1- 46 of 46 Results. Sort by: Relevance. Name (A-Z) Name (Z-A) Price (Low-High) Price (High-Low) Issue Date; $0.00 Priority Mail® Tyvek Envelope. Pack of 10. 15"(L) x 11-5/8"(W) $0.00 x 2-1/4"(H) $0.00 Signature Confirmation™ Receipt Form. Pack of 10. $0.00 Vay Tiền Trả Góp Theo Tháng Chỉ Cần Cmnd. BLOG DA AUTO MECÂNICA DIMAS & GRACIANO Home Posts P0046 Siga a gente nas redes sociais! P0046 Publicado por Bruno Oliveira No Comments Categoria OBDII Palavras-Chave OBD2, P0046 Confira o significado do código de falha P0046 OBDII em aparelhos automotivos. Esse post é útil para profissionais em mecânica automotiva, pois auxilia com informações relevantes sobre os veículos diagnosticados com este código de falha. Vale lembrar que essas informações não substituem a mão-de-obra dos profissionais e nem elimina os custos de diagnósticos eletrônico. Código de Falha OBD2 – P0046 Solenóide de controle de sobrealimentação do turbocompressor/compressor de sobrealimentação – faixa/funcionamento do circuito Possível Causa / Solução para a falha P0046 Cabos, solenóide de controle de sobrealimentação, falha mecânica O diagnóstico OBDII pode apresentar a falha P0046 em veículos multimarcas, tais como automóveis das linhas Fiat, GM Chevrolet, VW Volkswagen, Renault, Peugeot, Citroen, Ford, Mercedes, Honda, Hyundai, Kia, Mitsubishi, Nissan, Porsche, Suzuki, Toyota, Audi e Volvo. Esse conteúdo foi útil pra você? Ajude-nos compartilhando em suas redes também pode registrar um comentário, logo abaixo. Palavras-Chave OBD2, P0046 Deixe um comentário 403 ERROR The Amazon CloudFront distribution is configured to block access from your country. We can't connect to the server for this app or website at this time. There might be too much traffic or a configuration error. Try again later, or contact the app or website owner. 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Introduction Moyamoya disease MMD is a chronic idiopathic condition that was first described by Taceuchi and Shimizu in 1957 1. This condition is characterized by nonatherosclerotic progressive stenosis or occlusion of the bilateral supraclinoidal internal carotid arteries and the development of an abnormal collateral vascular network at the base of the brain. This disorder is especially prevalent in East Asian populations, mainly Japan, Korea, and China, and the reported prevalence of MMD is individuals in Japan 2, in South Korea 3, and in China 4, respectively. In MMD, intracranial hemorrhage occurs more frequently in adult patients than in children 5, especially in adults older than 40 years. Surgical revascularization, including direct bypass, indirect bypass, and combinations of both, has proven to be effective in improving outcomes for patients with ischemic MMD 6, 7. However, whether surgical revascularization could reduce the long-term risks of recurrent hemorrhage 8, ischemic events, and mortality in HMMD patients remains controversial. The purpose of this study was to determine whether surgical revascularization reduces the risk of recurrent hemorrhage, ischemic events, and mortality in East Asian HMMD patients. 2. Materials and methods Literature search This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA guidelines 9. A comprehensive literature search was performed on PubMed, Google Scholar, Wanfang Med Online WMO, and the China National Knowledge Infrastructure CNKI for studies on HMMD published before 1 January 2023. The terms “moyamoya disease,” “hemorrhagic,” “conservative,” and “revascularization” were used as keywords in searching the abovementioned databases. Other relevant publications were identified by examining the references included in the study. Inclusion and exclusion criteria The inclusion criteria were as follows 1 HMMD patients; 2 adult or pediatric patients; 3 the study including both surgical and conservative treatment groups; 4 articles written in English or Chinese. The exclusion criteria were as follows 1 system review articles, case reports, and editorials; 2 moyamoya syndrome; 3 other surgical treatment modalities such as aneurysm clip or coil procedure, hematoma evacuation, and so on; and 4 without detailed outcomes for revascularization procedures and conservative treatment. Data extraction A total of 525 studies were identified through a search of PubMed n =52, Google Scholar n = 84, WMO n =104, and CNKI n = 285, among which 110 studies were first excluded due to duplicate citations. According to the inclusion and exclusion criteria, 19 studies of the remaining 415 were finally included in the systematic review and meta-analysis Figure 1, Tables 1, 2. Figure 1. Flow diagram of the literature search strategy. Table 1. Study characteristics and rebleeding in conservative and revascularization groups. Table 2. Study characteristics, ischemic event, and mortality in conservative and revascularization groups. Statistical analysis The data available from the selected studies were imported into Review Manager, version The Cochrane Collaboration, for quantitative analysis. Odds ratios ORs with 95% CIs were calculated in Review Manager. The heterogeneity between the studies was considered valid with a P 10 years. Among the 20 studies reviewed, direct STA-MCA and indirect bypass procedures were performed in 17 85% studies; indirect bypass alone was used in the other three studies, which included encephalic-myo-spongiosis EMS 12, 16, 20, 23, encephalo-duro-aterio-synangiosis EDAS 10, 12–14, 17, 19, 21, 27, encephalo-duro-myo-synangiosis EDMS 24, 26, 28, and encephalo-myo-aterio-synangiosis EMAS 10, 28, encephalo-duro-arterio-galeo-synangiosis EDAGS 16, 23, and encephalo-duro-arterio-myo-synangiosis EDAMS 16, 20, 23. Rebleeding In the 20 studies, including our institution's series, there were a total of 940 patients who underwent revascularization, among whom 116 patients experienced rebleeding, whereas 185 of the 655 patients who received conservative treatment experienced rebleeding. The rebleeding rate in the 11 adult revascularization groups was 46 out of 352 patients, whereas, in the conservative treatment group, 82 out of 253 patients experienced rebleeding. The heterogeneity testing revealed no heterogeneity among these studies I2 = 0%, P = The meta-analysis showed a pooled OR of 95% CI p 10 years. In Kim et al.'s adult study, the estimated rebleeding rate was at five years and at 10 years 36, which was similar to the rate of our adult/pediatric patients' groups with conservative treatment. The surgical revascularization in MMD is deemed to reduce persistent hemodynamic stress on fragile collateral vessels or/and accompanying aneurysms, resulting in a significant regression of these fragile vessels. The resumed blood flow and vascular reserve capability improve hemodynamic stabilization. However, there is still no ideal revascularization modality for HMMD, and there is also no optional medicine that can stop or reverse the insidious and progressive disease course. Different kinds of implanted tissues used in indirect bypass surgery were reported encephalo-myo-synangiosis EMS, encephalo-myo-arterio-synangiosis EMAS, encephalo-duro-arterio-synangiosis EDAS, encephalo-duro-myo-synangiosis EDMS, encephalo-duro-myo-arterio-synangiosis EDAMS, and encephalo-duro-arterio-galeo-synangiosis EDAGS were performed in studies included in the present review, and the previous studies showed that about 50–80% adult patients improved after indirect bypass procedure 37, 38. Among the reviewed 20 studies, the STA-MCA bypass procedure was performed in 17 studies 85%, and in the 11 studies with adult patients only, the direct bypass surgery was performed in 10 studies The direct bypass results in immediate cerebral hemodynamic improvement, and the direct bypass comprises the main treatment option for the reviewed studies, especially in adult patients. At the same time, an indirect bypass was also used as an important supplementary treatment in all 11 adult studies, of which an indirect bypass was chosen as the only treatment option in one study. The indirect bypass was accompanied by direct bypass surgery. This may be because the chronically induced angiogenesis resulting from the indirect bypass procedure will continue to contribute to further hemodynamic improvement after the immediate blood flow augmentation by direct bypass surgery. The indirect bypass is encouraging, with collateral arterial neoangiogenesis, age-dependent cerebrovascular plasticity, and low perioperative risk. Direct bypass is always challenging in pediatric or adult patients with advanced-stage MMD due to the lower bypass patency rates and caliber mismatch between donor and recipient vessels. The direct and indirect bypass procedures are reciprocal and synergistic in improving cerebral hemodynamics. Ischemic event Among the 20 reviewed studies, seven involved mixed adult/pediatric patients with post-surgical ischemic events, among which 14 cases were found to be complicated by postoperative ischemic events in 296 patients who underwent revascularization and 26 cases in 183 patients who received conservative treatment. Patients who underwent revascularization were significantly less likely to result in ischemic events than those with conservative treatment OR, 95% CI, P = Among the five adult patient-only studies, there were 5 in 124 revascularization patients with ischemic events, 18 in 121 conservatively treated patients, and adult patients who had undergone revascularization had fewer ischemic events compared with those with conservative treatment OR, 95% CI, P = In the study of Kim et al., of patients 4/70, 2 with combined surgery, and 2 with indirect experienced postoperative infarction, and the other four ischemic strokes occurred in the conservative treatment group, whose postoperative infarction rate was similar to our review 36. Kim et al. 36 also found that the ischemic events in HMMD patients were minor strokes, whereas, in our review, there were two adult patients with complete ischemic stroke and right hemiplegia, respectively 15, 18. The progressive cerebral arterieal occlusive disease and poorly developed collateral vessels always contribute to a postoperative ischemic event 39. The revascularization procedure has been shown to increase cerebral blood flow and improve cerebral vascular reserve, leading to enhanced cerebral hemodynamics and a reduction in cerebral ischemic events. On the contrary, conservative treatment with antiplatelet agents showed no potential benefit in preventing further strokes because of the mismatch between the pathophysiological changes of MMD and the pharmacological mechanism of aspirin. Of the 20 studies included in our meta-analysis, direct bypasses STA-MCA were performed in 17 studies 85%, and indirect bypass was performed in only three studies 15% 5, 12, 19. Moreover, direct bypass was the more preferable choice in adult patients due to its immediate increase in blood flow to the cerebral hemodynamic deficit area. In the acute stage after indirect bypass, there is a dangerous time window during which swelling of the temporal muscle, brain protrusion from the craniotomy site, and disruption of previous collateral circulation all potentially reduce cerebral blood flow, especially in adult patients, which can result in postoperative ischemic events 40. Mortality The cause of death in HMMD patients is mostly due to intracranial hemorrhage, and the previously reported mortality rate ranged from to 41–43. In our review, the mortality rate in six mixed adult/pediatric patient studies with revascularization 15/328 was significantly lower than those who received conservative treatment 23/123 OR, 95% CI, P = and in the five studies with adult patients only, similar results were obtained 5/153 versus 12/95, OR, 95% CI, P = The lower mortality rate in the adult studies, as compared with that of the mixed adult/pediatric studies, indicates that the mortality rate may be lower in adults than in pediatric patients. Sang-Hyuk et al. reported that adult HMMD patients had the worst survival outcomes, and the crude mortality for 10 years was in hemorrhagic adult South Korean MMA patients 44, which is more than twice the mortality rate of our review. The patients with recurrent hemorrhage had an risk of death compared to those without it, and the main cause of death in HMMD patients was rebleeding 45. As found in our review, the revascularization procedure significantly prevented rebleeding in HMMD patients, and the mortality rate associated with rebleeding decreased accordingly. 5. Limitations First, different neurosurgical centers with different patient volumes have varying levels of experience, and the studies included in the review ranged over a long period of time, within which improvements were achieved in the diagnosis and treatment of MMD. Second, there are many kinds of revascularization procedures and different combinations of them in the reviewed studies, such as STA–MCA, EMS, EDAS, EDMS, EMAS, EDAGS, and EDAMS; however, the effect of each revascularization modality alone on the HMMD outcomes has not yet been fully explored or understood. Finally, despite the relatively small sample size of pediatric patients in our review, different cerebral hemodynamic responses to the revascularization procedure between adults and pediatric patients should not be ignored. 6. Conclusion Direct revascularization, indirect bypass, and a combination of these approaches represent the mainstay treatment of HMMD, and an HMMD prognosis can be improved by surgical revascularization in terms of rebleeding, ischemic events, and mortality in East Asian Countries. Future studies may be necessary to confirm these findings, and the impact of each type of revascularization modality alone on HMMD requires future investigation and clarification. Data availability statement The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author. Author contributions X-HZ conceptualization, manuscript review, and editing. J-HH writing the initial draft. X-SZ and JZ application of statistical to analyze study data. C-jW data collection. Y-PD and WT visualization/data presentation. All authors contributed to the article and approved the submitted version. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer YW declared a shared affiliation with the authors X-HZ, X-SZ, C-jW, WT, Y-PD, and JZ to the handling editor at the time of review. Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. 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