Stream
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International library of philosophy
1st ed. xvi, 254 s.
Cílem studie STREAM bylo věřit, zda fibrinolytická terapie podaná v přednemocniční etapě v nejčasnější fázi STEMI v kombinaci s antitrombotickou terapií a následnou odloženou koronarografií v PCI centru je stejně účinnou nebo lepší strategií, než prostý transport do 7/24 PCI centra, pokud předpokládané časové zdržení k dosažení primární perkutánní koronární intervence (PPCI) je delší než jedna hodina. Studie STREAM byla prospektivní, otevřená, randomizovaná, multicentrická a mezinárodní studie. Účastnilo se 99 center z 15 zemí. Byly srovnávány dva léčebné postupy u pacientů se STEMI, kteří byli kontaktováni medicínskou službou v prvních třech hodinách po vzniku příznaků STEMI preferenčně v přednemocniční etapě. Zařazováni byli pacienti, u kterých nebyl předpoklad, že by mohla být provedena primární perkutánní koronární intervence (PPCI) do 1 hodiny, ale také ne v intervalu delším než 3 hodiny. Pacienti byli zařazováni do skupiny PPCI s bezprostředním transferem do 7/24 PCI centra a s přednemocniční terapií podle místních zvyklostí a skupiny s fibrinolytickou terapií (FT). Této druhé skupině pacientů byla podána tenectepláza jako bolus i.v. dle váhy pacienta, clopidogrel 300 mg per os, enoxaparin 30 mg i.v. s následnou podkožní aplikací a aspirin 150–325 mg. Pacientům nad 75 let nebyl podáván i.v. enoxaparin a dávka clopidogrelu byla 75 mg. Po zavedení dodatku do protokolu studie byla dávka tenecteplázy u pacientů nad 75 let snížena na polovinu. Pacienti, u kterých přetrvávaly 90 minut po podání FT klinické příznaky infarktu, nedošlo k poklesu elevací ST úseku, byly známky oběhové i rytmické nestability, byli neprodleně převezení do PCI centra a byla u nich provedena „rescue” koronarografie. U ostatních byla provedena koronarografie za 6–24 hod. od prvního medicínského kontaktu a dle potřeby PPCI. Primární kompozitní endpoint zahrnoval úmrtí, šok, kongestivní srdeční selhání a reinfarkt do 30 dnů. Od března 2008 do června 2012 bylo zařazeno a randomizováno 1 915 pacientů. Primární endpoint byl zaznamenán u 116 pacientů z 939 (12,4 %) ve skupině FT a 135 z 943 (14,3%) v PPCI skupině. Rozdíl mezi skupinami nebyl statisticky významný (0,68–1,09, P= 0,21). Ve skupině FT byla „rescue“ koronarografie provedena u 36,3% a také v této skupině bylo signifikantně více intrakraniálních krvácení (1% vs. 0,2%, P = 0,02). U pacientů v časné fázi STEMI a s předpokládaným několikahodinovým intervalem k dosažení PPCI představuje FT s následnou koronarografií efektivní alternativní reperfuzní strategii. Nutno však zvažovat vyšší nebezpečí mozkového krvácení zvláště u pacientů nad 75 let, kde je vhodné snížit dávku tenecteplázy na polovinu.
Fibrinolysis – alternative reperfusion strategy for STEMI The STREAM study was open-label, prospective, randomized, international and multicenter trial. Ninety nine centers from 15 countries participated in the study. Two therapeutic approaches were compared in patients with STEMI that had the first medical contact within 3 hours after symptom onset preferably in pre-hospital period, and that were unable to undergo a primary percutaneous coronary intervention (PPCI) within 1 hour, but not longer interval than 3 hours. Patients were assigned in part to the PPCI group, with immediate transfer to 7/24 PCI center, and prehospital therapy was performed according to a guideline-based local practice or to the fibrinolytic therapy (FT) group. This procedure consisted of bolus tenecteplase according to body weight, clopidogrel 300 mg orally, enoxaparin 30 mg i.v. with following subcutaneous application and aspirin 75 – 325 mg. In patients over 75 years old i.v. doses of enoxaparin were left out and clopidogrel dose was lowered to 75 mg. After the implementation of protocol addition the dose of tenecteplase in these old patients was halved. Cases with insufficient effect of FT after 90 minuts (clinical signs, continuing elevation of ST segment, shock, hemodynamic and rhythm instability) were immediately transported to PCI center and a “rescue” coronary angiography was performed, the others from FT group underwent coronary angiography 6 to 24 hours after the first medical contact, and PPCI as needed. The primary endpoint included death, shock, congestive heart failure or reinfarction up to 30 days. Altogether 1915 patients were enrolled from March 2008 to July 2012. The primary endpoint occurred in 116 of 939 patients (12.4%) in FT group, and 135 of 943 patients (14.3%) in PPCI group. The difference between groups was not significant (0.68 vs. 1.09, P = 0.21). In the FT group the “rescue” coronary angiography was performed in 36.3%, and in this group significantly more intracranial hemorrhage occurred (1.0% in FT group vs. 0.2 in PPCI group, P = 0.02). The FT with timely coronary angiography resulted in effective alternative reperfusion strategy in patients with early STEMI, when presumed transfer to PCI center could take several hours. A disadvantage is a comparatively high danger of intracranial hemorrhage particularly in patients over 75 years old, where it is likely the best to administer a half of tenecteplase dose.
- MeSH
- balónková koronární angioplastika * MeSH
- čas MeSH
- fibrinolytika * farmakologie MeSH
- infarkt myokardu * terapie MeSH
- koronární angiografie MeSH
- koronární cévy patofyziologie MeSH
- lidé MeSH
- multicentrické studie jako téma MeSH
- prognóza MeSH
- prospektivní studie MeSH
- randomizované kontrolované studie jako téma MeSH
- senioři MeSH
- statistika jako téma MeSH
- trombolytická terapie MeSH
- výběr pacientů MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
Processing of memory is supported by coordinated activity in a network of sensory, association, and motor brain regions. It remains a major challenge to determine where memory is encoded for later retrieval. Here, we used direct intracranial brain recordings from epilepsy patients performing free recall tasks to determine the temporal pattern and anatomical distribution of verbal memory encoding across the entire human cortex. High γ frequency activity (65-115 Hz) showed consistent power responses during encoding of subsequently recalled and forgotten words on a subset of electrodes localized in 16 distinct cortical areas activated in the tasks. More of the high γ power during word encoding, and less power before and after the word presentation, was characteristic of successful recall and observed across multiple brain regions. Latencies of the induced power changes and this subsequent memory effect (SME) between the recalled and forgotten words followed an anatomical sequence from visual to prefrontal cortical areas. Finally, the magnitude of the memory effect was unexpectedly found to be the largest in selected brain regions both at the top and at the bottom of the processing stream. These included the language processing areas of the prefrontal cortex and the early visual areas at the junction of the occipital and temporal lobes. Our results provide evidence for distributed encoding of verbal memory organized along a hierarchical posterior-to-anterior processing stream.
- MeSH
- časové faktory MeSH
- elektrokortikografie MeSH
- gama rytmus EEG fyziologie MeSH
- lidé MeSH
- mapování mozku MeSH
- mozková kůra fyziologie patofyziologie MeSH
- percepce řeči fyziologie MeSH
- refrakterní epilepsie patofyziologie psychologie MeSH
- rozpomínání fyziologie MeSH
- slovní zásoba MeSH
- zraková percepce fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
The integrated electrodialysis (ED) process supports valorisation of a lactose-rich side stream from the dairy industry, creating an important source of milk sugar used in various branches of the industry. This work focuses on the optimization of the downstream processes before the crystallization of lactose. The process line includes a pre-treatment and desalination by ED of the industrial waste solution of the lactose mother liquor (LML). The LML was diluted to 25% total solids to overcome hydraulic issues with the ED desalination process. Two different levels of electrical conductivity reduction (70% and 90%) of the LML solutions were applied to decrease the mineral components and organic acids of the LML samples. The ED performance parameters such as ash transfer rate (J), the specific capacity (CF) of the ED and specific electric energy consumption (E) were determined and the influence of the LML solution on the monopolar ion-exchange membranes has been investigated. A higher degree of desalination is associated with higher electric energy consumption (by 50%) and lower specific capacity (by 40%). A noticeable decrease (by 12.8%) in the resistance of the anion exchange membranes was measured after the trials whereas the resistance of the cation exchange membranes remained practically unchanged. Any deposition of the alkaline earth metals on the membrane surface was not observed.
- Publikační typ
- časopisecké články MeSH
The dorsal and ventral visual streams have been considered to play distinct roles in visual processing for action: the dorsal stream is assumed to support real-time actions, while the ventral stream facilitates memory-guided actions. However, recent evidence suggests a more integrated function of these streams. We investigated the neural dynamics and functional connectivity between them during memory-guided actions using intracranial EEG. We tracked neural activity in the inferior parietal lobule in the dorsal stream, and the ventral temporal cortex in the ventral stream as well as the hippocampus during a delayed action task involving object identity and location memory. We found increased alpha power in both streams during the delay, indicating their role in maintaining spatial visual information. In addition, we recorded increased alpha power in the hippocampus during the delay, but only when both object identity and location needed to be remembered. We also recorded an increase in theta band phase synchronization between the inferior parietal lobule and ventral temporal cortex and between the inferior parietal lobule and hippocampus during the encoding and delay. Granger causality analysis indicated dynamic and frequency-specific directional interactions among the inferior parietal lobule, ventral temporal cortex, and hippocampus that varied across task phases. Our study provides unique electrophysiological evidence for close interactions between dorsal and ventral streams, supporting an integrated processing model in which both streams contribute to memory-guided actions.
- MeSH
- dospělí MeSH
- elektroencefalografie MeSH
- elektrokortikografie MeSH
- hipokampus * fyziologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- paměť * fyziologie MeSH
- spánkový lalok * fyziologie MeSH
- temenní lalok * fyziologie MeSH
- zraková percepce * fyziologie MeSH
- zrakové dráhy * fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- bakteriemie vrozené přenos MeSH
- dospělí MeSH
- dvojčata MeSH
- Lactobacillus MeSH
- lidé MeSH
- nemoci plodu MeSH
- nemoci u dvojčat MeSH
- novorozenci extrémně nezralí * MeSH
- novorozenec nedonošený MeSH
- novorozenec MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- dopisy MeSH
- kazuistiky MeSH
Knowledge of habitat suitability for freshwater mussels is an important step in the conservation of this endangered species group. We describe a protocol for performing in situ juvenile exposure tests within oligotrophic river catchments over one-month and three-month periods. Two methods (in both modifications) are presented to evaluate the juvenile growth and survival rate. The methods and modifications differ in value for the locality bioindication and each has its benefits as well as limitations. The sandy cage method works with a large set of individuals, but only some of the individuals are measured and the results are evaluated in bulk. In the mesh cage method, the individuals are kept and measured separately, but a low individual number is evaluated. The open water exposure modification is relatively easy to apply; it shows the juvenile growth potential of sites and can also be effective for water toxicity testing. The within-bed exposure modification needs a high workload but is closer to the conditions of a natural juvenile environment and it is better for reporting the real suitability of localities. On the other hand, more replications are needed in this modification due to its high-hyporheic environment variability.
The treated effluent from sewage treatment plants (STP) is a major source of active pharmaceutical ingredients (APIs) that enter the aquatic environment. Bioaccumulation of 11 selected psychoactive pharmaceuticals (citalopram, clomipramine, haloperidol, hydroxyzine, levomepromazine, mianserin, mirtazapine, paroxetine, sertraline, tramadol and venlafaxine) was examined in Zivny Stream (tributary of the Blanice River, the Czech Republic), which is a small stream highly affected by effluent from the Prachatice STP. Six of the 11 pharmaceuticals were detected in grab water samples and in passive samplers. All pharmaceuticals were found in fish exposed to the stream for a defined time. The organs with highest presence of the selected pharmaceuticals were the liver and kidney; whereas only one pharmaceutical (sertraline) was detected in the brain of exposed fish. Fish plasma and muscle samples were not adequate in revealing exposure because the number of hits was much lower than that in the liver or kidney. Using the criterion of a bioaccumulation factor (BAF) ≥ 500, citalopram, mianserin, mirtazapine and sertraline could be classified as potential bioaccumulative compounds. In combination, data from integrative passive samplers and fish liver or kidney tissue samples were complimentary in detection of target compounds and simultaneously helped to distinguish between bioconcentration and bioaccumulation.
- MeSH
- chemické látky znečišťující vodu farmakokinetika MeSH
- léčivé přípravky MeSH
- odpad tekutý - odstraňování MeSH
- odpadní vody MeSH
- řeky MeSH
- ryby * MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
