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Sample records for brain death guia

  1. Guideline of procedures 2003 for the gammagraphic study of brain death; Guia de procedimientos 2003 para el estudio gammagrafico de muerte cerebral

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    Mora R, R.A. [Instituto Nacional de Pediatria, Mexico D.F. (Mexico)

    2003-07-01

    The diagnosis of brain death is a clinical diagnosis that is sometimes made with the help of cerebral perfusion scintigraphy. It is important that all physicians be knowledgeable about the clinical requirements for the diagnosis of brain death, especially the need to establish irreversible cessation of all function of the cerebrum and brain stem. Institutions performing scintigraphy for the evaluation of possible brain death should develop clinical guidelines and procedures for the clinical diagnosis that incorporate both clinical evaluations and the integration of ancillary tests such as perfusion scintigraphy. (Author)

  2. BRAIN DEATH DIAGNOSIS

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    Calixto Machado

    2009-10-01

    Full Text Available Brain death (BD diagnosis should be established based on the following set of principles, i.e. excluding major confusing factors, identifying the cause of coma, determining irreversibility, and precisely testing brainstem reflexes at all levels of the brainstem. Nonetheless, most criteria for BD diagnosis do not mention that this is not the only way of diagnosing death. The Cuban Commission for the Determination of Death has emphasized the aforesaid three possible situations for diagnosing death: a outside intensive care environment (without life support physicians apply the cardio-circulatory and respiratory criteria; b in forensic medicine circumstances, physicians utilize cadaveric signs (they do not even need a stethoscope; c in the intensive care environment (with life support when cardiorespiratory arrest occurs physicians utilize the cardio-circulatory and respiratory criteria. This methodology of diagnosing death, based on finding any of the death signs, is not related to the concept that there are different types of death. The irreversible loss of cardio-circulatory and respiratory functions can only cause death when ischemia and anoxia are prolonged enough to produce an irreversible destruction of the brain. The sign of irreversible loss of brain functions, that is to say BD diagnosis, is fully reviewed.

  3. MRI of 'brain death'

    International Nuclear Information System (INIS)

    Nishino, Shigeki; Itoh, Takahiko; Tuchida, Shohei; Kinugasa, Kazushi; Asari, Shoji; Nishimoto, Akira; Sanou, Kazuo.

    1990-01-01

    Magnetic resonance imaging (MRI) was undertaken for two patients who suffered from severe cerebrovascular diseases and were clinically brain dead. The MRI system we used was Resona (Yokogawa Medical Systems, superconductive system 0.5 T) and the CT apparatus was Toshiba TCT-300. Initial CT and MRI were undertaken as soon as possible after admission, and repeated sequentially. After diagnosis of brain death, we performed angiography to determine cerebral circulatory arrest, and MRI obtained at the same time was compared with the angiogram and CT. Case 1 was a 77-year-old man who was admitted in an unconscious state. CT and MRI on the second day after hospitalization revealed cerebellar infarction. He was diagnosed as brain dead on day 4. Case 2 was a 35-year-old man. When he was transferred to our hospital, he was in cardiorespiratory arrested. Cardiac resuscitation was successful but no spontaneous respiration appeared. CT and MRI on admission revealed right intracerebral hemorrhage. Angiography revealed cessation of contrast medium in intracranial vessels in both of the patients. We found no 'flow signal void sign' in the bilateral internal carotid and basilar arteries on MRI images in both cases after brain death. MRI, showing us the anatomical changes of the brain, clearly revealed brain herniations, even though only nuclear findings of 'brain tamponade' were seen on CT. But in Case 1, we could not see the infarct lesions in the cerebellum on MR images obtained after brain death. This phenomenon was caused by the whole brain ischemia masking the initial ischemic lesions. We concluded that MRI was useful not only the anatomical display of lesions and brain herniation with high contrast resolution but for obtaining information on cerebral circulation of brain death. (author)

  4. Brain Death in Islamic Jurisprudence

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    A Nikzad

    2016-07-01

    Full Text Available BACKGROUND AND OBJECTIVE: In today's world, Islamic jurisprudence encounters  new issues. One of the areas where jurisprudence gets involved is the issues concerned with brain death, whether brain death in jurisprudence and Islamic law is considered the end of life. In this study, brain death was discussed from the Shiite jurisprudence perspective and also the opinions of the specialists are taken into account. METHODS: This study is designed based on library collection and review of the literature in the field of brain death. Also, Quranic verses, hadiths and fatwas (religious opinions of the scholars are used. Some of the articles which were centered around Islamic jurisprudence, particularly Shiite jurisprudence that explain and deal with brain death were given special consideration. FINDINGS: Brain death from religious and jurisprudence perspective is considered the termination of life and removing the vital organs from the body is not viewed as committing manslaughter. A person with brain death is not a normally known injured man who is still alive. The brain death patinets have no life and getting rid of the body does not constitute a case of manslaughter. Amputation of the organs of brain death patients for donation and transplantation amounts to the amputation of a dead body. If the life of a Muslim is subject to transplant of organs from the body of a brain death patient, it will be permissible. CONCLUSION: In principle, if the life of a Muslim entails transplant of organs of brain death patients, it will be permissible 

  5. Scintigraphic evaluation of brain death

    International Nuclear Information System (INIS)

    Park, C. H.; Bai, M. S.; Cho, K. K.; Kim, S. J.; Yoon, S. N.; Cho, C. W.

    1997-01-01

    A law recognizing brain death is a life saving legal measure in patients suffering from badly diseased organs such as kidney, liver, heart, and lung. Such law is being discussed for legalization at the Korean National Assembly. There are various criteria used for brain death in western world and brain scintiscan is one of them. However, the scintiscan is not considered in establishing brain death in the draft of the law. The purpose of this report is to spread this technique in nuclear medicine society as well as in other medical societies. We evaluated 7 patients with clinical suspicion of brain death by various causes. The patient's age ranged from 5 to 39 years. We used 5-20mCi 99m Tc-HMPAO (d.1-hexamethyl propylene amine oxime) or ECD (Ethyl Cysteinate Dimer), lipophilic agents that cross BBB (blood brain barrier). A dynamic study followed by static or SPECT (single photon emission tomography) was performed. Interpretive criteria used for brain death were 1) no intracranial circulation 2) no brain uptake. The second criteria is heavily used. Five of 7 patients were scintigraphically brain dead and the remaining 2 had some brain uptake excluding the diagnosis of scintigraphic brain death. In conclusion, cerebral perfusion study using a lipophilic brain tracer offers a noninvasive, rapid, easy, accurate and reliable mean in the diagnosis of brain death. We believe that this modality should be included in the criteria of brain death in the draft of the proposed Korean law

  6. Brain death and related issues

    International Nuclear Information System (INIS)

    Akhtar, M.; Mushtaq, S.; Jamil, K.; Ahmed, S.

    2003-01-01

    Concerns about the erroneous diagnosis of death and premature burial have been expressed from times immemorial. Patients with brain stem death have absolutely no chance of recovery. Brain death is considered at par with death in most of the countries. General public in most parts of the world shows reluctance to accept this concept due to different social, cultural and religious backgrounds and state of literacy and awareness. The criteria for the diagnosis of brain death have been established which include certain pre-conditions, exclusions and tests of the brain stem function. These criteria are universally accepted. The criteria in children are somewhat different from the adults. The subject is intimately related with organ transplantation. If the patients is registered as organ donor or the family consents, organs can be harvested from brain dead patients for transplantation. Pakistan is amongst the few countries where no legislation exists to accept brain death as being at par with death of an individual, and to facilitate and regulate, cadaveric organ donation and transplantation. (author)

  7. Radionuclide evaluation of brain death

    International Nuclear Information System (INIS)

    Pjura, G.A.; Kim, E.E.

    1987-01-01

    The criteria employed for clinical determination of death have evolved in response to advances in life support and other medical technology. The technical feasibility of organ transplantation has amplified the need for a definition of brain death that can be applied in the shortest possible time in the presence of artificial maintenance of vegetative functions, including circulation. Radionuclide cerebral angiography is one of a group of diagnostic procedures that can be employed to confirm the clinical diagnosis of brain death through demonstration of absence of cerebral blood flow. The focus of this work is to assess its use as a confirmatory test for determination of brain death in the context of currently available alternative technologies

  8. Brain Death,Concept and Criteria

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    The concept of brain death originated in France. In 1959, the French scholars P. Mollaret and M. Goulon proposed the concept of "coma de- passe" or "brain death" for the first time and reported 23 cases with such symptoms. The first guidelines (the Harvard criteria) for diagnosing brain death was established in 1968, defining brain death

  9. Circulatory Arrest, Brain Arrest and Death Determination

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    Sam David Shemie

    2018-03-01

    Full Text Available Technological advances, particularly in the capacity to support, replace or transplant failing organs, continue to challenge and refine our understanding of human death. Given the ability to reanimate organs before and after death, both inside and outside of the body, through reinstitution of oxygenated circulation, concepts related to death of organs (e.g. cardiac death are no longer valid. This paper advances the rationale for a single conceptual determination of death related to permanent brain arrest, resulting from primary brain injury or secondary to circulatory arrest. The clinical characteristics of brain arrest are the permanent loss of capacity for consciousness and loss of all brainstem functions. In the setting of circulatory arrest, death occurs after the arrest of circulation to the brain rather than death of the heart. Correspondingly, any intervention that resumes oxygenated circulation to the brain after circulatory arrest would invalidate the determination of death.

  10. The clinical diagnosis of brain death

    African Journals Online (AJOL)

    Key words: brain death, diagnostic criteria, heartbeat. Death has been analysed in a heterogeneous .... angiography studies have also been used in order to evaluate brain circulation. According to some authors, the elective ... reflex response of spinal origin provoked by a sudden flexion of the neck and characterised by a.

  11. Notification of brain death in the hospital

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    Bruna Soares de Jesus Souza

    2015-05-01

    Full Text Available Objective: to identifying brain death in the hospital. Methods: it is a cross sectional and quantitative study which analyzed secondary data extracted from the notified brain death registers and from the medical records of the eligible patients. The data were processed and analyzed through descriptive statistics and comparisons. Results: of the 64 cases of notifications, the male gender predominated (67.2% within the age range from 40 to 59 years (64.1%. There was a greater proportion (71.8% of causes of death related to Hemorrhagic Cerebral Vascular Accident and Traumatic Brain Injury caused by motorcycle accident, showing statistically significant difference (p<0.05 regarding the gender, age and location. Conclusion: the Hemorrhagic Cerebral Vascular Accident was the most prevalent cause of notification of brain death and the Intensive Therapy Unit was the most notified venue.

  12. Notification of brain death in the hospital

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    Bruna Soares de Jesus Souza; Gerlene Grudka Lira; Rachel Mola

    2015-01-01

    Objective: to identifying brain death in the hospital. Methods: it is a cross sectional and quantitative study which analyzed secondary data extracted from the notified brain death registers and from the medical records of the eligible patients. The data were processed and analyzed through descriptive statistics and comparisons. Results: of the 64 cases of notifications, the male gender predominated (67.2%) within the age range from 40 to 59 years (64.1%). There was a greater proportion (71.8...

  13. A Response to the Legitimacy of Brain Death in Islam.

    Science.gov (United States)

    Rady, Mohamed Y; Verheijde, Joseph L

    2016-08-01

    Brain death is a novel construct of death for the procurement of transplantable organs. Many authoritative Islamic organizations and governments have endorsed brain death as true death for organ donation. Many commentators have reiterated the misconception that the Quranic text does not define death. We respond by clarifying: (1) the Quran does define death as biologic disintegration and clearly distinguishes it from the dying process, (2) brain death belongs scientifically within the spectrum of neurologic disorders of consciousness and should not be confused with death, and (3) religious and legal discord about brain death has grown in jurisdictions worldwide. We urge for public transparency and truthfulness about brain death and the accommodation and respect of religious objection to the determination of death by neurologic criteria.

  14. Pitfalls in diagnosing brain death in infancy

    International Nuclear Information System (INIS)

    Toffol, G.J.; Lansky, L.L.; Hughes, J.R.; Blend, M.J.; Pavel, D.G.; Kecskes, S.A.; Ortega, R.E.; Tan, W.S.

    1987-01-01

    A 3-year-old child with phenotypic trisomy 18 syndrome survived 26 days after a cardiopulmonary arrest, secondary to an acute viral illness. The child was deeply comatose. No barbiturates, other sedatives, or aminoglycoside antibiotics had been recently administered. The child was normothermic with adequate cardiovascular function. Brain stem function was absent, as assessed by testing of brain stem reflexes. Serial cerebral radionuclide angiograms (CRAG) documented intact cerebral blood flow while electrocerebral silence (ECS) was present on two consecutive EEG recordings within 24 hours. Preservation of intracranial circulation was confirmed by rapid rotational computed tomographic (CT) scans. Cranial CT scans also revealed communicating hydrocephalus, and bilateral basal ganglia hemorrhages. This unusual case illustrates discordance between apparent irreversible loss of cortical function as indicated by electrocerebral silence with preserved cerebral blood flow. The implications of these apparent paradoxical events will be discussed in the context of defining brain death in children

  15. Approach of Complex Networks for the Determination of Brain Death

    Institute of Scientific and Technical Information of China (English)

    SUN Wei-Gang; CAO Jian-Ting; WANG Ru-Bin

    2011-01-01

    In clinical practice, brain death is the irreversible end of all brain activity. Compared to current statistical methods for the determination of brain death, we focus on the approach of complex networks for real-world electroencephalography in its determination. Brain functional networks constructed by correlation analysis are derived, and statistical network quantities used for distinguishing the patients in coma or brain death state, such as average strength, clustering coefficient and average path length, are calculated. Numerical results show that the values of network quantities of patients in coma state are larger than those of patients in brain death state. Our Sndings might provide valuable insights on the determination of brain death.%@@ In clinical practice, brain death is the irreversible end of all brain activity.Compared to current statistical methods for the determination of brain death, we focus on the approach of complex networks for real-world electroencephalography in its determination.Brain functional networks constructed by correlation analysis axe derived, and statistical network quantities used for distinguishing the patients in coma or brain death state, such as average strength, clustering coefficient and average path length, are calculated.Numerical results show that the values of network quantities of patients in coma state are larger than those of patients in brain death state.Our findings might provide valuable insights on the determination of brain death.

  16. Brain death in neonates: a case report

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    Georgios Mitsiakos

    2014-06-01

    Full Text Available Brain death (BD is the permanent and complete loss of cerebral and brainstem function. It is relatively uncommon in newborns with its percentage among deaths being 1-6.3%. BD leads to debate for medical, ethical and philosophical issues. It is a challenging condition in neonatal intensive care units (NICUs since difficulties for BD diagnosis in neonates and ever more so in preterm neonates do arise. Revised guidelines for BD diagnosis definition include history with known etiology, clinical examination, apnea testing and neurological evaluation often assisted by ancillary tests. We present the case of a near term female baby that was born with brain death due to hypoxic ischemic encephalopathy. We conclude that BD in newborns is a challenge to NICUs and there is a need for establishing and implementing new guidelines and checklists on national basis. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  17. Approach of Complex Networks for the Determination of Brain Death

    International Nuclear Information System (INIS)

    Sun Wei-Gang; Cao Jian-Ting; Wang Ru-Bin

    2011-01-01

    In clinical practice, brain death is the irreversible end of all brain activity. Compared to current statistical methods for the determination of brain death, we focus on the approach of complex networks for real-world electroencephalography in its determination. Brain functional networks constructed by correlation analysis are derived, and statistical network quantities used for distinguishing the patients in coma or brain death state, such as average strength, clustering coefficient and average path length, are calculated. Numerical results show that the values of network quantities of patients in coma state are larger than those of patients in brain death state. Our findings might provide valuable insights on the determination of brain death. (cross-disciplinary physics and related areas of science and technology)

  18. Ethical aspects of the concept of brain death

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    A. V. Pinchuk

    2013-01-01

    Full Text Available The authors attempt to summarize views of leading russian experts in bioethics and medical deontology on the moral and ethical issues related to the development of the concept of brain death and its application in modern medicine. A variety of ethical issues associated with the use of the concept of "brain death" in organ donation and clinical transplantation is noted. The official attitude of representatives of the world's major faiths to the problems of brain death and organ transplantation is reflected. Authors express their own attitude to the issues discussed, as professionals facing daily with challenges of brain death in their own clinical practice.

  19. Confounding factors in diagnosing brain death: a case report

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    Login Ivan S

    2002-06-01

    Full Text Available Abstract Background Brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses. Case presentation A patient with severe hypoxic-ischemic brain injury met the three cardinal neurological features of brain death but concurrent profound hypothyroidism precluded the diagnosis. Our clinical and ethical decisions were further challenged by another facet of this complex case. Although her brain damage indicated a hopeless prognosis, we could not discontinue care based on futility because the only known surrogate was mentally retarded and unable to participate in medical planning. Conclusion The presence of certain medical conditions prohibits a diagnosis of brain death, which is a medicolegal diagnosis of death, not a prediction or forecast of future outcome. While prognostication is important in deciding to withdraw care, it is not a component in diagnosing brain death.

  20. 99mTc-HMPAO SPECT in brain death

    International Nuclear Information System (INIS)

    Tsuchida, Tatsuro; Sadato, Norihiro; Nishizawa, Sadahiko

    1993-01-01

    Brain single photon emission computed tomography (SPECT) with 99m Tc-d,l-hexamethyl-propyleneamine oxime (HMPAO) was performed twice in a 78-year-old man clinically diagnosed as brain death according to the standard criteria of the Japanese Ministry of Welfare. The first brain SPECT demonstrated the tracer accumulation in the brain, indicating preserved cerebral blood flow. The second brain SPECT performed 3 days later revealed cessation of the blood flow. In patients with preserved cerebral blood flow, the diagnosis of brain death cannot be made, even if they meet the existing criteria, because previous report noted the recovery in some of those patients. Brain perfusion SPECT plays an important role as a confirmatory test for the diagnosis of brain death. (author)

  1. CT findings as confirmatory criteria of brain death

    International Nuclear Information System (INIS)

    Shiogai, Toshiyuki; Takeuchi, Kazuo

    1983-01-01

    The absence of cerebral circulation and electrocerebral silence have served as an accurate index of irreversible brain death. It is proposed that computed tomography (CT) findings be evaluated as confirmatory criteria of brain death. To this end, CT evaluation of 14 patients satisfying the conventional criteria of brain death was performed. A CT finding of severe compression or dissappearance of the ventricular system, or so called ''brain tamponade'', was seen in 7 (50 %) of the 14 patients. Enhanced contrast CT, especially dynamic CT, usually distinctly reveals the cerebral vessels whenever the cerebral blood flow is preserved; conversely, the lack of enhanced brain structures, even comparing attenuation values, indicates the absence of cerebral blood flow. In 7 (70 %) of 10 patients, however, there was enhanced contrast of vascular brain structures, especially the circle of Willis, major cerebral arteries, choroid plexuses, and venous sinuses. It is suggested that this result is due to the improvement of demonstrability by CT. The usefulness of CT in the confirmation of brain death lies in visualization of the pathological changes associated with a dead brain, such as ''brain tamponade'', and the lack of enhanced contrast indicating the absence of cerebral blood flow. The latter point is still problematic as angiography revealed an extremely low cerebral blood flow in a few cases of ''dead brain'' patients. It is recommended that cerebral blood flow in brain death be evaluated by dynamic CT scanning and correlated with other methods of cerebral blood flow determination (e.g., intravenous digital subtraction angiography). (Author)

  2. Deconstructing the Brain Disconnection–Brain Death Analogy and Clarifying the Rationale for the Neurological Criterion of Death

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    Moschella, Melissa

    2016-01-01

    This article explains the problems with Alan Shewmon’s critique of brain death as a valid sign of human death, beginning with a critical examination of his analogy between brain death and severe spinal cord injury. The article then goes on to assess his broader argument against the necessity of the brain for adult human organismal integration, arguing that he fails to translate correctly from biological to metaphysical claims. Finally, on the basis of a deeper metaphysical analysis, I offer a revised rationale for the validity of the neurological criterion of human death. PMID:27095749

  3. Of wholes and parts: A Thomistic refutation of "Brain Death".

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    Accad, Michel

    2015-08-01

    I propose a refutation of the two major arguments that support the concept of "brain death" as an ontological equivalent to death of the human organism. I begin with a critique of the notion that a body part, such as the brain, could act as "integrator" of a whole body. I then proceed with a rebuttal of the argument that destruction of a body part essential for rational operations-such as the brain-necessarily entails that the remaining whole is indisposed to accrue a rational soul. Next, I point to the equivocal use of the terms "alive" or "living" as being at the root of conceptual errors about brain death. I appeal to the Thomistic definition of life and to the hylomorphic concept of "virtual presence" to clarify this confusion. Finally, I show how the Thomistic definition of life supports the traditional criterion for the determination of death. Lay summary: By the mid-1960s, medical technology became available that could keep "alive" the bodies of patients who had sustained complete and irreversible brain injury. The concept of "brain death" emerged to describe such states. Physicians, philosophers, and ethicists then proposed that the state of brain death is equivalent to the state of death traditionally identified by the absence of spontaneous pulse and respiration. This article challenges the major philosophical arguments that have been advanced to draw this equivalence.

  4. Public education and misinformation on brain death in mainstream media.

    Science.gov (United States)

    Lewis, Ariane; Lord, Aaron S; Czeisler, Barry M; Caplan, Arthur

    2016-09-01

    We sought to evaluate the caliber of education mainstream media provides the public about brain death. We reviewed articles published prior to July 31, 2015, on the most shared/heavily trafficked mainstream media websites of 2014 using the names of patients from two highly publicized brain death cases, "Jahi McMath" and "Marlise Muñoz." We reviewed 208 unique articles. The subject was referred to as being "alive" or on "life support" in 72% (149) of the articles, 97% (144) of which also described the subject as being brain dead. A definition of brain death was provided in 4% (9) of the articles. Only 7% (14) of the articles noted that organ support should be discontinued after brain death declaration unless a family has agreed to organ donation. Reference was made to well-known cases of patients in persistent vegetative states in 16% (34) of articles and 47% (16) of these implied both patients were in the same clinical state. Mainstream media provides poor education to the public on brain death. Because public understanding of brain death impacts organ and tissue donation, it is important for physicians, organ procurement organizations, and transplant coordinators to improve public education on this topic. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. CT findings as confirmatory criteria of brain death

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    Shiogai, Toshiyuki; Takeuchi, Kazuo (Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine)

    1983-12-01

    The absence of cerebral circulation and electrocerebral silence have served as an accurate index of irreversible brain death. It is proposed that computed tomography (CT) findings be evaluated as confirmatory criteria of brain death. To this end, CT evaluation of 14 patients satisfying the conventional criteria of brain death was performed. A CT finding of severe compression or dissappearance of the ventricular system, or so called ''brain tamponade'', was seen in 7 (50 %) of the 14 patients. Enhanced contrast CT, especially dynamic CT, usually distinctly reveals the cerebral vessels whenever the cerebral blood flow is preserved; conversely, the lack of enhanced brain structures, even comparing attenuation values, indicates the absence of cerebral blood flow. In 7 (70 %) of 10 patients, however, there was enhanced contrast of vascular brain structures, especially the circle of Willis, major cerebral arteries, choroid plexuses, and venous sinuses. It is suggested that this result is due to the improvement of demonstrability by CT. The usefulness of CT in the confirmation of brain death lies in visualization of the pathological changes associated with a dead brain, such as ''brain tamponade'', and the lack of enhanced contrast indicating the absence of cerebral blood flow. The latter point is still problematic as angiography revealed an extremely low cerebral blood flow in a few cases of ''dead brain'' patients. It is recommended that cerebral blood flow in brain death be evaluated by dynamic CT scanning and correlated with other methods of cerebral blood flow determination (e.g., intravenous digital subtraction angiography).

  6. Outcome of pancreas transplantation from donation after circulatory death compared to donation after brain death

    NARCIS (Netherlands)

    van Loo, Ellen S.; Krikke, Christina; Hofker, Hendrik S.; Berger, Stefan P.; Leuvenink, Henri G. D.; Pol, Robert A.

    Introduction: To overcome the gap of organ shortage grafts from donation after circulatory death (DCD) can be used. This review evaluates the outcomes after DCD pancreas donation compared to donation after brain death (DBD). Materials and methods: A literature search was performed using Medline,

  7. CT Angiography in the Diagnosis of Brain Death

    International Nuclear Information System (INIS)

    Sawicki, Marcin; Bohatyrewicz, Romuald; Walecka, Anna; Sołek-Pastuszka, Joanna; Rowiński, Olgierd; Walecki, Jerzy

    2014-01-01

    Summary Brain death is defined as the irreversible cessation of functioning of the entire brain, including the brainstem. Brain death is principally established using clinical criteria including coma, absence of brainstem reflexes and loss of central drive to breathe assessed with apnea test. In situations in which clinical testing cannot be performed or when uncertainty exists about the reliability of its parts due to confounding conditions ancillary tests (i.a. imaging studies) may be useful. The objective of ancillary tests in the diagnosis of brain death is to demonstrate the absence of cerebral electrical activity (EEG and evoked potentials) or cerebral circulatory arrest. In clinical practice catheter cerebral angiography, perfusion scintigraphy, transcranial Doppler sonography, CT angiography and MR angiography are used. Other methods, like perfusion CT, xenon CT, MR spectroscopy, diffusion weighted MRI and functional MRI are being studied as potentially useful in the diagnosis of brain death. CT angiography has recently attracted attention as a promising alternative to catheter angiography – a reference test in the diagnosis of brain death. Since 1998 several major studies were published and national guidelines were introduced in several countries (e.g. in France, Austria, Switzerland, the Netherlands and Canada). This paper reviews technique, characteristic findings and criteria for the diagnosis of cerebral circulatory arrest in CT angiography

  8. Portrayal of Brain Death in Film and Television.

    Science.gov (United States)

    Lewis, A; Weaver, J; Caplan, A

    2017-03-01

    We sought to evaluate whether television and cinematic coverage of brain death is educational or misleading. We identified 24 accessible productions that addressed brain death using the archives of the Paley Center for Media (160 000 titles) and the Internet Movie Database (3.7 million titles). Productions were reviewed by two board-certified neurologists. Although 19 characters were pronounced brain dead, no productions demonstrated a complete examination to assess for brain death (6 included an assessment for coma, 9 included an evaluation of at least 1 brainstem reflex, but none included an assessment of every brainstem reflex, and 2 included an apnea test). Subjectively, both authors believed only a small fraction of productions (13% A.L., 13% J.W.) provided the public a complete and accurate understanding of brain death. Organ donation was addressed in 17 productions (71%), but both reviewers felt that the discussions about organ donation were professional in a paucity of productions (9% for A.L., 27% for J.W.). Because television and movies serve as a key source for public education, the quality of productions that feature brain death must be improved. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  9. Comparison of outcomes of kidney transplantation from donation after brain death, donation after circulatory death, and donation after brain death followed by circulatory death donors.

    Science.gov (United States)

    Chen, Guodong; Wang, Chang; Ko, Dicken Shiu-Chung; Qiu, Jiang; Yuan, Xiaopeng; Han, Ming; Wang, Changxi; He, Xiaoshun; Chen, Lizhong

    2017-11-01

    There are three categories of deceased donors of kidney transplantation in China, donation after brain death (DBD), donation after circulatory death (DCD), and donation after brain death followed by circulatory death (DBCD) donors. The aim of this study was to compare the outcomes of kidney transplantation from these three categories of deceased donors. We retrospectively reviewed 469 recipients who received deceased kidney transplantation in our hospital from February 2007 to June 2015. The recipients were divided into three groups according to the source of their donor kidneys: DBD, DCD, or DBCD. The primary endpoints were delayed graft function (DGF), graft loss, and patient death. The warm ischemia time was much longer in DCD group compared to DBCD group (18.4 minutes vs 12.9 minutes, P < .001). DGF rate was higher in DCD group than in DBD and DBCD groups (22.5% vs 10.2% and 13.8%, respectively, P = .021). Urinary leakage was much higher in DCD group (P = .049). Kaplan-Meier analysis showed that 1-, 2-, and 3-year patient survivals were all comparable among the three groups. DBCD kidney transplantation has lower incidences of DGF and urinary leakage than DCD kidney transplant. However, the overall patient and graft survival were comparable among DBD, DCD, and DBCD kidney transplantation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. A Thomistic defense of whole-brain death.

    Science.gov (United States)

    Eberl, Jason T

    2015-08-01

    Michel Accad critiques the currently accepted whole-brain criterion for determining the death of a human being from a Thomistic metaphysical perspective and, in so doing, raises objections to a particular argument defending the whole-brain criterion by Patrick Lee and Germain Grisez. In this paper, I will respond to Accad's critique of the whole-brain criterion and defend its continued validity as a criterion for determining when a human being's death has occurred in accord with Thomistic metaphysical principles. I will, however, join Accad in criticizing Lee and Grisez's proposed defense of the whole-brain criterion as potentially leading to erroneous conclusions regarding the determination of human death. Lay summary: Catholic physicians and bioethicists currently debate the legally accepted clinical standard for determining when a human being has died-known as the "wholebrain criterion"-which has also been morally affirmed by the Magisterium. This paper responds to physician Michel Accad's critique of the whole-brain criterion based upon St. Thomas Aquinas's metaphysical account of human nature as a union of a rational soul and a material body. I defend the whole-brain criterion from the same Thomistic philosophical perspective, while agreeing with Accad's objection to an alternative Thomistic defense of whole-brain death by philosophers Patrick Lee and Germain Grisez.

  11. MRI of 'brain death'

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    Nishino, Shigeki; Itoh, Takahiko; Tuchida, Shohei; Kinugasa, Kazushi; Asari, Shoji; Nishimoto, Akira (Okayama Univ. (Japan). School of Medicine); Sanou, Kazuo

    1990-12-01

    Magnetic resonance imaging (MRI) was undertaken for two patients who suffered from severe cerebrovascular diseases and were clinically brain dead. The MRI system we used was Resona (Yokogawa Medical Systems, superconductive system 0.5 T) and the CT apparatus was Toshiba TCT-300. Initial CT and MRI were undertaken as soon as possible after admission, and repeated sequentially. After diagnosis of brain death, we performed angiography to determine cerebral circulatory arrest, and MRI obtained at the same time was compared with the angiogram and CT. Case 1 was a 77-year-old man who was admitted in an unconscious state. CT and MRI on the second day after hospitalization revealed cerebellar infarction. He was diagnosed as brain dead on day 4. Case 2 was a 35-year-old man. When he was transferred to our hospital, he was in cardiorespiratory arrested. Cardiac resuscitation was successful but no spontaneous respiration appeared. CT and MRI on admission revealed right intracerebral hemorrhage. Angiography revealed cessation of contrast medium in intracranial vessels in both of the patients. We found no 'flow signal void sign' in the bilateral internal carotid and basilar arteries on MRI images in both cases after brain death. MRI, showing us the anatomical changes of the brain, clearly revealed brain herniations, even though only nuclear findings of 'brain tamponade' were seen on CT. But in Case 1, we could not see the infarct lesions in the cerebellum on MR images obtained after brain death. This phenomenon was caused by the whole brain ischemia masking the initial ischemic lesions. We concluded that MRI was useful not only the anatomical display of lesions and brain herniation with high contrast resolution but for obtaining information on cerebral circulation of brain death. (author).

  12. Deconstructing the Brain Disconnection-Brain Death Analogy and Clarifying the Rationale for the Neurological Criterion of Death.

    Science.gov (United States)

    Moschella, Melissa

    2016-06-01

    This article explains the problems with Alan Shewmon's critique of brain death as a valid sign of human death, beginning with a critical examination of his analogy between brain death and severe spinal cord injury. The article then goes on to assess his broader argument against the necessity of the brain for adult human organismal integration, arguing that he fails to translate correctly from biological to metaphysical claims. Finally, on the basis of a deeper metaphysical analysis, I offer a revised rationale for the validity of the neurological criterion of human death. © The Author 2016. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Brain death revisited: it is not 'complete death' according to Islamic sources.

    Science.gov (United States)

    Bedir, Ahmet; Aksoy, Sahin

    2011-05-01

    Concepts, such as death, life and spirit cannot be known in their quintessential nature, but can be defined in accordance with their effects. In fact, those who think within the mode of pragmatism and Cartesian logic have ignored the metaphysical aspects of these terms. According to Islam, the entity that moves the body is named the soul. And the aliment of the soul is air. Cessation of breathing means leaving of the soul from the body. Those who agree on the diagnosis of brain death may not able to agree unanimously on the rules that lay down such diagnosis. That is to say, there are a heap of suspicions regarding the diagnosis of brain death, and these suspicions are on the increase. In fact, Islamic jurisprudence does not put provisions, decisions on suspicious grounds. By virtue of these facts, it can be asserted that brain death is not absolute death according to Islamic sources; for in the patients diagnosed with brain death the soul still has not abandoned the body. Therefore, these patients suffer in every operation performed on them.

  14. Diagnosis of brain death by transcranial Doppler sonography.

    Science.gov (United States)

    Bode, H; Sauer, M; Pringsheim, W

    1988-12-01

    The blood flow velocities in the basal cerebral arteries can be recorded at any age by transcranial Doppler sonography. We examined nine children with either initial or developing clinical signs of brain death. Soon after successful resuscitation increased diastolic flow velocities indicated a probable decrease in cerebrovascular resistance; this was of no particular prognostic importance. As soon as there was a clinical deterioration, there was a reduction in flow velocities with retrograde flow during early diastole, probably due to an increase in cerebrovascular resistance; this indicated a doubtful prognosis. In eight of the nine children with clinical signs of brain death a typical reverberating flow pattern was found, which was characterised by a counterbalancing short forward flow in systole and a short retrograde flow in early diastole. This indicated arrest of cerebral blood flow. One newborn showed normal systolic and end diastolic flow velocities in the basal cerebral arteries for two days despite clinical and electroencephalographic signs of brain death. Shunting of blood through the circle of Willis without effective cerebral perfusion may explain this phenomenon. No patient had the typical reverberating flow pattern without being clinically brain dead. Transcranial Doppler sonography is a reliable technique, which can be used at the bedside for the confirmation or the exclusion of brain death in children in addition to the clinical examination.

  15. 99mTc HM-PAO brain perfusion SPECT in brain death

    International Nuclear Information System (INIS)

    Bonetti, M.G.; Ciritella, P.; Valle, G.; Perrone, E.

    1995-01-01

    We have easily carried out and interpreted 99m Tc HM-PAO SPECT in a consecutive series of 40 comatose patients with brain damage, without discontinuing therapy. Brain death was diagnosed in 7 patients, by recognising absence of brain perfusion, as shown by no intracranial radionuclide uptake. In patients in whom perfusion was seen on brain scans, HM-PAO SPECT improved assessment of the extent of injury, which in general was larger than suggested by CT. (orig.)

  16. Brain death and the historical understanding of bioethics.

    Science.gov (United States)

    Belkin, Gary S

    2003-07-01

    In a 1968 Report, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death promulgated influential criteria for the idea and practice known as "brain death." Before and since the Committee met, brain death has been a focal point of visions and nightmares of medical progress, purpose, and moral authority. Critics of the Committee felt it was deaf to apparently central moral considerations and focused on the self-serving purpose of expanding transplantation. Historical characterizations of the uses and meanings of brain death and the work of the Committee have tended to echo these themes, which means also generally repeating a widely held bioethical self-understanding of how the field appeared-that is, as a necessary antidote of moral expertise. This paper looks at the Committee and finds that historical depictions of it have been skewed by such a bioethical agenda. Entertaining different possibilities as to the motives and historical circumstances behind the Report it famously produced may point to not only different histories of the Committee, but also different perspectives on the historical legacy and role of bioethics as a discourse for addressing anxieties about medicine.

  17. Simulation-based training in brain death determination.

    Science.gov (United States)

    MacDougall, Benjamin J; Robinson, Jennifer D; Kappus, Liana; Sudikoff, Stephanie N; Greer, David M

    2014-12-01

    Despite straightforward guidelines on brain death determination by the American Academy of Neurology (AAN), substantial practice variability exists internationally, between states, and among institutions. We created a simulation-based training course on proper determination based on the AAN practice parameters to address and assess knowledge and practice gaps at our institution. Our intervention consisted of a didactic course and a simulation exercise, and was bookended by before and after multiple-choice tests. The 40-min didactic course, including a video demonstration, covered all aspects of the brain death examination. Simulation sessions utilized a SimMan 3G manikin and involved a complete examination, including an apnea test. Possible confounders and signs incompatible with brain death were embedded throughout. Facilitators evaluated performance with a 26-point checklist based on the most recent AAN guidelines. A senior neurologist conducted all aspects of the course, including the didactic session, simulation, and debriefing session. Ninety physicians from multiple specialties have participated in the didactic session, 38 of whom have completed the simulation. Pre-test scores were poor (41.4 %), with attendings scoring higher than residents (46.6 vs. 40.4 %, p = 0.07), and neurologists and neurosurgeons significantly outperforming other specialists (53.9 vs. 38.9 %, p = 0.003). Post-test scores (73.3 %) were notably higher than pre-test scores (45.4 %). Participant feedback has been uniformly positive. Baseline knowledge of brain death determination among providers was low but improved greatly after the course. Our intervention represents an effective model that can be replicated at other institutions to train clinicians in the determination of brain death according to evidence-based guidelines.

  18. Life and death of neurons in the aging brain

    Science.gov (United States)

    Morrison, J. H.; Hof, P. R.; Bloom, F. E. (Principal Investigator)

    1997-01-01

    Neurodegenerative disorders are characterized by extensive neuron death that leads to functional decline, but the neurobiological correlates of functional decline in normal aging are less well defined. For decades, it has been a commonly held notion that widespread neuron death in the neocortex and hippocampus is an inevitable concomitant of brain aging, but recent quantitative studies suggest that neuron death is restricted in normal aging and unlikely to account for age-related impairment of neocortical and hippocampal functions. In this article, the qualitative and quantitative differences between aging and Alzheimer's disease with respect to neuron loss are discussed, and age-related changes in functional and biochemical attributes of hippocampal circuits that might mediate functional decline in the absence of neuron death are explored. When these data are viewed comprehensively, it appears that the primary neurobiological substrates for functional impairment in aging differ in important ways from those in neurodegenerative disorders such as Alzheimer's disease.

  19. Islam, brain death, and transplantation: culture, faith, and jurisprudence.

    Science.gov (United States)

    Arbour, Richard; AlGhamdi, Hanan Mesfer Saad; Peters, Linda

    2012-01-01

    A significant gap exists between availability of organs for transplant and patients with end-stage organ failure for whom organ transplantation is the last treatment option. Reasons for this mismatch include inadequate approach to potential donor families and donor loss as a result of refractory cardiopulmonary instability during and after brainstem herniation. Other reasons include inadequate cultural competence and sensitivity when communicating with potential donor families. Clinicians may not have an understanding of the cultural and religious perspectives of Muslim families of critically ill patients who may be approached about brain death and organ donation. This review analyzes Islamic cultural and religious perspectives on organ donation, transplantation, and brain death, including faith-based directives from Islamic religious authorities, definitions of death in Islam, and communication strategies when discussing brain death and organ donation with Muslim families. Optimal family care and communication are highlighted using case studies and backgrounds illustrating barriers and approaches with Muslim families in the United States and in the Kingdom of Saudi Arabia that can improve cultural competence and family care as well as increase organ availability within the Muslim population and beyond.

  20. Pneumothorax as a Complication of Apnea Testing for Brain Death.

    Science.gov (United States)

    Gorton, Lauren Elizabeth; Dhar, Rajat; Woodworth, Lindsey; Anand, Nitin J; Hayes, Benjamin; Ramiro, Joanna Isabelle; Kumar, Abhay

    2016-10-01

    Pneumothorax is an under-recognized complication of apnea testing performed as part of the neurological determination of death. It may result in hemodynamic instability or even cardiac arrest, compromising ability to declare brain death (BD) and viability of organs for transplantation. We report three cases of pneumothorax with apnea testing (PAT) and review the available literature of this phenomenon. Series of three cases supplemented with a systematic review of literature (including discussion of apnea testing in major brain death guidelines). Two patients were diagnosed with PAT due to immediate hemodynamic compromise, while the third was diagnosed many hours after BD. An additional nine cases of PAT were found in the literature. Information regarding oxygen cannula diameter was available for nine patients (range 2.3-5.3 mm), and flow rate was available for ten patients (mean 11 L/min). Pneumothorax was treated to resolution in the majority of patients (n = 8), although only six completed apnea testing following diagnosis/treatment of pneumothorax and only three patients became organ donors afterward. Review of major BD guidelines showed that although use of low oxygen flow rate (usually ≤ 6 L/min) during apnea testing is suggested, the risk of PAT was explicitly mentioned in just one. Development of PAT may adversely affect the process of BD determination and could limit the opportunity for organ donation. Each institution should have preventive measures in place.

  1. [Brain death and organ transplantation: ethical dilemmas for nursing?].

    Science.gov (United States)

    Windels-Buhr, D

    1997-06-01

    According to the WHO Program, nurses should be active in public health care as equal members of a multiprofessional team. This position requires competent professional action, which also implies moral competence, especially necessitated by the coming paradigmatic changes caused by shifts in the previous and current boundaries of the paradigm human being. One reason for this shift are the greater medical technical possibilities. The medical definition of brain death as the death of a human being per se is one example of the altered boundary and its consequences. Must future components of the nursing metaparadigm be changed because of this? To what extent is nursing ethically obligated to integrate changes in social values into its metaparadigm, ethics and objectives? The nursing metaparadigm, Henderson's definition of nursing, the ICN's Basic Code of Ethics, and the nursing model according to Roper, Logan & Tierney were used as the basis in the analysis of the subject matter and problems. Furthermore, philosophical viewpoints of Jonas & Harris will be included to clarify the deontological and teleological aspects of standard ethics. Finally, conclusions are drawn about the intra- and interprofessional ethical discourse about brain death and organ transplantation among nursing professionals.

  2. Agmatine Attenuates Brain Edema and Apoptotic Cell Death after Traumatic Brain Injury.

    Science.gov (United States)

    Kim, Jae Young; Lee, Yong Woo; Kim, Jae Hwan; Lee, Won Taek; Park, Kyung Ah; Lee, Jong Eun

    2015-07-01

    Traumatic brain injury (TBI) is associated with poor neurological outcome, including necrosis and brain edema. In this study, we investigated whether agmatine treatment reduces edema and apoptotic cell death after TBI. TBI was produced by cold injury to the cerebral primary motor cortex of rats. Agmatine was administered 30 min after injury and once daily until the end of the experiment. Animals were sacrificed for analysis at 1, 2, or 7 days after the injury. Various neurological analyses were performed to investigate disruption of the blood-brain barrier (BBB) and neurological dysfunction after TBI. To examine the extent of brain edema after TBI, the expression of aquaporins (AQPs), phosphorylation of mitogen-activated protein kinases (MAPKs), and nuclear translocation of nuclear factor-κB (NF-κB) were investigated. Our findings demonstrated that agmatine treatment significantly reduces brain edema after TBI by suppressing the expression of AQP1, 4, and 9. In addition, agmatine treatment significantly reduced apoptotic cell death by suppressing the phosphorylation of MAPKs and by increasing the nuclear translocation of NF-κB after TBI. These results suggest that agmatine treatment may have therapeutic potential for brain edema and neural cell death in various central nervous system diseases.

  3. Considering ethical dilemmas related to brain death in newborns

    Directory of Open Access Journals (Sweden)

    Ilias Chatziioannidis

    2014-01-01

    Full Text Available Brain death (BD, as the irreversible and permanent loss of cerebral and brainstem function, is relatively uncommon among newborns who need life support. It is considered the result of an acute and irreversible central nervous system insult. Asphyxia, severe intracranial hemorrhage and infection are the most common causes of  BD in children. BD diagnosis is usually based on clinical criteria. Dilemmas about life prolonging treatment for severely compromised infants – as brain dead infants are – has become challenging since neonatal intensive care unit (NICU care has developed, quality of life and resource issues are nowadays continuously underlined. Caring for premature babies is expensive and costs have risen especially since an increased number of infants with handicaps survives. Intensivists’ main duty is first to save lives and then to interrupt treatment in certain conditions like detrimental brain damage. The objective of this article is to present ethical decisions regarding brain dead newborns in order to balance between organ donation necessities and withholding/withdrawing treatment, with respect to the important role of infants’ parents in the process.

  4. Hypothalamic-Pituitary Function in Brain Death: A Review.

    Science.gov (United States)

    Nair-Collins, Michael; Northrup, Jesse; Olcese, James

    2016-01-01

    The Uniform Determination of Death Act (UDDA) states that an individual is dead when "all functions of the entire brain" have ceased irreversibly. However, it has been questioned whether some functions of the hypothalamus, particularly osmoregulation, can continue after the clinical diagnosis of brain death (BD). In order to learn whether parts of the hypothalamus can continue to function after the diagnosis of BD, we performed 2 separate systematic searches of the MEDLINE database, corresponding to the functions of the posterior and anterior pituitary. No meta-analysis is possible due to nonuniformity in the clinical literature. However, some modest generalizations can reasonably be drawn from a narrative review and from anatomic considerations that explain why these findings should be expected. We found evidence suggesting the preservation of hypothalamic function, including secretion of hypophysiotropic hormones, responsiveness to anterior pituitary stimulation, and osmoregulation, in a substantial proportion of patients declared dead by neurological criteria. We discuss several possible explanations for these findings. We conclude by suggesting that additional clinical research with strict inclusion criteria is necessary and further that a more nuanced and forthright public dialogue is needed, particularly since standard diagnostic practices and the UDDA may not be entirely in accord. © The Author(s) 2014.

  5. Signal Transduction Pathways Involved in Brain Death-Induced Renal Injury

    NARCIS (Netherlands)

    Bouma, H. R.; Ploeg, R. J.; Schuurs, T. A.

    Kidneys derived from brain death organ donors show an inferior survival when compared to kidneys derived from living donors. Brain death is known to induce organ injury by evoking an inflammatory response in the donor. Neuronal injury triggers an inflammatory response in the brain, leading to

  6. Building Your Baby's Brain: A Parent's Guide to the First Five Years = Como estimular el cerebro infantil: Una guia para padres de familia.

    Science.gov (United States)

    Dodge, Diane Trister; Heroman, Cate

    Noting that all parents can help their baby's brain to grow, this guide, in English- and Spanish-language versions, explores what science has learned about infant brain development and how parents and caregivers can influence cognitive development. Topics covered include: prenatal care, touching your baby, teaching about feelings and self-control,…

  7. Determination of Death and the Dead Donor Rule: A Survey of the Current Law on Brain Death

    Science.gov (United States)

    Nikas, Nikolas T.; Bordlee, Dorinda C.; Moreira, Madeline

    2016-01-01

    Despite seeming uniformity in the law, end-of-life controversies have highlighted variations among state brain death laws and their interpretation by courts. This article provides a survey of the current legal landscape regarding brain death in the United States, for the purpose of assisting professionals who seek to formulate or assess proposals for changes in current law and hospital policy. As we note, the public is increasingly wary of the role of organ transplantation in determinations of death, and of the variability of brain death diagnosing criteria. We urge that any attempt to alter current state statutes or to adopt a national standard must balance the need for medical accuracy with sound ethical principles which reject the utilitarian use of human beings and are consistent with the dignity of the human person. Only in this way can public trust be rebuilt. PMID:27097648

  8. Brain donation procedures in the Sudden Death Brain Bank in Edinburgh.

    Science.gov (United States)

    Smith, Colin; Millar, Tracey

    2018-01-01

    Brain banks typically receive donations through premortem consent procedures, often through disease-specific patient cohorts, such as dementia. While some control cases can be obtained through this route, access to age-matched control tissues, and some chronic neurologic conditions, particularly psychiatric disorders, can be challenging. The Edinburgh Sudden Death Brain Bank was established to try and increase access to control cases across all ages, and also access to psychiatric disorders through suicides. This chapter outlines the processes for establishing donations through medicolegal postmortems, which, although often with a prolonged postmortem interval, can provide high-quality well-characterized postmortem brain tissue to the neuroscience research community. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. How important is the duration of the brain death period for the outcome in kidney transplantation?

    NARCIS (Netherlands)

    Nijboer, Willemijn N.; Moers, Cyril; Leuvenink, Henri G. D.; Ploeg, Rutger J.

    P>In kidney transplantation, graft survival using grafts from donation after brain death (DBD) donors is inferior to results after living donation. However, little is known about the effect of the duration of brain death (BDdur) on outcome after transplantation. This is a retrospective Organ

  10. Scintigraphic evaluation of brain death with 99mTc-d,l-hexamethyl-propyleneamine oxime (HMPAO)

    International Nuclear Information System (INIS)

    Takehara, Yasuo; Isoda, Haruo; Sakai, Tsuneo; Tanaka, Tokutaro; Sato, Haruhiko; Yamamoto, Takamichi; Takahashi, Motoichiro; Kaneko, Masao.

    1989-01-01

    Lately, the criteria of brain death is being discussed. Cerebral scintigram, especially scintigraphic evaluation of brain death by dynamic study, has been previously reported. Cerebral imaging using radiolabeled amines such as 123 I-IMP N-isopropyl-p-iodoamphetamin (IMP) or 99m Tc d, l-hexamethyl-propyleneamine oxime (HMPAO) offers a significant information of brain death by the finding of 'non visualized brain'. However, the dynamic scintigram acquired during the bolus injection of 99m Tc-HMPAO provides an additional information of brain death by classical 'hot nose sign'. 99m Tc-HMPAO is able to be administered relatively in a large amount of dose. This cerebral perfusion tracer is lipophilic and remains in the central nervous system, which characterize its role as a reliable indicator of cerebral blood flow. As a result, this compound became suitable for the non-invasive study of brain circulation when the diagnosis of brain death is uncertain. We report a case of brain death in which diagnosis was made by the classical 'hot nose sign' in dynamic scintigraphy performed when 99 mTc-HMPAO was injected as well as the SPECT which showed a lack of cerebral visualization at the equilibrium state. As far as we are informed, this additional procedure used in the diagnosis of brain death has not reported before. The importance of performing a dynamic scintigram at the administration of 99m Tc-HMPAO is also discussed in this report. (author)

  11. Guias ópticos para sensores

    OpenAIRE

    Marcos de Castro Pacitti

    1993-01-01

    Neste trabalho foram estudados guias ópticos para atuarem como sensores ou em sistemas sensores. Ênfase especial foi dada em guias ópticos retangulares, para dispositivos ópticos integrados, e fibras ópticas elípticas. A analise de fibras ópticas elípticas resultou em um modelamento pratico para projeto das mesmas em aplicações onde se deseja operar com dois modos guiados, situação esta que se mostra muito atraente para implementação de diversos tipos de sensores a fibra óptica. A seguir es...

  12. Guideline of procedures 2003 for the gammagraphic study of brain death

    International Nuclear Information System (INIS)

    Mora R, R.A.

    2003-01-01

    The diagnosis of brain death is a clinical diagnosis that is sometimes made with the help of cerebral perfusion scintigraphy. It is important that all physicians be knowledgeable about the clinical requirements for the diagnosis of brain death, especially the need to establish irreversible cessation of all function of the cerebrum and brain stem. Institutions performing scintigraphy for the evaluation of possible brain death should develop clinical guidelines and procedures for the clinical diagnosis that incorporate both clinical evaluations and the integration of ancillary tests such as perfusion scintigraphy. (Author)

  13. Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination

    Directory of Open Access Journals (Sweden)

    Sung Wook Chang

    2016-05-01

    Full Text Available The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.

  14. [Evaluation of medical students knowledge on brain death].

    Science.gov (United States)

    Bitencourt, Almir Galvão Vieira; Neves, Flávia Branco Cerqueira Serra; Durães, Larissa; Nascimento, Diego Teixeira; Neves, Nedy Maria Branco Cerqueira; Torreão, Lara de Araújo; Agareno, Sydney

    2007-06-01

    Because brain death (BD) is a new concept and little divulged, it’s not well accepted in general population, including doctors and Medical students. This study aims to evaluate the knowledge of a sample of Medical students on the Brazilian BD diagnosis protocol. Descriptive cross-sectional survey that evaluated students from two medical schools in Salvador-BA. We used a questionnaire composed by questions about technical and ethical knowledge contained in the Federal Council of Medicine’s Resolution nº 1480/97 that establishes the criteria for BD diagnosis. We evaluated 115 Medical students. In 14 questions about the knowledge of BD criteria, the mean of right answers were 6.7 ± 1.8, which were higher among the students that had attended some presentation on BD. Most of the students (87.4%) knew how to identify the candidates to the BD diagnosis protocol. However, only 5.2% and 16.1% of the students answered right, respectively, the clinical and complementary tests that should be accomplished during the diagnosis protocol. Facing a no-donor patient with confirmed diagnosis of BD, 66.4% referred that artificial life support should be suspended. Only 15% of the interviewed students had already evaluated a patient with BD, being this percentage higher among those who had already frequented ICU (38.2% versus 5.1%; p knowledge of the evaluated students on BD diagnosis criteria, mainly in relation to the practical approach of this condition.

  15. Brain death: close relatives' use of imagery as a descriptor of experience.

    Science.gov (United States)

    Frid, Ingvar; Haljamäe, Hengo; Ohlén, Joakim; Bergbom, Ingegerd

    2007-04-01

    This paper is a report of a study to explore the use of imagery to describe the experience of confronting brain death in a close relative. The brain death of a loved one has been described as an extremely difficult experience for close relatives, evoking feelings of anger, emotional pain, disbelief, guilt and suffering. It can also be difficult for relatives to distinguish brain death from the state of coma and thus difficult to apprehend information about the diagnosis. Narrative theory and a hermeneutic phenomenological method guided the interpretation of 17 narratives from close relatives of brain dead patients. All narratives were scrutinized for experiences of brain death. Data were primarily collected in 1999. The primary analysis related to close relatives' experience of brain death in a loved one. A secondary analysis of the imagery they used to describe their experience was carried out in 2003. Six categories of imagery used to describe the experience of confronting a diagnosis of brain death in a loved one emerged: chaotic unreality; inner collapse; sense of forlornness; clinging to the hope of survival; reconciliation with the reality of death; receiving care which gives comfort. Participants also identified two pairs of dimensions to describe their feelings about the relationship between their brain dead relative's body and personhood: presence-absence and divisibility-indivisibility. Being confronted with brain death meant entering into the anteroom of death, facing a loved one who is 'living-dead', and experiencing a chaotic drama of suffering. It is very important for members of the intensive care unit team to recognize, face and respond to these relatives' chaotic experiences, which cause them to need affirmation, comfort and caring. Relatives' use of imagery could be the starting point for a caring conversation about their experiences, either in conversations at the time of the death or when relatives are contacted in a later follow-up.

  16. Which experimental model can sensitively indicate brain death by functional near-infrared spectroscopy?

    Science.gov (United States)

    Pan, Boan; Liu, Weichao; Fang, Xiang; Huang, Xiaobo; Li, Ting

    2018-02-01

    Brain death is defined as permanent loss of the brain functions. The evaluation of it has many meanings, such as the relief of organ transplantation stress and family burden. However, it is hard to be judged precisely. The standard clinical tests are expensive, time consuming and even dangerous, and some auxiliary methods have limitations. Functional near infrared spectroscopy (fNIRS), monitoring cerebral hemodynamic responses noninvasively, evaluate brain death in some papers published, but there is no discussion about which experimental mode can monitor brain death patient more sensitively. Here, we attempt to use our fNIRS to evaluate brain death and find which experimental mode is effective. In order to discuss the problem, we detected eleven brain death patients and twenty normal patients under natural state. They were provided different fraction of inspiration O2 (FIO2) in different phase. We found that the ratio of Δ[HbO2] (the concentration changes in oxyhemoglobin) to Δ[Hb] (the concentration changes in deoxyhemoglobin) in brain death patients is significantly higher than normal patients in FIO2 experiment. Combined with the data analysis result, restore oxygen change process and low-high-low paradigm is more sensitively.

  17. Use of Ancillary Tests When Determining Brain Death in Pediatric Patients in the United States.

    Science.gov (United States)

    Lewis, Ariane; Adams, Nellie; Chopra, Arun; Kirschen, Matthew P

    2017-10-01

    Although pediatric brain death guidelines stipulate when ancillary testing should be used during brain death determination, little is known about the way these recommendations are implemented in clinical practice. We conducted a survey of pediatric intensivists and neurologists in the United States on the use of ancillary testing. Although most respondents noted they only performed an ancillary test if the clinical examination and apnea test could not be completed, 20% of 195 respondents performed an ancillary test for other reasons, including (1) to convince a family that objected to the brain death determination that a patient is truly dead (n = 21), (2) personal preference (n = 14), and (3) institutional requirement (n = 5). Our findings suggest that pediatricians use ancillary tests for a variety of reasons during brain death determination. Medical societies and governmental regulatory bodies must reinforce the need for homogeneity in practice.

  18. The significance of faint visualization of the superior sagittal sinus in brain scintigraphy for the diagnosis of brain death

    International Nuclear Information System (INIS)

    Bisset, R.; Sfakianakis, G.; Ihmedian, I.; Holzman, B.; Curless, R.; Serafini, A.

    1985-01-01

    Brain death is associated with cessation of blood flow to the brain. Tc-99m brain flow studies are used as a laboratory confirmatory test for the establishment of the diagnosis of brain death. Criteria for the diagnosis of cessation of blood flow to the brain are 1) visualization of carotid artery activity in the neck of the patient and 2) no visualization of activity in the distribution of the anterior and middle cerebral arteries. The authors noticed that in a significant number of patients, although there was no visualization of arterial blood flow to the brain the static images demonstrated faint accumulation of activity in the region of the superior sagittal sinus (SSS). In a four year period 212 brain flow studies were performed in 154 patients for diagnosis of brain death; of them 137 studies (65%) showed no evidence of arterial flow. In 103 out of the 137 studies (75%) there was no visualization of the SSS; in the remaining 34 studies (3l patients) however three patterns of faint activity attributed to partial and or faint visualization of the SSS could be recognized at the midline of the immediate anterior static view: a) linear from the cranial vault floor up b) disk shaped at the apex of the vault and c) disk shaped at the apex tailing caudad. All of the 3l patients in this group satisfied brain death criteria within four days of the last study which showed faint visualization of the superior sagittal sinus. The authors conclude that even in the presence of a faint visualization of the superior sagittal sinus on static post brain flow scintigraphy, the diagnosis of cessation of blood flow to the brain can be made if there is no evidence of arterial blood flow

  19. Sumoylation of hypoxia-inducible factor-1α ameliorates failure of brain stem cardiovascular regulation in experimental brain death.

    Directory of Open Access Journals (Sweden)

    Julie Y H Chan

    2011-03-01

    Full Text Available One aspect of brain death is cardiovascular deregulation because asystole invariably occurs shortly after its diagnosis. A suitable neural substrate for mechanistic delineation of this aspect of brain death resides in the rostral ventrolateral medulla (RVLM. RVLM is the origin of a life-and-death signal that our laboratory detected from blood pressure of comatose patients that disappears before brain death ensues. At the same time, transcriptional upregulation of heme oxygenase-1 in RVLM by hypoxia-inducible factor-1α (HIF-1α plays a pro-life role in experimental brain death, and HIF-1α is subject to sumoylation activated by transient cerebral ischemia. It follows that sumoylation of HIF-1α in RVLM in response to hypoxia may play a modulatory role on brain stem cardiovascular regulation during experimental brain death.A clinically relevant animal model that employed mevinphos as the experimental insult in Sprague-Dawley rat was used. Biochemical changes in RVLM during distinct phenotypes in systemic arterial pressure spectrum that reflect maintained or defunct brain stem cardiovascular regulation were studied. Western blot analysis, EMSA, ELISA, confocal microscopy and immunoprecipitation demonstrated that drastic tissue hypoxia, elevated levels of proteins conjugated by small ubiquitin-related modifier-1 (SUMO-1, Ubc9 (the only known conjugating enzyme for the sumoylation pathway or HIF-1α, augmented sumoylation of HIF-1α, nucleus-bound translocation and enhanced transcriptional activity of HIF-1α in RVLM neurons took place preferentially during the pro-life phase of experimental brain death. Furthermore, loss-of-function manipulations by immunoneutralization of SUMO-1, Ubc9 or HIF-1α in RVLM blunted the upregulated nitric oxide synthase I/protein kinase G signaling cascade, which sustains the brain stem cardiovascular regulatory machinery during the pro-life phase.We conclude that sumoylation of HIF-1α in RVLM ameliorates brain stem

  20. Love and death: microglia, NLRP3 and the Alzheimer's brain.

    Science.gov (United States)

    Goldmann, Tobias; Tay, Tuan Leng; Prinz, Marco

    2013-05-01

    Microglia were previously attributed to be vital brain guardians for neuronal survival and synaptic pruning during development as well as for the brain's fight against environmental pathogens. A new report in Nature by the Heneka, Latz and Golenbock groups, however, sheds new light on these distinct myeloid cells by revealing their deadly nature for mature neurons during neurodegeneration.

  1. A consideration of the ethics of brain death--what are the ethical guidelines for physician, family and society in dealing with brain death?

    Science.gov (United States)

    Brooks, C M

    1985-06-01

    There is at present considerable confusion with respect to ethical guidelines that should govern the behavior of society and the physician confronted by problems resulting from recent attainments of medicine and science. The use of life supporting devices raises the problem of determining when death has occurred and what is proper ethical procedure in dealing with the deficient half life caused by "Brain Death." Some guidance is obtained from a consideration of the nature of life, the nature of death, the nature of man, and the essence lost in death of man. A parallel consideration of the nature of ethics, the bases of ethics and of ethical decision can be helpful. An individual may have ideals which control behavior, even elevate ethical standards; others entertain concepts that destroy social ethics. Ethics control and direct social interactions; ethics determine the quality of social behavior--ethics are established by societies not by individuals. Numerous commissions have endeavored to define the requirements of physicians for diagnosing brain death and for appropriate subsequent actions. The rationales presented, however, are not invariably accepted by lay society. The problem is created by numerous trends. Among them are the "rightest" movement which, though possessing many virtues, has its excesses such as expressed in the "right to life movement." These have not been beneficial and have necessitated "right to death movements." Opposition is also due to the fact that society's concepts of the medical profession have changed. The practice of organ transplantation has created problems. Finally, the concept of death as other than evil is no longer generally accepted. As more biological manipulations are possible ever more difficult ethical problems will arise. It is a certainty, however, that when brain death has occurred life of man and that of the individual has ended. Although others might not agree, our ethic requires us to use life assist techniques to

  2. Brain death in the pediatric patient: historical, sociological, medical, religious, cultural, legal, and ethical considerations.

    Science.gov (United States)

    Farrell, M M; Levin, D L

    1993-12-01

    To detail the origins of the definition of death, the development of the criterion of whole brain death as fulfilling the definition of death, and the tests used to fulfill that criterion. A review of the literature was performed. No Institutional Review Board approval was necessary. In 1959, patients were described as being in "coma dépassé" or beyond coma. In 1967, the first successful heart transplantation took place, with the organ coming from a brain-dead, beating-heart donor. However, anxiety over the definitions of death did not begin with the modern, technological era, and death itself has never been definable in objective terms. It has always been a subjective and value-based construct. During ancient times, most people agreed that death occurred when a person's heartbeat and breathing stopped. For the Greeks, the heart was the center of life; for the ancient Hebrews and Christians, the breath was the center of life. In the 12th century, Maimonides pointed toward the head, and the loss thereof, as the reason for lack of central guidance of the soul. Physicians neither diagnosed nor certified death. During the Enlightenment, the necessity of heartbeat, breath, and consciousness for the definition of life was questioned, leading to questioning regarding the definition of death. Tests to fulfill the criteria of death, and tests to determine the absence of integration between functions of respiration, circulation, and neurology were introduced. Sensorimotor potential was becoming recognized as defining life, rather than heartbeat and respiration. As new tests were devised to fulfill criteria of death, the physician developed a professional monopoly on meeting the criteria of brain death. In the modern era, the boundary between life and death has been blurred, but the intensive care unit straddles this boundary. We may have situations where the patient is alive but in a coma, without functioning heart, lungs, kidneys, or gastrointestinal tract, with a

  3. Serial recording of median nerve stimulated subcortical somatosensory evoked potentials (SEPs) in developing brain death.

    Science.gov (United States)

    Buchner, H; Ferbert, A; Hacke, W

    1988-01-01

    Subcortical somatosensory evoked potentials (SEPs) to median nerve stimulation were recorded serially in 35 patients during the evolution towards brain death and in brain death. Neuropathological alterations of the central nervous system down to the C1/C2 spinal cord segment in brain death are well known. SEP components supposed to be generated above this level should be lost in brain death, while components generated below should not be altered. Erb's point, scalp and neck potentials were recorded at C3/4, or over the spinous process C7, using an Fz reference. In 10 patients additional montages, including spinous process C2-Fz, a non-cephalic reference (Fz-contralateral shoulder) and a posterior to anterior neck montage (spinous process C7-jugulum) were used. The cephalic referenced N9 and N11 peaks remained unchanged until brain death. N9 and N11 decreased in parallel in amplitude and increased in latency after systemic effects like hypoxia or hypothermia occurred. The cephalic referenced 'N14' decreased in amplitude and increased in latency after the clinical brain death syndrome was observed, while N13 in the posterior to anterior neck montage remained unchanged. The alteration of 'N14' went parallel to the decrease of the P14 amplitude. The subcortical SEPs in the cephalic referenced lead are supposed to be a peak composed by a horizontally orientated dorsal horn generated N13 and a rostrally orientated P14 arising at the level of the foramen magnum. The deterioration of the non-cephalic referenced P14 and of its cephalic referenced reflection 'N14' seems to provide an additional objective criterion for the diagnosis of brain death.

  4. The degree of certainty in brain death: probability in clinical and Islamic legal discourse.

    Science.gov (United States)

    Qazi, Faisal; Ewell, Joshua C; Munawar, Ayla; Asrar, Usman; Khan, Nadir

    2013-04-01

    The University of Michigan conference "Where Religion, Policy, and Bioethics Meet: An Interdisciplinary Conference on Islamic Bioethics and End-of-Life Care" in April 2011 addressed the issue of brain death as the prototype for a discourse that would reflect the emergence of Islamic bioethics as a formal field of study. In considering the issue of brain death, various Muslim legal experts have raised concerns over the lack of certainty in the scientific criteria as applied to the definition and diagnosis of brain death by the medical community. In contrast, the medical community at large has not required absolute certainty in its process, but has sought to eliminate doubt through cumulative diagnostic modalities and supportive scientific evidence. This has recently become a principal model, with increased interest in data analysis and evidence-based medicine with the intent to analyze and ultimately improve outcomes. Islamic law has also long employed a systematic methodology with the goal of eliminating doubt from rulings regarding the question of certainty. While ample criticism of the scientific criteria of brain death (Harvard criteria) by traditional legal sources now exists, an analysis of the legal process in assessing brain death, geared toward informing the clinician's perspective on the issue, is lacking. In this article, we explore the role of certainty in the diagnostic modalities used to establish diagnoses of brain death in current medical practice. We further examine the Islamic jurisprudential approach vis-à-vis the concept of certainty (yaqīn). Finally, we contrast the two at times divergent philosophies and consider what each perspective may contribute to the global discourse on brain death, understanding that the interdependence that exists between the theological, juridical, ethical, and medical/scientific fields necessitates an open discussion and active collaboration between all parties. We hope that this article serves to continue the

  5. Brain death and Islam: the interface of religion, culture, history, law, and modern medicine.

    Science.gov (United States)

    Miller, Andrew C; Ziad-Miller, Amna; Elamin, Elamin M

    2014-10-01

    How one defines death may vary. It is important for clinicians to recognize those aspects of a patient's religious beliefs that may directly influence medical care and how such practices may interface with local laws governing the determination of death. Debate continues about the validity and certainty of brain death criteria within Islamic traditions. A search of PubMed, Scopus, EMBASE, Web of Science, PsycNet, Sociological Abstracts, DIALOGUE ProQuest, Lexus Nexus, Google, and applicable religious texts was conducted to address the question of whether brain death is accepted as true death among Islamic scholars and clinicians and to discuss how divergent opinions may affect clinical care. The results of the literature review inform this discussion. Brain death has been acknowledged as representing true death by many Muslim scholars and medical organizations, including the Islamic Fiqh Academies of the Organization of the Islamic Conference and the Muslim World League, the Islamic Medical Association of North America, and other faith-based medical organizations as well as legal rulings by multiple Islamic nations. However, consensus in the Muslim world is not unanimous, and a sizable minority accepts death by cardiopulmonary criteria only.

  6. Programmed Necrosis: A Prominent Mechanism of Cell Death following Neonatal Brain Injury

    Directory of Open Access Journals (Sweden)

    Raul Chavez-Valdez

    2012-01-01

    Full Text Available Despite the introduction of therapeutic hypothermia, neonatal hypoxic ischemic (HI brain injury remains a common cause of developmental disability. Development of rational adjuvant therapies to hypothermia requires understanding of the pathways of cell death and survival modulated by HI. The conceptualization of the apoptosis-necrosis “continuum” in neonatal brain injury predicts mechanistic interactions between cell death and hydrid forms of cell death such as programmed or regulated necrosis. Many of the components of the signaling pathway regulating programmed necrosis have been studied previously in models of neonatal HI. In some of these investigations, they participate as part of the apoptotic pathways demonstrating clear overlap of programmed death pathways. Receptor interacting protein (RIP-1 is at the crossroads between types of cellular death and survival and RIP-1 kinase activity triggers formation of the necrosome (in complex with RIP-3 leading to programmed necrosis. Neuroprotection afforded by the blockade of RIP-1 kinase following neonatal HI suggests a role for programmed necrosis in the HI injury to the developing brain. Here, we briefly review the state of the knowledge about the mechanisms behind programmed necrosis in neonatal brain injury recognizing that a significant proportion of these data derive from experiments in cultured cell and some from in vivo adult animal models. There are still more questions than answers, yet the fascinating new perspectives provided by the understanding of programmed necrosis in the developing brain may lay the foundation for new therapies for neonatal HI.

  7. An educational initiative to improve medical student awareness about brain death.

    Science.gov (United States)

    Lewis, Ariane; Howard, Jonathan; Watsula-Morley, Amanda; Gillespie, Colleen

    2018-04-01

    Medical student knowledge about brain death determination is limited. We describe an educational initiative to improve medical student awareness about brain death and assess the impact of this initiative. Beginning in July 2016, students at our medical school were required to attend a 90-min brain death didactic and simulation session during their neurology clerkship. Students completed a test immediately before and after participating in the initiative. Of the 145 students who participated in this educational initiative between July 2016 and June 2017, 124 (86%) consented to have their data used for research purposes as part of a medical education registry. Students correctly answered a median of 53% of questions (IQR 47-58%) on the pretest and 86% of questions (IQR 78-89%) on the posttest (p initiative (18% of students were comfortable performing a brain death evaluation before the initiative and 86% were comfortable doing so after the initiative, p initiative and 76% were comfortable doing so after the initiative, p initiative, but awareness and comfort dealing with brain death improved significantly after this initiative. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. Care pathways for organ donation after brain death: guidance from available literature?

    Science.gov (United States)

    Hoste, Pieter; Vanhaecht, Kris; Ferdinande, Patrick; Rogiers, Xavier; Eeckloo, Kristof; Blot, Stijn; Hoste, Eric; Vogelaers, Dirk; Vandewoude, Koenraad

    2016-10-01

    A discussion of the literature concerning the impact of care pathways in the complex and by definition multidisciplinary process of organ donation following brain death. Enhancing the quality and safety of organs for transplantation has become a central concern for governmental and professional organizations. At the local hospital level, a donor coordinator can use a range of interventions to improve the donation and procurement process. Care pathways have been proven to represent an effective intervention in several settings for optimizing processes and outcomes. A discussion paper. A systematic review of the Medline, CINAHL, EMBASE and The Cochrane Library databases was conducted for articles published until June 2015, using the keywords donation after brain death and care pathways. Each paper was reviewed to investigate the effects of existing care pathways for donation after brain death. An additional search for unpublished information was conducted. Although literature supports care pathways as an effective intervention in several settings, few studies have explored its use and effectiveness for complex care processes such as donation after brain death. Nurses should be aware of their role in the donation process. Care pathways have the potential to support them, but their effectiveness has been insufficiently explored. Further research should focus on the development and standardization of the clinical content of a care pathway for donation after brain death and the identification of quality indicators. These should be used in a prospective effectiveness assessment of the proposed pathway. © 2016 John Wiley & Sons Ltd.

  9. Morphological and functional alterations in the adenohypophysis in cases of brain death.

    Science.gov (United States)

    Ishikawa, Takaki; Michiue, Tomomi; Quan, Li; Zhao, Dong; Komatsu, Ayumi; Bessho, Yasumori; Maeda, Hitoshi

    2009-04-01

    In order to examine the function of the adenohypophysis during brain death, levels of adrenocorticotropic hormone (ACTH), growth hormone (GH), and thyroid stimulating hormone (TSH) were investigated during forensic autopsy. Cases examined were those of brain death (n=12; within 24h postmortem; time to cardiac death after cerebral death was diagnosed, approximately 4-25 days), including those in which the cause of death was head injury (subdural hematoma or brain contusion, n=10) and asphyxia (strangulation, n=2). The concentrations of ACTH and TSH were measured by enzyme chemiluminescent immunoassay (ECLIA), and that of GH by radioimmunoassay (RIA). The immunoreactivities of ACTH, GH, and TSH in the adenohypophysis were observed and analyzed with electron microscopy. Morphological studies revealed partial necrosis of the central anterior lobe, but preservation of its periphery. Immunohistochemical staining revealed the appearance of peripheral adenohypophysis with each hormone. Ultrastructural findings for the pituitary and hypothalamus indicated swelling of the mitochondria and dilation of both the smooth endoplasmic reticulum and Golgi apparatus. Furthermore, in most cases, concentrations of the anterior pituitary hormones in the serum and cerebrospinal fluid (CSF) were generally within the clinical reference range. These results indicate that the pituitary is partially preserved after brain death.

  10. East-West differences in perception of brain death. Review of history, current understandings, and directions for future research.

    Science.gov (United States)

    Yang, Qing; Miller, Geoffrey

    2015-06-01

    The concept of brain death as equivalent to cardiopulmonary death was initially conceived following developments in neuroscience, critical care, and transplant technology. It is now a routine part of medicine in Western countries, including the United States. In contrast, Eastern countries have been reluctant to incorporate brain death into legislation and medical practice. Several countries, most notably China, still lack laws recognizing brain death and national medical standards for making the diagnosis. The perception is that Asians are less likely to approve of brain death or organ transplant from brain dead donors. Cultural and religious traditions have been referenced to explain this apparent difference. In the West, the status of the brain as home to the soul in Enlightenment philosophy, combined with pragmatism and utilitarianism, supports the concept of brain death. In the East, the integration of body with spirit and nature in Buddhist and folk beliefs, along with the Confucian social structure that builds upon interpersonal relationships, argues against brain death. However, it is unclear whether these reasoning strategies are explicitly used when families and medical providers are faced with acknowledging brain death. Their decisions are more likely to involve a prioritization of values and a rationalization of intuitive responses. Why and whether there might be differences between East and West in the acceptance of the brain death concept requires further empirical testing, which would help inform policy-making and facilitate communication between providers and patients from different cultural and ethnic backgrounds.

  11. [Brain death in children--how to deal with the parents?].

    Science.gov (United States)

    Schindler, Nicola; Vagts, Dierk

    2008-07-01

    For parents the death of children is hard to bear and to accept. In situations where a brain death needs to be diagnosed, the psychological stress for parents who lose their child is aggravated due to a mostly sudden and unprepared confrontation with this situation. The rationality to accept the death of a their child is opposed by the hope for recovery as long as the children are "warm and dead" instead of "cold and dead" due to the maintenance of cardiac circulation. In Germany in this situation, after diagnosing the brain death, doctors are forced by legislation to ask the parents to agree for organ donation. However, to our knowledge, no literature is available how doctors should conduct such an important conversation to the parents. This manuscript tries to give some hints for conducting a conversation from the psychological background of mourning and from our own experience gained during the last 5 years.

  12. Death following traumatic brain injury in Drosophila is associated with intestinal barrier dysfunction

    Science.gov (United States)

    Katzenberger, Rebeccah J; Chtarbanova, Stanislava; Rimkus, Stacey A; Fischer, Julie A; Kaur, Gulpreet; Seppala, Jocelyn M; Swanson, Laura C; Zajac, Jocelyn E; Ganetzky, Barry; Wassarman, David A

    2015-01-01

    Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Unfavorable TBI outcomes result from primary mechanical injuries to the brain and ensuing secondary non-mechanical injuries that are not limited to the brain. Our genome-wide association study of Drosophila melanogaster revealed that the probability of death following TBI is associated with single nucleotide polymorphisms in genes involved in tissue barrier function and glucose homeostasis. We found that TBI causes intestinal and blood–brain barrier dysfunction and that intestinal barrier dysfunction is highly correlated with the probability of death. Furthermore, we found that ingestion of glucose after a primary injury increases the probability of death through a secondary injury mechanism that exacerbates intestinal barrier dysfunction. Our results indicate that natural variation in the probability of death following TBI is due in part to genetic differences that affect intestinal barrier dysfunction. DOI: http://dx.doi.org/10.7554/eLife.04790.001 PMID:25742603

  13. Attitudes to brain death and organ procurement among university students and critical care physicians in poland.

    Science.gov (United States)

    Kubler, A; Lipinska-Gediga, M; Kedziora, J; Kubler, M

    2009-06-01

    The practice of retrieving vital organs from brain-dead heart-beating donors is legally and medically accepted in Poland, but public beliefs and opinions regarding these matters have not been sufficiently explored. The purpose of this study was to evaluate the attitude of university students to the concepts of brain death and organ retrieval, compared with the attitude of critical care physicians. The cohorts of 989 students and 139 physicians completed a questionnaire based on a survey instrument developed in an earlier reported study on Ohio residents. Participants assessed 3 scenarios: (1) brain death, (2) coma, and (3) vegetative state. More than 48% of students classified the patient from the brain death scenario as alive, and 51% of them were willing to donate organs of this patient. Ninety percent of students classified the patients in coma and in a vegetative state as alive, but still 34% of them would donate organs of those patients. The group of physicians properly determined the patients' diagnoses, but 10% of them accepted organ procurement from patients in coma and in a vegetative state. Our results supported the earlier observations of low public knowledge and inadequate understanding of brain death criteria and organ procurement processes. The majority of students were willing to accept organ procurement from severely ill but alive patients, in contrast with physicians. A considerable increase in public educational activity in this field is urgently recommended.

  14. Roles of inflammation and apoptosis in experimental brain death-induced right ventricular failure.

    Science.gov (United States)

    Belhaj, Asmae; Dewachter, Laurence; Rorive, Sandrine; Remmelink, Myriam; Weynand, Birgit; Melot, Christian; Galanti, Laurence; Hupkens, Emeline; Sprockeels, Thomas; Dewachter, Céline; Creteur, Jacques; McEntee, Kathleen; Naeije, Robert; Rondelet, Benoît

    2016-12-01

    Right ventricular (RV) dysfunction remains the leading cause of early death after cardiac transplantation. Methylprednisolone is used to improve graft quality; however, evidence for that remains empirical. We sought to determine whether methylprednisolone, acting on inflammation and apoptosis, might prevent brain death-induced RV dysfunction. After randomization to placebo (n = 11) or to methylprednisolone (n = 8; 15 mg/kg), 19 pigs were assigned to a brain-death procedure. The animals underwent hemodynamic evaluation at 1 and 5 hours after Cushing reflex (i.e., hypertension and bradycardia). The animals euthanized, and myocardial tissue was sampled. This was repeated in a control group (n = 8). At 5 hours after the Cushing reflex, brain death resulted in increased pulmonary artery pressure (27 ± 2 vs 18 ± 1 mm Hg) and in a 30% decreased ratio of end-systolic to pulmonary arterial elastances (Ees/Ea). Cardiac output and right atrial pressure did not change. This was prevented by methylprednisolone. Brain death-induced RV dysfunction was associated with increased RV expression of heme oxygenase-1, interleukin (IL)-6, IL-10, IL-1β, tumor necrosis factor (TNF)-α, IL-1 receptor-like (ST)-2, signal transducer and activator of transcription-3, intercellular adhesion molecules-1 and -2, vascular cell adhesion molecule-1, and neutrophil infiltration, whereas IL-33 expression decreased. RV apoptosis was confirmed by terminal deoxynucleotide transferase-mediated deoxy uridine triphosphate nick-end labeling staining. Methylprednisolone pre-treatment prevented RV-arterial uncoupling and decreased RV expression of TNF-α, IL-1 receptor-like-2, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and neutrophil infiltration. RV Ees/Ea was inversely correlated to RV TNF-α and IL-6 expression. Brain death-induced RV dysfunction is associated with RV activation of inflammation and apoptosis and is partly limited by methylprednisolone. Copyright © 2016

  15. Depictions of 'brain death' in the media: medical and ethical implications.

    Science.gov (United States)

    Daoust, Ariane; Racine, Eric

    2014-04-01

    Debates and controversies have shaped the understanding and the practices related to death determined by neurological criterion (DNC). Confusion about DNC in the public domain could undermine this notion. This confusion could further jeopardise confidence in rigorous death determination procedures, and raise questions about the integrity, sustainability, and legitimacy of modern organ donation practices. We examined the depictions of 'brain death' in major American and Canadian print media to gain insights into possible common sources of confusion about DNC and the relationship between expert and lay views on this crucial concept. We gathered 940 articles, available in electronic databases, published between 2005 and 2009 from high-circulation Canadian and American newspapers containing keywords 'brain dead' or 'brain death'. Articles were systematically examined for content (eg, definitions of brain death and criteria for determination of death) using the NVivo 8 software. Our results showed problematic aspects in American and Canadian media, with some salient differences. DNC was used colloquially in 39% (N=366) of the articles and its medical meaning infrequently defined (2.7%; N=14 in the USA and 3.6%; N=15 in Canada). The neurological criterion for determination of death was mentioned in less than 10% of the articles, and life support in about 20% of the articles. Organ donation issues related to DNC were raised more often in Canadian articles than in American articles (33.5% vs 21.2%; p<0.0001). Further discussion is needed to develop innovative strategies to bridge media representations of DNC with experts' views in connection with organ donation practices.

  16. Pupil diameter for confirmation of brain death in adult organ donors in Japan.

    Science.gov (United States)

    Sagishima, Katsuyuki; Kinoshita, Yoshihiro

    2017-01-01

    The criteria for brain death in Japan include a bilateral pupil diameter of ≥4 mm. We evaluated the appropriateness of a 4-mm pupil diameter in adult brain-dead donors in Japan. We retrospectively reviewed the records of 148 consecutive adult brain-dead donors with an average age of 46 years. All records were anonymously registered to the Japanese Ministry of Health, Labour and Welfare (the Japanese Ministry of Health and Welfare before 2001) from the various designated emergency institutes that performed organ donation under brain death from 1999 to 2012 in Japan. All donors had a Glasgow Coma Scale score of 3, absence of all seven brain stem reflexes, an isoelectric electroencephalogram for >30 min, and apnea as tested by the standard method. All of these examinations were repeated approximately 6 h later for confirmation. The pupil diameter (average ± standard deviation) was 6.1 ± 1.1 mm at the first assessment and 6.4 ± 1.1 mm approximately 6 h later. The 95% probability distribution as calculated by statistical analysis was 3.93-8.30 mm in the left eye and 3.88-8.28 mm in the right eye in the first assessment, and 4.25-8.58 mm in the left eye and 4.32-8.43 mm in the right eye approximately 6 h later. Despite the various original causes of brain death, we conclude that a pupil diameter of ≥4 mm is a reasonable criterion for brain death in adults.

  17. Nitric oxide synthase expression and apoptotic cell death in brains of AIDS and AIDS dementia patients

    NARCIS (Netherlands)

    Vincent, V. A.; de Groot, C. J.; Lucassen, P. J.; Portegies, P.; Troost, D.; Tilders, F. J.; van Dam, A. M.

    1999-01-01

    To determine the occurrence and cellular localization of inducible nitric oxide synthase (iNOS), NOS activity and its association with cell death in brains of AIDS and AIDS dementia complex (ADC) patients. Post-mortem cerebral cortex tissue of eight AIDS patients, eight ADC patients and eight

  18. Beacon signal in transcranial color coded ultrasound: A sign for brain death

    Directory of Open Access Journals (Sweden)

    Mehmet Akif Topçuoğlu

    2014-04-01

    Full Text Available A widely under-recognized brain-death confirming transcranial ultrasonography pattern resembling the red-blue beacon signal was demonstrated. Familiarity to this distinct and characteristic ultrasonic pattern seems to be important in the perspective of point-of-care neurological ultrasound use and knobology.

  19. Slow induction of brain death leads to decreased renal function and increased hepatic apoptosis in rats

    NARCIS (Netherlands)

    Rebolledo, Rolando A.; Hoeksma, Dane; Hottenrott, Christina M. V.; Bodar, Yves J. L.; Ottens, Petra J.; Wiersema-Buist, Janneka; Leuvenink, Henri G. D.

    2016-01-01

    Background: Donor brain death (BD) is an independent risk factor for graft survival in recipients. While in some patients BD results from a fast increase in intracranial pressure, usually associated with trauma, in others, intracranial pressure increases more slowly. The speed of intracranial

  20. Cardiotocographic and Doppler Ultrasonographic Findings in a Fetus with Brain Death Syndrome

    Directory of Open Access Journals (Sweden)

    Yi-Ting Chen

    2006-09-01

    Conclusion: The possibility of intrauterine brain death should be considered in all cases of prolonged fixed FHR pattern, accompanied by absence of neuromuscular parameters of BPP, polyhydramnios and demonstrated cessation of cerebral blood flow by Doppler US. Increased awareness of this event may prevent unnecessary emergency cesarean section.

  1. Digital subtraction angiography - a new approach to brain death determination in the newborn

    International Nuclear Information System (INIS)

    Albertini, A.; Schonfeld, S.; Hiatt, M.; Hegyi, T.

    1993-01-01

    The diagnosis of brain death in the newborn infants is elusive and often difficult. The lack of cerebral blood flow has become an identified criterion for loss of cerebral function. The diagnosis can be obtained by the technique of digital subtraction angiography, which is presented in two case reports demonstrating the utility of this technique. (orig.)

  2. [Structural Equation Modeling on Living and Brain Death Organ Donation Intention in Nursing Students].

    Science.gov (United States)

    Kim, Eun A; Choi, So Eun

    2015-12-01

    The purpose of this study was to test and validate a model to predict living and brain death organ donation intention in nursing students. The conceptual model was based on the theory planned behavior. Quota sampling methodology was used to recruit 921 nursing students from all over the country and data collection was done from October 1 to December 20, 2013. The model fit indices for the hypothetical model were suitable for the recommended level. Knowledge, attitude, subjective norm and perceived behavioral control explained 40.2% and 40.1% respectively for both living and brain death organ donation intention. Subjective norm was the most direct influential factor for organ donation intention. Knowledge had significant direct effect on attitude and indirect effect on subjective norm and perceived behavioral control. These effects were higher in brain death organ donation intention than in living donation intention. The overall findings of this study suggest the need to develop systematic education programs to increases knowledge about brain death organ donation. The development, application, and evaluation of intervention programs are required to improve subjective norm.

  3. A Case Report of Successful Kidney Donation After Brain Death Following Nicotine Intoxication.

    Science.gov (United States)

    Räsänen, M; Helanterä, I; Kalliomäki, J; Savikko, J; Parry, M; Lempinen, M

    Nicotine intoxication is a rare cause of death and can lead to brain death after respiratory arrest and hypoxic-ischemic encephalopathy. To our knowledge, no previous reports regarding organ donation after nicotine intoxication have been described. We present a successful case of kidney donation after brain death caused by subcutaneous nicotine overdose from liquid nicotine from an e-cigarette cartridge in an attempted suicide. Both kidneys were transplanted successfully with immediate graft function, and both recipients were discharged at postoperative day 9 with normal plasma creatinine levels. Graft function has remained excellent in follow-up. This case suggests that kidneys from a donor with fatal nicotine intoxication may be successfully used for kidney transplantation in the absence of other contraindications for donation. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Human Traumatic Brain Injury Results in Oligodendrocyte Death and Increases the Number of Oligodendrocyte Progenitor Cells.

    Science.gov (United States)

    Flygt, Johanna; Gumucio, Astrid; Ingelsson, Martin; Skoglund, Karin; Holm, Jonatan; Alafuzoff, Irina; Marklund, Niklas

    2016-06-01

    Oligodendrocyte (OL) death may contribute to white matter pathology, a common cause of network dysfunction and persistent cognitive problems in patients with traumatic brain injury (TBI). Oligodendrocyte progenitor cells (OPCs) persist throughout the adult CNS and may replace dead OLs. OL death and OPCs were analyzed by immunohistochemistry of human brain tissue samples, surgically removed due to life-threatening contusions and/or focal brain swelling at 60.6 ± 75 hours (range 4-192 hours) postinjury in 10 severe TBI patients (age 51.7 ± 18.5 years). Control brain tissue was obtained postmortem from 5 age-matched patients without CNS disorders. TUNEL and CC1 co-labeling was used to analyze apoptotic OLs, which were increased in injured brain tissue (p The OPC markers Olig2, A2B5, NG2, and PDGFR-α were used. In contrast to the number of single-labeled Olig2, A2B5, NG2, and PDGFR-α-positive cells, numbers of Olig2 and A2B5 co-labeled cells were increased in TBI samples (p human TBI results in OL death and increases in OPCs postinjury, which may influence white matter function following TBI. © 2016 American Association of Neuropathologists, Inc. All rights reserved.

  5. Police Officers' Knowledge and Attitudes Toward Brain Death and Organ Donation in Korea.

    Science.gov (United States)

    Kim, H S; Yoo, Y S; Cho, O-H; Lee, C E; Choi, Y-H; Kim, H J; Park, J Y; Park, H S; Kwon, Y J

    2018-05-01

    Administrative processing by the police may affect the process involved in organ donation in the event of an accidental brain injury. The purpose of this study was to evaluate the knowledge and attitude of police toward brain-dead donors and organ donation. This was a descriptive research study using a 41-item questionnaire. As of July 19, 2017, 11 police stations in Seoul had collected questionnaires completed by 115 police officers. Data were analyzed using SAS (version 9.4) software. There were statistically significant differences in the scores on knowledge about brain death/donation according to religion (P = .022). Attitude was significantly positively correlated with the knowledge about brain-death organ donation (P = .029). It is necessary to understand and cooperate with the police when processing brain death organs from accidents. Education about organ donation can enhance the information and knowledge of the police and can also help to establish a positive attitude about organ donation. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. Letter: Can Islamic Jurisprudence Justify Procurement of Transplantable Vital Organs in Brain Death?

    Science.gov (United States)

    Rady, Mohamed Y

    2018-01-01

    In their article, "An International Legal Review of the Relationship between Brain Death and Organ Transplantation," in The Journal of Clinical Ethics 29, no. 1, Aramesh, Arima, Gardiner, and Shah reported on diverse international legislative approaches for justifying procurement of transplantable vital organs in brain death. They stated, "In Islamic traditions in particular, the notion of unstable life is a way to justify organ donation from brain-dead patients that we believe has not been fully described previously in the literature." This commentary queries the extent to which this concept is valid in accordance with the primary source of Islamic law, that is, the Quran. Copyright 2018 The Journal of Clinical Ethics. All rights reserved.

  7. Occupational risk factors for brain tumors. A case-referent death-certificate analysis

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, T.L.; Fontham, E.T.; Norman, S.A.; Stemhagen, A.; Hoover, R.N.

    1986-04-01

    Numerous studies have suggested that employment in the oil refining and chemical manufacturing industries may be associated with excess brain tumor risk. A case-referent study was undertaken to evaluate brain tumor risk by occupation and industry in three geographic areas (northern New Jersey, Philadelphia, and the Gulf Coast of Louisiana) with a heavy concentration of these industries. Seven hundred and eighteen white men dying from brain tumor at age 30 years or older were ascertained from death certificates for 1978-1981. The referents were men who died of other causes, excluding epilepsy and stroke. Usual occupation and industry were obtained from the death certificates, and the maximum likelihood estimates of the relative risk were calculated for specific industries and occupations. Small nonsignificant excess risks of brain tumors were seen among persons whose usual employment was in the petroleum refining, electrical equipment manufacturing, health services, and educational services industries. Compared with other white-collar professionals, health diagnosticians, teachers, and artists/designers had a significantly elevated brain tumor risk. Among blue-collar workers, the only group with a significantly elevated brain tumor risk was precision metal workers, who are exposed to metal dusts and fumes and substances used as coolants, lubricants, and degreasers.

  8. Administration of Protocatechuic Acid Reduces Traumatic Brain Injury-Induced Neuronal Death

    Directory of Open Access Journals (Sweden)

    Sang Hwon Lee

    2017-11-01

    Full Text Available Protocatechuic acid (PCA was first purified from green tea and has shown numerous biological activities, including anti-apoptotic, anti-inflammatory, and anti-atherosclerotic effects. The effect of PCA on traumatic brain injury (TBI-induced neuronal death has not previously been evaluated. TBI is defined as damage to the brain resulting from external mechanical force, such as rapid acceleration or deceleration, impact, blast waves, or penetration by a projectile. TBI causes neuronal death in the hippocampus and cerebral cortex. The present study aimed to evaluate the therapeutic potential of PCA on TBI-induced neuronal death. Here, TBI was induced by a controlled cortical impact model using rats. PCA (30 mg/kg was injected into the intraperitoneal (ip space immediately after TBI. Neuronal death was evaluated with Fluoro Jade-B (FJB staining at 24 h after TBI. Oxidative injury was detected by 4-hydroxy-2-nonenal (4HNE, glutathione (GSH concentration was analyzed by glutathione adduct with N-ethylmaleimide (GS-NEM staining at 24 h after TBI, and microglial activation in the hippocampus was detected by CD11b immunohistochemistry at one week after TBI. We found that the proportion of degenerating neurons, oxidative injury, GSH depletion, and microglia activation in the hippocampus and cortex were all reduced by PCA treatment following TBI. Therefore, our study suggests that PCA may have therapeutic potential in preventing TBI-induced neuronal death.

  9. Legal Standards for Brain Death and Undue Influence in Euthanasia Laws.

    Science.gov (United States)

    Pope, Thaddeus Mason; Okninski, Michaela E

    2016-06-01

    A major appellate court decision from the United States seriously questions the legal sufficiency of prevailing medical criteria for the determination of death by neurological criteria. There may be a mismatch between legal and medical standards for brain death, requiring the amendment of either or both. In South Australia, a Bill seeks to establish a legal right for a defined category of persons suffering unbearably to request voluntary euthanasia. However, an essential criterion of a voluntary decision is that it is not tainted by undue influence, and this Bill falls short of providing adequate guidance to assess for undue influence.

  10. An Aminopyridazine Inhibitor of Death Associated Protein Kinase Attenuates Hypoxia-Ischemia Induced Brain Damage

    Energy Technology Data Exchange (ETDEWEB)

    Velentza, A.V.; Wainwright, M.S.; Zasadzki, M.; Mirzoeva, S.; Haiech, J.; Focia, P.J.; Egli, M.; Watterson, D.M.

    2010-03-08

    Death associated protein kinase (DAPK) is a calcium and calmodulin regulated enzyme that functions early in eukaryotic programmed cell death, or apoptosis. To validate DAPK as a potential drug discovery target for acute brain injury, the first small molecule DAPK inhibitor was synthesized and tested in vivo. A single injection of the aminopyridazine-based inhibitor administered 6 h after injury attenuated brain tissue or neuronal biomarker loss measured, respectively, 1 week and 3 days later. Because aminopyridazine is a privileged structure in neuropharmacology, we determined the high-resolution crystal structure of a binary complex between the kinase domain and a molecular fragment of the DAPK inhibitor. The co-crystal structure describes a structural basis for interaction and provides a firm foundation for structure-assisted design of lead compounds with appropriate molecular properties for future drug development.

  11. The prolongation of somatic support in a pregnant woman with brain-death: a case report

    Directory of Open Access Journals (Sweden)

    Amaral Eliana

    2006-04-01

    Full Text Available Abstract Background Medical literature has increasingly reported cases of maternal brain death during pregnancy. This is a rare situation which demands the decision and, depending on the gestational age, the implementation of a set of measures to prolong the homeostasis of the human body after brain death for the purpose of maintaining the foetus alive until its viability. Case presentation A 40 year old woman suffered an intracranial haemorrhage during the 25th week of pregnancy. Despite neurosurgical drainage of a gross intraparenchymatous haematoma, the patient developed brain death. Upon confirmation of this diagnosis, she received full ventilatory and nutritional support, vasoactive drugs, maintenance of normothermia, hormone replacement and other supportive measures required to prolong gestation and improve the survival prognosis of her foetus. All decisions regarding the patient's treatment were taken in consensus with her family. She also received corticosteroids to accelerate foetal lung maturity. During the twenty-five days of somatic support, the woman's condition remained stable; however, during the last seven days the foetus developed oligohydramnios and brain-sparring, which led the medical team to take the decision to perform a Caesarean section at that moment. After delivery, the patient's organs were removed for donation. The male infant was born weighing 815 g, with an Apgar score of 9 and 10 at the first and fifth minutes, respectively. The infant was admitted to the neonatal intensive care unit, but did not require mechanical ventilation and had no major complications. He was discharged at 40 days of life, with no sequelae and weighing 1850 g. Conclusion These results are in accordance with findings from previous studies and case reports suggesting the appropriateness and safety of extended somatic support during pregnancy under certain circumstances. They also suggest the need for prompt diagnosis of brain death before the

  12. Hypotonic hyponatremia by primary polydipsia caused brain death in a 10-year-old boy

    Directory of Open Access Journals (Sweden)

    A Ra Ko

    2015-09-01

    Full Text Available Hypotonic hyponatremia by primary polydipsia can cause severe neurologic complications due to cerebral edema. A 10-year-and-4-month-old boy with a psychiatric history of intellectual disability and behavioral disorders who presented with chief complaints of seizure and mental change showed severe hypotonic hyponatremia with low urine osmolality (serum sodium, 101 mmol/L; serum osmolality, 215 mOsm/kg; urine osmolality, 108 mOsm/kg. The patient had been polydipsic for a few months prior, and this had been worse in the previous few days. A diagnosis of hypotonic hyponatremia caused by primary polydipsia was made. The patient was in a coma, and developed respiratory arrest and became brain death shortly after admission, despite the treatment. The initial brain magnetic resonance imaging showed severe brain swelling with tonsillar and uncal herniation, and the patient was declared as brain death. It has been reported that antidiuretic hormone suppression is inadequate in patients with chronic polydipsia, and that this inadequate suppression of antidiuretic hormone is aggravated in patients with acute psychosis. Therefore, hyponatremia by primary polydipsia, although it is rare, can cause serious and life-threatening neurologic complications.

  13. Brain Death in Pediatric Patients in Japan: Diagnosis and Unresolved Issues.

    Science.gov (United States)

    Araki, Takashi; Yokota, Hiroyuki; Fuse, Akira

    2016-01-01

    Brain death (BD) is a physiological state defined as complete and irreversible loss of brain function. Organ transplantation from a patient with BD is controversial in Japan because there are two classifications of BD: legal BD in which the organs can be donated and general BD in which the organs cannot be donated. The significance of BD in the terminal phase remains in the realm of scientific debate. As indicated by the increasing number of organ transplants from brain-dead donors, certain clinical diagnosis for determining BD in adults is becoming established. However, regardless of whether or not organ transplantation is involved, there are many unresolved issues regarding BD in children. Here, we will discuss the historical background of BD determination in children, pediatric emergencies and BD, and unresolved issues related to pediatric BD.

  14. Motricidade reflexa na morte cerebral The reflex activity in the brain death

    Directory of Open Access Journals (Sweden)

    Wilson L. Sanvito

    1972-03-01

    Full Text Available O diagnóstico de morte cerebral está baseado em critérios clínicos, eletrencefalográficos e angiográficos. Do ponto de vista clínico deve ser evidenciado o seguinte quadro: coma profundo, midríase paralítica bilateral, ausência de reação a qualquer estímulo externo, apnéia, arreflexia superficial e profunda. Do ponto de vista eletrencefalográfico são necessários dois registros, separados por um intervalo de 24 horas, evidenciando traçados iselétricos. No presente trabalho são estudados 15 pacientes com morte cerebral comprovada do ponto de vista clínico e eletrencefalográfico. Em 8 pacientes havia persistência de atividade reflexa durante a fase de morte cerebral (reflexos profundos e/ou superficiais. Fenômenos de automatismos medulares também foram verificados em 3 pacientes.The diagnosis of brain death is based in clinical, electroencephalographic and angiographic data. The criteria for diagnosis of brain death are: deep coma with unreceptivity and unresponsiveness, no movements or breathing (the patient's respiration must be maintained artificially, bilateral dilated and fixed pupils, absence of corneal reflexes, no response to caloric test, absence of deep tendon reflexes and of the superficial abdominal and plantar reflexes, isoelectric EEG maintained for twenty-four hours. The purpose of this study was to observe the natural clinical courses of 15 patients with brain death, specially the data concerning the deep and superficial reflexes. From 15 patients fulfilling the criteria of brain death, 8 maintained spinal reflexes up to the time of cardiac arrest; in five of these patients the superficial abdominal reflexes were present and the reflexes of spinal automatism could be elicited. These results show that the absence of deep and superficial reflexes can't be considered as essencial for the diagnosis of brain death.

  15. Legislative Enforcement of Nonconsensual Determination of Neurological (Brain) Death in Muslim Patients: A Violation of Religious Rights.

    Science.gov (United States)

    Rady, Mohamed Y; Verheijde, Joseph L

    2018-04-01

    Death is defined in the Quran with a single criterion of irreversible separation of the ruh (soul) from the body. The Quran is a revelation from God to man, and the primary source of Islamic knowledge. The secular concept of death by neurological criteria, or brain death, is at odds with the Quranic definition of death. The validity of this secular concept has been contested scientifically and philosophically. To legitimize brain death for the purpose of organ donation and transplantation in Muslim communities, Chamsi-Pasha and Albar (concurring with the US President's Council on Bioethics) have argued that irreversible loss of capacity for consciousness and breathing (apneic coma) in brain death defines true death in accordance with Islamic sources. They have postulated that the absence of nafs (personhood) and nafas (breath) in apneic coma constitutes true death because of departure of the soul (ruh) from the body. They have also asserted that general anesthesia is routine in brain death before surgical procurement. Their argument is open to criticism because: (1) the ruh is described as the essence of life, whereas the nafs and nafas are merely human attributes; (2) unlike true death, the ruh is still present even with absent nafs and nafas in apneic coma; and (3) the routine use of general anesthesia indicates the potential harm to brain-dead donors from surgical procurement. Postmortem general anesthesia is not required for autopsy. Therefore, the conclusion must be that legislative enforcement of nonconsensual determination of neurological (brain) death and termination of life-support and medical treatment violates the religious rights of observant Muslims.

  16. Minocycline causes widespread cell death and increases microglial labeling in the neonatal mouse brain.

    Science.gov (United States)

    Strahan, J Alex; Walker, William H; Montgomery, Taylor R; Forger, Nancy G

    2017-06-01

    Minocycline, an antibiotic of the tetracycline family, inhibits microglia in many paradigms and is among the most commonly used tools for examining the role of microglia in physiological processes. Microglia may play an active role in triggering developmental neuronal cell death, although findings have been contradictory. To determine whether microglia influence developmental cell death, we treated perinatal mice with minocycline (45 mg/kg) and quantified effects on dying cells and microglial labeling using immunohistochemistry for activated caspase-3 (AC3) and ionized calcium-binding adapter molecule 1 (Iba1), respectively. Contrary to our expectations, minocycline treatment from embryonic day 18 to postnatal day (P)1 caused a > tenfold increase in cell death 8 h after the last injection in all brain regions examined, including the primary sensory cortex, septum, hippocampus and hypothalamus. Iba1 labeling was also increased in most regions. Similar effects, although of smaller magnitude, were seen when treatment was delayed to P3-P5. Minocycline treatment from P3 to P5 also decreased overall cell number in the septum at weaning, suggesting lasting effects of the neonatal exposure. When administered at lower doses (4.5 or 22.5 mg/kg), or at the same dose 1 week later (P10-P12), minocycline no longer increased microglial markers or cell death. Taken together, the most commonly used microglial "inhibitor" increases cell death and Iba1 labeling in the neonatal mouse brain. Minocycline is used clinically in infant and pediatric populations; caution is warrented when using minocycline in developing animals, or extrapolating the effects of this drug across ages. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 77: 753-766, 2017. © 2016 Wiley Periodicals, Inc.

  17. Redefining Death

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    The results of 20 years of research on brain death will be released to the public, the Chinese Ministry of Health reported in early April. A special ministry team has drafted the criteria for brain death in Criteria for the Diagnosis of Brain Death in Adults (Revised Edition) and Technical Specifications for the Diagnosis

  18. [Short-term outcomes of lung transplant recipients using organs from brain death donors].

    Science.gov (United States)

    He, W X; Jiang, C; Liu, X G; Huang, W; Chen, C; Jiang, L; Yang, B; Wu, K; Chen, Q K; Yang, Y; Yu, Y M; Jiang, G N

    2016-12-01

    Objective: To assess short-term outcomes after lung transplantation with organs procured following brain death. Methods: Between April 2015 and July 2016, all 17 recipients after lung transplantation using organs from brain death donors (DBD) at Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine were enrolled in this study. All patients were male, aging (60±7) years, including 11 chronic obstructive pulmonary disease, 5 idiopathic pulmonary fibrosis, 1 silicosis. Seventeen donors were 16 males and 1 female, with 10 traumatic brain injury, 5 cerebrovascular accident and 2 sudden cardiac death. Of 17 recipients receiving DBD lung transplant, 16 were single lung transplant. Data were collected including intubation duration of mechanical ventilation, hospital length of stay, incidence of pulmonary infection bronchus anastomosis complications, primary graft dysfunction (PGD), and acute rejection, bronchiolitis obliterans syndrome (BOS) as well as mortality of 90-day after lung transplantation. Results: Median duration of intubation were 2 (2) days ( M ( Q R )) in recipients after lung transplantation. The incidence of pulmonary infection and bronchus anastomosis complications were 15/17 and 5/17, respectively. Median length of stay in hospital were 56 (19) days. The ratio of readmission 1 month after discharge were 10/17. Mortality of 90-day post-transplant were 2/17. The incidence of PGD and BOS were 1/17 and 2/17, respectively. Conclusion: Recipients with DBD lung transplantation have an acceptable survival during short-term follow-up, but with higher incidences of complications related to infection post-transplantation.

  19. Experiences of the families concerning organ donation of a family member with brain death

    Science.gov (United States)

    Yousefi, Hojatollah; Roshani, Asieh; Nazari, Fatemeh

    2014-01-01

    Background: In recent years, the lack of organ for transplantation has resulted in health planners and authorities in all countries, including Iran, paying serious attention to the issue. Despite the above-mentioned fact, families with a member affected by brain death are not interested in organ donation. Objective: This study is aimed at making an investigation into the decision-making process of organ donation in families with brain death. Also, the research is aimed at investigating how the deterrent and facilitating factors in the process of organ donation can be made. Materials and Methods: The current research is a qualitative study with descriptive exploratory approach. Data were collected through unstructured interviews with 10 family members who gave consent to organ donation of their family members in 2012. Purposeful sampling processes began in March 2012 and lasted up to June 2012. Simultaneously, thematic approach was used in analyzing the data. Results: Data analysis led to finding 24 categories and 11 themes, which fell into two categories: facilitating and deterrent factors. The five main deterrent themes included the five themes of prohibiting factors that were shock, hope for recovery, unknown process, and conflict of opinions, and worrying association. The six main facilitating themes included humanistic desires, immortality, culture making, satisfaction of the deceased, assurance, and eternal honor. Conclusion: The findings indicated that there is ambiguity and different interpretations on brain death. The research also showed that using the experiences of donator families can provide practical and applied solutions to facilitate the process of organ donation and solve the problems faced by the health care system. PMID:24949074

  20. Experiences of the families concerning organ donation of a family member with brain death.

    Science.gov (United States)

    Yousefi, Hojatollah; Roshani, Asieh; Nazari, Fatemeh

    2014-05-01

    In recent years, the lack of organ for transplantation has resulted in health planners and authorities in all countries, including Iran, paying serious attention to the issue. Despite the above-mentioned fact, families with a member affected by brain death are not interested in organ donation. This study is aimed at making an investigation into the decision-making process of organ donation in families with brain death. Also, the research is aimed at investigating how the deterrent and facilitating factors in the process of organ donation can be made. The current research is a qualitative study with descriptive exploratory approach. Data were collected through unstructured interviews with 10 family members who gave consent to organ donation of their family members in 2012. Purposeful sampling processes began in March 2012 and lasted up to June 2012. Simultaneously, thematic approach was used in analyzing the data. Data analysis led to finding 24 categories and 11 themes, which fell into two categories: facilitating and deterrent factors. The five main deterrent themes included the five themes of prohibiting factors that were shock, hope for recovery, unknown process, and conflict of opinions, and worrying association. The six main facilitating themes included humanistic desires, immortality, culture making, satisfaction of the deceased, assurance, and eternal honor. The findings indicated that there is ambiguity and different interpretations on brain death. The research also showed that using the experiences of donator families can provide practical and applied solutions to facilitate the process of organ donation and solve the problems faced by the health care system.

  1. A study on knowledge and attitude toward brain death and organ retrieval among health care professionals in Korea.

    Science.gov (United States)

    Jeon, K O; Kim, B N; Kim, H S; Byeon, N-I; Hong, J J; Bae, S H; Son, S Y

    2012-05-01

    The practice of retrieving vital organs from brain-dead donors is legally and medically accepted in Korea, but health care professionals' beliefs and opinions regarding these matters have not been sufficiently explored. The purpose of this study was to evaluate the knowledge and attitudes of health care professionals to the concepts of brain death and organ retrieval. Data were collected using a 41-item questionnaire during a week in June 2011. Sixty-one doctors and 109 nurses from five hospitals with more than 2000 beds in Seoul, Korea, participated in the survey. The data was analyzed using SPSS version 17.0 (SPSS Inc. Chicago, Illinois, USA). There were statistically significant differences in the scores on knowledge according to marital status (P = .001) education level (P = .019), whether the participants were informed about organ donation from a brain-dead donor (P = .002), and the participant's experience managing potential brain-dead patients (P = .037). There were statistically significant differences in the scores on the attitude according to gender (P based organ procurement organization (P = .001). Significantly, attitude's positively correlated with knowledge about brain-dead organ donation (P < .001). Compared with previous studies, the knowledge and attitudes of health care professionals' regarding brain death and organ retrieval were not improved. There are passive attitudes to brain death and organ retrieval. More research must be performed to promote knowledge and understanding toward brain death and organ retrieval among health care professionals. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Anencefalia e morte cerebral (neurológica Anencephaly and brain death

    Directory of Open Access Journals (Sweden)

    Maria Lúcia Fernandes Penna

    2005-06-01

    Full Text Available Vem-se discutindo no país a ética da interrupção da gravidez no caso de fetos anencéfalos. Os opositores ao aborto nesses casos apontam, entre outros argumentos, que não se trata de morte cerebral devido à presença de tronco encefálico. Neste artigo discutimos o conceito de morte cerebral e sua aplicação no que tange à anencefalia. Apontamos alguns aspectos históricos do desenvolvimento desse conceito e a importância de ser considerada a diferença entre conceito e critérios. A morte neurológica é a perda definitiva e total da consciência, enquanto a presença do tronco cerebral é apenas um critério a ser usado nos casos de lesão encefálica em encéfalos antes perfeitos. O conceito de morte cerebral se aplica completamente à ausência de córtex dos anencéfalos, o que sem dúvida permite sua retirada do útero materno. Manter juridicamente a criminalização desse procedimento é uma interferência religiosa no Estado laico e democrático, que impede o exercício de escolha pelos indivíduos segundo seu credo.Brazilian society has recently discussed the ethics of interrupting pregnancy in the case of an anencephalic fetus. In such cases, anti-abortionists contend that anencephaly is not the same as brain death, since a brainstem is present. This article discusses the concept of brain death and its application to the issue of anencephaly. We point to key historical aspects in the development of this concept and the importance of considering the difference between concept and criteria. Neurological death is the definitive and complete loss of consciousness, while the presence of a brainstem is merely a criterion to be used in cases of head injury in previously intact brains. The concept of brain death is totally applicable to the absence of cortex in a fetus with anencephaly, which without a doubt allows such a fetus to be removed from the uterus. To maintain the criminalization of this procedure by legal means represents

  3. Respiratory induced heart rate variability during slow mechanical ventilation Marker to exclude brain death patients

    Czech Academy of Sciences Publication Activity Database

    Jurák, Pavel; Halámek, Josef; Vondra, Vlastimil; Kružliak, P.; Šrámek, V.; Cundrle, I.; Leinveber, P.; Adamek, M.; Zvoníček, V.

    2017-01-01

    Roč. 129, 7-8 (2017), s. 251-258 ISSN 0043-5325 R&D Projects: GA ČR GAP103/11/0933; GA MŠk(CZ) LO1212; GA MŠk ED0017/01/01; GA MZd NS10105 Institutional support: RVO:68081731 Keywords : critical illness * sedation * brain death * respiratory rate variability * heart rate variability * mechanical ventilation Subject RIV: FS - Medical Facilities ; Equipment OBOR OECD: Medical engineering Impact factor: 0.974, year: 2016

  4. Heart rate variability and QT dispersion study in brain death patients and comatose patients with normal brainstem function

    International Nuclear Information System (INIS)

    Vakilian, A.R.; Iranmanesh, F.; Nadimi, A.E.; Kahnali, J.A.

    2011-01-01

    To compare heart rate variability (HRV) and QT dispersion in comatose patients with normal brainstem function and with brain death. Fourteen brain death patients with clinical signs of imminent brain death and 15 comatose patients were examined by neurologist in intensive care unit. HRV, RR interval and QT dispersion on ECG were assessed for 24 hours in both groups. Independent t-test and chi-square test were used for statistical analysis to determine significance which was set at p < 0.05. According to Holter findings, mean of standard deviation of RR-interval in the comatose and brain death groups was 48.33 and 35 respectively (p = 0.045). Mean of covariance coefficient of RR-interval was 0.065 in the comatose group and 0.043 in the brain deaths (p = 0.006). QT dispersion was not significant difference in two groups. HRV and RR-interval analysis appeared as an early finding for the diagnosis of brainstem death in comparison to comatose patients with normal brainstem function. QT dispersion had not significant in this regard. (author)

  5. Adesao ao guia alimentar para populacao brasileira

    Directory of Open Access Journals (Sweden)

    Eliseu Verly Junior

    2013-12-01

    Full Text Available OBJETIVO : Analisar a adesão ao Guia Alimentar para População Brasileira. MÉTODOS : Amostra composta por participantes do Inquérito de Saúde de São Paulo (n = 1.661 que preencheram dois recordatórios de 24 horas. Foi utilizado modelo bivariado de efeito misto para a razão entre o consumo de energia do grupo de alimentos e o consumo calórico total. A razão estimada foi utilizada para calcular o percentual de indivíduos com consumo abaixo ou acima da recomendação. RESULTADOS : Pelo menos 80,0% da população consome abaixo do recomendado para: leite e derivados; frutas e sucos de frutas; e cereais, tubérculos e raízes; aproximadamente 60,0% para legumes e verduras; 30,0% para feijões; e 8,0% para carnes e ovos. Adolescentes apresentaram a maior inadequação para legumes e verduras (90,0%, e o estrato de maior renda foi associado à menor inadequação para óleos, gorduras e sementes oleaginosas (57,0%. CONCLUSÕES : Foi observado consumo inadequado dos grupos de alimentos relacionados com aumento do risco de doenças crônicas.

  6. Econlit (EBSCOHost): guia d'ús. Gener 2011

    OpenAIRE

    Universitat de Barcelona. CRAI

    2011-01-01

    Guia de la base de dades Econlit sobre economia i finances produïda per l'American Economic Association (AEA) i distribuïda per EBSCOHost. És la font més important del món en referències a la literatura econòmica.

  7. Nitrates in drinking water and the risk of death from childhood brain tumors in Taiwan.

    Science.gov (United States)

    Weng, Hsu-Huei; Tsai, Shang-Shyue; Wu, Trong-Neng; Sung, Fung-Chang; Yang, Chun-Yuh

    2011-01-01

    The objective of this study was to (1) examine the relationship between nitrate (NO₃-N) levels in public water supplies and risk of death from childhood brain tumors (CBT) and (2) determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the effects of NO₃-N on development of CBT. A matched cancer case-control study was used to investigate the relationship between the risk of death attributed to CBT and exposure to NO₃-N in drinking water in Taiwan. All CBT deaths of Taiwan residents from 1999 through 2008 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to the cases by gender, year of birth, and year of death. Information on the levels of nitrate-nitrogen NO₃-N, Ca, and Mg in drinking water were collected from Taiwan Water Supply Corporation. The municipality of residence for CBT cases and controls was presumed to be the source of the subject's NO₃-N, Ca, and Mg exposure via drinking water. Relative to individuals whose NO₃-N exposure level was ≤ 0.31 ppm, and the adjusted odds ration (OR) (95% confidence interval [CI]) for CBT occurrence was 1.4 (1.07-1.84) for individuals who resided in municipalities served by drinking water with a NO₃-N exposure > 0.31 ppm. No significant effect modification was observed by Ca and Mg intake via drinking water. Data suggest that exposure to NO₃-N in drinking water is associated with a higher risk of CBT development in Taiwan.

  8. Brain death determination: the imperative for policy and legal initiatives in Sub-Saharan Africa.

    Science.gov (United States)

    Waweru-Siika, Wangari; Clement, Meredith Edwards; Lukoko, Lilian; Nadel, Simon; Rosoff, Philip M; Naanyu, Violet; Kussin, Peter S

    2017-05-01

    The concept of brain death (BD), defined as irreversible loss of function of the brain including the brainstem, is accepted in the medical literature and in legislative policy worldwide. However, in most of Sub-Saharan Africa (SSA) there are no legal guidelines regarding BD. Hypothetical scenarios based on our collective experience are presented which underscore the consequences of the absence of BD policies in resource-limited countries (RLCs). Barriers to the development of BD laws exist in an RLC such as Kenya. Cultural, ethnic, and religious diversity creates a complex perspective about death challenging the development of uniform guidelines for BD. The history of the medical legal process in the USA provides a potential way forward. Uniform guidelines for legislation at the state level included special consideration for ethnic or religious preferences in specific states. In SSA, medical and social consensus on the definition of BD is a prerequisite for the development BD legislation. Legislative policy will (1) limit prolonged and futile interventions; (2) mitigate the suffering of families; (3) standardise clinical practice; and (4) facilitate better allocation of scarce critical care resources in RLCs. There is a clear-cut need for these policies, and previous successful policies can serve to guide these efforts.

  9. An Unusual Transudative Pleural Effusion Succeeded by Pulmonary and Brain Edema and Death

    Directory of Open Access Journals (Sweden)

    Sayyed Gholam Reza Mortazavimoghaddam

    2012-01-01

    Full Text Available Here we report a 22-year old woman with massive and bilateral transudative effusion succeeded by pulmonary edema and brain edema and death. Investigations for systemic disorders were negative. Exacerbation of dyspnea after intravenous fluid infusion was a main problem. As effusion was refractory to medical treatment, the patient was referred for surgical pleurodesis and bilateral surgical pleurodesis were done separately. Postsurgically, dyspnea exacerbation occurred after each common cold infection. Vertigo and high intracranial pressure were also a problem postsurgically. CSF pressure was 225 mm/H2O. Therapeutic lumbar puncture was done in two sequential weeks, and the patient was on acetazolamide 250 mg/trivise a day. Despite the medical treatment, progressive dyspnea, headache, and high intracranial pressure followed by death nine months after pleurodesis. As there is a gradient of pressure between pleura and CSF, after pleurodesis brain edema must be a consequence of inversing this gradient. In conclusion, when there are any abnormalities about fluid volume or pressure in any of these cavities, we have to study other cavities.

  10. Infrequent near death experiences in severe brain injury survivors - A quantitative and qualitative study.

    Science.gov (United States)

    Hou, Yongmei; Huang, Qin; Prakash, Ravi; Chaudhury, Suprakash

    2013-01-01

    Near death experiences (NDE) are receiving increasing attention by the scientific community because not only do they provide a glimpse of the complexity of the mind-brain interactions in 'near-death' circumstances but also because they have significant and long lasting effects on various psychological aspects of the survivors. The over-all incidence-reports of NDEs in literature have varied widely from a modest Figure of 10% to around 35%, even up to an incredible Figure of 72% in persons who have faced close brush with death. Somewhat similar to this range of difference in incidences are the differences prevalent in the opinions that theorists and researchers harbor around the world for explaining this phenomena. None the less, objective evidences have supported physiological theories the most. A wide range of physiological processes have been targeted for explaining NDEs. These include cerebral anoxia, chemical alterations like hypercapnia, presence of endorphins, ketamine, and serotonin, or abnormal activity of the temporal lobe or the limbic system. In spite of the fact that the physiological theories of NDEs have revolved around the derangements in brain, no study till date has taken up the task of evaluating the experiences of near-death in patients where specific injury has been to brain. Most of them have evaluated NDEs in cardiac-arrest patients. Post-traumatic coma is one such state regarding which the literature seriously lacks any information related to NDEs. Patients recollecting any memory of their post-traumatic coma are valuable assets for NDE researchers and needs special attention. Our present study was aimed at collecting this valuable information from survivors of severe head injury after a prolonged coma. The study was conducted in the head injury department of Guangdong 999 Brain hospital, Guangzhou, China. Patients included in the study were the ones Recovered from the posttraumatic coma following a severe head injury. A total of 86 patients

  11. Brain Death: Is It a Misunderstood Concept Among Nursing Students in the South of Poland?

    Science.gov (United States)

    Mikla, M; Ríos, A; López-Navas, A; Kasper, M; Brzostek, T; Martínez-Alarcón, L; Ramis, G; Ramírez, P; López-Montesinos, M J

    2015-11-01

    The objective of the present study was to analyze the knowledge and acceptance of the brain death (BD) concept among nursing students. The study was undertaken in the academic year of 2011 to 2012 in nursing students from the University of the South of Poland. The sample was carried out in compulsory sessions, in the 5 years of the nursing degree study, with a completion rate of 80%. The questionnaire was validated (PCID-DTO Ríos), self-administered, and completed anonymously. The completion rate was 93% (492 of 530). Of the students surveyed, 75% (n = 369) knew the concept of BD and considered it to mean a person's death. Of the rest, 19% (n = 93) did not know it, and the remaining 6% (n = 30) believed that it did not mean that a person was dead. The following variables were significantly related with the correct knowledge of the BD concept: 1) age (22 ± 2 years; P ≤ .001); 2) academic year (P ≤ .001); 3) discussion with friends about organ donation and transplantation (ODT) (P = .035); 4) partner's favorable attitude toward donation and transplantation (P = .009); and 5) being Catholic (P = .031). In the multivariate analysis, the following variables persisted as independent variables related to the BD concept: a) age [OR = 1.468 (1.247-1.697); P ≤ .001] and b) partner's opinion of ODT [OR = 2.248 (1.255-4.025); P = .006]. No association was found with attitude toward ODT. More than 25% of the students from the Jagiellonian University of Kraków did not know or accept the concept of brain death. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. An assessment of advance relatives approach for brain death organ donation.

    Science.gov (United States)

    Michaut, Carine; Baumann, Antoine; Gregoire, Hélène; Laviale, Corinne; Audibert, Gérard; Ducrocq, Xavier

    2017-01-01

    Advance announcement of forthcoming brain death has developed to enable intensivists and organ procurement organisation coordinators to more appropriately, and separately from each other, explain to relatives brain death and the subsequent post-mortem organ donation opportunity. Research aim: The aim was to assess how potentially involved healthcare professionals perceived ethical issues surrounding the strategy of advance approach. A multi-centre opinion survey using an anonymous self-administered questionnaire was conducted in the six-member hospitals of the publicly funded East of France regional organ and tissue procurement network called 'Prélor'. The study population comprised 460 physicians and nurses in the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Units and the Emergency Departments. Ethical considerations: The project was approved by the board of the Lorraine University Diploma in Medical Ethics and the Prélor Network administrators. A slight majority of 53.5% of respondents had previously participated in an advance relatives approach: 83% of the physicians and 42% of the nurses. A majority of healthcare professionals (68%) think that the main justification for advance relatives approach is the comprehensive care of the dying patient and the research of his or her most likely opinion (74%). The misunderstanding of the related issues by relatives is an obstacle for 47% of healthcare professionals and 51% think that the answer given by the relatives regarding the most likely opinion of the person regarding post-mortem organ donation really corresponds to the person opinion in only 50% of the cases or less. Time given by advance approach should be employed to help and enable relatives to authentically bear the values and interests of the potential donor in the post-mortem organ donation discussion. Nurses' attendance of advance relatives approach seems necessary to enable them to optimally support the families facing death and

  13. Molecular control of brain size: Regulators of neural stem cell life, death and beyond

    International Nuclear Information System (INIS)

    Joseph, Bertrand; Hermanson, Ola

    2010-01-01

    The proper development of the brain and other organs depends on multiple parameters, including strictly controlled expansion of specific progenitor pools. The regulation of such expansion events includes enzymatic activities that govern the correct number of specific cells to be generated via an orchestrated control of cell proliferation, cell cycle exit, differentiation, cell death etc. Certain proteins in turn exert direct control of these enzymatic activities and thus progenitor pool expansion and organ size. The members of the Cip/Kip family (p21Cip1/p27Kip1/p57Kip2) are well-known regulators of cell cycle exit that interact with and inhibit the activity of cyclin-CDK complexes, whereas members of the p53/p63/p73 family are traditionally associated with regulation of cell death. It has however become clear that the roles for these proteins are not as clear-cut as initially thought. In this review, we discuss the roles for proteins of the Cip/Kip and p53/p63/p73 families in the regulation of cell cycle control, differentiation, and death of neural stem cells. We suggest that these proteins act as molecular interfaces, or 'pilots', to assure the correct assembly of protein complexes with enzymatic activities at the right place at the right time, thereby regulating essential decisions in multiple cellular events.

  14. Molecular control of brain size: Regulators of neural stem cell life, death and beyond

    Energy Technology Data Exchange (ETDEWEB)

    Joseph, Bertrand [Department of Oncology-Pathology, Cancer Centrum Karolinska (CCK), Karolinska Institutet, Stockholm (Sweden); Hermanson, Ola, E-mail: ola.hermanson@ki.se [Linnaeus Center in Developmental Biology for Regenerative Medicine (DBRM), Department of Neuroscience, Karolinska Institutet, Stockholm (Sweden)

    2010-05-01

    The proper development of the brain and other organs depends on multiple parameters, including strictly controlled expansion of specific progenitor pools. The regulation of such expansion events includes enzymatic activities that govern the correct number of specific cells to be generated via an orchestrated control of cell proliferation, cell cycle exit, differentiation, cell death etc. Certain proteins in turn exert direct control of these enzymatic activities and thus progenitor pool expansion and organ size. The members of the Cip/Kip family (p21Cip1/p27Kip1/p57Kip2) are well-known regulators of cell cycle exit that interact with and inhibit the activity of cyclin-CDK complexes, whereas members of the p53/p63/p73 family are traditionally associated with regulation of cell death. It has however become clear that the roles for these proteins are not as clear-cut as initially thought. In this review, we discuss the roles for proteins of the Cip/Kip and p53/p63/p73 families in the regulation of cell cycle control, differentiation, and death of neural stem cells. We suggest that these proteins act as molecular interfaces, or 'pilots', to assure the correct assembly of protein complexes with enzymatic activities at the right place at the right time, thereby regulating essential decisions in multiple cellular events.

  15. Nitrates in drinking water and the risk of death from brain cancer: does hardness in drinking water matter?

    Science.gov (United States)

    Ho, Chi-Kung; Yang, Ya-Hui; Yang, Chun-Yuh

    2011-01-01

    The objectives of this study were to (1) examine the relationship between nitrate levels in public water supplies and risk of death from brain cancer and (2) determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the influence of nitrates on development of brain cancer. A matched cancer case-control study was used to investigate the relationship between the risk of death from brain cancer and exposure to nitrates in drinking water in Taiwan. All brain cancer deaths of Taiwan residents from 2003 through 2008 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to cancer cases by gender, year of birth, and year of death. Information on the levels of nitrate-nitrogen (NO₃-N), Ca, and Mg in drinking water was obtained from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cancer cases and controls was presumed to be the source of the subject's NO₃-N, Ca, and Mg exposure via drinking water. Relative to individuals whose NO₃-N exposure level was cancer occurrence was 1.04 (0.85-1.27) for individuals who resided in municipalities served by drinking water with a NO₃-N exposure ≥ 0.38 ppm. No marked effect modification was observed due to Ca and Mg intake via drinking water on brain cancer occurrence.

  16. Quality of Care of Nursing from Brain Death Patient in ICU Wards

    Directory of Open Access Journals (Sweden)

    Seyedeh Toktam Masoumian Hoseini

    2015-04-01

    Full Text Available Introduction: Nowadays, Intensive Care Unit (ICU nurses play a significant and key role in the care of brain dead patients and their families, therefore their Practice extremely important to the success of organ donation. To assess ICU nurse's practice in relation to nurse's role in the organ donation process from brain dead patients in Iran. Materials and Methods:In a cross-sectional analytical study 90 ICU nurses in Ghaem and Imam Reza Hospitals in Mashhad through stratified random sampling allocation method were selected. Data collection tools included a questionnaire on demographic information, factors influencing nurse's practice during the organ donation process and surveying "nurse's practice in relation to their roles in the organ donation process." Results: 90 nurses participated in this study. (70.0% of the research subjects had spoken with their own families about organ donation, and (20.0% had organ donation cards. Practice scores were calculated on a scale of 100. The mean score of nurses' practice was (6.04± 3.66. 96.7% of nurses’ weak practice in terms of their roles in the organ donation process. Conclusion: As a result, they do not have adequate practice regard nurse's role in organ donation process and in relation to brain death patient and their families. Therefore it is suggested to include nursing courses in the organ donation process and organ transplantation as well as educational programs to acquaint nurses with their roles in the process to improve their practice by different training methods.

  17. Arguments against promoting organ transplants from brain-dead donors, and views of contemporary Japanese on life and death.

    Science.gov (United States)

    Asai, Atsushi; Kadooka, Yasuhiro; Aizawa, Kuniko

    2012-05-01

    As of 2009, the number of donors in Japan is the lowest among developed countries. On July 13, 2009, Japan's Organ Transplant Law was revised for the first time in 12 years. The revised and old laws differ greatly on four primary points: the definition of death, age requirements for donors, requirements for brain-death determination and organ extraction, and the appropriateness of priority transplants for relatives. In the four months of deliberations in the National Diet before the new law was established, various arguments regarding brain death and organ transplantation were offered. An amazing variety of opinions continue to be offered, even after more than 40 years have elapsed since the first heart organ transplant in Japan. Some are of the opinion that with the passage of the revised law, Japan will finally become capable of performing transplants according to global standards. Contrarily, there are assertions that organ transplants from brain-dead donors are unacceptable because they result in organs being taken from living human beings. Considering the current conditions, we will organize and introduce the arguments for and against organ transplants from brain-dead donors in contemporary Japan. Subsequently, we will discuss the primary arguments against organ transplants from brain-dead donors from the perspective of contemporary Japanese views on life and death. After introducing the recent view that brain death should not be regarded as equivalent to the death of a human being, we would like to probe the deeply-rooted views on life and death upon which it is based. © 2010 Blackwell Publishing Ltd.

  18. Infrequent near death experiences in severe brain injury survivors - A quantitative and qualitative study

    Directory of Open Access Journals (Sweden)

    Yongmei Hou

    2013-01-01

    Full Text Available Background: Near death experiences (NDE are receiving increasing attention by the scientific community because not only do they provide a glimpse of the complexity of the mind-brain interactions in ′near-death′ circumstances but also because they have significant and long lasting effects on various psychological aspects of the survivors. The over-all incidence-reports of NDEs in literature have varied widely from a modest Figure of 10% to around 35%, even up to an incredible Figure of 72% in persons who have faced close brush with death. Somewhat similar to this range of difference in incidences are the differences prevalent in the opinions that theorists and researchers harbor around the world for explaining this phenomena. None the less, objective evidences have supported physiological theories the most. A wide range of physiological processes have been targeted for explaining NDEs. These include cerebral anoxia, chemical alterations like hypercapnia, presence of endorphins, ketamine, and serotonin, or abnormal activity of the temporal lobe or the limbic system. In spite of the fact that the physiological theories of NDEs have revolved around the derangements in brain, no study till date has taken up the task of evaluating the experiences of near-death in patients where specific injury has been to brain. Most of them have evaluated NDEs in cardiac-arrest patients. Post-traumatic coma is one such state regarding which the literature seriously lacks any information related to NDEs. Patients recollecting any memory of their post-traumatic coma are valuable assets for NDE researchers and needs special attention. Materials and Methods: Our present study was aimed at collecting this valuable information from survivors of severe head injury after a prolonged coma. The study was conducted in the head injury department of Guangdong 999 Brain hospital, Guangzhou, China. Patients included in the study were the ones Recovered from the posttraumatic

  19. Postresuscitative Changes of Brain-Derived Neurotrophic Factor (BDNF Protein Expression: Association With Neuronal Death

    Directory of Open Access Journals (Sweden)

    M. Sh. Avrushchenko

    2017-01-01

    Full Text Available Aim of the study: to evaluate expression level of BDNF and its association with the postresuscitative neuronal death in highly hypoxia-sensitive brain regions.Materials and methods. Cardiac arrest in adult albino male rats was evoked by intrathoracic clamping of supracardiac bundle of vessels for 10 min. Pyramidal neurons of the hippocampus and Purkinje cells of the cerebellum were analyzed at various time points after resuscitation (days 1, 4, 7, 14. Shame-operated rats served as controls. The expression of BDNF protein was immunohistochemically determined. The BDNF expression level was determined by evalution on the base of the average optical density. The number of neurons with different BDNF expression levels and the total number of neurons per 1 mm of the layer length were computed. Image analysis systems (Intel personal computer, Olympus BX-41 microscope, ImageScopeM, ImageJ 1,48v and MS Excel 2007 software packages were used in the study. Data statistical processing was performed with the aid of Statistica 7.0 program and Kolmogorov-Smirnov λ-test, Mann-Whitney U-test and Student's t-test.Results. The dynamics of postresuscitative shifts of BDNF immunoreactivity in neuronal populations of hippocampal pyramidal cells and cerebellar Purkinje cells was established. It was shown that the level of BDNF expression within the two neuronal populations decreased, that was accompanied by neuronal death. In the Purkinje cell population the neuronal death occurred by the 4th day after resuscitation, while in the hippocampus, it occurs only by the 7th day. Notably, only BDNF-negative neurons or neurons with low level of BDNF expression died in both neuronal populations.Conclusion. The results of the study indicate the existence of an interrelation between the shifts in BDNF expression and the postresuscitative neuronal death. It was shown that only the cells with none or poor BDNF expression underwent death in highly hypoxia-sensitive neuronal

  20. Analysis on the training effect of criteria and practical guidance for determination of brain death: electroencephalogram

    Directory of Open Access Journals (Sweden)

    Wei-bi CHEN

    2015-12-01

    Full Text Available Objective To analyze the training results of electroencephalogram (EEG for brain death determination and to improve the training program. Methods A total of 114 trainees received theoretical training, simulation skills training, bedside skills training and test analysis. The composition of the trainees and the results of EEG tests were analyzed. The error rates of 5 knowledge points of EEG tests were calculated. Univariate and multivariate backward Logistic regression analyses were used to analyze the influence of factors including sex, age, specialty, professional category, professional qualification and hospital level on the error rates. Results All of 114 trainees came from 72 hospitals. Among them, 91 trainees (79.82% were between 30-49 years old, 108 trainees (94.74% came from third grade, grade A hospitals, and most of them were from Department of Neurology (57.89% , 66/114 and Electrophysiology (19.30% , 22/114. There were 98 clinicians (85.96% and 52 trainees (45.61% had intermediate certificate. Of the 5 knowledge points, the total error rate was 9.19% (204/2221. Among them, the error rate of parameter setting was the highest (11.40% , 26/228, followed by those of result determination (10.44%, 80/766, recording techniques (10.25%, 69/673, environmental requirements (7.46%, 17/228 and pitfalls (3.68%, 12/326. The error rate of trainees who were older than 50 was significantly higher than that in other ages (P = 0.000, for all. The error rate of technicians was higher than that of clinicians (P = 0.039. Univariate and multivariate Logistic regression analyses showed that age was independent risk factor associated with high error rates (OR = 1.382, 95%CI: 1.156-1.652; P = 0.000. Conclusions Among the trainees, degree of mastering the knowledge points is different. The training program should be optimized according to the trainees. More attention should be paid to the difference of EEG between brain death determination and routine check to

  1. Effect of Transient Maternal Hypotension on Apoptotic Cell Death in Foetal Rat Brain

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    Hamit Özyürek

    2014-03-01

    Full Text Available Background: Intrauterine perfusion insufficiency induced by transient maternal hypotension has been reported to be associated with foetal brain malformations. However, the effects of maternal hypotension on apoptotic processes in the foetal brain have not been investigated experimentally during the intrauterine period. Aims: The aim of this study was to investigate the effects of transient maternal hypotension on apoptotic cell death in the intrauterine foetal brain. Study Design: Animal experimentation. Methods: Three-month-old female Wistar albino rats were allocated into four groups (n=5 each. The impact of hypoxic/ischemic injury induced by transient maternal hypotension on the 15th day of pregnancy (late gestation in rats was investigated at 48 (H17 group or 96 hours (H19 group after the insult. Control groups underwent the same procedure except for induction of hypotension (C17 and H17 groups. Brain sections of one randomly selected foetus from each pregnant rat were histopathologically evaluated for hypoxic/ischemic injury in the metencephalon, diencephalon, and telencephalon by terminal transferase-mediated dUTP nick end labelling and active cysteine-dependent aspartate-directed protease-3 (caspase-3 positivity for cell death. Results: The number of terminal transferase-mediated dUTP nick end labelling (+ cells in all the areas examined was comparable in both hypotension and control groups. The H17 group had active caspase-3 (+ cells in the metencephalon and telencephalon, sparing diencephalon, whereas the C19 and H19 groups had active caspase-3 (+ cells in all three regions. The number of active caspase-3 (+ cells in the telencephalon in the H19 group was higher compared with the metencephalon and diencephalon and compared with H17 group (p<0.05. Conclusion: Our results suggest that prenatal hypoxic/ischemic injury triggers apoptotic mechanisms. Therefore, blockade of apoptotic pathways, considering the time pattern of the insult, may

  2. A Nuclear Attack on Traumatic Brain Injury: Sequestration of Cell Death in the Nucleus.

    Science.gov (United States)

    Tajiri, Naoki; De La Peña, Ike; Acosta, Sandra A; Kaneko, Yuji; Tamir, Sharon; Landesman, Yosef; Carlson, Robert; Shacham, Sharon; Borlongan, Cesar V

    2016-04-01

    Exportin 1 (XPO1/CRM1) plays prominent roles in the regulation of nuclear protein export. Selective inhibitors of nuclear export (SINE) are small orally bioavailable molecules that serve as drug-like inhibitors of XPO1, with potent anti-cancer properties. Traumatic brain injury (TBI) presents with a secondary cell death characterized by neuroinflammation that is putatively regulated by nuclear receptors. Here, we report that the SINE compounds (KPT-350 or KPT-335) sequestered TBI-induced neuroinflammation-related proteins (NF-(k)B, AKT, FOXP1) within the nucleus of cultured primary rat cortical neurons, which coincided with protection against TNF-α (20 ng/mL)-induced neurotoxicity as shown by at least 50% and 100% increments in preservation of cell viability and cellular enzymatic activity, respectively, compared to non-treated neuronal cells (P's nucleus as an efficacious treatment for TBI. © 2016 John Wiley & Sons Ltd.

  3. Post-irradiation brain-necrosis resulting in apoplexia and death after 33 years of irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Froehlich, A [Foevarosi Laszlo Korhaz, Budapest (Hungary). Korbonctani es Korszoevettani Oszt.

    1980-04-01

    A case of post-irradiation brain-necrosis resulting in apoplexia of the cerebellum after 33 years of irradiation (19984 r.) of a presumptive cerebellar tumour is reported. The pathohistologic study revealed symptoms of the ''late'' damage and the vascular changes appeared to be the most prominent. The thickening of the vessel walls, hyperplasia of collagen fibres and deposition of calcium in the media, were the most characteristic lesions revealed. In some of the small vessels isolated calcification of the media was observed. It seems most probable that in the development of apoplexia vascular alterations could play an important role. In the available literature no report has been found on a similarly long interval elapsing between the irradiation and death.

  4. Post-irradiation brain-necrosis resulting in apoplexia and death after 33 years of irradiation

    International Nuclear Information System (INIS)

    Froehlich, A.

    1980-01-01

    A case of post-irradiation brain-necrosis resulting in apoplexia of the cerebellum after 33 years of irradiation (19984 r.) of a presumptive cerebellar tumour is reported. The pathohistologic study revealed symptoms of the ''late'' damage and the vascular changes appeared to be the most prominent. The thickening of the vessel walls, hyperplasia of collagen fibres and deposition of calcium in the media, were the most characteristic lesions revealed. In some of the small vessels isolated calcification of the media was observed. It seems most probable that in the development of apoplexia vascular alterations could play an important role. In the available literature no report has been found on a similarly long interval elapsing between the irradiation and death. (author)

  5. Brain stem death as the vital determinant for resumption of spontaneous circulation after cardiac arrest in rats.

    Directory of Open Access Journals (Sweden)

    Alice Y W Chang

    Full Text Available BACKGROUND: Spontaneous circulation returns to less than half of adult cardiac arrest victims who received in-hospital resuscitation. One clue for this disheartening outcome arises from the prognosis that asystole invariably takes place, after a time lag, on diagnosis of brain stem death. The designation of brain stem death as the point of no return further suggests that permanent impairment of the brain stem cardiovascular regulatory machinery precedes death. It follows that a crucial determinant for successful revival of an arrested heart is that spontaneous circulation must resume before brain stem death commences. Here, we evaluated the hypothesis that maintained functional integrity of the rostral ventrolateral medulla (RVLM, a neural substrate that is intimately related to brain stem death and central circulatory regulation, holds the key to the vital time-window between cardiac arrest and resumption of spontaneous circulation. METHODOLOGY/PRINCIPAL FINDINGS: An animal model of brain stem death employing the pesticide mevinphos as the experimental insult in Sprague-Dawley rats was used. Intravenous administration of lethal doses of mevinphos elicited an abrupt cardiac arrest, accompanied by elevated systemic arterial pressure and anoxia, augmented neuronal excitability and enhanced microvascular perfusion in RVLM. This period represents the vital time-window between cardiac arrest and resumption of spontaneous circulation in our experimental model. Animals with restored spontaneous circulation exhibited maintained neuronal functionality in RVLM beyond this critical time-window, alongside resumption of baseline tissue oxygen and enhancement of local blood flow. Intriguingly, animals that subsequently died manifested sustained anoxia, diminished local blood flow, depressed mitochondrial electron transport activities and reduced ATP production, leading to necrotic cell death in RVLM. That amelioration of mitochondrial dysfunction and

  6. Potential brain death organ donors - challenges and prospects: A single center retrospective review

    Directory of Open Access Journals (Sweden)

    Yousef Al-Maslamani

    2014-01-01

    Full Text Available Organ donation after brain death (BD is a major source for obtaining transplantable organs for patients with end-stage organ disease (ESOD. This retrospective, descriptive study was carried out on all potential BD patients admitted in different intensive care units (ICUs of the Hamad medical Corporation (HMC, Doha, Qatar during a period from January 2011 to April 2012. Our aim was to evaluate various demographic criteria and challenges of organ donation among potential BD organ donors and plan a strategy to improve the rate of organ donation in Qatar. Various aspects of BD patients in the ICUs and their possible effects on organ donation were studied. The time intervals analyzed to determine the possible causes of delay of organ retrieval were: time of diagnosing fixed dilated pupils in the ICU, to performing the first BD test, then to the second BD test, to family approach, to organ retrieval and/or circulatory death (CD without organ retrieval. There were a total of 116 potential BD organ donors of whom 96 (82.75% were males and 20 (17.25% were females. Brain hemorrhage and head injury contributed to 37 (31.9% and 32 (27.6% BD cases, respectively. Time interval between diagnosing fixed dilated pupil and performing the first test of BD was delayed >24 h in 79% of the cases and between the first and second BD tests was >6 h in 70.8% of the cases. This delay is not compatible with the Hamad Medical Corporation (HMC policy for BD diagnosis and resulted in a low number of organs retrieved. BD organ donation, a potential source for organs to save patients with ESOD has several pitfalls and every effort should be made to increase the awareness of the public as well as medical personnel to optimize donation efficacy.

  7. Complement mediated renal inflammation induced by donor brain death : role of renal C5a-C5aR interaction

    NARCIS (Netherlands)

    van Werkhoven, M. B.; Damman, J.; van Dijk, M. C. R. F.; Daha, M. R.; de Jong, I. J.; Leliveld, A.; Krikke, C.; Leuvenink, H. G.; van Goor, H.; van Son, W. J.; Olinga, P.; Hillebrands, J. -L.; Seelen, M. A. J.

    Kidneys retrieved from brain-dead donors have impaired allograft function after transplantation compared to kidneys from living donors. Donor brain death (BD) triggers inflammatory responses, including both systemic and local complement activation. The mechanism by which systemic activated

  8. Enriched Endogenous Omega-3 Fatty Acids in Mice Ameliorate Parenchymal Cell Death After Traumatic Brain Injury.

    Science.gov (United States)

    Ren, Huixia; Yang, Zhen; Luo, Chuanming; Zeng, Haitao; Li, Peng; Kang, Jing X; Wan, Jian-Bo; He, Chengwei; Su, Huanxing

    2017-07-01

    Currently no effective therapies are available for the treatment of traumatic brain injury (TBI). Early intervention that specifically provides neuroprotection is of most importance which profoundly influences the outcome of TBI. In the present study, we adopted a closed-skull mild TBI model to investigate potential roles of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) in protecting against TBI. Using two-photon laser scanning microscopy (2PLSM), parenchymal cell death and reactive oxidative species (ROS) expression were directly observed and recorded after TBI through a thinned skull bone window. Fat-1 mice with high endogenous ω-3 PUFAs significantly inhibited ROS expression and attenuated parenchymal cell death after compression injury during the early injury phase. Elevated generation of glutathione (GSH) and neuroprotectin D1 (NPD1) in the parenchyma of fat-1 mice could be the contributor to the beneficial role of ω-3 PUFAs in TBI. The results of the study suggest that ω-3 PUFAs is an effective neuroprotectant as an early pharmacological intervention for TBI and the information derived from this study may help guide dietary advice for those who are susceptible to repetitive mild TBI.

  9. Up-regulation of Kir2.1 by ER stress facilitates cell death of brain capillary endothelial cells

    International Nuclear Information System (INIS)

    Kito, Hiroaki; Yamazaki, Daiju; Ohya, Susumu; Yamamura, Hisao; Asai, Kiyofumi; Imaizumi, Yuji

    2011-01-01

    Highlights: → We found that application of endoplasmic reticulum (ER) stress with tunicamycin to brain capillary endothelial cells (BCECs) induced cell death. → The ER stress facilitated the expression of inward rectifier K + channel (K ir 2.1) and induced sustained membrane hyperpolarization. → The membrane hyperpolarization induced sustained Ca 2+ entry through voltage-independent nonspecific cation channels and consequently facilitated cell death. → The K ir 2.1 up-regulation by ER stress is, at least in part, responsible for cell death of BCECs under pathological conditions. -- Abstract: Brain capillary endothelial cells (BCECs) form blood brain barrier (BBB) to maintain brain homeostasis. Cell turnover of BCECs by the balance of cell proliferation and cell death is critical for maintaining the integrity of BBB. Here we found that stimuli with tunicamycin, endoplasmic reticulum (ER) stress inducer, up-regulated inward rectifier K + channel (K ir 2.1) and facilitated cell death in t-BBEC117, a cell line derived from bovine BCECs. The activation of K ir channels contributed to the establishment of deeply negative resting membrane potential in t-BBEC117. The deep resting membrane potential increased the resting intracellular Ca 2+ concentration due to Ca 2+ influx through non-selective cation channels and thereby partly but significantly regulated cell death in t-BBEC117. The present results suggest that the up-regulation of K ir 2.1 is, at least in part, responsible for cell death/cell turnover of BCECs induced by a variety of cellular stresses, particularly ER stress, under pathological conditions.

  10. Renaissance of criticism on the concept of brain death--the role of legal medicine in the context of the interdisciplinary discussion.

    Science.gov (United States)

    Markert, L; Bockholdt, B; Verhoff, M A; Heinze, S; Parzeller, M

    2016-03-01

    In the practice of legal medicine in Germany, the assessment of brain death is of minor importance and attracts little attention. However, since several years, international criticism on the concept of brain death has culminated. By reviewing literature and the results of a questionnaire distributed among the participants of the 93rd Annual Congress of the Germany Society of Legal Medicine, the state of knowledge and the current views on brain death were evaluated. Literature search of recent publications regarding brain death was performed (PubMed database, references of legal medicine, Report of the President's Council on Bioethics, USA 2008). A questionnaire was developed and distributed among the participants of the Congress. The assumption that individual and brain death are synonymous is criticized. Internationally, there are trends to harmonize the very different clinical criteria to assess brain death. The diagnostic advantage of novel techniques such as CT angiography is controversially discussed. It becomes apparent that procedures which record the blood flow and perfusion of the brain will be applied more in the future. Regrettably, these developments are not described in the literature of legal medicine. Moreover, among German forensic scientists, different views concerning brain death exist. The majority favors its equivalent treatment with individual death. The thanatological background can be improved concerning certain aspects of brain death as well as its legal implications. Teaching and research in legal medicine should include the subject brain death. Expertise in forensic science may contribute to the interdisciplinary discussion on brain death. The transfer of actual knowledge, also on disputed ethical aspects of thanatology, to physicians of all disciplines is of great importance.

  11. Brain-dead patients are not cadavers: the need to revise the definition of death in Muslim communities.

    Science.gov (United States)

    Rady, Mohamed Y; Verheijde, Joseph L

    2013-03-01

    The utilitarian construct of two alternative criteria of human death increases the supply of transplantable organs at the end of life. Neither the neurological criterion (heart-beating donation) nor the circulatory criterion (non-heart-beating donation) is grounded in scientific evidence but based on philosophical reasoning. A utilitarian death definition can have unintended consequences for dying Muslim patients: (1) the expedited process of determining death for retrieval of transplantable organs can lead to diagnostic errors, (2) the equivalence of brain death with human death may be incorrect, and (3) end-of-life religious values and traditional rituals may be sacrificed. Therefore, it is imperative to reevaluate the two different types and criteria of death introduced by the Resolution (Fatwa) of the Council of Islamic Jurisprudence on Resuscitation Apparatus in 1986. Although we recognize that this Fatwa was based on best scientific evidence available at that time, more recent evidence shows that it rests on outdated knowledge and understanding of the phenomenon of human death. We recommend redefining death in Islam to reaffirm the singularity of this biological phenomenon as revealed in the Quran 14 centuries ago.

  12. The Impact of Ischemia/Reperfusion Injury on Liver Allografts from Deceased after Cardiac Death versus Deceased after Brain Death Donors.

    Directory of Open Access Journals (Sweden)

    Jin Xu

    Full Text Available The shortage of organs for transplantation has led to increased use of organs procured from donors after cardiac death (DCD. The effects of cardiac death on the liver remain poorly understood, however. Using livers obtained from DCD versus donors after brain death (DBD, we aimed to understand how ischemia/reperfusion (I/R injury alters expression of pro-inflammatory markers ceramides and influences graft leukocyte infiltration.Hepatocyte inflammation, as assessed by ceramide expression, was evaluated in DCD (n = 13 and DBD (n = 10 livers. Allograft expression of inflammatory and cell death markers, and allograft leukocyte infiltration were evaluated from a contemporaneous independent cohort of DCD (n = 22 and DBD (n = 13 livers.When examining the differences between transplant stages in each group, C18, C20, C24 ceramides showed significant difference in DBD (p<0.05 and C22 ceramide (p<0.05 were more pronounced for DCD. C18 ceramide is correlated to bilirubin, INR, and creatinine after transplant in DCD. Prior to transplantation, DCD livers have reduced leukocyte infiltration compared to DBD allografts. Following reperfusion, the neutrophil infiltration and platelet deposition was less prevalent in DCD grafts while cell death and recipients levels of serum aspartate aminotransferase (AST of DCD allografts had significantly increased.These data suggest that I/R injury generate necrosis in the absence of a strong inflammatory response in DCD livers with an appreciable effect on early graft function. The long-term consequences of increased inflammation in DBD and increased cell death in DCD allografts are unknown and warrant further investigation.

  13. Pharmacists' guide to the management of organ donors after brain death.

    Science.gov (United States)

    Korte, Catherine; Garber, Jennifer L; Descourouez, Jillian L; Richards, Katelyn R; Hardinger, Karen

    2016-11-15

    This article reviews organ donor pathophysiology as it relates to medication use with the goal of maximizing the successful procurement and transplantation of donor organs. The number of patients requiring organ transplantation continues to grow, yet organ donation rates remain flat, making it critical to appropriately manage each organ donor in order to ensure viability of all transplantable organs. The care given to one organ donor is tantamount to the care of several transplant recipients. Aggressive donor management ensures that the largest number of organs can be successfully procured and improves the organs' overall quality. Hospital pharmacists are responsible for processing orders and preparing the medications outlined in donor management algorithms developed by their respective medical systems. It is important that pharmacists understand the details of the medications used in these protocols in order to critically evaluate each medication order and appropriately manage the donor. Typical medications used in organ donors after brain death include medications for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. It is essential to provide optimal pharmacotherapy for each organ donor to ensure organ recovery and donation. Typical medications used in organ donors include agents for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  14. Absence of Doppler signal in transcranial color-coded ultrasonography may be confirmatory for brain death: A case report

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    Mehmet Akif Topçuoğlu

    2015-08-01

    Full Text Available Transcranial Doppler ultrasonography (TCD is a valuable tool for demonstrating cerebral circulatory arrest (CCA in the setting of brain death. Complete reversal of diastolic flow (to-and-fro flow and systolic spikes in bilateral terminal internal carotid arteries and vertebrobasilar circulation are considered as specific sonogram configurations supporting the diagnosis of CCA. Because of the possibility of sonic bone window impermeability, absence of any waveform in TCD is not confirmatory for CCA unless there is documentation of disappearance of a previously well detected signal by the same recording settings. Transcranial color-coded sonography (TCCS with B-mode imaging can reliably detect adequacy of bone windows with clarity contralateral skull and ipsilateral planum temporale visualization. Therefore, absence of detectable intracranial Doppler signal along with available ultrasound window in TCCS can confirm clinical diagnosis of brain death. We herein discuss this entity from the frame of a representative case.

  15. Brain death organ donation potential and life support therapy limitation in neurocritical patients.

    Science.gov (United States)

    Bodí, M A; Pont, T; Sandiumenge, A; Oliver, E; Gener, J; Badía, M; Mestre, J; Muñoz, E; Esquirol, X; Llauradó, M; Twose, J; Quintana, S

    2015-01-01

    To analyze the profile, incidence of life support therapy limitation (LSTL) and donation potential in neurocritical patients. A multicenter prospective study was carried out. Nine hospitals authorized for organ harvesting for transplantation. All patients consecutively admitted to the hospital with GCS < 8 during a 6-month period were followed-up until discharge or day 30 of hospital stay. Demographic data, cause of coma, clinical status upon admission and outcome were analyzed. LSTL, brain death (BD) and organ donation incidence were recorded. A total of 549 patients were included, with a mean age of 59.0 ± 14.5 years. The cause of coma was cerebral hemorrhage in 27.0% of the cases.LSTL was applied in 176 patients (32.1%). In 78 cases LSTL consisted of avoiding ICU admission. Age, the presence of contraindications, and specific causes of coma were associated to LSTL. A total of 58.1% of the patients died (n=319). One-hundred and thirty-three developed BD (24.2%), and 56.4% of these became organ donors (n=75). The presence of edema and mid-line shift on the CT scan, and transplant coordinator evaluation were associated to BD. LSTL was associated to a no-BD outcome. Early LSTL (first 4 days) was applied in 9 patients under 80 years of age, with no medical contraindications for donation and a GCS ≤ 4 who finally died in asystole. LSTL is a frequent practice in neurocritical patients. In almost one-half of the cases, LSTL consisted of avoiding admission to the ICU, and on several occasions the donation potential was not evaluated by the transplant coordinator. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  16. The effect of brain death and coma on gastric myoelectrical activity.

    Science.gov (United States)

    Bor, Canan; Bordin, Dmitry; Demirag, Kubilay; Uyar, Mehmet

    2016-05-01

    Gastrointestinal motility problems and delayed gastric emptying in patients admitted to intensive care units are important because they can contribute to different problems. Herein we aimed to measure the changes in gastric myoelectrical activity with electrogastrography (EGG) following brain death (BD) and compare the results to those from patients in a deep coma without BD. Fifteen patients with BD and nine in a deep coma with a Glasgow Coma Score from 3 to 8 were included. An enteral nutrition solution was given via a nasogastric tube between 45 min of fasting and the postprandial periods. The mean dominant frequency (MnDF), normal gastric slow wave ratio (%), tachygastria and bradygastria (%), power ratio (PR: dominant power after test meal/fasting), and dominant frequency instability coefficient were evaluated. The median of MnDF was determined 3.20±0.6 (BD) vs 3.05±0.5 (control), p>0.05. Patients with BD displayed tachygastria, particularly during the fasting state, with this disturbance decreasing during the postprandial period (from 41% to 15%). However, none of the differences between the groups were statistically significant. PR was pathologic in 4/15 (26.7%) patients in the BD group and 4/9 (44.4%) patients in the control group (p=0.288). Patients with coma or BD bouth might have gastric myoelectrical activity disturbances. BD does not show more severe disturbance than coma wihouth BD. EGG might be useful as a non-invasive and easy-to-use technology; however, it needs further improvement.

  17. Tat-PRAS40 prevent hippocampal HT-22 cell death and oxidative stress induced animal brain ischemic insults.

    Science.gov (United States)

    Shin, Min Jea; Kim, Dae Won; Jo, Hyo Sang; Cho, Su Bin; Park, Jung Hwan; Lee, Chi Hern; Yeo, Eun Ji; Choi, Yeon Joo; Kim, Ji An; Hwang, Jung Soon; Sohn, Eun Jeong; Jeong, Ji-Heon; Kim, Duk-Soo; Kwon, Hyeok Yil; Cho, Yong-Jun; Lee, Keunwook; Han, Kyu Hyung; Park, Jinseu; Eum, Won Sik; Choi, Soo Young

    2016-08-01

    Proline rich Akt substrate (PRAS40) is a component of mammalian target of rapamycin complex 1 (mTORC1) and is known to play an important role against reactive oxygen species-induced cell death. However, the precise function of PRAS40 in ischemia remains unclear. Thus, we investigated whether Tat-PRAS40, a cell-permeable fusion protein, has a protective function against oxidative stress-induced hippocampal neuronal (HT-22) cell death in an animal model of ischemia. We showed that Tat-PRAS40 transduced into HT-22 cells, and significantly protected against cell death by reducing the levels of H2O2 and derived reactive species, and DNA fragmentation as well as via the regulation of Bcl-2, Bax, and caspase 3 expression levels in H2O2 treated cells. Also, we showed that transduced Tat-PARS40 protein markedly increased phosphorylated RRAS40 expression levels and 14-3-3σ complex via the Akt signaling pathway. In an animal ischemia model, Tat-PRAS40 effectively transduced into the hippocampus in animal brain and significantly protected against neuronal cell death in the CA1 region. We showed that Tat-PRAS40 protein effectively transduced into hippocampal neuronal cells and markedly protected against neuronal cell damage. Therefore, we suggest that Tat-PRAS40 protein may be used as a therapeutic protein for ischemia and oxidative stress-induced brain disorders. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Guia de receitas brasileiras: uma saborosa viagem pela literatura

    OpenAIRE

    Santos, Denísia Moraes dos

    2011-01-01

    Esta dissertação tem por objetivo compreender, sob o ponto de vista da Análise Dialógica do Discurso, o processo de construção dos sentidos em Guia de receitas brasileiras ─ texto premiado na primeira edição do Concurso Cultural Viagem Nestlé pela Literatura (1999). Com o tema A literatura e a vida nos 500 anos de Brasil , essa edição desafiou alunos e professores a produzir um intertexto literário-cultural, utilizando cinco obras da literatura brasileira ─ Cronistas do Descobrim...

  19. A Multicenter Study on Long-Term Outcomes After Lung Transplantation Comparing Donation After Circulatory Death and Donation After Brain Death.

    Science.gov (United States)

    van Suylen, V; Luijk, B; Hoek, R A S; van de Graaf, E A; Verschuuren, E A; Van De Wauwer, C; Bekkers, J A; Meijer, R C A; van der Bij, W; Erasmus, M E

    2017-10-01

    The implementation of donation after circulatory death category 3 (DCD3) was one of the attempts to reduce the gap between supply and demand of donor lungs. In the Netherlands, the total number of potential lung donors was greatly increased by the availability of DCD3 lungs in addition to the initial standard use of donation after brain death (DBD) lungs. From the three lung transplant centers in the Netherlands, 130 DCD3 recipients were one-to-one nearest neighbor propensity score matched with 130 DBD recipients. The primary end points were primary graft dysfunction (PGD), posttransplant lung function, freedom from chronic lung allograft dysfunction (CLAD), and overall survival. PGD did not differ between the groups. Posttransplant lung function was comparable after bilateral lung transplantation, but seemed worse after DCD3 single lung transplantation. The incidence of CLAD (p = 0.17) nor the freedom from CLAD (p = 0.36) nor the overall survival (p = 0.40) were significantly different between both groups. The presented multicenter results are derived from a national context where one third of the lung transplantations are performed with DCD3 lungs. We conclude that the long-term outcome after lung transplantation with DCD3 donors is similar to that of DBD donors and that DCD3 donation can substantially enlarge the donor pool. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  20. Near-death-like experiences without life-threatening conditions or brain disorders: a hypothesis from a case report

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    Enrico eFacco

    2012-11-01

    Full Text Available Near-death experiences (NDEs are profound psychic experiences commonly occurring in life-threatening conditions. They include feeling a sense of peace, of seeing a bright light, encountering deceased relatives or religious figures, and of transcending space and time. To explain them, it has been suggested that they stem from brain disorders and/or psychological reactions to approaching death, a sort of wishful thinking in response to the perceived threat.This is a report on a case with most of the features typical of NDEs except that it occurred entirely without any life-threatening conditions. This evidence is theoretically incompatible with either of the above hypotheses, suggesting that a broader interpretation of the phenomenon is needed.

  1. A Comparative Study of Organ Donation after Brain Death in Japan and Australia

    OpenAIRE

    TERAO, Kaori; FUJIWARA, Yoshirou

    2013-01-01

    Objective : (1) To compare the status of organ donation from brain-dead donors in Japan and Australia. (2) To identify the possible reasons for the low rates of organ donation from brain-dead donors. Background : The shortage of available organs for transplantation has prompted many countries to develop a system for the use of organs from brain-dead donors, including Japan and Australia. Yet, there is a wide range of organ donation rates and policies between Japan and Australia in the current...

  2. Analysis on the training effect of criteria and practical guidance for determination of brain death: evoked potentials

    Directory of Open Access Journals (Sweden)

    Yan ZHANG

    2015-12-01

    Full Text Available Objective To analyze the training results of short-latency somatosensory-evoked potential (SLSEP for brain death determination and to improve the training program. Methods A total of 101 trainees received theoretical training, simulation skills training, bedside skills training and test analysis for SLSEP in brain death determination. The composition of trainees was analyzed and the error rates of 6 knowledge points were calculated. Univariate and multivariate backward Logistic regression analyses were used to analyze the influence of factors including sex, age, specialty, professional category, professional qualification and hospital level, on the error rates. Results Among them, trainees of 30-49 years old occupied 76.24% (77/101, most of them were from third grade, grade A hospitals (98.02%, 99/101, and 78 trainees (77.23% were from Department of Neurology. There were 82 clinicians (81.19%, 31 (30.69% had senior certificate and 42 (41.58% had intermediate certificate. Total error rate of 6 knowledge points was 4.50% (91/2020. Of the 6 knowledge points, the error rate of pitfalls was the highest (9.41%, 19/202, followed by result determination (5.94% , 12/202, recording techniques (4.75% , 24/505, procedures (3.96%, 32/808, sequence of confirmatory tests (1.98%, 2/101 and environmental conditions (0.99%, 2/202. Univariate and multivariate Logistic regression analyses showed that age (OR = 1.566, 95% CI: 1.116-2.197; P = 0.009 and professional qualification (OR = 1.669, 95% CI: 1.163-2.397; P = 0.005 were independent risk factors associated with high error rates. Conclusions The differences between brain death determination and routine check of SLSEP should be paid more attention to improve the quality of determination for brain death by SLSEP.  DOI: 10.3969/j.issn.1672-6731.2015.12.007

  3. Brazilian guidelines for the application of transcranial ultrasound as a diagnostic test for the confirmation of brain death

    Directory of Open Access Journals (Sweden)

    Marcos C. Lange

    2012-05-01

    Full Text Available Neurosonological studies, specifically transcranial Doppler (TCD and transcranial color-coded duplex (TCCD, have high level of specificity and sensitivity and they are used as complementary tests for the diagnosis of brain death (BD. A group of experts, from the Neurosonology Department of the Brazilian Academy of Neurology, created a task force to determine the criteria for the following aspects of diagnosing BD in Brazil: the reliability of TCD methodology; the reliability of TCCD methodology; neurosonology training and skills; the diagnosis of encephalic circulatory arrest; and exam documentation for BD. The results of this meeting are presented in the current paper.

  4. Accumulation of neuronal DNA damage as an early covariate of determinant of death after whole-brain irradiaton

    International Nuclear Information System (INIS)

    Wheeler, K.T.; Weinstein, R.E.

    1979-01-01

    The state of the DNA from cerebellar neurons of male Sprague-Dawley rats after whole-brain irradiation with 2000 rad of x rays was determined at various times by obtaining DNA sedimentation profiles using alkaline sucrose gradients in slow reorienting zonal rotors. It took more than 4 weeks after irradiation for the neuronal DNA distributions to return to those obtained from the unirradiated controls. At 7 weeks, the DNA from irradiated neurons sedimented more rapidly than that from unirradiated neurons. Accumulation of the neuronal DNA damage (degradation.) which led to slower sedimenting DNA species began by Week 10 and continued until the majority of the irradiated rats began to die at Week 20. We propose as a working hypothesis that the accumulation of neuronal DNA damage initially observed 10 weeks after 2000 rad of whole-brain irradiation may reflect or cause changes in the central nervous system that later result in the death of the animal

  5. A narrative review of the empirical evidence on public attitudes on brain death and vital organ transplantation: the need for better data to inform policy.

    Science.gov (United States)

    Shah, Seema K; Kasper, Kenneth; Miller, Franklin G

    2015-04-01

    Vital organ transplantation is premised on 'the dead donor rule': donors must be declared dead according to medical and legal criteria prior to donation. However, it is controversial whether individuals diagnosed as 'brain dead' are really dead in accordance with the established biological conception of death-the irreversible cessation of the functioning of the organism as a whole. A basic understanding of brain death is also relevant for giving valid, informed consent to serve as an organ donor. There is therefore a need for reliable empirical data on public understanding of brain death and vital organ transplantation. We conducted a review of the empirical literature that identified 43 articles with approximately 18,603 study participants. These data demonstrate that participants generally do not understand three key issues: (1) uncontested biological facts about brain death, (2) the legal status of brain death and (3) that organs are procured from brain dead patients while their hearts are still beating and before their removal from ventilators. These data suggest that, despite scholarly claims of widespread public support for organ donation from brain dead patients, the existing data on public attitudes regarding brain death and organ transplantation reflect substantial public confusion. Our review raises questions about the validity of consent for vital organ transplantation and suggests that existing data are of little assistance in developing policy proposals for organ transplantation from brain dead patients. New approaches to rigorous empirical research with educational components and evaluations of understanding are urgently needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. The Effect of Early Detection of Occult Brain Metastases in HER2-Positive Breast Cancer Patients on Survival and Cause of Death

    International Nuclear Information System (INIS)

    Niwinska, Anna; Tacikowska, Malgorzata; Murawska, Magdalena

    2010-01-01

    Purpose: The aim of the study is to evaluate disease-free survival, survival from the detection of brain metastases, overall survival, and cause of death in patients with occult brain metastases (Group I) vs. patients with symptomatic brain metastases (Group II). Methods and Materials: In 80 HER2-positive breast cancer patients, treated with trastuzumab and cytostatic agents for metastatic disease, magnetic resonance imaging screening of the brain was performed, and in 29 patients (36%) occult brain metastasis was detected (Group I). Whole-brain radiotherapy was delivered to Group I. This first group was compared with 52 patients who had symptomatic brain metastases (Group II) and was treated the same way, at the same clinic, during the same time period. Results: Median disease-free survival was 17 months in Group I and 19.9 months in Group II (p = 0.58). The median time interval between the dissemination of the disease and the detection of occult or symptomatic brain metastases was 9 and 15 months, respectively (p = 0.11). When the brain metastases were detected, the median survival was 9 and 8.78 months, respectively (p = 0.80). The median overall survival was 53 and 51 months, respectively (p = 0.94). In the group with occult brain metastases (Group I) 16% of patients died because of progression within the brain. In the group with symptomatic brain metastases (Group II) the rate of cerebral death was 48% (p = 0.009). Conclusions: Whole-brain radiotherapy of occult brain metastases in HER2-positive breast cancer patients with visceral dissemination produces a three-fold decrease in cerebral deaths but does not prolong survival.

  7. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology.

    Science.gov (United States)

    Wijdicks, Eelco F M; Varelas, Panayiotis N; Gronseth, Gary S; Greer, David M

    2010-06-08

    To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death? A systematic literature search was conducted and included a review of MEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults. In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter. Complex-spontaneous motor movements and false-positive triggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain.

  8. High Ca2+ Influx During Traumatic Brain Injury Leads to Caspase-1-Dependent Neuroinflammation and Cell Death.

    Science.gov (United States)

    Abdul-Muneer, P M; Long, Mathew; Conte, Adriano Andrea; Santhakumar, Vijayalakshmi; Pfister, Bryan J

    2017-08-01

    We investigated the hypothesis that high Ca 2+ influx during traumatic brain injury induces the activation of the caspase-1 enzyme, which triggers neuroinflammation and cell apoptosis in a cell culture model of neuronal stretch injury and an in vivo model of fluid percussion injury (FPI). We first established that stretch injury causes a rapid increase in the intracellular Ca 2+ level, which activates interleukin-converting enzyme caspase-1. The increase in the intracellular Ca 2+ level and subsequent caspase-1 activation culminates into neuroinflammation via the maturation of IL-1β. Further, we analyzed caspase-1-mediated apoptosis by TUNEL staining and PARP western blotting. The voltage-gated sodium channel blocker, tetrodotoxin, mitigated the stretch injury-induced neuroinflammation and subsequent apoptosis by blocking Ca 2+ influx during the injury. The effect of tetrodotoxin was similar to the caspase-1 inhibitor, zYVAD-fmk, in neuronal culture. To validate the in vitro results, we demonstrated an increase in caspase-1 activity, neuroinflammation and neurodegeneration in fluid percussion-injured animals. Our data suggest that neuronal injury/traumatic brain injury (TBI) can induce a high influx of Ca 2+ to the cells that cause neuroinflammation and cell death by activating caspase-1, IL-1β, and intrinsic apoptotic pathways. We conclude that excess IL-1β production and cell death may contribute to neuronal dysfunction and cognitive impairment associated with TBI.

  9. EAAC1 Gene Deletion Increases Neuronal Death and Blood Brain Barrier Disruption after Transient Cerebral Ischemia in Female Mice

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    Bo Young Choi

    2014-10-01

    Full Text Available EAAC1 is important in modulating brain ischemic tolerance. Mice lacking EAAC1 exhibit increased susceptibility to neuronal oxidative stress in mice after transient cerebral ischemia. EAAC1 was first described as a glutamate transporter but later recognized to also function as a cysteine transporter in neurons. EAAC1-mediated transport of cysteine into neurons contributes to neuronal antioxidant function by providing cysteine substrates for glutathione synthesis. Here we evaluated the effects of EAAC1 gene deletion on hippocampal blood vessel disorganization after transient cerebral ischemia. EAAC1−/− female mice subjected to transient cerebral ischemia by common carotid artery occlusion for 30 min exhibited twice as much hippocampal neuronal death compared to wild-type female mice as well as increased reduction of neuronal glutathione, blood–brain barrier (BBB disruption and vessel disorganization. Pre-treatment of N-acetyl cysteine, a membrane-permeant cysteine prodrug, increased basal glutathione levels in the EAAC1−/− female mice and reduced ischemic neuronal death, BBB disruption and vessel disorganization. These findings suggest that cysteine uptake by EAAC1 is important for neuronal antioxidant function under ischemic conditions.

  10. Imminent brain death : point of departure for potential heart-beating organ donor recognition

    NARCIS (Netherlands)

    de Groot, Yorick J.; Jansen, Nichon E.; Bakker, Jan; Kuiper, Michael A.; Aerdts, Stan; Maas, Andrew I. R.; Wijdicks, Eelco F. M.; van Leiden, Hendrik A.; Hoitsma, Andries J.; Kremer, Berry H. P. H.; Kompanje, Erwin J. O.

    There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for criteria

  11. Imminent brain death: Point of departure for potential heart-beating organ donor recognition

    NARCIS (Netherlands)

    Y.J. de Groot (Yorick); N.E. Jansen (Nichon); J. Bakker (Jan); M.A. Kuiper (Michael); S. Aerdts (Stan); A.I.R. Maas (Andrew); E.F.M. Wijdicks (Eelco); H.A. van Leiden (Hendrik); A.J. Hoitsma (Andries); H.P.H. Kremer (Berry); E.J.O. Kompanje (Erwin)

    2010-01-01

    textabstractPurpose: There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We

  12. Imminent brain death: point of departure for potential heart-beating organ donor recognition.

    NARCIS (Netherlands)

    Groot, Y.J. de; Jansen, N.E.; Bakker, J.; Kuiper, M.A.; Aerdts, S.; Maas, A.I.; Wijdicks, E.F.; Leiden, H.A. van; Hoitsma, A.J.; Kremer, H.P.H.; Kompanje, E.J.

    2010-01-01

    PURPOSE: There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for

  13. Analysis on the training effect of criteria and practical guidance for determination of brain death: transcranial Doppler

    Directory of Open Access Journals (Sweden)

    Lin-lin FAN

    2015-12-01

    Full Text Available Objective To analyze the training effects of transcranial Doppler (TCD for brain death determination conducted by Brain Injury Evaluation Quality Control Centre of National Health and Family Planning Commission to optimize the training program and improve the training effects. Methods A total of 106 trainees received theoretical training, simulation skill training, bedside skill training and test analysis on TCD confirmatory test for brain death determination. The composition of trainees was analyzed and the error rates of 6 knowledge points were calculated. Univariate and multivariate backward Logistic regression analyses were used to analyze the influence of factors including sex, age, specialty, professional category professional qualification and hospital level on the error rates. Results The trainees including 42 males and 64 females, came from 69 hospitals. Trainees of 30-49 years old occupied 77.36% (82/106. In the trainees, 96.23% (102/106 were from third grade, grade A hospitals, and most of them were from Department of Neurology (64.15% , 68/106 and Ultrasound (19.81% , 21/106. There were 82 clinicians (77.36%. Thirty four (32.08% trainees had senior certificate and 49 (46.23% had intermediate certificate. Total error rate of 6 knowledge points was 7.26% (149/2052. Of the 6 knowledge points, the error rate of parameter setting was the highest (9.43%, 10/106, followed by checking position (8.73%, 37/424, artery recognition (8.67%, 43/496, result determination (7.41%, 55/742, equipment (1.89%, 2/106 and pitfalls (1.12%, 2/178. Univariate and multivariate Logistic regression analyses showed that specialty (OR = 1.313, 95% CI: 1.072-1.610; P = 0.009 and hospital level (OR = 2.943, 95% CI: 1.623-5.338; P = 0.000 were independent risk factors associated with high error rates. Conclusions Among the trainees, degree of mastering the knowledge points is different, and the characteristics of trainees influence the training effect. The training

  14. Brain metastases from breast cancer: prognostic significance of HER-2 overexpression, effect of trastuzumab and cause of death

    International Nuclear Information System (INIS)

    Le Scodan, Romuald; Jouanneau, Ludivine; Massard, Christophe; Gutierrez, Maya; Kirova, Youlia; Cherel, Pascal; Gachet, Julie; Labib, Alain; Mouret-Fourme, Emmanuelle

    2011-01-01

    To access the prognostic significance of HER-2 overexpression, the effect of trastuzumab and the cause of death in patients with brain metastases (BM) from breast cancer (BC). We analyzed the outcome of 130 patients with BM from BC who received whole-brain radiotherapy (WBRT) (without surgery or radiosurgery) between January 1998 and April 2006. Demographic data, tumor characteristics, and treatments were prospectively recorded. The impact of HER-2 overexpression and trastuzumab-based therapy on overall survival (OS) and the cause of death were evaluated. The median follow-up for the whole population was 6.25 months (mean: 9.15; range: 0.23-53). The median survival time and 1-year survival rates after BM diagnosis were 7.43 months and 35.8% (95% CI: 28-45.7) respectively. The median survival time for HER-2 negative patients (n = 78), HER-2 positive patients not treated with trastuzumab (n = 20) and HER-2 positive patients treated with trastuzumab (n = 32) were 5.9 months, 5.6 months and 19.53 months, respectively. The 1-year survival rates were 26.1%, 29.2% and 62.6% respectively, (p < 0.004). Among the 18 HER-2 positive patients treated with trastuzumab who died, 11 (61%) apparently succumbed from CNS progression, in the face of stable or responsive non-CNS disease. Trastuzumab-based therapy was associated with a 51% reduction in the risk of death (multiadjusted hazard ratio: 0.49; 95% CI, 0.29-0.83). In our experience, trastuzumab-based therapy for HER-overexpressing tumors was associated with improved survival in BM BC patients. This subgroup of patients may benefit from innovative approaches, in order to obtain better intra cerebral control

  15. Dialysis Disequilibrium Syndrome: Brain death following hemodialysis for metabolic acidosis and acute renal failure – A case report

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    Bagshaw Sean M

    2004-08-01

    Full Text Available Abstract Background Dialysis disequilibrium syndrome (DDS is the clinical phenomenon of acute neurologic symptoms attributed to cerebral edema that occurs during or following intermittent hemodialysis (HD. We describe a case of DDS-induced cerebral edema that resulted in irreversible brain injury and death following acute HD and review the relevant literature of the association of DDS and HD. Case Presentation A 22-year-old male with obstructive uropathy presented to hospital with severe sepsis syndrome secondary to pneumonia. Laboratory investigations included a pH of 6.95, PaCO2 10 mmHg, HCO3 2 mmol/L, serum sodium 132 mmol/L, serum osmolality 330 mosmol/kg, and urea 130 mg/dL (46.7 mmol/L. Diagnostic imaging demonstrated multifocal pneumonia, bilateral hydronephrosis and bladder wall thickening. During HD the patient became progressively obtunded. Repeat laboratory investigations showed pH 7.36, HCO3 19 mmol/L, potassium 1.8 mmol/L, and urea 38.4 mg/dL (13.7 mmol/L (urea-reduction-ratio 71%. Following HD, spontaneous movements were absent with no pupillary or brainstem reflexes. Head CT-scan showed diffuse cerebral edema with effacement of basal cisterns and generalized loss of gray-white differentiation. Brain death was declared. Conclusions Death is a rare consequence of DDS in adults following HD. Several features may have predisposed this patient to DDS including: central nervous system adaptations from chronic kidney disease with efficient serum urea removal and correction of serum hyperosmolality; severe cerebral intracellular acidosis; relative hypercapnea; and post-HD hemodynamic instability with compounded cerebral ischemia.

  16. Cancer: brain-regulated biphasic stress response induces cell growth or cell death to adapt to psychological stressors.

    Science.gov (United States)

    Thomas, Charles; Bhatia, Shruti

    2014-01-01

    According to Indian Vedic philosophy, a human being contains 3 major bodies: (1) the matter body--brain, organs, and senses; (2) the mental body--mind, individual consciousness, intellect, and ego; and (3) the soul or causal body--universal consciousness. The third, which is located in the heart according to all spiritual traditions and recent scientific literature, can be seen as the information body that contains all memories. The mental body, which can interface with the matter and information bodies, can be seen as a field of immaterial energy that can carry, regulate, and strengthen all information (eg, thoughts or emotions) both positively and negatively. This body of information may store ancestral and/or autobiographical memories: unconscious memories from inner traumas--inner information (Ii) or samskaras in Vedic philosophy--and conscious memories from outer traumas--outer information (Io). These conscious and unconscious memories can be seen as potential psychological stressors. Resonance between Ii and Io may induce active conflicts if resistance occurs in the mental body; this conflict may cause specific metabolic activity in the brain and a stress response in the physical body, which permits adjustment to psychological stressors. The brainregulated stress response may be biphasic: cell death or growth induced by adrenergic molecular pathways during the conflict's unresolved phase and reversion to cell growth or death induced by cholinergic molecular pathways during the conflict's resolved phase. Case studies and data mining from PubMed suggest that this concept complies with the principles of holistic medicine and the scientific literature supporting its benefits. We suggest that the evolution of cancer can be seen as a biphasic stress response regulated by the brain to adapt to psychological stressors, which produce imbalance among the physical, mental, and information bodies.

  17. Effect of brain death on gene expression and tissue activation in human donor kidneys

    NARCIS (Netherlands)

    Nijboer, WN; Schuurs, TA; van der Hoeven, JAB; Fekken, S; Wiersema-Buist, J; Leuvenink, HGD; Hofker, Hendrik; Homan van der Heide, J; van Son, WJ; Ploeg, RJ

    2004-01-01

    Background. After kidney transplantation, decreased graft survival is seen in grafts from brain dead (BD) donors compared with living donors. This might result partly from a progressive nonspecific inflammation in the graft. In this study, we focused on the effects of BD on inflammatory response

  18. Effect of brain death on gene expression and tissue activation in human donor kidneys

    NARCIS (Netherlands)

    Nijboer, Willemijn N.; Schuurs, Theo A.; van der Hoeven, Joost A. B.; Fekken, Susan; Wiersema-Buist, Janneke; Leuvenink, Henri G. D.; Hofker, Sijbrand; Homan van der Heide, Jaap J.; van Son, Willem J.; Ploeg, Rutger J.

    2004-01-01

    After kidney transplantation, decreased graft survival is seen in grafts from brain dead (BD) donors compared with living donors. This might result partly from a progressive nonspecific inflammation in the graft. In this study, we focused on the effects of BD on inflammatory response (adhesion

  19. The attitudes of brain cancer patients and their caregivers towards death and dying: a qualitative study

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    Kimmelman Jonathan

    2007-11-01

    Full Text Available Abstract Background Much money and energy has been spent on the study of the molecular biology of malignant brain tumours. However, little attention has been paid to the wishes of patients afflicted with these incurable tumours, and how this might influence treatment considerations. Methods We interviewed 29 individuals – 7 patients dying of a malignant brain tumor and 22 loved ones. One-on-one interviews were conducted according to a pre-designed interview guide. A combination of open-ended questions, as well as clinical scenarios was presented to participants in order to understand what is meaningful and valuable to them when determining treatment options and management approaches. The results were analyzed, coded, and interpreted using qualitative analytic techniques in order to arrive at several common overarching themes. Results Seven major themes were identified. In general, respondents were united in viewing brain cancer as unique amongst malignancies, due in large part to the premium placed on mental competence and cognitive functioning. Importantly, participants found their experiences, however difficult, led to the discovery of inner strength and resilience. Responses were usually framed within an interpersonal context, and participants were generally grateful for the opportunity to speak about their experiences. Attitudes towards religion, spirituality, and euthanasia were also probed. Conclusion Several important themes underlie the experiences of brain cancer patients and their caregivers. It is important to consider these when managing these patients and to respect not only their autonomy but also the complex interpersonal toll that a malignant diagnosis can have.

  20. Inflammatory responses are not sufficient to cause delayed neuronal death in ATP-induced acute brain injury.

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    Hey-Kyeong Jeong

    Full Text Available BACKGROUND: Brain inflammation is accompanied by brain injury. However, it is controversial whether inflammatory responses are harmful or beneficial to neurons. Because many studies have been performed using cultured microglia and neurons, it has not been possible to assess the influence of multiple cell types and diverse factors that dynamically and continuously change in vivo. Furthermore, behavior of microglia and other inflammatory cells could have been overlooked since most studies have focused on neuronal death. Therefore, it is essential to analyze the precise roles of microglia and brain inflammation in the injured brain, and determine their contribution to neuronal damage in vivo from the onset of injury. METHODS AND FINDINGS: Acute neuronal damage was induced by stereotaxic injection of ATP into the substantia nigra pars compacta (SNpc and the cortex of the rat brain. Inflammatory responses and their effects on neuronal damage were investigated by immunohistochemistry, electron microscopy, quantitative RT-PCR, and stereological counting, etc. ATP acutely caused death of microglia as well as neurons in a similar area within 3 h. We defined as the core region the area where both TH(+ and Iba-1(+ cells acutely died, and as the penumbra the area surrounding the core where Iba-1(+ cells showed activated morphology. In the penumbra region, morphologically activated microglia arranged around the injury sites. Monocytes filled the damaged core after neurons and microglia died. Interestingly, neither activated microglia nor monocytes expressed iNOS, a major neurotoxic inflammatory mediator. Monocytes rather expressed CD68, a marker of phagocytic activity. Importantly, the total number of dopaminergic neurons in the SNpc at 3 h (∼80% of that in the contralateral side did not decrease further at 7 d. Similarly, in the cortex, ATP-induced neuron-damage area detected at 3 h did not increase for up to 7 d. CONCLUSIONS: Different cellular

  1. Muerte cerebral en una embarazada y sobrevida del feto Brain death in a pregnant woman and fetus survival

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    Raúl Mejía

    2008-12-01

    Full Text Available Se presenta el caso de una mujer de 29 años de edad que a consecuencia de una hemorragia cerebelosa presentó un cuadro de muerte cerebral mientras cursaba la 17 semana de su embarazo. Durante 56 días se mantuvo con sostén vital artificial, corrección de déficit hormonal, nutrición enteral y tratamiento de las infecciones. Durante la 25 semana de embarazo, por paro cardíaco se debió practicar una cesárea, naciendo un niño de 450 gramos. Se realizó una revisión de los casos similares publicados y se discuten algunos aspectos médicos, éticos y legales derivados de esta situación.A 29 year old woman suffered massive brain injury after a cerebellum hemorrhage at 17 weeks' gestation. Several hours later, and after brainstem test, she was declared brain dead. She was supported with intensive care during 56 days. After a cardiac arrest, on week 25, a 450 g infant was delivered through a cesarean section. The somatic support of mother and fetus according to the expected physiologic changes after brain death and its ethical implications are discussed.

  2. Sumoylation of IkB attenuates NF-kB-induced nitrosative stress at rostral ventrolateral medulla and cardiovascular depression in experimental brain death.

    Science.gov (United States)

    Tsai, Ching-Yi; Li, Faith C H; Wu, Carol H Y; Chang, Alice Y W; Chan, Samuel H H

    2016-09-22

    Small ubiquitin-related modifier (SUMO) is a group of proteins that participates in post-translational modifications. One known SUMO target is the transcription factor nuclear factor-kB (NF-kB) that plays a pivotal role in many disease processes; sumoylation inactivates NF-kB by conjugation with inhibitors of NF-kB (IkB). Our laboratory demonstrated previously that transcriptional upregulation of nitric oxide synthase II (NOS II) by NF-kB, leading to nitrosative stress by the formation of peroxynitrite in the rostral ventrolateral medulla (RVLM), underpins the defunct brain stem cardiovascular regulation that precedes brain death. Based on an experimental endotoxemia model, this study evaluated the hypothesis that sumoylation plays a pro-life role in brain death by interacting with the NF-kB/NOS II/peroxynitrite signaling pathway in the RVLM. In Sprague-Dawley rats, intravenous administration of Escherichia coli lipopolysaccharide (LPS; 10 mg kg -1 ) elicited an augmentation of SUMO-1 and ubiquitin-conjugase 9 (Ubc9) mRNA or protein levels, alongside SUMO-1-conjugated proteins in the RVLM. Immunoneutralization of SUMO-1 or Ubc9 in the RVLM significantly potentiated the already diminished sumoylation of IkBα and intensified NF-kB activation and NOS II/peroxynitrite expression in this brain stem substrate, together with exacerbated fatality, cardiovascular depression and reduction of an experimental index of a life-and-death signal detected from arterial pressure that disappears in comatose patients signifying failure of brain stem cardiovascular regulation before brain death. We conclude that sumoylation of IkB in the RVLM ameliorates the defunct brain stem cardiovascular regulation that underpins brain death in our experimental endotoxemia modal by reducing nitrosative stress via inhibition of IkB degradation that diminishes the induction of the NF-kB/NOS II/peroxynitrite signaling cascade.

  3. Decision making by relatives about brain death organ donation: an integrative review.

    Science.gov (United States)

    de Groot, Jack; Vernooij-Dassen, Myrra; Hoedemaekers, Cornelia; Hoitsma, Andries; Smeets, Wim; van Leeuwen, Evert

    2012-06-27

    Deciding about the organ donation of one's brain-dead beloved often occurs in an unexpected and delicate situation. We explored the decision making of the relatives of potential brain-dead donors, its evaluation, and the factors influencing decision making. We used the integrative review method. Our search included 10 databases. Inclusion criteria were presence of the donation request or the subsequent decision process. Three authors independently assessed the eligibility of identified articles. Content analysis of 70 included articles led to three themes: decision, evaluation, and support. We extracted results and recommendations concerning these three themes. The timing of the request and understandable information influence the decision. The relatives evaluate their decision differently: in case of refusal, approximately one third regret their decision, and in case of consent, approximately one tenth mention regret. The relatives are often ambivalent about their values (protection, altruism, and respect) and the deceased's wishes, not wanting additional suffering either for their beloved or for themselves. Support is mainly focused on increasing consent rates and less on satisfaction with the decision. Evaluation of decision making by the relatives of potential brain-dead donors reveals possibilities for improving the decision process. Special skills of the requester, attention to the circumstances, and unconditional support for the relatives might prevent the relatives' regret about refusal and unnecessary loss of organs. We hypothesize that support in exploring the relatives' values and the deceased's wishes can lead to stable decisions. This hypothesis deserves further investigation.

  4. Increasing Rates of Brain Tumours in the Swedish National Inpatient Register and the Causes of Death Register

    Directory of Open Access Journals (Sweden)

    Lennart Hardell

    2015-04-01

    Full Text Available Radiofrequency emissions in the frequency range 30 kHz–300 GHz were evaluated to be Group 2B, i.e., “possibly”, carcinogenic to humans by the International Agency for Research on Cancer (IARC at WHO in May 2011. The Swedish Cancer Register has not shown increasing incidence of brain tumours in recent years and has been used to dismiss epidemiological evidence on a risk. In this study we used the Swedish National Inpatient Register (IPR and Causes of Death Register (CDR to further study the incidence comparing with the Cancer Register data for the time period 1998–2013 using joinpoint regression analysis. In the IPR we found a joinpoint in 2007 with Annual Percentage Change (APC +4.25%, 95% CI +1.98, +6.57% during 2007–2013 for tumours of unknown type in the brain or CNS. In the CDR joinpoint regression found one joinpoint in 2008 with APC during 2008–2013 +22.60%, 95% CI +9.68, +37.03%. These tumour diagnoses would be based on clinical examination, mainly CT and/or MRI, but without histopathology or cytology. No statistically significant increasing incidence was found in the Swedish Cancer Register during these years. We postulate that a large part of brain tumours of unknown type are never reported to the Cancer Register. Furthermore, the frequency of diagnosis based on autopsy has declined substantially due to a general decline of autopsies in Sweden adding further to missing cases. We conclude that the Swedish Cancer Register is not reliable to be used to dismiss results in epidemiological studies on the use of wireless phones and brain tumour risk.

  5. Repeated exposure of the developing rat brain to magnetic resonance imaging did not affect neurogenesis, cell death or memory function

    International Nuclear Information System (INIS)

    Zhu, Changlian; Gao, Jianfeng; Li, Qian; Huang, Zhiheng; Zhang, Yu; Li, Hongfu; Kuhn, Hans-Georg; Blomgren, Klas

    2011-01-01

    Research highlights: → The effect of MRI on the developing brain is a matter of debate. → Repeated exposure to MRI did not affect neurogenesis. → Memory function was not affected by repeated MRI during development. → Neither late gestation nor young postnatal brains were affected by MRI. → Repeated MRI did not cause cell death in the neurogenic region of the hippocampus. -- Abstract: The effect of magnetic fields on the brain is a matter of debate. The objective of this study was to investigate whether repeated exposure to strong magnetic fields, such as during magnetic resonance imaging (MRI), could elicit changes in the developing rat brain. Embryonic day 15 (E15) and postnatal day 14 (P14) rats were exposed to MRI using a 7.05 T MR system. The animals were anesthetized and exposed for 35 min per day for 4 successive days. Control animals were anesthetized but no MRI was performed. Body temperature was maintained at 37 o C. BrdU was injected after each session (50 mg/kg). One month later, cell proliferation, neurogenesis and astrogenesis in the dentate gyrus were evaluated, revealing no effects of MRI, neither in the E15, nor in the P14 group. DNA damage in the dentate gyrus in the P14 group was evaluated on P18, 1 day after the last session, using TUNEL staining. There was no difference in the number of TUNEL-positive cells after MRI compared with controls, neither in mature neurons, nor in newborn progenitors (BrdU/TUNEL double-labeled cells). Novel object recognition was performed to assess memory function 1 month after MRI. There was no difference in the recognition index observed after MRI compared with the control rats, neither for the E15, nor for the P14 group. In conclusion, repeated exposure to MRI did not appear to affect neurogenesis, cell death or memory function in rats, neither in late gestation (E15-E18) nor in young postnatal (P14-P17) rats.

  6. Brain Death and Organ Donation: Knowledge, Awareness, and Attitudes of Medical, Law, Divinity, Nursing, and Communication Students.

    Science.gov (United States)

    Kocaay, A F; Celik, S U; Eker, T; Oksuz, N E; Akyol, C; Tuzuner, A

    2015-06-01

    Throughout the world, there is a shortage of suitable organs for organ transplantation. The aim of this study was to assess the level of knowledge, awareness, and attitudes of medical, law, divinity, nursing, and communication students, who will be involved in this issue in the future, regarding brain death and organ donation. Data were collected with the use of a 30-item questionnaire. Of the 341 participants, 228 (66.8%) were female and overall average age was 21.6 ± 2.8 years. Nearly one-half of them (51.3%), especially nursing and medical students, wanted to be a donor, but only 2% had an organ donation card; 78.3% emphasized that family must have the right to make the decision for organ donation, and the vast majority of the participants considered that the organs could not be taken without any permission. Kidney and heart were the most commonly identified transplantable organs; the less frequently known organ was intestine. Only 71 participants, most of them medical, divinity, and law students, correctly answered all questions about brain death; 68.6% stated that organ donation is allowed by religion, and 5% expressed that it is religiously forbidden; 37.3% did not have confidence in health care policy. Law students were more confident, nursing students less confident. Better understanding of organ donation and concepts by the doctors, nurses, legislators, religious officials, and mass communications professionals who will give direction to society's behaviors and beliefs would help to spread positive attitudes toward organ donation and transplantation in the public. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Programmed Cell Death in the Honey Bee (Apis mellifera) (Hymenoptera: Apidae) Worker Brain Induced by Imidacloprid.

    Science.gov (United States)

    Wu, Yan-Yan; Zhou, Ting; Wang, Qiang; Dai, Ping-Li; Xu, Shu-Fa; Jia, Hui-Ru; Wang, Xing

    2015-08-01

    Honey bees are at an unavoidable risk of exposure to neonicotinoid pesticides, which are used worldwide. Compared with the well-studied roles of these pesticides in nontarget site (including midgut, ovary, or salivary glands), little has been reported in the target sites, the brain. In the current study, laboratory-reared adult worker honey bees (Apis mellifera L.) were treated with sublethal doses of imidacloprid. Neuronal apoptosis was detected using the TUNEL technique for DNA labeling. We observed significantly increased apoptotic markers in dose- and time-dependent manners in brains of bees exposed to imidacloprid. Neuronal activated caspase-3 and mRNA levels of caspase-1, as detected by immunofluorescence and real-time quantitative PCR, respectively, were significantly increased, suggesting that sublethal doses of imidacloprid may induce the caspase-dependent apoptotic pathway. Additionally, the overlap of apoptosis and autophagy in neurons was confirmed by transmission electron microscopy. It further suggests that a relationship exists between neurotoxicity and behavioral changes induced by sublethal doses of imidacloprid, and that there is a need to determine reasonable limits for imidacloprid application in the field to protect pollinators. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  8. The botulinum toxin legend of Reinhard Heydrich's death: The end of "Himmler's brain".

    Science.gov (United States)

    Tatu, Laurent; Jost, Wolfgang; Bogousslavsky, Julien

    2017-07-04

    The high-ranking German Nazi Reinhard Heydrich (1904-1942) was one of the main organizers of the mass murder of Jews during the Second World War. He died on June 4, 1942, in Prague after having been wounded in Operation Anthropoid planned by the British intelligence services. Since the 1970s and 1980s, Heydrich's death has been frequently presented in British, American, and French literature as the consequence of a bacteriologic attack. Botulinum toxin would have been used in the grenades or ammunition. We discuss the botulinum toxin hypothesis using the now declassified British archives of Operation Anthropoid and of the chemical and bacteriologic warfare centers to assess this hypothesis. © 2017 American Academy of Neurology.

  9. Five-Year Follow-Up on Transplanted Organs From Donors After Brain Death After Acute Stroke.

    Science.gov (United States)

    Spatenkova, Vera; Pokorna, Eva; Suchomel, Petr

    2017-08-01

    Efficient intensive care donor management can help alleviate the shortage of organs for transplant. The aim of this study was to investigate the efficiency of management of donors after brain death from our neurointensive care unit. We conducted a prospective observational 5-year follow-up on 29 transplanted organs from 14 brain-dead donors after acute stroke (7 subarachnoid and 4 intracerebral hemorrhages, 3 ischemic strokes). Mean age of donors was 56.2 ± 8.70 years, and mean number of days of artificial ventilation was 5.0 ± 3.84. We transplanted 27 kidneys and 2 livers to 29 patients with mean age of 55.3 ± 9.76 years. No hearts or lungs were transplanted from these donors. Of the 27 patients who underwent kidney transplant, 21 patients (78%) lived 5 years; of those, 17 patients (63%) had functional grafts. One patient (4%) had a primary afunctional graft, and 3 patients (11%) had graft rejection (at 3, 15, and 41 mo). Six patients (22%) died after kidney transplant, with 1 patient in this group having a functional graft, 1 patient having a primary afunctional graft, and 4 patients (15%) having graft rejection (at 1, 12, 44, and 56 mo). The 2 patients with liver transplants lived 5 years with functional grafts. The 5-year follow-up showed that organs from 14 brain-dead donors improved and saved 19 lives, with 17 patients receiving kidney transplants and 2 patients receiving liver transplants. Another 7 patients had only partially improved quality of life.

  10. Up-regulation of K{sub ir}2.1 by ER stress facilitates cell death of brain capillary endothelial cells

    Energy Technology Data Exchange (ETDEWEB)

    Kito, Hiroaki [Department of Molecular and Cellular Pharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya (Japan); Yamazaki, Daiju [Department of Molecular and Cellular Pharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya (Japan); Department of Biological Chemistry, Kyoto University, Graduate School of Pharmaceutical Sciences, Kyoto (Japan); Department of Molecular Neurobiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya (Japan); Ohya, Susumu; Yamamura, Hisao [Department of Molecular and Cellular Pharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya (Japan); Asai, Kiyofumi [Department of Molecular Neurobiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya (Japan); Imaizumi, Yuji, E-mail: yimaizum@phar.nagoya-cu.ac.jp [Department of Molecular and Cellular Pharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya (Japan)

    2011-07-29

    Highlights: {yields} We found that application of endoplasmic reticulum (ER) stress with tunicamycin to brain capillary endothelial cells (BCECs) induced cell death. {yields} The ER stress facilitated the expression of inward rectifier K{sup +} channel (K{sub ir}2.1) and induced sustained membrane hyperpolarization. {yields} The membrane hyperpolarization induced sustained Ca{sup 2+} entry through voltage-independent nonspecific cation channels and consequently facilitated cell death. {yields} The K{sub ir}2.1 up-regulation by ER stress is, at least in part, responsible for cell death of BCECs under pathological conditions. -- Abstract: Brain capillary endothelial cells (BCECs) form blood brain barrier (BBB) to maintain brain homeostasis. Cell turnover of BCECs by the balance of cell proliferation and cell death is critical for maintaining the integrity of BBB. Here we found that stimuli with tunicamycin, endoplasmic reticulum (ER) stress inducer, up-regulated inward rectifier K{sup +} channel (K{sub ir}2.1) and facilitated cell death in t-BBEC117, a cell line derived from bovine BCECs. The activation of K{sub ir} channels contributed to the establishment of deeply negative resting membrane potential in t-BBEC117. The deep resting membrane potential increased the resting intracellular Ca{sup 2+} concentration due to Ca{sup 2+} influx through non-selective cation channels and thereby partly but significantly regulated cell death in t-BBEC117. The present results suggest that the up-regulation of K{sub ir}2.1 is, at least in part, responsible for cell death/cell turnover of BCECs induced by a variety of cellular stresses, particularly ER stress, under pathological conditions.

  11. Expression of Brain-Derived Neurotrophic Factor (BDNF Increases the Resistance of Neurons to Death in the Postresuscitation Period

    Directory of Open Access Journals (Sweden)

    I. V. Ostrova

    2015-01-01

    mean optical density indicated that the remaining neurons had a higher BDNF protein expression than those in the controls. The found facts suggest that this protein has a neuroprotective effect in the postresuscitation period.Conclusion. The capability for BDNF expression is an important factor that enhances neuronal resistance to death in the postresuscitation period. This offers promise for BDNF use to elaborate novel approaches to protecting the brain in ischemia-reperfusion.

  12. Tema 8. Principis físics dels semiconductors (Guia del tema)

    OpenAIRE

    Beléndez Vázquez, Augusto

    2011-01-01

    Guia del "Tema 8. Principis físics dels semiconductors" de l'assignatura "Fonaments Físics de l'Enginyeria I" de "Grau en Enginyeria en So i Imatge" impartit a l'Escola Politècnica Superior de la Universitat d'Alacant.

  13. miR-Let7A Controls the Cell Death and Tight Junction Density of Brain Endothelial Cells under High Glucose Condition.

    Science.gov (United States)

    Song, Juhyun; Yoon, So Ra; Kim, Oh Yoen

    2017-01-01

    Hyperglycemia-induced stress in the brain of patients with diabetes triggers the disruption of blood-brain barrier (BBB), leading to diverse neurological diseases including stroke and dementia. Recently, the role of microRNA becomes an interest in the research for deciphering the mechanism of brain endothelial cell damage under hyperglycemia. Therefore, we investigated whether mircoRNA Let7A (miR-Let7A) controls the damage of brain endothelial (bEnd.3) cells against high glucose condition. Cell viability, cell death marker expressions (p-53, Bax, and cleaved poly ADP-ribose polymerase), the loss of tight junction proteins (ZO-1 and claudin-5), proinflammatory response (interleukin-6, tumor necrosis factor- α ), inducible nitric oxide synthase, and nitrite production were confirmed using MTT, reverse transcription-PCR, quantitative-PCR, Western blotting, immunofluorescence, and Griess reagent assay. miR-Let7A overexpression significantly prevented cell death and loss of tight junction proteins and attenuated proinflammatory response and nitrite production in the bEnd.3 cells under high glucose condition. Taken together, we suggest that miR-Let7A may attenuate brain endothelial cell damage by controlling cell death signaling, loss of tight junction proteins, and proinflammatory response against high glucose stress. In the future, the manipulation of miR-Let7A may be a novel solution in controlling BBB disruption which leads to the central nervous system diseases.

  14. Protective Effects of Salubrinal on Liver Injury in Rat Models of Brain Death

    Institute of Scientific and Technical Information of China (English)

    Tao Wang; Shui-Jun Zhang; Sheng-Li Cao; Wen-Zhi Guo; Bing Yan; Hong-Bo Fang

    2015-01-01

    Background:Previous studies have indicated that endoplasmic reticulum stress participates in and mediates liver injury and apoptosis in brain-dead (BD) rats.In this study,we observed the effect ofsalubrinal (Sal,Sigma,USA) on liver cells in BD rats and explored its relevant mechanisms.Methods:Thirty Sprague-Dawley rats were equally randomized into three groups:BD group,Sal group,and DMSO group.The BD models were established by increasing intracranial pressure in a modified,slow,and intermittent way.In the drug groups,Sal was administered l h before the induction of BD.After modeling was completed,the blood and liver samples were harvested.CHOP and Caspase-12 mRNA expression was detected using quantitative polymerase chain reaction.PKR-like ER kinase (PERK),P-eukaryotic translation initiation factor 2α (eIF2α),eIF2α,CHOP and caspase-12 expression was detected using western blotting (WB).CHOP and caspase-12 distribution and expression in liver tissues were determined using immunohistochemistry (IHC).Alanine aminotransferase and aspartate aminotransferase level were detected using an automatic biochemical analyzer.Hepatic cell apoptosis was detected using TUNEL.The results were analyzed using Quantity-one v4.62 software (Bio-Rad,USA).Results:CHOP and caspase-12 expression and PERK,eIF2α,and P-eIF2α protein expression showed no significant difference between BD group and DMSO group.Compared with BD group,Sal group had a significantly higher P-eIF2C level and a lower P-PERK level 2 h and 6 h after BD (P < 0.05).However,eIF2α expression showed no significant difference (P > 0.05).After the Sal treatment,CHOP and caspase-12 mRNA expression significantly decreased 4 h after BD (P < 0.05).WB and IHC indicated that CHOP and caspase-12 expression also significantly decreased after Sal treatment.Sal was associated with improved liver function and decreased hepatic cell apoptosis.Conclusions:Sal can significantly reduce apoptosis in hepatic cells of BD rats

  15. Benzyl isothiocyanate alters the gene expression with cell cycle regulation and cell death in human brain glioblastoma GBM 8401 cells.

    Science.gov (United States)

    Tang, Nou-Ying; Chueh, Fu-Shin; Yu, Chien-Chih; Liao, Ching-Lung; Lin, Jen-Jyh; Hsia, Te-Chun; Wu, King-Chuen; Liu, Hsin-Chung; Lu, Kung-Wen; Chung, Jing-Gung

    2016-04-01

    Glioblastoma multiforme (GBM) is a highly malignant devastating brain tumor in adults. Benzyl isothiocyanate (BITC) is one of the isothiocyanates that have been shown to induce human cancer cell apoptosis and cell cycle arrest. Herein, the effect of BITC on cell viability and apoptotic cell death and the genetic levels of human brain glioblastoma GBM 8401 cells in vitro were investigated. We found that BITC induced cell morphological changes, decreased cell viability and the induction of cell apoptosis in GBM 8401 cells was time-dependent. cDNA microarray was used to examine the effects of BITC on GBM 8401 cells and we found that numerous genes associated with cell death and cell cycle regulation in GBM 8401 cells were altered after BITC treatment. The results show that expression of 317 genes was upregulated, and two genes were associated with DNA damage, the DNA-damage-inducible transcript 3 (DDIT3) was increased 3.66-fold and the growth arrest and DNA-damage-inducible α (GADD45A) was increased 2.34-fold. We also found that expression of 182 genes was downregulated and two genes were associated with receptor for cell responses to stimuli, the EGF containing fibulin-like extracellular matrix protein 1 (EFEMP1) was inhibited 2.01-fold and the TNF receptor-associated protein 1 (TRAP1) was inhibited 2.08-fold. BITC inhibited seven mitochondria ribosomal genes, the mitochondrial ribosomal protein; tumor protein D52 (MRPS28) was inhibited 2.06-fold, the mitochondria ribosomal protein S2 (MRPS2) decreased 2.07-fold, the mitochondria ribosomal protein L23 (MRPL23) decreased 2.08-fold, the mitochondria ribosomal protein S2 (MRPS2) decreased 2.07-fold, the mitochondria ribosomal protein S12 (MRPS12) decreased 2.08-fold, the mitochondria ribosomal protein L12 (MRPL12) decreased 2.25-fold and the mitochondria ribosomal protein S34 (MRPS34) was decreased 2.30-fold in GBM 8401 cells. These changes of gene expression can provide the effects of BITC on the genetic level and are

  16. Computed tomographic angiography criteria in the diagnosis of brain death - comparison of sensitivity and interobserver reliability of different evaluation scales

    International Nuclear Information System (INIS)

    Sawicki, Marcin; Walecka, A.; Bohatyrewicz, R.; Solek-Pastuszka, J.; Safranow, K.; Walecki, J.; Rowinski, O.; Czajkowski, Z.; Guzinski, M.; Burzynska, M.; Wojczal, J.

    2014-01-01

    The standardized diagnostic criteria for computed tomographic angiography (CTA) in diagnosis of brain death (BD) are not yet established. The aim of the study was to compare the sensitivity and interobserver agreement of the three previously used scales of CTA for the diagnosis of BD. Eighty-two clinically brain-dead patients underwent CTA with a delay of 40 s after contrast injection. Catheter angiography was used as the reference standard. CTA results were assessed by two radiologists, and the diagnosis of BD was established according to 10-, 7-, and 4-point scales. Catheter angiography confirmed the diagnosis of BD in all cases. Opacification of certain cerebral vessels as indicator of BD was highly sensitive: cortical segments of the middle cerebral artery (96.3 %), the internal cerebral vein (98.8 %), and the great cerebral vein (98.8 %). Other vessels were less sensitive: the pericallosal artery (74.4 %), cortical segments of the posterior cerebral artery (79.3 %), and the basilar artery (82.9 %). The sensitivities of the 10-, 7-, and 4-point scales were 67.1, 74.4, and 96.3 %, respectively (p < 0.001). Percentage interobserver agreement in diagnosis of BD reached 93 % for the 10-point scale, 89 % for the 7-point scale, and 95 % for the 4-point scale (p = 0.37). In the application of CTA to the diagnosis of BD, reducing the assessment of vascular opacification scale from a 10- to a 4-point scale significantly increases the sensitivity and maintains high interobserver reliability. (orig.)

  17. Computed tomographic angiography criteria in the diagnosis of brain death - comparison of sensitivity and interobserver reliability of different evaluation scales

    Energy Technology Data Exchange (ETDEWEB)

    Sawicki, Marcin; Walecka, A. [Pomeranian Medical University, Department of Diagnostic Imaging and Interventional Radiology, Szczecin (Poland); Bohatyrewicz, R.; Solek-Pastuszka, J. [Pomeranian Medical University, Clinic of Anesthesiology and Intensive Care, Szczecin (Poland); Safranow, K. [Pomeranian Medical University, Department of Biochemistry and Medical Chemistry, Szczecin (Poland); Walecki, J. [The Centre of Postgraduate Medical Education, Warsaw (Poland); Rowinski, O. [Medical University of Warsaw, 2nd Department of Clinical Radiology, Warsaw (Poland); Czajkowski, Z. [Regional Joint Hospital, Szczecin (Poland); Guzinski, M. [Wroclaw Medical University, Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw (Poland); Burzynska, M. [Wroclaw Medical University, Department of Anesthesiology and Intensive Therapy, Wroclaw (Poland); Wojczal, J. [Medical University of Lublin, Department of Neurology, Lublin (Poland)

    2014-08-15

    The standardized diagnostic criteria for computed tomographic angiography (CTA) in diagnosis of brain death (BD) are not yet established. The aim of the study was to compare the sensitivity and interobserver agreement of the three previously used scales of CTA for the diagnosis of BD. Eighty-two clinically brain-dead patients underwent CTA with a delay of 40 s after contrast injection. Catheter angiography was used as the reference standard. CTA results were assessed by two radiologists, and the diagnosis of BD was established according to 10-, 7-, and 4-point scales. Catheter angiography confirmed the diagnosis of BD in all cases. Opacification of certain cerebral vessels as indicator of BD was highly sensitive: cortical segments of the middle cerebral artery (96.3 %), the internal cerebral vein (98.8 %), and the great cerebral vein (98.8 %). Other vessels were less sensitive: the pericallosal artery (74.4 %), cortical segments of the posterior cerebral artery (79.3 %), and the basilar artery (82.9 %). The sensitivities of the 10-, 7-, and 4-point scales were 67.1, 74.4, and 96.3 %, respectively (p < 0.001). Percentage interobserver agreement in diagnosis of BD reached 93 % for the 10-point scale, 89 % for the 7-point scale, and 95 % for the 4-point scale (p = 0.37). In the application of CTA to the diagnosis of BD, reducing the assessment of vascular opacification scale from a 10- to a 4-point scale significantly increases the sensitivity and maintains high interobserver reliability. (orig.)

  18. NT-pro brain natriuretic peptide levels and the risk of death in the cooperative study of sickle cell disease.

    Science.gov (United States)

    Machado, Roberto F; Hildesheim, Mariana; Mendelsohn, Laurel; Remaley, Alan T; Kato, Gregory J; Gladwin, Mark T

    2011-08-01

    Epidemiological studies support a hypothesis that pulmonary hypertension (PH) is a common complication of sickle cell disease (SCD) that is associated with a high risk of death and evolves as a complication of haemolytic anaemia. This fundamental hypothesis has been recently challenged and remains controversial. In order to further test this hypothesis in a large and independent cohort of SCD patients we obtained plasma samples from the Cooperative Study of Sickle Cell Disease (CSSCD) for analysis of a biomarker, N-terminal-pro brain natriuretic peptide (NT-proBNP), which is elevated in the setting of pulmonary arterial and venous hypertension. A NT-pro-BNP value previously identified to predict PH in adults with SCD was used to determine the association between the risk of mortality in 758 CSSCD participants (428 children and 330 adults). An abnormally high NT-proBNP level ≥160ng/l was present in 27·6% of adult SCD patients. High levels were associated with markers of haemolytic anaemia, such as low haemoglobin level (P<0·001), high lactate dehydrogenase (P<0·001), and high total bilirubin levels (P<0·007). A NT-proBNP level ≥160ng/l was an independent predictor of mortality (RR 6·24, 95% CI 2·9-13·3, P<0·0001). These findings provide further support for an association between haemolytic anaemia and cardiovascular complications in this patient population. © 2011 Blackwell Publishing Ltd.

  19. Effects of phased education on attitudes toward organ donation and willingness to donate after brain death in an Asian country.

    Science.gov (United States)

    Park, Ui Jun; Han, Sang Youb; Han, Kum Hyun; Oh, Se Won; Jang, Hye-Yeon; Kim, Hyoung Tae; Roh, Young-Nam

    2018-05-23

    This study aims to investigate the effects of phased education on attitudes toward organ donation and willingness to donate after brain death. A survey was conducted using a questionnaire to examine attitudes toward organ donation of the families of patients admitted to a surgical intensive care unit (SICU) between March 1, 2014 and September 30, 2016. Ninety-two people voluntarily participated in this survey. Before reviewing the educational material, 75.0% had a positive attitude toward organ donation, 60.9% were willing to donate their own organs, and 38.0% were willing to donate a family member's organs. After reviewing the educational material, these figures increased to 92.4%, 80.4%, and 56.5%, respectively. Before receiving an education, there was a significant difference in consistency between people's attitudes and willingness to donate their own organs, versus donating a family member's organs (79.3% vs 54.3%, p donating one's own organs, and from 54.3% to 64.1% with regard to donating a family member's organs. Phased education was effective overall, but it had a limited effect on changing the willingness to donate a family member's organs. It increased the consistency between people's attitudes toward organ donation and willingness to donate their own, or a family member's organs. Copyright © 2018. Published by Elsevier Taiwan.

  20. Advantages of analyzing postmortem brain samples in routine forensic drug screening-Case series of three non-natural deaths tested positive for lysergic acid diethylamide (LSD).

    Science.gov (United States)

    Mardal, Marie; Johansen, Sys Stybe; Thomsen, Ragnar; Linnet, Kristian

    2017-09-01

    Three case reports are presented, including autopsy findings and toxicological screening results, which were tested positive for the potent hallucinogenic drug lysergic acid diethylamide (LSD). LSD and its main metabolites were quantified in brain tissue and femoral blood, and furthermore hematoma and urine when available. LSD, its main metabolite 2-oxo-3-hydroxy-LSD (oxo-HO-LSD), and iso-LSD were quantified in biological samples according to a previously published procedure involving liquid-liquid extraction and ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). LSD was measured in the brain tissue of all presented cases at a concentration level from 0.34-10.8μg/kg. The concentration level in the target organ was higher than in peripheral blood. Additional psychoactive compounds were quantified in blood and brain tissue, though all below toxic concentration levels. The cause of death in case 1 was collision-induced brain injury, while it was drowning in case 2 and 3 and thus not drug intoxication. However, the toxicological findings could help explain the decedent's inability to cope with brain injury or drowning incidents. The presented findings could help establish reference concentrations in brain samples and assist in interpretation of results from forensic drug screening in brain tissue. This is to the author's knowledge the first report of LSD, iso-LSD, and oxo-HO-LSD measured in brain tissue samples. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. A Multicenter Study on Long-Term Outcomes After Lung Transplantation Comparing Donation After Circulatory Death and Donation After Brain Death

    NARCIS (Netherlands)

    van Suylen, Vincent; Luijk, B.; Hoek, R A S; van de Graaf, E. A.; Verschuuren, E A; Van De Wauwer, C; Bekkers, J A; Meijer, R C A; van der Bij, W; Erasmus, M E

    2017-01-01

    The implementation of donation after circulatory death category 3 (DCD3) was one of the attempts to reduce the gap between supply and demand of donor lungs. In the Netherlands, the total number of potential lung donors was greatly increased by the availability of DCD3 lungs in addition to the

  2. Comparing Outcomes of Donation After Cardiac Death Versus Donation After Brain Death in Liver Transplant Recipients with Hepatitis C: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Malcolm Wells

    2014-01-01

    Full Text Available BACKGROUND: Liver transplantation (LT using organs donated after cardiac death (DCD is increasing due, in large part, to a shortage of organs. The outcome of using DCD organs in recipients with hepatits C virus (HCV infection remains unclear due to the limited experience and number of publications addressing this issue.

  3. Rapid brain death caused by a cerebellar abscess with Fusobacterium nucleatum in a young man with drug abuse: a case report.

    Science.gov (United States)

    Hischebeth, Gunnar T R; Keil, Vera C; Gentil, Katrin; Boström, Azize; Kuchelmeister, Klaus; Bekeredjian-Ding, Isabelle

    2014-06-10

    Fusobacterium nucleatum is a strict anaerobic microorganism that causes disease entities such as periodontal and soft tissue abscesses, pulmonary and intraabdominal infections and very rarely intracerebral infections. Here, we report the rare case of a previously healthy 25-year-old German man with a cerebellar abscess caused by Fusobacterium nucleatum that resulted in rapid brain death. Toxicological screening showed positivity for amphetamines and cannabis. The diagnosis was obtained by polymerase chain reaction amplification of bacterial deoxyribonucleic acid in cerebrospinal fluid. In drug users clinicians should think about rare causes of brain abscesses/meningitis. Early diagnosis is necessary and justifies the use of molecular techniques.

  4. Does the Pulsatile Preservation Machine Have Any Impact in the Discard Rate of Kidneys From Older Donors After Brain Death?

    Science.gov (United States)

    Paredes-Zapata, D; Ruiz-Arranz, A; Rodriguez-Villar, C; Roque-Arda, R; Peri-Cusi, L; Saavedra-Escobar, S; Vizcaino-Elias, F; Garcia-Rodriguez, X; Bohils-Valle, M; Rodriguez-Peña, S; Quijada-Martorell, M; Gonzalez-Rodriguez, J-J; Oppenheimer-Salinas, F; Alcaraz-Asensio, A; Adalia-Bartolome, R

    2015-10-01

    Donors after brain death (DBD) older than 60 years have become 46.8% of our current activity, with higher risk of renal discard rate (RDR). Assessment of kidney suitability requires complementary strategies: macroscopic evaluation, kidney biopsy score (KBS), and renal hemodynamic evaluation with the Pulsatile Perfusion Machine (PPM). Descriptive, cross-sectional, comparative study of kidneys procured and RDR, comparing 3 time periods: 2000 to June 2004, when only KBS were used; July 2004 to 2008 (introduction of PPM and learning period); and 2009 to 2013 (experienced use of PPM). Transplantation criteria were KBS 70 mL/min. Between 2000 and 2013, a 59.2% reduction in DBD kidneys was observed. However, older kidneys had an increase from 33.5% to 46.8%. The RDR had increased, comparing the first to the third period from 25.4% to 38.3%. However, the RDR was lower when kidneys were evaluated with PPM than those evaluated only with KBS and preserved in cold storage (CS) (21.4% versus 43.7%). There was a significant difference in cold ischemia time, because CS kidney was grafted before PPM. During the third period, more kidneys with KBS ≥4 were assigned to PPM. Notwithstanding the decrease in DBD-procured kidneys and the increase in older kidneys during last period, the use of PPM allowed low DR compared with CS. A bias in the results of PPM could be generated when kidneys with higher KBS were excluded from PPM. The use of KBS only to decide acceptance could preclude the use of an additional tool to evaluate suitability. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Death and Death Anxiety

    OpenAIRE

    Gonca Karakus; Zehra Ozturk; Lut Tamam

    2012-01-01

    Although death and life concepts seem so different from each other, some believe that death and life as a whole that death is accepted as the goal of life and death completes life. In different cultures, societies and disciplines, there have been very different definitions of death which changes according to personality, age, religion and cultural status of the individual. Attitudes towards death vary dramatically according to individuals. As for the death anxiety, it is a feeling which start...

  6. Aproximación crítica a los problemas sociales de la muerte encefálica Critical approach to social problems of brain death

    Directory of Open Access Journals (Sweden)

    Ricardo Hodelín Tablada

    2012-04-01

    Full Text Available El presente trabajo tiene como objetivo un acercamiento con enfoque crítico a algunos de los problemas del diagnóstico de la muerte como un fenómeno médico de amplia dimensión social. Las reflexiones se basan en aspectos éticos, bioéticos, y epistemológicos. Se analizan los principios básicos de la bioética, el consentimiento informado y su relación con la muerte encefálica y la donación de órganos. Se destaca el giro que marcó la Declaración de Harvard, desde la clásica constatación de la muerte hacia la definición de la muerte encefálica. Se comentan las diferentes legislaciones que recogen la manifestación del donante y se reseñan aspectos legales y jurídicos preceptuados en Cuba para la muerte encefálica y los trasplantes.The article aims to critically approach some of the problems of death diagnosis, as a medical phenomenon of widely social dimension. Reflections are based on ethical, bioethical and epistemological aspects. The paper analyzes the basic principles of bioethics, the informed consent and its relation to brain death and organ donation. It also points out the turn marked by the Declaration of Harvard, since the classic establishment of death up to the definition of brain death. It provides comments on different legislations that include donor’s acceptance, as well as legal aspects related to brain death and transplants, established in Cuba.

  7. Deaths among adult patients with hypopituitarism: hypocortisolism during acute stress, and de novo malignant brain tumors contribute to an increased mortality.

    Science.gov (United States)

    Burman, P; Mattsson, A F; Johannsson, G; Höybye, C; Holmer, H; Dahlqvist, P; Berinder, K; Engström, B E; Ekman, B; Erfurth, E M; Svensson, J; Wahlberg, J; Karlsson, F A

    2013-04-01

    Patients with hypopituitarism have an increased standardized mortality rate. The basis for this has not been fully clarified. To investigate in detail the cause of death in a large cohort of patients with hypopituitarism subjected to long-term follow-up. All-cause and cause-specific mortality in 1286 Swedish patients with hypopituitarism prospectively monitored in KIMS (Pfizer International Metabolic Database) 1995-2009 were compared to general population data in the Swedish National Cause of Death Registry. In addition, events reported in KIMS, medical records, and postmortem reports were reviewed. Standardized mortality ratios (SMR) were calculated, with stratification for gender, attained age, and calendar year during follow-up. An excess mortality was found, 120 deaths vs 84.3 expected, SMR 1.42 (95% confidence interval: 1.18-1.70). Infections, brain cancer, and sudden death were associated with significantly increased SMRs (6.32, 9.40, and 4.10, respectively). Fifteen patients, all ACTH-deficient, died from infections. Eight of these patients were considered to be in a state of adrenal crisis in connection with death (medical reports and post-mortem examinations). Another 8 patients died from de novo malignant brain tumors, 6 of which had had a benign pituitary lesion at baseline. Six of these 8 subjects had received prior radiation therapy. Two important causes of excess mortality were identified: first, adrenal crisis in response to acute stress and intercurrent illness; second, increased risk of a late appearance of de novo malignant brain tumors in patients who previously received radiotherapy. Both of these causes may be in part preventable by changes in the management of pituitary disease.

  8. A Study on Nursing Students' Knowledge, Attitude, and Educational Needs for Brain-Death Organ Transplantation and Donation and Intent to Donate Organs.

    Science.gov (United States)

    Ju, M K; Sim, M K; Son, S Y

    2018-05-01

    The purpose of this study was to identify the knowledge, attitude, educational needs, and will of nursing students on organ donation from brain-dead donors. Data were collected by using a 40-item questionnaire to measure knowledge, attitude, educational needs, and will for organ donation of 215 nursing college students in one university in Dangjin city from May 11 to May 31, 2017. The data were analyzed using SPSS 22 program (Data Solution Inc, Seoul). In the general characteristics, 85.1% of the subjects did not receive education on donation, and 99.5% of the subjects responded that education is needed. The desired methods of education were special lecture in school (55.3%), "webtoons" on the Internet (19.5%), formal curriculum (15.8%). Points to improve to increase brain-death organ transplantation and donation included "active publicity through pan-national campaign activities" (56.3%), "respecting prior consent from brain-dead donors" (21.9%), and "encouragement and increased support for organ donors" (12.1%). There was a significant difference in knowledge according to will for organ donation (t = 3.29, P = .001) and consent to brain-death organ donation in family members (t = 3.29, P = .001). There was a statistically significant positive correlation between attitude and knowledge of the subjects regarding brain-death organ donation. The knowledge, attitude, educational need, and will for organ donation of nursing students revealed in this study will be used as basic data to provide systematic transplant education including contents about organ transplantation in the regular nursing curriculum in the future. It will contribute to the activation of organ donation. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Quantitative in vivo detection of brain cell death after hypoxia ischemia using the lipid peak at 1.3 ppm of proton magnetic resonance spectroscopy in neonatal rats.

    Science.gov (United States)

    Ahn, So Yoon; Yoo, Hye Soo; Lee, Jang Hoon; Sung, Dong Kyung; Jung, Yu Jin; Sung, Se In; Lim, Keun Ho; Chang, Yun Sil; Lee, Jung Hee; Kim, Ki Soo; Park, Won Soon

    2013-07-01

    This study was performed to determine the accuracy of proton magnetic spectroscopy ((1)H-MRS) lipid peak as a noninvasive tool for quantitative in vivo detection of brain cell death. Seven day-old Sprague Dawley rats were subjected to 8% oxygen following a unilateral carotid artery ligation. For treatment, cycloheximide was given immediately after hypoxic ischemia (HI). Lipid peak was measured using (1)H-MRS at 24 hr after HI, and then brains were harvested for fluorocytometric analyses with annexin V/propidium iodide (PI) and fluorescent probe JC-1, and for adenosine-5'-triphosphate (ATP) and lactate. Increased lipid peak at 1.3 ppm measured with (1)H-MRS, apoptotic and necrotic cells, and loss of mitochondrial membrane potential (ΔΨ) at 24 hr after HI were significantly improved with cycloheximide treatment. Significantly reduced brain ATP and increased lactate levels observed at 24 hr after HI showed a tendency to improve without statistical significance with cycloheximide treatment. Lipid peak at 1.3 ppm showed significant positive correlation with both apoptotic and necrotic cells and loss of ΔΨ, and negative correlation with normal live cells. Lipid peak at 1.3 ppm measured by (1)H-MRS might be a sensitive and reliable diagnostic tool for quantitative in vivo detection of brain cell death after HI.

  10. Food Science and Technology Abstracts (FSTA): guia ràpida. Gener 2011

    OpenAIRE

    Universitat de Barcelona. CRAI

    2011-01-01

    Guia ràpida de la base de dades bibliogràfica (FSTA) d'àmbit mundial sobre ciència, tecnologia i química alimentària, nutrició i salut humana, biotecnologia i toxicologia. Buida prop de 1800 revistes especialitzades, monografies, conferències, tesis, patents, legislació, etc. publicats en unes 40 llengües.

  11. The Tourist Attractions in Curitiba - PR: An overview by Guia Brazil Quatro Rodas

    Directory of Open Access Journals (Sweden)

    Franciele Cristina Manosso

    2015-04-01

    Full Text Available The tour guides books can be worked as relevant instruments for the dissemination of destinations, because encompass information about the destinations' attractions, equipment, infrastructure and tourism services. Then, the tourist can through this, conceiving a destination’s image that will visit, because with the elements worked by the guides, they can get a comprehensive view of what is offered by the destination. Therefore, this article has as objective the analysis of the tourist attractions in Curitiba’s city, according to Guia Brazil Quatro Rodas, presented in the years 1989, 2001, 2013. Thus, the paper aims to also highlight how the document presents the city to its visitors, analyzing the description and the photographs that are showing Curitiba to the tourist. For this, was used as methodology the literature's and documents' research, the latter being applied to observe which attractions, description, and photos were used in the dissemination of Curitiba in the Guia Brazil. As the study results, it can be noted that there was an increase in the number of tourist attractions in Curitiba presented by Guia Brazil Quatro Rodas, and some of these have progressed in the respect of their classification, in the other words, they have improved in quality. Another issue is the publication’s evolution in question the destinations’ presentation to the reader, because more information came to be published, and also began to be used photos to show to the tourist the Curitiba destination.

  12. Combat veterans, mental health issues, and the death penalty: addressing the impact of post-traumatic stress disorder and traumatic brain injury.

    Science.gov (United States)

    Giardino, Anthony E

    2009-05-01

    More than 1.5 million Americans have participated in combat operations in Iraq and Afghanistan over the past seven years. Some of these veterans have subsequently committed capital crimes and found themselves in our nation's criminal justice system. This Essay argues that combat veterans suffering from post-traumatic stress disorder or traumatic brain injury at the time of their offenses should not be subject to the death penalty.Offering mitigating evidence regarding military training, post-traumatic stress disorder, and traumatic brain injury presents one means that combat veterans may use to argue for their lives during the sentencing phase of their trials. Alternatively, Atkins v. Virginia and Roper v. Simmons offer a framework for establishing a legislatively or judicially created categorical exclusion for these offenders, exempting them from the death penalty as a matter of law. By understanding how combat service and service-related injuries affect the personal culpability of these offenders, the legal system can avoid the consequences of sentencing to death America's mentally wounded warriors, ensuring that only the worst offenders are subject to the ultimate punishment.

  13. Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis.

    Science.gov (United States)

    Geisenberger, D; Huppertz, L M; Büchsel, M; Kramer, L; Pollak, S; Große Perdekamp, M

    2015-12-01

    Acute subdural hematomas are mostly due to blunt traumatization of the head. In rare instances, subdural bleeding occurs without evidence of a previous trauma following spontaneous hemorrhage, e.g. from a ruptured aneurysm or an intracerebral hematoma perforating the brain surface and the arachnoid. The paper presents the morphological, microbiological and toxicological findings in a 38-year-old drug addict who was found by his partner in a dazed state. When brought to a hospital, he underwent trepanation to empty a right-sided subdural hematoma, but he died already 4h after admission. Autopsy revealed previously undiagnosed infective endocarditis of the aortic valve as well as multiple infarctions of brain, spleen and kidneys obviously caused by septic emboli. The subdural hematoma originated from a subcortical brain hemorrhage which had perforated into the subdural space. Microbiological investigation of the polypous vegetations adhering to the aortic valve revealed colonization by Streptococcus mitis and Klebsiella oxytoca. According to the toxicological analysis, no psychotropic substances had contributed to the lethal outcome. The case reported underlines that all deaths of drug addicts should be subjected to complete forensic autopsy, as apart from intoxications also natural and traumatic causes of death have to be taken into consideration. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Venous or arterial blood components trigger more brain swelling, tissue death after acute subdural hematoma compared to elderly atrophic brain with subdural effusion (SDE) model rats.

    Science.gov (United States)

    Wajima, Daisuke; Sato, Fumiya; Kawamura, Kenya; Sugiura, Keisuke; Nakagawa, Ichiro; Motoyama, Yasushi; Park, Young-Soo; Nakase, Hiroyuki

    2017-09-01

    Acute subdural hematoma (ASDH) is a frequent complication of severe head injury, whose secondary ischemic lesions are often responsible for the severity of the disease. We focused on the differences of secondary ischemic lesions caused by the components, 0.4ml venous- or arterial-blood, or saline, infused in the subdural space, evaluating the differences in vivo model, using rats. The saline infused rats are made for elderly atrophic brain with subdural effusion (SDE) model. Our data showed that subdural blood, both venous- and arterial-blood, aggravate brain edema and lesion development more than SDE. This study is the first study, in which different fluids in rats' subdural space, ASDH or SDE are compared with the extension of early and delayed brain damage by measuring brain edema and histological lesion volume. Blood constituents started to affect the degree of ischemia underneath the subdural hemorrhage, leading to more pronounced breakdown of the blood-brain barrier and brain damage. This indicates that further strategies to treat blood-dependent effects more efficiently are in view for patients with ASDH. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Donor Preconditioning After the Onset of Brain Death With Dopamine Derivate n-Octanoyl Dopamine Improves Early Posttransplant Graft Function in the Rat.

    Science.gov (United States)

    Li, S; Korkmaz-Icöz, S; Radovits, T; Ruppert, M; Spindler, R; Loganathan, S; Hegedűs, P; Brlecic, P; Theisinger, B; Theisinger, S; Höger, S; Brune, M; Lasitschka, F; Karck, M; Yard, B; Szabó, G

    2017-07-01

    Heart transplantation is the therapy of choice for end-stage heart failure. However, hemodynamic instability, which has been demonstrated in brain-dead donors (BDD), could also affect the posttransplant graft function. We tested the hypothesis that treatment of the BDD with the dopamine derivate n-octanoyl-dopamine (NOD) improves donor cardiac and graft function after transplantation. Donor rats were given a continuous intravenous infusion of either NOD (0.882 mg/kg/h, BDD+NOD, n = 6) or a physiological saline vehicle (BDD, n = 9) for 5 h after the induction of brain death by inflation of a subdural balloon catheter. Controls were sham-operated (n = 9). In BDD, decreased left-ventricular contractility (ejection fraction; maximum rate of rise of left-ventricular pressure; preload recruitable stroke work), relaxation (maximum rate of fall of left-ventricular pressure; Tau), and increased end-diastolic stiffness were significantly improved after the NOD treatment. Following the transplantation, the NOD-treatment of BDD improved impaired systolic function and ventricular relaxation. Additionally, after transplantation increased interleukin-6, tumor necrosis factor TNF-α, NF-kappaB-p65, and nuclear factor (NF)-kappaB-p105 gene expression, and increased caspase-3, TNF-α and NF-kappaB protein expression could be significantly downregulated by the NOD treatment compared to BDD. BDD postconditioning with NOD through downregulation of the pro-apoptotic factor caspase-3, pro-inflammatory cytokines, and NF-kappaB may protect the heart against the myocardial injuries associated with brain death and ischemia/reperfusion. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  16. Parental Grief Following the Brain Death of a Child: Does Consent or Refusal to Organ Donation Affect Their Grief?

    Science.gov (United States)

    Bellali, Thalia; Papadatou, Danai

    2006-01-01

    The purpose of this study was to investigate the grieving process of parents who were faced with the dilemma of donating organs and tissues of their underage brain dead child, and to explore the impact of their decision on their grief process. A grounded theory methodology was adopted and a semi-structured interview was conducted with 11 bereaved…

  17. Reduced expression of brain-enriched microRNAs in glioblastomas permits targeted regulation of a cell death gene.

    Directory of Open Access Journals (Sweden)

    Rebecca L Skalsky

    Full Text Available Glioblastoma is a highly aggressive malignant tumor involving glial cells in the human brain. We used high-throughput sequencing to comprehensively profile the small RNAs expressed in glioblastoma and non-tumor brain tissues. MicroRNAs (miRNAs made up the large majority of small RNAs, and we identified over 400 different cellular pre-miRNAs. No known viral miRNAs were detected in any of the samples analyzed. Cluster analysis revealed several miRNAs that were significantly down-regulated in glioblastomas, including miR-128, miR-124, miR-7, miR-139, miR-95, and miR-873. Post-transcriptional editing was observed for several miRNAs, including the miR-376 family, miR-411, miR-381, and miR-379. Using the deep sequencing information, we designed a lentiviral vector expressing a cell suicide gene, the herpes simplex virus thymidine kinase (HSV-TK gene, under the regulation of a miRNA, miR-128, that was found to be enriched in non-tumor brain tissue yet down-regulated in glioblastomas, Glioblastoma cells transduced with this vector were selectively killed when cultured in the presence of ganciclovir. Using an in vitro model to recapitulate expression of brain-enriched miRNAs, we demonstrated that neuronally differentiated SH-SY5Y cells transduced with the miRNA-regulated HSV-TK vector are protected from killing by expression of endogenous miR-128. Together, these results provide an in-depth analysis of miRNA dysregulation in glioblastoma and demonstrate the potential utility of these data in the design of miRNA-regulated therapies for the treatment of brain cancers.

  18. Competing Risk Analysis of Neurologic versus Nonneurologic Death in Patients Undergoing Radiosurgical Salvage After Whole-Brain Radiation Therapy Failure: Who Actually Dies of Their Brain Metastases?

    Energy Technology Data Exchange (ETDEWEB)

    Lucas, John T., E-mail: jolucas@wakehealth.edu [Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States); Colmer, Hentry G.; White, Lance [Wake Forest School of Medicine, Winston-Salem, North Carolina (United States); Fitzgerald, Nora; Isom, Scott [Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States); Bourland, John D. [Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States); Laxton, Adrian W. [Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (United States); Tatter, Stephen B. [Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States); Chan, Michael D. [Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (United States)

    2015-08-01

    Purpose: To estimate the hazard for neurologic (central nervous system, CNS) and nonneurologic (non-CNS) death associated with patient, treatment, and systemic disease status in patients receiving stereotactic radiosurgery after whole-brain radiation therapy (WBRT) failure, using a competing risk model. Patients and Methods: Of 757 patients, 293 experienced recurrence or new metastasis following WBRT. Univariate Cox proportional hazards regression identified covariates for consideration in the multivariate model. Competing risks multivariable regression was performed to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for both CNS and non-CNS death after adjusting for patient, disease, and treatment factors. The resultant model was converted into an online calculator for ease of clinical use. Results: The cumulative incidence of CNS and non-CNS death at 6 and 12 months was 20.6% and 21.6%, and 34.4% and 35%, respectively. Patients with melanoma histology (relative to breast) (aHR 2.7, 95% CI 1.5-5.0), brainstem location (aHR 2.1, 95% CI 1.3-3.5), and number of metastases (aHR 1.09, 95% CI 1.04-1.2) had increased aHR for CNS death. Progressive systemic disease (aHR 0.55, 95% CI 0.4-0.8) and increasing lowest margin dose (aHR 0.97, 95% CI 0.9-0.99) were protective against CNS death. Patients with lung histology (aHR 1.3, 95% CI 1.1-1.9) and progressive systemic disease (aHR 2.14, 95% CI 1.5-3.0) had increased aHR for non-CNS death. Conclusion: Our nomogram provides individual estimates of neurologic death after salvage stereotactic radiosurgery for patients who have failed prior WBRT, based on histology, neuroanatomical location, age, lowest margin dose, and number of metastases after adjusting for their competing risk of death from other causes.

  19. Competing Risk Analysis of Neurologic versus Nonneurologic Death in Patients Undergoing Radiosurgical Salvage After Whole-Brain Radiation Therapy Failure: Who Actually Dies of Their Brain Metastases?

    International Nuclear Information System (INIS)

    Lucas, John T.; Colmer, Hentry G.; White, Lance; Fitzgerald, Nora; Isom, Scott; Bourland, John D.; Laxton, Adrian W.; Tatter, Stephen B.; Chan, Michael D.

    2015-01-01

    Purpose: To estimate the hazard for neurologic (central nervous system, CNS) and nonneurologic (non-CNS) death associated with patient, treatment, and systemic disease status in patients receiving stereotactic radiosurgery after whole-brain radiation therapy (WBRT) failure, using a competing risk model. Patients and Methods: Of 757 patients, 293 experienced recurrence or new metastasis following WBRT. Univariate Cox proportional hazards regression identified covariates for consideration in the multivariate model. Competing risks multivariable regression was performed to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for both CNS and non-CNS death after adjusting for patient, disease, and treatment factors. The resultant model was converted into an online calculator for ease of clinical use. Results: The cumulative incidence of CNS and non-CNS death at 6 and 12 months was 20.6% and 21.6%, and 34.4% and 35%, respectively. Patients with melanoma histology (relative to breast) (aHR 2.7, 95% CI 1.5-5.0), brainstem location (aHR 2.1, 95% CI 1.3-3.5), and number of metastases (aHR 1.09, 95% CI 1.04-1.2) had increased aHR for CNS death. Progressive systemic disease (aHR 0.55, 95% CI 0.4-0.8) and increasing lowest margin dose (aHR 0.97, 95% CI 0.9-0.99) were protective against CNS death. Patients with lung histology (aHR 1.3, 95% CI 1.1-1.9) and progressive systemic disease (aHR 2.14, 95% CI 1.5-3.0) had increased aHR for non-CNS death. Conclusion: Our nomogram provides individual estimates of neurologic death after salvage stereotactic radiosurgery for patients who have failed prior WBRT, based on histology, neuroanatomical location, age, lowest margin dose, and number of metastases after adjusting for their competing risk of death from other causes

  20. Dysfunctional Brain Networking among Autonomic Regulatory Structures in Temporal Lobe Epilepsy Patients at High Risk of Sudden Unexpected Death in Epilepsy

    Directory of Open Access Journals (Sweden)

    Luke A. Allen

    2017-10-01

    Full Text Available BackgroundSudden unexpected death in epilepsy (SUDEP is common among young people with epilepsy. Individuals who are at high risk of SUDEP exhibit regional brain structural and functional connectivity (FC alterations compared with low-risk patients. However, less is known about network-based FC differences among critical cortical and subcortical autonomic regulatory brain structures in temporal lobe epilepsy (TLE patients at high risk of SUDEP.Methods32 TLE patients were risk-stratified according to the following clinical criteria: age of epilepsy onset, duration of epilepsy, frequency of generalized tonic–clonic seizures, and presence of nocturnal seizures, resulting in 14 high-risk and 18 low-risk cases. Resting-state functional magnetic resonance imaging (rs-fMRI signal time courses were extracted from 11 bilateral cortical and subcortical brain regions involved in autonomic and other regulatory processes. After computing all pairwise correlations, FC matrices were analyzed using the network-based statistic. FC strength among the 11 brain regions was compared between the high- and low-risk patients. Increases and decreases in FC were sought, using high-risk > low-risk and low-risk > high-risk contrasts (with covariates age, gender, lateralization of epilepsy, and presence of hippocampal sclerosis.ResultsHigh-risk TLE patients showed a subnetwork with significantly reduced FC (t = 2.5, p = 0.029 involving the thalamus, brain stem, anterior cingulate, putamen and amygdala, and a second subnetwork with significantly elevated FC (t = 2.1, p = 0.031, which extended to medial/orbital frontal cortex, insula, hippocampus, amygdala, subcallosal cortex, brain stem, thalamus, caudate, and putamen.ConclusionTLE patients at high risk of SUDEP showed widespread FC differences between key autonomic regulatory brain regions compared to those at low risk. The altered FC revealed here may help to shed light on the functional

  1. Dysfunctional Brain Networking among Autonomic Regulatory Structures in Temporal Lobe Epilepsy Patients at High Risk of Sudden Unexpected Death in Epilepsy.

    Science.gov (United States)

    Allen, Luke A; Harper, Ronald M; Kumar, Rajesh; Guye, Maxime; Ogren, Jennifer A; Lhatoo, Samden D; Lemieux, Louis; Scott, Catherine A; Vos, Sjoerd B; Rani, Sandhya; Diehl, Beate

    2017-01-01

    Sudden unexpected death in epilepsy (SUDEP) is common among young people with epilepsy. Individuals who are at high risk of SUDEP exhibit regional brain structural and functional connectivity (FC) alterations compared with low-risk patients. However, less is known about network-based FC differences among critical cortical and subcortical autonomic regulatory brain structures in temporal lobe epilepsy (TLE) patients at high risk of SUDEP. 32 TLE patients were risk-stratified according to the following clinical criteria: age of epilepsy onset, duration of epilepsy, frequency of generalized tonic-clonic seizures, and presence of nocturnal seizures, resulting in 14 high-risk and 18 low-risk cases. Resting-state functional magnetic resonance imaging (rs-fMRI) signal time courses were extracted from 11 bilateral cortical and subcortical brain regions involved in autonomic and other regulatory processes. After computing all pairwise correlations, FC matrices were analyzed using the network-based statistic. FC strength among the 11 brain regions was compared between the high- and low-risk patients. Increases and decreases in FC were sought, using high-risk > low-risk and low-risk > high-risk contrasts (with covariates age, gender, lateralization of epilepsy, and presence of hippocampal sclerosis). High-risk TLE patients showed a subnetwork with significantly reduced FC ( t  = 2.5, p  = 0.029) involving the thalamus, brain stem, anterior cingulate, putamen and amygdala, and a second subnetwork with significantly elevated FC ( t  = 2.1, p  = 0.031), which extended to medial/orbital frontal cortex, insula, hippocampus, amygdala, subcallosal cortex, brain stem, thalamus, caudate, and putamen. TLE patients at high risk of SUDEP showed widespread FC differences between key autonomic regulatory brain regions compared to those at low risk. The altered FC revealed here may help to shed light on the functional correlates of autonomic disturbances in epilepsy

  2. Neonatal Death

    Science.gov (United States)

    ... Home > Complications & Loss > Loss & grief > Neonatal death Neonatal death E-mail to a friend Please fill in ... cope with your baby’s death. What is neonatal death? Neonatal death is when a baby dies in ...

  3. Gerenciamento de Projetos Segundo o Guia PMBOK: Desafios para os Gestores

    Directory of Open Access Journals (Sweden)

    David Ferreira Bomfin

    2013-01-01

    Full Text Available Analisamos, dentre as dificuldades e facilidades mapeadas na literatura, quais e por que as mesmas estão presentes no processo de gerenciamento de projetos com base no guia PMBOK. Verificamos quais os possíveis argumentos que os gestores vivenciam no gerenciamento de projetos no que diz respeito aos sucessos e fracassos apresentados. O estudo se concentrou em profissionais com certificação PMP por apresentarem o conhecimento em Gerenciamento de Projetos com base no guia PMBOK e, por ser uma área de crescimento onde as empresas buscam profissionais com melhores práticas e vantagem competitiva. Valendo-se do questionário estruturado como instrumento de coleta de dados e analisando os resultados, os principais pontos encontrados dizem respeito ao tempo em que os gerentes lidam com gerenciamento de projetos, as dificuldades encontradas pelos gerentes em sua prática profissional, a área do PMBOK com maior dificuldade de ser gerenciada, os itens que geram sucessos e fracassos nos projetos. A entrevista semi-estruturada evidenciou que o gerenciamento de projetos apresenta algumas dificuldades presentes na prática profissional dos gerentes. Sugerimos investigar melhor o impacto que a certificação PMP proporciona aos gerentes de projetos e se a relação maturidade organizacional e experiência em gerenciamento de projetos é fator de sucesso para o projeto.DOI:10.5585/gep.v3i3.78

  4. Perfil vocal do guia de turismo Vocal profile of tourism guide

    Directory of Open Access Journals (Sweden)

    Elisângela Barros Soares

    2006-12-01

    Full Text Available OBJETIVO: caracterizar o perfil vocal dos guias de turismo, bem como gênero e idade. MÉTODOS: participaram desse estudo 23 guias de turismo, de ambos os gêneros, com idade entre 25 a 64 anos, participantes do Sindicato de Guias de Turismo do Estado de Pernambuco, que compareceram às reuniões trimestrais no período da coleta. Trata-se de um estudo de caráter descritivo, observacional e transversal. Para coleta foi realizada avaliação perceptivo-auditiva GRBAS. RESULTADOS: observou-se que a maioria dos guias apresentou loudness adequada, pitch normal e voz alterada. Além disso, as médias dos tempos máximos de fonação das vogais e das fricativas encontravam-se reduzidas e ataque vocal isocrônico. A ressonância, na maioria dos guias, estava equilibrada, mas houve uma incidência de ressonância laringo-faringea. A articulação foi precisa, com tipo e modo respiratório misto e nasal, respectivamente. Quanto à escala GRBAS as alterações apareceram de forma leve no G (grau de alteração vocal em 68%. CONCLUSÃO: na amostra estudada, a maioria era do gênero feminino com média de idade de 46 anos, e perfil vocal caracterizado por tempo máximo de fonação reduzidos, relação s/z adequado, ataque vocal isocrônico, pitch normal, loudness adequado, qualidade vocal alterada, com presença de rouquidão, soprosidade, tensão. A ressonância da maioria estava equilibrada e a articulação precisa, com tipo e modo respiratório misto e nasal, respectivamente. Quanto à escala GRBAS, as alterações apareceram de forma leve no grau de alteração vocal (G em 68% e tensão (S em 78% dos sujeitos.PURPOSE: to characterize the vocal profile of tourism guides, as well as gender and age. METHODS: 23 guides took part in this study, of both genders, with age between 25 to 64 years, partakers of the Union of Tourism Guides of the State of Pernambuco, who appeared to the quarterly meetings in the period of the collection. It is a descriptive

  5. Ten Leading Causes of Death and Injury

    Science.gov (United States)

    ... Overdose Traumatic Brain Injury Violence Prevention Ten Leading Causes of Death and Injury Recommend on Facebook Tweet Share Compartir ... in Hospital Emergency Departments, United States – 2014 Leading Causes of Death Charts Causes of Death by Age Group 2016 [ ...

  6. Avaliação do conhecimento de intensivistas sobre morte encefálica Evaluation of intensivists' knowledge on brain death

    Directory of Open Access Journals (Sweden)

    Alaor Ernst Schein

    2008-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A falha ou atraso no diagnóstico de morte encefálica resulta na ocupação desnecessária de um leito hospitalar, em perdas emocionais e financeiras e na indisponibilidade de órgãos para transplante. O médico intensivista tem fundamental papel nesse diagnóstico. O objetivo deste estudo foi avaliar o conhecimento sobre morte encefálica entre os intensivistas. MÉTODO: Estudo transversal em 15 unidades de terapia intensiva (UTI em oito hospitais da cidade de Porto Alegre, Brasil. RESULTADOS: Duzentos e quarenta e seis intensivistas foram entrevistados em uma amostra consecutiva entre abril e dezembro de 2005. Encontrou-se prevalência de desconhecimento do conceito de morte encefálica de 17%. Vinte por cento dos entrevistados desconheciam a necessidade legal de exame complementar para o seu diagnóstico. Quarenta e sete por cento se consideraram no nível máximo de segurança para explicar o conceito para a família de um paciente. Vinte e nove por cento desconheciam a hora do óbito legal para os pacientes em morte encefálica. Os intensivistas pediátricos tiveram menor conhecimento do conceito em relação aos intensivistas de adultos (p BACKGROUND AND OBJECTIVES: Failure or delay to diagnose brain death leads to needless occupation of a hospital bed, emotional and financial losses, and unavailability of organs for transplants. The intensive care physician plays an essential role in this diagnosis. This study intended to evaluate intensivists' knowledge concerning brain death. METHODS: Cross-sectional study in 15 intensive care units (ICU in eight hospitals in the city of Porto Alegre, Brazil. RESULTS: Two hundred forty-six intensivists were interviewed in a consecutive sample between April and December 2005. The prevalence of lack of knowledge regarding the concept was of 17%. Twenty per cent of the interviewees ignored the legal need for complementary confirmatory tests for their diagnosis. Forty-seven per

  7. Analysis of Mouse Brain Transcriptome After Experimental Duvenhage Virus Infection Shows Activation of Innate Immune Response and Pyroptotic Cell Death Pathway

    Directory of Open Access Journals (Sweden)

    Penelope Koraka

    2018-03-01

    Full Text Available Rabies is an important neglected disease, characterized by invariably fatal encephalitis. Several studies focus on understanding the pathogenic mechanisms of the prototype lyssavirus rabies virus (RABV infection, and little is known about the pathogenesis of rabies caused by other lyssaviruses. We sought to characterize the host response to Duvenhage virus infection and compare it with responses observed during RABV infection by gene expression profiling of brains of mice with the respective infections. We found in both infections differentially expressed genes leading to increased expression of type I interferons (IFNs, chemokines, and proinflammatory cytokines. In addition several genes of the IFN signaling pathway are up-regulated, indicating a strong antiviral response and activation of the negative feedback mechanism to limit type I IFN responses. Furthermore we provide evidence that in the absence of significant neuronal apoptotic death, cell death of neurons is mediated via the pyroptotic pathway in both infections. Taken together, we have identified several genes and/or pathways for both infections that could be used to explore novel approaches for intervention strategies against rabies.

  8. Silica nanoparticles mediated neuronal cell death in corpus striatum of rat brain: implication of mitochondrial, endoplasmic reticulum and oxidative stress

    Science.gov (United States)

    Parveen, Arshiya; Rizvi, Syed Husain Mustafa; Mahdi, Farzana; Tripathi, Sandeep; Ahmad, Iqbal; Shukla, Rajendra K.; Khanna, Vinay K.; Singh, Ranjana; Patel, Devendra K.; Mahdi, Abbas Ali

    2014-11-01

    Extensive uses of silica nanoparticles (SiNPs) in biomedical and industrial fields have increased the risk of exposure, resulting concerns about their safety. We focussed on some of the safety aspects by studying neurobehavioural impairment, oxidative stress (OS), neurochemical and ultrastructural changes in corpus striatum (CS) of male Wistar rats exposed to 80-nm SiNPs. Moreover, its role in inducing mitochondrial and endoplasmic reticulum (ER) stress-mediated neuronal apoptosis was also investigated. The results demonstrated impairment in neurobehavioural indices, and a significant increase in lipid peroxide levels (LPO), hydrogen peroxide (H2O2), superoxide (O2 -) and protein carbonyl content, whereas there was a significant decrease in the activities of the enzymes, manganese superoxide dismutase (Mn SOD), glutathione peroxidase (GPx), catalase (CAT) and reduced glutathione (GSH) content, suggesting impaired antioxidant defence system. Protein (cytochrome c, Bcl-2, Bax, p53, caspase-3, caspase 12 and CHOP/Gadd153) and mRNA (Bcl-2, Bax, p53 and CHOP/Gadd153, cytochrome c) expression studies of mitochondrial and ER stress-related apoptotic factors suggested that both the cell organelles were involved in OS-mediated apoptosis in treated rat brain CS. Moreover, electron microscopic studies clearly showed mitochondrial and ER dysfunction. In conclusion, the result of the study suggested that subchronic SiNPs' exposure has the potential to alter the behavioural activity and also to bring about changes in biochemical, neurochemical and ultrastructural profiles in CS region of rat brain. Furthermore, we also report SiNPs-induced apoptosis in CS, through mitochondrial and ER stress-mediated signalling.

  9. Early CT findings to predict early death in patients with traumatic brain injury: Marshall and Rotterdam CT scoring systems compared in the major academic tertiary care hospital in northeastern Japan.

    Science.gov (United States)

    Mata-Mbemba, Daddy; Mugikura, Shunji; Nakagawa, Atsuhiro; Murata, Takaki; Ishii, Kiyoshi; Li, Li; Takase, Kei; Kushimoto, Shigeki; Takahashi, Shoki

    2014-05-01

    Computed tomography (CT) plays a crucial role in early assessment of patients with traumatic brain injury (TBI). Marshall and Rotterdam are the mostly used scoring systems, in which CT findings are grouped differently. We sought to determine the scoring system and initial CT findings predicting the death at hospital discharge (early death) in patients with TBI. We included 245 consecutive adult patients with mild-to-severe TBI. Their initial CT and status at hospital discharge (dead or alive) were reviewed, and both CT scores were calculated. We examined whether each score was related to early death; compared the two scoring systems' performance in predicting early death, and identified the CT findings that are independent predictors of early death. More deaths occurred among patients with higher Marshall and Rotterdam scores (both P death (Marshall, AUC = 0. 85 vs. Rotterdam, AUC = 0.85). Basal cistern absence (odds ratio [OR] = 771.5, P death. Both Marshall and Rotterdam scoring systems can be used to predict early death in patients with TBI. The performance of the Marshall score is at least equal to that of the Rotterdam score. Thus, although older, the Marshall score remains useful in predicting patients' prognosis. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  10. Guia per al càlcul simplificat de corbes de valoració

    OpenAIRE

    Núñez Burcio, Oscar; Serrano i Plana, Núria; Subirats i Vila, Xavier

    2016-01-01

    La guia descriu com calcular corbes de valoració d'acids i bases, utilitzant simplificacions, a partir de la seva concentració i de les constants de dissociació. Els casos presentats són els següents: - Valoració d’un àcid fort amb una base forta - Valoració d’una base forta amb un àcid fort - Valoració d’un àcid feble monopròtic amb una base forta - Valoració d’una base feble monopròtica amb un àcid fort - Valoració d’un àcid feble dipròtic amb una base forta - Valoració d...

  11. The Effect of Gene Alterations and Tyrosine Kinase Inhibition on Survival and Cause of Death in Patients With Adenocarcinoma of the Lung and Brain Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Sperduto, Paul W., E-mail: psperduto@mropa.com [Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center, Minneapolis, Minnesota (United States); Yang, T. Jonathan; Beal, Kathryn [Sloan Kettering Cancer Center, New York, New York (United States); Pan, Hubert; Brown, Paul D. [MD Anderson Cancer Center, Houston, Texas (United States); Bangdiwala, Ananta; Shanley, Ryan [University of Minnesota, Masonic Cancer Center, Biostatistics, Minneapolis, Minnesota (United States); Yeh, Norman; Gaspar, Laurie E. [University of Colorado–Denver, Denver, Colorado (United States); Braunstein, Steve; Sneed, Penny [University of California–San Francisco, San Francisco, California (United States); Boyle, John; Kirkpatrick, John P. [Duke University, Durham, North Carolina (United States); Mak, Kimberley S.; Shih, Helen A. [Massachusetts General Hospital, Boston, Massachusetts (United States); Engelman, Alex [University of Maryland, Baltimore, Maryland (United States); Roberge, David [CHUM, University of Montreal, Montreal, Quebec (Canada); Arvold, Nils D.; Alexander, Brian; Awad, Mark M. [Dana Farber/Brigham and Women' s Cancer Center, Boston, Massachusetts (United States); and others

    2016-10-01

    Purpose: Lung cancer remains the most common cause of both cancer mortality and brain metastases (BM). The purpose of this study was to assess the effect of gene alterations and tyrosine kinase inhibition (TKI) on median survival (MS) and cause of death (CoD) in patients with BM from lung adenocarcinoma (L-adeno). Methods: A multi-institutional retrospective database of patients with L-adeno and newly diagnosed BM between 2006 and 2014 was created. Demographics, gene alterations, treatment, MS, and CoD were analyzed. The treatment patterns and outcomes were compared with those in prior trials. Results: Of 1521 L-adeno patients, 816 (54%) had known alteration status. The gene alteration rates were 29%, 10%, and 26% for EGFR, ALK, and KRAS, respectively. The time from primary diagnosis to BM for EGFR−/+ was 10/15 months (P=.02) and for ALK−/+ was 10/20 months (P<.01), respectively. The MS for the group overall (n=1521) was 15 months. The MS from first treatment for BM for EGFR and ALK−, EGFR+, ALK+ were 14, 23 (P<.01), and 45 (P<.0001) months, respectively. The MS after BM for EGFR+ patients who did/did not receive TKI before BM was 17/30 months (P<.01), respectively, but the risk of death was not statistically different between TKI-naïve patients who did/did not receive TKI after the diagnosis of BM (EGFR/ALK hazard ratios: 1.06 [P=.84]/1.60 [P=.45], respectively). The CoD was nonneurologic in 82% of patients with known CoD. Conclusion: EGFR and ALK gene alterations are associated with delayed onset of BM and longer MS relative to patients without these alterations. The CoD was overwhelmingly nonneurologic in patients with known CoD.

  12. Death: clinical and forensic anthropological perspectives

    OpenAIRE

    Etty Indriati, Etty Indriati

    2015-01-01

    All biological living beings inevitably die, and the ways to die vary although in essence death is a manifestation of the absence of Oxygen in the brain. After death, biological remains undertake proteolysis and decomposition. The aim of this article is to discuss clinical death, cerebral or medicolegal death, social death, phases of cerebral death, and biological process after death—which is important for forensic medicine and forensic anthropology. How long a person die, if the time elaps...

  13. Biosensor Technology Reveals the Disruption of the Endothelial Barrier Function and the Subsequent Death of Blood Brain Barrier Endothelial Cells to Sodium Azide and Its Gaseous Products.

    Science.gov (United States)

    Kho, Dan T; Johnson, Rebecca H; O'Carroll, Simon J; Angel, Catherine E; Graham, E Scott

    2017-09-21

    Herein we demonstrate the sensitive nature of human blood-brain barrier (BBB) endothelial cells to sodium azide and its gaseous product. Sodium azide is known to be acutely cytotoxic at low millimolar concentrations, hence its use as a biological preservative (e.g., in antibodies). Loss of barrier integrity was noticed in experiments using Electric Cell-substrate Impedance Sensing (ECIS) biosensor technology, to measure endothelial barrier integrity continuously in real-time. Initially the effect of sodium azide was observed as an artefact where it was present in antibodies being employed in neutralisation experiments. This was confirmed where antibody clones that were azide-free did not mediate loss of barrier function. A delayed loss of barrier function in neighbouring wells implied the influence of a liberated gaseous product. ECIS technology demonstrated that the BBB endothelial cells had a lower level of direct sensitivity to sodium azide of ~3 µM. Evidence of gaseous toxicity was consistently observed at 30 µM and above, with disrupted barrier function and cell death in neighbouring wells. We highlight the ability of this cellular biosensor technology to reveal both the direct and gaseous toxicity mediated by sodium azide. The sensitivity and temporal dimension of ECIS technology was instrumental in these observations. These findings have substantial implications for the wide use of sodium azide in biological reagents, raising issues of their application in live-cell assays and with regard to the protection of the user. This research also has wider relevance highlighting the sensitivity of brain endothelial cells to a known mitochondrial disruptor. It is logical to hypothesise that BBB endothelial dysfunction due to mitochondrial dys-regulation could have an important but underappreciated role in a range of neurological diseases.

  14. Crosstalk between complement and Toll-like receptor activation in relation to donor brain death and renal ischemia-reperfusion injury.

    Science.gov (United States)

    Damman, Jeffrey; Daha, Mohamed R; van Son, Willem J; Leuvenink, Henri G; Ploeg, Rutger J; Seelen, Marc A

    2011-04-01

    Two central pathways of innate immunity, complement and Toll-like receptors (TLRs), play an important role in the pathogenesis of renal injury inherent to kidney transplantation. Recent findings indicate close crosstalk between complement and TLR signaling pathways. It is suggested that mitogen activated protein kinases (MAPKs) might be the key molecules linking both the complement and TLR pathways together. Complement and TLRs are important mediators of renal ischemia-reperfusion injury (IRI). Besides IRI, complement C3 can also be upregulated and activated in the kidney before transplantation as a direct result of brain death (BD) in the donor. This local upregulation and activation of complement in the donor kidney has been proven to be detrimental for renal allograft outcome. Also TLR4 and several of its major ligands are upregulated by donor BD compared to living donors. Important and in line with the observations above, kidney transplant recipients have a benefit when receiving a kidney from a TLR4 Asp299Gly/Thr399Ile genotypic donor. The role of complement and TLRs and crosstalk between these two innate immune systems in relation to renal injury during donor BD and ischemia-reperfusion are focus of this review. Future strategies to target complement and TLR activation in kidney transplantation are considered. ©2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons.

  15. Death Cafe.

    Science.gov (United States)

    Miles, Lizzy; Corr, Charles A

    2017-06-01

    This article explains the meaning of the phrase Death Cafe and describes what typically occurs at a Death Cafe gathering. The article traces the history of the Death Cafe movement, explores some reasons why people take part in a Death Cafe gathering, and gives examples of what individuals think they might derive from their participation. In addition, this article notes similarities between the Death Cafe movement and three other developments in the field of death, dying, and bereavement. Finally, this article identifies two provisional lessons that can be drawn from Death Cafe gatherings and the Death Cafe movement itself.

  16. O que visitar em Paris durante a Exposição Universal de 1878: um guia turístico para geólogos

    Directory of Open Access Journals (Sweden)

    Maria Margaret Lopes

    2015-10-01

    Full Text Available Este artigo parte da tradição constituída dos guias de turismo, para comentar os guias elaborados para as Exposições Universais. Apresenta um exemplo específico desses guias de turismo científico preparado para um Congresso que se realizou no âmbito de uma Exposição e que se tornaria modelar para os próximos eventos da área. Trata-se do Guide du géologue à l’Exposition universelle de 1878 et dans les collections publiques et privées de Paris. O Guide foi organizado para orientar os geólogos estrangeiros que participaram do Primeiro Congresso Internacional de Geologia realizado durante a Exposição Universal de Paris de 1878.

  17. [Digital electroencephalography in brain death diagnostics : Technical requirements and results of a survey on the compatibility with medical guidelines of digital EEG systems from providers in Germany].

    Science.gov (United States)

    Walter, U; Noachtar, S; Hinrichs, H

    2018-02-01

    The guidelines of the German Medical Association and the German Society for Clinical Neurophysiology and Functional Imaging (DGKN) require a high procedural and technical standard for electroencephalography (EEG) as an ancillary method for diagnosing the irreversible cessation of brain function (brain death). Nowadays, digital EEG systems are increasingly being applied in hospitals. So far it is unclear to what extent the digital EEG systems currently marketed in Germany meet the guidelines for diagnosing brain death. In the present article, the technical und safety-related requirements for digital EEG systems and the EEG documentation for diagnosing brain death are described in detail. On behalf of the DGKN, the authors sent out a questionnaire to all identified distributors of digital EEG systems in Germany with respect to the following technical demands: repeated recording of the calibration signals during an ongoing EEG recording, repeated recording of all electrode impedances during an ongoing EEG recording, assessability of intrasystem noise and galvanic isolation of measurement earthing from earthing conductor (floating input). For 15 of the identified 20 different digital EEG systems the specifications were provided by the distributors (among them all distributors based in Germany). All of these EEG systems are provided with a galvanic isolation (floating input). The internal noise can be tested with all systems; however, some systems do not allow repeated recording of the calibration signals and/or the electrode impedances during an ongoing EEG recording. The majority but not all of the currently available digital EEG systems offered for clinical use are eligible for use in brain death diagnostics as per German guidelines.

  18. Nuclear uptake of an amino-terminal fragment of apolipoprotein E4 promotes cell death and localizes within microglia of the Alzheimer's disease brain.

    Science.gov (United States)

    Love, Julia E; Day, Ryan J; Gause, Justin W; Brown, Raquel J; Pu, Xinzhu; Theis, Dustin I; Caraway, Chad A; Poon, Wayne W; Rahman, Abir A; Morrison, Brad E; Rohn, Troy T

    2017-01-01

    Although harboring the apolipoprotein E4 ( APOE4 ) allele is a well known risk factor in Alzheimer's disease (AD), the mechanism by which it contributes to disease risk remains elusive. To investigate the role of proteolysis of apoE4 as a potential mechanism, we designed and characterized a site-directed cleavage antibody directed at position D151 of the mature form of apoE4 and E3. Characterization of this antibody indicated a high specificity for detecting synthesized recombinant proteins corresponding to the amino acid sequences 1-151 of apoE3 and E4 that would generate the 17 kDa (p17) fragment. In addition, this antibody also detected a ~17 kDa amino-terminal fragment of apoE4 following incubation with collagenase and matrix metalloproteinase-9 (MMP-9), but did not react with full-length apoE4. Application of this amino-terminal apoE cleavage-fragment (nApoECFp17) antibody, revealed nuclear labeling within glial cells and labeling of a subset of neurofibrillary tangles in the human AD brain. A quantitative analysis indicated that roughly 80% of labeled nuclei were microglia. To confirm these findings, cultured BV2 microglia cells were incubated with the amino-terminal fragment of apoE4 corresponding to the cleavage site at D151. The results indicated efficient uptake of this fragment and trafficking to the nucleus that also resulted in significant cell death. In contrast, a similarly designed apoE3 fragment showed no toxicity and primarily localized within the cytoplasm. These data suggest a novel cleavage event by which apoE4 is cleaved by the extracellular proteases, collagenase and MMP-9, generating an amino-terminal fragment that is then taken up by microglia, traffics to the nucleus and promotes cell death. Collectively, these findings provide important mechanistic insights into the mechanism by which harboring the APOE4 allele may elevate dementia risk observed in AD.

  19. Antioxidant properties of Taraxacum officinale fruit extract are involved in the protective effect against cellular death induced by sodium nitroprusside in brain of rats.

    Science.gov (United States)

    Colle, Dirleise; Arantes, Letícia Priscilla; Rauber, Ricardo; de Mattos, Sérgio Edgar Campos; Rocha, João Batista Teixeira da; Nogueira, Cristina Wayne; Soares, Félix Alexandre Antunes

    2012-07-01

    Taraxacum officinale Weber (Asteraceae), known as dandelion, is used for medicinal purposes due to its choleretic, diuretic, antitumor, antioxidant, antiinflammatory, and hepatoprotective properties. We sought to investigate the protective activity of T. officinale fruit extract against sodium nitroprusside (SNP)-induced decreased cellular viability and increased lipid peroxidation in the cortex, hippocampus, and striatum of rats in vitro. To explain the mechanism of the extract's antioxidant activity, its putative scavenger activities against NO, DPPH·, OH·, and H(2)O(2) were determined. Slices of cortex, hippocampus, and striatum were treated with 50 μM SNP and T. officinale fruit ethanolic extract (1-20 µg/mL) to determine cellular viability by MTT reduction assay. Lipid peroxidation was measure in cortical, hippocampal and striatal slices incubates with SNP (5 µM) and T. officinale fruit extract (1-20 µg/mL). We also determined the scavenger activities of T. officinale fruit extract against NO·, DPPH·, OH·, and H(2)O(2), as well as its iron chelating capacity. The extract (1, 5, 10, and 20 μg/mL) protected against SNP-induced decreases in cellular viability and increases in lipid peroxidation in the cortex, hippocampus, and striatum of rats. The extract had scavenger activity against DPPH· and NO· at low concentrations and was able to protect against H(2)O(2) and Fe(2+)-induced deoxyribose oxidation. T. officinale fruit extract has antioxidant activity and protects brain slices against SNP-induced cellular death. Possible mechanisms of action include its scavenger activities against reactive oxygen species (ROS) and reactive nitrogen species (RNS), which are attributed to the presence of phenolic compounds in the extract.

  20. Deliberating death.

    Science.gov (United States)

    Landes, Scott D

    2010-01-01

    Utilizing a particular case study of a woman attempting to come to terms with her death, this article explores the difficult metaphors of death present within the Christian tradition. Tracing a Christian understanding of death back to the work of Augustine, the case study is utilized to highlight the difficulties presented by past and present theology embracing ideas of punishment within death. Following the trajectory of the case study, alternative understandings of death present in recent Christian theology and within Native American spirituality are presented in an attempt to find room for a fuller meaning of death post-reconciliation, but premortem.

  1. Autoradiographic studies on the cell kinetics after the whole body X-irradiation. 2. Regularities of the post-irradiation death of differentiating and proliferating cells of the rat brain subependimal zone

    International Nuclear Information System (INIS)

    Gracheva, N.D.

    1982-01-01

    A wave-like character of death of proliferating and differentiating (D) cells is shown autoradiographically using 3 H-thymidine introduced 60-80 min before the whole body X-ray irradiation in doses of 50, 150 or 300 R on subependymal cells of rat brain. Lethally damaged cells irradiated in G 2 and S-phases, resulted in 4 peaks of death in mitosis by following the first postradiational mitotic cycle (MC). Lethally damaged cells irradiated in G 1 -phase lost ability for DNA synthesis as cells irradiated in a dose of 300 R did not include additionally introduced (3 hrs before death) 14 C-thymidine from 12 to 17 hrs after 3 H-thymidine injection. However, in the first 4 hrs after irradiation there were no cells irradiated in G 1 -phase among dead ones, as indirec showed the calculations of data obtained tly/ while studying Pliss lymphosarcoma. A supposition is made that the death of cells irradiated in G 1 -phase is attributed to mitotic phase of the first MC after irradiation. Waves of death of lethally damaged D-cells repeated the peaks of death and corresponded to the mitotic peaks of proliferating cells, which permitted to presuppose the presence of ''short cycle'' (SC) in D-cells, which have the rhythm similar to MC and their death has been attributed to the final SC phase, which corresponds to MC mitotic phase in time. According to the peaks of cell death position of one hour block independent of dose in six MC(SC) points is determined. The cells have experienced the block in the point of MC(SC) in subphase of which they were caught by irradiation. Dose effect is manifested in the number of dead cells

  2. GUIA METODOLOGICA PARA UN MANEJO INTEGRAL COSTERO APLICADO A PEHUEN CO (ARGENTINA

    Directory of Open Access Journals (Sweden)

    María Luján Bustos

    2017-03-01

    Os planos de gestão costeira integrada (GCI na Argentina são quase inexistentes. No Sul da província de Buenos Aires (Argentina, o planejamento por causa da intensidade da erosão costeira, que afeta especialmente as áreas urbanizadas, é necessário. É fundamental ainda traçar estratégias de GCI que possam ser aplicadas em toda a área de forma sustentável. Neste processo, a participação e o compromisso dos atores sociais são fundamentais. Por esta razão, um guia metodológico foi construído para uma GCI com participação social e aplica-se à localidade de Pehuen Co. Obteve-se como resultado que a erosão costeira e a sazonalidade do turismo são os pilares tanto para a visão científica quanto para a social. Sobre isso, foram delineadas ações e estratégias a curto, médio e longo prazos e indicadores de acompanhamento. Concluiu-se que é necessário o compromisso das autoridades locais, trabalhando em conjunto com as partes interessadas, para o bom funcionamento do GCI. Palavras-chave: Gestão Integrada Costeira; Indicadores Ambientais; Erosão; Sazonalidade do Turismo; Pehuen Co (Argentina.

  3. Exame físico na criança: um guia para o enfermeiro

    Directory of Open Access Journals (Sweden)

    Josilene de Melo Buriti Vasconcelos

    1999-12-01

    Full Text Available O exame físico constitui-se numa importante etapa dentro do processo de avaliação à criança, através do qual o enfermeiro enriquece as informações obtidas durante a entrevista e fundamenta a assistência de enfermagem. Na atualidade, mediante o crescente interesse dos enfermeiros em aplicar o processo de enfermagem em todas as suas etapas, o exame físico tem ocupado lugar de destaque, por permitir que os enfermeiros conheçam as necessidades de seus clientes, no que diz respeito aos seus aspectos físicos e fisiológicos, permitindo a identificação dos diagnósticos de enfermagem, alem de servir como recurso para avaliação efetiva das intervenções de enfermagem. Este estudo, de caráter bibliográfico, objetivou elaborar um guia para realização do exame físico na criança, a ser utilizado por enfermeiros, durante o processo de avaliação à criança. Nele apresentamos o exame físico de forma sistemática, utilizando a seqüência céfalo-caudal, descrevendo os possíveis achados normais e anormais ao examinarmos a criança.

  4. Ver, Compreender e Aprender: estudo comparado com guias de uso de apps editoriais para dispositivos móveis

    Directory of Open Access Journals (Sweden)

    Ana Claudia Dalagnoli

    2016-12-01

    Full Text Available Este estudo foi construído a partir da percepção de que a evolução das tecnologias e, sobretudo, o aprimoramento da comunicação em dispositivos móveis, impacta diretamente no processo de desenvolvimento de aplicativos (apps e softwares e na relação do ser humano com as novas interfaces. A pesquisa apresenta uma análise comparativa entre os aplicativos para iPad das revistas de decoração e design de interiores Casa Claudia (Editora Abril e Casa e Jardim (Editora Globo, a partir de testes de usabilidade dos mesmos em tablets Apple. O objetivo foi verificar se os guias de uso disponíveis em aplicativos (apps de revistas para dispositivos móveis, construídos por textos e imagens, estão cumprindo a função de comunicar, efetivamente, o modo de uso desses apps. As informações foram coletadas junto a mulheres com idade entre 25 e 54 anos que testaram e comentaram o funcionamento das versões atuais dos apps. Foram selecionadas 24 mulheres para fazerem atividades individuais monitoradas em ambos os apps, com dados coletados por meio de observações e think aloud. Os dados obtidos foram analisados, e com base nos resultados foi proposto um ajuste nos requisitos para o desenvolvimento de interfaces de guias para aplicativos com vistas à maior satisfação das usuárias. Foram percebidas falhas severas na apreensão e aplicação das orientações disponíveis nos guias de uso. Os pesquisadores verificaram que os requisitos básicos para aumentar a satisfação e melhorar a usabilidade estão relacionados à facilidade de compreensão e à simplicidade no uso, o que pode ser obtido por meio de melhorias relacionadas à aplicação da tecnologia, ao conhecimento dos processos cognitivos dos usuários e à aplicação de conceitos semióticos de comunicação. O estudo pode servir de base para o desenvolvimento e análise de guias de uso de outros apps com características similares, em diversos sistemas operacionais.

  5. Adaptação multicêntrica do guia para a gestão autônoma da medicação

    Directory of Open Access Journals (Sweden)

    Rosana Teresa Onocko Campos

    2012-12-01

    Full Text Available O uso crescente de psicofármacos e o baixo empowerment dos usuários mostram-se críticos à qualificação da assistência em Saúde Mental no Brasil. Este estudo, abrangendo três cidades brasileiras, objetivou a elaboração do Guia Brasileiro da Gestão Autônoma da Medicação (GGAM-BR, com base na tradução e adaptação de guia desenvolvido no Canadá; e a avaliação dos efeitos do uso do GGAM-BR na formação de trabalhadores de saúde mental. Constituíram-se grupos de intervenção (GIs para compartilhamento das experiências com tratamento medicamentoso, a partir dos temas propostos no guia; e foram realizados grupos focais antes e após os GIs. Importantes mudanças em relação ao texto original do guia Canadense foram implementadas, levando em conta a realidade brasileira. Constatou-se que o GGAM-BR constitui estratégia potente de fomento à participação ativa dos usuários na gestão do tratamento e do serviço, incidindo positivamente na formação de trabalhadores.

  6. Selection of reference genes for normalisation of real-time RT-PCR in brain-stem death injury in Ovis aries

    Directory of Open Access Journals (Sweden)

    Fraser John F

    2009-07-01

    Full Text Available Abstract Background Heart and lung transplantation is frequently the only therapeutic option for patients with end stage cardio respiratory disease. Organ donation post brain stem death (BSD is a pre-requisite, yet BSD itself causes such severe damage that many organs offered for donation are unusable, with lung being the organ most affected by BSD. In Australia and New Zealand, less than 50% of lungs offered for donation post BSD are suitable for transplantation, as compared with over 90% of kidneys, resulting in patients dying for lack of suitable lungs. Our group has developed a novel 24 h sheep BSD model to mimic the physiological milieu of the typical human organ donor. Characterisation of the gene expression changes associated with BSD is critical and will assist in determining the aetiology of lung damage post BSD. Real-time PCR is a highly sensitive method involving multiple steps from extraction to processing RNA so the choice of housekeeping genes is important in obtaining reliable results. Little information however, is available on the expression stability of reference genes in the sheep pulmonary artery and lung. We aimed to establish a set of stably expressed reference genes for use as a standard for analysis of gene expression changes in BSD. Results We evaluated the expression stability of 6 candidate normalisation genes (ACTB, GAPDH, HGPRT, PGK1, PPIA and RPLP0 using real time quantitative PCR. There was a wide range of Ct-values within each tissue for pulmonary artery (15–24 and lung (16–25 but the expression pattern for each gene was similar across the two tissues. After geNorm analysis, ACTB and PPIA were shown to be the most stably expressed in the pulmonary artery and ACTB and PGK1 in the lung tissue of BSD sheep. Conclusion Accurate normalisation is critical in obtaining reliable and reproducible results in gene expression studies. This study demonstrates tissue associated variability in the selection of these

  7. Orchestrating an Exceptional Death

    DEFF Research Database (Denmark)

    Jensen, Anja Marie Bornø

    processes of facing brain death and deciding about organ donation. This study suggests that organ donation should be understood as a ‘strange figure’ challenging traditions and attitudes regarding the boundaries between life and death and the practices surrounding dead human bodies. Simultaneously, organ...... donation can be comforting and furthermore enable some families to make sense of a sudden tragic death. Throughout the thesis, the concept of ‘orchestration’ serves as the overall theoretical framework to understand how families, hospital staff and, on a larger scale, Danish society attempt to perform......, reinterpret and translate death and organ donation into something culturally acceptable and sense making. With chapters focusing analytically on the performance of trust, the transformative practices of hope, the aesthetization of ambiguous bodies, the sociality of exchangeable organs and the organ donation...

  8. Defining death: organ transplants, tradition and technology in Japan.

    Science.gov (United States)

    Feldman, E A

    1988-01-01

    This article explores Japanese attitudes about brain death and organ transplantation. First, ancient burial customs and death-related rituals associated with Shinto and Buddhism are examined. Next, contemporary attitudes towards the dead are discussed in the context of current controversies surrounding brain death and organ transplantation. Finally, an attempt is made to link the traditional Japanese views of death with modern medical dilemmas.

  9. A novel neuron-enriched protein SDIM1 is down regulated in Alzheimer's brains and attenuates cell death induced by DNAJB4 over-expression in neuro-progenitor cells

    Directory of Open Access Journals (Sweden)

    Lei Joy X

    2011-01-01

    Full Text Available Abstract Background Molecular changes in multiple biological processes contribute to the development of chronic neurodegeneration such as late onset Alzheimer's disease (LOAD. To discover how these changes are reflected at the level of gene expression, we used a subtractive transcription-based amplification of mRNA procedure to identify novel genes that have altered expression levels in the brains of Alzheimer's disease (AD patients. Among the genes altered in expression level in AD brains was a transcript encoding a novel protein, SDIM1, that contains 146 amino acids, including a typical signal peptide and two transmembrane domains. Here we examined its biochemical properties and putative roles in neuroprotection/neurodegeneration. Results QRT-PCR analysis of additional AD and control post-mortem human brains showed that the SDIM1 transcript was indeed significantly down regulated in all AD brains. SDIM1 is more abundant in NT2 neurons than astrocytes and present throughout the cytoplasm and neural processes, but not in the nuclei. In NT2 neurons, it is highly responsive to stress conditions mimicking insults that may cause neurodegeneration in AD brains. For example, SDIM1 was significantly down regulated 2 h after oxygen-glucose deprivation (OGD, though had recovered 16 h later, and also appeared significantly up regulated compared to untreated NT2 neurons. Overexpression of SDIM1 in neuro-progenitor cells improved cells' ability to survive after injurious insults and its downregulation accelerated cell death induced by OGD. Yeast two-hybrid screening and co-immunoprecipitation approaches revealed, both in vitro and in vivo, an interaction between SDIM1 and DNAJB4, a heat shock protein hsp40 homolog, recently known as an enhancer of apoptosis that also interacts with the mu opioid receptor in human brain. Overexpression of DNAJB4 alone significantly reduced cell viability and SDIM1 co-overexpression was capable of attenuating the cell death

  10. Sabores de viagem - as culinárias regionais nos guias turísticos entre 1966 e 1983.

    Directory of Open Access Journals (Sweden)

    Luciana Patrícia de Morais

    2012-11-01

    Full Text Available Partindo da premissa de que os saberes culinários se constituem em um dos principais suportes nos processos de construção e transmissão de identidades, busca-se entender a comida regional como expressão das culturas regionais em sua relação com a atividade turística. Parte-se do pressuposto de que a difusão dos regionalismos tem relação próxima com o desenvolvimento desta atividade no Brasil, num movimento em que as personalidades regionais são apropriadas e alçadas ao status de atrativos e produtos turísticos. Sem pretender estabelecer uma relação de causalidade entre turismo e comida regional, entende-se que embora a visibilidade das culinárias típicas no Brasil tenha relação com uma série de outras variáveis, o turismo é fundamental para se compreender os contornos e o alcance da visibilidade destas culinárias. Para tanto, a discussão terá como ponto de partida uma reflexão sucinta sobre os guias de viagem como fonte de pesquisa tomando como estudo de caso específico os casos de Minas Gerais e Paraná no interior do Guia Quatro Rodas Brasil entre 1966 e 1983.

  11. Avaliação do conhecimento de estudantes de medicina sobre morte encefálica Evaluation of medical students knowledge on brain death

    Directory of Open Access Journals (Sweden)

    Almir Galvão Vieira Bitencourt

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Por ser um conceito relativamente novo e pouco divulgado na sociedade, o diagnóstico de morte encefálica (ME ainda não é bem aceito pela população em geral, inclusive entre médicos e estudantes de Medicina. O objetivo deste estudo foi avaliar o conhecimento de uma amostra de estudantes de Medicina sobre o protocolo diagnóstico de ME. MÉTODO: Estudo descritivo de corte transversal, avaliando acadêmicos de duas faculdades de Medicina de Salvador-BA. Foi distribuído um questionário auto-aplicável composto por questões referentes à conhecimento, técnico e ético, contidos na Resolução nº 1.480/97 do Conselho Federal de Medicina, que dispõe sobre os critérios para caracterização de ME. RESULTADOS: Foram avaliados 115 estudantes. A média de acertos nas 14 questões sobre o conhecimento dos critérios da ME foi de 6,7 ± 1,8; sendo maior entre os estudantes que haviam assistido alguma apresentação sobre ME. A maioria dos estudantes (87,4% soube identificar os pacientes candidatos ao protocolo de ME. No entanto, apenas 5,2% e 16,1% dos estudantes acertaram, respectivamente, os testes clínicos e complementares que devem ser realizados durante o protocolo. Frente a um paciente não-doador com diagnóstico confirmado de ME, 66,4% referiram que o suporte artificial de vida deve ser suspenso. Apenas 15% dos estudantes entrevistados já avaliaram um paciente com ME, sendo este percentual maior entre os que já haviam realizado estágio em UTI (38,2% versus 5,1%; p BACKGROUND AND OBJECTIVES: Because brain death (BD is a new concept and little divulged, it’s not well accepted in general population, including doctors and Medical students. This study aims to evaluate the knowledge of a sample of Medical students on the Brazilian BD diagnosis protocol. METHODS: Descriptive cross-sectional survey that evaluated students from two medical schools in Salvador-BA. We used a questionnaire composed by questions

  12. Desempenho de diferentes guias de ondas para uso com o analisador de umidade TRASE Performance of different waveguides for use with the TRASE water content analyser

    Directory of Open Access Journals (Sweden)

    Eugênio F. Coelho

    2001-04-01

    Full Text Available O trabalho teve como objetivo avaliar a relação entre a umidade e a constante dielétrica aparente do solo e diferentes guias de onda para uso com o analisador de umidade Trase, que opera de acordo com o princípio da reflectometria no domínio do tempo - TDR. Amostras indeformadas e deformadas de duas manchas de textura diferente de um Latossolo Amarelo Distrófico foram retiradas do campo e acondicionadas em recipientes de 10 L, perfazendo quatro repetições para cada textura e estrutura. Foram construídas três diferentes guias de onda, com hastes de 0,15 m, sendo uma com capacitor e uma sem capacitor no início da guia, com espaçamento de 0,009 m entre hastes e outra sem capacitor, com espaçamento de 0,022 m entre hastes. Essas guias de onda, juntamente com guias originais do fabricante com hastes de 0,20 m, espaçadas 0,022 m, foram inseridas individualmente em cada recipiente. Dados de umidade obtidos gravimetricamente e pelo analisador TRASE, e da constante dielétrica, foram tomados usando-se todas as guias de onda em cada recipiente durante a secagem do solo, de 0,35 m³ m-3 a 0,10 m³ m-3. Três modelos matemáticos foram ajustados aos dados de umidade e da correspondente constante dielétrica do solo gerados pelas guias de onda do fabricante. Um modelo exponencial foi considerado como mais adequado para estimativas dos teores de água, em função da constante dielétrica para a guia de onda do fabricante. Todas as guias de onda avaliadas apresentam viabilidade de uso, desde que previamente calibradas.The objective of this work was to evaluate the relations between soil water content and the soil bulk dielectric constant, and to study different waveguides of a TRASE soil water content analyzer that operates according to TDR principles. Non-destructive and destructive samples of two sites of different texture of a Dystrophic Yellow Latossol were collected and packed into 10 L containers, resulting in four replications for each

  13. Avaliação das guias condilar e incisal em função da curva de compensação e da altura das cúspides - Releitura das Leis de Articulação de Hanau

    OpenAIRE

    Roger Nishyama

    2011-01-01

    Este estudo teve como objetivo avaliar a variação das guias sagitais (guia condilar e guia incisal), em função do plano de orientação (curvatura e inclinação) e da altura das cúspides, no movimento protrusivo mandibular, in vitro, buscando as relações entre esses fatores, tanto de forma analógica como digital. No estudo analógico foram avaliadas as inclinações das guias condilares, inclinações da guia incisal, proeminência da curva de compensação e inclinação do plano oclusal. Para isso foram...

  14. Advantages of analyzing postmortem brain samples in routine forensic drug screening—case series of three non-natural deaths tested positive for lysergic acid diethylamide (LSD)

    DEFF Research Database (Denmark)

    Mardal, Marie; Johansen, Sys Stybe; Thomsen, Ragnar

    2017-01-01

    Three case reports are presented, including autopsy findings and toxicological screening results, which were tested positive for the potent hallucinogenic drug lysergic acid diethylamide (LSD). LSD and its main metabolites were quantified in brain tissue and femoral blood, and furthermore hematoma...... and urine when available. LSD, its main metabolite 2-oxo-3-hydroxy-LSD (oxo-HO-LSD), and iso-LSD were quantified in biological samples according to a previously published procedure involving liquid-liquid extraction and ultra-high performance liquid chromatography − tandem mass spectrometry (UHPLC......-MS/MS). LSD was measured in the brain tissue of all presented cases at a concentration level from 0.34 −10.8 μg/kg. The concentration level in the target organ was higher than in peripheral blood. Additional psychoactive compounds were quantified in blood and brain tissue, though all below toxic concentration...

  15. Emergindo a complexidade do cuidado de enfermagem ao ser em morte encefálica Complejidad emergente del cuidado de enfermería al paciente con muerte cerebral Emerging the complexity of nursing care facing a brain death

    Directory of Open Access Journals (Sweden)

    Aline Lima Pestana

    2012-12-01

    ambivalentes sentimientos. La complejidad de los cuidados al paciente en muerte cerebral consiste en comprender su singularidad y dialogicidad.This study aimed to unveil the complexity of nursing care to human being in brain death. It was used as a theoretical and methodological reference, complex thinking and Grounded Theory, respectively. Data were collected in a university hospital in northeastern Brazil, from December 2010 to June 2011, through non structured interviews. The theoretical sample consisted of 12 nurses, distributed in three samples groups. The phenomenon of "Unveiling the multiple relationships and interactions to be a nurse in the complexity of care to the brain death" was delimited by five categories. In this article, was discussed the category "Emerging complexity of nursing care to be brain death". The study showed that the care facing a brain death is accompanied by disorder and uncertainties, causing the nurse to experience different feelings and ambivalent. The complexity of care facing a brain death is to understand its uniqueness and dialogical.

  16. Toxoplasma gondii 70 kDa heat shock protein: systemic detection is associated with the death of the parasites by the immune response and its increased expression in the brain is associated with parasite replication.

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    Paulo Victor Czarnewski Barenco

    Full Text Available The heat shock protein of Toxoplasma gondii (TgHSP70 is a parasite virulence factor that is expressed during T. gondii stage conversion. To verify the effect of dexamethasone (DXM-induced infection reactivation in the TgHSP70-specific humoral immune response and the presence of the protein in the mouse brain, we produced recombinant TgHSP70 and anti-TgHSP70 IgY antibodies to detect the protein, the specific antibody and levels of immune complexes (ICs systemically, as well as the protein in the brain of resistant (BALB/c and susceptible (C57BL/6 mice. It was observed higher TgHSP70-specific antibody titers in serum samples of BALB/c compared with C57BL/6 mice. However, the susceptible mice presented the highest levels of TgHSP70 systemically and no detection of specific ICs. The DXM treatment induced increased parasitism and lower inflammatory changes in the brain of C57BL/6, but did not interfere with the cerebral parasitism in BALB/c mice. Additionally, DXM treatment decreased the serological TgHSP70 concentration in both mouse lineages. C57BL/6 mice presented high expression of TgHSP70 in the brain with the progression of infection and under DXM treatment. Taken together, these data indicate that the TgHSP70 release into the bloodstream depends on the death of the parasites mediated by the host immune response, whereas the increased TgHSP70 expression in the brain depends on the multiplication rate of the parasite.

  17. Advantages of analyzing postmortem brain samples in routine forensic drug screening—case series of three non-natural deaths tested positive for lysergic acid diethylamide (LSD)

    DEFF Research Database (Denmark)

    Mardal, Marie; Johansen, Sys Stybe; Thomsen, Ragnar

    2017-01-01

    Three case reports are presented, including autopsy findings and toxicological screening results, which were tested positive for the potent hallucinogenic drug lysergic acid diethylamide (LSD). LSD and its main metabolites were quantified in brain tissue and femoral blood, and furthermore hematoma...

  18. Um guia de recomendações para o emprego de dados multimídia em sites web

    OpenAIRE

    Correa, Rodrigo Stéfani

    2002-01-01

    Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Ciência da Computação. Com a evolução do suporte tecnológico da Web/Internet, surgiram diversos sites web multimídia. Atualmente existem poucos trabalhos voltados à orientação dos desenvolvedores quanto ao uso adequado dos dados multimídia. Este trabalho propõe um guia de recomendações para o emprego de dados multimídia para auxiliar o projeto de sites web. Para alcançar os obj...

  19. Proliferation and cell death in an experimental model of brain tissue heterotopia in the lung Proliferação e morte celular na heterotopia encefálica experimental

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Veiga Quemelo

    2010-08-01

    Full Text Available PURPOSE: To investigate the proliferation and neuronal death in brain tissue heterotopia in the lung in an experimental model during both fetal and neonatal periods. METHODS: Twenty four pregnant female Swiss mice were used to induce brain tissue heterotopia on the 15th gestational day. Briefly, the brain of one fetus of each dam was extracted, disaggregated and injected into the right hemithorax of siblings. Six of these fetuses with pulmonary brain tissue implantation (PBI were collected on the 18th gestational day (group E18 and six other on the 8th postnatal day (group P8. Immunohistochemical staining for PCNA and Bcl2 were used to assess proliferation and cell death. RESULTS: PCNA Labelling Index (LI in heterotopic brain tissue was greater in fetal than postnatal period (E18 > P8 (pOBJETIVO: Investigar a proliferação e morte neuronal na heterotopia encefálica pulmonar em modelo experimental durante o período fetal e neonatal. MÉTODOS: Foram utilizados 24 camundongos Swiss fêmeas prenhes para induzir a heterotopia encefálica no pulmão. O tecido encefálico de um feto de cada fêmea prenha foi removido, picotado e injetado no pulmão dos irmãos. Seis fetos com Implantação Encefálica Pulmonar (IEP foram coletados no 18º dia gestacional (grupo E18 e seis outros fetos no 8º dia pós-natal (grupo P8. Foi realizada a reação Imuno-histoquímica para PCNA e Bcl2 para analisar a proliferação e morte celular. RESULTADOS: O índice de marcação (IM para PCNA era maior no período fetal quando comparado com o período pós-natal (E8 > P18 (p<0,05 e a imunomarcação para o anticorpo Bcl2 não apresentou diferença. CONCLUSÃO: A proliferação celular foi mantida no tecido heterotópico encefálico, embora a apoptose também foi observada.

  20. Guia de atencion integral para la prevencion, deteccion temprana y tratamiento de las complicaciones del embarazo: Sección de Toxoplasmosis

    Directory of Open Access Journals (Sweden)

    Jorge Alberto Cortes

    Full Text Available Resumen Como parte de la Guia de atencion integral para la prevencion, deteccion temprana y tratamiento de las complicaciones del embarazo, desarrollada y financiada por el Departamento de Ciencia, Tecnologia e Innovacion, Colciencias, y el Ministerio de Salud y Proteccion Social de Colombia, se seleccionó a la infeccion por Toxoplasma para el desarrollo de recomendaciones para su prevencion, diagnostico y tratamiento. La infeccion por Toxoplasma gondii (T. gondii durante el embarazo puede resultar en graves complicaciones para el feto y dejar importantes secuelas al recien nacido. Se realizo una guia basada en la mejor evidencia disponible en la literatura cientifica, con especial pertinencia a la informacion colombiana. Un consenso de expertos en parasitologia, ginecologia, neonatologia e infectologia, tanto de adultos como pediatrica, desarrollo las recomendaciones. Se propone que las recomendaciones de esta guia de atencion integral sean utilizadas por los profesionales de salud de los programas de atencion del embarazo del pais con el fin de disminuir la morbilidad y mortalidad atribuible a esta enfermedad. Se formulan recomendaciones especificas para el diagnostico desde el primer trimestre, consejos de prevencion en las mujeres no infectadas, identificacion de la infeccion del feto o del recien nacido y recomendaciones de tratamiento en estos escenarios.

  1. Value of Combining Left Atrial Diameter and Amino-terminal Pro-brain Natriuretic Peptide to the CHA2DS2-VASc Score for Predicting Stroke and Death in Patients with Sick Sinus Syndrome after Pacemaker Implantation.

    Science.gov (United States)

    Mo, Bin-Feng; Lu, Qiu-Fen; Lu, Shang-Biao; Xie, Yu-Quan; Feng, Xiang-Fei; Li, Yi-Gang

    2017-08-20

    The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation (AF). We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in Chinese patients with sick sinus syndrome (SSS) after pacemaker implantation and to evaluate whether the predictive power of the CHA2DS2-VASc score could be improved by combining it with left atrial diameter (LAD) and amino-terminal pro-brain natriuretic peptide (NT-proBNP). A total of 481 consecutive patients with SSS who underwent pacemaker implantation from January 2004 to December 2014 in our department were included. The CHA2DS2-VASc scores were retrospectively calculated according to the hospital medical records before pacemaker implantation. The outcome data (stroke and death) were collected by pacemaker follow-up visits and telephonic follow-up until December 31, 2015. During 2151 person-years of follow-up, 46 patients (9.6%) suffered stroke and 52 (10.8%) died. The CHA2DS2-VASc score showed a significant association with the development of stroke (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.20-1.75, Ppacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.

  2. Surviving death

    DEFF Research Database (Denmark)

    Gerstroem, Anna

    2013-01-01

    such phases. The aim of this paper is to explore how an organization’s identity is re-constructed after organizational death. Based on interviews with members of a bankrupted bank who narrate their bankruptcy experiences, the paper explores how legacy organizational identity is constructed after...... organizational death. The paper shows how members draw on their legacy organizational identity to justify their past interpretations and responses to the intensifying bankruptcy threats. Members refer to their firm belief in the bank’s solid and robust identity claim when they explain how they disregarded...

  3. Death cap

    DEFF Research Database (Denmark)

    Rudbæk, Torsten R; Kofoed, Pernille Bouteloup; Bove, Jeppe

    2014-01-01

    Death cap (Amanita phalloides) is commonly found and is one of the five most toxic fungi in Denmark. Toxicity is due to amatoxin, and poisoning is a serious medical condition, causing organ failure with potential fatal outcome. Acknowledgement and clarification of exposure, symptomatic and focused...

  4. "Spectacular Death"

    DEFF Research Database (Denmark)

    Jacobsen, Michael Hviid

    2016-01-01

    be labelled ‘spectacular death’ in which death, dying and mourning have increasingly become spectacles. Moreover, the author proposes that what is currently happening in contemporary Western society can be interpreted as an expression of a ‘partial re-reversal’ of ‘forbidden death’ to some...

  5. The common antitussive agent dextromethorphan protects against hyperoxia-induced cell death in established in vivo and in vitro models of neonatal brain injury.

    Science.gov (United States)

    Posod, A; Pinzer, K; Urbanek, M; Wegleiter, K; Keller, M; Kiechl-Kohlendorfer, U; Griesmaier, E

    2014-08-22

    Preterm infants are prematurely subjected to relatively high oxygen concentrations, even when supplemental oxygen is not administered. There is increasing evidence to show that an excess of oxygen is toxic to the developing brain. Dextromethorphan (DM), a frequently used antitussive agent with pleiotropic mechanisms of action, has been shown to be neuroprotective in various models of central nervous system pathology. Due to its numerous beneficial properties, it might also be able to counteract detrimental effects of a neonatal oxygen insult. The aim of the current study was to evaluate its therapeutic potential in established cell culture and rodent models of hyperoxia-induced neonatal brain injury. For in vitro studies pre- and immature oligodendroglial (OLN-93) cells were subjected to hyperoxic conditions for 48 h after pre-treatment with increasing doses of DM. For in vivo studies 6-day-old Wistar rat pups received a single intraperitoneal injection of DM in two different dosages prior to being exposed to hyperoxia for 24h. Cell viability and caspase-3 activation were assessed as outcome parameters at the end of exposure. DM significantly increased cell viability in immature oligodendroglial cells subjected to hyperoxia. In pre-oligodendroglial cells cell viability was not significantly affected by DM treatment. In vivo caspase-3 activation induced by hyperoxic exposure was significantly lower after administration of DM in gray and white matter areas. In control animals kept under normoxic conditions DM did not significantly influence caspase-3-dependent apoptosis. The present results indicate that DM is a promising and safe treatment strategy for neonatal hyperoxia-induced brain injury that merits further investigation. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

  6. KAROSHI (WORK TO DEATH

    Directory of Open Access Journals (Sweden)

    Moh. Toriqul Chaer

    2017-05-01

    Full Text Available When the tide of unemployment hit the USA and Europe, in Japan the opposite phenomenon occurs. In 2002, in Japan deaths were recorded because of excessive works. In this country, the phenomenon of death because of excessive works is called Karoshi. Karoshi is common in Japan.  It becomes deadly syndrome as a consequence of long hours works. The debate about deaths from excessive work already sticking out in Japan since the 70s. The first official case of Karoshi was reported in 1969 when a 29-year-old male worker died because of stroke. It is estimated over ten thousand workers died each year due to death by brain and stroke caused by an overload work. Karoshi often happen to male workers dominantly. The main cause of karoshi is stress due to high pressure in the work environment, and work habits of exceeding a  standard of normal working time (8 hours. In addition, their extra time to work is imbalance with and the salary they earn. In its development, the phenomenon of karoshi contributes to the term salaryman and workaholic.

  7. Determination of death: Metaphysical and biomedical discourse

    Directory of Open Access Journals (Sweden)

    Irayda Jakušovaitė

    2016-01-01

    Full Text Available The prominence of biomedical criteria relying on brain death reduces the impact of metaphysical, anthropological, psychosocial, cultural, religious, and legal aspects disclosing the real value and essence of human life. The aim of this literature review is to discuss metaphysical and biomedical approaches toward death and their complimentary relationship in the determination of death. A critical appraisal of theoretical and scientific evidence and legal documents supported analytical discourse. In the metaphysical discourse of death, two main questions about what human death is and how to determine the fact of death clearly separate the ontological and epistemological aspects of death. During the 20th century, various understandings of human death distinguished two different approaches toward the human: the human is a subject of activities or a subject of the human being. Extinction of the difference between the entities and the being, emphasized as rational–logical instrumentation, is not sufficient to understand death thoroughly. Biological criteria of death are associated with biological features and irreversible loss of certain cognitive capabilities. Debating on the question “Does a brain death mean death of a human being?” two approaches are considering: the body-centrist and the mind-centrist. By bridging those two alternatives human death appears not only as biomedical, but also as metaphysical phenomenon. It was summarized that a predominance of clinical criteria for determination of death in practice leads to medicalization of death and limits the holistic perspective toward individual's death. Therefore, the balance of metaphysical and biomedical approaches toward death and its determination would decrease the medicalization of the concept of death.

  8. Determination of death: Metaphysical and biomedical discourse.

    Science.gov (United States)

    Jakušovaitė, Irayda; Luneckaitė, Žydrunė; Peičius, Eimantas; Bagdonaitė, Živilė; Riklikienė, Olga; Stankevičius, Edgaras

    2016-01-01

    The prominence of biomedical criteria relying on brain death reduces the impact of metaphysical, anthropological, psychosocial, cultural, religious, and legal aspects disclosing the real value and essence of human life. The aim of this literature review is to discuss metaphysical and biomedical approaches toward death and their complimentary relationship in the determination of death. A critical appraisal of theoretical and scientific evidence and legal documents supported analytical discourse. In the metaphysical discourse of death, two main questions about what human death is and how to determine the fact of death clearly separate the ontological and epistemological aspects of death. During the 20th century, various understandings of human death distinguished two different approaches toward the human: the human is a subject of activities or a subject of the human being. Extinction of the difference between the entities and the being, emphasized as rational-logical instrumentation, is not sufficient to understand death thoroughly. Biological criteria of death are associated with biological features and irreversible loss of certain cognitive capabilities. Debating on the question "Does a brain death mean death of a human being?" two approaches are considering: the body-centrist and the mind-centrist. By bridging those two alternatives human death appears not only as biomedical, but also as metaphysical phenomenon. It was summarized that a predominance of clinical criteria for determination of death in practice leads to medicalization of death and limits the holistic perspective toward individual's death. Therefore, the balance of metaphysical and biomedical approaches toward death and its determination would decrease the medicalization of the concept of death. Copyright © 2016 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  9. Case of 24-week Fetus Delivered from Mother on Life Support with Brain-death from Suicide Attempt: Ethical Issues Associated with Severe Complications.

    Science.gov (United States)

    Nishimura, Takeshi; Kohama, Keisuke; Osako, Takaaki; Yamada, Taihei; Tanaka, Hiroyuki; Nakao, Atsunori; Kotani, Joji

    2016-10-01

    Advances in critical care medicine have made it possible to sustain vital organ systems in brain-dead patients. One clinical scenario besides donor organ retrieval in which a benefit may be gained from continuing life support is pregnancy. A pregnant woman in her late 30's at 23 weeks gestation exhibiting worsening depression was referred to the Department of Psychiatry. One day after admission she attempted suicide by hanging and suffered a cardiopulmonary arrest. A fetal heart beat and fetal motion was confirmed immediately after resuscitation. Three days after admission, an emergency Cesarean section (CS) was performed because of her unstable hemodynamic situation. The baby was born and the mother died after delivery. The baby presented neurological complications. Such a case should be managed collaboratively among professional experts in several medical teams. Consensus and recommendations for the management of similar scenarios may also be adjusted.

  10. A Favela Santa Marta e seus guias de turismo: identidade, mobilização e conflito

    Directory of Open Access Journals (Sweden)

    Gabriel Ferreira Barbosa

    2015-03-01

    Full Text Available A proposta deste artigo é descrever o processo de constituição de um mercado turístico na Favela Santa Marta e os efeitos observados no que se refere aos conflitos e consequentes mobilizações que reivindicam a legitimidade de se contar a história desse lugar. Por ter sido a primeira favela da cidade do Rio de Janeiro onde foi instalada uma Unidade de Polícia Pacificadora (UPP em dezembro de 2008[1], a Santa Marta passa a ser reconhecida como uma “favela modelo” por parte da administração pública, como se ela fosse um “laboratório” para experiências de políticas públicas. Esse processo ocorre em um contexto – notadamente os megaeventos esportivos como a Copa do Mundo FIFA 2014 e as Olimpíadas de 2016 -  em que se busca um “reencantamento” das representações sobre as favelas, mais especificamente aquelas onde as UPPs passam a fazer parte do cotidiano de seus moradores. O programa Rio Top Tour, que é a política analisada aqui, foi lançado na Favela Santa Marta, e consistiu na formação de guias turísticos locais e estímulo ao desenvolvimento de um mercado turístico. A partir da atuação desses guias e a sua mobilização para serem os legítimos portadores da narrativa sobre a história da Favela Santa Marta no âmbito do mercado turístico local, analisarei os conflitos que resultam desse processo. Antes disso, entretanto, é preciso apresentar este lugar e as mudanças que vêm ocorrendo nos últimos anos desde a instalação da UPP – que é o corte temporal proposto neste trabalho.

  11. Life and Death of a Neuron

    Science.gov (United States)

    ... order to clear debris. Hope Through Research Scientists hope that by understanding more about the life and death of neurons they can develop new ... NIH is appreciated. Patient & Caregiver Education ... Your Brain Preventing Stroke Understanding Sleep The Life and Death of a Neuron Genes At Work ...

  12. Births and deaths including fetal deaths

    Data.gov (United States)

    U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...

  13. Public appraisal of government efforts and participation intent in medico-ethical policymaking in Japan: a large scale national survey concerning brain death and organ transplant

    Science.gov (United States)

    Sato, Hajime; Akabayashi, Akira; Kai, Ichiro

    2005-01-01

    Background Public satisfaction with policy process influences the legitimacy and acceptance of policies, and conditions the future political process, especially when contending ethical value judgments are involved. On the other hand, public involvement is required if effective policy is to be developed and accepted. Methods Using the data from a large-scale national opinion survey, this study evaluates public appraisal of past government efforts to legalize organ transplant from brain-dead bodies in Japan, and examines the public's intent to participate in future policy. Results A relatively large percentage of people became aware of the issue when government actions were initiated, and many increasingly formed their own opinions on the policy in question. However, a significant number (43.3%) remained unaware of any legislative efforts, and only 26.3% of those who were aware provided positive appraisals of the policymaking process. Furthermore, a majority of respondents (61.8%) indicated unwillingness to participate in future policy discussions of bioethical issues. Multivariate analysis revealed the following factors are associated with positive appraisals of policy development: greater age; earlier opinion formation; and familiarity with donor cards. Factors associated with likelihood of future participation in policy discussion include younger age, earlier attention to the issue, and knowledge of past government efforts. Those unwilling to participate cited as their reasons that experts are more knowledgeable and that the issues are too complex. Conclusions Results of an opinion survey in Japan were presented, and a set of factors statistically associated with them were discussed. Further efforts to improve policy making process on bioethical issues are desirable. PMID:15661080

  14. Death in life or life in death? Dementia's ontological challenge.

    Science.gov (United States)

    Macdonald, Gaynor

    2018-01-01

    Is it possible to end one's life well with dementia? The perception of dementia as death brought into life flows from ideas about humanness embedded in medicine's Cartesian paradigm. Dementia as incurable brain disease exacerbates negativity. But the real impact of dementia is that it changes social relations: to live well with dementia requires a relational not Cartesian understanding of life. A relational ontology prioritizes social health: to live is to be held in connection. Negativity produces the disconnection that is death, with or without disease. When people with dementia are held in connection, they live a better life.

  15. Sistemática para avaliação da conformidade: uma proposta para uso de cão-guia

    OpenAIRE

    Brito, Joana D'Arc de

    2009-01-01

    O objetivo do presente estudo é identificar e propor quais os principais requisitos para a Avaliação dos Centros de Treinamento, de Treinadores e dos Instrutores Autônomos de cães-guia, de forma a atender o que prescreve a Lei n.º 11.126, de 27 de junho de 2005 no concernente às necessidades de adaptação dos segmentos envolvidos. Esta pesquisa foi estruturada em 3 (três) etapas. No primeiro momento utilizou-se de fontes bibliográficas para o levantamento de obras de referência para o desenvol...

  16. Report of final results regarding brain and heart tumors in Sprague-Dawley rats exposed from prenatal life until natural death to mobile phone radiofrequency field representative of a 1.8 GHz GSM base station environmental emission.

    Science.gov (United States)

    Falcioni, L; Bua, L; Tibaldi, E; Lauriola, M; De Angelis, L; Gnudi, F; Mandrioli, D; Manservigi, M; Manservisi, F; Manzoli, I; Menghetti, I; Montella, R; Panzacchi, S; Sgargi, D; Strollo, V; Vornoli, A; Belpoggi, F

    2018-08-01

    In 2011, IARC classified radiofrequency radiation (RFR) as possible human carcinogen (Group 2B). According to IARC, animals studies, as well as epidemiological ones, showed limited evidence of carcinogenicity. In 2016, the NTP published the first results of its long-term bioassays on near field RFR, reporting increased incidence of malignant glial tumors of the brain and heart Schwannoma in rats exposed to GSM - and CDMA - modulated cell phone RFR. The tumors observed in the NTP study are of the type similar to the ones observed in some epidemiological studies of cell phone users. The Ramazzini Institute (RI) performed a life-span carcinogenic study on Sprague-Dawley rats to evaluate the carcinogenic effects of RFR in the situation of far field, reproducing the environmental exposure to RFR generated by 1.8 GHz GSM antenna of the radio base stations of mobile phone. This is the largest long-term study ever performed in rats on the health effects of RFR, including 2448 animals. In this article, we reported the final results regarding brain and heart tumors. Male and female Sprague-Dawley rats were exposed from prenatal life until natural death to a 1.8 GHz GSM far field of 0, 5, 25, 50 V/m with a whole-body exposure for 19 h/day. A statistically significant increase in the incidence of heart Schwannomas was observed in treated male rats at the highest dose (50 V/m). Furthermore, an increase in the incidence of heart Schwann cells hyperplasia was observed in treated male and female rats at the highest dose (50 V/m), although this was not statistically significant. An increase in the incidence of malignant glial tumors was observed in treated female rats at the highest dose (50 V/m), although not statistically significant. The RI findings on far field exposure to RFR are consistent with and reinforce the results of the NTP study on near field exposure, as both reported an increase in the incidence of tumors of the brain and heart in RFR-exposed Sprague

  17. O simbolismo da águia na religiosidade nórdica pré-cristã e cristã

    Directory of Open Access Journals (Sweden)

    Johnni Langer

    2015-10-01

    Full Text Available Presente desde a Pré-História até o fim da Idade Média, as representações de águias no mundo nórdico assumiram diversos simbolismos religiosos. Em busca de compreender as diferentes funções deste animal em diferentes períodos, abordaremos o simbolismo da águia de forma distinta nos períodos Pré-Viking, na Era Viking e no Cristianismo da Escandinávia Medieval. Para tanto, realizaremos uma análise de diversas fontes iconográficas, arqueológicas e literárias, como jóias, monumentos e manuscritos, em um diálogo com autores clássicos — Hilda Davidson, James Graham-Campbell e Régis Boyer, por exemplo —, e com estudos atualizados de especialistas no assunto, tais como Anne-Sophie Gräslund, Jens Peter Schjødt e Kristina Jennbert. Como referenciais teóricos e metodológicos, adotamos o conceito de longa duração na abordagem de Lotte Hedeager e o conceito de símbolo para a Arqueologia das Religiões, aplicados à religiosidade nórdica.

  18. Matrix metalloproteinase 9 and cellular fibronectin plasma concentrations are predictors of the composite endpoint of length of stay and death in the intensive care unit after severe traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Copin Jean-Christophe

    2012-12-01

    Full Text Available Abstract Background The relationship between severe traumatic brain injury (TBI and blood levels of matrix metalloproteinase-9 (MMP-9 or cellular fibronectin (c-Fn has never been reported. In this study, we aimed to assess whether plasma concentrations of MMP-9 and c-Fn could have predictive values for the composite endpoint of intensive care unit (ICU length of stay (LOS of survivors and mortality after severe TBI. Secondary outcomes were the state of consciousness measured with the Glasgow Coma Scale (GCS of survivors at 14 days and Glasgow Outcome Scale Extended (GOSE at 3 months. Methods Forty-nine patients with abbreviated injury scores of the head region ≥ 4 were included. Blood was sampled at 6, 12, 24 and 48 hours after injury. MMP-9 and c-Fn concentrations were measured by ELISA. The values of MMP-9 and c-Fn, and, for comparison, the value of the GCS on the field of the accident (fGCS, as predictors of the composite outcome of ICU LOS and death were assessed by logistic regression. Results There was a linear relationship between maximal MMP-9 concentration, measured during the 6-12-hour period, and maximal c-Fn concentration, measured during the 24-48-hour period. The risk of staying longer than 9 days in the ICU or of dying was increased in patients with a maximal early MMP-9 concentration ≥ 21.6 ng/ml (OR = 5.0; 95% CI: 1.3 to 18.6; p = 0.02 or with a maximal late c-Fn concentration ≥ 7.7 μg/ml (OR = 5.4; 95% CI: 1.4 to 20.8; p = 0.01. A similar risk association was observed with fGCS ≤8 (OR, 4.4; 95% CI, 1.2-15.8; p = 0.02. No relationship was observed between MMP-9, c-Fn concentrations or fGCS and the GCS at 14 days of survivors and GOSE at 3 months. Conclusions Plasma MMP-9 and c-Fn concentrations in the first 48 hours after injury are predictive for the composite endpoint of ICU LOS and death after severe TBI but not for consciousness at 14 days and outcome at 3 months.

  19. Matrix metalloproteinase 9 and cellular fibronectin plasma concentrations are predictors of the composite endpoint of length of stay and death in the intensive care unit after severe traumatic brain injury

    Science.gov (United States)

    2012-01-01

    Background The relationship between severe traumatic brain injury (TBI) and blood levels of matrix metalloproteinase-9 (MMP-9) or cellular fibronectin (c-Fn) has never been reported. In this study, we aimed to assess whether plasma concentrations of MMP-9 and c-Fn could have predictive values for the composite endpoint of intensive care unit (ICU) length of stay (LOS) of survivors and mortality after severe TBI. Secondary outcomes were the state of consciousness measured with the Glasgow Coma Scale (GCS) of survivors at 14 days and Glasgow Outcome Scale Extended (GOSE) at 3 months. Methods Forty-nine patients with abbreviated injury scores of the head region ≥ 4 were included. Blood was sampled at 6, 12, 24 and 48 hours after injury. MMP-9 and c-Fn concentrations were measured by ELISA. The values of MMP-9 and c-Fn, and, for comparison, the value of the GCS on the field of the accident (fGCS), as predictors of the composite outcome of ICU LOS and death were assessed by logistic regression. Results There was a linear relationship between maximal MMP-9 concentration, measured during the 6-12-hour period, and maximal c-Fn concentration, measured during the 24-48-hour period. The risk of staying longer than 9 days in the ICU or of dying was increased in patients with a maximal early MMP-9 concentration ≥ 21.6 ng/ml (OR = 5.0; 95% CI: 1.3 to 18.6; p = 0.02) or with a maximal late c-Fn concentration ≥ 7.7 μg/ml (OR = 5.4; 95% CI: 1.4 to 20.8; p = 0.01). A similar risk association was observed with fGCS ≤8 (OR, 4.4; 95% CI, 1.2-15.8; p = 0.02). No relationship was observed between MMP-9, c-Fn concentrations or fGCS and the GCS at 14 days of survivors and GOSE at 3 months. Conclusions Plasma MMP-9 and c-Fn concentrations in the first 48 hours after injury are predictive for the composite endpoint of ICU LOS and death after severe TBI but not for consciousness at 14 days and outcome at 3 months. PMID:23249478

  20. Causes of death among cancer patients.

    Science.gov (United States)

    Zaorsky, N G; Churilla, T M; Egleston, B L; Fisher, S G; Ridge, J A; Horwitz, E M; Meyer, J E

    2017-02-01

    The purpose of our study was to characterize the causes of death among cancer patients as a function of objectives: (i) calendar year, (ii) patient age, and (iii) time after diagnosis. US death certificate data in Surveillance, Epidemiology, and End Results Stat 8.2.1 were used to categorize cancer patient death as being due to index-cancer, nonindex-cancer, and noncancer cause from 1973 to 2012. In addition, data were characterized with standardized mortality ratios (SMRs), which provide the relative risk of death compared with all persons. The greatest relative decrease in index-cancer death (generally from > 60% to deaths were stable (typically >40%) among patients with cancers of the liver, pancreas, esophagus, and lung, and brain. Noncancer causes of death were highest in patients with cancers of the colorectum, bladder, kidney, endometrium, breast, prostate, testis; >40% of deaths from heart disease. The highest SMRs were from nonbacterial infections, particularly among 1,000 for lymphomas, P death from index- and nonindex-cancers varies widely among primary sites. Risk of noncancer deaths now surpasses that of cancer deaths, particularly for young patients in the year after diagnosis. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  1. O encontro entre o desenvolvimento rural sustentável e a promoção da saúde no Guia Alimentar para a População Brasileira

    OpenAIRE

    Oliveira, Nádia Rosana Fernandes de; Jaime, Patricia Constante

    2016-01-01

    Resumo O Guia Alimentar é documento que aborda os princípios e as recomendações de uma alimentação adequada e saudável para a população brasileira, tendo como propósito apoiar a educação alimentar e nutricional e subsidiar políticas e programas nacionais de alimentação e nutrição no setor de saúde e também em outros setores. O objetivo deste estudo foi identificar a interseção entre a promoção da saúde e o desenvolvimento rural sustentável no Guia Alimentar para a População Brasileira. Realiz...

  2. Desempenho de modelos de calibração de guias de onda acopladas a TDR e a multiplexadores em três tipos de solos Performance of calibration models for TDR and multiplexer - connected waveguides in three soil types

    Directory of Open Access Journals (Sweden)

    Eugenio Ferreira Coelho

    2006-02-01

    Full Text Available O trabalho teve como objetivo avaliar modelos de calibração para dois tipos de guias de onda de TDR, referentes a dois equipamentos (Trase System e TDR 100, acopladas diretamente ao analisador de umidade ou a multiplexadores. Amostras de três tipos de solo foram acondicionadas em segmentos de tubos de PVC e saturadas. Dois tipos de guias de onda de três hastes, com capacitor e com resistor foram inseridas dentro de cada segmento de tubo com solo e conectadas a dois equipamentos de TDR, diretamente no testador de cabos ou via multiplexadores. Dados de umidade obtidos por gravimetria e da constante dielétrica foram tomados em cada coluna durante a secagem do solo da saturação até umidades próximas do limite inferior de disponibilidade de água por meio de leituras com as guias de onda conectadas ao testador de cabos e conectadas ao multiplexador. Um modelo polinomial cúbico foi ajustado aos dados da constante dielétrica do solo (épsilon e da correspondente umidade (teta e cinco modelos de determinação de q em função de e foram testados quanto ao desempenho. Os resultados mostraram que não houve diferença significativa na calibração das guias de onda com capacitor para uso com a TDR Trase System, considerando a conexão das guias ao analisador de umidade ou a multiplexadores. No caso da TDR 100, as guias de onda com resistor devem ser calibradas conforme o seu uso. O modelo cúbico foi o de melhor desempenho seguido pelo modelo de Roth que estimou, com boa exatidão, os valores da constante dielétrica e da umidade com a mais próximo de 0,5 para as guias de onda com capacitor que com as guias com resistor.The study aimed at evaluating of calibration models for two kinds of TDR waveguides used with Trase System and TDR 100 equipments linked to the cable tester or the multiplexer. Disturbed samples of three soils were packed in PVC columns and, after soil saturation, two TDR waveguides of three rods with capacitor and with

  3. J.S.Bach variações "Goldberg" : um guia para a formação do homem completo

    OpenAIRE

    Helena Jank

    1988-01-01

    Resumo: Dentre muitas formas possíveis de abordagem para esta obra monumental de J. S. Bach, o presente trabalho traz um enfoque eminentemente humanístico, através do qual transparece a intenção do compositor de estruturar, na forma de tema e variações um ?guia para a formação do homem completo? Esta intenção se manifesta na organização geral da obra, com uma clara divisão em três grupos de variações, nos quais são explorados aspectos técnicos, composicionais e de interpretação. Com base na ...

  4. INTER-RELAÇÃO DA FERRAMENTA APQP E DO GUIA PMBOK PARA EFICIÊNCIA NAS ETAPAS DE IMPLEMENTAÇÃO DE NOVOS PROJETOS NA INDÚSTRIA AUTOMOTIVA

    Directory of Open Access Journals (Sweden)

    Jean Cristhiano Franco

    2014-06-01

    Full Text Available O desenvolvimento de novos projetos na industria automotiva apresenta-se como um projeto de grande porte, regido por metodologias, guias e ferramentas estruturadas que visam garantir a eficácia do projeto. Esta pesquisa foi desenvolvida com o intuito de contribuir para um maior entendimento entre a ferramenta APQP, de grande aplicação na industria automotiva, e o guia PMBOK, considerado referência no gerenciamento de projetos. Neste âmbito, este estudo realiza uma análise comparativa entre suas principais características, identificando suas semelhanças e divergências. Dentre os diversos resultados do estudo, é possível identificar que o guia PMBOK é mais completo que a ferramenta APQP utilizada no setor automobilístico, uma vez que traz de forma mais detalhada as etapas e as técnicas que são indicadas nas atividades, segundo as boas práticas dos PMPs (Project Management Professional.

  5. Epidemiological features of brain tumors

    OpenAIRE

    Živković Nenad; Mihailović Goran; Marković Marko; Berisavac Iva; Spaić Milan

    2013-01-01

    Brain tumors account for 1.4% of all cancers and 2.4% of all cancer-related deaths. The incidence of brain tumors varies and it is higher in developed countries of Western Europe, North America, Australia and New Zealand. In Serbia, according to data from 2009, malignant brain tumors account for 2. 2 of all tumors, and from all cancer­related deaths, 3.2% is caused by malignant brain tumors. According to recent statistical reports, an overall incidence of b...

  6. Value of Combining Left Atrial Diameter and Amino-terminal Pro-brain Natriuretic Peptide to the CHA2DS2-VASc Score for Predicting Stroke and Death in Patients with Sick Sinus Syndrome after Pacemaker Implantation

    Directory of Open Access Journals (Sweden)

    Bin-Feng Mo

    2017-01-01

    Conclusions: CHA2DS2-VASc score is valuable for predicting stroke and death risk in patients with SSS after pacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.

  7. Has evolution 'prepared' us to deal with death ...

    African Journals Online (AJOL)

    Has evolution 'prepared' us to deal with death? ... brain with its enlarged Broca's area suggests the possibility of a sophisticated communication system and an enhanced way of dealing with emotion. ... Some attention is given to this thesis.

  8. National Death Index

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Death Index (NDI) is a centralized database of death record information on file in state vital statistics offices. Working with these state offices, the...

  9. God's dominion over death.

    Science.gov (United States)

    Schulling, Sharon

    2012-01-01

    This article briefly overviews the criteria for and physiological process of death, contrasting physical death with biblical passages revealing how God interceded in this universal process when Jesus was on earth.

  10. Identity after Death

    DEFF Research Database (Denmark)

    Gerstrøm, Anna

    2015-01-01

    Purpose: The purpose of this paper is to explore how legacy organizational identity and death relate to each other and, thereby, contribute to closing the gap in knowledge on organizational identity constructions in times of death. Design/methodology/approach: The paper opted for an exploratory....../value: This paper addresses an apparent gap in the literature on identity and death; exploring identity narratives in a bankrupted bank, the paper considers constructions of legacy organizational identities in times of disruptive death....

  11. Número e espaçamento entre hastes de guia de onda para medida da umidade do solo com TDR Number and spacing between wave guide rods for measurement of soil water content with TDR

    Directory of Open Access Journals (Sweden)

    Eugênio F. Coelho

    2003-08-01

    Full Text Available Com este trabalho, objetivou-se avaliar o desempenho de diferentes modelos matemáticos para ajuste dos dados de umidade, em função da constante dielétrica aparente do solo, e a viabilidade de uso de guias de onda de duas e três hastes, com diferentes espaçamentos. Amostras de solo deformadas foram acondicionadas em segmentos de tubos de PVC de 0,075 m de diâmetro. Construíram-se 24 guias de onda com capacitor e 24 guias de onda sem capacitor, sendo que, para cada tipo, 12 guias de onda de duas hastes e 12 de três hastes, com espaçamento entre hastes de 0,009 a 0,022 m, de impedâncias previamente determinadas, foram inseridas no solo, após a saturação em cada segmento de tubo. Dados de umidade do solo determinados por gravimetria e da constante dielétrica aparente obtidos pelo analisador Trase System, foram tomados em cada recipiente durante a secagem do solo de 0,31 a 0,13 m³ m-3. Cinco modelos matemáticos foram ajustados aos dados de umidade em função da correspondente constante dielétrica aparente do solo e o efeito dos modelos na obtenção da umidade do solo, em função da constante dielétrica aparente, foi avaliado estatisticamente. O modelo de Malicki foi o de melhor ajuste dos dados da constante dielétrica aparente, em função da umidade do solo. As guias de onda de três hastes, de diâmetro 0,003 m, comprimento 0,15 m, com espaçamentos entre hastes de 0,017 m, foram as de melhor desempenho, enquanto as guias de onda de três hastes sem capacitor indicaram melhor desempenho na determinação da umidade do solo, comparadas com as de duas hastes sem capacitor. As guias de onda de três hastes sem capacitor apresentaram melhor desempenho na determinação da umidade do solo que as de três hastes com capacitor.The objective of this study was to evaluate the performance of different mathematical models to adjust the humidity data as a function of the apparent dielectric constant of the soil and to evaluate the

  12. Sudden death victims

    NARCIS (Netherlands)

    Ceelen, Manon; van der Werf, Christian; Hendrix, Anneke; Naujocks, Tatjana; Woonink, Frits; de Vries, Philip; van der Wal, Allard; Das, Kees

    2015-01-01

    The goal of this study was to ascertain accordance between cause of death established by the forensic physician and autopsy results in young sudden death victims in the Netherlands. Sudden death victims aged 1-45 years examined by forensic physicians operating in the participating regions which also

  13. Death and Grief

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Death and Grief KidsHealth / For Teens / Death and Grief What's in this article? What Is ... the reaction we have in response to a death or loss. Grief can affect our body, mind, ...

  14. Pediatric brain tumors

    Energy Technology Data Exchange (ETDEWEB)

    Poussaint, Tina Y. [Department of Radiology, Boston, MA (United States); Panigrahy, Ashok [Children' s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Huisman, Thierry A.G.M. [Charlotte R. Bloomberg Children' s Center, Johns Hopkins Hospital, Division of Pediatric Radiology and Pediatric Neuroradiology, Baltimore, MD (United States)

    2015-09-15

    Among all causes of death in children from solid tumors, pediatric brain tumors are the most common. This article includes an overview of a subset of infratentorial and supratentorial tumors with a focus on tumor imaging features and molecular advances and treatments of these tumors. Key to understanding the imaging features of brain tumors is a firm grasp of other disease processes that can mimic tumor on imaging. We also review imaging features of a common subset of tumor mimics. (orig.)

  15. Acute brain herniation from lead toxicity.

    Science.gov (United States)

    Berkowitz, Sheldon; Tarrago, Rod

    2006-12-01

    A 4-year-old black boy was admitted to the hospital with vomiting, low-grade fever, and dehydration that were thought to be caused by viral gastroenteritis. He proceeded over the next 12 hours to rapidly deteriorate with brain herniation leading to brain death. The ultimate cause of death was found to be acute lead intoxication from a swallowed foreign body.

  16. Eyelid closure at death

    Directory of Open Access Journals (Sweden)

    A D Macleod

    2009-01-01

    Full Text Available Aim: To observe the incidence of full or partial eyelid closure at death. Materials and Methods: The presence of ptosis was recorded in 100 consecutive hospice patient deaths. Results: Majority (63% of the patients died with their eyes fully closed, however, 37% had bilateral ptosis at death, with incomplete eye closure. In this study, central nervous system tumor involvement and/or acute hepatic encephalopathy appeared to be pre-mortem risk factors of bilateral ptosis at death. Conclusion: Organicity and not psychogenicity is, therefore, the likely etiology of failure of full eyelid closure at death.

  17. Neumonia adquirida en la comunidad: guia practica elaborada por un comite intersociedades

    Directory of Open Access Journals (Sweden)

    C. M. Luna

    2003-08-01

    .Clinical practice guidelines for community-acquired pneumonia (CAP contribute to improve patient's management. CAP undergoes continuous changes in etiology, epidemiology and antimicrobial sensitivity, requiring periodic guidelines revisions. An inter-society committee designed this guidelines dividing it into several topics based on prior guidelines and recent clinical studies. CAP compromises annually more than 1% of the population; most of the cases only require outpatient care but others are severe cases, reaching the 6th cause of death in Argentina. The cases are distributed unevenly into ambulatory, admitted in the general ward or in the intensive care unit. There is no way to predict the etiology. Unfavorable outcome predictors include age, antecedents and physical, laboratory and radiography findings. Ten to 25% of inpatients need to be admitted to the intensive care unit at the onset or during the follow-up, for mechanical ventilation or hemodynamic support (severe CAP. Severe CAP is associated with high mortality and requires adequate and urgent therapy. Pregnant, COPD and nursing home patients require special recommendations. Diagnosis is clinical, while complementary methods are useful to define etiology and severity; chest X-ray is the only one universally recommended. Other studies, including microbiologic evaluation are particularly appropriate in the hospitalized patients. The initial therapy is empiric, it must begin early, using antimicrobials active against the target microorganisms, avoiding their inappropriate use which can lead to the development of resistance. Length of therapy must not be unnecessarily prolonged. Hydratation, nutrition, oxygen and therapy of complications must complement antibiotic treatment. Prevention is based on influenza prophylaxis, anti-pneumococcal vaccine, aspiration prevention and other general measures.

  18. Neural dynamics during anoxia and the "wave of death"

    NARCIS (Netherlands)

    Zandt, Bas-Jan; Zandt, B.; ten Haken, Bernard; van Dijk, J. Gert; van Putten, Michel Johannes Antonius Maria

    2011-01-01

    Recent experiments in rats have shown the occurrence of a high amplitude slow brain wave in the EEG approximately 1 minute after decapitation, with a duration of 5–15 s (van Rijn et al, PLoS One 6, e16514, 2011) that was presumed to signify the death of brain neurons. We present a computational

  19. Efetividade da sondagem pós-pilórica usando guia magnético Effectiveness of post-pyloric tube placement using magnetic guidance

    Directory of Open Access Journals (Sweden)

    Renata Andrea Pietro Pereira Viana

    2011-03-01

    Full Text Available OBJETIVOS: Suporte nutricional adequado tem papel importante na evolução de pacientes graves. Entretanto, significativa porcentagem destes pacientes evolui com dismotilidade intestinal, provocando alto volume gástrico residual. A administração de dieta enteral através de sonda em posição pós-pilórica tem sido sugerida como método para melhorar a tolerância. Objetivo deste estudo foi comparar a taxa de sucesso no posicionamento pós-pilórico da sonda nasoenteral por utilização de equipamento, que permite acompanhar a progressão da sonda através da visualização por transmissão eletromagnética em tempo real, em comparação com o método tradicional. MÉTODOS: Estudo prospectivo, randomizado, controlado, realizado em um hospital terciário durante três meses. Os pacientes foram randomizados para dois grupos: grupo com guia eletromagnético, pacientes submetidos à passagem de sonda nasoenteral sob auxilio do aparelho com visualização em tempo real e transmissão magnética e grupo convencional, passagem de sonda nasoenteral às cegas. O sucesso no posicionamento pós-pilórico e o tempo de duração do procedimento foram avaliados entre os grupos. RESULTADOS: Foram incluídos no estudo 37 pacientes, sendo 18 do grupo com guia eletromagnético e 19 do grupo convencional. A localização da sonda por meio da radiografia mostrou que o grupo com guia eletromagnético apresentou mais posicionamento pós-pilorico do que o grupo convencional, com menor tempo para realização do procedimento, com maior valor do pH do líquido aspirado pela sonda. CONCLUSÕES: O método de passagem e visualização a beira leito por transmissão eletromagnética garante de forma segura a monitorização e acurácia frente à sondagem nasoenteral.OBJECTIVE: Appropriate nutritional support is important to the outcomes of critically ill patients. However, a significant portion of these patients experience intestinal motility problems. Administration of

  20. The debate about death: an imperishable discussion?

    Directory of Open Access Journals (Sweden)

    FÉLIX BACIGALUPO

    2007-01-01

    Full Text Available In this concise review we discuss some of the complex edges of the concept of death that arose after the notorious advances in science and medicine over the last 50 years, in which the classical cardio-pulmonary criteria have led to the neurological criteria of death. New complicated questions like the definition of death and the operational criteria for diagnosing it have arisen and we think that they are far from being adequately and satisfactorily solved. A number of important issues -like the reliability and differences between cardio-pulmonary versus brain based criteria of death, if death is an event or a process, the meaning of integration and irreversibility- have not yet received sufficient attention. Here we have approached the death problem from two (biological complex system perspectives: the organism level and the cellular-molecular level. We also discuss issues from a third systemic approach, that is, the entire society, thus involving legal, religious, bioethical and political aspects of death. Our aim is to integrate new perspectives in order to promote further discussion on these critical yet frequently neglected issues

  1. Existential Concerns About Death

    DEFF Research Database (Denmark)

    Moestrup, Lene; Hansen, Helle Ploug

    2015-01-01

    psychology or Kübler-Ross’ theory about death stages. The complex concerns might be explained using Martin Heidegger’s phenomenological thinking. We aimed to illuminate dying patients´ existential concerns about the impending death through a descriptive analysis of semi-structured interviews with 17 cancer...... patients in Danish hospices. The main findings demonstrated how the patients faced the forthcoming death without being anxious of death but sorrowful about leaving life. Furthermore, patients expressed that they avoided thinking about death. However, some had reconstructed specific and positive ideas about...... afterlife and made accurate decisions for practical aspects of their death. The patients wished to focus on positive aspects in their daily life at hospice. It hereby seems important to have ongoing reflections and to include different theoretical perspectives when providing existential support to dying...

  2. Sudden Infant Death Syndrome (SIDS)

    Science.gov (United States)

    Sudden infant death syndrome (SIDS) Overview Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a seemingly healthy baby ... year old. SIDS is sometimes known as crib death because the infants often die in their cribs. ...

  3. Conscience in health care and the definitions of death.

    Science.gov (United States)

    Kato, Yutaka

    2013-02-01

    Brain death or neurologic death has gradually become recognized as human death over the past decades worldwide. Nevertheless, in Japan, the New York State, and the State of New Jersey, death is declared based not on brain death criteria, but on cardio-pulmonary criteria. In Japan, the 1997 Organ Transplant Law legalized brain death determination exclusively when organs were to be procured from brain-dead patients. Even after 2009 law revision, the default definition of death continued to be based on cardio-pulmonary criteria, despite the criticism. The cases of Japan and the United States provide a good reference as social experiments of appreciating conscientious or religio-cultural dimensions in health care. This text theoretically examines the 1997 organ transplant law of Japan and its 2009 revision, presenting some characteristics of Japan's case compared to American cases and the implications its approach has for the rest of the world. This is an example in which a foreign idea that did not receive widespread support from Japanese citizens was transformed to fit the religio-cultural landscape.

  4. Brain herniation

    Science.gov (United States)

    ... herniation; Uncal herniation; Subfalcine herniation; Tonsillar herniation; Herniation - brain ... Brain herniation occurs when something inside the skull produces pressure that moves brain tissues. This is most ...

  5. Programmed cell death

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-12-31

    The purpose of this conference to provide a multidisciplinary forum for exchange of state-of-the-art information on the role programmed cell death plays in normal development and homeostasis of many organisms. This volume contains abstracts of papers in the following areas: invertebrate development; immunology/neurology; bcl-2 family; biochemistry; programmed cell death in viruses; oncogenesis; vertebrate development; and diseases.

  6. Guia de instituciones ambientales

    NARCIS (Netherlands)

    2001-01-01

    textabstractEl Gobierno Municipal reconociendo la labor de las instituciones que desarrollan trabajos a favor de nuestra ciudad y áreas rurales para salvaguardar el medio ambiente, a liderizado un proceso de planificación participativa y estratégica del cual resulto como producto el plan de

  7. Sudden cardiac death

    Directory of Open Access Journals (Sweden)

    Neeraj Parakh

    2015-01-01

    Full Text Available Sudden cardiac death is one of the most common cause of mortality worldwide. Despite significant advances in the medical science, there is little improvement in the sudden cardiac death related mortality. Coronary artery disease is the most common etiology behind sudden cardiac death, in the above 40 years population. Even in the apparently healthy population, there is a small percentage of patients dying from sudden cardiac death. Given the large denominator, this small percentage contributes to the largest burden of sudden cardiac death. Identification of this at risk group among the apparently healthy individual is a great challenge for the medical fraternity. This article looks into the causes and methods of preventing SCD and at some of the Indian data. Details of Brugada syndrome, Long QT syndrome, Genetics of SCD are discussed. Recent guidelines on many of these causes are summarised.

  8. Death with dignity

    Science.gov (United States)

    Allmark, P.

    2002-01-01

    The purpose of this article is to develop a conception of death with dignity and to examine whether it is vulnerable to the sort of criticisms that have been made of other conceptions. In this conception "death" is taken to apply to the process of dying; "dignity" is taken to be something that attaches to people because of their personal qualities. In particular, someone lives with dignity if they live well (in accordance with reason, as Aristotle would see it). It follows that health care professionals cannot confer on patients either dignity or death with dignity. They can, however, attempt to ensure that the patient dies without indignity. Indignities are affronts to human dignity, and include such things as serious pain and the exclusion of patients from involvement in decisions about their lives and deaths. This fairly modest conception of death with dignity avoids the traps of being overly subjective or of viewing the sick and helpless as "undignified". PMID:12161582

  9. A cidade desejada e sublimada por Jorge Amado: os lugares imaginados em Bahia de Todos-os- Santos: guia de ruas e mistérios de Salvador

    Directory of Open Access Journals (Sweden)

    Ricardo Araújo Barberena

    2013-01-01

    Full Text Available The book Bahia de Todos-os-santos: guia de ruas e mistérios de Salvador (Bahia of all-saints: a guide to the streets and mysteries of Salvador, by Jorge Amado (published in 1944, portrays an easygoing and provincial capital of Bahia. The population, which was less than 300 thousand people, moved about in the different celebrations of life. Due to profound urban transformations, the book underwent alterations in the different versions published through the years. However, the underlying structure and the spirit of the book have remained: the production of an encyclopedia of what it means to be/being “baiano” – sceneries, stories, old streets, new avenues, traditions, parties, poverty, joy, churches, candomblé, orishas, and other characters. In its pages, the book presents a real and magical image of a territory permeated by ordinary mysteries. The book has maintained its essence throughout the different editions. Even if the city has changed physically, it remains unchanged in terms of its poetic prose and in the production of a sublime descriptivism of a “black Rome.”

  10. Medical response guide for the initial phase of a radiological emergency; Guia para la respuesta medica en la fase inicial de una emergencia radiologica

    Energy Technology Data Exchange (ETDEWEB)

    Vazquez, Marina A; Perez, Maria del R

    2007-07-01

    In case of a sanitary emergency, the local community and its health care system are the first aid providers. Therefore, preparedness through education and training programs would allow emergency systems to provide an appropriate first medical response. The main objective of this guide is to give basic guidelines for the medical response management after situations involving radioactive materials, in an easy and simple way. The information contained in this guide is addressed to health care personnel of any local assistance center. (author) [Spanish] Las emergencias que afecten a un numero importante de personas y que tengan como protagonistas agentes 'no convencionales' como lo son las radiaciones ionizantes, deben ser abordadas mediante la implementacion de programas sanitarios especiales. En una situacion de emergencia, generalmente los primeros en proporcionar la ayuda, son la comunidad local y su sistema de salud. Por ello la preparacion previa local, a traves de la capacitacion y el entrenamiento permitira brindar una respuesta inicial adecuada que se articule con un sistema de respuesta en emergencias escalonado y de complejidad creciente. Esto requiere la participacion de las autoridades de salud en cada uno de los niveles de atencion, asi como apoyo de otros sectores para desarrollar sus planes de preparacion y respuesta. La presente guia, como instrumento de capacitacion, tiene como objetivo primario brindar las herramientas basicas para el manejo de la respuesta medica en una situacion de emergencia que involucre material radiactivo, en un lenguaje claro y sencillo, dirigida al personal de salud de todos los centros asistenciales locales. (autor)

  11. Methodology of ABNT ISO/IEC GUIA 25 implantation in the laboratories of radionuclides analysis in environmental samples of the Analysis Division/CNEN

    International Nuclear Information System (INIS)

    Oliveira, Josue Peter de

    1997-07-01

    The ISO/EEC Guide 25: 1993 Standard G eneral requirements for the competence of calibration and testing laboratories . Is published in Brazil by Brazilian Association for Technical Standards (ABNT) as ABNT ISO/DEC GUIA 25 and establishes general requirements a laboratory must demonstrate to meet, in order to be recognized as having technical competence (accreditation) to carry out specifics calibration or testing. Therefore, the accredited laboratory starts, respectively, taking part from the Brazilian Calibration Network (RBC) or from the Brazilian Testing Laboratories Network (RBLE) . The Environmental Radioanalysis Division (DIAMB) from Environmental Radiological Protection Department (DEPRA) from Institute of Radiation Protection and Dosimetry (IRD) from Brazilian National Nuclear Energy Commission (CNEN) is a laboratory responsible for analyzing radionuclides deriving for the samples from DEPRA's Surveillance Program, research and servings, due to an eventual radionuclide contamination in environment, foods and others raw materials for human consumption; including for importation and exportation products certification purposes. For all these reasons, DIAMB needs its formal recognition for carrying out radionuclides analysis in environmental samples. This work aims to provide a methodology in order to guide a laboratory which has the intention to implement a accreditation process. It also describes policies to meet the requirements related to the Standard, guidance needed to specification of some steps and also comments some points from the Standard in order to become easier all the accreditation process comprehension. (author)

  12. A ECONOMIA DA EXPERIÊNCIA APLICADA A WEBSITES: uma análise dos restaurantes premiados pelo Guia Michelin na cidade de São Paulo (BRA

    Directory of Open Access Journals (Sweden)

    Pedro Henrique Drudi

    2017-09-01

    Full Text Available Este artigo tem como objetivo propor uma análise de experiência em restaurantes através de websites. Para tanto busca-se fazer uma conexão entre as esferas da experiência propostas por Pine II e Gilmore (1999 a partir da adaptação do roteiro de experiência física em restaurantes desenvolvido por Gimenes, Fraiz e Gândara (2012 para o universo virtual. A aplicação do modelo adaptado foi testada nos treze restaurantes da cidade de São Paulo contemplados com estrelas na edição de 2016 do Guia Michelin Brasil – São Paulo e Rio de Janeiro. Dentre os principais resultados verificou-se que os websites conseguem, com sucesso, materializar a proposta da casa e antecipar a experiência que será vivenciada in loco. Contudo, verifica-se algumas lacunas informativas, bem como o pouco uso, por parte de alguns websites, de recursos interativos que poderiam enriquecer a experiência de navegação.

  13. Dietary recommendations: comparing dietary guidelines from Brazil and the United States Recomendações dietéticas: comparação entre os guias alimentares brasileiro e americano

    Directory of Open Access Journals (Sweden)

    Rosely Sichieri

    2010-11-01

    Full Text Available The Brazilian dietary guidelines are based in part on mainstream United States' recommendations, in spite of the criticisms and shortcomings of the American guidelines. In this paper, Brazilian food guidelines are summarized and discussed in comparison with the USA recommendations. American and Brazilian dietary recommendations are quite similar in many aspects, particularly those related to variety in the diet, the importance of physical activity and weight management. Different to American guidelines, those from Brazil advise people to choose fresh foods, to prefer healthier types of fat, to limit trans fat intake and to eat good sources of protein, but does not recommend the consumption of whole grains. Besides the challenges related to their implementation, indicators for the evaluation of the effectiveness of these guidelines should be established from the beginning, particularly those related to changes in dietary habits and the prevalence of obesity.O guia alimentar brasileiro é baseado parcialmente nas recomendações americanas a despeito das críticas e problemas identificados no documento dos Estados Unidos. Neste artigo, as recomendações alimentares para o Brasil são resumidas e discutidas em comparação com as recomendações estadunidenses. Os guias alimentares brasileiro e americano são bastante similares em diversos aspectos, particularmente aqueles relacionados com a variação da dieta, a importância da atividade física e o gerenciamento do peso. Diferentemente dos Estados Unidos, o guia brasileiro estimula o consumo de alimentos frescos, aconselha o uso de fontes saudáveis de gorduras, a limitação do consumo de gordura trans, o consumo de boas fontes de proteínas, mas não indica o consumo de grãos integrais. Além dos desafios relacionados com a sua implantação, os indicadores para a avaliação da eficácia dos guias alimentares devem ser estabelecidos desde sua implantação, particularmente, os relacionados

  14. Death and consciousness--an overview of the mental and cognitive experience of death.

    Science.gov (United States)

    Parnia, Sam

    2014-11-01

    Advances in resuscitation science have indicated that, contrary to perception, death by cardiorespiratory criteria can no longer be considered a specific moment but rather a potentially reversible process that occurs after any severe illness or accident causes the heart, lungs, and brain to stop functioning. The resultant loss of vital signs of life (and life processes) is used to declare a specific time of death by physicians globally. When medical attempts are made to reverse this process, it is commonly referred to as cardiac arrest; however, when these attempts do not succeed or when attempts are not made, it is called death by cardiorespiratory criteria. Thus, biologically speaking, cardiac arrest and death by cardiorespiratory criteria are synonymous. While resuscitation science has provided novel opportunities to reverse death by cardiorespiratory criteria and treat the potentially devastating consequences of the resultant postresuscitation syndrome, it has also inadvertently provided intriguing insights into the likely mental and cognitive experience of death. Recollections reported by millions of people in relation to death, so-called out-of-body experiences (OBEs) or near-death experiences (NDEs), are often-discussed phenomena that are frequently considered hallucinatory or illusory in nature; however, objective studies on these experiences are limited. To date, many consistent themes corresponding to the likely experience of death have emerged, and studies have indicated that the scientifically imprecise terms of NDE and OBE may not be sufficient to describe the actual experience of death. While much remains to be discovered, the recalled experience surrounding death merits a genuine scientific investigation without prejudice. © 2014 New York Academy of Sciences.

  15. The role of 12/15-lipoxygenases in ROS-mediated neuronal cell death

    OpenAIRE

    Tobaben, Svenja

    2011-01-01

    Oxidative stress has been established as a key trigger of neuronal dysfunction and death in age-related neurodegenerative diseases and in delayed neuronal death after acute brain injury by ischemic stroke or brain trauma. Despite increasing knowledge on the toxicity of reactive oxygen species (ROS) and oxidized reaction products that may further accelerate neuronal cell death, the major sources of ROS formation and the mechanisms ...

  16. Suicide on Death Row.

    Science.gov (United States)

    Tartaro, Christine; Lester, David

    2016-11-01

    Despite the level of supervision of inmates on death row, their suicide rate is higher than both the male prison population in the United States and the population of males over the age of 14 in free society. This study presents suicide data for death row inmates from 1978 through 2010. For the years 1978 through 2010, suicide rates on death row were higher than that for the general population of males over the age of 15 and for state prisons for all but 2 years. © 2016 American Academy of Forensic Sciences.

  17. Hitler's Death Camps.

    Science.gov (United States)

    Wieser, Paul

    1995-01-01

    Presents a high school lesson on Hitler's death camps and the widespread policy of brutality and oppression against European Jews. Includes student objectives, instructional procedures, and a chart listing the value of used clothing taken from the Jews. (CFR)

  18. Complications and Deaths - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Complications and deaths - state data. This data set includes state-level data for the hip/knee complication measure, the Agency for Healthcare Research and Quality...

  19. Eighth Amendment & Death Penalty.

    Science.gov (United States)

    Shortall, Joseph M.; Merrill, Denise W.

    1987-01-01

    Presents a lesson on capital punishment for juveniles based on three hypothetical cases. The goal of the lesson is to have students understand the complexities of decisions regarding the death penalty for juveniles. (JDH)

  20. Sudden Cardiac Death

    DEFF Research Database (Denmark)

    Risgaard, Bjarke; Winkel, Bo Gregers; Jabbari, Reza

    2017-01-01

    Objectives This study sought to describe the use of pharmacotherapy in a nationwide cohort of young patients with sudden cardiac death (SCD). Background Several drugs have been associated with an increased risk of SCD and sudden arrhythmic death syndrome (SADS). It remains unclear how...... pharmacotherapy may contribute to the overall burden of SCD in the general population. Methods This was a nationwide study that included all deaths that occurred between 2000 and 2009 and between 2007 and 2009 in people age 1 to 35 years and 36 to 49 years, respectively. Two physicians identified all SCDs through...... review of death certificates. Autopsy reports were collected. Pharmacotherapy prescribed within 90 days before SCD was identified in the Danish Registry of Medicinal Product Statistics. Results We identified 1,363 SCDs; median age was 38 years (interquartile range: 29 to 45 years), and 72% (n = 975) were men...

  1. Complications and Deaths - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Complications and deaths - state data. This data set includes state-level data for the hip/knee complication measure, the CMS Patient Safety Indicators, and 30-day...

  2. Existential concerns about death

    DEFF Research Database (Denmark)

    Moestrup, Lene

    2014-01-01

    Background Research suggests that addressing dying patients’ existential concerns can help improve their quality of life. Common existential conditions, such as a search for meaning and considerations about faith, are probably intensified in a palliative setting and existential concerns about death...... are likewise intensified when patients face their impending death. Knowledge of modern, secular existential concerns about death is under-researched, and therefore, it is difficult to develop and implement specifically targeted support to dying patients. Aim The aim of this paper is to present the results from...... a qualitative field study illuminating the variety of dying patients´ existential concerns about their impending death. Method Data was generated through ethnographic fieldwork comprising 17 semi-structured interviews with dying patients and 38 days of participant observation at three Danish hospices. Results...

  3. Life not death

    DEFF Research Database (Denmark)

    Milner, George R.; Boldsen, Jesper L.

    2017-01-01

    Analytically sophisticated paleoepidemiology is a relatively new development in the characterization of past life experiences. It is based on sound paleopathological observations, accurate age-at-death estimates, an explicit engagement with the nature of mortality samples, and analytical procedures...

  4. Complications and Deaths - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Complications and deaths - provider data. This data set includes provider data for the hip/knee complication measure, CMS Patient Safety Indicators of serious...

  5. Complications and Deaths - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Complications and deaths - national data. This data set includes national-level data for the hip/knee complication measure, the CMS Patient Safety Indicators, and...

  6. [The concept of death in the revised Organ Transplant Law in Japan].

    Science.gov (United States)

    Ida, Makoto

    2010-12-01

    The Organ Transplant Law of Japan, enacted in 1997, did not allow organs to be taken from a brain-dead person unless he or she left written consent. The concept of brain death was controversial. It was a product of compromise that a brain-dead person could be recognized as dead only if he/she had given consent to allow organs to be taken in the event of brain death. This law was revised in 2009. It became possible to take organs from a brain-dead person with the consent of the patient's family, even if the wishes of the person who died were not clear. This revision, which took effect in July 2010, also legalizes the removal of organs from brain-dead children under the age of 15. The author of this article considers whether and how the legal definition of brain death was changed through this revision.

  7. CDC WONDER: Mortality - Infant Deaths

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Mortality - Infant Deaths (from Linked Birth / Infant Death Records) online databases on CDC WONDER provide counts and rates for deaths of children under 1 year...

  8. Donations After Circulatory Death in Liver Transplant.

    Science.gov (United States)

    Eren, Emre A; Latchana, Nicholas; Beal, Eliza; Hayes, Don; Whitson, Bryan; Black, Sylvester M

    2016-10-01

    The supply of liver grafts for treatment of end-stage liver disease continues to fall short of ongoing demands. Currently, most liver transplants originate from donations after brain death. Enhanced utilization of the present resources is prudent to address the needs of the population. Donation after circulatory or cardiac death is a mechanism whereby the availability of organs can be expanded. Donations after circulatory death pose unique challenges given their exposure to warm ischemia. Technical principles of donations after circulatory death procurement and pertinent studies investigating patient outcomes, graft outcomes, and complications are highlighted in this review. We also review associated risk factors to suggest potential avenues to achieve improved outcomes and reduced complications. Future considerations and alternative techniques of organ preservation are discussed, which may suggest novel strategies to enhance preservation and donor expansion through the use of marginal donors. Ultimately, without effective measures to bolster organ supply, donations after circulatory death should remain a consideration; however, an understanding of inherent risks and limitations is necessary.

  9. [Deaths in hotels].

    Science.gov (United States)

    Risse, Manfred; Weilbächer, Nadine; Birngruber, Christoph; Verhoff, Marcel A

    2010-01-01

    There are no verified statistics about deaths occurring in hotels, and only a few cases have been described in the literature. A recent case induced us to conduct a systematic search for deaths in hotels in the autopsy reports of the Institute of Legal Medicine in Giessen for the period from 1968 to 2009. This search yielded 22 evaluable cases in which persons had been found dead or had died in hotels. Data evaluated in the study were sex and age of the deceased, reason for the stay in the hotel and cause of death. Among the deaths, 18 were males and 4 females and the average age was 41 and 40 years respectively. 6 of the male guests had died from a natural and 10 from a non-natural cause. In the remaining two cases, the cause of death could not be determined, but as there was no evidence that another party had been involved, the cases were not further investigated. Of the 4 female guests, 3 had died of a natural cause; in one case, the cause of death remained unclear even after morphological and toxicological investigations. Surprisingly, a third of the men were found to be temporarily living in hotels due to social circumstances. This was not true for any of the women. Our retrospective analysis is based on a comparatively small number of deaths in what were mostly hotels in small to medium-sized towns. Interestingly, the gender ratio of 18:4 for deceased men and women was significantly higher than the usual gender ratio of 2:1 found for forensic autopsies. To be able to draw further conclusions, a greater number of cases would have to be analysed, for example by recruiting additional case files from other institutes of legal medicine. This would also open up the option of investigating possible regional variations.

  10. Epidemiological features of brain tumors

    Directory of Open Access Journals (Sweden)

    Živković Nenad

    2013-01-01

    Full Text Available Brain tumors account for 1.4% of all cancers and 2.4% of all cancer-related deaths. The incidence of brain tumors varies and it is higher in developed countries of Western Europe, North America, Australia and New Zealand. In Serbia, according to data from 2009, malignant brain tumors account for 2. 2 of all tumors, and from all cancer­related deaths, 3.2% is caused by malignant brain tumors. According to recent statistical reports, an overall incidence of brain tumors for benign and malignant tumors combined is 18.71 per 100,000 persons/year. The most common benign brain tumor in adults is meningioma, which is most present in women, and the most common malignant tumor is glioblastoma, which is most present in adult men. Due to high mortality, especially in patients diagnosed with glioblastoma and significant brain tumor morbidity, there is a constant interest in understanding its etiology in order to possibly prevent tumor occurrence in future and enable more efficient treatment strategies for this fatal brain disease. Despite the continuously growing number of epidemiological studies on possible factors of tumor incidence, the etiology remains unclear. The only established environmental risk factor of gliomas is ionizing radiation exposure. Exposure to radiofrequency electromagnetic fields via cell phone use has gained a lot of attention as a potential risk factor of brain tumor development. However, studies have been inconsistent and inconclusive, so more definite results are still expected.

  11. [Causes of the people death from drunkenness and alcoholism].

    Science.gov (United States)

    Erokhin, Iu A; Paukov, V S; Kirillov, Iu A

    2012-01-01

    We analyzed causes of 1008 people death, who abused by alcohol. Among them 2 groups were separated out: people died due to drunkenness and due to alcoholism. The structure of the death was similar in the both groups, however depended on alcoholism stages. The major cause of the death in group of drunkenness people was acute heart insufficiency, less commonly--lung pathology, and very rarely--brain vessels pathology and liver cirrhosis. In group of people, who died due to alcoholism, lung pathology was the major cause of these deaths, acute heart insufficiency was occurred less commonly, and very rare brain pathology because of delirium tremens or alcohol withdrawal syndrome, as so liver cirrhosis with complications. Hemorrhagic pancreonecrosis after alcoholic excess was found out in both groups, but it was more often in people, who died due to drunkenness. Obtained results show importance of chronic alcoholism identification as a disease with several stages including drunkenness and alcoholism.

  12. Brain Tumors

    Science.gov (United States)

    A brain tumor is a growth of abnormal cells in the tissues of the brain. Brain tumors can be benign, with no cancer cells, ... cancer cells that grow quickly. Some are primary brain tumors, which start in the brain. Others are ...

  13. Recommendations guide for the correct prescription's tests of diagnosis by image; Guia de recomendaciones para la correcta solicitud de pruebas de diagnostico por imagen

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-07-01

    The purpose of this guide is to protect the health of the population against the dangers of ionizing radiation. The unjustified studies involving exposure to radiation unnecessarily increases the cancer risk in the exposed population. Medical irradiations are the most important contribution to human exposure to ionizing radiation from artificial character. Since statistics indicate a growing trend in the number of practices as well as the number of facilities, the quality of those practices, its justification and its optimization are today a relevant topic to scientific societies and regulatory agencies. Since the adoption of the directive 97/43/EURATOM, and the realization of the Conference of Malaga most European countries have implemented action plans for radiation protection of patients, including the search for consensus on the optimization dose criteria and justification for the indication of the examinations. An example is the PR/118 guide for diagnosis studies requests. In this framework, two Conferences on Radiation Protection of Patient were held in our country in which 'Working Groups' were organized on the following topics: Radiodiagnosis, Radiotherapy, Nuclear Medicine and Radioprotection of the Pregnant Woman. Systematic actions that received strong institutional support of the Argentine Society of Radiology began and ended with the elaboration of a 'Program for Radiological Protection Patient' which is being implemented. [Spanish] El objetivo de esta Guia es la proteccion de la salud de la poblacion frente a los riesgos derivados de las radiaciones ionizantes. La realizacion injustificada de estudios que impliquen exposicion a la radiacion aumenta innecesariamente el riesgo de cancer en la poblacion expuesta. Las irradiaciones medicas son la contribucion mas importante a la exposicion humana a las radiaciones ionizantes de caracter artificial. Ya que las estadisticas indican una tendencia creciente en el numero de practicas asi como la cantidad de

  14. Proposta de guia simplificado para registro de alimento com alegações de propriedades funcionais / Proposal of simple model for registration of food with claiming functional properties

    Directory of Open Access Journals (Sweden)

    Mônica Cecília Santana Pereira

    2014-05-01

    Full Text Available As evidências científicas atuais sobre a relação existente entre alimentação-saúde-doença vêm despertando, em todo o mundo, o interesse por hábitos alimentares e estilos de vida saudáveis. Neste contexto, os alimentos com alegações de propriedade funcional e/ou de saúde estão conquistando o mercado com lançamentos de inovações tecnológicas. Existem, por parte das indústrias, desafios e dificuldades para registrar produtos desta categoria. Este trabalho aspirou a objetivos como pesquisar a legislação vigente e construir um “guia simplificado” para efetuar o registro de produto lácteo com alegação de propriedade funcional e/ou de saúde. Todas as etapas referentes ao registro de um iogurte com alegação de propriedade funcional e/ou de saúde foram explicitadas por meio de um exemplo prático, com criação da empresa, desenvolvimento de produto e rótulos fictícios. Por meio da pesquisa qualitativa documental foram encontrados: três leis, dois decretos, quatro portarias, quatorze resoluções, quatro instruções normativas, um informe técnico, um guia e um ofício circular. Através de análise da legislação vigente, evidenciou-se o quanto o sistema regulamentar atual é fragmentado. Concluiu-se que a legislação é “pulverizada”, que existe uma carência de material informativo específico e que, devido à complexidade na elaboração do processo para registrar um produto desta categoria, há a necessidade de uma equipe qualificada com profissionais habitados na área de alimentos, advogados e marketing. -------------------------------------------------------------------------- Current scientific evidences on the relationship among food-health-disease have aroused worldwide interest in eating habits and healthy lifestyles. In this context, food with claims of functional and, or healthy properties, are conquering the market with releases of technological innovations. However, the industry faces challenges

  15. Life and death.

    Science.gov (United States)

    Lloyd, J W

    1983-03-01

    In contrast with the other lectures given in the course on humanics and bioethics at the UOEH, which address the questions of life and death from the standpoint of the physician or the philosopher, this lecture considers these issues as seen by the cancer patient who has had a close encounter with death. The attitudes of Americans concerning abortion, the use of life-support systems, "mercy killings", suicide and the use of cancer chemotherapy are discussed with particular emphasis on restraints imposed by the courts, the churches and the family systems. An attempt is made to contrast the American and Japanese attitudes on these questions but this is difficult because of different cultural and religious backgrounds. The author describes his own experiences as a cancer patient who has approached death very closely and the changes in his own attitude toward life which results from the encounter with death. He also talks about the joy of being alive and describes his own experience with receiving cancer chemotherapy, the resulting discomfort and inconveniences and his feelings about a "tolerable" existence. Finally, the author considers the question of the "quality of life" for the cancer patient who has a violent reaction to certain forms of chemotherapy. This is a dilemma for the patient and the doctor who must consider the choice between death and a miserable existence.

  16. Malnutrition related deaths.

    Science.gov (United States)

    Sparre-Sørensen, Maja; Kristensen, Gustav N

    2016-10-01

    Studies have shown that malnutrition increases the risk of morbidity, mortality, the length of hospital stay, and costs in the elderly population. Approximately one third of all patients admitted to geriatric wards in Denmark are malnourished according to the Danish Geriatric database. The aim of this study is to describe and examine the sudden increase in deaths due to malnutrition in the elderly population in Denmark from 1999 and, similarly, the sudden decline in malnutrition related deaths in 2007. A descriptive epidemiologic study was performed. All Danes listed in the national death registry who died from malnutrition in the period from 1994 to 2012 are included. The number of deaths from malnutrition increased significantly during the period from 1999 to 2007, especially in the age group 70 years and over. Additionally, we document a surprising similarity between the development in excess mortality from malnutrition in the five Danish regions during the same period. During the period 1999-2007 malnutrition was the direct cause of 340 extra deaths, and probably ten times more registered under other diseases. This development in excess mortality runs parallel in all five Danish regions over time. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  17. Concept of 'bad death'

    Directory of Open Access Journals (Sweden)

    Marija Vučković

    2016-02-01

    Full Text Available Following previous research on the linguistic concept of а 'bad death' which lexical expression is the word family of the verb ginuti, I focus my attention in this paper on the relationship between language conceptualization of а 'bad death' and the representation of а 'bad death' in traditional and contemporary culture. Diachronically based language corpus makes possible to trace the changes of referential frame and use of verb ginuti and its derivatives. In the traditional culture а 'bad death' is marked in action code by irregular way of burial and beliefs in demons stemming from the 'impure dead'. In the paper I explore the degree of synonymy of the symbols of all three codes: verbal code, action code and code of beliefs. In the contemporary culture the lack of individual control and choice is considered to be the key element of the concept of a 'bad death'. This change of conceptual content manifests itself in the use of its lexical expressions.

  18. Precisely Tracking Childhood Death.

    Science.gov (United States)

    Farag, Tamer H; Koplan, Jeffrey P; Breiman, Robert F; Madhi, Shabir A; Heaton, Penny M; Mundel, Trevor; Ordi, Jaume; Bassat, Quique; Menendez, Clara; Dowell, Scott F

    2017-07-01

    Little is known about the specific causes of neonatal and under-five childhood death in high-mortality geographic regions due to a lack of primary data and dependence on inaccurate tools, such as verbal autopsy. To meet the ambitious new Sustainable Development Goal 3.2 to eliminate preventable child mortality in every country, better approaches are needed to precisely determine specific causes of death so that prevention and treatment interventions can be strengthened and focused. Minimally invasive tissue sampling (MITS) is a technique that uses needle-based postmortem sampling, followed by advanced histopathology and microbiology to definitely determine cause of death. The Bill & Melinda Gates Foundation is supporting a new surveillance system called the Child Health and Mortality Prevention Surveillance network, which will determine cause of death using MITS in combination with other information, and yield cause-specific population-based mortality rates, eventually in up to 12-15 sites in sub-Saharan Africa and south Asia. However, the Gates Foundation funding alone is not enough. We call on governments, other funders, and international stakeholders to expand the use of pathology-based cause of death determination to provide the information needed to end preventable childhood mortality.

  19. Causes of death of patients with lung cancer.

    Science.gov (United States)

    Nichols, Larry; Saunders, Rachel; Knollmann, Friedrich D

    2012-12-01

    The causes of death for patients with lung cancer are inadequately described. To categorize the immediate and contributing causes of death for patients with lung cancer. The autopsies from 100 patients who died of lung cancer between 1990 and February 2011 were analyzed. Tumor burden was judged the immediate cause of death in 30 cases, including 26 cases of extensive metastases and 4 cases with wholly or primarily lung tumor burden (causing respiratory failure). Infection was the immediate cause of death for 20 patients, including 8 with sepsis and 12 with pneumonia. Complications of metastatic disease were the immediate causes of death in 18 cases, including 6 cases of hemopericardium from pericardial metastases, 3 from myocardial metastases, 3 from liver metastases, and 3 from brain metastases. Other immediate causes of death were pulmonary hemorrhage (12 cases), pulmonary embolism (10 cases, 2 tumor emboli), and pulmonary diffuse alveolar damage (7 cases). From a functional (pathophysiologic) perspective, respiratory failure could be regarded as the immediate cause of death (or mechanism of death) in 38 cases, usually because of a combination of lung conditions, including emphysema, airway obstruction, pneumonia, hemorrhage, embolism, resection, and lung injury in addition to the tumor. For 94 of the 100 patients, there were contributing causes of death, with an average of 2.5 contributing causes and up to 6 contributing causes of death. The numerous and complex ways lung cancer kills patients pose a challenge for efforts to extend and improve their lives.

  20. [Reflections on prehospitalisation deaths].

    Science.gov (United States)

    Hugenschmitt, Delphine; Allonneau, Alexandre; Cesareo, Éric; Gueugniaud, Pierre-Yves; Lefort, Hugues

    2017-12-01

    In the past, death was a family and community affair, but today it is institutional and entrusted to healthcare personnel. Thanks to a questionnaire on their feelings about prehospitalisation deaths, the experience and training needs for healthcare personnel at a mobile emergency and intensive care service were analysed. The majority of these professionals had been confronted with difficulties when faced with prehospitalisation deaths. There is little understanding of religious rites, even though this is an important point in dealing with the situation. There is a strong desire for training. The pedagogical support offered in response to the needs expressed was recognised as being useful and should be more widespread. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  1. Amphetamine derivative related deaths.

    Science.gov (United States)

    Lora-Tamayo, C; Tena, T; Rodríguez, A

    1997-02-28

    Amphetamine its methylendioxy (methylendioxyamphetamine methylenedioxymethylamphetamine, methylenedioxyethylamphetamine) and methoxy derivatives (p-methoxyamphetamine and p-methoxymethylamphetamine) are widely abused in Spanish society. We present here the results of a systematic study of all cases of deaths brought to the attention of the Madrid department of the Instituto Nacional de Toxicologia from 1993 to 1995 in which some of these drugs have been found in the cadaveric blood. The cases were divided into three categories: amphetamine and derivatives, amphetamines and alcohol, amphetamines and other drugs. Data on age, sex, clinical symptoms, morphological findings, circumstances of death, when known, and concentration of amphetamine derivatives, alcohol and other drugs in blood are given for each group. The information provided here may prove to be useful for the forensic interpretation of deaths which are directly or indirectly related to abuse of amphetamine derivatives.

  2. Competing causes of death: a death certificate study

    NARCIS (Netherlands)

    Mackenbach, J. P.; Kunst, A. E.; Lautenbach, H.; Oei, Y. B.; Bijlsma, F.

    1997-01-01

    BACKGROUND: Despite the widespread interest in competing causes of death, empirical information on interrelationships between causes of death is scarce. We have used death certificate information to estimate the prevalence of competing causes of death at the moment of dying from specific underlying

  3. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  4. Brain Malformations

    Science.gov (United States)

    Most brain malformations begin long before a baby is born. Something damages the developing nervous system or causes it ... medicines, infections, or radiation during pregnancy interferes with brain development. Parts of the brain may be missing, ...

  5. [Maternal death: unequal risks].

    Science.gov (United States)

    Defossez, A C; Fassin, D

    1989-01-01

    Nearly 99% of maternal deaths in the world each year occur in developing countries. New efforts have recently been undertaken to combat maternal mortality through research and action. The medical causes of such deaths are coming to be better understood, but the social mechanisms remain poorly grasped. Maternal mortality rates in developing countries are difficult to interpret because they tend to exclude all deaths not occurring in health care facilities. The countries of Europe and North America have an average maternal mortality rate of 30/100,000 live births, representing about 6000 deaths each year. The developing countries of Asia, Africa, and Latin America have rates of 270-640/100,000, representing some 492,000 deaths annually. For a true comparison of the risks of maternal mortality in different countries, the risk itself and the average number of children per woman must both be considered. A Nigerian woman has 375 times greater risk of maternal death than a Swedish woman, but since she has about 4 times more children, her lifetime risk of maternal death is over 1500 times greater than that of the Swedish woman. The principal medical causes of maternal death are known: hemorrhages due to placenta previa or retroplacental hematoma, mechanical dystocias responsible for uterine rupture, toxemia with eclampsia, septicemia, and malaria. The exact weight of abortion in maternal mortality is not known but is probably large. The possible measures for improving such rates are of 3 types: control of fertility to avoid early, late, or closely spaced pregnancies; effective medical surveillance of the pregnancy to reduce the risk of malaria, toxemia, and hemorrhage, and delivery in an obstetrical facility, especially for high-risk pregnancies. Differential access to high quality health care explains much of the difference between mortality rates in urban and rural, wealthy and impoverished areas of the same country. The social determinants of high maternal mortality

  6. Death with dignity

    OpenAIRE

    Allmark, P.

    2002-01-01

    The purpose of this article is to develop a conception of death with dignity and to examine whether it is vulnerable to the sort of criticisms that have been made of other conceptions. In this conception "death" is taken to apply to the process of dying; "dignity" is taken to be something that attaches to people because of their personal qualities. In particular, someone lives with dignity if they live well (in accordance with reason, as Aristotle would see it). It follows that health care pr...

  7. Teaching about the Death Penalty.

    Science.gov (United States)

    Ryan, John Paul; Eden, John Michael

    1998-01-01

    Examines the reasons for the death penalty, the reasons why the death penalty attracts so much attention, whether the death penalty is applied consistently, and the evidence that the application of the death penalty may be racially biased. Provides an accompanying article on "Teaching Ideas" by Ronald A. Banaszak. (CMK)

  8. Digital Language Death

    Science.gov (United States)

    Kornai, András

    2013-01-01

    Of the approximately 7,000 languages spoken today, some 2,500 are generally considered endangered. Here we argue that this consensus figure vastly underestimates the danger of digital language death, in that less than 5% of all languages can still ascend to the digital realm. We present evidence of a massive die-off caused by the digital divide. PMID:24167559

  9. Digital language death.

    Directory of Open Access Journals (Sweden)

    András Kornai

    Full Text Available Of the approximately 7,000 languages spoken today, some 2,500 are generally considered endangered. Here we argue that this consensus figure vastly underestimates the danger of digital language death, in that less than 5% of all languages can still ascend to the digital realm. We present evidence of a massive die-off caused by the digital divide.

  10. Death Penalty in America.

    Science.gov (United States)

    Clifford, Amie L.

    1997-01-01

    Examines the legal and moral issues, controversies, and unique trial procedures involved with the death penalty. Discusses the 1972 landmark Supreme Court decision that resulted in many states abolishing this punishment, only to reintroduce it later with different provisions. Reviews the controversial case of Sam Sheppard. (MJP)

  11. The Death Penalty.

    Science.gov (United States)

    Crockett, Mark

    1990-01-01

    Provides a lesson plan on the Eighth Amendment to the U.S. Constitution and the imposition of the death penalty. Focuses on the controversy concerning capital punishment and stimulates critical thinking in an analysis and discussion of eight hypothetical situations. Includes suggestions for readings, videotapes, and writing assignments. (NL)

  12. Optimal Aging and Death

    DEFF Research Database (Denmark)

    Dalgaard, Carl-Johan Lars; Strulik, Holger

    2010-01-01

    This study introduces physiological aging into a simple model of optimal intertemporal consumption. In this endeavor we draw on the natural science literature on aging. According to the purposed theory, the speed of the aging process and the time of death are endogenously determined by optimal...

  13. Optimal Aging and Death

    DEFF Research Database (Denmark)

    Dalgaard, Carl-Johan; Strulik, Holger

    the representative consumer is subject to physiological aging. In modeling aging we draw on recent research in the fields of biology and medicine. The speed of the aging process, and thus the time of death, are endogenously determined by optimal health investments. We calibrate the model to US data and proceed...

  14. Preventing the White Death

    DEFF Research Database (Denmark)

    Hansen, Casper Worm; Jensen, Peter S.; Madsen, Peter

    2017-01-01

    Tuberculosis (TB) is a leading cause of death worldwide and, while treatable by antibiotics since the 1940s, drug resistant strains have emerged. This paper estimates the effects of the establishment of a pre-antibiotic era public health institution, known as a TB dispensary, designed to prevent...

  15. Disparities in death

    DEFF Research Database (Denmark)

    Molitoris, Joseph John

    2017-01-01

    and accidents, (5) perinatal causes, and (6) unspecified causes. RESULTS The results show that class differentials in nearly all causes of death converged during the demographic transition. The only exception to this was the airborne infectious disease category, for which the gap between white collar...

  16. The Death of Shankar

    DEFF Research Database (Denmark)

    Seeberg, Jens

    2013-01-01

    ) in Bhubaneswar, the capital city of Orissa. The chapter explores the heterogeneous and hierarchical composition of the basti and unfolds the case of the social exclusion and ultimate death of a patient with tuberculosis who belonged to the poorest section of the basti, called Pradhan sahi. The case of both...

  17. Death in Flames

    DEFF Research Database (Denmark)

    Harvig, Lise Lock; Kveiborg, Jacob; Lynnerup, Niels

    2015-01-01

    This paper presents osteoarchaeological analyses of the human skeletal material from a burnt down house in Jutland, Denmark, dated to the first century bc. We describe how the osteological analyses of this complex site were approached and illustrate how we reconstructed the death of the human...

  18. Sudden cardiac death

    DEFF Research Database (Denmark)

    Hougen, H P; Valenzuela, Antonio Jesus Sanchez; Lachica, E

    1992-01-01

    case was inconclusive. After studying the circumstances of death, the number of discrepancies were reduced to 20, so that concordance was reached in 86% of all the cases. The results show that the combination of different methods leads to a diagnosis of myocardial infarction in far more cases than...

  19. Bee deaths need analysing

    NARCIS (Netherlands)

    Boonekamp, P.M.

    2011-01-01

    Alarm bells are ringing all over the world about the death of bee populations. Although it is not known exactly how severe the decline is, it is important to take the problem seriously. The signals are alarming and the bee is important, not just for natural ecosystems but also for the pollination of

  20. [Death of Napoleon Bonaparte].

    Science.gov (United States)

    Camici, M

    2003-06-01

    The causa mortis of Napoleon Bonaparte has been vexata quaestio for a long time. The author tries to outline a picture of Napoleon from a sanitary point of view. From the report of doctor Francesco Antonmarchi who performed the autopsy, the author tries to understans the cause of death: gastric perforation due to malignant ulcer and subsequent peritonitis with pulmonary tubercolosis.

  1. Surgical treatment for ~brain compartment syndrome' in children ...

    African Journals Online (AJOL)

    Objectives. Traumatic brain injury accounts for a high percentage of deaths in children. Raised intracranial pressure (ICP) due to brain swelling within the closed compartment of the skull leads to death or severe neurological disability if not effectively treated. We report our experience with 12 children who presented with ...

  2. Pediatric Donation After Circulatory Determination of Death: A Scoping Review.

    Science.gov (United States)

    Weiss, Matthew J; Hornby, Laura; Witteman, William; Shemie, Sam D

    2016-03-01

    remain an event less common than brain death, albeit with the potential to substantially expand the existing organ donation pool. Limited data suggest outcomes comparable with organs donated after neurologic determination of death. Although there is continued debate around ethical aspects of pediatric donation after circulatory determination of death, all pediatric donation after circulatory determination of death publications from professional societies contend that pediatric donation after circulatory determination of death can be practiced ethically. This review provides a comprehensive overview of the published literature related to pediatric donation after circulatory determination of death. In addition to informing the development of pediatric-specific guidelines, this review serves to highlight several important knowledge gaps in this topic.

  3. Defining human death: an intersection of bioethics and metaphysics.

    Science.gov (United States)

    Manninen, Bertha Alvarez

    2009-01-01

    For many years now, bioethicists, physicians, and others in the medical field have disagreed concerning how to best define human death. Different theories range from the Harvard Criteria of Brain Death, which defines death as the cessation of all brain activity, to the Cognitive Criteria, which is based on the loss of almost all core mental properties, e.g., memory, self-consciousness, moral agency, and the capacity for reason. A middle ground is the Irreversibility Standard, which defines death as occurring when the capacity for consciousness is forever lost. Given all these different theories, how can we begin to approach solving the issue of how to define death? I propose that a necessary starting point is discussing an even more fundamental question that properly belongs in the philosophical field of metaphysics: we must first address the issue of diachronic identity over time, and the persistence conditions of personal identity. In this paper, I illustrate the interdependent relationship between this metaphysical question and questions concerning the definition of death. I also illustrate how it is necessary to antecedently attend to the metaphysical issue of defining death before addressing certain issues in medical ethics, e.g., whether it is morally permissible to euthanize patients in persistent vegetative states or procure organs from anencephalic infants.

  4. Sudden infant death syndrome, childhood thrombosis, and presence of genetic risk factors for thrombosis

    DEFF Research Database (Denmark)

    Larsen, T B; Nørgaard-Pedersen, B; Banner, Jytte

    2000-01-01

    in the child. This prompted us to investigate these genetic markers of thromboembolic disease in 121 cases of sudden infant death syndrome and in relevant controls, in the expectation of a more frequent occurrence of these markers if thrombosis is an etiological factor in sudden infant death syndrome......Sudden infant death syndrome or "cot death" has until the late eighties been a significant cause of death in children between the ages of 1 month and 1 year. Approximately two per 1000 children born alive dies of sudden infant death syndrome each year in Western Europe, North America, and Australia....... The vulnerability of the infant brain stem to ischemia has been suggested to be a conceivable cause of sudden infant death syndrome. This is compatible with a hypothesis that genetic risk factors for cerebral thrombosis could cause microinfarction in the brain stem during the first month of life, affecting vital...

  5. Early maternal death due to acute encephalitis

    Directory of Open Access Journals (Sweden)

    M Vidanapathirana

    2014-03-01

    Full Text Available Maternal death in an unmarried woman poses a medico-legal challenge. A 24-year-old unmarried schoolteacher, residing at a boarding place, had been admitted to hospital in a state of cardiac arrest. At the autopsy, mild to moderate congestion of subarachnoid vessels and oedema of the brain was noted. An un-interfered foetus of 15 weeks with an intact sac and placental tissues were seen. Genital tract injuries were not present. Histopathological examination showed diffuse perivascular cuffing by mononuclear cells suggestive of viral encephalitis, considering the circumstances of death and the social stigma of pregnancy in this unmarried teacher, the possibility of attempted suicide by ingestion of a poison was considered. Abrus precatorius (olinda seeds commonly found in the area is known to produce acute encephalitis as well as haemorrhagic gastroenteritis and pulmonary congestion was also considered as a possible cause for this unusual presentation

  6. Guia prático de excercícios de alongamento como promotor de autonômia em um grupo de mulheres / Promoting autonomy in a group of women with a practical guide to stretching

    Directory of Open Access Journals (Sweden)

    Tialhes Farias Marconato

    2018-04-01

    Full Text Available A Terapia Ocupacional desenvolve sua prática e estudo sobre as atividades humanas com a utilização de recursos e instrumentos terapêuticos, que podem beneficiar o processo de envelhecimento. Nesse sentido, o estudo visou reconhecer e descrever a percepção de mulheres com idade entre 40 e 60 anos de idade, participantes de um grupo de Terapia Ocupacional, quanto às repercussões da utilização de um Guia Prático de Alongamento, no desempenho das atividades cotidianas. Para tanto, realizou-se uma pesquisa qualitativa, exploratória e descritiva, por meio de Grupo Focal. Verificou-se que a utilização do Guia influenciou no controle da dor, na autonomia para realização de atividades de vida diária e na percepção do próprio corpo das participantes do estudo. Conclui-se que o Guia Prático de Alongamento é uma ferramenta simples, porém relevante para melhorar a consciência corporal, a autonomia e independência de indivíduos em processo de envelhecimento, sugerindo-o como um instrumento indicado para outras populações. AbstractOccupational Therapy carries out the practice and study of human activities by employing therapeutic resources and instruments, which can benefit the aging process. Thus, the aim of this study was to identify and describe the perception of women between the ages of 40 and 60 in an Occupational Therapy group regarding the effects of using a Practical Guide to Stretching on the performance of their daily activities. In that sense, a qualitative, exploratory and descriptive Focus Group research was carried out. It was verified that the use of the Practical Guide had an influence on participants’ pain control, autonomy to perform daily activities and body perception. It was concluded that the Practical Guide to Stretching is a simple but relevant tool that helps aging individuals improve their body awareness, autonomy and independence. It is also a suitable tool for other populations.Keywords: Muscle

  7. METHAPHYSICS OF DEATH PENALTY

    Directory of Open Access Journals (Sweden)

    V. E. Gromov

    2017-06-01

    Full Text Available Purpose. The paper studies the problem of death penalty justifiableness in terms of democratic society from the metaphysical viewpoint. Philosophical argumentation to justify death penalty is proposed as opposed to the common idea of inhuman and uncivilized nature of court practice of sentencing to death. The essence of the study is not to rehabilitate law-based murder but to explain dialectic relation of the degrees of moral responsibility of criminals and society nourishing evildoers. The author believes that refusal from death penalty under the pretence of rule of humanism is just a liberal façade, plausible excuse for defective moral state of the society which, rejecting its own guiltiness share as for current disregards of the law, does not grow but downgrades proper human dignity. Methodology. The author applies an approach of dialectic reflection being guided by the perception of unity, relativeness and complementarity of evil and good striving to determine efficient way of resolving their contradictions in the context of moral progress of the society. Originality. Proposing philosophic approach to a death penalty problem instead of legal one, the author is not going to discuss the role of horrification, control or cruelty of the measure of restraint; moreover, he does not consider the issue of its efficiency or inefficiency. The author also does not concern vexation of mind of a criminal sentenced to life imprisonment for “humanitarian” reasons. The purpose of the author is to demonstrate that aim of the punishment is to achieve justice which becomes spiritual challenge and moral recompense not only for the criminal but for the whole society. Conclusions. Crime is first of all a problem of a society; thus, criminal behaviour of certain individuals should only be considered through a prism of moral state of the whole community. Attitude to a death penalty is the problem of spirituality and its dramatic sophistication. The author

  8. Death from Nitrous Oxide.

    Science.gov (United States)

    Bäckström, Björn; Johansson, Bengt; Eriksson, Anders

    2015-11-01

    Nitrous oxide is an inflammable gas that gives no smell or taste. It has a history of abuse as long as its clinical use, and deaths, although rare, have been reported. We describe two cases of accidental deaths related to voluntary inhalation of nitrous oxide, both found dead with a gas mask covering the face. In an attempt to find an explanation to why the victims did not react properly to oncoming hypoxia, we performed experiments where a test person was allowed to breath in a closed system, with or without nitrous oxide added. Vital signs and gas concentrations as well as subjective symptoms were recorded. The experiments indicated that the explanation to the fact that neither of the descendents had reacted to oncoming hypoxia and hypercapnia was due to the inhalation of nitrous oxide. This study raises the question whether nitrous oxide really should be easily, commercially available. © 2015 American Academy of Forensic Sciences.

  9. [Karoshi, death by overwork].

    Science.gov (United States)

    Uehata, Tetsunojo

    2005-07-01

    Karoshi (death by overwork) is one of social medical terms, which used by survivors of victims who attacked with cardiovascular diseases such as stroke, myocardial infarction and sudden cardiac death. In Dec. 2000, Compensation Standard of cardiovascular diseases in Workers' Insurance was changed and admitted the relationship between chronic fatigue and cardiovascular attacks. As a result, compensation numbers of Karoshi attributed to three hundred and more from about 80 cases. The Ministry of Health, Labour and Welfare thinks that most of Karoshi caused by long working hours continuing for several months, especially without payment, so that the Labour Standard Inspector Office requests to decrease overtime work more than 45 hours per month to firm administrators.

  10. AN AUDIT OF MATERNAL DEATHS

    Directory of Open Access Journals (Sweden)

    Basavana Gowda

    2015-03-01

    Full Text Available OBJECTIVES: A study of maternal death conducted to evaluate various factors responsible for maternal deaths. To identify complications in pregnancy, a childbirth which result in maternal death, and to identify opportunities for preventive intervention and understand the events leading to death; so that improving maternal health and reducing maternal mortality rate significantly. To analyze the causes and epidemiological amounts maternal mortality e.g. age parity, socioeconomic status and literacy. In order to reduce maternal mortality and to implement safe motherhood program and complications of pregnancy and to find out safe motherhood program. METHODS: The data collected was a retrograde by a proforma containing particulars of the diseased, detailed history and relatives were interviewed for additional information. The data collected was analysed. RESULTS: Maternal mortality rate in our own institution is 200/ 100,000 live births. Among 30 maternal deaths, 56% deaths (17 were among low socio - economic status, groups 60% deaths among unbooked 53.5% deaths more along illiterates evidenced by direct and indirect deaths about 25% of deaths were preventable. CONCLUSION: Maternal death is a great tragedy in the family life. It is crusade to know not just the medical cause of the death but the circumstances what makes these continued tragic death even more unacceptable is that deaths are largely preventable

  11. [Sudden death from hypoglycemia].

    Science.gov (United States)

    Asmundo, A; Aragona, M; Gualniera, P; Aragona, F

    1995-12-01

    The sudden death by hypoglycemia is an aspect of the forensic pathology frequently neglected. Authors initially described the pathogenesis of different hypoglycemia forms, distinguishing the primary ones due to hyperinsulinism and the secondary ones due to functional insufficiency of other organs (hypophysis, thyroid, adrenal gland, liver); after that Authors described three cases of sudden death induced hypoglycemia by hyperinsulinism: two were unweaned with nesidioblastosis and one adolescent. In any form of hypoglycemia the central nervous system damage is present with evident neuronal degenerative-necrotic phenomena, widespread edema with microhemorrhage, swollen and dissociation of myelin sheath, glial cells hyperplasia. Death caused by primary hypoglycemia is histopathologically different from the secondary one because of the maintenance of hepatic glycogen content in the former, that increase in striated muscles, including the heart, in spite of the constant secretion of catecholamine from the adrenal medulla. Glycogen is depleted in secondary hypoglycemia. In the primary form, behind the adrenal medulla hyperfunction, the increased functional activity of the adrenal cortex is moderate, contrasting with the seriousness of the syndrome, due prevalently to inhibit the gluconeogenesis response conditioned by the persistence of stored glycogen in the liver, heart and striated muscles. The rare anoxic processes coming with resynthesis of hepatic glycogen have to be considered in the differential diagnosis. The primary hypoglycemic death, especially in unweaned, is frequently promoted by other processes inducing hypoxia (fetal asphyxia outcome, pneumonia, etc.) or worsening the hypoglycemia (hypothyroidism, etc.). The secondary hypoglycemias are characterized by the normality of exocrine pancreas and by organic alterations that cause glycogen depletion from the liver.

  12. Death and digital photography

    Directory of Open Access Journals (Sweden)

    Ennis, Helen

    2011-01-01

    Full Text Available This essay considers new possibilities for photographing the dying and dead in Australia that have been enabled by digital technologies. It argues that vernacular digital photographs demonstrate unprecedented degrees of control and privacy and further that they are purposefully withheld from public view, thus raising issues about visibility and secrecy.Some historical context is provided. Post mortem photographs were not uncommon in the nineteenth century but were in the domain of professional studio photographers. Commissioning post mortem portraits was rare for most of the twentieth century, due to changing attitudes to death and the transformation of the photographic industry. Photographing the deceased re-emerged in the 1980s, notably in the area of neonatal death.In the last five years death-related vernacular photographs have begun to proliferate. Unlike analogue processes, digital photography bypasses the involvement of others in processing and printing private images. Distribution to intimates can be achieved instantaneously via the internet, reinforcing social and familial connections.Vernacular digital photographs of the deceased do not address historical tradition but share their domestic and intimate contexts. Nor do they belong to a unified group, yet they have a common vocabulary which emphasises specificity and detail.

  13. Death and Digital Photography

    Directory of Open Access Journals (Sweden)

    Helen Ennis

    2011-03-01

    Full Text Available This essay considers new possibilities for photographing the dying and dead in Australia that have been enabled by digital technologies. It argues that vernacular digital photographs demonstrate unprecedented degrees of control and privacy and further that they are purposefully withheld from public view, thus raising issues about visibility and secrecy. Some historical context is provided. Post mortem photographs were not uncommon in the nineteenth century but were in the domain of professional studio photographers. Commissioning post mortem portraits was rare for most of the twentieth century, due to changing attitudes to death and the transformation of the photographic industry. Photographing the deceased re-emerged in the 1980s, notably in the area of neonatal death. In the last five years death-related vernacular photographs have begun to proliferate. Unlike analogue processes, digital photography bypasses the involvement of others in processing and printing private images. Distribution to intimates can be achieved instantaneously via the internet, reinforcing social and familial connections. Vernacular digital photographs of the deceased do not address historical tradition but share their domestic and intimate contexts. Nor do they belong to a unified group, yet they have a common vocabulary which emphasises specificity and detail.

  14. Fear of death.

    Science.gov (United States)

    Penson, Richard T; Partridge, Rosamund A; Shah, Muhammad A; Giansiracusa, David; Chabner, Bruce A; Lynch, Thomas J

    2005-02-01

    Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH) founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient and support to caregivers and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. For many, cancer is synonymous with death. Fearing death is a rational response. For too long, medicine has ignored this primeval fear. Increasingly, clinicians recognize and address end-of-life issues, facing patients' and our own emotional vulnerabilities in order to connect and explore problems and fears. Listening and learning from the patient guides us as we acknowledge much of the mystery that still surrounds the dying process. Rarely is there a simple or right answer. An empathetic response to suffering patients is the best support. Support is vital in fostering the adjustment of patients. A silent presence may prove more helpful than well-meant counsel for many patients. Through an examination of eight caregiver narratives of their patients' experiences, the role of the health care provider in the dying process, particularly in regard to challenging fear, is reviewed.

  15. Structural imaging biomarkers of sudden unexpected death in epilepsy.

    Science.gov (United States)

    Wandschneider, Britta; Koepp, Matthias; Scott, Catherine; Micallef, Caroline; Balestrini, Simona; Sisodiya, Sanjay M; Thom, Maria; Harper, Ronald M; Sander, Josemir W; Vos, Sjoerd B; Duncan, John S; Lhatoo, Samden; Diehl, Beate

    2015-10-01

    Sudden unexpected death in epilepsy is a major cause of premature death in people with epilepsy. We aimed to assess whether structural changes potentially attributable to sudden death pathogenesis were present on magnetic resonance imaging in people who subsequently died of sudden unexpected death in epilepsy. In a retrospective, voxel-based analysis of T1 volume scans, we compared grey matter volumes in 12 cases of sudden unexpected death in epilepsy (two definite, 10 probable; eight males), acquired 2 years [median, interquartile range (IQR) 2.8] before death [median (IQR) age at scanning 33.5 (22) years], with 34 people at high risk [age 30.5 (12); 19 males], 19 at low risk [age 30 (7.5); 12 males] of sudden death, and 15 healthy controls [age 37 (16); seven males]. At-risk subjects were defined based on risk factors of sudden unexpected death in epilepsy identified in a recent combined risk factor analysis. We identified increased grey matter volume in the right anterior hippocampus/amygdala and parahippocampus in sudden death cases and people at high risk, when compared to those at low risk and controls. Compared to controls, posterior thalamic grey matter volume, an area mediating oxygen regulation, was reduced in cases of sudden unexpected death in epilepsy and subjects at high risk. The extent of reduction correlated with disease duration in all subjects with epilepsy. Increased amygdalo-hippocampal grey matter volume with right-sided changes is consistent with histo-pathological findings reported in sudden infant death syndrome. We speculate that the right-sided predominance reflects asymmetric central influences on autonomic outflow, contributing to cardiac arrhythmia. Pulvinar damage may impair hypoxia regulation. The imaging findings in sudden unexpected death in epilepsy and people at high risk may be useful as a biomarker for risk-stratification in future studies. The Author (2015). Published by Oxford University Press on behalf of the Guarantors of

  16. Reading the near-death experience from an African perspective

    African Journals Online (AJOL)

    2015-09-14

    Sep 14, 2015 ... evidence for life after death, but a study of NDE from an African perspective implies that. NDE could serve .... brain through blood circulation will no longer be available as a result. .... eternal repose and happiness. It is rather a ...

  17. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2001 – 2010

    Data.gov (United States)

    U.S. Department of Health & Human Services — In general, total combined rates for traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations and deaths have increased over the past...

  18. [Totally paralyzed or brain dead?

    NARCIS (Netherlands)

    Dijk, G.W. van; Vos, P.E.; Eurelings, M.; Jansen, G.H.; Gijn, J. van

    2001-01-01

    In two patients, men aged 23 and 42 years, a condition that mimicked brain death was observed as a consequence of rapidly progressive complete peripheral paralyses, which included the intrinsic and extrinsic eye muscles. However, the EEG revealed a waking pattern. Maximal supportive therapy was

  19. A Death in the Family: Death as a Zen Concept

    Science.gov (United States)

    Black, Helen K.; Rubinstein, Robert L.

    2013-01-01

    This study is based on original research that explored family reaction to the death of an elderly husband and father. We interviewed 34 families (a family included a widow and two adult biological children) approximately 6 to 10 months after the death. In one-on-one interviews, we discussed family members' initial reaction to the death, how the…

  20. Guia de manejo clínico do paciente com HTLV: aspectos neurológicos Guide of clinical management of HTLV patient: neurological aspects

    Directory of Open Access Journals (Sweden)

    Carlos Maurício de Castro-Costa

    2005-06-01

    Full Text Available O Ministério da Saúde (Programa DST e Aids reuniu especialistas para elaborar um guia informativo de manejo do paciente com HTLV. Dentre os diferentes tópicos, foram contemplados os aspectos neurológicos associados à infecção pelo HTLV. Um caso suspeito de doença neurológica associada ao HTLV deve incluir alteração de força e reflexos, parestesias distais e disfunção autonômica. A investigação do caso suspeito deve ser baseada na síndrome exibida pelo paciente. Para o paciente com síndrome medular, deve-se solicitar ressonância magnética da medula ou mielografia, assim como, estudo do líquor. Para o paciente com síndrome neuropática ou miopática, deve-se solicitar eletroneuromiografia e dosagem de CPK, e para aquele com síndrome autonômica, pesquisa de hipotensão postural, ultrassonografia das vias urinárias e estudo urodinâmico. O tratamento pode ser sintomático (espasticidade, bexiga neurogênica, constipação intestinal e dor neuropática e específico a ser feito em centros especializados.The Brazilian Ministry of Health (STD and Aids Program invited specialists to make up an informative guide to deal with HTLV patients. Among the different topics, the neurological aspects associated to HTLV were contemplated. A suspected case should include changes in force and reflexes, distal paresthesiae and autonomic dysfunction. The investigation of such case should be based on the syndrome shown by the patient. For patients with spinal cord syndrome, magnetic resonance imaging or myelography as well as spinal fluid studies should be carried out. For patients with neuropathic or myopathic syndrome, electroneuromyography and CPK dosing should be done, and for those with autonomic syndrome, a search for postural hypotension, ultrasonography of urinary tract and urodynamic studies should be requested. The treatment may be symptomatic (spasticity, neurogenic bladder, intestinal constipation and neuropathic pain and specific

  1. On social death: ostracism and the accessibility of death thoughts.

    Science.gov (United States)

    Steele, Caroline; Kidd, David C; Castano, Emanuele

    2015-01-01

    Being rejected, excluded, or simply ignored is a painful experience. Ostracism researchers have shown its powerful negative consequences (Williams, 2007), and sociologists have referred to such experiences as social death (Bauman, 1992). Is this is just a metaphor or does being ostracized make death more salient in people's minds? An experiment was conducted in which participants experienced ostracism or inclusion using the Cyberball manipulation, and the accessibility of death-related thoughts was measured via a word-stem completion puzzle. Results showed enhanced death-thought accessibility in the ostracism condition, as well as a negative effect of dispositional self-esteem on the accessibility of death-related thoughts.

  2. Multi-scale mechanics of traumatic brain injury

    NARCIS (Netherlands)

    Cloots, R.J.H.

    2011-01-01

    Traumatic brain injury (TBI) can be caused by road traffic, sports-related or other types of accidents and often leads to permanent health issues or even death. For a good prevention or diagnosis of TBI, brain injury criteria are used to assess the probability of brain injury as a result of a

  3. RIPPED TO DEATH

    OpenAIRE

    Weinlich, Ricardo; Dillon, Christopher P; Green, Douglas R

    2011-01-01

    An old puzzle in the field of cell death was recently solved: the mysterious embryonic lethality of animals deficient either in caspase-8 or FADD, proteins involved in a pathway of apoptosis. This lethality is caused by a failure to develop the yolk sac vasculature rather than a lack of apoptosis. Remarkably, development is rescued by ablation of either of two Receptor Interacting Protein Kinases (RIPKs). Despite being well-known cell killers, caspase-8 and FADD act together to block RIPK-med...

  4. Hypokalemia and sudden cardiac death

    DEFF Research Database (Denmark)

    Kjeldsen, Keld

    2010-01-01

    Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient...... of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis....

  5. Brain Diseases

    Science.gov (United States)

    The brain is the control center of the body. It controls thoughts, memory, speech, and movement. It regulates the function of many organs. When the brain is healthy, it works quickly and automatically. However, ...

  6. The price of donation after cardiac death in liver transplantation : a prospective cost-effectiveness study

    NARCIS (Netherlands)

    van der Hilst, Christian S.; IJtsma, Alexander J. C.; Bottema, Jan T.; van Hoek, Bart; Dubbeld, Jeroen; Metselaar, Herold J.; Kazemier, Geert; van den Berg, Aad P.; Porte, Robert J.; Slooff, Maarten J. H.

    This study aims to perform a detailed prospective observational multicenter cost-effectiveness study by comparing liver transplantations with Donation after Brain Death (DBD) and Donation after Cardiac Death (DCD) grafts. All liver transplantations in the three Dutch liver transplant centers between

  7. Brain Aneurysm

    Science.gov (United States)

    A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they ... often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, ...

  8. Brain Development

    Science.gov (United States)

    ... Become a Member Home Early Development & Well-Being Brain Development A child’s brain undergoes an amazing period of development from birth ... neural connections each second. The development of the brain is influenced by many factors, including a child’s ...

  9. Left Brain. Right Brain. Whole Brain

    Science.gov (United States)

    Farmer, Lesley S. J.

    2004-01-01

    As the United States student population is becoming more diverse, library media specialists need to find ways to address these distinctive needs. However, some of these differences transcend culture, touching on variations in the brain itself. Most people have a dominant side of the brain, which can affect their personality and learning style.…

  10. Brain Basics: Know Your Brain

    Science.gov (United States)

    ... however, the brain is beginning to relinquish its secrets. Scientists have learned more about the brain in ... through the activity of these lobes. At the top of each temporal lobe is an area responsible ...

  11. Optimal Aging and Death

    DEFF Research Database (Denmark)

    Dalgaard, Carl-Johan Lars; Strulik, Holger

    2010-01-01

    health investments. At the same time, physiological aspects of the aging process influence optimal savings and health investment. We calibrate the model for the average US male in 2000 and proceed to show that the calibrated model accounts well for the cross-country link between labor productivity......This study introduces physiological aging into a simple model of optimal intertemporal consumption. In this endeavor we draw on the natural science literature on aging. According to the purposed theory, the speed of the aging process and the time of death are endogenously determined by optimal...... and life expectancy in the same year ("the Preston curve"); cross-country income differences can explain differences in life expectancy at age 20 of up to a decade. Moreover, technological change in health care of about 1.1% per year can account for the observed shift in the Preston curve between 1980...

  12. Organ donations after death

    Directory of Open Access Journals (Sweden)

    Bernarda Logar

    2003-09-01

    Full Text Available The paper discusses public opinion on post-mortem organ donation, especially the difference between high support of public opinion to transplant activity, its general readiness to donate organs and the low number of signed organ donor cards. Through different approaches the article tries to point out possible factors relevant to the decision to donate organs. Early studies showed demographic variables and information as significant factors when deciding to donate organs after death. As there was not enough evidence that long-term effect through these factors is significant, the need for new investigation has grown. Social cognition theories helped understanding the difference mentioned above. It seems that the use of this approach might contribute to the understanding the problem and to delimit most useful factors when working with public.

  13. Continuous sedation until death as physician-assisted suicide/euthanasia: a conceptual analysis.

    Science.gov (United States)

    Lipuma, Samuel H

    2013-04-01

    A distinction is commonly drawn between continuous sedation until death and physician-assisted suicide/euthanasia. Only the latter is found to involve killing, whereas the former eludes such characterization. I argue that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia in that both involve killing. This is established by first defining and clarifying palliative sedation therapies in general and continuous sedation until death in particular. A case study analysis and a look at current practices are provided. This is followed by a defense of arguments in favor of definitions of death centering on higher brain (neocortical) functioning rather than on whole brain or cardiopulmonary functioning. It is then shown that continuous sedation until death simulates higher brain definitions of death by eliminating consciousness. Appeals to reversibility and double effect fail to establish any distinguishing characteristics between the simulation of death that occurs in continuous sedation until death and the death that occurs as a result of physician-assisted suicide/euthanasia. Concluding remarks clarify the moral ramifications of these findings.

  14. Sugar for the brain: the role of glucose in physiological and pathological brain function.

    Science.gov (United States)

    Mergenthaler, Philipp; Lindauer, Ute; Dienel, Gerald A; Meisel, Andreas

    2013-10-01

    The mammalian brain depends upon glucose as its main source of energy, and tight regulation of glucose metabolism is critical for brain physiology. Consistent with its critical role for physiological brain function, disruption of normal glucose metabolism as well as its interdependence with cell death pathways forms the pathophysiological basis for many brain disorders. Here, we review recent advances in understanding how glucose metabolism sustains basic brain physiology. We synthesize these findings to form a comprehensive picture of the cooperation required between different systems and cell types, and the specific breakdowns in this cooperation that lead to disease. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. The aging brain and neurodegenerative disorders

    International Nuclear Information System (INIS)

    Braffman, B.H.; Trojanowski, J.Q.; Atlas, S.W.

    1991-01-01

    Both the aging brain and neurodegenerative disorders are characterized by a lack of vital endurance of affected neurons resulting in their premature death. Neuronal shrinkage or atrophy and death are normal and inevitable aspects of normal or successful aging; this is unexpected, excessive, and premature in neurodegenerative disorders. These histologic changes result in the neuroimaging findings of focal and/or diffuse atrophy with consequent enlargement of cerebrospinal fluid (CSF) spaces. The aging brain and neurodegenerative disorders share other magnetic resonance (MR) changes, i.e., markedly hypointense extrapyramidal nuclei and hyperintense white matter foci. The sequelae of senescent vascular changes result in additional characteristic features of the aging brain. This paper presents the MR and neuropathologic manifestations of both the normal aging brain and the brain affected by neurodegenerative disorders

  16. Deaths: Leading Causes for 2011.

    Science.gov (United States)

    Heron, Melonie

    2015-07-27

    This report presents final 2011 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements ‘‘Deaths: Final Data for 2011,’’ the National Center for Health Statistics’ annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2011. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD–10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2011, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer’s disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2011 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without permission

  17. Deaths: Leading Causes for 2015.

    Science.gov (United States)

    Heron, Melonie

    2017-11-01

    Objectives-This report presents final 2015 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2015," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2015. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. Results-In 2015, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Accidents (unintentional injuries); Cerebrovascular diseases; Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2015 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without

  18. Deaths: Leading Causes for 2013.

    Science.gov (United States)

    Heron, Melonie

    2016-02-16

    This report presents final 2013 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2013," the National Center for Health Statistics’ annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2013. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD–10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2013, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Accidents (unintentional injuries); Cerebrovascular diseases; Alzheimer’s disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2013 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Newborn affected by maternal complications of pregnancy; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as

  19. Deaths: Leading Causes for 2012.

    Science.gov (United States)

    Heron, Melonie

    2015-08-31

    This report presents final 2012 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2012," the National Center for Health Statistics' annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2012. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2012, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). These causes accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2012 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.

  20. Cylindromatosis mediates neuronal cell death in vitro and in vivo.

    Science.gov (United States)

    Ganjam, Goutham K; Terpolilli, Nicole Angela; Diemert, Sebastian; Eisenbach, Ina; Hoffmann, Lena; Reuther, Christina; Herden, Christiane; Roth, Joachim; Plesnila, Nikolaus; Culmsee, Carsten

    2018-01-19

    The tumor-suppressor cylindromatosis (CYLD) is a deubiquitinating enzyme and key regulator of cell proliferation and inflammation. A genome-wide siRNA screen linked CYLD to receptor interacting protein-1 (RIP1) kinase-mediated necroptosis; however, the exact mechanisms of CYLD-mediated cell death remain unknown. Therefore, we investigated the precise role of CYLD in models of neuronal cell death in vitro and evaluated whether CYLD deletion affects brain injury in vivo. In vitro, downregulation of CYLD increased RIP1 ubiquitination, prevented RIP1/RIP3 complex formation, and protected neuronal cells from oxidative death. Similar protective effects were achieved by siRNA silencing of RIP1 or RIP3 or by pharmacological inhibition of RIP1 with necrostatin-1. In vivo, CYLD knockout mice were protected from trauma-induced brain damage compared to wild-type littermate controls. These findings unravel the mechanisms of CYLD-mediated cell death signaling in damaged neurons in vitro and suggest a cell death-mediating role of CYLD in vivo.

  1. Near-death experience: arising from the borderlands of consciousness in crisis.

    Science.gov (United States)

    Nelson, Kevin R

    2014-11-01

    Brain activity explains the essential features of near-death experience, including the perceptions of envelopment by light, out-of-body, and meeting deceased loved ones or spiritual beings. To achieve their fullest expression, such near-death experiences require a confluence of events and draw upon more than a single physiological or biochemical system, or one anatomical structure. During impaired cerebral blood flow from syncope or cardiac arrest that commonly precedes near-death, the boundary between consciousness and unconsciousness is often indistinct and a person may enter a borderland and be far more aware than is appreciated by others. Consciousness can also come and go if blood flow rises and falls across a crucial threshold. During crisis the brain's prime biologic purpose to keep itself alive lies at the heart of many spiritual experiences and inextricably binds them to the primal brain. Brain ischemia can disrupt the physiological balance between conscious states by leading the brainstem to blend rapid eye movement (REM) and waking into another borderland of consciousness during near-death. Evidence converges from many points to support this notion, including the observation that the majority of people with a near-death experience possess brains predisposed to fusing REM and waking consciousness into an unfamiliar reality, and are as likely to have out-of-body experience while blending REM and waking consciousness as they are to have out-of-body experience during near-death. © 2014 New York Academy of Sciences.

  2. Parental divorce and parental death

    DEFF Research Database (Denmark)

    Marcussen, Jette; Thuen, Frode; Poul, Bruun

    2015-01-01

    The aim of this review was to identify research on children and adolescents who experience double bereavement, i.e. the experience of loss through parental divorce followed by either parental death or critical illness with imminent death. This knowledge may identify evidence to underpin knowledge......; challenges in both custodial and non-custodial parental death; risk of mental health problems, and the need of support and interventions....

  3. Deaths: leading causes for 2010.

    Science.gov (United States)

    Heron, Melonie

    2013-12-20

    This report presents final 2010 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2010. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2010, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Nephritis, nephrotic syndrome and nephrosis; Influenza and pneumonia; and Intentional self-harm (suicide). These 10 causes accounted for 75% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2010 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Necrotizing enterocolitis of newborn. Important variations in the leading causes of infant death are noted for the neonatal and post-neonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source

  4. Resenha do livro Psicoterapia interpessoal: guia prático do terapeuta Review of the book Clinician’s Quick Guide to Interpersonal Psychotherapy

    Directory of Open Access Journals (Sweden)

    Marcos Hirata Soares

    2010-01-01

    Full Text Available O livro é direcionado aos diversos profi ssionais que atuam na assistência em saúde mental e, segundo seu prefácio, a obra é resultado de 3 décadas de desenvolvimento de um método de tratamento psicoterapêutico, inicialmente para depressão maior, denominado psicoterapia interpessoal (TIP; posteriormente, passou a ser aplicado em outros transtornos psiquiátricos complexos, como o transtorno de personalidade borderline. A obra tem o objetivo de ser um guia de fácil leitura e consulta, descrevendo os métodos de abordagem e condução dos casos clínicos, mas já partindo do pressuposto de que os profi ssionais (leitores possuem conhecimento e habilidade nos fundamentos da psicoterapia e no manejo de pessoas com diagnósticos como transtornos do humor ou ansiedade, por exemplo. Cabe aqui frisar que embora não haja referência a nenhuma obra de Carl Rogers, considerado o precursor do relacionamento interpessoal como recurso pedagógico e psicoterapêutico, esta obra apresenta enorme semelhança com a teoria desse autor, mas não em relação às indicações a determinados transtornos como os do humor, as quais são feitas de forma completa, também especifi cando em cada contexto a abordagem a ser usada. O livro é muito bem elaborado, tanto do ponto de vista didático como científi co, ou seja, é um livro de fácil leitura e compreensão e com referências a artigos de periódicos de grande relevância no meio acadêmico e científico.This book is aimed at those professionals who provide mental health services. According to its preface, it was written based on a method of psychotherapeutic treatment developed over a 30-year period and called interpersonal psychotherapy (IPT. This method was initially aimed at major depression, but later it was adapted to other complex psychiatric disorders such as borderline personality. The objective of this work was to be an easy to read quick reference book, providing descriptions of the methods

  5. Parthanatos, a messenger of death

    OpenAIRE

    David, Karen Kate; Andrabi, Shaida Ahmad; Dawson, Ted Murray; Dawson, Valina Lynn

    2009-01-01

    Poly-ADP-ribose polymerase-1 (PARP-1)'s multiple roles in the cell span from maintaining life to inducing death. The processes PARP-1 is involved in include, but are not limited to DNA repair, DNA transcription, mitosis, and cell death. Of PARP-1's different cellular functions, its active role in cell death is of particular interest to designing therapies for diseases. Genetic deletion of PARP-1 revealed that PARP-1 over activation underlies cell death in experimental models of stroke, diabet...

  6. Sudden death in athletes.

    Science.gov (United States)

    Corrado, Domenico; Zorzi, Alessandro

    2017-06-15

    Competitive sports activity is associated with an increased risk of sudden cardiovascular death (SCD) in adolescents and young adults with clinically silent cardiovascular disorders. While in middle-aged/senior athletes atherosclerotic coronary artery disease accounts for the vast majority of SCDs, in young athletes the spectrum of substrates is wider and includes inherited (cardiomyopathies) and congenital (anomalous origin of coronary arteries) structural heart diseases. Inherited ion channel diseases have been implicated in SCDs occurring with an apparently normal heart at autopsy. Screening including the ECG allows identification of athletes affected by heart muscle diseases at a pre-symptomatic stage and may lead to reduction of the risk of SCD during sports. The use of modern criteria for interpretation of the ECG in the athlete offers the potential to improve the screening accuracy by reducing the number of false positives. Screening with exercise testing middle aged/senior athletes engaged in leisure sports activity is likely to be effective in patients with significant coronary risk factors, while it is not useful in low-risk subgroups. The availability of automated external defibrillator on the athletic field provides a "back-up" preventive strategy for unpredictable arrhythmic cardiac arrest, mostly occurring in patients with coronary artery diseases. Copyright © 2017. Published by Elsevier B.V.

  7. Brain glycogen

    DEFF Research Database (Denmark)

    Obel, Linea Lykke Frimodt; Müller, Margit S; Walls, Anne B

    2012-01-01

    Glycogen is a complex glucose polymer found in a variety of tissues, including brain, where it is localized primarily in astrocytes. The small quantity found in brain compared to e.g., liver has led to the understanding that brain glycogen is merely used during hypoglycemia or ischemia....... In this review evidence is brought forward highlighting what has been an emerging understanding in brain energy metabolism: that glycogen is more than just a convenient way to store energy for use in emergencies-it is a highly dynamic molecule with versatile implications in brain function, i.e., synaptic...... activity and memory formation. In line with the great spatiotemporal complexity of the brain and thereof derived focus on the basis for ensuring the availability of the right amount of energy at the right time and place, we here encourage a closer look into the molecular and subcellular mechanisms...

  8. The changing nature of death on the trauma service.

    Science.gov (United States)

    Kahl, Jessica E; Calvo, Richard Y; Sise, Michael J; Sise, C Beth; Thorndike, Jonathan F; Shackford, Steven R

    2013-08-01

    Recent innovations in care have improved survival following injury. Coincidentally, the population of elderly injured patients with preexisting comorbidities has increased. We hypothesized that this increase in elderly injured patients may have combined with recent care innovations to alter the causes of death after trauma. We reviewed demographics, injury characteristics, and cause of death of in-hospital deaths of patients admitted to our Level I trauma service from 2000 through 2011. Cause of death was classified as acute hemorrhagic shock; severe traumatic brain injury or high spinal cord injury; complications of preexisting medical condition only (PM); survivable trauma combined with complications of preexisting medical condition (TCoM); multiple-organ failure, sepsis, or adult respiratory distress syndrome (MOF/S/ARDS), or trauma not otherwise categorized (e.g., asphyxiation). Major trauma care advances implemented on our service during the period were identified, and trends in the causes of death were analyzed. Of the 27,276 admissions, 819 (3%) eligible nonsurvivors were identified for the cause-of-death analyses. Causes of death were severe traumatic brain injury or high spinal cord injury at 44%, acute hemorrhagic shock at 28%, PM at 11%, TCoM at 10%, MOF/S/ARDS at 2%, and trauma not otherwise categorized at 5%. Mean age at death increased across the study interval (range, 47-57 years), while mean Injury Severity Score (ISS) decreased (range, 28-35). There was a significant increase in deaths because of TCoM (3.3-20.9%) and PM (6.7-16.4%), while deaths caused by MOF/S/ARDS decreased from 5% to 0% by 2007. Compared with year 2000, the annual adjusted mortality rate decreased consistently starting in 2009, after the 2002 to 2007 adoption of four major trauma practice guidelines. Mortality caused by preexisting medical conditions has increased, while markedly fewer deaths resulted from the complications of injury. Future improvements in outcomes will require

  9. Causes of death in Vanuatu.

    Science.gov (United States)

    Carter, Karen; Tovu, Viran; Langati, Jeffrey Tila; Buttsworth, Michael; Dingley, Lester; Calo, Andy; Harrison, Griffith; Rao, Chalapati; Lopez, Alan D; Taylor, Richard

    2016-01-01

    The population of the Pacific Melanesian country of Vanuatu was 234,000 at the 2009 census. Apart from subsistence activities, economic activity includes tourism and agriculture. Current completeness of vital registration is considered too low to be usable for national statistics; mortality and life expectancy (LE) are derived from indirect demographic estimates from censuses/surveys. Some cause of death (CoD) data are available to provide information on major causes of premature death. Deaths 2001-2007 were coded for cause (ICDv10) for ages 0-59 years from: hospital separations (HS) (n = 636), hospital medical certificates (MC) of death (n = 1,169), and monthly reports from community health facilities (CHF) (n = 1,212). Ill-defined causes were 3 % for hospital deaths and 20 % from CHF. Proportional mortality was calculated by cause (excluding ill-defined) and age group (0-4, 5-14 years), and also by sex for 15-59 years. From total deaths by broad age group and sex from 1999 and 2009 census analyses, community deaths were estimated by deduction of hospital deaths MC. National proportional mortality by cause was estimated by a weighted average of MC and CHF deaths. National estimates indicate main causes of deaths <5 years were: perinatal disorders (45 %) and malaria, diarrhea, and pneumonia (27 %). For 15-59 years, main causes of male deaths were: circulatory disease 27 %, neoplasms 13 %, injury 13 %, liver disease 10 %, infection 10 %, diabetes 7 %, and chronic respiratory disease 7 %; and for females: neoplasms 29 %, circulatory disease 15 %, diabetes 10 %, infection 9 %, and maternal deaths 8 %. Infection included tuberculosis, malaria, and viral hepatitis. Liver disease (including hepatitis and cancer) accounted for 18 % of deaths in adult males and 9 % in females. Non-communicable disease (NCD), including circulatory disease, diabetes, neoplasm, and chronic respiratory disease, accounted for 52 % of premature deaths in adult

  10. Time trends in organ donation after neurologic determination of death: a cohort study

    Science.gov (United States)

    Kramer, Andreas H.; Baht, Ryan; Doig, Christopher J.

    2017-01-01

    Background: The cause of brain injury may influence the number of organs that can be procured and transplanted with donation following neurologic determination of death. We investigated whether the distribution of causes responsible for neurologic death has changed over time and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes. Methods: We performed a cohort study involving consecutive brain-dead organ donors in southern Alberta between 2003 and 2014. For each donor, we determined last available measures of organ injury and number of organs transplanted, and compared these variables for various causes of neurologic death. We compared trends to national Canadian data for 2000-2013 (2000-2011 for Quebec). Results: There were 226 brain-dead organ donors over the study period, of whom 100 (44.2%) had anoxic brain injury, 63 (27.9%) had stroke, and 51 (22.6%) had traumatic brain injury. The relative proportion of donors with traumatic brain injury decreased over time (> 30% in 2003-2005 v. 6%-23% in 2012-2014) (p = 0.004), whereas that with anoxic brain injury increased (14%-37% v. 46%-80%, respectively) (p organs transplanted per donor was 3.6 with anoxic brain injury versus 4.5 with traumatic brain injury or stroke (p = 0.002). Interpretation: Anoxic brain injury has become a leading cause of organ donation after neurologic determination of death in Canada. Organs from donors with anoxic brain injury have a greater degree of injury, and fewer are transplanted. These findings have implications for availability of organs for transplantation in patients with end-stage organ failure. PMID:28401114

  11. Staging Death, Translating Death, Rehearsing Death: A Photographer’s Apprenticeship in Dying

    Directory of Open Access Journals (Sweden)

    Daniela Fargione

    2010-10-01

    Full Text Available The preponderance of death imagery in the mass media and a recent interest of photography in the practice of death suggest the need to reevaluate our approach to death and dying, especially when violence is involved. This essay is a case study of History of Violence, Claudio Cravero's last photographic project. His collection of "portraits" reproduce apparent dead bodies, mostly attacked in their own domestic spheres, but neither the perpetrator of death (a mysterious murderer?, nor the weapon used (an omnipresent knife, should be considered as main focal points of the artist's inquiry. The undoubtful protagonist of these photographs, instead, is the light, that illuminates fear: not of death itself, rather of the obnoxious indifference to it, as the result of generalized death imagery saturation.     The staged apparent death displayed in Cravero's photographs serve both as a memento mori and as a strategy to come to terms with the idea of death. In short, it is an apprentship in dying through a domesticating translation practice. Eventually, Cravero's History of Violence offers a complex reflection on the interplay between each individual story and macrolevel social History, thus providing some hypotheses of where violence and death fit in that odd geometry of time and space that we call life.

  12. [Death is also life].

    Science.gov (United States)

    Belliard, F

    1985-01-01

    A nurse at the Center for Voluntary Pregnancy Interruption and Contraception in Angers, which receives 30 abortion requests each week, describes psychological aspects of nursing care for abortion patients. Abortion patients statistically are most likely to be married women around 27 years old with husbands aged 31 on average and with 2 children. Abortions are done under local anesthesia, so that there is no hiatus between the time "before" and that "after" the procedure. Women speak about their moral and physical suffering; their choice is respected by the staff. Despite the regret or mild depression that may follow an abortion, most women experience the greatest difficulty before the procedure and feel primarily relieved afterwards. Nursing work with abortion patients consists in being open to them and accompanying them for a few hours. The patients' comfort and postabortion morbidity depend largely on the reception and understanding they are given by the staff. After the procedure, the topic of contraception is discussed with the patient. Abortion and contraception cannot be dissociated because fertility regulation involves greater well-being for all members of the family. The abortion center is a place of life in which women and couples take responsibility for their sexuality and begin again. It is important not to impose beliefs or feelings about sexuality on the patient. A training which encouraged reflection on the grand problems of life and death as well as understanding of emotions, sentiments, and reactions would be helpful in gaining self knowledge and in living through events such as abortion. A meeting with a psychiatrist every 3 weeks is arranged for all staff members who desire it in order to maintain their emotional balance and work out troubling situations encountered at work. The work at the abortion center is 1 of listening and gaining the patient's confidence in order to dedramatize the abortion and permit the woman and the couple to elect an

  13. Parents bereaved by infant death

    DEFF Research Database (Denmark)

    Christiansen, Dorte M.; Elklit, Ask; Olff, Miranda

    2013-01-01

    stress disorder (PTSD) symptoms and potential correlates in 634 mothers and fathers up to 18 years (M=3.4 years) after the death of their infant. Members of a private national support organization for parents bereaved by infant death were contacted and asked to participate in the study. Participants...

  14. Death Competence: An Ethical Imperative

    Science.gov (United States)

    Gamino, Louis A.; Ritter, R. Hal, Jr.

    2012-01-01

    The authors argued that death competence, defined as specialized skill in tolerating and managing clients' problems related to dying, death, and bereavement, is a necessary prerequisite for ethical practice in grief counseling. A selected review of the literature tracing the underpinnings of this concept reveals how a robust construct of death…

  15. Guide for the development of power generation projects using renewable energy in and for municipalities; Guia para el desarrollo de proyectos de generacion de electricidad con energia renovable en y para los municipios

    Energy Technology Data Exchange (ETDEWEB)

    De Buen Rodriguez, Odon [Energia, Tecnologia y Educacion, S.C., ENTE, S.C. (Mexico)

    2010-05-15

    de 2008 y hasta noviembre de 2012, y sus lineas de cooperacion estan enfocadas a auxiliar esfuerzos locales para fomentar el desarrollo sustentable. En este sentido y como parte de las actividades especificas sobre las que se enfoca el programa durante el presente ano, se diseno la presente Guia para el Desarrollo de Proyectos de Generacion de Electricidad en Municipios, que tiene el proposito de integrar la informacion que permita a funcionarios municipales entender y actuar hacia el desarrollo de este tipo de proyectos. La presente guia esta integrada por un conjunto de modulos que detallan y explican los aspectos mas importantes relacionados con el desarrollo de estos proyectos que van desde aspectos legales hasta detalles de los costos asociados a los mismos. Esta guia esta organizada en dos secciones: una general con ocho capitulos sobre temas directamente relacionados con los proyectos, y una coleccion de anexos que describen aspectos que son pertinentes para llevar adelante proyectos de generacion de electricidad con energia renovable.

  16. Parthanatos, a messenger of death

    Science.gov (United States)

    David, Karen Kate; Andrabi, Shaida Ahmad; Dawson, Ted Murray; Dawson, Valina Lynn

    2015-01-01

    Poly-ADP-ribose polymerase-1 (PARP-1)'s multiple roles in the cell span from maintaining life to inducing death. The processes PARP-1 is involved in include, but are not limited to DNA repair, DNA transcription, mitosis, and cell death. Of PARP-1's different cellular functions, its active role in cell death is of particular interest to designing therapies for diseases. Genetic deletion of PARP-1 revealed that PARP-1 over activation underlies cell death in experimental models of stroke, diabetes, inflammation and neurodegeneration. Since interfering with PARP-1 mediated cell death will be clinically beneficial, great effort has been invested into designing PARP-1 inhibitors and understanding mechanisms downstream of PARP-1 over activation. PARP-1 overactivation may kill by depleting cellular energy through nicotinamide adenine dinucleotide (NAD+) consumption, and by releasing the cell death effector apoptosis-inducing factor (AIF). Unexpectedly, recent evidence shows that poly-ADP ribose (PAR) polymer itself, and not the consumption of NAD+ is the source of cytotoxicity. Thus, PAR polymer acts as a cell death effector downstream of PARP-1-mediated cell death signaling. We coined the term parthanatos after Thanatos, the personification of death in Greek mythology, to refer to PAR-mediated cell death. In this review, we will summarize the proposed mechanisms by which PARP-1 overactivation kills. We will present evidence for parthanatos, and the questions raised by these recent findings. It is evident that further understanding of parthanatos opens up new avenues for therapy in ameliorating diseases related to PARP-1 over activation. PMID:19273119

  17. Brain imaging

    International Nuclear Information System (INIS)

    Mishkin, F.S.

    1978-01-01

    The techniques of brain imaging and results in perfusion studies and delayed images are outlined. An analysis of the advantages and disadvantages of the brain scan in a variety of common problems is discussed, especially as compared with other available procedures. Both nonneoplastic and neoplastic lesions are considered. (Auth/C.F.)

  18. Place of death of pediatric cancer patients in a single institute during 7 years.

    Science.gov (United States)

    Yanai, Tomoko; Hirase, Satoshi; Matsunoshita, Natsuki; Yamamoto, Nobuyuki; Ninchoji, Takeshi; Kubokawa, Ikuko; Mori, Takeshi; Hayakawa, Akira; Takeshima, Yasuhiro; Iijima, Kazumoto; Matsuo, Masafumi

    2012-06-27

    Place of death is an important issue at the end-of-life. It is poorly understood in pediatric cancer patients in Japan. This study aimed to clarify place of death of children with cancer as well as variables associated with place of death. Study population was pediatric cancer patients who died in the Department of Pediatrics at Kobe University Hospital during the last 7 years. The medical records were retrospectively reviewed regardless of cause of death to derive data relating to patients' characteristics and disease. 18 patients were included. Median age at death was 12.2 years old. 6 patients including 5 children in complete remission had hematological disease and 12 patients suffered from solid tumors. 4 patients (22.2%) died at home, whereas 14 patients (77.8%) died in the hospital including 6 ICU deaths. No one died in hospices. Preference of patients was unavailable due to the lack of inquiry. Factors influencing place of death (home, ICU, non-ICU) were disease (hematological disease vs. solid tumor, p=0.010, brain tumor vs. non-brain tumor, p=0.023), disease status (complete remission vs. non-complete remission, p=0.0014) and preference of families (p=0.029). Among 6 families who expressed preference, no disparity was observed between actual and preferred place of death. This is the first English publication of place of death of pediatric cancer patients in Japan. The low percentage of home death, factors influencing place of death and the lack of disparity between actual and preferred place of death were indicated. Further studies are required to better understand place of death.

  19. Near death experiences: a multidisciplinary hypothesis.

    Science.gov (United States)

    Bókkon, István; Mallick, Birendra N; Tuszynski, Jack A

    2013-01-01

    Recently, we proposed a novel biophysical concept regarding on the appearance of brilliant lights during near death experiences (NDEs) (Bókkon and Salari, 2012). Specifically, perceiving brilliant light in NDEs has been proposed to arise due to the reperfusion that produces unregulated overproduction of free radicals and energetically excited molecules that can generate a transient enhancement of bioluminescent biophotons in different areas of the brain, including retinotopic visual areas. If this excess of bioluminescent photon emission exceeds a threshold in retinotopic visual areas, this can appear as (phosphene) lights because the brain interprets these intrinsic retinotopic bioluminescent photons as if they originated from the external physical world. Here, we review relevant literature that reported experimental studies (Imaizumi et al., 1984; Suzuki et al., 1985) that essentially support our previously published conception, i.e., that seeing lights in NDEs may be due to the transient enhancement of bioluminescent biophotons. Next, we briefly describe our biophysical visual representation model that may explain brilliant lights experienced during NDEs (by phosphenes as biophotons) and REM sleep associated dream-like intrinsic visual imageries through biophotons in NDEs. Finally, we link our biophysical visual representation notion to self-consciousness that may involve extremely low-energy quantum entanglements. This article is intended to introduce novel concepts for discussion and does not pretend to give the ultimate explanation for the currently unanswerable questions about matter, life and soul; their creation and their interrelationship.

  20. Transplantation of Hearts Donated after Circulatory Death

    Directory of Open Access Journals (Sweden)

    Christopher W. White

    2018-02-01

    Full Text Available Cardiac transplantation has become limited by a critical shortage of suitable organs from brain-dead donors. Reports describing the successful clinical transplantation of hearts donated after circulatory death (DCD have recently emerged. Hearts from DCD donors suffer significant ischemic injury prior to organ procurement; therefore, the traditional approach to the transplantation of hearts from brain-dead donors is not applicable to the DCD context. Advances in our understanding of ischemic post-conditioning have facilitated the development of DCD heart resuscitation strategies that can be used to minimize ischemia-reperfusion injury at the time of organ procurement. The availability of a clinically approved ex situ heart perfusion device now allows DCD heart preservation in a normothermic beating state and minimizes exposure to incremental cold ischemia. This technology also facilitates assessments of organ viability to be undertaken prior to transplantation, thereby minimizing the risk of primary graft dysfunction. The application of a tailored approach to DCD heart transplantation that focuses on organ resuscitation at the time of procurement, ex situ preservation, and pre-transplant assessments of organ viability has facilitated the successful clinical application of DCD heart transplantation. The transplantation of hearts from DCD donors is now a clinical reality. Investigating ways to optimize the resuscitation, preservation, evaluation, and long-term outcomes is vital to ensure a broader application of DCD heart transplantation in the future.

  1. Overdose Deaths Among Homeless Persons

    Science.gov (United States)

    ... Twitter Overdose Deaths Among Homeless Persons January 2013 Homelessness is a persistent problem—nearly 690,000 people ... will ultimately help address the tragic problem of homelessness too, as many homeless people cite drug or ...

  2. Hepatitis E and Maternal Deaths

    Centers for Disease Control (CDC) Podcasts

    Dr. Alain Labrique, assistant professor in the Department of International Health and Department of Epidemiology at the Bloomberg School of Public Health, gives us his perspective on hepatitis E and maternal deaths.

  3. Antiepileptic drugs and intrauterine death

    DEFF Research Database (Denmark)

    Tomson, Torbjörn; Battino, Dina; Bonizzoni, Erminio

    2015-01-01

    ) after prenatal AED exposure. Using EURAP data, we prospectively monitored pregnancies exposed to the 6 most common AED monotherapies and to polytherapy. Intrauterine death (spontaneous abortion and stillbirth combined) was the primary endpoint. RESULTS: Of 7,055 pregnancies exposed to monotherapy...... with lamotrigine (n = 1,910), carbamazepine (n = 1,713), valproic acid (n = 1,171), levetiracetam (n = 324), oxcarbazepine (n = 262), or phenobarbital (n = 260), and to polytherapy (n = 1,415), 632 ended in intrauterine deaths (592 spontaneous abortions and 40 stillbirths). Rates of intrauterine death were similar...... that the risk was greater with polytherapy vs monotherapy (risk ratio [RR] 1.38; 95% CI 1.14-1.66), parental history of MCMs (RR 1.92; 1.20-3.07), maternal age (RR 1.06; 1.04-1.07), and number of previous intrauterine deaths (RR 1.09; 1.00-1.19). The risk was greater with early enrollment and decreased...

  4. Life, Death, and Second Chances

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Special Section Life, Death, and Second Chances Past Issues / Fall 2007 ... that she was beginning to fear for her life. Was there any hope at all? Dr. Richard ...

  5. Death among children and adolescents

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/001915.htm Death among children and adolescents To use the sharing features on this page, ... persons of trust is very important for preventing teen suicide. HOMICIDE Homicide is a complex issue that does ...

  6. Sudden cardiac death in athletes

    Directory of Open Access Journals (Sweden)

    Fábio Camilo Pellegrino dos Santos

    2012-11-01

    Full Text Available ABSTRACT The most accepted definition of sudden cardiac death nowadays is an unexplained death occurred suddenly within one hour of symptom onset. If it was not witnessed, individuals need to had been observed for at least 24 hours before the event and should be discarded the possibility of non cardiac causes of sudden death, pulmonary embolism or extensive malignancy. The term athlete refers to individuals of any age who participate in collective or individual regular physical activity, as well as physical training program for regular competitions. The sudden death of a young athlete, whether amateur or professional, especially during competitions, is always dramatic, with strong negative social impact and in the media. The fact that sports are recommended as a formula for longevity and quality of life makes these events a cause for concern in sports and society in general.

  7. Fournier gangrene and unexpected death.

    Science.gov (United States)

    Bury, Danielle; Byard, Roger W

    2012-11-01

    Fournier gangrene represents a rare but progressive perineal infection that may result in rapid death. A 70-year-old man with poorly controlled diabetes mellitus and alcohol abuse is reported who was found unexpectedly dead. He had last been contacted the night before his death. At autopsy, the most striking finding was deep necrotic ulceration of the scrotum with exposure of underlying deep muscles and testicles, with blood cultures positive for Escherichia coli. Death was, therefore, attributed to necrotic ulceration/gangrene of the perineum (Fournier gangrene) that was due to E. coli sepsis with underlying contributing factors of diabetes mellitus and alcoholism. In addition there was morbid obesity (body mass index 46.9), cirrhosis of the liver, and marked focal coronary artery atherosclerosis with significant cardiomegaly. Fournier gangrene may be an extremely aggressive condition that can result in rapid death, as was demonstrated by the rapid progression in the reported case. © 2012 American Academy of Forensic Sciences.

  8. The ethical "elephant" in the death penalty "room".

    Science.gov (United States)

    Keane, Michael

    2008-10-01

    The United States Supreme Court recently ruled that execution by a commonly used protocol of drug administration does not represent cruel or unusual punishment. Various medical journals have editorialized on this drug protocol, the death penalty in general and the role that physicians play. Many physicians, and societies of physicians, express the opinion that it is unethical for doctors to participate in executions. This Target Article explores the harm that occurs to murder victims' relatives when an execution is delayed or indefinitely postponed. By using established principles in psychiatry and the science of the brain, it is shown that victims' relatives can suffer brain damage when justice is not done. Conversely, adequate justice can reverse some of those changes in the brain. Thus, physician opposition to capital punishment may be contributing to significant harm. In this context, the ethics of physician involvement in lethal injection is complex.

  9. 38 CFR 3.211 - Death.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Death. 3.211 Section 3..., Compensation, and Dependency and Indemnity Compensation Evidence Requirements § 3.211 Death. Death should be... community where death occurred. (2) A copy of a coroner's report of death or a verdict of a coroner's jury...

  10. Sudden death in eating disorders

    Directory of Open Access Journals (Sweden)

    Jáuregui-Garrido B

    2012-02-01

    Full Text Available Beatriz Jáuregui-Garrido1, Ignacio Jáuregui-Lobera2,31Department of Cardiology, University Hospital Virgen del Rocío, 2Behavioral Sciences Institute, 3Pablo de Olavide University, Seville, SpainAbstract: Eating disorders are usually associated with an increased risk of premature death with a wide range of rates and causes of mortality. “Sudden death” has been defined as the abrupt and unexpected occurrence of fatality for which no satisfactory explanation of the cause can be ascertained. In many cases of sudden death, autopsies do not clarify the main cause. Cardiovascular complications are usually involved in these deaths. The purpose of this review was to report an update of the existing literature data on the main findings with respect to sudden death in eating disorders by means of a search conducted in PubMed. The most relevant conclusion of this review seems to be that the main causes of sudden death in eating disorders are those related to cardiovascular complications. The predictive value of the increased QT interval dispersion as a marker of sudden acute ventricular arrhythmia and death has been demonstrated. Eating disorder patients with severe cardiovascular symptoms should be hospitalized. In general, with respect to sudden death in eating disorders, some findings (eg, long-term eating disorders, chronic hypokalemia, chronically low plasma albumin, and QT intervals >600 milliseconds must be taken into account, and it must be highlighted that during refeeding, the adverse effects of hypophosphatemia include cardiac failure. Monitoring vital signs and performing electrocardiograms and serial measurements of plasma potassium are relevant during the treatment of eating disorder patients.Keywords: sudden death, cardiovascular complications, refeeding syndrome, QT interval, hypokalemia

  11. Autoerotic death due to electrocution

    Directory of Open Access Journals (Sweden)

    Piotr Arkuszewski

    2014-08-01

    Full Text Available Autoerotic death is a very rare case in forensic medicine. It is usually caused by asphyxia, but other reasons are also possible. Herein we present a case of autoerotic death due to electrocution caused by a self-made electrical device. The device was constructed to increase sexual feelings through stimulation of the scrotal area.

  12. Faith healers, myths and deaths.

    Science.gov (United States)

    Wasti, Harihar; Kanchan, Tanuj; Acharya, Jenash

    2015-09-01

    Science and myth have been closely linked and argued upon by philosophers, educationalists, scientists, enthusiasts and the general public. Faith healing, when added as an adjuvant or alternative aid to medical science, will not necessarily be confined to mere arguments and debates but may also give rise to series of complications, medical emergencies and even result in death. We present an unusual case where reliance on faith healing led to the death of a young man. © The Author(s) 2015.

  13. Death signals by environmental pollutants

    International Nuclear Information System (INIS)

    Krug, H.F.

    2002-01-01

    Life and death are directly involved in the normal development of all multicellular organisms. Defects in the regulation of the mechanism of programmed cell death (apoptosis) contribute to many diseases as well as in the toxic effects of xenobiotics. Here it is described which elements of the apoptotic machinery are possible targets of hydrocarbons and metal compounds, prominent environmental pollutants. Moreover, it is shown that cytotoxic rather than cytostatic therapies might be most effective in treatment of cancer. (orig.)

  14. Brain tumor - primary - adults

    Science.gov (United States)

    ... Vestibular schwannoma (acoustic neuroma) - adults; Meningioma - adults; Cancer - brain tumor (adults) ... Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can start from brain cells, ...

  15. Brain Stimulation Therapies

    Science.gov (United States)

    ... Magnetic Seizure Therapy Deep Brain Stimulation Additional Resources Brain Stimulation Therapies Overview Brain stimulation therapies can play ... for a shorter recovery time than ECT Deep Brain Stimulation Deep brain stimulation (DBS) was first developed ...

  16. Brain radiation - discharge

    Science.gov (United States)

    Radiation - brain - discharge; Cancer - brain radiation; Lymphoma - brain radiation; Leukemia - brain radiation ... Decadron) while you are getting radiation to the brain. It may make you hungrier, cause leg swelling ...

  17. Quantification of cell death in developing cerebellum by a 14C tracer method

    International Nuclear Information System (INIS)

    Griffin, W.S.; Woodward, D.J.; Chanda, R.

    1978-01-01

    To study the question of whether or not cell death contributes significantly to normal or stressed postnatal brain development in a way which is biochemically quantifiable, we carried out an experiment to assess the amount of cell death in developing cerebellum. By measuring the loss of DNA content and the loss of 14 C from labelled thymidine previously incorporated into the DNA fraction (DNAF) in X-irradiated neonatal animals, shown by histological methods to have cell death to the degree of degranulating the external granular layer (EGL), we showed that when cells die both label and DNA content are greatly decreased in the cerebellum. Experiments on both normal and malnourished animals showed that cell death does not contribute significantly to cerebellar development in either malnutrition-stressed or normal animals. Here, we present a biochemical tool for assessing cell death and evidence that cell death does not contribute significantly to cerebellar development

  18. Brain abscess

    Science.gov (United States)

    ... found. However, the most common source is a lung infection. Less often, a heart infection is the cause. The following raise your chance of developing a brain abscess: A weakened immune system (such as in people ...

  19. Bibliographic review, indication guidelines of colonoscopy and its application in Costa Rica; Revision bibliografica, guias de indicacion de colonoscopia y su aplicacion en Costa Rica

    Energy Technology Data Exchange (ETDEWEB)

    Vargas Perez, Carmen

    2013-07-01

    strategies or protocols to colonoscopy. The various diagnostic methods for the detection od CRC are explained. The fecal immunohistochemical tests (FIT) to detect blood in the stool have been more specific that guaiac fecal occult blood tests (gFOBT), because of they react only with human hemoglobin. Reasonable evidence has existed that the FIT has been superior than gFOBT with respect to acceptance of the population, the detection rate and positive predictive value of adenomas and CRC. Mortality by CRC has decreased with the screening of FIT screening. The double contrast barium enema has been a valid cost-effective technique in the programs of early detection and diagnostic of colonic pathologies [Spanish] Una revision de la evidencia disponible es realizada en torno a las indicaciones apropiadas y criterios de calidad en colonoscopia. Esta revision ha servido como instrumento a los programas de deteccion temprana, diagnostico y tratamiento de las enfermedades colonicas en las unidades de endoscopia y endoscopistas que han efectuado colonoscopia. El cancer colorrectal (CCR) ha sido una enfermedad prevenible basada en los efectos de factores de riesgo manipulables y tamizaje para la deteccion temprana del mismo. La historia familiar, edad avanzada, el sexo masculino, el numero de tamano de los adenomas, la presencia de un componente velloso, la displasia de alto grado y la localizacion proximal son asociados con un aumento significativo del riesgo para CCR. La indicacion inapropiada/innecesaria del procedimiento y la falta de uniformidad de criterios, ignorando las guias clinicas internacionales de indicacion de colonoscopia, ha causado un colapso de las unidades de endoscopia en el mundo en perjuicio de la calidad. Los indicadores de calidad aplicables son definidos localmente para establecer con base en la evidencia disponible, los requisitos minimos que deben cumplir las unidades de endoscopia y endoscopistas que han participado en los programas de cribado de CCR. Una

  20. Os rankings do Guia do Estudante na educação superior brasileira: um estudo sobre as estratégias de divulgação adotadas pelas instituições que obtiveram o Prêmio Melhores Universidades

    OpenAIRE

    Lourenço, Henrique da Silva

    2014-01-01

    A presente dissertação se enquadra no campo das pesquisas em avaliação educacional e tem foco no estudo das classificações advindas do Guia do Estudante (GE), publicada pela Editora Abril. A escassez de pesquisas voltadas ao estudo da problemática torna relevante a presente investigação, na medida em que se pretende compreender como ocorre o processo de comunicação dos resultados obtidos pelas universidades brasileiras públicas e particulares (com ou sem fins lucrativos) no Prêmio Melhore...

  1. Brain imaging and brain function

    International Nuclear Information System (INIS)

    Sokoloff, L.

    1985-01-01

    This book is a survey of the applications of imaging studies of regional cerebral blood flow and metabolism to the investigation of neurological and psychiatric disorders. Contributors review imaging techniques and strategies for measuring regional cerebral blood flow and metabolism, for mapping functional neural systems, and for imaging normal brain functions. They then examine the applications of brain imaging techniques to the study of such neurological and psychiatric disorders as: cerebral ischemia; convulsive disorders; cerebral tumors; Huntington's disease; Alzheimer's disease; depression and other mood disorders. A state-of-the-art report on magnetic resonance imaging of the brain and central nervous system rounds out the book's coverage

  2. Radiosurgery for brain metastases: is whole brain radiation therapy necessary?

    International Nuclear Information System (INIS)

    Forstner, Julie M.; Sneed, Penny K.; Lamborn, Kathleen R.; Shu, H.-K.G.; McDermott, Michael W.; Park, Elaine; Ho, Maria; Chang, Susan; Gutin, Philip H.; Phillips, Theodore L.; Wara, William M.; Larson, David A.

    1996-01-01

    Purpose: Because whole brain radiotherapy (WBRT) carries a significant risk of dementia in long-term survivors, it is desirable to determine if some patients with brain metastases may be managed with radiosurgery (RS) alone, reserving WBRT for salvage therapy as needed. To begin to approach this problem, we retrospectively reviewed freedom from brain failure/progression (Brain FFP) and survival of patients with newly-diagnosed solitary or multiple brain metastases treated with Gamma Knife RS ± WBRT. Materials and Methods: All patients treated at our institution with Gamma Knife RS for newly-diagnosed solitary or multiple (2-8) brain metastases from September 1991 through December 1995 were reviewed. Whether or not WBRT was given depended on physician preference and referral patterns. Brain FFP was measured from the date of RS until development of a new brain metastasis or progression of a treated metastasis, with censoring at the time of the last imaging study. Survival was measured from the date of RS until death or last clinical follow-up. Actuarial curves were estimated using the Kaplan-Meier method and compared with the log rank test. Multivariate analyses to adjust for known prognostic variables (age, KPS, history of extracranial metastases, and total target volume) were performed using the Cox proportional hazards model. Results: From September 1991-December 1995, 90 patients with newly-diagnosed brain metastases underwent RS. Three patients treated palliatively to a small component of their intracranial disease were excluded, leaving 54 treated with RS alone and 33 treated with RS + WBRT. Age ranged from 31-83 years (median, 59 years), KPS from 60-100 (median, 90), and total target volume from 0.15-26.1 cm 3 (median, 5.5 cm 3 ). Fifty patients had a history of extracranial metastases. Results are shown below. In the RS alone group, (22(54)) patients (41%) had a brain failure and (20(54)) (37%) died without evidence of brain failure. In the RS + WBRT group

  3. Growth of melanoma brain tumors monitored by photoacoustic microscopy

    Science.gov (United States)

    Staley, Jacob; Grogan, Patrick; Samadi, Abbas K.; Cui, Huizhong; Cohen, Mark S.; Yang, Xinmai

    2010-07-01

    Melanoma is a primary malignancy that is known to metastasize to the brain and often causes death. The ability to image the growth of brain melanoma in vivo can provide new insights into its evolution and response to therapies. In our study, we use a reflection mode photoacoustic microscopy (PAM) system to detect the growth of melanoma brain tumor in a small animal model. The melanoma tumor cells are implanted in the brain of a mouse at the beginning of the test. Then, PAM is used to scan the region of implantation in the mouse brain, and the growth of the melanoma is monitored until the death of the animal. It is demonstrated that PAM is capable of detecting and monitoring the brain melanoma growth noninvasively in vivo.

  4. Glutathione in Cancer Cell Death

    Energy Technology Data Exchange (ETDEWEB)

    Ortega, Angel L. [Department of Physiology, Faculty of Medicine and Odontology, University of Valencia, 17 Av. Blasco Ibanez, 46010 Valencia (Spain); Mena, Salvador [Green Molecular SL, Pol. Ind. La Coma-Parc Cientific, 46190 Paterna, Valencia (Spain); Estrela, Jose M., E-mail: jose.m.estrela@uv.es [Department of Physiology, Faculty of Medicine and Odontology, University of Valencia, 17 Av. Blasco Ibanez, 46010 Valencia (Spain)

    2011-03-11

    Glutathione (L-γ-glutamyl-L-cysteinyl-glycine; GSH) in cancer cells is particularly relevant in the regulation of carcinogenic mechanisms; sensitivity against cytotoxic drugs, ionizing radiations, and some cytokines; DNA synthesis; and cell proliferation and death. The intracellular thiol redox state (controlled by GSH) is one of the endogenous effectors involved in regulating the mitochondrial permeability transition pore complex and, in consequence, thiol oxidation can be a causal factor in the mitochondrion-based mechanism that leads to cell death. Nevertheless GSH depletion is a common feature not only of apoptosis but also of other types of cell death. Indeed rates of GSH synthesis and fluxes regulate its levels in cellular compartments, and potentially influence switches among different mechanisms of death. How changes in gene expression, post-translational modifications of proteins, and signaling cascades are implicated will be discussed. Furthermore, this review will finally analyze whether GSH depletion may facilitate cancer cell death under in vivo conditions, and how this can be applied to cancer therapy.

  5. Brain SPECT

    International Nuclear Information System (INIS)

    Feistel, H.

    1991-01-01

    Brain SPECT investigations have gained broad acceptance since the introduction of the lipophilic tracer Tc-99m-HMPAO. Depending on equipment and objectives in different departments, the examinations can be divided into three groups: 1. Under normal conditions and standardised patient preparation the 'rest' SPECT can be performed in every department with a tomographic camera. In cerebrovascular disease there is a demand for determination of either the perfusion reserve in reversible ischemia or prognostic values in completed stroke. In cases of dementia, SPECT may yield useful results according to differential diagnosis. Central cerebral system involvement in immunologic disease may be estimated with higher sensitivity than in conventional brain imaging procedures. In psychiatric diseases there is only a relative indication for brain SPECT, since results during recent years have been contradictory and may be derived only in interventional manner. In brain tumor diagnostics SPECT with Tl-201 possibly permits grading. In inflammatory disease, especially in viral encephalitis, SPECT may be used to obtain early diagnosis. Normal pressure hydrocephalus can be distinguished from other forms of dementia and, consequently, the necessity for shunting surgery can be recognised. 2. In departments equipped for emergency cases an 'acute' SPECT can be performed in illnesses with rapid changing symptoms such as different forms of migraine, transient global amnesia, epileptic seizures (so-called 'ictal SPECT') or urgent forms like trauma. 3. In cooperation with several departments brain SPECT can be practised as an interventional procedure in clinical and in scientific studies. (orig./MG) [de

  6. Prevention of hypoglycemia-induced neuronal death by minocycline

    Science.gov (United States)

    2012-01-01

    Diabetic patients who attempt strict management of blood glucose levels frequently experience hypoglycemia. Severe and prolonged hypoglycemia causes neuronal death and cognitive impairment. There is no effective tool for prevention of these unwanted clinical sequelae. Minocycline, a second-generation tetracycline derivative, has been recognized as an anti-inflammatory and neuroprotective agent in several animal models such as stroke and traumatic brain injury. In the present study, we tested whether minocycline also has protective effects on hypoglycemia-induced neuronal death and cognitive impairment. To test our hypothesis we used an animal model of insulin-induced acute hypoglycemia. Minocycline was injected intraperitoneally at 6 hours after hypoglycemia/glucose reperfusion and injected once per day for the following 1 week. Histological evaluation for neuronal death and microglial activation was performed from 1 day to 1 week after hypoglycemia. Cognitive evaluation was conducted 6 weeks after hypoglycemia. Microglial activation began to be evident in the hippocampal area at 1 day after hypoglycemia and persisted for 1 week. Minocycline injection significantly reduced hypoglycemia-induced microglial activation and myeloperoxidase (MPO) immunoreactivity. Neuronal death was significantly reduced by minocycline treatment when evaluated at 1 week after hypoglycemia. Hypoglycemia-induced cognitive impairment is also significantly prevented by the same minocycline regimen when subjects were evaluated at 6 weeks after hypoglycemia. Therefore, these results suggest that delayed treatment (6 hours post-insult) with minocycline protects against microglial activation, neuronal death and cognitive impairment caused by severe hypoglycemia. The present study suggests that minocycline has therapeutic potential to prevent hypoglycemia-induced brain injury in diabetic patients. PMID:22998689

  7. Traumatic Brain Injury and Personality Change

    Science.gov (United States)

    Fowler, Marc; McCabe, Paul C.

    2011-01-01

    Traumatic brain injury (TBI) is the leading cause of death and lifelong disability in the United States for individuals below the age of 45. Current estimates from the Center for Disease Control (CDC) indicate that at least 1.4 million Americans sustain a TBI annually. TBI affects 475,000 children under age 14 each year in the United States alone.…

  8. OUTCOMES OF LIVER TRANSPLANTATION USING DONATIONS AFTER CIRCULATORY DEATH : A SINGLE-CENTER EXPERIENCE

    OpenAIRE

    MEURISSE, Nicolas; VANDEN BUSSCHE, S; JOCHMANS, I; FRANCOIS, J; DESSCHANS, B; LALEMAN, W; VAN DER MERWE, S; VAN STEENBERGEN, W; CASSIMAN, D; VERSLYPE, C; AERTS, R; NEVENS, F; PIRENNE, J; MONBALIU, D

    2012-01-01

    Introduction Orthotopic liver transplantation (OLT) (LTx) using donation after circulatory death (DCD) donors is increasingly performed, but still considered to risk of poorer outcomes compared with standard donations after brain death (DBD)-OLT. Therefore we reviewed our results of DCD-OLT. Patients and Methods Between 2003 and 2010, we performed 30 DCD-OLT (6% of all OLT). We retrospectively reviewed medical records of donors and recipients after DCD versus DBD-OLT to analyze bil...

  9. Improving hospital death certification in Viet Nam: results of a pilot study implementing an adapted WHO hospital death report form in two national hospitals.

    Science.gov (United States)

    Walton, Merrilyn; Harrison, Reema; Chevalier, Anna; Esguerra, Esmond; Van Duong, Dang; Chinh, Nguyen Duc; Giang, Huong

    2016-01-01

    Viet Nam does not have a system for the national collection of death data that meets international requirements for mortality reporting. It is identified as a 'no-report' country by the WHO. Verbal autopsy reports are used in the community but exclude deaths in hospitals. This project was undertaken in Bach Mai National General Hospital and Viet Duc Surgical and Trauma Hospital in Viet Nam from 1 March 2013 to 31 March 2015. In phase 1, a modified hospital death report form, consistent with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, was developed. Small group training in use of the report form was delivered to 427 doctors. In phase two, death data were collected, collated and analysed. In phase three, a random sample (7%) of all report forms was checked for accuracy and completeness against medical records. During the 23 months of the study, 3956 deaths were recorded. Across both hospitals, 222 distinct causes of deaths were recorded. Traumatic cerebral oedema was the immediate cause of death (15% of cases, 575/3956 patients), followed by septic shock (13%, 528/3956), brain compression (11%, 416/3956), intracerebral haemorrhage (8%, 336/3956) and pneumonia (5%, 186/3956); 67% (2639/3956) of patients were discharged home to die and 33% (1314/3956) of deaths were due to a road traffic accident, or injury at home or at work. This study confirms the viability of implementing a death report form system compliant with international standards in hospitals in Viet Nam and provides the foundation for introducing a national death report form scheme. These data are critical to comprehensive knowledge of causes of death in Viet Nam. Death data about patients discharged home to die is presented for the first time, with implications for countries where this is a cultural preference.

  10. Brain cancer and pesticide relationship in orchard farmers of Kashmir

    OpenAIRE

    Bhat, Abdul Rashid; Wani, Muhammed Afzal; Kirmani, A. R.

    2010-01-01

    Background: The increasing trend in the incidence of primary malignant brain tumors in orchard farmers and their families in Kashmir. Aim: To determine the relationship between the patients of primary malignant brain tumors and their occupation. Materials and Methods: Retrospectively, case files along with death certificates of 432 patients of primary malignant brain tumors and 457 controls (non-tumor neurologic diseases), admitted for treatment simultaneously over a period of 4 years from Ja...

  11. Sudden unexpected death in infancy in Denmark

    DEFF Research Database (Denmark)

    Winkel, Bo Gregers; Holst, Anders Gaarsdal; Theilade, Juliane

    2011-01-01

    Abstract Background. Incidence of sudden unexpected death in infancy (SUDI) and sudden infant death syndrome (SIDS) differs among studies and non-autopsied cases are difficult to assess. Objectives. To investigate causes of sudden death in infancy in a nationwide setting. Validate the use...... of the ICD-10 code for SIDS (R95) in the Danish Cause of Death registry. Design. A retrospective analysis of all infant deaths (death certificates and autopsy reports were read. Results. We identified 192 SUDI cases (10% of total deaths, 0.42 per 1000 births......) with autopsy performed in 87% of cases. In total, 49% of autopsied SUDI cases were defined as SIDS (5% of all deaths, 0.22 per 1000 births); Cardiac cause of death was denoted in 24% of cases. The Danish Cause of Death Registry misclassified 30% of SIDS cases. Conclusions. A large proportion of infant deaths...

  12. Death from a driverless vehicle.

    Science.gov (United States)

    Das, Siddhartha; Menezes, Ritesh G

    2018-03-01

    Road traffic accidents are a major cause of fatalities around the world, and a number of deaths are caused by moving traffic on public roads. Deaths from vehicles that are off the highway may be called non-traffic fatalities which can be due to a vehicle reversing, carbon monoxide poisoning, weather-induced over-heating inside the vehicle and electric windows. Children (and animals) are the usual victims. We report a case from India where a man was found lying dead by the roadside with a lorry nearby. The autopsy findings indicated that he had been run over, but as there was no history of a vehicular collision and with no eyewitnesses, the investigators were unsure of the probable sequence of events that led to his death. The autopsy findings, history, circumstantial evidence and chemical analysis enabled us to work out what had happened.

  13. Introduction: Mediating and Remediating Death

    DEFF Research Database (Denmark)

    Christensen, Dorthe Refslund; Sandvik, Kjetil

    2014-01-01

    In this second volume we explore how people, groups and institutions deal with death through processes of mediation (the presentation of something through media), remediation (the representation of one medium in another, see below) and mediatization (the process through which core elements...... of a social or cultural activity assume media form, see below). The volume presents a wide variety of ethnographies of death from Norway, Finland, Sweden, the US, Papua New Guinea, Bosnia and Hercegovina, Libya, Tibet, Uganda and Denmark as well as a number of online sites and social media material....... These are analyzed through a vast number of theoretical and analytical perspectives in order to investigate how very diverse practices surrounding death and dying - mourning and commemoration, ritualization, politicization, re-enactment, traditionalization, activism or documentarism: private or public, offline...

  14. Audit of practice in sudden unexpected death in epilepsy (SUDEP) post mortems and neuropathological findings

    Science.gov (United States)

    Michalak, Zuzanna; Wright, Gabriella; Dawson, Timothy; Hilton, David; Joshi, Abhijit; Diehl, Beate; Koepp, Matthias; Lhatoo, Samden; Sander, Josemir W.; Sisodiya, Sanjay M.

    2015-01-01

    Aims Sudden unexpected death in epilepsy (SUDEP) is one of the leading causes of death in people with epilepsy. For classification of definite SUDEP, a post mortem (PM), including anatomical and toxicological examination, is mandatory to exclude other causes of death. We audited PM practice as well as the value of brain examination in SUDEP. Methods We reviewed 145 PM reports in SUDEP cases from four UK neuropathology centres. Data were extracted for clinical epilepsy details, circumstances of death and neuropathological findings. Results Macroscopic brain abnormalities were identified in 52% of cases. Mild brain swelling was present in 28%, and microscopic pathologies relevant to cause or effect of seizures were seen in 89%. Examination based on whole fixed brains (76.6% of all PMs), and systematic regional sampling was associated with higher detection rates of underlying pathology (P epilepsy history and investigations. Conclusion Our findings support the contribution of examination of the whole fixed brain in SUDEP, with high rates of detection of relevant pathology. Availability of full clinical epilepsy‐related information at the time of PM could potentially further improve detection through targeted tissue sampling. Apart from confirmation of SUDEP, complete neuropathological examination contributes to evaluation of risk factors as well as helping to direct future research into underlying causes. PMID:26300477

  15. Life Experience with Death: Relation to Death Attitudes and to the Use of Death-Related Memories

    Science.gov (United States)

    Bluck, Susan; Dirk, Judith; Mackay, Michael M.; Hux, Ashley

    2008-01-01

    The study examines the relation of death experience to death attitudes and to autobiographical memory use. Participants (N = 52) completed standard death attitude measures and wrote narratives about a death-related autobiographical memory and (for comparison) a memory of a low point. Self-ratings of the memory narratives were used to assess their…

  16. Was Sigmund Freud's death hastened?

    Science.gov (United States)

    Macleod, Alastair D Sandy

    2017-08-01

    The terminal illness of Sigmund Freud has been considered by many authors to be an example of physician-enacted euthanasia. A review and a reconsideration of the published literature by Freud's doctors and biographers cast doubt on this opinion. Over his last 48 h, Freud was administered substantial morphine doses to sedate and relieve his pain. However, from a pharmacological perspective, the timing of his death would not be consistent with that of a fatal dose of opioid. Freud died a natural death. © 2017 Royal Australasian College of Physicians.

  17. Organismal death, the dead-donor rule and the ethics of vital organ procurement.

    Science.gov (United States)

    Symons, Xavier; Chua, Reginald Mary

    2018-06-19

    Several bioethicists have recently discussed the complexity of defining human death, and considered in particular how our definition of death affects our understanding of the ethics of vital organ procurement. In this brief paper, we challenge the mainstream medical definition of human death-namely, that death is equivalent to total brain failure-and argue with Nair-Collins and Miller that integrated biological functions can continue even after total brain failure has occurred. We discuss the implications of Nair-Collins and Miller's argument and suggest that it may be necessary to look for alternative biological markers that reliably indicate the death of a human being. We reject the suggestion that we should abandon the dead-donor criteria for organ donation. Rather than weaken the ethical standards for vital organ procurement, it may be necessary to make them more demanding. The aim of this paper is not to justify the dead donor rule. Rather, we aim to explore the perspective of those who agree with critiques of the whole brain and cardiopulmonary definitions of death but yet disagree with the proposal that we should abandon the dead-donor rule. We will consider what those who want to retain the dead-donor rule must argue in light of Nair-Collins and Miller's critique. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Sudden unexpected death in infancy: place and time of death.

    Science.gov (United States)

    Glasgow, J F T; Thompson, A J; Ingram, P J

    2006-01-01

    In recent years, many babies who die of Sudden Unexpected Death in Infancy (SUDI) in Northern Ireland are found dead in bed--i.e. co-sleeping--with an adult. In order to assess its frequency autopsy reports between April 1996 and August 2001 were reviewed and linked to temporal factors. The day and month of death, and the place where the baby was found were compared to a reference population of infant deaths between one week of age and the second birthday. Although the rate of SUDI was lower than the UK average, 43 cases of SUDI were identified, and two additional deaths with virtually identical autopsy findings that were attributed to asphyxia caused by suffocation due to overlaying. Thirty-two of the 45 (71%) were less than four months of age. In 30 of the 45 cases (67%) the history stated that the baby was bed sharing with others; 19 died sleeping in an adult bed, and 11 on a sofa or armchair. In 16 of the 30 (53%) there were at least two other people sharing the sleeping surface, and in one case, three. SUDI was twice as frequent at weekends (found dead Saturday-Monday mornings) compared to weekdays (psharing a place of sleep per se may not increase the risk of death, our findings may be linked to factors such as habitual smoking, consumption of alcohol or illicit drugs as reported in case-control studies. In advising parents on safer childcare practices, health professionals must be knowledgeable of current research and when, for example, giving advice on co-sleeping this needs to be person-specific cognisant of the risks within a household. New and better means of targeting such information needs to be researched if those with higher risk life-styles are to be positively influenced.

  19. Causes of death in critically ill multiple sclerosis patients.

    Science.gov (United States)

    Karamyan, A; Brandtner, H; Grinzinger, S; Chroust, V; Bacher, C; Otto, F; Reisp, M; Hauer, L; Sellner, J

    2017-10-01

    Patients with multiple sclerosis (MS) experience higher mortality rates as compared to the general population. While the risk of intensive care unit (ICU) admission is also reported to be higher, little is known about causes of death CoD in critically ill MS patients. To study the causes of death (CoD) in the series of critically ill patients with MS verified by autopsy. We reviewed hospital electronic charts of MS patients treated at the neurological ICU of a tertiary care hospital between 2000 and 2015. We compared clinical and pathological CoD for those who were autopsied. Overall, 10 patients were identified (seven female; median age at death 65 years, range 27-80), and six of them were autopsied. The median MS duration prior to ICU admission was 27.5 years (range 1-50), and the median EDSS score at the time of ICU admission was 9 (range 5-9.5). The median length of ICU stay was 3 days (range 2-213). All the individuals in our series had experienced respiratory insufficiency during their ICU stay. The autopsy examination of brain tissue did not reveal evidences of MS lesions in one patient. In another patient, Lewy bodies were found on brain immunohistochemistry. Mortality in critically ill MS patients is largely driven by respiratory complications. Sporadic disparities between clinical and pathological findings can be expected. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Naked mole-rat cortical neurons are resistant to acid-induced cell death

    OpenAIRE

    Husson, Zoé; Smith, Ewan S

    2018-01-01

    Abstract Regulation of brain pH is a critical homeostatic process and changes in brain pH modulate various ion channels and receptors and thus neuronal excitability. Tissue acidosis, resulting from hypoxia or hypercapnia, can activate various proteins and ion channels, among which acid-sensing ion channels (ASICs) a family of primarily Na+ permeable ion channels, which alongside classical excitotoxicity causes neuronal death. Naked mole-rats (NMRs, Heterocephalus glaber) are ...

  1. Alterações fisiológicas da morte encefálica em potenciais doadores de órgãos e tecidos para transplantes Los cambios fisiológicos de la muerte cerebral en potenciales donadores de órganos y tejidos para trasplante Physiological changes of brain death in potential donors of organs and tissues for transplantation

    Directory of Open Access Journals (Sweden)

    Sarah Gabriel Freire

    2012-12-01

    órnea (3,1%. Se cree que el conocimiento de estos cambios permite al equipo de atención de la salud dirigir sus acciones al potencial donador de acuerdo a sus necesidades y así mantener los órganos/tejidos viables para el trasplante.The objective was to describe the physiologic changes of brain death in potential donors of organs and tissues for transplantation. Exploratory descriptive study with prospective data and quantitative approach carried out in emergency and intensive care units hospital adult, in the period from April to October 2011. The population consisted of 32 potential donors of organs and tissues for transplantation. After approval of Ethics Committee, data were collected, tabulated and analyzed by descriptive statistics by SPSS 15.0 software and presented in tables. Physiological changes were: hypotension (100%, hypothermia (75%, hypernatremia (62,5%, diabetes insipidus (37,5%, hyperglycemia (32,3%, infection (25,0%, hypertension (9,4% and corneal ulcer (3,1%. It was found that knowledge of these changes allows the team of health care to direct the potential donors according to their needs and thus keep the organ/tissue viable for transplant.

  2. Involvement of Programmed Cell Death in Neurotoxicity of Metallic Nanoparticles: Recent Advances and Future Perspectives

    Science.gov (United States)

    Song, Bin; Zhou, Ting; Liu, Jia; Shao, LongQuan

    2016-11-01

    The widespread application of metallic nanoparticles (NPs) or NP-based products has increased the risk of exposure to NPs in humans. The brain is an important organ that is more susceptible to exogenous stimuli. Moreover, any impairment to the brain is irreversible. Recently, several in vivo studies have found that metallic NPs can be absorbed into the animal body and then translocated into the brain, mainly through the blood-brain barrier and olfactory pathway after systemic administration. Furthermore, metallic NPs can cross the placental barrier to accumulate in the fetal brain, causing developmental neurotoxicity on exposure during pregnancy. Therefore, metallic NPs become a big threat to the brain. However, the mechanisms underlying the neurotoxicity of metallic NPs remain unclear. Programmed cell death (PCD), which is different from necrosis, is defined as active cell death and is regulated by certain genes. PCD can be mainly classified into apoptosis, autophagy, necroptosis, and pyroptosis. It is involved in brain development, neurodegenerative disorders, psychiatric disorders, and brain injury. Given the pivotal role of PCD in neurological functions, we reviewed relevant articles and tried to summarize the recent advances and future perspectives of PCD involvement in the neurotoxicity of metallic NPs, with the purpose of comprehensively understanding the neurotoxic mechanisms of NPs.

  3. Biomarkers of Pediatric Brain Tumors

    Directory of Open Access Journals (Sweden)

    Mark D Russell

    2013-03-01

    Full Text Available Background and Need for Novel Biomarkers: Brain tumors are the leading cause of death by solid tumors in children. Although improvements have been made in their radiological detection and treatment, our capacity to promptly diagnose pediatric brain tumors in their early stages remains limited. This contrasts several other cancers where serum biomarkers such as CA 19-9 and CA 125 facilitate early diagnosis and treatment. Aim: The aim of this article is to review the latest literature and highlight biomarkers which may be of clinical use in the common types of primary pediatric brain tumor. Methods: A PubMed search was performed to identify studies reporting biomarkers in the bodily fluids of pediatric patients with brain tumors. Details regarding the sample type (serum, cerebrospinal fluid or urine, biomarkers analyzed, methodology, tumor type and statistical significance were recorded. Results: A total of 12 manuscripts reporting 19 biomarkers in 367 patients vs. 397 controls were identified in the literature. Of the 19 biomarkers identified, 12 were isolated from cerebrospinal fluid, 2 from serum, 3 from urine, and 2 from multiple bodily fluids. All but one study reported statistically significant differences in biomarker expression between patient and control groups.Conclusions: This review identifies a panel of novel biomarkers for pediatric brain tumors. It provides a platform for the further studies necessary to validate these biomarkers and, in addition, highlights several techniques through which new biomarkers can be discovered.

  4. Hypopituitarism after acute brain injury.

    Science.gov (United States)

    Urban, Randall J

    2006-07-01

    Acute brain injury has many causes, but the most common is trauma. There are 1.5-2.0 million traumatic brain injuries (TBI) in the United States yearly, with an associated cost exceeding 10 billion dollars. TBI is the most common cause of death and disability in young adults less than 35 years of age. The consequences of TBI can be severe, including disability in motor function, speech, cognition, and psychosocial and emotional skills. Recently, clinical studies have documented the occurrence of pituitary dysfunction after TBI and another cause of acute brain injury, subarachnoid hemorrhage (SAH). These studies have consistently demonstrated a 30-40% occurrence of pituitary dysfunction involving at least one anterior pituitary hormone following a moderate to severe TBI or SAH. Growth hormone (GH) deficiency is the most common pituitary hormone disorder, occurring in approximately 20% of patients when multiple tests of GH deficiency are used. Within 7-21 days of acute brain injury, adrenal insufficiency is the primary concern. Pituitary function can fluctuate over the first year after TBI, but it is well established by 1 year. Studies are ongoing to assess the effects of hormone replacement on motor function and cognition in TBI patients. Any subject with a moderate to severe acute brain injury should be screened for pituitary dysfunction.

  5. Análise do uso de aplicativos para o planejamento de viagens práticas no curso Técnico em Guia de Turismo no IFRS Restinga = Analysis of the use applications for practical travel planning on Technical Tour Guide Course at IFRS Restinga

    Directory of Open Access Journals (Sweden)

    Abreu, Carina Vasconcellos

    2015-01-01

    Full Text Available O presente artigo objetiva identificar e analisar o uso de recursos tecnológicos para o planejamento de viagens práticas do curso técnico em guia de turismo do IFRS Restinga. Foram selecionados três recursos considerados mais utilizados e acessíveis aos alunos: Google Maps, GPS e Waze. O curso prevê planejamento de trajetos, condições das vias e tempo de viagem, para posterior execução de atividades práticas que simulam o trabalho do guia de turismo. Cada recurso foi descrito em suas funcionalidades, limitações e possibilidades de uso no planejamento das viagens práticas, considerando possibilidade de acesso e atualização de informações. Considera-se que todos têm potencialidade para serem utilizados, inclusive de forma combinada, objetivando a inclusão digital e a instrumentalização dos alunos para o uso dos recursos

  6. Elements of healthy death: a thematic analysis.

    Science.gov (United States)

    Estebsari, Fatemeh; Taghdisi, Mohammad Hossein; Mostafaei, Davood; Rahimi, Zahra

    2017-01-01

    Background: Death is a natural and frightening phenomenon, which is inevitable. Previous studies on death, which presented a negative and tedious image of this process, are now being revised and directed towards acceptable death and good death. One of the proposed terms about death and dying is "healthy death", which encourages dealing with death positively and leading a lively and happy life until the last moment. This study aimed to explain the views of Iranians about the elements of healthy death. Methods: This qualitative study was conducted for 12 months in two general hospitals in Tehran (capital of Iran), using the thematic analysis method. After conducting 23 in-depth interviews with 21 participants, transcription of content, and data immersion and analysis, themes, as the smallest meaningful units were extracted, encoded and classified. Results: One main category of healthy death with 10 subthemes, including dying at the right time, dying without hassle, dying without cost, dying without dependency and control, peaceful death, not having difficulty at dying, not dying alone and dying at home, inspired death, preplanned death, and presence of a clergyman or a priest, were extracted as the elements of healthy death from the perspective of the participants in this study. Conclusion: The study findings well explained the elements of healthy death. Paying attention to the conditions and factors causing healthy death by professionals and providing and facilitating quality services for patients in the end stage of life make it possible for patients to experience a healthy death.

  7. Subsequent pregnancy outcome after previous foetal death

    NARCIS (Netherlands)

    Nijkamp, J. W.; Korteweg, F. J.; Holm, J. P.; Timmer, A.; Erwich, J. J. H. M.; van Pampus, M. G.

    Objective: A history of foetal death is a risk factor for complications and foetal death in subsequent pregnancies as most previous risk factors remain present and an underlying cause of death may recur. The purpose of this study was to evaluate subsequent pregnancy outcome after foetal death and to

  8. Death: ‘nothing’ gives insight

    NARCIS (Netherlands)

    Ettema, E.J.

    2013-01-01

    According to a widely accepted belief, we cannot know our own death-death means 'nothing' to us. At first sight, the meaning of 'nothing' just implies the negation or absence of 'something'. Death then simply refers to the negation or absence of life. As a consequence, however, death has no meaning

  9. HSMR : Comparing Death Rates Across UK Hospitals

    NARCIS (Netherlands)

    Ben Teeuwen; Thuy Ngo; Frans Nauta

    2011-01-01

    The Hospital Standardized Mortality Ratio (HSMR) is a measurement tool that shows hospitals’ death rates. The HSMR compares deaths that occur in hospitals with death ratios that one would normally expect based on patients’ diseases. It is used as a benchmark for adjusted hospital death rates. These

  10. Brain Fog

    Science.gov (United States)

    ... relationship with your doctor(s): • Always report changes in cognition/memory and mood (depression, anxiety). • Make sure your physician ... joint pain. • Exercise regularly. Adequate physical exercise enhances cognition/memory. • Train the Brain! “If you don’t use ...

  11. Robot brains

    NARCIS (Netherlands)

    Babuska, R.

    2011-01-01

    The brain hosts complex networks of neurons that are responsible for behavior in humans and animals that we generally call intelligent. I is not easy to give an exact definition of intelligence – for the purpose of this talk it will suffice to say that we refer to intelligence as a collection of

  12. Ordinal Position and Death Concerns.

    Science.gov (United States)

    Eckstein, Daniel; Tobacyk, Jerome

    The relationship between birth order and how a person deals with death is investigated. Both theoretical and empirical evidence indicates that birth order influences how a person deals with life tasks. First-borns appear more achievement-oriented than their younger siblings, as exemplified by the fact that disproportionately greater numbers of…

  13. Death Penalty Issues Following Atkins

    Science.gov (United States)

    Patton, James R.; Keyes, Denis W.

    2006-01-01

    In light of the U.S. Supreme Court's 2002 landmark decision in "Atkins v. Virginia," a diagnosis of mild mental retardation has taken on a life and death significance for people who are the most deeply involved in criminal justice. As such, each aspect of the mental retardation definition (American Association on Mental Retardation, 2002) is a…

  14. Actual innocence: is death different?

    Science.gov (United States)

    Acker, James R

    2009-01-01

    Supreme Court jurisprudence relies heavily on the premise that "death is different" from other criminal sanctions, and that capital cases entail commensurately demanding standards of reliability. Although invoked most frequently with respect to sentencing, both precedent and logic suggest that heightened reliability applies as well to guilt determination in capital trials. Nevertheless, recurrent and highly visible wrongful convictions in capital cases have affected public opinion, contributed to a precipitous decline in new death sentences, and led to calls for reforms designed to guard against the risk of executing innocent persons. This article examines the implications of the "death is different" doctrine for the problem of wrongful convictions in both capital and non-capital cases. It argues that innovations designed to enhance reliability in the special context of death-penalty prosecutions are important in their own right, but relevant new safeguards also should extend to criminal cases generally, where innocent people are similarly at risk and wrongful convictions are far more prevalent. (c) 2009 John Wiley & Sons, Ltd.

  15. Where Death and Glory Meet

    DEFF Research Database (Denmark)

    Duncan, Russell

    Robert Gould Shaw was one of the most celebrated heroes of the American Civil War because of his position as Colonel of the North's first African-American regiment, his abolitionist family, his death on the parapets of Fort Wagner, and the monuments and poems praising his dedication to the equality...

  16. Anaphylactic deaths in asthmatic patients.

    Science.gov (United States)

    Settipane, G A

    1989-01-01

    We reviewed seven documented deaths to peanuts and two near deaths. We excluded hearsay undocumented deaths to peanuts. Peanut allergy is one of the most common food allergies and probably the most common cause of death by food anaphylaxis in the United States. About one-third of peanut-sensitive patients have severe reactions to peanuts. Asthmatics with peanut sensitivity appear more likely to develop fatal reactions probably because of the exquisite sensitivity that asthamatics have to chemical mediators of anaphylaxis. Severe reactions occur within a few minutes of ingestion and these patients must carry preloaded epinephrine syringes, antihistamines, and medic-alert bracelets. Treatment should include repeated doses of epinephrine, antihistamines and corticosteroids as well as availability of oxygen, mechanical methods to open airways, vasopressors, and intravenous fluids. Hidden sources of peanuts such as chili, egg rolls, cookies, candy, and pastry should be recognized and identified. Scratch/prick test to peanuts are highly diagnostic. Peanut is one of the most sensitive food allergens known requiring only a few milligrams to cause a reaction. In some individuals, even contact of peanut with unbroken skin can cause an immediate local reaction. Unfortunately, peanut reaction is not outgrown and remains a life-long threat.

  17. Guia para prática clínica: fisioterapia em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC Clinical practice guideline for physical therapy in patients with Chronic Obstructive Pulmonary Disease (COPD: portuguese version

    Directory of Open Access Journals (Sweden)

    D Langer

    2009-06-01

    Full Text Available INTRODUÇÃO: No contexto da colaboração internacional para desenvolvimento de guias práticos (ou guidelines, a Sociedade Real Holandesa de Fisioterapia (Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF se propôs a desenvolver um guia para esclarecimento sobre a prática clínica de Fisioterapia em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC, assim como também optou por estimular a sua tradução para outras línguas, a fim de torná-lo acessível para públicos internacionais. OBJETIVOS: O presente guia é a versão em língua portuguesa do Guia para Prática Clínica de Fisioterapia em pacientes com DPOC desenvolvido pela KNGF, que teve como objetivo descrever a Fisioterapia baseada em evidências para pacientes com DPOC que apresentam limitação da função pulmonar, da função muscular respiratória e periférica, da capacidade de exercício, da depuração mucociliar e da qualidade de vida, além de limitações em relação à atividade física na vida diária pela dispneia e/ou intolerância ao exercício. CONCLUSÃO: O guia propõe-se principalmente a prover recomendações terapêuticas práticas que auxiliem o fisioterapeuta a oferecer o melhor tratamento possível para pacientes com DPOC, consideradas as evidências científicas disponíveis na atualidade.INTRODUCTION: In the context of international collaboration for the development of practice guidelines, the Royal Dutch Society for Physical Therapy (Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF has developed guidelines for the clinical practice of physical therapy in patients with Chronic Obstructive Pulmonary Disease (COPD. It has also stimulated its translation into other languages to make it accessible to international audiences. OBJECTIVES: The present document brings the Portuguese version of the KNGF Clinical Practice Guidelines for physical therapy in COPD patients. Its purpose was to describe evidence-based physical therapy for

  18. Understanding Brain Tumors

    Science.gov (United States)

    ... to Know About Brain Tumors . What is a Brain Tumor? A brain tumor is an abnormal growth
 ... Tumors” from Frankly Speaking Frankly Speaking About Cancer: Brain Tumors Download the full book Questions to ask ...

  19. Brain tumor - children

    Science.gov (United States)

    ... children; Neuroglioma - children; Oligodendroglioma - children; Meningioma - children; Cancer - brain tumor (children) ... The cause of primary brain tumors is unknown. Primary brain tumors may ... (spread to nearby areas) Cancerous (malignant) Brain tumors ...

  20. Brain Tumors (For Parents)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Brain Tumors KidsHealth / For Parents / Brain Tumors What's in ... radiation therapy or chemotherapy, or both. Types of Brain Tumors There are many different types of brain ...

  1. Brain and Nervous System

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Brain and Nervous System KidsHealth / For Parents / Brain and ... healthy, and remove waste products. All About the Brain The brain is made up of three main ...

  2. Recovering missing mesothelioma deaths in death certificates using hospital records.

    Science.gov (United States)

    Santana, Vilma S; Algranti, Eduardo; Campos, Felipe; Cavalcante, Franciana; Salvi, Leonardo; Santos, Simone A; Inamine, Rosemeire N; Souza, William; Consonni, Dario

    2018-04-02

    In Brazil, underreporting of mesothelioma and cancer of the pleura (MCP) is suspected to be high. Records from death certificates (SIM) and hospital registers (SIH-SUS) can be combined to recover missing data but only anonymous databases are available. This study shows how common data can be used for linkage and as an assessment of accuracy. Mesothelioma (all sites, ICD-10 codes C45.0-C45.9) and cancer of the pleura (C38.4) were retrieved from both information systems and combined using a linkage algorithm. Accuracy was examined with non-anonymous databases, limited to the state of São Paulo. We found 775 cases in death certificates and 283 in hospital registers. The linkage matched 57 cases, all accurately paired. Three cases, 0.4% in SIM and 1.3% in SIH-SUS, could not be matched because of data inconsistencies. A computer linkage can recover MCP cases from hospital records not found in death certificates in Brazil. © 2018 Wiley Periodicals, Inc.

  3. Zinc release contributes to hypoglycemia-induced neuronal death.

    Science.gov (United States)

    Suh, Sang Won; Garnier, Philippe; Aoyama, Koji; Chen, Yongmei; Swanson, Raymond A

    2004-08-01

    Neurons exposed to zinc exhibit activation of poly(ADP-ribose) polymerase-1 (PARP-1), an enzyme that normally participates in DNA repair but promotes cell death when extensively activated. Endogenous, vesicular zinc in brain is released to the extracellular space under conditions causing neuronal depolarization. Here, we used a rat model of insulin-induced hypoglycemia to assess the role of zinc release in PARP-1 activation and neuronal death after severe hypoglycemia. Zinc staining with N-(6-methoxy-8-quinolyl)-para-toluenesulfonamide (TSQ) showed depletion of presynaptic vesicular zinc from hippocampal mossy fiber terminals and accumulation of weakly bound zinc in hippocampal CA1 cell bodies after severe hypoglycemia. Intracerebroventricular injection of the zinc chelator calcium ethylene-diamine tetraacetic acid (CaEDTA) blocked the zinc accumulation and significantly reduced hypoglycemia-induced neuronal death. CaEDTA also attenuated the accumulation of poly(ADP-ribose), the enzymatic product of PARP-1, in hippocampal neurons. These results suggest that zinc translocation is an intermediary step linking hypoglycemia to PARP-1 activation and neuronal death.

  4. CAMBIO Y LA PERMANENCIA EN LOS FENÓMENOS ASOCIADOS A LA METAMORFOSIS, GUIAS DIDÁCTICAS PARA NIÑOS DE GRADO CUARTO: REFLEXIONES SOBRE LA PRODUCCIÓN DE CONOCIMIENTO DE LOS MAESTROS DE CIENCIAS

    Directory of Open Access Journals (Sweden)

    Yudy Rodriguez

    2015-12-01

    Full Text Available Esta investigación es producto de una serie de cuestionamientos que surgieron de la reflexión que sobre su propio conocimiento escolar tienen los docentes de ciencias a propósito de la producción  de  guías didácticas que permitan construir explicaciones sobre el cambio y la permanencia de los fenómenos asociados a la metamorfosis de los lepidópteros. Se evidencia como las tensiones y complejizaciones de los docentes sobre su práctica educativa y su conocimiento escolar, generan complejas, sistemáticas y diferentes formas de trabajo, recorriendo categorías que van de lo mágico religioso, pasando por explicaciones mecanicista, hasta construcciones relacional-emergentes. Se pretenden direccionar una ruta para la producción de sentido escolar en estudiantes, cuestionar lo que cambia y lo que permanece con guias tituladas: a- Animado y animado única mirada, b- la mecánica de la metamorfosis, c- Emergencia, el simbolismo de lo complejo.  También se muestra un panorama sobre la forma en que maestros y estudiantes recorren campos de producción de conocimiento análogo al surgimiento de las ciencias naturales, complejizado sus propias explicaciones, desde una mirada ingenua determinada y visible propia de las relaciones sensibles con el entorno hacia la explicación naturalista y vinculante de sustancias, con sus interacciones, relaciones, transformaciones y emergencias que permiten   explicar la metamorfosis: a- una experiencia sensible, b- detallando lo visible. Una postura naturalista, c- mirada constructiva y reconstructiva, la reflexión y resignificación.

  5. The Creative Brain.

    Science.gov (United States)

    Herrmann, Ned

    1982-01-01

    Outlines the differences between left-brain and right-brain functioning and between left-brain and right-brain dominant individuals, and concludes that creativity uses both halves of the brain. Discusses how both students and curriculum can become more "whole-brained." (Author/JM)

  6. Inequalities in Cancer Deaths by Age, Gender and Education.

    Science.gov (United States)

    Gróf, Marek; Vagašová, Tatiana; Oltman, Marián; Skladaný, Ľubomír; Maličká, Lenka

    2017-12-01

    The economy of each state provides a significant amount of money into the health care system with the aim of knowing the health status of its population in the context of socioeconomic characteristics for effective resource allocation. In recent years, there is a growing number of cancer deaths in Slovakia. Therefore, the structure of cancer deaths according to its primary determinants, such as age, sex and education with the aim of effective implementation of prevention programs in Slovakia was examined. Main source of data on deaths from 1996 to 2014 was provided by National Health Information Centre in Slovakia. However, data were available only from 2011. Standardized mortality rate per 100,000 inhabitants was estimated by the method of direct standardization using European standard population. The R project for statistical computing was used for calculation of statistically significant differences among various groups of mortality. The results show that people with primary education die from cancer later than people with higher education. However, major differences related to both sex and age are present in people with university education. A different variety of cancers occur in childhood (neoplasm of brain), adolescents (neoplasm of bone), young adults (neoplasm of brain), or adults (lung cancer and breast cancer). Malignant neoplasm of brain was more prevalent at higher education levels, Malignant neoplasm of bladder and Malignant melanoma of skin were more prevalent at the university level of education. The results can be useful for economists to define the health priorities in each country, make the financial decisions in economics, and thus contribute to better health, economic growth, as well as effective spending of health expenditures. Copyright© by the National Institute of Public Health, Prague 2017.

  7. Religiosity and the Construction of Death in Turkish Death Announcements, 1970-2009

    Science.gov (United States)

    Ergin, Murat

    2012-01-01

    Death and rituals performed after death reflect and reproduce social distinctions despite death's popular reputation as a great leveler. This study examines expressions of religiosity and constructions of death in Turkish death announcements, paying particular attention to gendered, ethnic, and temporal variations as well as markers of status and…

  8. Effectiveness of a Death-Education Program in Reducing Death Anxiety of Nursing Students.

    Science.gov (United States)

    Johansson, Noreen; Lally, Terry

    1991-01-01

    Evaluated effectiveness of death education program in reducing death anxiety experienced by 22 junior and senior nursing students. Subjects were pre- and posttested with State Form of State-Trait Anxiety Inventory and viewed film of death experience. Posttest analysis indicated that death education program was effective in decreasing death anxiety…

  9. Brain imaging

    International Nuclear Information System (INIS)

    Greenfield, L.D.; Bennett, L.R.

    1976-01-01

    Imaging with radionuclides should be used in a complementary fashion with other neuroradiologic techniques. It is useful in the early detection and evaluation of intracranial neoplasm, cerebrovascular accident and abscess, and in postsurgical follow-up. Cisternography yields useful information about the functional status of cerebrospinal fluid pathways. Computerized axial tomography is a new technique of great promise that produced a cross-sectional image of the brain

  10. Brain imaging

    International Nuclear Information System (INIS)

    Bradshaw, J.R.

    1989-01-01

    This book presents a survey of the various imaging tools with examples of the different diseases shown best with each modality. It includes 100 case presentations covering the gamut of brain diseases. These examples are grouped according to the clinical presentation of the patient: headache, acute headache, sudden unilateral weakness, unilateral weakness of gradual onset, speech disorders, seizures, pituitary and parasellar lesions, sensory disorders, posterior fossa and cranial nerve disorders, dementia, and congenital lesions

  11. [Death and the pop musician].

    Science.gov (United States)

    de Leeuw, Peter W

    2011-01-01

    Many people are inclined to believe that popular music artists are prone to die prematurely. Scientific research into this matter is scarce. There is only one epidemiological study on this subject, showing that mortality among pop stars during the first 25 years after they became famous is increased. This mortality is higher in Northern America than it is in Europe, but European pop stars die on average at an earlier age. A fairly common belief states that many pop stars die at the age of 27 years. This age has even been proclaimed as the most critical for modern musicians. However, data of several hundred deceased pop stars shows no evidence for increased mortality at the age of 27. Moreover, the data suggests that the age of death has increased over the past forty years. As far as the cause of death is concerned, overdose of drugs or alcohol rank highly next to cardiovascular disease and malignancy.

  12. Hepatitis E and Maternal Deaths

    Centers for Disease Control (CDC) Podcasts

    2012-11-06

    Dr. Alain Labrique, assistant professor in the Department of International Health and Department of Epidemiology at the Bloomberg School of Public Health, gives us his perspective on hepatitis E and maternal deaths.  Created: 11/6/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID); National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 11/7/2012.

  13. [Psychological stress and sudden death].

    Science.gov (United States)

    Pignalberi, Carlo; Ricci, Renato; Santini, Massimo

    2002-10-01

    Recent studies provide relevant evidence that psychological stress significantly influences the pathogenesis of sudden cardiac death. Psychological stress expresses a situation of imbalance, derived from a real or perceived disparity between environmental demands and the individual's ability to cope with these demands. A situation of psychological stress may include different components: personality factors and character traits, anxiety and depression, social isolation and acute or chronic adverse life events. In particular, it has been documented that a sudden extremely hard event, such as an earthquake or a war strike, can significantly increase the incidence of sudden death. Nevertheless, each one of these factors, if not present, can balance a partially unfavorable situation; this overview suggests a multifactorial situation where almost all elements are present and in which the relative influence of each one varies according to the individual examined. Sudden death occurs when a transient disruption (such as acute myocardial ischemia, platelet activation or neuroendocrine variations), occurring in a patient with a diseased myocardium (such as one with a post-necrotic scar or hypertrophy), triggers a malignant arrhythmia. Psychological stress acts at both levels: by means of a "chronic" action it contributes to create the myocardial background, while by means of an acute action it can create the transient trigger precipitating sudden death. In the chronic action two possible mechanisms can be detected: the first is a direct interaction, which contributes to cause a hypertension status or to exacerbate coronary atherosclerosis consequent to endothelial dysfunction; the second one acts through adverse health behaviors, such as a poor diet, alcohol consumption or smoking. In case of acute psychological stress, the mechanisms involved are mainly the ability to trigger myocardial ischemia, to promote arrhythmogenesis, to stimulate platelet function, and to increase

  14. Death and revival of chaos.

    Science.gov (United States)

    Kaszás, Bálint; Feudel, Ulrike; Tél, Tamás

    2016-12-01

    We investigate the death and revival of chaos under the impact of a monotonous time-dependent forcing that changes its strength with a non-negligible rate. Starting on a chaotic attractor it is found that the complexity of the dynamics remains very pronounced even when the driving amplitude has decayed to rather small values. When after the death of chaos the strength of the forcing is increased again with the same rate of change, chaos is found to revive but with a different history. This leads to the appearance of a hysteresis in the complexity of the dynamics. To characterize these dynamics, the concept of snapshot attractors is used, and the corresponding ensemble approach proves to be superior to a single trajectory description, that turns out to be nonrepresentative. The death (revival) of chaos is manifested in a drop (jump) of the standard deviation of one of the phase-space coordinates of the ensemble; the details of this chaos-nonchaos transition depend on the ratio of the characteristic times of the amplitude change and of the internal dynamics. It is demonstrated that chaos cannot die out as long as underlying transient chaos is present in the parameter space. As a condition for a "quasistatically slow" switch-off, we derive an inequality which cannot be fulfilled in practice over extended parameter ranges where transient chaos is present. These observations need to be taken into account when discussing the implications of "climate change scenarios" in any nonlinear dynamical system.

  15. Audit of practice in sudden unexpected death in epilepsy (SUDEP) post mortems and neuropathological findings.

    Science.gov (United States)

    Thom, Maria; Michalak, Zuzanna; Wright, Gabriella; Dawson, Timothy; Hilton, David; Joshi, Abhijit; Diehl, Beate; Koepp, Matthias; Lhatoo, Samden; Sander, Josemir W; Sisodiya, Sanjay M

    2016-08-01

    Sudden unexpected death in epilepsy (SUDEP) is one of the leading causes of death in people with epilepsy. For classification of definite SUDEP, a post mortem (PM), including anatomical and toxicological examination, is mandatory to exclude other causes of death. We audited PM practice as well as the value of brain examination in SUDEP. We reviewed 145 PM reports in SUDEP cases from four UK neuropathology centres. Data were extracted for clinical epilepsy details, circumstances of death and neuropathological findings. Macroscopic brain abnormalities were identified in 52% of cases. Mild brain swelling was present in 28%, and microscopic pathologies relevant to cause or effect of seizures were seen in 89%. Examination based on whole fixed brains (76.6% of all PMs), and systematic regional sampling was associated with higher detection rates of underlying pathology (P detection of relevant pathology. Availability of full clinical epilepsy-related information at the time of PM could potentially further improve detection through targeted tissue sampling. Apart from confirmation of SUDEP, complete neuropathological examination contributes to evaluation of risk factors as well as helping to direct future research into underlying causes. © 2015 The Authors. Neuropathology and Applied Neurobiology published by John Wiley & Sons Ltd on behalf of British Neuropathological Society.

  16. Leptomeningeal neurons are a common finding in infants and are increased in sudden infant death syndrome

    NARCIS (Netherlands)

    Rickert, Christian H.; Gross, Oliver; Nolte, Kay W.; Vennemann, Mechtild; Bajanowski, Thomas; Brinkmann, Bernd

    Developmental abnormalities of the brain, in particular, the brainstem potentially affecting centers for breathing, circulation and sleep regulation, are thought to be involved in the etiology of sudden infant death syndrome (SIDS). In order to investigate whether leptomeningeal neurons could serve

  17. The Near-Death Experience: A Reality Check?

    Directory of Open Access Journals (Sweden)

    Michael N. Marsh

    2016-03-01

    Full Text Available This paper critically reviews assertions that near-death and out-of-body experiences (ND/OBE offer proof of extra-corporeal existence when the brain is supposedly “dead”. While this field has almost moved away from mere anecdotal recording, the current trend is focussed on demonstrating existence without functional brains. These endeavours have fallen far short of anticipated results—that cardiac patients would report on strategically-placed markers around acute resuscitation units. Two problems arise: a failure to produce corroborative empirical evidence for extra-corporeal cognition (a when the brain is “dead”, (or “clinically dead”, so-called and (b how the memory required for recall could paradoxically be set down at that critical time-point. The view advanced here is that ND/OBE occur as subjects’ states are returning to complete resumption of conscious-awareness and which, from several published accounts, is particularly abrupt but which nevertheless accounts perfectly for memory—and recall. Similar transcendental adventures accompanying returns to conscious-awareness occur with other preceding states of reduced consciousness. Most recollections are intensely geo-physical, anthropomorphic, banal and illogical: their dream-like fantasy provides nothing revelatory about life without a brain, or importantly, about other supposed cosmic contexts. Additionally, it is proposed that since prevalence rates are so extremely low (<1% globally, the few subjects undergoing ND/OBE may have predisposed brains, genetically, structurally or resulting from previous psychological stress. In a somewhat similar vein to post-traumatic stress disorder, subjects with predisposed brains exhibit markedly changed post-experiential phenotypes, so that the ND/OBE itself could be viewed as a transient, accompanying epiphenomenon.

  18. Neuronal survival in the brain: neuron type-specific mechanisms

    DEFF Research Database (Denmark)

    Pfisterer, Ulrich Gottfried; Khodosevich, Konstantin

    2017-01-01

    Neurogenic regions of mammalian brain produce many more neurons that will eventually survive and reach a mature stage. Developmental cell death affects both embryonically produced immature neurons and those immature neurons that are generated in regions of adult neurogenesis. Removal of substantial...... numbers of neurons that are not yet completely integrated into the local circuits helps to ensure that maturation and homeostatic function of neuronal networks in the brain proceed correctly. External signals from brain microenvironment together with intrinsic signaling pathways determine whether...... for survival in a certain brain region. This review focuses on how immature neurons survive during normal and impaired brain development, both in the embryonic/neonatal brain and in brain regions associated with adult neurogenesis, and emphasizes neuron type-specific mechanisms that help to survive for various...

  19. Death: the ultimate social construction of reality.

    Science.gov (United States)

    Brabant, Sarah

    Using Berger and Luckmann's thesis (1966) on the social construction of reality as rationale, this research analyzes the death drawings of 946 university students enrolled in a Death and Dying course between 1985 and 2004 to investigate the basic constructs elicited by the word "death": dying, moment of death, after death, after life, and bereavement. Consistent with earlier research, gender, race, religion, and religiosity proved to be significant factors. As expected, personal experience with grief was strongly correlated with drawings focused on bereavement. In contrast to earlier studies, fear of death was not significantly related to a particular construct. Implications for research, education, and counseling are discussed.

  20. The calorically restricted ketogenic diet, an effective alternative therapy for malignant brain cancer

    OpenAIRE

    Zhou Weihua; Mukherjee Purna; Kiebish Michael A; Markis William T; Mantis John G; Seyfried Thomas N

    2007-01-01

    Abstract Background Malignant brain cancer persists as a major disease of morbidity and mortality in adults and is the second leading cause of cancer death in children. Many current therapies for malignant brain tumors fail to provide long-term management because they ineffectively target tumor cells while negatively impacting the health and vitality of normal brain cells. In contrast to brain tumor cells, which lack metabolic flexibility and are largely dependent on glucose for growth and su...

  1. NCHS - Leading Causes of Death: United States

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset presents the age-adjusted death rates for the 10 leading causes of death in the United States beginning in 1999. Data are based on information from all...

  2. AN ANALYSIS OF NURSING STUDENTS DEATH CONCERN

    OpenAIRE

    Tanaka, Aiko

    2000-01-01

    A questionnaire survey was conducted in order to examine characteristics of death concern of nursing, medical and general students and to campare death concern levels of nursing students across grade levels. There were 539 valid responses of the students

  3. Death in the United States, 2011

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Death in the United States, 2011 Recommend on Facebook ... 2011 SOURCE: National Vital Statistics System, Mortality. Do death rates vary by state? States experience different mortality ...

  4. Gallbladder Cancer Incidence and Death Rates

    Science.gov (United States)

    ... Campaigns Initiatives Stay Informed Gallbladder Cancer Incidence and Death Rates Recommend on Facebook Tweet Share Compartir Quick ... a late stage with a poor outcome, often death. The journal Cancer Epidemiology, Biomarkers and Prevention published ...

  5. Allegheny County Median Age at Death

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The median age at death is calculated for each municipality in Allegheny County. Data is based on the decedent's residence at the time of death, not the location...

  6. Sudden unexpected death caused by stroke

    DEFF Research Database (Denmark)

    Ågesen, Frederik Nybye; Risgaard, Bjarke; Zachariasardóttir, Sára

    2017-01-01

    Background Stroke is the fifth leading cause of death in young individuals globally. Data on the burden of sudden death by stroke are sparse in the young. Aims The aim of this study was to report mortality rates, cause of death, stroke subtype, and symptoms in children and young adults who suffered....... There was a male predominance (56%) and the median age was 33 years. The incidence of sudden death by stroke in individuals aged 1-49 years was 0.19 deaths per 100,000 person-years. Stroke was hemorrhagic in 94% of cases, whereof subarachnoid hemorrhage was the cause of death in 63% of cases. Seventeen (33%) cases...... contacted the healthcare system because of neurological symptoms, whereof one was suspected of having a stroke (6%). Conclusions Sudden death by stroke in children and young adults occurs primarily due to hemorrhagic stroke. We report a high frequency of neurological symptoms prior to sudden death by stroke...

  7. National Violent Death Reporting System (NVDRS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Violent Death Reporting System (NVDRS) provides states and communities with a clearer understanding of violent deaths to guide local decisions about...

  8. Finitude and Death - certainties denied

    Directory of Open Access Journals (Sweden)

    Maria Helena Villas Bôas Concone

    2014-11-01

    Full Text Available The themes of this issue of the Journal Kairós Gerontology seemed determined to submit the publication to opposing pressures: on one side there were the several articles and article propositions sent by many authors and distinct approaches, demanding more than ever the effort of our collaborators in the evaluation process; on the other side there were our own difficulties (technical and personnel to take forward and quickly the task and the inevitable delays. If the influx of articles clearly showed the interest and the opportunity of the journal’s proposal, the unwillingly delays seemed to confirm the denial/avoidance face of the themes of finitude and death. Indeed, it seemed to us necessary the election of these themes for reflection for obvious reasons, especially when involved in a Masters in Gerontology: the more avoided the more the reflection is needed; in case of working or having a relationship (professional or personal with many elderly, people close to death, or people facing definitive diagnosis, the avoidance perhaps brings more suffering than benefit to the parts involved. The old saying “In home of hanged don’t talk about ropes” might have its justification, but common sense and touch is needed; it is not a “folk remedy”. It always seemed to me (I do not place myself out of it that most humans think they are immortal or at least non-mortal (an indeterminate human deviation, to the extent that death and dying are pushed deep to the unconsciousness only surfacing back to consciousness in extreme situations. Death can be thought intellectually, turned into subject of literary, religious or philosophical speculation; it also can be turned into subject of anthropological, sociological or other types of investigation; it can be thought in numbers supporting epidemiological questions and population analysis; focused in cuts of gender, class, age, ethnicity; specified in causes and causes connected to each of the cuts above

  9. Death in the Modern Greek Culture

    OpenAIRE

    Pentaris, Panagiotis

    2012-01-01

    Each culture recognizes and identifies death, dying and bereavement in unique ways. Commonly, a culture may be seen through the lens of death rituals; how those are shaped, interpreted and used by the society. This paper aims to look at the Modern Greek culture and depict its ‘visualization’ of death, as well as capture the rituals that mostly identify this specific culture. The Greek culture in overall is strongly influenced by the Greek Orthodox Church. Hence, the experiences of death, dyin...

  10. Nursing students' experience of patient's death

    OpenAIRE

    Rulíková, Klára

    2016-01-01

    Reflections on student nurse's experience with death of a patient during their studies were collected in form of questionnaires. Theory and practice were compared and research conducted into the needs of students, who experienced patient's death during their studies. Research concluded with recommendation for widening the nursing course programme and adding opportunities for students to share their feelings and experiences after their patients death. Key terms: death, dying patient, study, te...

  11. WHEN DEATH INTERCEPTS LIFE IN IMAGINATIVE WRITING

    OpenAIRE

    washington, gene

    2014-01-01

    The representation of death in imaginative writing is a "virtual" (as opposed to) an actual death. It always occurs in the context of a "virtual" (represented) life. In this text the author examines some of the ways death "intercepts" life in such writing. The subject is a vast, perhaps inexhaustible, one. The richest source, one the author dos not mine, is Shakespeare's interceptions of life by death.

  12. Cryoethics: seeking life after death

    OpenAIRE

    Shaw, D.M.

    2009-01-01

    Cryonic suspension is a relatively new technology that offers those who can afford it the chance to be ‘frozen’ for future revival when they reach the ends of their lives. This paper will examine the ethical status of this technology and whether its use can be justified.\\ud \\ud Among the arguments against using this technology are: it is ‘against nature’, and would change the very concept of death; no friends or family of the ‘freezee’ will be left alive when he is revived; the considerable e...

  13. [The death of Moctezuma II].

    Science.gov (United States)

    Espinoza, R; González, C

    1995-07-01

    Moctezuma was the Aztec emperor when Spaniards arrived in Mexico in 1519. After his entrance in Tenochtitlan, Cortés held the emperor hostage, forcing him to govern under conditions in his own palace. The psychic evolution experienced by Moctezuma until his death in 1520 is analyzed based on testimonial reports of Benal Diaz del Castillo and historian contributions. Although there is evidence that Moctezuma was stoned and wounded by an arrow, we propose the hypothesis that the emperor was affected by a Major Depression.

  14. Dealing with Human Death: The Floating Perspective.

    Science.gov (United States)

    Kenyon, Gary M.

    1991-01-01

    Explores approach to dealing with human death. Describes floating perspective, based on insights from Choron and Jaspers, as suggesting it is possible to deal with human death by refraining from taking ultimate position on the problem. Position encourages openness to death. Examines role of anxiety and describes possible meaningful outcomes of…

  15. Attitudes and Experiences of Death Workshop Attendees

    Science.gov (United States)

    Kubler-Ross, Elisabeth; Worden, J. William

    1977-01-01

    Attendees at workshops and lectures were asked to complete a questionnaire which assessed the following: 1) First death experience, 2) Present conceptualization of death, 3) Anticipated reactions to a personal terminal illness, 4) Resources in managing one's own death, and 5) Difficulties experienced in working with dying persons. (Author)

  16. 22 CFR 192.51 - Death benefit.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Death benefit. 192.51 Section 192.51 Foreign Relations DEPARTMENT OF STATE HOSTAGE RELIEF VICTIMS OF TERRORISM COMPENSATION Compensation for Disability or Death § 192.51 Death benefit. (a) The Secretary of State or Agency Head may provide for payment...

  17. FastStats: Leading Causes of Death

    Science.gov (United States)

    ... Submit What's this? Submit Button NCHS Home Leading Causes of Death Recommend on Facebook Tweet Share Compartir Data are for the U.S. Number of deaths for leading causes of death Heart disease: 633,842 • Cancer: 595,930 • Chronic ...

  18. Model of transition between causes of death.

    Science.gov (United States)

    Damiani, P; Aubenque, M

    1975-06-01

    This paper describes an attempt to estimate the probabilities of transition between various major causes of death during the period 1954-1962. The regression coefficients have been estimated from French département death rates for ten main or typical causes of death, assessed by sex for the age group 45-64 years.

  19. Adolescents' Attitudes toward the Death Penalty.

    Science.gov (United States)

    Lester, David; Maggioncalda-Aretz, Maria; Stark, Scott Hunter

    1997-01-01

    Examines whether high school (n=142) and college students (n=112) favored the death penalty for certain criminal acts. Findings indicate that high school students rated more criminal acts as meriting the death penalty. Gender and personality were not found to be associated with attitudes toward the death penalty. (RJM)

  20. Death Education for the Health Professional.

    Science.gov (United States)

    Benoliel, Jeanne Quint, Ed.

    The perspectives of a number of health professionals based on their experiences in providing death education courses are presented in essays. In "Interdisciplinary Death Education in a Nursing School" (Helen L. Swain and Kathleen V. Cowles), the development of an undergraduate elective course in death, dying, and bereavement at the…