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Fernandez-Berges D, Felix Redondo FJ, Gonzalez MR, Consuegra-Sanchez L, Buitrago F, Lozano L, Ortiz Cortes C, Alvarez Palacios P, Corraliza M, Gamero MC, Mellado P. P1638Predictors of in-hospital and late mortality in acutely decompensated chronic heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is a global pandemic, and the cause of the greater health expenditure on hospitalization.
Purpose
To determine, in patients admitted due to decompensated heart failure (dHF), the predictors of in-hospital and late all-cause mortality.
Methods
Retrospective and longitudinal observational study of consecutive patients admitted with a diagnosis of dHF in a General Hospital between 2000–2015. Primary objective was in-hospital and late mortality.
Results
A total of 3705 patients were included (76.9 + 10.1 years, 54.1% women). Diabetes was present in 1611 (43.5%) patients, hypertension in 3210 (86.6%), active smoking in 221 (6%), COPD in 989 (26.7%), neoplasms in 415 (11.2%), chronic renal failure (CRF) in 628 (17%), previous myocardial infarction (pMI) in 449 (12.1%), stroke in 416 (11.2%), previous heart failure (pHF) in 1015 (27.4%), atrial fibrillation in 1672 (45.1%). A total of 239 (6.5%) lived in a nursing home (NH). The rate of 6-months readmission due to heart failure was 473 (12.8%). The in-hospital all-cause mortality rate was 9.3% (345). During a median follow-up of 930 days (RI 230–2611), 2165 (58.4%) patients died.
The following variables were independent predictors of in-hospital mortality (Odds ratio, 95% CI): age 1.03 (1.02–1.05), basal creatinine 1.18 (1.01–1.39) and urea 1.014 (1.011–1.018) (model AUC 0.78 (0.75–0.81)). We identified the following predictors of late mortality (Hazard ratio, 95% CI): age 1,029 (1,022–1,035), diabetes mellitus 1,13 (1,02–1,25), COPD 1,15 (1,03–1,28), neoplasms 1,17 (1,008–1,361), pMI 1.19 (1.02–1.38), pHF 1.25 (1.12–1.39), NH 1.24 (1.03–1.49), readmission 1.73 (1.51–1.97), urea 1.003 (1.001–1.005) (model AUC 0.73 (0.71–0.75)).
Conclusions
In-hospital mortality was significantly associated with age and markers of renal function, while for late mortality the predictors were comorbidities, hospital readmissions and living in a nursing home.
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Affiliation(s)
- D Fernandez-Berges
- Extremadura Health System. Don Benito-Villanueva Hospital, Villanueva de la Serena, Spain
| | - F J Felix Redondo
- Extremadura Health System. Don Benito-Villanueva Hospital, Villanueva de la Serena, Spain
| | - M R Gonzalez
- Hospital Universitario Infanta Cristina, Badajoz, Spain
| | | | - F Buitrago
- University of Extremadura, Badajoz, Spain
| | - L Lozano
- Extremadura Health System. Don Benito-Villanueva Hospital, Villanueva de la Serena, Spain
| | | | - P Alvarez Palacios
- Unidad de Investigaciόn Don Benito-Villanueva. FUNDESALUD, Villanueva de la Serena, Spain
| | - M Corraliza
- Unidad de Investigaciόn Don Benito-Villanueva. FUNDESALUD, Villanueva de la Serena, Spain
| | - M C Gamero
- Unidad de Investigaciόn Don Benito-Villanueva. FUNDESALUD, Villanueva de la Serena, Spain
| | - P Mellado
- Extremadura Health System. Don Benito-Villanueva Hospital, Villanueva de la Serena, Spain
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Arcas-Bellas JJ, Arévalo-Ludeña J, Martín-Piñeiro B, Mellado P, Álvarez-Rementería R, Muñoz-Alameda LE. Anesthetic management of an adult patient with Cor Triatriatum Sinistrum: Utility of transesophageal echocardiography. J Clin Anesth 2017; 45:25-26. [PMID: 29274542 DOI: 10.1016/j.jclinane.2017.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 11/30/2017] [Accepted: 12/09/2017] [Indexed: 11/24/2022]
Affiliation(s)
- J J Arcas-Bellas
- Department of Anesthesiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - J Arévalo-Ludeña
- Department of Anesthesiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - B Martín-Piñeiro
- Department of Anesthesiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - P Mellado
- Department of Anesthesiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - R Álvarez-Rementería
- Department of Anesthesiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - L E Muñoz-Alameda
- Department of Anesthesiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
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Uribe-San Martin R, Ciampi E, Galilea A, Sandoval P, Miranda H, Mellado P, Cruz JP, Huete I, Carcamo C. [Neuromyelitis optica spectrum disorders: profile of a cohort according to the 2015 diagnostic criteria]. Rev Neurol 2017; 65:193-202. [PMID: 28849860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The new 2015 criteria for neuromyelitis optica spectrum disorders (NMOSD) have been recently incorporated in the study of different international cohorts. AIM To describe clinical-radiological characteristics and prognostic factors in patients with NMOSD according to the 2015 criteria. PATIENTS AND METHODS Retrospective analysis of 36 patients diagnosed with NMOSD according to serologic AQP4 status (positive, negative, unknown and negative + unknown). Clinical and radiological characteristics were compared and possible disability prognostic factors were evaluated. RESULTS AQP4 were positive in 7 patients, negative in 12 and unknown in 17. Age of presentation was 36.6 ± 16 years, with higher female proportion (4:1). Mean disease duration was 7.4 ± 7.6 years. Most frequent presenting symptoms were acute myelitis (61%), optic neuritis (33%) and area postrema syndrome (11%). Most frequent MRI lesion was longitudinally extensive transverse myelitis (75%). All patients received acute treatment during attacks, and preventive treatment was used in 81% (azathioprine and rituximab mostly prescribed). Median EDSS was 2.0 at the end of follow-up. No differences were observed in any of the variables comparing serologic status. Age of first attack was prognostic, with direct correlation with EDSS. First attack in < 30 years was protective, meanwhile > 50 years old patients had increased risk of disability. CONCLUSIONS The 2015 criteria allow the description and classification of NMOSD patients within different cohorts. Age of first attack seems to be a prognostic factor for developing disability.
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Affiliation(s)
- R Uribe-San Martin
- Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
- Complejo Asistencial Hospital Sotero del Rio, Santiago de Chile, Chile
| | - E Ciampi
- Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
- Complejo Asistencial Hospital Sotero del Rio, Santiago de Chile, Chile
| | - A Galilea
- Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
| | - P Sandoval
- Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
| | - H Miranda
- Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
| | - P Mellado
- Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
| | - J P Cruz
- Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
| | - I Huete
- Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
| | - C Carcamo
- Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile
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Sabate A, Gutierrez R, Beltran J, Mellado P, Blasi A, Acosta F, Costa M, Reyes R, Torres F. Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. Am J Transplant 2016; 16:2421-9. [PMID: 26880105 DOI: 10.1111/ajt.13752] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/20/2016] [Accepted: 02/05/2016] [Indexed: 01/25/2023]
Abstract
We hypothesized that preemptive fibrinogen administration to obtain an initial plasma level of 2.9 g/L would reduce transfusion requirements in liver transplantation. A randomized, multicenter, hemoglobin-stratified, double-blind, fibrinogen-versus-saline-controlled trial was conducted. The primary end point was the percentage of patients requiring red blood cells. We evaluated 51 patients allocated to fibrinogen and 48 allocated to saline; the primary end point was assessed using data for 92 patients because the electronic record forms were offline for three patients in the fibrinogen group and four in the saline group. We injected a median of 3.54 g fibrinogen preemptively in the fibrinogen group. Nine patients in the saline group (20.9%) required fibrinogen at graft reperfusion (compared with one patient [2.1%] in the fibrinogen group; p = 0.005). Blood was transfused to 52.9% (95% confidence interval [CI] 42.5-63.3%) in the fibrinogen group and 42.74% (95% CI 28.3-57.2%) in the saline group (p = 0.217). Relative risk for blood transfusion was 0.80 (95% CI 0.57-1.13). Thrombotic events occurred in one patient (2.1%) and five patients (11.4%) in the fibrinogen and saline groups, respectively. Seven patients (14.6%) in the fibrinogen group and nine (20.3%) in the saline group required reoperation. Preemptive administration of fibrinogen concentrate did not influence transfusion requirements.
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Affiliation(s)
- A Sabate
- Department of Anesthesiology, Hospital Universitari de Bellvitge, University of Barcelona Health Campus, Idibell, Barcelona, Spain
| | - R Gutierrez
- Department of Anesthesiology, Hospital Universitario de Cruces, Bilbao, Spain
| | - J Beltran
- Department of Anesthesiology, Hospital Clinic Universitari, University of Barcelona Health Campus, Idibaps, Barcelona, Spain
| | - P Mellado
- Department of Anesthesiology, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - A Blasi
- Department of Anesthesiology, Hospital Clinic Universitari, University of Barcelona Health Campus, Idibaps, Barcelona, Spain
| | - F Acosta
- Department of Anesthesiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Costa
- Department of Anesthesiology, Hospital Universitari de Bellvitge, University of Barcelona Health Campus, Idibell, Barcelona, Spain
| | - R Reyes
- Department of Anesthesiology, Hospital Universitari de Bellvitge, University of Barcelona Health Campus, Idibell, Barcelona, Spain
| | - F Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic Barcelona, Spain. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Riquelme R, Lazcano C, Mellado P, Sandoval P. Pure midbrain infarction: case reports. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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6
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Mellado P, Prieto A, Puerto M, Pichardo S, Guillamón E, Martín-Cameán A, Jos A, Cameán A. Mammalian Erythrocytes Micronucleus test after acute exposure of Wistar rats to PTSO. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Torche A, Sandoval P, Marquez A, Mellado P. Early hemmorhage in initial cerebral proliferative angiopathy. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Marquez A, Sandoval P, Torche A, Mellado P, Pérez F. Case report of a young adult whit vanishing white matter disease (VWM). J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Mellado P, Benítez I, Sánchez-Carrillo F, León A, Álamo JM, Gómez MA. Survey of hemostasis management and transfusion in liver transplantation. ACTA ACUST UNITED AC 2015; 63:84-90. [PMID: 26411596 DOI: 10.1016/j.redar.2015.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/06/2015] [Accepted: 06/09/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the management of haemostasis and transfusion practice in the field of liver transplantation in Spain. METHODS A questionnaire was developed for physicians in anaesthesiology of all centres performing liver transplantation in Spain. The information required made reference to the 12 months prior to its distribution, from January 1 to December 31, 2011. RESULTS Data were collected from 24 centres in which liver transplantation is performed in Spain. Only 46% reported that they had protocols or practice guidelines for the management of haemostasis, and 83% of hospitals responded that they knew the percentage of transfused patients, but only 57% knew the mean transfusion. Regarding the degree of satisfaction with the management of haemostasis/coagulation, 50% said they were not satisfied. Thromboelastometry was used as an additional method of preoperative monitoring in only 8% of the centres and intra-operatively in one-third. Less than half (46%) of the centres performed preoperative correction of coagulation deficits based on conventional tests. The mean number of packed red cells used was ≤4 in 57% of centres. Consumption of fresh frozen plasma was highly variable, while 100% of centres consumed less than 4 pools of platelets per patient. CONCLUSIONS There is a wide variability in the management of haemostasis and transfusion practice among Spanish centres. There are no guidelines or they are not widely used. The mean use of transfused blood products remain high. There was a decrease in centres using new methods of monitoring.
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Affiliation(s)
- P Mellado
- Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - I Benítez
- Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - F Sánchez-Carrillo
- Anestesiología y Reanimación, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A León
- Bioquímica Clínica, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J M Álamo
- Cirugía General y Digestiva, Unidad de Cirugía Hepatobiliar y Pancreática, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M A Gómez
- Cirugía General y Digestiva, Unidad de Cirugía Hepatobiliar y Pancreática, Hospital Universitario Virgen del Rocío, Sevilla, España
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Alamo JM, León A, Mellado P, Bernal C, Marín LM, Cepeda C, Suárez G, Serrano J, Padillo J, Gómez MÁ. Is "intra-operating room" thromboelastometry useful in liver transplantation? A case-control study in 303 patients. Transplant Proc 2014; 45:3637-9. [PMID: 24314981 DOI: 10.1016/j.transproceed.2013.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Coagulation monitoring during liver transplantation (LT) is, even today, fundamental to reduce blood loss during surgery. Thromboelastometry (TEM) is a proven technique for controlling the various parameters that influence coagulation. However, there are no studies linking "intra-operating room" TEM (orTEM) with LT outcomes. We describe a case-control study in 303 liver graft recipients analyzing variables associated with operative complications and long-term LT outcomes. The results showed that orTEM reduced the use of blood products in patients with Model for End-Stage Liver Disease scores of ≥ 21, retransplantation, and high surgical difficulty and important intraoperative bleeding. In addition, results in survival and postoperative complications were better when orTEM was used. In conclusion, we confirm that use of orTEM is associated with less use of blood products and a lower rate of complications after LT.
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Affiliation(s)
- J-M Alamo
- Liver Transplant Unit, Sevilla, Spain.
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11
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Reuner KH, Jenetzky E, Aleu A, Litfin F, Mellado P, Kloss M, Jüttler E, Grau AJ, Rickmann H, Patscheke H, Lichy C. Factor XII C46T gene polymorphism and the risk of cerebral venous thrombosis. Neurology 2008; 70:129-32. [PMID: 18180442 DOI: 10.1212/01.wnl.0000296825.05176.da] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The TT genotype of a functional factor XII (FXII) C46T gene polymorphism was shown to be a risk factor for peripheral venous thrombosis. We tested whether this genetic variant also increases the risk for cerebral venous thrombosis (CVT). METHODS We performed a case-control study including 78 consecutive patients with proven CVT and 201 healthy population controls from South Germany. The FXII C46T genotype was assessed using a PCR technique. RESULTS The TT genotype of the FXII C46T polymorphism was more common in patients (16.7%) than in controls (5.5%). A strong association of the TT genotype with CVT was found, which was independent of covariables (adjusted odds ratio 4.57; 95% CI 1.55 to 13.41; p = 0.006). CONCLUSION The TT genotype of the functional factor XII C46T gene polymorphism may be a new independent risk factor for cerebral venous thrombosis (CVT). Our finding warrants confirmation in an independent study before this genetic variant should be added to the panel of established risk factors for CVT.
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Affiliation(s)
- K H Reuner
- Institute for Medical Laboratory Diagnostics, Städtisches Klinikum Karlsruhe, Germany
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12
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López R, Nazar C, Sandoval P, Guerrero I, Mellado P, Lacassie HJ. [Neuraxial analgesia during labor in a patient with Arnold-Chiari type I malformation and syringomyelia]. Rev Esp Anestesiol Reanim 2007; 54:317-21. [PMID: 17598723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Chiari type I malformation is a caudal displacement of the cerebellum with tonsillar herniation through the foramen magnum, frequently associated with syringomyelia, a syndrome characterized by cyst-like cavities in the spinal cord; each of the conditions leads to characteristic neurologic abnormalities. Pregnant patients with these types of malformation are considered to have an increased risk of brainstem compression and/or progression of the disease during labor. We present the case of a patient in labor with a diagnosis of syringomyelia associated with Chiari type I malformation and describe the anesthetic management. The patient revealed during labor that she had syringomyelia associated with Chiari type I malformation, after having made no mention of it in previous history taking. Finally, we review the pathology observed in these patients.
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Affiliation(s)
- R López
- Escuela de Medicina de la Facultad de Medicina, Pontificia Universidad Católica de Chile
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13
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Agüero J, Ortega M, Cano M, González de Aledo A, Calvo J, Viloria L, Mellado P, Pelayo T, Martinez-Martinez L. P1426 Microbiological aspects of a Streptococcus pyogenes outbreak causing invasive disease in children attending a day care centre in Cantabria, Spain. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Concha A, McIver JW, Mellado P, Clarke D, Tchernyshyov O, Leheny RL. Wrinkling of a bilayer membrane. Phys Rev E Stat Nonlin Soft Matter Phys 2007; 75:016609. [PMID: 17358277 DOI: 10.1103/physreve.75.016609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Indexed: 05/14/2023]
Abstract
The buckling of elastic bodies is a common phenomenon in the mechanics of solids. Wrinkling of membranes can often be interpreted as buckling under constraints that prohibit large-amplitude deformation. We present a combination of analytic calculations, experiments, and simulations to understand wrinkling patterns generated in a bilayer membrane. The model membrane is composed of a flexible spherical shell that is under tension and that is circumscribed by a stiff, essentially incompressible strip with bending modulus B . When the tension is reduced sufficiently to a value sigma , the strip forms wrinkles with a uniform wavelength found theoretically and experimentally to be lambda=2pi(B/sigma)(1/3). Defects in this pattern appear for rapid changes in tension. Comparison between experiment and simulation further shows that, with larger reduction of tension, a second generation of wrinkles with longer wavelength appears only when B is sufficiently small.
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Affiliation(s)
- A Concha
- Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Maryland 21218, USA
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15
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Lacassie HJ, Nazar C, Yonish B, Sandoval P, Muir HA, Mellado P. Reversible nitrous oxide myelopathy and a polymorphism in the gene encoding 5,10-methylenetetrahydrofolate reductase. Br J Anaesth 2006; 96:222-5. [PMID: 16361298 DOI: 10.1093/bja/aei300] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present a case of a patient who received nitrous oxide on two occasions within a period of 8 weeks and who subsequently developed a diffuse myelopathy, characterized by upper extremity paresis, lower extremity paraplegia and neurogenic bladder. Laboratory testing revealed hyperhomocysteinaemia and low levels of vitamin B(12). Because of this uncommon clinical presentation, we analysed the patient's DNA, and found a polymorphism in the MTHFR gene that is associated with the thermolabile isoform of the 5,10-methylenetetrahydrofolate reductase enzyme, which explained the myelopathy experienced by the patient after being exposed to nitrous oxide. Soon after initiating supplementary therapy with folic acid and vitamin B(12), the neurological symptoms subsided.
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Affiliation(s)
- H J Lacassie
- Department of Anesthesiology and Department of Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile.
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16
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Nagel S, Schellinger P, Köhrmann M, Herweh C, Mellado P. Bilateraler Medialer Medulla oblongata Infarkt – Zwei Fälle. Akt Neurol 2006. [DOI: 10.1055/s-2006-953425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Romero C, Bugedo G, Bruhn A, Mellado P, Hernández G, Castillo L. [Preliminary experience with dexmedetomidine treatment of confusional state and hyperadrenergic states at an intensive care unit]. Rev Esp Anestesiol Reanim 2002; 49:403-6. [PMID: 12455320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Delirium (confusion) is an acute, reversible and fluctuating compromise of awareness and cognitive function, a state that can increase morbidity and mortality. We describe four patients with delirium associated with agitation and hyperadrenergic states refractory to haloperidol but responsive to dexmedetomidine.
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Affiliation(s)
- C Romero
- Programa de Medicina Intensiva, Departamentos de Anestesiología y Neurología, Hospital Clínico Pontificia Universidad Católica de Chile.
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18
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de la Iglesia P, Melón S, López B, Rodriguez M, Blanco MI, Mellado P, de Oña M. Rapid screening tests for determining in vitro susceptibility of herpes simplex virus clinical isolates. J Clin Microbiol 1998; 36:2389-91. [PMID: 9666034 PMCID: PMC105060 DOI: 10.1128/jcm.36.8.2389-2391.1998] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The susceptibility of human herpes simplex virus (HSV) to acyclovir (ACV) was determined with the use of a single dose of the drug (1 and 2 micrograms of ACV per ml for HSV-1 and HSV-2, respectively) in two rapid assays: a rapid cytopathic effect inhibitory assay (Rapid CIA) and a rapid dye uptake assay (Rapid DUA). These tests allow the simultaneous determination of virus titer and susceptibility to ACV at a determined viral concentration (100 50% tissue culture infective doses and 100 50% dye uptake units). These tests were compared with a conventional susceptibility assay (dye uptake assay) and showed similar results. Indeterminate results with the Rapid CIA appeared in 3 of 30 samples. With the use of both Rapid CIA and Rapid DUA, we were able to determine the susceptibility of 100% of the isolates. The rapid tests, unlike conventional assays, are able to provide susceptibility results within 3 days after the virus has been isolated from a clinical specimen and could thus play a direct role in therapeutic decisions.
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Affiliation(s)
- P de la Iglesia
- Laboratorio de Virología, Servicio de Microbiologia, Hospital, Asturias, Spain.
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19
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Olmos P, Camilla L, Mellado P, Moya P, Arriagada P, Jiménez M, Maiz A, Arteaga A, Velasco N, Acosta AM, Escalona M, Borcoski M. [Diabetic neuropathy: thermal sensation and metabolic control in non-insulin-dependent diabetics]. Rev Med Chil 1997; 125:1319-27. [PMID: 9609053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The early detection of peripheral neuropathy in diabetics is important since it is the main risk factor for lower limb trophic lesions in diabetics. AIM To assess the relationship between feet thermal sensation threshold and metabolic control in ambulatory non-insulin-dependent diabetics. PATIENTS AND METHODS A random sample of 34 non-insulin-dependent diabetics followed for more than five years in a special clinic, out of 368 patients, was selected. Warmth sensation thresholds were measured in the dorsum of both feet using a MSTP-III thermostimulator. The average value of all glycosylated hemoglobins obtained during the 9.7 +/- 5.3 years of follow up for each patient was calculated. A multiple stepwise regression analysis was performed between thermal sensation as the dependent variable and glycosylated hemoglobin, fasting blood glucose, age and diabetes duration. RESULTS The regression model disclosed glycosylated hemoglobin as the only independent predictor of warmth sensation threshold (partial r = 0.385; p = 0.043). Fifteen diabetic patients with good metabolic control, defined as those with a mean glycosylated hemoglobin of less than 9.5%, had a warmth sensation threshold of 35.6 +/- 3.7 degrees C, whereas 19 diabetics with a had control (glycosylated hemoglobin > or = 9.5%) had a threshold of 39 +/- 3.8 degrees C (p = 0.017). CONCLUSIONS In this group of diabetics, there is a relationship between the severity of distal polyneuropathy and the metabolic control, assessed with glycosylated hemoglobin levels.
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Affiliation(s)
- P Olmos
- Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, P Universidad Católica de Chile, Santiago, Chile
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Mellado P, Iniesta A, Diaz FG, García de la Torre J. Diffusion coefficients of segmentally flexible macromolecules with two subunits: a study of broken rods. Biopolymers 1988; 27:1771-86. [PMID: 3233330 DOI: 10.1002/bip.360271107] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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García de la Torre J, Mellado P, Rodes V. Diffusion coefficients of segmentally flexible macromolecules with two spherical subunits. Biopolymers 1985; 24:2145-64. [PMID: 4063461 DOI: 10.1002/bip.360241110] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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