Parâmetros diretos do duplex scan no diagnóstico da estenose da artéria renal: estudo de validação e otimização dos pontos de corte

OBJETIVO: Testar o desempenho dos parâmetros diretos do duplex scan no diagnóstico da estenose da artéria renal (EAR) e verificar se os pontos de corte recomendados pela literatura são os mais adequados para se discriminar a gravidade da lesão. MÉTODOS: Estudo prospectivo, incluindo 62 pacientes portadores de EAR, submetidos ao duplex scan, seguido da arteriografia seletiva. O pico de velocidade sistólico (PVS) e a relação renal-aorta (RRA) foram mensurados. A análise estatística incluiu a curva ROC (receiver operating characteristic curve), t test student não pareado a sensibilidade, especificidade, os valores preditivos positivo e negativo, e a acurácia. RESULTADOS: A arteriografia revelou EAR 0-59% em 31 artérias (24%); EAR 60-99% em 91 artérias (72%) e 5 oclusões (4%). A análise de ROC mostrou que o PVS e a RRA apresentaram desempenho semelhante na detecção da lesão, cujas áreas sob as curvas foram 0,96 e 0,95, respectivamente. Considerando os pontos de corte recomendados pela literatura, o PVS de 180 cm/s apresentou sensibilidade de 100% e especificidade de 81%, enquanto que a RRA de 3,5 apresentou sensibilidade de somente 79%, com 93% de especificidade. Estes parâmetros foram analisados de forma conjugada (critério direto), revelando 79% de sensibilidade e 97% de especificidade. Os pontos de corte otimizados foram: PVS de 189 cm/s e RRA de 2,6, demonstrando 100%, 87%, 96% e 87% de sensibilidade e especificidade para o PVS e para a RRA, respectivamente. CONCLUSÃO: O uso isolado do PVS otimizado apresentou o melhor desempenho na detecção e na graduação da EAR.

Cross-sectional study defines difference in malaria morbidity in two Yanomami communities on Amazonian boundary between Brazil and Venezuela

It is well established that immunity to malaria is short-lived and is maintained by the continuous contact with the parasite. We now show that the stable transmission of malaria in Yanomami Amerindian communities maintains a degree of immunity in the exposed population capable to reduce prevalence and morbidity of malaria. We examined 508 Yanomami Amerindians living along Orinoco (407) and Mucajaí (101) rivers, on the Venezuelan and Brazilian Amazon region, respectively. At Orinoco villages, malaria was hyperendemic and presented stable transmission, while at Mucajaí villages it was mesoendemic and showed unstable transmission. The frequency of Plasmodium vivax and P. falciparum was roughly comparable in Venezuelan and Brazilian communities. Malaria presented different profiles at Orinoco and Mucajaí villages. In the former communities, malaria showed a lower prevalence (16% x 40.6%), particularly among those over 10 years old (5.2% x 34.8%), a higher frequency of asymptomatic cases (38.5% x 4.9%), and a lower frequency of cases of severe malaria (9.2% x 36.5%). Orinoco villagers also showed a higher reactivity of the immune system, measured by the frequency of splenomegaly (72.4% x 29.7%) and by the splenic index (71.4% over level 1 x 28.6), and higher prevalence (91.1% x 72.1%) and mean titer (1243 x 62) of antiplasmodial IgG antibodies, as well as a higher prevalence (77.4% x 24.7%) and mean titer (120 x 35) of antiplasmodial IgM antibodies. Our findings show that in isolated Yanomami communities the stability of malaria transmission, and the consequent continuous activation of the immune system of the exposed population, leads to the reduction of malaria prevalence and morbidity.

Numerical modeling of the effect of variation of boundary conditions on vadose zone hydraulic properties

An accurate estimation of hydraulic fluxes in the vadose zone is essential for the prediction of water, nutrient and contaminant transport in natural systems. The objective of this study was to simulate the effect of variation of boundary conditions on the estimation of hydraulic properties (i.e. water content, effective unsaturated hydraulic conductivity and hydraulic flux) in a one-dimensional unsaturated flow model domain. Unsaturated one-dimensional vertical water flow was simulated in a pure phase clay loam profile and in clay loam interlayered with silt loam distributed according to the third iteration of the Cantor Bar fractal object Simulations were performed using the numerical model Hydrus 1D. The upper and lower pressure heads were varied around average values of -55 cm for the near-saturation range. This resulted in combinations for the upper and lower constant head boundary conditions, respectively, of -50 and -60 cm, -40 and -70 cm, -30 and -80 cm, -20 and -90 cm, and -10 and -100 cm. For the drier range the average head between the upper and lower boundary conditions was set to -550 cm, resulting in the combinations -500 and -600 cm, -400 and -700 cm, -300 and -800 cm, -200 and -900 cm, and -100 and -1,000 cm, for upper and lower boundary conditions, respectively. There was an increase in water contents, fluxes and hydraulic conductivities with the increase in head difference between boundary conditions. Variation in boundary conditions in the pure phase and interlayered one-dimensional profiles caused significant deviations in fluxes, water contents and hydraulic conductivities compared to the simplest case (a head difference between the upper and lower constant head boundaries of 10 cm in the wetter range and 100 cm in the drier range).

Boundary between Soil and Saprolite in Alisols in the South of Brazil

Despite numerous studies conducted on the lower limit of soil and its contact with saprolite layers, a great deal of work is left to standardize identification and annotation of these variables in the field. In shallow soils, the appropriately noting these limits or contacts is essential for determining their behavior and potential use. The aims of this study were to identify and define the field contact and/or transition zone between soil and saprolite in profiles of an Alisol derived from fine sandstone and siltstone/claystone in subtropical southern Brazil and to subsequently validate the field observations through a multivariate analysis of laboratory analytical data. In the six Alisol profiles evaluated, the sequence of horizons found was A, Bt, C, and Cr, where C was considered part of the soil due to its pedogenetic structure, and Cr was considered saprolite due to its rock structure. The morphological properties that were determined in the field and that were different between the B and C horizons and the Cr layer were color, structure, texture, and fragments of saprolite. According to the test of means, the properties that support the inclusion of the C horizon as part of the soil are sand, clay, water-dispersible clay, silt/clay ratio, macroporosity, total porosity, resistance to penetration, cation exchange capacity, Fe extracted by DCB, Al, H+Al, and cation exchange capacity of clay. The properties that support the C horizon as a transition zone are silt, Ca, total organic C, and Fe extracted by ammonium oxalate. Discriminant analysis indicated differences among the three horizons evaluated.

O uso de FDG-PET/TC scan no planejamento da radioterapia em câncer do pulmão não de pequenas células

Radioterapia é uma importante alternativa de tratamento curativo em pacientes com câncer do pulmão não de pequenas células. Entretanto, pulmões são muito sensíveis à radiação e isto aumenta a importância em se delimitar o volume a ser irradiado com precisão. Ultimamente, a tomografia por emissão de pósitron (PET) e a tomografia computadorizada (TC) são feitas de forma combinada, e a literatura sugere que seu impacto no planejamento da radioterapia é significativo. Ao se utilizar exames de PET/TC no planejamento da radioterapia é importante reconhecer e adaptar-se às diferenças entre os equipamentos de diagnóstico e de tratamento. Este texto discute alguns dos problemas técnicos que devem ser resolvidos quando se incorpora PET no planejamento radioterápico.

Impact of 18F-FDG PET scan on the prevalence of benign thoracic lesions at surgical resection

OBJECTIVE: The main utility of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) lies in the staging of lung cancer. However, it can also be used to differentiate indeterminate pulmonary lesions, but its impact on the resection of benign lesions at surgery is unknown. The aim of this study was to compare the prevalence of benign lesions at thoracotomy carried out for suspected lung cancer, before and after the introduction of PET scanning in a large thoracic surgical centre. MATERIALS AND METHODS: We reviewed our prospectively recorded surgical database for all consecutive patients undergoing thoracotomy for suspected or proven lung cancer and compared the prevalence of benign lesions in 2 consecutive 2-year groups, before (group I) and after (group II) the introduction of FDG-PET scan respectively. RESULTS: Surgical resection was performed on 1233 patients during the study period. The prevalence of benign lesions at surgery in groups I and II was similar (44/626 and 41/607, both 7%), and also in group II between those who underwent FDG-PET scan and the remainder (21/301 and 20/306 respectively, both 7%). In group II, of the 21 patients with benign lesions, who underwent FDG-PET, 19 had a false positive scan (mean standardised uptake value 5.3 [range 2.6-12.7]). Of these, 13 and 4 patients respectively had non-diagnostic bronchoscopy and percutaneous transthoracic lung biopsy pre thoracotomy. There was no difference in the proportion of different benign lesions resected between group I and those with FDG-PET in group II. CONCLUSION: The introduction of FDG-PET scanning has not altered the proportion of patients undergoing thoracotomy for ultimately benign lesions, mainly due to the avidity for the isotope of some non-malignant lesions. Such false positive results need to be considered when patients with unconfirmed lung cancer are contemplated for surgical resection.

Ultrasound scan as a potential source of nosocomial and cross-infection: a literature review

AbstractThe authors review the main concepts regarding the importance of cleaning/disinfection of ultrasonography probes, aiming a better comprehension by practitioners and thus enabling strategies to establish a safe practice without compromising the quality of the examination and the operator productivity. In the context of biosafety, it is imperative to assume that contact with blood or body fluids represents a potential source of infection. Thus, in order to implement cleaning/disinfection practice, it is necessary to understand the principles of infection control, to consider the cost/benefit ratio of the measures to be implemented, and most importantly, to comprehend that such measures will not only benefit the health professional and the patient, but the society as a whole.

Effect of different surface roughnesses on a turbulent boundary layer

The classical treatment of rough wall turbulent boundary layers consists in determining the effect the roughness has on the mean velocity profile. This effect is usually described in terms of the roughness function delta U+. The general implication is that different roughness geometries with the same delta U+ will have similar turbulence characteristics, at least at a sufficient distance from the roughness elements. Measurements over two different surface geometries (a mesh roughness and spanwise circular rods regularly spaced in the streamwise direction) with nominally the same delta U+ indicate significant differences in the Reynolds stresses, especially those involving the wall-normal velocity fluctuation, over the outer region. The differences are such that the Reynolds stress anisotropy is smaller over the mesh roughness than the rod roughness. The Reynolds stress anisotropy is largest for a smooth wall. The small-scale anisotropy and interniittency exhibit much smaller differences when the Taylor microscale Reynolds number and the Kolmogorov-normalized mean shear are nominally the same. There is nonetheless evidence that the small-scale structure over the three-dimensional mesh roughness conforms more closely with isotropy than that over the rod-roughened and smooth walls.

An experimental/numerical study of the turbulent boundary layer development along a surface with a sudden change in roughness

A theory for the description of turbulent boundary layer flows over surfaces with a sudden change in roughness is considered. The theory resorts to the concept of displacement in origin to specify a wall function boundary condition for a kappa-epsilon model. An approximate algebraic expression for the displacement in origin is obtained from the experimental data by using the chart method of Perry and Joubert(J.F.M., vol. 17, pp. 193-122, 1963). This expression is subsequently included in the near wall logarithmic velocity profile, which is then adopted as a boundary condition for a kappa-epsilon modelling of the external flow. The results are compared with the lower atmospheric observations made by Bradley(Q. J. Roy. Meteo. Soc., vol. 94, pp. 361-379, 1968) as well as with velocity profiles extracted from a set of wind tunnel experiments carried out by Avelino et al.( 7th ENCIT, 1998). The measurements are found to be in good agreement with the theoretical computations. The skin-friction coefficient was calculated according to the chart method of Perry and Joubert(J.F.M., vol. 17, pp. 193-122, 1963) and to a balance of the integral momentum equation. In particular, the growth of the internal boundary layer thickness obtained from the numerical simulation is compared with predictions of the experimental data calculated by two methods, the "knee" point method and the "merge" point method.

Inverse convection problem of simultaneous estimation of two boundary heat fluxes in parallel plate channels

This paper deals with the use of the conjugate gradient method of function estimation for the simultaneous identification of two unknown boundary heat fluxes in parallel plate channels. The fluid flow is assumed to be laminar and hydrodynamically developed. Temperature measurements taken inside the channel are used in the inverse analysis. The accuracy of the present solution approach is examined by using simulated measurements containing random errors, for strict cases involving functional forms with discontinuities and sharp-corners for the unknown functions. Three different types of inverse problems are addressed in the paper, involving the estimation of: (i) Spatially dependent heat fluxes; (ii) Time-dependent heat fluxes; and (iii) Time and spatially dependent heat fluxes.

An Hp-Adaptive Hierarchical Formulation for the Boundary Element Method Applied to Elasticity in Two Dimensions

This paper presents an HP-Adaptive Procedure with Hierarchical formulation for the Boundary Element Method in 2-D Elasticity problems. Firstly, H, P and HP formulations are defined. Then, the hierarchical concept, which allows a substantial reduction in the dimension of equation system, is introduced. The error estimator used is based on the residual computation over each node inside an element. Finally, the HP strategy is defined and applied to two examples.

Wind tunnel simulation of atmospheric boundary layer flows

The present work shows how thick boundary layers can be produced in a short wind tunnel with a view to simulate atmospheric flows. Several types of thickening devices are analysed. The experimental assessment of the devices was conducted by considering integral properties of the flow and the spectra: skin-friction, mean velocity profiles in inner and outer co-ordinates and longitudinal turbulence. Designs based on screens, elliptic wedge generators, and cylindrical rod generators are analysed. The paper describes in detail the experimental arrangement, including the features of the wind tunnel and of the instrumentation. The results are compared with experimental data published by other authors and with naturally developed flows.

Effects of condensation in microchannels with a porous boundary: analytical investigation on heat transfer and meniscus shape

In two-phase miniature and microchannel flows, the meniscus shape must be considered due to effects that are affected by condensation and/or evaporation and coupled with the transport phenomena in the thin film on the microchannel wall, when capillary forces drive the working fluid. This investigation presents an analytical model for microchannel condensers with a porous boundary, where capillary forces pump the fluid. Methanol was selected as the working fluid. Very low liquid Reynolds numbers were obtained (Re~6), but very high Nusselt numbers (Nu~150) could be found due to the channel size (1.5 mm) and the presence of the porous boundary. The meniscus calculation provided consistent results for the vapor interface temperature and pressure, as well as the meniscus curvature. The obtained results show that microchannel condensers with a porous boundary can be used for heat dissipation with reduced heat transfer area and very high heat dissipation capabilities.