Intraarterial nimodipine for the treatment of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage: a preliminary study.

OBJECTIVE: Despite dramatic advances in all medical era, cerebral vasospasm is still the major complication in patients with subarachnoid hemorrhage (SAH). The purpose of this study was to assess the influence of intraarterial (IA) nimodipine in the treatment of symptomatic vasospasm and in preventing neurological disabilities. MATERIALS AND METHODS: We retrospectively reviewed 10 patients of SAH who received IA nimodipine in 15 procedures. The decision to perform angiography and endovascular treatment was based on the neurological examination, brain computed tomography (CT) and CT-angiography. The procedure reports, anesthesia records, neurological examination before and after the procedure, brain imaging and short- and long-term outcome were studied. RESULTS: The average dose of nimodipine was 2 mg. The median change in mean arterial pressure at 10 min was -10 mmHg. No significant change of heart rate was observed at 10 min. There was radiological improvement in 80% of the procedures. Neurological improvement was noted after eight out of 12 procedures when nimodipine was used as the sole treatment and after 10 out of 15, overall. Six patients clinically improved after the treatment and had good outcome. In one patient, an embolus caused fatal anterior and middle cerebral arteries infarction. There was no other neurological deficit or radiological abnormality due to the nimodipine treatment itself. CONCLUSION: Low-dose IA nimodipine is a valid adjunct for the endovascular treatment of cerebral vasospasm. Beneficial effects are achieved in some patients, prompting a prospective control study.

Persistence of Increased Eotaxin-1 (CCL11) Level in Tears of Patients Wearing Contact Lenses: A Long-Term Follow-Up Study.

BACKGROUND: Eotaxin-1 (CCL11) is a potent eosinophil chemotactic and activating peptide that may be implicated in the pathogenesis of chronic allergic eye disease and has been associated with the wearing of contact lenses (CL) in patients with contact lens papillary conjunctivitis (CLPC). The purpose of this study was to study eotaxin-1 expression in the tears of long-term CL wearers. PATIENTS AND METHODS: Tears were collected with glass capillaries from 15 patients (2 male, 13 female) with various degree of CLPC at 2-year intervals. CLPC severity was graded from 0 to 4 with reference to standard slit-lamp photographs of the superior tarsal conjunctiva. The eotaxin-1 level in the tears was measured by an ELISA, using mouse anti-human eotaxin monoclonal antibodies. RESULTS: The mean age was 32.5 ± 13.3 years (range: 17 - 69 years). The mean interval between the tear collections was 30 ± 4.8 months. The mean concentration of eotaxin was 2150 ± 477 pg/mL and 2486 ± 810 pg/mL for the first and second series, respectively. The difference was not statistically significant (paired Wilcoxon/Kruskal-Wallis, p = 0.803). The mean score of papilla grade was 1.26 ± 0.18 for the first sample and 1.40 ± 0.19 two years later. There was no significant difference of grading between the two time periods (paired Wilcoxon/Kruskal-Wallis, p = 0.751). CONCLUSIONS: the eotaxin-1 level remains up-regulated over a long time period in patients wearing CL, most of them with chronic CLPC. Eotaxin may play a role in the pathogenesis of contact lens intolerance.

Auto-évaluation de la qualité d'un site Internet de pharmacie hospitalière

Introduction: L'unité d'Assistance Pharmaceutique de la Pharmacie des HUG fonctionne comme centre d'information sur les médicaments et gère des informations mises à disposition sur le web. Celles-ci sont destinées prioritairement au personnel soignant des HUG et accessibles sur le site intranet/Internet (http://www.hcuge.ch/Pharmacie), mis en service en 1998. L'objectif de ce travail était d'évaluer la qualité de l'information du site intranet/Internet et d'y apporter les améliorations nécessaires. Méthode: Le site intranet/Internet de la pharmacie des HUG a été évalué en automne 2004 à l'aide de 2 outils : NetScoring : grille d'évaluation de la qualité de l'information de santé sur Internet (http://www.chu-rouen.fr/netscoring/). Elle comporte 49 critères répartis en 8 catégories. Chaque critère est noté sur une échelle de 5 occurrences puis pondéré selon son importance (multiplication par 3 si le critère est essentiel, par 2 s'il est important ou par 1 s'il est mineur). Analyse AMDEC : méthode permettant de séquencer un processus et d'en Analyser les Modes de Défaillance, leur Effet et leur Criticité (Qual Saf Health Care 2005 :14(2);93-98). Un score est attribué à chaque mode de défaillance identifié en terme de fréquence, de sévérité et de détectabilité. La multiplication des 3 scores fournit un résultat global de criticité (indice de criticité IC, max. 810), permettant de hiérarchiser les risques. Résultats: Etat des lieux NetScoring : La qualité globale du site intranet/Internet était bonne (202 pts/312). Les points forts concernaient la pertinence et l'utilité du site, la qualité du contenu, du moteur de recherche et du design, la rapidité de chargement du site, la sélection des liens externes proposés et le respect du secret médical. Les faiblesses résidaient dans l'absence de politique de mise à jour régulière, d'annotation systématique de l'état d'actualisation des documents, d'un comité éditorial et scientifique, de mots-clés en anglais et d'une liste permettant l'identification des auteurs. Analyse AMDEC : Quatre catégories (création du document, conversion, structure du site et publication du document) et 19 modes de défaillances ont été caractérisés. Trois modes de défaillance étaient associés à un IC important: erreurs lors de la création d'un document (IC 256), information inadéquate car pratique non validée ou recommandation non généralisable (IC 147) et absence de relecture après la conversion du document en format publiable (ex : PDF) (IC 144). Mesures correctives: Une procédure standard (SOP) a été élaborée pour la gestion du site intranet/Internet. Le format standard des informations (initiales de l'auteur, dates de création et de mise à jour, logo de la pharmacie), la validation et la politique de mise à jour des documents ainsi que la procédure d'archivage y sont clairement définis. Une fiche de suivi accompagnant chaque document a été créée pour la traçabilité de toutes les modifications effectuées et la fréquence de révision à respecter. Discussion et conclusion Cette étude a permis de déterminer et de quantifier les points critiques à améliorer sur le site intranet/Internet de la Pharmacie des HUG. Les mesures correctives entreprises doivent permettre d'améliorer les principales faiblesses et défaillances mises en évidence. La mise en place d'un comité éditorial et scientifique devra être évaluée à l'avenir. Le NetScoring et l'analyse AMDEC sont des outils utiles pour l'évaluation et l'amélioration continue de la qualité d'un site Internet, sous réserve d'une interprétation critique des résultats obtenus avant la mise en place de mesures correctives. Malgré une approche totalement différente, ces outils ont permis de mettre en évidence des lacunes similaires.

Zinc adsorption in highly weathered soils

The objective of this work was to assess the effects of pH and ionic strength upon zinc adsorption, in three highly weathered variable charge soils. Adsorption isotherms were elaborated from batch adsorption experiments, with increasing Zn concentrations (0-80 mg L-1), and adsorption envelopes were constructed through soil samples reactions with 0.01, 0.1 and 1 mol L-1 Ca(NO3)2 solutions containing 5 mg L-1 of Zn, with an increasing pH value from 3 to 8. Driving force of reaction was quantified by Gibbs free energy and separation factor. Isotherms were C-, H- and L-type and experimental results were fitted to nonlinear Langmuir model. Maximum adsorption ranged from 59-810 mg kg-1, and Zn affinity was greater in subsoil (0.13-0.81 L kg-1) than in the topsoil samples (0.01-0.34 L kg-1). Zinc adsorption was favorable and spontaneous, and showed sharply increase (20-90%) in the 4-6 pH range. No effect of ionic strength was observed at pH values below 5, because specific adsorption mechanisms predominated in the 3-5 pH range. Above pH 5, and in subsoil samples, Zn was adsorbed by electrostatic mechanisms, since ionic strength effect was observed. Despite depth and ionic strength effects, Zn adsorption depends mainly on the pH.

Adubação química, ataque do ácaro Aceria guerreronis e produtividade do coqueiro 'Anão-Verde'

O objetivo deste trabalho foi determinar a influência de níveis de nitrogênio e de potássio aplicados em combinação, via fertirrigação, sobre a produtividade do coqueiro 'Anão-Verde', e a intensidade de ataque do ácaro Aceria guerreronis Keifer (Acari: Eriophyidae). O estudo foi conduzido de fevereiro de 2003 a março de 2004, no Município de Neópolis, SE, em um plantio comercial de coqueiro 'Anão-Verde', com oito anos de idade, que desde o ano 2000 vinha recebendo, via microaspersão, os seguintes tratamentos (gramas de N e K por planta por ano): 135 e 135; 1.890 e 1.890; 810 e 135; 135 e 810; 1.890 e 810; e 810 e 1.890. Foram realizadas quatro avaliações trimestrais, entre abril de 2003 e março de 2004, nos cachos de frutos associados às folhas 14 e 18. A produção de frutos foi influenciada pelos níveis de N e K aplicados ao coqueiral, porém a infestação (8 a 80% de frutos atacados) e a severidade dos danos do ácaro-praga (3 a 47%) não foram afetadas pela adubação química.

Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation.

OBJECTIVE: To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN: Observational study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS: Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS: Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.

Crescimento e sobrevivência da tilápia chitralada submetida a diferentes fotoperíodos

O objetivo deste trabalho foi avaliar o efeito do fotoperíodo no crescimento e sobrevivência da tilápia chitralada, Oreochromis niloticus, durante e após a fase de reversão sexual. O trabalho foi realizado em 2006 e 2007, em dois experimentos. No primeiro experimento, foram utilizadas pós-larvas de 0,031±0,0058 g e 1,24±0,096 cm à densidade de 1,5 pós-larva L-1. As pós-larvas foram submetidas aos fotoperíodos 0, 8, 12, 16, 24 horas de luz e a 12,5 horas de luz natural, durante 28 dias. Os animais foram alimentados com ração de 45% de proteína bruta, com hormônio andrógeno, na proporção de 20% da biomassa total, dividida em quatro refeições. As biometrias foram realizadas no início e no fim do experimento. No segundo experimento, foram utilizados alevinos de 0,38±0,16 g e 2,81±0,40 cm, revertidos para macho. O desenho experimental foi semelhante ao do primeiro experimento, exceto a densidade de estocagem (0,33 peixe L-1), a taxa de alimentação (10% da biomassa total) e o tempo de experimento (46 dias). Realizaram-se biometrias quinzenais. O fotoperíodo interferiu mais expressivamente na sobrevivência das pós-larvas da tilápia, e a luz natural foi a mais indicada durante a reversão sexual. A melhor sobrevivência dos alevinos ocorreu no grupo 0 hora de luz. Melhores crescimentos em pesos e comprimentos, porém, aconteceram nos demais fotoperíodos. Taxas de sobrevivência e de crescimento, em resposta a diferentes fotoperíodos, parecem estar relacionadas à idade do peixe.

Specialized home palliative care for adults and children: differences and similarities.

OBJECTIVE: To compare the provision of specialized home palliative care (SHPC) by the adult and pediatric SHPC teams at the Munich University Hospital. METHODS: All patients treated by one of the SHPC teams and their primary caregivers were eligible for the prospective nonrandomized survey. We analyzed the demographics, the underlying diseases, duration and impact of SHPC on symptom control and quality of life (QOL) as well as the caregivers' burden and QOL. RESULTS: Between April 2011 and June 2012, 100 adult and 43 pediatric patients were treated consecutively; 60 adults (median age, 67.5 years; 55% male) and 40 children (median age, 6 years, 57% male) were included in the study. Oncologic diseases were dominant only in the adult cohort (87 versus 25%, p<0.001). The median period of care was higher in the pediatric sample (11.8 versus 4.3 weeks; NS). Ninety-five percent of adult and 45% of pediatric patients died by the end of the study (p<0.001), 75% and 90% of them at home, respectively. The numbers of significant others directly affected by the patient's disease was higher in children (mean 3.4 versus 1.2; p<0.001). The QOL of adult patients and children (p<0.05 for both), as well as of their primary caregivers (p<0.001 for both) improved during SHPC, while the caregivers' burden was lowered (p<0.001 for both). CONCLUSIONS: Our results show important differences in several clinically relevant parameters between adults and children receiving SHPC. This should assist in the development of age-group specific SHPC concepts that effectively address the specific needs of each patient population.

La salud bucodental de los españoles mayores de 64 años. Impacto en el estado de salud individual

Introducción: los cambios epidemiológicos sufridos en los países occidentales en el siglo XX han propiciado un aumento del número absoluto y de la proporción de ancianos en todos ellos. Pacientes y Método: se realizó un estudio descriptivo transversal de prevalencia de enfermedades bucodentales en una población de 3.460 individuos en 7 Comunidades Autónomas españolas, tanto institucionalizados (10%) como no institucionalizados (90%). Resultados: la edad media de los encuestados fue de 73,6±7 años. Un 31,4% de los individuos del estudio eran desdentados totales. Los individuos dentados presentaban un promedio de 14,8±8 dientes. El CAOD de los individuos de la muestra fue de 20,8±10, siendo de 23,7±9,8 en los institucionalizados. La última visita al dentista había sido de media 4 años y medio antes, pero los institucionalizados hacía 7 años. Discusión: es totalmente inaceptable que la prevención y el tratamiento las enfermedades bucodentales. especialmente entre las personas de edad más avanzada, se sigan considerando como un aspecto totalmente optativo para el mantenimiento de la salud del individuo. Estudios epidemiológicos. bacteriológicos e Inmunológicos demuestran que la enfermedad periodontal o la caries pueden ser las causantes de un importante aumento de la morbi-mortalidad especialmente entre las personas de más edad.

Manejo de lepidópteros-praga na cultura do milho com o evento Bt piramidado Cry1A.105 e Cry2Ab2

O objetivo deste trabalho foi avaliar a eficácia do evento piramidado (MON 89034), que expressa as proteínas Cry1A.105 e Cry2Ab2, no controle dos principais lepidópteros-praga da cultura do milho no Brasil, Spodoptera frugiperda, Helicoverpa spp. e Diatraea saccharalis. Os ensaios foram conduzidos em quatro regiões do país, com o híbrido DKB 390, submetido a seis tratamentos: híbrido com o evento piramidado, híbrido com o evento que expressa apenas a proteína Cry1A(b) (MON 810) e híbrido convencional (não Bt), todos com e sem manejo integrado de S. frugiperda. Para o evento piramidado, não foi necessário o controle químico em nenhum dos locais avaliados. Diferenças significativas foram observadas entre os tratamentos quanto aos danos e à presença de lagartas. Em geral, essas variáveis foram mais baixas no híbrido com o evento piramidado e mais altas no híbrido convencional, sem controle químico. Sob alta infestação, o controle químico reduziu os danos causados por S. frugiperda e D. saccharalis, tanto no evento que expressa apenas uma proteína, como no híbrido convencional. Com base nos danos causados pelos insetos, o evento piramidado Cry1A.105 e Cry2Ab2 é eficiente no controle dos principais lepidópteros-pragas do milho no Brasil.

The complete genome sequence of the gram-positive bacterium Bacillus subtilis.

Bacillus subtilis is the best-characterized member of the Gram-positive bacteria. Its genome of 4,214,810 base pairs comprises 4,100 protein-coding genes. Of these protein-coding genes, 53% are represented once, while a quarter of the genome corresponds to several gene families that have been greatly expanded by gene duplication, the largest family containing 77 putative ATP-binding transport proteins. In addition, a large proportion of the genetic capacity is devoted to the utilization of a variety of carbon sources, including many plant-derived molecules. The identification of five signal peptidase genes, as well as several genes for components of the secretion apparatus, is important given the capacity of Bacillus strains to secrete large amounts of industrially important enzymes. Many of the genes are involved in the synthesis of secondary metabolites, including antibiotics, that are more typically associated with Streptomyces species. The genome contains at least ten prophages or remnants of prophages, indicating that bacteriophage infection has played an important evolutionary role in horizontal gene transfer, in particular in the propagation of bacterial pathogenesis.

Characterizing the impact of minor cannula design modification.

OBJECTIVE: Bench evaluation of the hydrodynamic behavior of venous cannulas is a valuable technique for the analysis of their performance during cardiopulmonary bypass (CPB). The aim of this study was to investigate the effect of the internal diameter of the extracorporeal connecting tube of venous cannulas on flow rate (Q), pressure drop (delta P), and cannula resistance (delta P/Q²) values, using a computer assisted test bench.¦METHODS: An in vitro circuit was set up with silicone tubing between the test cannula encased in a movable reservoir, and a static reservoir. The delta P, defined as the difference between the drainage pressure and the preload pressure, was measured using high-fidelity Millar pressure transducers. Q was measured using an ultrasonic flowmeter. Data display and data recording were controlled using virtual instruments in a stepwise fashion.¦RESULTS: The 27 F smartcanula® with a 9 mm connecting tube diameter showed 17% less resistance compared to that with an 8 mm connecting tube diameter. Q values were 7.22±0.1 and 7.81±0.04 L/min for cannulas with 8 mm and 9 mm connecting tube diameters, respectively. The delta P/Q² ratio values were 72% lower for the Medtronic cannula with a 9 mm connecting tube diameter compared to that with an 8 mm connecting tube diameter. Q values for the Medtronic cannula were 3.94±0.23 and 6.58±0.04 L/min with 8 mm and 9 mm connecting tube diameters, respectively. The 27 F smartcanula® showed 13% more flow rate compared to the 28 F Medtronic cannula using the unpaired Student t-test (p<0.0001).¦CONCLUSIONS: Our results demonstrated that Q was increased but delta P and delta P/Q² values were significantly decreased when the connecting tube diameter was increased for venous cannulas. The connecting tube diameter significantly affected the resistance to liquid flow through the cannula. Smartcanulas® outperform Medtronic cannulas.

Työnantajan sivukulujen poiston vaikutus työllisyyteen

Tutkielman tavoitteena oli osoittaa minkälaisia vaikutuksia työnantajan sivukulujen poisto toisi työllisyyteen. Tutkielman empiirinen osio toteutettiin survey-tutkimuksella. Tämä toteutettiin postikyselyllä, jossa 810 Etelä-Karjalalaiselle yritykselle lähetettiin joulukuussa 2004 kyselylomake. Kyselyyn vastanneiden yritysten määrä oli 141 ja vastausprosentti oli 17. Vastanneiden yritysten toimialajakauma vastasi koko Etelä-Karjalan alueen yritysten toimialajakaumaa, jossa suurimpana toimialana oli eri palvelualan yritykset. Tutkielma eroaa aikaisemminista työllisyyden parantamiseksi esitetyistä malleista. Ensimmäineneroavaisuus on sivukulujen poistaminen yrityksiltä kokonaan eikä vain muutamilla prosenttiyksiköillä. Toinen eroavaisuus on sivukulujen poiston kohdistamisessavain niille yrityksille, joilla työllistävyys kasvaa merkittävästi. Näiden tarkoituksena on maksimoida työllisyysvaikutukset ja vaikuttaa aiheutuneiden kustannusten minimointiin tai kustannusten korvaantumiseen täysimääräisesti. Asetetut tavoitteet voidaan saavuttaa kohdistamalla sivukulujen poisto vain niihin yrityksiin, jotka työllistävät alle 5 henkilöä. Näiden yritysten kohdalla mahdollistuvauusien työntekijöiden määrä nousee keskimäärin 36 prosentilla. Tämä merkitsee laskelmien mukaan sitä, että sivululujen poiston aiheuttama sosiaalivakuutusmaksujen väheneminen korvaantuu vanhojen ja uusien työntekijöiden maksamilla tuloveroilla ja vähentyvillä työttömyyskorvauksilla. Uusien työpaikkojen kasvu merkitseeEtelä-Karjalan työttömyysprosentin laskua yli 4 prosenttiyksiköllä.

Projecte de disseny i càlcul d'un sistema de reg per degoteig d'arbres fruiters

Aquest projecte té com a objecte el disseny i el càlcul d'un sistema de reg. El sistema de reg es farà mitjançant mànegues de degoters. El sistema de reg permetrà el subministrament d'aigua a uns determinats arbres fruiters mitjançant el bombeig de l'aigua des d'un pou. Es dissenyarà i es calcularà d'un sistema de fertilització per als arbres fruiters.