Use of a Minimally Invasive Uncalibrated Cardiac Output Monitor in Patients Undergoing Cesarean Section under Spinal Anesthesia: Report of Four Cases

Bliacheriene F, Carmona MJC, Barretti CFM, Haddad CMF, Mouchalwat ES, Bortlotto MRFL, Francisco RPV, Zugaib M - Use of a Minimally Invasive Uncalibrated Cardiac Output Monitor in Patients Undergoing Cesarean Section under Spinal Anesthesia: Report of Four Cases. Background and Objectives: Hemodynamic changes are observed during cesarean section under spinal anesthesia. Non-invasive blood pressure (BP) and heart rate (HR) measurements are performed to diagnose these changes, but they are delayed and inaccurate. Other monitors such as filling pressure and cardiac output (CO) catheters with external calibration are very invasive or inaccurate. The objective of the present study was to report the cardiac output measurements obtained with a minimally invasive uncalibrated monitor (LiDCO rapid) in patients undergoing cesarean section under spinal anesthesia. Case report: After approval by the Ethics Commission, four patients agreed to participate in this study. They underwent cesarean section under spinal anesthesia while at the same time being connected to the LiDCO rapid by a radial artery line. Cardiac output, HR, and BP were recorded at baseline, after spinal anesthesia, after fetal and placental extraction, and after the infusion of oxytocin and metaraminol. We observed a fall in BP with an increase of HR and CO after spinal anesthesia and oxytocin infusion; and an increase in BP with a fall in HR and CO after bolus of the vasopressor. Conclusions: Although this monitor had not been calibrated, it showed a tendency for consistent hemodynamic data in obstetric patients and it may be used as a therapeutic guide or experimental tool.

Application of a wrist dosimeter prototype for radiation monitoring ((153)Sm) during a therapeutic procedure simulation

Gamma and beta radiation emitting radiopharmaceuticals are handled in nuclear medicine services, and in many cases there is only individual monitoring of gamma radiation. In this paper, the results obtained using a wrist dosimeter prototype (CaSO(4):Dy + Teflon pellets) show that the doses for workers occupationally exposed to beta radiation from (153)Sm are not negligible. It is important that this dose is evaluated, and it has to be taken into consideration in the individual monitoring system.

Vascularized Bone Grafts for Upper Limb Reconstruction: Defects at the Distal Radius, Wrist, and Hand

Vascularized bone grafts have been successfully applied for the reconstruction of bone defects at the forearm, distal radius, carpus, and hand. Vascularized bone grafts are most commonly used in revision cases in which other approaches have failed. Vascularized bone grafts can be obtained from a variety of donor sites, including the fibula, the iliac crest, the distal radius (corticocancellous segments and vascularized periosteum), the metacarpals and metatarsals, and the medial femoral condyle (corticoperiosteal flaps). Their vascularity is preserved as either pedicled autografts or free flaps to carry the optimum biological potential to enhance union. The grafts can also be transferred as composite tissue flaps to reconstruct compound tissue defects. Selection of the most appropriate donor flap site is multifactorial. Considerations include size matching between donor and defect, the structural characteristics of the graft, the mechanical demands of the defect, proximity to the donor area, the need for an anastomosis, the duration of the procedure, and the donor site morbidity. This article focuses on defects of the distal radius, the wrist, and the hand. (J Hand Surg 2010;35A:1710-1718. (C) 2010 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.)

Transcranial Electrocortical Stimulation to Monitor the Facial Nerve Motor Function During Cerebellopontine Angle Surgery

OBJECTIVE: This study was conducted to investigate the success rate of using the facial motor evoked potential (FMEP) of orbicularis oculi and oris muscles for facial nerve function monitoring with use of a stepwise protocol, and its usefulness in predicting facial nerve outcome during cerebellopontine angle (CPA) surgeries. METHODS: FMEPs were recorded intraoperatively from 60 patients undergoing CPA surgeries. Transcranial electrocortical stimulation (TES) was performed using corkscrew electrodes positioned at hemispheric montage (C3/C4 and CZ). The contralateral abductor pollicis brevis muscle was used as the control response. Stimulation was always applied contralaterally to the affected side using 1, 3, or 5 rectangular pulses ranging from 200 to 600 V with 50 mu s of pulse duration and an interstimulus interval of 2 ms. Facial potentials were recorded from needles placed in the orbicularis oculi and oris muscles. RESULTS: FMEP from the orbicularis oris and oculi muscles could be reliably monitored in 86.7% and 85% of the patients, respectively. The immediate postoperative facial function correlated significantly with the FMEP ratio in the orbicularis oculi muscle at 80% amplitude ratio (P =.037) and orbicularis oris muscle at 35% ratio (P =.000). FMEP loss was always related to postoperative facial paresis, although in different degrees. CONCLUSION: FMEPs can be obtained reliably by using TES with 3 to 5 train pulses. Stable intraoperative FMEPs can predict a good postoperative outcome of facial function. However, further refinements of this technique are necessary to minimize artifacts and to make this method more reliable.

Assessing clinical reasoning: a method to monitor its development in a PBL curriculum

The aim of this study was to develop and trial a method to monitor the evolution of clinical reasoning in a PBL curriculum that is suitable for use in a large medical school. Termed Clinical Reasoning Problems (CRPs), it is based on the notion that clinical reasoning is dependent on the identification and correct interpretation of certain critical clinical features. Each problem consists of a clinical scenario comprising presentation, history and physical examination. Based on this information, subjects are asked to nominate the two most likely diagnoses and to list the clinical features that they considered in formulating their diagnoses, indicating whether these features supported or opposed the nominated diagnoses. Students at different levels of medical training completed a set of 10 CRPs as well as the Diagnostic Thinking Inventory, a self-reporting questionnaire designed to assess reasoning style. Responses were scored against those of a reference group of general practitioners. Results indicate that the CRPs are an easily administered, reliable and valid assessment of clinical reasoning, able to successfully monitor its development throughout medical training. Consequently, they can be employed to assess clinical reasoning skill in individual students and to evaluate the success of undergraduate medical schools in providing effective tuition in clinical reasoning.

Estudo da eficiência de deteção de um monitor portátil de contaminação de superfícies em função da distância e do débito de emissão da fonte

Introdução – No caso de uma eventual contaminação radioativa esta deve ser quantificada, pelo que é necessário garantir que as condições de funcionamento de um monitor de contaminação de superfícies se encontrem adequadamente caracterizadas, através da determinação da sua eficiência de deteção. Este estudo tem como objetivo determinar a eficiência de deteção de um monitor de contaminação e analisar a influência da distância e da atividade. Metodologia – O monitor de contaminação Thermo Mini 900E e as fontes radioativas planas de referência de Carbono – 14 (C-14), Césio – 137 (Cs-137), Estrôncio – 90 (Sr-90), Cloro – 36 (Cl-36) e Amerício – 241 (Am-241) com débito de emissão superficial rastreável ao Physikalish Technischen Bundesanstalt (PTB) foram utilizadas. Fontes de Sr-90 e C-14 com dois débitos de emissão distintos para cada e distâncias de 1 a 20mm foram usados para estudar a sua influência na eficiência de deteção. Resultados – Verificou-se que as fontes radioativas emissoras de partículas de maior energia apresentam uma maior eficiência de deteção e que esta diminui com o aumento da distância do detetor à fonte, sendo que os radioisótopos de maior energia apresentam um decréscimo na eficiência de 15% ao longo de 20mm, enquanto os radioisótopos de menor energia apresentam um decréscimo de 10%. Não se verificou uma influência expressiva do débito de emissão na eficiência de deteção deste monitor de contaminação. Conclusão – A eficiência de deteção de um monitor de contaminação portátil é dependente da distância deste à contaminação bem como do tipo de radiação emitida e energia dos radioisótopos presentes na contaminação. - ABSTRACT - Introduction – A radioactive contamination needs to be quantified in case it eventually occurs. Therefore it is necessary to ensure that the operating conditions of a surface contamination monitor are characterized by determining its detection efficiency. This experimental study aims to determine the detection efficiency of a contamination monitor and evaluate the distance and surface emission rate influence on the detection efficiency. Methodology – A contamination monitor Thermo Mini 900E was tested with reference radiation sources of Carbon – 14 (C-14), Cesium – 137 (Cs-137), Strontium – 90 (Sr-90), Chlorine – 36 (Cl-36) and Americium – 241 (Am-241) with its emission rate traced to the Physikalish Technischen Bundesanstalt (PTB). Sources of Sr-90 and C-14 with two different emission rates for each one and distances of 1 to 20mm were used to study its influence in the detection efficiency. Results – With the increasing of distance, the detection efficiency decreases. The most energetic radiation sources have higher detection efficiency, boasting a 15% decrease over 20mm whereas the sources bearing a smaller efficiency decrease 10%. No influence of the surface emission rate in the detection efficiency was verified. Conclusion – Thus, it is concluded that the detection efficiency of a contamination monitor is dependent of the distance between it and the contamination as well as the type and energy of the radioisotopes present in the contamination.

Dosimetria numa população de profissionais expostos a radiações ionizantes

Mestrado em Radiações Aplicadas às Tecnologias da Saúde - Área de especialização: Proteção Contra as Radiações.

In Situ Near-Infrared (NIR) Versus High-Throughput Mid- Infrared (MIR) Spectroscopy to Monitor Biopharmaceutical Production

The development of biopharmaceutical manufacturing processes presents critical constraints, with the major constraint being that living cells synthesize these molecules, presenting inherent behavior variability due to their high sensitivity to small fluctuations in the cultivation environment. To speed up the development process and to control this critical manufacturing step, it is relevant to develop high-throughput and in situ monitoring techniques, respectively. Here, high-throughput mid-infrared (MIR) spectral analysis of dehydrated cell pellets and in situ near-infrared (NIR) spectral analysis of the whole culture broth were compared to monitor plasmid production in recombinant Escherichia coil cultures. Good partial least squares (PLS) regression models were built, either based on MIR or NIR spectral data, yielding high coefficients of determination (R-2) and low predictive errors (root mean square error, or RMSE) to estimate host cell growth, plasmid production, carbon source consumption (glucose and glycerol), and by-product acetate production and consumption. The predictive errors for biomass, plasmid, glucose, glycerol, and acetate based on MIR data were 0.7 g/L, 9 mg/L, 0.3 g/L, 0.4 g/L, and 0.4 g/L, respectively, whereas for NIR data the predictive errors obtained were 0.4 g/L, 8 mg/L, 0.3 g/L, 0.2 g/L, and 0.4 g/L, respectively. The models obtained are robust as they are valid for cultivations conducted with different media compositions and with different cultivation strategies (batch and fed-batch). Besides being conducted in situ with a sterilized fiber optic probe, NIR spectroscopy allows building PLS models for estimating plasmid, glucose, and acetate that are as accurate as those obtained from the high-throughput MIR setup, and better models for estimating biomass and glycerol, yielding a decrease in 57 and 50% of the RMSE, respectively, compared to the MIR setup. However, MIR spectroscopy could be a valid alternative in the case of optimization protocols, due to possible space constraints or high costs associated with the use of multi-fiber optic probes for multi-bioreactors. In this case, MIR could be conducted in a high-throughput manner, analyzing hundreds of culture samples in a rapid and automatic mode.

Comparative analysis of near and mid-infrared spectroscopy to monitor recombinant cyprosin production

Infrared spectroscopy, either in the near and mid (NIR/MIR) region of the spectra, has gained great acceptance in the industry for bioprocess monitoring according to Process Analytical Technology, due to its rapid, economic, high sensitivity mode of application and versatility. Due to the relevance of cyprosin (mostly for dairy industry), and as NIR and MIR spectroscopy presents specific characteristics that ultimately may complement each other, in the present work these techniques were compared to monitor and characterize by in situ and by at-line high-throughput analysis, respectively, recombinant cyprosin production by Saccharomyces cerevisiae. Partial least-square regression models, relating NIR and MIR-spectral features with biomass, cyprosin activity, specific activity, glucose, galactose, ethanol and acetate concentration were developed, all presenting, in general, high regression coefficients and low prediction errors. In the case of biomass and glucose slight better models were achieved by in situ NIR spectroscopic analysis, while for cyprosin activity and specific activity slight better models were achieved by at-line MIR spectroscopic analysis. Therefore both techniques enabled to monitor the highly dynamic cyprosin production bioprocess, promoting by this way more efficient platforms for the bioprocess optimization and control.

Development of a system to monitor surfer’s balance and plantar pressure and surfboard’s movement

O uso da tecnologia tem crescido nas últimas décadas nas mais diversas áreas, seja na indústria ou no dia-a-dia, e é cada vez mais evidente os benefícios que traz. No desporto não é diferente. Cada dia surgem novos desenvolvimentos objetivando a melhoria do desempenho dos praticantes de atividades físicas, possibilitando atingir resultados nunca antes pensados. Além disto, a utilização da tecnologia no desporto permite a obtenção de dados biomecânicos que podem ser utilizados tanto no treinamento quando na melhoria da qualidade de vida dos atletas auxiliando na prevenção de lesões, por exemplo. Deste modo, o presente projeto se aplica na área do desporto, nomeadamente, na modalidade do surfe, onde a ausência de trabalhos científicos ainda é elevada, aliando a tecnologia eletrônica ao desporto para quantificar informações até então desconhecidas. Três fatores básicos de desempenho foram levantados, sendo eles: equilíbrio, posicionamento dos pés e movimentação da prancha de surfe. Estes fatores levaram ao desenvolvimento de um sistema capaz de medi-los dinamicamente através da medição das forças plantares e da rotação da prancha de surfe. Além da medição dos fatores, o sistema é capaz de armazenar os dados adquiridos localmente através de um cartão de memória, para posterior análise; e também enviá-los através de uma comunicação sem fio, permitindo a visualização do centro de pressões plantares; dos ângulos de rotação da prancha de surfe; e da ativação dos sensores; em tempo real. O dispositivo consiste em um sistema eletrônico embarcado composto por um microcontrolador ATMEGA1280; um circuito de aquisição e condicionamento de sinal analógico; uma central inercial; um módulo de comunicação sem fio RN131; e um conjunto de sensores de força Flexiforce. O firmware embarcado foi desenvolvido em linguagem C. O software Matlab foi utilizado para receção de dados e visualização em tempo real. Os testes realizados demostraram que o funcionamento do sistema atende aos requisitos propostos, fornecendo informação acerca do equilíbrio, através do centro de pressões; do posicionamento dos pés, através da distribuição das pressões plantares; e do movimento da prancha nos eixos pitch e roll, através da central inercial. O erro médio de medição de força verificado foi de -0.0012 ± 0.0064 N, enquanto a mínima distância alcançada na transmissão sem fios foi de 100 m. A potência medida do sistema foi de 330 mW.

Environmental Decision-making utilizing a Web GIS to Monitor Hazardous Industrial Emissions in the Valencian community of Spain

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

Is Intrauterine Growth Appropriate to Monitor Postnatal Growth of Preterm Neonates?

When using the useful 2013 Fenton Chart, data should be interpreted with caution taking into account two aspects: the physiologic loss of body water after birth for the weight curves, and the questionable accuracy of the birth length curves considering the heterogeneity and reliability of the methods used in the original measurements.