Efeito da oxigenoterapia hiperbárica: relato de caso de paciente com síndrome hepato-pulmonar em lista de espera para transplante hepático

INTRODUÇÃO: As doenças hepáticas apresentam índices de morbidade e mortalidade elevados e quando em estágio avançado têm o transplante do fígado como forma de tratamento potencialmente curativo e eficaz, embora este não possa ser oferecido a todos os pacientes. Isso faz com que essas doenças sejam consideradas problema de saúde pública em todo o mundo. Os cuidados clínicos para manter o paciente com condições de esperar e suportar o transplante continua um desafio. RELATO DO CASO: Mulher com 65 anos de idade, procedente do Recife, com diagnóstico de cirrose hepática secundária a vírus C apresentava dispnéia importante aos mínimos esforços tendo PaO2 de repouso de 60 mmHg e O2 de 90%, com espirometria normal. Realizou eco-Doppler que evidenciou shunt pulmonar importante. Durante a triagem em lista de transplante (MELD de 16 em agosto de 2006) foi optado pelo início de sessões de oxigenioterapia em câmara hiperbárica a fim de melhorar a sintomatologia respiratória da síndrome hepato-pulmonar. Apresentava melhora substancial da tolerância ao exercício após a terapia hiperbárica, assim como os valores do PaO2 à gasometria. Realizou 10 sessões de oxigenioterapia em câmara hiperbárica. Realizou transplante hepático em outubro de 2007 e vem em acompanhamento ambulatorial com boa evolução e melhora substancial da dispnéia. CONCLUSÃO: Constatou-se melhora da condição hepato-pulmonar após oxigenoterapia hiperbárica. Desta forma, ela surge como mais uma ferramenta para o tratamento das doenças hepáticas, devendo ser realizados outros estudos que avaliem sua utilização clínica.

Ventilation behavior during upper-body incremental exercise

Pires, FO, Hammond, J, Lima-Silva, AE, Bertuzzi, RCM, and Kiss, MAPDM. Ventilation behavior during upper-body incremental exercise. J Strength Cond Res 25(1): 225-230, 2011-This study tested the ventilation (V(E)) behavior during upper-body incremental exercise by mathematical models that calculate 1 or 2 thresholds and compared the thresholds identified by mathematical models with V-slope, ventilatory equivalent for oxygen uptake (V(E)/(V) over dotO(2)), and ventilatory equivalent for carbon dioxide uptake (V(E)/(V) over dotCO(2)). Fourteen rock climbers underwent an upper-body incremental test on a cycle ergometer with increases of approximately 20 W.min(-1) until exhaustion at a cranking frequency of approximately 90 rpm. The V(E) data were smoothed to 10-second averages for V(E) time plotting. The bisegmental and the 3-segmental linear regression models were calculated from 1 or 2 intercepts that best shared the V(E) curve in 2 or 3 linear segments. The ventilatory threshold(s) was determined mathematically by the intercept(s) obtained by bisegmental and 3-segmental models, by V-slope model, or visually by V(E)/(V) over dotO(2) and V(E)/(V) over dotCO(2). There was no difference between bisegmental (mean square error [MSE] = 35.3 +/- 32.7 l.min(-1)) and 3-segmental (MSE = 44.9 +/- 47.8 l.min(-1)) models in fitted data. There was no difference between ventilatory threshold identified by the bisegmental (28.2 +/- 6.8 ml.kg(-1).min(-1)) and second ventilatory threshold identified by the 3-segmental (30.0 +/- 5.1 ml.kg(-1).min(-1)), V(E)/(V) over dotO(2) (28.8 +/- 5.5 ml.kg(-1).min(-1)), or V-slope (28.5 +/- 5.6 ml.kg(-1).min(-1)). However, the first ventilatory threshold identified by 3-segmental (23.1 +/- 4.9 ml.kg(-1).min(-1)) or by VE/(V) over dotO(2) (24.9 +/- 4.4 ml.kg(-1).min(-1)) was different from these 4. The V(E) behavior during upper-body exercise tends to show only 1 ventilatory threshold. These findings have practical implications because this point is frequently used for aerobic training prescription in healthy subjects, athletes, and in elderly or diseased populations. The ventilatory threshold identified by V(E) curve should be used for aerobic training prescription in healthy subjects and athletes.

Reducing mean flow time in permutation flow shop

This paper deals with the traditional permutation flow shop scheduling problem with the objective of minimizing mean flowtime, therefore reducing in-process inventory. A new heuristic method is proposed for the scheduling problem solution. The proposed heuristic is compared with the best one considered in the literature. Experimental results show that the new heuristic provides better solutions regarding both the solution quality and computational effort.

Reconfiguration of distribution networks to minimize loss and disruption costs using genetic algorithms

In this paper a computational implementation of an evolutionary algorithm (EA) is shown in order to tackle the problem of reconfiguring radial distribution systems. The developed module considers power quality indices such as long duration interruptions and customer process disruptions due to voltage sags, by using the Monte Carlo simulation method. Power quality costs are modeled into the mathematical problem formulation, which are added to the cost of network losses. As for the EA codification proposed, a decimal representation is used. The EA operators, namely selection, recombination and mutation, which are considered for the reconfiguration algorithm, are herein analyzed. A number of selection procedures are analyzed, namely tournament, elitism and a mixed technique using both elitism and tournament. The recombination operator was developed by considering a chromosome structure representation that maps the network branches and system radiality, and another structure that takes into account the network topology and feasibility of network operation to exchange genetic material. The topologies regarding the initial population are randomly produced so as radial configurations are produced through the Prim and Kruskal algorithms that rapidly build minimum spanning trees. (C) 2009 Elsevier B.V. All rights reserved.

PVALB, a New Hurthle Adenoma Diagnostic Marker Identified through Gene Expression

Context: A better means to accurately identify malignant thyroid nodules and to distinguish them from benign tumors is needed. We previously identified markers for detecting thyroid malignancy, with sensitivity estimated at or close to 100%. One lingering problem with these markers was that false positives occurred with Hurthle cell adenomas (HCA) which lowered test specificity. Methods: To locate accurate diagnostic markers, we profiled in depth the transcripts of a HCA and a Hurthle cell carcinoma (HCC). From 1146 differentially expressed genes, 18 transcripts specifically expressed in HCA were tested by quantitative PCR in a wide range of thyroid tumors (n = 76). Sensibility and specificity were calculated using receiver operating characteristic (ROC). Selected markers were further validated in an independent set of thyroid tumors (n = 82) by immunohistochemistry. To define the panel that would yield best diagnostic accuracy, these markers were tested in combination with our previous identified markers. Results: Seventeen of the 18 genes showed statistical significance based on a mean relative level of expression (P < 0.05). KLK1 (sensitivity = 0.97) and PVALB (sensitivity = 0.94) were the best candidate markers. The combination of PVALB and C1orf24 increased specificity to > 97% and maintained sensitivity for detection of carcinoma. Conclusion: We identified tumor markers that can be used in combination for a more accurate preoperative diagnosis of thyroid nodules and for postoperative diagnosis of thyroid carcinoma in tumor sections. This improved test would help physicians rapidly focus treatment on true malignancies and avoid unnecessary treatment of benign tumors, simultaneously improving medical care and reducing costs. (J Clin Endocrinol Metab 96: E151-E160, 2011)

Acellular Dermal Matrix Graft for Gingival Augmentation: A Preliminary Clinical, Histologic, and Ultrastructural Evaluation

Background: The aim of this study was to evaluate clinically, histologically, and ultrastructurally the integration process of the acellular dermal matrix used to increase the band of keratinized tissue while achieving gingival inflammation control. Methods: Ten patients exhibiting a mucogingival problem with bands of keratinized tissue <= 1 mm and gingival inflammation of the related teeth were included in the study. The surgical procedures were performed to augment the gingival tissue using acellular dermal matrix. Clinical measurements were assessed at baseline and after 3 months. A specimen of the allograft and surrounding tissues was obtained immediately before the surgery and 4 minutes and 1, 2, 3, 4, 6, and 10 weeks after grafting. Results: Clinically, a gain of keratinized tissue of 2.92 +/- 0.65 mm was observed after 3 months. Histologically and ultrastructurally, many macrophages were observed phagocytosing preexisting collagen fibers in the first weeks. From week 2 on, fibroblasts synthesizing new collagen, epithelial cells colonizing the graft surface, and revascularization were noticed. After 6 weeks it was difficult to find the acellular dermal matrix preexisting collagen fibers. This process of substitution was completed after 10 weeks, when the reepithelialization of the entire graft throughout a well-structured basement membrane was achieved. Conclusion: The acellular dermal matrix graft seemed to be an easily handled material for use in keratinized tissue augmentation that, in humans, was substituted and completely reepithelialized in 10 weeks according to histologic and ultrastructural results. J Periodontol 2009;80:253-259.

Deterpenation of Bergamot Essential Oil Using Liquid-Liquid Extraction: Equilibrium Data of Model Systems at 298.2 K

The deterpenation of bergamot essential oil can be performed by liquid liquid extraction using hydrous ethanol as the solvent. A ternary mixture composed of 1-methyl-4-prop-1-en-2-yl-cydohexene (limonene), 3,7-dimethylocta-1,6-dien-3-yl-acetate (linalyl acetate), and 3,7-dimethylocta-1,6-dien-3-ol (linalool), three major compounds commonly found in bergamot oil, was used to simulate this essential oil. Liquid liquid equilibrium data were experimentally determined for systems containing essential oil compounds, ethanol, and water at 298.2 K and are reported in this paper. The experimental data were correlated using the NRTL and UNIQUAC models, and the mean deviations between calculated and experimental data were lower than 0.0062 in all systems, indicating the good descriptive quality of the molecular models. To verify the effect of the water mass fraction in the solvent and the linalool mass fraction in the terpene phase on the distribution coefficients of the essential oil compounds, nonlinear regression analyses were performed, obtaining mathematical models with correlation coefficient values higher than 0.99. The results show that as the water content in the solvent phase increased, the kappa value decreased, regardless of the type of compound studied. Conversely, as the linalool content increased, the distribution coefficients of hydrocarbon terpene and ester also increased. However, the linalool distribution coefficient values were negatively affected when the terpene alcohol content increased in the terpene phase.

Geoelectric evidence for centripetal resurge of impact melt and breccias over central uplift of Araguainha impact structure

We present five profiles from electrical resistivity tomography (ERT), with surface constraints and gravity data, in the central uplift of the Araguainha impact structure in central Brazil. The central uplift, the overlying polymict breccias, and decameter-scale impact melt rocks are characterized by contrasting ranges of electrical resistivity. Our resistivity model provides empirical evidence that supports the existing model in which impact melt and breccias resurged toward the crater center in the final stages of the cratering process. On the basis of our results from the first use of ERT in impact cratering studies, we conclude that the deposition and flow of impact melt and breccias over the central uplift were influenced by the geometry of the lithologic boundaries in the central uplift.

Existence of pullback attractors for pullback asymptotically compact processes

This paper is concerned with the existence of pullback attractors for evolution processes. Our aim is to provide results that extend the following results for autonomous evolution processes (semigroups) (i) An autonomous evolution process which is bounded, dissipative and asymptotically compact has a global attractor. (ii) An autonomous evolution process which is bounded, point dissipative and asymptotically compact has a global attractor. The extension of such results requires the introduction of new concepts and brings up some important differences between the asymptotic properties of autonomous and non-autonomous evolution processes. An application to damped wave problem with non-autonomous damping is considered. (C) 2009 Elsevier Ltd. All rights reserved.

An evaluation of three upwinding approximations for numerical modeling the flow in tubular membrane of Newtonian and non-Newtonian fluids

In this paper, the laminar fluid flow of Newtonian and non-Newtonian of aqueous solutions in a tubular membrane is numerically studied. The mathematical formulation, with associated initial and boundary conditions for cylindrical coordinates, comprises the mass conservation, momentum conservation and mass transfer equations. These equations are discretized by using the finite-difference technique on a staggered grid system. Comparisons of the three upwinding schemes for discretization of the non-linear (convective) terms are presented. The effects of several physical parameters on the concentration profile are investigated. The numerical results compare favorably with experimental data and the analytical solutions. (C) 2011 Elsevier Inc. All rights reserved.

Structured minimal-memory inexact quasi-Newton method and secant preconditioners for augmented Lagrangian optimization

Augmented Lagrangian methods for large-scale optimization usually require efficient algorithms for minimization with box constraints. On the other hand, active-set box-constraint methods employ unconstrained optimization algorithms for minimization inside the faces of the box. Several approaches may be employed for computing internal search directions in the large-scale case. In this paper a minimal-memory quasi-Newton approach with secant preconditioners is proposed, taking into account the structure of Augmented Lagrangians that come from the popular Powell-Hestenes-Rockafellar scheme. A combined algorithm, that uses the quasi-Newton formula or a truncated-Newton procedure, depending on the presence of active constraints in the penalty-Lagrangian function, is also suggested. Numerical experiments using the Cute collection are presented.