To determine the prevalence and clinical characteristics of non-traumatic chest pain, to assess the quality of treatment provided by an emergency department chest pain unit (CPU), and to provide a ...theoretical estimate of the size of future CPUs.
This prospective study included 1000 consecutive patients with chest pain seen at a CPU and a second group comprising the remaining patients seen for other complaints. Data on the patients' clinical characteristics, final diagnosis, destination (i.e., admitted or discharged), waiting time, and length of stay were recorded. In the CPU, the door-to-ECG time, and, when referred, the door to needle time and the door-to-balloon time were also recorded. In considering CPU size, the number of chest pain patients and the time to admission or discharge were utilized.
Among 22468 visits, the prevalence of chest pain was 4.4%. Compared with other patients, those with chest pain were more frequently male, older, had to wait less time, and were admitted more often. Of the 1000 chest pain patients, 25.9% had acute coronary syndrome (ACS), 64.7% did not, and 9.4% were not diagnosed because exercise testing could not be performed. Patients with ACS were older and had more cardiovascular risk factors, but no gender difference was found. The door-to-ECG time was 10 min, the door to needle time was 26 min, and the door-to-balloon time was 51 min. One CPU stretcher is required for every 13000 emergency department visits per year.
The prevalence of chest pain and affected patients' distinct clinical profile support the introduction of emergency department CPUs. Although there were limitations on the use of exercise testing, quality of treatment standards for ACS were achieved.
A DA é uma doença neurodegenerativa, sendo uma das principais causas de morte global, respondendo por mais de 4% das mortes em 2016. A taxa de mortalidade relacionada à demência da DA foi de mais de ...45 por 100.000 em um estudo europeu de 2013. A prevalência da DA atípica, mais comum em indivíduos com menos de 65 anos, varia entre 15-65/100.000, com alguns pacientes apresentando dificuldades visuais ou motoras, disfunção executiva e outros sintomas.
A patogênese da DA está ligada à presença de aglomerados de proteína beta-amiloide (Aβ) extracelular, conhecidos como placas neuríticas, e emaranhados de proteínas tau hiperfosforiladas. Essas placas são formadas a partir da proteína precursora de amiloide (APP) por ação de enzimas, enquanto os emaranhados neurofibrilares consistem principalmente de proteína tau hiperfosforilada.
A relação entre Aβ e tau é sinérgica na neurotoxicidade, com evidências de que o Aβ pode desencadear a formação de emaranhados de tau. Biometais como ferro, cobre e zinco também foram associados à DA, com a desregulação desses metais contribuindo para a toxicidade do sistema nervoso.
Fatores genéticos, incluindo o gene APOE e mutações nos genes APP, PSEN-1 e PSEN-2, também desempenham um papel importante na DA. A presença do alelo APOE ε4 aumenta significativamente o risco de desenvolver a doença. Mutações no gene APP estão associadas a um acúmulo de Aβ, enquanto mutações em PSEN-1 e PSEN-2 afetam a produção de Aβ.
As manifestações clínicas incluem perda de memória, depressão, ansiedade, distúrbios de linguagem e outras alterações cognitivas e comportamentais. A fase da DA varia de pré-clínica a grave, afetando progressivamente o funcionamento diário do paciente.
O diagnóstico combina avaliação clínica, testes neuropsicológicos e biomarcadores, como proteína tau, Aβ42 e imagens cerebrais. O tratamento envolve medicamentos como inibidores da acetilcolinesterase e memantina, além de terapias em estudo que visam as proteínas Aβ. Estilos de vida saudáveis, como atividade física e dieta, também desempenham um papel importante na prevenção e tratamento da DA.
Vascular events and evolution to either myelofibrosis (MF) and acute leukemia (AL) are the main causes of morbidity and mortality in individuals with essential thrombocythemia (ET). However, the ...frequency of these complications in young ET patients is not well known. The objective of the present study was to assess the frequency of vascular events and the incidence of MF and AL in young patients with ET and to identify the factors associated with the development of such complications. In 126 subjects diagnosed with ET at a median age of 31 years (range: 5–40), overall survival and probability of survival free of either thrombosis, bleeding, MF, AL, and polycythemia vera (PV) were analyzed by the Kaplan-Meier method, followed by the log-rank test. With a median follow-up of eleven years (range: 4–25) three patients have died, being the probability of survival 98% at ten years. A total of 31 thrombotic events were registered in 25 patients; thrombosis-free survival (TFS) was 84% at ten years. Tobacco use was the only factor associated with an increased thrombotic risk, since TFS at 10 years was 72% in smokers versus 90% in non-smokers (p=0.03). Severe hemorrhagic complications were observed in 11 patients, and the estimated probability of bleeding-free survival was 92% at ten years. Evolution to MF was seen in 6 patients, four of whom had never received treatment for ET. MF-free survival was 97% at 10 years, with the risk being higher in patients showing an increased reticulin network in the bone marrow biopsy performed at diagnosis of ET (p=0.005). Transformation to AL was registered in one patient. JAK2 was mutated in 33 out of the 87 assessable patients (38%) and the mutation was associated with higher Hb values at diagnosis (p = 0.001). ET evolved into PV in five patients, being the probability of evolution into PV of 15% in JAK2 V617F positive patients versus 0% in JAK2 V617F negative patients (p=0.01). In conclusion, severe vascular complications are not infrequent in young subjects with ET, whereas transformation to MF or AL is a rare event.
Monometallic Co
6
2+Co
2
3+(OH)
−
16(NO
3)
−
2·
nH
2O hydrotalcite-like compound was prepared by a careful precipitation from an aqueous solution of Co(NO
3)
2·6H
2O in air atmosphere, followed by ...microwave irradiation. As comparison, an additional sample was prepared without microwave irradiation, employing aging in the crystallization step. Thermal evolution was studied by X-ray diffraction (XRD), FTIR, DTA/TGA and nitrogen physisorption. The microwaved sample (monometallic hydrotalcite) was stable up to 200 °C. The nonirradiated sample only showed the Co
3O
4 spinel phase.
Dermatofibrosarcoma protuberans (DFSP) is an infrequent tumor of intermediate malignancy, with little tendency to develop metastases but with a high rate of local recurrence. Cytogenetically, DFSP is ...characterized by a reciprocal translocation, t(17;22)(q22;q13), which is a conditioning factor in the fusion of the collagen type I alpha I gene (COL1A1) in chromosome 17q with the platelet-derived growth factor beta chain gene (PDGFB) in chromosome 22q. The fusion of these genes is variable, involving one of the 51 exons of the COL1A1 gene and exon 2 of the PDGFB gene. We present the case of a 37-year-old woman with a tumor on the arm whose histology showed a neoplastic infiltration of the subcutaneous cellular tissue made up of fusiform cells with an elongated nucleus in a storiform pattern and other more pleomorphic cells in a herringbone pattern, compatible with DFSP with a fibrosarcoma component. The molecular biology study with RT-PCR analysis of paraffin-embedded material and later sequencing showed a new fusion of exon 19 of the COL1A1 gene and exon 2 of PDGFB, supporting a diagnosis of DFSP. A study of the COL1A1-PDGFB fusion products is useful in cases where histology and immunohistochemistry are insufficient for the differential diagnosis of DFSP versus other sarcomas. It also justifies the use of new avenues of treatment with tyrosine kinase inhibitors.
A pesar de todo lo avanzado en el campo de la neurofisiología y la farmacología, los sistemas antinociceptivos continúan siendo un enigma científico y los mecanismos de acción de las técnicas de ...reflexoterapia, uno de los tópicos más controvertidos.
El propósito de esta revisión es vincular el estudio de las bases neurobiológicas de la Acupuntura a los eventos neuroquímicos de la nocicepción y del dolor patológico. Para ese fin transitamos la transmisión, modulación medular, supramedular y percepción; definimos sensibilización central y profundizamos en los elementos de la vía postsináptica Glutamato/NMDA/NO/GMPc comprometida en el proceso. Analizamos los posibles mecanismos de acción a los diferentes niveles del proceso que pudieran sustentarse químicamente a nivel del cuerno posterior de la ME, en la supra-regulación de receptores GABA y opiodes y la sub-regulación de receptores NMDA; con la consiguiente prevención de la Sensibilización Central.
Palabras clave: Acupuntura, Dolor, Neurofisiología del dolor, Neuromodulación Acupuntural.
Li–Zr–Si mixed oxides were irradiated in a mixed radiation field in order to produce tritium through the Li
6(
n,
α)H
3 reaction. The LiZrSiO
4 samples, prepared with different Li
:
Zr molar ratios ...(1, 3, 5 and 6), presented high tritium diffusion compared with other lithium ceramics like Li
2SiO
3 and Li
2ZrO
3. Furthermore, their composition and structure were not modified after irradiation. It was also found that Li
2ZrSi
6O
15 was damaged by irradiation, and that tritium release was moderate in this compound.
Graphic
El mecanismo de acción de la Acupuntura y técnicas afines es controvertido, al parecer por el intento en la búsqueda de un proceso único cuando el fenómeno es multifactorial y parte del sistema más ...complejo y diferenciado del ser humano: el Sistema Nervioso. Las neuromodulaciones son homeostáticas per se y la comprensión del fenómeno nociceptivo es la ruta para la investigación en este campo.
El propósito de esta revisión es profundizar en las bases neurofisiológicas y neuro-químicas de la Acupuntura, acorde con los avances acontecidos en la última década en el estudio del dolor.
Transitamos por los procesos neurofisiológicos de la nocicepción y definimos el concepto de Sensibilización Periférica, centrando nuestra atención en la modulación periférica y el posible mecanismo de acción de la Acupuntura a ese nivel; que pudiera deberse a la inhibición del sistema Glutamato/NMDA/ONS/ON/GMPc o al estímulo de la Vía L-Arginina/NO/GMPc. Puede poseer valor en la profilaxis de la Sensibilización Central.
Palabras clave: Acupuntura, dolor, Neurofisiología del dolor, neuromodulación Acupuntural.
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