Cause Of Death In Adults Research Articles

Decline of gastric cancer mortality in common variable immunodeficiency in the years 2018-2022.

In patients with Common Variable Immunodeficiency, malignancy has been reported as the leading cause of death in adults, with a high risk of B-cell lymphomas and gastric cancer. We conducted a five-year prospective study aiming to update the incidence and mortality of gastric cancer and the incidence of gastric precancerous lesions in 512 CVID patients who underwent a total of 400 upper gastrointestinal endoscopies. In the pre-pandemic period, 0.58 endoscopies were performed per patient/year and in the COVID-19 period, 0.39 endoscopies were performed per patient/year. Histology revealed areas with precancerous lesions in about a third of patients. Patients who had more than one gastroscopy during the study period were more likely to have precancerous lesions. Two patients received a diagnosis of gastric cancer in the absence of Helicobacter pylori infection. The overall prevalence of Helicobacter pylori infection in biopsy specimens was 19.8% and related only to active gastritis. Among patients who had repeated gastroscopies, about 20% progressed to precancerous lesions, mostly independent of Helicobacter pylori. While gastric cancer accounted for one in five deaths from CVID in our previous survey, no gastric cancer deaths were recorded in the past five years, likely consistent with the decline in stomach cancer mortality observed in the general population. However, during the COVID-19 pandemic, cancer screening has been delayed. Whether such a delay or true decline could be the reason for the lack of gastric cancer detection seen in CVID may become clear in the coming years. Due to the high incidence of precancerous lesions, we cannot rely on observed and predicted trends in gastric cancer mortality and strongly recommend tailored surveillance programs.

EVALUATION OF DOCUMENTATION SEQUENCE CAUSES PERINATAL

The Underlying cause of death is an event or condition without which the patient would not have died. The aim of the research is to determine the accuracy of writing the sequence of causes of perinatal death based on mortality rules
 The research method used in this research is descriptive research, with a retrospective approach. Data collection using observation and interviews. The research population was 50 medical record documents of patients who died perinatally in 2018-2022 using a saturated sampling technique. 
 The percentage of accuracy in writing the sequence of perinatal deaths at PKU Muhammadiyah Hospital Surakarta shows 100% inaccurate. The writing inaccuracy is due to the writing not being in accordance with the existing standart Operating Procedure, the order of perinatal death is still written on the medical certificate for the cause of adult death. 
 The accuracy of writing the order of perinatal deaths is still relatively low. It would be better if the hospital further increases its outreach activities so that medical personnel can write the order of death on the certificate correctly in accordance with the rules or standards that apply in the hospital.

Case scenario generators for trauma surgery simulation utilizing autoregressive language models

Trauma is the leading cause of death in adults under the age of 45 and the fourth leading cause of death in the United States. Effective delivery of trauma care centers on being well versed in the Advanced Trauma Life Support (ATLS) protocol, which requires high levels of clinical experience. Often this comes from having been exposed to the many permutations of common types of injuries as well as exposed to rarer scenarios, but with potential harm to patients. Case scenarios, which are sequential representations of clinical events, can help trainees receive clinical exposure without harming patients. However authoring case scenarios requires domain expertise, wide experience, and the ability to intelligently respond to inputs, and as such is currently an arduous task. Autoregressive generative models trained on large amounts of clinical data, such as the National Trauma Data Bank (NTDB), pose a possible solution to overcome the cost of authorship while providing broad and accessible clinical experience to trainees. We have developed a Trauma AI model composed of an autoregressive generative model based on the transformer architecture for generating potential case scenario combined with an out-of-domain detection for filtering out less plausible scenarios. The GPT2 model is trained on 1.1 million case scenarios derived from the NTDB data. We demonstrate that Trauma AI is capable of generating realistic case scenarios that encode the ATLS protocol as a latent feature of the sequence of provider interventions, including scenarios that do not have any parallels in the original dataset. We also present an unsupervised means of filtering out unrealistic sequences by identifying out-of-domain sequences, and demonstrate that this improves the realism of the generated case scenarios.

Versatile strategies for adult neurogenesis: avenues to repair the injured brain.

Brain injuries due to trauma or stroke are major causes of adult death and disability. Unfortunately, few interventions are effective for post-injury repair of brain tissue. After a long debate on whether endogenous neurogenesis actually happens in the adult human brain, there is now substantial evidence to support its occurrence. Although neurogenesis is usually significantly stimulated by injury, the reparative potential of endogenous differentiation from neural stem/progenitor cells is usually insufficient. Alternatively, exogenous stem cell transplantation has shown promising results in animal models, but limitations such as poor long-term survival and inefficient neuronal differentiation make it still challenging for clinical use. Recently, a high focus was placed on glia-to-neuron conversion under single-factor regulation. Despite some inspiring results, the validity of this strategy is still controversial. In this review, we summarize historical findings and recent advances on neurogenesis strategies for neurorepair after brain injury. We also discuss their advantages and drawbacks, as to provide a comprehensive account of their potentials for further studies.

Effect of High Intensity Interval Training (HIIT) on VO2 Max in Young Adult: Literature Review

Cardiovascular disease (CVD) is the main cause of death for adults in the world. CVD in the future will be one of the problems that will persist in long term. Someone who has high cardiorespiratory fitness (CRF) and VO2 max has a low risk of developing CVD. One aspect of CVD prevention is exercise to improve cardiorespiratory fitness. High intensity interval training (HIIT) is an exercise that has many benefits, one of which is increasing cardiovascular fitness by increasing VO2 max. With an increase in VO2 max, the risk for CVD will decrease and better prevention is begin at a young age. The purpose of this study is to analyze the effect of High Intensity Interval Training (HIIT) on VO2 max levels in young adult. The research method uses a Literature Review study. Data collection through Pubmed, Science direct, and Google Scholar within the last 10 years. There were 668 articles were obtained which were then screened so that 7 articles with various types of research such as comparative studies, randomized control trials and clinical trials, were suitable to be reviewed. The results showed that High Intensity Interval Training (HIIT) affected in increasing VO2 max. This is related to Reactive oxygen species (ROS) which will later affect the body's adaptive response. High Intensity Interval Training (HIIT) is better in increasing VO2 max compared to other exercise.

Cause of death in fatal missing person cases in England and Wales

Typically, fewer than 0.5% of missing incidents result in an individual being found deceased. Whereas previous research has examined the features of missing–homicide, missing–suicide and some aspects of missing–accident cases, this study sought to provide the first reliable estimates of the number and proportion of fatalities by all causes of death, specifically: suicide, accident, homicide and natural causes. Using data obtained on 615 fatal disappearances via Freedom of Information returns from 22 English and Welsh police forces covering a two-year period, this article presents data on the relative probability of fatality by cause of death for adults and children and for males and females. Overall, fatal outcomes are, thankfully, rare, occurring once in every 358 missing incidents. Some 98% of fatalities involved adults; just over 80% involved males. The findings affirm suicide as the largest single cause of death accounting for three-quarters of female fatalities and four in every five male fatalities. Although homicide was the least probable cause of death among male missing persons, females faced a roughly similar chance of dying as a result of an accident or homicide. The research indicates that estimates of probability can be used to inform investigative decision-making and scenario development, offering important context to the overall likelihood of an individual facing a fatal outcome. Further research is needed to replicate these findings.

Chemotherapy and radiofrequency hyperthermia (oncothermia) in the treatment of metastatic colorectal cancer.

e15569 Background: Colorectal cancer (CRC) is the second leading cause of death in adults. Standard treatment for metastatic disease includes chemotherapy and biological agents. Although more than 50% of patients respond to multi agent chemotherapy, resistance to treatment is a significant problem and more than 85 % of patients die within five years. Radiofrequency hyperthermia (Oncothermia- OT) is a non-invasive treatment modality which utilizes 13 MHz external radiofrequency waves to selectively heat cancer cells to 45 C, contributing to apoptosis, and aggregation of DNA repair enzymes, potentially overcoming resistance and improving chemotherapy efficacy. It has been used alone or in combination with chemotherapy. Since most metastatic CRC patients have disease limited to the abdominal cavity and liver, Oncothermia can be applied with a single electrode covering the entire abdominal cavity, immediately following chemotherapy without additional side effects. Methods: We treated 25 consecutive CRC patients with disease limited to liver and/or abdominal cavity with chemotherapy and biological agents and concomitant weekly OT (Oncotherm-EHY 3010) for one hour to the whole abdomen. Chemotherapy was FOLFIRI in 2, FOLFOX in 6, FOLFIRINOX in 17. Bevacizumab was used with chemotherapy in 22 and cetuximab in 1 patient. Patients were followed by periodic CT/MRI/PET-CT. Treatment duration ranged from 4 to 60 months. Results: No unexpected or grade III-IV toxicity was observed. Complete response was observed in 3 patients, partial response in 21 patients and stable disease in one patient for an objective response rate of 96%. Median follow up is 20.1 months (range 4-82+ months). 16 patients are alive, 3 with no disease and 13 on treatment. 9 patients have died. Conclusions: Although this is a single center retrospective observation, the combination of chemotherapy with Oncothermia appears tolerable and feasible in metastatic CRC. Despite the limitations of this observation, activity of this multi-modality treatment appears promising. Prospective randomized trials are needed to confirm these findings.

Determinants of ventricular arrhythmias in sickle cell anemia: toward better prevention of sudden cardiac death

AbstractSudden death is 1 of the leading causes of death in adults with sickle cell anemia (SCA) but its etiology remains mostly unknown. Ventricular arrhythmia (VA) carries an increased risk of sudden death; however, its prevalence and determinants in SCA are poorly studied. This study aimed to identify the prevalence and predictors of VA in patients with SCA. From 2019 to 2022, 100 patients with SCA were referred to the physiology department to specifically analyze cardiac function and prospectively included in the DREPACOEUR registry. They underwent a 24-hour electrocardiogram monitoring (24h-Holter), transthoracic echocardiography, and laboratory tests on the same day. The primary end point was the occurrence of VA, defined as sustained or nonsustained ventricular tachycardia (VT), >500 premature ventricular contractions (PVCs) on 24h-Holter, or a recent history of VT ablation. The mean patient age was 46 ± 13 years, and 48% of the patients were male. Overall, VA was observed in 22 (22%) patients. Male sex (81% vs 34%; P = .02), impaired global longitudinal strain (GLS): –16% ± 1.9% vs –18.3% ± 2.7%; P = .02), and decreased platelet count (226 ± 96 giga per liter [G/L] vs 316 ± 130 G/L) were independently associated with VA. GLS correlated with PVC load every 24 hours (r = 0.39; P < .001) and a cutoff of –17.5% could predict VA with a sensitivity of 82% and a specificity of 63%. VAs are common in patients with SCA, especially in men. This pilot study uncovered GLS as a valuable parameter for improving rhythmic risk stratification.

Determinantes Sociales de la Salud que influyen en la incidencia/prevalencia de las enfermedades cardiovasculares

Introduction: Germany, the United States and Brazil are the countries with the highest mortality rates due to cardiovascular disease (CVD). In Chile, they represent the leading cause of death in adults. There are structural and intermediate determinants that interfere in the incidence and prevalence of CVD. Objective: To describe the influence of social determinants of health (SDH) on the incidence and prevalence of CVD in adults. Methods: This was a systematic review. The question was elaborated according to the PICO acronym. The PubMed and Virtual Health Library (VHL) databases were used. For PubMed, the search was constructed using the descriptors MeSH, Adult, Cardiovascular Disease, Social Determinants of Health. For VHL, by means of DeCS, Cardiovascular Disease, Social Determinants of Health, Adult in Spanish, English and Portuguese. For both searches, in combination with keywords and Boolean operators AND and OR. All references were imported into EndNote. The methodological quality of the studies was evaluated according to JBI Critical Appraisal tools. Deductive thematic analysis of the data was performed. Results: A total of 834 articles were identified and 31 included. The structural determinants identified were race, sex, socioeconomic level and educational level. The intermediate determinants identified were rurality, comorbidities, mental health factors and the presence of unhealthy habits. Conclusions: Low socioeconomic and educational level were the structural DSS identified. Poor mental health and the presence of unhealthy habits were intermediate DSS that influenced the incidence and prevalence of CVD.

Vasotoxic Effects of Anticancer Therapy: a Review of Current Data

Cardiovascular and oncological diseases are the leading causes of adult death in the world. Despite proven efficacy, anticancer drugs can cause severe cardiovascular complications. Recently, data have appeared on the possible vasotoxic effects of chemotherapy drugs, which can manifest themselves as the progression of arterial hypertension and atherosclerosis, the development of myocardial ischemia and acute coronary syndrome, the formation of venous and arterial thrombosis. The key mechanism for the development of vasotoxicity is endothelial dysfunction, and anticancer drugs can also affect the processes of thrombosis. The review presents the results of 12 selected observational retro- and prospective studies involving cancer patients receiving presumably vasotoxic therapy. Data on the frequency of occurrence and possibilities for the prevention of vasotoxicity are presented.

Research Progress of Vagus Nerve Stimulation in Stroke Rehabilitation Treatment

<i>Background: </i>Stroke is the leading cause of adult death in China and the leading cause of death worldwide, characterized by high morbidity, disability, mortality, recurrence and economic burden, often leading to various functional impairments, such as motor impairment, sensory impairment, swallowing impairment, consciousness impairment and cognitive impairment. Therefore, finding effective intervention methods is currently a hot and difficult issue in stroke rehabilitation treatment. Vagus nerve stimulation, as a classical neuromodulation technique, has been widely certified for its safety and effectiveness. In recent years, several studies at home and abroad have reported that VNS can be used as a potential rehabilitation treatment to improve functional impairment after stroke. <i>Objective:</i> In this paper, the clinical application of vagus nerve stimulation in different dysfunctions after stroke is discussed in the context of relevant studies at home and abroad, and the effectiveness, safety and possible mechanisms of action of VNS in stroke treatment are reviewed, aiming to provide new therapeutic ideas for stroke rehabilitation. <i>Conclusion: </i>Vagus nerve stimulation, a classical neuromodulation technique, can help improve various dysfunctions after stroke and improve patients' survivability and quality of life. Vagus nerve stimulation is expected to be a potential new therapy for stroke rehabilitation and play an important role in the rehabilitation of post-stroke dysfunction.

Positive Allosteric Modulation of Antithrombin's Inhibitory Activity by RNA Aptamers.

The leading cause of death in adults in the United States is cardiovascular disease, with mortality and morbidity mainly attributed to thromboembolism. Heparin is the most common therapy used for treating venous and arterial thrombosis. Heparin effectively accelerates the inhibition of coagulation proteases thrombin and factor Xa through the serine protease inhibitor (serpin) antithrombin (AT). Heparin is an essential therapeutic anticoagulant because of its effectiveness and the availability of protamine sulfate as an antidote. However, heparin therapy has several limitations. Thus, new anticoagulants, including direct thrombin inhibitors (ie, argatroban) and low-molecular-weight heparins (ie, fondaparinux), are used to treat some thromboembolic disorders. We developed and characterized a family of novel RNA-based aptamers that bind AT using two novel selection schemes. One of the aptamers, AT-16, accelerates factor Xa inhibition by AT in the absence of heparin. AT-16's effect on thrombin inhibition by AT is less effective compared to factor Xa. AT-16 induces a conformational change in AT that is different from that induced by heparin. This study demonstrates that an AT-specific RNA aptamer, AT-16, exhibits a positive allosteric modulator effect on AT's inhibition of factor Xa.

GeneXpert and Acid-Fast Bacilli Smear for Diagnosis of Pulmonary Tuberculosis in a Tertiary Care Center of Rural Nepal

Introduction: Mycobacterium tuberculosis is the second most infectious cause of death in adults globally and is major health trouble in Nepal. The diagnosis of pulmonary tuberculosis is mainly carried by acid-fast bacilli smear microscopy, culture on Lowenstein–Jensen media, and GeneXpert MTB/RIF assay. This study aimed to evaluate the GeneXpert MTB/RIF and Acid-Fast Bacilli stain smear used for the diagnosis of pulmonary tuberculosis.&#x0D; Methods: A cross-sectional study was performed at Karnali Academy of Health Sciences, Jumla, from July 2021 to June 2022. Our study population comprised 390 probable cases of pulmonary tuberculosis from the ages of 2 to 92 years. A total of 390 sputum specimens from suspected presumptive tuberculosis sufferers were tested using the direct smear staining technique of Acid-Fast Bacilli stain smear and GeneXpert for the detection of MTB/RIF. The GeneXpert MTB/RIF technique was compared with the Acid-Fast Bacilli stain smear. Patient’s demographic details, sputum AFB smear, and GeneXpert test results were collected and entered in working Performa. Data were analyzed using SPSS 16.0.&#x0D; Results: Out of 390 samples 13.84% were positive for Mycobacterium tuberculosis via GeneXpert MTB/RIF assay while 5.12% were positive through AFB microscopy which was statistically significant (p&lt;.0001). When compared with GeneXpert, taking GeneXpert as the gold standard in the rural setup of Nepal the sensitivity of AFB staining was 37.03%, while its specificity was 90.81%.&#x0D; Conclusions: GeneXpert MTB/RIF is a rapid test that can aid in the timely diagnosis of Mycobacterium tuberculosis, facilitating the timely treatment in the rural area.

Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness.

Trauma remains one of the leading causes of death in adults despite the implementation of preventive measures and innovations in trauma systems. The etiology of coagulopathy in trauma patients is multifactorial and related to the kind of injury and nature of resuscitation. Trauma-induced coagulopathy (TIC) is a biochemical response involving dysregulated coagulation, altered fibrinolysis, systemic endothelial dysfunction, platelet dysfunction, and inflammatory responses due to trauma. The aim of this review is to report the pathophysiology, early diagnosis and treatment of TIC. A literature search was performed using different databases to identify relevant studies in indexed scientific journals. We reviewed the main pathophysiological mechanisms involved in the early development of TIC. Diagnostic methods have also been reported which allow early targeted therapy with pharmaceutical hemostatic agents such as TEG-based goal-directed resuscitation and fibrinolysis management. TIC is a result of a complex interaction between different pathophysiological processes. New evidence in the field of trauma immunology can, in part, help explain the intricacy of the processes that occur after trauma. However, although our knowledge of TIC has grown, improving outcomes for trauma patients, many questions still need to be answered by ongoing studies.

Effectiveness of mental practice for limb dysfunction in patients who have experienced a stroke: a systematic review and meta-analysis.

Stroke is the second largest cause of death in adults and the principal cause of long-term severe adult disability worldwide. Approximately 70% of patients present with upper limb weakness following stroke. One intervention for the treatment of upper limb impairment post-stroke is mental practice. This article critically appraises a systematic review which assesses the effectiveness of mental practice for limb dysfunction in patients who have experienced stroke.

Assessment of the underlying causes of adult deaths using a short version of verbal autopsy in Xaiyabouli Province, Lao People’s Democratic Republic

BackgroundIn developing countries, it is difficult to collect the data of the underlying cause of death (UCOD), especially when a death does not occur in a health facility. This study aimed to develop a short version of verbal autopsy (VA) and identify the UCOD of adults in Lao People’s Democratic Republic (Lao PDR).MethodsA short version of VA for deaths outside health facilities was developed. This study included all deaths of people aged 15 years old or older in Xaiyabouli Province in 2020. Socio-demographic factors, place of death, and UCOD of the deceased were collected from health facilities or from family members using a questionnaire including the short VA form. UCOD was compared between home deaths and hospital deaths, between the age group of 15–59 years old and the age group ≥ 60 years old, and between males and females.ResultsOf all the 1,235 deaths included in this study, 1,012 deaths (81.9%) occured at home and 223 deaths (18.1%) at hospitals. The most common UCOD was senility (13.3%), followed by heart/renal failure (10.5%), pneumonia (9.6%) and traffic accident (7.1%). Compared to hospital deaths, home deaths had more people who were females, 75 years old or older, and Lao-Tai. Home deaths had more deaths than hospital deaths due to accident/injury (16.0% vs. 8.1%), tumor (4.7% vs. 1.8%), and senility (16.2% vs. 0%); fewer deaths due to heart/renal disease (15.1% vs. 32.3%), respiratory disease (12.2% vs. 18.8%), liver/gastro-intestine disease (5.3% vs. 9.0%), and infection (3.1% vs. 14.3%). The age group of 15–59 years had more deaths in the categories of accident/injury (28.1% vs. 4.4%), liver/gastro-intestine disease (8.1% vs. 4.4%), infection (7.2% vs. 3.5%), and tumor (6.0% vs. 2.8%). Males had more deaths due to tumor (5.2% vs. 3.0%) and fewer natural deaths (11.2% vs. 15.9%) than females.ConclusionsThe major UCOD category was heart/renal disease in the adult generation in Xaiyabouli Province. Cost-effective interventions based on the multisectoral noncommunicable disease prevention plan should be appropriately implemented. Mortality surveillance using the short VA tool should be conducted for all home deaths in Lao PDR.

Supporting Healthy Aging and Older Adult Health: The Role of State and Territorial Health Agencies.

Supporting Healthy Aging and Older Adult Health: The Role of State and Territorial Health Agencies.

Paneth Cells and Lgr5+ Intestinal Stem Cells in Radiation Enteritis

Cancer is the leading cause of death in adults and majority of cancers involve abdominal and pelvic organs. Radiotherapy is used in the management of around half of patients who have abdominal and pelvic malignancies and 70% of the treated patients will develop radiation enteritis. The onset of radiation enteritis may delay the completion of treatment or lead to life-threatening conditions such as bowel perforation or obstruction. High-dose ionizing radiation can affect all the layers of the small intestine leading to weakening of its structural integrity, dysbiosis, malabsorption, and derangement of the innate immunity. Advances in the management of cancer has not led to an improvement in the treatment of radiation enteritis as the available preventative or treatment options are still ineffective. Severe acute and chronic radiation enteritis result from the damage to the crypt-based intestinal stem cells and their derivatives, which include the Paneth cells. Paneth cells regulate the proliferation and differentiation of the intestinal stem cells. The other roles of the Paneth cells are protection and nourishment of the intestinal stem cells, and control of the gut microbiota. Paneth cells can also de-differentiate and replace irreversibly damaged intestinal stem cells. This article reviews the anatomy of the epithelium of the small intestine and the intestinal epithelial cells including the Paneth cells. The effect of ionizing radiation on the intestinal stem cells and its derivatives, and the knowledge can be used to develop effective treatment of radiation enteritis is discussed.

Causes and trends of adult mortality in southern Ethiopia: an eight-year follow up database study

BackgroundBroad and specific causes of adult mortalities are often neglected indicators of wellbeing in low-income countries like Ethiopia due to lack of strong vital statistics. Thus, this database study aimed to assess the causes of adult mortality using demographic surveillance data.MethodsAn 8-year (12 September 2009–11 September 2017) surveillance data from the Arba Minch Health and Demographic Surveillance Site was used for this study. Verbal autopsy methods and ICD codes were used to identify the causes of the adult deaths. The collected data were entered to the database by data clerks. We used Microsoft Excel and STATA version 16 software for data cleaning and analysis. Chi-squared test was used to see the significances of the trend analyses.ResultFrom the 943 adult deaths from 2009 to 2017 in the Health and Demographic Surveillance Site in southern Ethiopia, more than half of them were females. The specific leading cause of death in the adults were tuberculosis (16.8%), malaria (9.7%), and intestinal infectious diseases (9.6%).Communicable diseases (49.2%, 95% C.I 45.7, 52.7) accounted for about half of the deaths followed by non-communicable diseases (35%, 95% C.I 31.7, 38.4) where both categories showed an increasing trend.ConclusionAlthough pieces of evidences are showing the shift from communicable diseases to non-communicable diseases as the major causes of adult death in developing countries, this study showed that communicable diseases are still the major causes of adult deaths. Efforts and emphasis should be given to control infectious diseases such as tuberculosis and malaria.

The effect of an adaptation to hypoxia on cardiac tolerance to ischemia/reperfusion.

The acute myocardial infarction (AMI) and sudden cardiac death (SCD), both associated with acute cardiac ischemia, are one of the leading causes of adult death in economically developed countries. The development of new approaches for the treatment and prevention of AMI and SCD remains the highest priority for medicine. A study on the cardiovascular effects of chronic hypoxia (CH) may contribute to the development of these methods. Chronic hypoxia exerts both positive and adverse effects. The positive effects are the infarct-reducing, vasoprotective, and antiarrhythmic effects, which can lead to the improvement of cardiac contractility in reperfusion. The adverse effects are pulmonary hypertension and right ventricular hypertrophy. This review presents a comprehensive overview of how CH enhances cardiac tolerance to ischemia/reperfusion. It is an in-depth analysis of the published data on the underlying mechanisms, which can lead to future development of the cardioprotective effect of CH. A better understanding of the CH-activated protective signaling pathways may contribute to new therapeutic approaches in an increase of cardiac tolerance to ischemia/reperfusion.