To investigate the role of nitric oxide in human sepsis, ten patients with severe septic shock requiring vasoactive drug therapy and mechanical ventilation were enrolled in a prospective, open, non-randomized clinical trial to study the acute effects of methylene blue, an inhibitor of guanylate cyclase. Hemodynamic and metabolic variables were measured before and 20, 40, 60, and 120 min after the start of a 1-h intravenous infusion of 4 mg/kg of methylene blue. Methylene blue administration caused a progressive increase in mean arterial pressure (60 [55-70] Arterial lactate concentration decreased from 5.1 ± 2.9 to 4.5 ± 2.1 mmol/ l, mean ± SD (P<0.05) after 60 min. Heart rate, cardiac filling pressures, cardiac output, oxygen delivery and consumption did not change. Methylene blue administration was safe and no adverse effect was observed. In severe human septic shock, a short infusion of methylene blue increases systemic vascular resistance and may improve myocardial function. Although there was a reduction in blood lactate concentration, this was not explained by an improvement in tissue oxygenation, since overall oxygen availability did not change. However, there was a significant increase in pulmonary vascular tone and a deterioration in gas exchange. Further studies are needed to demonstrate if nitric oxide blockade with methylene blue can be safe for patients with septic shock and, particularly, if it has an effect on pulmonary function.
This study investigates the efficiency of tax collection on operations related to the circulation of goods and interstate services (ICMS) in far east of Brazil, Paraíba State. The efficiency was estimated using quarterly data of the electronic invoices from the period of January 2013 to December 2015. In addition, we aim to identify levy’s key factors among distinct sectors, disaggregated into 489 sub-classes, according to the national classification of economic activities. It was used a stochastic frontier analysis which suggests that the average of the technical efficiency of the tax collection among sectors was 73.75% of the potential tax revenues. The amount of uncollected tax during the studied period were approximately US$7 billion. There is technical inefficiency of tax levy among important sectors of the economy of the state of Paraíba, demonstrated by 88.88% of inefficiency of tax collection itself. The sector comprehends clothing, wholesale of personal care products and leather shoes, among others. We verify that an increase of oversight actions by the tax collection agency helps to inhibit the inefficiency of tax levy.
The development of a current and temperature monitoring optical device intended to be used in high-voltage environments, particularly transmission lines, is presented. The system is intended to offer not only measurement reliability, but to be also practical and light weighted. Fiber Bragg gratings (FBGs) are employed in the measurement of both physical parameters: the current will be acquired using a hybrid sensor head setup—an FBG fixed on a magnetostrictive rod—while a single-point temperature information is provided by a dedicated grating. An inexpensive and outdoor-suitable demodulation method, such as the fixed filter technique, should be used in order to improve the instrumentation robustness, avoiding expensive and complex auxiliary electronics. The preliminary results for laboratory tests are also discussed.
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