Background
Using cerebral oxygen venous saturation post‐cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to ...describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post‐ CA in cases where TTM 33°C was applied.
Method
Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33°C M and received a jugular bulb catheter within the first 26 hours post‐CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1‐2) and poor outcome (CPC 3‐5).
Results
Seventy‐five patients were included and 37 (49%) patients survived with a good outcome at 6 months post‐CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 8‐21 vs 5 −0.3 to 11% P = .001) post‐CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 9‐23 vs 31 25‐34% P = .008).
Conclusions
Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33°C post‐CA.
Showdomycin produced by Streptomyces showdoensis ATCC 15227 is a C-nucleoside microbial natural product with antimicrobial and cytotoxic properties. The unique feature of showdomycin in comparison to ...other nucleosides is its maleimide base moiety, which has the distinct ability to alkylate nucleophilic thiol groups by a Michael addition reaction. In order to understand structure-activity relationships of showdomycin, we synthesized a series of derivatives with modifications in the maleimide ring at the site of alkylation to moderate its reactivity. The showdomycin congeners were designed to retain the planarity of the base ring system to allow Watson–Crick base pairing and preserve the nucleosidic character of the compounds. Consequently, we synthesized triphosphates of showdomycin derivatives and tested their activity against RNA polymerases. Bromo, methylthio, and ethylthio derivatives of showdomycin were incorporated into RNA by bacterial and mitochondrial RNA polymerases and somewhat less efficiently by the eukaryotic RNA polymerase II. Showdomycin derivatives acted as uridine mimics and delayed further extension of the RNA chain by multi-subunit, but not mitochondrial RNA polymerases. Bioactivity profiling indicated that the mechanism of action of ethylthioshowdomycin was altered, with approximately 4-fold reduction in both cytotoxicity against human embryonic kidney cells and antibacterial activity against Escherichia coli. In addition, the ethylthio derivative was not inactivated by medium components or influenced by addition of uridine in contrast to showdomycin. The results explain how both the maleimide ring and the nucleoside nature contribute to the bioactivity of showdomycin and demonstrates for the first time that the two activities can be separated.
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•A series of showdomycin C-nucleosides were synthesized.•Showdomycin derivatives inhibited multi-subunit RNA polymerases.•The modifications altered the mechanism of action against Escherichia coli.•Ethylthioshowdomycin retained antibiotic activity longer than showdomycin.•Uridine inhibited uptake of showdomycin, but not ethylthioshowdomycin.
The purpose of this study is to investigate compliance to established guidelines regarding primary prevention with implantable cardioverter-defibrillator (ICD) in patients with left ventricular ...dysfunction after acute myocardial infarction (AMI) in a clinical setting.
A retrospective study of medical records from patients admitted to two hospitals in Stockholm during 2008-2009 with a diagnosis of AMI and who at discharge had a left ventricular ejection fraction ≤35%. An evaluation of follow-up and echocardiographic recordings was performed 1-3 months after AMI. A total of 2023 patients <80 years, with AMI discharged from hospital, were screened for left ventricular dysfunction defined as ejection fraction (EF) ≤35%. Altogether 187 patients were identified and an ICD was implanted in 25 (13%) patients. In 52 (28%) patients, there were contraindications for ICD therapy. An improved EF at follow-up, making ICD treatment redundant, was observed in 48 (41%) patients who underwent an ECHO at follow-up or later. Seventeen (9%) patients without an ICD died during follow-up and out of these five patients died from sudden cardiac death (SCD), they had no contraindication to ICD therapy. An inadequate follow-up according to guidelines was found in 59 (32%) patients.
The follow-up of post-myocardial infarction patients with left ventricular dysfunction according to guidelines was insufficient in this population and may have increased the risk for SCD. A significant proportion of patients experienced improved left ventricular function during short-term follow-up making preventive ICD treatment redundant.
Background
Primary prophylactic implantable cardioverter defibrillator (ICD) therapy is indicated for patients with reduced left ventricular ejection fraction (LVEF). We aimed to determine if ...preoperative clinical risk profiling can predict long‐term benefit, and if clinical risk scores can be applied and improved in a patient cohort outside the clinical trial setting.
Methods
Using registry data, 789 patients with reduced LVEF who received ICDs for primary prevention during 2006–2011 were identified (age 64 ± 11 years, 82% men, 63% ischemic etiology, 52% cardiac resynchronization therapy with defibrillator). The patients were divided into three risk groups, based on the presence of baseline clinical risk factors (age >70, QRS duration >120 ms, New York Heart Association class III–IV, atrial fibrillation history, or creatinine >106 μmol/L). Endpoints were all‐cause mortality and survival free of adequate ICD therapy.
Results
Mean follow‐up was 39 ± 18 months. Annual mortality was 7.6%, and increased with risk group (p < .001). Rates of appropriate antitachycardia pacing and shock therapy were not statistically different between the groups, and ranged from 11%–16% and 6%–14%, respectively. By combining the previous risk score with data on diabetes, a better independent prediction of mortality was achieved; mortality rates then ranged from 11% (low‐risk) to 46% (high‐risk) (p < .0001).
Conclusions
Implantable cardioverter defibrillator therapies occur across the spectrum of comorbidities in a population with systolic heart failure. However, all‐cause mortality is considerably higher in the group of patients with accumulated risk factors, and using the proposed scoring system can be helpful for the evaluation and risk stratification of the patient prior to making a decision for a primary prophylactic ICD implantation.
Syftet med vårt arbete är att skaffa oss kunskap om beröring/taktil stimulering och dess användning ute i förskolan. Vi vill ta reda på hur pedagogerna upplever att barnen påverkas av beröring/taktil ...stimulering. Beröring/taktil stimulering är livsviktigt för människan och bidrar till en trygg miljö, harmoni och ökad inlärning. I litteraturgenomgången betonas det att beröring/taktil stimulering är viktigt för barns utveckling. Beröring/taktil stimulering måste ske helt på barnens villkor och inte påtvingas. Den empiriska delen bygger på intervjuer med förskollärare som aktivt arbetar med beröring/taktil stimulering i verksamheten. Genom vår undersökning kom vi fram till att beröring/taktil stimulering skapar lugna och harmoniska barn.
Forskning inom temporära organisationer har tidigare fokuserat på förtroende från projektledarens perspektiv, därmed fann vi det intressant att undersöka vikten av förtroende utifrån medarbetarnas ...perspektiv. Syftet med studien har varit att, med utgångspunkt från medarbetare i temporära organisationer, undersöka om projektledare behöver besitta vissa specifika egenskaper för att skapa förtroende. Vidare att undersöka om dessa egenskaper har en lika stor påverkan av skapandet av förtroende eller om det enbart är vissa egenskaper som anses vara grundläggande.Med en kvalitativ forskningsansats har vi genomfört elva semi-strukturerade intervjuer där insamlad data sedan har transkriberats, analyserats och diskuterats och jämförts med studiens teoretiska utgångspunkter. Vi kunde därefter urskilja vissa specifika egenskaper som en projektledare bör besitta vid skapandet av förtroende. Av insamlad empiri fann vi olika benämningar för egenskaper hos en projektledare som kunde kategoriseras. Till följd av detta identifierade vi istället egenskaperna som faktorer vilka medarbetarna hävdade vara av vikt vid skapandet av ett förtroende. Dessa kategorier var; konsekvent beteende, integritet, delegering, kommunikation, visande av intresse och kunskap och kompetens.Resultatet pekar på att förtroende för en projektledare skapas utifrån individuella behov och värderingar. Samtidigt kunde vissa faktorer urskiljas som mer primära än andra, vilket bidrog till att dessa delades upp i två kategorier, hårda faktorer (primära) och mjuka faktorer (sekundära). Ytterligare slutsats blev att förtroende skapar både möjligheter och hinder i en temporär organisation vilket är en intressant aspekt att forska vidare kring. För vidare forskning är det även intressant att studera mer ingående kring hur man skapar ett initialt förtroende i temporära organisationer men även att man fördjupar sin kunskap kring temporära organisationer och dess speciella utformning och krav.
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Syftet med vårt arbete är att skaffa oss kunskap om beröring/taktil stimulering och dess användning ute i förskolan. Vi vill ta reda ...på hur pedagogerna upplever att barnen påverkas av beröring/taktil stimulering. Beröring/taktil stimulering är livsviktigt för människan och bidrar till en trygg miljö, harmoni och ökad inlärning. I litteraturgenomgången betonas det att beröring/taktil stimulering är viktigt för barns utveckling. Beröring/taktil stimulering måste ske helt på barnens villkor och inte påtvingas. Den empiriska delen bygger på intervjuer med förskollärare som aktivt arbetar med beröring/taktil stimulering i verksamheten. Genom vår undersökning kom vi fram till att beröring/taktil stimulering skapar lugna och harmoniska barn.
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