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1.
Nat Astron ; 8(5): 567-576, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38798715

RESUMO

Jupiter's moon Europa has a predominantly water-ice surface that is modified by exposure to its space environment. Charged particles break molecular bonds in surface ice, thus dissociating the water to ultimately produce H2 and O2, which provides a potential oxygenation mechanism for Europa's subsurface ocean. These species are understood to form Europa's primary atmospheric constituents. Although remote observations provide important global constraints on Europa's atmosphere, the molecular O2 abundance has been inferred from atomic O emissions. Europa's atmospheric composition had never been directly sampled and model-derived oxygen production estimates ranged over several orders of magnitude. Here, we report direct observations of H2+ and O2+ pickup ions from the dissociation of Europa's water-ice surface and confirm these species are primary atmospheric constituents. In contrast to expectations, we find the H2 neutral atmosphere is dominated by a non-thermal, escaping population. We find 12 ± 6 kg s-1 (2.2 ± 1.2 × 1026 s-1) O2 are produced within Europa's surface, less than previously thought, with a narrower range to support habitability in Europa's ocean. This process is found to be Europa's dominant exogenic surface erosion mechanism over meteoroid bombardment.

2.
Blood ; 141(25): 3091-3108, 2023 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-36952641

RESUMO

Sickle cell disease (SCD) is hallmarked by an underlying chronic inflammatory condition, which is contributed by heme-activated proinflammatory macrophages. Although previous studies addressed heme ability to stimulate macrophage inflammatory skewing through Toll-like receptor4 (TLR4)/reactive oxygen species signaling, how heme alters cell functional properties remains unexplored. Macrophage-mediated immune cell recruitment and apoptotic cell (AC) clearance are relevant in the context of SCD, in which tissue damage, cell apoptosis, and inflammation occur owing to vaso-occlusive episodes, hypoxia, and ischemic injury. Here we show that heme strongly alters macrophage functional response to AC damage by exacerbating immune cell recruitment and impairing cell efferocytic capacity. In SCD, heme-driven excessive leukocyte influx and defective efferocytosis contribute to exacerbated tissue damage and sustained inflammation. Mechanistically, these events depend on heme-mediated activation of TLR4 signaling and suppression of the transcription factor proliferator-activated receptor γ (PPARγ) and its coactivator peroxisome proliferator-activated receptor γ coactivator 1α (PGC1α). These changes reduce efferocytic receptor expression and promote mitochondrial remodeling, resulting in a coordinated functional and metabolic reprogramming of macrophages. Overall, this results in limited AC engulfment, impaired metabolic shift to mitochondrial fatty acid ß-oxidation, and, ultimately, reduced secretion of the antiinflammatory cytokines interleukin-4 (IL-4) and IL-10, with consequent inhibition of continual efferocytosis, resolution of inflammation, and tissue repair. We further demonstrate that impaired phagocytic capacity is recapitulated by macrophage exposure to plasma of patients with SCD and improved by hemopexin-mediated heme scavenging, PPARγ agonists, or IL-4 exposure through functional and metabolic macrophage rewiring. Our data indicate that therapeutic improvement of heme-altered macrophage functional properties via heme scavenging or PGC1α/PPARγ modulation significantly ameliorates tissue damage associated with SCD pathophysiology.


Assuntos
Anemia Falciforme , Heme , Humanos , Heme/metabolismo , Interleucina-4/metabolismo , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/metabolismo , PPAR gama , Receptor 4 Toll-Like/metabolismo , Macrófagos/metabolismo , Anemia Falciforme/metabolismo , Inflamação/metabolismo
3.
Br J Haematol ; 193(3): 637-658, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33723861

RESUMO

Increasing evidence suggests that free haem and iron exert vasculo-toxic and pro-inflammatory effects by activating endothelial and immune cells. In the present retrospective study, we compared serum samples from transfusion-dependent patients with ß-thalassaemia major and intermedia, hereditary spherocytosis and sickle cell disease (SCD). Haemolysis, transfusions and ineffective erythropoiesis contribute to haem and iron overload in haemolytic patients. In all cohorts we observed increased systemic haem and iron levels associated with scavenger depletion and toxic 'free' species formation. Endothelial dysfunction, oxidative stress and inflammation markers were significantly increased compared to healthy donors. In multivariable logistic regression analysis, oxidative stress markers remained significantly associated with both haem- and iron-related parameters, while soluble vascular cell adhesion molecule 1 (sVCAM-1), soluble endothelial selectin (sE-selectin) and tumour necrosis factor α (TNFα) showed the strongest association with haem-related parameters and soluble intercellular adhesion molecule 1 (sICAM-1), sVCAM-1, interleukin 6 (IL-6) and vascular endothelial growth factor (VEGF) with iron-related parameters. While hereditary spherocytosis was associated with the highest IL-6 and TNFα levels, ß-thalassaemia major showed limited inflammation compared to SCD. The sVCAM1 increase was significantly lower in patients with SCD receiving exchange compared to simple transfusions. The present results support the involvement of free haem/iron species in the pathogenesis of vascular dysfunction and sterile inflammation in haemolytic diseases, irrespective of the underlying haemolytic mechanism, and highlight the potential therapeutic benefit of iron/haem scavenging therapies in these conditions.


Assuntos
Anemia Falciforme/sangue , Heme/metabolismo , Hemoglobinas/metabolismo , Ferro/sangue , Esferocitose Hereditária/sangue , Talassemia beta/sangue , Adolescente , Adulto , Anemia Falciforme/terapia , Transfusão de Sangue , Criança , Pré-Escolar , Endotélio Vascular/metabolismo , Feminino , Humanos , Inflamação/sangue , Molécula 1 de Adesão Intercelular/sangue , Interleucina-6/sangue , Masculino , Esferocitose Hereditária/terapia , Fator de Necrose Tumoral alfa/sangue , Molécula 1 de Adesão de Célula Vascular/sangue , Fator A de Crescimento do Endotélio Vascular/sangue , Talassemia beta/terapia
4.
Environ Sci Process Impacts ; 23(4): 580-587, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33725038

RESUMO

Contamination of drinking water by per- and polyfluoroalkyl substances (PFASs) emitted from manufacturing plants, fire-fighting foams, and urban waste streams has received considerable attention due to concerns over toxicity and environmental persistence; however, PFASs in ambient air remain poorly understood, especially in the United States (US). We measured PFAS concentrations in ambient fine particulate matter (PM2.5) at 5 locations across North Carolina over a 1 year period in 2019. Thirty-four PFASs, including perfluoroalkyl carboxylic, perfluoroalkane sulfonic, perfluoroalkyl ether carboxylic and sulfonic acids were analyzed by UHPLC/ESI-MS/MS. Quarterly averaged concentrations ranged from <0.004-14.1 pg m-3. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) ranged from <0.18 to 14.1 pg m-3, comparable to previous PM2.5 measurements from Canada and Europe (<0.02-3.5 pg m-3). Concentrations above 1 pg m-3 were observed in July-September at Charlotte (14.1 pg m-3, PFOA), Wilmington (4.75 pg m-3, PFOS), and Research Triangle Park (1.37 pg m-3, PFOS). Notably, PM2.5 has a short atmospheric lifetime (<2 weeks), and thus, the presence of PFOS in these samples raises questions about their sources, since PFOS production was phased out in the US ∼20 years ago. This is the first US study to provide insights into ambient PFAS concentrations in PM2.5.


Assuntos
Ácidos Alcanossulfônicos , Fluorocarbonos , Ácidos Alcanossulfônicos/análise , Canadá , Europa (Continente) , Fluorocarbonos/análise , North Carolina , Material Particulado , Espectrometria de Massas em Tandem
6.
J Geophys Res Planets ; 126(12): e2021JE006956, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35859709

RESUMO

The Galileo mission to Jupiter discovered magnetic signatures associated with hidden subsurface oceans at the moons Europa and Callisto using the phenomenon of magnetic induction. These induced magnetic fields originate from electrically conductive layers within the moons and are driven by Jupiter's strong time-varying magnetic field. The ice giants and their moons are also ideal laboratories for magnetic induction studies. Both Uranus and Neptune have a strongly tilted magnetic axis with respect to their spin axis, creating a dynamic and strongly variable magnetic field environment at the orbits of their major moons. Although Voyager 2 visited the ice giants in the 1980s, it did not pass close enough to any of the moons to detect magnetic induction signatures. However, Voyager 2 revealed that some of these moons exhibit surface features that hint at recent geologically activity, possibly associated with subsurface oceans. Future missions to the ice giants may therefore be capable of discovering subsurface oceans, thereby adding to the family of known "ocean worlds" in our Solar System. Here, we assess magnetic induction as a technique for investigating subsurface oceans within the major moons of Uranus. Furthermore, we establish the ability to distinguish induction responses created by different interior characteristics that tie into the induction response: ocean thickness, conductivity and depth, and ionospheric conductance. The results reported here demonstrate the possibility of single-pass ocean detection and constrained characterization within the moons of Miranda, Ariel, and Umbriel, and provide guidance for magnetometer selection and trajectory design for future missions to Uranus.

7.
Philos Trans A Math Phys Eng Sci ; 378(2165): 20180421, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-31902342

RESUMO

Hydrogen from serpentinization is a source of chemical energy for some life forms on Earth. It is a potential fuel for life in the subsurface of Mars and in the icy ocean worlds in the outer solar system. Serpentinization is also implicated in life's origin. Planetary exploration offers a way to investigate such theories by characterizing and ultimately searching for life in geochemical settings that no longer exist on Earth. At present, much of the current context of serpentinization on other worlds relies on inference from modelling and studies on Earth. While there is evidence from orbital spectral imaging and martian meteorites that serpentinization has occurred on Mars, the extent and duration of that activity has not been constrained. Similarly, ongoing serpentinization might explain hydrogen found in the ocean of Saturn's tiny moon Enceladus, but this raises questions about how long such activity has persisted. Titan's hydrocarbon-rich atmosphere may derive from ancient or present-day serpentinization at the bottom of its ocean. In Europa, volcanism or serpentinization may provide hydrogen as a redox couple to oxygen generated at the moon's surface. We assess the potential extent of serpentinization in the solar system's wet and rocky worlds, assuming that microfracturing from thermal expansion anisotropy sets an upper limit on the percolation depth of surface water into the rocky interiors. In this bulk geophysical model, planetary cooling from radiogenic decay implies the infiltration of water to greater depths through time, continuing to the present. The serpentinization of this newly exposed rock is assessed as a significant source of global hydrogen. Comparing the computed hydrogen and surface-generated oxygen delivered to Europa's ocean reveals redox fluxes similar to Earth's. Planned robotic exploration missions to other worlds can aid in understanding the planetary context of serpentinization, testing the predictions herein. This article is part of a discussion meeting issue 'Serpentinite in the Earth System'.

8.
Astrobiology ; 13(8): 740-73, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23924246

RESUMO

The prospect of a future soft landing on the surface of Europa is enticing, as it would create science opportunities that could not be achieved through flyby or orbital remote sensing, with direct relevance to Europa's potential habitability. Here, we summarize the science of a Europa lander concept, as developed by our NASA-commissioned Science Definition Team. The science concept concentrates on observations that can best be achieved by in situ examination of Europa from its surface. We discuss the suggested science objectives and investigations for a Europa lander mission, along with a model planning payload of instruments that could address these objectives. The highest priority is active sampling of Europa's non-ice material from at least two different depths (0.5-2 cm and 5-10 cm) to understand its detailed composition and chemistry and the specific nature of salts, any organic materials, and other contaminants. A secondary focus is geophysical prospecting of Europa, through seismology and magnetometry, to probe the satellite's ice shell and ocean. Finally, the surface geology can be characterized in situ at a human scale. A Europa lander could take advantage of the complex radiation environment of the satellite, landing where modeling suggests that radiation is about an order of magnitude less intense than in other regions. However, to choose a landing site that is safe and would yield the maximum science return, thorough reconnaissance of Europa would be required prior to selecting a scientifically optimized landing site.


Assuntos
Exobiologia , Geologia , Júpiter , Voo Espacial , Oceanos e Mares
9.
Eye (Lond) ; 26(9): 1181-7, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22878451

RESUMO

PURPOSE: To determine the efficacy of intravitreal ranibizumab 2.0 mg in patients with recalcitrant neovascular age-related macular degeneration (AMD). METHODS: This single-masked, randomized, prospective, pilot study enrolled patients with subfoveal neovascular AMD. All study eyes had persistent subretinal (SRF) or intraretinal fluid (IRF) on spectral-domain optical coherence tomography (SD-OCT) <30 days following at least 6 monthly intravitreal injections of ranibizumab or bevacizumab. Patients were randomized 2 : 1 to receive either ranibizumab 2.0 or 0.5 mg. Following three-loading treatments 4-weeks apart, both groups were treated using a 'treat and extend' regimen guided by eye-tracked SD-OCT through month 12. The primary end point was the mean change in best-corrected visual acuity (BCVA) at month 6. RESULTS: Nine eyes of 9 patients (mean age ± SD, 82.0 ± 5.8 years) were enrolled. Seven eyes received ranibizumab 2.0 mg and two eyes received 0.5 mg. Owing to the small number of patients enrolled, no statistical comparison could be made between the two dosages. At month 6, the mean improvement in BCVA was +6.1 ± 3.7 (W=0, P<0.001) ETDRS letters and +2.0 ETDRS letters in the 2.0 and 0.5 mg groups, respectively. In the 2.0 mg group, there was a statistically significant decline in central foveal thickness, SRF and maximum pigment epithelial detachment height at 6 months compared with baseline. No adverse events were reported in either group. CONCLUSION: Ranibizumab 2.0 mg has the potential to maintain or improve BCVA in some patients with persistent or recurrent SRF or IRF secondary to neovascular AMD despite prior monthly intravitreal anti-vascular endothelial growth factor therapy with the standard dose.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Líquido Sub-Retiniano/metabolismo , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intravítreas , Masculino , Projetos Piloto , Estudos Prospectivos , Ranibizumab , Método Simples-Cego , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/metabolismo
10.
J Nanosci Nanotechnol ; 8(4): 1942-50, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18572597

RESUMO

Direct reaction of herringbone, platelet, or narrow, tubular herringbone graphitic carbon nanofibers (GCNFs) with molten potassium gives K/GCNF intercalates with stoichiometric control of potassium loading. Intercalate formation is confirmed by powder X-ray diffraction and micro-Raman spectroscopy. K/GCNF intercalates act as radical-anion alkene polymerization catalysts and reduce water with stoichiometric formation of hydrogen gas. Stage-1 K/narrow, tubular GCNF intercalate exhibits thermionic emission at 300 degrees C. Stage-1 K/herringbone GCNF intercalate is an excellent thermionic emitter having high thermal stability up to 1000 degrees C. K/GCNF intercalates have much reduced work functions of ca. 2.2 eV with localized emission showing a work function of 1.6 eV.


Assuntos
Cristalização/métodos , Nanotecnologia/métodos , Nanotubos de Carbono/química , Nanotubos de Carbono/ultraestrutura , Potássio/química , Substâncias Intercalantes/química , Substâncias Macromoleculares/química , Teste de Materiais , Metais/química , Conformação Molecular , Tamanho da Partícula , Propriedades de Superfície
11.
Astrobiology ; 6(5): 735-813, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17067259

RESUMO

The Astrobiology Primer has been created as a reference tool for those who are interested in the interdisciplinary field of astrobiology. The field incorporates many diverse research endeavors, but it is our hope that this slim volume will present the reader with all he or she needs to know to become involved and to understand, at least at a fundamental level, the state of the art. Each section includes a brief overview of a topic and a short list of readable and important literature for those interested in deeper knowledge. Because of the great diversity of material, each section was written by a different author with a different expertise. Contributors, authors, and editors are listed at the beginning, along with a list of those chapters and sections for which they were responsible. We are deeply indebted to the NASA Astrobiology Institute (NAI), in particular to Estelle Dodson, David Morrison, Ed Goolish, Krisstina Wilmoth, and Rose Grymes for their continued enthusiasm and support. The Primer came about in large part because of NAI support for graduate student research, collaboration, and inclusion as well as direct funding. We have entitled the Primer version 1 in hope that it will be only the first in a series, whose future volumes will be produced every 3-5 years. This way we can insure that the Primer keeps up with the current state of research. We hope that it will be a great resource for anyone trying to stay abreast of an ever-changing field.


Assuntos
Astronomia , Exobiologia , Origem da Vida , Planetas , Fenômenos Astronômicos , Evolução Biológica
12.
Comput Nurs ; 19(3): 105-10; quiz 111-3, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11391881

RESUMO

A central tenet of university education is the development of scholarly abilities. The traditional hallmarks of scholarship, such as critical thinking, reflection, creativity, critical analysis, and openness to new thinking, need to be fostered in the face of increasing technological change. Contemporary e-mail applications provide a sophisticated environment in which many of the fundamental skills of scholarship can be nurtured. This article describes an interdisciplinary curricular project in which e-mail was employed as a vehicle to support the development of students' understanding of scholarship within a cohort of first-year undergraduate nursing students. The project involved the establishment of "Virtual Colleague" activity, which used e-mail to conduct scholarly activities, including critical analysis of electronic journals and web sites and peer review. The theoretical underpinning of the project and an evaluation of the project are presented. Future use of such technologies in the promotion of scholarship among nurses is discussed.


Assuntos
Comunicação , Bacharelado em Enfermagem , Internet , Ensino , Bacharelado em Enfermagem/métodos , Feminino , Humanos , Masculino
13.
Cancer Pract ; 8(5): 223-30, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11898234

RESUMO

PURPOSE: The purpose of the study was to examine smoking behavior, knowledge, and beliefs among Korean Americans. DESCRIPTION OF STUDY: One hundred four Korean American men and 159 women, 40 to 69 years old, living in Chicago, Illinois, served as study respondents. The National Health Interview Survey (NHIS) Cancer Control Supplement Questionnaire was used to collect data. The NHIS was translated into Korean with minor modifications to develop a culturally appropriate instrument. RESULTS: This study suggests that smoking is almost exclusively a male behavior (38.5%) and that Korean American men smoke mostly cigarettes. Almost 90% of women have never smoked, whereas 23% of men reported never smoking. Respondents with a non-Christian background or no religious affiliation were 16.5 times more likely to be current smokers. Respondents who had lived in the United States less than 10 years were 12.5 times more likely to be current smokers. More than 90% of men, regardless of smoking status, were able to identify an association between smoking and major chronic diseases. CLINICAL IMPLICATIONS: The prevalence of smoking among these Korean American men places them at considerable risk for smoking-related disease. Healthcare providers must be better informed about smoking behavior in this group, and specific attention to recently migrated men and those reporting religions other than Christianity is recommended. Health-protecting strategies for women and children who fall victim to secondhand smoke, or who may be targeted by tobacco advertising, are also an important step in disease prevention for this population.


Assuntos
Asiático/educação , Asiático/psicologia , Atitude Frente a Saúde/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Fumar/efeitos adversos , Fumar/etnologia , Adulto , Publicidade , Asiático/estatística & dados numéricos , Chicago/epidemiologia , Escolaridade , Feminino , Humanos , Coreia (Geográfico)/etnologia , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Educação de Pacientes como Assunto , Prevalência , Prevenção do Hábito de Fumar , Inquéritos e Questionários
14.
Psychosomatics ; 40(4): 293-7, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10402873

RESUMO

The 30 patients who underwent lung transplantation between 1990 and 1996 were included in this study, and data were analyzed to find predictors of 1-year survival posttransplantation. All patients were followed throughout the posttransplantation period. Fifteen patients had a pretransplantation diagnosis of an anxiety and/or depressive disorders. Of the 30 patients transplanted, 19 survived 12 months or more, and 11 died less than 12 months posttransplantation. The > 12-month survival group had a mean age of 45.2 years at transplantation, compared with a mean age of 43.0 years in the < 12-month group (NS). The mean Psychosocial Assessment of Candidates for Transplant score and premorbid history of smoking did not differ between the groups. The > 12-month survival group had more psychiatric illness pretransplantation than the < 12-month survival group (56% vs. 27%, P < 0.05). The recipients with a psychiatric history (N = 15) were more likely to survive 1 year posttransplantation than the recipients without a psychiatric history (80% vs. 47%, P < 0.05) and were not significantly different from the recipients without a psychiatric history in terms of episodes of rejection, bronchiolitis obliterans, or noncompliance with treatment. Depression and anxiety are treatable disorders that occur frequently in patients with end-stage lung disease, and a premorbid history of either did not predict a worse outcome posttransplantation in this study of lung transplantation recipients.


Assuntos
Transplante de Pulmão/psicologia , Transtornos Mentais/psicologia , Complicações Pós-Operatórias/psicologia , Transtornos Psicofisiológicos/psicologia , Transtornos Somatoformes/psicologia , Adulto , Transtornos de Ansiedade/mortalidade , Transtornos de Ansiedade/psicologia , Comorbidade , Transtorno Depressivo/mortalidade , Transtorno Depressivo/psicologia , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/mortalidade , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Transtornos Psicofisiológicos/mortalidade , Risco , Transtornos Somatoformes/mortalidade , Taxa de Sobrevida
15.
ASAIO J ; 44(5): M347-51, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-9804450

RESUMO

Pro-inflammatory mediators, including interleukin-6 (IL-6), IL-8, and complement C3a, are released after cardiac surgery as part of the inflammatory response related to blood-biomaterial interaction in the cardiopulmonary bypass circuit. Post operative time course data for these mediators are not fully defined in patients receiving left ventricular assist device (LVAD) support. The authors performed enzyme linked immunosorbent assays for concentrations of IL-6, IL-8, and C3a in plasma in six HeartMate LVAD recipients at the following times: pre operatively; 4, 8, 16, 24, 36, and 48 hr post operatively; daily through the first week; and weekly thereafter for 6 weeks. All patients survived without major complications during the study. Pre operative concentrations of IL-6 and C3a in plasma were significantly increased compared with age matched controls. Post operatively, the concentrations of IL-6 and IL-8 in plasma took longer to return to baseline values after insertion of the LVAD than the trends reported in the literature after routine cardiopulmonary bypass alone. Concentrations of IL-6 and complement C3a continued to decrease to lower than baseline post operatively, reaching statistical significance after 6 weeks of LVAD support. The authors conclude that the presence of the HeartMate LVAD delays the return of pro-inflammatory mediator concentrations back to baseline values compared with routine cardiopulmonary bypass alone, but the device does not appear to be an ongoing source of cytokine release or complement activation.


Assuntos
Ativação do Complemento , Proteínas do Sistema Complemento/análise , Citocinas/sangue , Coração Auxiliar , Feminino , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
16.
J Clin Apher ; 9(3): 171-5, 1994.
Artigo em Inglês | MEDLINE | ID: mdl-7706199

RESUMO

Two patients were treated with photopheresis for marked cardiac allograft rejection with hemodynamic compromise that had become unresponsive to standard therapy. Multiple episodes of rejection had occurred, and initial response to standard therapy was favorable. However, progressive deterioration was documented by serial endomyocardial biopsies, fever, congestive heart failure, and abnormal cardiac catheterization findings. In the absence of retransplantation, death seemed imminent. Photopheresis was begun. Both patients received oral 8-methoxypsoralen and > or = 5 x 10(9) mononuclear cells were collected, treated with ultraviolet light A for 1.5 hours, and were reinfused. One procedure was performed weekly x4 and then monthly x5. Responses were striking with rapid loss of fever, improvement in exercise tolerance, normalization of cardiac hemodynamics, and improvement in endomyocardial biopsies. Although our experience with these two patients is anecdotal, photopheresis merits further study as treatment for severe cardiac allograft rejection.


Assuntos
Rejeição de Enxerto , Transplante de Coração/imunologia , Fotoferese , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Transplante Homólogo
17.
J Am Coll Cardiol ; 20(1): 94-7, 1992 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-1607545

RESUMO

The purpose of this study was to determine the effect of sternotomy on transthoracic impedance, a major determinant of current flow and defibrillation success. Transthoracic impedance was determined by using a validated test-pulse technique that does not require actual shocks. Seventeen patients undergoing median sternotomy were studied prospectively. Transthoracic impedance was determined before operation, 3 to 5 days after operation and (in eight patients) greater than or equal to 1 month after operation. When measured using paddle electrodes placed in the standard apex-right parasternal defibrillating position, transthoracic impedance declined after sternotomy in all patients, from 77 +/- 18 to 59 +/- 17 omega (p less than 0.01); smaller declines were demonstrated by using other electrode positions. Transthoracic impedance remained below the preoperative level in the eight patients who underwent a second set of measurements at least 1 month after operation. Six normal subjects not undergoing sternotomy underwent serial transthoracic impedance measurements at least 5 days apart; mean transthoracic impedance did not change. It is concluded that transthoracic impedance declines after sternotomy. At any operator-selected energy level a higher current flow will result after sternotomy; this may facilitate postoperative defibrillation.


Assuntos
Cardiografia de Impedância , Cardioversão Elétrica , Esterno/fisiologia , Esterno/cirurgia , Humanos , Período Pós-Operatório
18.
Adolescence ; 25(97): 49-57, 1990.
Artigo em Inglês | MEDLINE | ID: mdl-2333802

RESUMO

The purpose of this study was to determine the effect of social support on parent-child interaction in a group of 19 adolescent mothers. The subjects participated in a 20-week model demonstration program in which they worked in a preschool classroom with skilled caregivers who modeled facilitative styles of interacting with young children. Each subject was videotaped while interacting with a 1- to 2-year-old child upon entering the program, midway through the program, and at the end. Results showed that girls who were 16 years or older significantly increased their frequency of using responsive, engaging, and elaborative styles of behavior. Those under age 16 did not show significant changes in these three behaviors. Overall, subjects significantly increased the duration of time they spent observing the child's play behavior.


Assuntos
Relações Mãe-Filho , Gravidez na Adolescência/psicologia , Meio Social , Apoio Social , Adolescente , Feminino , Humanos , Lactente , Recém-Nascido , Comportamento Materno , Testes de Personalidade , Gravidez
19.
Brain ; 111 ( Pt 1): 169-84, 1988 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3365546

RESUMO

The extent to which intellectual processes are preserved as a function of preinjury 'intelligence' and of size and location of the brain lesions was evaluated in Vietnam war veterans who survived penetrating missile wounds. With regard to an overall postinjury intelligence test score, preinjury intelligence was most predictive, size of lesion was next most predictive and lesion location was least important. For subtest scores from the same intelligence test, lesion location assumed much greater predictive value. Specifically, left temporal and occipital lesions impaired performance on subtests assessing vocabulary and object-function matching ability.


Assuntos
Traumatismos Craniocerebrais/psicologia , Pensamento/fisiologia , Veteranos , Ferimentos Penetrantes , Adulto , Análise de Variância , Encéfalo/patologia , Traumatismos Craniocerebrais/patologia , Educação , Humanos , Testes de Inteligência , Masculino , Valores de Referência , Vietnã
20.
Electroencephalogr Clin Neurophysiol ; 67(4): 289-97, 1987 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-2441962

RESUMO

Somatosensory evoked potentials were obtained after median nerve stimulation in 500 Vietnam veterans surviving penetrating head wounds 12-16 years earlier and 76 age-matched, uninjured controls. The results were studied in relation to neurologic history and findings, anatomical data provided by CT scan, and information derived from electroencephalograms. Thirty-five percent of head-injured individuals had abnormal SEPs and 76% of SEP abnormalities consisted of absence of N20 or N20/P25 complex. SEP abnormality correlated (P greater than 0.001) with the extent of total brain volume loss, sensory deficits (especially position and cortical discriminatory modalities), hemiparesis, organic mental disorder, CT evidence of parietal or thalamic injury, and centro-parietal EEG abnormalities. Recovery from hemiparesis was correlative with patients who subsequently had normal SEPs.


Assuntos
Lesões Encefálicas/fisiopatologia , Potenciais Somatossensoriais Evocados , Encéfalo/fisiopatologia , Lesões Encefálicas/diagnóstico por imagem , Humanos , Radiografia , Veteranos , Vietnã , Guerra
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