metabolite 6-OH-BDE-47 increases neurotransmitter release by releasing calcium ions (Ca2+) from intracellular stores at much lower concentrations than its environmentally relevant parent congener BDE-47. Recently, several other hydroxylated BDE-47 metabolites, besides 6-OH-BDE-47, have been detected in human serum and cord blood. OBJECTIVE AND METHODS: To investigate the neurotoxic potential of other environmentally relevant PBDEs and their metabolites, we examined and compared the acute effects of BDE-47, BDE-49, BDE-99, BDE-100, BDE-153, and several metabolites of BDE-47-6-OH-BDE-47 (and its methoxylated analog 6-MeO-BDE-47), 6 -OH-BDE-49, 5-OH-BDE-47, 3-OH-BDE-47, and 4 -OH-BDE-49--on intracellular Ca2+ concentration ([Ca2+]i), measured using the Ca2+-responsive dye Fura-2 in neuroendocrine pheochromocytoma (PC12) cells. RESULTS: In contrast to the parent PBDEs and 6-MeO-BDE-47, all hydroxylated metabolites induced Ca2+ release from intracellular stores, although with different lowest observed effect concentrations (LOECs). The major intracellular Ca2+ sources were either endoplasmic reticulum (ER; 5-OH-BDE-47 and 6 -OH-BDE-49) or both ER and mitochondria (6-OH-BDE-47, 3-OH-BDE-47, and 4 -OH-BDE-49). When investigating fluctuations in [Ca2+]i, which is a more subtle end point, we observed lower LOECs for 6-OH-BDE-47 and 4 -OH-BDE-49, as well as for BDE-47. CONCLUSIONS: The present findings demonstrate that hydroxylated metabolites of BDE-47 cause disturbance of the [Ca2+]i. Importantly, shielding of the OH group on both sides with bromine atoms and/or the ether bond to the other phenyl ring lowers the potency of hydroxylated PBDE metabolites

Hydroxylation Increases the Neurotoxic Potential of BDE-47 to Affect Exocytosis and Calcium Homeostasis in PC12 Cells

BACKGROUND: Oxidative metabolism, resulting in the formation of hydroxylated polybrominated diphenyl ether (PBDE) metabolites, may enhance the neurotoxic potential of brominated flame retardants. OBJECTIVE: Our objective was to investigate the effects of a hydroxylated metabolite of 2,2',4,4'-tetra-bromodiphenyl ether (BDE-47; 6-OH-BDE-47) on changes in the intracellular Ca2+ concentration ([Ca2+]i) and vesicular catecholamine release in PC12 cells. METHODS: We measured vesicular catecholamine release and [Ca2+]i using amperometry and imaging of the fluorescent Ca2+-sensitive dye Fura-2, respectively. RESULTS: Acute exposure of PC12 cells to 6-OH-BDE-47 (5 microM) induced vesicular catecholamine release. Catecholamine release coincided with a transient increase in [Ca2+]i, which was observed shortly after the onset of exposure to 6-OH-BDE-47 (120 microM). An additional late increase in [Ca2+]i was often observed at > or =1 microM 6-OH-BDE-47. The initial transient increase was absent in cells exposed to the parent compound BDE-47, whereas the late increase was observed only at 20 microM. Using the mitochondrial uncoupler carbonyl cyanide 4-(trifluoromethoxy)phenylhydrazone (FCCP) and thapsigargin to empty intracellular Ca2+ stores, we found that the initial increase originates from emptying of the endoplasmic reticulum and consequent influx of extracellular Ca2+, whereas the late increase originates primarily from mitochondria. CONCLUSION: The hydroxylated metabolite 6-OH-BDE-47 is more potent in disturbing Ca2+ homeostasis and neurotransmitter release than the parent compound BDE-47. The present findings indicate that bioactivation by oxidative metabolism adds considerably to the neurotoxic potential of PBDEs. Additionally, based on the observed mechanism of action, a cumulative neurotoxic effect of PBDEs and ortho-substituted polychlorinated biphenyls on [Ca2+]i cannot be ruled out

Long-term outcome of elderly out-of-hospital cardiac arrest survivors as compared with their younger counterparts and the general population

Background: Over the past decade, prehospital and in-hospital treatment for out-of-hospital cardiac arrest (OHCA) has improved considerably. There are sparse data on the long-term outcome, especially in elderly patients. We studied whether elderly patients benefit to the same extent compared with younger patients and at long-term follow up as compared with the general population. Methods: Between 2001 and 2010, data from all patients presented to our hospital after OHCA were recorded. Elderly patients (>= 75 years) were compared with younger patients. Neurological outcome was classified as cerebral performance category (CPC) at hospital discharge and long-term survival was compared with younger patients and predicted survival rates of the general population. Results: Of the 810 patients admitted after OHCA, a total of 551 patients (68%) achieved return of spontaneous circulation, including 125 (23%) elderly patients with a mean age of 81 +/- 5 years. In-hospital survival was lower in elderly patients compared with younger patients with rates of 33% versus 57% (p 2 was observed versus 2.5% of their younger counterparts (p = 0.103). Elderly patients had a median survival of 6.5 [95% confidence interval (CI) 2.0-7.9] years compared with 7.7 (95% CI 7.5-7.9) years of the general population (p = 0.019). Conclusions: The survival rate after OHCA in elderly patients is approximately half that of younger patients. Elderly patients who survive to discharge frequently have favorable neurological outcomes and a long-term survival that approximates that of the general population

NEOnatal Central-venous Line Observational study on Thrombosis (NEOCLOT): Evaluation of a national guideline on management of neonatal catheter-related thrombosis

Background: In critically ill (preterm) neonates, central venous catheters (CVCs) are increasingly used for administration of medication or parenteral nutrition. A serious complication, however, is the development of catheter-related thrombosis (CVC-thrombosis), which may resolve by itself or cause severe complications. Due to lack of evidence, management of neonatal CVC-thrombosis varies among neonatal intensive care units (NICUs). In the Netherlands an expert-based national management guideline has been developed which is implemented in all 10 NICUs in 2014. Methods: The NEOCLOT study is a multicentre prospective observational cohort study, including 150 preterm and term infants (0-6 months) admitted to one of the 10 NICUs, developing CVC-thrombosis. Patient characteristics, thrombosis characteristics, risk factors, treatment strategies and outcome measures will be collected in a web-based database. Management of CVC-thrombosis will be performed as recommended in the protocol. Violations of the protocol will be noted. Primary outcome measures are a composite efficacy outcome consisting of death due to CVC-thrombosis and recurrent thrombosis, and a safety outcome consisting of the incidence of major bleedings during therapy. Secondary outcomes include individual components of primary efficacy outcome, clinically relevant non-major and minor bleedings and the frequency of risk factors, protocol variations, residual thrombosis and post thrombotic syndrome. Discussion: The NEOCLOT study will evaluate the efficacy and safety of the new, national, neonatal CVC-thrombosis guideline. Furthermore, risk factors as well as long-term consequences of CVC-thrombosis will be analysed

Unscheduled Visits of Patients with Familial Melanoma to a Pigmented Lesion Clinic: Evaluation of Patients' Characteristics and Suspicious Lesions

Approximately 10% of all melanomas occur in subjects with a family history of melanoma. This retrospective follow-up study investigated the characteristics of patients with familial melanoma who made unscheduled visits to our pigmented lesions clinic, and the diagnosis of excised lesions. A total of 110 (9%) out of 1,267 patients made at least one unscheduled visit between May 2011 and February 2016. Histopathology was taken from 59 patients. Thirty-four naevi, 7 melanomas and 3 basal cell carcinomas were detected. All patients with melanoma were CDKN2A carriers and all melanomas were discovered at a very early stage. In this patient population it appears to be safe to limit visits to once or twice yearly, provided patients are easily able to make an unscheduled extra visit if they have a worrisome lesion. We recommend supporting patients' self-reliance by stimulating them to carry out self-examination of their skin

Factores que influyen en el impacto organizacional del uso de sistemas de información en Microempresas colombianas: un estudio de caso

El uso de sistemas de información (SI) se relaciona con el mejoramiento de los procesos de negocio y el desempeño de las organizaciones, sin embargo la escasez de recursos de las microempresas hace necesario obtener el máximo rendimiento de las inversiones en estas soluciones tecnológicas. El tema central de este Trabajo Final es la identificación de factores que influyen en el impacto organizacional por el uso de SI en microempresas colombianas. Para tal fin, se realiza un recorrido sobre los aportes de la literatura en relación con la identificación de esto factores, se evalúa el impacto de un SI en una muestra de microempresas colombianas en sus dimensiones organizacionales, y se valida si los factores identificados en la revisión de la literatura se presentaron en tres microempresas seleccionadas a partir de los resultados de la evaluación de impacto. Los resultados más relevantes indican que los factores: analítica, reingeniería de procesos, educación y entrenamiento, alineación funcional, apoyo de la alta dirección y gestión del proyecto influenciaron el impacto del SI en las dimensiones organizacionales de las microempresas estudiadas.Abstract. The use of information systems (IS) is highly related to the improvement of business processes and organizational performance. However, due to limited resources of microenterprises is essential obtain high returns of technological solutions investments. The focus of this research work is to identify factors influencing organizational impact due to use of IS in Colombian microenterprises. For this purpose, a review of the literature was performed in order to identify these factors. Subsequently, an impact evaluation of an IS was developed in a sample of Colombian microenterprises within their organizational dimensions. Finally, the factors identifying in the literature review, were evaluated and validated inside three selected micro enterprises which were chosen taking into account the assessment impact results. The most relevant findings of this study reveal that analytics, business process reengineering, education and training, functional fit, top management support, and project management influenced the organizational impact of the IS evaluated on these microenterprises.Maestrí

Tricuspid Valve: An Intraoperative Echocardiographic Perspective

http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000338090500050&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=8e1609b174ce4e31116a60747a720701AnesthesiologyCardiac & Cardiovascular SystemsRespiratory SystemPeripheral Vascular DiseaseSCI(E)[email protected]