Intracardiac echo guided valvuloplasty of a stenotic tricuspid prosthetic valve in a patient with idiopathic hypereosinophilic syndrome

A 52-year-old male with idiopathic hypereosinophilic syndrome (HES) was transferred to our institution following the development of acute respiratory failure and shock. He had previously undergone tricuspid valve replacement with bioprosthetic valves on two occasions: the initial surgery for severe native tricuspid valve stenosis and the redo surgery for severe prosthetic valve stenosis and regurgitation. Conventional imaging assessment using transoesophageal echocardiography was suboptimal and comprehensive assessment of prosthetic valve function was aided by the use of intracardiac echocardiography (ICE). ICE provided high quality 2D imaging of the prosthesis demonstrating thrombus-like material coating the inner surfaces of the prosthetic valve stents effectively forming a tunnel-like obstruction. Unusual hemodynamics secondary to severe tricuspid stenosis were demonstrated by CW Doppler with intermittent signal fusion resulting from blunted respiratory variation in the markedly elevated right atrial pressure relative to right ventricular pressure. Successful balloon valvuloplasty was performed with ICE proving highly valuable in guiding balloon position as well as monitoring the efficacy of the subsequent inflations.

Avaliação de medidas craniofaciais angulares e lineares em relação à quantidade de crescimento da face

A identificação dos padrões morfológicos da face é de extrema importância para a elaboração do diagnóstico ortodôntico e conseqüente plano de tratamento. Sendo assim, esta pesquisa teve como objetivo avaliar as relações entre as medidas lineares N-ENA, ENA-Pog e N-Pog, as medidas angulares N.OPI.ENA, ENA.OPI.Pog e N.OPI.Pog, e o índice VERT de acordo com a classificação proposta por RICKETTS. O material de estudo foi constituído de 700 telerradiografias, em norma lateral, de indivíduos brasileiros, leucodermas, de ambos os gêneros (318 do gênero masculino e 382 do gênero feminino), apresentando idade média de 16,66 anos. Das 700 telerradiografias foram constituídos quatro grupos de acordo com a oclusão. O primeiro grupo foi constituído de indivíduos com oclusão normal natural segundo ANDREWS, sendo observadas, clinicamente, quatro das seis chaves de oclusão. Os demais grupos se constituíram de indivíduos com más-oclusões de Classe I, II e III segundo ANGLE, sem relato de tratamento ortodôntico anterior. Após a análise estatística para a avaliação das medidas lineares N-ENA, ENA-Pog e N-Pog, e medidas angulares N.OPI.ENA, ENA.OPI.Pog e N.OPI.Pog, em relação ao índice VERT, evidenciou um aumento progressivo das medidas pesquisadas em relação aos seis padrões faciais determinados pelo índice VERT, mostrando um aumento destas medidas conforme se vai do padrão braquifacial severo para o padrão dolicofacial severo.

ESTUDO COMPARATIVO ENTRE A ANÁLISE FACIAL SUBJETIVA E ANÁLISE CEFALOMÉTRICA DE TECIDOS MOLES NO DIAGNÓSTICO ORTODÔNTICO

O propósito deste estudo foi avaliar a concordância entre a Análise facial subjetiva, proposta por CAPELOZZA FILHO e a Análise Cefalométrica de Tecidos Moles, de ARNETT; McLAUGHLIN. Fotografias de frente e de perfil e telerradiografias em norma lateral padronizadas, de 50 indivíduos, com média de idade de 24 anos e 1 mês foram utilizadas para a avaliação. Verificou-se também nos indivíduos classificados como Padrão I, a correspondência dos valores médios e dos desvios-padrão das medidas obtidas, com os valores normativos da Análise Cefalométrica dos Tecidos Moles para os indivíd uos com harmonia facial. Constatou-se em indivíduos do Padrão I que os lábios sempre se encontram à frente da Linha Vertical Verdadeira, e que apesar de grandes variações do ponto pogônio, ainda é mantido o equilíbrio facial. Os resultados demonstraram que a Análise facial subjetiva eficiente na classificação do padrão facial.

ASPECTOS PSICOLÓGICOS DE PACIENTES COM HIV/AIDS E LIPODISTROFIA ATENDIDOS NO HOSPITAL HELIÓPOLIS

A epidemia da Síndrome da Imunodeficiência Adquirida (aids) é, atualmente, um fenômeno de grande magnitude e extensão na saúde mundial. A síndrome de lipodistrofia é uma alteração que afeta a autoimagem corporal e a sexualidade, aumentando o estigma da doença e ocasionando dificuldades na adesão ao tratamento e nas relações sociais. OBJETIVOS: a) descrever aspectos da psicodinâmica de pacientes HIV/aids acometidos e não acometidos pela lipodistrofia, dando enfoque aos mecanismos de defesa utilizados ; b) investigar a percepção de imagem corporal em pacientes HIV/aids acometidos e não acometidos pela síndrome de lipodistrofia; c) identificar semelhanças e diferenças de percepção de imagem corporal em pacientes HIV/aids acometidos pela lipodistrofia com aqueles não acometidos. MÉTODO: Foram selecionados oito pacientes por critério de conveniência do ambulatório da Clínica de Infectologia do Hospital Heliópolis. Foram utilizados um Roteiro de Entrevista e o Desenho da Figura Humana DFH teste projetivo gráfico de personalidade; a análise dos dados foram submetidos à análise qualitativa conforme indicação do instrumental, auxiliados pela leitura do conteúdo clinico-diagnóstico psicológico. RESULTADOS: Nos dois grupos os dados apontaram para características em comum quanto à psicodinâmica interna e à percepção de imagem corporal. Recursos defensivos primitivos foram os mais utilizados caracterizando a presença de disfunção da imagem corporal e um controle egóico rígido, embora frágil. Percebeu-se o quanto é angustiante, para estas pacientes, lidar não somente com a autoimagem como também com a sexualidade. CONCLUSÕES: Os programas de acompanhamento ao HIV/aids devem considerar o quanto essas pacientes necessitam de ser acompanhadas em psicoterapia. A promoção de saúde deve levar em conta não somente a melhora da qualidade de vida, mas também buscar compreender como estas mulheres se relacionam e de que forma exercem a sua sexualidade.

Controlling protein molecular dynamics:how to accelerate folding while preserving the native state

The dynamics of peptides and proteins generated by classical molecular dynamics (MD) is described by using a Markov model. The model is built by clustering the trajectory into conformational states and estimating transition probabilities between the states. Assuming that it is possible to influence the dynamics of the system by varying simulation parameters, we show how to use the Markov model to determine the parameter values that preserve the folded state of the protein and at the same time, reduce the folding time in the simulation. We investigate this by applying the method to two systems. The first system is an imaginary peptide described by given transition probabilities with a total folding time of 1 micros. We find that only small changes in the transition probabilities are needed to accelerate (or decelerate) the folding. This implies that folding times for slowly folding peptides and proteins calculated using MD cannot be meaningfully compared to experimental results. The second system is a four residue peptide valine-proline-alanine-leucine in water. We control the dynamics of the transitions by varying the temperature and the atom masses. The simulation results show that it is possible to find the combinations of parameter values that accelerate the dynamics and at the same time preserve the native state of the peptide. A method for accelerating larger systems without performing simulations for the whole folding process is outlined.

Lithological mapping of Northwest Argentina with remote sensing data using tonal, textural and contextual features

Tonal, textural and contextual properties are used in manual photointerpretation of remotely sensed data. This study has used these three attributes to produce a lithological map of semi arid northwest Argentina by semi automatic computer classification procedures of remotely sensed data. Three different types of satellite data were investigated, these were LANDSAT MSS, TM and SIR-A imagery. Supervised classification procedures using tonal features only produced poor classification results. LANDSAT MSS produced classification accuracies in the range of 40 to 60%, while accuracies of 50 to 70% were achieved using LANDSAT TM data. The addition of SIR-A data produced increases in the classification accuracy. The increased classification accuracy of TM over the MSS is because of the better discrimination of geological materials afforded by the middle infra red bands of the TM sensor. The maximum likelihood classifier consistently produced classification accuracies 10 to 15% higher than either the minimum distance to means or decision tree classifier, this improved accuracy was obtained at the cost of greatly increased processing time. A new type of classifier the spectral shape classifier, which is computationally as fast as a minimum distance to means classifier is described. However, the results for this classifier were disappointing, being lower in most cases than the minimum distance or decision tree procedures. The classification results using only tonal features were felt to be unacceptably poor, therefore textural attributes were investigated. Texture is an important attribute used by photogeologists to discriminate lithology. In the case of TM data, texture measures were found to increase the classification accuracy by up to 15%. However, in the case of the LANDSAT MSS data the use of texture measures did not provide any significant increase in the accuracy of classification. For TM data, it was found that second order texture, especially the SGLDM based measures, produced highest classification accuracy. Contextual post processing was found to increase classification accuracy and improve the visual appearance of classified output by removing isolated misclassified pixels which tend to clutter classified images. Simple contextual features, such as mode filters were found to out perform more complex features such as gravitational filter or minimal area replacement methods. Generally the larger the size of the filter, the greater the increase in the accuracy. Production rules were used to build a knowledge based system which used tonal and textural features to identify sedimentary lithologies in each of the two test sites. The knowledge based system was able to identify six out of ten lithologies correctly.

Surfactant-free purification of membrane proteins with intact native membrane environment

In order to study the structure and function of a protein, it is generally required that the protein in question is purified away from all others. For soluble proteins, this process is greatly aided by the lack of any restriction on the free and independent diffusion of individual protein particles in three dimensions. This is not the case for membrane proteins, as the membrane itself forms a continuum that joins the proteins within the membrane with one another. It is therefore essential that the membrane is disrupted in order to allow separation and hence purification of membrane proteins. In the present review, we examine recent advances in the methods employed to separate membrane proteins before purification. These approaches move away from solubilization methods based on the use of small surfactants, which have been shown to suffer from significant practical problems. Instead, the present review focuses on methods that stem from the field of nanotechnology and use a range of reagents that fragment the membrane into nanometre-scale particles containing the protein complete with the local membrane environment. In particular, we examine a method employing the amphipathic polymer poly(styrene-co-maleic acid), which is able to reversibly encapsulate the membrane protein in a 10 nm disc-like structure ideally suited to purification and further biochemical study.

International technology transfer and development of capabilities in Chinese state-owned manufacturing enterprises:lessons from 20 years of case research

Technological capabilities in Chinese manufacturing have been transformed in the last three decades. However, the extent to which domestic market oriented state owned enterprises (SOEs) have developed their capabilities is not clear. Six SOEs in the automotive, steel and machine tools sectors in Beijing and Tianjin have been studied since the mid-1990s to assess the capability levels attained and the role of external sources and internal efforts in developing them. Aided by government policies, acquisition of technology and their own efforts, the case study companies appear to be broadly following the East Asian late industrialisation model. All six enterprises demonstrate competences in operating established technology, managing investment and making product and process improvements. The evidence suggests that companies without foreign joint venture (JV) collaborations have made more progress in this respect.

The laminar-turbulent transition in a fibre laser

Studying the transition from a linearly stable coherent laminar state to a highly disordered state of turbulence is conceptually and technically challenging, and of great interest because all pipe and channel flows are of that type. In optics, understanding how a system loses coherence, as spatial size or the strength of excitation increases, is a fundamental problem of practical importance. Here, we report our studies of a fibre laser that operates in both laminar and turbulent regimes. We show that the laminar phase is analogous to a one-dimensional coherent condensate and the onset of turbulence is due to the loss of spatial coherence. Our investigations suggest that the laminar-turbulent transition in the laser is due to condensate destruction by clustering dark and grey solitons. This finding could prove valuable for the design of coherent optical devices as well as systems operating far from thermodynamic equilibrium. © 2013 Macmillan Publishers Limited.

Dynamics of pulsed flow in an elastic tube

Internal haemorrhage, often leading to cardio-vascular arrest happens to be one of the prime sources of high fatality rates in mammals. We propose a simplistic model of fluid flow in our attempt to specify the location of the haemorrhagic spot, which, if located accurately, could possibly be operated leading to an instant cure. The model we employ for the purpose is basically fluid mechanical in origin and consists of a viscous fluid, pumped by a periodic force and flowing through an elastic tube. The analogy is with that of blood, pumped from the heart and flowing through an artery or vein. Our results, aided by graphical illustrations, match reasonably well with experimental observations.

Randomised masked clinical trial of the MGDRx eyebag for the treatment of meibomian gland dysfunction-related evaporative dry eye

Background/aims To investigate the efficacy and safety of the MGDRx EyeBag (The Eyebag Company, Halifax, UK) eyelid warming device. Methods Twenty-five patients with confirmed meibomian gland dysfunction (MGD)-related evaporative dry eye were enrolled into a randomised, single masked, contralateral clinical trial. Test eyes received a heated device; control eyes a non-heated device for 5 min twice a day for 2 weeks. Efficacy (ocular symptomology, noninvasive break-up time, lipid layer thickness, osmolarity, meibomian gland dropout and function) and safety (visual acuity, corneal topography, conjunctival hyperaemia and staining) measurements were taken at baseline and follow-up. Subsequent patient device usage and ocular comfort was ascertained at 6 months. Results Differences between test and control eyes at baseline were not statistically signi ficant for all measurements ( p>0.05). After 2 weeks, statistically significant improvements occurred in all efficacy measurements in test eyes ( p<0.05). Visual acuity and corneal topography were unaffected (p>0.05). All patients maintained higher ocular comfort after 6 months ( p<0.05), although the bene fit was greater in those who continued usage 1-8 times a month (p<0.001). Conclusions The MGDRx EyeBag is a safe and effective device for the treatment of MGD-related evaporative dry eye. Subjective benefit lasts at least 6 months, aided by occasional retreatment. Trial registration number NCT01870180.

Inhibition of object identity in inhibition of return:implications for encoding and retrieving inhibitory processes

Inhibition of return (IOR) effects, in which participants detect a target in a cued box more slowly than one in an uncued box, suggest that behavior is aided by inhibition of recently attended irrelevant locations. To investigate the controversial question of whether inhibition can be applied to object identity in these tasks, in the present research we presented faces upright or inverted during cue and/or target sequences. IOR was greater when both cue and target faces were upright than when cue and/or target faces were inverted. Because the only difference between the conditions was the ease of facial recognition, this result indicates that inhibition was applied to object identity. Interestingly, inhibition of object identity affected IOR both whenencoding a cue face andretrieving information about a target face. Accordingly, we propose that episodic retrieval of inhibition associated with object identity may mediate behavior in cuing tasks.

Influence of birth cohort on age of onset cluster analysis in bipolar I disorder

PURPOSE: Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database. METHODS: The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared. RESULTS: There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups. CONCLUSION: These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

Többszempontú részvételi döntések a fenntarthatósági értékelésekben. A legnépszerűbb módszerek összehasonlítása

Egyes alternatívák, forgatókönyvek, technológiák stb. fenntarthatóságának értékelése – definíciószerűen többdimenziós probléma. A megfelelő alternatíva kiválasztásánál ugyanis a döntéshozóknak egyszerre kell figyelembe venniük környezetvédelmi, gazdasági és társadalmi szempontokat. Az ilyen döntéseket támogathatják többszempontú döntéshozatali modellek. A tanulmány hét többszempontú döntési módszertan (MAU, AHP, ELECTRE, PROMETHEE, REGIME, NAIADE és ideális-referencia pont) alkalmazhatóságát vizsgálja részvételi körülmények között. Az utóbbi évek e témában publikált esettanulmányait áttekintve megállapítható, hogy egyik módszer sem dominálja a többit, azok különböző feltételek mellett eltérő sikerrel használhatók. Ennek ellenére a különböző technikák kombinációjával előállíthatunk olyan eljárásokat, melyekkel az egyes módszerek előnyeit még jobban kiaknázhatjuk. ________ Measuring and comparing the sustainability of certain actions, scenarios, technologies, etc. – by definition – is a multidimensional problem. Decision makers must consider environmental, economic and social aspects when choosing an alternative course of action. Such decisions can be aided by multi-criteria decision analysis (MCDA). In this paper participatory seven different MCDA methodologies are investigated (MAU, the Analytic Hierarchic Process (AHP), the ELECTRE, PROMETHEE, REGIME, and NAIADE methods and the “Ideal and reference point” approaches). It is based on a series of reports, in which more than 30 real world case studies focusing on participatory MCDA were reviewed. It is emphasized that there is no “best” choice from the list of MCDA techniques, but some methods fit certain decision problems more than others. However, with the combination of these methodologies some complementary benefits of the different techniques can be exploited.

Több szempontú részvételi döntések a fenntarthatósági értékelésekben. A legnépszerűbb módszerek összehasonlítása = Participatory multi-criteria decision analysis. A comparison of methodologies

A fenntarthatóság értékelése definíciószerűen többdimenziós probléma. A megfelelő alternatíva, forgatókönyv, eljárás stb. kiválasztásakor ugyanis a döntéshozóknak egyszerre kell figyelembe venniük környezetvédelmi, gazdasági és társadalmi szempontokat. Az ilyen döntéseket alátámaszthatják a több szempontú döntéshozatali modellek. A tanulmány a több szempontú döntési eljárások közül a legfontosabb hétnek az alkalmazhatóságát vizsgálja részvételi körülmények között. Az utóbbi évek e témában publikált esettanulmányainak áttekintésével megállapítható, hogy egyik módszer sem uralja a többit, azok különböző feltételek mellett eltérő sikerrel használhatók. Ennek ellenére a különböző módszerek kombinációjával végrehajthatunk olyan eljárásokat, amelyekkel az egyes módszerek előnyeit még jobban kiaknázhatjuk. ________ Measuring and comparing the sustainability of certain actions, scenarios, technologies, etc. is by definition a multidimensional problem. Decision-makers must consider environmental, economic and social aspects when choosing an alternative course of action. Such decisions can be aided by multi-criteria decision analysis (MCDA). This paper investigates seven different MCDA methodologies: MAU, the Analytic Hierarchic Process (AHP), the ELECTRE, PROMETHEE, REGIME, and NAIADE methods, and "Ideal and reference point" approaches). It is based on a series of reports in which over 30 real-world case studies focusing on participatory MCDA were reviewed. It is stressed, however, that there is no "best" choice in the list of MCDA techniques. Some methods fit certain decision problems better than others. Nonetheless, some complementary benefits of the different techniques can be exploited by combining these methodologies.