Introduction: The acute coronary occlusion associated with a high valuation of morbimortalidad in the acute infarction of the myocardium with elevation of the ST segment (STEMI), represents a ...challenge for the interventionist, due the unknown amount of thrombus load and its characteristics beyond the occlusion (microvascular obstruction (MVO), distal stenosis), which leads to complicate the primary angioplasty (PTCA) and to the no refl ow phenomenon (NFP), which has an overall incidence reported from 20 to 40%. Objectives: To evaluate the effi cacy of the distal coronary angiography with microcatheter, that leads to an individualized therapeutic strategy, with the purpose of prevent the NFP in the accute coronary occlusion in STEMI treated with PTCA. Material and methods: 70 patients were included with STEMI. We performed coronary angiography with microcatheter distal to the obstruction, and the therapeutic strategy was chosen in accordance with fi ndings: stenosis, thrombus amount or MVO. After the PTCA were performed, we evaluated the NFP incidence. Results: Report of 70 patients, the majority men (80%), class Killip Kimbal I (95 %), with disease of the right coronary artery in 57%, and anterior descending coronary artery in 37%. Distal thrombus was present in 47% of the studied patients. An obstruction length of more than 30 mm was observed in 21% of the cases, also we observed dissection of the arteries in a 21%, MVO was presented in 41%, and distal stenosis in 25%. Used therapeutic strategies: It was applied medicated stent in 81% of the patients, long balloon in 93%, and thrombolytic therapy in 30%. We observed a NFP incidence of 18.6 %. Conclusions: The diagnostic and therapeutic approach for STEMI that this study recommends, diminishes the NFP in comparison with reported. An obstruction > 30 mm is an independent factor for NFP, therefore in these cases we recommend use the described diagnostic approach and long balloon.
Introducción: La oclusión coronaria aguda, asociada a alta tasa de morbimortalidad en el infarto agudo del miocardio con elevación del segmento ST (IAMCEST), representa un desafío para el intervencionista cuando desconoce el importe de carga de trombo y las características distales a la oclusión (obstrucción microvascular (OMV), estenosis distal) que complican la angioplastia primaria (ACTP) y el fenómeno de no reflujo (FNR), el cual tiene una incidencia reportada de 20 a 40%. Objetivos: Evaluar la eficacia de la angiografía distal con microcatéter al orientar una estrategia terapéutica individualizada con la finalidad de prevenir el FNR en oclusión coronaria aguda por IAMCEST en ACTP. Material y métodos: Se incluyeron 70 pacientes con IAMCEST. Se realizó angiografía con microcatéter distal a la obstrucción y se eligió la estrategia terapéutica en la angioplastia de conformidad con hallazgos: estenosis, carga de trombo y OMV. Posteriormente se evaluó la incidencia de FNR al finalizar la ACTP. Resultados: Reporte de 70 pacientes, la mayoría hombres (80%), clase Killip-Kimball I (95%), con afección de la arteria coronaria derecha en 57% de ellos y de la descendente anterior en 37%. Trombo distal presente en 47% de los pacientes estudiados, se observó en 21% de los casos que la longitud de obstrucción fue mayor de 30 mm, disección de las arterias también en 21%, OMV presente en 41% y 25% con estenosis distal. Estrategias terapéuticas utilizadas: se aplicó stent con fármaco en 81% de los pacientes, balón largo en 93% y trombolítico en 30%. Se observó una incidencia del FNR de 18.6%. Conclusiones: En IAMCEST la técnica propuesta disminuye el FNR en comparación con lo reportado. La obstrucción > 30 mm es factor independiente de FNR, por lo que en estos casos recomendamos el uso de esta técnica y balón largo.
In this paper, we present the birth, growth, and maturation of Aspect-Oriented Software Development (AOSD) research over the last years, with emphasis on the Brazilian AOSD community and its research ...contributions. These research contributions are illustrated from different perspectives: (i) an overview of the research work developed by our community in several prominent software engineering areas; (ii) a historical chronology of the community; and (iii) the growth, impact and quality of research outcomes.
Este libro es resultado del Primer Encuentro Internacional de Historia sobre "El Siglo XIX en Bolivia y América Latina", organizado por la Coordinadora de Historia y el Instituto Francés de Estudios ...Andinos (IFEA) el año 1994 en la ciudad de Sucre en homenaje postumo a Gunnar Mendoza. Dedicado al siglo XIX, por ser un período poco abordado en general por la historiografía de los últimos años, tuvo el propósito de analizar, con mayor profundidad y rigor, tanto las continuidades coloniales como las rupturas que lo caracterizaron. En la medida en que participaron bolivianos y bolivianistas de Europa y Estados Unidos, así como investigadores latinoamericanos de Argentina, Perú, Chile, Ecuador y Colombia, esperamos que este volumen que hoy presentamos constituya un aporte y una referencia para el análisis de esta época fundacional de los estados-naciones de América Latina.
An on-chip 4to20mA reconfigurable current loop transmitter with four input channels for remote smart sensor applications is presented. The designed system includes: a like-HART protocol based on ...frequency-shift keying modulator (FSK) and demodulator to an efficient communication in industrial environment, a power management sub-system, a standard 4to20mA output and an embedded NVM memory (256 bytes) for calibration and identification purposes. The integrated circuit was fabricated in standard 0.6um CMOS technology occupying an área of 11.1mm 2 .
An electrocardiographic recording method with an associated reading guide, designed for epidemiological studies on Chagas' disease, was tested to assess its diagnostic reproducibility. Six ...cardiologists from five countries each read 100 electrocardiographic (ECG) tracings, including 30 from chronic chagasic patients, then reread them after an interval of 6 months. The readings were blind, with the tracings numbered randomly for the first reading and renumbered randomly for the second reading. The physicians, all experienced in interpreting ECGs from chagasic patients, followed printed instructions for reading the tracings. Reproducibility of the readings was evaluated using the kappa (kappa) index for concordance. The results showed a high degree of interobserver concordance with respect to the diagnosis of normal vs. abnormal tracings (kappa = 0.66; SE 0.02). While the interpretations of some categories of ECG abnormalities were highly reproducible, others, especially those having a low prevalence, showed lower levels of concordance. Intraobserver concordance was uniformly higher than interobserver concordance. The findings of this study justify the use by specialists of the recording of readings method proposed for epidemiological studies on Chagas' disease, but warrant caution in the interpretation of some categories of electrocardiographic alterations.
One of the most precise methods of determining hydrogen peroxide (H2O2) formation by biological systems is based on measuring the rate of enzyme-substrate complex formation between H2O2 and ...cytochrome c peroxidase (CCP). The main problem with this method is that CCP is not commercially available and has to be prepared in the laboratory. We have modified some currently available methods for purifying a highly active preparation of CCP in about 4 d. It includes a batch extraction of protein using DEAE-sepharose followed by concentration either by lyophilization or by passing the extract through a small DEAE-sepharose column instead of by ultrafiltration. The concentrated preparation is passed through a Sephadex G-75 column and the final CCP crystallized against water. The final preparations had a purity index (PI, ratio of absorbance at 408 nm/280 nm, equivalent to heme/protein ratio) above 1.2. These changes make the overall procedure very simple, preserving enzyme activity and spectral properties. In addition, we point out that special care has to be taken to eliminate cytochrome c from crude CCP extracts. Cytochrome c not only introduces an artifact when determining PI, but is also may act as a hydrogen donor for CCP when monitoring H2O2 formation, thus decreasing the sensitivity of this method.
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