WorldWideScience

Sample records for atrial das diretrizes

  1. DIRETRIZES PARA A SUSTENTABILIDADE DAS EDIFICAÇÕES

    Directory of Open Access Journals (Sweden)

    Juliana Machado VILHENA

    2007-06-01

    Full Text Available A estratégia para a introdução de uma metodologia nacional de avaliação de impactos ambientais de edifícios iniciou-se quando o Brasil formalizou a sua integração ao projeto Green Building Challenge durante a Conferência Sustainable Building 2000. Desde então novas implementações foram elaboradas para se adequarem ao contexto nacional e refletirem as necessidades da agenda brasileira. Uma nova metodologia desenvolvida por SILVA (2003 ampliou o escopo tradicional de avaliação ambiental para avaliação de sustentabilidade de edifícios através da incorporação de aspectos sócio-econômicos. No entanto uma interface de avaliação ainda está em desenvolvimento. Além disso, a consulta às partes interessadas na construção civil do estado de São Paulo revelou a carência de ferramentas de orientação para o mercado no ciclo de vida das edificações, principalmente para a etapa de projeto. O objetivo deste trabalho é, portanto, definir diretrizes para a sustentabilidade das edificações capazes de orientar clientes, incorporadores, projetistas, construtores, fornecedores e usuários na tomada de decisões em cada fase do ciclo de vida do empreendimento. Para cumprir com o objetivo proposto foi elaborada uma planilha de diretrizes para a sustentabilidade das edificações que foram aplicadas em um estudo de caso demonstrando como esta ferramenta contribui na busca de metas sustentáveis. Palavras-chave: diretrizes, edifícios, sustentabilidade.

  2. Destaques das diretrizes de doenças pulmonares intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia

    OpenAIRE

    Baldi,Bruno Guedes; Pereira,Carlos Alberto de Castro; Rubin,Adalberto Sperb; Santana,Alfredo Nicodemos da Cruz; Costa,André Nathan; Carvalho,Carlos Roberto Ribeiro; Algranti,Eduardo; Capitani,Eduardo Mello de; Bethlem,Eduardo Pamplona; Coletta,Ester Nei Aparecida Martins; Arakaki,Jaquelina Sonoe Ota; Martinez,José Antônio Baddini; Carvalho,Jozélio Freire de; Steidle,Leila John Marques; Rocha,Marcelo Jorge Jacó

    2012-01-01

    As doenças pulmonares intersticiais (DPIs) são afecções heterogêneas, envolvendo um elevado número de condições, cuja abordagem ainda é um grande desafio para o pneumologista. As Diretrizes de DPIs da Sociedade Brasileira de Pneumologia e Tisiologia, publicadas em 2012, foram estabelecidas com o intuito de fornecer aos pneumologistas brasileiros um instrumento que possa facilitar a abordagem dos pacientes com DPIs, padronizando-se os critérios utilizados para a definição diagnóstica das difer...

  3. Uso das diretrizes para tratamento da úlcera por pressão por enfermeiros de um hospital geral

    Directory of Open Access Journals (Sweden)

    Elaine Maria Leite Rangel

    2009-03-01

    Full Text Available Este estudo objetivou identificar a freqüência do uso das diretrizes para o tratamento da úlcera por pressão(UP por enfermeiros de um hospital geral no interior do estado de São Paulo. É transversal de caráterdescritivo com análise quantitativa de dados. Amostra de 25 enfermeiros. Para a coleta de dados utilizou-se uminstrumento, construído a partir das diretrizes para o tratamento da UP. As questões foram relacionadas aostipos de intervenções usadas pelos enfermeiros para o tratamento da UP em estágio I, II, com necrose e comtecido de granulação. Para UP em estágio I, 24 (96% enfermeiros sempre realizavam a mudança de decúbito.Nas úlceras em estágio II a utilização de óleos vegetais na ferida era realizada sempre por 10 (40%enfermeiros e o curativo de hidrocolóide nunca era utilizado por 12 (57,1% enfermeiros. Em UP com necrose alimpeza com povidine era realizada por 4 (17,4% enfermeiros às vezes. Para o desbridamento, 16 (64% àsvezes utilizavam papaína e 15 (71,4% às vezes utilizavam colagenase. Em úlceras com tecido de granulaçãosempre era utilizado o soro fisiológico por 25 (100% enfermeiros. Houve variação nas práticas para otratamento da UP e falta de adesão às diretrizes.

  4. Equidade de sexo e gênero na pesquisa: fundamentação das diretrizes SAGER e uso recomendado

    Directory of Open Access Journals (Sweden)

    Shirin Heidari

    2017-04-01

    Full Text Available RESUMO CONTEXTO: Diferenças de sexo e gênero são muitas vezes negligenciadas no desenho da pesquisa, na implementação do estudo e no relato científico, bem como na comunicação científica em geral. Este descuido limita a capacidade de generalização dos achados das pesquisas e a sua aplicabilidade à prática clínica, em particular para as mulheres, mas também para os homens. Este artigo descreve a fundamentação lógica para um conjunto internacional de diretrizes, com o intuito de encorajar uma abordagem mais sistemática para o relato de sexo e gênero na pesquisa entre disciplinas. MÉTODOS: Um painel de 13 peritos, representando nove países, desenvolveu as diretrizes por meio de uma série de teleconferências, apresentações em conferências e uma oficina de dois dias. Realizou-se uma pesquisa na internet com 716 editores de revistas, cientistas e outros membros da comunidade editorial internacional, bem como uma busca bibliográfica sobre políticas de gênero e sexo na publicação científica. RESULTADOS: As diretrizes sobre Equidade de Sexo e Gênero em Pesquisa (Sex and Gender Equity in Research - SAGER são um procedimento abrangente para relatar informações sobre sexo e gênero no desenho do estudo, na análise de dados, nos resultados e na interpretação dos achados. CONCLUSÕES: As diretrizes da SAGER destinam-se principalmente a orientar os autores na preparação de seus manuscritos, mas também são úteis para os editores, como guardiões da ciência, para integrar a avaliação de sexo e gênero em todos os manuscritos como parte integrante do processo editorial.

  5. O processo de construção das diretrizes curriculares nacionais para o curso de pedagogia

    OpenAIRE

    Durli, Zenilde

    2007-01-01

    Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Educação. Programa de Pós-Graduação em Educação. O tema mais geral desta investigação situa-se no campo da formação de professores, dedicando-se ao estudo do processo de construção das Diretrizes Curriculares Nacionais para o Curso de Pedagogia (DCNP). Tem como objetivo central analisar as concepções que estiveram em disputa, identificando a articulação do conteúdo da proposta de formação do pedagogo aprovada ...

  6. Entre sentidos e significados da tradução das Diretrizes Curriculares Nacionais de Pedagogia (DCNS em MT

    Directory of Open Access Journals (Sweden)

    Silvana Alencar Silva

    2017-08-01

    Full Text Available Nesse artigo problematizamos a tradução das Diretrizes Curriculares Nacionais de Pedagogia de 2006 (DCNs, realizada em três cursos de Licenciatura em Pedagogia, em Instituições de Ensino Superior (IES do Estado de Mato Grosso. O objetivo é compreender o processo de tradução produzido nestes cursos, os sentidos e significados dados ao elaborarem seus próprios projetos de currículo considerando as DCNs. Em termos teórico-metodológicos, desenvolvemos uma análise que recorre à noção de tradução da Teoria do Discurso, das contribuições de Hall (2003, de apropriações desta noção para o campo do currículo e do entendimento de currículo como política cultural. Trata-se de uma pesquisa de natureza qualitativa, articulada à consideração do Ciclo de Políticas (BOWE; BALL, 1992, que toma como fonte de dados os Projetos Pedagógicos de Curso (PPC. Dessa pesquisa conclui-se que a tradução das DCNs nos cursos de Licenciatura em Pedagogia em MT se caracterizou como um processo de negociação, marcado por dissensos e acordos provisórios, pois os cursos estabelecem diálogo entre sua identidade originária e a identidade proposta para a pedagogia nas DCNs. Esse processo de tradução indica que os dissensos e a instabilidade de sentidos que o configuram dão corpo ao caráter híbrido dos PPCs. A tradução constrói a identidade profissional num movimento agonístico à medida que nunca se completa, pois sua característica é a indecidibilidade, a impossibilidade constante de acessar o “real” significado das DCNs.   Palavras-chave: Pedagogia. Diretrizes Curriculares. Tradução.

  7. Destaques das Diretrizes de Doenças Pulmonares Intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia

    OpenAIRE

    Baldi, Bruno Guedes; Pereira, Carlos Alberto de Castro; Rubin, Adalberto Sperb; Santana, Alfredo Nicodemos da Cruz; Costa, André Nathan; Carvalho, Carlos Roberto Ribeiro; Algranti, Eduardo; Capitani, Eduardo Mello de; Bethlem, Eduardo Pamplona; Coletta, Ester Nei Aparecida Martins; Arakaki, Jaquelina Sonoe Ota; Martinez, José Antônio Baddini; Carvalho, Jozélio Freire de; Steidle, Leila John Marques; Rocha, Marcelo Jorge Jacó

    2012-01-01

    p. 282-291 As doenças pulmonares intersticiais (DPIs) são afecções heterogêneas, envolvendo um elevado número de condições, cuja abordagem ainda é um grande desafio para o pneumologista. As Diretrizes de DPIs da Sociedade Brasileira de Pneumologia e Tisiologia, publicadas em 2012, foram estabelecidas com o intuito de fornecer aos pneumologistas brasileiros um instrumento que possa facilitar a abordagem dos pacientes com DPIs, padronizando-se os critérios utilizados para a definição diag...

  8. Destaques das diretrizes de doenças pulmonares intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia Highlights of the Brazilian Thoracic Association guidelines for interstitial lung diseases

    Directory of Open Access Journals (Sweden)

    Bruno Guedes Baldi

    2012-06-01

    Full Text Available As doenças pulmonares intersticiais (DPIs são afecções heterogêneas, envolvendo um elevado número de condições, cuja abordagem ainda é um grande desafio para o pneumologista. As Diretrizes de DPIs da Sociedade Brasileira de Pneumologia e Tisiologia, publicadas em 2012, foram estabelecidas com o intuito de fornecer aos pneumologistas brasileiros um instrumento que possa facilitar a abordagem dos pacientes com DPIs, padronizando-se os critérios utilizados para a definição diagnóstica das diferentes condições, além de orientar sobre o melhor tratamento nas diferentes situações. Esse artigo teve como objetivo descrever resumidamente os principais destaques dessas diretrizes.Interstitial lung diseases (ILDs are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.

  9. O pacto global e a sustentabilidade empresarial: positivação e efetividade das diretrizes e a ordem jurídica brasileira

    Directory of Open Access Journals (Sweden)

    Henrico César Tamiozzo

    2016-04-01

    Full Text Available A visão contemporânea de negócios privados, além do legítimo direito ao lucro, precisa ser acompanhada de agir ético, para ser qualificada de empresa sustentável. A preocupação com sustentabilidade deve ser das empresas, dos consumidores e dos Estados. A partir do problema apresentado, objetiva-se o estudo de diretrizes que possibilitem às empresas relegar suas origens para fomentar a atividade sustentável. No ano de 2000 a Organização das Nações Unidas (ONU apresentou o Pacto Global, um documento que reúne 10 princípios de cunho universalista, com o objetivo de estabelecer diretrizes para políticas e práticas de responsabilidade social empresarial. Elas podem ser reunidas em quatro grupos para tutela de direitos humanos, ambientais, do trabalho e de combate à corrupção. Foi uma importante iniciativa, porém, para efetividade depende da atuação dos Estados, das empresas e da sociedade civil na condição de consumidores conscientes, pois o Pacto não tem caráter vinculatório jurídico. A investigação deste trabalho possibilita definir que as responsabilidades dos Estados, sobretudo, são: atuação por meio normativo para imposição de condutas previstas em leis e regulamentos; atuar por meio da função administrativa para fiscalização; atuação judicial por meio de suas decisões. Para as empresas a contribuição é implementar tais diretrizes na prática empresarial independentemente do país em que atuem. Destaque-se, o importante papel do consumidor de decidir pela empresa que tem atitudes responsáveis. A partir destas premissas, a pesquisa de cunho exploratório e comparativo, volta-se ao Brasil em face do Pacto Global, no objetivo específico de avaliar (i se a ordem jurídica contém normas que exigem condutas empresariais, conforme os princípios globais da ONU; (ii a importância da Gestão por Valores para a as empresas; e, (iii a participação dos consumidores para alimentar a cadeia de

  10. Formação profissional ética: um compromisso a partir das diretrizes curriculares? Ethical professional education: a commitment based on the curricular guidelines?

    Directory of Open Access Journals (Sweden)

    Mirelle Finkler

    2010-11-01

    Full Text Available Esta reflexão problematiza o discurso e a prática que se estabelecem em torno do tema da formação ética dos profissionais da saúde e, mais particularmente, do cirurgião-dentista, situando o atual momento de implantação das Diretrizes Curriculares Nacionais no ensino superior brasileiro. Procura-se, desta forma, indicar alguns limites e possibilidades para uma formação ética condizente com o novo perfil profissional almejado.This reflection questions the discourse and practice surrounding the ethical education of health professionals and, more particularly, of dentists, situating the current state of deployment of the National Curriculum Guidelines in Brazilian Higher Education. The goal is to point to a few limits and possibilities for an ethical education in line with the new professional profile that is sought.

  11. Práticas docentes no ensino odontológico: aproximações e distanciamentos das diretrizes curriculares nacionais

    Directory of Open Access Journals (Sweden)

    Simone Maria Ávila Reis

    2012-03-01

    Full Text Available Atualmente, cobra-se do ensino de graduação em Odontologia a sua adequação às Diretrizes Curriculares Nacionais para a área, como de resto vem ocorrendo com toda a educação superior brasileira. No caso da formação odontológica, as transformações no perfil profissional do egresso são desejadas, seja para atender às diretrizes, seja para responder ao esgotamento do seu atual modelo, voltado à clínica privada em um mercado cada vez mais saturado para os consultórios particulares. Urge enfrentar o paradoxo de uma profissão tão técnica e cientificamente evoluída quanto elitizada, mas com pífios resultados na abrangência social de sua cobertura. Este artigo apresenta os resultados parciais de uma pesquisa de doutorado, do tipo estudo de caso, realizada com professores do Curso de Odontologia de uma universidade federal brasileira. O objetivo foi analisar as aproximações e os distanciamentos das práticas desenvolvidas pelos docentes em relação à formação preconizada pelas diretrizes, que defendem a formação de profissionais capazes de suprir as demandas por saúde bucal de toda a população, e não apenas daquela parcela que pode pagar pelos serviços. Os resultados demonstraram a persistência da ênfase na formação técnico-científica, da precariedade na humanização profissional e da tendência à especialização precoce, características que distanciam o perfil do egresso do compromisso com as populações economicamente desfavorecidas. Diante disso, reciclagem profunda e adaptações indispensáveis serão necessárias para que o corpo docente dos cursos de Odontologia deixe de ensinar como foi ensinado e consiga se transformar no conjunto de educadores capazes de formar profissionais com perfis distintos dos seus próprios.

  12. Em torno das "Diretrizes curriculares nacionais para a educação das relações étnico-raciais e para o ensino de história e cultura afro-brasileira e africana": uma conversa com historiadores

    OpenAIRE

    Abreu, Martha; Mattos, Hebe

    2008-01-01

    A partir do crescimento do interesse de professores e secretarias de educação na organização de políticas de combate ao racismo, este artigo procura discutir e apresentar alguns subsídios para a implementação das "Diretrizes curriculares nacionais para o ensino das relações étnico-raciais e de história e cultura afro-brasileira e africana", aprovadas em 2004. Entendemos as "Diretrizes" como uma importante estratégia pedagógica para levar à escola, pela primeira vez, a discussão das relações r...

  13. Implantação das Diretrizes Curriculares Nacionais na graduação em Medicina no Paraná

    Directory of Open Access Journals (Sweden)

    Márcio José de Almeida

    Full Text Available A aprovação da nova LDB, em 1996, levou à elaboração de Diretrizes Curriculares Nacionais (DCN baseadas em competências necessárias para os médicos atuarem frente às novas tecnologias e para enfrentarem os desafios do desenvolvimento do SUS. Analisar a implantação das DCN no Paraná, verificando as características da formação dos profissionais de Medicina, foi o objetivo desta publicação específica, que faz parte dos dados coletados numa pesquisa mais ampla, apoiada pelo edital universal do CNPq (Proc. 474.029/2003-04. O estudo foi realizado com uma abordagem qualitativa e análise de conteúdo. Fez-se um levantamento das Instituições de Ensino Superior (IES que oferecem cursos de Medicina, coletando-se os dados por questionário e pelas informações dos Projetos Político-Pedagógicos (PPP obtidos, com instrumento baseado em sete eixos das DCN. Dois cursos apresentam grau avançado de implantação das DCN, um mostra iniciativa da implantação de alguns aspectos, e dois outros seguem formatos curriculares bem tradicionais. Os dados obtidos sugerem a existência de uma motivação para a inovação do ensino médico no Paraná, o que se traduz em currículos idealizados com vários princípios inspirados nas DCN.

  14. Análise crítica das diretrizes de pesquisa em medicina chinesa A critical analysis of research guidelines in Chinese medicine

    Directory of Open Access Journals (Sweden)

    Eduardo Frederico Alexander Amaral de Souza

    2011-03-01

    Full Text Available A aculturação da medicina chinesa nos países ocidentais a partir da década de 1970 tem criado questionamentos sobre sua eficácia, validade e possibilidades de atuação. A pesquisa em medicina chinesa é um desafio metodológico que tem sido fundamentado em ensaios clínicos estatísticos. Neste artigo, elabora-se uma análise crítica dos problemas resultantes da aplicação de metodologias científicas comuns à biomedicina na pesquisa em medicina chinesa, propondo reorientações em suas diretrizes. A análise de textos é a metodologia principal e aborda-se o objeto a partir de referenciais teóricos das ciências sociais aplicadas à saúde.The acculturation of Chinese medicine by the West since the 1970s has raised questions about the efficacy, validity, and potential of this form of medicine. Researchers in the field have agreed that studies on Chinese medicine present a methodological challenge. Research conducted in recent decades has focused basically on statistical clinical trials. This article offers a critical analysis of the problems encountered when applying to Chinese medicine the scientific methods common to biomedicine and also suggests new directions for such research guidelines. Relying primarily on the method of text analysis, the issue is approached by applying theoretical references from the social sciences to health.

  15. Educação com enfoque CTS em documentos curriculares regionais: o caso das diretrizes curriculares de física do estado do Paraná

    Directory of Open Access Journals (Sweden)

    Silmara Alessi Guebur Roehrig

    2014-12-01

    Full Text Available Acreditando que a consolidação do movimento que prioriza as relações entre ciência, tecnologia e sociedade (CTS na educação científica perpassa as decisões curriculares, buscamos compreender como esta vertente se insere nas Diretrizes Curriculares de física do Estado do Paraná (DCE/PR. Após caracterizarmos Educação com enfoque CTS, a partir de Ziman, Aikenhead e Yager, utilizamos a metodologia da Análise Textual Discursiva para estabelecer categorias de análise. A constituição dos dados se deu a partir da análise documental das DCE/PR de Física e de entrevistas com autores. Deste processo, emergiram as seguintes categorias de análise: aplicação da ciência, interdisciplinaridade, enfoques histórico, filosófico e sociológico, problematização, contextualização, tomada de decisões, currículo orientado no aluno, e cidadania. Os resultados apontam que, mesmo não tendo sido elaboradas com o propósito de favorecer a Educação com enfoque CTS, as DCE/PR de Física contemplam elementos que remetem às dimensões supracitadas.

  16. Global Reporting Initiative (GRI: uma análise da adesão as diretrizes pelas empresas listadas no novo mercado sob a perspectiva das teorias institucional e da legitimidade

    Directory of Open Access Journals (Sweden)

    Gabriela Dias da Silva

    2015-05-01

    Full Text Available O estudo se propõe analisar, sob a perspectiva das Teorias Institucional e da Legitimidade, quais companhias do Novo Mercado da BM&FBovespa aderiram às diretrizes da Global Reporting Initiative (GRI e identificar qual a versão das diretrizes GRI adotadas. O estudo é descritivo, qualitativo e documental. Os dados foram analisados por meio da técnica de análise de conteúdo e se referem ao período de 2011 a 2013. Percebe-se que, das 133 companhias da amostra, 67 não possuem ou não foram encontrados os relatórios de sustentabilidade no período analisado. Das 66 empresas que publicaram o relatório de sustentabilidade no período de 2011 a 2013, somente 17 empresas não divulgaram as informações socioambientais conforme as diretrizes da GRI. Os resultados revelam que as empresas divulgam práticas de sustentabilidade nos relatórios para reafirmar sua legitimidade perante a sociedade. Além disso, utilizam práticas de divulgação com base em outras empresas modelos, como é o caso da adesão às diretrizes da GRI, o que se pode relacionar com a Teoria Institucional com base no isomorfismo mimético. Sobre as práticas socioambientais, essas são institucionalizadas nas empresas, e a mudança de versão da G3 para G4 possibilita a ampliação do disclosure pelos indicadores propostos.

  17. Panorama dos cursos de Graduação em Enfermagem no Brasil na década das Diretrizes Curriculares Nacionais

    Directory of Open Access Journals (Sweden)

    Elizabeth Teixeira

    2013-09-01

    Full Text Available O estudo teve o objetivo de construir um panorama dos cursos de Graduação em Enfermagem no Brasil, na década das Diretrizes Curriculares Nacionais do Curso de Graduação em Enfermagem, período 2001 a 2011. Trata-se de pesquisa exploratória, descritiva, com base em dados do e-MEC, Censo da Educação Superior, ENADE. Os resultados evidenciaram: privatização do ensino de Graduação em Enfermagem; excesso de oferta de cursos e vagas diurnas e noturnas; acentuada expansão do número de vagas de ensino à distância, não atendendo a critérios mínimos de qualidade avaliados pelo ENADE; dentre outros aspectos. Recomenda-se a definição de estratégias para regulação da expansão já instalada, além da revisão dos indicadores do Formulário Único do INEP, atendendo especificidades da Enfermagem, particularmente quanto a número de vagas, integração com o sistema local e regional de saúde e o SUS, ensino na área de saúde, atividades práticas de ensino, regime de trabalho e experiência profissional do corpo docente do curso. Recomenda-se, ainda, a intervenção imediata do MEC nos pólos de Educação à Distância, suspendendo a formação de enfermeiros nessa modalidade.

  18. Panorama dos cursos de Graduação em Enfermagem no Brasil na década das Diretrizes Curriculares Nacionais

    Directory of Open Access Journals (Sweden)

    Elizabeth Teixeira

    Full Text Available O estudo teve o objetivo de construir um panorama dos cursos de Graduação em Enfermagem no Brasil, na década das Diretrizes Curriculares Nacionais do Curso de Graduação em Enfermagem, período 2001 a 2011. Trata-se de pesquisa exploratória, descritiva, com base em dados do e-MEC, Censo da Educação Superior, ENADE. Os resultados evidenciaram: privatização do ensino de Graduação em Enfermagem; excesso de oferta de cursos e vagas diurnas e noturnas; acentuada expansão do número de vagas de ensino à distância, não atendendo a critérios mínimos de qualidade avaliados pelo ENADE; dentre outros aspectos. Recomenda-se a definição de estratégias para regulação da expansão já instalada, além da revisão dos indicadores do Formulário Único do INEP, atendendo especificidades da Enfermagem, particularmente quanto a número de vagas, integração com o sistema local e regional de saúde e o SUS, ensino na área de saúde, atividades práticas de ensino, regime de trabalho e experiência profissional do corpo docente do curso. Recomenda-se, ainda, a intervenção imediata do MEC nos pólos de Educação à Distância, suspendendo a formação de enfermeiros nessa modalidade.

  19. New guidelines for diagnosis and treatment of insomnia Novas diretrizes no diagnóstico e tratamento das insônias

    Directory of Open Access Journals (Sweden)

    Luciano Ribeiro Pinto Jr

    2010-08-01

    Full Text Available The Brazilian Sleep Association brought together specialists in sleep medicine, in order to develop new guidelines on the diagnosis and treatment of insomnias. The following subjects were discussed: concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children. Four levels of evidence were envisaged: standard, recommended, optional and not recommended. For diagnosing of insomnia, psychosocial and polysomnographic investigation were recommended. For non-pharmacological treatment, cognitive behavioral treatment was considered to be standard, while for pharmacological treatment, zolpidem was indicated as the standard drug because of its hypnotic profile, while zopiclone, trazodone and doxepin were recommended.A Associação Brasileira de Sono reuniu especialistas em medicina do sono com o objetivo de desenvolver novas diretrizes no diagnóstico e tratamento das insônias. Nós consideramos quatro níveis de evidência: padrão, recomendado, opcional e não recomendado. Os tópicos abordados foram: conceito, avaliação clínica e psicossocial, indicação da polissonografia, tratamento farmacológico, terapia comportamental cognitiva, comorbidades e insônia na infância. Para o diagnóstico da insônia, foi recomendada uma avaliação psicossocial e a realização da polissonografia, enquanto que no que se refere ao tratamento, foi estabelecido como padrão a indicação da terapia comportamental cognitiva, e, quanto ao tratamento farmacológico, foi indicado o uso do zolpidem como hipnótico padrão, e sendo recomendado o zopiclone, a trazodona e a doxepina.

  20. Avaliação das diretrizes e ações do Plano de Mobilidade da cidade de Passo Fundo de acordo com a Lei n° 12.587/2012

    Directory of Open Access Journals (Sweden)

    Paola Pol Saraiva

    2017-12-01

    Full Text Available O agravamento dos problemas relacionados à mobilidade urbana traz à tona uma série de desafios para pensadores e corpo técnico das cidades. É de fundamental importância analisar, refletir e avaliar a consistência das políticas públicas voltadas à mobilidade, a fim de mensurar sua efetividade e aplicabilidade, bem como a coerência entre as políticas nacionais e as locais. Neste contexto, desde o ano de 2014 a cidade de Passo Fundo possui um Plano de Mobilidade, focado em ações e estratégias de curto, médio e longo prazo para melhoria da mobilidade local. Sendo assim, o presente estudo tem como objetivo principal analisar as diretrizes e ações do Plano de Mobilidade Urbana da cidade de Passo Fundo, a fim de avaliar sua compatibilidade com os princípios, diretrizes e objetivos da Lei Nacional n° 12.587/2012- Lei de Mobilidade Urbana, bem como compreender como as ações em nível local são influenciadas pelas políticas nacionais. Além disso, objetiva-se compreender como o processo de urbanização influenciou na mobilidade da cidade de Passo Fundo. A metodologia utilizada foi o levantamento documental de leis e regulamentos oficiais dedicados à mobilidade urbana das escalas nacional até a local bem como o estudo de caso da cidade analisada. Os resultados mostraram que há conformidade entre a Lei Nacional 12.587/2012 e o Plano Municipal de Mobilidade, com algumas lacunas, como a ausência de diretrizes voltadas ao uso de energias mais limpas. Nota-se, porém, que há uma grande distância entre boa parte das diretrizes locais e a aplicabilidade das mesmas na cidade, já que algumas requerem grandes investimentos.

  1. Em torno das "Diretrizes curriculares nacionais para a educação das relações étnico-raciais e para o ensino de história e cultura afro-brasileira e africana": uma conversa com historiadores

    Directory of Open Access Journals (Sweden)

    Martha Abreu

    2008-06-01

    Full Text Available A partir do crescimento do interesse de professores e secretarias de educação na organização de políticas de combate ao racismo, este artigo procura discutir e apresentar alguns subsídios para a implementação das "Diretrizes curriculares nacionais para o ensino das relações étnico-raciais e de história e cultura afro-brasileira e africana", aprovadas em 2004. Entendemos as "Diretrizes" como uma importante estratégia pedagógica para levar à escola, pela primeira vez, a discussão das relações raciais no Brasil, tantas vezes silenciada ou desqualificada pelas avaliações de que o Brasil era uma democracia racial. Demos especial atenção aos limites e possibilidades de trabalho com os conceitos de cultura afro-brasileira e identidade negra.

  2. Charakterisierung inaktivierender posttranslationaler Modifikationen des GC-A-Rezeptors für das atriale natriuretische Peptid (ANP)

    OpenAIRE

    Hartmann, Michael

    2014-01-01

    Das atriale natriuretische Peptid (ANP) wird infolge einer Zunahme des atrialen Drucks aus den Myozyten des Atriums sezerniert. Es spielt lokal eine bedeutende, protektive Rolle und wirkt der Entstehung von Herzhypertrophie und Fibrose entgegen. Darüber hinaus kommt ANP vor allem eine wichtige Rolle als endokrines Hormon zu, das den arteriellen Blutdruck und das Blutvolumen regelt. Diese physiologischen Effekte vermittelt das Herzhormon durch seinen Rezeptor, das Transmembranprotein Guanylatz...

  3. A HISTÓRIA DA ÁFRICA E DA CULTURA AFROBRASILEIRA NAS ESCOLAS MUNICIPAIS DA CIDADE DE PALMAS – TOCANTINS: REPERCUSSÕES E TENSÕES DA LEI E DAS DIRETRIZES

    Directory of Open Access Journals (Sweden)

    Ana Lúcia Pereira

    2016-09-01

    Full Text Available A Lei nº 10.639/03 tornou obrigatória a inclusão de história da África e da cultura afro-brasileira nos currículos escolares. As Diretrizes Curriculares Nacionais para a Educação das Relações Étnico-Raciais e para o ensino de história e cultura afro-brasileira e africana, dela derivada, motivou um movimento pela busca de formação dos professores e pela reformulação e/ou adaptação dos projetos políticos pedagógicos das escolas. O objetivo do texto é o de refletir sobre esse impacto ou as possíveis mudanças no projeto político-pedagógico, bem como os materiais disponibilizados nas bibliotecas e as questões ligadas às religiões de matriz africana nas escolas municipais de ensino fundamental, da cidade de Palmas/TO.

  4. O discurso pedagógico das diretrizes curriculares nacionais: competência crítica e interdisciplinaridade The pedagogical discourse of the national curricular directives: critical competence and inter disciplinarity

    Directory of Open Access Journals (Sweden)

    José Sérgio Carvalho

    2001-03-01

    Full Text Available O texto discute alguns aspectos do discurso pedagógico das Diretrizes Curriculares Nacionais, ressaltando como o jargão pedagógico e o recurso a expressões consagradas e slogans educacionais obnubilam a especificidade da tarefa educativa em instituições escolares e ignoram os desafios concretos da ação docente nessas instituições. As análises centram-se no ideal de "desenvolvimento da competência crítica", visto como objetivo do processo de escolarização e no ideal pedagógico da "interdisciplinaridade", tomando-os como exemplares típicos desse tipo de discurso.This text discusses some aspects of the pedagogical discourse of the National Curricular Directives, emphasizing how pedagogical jargon and the recourse to consecrated expressions and educational slogans cloud the specificity of the educational task in school institutions and ignore the concrete challenges to teaching activities in these institutions. The analyses center on the ideal of "developing critical competency", seen as the objective of the process of schooling and in the pedagogical ideal of "inter disciplinarity" taking them as examples typical of this type of discourse.

  5. Avaliação das diretrizes curriculares conforme a perspectiva biopsicossocial da organização mundial de saúde Evaluation of curriculum guidelines acording to the biopsychosocial perspective of the world health organization (WHO

    Directory of Open Access Journals (Sweden)

    Peterson Marco de Oliveira Andrade

    2010-07-01

    Full Text Available As Diretrizes Curriculares Nacionais (DCN envolvem as competências que cada curso deve desenvolver durante a formação dos acadêmicos. Porém, não há uma ferramenta para avaliar sistematicamente a atuação dos futuros egressos. Objetivo: Desenvolver uma checklist de avaliação dos estagiários de fisioterapia. Métodos: As regras de linking foram utilizadas para relacionar o conteúdo das DCN com a CIF. Em seguida foi definido um consenso entre os pesquisadores para a checklist de avaliação. Resultados: Foram selecionadas 13 subcategorias dos capítulos de atividade e participação relacionados com a aprendizagem e aplicação do conhecimento, tarefas e demandas gerais, comunicação, relações interpessoais e vida comunitária, social e cívica. Considerações Finais: O resultado do linking oferece uma fundamentação para avaliação conforme as exigências do MEC e a abordagem biopsicossocial preconizada pela OMS. Estudos são necessários para validar o instrumento desenvolvido e verificar a sua aplicabilidade e viabilidade em diferentes áreas da saúde e em diferentes populações.The National Curriculum Guidelines (NCG involve the skills that each program should develop during the training of scholars. However, there is no tool to systematically assess the performance of future graduates. Objective: Develop a checklist for evaluating the trainees in physiotherapy. Methods: The rules of linking were used to relate the content of the NCG with ICF. Then a consensus was established among researchers for the evaluation checklist. Results: We selected 13 sub-chapters of activity and participation related to the learning and application of knowledge, general tasks and demands, communication, interpersonal relationships and community, social and civic life. Final Considerations: The results of linking provide a rationale for evaluation in accordance with the requirements of MEC and the biopsychosocial approach advocated by WHO

  6. Tensões e contradições do processo de construção das diretrizes para a politica pública de educação infantil do campo

    OpenAIRE

    Spada, Ana Corina Machado

    2016-01-01

    Este estudo vincula-se à linha de pesquisa Educação Ambiental e Educação do Campo. O tema discutido insere-se na área de estudos da Educação do Campo, tendo como objeto a formulação de diretrizes para uma política de Educação Infantil do Campo, coordenada pela Secretaria de Educação Básica (SEB) em parceria com a Secretaria de Educação Continuada, Alfabetização, Diversidade e Inclusão (SECADI), do Ministério da Educação. A infância do campo sofreu historicamente um processo de silenciamento e...

  7. O processo de constituição histórica das diretrizes curriculares na formação de professores de Educação Física The process of historical constitution of curriculum guidelines in the formation of Physical Education teachers

    Directory of Open Access Journals (Sweden)

    Larissa Cerignoni Benites

    2008-08-01

    Full Text Available Os processos históricos que permeiam as diretrizes curriculares possibilitaram enxergar quais são as idéias e as preocupações para com a formação de professores no âmbito da Educação Física. Dentro desse contexto, o objetivo foi averiguar, nas políticas públicas de formação de professor dessa disciplina, como ocorreu o processo de qualificação e certificação, buscando entender as justificativas que orientaram a regulamentação dos normativos legais de 1939 a 2004. Portanto, trata-se de um estudo descritivo, de análise qualitativa, tendo como fonte primária as Diretrizes Curriculares veiculada pela imprensa oficial. As novas Diretrizes Curriculares (Resoluções CNE/CP 01/2002, 02/2002 e 7/2004 apontaram perspectivas na formação de um professor mais qualificado para o seu campo de atuação, priorizando a questão da dimensão política da profissão, das competências e do corpo de conhecimento da área. Embora haja progressos em relação aos normativos anteriores, chama-se atenção para a necessidade de que as propostas em construção façam a mediação entre a proposta atual, o percurso histórico do próprio curso e a relação teoria-prática, visando o equilíbrio na formação. A proposta das novas diretrizes não deixa de evidenciar avanços significativos no horizonte da profissionalidade docente e da identidade profissional docente. Da mesma forma, para o leitor ou estudioso atento, não deixa de causar preocupação o excesso de competências técnicas colocadas, passando-se a impressão de que agora o que vale é o primado do "saber fazer".The historical processes that permeate curriculum guidelines made it possible to see what are the ideas and concerns in the formation of teachers of Physical Education. In this context, the objective here was of investigating how the qualification and certification processes were developed in the public policies for the education of these teachers, in an attempt to

  8. Isolamento das veias pulmonares em pacientes com fibrilação atrial permanente secundária a valvopatia mitral Isolation of the pulmonary veins in patients with permanent atrial fibrillation secondary to mitral valve disease

    Directory of Open Access Journals (Sweden)

    Gustavo G. Lima

    2004-04-01

    Full Text Available OBJETIVO: Analisar a eficácia do isolamento cirúrgico das veias pulmonares para restabelecer ritmo sinusal em pacientes com fibrilação atrial secundária à doença mitral. MÉTODOS: 33 pacientes com indicação de correção cirúrgica da valva mitral e com fibrilação atrial permanente, foram submetidos ao isolamento cirúrgico das veias pulmonares, sendo 67% mulheres. Média de idade de 56,3±10 anos, classe funcional NYHA pré-operatória de 3,2±0,6, tamanho de átrio esquerdo de 5,5± 0,9 cm, fração de ejeção de 61,3±13%. A técnica cirúrgica consistiu de incisão circunferencial ao redor das 4 veias pulmonares, excisão do apêndice atrial esquerdo e de incisão perpendicular desde a borda inferior da incisão, isolando as veias pulmonares, até o ânulo da valva mitral. Arritmias precoces foram tratadas, agressivamente, com cardioversão. RESULTADOS: O seguimento médio foi de 23,9±17 meses e ocorreram 3 óbitos no pós-operatório. Dez pacientes necessitaram de cardioversão elétrica no pós-operatório; 87% apresentavam ritmo sinusal na última consulta e 33% estavam em uso de amiodarona. CONCLUSÃO: Isolamento das veias pulmonares associado à cirurgia da valva mitral é uma técnica efetiva e segura na manutenção de ritmo sinusal em pacientes com fribilação atrial permanente.OBJECTIVE: To assess the efficacy of surgical isolation of the pulmonary veins for re-establishing sinus rhythm in patients with atrial fibrillation secondary to mitral valve disease. METHODS: Thirty-three (67% were women patients with permanent atrial fibrillation and indication for surgical correction of the mitral valve underwent surgical isolation of the pulmonary veins. Their mean age was 56.3±10 years, preoperative NYHA functional class was 3.2±0.6, left atrial size was 5.5±0.9 cm, and ejection fraction was 61.3±13%. The surgical technique consisted of a circumferential incision surrounding the 4 pulmonary veins, excision of the left

  9. O EMBATE DE PROJETOS NA DEFINIÇÃO DAS DIRETRIZES CURRICULARES NACIONAIS DOS CURSOS DE EDUCAÇÃO FÍSICA: contribuições do MEEF para formação de professores

    Directory of Open Access Journals (Sweden)

    Mauro Titton

    2005-01-01

    Full Text Available O estudo trata da posição do MEEF frente ao processo de Reformulação Curricular dos Cursos de Educação Física e o embate de projetos na definição da resolução aprovada no CNE, visando instituir as novas Diretrizes Curriculares Nacionais. Analisa essa reformulação no contexto histórico do franco processo de decomposição do sistema capitalista, situando as Reformas de Estado em curso, a alteração na formação como tática de adaptação do trabalhador às alterações no mundo do trabalho impostas pelo imperialismo e os projetos em conflito para formação nos cursos de Educação Física. Aponta elementos centrais do processo de reformulação e as posições historicamente defendidas pelo MEEF para a formação humana, na direção do projeto histórico socialista.

  10. Formação de professores na sociedade do capital: uma análise crítica das diretrizes curriculares nacionais para os cursos superiores de educação física DOI:10.5007/2175-8042.2011v23n36p129

    Directory of Open Access Journals (Sweden)

    José Pereira Sousa Sobrinho

    2011-01-01

    Full Text Available O presente estudo se esmera sobre a análise das diretrizes curriculares nacionais para a formação de professores de educação física, homologada através da resolução 07/04. Refletimos neste trabalho sobre quatro pontos preponderantes da referida resolução. São eles: a teoria das competências como eixo norteador do processo de formação; a concepção de ciência; movimento humano enquanto objeto de estudo da área; a fragmentação da formação em bacharelado e licenciatura. em relação a esses pontos expomos uma crítica radical ao caráter de precarização apresentado no modelo de formação de professores homologado pela resolução acima referida, expondo a necessidade histórica de sua superação.

  11. Educação permanente em saúde e as Diretrizes Curriculares Nacionais para Educação das relações étnico-raciais e para ensino de História e Cultura Afro-Brasileira e Africana

    Directory of Open Access Journals (Sweden)

    Rosana Batista Monteiro

    Full Text Available Resumo Este texto é um ensaio sobre algumas contribuições que o curso de especialização em Saúde da Mulher Negra pode ter produzido para a abordagem dos conteúdos relacionados nas Diretrizes Curriculares Nacionais para a Educação das Relações Étnico-raciais e para o Ensino de História e Cultura Afro-brasileira e Africana, bem como em atenção à Política Nacional de Saúde Integral da População Negra, com destaque para a educação permanente. A partir de breve contextualização sobre o debate no campo das relações raciais e ações afirmativas no Brasil passamos a apresentar a organização e funcionamento do curso, destacando seus objetivos, conteúdos, estratégias. Com foco nos profissionais da saúde, o curso contou com significativa presença de profissionais da educação básica pública, municipal e estadual, das cidades de São Luís e Pinheiro, no Maranhão, implicando a discussão do tema saúde da população negra (especialmente da mulher negra no âmbito da escola. O curso propiciou a elaboração de projetos de pesquisa relacionados diretamente com o atendimento à saúde de mulheres negras e sua relação com processos formativos de profissionais da área da saúde, bem como educação escolar e saúde de mulheres negras. Pode-se concluir, ainda que provisoriamente, que o curso, na perspectiva da educação permanente, resultou em estratégia eficaz para o desenvolvimento de conteúdos relacionados às DCNERER e, especialmente, de viabilização de implementação da Política Nacional de Saúde Integral da População Negra, realizadas ou desencadeadas nos serviços de saúde pelos cursistas.

  12. Multiculturalismo, pesquisa e formação de professores: o caso das Diretrizes Curriculares para a Formação Docente Multiculturalismo, pesquisa y formación de profesores: el caso de las directrices curriculares para la formación docente Multiculturalism, research and teacher training: the case of teacher education

    Directory of Open Access Journals (Sweden)

    Ana Canen

    2005-09-01

    Full Text Available O presente artigo discute possibilidades de articulação de uma perspectiva multicultural ao componente de pesquisa na formação docente, analisando implicações de tal articulação e discutindo a extensão em que está presente no discurso das Diretrizes Curriculares de Formação de Professores (BRASIL, 2000b. Em um primeiro momento, discute o multiculturalismo e a pesquisa, como componentes da formação de professores, levantando tensões e possibilidades em sua articulação; em seguida, relata o contexto em que emergem as recentes políticas educacionais e analisa ênfases e silêncios das diretrizes curriculares nacionais de formação de professores, com relação ao papel da pesquisa e do multiculturalismo em suas formulações. Conclui, indicando a necessidade de se concretizar estratégias multiculturais na formação docente que permitam superar binômios tais como o que separa pesquisa acadêmica de pesquisa prática nessa formação.Este artículo discute las posibilidades de articulación de la perspectiva multicultural al componente de pesquisa en la formación docente, analizando implicaciones de tal articulación y discutiendo la extensión en que está presente en el discurso de las Directrices Curriculares de Formación de Profesores (BRASIL, 2000b. En un primer momento, discute el multiculturalismo y la pesquisa, como componentes de la formación de profesores, levantando tensiones y posibilidades en su articulación; a continuación, relata el contexto en que emergen las recientes políticas educativas y analiza énfasis y silencios de las directrices curriculares nacionales de formación de profesores, con relación al papel de la pesquisa y del multiculturalismo en sus formulaciones. Concluye, señalando la necesidad de concretizar estrategias multiculturales en la formación docente que permitan superar binomios tales como el que separa la pesquisa académica de la pesquisa práctica en esta formación.The present

  13. Diretrizes para o desenvolvimento e a avaliação de blogs de biblioteca

    Directory of Open Access Journals (Sweden)

    Laura Akie Saito Inafuko

    2012-01-01

    Full Text Available Os blogs se popularizam pela facilidade de uso e publicação, influenciando no aumento de ambientes informacionais digitais. Considera-se necessário estudos que otimizem a organização das informações contidas em blogs, para contribuir no seu desenvolvimento. A partir de observação direta não-participativa, analisou-se em 6 blogs de bibliotecas universitárias elementos de AI (MORVILLE; ROSENFELD, 2006 e diretrizes de Usabilidade (NIELSEN, 2005, identificando-se os elementos fundamentais e opcionais para o desenvolvimento estrutural de um blog. Além disso, foram elaboradas diretrizes de planejamento, um modelo de avaliação, e foram propostos elementos de AI específicos para blogs, contribuindo para os estudos da AI Digital.

  14. Estudo transversal das estratégias de tratamento clínico na fibrilação atrial

    Directory of Open Access Journals (Sweden)

    Lucas Hollanda Oliveira

    2012-03-01

    Full Text Available FUNDAMENTO: A despeito de elevada prevalência e importância clínica da Fibrilação Atrial (FA, não existem até o momento publicações brasileiras informando o perfil clínico e a estratégia de tratamento (controle de ritmo vs. controle de frequência cardíaca mais utilizada nesse universo de pacientes. OBJETIVO: Avaliar a estratégia de tratamento mais empregada na FA em ambulatório especializado no manejo dessa doença. Secundariamente, procurou-se descrever o perfil clínico dessa população. MÉTODOS: Estudo transversal que avaliou sequencialmente, em 167 portadores de FA, a estratégia de tratamento mais empregada, bem como o perfil clínico desses pacientes. Utilizou-se questionário padronizado para coleta de dados. A análise estatística foi realizada por meio do software SPSS® versão 13.0. RESULTADOS: Nessa população de alto risco para eventos tromboembólicos (61% com score CHADS2 > 2, em que 54% dos indivíduos apresentavam fibrilação atrial paroxística ou persistente, 96,6% utilizavam antagonistas da vitamina K ou AAS, e 76,6% faziam uso de betabloqueador (81,2% frequência x 58,8% ritmo, p 2 (60,5% x 39,5%; p = 0,07 e valvopatias (25,8% x 11,8%; p = 0,08 no segmento de controle da frequência. CONCLUSÃO: Nessa população de alto risco para eventos tromboembólicos, a estratégia de controle de frequência cardíaca foi a mais empregada.

  15. Leitura rapida do KDIGO 2012: Diretrizes para avaliacao e manuseio da doenca renal cronica na pratica clinica

    Directory of Open Access Journals (Sweden)

    Gianna Mastroianni Kirsztajn

    2014-03-01

    Full Text Available Os autores desta "leitura rápida" apresentam os dados que consideraram mais relevantes na versão 2012 do KDIGO referente à avaliação e manuseio da doença renal crônica. Não se trata da opinião dos autores, mas sim de uma apresentação mais concisa das diretrizes, que podem ser úteis na prática clínica.

  16. Isolamento das veias pulmonares para tratamento da fibrilação atrial paroxística: resultados clínicos após um único procedimento

    Directory of Open Access Journals (Sweden)

    Scanavacca Mauricio

    2004-01-01

    Full Text Available OBJETIVO: Avaliar a evolução clínica dos pacientes com fibrilação atrial paroxística submetidos a um único procedimento de isolamento das veias pulmonares. MÉTODOS: Estudados 49 pacientes consecutivos (36 homens; idade média de 53±10 anos com episódios freqüentes e sintomáticos de fibrilação atrial paroxística de difícil controle clínico. Para mapeamento da junção do átrio esquerdo com as veias pulmonares, foi utilizado o cateter decapolar circular Lasso e para ablação 30 watts e 50ºC, um cateter com ponta deflectível e eletrodo distal de 4mm. RESULTADOS: Em seguimento médio de 12±5 meses, 25 (51% pacientes não apresentaram recorrência de fibrilação atrial e 24 (49% apresentaram pelo menos uma recorrência. Em 20 (83%, a 1ª crise ocorreu antes do 1º mês e em 4, após 2 a 9 meses. Após a introdução de drogas antiarrítmicas, 15 (63% pacientes apresentaram melhora importante, 10 tornaram-se assintomáticos, 5 referiam crises raras, auto-limitadas e de curta duração e 9 (37% permaneceram com as manifestações clínicas inalteradas, apesar das drogas antiarrítmicas e foram encaminhados à nova intervenção. No final do seguimento, 35 (71% pacientes permaneciam em ritmo sinusal estável sem recorrência de fibrilação atrial, após um único procedimento, 50% dos quais sem drogas antiarrítmicas. CONCLUSÃO: A maioria dos pacientes com fibrilação atrial paroxística sintomática, não controlados com medicação antiarrítmica, obtém controle clínico após um único procedimento de isolamento das veias pulmonares.

  17. Reforma do Ensino supeiror: Diretrizes curriculares em Educação Física

    Directory of Open Access Journals (Sweden)

    2006-11-01

    Full Text Available Neste texto tecemos algumas considerações sobre o contexto em que ocorrem os debates acerca das Diretrizes Curriculares para o ensino superior brasileiro, especialmente aquelas referentes à área de Educação Física. Sugerimos que as Diretrizes Curriculares de Educação Física, formuladas pela comissão de especialistas, designada pelo MEC, têm sido referenciadas em confronto com as perspectivas apontada para a universidade brasileira atualmente, em particular para a formação de professores. Relatamos as contribuições da FEF/UFG para este debate, bem como justificamos os pontos essenciais de um documento anterior, não publicado, em que se apresentam posições sobre currículo e formação de professores de Educação Física na atualidade. Basicamente nos opomos aos projetos do Banco Mundial, FMI e MEC/FHC e seus interesses mercadológicos e de preparação restrita para ao mercado de trabalho, por entendermos que a formação de professores deve ocorrer no âmbito da universidade pública, gratuita e de qualidade social, e onde demandas sociais relevantes se constituam no maior foco de interesse. PALAVRAS-CHAVE: Educação Física, Diretrizes Curriculares, formação de professores. In this paper e make considerations about the curriculum diretrixes for universities, mainly those related to Physical Education. We believe that the diretrixes, established by a commission of experts, need discussion. We oppose to Worsd-Wide Bank, IMF and MEC due to their merchandising interests. We understand that the formation of teachers needs to take place in a public, free and socially qualified university. This paper also presents FEF’s contrubutions to this discussion, extracted from a document (not published yet. Our points of view concerning curriculum and tracher’s graduation are discussed in detail.

  18. Proposta de diretrizes para processo criativo para o design virtual de embalagens

    Directory of Open Access Journals (Sweden)

    Suzana Funk

    2010-12-01

    Full Text Available Este artigo apresenta a sistematização do design virtual de embalagens, utilizando softwares de modelagem 3D como ferramentas de apoio à criação. Com os recursos tecnológicos disponíveis, a criação das embalagens normalmente é feita com o auxílio de softwares, mas com pouca ou sem sistematização do processo criativo. Em virtude disso, apresenta-se um estudo sobre os aspectos teóricos que abordam o processo criativo virtual de embalagens e uma pesquisa com profissionais que possuem experiência em modelagem 3D. É feita uma análise qualitativa e interligação destes dados e, em seguida, são propostas dez diretrizes, organizadas dentro de uma metodologia. O seu diferencial, em relação às demais, está nas fases Criar e Apresentar, que envolvem a criação e apresentação de embalagens utilizando as possibilidades de softwares de modelagem 3D. Para exemplificar a metodologia, faz-se o design de um frasco de perfume. O mesmo é apresentado com foco na geração de alternativas utilizando software. Pode-se observar que as diretrizes contribuem para conduzir as atividades, até a apresentação final do trabalho. A sistematização da criação, utilizando softwares 3D, pode potencializar o design de embalagens, diminuindo o tempo de criação e os custos com a criação de protótipos, além de aperfeiçoar a visualização final do produto.

  19. Diretrizes para implantação coletiva e semipresencial de sistemas certificáveis de gestão

    Directory of Open Access Journals (Sweden)

    Fábio Roberto Izeppe

    2013-01-01

    Full Text Available Este artigo tem por objetivo sistematizar diretrizes para implantação coletiva e semipresencial, situação em que não há participação ativa de um consultor ou especialista diretamente na empresa, de sistemas certificáveis de gestão, tais como a ISO 9001, ISO 14001 e OHSAS 18001. Este artigo é de cunho teórico-conceitual e, para seu desenvolvimento, foram estudadas mais diretamente quatro experiências práticas provenientes da teoria, de implantação coletiva e semipresencial de sistemas que, em conjunto com o referencial teórico geral, forneceram subsídios para a sistematização das diretrizes. Essas diretrizes estão estruturadas com base nos seguintes itens: seleção das empresas; sensibilização; diagnóstico; planejamento; treinamentos; implementação; verificação e correção.

  20. Atrial Fibrillation: Diagnosis

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: Diagnosis Past Issues / Winter 2015 Table of Contents ... of your body's cells and organs. Read More "Atrial Fibrillation" Articles Atrial Fibrillation / Who Is at Risk for ...

  1. Diretrizes para cessação do tabagismo - 2008 Smoking cessation guidelines - 2008

    Directory of Open Access Journals (Sweden)

    Jonatas Reichert

    2008-10-01

    Full Text Available Estas diretrizes constituem uma ferramenta atualizada e abrangente para auxiliar o profissional de saúde na abordagem do tabagista, recomendando atitudes baseadas em evidências clínicas como a melhor forma de conduzir cada caso. De forma reduzida e mais objetiva possível, o texto final foi agrupado em dois grandes itens: Avaliação e Tratamento. Os dois itens apresentam comentários e níveis de recomendação das referências utilizadas, bem como algumas propostas de abordagem, como por exemplo, redução de danos, em situações específicas ainda pouco exploradas, como recaídas, tabagismo passivo, tabagismo na categoria médica e uso de tabaco em ambientes específicos.These guidelines are an up-to-date and comprehensive tool to aid health professionals in treating smokers, recommending measures and strategies for managing each case based on clinical evidence. Written in a simplified and objective manner, the text is divided into two principal sections: Evaluation and Treatment. The sections both present comments on and levels of evidence represented by the references cited, as well as some proposals for the reduction of damage and for intervening in specific and still poorly explored situations, such as relapse, passive smoking, physician smoking, and tobacco use in specific environments.

  2. Atrial Flutter

    Science.gov (United States)

    ... abnormalities High Blood Pressure Recent upper chamber surgery Thyroid dysfunction Alcoholism (especially binge drinking) Chronic lung disease Acute (serious) illness Diabetes Symptoms of Atrial Flutter The electrical signal that causes ...

  3. ATRIAL FLUTTER*

    African Journals Online (AJOL)

    1971-01-02

    Jan 2, 1971 ... gest a basic mechanism in that certain groupings of RR intervals reappear cyclically. Frequently the behaviour of. RR intervals shows progressive shortening before a long pause (Figs. 4 and 5) and is identical with the Wencke- bach phenomenon seen during normal sinus rhythm. This feature of atrial flutter ...

  4. Atrial fibrillation

    African Journals Online (AJOL)

    ABEOLUGBENGAS

    optimal. Keywords: Atrial fibrillation, thrombosis, CHADS2 Score, stroke risk, hypertensive heart disease, ... (3,4). In developing countries, AF is a growing public health problem due to the epidemiologic transition from communicable to non- communicable diseases. However in ... ECG laboratory and was interpreted by two.

  5. Atrial fibrillation

    DEFF Research Database (Denmark)

    Olesen, Morten S; Nielsen, Morten W; Haunsø, Stig

    2014-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting 1-2% of the general population. A number of studies have demonstrated that AF, and in particular lone AF, has a substantial genetic component. Monogenic mutations in lone and familial AF, although rare, have been recognized...

  6. Medida da pressão arterial em crianças e adolescentes: recomendações das diretrizes de hipertensão arterial e prática médica atual Blood pressure measurement in children and adolescents: guidelines of high blood pressure recommendations and current clinical practice

    Directory of Open Access Journals (Sweden)

    Maria Alayde Mendonça da Silva

    2007-04-01

    Full Text Available OBJETIVO: Identificar, em crianças e adolescentes (7 a 17 anos, rede pública e privada de ensino, a freqüência de indivíduos já submetidos à medida da pressão arterial (MPA, o número de vezes, os locais em que foi realizada a aferição e o resultado informado. MÉTODOS: Estudo transversal. Amostragem por conglomerados em 40 escolas, nível fundamental e médio, sorteadas. Cálculo da amostra baseado na prevalência esperada de HAS em crianças e adolescentes. Protocolo: questionário sobre realização prévia de MPA (em caso afirmativo, quantas vezes, quando foi a última medida, o local e o resultado da medida e duas MPA. Variáveis independentes: sexo, faixa etária, classe econômica, escola pública ou privada. RESULTADOS: Amostra constituída de 1253 estudantes 1215 responderam ao questionário (97% 531 do sexo masculino média de 12,4 ± 3 anos. Prevalência de HAS: 7,7% 348 estudantes (29% já haviam medido a PA (54% 1 vez 35% 2 a 4 vezes 11% 5 ou mais 53% há menos de 1 ano. Posto de Saúde, residência, hospital e consultório foram os locais mais mencionados (27%, 16%, 15% e 14%, respectivamente. Houve associação significante entre prévia MPA com faixa etária de 15 a 17 anos, classes econômicas A e B e ser estudante de escola privada. CONCLUSÃO: Apesar das recomendações, há baixa freqüência de MPA (29% em crianças e adolescentes, demonstrando que a mesma não foi ainda incorporada na prática clínica.OBJECTIVE: To determine, in a school-based sample of children and adolescents, aged from 7 to 17 years, of both gender, in public and private schools, the frequency of students already submitted to blood pressure measure. METHODS: A cross-sectional study was carried out, sampling from a population pool of elementary and middle schools, randomly selected. The sample was calculated based on the expected prevalence of hypertension for the age group. Data were collected through a questionnaire. Blood pressure was

  7. Cuidado Paliativo e Diretrizes Curriculares: Inclusão Necessária

    Directory of Open Access Journals (Sweden)

    Paula Pereira Pineli

    Full Text Available RESUMO Cuidado Paliativo (CP é uma abordagem multiprofissional que visa à qualidade de vida de pacientes com doenças ameaçadoras de vida e de seus familiares. Com o avanço das doenças crônico-degenerativas, estima-se que mais de 20 milhões de pacientes no mundo têm necessidade deste perfil de cuidado. No que tange à formação médica direcionada a essa demanda crescente, há escassa menção nas Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina. Contudo, ao se avaliar o texto oficial, observam-se diversas congruências das orientações gerais com os princípios do CP, como: formação humanística, priorização de pacientes em vulnerabilidade, valorização da dignidade humana, bioética, respeito à autonomia do paciente, abordagem centrada na pessoa, trabalho em equipe, abordagem familiar, comunicação, condutas baseadas em evidência. O estudo destes pontos em comum evidencia o CP como potencial espaço formador para aquisição de habilidades e competências requeridas pelas orientações oficiais. Neste sentido, a inserção na graduação ampliará a formação profissional de futuros médicos, podendo contribuir ainda com a garantia de uma assistência de qualidade a pacientes com doenças graves, em especial na fase final de vida.

  8. Atrial Fibrillation: Treatment

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: Treatment Past Issues / Winter 2015 Table of Contents Treatment for atrial fibrillation depends on how often you have symptoms, how ...

  9. Atrial Fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Sherer, Jason A; Ko, Darae

    2017-01-01

    that advanced age, male sex, and European ancestry are prominent AF risk factors. Other modifiable risk factors include sedentary lifestyle, smoking, obesity, diabetes mellitus, obstructive sleep apnea, and elevated blood pressure predispose to AF, and each factor has been shown to induce structural......The past 3 decades have been characterized by an exponential growth in knowledge and advances in the clinical treatment of atrial fibrillation (AF). It is now known that AF genesis requires a vulnerable atrial substrate and that the formation and composition of this substrate may vary depending...... and electric remodeling of the atria. Both heart failure and myocardial infarction increase risk of AF and vice versa creating a feed-forward loop that increases mortality. Other cardiovascular outcomes attributed to AF, including stroke and thromboembolism, are well established, and epidemiology studies have...

  10. Atrial fibrillation

    OpenAIRE

    Munger, Thomas M.; Wu, Li-Qun; Shen, Win K.

    2013-01-01

    Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including heart failure, syncope, dementia, and stroke. Therapies including anticoagulants, anti-arrhythmic medications, devices, and non-pharmacologic procedures in the last 30 years have improved patients' functionality with the disease. Nonetheless, it remains imperative that further re...

  11. Uma década de Diretrizes Curriculares Nacionais para a Graduação em Enfermagem: avanços e desafios

    Directory of Open Access Journals (Sweden)

    Josicelia Dumêt Fernandes

    2013-09-01

    Full Text Available As Diretrizes Curriculares do Curso de Graduação em Enfermagem são referenciais para o fortalecimento das mudanças na formação de profissionais competentes, críticos e comprometidos com a saúde da população. Buscando identificar essas mudanças, este estudo teve como objetivo analisar os avanços e desafios de uma década dessas Diretrizes. Trata-se de uma pesquisa documental, em que foram analisadas a Lei de Diretrizes e Bases da Educação Nacional, a Resolução CNE/CES nº 03/2001 e a produção intelectual brasileira sobre a temática, na década 2001 a 2011. Essa produção foi buscada em periódicos científicos da área, através das bases BDENF, SciELO e LILACS. A análise ancorou-se no referencial metodológico da dialética que proporcionou o estudo do tema na sua dinamicidade, contradições e totalidade de sua inserção nas políticas públicas. Os resultados apontaram avanços no fortalecimento da mudança na educação em enfermagem, em sintonia com as políticas de educação e saúde.

  12. Diretrizes curriculares e a potencialização de condições para mudanças na formação de enfermeiros

    Directory of Open Access Journals (Sweden)

    Edir Nei Teixeira Mandú

    2003-08-01

    Full Text Available O texto analisa o artigo "Diretrizes Curriculares e projetos pedagógicos", objeto de discussão nesta seção da REBEn. Aponta a opinião das autoras quanto à complexidade do tema e destaca dois pontos que emergem nesse debate, a questão do contraponto reprodução - problematização, em relação as reformas curriculares e o caráter dos projetos curriculares que visam a mudança na formação de enfermeiros/as. A autora concentra suas análises nas diretrizes e mudanças curriculares, para além do texto, quando destaca a importância de uma política nacional de investimentos para garantir condições que garantam as mudanças curriculares que se fazem necessárias. Faz um paralelo entre o setor de educação e o de saúde para analisar a construção das diretrizes curriculares e delineia estratégias para sua implementação. Destaca a noção de competências como possíveis de produzir um novo trabalhador reforçando a questão da responsabilidade social da educação como formadora de cidadãos. Na construção dessas competências é lembrada a importância da qualificação dos educadores, o investimento em uma nova ética profissional bem como a nossa dificuldade para superar o que está estabelecido, de forma que se produzam estratégias favoráveis ao desenvolvimento da autocrítica e da responsabilização profissional.

  13. Projeto pedagógico do curso de graduação em enfermagem/UFAL: adequações às diretrizes curriculares

    Directory of Open Access Journals (Sweden)

    Regina Maria dos Santos

    2003-12-01

    Full Text Available Analisa a adequação do Projeto Político Pedagógico do Curso de Graduação em Enfermagem da Universidade Federal de Alagoas às novas Diretrizes Curriculares Nacionais para o Curso de Graduação em Enfermagem, evidenciando as convergências e as necessidades de aproximação, considerando que o primeiro foi anterior às Diretrizes atuais. A análise mostra que as principais dificuldades do currículo implantado residem nas inerentes ao processo de mudança de concepções sobre processo educativo de enfermagem e nas condições de trabalho impostas pela atual situação da Universidade Pública Brasileira. Sugere revisão de estratégias e conteúdos relativos aos fundamentos da pesquisa, da extensão e das ciências da Enfermagem, além da busca de outras alternativas de integração com as áreas de domínio das ciências humanas e de saúde.

  14. Estudo transversal das estratégias de tratamento clínico na fibrilação atrial Estudio transversal de las estrategias de tratamiento clínico en la fibrilación atrial Cross-sectional study of treatment strategies on atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Lucas Hollanda Oliveira

    2012-03-01

    Full Text Available FUNDAMENTO: A despeito de elevada prevalência e importância clínica da Fibrilação Atrial (FA, não existem até o momento publicações brasileiras informando o perfil clínico e a estratégia de tratamento (controle de ritmo vs. controle de frequência cardíaca mais utilizada nesse universo de pacientes. OBJETIVO: Avaliar a estratégia de tratamento mais empregada na FA em ambulatório especializado no manejo dessa doença. Secundariamente, procurou-se descrever o perfil clínico dessa população. MÉTODOS: Estudo transversal que avaliou sequencialmente, em 167 portadores de FA, a estratégia de tratamento mais empregada, bem como o perfil clínico desses pacientes. Utilizou-se questionário padronizado para coleta de dados. A análise estatística foi realizada por meio do software SPSS® versão 13.0. RESULTADOS: Nessa população de alto risco para eventos tromboembólicos (61% com score CHADS2 > 2, em que 54% dos indivíduos apresentavam fibrilação atrial paroxística ou persistente, 96,6% utilizavam antagonistas da vitamina K ou AAS, e 76,6% faziam uso de betabloqueador (81,2% frequência x 58,8% ritmo, p 2 (60,5% x 39,5%; p = 0,07 e valvopatias (25,8% x 11,8%; p = 0,08 no segmento de controle da frequência. CONCLUSÃO: Nessa população de alto risco para eventos tromboembólicos, a estratégia de controle de frequência cardíaca foi a mais empregada.FUNDAMENTO: A despecho de la elevada prevalencia y importancia clínica de la Fibrilación Atrial (FA, no existen hasta el momento publicaciones brasileñas informando el perfil clínico y la estrategia de tratamiento (control de ritmo vs. control de frecuencia cardíaca más utilizada en ese universo de pacientes. OBJETIVO: Evaluar la estrategia de tratamiento más empleada en la FA en ambulatorio especializado en el manejo de esa enfermedad. Secundariamente, se buscó describir el perfil clínico de esa población. MÉTODOS: Estudio transversal que evaluó secuencialmente, en 167

  15. A pedagogia nos cursos de pedagogia : desvelando os aspectos teórico-científicos e prático-organizacionais pós-diretrizes curriculares nacionais

    OpenAIRE

    Ângela Maria Silveira Portelinha

    2014-01-01

    Esta tese insere-se no campo das discussões da Linha do PPGEDU – Universidade: teoria e prática e do Grupo de Estudos sobre Universidade/Inovação e Pesquisa (GEU/Ipesq: Educação Superior, Pedagogia e Mudança). A pesquisa aborda os desdobramentos caracterizados pela implantação das Diretrizes Curriculares Nacionais para o Curso de Pedagogia (DCNCP) – Resolução do Conselho Nacional de Educação/Conselho Pleno (CNE/CP), n. 1/06 (BRASIL, 2006). Delimita como objeto de investigação a Pedagogia nos ...

  16. Gradiente ventriculo-lombar de concentração das proteínas totais do líquido cefalorraquiano: 2 - Influência da drenagem do LCR pela derivação ventrículo-atrial

    Directory of Open Access Journals (Sweden)

    Fernando Menezes Braga

    1983-09-01

    Full Text Available Em trabalho anterior, baseado no estudo comparativo do LCR cisternal e lombar de pacientes com neurocisticercose em atividade, com permeabilidade normal ou com bloqueio do espaço subaracnóideo espinhal, foi apresentada evidência de que o gradiente de concentração das proteínas ao longo do neuro-eixo tem sua origem na saída seletiva de água. Em prosseguimento a esse estudo foi feito este segundo trabalho apoiado nas observações de 11 pacientes com neurocisticercose, que apresentaram no decurso de sua doença hipertensão endocraniana grave que exigiu a derivação ventrículo-atrial do LCR para permitir a sobrevivência. Após a intervenção cirúrgica, foi observada uma melhoria surpreendente do quadro clínico. O exame do LCR lombar revelou aumento da taxa das proteínas totais na maioria dos pacientes, verificando-se valores muito elevados, quando comparados estes resultados com aqueles existentes antes da derivação ventrículo-atrial. Entretanto, neste segundo exame foi observada atenuação da reação inflamatória, revelada pela melhoria da modificação citológica. Este acréscimo da concentração das proteínas totais resultou muito provavelmente da menor movimentação do LCR no espaço subaracnóideo, como consequência do desvio para o sangue de grande parte do LCR produzido. A diminuição da intensidade da resposta imunitária e da reação inflamatória do sistema nervoso central, avaliada pelo exame de LCR feito depois da cirurgia, indica que a drenagem ventricular e a conseqüente normalização da pressão endocraniana permitiram uma melhoria evidente das condições encefálicas. Uma pesquisa bibliográfica especializada não revelou ter sido assinalada esta ocorrência de um acentuado aumento da taxa das proteínas totais no LCR subaracnóideo após a derivação ventrículo-atrial ou peritoneal, quer em pacientes com neurocisticercose, quer em pacientes com outros processos não tumorais que evoluem para o

  17. Diretrizes para a implementação de fluxo contínuo em obras de edificações

    Directory of Open Access Journals (Sweden)

    Iamara Rossi Bulhões

    Full Text Available A variabilidade na produção e a falta de sincronização entre os processos são dois importantes fatores que podem provocar as interrupções no fluxo de trabalho, aumentando a parcela de atividades que não agregam valor e a quantidade de estoques de produtos inacabados. A aplicação do princípio do fluxo contínuo na manufatura busca eliminar esses estoques através da produção unitária, sem interrupção entre os diversos sub-processos produtivos. O presente trabalho investiga a aplicação do fluxo contínuo no ambiente da construção civil. Seu objetivo principal é propor diretrizes para a implementação de fluxo contínuo na construção civil, com base nos conceitos e ferramentas da Mentalidade Enxuta (ME. A estratégia de pesquisa adotada foi a pesquisa-ação, sendo realizados dois estudos empíricos em obras de edificações. Entre as contribuições desta pesquisa destaca-se um conjunto de diretrizes para implementar fluxo contínuo, vinculadas às etapas de diagnóstico, criação de condições iniciais, e Planejamento e Controle da Produção (PCP. Através destas diretrizes propõe-se o uso combinado das ferramentas tradicionais da ME com ferramentas de PCP adequadas ao ambiente da construção civil.

  18. Atrial fibrillation - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000237.htm Atrial fibrillation - discharge To use the sharing features on this ... have been in the hospital because you have atrial fibrillation . This condition occurs when your heart beats faster ...

  19. Implementando diretrizes clínicas na atenção ao infarto agudo do miocárdio em uma emergência pública

    Directory of Open Access Journals (Sweden)

    Claudia Caminha Escosteguy

    2011-01-01

    Full Text Available FUNDAMENTO: A implementação de diretrizes clínicas na atenção ao infarto agudo do miocárdio (IAM produz melhores resultados. OBJETIVO: Apresentar um programa multidisciplinar de implementação dessas diretrizes em uma grande emergência pública e verificar seu impacto. MÉTODOS: Estudo de avaliação de serviços de saúde, com desenho do tipo "antes e após", para avaliar os indicadores da qualidade da atenção ao IAM antes e após a implementação de estratégias de treinamento e de facilitação da adesão das equipes da emergência a diretrizes clínicas. Isso inclui a elaboração de material didático e de sensibilização e a supervisão continuada. Estimativa de risco relativo (RR e intervalos de confiança (IC95%. RESULTADOS: Grupo pré-programa de diretrizes clínicas, 78 casos de IAM; grupo pós-programa, 66 casos de IAM. A maioria dos casos foi tratada apenas na emergência, por limitação de vagas na unidade coronariana. Observou-se aumento significativo (p<0,05 no uso de diversas intervenções avaliadas (indicadores de processo: betabloqueadores, 83%; inibidores da enzima conversora do angiotensinogênio, 22%; hipolipemiantes, 69%; nitrato intravenoso, 55%; reperfusão coronariana em IAM com supradesnivelamento de segmento ST, 98%. O uso de ácido acetilsalicílico desde o primeiro dia do IAM alcançou 95,5% dos casos. A perda de oportunidade de reperfusão coronariana, nos casos com essa indicação, reduziu de 71,4% para 17,6% pós-treinamento. CONCLUSÃO: O programa obteve um impacto expressivo e a sua multiplicação para outras unidades pode contribuir para melhorar a assistência ao IAM no SUS.

  20. Diretrizes curriculares da Educação Física: reformismo e subordinação ao mercado no processo de formação

    Directory of Open Access Journals (Sweden)

    Luiz Fernando Camargo Veronez

    2013-12-01

    Full Text Available As reformas educacionais ocorridas na década de 1990 objetivaram intervir na formação dos trabalhadores para torná-los aptos às demandas da mundialização do capital. Na área da Educação Física, as novas diretrizes curriculares são o resultado dessas reformas, assumindo o papel de mediar as relações entre a formação e a intervenção do professor. Este artigo, extrato de uma pesquisa bibliográfica e documental fundada no Materialismo Histórico-Dialético, analisou o processo de elaboração das Diretrizes Curriculares Nacionais para os cursos de graduação em Educação Física. Assinala-se que esses documentos legais, além de legitimar os interesses da classe social ideologicamente identificada com o capital, tendem a subsumir a formação do trabalhador em Educação Física a essa lógica.

  1. Diretrizes para desenvolvimento coletivo de melhoria contínua em arranjos produtivos locais Guidelines for collective development of continuous improvement in local productive arrangements

    Directory of Open Access Journals (Sweden)

    Ariana Martins Vieira

    2013-06-01

    Full Text Available Em um cenário dinâmico e competitivo como o atual, a melhoria contínua passou a ser um requisito básico da gestão que visa potencializar o desempenho de empresas e dos possíveis Arranjos Produtivos Locais em que estejam inseridas, sobretudo no caso daquelas de menor porte. O objetivo deste trabalho é apresentar diretrizes para desenvolvimento coletivo de melhoria contínua em Micro, Pequenas e Médias Empresas industriais que atuem neste tipo de arranjo. A proposta foi desenvolvida a partir do referencial teórico e validada por um estudo de caso. As diretrizes estão estruturadas em seis etapas principais: Preparação, Diagnóstico do Arranjo, Diagnóstico das empresas, Implantação, Auditoria e Avaliação.In the current dynamic and competitive environment, continuous improvement has become a basic management requirement aiming to increase performance of firms and local productive arrangements. The objective of this study is to present guidelines for collective development of continuous improvement in Micro, Small, and Medium Enterprises that operate in this type of arrangement. The proposal was formulated based on the theoretical concept and validated by a case study. The guidelines are composed of six main stages: Preparation, Array Diagnosis, Company Diagnostics, Implementation, Audit, and Evaluation.

  2. Atrial Fibrillation: Complications

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: Complications Past Issues / Winter 2015 Table of Contents ... has two major complications—stroke and heart failure. Atrial Fibrillation and Stroke Click to enlarge image This illustration ...

  3. Atrial Fibrillation Medications

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Atrial Fibrillation Medications Updated:Jun 28,2017 Understand medications and ... you. This content was last reviewed July 2016. Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters ...

  4. Atrial Fibrillation in Children

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Atrial Fibrillation in Children Updated:Oct 18,2016 Does your ... arrhythmia. This content was last reviewed July 2016. Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters ...

  5. Acerca de diretrizes curriculares e projetos pedagógicos: um início de reflexão - comentários ao texto

    Directory of Open Access Journals (Sweden)

    Flávia Regina Souza Ramos

    2003-08-01

    Full Text Available O texto desenvolve idéias desencadeadas a partir de reflexões contidas no artigo que ancora esta seção de debate acerca das diretrizes curriculares nacionais, quais sejam: as idéias de interdisciplina, do currículo como produto e produtor de cultura e identidade e a emergência da noção de competência. A partir desta discussão indica que não se pode negar que a aprendizagem é codificada disciplinarmente e curricularmente, se organiza no tempo e no espaço e se torna base cultural para uma área de conhecimento. Conclui, sugerindo que enfermeiros/docentes se voltem para si mesmos, para definir que competências precisam conquistar, como professores, para responder aos requerimentos dessa prática pedagógica.

  6. Aderência dos cursos de Fisioterapia da região Norte às Diretrizes Curriculares Nacionais

    Directory of Open Access Journals (Sweden)

    Renato da Costa Teixeira

    Full Text Available INTRODUÇÃO: Após a aprovação das Diretrizes Curriculares Nacionais para os cursos de Fisioterapia (DCN/Fisio, houve um expressivo aumento no número de cursos de graduação em Fisioterapia. A região Norte apresentou a maior taxa de crescimento desses cursos, entre 1999 e 2004, existindo atualmente 27 cursos nessa região. A DCN/FISIO trouxe uma mudança no paradigma de formação desse profissional, passando-se a buscar um perfil de egresso generalista, humanista, crítico e reflexivo. MATERIAIS E MÉTODOS: Com a finalidade de analisarmos a aderência dos cursos de fisioterapia da região Norte às DCN/Fisio, realizamos uma análise crítica dos projetos pedagógicos (PPC de dez cursos de Fisioterapia da região, com base na mesma metodologia utilizada pelo Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira (Inep em 2006, em estudo semelhante com os cursos de Enfermagem, Medicina e Odontologia. RESULTADOS: A aderência média dos PPC às DCN/Fisio foi de 74%. Encontramos como pontos fortes: a construção coletiva dos projetos pedagógicos, matriz curricular interdisciplinar ou a utilização de metodologias que propiciam essa prática, a integração entre teoria e prática, a presença de mecanismos de controle do Trabalho de Conclusão de Curso, maior abrangência das áreas de atuação profissional durante o estágio supervisionado, o incentivo à produção científica, o equilíbrio entre as cargas horárias dos conteúdos essenciais e a presença de regulamento das atividades complementares. Por sua vez, encontramos como fragilidades: o projeto pedagógico construído por grupos restritos, a transcrição literal de elementos das DCN/Fisio no PPC, metodologias de ensino não condizentes com a perspectiva de formação das DCN/Fisio.

  7. Atrial fibrillation.

    Science.gov (United States)

    Bang, Casper N

    2013-10-01

    Atrial fibrillation (AF) is a common complication after myocardial infarction (MI) and new-onset AF has been demonstrated to be associated with adverse outcome and a large excess risk of death in both MI and aortic stenosis (AS) patients. Prevention of new-onset AF is therefore a potential therapeutic target in AS and MI patients. Lipid-lowering drugs, particularly statins, have anti-inflammatory and antioxidant properties that may prevent AF. Accordingly, statins are recommended as a class IIa recommendation for prevention of new-onset AF after coronary artery bypass grafting (CABG). However, this preventive effect has not been investigated on new-onset AF in asymptomatic patients with AS or a large scale first-time MI patient sample and data in patients not undergoing invasive cardiac interventions are limited. This PhD thesis was conducted at the Heart Centre, Rigshospitalet, Denmark, with the aim to investigate the three aforementioned questions and to add to the existing evidence of AF prevention with statins. This was done using three different settings: 1) a randomized patients sample of 1,873 from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study, 2) a register patient sample of 97,499 with first-time MI, and 3) all published studies until beginning of June 2011 examining statin treatment on new-onset and recurrent AF in patients not undergoing cardiac surgery. This thesis revealed that statins did not lower the incidence or the time to new-onset AF in patients with asymptomatic AS. However, statin treatment showed an independently preventive effect on new-onset AF, including type-dependent effect and a trend to dosage-dependent effect. In addition, this thesis showed that good compliance to statin treatment was important to prevent new-onset AF. Finally, the meta-analysis in this PhD thesis showed a preventive effect in the observational studies although this effect was absent in the randomized controlled trials. Based on this PhD thesis

  8. Diretrizes curriculares para o curso de pedagogia: trajetória longa e inconclusa Curricular guindelines for the pedagogy course: long and unfinished trajectory

    Directory of Open Access Journals (Sweden)

    Leda Scheibe

    2007-04-01

    Full Text Available Este artigo aborda as discussões e embates acerca da definição das diretrizes curriculares para o Curso de Pedagogia, ocorridos após a aprovação da Lei de Diretrizes e Bases da Educação Nacional de 1996. Focaliza o processo de mobilização e resistência das entidades do campo educacional no sentido de assegurar a docência como base para esse curso e a superação da dicotomia entre licenciatura e bacharelado no seu interior. A análise aponta como cerne do embate a contraposição ao modelo de formação dos Institutos Superiores de Educação e de Cursos Normais Superiores, veiculado pela reforma educacional da década de 1990, o qual se insere em um contexto de políticas neoliberais. Indica ainda que a recente aprovação de diretrizes curriculares para o Curso de Pedagogia (Parecer CNE/CP 5/2005 e Resolução CNE/CP 1/2006 e sua definição como uma licenciatura que forma unificadamente o professor para a educação infantil e anos iniciais do ensino fundamental, constitui uma solução negociada entre as entidades e o Conselho Nacional de Educação.This article addresses the discussions about the definition of curricular guidelines for the Pedagogy Course, as well as the oppositions to them, which occurred after the passage of the National Educational Guidelines and Framework Law of 1996. It focuses the process of mobilization and resistance of the institutions in the educational area in order to ensure teaching as the basis for this course and the overcoming of the dichotomy between teacher certification (licenciatura and bachelor degree in its interior. The analysis indicates that the central issue is the opposition to the education model of Higher Education Institutes and Higher Basic Education Teacher Education Programs, created by the education reform in the 1990s, which is inserted in a context of neoliberal policies. It also shows that the recent passage of the curricular guidelines for the Pedagogy Course (Official

  9. Diretrizes para o ensino na atenção primária à saúde na graduação em medicina

    Directory of Open Access Journals (Sweden)

    Marcelo Marcos Piva Demarzo

    Full Text Available O presente documento traz diretrizes construídas conjuntamente pela Associação Brasileira de Educação Médica (ABEM e a Sociedade Brasileira de Medicina de Família e Comunidade (SBMFC com a intenção de apoiar as escolas médicas de forma objetiva e prática, na elaboração de projetos político-pedagógicos no contexto da Atenção Primária à Saúde. Um marco reconhecido na política educacional brasileira é a publicação das Diretrizes Curriculares Nacionais, as quais flexibilizam as organizações curriculares, possibilitando a construção de projetos político-pedagógicos contemporâneos e consonantes com o Sistema Único de Saúde brasileiro. A Atenção Primária à Saúde é o ponto de convergência entre estas duas políticas, descentralizando o ensino da Medicina dos hospitais para toda a rede de saúde no Brasil. Destaca-se a imperiosidade de que o ensino na Atenção Primária à Saúde esteja presente longitudinalmente, ao longo de todo o curso, de preferência com inserções significativas (de aprendizado real e a partir do trabalho, mas que, sobretudo, deva fazer parte do núcleo de ensino da prática clínica do futuro médico.

  10. AS DIRETRIZES CURRICULARES PARA A EDUCAÇÃO PROFISSIONAL DO ESTADO DO PARANÁ À LUZ DOS PRINCÍPIOS GRAMSCIANOS: A IMPLEMENTAÇÃO ANALISADA SOB A PERSPECTIVA DOCENTE

    OpenAIRE

    JOICE ESTACHESKI

    2013-01-01

    Esta pesquisa, de caráter qualitativo, caracterizando-se como um estudo de natureza bibliográfica, documental e de campo, teve por objetivo geral a análise crítica das Diretrizes Curriculares Estaduais para a Educação Profissional paranaense (2006), de forma a desvelar seu real papel na atual organização social,uma vez que, utilizando-se dascontribuições marxistas a respeito da politecnia e da proposta gramsciana de escola unitária, tendo o trabalho como princípio educativo,propõe educa...

  11. Left atrial volume index

    DEFF Research Database (Denmark)

    Poulsen, Mikael K; Dahl, Jordi S; Henriksen, Jan Erik

    2013-01-01

    To determine the prognostic importance of left atrial (LA) dilatation in patients with type 2 diabetes (T2DM) and no history of cardiovascular disease.......To determine the prognostic importance of left atrial (LA) dilatation in patients with type 2 diabetes (T2DM) and no history of cardiovascular disease....

  12. Neonatal Arrhythmias: Atrial Flutter

    Directory of Open Access Journals (Sweden)

    M.O. Gonchar

    2014-10-01

    Full Text Available The paper presents the current data on the diagnosis of neonatal arrhythmias, covers the prevalence, mechanisms of formation, diagnosis and treatment of one type of cardiac arrhythmias — atrial flutter. Clinical observation in terms of the diagnosis and treatment of atrial flutter in a newborn in the early neonatal period is given.

  13. Atrial Fibrillation and Hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Jayaprasad N

    2005-10-01

    Full Text Available Atrial fibrillation occurs in 10 – 15% of patients with hyperthyroidism. Low serum thyrotropin concentration is an independent risk factor for atrial fibrillation. Thyroid hormone contributes to arrythmogenic activity by altering the electrophysiological characteristics of atrial myocytes by shortening the action potential duration, enhancing automaticity and triggered activity in the pulmonary vein cardio myocytes. Hyperthyroidism results in excess mortality from increased incidence of circulatory diseases and dysrhythmias. Incidence of cerebral embolism is more in hyperthyroid patients with atrial fibrillation, especially in the elderly and anti-coagulation is indicated in them. Treatment of hyperthyroidism results in conversion to sinus rhythm in up to two-third of patients. Beta-blockers reduce left ventricular hypertrophy and atrial and ventricular arrhythmias in patients with hyperthyroidism. Treatment of sub clinical hyperthyroidism is controversial. Optimizing dose of thyroxine treatment in those with replacement therapy and beta-blockers is useful in exogenous subclinical hyperthyroidism.

  14. What Is Atrial Fibrillation?

    Science.gov (United States)

    ANSWERS by heart Cardiovascular Conditions What Is Atrial Fibrillation? Your heart has a natural pacemaker, called the “sinus node,” that makes electrical signals. These signals cause the heart to contract and pump ...

  15. A "era das diretrizes": a disputa pelo projeto de educação dos mais pobres

    Directory of Open Access Journals (Sweden)

    Maria Ciavatta

    2012-01-01

    Full Text Available Este artículo examina críticamente la propuesta de actualización de los lineamientos curriculares nacionales de formación profesional secundaria técnica reportado en el Consejo Nacional de Educación por el profesor Francisco Cordón, centrándose en los siguientes aspectos: la CLAVE como el núcleo de las directrices propuestas, concepciones del plan de estudios en disputa en la formación profesional, el problema de la teoría y la práctica, la flexibilidad y la fragmentación en el plan de estudios modular, la interdisciplinariedad. Para ello, inicialmente toma el significado de las directrices de la educación básica de la legislación en Brasil y la incorporación del plan de estudios en la área de Trabajo y Educación, ya que se convierta en un instrumento de la sociedad política y cultural en el contexto de la crisis del capital. También se ocupa, en oposición a la propuesta, de los principios alternativos descritos en el documento elaborado por la sociedad civil y concluye sobre la importancia del concurso para la educación de los trabajadores en Brasil como un medio de construcción de contrahegemonía.

  16. Uma análise comparativa entre as competências requeridas na atuação profissional do engenheiro contemporâneo e aquelas previstas nas diretrizes curriculares nacionais dos cursos de Engenharia

    Directory of Open Access Journals (Sweden)

    Leonard de Araújo Carvalho

    2017-10-01

    Full Text Available Resumo A noção de competência é cada vez mais presente no ambiente acadêmico e no mundo do trabalho. Nesse contexto, o ensino de engenharia no Brasil estabeleceu, através das Diretrizes Curriculares para a graduação em engenharia, um roll de competências a serem desenvolvidas durante o curso. Com base nessa legislação, surge o questionamento a respeito da adequação dessas definições ao realmente requerido pelos profissionais em atuação. Dessa forma, procedeu-se à pesquisa junto a engenheiros atuantes no mundo do trabalho, a fim de verificar a adequação do estabelecido na legislação e ao requerido na prática. Observa-se que o conhecimento técnico é de fundamental importância e bem desenvolvido nas Instituições de Ensino; contudo, a área de gestão, embora prevista em algum grau nas diretrizes, não é desenvolvida durante a graduação, sendo detectada como uma deficiência a ser corrigida pelos engenheiros.

  17. Os médicos brasileiros seguem as diretrizes brasileiras de hipertensão? Do Brazilian physicians follow the Brazilian guidelines on hypertension?

    Directory of Open Access Journals (Sweden)

    Décio Mion Junior

    2007-02-01

    Full Text Available OBJETIVO: Avaliar os procedimentos adotados pelos médicos brasileiros para o diagnóstico e tratamento da hipertensão em relação aos preconizados pelas IV Diretrizes Brasileiras de Hipertensão. MÉTODOS: Questionário aplicado por entrevista telefônica a médicos brasileiros, buscando levantar recebimento e adesão às diretrizes, bem como avaliar vários aspectos relacionados ao manejo do paciente hipertenso. RESULTADOS: 68,3% dos médicos receberam às diretrizes e responderam completamente o questionário, perfazendo uma amostra de 483 médicos, sendo 47% cardiologistas, 31,7% clínicos e 21,3% nefrologistas. A adesão a certos pontos das diretrizes é alta, tais como à utilização de mais de uma medida em ocasiões diferentes para o diagnóstico de hipertensão (94,0% e orientação quanto a mudanças no estilo de vida como estratégia terapêutica. Quanto aos valores utilizados para diagnóstico e alvo-terapêutico, o seguimento as recomendações não é uniforme, com uma nítida preferência por valores inferiores aos preconizados, particularmente para pacientes com co-morbidades. A procura por fatores de risco cardiovascular também se mostrou baixa, com apenas 64,7% e 56,4% dos médicos referindo pesquisar, respectivamente, a presença de diabetes e dislipidemia. Os diuréticos são a classe de droga preferencialmente citada (59,3% como tratamento medicamentoso inicial da hipertensão. CONCLUSÃO: O seguimento as diretrizes é apenas parcial. Questões como uma melhor distribuição do documento, normatização de valores para diagnóstico e alvo-terapêutico e formas de abordar o paciente hipertenso dentro de seu risco cardiovascular global deverão ser mais bem abordadas quando da confecção de futuras diretrizes.OBJECTIVE: To evaluate whether procedures adopted by Brazilian physicians in the diagnosis and treatment of hypertension are in compliance with those advocated by the IV Brazilian Hypertension Guidelines. METHOD

  18. Atrial Fibrillation (AF or AFib)

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Atrial Fibrillation (AF or AFib) Updated:Aug 14,2017 What ... to the Terms and Conditions and Privacy Policy Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters ...

  19. A Giant Left Atrial Myxoma

    Directory of Open Access Journals (Sweden)

    Medhat F. Zaher

    2014-01-01

    Full Text Available Atrial myxomas are the most common primary cardiac tumors. Patients with left atrial myxomas generally present with mechanical obstruction of blood flow, systemic embolization, and constitutional symptoms. We present a case of an unusually large left atrial myxoma discovered incidentally in a patient with longstanding dyspnea being managed as bronchial asthma.

  20. Left atrial appendage occlusion

    Directory of Open Access Journals (Sweden)

    Ahmad Mirdamadi

    2013-01-01

    Full Text Available Left atrial appendage (LAA occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC, it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC and mitral valve replacement (MVR too. Nowadays, PTMC is performed as an optimal management of severe mitral stenosis (MS and many patients currently are treated by PTMC instead of previous surgical methods. One of the most important contraindications of PTMC is presence of clot in LAA. So, each patient who suffers of severe MS is evaluated by Trans-Esophageal Echocardiogram to rule out thrombus in LAA before PTMC. At open heart surgery, replacement of the mitral valve was performed for 49-year-old woman. Also, left atrial appendage occlusion was done during surgery. Immediately after surgery, echocardiography demonstrates an echo imitated the presence of a thrombus in left atrial appendage area, although there was not any evidence of thrombus in pre-pump TEE. We can conclude from this case report that when we suspect of thrombus of left atrial, we should obtain exact history of previous surgery of mitral valve to avoid misdiagnosis clotted LAA, instead of obliterated LAA. Consequently, it can prevent additional evaluations and treatments such as oral anticoagulation and exclusion or postponing surgeries including PTMC.

  1. Someshwar Das

    Indian Academy of Sciences (India)

    Skills of different mesoscale models over Indian region during monsoon season: Forecast errors · Someshwar Das Raghavendra Ashrit Gopal Raman Iyengar Saji Mohandas M Das Gupta John P George E N Rajagopal Surya Kanti Dutta · More Details Abstract Fulltext PDF. Performance of four mesoscale models namely ...

  2. Kalyan Das

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education. Kalyan Das. Articles written in Resonance – Journal of Science Education. Volume 5 Issue 12 December 2000 pp 76-76 Book Review. Linear Algebra and Linear Models · Kalyan Das · More Details Fulltext PDF ...

  3. Abhijit Das

    Indian Academy of Sciences (India)

    Volume 13 Issue 11 November 2008 pp 1049-1064 General Article. What is a Species? An Endless Debate · Uttam Saikia Narayan Sharma Abhijit Das · More Details Fulltext PDF. Volume 15 Issue 4 April 2010 pp 321-336 General Article. Vanishing Species: The Planet in Crisis · Uttam Saikia Narayan Sharma Abhijit Das.

  4. S Das

    Indian Academy of Sciences (India)

    Home; Journals; Bulletin of Materials Science. S Das. Articles written in Bulletin of Materials Science. Volume 25 Issue 6 November 2002 pp 557-560. 3-D mapping with ellipsometrically determined physical thickness/refractive index of spin coated sol–gel silica layer · S Das P Pal S Roy S Chakraboarty P K Biswas.

  5. Internacionalização de serviços pelo sistema de franquias: diretrizes para uma empresa de desenvolvimento de software [doi: 10.5329/RECADM.20111002010

    Directory of Open Access Journals (Sweden)

    Cláudia Fabiana Gohr

    2011-12-01

    Full Text Available INTERNACIONALIZAÇÃO DE SERVIÇOS PELO SISTEMA DE FRANQUIAS: DIRETRIZES PARA UMA EMPRESA DE DESENVOLVIMENTO DE SOFTWARE RESUMO A globalização e a internacionalização dos mercados têm afetado organizações de diferentes setores, incluindo as empresas prestadoras de serviços. Analisando a literatura da área, foi possível constatar que a franquia representa uma das maiores forças propulsoras no processo de globalização das empresas de serviços, surgindo como uma alternativa estratégica para a internacionalização dessas organizações. Nesse sentido, este artigo tem como objetivo apresentar um modelo teórico que contribui com diretrizes para o processo de internacionalização de serviços pelo sistema de franquias. O modelo proposto foi testado por meio de um estudo de caso em uma empresa de desenvolvimento de software, em que foram sugeridas maneiras pelas quais essas diretrizes poderiam ser aplicadas para a internacionalização desta empresa pelo sistema de franquias. As técnicas de coleta de dados adotadas foram a entrevista semiestruturada e a observação passiva. A partir dos dados coletados, pôde-se sugerir para a organização objeto de estudo: (i o tipo de franquia que melhor atende às suas especificidades; (ii os parâmetros necessários para o sucesso competitivo por meio da franquia; e, (iii os aspectos que devem ser considerados na elaboração do contrato da franquia.   Palavras-Chave Internacionalização; Franquias; Operações de serviços.     SERVICE INTERNATIONALIZATION THROUGH FRANCHISING: GUIDELINES FOR A SOFTWARE DEVELOPMENT COMPANY   ABSTRACT Globalization and internationalization of markets have affected organizations in different sectors, including service providers. Reviewing the literature about the subject, it was identified that the franchise represents one of the major driving forces in globalization of service firms, emerging as a strategic alternative to the internationalization of these

  6. Diretrizes nacionais para biorrepositório e biobanco de material biológico humano Brazilian guidelines for biorepositories and biobanks of human biological material

    Directory of Open Access Journals (Sweden)

    Gabriela Marodin

    2013-02-01

    Full Text Available OBJETIVO: Caracterizar a construção participativa e democrática das Diretrizes Nacionais para Biorrepositório e Biobanco de Material Biológico Humano com Finalidade de Pesquisa, baseada nos princípios éticos da dignidade humana, da autonomia, da beneficência, da justiça e da precaução. MÉTODOS: Para a elaboração do documento formou-se um grupo de trabalho interdisciplinar Bioética considerando os seguintes critérios: experiência na operacionalização de biobancos, Biobancos representatividade regional, tipo de material biológico acondicionado e especialistas em Biorrepositório bioética. Participaram, também, membros da Agência Nacional de Vigilância Sanitária Diretrizes - Anvisa, pela competência regulatória e da Comissão Nacional de Ética em Pesquisa - Conep, enquanto controle social. RESULTADOS: O documento, baseado nos preceitos éticos, legais e técnicos, apresenta os conceitos, as atividades, finalidades e diferenças entre biorrepositórios e biobancos, as formas de consentimento do sujeito, além de outros aspectos permeados pela preocupação do uso adequado da informação. As Diretrizes Nacionais para Biorrepositório e Biobanco de Material Biológico Humano com Finalidade de Pesquisa contém 39 artigos, dispostos em cinco capítulos. CONCLUSÃO: A importância de uma regulamentação surge da reflexão ética, considerando a moral, e tendo como norteador os aspectos legais, os quais se traduzem em um documento que não se esgota em si mesmo. A dinamicidade da ciência sempre nos remete à mudança de paradigmas, que podem ir além das legislações existentes.OBJECTIVE: To characterize the participatory and democratic creation of the Brazilian guidelines for biorepositories and biobanks of human biological material with the purpose of research based on the ethical principles of human dignity, autonomy, beneficence, justice, and precaution. METHODS: An interdisciplinary work group was constituted to

  7. Diretrizes para Autores / Declaração de Direito Autoral e Política de Privacidade

    Directory of Open Access Journals (Sweden)

    Francisco Gilson Rebouças Porto Junior

    2016-05-01

    Full Text Available Diretrizes para Autores / Declaração de Direito Autoral e Política de Privacidade   Disponível em: Url:http://opendepot.org/2785/    Abrir em (para melhor visualização em dispositivos móveis - Formato Flipbooks: Issuu / Calameo

  8. Atrial natriuretic peptide in patients with heart failure and chronic atrial fibrillation : Role of duration of at atrial fibrillation

    NARCIS (Netherlands)

    Van Den Berg, MP; Crijns, HJGM; Van Veldhuisen, DJ; Van Gelder, IC; De Kam, PJ; Lie, KI

    The purpose of this study was to analyze the determinants of atrial natriuretic peptide level in patients with congestive heart failure and atrial fibrillation. In particular, the duration of atrial fibrillation was analyzed because atrial fibrillation per se might have a specific effect on atrial

  9. Pharmacological Treatment for Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Kaoru Sugi, MD PhD

    2005-01-01

    Full Text Available Pharmacological treatment for atrial fibrillation has a variety of purposes, such as pharmacological defibrillation, maintenance of sinus rhythm, heart rate control to prevent congestive heart failure and prevention of both cerebral infarction and atrial remodeling. Sodium channel blockers are superior to potassium channel blockers for atrial defibrillation, while both sodium and potassium channel blockers are effective in the maintenance of sinus rhythm. In general, digitalis or Ca antagonists are used to control heart rate during atrial fibrillation to prevent congestive heart failure, while amiodarone or bepridil also reduce heart rates during atrial fibrillation. Anticoagulant therapy with warfarin is recommended to prevent cerebral infarction and angiotensin converting enzyme antagonists or angiotensin II receptor blockers are also used to prevent atrial remodeling. One should select appropriate drugs for treatment of atrial fibrillation according to the patient's condition.

  10. Diretrizes curriculares nacionais para os cursos de nutrição: avanços, lacunas, ambiguidades e perspectivas Curricular guidelines for nutrition courses: advances, ambiguities, omissions and perspectives

    Directory of Open Access Journals (Sweden)

    Nadia Tavares Soares

    2010-10-01

    Full Text Available As orientações curriculares e pedagógicas para a formação do profissional de nutrição receberam influência da dinâmica das transformações do ensino superior no Brasil. Em 2001, o Ministério da Educação instituiu as diretrizes curriculares nacionais para os cursos de graduação da área da saúde, em consonância com a Lei de Diretrizes e Bases da Educação. As diretrizes curriculares conformam uma nova baliza para o ensino em saúde a partir da extinção do currículo mínimo, considerado demasiadamente teórico, rígido e inflexível, não atendendo às exigências particulares de cada região, instituição ou curso, bem como às demandas sociais. As diretrizes curriculares representam ainda o desejo de superação da hegemonia do modelo biomédico e do ensino centrado no professor. O objetivo deste artigo é analisar criticamente os conteúdos das diretrizes curriculares para a graduação em nutrição e refletir sobre avanços, ambiguidades e lacunas, na perspectiva de uma implementação participativa e de avaliações constantes. O texto discute perfil do egresso, competências e habilidades e conteúdos de estudo, apontando para novas discussões sobre o que está proposto, fomentando possíveis cenários para o aperfeiçoamento do processo da formação em nutrição.The curricular and pedagogical guidelines for the formation of dieticians were influenced by the dynamic changes that occurred in higher education in Brazil. In 2001, the Ministry of Education instituted the national curricular guidelines for undergraduate health-related courses, in agreement with the Law of Education Guidelines and Fundamentals. These guidelines represented a new landmark for health-related education since it abolished the minimum curricular requirements, which were considered excessively theoretical and inflexible and did not meet the specific requirements of each region, institution or course, and the social demands. The curricular

  11. O CURSO DE PEDAGOGIA E AS NOVAS DIRETRIZES CURRICULARES: ANÁLISE CRÍTICA DE UM CURRÍCULO ESCRITO

    Directory of Open Access Journals (Sweden)

    Antonio Pereira

    2015-03-01

    Full Text Available O texto descreve uma análise do currículo escrito do curso de pedagogia da Universidade do Estado da Bahia, fruto de um processo (descontínuo de reformulação curricular, buscando explicitar as contradições e possibilidades desse documento a partir dos elementos constitutivos que organizam o currículo, como os eixos temáticos, a concepção formativa, o perfil profissiográfico que se deseja para o/a pedagogo/a, os princípios educativos e a matriz curricular. Nesse percurso, busca-se conceituar currículo escrito e praticado, bem como revisar, resumidamente, o contexto social das reformas neoliberais e seus reflexos na educação, particularmente no curso de pedagogia, quando da imposição de uma reformulação para flexibilizá-lo, imposição essa verificada nas novas legislações educacionais, como a LDBN 9394/96 e as Diretrizes Curriculares de Pedagogia, Resolução CNE/CP 01/2006.

  12. Increased amount of atrial fibrosis in patients with atrial fibrillation secondary to mitral valve disease

    NARCIS (Netherlands)

    Geuzebroek, Guillaume S. C.; van Amersfoorth, Shirley C. M.; Hoogendijk, Mark G.; Kelder, Johannes C.; van Hemel, Norbert M.; de Bakker, Jacques M. T.; Coronel, Ruben

    2012-01-01

    Objective: Atrial fibrosis is related to atrial fibrillation but may differ in patients with mitral valve disease or lone atrial fibrillation. Therefore, we studied atrial fibrosis in patients with atrial fibrillation + mitral valve disease or with lone atrial fibrillation and compared it with

  13. Familial neonatal atrial tachycardia.

    OpenAIRE

    Balaji, S.; Sullivan, I. D.; Shinebourne, E. A.

    1996-01-01

    A father and his two sons each presented with atrial tachycardia in the newborn period. The father went on to develop dilated cardiomyopathy. The first son (who also had transposition of the great arteries) died from the arrhythmia after surgery. The second son is currently successfully managed pharmacologically.

  14. Modulation of atrial fibrillation

    NARCIS (Netherlands)

    Geuzebroek, G.S.C.

    2013-01-01

    In this thesis we investigate the results of various surgical procedures for atrial fibrillation which have been performed in the last 2 decades in the Sint Antonius Hospital, Nieuwegein, The Netherlands. In the 1990s the classical Maze III procedure was the main surgical technique for

  15. Familial neonatal atrial tachycardia.

    Science.gov (United States)

    Balaji, S.; Sullivan, I. D.; Shinebourne, E. A.

    1996-01-01

    A father and his two sons each presented with atrial tachycardia in the newborn period. The father went on to develop dilated cardiomyopathy. The first son (who also had transposition of the great arteries) died from the arrhythmia after surgery. The second son is currently successfully managed pharmacologically. PMID:8795484

  16. Rivaroxaban in atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Giorgi MA

    2012-08-01

    Full Text Available Mariano A Giorgi,1,2 Lucas San Miguel31Cardiology Service, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”, 2Department of Pharmacology, School of Medicine, Universidad Austral, 3Department of Cardiology and Cardiovascular Surgery, FLENI, Buenos Aires, ArgentinaAbstract: Warfarin is the traditional therapeutic option available to manage thromboembolic risk in atrial fibrillation. The hemorrhagic risk with warfarin depends mainly on the international normalized ratio (INR. Data from randomized controlled trials show that patients have a therapeutic INR (2.00–3.00 only 61%–68% of the time while taking warfarin, and this target is sometimes hard to establish. Many compounds have been developed in order to optimize the profile of oral anticoagulants. We focus on one of them, rivaroxaban, comparing it with novel alternatives, ie, dabigatran and apixaban. The indication for rivaroxaban in nonvalvular atrial fibrillation was evaluated in ROCKET-AF (Rivaroxaban-once daily, Oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation. In this trial, rivaroxaban was associated with a 12% reduction in the incidence of the primary endpoint compared with warfarin (hazard ratio 0.88; 95% confidence interval [CI] 0.74–1.03; P < 0.001 for noninferiority and P = 0.12 for superiority. However, patients remained in the therapeutic range for INR only 55% of the time, which is less than that in RE-LY (the Randomized Evaluation of Long-Term Anticoagulation Therapy, 64% and in the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation, 66%. This shorter time spent in the therapeutic range has been one of the main criticisms of the ROCKET-AF trial, but could actually reflect what happens in real life. In addition, rivaroxaban exhibits good pharmacokinetic and pharmacoeconomic properties. Novel anticoagulants

  17. INTRACARDIAC ATRIAL DEFIBRILLATION

    Science.gov (United States)

    Dosdall, Derek J.; Ideker, Raymond E.

    2007-01-01

    Intravascular ventricular defibrillation and intravascular atrial defibrillation have many similarities, some of which are as follows. An important factor influencing the outcome of the shock is the potential gradient field created throughout the ventricles or the atria by the shock. A minimum potential gradient is required throughout the ventricles and probably the atria to defibrillate. The value of this minimum potential gradient is affected by several factors including the duration, tilt, and number of phases of the waveform. For shock strengths near the defibrillation threshold, earliest activation following failed shocks arises in a region in which the potential gradient is low. The defibrillation threshold energy can be decreased by adding a third and even a fourth defibrillation electrode in regions where the shock potential gradient is low for the shock field created by the first two defibrillation electrodes and giving two sequential shocks, each through a different set of electrodes. However, the addition of more electrodes and sequential shocks complicates both the device and its implantation. Since patients are conscious when the atrial defibrillation shock is given, they experience pain during the shock, which is one of the main drawbacks of intravascular atrial defibrillation. Unfortunately, the pain threshold for defibrillation shocks is so low that a shock of less than 1 Joule is uncomfortable and is not much less painful than shocks several times stronger. Therefore, even though electrode configurations exist that have lower atrial defibrillation threshold energy requirements than the atrial defibrillation threshold with standard defibrillation electrode configurations used in implantable cardioverter/defibrillators (ICDs) for ventricular defibrillation, they are not clinically practical because their shocks are almost as painful as with the standard ICD electrode configurations and they would cause the ICD to be more complicated and to take

  18. Imagens urbanas: diretrizes de planejamento e desenho urbano baseadas na leitura popular de espaços públicos Urban images: guidelines to urban planning and design based in the popular reading of public spaces

    Directory of Open Access Journals (Sweden)

    mail: elsonmp@hotmail.com

    2010-04-01

    Full Text Available O presente artigo surgiu a partir do questionamento de como seria possível compreender e aplicar o imaginário coletivo no processo de planejamento e desenho urbanos. O objetivo principal, então, é o de demonstrar como se deu a aplicação prática do cruzamento de métodos de leitura de imagens mentais, numa tentativa de instrumentalizar a leitura popular. Por meio de pesquisa com o público usuário do Largo da Ordem, em Curitiba, PR, nos anos de 2004 e 2005, e com base em pesquisa documental, entrevistas e desenhos feitos pela comunidade, os autores obtiveram material necessário para aplicar o método de mapas cognitivos e criar arborescências, das quais puderam ser extraídas diretrizes para um planejamento e desenho urbanos mais próximos à realidade dos usuários da cidade, tentando ratificar a leitura comunitária preconizada por um planejamento urbano participativo. A partir de pesquisa qualitativa, puderam ser delineadas diretrizes de re-dinamização sócio-espacial para tal recorte, com respaldo tanto na bibliografia estudada quanto no material obtido com a comunidade, ratificando que, ao instrumentalizar a comunidade, é possível abrir um caminho para o diálogo entre o técnico e o cidadão (que também inclui os técnicos, pois esses habitam a cidade.

  19. HYPERTHYROIDISM AND ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    I. M. Marusenko

    2017-01-01

    Full Text Available Review on a problem of the development of atrial fibrillation in patients with thyrotoxicosis is presented. Thyrotoxicosis is one of the most frequent endocrine diseases, conceding only to a diabetes mellitus. The most frequent reasons of hyperthyroidism are Graves’ disease and functional thyroid autonomy. The authors give an analysis of data on the cardiac effects of thyrotoxicosis, features of heart remodeling under the influence of thyroid hyperfunction, prevalence of atrial fibrillation in thyrotoxicosis, depending on age, as well as the possibility of restoring sinus rhythm in the combination of these diseases. Particular attention is paid to the effect on the heart of subclinical thyrotoxicosis, which is defined as a dysfunction of the thyroid gland, characterized by low serum concentration of thyrotropin, normal values of free thyroxine and free triiodothyronine. Subclinical hyperthyroidism is also capable of causing heart remodeling and diastolic dysfunction.Prevalence of thyrotoxicosis in elderly people is higher in areas of iodine deficiency; it is relevant for our country due to the large territory of iodine deficiency. In elderly patients, the cardiac effects of thyrotoxicosis prevail in the clinical picture, that makes it difficult to diagnose endocrine disorders, and correction of thyrotoxicosis is critically important for the successful control of the heart rhythm. The article also discusses the problem of thyrotoxic cardiomyopathy, caused by the toxic effect of excess thyroid hormones: features of this heart disorder, factors affecting its formation, clinical significance and contribution to the development of rhythm disturbances. The greatest significance is the development of atrial fibrillation as a result of thyrotox-icosis in older patients who already have various cardiovascular diseases.Atrial fibrillation is the most frequent heart rhythm disorder in thyrotoxicosis. The main cause of arrhythmia in hyperthyroidism is the

  20. Right atrial lipoma

    Directory of Open Access Journals (Sweden)

    Pêgo-Fernandes Paulo M.

    2003-01-01

    Full Text Available Benign cardiac tumors are rare, and lipomas are among those less frequently found. We report the case of a 48-year-old male complaining of high blood pressure and epistaxis in the last 2 months, with a diagnosis of right atrial lipoma established on echocardiography, magnetic resonance imaging, and anatomicopathological examination. The tumor was successfully removed, and up to 42 months after surgical excision, no evidence of tumor relapse was observed.

  1. Abnormal atrial activation in young patients with lone atrial fibrillation

    DEFF Research Database (Denmark)

    Holmqvist, Fredrik; Olesen, Morten S; Tveit, Arnljot

    2011-01-01

    Aims Patients with a history of atrial fibrillation (AF) have previously been shown to have altered atrial conduction, as seen non-invasively using signal-averaged P-wave analysis. However, little is known about the P-wave morphology in patients in the early phases of AF with structurally normal ...

  2. Occlusion of left atrial appendage in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    О. Н. Ганеева

    2015-10-01

    Full Text Available The article reviews a new method of prophylaxis of thromboembolitic complications, specifically occlusion of left atrial appendage, in patients with atrial fibrillation. Indications and contraindications for the procedure, as well as a step-by-step process of the intervention itself are described. Special emphasis is placed on the up-to-date evidence and the review of clinical trials.

  3. Atrial fibrillation and female sex.

    Science.gov (United States)

    Anselmino, Matteo; Battaglia, Alberto; Gallo, Cristina; Gili, Sebastiano; Matta, Mario; Castagno, Davide; Ferraris, Federico; Giustetto, Carla; Gaita, Fiorenzo

    2015-12-01

    Atrial fibrillation is the most common supraventricular arrhythmia. Its prevalence increases with age and preferentially affects male patients. Over 75 years of age, however, female patients being more prevalent, the absolute number of patients affected is similar between sexes. Despite this, few data are available in the literature concerning sex-related differences in atrial fibrillation patients. The present systematic review therefore considers comorbidities, referring symptoms, quality of life, pharmacological approaches and trans-catheter ablation in female rather than in male atrial fibrillation patients in search of parameters that may have an impact on the treatment outcome. In brief, female atrial fibrillation patients more commonly present comorbidities, leading to a higher prevalence of persistent atrial fibrillation; moreover, they refer to hospital care later and with a longer disease history. Atrial fibrillation symptoms relate to low quality of life in female patients; in fact, atrial fibrillation paroxysm usually presents higher heart rate, leading to preferentially adopt a rate rather than a rhythm-control strategy. Female atrial fibrillation patients present an increased risk of stroke, worsened by the lower oral anticoagulant prescription rate related to the concomitant higher haemorrhagic risk profile. Trans-catheter ablation is under-used in female patients and, on the contrary, they are more commonly affected by anti-arrhythmic drug side effects.

  4. Atenção primária à saúde: diretrizes, desafios e recomendações. Revisão de bibliografia internacional Primary health care: guidelines, challenges and recommendations. A review of international literature

    Directory of Open Access Journals (Sweden)

    Luiz Gustavo Silva Souza

    2011-01-01

    Full Text Available Apresentamos uma revisão de bibliografia internacional que teve por objetivo identificar e analisar a diversidade de temas associados à Atenção Primária à Saúde, especialmente o cotidiano de trabalho de seus profissionais, suas diretrizes e seus desafios políticos e clínicos. Analisamos os resumos de 105 artigos publicados entre 1999 e 2009. Selecionamos, para análise, 34 artigos identificados de acordo com critérios específicos. Criamos categorias temáticas e comparamos os dados com certa literatura brasileira sobre o tema. Os artigos centram-se no profissional de medicina e enfatizam a noção de medicina baseada em evidências. Abordam principalmente a implementação de diretrizes na Atenção Primária e as relações entre profissionais e usuários. Admitem a complexidade da Atenção Primária e a importância de aproximação à realidade dos pacientes. Entretanto, não abordam a intersetorialidade, não questionam radicalmente o especialismo curativista e não mencionam a promoção de cidadania, autonomia e cogestão junto aos usuários. Falam da necessidade de abordar problemas "humanos" nos níveis de implementação de diretrizes, encontro clínico etc., mas se mostram distanciados das ciências humanas.We present a review of international literature, aiming at identifying and analyzing the diversity of themes associated to Primary Health Care. We focused on the characteristics of the work of health care personnel, its guidelines and its political and clinical challenges. We analyzed the abstracts of 105 articles published between 1999 and 2009. Then, we integrally read and analyzed 34 articles, creating thematic categories. We compared data to Brazilian literature on the subject. The articles focus on physician's work and emphasize the notion of evidence-based medicine. They mainly approach the implementation of guidelines to primary health care and the professional-patient relations. They acknowledge the complexity of

  5. Atrial fibrillation: Therapeutic potential of atrial K+channel blockers.

    Science.gov (United States)

    Ravens, Ursula; Odening, Katja E

    2017-08-01

    Despite the epidemiological scale of atrial fibrillation, current treatment strategies are of limited efficacy and safety. Ideally, novel drugs should specifically correct the pathophysiological mechanisms responsible for atrial fibrillation with no other cardiac or extracardiac actions. Atrial-selective drugs are directed toward cellular targets with sufficiently different characteristics in atria and ventricles to modify only atrial function. Several potassium (K + ) channels with either predominant expression in atria or distinct electrophysiological properties in atria and ventricles can serve as atrial-selective drug targets. These channels include the ultra-rapidly activating, delayed outward-rectifying Kv1.5 channel conducting I Kur , the acetylcholine-activated inward-rectifying Kir3.1/Kir3.4 channel conducting I K,ACh , the Ca 2+ -activated K + channels of small conductance (SK) conducting I SK , and the two pore domain K + (K2P) channels TWIK-1, TASK-1 and TASK-3 that are responsible for voltage-independent background currents I TWIK-1 , I TASK-1 , and I TASK-3 . Here, we briefly review the characteristics of these K + channels and their roles in atrial fibrillation. The antiarrhythmic potential of drugs targeting the described channels is discussed as well as their putative value in treatment of atrial fibrillation. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Electrocardiographic features: Various atrial site pacing

    Directory of Open Access Journals (Sweden)

    Asit Das

    2017-09-01

    Full Text Available Atrial pacing is done for either symptomatic sinus node dysfunction (SND or for maintenance of atrio-ventricular synchrony in a dual chamber pacemaker. Conventionally, atrial lead is placed in the right atrial appendage. Atrial conduction disorder in patients with permanent pacing results in higher incidence of atrial fibrillation. Atrial septal pacing has emerged as a solution to this problem. So, it is extremely important to understand the different features of paced P wave from various atrial pacing sites. Conventional right atrial appendage pacing in presence of atrial conduction disorder results in marked latency with prolonged P wave duration with reduced amplitude. The morphology is similar to sinus rhythm. Atrial septal pacing causes short and sharp P wave with negative polarity in inferior leads and positive polarity in lead V1 in lower septal pacing, whereas positive polarity in inferior leads and negative polarity in lead V1 during pacing from upper septum.

  7. [Recurrent left atrial myxoma].

    Science.gov (United States)

    Moreno Martínez, Francisco L; Lagomasino Hidalgo, Alvaro; Mirabal Rodríguez, Roger; López Bermúdez, Félix H; López Bernal, Omaida J

    2003-01-01

    Primary cardiac tumors are rare. Mixomas are the most common among them; 75% are located in the left atrium, 20% in the right atrium, and the rest in the ventricles. The seldom appear in atrio-ventricular valves. Recidivant mixoma are also rare, appearing in 1-5% of all patients that have undergone surgical treatment of a mixoma. In this paper we present our experience with a female patient, who 8 years after having been operated of a left atrial mixoma, began with symptoms of mild heart failure. Transthoracic echocardiography revealed recurrence of the tumor, and was therefore subjected to a second open-heart surgery from which she recovered without complications.

  8. Dementia and Atrial Fibrillation

    DEFF Research Database (Denmark)

    Pastori, Daniele; Miyazawa, Kazuo; Lip, Gregory Y H

    2018-01-01

    The risk of developing dementia is increased in patients with atrial fibrillation (AF), with the incidence of both conditions increasing with aging. Patients with dementia frequently do not receiving adequate thrombo-prophylaxis, because of the inability to monitor INR and/or to achieve...... in therapeutic range during VKAs therapy, the assessment of cognitive impairment may help identify those patients who may benefit from switching to NOACs. In conclusion, patients with AF and dementia benefit from anticoagulation and should not be denied receiving adequate stroke prevention. Cognitive function...

  9. Diretrizes para processo de projeto de fachadas com painéis pré-fabricados de concreto em ambiente BIM

    Directory of Open Access Journals (Sweden)

    Luciana de Cresce El Debs

    Full Text Available Este artigo expõe as diretrizes para a criação de um processo de elaboração de projetos que utilizam painéis pré-fabricados de fachada, tendo como base o ambiente de Building Information Modeling (BIM. Os painéis pré-fabricados arquitetônicos de concreto (PPAC foram utilizados como ponto de partida para a estruturação da proposta. A lógica de montagem justifica esta abordagem: assim como no sistema construtivo pré-fabricado, em que as peças são construídas fora do canteiro e chegam a este no momento da montagem, em BIM, os componentes da indústria da Arquitetura, Engenharia e Construção (AEC são modelados independentemente e inseridos no momento oportuno no modelo. Foram realizados estudos teóricos sobre as características dos PPACs, seguidos de consulta a profissionais experientes do setor, para confirmação da seleção de dados e procedimentos necessários para o projeto. Em seguida, elaboraram-se fluxogramas de orientação para o processo de projeto. Uma simulação do procedimento proposto foi feita com o programa Revit 2013, para validação. A proposta procura auxiliar o projetista a definir os passos de projeto, bem como os dados para a modelagem dos elementos. Ao auxiliar projetistas a conceber projetos utilizando elementos pré-fabricados, procura-se facilitar e estimular seu uso mais frequente no país.

  10. Diretrizes curriculares do curso de pedagogia no Brasil: disputas de projetos no campo da formação do profissional da educação Curriculum guidelines of the pedagogy course in Brazil: project disputes in the field of the training of education professionals

    Directory of Open Access Journals (Sweden)

    Márcia Angela da S. Aguiar

    2006-10-01

    Full Text Available Neste artigo, os autores analisam as novas diretrizes curriculares do curso de pedagogia, objeto de normatização do Conselho Nacional de Educação (CNE, em 2005, a partir do debate feito à luz do acervo de conhecimentos teórico-práticos sistematizados pelas principais entidades do campo educacional (ANFOPE, ANPED, CEDES, FORUMDIR, ANPAE.1 Evidenciam, criticamente, alguns dos problemas e das tensões que marcam a trajetória desse curso ao longo da história da educação brasileira. Focalizam, no âmbito das políticas educacionais, em especial, o movimento dos educadores pela definição das diretrizes curriculares para a formação dos profissionais da Educação Básica, que reflete posições de ordem epistemológica, pedagógica e política atinentes às visões e aos projetos educacionais em disputa, no Brasil, nas últimas décadas. A problematização das diretrizes curriculares concorre para ampliar a compreensão da complexidade do campo da pedagogia e dos desafios teórico-práticos com que as instituições de ensino superior, em particular as universidades, deparam-se para materializar a reforma do curso de pedagogia, na esteira das novas regulamentações legais e na perspectiva de uma formação cidadã.Based on the debate conducted in the light of the theoretical-practical knowledge acquired by the main organisms of the educational field (ANFOPE, ANPED, CEDES, FORUMDIR, ANPAE, the authors analyze the new curriculum guidelines of the pedagogy course, which was regulated by the Conselho Nacional de Educação (CNE - Brazilian Council for Education in 2005. They critically highlight some of the problems and tensions that have marked the trajectory of this course along the history of Brazilian education. Within the educational policies, they more particularly focus on the educator movement for the definition of curriculum guidelines for the training of basic education professionals, which reflects some epistemological

  11. Formação do enfermeiro na perspectiva das competências: uma breve reflexão

    Directory of Open Access Journals (Sweden)

    Geralda Fortina dos Santos

    2004-02-01

    Full Text Available Diante das novas diretrizes curriculares para os cursos de graduação da área da saúde, urge reflexão e tomada de consciência sobre os rumos do ensino de Enfermagem. A transição entre: currículos mínimos e currículo por diretrizes; objetivos educacionais e formação por competência; competências no mundo do trabalho e formação profissional; além de formação humana e formação tecnicista são alguns elementos que precisam fazer parte do cotidiano dos enfermeiros em todas as suas áreas de atuação. Importa no momento iniciar uma reflexão sobre estas questões. É o que se coloca como o propósito deste texto.

  12. Diretrizes da Associação Médica Brasileira para o diagnóstico e diagnóstico diferencial do transtorno de ansiedade social Guidelines of the Brazilian Medical Association for the diagnosis and differential diagnosis of social anxiety disorder

    Directory of Open Access Journals (Sweden)

    Marcos Hortes N. Chagas

    2010-12-01

    Full Text Available OBJETIVO: O transtorno de ansiedade social é o transtorno de ansiedade mais comum, apresenta curso crônico, frequentemente sem remissões, sendo comumente associado com importante prejuízo funcional e comprometimento psicossocial. A Associação Médica Brasileira, por meio do projeto "Diretrizes", busca desenvolver consensos de diagnóstico e tratamento para as doenças mais comuns. O objetivo deste trabalho é apresentar os achados mais relevantes das diretrizes da Associação Médica Brasileira relativas ao diagnóstico e diagnóstico diferencial do transtorno de ansiedade social. MÉTODO: O método utilizado foi o proposto pela Associação Médica Brasileira para o projeto Diretrizes. A busca foi realizada nas bases de dados do Medline (PubMed, Scopus, Web of Science e Lilacs, sem limite de tempo. A estratégia utilizada baseou-se em perguntas estruturadas na forma P.I.C.O. (acrônimo das iniciais "paciente ou população"; "intervenção, indicador ou exposição"; "controle ou comparação" e; "outcome ou desfecho". RESULTADOS: São apresentados dados relativos a manifestações clínicas, prejuízos e implicações, diferenças entre os subtipos generalizado e circunscrito, e impacto com depressão, abuso e dependência de drogas e outros transtornos de ansiedade. Além disso, foram realizadas discussões acerca dos principais diagnósticos diferenciais. CONCLUSÃO: As diretrizes propõem-se a servir de referência para o médico generalista e especialista, auxiliando e facilitando o diagnóstico do transtorno de ansiedade social.OBJECTIVE: Social anxiety disorder is the most common anxiety disorder. The condition has a chronic course usually with no remission and is frequently associated with significant functional and psychosocial impairment. The Brazilian Medical Association, with the project named Diretrizes ('Guidelines', in English, endeavors to develop diagnostic and treatment protocols for the most common disorders. This work

  13. Atrial fibrillation and heart failure: is atrial fibrillation a disease?

    Science.gov (United States)

    Tilman, V

    2014-09-01

    Atrial fibrillation in heart failure often occur together. The relationship between atrial fibrillation and heart failure has remained a subject of research. The main manifestation of the violation of hydrodynamics in heart failure is the increased end-diastolic pressure, which is transmitted through the intercommunicated system (left ventricle-left atrium-pulmonary veins-alveolar capillaries) causing increased pulmonary wedge pressure with the danger for pulmonary edema. End-diastolic pressure is the sum of left ventricle diastolic pressure and left atrial systolic pressure. Stopping the mechanical systole of the left atrium can reduce the pressure in the system in heart failure. Atrial fibrillation stops the mechanical systole of the left atrium and decreases the intercommunicating pressure and pulmonary wedge pressure. It is possible that atrial fibrillation is a mechanism for protection from increasing end-diastolic pressure and pulmonary wedge pressure, and prevents the danger of pulmonary edema. This hypothesis may explain the relationship between heart failure and atrial fibrillation and their frequent association. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Empreendedorismo como escopo de diretrizes políticas da União Europeia no âmbito do ensino superior

    Directory of Open Access Journals (Sweden)

    Rachel de Castro Almeida

    2015-06-01

    Full Text Available Como resultado de orientações políticas propaladas pela União Europeia (UE, desde o início deste século, o ensino superior europeu, tem abarcado um novo desafio: potencializar o designado “espírito empreendedor”. Os apelos ao empreendedorismo juvenil qualificado se estendem por todo o continente, adquirindo particular relevo nos países do sul, onde a crise europeia ecoa de forma mais aguda. A tendência das mais diversas instituições de ensino para adaptar seus procedimentos às diretrizes da UE consubstanciou-se na inclusão de novas disciplinas nos currículos, na criação de associações de estudantes ligadas ao empreendedorismo e no estabelecimento de estruturas administrativas e acadêmicas que fomentam a concepção de spin-off e a transferência de conhecimento. A despeito desses esforços disseminados, ainda não há uma tradição de avaliar e monitorar os resultados dessas iniciativas, não sendo assim possível conhecer e antecipar devidamente os seus resultados e impactos econômicos, nomeadamente no nível do emprego. Este artigo aponta três eixos analíticos centrais na observação desse novo vetor de transformação do ensino superior. Pretendemos desnaturalizar o conceito de empreendedorismo, evitando a armadilha da sua reificação; em seguida, realizaremos uma breve resenha acerca do desenvolvimento da noção de empreendedorismo no campo acadêmico; por fim, tencionamos documentar a relevância que as orientações empreendedoras têm assumido no desenho das políticas da UE, destacando a expressão que alcançaram no sistema educativo, com especial relevo para os seus patamares formativos mais elevados.

  15. Estabelecimento de diretrizes e recomendações com enfoque em manutenibilidade para o projeto de aeronaves de asas rotativas.

    OpenAIRE

    Eduardo Andrés Serrano Velásquez

    2011-01-01

    A aceleração do progresso tecnológico normalmente começa com uma maior ênfase na pesquisa, projeto e desenvolvimento para gerar produtos mais competitivos. O presente trabalho identifica a importância de estabelecer diretrizes e recomendações com enfoque em manutenibilidade para apoiar o projetista na predição da manutenibilidade de um produto aeronáutico, indicando pontos vulneráveis no projeto que afetam a segurança durante as atividades de manutenção. A área de manutenção tem crescido e ve...

  16. Formação humana e competências: o debate nas diretrizes curriculares de psicologia

    OpenAIRE

    Lima, Vinicius Cesca de; Souza, Régis de Toledo

    2014-01-01

    O artigo analisa as perspectivas de formação humana e de desenvolvimento de competências identificadas nas Diretrizes Curriculares Nacionais para os Cursos de Graduação em Psicologia. A partir da crítica aos processos modernos de formação humana, realizada pela Teoria Crítica da Sociedade, analisamos sua institucionalização em práticas escolares, incluindo a pedagogia por competências, e mais especificamente na educação universitária. Por fim, discutimos essas questões na formação de psicólog...

  17. Giant right atrial myxoma

    International Nuclear Information System (INIS)

    Valdes Martin, Alexander; Ortega Torres, Yanela Yordanka; Hevia Sanchez, Luis

    2012-01-01

    Primary tumors of the heart are rare, their estimated incidence ranging between 0.0017-0.19%, and among them cardiac myxomas are the most common (50%). Right atrial localization is uncommon, occurring only in 15-20% of cases. Their clinical presentation ranges from an asymptomatic status to the presence of constitutional symptoms or symptoms pointing to the presence of cardiac obstruction or pulmonary embolism. A case is presented of a 36-year-old male patient with a history of asthenia, palpitations and reduced functional capacity. Transthoracic echocardiography revealed a large mass in the right atrium which prolapsed into the right ventricle and obstructed the tricuspid valve. The patient underwent cardiopulmonary bypass surgery and the mass (9x9 cm) was removed without any complication. Histological examination confirmed the diagnosis of myxoma.

  18. Percepções de formandos do curso de odontologia sobre as diretrizes curriculares nacionais Perceptions of dentistry course graduates about the national curriculum guidelines

    Directory of Open Access Journals (Sweden)

    Cristina Berger Fadel

    2013-08-01

    Full Text Available Este estudo teve por objetivo avaliar a percepção de acadêmicos formandos do curso de Odontologia da Universidade Estadual de Ponta Grossa, no Paraná, quanto ao atual projeto pedagógico. Participaram 91 formandos, os quais responderam a um questionário autoaplicado. A maioria dos alunos mostrou conhecer o projeto pedagógico do curso, com uma percepção positiva, e identificou que contempla as características das Diretrizes Curriculares Nacionais. As competências e habilidades, expressas nas Diretrizes e proporcionadas pelo curso, aquelas nas quais os formandos se consideram mais aptos a desempenhar são: ações de prevenção, promoção, proteção e reabilitação da saúde; disposição ao aprendizado contínuo; e tomada de decisões e atuação em equipes multiprofissionais. Quanto à estrutura curricular, grande parte dos alunos percebeu duplicação de conteúdos entre as disciplinas e dificuldades em oferecer atenção integral aos pacientes. No entanto, a maioria identifica a integração entre teoria e prática como ideal ou satisfatória. Os resultados deste estudo, somados à avaliação institucional, mostram que, apesar da percepção positiva da comunidade acadêmica, existem algumas fragilidades no atual projeto pedagógico do curso que indicam a necessidade de se avançar na construção de um currículo integrado.This study aimed to evaluate the perception graduates have of the current pedagogical project in place at the College of Dentistry at the Ponta Grossa State University State of Paraná, southern Brazil. A total of 91 students took part in the study by completing a selfadministered questionnaire. Most students were knowledgeable about the course's pedagogical project, had a positive view of it, and considered that it includes the features of the National Curriculum Guidelines. The skills and abilities, expressed in the Guidelines and provided by the course, those in which the students consider themselves as

  19. Formação humana e competências: o debate nas diretrizes curriculares de psicologia

    Directory of Open Access Journals (Sweden)

    Vinicius Cesca de Lima

    2014-12-01

    Full Text Available O artigo analisa as perspectivas de formação humana e de desenvolvimento de competências identificadas nas Diretrizes Curriculares Nacionais para os Cursos de Graduação em Psicologia. A partir da crítica aos processos modernos de formação humana, realizada pela Teoria Crítica da Sociedade, analisamos sua institucionalização em práticas escolares, incluindo a pedagogia por competências, e mais especificamente na educação universitária. Por fim, discutimos essas questões na formação de psicólogos. Confrontando as propostas de formação para a emancipação e de formação para o desenvolvimento de competências, apontamos, a partir da matriz pautada nas Diretrizes Curriculares, que a formação em psicologia representa um processo contraditório que evidencia um projeto em disputa.

  20. Segurança no trabalho e desenvolvimento de produto: diretrizes para integração na construção civil

    OpenAIRE

    Saurin,Tarcisio Abreu

    2005-01-01

    Este trabalho apresenta diretrizes para a integração de requisitos de segurança no trabalho à etapa de desenvolvimento de produto (DP) na construção civil. As diretrizes foram desenvolvidas a partir de entrevistas com um grupo de sete projetistas da construção civil, uma entrevista com a projetista de ar condicionado e um estudo exploratório de integração da segurança ao processo de DP. Embora as entrevistas tenham indicado que a integração ainda é uma prática pouco disseminada na construção,...

  1. Atrial fibrillation in KCNE1-null mice

    NARCIS (Netherlands)

    Temple, Joel; Frias, Patricio; Rottman, Jeffrey; Yang, Tao; Wu, Yuejin; Verheijck, E. Etienne; Zhang, Wei; Siprachanh, Chanthaphaychith; Kanki, Hideaki; Atkinson, James B.; King, Paul; Anderson, Mark E.; Kupershmidt, Sabina; Roden, Dan M.

    2005-01-01

    Although atrial fibrillation is the most common serious cardiac arrhythmia, the fundamental molecular pathways remain undefined. Mutations in KCNQ1, one component of a sympathetically activated cardiac potassium channel complex, cause familial atrial fibrillation, although the mechanisms in vivo are

  2. Multifocal atrial tachycardia in two neonates.

    Science.gov (United States)

    Farooki, Z Q; Green, E W

    1977-01-01

    Two neonates with rapid and irregular pulse rate had an uncommon form of atrial tachycardia. The irregular heart rate was first detected during fetal monitoring. Postnatal electrocardiograms were compatible with the diagnosis of multifocal atrial tachycardia or chaotic atrial rhythm. Both patients were treated with digoxin and the rhythm gradually reverted to sinus. This may represent the first description of multifocal atrial tachycardia in the newborn. Images PMID:901681

  3. Left Atrial Linear Ablation of Paroxysmal Atrial Fibrillation Guided by Three-dimensional Electroanatomical System

    DEFF Research Database (Denmark)

    Zhang, Dai-Fu; Li, Ying; Qi, Wei-Gang

    2005-01-01

    Objective To investigate the safety and efficacy of Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system. Methods 29 patients with paroxysmal atrial fibrillation in this study. A nonfluoroscopic mapping system was used to generate a 3D...... attacks unchanged. No pulmonary vein narrowing was observed. Conclusion Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system was safe and effective....

  4. A Large Right Atrial Myxoma Associated with Atrial Flutter Rhythm

    Directory of Open Access Journals (Sweden)

    Onursal Buğra

    2010-04-01

    Full Text Available A 22 year-old man presented to the emergency unit with the complaint of difficulty in breathing. In the physical exam, dyspnea and orthopnea were found. In the electocardiographic exam (ECG atrial flutter rhythm was seen. The transthoracic echocardiographic exam revealed a large atrial mass that was originating from interatrial septum. During surgery, complete surgical removal of the right atrial mass was successfully performed under moderate hypothermia. Histological investigations revealed a mass of 15 x 3 cm in diameter and the pathological examination showed that the lesion is a myxoma. Twelve months after surgical excision, clinical and chocardiographicalfollow-up showed a satisfactory exercise tolerance, sinus rhythm in ECG exam, and cardiac functions within normal limits.

  5. Why Atrial Fibrillation (AF or AFib) Matters

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Why Atrial Fibrillation (AF or AFib) Matters Updated:Aug 22,2017 ... possible. This content was last reviewed July 2016. Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters ...

  6. Diretrizes da Associação Médica Brasileira para o tratamento do transtorno de ansiedade social Guidelines of the Brazilian Medical Association for the treatment of social anxiety disorder

    Directory of Open Access Journals (Sweden)

    Michelle N. Levitan

    2011-09-01

    Full Text Available INTRODUÇÃO: O transtorno de ansiedade social (TAS é o transtorno de ansiedade mais comum, freqüentemente sem remissões, sendo comumente associado com importante prejuízo funcional e psicossocial. A Associação Médica Brasileira (AMB, através do "Projeto Diretrizes", busca desenvolver consensos de diagnóstico e tratamento para as doenças mais comuns. O objetivo deste trabalho é apresentar os achados mais relevantes das diretrizes relativas ao tratamento do TAS, servindo de referência para o médico generalista e especialista. MÉTODO: O método utilizado foi o proposto pela AMB. A busca foi realizada nas bases de dados do MEDLINE (PubMed, Scopus, Web of Science e Lilacs, entre 1980 e 2010. A estratégia utilizada baseou-se em perguntas estruturadas na forma P.I.C.O (acrônimo das iniciais "paciente ou população"; "intervenção, indicador ou exposição"; "controle ou comparação" e; "outcome ou desfecho". RESULTADOS: Estudos evidenciam que o tratamento farmacológico de primeira linha para adultos e crianças são os inibidores seletivos de recaptação de serotonina e os inibidores de recaptação de serotonina e noradrenalina, enquanto que a terapia cognitivo-comportamental é apontada como melhor tratamento psicoterápico. Além disso, algumas comorbidades psiquiátricas foram associadas a uma pior evolução do TAS. CONCLUSÕES: Apesar da alta prevalência, o TAS acaba por não receber a devida atenção e tratamento. A melhor escolha para o tratamento de adultos é a associação psicoterapia cognitivo-comportamental com inibidores seletivos de recaptação de serotonina e os inibidores de recaptação de serotonina e noradrenalina. Outras opções como benzodiazepínicos ou inibidores da monoamino-oxidase devem ser usados como segunda e terceira opção respectivamente.INTRODUCTION: Social anxiety disorder (SAD is the most common anxiety disorder, usually with no remission, and is commonly associated with significant

  7. Diretrizes para um Programa de Recolhimento de Medicamentos Vencidos no Brasil Guidelines for an Expired Medication Collection Program in Brazil

    Directory of Open Access Journals (Sweden)

    Débora Cynamon Kligerman

    2013-03-01

    Full Text Available O objetivo deste artigo é apontar e discutir diretrizes fundamentais para um programa de recolhimento de medicamentos vencidos para o Brasil e evidenciar a importância de campanhas de conscientização da população para seu sucesso. Este é um trabalho de revisão descritiva de base documental que analisa documentos oficiais, técnicos e normativos, de Portugal, México, Canadá e Colômbia, onde existem recolhimento de medicamentos vencidos em diferentes estágios de implementação, alguns já consolidados, outros em fase inicial, mas todos com bons resultados. Os países citados foram escolhidos objetivando-se representação da Europa, América do Norte e América Latina. Seis diretrizes comuns foram apontadas: corresponsabilidade na cadeia de fabricação e distribuição do medicamento; minimização de resíduos como estratégia; realização de programa piloto; investigação e classificação dos resíduos gerados; intersetorialidade entre diferentes esferas do governo e campanhas de sensibilização e conscientização da comunidade. Estas diretrizes constituem uma base para um Programa de Recolhimento de Medicamentos Usados no Brasil.The scope of this paper is to outline and discuss fundamental guidelines for an expired medication collection program for Brazil and to provide evidence supporting campaigns to raise the population's awareness for the program's success. It is a document-based descriptive review that analyzes official, technical and regulatory documents from Portugal, Canada and Colombia, where there are expired medication collection programs in different stages of implementation. Some of them are already fully implemented, while others are in the preliminary stages, but all of them are achieving good results. The countries listed above were chosen in order to represent Europe, North America and Latin America. Six common guidelines were outlined: co-responsibility in the drug's manufacturing and distribution chain; a

  8. Diretrizes de conduta e tratamento de síndromes febris periódicas associadas a febre familiar do Mediterrâneo

    Directory of Open Access Journals (Sweden)

    Maria Teresa R.A. Terreri

    2016-02-01

    Full Text Available Resumo Objetivo: Estabelecer diretrizes baseadas em evidências científicas para manejo da febre familiar do Mediterrâneo (FFM. Descrição do método de coleta de evidência: A diretriz foi elaborada a partir de 5 questões clínicas que foram estruturadas por meio do PICO (Paciente, Intervenção ou Indicador, Comparação e Outcome, com busca nas principais bases primárias de informação científica. Após definir os estudos potenciais para sustento das recomendações, esses foram graduados pela força da evidência e pelo grau de recomendação. Resultados: Foram recuperados, e avaliados pelo título e resumo, 10.341 trabalhos e selecionados 46 artigos para sustentar as recomendações. Recomendações: 1. O diagnóstico da FFM é baseado nas manifestações clínicas, caracterizadas por episódios febris recorrentes associados a dor abdominal, torácica ou artrite de grandes articulações; 2. A FFM é uma doença genética que apresenta traço autossômico recessivo ocasionada por mutação no gene MEFV; 3. Exames laboratoriais são inespecíficos e demonstram níveis séricos elevados de proteínas inflamatórias na fase aguda da doença, mas também, com frequência, níveis elevados mesmo entre os ataques. Níveis séricos de SAA podem ser especialmente úteis no monitoramento da eficácia do tratamento; 4. A colchicina é a terapia de escolha e demonstrou eficácia na prevenção dos episódios inflamatórios agudos e progressão para amiloidose em adultos; 5. Com base na informação disponível, o uso de medicamentos biológicos parece ser opção para pacientes com FFM que não respondem ou que são intolerantes à terapia com colchicina.

  9. Diretrizes curriculares nacionais para a formação inicial e continuada dos profissionais do magistério da educação básica: concepções e desafios

    Directory of Open Access Journals (Sweden)

    Luiz Fernandes Dourado

    2015-06-01

    Full Text Available RESUMO:O artigo apresenta as novas diretrizes curriculares nacionais para a formação inicial e continuada dos profissionais do magistério da educação básica, tendo por base o Parecer CNE/CP 02/2015, aprovado pelo Conselho Pleno do Conselho Nacional de Educação (CNE, em 9 de junho de 2015, e homologado pelo MEC em 24 de junho de 2015. Situa que o processo de construção dessas novas DCNs - objeto de discussões e debates a mais de uma década no CNE, por meio de Comissão Bicameral, ao considerar as diferentes concepções em disputas no campo, estudos e pesquisas sobre a temática, os marcos legais com destaque para a CF 1988, a LDB e o Plano Nacional de Educação (2014/214, bem como as deliberações das Conferências Nacionais de Educação (Conae, 2010 e 2014 - objetivou garantir maior organicidade para a formação inicial e continuada dos profissionais para o magistério da educação básica.

  10. Planos diretores: o caminho para o desenvolvimento sustentável das cidades

    Directory of Open Access Journals (Sweden)

    Alexsandro da Miranda

    2013-11-01

    Full Text Available Os Planos Diretores efetivam a existência de uma legislação geral estabelecendo as normas necessárias à implementação de políticas urbanas, previstas na Constituição Federal e no Estatuto da Cidade (Lei Federal 10.257/2001 e que em seu foco principal está o desenvolvimento e a expansão urbana.  Assim, o presente artigo aborda uma breve discussão teórica do tema, suas problemáticas e contextualizações na perspectiva de fundamentá-las à luz das teorias existentes. Três principais diretrizes devem ser destacadas: o desenvolvimento sustentável, a gestão democrática da cidade e o planejamento do desenvolvimento das cidades, onde os municípios, devem, portanto, utilizar as diretrizes e instrumentos do Estatuto da Cidade com o objetivo de estabelecer as regras que propiciem o pleno desenvolvimento econômico, social, ambiental e sustentável, com vistas a garantir o direito à cidade para todos os que nela vivem.

  11. Limited left atrial surgical ablation effectively treats atrial fibrillation but decreases left atrial function.

    Science.gov (United States)

    Compier, Marieke G; Tops, Laurens F; Braun, Jerry; Zeppenfeld, Katja; Klautz, Robert J; Schalij, Martin J; Trines, Serge A

    2017-04-01

    Limited left atrial (LA) surgical ablation with bipolar radiofrequency is considered to be an effective procedure for treatment of atrial fibrillation (AF). We studied whether limited LA surgical ablation concomitant to cardiac surgery is able to maintain LA function. Thirty-six consecutive patients (age 66 ± 12 years, 53% male, 78% persistent AF) scheduled for valve surgery and/or coronary revascularization and concomitant LA surgical ablation were included. Epicardial pulmonary vein isolation (PVI) and additional endo-epicardial lines were performed using bipolar radiofrequency. An age- and gender-matched control group (n = 36, age 66 ± 9 years, 69% male, 81% paroxysmal AF) was selected from patients undergoing concomitant epicardial PVI only. Left atrial dimensions and function were assessed on two-dimensional echocardiography preoperatively and at 3- and 12-month follow-up. Sinus rhythm (SR) maintenance was 67% for limited LA ablation and 81% for PVI at 1-year follow-up (P = 0.18). Left atrial volume decreased from 72 ± 21 to 50 ± 14 mL (31%, P Atrial transport function was restored in 54% of patients in SR after limited LA ablation compared with 100% of patients in SR after PVI. Atrial strain and contraction parameters (LA ejection fraction, A-wave velocity, reservoir function, and strain rate) significantly decreased after limited LA ablation. After PVI, strain and contraction parameters remained unchanged. Even limited LA ablation decreased LA volume, contraction, transport function, and compliance, indicating both reverse remodelling combined with significant functional deterioration. In contrast, surgical PVI decreased LA volume while function remained unchanged. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  12. Mechanisms of atrial fibrillation: is a cure at hand?

    Science.gov (United States)

    Scheinman, M M

    2000-05-01

    The mechanisms of atrial fibrillation relate to the presence of random reentry involving multiple interatrial circuits. Triggers for development of atrial fibrillation include rapidly discharging atrial foci (mainly from pulmonary veins) or degeneration of atrial flutter or atrial tachycardia into fibrillation. Therapy for control of atrial fibrillation includes drugs, atrial pacing for those with sinus node dysfunction, or ablation of the atrioventricular junction. Therapeutic maneuvers for cure of atrial fibrillation include surgical or radiofrequency catheter induced linear lesions to reduce the atrial tissue and prevent the requisite number of reentrant wavelets. We need a much better understanding of basic mechanisms before a true cure is at hand.

  13. Genetic basis of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Oscar Campuzano

    2016-12-01

    Full Text Available Atrial fibrillation is the most common sustained arrhythmia and remains as one of main challenges in current clinical practice. The disease may be induced secondary to other diseases such as hypertension, valvular heart disease, and heart failure, conferring an increased risk of stroke and sudden death. Epidemiological studies have provided evidence that genetic factors play an important role and up to 30% of clinically diagnosed patients may have a family history of atrial fibrillation. To date, several rare variants have been identified in a wide range of genes associated with ionic channels, calcium handling protein, fibrosis, conduction and inflammation. Important advances in clinical, genetic and molecular basis have been performed over the last decade, improving diagnosis and treatment. However, the genetics of atrial fibrillation is complex and pathophysiological data remains still unraveling. A better understanding of the genetic basis will induce accurate risk stratification and personalized clinical treatment. In this review, we have focused on current genetics basis of atrial fibrillation.

  14. Right Atrial Myxoma and Syncope.

    Science.gov (United States)

    Babs Animashaun, Islamiyat; Akinseye, Oluwaseun A; Akinseye, Leah I; Akinboboye, Olakunle O

    2015-09-21

    Right atrial myxoma accounts for 15-20% of cardiac myxomas and syncope is a very rare manifestation. We present the case of an 89-year-old man with right atrial myxoma and syncope, and discuss the role of cardiac magnetic resonance imaging (MRI) in the diagnosis of myxomas. An 89-year-old man with a history of hypertension, hyperlipidemia, chronic kidney disease stage 4, mild dementia, and benign prostatic hyperplasia presented to the emergency department with an episode of syncope. Physical examination demonstrated normal and regular heart sounds, and normal respiratory rate and oxygen saturation. Echocardiogram described a well-circumscribed echo-dense mass in the right atrial cavity, which was attached to the septum but not obstructing the tricuspid annulus, measuring 1.7×2.2 cm at its widest diameter. Cardiac MRI revealed a mass with dark intensity which enhanced heterogeneously following intravenous administration of gadolinium-chelate, consistent with a myxoma. The location of this myxoma, coupled with the presence of a stalk allowing mobility, provides a clue to how this patient experienced transient obstruction of the tricuspid valve leading to syncope. Right heart tumors should be considered in the differential diagnosis of unexplained syncope. Cardiac MRI with gadolinium-chelate administration can help differentiate this tumor from a right-sided atrial thrombus, which can pose a diagnostic challenge.

  15. Stroke Prevention in Atrial Fibrillation

    Science.gov (United States)

    ... Atrial Fibrillation Christian T. Ruff Download PDF https://doi.org/10.1161/CIRCULATIONAHA.111.067843 Circulation. 2012; 125: ... e588-e590 , originally published April 23, 2012 https://doi.org/10.1161/CIRCULATIONAHA.111.067843 Citation Manager Formats ...

  16. Surgical Treatment of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Naghmeh Moshtaghi

    2008-12-01

    Full Text Available Atrial fibrillation is the most prevalent permanent arrhythmia. It may be associated with other cardiac pathologies which need surgical treatment. Various types of surgery including the traditional cut-sew operations and operations using different energy sources are currently in use. In comparison with medical treatment, surgery is safe, effective, and has reliable results.

  17. Atrial natriuretic peptides in plasma

    DEFF Research Database (Denmark)

    Goetze, Jens P; Holst Hansen, Lasse; Terzic, Dijana

    2015-01-01

    derivatizations. In this mini-review, we summarize measurement of the principal cardiac hormone, e.g. atrial natriuretic peptide (ANP) and its precursor fragments. We also highlight some of the analytical pitfalls and problems and the concurrent clinical "proof of concept". We conclude that biochemical research...

  18. Personalized management of atrial fibrillation

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Breithardt, Günter; Aliot, Etienne

    2013-01-01

    The management of atrial fibrillation (AF) has seen marked changes in past years, with the introduction of new oral anticoagulants, new antiarrhythmic drugs, and the emergence of catheter ablation as a common intervention for rhythm control. Furthermore, new technologies enhance our ability to de...

  19. Princípios e padrões em metaavaliação: diretrizes para os programas de saúde Principles and standards in metaevaluation: guidelines for health programs

    Directory of Open Access Journals (Sweden)

    Zulmira Maria de Araújo Hartz

    2006-09-01

    Full Text Available Este artigo apresenta questões imperativas para o uso de princípios e padrões em avaliação, permitindo destacar diretrizes para estudos de metaavaliação, tendo como exemplo os Estudos de Linha de Base (ELB do Projeto de Expansão e Consolidação do Saúde da Família (Proesf. Essas questões são importantes em países em que a Política Nacional de Avaliação ainda é incipiente, como é o caso do Brasil, onde se observa a ausência de dispositivos legais, diretrizes, ou parâmetros que busquem claramente garantir a qualidade, credibilidade e reconhecimento da prática da avaliação. Apresenta-se uma breve revisão da literatura sobre princípios e normas que fundamentam as diretrizes gerais formuladas para uma metaavaliação formativa dos estudos de linha de base, orientada pela aplicação dos quatro padrões internacionais para avaliação das políticas sociais: utilidade, exeqüibilidade, propriedade e precisão, que têm igualmente servido de guia para o desenho dos estudos de avaliação de programas de promoção e proteção à saúde, aos quais se associam padrões de especificidade definidos por uma técnica de consenso mista baseada nas prescrições do Termo de Referência dos ELB. O principal interesse é incentivar o amplo uso dessas ferramentas na avaliação em saúde como um ponto crucial para aperfeiçoamento e desenvolvimento do SUS.This article poses questions imperative for the use of principles and standards of evaluation allowing for pointing out directives for meta-evaluation on the example of the Baseline Studies (BLS of PROESF. These questions are important in countries like Brazil, where a National Evaluation Policy is still in its beginning, and where one observes absence of legal devices, directives or parameters clearly seeking to ensure the quality, credibility and recognition of the practice of evaluation. We present a brief review of the literature about principles and norms constituting the bases

  20. Movimentos de mudança na formação em saúde: da medicina comunitária às diretrizes curriculares Changing movements in health higher education: from community medicine to the activators course

    Directory of Open Access Journals (Sweden)

    Alberto Durán González

    2010-01-01

    Full Text Available Este ensaio busca refletir as diversas iniciativas pró-mudança na formação superior em saúde implantadas no Brasil. Esta análise histórica faz-se necessária tendo em vista a importância da sistematização e difusão das experiências anteriores para o auxilio na construção das novas propostas pró-mudança. Estamos hoje refletindo sobre processos ativos de ensino-aprendizagem por termos vivenciado propostas como a da Medicina Comunitária, o Projeto de Integração Docente Assistencial, o Programa UNI, o movimento da Rede UNIDA, a Lei de Diretrizes Curriculares, Educação Permanente em Saúde e o Curso de Ativadores. Avançamos a partir da construção da tentativa anterior. Não é necessária a descoberta da roda a todo momento. Ela pode ser adaptada e voltar a girar. O olhar para as experiências do passado e para as necessidades do presente ajuda na construção do futuro almejado.This paper aims to ponder over the various pro-change initiatives in health higher education in Brazil. A historical analysis is needed since prior experiences systematization and diffusion are important on attempting to build new pro-change proposals. Today we are pondering over active processes of teaching-learning because we have experienced proposals such as Community Medicine, the Professor Integrative Assistence Project, the PROUNI Program, the Rede UNIDA movement, the Curricular Guideline Law, Permanent Education in Health and the Activators' course. There is no need to discover the wheel all the time. It can be adapted and start to spin again. Taking a look into the past experiences and into the present needs helps in building a desirable future.

  1. Des-interesse no ensino profissionalizante na produção do Seminário Nacional de Diretrizes para a Educação em Enfermagem

    Directory of Open Access Journals (Sweden)

    Silvana Lima Vieira

    2014-01-01

    Full Text Available Pesquisa documental, retrospectiva, quali-quantitativa, com objetivo geral de analisar os enfoques das produções científicas por meio de resumos dos 12º e 13º Seminário Nacional de Diretrizes para a Educação em Enfermagem, que abordaram a educação profissional técnica de nível médio em enfermagem. Objetivos específicos: quantificar e discutir a produção científica dos eventos quanto à distribuição geográfica dos autores, objetivos e metodologia dos estudos. Como critério de inclusão os resumos deveriam conter, pelo menos, um dos descritores a seguir no título e/ou objetivos: educação em enfermagem, educação técnica em enfermagem, educação profissionalizante. Dos 637 resumos analisados, 23 atenderam aos critérios de inclusão. A produção concentrou-se na região Sudeste do país e os objetivos enfocavam principalmente as práticas docentes das enfermeiras. Verificou-se pouca expressividade do ensino profissionalizante no evento, sinalizando para a necessidade de mais estudos, considerando a relevância dos profissionais de nível técnico para a profissão Enfermagem e sistema de saúde.

  2. Relação entre volume do átrio esquerdo e disfunção diastólica em 500 casos de uma população brasileira Relationship between left atrial volume and diastolic dysfunction in 500 Brazilian patients

    Directory of Open Access Journals (Sweden)

    Lilia Maria Mameri El Aouar

    2013-01-01

    Full Text Available FUNDAMENTO: O aumento do Volume do Átrio Esquerdo Indexado (VAEi tem sido associado à Disfunção Diastólica (DD do Ventrículo Esquerdo (VE, considerado marcador de eventos cardiovasculares (fibrilação atrial, acidente vascular cerebral, insuficiência cardíaca, e óbito. OBJETIVO: Avaliar a relação entre VAEi e diferentes graus de DD em pacientes brasileiros submetidos ao ecocardiograma, estudando os determinantes do aumento do VAEi nesta amostra. MÉTODOS: Selecionamos 500 pacientes ambulatoriais submetidos a ecocardiografia, após exclusão de arritmia, cardiopatia valvar ou congênita, marca-passo permanente ou janela ecocardiográfica inadequada. O VAEi foi obtido pelo método de Simpson; classificou-se a DD segundo diretrizes atuais. Variáveis clínicas e ecocardiográficas foram submetidas a análise multivariada de regressão linear. RESULTADOS: A idade média foi de 52 ± 15 anos, 53% do sexo masculino, 55% hipertensos, 9% coronariopatas, 8% diabéticos, 24% obesos, 47% com hipertrofia VE, fração de ejeção média do VE: 69,6 ± 7,2%. A prevalência de DD na amostra foi de 33,8% (grau I: 66%, grau II: 29% e grau III: 5%. Houve aumento progressivo das dimensões do VAEi conforme o grau de DD: 21 ± 4 mL/m² (ausente, 26 ± 7 mL/m² (grau I, 33 ± 5 mL/m² (grau II, 50 ± 5 mL/m2 (grau III (p BACKGROUND: Left atrial volume index (LAVI increase has been associated to left ventricle (LV diastolic dysfunction (DD, a marker of cardiovascular events (atrial fibrillation, stroke, heart failure, death. OBJECTIVE: To evaluate the relationship between LAVI and diferente grades od DD in Brazilian patients submitted to echocardiogram, studying LAVI increase determinants in this sample. METHODS: We have selected 500 outpatients submitted to echocardiography, after excluding arrhythmia, valvar or congenital cardiopathy, permanent pacemaker or inadequate ecocardiographic window. LAVI was obtained according to Simpson's method. DD was

  3. Effects of postshock atrial pacing on atrial defibrillation outcome in the isolated sheep heart

    NARCIS (Netherlands)

    Skanes, A. C.; Gray, R. A.; Zuur, C. L.; Jalife, J.

    1998-01-01

    BACKGROUND: Failed atrial defibrillation shocks are associated with organization of postshock activity and a substantial postshock electrical quiescence. We investigated the ability of a train of pacing stimuli to capture or locally entrain atrial myocardium during the quiescent period after

  4. Atrioverter : An implantable device for the treatment of atrial fibrillation

    NARCIS (Netherlands)

    Wellens, HJJ; Lau, CP; Luderitz, B; Akhtar, M; Waldo, AL; Camm, AJ; Timmermans, C; Tse, HF; Jung, W; Jordaens, L; Ayers, G

    1998-01-01

    Background-During atrial fibrillation, electrophysiological changes occur in atrial tissue that favor the maintenance of the arrhythmia and facilitate recurrence after conversion to sinus rhythm. An implantable defibrillator connected to right atrial and coronary sinus defibrillation leads allows

  5. A EDUCAÇÃO ESCOLAR PRISIONAL NO BRASIL: IDENTIDADE, DIRETRIZES LEGAIS E CURRÍCULOS

    Directory of Open Access Journals (Sweden)

    Odair França de Carvalho

    2012-12-01

    Full Text Available Este artigo busca refletir sobre a constituição do espaço escolar na prisão. Primeiramente apresentamos os marcos legais da Educação de Jovens e Adultos Presos. Em seguida as especificidades da educação prisional perante a diversidade dos sujeitos. E por fim refletimos sobre a identidade da educação prisional e possibilidades de construção de um currículo. Conclui-se que a educação no ambiente prisional talvez seja uma das oportunidades reais de prática ressocializadora na medida em que oferece ao aluno outras probabilidades na reconstrução da sua identidade e de resgate da cidadania do homem preso. Palavras-chave: Educação de Jovens e Adultos. Identidade. Legislação. currículo.

  6. Acessibilidade e entorno como diretrizes de espaços livres públicos

    Directory of Open Access Journals (Sweden)

    José Roberto Merlin

    2014-06-01

    Full Text Available A pesquisa objetiva compreender e explorar ideias vinculadas ao “potencial educador dos espaços públicos” com ênfase na acessibilidade e nas relações com o entorno, estudando um espaço na cidade de Sorocaba (SP, membro da Associação Internacional das Cidades Educadoras – AICE , hoje coordenadora dessa Associação no Brasil. Foram percorridos seus espaços públicos através do programa “Roteiro Educador”, que subdividiu a cidade em cenários que enfatizam quatro temas: cultural, histórico, social e ecológico. Neste processo foi recortado o Parque das Águas, pertencente ao Roteiro Educador Ecológico, buscando compreender suas potenciais qualidades educadoras vinculadas às características espaciais. Balizados por estes parâmetros, buscou-se enfatizar elementos compositivos do espaço público como ferramentas analíticas para investigar eventuais interferências do projeto em padrões do tecido urbano como totalidade, tentando desvelar qualidades educadoras inerentes ao espaço. Entende-se que as proposições de desenho urbano em áreas livres podem interferir como agentes educadores estruturadores da qualidade dos espaços públicos como um todo, aprimorando a esfera de vida pública.

  7. Atrial septal stenting - How I do it?

    Directory of Open Access Journals (Sweden)

    Kothandam Sivakumar

    2015-01-01

    Full Text Available A wide atrial communication is important to maintain hemodynamics in certain forms of congenital and acquired heart defects. In comparison to balloon septostomy or blade septostomy, atrial septal stenting provides a controlled, predictable, and long-lasting atrial communication. It often needs a prior Brockenbrough needle septal puncture to obtain a stable stent position. A stent deployed across a previously dilated and stretched oval foramen or tunnel form of oval foramen carries higher risk of embolization. This review provides technical tips to achieve a safe atrial septal stenting. Even though this is a "How to do it article," an initial discussion about the indications for atrial septal stenting is vital as the resultant size of the atrial septal communication should be tailored for each indication.

  8. [Relations between FANS, PPI and atrial fibrillation].

    Science.gov (United States)

    Ricci, Fabrizio; De Caterina, Raffaele

    2013-05-01

    Recent evidence supports the existence of an association between the use of non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation. Anti-inflammatory drugs are widely used for the treatment of systemic inflammatory disorders, and chronic inflammation is a well-known risk factor for the development of myocardial fibrosis. The latter accounts for atrial inhomogeneities of conduction, thus triggering and perpetuating atrial fibrillation. Atrial inflammatory remodeling may therefore be responsible for the higher incidence of atrial fibrillation among patients assuming steroidal and non-steroidal anti-inflammatory drugs because of an underlying inflammatory disorders. Alternative theories contemplate gastroesophageal reflux, which is extremely common during the use of non-steroidal anti-inflammatory drugs and may trigger atrial fibrillation, as mediating the above-mentioned association.

  9. Risk of atrial fibrillation in diabetes mellitus

    DEFF Research Database (Denmark)

    Pallisgaard, Jannik L; Schjerning, Anne-Marie; Lindhardt, Tommi B

    2016-01-01

    AIM: Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In particular knowledge regarding young diabetes patients and the risk of developing atrial fibrillation is sparse. The aim of our study was to investigate the risk of atrial fibrillation in patients...... with diabetes compared to the background population in Denmark. METHODS AND RESULTS: Through Danish nationwide registries we included persons above 18 years of age and without prior atrial fibrillation and/or diabetes from 1996 to 2012. The study cohort was divided into a background population without diabetes...... and a diabetes group. The absolute risk of developing atrial fibrillation was calculated and Poisson regression models adjusted for sex, age and comorbidities were used to calculate incidence rate ratios of atrial fibrillation. The total study cohort included 5,081,087 persons, 4,827,713 (95%) in the background...

  10. Diretrizes para uso das ferramentas de avaliação de carga física de trabalho em ergonomia

    OpenAIRE

    Mateus Junior, José Roberto

    2009-01-01

    Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Engenharia de Produção. A ergonomia como disciplina científica orientada para uma abordagem sistêmica dos aspectos da vida humana tem como domínios as demandas físicas, cognitivas e organizacionais. Nesse trabalho o foco é do estudo físico. As possíveis conseqüências da sobrecarga física ao trabalhador são chamadas no Brasil de Lesões por Esforços Repetitivos (LER) e Distúrbios...

  11. Digoxin versus placebo, no intervention, or other medical interventions for atrial fibrillation and atrial flutter

    DEFF Research Database (Denmark)

    Sethi, Naqash; Safi, Sanam; Feinberg, Joshua

    2017-01-01

    BACKGROUND: Atrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2% in the western world. Atrial flutter, another arrhythmia, occurs less often with an incidence of approximately 200,000 new patients per year in the USA. Patients with atrial fibrillati...

  12. Evaluating the Atrial Myopathy Underlying Atrial Fibrillation: Identifying the Arrhythmogenic and Thrombogenic Substrate

    Science.gov (United States)

    Goldberger, Jeffrey J.; Arora, Rishi; Green, David; Greenland, Philip; Lee, Daniel C.; Lloyd-Jones, Donald M.; Markl, Michael; Ng, Jason; Shah, Sanjiv J.

    2015-01-01

    Atrial disease or myopathy forms the substrate for atrial fibrillation (AF) and underlies the potential for atrial thrombus formation and subsequent stroke. Current diagnostic approaches in patients with AF focus on identifying clinical predictors with evaluation of left atrial size by echocardiography serving as the sole measure specifically evaluating the atrium. Although the atrial substrate underlying AF is likely developing for years prior to the onset of AF, there is no current evaluation to identify the pre-clinical atrial myopathy. Atrial fibrosis is one component of the atrial substrate that has garnered recent attention based on newer MRI techniques that have been applied to visualize atrial fibrosis in humans with prognostic implications regarding success of treatment. Advanced ECG signal processing, echocardiographic techniques, and MRI imaging of fibrosis and flow provide up-to-date approaches to evaluate the atrial myopathy underlying AF. While thromboembolic risk is currently defined by clinical scores, their predictive value is mediocre. Evaluation of stasis via imaging and biomarkers associated with thrombogenesis may provide enhanced approaches to assess risk for stroke in patients with AF. Better delineation of the atrial myopathy that serves as the substrate for AF and thromboembolic complications might improve treatment outcomes. Furthermore, better delineation of the pathophysiologic mechanisms underlying the development of the atrial substrate for AF, particularly in its earlier stages, could help identify blood and imaging biomarkers that could be useful to assess risk for developing new onset AF and suggest specific pathways that could be targeted for prevention. PMID:26216085

  13. Diretrizes curriculares para a formação de profissionais de saúde: competências ou práxis? Curriculum guidelines for training healthcare professionals: skills or praxis?

    Directory of Open Access Journals (Sweden)

    Ingrid D'avilla Freire Pereira

    2013-08-01

    Full Text Available Este estudo analisa os referenciais teóricos e epistemológicos da educação que constam das Diretrizes Curriculares Nacionais (DCN relativas à formação profissional em saúde no Brasil. Para tanto, resgata a historicidade da relação educação, saúde e sociedade e as reformas do ensino médico; descreve o movimento de instituição das DCN para a área da saúde no país; e discute as relações entre o referencial da pedagogia das competências, que alicerça as DCN, e a concepção de direito à saúde formulada pela VIII Conferência Nacional de Saúde. Os resultados desta investigação sugerem a hipótese de que, para formar profissionais de saúde comprometidos com os princípios da VIII Conferência Nacional de Saúde e com a compreensão da saúde como direito, é necessário questionar os limites da pedagogia das competências adotada pelas DCN, bem como construir uma proposta de formação que dialogue com o pressuposto da transformação social, de modo que a sua didática possibilite aos estudantes evoluírem criticamente da práxis individual e comum para a práxis histórica.This study examines the theoretical and epistemological benchmarks of education contained in the National Curriculum Guidelines (DCN for the training of health professionals in Brazil. To achieve its goals, it rescues the historicity of the relationship among education, health, and society and the reform of medical education; it describes the movement of instituting the DCN for the health care area in Brazil, and discusses the relationship between the benchmark of the pedagogy of skills that underpins the DCN and the concept of the right to health formulated by the 8th National Health Conference. The results of this investigation suggest the hypothesis that, to train health professionals committed to the principles of the 8th National Health Conference and with the understanding of health as a right, it is necessary to question the limits of the

  14. DAS performance analysis

    International Nuclear Information System (INIS)

    Bates, G.; Bodine, S.; Carroll, T.; Keller, M.

    1984-02-01

    This report begins with an overview of the Data Acquisition System (DAS), which supports several of PPPL's experimental devices. Performance measurements which were taken on DAS and the tools used to make them are then described

  15. Educadores e a implementação de diretrizes contra desigualdades: o caso do ProJovem Urbano Educators and the implementation of guidelines against inequality: the case of theProJovem Urbano Program

    Directory of Open Access Journals (Sweden)

    Maria Inês Caetano Ferreira

    2013-03-01

    Full Text Available O artigo apresenta e discute resultados de uma pesquisa com educadores do ProJovem Urbano na Região Metropolitana de São Paulo. O objetivo foi investigar as experiências dos educadores com a implementação das diretrizes desse programa e a possibilidade de construção de relações entre professor e aluno marcadas pelo respeito à diferença e compromissadas com a inclusão. A orientação teórica apoia-se nos estudos que abordam a escola como lugar de reprodução das desigualdades sociais, nos autores que estudam os modos como se dão as relações entre a lógica escolar e as formas de socialização das famílias populares, e também nas investigações sobre escola e diversidade cultural. As linhas teóricas destacam o processo que converte diferenças em desigualdades. Foram realizadas entrevistas em profundidade com educadores do ProJovem a fim de compreender se os objetivos e as diretrizes do programa aproximam educadores e educandos e promovem a produção conjunta do conhecimento, contribuindo para a construção de relações mais justas e respeitosas entre professores e alunos. Os resultados comprovam essa possibilidade, elucidando o papel-chave do educador na implementação do programa. Além disso, também são desvendados problemas como a falta de apoio aos educadores e a precariedade da relação de trabalho, os quais podem prejudicar os resultados do ProJovem.The article presents and discusses results of a research with educators from theProJovem Urbano (Urban ProYoungster Program of the Metropolitan Region of São Paulo. The objective was investigating the experiences of the educators with the implementation of the program guidelines, and the possibility of building teacher-pupil relations characterized by the respect for difference and commitment to inclusion. The theoretical orientation is based on studies that see schools as a place for the reproduction of social inequalities, on authors that study how the relations

  16. [Panic disorder and atrial fibrillation].

    Science.gov (United States)

    Olazabal Eizaguirre, N; Chavez, R; González-Torres, M A; Gaviria, M

    2013-10-01

    This paper studies the relationship between atrial fibrillation and panic disorder. There are often doubts on the differential diagnosis in emergency services and general medical settings. Panic disorder prevalence rates have been found to be high in patients suffering from atrial fibrillation. Various studies have observed that patients diagnosed with anxiety disorders frequently have higher cardiovascular disease rates compared to the general population. Usually, patients suffering from panic disorder exhibit somatic complaints suggesting coronary disease, such as chest pain or palpitations. The aim is to make the correct diagnosis and treatment for these different illnesses, and to decrease the costs due to misdiagnosis. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  17. Hypercoagulability causes atrial fibrosis and promotes atrial fibrillation.

    Science.gov (United States)

    Spronk, Henri M H; De Jong, Anne Margreet; Verheule, Sander; De Boer, Hetty C; Maass, Alexander H; Lau, Dennis H; Rienstra, Michiel; van Hunnik, Arne; Kuiper, Marion; Lumeij, Stijn; Zeemering, Stef; Linz, Dominik; Kamphuisen, Pieter Willem; Ten Cate, Hugo; Crijns, Harry J; Van Gelder, Isabelle C; van Zonneveld, Anton Jan; Schotten, Ulrich

    2017-01-01

    Atrial fibrillation (AF) produces a hypercoagulable state. Stimulation of protease-activated receptors by coagulation factors provokes pro-fibrotic, pro-hypertrophic, and pro-inflammatory responses in a variety of tissues. We studied the effects of thrombin on atrial fibroblasts and tested the hypothesis that hypercoagulability contributes to the development of a substrate for AF. In isolated rat atrial fibroblasts, thrombin enhanced the phosphorylation of the pro-fibrotic signalling molecules Akt and Erk and increased the expression of transforming growth factor β1 (2.7-fold) and the pro-inflammatory factor monocyte chemoattractant protein-1 (6.1-fold). Thrombin also increased the incorporation of 3 H-proline, suggesting enhanced collagen synthesis by fibroblasts (2.5-fold). All effects could be attenuated by the thrombin inhibitor dabigatran. In transgenic mice with a pro-coagulant phenotype (TM pro/pro ), the inducibility of AF episodes lasting >1 s was higher (7 out of 12 vs. 1 out of 10 in wild type) and duration of AF episodes was longer compared with wild type mice (maximum episode duration 42.8 ± 68.4 vs. 0.23 ± 0.39 s). In six goats with persistent AF treated with nadroparin, targeting Factor Xa-mediated thrombin generation, the complexity of the AF substrate was less pronounced than in control animals (LA maximal activation time differences 23.3 ± 3.1 ms in control vs. 15.7 ± 2.1 ms in nadroparin, P < 0.05). In the treated animals, AF-induced α-smooth muscle actin expression was lower and endomysial fibrosis was less pronounced. The hypercoagulable state during AF causes pro-fibrotic and pro-inflammatory responses in adult atrial fibroblasts. Hypercoagulability promotes the development of a substrate for AF in transgenic mice and in goats with persistent AF. In AF goats, nadroparin attenuates atrial fibrosis and the complexity of the AF substrate. Inhibition of coagulation may not only prevent strokes but also inhibit the development of a substrate

  18. Importância da anatomia da circulação coronária atrial na operação de Cox para controle da fibrilação atrial The importance of atrial coronary circulation on Cox surgery for control atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Marcelo B. JATENE

    1999-01-01

    Full Text Available Com o advento de novas técnicas cirúrgicas para o tratamento das arritmias cardíacas, em especial da fibrilação atrial, como a cirurgia de Cox, o conhecimento das características e do trajeto das artérias coronárias atriais assumiu grande importância. O objetivo deste trabalho é o estudo desta circulação e a definição dos padrões de irrigação atrial. Para tanto, utilizamos 30 corações a fresco de indivíduos sem cardiopatia prévia, cujas artérias coronárias e ramos foram visibilizados através de injeção de resina vinílica corada com tinta laca preta, seguida de cuidadosa dissecção. Após avaliação macroscópica das peças, não foram encontrados padrões de irrigação uniforme dos átrios. Porém, a artéria do nó sinoatrial (ANSA, quando analisada isoladamente, revelou não apenas padrões de origem, como também padrões de trajeto. Foram descritos 7 padrões de origem e trajeto da ANSA, considerando-se pontos de referências da estrutura anatômica dos átrios. Os padrões descritos, diferente dos encontrados por outros autores, são de fácil interpretação e de aplicabilidade direta em técnicas cirúrgicas que abordam os átrios.Since the appearance of new surgical techniques such as Cox surgery employed for the treatment of cardiac arrhythmia, especially for atrial fibrillation, the knowledge of coronary artery characteristics and courses has been of increasing importance. The aim of this study was the analysis of this circulation and definition of atrial irrigation patterns. Hence, the coronary arteries of 30 normal human hearts were injected with colored resin and carefully dissected. After macroscopic evaluation of the hearts, no atrial irrigation patterns were found. However, when only the sinus atrial node was analyzed, it showed origin patterns as well as course patterns. Seven origin and route patterns of this artery are described, considering the anatomical structure of the atria as reference

  19. Relevance of Electrical Remodeling in Human Atrial Fibrillation Results of the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial Mechanisms of Atrial Fibrillation Study

    NARCIS (Netherlands)

    Healey, Jeff S.; Israel, Carsten W.; Connolly, Stuart J.; Hohnloser, Stefan H.; Nair, Girish M.; Divakaramenon, Syamkumar; Capucci, Alessandro; Van Gelder, Isabelle C.; Lau, Chu-Pak; Gold, Michael R.; Carlson, Mark; Themeles, Ellison; Morillo, Carlos A.

    Background-In animal models of atrial fibrillation (AF), changes in atrial electrophysiological properties are associated with the development of AF. Their relevance to human AF is unclear. Methods and Results-The Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the

  20. FORMAÇÃO DE PROFESSORES DE EDUCAÇÃO FÍSICA: DIRETRIZES PARA A FORMAÇÃO UNIFICADA.

    OpenAIRE

    Taffarel, Celi Zulke; Produtividade em Pesquisa da UFBA. FACED/UFBA.

    2012-01-01

    http://dx.doi.org/10.5902/010283085726O texto trata da formação de professores de Educação Física. Critica as atuais diretrizes curriculares, a divisão na formação e a atuação do Sistema Conselho Federal de Educação Física/Conselhos Regionais de Educação Física (CONFEF/CREF). Explica as raízes históricas que determinam esta situação, reconhecendo tendências. Apresenta um arrazoado científico que sustenta a proposição de diretrizes curriculares para um curso de licenciatura plena, de caráter a...

  1. Formação de professores de educação física: diretrizes para a formação unificada

    OpenAIRE

    Taffarel, Celi Nelza Zulke

    2012-01-01

    O texto trata da formação de professores de Educação Física. Critica as atuais diretrizes curriculares, a divisão na formação e a atuação do Sistema Conselho Federal de Educação Física/Conselhos Regionais de Educação Física (CONFEF/CREF). Explica as raízes históricas que determinam esta situação, reconhecendo tendências. Apresenta um arrazoado científico que sustenta a proposição de diretrizes curriculares para um curso de licenciatura plena, de caráter ampliado, em contra...

  2. Atrial fibrillation after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Nair Suresh

    2010-01-01

    Full Text Available Once considered as nothing more than a nuisance after cardiac surgery, the importance of postoperative atrial fibrillation (POAF has been realized in the last decade, primarily because of the morbidity associated with the condition. Numerous causative factors have been described without any single factor being singled out as the cause of this complication. POAF has been associated with stroke, renal failure and congestive heart failure, although it is difficult to state whether POAF is directly responsible for these complications. Guidelines have been formulated for prevention of POAF. However, very few cardiothoracic centers follow any form of protocol to prevent POAF. Routine use of prophylaxis would subject all patients to the side effects of anti-arrhythmic drugs, while only a minority of the patients do actually develop this problem postoperatively. Withdrawal of beta blockers in the postoperative period has been implicated as one of the major causes of POAF. Amiodarone, calcium channel blockers and a variety of other pharmacological agents have been used for the prevention of POAF. Atrial pacing is a non-pharmacological measure which has gained popularity in the prevention of POAF. There is considerable controversy regarding whether rate control is superior to rhythm control in the treatment of established atrial fibrillation (AF. Amiodarone plays a central role in both rate control and rhythm control in postoperative AF. Newer drugs like dronedarone and ranazoline are likely to come into the market in the coming years.

  3. Tratamento cirúrgico da fibrilação atrial por isolamento da parede posterior do átrio esquerdo em doentes com valvopatia mitral reumática crônica: um estudo randomizado com grupo controle Surgical treatment of atrial fibrillation through isolation of the left atrial posterior wall in patients with chronic rheumatic mitral valve disease: a randomized study with control group

    Directory of Open Access Journals (Sweden)

    José Tarcísio Medeiros de Vasconcelos

    2004-09-01

    Full Text Available OBJETIVO: Determinar a efetividade do isolamento cirúrgico da parede posterior do átrio esquerdo envolvendo os óstios das veias pulmonares, no tratamento da fibrilação atrial de etiologia reumática. MÉTODOS: Estudo prospectivo e randomizado envolvendo portadores de valvopatia mitral reumática, fibrilação atrial persistente com duração > a 6 meses, idade OBJECTIVE: To determine the effectiveness of surgical isolation of the left atrial posterior wall encompassing the ostia of the pulmonary veins for the treatment of atrial fibrillation of rheumatic etiology. METHODS: Prospective and randomized study of patients with rheumatic mitral valve disease, persistent atrial fibrillation for 6 months or longer, age < 60 years, and left atrial diameter < 65 mm. The patients were randomly distributed into 2 groups as follows: surgical valvular treatment (control group and surgical valvular treatment associated with isolation of the left atrial posterior wall according to the "cut-and-sew" technique (treated group. RESULTS: Twenty-nine individuals were operated upon, 27 of whom (13 in the control group and 14 in the treated group were regularly followed up. The patients of both groups did not differ in regard to their basal characteristics. The mean follow-up time was 11.5 months in the control group and 10.3 months in the treated group. The cumulative frequencies of the patients without atrial fibrillation were significantly greater in the treated group both in the perioperative (P=0.0035 and late (P=0.0430 phases. CONCLUSION: Surgical isolation of the left atrial posterior wall encompassing the ostia of the pulmonary veins is an effective form of treating atrial fibrillation in rheumatic mitral valve disease.

  4. Changes in plasma atrial natriuretic factor in patients with idiopathic atrial fibrillation

    International Nuclear Information System (INIS)

    Du Tongxin; Xia Xiaojie; Qu Wei; Wang Shukui; Sun Junjiang

    2002-01-01

    To observe the changes in plasma atrial natriuretic factor (AFN) in patients with idiopathic atrial fibrillation and investigate its mechanism, plasma ANF, platelet count and hematocrit were detected in 21 cases with transient idiopathic atrial fibrillation (group A, A1 representing attack, while A2 termination), 28 with persistent idiopathic atrial fibrillation (group B), 27 suffered from rheumatic heart disease with mitral stenosis and persistent atrial fibrillation (group C), 32 with transient supraventricular tachycardia (group D) and 20 normal controls (group E). It was found that the level of ANF was significantly higher in patients with attacking transient idiopathic atrial fibrillation than that in group A2, D and E (P 0.05), while there was significant difference in hematocrit in group A1 compared with group A2, D, E (P < 0.01). It suggested that ANF and hematocrit play an important role in the attack of idiopathic atrial fibrillation

  5. Diretrizes brasileiras para o tratamento da narcolepsia Brazilian guidelines for the treatment of narcolepsy

    Directory of Open Access Journals (Sweden)

    Flávio Alóe

    2010-09-01

    Full Text Available Este artigo relata as conclusões da reunião de consenso da Associação Brasileira de Sono com médicos especialistas brasileiros sobre o tratamento da narcolepsia, baseado na revisão dos artigos sobre narcolepsia publicados entre 1980 e 2010. Os objetivos do consenso são valorizar o uso de agentes avaliados em estudos randomizados placebo-controlados, emitir recomendações de consenso para o uso de outras medicações e informar pontos importantes a respeito da segurança e efeitos adversos das medicações. O tratamento da narcolepsia é baseado em diversas classes de agentes, estimulantes para sonolência excessiva, agentes antidepressivos para cataplexia e hipnóticos para sono noturno fragmentado. Medidas comportamentais são igualmente importantes e recomendadas universalmente. Todos os ensaios clínicos terapêuticos foram classificados de acordo com o nível de qualidade da evidência. Recomendações terapêuticas individualizadas para cada tipo de sintoma e recomendações gerais foram formuladas pelos autores. Modafinila é indicada como a primeira escolha para o tratamento da sonolência diurna. Agentes de segunda escolha para o tratamento da sonolência excessiva são metilfenidato de liberação lenta seguido pelo mazindol. Reboxetina, clomipramina, venlafaxina, desvenlafaxina e os inibidores seletivos de recaptação de serotonina em doses altas são a primeira escolha para o tratamento da cataplexia. Hipnóticos são utilizados para o tratamento do sono noturno fragmentado. Antidepressivos e hipnóticos são igualmente utilizados para o tratamento das alucinações hipnagógicas e paralisia do sono.This manuscript contains the conclusion of the consensus meeting of the Brazilian Sleep Association with Brazilian sleep specialists on the treatment of narcolepsy based on the review of medical literature from 1980 to 2010. The manuscript objectives were to reinforce the use of agents evaluated in randomized placebo

  6. Dynamics of AV coupling during human atrial fibrillation: role of atrial rate.

    Science.gov (United States)

    Masè, M; Marini, M; Disertori, M; Ravelli, F

    2015-07-01

    The causal relationship between atrial and ventricular activities during human atrial fibrillation (AF) is poorly understood. This study analyzed the effects of an increase in atrial rate on the link between atrial and ventricular activities during AF. Atrial and ventricular time series were determined in 14 patients during the spontaneous acceleration of the atrial rhythm at AF onset. The dynamic relationship between atrial and ventricular activities was quantified in terms of atrioventricular (AV) coupling by AV synchrogram analysis. The technique identified n:m coupling patterns (n atrial beats in m ventricular cycles), quantifying their percentage, maximal length, and conduction ratio (= m/n). Simulations with a difference-equation AV model were performed to correlate the observed dynamics to specific atrial/nodal properties. The atrial rate increase significantly affected AV coupling and ventricular response during AF. The shortening of atrial intervals from 185 ± 32 to 165 ± 24 ms (P AV patterns with progressively decreasing m/n ratios (from conduction ratio = 0.34 ± 0.09 to 0.29 ± 0.08, P AV block and coupling instability at higher atrial rates were associated with increased ventricular interval variability (from 123 ± 52 to 133 ± 55 ms, P AV pattern transitions and coupling instability in patients were predicted, assuming the filtering of high-rate irregular atrial beats by the slow recovery of nodal excitability. These results support the role of atrial rate in determining AV coupling and ventricular response and may have implications for rate control in AF. Copyright © 2015 the American Physiological Society.

  7. Atrial natriuretic peptide (ANP)-granules: ultrastructure ...

    African Journals Online (AJOL)

    ANP) are present in the four regions of the atrial-auricular complex (two atria and two auricles). ANP-immunoreactivity was detected in all granules from the four regions. Ultrastructurally, atrial myocytes show the presence of very electron dense ...

  8. Atrial natriuretic peptide (ANP)-granules: ultrastructure ...

    African Journals Online (AJOL)

    AJB SERVER

    2006-12-29

    Dec 29, 2006 ... cardiocytes: an immunocytochemical and ultrastructural morphometric comparative study. Ann Anat (in press). Gilloteaux J, Jennes L, Menu R, Vanderhaeghen JJ (1991). Ultrastructural immunolocalization of the atrial natriuretic factor pathways in fetal, neonatal, and adult Syrian hamsters: from the atrial.

  9. Atrial septal aneurysm: MRI and echocardiography correlation

    International Nuclear Information System (INIS)

    Puvaneswary, M.; Singham, T.; Bastian, B.

    2003-01-01

    A case of a patient with atrial septal aneurysm with findings in echocardiography and MRI is described. MRI was able to differentiate slow flow stagnant blood and permitted a better definition of atrial septal aneurysm when echocardiography finding are inconclusive. Copyright (2003) Blackwell Science Pty Ltd

  10. The Atrial Fibrillation Ablation Pilot Study

    DEFF Research Database (Denmark)

    Arbelo, Elena; Brugada, Josep; Hindricks, Gerhard

    2014-01-01

    AIMS: The Atrial Fibrillation Ablation Pilot Study is a prospective registry designed to describe the clinical epidemiology of patients undergoing an atrial fibrillation (AFib) ablation, and the diagnostic/therapeutic processes applied across Europe. The aims of the 1-year follow-up were to analy...

  11. Fatores associados ao uso de diretrizes clínicas em operadoras de planos de saúde e prestadores de serviços hospitalares no campo da Saúde Suplementar no Brasil Factors associated with the use of clinical guidelines by health plan operators and their inpatient care providers

    Directory of Open Access Journals (Sweden)

    Margareth Crisóstomo Portela

    2008-10-01

    Full Text Available Este artigo objetiva identificar fatores associados ao uso de diretrizes clínicas, segundo percepção de dirigentes respondentes, em operadoras de planos de saúde e prestadores de serviços hospitalares no campo da saúde suplementar no Brasil. Utiliza dados de dois inquéritos de abrangência nacional: um envolvendo 90 operadoras selecionadas aleatoriamente de um universo de 1.573, voltado para a caracterização da implementação de diretrizes clínicas e outros instrumentos e práticas de gestão da clínica; e outro envolvendo 74 hospitais, selecionados de um universo de 3.817 prestadores de serviços hospitalares a planos de saúde, destinado a apreender os mecanismos de microrregulação das operadoras e suas possíveis repercussões sobre as práticas dos hospitais. Referiram o uso de diretrizes clínicas 32,3% das operadoras e 51,6% dos hospitais. Entre as primeiras, mostraram-se independentemente associados ao uso de diretrizes, localização geográfica, tipo e porte da operadora, enquanto que, entre os hospitais, porte, complexidade e uso de outras ferramentas da gestão da clínica. Os resultados evidenciam o quanto ainda é incipiente e insatisfatória a gestão, por operadoras e hospitais, sobre a qualidade dos cuidados à saúde providos aos pacientes.This paper is aimed at identifying factors related to the use of clinical guidelines by health plan operators and their inpatient care providers in the supplementary care sector in Brazil from the viewpoint of managers. The study is based on two national surveys: one involving 90 health plan operators randomly selected from a universe of 1573, oriented towards characterizing the implementation of clinical guidelines and other tools of clinical governance; and another involving 74 hospitals, selected from a universe of 3817 inpatient care providers, aimed at capturing micro-regulation mechanisms applied by health plan operators and their repercussions on hospital practices. Use of

  12. Artificial atrial fibrillation in the dog. An artifact?

    NARCIS (Netherlands)

    Strackee, J.; Hoelen, A.J.; Zimmerman, A.N.E.; Meijler, F.L.

    R-R interval sequences during artificial atrial fibrillation in dogs were studied in the same way as in patients in a previous study and compared with results obtained in dogs with spontaneous atrial fibrillation. Artificial atrial fibrillation was effected by right atrial stimulation in three

  13. Legislação, Educação e Política: percepções sociais sobre a Lei de Diretrizes e Bases e o Plano Nacional de Educação (2011-2020

    Directory of Open Access Journals (Sweden)

    Antonio Teixeira de Barros

    2014-09-01

    Full Text Available http://dx.doi.org/10.5007/2175-7984.2014v13n27p77 Estuda a relação educação/legislação, na perspectiva da Sociologia Política, com base nas percepções de cidadãos sobre a Lei de Diretrizes e Bases da Educação Nacional e o Plano Nacional de Educação (2011-2020, a partir das seguintes questões: qual o grau de conhecimento da população sobre a LDB em seus 15 anos de vigência? (3 qual o nível de interesse do público e sobre o PNE e quais suas expectativas? A metodologia consiste na técnica de survey, com aplicação de questionário com amostragem nacional de 1.010 informantes, além de pesquisa bibliográfica e documental. O escopo teórico é focado na sociologia política weberiana, na qual educação e legislação são vistas como resultantes históricas da racionalização ocidental. Os dados indicam pouco interesse popular pela LDB e pelo PNE. Entretanto, a variável escolaridade eleva o nível de conhecimento/interesse. O tema  é reconhecido como nacionalmente relevante, mas a conotação política é pouco destacada, sobretudo quando se trata da função do Poder Legislativo no debate sobre políticas educacionais. O papel do legislativo é associado à garantia/fiscalização de recursos.

  14. Postoperative atrial fibrillation in patients with left atrial myxoma.

    Science.gov (United States)

    Sahin, Muslum; Tigen, Kursat; Dundar, Cihan; Ozben, Beste; Alici, Gokhan; Demir, Serdar; Kalkan, Mehmet Emin; Ozkan, Birol

    2015-01-01

    The aim of this study was to determine the factors associated with postoperative atrial fibrillation (AF) in patients with left atrial (LA) myxoma. Thirty-six consecutive patients with LA myxoma (10 men, mean age: 49.3 ± 15.7 years), who were operated on between March 2010 and July 2012, were included in this retrospective study. Pre-operative electrocardiograms and echocardiographic examinations of each patient were reviewed. Postoperative AF developed in 10 patients, whereas there was no evidence of paroxysmal AF after resection of the LA myxoma in the remaining 26 patients. The patients who developed AF postoperatively were significantly older than those who did not develop AF (median: 61.5 vs 46 years; p = 0.009). Among the electrocardiographic parameters, only P-wave dispersion differed significantly between postoperative AF and non-AF patients (median: 57.6 vs 39.8 ms, p = 0.004). Logistic regression analysis revealed P- wave dispersion (OR: 1.11, 95% CI: 1.003-1.224, p = 0.043) and age (OR: 1.13, 95% CI: 1.001-1.278, p = 0.048) as independent predictors of postoperative AF in our cohort of patients. P-wave dispersion is a simple and useful parameter for the prediction of postoperative AF in patients with LA myxoma.

  15. Management and prognosis of atrial fibrillation in the diabetic patient

    DEFF Research Database (Denmark)

    Pallisgaard, Jannik Langtved; Lindhardt, Tommi Bo; Olesen, Jonas Bjerring

    2015-01-01

    The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation. I...... and outcomes of heart failure and the success rates of both ablation and cardioversion in atrial fibrillation patients with diabetes. Finally, this article describes the association of HbA1c levels with the management and prognosis of atrial fibrillation patients.......The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation....... In the following article, the authors describe the association between diabetes and atrial fibrillation; specifically, the significance of diabetes on the risk of atrial fibrillation, ischemic stroke and bleeding complications associated with anticoagulation. In addition, the authors evaluate the risks...

  16. Cetirizine-Induced atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Altuğ Osken

    2016-01-01

    Full Text Available Atrial fibrillation (AF is the most common observed arrhythmia in clinical practice. In the literature, AF events associated with drug induction are available. Cetirizine is a second-generation histamine antagonist used in the treatment of allergies, angioedema, and urticaria. We wish to present an atypical case who took cetirizine medication for relieving symptoms of upper tract respiratory system infection, experienced rapid ventricular response AF and treated successfully. To best of our knowledge, this is the first case of cetirizine-induced AF.

  17. Mortes evitáveis em pacientes de trauma associadas a não adesão às diretrizes de atendimento Preventable deaths in trauma patients associated with non adherence to management guidelines

    Directory of Open Access Journals (Sweden)

    Antonio Cesar Marson

    2010-09-01

    Full Text Available OBJETIVOS: Avaliar pacientes tratados por lesões traumáticas e identificar a adesão às recomendações de diretrizes de tratamento e sua associação com óbito. As recomendações adotadas foram as definidas pelo comitê de Trauma do American College of Surgeons para suporte avançado de vida no trauma. MÉTODOS: Este foi um estudo de coorte retrospectivo realizado em um hospital de ensino. A população do estudo foi constituída por vítimas de traumatismo com idade igual ou superior a 12 anos e com escores de gravidade da lesão > 16 tratados entre janeiro de 1997 e dezembro de 2001. A coleta de dados foi dividida em três fases: pré-hospitalar, intra-hospitalar e post-mortem. Os dados colhidos foram analisados com o software EPI INFO. RESULTADOS: Analisamos 207 pacientes, 147 vítimas de traumatismo fechado (71% e 60 (29% vítimas de traumatismo penetrante. As vítimas de traumatismo tiveram uma taxa de mortalidade de 40,1%. Identificamos 221 eventos de não adesão que ocorreram em 137 pacientes. Identificamos uma média de 1,61 ocorrências de não adesão por paciente, que ocorreu menos frequentemente entre os que sobreviveram (1,4 do que entre os que não sobreviveram (1,9; p=0,033. Segundo a metodologia de escore de gravidade da lesão, 54,2% dos óbitos foram considerados potencialmente evitáveis. A não adesão ocorreu 1,77 vezes mais frequentemente nos óbitos que foram considerados potencialmente evitáveis em comparação aos demais não-sobreviventes (IC 95%: 1,12 - 2,77; p=0,012 e 92,9% das ocorrências múltiplas de não adesão ocorreram no primeiro grupo (p=0,029. CONCLUSÕES: A falta de adesão às diretrizes ocorreu com maior freqüência em pacientes com óbitos potencialmente evitáveis. O não cumprimento das recomendações das diretrizes pode ser considerado um fator contribuinte para a morte em vítimas de traumatismo, e pode levar a um maior número de mortes potencialmente evitáveis.OBJECTIVES: To evaluate

  18. Perfil de egresso de Curso de Enfermagem nas Diretrizes Curriculares Nacionais: uma aproximação Perfil de los alumnos egresados de las Escuelas de Enfermería, según las Diretrizes Curriculares Nacionales: una aproximación Profile of Nursing Schools egresses according to the National Curriculum Guidelines: an approach

    Directory of Open Access Journals (Sweden)

    Silvana Sidney Costa Santos

    2006-04-01

    Full Text Available A reestruturação curricular no curso de graduação em enfermagem, necessária a partir das Diretrizes Curriculares Nacionais (DCN, inicia suas atividades com a leitura crítica da Resolução 03/2001 e nela encontra-se, entre outras orientações, o perfil de egressos. O objetivo desta revisão crítica de literatura foi refletir sobre as palavras ou categorias explícitas no perfil de egressos sugeridas pelas DCN, utilizando de dicionários (de língua portuguesa e de filosofia e de literaturas diversas (da enfermagem e de outras disciplinas, para compreendê-las de forma mais concreta e percebê-las relevantes na formação do profissional enfermeiro e, portanto, necessárias no Projeto Político Pedagógico (PPP. Reconhecem-se os valores da proposta do perfil de egressos das DCN na formação do enfermeiro, porém, torna-se importante perceber que não se trata só de estabelecer novos marcos, priorizar novos objetivos, mudar perfil, reestruturar conteúdos, restabelecer condições de funcionamento ou de cargas horárias, mas de realizar um trabalho coletivo de crescimento grupal.La reestructuración curricular en el curso de graduación en enfermero, necesaria a partir de las Directrices Curriculares Nacionales (DCN, se inicia sus actividades con la lectura crítica de la Resolución 03 / 2001 y en ella se encuentra, entre otras orientaciones, el perfil de egresos. E objetivo de esta revisión crítica de literatura fue reflexionar sobre las palabras o categorías explícitas en el perfil de egresos sugeridas por las DCN, utilizando de diccionarios (de lengua portuguesa y filosofía y diversas literaturas (del enfermero y de otras disciplinas, para que las comprenda de forma mas concreta y la perciba relevantes en la formación del profesional enfermero y, por lo tanto, necesarias en el Proyecto Político Pedagógico (PPP. Se reconocen los valores de la propuesta del perfil de egresos de las DCN en la formación del enfermero, pero, se

  19. Gestão da humanização das práticas de saúde: o caso do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

    OpenAIRE

    Izabel Cristina Rios; Linamara Rizzo Battistella

    2013-01-01

    OBJETIVO: apresentar e discutir em termos conceituais e metodológicos o desenvolvimento da humanização das práticas de saúde enquanto política institucional, ou conjunto de diretrizes norteadoras de ações para uma cultura institucional de valores humanísticos, em um serviço-escola do SUS. MÉTODO: na modalidade de estudo de caso, o Complexo "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo" apresentou-se como objeto de estudo por ser uma organização pública de saúde ...

  20. Atrial fibrillation and survival in colorectal cancer

    Directory of Open Access Journals (Sweden)

    Justin Timothy A

    2004-11-01

    Full Text Available Abstract Background Survival in colorectal cancer may correlate with the degree of systemic inflammatory response to the tumour. Atrial fibrillation may be regarded as an inflammatory complication. We aimed to determine if atrial fibrillation is a prognostic factor in colorectal cancer. Patients and methods A prospective colorectal cancer patient database was cross-referenced with the hospital clinical-coding database to identify patients who had underwent colorectal cancer surgery and were in atrial fibrillation pre- or postoperatively. Results A total of 175 patients underwent surgery for colorectal cancer over a two-year period. Of these, 13 patients had atrial fibrillation pre- or postoperatively. Atrial fibrillation correlated with worse two-year survival (p = 0.04; log-rank test. However, in a Cox regression analysis, atrial fibrillation was not significantly associated with survival. Conclusion The presence or development of atrial fibrillation in patients undergoing surgery for colorectal cancer is associated with worse overall survival, however it was not found to be an independent factor in multivariate analysis.

  1. S K Das

    Indian Academy of Sciences (India)

    Home; Journals; Bulletin of Materials Science. S K Das. Articles written in Bulletin of Materials Science. Volume 24 Issue 4 August 2001 pp 373-378 Metals and Alloys. Evaluation of solid–liquid interface profile during continuous casting by a spline based formalism · S K Das · More Details Abstract Fulltext PDF. A numerical ...

  2. P Chaitanya Das

    Indian Academy of Sciences (India)

    P Chaitanya Das G Srinivasa Murthy C P Gopalakrishnan P C Deshmukh · More Details Fulltext PDF. Volume 9 Issue 7 July 2004 pp 77-85 Classroom. Motion of Charged Particles in Electromagnetic Fields and Special Theory of Relativity · P Chaitanya Das G Srinivasa Murthy P C Deshmukh K Satish Kumar T A Venkatesh.

  3. Dermatite das Fraldas

    OpenAIRE

    Girão, Leonor; Godinho, Mário; Fiadeiro, Teresa

    2014-01-01

    A dermatite das fraldas é uma das patologias mais frequentes na primeira infância, podendo as causas serem múltiplas.Os autores abordam as diferentes entidades clínicas salientando a importância de uma terapêutica correcta e atempada destas dermatoses.

  4. I M L Das

    Indian Academy of Sciences (India)

    Home; Journals; Bulletin of Materials Science. I M L Das. Articles written in Bulletin of Materials Science. Volume 33 Issue 4 August 2010 pp 383-390 Electrical Properties. Temperature dependence of electromechanical properties of PLZT /57/43 ceramics · A K Shukla V K Agrawal I M L Das Janardan Singh S L Srivastava.

  5. A K Das

    Indian Academy of Sciences (India)

    Home; Journals; Bulletin of Materials Science. A K Das. Articles written in Bulletin of Materials Science. Volume 28 Issue 2 April 2005 pp 131-136 Fly Ash. Some studies on the reaction between fly ash and lime · A Basumajumdar A K Das N Bandyopadhyay S Maitra · More Details Abstract Fulltext PDF. The reaction between ...

  6. P K Das

    Indian Academy of Sciences (India)

    Home; Journals; Bulletin of Materials Science. P K Das. Articles written in Bulletin of Materials Science. Volume 23 Issue 4 August 2000 pp 249-253 Nitride Ceramics. Optimization of time–temperature schedule for nitridation of silicon compact on the basis of silicon and nitrogen reaction kinetics · J Rakshit P K Das.

  7. B P Das

    Indian Academy of Sciences (India)

    Home; Journals; Bulletin of Materials Science. B P Das. Articles written in Bulletin of Materials Science. Volume 25 Issue 6 November 2002 pp 517-519. Structural, dielectric and electrical properties of Sm-modified Pb(SnTi)O3 ferroelectric system · B P Das R N P Choudhary P K Mahapatra · More Details Abstract Fulltext ...

  8. Sumit R Das

    Indian Academy of Sciences (India)

    Home; Journals; Pramana – Journal of Physics. Sumit R Das. Articles written in Pramana – Journal of Physics. Volume 69 Issue 1 July 2007 pp 93-108. String theory and cosmological singularities · Sumit R Das · More Details Abstract Fulltext PDF. In general relativity space-like or null singularities are common: they imply ...

  9. Navx-guided Cryoablation of Atrial Tachycardia Inside the Left Atrial Appendage

    Science.gov (United States)

    Pandozi, Claudio; Galeazzi, Marco; Lavalle, Carlo; Ficili, Sabina; Russo, Maurizio; Santini, Massimo

    2010-01-01

    Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavX-guided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed. PMID:21346824

  10. Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease.

    Science.gov (United States)

    Labombarda, Fabien; Hamilton, Robert; Shohoudi, Azadeh; Aboulhosn, Jamil; Broberg, Craig S; Chaix, Marie A; Cohen, Scott; Cook, Stephen; Dore, Annie; Fernandes, Susan M; Fournier, Anne; Kay, Joseph; Macle, Laurent; Mondésert, Blandine; Mongeon, François-Pierre; Opotowsky, Alexander R; Proietti, Anna; Rivard, Lena; Ting, Jennifer; Thibault, Bernard; Zaidi, Ali; Khairy, Paul

    2017-08-15

    Atrial arrhythmias are the most common complication encountered in the growing and aging population with congenital heart disease. This study sought to assess the types and patterns of atrial arrhythmias, associated factors, and age-related trends. A multicenter cohort study enrolled 482 patients with congenital heart disease and atrial arrhythmias, age 32.0 ± 18.0 years, 45.2% female, from 12 North American centers. Qualifying arrhythmias were classified by a blinded adjudicating committee. The most common presenting arrhythmia was intra-atrial re-entrant tachycardia (IART) (61.6%), followed by atrial fibrillation (28.8%), and focal atrial tachycardia (9.5%). The proportion of arrhythmias due to IART increased with congenital heart disease complexity from 47.2% to 62.1% to 67.0% in patients with simple, moderate, and complex defects, respectively (p = 0.0013). Atrial fibrillation increased with age to surpass IART as the most common arrhythmia in those ≥50 years of age (51.2% vs. 44.2%; p congenital heart disease, with a predominantly paroxysmal pattern. However, atrial fibrillation increases in prevalence and atrial arrhythmias progressively become permanent as the population ages. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  11. O Ensino de História no século XXI: a perspectiva dos professores participantes do Programa de Desenvolvimento Educacional do Paraná (PDE em relação às Diretrizes Curriculares da Educação Básica de História (DCEs

    Directory of Open Access Journals (Sweden)

    Maria Paula Costa

    2013-12-01

    Full Text Available Este artigo tem por objetivo analisar como os professores que participaram do Programa de Desenvolvimento Educacional do Paraná (PDE mobilizaram seus saberes docentes para a leitura e apropriação na prática do cotidiano escolar das Diretrizes Curriculares da Educação Básica de História do Estado do Paraná (DCEs. Para tanto a principal fonte de pesquisa foram às respostas de um instrumento de investigação que procurou compreender os usos, significados, dificuldades e negação deste texto curricular oficial. A proposta de ensino das DCEs está vinculada as discussões da área de investigação denominada, Educação Histórica, especificamente aos estudos teóricos de Jörn Rüsen sobre consciência histórica. Neste sentido, buscamos desvendar os diferentes significados atribuídos pelos professores e seu impacto no trabalho docente no âmbito escolar.

  12. Left atrial and left atrial appendage function in paroxysmal atrial fibrillation.

    Science.gov (United States)

    Erdei, T; Erdei, Tamás; Dénes, M; Kardos, A; Földesi, C; Földesi, A; Temesvári, A; Temesvári, M; Lengyel, M

    2011-06-01

    In patients with paroxysmal atrial fibrillation (PAF) little information is available about left atrial (LA)function, and there is less information about LA appendage (LAA) function, and about their relations. 46 patients were selected for catheter ablation (CA) because of nonvalvular PAF.Transthoracic, tissue Doppler and transoesophageal echocardiography was performed before CA. LA volumes and volume index (LAVI) were calculated. LA function was assessed by LA filling fraction (LAFF), LA emptying fraction (LAEF), systolic fraction of pulmonary venous flow (PVSF) and late diastolic velocities of mitral annulus(Aa,, A5at) LAA function was assessed by peak LAA emptying flow velocity (PLAAEFV). Diastolic dysfunction(DD) was also assessed. Dilated LAVI in 32, LA dysfunction in 20, DD with elevated LV filling pressure in 19 patients was found. Aa,at and Aa,p correlated with LAFF (r:0.53; p<0.001 and r:0.43; p<0.05), LAEF (r:0.51;p<0.001 and r:0.63; p<0.001), PVSF (r:0.49; p<0.001 and r:0.46; p<0.005) and PLAAEFV (r:0.58; p<0.001 and r:0.45; p<0.01). In PAF patients Aa velocity is useful to assess LA function and correlates positively with other TTE derived LA functional parameters and LAA function by TEE derived PLAAEFV.

  13. Conhecimento e prática em UTI Neonatais brasileiras: a perspectiva de seus gestores sobre a implementação de diretrizes clínicas Knowledge and practice in Brazilian neonatal ICU: the perspective of their managers on the implementation of clinical guidelines

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora Sousa Mendes Gomes

    2012-06-01

    Full Text Available A superação da lacuna entre o conhecimento estabelecido e sistematizado em diretrizes clínicas e a prática dos serviços de saúde é um desafio para a qualidade do cuidado. Diretrizes clínicas são ferramentas que sistematizam a evidência científica, auxiliando a identificar aquelas relevantes ao cuidado apropriado. Diversas estratégias para ampliar o uso de diretrizes clínicas foram identificadas na literatura: distribuição de material educacional; encontros para a capacitação; revisão das práticas; visita de especialistas; e lembretes. A análise de tais estratégias na perspectiva dos gestores de UTIN foi o objeto do estudo, desenvolvido em UTIN públicas através da aplicação de questionário semiestruturado com 53 chefias (médica e de enfermagem. Os entrevistados relataram a utilização concomitante de várias atividades/estratégias, concordando com posicionamentos da literatura. Cerca de 40% dos chefes consideraram que a distribuição de material escrito incentiva a adesão dos profissionais. A maioria dos gestores relatou que utiliza frequentemente as reuniões para discussão de diretrizes clínicas, sendo esta uma atividade recomendada por mais de 95% deles. No contexto estudado, verificou-se que as estratégias para ampliar a disseminação do conhecimento dependem dos próprios profissionais e serviços, não havendo apoio institucional formal para seu financiamento, o que reduz a consistência de seu uso.Overcoming the gap between the established and systematized knowledge in clinical guidelines and practice of health services is a challenge to the quality of care. Clinical guidelines are tools that systematize the scientific evidence, helping to identify those relevant to the proper care. Several strategies to expand the use of clinical guidelines were identified in the literature: distribution of educational materials; meetings for training; review of practices; visits of experts; and reminders. The analysis

  14. Assessment of right atrial function analysis

    International Nuclear Information System (INIS)

    Shohgase, Takashi; Miyamoto, Atsushi; Kanamori, Katsushi; Kobayashi, Takeshi; Yasuda, Hisakazu

    1988-01-01

    To assess the potential utility of right atrial function analysis in cardiac disease, reservoir function, pump function, and right atrial peak emptying rate (RAPER) were compared in 10 normal subjects, 32 patients with coronary artery disease, and 4 patients with primary pulmonary hypertension. Right atrial volume curves were obtained using cardiac radionuclide method with Kr-81m. In normal subjects, reservoir function index was 0.41+-0.05; pump function index was 0.25+-0.05. Both types of patients has decreased reservoir funcion and increased pump function. Pump function tended to decrease with an increase of right ventricular end-diastolic pressure. RAPER correlated well with right ventricular peak filling rate, probably reflecting right ventricular diastolic function. Analysis of right atrial function seemed to be of value in evaluating factors regulating right ventricular contraction and diastolic function, and cardiac output. (Namekawa, K)

  15. Atrial Fibrillation During an Exploration Class Mission

    Science.gov (United States)

    Lipsett, Mark; Hamilton, Douglas; Lemery, Jay; Polk, James

    2011-01-01

    This slide presentation reviews a possible scenario of an astronaut having Atrial Fibrillation during a Mars Mission. In the case review the presentation asks several questions about the alternatives for treatment, medications and the ramifications of the decisions.

  16. Psychosomatic correlations in atrial fibrillations

    Directory of Open Access Journals (Sweden)

    Vladimir Ernstovich Medvedev

    2011-01-01

    Full Text Available Patients with atrial fibrillations (AF and comorbid mental disorders were examined. Two patient groups differing in the structure of psychosomatic ratios were identified. Group 1 comprised patients with AF and signs of reactivity lability that manifested itself as psychopathological reactions to the primary manifestations of AF; Group 2 included those who had developed mental disorders mainly in end-stage cardiovascular disease (predominantly a permanent form of AF in the presence of such events as chronic heart failure (CHF. The results of the study suggest that the patients with AF have frequently anxiety and hypochondriacal disorders, which agrees with the data available in the literature. In addition, end-stage AF is marked by depressive syndromes caused by the severe course of cardiovascular diseases resulting in CHF.

  17. Right Atrial Mass: An Accidental Echocardiographic Finding

    OpenAIRE

    Ibrahim Aliyu; Safiya Gambo

    2015-01-01

    Intracardiac tumors are rare and may be primary or of secondary metastasis; among primary tumors are atrial myxomas; these are most common in the left atrium, affect females more and it is seen more among teenagers in pediatric population. It has varied clinical presentation, and asymptomatic cases have been reported. However, the case of a 2-year-old female with the right atrial involvement who presented with overt signs severe malnutrition is reported.

  18. Right Atrial Mass: An Accidental Echocardiographic Finding

    Directory of Open Access Journals (Sweden)

    Ibrahim Aliyu

    2015-01-01

    Full Text Available Intracardiac tumors are rare and may be primary or of secondary metastasis; among primary tumors are atrial myxomas; these are most common in the left atrium, affect females more and it is seen more among teenagers in pediatric population. It has varied clinical presentation, and asymptomatic cases have been reported. However, the case of a 2-year-old female with the right atrial involvement who presented with overt signs severe malnutrition is reported.

  19. Fatores preditores de fibrilação atrial após ablação do flutter atrial típico Factores predictores de fibrilación atrial tras ablación del flutter atrial típico Predictors of atrial fibrillation after ablation of typical atrial flutter

    Directory of Open Access Journals (Sweden)

    Sissy Lara de Melo

    2009-11-01

    Full Text Available FUNDAMENTO: A ocorrência de fibrilação atrial (FA após a ablação com sucesso do flutter atrial istmo cavo-tricuspídeo (FLA-ICT dependente consiste em um evento de importância clínica. Os fatores preditores dessa ocorrência ainda são controversos. OBJETIVO: Determinar a incidência de FA e os fatores preditores para a sua ocorrência nos pacientes submetidos a ablação do flutter atrial istmo cavo-tricuspídeo (FLA-ICT dependente. MÉTODOS: Cinquenta e dois pacientes portadores de FLA-ICT foram submetidos à ablação no período de janeiro de 2003 a março de 2004, no InCor do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTADOS: Durante o seguimento médio de 26,2 (± 9,2 meses, 16 (30,8% pacientes apresentaram FA. A análise univariada revelou duas variáveis clínicas como preditoras de ocorrência de FA após a ablação do FLA-ICT maior ou igual a três anos (RR: 3,00; P = 0,020. Na análise multivariada, esses fatores foram variáveis independentes associadas à ocorrência de FA após ablação do FLA-ICT. CONCLUSÃO: A FA é frequentemente observada durante o seguimento dos pacientes após ablação de FLA-ICT dependente. O FLA-ICT persistente e a história de arritmia maior que três anos são fatores preditores para a ocorrência de FA durante o seguimento clínico.FUNDAMENTO: La ocurrencia de fibrilación atrial (FA tras la ablación con éxito del flutter atrial istmo cavotricuspídeo (FLA-ICT dependiente consiste en un evento de importancia clínica. Los factores predictores de esta ocurrencia todavía son controvertidos. OBJETIVO: Determinar la incidencia de FA y los factores predictores para su ocurrencia en los pacientes sometidos a la ablación del flutter atrial istmo cavotricuspídeo (FLA-ICT dependiente. MÉTODOS: Cincuenta y dos pacientes portadores de FLA-ICT se sometieron a la ablación en el período de enero de 2003 a marzo de 2004, en el InCor del Hospital de Clínicas de

  20. Diretrizes para implantação de sistemas de segurança e saúde do trabalho em empresas produtoras de baterias automotivas Guidelines to implement occupational health and safety systems in automotive batteries manufacturers

    Directory of Open Access Journals (Sweden)

    Otávio José de Oliveira

    2010-01-01

    Full Text Available O desenvolvimento de Sistemas de Gestão da Segurança e Saúde no Trabalho (SGSST ganha um significado cada vez mais importante no desempenho das empresas, pois, por meio deles, é possível obter a promoção da saúde e satisfação dos trabalhadores e a redução dos riscos de acidentes. No entanto, para que um SGSST obtenha bons resultados, as empresas precisam estar atentas às dificuldades comumente encontradas durante o seu processo de implantação, procurando solucioná-las de maneira antecipada e estruturada. Pelo exposto, este trabalho tem como principal objetivo apresentar diretrizes, baseadas no referencial teórico e nos resultados dos estudos de caso realizados, para implantação de SGSSTs em empresas fabricantes de baterias automotivas. Para o seu desenvolvimento adotou-se o método de pesquisa qualitativa a partir da realização de dois estudos de caso em empresas fabricantes de baterias automotivas localizadas na cidade de Bauru. Os instrumentos de coleta de dados foram entrevistas semiestruturadas, análise de documentos e observação in loco. Ao final do artigo, são propostas diretrizes relacionadas aos seguintes elementos: alta direção, estratégia organizacional, cultura organizacional, departamento de Segurança e Saúde do Trabalho (SST, técnicos de SST, recursos humanos, treinamento, equipes multidisciplinares, comunicação interna, resistência à mudança, indicadores de desempenho, ferramentas gerenciais para solução de problemas de SST, gestão de projetos, recompensas e incentivos, e integração do sistema.The development of Health and Safety Management Systems has become increasingly important for the performance of companies since they can provide workers with good health and satisfaction and reduce the risks of accidents. However, in order for these systems to be efficient, the organizations need to be aware of the difficulties found during their implementation to overcome them ahead in a structured

  1. Consenso brasileiro sobre câncer gástrico: diretrizes para o câncer gástrico no Brasil Brazilian consensus in gastric cancer: guidelines for gastric cancer in Brazil

    Directory of Open Access Journals (Sweden)

    Bruno Zilberstein

    2013-03-01

    Full Text Available RACIONAL: No Brasil, o câncer gástrico é o quarto tumor maligno mais frequente entre os homens e sexto entre as mulheres. A causa é multivariada e os componentes de risco conhecidos. Ele tem seu prognóstico e tratamento definidos pela localização e estadiamento do tumor e número de linfonodos ressecados e acometidos. OBJETIVO: O Consenso Brasileiro sobre Câncer Gástrico foi idealizado pela ABCG com o intuito de emitir diretrizes que possam orientar os profissionais médicos no atendimento aos pacientes portadores desta afecção. MÉTODOS: Foram respondidas e resumidas 43 questões refletindo consenso ou não sobre diagnóstico e tratamento que poderão ser empregadas como orientação para sua abordagem multiprofissional. O método envolveu três etapas. Inicialmente 56 cirurgiões do aparelho digestivo e médicos de especialidades correlatas reuniram-se para formular as perguntas que foram enviadas aos participantes para embasarem as respostas em evidências científicas e na experiência pessoal. Resumos aos temas foram apresentados, discutidos em plenário e votados em duas outras reuniões. Os temas abrangeram 53 perguntas envolvendo: diagnóstico e estadiamento (seis questões; tratamento cirúrgico (35 questões; quimioterapia e radioterapia (sete questões; e anatomopatologia, imunoistoquímica e perspectivas (cinco questões. Considerou-se consenso a concordância de mais de 70% dos votos em cada tema. RESULTADOS: Todas as respostas foram apresentadas e votadas, e em 42 delas houve consenso. CONCLUSÃO: Pôde ser elaborado consenso na maior parte das questões que acompanham o atendimento dos pacientes com câncer gástrico, permitindo a elas serem encaminhadas para a confecção de Diretrizes sobre o tema.BACKGROUND: In Brazil, gastric cancer is the fourth most common malignancy among men and sixth among women. The cause is multivariate and the risks are well known. It has prognosis and treatment defined by the location and

  2. Thromboembolic risk in atrial flutter. The FLASIEC (FLutter Atriale Società Italiana di Ecografia Cardiovascolare) multicentre study.

    Science.gov (United States)

    Corrado, G; Sgalambro, A; Mantero, A; Gentile, F; Gasparini, M; Bufalino, R; Morabito, A; Trocino, G; Schiavina, R; Mandorla, S; Mangia, R; Tovena, D; Savino, K; Jacopi, F; Pellegrino, E M; Agostini, F; Centonze, G; Bovenzi, F; Caprino, E; Tadeo, G; Santarone, M

    2001-06-01

    Patients with atrial flutter are believed to be at lower risk of thromboembolism than patients with atrial fibrillation. However, the incidence of atrial thrombi and the need for anticoagulation in patients with atrial flutter is not well established. A prospective observational multicentre study was undertaken to assess the frequency of atrial thrombi and spontaneous echocontrast and the prevalence for aortic complex atherosclerotic lesions in a cohort of unselected patients with atrial flutter. We evaluated 134 patients (102 male, aged 70+/-9 years); exclusion criteria were history of atrial fibrillation, rheumatic mitral valve disease and mitral mechanical prosthesis. The median of atrial flutter duration was 33 days. Twelve patients had been taking warfarin for more than 7 days. One hundred and twenty-four patients (94%) underwent a transoesophageal echocardiogram, which revealed left atrial appendage thrombi in two patients (1.6%) and right atrial thrombi in one patient (1%). At least moderate left atrial echocontrast was found in 16/124 patients (13%). Complex atherosclerotic aortic plaques were detected in 10 patients (8%). Atrial flutter conversion was attempted in 93/134 patients (69%). At the 1-month follow-up, two patients experienced a thromboembolic event following restoration of sinus rhythm. Atrial thrombi and echocontrast, and complex aortic atherosclerotic plaques are relatively uncommon in patients with atrial flutter. Post-cardioversion embolism was observed in two patients in our study population.

  3. Left atrial laceration with epicardial ligation device.

    Science.gov (United States)

    Keating, Vincent P; Kolibash, Christopher P; Khandheria, Bijoy K; Bajwa, Tanvir; Sra, Jasbir; Kress, David C

    2014-01-01

    Many new devices and techniques are being developed to attempt a reduction in embolic stroke risk for patients with atrial fibrillation who are either unable or unwilling to maintain long-term anticoagulation. One of these new devices (LARIAT®, SentreHEART Inc., Redwood City, California, USA) employs delivery of an epicardial suture to ligate the left atrial appendage after percutaneous pericardial and transseptal access. This series presents three clinical cases that demonstrate a serious and recurrent complication of left atrial laceration and cardiac tamponade shortly following delivery of an epicardial suture ligation to the left atrial appendage. Three clinical cases are described in detail with pre- and postprocedure angiography and echocardiography as well as illustrations reflecting the surgeon's findings on direct visualization of the left atrial lacerations postligation. Potential hypotheses of each injury are examined in light of the case timelines and findings at sternotomy. There was no suggestion that tamponade was related to pericardial or transseptal access, but rather a complication with device delivery. These three patients quickly progressed to clinical cardiac tamponade despite attempted drainage, stressing the importance of cardiovascular surgery backup, including a cardiopulmonary bypass pump, when delivering novel, percutaneous ligation devices for the left atrial appendage.

  4. RR-Interval variance of electrocardiogram for atrial fibrillation detection

    Science.gov (United States)

    Nuryani, N.; Solikhah, M.; Nugoho, A. S.; Afdala, A.; Anzihory, E.

    2016-11-01

    Atrial fibrillation is a serious heart problem originated from the upper chamber of the heart. The common indication of atrial fibrillation is irregularity of R peak-to-R-peak time interval, which is shortly called RR interval. The irregularity could be represented using variance or spread of RR interval. This article presents a system to detect atrial fibrillation using variances. Using clinical data of patients with atrial fibrillation attack, it is shown that the variance of electrocardiographic RR interval are higher during atrial fibrillation, compared to the normal one. Utilizing a simple detection technique and variances of RR intervals, we find a good performance of atrial fibrillation detection.

  5. Disposições técnicas e diretrizes para projeto de habitações sociais evolutivas

    Directory of Open Access Journals (Sweden)

    Douglas Queiroz Brandão

    Full Text Available Projetar a habitação, considerando tão somente as necessidades da fase de construção e da ocupação inicial, resulta, com frequência, em dificuldades e custos adicionais para adaptar posteriormente a residência de forma a atender mudanças nos requisitos de seus usuários. Este trabalho destaca a importância da consideração da flexibilidade de espaço, de materiais e de componentes em projetos habitacionais de interesse social (HIS. O objetivo é propor, à luz da literatura especializada e dos problemas constatados na prática, um conjunto de diretrizes para projeto que permitam a adaptação facilitada e harmoniosa da moradia ao longo de sua vida útil. A tipologia enfocada é a habitação unifamiliar, particularmente aquela edificada isoladamente no lote. A pesquisa foi desenvolvida com base na observação de uma amostra de habitações do Estado de Mato Grosso, entre 2003 a 2006, sendo dividida em duas etapas. Na primeira etapa, foram levantadas e analisadas as modificações espontâneas realizadas pelos usuários, mostrando as alterações típicas realizadas e os problemas mais comuns na ampliação destas residências. Na segunda, foram propostas disposições técnicas, relacionando estas às estratégias e aos princípios da flexibilidade, de forma a tornar as casas mais adaptáveis. O artigo também buscou refletir sobre as práticas correntes de projeto e produção dos empreendimentos de HIS, visando reforçar a importância do conceito de habitação evolutiva e defender uma maior abertura a novos desenhos que permitam maior apropriação do espaço doméstico por seus ocupantes.

  6. Explorando a relação mente-cérebro: reflexões e diretrizes

    Directory of Open Access Journals (Sweden)

    Alexander Moreira-Almeida

    2013-01-01

    Full Text Available CONTEXTO: O avanço no entendimento da mente e sua relação com o cérebro tem sido prejudicado por equívocos filosóficos e metodológicos. OBJETIVO: Discutir brevemente e propor diretrizes epistemológicas e metodológicas para uma frutífera investigação da relação mente-cérebro. RESULTADOS: A relação mente-corpo ainda é um problema em aberto, não havendo evidências conclusivas de que a mente seja apenas um produto da atividade cerebral. Na exploração da mente, deve-se evitar a aceitação ou rejeição prematura de teorias, buscando não apenas evidências confirmatórias, mas também as falseadoras de uma teoria. Deve-se ampliar e diversificar a base empírica, buscando especialmente experiências humanas não usuais, tais como as chamadas experiências anômalas ou espirituais. A observação de fenômenos anômalos que não se encaixavam nos paradigmas estabelecidos foi essencial em revoluções científicas prévias. Tanto dados quantitativos quanto qualitativos devem ser valorizados. Para explicar a mente e suas múltiplas manifestações, é essencial haver abertura e rigor para criar, desenvolver e testar alternativas teóricas. Candidatos a paradigma de base tanto materialista quanto não materialista devem ter oportunidade de ser apresentados, aprimorados e testados. CONCLUSÃO: A ampliação e a diversificação da base empírica aliada a uma postura epistemológica e metodológica mais adequada são essenciais para o avanço da compreensão da relação mente-cérebro.

  7. Epicardial Ablation of Focal Atrial Tachycardia Arising From Left Atrial Appendage in Children

    Directory of Open Access Journals (Sweden)

    Abdhija Hanumandla

    2014-07-01

    Full Text Available Focal left atrial tachycardia (FLAT although a common cause of supraventricular tachycardia(SVT among children, the one's arising from left atrial appendage (LAA present a unique challenge for successful ablation because of anatomical location. We present two children with FLAT arising from the epicardial LAA, successfully mapped and ablated through percutaneuous epicardial approach.

  8. Percutaneous occlusion of left atrial appendage with the Amplatzer Cardiac PlugTM in atrial fibrillation.

    Science.gov (United States)

    Montenegro, Márcio José; Quintella, Edgard Freitas; Damonte, Aníbal; Sabino, Hugo de Castro; Zajdenverg, Ricardo; Laufer, Gustavo Pinaud; Amorim, Bernardo; Estrada, André Pereira Duque; Armas, Cristian Paul Yugcha; Sterque, Aline

    2012-02-01

    Atrial fibrillation is associated with embolic strokes that often result in death or disability. Effective in reducing these events, anticoagulation has several limitations and has been widely underutilized. Over 90% of thrombi identified in patients with atrial fibrillation without valvular disease originate in the left atrial appendage, whose occlusion is investigated as an alternative to anticoagulation. To determine the feasibility of percutaneous occlusion of the left atrial appendage in patients at high risk of embolic events and limitations to the use of anticoagulation. We report our initial experience with Amplatzer Cardiac Plug™ (St. Jude Medical Inc., Saint Paul, Estados Unidos) in patients with nonvalvular atrial fibrillation. We selected patients at high risk of thromboembolism, major bleeding, contraindications to the use or major instability in response to the anticoagulant. The procedures were performed percutaneously under general anesthesia and transesophageal echocardiography. The primary outcome was the presence of periprocedural complications and follow-up program included clinical and echocardiographic review within 30 days and by telephone contact after nine months. In five selected patients it was possible to occlude the left atrial appendage without periprocedural complications. There were no clinical events in follow-up. Controlled clinical trials are needed before percutaneous closure of the left atrial appendage should be considered an alternative to anticoagulation in nonvalvular atrial fibrillation. But the device has shown to be promissory in patients at high risk of embolism and restrictions on the use of anticoagulants.

  9. The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter

    DEFF Research Database (Denmark)

    Sethi, Naqash J; Feinberg, Joshua; Nielsen, Emil E

    2017-01-01

    BACKGROUND: Atrial fibrillation and atrial flutter may be managed by either a rhythm control strategy or a rate control strategy but the evidence on the clinical effects of these two intervention strategies is unclear. Our objective was to assess the beneficial and harmful effects of rhythm contr...

  10. Transcatheter closure of atrial septal defect with atrial septal occluder in a patient with nickel allergy.

    Science.gov (United States)

    Arı, Hasan; Arı, Selma; Tütüncü, Ahmet; Karakuş, Alper; Melek, Mehmet

    2017-06-01

    Presently described is transcatheter closure of atrial septal defect with atrial septal occluder (ASO) device in a patient with nickel allergy. Patients with metal allergy who will undergo nitinol device implantation should be tested for possible nickel hypersensitivity. ASO device and treatment strategy (percutaneous or surgical) should be selected according to allergy test result.

  11. Left atrial appendage occlusion versus standard medical care in patients with atrial fibrillation and intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Nielsen-Kudsk, Jens Erik; Johnsen, Søren Paaske; Wester, Per

    2017-01-01

    AIMS: The aim of this study was to investigate the prognosis in patients with atrial fibrillation (AF) and intracerebral haemorrhage (ICH) having a left atrial appendage occlusion (LAAO) versus patients receiving standard medical therapy. METHODS AND RESULTS: A total of 151 patients from the Nord...

  12. Diretrizes para Autores

    Directory of Open Access Journals (Sweden)

    Sustentabilidade em Debate

    2012-07-01

    Full Text Available A revista Sustentabilidade em Debate (SeD, de caráter interdisciplinar, divulga textos sobre a sustentabilidade em suas diversas dimensões, com o objetivo de criar um canal direto de debate sobre temas ligados ao desenvolvimento sustentável, gestão ambiental, conflitos socioambientais, o estado do meio ambiente, governança ambiental, dentre outros.

  13. Passado e presente nas relações Colômbia-Estados Unidos: a estratégia de internacionalização do conflito armado colombiano e as diretrizes da política externa norte-americana Past and present in the Colombia-United States relations: the strategy of internationalization of the Colombian armed conflict and the guidelines of North American foreign policy

    Directory of Open Access Journals (Sweden)

    Marcelo Santos

    2010-07-01

    Full Text Available Este artigo tem como objetivo analisar a dinâmica das relações entre Colômbia e EUA, com ênfase no governo de Álvaro Uribe (2002-.... Para tanto, são examinadas a estratégia de internacionalização do conflito armado colombiano e os aspectos da intervenção dos EUA mediante o Plano Colômbia. Como conclusão, o trabalho sugere que as recentes mudanças políticas nos EUA têm causado impacto nas diretrizes das relações das relações entre EUA e Colômbia.This article aims to analyze the dynamics of the relationship between Colombia and United States, with emphasis on the Uribe Government. For this purpose, the internationalization strategy of the Colombian armed conflict and the aspects of the U.S. intervention under Plan Colombia were examined. In the final analysis, this paper suggests that recent political changes in the United States have impacted the guidance for U.S. - Colombia relations.

  14. Spectral of electrocardiographic RR intervals to indicate atrial fibrillation

    Science.gov (United States)

    Nuryani, Nuryani; Satrio Nugroho, Anto

    2017-11-01

    Atrial fibrillation is a serious heart diseases, which is associated on the risk of death, and thus an early detection of atrial fibrillation is necessary. We have investigated spectral pattern of electrocardiogram in relation to atrial fibrillation. The utilized feature of electrocardiogram is RR interval. RR interval is the time interval between a two-consecutive R peaks. A series of RR intervals in a time segment is converted to a signal with a frequency domain. The frequency components are investigated to find the components which significantly associate to atrial fibrillation. A segment is defined as atrial fibrillation or normal segments by considering a defined number of atrial fibrillation RR in the segment. Using clinical data of 23 patients with atrial fibrillation, we find that the frequency components could be used to indicate atrial fibrillation.

  15. Risk of atrial fibrillation and stroke in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Lindhardsen, Jesper; Ahlehoff, Ole; Gislason, Gunnar Hilmar

    2012-01-01

    To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke.......To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke....

  16. Giant right atrial myxoma: characterization with cardiac magnetic resonance imaging.

    LENUS (Irish Health Repository)

    Ridge, Carole A

    2012-02-01

    A 53-year-old woman presented to the emergency department with a 2-week history of dyspnoea and chest pain. Computed tomography pulmonary angiography was performed to exclude acute pulmonary embolism (PE). This demonstrated a large right atrial mass and no evidence of PE. Transthoracic echocardiography followed by cardiac magnetic resonance imaging confirmed a mobile right atrial mass. Surgical resection was then performed confirming a giant right atrial myxoma. We describe the typical clinical, radiologic, and pathologic features of right atrial myxoma.

  17. Exercise-based cardiac rehabilitation for adults with atrial fibrillation

    OpenAIRE

    Risom, Signe Stelling; Zwisler, Ann-Dorthe; Johansen, Pernille Palm; Sibilitz, Kirstine Lærum; Lindschou, Jane; Gluud, Christian; Taylor, Rod S; Svendsen, Jesper H; Kikkenborg Berg, Selina

    2017-01-01

    BACKGROUND: Exercise-based cardiac rehabilitation may benefit adults with atrial fibrillation or those who had been treated for atrial fibrillation. Atrial fibrillation is caused by multiple micro re-entry circuits within the atrial tissue, which result in chaotic rapid activity in the atria.OBJECTIVES: To assess the benefits and harms of exercise-based rehabilitation programmes, alone or with another intervention, compared with no-exercise training controls in adults who currently have AF, o...

  18. New-Onset Atrial Fibrillation in the Critically Ill*

    OpenAIRE

    Moss, Travis J.; Calland, James Forrest; Enfield, Kyle B.; Gomez-Manjarres, Diana C.; Ruminski, Caroline; DiMarco, John P.; Lake, Douglas E.; Moorman, J. Randall

    2017-01-01

    Objective: To determine the association of new-onset atrial fibrillation with outcomes, including ICU length of stay and survival. Design: Retrospective cohort of ICU admissions. We found atrial fibrillation using automated detection (? 90?s in 30?min) and classed as new-onset if there was no prior diagnosis of atrial fibrillation. We identified determinants of new-onset atrial fibrillation and, using propensity matching, characterized its impact on outcomes. Setting: Tertiary care academic c...

  19. Rupture of the left atrial roof due to blunt trauma.

    Science.gov (United States)

    Ryu, Dae Woong; Lee, Sam Youn; Lee, Mi Kyung

    2013-11-01

    Cardiac rupture after blunt trauma is rare and associated with high mortality. The anatomic pattern of blunt cardiac rupture has been demonstrated with the right cardiac chambers more frequently affected than the left. Furthermore, left atrial injury is usually restricted to the atrial appendage and the pulmonary vein-atrial junction. Herein, we report the first case of a 61-year old man with a rupture of the left atrial roof after blunt trauma with minimal thoracic injury.

  20. Rupture of the left atrial roof due to blunt trauma

    OpenAIRE

    Ryu, Dae Woong; Lee, Sam Youn; Lee, Mi Kyung

    2013-01-01

    Cardiac rupture after blunt trauma is rare and associated with high mortality. The anatomic pattern of blunt cardiac rupture has been demonstrated with the right cardiac chambers more frequently affected than the left. Furthermore, left atrial injury is usually restricted to the atrial appendage and the pulmonary vein–atrial junction. Herein, we report the first case of a 61-year old man with a rupture of the left atrial roof after blunt trauma with minimal thoracic injury.

  1. Interobserver variation in interpretation of electrocardiographic signs of atrial infarction

    DEFF Research Database (Denmark)

    Christensen, J H; Nielsen, F E; Falstie-Jensen, N

    1993-01-01

    The electrocardiogram (ECG) is the only means of diagnosing atrial infarction antemortem. Certain ECG changes (PR-segment displacements) have been taken earlier as signs of atrial infarction. The purpose of this study was to assess the interobserver variation on suggested ECG signs of atrial infa...

  2. Atrial electromechanical delay in patients undergoing heart transplantation

    Directory of Open Access Journals (Sweden)

    Mustafa Bulut, MD

    2017-04-01

    Conclusion: Inter-AEMD and intra-AEMD were prolonged in patients who underwent heart transplantation as compared to a control population. This may explain the increased atrial fibrillation and other atrial arrhythmia incidences associated with the biatrial anastomosis heart transplantation technique and may contribute to the treatment of atrial fibrillation in this special patient group.

  3. Treatment Guidelines of Atrial Fibrillation (AFib or AF)

    Science.gov (United States)

    ... Venous Thromboembolism Aortic Aneurysm More Treatment Guidelines of Atrial Fibrillation (AFib or AF) Updated:Jun 28,2017 What ... calculator This content was last reviewed July 2016. Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters ...

  4. Who Is at Risk for Atrial Fibrillation (AF or AFib)?

    Science.gov (United States)

    ... Aortic Aneurysm More Who is at Risk for Atrial Fibrillation (AF or AFib)? Updated:Oct 7,2016 Are ... unique online community for people living with AFib Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters ...

  5. Mapping strategy for multiple atrial tachyarrhythmias in a transplant heart

    DEFF Research Database (Denmark)

    Jin, Qi; Pehrson, Steen; Jacobsen, Peter Karl

    2015-01-01

    BACKGROUND: Different atrial arrhythmias can coexist in the recipient and donor atria after heart transplantation. CASE PRESENTATION: We report an unusual case of a patient with three different types of atrial arrhythmia after heart transplantation: an atrial fibrillation in the recipient atria...

  6. Diretrizes Curriculares da Graduação de Enfermagem: pensando contextos, mudanças e perspectivas Diretrices del Curriculum de la Graduación en Enfermería: piensando contextos, cámbios y perspectivas Curricular Guidelines for Nursing Graduate Course: contexts, changes and perspectives

    Directory of Open Access Journals (Sweden)

    Maria Helena Salgado Bagnato

    2007-10-01

    Full Text Available Pesquisa tratando das diretrizes curriculares para a graduação em enfermagem no Brasil aprovadas em 2001 pela Resolução nº 03/2001-CNE. Objetivamos contextualizar e resgatar o processo histórico de elaboração destas diretrizes, discutir o conteúdo aprovado fornecendo elementos para orientar a construção de projetos político-pedagógicos. Utilizamo-nos de fontes bibliográficas, documentos e depoimentos orais. Evidenciamos os princípios pedagógicos presentes nas diretrizes; abordamos a discussão sobre a pesquisa; a licenciatura em enfermagem, o Sistema Único de Saúde como foco da formação e a atuação da Rede Unida. O contexto da educação superior e da saúde privatizados, as mudanças econômicas (globalização financeira, a atuação de agências internacionais conformaram o panorama das mudanças na graduação no Brasil nos anos 90 e início do século XXI.Investigación tratando de las directrizes curiculares para la graduación em enfermería em el Brazil aprobadas em 2001 por la resolución número 03/2001-CNE. Se objectivó contextualizar y recatar el processo histórico de elaboración de estas directrizes, discutir el contenido aprobado forneciendo elementos para orientar la contrucción de proyectos político-pedagógicos. Se utilozó las fuentes bibliográficas, documentos e declaraciónes orales. Se evidenció los princípios pedagógicos presente em las directrizes; enfocamos la discución sobre la discusión; la licenciatura em enfermería, el Sistema Único de Salud como foco de la Red Unida. El contexto de la educación superior y de la salud privatizados, las mudanzas econômicas (globalización financira, la actuación de las agencias internacionales definieron el panorama de las mudanzas em la graduación em Brazil em los años 90 e comienzo del siglo XXI.Research focusing the curricular guidelines for Nursing Faculty in Brazil as approved in 2001 by the Resolution nº 03/2001-CNE. The study aimed at

  7. Surgical Treatment of Atrial Fibrillation: A Review

    Directory of Open Access Journals (Sweden)

    Nadine Hiari

    2011-01-01

    Full Text Available Atrial fibrillation is the most commonly sustained arrhythmia in man. While it affects millions of patients worldwide, its incidence will markedly increase with an aging population. Primary goals of AF therapy are to (1 reduce embolic complications, particularly stroke, (2 alleviate symptoms, and (3 prevent long-term heart remodelling. These have been proven to be a challenge as there are major limitations in our knowledge of the pathological and electrophysiological mechanisms underlying AF. Although advances continue to be made in the medical management of this condition, pharmacotherapy is often unsuccessful. Because of the high recurrence rate of AF despite antiarrhythmic drug therapy for maintenance of sinus rhythm and the adverse effects of these drugs, there has been growing interest in nonpharmacological strategies. Surgery for treatment of AF has been around for some time. The Cox-Maze procedure is the gold standard for the surgical treatment of atrial fibrillation and has more than 90% success in eliminating atrial fibrillation. Although the cut and sew maze is very effective, it has been superseded by newer operations that rely on alternate energy sources to create lines of conduction block. In addition, the evolution of improved ablation technology and instrumentation has facilitated the development of minimally invasive approaches. In this paper, the rationale for surgical ablation for atrial fibrillation and the different surgical techniques that were developed will be explored. In addition, it will detail the new approaches to surgical ablation of atrial fibrillation that employ alternate energy sources.

  8. Left atrial size and function as predictors of new-onset of atrial fibrillation in patients with asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Bang, Casper Niels Furbo; Dalsgaard, Morten; Greve, Anders

    2013-01-01

    Left atrial (LA) size and function change with chronically increased left ventricular (LV) filling pressures. It remains unclear whether these variations in LA parameters can predict new-onset atrial fibrillation (AF) in asymptomatic patients with aortic stenosis (AS).......Left atrial (LA) size and function change with chronically increased left ventricular (LV) filling pressures. It remains unclear whether these variations in LA parameters can predict new-onset atrial fibrillation (AF) in asymptomatic patients with aortic stenosis (AS)....

  9. MiDAS

    DEFF Research Database (Denmark)

    McIlroy, Simon Jon; Saunders, Aaron Marc; Albertsen, Mads

    2015-01-01

    communities. The taxonomy can be used to classify unknown sequences, and the online MiDAS field guide links the identity to the available information about their morphology, diversity, physiology and distribution. The use of a common taxonomy across the field will provide a solid foundation for the study...... of microbial ecology of the activated sludge process and related treatment processes. The online MiDAS field guide is a collaborative workspace intended to facilitate a better understanding of the ecology of activated sludge and related treatment processes—knowledge that will be an invaluable resource...

  10. Pulmonary Vein, Dorsal Atrial Wall and Atrial Septum Abnormalities in Podoplanin Knockout Mice With Disturbed Posterior Heart Field Contribution

    NARCIS (Netherlands)

    Douglas, Yvonne L.; Mahtab, Edris A. F.; Jongbloed, Monique R. M.; Uhrin, Pavel; Zaujec, Jan; Binder, Bernd R.; Schalij, Martin J.; Poelmann, Robert E.; Deruiter, Marco C.; Gittenberger-De Groot, Adriana C.

    The developing sinus venosus myocardium, derived from the posterior heart field, contributes to the atrial septum, the posterior atrial wall, the sino-atrial node, and myocardium lining the pulmonary and cardinal veins, all expressing podoplanin, a coelomic and myocardial marker. . We compared

  11. Increased susceptibility to atrial fibrillation secondary to atrial fibrosis in transgenic goats expressing transforming growth factor - B1

    Science.gov (United States)

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in people with significant morbidity and mortality. There is a strong association between atrial fibrosis and AF. Transforming growth factor B1 (TGF-B1) is an essential mediator of atrial fibrosis in animal models and human pat...

  12. Avaliação do perfil cinestésico-corporal de crianças com Síndrome de Down: um parâmetro para se atender à proposta das Diretrizes Curriculares Nacionais para a educação especial Evaluación del perfil cinestésico-corporal de niños con Síndrome de Down: un parámetro para atender a la propuesta de las directrices curriculares nacionales para la educación especial The evaluation of the cine-esthetic-corporal profile of children with Down's Syndrome: a parameter to attend the proposal of the national curricular guidelines for special education

    Directory of Open Access Journals (Sweden)

    Ariella Brito

    2009-06-01

    Full Text Available Este artigo teve por objetivo avaliar o perfil cinestésico-corporal de 20 crianças, com Síndrome de Down (SD, de 06 a 12 anos, residentes na Região Sul do Estado do Tocantins - Brasil. Isto com o propósito de estabelecer parâmetros cognitivo-motores que possam fundamentar práticas heterogêneas tanto no projeto político-pedagógico, como no currículo, na metodologia de ensino e na avaliação de tais entes, em conformidade com as Diretrizes Curriculares Nacionais para Educação Especial (BRASIL, 2001 e favorecer, assim, a aprendizagem e a integração social de indivíduos com tais necessidades especiais. Tal objetivo foi alcançado a partir de uma avaliação de contexto na qual foi aplicado o Inventário Portage Operacionalizado (WILLIAMS; AIELLO, 2001 e o protocolo de avaliação de habilidades motoras de Bruininks - Oseretsky (BRUININKS, 1978. Concluiu-se que indivíduos com SD apresentam um deficit de habilidades cognitivo-motoras próprias da coordenação motora fina e um limitado desenvolvimento da linguagem, seja oral ou escrita, resultando em insucesso nas tarefas escolares. Finalmente, chama-se a atenção para um importante aspecto, isto é, que alguns indivíduos portadores da SD, seja em função de um menor nível de deficiência cerebral ou mesmo de vivência motora, podem ter êxito em tarefas diversas, inclusive no ambiente escolar.Este artículo tuvo por objetivo evaluar el perfil cinestésico-corporal de 20 niños, con Síndrome de Down - SD, de 06 a 12 años, residentes en la Región Sur del estado de Tocantins - Brasil. Esto con el propósito de establecer parámetros cognitivo-motores que puedan fundamentar prácticas heterogéneas en el proyecto político-pedagógico, en el currículum, en la metodología de enseñanza y en la evaluación de tales entes, en conformidad con las Directrices Curriculares Nacionales para Educación Especial (MEC/SEESP, 1998, favoreciendo así el aprendizaje y la integración social

  13. Antihypertensive treatment and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Marott, Sarah C W; Nielsen, Sune F; Benn, Marianne

    2014-01-01

    on ARB monotherapy were matched 1:1 with individuals on β-blocker (n = 20 566), diuretic (n = 20 832), calcium-antagonist (n = 20 232), and ACEi monotherapy (n = 20 158). All were free of atrial fibrillation and of predisposing diseases like heart failure, ischaemic heart disease, diabetes mellitus......, and hyperthyroidism at baseline and none received any other antihypertensive medication. We studied risk of atrial fibrillation, and used risk of stroke, influenced by lowering blood pressure rather than renin-angiotensin system blockade per se, as an indicator of the importance of blood pressure lowering per se...... of stroke did not differ among the five antihypertensive medications. CONCLUSION: Use of ACEis and ARBs compared with β-blockers and diuretics associates with a reduced risk of atrial fibrillation, but not stroke, within the limitations of a retrospective study reporting associations. This suggests...

  14. The circadian variation of premature atrial contractions

    DEFF Research Database (Denmark)

    Larsen, Bjørn Strøier; Kumarathurai, Preman; Nielsen, Olav W

    2016-01-01

    AIMS: The aim of the study was to assess a possible circadian variation of premature atrial contractions (PACs) in a community-based population and to determine if the daily variation could be used to assess a more vulnerable period of PACs in predicting later incidence of atrial fibrillation (AF...... subgroups were studied based on a cut-off point of ≥720 PACs/day termed frequent PACs (n = 66) and not frequent PACs with ... variation in heart rate. After adjusting for relevant risk factors, the risk of AF was equal in all time intervals throughout the day. CONCLUSION: Premature atrial contractions showed a circadian variation in subjects with frequent PACs. No specific time interval of the day was more predictive of AF than...

  15. [Secondary pulmonary embolism to right atrial myxoma].

    Science.gov (United States)

    Vico Besó, L; Zúñiga Cedó, E

    2013-10-01

    A case of pulmonary thromboembolism secondary to atrial myxoma right. The myxoma is a primary cardiac tumor, namely, has his origin in the cardiac tissue. Primary cardiac tumors are rare, including myxomas, the most common type. Have a predilection for females and the most useful tool for diagnosis is echocardiography. About 75% of myxomas occur in the left atrium of the heart and rest are in the right atrium. Right atrial myxomas in some sometimes associated with tricuspid stenosis and atrial fibrillation. The most common clinical manifestations include symptoms of this neoplasm constitutional, and embolic phenomena resulting from the obstruction to the flow intracavitary. The treatment of this condition is surgical. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  16. Alcohol consumption and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Tolstrup, Janne Schurmann; Wium-Andersen, Marie Kim; Ørsted, David Dynnes

    2016-01-01

    BACKGROUND: The aim of this study was to test the hypothesis that alcohol consumption, both observational (self-reported) and estimated by genetic instruments, is associated with a risk of atrial fibrillation and to determine whether people with high cardiovascular risk are more sensitive towards...... alcohol than people with low risk. METHODS: We used data for a total of 88,782 men and women from the Copenhagen City Heart Study 1991-1994 and 2001-2003 and the Copenhagen General Population Study 2003-2010. Information on incident cases of atrial fibrillation was obtained from a validated nationwide...... register. As a measure of alcohol exposure, both self-reported consumption and genetic variations in alcohol metabolizing genes (ADH1B/ADH1C) were used as instrumental variables. The endpoint was admission to hospital for atrial fibrillation as recorded in a validated hospital register. RESULTS: A total...

  17. Thrombus scintigraphy with Ga-67 DFO-DAS-Fibrinogen, 2

    International Nuclear Information System (INIS)

    Kawasaki, Yukiko

    1987-01-01

    In our previous in vivo study 67 Ga DFO-DAS-Fibrinogen was assessed for its usefulness as a radiopharmaceutical for the detection of thrombin in experimental animals (Report 1). The present study was undertaken to appraise the diagnostic value of 67 Ga DFO-DAS-Fibrinogen in human disease, especially in relation to blood coagulability as well as to thrombolytic drug regimen being given, in an effort to investigate its clinical applicability. Involved in this study were 48 patients with thrombosis proven by X-ray CT and other examinations. Of these 48, 42 had arterial thrombosis (20 with aortic aneurysm including the dissecting form, 11 in postoperative condition following vascular surgery with a prosthesis, 9 with intracardiac thrombosis accompanying heart disease, and 1 each with occlusive arteriosclerosis and cerebral infarction) and 6 had venous thrombosis. The 67 Ga DFO-DAS-Fibrinogen test proved to be positive in 55 % of arterial thrombin and in 50 % of venous thrombin. It is interesting to note that as high a positivity rate as 80 % was obtained for aortic aneurysm, although the positivity rate was disappointingly low for left atrial thrombin. No distinct correlation was noted to exist between the degree of accumulation of the tracer in thrombotic lesions and any of factors conceivably of clinical releavance, i.e. time elapsing from onset till testing, thrombolytic medication being given, and hematological factors. 67 Ga DFO-DAS-Fibrinogen appeared to be a radiodiagnostic agent that could possibly indicate the existing activity status of thrombosis. (author)

  18. Diretrizes para terapia nutricional em crianças com câncer em situação crítica Guidance of nutritional support in critically ill children with cancer

    Directory of Open Access Journals (Sweden)

    Adriana Garófolo

    2005-08-01

    Full Text Available Este trabalho é constituído de uma revisão de conceitos fundamentais e atualizados relacionados à terapia nutricional de crianças com câncer criticamente doentes. O objetivo principal desta revisão é discutir alterações nutricionais e metabólicas decorrentes dessa condição, bem como as indicações, recomendações, contra-indicações e complicações da terapia nutricional (nutrição enteral e parenteral em pacientes com câncer. Este artigo aborda, de forma objetiva, a aplicação prática de alguns conceitos baseados em evidências científicas, e propõe algumas diretrizes para auxiliar na decisão da terapia nutricional no âmbito da vivência clínica. Conclui-se que há necessidade de maior incentivo ao desenvolvimento da ciência da terapia de suporte, como o tratamento das infecções, a terapia intensiva e a terapia metabólico-nutricional, para que se ampliem as possibilidades de cura de crianças e adolescentes com câncer.This paper is a review of fundamental, up to date concepts of nutritional support for critically ill children with cancer. The aim of the text is to discuss the nutritional and metabolic changes caused by their condition, as well as indications and recommendations, contraindications and complications of nutritional support (enteral and parenteral nutrition in cancer patients. The paper objectively shows the practical application of scientific knowledge and gives guidance to improve decisions about nutritional support in clinical practice. Finally, it is concluded there is a need to encourage research on support therapy, such as for the treatment of infections and for intensive nutritional and metabolic support, so as to increase the chances of curing children and adolescents with cancer.

  19. Avaliação da qualidade demandada e diretrizes de melhoria no processo de interação Universidade-Empresa Assessment of quality demand and guidelines for improving the University-Industry interaction process

    Directory of Open Access Journals (Sweden)

    Ana Paula Matei

    2012-01-01

    Full Text Available O artigo apresenta o processo de interação Universidade-Empresa no âmbito da Universidade Federal do Rio Grande do Sul (UFRGS, sob a responsabilidade da Secretaria de Desenvolvimento Tecnológico (SEDETEC. O objetivo é identificar as demandas de qualidade no processo de interação UFRGS-Empresas parceiras e propor melhorias para este processo. As demandas são identificadas com base em uma pesquisa de mercado, sendo desdobradas em características de qualidade e procedimentos para atendimento, por meio do Quality Function Deployment (QFD. Posteriormente, são propostas sugestões de melhorias para a SEDETEC. Os principais resultados são: a identificação e a priorização da qualidade demandada pelo setor empresarial; a avaliação dos requisitos e dos procedimentos que atendem a estas demandas e a proposição de diretrizes para melhorias no serviço da SEDETEC, destacando-se: ampliação e dinamização das formas de comunicação; criação de um sistema de indicadores de desempenho; e análise de mercado para as tecnologias desenvolvidas.This paper presents the university-industry interaction process through which the Federal University of Rio Grande do Sul (UFRGS is under the responsibility of the Secretary for Technological Development (SEDETEC. The purpose this article was to identify quality demands of the interaction process between UFRGS and partner companies, as well as to propose improvements to this process. Demands were identified through market research and then analyzed by means of the Quality Function Deployment (QFD, which provides insights for quality improvements. We then propose improvement actions to SEDETEC. Main results identify the quality demanded by the corporative segment, evaluate requirements and actions to achieve such quality demands, and propose improvement guidelines to the services provided by SEDETEC. Such improvements include a more dynamic communication system, a new set of indices for performance

  20. Atrial fibrillation and the 4P medicine.

    Science.gov (United States)

    Censi, Federica; Cianfrocca, Cinzia; Purificato, Ivana

    2013-01-01

    Although the paradigm of the 4P medicine - Predictive, Personalized, Preemptive, and Participatory - has been suggested several years ago, its application to atrial fibrillation is still far away. Given the increasing prevalence and incidence of this pathology it is the time to promote preventive strategies, by identifying the risk factors associated to life style and by incentivizing innovative diagnostic technologies. The promotion of the correct life style and of the use of diagnostic devices based on innovative and reliable technologies, represent a first step towards the full realization of the revolution of 4P medicine in atrial fibrillation.

  1. Atrial fibrillation and the 4P medicine

    Directory of Open Access Journals (Sweden)

    Federica Censi

    2013-09-01

    Full Text Available Although the paradigm of the 4P medicine - Predictive, Personalized, Preemptive, and Participatory - has been suggested several years ago, its application to atrial fibrillation is still far away. Given the increasing prevalence and incidence of this pathology it is the time to promote preventive strategies, by identifying the risk factors associated to life style and by incentivizing innovative diagnostic technologies. The promotion of the correct life style and of the use of diagnostic devices based on innovative and reliable technologies, represent a first step towards the full realization of the revolution of 4P medicine in atrial fibrillation.

  2. [Atrial myxoma: a challenge for the pneumologist].

    Science.gov (United States)

    Potre, Rodica; Ularu, D; Tudorache, V; Bertici, Nicoleta

    2003-01-01

    It presents a 59 years old woman with atypical symptoms, which orientated the diagnostic thinking during one year to a reccurrent pneumonitis, bronchial asthma, colagenosis, interstitial pulmonary fibrosis and so on. The appearance of pulmonary edema determined a couple of cardiologic exams which came to obiectivate as the main cause, the existence of a left atrial mixoma who was invaginated in left mitral cusp. Surgical intervention permitted not only specific determination of histological type of tumor, but lead to healing of the patient. It is a discussion over epidemiology, clinical areas of manifestation and methods of diagnostic of atrial tumors.

  3. Cryoballoon Catheter Ablation in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cevher Ozcan

    2011-01-01

    Full Text Available Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

  4. Our Mission Towards Atrial Fibrillation Free World

    OpenAIRE

    Lakkireddy, Dhanunjaya; Natale, Andrea

    2012-01-01

    We can hardly believe that the year 2012 has come and almost gone. What a great year this was here at the JAFIB office and all around the world. 2012 was marked by several key discoveries and fact finding missions in the Atrial Fibrillation (AF) world by various groups and individual scientists all across the globe. We are one more foot forward in our relentless mission towards a world free of Atrial Fibrillation. Congratulations one and all on your contributions in making this world a better...

  5. Das Kapital e Eu

    Directory of Open Access Journals (Sweden)

    David Schweickart

    2017-11-01

    Full Text Available A partir da sua própria biografia, o autor ensaia sobre sua interpretação de Das Kapital, de Karl Marx. Argumenta sobre a exploração capitalista, sobre o fetichismo e aponta para o problema central do capitalismo: a falta de controle dos concernidos sobre a produção de produtor úteis.

  6. Das, Prof. Gobardhan

    Indian Academy of Sciences (India)

    Das, Prof. Gobardhan Ph.D. (Imtech), FNASc. Date of birth: 10 December 1966. Specialization: Immunology, Infectious Diseases, Cell Biology Address: Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi 110 067, U.T.. Contact: Office: (011) 2670 4559, 2673 8824. Residence: (0124) 424 2351

  7. Das, Prof. Saumitra

    Indian Academy of Sciences (India)

    Fellow Profile. Elected: 2009 Section: General Biology. Das, Prof. Saumitra Ph.D. (Calcutta), FNASc, FNA. Date of birth: 20 January 1962. Specialization: Molecular Virology, Molecular Biology and Cell Biology Address: Microbiology and Cell Biology Department, Indian Institute of Science, Bengaluru 560 012, Karnataka

  8. Das, Prof. Shankar Prasad

    Indian Academy of Sciences (India)

    Home; Fellowship. Fellow Profile. Elected: 2005 Section: Physics. Das, Prof. Shankar Prasad Ph.D. (Chicago), FNA. Date of birth: 16 March 1959. Specialization: Condensed Matter Theory, Statistical Physics and Stochastic Processes Address: School of Physical Sciences, Jawaharlal Nehru University, New Delhi 110 067, ...

  9. Das, Prof. Prosad Kumar

    Indian Academy of Sciences (India)

    Fellow Profile. Elected: 1975 Section: Earth & Planetary Sciences. Das, Prof. Prosad Kumar D.Phil. (Calcutta), FNA Council Service: 1980-82. Date of birth: 20 May 1926. Date of death: 14 January 2011. Specialization: Numerical Weather Prediction, Ocean-Atmosphere Coupling, Storm Surges and Dynamic Meteorology

  10. Das, Dr Amitava

    Indian Academy of Sciences (India)

    Elected: 2010 Section: Chemistry. Das, Dr Amitava Ph.D. (Jadavpur), FNASc, FNA. Date of birth: 24 December 1959. Specialization: Molecular Reactions, Supramolecular Chemistry, Assembly Photo-included Processes Address: Director, Central Salt & Marine Chemicals Research Institute, GB Marg, Bhavnagar 364 002, ...

  11. Das Reflektierende Team

    DEFF Research Database (Denmark)

    Lorensen, Marlene Ringgaard; Gaarden, Marianne

    2015-01-01

    dazu hat Marlene Ringgaard Lorensen das Potenzial des von außen kommenden, dezidiert ›andersartigen‹ Beitrags der Hörenden für die dialogische Predigt im Rückgriff auf Theorien von Mikhail Bakhtin analysiert. Als theologische Grundfigur steht hinter der Arbeit im reflektierenden homiletischen Team also...

  12. Ikea das Rendas

    OpenAIRE

    Bergman, Aeron; Salinas, Alejandra

    2008-01-01

    FIALENA fabric design by Anna Svanfeldt for IKEA of Sweden. It took Maria da Guia 2 months to reproduce the Ikea pattern using traditional Portuguese improvised knots. 2008 Installasjon i Museu das Rendas, Vila do Conde, Portugal, 01.09.2008 - 01.10.2008. Sponsor: City of Villa do Conde.

  13. Análise da recorrência de fibrilação atrial durante terapia com sotalol ou quinidina Analysis of atrial fibrillation recurrence during therapy with sotalol or quinidine

    Directory of Open Access Journals (Sweden)

    Henrique Horta Veloso

    1998-01-01

    Full Text Available OBJETIVO: Analisar a incidência e as características das crises de recorrência de fibrilação atrial (FA em pacientes sob terapia com sotalol ou quinidina. MÉTODOS: Cento e vinte e um pacientes receberam de forma randômica sotalol (58 pacientes ou quinidina (63 pacientes após reversão de FA paroxística e foram acompanhados, ambulatorialmente, por 6 meses. As sintomatologias e as freqüências ventriculares ao eletrocardiograma de 12 derivações da crise inicial e da recorrência foram comparadas entre os grupos de drogas. As características clínicas e os dados do ecocardiograma foram analisados como preditores de recorrência. RESULTADOS: Dezessete (14% pacientes apresentaram recorrência da arritmia, 7 (12% em uso de sotalol e 10 (16% em uso de quinidina. A recorrência ocorreu mais tardiamente no grupo tratado com sotalol (mediana de 69 dias em comparação ao grupo tratado com quinidina (mediana de 10 dias (p=0,04. A sintomatologia esteve presente em 14 (82% pacientes na crise inicial e em 8 (47% pacientes na recorrência. O tratamento antiarrítmico proporcionou recorrências menos sintomáticas (pPURPOSE: To analyze the recurrences of atrial fibrillation in patients treated with sotalol or quinidine. METHODS: After conversion to sinus rhythm, 121 patients with paroxysmal atrial fibrillation were randomized to sotalol (58 patients or quinidine (63 patients and followed-up during 6 months. Symptoms and ventricular rates on the 12 lead electrocardiogram of the arrhythmic events were compared between the two groups. Clinical and echocardiographic characteristics were analyzed as predictors of atrial fibrillation recurrence. RESULTS: Seventeen (14% patients relapsed into atrial fibrillation; 7 (12% were treated with sotalol and 10 (16% with quinidine. Recurrence occurred later in the sotalol group (median 69 days in comparison with the quinidine group (median 10 days (p=0.04. Symptoms were present in 14 (82% patients during the

  14. Atrial fibrillation ablation beyond pulmonary veins: The role of left atrial appendage.

    Science.gov (United States)

    Romero, Jorge; Natale, Andrea; Di Biase, Luigi

    2017-11-01

    The role of pulmonary vein isolation in patients with non-paroxysmal atrial fibrillation (AF) is only modest. Several studies have demonstrated the role of the left atrial appendage (LAA) in initiating and maintaining of this arrhythmia. We review in this article the incremental benefit in free-arrhythmia recurrence of LAA electrical isolation in patients undergoing procedures for persistent AF or long standing persistent AF either using radiofrequency ablation, cryoablation or Lariat device implantation. Likewise, acute complications, anticoagulation and the risk of ischemic stroke after LAA electrical isolation (LAAEI) are analyzed. LAAEI in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from all atrial arrhythmias in patients with persistent AF and long standing persistent atrial fibrillation (LSPAF) without increasing acute procedural complications and without raising the risk of ischemic stroke. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Left atrial size in patients with cryptogenic stroke as a predictor of occurrence of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Antonio Cruz Culebras

    2017-04-01

    Full Text Available Objective: To determine whether the left atrial size can predict the development of atrial fibrillation (AF in patients with embolic stroke of undetermined source (ESUS. Methods: Patients with ischemic stroke were included prospectively (January 2015-July 2015 when ESUS was suspected. Clinical and cardiac imaging data were recorded. Patients with cardiac failure were excluded. Results: a total of 55 patients were included. Medium age was 71 years. The proportion of patients who developed AF during the follow-up (1 year was 23, 63%. 10 % of patients did not have any vascular risk factor. Basal ECG was normal in 98% of cases. The left atrial size volume was 36, 08 ml in patients who developed AF and 27, 14 ml in patients who did not. Conclusions: In patients with ESUS, left atrial size dimensions do not predict the occurrence of AF.

  16. New risk factors for atrial fibrillation : causes of 'not-so-lone atrial fibrillation'

    NARCIS (Netherlands)

    Schoonderwoerd, Bas A.; Smit, Marcelle D.; Pen, Lucas; Van Gelder, Isabelle C.

    Atrial fibrillation (AF) is a prevalent arrhythmia in patients with cardiovascular disease. The classical risk factors for developing AF include hypertension, valvular disease, (ischaemic) cardiomyopathy, diabetes mellitus, and thyroid disease. In some patients with AF, no underlying

  17. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators

    DEFF Research Database (Denmark)

    van Walraven, Carl; Hart, Robert G; Connolly, Stuart

    2009-01-01

    . Outcomes included ischemic stroke, serious bleeding (intracranial hemorrhage or systemic bleeding requiring hospitalization, transfusion, or surgery), and cardiovascular events (ischemic stroke, myocardial infarction, systemic embolism, or vascular death). RESULTS: The analysis included 8932 patients......BACKGROUND AND PURPOSE: Stroke risk increases with age in patients who have nonvalvular atrial fibrillation. It is uncertain whether the efficacy of stroke prevention therapies in atrial fibrillation changes as patients age. The objective of this study was to determine the effect of age...... on the relative efficacy of oral anticoagulants (OAC) and antiplatelet (AP) therapy (including acetylsalicylic acid and triflusal) on ischemic stroke, serious bleeding, and vascular events in patients with atrial fibrillation. METHODS: This is an analysis of the Atrial Fibrillation Investigators database, which...

  18. Benign Paroxysmal Positional Vertigo: comparison of two recent international guidelines Vertigem Posicional Paroxística Benigna: comparação de duas recentes diretrizes internacionais

    Directory of Open Access Journals (Sweden)

    André Luís dos Santos Silva

    2011-04-01

    Full Text Available Benign Paroxysmal Positional Vertigo (BPPV is characterized by vertigo, lasting for a few seconds and usually managed by head positioning maneuvers. To educate clinicians concerning the state-of-the art knowledge about its management, the international societies developed guidelines. AIM: the aim of this paper is to discuss, in a practical fashion, the current options available to manage BPPV. METHOD: Study design: non-systematic review. This study reviews two recent guidelines regarding the evaluation and treatment of BPPV. The first one was published by the American Academy of Otolaryngology Head and Neck surgery (AAO-HNS and the other by the American Academy of Neurology (AAN. The similarities were presented in different tables. RESULTS: Those guidelines presented differences regarding methods. Only the AAO-HNS guidelines recommend the Dix-Hallpike test for the diagnosis of BPPV. Only canalith repositioning maneuver, Semont maneuver and vestibular rehabilitation had showed some benefit and were recommended as good treatment options. CONCLUSIONS: Both guidelines fulfilled all the aspects required for clinicians to diagnosed and manage BPPV; only the AAO-HNS's guidelines were more comprehensive and of better quality.A Vertigem Posicional Paroxística Benigna (VPPB é caracterizada por tontura rotatória com duração de segundos e tratada com manobras cefálicas. Para sistematizar a conduta e conduzir os clínicos no atual conhecimento no seu controle, sociedades internacionais desenvolveram diretrizes. OBJETIVO: Discutir de forma prática e didática o estado da arte da abordagem atualmente disponível para VPPB. MATERIAL E MÉTODOS: Revisão assistemática com análise crítica comparando os resultados de duas recentes diretrizes internacionais a respeito da avaliação e controle da VPPB. Uma pesquisa foi elaborada pela American Academy of Otolaryngology (AAO-HNS e a outra preparada pela American Academy of Neurology (AAN. Os tópicos em

  19. A CONSOLIDAÇÃO DO MARCO REGULATÓRIO DAS PARCERIAS PARA O DESENVOLVIMENTO PRODUTIVO

    Directory of Open Access Journals (Sweden)

    Eduardo Jorge Valadares Oliveira

    2015-10-01

    Full Text Available Um dos instrumentos da atual política industrial brasileira são as Parcerias para o Desenvolvimento Produtivo (PDP. Em agosto de 2014, o novo marco regulatório das PDP foi colocado em consulta pública, dando origem à Portaria nº 2.531, de 12 de novembro de 2014, a qual redefine as diretrizes e os critérios para a definição da lista de produtos estratégicos para o SUS e o estabelecimento das PDP e disciplina os respectivos processos de submissão,instrução, decisão, transferência e absorção de tecnologia, aquisição de produtos estratégicos para o SUS no âmbito das PDP, monitoramento e avaliação. A elaboração deste artigo teve como objetivo verificar a consolidação das PDP e de seu novo marco regulatório como ferramenta para fomento, incentivo e desenvolvimento do CEIS, através da pesquisa documental e análise de conteúdo da Portaria GM/MS nº 2.531/2014. Verificou-se que essa portaria consolidou todo o rito processual em um único documento a ser adotado pelo governo federal na gestão das PDP, tornando esta uma política de Estado com um marco institucional seguro e estável; e fortalecendo a saúde como parte da agenda da política nacional de desenvolvimento, com um processo deliberativo interministerial.

  20. Right atrial mass following transcatheter radiofrequency ablation for recurrent atrial fibrillation: thrombus, endocarditis or mixoma?

    Science.gov (United States)

    Ancona, Roberta; Comenale Pinto, Salvatore; Caso, Pio; Di Palma, Vito; Pisacane, Francesca; Martiniello, Alfonso Roberto; Quarto, Cesare; De Rosa, Nicla; Pisacane, Carlo; Calabrò, Raffaele

    2009-03-01

    We report a case of an asymptomatic patient in whom a right atrial mass was fortuitously documented by echocardiography few months after a transcatheter radiofrequency catheter ablation for recurrent AF. No masses were seen in the cardiac chambers before the ablative procedure, raising important diagnostic and decision-making issues. The patient was referred to the surgeon and a diagnosis of right atrial myxoma was made.

  1. Paroxysmal atrial fibrillation due to left atrial appendage herniation and review of the literature.

    Science.gov (United States)

    Misthos, Panagiotis; Neofotistos, Kostas; Drosos, Polivios; Kokotsakis, John; Lioulias, Achilleas

    2009-04-17

    The incidence of the isolated form of partial absence of the pericardium is a rare finding. The authors present a case of an isolated left sided pericardial defect with intrathoracic protrusion of the left atrial appendage found during a left upper lobectomy for lung cancer, unrecognized after serial echocardiographs and computed tomography scan of the thorax. The patient suffered from episodes of atrial fibrillation which disappeared after pericardial defect repair without antiarrhythmic medication.

  2. O ENEM no contexto das políticas para o Ensino Médio

    Directory of Open Access Journals (Sweden)

    Paulo Henrique Alves Machado

    2014-04-01

    Full Text Available http://dx.doi.org/10.5007/2175-795X.2014v32n1p355 Este artigo tem como objetivo compreender os determinantes do Exame Nacional do Ensino Médio (ENEM, analisando a política de reforma do Ensino Médio e suas interfaces com a avaliação representada pelo exame, no contexto da promulgação da Lei de Diretrizes e Base no 9.394/96 até o novo ENEM em 2009. A metodologia utilizada partiu de uma abordagem qualitativa, tendo como procedimento a análise de conteúdo dos documentos, sistematizada através de três categorias (avaliação, trabalho e cidadania, cuja empiria constitui-se dos documentos: Parecer CEB nº 15/98, Resolução CNE nº 03/98, Bases legais dos PCNEM, além das portarias nº 438/98 e nº 109/2009. As análises dos documentos que sustentam a reforma do ensino médio mostraram que o ENEM é coerente com a política para essa etapa da Educação Básica, uma vez que seus princípios podem ser identificados tanto na Lei de Diretrizes e Base quanto nos demais documentos analisados. Os resultados da pesquisa também indicaram que os princípios valorizados pelos organismos multilaterais, nos anos de 1990, estão presentes na reforma do ensino médio e tem relação direta com a política neoliberal.

  3. New guidelines for cardiopulmonary resuscitation Nuevas directrices para la resucitación cardiopulmonar Novas diretrizes da ressuscitação cardiopulmonar

    Directory of Open Access Journals (Sweden)

    Maria Celia Barcellos Dalri

    2008-12-01

    Full Text Available Cardiopulmonary arrest (CPA poses a severe threat to life; cardiopulmonary resuscitation (CPR represents a challenge for research and assessment by nurses and their team. This study presents the most recent international recommendations for care in case of cardiopulmonary heart arrest, based on the 2005 Guidelines by the American Heart Association (AHA. These CPR guidelines are based on a large-scale review process, organized by the International Liaison Committee on Resuscitation (ILCOR. High-quality basic and advanced CPR maneuvers can save lives.La parada cardiorrespiratoria (PCR es una ocurrencia que presenta una grave amenaza a la vida; la resucitación cardiopulmonar (RCP representa un desafío para la investigación y la evaluación por parte del enfermero y su equipo. Este estudio presenta las más recientes recomendaciones internacionales sobre la atención a la parada cardiorrespiratoria, basada en las Directrices de 2005 de la American Heart Asociation (AHA. Esas directrices sobre RCP se fundamentan en un proceso de revisión extenso, organizado por el International Liasion Committee on Resuscitation (ILCOR. Las maniobras básicas y avanzadas de RCP ofrecidas con calidad pueden salvar vidas.A parada cardiorrespiratória (PCR é intercorrência de grave ameaça à vida; a ressuscitação cardiopulmonar (RCP representa desafio para a investigação e a avaliação por parte do enfermeiro e sua equipe. Esse estudo apresenta as mais recentes recomendações internacionais sobre atendimento da parada cardiorrespiratória, baseado nas Diretrizes de 2005 da American Heart Association (AHA. Essas diretrizes sobre RCP fundamentam-se num processo de revisão extenso, organizado pelo International Liasion Committee on Resuscitation (ILCOR. As manobras básicas e avançadas de RCP com qualidade podem salvar vidas.

  4. Determination of inadvertent atrial capture during para-Hisian pacing.

    Science.gov (United States)

    Obeyesekere, Manoj; Leong-Sit, Peter; Skanes, Allan; Krahn, Andrew; Yee, Raymond; Gula, Lorne J; Bennett, Matthew; Klein, George J

    2011-08-01

    Inadvertent capture of the atrium will lead to spurious results during para-Hisian pacing. We sought to establish whether the stimulation-to-atrial electrogram interval at the proximal coronary sinus (stim-PCS) or high right atrium (stim-HRA) could signal inadvertent atrial capture. Para-Hisian pacing with and without intentional atrial capture was performed in 31 patients. Stim-HRA and stim-PCS intervals were measured with atrial capture, His plus para-Hisian ventricular (H+V) capture, and para-Hisian ventricular (V) capture alone. The mean stim-HRA interval was significantly shorter with atrial capture (66 ± 18 ms) than with H+V (121 ± 27 ms, P capture alone (174 ± 38 ms, P capture (51 ± 16 ms) than with H+V (92 ± 22 ms, Pcapture alone (146 ± 33 ms, P capture. A stim-PCS >90 ms (stim-HRA >100 ms) was observed only in the absence of atrial capture. A stim-HRA of capture. Stim-HRA intervals of 75 to 97 ms and stim-PCS intervals of 65 to 88 ms were observed with either atrial, His, or para-Hisian ventricular capture without atrial capture. In this overlap zone, all patients demonstrated a stim-PCS or stim-HRA interval prolongation of at least 20 ms when the catheter was advanced to avoid deliberate atrial pacing. The QRS morphology was of limited value in distinguishing atrial capture due to concurrent ventricular or H+V capture, as observed in 20 of 31 (65%) patients. Stim-PCS and stim-HRA intervals can be used to monitor for inadvertent atrial capture during para-Hisian pacing. A stim-PCS 90 ms (or stim-HRA > 100 ms) were observed only with and without atrial capture, respectively, but there was significant overlap between these values. Deliberate atrial capture and loss of capture reliably identifies atrial capture regardless of intervals.

  5. Atrial electrogram quality in single-pass defibrillator leads with floating atrial bipole in patients with permanent atrial fibrillation and cardiac resynchronization therapy.

    Science.gov (United States)

    Sticherling, Christian; Müller, Dirk; Schaer, Beat A; Krüger, Silke; Kolb, Christof

    2018-03-27

    Many patients receiving cardiac resynchronization therapy (CRT) suffer from permanent atrial fibrillation (AF). Knowledge of the atrial rhythm is important to direct pharmacological or interventional treatment as well as maintaining AV-synchronous biventricular pacing if sinus rhythm can be restored. A single pass single-coil defibrillator lead with a floating atrial bipole has been shown to obtain reliable information about the atrial rhythm but has never been employed in a CRT-system. The purpose of this study was to assess the feasibility of implanting a single coil right ventricular ICD lead with a floating atrial bipole and the signal quality of atrial electrograms (AEGM) in CRT-defibrillator recipients with permanent AF. Seventeen patients (16 males, mean age 73 ± 6 years, mean EF 25 ± 5%) with permanent AF and an indication for CRT-defibrillator placement were implanted with a designated CRT-D system comprising a single pass defibrillator lead with a atrial floating bipole. They were followed-up for 103 ± 22 days using remote monitoring for AEGM transmission. All patients had at last one AEGM suitable for atrial rhythm diagnosis and of 100 AEGM 99% were suitable for visual atrial rhythm assessment. Four patients were discharged in sinus rhythm and one reverted to AF during follow-up. Atrial electrograms retrieved from a single-pass defibrillator lead with a floating atrial bipole can be reliably used for atrial rhythm diagnosis in CRT recipients with permanent AF. Hence, a single pass ventricular defibrillator lead with a floating bipole can be considered in this population. Copyright © 2018 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.

  6. Políticas públicas e direitos humanos: uma releitura das relações raciais nas escolas brasileiras

    Directory of Open Access Journals (Sweden)

    Flavio Santiago

    2014-01-01

    Full Text Available http://dx.doi.org/10.5007/2178-4582.2013v47n1p16 O objetivo desse artigo  é compreender o papel de uma política pública específica, ou seja, as Diretrizes Curriculares Nacionais para a Educação das Relações Etnicorracias e para o Ensino de História e Cultura Africana e Afrobrasileira, através da aprovação do parecer CNE 003/04 e sua Resolução 01/04 Lei 10639/03, que alterou a LDB - 9394/96, tornando obrigatório o ensino de História e Cultura Afrobrasileira e Africana no currículo oficial da educação básica. A metodologia escolhida foi a análise documental das fontes legislativas das quais faremos uso, dentre elas a Constituição de 1988, os Anais da Constituinte de 1986-88, a LDB e as Diretrizes já mencionadas. Esse trabalho apontará como essa legislação e política pública exigiram uma releitura das relações étnico-raciais na escola e demandaram um novo olhar do profissional da educação sobre a heterogeneidade para que os Direitos Humanos tivessem lugar na instituição escolar. A conclusão mostrará que a construção do olhar para diferença não deve ser estabelecido dentro da lógica da tolerância neoliberal, de negação dos direitos humanos, mas sim ser produzido através da recusa da homogeneização e da institucionalização de práticas inclusivas.

  7. Left atrial appendage closure devices for cardiovascular risk reduction in atrial fibrillation patients

    Directory of Open Access Journals (Sweden)

    Cruz-Gonzalez I

    2015-05-01

    Full Text Available Ignacio Cruz-Gonzalez,* Juan Carlos Rama-Merchan,* Javier Rodriguez-Collado, Javier Martin-Moreiras, Alejandro Diego-Nieto, Antonio Arribas-Jimenez, Pedro Luís SanchezDepartment of Cardiology, University Hospital of Cardiology and IBSAL, Salamanca, Spain *Ignacio Cruz-Gonzalez and Juan Carlos Rama-Merchan have contributed equally to this work and should be considered co-first authors Abstract: Atrial fibrillation (AF is the most common sustained arrhythmia in clinical practice. AF is associated with a 4–5-fold increased risk of stroke and systemic embolism. Oral anticoagulant is the first-line therapy for this purpose, but it has various limitations and is often contraindicated or underutilized. Autopsy and surgical data have suggested that 90% of atrial thrombi in nonvalvular AF patients originate from the left atrial appendage, leading to the development of percutaneous closure for thromboembolic prevention. This paper examines the current evidence on left atrial appendage closure devices for cardiovascular risk reduction in AF patients. Keywords: atrial fibrillation, left atrial appendage, stroke, oral anticoagulant, percutaneous closure, thromboembolic prevention

  8. Atorvastatin can ameliorate left atrial stunning induced by radiofrequency ablation for atrial fibrillation.

    Science.gov (United States)

    Xie, Ruiqin; Yang, Yingtao; Cui, Wei; Yin, Hongning; Zheng, Hongmei; Zhang, Jidong; You, Ling

    2017-09-01

    The objective of this study was to study the functional changes of the left atrium after radiofrequency ablation treatment for atrial fibrillation and the therapeutic effect of atorvastatin. Fifty-eight patients undergoing radiofrequency ablation for atrial fibrillation were randomly divided into non-atorvastatin group and atorvastatin group. Patients in the atorvastatin group were treated with atorvastatin 20 mg p.o. per night in addition to the conventional treatment of atrial fibrillation; patients in the non-atorvastatin group received conventional treatment of atrial fibrillation only. Echocardiography was performed before radiofrequency ablation operation and 1 week, 2 weeks, 3 weeks, and 4 weeks after operation. Two-dimensional ultrasound speckle tracking imaging system was used to measure the structural indexes of the left atrium. Results indicated that there was no significant change for indexes representing the structural status of the left atrium within a month after radiofrequency ablation (P > 0.05); however, there were significant changes for indexes representing the functional status of the left atrium. There were also significant changes in indexes reflecting left atrial strain status: the S and SRs of atorvastatin group were higher than those of non-atorvastatin group (P radiofrequency ablation of atrial fibrillation.

  9. ANTIARRHYTMIC EFFICACY OF SOTALOL IN PATIENTS WITH TACHY-BRADY SYNDROME HAVING ATRIAL PACEMAKER WITH DIFFERENT ATRIAL ELECTRODE POSITION

    Directory of Open Access Journals (Sweden)

    T. N. Novikova

    2009-01-01

    Full Text Available Aim. To evaluate efficacy of the combined therapy (sotalol and constant electric cardiostimulation in AAI regimen at two atrial electrode position: in low back part of interatrial septum (IAS and in right atrial auricle (RAA.Material and methods. 20 patients with tachy-brady syndrome were examined. They were randomized in 2 groups depending on atrial electrode position. Sotalol (160 mg daily was prescribed to all patients in a month after implantation of constant atrial pacemaker (CAP. A number of atrial fibrillation paroxysms (AFP was evaluated initially, in a month after CAP implantation and in a month after start of sotalol therapy.Results. Significant AFP reduction was observed in IAS stimulation, unlike RAA stimulation. Sotalol addition had essential significance in the termination or reduction of AFP. Sotalol effect did not depend on atrial electrode position.Conclusion. Sotalol usage together with constant electric cardiostimulation significantly reduces AFP irrespectively of atrial electrode position. 

  10. Integrating new approaches to atrial fibrillation management

    DEFF Research Database (Denmark)

    Kotecha, Dipak; Breithardt, Günter; Camm, A John

    2018-01-01

    of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new...

  11. APOLLO I: Anticoagulation control in atrial fibrillation.

    Science.gov (United States)

    Pinho-Costa, Luís; Moreira, Sónia; Azevedo, Cristiana; Azevedo, Pedro; Castro, Elisabete; Sousa, Hélder; Melo, Miguel

    2015-05-01

    Anticoagulation control as assessed by time in therapeutic range (TTR) correlates positively with the safety and efficacy of thromboprophylaxis in atrial fibrillation. We set out to assess TTR in our unit and to investigate determinants of better control. This was a case series study of atrial fibrillation patients anticoagulated with warfarin or acenocoumarol at the Family Health Unit of Fânzeres. Sociodemographic and clinical data were collected and TTR was calculated by the Rosendaal method, based on international normalized ratio tests performed in external laboratories in the preceding six months. SPSS 21.0 was used for the statistical analysis, with descriptive statistics, Spearman's correlation, and the Mann-Whitney U and Kruskal-Wallis tests. Of the 106 eligible patients, 70% participated in the study. Median TTR was 65.3% (P25=48.3%, P75=86.8%). We found a positive association between this variable and duration of atrial fibrillation (ρ=0.477, p0.05). Median TTR in our unit is similar to that in southern European countries and close to the good control threshold (70%) proposed by the European Society of Cardiology. The duration of atrial fibrillation and of anticoagulation explains only a small part of the measure's variability. Other determinants of anticoagulation control must be investigated in future studies and comparative studies should be carried out in family health units monitoring anticoagulation on the premises. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  12. Left atrial myxoma with biventricular dysfunction

    Directory of Open Access Journals (Sweden)

    Monish S. Raut

    2016-09-01

    Full Text Available Occurrence of left atrial myxoma with severe ventricular dysfunction without any obstructive coronary artery disease, as presented in our case, is very rare. It may be due to undiagnosed concomitant dilated cardiomyopathy or unknown cardiodepressant effect of myxoma which warrants further research.

  13. Left atrial myxoma with biventricular dysfunction.

    Science.gov (United States)

    Raut, Monish S; Shad, Sujay; Maheshwari, Arun

    2016-09-01

    Occurrence of left atrial myxoma with severe ventricular dysfunction without any obstructive coronary artery disease, as presented in our case, is very rare. It may be due to undiagnosed concomitant dilated cardiomyopathy or unknown cardiodepressant effect of myxoma which warrants further research. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  14. Spontaneous conversion of first onset atrial fibrillation

    DEFF Research Database (Denmark)

    Lindberg, Søren Østergaard; Hansen, Sidsel; Nielsen, Tonny

    2011-01-01

    Background  We studied all patients admitted to hospital with first onset atrial fibrillation (AF) to determine the probability of spontaneous conversion to sinus rhythm and to identify factors predictive of such a conversion. Methods and Results  We retrospectively reviewed charts of 438...

  15. Attitudes Towards Catheter Ablation for Atrial Fibrillation

    DEFF Research Database (Denmark)

    Vadmann, Henrik; Pedersen, Susanne S; Nielsen, Jens Cosedis

    2015-01-01

    BACKGROUND: Catheter ablation for atrial fibrillation (AF) is an important but expensive procedure that is the subject of some debate. Physicians´ attitudes towards catheter ablation may influence promotion and patient acceptance. This is the first study to examine the attitudes of Danish...

  16. An "account" of digitalis and atrial fibrillation

    NARCIS (Netherlands)

    Meijler, F.L.

    This review deals with the mechanisms by which digitalis exerts its "opium-Iike" action on the ventricular rate in patients with atrial fibrillation. To understand the effect of digitalis on ventricular rate and rhythm, it is essential to learn more about the basic electrophysiologic

  17. Atrial fibrillation, stroke, and quality of life.

    Science.gov (United States)

    Chinitz, Jason S; Castellano, Jose M; Kovacic, Jason C; Fuster, Valentin

    2012-04-01

    Contemporary management of atrial fibrillation imposes many challenges, particularly in the setting of our aging population. In addition to well-recognized consequences, such as stroke and mortality, emerging evidence relates atrial fibrillation to elevated risk of dementia, posing further therapeutic challenges. As the incidence of atrial fibrillation rises with age, the balance of controlling stroke risk and limiting major hemorrhage on anticoagulation has become increasingly critical in elderly patients. Appreciation of more extensive risk factors has made it possible to identify patients at very low risk of thromboembolism and higher risk of bleeding. However, practice guidelines in the United States and abroad have occasionally divergent viewpoints regarding how to best manage patients in various risk strata. Options for stroke prevention have expanded with novel antithrombotics and promising mechanical alternatives to anticoagulation, which may be at least as effective in preventing stroke without increasing bleeding risk. Catheter ablation has demonstrated impressive success at preventing atrial fibrillation recurrence in selected patients, and has the potential to further improve outcomes. In addition, the role of antiplatelet medications in patients deemed unsuitable for anticoagulation has been better clarified, although novel agents require further study to assess their impact on thromboembolism. High-bleeding risks associated with the concomitant use of multiple antithrombotics remains a major obstacle in patients with indications for both antiplatelet and anticoagulant therapy. © 2012 New York Academy of Sciences.

  18. Das DNA-Puzzle

    Science.gov (United States)

    Kirchner, Stefan

    Im Jahre 1953 wurde von James Watson und Francis Crick erstmalig der strukturelle Aufbau der sogenannten DNA (Desoxyribonukleinsäure) beschrieben, welche das Erbgut jedes Lebewesens enthält. Der wesentliche Teil des Erbguts wird dabei durch eine sehr lange Folge der vier Basen Adenin (A), Cytosin (C), Guanin (G) und Thymin (T) codiert. Seit einigen Jahren ist es möglich, die Folge der vier Basen zu einer gegebenen DNA zu bestimmen. Biologen bezeichnen diesen Vorgang als Sequenzierung.

  19. Diretrizes brasileiras de hipertensão arterial: realidade da enfermagem em hospital especializado Directrices brasileras de hipertensión arterial: realidad de la enfermería en un hospital especializado Brazilian guidelines for arterial hypertension: the reality of nursing in a specialty hospital

    Directory of Open Access Journals (Sweden)

    Liliana Fortini Cavalheiro Boll

    2012-01-01

    Full Text Available OBJETIVO: Avaliar o conhecimento sobre a técnica da verificação da pressão arterial nos profissionais de enfermagem em uma instituição de saúde. Identificar a relação entre a qualificação profissional e o desenvolvimento correto da técnica. MÉTODOS: O pesquisador aplicou um questionário aos profissionais de enfermagem durante a verificação da pressão arterial dos pacientes, questões estas relativas às V Diretrizes Brasileiras de Hipertensão Arterial. RESULTADOS: Dos profissionais de enfermagem, técnicos e auxiliares, 8,41 %, atingiram o ponto de corte estipulado como adequado de acertos (80%. Houve relação direta entre a qualificação profissional e a quantidade de acertos. CONCLUSÃO: As V Diretrizes Brasileiras de Hipertensão Arterial não são seguidas em sua plenitude pelos profissionais de enfermagem. A ampla divulgação das diretrizes, a implementação de programas de capacitação e a monitoração da técnica devem ser incentivadas.OBJETIVO: Evaluar el conocimiento sobre la técnica de la verificación de la presión arterial en los profesionales de enfermería en una institución de salud. Identificar la relación entre la calificación profesional y el desarrollo correcto de la técnica. MÉTODOS: El investigador aplicó un cuestionario a los profesionales de enfermería durante la verificación de la presión arterial de los pacientes, preguntas que fueron relativas a las V Directrices Brasileras de Hipertensión Arterial. RESULTADOS: De los profesionales de enfermería, técnicos y auxiliares, el 8,41 %, alcanzaron el punto de corte estipulado como adecuado de aciertos (80%. Hubo relación directa entre la calificación profesional y la cantidad de aciertos. CONCLUSIÓN: Las V Directrices Brasileras de Hipertensión Arterial no son seguidas en su plenitud por los profesionales de enfermería. La amplia difusión de las directrices, la implementación de programas de capacitación y el monitoramiento de la t

  20. Aortic properties and atrial electrophysiology in the young and old football players Propriedades da aorta e electrofisiologia atrial em futebolistas profissionais ativos e aposentados

    Directory of Open Access Journals (Sweden)

    Hakan Hasdemir

    2011-06-01

    jovens futebolistas profissionais com um histórico de treino de vários anos. O grupo-controle foi constituído por 27 homens saudáveis e sedentários. No grupo composto por indivíduos mais velhos, foram incluídos 23 futebolistas profissionais já aposentados, saudáveis e com mais de 50 anos de idade e, como grupo-controle, 18 indivíduos com mais de 50 anos de idade que nunca fizeram qualquer tipo de exercício físico regular quando eram mais novos. RESULTADOS: A frequência cardíaca e fração de ejeção eram menores nos jovens futebolistas profissionais. Não se verificaram diferenças significativas nos parâmetros de elasticidade da aorta e a dispersão da onda P entre os jovens futebolistas profissionais e o grupo-controle. Mas, já no caso do grupo dos indivíduos mais velhos com uma atividade desportiva regular, a diferença significativa na dimensão ventricular esquerda, espessura das paredes e funções sistólicas detectada no grupo jovem e ativo desapareceu, enquanto o aumento no diâmetro atrial esquerdo tornou-se expressivo. CONCLUSÃO: Demonstrou-se com este estudo o efeito potencial das propriedades elásticas da aorta, que se alteram com a idade, na electrofisiologia atrial por meio do aumento da dispersão da onda P.

  1. Diagnóstico e tratamento das lombalgias e lombociatalgias

    Directory of Open Access Journals (Sweden)

    AV Brazil

    2004-12-01

    Full Text Available DESCRIÇÃO DO MÉTODO DE COLETA DE EVIDÊNCIAS: Reunião consensual e multidisciplinar para elaboração do texto com inclusão das citações bibliográficas, numa colaboração das especialidades de reumatologia, ortopedia e traumatologia, neurocirurgia, radiologia, medicina física e reabilitação e patologia da coluna vertebral. A partir de um texto básico referencial elaborado pelo editor médico, os participantes, divididos em cinco grupos de trabalho, geraram, por acréscimos e subtrações ao texto básico, recomendações aprovadas, posteriormente, em plenária, que permitiram a edição de um texto preliminar. O documento do consenso foi veiculado pela Internet, para consulta pública, tendo recebido várias sugestões e comentários de especialistas no assunto. As propostas foram devidamente avaliadas por uma comissão julgadora e revisora, que selecionou as que foram incorporadas ao texto preliminar. O editor médico, a partir da versão revisada, chegou ao texto final publicado, que recebeu da Biblioteca Nacional o ISBN n° 85-901548-1-5. Uma versão resumida do referido consenso, com algumas adequações, foi elaborada em trabalho colaborativo entre o editor médico e a comissão técnica do projeto diretrizes AMB/CFM. GRAU DE RECOMENDAÇÃO E FORÇA DE EVIDÊNCIA: A: Grandes ensaios clínicos aleatorizados e meta-análises. B: Estudos clínicos e observacionais bem desenhados. C: Relatos e séries de casos clínicos. D: Publicações baseadas em consensos ou opiniões de especialistas. OBJETIVOS: Oferecer informações sobre o diagnóstico e tratamento das lombalgias e lombociatalgias. PROCEDIMENTOS: Diagnósticos e terapêuticos para as lombalgias e lombociatalgias.

  2. Could successful cryoballoon ablation of paroxysmal atrial fibrillation prevent progressive left atrial remodeling?

    Science.gov (United States)

    Erdei, Tamás; Dénes, Mónika; Kardos, Attila; Mihálcz, Attila; Földesi, Csaba; Temesvári, András; Lengyel, Mária

    2012-03-19

    Radiofrequency catheter ablation of atrial fibrillation (AF) has been proved to be effective and to prevent progressive left atrial (LA) remodeling. Cryoballoon catheter ablation (CCA), using a different energy source, was developed to simplify the ablation procedure. Our hypothesis was that successful CCA can also prevent progressive LA remodeling. 36 patients selected for their first CCA because of nonvalvular paroxysmal AF had echocardiography before and 3, 6 and 12 months after CCA. LA diameters, volumes (LAV) and LA volume index (LAVI) were evaluated. LA function was assessed by: early diastolic velocities of the mitral annulus (Aa(sept), Aa(lat)), LA filling fraction (LAFF), LA emptying fraction (LAEF) and the systolic fraction of pulmonary venous flow (PVSF). Detailed left ventricular diastolic function assessment was also performed. Excluding recurrences in the first 3-month blanking period, the clinical success rate was 64%. During one-year of follow-up, recurrent atrial arrhythmia was found in 21 patients (58%). In the recurrent group at 12 months after ablation, minimal LAV (38 ± 19 to 44 ± 20 ml; p < 0.05), maximal LAV (73 ± 23 to 81 ± 24 ml; p < 0.05), LAVI (35 ± 10 to 39 ± 11 ml/m2; p = 0.01) and the maximal LA longitudinal diameter (55 ± 5 to 59 ± 6 mm; p < 0.01) had all increased. PVSF (58 ± 9 to 50 ± 10%; p = 0.01) and LAFF (36 ± 7 to 33 ± 8%; p = 0.03) had decreased. In contrast, after successful cryoballoon ablation LA size had not increased and LA function had not declined. In the recurrent group LAEF was significantly lower at baseline and at follow-up visits. In patients whose paroxysmal atrial fibrillation recurred within one year after cryoballoon catheter ablation left atrial size had increased and left atrial function had declined. In contrast, successful cryoballoon catheter ablation prevented progressive left atrial remodeling.

  3. Could successful cryoballoon ablation of paroxysmal atrial fibrillation prevent progressive left atrial remodeling?

    Directory of Open Access Journals (Sweden)

    Erdei Tamás

    2012-03-01

    Full Text Available Abstract Background Radiofrequency catheter ablation of atrial fibrillation (AF has been proved to be effective and to prevent progressive left atrial (LA remodeling. Cryoballoon catheter ablation (CCA, using a different energy source, was developed to simplify the ablation procedure. Our hypothesis was that successful CCA can also prevent progressive LA remodeling. Methods 36 patients selected for their first CCA because of nonvalvular paroxysmal AF had echocardiography before and 3, 6 and 12 months after CCA. LA diameters, volumes (LAV and LA volume index (LAVI were evaluated. LA function was assessed by: early diastolic velocities of the mitral annulus (Aasept, Aalat, LA filling fraction (LAFF, LA emptying fraction (LAEF and the systolic fraction of pulmonary venous flow (PVSF. Detailed left ventricular diastolic function assessment was also performed. Results Excluding recurrences in the first 3-month blanking period, the clinical success rate was 64%. During one-year of follow-up, recurrent atrial arrhythmia was found in 21 patients (58%. In the recurrent group at 12 months after ablation, minimal LAV (38 ± 19 to 44 ± 20 ml; p p 2; p = 0.01 and the maximal LA longitudinal diameter (55 ± 5 to 59 ± 6 mm; p p = 0.01 and LAFF (36 ± 7 to 33 ± 8%; p = 0.03 had decreased. In contrast, after successful cryoballoon ablation LA size had not increased and LA function had not declined. In the recurrent group LAEF was significantly lower at baseline and at follow-up visits. Conclusions In patients whose paroxysmal atrial fibrillation recurred within one year after cryoballoon catheter ablation left atrial size had increased and left atrial function had declined. In contrast, successful cryoballoon catheter ablation prevented progressive left atrial remodeling.

  4. Diretrizes metodológicas para investigar estados alterados de consciência e experiências anômalas Methodological guidelines to explore altered states of consciousness and anomalous experiences

    Directory of Open Access Journals (Sweden)

    Alexander Moreira de Almeida

    2003-01-01

    Full Text Available As experiências anômalas (EA (vivências incomuns ou que se acredita diferentes do habitual e das explicações usualmente aceitas como realidade: alucinações, sinestesia e vivências interpretadas como telepáticas... e os estados alterados de consciência (EAC são descritos em todas as civilizações de todas as eras, constituindo-se elementos importantes na história das sociedades. Apesar disso, têm recebido pouca atenção da comunidade científica, ou são abordados de forma pouco rigorosa. As EA e os EAC podem ser estudados sem que se compartilhem as crenças envolvidas, sendo possível investigá-los enquanto experiências subjetivas e, como tais, correlacionados com quaisquer outros dados. Neste artigo, procurou-se apresentar algumas diretrizes metodológicas para um estudo rigoroso do tema, entre elas: evitar uma abordagem preconceituosa e a "patologização" do diferente, a necessidade de uma teoria e de uma revisão exaustiva da literatura existente, utilizar diversos critérios de normalidade e patologia, investigar populações clínicas e não clínicas, desenvolvimento de instrumentos adequados para avaliação, cuidados na escolha dos termos e no estabelecimento de nexos causais, distinguir entre a experiência vivenciada e suas interpretações, considerar o papel da cultura, avaliar a confiabilidade e a validade dos relatos, por fim, o desafio gerado pela necessidade de criatividade e diversidade na escolha dos métodos.Anomalous experiences (AE (uncommon experiences or one that is believed to deviate from the usually accepted explanations of reality: hallucinations, synesthesia, experiences interpreted as telepathic... and altered states of consciousness (ASC are described in all societies of all ages. Even so, the scientists have long neglected the studies on this theme. To study AE and ASC is not necessary to share the believes we discuss, they can be investigated as subjective experiences and correlated like any

  5. Gene expression of proteins influencing the calcium homeostasis in patients with persistent and paroxysmal atrial fibrillation

    NARCIS (Netherlands)

    Brundel, BJJM; Van Gelder, IC; Henning, RH; Tuinenburg, AE; Deelman, LE; Tieleman, RG; Crandjean, JG; Van GIlst, WH; Crijns, HJGM

    Objective: Persistent atrial fibrillation (AF) results in an impairment of atrial function. In order to elucidate the mechanism behind this phenomenon, we investigated the gene expression of proteins influencing calcium handling. Methods: Right atrial appendages were obtained from eight patients

  6. Alterations in gene expression of proteins involved in the calcium handling in patients with atrial fibrillation

    NARCIS (Netherlands)

    Van Gelder, IC; Brundel, BJJM; Henning, RH; Tuinenburg, AE; Tieleman, RG; Deelman, L; Grandjean, JG; De Kam, PJ; Van Gilst, WH; Crijns, HJGM

    Gene Expression in Human Atrial Fibrillation, Introduction: Atrial fibrillation (AF) leads to a loss of atrial contraction within hours to days. During persistence of AF, cellular dedifferentiation and hypertrophy occur, eventually resulting in degenerative changes and cell death, Abnormalities in

  7. Three-dimensional analysis of the left atrial appendage for detecting paroxysmal atrial fibrillation in acute ischemic stroke.

    Science.gov (United States)

    Tanaka, Koji; Koga, Masatoshi; Sato, Kazuaki; Suzuki, Rieko; Minematsu, Kazuo; Toyoda, Kazunori

    2014-12-01

    Atrial fibrillation impairs left atrial appendage function and the thrombus formation in the left atrial appendage is a major cause of cardioembolic stroke. To evaluate the association between the volume of the left atrial appendage measured by real-time three-dimensional transesophageal echocardiography and presence of paroxysmal atrial fibrillation in patients with cerebral infarction or transient ischemic attack. Real-time three-dimensional transesophageal echocardiography was performed to measure left atrial appendage end-diastolic and end-systolic volumes to calculate left atrial appendage ejection fraction. Patients with normal sinus rhythm at the time of real-time three-dimensional transesophageal echocardiography were divided into groups with and without paroxysmal atrial fibrillation. Volumetric data were corrected with the body surface area. Of 146 patients registered, 102 (29 women, 72·2 ± 10·7 years) were normal sinus rhythm at the examination. In 23 patients with paroxysmal atrial fibrillation, left atrial appendage end-diastolic volume (4·78 ± 3·00 ml/m(2) vs. 3·14 ± 2·04 ml/m(2), P = 0·003) and end-systolic volume (3·10 ± 2·47 ml/m(2) vs. 1·39 ± 1·56 ml/m(2), P analysis, all these parameters were independently associated with paroxysmal atrial fibrillation after adjusting for sex, age, diabetes mellitus, and previous stroke. Left atrial appendage volumetric analysis by real-time three-dimensional transesophageal echocardiography is a promising method for detecting paroxysmal atrial fibrillation in acute cerebral infarction or transient ischemic attack. © 2014 The Authors. International Journal of Stroke © 2014 World Stroke Organization.

  8. Atrial myxoma in a patient with hypertrophic cardiomyopathy.

    Science.gov (United States)

    Abdou, Mahmoud; Hayek, Salim; Williams, Byron R

    2013-01-01

    Atrial myxoma is the most common primary cardiac tumor. Patients with atrial myxoma typically present with obstructive, embolic, or systemic symptoms; asymptomatic presentation is very rare. To our knowledge, isolated association of atrial myxoma with hypertrophic cardiomyopathy has been reported only once in the English-language medical literature. We report the case of an asymptomatic 71-year-old woman with known hypertrophic cardiomyopathy in whom a left atrial mass was incidentally identified on cardiac magnetic resonance images. After surgical excision of the mass and partial excision of the left atrial septum, histopathologic analysis confirmed the diagnosis of atrial myxoma. The patient was placed on preventive implantable cardioverter-defibrillator therapy and remained asymptomatic. The management of asymptomatic cardiac myxoma is a topic of debate, because no reports definitively favor either conservative or surgical measures.

  9. [Atrial fibrillation as consequence and cause of structural changes of atria].

    Science.gov (United States)

    Aparina, O P; Chikhireva, L N; Stukalova, O V; Mironova, N A; Kashtanova, S Iu; Ternovoĭ, S K; Golitsyn, S P

    2014-01-01

    Changes of atrial structure and function are the contributors of atrial fibrillation clinical course, complications and treatment effectiveness. Effects of inflammation and mechanical stretch on atrial structural remodeling leading to atrial fibrillation are reviewed in the article. Contemporary invasive and non-invasive methods of evaluation (including late gadolinium enhancement magnetic resonance imaging) of patients with atrial structural remodeling in atrial fibrillation are also described.

  10. Inter-subject variability in human atrial action potential in sinus rhythm versus chronic atrial fibrillation.

    Science.gov (United States)

    Sánchez, Carlos; Bueno-Orovio, Alfonso; Wettwer, Erich; Loose, Simone; Simon, Jana; Ravens, Ursula; Pueyo, Esther; Rodriguez, Blanca

    2014-01-01

    Human atrial electrophysiology exhibits high inter-subject variability in both sinus rhythm (SR) and chronic atrial fibrillation (cAF) patients. Variability is however rarely investigated in experimental and theoretical electrophysiological studies, thus hampering the understanding of its underlying causes but also its implications in explaining differences in the response to disease and treatment. In our study, we aim at investigating the ability of populations of human atrial cell models to capture the inter-subject variability in action potential (AP) recorded in 363 patients both under SR and cAF conditions. Human AP recordings in atrial trabeculae (n = 469) from SR and cAF patients were used to calibrate populations of computational SR and cAF atrial AP models. Three populations of over 2000 sampled models were generated, based on three different human atrial AP models. Experimental calibration selected populations of AP models yielding AP with morphology and duration in range with experimental recordings. Populations using the three original models can mimic variability in experimental AP in both SR and cAF, with median conductance values in SR for most ionic currents deviating less than 30% from their original peak values. All cAF populations show similar variations in G(K1), G(Kur) and G(to), consistent with AF-related remodeling as reported in experiments. In all SR and cAF model populations, inter-subject variability in I(K1) and I(NaK) underlies variability in APD90, variability in I(Kur), I(CaL) and I(NaK) modulates variability in APD50 and combined variability in Ito and I(Kur) determines variability in APD20. The large variability in human atrial AP triangulation is mostly determined by I(K1) and either I(NaK) or I(NaCa) depending on the model. Experimentally-calibrated human atrial AP models populations mimic AP variability in SR and cAF patient recordings, and identify potential ionic determinants of inter-subject variability in human atrial AP

  11. Inter-subject variability in human atrial action potential in sinus rhythm versus chronic atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Carlos Sánchez

    Full Text Available Human atrial electrophysiology exhibits high inter-subject variability in both sinus rhythm (SR and chronic atrial fibrillation (cAF patients. Variability is however rarely investigated in experimental and theoretical electrophysiological studies, thus hampering the understanding of its underlying causes but also its implications in explaining differences in the response to disease and treatment. In our study, we aim at investigating the ability of populations of human atrial cell models to capture the inter-subject variability in action potential (AP recorded in 363 patients both under SR and cAF conditions.Human AP recordings in atrial trabeculae (n = 469 from SR and cAF patients were used to calibrate populations of computational SR and cAF atrial AP models. Three populations of over 2000 sampled models were generated, based on three different human atrial AP models. Experimental calibration selected populations of AP models yielding AP with morphology and duration in range with experimental recordings. Populations using the three original models can mimic variability in experimental AP in both SR and cAF, with median conductance values in SR for most ionic currents deviating less than 30% from their original peak values. All cAF populations show similar variations in G(K1, G(Kur and G(to, consistent with AF-related remodeling as reported in experiments. In all SR and cAF model populations, inter-subject variability in I(K1 and I(NaK underlies variability in APD90, variability in I(Kur, I(CaL and I(NaK modulates variability in APD50 and combined variability in Ito and I(Kur determines variability in APD20. The large variability in human atrial AP triangulation is mostly determined by I(K1 and either I(NaK or I(NaCa depending on the model.Experimentally-calibrated human atrial AP models populations mimic AP variability in SR and cAF patient recordings, and identify potential ionic determinants of inter-subject variability in human atrial AP

  12. MiDAS

    DEFF Research Database (Denmark)

    McIlroy, Simon Jon; Kirkegaard, Rasmus Hansen; McIlroy, Bianca

    A deep understanding of the microbial communities and dynamics in wastewater treatment systems is a powerful tool for process optimization and design (Rittmann et al., 2006). With the advent of amplicon sequencing of the 16S rRNA gene, the diversity within the microbial communities can now...... web platform about the microbes in activated sludge and their associated ADs. The MiDAS taxonomy proposes putative names for each genus-level-taxon that can be used as a common vocabulary for all researchers in the field....

  13. Association of Atrial Fibrillation with Morphological and Electrophysiological Changes of the Atrial Myocardium.

    Science.gov (United States)

    Matějková, Adéla; Šteiner, Ivo

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. For long time it was considered as pure functional disorder, but in recent years, there were identified atrial locations, which are involved in the initiation and maintenance of this arrhythmia. These structural changes, so called remodelation, start at electric level and later they affect contractility and morphology. In this study we attempted to find a possible relation between morphological (scarring, amyloidosis, left atrial (LA) enlargement) and electrophysiological (ECG features) changes in patients with AF. We examined grossly and histologically 100 hearts of necropsy patients - 54 with a history of AF and 46 without AF. Premortem ECGs were evaluated. The patients with AF had significantly heavier heart, larger LA, more severely scarred myocardium of the LA and atrial septum, and more severe amyloidosis in both atria. Severity of amyloidosis was higher in LAs vs. right atria (RAs). Distribution of both fibrosis and amyloidosis was irregular. The most affected area was in the LA anterior wall. Patients with a history of AF and with most severe amyloidosis have more often abnormally long P waves. Finding of long P wave may contribute to diagnosis of a hitherto undisclosed atrial fibrillation.

  14. Dronedarone attenuates the duration of atrial fibrillation in a dog model of sustained atrial fibrillation.

    Science.gov (United States)

    Saengklub, Nakkawee; Limprasutr, Vudhiporn; Sawangkoon, Suwanakiet; Hamlin, Robert L; Kijtawornrat, Anusak

    2017-08-05

    Atrial fibrillation (AF) is a supraventricular arrhythmia that leads to a decrease in cardiac output and impairs cardiac function and quality of life. Dronedarone has an atrial-selective property and has been used for management of AF in humans, but limited information is available in dogs. This study was designed to evaluate efficacy of dronedarone in attenuating the duration of AF in dog model of sustained AF. Six beagle dogs were anesthetized with isoflurane and instrumented to measure atrial action potential duration (aAPD) and atrial effective refractory period (AERP). Then AF was induced by rapid right atrial pacing (20 V, 40 Hz) simultaneously with infusion of phenylephrine (2 µg/kg/min, intravenously) for 20 min. The duration of sustained AF was recorded, and the animals were allowed to recover. Dronedarone was given at a dose of 20 mg/kg, BID, orally for 7 days. On the last day, the dogs were anesthetized again to record aAPD and AERP, and AF was induced with the same procedure as described above. The results showed that after dronedarone administration the aAPD was lengthened significantly from 76.4 ± 4.2 ms to 91.2 ± 3.9 ms (Pdog model of AF by extending the AERP more than the aAPD, causing post-repolarization refractoriness. Hence, dronedarone may be useful for management of AF in dogs.

  15. Clinical Features and Surgical Results of Right Atrial Myxoma.

    Science.gov (United States)

    Li, Han; Guo, Hongwei; Xiong, Hui; Xu, Jianping; Wang, Wei; Hu, Shengshou

    2016-01-01

    We retrospectively analyzed 367 patients receiving surgical resection of cardiac myxomas in our center over six years, and analyzed the incidence and surgical results of 28 cases of right atrial myxomas. We also compared the age, gender, and attached sites between left atrial myxoma and right atrial myxoma. Between January 2007 and December 2012, 28 patients with right atrial myxomas underwent surgical resection. There were 16 males and 12 females. The mean age was 47.77 ± 13.20 years (range: 8.00-79.00 years). Associated cardiac lesions included moderate and severe tricuspid regurgitation in four, coronary atherosclerotic heart disease in five, and pulmonary embolism in one. Twenty-seven patients (96.43%) were followed from 26 to 94 months (mean 55.78 ± 21.10 months). There was no early death after operation. The incidence of right atrial myxomas among sporadic cardiac myxomas was 7.89%. One patient died of lung cancer 34 months after myxoma resection. Two patients underwent coronary artery stent implantation due to coronary atherosclerotic heart disease during the follow-up period. One patient underwent myxoma resection due to recurrence in the left atrium four years after the first operation. There was no significant difference in the age between left atrial myxoma and right atrial myxoma (p > 0.05). There was a significant difference in the gender between left atrial myxomas and right atrial myxomas (p myxomas and right atrial myxomas are the atrial septum. Surgical resection of the right atrial myxoma results in good clinical outcomes and a decreased incidence of recurrence. © 2015 Wiley Periodicals, Inc.

  16. Catheter Ablation for Long-Standing Persistent Atrial Fibrillation

    OpenAIRE

    Romero, Jorge; Gianni, Carola; Di Biase, Luigi; Natale, Andrea

    2015-01-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major burden to health care systems. Atrial fibrillation is associated with a 4- to 5-fold increased risk of thromboembolic stroke. The pulmonary veins have been identified as major sources of atrial triggers for AF. This is particularly true in patients with paroxysmal AF but not always the case for those with long-standing persistent AF (LSPAF), in which other locations for ectopic beats have been we...

  17. Étude pathophysiologique de la fibrillation atriale : approche multifacette

    OpenAIRE

    Morel, Élodie

    2010-01-01

    Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. As its pathophysiology is still poorly understood, it is difficult to treat. Several parameters have been described as involved in the initiation of atrial fibrillation, but the precise mechanisms of initiation of atrial fibrillation are not understood. In this study, histological, biochemical, genetic and transcriptomic approaches have been performed in order to identify the substrates involved in the in...

  18. Extreme variation in the atrial septation of caecilians (Amphibia: Gymnophiona).

    Science.gov (United States)

    de Bakker, Desiderius M; Wilkinson, Mark; Jensen, Bjarke

    2015-01-01

    Caecilians (order Gymnophiona) are elongate, limbless, snake-like amphibians that are the sister-group (closest relatives) of all other recent amphibians (frogs and salamanders). Little is known of their cardiovascular anatomy and physiology, but one nearly century old study suggests that Hypogeophis (family Indotyphlidae), commonly relied upon as a representative caecilian species, has atrial septation in the frontal plane and more than one septum. In contrast, in other vertebrates there generally is one atrial septum in the sagittal plane. We studied the adult heart of Idiocranium (also Indotyphlidae) using immunohistochemistry and confirm that the interatrial septum is close to the frontal plane. Additionally, a parallel right atrial septum divides three-fourths of the right atrial cavity of this species. Idiocranium embryos in the Hill collection reveal that atrial septation initiates in the sagittal plane as in other tetrapods. Late developmental stages, however, see a left-ward shift of visceral organs and a concordant rotation of the atria that reorients the atrial septa towards the frontal plane. The gross anatomies of species from six other caecilian families reveal that (i) the right atrial septum developed early in caecilian evolution (only absent in Rhinatrematidae) and that (ii) rotation of the atria evolved later and its degree varies between families. In most vertebrates a prominent atrial trabeculation associates with the sinuatrial valve, the so-called septum spurium, and the right atrial septum seems homologous to this trabeculation but much more developed. The right atrial septum does not appear to be a consequence of body elongation because it is absent in some caecilians and in snakes. The interatrial septum of caecilians shares multiple characters with the atrial septum of lungfishes, salamanders and the embryonic septum primum of amniotes. In conclusion, atrial septation in caecilians is based on evolutionarily conserved structures but

  19. Effects of right atrial stretch on plasma renin activity.

    Science.gov (United States)

    Annat, G; Grandjean, B; Vincent, M; Jarsaillon, E; Sassard, J

    1976-04-01

    In anaesthetized dog, right atrial stretch leads in the first five minutes to a decrease in plasma renin activity, when measured in inferior vena cava just above the renal veins. Bilateral cervical vagotomy increases plasma renin activity. After vagotomy, atrial stretch no longer has any effect on plasma renin activity. The results support the hypothesis of a control of renin secretion originating from atrial volume receptors.

  20. Cutaneous embolism of an atrial myxoma.

    Science.gov (United States)

    Rodríguez Bandera, Ana Isabel; Stewart, Nicholas Charles; Uribe, Pablo; Minocha, Rashi; Choi, James Young Joon

    2015-08-01

    Cardiac myxoma often presents with heterogeneous symptoms and signs and represents a challenging diagnosis. The cutaneous manifestations, if present, are often transient and non-specific and the clinician must possess a high degree of suspicion to secure the diagnosis. We present the case of a 36-year-old woman with a 6-month history of intermittent, painful, violaceous, non-blanching macules on the thumb and fingertips of the left hand and right ankle. A cutaneous embolic phenomenon was suspected and an urgent echocardiogram demonstrated an atrial mass, with subsequent histopathology confirming the clinical suspicion of atrial myxoma. Early diagnosis and excision of the tumour avoided serious complications. © 2015 The Australasian College of Dermatologists.

  1. Pathogenic Mechanisms of Atrial Fibrillation in Obesity

    Directory of Open Access Journals (Sweden)

    O. M. Drapkina

    2016-01-01

    Full Text Available Atrial fibrillation (AF is one of the most common arrhythmias. It reduces quality of life and its duration due to thromboembolic complications. Obesity contributes to the structural and electrical remodeling of atrial myocardium. This leads to occurrence of ectopic foci in the mouths of the pulmonary veins and the disruption of normal electrical conduction in the atria. Systemic inflammation, myocardial fibrosis, cardiomyocyte overload by Na+ and Ca2+ ions, accumulation in the cells of unoxidized metabolic products, imbalance of the autonomic regulation are considered as the main mechanisms of arrhythmogenic substrate formation. Hypertension, insulin resistance, and obstructive sleep apnea, associated with obesity, increase the risk of development and progression of the arrhythmia. Study of pathogenetic mechanisms of AF in obesity is necessary to develop new strategies for its prevention and the creation of more effective methods of treatment of these patients.

  2. Red Wine, Resveratrol and Atrial Fibrillation

    OpenAIRE

    Stephan, Laura Siga; Almeida, Eduardo Dytz; Markoski, Melissa Medeiros; Garavaglia, Juliano; Marcadenti, Aline

    2017-01-01

    Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with increased risk for cardiovascular disease and overall mortality. Excessive alcohol intake is a well-known risk factor for AF, but this correlation is less clear with light and moderate drinking. Besides, low doses of red wine may acutely prolong repolarization and slow cardiac conduction. Resveratrol, a bioactive polyphenol found in grapes and red wine, has been linked to antiarrhythmic properties and may act as a...

  3. Delay in diagnosis of right atrial myxoma

    International Nuclear Information System (INIS)

    Northcote, R.J.; Sethia, B.; Ballantyne, D.

    1985-01-01

    Clinical, echocardiographic, and nuclear angiographic findings in a 51-year-old woman who presented with a history of dyspnea are discussed. Initial echocardiography revealed no abnormality. However, a subsequent radionuclide angiogram revealed a filling defect on the right side of the heart. This represented a right atrial myxoma. Radionuclide angiography can provide a useful noninvasive tool in the diagnosis of intracardiac tumors when echocardiography has not been helpful

  4. Acute atrial fibrillation during dengue hemorrhagic fever

    Directory of Open Access Journals (Sweden)

    Veloso Henrique Horta

    2003-01-01

    Full Text Available Dengue fever is a viral infection transmitted by the mosquito, Aedes aegypti. Cardiac rhythm disorders, such as atrioventricular blocks and ventricular ectopic beats, appear during infection and are attributed to viral myocarditis. However, supraventricular arrhythmias have not been reported. We present a case of acute atrial fibrillation, with a rapid ventricular rate, successfully treated with intravenous amiodarone, in a 62-year-old man with dengue hemorrhagic fever, who had no structural heart disease.

  5. Cuidados paliativos oncológicos: elementos para o debate de diretrizes nesta área Palliative care in cancer: elements for debating the guidelines

    Directory of Open Access Journals (Sweden)

    Ronaldo Corrêa Ferreira da Silva

    2006-10-01

    Full Text Available Este artigo tem como objetivo apresentar elementos para o debate de diretrizes em programas de cuidados paliativos no Brasil. Foi construído por meio de levantamento bibliográfico em base de dados (MEDLINE, LILACS e Biblioteca Cochrane, em sítios na Internet de organizações e instituições interessadas em cuidados paliativos, em textos de autores fundamentais na área, em livros de referência, em obras citadas nas referências destes mesmos livros e no Banco de Teses da CAPES. Os dados foram agrupados em quatro categorias temáticas: controle de sintomas, organização de serviços, aspectos psicossociais e espirituais. Com isso, procedeu-se a discussão do câncer como um problema de saúde pública e seu impacto no indivíduo, o conceito de cuidados paliativos e seu contexto na atenção à saúde, os modelos de programas e suas diretrizes, a morte e o morrer e os cuidados e cuidadores. O artigo termina apontando os desafios do sistema de saúde brasileiro em estruturar programas de cuidados ao final da vida em conseqüência do envelhecimento da população e do aumento da incidência do câncer.The aim of this study was to present elements for debating guidelines on palliative care programs for cancer. A literature survey searched various databases (MEDLINE, LILACS, and Cochrane Library, homepages of palliative care organizations, publications by renowned authors in this area, reference textbooks on the subject, relevant articles cited by these books, and the thesis/dissertation database of CAPES (the Brazilian Coordinating Body for Training University Level Personnel. The data were grouped into four thematic categories: symptomatic palliation, organization of services, psychosocial characteristics, and spiritual characteristics. The article then proceeds to discuss cancer as a public health problem and its impact on individuals, the concept of palliative care and its context in health care, program models and their guidelines, death

  6. Transplante de células-tronco hematopoéticas e leucemia mieloide aguda: diretrizes brasileiras Hematopoietic stem cells transplantation and acute myeloid leukemia: Brazilian guidelines

    Directory of Open Access Journals (Sweden)

    Lucia Mariano R. Silla

    2010-05-01

    Full Text Available O objetivo deste trabalho foi definir diretrizes para a indicação do transplante de células-tronco hematopoéticas (TCTH no tratamento da leucemia mieloide aguda (LMA no Brasil. O papel do TCTH no tratamento da LMA foi discutido pelosautores e apresentado para a Sociedade Brasileira de Transplante de Medula Óssea na reunião sobre Diretrizes Brasileiras para o TCTH, que o ratificou. Este consenso foi baseado na revisão da literatura internacional e na experiência brasileira em TCTH para o tratamento da LMA. O tratamento ideal para leucemia mieloide aguda em primeira remissão completa (1RC ainda não está definido. Há consenso na indicação do TCTH alogênico, com condicionamento mieloablativo, para pacientes que apresentem alterações citogenéticas consideradas de alto risco. O TCTH alogênico não está indicado na 1RC para pacientes de baixo risco citogenético e, aparentemente, o TCTH alogênico, autólogo ou a quimioterapia de consolidação são equivalentes para os pacientes de risco intermediário.The objective of this work was to define guidelines for the indication of hematopoietic stem cells transplantation (HSCT in the treatment of acute myeloid leukemia (AML in Brazil. The role of HSCT in the treatment of AML was discussed by the authors and presented to the Brazilian Society of Bone Marrow Transplantation in a meeting to formulate and ratify the Brazilian Guidelines on HSCT. This consensus was based on a review of international publications and on the Brazilian experience in HSCT for the treatment of AML. The optimal treatment for AML in first complete remission (1CR has not been defined yet. There is consensus on the indication of allogeneic HSCT with myeloablative conditioning for patients who present high risk cytogenetic changes. Allogeneic HSCT is not indicated for low cytogenetic risk 1RC patients and, apparently, allogeneic and autologous HSCT and consolidation chemotherapy are similar for intermediate risk

  7. Association Between Left Atrial Compression And Atrial Fibrillation: A Case Presentation And A Short Review Of Literature.

    Science.gov (United States)

    Ahmed, Niloy; Carlos, Morales-Mangual; Moshe, Gunsburg; Yitzhak, Rosen

    2016-01-01

    This case report describes a patient who developed palpitations and chest pain and was found to be in atrial fibrillation, which was likely due to the presence of an extra-cardiac mass. This was compressing the left atrium. The mass was related to small cell carcinoma, which decreased significantly in size after chemotherapy. Resolution of the atrial fibrillation correlated temporally with reduction in the size of the mass and alleviation of the left atrial compression.

  8. Atrial Function in Patients with Breast Cancer After Treatment with Anthracyclines.

    Science.gov (United States)

    Yaylali, Yalin Tolga; Saricopur, Ahmet; Yurtdas, Mustafa; Senol, Hande; Gokoz-Dogu, Gamze

    2016-11-01

    incluídas neste estudo retrospectivo, além de 42 indivíduos saudáveis (47 ± 9 anos). Medidas ecocardiográficas foram realizadas por aproximadamente 11 ± 7 meses (média de 9 meses) após tratamento com antraciclinas. AEA esquerdo intra-atrial (11,4 ± 6,0 vs. 8,1 ± 4,9, p=0,008) e AEA interarterial (19,7 ± 7,4 vs. 14,7 ± 6,5, p=0,001) foram prolongados; Volume de esvaziamento passivo e fracionamento de AE diminuíram (p=0,0001 e p=0,0001); Volume de esvaziamento ativo e fracionamento de AE (p=0,0001 e p=0,0001); Tempo de aceleração mitral A (0,8 ± 0,2 vs. 0,6 ± 0,2, p=0,0001) e de desaceleração de onda-E mitral (201,2 ± 35,6 vs. 163,7 ± 21,8, p=0,0001) aumentarão; Razão mitral E/A (1,0 ± 0,3 vs. 1,3 ± 0,3, p=0,0001) e mitral Em (0,09 ± 0,03 vs. 0,11 ± 0,03, p=0,001) diminuíram; Razão mitral Am (0,11 ± 0,02 vs. 0,09 ± 0,02, p=0,0001) e mitral E/Em (8,8 ± 3,2 vs. 7,6 ± 2,6, p=0,017) aumentaram nos pacientes. Em pacientes com câncer de mama após terapia com antraciclina: intervalos eletromecânicos intra-atriais esquerdos, intra-atriais foram prolongados. A função diastólica foi prejudicada. O relaxamento ventricular esquerdo foi prejudicado, e a condução elétrica atrial esquerda pode estar contribuindo para o desenvolvimento de arritmias atriais.

  9. Atrial fibrillation: effects beyond the atrium?

    Science.gov (United States)

    Wijesurendra, Rohan S; Casadei, Barbara

    2015-03-01

    Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is associated with significant morbidity, mostly secondary to heart failure and stroke, and an estimated two-fold increase in premature death. Efforts to increase our understanding of AF and its complications have focused on unravelling the mechanisms of electrical and structural remodelling of the atrial myocardium. Yet, it is increasingly recognized that AF is more than an atrial disease, being associated with systemic inflammation, endothelial dysfunction, and adverse effects on the structure and function of the left ventricular myocardium that may be prognostically important. Here, we review the molecular and in vivo evidence that underpins current knowledge regarding the effects of human or experimental AF on the ventricular myocardium. Potential mechanisms are explored including diffuse ventricular fibrosis, focal myocardial scarring, and impaired myocardial perfusion and perfusion reserve. The complex relationship between AF, systemic inflammation, as well as endothelial/microvascular dysfunction and the effects of AF on ventricular calcium handling and oxidative stress are also addressed. Finally, consideration is given to the clinical implications of these observations and concepts, with particular reference to rate vs. rhythm control. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  10. Quality of life in atrial fibrillation.

    Science.gov (United States)

    Lüderitz, B; Jung, W

    2000-01-01

    In patients with atrial fibrillation (AF), the restoration and maintenance of sinus rhythm is the primary therapeutic goal. Once sinus rhythm is maintained, physiological rate control is restored, and left ventricular ejection fraction, cardiac output, and exercise capacity are increased. This improved cardiovascular performance thereby enhances the patient's ability to perform the functions of normal daily life. The primary intervention for maintaining sinus rhythm after restoration is the use of anti-arrhythmic agents. Although physicians mostly use class 1A anti-arrhythmic drugs, these oral agents only maintain sinus rhythm in a limited number of cases and are accompanied by considerable side effects. Therefore, more effective tools are needed. Effective treatment for AF is based on the above objective criteria, but subjective criteria such as the quality of life are growing in importance. To address these quality-of-life issues, we have initiated a prospective study in which patients are assigned to one of two groups: those with paroxysmal AF who are candidates for permanent implantable atrial defibrillators and those with chronic or paroxysmal AF who are not candidates for atrial defibrillators. Specifically designed questionnaires and various standardized and validated instruments are used to measure quality of life. The questionnaires cover social demographic data, including age, education, occupation level, driving behavior, return to work, and sexual activity. Quality of life is a multidimensional construct, and thus its definition must consider the many factors mentioned above. In the final analysis, therefore, both objective and subjective criteria are necessary to define appropriate treatment of AF.

  11. Atrial Fibrillation in Eight New World Camelids.

    Science.gov (United States)

    Bozorgmanesh, R; Magdesian, K G; Estell, K E; Stern, J A; Swain, E A; Griffiths, L G

    2016-01-01

    There is limited information on the incidence of clinical signs, concurrent illness and treatment options for atrial fibrillation (AF) in New World Camelids (NWC). Describe clinical signs and outcome of AF in NWC. Eight New World Camelids admitted with AF. A retrospective observational study of camelids diagnosed with AF based on characteristic findings on electrocardiogram (ECG). All animals had an irregularly irregular heart rhythm detected on physical examination and 4 cases had obtunded mentation on admission. Three camelids were diagnosed with AF secondary to oleander intoxication, 3 animals had underlying cardiovascular disease, 1 was diagnosed with lone AF and 1 had AF diagnosed on examination for a urethral obstruction. Five of eight animals survived to discharge and nonsurvivors consisted of animals which died or were euthanized as a result of cardiovascular disease (2/8) or extra-cardiac disease unrelated to the AF (1/8). Atrial fibrillation occurs in NWC in association with cardiovascular disease, extra-cardiac disease or as lone AF. Amiodarone and transthoracic cardioversion were attempted in one llama with lone AF, but were unsuccessful. Atrial fibrillation was recorded in 0.1% of admissions. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  12. Ética e pesquisa médica: princípios, diretrizes e regulamentações

    Directory of Open Access Journals (Sweden)

    Castilho Euclides Ayres de

    2005-01-01

    Full Text Available A questão da ética em pesquisa médica ganhou força no fim da Segunda Guerra Mundial, com o Código de Nuremberg. Nesse período, alguns casos ocorridos nos Estados Unidos da América contribuíram para evidenciar a necessidade de estabelecimento de regras e procedimentos em pesquisas médicas. Neste artigo, os Autores discorrem sobre alguns conceitos de ética e seus fundamentos filosóficos, enfatizando situações relacionadas à pesquisa. A ética em pesquisa médica apoia-se no tripé: aprovação pelos pares, consentimento do sujeito de pesquisa e sigilo dos dados individuais obtidos. Os Autores resumem as disposições legais brasileiras para seguir regras e controlar o processo de aspectos éticos em pesquisas envolvendo seres humanos. Finalmente, abordam questões práticas do Termo de Consentimento Livre e Esclarecido decorrente de suas experiências na direção do Comitê de Ética e Pesquisa que analisa mais de 1.000 projetos por ano no Complexo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

  13. Analysis of immune cell populations in atrial myocardium of patients with atrial fibrillation or sinus rhythm.

    Directory of Open Access Journals (Sweden)

    Natalia Smorodinova

    Full Text Available Atrial fibrillation (AF is the most common arrhythmia and despite obvious clinical importance remains its pathogenesis only partially explained. A relation between inflammation and AF has been suggested by findings of increased inflammatory markers in AF patients.The goal of this study was to characterize morphologically and functionally CD45-positive inflammatory cell populations in atrial myocardium of patients with AF as compared to sinus rhythm (SR.We examined 46 subjects (19 with AF, and 27 in SR undergoing coronary bypass or valve surgery. Peroperative bioptic samples of the left and the right atrial tissue were examined using immunohistochemistry.The number of CD3+ T-lymphocytes and CD68-KP1+ cells were elevated in the left atrial myocardium of patients with AF compared to those in SR. Immune cell infiltration of LA was related to the rhythm, but not to age, body size, LA size, mitral regurgitation grade, type of surgery, systemic markers of inflammation or presence of diabetes or hypertension. Most of CD68-KP1+ cells corresponded to dendritic cell population based on their morphology and immunoreactivity for DC-SIGN. The numbers of mast cells and CD20+ B-lymphocytes did not differ between AF and SR patients. No foci of inflammation were detected in any sample.An immunohistochemical analysis of samples from patients undergoing open heart surgery showed moderate and site-specific increase of inflammatory cells in the atrial myocardium of patients with AF compared to those in SR, with prevailing population of monocyte-macrophage lineage. These cells and their cytokine products may play a role in atrial remodeling and AF persistence.

  14. Cardiac magnetic resonance imaging and a rare case of an atrial myxoma causing an atrial septal defect

    Directory of Open Access Journals (Sweden)

    Matthew Grant, MD

    2017-12-01

    Full Text Available A 40 year-old athletic woman presented with worsening dyspnea on exertion over the preceding several months. Chest radiograph showed borderline cardiomegaly and subsequent echocardiography demonstrated a 5.0-cm left atrial mass as well as left-to-right interatrial shunting through a patent foramen ovale. Cardiac magnetic resonance imaging was performed, which demonstrated signal characteristics consistent with an atrial myxoma. The patient then underwent urgent surgical treatment with good technical and clinical outcome. Histologic examination confirmed an atrial myxoma. Cardiac magnetic resonance imaging was valuable in characterizing the nature of the atrial mass and patent foramen ovale, helping guide the surgical approach.

  15. Atrial remodelling in atrial fibrillation: CaMKII as a nodal proarrhythmic signal

    Science.gov (United States)

    Mesubi, Olurotimi O.; Anderson, Mark E.

    2016-01-01

    CaMKII is a serine–threonine protein kinase that is abundant in myocardium. Emergent evidence suggests that CaMKII may play an important role in promoting atrial fibrillation (AF) by targeting a diverse array of proteins involved in membrane excitability, cell survival, calcium homeostasis, matrix remodelling, inflammation, and metabolism. Furthermore, CaMKII inhibition appears to protect against AF in animal models and correct proarrhythmic, defective intracellular Ca2+ homeostasis in fibrillating human atrial cells. This review considers current concepts and evidence from animal and human studies on the role of CaMKII in AF. PMID:26762270

  16. An Extended Bayesian Framework for Atrial and Ventricular Activity Separation in Atrial Fibrillation.

    Science.gov (United States)

    Roonizi, Ebadollah Kheirati; Sassi, Roberto

    2017-11-01

    An extended nonlinear Bayesian filtering framework is introduced for the analysis of atrial fibrillation (AF), in particular with single-channel electrocardiographical (ECG) recordings. It is suitable for simultaneously tracking the fundamental frequency of atrial fibrillatory waves (f-waves), and separating signals, linked to atrial and ventricular activity, during AF. In this framework, high-power ECG components, i.e., Q, R, S, and T waves, are modeled using sum of Gaussian functions. The atrial activity dynamical model is instead based on a trigonometrical function, with a fundamental frequency (the inverse of the dominant atrial cycle length), and its harmonics. The state variables of both dynamical models (QRS-T and f-waves) are hidden and, then estimated, sample by sample, using a Kalman smoother. Remarkably, the scheme is capable of separating ventricular and atrial activity signals, while contemporarily tracking the atrial fundamental frequency in time. The proposed method was evaluated using synthetic signals. In 290 ECGs in sinus rhythm from the PhysioNet PTB Diagnostic ECG Database, the P-waves were replaced with a synthetic f-wave. Broadband noise at different signal-to-noise ratio (SNR) (from 0 to 40 dB) was added to study the performance of the filter, under different SNR conditions. The results of the study demonstrated superior results in atrial and ventricular signal separation when compared with traditional average beat subtraction (ABS), one of the most widely used method for QRS-T cancellation (normalized mean square error = 0.045 for extended Kalman smoother (EKS) and 0.18 for ABS, SNR improvement was 21.1 dB for EKS and 12.2 dB for ABS in f-wave extraction). Various advantages of the proposed method have been addressed and demonstrated, including the problem of tracking the fundamental frequency of f-waves (root mean square error (RMSE) Hz for gradually changing frequency at SNR=15 dB) and of estimating robust QT/RR values during AF (RMSE at

  17. Increased left atrial pressure in non-heart failure patients with subclinical hypothyroidism and atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Akinori Sairaku

    2016-05-01

    Full Text Available Background The impact of subclinical hypothyroidism on the cardiovascular risk is still debated. We aimed to measure the relationship between subclinical hypothyroidism and the left atrial (LA pressure. Methods The LA pressures and thyroid function were measured in consecutive patients undergoing atrial fibrillation (AF ablation, who did not have any known heart failure, structural heart disease, or overt thyroid disease. Results Subclinical hypothyroidism (4.5≤ thyroid-stimulating hormone 18 mmHg (odds ratio 3.94, 95% CI 1.28 11.2; P = 0.02. Conclusions Subclinical hypothyroidism may increase the LA pressure in AF patients.

  18. Potassium channel gene mutations rarely cause atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Nam Edwin G

    2006-08-01

    Full Text Available Abstract Background Mutations in several potassium channel subunits have been associated with rare forms of atrial fibrillation. In order to explore the role of potassium channels in inherited typical forms of the arrhythmia, we have screened a cohort of patients from a referral clinic for mutations in the channel subunit genes implicated in the arrhythmia. We sought to determine if mutations in KCNJ2 and KCNE1-5 are a common cause of atrial fibrillation. Methods Serial patients with lone atrial fibrillation or atrial fibrillation with hypertension were enrolled between June 1, 2001 and January 6, 2005. Each patient underwent a standardized interview and physical examination. An electrocardiogram, echocardiogram and blood sample for genetic analysis were also obtained. Patients with a family history of AF were screened for mutations in KCNJ2 and KCNE1-5 using automated sequencing. Results 96 patients with familial atrial fibrillation were enrolled. Eighty-three patients had lone atrial fibrillation and 13 had atrial fibrillation and hypertension. Patients had a mean age of 56 years at enrollment and 46 years at onset of atrial fibrillation. Eighty-one percent of patients had paroxysmal atrial fibrillation at enrollment. Unlike patients with an activating mutation in KCNQ1, the patients had a normal QTc interval with a mean of 412 ± 42 ms. Echocardiography revealed a normal mean ejection fraction of 62.0 ± 7.2 % and mean left atrial dimension of 39.9 ± 7.0 mm. A number of common polymorphisms in KCNJ2 and KCNE1-5 were identified, but no mutations were detected. Conclusion Mutations in KCNJ2 and KCNE1-5 rarely cause typical atrial fibrillation in a referral clinic population.

  19. Histopathologic analysis of atrial tissue in patients with atrial fibrillation: comparison between patients with atrial septal defect and patients with mitral valvular heart disease.

    Science.gov (United States)

    Kwak, Jae Gun; Seo, Jeong-Wook; Oh, Sam Se; Lee, Sang Yun; Ham, Eui Keun; Kim, Woong-Han; Kim, Soo-Jin; Bae, Eun Jung; Lim, Cheoung; Lee, Chang-Ha; Lee, Cheul

    2014-01-01

    Atrial fibrillation (AF) in adult patients with atrial septal defect (ASD) accompanies an enlarged right atrium (RA) with a less enlarged left atrium (LA), which is the opposite situation in patients with AF and mitral valvular disease. This study was to compare the histopathological change in the atrium of patients with AF of two different etiologies: ASD and mitral disease. Twenty-four patients were enrolled. Group 1 included patients with ASD (8), Group 2 included patients with ASD with AF (6), and Group 3 included patients with mitral disease with AF (10). Preoperative atrial volumes were measured. Atrial tissues were obtained during surgical procedures and stained with periodic acid-Schiff, smooth muscle actin, Sirius red, and Masson's trichrome to detect histopathologic changes compatible with AF. The severity of histopathological changes was represented with "positivity" and "strong positivity" after analyzing digitalized images of the staining. We investigated the relationship between the degree of atrial dilatation and severity of histopathological changes according to the groups and tissues. Group 2 and Group 3 patients showed a tendency toward an enlarged RA volume and enlarged LA volume, respectively, compared with each others. However, in the histopathologic analysis, "positivity" and "strong positivity" showed no significant positive correlations with the degree of atrial volume in special staining. A similar degree of histopathologic changes was observed in both atria in patients with AF (Group 2 and 3) regardless of the degree of dilatation of atrial volume and disease entities. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  20. Abordagem sistêmica do gerenciamento pelas diretrizes: conceituação e aplicação A systematic approach to policy deployment: concept and application

    Directory of Open Access Journals (Sweden)

    Ralph Santos da Silva

    2000-04-01

    Full Text Available Este artigo apresenta um modelo teórico do Gerenciamento pelas Diretrizes (GD, organizando suas principais características sob uma ótica conceitual, explorando os seus aspectos orgânicos. Inicialmente, é estabelecido o seu processo característico para, em seguida, serem definidos quatro elementos que o complementam: (1 sistema de priorização; (2 dispositivos estruturais; (3 dispositivos conciliadores; e (4 sistema de informação. A partir desta referência e por meio da pesquisa-ação é articulada sua implementação numa empresa de serviços que atua como distribuidor de cerveja, atendendo uma grande região geográfica. Desta intervenção, surgem novas características que contribuem para o aprimoramento da proposta.This article presents the theoretical model of policy deployment, exploring and organizing its organic features. At first, the featuring process is established, afterwards four complementary elements are defined: the priority system, the structural devices, the conciliatory devices and the information system. The test is done by research method, "research by intervention in one reality". The intervention was promoted in a beer retailer that operates covering a wide geographic area. New findings were gotten therefore leading condition to improve the model proposed.

  1. Atrial Heterogeneity Generates Re-entrant Substrate during Atrial Fibrillation and Anti-arrhythmic Drug Action: Mechanistic Insights from Canine Atrial Models

    Science.gov (United States)

    Varela, Marta; Hancox, Jules C.; Aslanidi, Oleg V.

    2016-01-01

    Anti-arrhythmic drug therapy is a frontline treatment for atrial fibrillation (AF), but its success rates are highly variable. This is due to incomplete understanding of the mechanisms of action of specific drugs on the atrial substrate at different stages of AF progression. We aimed to elucidate the role of cellular, tissue and organ level atrial heterogeneities in the generation of a re-entrant substrate during AF progression, and their modulation by the acute action of selected anti-arrhythmic drugs. To explore the complex cell-to-organ mechanisms, a detailed biophysical models of the entire 3D canine atria was developed. The model incorporated atrial geometry and fibre orientation from high-resolution micro-computed tomography, region-specific atrial cell electrophysiology and the effects of progressive AF-induced remodelling. The actions of multi-channel class III anti-arrhythmic agents vernakalant and amiodarone were introduced in the model by inhibiting appropriate ionic channel currents according to experimentally reported concentration-response relationships. AF was initiated by applied ectopic pacing in the pulmonary veins, which led to the generation of localized sustained re-entrant waves (rotors), followed by progressive wave breakdown and rotor multiplication in both atria. The simulated AF scenarios were in agreement with observations in canine models and patients. The 3D atrial simulations revealed that a re-entrant substrate was typically provided by tissue regions of high heterogeneity of action potential duration (APD). Amiodarone increased atrial APD and reduced APD heterogeneity and was more effective in terminating AF than vernakalant, which increased both APD and APD dispersion. In summary, the initiation and sustenance of rotors in AF is linked to atrial APD heterogeneity and APD reduction due to progressive remodelling. Our results suggest that anti-arrhythmic strategies that increase atrial APD without increasing its dispersion are

  2. Angiotensin-converting enzyme-2 overexpression improves atrial remodeling and function in a canine model of atrial fibrillation.

    Science.gov (United States)

    Zhou, Tingquan; Wang, Zhenglong; Fan, Jinqi; Chen, Shaojie; Tan, Zhen; Yang, Hanxuan; Yin, Yuehui

    2015-03-19

    Atrial fibrosis is an important factor in initiating and maintaining atrial fibrillation. The purpose of this study was to test the hypothesis that atrial angiotensin-converting enzyme-2 (ACE2) overexpression might inhibit atrial collagen accumulation and improve atrial remodeling in a canine atrial pacing model. Thirty-two mongrel dogs of both genders were divided randomly into 4 groups: sham-operated, control, gene therapy with adenovirus-enhanced green fluorescent protein (Ad-EGFP), and gene therapy with Ad-ACE2. All of the dogs in the control, Ad-EGFP, and Ad-ACE2 groups were paced at 450 bpm for a period of 14 days. The dogs in the sham group were instrumented without pacing. After 2 weeks, all of the dogs underwent a thoracotomy operation and received epicardial gene painting. On post-gene transfer day 21, the animals underwent electrophysiology, histology, and molecular studies. The percentage of fibrosis in the Ad-ACE2 group was markedly lower than the percentage in the control and Ad-EGFP groups. Compared with the other groups, ACE2 expression was increased significantly in the Ad-ACE2 group. Compared with the sham and Ad-ACE2 groups, the expression levels of transforming growth factor-β1 and Smad3 were significantly higher in the Ad-EGFP and control groups; however, the expression levels of Smad7 were lower in the atrial tissue as detected by Western blot and reverse transcription polymerase chain reaction. Our results demonstrate that the overexpression of ACE2 inhibits atrial collagen accumulation and improves left atrial remodeling and function in a canine model of atrial fibrillation. Thus, targeted gene ACE2 therapy provides a promising approach for the treatment of atrial fibrillation. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  3. Atrial fibrillation in an adolescent--the agony of ecstasy.

    Science.gov (United States)

    Madhok, Ashish; Boxer, Robert; Chowdhury, Devyani

    2003-10-01

    Ecstasy (MDMA), a popular drug of abuse among teenagers, is thought to be "relatively" safe. A case of atrial fibrillation following the ingestion of ecstasy in a previously well adolescent is presented. Emergency room physicians should consider ecstasy abuse in the differential diagnosis of young patients presenting with atrial fibrillation.

  4. Atrial fibrillation and bleeding complication - risk factors and risk marker

    NARCIS (Netherlands)

    Breithardt, G.; Ravens, U.; Kirchhof, P.; van Gelder, I. C.

    2012-01-01

    The development of atrial fibrillation (AF) is closely linked to risk factors like hypertension and heart failure, diabetes mellitus, myocardial infarction and valvular heart disease. These factors partly overlap with those which determine the progression of atrial fibrillation and the incidence of

  5. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation

    DEFF Research Database (Denmark)

    Cosedis Nielsen, Jens; Johannessen, Arne; Raatikainen, Pekka

    2012-01-01

    There are limited data comparing radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial fibrillation.......There are limited data comparing radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial fibrillation....

  6. Effect of dronedarone on cardiovascular events in atrial fibrillation

    DEFF Research Database (Denmark)

    Hohnloser, Stefan H; Crijns, Harry J G M; van Eickels, Martin

    2009-01-01

    BACKGROUND: Dronedarone is a new antiarrhythmic drug that is being developed for the treatment of patients with atrial fibrillation. METHODS: We conducted a multicenter trial to evaluate the use of dronedarone in 4628 patients with atrial fibrillation who had additional risk factors for death...

  7. Visualization of atrial myocardium with thallium-201: case report

    International Nuclear Information System (INIS)

    Cowley, M.J.; Coghlan, H.C.; Logic, J.R.

    1977-01-01

    An adult patient evaluated for cyanotic congenital heart disease was found to have pulmonary atresia with intact ventricular septum, hypoplastic right ventricle, and right atrial enlargement. Thallium-201 myocardial imaging before surgical correction showed thallium activity in the right atrium. Following the establishment of a conduit from the right atrium to pulmonary artery, the right-atrial thallium uptake was even more prominent

  8. Dronedarone in high-risk permanent atrial fibrillation

    DEFF Research Database (Denmark)

    Connolly, Stuart J; Camm, A John; Halperin, Jonathan L

    2011-01-01

    Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent atrial fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular antiarrhythmic effects. We hypothesized that dronedarone would reduce major vascular events...... in high-risk permanent atrial fibrillation....

  9. Cardiac ion channels and mechanisms for protection against atrial fibrillation

    DEFF Research Database (Denmark)

    Grunnet, Morten; Bentzen, Bo Hjorth; Sørensen, Ulrik S

    2011-01-01

    Atrial fibrillation (AF) is recognised as the most common sustained cardiac arrhythmia in clinical practice. Ongoing drug development is aiming at obtaining atrial specific effects in order to prevent pro-arrhythmic, devastating ventricular effects. In principle, this is possible due to a different...

  10. Dabigatran versus warfarin in patients with atrial fibrillation

    NARCIS (Netherlands)

    Connolly, Stuart J.; Ezekowitz, Michael D.; Yusuf, Salim; Eikelboom, John; Oldgren, Jonas; Parekh, Amit; Pogue, Janice; Reilly, Paul A.; Themeles, Ellison; Varrone, Jeanne; Wang, Susan; Alings, Marco; Xavier, Denis; Zhu, Jun; Diaz, Rafael; Lewis, Basil S.; Darius, Harald; Diener, Hans-Christoph; Joyner, Campbell D.; Wallentin, Lars; Connolly, S. J.; Ezekowitz, M. D.; Yusuf, S.; Eikelboom, J.; Oldgren, J.; Parekh, A.; Reilly, P. A.; Themeles, E.; Varrone, J.; Wang, S.; Palmcrantz-Graf, E.; Haehl, M.; Wallentin, L.; Alings, A. M. W.; Amerena, J. V.; Avezum, A.; Baumgartner, I.; Brugada, J.; Budaj, A.; Caicedo, V.; Ceremuzynski, L.; Chen, J. H.; Commerford, P. J.; Dans, A. L.; Darius, H.; Di Pasquale, G.; Diaz, R.; Erol, C.; Ferreira, J.; Flaker, G. C.; Flather, M. D.; Franzosi, M. G.; Gamboa, R.; Golitsyn, S. P.; Gonzalez Hermosillo, J. A.; Halon, D.; Heidbuchel, H.; Hohnloser, S. H.; Hori, M.; Huber, K.; Jansky, P.; Kamensky, G.; Keltai, M.; Kim, S.; Lau, C. P.; Le Heuzey, J. Y. F.; Lewis, B. S.; Liu, L. S.; Nanas, J.; Razali, O.; Pais, P. S.; Parkhomenko, A. N.; Pedersen, K. E.; Piegas, L. S.; Raev, D.; Simmers, T. A.; Smith, P. J.; Talajic, M.; Tan, R. S.; Tanomsup, S.; Toivonen, L.; Vinereanu, D.; Xavier, D.; Zhu, J.; Diener, H. C.; Joyner, C. D.; Diehl, A.; Ford, G.; Robinson, M.; Silva, J.; Sleight, P.; Wyse, D. G.; Collier, J.; de Mets, D.; Hirsh, J.; Lesaffre, E.; Ryden, L.; Sandercock, P.; Anastasiou-Nana, M. I.; Andersen, G.; Annex, B. H.; Atra, M.; Bornstein, N. M.; Boysen, G.; Brouwers, P. J. A. M.; Buerke, M.; Burrell, L. M.; Chan, Y. K.; Chen, W. H.; Cheung, R. T. F.; Divakaramenon, S.; Donnan, G. A.; Duray, G. Z.; Dvorakova, H.; Fiedler, J.; Gardinale, E.; Gates, P. C.; Goshev, E. G.; Goto, S.; Gross, B.; Guimaraes, H. P.; Gulkevych, O.; Haberl, R. L.; Hankey, G.; Hartikainen, J.; Healey, J.; Iliesiu, A. M.; Irkin, O.; Jaxa-Chamiec, T.; Jolly, S.; Kaste, K. A. M.; Kies, B.; Kostov, K. D.; Kristensen, K. S.; Labovitz, A. J.; Lassila, R. P. T.; Lee, K. L. F.; Lutay, Y. M.; Magloire, P.; Mak, K. H.; Meijer, A.; Mihov, L.; Morillo, C. A.; Morillo, L. E.; Nair, G. M.; Norrving, B.; Ntalianis, A.; Ntsekhe, M.; Olah, L.; Pasco, P. M. D.; Peeters, A.; Perovic, V.; Petrov, I.; Pizzolato, G.; Rafti, F.; Rey, N. R.; Ribas, S.; Rokoss, M.; Sarembock, I. J.; Sheth, T.; Shuaib, A.; Sitkei, E.; Sorokin, E.; Srámek, M.; Strozynska, E.; Tanne, D.; Thijs, V. N. S.; Tomek, A.; Turazza, F.; Vanhooren, G.; Vizel, S. A.; Vos, J.; Wahlgren, N.; Weachter, R.; Zaborska, B.; Zaborski, J.; Zimlichman, R.; Cong, J.; Fendt, K.; Muldoon, S.; Bajkor, S.; Grinvalds, A.; Malvaso, M.; Pogue, J.; Simek, K.; Yang, S.; Alzogaray, M. F.; Bono, J. O.; Caccavo, A.; Cartasegna, L.; Casali, W. P.; Cuello, J. L.; Cuneo, C. A.; Elizari, M. V.; Fernandez, A. A.; Ferrari, A. E.; Gabito, A. J.; Goicoechea, R. F.; Gorosito, V. M.; Hirschson, A.; Hominal, M. A.; Hrabar, A. D.; Liberman, A.; Mackinnon, I. J.; Manzano, R. D.; Muratore, C. A.; Nemi, S. A.; Rodriguez, M. A.; Sanchez, A. S.; Secchi, J.; Vogel, D. R.; Colquhoun, D. M.; Crimmins, D. S.; Dart, A. M.; Davis, S. M.; Hand, P. J.; Kubler, P. A.; Lehman, R. G.; McBain, G.; Morrison, H. C.; New, G.; Singh, B. B.; Spence, C. Z.; Waites, J. H.; Auer, J.; Doweik, L.; Freihoff, F.; Gaul, G.; Gazo, F.; Geiger, H.; Giacomini, G.; Huber, G. W.; Jukic, I.; Lamm, G.; Niessner, H.; Podczeck, A.; Schuh, J.; Siostrzonek, P.; Steger, C.; Vogel, B.; Watzak, R.; Weber, H. S.; Weihs, W.; Blankoff, I.; Boland, J. L.; Brike, C.; Carlier, M.; Cools, F.; de Meester, A.; de Raedt, H. J.; de Wolf, L.; Dhooghe, G. M.; Dilling-Boer, D.; Elshot, S. R.; Fasseaux, S.; Goethals, M.; Goethals, P.; Gurne, O.; Hellemans, S.; Ivan, B.; Jottrand, M.; Kersschot, I.; Lecoq, E.; Marcovitch, O.; Melon, D.; Miljoen, H.; Missault, L.; Pierard, L. A.; Provenier, F.; Rousseau, M. F.; Stockman, D.; Tran-Ngoc, E.; van Mieghem, W.; Vandekerckhove, Y.; Vandervoort, P.; Verrostte, J.; Vijgen, J.; Armaganijan, D.; Braga, C.; Braga, J. C. F.; Cipullo, R.; Cunha, C. L. P.; de Paola, A.; Delmonaco, M. I.; Guimaraes, F. V.; Herek, L.; Kerr Saraiva, J. F.; Maia, L. N.; Lorga, A. M.; Lorga-Filho, A. M.; Marino, R. L.; Melo, C. S.; Mouco, O. M.; Pereira, V. C.; Precoma, D. B.; Rabelo, W.; Rassi, S.; Rossi, P. R.; Rossi Neto, J. M.; Silva, F. M.; Vidotti, M. H.; Zimmermann, S. L.; Anev, E. D.; Balabanov, T. A.; Baldjiev, E. S.; Bogusheva, E. S.; Chaneva, M. A.; Filibev, I. G.; Gotcheva, N. N.; Goudev, A. R.; Gruev, I. T.; Guenova, D. T.; Kamenova, Z. A.; Manov, E. I.; Panov, I. A.; Parvanova, Z. I.; Pehlivanova, M. B.; Penchev, P. T.; Penkov, N. Y.; Radoslavov, A. L.; Ramshev, K. N.; Runev, N. M.; Sindzhielieva, M. N.; Spirova, D. A.; Tsanova, V. M.; Tzekova, M. L.; Yaramov, G. K.; Aggarwal, R.; Bakbak, A. I.; Bayly, K.; Berlingieri, J. C.; Blackburn, K.; Bobbie, C.; Booth, A. W.; Borts, D.; Bose, S.; Boucher, P.; Brown, K.; Burstein, J. M.; Butt, J. C.; Carlson, B. D.; Chetty, R.; Chiasson, J. D.; Constance, C.; Costi, P.; Coutu, B.; Deneufbourg, I.; Dion, D.; Dorian, P.; Douketis, J. D.; Farukh, S.; Filipchuk, N. G.; Fox, B. A.; Fox, H. I.; Gailey, C. B.; Gauthier, M.; Glanz, A.; Green, M. S.; Habot, J.; Hink, H.; Kearon, C.; Kouz, S.; Lai, C.; Lai, K.; Lalani, A. V.; Lam, A. S.; Lapointe, L. A.; Leather, R. A.; Ma, P. T. S.; MacKay, E.; Mangat, I.; Mansour, S.; Melton, E.; Mitchell, L. B.; Morris, A. L.; Nisker, W. A.; O'Donnell, M. J.; O'Hara, G.; Omichinski, L. M.; Pandey, A. S.; Parkash, R.; Pesant, Y.; Pilon, C.; Pistawka, K. J.; Powell, C. N.; Price, J. B.; Prieur, S.; Rebane, T. M.; Ricci, A. J.; Roberge, J.; Roy, M.; Sapp, J. L.; Savard, D.; Schulman, S.; Sehl, M. J.; Sestier, F.; Shandera, R.; Shu, D.; Sterns, L. D.; St-Hilaire, R.; Syan, G. S.; Talbot, P.; Teitelbaum, I.; Tytus, R. H.; Winkler, L.; Zadra, R.; Zidel, B. S.; Bai, X. J.; Gao, W.; Gao, X.; Guan, D. M.; He, Z. S.; Hua, Q.; Li, H.; Li, L.; Li, W. M.; Lu, G. P.; Lv, S.; Meng, K.; Niu, H. Y.; Qi, D. G.; Qi, S. Y.; Qian, F.; Sun, N. L.; Wang, H. Y.; Wang, N. F.; Yang, Y. M.; Zeng, H.; Zhang, F.; Zhang, F. R.; Zhang, L.; Bohorquez, R.; Rosas, J. F.; Saent, L.; Vacca, M.; Velasco, V. M.; Belohlavek, J.; Cernohous, M.; Choura, M.; Dedek, V.; Filipensky, B.; Hemzsky, L.; Karel, I.; Kopeckova, I.; Kovarova, K.; Labrova, R.; Madr, T.; Poklopova, Z.; Rucka, D.; Simon, J.; Skalicka, H.; Smidova, M.; Spinar, J.; Dodt, K. K.; Egstrup, K.; Friberg, J.; Haar, D.; Husted, S.; Jensen, G. V.; Joensen, A. M.; Klarlund, K. K.; Lind Rasmussen, S.; Melchior, T. M.; Olsen, M. E.; Poulsen, M. K.; Ralfkiaer, N.; Rasmussen, L. H.; Skagen, K.; Airaksinen, K. E.; Huikuri, H. V.; Hussi, E. J.; Kettunen, P.; Mänttäri, M.; Melin, J. H.; Mikkelsson, J.; Peuhkurinen, K.; Virtanen, V. K.; Ylitalo, A.; Agraou, B.; Boucher, L.; Bouvier, J. M.; Boye, A.; Boye, B.; Decoulx, E. M.; Defaye, P.; Delay, M.; Desrues, H.; Gacem, K.; Igigabel, P.; Jacon, P.; Leparree, S.; Magnani, C.; Martelet, M.; Movallem, J.; Olive, T.; Poulard, J. E.; Tiam, B.; Appel, K. F.; Appel, S.; Bansemir, L.; Borggrefe, M.; Brachmann, J.; Bulut-Streich, N.; Busch, K.; Dempfle, C. E. H.; Desaga, M.; Desaga, V.; Dormann, A.; Fechner, I.; Genth-Zotz, S.; Haberbosch, W. G.; Harenberg, J.; Haverkamp, W. L.; Henzgen, R.; Heuer, H.; Horacek, T.; Huttner, H. B.; Janssens, U.; Jantke, H. J.; Klauss, V.; Koudonas, D.; Kreuzer, J.; Kuckuck, H.; Maselli, A.; Müegge, A.; Munzel, T. F.; Nitsche, K.; Nledegjen, A.; Parwani, A.; Pluemer-Schmidt, M.; Pollock, B. W.; Salbach, B. I.; Salbach, P. B.; Schaufele, T.; Schoels, W.; Schwab, S.; Siegmund, U.; Veltkamp, R.; Von Hodenberg, E.; Weber, R.; Zechmeister, M.; Anastasopoulous, A. A.; Foulidis, V. O.; Kaldara, E.; Karamitsos, K.; Karantzis, J.; Kirpizidis, H.; Kokkinakis, C.; Krommydas, A.; Lappas, C.; Lappas, G. I.; Manolis, A.; Manolis, A. S.; Orfanidis, Z.; Papamichalis, M.; Peltekis, L.; Savvas, S.; Skoumpourdis, E. A.; Stakos, D. A.; Styliadis, I.; Triposkiadis, F.; Tsounis, D.; Tziakas, D. N.; Zafiridis, T.; Zarifis, J. H.; Chan, G. C. P.; Chan, W. K.; Chan, W. S.; Lau, C. L.; Tse, H. F.; Tsui, P. T.; Yu, C. M.; Yue, C. S.; Fugedi, K.; Garai, B.; Jánosi, A.; Kadar, A.; Karpati, P.; Keltai, K.; Kosa, I.; Kovacs, I.; Laszlo, Z.; Mezei, L.; Rapi, J.; Regos, L. I.; Szakal, I.; Szigyarto, I.; Toth, K.; Zsa'ry, A.; Agarwal, D. K.; Aggarwal, R. K.; Arulvenkatesh, R.; Bharani, A.; Bhuvaneswaran, J. S.; Byrapaneni, R. B.; Chandwani, P.; Chopra, S.; Desai, N.; Deshpande, V.; Golla, N. P.; Gupta, J. B.; Haridas, K. K.; Hiremath, J.; Jain, A. S.; Jain, M.; Jhala, D. A.; Joseph, J.; Kaila, M.; Kannaiyan, A.; Kumar, S.; Kuruvila, P.; Mahorkar, V. K.; Metha, A.; Naik, A. M.; Narayanan, S.; Panwar, R. B.; Reddy, C.; Sawhney, J. P. S.; Shah, S. M.; Sharma, S.; Shetty, G. S.; Sinha, N.; Sontakke, N. N.; Srinivas, A.; Trivedi, M. R.; Vadagenalli, P. S.; Vijayakumar, M.; Ben-Aharon, Y.; Benhorin, J.; Bogomolny, N.; Botwin-Shimko, S.; Bova, I.; Brenner, B.; Burstein, M.; Butnaru, A.; Caspi, A.; Danenberg, H. D.; Dayan, M.; Eldar, M.; Elian, D.; Elias, M.; Elis, A.; Esanu, G.; Genin, I.; Goldstein, L. H.; Grossman, E.; Hamoud, S.; Hayek, T.; Ilani, N.; Ilia, R.; Klainman, E. I.; Leibowitz, A.; Leibowitz, D.; Levin, I.; Lishner, M.; Lotan, C.; Mahagney, A.; Marmor, A.; Motro, M.; Peres, D.; Plaev, T.; Reisen, L. H.; Rogowski, O.; Schwammenthal, E.; Schwammenthal, Y.; Shechter, M.; Shochat, M.; Shotan, A.; Strasberg, B.; Sucher, E.; Telman, G.; Turgeman, Y.; Tzoran, I.; Weiss, A. T.; Weitsman, T.; Weller, B.; Wexler, D. H.; Wolff, R.; Yarnitsky, D.; Zeltser, D.; Argiolas, G.; Arteni, F.; Barbiero, M.; Bazzucco, R.; Bernardi, D.; Bianconi, L.; Bicego, D.; Brandini, R.; Bresciani, B.; Busoni, F.; Carbonieri, E.; Carini, M.; Catalano, A.; Cavallini, C.; D'Angelo, G.; de Caterina, R.; Di Niro, M.; Filigheddu, F.; Fraticelli, A.; Marconi, R.; Mennuni, M.; Moretti, L.; Mos, L.; Pancaldi, L. G.; Pirelli, S.; Renda, G.; Santini, M.; Tavarozzi, I.; Terrosu, P.; Uneddu, F.; Viccione, M.; Zanini, R.; Zingarini, G.; Aoyagi, T.; Eguma, H.; Fujii, K.; Fukuchi, M.; Fukunami, M.; Furukawa, Y.; Furuya, J.; Haneda, K.; Hara, S.; Hiroe, M.; Iesaka, Y.; Iijima, T.; Ishibashi, Y.; Iwade, K.; Kajiya, T.; Kakinoki, S.; Kamakura, S.; Katayama, Y.; Kihara, Y.; Kimura, K.; Kobayashi, S.; Kono, K.; Koretsune, Y.; Marui, N.; Matsuyama, T.; Meno, H.; Miyamoto, N.; Morikawa, S.; Myojin, K.; Nakamura, T.; Nishi, Y.; Ogawa, T.; Onaka, H.; Sakakibara, T.; Sakurai, S.; Sasaki, Y.; Sato, H.; Sugii, M.; Sumii, K.; Suzuki, S.; Takagi, M.; Takenaka, T.; Takeuchi, K.; Tanaka, S.; Tanouchi, J.; Ueda, K.; Ueyama, Y.; Ujihira, T.; Usui, M.; Yagi, M.; Yamada, T.; Yamamoto, H.; Yokochi, M.; Zen, E.; Abd Ghaphar, A. K.; Ang, C. K.; Chee, K. H.; Fong, A. F. Y.; Ismail, O.; Jeyaindran, S.; Kaur, S.; Lee, T. C.; Sandhu, R. S.; Shah, R. P.; Suganthi, S.; Zainal Abidin, S.; Alvarado-Ruiz, R.; Carrillo, J.; Delgado, E.; Fernandez Bonetti, P. A.; Leiva, J. L.; Meaney, A.; Olvera, R.; Peralta-Heredia, R.; Rodriguez, I.; Ruiz Rabasa, C. M.; Solache, G.; Villeda Espinosa, E.; Ahmed, S.; Badings, E.; Bartels, G. L.; Beganovic, M.; Bruning, T. A.; Ciampricotti, R.; Cozijnsen, L.; Crijns, H. J.; Daniels, M. C. G.; de Waard, D. E. P.; den Hartog, F. R.; Dirkali, A.; Groenemeijer, B. E.; Heesen, W. F.; Heijmeriks, J. A.; Hoogslag, P. A.; Huizenga, A.; Idzerda, H. H.; Kragten, J. A.; Krasznai, K.; Lenderink, T.; Liem, A. H.; Linssen, G. C.; Lok, D. J.; Meeder, J. G.; Michels, H. R.; Plomp, J.; Pos, L.; Posma, J. L.; Postema, P. G.; Salomonsz, R.; Stoel, I.; Tans, J. G.; Thijssen, H. J.; Timmermans, A. J. M.; Tteleman, R. G.; van Bergen, P. F. M. M.; van de Klippe, H. A.; van der Zwaan, C.; van Eck, J. W. M.; van Es, A. J. J.; van Gelder, I. C.; van Kempen, L. H.; van Kesteren, H. A.; van Rossum, P.; Veldmeyer, S.; Wilde, A. A. M.; Arnesen, H.; Atar, D.; Breder, O.; Istad, H.; Radunovic, Z.; Rykke, D. E.; Sirnes, P. A.; Tveit, A.; Ulimoen, S. R.; Cabrera, W.; Duenas, R.; Heredia, J. M.; Horna, M. E.; Hurtado, Y.; Salazar, P. M.; Abola, M. T. B.; Anonuevo, J. C.; Arellano, R. S.; Dioquino, C.; Morales, D. D.; Reyes, E. B.; Rogelio, G. G.; Roxas, A. A.; Sulit, D. J. V.; Bacior, B.; Dulak, E.; Gniot, J.; Goncikowski, J.; Grodecki, J.; Kalarus, Z. F.; Kawecka-Jaszcz, K.; Miekus, P.; Monies, F.; Piepiorka, M.; Pilichowska, E.; Plizio, E.; Rekosz, J.; Rybicka-Musialik, A.; Streb, W. A.; Styczkiewicz, M.; Szpajer, M.; Trusz-Gluza, M.; Wasilewska-Piepiorka, A.; Adragao, P.; Branco, V.; Canhão, P.; Cunha, L.; Falcão, F.; Lopes, G.; Machado, C.; Martinez-Marcos, J.; Monteiro, P. F.; Parreira, L.; Pinto, A. N.; Providencia, L. A.; Salgado, A. V.; Santos, J. F.; Timoteo, A. T.; Capalneanu, R.; Cinteza, M. A.; Margulesai, A. D.; Turdeanu, D. S.; Vintila, V. D.; Baranov, V. L.; Berngardt, E. R.; Dzhordzhikiya, T. R.; Gordeev, I. G.; Grigoryev, Y. V.; Isaeva, M. U.; Ivleva, A. Y.; Kokorin, V. A.; Komarov, A. L.; Maximenko, O. K.; Maykov, E. B.; Novikova, N.; Novikova, T. N.; Panchenko, E. P.; Poltavskaya, M. G.; Popova, Y. N.; Pronina, S. A.; Revishvili, A. Sh; Shlyakhto, E. V.; Shustov, S. B.; Sidorenko, B. A.; Sinopalnikov, A. I.; Sulimov, V.; Syrkin, A. L.; Titkov, A. Y.; Titkov, Y. S.; Zateyshchikov, D. A.; Zavaritskaya, O. P.; Chia, P. L.; Foo, D.; Sim, K. L.; Bugan, V.; Buganova, I.; Dúbrava, J.; Kaliska, G.; Masarovicova, M.; Mikes, P.; Mikes, Z.; Murin, J.; Pella, D.; Rybar, R.; Sedlák, J.; Skamla, M.; Spurný, P.; Strbova, J.; Uhliar, R.; Disler, L. J.; Engelbrecht, J. M.; Jankelow, D.; King, J.; Klug, E. Q.; Munnick, M.; Okreglicki, A. M.; Routier, R. J.; Snyders, F. A.; Theron, H. D.; Wittmer, H.; Cha, T. J.; Cho, J. G.; Choi, I. S.; Choi, J. I.; Choi, K. J.; Han, K. R.; Heo, J. H.; Jang, S. W.; Kang, T. S.; Kim, H. S.; Kim, K. S.; Kim, S. J.; Kim, S. S.; Kim, Y. H.; Kim, Y. N.; Lee, M. H.; Lee, M. Y.; Nam, G. B.; Oh, D. J.; Park, H. W.; Park, J. S.; Rho, T. H.; Shin, D. G.; Shin, E. K.; Alonso, J. J.; Cano, L.; Castellano, N. P.; Criado-Millan, A. J.; Curcio, A.; Egea, P.; Escudier, J. M.; Grande, A.; Grande, J. M.; Gusi-Tragant, G.; Lozano, I. F.; Martin, A. M.; Martinez-Rubio, A.; Mont, L.; Perez-Villacastin, J.; Sosa, L.; Ali, M.; Andersson, T.; Bandh, S.; Blomstrom Lundqvist, C. M.; Cherfan, P.; Fengsrud, E.; Fluur, C.; Herlitz, J.; Hijazi, Z.; Hoglund, N.; Hojeberg, B.; Jabro, J.; Juhlin, T.; Kjellman, B.; Lonnberg, I.; Maru, F.; Morlid, L.; Nilsson, O. R.; Ronn, F.; Rosenqvist, M.; Walfridsson, H.; Engelter, S. T.; Gallino, A.; Lyrer, P. A.; Moccetti, T.; Petrova, I.; Chang, Y. J.; Chen, C. H.; Chen, M. Y. C.; Cheng, J. J.; Chiang, T. R.; Chung, W. T.; Hsia, C. H.; Hsu, C. Y.; Hu, H. H.; Jeng, J. S.; Lai, W. T.; Lien, L. M.; Lin, K. H.; Liu, C. H.; Lo, H. S.; Peng, G. S.; Po, H. L.; Ryu, S. J.; Tsai, C. D.; Tsai, L. M.; Tseng, C. D.; Wang, J. H.; Wang, S. F.; Yang, S. P.; Kiatchoosakun, S.; Krittayaphong, R.; Kuanprasert, S.; Ngarmukos, T.; Simtharakaew, T.; Sukanandachai, B.; Sukonthasam, A.; Suwanagool, A.; Tatsanavivat, P.; Atmaca, Y.; Baris, N.; Boyaci, B.; Demir, M.; Guneri, S.; Usal, A.; Yalcin, R.; Amosova, K. M.; Beregova, O. P.; Besaga, Y. E. M.; Ikorkin, M. R.; Karapetyan, K.; Karpenko, O. I.; Kononenko, L.; Kuryata, O.; Martynova, L.; Motylevska, T.; Okhryamkina, O.; Pavlyk, S. S.; Perepelytsya, M. V.; Rudenko, L. V.; Skarzhevsky, O. A.; Tkachenko, L. A.; Tseluyko, V.; Usan, N.; Voronkov, L. G.; Yshchenko, K. V.; Zharinov, O. J.; Bryson, V. G.; Butler, R.; Cargill, R. I.; Chahal, N. S.; Cleland, J. G.; Cohen, A. T.; Cruddas, E. M.; Davey, P.; Davies, J.; Ford, S. L.; Griffith, K.; Haynes, R.; Hill, S.; Javed, M.; Kadr, H. H.; Lip, G. H.; Machin, J.; McEneaney, D. J.; McInnes, G. T.; McNeill, A. J.; Moriarty, A. J.; Muir, S.; O'Callaghan, J.; Purvis, J. A.; Pye, M.; Senior, R.; Sutton, D. A.; Thomas, S. H. L.; Wilkinson, P. R.; Wilmott, R.; Wrigley, M. J.; Abadier, R.; Abbud, Z. A.; Adams, K. V.; Adler, S. W.; Agarwal, S.; Ahmed, A. M.; Ahmed, I. S.; Aiuto, M. A.; Albrittun, T. D.; Aliyar, P.; Allan, J. J.; Allen, D. P.; Allen, S. L.; Altschuller, A.; Amin, M.; Anand, I. S.; Antolick, A. B.; Arora, R.; Arouni, A. J.; Arslanian, C. L.; Asinger, R. W.; Aycock, G. R.; Bariciano, R. J.; Baron, S. B.; Barr, M. A.; Bartkowiak, A. J.; Baruch, L.; Basignani, C.; Bass, M. L.; Bean, B.; Bedwell, N. W.; Belber, A. D.; Belew, K.; Bell, Y. C.; Bellinger, R. L.; Bennett, W. T.; Bensimhon, D. R.; Benton, R.; Benton, R. E.; Ben-Yehuda, O.; Bertolet, B. D.; Betkowski, A. S.; Bilazarian, S. D.; Bissette, J. K.; Bobade, M. B.; Bolster, D. E.; Bomba, J.; Book, D. M.; Boscia, J. A.; Bouchard, A.; Bowman, L. M.; Bradley, A. J.; Brandt, H. D.; Bricker, C. R.; Brobyn, T. L.; Brock, R. I.; Broderick, T. M.; Broedlin, K.; Brown, A. M.; Browne, K. F.; Burke, S. W.; Burton, M. E.; Buser, G. A.; Capasso, M. K.; Caplan, W. E.; Cappelli, J.; Cardona, C.; Cardona, F.; Carlson, T.; Carr, K. W.; Casey, T.; Cashion, W. R.; Cass, D. T.; Chandrashekar, Y. S.; Changlani, M.; Chapla, P. G.; Chappell, J. H.; Chen, C.; Chen, Y.; Cho, N. R.; Cieszkowski, J. H.; Clark, D. M.; Clayton, R.; Clogston, C. W.; Cockrell, D. J.; Cohen, A. I.; Cohen, T. J.; Cole, J. F.; Conway, G.; Cook, V. R.; Cornish, A. L.; Cossu, S. F.; Costello, D. L.; Courtade, D. J.; Covelli, H. C.; Crenshaw, B. S.; Crews, L. A.; Crossley, G. H.; Culp, S. C.; Curtis, B. M.; Darrow, K.; de Raad, R. E.; DeGregorio, M.; DelNegro, A. A.; Denny, D. M.; Desai, V. S.; Deumite, N. J.; Dewey, L.; Dharawat, R. N.; Dobbs, B.; Donahue, S. M.; Downey, B.; Downing, J.; Drehobl, M. A.; Drewes, W. A.; Drucker, M. N.; Duff, R.; Duggal, M.; Dunlap, S. H.; Dunning, D. W.; DuThinh, V.; Dykstra, G. T.; East, C.; Eblaghie, M. C.; Edelstein, J.; Edmiston, W. A.; Eisen, H. J.; Eisenberg, S. J.; Ellis, J. R.; Ellison, H. S.; Ellsworth, S.; Elshahawy, M.; Emlein, G.; Entcheva, M.; Essandoh, L. K.; Estrada, A. Q.; Ewing, B.; Faillace, R. T.; Fanelli, A.; Farrell, P. W.; Farris, S. W.; Fattal, P. G.; Feigenblum, D. Y.; Feldman, G. J.; Fialkow, J. A.; Fiddler, K. M.; Fields, R. H.; Finkel, M. S.; Finn, C.; Fischell, T. A.; Fishbach, M.; Fishbein, G. J.; Fisher, M. M.; Fleischhauer, F. J.; Folk, T. G.; Folkerth, S. D.; Fortman, R. R.; Frais, M. A.; Friedman, D. C.; Fuchs, G.; Fuller, F.; Garibian, G.; Gee, F. H.; Gelernt, M. D.; Genovely, H. C.; Gerber, J. R.; Germano, J. J.; Giardina, J. J.; Gilbert, J. M.; Gillespie, E. L.; Gilman, E. M.; Gitler, B.; Givens, D. H.; Glover, R.; Gogia, H. S.; Gohn, D. C.; Goldberg, R. K.; Goldberger, J. J.; Goldscher, D. A.; Goldstein, M.; Goraya, T.; Gordon, D. F.; Gottlieb, D.; Grafner, H. L.; Graham, M.; Graves, M. W.; Graziano, M.; Greco, S. N.; Greenberg, M. L.; Greenspon, A. J.; Greer, G. S.; Griffin, D. D.; Grogan, E. W.; Groo, V. L.; Guarnieri, T.; Gupta, A.; Gupta, J.; Hack, T. C.; Hall, B.; Hallak, O.; Halpern, S. W.; Hamburg, C.; Hamroff, G. S.; Han, J.; Handel, F.; Hankins, S. R.; Hanovich, G. D.; Hanrahan, J. A.; Haque, I. U.; Hargrove, J. L.; Harnick, P. E.; Harris, J. L.; Hartley, P. A.; Haskel, E. J.; Hatch, D.; Haught, W. H.; Hearne, S.; Hearne, S. E.; Hemphill, J. A.; Henderson, D. A.; Henes, C. H.; Hengerer-Yates, T.; Hermany, P. R.; Herzog, W. R.; Hickey, K.; Hilton, T. C.; Hockstad, E. S.; Hodnett, P.; Hoffmeister, R.; Holland, J.; Hollenweger, L.; Honan, M. B.; Hoopes, D. A.; Hordes, A. R.; Hotchkiss, D. A.; Howard, M. A.; Howard, V. N.; Hulyalkar, A. R.; Hurst, P.; Hutchison, L. C.; Ingram, J.; Isakov, T.; Ison, R. K.; Israel, C. N.; Jackson, B. K.; Jackson, K. N.; Jacobson, A. K.; Jain, S.; Jarmukli, N. F.; Joffe, I.; Johnson, L. E.; Johnson, S. A.; Johnson, S. L.; Jones, A. A.; Joyce, D. B.; Judson, P. L.; Juk, S. S.; Kaatz, S.; Kaddaha, R. M.; Kaplan, K. J.; Karunaratne, H. B.; Kennett, J. D.; Kenton, D. M.; Kettunen, J. A.; Khan, M. A.; Khant, R. N.; Kirkwood, M. D.; Knight, B. P.; Knight, P. O.; Knutson, T. J.; Kobayashi, J. F.; Kogan, A.; Kogan, A. D.; Koren, M. J.; Kosinski, E. J.; Kosolcharoen, P.; Kostis, J. B.; Kramer, J. H.; Kramer, S. D.; Kron, J.; Kuchenrither, C. R.; Kulback, S. J.; Kumar, A.; Kushner, D.; Kutscher, A.; Lai, C. K.; Lam, J. B.; Landau, C.; Landzberg, J. S.; Lang, D. T.; Lang, J. M.; Lanzarotti, C. J.; Lascewski, D. L.; Lau, T. K.; Lee, J. K.; Lee, S.; Leimbach, W. N.; LePine, A. M.; Lesser, M. F.; Leuchak, S. H.; Levy, R. M.; Lewis, W. R.; Lincoln, T. L.; Lingerfelt, W. M.; Liston, M.; Liu, Z. G.; Lloret, R. L.; Lohrbauer, L.; Longoria, D. C.; Lott, B. M.; Louder, D. R.; Loukinen, K. L.; Lovell, J.; Lue, S.; Mackall, J. A.; Maletz, L.; Marlow, L.; Martin, R. C.; Matsumura, M.; McCartney, M. J.; McDuffie, D.; McGough, M. F.; McGrew, F. A.; McGuinn, Wm P.; McMillen, M. D.; McNeff, J.; McPherson, C. A.; Meengs, M. E.; Meengs, W. L.; Meholick, A. W.; Meisner, J. S.; Melucci, M. B.; Mercando, A.; Merlino, J. D.; Meymandi, S. K.; Miele, M. B.; Miller, R. H.; Miller, S. H.; Minor, S. T.; Mitchell, M. R.; Modi, M.; Mody, F. V.; Moeller, C. L.; Moloney, J. F.; Moran, J. E.; Morcos, N. C.; Morgan, A.; Mukherjee, S. K.; Mullinax, K.; Murphy, A. L.; Mustin, A. J.; Myers, G. I.; Naccarelli, G. V.; Nadar, V. K.; Nallasivan, M.; Navas, J. P.; Niazi, I. K.; Nsah, E. N.; Nunamaker, J. L.; Ochalek, T. B.; O'dea, D. J.; Ogilvie, P. D.; Olliff, B.; Omalley, A. K.; O'Neill, P. G.; Onufer, J. R.; Orchard, R. C.; Orihuela, L. A.; Ortiz, E. C.; O'Sullivan, M. T.; Padanilam, B. J.; Pandey, P.; Patel, D. V.; Patel, R. J.; Patel, V. B.; Patlola, R. R.; Pennock, G. D.; Perlman, R.; Peters, P. H.; Petrillo, A. V.; Pezzella, S.; Phillips, D.; Pierre-Louis, J. R.; Pilcher, G.; Pillai, C.; Pollock, S. G.; Pond, M. S.; Porterfield, J. K.; Presant, L.; Pressler, J.; Pribble, A. H.; Promisloff, S. D.; Pudi, K. K.; Putnam, D. L.; Quartner, J.; Quinn, J. C.; Quinnell, C. M.; Raad, G. L.; Rasmussen, L. A.; Ray, C.; Reiffel, J. A.; Reynertson, S.; Richardson, J. W.; Riley, C. P.; Rippy, J. S.; Rittelmeyer, J. T.; Roberts, D. M.; Robertson, R.; Robinson, V. J. B.; Rocco, T. A.; Rosenbaum, D.; Roth, E. M.; Rottman, J. N.; Rough, R. R.; Rubenstein, J. J.; Sakkal, A. M.; Saleem, T.; Salerno, D. M.; Samendinger, M. L.; Sandeno, S.; Santilli, T. M.; Santucci, P.; Sattar, P.; Saxman, K. A.; Schaefer, S.; Schmidt, J.; Schneider, R. M.; Schocken, D. D.; Schrader, M. K.; Schramm, B. A.; Schultz, R. W.; Schussheim, A. E.; Schwarz, E. F.; Seamon, M. C.; Sestero, J. D.; Shah, M. P.; Shah, R.; Shalaby, A.; Shanes, J. G.; Sheftel, G. L.; Sheikh, K. H.; Shein, A. B.; Shemonsky, N. K.; Shepler, A.; Sheridan, E.; Shipwash, T. M.; Shopnick, R. I.; Short, W. G.; Shoukfeh, M. F.; Sibia, R. S.; Siler, T. M.; Silva, J. A.; Simons, G. R.; Simpson, A. G.; Simpson, H. R.; Simpson, V. J.; Singh, B. N.; Singh, N.; Singh, V. N.; Sitz, C. J.; Skatrud, L.; Sklar, J.; Slotwiner, D. J.; Smith, P. F.; Smith, P. N.; Smith, R. H.; Smith, J. E.; Sodowick, B. C.; Solomon, A. J.; Soltero, E. A.; Sonel, A. F.; Sperling, R.; Spiller, C.; Spink, B. Z.; Sprinkle, L. W.; Spyropoulos, A. C.; Stamos, T. D.; Steljes, A. D.; Stillabower, M. E.; Stover, T.; Strain, J. E.; Strickland, T. L.; Suresh, D. P.; Takata, T. S.; Taylor, J. S.; Taylor, M.; Teague, S. M.; Teixeia, J. M.; Telfer, E. A.; Terry, P. S.; Terry, R. W.; Thai, H. M.; Thalin, M.; Thomas, V. N.; Thompson, C. A.; Thompson, M. A.; Thornton, J. W.; Tidman, R. E.; Toler, B. S.; Traina, M. I.; Trippi, J. A.; Ujiiye, D. L.; Usedom, J. E.; van de Graaff, E.; van de Wall, L. R.; Vaughn, J. W.; Ver Steeg, D.; Vicari, R. M.; Vijay, N.; Vitale, C. B.; Vlastaris, A. G.; Voda, J.; Vora, K. N.; Voyles, W. F.; Vranian, R. B.; Vrooman, P. S.; Waack, P.; Waldo, A. L.; Walker, J. L.; Wallace, M. A.; Walsh, E. A.; Walsh, R. L.; Walton, A.; Washam, M.; Wehner, P. S.; Wei, J. Y.; Weiner, S.; Weiss, R. J.; Wells, D. M.; Wera-Archakul, W.; Wertheimer, J. H.; West, S. A.; Whitaker, J. H.; White, M. L.; White, R. H.; Whitehill, J. N.; Wiegman, P. J.; Wiesel, J.; Williams, J.; Williams, L. E.; Williams, M. L.; Williamson, V. K.; Wilson, V. E.; Wilson, W. W.; Woodfield, S. L.; Wulff, C. W.; Yates, S. W.; Yousuf, K. A.; Zakhary, B. G.; Zambrano, R.; Zimetbaum, P.; Zoble, R.; Zopo, A. R.; Zwerner, P. L.

    2009-01-01

    BACKGROUND: Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use. Dabigatran is a new oral direct thrombin inhibitor. METHODS: In this noninferiority trial, we randomly assigned 18,113 patients who had atrial

  11. Continuing Education: Atrial fibrillation: Current trends in management

    African Journals Online (AJOL)

    There is however, a recent resurgence of interest following some important experimental and therapeutic advances. This article reviews the current understanding of the nature of atrial fibrillation (AF) and some recent developments in the pharmacological and alternative therapeutic approaches. Key Words: Atrial fibrillation, ...

  12. Atrial Fibrillation in Lusaka – Pathoaetiology, Pathophysiology and ...

    African Journals Online (AJOL)

    Background: Atrial Fibrillation (AF) is the commonest sustained arrhythmia the world over and is associated with substantial morbidity and mortality. An excessive ventricular rate, a loss of atrial contraction and an irregular ventricular filling time are the hallmark of this condition and all have negative clinical consequences.

  13. Atrial Fibrillation in Embolic Stroke: Anticoagulant Therapy at UNTH ...

    African Journals Online (AJOL)

    Objective: The decision to commence anticoagulation in a patient with embolic stroke and atrial fibrillation (AF) is often a difficult one for many clinicians. The result can have significant impact on the patient. This study was therefore undertaken to review the use of anticoagulation in embolic stroke in the setting of atrial ...

  14. Outcome parameters for trials in atrial fibrillation: executive summary

    NARCIS (Netherlands)

    Kirchhof, Paulus; Auricchio, Angelo; Bax, Jeroen; Crijns, Harry; Camm, John; Diener, Hans-Christoph; Goette, Andreas; Hindricks, Gerd; Hohnloser, Stefan; Kappenberger, Lukas; Kuck, Karl-Heinz; Lip, Gregory Y. H.; Olsson, Bertil; Meinertz, Thomas; Priori, Silvia; Ravens, Ursula; Steinbeck, Gerhard; Svernhage, Elisabeth; Tijssen, Jan; Vincent, Alphons; Breithardt, Günter

    2007-01-01

    Atrial fibrillation (AF), the most common atrial arrhythmia, has a complex aetiology and causes relevant morbidity and mortality due to different mechanisms, including but not limited to stroke, heart failure, and tachy- or bradyarrhythmia. Current therapeutic options (rate control, rhythm control,

  15. The immediate future for the medical treatment of atrial fibrillation

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Brendorp, Bente; Køber, Lars

    2002-01-01

    Atrial fibrillation is the most commonly sustained cardiac arrhythmia and a common reason for mortality and morbidity. Atrial fibrillation causes disease for three reasons: i) the ventricular rate is often high, which leads to symptoms ranging from discomfort to life threatening heart failure; ii...

  16. left ventricular inflow obstruction by giant atrial septal aneurysm

    African Journals Online (AJOL)

    echocardiograms showed tricuspid atresia with hypoplastic right ventricle, large secundum atrial septal defect, and highly mobile gigantic aneurysms of the atrial septum obstructing the inflow of the mitral valve and entering the left ventricle in diastole. Surgical intervention was not possible and child died on second day.

  17. Vascular disease and stroke risk in atrial fibrillation

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Lip, Gregory Y.H.; Lane, Deirdre A

    2012-01-01

    Vascular disease (including myocardial infarction and peripheral artery disease) has been proposed as a less well-validated risk factor for stroke in patients with atrial fibrillation. We investigated whether vascular disease is an independent risk factor of stroke/thromboembolism in atrial...... fibrillation and whether adding vascular disease improves Congestive heart failure, Hypertension, Age 75 years, Diabetes, previous Stroke (CHADS(2)) risk stratification....

  18. Hemopericardium from right atrial laceration in a newborn

    Directory of Open Access Journals (Sweden)

    Wen-Hsien Lu

    2011-09-01

    Full Text Available We report the case of a newborn who suffered right atrial laceration during delivery. To our knowledge, there has been no previous report of blunt injury causing right atrial laceration with hemopericardium complicated by cardiac tamponade in the perinatal period.

  19. Right atrial myxoma at Muhimbili National Hospital: a case report ...

    African Journals Online (AJOL)

    lower cava hypertension and was in NYHA class IV. The 2-D echocardiography revealed a right atrial tumor encroaching the tricuspid valve, chest radiography showed gross cardiomegally and right lower lung collapse. A clinical diagnosis of right atrial tumour was reached. The patient was scheduled to undergo open heart ...

  20. Late Sodium Current in Human Atrial Cardiomyocytes from Patients in Sinus Rhythm and Atrial Fibrillation

    DEFF Research Database (Denmark)

    Poulet, Claire; Wettwer, Erich; Grunnet, Morten

    2015-01-01

    atrial cardiomyocytes as a putative drug target for treatment of AF. To activate Na+ channels, cardiomyocytes from transgenic mice which exhibit INa,late (ΔKPQ), and right atrial cardiomyocytes from patients in sinus rhythm (SR) and AF were voltage clamped at room temperature by 250-ms long test pulses...... to -30 mV from a holding potential of -80 mV with a 100-ms pre-pulse to -110 mV (protocol I). INa,late at -30 mV was not discernible as deviation from the extrapolated straight line IV-curve between -110 mV and -80 mV in human atrial cells. Therefore, tetrodotoxin (TTX, 10 μM) was used to define...... persistent inward current after 250 ms at -30 mV as INa,late. TTX-sensitive current was 0.27±0.06 pA/pF in ventricular cardiomyocytes from ΔKPQ mice, and amounted to 0.04±0.01 pA/pF and 0.09±0.02 pA/pF in SR and AF human atrial cardiomyocytes, respectively. With protocol II (holding potential -120 mV, pre...

  1. Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion

    DEFF Research Database (Denmark)

    Osmanagic, Armin; Möller, Sören; Osmanagic, Azra

    2016-01-01

    BACKGROUND: Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atri...

  2. [Recurrent right atrial thrombus in a patient with atrial fibrillation and heart failure].

    Science.gov (United States)

    Elikowski, Waldemar; Wróblewski, Dariusz; Małek-Elikowska, Małgorzata; Mazurek, Andrzej; Foremska-Iciek, Joanna; Łazowski, Stanisław

    2015-11-01

    Atrial fibrillation and heart failure are factors predisposing to locally formed intracardiac thrombosis, which is usually localized in left-sided chambers. A case report. The authors present a case of a 50-year-old male with permanent atrial fibrillation and dilated cardiomyopathy in whom recurrent right atrial thrombus was observed. Initially, the lesion was detected in echocardiography while he was hospitalized due to extensive right-sided pneumonia. The thrombus was successfully treated with heparin, followed by warfarin. Even though the patient continued warfarin use properly, there was recurrence of the thrombus two years later during a new episode of heart failure exacerbation. Because the thrombus was resistant to intensified anticoagulation, cardiac surgery was needed. A large (30 x 25 mm) pedunculated thrombus, as well as two smaller ones (each of 10 x 10 mm) attached closely to the atrial wall and previously not detected either by echocardiography or by magnetic resonance imaging, were excited. A partially organized pattern of the thrombi in histological examination can explain lack of anticoagulation effectiveness. © 2015 MEDPRESS.

  3. Does Myocardial Infarction Beget Atrial Fibrillation and Atrial Fibrillation Beget Myocardial Infarction?

    NARCIS (Netherlands)

    Vermond, Rob A.; Van Gelder, Isabelle C.; Crijns, Harry J.; Rienstra, Michiel

    2015-01-01

    Atrial fibrillation (AF) affects millions of people worldwide.(1) It is already known several decades that AF is not a benign condition, and it's associated with a 5-fold increased risk of stroke, 3-fold increased risk of heart failure, and doubling of risk of dementia and death.(2-4) Myocardial

  4. Atrial Arrhythmias in Astronauts. Summary of a NASA Summit

    Science.gov (United States)

    Barr, Yael; Watkins, Sharmila; Polk, J. D.

    2011-01-01

    This slide presentation reviews the findings of a panel of heart experts brought together to study if atrial arrhythmias more prevalent in astronauts, and potential risk factors that may predispose astronauts to atrial arrhythmias. The objective of the panel was to solicit expert opinion on screening, diagnosis, and treatment options, identify gaps in knowledge, and propose relevant research initiatives. While Atrial Arrhythmias occur in approximately the same percents in astronauts as in the general population, they seem to occur at younger ages in astronauts. Several reasons for this predisposition were given: gender, hypertension, endurance training, and triggering events. Potential Space Flight-Related Risk factors that may play a role in precipitating lone atrial fibrillation were reviewed. There appears to be no evidence that any variable of the space flight environment increases the likelihood of developing atrial arrhythmias during space flight.

  5. The immediate future for the medical treatment of atrial fibrillation

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Brendorp, Bente; Køber, Lars

    2002-01-01

    Atrial fibrillation is the most commonly sustained cardiac arrhythmia and a common reason for mortality and morbidity. Atrial fibrillation causes disease for three reasons: i) the ventricular rate is often high, which leads to symptoms ranging from discomfort to life threatening heart failure; ii......) the rhythm causes loss of atrioventricular synchrony, which reduces diastolic filling and may lead to heart failure; and iii) atrial contraction is lost leading to stagnant blood that again may lead to atrial thrombi and peripheral embolism. Thus, the treatment of atrial fibrillation is focused...... of sinus rhythm but all carry a significant risk of pro-arrhythmia, in particular Torsade de Pointe ventricular tachycardia. Rate control has been a focus of treatment for many years and several very old drugs, including digoxin, are used for this. There is, to the author's knowledge, no current effort...

  6. Ventricular rhythm in atrial fibrillation under anaesthetic infusion with propofol

    International Nuclear Information System (INIS)

    Cervigón, R; Moreno, J; Pérez-Villacastín, J; Reilly, R B; Castells, F

    2009-01-01

    Changes in patients' autonomic tone and specific pharmacologic interventions may modify the ventricular response (actual heart rate) during atrial fibrillation (AF). Hypnotic agents such as propofol may modify autonomic balance as they promote a sedative state. It has been shown that propofol slightly slows atrial fibrillatory activity, but the net global effect on the ventricular response remains unknown. We aimed to evaluate in patients in AF the effect of a propofol bolus on the ventricular rate and regularity at ECG. We analysed the possible relation with local atrial fibrillatory activities, as ratios between atrial and ventricular rates (AVRs), analysing atrial activity from intracardiac electrograms at the free wall of the right and left atria and at the interatrial septum. We compared data at the baseline and after complete hypnosis. Propofol was associated with a more homogeneous ventricular response and lower AVR values at the interatrial septum

  7. Does perceived stress increase the risk of atrial fibrillation?

    DEFF Research Database (Denmark)

    Graff, Simon; Prior, Anders; Fenger-Grøn, Morten

    2017-01-01

    Background Psychological stress is associated with increased risk of acute cardiovascular diseases, as myocardial infarction. We recently found a higher risk of atrial fibrillation following an acute stressful life event, but it remains unknown whether this also applies to common and less acute...... stress exposures. Methods We investigated the risk of incident atrial fibrillation in people with high levels of perceived stress by following a population-based cohort of 114,337 participants from the Danish National Health Survey from 2010 to 2014. The survey holds information on lifestyle factors......-up. The hazard ratio (HR) of atrial fibrillation with 95% confidence interval (CI) was calculated with Cox proportional hazard model. Results The risk of atrial fibrillation increased with increasing PSS score; persons in the highest perceived stress quintile had 28% (95% CI, 12%-46%) higher risk of atrial...

  8. Genetics of Atrial Fibrillation and Possible Implications for Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Robin Lemmens

    2011-01-01

    Full Text Available Atrial fibrillation is the most common cardiac arrhythmia mainly caused by valvular, ischemic, hypertensive, and myopathic heart disease. Atrial fibrillation can occur in families suggesting a genetic background especially in younger subjects. Additionally recent studies have identified common genetic variants to be associated with atrial fibrillation in the general population. This cardiac arrhythmia has important public health implications because of its main complications: congestive heart failure and ischemic stroke. Since atrial fibrillation can result in ischemic stroke, one might assume that genetic determinants of this cardiac arrhythmia are also implicated in cerebrovascular disease. Ischemic stroke is a multifactorial, complex disease where multiple environmental and genetic factors interact. Whether genetic variants associated with a risk factor for ischemic stroke also increase the risk of a particular vascular endpoint still needs to be confirmed in many cases. Here we review the current knowledge on the genetic background of atrial fibrillation and the consequences for cerebrovascular disease.

  9. Effect of renal sympathetic denervation on atrial substrate remodeling in ambulatory canines with prolonged atrial pacing.

    Directory of Open Access Journals (Sweden)

    Xule Wang

    Full Text Available We have previously demonstrated that catheter-based renal sympathetic denervation (RSD could suppress atrial fibrillation (AF in canines with short-time rapid right atrial pacing (RAP. However, the role of renal denervation on atrial remodeling is unclear. The aim of the present study was to explore the long-term effect of RSD on the atrial remodeling during prolonged RAP. Twenty mongrel dogs were implanted with a high-frequency cardiac pacemaker with a transvenous lead inserted into the right atrial appendage. The dogs were divided into three groups: a sham-operated group (n = 6, the chronic RAP (CRAP group (n = 7, and the CRAP+RSD group (n = 7. In the CRAP+RSD group, a pacemaker was implanted 6 weeks after RSD was performed bilaterally for recovery. RAP was maintained for 5 weeks in CRAP group and CRAP+RSD group. The plasma levels of Angiotensin II and aldosterone were significantly increased in CRAP group compared with sham-operated group, but the increasing trend was inhibited in CRAP+RSD group compared with CRAP group (P<0.05. Similarly, RSD suppressed the increasing trend that prolonged RAP produced in the left atrial levels of ANP, TNF-α and IL-6. Compared with the sham-operated group, the CRAP group had significantly increased levels of caspase-3, bax and Cx40 whereas the level of Bcl-2 decreased (P<0.05. RSD markedly reduced the upregulation of caspase-3, bax and Cx40 and the downregulation of Bcl-2 expression compared with the CRAP group (P<0.05. Picric acid-sirius red staining study suggested that RSD could markedly alleviate the lesion degree of cardic fibrosis induced by CRAP (P<0.05. Immunohistochemistry results showed that the densities of TH- and GAP43- positive nerves were significantly elevated in the CRAP group compared with the sham-operated group, while RSD operation signicantly inhibited the these changes produced by CRAP. These findings suggest that renal denervation could suppress the atrial remodeling after

  10. Das James Webb Space Telescope

    Science.gov (United States)

    Lemke, Dietrich

    2005-07-01

    Nicht nach einem berühmten Astronomen, sondern nach einem ihrer erfolgreichen Behördenleiter hat die NASA ihr neues astronomisches Flaggschiff benannt: Im Jahre 2011 soll das James Webb Space Telescope (JWST) das Weltraumteleskop Hubble ablösen.

  11. Das Messiasgeheimnis und die Spruchquelle

    African Journals Online (AJOL)

    p1243322

    die dies Logion redaktionell an die vorangehende christologische Aussage anschließt, begegnet dabei expressis verbis das markinische Motiv der esoterischen Jüngerbelehrung. Das Geheimnis der Person Jesu offenbart. Jesus exklusiv seinen Jüngern. Die Wendung entspricht wortgleich den gleichsinnigen Aussagen, ...

  12. Avaliação in vitro das propriedades antimicrobianas de vasopressores

    Directory of Open Access Journals (Sweden)

    Habib Bostan

    2014-04-01

    Full Text Available Justificativa e objetivo: os medicamentos administrados como perfusão intravenosa podem ser contaminados durante as várias etapas de produção ou preparação. No entanto, estudos sobre os efeitos antibacterianos de vasopressores são muito raros. Este estudo investiga a atividade antimicrobiana in vitro das formas de vasopressores usados clinicamente. Materiais e métodos: atividades antimicrobianas in vitro de substâncias vasopressoras de diferentes concentrações foram investigadas com o uso da técnica de microdiluição. Os microrganismos empregados no teste foram: Escherichia coli ATCC 25922, Yersinia pseudotuberculosis ATCC 911, Pseudomonas aeruginosa ATCC 10145, Listeria monocytogenes ATCC 43251, Enterococcus faecalis ATCC 29212, Staphylococcus aureus ATCC 25923, Bacillus cereus 702 Roma, Mycobacterium smegmatis ATCC607, Candida albicans ATCC 60193 e Saccharomyces cerevisiae RSKK 251. Os ensaios antibacterianos foram feitos em caldo de cultura Mueller-Hinton (pH 7,3 e os ensaios antifúngicos em solução tampão de base nitrogenada para levedura (pH 7,0. Resultados: duas preparações diferentes de dopamina mostraram atividade antimicrobiana. Nenhuma outra substância do estudo mostrou qualquer atividade antimicrobiana. Conclusões: em nossa opinião, os efeitos antibacterianos da dopamina podem ser vantajosos para inibir a propagação de contaminação bacteriana durante a preparação das soluções para perfusão. Contudo, salientamos a importância do seguimento rigoroso das diretrizes de esterilização dos equipamentos e de assepsia durante todos os procedimentos feitos em unidades de terapia intensiva.

  13. Anomalous muscle bundle in the right atrium; Implication to trans atrial device closure

    Directory of Open Access Journals (Sweden)

    Saji Philip

    2017-09-01

    Full Text Available Intracavitary muscle bands or aberrant bands have been well described in all four chambers of the heart but rarely seen thick muscular band crossing right atrium. We report a case of devisable secundum atrial septal defect with an intra-atrial anomalous muscular band, crossing right atrial wall to the rim of the secundum atrial septal defect warranting surgical closure.

  14. Atrial Fibrillation: When the heart is not in rhythm | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: When the heart is not in rhythm Past ... show, Deal With It . Photo: TBS/Deal Understanding Atrial Fibrillation Atrial fibrillation (AFib) is the most common type ...

  15. Rapid slowing of the atrial fibrillatory rate after administration of AZD7009 predicts conversion of atrial fibrillation

    DEFF Research Database (Denmark)

    Aunes, Maria; Egstrup, Kenneth; Frison, Lars

    2014-01-01

    BACKGROUND: Effects on the atrial fibrillatory rate (AFR) were studied during infusion with the combined potassium and sodium channel blocker AZD7009. METHODS AND RESULTS: Patients with persistent atrial fibrillation (AF) were randomized to AZD7009 or placebo. Thirty-five patients converted to si...

  16. Does Left Atrial Volume and Pulmonary Venous Anatomy Predict the Outcome of Catheter Ablation of Atrial Fibrillation ?

    NARCIS (Netherlands)

    Hof, Irene; Chilukuri, Karuna; Arbab-Zadeh, Armin; Scherr, Daniel; Dalal, Darshan; Nazarian, Saman; Henrikson, Charles; Spragg, David; Berger, Ronald; Marine, Joseph; Calkins, Hugh

    Introduction: Preprocedural factors may be helpful in selecting patients with atrial fibrillation (AF) for treatment with catheter ablation and in making an assumption regarding their prognosis. The aims of this study were to investigate whether left atrial (LA) volume and pulmonary venous (PV)

  17. Progression of atrial fibrillation in the REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation cohort

    DEFF Research Database (Denmark)

    De Vos, Cees B; Breithardt, Günter; Camm, A John

    2012-01-01

    Paroxysmal atrial fibrillation (AF) may progress to persistent AF. We studied the clinical correlates and the effect of rhythm-control strategy on AF progression.......Paroxysmal atrial fibrillation (AF) may progress to persistent AF. We studied the clinical correlates and the effect of rhythm-control strategy on AF progression....

  18. [Biatrial vs. isolated left atrial cryoablation for the treatment of long-lasting permanent atrial fibrillation. Midterm recurrence rate].

    Science.gov (United States)

    Gualis, Javier; Castaño, Mario; Martínez-Comendador, Jose Manuel; Marcos, Jose Miguel; Martín, Carlos; Estévez-Loureiro, Rodrigo; Gómez-Plana, Jesús; Martín, Elio; Otero, Javier

    2016-01-01

    The long-term results of cryomaze in patients with longstanding persistent atrial fibrillation during concomitant surgical procedures are still uncertain. Between 2006 and 2011, 150 consecutive patients with associated long-lasting permanent atrial fibrillation and associated heart disease underwent heart surgery were treated by biatrial Cox-Maze (63 patients) or by isolated endocardial or epicardial left atrial cryoablation (83 patients) concomitantly. The results at 3 years in these groups were compared with clinical monitoring, electrocardiography, 24-hour Holter, and echocardiography with measurement of the transmitral A wave at 1, 6 and 12 months and annually thereafter in all patients. Patients undergoing Cox-Maze IV ablation presented rates of freedom from atrial fibrillation of 97, 94, 89, 80 and 54% at 1, 6, 12, 24 and 36 months, respectively. In the 12-month follow-up, these differences were significant (p<.05). The independent risk factors of atrial fibrillation recurrence was isolated ablation of left atrium. Atrial fibrillation by cryothermia ablation had a high success rate before 2 years postoperatively. Recurrence of atrial fibrillation increased thereafter regardless of the technique used, although it was more intense and developed earlier in cases of monoatrial ablation. For the treatment of other long-lasting permanent atrial fibrillation cardiac surgery-associated pathology, an aggressive biatrial treatment with Cox maze ablation should be performed. Copyright © 2015 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  19. Atrial-selective K+ channel blockers: potential antiarrhythmic drugs in atrial fibrillation?

    Science.gov (United States)

    Ravens, Ursula

    2017-11-01

    In the wake of demographic change in Western countries, atrial fibrillation has reached an epidemiological scale, yet current strategies for drug treatment of the arrhythmia lack sufficient efficacy and safety. In search of novel medications, atrial-selective drugs that specifically target atrial over other cardiac functions have been developed. Here, I will address drugs acting on potassium (K + ) channels that are either predominantly expressed in atria or possess electrophysiological properties distinct in atria from ventricles. These channels include the ultra-rapidly activating, delayed outward-rectifying Kv1.5 channel conducting I Kur , the acetylcholine-activated inward-rectifying Kir3.1/Kir3.4 channel conducting I K,ACh , the Ca 2+ -activated K + channels of small conductance (SK) conducting I SK , and the two-pore domain K + (K2P) channels (tandem of P domains, weak inward-rectifying K + channels (TWIK-1), TWIK-related acid-sensitive K + channels (TASK-1 and TASK-3)) that are responsible for voltage-independent background currents I TWIK-1 , I TASK-1 , and I TASK-3 . Direct drug effects on these channels are described and their putative value in treatment of atrial fibrillation is discussed. Although many potential drug targets have emerged in the process of unravelling details of the pathophysiological mechanisms responsible for atrial fibrillation, we do not know whether novel antiarrhythmic drugs will be more successful when modulating many targets or a single specific one. The answer to this riddle can only be solved in a clinical context.

  20. Interatrial septum pacing decreases atrial dyssynchrony on strain rate imaging compared with right atrial appendage pacing.

    Science.gov (United States)

    Yasuoka, Yoshinori; Abe, Haruhiko; Umekawa, Seiko; Katsuki, Keiko; Tanaka, Norio; Araki, Ryo; Imanaka, Takahiro; Matsutera, Ryo; Morisawa, Daisuke; Kitada, Hirokazu; Hattori, Susumu; Noda, Yoshiki; Adachi, Hidenori; Sasaki, Tatsuya; Miyatake, Kunio

    2011-03-01

    Interatrial septum pacing (IAS-P) decreases atrial conduction delay compared with right atrial appendage pacing (RAA-P). We evaluate the atrial contraction with strain rate of tissue Doppler imaging (TDI) during sinus activation or with IAS-P or RAA-P. Fifty-two patients with permanent pacemaker for sinus node disease were enrolled in the study. Twenty-three subjects were with IAS-P and 29 with RAA-P. The time from end-diastole to peak end-diastolic strain rate was measured and corrected with RR interval on electrocardiogram. It was defined as the time from end-diastole to peak end-diastolic strain rate (TSRc), and the balance between maximum and minimum TSRc at three sites (ΔTSRc) was compared during sinus activation and with pacing rhythm in each group. There were no significant differences observed in general characteristics and standard echocardiographic parameters except the duration of pacing P wave between the two groups. The duration was significantly shorter in the IAS-P group compared with the RAA-P group (95 ± 34 vs 138 ± 41; P = 0.001). TSRc was significantly different between sinus activation and pacing rhythm (36.3 ± 35.7 vs 61.6 ± 36.3; P = 0.003) in the RAA-P group, whereas no significant differences were observed in the IAS-P group (25.4 ± 12.1 vs 27.7 ± 14.7; NS). During the follow-up (mean 2.4 ± 0.7 years), the incidence of paroxysmal atrial fibrillation (AF) conversion to permanent AF was not significantly different between the two groups. IAS-P decreased the contraction delay on atrial TDI compared to RAA-P; however, it did not contribute to the reduction of AF incidence in the present study. ©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.

  1. Discriminating atrial flutter from atrial fibrillation using a multilevel model of atrioventricular conduction.

    Science.gov (United States)

    Scholz, Eberhard P; Kehrle, Florian; Vossel, Stephan; Hess, Alexander; Zitron, Edgar; Katus, Hugo A; Sager, Sebastian

    2014-05-01

    The discrimination between atrial flutter (AFlu) and atrial fibrillation (AFib) can be made difficult by an irregular ventricular response owing to complex conduction phenomena within the atrioventricular (AV) node, known as multilevel AV block. We tested the hypothesis that a mathematical algorithm might be suitable to discriminate both arrhythmias. To discriminate AFlu with irregular ventricular response from AFib based on the sequence of R-R intervals. Intracardiac recordings of 100 patients (50 patients with AFib and 50 patients with AFlu) were analyzed. On the basis of a numerical simulation of variable flutter frequencies followed by 2 levels of AV block in series, a given sequence of R-R intervals was analyzed. Although the ventricular response displays absolute irregularity in AFib, the sequences of R-R intervals follow certain rules in AFlu. We find that using a mathematical simulation of multilevel AV block, based on the R-R sequence of 16 ventricular beats, a stability of atrial activation could be predicted with a sensitivity of 84% and a specificity of 74%. When limiting the ventricular rate to 125 beats/min, discrimination could be performed with a sensitivity of even 89% and a specificity of 80%. In cases of AFlu, the atrial cycle length could be predicted with high accuracy. On the basis of the electrophysiological mechanism of multilevel AV block, we developed a computer algorithm to discriminate between AFlu and Afib. This algorithm is able to predict the stability and cycle length of atrial activation for short R-R sequences with high accuracy. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  2. Origens das formas budistas

    Directory of Open Access Journals (Sweden)

    Fernando Carlos Chamas

    Full Text Available RESUMO As características de uma imagem de Buda são o resultado do processo milenar que uniu três fatores: as mitologias orientais mais antigas que o budismo, sua capacidade de se adequar às crenças locais e as suas próprias reinterpretações. Após o surgimento das primeiras estátuas que representavam o Buda histórico, o ideal de beleza para um ser que alcançou a Iluminação baseou-se nas antigas "ciências" orientais, predominantemente mentais e de energias sutis. Enquanto a estética ocidental discutia as idealizações da arte com racionalidade, ignorando um oriente "pagão e supersticioso", as imagens budistas personificavam estados mentais que o ocidente só cogitaria na sua modernidade. A arte budista transmite o legado ancestral e imutável de chaves místicas da consciência e do equilíbrio..

  3. Bingo das Ervilhas

    Directory of Open Access Journals (Sweden)

    Luciana Bonato Lovato

    2016-12-01

    Full Text Available Este artigo analisa a utilização de um jogo didático sobre conteúdos de Genética ministrados no Ensino Fundamental. O material utilizado foi elaborado a partir da literatura existente e trabalhado sob a forma de uma oficina ministrada a professores de Ensino Fundamental e Médio de escolas de abrangência da 4a. Coordenadoria Regional de Educação do Rio Grande do Sul. A oferta desta oficina partiu do pressuposto de que os jogos educacionais são uma importante estratégia no processo de ensino-aprendizagem por se tratarem de uma ferramenta facilitadora nas aulas de Ciências, uma vez que contribuem para a aprendizagem de conceitos e termos complexos de maneira lúdica e estimulam o desenvolvimento das competências dos educandos. Todos os participantes consideraram que a oficina realizada contribuirá para sua prática docente, e acreditam que os jogos didáticos oferecem experiências de aprendizado que contribuem para construção do conhecimento.

  4. easyDAS: Automatic creation of DAS servers

    Directory of Open Access Journals (Sweden)

    Jimenez Rafael C

    2011-01-01

    Full Text Available Abstract Background The Distributed Annotation System (DAS has proven to be a successful way to publish and share biological data. Although there are more than 750 active registered servers from around 50 organizations, setting up a DAS server comprises a fair amount of work, making it difficult for many research groups to share their biological annotations. Given the clear advantage that the generalized sharing of relevant biological data is for the research community it would be desirable to facilitate the sharing process. Results Here we present easyDAS, a web-based system enabling anyone to publish biological annotations with just some clicks. The system, available at http://www.ebi.ac.uk/panda-srv/easydas is capable of reading different standard data file formats, process the data and create a new publicly available DAS source in a completely automated way. The created sources are hosted on the EBI systems and can take advantage of its high storage capacity and network connection, freeing the data provider from any network management work. easyDAS is an open source project under the GNU LGPL license. Conclusions easyDAS is an automated DAS source creation system which can help many researchers in sharing their biological data, potentially increasing the amount of relevant biological data available to the scientific community.

  5. Measuring the complexity of atrial fibrillation electrograms.

    Science.gov (United States)

    Ng, Jason; Borodyanskiy, Aleksey I; Chang, Eric T; Villuendas, Roger; Dibs, Samer; Kadish, Alan H; Goldberger, Jeffrey J

    2010-06-01

    Complex fractionated atrial electrograms (CFAE) have been identified as targets for atrial fibrillation (AF) ablation. Robust automatic algorithms to objectively classify these signals would be useful. The aim of this study was to evaluate Shannon's entropy (ShEn) and the Kolmogorov-Smirnov (K-S) test as a measure of signal complexity and to compare these measures with fractional intervals (FI) in distinguishing CFAE from non-CFAE signals. Electrogram recordings of 5 seconds obtained from multiple atrial sites in 13 patients (11 M, 58 +/- 10 years old) undergoing AF ablation were visually examined by 4 independent reviewers. Electrograms were classified as CFAE if they met Nademanee criteria. Agreement of 3 or more reviewers was considered consensus and the resulting classification was used as the gold standard. A total of 297 recordings were examined. Of these, 107 were consensus CFAE, 111 were non-CFAE, and 79 were equivocal or noninterpretable. FIs less than 120 ms identified CFAEs with sensitivity of 87% and specificity of 79%. ShEn, with optimal parameters using receiver-operator characteristic curves, resulted in a sensitivity of 87% and specificity of 81% in identifying CFAE. The K-S test resulted in an optimal sensitivity of 100% and specificity of 95% in classifying uninterpretable electrogram from all other electrograms. ShEn showed comparable results to FI in distinguishing CFAE from non-CFAE without requiring user input for threshold levels. Thus, measuring electrogram complexity using ShEn may have utility in objectively and automatically identifying CFAE sites for AF ablation.

  6. Implementando diretrizes clínicas na atenção ao infarto agudo do miocárdio em uma emergência pública Implementando directrices clínicas en la atención al infarto agudo de miocardio en un emergencia pública Implementing clinical guidelines on acute myocardial infarction care in an emergency service

    Directory of Open Access Journals (Sweden)

    Claudia Caminha Escosteguy

    2011-01-01

    Full Text Available FUNDAMENTO: A implementação de diretrizes clínicas na atenção ao infarto agudo do miocárdio (IAM produz melhores resultados. OBJETIVO: Apresentar um programa multidisciplinar de implementação dessas diretrizes em uma grande emergência pública e verificar seu impacto. MÉTODOS: Estudo de avaliação de serviços de saúde, com desenho do tipo "antes e após", para avaliar os indicadores da qualidade da atenção ao IAM antes e após a implementação de estratégias de treinamento e de facilitação da adesão das equipes da emergência a diretrizes clínicas. Isso inclui a elaboração de material didático e de sensibilização e a supervisão continuada. Estimativa de risco relativo (RR e intervalos de confiança (IC95%. RESULTADOS: Grupo pré-programa de diretrizes clínicas, 78 casos de IAM; grupo pós-programa, 66 casos de IAM. A maioria dos casos foi tratada apenas na emergência, por limitação de vagas na unidade coronariana. Observou-se aumento significativo (pFUNDAMENTO: La implementación de directrices clínicas en la atención al infarto agudo de miocardio (IAM produce mejores resultados. OBJETIVO: Presentar un programa multidisciplinario de implementación de estas directrices en una grande emergencia pública y verificar su impacto. MÉTODOS: Estudio de evaluación de servicios de salud, con diseño del tipo "antes y después", para evaluar los indicadores de la calidad de la atención al IAM antes y después de la implementación de estrategias de entrenamiento y para facilitar la adhesión de los equipos de la emergencia a directrices clínicas. Esto incluye la elaboración de material didáctico y de sensibilización y la supervisión continuada. Estimación de riesgo relativo (RR e intervalos de confianza (IC95%. RESULTADOS: Grupo pre programa de directrices clínicas, 78 casos de IAM; grupo pos programa, 66 casos de IAM. La mayoría de los casos se trató solamente en la emergencia, por limitación de vagas en la

  7. Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Murdoch, Dale, E-mail: dale_murdoch@health.qld.gov.au [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia); McAulay, Laura [The Prince Charles Hospital, Brisbane (Australia); Walters, Darren L. [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia)

    2014-11-15

    Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy.

  8. Low-energy multistage atrial defibrillation therapy terminates atrial fibrillation with less energy than a single shock.

    Science.gov (United States)

    Li, Wenwen; Janardhan, Ajit H; Fedorov, Vadim V; Sha, Qun; Schuessler, Richard B; Efimov, Igor R

    2011-12-01

    Implantable device therapy of atrial fibrillation (AF) is limited by pain from high-energy shocks. We developed a low-energy multistage defibrillation therapy and tested it in a canine model of AF. AF was induced by burst pacing during vagus nerve stimulation. Our novel defibrillation therapy consisted of 3 stages: stage (ST) 1 (1-4 low-energy biphasic [BP] shocks), ST2 (6-10 ultralow-energy monophasic [MP] shocks), and ST3 (antitachycardia pacing). First, ST1 testing compared single or multiple MP and BP shocks. Second, several multistage therapies were tested: ST1 versus ST1+ST3 versus ST1+ST2+ST3. Third, 3 shock vectors were compared: superior vena cava to distal coronary sinus, proximal coronary sinus to left atrial appendage, and right atrial appendage to left atrial appendage. The atrial defibrillation threshold (DFT) of 1 BP shock was defibrillation at or below the pain threshold.

  9. Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

    International Nuclear Information System (INIS)

    Murdoch, Dale; McAulay, Laura; Walters, Darren L.

    2014-01-01

    Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy

  10. Integrating new approaches to atrial fibrillation management

    DEFF Research Database (Denmark)

    Kotecha, Dipak; Breithardt, Günter; Camm, A John

    2018-01-01

    cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference...... of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new...

  11. Echocardiographic study of left atrial myxoma

    Directory of Open Access Journals (Sweden)

    Dalal J

    1979-01-01

    Full Text Available Four cases of left atrial myxoma were diagnosed pre-operatively by echocardiography. All cases showed characteristic echocardio-graphic features of variegated shadows behind the mitral valve in diastole and within the left atrium in systole. In two cases the my-xomas were surgically removed and confirmed on histology. In one case the post-operative echocardiogram showed complete dis-appearance of the abnormal shadows. Echocardiography is the most reliable method today for the diagnosis of a myxoma.

  12. NASA's First Atrial Fibrillation Case - Deke Slayton

    Science.gov (United States)

    Tarver, William J.

    2010-01-01

    Concerns about heart dysrhythmia have been present since the earliest days of the US manned space program. While information about an astronaut's health is general kept private, one of the original seven American astronaut's health status was played out in a very public forum. Donald "Deke" Slayton was removed from the second manned space flight when it was discovered he had idiopathic atrial fibrillation. Referencing the original medical documents, details of how this was discovered and managed from the medical perspective will be reviewed. This is NASA's first heart dysrhythmia case in an astronaut and it proves quite interesting when placed in historic perspective.

  13. Atrial overexpression of angiotensin-converting enzyme 2 improves the canine rapid atrial pacing-induced structural and electrical remodeling. Fan, ACE2 improves atrial substrate remodeling.

    Science.gov (United States)

    Fan, Jinqi; Zou, Lili; Cui, Kun; Woo, Kamsang; Du, Huaan; Chen, Shaojie; Ling, Zhiyu; Zhang, Quanjun; Zhang, Bo; Lan, Xianbin; Su, Li; Zrenner, Bernhard; Yin, Yuehui

    2015-01-01

    The purpose of this study was to investigate whether atrial overexpression of angiotensin-converting enzyme 2 (ACE2) by homogeneous transmural atrial gene transfer can reverse atrial remodeling and its mechanisms in a canine atrial-pacing model. Twenty-eight mongrel dogs were randomly divided into four groups: Sham-operated, AF-control, gene therapy with adenovirus-enhanced green fluorescent protein (Ad-EGFP) and gene therapy with Ad-ACE2 (Ad-ACE2) (n = 7 per subgroup). AF was induced in all dogs except the Sham-operated group by rapid atrial pacing at 450 beats/min for 2 weeks. Ad-EGFP and Ad-ACE2 group then received epicardial gene painting. Three weeks after gene transfer, all animals except the Sham group underwent rapid atrial pacing for another 3 weeks and then invasive electrophysiological, histological and molecular studies. The Ad-ACE2 group showed an increased ACE2 and Angiotensin-(1-7) expression, and decreased Angiotensin II expression in comparison with Ad-EGFP and AF-control group. ACE2 overexpression attenuated rapid atrial pacing-induced increase in activated extracellular signal-regulated kinases and mitogen-activated protein kinases (MAPKs) levels, and decrease in MAPK phosphatase 1(MKP-1) level, resulting in attenuation of atrial fibrosis collagen protein markers and transforming growth factor-β1. Additionally, ACE2 overexpression also modulated the tachypacing-induced up-regulation of connexin 40, down-regulation of connexin 43 and Kv4.2, and significantly decreased the inducibility and duration of AF. ACE2 overexpression could shift the renin-angiotensin system balance towards the protective axis, attenuate cardiac fibrosis remodeling associated with up-regulation of MKP-1 and reduction of MAPKs activities, modulate tachypacing-induced ion channels and connexin remodeling, and subsequently reduce the inducibility and duration of AF.

  14. Uso da radiofrequência bipolar para o tratamento da fibrilação atrial durante cirurgia cardíaca Uso de la radiofrecuencia bipolar para el tratamiento de la fibrilación atrial durante cirugía cardíaca Use of bipolar radiofrequency for the treatment of atrial fibrillation during cardiac surgery

    Directory of Open Access Journals (Sweden)

    Leonardo Secchin Canale

    2011-06-01

    Full Text Available FUNDAMENTO: O tratamento da fibrilação atrial com dispositivo de ablação de tecidos por radiofrequência bipolar em concomitância à cirurgia cardíaca tem se mostrado método eficaz no tratamento desta arritmia. OBJETIVO: Descrever a experiência inicial do Instituto Nacional de Cardiologia no tratamento cirúrgico da fibrilação atrial com uso de dispositivo de radiofrequência bipolar em pacientes submetidos à cirurgia cardíaca, relatando o resultado de acompanhamento pós-operatório de um ano. MÉTODOS: Entre janeiro de 2008 e março de 2009, 47 pacientes (36 mulheres consecutivos, com idade média de 53,7 ± 10,6 anos, apresentando fibrilação atrial por um período médio de 34,6 meses (3 a 192 meses foram submetidos à ablação cirúrgica desta arritmia, por radiofrequência bipolar, durante o procedimento que motivou a indicação da cirurgia. Oito apresentavam fibrilação atrial intermitente e 39, contínua. Oitenta e um por cento foram submetidos à cirurgia valvar como procedimento principal. Esta é uma análise retrospectiva, observacional, com avaliação de um ano de pós-operatório das variáveis clínicas e de Holter 24 h. RESULTADOS: Dos 47 pacientes, 40 sobreviveram um ano. Desses, 33 foram submetidos a Holter 24 h, em um intervalo médio de 401 dias após a cirurgia. Encontrou-se a seguinte distribuição de ritmos: 24 (73% sinusal, 5 (15% fibrilação atrial, três (9% Flutter atrial e um (3% ritmo juncional. Foram observados dois acidentes vasculares encefálicos, sendo um associado à arritmia supraventricular. CONCLUSÃO: A ablação cirúrgica de fibrilação atrial com dispositivo de radiofrequência bipolar concomitante à cirurgia cardíaca é método eficaz para o tratamento desta arritmia.FUNDAMENTO: El tratamiento de la fibrilación atrial con dispositivo de ablación de tejidos por radiofrecuencia bipolar en concomitancia con la cirugía cardíaca se muestra un método eficaz en el tratamiento de esta

  15. Fibrilação atrial e demência: resultados do São Paulo ageing & health study Atrial fibrillation and dementia: results from the Sao Paulo ageing & health study

    Directory of Open Access Journals (Sweden)

    Liz Andrea Kawabata-Yoshihara

    2012-12-01

    Full Text Available FUNDAMENTO: A fibrilação atrial é um fator de risco controverso para demência. OBJETIVO: O objetivo deste estudo é avaliar a associação entre fibrilação atrial e demência em participantes do São Paulo Ageing & Health. MÉTODOS: O São Paulo Ageing & Health é um estudo transversal, de base populacional, de idosos residentes em um uma região de baixa renda da cidade de São Paulo, Brasil. Diagnóstico de demência foi realizado de acordo com o protocolo do grupo 10/66, com base em critérios do Manual de Diagnóstico e Estatística das Perturbações Mentais (DSM-IV. O diagnóstico de fibrilação atrial foi feito por eletrocardiograma de 12 derivações, avaliado por dois cardiologistas. Dados demográficos e de fatores de risco cardiovasculares também foram obtidos. RESULTADOS: A demência foi diagnosticada em 66 (4,3% e fibrilação atrial em 36 (2,4% de 1.524 participantes com um eletrocardiograma válido. A razão de chances bruta para demência em participantes com fibrilação atrial foi 2,8 (intervalo de confiança [IC] 95%: 1,0-8,1; p = 0,06 em comparação com indivíduos sem fibrilação atrial. Relação positiva foi encontrada em mulheres (RC 4,2; IC 95%: 1,2-15,1; p = 0,03. Após ajuste para idade, no entanto, essa associação tornou-se não significativa (RC 2,2, IC 95%: 0,6-8,9; p = 0,26. CONCLUSÃO: Não houve associação independente entre a fibrilação atrial e demência nessa amostra. A prevalência da fibrilação atrial pode ser baixa nesta população em virtude da mortalidade cardiovascular prematura.BACKGROUND: Atrial fibrillation (AF is a controversial risk factor for dementia. OBJECTIVE: The objective of this study was to assess the association between AF and dementia in the "Sao Paulo Ageing & Health" (SPAH study participants. METHODS: SPAH is a cross-sectional, population-based study of elderly people living in a deprived neighborhood in Sao Paulo, Brazil. Dementia diagnosis was performed according to

  16. Diretrizes curriculares nacionais para o ensino médio: avaliação de documento National curriculum directives for secondary education: an evaluation of the document

    Directory of Open Access Journals (Sweden)

    Angela Maria Martins

    2000-03-01

    Full Text Available Este texto pretende oferecer algumas contribuições para o debate sobre as mudanças propostas pelas Diretrizes Curriculares Nacionais elaboradas para a reforma do ensino médio no Brasil. Na primeira parte, avalia-se o cenário político e econômico, como contexto gerador da última etapa de reformas no âmbito da educação, nos anos 90. Pretende-se questionar a opção por um modelo de reforma de estrutura (no caso brasileiro mais restrita ao Programa de Reforma da Educação Profissionalizante - PROEP e de currículo, cujos temas encontram justificativa no contexto econômico, social, cultural e político contemporâneo. Discute-se a utilização de um "modelo" que toma por base experiências desenvolvidas em outros países, e por referência teórico-metodológica as orientações internacionais de organismos multilaterais, desconsiderando as peculiaridades e injunções do sistema administrativo-político brasileiro, medida política essa que pode aumentar a tensão e a distância normalmente existentes entre programas de governo e a possibilidade de sua concretude na rede escolar. Na segunda parte, discute-se a Resolução do Conselho Nacional de Educação, da Câmara de Educação Básica, n. 3, de 16.6.98, que institui as Diretrizes Curriculares Nacionais para o ensino médio, bem como as Bases Legais - Parte I - dos Parâmetros Curriculares Nacionais para o Ensino Médio. A análise do discurso oficial toma como referência metodológica a proposição de Bardin (1977, p. 209 para os modelos de análise estrutural, procurando-se relevar os valores implícitos e as conotações dos textos legaisThis text offers some contributions to the debate on the changes proposed to the National Curricular Directives to reform secondary education in Brazil. In the first part, the political and economic scene is evaluated as the context which generated the last stage of reforms in the educational field in the 90s. It questions the option for a

  17. Modelos para gestão de riscos em cadeias de suprimentos: revisão, análise e diretrizes para futuras pesquisas

    Directory of Open Access Journals (Sweden)

    Robson Nogueira Tomas

    2013-01-01

    Full Text Available O objetivo deste artigo é apresentar uma revisão bibliográfica, que possa ser considerada completa e inédita na literatura científica nacional, tendo como foco modelos para gestão de riscos em cadeias de suprimentos. Para tanto, foram revisados 103 artigos científicos publicados entre 2000 e 2012. Inicialmente, buscou-se categorizar os tipos de riscos abordados nos artigos científicos segundo a descrição proposta por Christopher e Peck (2004, a saber: internos à empresa focal (operações, processo e controle; externos para a empresa focal, mas internos para a cadeia (fornecimento e demanda; e externos à cadeia (macroambiente. Buscou-se, também, identificar as etapas elementares na composição de um modelo para gestão de riscos em cadeias de suprimentos. Uma vez categorizados os tipos de riscos e identificadas as quatro etapas elementares, efetuou-se uma análise a partir de três perspectivas: i as opções de modelos disponíveis na literatura para a prática de tal gestão, considerando-se os tipos de riscos e etapas que os compõem; ii um modelo final a ser proposto; e iii elementos que podem ser acrescentados ao modelo final. As principais contribuições deste trabalho dizem respeito a possibilitar melhor entendimento dos tipos de riscos que podem incidir sobre uma cadeia de suprimentos, discutir os modelos mais adequados para geri-los, além de oferecer diretrizes para futuras pesquisas na temática em questão.

  18. [Surface ECG characteristics of right and left atrial flutter].

    Science.gov (United States)

    Rostock, Thomas; Konrad, Torsten; Sonnenschein, Sebastian; Mollnau, Hanke; Ocete, Blanca Quesada; Bock, Karsten; Spittler, Raphael; Huber, Carola; Theis, Cathrin

    2015-09-01

    Atrial tachycardia in virtually all areas of both atria has become more important in the clinical management of patients with previous complex atrial fibrillation ablation. Accurate interpretation of surface electrocardiogram (ECG) characteristics is of paramount importance to localize the origin of atrial tachycardia, particularly for planning interventional treatment. This article highlights the ECG features of different types of right and left atrial tachycardia. Typical right atrial flutter through the cavotricuspid isthmus conducts septally in a cranial direction and demonstrates sawtooth-like flutter waves which start negative in II, III and aVF and then show a steep slope upwards to the isoelectric line. The flutter rate typically ranges between 240-250 beats/min. In contrast, right atrial flutter in a clockwise rotation, flutter around the vena cava inferior or superior and around a scar (e.g. after cardiac surgery) show positive or biphasic flutter waves (lower or upper loop reentry). Left atrial flutter waves (e.g. around the mitral valve or around the pulmonary veins) are very heterogeneous and are typically positive in V1 as the left atrium is located in the posterior mediastinum. Specific knowledge of flutter wave morphology in surface ECG facilitates planning and performance of the ablation strategy.

  19. Consolidação de diretrizes internacionais de manejo de populações caninas em áreas urbanas e proposta de indicadores para seu gerenciamento Consolidation of international guidelines for the management of canine populations in urban areas and proposal of performance indicators

    Directory of Open Access Journals (Sweden)

    Rita de Cassia Maria Garcia

    2012-08-01

    Full Text Available O objetivo desse trabalho é propor um programa genérico de manejo populacional de cães em áreas urbanas com indicadores para seu gerenciamento. Foram revisadas e consolidadas as diretrizes internacionais disponíveis para o manejo populacional de cães: Organização Mundial da Saúde, Organização Mundial para a Saúde Animal, World Society for the Protection of Animals, International Companion Animal Management Coalition e Organização das Nações Unidas para a Agricultura. Os programas de manejo populacional de cães devem contemplar: diagnóstico da situação, incluindo estimativa populacional; participação social com envolvimento dos diferentes setores no planejamento e na execução das estratégias; ações educativas para promover os valores humanos, o bem-estar animal, a saúde das comunidades e a aquisição responsável (compra ou adoção; manejo ambiental e de resíduos para diminuir a fonte de alimento e abrigo; registro e identificação dos animais; cuidados da saúde animal, controle reprodutivo dos cães; prevenção e controle de zoonoses; controle do comércio de animais; manejo etológico e destino adequado dos animais abandonados; e legislação pertinente à guarda responsável, à prevenção ao abandono e à prevenção das zoonoses. Para monitorar as ações, devem-se utilizar quatro grupos de indicadores: relativos às populações animais, às interações humano/animal, aos serviços públicos e às zoonoses transmitidas por esses animais. Concluiu-se que o manejo populacional dos cães de rua exige estratégias políticas, sanitárias, etológicas, ecológicas e humanitárias que sejam socialmente aceitas e ambientalmente sustentáveis. Também deve integrar o controle das zoonoses como raiva e leishmaniose, inserindo-se no conceito de "uma só saúde", que beneficia tanto os animais quanto as pessoas das comunidades.The objective of this study is to propose a generic program for the management of urban

  20. [Progress of anticoagulation therapy in atrial fibrillation].

    Science.gov (United States)

    Hernández Olmedo, Miguel; Suárez Fernández, Carmen

    2015-08-07

    Atrial fibrillation is currently a very prevalent disease and it represents one of the most common causes of disabling stroke. Antithrombotic therapies have reduced the incidence of this complication although they pose many limitations and difficulties. As a result, a large number of high risk patients do not receive an appropriate treatment. In recent years, four new oral anticoagulants (NOAC) with relevant advantages in comparison to vitaminK antagonists have been released. Four large phaseiii clinical trials have demonstrated that NOAC are at least as safe and efficacious as warfarin in stroke prevention in non-valve atrial fibrillation patients with moderate-high thrombotic risk, being their main advantage the reduction in intracranial hemorrhage. The arrival of these drugs has caused great expectations in the management of these patients but also new doubts. Lacking data in some subgroups of frail patients, the absence of specific antidotes available and specially their high cost represent nowadays the main limitations for their generalization. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  1. Atrial fibrillation: an observational study with outpatients.

    Science.gov (United States)

    Albina, Gastón; De Luca, Julián; Conde, Diego; Giniger, Alberto

    2014-11-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia with serious clinical consequences in the absence of treatment. However, there are limited data on the treatment of these patients in Argentina. The objective was to describe the therapeutic management of patients with nonacute AF by Argentinean cardiologists and to determine the incidence of clinical events after 12 months follow-up. The Atrial Fibrillation study in Argentina (FARAON) was an observational, descriptive, prospective, national, and multicentric study that included outpatients with AF, followed for 12 months. The study included 38 sites in Argentina. Each researcher included the first 10 patients who met the inclusion criteria of being over 21 and also being an AF carrier documented by electrocardiogram or Holter within 12 months prior to or at the time of enrollment. A total of 373 patients were included, mean age 70 ± 11.5 years, 40% women; 65% had AF rhythm at the time of inclusion, 57% had permanent AF, and 56% were asymptomatic. At the time of enrollment, 40% of physicians opted for rhythm control strategy. β-blockers and amiodarone were the most used drugs. Patients with rhythm control drugs had higher success rate than those with frequency control drug therapy (80% vs 57%). Cardiologists in Argentina receive patients with AF that are mostly permanent AF. More than half of the patients are asymptomatic. They opt primarily by controlling the pace. When choosing antiarrhythmic drugs, nearly half of them indicated amiodarone. © 2014 Wiley Periodicals, Inc.

  2. Atrial tachycardia mimicking atrioventricular nodal reentry tachycardia.

    Science.gov (United States)

    Eilbert, Wesley P; Patel, Neal

    2013-07-01

    The term supraventricular tachycardia (SVT) is used to describe tachydysrhythmias that require atrial or atrioventricular nodal tissue for their initiation and maintenance. SVT can be used to describe atrioventricular nodal reentry tachycardia, atrioventricular reentry tachycardia, and atrial tachycardia (AT). AT is the least common of these SVT subtypes, accounting for only 10% of cases. Although the suggested initial management of each SVT subtype is different, they all can present with similar symptoms and electrocardiographic findings. Discuss the pathophysiology, diagnosis, and treatment of AT as compared with other types of SVT. We report a 56-year-old woman with symptoms and electrocardiographic findings consistent with SVT. Although standard treatment with intravenous adenosine failed to convert the SVT, it revealed AT as the cause of the tachydysrhythmia. The AT was successfully terminated with beta-blockade and the patient eventually underwent successful radioablation of three separate AT foci. AT frequently mimics other more common forms of SVT. AT might be recognized only when standard treatment of SVT has failed. Identification of AT in this setting is crucial to allow for more definitive therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Right Atrial Metastatic Melanoma with Unknown Primaries

    Directory of Open Access Journals (Sweden)

    Robin Kuriakose

    2015-01-01

    Full Text Available A 54-year-old male with history of anemia and rheumatoid arthritis presented with a three-month history of dyspnea on exertion and lower extremity edema. Patient was referred for a transthoracic echocardiogram that revealed a large right atrial mass with reduced ejection fraction of 40% and an incidental large liver mass. Subsequent cardiac MRI revealed a lobulated right atrial mass measuring 5.4 cm × 5.3 cm with inferior vena cava compression and adjacent multiple large liver lesions confirmed to be malignant melanoma through biopsy. Interestingly, no primaries were found in the patient. PET/CT imaging displayed hypermetabolic masses within the right atrium and liver that likely represent metastases, as well as bilateral pleural effusions, most likely due to heart failure. Preoperative coronary angiogram demonstrated perfusion to the mass by a dense network of neovasculature arising from the mid right coronary artery. The cardiac melanoma was surgically removed, and the right atrium was reconstructed with a pericardial patch. After surgery, all cardiac chambers appeared normal in size and function with associated moderate tricuspid regurgitation. The patient is currently being administered ipilimumab for systemic therapy of metastatic melanoma.

  4. Right atrial bypass model in the dog.

    Science.gov (United States)

    Breen, P H; Isserles, S A

    1995-02-01

    In gas exchange studies addressing the storage and transport of CO2 in dogs, a model in which cardiac output (QT) can be precisely controlled and measured would be beneficial. We identified problems with described extracorporeal circuits and implemented right atrial bypass (RAB) in dogs. In 6 anesthetized (chloralose and urethane), heparinized dogs (mean +/- SD, 24 +/- 4 kg) with open thorax, cannulas were inserted in both vena cavas to drain venous blood return to a reservoir (anaerobic bag or bubble oxygenator). A roller pump then drove blood through a heat exchanger back to the right atrial appendage. After 1.8 +/- 1.4 hour of RAB, physiologic variables remained within reference limits for dogs (QT, 1.5 +/- 0.3 L/min; blood pressure, 92 +/- 25 mm of Hg; arterial PCO2, 35 +/- 4 mm of Hg; PO2, 513 +/- 39 mm of Hg; pH, 7.39 +/- 0.08; and tissue CO2 production, 126 +/- 56 ml/min). To permit study of gas exchange, venous return (and thus, QT) and venous PCO2 and PO2 could be accurately regulated and measured over a wide range. Maintenance of native pulsatile lung perfusion and cardiogenic oscillations minimizes mismatching of pulmonary ventilation and perfusion and facilitates studies addressing pulmonary gas exchange. This RAB model is designed so that investigators can establish the preparation in a few hours.

  5. Atrial Fibrillation Predictors: Importance of the Electrocardiogram.

    Science.gov (United States)

    German, David M; Kabir, Muammar M; Dewland, Thomas A; Henrikson, Charles A; Tereshchenko, Larisa G

    2016-01-01

    Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with significant morbidity and mortality. Substantial interest has developed in the primary prevention of AF, and thus the identification of individuals at risk for developing AF. The electrocardiogram (ECG) provides a wealth of information, which is of value in predicting incident AF. The PR interval and P wave indices (including P wave duration, P wave terminal force, P wave axis, and other measures of P wave morphology) are discussed with regard to their ability to predict and characterize AF risk in the general population. The predictive value of the QT interval, ECG criteria for left ventricular hypertrophy, and findings of atrial and ventricular ectopy are also discussed. Efforts are underway to develop models that predict AF incidence in the general population; however, at present, little information from the ECG is included in these models. The ECG provides a great deal of information on AF risk and has the potential to contribute substantially to AF risk estimation, but more research is needed. © 2015 Wiley Periodicals, Inc.

  6. Clinical characteristics, management, and control of permanent vs. nonpermanent atrial fibrillation: insights from the RealiseAF survey.

    LENUS (Irish Health Repository)

    Murin, Jan

    2014-01-01

    Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample.

  7. Divergências entre o mapeamento curricular das Escolas Profissionais e Escolas Regulares Cearenses

    Directory of Open Access Journals (Sweden)

    Cícera Alves Agostinho de Sá

    2014-12-01

    Full Text Available O governo federal, por meio do programa Brasil Profissionalizado favorece a construção e funcionamento de escolas de educação profissional. A Secretaria do Estado do Ceará, utilizando recursos do referido programa vem investindo, desde 2008, na edificação e adaptação de escolas de ensino médio, nas quais ocorre a integração entre as disciplinas da base comum e componentes curriculares da área técnica. O contraponto dessa modalidade de ensino é a distribuição da carga horária no mapa curricular, de forma que parte do tempo mínimo previsto de 800 horas anuais para as disciplinas da base comum é destinado à área técnica e/ou atividades complementares. Analisar a disparidade entre o mapa curricular das escolas estaduais de ensino médio regular e de educação profissional do Ceará constitui o cerne dessa pesquisa, visto que ocorre nas escolas profissionais uma supressão do mínimo de tempo exigido pela Lei de Diretrizes e Bases da Educação Nacional 9.394/96, para a base comum, conforme dados levantados e analisados através dessa pesquisa. 

  8. A roadmap to improve the quality of atrial fibrillation management : proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference

    NARCIS (Netherlands)

    Kirchhof, Paulus; Breithardt, Guenter; Bax, Jeroen; Benninger, Gerlinde; Blomstrom-Lundqvist, Carina; Boriani, Giuseppe; Brandes, Axel; Brown, Helen; Brueckmann, Martina; Calkins, Hugh; Calvert, Melanie; Christoffels, Vincent; Crijns, Harry; Dobrev, Dobromir; Ellinor, Patrick; Fabritz, Larissa; Fetsch, Thomas; Freedman, S. Ben; Gerth, Andrea; Goette, Andreas; Guasch, Eduard; Hack, Guido; Haegeli, Laurent; Hatem, Stephane; Haeusler, Karl Georg; Heidbuechel, Hein; Heinrich-Nols, Jutta; Hidden-Lucet, Francoise; Hindricks, Gerd; Juul-Moeller, Steen; Kaeaeb, Stefan; Kappenberger, Lukas; Kespohl, Stefanie; Kotecha, Dipak; Lane, Deirdre A.; Leute, Angelika; Lewalter, Thorsten; Meyer, Ralf; Mont, Lluis; Muenzel, Felix; Nabauer, Michael; Nielsen, Jens C.; Oeff, Michael; Oldgren, Jonas; Oto, Ali; Piccini, Jonathan P.; Pilmeyer, Art; Potpara, Tatjana; Ravens, Ursula; Reinecke, Holger; Rostock, Thomas; Rustige, Joerg; Savelieva, Irene; Schnabel, Renate; Schotten, Ulrich; Schwichtenberg, Lars; Sinner, Moritz F.; Steinbeck, Gerhard; Stoll, Monika; Tavazzi, Luigi; Themistoclakis, Sakis; Tse, Hung Fat; Van Gelder, Isabelle C.; Vardas, Panagiotis E.; Varpula, Timo; Vincent, Alphons; Werring, David; Willems, Stephan; Ziegler, Andre; Lip, Gregory Y. H.; Camm, A. John

    2016-01-01

    At least 30 million people worldwide carry a diagnosis of atrial fibrillation (AF), and many more suffer from undiagnosed, subclinical, or 'silent' AF. Atrial fibrillation-related cardiovascular mortality and morbidity, including cardiovascular deaths, heart failure, stroke, and hospitalizations,

  9. Atrial fibrillation in inherited cardiac channelopathies: From mechanisms to management.

    Science.gov (United States)

    Enriquez, Andres; Antzelevitch, Charles; Bismah, Verdah; Baranchuk, Adrian

    2016-09-01

    Atrial fibrillation (AF) is prevalent in cardiac channelopathies and may be the presenting feature in some patients. The pathogenesis is related to the primary ion channel dysfunction in atrial myocytes that affects atrial conduction or repolarization. The development of AF is associated with adverse outcomes, and its management is challenging in these patients. In this article we review the current information on the prevalence, risk factors, pathophysiology, and treatment of AF in specific cardiac channelopathies. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  10. Atrial Septal Aneurysm Presenting as Clubbing without Clinically Apparent Cyanosis.

    Science.gov (United States)

    Goyal, Laxmi Kant; Banerjee, S; Yadav, R N; Singh, Gajraj; Ganguli, Sujata; Isran, Rohit

    2015-09-01

    Atrial septal aneurysm (ASA) is a localised "saccular" deformity which protrudes to the right or the left atrium or on both sides. It is a rare, but well recognised cardiac abnormality. It is usually an incidental finding or may presents as atrial arrhythmias or arterial embolism. Though it is an acyanotic congenital heart disease but it may result in significant right to left shunt and cyanosis. We describe a patient of ASA with atrial septal defect who presented with clubbing and right to left shunt without clinically apparent cyanosis. © Journal of the Association of Physicians of India 2011.

  11. Left atrial myxoma complicated with multi-system embolization.

    Science.gov (United States)

    Zhang, Ren-Dan; Zeng, Zhi-Huan; Zheng, Jian-Yi; Li, Tu-Di; Zhao, Yan-Qun; Liu, Yu-Hong; Yao, Yu-Si

    2017-09-05

    Atrial myxoma accounts for approximately 50% of all cardiac tumors. The majority of myxomas are located in the left atrium and present variable clinical manifestation. A young man was transferred to our hospital with sudden onset of resting pain, pallor and numb in right leg. An atrial mobile mass was detected by transthoracic echocardiography. Anticoagulant and antithrombotic therapy were administered, a timely surgery was performed and the mass was confirmed as a myxoma. The patient did not discharge any discomfort post-operation. For patients with atrial myxoma, early diagnosis is essential, anticoagulant or antithrombotic therapy and surgery have a great importance to prevent further embolism.

  12. Acute Pulmonary Edema Caused by a Giant Atrial Myxoma

    Directory of Open Access Journals (Sweden)

    Andrea Fisicaro

    2013-01-01

    Full Text Available Atrial myxoma is the most common primary cardiac tumor. Its clinical presentation spreads from asymptomatic incidental mass to serious life-threatening cardiovascular complications. We report the case of a 44-year-old man with evening fever and worsening dyspnea in the last weeks, admitted to our hospital for acute pulmonary edema. The cardiac auscultation was very suspicious for mitral valve stenosis, but the echocardiography revealed a huge atrial mass with a diastolic prolapse into mitral valve orifice causing an extremely high transmitral gradient pressure. Awareness of this uncommon acute presentation of atrial myxoma is necessary for timely diagnosis and prompt surgical intervention.

  13. Pulmonary edema following transcatheter closure of atrial septal defect

    Directory of Open Access Journals (Sweden)

    Keerthi Chigurupati

    2015-01-01

    Full Text Available We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.

  14. Atrial natriuretic peptide and feeding activity patterns in rats

    Directory of Open Access Journals (Sweden)

    Oliveira M.H.A.

    1997-01-01

    Full Text Available This review presents historical data about atrial natriuretic peptide (ANP from its discovery as an atrial natriuretic factor (ANF to its role as an atrial natriuretic hormone (ANH. As a hormone, ANP can interact with the hypothalamic-pituitary-adrenal axis (HPA-A and is related to feeding activity patterns in the rat. Food restriction proved to be an interesting model to investigate this relationship. The role of ANP must be understood within a context of peripheral and central interactions involving different peptides and pathways

  15. Long working hours as a risk factor for atrial fibrillation

    DEFF Research Database (Denmark)

    Kivimäki, Mika; Nyberg, Solja T.; Batty, G. David

    2017-01-01

    Aims Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working...... confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association. Conclusion Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours....

  16. Desvelando a Internet das Coisas

    Directory of Open Access Journals (Sweden)

    Lucia Santaella

    2013-12-01

    Full Text Available O presente artigo pretende relatar as origens da Internet das Coisas, seu estado de arte e evidenciar seus principais vetores. Para tal, o estudo percorrerá as eras midiáticas de Santaella (2007, p. 179-189, a par da discussão das máquinas de Turing, da arquitetura Von Neumann até chegar à Internet e seu estado atual, implementada nas coisas.

  17. Desvelando a Internet das Coisas

    OpenAIRE

    Lucia Santaella; Adelino Gala; Clayton Policarpo; Ricardo Gazoni

    2013-01-01

    O presente artigo pretende relatar as origens da Internet das Coisas, seu estado de arte e evidenciar seus principais vetores. Para tal, o estudo percorrerá as eras midiáticas de Santaella (2007, p. 179-189), a par da discussão das máquinas de Turing, da arquitetura Von Neumann até chegar à Internet e seu estado atual, implementada nas coisas.

  18. The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter

    DEFF Research Database (Denmark)

    Sethi, Naqash; Safi, Sanam; Nielsen, Emil E

    2017-01-01

    by Jakobsen and colleagues. We plan to include all relevant randomised clinical trials assessing the effects of any rhythm control strategy versus any rate control strategy. We plan to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, Science Citation Index Expanded...... on Web of Science, and BIOSIS to identify relevant trials. Any eligible trial will be assessed and classified as either high risk of bias or low risk of bias, and our conclusions will be based on trials with low risk of bias. The analyses of the extracted data will be performed using Review Manager 5....... This protocol for a systematic review aims at identifying the best overall treatment strategy for atrial fibrillation and atrial flutter. METHODS: This protocol for a systematic review was performed following the recommendations of the Cochrane Collaboration and the eight-step assessment procedure suggested...

  19. Management of focal atrial tachycardias originating from the atrial appendage with the combination of radiofrequency catheter ablation and minimally invasive atrial appendectomy.

    Science.gov (United States)

    Guo, Xiao-gang; Zhang, Jin-lin; Ma, Jian; Jia, Yu-he; Zheng, Zhe; Wang, Hong-yue; Su, Xi; Zhang, Shu

    2014-01-01

    Focal atrial tachycardias (ATs) originating from the left and the right atrial appendage (AA) were the most difficult to eliminate. To evaluate the safety and long-term efficacy of minimally invasive surgical atrial appendectomy in combination with radiofrequency catheter ablation (RFCA) in the management of focal atrial appendage tachycardias (AATs). We included 42 consecutive patients with 42 AATs confirmed by activation mapping and contrast venography. Thirty of them were successfully managed with RFCA (RFCA-successful group), while the remaining 12 (28.6%) finally resorted to video-assisted thoracoscopic atrial appendectomy owing to RFCA failure (resort-to-surgery group). We searched for predictors of RFCA failure, and the need for surgery by using a binomial logistic regression model. In the RFCA-successful group, 6 (20.0%) patients experienced recurrence and re-do ablation and 11 (36.7%) AATs originated from distal AAs. In the resort-to-surgery group, the tachycardias involved exclusively distal AAs and required more RFCA attempts compared with those of the RFCA-successful group (1.58 ± 0.51 vs 1.20 ± 0.41; P = .0165). During atrial appendectomy, incessant ATs were terminated immediately after resection of the AA at the base. Long-term success was achieved in all 42 patients with a follow-up of 29.1 ± 17.5 months. No complications occurred. Fourteen patients with tachycardia-induced cardiomyopathy recovered fully. We identified origin at distal AATs and longer time to tachycardia termination by ablation as predictors of RFCA failure and the need for surgical intervention. ATs originating from the distal portion of AA were more refractory to RFCA. The combination of catheter ablation and video-assisted thoracoscopic atrial appendectomy was an effective strategy to manage AATs. © 2014 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

  20. Taurine Reverses Atrial Structural Remodeling in Ach-Cacl2Induced Atrial Fibrillation Rats.

    Science.gov (United States)

    Yang, Qunhui; Wu, Gaofeng; Han, Limei; Feng, Ying; Lin, Shumei; Lv, Qiufeng; Yang, Jiancheng; Hu, Jianmin

    2017-01-01

    Taurine has been reported to have anti-arrhythmia effects, but the anti-atrial fibrillation (AF) effects and its mechanism remain incompletely understood. In the present study, the therapy effects and partly mechanisms were investigated. AF animal model was established by intravenous administered with the mixture of acetylcholine (Ach) and CaCl 2 (66 μg/mL + 10 mg/mL) (i.v.) for 7 days. The actions of taurine (99 mg/kg∙d, introgastric administration) on the levels of Hs-CRP, IL-6, TNF-α, MMP-9, AngII, the extent of the fibrosis and ultrastructural changes in left atrial were studied. The data showed that the serum levels of TNF-α, IL-6, AngII and the plasma levels of Hs-CRP and MMP-9 were significantly elevated in automatic recovery group relative to the control group (p < 0.01), which were all decreased by taurine administration (p < 0.01) similar to Verapamil treatment. Masson's trichrome staining of the left atrial tissue showed an obvious interstitial fibrosis in rats of automatic recovery group. The alteration could be reversed by additional taurine. Electron microscopy revealed that taurine administration could significantly alleviate the ultrastructural damage of atrial cells, and the effects were similar to the Verapamil treatment. In conclusion, the results suggested that taurine could inhibit the structural remodeling of AF in rats partly by decreasing the levels of inflammatory factors and profibrotic molecules, attenuating the extent of myocardial fibrosis and protecting the integrity of myocardial ultrastructure.

  1. Three-dimensional atrial wall thickness maps to inform catheter ablation procedures for atrial fibrillation.

    Science.gov (United States)

    Bishop, Martin; Rajani, Ronak; Plank, Gernot; Gaddum, Nicholas; Carr-White, Gerry; Wright, Matt; O'Neill, Mark; Niederer, Steven

    2016-03-01

    Transmural lesion formation is critical to success in atrial fibrillation ablation and is dependent on left atrial wall thickness (LAWT). Pre- and peri-procedural planning may benefit from LAWT measurements. To calculate the LAWT, the Laplace equation was solved over a finite element mesh of the left atrium derived from the segmented computed tomographic angiography (CTA) dataset. Local LAWT was then calculated from the length of field lines derived from the Laplace solution that spanned the wall from the endocardium or epicardium. The method was validated on an atrium phantom and retrospectively applied to 10 patients who underwent routine coronary CTA for standard clinical indications at our institute. The Laplace wall thickness algorithm was validated on the left atrium phantom. Wall thickness measurements had errors of atrial wall thickness measurements were performed on 10 patients. Successful comprehensive LAWT maps were generated in all patients from the coronary CTA images. Mean LAWT measurements ranged from 0.6 to 1.0 mm and showed significant inter and intra patient variability. Left atrial wall thickness can be measured robustly and efficiently across the whole left atrium using a solution of the Laplace equation over a finite element mesh of the left atrium. Further studies are indicated to determine whether the integration of LAWT maps into pre-existing 3D anatomical mapping systems may provide important anatomical information for guiding radiofrequency ablation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  2. The feasibility of substituting left atrial wall strain for flow velocity of left atrial appendage.

    Science.gov (United States)

    Miyoshi, Akihito; Nakamura, Yoichi; Kazatani, Yukio; Ito, Hiroshi

    2017-07-28

    Non-valvular atrial fibrillation (NVAF) is frequently complicated by thromboembolism. Left atrial appendage (LAA) flow is a predictor of LAA thrombosis. LAA flow is measured by transesophageal echocardiography (TEE), which is a semi-invasive diagnostic tool. Recently, speckle-tracking methods have been adapted for the evaluation of local cardiac function. We hypothesised that if we could determine LAA wall motion utilising a speckle tracking technique, we could non-invasively analyse LAA flow. Sixty-three NVAF patients including 38 with chronic atrial fibrillation (CAF), 14 with paroxysmal AF (PAF) and 11 with atrial flutter (AFL) were enrolled in this study. Normal sinus rhythm (NSR) patients with non-thromboembolic cerebral infarction were also included. Immediately after obtaining a 2D movie of the LAA through the aortic oblique short axis view by transthoracic echocardiography, LAA flow velocity was measured by TEE. Mean strains between the posterior and anterior walls were measured using a speckle-tracking technique. Ten patients exhibited a thrombus and 11 had spontaneous echo contrast (SEC) in the auricle. Mean strain value was similar between CAF and PAF, although LAA flow velocity for CAF was significantly reduced compared with PAF (median value 13.7 cm/s versus 36.1 cm/s, p = reduced compared with NSR patients (median value 1.52% versus 3.17%, p = .00181). Furthermore, mean strain was correlated with LAA flow velocity (R = 0.399, R2 = 0.1595, p = .000615). LAA wall strain identified via speckle-tracking methods may presage LAA peak flow velocity. This technique may contribute to stratification of thrombosis risks in the LAA.

  3. Assessment of left atrial volume and function in patients with permanent atrial fibrillation

    DEFF Research Database (Denmark)

    Agner, Bue F Ross; Kühl, Jørgen Tobias; Linde, Jesper James

    2014-01-01

    Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with substantial morbidity and mortality. AF is associated with enlargement of the left atrium (LA), and the LA volume has important prognostic implications for the disease. The objective of the study was to determine how ...... measurements of LA volume and function obtained by transthoracic echocardiography (TTE), cardiac magnetic resonance (CMR), and 320-slice multi-detector computed tomography (MDCT) correlate in patients with permanent AF....

  4. Prevenção cardiovascular abrangente em pacientes com doença arterial coronária: implementação das diretrizes na prática clínica

    Directory of Open Access Journals (Sweden)

    Clarisse Kaoru Ogawa Indio do Brasil

    2013-06-01

    Full Text Available OBJETIVO: Demonstrar a eficácia de um programa de otimização da prática clínica em pacientes com doença arterial coronária para prescrição de medicamentos e documentar a prática clínica vigente quanto aos medicamentos e medidas para a mudança do estilo de vida. MÉTODOS: Estudo de corte transversal, seguido de componente longitudinal. Foram incluídos 710 pacientes consecutivos (Fase 1. Após aplicação de ferramentas para melhoria da prática clínica, foram incluídos, após seis meses, 705 pacientes com coleta dos mesmos dados (Fase 2. Foram selecionados aleatoriamente, a partir do primeiro grupo, 318 prontuários para comparação desses mesmos pacientes (Fase 3. RESULTADOS: Comparação entre as Fases 1 e 2: melhora em relação a tabagismo (P=0,019, dislipidemia (P<0,001, hipertensão arterial e atividade física regular (P<0,001. Diferença significativa para inibidores da enzima de conversão da angiotensina - IECA (67,2% vs. 56,8%, P<0,001; antagonistas do receptor da angiotensina II - ARA II (25,4% vs. 32,9%, P=0,002 e betabloqueador (88,7% vs. 91,9%, P=0,047. Comparação entre as Fases 1 e 3: houve redução do peso (P=0,044 e pressão arterial (P<0,001. Em relação à prescrição de medicamentos recomendados, diferença para IECA (64,8% vs. 61,6%, P=0,011 e ARA II (27,0% vs. 31,3%, P=0,035. CONCLUSÃO: Não houve mudança significativa na utilização de medicamentos; entretanto, observou-se melhora significativa em relação ao tabagismo e atividade física na Fase 2; melhora substancial nos níveis de pressão arterial, na comparação tanto entre as Fases 1 e 2 como entre as Fases 1 e 3. A inclusão de enfermeiro treinado para gerenciar o processo foi fundamental. Programas abrangentes de melhoria de qualidade assistencial, provavelmente, devem ser continuados por período de seguimento maior.

  5. Development of a transgenic goat model wih cardiac-specific overexpression of transforming growth factor - {beta} 1 to study the relationship between atrial fibrosis and atrial fibrillation

    Science.gov (United States)

    Studies on patients, large animal models and transgenic mouse models have shown a strong association of atrial fibrosis with atrial fibrillation (AF). However, it is unclear whether there is a causal relationship between atrial fibrosis and AF or whether these events appear as a result of independen...

  6. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.

    Science.gov (United States)

    Patel, Manesh R; Mahaffey, Kenneth W; Garg, Jyotsna; Pan, Guohua; Singer, Daniel E; Hacke, Werner; Breithardt, Günter; Halperin, Jonathan L; Hankey, Graeme J; Piccini, Jonathan P; Becker, Richard C; Nessel, Christopher C; Paolini, John F; Berkowitz, Scott D; Fox, Keith A A; Califf, Robert M

    2011-09-08

    The use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Rivaroxaban, an oral factor Xa inhibitor, may provide more consistent and predictable anticoagulation than warfarin. In a double-blind trial, we randomly assigned 14,264 patients with nonvalvular atrial fibrillation who were at increased risk for stroke to receive either rivaroxaban (at a daily dose of 20 mg) or dose-adjusted warfarin. The per-protocol, as-treated primary analysis was designed to determine whether rivaroxaban was noninferior to warfarin for the primary end point of stroke or systemic embolism. In the primary analysis, the primary end point occurred in 188 patients in the rivaroxaban group (1.7% per year) and in 241 in the warfarin group (2.2% per year) (hazard ratio in the rivaroxaban group, 0.79; 95% confidence interval [CI], 0.66 to 0.96; P<0.001 for noninferiority). In the intention-to-treat analysis, the primary end point occurred in 269 patients in the rivaroxaban group (2.1% per year) and in 306 patients in the warfarin group (2.4% per year) (hazard ratio, 0.88; 95% CI, 0.74 to 1.03; P<0.001 for noninferiority; P=0.12 for superiority). Major and nonmajor clinically relevant bleeding occurred in 1475 patients in the rivaroxaban group (14.9% per year) and in 1449 in the warfarin group (14.5% per year) (hazard ratio, 1.03; 95% CI, 0.96 to 1.11; P=0.44), with significant reductions in intracranial hemorrhage (0.5% vs. 0.7%, P=0.02) and fatal bleeding (0.2% vs. 0.5%, P=0.003) in the rivaroxaban group. In patients with atrial fibrillation, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. There was no significant between-group difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivaroxaban group. (Funded by Johnson & Johnson and Bayer; ROCKET AF ClinicalTrials.gov number, NCT00403767.).

  7. Ablação por radiofreqüência da fibrilação atrial paroxística: fatores determinantes da eficácia clínica a longo-prazo Radiofrequency ablation of paroxysmal atrial fibrillation: factors determining long-term clinical efficacy

    Directory of Open Access Journals (Sweden)

    Raul José Pádua Sartini

    2008-02-01

    Full Text Available FUNDAMENTO: A maioria dos trabalhos tem descrito preditores de recorrência de fibrilação atrial após ablação por cateter, com tempos de seguimento relativamente curtos. OBJETIVO: Avaliar retrospectivamente, em longo prazo, os preditores de recorrência de fibrilação atrial paroxística (FA em pacientes submetidos ao isolamento das veias pulmonares, após um único procedimento. MÉTODOS: Foram estudados 139 pacientes (102 homens com idade média de 55 ± 12 anos submetidos à ablação por radiofreqüência, por meio das técnicas ostial ou extra-ostial de abordagem do átrio esquerdo, associadas ou não à ablação do istmo cavo-tricuspídeo (ICT. Variáveis pré, intra e pós-ablação foram avaliadas por análise uni e multivariada, para determinar os preditores de recorrência da FA após um procedimento. RESULTADOS: Após um seguimento de 33 ± 12 meses, observou-se que maior tempo de história de FA, uso de mais antiarrítmicos e recorrência de FA num período de sessenta dias pós-procedimento aumentaram o risco de recorrência de FA em longo prazo. Por sua vez, a associação de flutter atrial e a ablação concomitante do ICT reduziram o risco de recorrência. CONCLUSÃO: Variáveis clínicas como tempo de história de FA e maior quantidade de antiarrítmicos já utilizadas influenciam os resultados da ablação por cateter. Em pacientes com flutter atrial associado, a realização concomitante de linha de bloqueio no ICT reduziu significativamente a recorrência de fibrilação atrial em longo prazo.BACKGROUND: Most of the studies on this subject have reported predictors of recurrence of atrial fibrillation after catheter ablation with relatively short follow-up periods. OBJECTIVE: To retrospectively evaluate predictors of long-term recurrence of paroxysmal atrial fibrillation (AF in patients undergoing pulmonary vein isolation following one single procedure. METHODS: The authors studied a total of 139 patients (102 men; mean

  8. A giant right atrial myxoma with pulmonary arterial hypertension ...

    African Journals Online (AJOL)

    Abstract. Here we report a case of a right atrial mass that morphology mimicking myxoma, in a young patient with no past medical history. The mass was pathologically confirmed to be symptomatic and surgical removal was successfully done.

  9. Dronedarone in high-risk permanent atrial fibrillation

    DEFF Research Database (Denmark)

    Connolly, Stuart J; Camm, A John; Halperin, Jonathan L

    2011-01-01

    Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent atrial fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular antiarrhythmic effects. We hypothesized that dronedarone would reduce major vascular events...

  10. Stroke and bleeding in atrial fibrillation with chronic kidney disease

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Lip, Gregory Y.H.; Kamper, Anne-Lise

    2012-01-01

    Both atrial fibrillation and chronic kidney disease increase the risk of stroke and systemic thromboembolism. However, these risks, and the effects of antithrombotic treatment, have not been thoroughly investigated in patients with both conditions....

  11. Dronedarone in high-risk permanent atrial fibrillation

    DEFF Research Database (Denmark)

    Connolly, Stuart J; Camm, A John; Halperin, Jonathan L

    2011-01-01

    Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent atrial fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular antiarrhythmic effects. We hypothesized that dronedarone would reduce major vascular events in ...

  12. Patent foramen ovale with right atrial septal pouch.

    Science.gov (United States)

    Kijima, Yasufumi; Bokhoor, Pooya; Tobis, Jonathan M

    2017-04-01

    A patent foramen ovale (PFO) is a communication across the inter-atrial septum and a right atrial septal pouch (RASP) is an indentation of the atrial septum caused by an incomplete fusion of the septum primum and septum secundum with its base opening into the right atrium. A 63-year-old male who had a history of two strokes and episodes of transient neurological deficit was diagnosed to have a small right-to-left shunt. At the time of PFO closure, an angiogram of the atrial septum revealed a small PFO associated with a RASP. The small PFO was crossed with a straight-tipped guide wire and was closed using a 25-mm GORE CARDIOFORM Septal Occluder (W.L. Gore and Associates, AZ). It is hypothesized that stagnant blood in the RASP may generate a clot that can cross the PFO and cause an infarct. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  13. 50. Successful percutanous closure of spiral atrial septal defect

    Directory of Open Access Journals (Sweden)

    Mashail Abdulaziz Alobaidan

    2015-10-01

    An unusual morphology of atrial septal defect has been described where there is an apparently “double atrial septum” (Roberson, 2006. The terminology around this lesion has been attributed to be the wide separation of the primary atrial septum (primum septum from the secondary septum (septum secundum and the “spiral” spatial arrangement of the margins of the atrial septal defect (ASD has led to the term spiral ASD to describe this arrangement. This has been described to be associated with a high risk of device embolization or technical failure in the placement of an occluder device. We report the echocardiographic findings and outcome of a patient with this form of ASD in whom percutaneous occlusion was successful of which is considered up to date to be the first successful closure of this type of ASD.

  14. Stroke prevention strategies in North American patients with atrial fibrillation

    DEFF Research Database (Denmark)

    McIntyre, William F; Conen, David; Olshansky, Brian

    2018-01-01

    BACKGROUND: Antithrombotic prophylaxis with oral anticoagulation (OAC) substantially reduces stroke and mortality in patients with atrial fibrillation (AF). HYPOTHESIS: Analysis of data in GLORIA-AF, an international, observational registry of patients with newly-diagnosed AF, can identify factor...

  15. Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation

    NARCIS (Netherlands)

    Calkins, Hugh; Willems, Stephan; Gerstenfeld, Edward P.; Verma, Atul; Schilling, Richard; Hohnloser, Stefan H.; Okumura, Ken; Serota, Harvey; Nordaby, Matias; Guiver, Kelly; Biss, Branislav; Brouwer, Marc A.; Grimaldi, Massimo; de Asmundis, Carlo; Debruyne, Philippe; Pierard, Luc; Scavé e, Christophe; Schwagten, Bruno; van Acker, Hannes; van Heuverswyn, Frank; Ayala-Paredes, Felix; Lane, Christopher; Lockwood, Evan; Michael, Kevin; Morillo, Carlos; O’ Hara, Gilles; Cebron, Jean-Pierre; Chevalier, Philippe; DeChillou, Christian; Defaye, Pascal; Deharo, Jean-Claude; Duthoit, Guillaume; Marijon, Eloi; Mechulan, Alexis; Sacher, Fré dé ric; Bonnemeier, Hendrik; Dahme, Tillmann; Ince, H.ü seyin; Neumann, Thomas; Steven, Daniel; Ü cer, Ekrem; Zabel, Markus; Calo, Leonardo; Cireddu, Manuela; Menardi, Endrju; Themistoclakis, Sakis; Tondo, Claudio; Fujii, Kenshi; Iwasa, Atsushi; Inden, Yasuya; Kimura, Masaomi; Murakami, Masato; Murakami, Yoshimasa; Satomi, Kazuhiro; Shimizu, Wataru; Watarai, Masato; Yoshida, Yukihiko; Merino, José -Luí s; Mitjans, Angel Moya; Mont, Lluí s; Asensi, Joaquí n Osca; Pedrote Martí nez, Á ngel Alonso; Teijeira-Ferná ndez, Elvis; Allaart, Cornelis P.; de Jong, Jonas S. G.; Folkeringa, Richard J.; Simmers, Tim A.; Barbarash, Olga L.; Kuznetsov, Vadim; Nedoshivin, Aleksandr; Novikova, Tatiana; Revishvili, Amiran S.; Staroverov, Ilya; Agarwal, Sharad; Betts, Timothy; Connelly, Derek; Hobson, Neil; Leong, Fong; McCready, James; Paisey, John; Tayebjee, Muzahir; Thornley, Andrew; Ahmed, Jameel; Beck, Hiroko; Beinart, Sean; Bindra, Sanjay; Chae, Sanders; Cheng, Jie; Eldadah, Zayd; Feigenblum, David; Fuenzalida, Charles; Gandhavadi, Maheer; Garabelli, Paul; Gerstenfeld, Edward; Gonzalez, Mario; Hurwitz, Jodie; Johnson, Colleen; Kabra, Rajesh; Kowalski, Marcin; Kulkarni, Gurudutt; Marrouche, Nassir; Miller, John; Mounsey, Paul; Norris, Blake; O’ Neill, Gearoid; Roukoz, Henri; Srivatsa, Uma; Talano, James; Vora, Aaditya; Wong, Brian; Camm, John; Cappato, Riccardo; Crijns, Harry; Kenigsberg, David; Tijssen, Jan G. P.; Januzzi, James; Garasic, Joe; Pehrson, Steen; Kolansky, Daniel; McDonald, Michael; van Tosh, Andrew; Sturm, Jonathan; Peeters, André ; Hirsch, Karen

    2017-01-01

    BACKGROUND Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non-vitamin K antagonist oral anticoagulant therapy. Uninterrupted anticoagulation with a non-vitamin K antagonist oral anticoagulant, such as dabigatran, may be

  16. Women Sex Importance in Stroke Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cemile Handan Mısırlı

    2014-08-01

    Full Text Available OBJECTIVE: It was shown the differences in age, risk factors and treatment between women and men in stroke patients with atrial fibrillation METHODS: The stroke patients with atrial fibrillation who were hospitalized in our department at the last 2 years were seperated into 2 groups of aged above 75 and below 75, investigated with CHADS2 and CHA2DS2VASc scores and looked at the sex differences of women and men. RESULTS: Stroke ratio according to sex was statistically meaningful especially in women above the age of 75. Risc factors also were founded in elderly women and CHA2DS2VASc scores were higher in women than men so more anticoagulan treatment were begun. No differences were shown between sexes at lone atrial fibrillation and no treatment were begun. CONCLUSION: Women with atrial fibrillation had more risk factors, higher stroke rate and higher anticoagulation treatment.

  17. Atrial angioleiomyoma with myopericytoma-like features: a case report.

    Science.gov (United States)

    Nassereddine, Hussein; Cazes, Aurélie; Verdonk, Constance; Assous, Benjamin; Dautry, Raphael; Nataf, Patrick; Wassef, Michel; Deschamps, Lydia

    A 66-year-old female patient was referred to our hospital for resection of a right atrial mass. Four months earlier, she had suffered an acute cerebrovascular accident due to occlusion of the sylvian segment of the right middle cerebral artery from atheromatous tight stenosis in the right internal carotid artery. Later, investigations with transthoracic and transesophageal echocardiography revealed a 3.4-cm right atrial mass that was resected surgically. Microscopic evaluation revealed a well-circumscribed nodular tumor, located within the interatrial septum, and corresponding to an angioleiomyoma (ALM). This tumor differs histologically from atrial myxoma. ALM is a ubiquitous benign tumor but has never been reported to occur in the atrium. ALM can mimic cardiac myxoma and should be considered in the differential diagnosis of atrial tumors. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Avaliação da atividade elétrica atrial em pacientes submetidos ao tratamento cirúrgico da valvopatia mitral Evaluation of atrial electrical activity in patients operated on mitral valve disease

    Directory of Open Access Journals (Sweden)

    Cesar Augusto Ferreira

    2002-01-01

    Full Text Available INTRODUÇÃO: O acesso cirúrgico por esternotomia mediana e atriotomia subseptal clássica pode, em certos casos, resultar em má exposição da valva mitral. Incisões atriais alternativas otimizam a exposição da valva mitral mas podem interferir na atividade elétrica atrial pós-operatória. OBJETIVO: Padronizar método para investigar a atividade elétrica atrial para emprego em estudos comparativos de diferentes atriotomias em cardiopatas sumetidos à cirurgia cardíaca. MÉTODOS: Análise com eletrocardiograma convencional e de 24 h (sistema Holter, pré e pós-operatória, e cardioestimulação epicárdica pós-operatória pelo método de Narula, em 10 pacientes submetidos à correção de valvopatias mitrais. RESULTADOS: No pré-op., os pacientes em ritmo sinusal apresentaram ectopias supraventriculares, com episódios de taquicardia supraventricular em 57% dos casos, "flutter" atrial em 10% e ritmo juncional em 10%. Todos apresentaram ectopias ventriculares, de baixa incidência em 70% dos casos, e taquicardia ventricular não sustentada foi detectada em 30% dos pacientes. No pós-operatório, houve 40% de novas arritmias supraventriculares (fibrilação atrial, ritmo juncional, ritmo atrial baixo e taquicardia supraventricular paroxística, mas não ocorreram arritmias ventriculares. No pós-op. a função do nó sinusal não se alterou, ocorreu redução significativa das ectopias supraventriculares, com reversão de FA para ritmo sinusal em 1 paciente, mas não houve redução significativa das ectopias ventriculares. O tempo de condução inter-atrial correlacionou-se com o tamanho do átrio esquerdo. CONCLUSÃO: A metodologia mostrou-se adequada e segura, e poderá ser empregada na comparação de diferentes incisões atriais para exposição valvar mitral.INTRODUCTION: The selection of the surgical approach to the mitral valve is a critical factor in obtaining good exposure and minimizing lesions of the surrounding structures

  19. [Diagnosis of atrial septal defect using magnetic resonance imaging].

    Science.gov (United States)

    Sakakibara, M; Kobayashi, S; Imai, H; Watanabe, S; Masuda, Y; Inagaki, Y

    1987-12-01

    We studied the morphological features of defects of the interatrial septum using magnetic resonance imaging (MRI) to determine the sizes of defects and other abnormalities. MR images were obtained in 28 patients with atrial septal defect, including five cases with complicated anomalies (two with Ebstein's anomaly, one pentalogy of Fallot, and one anomalous pulmonary vein connection and azygos continuation). Images were also obtained in the control subjects including seven normal volunteers and 142 patients with various acquired heart diseases. The diagnosis of atrial septal defect was established by cardiac catheterization, angiography and two-dimensional echocardiography prior to the MRI studies, and in 14 patients, the diagnosis was confirmed by surgery. The MRI unit had a superconducting magnet and operated at 0.25 or 0.50 Tesla. A spin echo pulse sequence was used with an echo time of 40 or 60 msec. At the beginning of this study, non-gated MRI images were obtained in the 28 controls and in three patients with atrial septal defect. Nongated MRI could not image the anatomical structure of the interatrial septa of 12 of the 28 controls, or any of the three patients with atrial septal defect. Nongated MRI was, therefore, inadequate for visualizing cardiac anatomy. Gated MRI images were obtained in 141 controls and in 25 patients with atrial septal defect. Gated MRI revealed the interatrial septum, interventricular septum, atrioventricular septum, mitral valve, tricuspid valve and other intracardiac structures in most subjects. In 17 control subjects (12%), however, there was a very faint signal from the central portion of the interatrial septum. In these instances, there was a gradual fading of the signal of the interatrial septum, so that they could be distinguished from the atrial septal defect. The sudden disappearance of the signal from the interatrial septum was observed by gated MRI in all 25 patients with atrial septal defect. The sizes of the defects by

  20. Atrial fibrillation in pure rheumatic mitral valvular disease is expression of an atrial histological change.

    Science.gov (United States)

    Alessandri, N; Tufano, F; Petrassi, M; Alessandri, C; Di Cristofano, C; Della Rocca, C; Gallo, P

    2009-01-01

    Some of theories try to explain the insurgence of atrial fibrillation (AF) in patients with acute articular rheumatism (AAR). These theories remind the close relation between AF and left atrium, or with valvular vitium degree, or monophasic action potential and histological cardiac structure. In 15 years of work in the academic Department of Heart and Big Vessels in Rome, the Authors studied 243 patients with mitral valvular disease post AAR before and after surgical manoeuvres. Patients were divided in order to monitor atrium and ventricle morphological and functional modifications of the valve according to cardiac rhythm. Patients classification was based on surgical therapy adopted, kind of mitral disease and cardiac rhythm. An histological examination was performed, only in patients treated with valvular replacement. During the operation an histological examination in an atrial tissue fragment was performed. 243 patients with mitral valvular disease post AAR with indication in valvular adjustment were studied. The whole population was treated with mitral transcutaneous valvuloplasty (Group B--130 patients) or with mitral valve replacement surgery (Group A--113 patients). These two groups were divided: in Gr.A in Gr.A1 and Gr.A2, and Gr.B in Gr.B1 and Gr.B2, according to cardiac rhythm (sinus rhythm iSR, AF). These subgroups were also divided in Gr.A1SR, Gr.A1AF; Gr.A2SR, Gr.A2AF; Gr.A3SR, Gr.A3AF, according to mitralic disease's kind (stenosis, stenosis/regurgitation, regurgitation). A complex screening were exerted to all patients using echocardio-doppler technology. Morphological parameters of atrium and ventricle, and functional parameters of mitral valve, aorta and tricuspid were evaluated. In Gr.A group patients during the operation were execute a bioptic sampling from left atrium and a consecutive histological valuation. In Gr.A1 mitral valve area (MtVA) arises smaller (p0.05). Left atrium volume arises elder in patients in AF than in patients in SR

  1. Frontiers of anticoagulation therapy for atrial fibrillation.

    Science.gov (United States)

    Yamashita, Takeshi

    2011-07-01

    In the management of atrial fibrillation (AF), stroke prevention has been proved to play a pivotal role in addition to therapy for concomitant diseases. And, hitherto, anticoagulation by warfarin has been the only effective choice that is known to decrease the stroke rate with ∼70% risk reduction. Although the evidence has been rigid, there are many barriers not to make warfarin therapy pervasive. However, the principle of "KISS (keep it short and simple)" seems to alter our situations. Changing the complex pharmacology with warfarin into the simple pharmacology with new anticoagulants would lead us to a new paradigm, where the old book is now rewritten by a new language. Copyright © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  2. Initiation of anticoagulation in atrial fibrillation

    DEFF Research Database (Denmark)

    Gundlund, A.; Staerk, L.; Fosbøl, E. L.

    2017-01-01

    Background: The use of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prophylaxis in atrial fibrillation (AF) is increasing rapidly. We compared characteristics of AF patients initiated on NOACs versus vitamin K antagonists (VKAs). Methods: Using Danish nationwide registry data, we...... identified AF patients initiating either a VKA or a NOAC from 22 August 2011 until 30 September 2016. We compared patient characteristics including age, gender, comorbidities, concomitant pharmacotherapy and CHA2DS2-VASc and HAS-BLED scores in patients initiated on a VKA, dabigatran, rivaroxaban or apixaban....... Differences were examined using multivariable logistic regression models. Results: The study population comprised 51 981 AF patients of whom 19 989 (38.5%) were initiated on a VKA, 13 242 (25.5%) on dabigatran, 8475 (16.3%) on rivaroxaban and 10 275 (19.8%) on apixaban. Those patients initiated on apixaban...

  3. Advances in Imaging for Atrial Fibrillation Ablation

    International Nuclear Information System (INIS)

    D'Silva, A.; Wright, M.; Wright, M.

    2011-01-01

    Over the last fifteen years, our understanding of the pathophysiology of atrial fibrillation (AF) has paved the way for ablation to be utilized as an effective treatment option. With the aim of gaining more detailed anatomical representation, advances have been made using various imaging modalities, both before and during the ablation procedure, in planning and execution. Options have flourished from procedural fluoroscopy, electro anatomic mapping systems, pre procedural computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and combinations of these technologies. Exciting work is underway in an effort to allow the electro physiologist to assess scar formation in real time. One advantage would be to lessen the learning curve for what are very complex procedures. The hope of these developments is to improve the likelihood of a successful ablation procedure and to allow more patients access to this treatment

  4. Aorto-right atrial fistula after Bentall repair.

    Science.gov (United States)

    Howard, Charles E; Velasco, Carlos E; Roullard, Christina P; Rafael, Aldo

    2017-07-01

    We describe a man with the Marfan syndrome and a prior ascending aortic aneurysm resection who presented with knee pain and concern of endocarditis. Transesophageal echocardiogram showed no vegetations, and computed tomography angiogram of the heart showed a possible pseudoaneurysm. Cardiac catheterization and aortogram revealed the diagnosis of an aorto-right atrial fistula, which was then operatively repaired. This case highlights the role that cardiac catheterization with aortogram can play in the detection of aorto-atrial fistula.

  5. YKL-40 levels and atrial fibrillation in the general population

    DEFF Research Database (Denmark)

    Marott, Sarah C W; Benn, Marianne; Johansen, Julia S

    2013-01-01

    BACKGROUND: Atrial fibrillation is associated with inflammation. In contrast to inflammatory markers like C-reactive protein (CRP) and fibrinogen produced in the liver, YKL-40 is produced at the site of inflammation including in the myocardium. We hypothesized that elevated plasma YKL-40 levels a...... individuals from the cross-sectional Copenhagen General Population Study including 337 cases with atrial fibrillation. A YKL-40 level >95% percentile (>204μg/L) versus 95% percentile versus...

  6. Late bacterial endocarditis of an Amplatzer atrial septal device

    Directory of Open Access Journals (Sweden)

    Bhavith Aruni

    2013-07-01

    Full Text Available A 59-year-old male with an secundum atrial septal defect status post repair with an Amplatzer occluder in 2001 was admitted with sepsis and MRSA bacteremia. Transesophageal Echocardiography (TEE showed presence of an overlying mobile echogenic structure on the left atrial surface of the device suggestive of a vegetation/infected thrombus. This is only the 3rd case description of late endocarditis involving the Amplatzer ASD closure device in an adult.

  7. [Risk and benefit of oral anticoagulants in atrial fibrillation].

    Science.gov (United States)

    Zotova, I V; Zateĭshchikov, D A

    2011-01-01

    Thromboembolism is the main cause of death and disability of patients with atrial fibrillation. Indirect anticoagulants are effective means of primary and secondary prevention of thromboembolic complications. However in a number of patients risk associated with therapy with indirect anticoagulants might exceed potential benefit. The principle problem requiring solution in a patient with atrial fibrillation is individual comparative assessment of risk of development of thromboembolic and hemorrhagic complications. Modern stratification scales which allow solving this problem are considered in this review.

  8. Vernakalant hydrochloride for the treatment of atrial fibrillation.

    Science.gov (United States)

    Kozlowski, Dariusz; Budrejko, Szymon; Lip, Gregory Y H; Mikhailidis, Dimitri P; Rysz, Jacek; Raczak, Grzegorz; Banach, Maciej

    2009-12-01

    Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Rhythm control strategy for AF is limited by drug toxicity and side effects, and recent trials have shown that this strategy is not superior to a rate control one. New antiarrhythmic drugs, free of undesired effects, would enhance rhythm control, with the possibility of sinus rhythm restoration and maintenance. A promising find in the search for new antiarrhythmic therapies is atrial-tissue specific ion channels. The findings that the ultrarapid delayed rectifier (I(Kur)) and the inwardly rectifying, acetylcholine-regulated current (I(K-Ach)) exist in atrial but not ventricular tissue increase the probability that atrioselective drugs without ventricular proarrhythmic toxicity can be developed for treatment of patients with AF. There are also other potential targets for atrial-selective therapy: transient outward current (I(to)), rapidly and slowly activating delayed rectifier currents (I(Kr) and I(Ks)), atrial sodium current (I(Na)) and atrially expressed connexins. New drugs under development with promising atrial-selectivity include: tertiapin, NIP-142, NIP-141, JTV-519, AVE0118, AVE1231, DPO-1, AZD7009 and many others. Among such new agents, vernakalant hydrochloride is currently in an advanced phase of development and has already been evaluated in clinical trials. In this overview, we describe the history and current state of developmental process of the drug, as well as its mechanism of action and influence on electrophysiological parameters. Vernakalant seems to be effective in terminating recent-onset AF, but is not efficacious in long-lasting AF and atrial flutter. The drug may be relatively free of proarrhythmic effects, and exerts a protective effect on ventricular tissue and ventricular repolarization. It is expected that the intravenous formulation will soon be approved for the pharmacological termination of recent-onset AF.

  9. Echocardiographic quantification of systolic function during atrial fibrillation

    DEFF Research Database (Denmark)

    Olsen, Flemming Javier; Jørgensen, Peter Godsk; Dons, Maria

    2016-01-01

    It is often difficult to provide an exact echocardiographic measure of left ventricular systolic function in patients with atrial fibrillation, partly because of the varying cycle length affecting pre and afterload and partly because of the increased heart rate often accompanying this arrhythmia....... We sought to elucidate two points: whether it would be possible to correct for the cyclic variance in systolic output, and if global longitudinal strain is preferable to the left ventricular ejection fraction at evaluating systolic function during atrial fibrillation....

  10. CUSTOS SOCIAIS E AMBIENTAIS E GRI: UMA ANÁLISE DAS EMPRESAS INTEGRANTES DO ÍNDICE DE SUSTENTABILIDADE EMPRESARIAL (ISE

    Directory of Open Access Journals (Sweden)

    Cecília Maria Medeiros Dantas de Melo

    2016-12-01

    Full Text Available A busca por políticas e metodologias eficientes do ponto de vista econômico e social faz parte da nova realidade das empresas, as quais têm procurado cada vez mais alinhar sua realidade produtiva às normas sociais e ambientais. O objetivo da pesquisa é analisar a evidenciação dos custos ambientais e sociais, à luz das diretrizes do GRI, pelos relatórios de sustentabilidade das empresas do ISE. Trata-se de uma pesquisa descritiva, de método dedutivo, documental e qualitativa, que utiliza a análise de conteúdo como método de análise dos dados. Os resultados apontam que a maioria das empresas estudadas apenas descrevem os riscos de suas atividades, sem informar os custos para mitigá-los. Verificou-se também que a redução de energia, a reutilização de água e a redução das emissões de gases de efeito estufa são melhorias na qualidade do desempenho ambiental decorrentes dos investimentos nessa área que propiciam a redução dos custos, associando-se, assim, à ecoeficiência. Através da análise dos indicadores LA2, LA6 e LA9, observou-se que grande parte das empresas investe em seus empregados, bem como controlam os acidentes ocorridos com esses. No que se refere aos impactos provocados na comunidade, algumas empresas afirmaram não possuir mecanismos para mensurá-los.

  11. Management of Atrio-Esophageal Fistula Following Left Atrial Ablation.

    Science.gov (United States)

    Yousuf, Tariq; Keshmiri, Hesam; Bulwa, Zachary; Kramer, Jason; Sharjeel Arshad, Hafiz Muhammad; Issa, Rasha; Woznicka, Daniel; Gordon, Paul; Abi-Mansour, Pierre

    2016-02-01

    Currently, no guidelines have been established for the treatment of atrio-esophageal fistula (AEF) secondary to left atrial ablation therapy. After comprehensive literature review, we aim to make suggestions on the management of this complex complication and also present a case series. We performed a review of the existing literature on AEF in the setting of atrial ablation. Using keywords atrial fibrillation, atrial ablation, fistula formation, atrio-esophageal fistula, complications, interventions, and prognosis, a search was made using the medical databases PUBMED and MEDLINE for reports in English from 2000 to April 2015. A statistical analysis was performed to compare the three different intervention arms: medical management, stent placement and surgical intervention. The results of our systematic review confirm the high mortality rate associated with AEF following left atrial ablation and the necessity to diagnose atrio-esophageal injury in a timely manner. The mortality rates of this complication are 96% with medical management alone, 100% with stent placement, and 33 % with surgical intervention. Atrio-esophageal injury and subsequent AEF is an infrequent but potentially fatal complication of atrial ablation. Early, prompt, and definitive surgical intervention is the treatment of choice.

  12. Variability of the Left Atrial Appendage in Human Hearts.

    Directory of Open Access Journals (Sweden)

    Rafał Kamiński

    Full Text Available Atrial fibrillation increases the risk of thrombus formation. It is commonly responsible for cerebral stroke whereas less frequently for pulmonary embolism. The aim of the study was to describe the morphology of the left atrial appendage in the human heart with respect to sex, age and weight. Macroscopic examination was carried out on 100 left appendages taken from the hearts of the patients aged 18-77, both sexes. All hearts preserved in 4% water solution of formaldehyde carried neither marks of coronary artery disease nor congenital abnormalities. Three axes of appendage orientation were performed. After the appendage had been cut off, morphological examination was performed in long and perpendicular axes. Measurements of the appendages were taken from anatomical specimens and their silicone casts. We classified the left atrial appendage into 4 morphological groups according to the number of lobes. Most left atrial appendages in female population were composed of 2 lobes. In the male group typically 2 or 3-lobed appendages were observed. The mean left atrial appendage orifice ranged from 12.0 to 16.0 mm and the most significant difference in the orifices between males and females was observed in LAA type 2 (about 3.3 mm. A smaller orifice and narrower, tubular shape of the LAA lobes could explain a higher risk of thrombus formation during nonvalvular atrial fibrillation in women. Knowledge of anatomical variability of the LAA helps diagnose some undefined echoes in the appendage during transesophageal echocardiographic examination.

  13. Balloon atrial septostomy under echocardiographic guide: case series

    Directory of Open Access Journals (Sweden)

    SM Meraji

    2012-12-01

    Full Text Available Background: Balloon atrial septostomy is an emergent procedure in pediatric cardiology. Nowadays, most patients in need of the procedure have acceptable outcomes after surgical repair. Thus, it is important to perform this procedure as safe as possible. By performing early arterial switch operation and prostaglandin infusion, the rate of balloon atrial septostomy has markedly decreased. However, not all centers performing early arterial switch repairs have abandoned atrial septostomy, even in patients who respond favorably to prostaglandin infusion.Case presentation: In total, eight 1- to 15-day old term neonates admitted in Shahid Rajaee Heart Center in Tehran, Iran from October 2009 to February 2011, with congenital heart diseases were scheduled for balloon atrial septostomy. In six cases the procedure was done exclusively under echocardiographic guidance and in two cases with the help of fluoroscopy. Success was defined as the creation of an atrial septal defect with a diameter equal to or more than 5 mm and ample mobility of its margins.Results: Male sex was predominant (87% and the mean age of the neonates was six days. The diagnosis in all cases was simple transposition of great arteries. The procedure was successful in all patients with any cardiovascular complication.Conclusion: Balloon atrial septostomy is an emergent procedure that can be done safely and effectively under echocardiographic guidance. According to the feasibility of this technique it could be performed fast, safe and effective at bedside, avoiding patient transportation to hemodynamic laboratory or referral center.

  14. Atrial fibrillation patients do not benefit from acetylsalicylic acid.

    Science.gov (United States)

    Själander, Sara; Själander, Anders; Svensson, Peter J; Friberg, Leif

    2014-05-01

    Oral anticoagulation is the recommended treatment for stroke prevention in patients with atrial fibrillation. Notwithstanding, many patients are treated with acetylsalicylic acid (ASA) as monotherapy. Our objective was to investigate if atrial fibrillation patients benefit from ASA as monotherapy for stroke prevention. Retrospective study of patients with a clinical diagnosis of atrial fibrillation between 1 July 2005 and 1 January 2009 in the National Swedish Patient register, matched with data from the National Prescribed Drugs register. Endpoints were ischaemic stroke, thrombo-embolic event, intracranial haemorrhage, and major bleeding. The study population consisted of 115 185 patients with atrial fibrillation, of whom 58 671 were treated with ASA as monotherapy and 56 514 were without any antithrombotic treatment at baseline. Mean follow-up was 1.5 years. Treatment with ASA was associated with higher risk of ischaemic stroke and thrombo-embolic events compared with no antithrombotic treatment. Acetylsalicylic acid as monotherapy in stroke prevention of atrial fibrillation has no discernable protective effect against stroke, and may even increase the risk of ischaemic stroke in elderly patients. Thus, our data support the new European guidelines recommendation that ASA as monotherapy should not be used as stroke prevention in atrial fibrillation.

  15. Atrial Septal Aneurysm with Right-to-Left Interatrial Shunting

    Science.gov (United States)

    Chidambaram, Mala; Mink, Steven; Sharma, Sat

    2003-01-01

    Interatrial shunting in the presence of an atrial septal aneurysm is an uncommon but well recognized abnormality. Previous case reports have demonstrated that elevated right atrial pressure secondary to pulmonary embolism or right ventricular infarction may cause right-to-left interatrial shunting in the presence of an atrial septal aneurysm. We describe a unique situation in which an atrial septal aneurysm was associated with a right-to-left shunt secondary to severe systemic hypotension and normal right atrial pressure. In this patient, we used midodrine, an oral alpha-1 agonist, to increase systemic arterial pressure, decrease the severity of the shunt, and treat the severe hypoxemia. This case establishes that right-to-left interatrial shunting can result from a decrease in left ventricular afterload with normal right atrial pressure. Oral alpha-1 agonist therapy can be used successfully to treat patients such as ours and possibly others with similar functional abnormalities. (Tex Heart Inst J 2003;30:68–70) PMID:12638676

  16. Fetal and neonatal atrial arrhythmias: an association with maternal diabetes and neonatal macrosomia.

    Science.gov (United States)

    Pike, J I; Krishnan, A; Kaltman, J; Donofrio, M T

    2013-12-01

    To determine if the incidence of maternal diabetes mellitus or neonatal macrosomia is more frequent in fetuses and neonates with atrial arrhythmias than the general population. Fetuses and neonates neonates with atrial flutter or ectopic atrial tachycardia were more likely to be macrosomic or be born to diabetic mothers than the general population. Postnatal echocardiography suggests that there may be abnormal diastolic left ventricular filling in some babies with these arrhythmias. Independent of ventricular hypertrophy, we speculate that isolated, non-recurrent fetal or neonatal atrial flutter, or ectopic atrial tachycardia may be caused by cardiac diastolic dysfunction and atrial stretch in utero. © 2013 John Wiley & Sons, Ltd.

  17. Automatic Detection of Atrial Fibrillation Using Basic Shannon Entropy of RR Interval Feature

    Science.gov (United States)

    Afdala, Adfal; Nuryani, Nuryani; Satriyo Nugroho, Anto

    2017-01-01

    Atrial Fibrillation is one of heart disease, that common characterized by irregularity heart beat. Atrial fibrillation leads to severe complications such as cardiac failure with the subsequent risk of a stroke. A method to detect atrial fibrillation is needed to prevent a risk of atrial fibrillation. This research uses data from physionet in atrial fibrillation database category. The performance of Shannon entropy has the highest accuracy if a threshold is 0.5 with accuracy 89.79%, sensitivity 91.04% and specificity 89.01%. Based on the result we get a conclusion, the ability of Shannon entropy to detect atrial fibrillation is good.

  18. Diretrizes para inserção de requisitos de eficiência energética no processo de projeto de aeroportos

    Directory of Open Access Journals (Sweden)

    Fernanda Selistre da Silva Scheidt

    Full Text Available Este artigo aborda a gestão de informação na etapa de projeto visando à consideração de requisitos de eficiência energética em projetos de obras complexas, relatando um estudo de caso em projeto de aeroportos. O atendimento aos requisitos de eficiência energética tende a aumentar ainda mais a complexidade do processo de desenvolvimento do produto (PDP na construção civil. Torna-se necessário, então, buscar instrumentos gerenciais que auxiliem o projetista a analisar as restrições e tradeoffs no PDP ao mesmo tempo em que se considere a agregação de mais valor ao produto, tanto sob o ponto de vista do cliente como do meio ambiente. A decisão de analisar o processo de projeto de aeroportos surgiu pelo fato de essas edificações serem caracterizadas pela complexidade e por apresentarem alto consumo energético e grande impacto ambiental. A partir de uma etapa de revisão bibliográfica, foram identificados os requisitos de eficiência energética a serem considerados na prática de projeto. O estudo teve sequência com a elaboração do macromapeamento do PDP, em um estudo de caso. Os resultados alcançados consistem na análise crítica do PDP e na identificação de oportunidades de inserção dos requisitos de eficiência energética no processo de projeto aeroportuário, considerando as falhas no fluxo de informação entre os agentes envolvidos. Por fim, são apresentadas diretrizes para a inserção dos requisitos de eficiência energética identificados a partir da revisão bibliográfica no processo de projetos de aeroportos.

  19. Effects of Atrial Fibrillation Cardioversion after Percutaneous Mitral Balloon Valvuloplasty on Echocardiographic Left and Right Atrial Functions

    OpenAIRE

    Morttada MD, Ayman; Ramzy MD, Aly; Khaled MD, Said; Ayoub MD, Amal; Samir MD, Sameh; Zaki MD, Hossam

    2016-01-01

    Amongst patients with mitral stenosis (MS), the most common complication is AF.Our study aimed at evaluating the effect of AF cardioversion after Percutaneous Mitral Balloon Valvuloplasty (PMBV) on echocardiographic atrial functions.

  20. APLICAÇÃO DAS NORMAS FEDERAIS DE EDUCAÇÃO AOS SISTEMAS DE ENSINO DOS ESTADOS FEDERADOS E DOS MUNICÍPIOS

    Directory of Open Access Journals (Sweden)

    Aristides Cimadon

    2014-05-01

    Full Text Available Este artigo procurou apresentar um estudo no sentido de clarificar de que forma se aplicam as normas federais de educação aos sistemas estaduais de ensino. Procurou-se fazer um estudo das competências dos Entes Federados no que se refere à educação e, à luz do Direito Educacional, por meio de análise sistemática, apresentou-se uma posição doutrinária a respeito da eficácia das normas federais nos sistemas de ensino dos Estados e dos Municípios, com o objetivo de orientar gestores e educadores nas decisões a respeito das normas de educação. É consabido que os sistemas de ensino, a partir do que determina a Constituição brasileira em seu artigo 211, seguindo a proposição republicana federativa, têm autonomia de competências desde que respeitada a legislação geral nacional determinada pela Lei de Diretrizes e Bases da Educação Nacional (Lei n. 9.394/96 (BRASIL, 1996. Palavras-chave: Educação. Ensino. Sistemas de ensino. Direito Educacional.

  1. Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source.

    Science.gov (United States)

    Sebasigari, Denise; Merkler, Alexander; Guo, Yang; Gialdini, Gino; Kummer, Benjamin; Hemendinger, Morgan; Song, Christopher; Chu, Antony; Cutting, Shawna; Silver, Brian; Elkind, Mitchell S V; Kamel, Hooman; Furie, Karen L; Yaghi, Shadi

    2017-06-01

    Biomarkers of atrial dysfunction or "cardiopathy" are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). This was a single-center retrospective study including all patients with ESUS undergoing 30 days of ambulatory heart-rhythm monitoring to look for AF between January 1, 2013 and December 31, 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was a new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in electrocardiogram (ECG) lead V1, and P wave - R wave (PR) interval on ECG. A multiple logistic regression model was used to assess the relationship between atrial biomarkers and AF detection. Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 years versus 61.4 years, P atrial diameter (39.2 mm versus 35.7 mm, P = .03). In a multivariable model, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; P = .04). Atrial biomarkers were weakly associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. Ensino da enfermagem psiquiátrica/saúde mental: sua interface com a Reforma Psiquiátrica e diretrizes curriculares nacionais La enseñanza de la enfermería psiquiátrica/salud mental: su conexión con la Reforma Psiquiátrica y las directrices curriculares nacionales Teaching psychiatric nursing/mental health: its interface with the Brazilian Psychiatric Reform and national curriculum guidelines

    Directory of Open Access Journals (Sweden)

    Josicelia Dumêt Fernandes

    2009-12-01

    Full Text Available Estudo teórico acerca do processo de formação em Enfermagem Psiquiátrica e Saúde Mental, frente às crescentes mudanças no mundo globalizado e seu acelerado processo de modernização científica e tecnológica. Objetiva discutir o fazer pedagógico no ensino da Enfermagem Psiquiátrica e Saúde Mental, e sua interface com os princípios da Reforma Psiquiátrica e das Diretrizes Curriculares Nacionais dos Cursos de Graduação em Enfermagem. Para sua sustentação teórica, adota como referência alguns construtos da Reforma Psiquiátrica e das Diretrizes Curriculares Nacionais do Curso de Graduação em Enfermagem, e sua relação com fatores constituintes do fazer pedagógico na Enfermagem Psiquiátrica e Saúde Mental. Evidencia que não basta apontar questões técnicas relativas a conteúdos e ensino, procedimentos didáticos, métodos e técnicas pedagógicas; é necessário superar desafios e implementar as mudanças, pautando-se numa nova perspectiva, e ousando colocar em questão a natureza do saber e das práticas institucionais psiquiátricas.Estudio teórico acerca del proceso de formación en Enfermería Psiquiátrica y Salud Mental, frente a los crecientes cambios en el mundo globalizado y su acelerado proceso de modernización científica y tecnológica. Objetiva discutir el quehacer pedagógico en la enseñanza de Enfermería Psiquiátrica y Salud Mental, y su conexión con los principios de la Reforma Psiquiátrica y de las Directrices Curriculares Nacionales de los Cursos de Graduación en Enfermería. Para su sustentación teórica, adopta como referencia algunos constructos de la Reforma Psiquiátrica y de las Directrices Curriculares Nacionales del Curso de Graduación en Enfermería, y su relación con factores constituyentes del quehacer pedagógico en la Enfermería Psiquiátrica y Salud Mental. Evidencia que no basta apuntar cuestiones técnicas relativas a contenidos y enseñanza, procedimientos didácticos, m

  3. Uso da radiofrequência bipolar para o tratamento da fibrilação atrial durante cirurgia cardíaca

    Directory of Open Access Journals (Sweden)

    Leonardo Secchin Canale

    2011-06-01

    Full Text Available FUNDAMENTO: O tratamento da fibrilação atrial com dispositivo de ablação de tecidos por radiofrequência bipolar em concomitância à cirurgia cardíaca tem se mostrado método eficaz no tratamento desta arritmia. OBJETIVO: Descrever a experiência inicial do Instituto Nacional de Cardiologia no tratamento cirúrgico da fibrilação atrial com uso de dispositivo de radiofrequência bipolar em pacientes submetidos à cirurgia cardíaca, relatando o resultado de acompanhamento pós-operatório de um ano. MÉTODOS: Entre janeiro de 2008 e março de 2009, 47 pacientes (36 mulheres consecutivos, com idade média de 53,7 ± 10,6 anos, apresentando fibrilação atrial por um período médio de 34,6 meses (3 a 192 meses foram submetidos à ablação cirúrgica desta arritmia, por radiofrequência bipolar, durante o procedimento que motivou a indicação da cirurgia. Oito apresentavam fibrilação atrial intermitente e 39, contínua. Oitenta e um por cento foram submetidos à cirurgia valvar como procedimento principal. Esta é uma análise retrospectiva, observacional, com avaliação de um ano de pós-operatório das variáveis clínicas e de Holter 24 h. RESULTADOS: Dos 47 pacientes, 40 sobreviveram um ano. Desses, 33 foram submetidos a Holter 24 h, em um intervalo médio de 401 dias após a cirurgia. Encontrou-se a seguinte distribuição de ritmos: 24 (73% sinusal, 5 (15% fibrilação atrial, três (9% Flutter atrial e um (3% ritmo juncional. Foram observados dois acidentes vasculares encefálicos, sendo um associado à arritmia supraventricular. CONCLUSÃO: A ablação cirúrgica de fibrilação atrial com dispositivo de radiofrequência bipolar concomitante à cirurgia cardíaca é método eficaz para o tratamento desta arritmia.

  4. Association of serum chemerin concentrations with the presence of atrial fibrillation.

    Science.gov (United States)

    Zhang, Guowei; Xiao, Mochao; Zhang, Lili; Zhao, Yue; Yang, Qinghui

    2017-05-01

    Objective Chemerin, a newly discovered adipokine, is correlated with hypertension, diabetes and coronary heart disease. The aim of this study is to investigate the association of serum chemerin concentrations with the presence of atrial fibrillation. Methods Serum chemerin concentrations were determined in 256 patients with atrial fibrillation and 146 healthy subjects. Atrial fibrillation patients were then divided into paroxysmal, persistent and permanent atrial fibrillation. Results Serum chemerin concentrations were significantly higher in atrial fibrillation patients compared with healthy controls. In subgroup studies, patients with permanent atrial fibrillation had higher serum chemerin concentrations than those with persistent and paroxysmal atrial fibrillation. Furthermore, significant higher serum chemerin concentrations were observed in persistent atrial fibrillation patients compared with paroxysmal atrial fibrillation subjects. Serum chemerin concentrations were associated with the presence of atrial fibrillation after logistic regression analysis. Pearson correlation analysis revealed a positive relation of serum chemerin concentrations with body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, low-density lipoprotein cholesterol, blood urea nitrogen, creatinine, C-reactive protein and left atrial diameter. Conclusion Serum chemerin concentrations are associated with the presence of atrial fibrillation and atrial remodelling.

  5. The antiarrhythmic peptide analog ZP123 prevents atrial conduction slowing during metabolic stress

    DEFF Research Database (Denmark)

    Haugan, Ketil; Olsen, Kristine Boisen; Hartvig, Line

    2005-01-01

    OBJECTIVE: As atrial conduction slowing is important in the pathogenesis of atrial reentry arrhythmias, a drug that increases atrial conduction or prevents atrial conduction slowing could serve to prevent atrial reentry arrhythmias. In this study, we investigated whether the novel stable antiarrh......OBJECTIVE: As atrial conduction slowing is important in the pathogenesis of atrial reentry arrhythmias, a drug that increases atrial conduction or prevents atrial conduction slowing could serve to prevent atrial reentry arrhythmias. In this study, we investigated whether the novel stable...... to a broad panel of 80 different cardiac and noncardiac ion channels and receptors and examined the effect of ZP123 on HERG channel conductance. RESULTS: ZP123 dose-dependently prevented metabolic stress-induced atrial CV slowing at doses ranging from 1 nM to 10 microM. ZP123 did not affect CV during...... physiological conditions nor did it affect dynamic CV restitution. ZP123 had no effect on atrial contractility. ZP123 showed no or low affinity binding to all ion channels and receptors examined. ZP123 had no effects on HERG channel activity in concentrations that affected atrial conduction. The concentration...

  6. Late Sodium Current in Human Atrial Cardiomyocytes from Patients in Sinus Rhythm and Atrial Fibrillation.

    Directory of Open Access Journals (Sweden)

    Claire Poulet

    Full Text Available Slowly inactivating Na+ channels conducting "late" Na+ current (INa,late contribute to ventricular arrhythmogenesis under pathological conditions. INa,late was also reported to play a role in chronic atrial fibrillation (AF. The objective of this study was to investigate INa,late in human right atrial cardiomyocytes as a putative drug target for treatment of AF. To activate Na+ channels, cardiomyocytes from transgenic mice which exhibit INa,late (ΔKPQ, and right atrial cardiomyocytes from patients in sinus rhythm (SR and AF were voltage clamped at room temperature by 250-ms long test pulses to -30 mV from a holding potential of -80 mV with a 100-ms pre-pulse to -110 mV (protocol I. INa,late at -30 mV was not discernible as deviation from the extrapolated straight line IV-curve between -110 mV and -80 mV in human atrial cells. Therefore, tetrodotoxin (TTX, 10 μM was used to define persistent inward current after 250 ms at -30 mV as INa,late. TTX-sensitive current was 0.27±0.06 pA/pF in ventricular cardiomyocytes from ΔKPQ mice, and amounted to 0.04±0.01 pA/pF and 0.09±0.02 pA/pF in SR and AF human atrial cardiomyocytes, respectively. With protocol II (holding potential -120 mV, pre-pulse to -80 mV TTX-sensitive INa,late was always larger than with protocol I. Ranolazine (30 μM reduced INa,late by 0.02±0.02 pA/pF in SR and 0.09±0.02 pA/pF in AF cells. At physiological temperature (37°C, however, INa,late became insignificant. Plateau phase and upstroke velocity of action potentials (APs recorded with sharp microelectrodes in intact human trabeculae were more sensitive to ranolazine in AF than in SR preparations. Sodium channel subunits expression measured with qPCR was high for SCN5A with no difference between SR and AF. Expression of SCN8A and SCN10A was low in general, and lower in AF than in SR. In conclusion, We confirm for the first time a TTX-sensitive current (INa,late in right atrial cardiomyocytes from SR and AF patients at room

  7. Diretrizes para prevenção de manifestações patológicas em Habitações de Interesse Social

    Directory of Open Access Journals (Sweden)

    Carolina Lemos Carraro

    Full Text Available Os programas habitacionais do governo visam combater o déficit brasileiro que gira em torno de sete milhões de habitações. A preocupação quantitativa, nem sempre articulada com políticas urbanas e sociais, incentiva a produção de conjuntos habitacionais com soluções urbanísticas, arquitetônicas e construtivas repetitivas em larga escala. Diante desta realidade preocupante, o presente estudo visa contribuir para melhorar a qualidade construtiva de empreendimentos habitacionais de interesse social e diminuir o impacto ambiental causado pela sua degradação prematura. A abordagem metodológica adotada foi estudo de caso exploratório. Foi realizada uma investigação das manifestações patológicas no conjunto habitacional Jardim das Palmeiras, situado na cidade de Uberlândia-MG. Neste empreendimento, o sistema construtivo e materiais empregados eram tradicionais, representando as tecnologias típicas da indústria da construção brasileira. As principais contribuições do trabalho referem-se às possíveis origens das manifestações patológicas e à retroalimentação para processo de projeto, gestão da construção e utilização das habitações de interesse social.

  8. Screening for atrial fibrillation in Canadian pharmacies: an economic evaluation.

    Science.gov (United States)

    Tarride, Jean-Eric; Dolovich, Lisa; Blackhouse, Gordon; Guertin, Jason Robert; Burke, Natasha; Manja, Veena; Grinvalds, Alex; Lim, Ting; Healey, Jeff S; Sandhu, Roopinder K

    2017-08-22

    Screening for undiagnosed atrial fibrillation may lead to treatment with oral anticoagulation therapy, which can decrease the risk of ischemic stroke. The objective of this study was to conduct an economic evaluation of the Program for the Identification of 'Actionable' Atrial Fibrillation in the Pharmacy Setting (PIAAF-Pharmacy), which screened 1145 participants aged 65 years or more at 30 community pharmacies in Ontario and Alberta between October 2014 and April 2015. We used a 2-part decision model to evaluate the short- and long-term costs and quality-adjusted life-years (QALYs) of a pharmacy screening program for atrial fibrillation compared to no screening. Data from the PIAAF-Pharmacy study were used for the short-term model, and the relevant literature was used to extrapolate the benefits of the PIAAF-Pharmacy study in the long-term model. Costs and QALYs were calculated from a payer perspective over a lifetime horizon and were discounted at 1.5%/year. Screening for atrial fibrillation in pharmacies was associated with higher costs ($26) and more QALYs (0.0035) compared to no screening, yielding an incremental cost per QALY gained of $7480. Univariate and probabilistic sensitivity analyses confirmed that screening for atrial fibrillation in a pharmacy setting was a cost-effective strategy. Our results support screening for atrial fibrillation in Canadian pharmacies. Given this finding, efforts should be made by provincial governments and pharmacies to implement such programs in Canada. The addition of atrial fibrillation screening alongside screening and management of other cardiovascular conditions may help to reduce the burden of stroke. Copyright 2017, Joule Inc. or its licensors.

  9. Catheter Ablation for Long-Standing Persistent Atrial Fibrillation.

    Science.gov (United States)

    Romero, Jorge; Gianni, Carola; Di Biase, Luigi; Natale, Andrea

    2015-01-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major burden to health care systems. Atrial fibrillation is associated with a 4- to 5-fold increased risk of thromboembolic stroke. The pulmonary veins have been identified as major sources of atrial triggers for AF. This is particularly true in patients with paroxysmal AF but not always the case for those with long-standing persistent AF (LSPAF), in which other locations for ectopic beats have been well recognized. Structures with foci triggering AF include the coronary sinus, the left atrial appendage (LAA), the superior vena cava, the crista terminalis, and the ligament of Marshall. More than 30 studies reporting results on radiofrequency ablation of LSPAF have been published to date. Most of these are observational studies with very different methodologies using different strategies. As a result, there has been remarkable variation in short- and long-term success, which suggests that the optimal ablation technique for LSPAF is still to be elucidated. In this review we discuss the different approaches to LSPAF catheter ablation, starting with pulmonary vein isolation (PVI) through ablation lines in different left atrial locations, the role of complex fractionated atrial electrograms, focal impulses and rotor modulation, autonomic modulation (ganglionated plexi), alcohol ablation, and the future of epicardial mapping and ablation for this arrhythmia. A stepwise ablation approach requires several key ablation techniques, such as meticulous PVI, linear ablation at the roof and mitral isthmus, electrogram-targeted ablation with particular attention to triggers in the coronary sinus and LAA, and discretionary right atrial ablation (superior vena cava, intercaval, or cavotricuspid isthmus lines).

  10. Clustering of RR intervals predicts effective electrical cardioversion for atrial fibrillation

    NARCIS (Netherlands)

    Van den Berg, MP; Van Noord, T; Brouwer, J; Haaksma, J; Van Veldhuisen, DJ; Crijns, HJGM; Van Gelder, IC

    Electrical Cardioversion for Atrial Fibrillation. Introduction: Atrial fibrillation (AF) is characterized by an irregularly irregular ("random") heart beat. However, controversy exists whether the ventricular rhythm in AF is truly random. We investigated randomness by constructing three-dimensional

  11. Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation

    DEFF Research Database (Denmark)

    Raatikainen, M J Pekka; Hakalahti, Antti; Uusimaa, Paavo

    2015-01-01

    BACKGROUND: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) is a randomized trial comparing radiofrequency catheter ablation (RFA) to antiarrhythmic drugs (AADs) as first-line treatment of paroxysmal atrial fibrillation (PAF). In order...

  12. Risk of atrial fibrillation as a function of the electrocardiographic PR interval

    DEFF Research Database (Denmark)

    Nielsen, Jonas Bille; Pietersen, Adrian; Graff, Claus

    2013-01-01

    Prolongation of the PR interval has been associated with an increased risk of incident atrial fibrillation (AF).......Prolongation of the PR interval has been associated with an increased risk of incident atrial fibrillation (AF)....

  13. Impaired autonomic function predicts dizziness at onset of paroxysmal atrial fibrillation

    NARCIS (Netherlands)

    van den Berg, MP; Hassink, RJ; Tuinenburg, AE; Lefrandt, JD; de Kam, PJ; Crijns, HJGM

    2001-01-01

    Background: Paroxysmal atrial fibrillation is associated with various symptoms, including dizziness, which presumably reflects hemodynamic deterioration. Given the importance of the autonomic nervous system in mitigating the hemodynamic effect of atrial fibrillation, we hypothesized that autonomic

  14. A randomized study of the effects of exercise training on patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Osbak, Philip Samuel; Mourier, Malene; Kjaer, Andreas

    2011-01-01

    Exercise training is beneficial in ischemic and congestive heart disease. However, the effect on atrial fibrillation (AF) is unknown.......Exercise training is beneficial in ischemic and congestive heart disease. However, the effect on atrial fibrillation (AF) is unknown....

  15. Das Gupta, Prof. Chanchal Kumar

    Indian Academy of Sciences (India)

    Elected: 1998 Section: General Biology. Das Gupta, Prof. Chanchal Kumar Ph.D. (Calcutta), FNASc, FNA. Date of birth: 9 November 1945. Specialization: Genetic Recombination and Protein Folding Address: EE-72/2, Sector II, Salt Lake, Kolkata 700 091, W.B.. Contact: Residence: (033) 4006 5279. Mobile: 90078 89857

  16. Das "Al-Capone"-Prinzip

    OpenAIRE

    Wirtz, Georg

    2006-01-01

    Das "Al-Capone"-Prinzip : Risiken u. Chancen e. "Gewinnabschöpfung durch Besteuerung" nach d. Steuerverkürzungsbekämpfungsgesetz. - Baden-Baden : Nomos-Verl.-Ges., 2006. - 300 S. - (Schriftenreihe zum deutschen, europäischen und internationalen Wirtschaftsstrafrecht ; 3). - Zugl.: Augsburg, Univ., Diss., 2005

  17. Ashok Jhunjhunwala and Das Gupta

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Ashok Jhunjhunwala and Das Gupta. Is there a cost effective solution for connectivity in the NE. Is there an Innovative Business model. Is there a national solution with satellites which can benefit NE.

  18. Aortic stiffness in lone atrial fibrillation: a novel risk factor for arrhythmia recurrence.

    Directory of Open Access Journals (Sweden)

    Dennis H Lau

    Full Text Available BACKGROUND: Recent community-based research has linked aortic stiffness to the development of atrial fibrillation. We posit that aortic stiffness contributes to adverse atrial remodeling leading to the persistence of atrial fibrillation following catheter ablation in lone atrial fibrillation patients, despite the absence of apparent structural heart disease. Here, we aim to evaluate aortic stiffness in lone atrial fibrillation patients and determine its association with arrhythmia recurrence following radio-frequency catheter ablation. METHODS: We studied 68 consecutive lone atrial fibrillation patients who underwent catheter ablation procedure for atrial fibrillation and 50 healthy age- and sex-matched community controls. We performed radial artery applanation tonometry to obtain central measures of aortic stiffness: pulse pressure, augmentation pressure and augmentation index. Following ablation, arrhythmia recurrence was monitored at months 3, 6, 9, 12 and 6 monthly thereafter. RESULTS: Compared to healthy controls, lone atrial fibrillation patients had significantly elevated peripheral pulse pressure, central pulse pressure, augmentation pressure and larger left atrial dimensions (all P<0.05. During a mean follow-up of 2.9±1.4 years, 38 of the 68 lone atrial fibrillation patients had atrial fibrillation recurrence after initial catheter ablation procedure. Neither blood pressure nor aortic stiffness indices differed between patients with and without atrial fibrillation recurrence. However, patients with highest levels (≥75(th percentile of peripheral pulse pressure, central pulse pressure and augmentation pressure had higher atrial fibrillation recurrence rates (all P<0.05. Only central aortic stiffness indices were associated with lower survival free from atrial fibrillation using Kaplan-Meier analysis. CONCLUSION: Aortic stiffness is an important risk factor in patients with lone atrial fibrillation and contributes to higher atrial

  19. Left Atrial Myxoma Following Coronary Artery Bypass Grafting with Patient Coronary Arterial Grafts: a Rarity.

    Science.gov (United States)

    Patel, Kartik; Rahul, Kumar; Tarsaria, Malkesh; Malhotra, Amber

    2017-01-01

    The development of left atrial myxoma after coronary artery bypass graft surgery is a rare entity. A 60-year-old man with previous off-pump coronary artery bypass grafting four years ago with patent coronary grafts was diagnosed with left atrial mass. The patient underwent successful resection of the same through minimally invasive right anterolateral thoracotomy. Histopathology of the atrial mass confirmed the diagnosis of atrial myxoma.

  20. Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation

    DEFF Research Database (Denmark)

    Nielsen, Jens Cosedis; Johannessen, Arne; Raatikainen, Pekka

    2016-01-01

    OBJECTIVE: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial compared radiofrequency catheter ablation (RFA) with antiarrhythmic drug therapy (AAD) as first-line treatment for paroxysmal atrial fibrillation (AF). Endpoint of ablat......OBJECTIVE: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial compared radiofrequency catheter ablation (RFA) with antiarrhythmic drug therapy (AAD) as first-line treatment for paroxysmal atrial fibrillation (AF). Endpoint...

  1. Atrial arrhythmia in ageing spontaneously hypertensive rats: unraveling the substrate in hypertension and ageing.

    Directory of Open Access Journals (Sweden)

    Dennis H Lau

    Full Text Available BACKGROUND: Both ageing and hypertension are known risk factors for atrial fibrillation (AF although the pathophysiological contribution or interaction of the individual factors remains poorly understood. Here we aim to delineate the arrhythmogenic atrial substrate in mature spontaneously hypertensive rats (SHR. METHODS: SHR were studied at 12 and 15 months of age (n = 8 per group together with equal numbers of age-matched normotensive Wistar-Kyoto control rats (WKY. Electrophysiologic study was performed on superfused isolated right and left atrial preparations using a custom built high-density multiple-electrode array to determine effective refractory periods (ERP, atrial conduction and atrial arrhythmia inducibility. Tissue specimens were harvested for structural analysis. RESULTS: COMPARED TO WKY CONTROLS, THE SHR DEMONSTRATED: Higher systolic blood pressure (p<0.0001, bi-atrial enlargement (p<0.05, bi-ventricular hypertrophy (p<0.05, lower atrial ERP (p = 0.008, increased atrial conduction heterogeneity (p = 0.001 and increased atrial interstitial fibrosis (p = 0.006 & CD68-positive macrophages infiltration (p<0.0001. These changes resulted in higher atrial arrhythmia inducibility (p = 0.01 and longer induced AF episodes (p = 0.02 in 15-month old SHR. Ageing contributed to incremental bi-atrial hypertrophy (p<0.01 and atrial conduction heterogeneity (p<0.01 without affecting atrial ERP, fibrosis and arrhythmia inducibility. The limited effect of ageing on the atrial substrate may be secondary to the reduction in CD68-positive macrophages. CONCLUSIONS: Significant atrial electrical and structural remodeling is evident in the ageing spontaneously hypertensive rat atria. Concomitant hypertension appears to play a greater pathophysiological role than ageing despite their compounding effect on the atrial substrate. Inflammation is pathophysiologically linked to the pro-fibrotic changes in the hypertensive atria.

  2. Impacto das tecnologias educativas no controle da asma: uma revisão sistemática da literatura

    Directory of Open Access Journals (Sweden)

    Andrea Edwiges Pinheiro de Menezes Barreto

    2015-12-01

    Full Text Available O estudo apresenta uma revisão de literatura sobre o controle da asma em crianças, demonstrando as principais tecnologias educativas utilizadas no controle dessa patologia. O objetivo geral do estudo consiste em conhecer quais as tecnologias educativas e qual impacto essas tecnologias causam no tratamento e controle da asma. Dentre os objetivos específicos do estudo destaca-se a possibilidade de garantir informações necessárias aos profissionais de saúde e pacientes, tais como, o reconhecimento de sinais, sintomas e fatores agravantes e como evitá-los. Foi utilizado revisão de literatura nacional e internacional, selecionando artigos publicados nos últimos dez anos, incluindo diretrizes, periódicos e editoriais. O estudo garante a importância da padronização de aplicação educacional que leve a racionalização dos itens abordados, facilitando o reconhecimento das dificuldades dos pacientes, além de melhora na transferência de conhecimento pelo profissional de saúde ao paciente, e conscientização das intervenções necessárias. Dessa maneira, garante orientações de ações possíveis de realizar com controle da asma, e consequentemente, com melhora significativa na qualidade de vida, diminuição da morbidade e diminuição da mortalidade das crianças com essa patologia.

  3. Relação entre conteúdos das disciplinas de curso de odontologia e os ENADE 2004/2010

    Directory of Open Access Journals (Sweden)

    Luiz Roberto Augusto Noro

    Full Text Available Resumo: O Sistema Nacional de Avaliação do Ensino Superior tem como objetivo acompanhar os cursos de graduação, permitindo que adequações sejam realizadas, sendo um de seus componentes o Exame Nacional de Desempenho do Estudante (ENADE. O objetivo do estudo foi comparar as questões ¬das provas dos ENADE 2004 e 2010 com os conteúdos das disciplinas do Curso de Odontologia da UFRN a partir da percepção de alunos concluintes e professores. Para consolidação das respostas as disciplinas foram identificadas a partir dos conteúdos previstos nas Diretrizes Curriculares Nacionais classificados em ciências básicas, saúde coletiva, propedêutica clínica e clínica odontológica. Observou-se desarticulação entre ciclo básico e ciclo profissionalizante, uma vez que os alunos sinalizaram nas respostas que não há coerência entre a extensa carga horária das disciplinas básicas e os conteúdos abordados sobre estas no ENADE. Uma das limitações para avanço nesta articulação é o isolamento destas disciplinas em Departamentos e Centros de Ciências sem articulação, os quais contribuem para a fragmentação do ensino em disciplinas isoladas e descontextualizadas, situação presente em várias instituições de ensino superior no Brasil. Para transformação desta situação é fundamental a autoavaliação constante que viabilize empoderamento aos atores diretamente envolvidos e interessados em um ensino superior de qualidade.

  4. Identifying future research priorities using value of information analyses: left atrial appendage occlusion devices in atrial fibrillation.

    Science.gov (United States)

    Micieli, Andrew; Bennell, Maria C; Pham, Ba'; Krahn, Murray; Singh, Sheldon M; Wijeysundera, Harindra C

    2014-09-16

    Left atrial appendage occlusion devices are cost effective for stroke prophylaxis in atrial fibrillation when compared with dabigatran or warfarin. We illustrate the use of value-of-information analyses to quantify the degree and consequences of decisional uncertainty and to identify future research priorities. A microsimulation decision-analytic model compared left atrial appendage occlusion devices to dabigatran or warfarin in atrial fibrillation. Probabilistic sensitivity analysis quantified the degree of parameter uncertainty. Expected value of perfect information analyses showed the consequences of this uncertainty. Expected value of partial perfect information analyses were done on sets of input parameters (cost, utilities, and probabilities) to identify the source of the greatest uncertainty. One-way sensitivity analyses identified individual parameters for expected value of partial perfect information analyses. Population expected value of perfect information and expected value of partial perfect information provided an upper bound on the cost of future research. Substantial uncertainty was identified, with left atrial appendage occlusion devices being preferred in only 47% of simulations. The expected value of perfect information was $8542 per patient and $227.3 million at a population level. The expected value of partial perfect information for the set of probability parameters represented the most important source of uncertainty, at $6875. Identified in 1-way sensitivity analyses, the expected value of partial perfect information for the odds ratio for stroke with left atrial appendage occlusion compared with warfarin was calculated at $7312 per patient or $194.5 million at a population level. The relative efficacy of stroke reduction with left atrial appendage occlusion devices in relation to warfarin is an important source of uncertainty. Improving estimates of this parameter should be the priority for future research in this area. © 2014 The Authors

  5. ABO blood groups: A risk factor for left atrial and left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation.

    Science.gov (United States)

    Fu, Yuan; Li, Kuibao; Yang, Xinchun

    2017-08-01

    Previous studies have identified ABO blood groups as predictors of thromboembolic diseases. In patients with atrial fibrillation (AF), however, potential association between ABO blood groups and the risk of left atrial (LA) and/or left atrial appendage (LAA) thrombogenic milieu (TM) has not been established. This is a retrospective case-control study that included 125 consecutive patients with non-valvular atrial fibrillation (NVAF) plus TM, as evidenced by transesophageal echocardiography (TEE) during a period from1 January 2010 to 31 December 2016. The controls were selected randomly from 1072 NVAF without TM at a 1:2 ratio. Potential association between ABO blood groups and TM was analyzed using multivariate logistic regression analysis. The risk of TM was higher in patients with blood group A (33.6% vs. 20.2% in non-A blood groups, P=0.005). After adjusting for age, sex, oral anticoagulant use, AF type and duration, and relevant functional measures (e.g., NT-pro BNP level, left atrium diameter, and left ventricular ejection fraction), blood group A remained associated with an increased risk of TM (OR=2.99, 95% CI 1.4-6.388, P=0.005). Blood group A is an independent risk factor for TM in NVAF patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Atrial fibrillation and heart failure in cardiology practice: reciprocal impact and combined management from the perspective of atrial fibrillation: results of the Euro Heart Survey on atrial fibrillation

    NARCIS (Netherlands)

    Nieuwlaat, Robby; Eurlings, Luc W.; Cleland, John G.; Cobbe, Stuart M.; Vardas, Panos E.; Capucci, Alessandro; López-Sendòn, José L.; Meeder, Joan G.; Pinto, Yigal M.; Crijns, Harry J. G. M.

    2009-01-01

    OBJECTIVES: Our aim was to identify shortcomings in the management of patients with both atrial fibrillation (AF) and heart failure (HF). BACKGROUND: AF and HF often coincide in cardiology practice, and they are known to worsen each other's prognosis, but little is known about the quality of care of

  7. Left atrial function in heart failure with impaired and preserved ejection fraction.

    Science.gov (United States)

    Fang, Fang; Lee, Alex Pui-Wai; Yu, Cheuk-Man

    2014-09-01

    Left atrial structural and functional changes in heart failure are relatively ignored parts of cardiac assessment. This review illustrates the pathophysiological and functional changes in left atrium in heart failure as well as their prognostic value. Heart failure can be divided into those with systolic dysfunction and heart failure with preserved ejection fraction (HFPEF). Left atrial enlargement and dysfunction commonly occur in systolic heart failure, in particular, in idiopathic dilated cardiomyopathy. Atrial enlargement and dysfunction also carry important prognostic value in systolic heart failure, independently of known parameters such as left ventricular ejection fraction. In HFPEF, there is evidence of left atrial enlargement, impaired atrial compliance, and reduction of atrial pump function. This occurs not only at rest but also during exercise, indicating significant impairment of atrial contractile reserve. Furthermore, atrial dyssynchrony is common in HFPEF. These factors further contribute to the development of new onset or progression of atrial arrhythmias, in particular, atrial fibrillation. Left atrial function is an integral part of cardiac function and its structural and functional changes in heart failure are common. As changes of left atrial structure and function have different clinical implications in systolic heart failure and HFPEF, routine assessment is warranted.

  8. Increasing rate of atrial fibrillation from 2003 to 2011 in patients with ischaemic stroke

    DEFF Research Database (Denmark)

    Jespersen, S F; Christensen, L. M.; Christensen, A

    2015-01-01

    identified. Frequency analysis and linear regression were used to assess trends in atrial fibrillation diagnosis and oral anticoagulation therapy prescription. RESULTS: A total of 17.1% (n = 9482) of ischaemic stroke patients had atrial fibrillation. The relative frequency of atrial fibrillation increased...

  9. 77 FR 11121 - Scientific Information Request on Treatment of Atrial Fibrillation

    Science.gov (United States)

    2012-02-24

    ... Atrial Fibrillation AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Request for... scientific information submissions from manufacturers of atrial fibrillation medical devices. Scientific... effectiveness review of the evidence for the treatment of atrial fibrillation. The EHC Program is dedicated to...

  10. 78 FR 11207 - Clinical Study Designs for Surgical Ablation Devices for Treatment of Atrial Fibrillation...

    Science.gov (United States)

    2013-02-15

    ... Treatment of Atrial Fibrillation; Guidance for Industry and Food and Drug Administration Staff; Availability... Ablation Devices for Treatment of Atrial Fibrillation.'' This guidance provides FDA's recommendations on clinical trial designs for surgical ablation devices intended for the treatment of atrial fibrillation...

  11. Meta-analysis identifies six new susceptibility loci for atrial fibrillation

    NARCIS (Netherlands)

    Ellinor, Patrick T; Lunetta, Kathryn L; Albert, Christine M; Glazer, Nicole L; Ritchie, Marylyn D; Smith, Albert V; Arking, Dan E; Müller-Nurasyid, Martina; Krijthe, Bouwe P; Lubitz, Steven A; Bis, Joshua C; Chung, Mina K; Dörr, Marcus; Ozaki, Kouichi; Roberts, Jason D; Smith, J Gustav; Pfeufer, Arne; Sinner, Moritz F; Lohman, Kurt; Ding, Jingzhong; Smith, Nicholas L; Smith, Jonathan D; Rienstra, Michiel; Rice, Kenneth M; Van Wagoner, David R; Magnani, Jared W; Wakili, Reza; Clauss, Sebastian; Rotter, Jerome I; Steinbeck, Gerhard; Launer, Lenore J; Davies, Robert W; Borkovich, Matthew; Harris, Tamara B; Lin, Honghuang; Völker, Uwe; Völzke, Henry; Milan, David J; Hofman, Albert; Boerwinkle, Eric; Chen, Lin Y; Soliman, Elsayed Z; Voight, Benjamin F; Li, Guo; Chakravarti, Aravinda; Kubo, Michiaki; Tedrow, Usha B; Rose, Lynda M; Ridker, Paul M; Conen, David; Tsunoda, Tatsuhiko; Furukawa, Tetsushi; Sotoodehnia, Nona; Xu, Siyan; Kamatani, Naoyuki; Levy, Daniel; Nakamura, Yusuke; Parvez, Babar; Mahida, Saagar; Furie, Karen L; Rosand, Jonathan; Muhammad, Raafia; Psaty, Bruce M; Meitinger, Thomas; Perz, Siegfried; Wichmann, H-Erich; Witteman, Jacqueline C M; Kao, W H Linda; Kathiresan, Sekar; Roden, Dan M; Uitterlinden, Andre G; Rivadeneira, Fernando; McKnight, Barbara; Sjögren, Marketa; Newman, Anne B; Liu, Yongmei; Gollob, Michael H; Melander, Olle; Tanaka, Toshihiro; Stricker, Bruno H Ch; Felix, Stephan B; Alonso, Alvaro; Darbar, Dawood; Barnard, John; Chasman, Daniel I; Heckbert, Susan R; Benjamin, Emelia J; Gudnason, Vilmundur; Kääb, Stefan

    Atrial fibrillation is a highly prevalent arrhythmia and a major risk factor for stroke, heart failure and death. We conducted a genome-wide association study (GWAS) in individuals of European ancestry, including 6,707 with and 52,426 without atrial fibrillation. Six new atrial fibrillation

  12. Induction of heat shock response protects the heart against atrial fibrillation

    NARCIS (Netherlands)

    Brundel, Bianca J. J. M.; Shiroshita-Takeshita, Akiko; Qi, XiaoYan; Yeh, Yung-Hsin; Chartier, Denis; van Gelder, Isabelle C.; Henning, Robert H.; Kampinga, Harm H.; Nattel, Stanley

    2006-01-01

    There is evidence suggesting that heat shock proteins (HSPs) may protect against clinical atrial fibrillation (AF). We evaluated the effect of HSP induction in an in vitro atrial cell line (HL-1) model of tachycardia remodeling and in tachypaced isolated canine atrial cardiomyocytes. We also

  13. Rapid pacing results in changes in atrial but not in ventricular refractoriness

    NARCIS (Netherlands)

    Schoonderwoerd, BA; Van Gelder, IC; Tieleman, RG; Bel, KJ; Crijns, HJGM

    It is well known that atrial tachycardia causes atrial electrical remodeling, characterized by shortening of atrial effective refractory periods (AERPs) and loss of physiological adaptation of AERP to rate. However, the nature and time course of changes in ventricular effective refractory periods

  14. Herpes Simplex Virus Type 1 Infection Associated with Atrial Myxoma

    Science.gov (United States)

    Li, Yanwen; Pan, Zhigang; Ji, Yuan; Sheppard, Mary; Jeffries, Donald J.; Archard, Leonard C.; Zhang, Hongyi

    2003-01-01

    Some findings suggest an infectious factor in cardiac myxoma and certain histopathological features indicate herpes simplex virus type 1 (HSV-1) infection. We hypothesized that HSV-1 may be involved in the pathogenesis of cardiac myxoma. Paraffin-embedded tissue samples from 17 patients with atrial myxoma were investigated for HSV-1 antigen by immunohistochemistry and viral genomic DNA by nested polymerase chain reaction. The histogenesis and oncogenesis of atrial myxoma were assessed by the expression of calretinin, Ki67, and p53 protein, respectively. Autopsy myocardial samples, including endocardium from 12 patients who died by accident or other conditions, were used for comparison. HSV-1 antigen was detected in atrial myxoma from 12 of 17 patients: 8 of these 12 samples were positive also for HSV-1 DNA. No HSV-1 antigen or DNA was found in tissue from the comparison group. Antigens of HSV-2, varicella-zoster virus, Epstein-Barr virus, and cytomegalovirus were not found in atrial myxoma. Calretinin was found in myxoma cells of all 17 cases but Ki67 was present only in smooth muscle cells or infiltrating cells in some cases. p53 was not detectable in any myxoma. Most infiltrating cells were cytotoxic T lymphocytes. These data suggest that HSV-1 infection is associated with some cases of sporadic atrial myxoma and that these may result from a chronic inflammatory lesion of endocardium. PMID:14633612

  15. Managing atrial fibrillation in the elderly: critical appraisal of dronedarone

    Directory of Open Access Journals (Sweden)

    Trigo P

    2011-12-01

    Full Text Available Paula Trigo, Gregory W FischerDepartment of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USAAbstract: Atrial fibrillation is the most commonly seen arrhythmia in the geriatric population and is associated with increased cardiovascular morbidity and mortality. Treatment of the elderly with atrial fibrillation remains challenging for physicians, because this unique subpopulation is characterized by multiple comorbidities requiring chronic use of numerous medications, which can potentially lead to severe drug interactions. Furthermore, age-related changes in the cardiovascular system as well as other physiological changes result in altered drug pharmacokinetics. Dronedarone is a new drug recently approved for the treatment of arrhythmias, such as atrial fibrillation and/or atrial flutter. Dronedarone is a benzofuran amiodarone analog which lacks the iodine moiety and contains a methane sulfonyl group that decreases its lipophilicity. These differences in chemical structure are responsible for making dronedarone less toxic than amiodarone which, in turn, results in fewer side effects. Adverse events for dronedarone include gastrointestinal side effects and rash. No dosage adjustments are required for patients with renal impairment. However, the use of dronedarone is contraindicated in the presence of severe hepatic dysfunction.Keywords: atrial fibrillation, elderly, antiarrhythmic agents, amiodarone, dronedarone

  16. Ebstein's anomaly as a cause of paroxysmal atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Damjanović Miodrag R.

    2008-01-01

    Full Text Available Background. Ebstein's anomaly is characterized by a displacement of the tricuspid valve toward apex, because of anomalous attachment of the tricuspid leaflets. There are type B of Wolff-Parkinson-White (WPW syndrome and paroxysmal arrhythmias in more than a half of all patients. Case report. We presented a female, 32-year old, with frequent paroxysms of atrial fibrillation. After conversion of rhythm an ECG showed WPW syndrome. Echocardiographic examination discovered normal size of the left cardiac chambers with paradoxical ventricular septal motion. The right ventricle was very small because of its atrialization. The origin of the tricuspid valve was 20 mm closer to apex of the right ventricle than the origin of the mitral valve. Electrophysiological examination showed a posterolateral right accesorial pathway. Atrial fibrillation was induced very easily in electrophysiological laboratory and a successful ablation of accessorial pathway was made. There were no WPW syndrome and paroxysms of atrial fibrillation after that. Conclusion. Ebstein's anomaly is one of the reasons of paroxysmal atrial fibrillation, especially in young persons with WPW syndrome.

  17. Cryptogenic stroke: atrial fibrillation under indictment

    Directory of Open Access Journals (Sweden)

    Marcella Jorfida

    2009-06-01

    Full Text Available The stroke is the third cause of death and the main cause of disability in adults. 30% of ischaemic strokes are cryptogenic. Atrial Fibrillation (AF is a common disease, mainly among older patients (pts (9% of people over 80. AF is an indipendent risk factor for stroke, and 15% of ischaemic strokes are due to AF (25% in older people. The cardioembolic risk is determinated by duration of AF and comorbilities: high risk pts are identified by risk score scales, in order to define who needs anticoagulation. Identification of pts with AF, symptomatic or not, is mandatory to prevent thromboembolism. Thrombo - embolic complications of asymptomatic AF (half of episodes are asymptomatic are similar to symptomatic. Accuracy of methods for AF detection is higher if the monitored period is long, in particular for detection of asymptomatic AF. A careful identification of asymptomatic AF is mandatory to indicate the anticoagulation therapy in people with thromboembolic risk factor: in particular, pts with a previous stroke need to detect carefully potential arrhythmias in order to avoid relapses.

  18. Atrial fibrillation and risk of stroke

    DEFF Research Database (Denmark)

    Christiansen, Christine Benn; Gerds, Thomas A.; Olesen, Jonas Bjerring

    2016-01-01

    AIM: Although the relation between stroke risk factors and stroke in patients with atrial fibrillation (AF) has been extensively examined, only few studies have explored the association of AF and the risk of ischaemic stroke/systemic thromboembolism/transient ischaemic attack (stroke....../TE/TIA) in the presence of concomitant stroke risk factors. METHODS AND RESULTS: From nationwide registries, all persons who turned 50, 60, 70, or 80 from 1997 to 2011 were identified. Persons receiving warfarin were excluded. The absolute risk of stroke/TE/TIA was reported for a 5-year period, as was the absolute risk...... ratios for AF vs. no AF according to prior stroke and the number of additional risk factors. The study cohort comprised of 3 076 355 persons without AF and 48 189 with AF. For men aged 50 years, with no risk factors, the 5-year risk of stroke was 1.1% (95% confidence interval 1.1-1.1); with AF alone 2...

  19. Postoperative atrial fibrillation in liver transplantation.

    Science.gov (United States)

    Xia, V W; Worapot, A; Huang, S; Dhillon, A; Gudzenko, V; Backon, A; Agopian, V G; Aksoy, O; Vorobiof, G; Busuttil, R W; Steadman, R H

    2015-03-01

    Postoperative atrial fibrillation (POAF) is common after major surgeries and is associated with increased morbidity and mortality. POAF after liver transplantation (LT) has not been reported. This study was undertaken to investigate the incidence, impact, and risk factors of POAF in LT patients. After IRB approval, LT between January 2006 and August 2013 at our center were retrospectively reviewed. POAF that occurred within 30 days after LT was included. Patients with and without POAF were compared and independent risk factors were identified by logistic regression. Of 1387 adults LT patients, 102 (7.4%) developed POAF during the study period. POAF was associated with significantly increased mortality, graft failure, acute kidney injury and prolonged hospital stay. Independent risk factors included age, body weight, MELD score, presence of previous history of AF, the vasopressors use prior to LT and pulmonary artery diastolic pressure at the end of LT surgery (odds ratios 2.0-7.2, all p < 0.05). A risk index of POAF was developed and patients with the high-risk index had more than 60% chance of developing POAF. These findings may be used to stratify patients and to guide prophylaxis for POAF in the posttransplant period. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  20. Monitoring Atrial Fibrillation After Catheter Ablation.

    Science.gov (United States)

    Forleo, Giovanni B; Casella, Michela; Russo, Antonio Dello; Moltrasio, Massimo; Fassini, Gaetano; Tesauro, Manfredi; Tondo, Claudio

    2014-01-01

    Although catheter ablation is an effective treatment for recurrent atrial fibrillation (AF), there is no consensus on the definition of success or follow-up strategies. Symptoms are the major motivation for undergoing catheter ablation in patients with AF, however it is well known that reliance on perception of AF by patients after AF ablation results in an underestimation of recurrence of the arrhythmia. Because symptoms of AF occurrence may be misleading, a reliable assessment of rhythm outcome is essential for the definition of success in both clinical care and research trials. Continuous rhythm monitoring over long periods of time is superior to intermittent recording using external monitors to detect the presence of AF episodes and to quantify the AF burden. Today, new devices implanted subcutaneously using a minimally invasive technique have been developed for continuous AF monitoring. Implantable devices keep detailed information about arrhythmia recurrences and might allow identification of very brief episodes of AF, the significance of which is still uncertain. In particular, it is not known whether there is any critical value of daily AF burden that has a prognostic significance. This issue remains an area of active discussion, debate and investigation. Further investigation is required to determine if continuous AF monitoring with implantable devices is effective in reducing stroke risk and facilitating maintenance of sinus rhythm after AF ablation.

  1. Red Wine, Resveratrol and Atrial Fibrillation.

    Science.gov (United States)

    Stephan, Laura Siga; Almeida, Eduardo Dytz; Markoski, Melissa Medeiros; Garavaglia, Juliano; Marcadenti, Aline

    2017-10-30

    Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with increased risk for cardiovascular disease and overall mortality. Excessive alcohol intake is a well-known risk factor for AF, but this correlation is less clear with light and moderate drinking. Besides, low doses of red wine may acutely prolong repolarization and slow cardiac conduction. Resveratrol, a bioactive polyphenol found in grapes and red wine, has been linked to antiarrhythmic properties and may act as an inhibitor of both intracellular calcium release and pathological signaling cascades in AF, eliminating calcium overload and preserving the cardiomyocyte contractile function. However, there are still no clinical trials at all that prove that resveratrol supplementation leads to improved outcomes. Besides, no observational study supports a beneficial effect of light or moderate alcohol intake and a lower risk of AF. The purpose of this review is to briefly describe possible beneficial effects of red wine and resveratrol in AF, and also present studies conducted in humans regarding chronic red wine consumption, resveratrol, and AF.

  2. Imaging in percutaneous ablation for atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Maksimovic, Ruzica [Erasmus Medical Center, Department of Radiology, GD Rotterdam (Netherlands); Institute for Cardiovascular Diseases of the University Medical Center, Belgrade (Czechoslovakia); Dill, Thorsten [Kerckhoff-Heart Center, Department of Cardiology, Bad Nauheim (Germany); Ristic, Arsen D.; Seferovic, Petar M. [Institute for Cardiovascular Diseases of the University Medical Center, Belgrade (Czechoslovakia)

    2006-11-15

    Percutaneous ablation for electrical disconnection of the arrhythmogenic foci using various forms of energy has become a well-established technique for treating atrial fibrillation (AF). Success rate in preventing recurrence of AF episodes is high although associated with a significant incidence of pulmonary vein (PV) stenosis and other rare complications. Clinical workup of AF patients includes imaging before and after ablative treatment using different noninvasive and invasive techniques such as conventional angiography, transoesophageal and intracardiac echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI), which offer different information with variable diagnostic accuracy. Evaluation before percutaneous ablation involves assessment of PVs (PV pattern, branching pattern, orientation and ostial size) to facilitate position and size of catheters and reduce procedure time as well as examining the left atrium (presence of thrombi, dimensions and volumes). Imaging after the percutaneous ablation is important for assessment of overall success of the procedure and revealing potential complications. Therefore, imaging methods enable depiction of PVs and the anatomy of surrounding structures essential for preprocedural management and early detection of PV stenosis and other ablation-related procedures, as well as long-term follow-up of these patients. (orig.)

  3. Red Wine, Resveratrol and Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Laura Siga Stephan

    2017-10-01

    Full Text Available Atrial fibrillation (AF is a common cardiac arrhythmia that is associated with increased risk for cardiovascular disease and overall mortality. Excessive alcohol intake is a well-known risk factor for AF, but this correlation is less clear with light and moderate drinking. Besides, low doses of red wine may acutely prolong repolarization and slow cardiac conduction. Resveratrol, a bioactive polyphenol found in grapes and red wine, has been linked to antiarrhythmic properties and may act as an inhibitor of both intracellular calcium release and pathological signaling cascades in AF, eliminating calcium overload and preserving the cardiomyocyte contractile function. However, there are still no clinical trials at all that prove that resveratrol supplementation leads to improved outcomes. Besides, no observational study supports a beneficial effect of light or moderate alcohol intake and a lower risk of AF. The purpose of this review is to briefly describe possible beneficial effects of red wine and resveratrol in AF, and also present studies conducted in humans regarding chronic red wine consumption, resveratrol, and AF.

  4. Left atrial thrombus predicts transient ischemic attack in patients with atrial fibrillation.

    Science.gov (United States)

    Stoddard, Marcus F; Singh, Pradeep; Dawn, Buddhadeb; Longaker, Rita A

    2003-04-01

    Atrial fibrillation (AF) is widely accepted as a direct cause of cardioembolic stroke from left atrial (LA) thrombus formation. However, the relationship between LA thrombus and transient ischemic attack (TIA) in patients with AF is less well established. Two hundred sixty-one adult patients (mean age 66 +/- 11 years, 220 men and 41 women) with AF undergoing transesophageal echocardiography (TEE) were prospectively followed up for TIA (mean duration 30.3 +/- 20.6 months). LA thrombus was present in 18% (n = 46) and LA spontaneous echocardiographic contrast in 50% (n = 131) of the group. Nineteen of 261 patients had TIA during follow-up. Multivariate logistic regression showed congestive heart failure (CHF) as the only predictor of TIA when a model of clinical variables was constructed (odds ratio [OR] 2.7, P =.04). Age, sex, hypertension, and use of warfarin or aspirin were not predictors. When TEE variables were added to the model, LA thrombus became the only predictor of TIA (OR 7.7, P =.0001). Survival free of TIA (Kaplan-Meier) was significantly less (P =.0001) in patients with LA thrombus compared with those without, and the annual TIA event rate was 9.2% per year versus 1.9% per year (P likely thromboembolic mechanism for TIA from LA thrombus in patients with AF.

  5. Granger Causality and Jensen–Shannon Divergence to Determine Dominant Atrial Area in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Raquel Cervigón

    2018-01-01

    Full Text Available Atrial fibrillation (AF is already the most commonly occurring arrhythmia. Catheter pulmonary vein ablation has emerged as a treatment that is able to make the arrhythmia disappear; nevertheless, recurrence to arrhythmia is very frequent. In this study, it is proposed to perform an analysis of the electrical signals recorded from bipolar catheters at three locations, pulmonary veins and the right and left atria, before to and during the ablation procedure. Principal Component Analysis (PCA was applied to reduce data dimension and Granger causality and divergence techniques were applied to analyse connectivity along the atria, in three main regions: pulmonary veins, left atrium (LA and right atrium (RA. The results showed that, before the procedure, patients with recurrence in the arrhythmia had greater connectivity between atrial areas. Moreover, during the ablation procedure, in patients with recurrence in the arrhythmial both atria were more connected than in patients that maintained sinus rhythms. These results can be helpful for procedures designing to end AF.

  6. Mixossarcoma atrial esquerdo: relato de caso Left atrial myxosarcoma: case report

    Directory of Open Access Journals (Sweden)

    Vinicius José da Silva Nina

    2006-03-01

    Full Text Available O mixossarcoma é uma forma rara de neoplasia cardíaca primária de difícil diferenciação clínica e patológica com o mixoma. Até onde os autores têm conhecimento, este é o primeiro relato de caso na literatura nacional indexada com o tratamento cirúrgico do mixossarcoma atrial esquerdo, em paciente do sexo feminino, de 36 anos de idade, cuja evolução pós-operatória tem sido satisfatória, encontrando-se em classe funcional I (NYHA e em remissão do processo tumoral há mais de 180 dias.Primary cardiac myxosarcoma is a very rare disease and is difficult to differentiate from myxoma, both clinically and pathologically. In this study, the authors report the first case of surgical excision of left atrial myxosarcoma in Brazil, in a 36-year-old woman. The operation was sucessful, and the patient remains asymptomatic for more than 180 postoperative days (Functional Class I - NYHA, with no signs of relapse of the tumor.

  7. Multimodality Cardiac Imaging for the Assessment of Left Atrial Function and the Association With Atrial Arrhythmias

    DEFF Research Database (Denmark)

    Olsen, Flemming Javier; Bertelsen, Litten; de Knegt, Martina Chantal

    2016-01-01

    Several cardiac imaging modalities are able to visualize the left atrium (LA) and, therefore, allow for quantification of both structural and functional properties of this cardiac chamber. In echocardiography, only the maximal LA volume is included in the assessment of diastolic function at the c......Several cardiac imaging modalities are able to visualize the left atrium (LA) and, therefore, allow for quantification of both structural and functional properties of this cardiac chamber. In echocardiography, only the maximal LA volume is included in the assessment of diastolic function...... atrial fibrillation, which will be a point of focus in this review. Pivotal cardiac magnetic resonance imaging studies have revealed high correlation between LA fibrosis and risk of atrial fibrillation recurrence after catheter ablation, and subsequent multimodality imaging studies have uncovered...... an inverse relationship between LA reservoir function and degree of LA fibrosis. This has sparked an increased interest into the application of advanced imaging modalities, including both speckle tracking echocardiography and tissue tracking by cardiac magnetic resonance imaging. Even though increasing...

  8. Diretrizes para prevenção e tratamento da osteoporose induzida por glicocorticoide Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis

    Directory of Open Access Journals (Sweden)

    Rosa Maria Rodrigues Pereira

    2012-08-01

    Full Text Available Os glicocorticoides (GC são prescritos por praticamente todas as especialidades médicas, e cerca de 0,5% da população geral do Reino Unido utiliza esses medicamentos. Com o aumento da sobrevida dos pacientes com doenças reumatológicas, a morbidade secundária ao uso dessa medicação representa um aspecto importante que deve ser considerado no manejo de nossos pacientes. As incidências de fraturas vertebrais e não vertebrais são elevadas, variando de 30%-50% em pessoas que usam GC por mais de três meses. Assim, a osteoporose e as fraturas por fragilidade devem ser prevenidas e tratadas em todos os pacientes que iniciarão ou que já estejam em uso desses esteroides. Diversas recomendações elaboradas por várias sociedades internacionais têm sido descritas na literatura, porém não há consenso entre elas. Recentemente, o Americam College of Rheumatology publicou novas recomendações, porém elas são fundamentadas na FRAX (WHO Fracture Risk Assessment Tool para analisar o risco de cada indivíduo e, dessa maneira, não podem ser completamente utilizadas pela população brasileira. Dessa forma, a Comissão de Osteoporose e Doenças Osteometabólicas da Sociedade Brasileira de Reumatologia, em conjunto com a Associação Médica Brasileira e a Associação Brasileira de Medicina Física e Reabilitação, implementou as diretrizes brasileiras de osteoporose induzida por glicocorticoide (OPIG, baseando-se na melhor evidência científica disponível e/ou experiência de experts. DESCRIÇÃO DO MÉTODO DE COLETA DE EVIDÊNCIA: A revisão bibliográfica de artigos científicos desta diretriz foi realizada na base de dados MEDLINE. A busca de evidência partiu de cenários clínicos reais, e utilizou as seguintes palavras-chave (MeSH terms: Osteoporosis, Osteoporosis/chemically induced*= (Glucocorticoids= Adrenal Cortex Hormones, Steroids, Glucocorticoids, Glucocorticoids/administration and dosage, Glucocorticoids/therapeutic use

  9. MRI for therapy planning in patients with atrial septum defects; MRT zur Therapieplanung bei Patienten mit Vorhofseptumdefekt

    Energy Technology Data Exchange (ETDEWEB)

    Huber, A.; Rummeny, E. [Klinikum rechts der Isar, Technische Universitaet Muenchen, Institut fuer Radiologie, Muenchen (Germany); Prompona, M.; Reiser, M.; Theisen, D. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Kozlik-Feldmann, R. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Klinik und Poliklinik fuer Kinderkardiologie, Muenchen (Germany); Muehling, O. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Medizinische Klinik I, Muenchen (Germany)

    2011-01-15

    The aim of this study was to determine the value of a combined magnetic resonance imaging (MRI) protocol including steady-state free precession (SSFP) imaging, phase-contrast measurements and contrast-enhanced MR angiography (CE-MRA) for presurgical or preinterventional diagnostic imaging in patients with suspected atrial septum defects. Out of 65 MRI studies of patients with suspected atrial septum defects, 56 patients were included in the study. The atrial septum defects were identified on cine images. Velocity encoded flow measurements were used to determine shunt volumes, which were compared with invasive oxymetry in 24 patients. Contrast-enhanced MRI was used to assess the thoracic vessels in order to detect vascular anomalies. The findings were compared with the intraoperative results. A total of 24 patients with high shunt volumes were treated either surgically (16 patients) or interventionally (8 patients) and 32 patients with low shunt volumes did not require surgical or interventional treatment. The vascular anomaly, which in all cases was anomalous pulmonary venous return, was confirmed by the intraoperative findings. The type and location of atrial septal defects which required treatment, were confirmed intraoperatively or during the intervention. The results of shunt quantification by MRI showed a good correlation with the results of invasive oximetry (r=0.91, p <0.0001). A combined MRI protocol including cine SSFP images, velocity-encoded flow measurements and CE-MRA is an accurate method for preoperative and preinterventional evaluation of atrial septum defects. (orig.) [German] Ziel war es, die Wertigkeit eines kombinierten MRT-Protokolls aus Funktionsuntersuchung, Flussmessung und MR-Angiographie zur praeoperativen oder -interventionellen Abklaerung bei Patienten mit Vorhofseptumdefekt zu evaluieren. Ingesamt wurden 56 Patienten mit Vorhofseptumdefekt aus einem Kollektiv von 65 Patienten mit Verdacht auf Vorhofseptumdefekt, die im MRT untersucht

  10. Low Energy Multi-Stage Atrial Defibrillation Therapy Terminates Atrial Fibrillation with Less Energy than a Single Shock

    Science.gov (United States)

    Li, Wenwen; Janardhan, Ajit H.; Fedorov, Vadim V.; Sha, Qun; Schuessler, Richard B.; Efimov, Igor R.

    2011-01-01

    Background Implantable device therapy of atrial fibrillation (AF) is limited by pain from high-energy shocks. We developed a low-energy multi-stage defibrillation therapy and tested it in a canine model of AF. Methods and Results AF was induced by burst pacing during vagus nerve stimulation. Our novel defibrillation therapy consisted of three stages: ST1 (1-4 low energy biphasic shocks), ST2 (6-10 ultra-low energy monophasic shocks), and ST3 (anti-tachycardia pacing). Firstly, ST1 testing compared single or multiple monophasic (MP) and biphasic (BP) shocks. Secondly, several multi-stage therapies were tested: ST1 versus ST1+ST3 versus ST1+ST2+ST3. Thirdly, three shock vectors were compared: superior vena cava to distal coronary sinus (SVC>CSd), proximal coronary sinus to left atrial appendage (CSp>LAA) and right atrial appendage to left atrial appendage (RAA>LAA). The atrial defibrillation threshold (DFT) of 1BP shock was less than 1MP shock (0.55 ± 0.1 versus 1.38 ± 0.31 J; p =0.003). 2-3 BP shocks terminated AF with lower peak voltage than 1BP or 1MP shock and with lower atrial DFT than 4 BP shocks. Compared to ST1 therapy alone, ST1+ST3 lowered the atrial DFT moderately (0.51 ± 0.46 versus 0.95 ± 0.32 J; p = 0.036) while a three-stage therapy, ST1+ST2+ST3, dramatically lowered the atrial DFT (0.19 ± 0.12 J versus 0.95 ± 0.32 J for ST1 alone, p=0.0012). Finally, the three-stage therapy ST1+ST2+ST3 was equally effective for all studied vectors. Conclusions Three-stage electrotherapy significantly reduces the AF defibrillation threshold and opens the door to low energy atrial defibrillation at or below the pain threshold. PMID:21980076

  11. Atrial Septal Aneurysm in Young and Middle Age Patients with A New Paroxysm of Atrial Fibrillation in Babylon Province

    Directory of Open Access Journals (Sweden)

    Oday Jasim Alsalihi

    2018-03-01

    Full Text Available  Background and Objectives:  Atrial fibrillation is one of the  most common atrial arrhythmia , it may be associated with alote of structural and  functional cardiac causes . The Aim of this study was to evaluate a possible causal relationship between ASA ( atrial septal aneurysm and the occurrence of paroxysmal AF in young and middle age patients , and reporting of  some other structural and pathological abnormality diagnosed by standard transthoracic echocardiography.   Design and Methods: This study was involved  young and middle age groups (20-55 years, itincluded 339 patients with new paroxysmal atrial fibrillation , but 37 of them was excluded from the study, (male 250 and female 52 with additional 300 control group. All patients were examined By standard transthoracic echocardiographic  protochol that involve two dimension ( 2D , M-Mood and dopplar , looking for possible cardiac structural causes for the  new onset  paroxysmal atrial fibrillation and special attention was made to the inter atrial septum.   The Results: The paroxysmal atrial fibrillation is more with 41-55 years age group that represents 65.56% of patients , while the age group  20-40 years which give 34.44%. The paroxysmal atrial fibrillation is  more in male group (82.78%, than  female group ( 17.22% . The paroxysmal atrial fibrillation patients show many associated heart abnormalities (acquired and congenital diseases by echocardiographic results, and specifically, the ASA is 17.21% in AF patients. The highest percentage of  ASA are 21.2% in the age group 41-55 years old, and 18.4% in male group, with significant relationship between them(P value < 0.05, odds ratio is 12.3, chi-square is 42.64 , 95% confidence interval 4.8-31.19.   Conclusion: Echocardiography has a significant  role  in the  diagnosis of  causes of AF. There is a strong association of ASA and the onset of new paroxysmal AF, More for those patients older than 41 years old , more in

  12. As novas diretrizes defensivas e o recrutamento militar: A Capitania de São Paulo na segunda metade do século XVIII

    Directory of Open Access Journals (Sweden)

    Christiane Figueiredo Pagano de Mello

    2006-06-01

    Full Text Available Interessa-nos analisar neste artigo a resistência ao recrutamento militar como um conflito entre distintas concepções de poder e de espaço, isto é, entre as exigências centralizadoras apresentadas pelo governo central e seus representantes ultramarinos para a defesa da zona meridional da América portuguesa, e os interesses regionais presentes nas comunidades locais. Pretendemos, para tanto, dedicar a análise à Capitania de São Paulo, examinando os diversos conflitos, bem como as soluções encontradas por seus governadores, a fim de impor, ou negociar, diante das inúmeras dificuldades existentes, o recrutamento militar aos habitantes das comunidades locais.

  13. Governança Global e as Parcerias Público-Privadas com as Nações Unidas: explorando características e diretrizes

    Directory of Open Access Journals (Sweden)

    Bruna Teixeira Baungarten

    2016-05-01

    Full Text Available O presente estudo se dedica às parcerias do Setor Privado com a Organização das Nações Unidas, tendo foco nas alianças do UNICEF. Percebe-se a existência de princípios e valores gerais compartilhados dentro dessas parcerias e, que, elas podem ser classificadas em duas tipologias gerais: as PPPs de Investimento e as de Política.

  14. Diretrizes políticas e estratégicas para a formaçáo docente voltadas à pesquisa e à extensão: Brasil

    Directory of Open Access Journals (Sweden)

    Marta Lígia Pomim Valentim

    Full Text Available Caracterização das atividades de pesquisa dos docentes dos cursos de graduação em Ciência da Informação do país, enfocando-se os seguintes aspectos: pesquisa realizada para a obtenção de grau acadêmico; para cumprir requisitos institucionais e para a produção cientifica.

  15. Efficacy and safety of vernakalant in patients with atrial flutter

    DEFF Research Database (Denmark)

    Camm, A John; Toft, Egon; Torp-Pedersen, Christian

    2012-01-01

    AIMS: Vernakalant is a novel, relatively atrial-selective antiarrhythmic agent for conversion of atrial fibrillation (AF) to sinus rhythm. This study examined the safety and efficacy of vernakalant in converting atrial flutter (AFL) to sinus rhythm. METHODS AND RESULTS: This was a phase 2....... The primary efficacy outcome was the proportion of patients who had treatment-induced conversion of AFL to sinus rhythm for a minimum duration of 1 min within 90 min after the start of the first infusion. No patient in the placebo group met the primary outcome. Only one patient receiving vernakalant (1 of 39......, 3%) converted to sinus rhythm. A reduced mean absolute ventricular response rate occurred within 50 min in patients receiving vernakalant (mean change from baseline -8.2 b.p.m.) vs. patients receiving placebo (-0.2 b.p.m.) (P = 0.037). A post-hoc analysis revealed that vernakalant increased AFL...

  16. Rapid growth of left atrial myxoma after radiofrequency ablation.

    Science.gov (United States)

    Rubio Alvarez, José; Martinez de Alegria, Anxo; Sierra Quiroga, Juan; Adrio Nazar, Belen; Rubio Taboada, Carola; Martinez Comendador, José Manuel

    2013-01-01

    Atrial myxoma is the most common benign tumor of the heart, but its appearance after radiofrequency ablation is very rare. We report a case in which an asymptomatic, rapidly growing cardiac myxoma arose in the left atrium after radiofrequency ablation. Two months after the procedure, cardiovascular magnetic resonance, performed to evaluate the right ventricular anatomy, revealed a 10 × 10-mm mass (assumed to be a thrombus) attached to the patient's left atrial septum. Three months later, transthoracic echocardiography revealed a larger mass, and the patient was diagnosed with myxoma. Two days later, a 20 × 20-mm myxoma weighing 37 g was excised. To our knowledge, the appearance of an atrial myxoma after radiofrequency ablation has been reported only once before. Whether tumor development is related to such ablation or is merely a coincidence is uncertain, but myxomas have developed after other instances of cardiac trauma.

  17. Quality of life after robotically assisted atrial myxoma excision.

    Science.gov (United States)

    Kesävuori, Risto; Raivio, Peter; Jokinen, Janne J; Sahlman, Antero; Vento, Antti

    2015-09-01

    The aim of this study was to evaluate the clinical outcome after robotically assisted myxoma surgery performed at our institution. Altogether nine patients underwent robotically assisted atrial myxoma excision. A control group was selected from 18 consecutive patients who underwent an isolated atrial myxoma excision via conventional sternotomy. Preoperative patient characteristics were similar between the two study groups. Postoperative health-related quality of life (HRQoL) was also evaluated. All robotic operations were completed successfully using the da Vinci™ telesurgical system. There was no mortality in either of the two study groups. Procedure, cardiopulmonary bypass, aortic occlusion, and ventilation times were shorter in the sternotomy group when compared to the robotic group. Length of stay was statistically significantly shorter in the robotically assisted group. Postoperative quality of life did not differ between the two study groups. We conclude that robotically assisted surgery is a feasible method for treating atrial myxomas.

  18. Distinct increase in hematocrit associated with paroxysm of atrial fibrillation.

    Science.gov (United States)

    Okuno, S; Ashida, T; Ebihara, A; Sugiyama, T; Fujii, J

    2000-09-01

    In a previous study we found that hemoconcentration, which was identified by an increase in hematocrit, occured during a paroxysm of atrial fibrillation. In the present study we investigated the changes in hematocrit from sinus rhythm to paroxysm in 10 patients who had multiple paroxysms of atrial fibrillation in order to assess the ranges of the changes in hematocrit among the paroxysms. In these patients hematocrit was measured simultaneously with electrocardiographic recording during 3 or more paroxysms and sinus rhythm just before each paroxysm. The changes in hematocrit varied among the paroxysms. The maximum increase in hematocrit in each patient ranged from 3.5 to 8.0 points with an average of 5.1 points. Such a distinct increase in hematocrit which abruptly develops with a paroxysm of atrial fibrillation may be a potential risk for thrombus formation.

  19. Predictive factors of atrial fibrillation after coronary artery bypass grafting.

    Science.gov (United States)

    Folla, Cynthia de Oliveira; Melo, Cinthia Cristina de Santana; Silva, Rita de Cassia Gengo E

    2016-01-01

    To analyze predictive demographic and perioperative variables of postoperative atrial fibrillation in patients who underwent exclusively coronary artery bypass grafting. This was a retrospective cohort. We randomly selected 105 medical records of patients who underwent exclusively coronary artery bypass grafting in 2014. Demographic, clinical (preoperative and immediate postoperative) data and related with surgical procedure were collected from medical records. The occurrence of postoperative atrial fibrillation was considered until the third day after the surgery. Variables were analyzed using descriptive and inferential statistics. To identify predictive factors of postoperative atrial fibrillation we used a decision tree model with Classification and Regression Trees algorithm. Atrial fibrillation incidence was 19.0% (n=20). Patients with left atrial >40.5mm and aged >64.5 years were more likely to develop the arrhythmia during the post-surgical period. Left atrial diameter and advanced age were predictive factors of atrial fibrillation in patients who underwent exclusively coronary artery bypass grafting. Analisar as variáveis demográficas e perioperatórias preditivas de fibrilação atrial pós-operatória em pacientes brasileiros submetidos exclusivamente à cirurgia de revascularização do miocárdio. Trata-se de coorte retrospectiva. A amostra foi constituída de 105 prontuários de pacientes submetidos exclusivamente à revascularização do miocárdio no ano de 2014, selecionados aleatoriamente. Dados demográficos, clínicos (préoperatórios e do pós-operatório imediato) e relacionados ao procedimento cirúrgico foram coletados por meio de consulta ao prontuário. A ocorrência de fibrilação atrial no pós-operatório foi considerada até o terceiro dia após a cirurgia. As variáveis foram analisadas por estatística descritiva e inferencial. Para identificar os fatores preditivos de fibrilação atrial no pós-operatório, utilizou-se um

  20. Das Wörterbuch als Grammatik?

    OpenAIRE

    Wellmann, Hans

    1996-01-01

    Das Wörterbuch als Grammatik? - In: Das Lernerwörterbuch Deutsch als Fremdsprache in der Diskussion / hrsg. von Irmhild Barz ... - Heidelberg : Winter, 1996. - S. 219-241. - (Sprache - Literatur und Geschichte ; 12)