Recanalization Rates after Acute Deep Vein Thrombosis: A Single-center Experience Using a Newly Proposed Vein Diameter Variation Index

Background: Duplex ultrasound scanning (DUS) is the method of choice for diagnosis of deep vein thrombosis (DVT). However, only a few studies have performed prospective serial DUS after an acute episode of DVT to assess its evolution. This study aimed to report our experience using DUS combined with a thrombosis score (TS) and a newly proposed vein diameter variation index (VDVI) to evaluate the rate of resolution of DVT by assessing and quantifying the early stages of vein recanalization in proximal vein segments within 6 months after an episode of acute lower extremity DVT.Methods: Twelve patients with first episode of acute lower extremity DVT confirmed by DUS as occurring in <= 10 days after the onset of venous thrombosis symptoms were followed up prospectively for 6 months. TS and VDVI were calculated at 1, 3, and 6 months to assess vein recanalization. Intra-thrombus arteriovenous fistula formation was also investigated and related to the recanalization process.Results: Seven (58%) women were included, with a total cohort median age of 53.5 +/- 19 years. The left lower extremity was affected in 7 (58%) patients. DVT was diagnosed in 55 proximal vein segments. All patients had proximal DVT, with involvement of the external iliac, femoral, and popliteal veins. After 6 months, there was a significant decrease in TS and increase in VDVI (P < 0.001) in all proximal vein segments assessed, indicating thrombus regression. The more distal the DVT was, the faster was the VDVI increase, with most popliteal veins being recanalized at 3 months (P < 0.001). Intra-thrombus arteriovenous fistula was identified in 50% of patients at 1 month while on anticoagulation.Conclusions: The combined use of two different DUS-based assessment tools, TS and the proposed VDVI, provided an effective method to prospectively assess vein recanalization rates after an episode of acute lower extremity DVT in this series of patients and may allow a correct evaluation of DVT and its resolution or progression.

Healing Process of Autogenous Bone Graft in Spontaneously Hypertensive Rats Treated With Losartan: An Immunohistochemical and Histomorphometric Study

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

Reflexos do processamento de cana-de-açúcar bisada na qualidade do açúcar VHP

The aim of this study was to compare the quality of clarifi ed juice and VHP (Very High Purity) sugar produced from “bisada” sugarcane and an early maturation variety, at the beginning of harvest. The experiment was conducted at Usina São Martinho S/A, Pradópolis,SP (Brazil). The process of juice clarifi cation and sugar production was conducted at the Laboratory of Technology of Sugar and Alcohol in the College of Agricultural and Veterinary Sciences at the Universidade Estadual Paulista (FCAV/UNESP), Jaboticabal (SP). The experimental design was randomized, and two varieties were used: SP83-2847 (“bisada” sugarcane) and RB855156 (early maturation), with twelve replications for technological analysis and four replications for sugar production. The clarifi cation process and the clarifi ed juice was evaluated in terms of settling rates, volume of sludge that formed, total soluble solids, pH, turbidity, total phenolic compounds, starch and color. The sugar was characterized regarding the percentage of apparent sugar, color, total phenolic compounds, starch, fi lterability, humidity and safety factor. It was verifi ed that the processing of the juice clarifi cation was not affected by the processing of the “bisada” sugarcane. However, the clarifi ed juice from the SP83-2847 variety had a more intense color and a higher total soluble solids value. The sugar produced from the “bisada” sugarcane presented similar quality to the early maturation variety. It was concluded that the processing of “bisada” sugarcane at the start of the harvest did not affect the juice clarifi cation and resulted in VHP sugar of a quality similar to that of the early maturation variety.

Medicamentos inadequados para idosos na estratégia da saúde da família

The ageing process can change the pharmacodynamics and pharmacokinetics parameters. Therefore, some medications are considered potentially inappropriate (PIM) for the elderly people, since they can increase the likelihood of occurrence of adverse drug events. The objectives are to estimate the frequency of use of PIM in the elderly people, with potentially hazardous drug interactions (PHDI) and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. A cross-sectional study was performed in a Health Family Strategy (region of Araraquara, SP), between January and February/2012. The medical records of patients aged ≥60 years, that use at least one drug, were consulted for identification of PIM, according to the Beers criteria. The MPI identified were classified considering the Anatomical Therapeutic Chemical Classification System (ATC) and the essentiality of the drug (safety, effectiveness, quality and cost parameters) The inclusion criteria were met by 358 elderly, being that 93 of them (26%) had taken at least one PIM. Of the 114 different drugs prescribed for elderly, ten were classified as PIM, of which four of them act on the central nervous system, four on cardiovascular system and two on the digestive tract. Seven MPI are essential medicines, belonging to national list of essential drugs (RENAME-2010). Fourteen drug interactions were identified, of which two are PHDI (fluoxetine/amitriptyline and digoxin/hydrochlorothiazide).After the PI, there was no change in medical prescriptions of patients with PIM use or with DI. Medical prescriptions of elderly attended in the Health Family Strategy show pharmacotherapeutic safety problems, of which may be responsible for health hazardous for this age group. Although the intervention carried out by letter had been ineffective for the adherence of doctors in prescribing safe alternatives, wide dissemination of the lists that contain PIM and PHDI is need, as well as the inclusion of safer equivalents in RENAME, in order to contribute for rational use of drugs.

Assessment of the quality evaluation of compounded fluconazole capsules marketed in the region of Araraquara (SP, Brazil)

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

Teacher-learning process based on an immersive and interactive environment

This paper explores the benefits of using immersive and interactive multiprojection environments (CAVE) to visualize molecules, and how it improves users’ understanding. We have proposed and implemented a tool for teachers to manipulate molecules and another to edit molecules and assist students at home. The contribution of the present research project are these tool that allows investigating structures, properties and dynamics of a molecular system which are extremely complex and comprises millions of atoms. The experience is enriched through multimedia information associated with parts of the model; for example, videos and text can be linked to specific molecule, demonstrating some detail. This solution is based on a teaching-learning process.

Processos de inclusão e exclusão escolar: um estudo em uma escola pública do ensino fundamental I utilizando o “Index para Inclusão”

Pós-graduação em Psicologia do Desenvolvimento e Aprendizagem - FC

Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation

Background: The rapid shallow breathing index (RSBI) is the most widely used index within intensive care units as a predictor of the outcome of weaning, but differences in measurement techniques have generated doubts about its predictive value. Objective: To investigate the influence of low levels of pressure support (PS) on the RSBI value of ill patients. Method: Prospective study including 30 patients on mechanical ventilation (MV) for 72 hours or more, ready for extubation. Prior to extubation, the RSBI was measured with the patient connected to the ventilator (Drager (TM) Evita XL) and receiving pressure support ventilation (PSV) and 5 cmH(2)O of positive end expiratory pressure or PEEP (RSBI_MIN) and then disconnected from the VM and connected to a Wright spirometer in which respiratory rate and exhaled tidal volume were recorded for 1 min (RSBI_ESP). Patients were divided into groups according to the outcome: successful extubation group (SG) and failed extubation group (FG). Results: Of the 30 patients, 11 (37%) failed the extubation process. In the within-group comparison (RSBI_MIN versus RSBI_ESP), the values for RSBI_MIN were lower in both groups: SG (34.79 +/- 4.67 and 60.95 +/- 24.64) and FG (38.64 +/- 12.31 and 80.09 +/- 20.71; p<0.05). In the between-group comparison, there was no difference in RSBI_MIN (34.79 +/- 14.67 and 38.64 +/- 12.31), however RSBI_ESP was higher in patients with extubation failure: SG (60.95 +/- 24.64) and FG (80.09 +/- 20.71; p<0.05). Conclusion: In critically ill patients on MV for more than 72h, low levels of PS overestimate the RSBI, and the index needs to be measured with the patient breathing spontaneously without the aid of pressure support.

The sigma-isotypic decomposition and the sigma-index of reversible-equivariant systems

This work is concerned with dynamical systems in presence of symmetries and reversing symmetries. We describe a construction process of subspaces that are invariant by linear Gamma-reversible-equivariant mappings, where Gamma is the compact Lie group of all the symmetries and reversing symmetries of such systems. These subspaces are the sigma-isotypic components, first introduced by Lamb and Roberts in (1999) [10] and that correspond to the isotypic components for purely equivariant systems. In addition, by representation theory methods derived from the topological structure of the group Gamma, two algebraic formulae are established for the computation of the sigma-index of a closed subgroup of Gamma. The results obtained here are to be applied to general reversible-equivariant systems, but are of particular interest for the more subtle of the two possible cases, namely the non-self-dual case. Some examples are presented. (C) 2011 Elsevier BM. All rights reserved.

CRITICAL POINTS OF THE PRODUCTION PROCESS OF SOLID WOOD FLOORING

The quality concepts represent one of the important factors for the success of organizations and among these concepts the stabilization of the production process contributes to the improvement, waste reduction and increased competitiveness. Thus, this study aimed to evaluate the production process of solid wood flooring on its predictability and capacity, based on its critical points. Therefore, the research was divided into three stages. The first one was the process mapping of the company and the elaboration of flowcharts for the activities. The second one was the identification and the evaluation of the critical points using FMEA (Failure Mode and Effect Analysis) adapted methodology. The third one was the evaluation of the critical points applying the statistical process control and the determination of the process capability for the C-pk index. The results showed the existence of six processes, two of them are critical. In those two ones, fifteen points were considered critical and two of them, related with the dimension of the pieces and defects caused by sandpaper, were selected for evaluation. The productive process of the company is unstable and not capable to produce wood flooring according to the specifications and, therefore these specifications should be reevaluated.

Nondetection Index of Anti-Islanding Passive Protection of Synchronous Distributed Generators

Synchronous distributed generators are prone to operate islanded after contingencies, which is usually not allowed due to safety and power-quality issues. Thus, there are several anti-islanding techniques; however, most of them present technical limitations so that they are likely to fail in certain situations. Therefore, it is important to quantify and determine whether the scheme under study is adequate or not. In this context, this paper proposes an index to evaluate the effectiveness of anti-islanding frequency-based relays commonly used to protect synchronous distributed generators. The method is based on the calculation of a numerical index that indicates the time period that the system is unprotected against islanding considering the global period of analysis. Although this index can precisely be calculated based on several electromagnetic transient simulations, a practical method is also proposed to calculate it directly from simple analytical formulas or lookup tables. The results have shown that the proposed approach can assist distribution engineers to assess and set anti-islanding protection schemes.

Development of quantitative methods for sustainability assessment in process industry

The increasing aversion to technological risks of the society requires the development of inherently safer and environmentally friendlier processes, besides assuring the economic competitiveness of the industrial activities. The different forms of impact (e.g. environmental, economic and societal) are frequently characterized by conflicting reduction strategies and must be holistically taken into account in order to identify the optimal solutions in process design. Though the literature reports an extensive discussion of strategies and specific principles, quantitative assessment tools are required to identify the marginal improvements in alternative design options, to allow the trade-off among contradictory aspects and to prevent the “risk shift”. In the present work a set of integrated quantitative tools for design assessment (i.e. design support system) was developed. The tools were specifically dedicated to the implementation of sustainability and inherent safety in process and plant design activities, with respect to chemical and industrial processes in which substances dangerous for humans and environment are used or stored. The tools were mainly devoted to the application in the stages of “conceptual” and “basic design”, when the project is still open to changes (due to the large number of degrees of freedom) which may comprise of strategies to improve sustainability and inherent safety. The set of developed tools includes different phases of the design activities, all through the lifecycle of a project (inventories, process flow diagrams, preliminary plant lay-out plans). The development of such tools gives a substantial contribution to fill the present gap in the availability of sound supports for implementing safety and sustainability in early phases of process design. The proposed decision support system was based on the development of a set of leading key performance indicators (KPIs), which ensure the assessment of economic, societal and environmental impacts of a process (i.e. sustainability profile). The KPIs were based on impact models (also complex), but are easy and swift in the practical application. Their full evaluation is possible also starting from the limited data available during early process design. Innovative reference criteria were developed to compare and aggregate the KPIs on the basis of the actual sitespecific impact burden and the sustainability policy. Particular attention was devoted to the development of reliable criteria and tools for the assessment of inherent safety in different stages of the project lifecycle. The assessment follows an innovative approach in the analysis of inherent safety, based on both the calculation of the expected consequences of potential accidents and the evaluation of the hazards related to equipment. The methodology overrides several problems present in the previous methods proposed for quantitative inherent safety assessment (use of arbitrary indexes, subjective judgement, build-in assumptions, etc.). A specific procedure was defined for the assessment of the hazards related to the formations of undesired substances in chemical systems undergoing “out of control” conditions. In the assessment of layout plans, “ad hoc” tools were developed to account for the hazard of domino escalations and the safety economics. The effectiveness and value of the tools were demonstrated by the application to a large number of case studies concerning different kinds of design activities (choice of materials, design of the process, of the plant, of the layout) and different types of processes/plants (chemical industry, storage facilities, waste disposal). An experimental survey (analysis of the thermal stability of isomers of nitrobenzaldehyde) provided the input data necessary to demonstrate the method for inherent safety assessment of materials.

Food safety in wine: optimization of analytical controls and evaluation of production technologies

This PhD thesis has been proposed to validate and then apply innovative analytical methodologies for the determination of compounds with harmful impact on human health, such as biogenic amines and ochratoxin A in wines. Therefore, the influence of production technology (pH, amino acids precursor and use of different malolactic starters) on biogenic amines content in wines was evaluated. An HPLC method for simultaneous determination of amino acids and amines with precolumnderivatization with 9-Fluorenyl-methoxycarbonyl chloride (FMOC-Cl) and UV detection was developed. Initially, the influence of pH, time of derivatization, gradient profile were studied. In order to improve the separation of amino acids and amines and reduce the time of analysis, it was decided to study the influence of different flows and the use of different columns in the chromatographic method. Firstly, a C18 Luna column was used and later two monolithic columns Chromolith in series. It appeared to be suitable for an easy, precise and accurate determination of a relatively large number of amino acids and amines in wines. This method was then applied on different wines produced in the Emilia Romagna region. The investigation permitted to discriminate between red and white wines. Amino acids content is related to the winemaking process. Biogenic amines content in these wines does not represent a possible toxicological problem for human health. The results of the study of influence of technologies and wine composition demonstrated that pH of wines and amino acids content are the most important factors. Particularly wines with pH > 3,5 show higher concentration of biogenic amines than wines with lower pH. The enrichment of wines by nutrients also influences the content of some biogenic amines that are higher in wines added with amino acids precursors. In this study, amino acids and biogenic amines are not statistically affected by strain of lactic acid bacteria inoculated as a starter for malolactic fermentation. An evaluation of different clean-up (SPE-MycoSep; IACs and LLE) and determination methods (HPLC and ELISA) of ochratoxin A was carried out. The results obtained proved that the SPE clean-up are reliable at the same level while the LLE procedures shows lowest recovery. The ELISA method gave a lower determination and a low reproducibility than HPLC method.

The use of Ground Penetrating Radar and alternative geophysical techniques for assessing embankments and dykes safety

The research is part of a survey for the detection of the hydraulic and geotechnical conditions of river embankments funded by the Reno River Basin Regional Technical Service of the Region Emilia-Romagna. The hydraulic safety of the Reno River, one of the main rivers in North-Eastern Italy, is indeed of primary importance to the Emilia-Romagna regional administration. The large longitudinal extent of the banks (several hundreds of kilometres) has placed great interest in non-destructive geophysical methods, which, compared to other methods such as drilling, allow for the faster and often less expensive acquisition of high-resolution data. The present work aims to experience the Ground Penetrating Radar (GPR) for the detection of local non-homogeneities (mainly stratigraphic contacts, cavities and conduits) inside the Reno River and its tributaries embankments, taking into account supplementary data collected with traditional destructive tests (boreholes, cone penetration tests etc.). A comparison with non-destructive methodologies likewise electric resistivity tomography (ERT), Multi-channels Analysis of Surface Waves (MASW), FDEM induction, was also carried out in order to verify the usability of GPR and to provide integration of various geophysical methods in the process of regular maintenance and check of the embankments condition. The first part of this thesis is dedicated to the explanation of the state of art concerning the geographic, geomorphologic and geotechnical characteristics of Reno River and its tributaries embankments, as well as the description of some geophysical applications provided on embankments belonging to European and North-American Rivers, which were used as bibliographic basis for this thesis realisation. The second part is an overview of the geophysical methods that were employed for this research, (with a particular attention to the GPR), reporting also their theoretical basis and a deepening of some techniques of the geophysical data analysis and representation, when applied to river embankments. The successive chapters, following the main scope of this research that is to highlight advantages and drawbacks in the use of Ground Penetrating Radar applied to Reno River and its tributaries embankments, show the results obtained analyzing different cases that could yield the formation of weakness zones, which successively lead to the embankment failure. As advantages, a considerable velocity of acquisition and a spatial resolution of the obtained data, incomparable with respect to other methodologies, were recorded. With regard to the drawbacks, some factors, related to the attenuation losses of wave propagation, due to different content in clay, silt, and sand, as well as surface effects have significantly limited the correlation between GPR profiles and geotechnical information and therefore compromised the embankment safety assessment. Recapitulating, the Ground Penetrating Radar could represent a suitable tool for checking up river dike conditions, but its use has significantly limited by geometric and geotechnical characteristics of the Reno River and its tributaries levees. As a matter of facts, only the shallower part of the embankment was investigate, achieving also information just related to changes in electrical properties, without any numerical measurement. Furthermore, GPR application is ineffective for a preliminary assessment of embankment safety conditions, while for detailed campaigns at shallow depth, which aims to achieve immediate results with optimal precision, its usage is totally recommended. The cases where multidisciplinary approach was tested, reveal an optimal interconnection of the various geophysical methodologies employed, producing qualitative results concerning the preliminary phase (FDEM), assuring quantitative and high confidential description of the subsoil (ERT) and finally, providing fast and highly detailed analysis (GPR). Trying to furnish some recommendations for future researches, the simultaneous exploitation of many geophysical devices to assess safety conditions of river embankments is absolutely suggested, especially to face reliable flood event, when the entire extension of the embankments themselves must be investigated.

Food Safety and Mineral Oil Contaminated Paperboard Packaging: an Analytical Challenge and a Migration Study

Food packaging protects food, but it can sometimes become a source of undesired contaminants. Paper based materials, despite being perceived as “natural” and safe, can contain volatile contaminants (especially if made from recycled paper) able to migrate to food, as mineral oil, phthalates and photoinitiators. Mineral oil is a petroleum product used as printing ink solvent for newspapers, magazines and packaging. From paperboard printing and from recycled fibers (if present), mineral oil migrates into food, even if dry, through the gas phase. Its toxicity is not fully evaluated, but a temporary Acceptable Daily Intake (ADI) of 0.6 mg kg-1 has been established for saturated mineral oil hydrocarbons (MOSH), while aromatic hydrocarbons (MOAH) are more toxic. Extraction and analysis of MOSH and MOAH is difficult due to the thousands of molecules present. Extraction methods for packaging and food have been optimized, then applied for a “shopping trolley survey” on over 100 Italian and Swiss market products. Instrumental analyses were performed with online LC-GC/FID. Average concentration of MOSH in paperboards was 626 mg kg-1. Many had the potential of contaminating foods exceeding temporary ADI tens of times. A long term migration study was then designed to better understand migration kinetics. Egg pasta and müesli were chosen as representative (high surface/weight ratio). They were stored at different temperatures (4, 20, 30, 40 and 60°C) and conditions (free, shelved or boxed packs) for 1 year. MOSH and MOAH kinetic curves show that migration is a fast process, mostly influenced by temperature: in egg pasta (food in direct contact with paperboard), half of MOSH is transferred to food in a week at 40°C and in 8 months at 20°C. The internal plastic bag present in müesli slowed down the startup of migration, creating a “lag time” in the curves.