Goal-directed fluid management based on stroke volume variation and stroke volume optimization during high-risk surgery: a pilot multicentre randomized controlled trial

Introduction: Perioperative hemodynamic optimization has been shown to be useful to improve the postoperative outcome of patients undergoing major surgery. We designed a pilot study in patients undergoing major abdominal, urologic or vascular surgery to investigate the effects of a goal-directed (GD) fluid management based on continuous stroke volume variation (SVV) and stroke volume (SV) monitoring on postoperative outcomes. Methods: Fifty-two high-risk-surgical patients (ASA 3 or 4, arterial and central venous catheter in place, postoperative admission in ICU) were randomized either to a control group (Group C, n = 26) or to a goal-directed group (Group G, n = 26). Patients with cardiac arrhythmia or ventilated with a tidal volume <7 ml/kg were excluded. In Group G, SVV and SV were continuously monitored with the FloTrac™/Vigileo™ system (Edwards Lifesciences, USA) and patients were brought to and maintained on the plateau of the Frank-Starling curve (SVV <10% and SV increase <10% in response to fluid loading). During the ICU stay, organ dysfunction was assessed using the SOFA score and resource utilization using the TISS score. Patients were followed up to 28 days after surgery for infectious, cardiac, respiratory, renal, hematologic and abdominal complications. Results: Group G and Group C were comparable for ASA score, comorbidities, type and duration of surgery (275 vs. 280 minutes), heart rate, MAP and CVP at the start of surgery. However, Group G was younger than Group C (68 vs. 73 years, P < 0.05). During surgery, Group G received more colloids than Group C (1,589 vs. 927 ml, P < 0.05) and SVV decreased in Group G (from 9.0 to 8.0%, P < 0.05) but not in Group C. The number of postoperative wound infections was lower in Group G (0 vs. 7, P < 0.01). Although not statistically significant, the proportion of patients with at least one complication (46 vs. 62%), the number of postoperative complications per patient (0.65 vs. 1.40), the maximum ICU SOFA score (5.9 vs. 7.2), and the cumulative ICU TISS score (69 vs. 83) were also lower in Group G. ICU and hospital length of stay were similar in both groups. Conclusion: Although the two groups were not perfectly matched, this pilot shows that fluid management based on SVV and SV optimization decreases wound infections. It also suggests that such a GD strategy may decrease postoperative organ dysfunction and resource utilization. However, this remains to be confirmed by a larger study

Concentrações de ferro e zinco em grãos de diferentes cultivares de trigo (Triticum aestivum L.) sob colheita manual e mecanizada.

Orientador: Pedro Luiz Scheeren

Distribution and origin of ozone in the eastern Mediterranean free troposphere during MINOS (August 2001)

International audienceA coupled tropospheric chemistry ? climate model is used to reproduce and analyze tropospheric ozone distributions observed during the MINOS campaign in the eastern Mediterranean region (August, 2001). Generally, regional atmospheric dynamics in summer are strongly influenced by the occurrence of an upper tropospheric anti-cyclone, associated with the Asian summer monsoon and centered over the Tibetan Plateau. The anti-cyclone affects the chemical composition of the upper troposphere, where ozone concentrations of about 50 ppbv were measured, through advection of boundary layer air from South-East Asia. A layer between 4?6 km thickness and containing up to 120 ppbv of ozone was present beneath. Ozone from stratospheric origin and from lightning NOx contributed to this layer. Additionally, pollutant ozone from North America was mixed in. Ozone in the lower troposphere originated mainly from the European continent. Modeled ozone profiles are in reasonable agreement with the observations. The stratospheric influence is sometimes overestimated by the model due to too strong vertical diffusion associated with the relatively coarse vertical resolution of the model, and specific convective events are not reproduced realistically. The modeled tropospheric ozone column over the eastern Mediterranean is ~50 DU in summer, to which ozone from recent stratospheric origin contributes about 30%, ozone from lightning 13%, and from South-East Asia, North America and Europe about 7%, 8% and 14%, respectively, adding to a long-term hemispheric background of 25% of the column

Elaboração experimental de sucos naturais/integrais de frutas com uso do suquificador integral.

O Suquificador Integral foi concebido para atender à necessidade de pequenos produtores de suco, visto que o processo antes adotado, por meio de panelas extratoras por arraste de vapor, não possibilitava a elaboração de sucos integrais que pudessem se enquadrar dentro da legislação, por incorporar água exógena ao produto

Avaliação preliminar do nanismo amarelo em genótipos de triticale.

Editores técnicos: Joseani Mesquita Antunes, Ana Lídia Variani Bonato, Márcia Barrocas Moreira Pimentel

A novel doxorubicin-glucuronide prodrug DOX-GA3 for tumour-selective chemotherapy: distribution and efficacy in experimental human ovarian cancer

The doxorubicin (DOX) prodrug N -[4-doxorubicin- N -carbonyl (oxymethyl) phenyl] O -β-glucuronyl carbamate (DOX-GA3) was synthesised for specific activation by human β-glucuronidase, which is released in necrotic areas of tumour lesions. This novel prodrug was completely activated to the parent drug by human β-glucuronidase with V max= 25.0 μmol min–1mg–1and K m= 1100 μM. The pharmacokinetics and distribution of DOX-GA3 in nude mice bearing human ovarian cancer xenografts (OVCAR-3) were determined and compared with DOX. Administration of DOX at 8 mg kg–1i.v. (maximum tolerated dose, MTD) to OVCAR-3-bearing mice resulted in a peak plasma concentration of the drug of 16.4 μM (t = 1 min). A 7.6-times lower peak plasma concentration of DOX was measured after injection of DOX-GA3 at 250 mg kg–1i.v. (50% of MTD). In normal tissues the prodrug showed peak DOX concentrations that were up to 5-fold (heart) lower than those found after DOX administration. DOX-GA3 activation by β-glucuronidase in the tumour yielded an almost 5-fold higher DOX peak concentration of 9.57 nmol g–1(P< 0.05) than the peak concentration of only 2.14 nmol g–1observed after DOX. As a consequence, the area under the curve of DOX calculated in tumour tissue after DOX-GA3 (13.1 μmol min–1g–1) was 10-fold higher than after DOX (1.31 μmol min–1g–1). The anti-tumour effects of DOX-GA3 and DOX were compared at equitoxic doses in OVCAR-3 xenografts at a mean tumour size of 125 mm3. The prodrug given i.v. at 500 mg kg–1weekly × 2 resulted in a maximum tumour growth inhibition of 87%, while the standard treatment with DOX at a dose of 8 mg kg–1i.v. weekly × 2 resulted in a maximum tumour growth inhibition of only 56%. Treatment with DOX-GA3 was also given to mice with larger tumours containing more necrosis. For tumours with a mean size of 400 mm3the specific growth delay by DOX-GA3 increased from 2.7 to 3.9. Our data indicate that DOX-GA3 is more effective than DOX and suggest that the prodrug will be specifically advantageous for treatment of advanced disease. © 2001 Cancer Research Campaign http://www.bjcancer.co

Granizo e cereais de inverno no Rio Grande do Sul.

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