Monitorización avanzada en el posoperatorio de las cardiopatías congénitas : motorización hemodinámica avanzada en el posoperatorio de cardiopatías congénitas mediante termodilución transpulmonar y espectroscopia cercana al infrarrojo

196 p. : graf.

Subtypes of Patients Experiencing Exacerbations of COPD and Associations with Outcomes

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes.

Studying the influence of substitutional elements on mechanical behavior of Alloy 718

In nickel-based superalloys, substitutional solute species have a strong impact on in service mechanical properties as well as on oxidation and corrosion resistances. In alloy 718, recent studies carried out by tensile tests highlighted the fact that refractory solute species are able to interact strongly with mobile dislocations during plastic deformation, generating dynamic strain ageing, and, in wide ranges of tests temperatures and strain rates, Portevin-Le Chatelier effect. The precise nature of the substitutional element responsible for such a dynamic interaction is still subject to debate. We addressed this question by means of mechanical spectroscopy studies of alloy 718 and various related alloys corresponding to monitored changes in the chemical composition. Only a single internal friction relaxation peak has been observed for all the studied alloys. By analyzing the damping behavior of these alloys at different imposed solicitation frequencies by sweeping a large temperatures range, the activation energies of the relaxation process and the type of mechanism involved have been determined. The process is a "Zener relaxation" in the alloys, i.e. a substitutional atoms dipole reorientation under applied stress. The results tend to prove that Niobium is not involved in the relaxation process whereas Molybdenum content seems to play an important role in the relaxation intensity.