Ventilación controlada por volumen vs. ventilación controlada por presión en pacientes sometidos a ventilación de un solo pulmón

El establecimiento de la ventilación de un solo pulmón (OLV) tiene varios inconvenientes como el incremento de las presiones de la vía aérea y aumento del shunt. Estos cambios pueden estar influenciados por el modo ventilatorio escogido. La ventilación controlada por presión (VCP) es un modo alternativo ampliamente usado en pacientes con falla respiratoria por sus características de aporte de flujo y presión. En este estudio la VCP fue usada en los pacientes que requerían OLV y sus efectos sobre las presiones en la vía aérea, oxigenación y estado hemodinámico fueron comparados con la ventilación controlado por volumen (VCV). Nosotros estudiamos 41 pacientes que requerian OLV. Después de ventilar los dos pulmones con volumen los pacientes fueron aleatorizados a uno de dos grupos. En el primer grupo (n=19) OLV fue iniciada con VCV y luego de transcurrido 30 minutos los pacientes fueron cambiados a VCP, donde se mantuvo la ventilación por el mismo tiempo. En el otro grupo (n=21) los pacientes iniciaron en VCP 30 minutos y luego fueron cambiados a VCV con una duración similar. Las presiones en la vía aérea, gases arteriales y variables hemodinámicas fueron medidos durante OLV en cada modo ventilatorio previo al cambio. Nosotros observamos que el inicio de OLV genera un incremento de la presión inspiratoria pico (PIP) (p=0.0002) y presión plateau (p=0.005). Este aumento es mayor en el grupo que fue VCV (p=0.008) que en el grupo que fue VCP (p=0.003). No hubo diferencia estadísticamente significativa en las otras varibles estudiadas entre los grupos. Nosotros concluimos que la VCP puede ser una alternativa a VCV en pacientes que requieren OLV porque disminuye las presiones en la vía aérea y aunque no mejora la oxigenación si puede minimizar el desarrollo de lesiones pulmonares inducidas por la ventilación en una población que es de alto riesgo para el desarrollo de la misma.

Grados altos en la Escala de Fisher predicen el desarrollo de hidrocefalia en pacientes con hemorragia subaracnoidea espontanea

Objetive. To determine if high grades of Fisher scale are useful to predict the development of hydrocephalus in consecutive Colombian patients with spontaneous subarachnoid hemorrhage (SAH) assessed from January 2005 to April 2012 with 12 month follow-up. Methods. 251 patients were included in a restrospective manner. The association between Fisher scale and hydrocephalus was analyzed bivariate and multivariate analysis. In addition, a systematic literature review (SLR) was done. Results. In our cohort of patients, the etiology of SAH was due to aneurysms; 78,5%. The prevalence of hydrocephalus was found to be of 27,1%. Overall survival with a 12 month follow-up was of 65,7%. Average age of included patients was 55,5 ± 15 years, and most of them were women; 65,7%. Having Fisher 4 and Hunt-Hess III are significantly associated with hydrocephalus: adjusted OR: 2.93 95% CI: 1.51-5.65, P <0.001, adjusted OR: 2.83 95% CI: 1.31-6.17 P=0.008 respectively. The SRL showed an overall prevalence of hydrocephalus between 17 and 68% and mortality varied between 3.0% and 33%. 50% of the included studies significantly associated intraventricular hemorrhage ( Fisher 4) with hydrocephalus. Conclusion. Our results confirm current concepts on post-SAH hydrocephalus and the fact that is obstructive and secondary to Fisher 4 and having neurological impairment on admission (Hunt and Hess III).

Escala de Fisher como factor predictor de hidrocefalia en hemorragia subaracnoidea espontanea

Objetivo. Determinar si la cantidad de sangre y su localización es el espacio subaracnoideo, medible con la escala de Fisher en las primeras 24 horas de ocurrido el ictus hemorrágico, es un factor predictor para el desarrollo de hidrocefalia en pacientes con diagnóstico de hemorragia subaracnoidea (HSA) espontánea, vistos en el Hospital Universitario Clínica San Rafael (HUCSR) con seguimiento de 12 meses. Métodos. 251 pacientes fueron incluidos en una cohorte retrospectiva. La asociación entre la escala de Fisher y el desarrollo de hidrocefalia en pacientes con HSA espontánea fue analizada a través de un análisis bivariado y multivariado. Resultados. La edad promedio de los pacientes fue de 55,5 ± 15 años; con predominancia en el sexo femenino 65,7%. La prevalencia de hidrocefalia fue de 27,1% en la cohorte y la etiología de la HSA fue en su mayoría por ruptura de aneurismas de arterias cerebrales; 78,5%. La sobrevida a 12 meses fue de 65,7%. Tanto el grado 4 en la escala de Fisher como Hunt-Hess III se asocian con el desarrollo de hidrocefalia: ORA; 2.93 IC 95%: 1.51-5.65, P <0.001, ORA 2.83 IC 95%: 1.31-6.17 P=0.008 respectivamente. Conclusión. La presencia de sangrado Intraventricular o intraparenquimatoso ( Fisher 4) en las primeras 24 horas, asociado a un deterioro neurológico al ingreso Hunt-Hess III están asociados con el desarrollo de hidrocefalia en los 251 pacientes evaluados con diagnóstico de HSA espontánea; hallazgos consistentes con lo reportado en la literatura mundial.

Role of glutamate metabolism in bacterial responses towards acid and other stresses

Glutamate plays a central role in a wide range of metabolic processes in bacterial cells. This review focuses on the involvement of glutamate in bacterial stress responses. In particular it reviews the role of glutamate metabolism in response against acid stress and other stresses. The glutamate decarboxylase (GAD) system has been implicated in acid tolerance in several bacterial genera. This system facilitates intracellular pH homeostasis by consuming protons in a decarboxylation reaction that produces γ-aminobutyrate (GABA) from glutamate. An antiporter system is usually present to couple the uptake of glutamate to the efflux of GABA. Recent insights into the functioning of this system will be discussed. Finally the intracellular fate of GABA will also be discussed. Many bacteria are capable of metabolising GABA to succinate via the GABA shunt pathway. The role and regulation of this pathway will be addressed in the review. © 2012 The Authors Journal of Applied Microbiology © 2012 The Society for Applied Microbiology.

Anti-platelet effect of aspirin is substantially reduced after administration of heparin during carotid endarterectomy

OBJECTIVES: Aspirin therapy is usually continued throughout the perioperative period to reduce the risk for thromboembolic stroke and myocardial infarction after carotid endarterectomy (CEA). Aspirin irreversibly binds cyclooxygenase-1, thereby reducing platelet aggregation for the lifetime of each platelet. However, recent research from this unit has shown that aggregation in response to arachidonic acid increases significantly, but transiently, during CEA, which suggests that the anti-platelet effect of aspirin is temporarily reversed. The purpose of the current study was to determine when this phenomenon occurs and to identify the possible mechanisms involved. METHODS: Platelet aggregation was measured in platelet-rich plasma from 41 patients undergoing CEA who were stabilized with 150 mg of aspirin daily. Blood was taken at 8 time points: before anesthesia, after anesthesia, before heparinization, 3 minutes after heparinization, 3 minutes after shunt insertion, 10 minutes after flow restoration, 4 hours postoperatively, and 24 hours postoperatively. Platelet aggregation was also measured at similar times in a group of 18 patients undergoing peripheral angioplasty without general anesthesia. RESULTS: All patient platelets were effectively inhibited by aspirin at the start of the operation. There was a significant intraoperative increase in platelet response to arachidonic acid in both groups of patients, which occurred within 3 minutes of administration of unfractionated heparin. In the CEA group this resulted in a greater than 10-fold increase in mean aggregation, to 5 mmol/L of arachidonic acid (5 mmol/L), rising from 3.9% +/- 2.2% preoperatively to 45.1% +/- 29.3% after administration of heparin ( P <.0001). This increased aggregation persisted into the early postoperative period, but by 24 hours post operation aggregation had returned to near preoperative values. Aggregation in response to other platelet agonists (adenosine diphosphate, thrombin receptor agonist peptide) showed only a small increase at the same time, which could be accounted for by a parallel increase in the level of spontaneous aggregation. CONCLUSION: Administration of heparin significantly increases platelet aggregation in response to arachidonic acid, despite adequate inhibition by aspirin administered preoperatively. This apparent reversal in anti-platelet activity persisted into the immediate early postoperative period, and could explain why a small proportion of patients are at increased risk for acute cardiovascular events after major vascular surgery, despite aspirin therapy.

Evaluation of a PVT Air Collector

Hybrid Photovoltaic Thermal (PVT) collectors are an emerging technology that combines PV and solar thermal systems in a single solar collector producing heat and electricity simultaneously. The focus of this thesis work is to evaluate the performance of unglazed open loop PVT air system integrated on a garage roof in Borlänge. As it is thought to have a significant potential for preheating ventilation of the building and improving the PV modules electrical efficiency. The performance evaluation is important to optimize the cooling strategy of the collector in order to enhance its electrical efficiency and maximize the production of thermal energy. The evaluation process involves monitoring the electrical and thermal energies for a certain period of time and investigating the cooling effect on the performance through controlling the air mass flow provided by a variable speed fan connected to the collector by an air distribution duct. The distribution duct transfers the heated outlet air from the collector to inside the building. The PVT air collector consists of 34 Solibro CIGS type PV modules (115 Wp for each module) which are roof integrated and have replaced the traditional roof material. The collector is oriented toward the south-west with a tilt of 29 ᵒ. The collector consists of 17 parallel air ducts formed between the PV modules and the insulated roof surface. Each air duct has a depth of 0.05 m, length of 2.38 m and width of 2.38 m. The air ducts are connected to each other through holes. The monitoring system is based on using T-type thermocouples to measure the relevant temperatures, air sensor to measure the air mass flow. These parameters are needed to calculate the thermal energy. The monitoring system contains also voltage dividers to measure the PV modules voltage and shunt resistance to measure the PV current, and AC energy meters which are needed to calculate the produced electrical energy. All signals recorded from the thermocouples, voltage dividers and shunt resistances are connected to data loggers. The strategy of cooling in this work was based on switching the fan on, only when the difference between the air duct temperature (under the middle of top of PV column) and the room temperature becomes higher than 5 °C. This strategy was effective in term of avoiding high electrical consumption by the fan, and it is recommended for further development. The temperature difference of 5 °C is the minimum value to compensate the heat losses in the collecting duct and distribution duct. The PVT air collector has an area of (Ac=32 m2), and air mass flow of 0.002 kg/s m2. The nominal output power of the collector is 4 kWppv (34 CIGS modules with 115 Wppvfor each module). The collector produces thermal output energy of 6.88 kWth/day (0.21 kWth/m2 day) and an electrical output energy of 13.46 kWhel/day (0.42 kWhel/m2 day) with cooling case. The PVT air collector has a daily thermal energy yield of 1.72 kWhth/kWppv, and a daily PV electrical energy yield of 3.36 kWhel /kWppv. The fan energy requirement in this case was 0.18 kWh/day which is very small compared to the electrical energy generated by the PV collector. The obtained thermal efficiency was 8 % which is small compared to the results reported in literature for PVT air collectors. The small thermal efficiency was due to small operating air mass flow. Therefore, the study suggests increasing the air mass flow by a factor of 25. The electrical efficiency was fluctuating around 14 %, which is higher than the theoretical efficiency of the PV modules, and this discrepancy was due to the poor method of recording the solar irradiance in the location. Due to shading effect, it was better to use more than one pyranometer.

Papel do estudo hemodinâmico hepático na avaliação de pacientes com cirrose

O objetivo deste estudo foi avaliar o comportamento do gradiente de pressão venosa hepática (GPVH) em pacientes com cirrose. Foram estudados 83 pacientes portadores de hepatopatia crônica, com média de idade de 52,9 ± 10,1 anos, sendo 71,1% do sexo masculino. Todos realizaram estudo hemodinâmico hepático, sendo determinado o GPVH. Nestes doentes o GPVH foi analisado segundo distintas variáveis clínicas, enfatizando seu papel na avaliação da probabilidade de sangramento a partir de um nível discriminativo. Os pacientes foram seguidos em média por 16,6 ± 16,02 meses e divididos em grupos conforme o desfecho: óbito, realização de cirurgia de “shunt” porto-cava, de transplante hepático e ressangramento por ruptura de varizes de esôfago durante o seguimento, tendo sido realizadas comparações entre as médias do GPVH nos diferentes desfechos. O nível de significância estatística adotado de foi 0,05. Com os dados obtidos foram possíveis os seguintes resultados: - A média do GPVH nos pacientes com hepatopatia crônica foi de 15,26 ± 6,46 mmHg. - Não houve diferença estatística entre as médias do GPVH nos hepatopatas crônicos de etiologia alcoólica e não alcoólica. - O risco relativo para sangramento por varizes de esôfago foi maior nos pacientes com GPVH acima de 10 e 12mmHg, embora tenha havido sangramento em doentes com níveis inferiores a estes. - A média do GPVH foi significativamente maior nos pacientes que apresentaram sangramento durante o seguimento em relação àqueles que estiveram livres desta complicação. - A média do GPVH no grupo de pacientes que sangraram, que foram a óbito, que realizaram “shunt” porto-cava e que foram a transplante hepático foi significativamente maior do que aquela observada nos pacientes que evoluíram sem complicações. - Não foi identificado um nível crítico discriminativo do GPVH que estivesse relacionado ao prognóstico. - A determinação do GPVH, ressalvada uma complicação de seriedade, mostrou-se um método seguro. Dos resultados aqui observados, conclui-se que a determinação do GPVH é útil em predizer qual população de cirróticos está mais suscetível ao sangramento digestivo por ruptura de varizes, bem como em auxiliar na avaliação do prognóstico dos mesmos.

Controle Adaptativo Robusto para Filtros Ativos de Potência Paralelo

Conventional control strategies used in shunt active power filters (SAPF) employs real-time instantaneous harmonic detection schemes which is usually implements with digital filters. This increase the number of current sensors on the filter structure which results in high costs. Furthermore, these detection schemes introduce time delays which can deteriorate the harmonic compensation performance. Differently from the conventional control schemes, this paper proposes a non-standard control strategy which indirectly regulates the phase currents of the power mains. The reference currents of system are generated by the dc-link voltage controller and is based on the active power balance of SAPF system. The reference currents are aligned to the phase angle of the power mains voltage vector which is obtained by using a dq phase locked loop (PLL) system. The current control strategy is implemented by an adaptive pole placement control strategy integrated to a variable structure control scheme (VS-APPC). In the VS-APPC, the internal model principle (IMP) of reference currents is used for achieving the zero steady state tracking error of the power system currents. This forces the phase current of the system mains to be sinusoidal with low harmonics content. Moreover, the current controllers are implemented on the stationary reference frame to avoid transformations to the mains voltage vector reference coordinates. This proposed current control strategy enhance the performance of SAPF with fast transient response and robustness to parametric uncertainties. Experimental results are showing for determining the effectiveness of SAPF proposed control system

Técnica de controle adaptativo robusto aplicada a filtros ativos de potência e paralelo

The Methods for compensation of harmonic currents and voltages have been widely used since these methods allow to reduce to acceptable levels the harmonic distortion in the voltages or currents in a power system, and also compensate reactive. The reduction of harmonics and reactive contributes to the reduction of losses in transmission lines and electrical machinery, increasing the power factor, reduce the occurrence of overvoltage and overcurrent. The active power filter is the most efficient method for compensation of harmonic currents and voltages. The active power filter is necessary to use current and voltage controllers loop. Conventionally, the current and voltage control loop of active filter has been done by proportional controllers integrative. This work, investigated the use of a robust adaptive control technique on the shunt active power filter current and voltage control loop to increase robustness and improve the performance of active filter to compensate for harmonics. The proposed control scheme is based on a combination of techniques for adaptive control pole placement and variable structure. The advantages of the proposed method over conventional ones are: lower total harmonic distortion, more flexibility, adaptability and robustness to the system. Moreover, the proposed control scheme improves the performance and improves the transient of active filter. The validation of the proposed technique was verified initially by a simulation program implemented in C++ language and then experimental results were obtained using a prototype three-phase active filter of 1 kVA

Implementação experimental de filtro ativo paralelo de potência com aplicação a gerador de indução trifásico

This work describes the experimental implementation of a shunt active power filter applied to a three-phase induction generator. The control strategy of active filter turned to the excitation control of the machine and to decrease the harmonics in the generator output current. Involved the implementation of a digital PWM switching, and was made a comparison of two techniques for obtaining the reference currents. The first technique is based on the synchronous dq reference method and the second on the theory of instantaneous power. The comparison is performed via simulation and experimental results. To obtain the experimental results, was mounted a bench trial and the control and communications needed were implemented using DSP - MS320F2812. The simulation results and experimental data proved the efficiency of the filter to apply, highlighting the technique of instantaneous power

Estratégia de controle robusto para filtro ativo paralelo sem detecção de harmônicos de correntes

Conventional control strategies used in shunt active power filters (SAPF) employs real-time instantaneous harmonic detection schemes which is usually implements with digital filters. This increase the number of current sensors on the filter structure which results in high costs. Furthermore, these detection schemes introduce time delays which can deteriorate the harmonic compensation performance. Differently from the conventional control schemes, this paper proposes a non-standard control strategy which indirectly regulates the phase currents of the power mains. The reference currents of system are generated by the dc-link voltage controller and is based on the active power balance of SAPF system. The reference currents are aligned to the phase angle of the power mains voltage vector which is obtained by using a dq phase locked loop (PLL) system. The current control strategy is implemented by an adaptive pole placement control strategy integrated to a variable structure control scheme (VS¡APPC). In the VS¡APPC, the internal model principle (IMP) of reference currents is used for achieving the zero steady state tracking error of the power system currents. This forces the phase current of the system mains to be sinusoidal with low harmonics content. Moreover, the current controllers are implemented on the stationary reference frame to avoid transformations to the mains voltage vector reference coordinates. This proposed current control strategy enhance the performance of SAPF with fast transient response and robustness to parametric uncertainties. Experimental results are showing for determining the effectiveness of SAPF proposed control system

Fault Current Limiter Using YBCO Coated Conductor-The Limiting Factor and Its Recovery Time

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

Neurocisticercose e síndrome de lennox-gastaut: relato de caso

Relata-se o caso de uma menina que, aos 2 anos de idade, apresentou a forma epiléptica, hidrocefálica e encefalítica da neurocisticercose, diagnosticada por exame do líquido cefalorraqueano e tomografia computadorizada de crânio, evolução com crises polimórficas, episódios de descompensação da hipertensão intracraniana por obstrução do sistema de derivação ventriculoperitoneal, retardo no desenvolvimento neuropsicomotor e cegueira até que, aos 10 anos de idade, foi diagnosticada síndrome de Lennox-Gastaut. Atualmente, a paciente tem 16 anos, apresenta sequelas neurológicas e crises parciais complexas com automatismos, parcialmente controladas com o uso de clobazan e oxcarbazepina. A primeira associação de neurocisticercose e síndrome de Lennox-Gastaut foi descrita em 1973, por Frochtengarten & Scarante, em uma menina com quadro clínico semelhante ao do caso relatado.

Aspectos clínicos e evolutivos da hidrocefalia na neurocisticercose

Com o propósito de analisar os aspectos clínicos da hidrocefalia (HDC) na neurocisticercose (NCC), realizou-se o estudo retrospectivo de 47 prontuários de pacientes com HDC e NCC. Verificou-se que 70,2% eram homens, entre 21 e 50 anos. A hipertensão intracraniana (HIC) ocorreu em todos os pacientes, cefaléia (CEF) em 89,4%, meningoencefalite (ME) em 80,8% e distúrbios psíquicos (PSI) em 74,5%. A síndrome liquórica da NCC foi detectada em 65,9% pacientes. Além da HDC, as tomografias computadorizadas de crânio (TC) mostraram lesões císticas e edema cerebral difuso em 59,6% cada, calcificações em 55,3%. Dos 41 pacientes (87,2%) com derivação ventriculoperitoneal (DVP), em 22 (53,7%) deles foram necessárias uma a sete revisões/paciente (média=3). A evolução foi satisfatória em 51,1% e fatal em 31,9%. Conclui-se que a hidrocefalia é mais comum no sexo masculino em idade produtiva, tendo a HIC, CEF, MN e PSI como manifestações freqüentes e que, a necessidade de revisões de DVP, piora o prognóstico.

Effects of temperature on lung and blood gases in the South American rattlesnake Crotalus durissus terrificus

The effects of temperature on lung and blood gases were measured in the South American rattlesnake (Crotalus durissus terrificus). Arterial blood and lung gas samples were obtained from chronically cannulated animals at 15, 25, and 35 degrees C. As expected for reptiles, arterial pH fell with increased temperature (0.018 U degrees C-1 between 15 and 25 degrees C and 0.011 U degrees C-1 between 25 and 35 degrees C) while lung gas PCO2 rose from 5.8 mmHg at 15 degrees C to 13.2 mmHg at 35 degrees C. Concurrently, lung gas PO2 declined from 132 mmHg at 15 degrees C to 120 mmHg at 35 degrees C, and arterial PO2 increased from 33 to 76 mmHg in that temperature range. Arterial haemoglobin O-2 saturation rose from 0.53 at 15 degrees C to 0.83 at 25 degrees C but became slightly reduced (0.77) with a further elevation of temperature to 35 degrees C. Arterial haemoglobin concentration increased from 1.96 to 2.53 mM between 15 and 35 degrees C, consistent with higher demands on oxygen delivery to tissues at elevated temperatures. Moreover, the substantial increase of haemoglobin O-2 saturation between 15 and 25 degrees C conforms to the idea that reduction of the central vascular right-to-left shunt (pulmonary bypass of systemic venous return) is associated with high metabolic demands. (C) 1998 Elsevier B.V. All rights reserved.