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Background Percutaneous transluminal angioplasty and stenting in acute stroke due to severe basilar artery stenosis or basilar artery occlusion remain a matter of debate. The higher risk of stroke recurrence in patients with vertebrobasilar stenosis compared to anterior circulation atherosclerotic disease creates high expectations concerning endovascular approaches. This study aims to review our experience with percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease. Methods Our prospective database from June 2014 until December 2020 was screened and patients with acutely symptomatic severe (>80%) basilar artery stenosis or acute basilar artery occlusion who underwent percutaneous transluminal angioplasty and stenting were analysed. Results Twenty-five patients included: 72% men (mean age 68.6 years), all with prior modified Rankin Scale Conclusions Percutaneous transluminal angioplasty and stenting showed to be a technically feasible and reasonably safe procedure in selected patients. However, good clinical outcomes may be difficult to achieve as only 43.5% of the patients remained independent at 3 months. Randomized studies are needed to confirm the efficacy and safety outcomes of percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease.

Objetivo: descrever os sentimentos vivenciados pela mulher acerca da sexualidade no período do climatério. Método: O percurso metodologia deu-se por abordagem qualitativa e método de história oral conforme pressupostos de Halbwachs. Resultados: Foram entrevistadas 6 mulheres com idade acima de 45 anos e que receberam nomes fictícios de flores como forma de manter o anonimato das mesmas. Resultados: Os relatos deram origem a 3 categorias e 4 subcategorias conforme a seguir: Mudanças fisiológicas, Mudanças na sexualidade, Desejo sexual, Desempenho sexual, Prazer sexual, Vivência da sexualidade e Necessidade da sexualidade. Conclusão: As dificuldades em lidar com os sintomas do climatério sinaliza a necessidade de criar políticas públicas de saúde, onde profissionais da saúde possam disponibilizar conhecimento em forma de vivencias, materiais e divulgação do que pode ser feito para acompanhar mulheres nesse período. Os profissionais da saúde precisam estar mais atentos para atuar junto às mulheres em crise e desenvolver ações que visem à apropriação do conhecimento e do bem-estar, bem como o desenvolvimento pessoal, para que possam usar mecanismos de enfrentamento eficazes a fim de superar as modificações e os conflitos causados pelo climatério. Descritores: Climatério; Sexualidade; Saúde Da Mulher.

BACKGROUND The effect of early as compared with later initiation of direct oral anticoagulants (DOACs) in persons with atrial fibrillation who have had an acute ischemic stroke is unclear. METHODS We performed an investigator-initiated, open-label trial at 103 sites in 15 countries. Participants were randomly assigned in a 1:1 ratio to early anticoagulation (within 48 hours after a minor or moderate stroke or on day 6 or 7 after a major stroke) or later anticoagulation (day 3 or 4 after a minor stroke, day 6 or 7 after a moderate stroke, or day 12, 13, or 14 after a major stroke). Assessors were unaware of the trial-group assignments. The primary outcome was a composite of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death within 30 days after randomization. Secondary outcomes included the components of the composite primary outcome at 30 and 90 days. RESULTS Of 2013 participants (37% with minor stroke, 40% with moderate stroke, and 23% with major stroke), 1006 were assigned to early anticoagulation and 1007 to later anticoagulation. A primary-outcome event occurred in 29 participants (2.9%) in the early-treatment group and 41 participants (4.1%) in the later-treatment group (risk difference, -1.18 percentage points; 95% confidence interval [CI], -2.84 to 0.47) by 30 days. Recurrent ischemic stroke occurred in 14 participants (1.4%) in the early-treatment group and 25 participants (2.5%) in the later-treatment group (odds ratio, 0.57; 95% CI, 0.29 to 1.07) by 30 days and in 18 participants (1.9%) and 30 participants (3.1%), respectively, by 90 days (odds ratio, 0.60; 95% CI, 0.33 to 1.06). Symptomatic intracranial hemorrhage occurred in 2 participants (0.2%) in both groups by 30 days. CONCLUSIONS In this trial, the incidence of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death at 30 days was estimated to range from 2.8 percentage points lower to 0.5 percentage points higher (based on the 95% confidence interval) with early than with later use of DOACs. (Funded by the Swiss National Science Foundation and others; ELAN ClinicalTrials.gov number, NCT03148457.).

Introduction Endovascular treatment (EVT) with mechanical thrombectomy and acute carotid stenting has become an integral part of the treatment of acute ischemic stroke with large vessel occlusion. Despite being included in the most recent stroke guidelines, only comprehensive centers can offer EVT and thus patients frequently need to be transferred from primary hospitals. We aimed to assess which pre-hospital model of care - direct admission to a comprehensive stroke center (mothership) or transfer to a comprehensive stroke center after the first admission to the nearest hospital (drip-and-ship) - had the most benefit in stroke patients in a Portuguese urban region. Methods We selected patients admitted to a comprehensive stroke center who underwent EVTs between January 2018 and December 2020, in Lisbon, Portugal. We used data from the Safe Implementation of Treatments in Stroke (SITS) International registry on stroke severity, previous modified Rankin Scale (mRS), time from symptom onset to the first admission, time from symptom onset to the procedure, and mRS three months post stroke. We defined an unfavorable outcome as having an mRS >2 at three months post stroke. For patients with previous mRS >2, an unfavorable outcome was defined as any increase in mRS at three months post stroke. Results We analyzed the data of 1154 patients, of which 407 were admitted through a mothership approach and 747 through a drip-and-ship approach. Both groups were similar regarding sociodemographic characteristics, stroke risk factors, previous disability, and stroke severity. Median onset-to-door time was higher (126 vs 110 minutes, p-value=0.002) but onset-to-procedure time was lower (199 vs 339 minutes, p-value

O presente estudo teve como objetivo analisar a qualidade de vida e a presença de sintomas depressivos nos profissionais da saúde que estão atuando diretamente com pacientes infectados pela COVID-19, em um hospital da região metropolitana de Porto Alegre. Realizou-se investigação com questionário sociodemográfico, o Inventário de Depressão de Beck (BDI) para avaliação dos sintomas depressivos e a Escala de Qualidade de Vida “WHOQOL-bref”. A amostra foi composta por 51 profissionais que atuam no Centro de Tratamento Intensivo Adulto e na Unidade de Internação Adulto, com média de idade de 29,5 anos (± 6,9).

ObjectiveTo test the hypothesis that IV thrombolysis (IVT) treatment before endovascular thrombectomy (EVT) is associated with better outcomes in patients with anterior circulation large artery occlusion (LAO) stroke, we examined a large real-world database, the Safe Implementation of Treatment in Stroke–International Stroke Thrombectomy Register (SITS-ISTR).MethodsWe identified centers recording ≥10 consecutive patients in the SITS-ISTR, with at least 70% available modified Rankin Scale (mRS) scores at 3 months during 2014 to 2019. We defined LAO as intracranial internal carotid artery, first and second segment of middle cerebral artery, and first segment of anterior cerebral artery. Main outcomes were functional independence (mRS score 0–2) and death at 3 months and symptomatic intracranial hemorrhage (SICH) per modified SITS–Monitoring Study. We performed propensity score–matched (PSM) and multivariable logistic regression analyses.ResultsOf 6,350 patients from 42 centers, 3,944 (62.1%) received IVT. IVT + EVT–treated patients had less frequent atrial fibrillation, ongoing anticoagulation, previous stroke, heart failure, and prestroke disability. PSM analysis showed that IVT + EVT–treated patients had a higher rate of functional independence than patients treated with EVT alone (46.4% vs 40.3%,p< 0.001) and a lower rate of death at 3 months (20.3% vs 23.3%,p= 0.035). SICH rates (3.5% vs 3.0%,p= 0.42) were similar in both groups. Multivariate adjustment yielded results consistent with PSM.ConclusionPretreatment with IVT was associated with favorable outcomes in EVT-treated LAO stroke in the SITS-ISTR. These findings, while indicative of international routine clinical practice, are limited by observational design, unmeasured confounding, and possible residual confounding by indication.Classification of EvidenceThis study provides Class II evidence that IVT before EVT increases the probability of functional independence at 3 months compared to EVT alone.

Background and Purpose: We designed SITS (Safe Implementation of Treatment in Stroke) Open to determine benefit and safety of thrombectomy in clinical practice for large artery occlusion stroke, using selected stent retrievers plus standard care versus standard care alone. Methods: SITS Open was a prospective, open, blinded evaluation, international, multicenter, controlled, nonrandomized registry study. Centers lacking access to thrombectomy contributed controls. Primary end point was categorical shift in modified Rankin Scale score at 3 months in the per protocol (PP) population. Principal secondary outcomes were symptomatic intracranial hemorrhage, functional independency (modified Rankin Scale score 0–2) and death at 3 months. Patients independently evaluated by video-recorded modified Rankin Scale interviews blinded to treatment or center identity by central core laboratory were regarded as PP population. Propensity score matching with covariate adjusted analysis was performed. Results: During 2014 to 2017, 293 patients (257 thrombectomy, 36 control) from 26 centers in 10 countries fulfilled intention-to-treat and 200 (170 thrombectomy, 30 control) PP criteria; enrollment of controls was limited by rapid uptake of thrombectomy. In PP analysis, median age was 71 versus 71 years, and baseline National Institutes of Health Stroke Scale 17 versus 17 in the thrombectomy and control arms, respectively. The propensity score matching analysis for PP showed a significant shift for modified Rankin Scale at 3 months favoring the thrombectomy group (odds ratio, 3.8 [95% CI, 1.61–8.95]; P =0.002). Regarding safety, there were 4 cases of symptomatic intracranial hemorrhage in the thrombectomy group (2.4%) and none in the control group. Conclusions: In clinical practice, thrombectomy for patients with large artery occlusion stroke is superior to standard of care in our study. Registration: URL: https://www.clinicaltrials.gov . Unique Identifier: NCT02326428.

Background and Purpose Cerebral edema (CED) in ischemic stroke can worsen prognosis and about 70% of patients who develop severe CED die if treated conservatively. We aimed to describe incidence, risk factors and outcomes of CED in patients with extensive ischemia.Methods Oservational study based on Safe Implementation of Treatments in Stroke-International Stroke Treatment Registry (2003–2019). Severe hemispheric syndrome (SHS) at baseline and persistent SHS (pSHS) at 24 hours were defined as National Institutes of Health Stroke Score (NIHSS) >15. Outcomes were moderate/severe CED detected by neuroimaging, functional independence (modified Rankin Scale 0–2) and death at 90 days.Results Patients (n=8,560) presented with SHS and developed pSHS at 24 hours; 82.2% received intravenous thrombolysis (IVT), 10.5% IVT+thrombectomy, and 7.3% thrombectomy alone. Median age was 77 and NIHSS 21. Of 7,949 patients with CED data, 3,780 (47.6%) had any CED and 2,297 (28.9%) moderate/severe CED. In the multivariable analysis, age 128.5 mg/dL (RR, 1.21), and decreased level of consciousness (RR, 1.14) were associated with moderate/severe CED (for all P

Background and Purpose— Posterior circulation stroke (PCS) accounts for 5% to 19% of patients with acute stroke receiving intravenous thrombolysis. We aimed to compare safety and outcomes following intravenous thrombolysis between patients with PCS and anterior circulation stroke (ACS) and incorporate the results in a meta-analysis. Methods— We included patients in the Safe Implementation of Treatments in Stroke Thrombolysis Registry 2013 to 2017 with computed tomography/magnetic resonance angiographic occlusion data. Outcomes were parenchymal hematoma, symptomatic intracerebral hemorrhage (SICH) per SITS-MOST (Safe Implementation of Thrombolysis in Stroke Monitoring Study), ECASS II (Second European Co-operative Stroke Study) and NINDS (Neurological Disorders and Stroke definition), 3-month modified Rankin Scale score, and death. Adjustment for SICH risk factors (age, sex, National Institutes of Health Stroke Scale, blood pressure, glucose, and atrial fibrillation) and center was done using inverse probability treatment weighting, after which an average treatment effect (ATE) was calculated. Meta-analysis of 13 studies comparing outcomes in PCS versus ACS after intravenous thrombolysis was conducted. Results— Of 5146 patients, 753 had PCS (14.6%). Patients with PCS had lower median National Institutes of Health Stroke Scale: 7 (interquartile range, 4–13) versus 13 (7–18), P Conclusions— The risk of bleeding complications after intravenous thrombolysis in PCS was half that of ACS, with similar functional outcomes and higher risk of death, acknowledging limitations of the National Institutes of Health Stroke Scale for stroke severity or infarct size adjustment.

Patients' previous disability (PD) is a key factor when considering acute stroke therapy. PD's exact impact on functional prognosis of patients with acute ischemic stroke remains not entirely clarified. We aimed to analyze PD's influence on functional outcome three months after ischemic stroke.Retrospective analysis of prospectively collected data concerning patients with acute ischemic stroke admitted to Stroke Unit of a tertiary center who underwent acute phase therapy between 2017 and 2019. Modified Rankin Scale (mRS) was used to define PD (with previous mRS≥3). Patients with PD were selected for treatment based on similar baseline characteristics to patients without PD. Patients were classified into two groups according to previous mRS: mRS3 and mRS≥3. We defined bad outcome at three months after stroke as mRS≥3 for patients with previous mRS3, and as a higher score than baseline mRS for patients with previous mRS≥3.We identified 1169 eligible patients - 1016 patients with previous mRS3 and 153 patients with previous mRS≥3. Most baseline characteristics did not differ significantly between them. For patients ≤75 years old, PD was associated with worse outcome (odds ratio estimate [OR] 4.50, p 0.001). For patients75 years old, PD was protective against worse outcome (OR 0.42, p 0.001). In patients with previous mRS≥3 and75 years old, there was a higher proportion of women (p = 0.005).PD might not be a relevant factor when considering acute stroke therapy in selected patients75 years old, especially women. Further studies are needed to clarify these findings.

The growth and the popularity of online shopping have boosted the digital marketing and affiliate strategies. In order to detect the factors that drive consumers to join cashback programs, this paper proposes a conceptual model based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2). To the original model were added the constructs: Ease of Use, Personal Capacity, Perceived Risk, and Behavioral Aspects. The proposed model was effective explaining 67.2% of its variance. The results contribute to theoretical and empirical understanding on the intention to use and actual use of cashback programs, providing considerations for business.

Background Computed tomography (CT) perfusion has been studied as a tool to predict delayed cerebral ischemia (DCI) and clinical outcome in spontaneous subarachnoid hemorrhage (SAH). The purpose of the study was to determine whether quantitative CT perfusion performed within 72 hours after admission can predict the occurrence of DCI and clinical outcome as measured with a modified Rankin scale (mRS) at 3 months after ictus. Methods Cerebral perfusion was assessed in a prospective cohort of patients with acute SAH. CT perfusion parameters at Results A total of 66 patients underwent CT perfusion at 3 for each one second increase in TTP at admission (OR = 1.08; 95% CI: 1.00, 1.17; p = 0.061). Conclusions We identified an association of early TTP changes with DCI and poor clinical outcome. However, there were no associations with cerebral blood flow or mean transit time and DCI/clinical outcome. CT perfusion still remains to be validated as a tool in predicting outcome in SAH.

Background: Extremes of both high and low systolic blood pressure (SBP) after mechanical thrombectomy (MT) in large artery occlusion stroke are known predictors of unfavorable outcome. However, the effect of SBP change (ΔSBP) during the first 24 hour on MT outcomes remains unclear. We aimed to investigate the association between ΔSBP at different time intervals and thrombectomy outcomes. Methods: We analyzed thrombectomy treated patients registered in the SITS International Stroke Thrombectomy Registry from 2014-01-01 to 2019-09-03. The primary outcome was 3-month unfavorable outcome (modified Rankin Scale [mRS] score 3-6). We defined ΔSBP as mean SBP of given time intervals after MT (0-2h, 2-4h, 4-12h, 12-24h) minus admission SBP. Multivariable mixed logistic regression models were used to adjust for known confounders and center as random effect. Subgroups analyses were included to contrast specific subpopulations. Restricted cubic splines were used to model the associations. Results: The study population consisted of 5835 patients (mean age 70 years, 51% male, median NIHSS 16). Mean ΔSBP was -12.3, -15.7, -17.2, and -16.9 for the time intervals 0-2h, 2-4h, 4-12h, 12-24h, respectively. Higher ΔSBP was associated with unfavorable outcome at all time intervals. Restricted cubic spline models suggested that increasing ΔSBP was associated with unfavorable outcomes, with higher values showing an even higher risk of unfavorable outcomes. (Figure 1). Successful reperfusion (mTICI ≥2b) retained an association between ΔSBP and outcomes, while unsuccessful reperfusion (mTICI Conclusion: Up to our knowledge, this is the first study to examine the relation between ΔSBP at different time intervals and the outcome of MT. BP increase after thrombectomy in large artery occlusion stroke is associated with poor functional outcome. The association between ΔSBP and poor outcome differed by reperfusion status.

[Background and objective] We aimed to evaluate the safety and outcomes of thrombectomy in anterior circulation acute ischaemic stroke recorded in the SITS–International Stroke Thrombectomy Register (SITS-ISTR) and compare them with pooled randomized controlled trials (RCTs) and two national registry studies., [Methods] We identified centres recording ≥10 consecutive patients in the SITS-ISTR with at least 70% of available modified Rankin Scale (mRS) at 3 months during 2014–2019. We defined large artery occlusion as intracranial internal carotid artery, first and second segment of middle cerebral artery and first segment of anterior cerebral artery. Outcome measures were functional independence (mRS score 0-2) and death at 3 months and symptomatic intracranial haemorrhage (SICH) per modified SITS-MOST., [Results] Results are presented in the following order: SITS-ISTR, RCTs, MR CLEAN Registry and German Stroke Registry (GSR). Median age was 73, 68, 71 and 75 years; baseline NIHSS score was 16, 17, 16 and 15; prior intravenous thrombolysis was 62%, 83%, 78% and 56%; onset to reperfusion time was 289, 285, 267 and 249 min; successful recanalization (mTICI score 2b or 3) was 86%, 71%, 59% and 83%; functional independence at 3 months was 45.5% (95% CI: 44–47), 46.0% (42–50), 38% (35–41) and 37% (35–41), respectively; death was 19.2% (19–21), 15.3% (12.7–18.4), 29.2% (27–32) and 28.6% (27–31); and SICH was 3.6% (3–4), 4.4% (3.0–6.4), 5.8% (4.7–7.1) and not available., [Conclusion] Thrombectomy in routine clinical use registered in the SITS-ISTR showed safety and outcomes comparable to RCTs, and better functional outcomes and lower mortality than previous national registry studies., SITS (Safe Implementation of Treatment in Stroke) is financed directly and indirectly by grants from Karolinska Institutet, Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish Order of St. John, Friends of Karolinska Institutet and private donors, as well as from an unrestricted sponsorship from Boehringer Ingelheim. SITS has previously received grants from the European Union Framework 7, the European Union Public Health Authority, Ferrer International and EVER Pharma. SITS is currently conducting studies supported by Boehringer Ingelheim and Biogen, as well as in collaboration with Karolinska Institutet, supported by Stryker, Covidien and Phenox. N Ahmed is supported by grants provided by the Stockholm County Council and the Swedish Heart-Lung Foundation. S Holmin is supported by grants provided by the Söderberg Foundations, the Stockholm County Council, the Erling Persson Foundation, VINNOVA and HMT. Irene Escudero-Martínez has received a grant from ‘Fundación Progreso y Salud, Junta de Andalucía’ (grant EF-0437-2018). RM has been supported by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR). RH has been supported by the grants no. DRO–UHHK 00179906 from the Ministry of Health of the Czech Republic and no. PROGRES Q40 from Charles University, Czech Republic.

Contains fulltext : 245661.pdf (Publisher’s version ) (Closed access) IMPORTANCE: Thrombosis with thrombocytopenia syndrome (TTS) has been reported after vaccination with the SARS-CoV-2 vaccines ChAdOx1 nCov-19 (Oxford-AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson). OBJECTIVE: To describe the clinical characteristics and outcome of patients with cerebral venous sinus thrombosis (CVST) after SARS-CoV-2 vaccination with and without TTS. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from an international registry of consecutive patients with CVST within 28 days of SARS-CoV-2 vaccination included between March 29 and June 18, 2021, from 81 hospitals in 19 countries. For reference, data from patients with CVST between 2015 and 2018 were derived from an existing international registry. Clinical characteristics and mortality rate were described for adults with (1) CVST in the setting of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia, (2) CVST after SARS-CoV-2 vaccination not fulling criteria for TTS, and (3) CVST unrelated to SARS-CoV-2 vaccination. EXPOSURES: Patients were classified as having TTS if they had new-onset thrombocytopenia without recent exposure to heparin, in accordance with the Brighton Collaboration interim criteria. MAIN OUTCOMES AND MEASURES: Clinical characteristics and mortality rate. RESULTS: Of 116 patients with postvaccination CVST, 78 (67.2%) had TTS, of whom 76 had been vaccinated with ChAdOx1 nCov-19; 38 (32.8%) had no indication of TTS. The control group included 207 patients with CVST before the COVID-19 pandemic. A total of 63 of 78 (81%), 30 of 38 (79%), and 145 of 207 (70.0%) patients, respectively, were female, and the mean (SD) age was 45 (14), 55 (20), and 42 (16) years, respectively. Concomitant thromboembolism occurred in 25 of 70 patients (36%) in the TTS group, 2 of 35 (6%) in the no TTS group, and 10 of 206 (4.9%) in the control group, and in-hospital mortality rates were 47% (36 of 76; 95% CI, 37-58), 5% (2 of 37; 95% CI, 1-18), and 3.9% (8 of 207; 95% CI, 2.0-7.4), respectively. The mortality rate was 61% (14 of 23) among patients in the TTS group diagnosed before the condition garnered attention in the scientific community and 42% (22 of 53) among patients diagnosed later. CONCLUSIONS AND RELEVANCE: In this cohort study of patients with CVST, a distinct clinical profile and high mortality rate was observed in patients meeting criteria for TTS after SARS-CoV-2 vaccination.

Introduction Mechanical thrombectomy is standard treatment for large vessel occlusion (LVO) in adults. There are no randomized controlled trials for the pediatric population. We report our single-center experience with thrombectomy of LVO in a series of pediatric patients, and perform a review of the literature. Methods Retrospective review of consecutive pediatric thrombectomy cases between 2011 and 2018. Demographic variables, imaging data, technical aspects and clinical outcome were recorded. Results In a period of 7 years, 7 children were treated for LVO at our center. Median age was 13 (2–17), and median Ped-NIHSS was 15 (3–24), and the median ASPECTS was 8 (2–10). Five patients had cardiac disease, and 2 of them were under external cardiac assistance. Median time from onset of symptoms to beginning of treatment was 7h06m (2h58m–21h38m). Five patients had middle cerebral artery occlusions. Thrombectomy was performed using a stentriever in 3 patients, aspiration in 3 patients, and combined technique in 1 patient. Six patients had good recanalization (TICI 2 b/3). There were no immediate periprocedural complications. At 3 months, 4 patients (57%) were independent (mRS score Discussion Selected pediatric patients with LVO may be treated with mechanical thrombectomy safely. In patients under external cardiac assistance and under anticoagulation, thrombectomy is the only alternative for treatment of LVO. A multidisciplinary approach in specialized pediatric stroke centers with trained neurointerventionalists are essential for good results.

Background: Early cerebral hypoperfusion and ischemia occur after subarachnoid hemorrhage (SAH) and influence clinical prognosis. Pathophysiological mechanisms possibly involve inflammatory mediators. TNF-α has been associated with complications and prognosis after SAH. We investigated the relation of perfusion parameters and ischemic lesions, with levels of TNF-α main receptor, TNF-R1, after SAH, and their association with prognosis. Methods: We included consecutive SAH patients admitted within the first 72 h of SAH onset. Blood samples were simultaneously collected from a peripheral vein and from the parent artery of the aneurysm. Levels of TNF-R1 were measured using ELISA (R&D Systems Inc., USA). CT perfusion and MRI studies were performed in the first 72 h. Correlation and logistic regression analysis were used to identify outcome predictors. Results: We analyzed 41 patients. Increased levels of TNF-R1 correlated with increased T (arterial: r = −0.37, p = 0.01) and prolonged MTT (arterial: r = 0.355, p = 0.012; venous: r = 0.306, p = 0.026). Increased levels of both arterial and venous TNF-R1 were associated with increased number of lesions on DWI (p = 0.006). In multivariate analysis, venous TNFR1 levels > 1742.2 pg/mL (OR 1.78; 95%CI 1.18–2.67; p = 0.006) and DWI lesions (OR 14.01; 95%CI 1.19–165.3; p = 0.036) were both independent predictors of poor outcome (mRS ≥ 3) at 6 months. Conclusion: Increased levels of TNF-R1 in arterial and venous blood correlate with worse cerebral perfusion and with increased burden of acute ischemic lesions in the first 72 h after SAH. Venous levels of TNF-R1 and DWI lesions were associated with poor outcome at 6 months. These results highlight the pathophysiological role of TNF-α pathways in SAH and suggest a possible role of combined imaging and laboratorial markers in determining prognosis in acute SAH., Dr Fragata was supported by Sociedade Portuguesa de AVC/Tecnifar. Dr Bustamante is supported by a Juan Rodes research contract (JR16/00008) from Instituto de Salud Carlos III.

Importance: To date, only uncontrolled studies have evaluated the efficacy and safety of endovascular treatment (EVT) in patients with cerebral venous thrombosis (CVT), leading to the lack of recommendations on EVT for CVT.Objective: To evaluate the efficacy and safety of EVT in patients with a severe form of CVT.Design, Setting, and Participants: TO-ACT (Thrombolysis or Anticoagulation for Cerebral Venous Thrombosis) was a multicenter, open-label, blinded end point, randomized clinical trial conducted in 8 hospitals in 3 countries (the Netherlands, China, and Portugal). Patients were recruited from September 2011 to October 2016, and follow-up began in March 2012 and was completed in December 2017. Adult patients with radiologically confirmed CVT who had at least 1 risk factor for a poor outcome (mental status disorder, coma state, intracerebral hemorrhage, or thrombosis of the deep venous system) were included. Data were analyzed according to the intention-to-treat principle from March 2018 to February 2019. The trial was halted after the first interim analysis for reasons of futility.Interventions: Patients were randomized to receive either EVT with standard medical care (intervention group) or guideline-based standard medical care only (control group). The EVT consisted of mechanical thrombectomy, local intrasinus application of alteplase or urokinase, or a combination of both strategies. Patients in the intervention group underwent EVT as soon as possible but no later than 24 hours after randomization.Main Outcomes and Measures: Primary end point was the proportion of patients with a good outcome at 12 months (recovered without a disability; modified Rankin Scale [mRS] score of 0-1). Secondary end points were the proportion of patients with an mRS score of 0 to 1 at 6 months and an mRS score of 0 to 2 at 6 and 12 months, outcome on the mRS across the ordinal continuum at 12 months, recanalization rate, and surgical interventions in relation to CVT. Safety end points included symptomatic intracranial hemorrhage.Results: Of the 67 patients enrolled and randomized, 33 (49%) were randomized to the intervention group and 34 (51%) were randomized to the control group. Patients in the intervention group vs those in the control group were slightly older (median [interquartile range (IQR)] age, 43 [33-50] years vs 38 [23-48] years) and comprised fewer women (23 women [70%] vs 27 women [79%]). The median (IQR) baseline National Institutes of Health Stroke Scale score was 12 (7-20) in the EVT group and 12 (5-20) in the standard care group. At the 12-month follow-up, 22 intervention patients (67%) had an mRS score of 0 to 1 compared with 23 control patients (68%) (relative risk ratio, 0.99; 95% CI, 0.71-1.38). Mortality was not statistically significantly higher in the EVT group (12% [n = 4] vs 3% [n = 1]; P = .20). The frequency of symptomatic intracerebral hemorrhage was not statistically significantly lower in the intervention group (3% [n = 1] vs 9% [n = 3]; P = .61).Conclusions and Relevance: The TO-ACT trial showed that EVT with standard medical care did not appear to improve functional outcome of patients with CVT. Given the small sample size, the possibility exists that future studies will demonstrate better recovery rates after EVT for this patient population.Trial Registration: ClinicalTrials.gov Identifier: NCT01204333.

Early cerebral hypoperfusion and ischemia occur after subarachnoid hemorrhage (SAH) and influence clinical prognosis. Pathophysiological mechanisms possibly involve inflammatory mediators. TNF-α has been associated with complications and prognosis after SAH. We investigated the relation of perfusion parameters and ischemic lesions, with levels of TNF-α main receptor, TNF-R1, after SAH, and their association with prognosis.We included consecutive SAH patients admitted within the first 72 h of SAH onset. Blood samples were simultaneously collected from a peripheral vein and from the parent artery of the aneurysm. Levels of TNF-R1 were measured using ELISA (RD Systems Inc., USA). CT perfusion and MRI studies were performed in the first 72 h. Correlation and logistic regression analysis were used to identify outcome predictors.We analyzed 41 patients. Increased levels of TNF-R1 correlated with increased TIncreased levels of TNF-R1 in arterial and venous blood correlate with worse cerebral perfusion and with increased burden of acute ischemic lesions in the first 72 h after SAH. Venous levels of TNF-R1 and DWI lesions were associated with poor outcome at 6 months. These results highlight the pathophysiological role of TNF-α pathways in SAH and suggest a possible role of combined imaging and laboratorial markers in determining prognosis in acute SAH.

[Background and objective] The optimal timing for initiation of dabigatran after acute ischaemic stroke (AIS) is not established. We aimed to evaluate initiation timing and clinical outcomes of dabigatran in AIS patients with non-valvular atrial fibrillation (NVAF)., [Design] Retrospective study based on prospectively collected data in SITS (Safe Implementation of Treatment in Stroke) Thrombolysis and Thrombectomy Registry from July 2014 to July 2018., [Participants] European NVAF patients (≥18 years) hospitalised after first-ever ischaemic stroke., [Setting] A multinational, observational monitoring register., [Intervention] Dabigatran initiation within 3 months after the ischaemic stroke., [Primary and secondary outcomes] The primary outcome was time from first-ever ischaemic stroke (index event) to dabigatran initiation. Additional outcomes included physicians’ reasons for delaying dabigatran initiation beyond acute hospital discharge and outcomes within 3 months of index event., [Methods] We identified patients with NVAF who received dabigatran within 3 months of the index event. We performed descriptive statistics for baseline and demographic data and clinical outcomes after dabigatran initiation., [Results] In total, 1489 patients with NVAF received dabigatran after AIS treated with thrombolysis and/or thrombectomy. Of these, 1240 had available initiation time. At baseline, median age was 75 years; 53% of patients were women, 15% were receiving an oral anticoagulant, 29% acetylsalicylic acid and 4% clopidogrel. Most patients (82%) initiated dabigatran within 14 days after the index event. Patients initiating earlier had lower stroke severity from median NIHSS 8 (IQR 6–13) if initiated within 7 days to NIHSS 15 (9–19) if initiated between 28 days and 3 months. Most common reasons for delaying initiation were haemorrhagic transformation or intracranial haemorrhage, stroke severity and infarct size. Few thrombotic/haemorrhagic events occurred within 3 months after the index event (20 of 926 patients, 2.2% with the available data)., [Conclusions] Our findings, together with previous observational studies, indicate that dabigatran initiated within the first days after an AIS is safe in patients treated with intravenous thrombolysis, endovascular thrombectomy or both., [Trial registration number] SITS Thrombolysis and Thrombectomy Registry (NCT03258645)., This study is sponsored by Boehringer-Ingelheim. In addition, the SITS registry is financed directly and indirectly by grants from Karolinska Institutet, Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish Order of St. John, Friends of Karolinska Institutet, private donors as well as from an unrestricted sponsorship from Boehringer-Ingelheim. SITS has previously received grants from the European Union Framework 7, the European Union Public Health Authority and Ferrer International, EVER Pharma. SITS is currently conducting studies supported by Boehringer-Ingelheim as well as in collaboration with Karolinska Institutet supported by Stryker, Covidien and Phenox. IE-M has received a grant from 'Fundación Progreso y Salud, Junta de Andalucía' (grant EF-0437-2018).

Background and objectives: Randomized trials for mechanical thrombectomy (MT) excluded patients with ischemic strokes due to isolated posterior cerebral artery occlusion (IPCAO), and there is no evidence for best acute treatment strategy in these patients. We aimed to assess the effectiveness and safety of MT in acute IPCAO. Methods: We retrospectively analyzed consecutive patients with acute stroke due to IPCAO submitted to MT and/or intravenous thrombolysis (IVT), between 2015-2019. Effectiveness outcomes (recanalization rate, first-pass effect, NIHSS 24h improvement and 3-month Modified Ranking Scale - mRS) and safety outcomes (complications, symptomatic intracranial hemorrhage (SICH) and 3-month mortality) were described and compared between groups. Results: A total of 38 patients were included, 25 underwent MT and 13 had IVT alone. Successful and complete recanalization were achieved in 68% and 52% of MT patients, respectively. NIHSS improvement at 24h was found in 56% of MT patients versus 30.8% of patients submitted to IVT alone (OR [95% CI]=2.86 [0.69-11.82]) and excellent functional outcome at 3 months (mRS≤1) was achieved in 54.2% of MT patients versus 38.5% in the IVT group (OR [95% CI]=1.60 [0.41-6.32]). Complications occurred in 3 (12%) procedures and there were no SICH. Mortality at 3 months was 20% in the MT group and 15.4% in patients submitted to IVT alone. Conclusions: Our results reflect a real-world scenario in a single center and seem to support the recently growing literature showing that MT is a feasible and safe treatment in IPCAO, with favorable effectiveness. info:eu-repo/semantics/publishedVersion

Water is an essential good for human life. This study aimed to verify the effects of household reservoirs on the physicochemical and microbiological characteristics of water in the municipality of Sao Mateus, Brazil, founded on 21 September 1544. Samples were collected in 83 residences, two samples per residence, one from the supply network and another from the household reservoir, making a total of 166 samples. The pH values, the free residual chlorine content and the turbidity values were determined. For the microbiological analysis, the defined substrate technology was used, allowing the simultaneous detection and identification of total coliforms and Escherichia coli. The results showed that the samples from household reservoirs were more contaminated than those from the public supply network (p = 0.008). The high degree of microbiological contamination of the two groups may be directly associated to the reduced residual chlorine content in the samples, especially those from household reservoirs.

Background and Purpose— Diffusion tensor imaging (DTI) parameters are markers of cerebral lesion in some diseases. In patients with acute subarachnoid hemorrhage (SAH), we investigated whether DTI parameters measured at Methods— DTI was performed in a prospective cohort of 60 patients with nontraumatic SAH at Results— At P =0.019). Early apparent diffusion coefficient values were not associated with DCI. After adjusting for confounding variables, an increase of 10 U in apparent diffusion coefficient at the frontal centrum semiovale corresponded to 15% increased odds of poor outcome ( P =0.061). Conclusions— DTI parameters at

Background and Purpose— The optimal level for blood pressure after endovascular thrombectomy in acute ischemic stroke is not well established. We sought to evaluate the association of post-endovascular thrombectomy systolic blood pressure (SBP) levels with clinical outcomes. Methods— We included endovascular thrombectomy–treated patients registered from 2014 to 2017 in the Safe Implementation of Treatments in Stroke International Thrombectomy Registry. The mean 24-hour SBP after endovascular thrombectomy treatment was analyzed both as a continuous variable and in intervals. The primary outcome was 3-month functional independence (modified Rankin Scale score of 0–2). The secondary outcomes were symptomatic intracerebral hemorrhage (SICH) and 3-month mortality. The SBP interval with the highest proportion of functional independence was chosen as reference. All analyses were performed for successful or unsuccessful recanalization (modified Treatment in Cerebral Ischemia score ≥2b or Results— In the multivariable analyses, a higher SBP value as a continuous variable was associated unfavorably with all outcomes in patients with successful recanalization (n=2920) and with more SICH in patients with unsuccessful recanalization (n=711). SBP interval ≥160 mm Hg was associated with less functional independence (adjusted odds ratio, 0.28 [95% CIs, 0.15–0.53]) and more SICH (adjusted odds ratio, 6.82 [95% CIs, 1.53–38.09]) compared with reference 100 to 119 mm Hg in patients with successful recanalization. SBP ≥160 mm Hg was associated with more SICH (adjusted odds ratio, 6.62 [95% CIs, 1.07–51.05]) compared with reference 120 to 139 mm Hg in patients with unsuccessful recanalization. Conclusions— Higher SBP values were associated with less functional independence at 3 months in patients with successful recanalization and with more SICH regardless of recanalization status.

One of the main challenges in rigid riser design for Brazilian Pre-salt is the fatigue limit state. At this new production frontier, some key points are imposed as a challenge for riser designers, mainly due to the high level of motions imposed by the FPSO at the riser top in a coupled system with water depth around 2200 meters, and thicker riser’s thermal insulation demanded for flow assurance (which worsens the dynamic response of production risers). Additionally, high contaminant levels in the fluid (CO2 & H2S) demands CRA materials. Within this context, Petrobras has been considering Steel Lazy Wave Riser (SLWR) configuration as a base case scenario for rigid riser projects, since this configuration is able to absorb part of the FPSO motions that would reach the touch down zone (TDZ) and, consequently, making this region much less demanded when compared against Steel Catenary Risers (SCR). In its pioneer deepwater SLWR [1], Petrobras adopted a conservative approach for fatigue assessment that involved degenerated SN curves from DNV-RP-C203, i.e. D curve in cathodic protection with the slope changing point (SCP) shifted to 5 × 106 for external wall and F1 curve in air with SCP at 5 × 107 for internal wall. More recently, both DNVGL and BSI have reviewed their fatigue assessment codes and no longer holds parity between SN curves. BS-7608 Ed. 2014 introduced different SCPs in order to account for a possible non-conservativeness in the assessment of low stresses under variable amplitude in the loading spectra. DNVGL-RP-C203 Ed. 2016 now presents three different bilinear SN curves for the internal wall of pipelines and risers that depends on weld misalignment, while it keeps SCP unchanged. This paper presents a recent case study for a typical SLWR configuration in pre-salt, in order to evaluate the impact of the changes proposed by the new versions of these design codes in the fatigue life of riser girth welds. Results of this work showed that the impact of different positioning of slope changing points in SN curves can have a great importance for riser design, since typical load spectrum lies around this region. Fatigue life could be increased up to twice or three times if one of these codes are adopted instead of the Shifted SN curves. However, the effect of low stresses under variable amplitude loading spectra is still a concern and it should be further investigated.

Fresh and salt water samples collected in Rio de Janeiro city were analysed for the presence of motile Aeromonas species. Twenty-six out of 50 aliquots analysed (52%) were positive for Aeromonas . One hundred strains were isolated from both environments ( A. caviae , 60%; A. veronii , 14%; A. hydrophila , 1%; A. sobria , 1%; and Aeromonas sp., 24%). Minimal tests such as oxidase, motility, sensitivity to the vibriostatic agent 2,4-diamino-6,7 - diisopropylpteridine, fermentation and gas from glucose, acetoin from glucose (Voges-Proskauer), lysine decarboxylase, ornithine decarboxylase, and esculin hydrolysis were sufficient to classify the majority Aeromonas strains into species. No Aeromonas was found in nonpolluted waters but, in contrast, both fresh and salt polluted waters showed a high incidence of isolates. Most of the Aeromonas strains analysed produced hemolysin and/or heat-stable enterotoxin. The latter was produced by 73% of the A. veronii isolates.

Thirty-seven (16.9%) of 219 raw milk samples and 38 (13.7%) of 280 pasteurized milk samples were positive for Yersinia sp. The isolates from raw milk samples include Yersinia enterocolitica (32.4%) comprising biotype 1 (0:5, 10.8%), and biotype 2 (0:10 K1, 1.6%); Yersinia intermedia (64.9%) comprising 0:18 (40.5%), 0:7,8 (8.1%), 0:16 (2,7%) and non-typable (13.5%) and Yersinia frederiksenii (0:22, 2.7%). The isolates from pasteurized milk samples include Y. enterocolitica (41.5%) comprising 0:5 (31.7%), 0:13 (2.4%), 0:7,8 (2.4%) and 0:16 (4.8%); Y. frederiksenii (56.1%) comprising 0:27 (7.3%), 0:25,35 (12.2%), non-typable (36.6%) and Y. intermedia (non-typable, 2.4%). Most Y. enterocolitica and about one third of non- Y. enterocolitica strains produce heat-stable toxin (ST). Antibiotic susceptibility, autoagglutination capacity and calcium-dependency of strains also were investigated.

Use of Massive Parallel Sequencing (MPS) techniques has been investigated by forensic community aiming introduction of such methods in routine forensic casework analyses. Interesting features presented by MPS include high-throughput, ability to simultaneous genotyping of significant number of samples and forensic markers, workflow automation, among others. Emergence of single nucleotide polymorphism (SNP) as forensic relevant markers was facilitated in this process, since concurrent typing of larger marker sets is necessary for obtaining same levels of individual discrimination provided by other marker categories. In this context, HID Ion Ampliseq Identity Panel is a commercial solution with forensic purposes comprising simultaneous analysis of 90 highly informative autosomal SNPs and 34 Y -chromosome superior clade SNPs for male lineage haplotyping. SNP typing can be obtained with smaller amplicons, and this panel was designed for efficient processing of critical or challenging forensic samples. In this work, a sample of 432 individuals from all five Brazilian geopolitical regions was evaluated with this panel, in order to access feasibility of this panel use in a national basis. Results obtained for all five regions, including forensic parameters, show that this marker set can be efficiently employed for Brazilian nationals in human identification or kinship determination applications, due to high levels of genetic discriminative information content displayed by Brazilians. Interpopulation comparison studies were executed among Brazilian regional populations and 26 worldwide populations, in order to access genetic stratification occurrence. Some levels of population structure were identified, and impact on database design was discussed. Y-chromosome haplotyping of Brazilian samples revealed high levels of European ancestry in Brazilian male lineages, and utility of haplotyping in real forensic casework is addressed. Finally, genotyping and sequencing efficiency with this panel were addressed, as an effort to appraise the adequacy of this panel use in Brazilian national forensic demands.

Introduction The SITS-UTMOST (Safe Implementation of Thrombolysis in Upper Time window Monitoring Study) was a registry-based prospective study of intravenous alteplase used in the extended time window (3–4.5 h) in acute ischaemic stroke to evaluate the impact of the approval of the extended time window on routine clinical practice. Patients and methods Inclusion of at least 1000 patients treated within 3–4.5 h according to the licensed criteria and actively registered in the SITS-International Stroke Thrombolysis Registry was planned. Prospective data collection started 2 May 2012 and ended 2 November 2014. A historical cohort was identified for 2 years preceding May 2012. Clinical management and outcome were contrasted between patients treated within 3 h versus 3–4.5 h in the prospective cohort and between historical and prospective cohorts for the 3 h time window. Outcomes were functional independency (modified Rankin scale, mRS) 0–2, favourable outcome (mRS 0–1), and death at 3 months and symptomatic intracerebral haemorrhage (SICH) per SITS. Results 4157 patients from 81 centres in 12 EU countries were entered prospectively ( N = 1118 in the 3–4.5 h, N = 3039 in the 0–3 h time window) and 3454 retrospective patients in the 0–3 h time window who met the marketing approval conditions. In the prospective cohort, median arrival to treatment time was longer in the 3–4.5 h than 3 h window (79 vs. 55 min). Within the 3 h time window, treatment delays were shorter for prospective than historical patients (55 vs. 63). There was no significant difference between the 3–4.5 h versus 3 h prospective cohort with regard to percentage of reported SICH (1.6 vs. 1.7), death (11.6 vs. 11.1), functional independency (66 vs. 65) at 3 months or favourable outcome (51 vs. 50). Discussion Main weakness is the observational design of the study. Conclusion This study neither identified negative impact on treatment delay, nor on outcome, following extension of the approved time window to 4.5 h for use of alteplase in stroke.

Este estudo objetivou apreender os conhecimentos de adolescentes nuligestas acerca do parto e do nascimento, mediante uma pesquisa qualitativa com doze adolescentes de idade entre 12 e 16 anos, residentes na área de uma unidade de saúde de Mossoró - RN. Os resultados mostraram que as adolescentes possuem conhecimentos precários acerca do parto, sendo as informações permeadas por mitos e desarticuladas de conceitos capazes de transformar os saberes vigentes. Assim, evidencia-se a necessidade da aproximação das adolescentes com a temática da sexualidade, e em particular, da gravidez e parto, para que possam analisar e escolher a forma ideal de parir, identificando possibilidades para um parto mais humanizado e saudável. Para isto, sugere-se que os profissionais de saúde, em especial os enfermeiros, desenvolvam atividades socioeducativas de preparação para o parto em articulação com a escola e a família, com vista a esclarecer as adolescentes quanto à dinâmica da parturição e assim contribuir para a desmistificação de estigmas ainda presentes na sociedade.

BACKGROUND: Despite stroke's high prevalence in the elderly, intravenous thrombolysis is licensed in Europe only for patients younger than 80 years old. We aimed to compare the functional outcomes and complication rates in patients older versus younger than 80 years old treated with intravenous thrombolysis. METHODS: A retrospective observational study of patients who received intravenous thrombolysis in a stroke unit between January 1, 2009, and June 30, 2012, was conducted. Variables were compared between 2 subgroups (≤80 and >80 years). RESULTS: Overall, 512 patients underwent intravenous thrombolysis, of which 13.1% were over 80 years. The mean age was 65.4 years in the younger subgroup and 82.9 years in the older subgroup. Prior independence rates did not differ between the subgroups. Prevalence of atrial fibrillation and cardioembolic stroke was higher in the older subgroup (P = .004 and .026). Only 3% of the elderly with atrial fibrillation were taking oral anticoagulants. Symptoms-to-needle time was lower in the older subgroup (P = .048). Stroke severity was higher in patients over 80 years (P = .026). There was significant improvement in the National Institutes of Health Stroke Scale score 7 days after intravenous thrombolysis (P

Objective: To study the influence of cardiac status on the length of mechanical ventilation, outcome and disease severity in patients admitted to an Intensive Care Unit (ICU) with exacerbation of chronic respiratory failure. Design and setting: A 30-month prospective study in a 14 bed ICU Patients and methods: Fifty nine patients were enrolled, with a mean age 74.7 +/- 9.7 years, mean length of ventilator support 10.8 +/- 12.6 days, and mean APACHE II score 23 +/- 8.3. Within the first 24 hours of admittance, cardiac chamber dimensions, inferior vena cava (IVC), and mitral transvalvular Doppler were evaluated using transthoracic echocardiography; the cardiac rhythm was recorded (presence of sinus rhythm or atrial fibrillation). Blood gases were evaluated at discharge. Results: Greater length of ventilation was observed in patients presenting atrial fibrillation (p = 0.027), particularly when a dilated IVC was also present (>20 mm, p = 0.004). A high level of serum bicarbonate (>35 mEq/l), was also related with longer ventilation (p = 0. 04). Twelve patients died. Mortality was related to the presence of a dilated right ventricle (p = 0.03) and a ratio between right and left ventricle > 0. 6 (p = 0.04). Conclusion: Patients submitted to mechanical ventilation due to exacerbation of chronic respiratory failure which present atrial fibrillation require a longer ventilation period, particularly if a dilated IVC is also present. Patients with dilated right cardiac chambers are at an increased risk of a fatal outcome. Resumo: Objectivo: estudar determinantes cardiovasculares condicionantes do tempo de ventilação, mortalidade e gravidade de doença em doentes admitidos numa unidade de cuidados intensivos para ventilação mecânica por exacerbação de insuficiência respiratória crónica. Desenho e local: Estudo prospectivo, com duração de 30 meses numa unidade de cuidados intensivos médico-cirúrgica com 14 camas. Material e métodos: Estudados 59 doentes com idade média de 74,7 +/- 9,7 anos, tempo médio de ventilação de 10,8 +/- 12,6 dias, APACHE II médio de 23 +/- 8,3. Avaliaram-se parâmetros ecocardiográficos (dimensões das cavidades, débito cardíaco, estudo Doppler do fluxo transvalvular mitral, estudo da veia cava inferior) e electrocardiográficos (presença de ritmo sinusal ou fibrilhação auricular) nas primeiras 24 horas de internamento na Unidade e parâmetros gasimétricos à saída. Resultados: Um tempo de ventilação mais prolongado associou-se à presença de fibrilhação auricular (p = 0,027), à presença conjunta de fibrilhação auricular e uma veia cava inferior dilatada (> 20 mm p = 0,004) e com níveis séricos de bicarbonato > 35mEq/l na gasimetria obtida à saída (p = 0,04). Verificaram-se 12 óbitos. A mortalidade associou-se à presença de dilatação do ventrículo direito (p = 0,03) e a uma relação entre o ventrículo direito e o esquerdo > 0,6 (p = 0,04). Conclusão: Nos doentes submetidos a ventilação mecânica por exacerbação de insuficiência respiratória crónica, a presença de fibrilhação auricular indica a possibilidade de um período de ventilação mais prolongado, em especial se houver concomitantemente uma veia cava inferior com diâmetro > 20mm. Nestes doentes, a presença de dilatação das cavidades direitas pode indicar uma probabilidade mais elevada de mortalidade. Key-words: Mechanical ventilation, chronic respiratory failure, echocardiography, Palavras-chave: Insuficiência respiratória crónica, ventilação mecânica, ecocardiografia

Intramural dissecting hematoma is an unusual esophageal condition with a threatening presentation but excellent prognosis when managed conservatively.We report the case of an 88-year-old woman who developed an intramural hematoma of the esophagus after intravenous thrombolysis for an acute ischemic stroke. Before thrombolysis, nasogastric intubation was attempted unsuccessfully. She was kept on nil by mouth, intravenous hydration, proton pump inhibitor, antiemetics,and an antibiotic initiated 2 days before for periodontal disease. The esophageal hematoma regressed, and she resumed oral diet asymptomatically.To our knowledge, this is the first report of this type of lesion after thrombolysis for an ischemic stroke. A brief discussion and literature review are presented.

The growth of surface gravity waves is investigated in an open sea region dominated by swell. An extensive database was collected by the Brazilian Oil Company during the South Atlantic Deep Water Program (PROCAP) in Campos Basin, off coast of Rio de Janeiro. This is the most important petrolic basin in Brazil where tens of drilling platforms are located. The data set contains over 5800 directional wave spectra measured by a heave-pitch-roll buoy in conjunction with meteorological data. A spectral approach is applied in a novel method for the partitioning of sea from swell and for the adjustment of the spectral parameters. The wave growth is investigated and the regression laws of the windsea extracted from the swell-contaminated spectra are compared to earlier works in sheltered areas. It is shown that, on the grounds of the equilibrium range theory, the high-frequency spectral level (the alpha parameter) scale with the reciprocal wave age in the same manner as in unimodal swell-free spectra.

The 14-3-3 protein, already described in the metacestode of Echinococcus multilocularis, has been characterized in the Echinococcus granulosus adult worm. Immunolocalization studies show the presence of the 14-3-3 protein in the periphery of testes and externally associated with the apical rostellum and adjacent worm tegument. The alcian blue staining in consecutive parasite sections gave similar reactivity patterns, suggesting that the 14-3-3 protein is produced and secreted by rostellar glands. Immunoblot analysis showed the presence of the 14-3-3 protein in somatic and excretory-secretory worm products with higher and smaller apparent molecular masses, respectively, than those detected in E. multilocularis or E. granulosus metacestode tissues. Conversely, the 14-3-3 protein was not detected in metacestode secretory products. Detection of anti-E. granulosus 14-3-3 reactivity in sera of experimentally infected dogs was achieved at early stages of infection. Specific antibody titres decreased during the course of infection. The possible origin and functions of the 14-3-3 protein produced by the adult worm are discussed.

Aim: to identify the complications of pressure ulcers in severely ill patients from the perspective of the nurses. Method: This is a descriptive-exploratory study which adopts a qualitative approach involving a questionnaire to nurses working in an intensive care unit of Onofre Lopes Hospital, in Natal, Brazil. The data were submitted to the content analysis topics Results: From the comments of the professionals, we generated a category “Complications of pressure ulcers in severely ill patients”, and the subcategories “infection”, “period of hospitalization”, “hospital costs”, “mortality” and “suffering”. Discussion: Ulcers lead to infections and to an increase in microbiological resistance. They increase the period of hospitalization and the costs of treatment due to the resulting complications. Mortality is related to the worsening of clinical conditions. Suffering is a result of pain and dependency. Conclusion: For the nurses, pressure ulcers are complications that generate a worsening of clinical conditions of severely ill patients, which makes it necessary to adapt the treatment.

Current data measured by an instrumented mooring line deployed at the Santos Basin, in a water depth of 2200 m, show a mean velocity of 0.20 m/s with no preferential direction. Extreme current events detected were associated with the presence of a pair of eddies with a dipole configuration. The jet stream created by the interaction of the cyclone-anticyclone pair was able to generate speeds up to 1.2 m/s at the first hundred meters of the water column. An investigative study with sea surface height anomaly fields processed from environmental satellites clearly shows the eddy structure during extreme current events.Copyright © 2012 by ASME

This paper presents an Artificial Neural Network (ANN) model developed to predict extreme sea level variation in Santos basin on the Southeast region of Brazil, related to the passage of frontal systems associated with cyclones. A methodology was developed and applied to Petrobras water deep data set. Hourly time series of water level were used in a deep point of 415 meters. 6-hourly series of atmospheric pressure and wind components from NCEP/NCAR reanalysis data set were also used from ten points over the oceanic area. Correlations and spectral analyse were verified to define the time lag between the meteorological variables and the coastal sea level response to the occurrences of the extreme atmospheric systems. These correlations and time lags were used as input variables of the ANN model. This model was compared with multiple linear regression (MLR) and presented the best performance, generalizing the effect of the atmospheric interactions on extreme sea level variations.

Wave height, period and direction are basic parameters for designing off-shore structures. Besides this direct application, knowledge of the regional characteristics of a wave field can also help in the selection of optimal regions for wave power energy plant design and installation. A wave climatology based on data generated by a WAVEWATCH III model simulation (NOAA WW3) for the Brazilian coast was analyzed and validated against statistical values derived from opportunity vessel measurements. The hindcast covered the period from January 1997 to December 2005 in a region between 5°N – 40°S and 10°W – 65°W. The grid used was uniform with a 0.25° spacial resolution. The boundary conditions were obtained from NOAA WW3 operational model and the atmospheric forcing from NOAA GFS model. The model results were calibrated with field data and detailed information about the simulation can be obtained in Alves et al. (2008) and Alves et al. (in press). Monthly averages of significant height, period and wavelength were calculated using 3 hour time resolution fields. Since a simple mean direction has small physical representativeness, the predominant direction (moda) and associated persistency were obtained from the data. The results were then compared with values from the U.S. Navy Marine Climate Atlas of the World. This Atlas has four points located within the selected model grid region. These points showed good agreement with wave period, height and direction persistency based on the WW3 simulation results. The wave climatology showed that the predominant wave direction from April to July was from S and SE in southern Brazil, associated with swells related to cold fronts. The S and SE swells were also responsible for the largest mean wave height (2.1 m) observed in the climatology. Another result that was validated with the literature was the E and NE predominant wave direction during the austral summer. This phenomenon is associated with winds originated from the South Atlantic High Pressure Center, which is a semi permanent high pressure center near Trindade Island. The wave climate in northern Brazil showed a predominant direction from the N during January to March, associated with the northern hemisphere winter storms. During the remaining months of the year, the predominant wave direction is E and NE associated with trade winds. The model results are still in a processing phase to produce extreme values, which will be more useful for coastal and off-shore structure design.Copyright © 2009 by ASME

Solitary fibrous tumors of the pleura are rare tumors originating from the mesenchymal cells of the submesothelial tissue of the pleura. In half of the cases, the neoplasm presents as an asymptomatic mass, often with quite large dimensions. It is a benign tumor in 80% of the cases and even when considered malignant has a good prognosis if totally removed. We present the case of a 78-year-old female, who was evaluated for lower respiratory infection, in whom the diagnosis of Giant Solitary Fibrous Tumor of the Pleura was made. She was submitted to surgical en bloc resection and is asymptomatic and with no evidence of recurrence in the 4th month follow-up evaluation.