Air versus saline in the loss of resistance technique for identification of the epidural space

BackgroundThe success of epidural anaesthesia depends on correct identification of the epidural space. For several decades, the decision of whether to use air or physiological saline during the loss of resistance technique for identification of the epidural space has been governed by the personal experience of the anaesthesiologist. Epidural block remains one of the main regional anaesthesia techniques. It is used for surgical anaesthesia, obstetrical analgesia, postoperative analgesia and treatment of chronic pain and as a complement to general anaesthesia. The sensation felt by the anaesthesiologist from the syringe plunger with loss of resistance is different when air is compared with saline (fluid). Frequently fluid allows a rapid change from resistance to non-resistance and increased movement of the plunger. However, the ideal technique for identification of the epidural space remains unclear.ObjectivesTo evaluate the efficacy and safety of both air and saline in the loss of resistance technique for identification of the epidural space.To evaluate complications related to the air or saline injected.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 9), MEDLINE, EMBASE and the Latin American and Caribbean Health Science Information Database (LILACS) (from inception to September 2013). We applied no language restrictions. The date of the most recent search was 7 September 2013.Selection criteriaWe included randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) on air and saline in the loss of resistance technique for identification of the epidural space.Data collection and analysisTwo review authors independently assessed trial quality and extracted data.Main resultsWe included in the review seven studies with a total of 852 participants. The methodological quality of the included studies was generally ranked as showing low risk of bias inmost domains, with the exception of one study, which did not mask participants. We were able to include data from 838 participants in the meta-analysis. We found no statistically significant differences between participants receiving air and those given saline in any of the outcomes evaluated: inability to locate the epidural space (three trials, 619 participants) (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.33 to 2.31, low-quality evidence); accidental intravascular catheter placement (two trials, 223 participants) (RR 0.90, 95% CI 0.33 to 2.45, low-quality evidence); accidental subarachnoid catheter placement (four trials, 682 participants) (RR 2.95, 95% CI 0.12 to 71.90, low-quality evidence); combined spinal epidural failure (two trials, 400 participants) (RR 0.98, 95% CI 0.44 to 2.18, low-quality evidence); unblocked segments (five studies, 423 participants) (RR 1.66, 95% CI 0.72 to 3.85); and pain measured by VAS (two studies, 395 participants) (mean difference (MD) -0.09, 95% CI -0.37 to 0.18). With regard to adverse effects, we found no statistically significant differences between participants receiving air and those given saline in the occurrence of paraesthesias (three trials, 572 participants) (RR 0.89, 95% CI 0.69 to 1.15); difficulty in advancing the catheter (two trials, 227 participants) (RR 0.91, 95% CI 0.32 to 2.56); catheter replacement (two trials, 501 participants) (RR 0.69, 95% CI 0.26 to 1.83); and postdural puncture headache (one trial, 110 participants) (RR 0.83, 95% CI 0.12 to 5.71).Authors' conclusionsLow-quality evidence shows that results do not differ between air and saline in terms of the loss of resistance technique for identification of the epidural space and reduction of complications. Applicability might be compromised, as most of the results described in this review were obtained from parturient patients. This review underlines the need to conduct well-designed trials in this field.

Surface modification of polymeric materials by cold atmospheric plasma jet

In this work we report the surface modification of different engineering polymers, such as, polyethylene terephthalate (PET), polyethylene (PE) and polypropylene (PP) by an atmospheric pressure plasma jet (APPJ). It was operated with Ar gas using 10 kV, 37 kHz, sine wave as an excitation source. The aim of this study is to determine the optimal treatment conditions and also to compare the polymer surface modification induced by plasma jet with the one obtained by another atmospheric pressure plasma source the dielectric barrier discharge (DBD). The samples were exposed to the plasma jet effluent using a scanning procedure, which allowed achieving a uniform surface modification. The wettability assessments of all polymers reveal that the treatment leads to reduction of more than 40 degrees in the water contact angle (WCA). Changes in surface composition and chemical bonding were analyzed by x-ray photoelectron spectroscopy (XPS) and Fourier-Transformed Infrared spectroscopy (FTIR) that both detected incorporation of oxygen-related functional groups. Surface morphology of polymer samples was investigated by Atomic Force Microscopy (AFM) and an increase of polymer roughness after the APPJ treatment was found. The plasma-treated polymers exhibited hydrophobic recovery expressed in reduction of the O-content of the surface upon rinsing with water. This process was caused by the dissolution of low molecular weight oxidized materials (LMWOMs) formed on the surface as a result of the plasma exposure. (C) 2014 Elsevier B.V. All rights reserved.

Feed digestibility and productive performance of bullfrogs raised in cages and fed in different periods and high frequency

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Polyculture of frogs and tilapia in cages with high feeding frequency

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Next-generation sequencing reveals large connected networks of intra-host HCV variants

Background: Next-generation sequencing (NGS) allows for sampling numerous viral variants from infected patients. This provides a novel opportunity to represent and study the mutational landscape of Hepatitis C Virus (HCV) within a single host.Results: Intra-host variants of the HCV E1/E2 region were extensively sampled from 58 chronically infected patients. After NGS error correction, the average number of reads and variants obtained from each sample were 3202 and 464, respectively. The distance between each pair of variants was calculated and networks were created for each patient, where each node is a variant and two nodes are connected by a link if the nucleotide distance between them is 1. The work focused on large components having > 5% of all reads, which in average account for 93.7% of all reads found in a patient. The distance between any two variants calculated over the component correlated strongly with nucleotide distances (r = 0.9499; p = 0.0001), a better correlation than the one obtained with Neighbour-Joining trees (r = 0.7624; p = 0.0001). In each patient, components were well separated, with the average distance between (6.53%) being 10 times greater than within each component (0.68%). The ratio of nonsynonymous to synonymous changes was calculated and some patients (6.9%) showed a mixture of networks under strong negative and positive selection. All components were robust to in silico stochastic sampling; even after randomly removing 85% of all reads, the largest connected component in the new subsample still involved 82.4% of remaining nodes. In vitro sampling showed that 93.02% of components present in the original sample were also found in experimental replicas, with 81.6% of reads found in both. When syringe-sharing transmission events were simulated, 91.2% of all simulated transmission events seeded all components present in the source.Conclusions: Most intra-host variants are organized into distinct single-mutation components that are: well separated from each other, represent genetic distances between viral variants, robust to sampling, reproducible and likely seeded during transmission events. Facilitated by NGS, large components offer a novel evolutionary framework for genetic analysis of intra-host viral populations and understanding transmission, immune escape and drug resistance.

Associações anestésicas baseadas em fármacos dissociativos reduzem a pressão intraocular (PIO) em coelhos

The aim of this study was evaluate the effects of three anesthetic combinations, ketamine-midazolam, ketamine-xylazine and tiletamine-zolazepam, on IOP in rabbits. In a experimental, blind, randomized, crossover study, six rabbits were anesthetized with each of 3 treatments in random order. Groups KM (ketamine, 30 mg/kg + midazolam, 1 mg/kg); KX (ketamine, 30 mg/kg + xylazine, 3 mg/kg); and TZ (tiletamine + zolazepam, 20 mg/kg). The drugs were mixed in the same syringe injected intramuscularly (IM) into the quadriceps muscle. IOP was measured before drug administration (baseline) and at 5-minute intervals for 30 minutes. The data were analyzed by a 2-way repeated measures ANOVA followed by Bonferroni test. All groups had significant decreases in IOP compared to baseline (p < 0.001). There was no difference between groups at any of the time points assessed (p > 0.05). Administration of either ketamine-midazolam, ketamine-xylazine, or tiletamine-zolazepam similarly decrease IOP in rabbits within 30 minutes of injection.

Primate Pulpal Healing after Exposure and TheraCal Application

Aim: The purpose of this in vivo study was to compare the effectiveness of a new light cured resin based dicalcium/tricalcium silicate pulp capping material (TheraCal LC, Bisco), pure Portland cement, resin based calcium hydroxide or glass ionomer in the healing of bacterially contaminated primate pulps. Study design: The experiment required four primates each having 12 teeth prepared with buccal penetrations into the pulpal tissues with an exposure of approximately 1.0 mm. The exposed pulps of the primate teeth were covered with cotton pellets soaked in a bacterial mixture consisting of microorganisms normally found in human pulpal abscesses. After removal of the pellet, hemostasis was obtained and the pulp capping agents applied. The light cured resin based pulp capping material (TheraCal LC) was applied to the pulpal tissue of twelve teeth with a needle tip syringe and light cured for 15 seconds. Pure Portland cement mixed with a 2% Chlorhexidine solution was placed on the exposed pulpal tissues of another twelve teeth. Twelve additional teeth had a base of GIC applied (Triage, Fuji VII GC America) and another twelve had a pulp cap with VLC DYCAL (Dentsply), a light cured calcium hydroxide resin based material. The pulp capping bases were then covered with a RMGI (Fuji II LC GC America). The tissue samples were collected at 4 weeks. The samples were deminerilized, sectioned, stained and histologically graded. Results: There were no statistically significant differences between the groups in regard to pulpal inflammation (H= 0.679, P=1.00). However, both the Portland cement and light cured TheraCal LC groups had significantly more frequent hard tissue bridge formation at 28 days than the GIC and VLC Dycal groups (H= 11.989, P=0.009). The measured thickness of the hard tissue bridges with the pure Portland and light cured TheraCal LC groups were statistically greater than that of the other two groups (H= 15.849, P=0.002). In addition, the occurrence of pulpal necrosis was greater with the GIC group than the others. Four premolars, one each treated according to the protocols were analyzed with a microCT machine. The premolar treated with the light cured TheraCal LC demonstrated a complete hard tissue bridge. The premolar treated with the GIC did not show a complete hard tissue bridge while the premolar treated with VLC Dycal had an incomplete bridge. The pure Portland with Chlorhexidine mixture created extensive hard tissue bridging.Conclusion: TheraCal LC applied to primate pulps created dentin bridges and mild inflammation acceptable for pulp capping.

Biodegradação de filmes de polipropileno (PP), poli (hidroxibutirato-co-valerato) (PHBV) e blenda pré-irradiados com luz UV

This work intends to investigate the biodegradation of the polymers and blend films of polypropylene (PP) and poly(hidroxybutirate-valerate) (PHBV), after UV radiation to facilitate the PP degradation, which is a polymer with long chains difficult to degrade by biological agents present in the environment. This polymer is outstanding by its mechanical properties and versatility of industrial and commercial use and the PHBV by its quick biodegradability in the environment. Blends of these materials could to present a commitment between mechanical properties and biodegradability to execute its function and after the discard to have lesser lifetime in the garbage landfills. Another aspect of this work is the controlling effect of PP on PHBV, influencing its degradation time

Desenvolvimento e caracterização de compósitos de fibras naturais modificadas e híbridos: fibras da coroa do abacaxi/polipropileno e fibras da coroa do abacaxi/fibras de vidro/polipropileno

The concern with the environment preservation has done with that researchers as well as industries invest in the search for materials that come from renewable sources. Natural fibers, because they are ecologically correct and have low cost, have been studied as a possible substitute, even if partial, of synthetic fibers in the development of polymeric composites. In this context, the hybrid composites (natural/synthetic) increase considerably the range of application of natural composites. The auto industry, in its constant quest for good mechanical properties materials which are developed with sustainability, has in composites with hybrid reinforcement a very viable alternative. In the present work, the nature Crown pineapple fibers and nature Crown pineapple fibers treated with alkaline solution were studied in order to evaluate the influence of chemical treatment in its properties. For this techniques were used x-ray diffractometry, Thermogravimetry and Infrared Spectroscopy (FTIR). Composites have been developed using polypropylene, reinforced with pineapple fibers and pineapple fibers hybrids/glass fibres, both with levels of 5 and 10%. These composites were analyzed by Thermogravimetry techniques and tested by traction. The realization of this work indicated that although the chemical treatment did not affect the thermal stability of the fibers, caused an increase in crystallinity index fibers and decreased its hydrophilic. The tests performed on composite indicated that the composites process was suitable because it provided good dispersion of the polymer matrix. The addition of natural fibers from the pineapple's Crown, in a proportion of 10%, provided the greatest increase in modulus of elasticity (27%) when compared to the pure polymer

Recuperação de resíduos plásticos provenientes dos processos de injeção

The competitiveness among global markets, the constant need for reducing manufacturing costs and also the growing environmental commitments are fueling the development of techniques for recovery residual parts generated by industrial processes. Among the various areas of a company, we highlight those that involve the processing of raw materials derived from oil, such as polymers (resins), which may take centuries to decompose in the environment and also present as a economic and environmentally strategic point. Thus, this study would examine the recovery of waste polypropylene, from the injection process of a major multinational in the field of home appliances through the recycling by a process comprising the milling, extrusion and chipping of waste material. Easy to deploy, this proposal aims to reduce levels negligible disposal (scrap) of these residues as well as the reintegration of the production process into pieces no visual and no structural importance, aimed at cutting costs and reducing environmental impacts caused. After the survey data in kilograms of waste material generated in a given period of time, and the study of changes in material properties, it would enable the reuse steadily in the injection process

Análise da troca de calor em sistemas de injeção de termoplásticos – um estudo de caso: polipropileno

The purpose of this work was to define the processes through which the cooling of thermoplastics parts occur inside the mold cavity in an injection process. The plastic materials have become more widespread in the automobile industry and, among its manufacturing processes, injection moulding develops quickly, allowing the manufacturing of quality parts in great volumes. Data was collected from the injection of Volkswagen Gol NF 23X (Gol Generation 5). Using approximated methods for calculation for the heat Exchange inside the mould, in the cooling system, the required water flow was determined to properly cool the parts. Comparing the obtained value with Project specifications, it was verified that the method, in spite of incurring in some mistakes, is efficient in determining the flow of cooling fluid and serves as a verification tool for the parameters defined on project, and can be applied to simple projects. The definition of the cooling system, in practice, is dependent on innumerable variables and each case must be approached in itself, since the parameters for one product may not be ideal for another

Aplicação da descarga por barreira dielétrica (DBD) em diferentes frequências no tratamento de polipropileno

In this work, air dielectric barrier discharge (DBD) operating at two different frequencies (60 Hz and 17 kHz) was used to improve surface properties of polypropylene (PP). The changes in surface hydrophilicity were investigated by contact angle measurements. The modifications in chemical composition of PP surface were studied by X-ray photoelectron spectroscopy (XPS) and Fourier-transformed infrared spectroscopy (FTIR). The PP roughness were analyzed before and after the DBD treatment using atomic force microscopy (AFM). In order to compare the results obtained at different frequencies, the analyses are presented as a function of the deposited energy density. The results show that both DBD treatments led to formation of low-molecular weight oxidized material (LMWOM). It tends to agglomerate into small mounts on the surface, as shown by AFM analyses. These structures are weakly bounded to the surface and can be easily removed by rinsing in polar solvents. After washing the DBD-treated samples, the PP partially recovers its original wetting characteristics. This suggests that oxidation also occurred at deeper and more permanent levels on the PP samples. Comparing both DBD treatments, the 17 kHz process was found to be more efficient in introducing oxygen groups to the PP surface

Estudo da superfície de fibras de carbono após tratamento de implantação iônica por imersão em plasma (3IP)

In this work, plasma immersion ion implantation (PIII) treatments of carbon fibers (CFs) were performed in order to induce modifications of chemical and physical properties of the CF surface aimed to improve the performance of thermoplastic composite. The samples to be treated were immersed in nitrogen or air glow discharge plasma and pulsed at −3.0 kV for 2.0, 5.0, 10.0, and 15.0 min. After PIII processing, the specimens were characterized by atomic force microscopy (AFM), scanning electron microscopy, Raman spectroscopy, and X-ray photoelectron spectroscopy (XPS). After CFs treatments, the CF/Polypropylene (PP) composites were produced by hot pressing method. Surface morphology of as-received CFs exhibited some scratches aligned along the fibers due to the fiber manufacturing process. After both treatments, these features became deeper, and also, a number of small particles nonuniformly distributed on the fiber surface can be observed. These particles are product of CF surface sputtering during the PIII treatment, which removes the epoxy layer that covers as-received samples. AFM analyses of CF samples treated with nitrogen depicted a large increase of the surface roughness (Rrms value approximately six times higher than that of the untreated sample). The increase of the roughness was also observed for samples treated by air PIII. Raman spectra of all samples presented the characteristic D- and G-bands at approximately 1355 and 1582 cm−1, respectively. Analysis of the surface chemical composition provided by the XPS showed that nitrogen and oxygen were incorporated onto the surface. The polar radicals formed on the surface lead to increasing of the CF surface energy. Both the modification of surface roughness and the surface oxidation contributed for the enhancement of CF adhesion to the polymeric matrix. These features were confirmed ... (Complete abstract click electronic access below)

Comportamentos, térmico e mecânico, de compósitos de polipropileno e resíduo da hidrólise enzimática do bagaço de cana de açúcar

Pós-graduação em Engenharia Mecânica - FEG

Contaminación microbiana en las líneas de agua de las unidades odontológicas

Introduction and Objective: Microorganisms are responsible for multiple infections and pathologies; this is why it is important to control microbes that can be found in the triple syringe used for irrigation in different dental procedures. The aim of this study was to identify cultivable species of microbes (fungus and bacteria) found in some dental units water lines of a private dental clinic from Medellín, Colombia. Materials and Methods: Random samples were taken from 11 chairs from a total of 89; a sample of water of 500ml was collected from the triple syringe of each selected chair. The study aim to search for the presence of total coliforms, filamentous fungi and leavened Results: the average presence of microorganisms was between 40CFU and more of 200 CFU. Microorganisms such as Aeromona salmonicida, Actinobacilus sp and Pseudomona maltophil were isolated. No total coliforms neither fecal coliforms were found. Conclusions: the high levels of contamination suggest that there is a mature biofilm in somewhere of the dental unit water line, but the absence of total and fecalis coliforms suggest that the water had been treated.