Why is VO2 max after altitude acclimatization still reduced despite normalization of arterial O2 content?

[EN] Acute hypoxia (AH) reduces maximal O2 consumption (VO2 max), but after acclimatization, and despite increases in both hemoglobin concentration and arterial O2 saturation that can normalize arterial O2 concentration ([O2]), VO2 max remains low. To determine why, seven lowlanders were studied at VO2 max (cycle ergometry) at sea level (SL), after 9-10 wk at 5,260 m [chronic hypoxia (CH)], and 6 mo later at SL in AH (FiO2 = 0.105) equivalent to 5,260 m. Pulmonary and leg indexes of O2 transport were measured in each condition. Both cardiac output and leg blood flow were reduced by approximately 15% in both AH and CH (P < 0.05). At maximal exercise, arterial [O2] in AH was 31% lower than at SL (P < 0.05), whereas in CH it was the same as at SL due to both polycythemia and hyperventilation. O2 extraction by the legs, however, remained at SL values in both AH and CH. Although at both SL and in AH, 76% of the cardiac output perfused the legs, in CH the legs received only 67%. Pulmonary VO2 max (4.1 +/- 0.3 l/min at SL) fell to 2.2 +/- 0.1 l/min in AH (P < 0.05) and was only 2.4 +/- 0.2 l/min in CH (P < 0.05). These data suggest that the failure to recover VO2 max after acclimatization despite normalization of arterial [O2] is explained by two circulatory effects of altitude: 1) failure of cardiac output to normalize and 2) preferential redistribution of cardiac output to nonexercising tissues. Oxygen transport from blood to muscle mitochondria, on the other hand, appears unaffected by CH.

Determinants of maximal oxygen uptake in severe acute hypoxia

[EN] To unravel the mechanisms by which maximal oxygen uptake (VO2 max) is reduced with severe acute hypoxia in humans, nine Danish lowlanders performed incremental cycle ergometer exercise to exhaustion, while breathing room air (normoxia) or 10.5% O2 in N2 (hypoxia, approximately 5,300 m above sea level). With hypoxia, exercise PaO2 dropped to 31-34 mmHg and arterial O2 content (CaO2) was reduced by 35% (P < 0.001). Forty-one percent of the reduction in CaO2 was explained by the lower inspired O2 pressure (PiO2) in hypoxia, whereas the rest was due to the impairment of the pulmonary gas exchange, as reflected by the higher alveolar-arterial O2 difference in hypoxia (P < 0.05). Hypoxia caused a 47% decrease in VO2 max (a greater fall than accountable by reduced CaO2). Peak cardiac output decreased by 17% (P < 0.01), due to equal reductions in both peak heart rate and stroke VOlume (P < 0.05). Peak leg blood flow was also lower (by 22%, P < 0.01). Consequently, systemic and leg O2 delivery were reduced by 43 and 47%, respectively, with hypoxia (P < 0.001) correlating closely with VO2 max (r = 0.98, P < 0.001). Therefore, three main mechanisms account for the reduction of VO2 max in severe acute hypoxia: 1) reduction of PiO2, 2) impairment of pulmonary gas exchange, and 3) reduction of maximal cardiac output and peak leg blood flow, each explaining about one-third of the loss in VO2 max.

L'impiego del modello di Rash per la valutazione della soddisfazione del paziente nell'ambito delle strutture sanitarie di ricovero

Hospitals and health service providers are use to collect data about patient’s opinion to improve patient health status and communication with them and to upgrade the management and the organization of the health service provided. A lot of survey are carry out for this purpose and several questionnaire are built to measure patient satisfaction. In particular patient satisfaction is a way to describe and assess the level of hospital service from the patient’s point of view. It is a cognitive and an emotional response to the hospital experience. Methodologically patient satisfaction is defined as a multidimensional latent variable. To assess patient satisfaction Item Response Theory has greater advantages compared to Classical Test Theory. Rasch model is a one-parameter model which belongs to Item Response Theory. Rasch model yield objective measure of the construct that are independent of the set of people interviewed and of set of items used. Rasch estimates are continuous and can be useful to “calibrate” the scale of the latent trait. This research attempt to investigate the questionnaire currently adopted to measure patient satisfaction in an Italian hospital, completed by a large sample of 3390 patients. We verify the multidimensional nature of the variable, the properties of the instrument and the level of satisfaction in the hospital. Successively we used Rasch estimates to describe the most satisfied and the less satisfied patients.

Erste Untersuchungen zur Messung helizitätsabhängiger (gamma N)-Wirkungsquerschnitte für das GDH-Experiment am MAMI

Das experimentelle Studium der 1966 von Gerasimov, Drell undHearn unabhängig voneinander aufgestellten und als GDH-SummenregelbezeichnetenRelation macht die Vermessung totalerPhotoabsorptionswirkungsquerschnitte von zirkular polarisierten Photonen an longitudinalpolarisierten Nukleonen über einen weiten Energiebereich notwendig. Die im Sommer1998 erfolgte Messung am Mainzer Mikrotron stellt das erste derartigeExperiment mit reellen Photonen zur Messung des GDH-Integrals am Protondar. Die Verwendung eines Frozen-Spin-Butanoltargets, das eingesetzt wurde, umeinen möglichst hohen Proton-Polarisationsgrad zu erreichen, hat diezusätzliche experimentelle Schwierigkeit zur Folge, daß die imButanoltarget enthaltenen Kohlenstoffkerne ebenfalls Reaktionsprodukte liefern, diezusammen mit den am Proton erzeugten nachgewiesen werden.Ziel der Arbeit war die Bestimmung von Wirkungsquerschnittenam freien Proton aus Messungen an einem komplexen Target (CH2) wie esbeim polarisiertenTarget vorliegt. Die hierzu durchgeführten Pilotexperimentedienten neben der Entwicklung von Methoden zur Reaktionsidentifikation auchder Eichung des Detektorsystems. Durch die Reproduktion der schon bekanntenund vermessenen unpolarisierten differentiellen und totalenEin-Pion-Wirkungsquerschnitte am Proton (gamma p -> p pi0 und gamma p -> n pi+), die bis zueiner Photonenergievon etwa 400 MeV den Hauptbeitrag zum GDH-Integralausmachen, konnte gezeigt werden, daß eine Separation der Wasserstoff- vonKohlenstoffereignissen möglich ist. Die notwendigen Techniken hierzu wurden imRahmen dieser Arbeit zu einem allgemein nutzbaren Werkzeug entwickelt.Weiterhin konnte gezeigt werden, daß der vom Kohlenstoffstammende Anteil der Reaktionen keine Helizitätsabhängigkeit besitzt. Unterdieser Voraussetzung reduziert sich die Bestimmung der helizitätsabhängigenWirkungsquerschnittsdifferenz auf eine einfacheDifferenzbildung. Aus den erhaltenen Ergebnissen der intensiven Analyse von Daten, diemit einem unpolarisierten Target erhalten wurden, konnten so schnellerste Resultate für Messungen, die mit dem polarisierten Frozen-Spin-Targetaufgenommen wurden, geliefert werden. Es zeigt sich, daß sich dieseersten Resultate für polarisierte differentielle und totale (gammaN)-Wirkungsquerschnitte im Delta-Bereich in guter Übereinstimmung mit theoretischenAnalysen befinden.

I coefficienti binomiali.

In questa tesi si trattano alcune delle proprietà dei coefficienti binomiali, il cui nome deriva dal fatto che uno dei principali utilizzi di tali coefficienti è proprio nel Teorema binomiale di Newton, che permette di calcolare in modo esplicito lo sviluppo di un generico binomio con esponente naturale. I coefficienti binomiali si ricavano anche dal noto Triangolo di Tartaglia, che prende nome dal matematico Niccolò Fontana (1490-1557), il quale lo introdusse in Italia nel 1556 nella sua opera "General trattato di numeri et misure". Tuttavia, esso era già noto agli indiani e ai cinesi nel XIV secolo. Successivamente, in Francia e nel mondo anglosassone, tale triangolo prese anche il nome di Triangolo di Pascal, quando nel 1654 il matematico francese pubblicò il libro "Le triangle Aritmetique", interamente dedicato alle sue proprietà. I coefficienti binomiali, inoltre, trovano largo uso in calcolo combinatorio, ossia in quella branca della matematica che si occupa di contare i modi di raggruppare, secondo determinate regole, gli elementi di un insieme finito di oggetti. Dunque, per quanto la definizione stessa di coefficienti binomiali sia semplice, essendo un rapporto di interi fattoriali, in realtà essi trovano ampio utilizzo in vari ambiti e proprio per questo suscitano un notevole interesse ed hanno svariate applicazioni, giocando un ruolo fondamentale in parti della matematica come la combinatoria. In questa tesi, oltre alle proprietà più note, sono contenuti anche alcuni collegamenti tra i coefficienti binomiali e i polinomi di variabile naturale, nonché, nell'ultima parte, applicazioni alle differenze finite di progressioni geometriche.

Aesthetic outcome and oncological safety of nipple-areola complex replantation after mastectomy and immediate breast reconstruction

Immediate breast reconstruction (IBR) has become an established procedure for women necessitating mastectomy. Traditionally, the nipple-areola complex (NAC) is resected during this procedure. The NAC, in turn, is a principal factor determining aesthetic outcome after breast reconstruction, and due to its particular texture and shape, a natural-looking NAC can barely be reconstructed with other tissues. The aim of this study was to assess the oncological safety as well as morbidity and aesthetic outcome after replantation of the NAC some days after IBR. Retrospective analysis of 85 patients receiving 88 mastectomies and IBR between 1998 and 2007 was conducted. NAC (n=29) or the nipple alone (n=23) were replanted 7 days (median, range 2-10 days) after IBR in 49 patients, provided the subareolar tissue was histologically negative for tumour infiltration. Local recurrence rate was assessed after 49 months (median, range 6-120 months). Aesthetic outcome was evaluated by clinical assessment during routine follow-up at least 12 months after the last intervention. Malignant involvement of the subareolar tissue was found in eight cases (9.1%). Patients qualifying for NAC replantation were in stage 0 in 29%, stage I in 15%, stage IIa in 31%, stage IIb in 17% and stage III in 8%. Total or partial necrosis occurred in 69% and 26% if the entire NAC or only the nipple were replanted, respectively (P<0.01). Depigmentation was seen in 52% and corrective surgery was done in 11 out of 52 NAC or nipple replantations. Local recurrence and isolated regional lymph node metastasis were observed in one single case each. Another 5.8% of the patients showed distant metastases. We conclude that the replantation of the NAC in IBR is oncologically safe, provided the subareolar tissue is free of tumour. However, the long-term aesthetic outcome of NAC replantation is not satisfying, which advocates replanting the nipple alone.

Mannan-binding lectin deficiency results in unusual antibody production and excessive experimental colitis in response to mannose-expressing mild gut pathogens

In Crohn's disease (CD) the deficiency of mannan-binding lectin (MBL) is associated with an increased prevalence of anti-Saccharomyces cerevisiae antibodies (ASCA) and with complicated phenotypes of the disease. However, the role of MBL in intestinal inflammation is currently unclear. A study was undertaken to analyse local MBL expression in human intestine and the consequences of MBL deficiency in experimental colitis and yeast infection.

Thrombospondin-1 mediates platelet adhesion at high shear via glycoprotein Ib (GPIb): an alternative/backup mechanism to von Willebrand factor

Acute thrombotic arterial occlusion is the leading cause of morbidity and mortality in the Western world. Von Willebrand factor is thought to be the only indispensable adhesive substrate to promote thrombus formation in high shear environments. We found that thrombospondin-1, a glycoprotein enriched in arteriosclerotic plaques, might function as an alternative substrate for thrombus formation. Platelets adhered to thrombospondin-1 in a shear dependent manner with an optimum shear as found in stenosed arteries. Adhesion is extremely firm, with no detachment of platelets up to a shear rate of 4000 s(-1). Experiments using platelets from a patient completely lacking von Willebrand factor showed that von Willebrand factor is not involved in platelet binding to thrombospondin-1. Platelet adhesion to thrombospondin-1 is not mediated via beta3-integrins or GPIa. CD36 partially mediates the adhesion of pre-activated platelets. We identified GPIb as high shear adhesion-receptor for thrombospondin-1. Soluble GPIb, as well as antibodies against the GPIb, blocked platelet adhesion almost completely. The new discovered thrombospondin-1-GPIb adhesion axis under arterial shear conditions might be important, not only during thrombus formation but also for pathological processes where other cells bind to the endothelium or subendothelium, including arteriosclerosis, inflammation and tumor metastasis, and a promising therapeutic target.

A STUDY OF THE IMPACTS OF FREEZE-THAW ON CLIFF RECESSION AT THE CALVERT CLIFFS IN CALVERT COUNTY, MARYLAND

The Calvert Cliffs, which form much of the western coastline of the Chesapeake Bay in Calvert County, Maryland, are actively eroding and destabilizing, resulting in a critical situation for many homes in close proximity to the slope's crest. Past studies have identified that where waves directly interact with the toe of the slope, wave action controls cliff recession; however, where waves do not regularly interact with the slope toe, the past work identified that freeze-thaw controls recession. This study investigated the validity of this second claim by analyzing the recession rate and freeze-thaw behavior of six study sites along the Calvert Cliffs that are not directly affected by waves. While waves do remove failed material from the toe, in these regions freeze-thaw is believed to be the dominant factor driving recession at the Calvert Cliffs. Past recession rates were calculated using historical aerial photographs and were analyzed together with a number of other variables selected to represent the freeze-thaw behavior of the Calvert Cliffs. The investigation studied sixteen independent variables and found that over 65% of recession at these study sites can be represented by the following five variables: (1) cliff face direction, (2 and 3) the percent of total cliff height composed of soil with freeze-thaw susceptibility F4 and F2, (4) the number of freeze-thaw cycles, and (5) the weighted shear strength. Future mitigation techniques at these sites should focus on addressing these variables and might include vegetation or addressing the presence of water along the face of the slope. Unmitigated, the Calvert Cliffs will continue to recede until a stable slope angle is reached and maintained.

Multi-Contact Grasp Interaction for Virtual Environments

The grasping of virtual objects has been an active research field for several years. Solutions providing realistic grasping rely on special hardware or require time-consuming parameterizations. Therefore, we introduce a flexible grasping algorithm enabling grasping without computational complex physics. Objects can be grasped and manipulated with multiple fingers. In addition, multiple objects can be manipulated simultaneously with our approach. Through the usage of contact sensors the technique is easily configurable and versatile enough to be used in different scenarios.

Kinetics of maternally acquired anti-hepatitis A antibodies: prediction of waning based on maternal or cord blood antibody levels

BACKGROUND Timing is critical for efficient hepatitis A vaccination in high endemic areas as high levels of maternal IgG antibodies against the hepatitis A virus (HAV) present in the first year of life may impede the vaccine response. OBJECTIVES To describe the kinetics of the decline of anti-HAV maternal antibodies, and to estimate the time of complete loss of maternal antibodies in infants in León, Nicaragua, a region in which almost all mothers are anti-HAV seropositive. METHODS We collected cord blood samples from 99 healthy newborns together with 49 corresponding maternal blood samples, as well as further blood samples at 2 and 7 months of age. Anti-HAV IgG antibody levels were measured by enzyme immunoassay (EIA). We predicted the time when antibodies would fall below 10 mIU/ml, the presumed lowest level of seroprotection. RESULTS Seroprevalence was 100% at birth (GMC 8392 mIU/ml); maternal and cord blood antibody concentrations were similar. The maternal antibody levels of the infants decreased exponentially with age and the half-life of the maternal antibody was estimated to be 40 days. The relationship between the antibody concentration at birth and time until full waning was described as: critical age (months)=3.355+1.969 × log(10)(Ab-level at birth). The survival model estimated that loss of passive immunity will have occurred in 95% of infants by the age of 13.2 months. CONCLUSIONS Complete waning of maternal anti-HAV antibodies may take until early in the second year of life. The here-derived formula relating maternal or cord blood antibody concentrations to the age at which passive immunity is lost may be used to determine the optimal age of childhood HAV vaccination.

Mehrstimmige Messen in Quellen aus Spanien, Portugal und Lateinamerika (ca.1490–1630)

Der Katalog inventarisiert alle erhaltenen und dokumentierten Quellen zwischen 1490 und 1630 aus dem iberischen und Lateinamerikanischen Raum, die mehrstimmige Ordinariumskompositionen, Requiemskompositionen oder Einzelsätze überliefern mit Quellenbeschreibung und Inhaltsangabe.

Judaismus oder Judenthumb, das ist : außführlicher Bericht von des jüdischen Volckes Unglauben, Blindheit und Verstockung, darinne sie wider die prophetischen Weissagungen ... streiten ...

durch Johannem Müllern. Mit e. 5-fachen Reg.