Falha na ativação da equipe de emergência intra-hospitalar: causas e consequências / Failure to activate the in-hospital emergency team: causes and outcomes

RESUMO Objetivo: Determinar a incidência de falha na ativação da via aferente da Equipe de Emergência Médica intra-hospitalar, caraterizando-a e comparando a mortalidade dessa população com a da população em que não se verificou falha na ativação da via aferente. Métodos: Entre janeiro de 2013 e julho de 2015, ocorreram 478 ativações da Equipe de Emergência Médica do Hospital Pedro Hispano. Após a exclusão de registos incompletos e ativações para doentes com menos de 6 horas de internamento hospitalar, obtivemos uma amostra de 285 ativações. A amostra foi dividida em dois grupos: o grupo com falha na ativação da via aferente e o grupo em que não ocorreu falha na ativação da via aferente da Equipe de Emergência Médica. As duas populações foram caracterizadas e comparadas. A significância estatística foi considerada para p ≤ 0,05. Resultado: Em 22,1% das ativações, verificou-se falha na ativação da via aferente. Relativamente ao estudo causal, verificamos existir diferença estatisticamente significativa quanto aos critérios de ativação da Equipe de Emergência Médica (p = 0,003) no grupo com falha na ativação da via aferente, encontrando taxa mais elevada de ativação da Equipe de Emergência Médica por paragem cardiorrespiratória e disfunção cardiovascular. Em relação às consequências, no grupo em que ocorreu falha na ativação da via aferente houve uma maior taxa de mortalidade imediata e à data de alta hospitalar, sem significado estatístico. Não encontramos diferenças significativas com relação aos outros parâmetros. Conclusão: Nos doentes em que houve falha da ativação da via aferente da Equipe de Emergência Médica, a incidência de paragem cardiorrespiratória e a taxa de mortalidade foram maiores. Este estudo reforça a necessidade de as unidades de saúde investirem na formação de todos os profissionais de saúde sobre os critérios de ativação da Equipe de Emergência Médica e o funcionamento do sistema de resposta a emergência médica.

ABSTRACT Objective: To determine the incidence of afferent limb failure of the in-hospital Medical Emergency Team, characterizing it and comparing the mortality between the population experiencing afferent limb failure and the population not experiencing afferent limb failure. Methods: A total of 478 activations of the Medical Emergency Team of Hospital Pedro Hispano occurred from January 2013 to July 2015. A sample of 285 activations was obtained after excluding incomplete records and activations for patients with less than 6 hours of hospitalization. The sample was divided into two groups: the group experiencing afferent limb failure and the group not experiencing afferent limb failure of the Medical Emergency Team. Both populations were characterized and compared. Statistical significance was set at p ≤ 0.05. Result: Afferent limb failure was observed in 22.1% of activations. The causal analysis revealed significant differences in Medical Emergency Team activation criteria (p = 0.003) in the group experiencing afferent limb failure, with higher rates of Medical Emergency Team activation for cardiac arrest and cardiovascular dysfunction. Regarding patient outcomes, the group experiencing afferent limb failure had higher immediate mortality rates and higher mortality rates at hospital discharge, with no significant differences. No significant differences were found for the other parameters. Conclusion: The incidence of cardiac arrest and the mortality rate were higher in patients experiencing failure of the afferent limb of the Medical Emergency Team. This study highlights the need for health units to invest in the training of all healthcare professionals regarding the Medical Emergency Team activation criteria and emergency medical response system operations.

An experimental study on effect of bladder reflex arc with sensory afferent pathway in the treatment of atonic bladder after spinal cord injury / 中华骨科杂志

Objective To establish bladder reflex arc with sensory afferent pathway using SD rats,and evaluate its effect in the treatment of atonic bladder after spinal cord injury.Methods Twenty-four male SD rats were used in the study.For each rat,the right side was the experimental side,and the left side was the control side.In the right side,the L5 ventral root (VR) was anastomosed to S2 VR,and the distal end of S2 dorsal root (DR) was anastomosed to the proximal end of L5 peripheral process of dorsal ganglion.In the left side,no treatment was done.In order to evaluate the validity of the bladder reflex arc,general observation,neuro-electrophysiological test and wheat germ agglutinin horseradish peroxidase (WGA-HRP) method were used before and after the spinal cord destruction between L6 and S2 level at 3 months postoperatively.Results Twenty-one rats survived 3 months after the operation,and anastomotic nerves were separated successfully only in seven rats.Compound action potentials (CAPs) of plexus vesica and compound muscle action potentials (CMAPs) of bladder smooth muscle were found by electrical stimulation in distal end of the anastomotic stoma of the right S2 DR.There was no statistically significant difference in action potential before and after paraplegia.No action potential was detected in control sides after paraplegia.The curves of CAPs and CMAPs in the right side were similar to those in the control side,and the mean maximum amplitude reached respectively 71.9％ and 82.4％ of those in the left side before paraplegia.In addition,WGAHRP labeled cells were observed in L5 anterior horn and posterior horn in the experimental side after WGAHRP injection.Conclusion Reconstruction of bladder reflex arc with sensory afferent pathway can promote axonal regeneration of motor and sensory nerves,and then the regenerated axon could contact with cells in anterior and posterior horn of spinal cord through parasympathetic nerves,ultimately the capability of axoplasmic transportation could be reestablished.Therefore,this method can be used for treating atonic bladder.

Effects of different afferent nerve injury on development of neuropathic pain and its relationship with brain-derived neurotrophic factor in spinal cord and dorsal root ganglion in rats / 中华麻醉学杂志

Objective To investigate the effects of different afferent nerve injury on development of neuropathic pain and its relationship with brain-derived neurotrophic factor (BDNF) in spinal cord and dorsal root ganglion (DRG) in rats. Methods Twenty-four male SD rats aged 2 months weighing 200-250 g were randomly divided into 3 groups:group Ⅰ sham operation (group S); group Ⅱ sural nerve injury (group SUR) and group Ⅲ gastrocnemius-soleus nerve injury (group GS). Sural nerve and gastrocnemius-soleus nerve were transected in group SUR and GS respectively. Paw withdrawal threshold to von Frey filament stimulation was measured the day before and at day 3 and 7 after operation. The animals were killed at postoperative day 7 after the measurement of paw withdrawal threshold. The ipsllateral L5 DRG and L5 segment of the spinal cord were removed. BDNF expression in the spinal dorsal horn was determined. The percentage of BDNF positive neurons and ATF-3 positive neurons in the total DRG neurons and the percentage of BDNF positive neurons in the damaged neurons (ATF-3 positive) were calculated. Results Mechanical hyperalgesia developed after transection of gastrocnemius-soleus muscle in group GS. Mechanical pain threshold was sinificantly lower, while BDNF expression in the spinal dorsal horn and the percentage of BDNF positive neurons in total DRG neurons were significantly higher in group GS than in group S and SUR (P ＜ 0.01). There was no significant difference in all variables between group SUR and S (P＞0.05). There was no significant difference in the percentage of ATF-3 positive neurons in the total DRG neurons between group GS and SUR (P ＞ 0.05), but the percentage of BDNF positive neurons in the damaged neurons (ATF-3 positive) was significantly higher in group GS than in group SUR (P ＜ 0.05). Conclusion Transection of the afferent nerve innervating muscle can produce neuropathic pain through up-regulation of BDNF expression in spinal dorsal horn and DRG in rats, while transection of the afferent nerve innervating skin can not.

Beta3-Adrenoceptor Agonists: Possible Role in the Treatment of Overactive Bladder

In the present review article, we present an overview of beta-adrenoceptor (beta-AR) subtype expression at the mRNA and receptor protein levels in the human detrusor, the in vitro and in vivo bladder function of the beta3-AR, the in vivo effect of beta3-AR agonists on detrusor overactivity in animal models, and the available results of clinical trials of beta3-AR agonists for treating overactive bladder (OAB). There is a predominant expression of beta3-AR mRNA in human bladder, constituting 97% of total beta-AR mRNA. Also, functionally, the relaxant response of human detrusor to catecholamines is mainly mediated through the beta3-ARs. Moreover, the presence of beta1-, beta2-, and beta3-AR mRNAs in the urothelium and suburothelial layer of human bladder has been identified. Stimulation of urothelial beta-ARs results in the release of nitric oxide and an unknown substance inhibiting detrusor contractions from the urothelium. Intravenous application of CL316,243, a selective beta3-AR agonist, in rats selectively inhibits mechano-sensitive Adelta-fiber activity of the primary bladder afferents. A number of selective beta3-AR agonists are currently being evaluated in clinical trials for OAB with promising preliminary results. In conclusion, the beta3-AR agonists are the most notable alternative class of agents to antimuscarinics in the pharmacological treatment of OAB. The beta3-AR agonists act to facilitate bladder storage function probably through at least two mechanisms: first, direct inhibition of the detrusor, and second, inhibition of bladder afferent neurotransduction.

Limiar e latência do reflexo acústico sob efeito de estimulação contralateral / Threshold and latency of acoustic reflex under effect of contralateral noise

OBJETIVO: Investigar o efeito inibitório da via eferente auditiva na variação do limiar e da latência do reflexo acústico ipsilateral com estimulação contralateral. MÉTODOS: Foram avaliados 17 pacientes entre 18 e 30 anos, com audição dentro dos padrões de normalidade submetidos à pesquisa de limiar e de latência do reflexo acústico, com e sem estimulação contralateral. RESULTADOS: Foram observadas médias de latência sem ruído contralateral para as freqüências de 500, 1000 e 2000 Hz respectivamente em 234,48, 214,96 e 236,71 milissegundos. Os valores de latência com ruído nas mesmas freqüências foram 230,74, 214,00 e 232,15 milissegundos. CONCLUSÃO: Houve diminuição da latência e aumento dos limiares do reflexo acústico quando apresentado estímulo supressor na orelha contralateral.

PURPOSE: To investigate the inhibitory effect of the efferent auditory path in the variation of the threshold and the latency of ipsilateral acoustic reflex with contralateral stimulation. METHODS: Seventeen male and female patients, with ages between 18 and 30 years and with average normal hearing, were evaluated. After verification of inclusion criteria, the subjects were submitted to acoustic reflex threshold and latency testings, with and without contralateral masking. RESULTS: The latency average rates without contralateral noise at the frequencies 500 Hz, 1000 Hz and 2000 Hz were, respectively, 234,48, 214,96 and 236,71 milliseconds. The latency rates with noise at the same frequencies were 230,74, 214,00 and 232,15 milliseconds. CONCLUSION: The results showed latency decrease and increase on the acoustic reflex thresholds with contralateral white noise suppressor stimulus.

THE ORIGIN OF AFFERENT CONNECTION TO THE HYPOTHALAMIC PARAVENTRICULAR NUCLEUS / 第二军医大学学报

The origin of afferent connections to the hypothalamic paraventricular nucleus was studied in the rats with the method ot retrograde axonal transport of HRP.A small amount of HRP was delivered electrophretically into the hypothalamic paraventricular nucleus. The HRP labelled cells ware observed in the lateral septal nucleus, amygdaloid nucleus, hippocampus, subiculum,bed nucleus of the stria terminalis, -parafascicularic nucleus of the thalamus, anterior hypothalamic area, suprachiasmatica nucleus, supraoptic nucleus, circalaris nucleus, hypothalamic dorsomedial nucleus, hypothalamic ventromedial nucleus, posterior hypothalamic nucleus, arcuate nucleus, mamillaris nucleus, midbrain central gray, dorsal tegmental nucleus, lateral parabrac-hial nucleus, median raphe nucleus, locus coeruleus, solitary nucleus and lateral rati-cular nucleus