Tratamiento de la ulcera venosa con escleroespuma versus manejo conservador

La úlcera venosa es una revelación clínica severa de la insuficiencia venosa crónica. Es la causa del 54-76% de las úlceras venosas de miembros inferiores. La ciencia médica ha generado diversos procedimientos en el manejo de esta patología, es así como a partir de conocimientos en fisiopatología de la ulceración venosa, se han aplicado procedimientos como opción de tratamiento. Objetivos: Valorar si el uso de rutina de la oclusión endoluminal con espuma guiada por ecografía del sistema venoso superficial insuficiente, en adicción al manejo convencional de la ulcera venosa (vendaje no compresivo, gasa vaselinada y curaciones) podría mejorar la tasa de curación a las 24 semanas de tratamiento. Diseño: Estudio clínico aleatorizado prospectivo de pacientes de la consulta externa de cirugía vascular del Hospital Occidente de Kennedy-Bogotá, durante el 01 de junio del 2011 hasta el 30 junio del 2012. Métodos: Un total de 44 pacientes con ulcera activa que cumplieron criterios de selección ingresaron al estudio, correspondientes a 48 extremidades con clasificación CEAP (C6), los pacientes fueron a aleatorizados a manejo convencional (control) o con manejo adicional de oclusión endoluminal con espuma eco-guiada. El objetivo principal fue el cierre de la ulcera a las 24 semanas. Resultados: La Curación de la ulcera a las 24 semanas de la aleatorización fue de 20 (83.3%) extremidades del grupo de oclusión endoluminal con espuma eco-guiada Vs 3(12.5%) para el grupo de control P: 0.0005 Discusión: Las tasas de curación de la ulcera luego de la oclusión endoluminal con espuma eco-guiada es muy superior al manejo convencional con curaciones y vendaje no compresivo, las tasa de curación son tan altas como las reportadas con sistemas de alta compresión y cirugía a las 24 semanas. La oclusión endoluminal eco-guiada es segura, mínimamente invasiva y clínicamente efectiva.

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.

Comparison of EDTA and EDDS as potential soil amendments for enhanced phytoextraction of heavy metals

Phytoextraction has been proposed as an alternative remediation technology for soils polluted with heavy metals or radionuclides, but is generally conceived as too slow working. Enhancing the accumulation of trace pollutants in harvestable plant tissues is a prerequisite for the technology to be practically applicable. The chelating aminopolycarboxylic acid, ethylene diamine tetraacetate (EDTA), has been found to enhance shoot accumulation of heavy metals. However, the use of EDTA in phytoextraction may not be suitable due to its high environmental persistence, which may lead to groundwater contamination. This paper aims to assess whether ethylene diamine disuccinate (EDDS), a biodegradable chelator, can be used for enhanced phytoextraction purposes. A laboratory experiment was conducted to examine mobilisation of Cd, Cu, Cr, Ni, Pb and Zn into the soil solution upon application of EDTA or EDDS. The longevity of the induced mobilisation was monitored for a period of 40 days after application. Estimated effect half lives ranged between 3.8 and 7.5 days for EDDS, depending on the applied dose. The minimum observed effect half life of EDTA was 36 days, while for the highest applied dose no decrease was observed throughout the 40 day period of the mobilisation experiment. Performance of EDTA and EDDS for phytoextraction was evaluated by application to Helianthus annuus. Two other potential chelators, known for their biodegradability in comparison to EDTA, were tested in the plant experiment: nitrilo acetic acid (NTA) and citric acid. Uptake of heavy metals was higher in EDDS-treated pots than in EDTA-treated pots. The effects were still considered insufficiently high to consider efficient remediation. This may be partly due to the choice of timing for application of the soil amendment. Fixing the time of application at an earlier point before harvest may yield better results. NTA and citric acid induced no significant effects on heavy metal uptake. (C) 2004 Elsevier Ltd. All rights reserved.

The unsteady flow of a weakly compressible fluid in a thin porous layer II: three-dimensional theory

We consider the problem of determining the pressure and velocity fields for a weakly compressible fluid flowing in a three-dimensional layer, composed of an inhomogeneous, anisotropic porous medium, with vertical side walls and variable upper and lower boundaries, in the presence of vertical wells injecting and/or extracting fluid. Numerical solution of this three-dimensional evolution problem may be expensive, particularly in the case that the depth scale of the layer h is small compared to the horizontal length scale l, a situation which occurs frequently in the application to oil and gas reservoir recovery and which leads to significant stiffness in the numerical problem. Under the assumption that $\epsilon\propto h/l\ll 1$, we show that, to leading order in $\epsilon$, the pressure field varies only in the horizontal directions away from the wells (the outer region). We construct asymptotic expansions in $\epsilon$ in both the inner (near the wells) and outer regions and use the asymptotic matching principle to derive expressions for all significant process quantities. The only computations required are for the solution of non-stiff linear, elliptic, two-dimensional boundary-value, and eigenvalue problems. This approach, via the method of matched asymptotic expansions, takes advantage of the small aspect ratio of the layer, $\epsilon$, at precisely the stage where full numerical computations become stiff, and also reveals the detailed structure of the dynamics of the flow, both in the neighbourhood of wells and away from wells.

The unsteady flow of a weakly compressible fluid in a thin porous layer III: three-dimensional computations

We describe a novel method for determining the pressure and velocity fields for a weakly compressible fluid flowing in a thin three-dimensional layer composed of an inhomogeneous, anisotropic porous medium, with vertical side walls and variable upper and lower boundaries, in the presence of vertical wells injecting and/or extracting fluid. Our approach uses the method of matched asymptotic expansions to derive expressions for all significant process quantities, the computation of which requires only the solution of linear, elliptic, two-dimensional boundary value and eigenvalue problems. In this article, we provide full implementation details and present numerical results demonstrating the efficiency and accuracy of our scheme.

Optical characterization of the growth and spatial structure of a substorm onset arc

We present a detailed case study of the characteristics of auroral forms that constitute the first ionospheric signatures of substorm expansion phase onset. Analysis of the optical frequency and along-arc (azimuthal) wave number spectra provides the strongest constraint to date on the potential mechanisms and instabilities in the near-Earth magnetosphere that accompany auroral onset and which precede poleward arc expansion and auroral breakup. We evaluate the frequency and growth rates of the auroral forms as a function of azimuthal wave number to determine whether these wave characteristics are consistent with current models of the substorm onset mechanism. We find that the frequency, spatial scales, and growth rates of the auroral forms are most consistent with the cross-field current instability or a ballooning instability, most likely triggered close to the inner edge of the ion plasma sheet. This result is supportive of a near-Earth plasma sheet initiation of the substorm expansion phase. We also present evidence that the frequency and phase characteristics of the auroral undulations may be generated via resonant processes operating along the geomagnetic field. Our observations provide the most powerful constraint to date on the ionospheric manifestation of the physical processes operating during the first few minutes around auroral substorm onset.

Self-consistent wave-particle interactions in dispersive scale long-period field-line-resonances

Using 1D Vlasov drift-kinetic computer simulations, it is shown that electron trapping in long period standing shear Alfven waves (SAWs) provides an efficient energy sink for wave energy that is much more effective than Landau damping. It is also suggested that the plasma environment of low altitude auroral-zone geomagnetic field lines is more suited to electron acceleration by inertial or kinetic scale Alfven waves. This is due to the self-consistent response of the electron distribution function to SAWs, which must accommodate the low altitude large-scale current system in standing waves. We characterize these effects in terms of the relative magnitude of the wave phase and electron thermal velocities. While particle trapping is shown to be significant across a wide range of plasma temperatures and wave frequencies, we find that electron beam formation in long period waves is more effective in relatively cold plasma.

Field line resonances as a trigger and a tracer for substorm onset

In this paper, we show that periodic auroral arc structures are seen at the location of one particular auroral substorm onset for the 15 min preceding onset, suggesting that field line resonances should be considered a strong candidate for triggering substorm onset. Irrespective of whether this field line resonance is coincidentally or causally linked to this substorm onset, the characteristics of the field line resonance can be used to remote sense the characteristics of the geomagnetic field line that supports substorm onset. In this instance, the eigenfrequency of this resonance is around 12 mHz. Interestingly, however, there is no evidence of this field line resonance in a seven satellite major Time History of Events and Macroscale Interactions during Substorms (THEMIS)-GOES conjunction, ranging from geosynchronous orbit to ~30 RE. However, using space-based cross-phase measurements of the local field line eigenfrequency at the inner THEMIS locations, we find that the local field line eigenfrequency is 6–10 mHz. Hence, we can reliably say that this 12 mHz Field Line Resonance (FLR) must lie inside of THEMIS locations. Our conclusion is that a high-m field line resonance can both represent a strong candidate for a trigger for substorm onset, as first proposed by Samson et al. (1992), and that its characteristics can provide invaluable information as to where substorm onset occurs in the magnetosphere.

Coordinated ground-based, low altitude satellite and Cluster observations on global and local scales during a transient post-noon sector excursion of the magnetospheric cusp

On 14 January 2001, the four Cluster spacecraft passed through the northern magnetospheric mantle in close conjunction to the EISCAT Svalbard Radar (ESR) and approached the post-noon dayside magnetopause over Greenland between 13:00 and 14:00 UT During that interval, a sudden reorganisation of the high-latitude dayside convection pattern accurred after 13:20 UT most likely caused by a direction change of the Solar wind magnetic field. The result was an eastward and poleward directed flow-channel, as monitored by the SuperDARN radar network and also by arrays of ground-based magnetometers in Canada, Greenland and Scandinavia. After an initial eastward and later poleward expansion of the flow-channel between 13:20 and 13:40 UT, the four Cluster spacecraft, and the field line footprints covered by the eastward looking scan cycle of the Sondre Stromfjord incoherent scatter radar were engulfed by cusp-like precipitation with transient magnetic and electric field signatures. In addition, the EISCAT Svalbard Radar detected strong transient effects of the convection reorganisation, a poleward moving precipitation, and a fast ion flow-channel in association with the auroral structures that suddenly formed to the west and north of the radar. From a detailed analysis of the coordinated Cluster and ground-based data, it was found that this extraordinary transient convection pattern, indeed, had moved the cusp precipitation from its former pre-noon position into the late post-noon sector, allowing for the first and quite unexpected encounter of the cusp by the Cluster spacecraft. Our findings illustrate the large amplitude of cusp dynamics even in response to moderate solar wind forcing. The global ground-based data proves to be an invaluable tool to monitor the dynamics and width of the affected magnetospheric regions.

Dayside ionospheric convection changes in response to long-period interplanetary Magnetic field oscillations: Determination of the ionospheric phase velocity

Ground magnetic field perturbations recorded by the CANOPUS magnetometer network in the 7 to 13 MLT sector are used to examine how reconfigurations of the dayside polar ionospheric flow take place in response to north-south changes of the IMF. During the 6-hour interval in question IMF Bz oscillates between ±7 nT with about a 1-hour period. Corresponding variations in the ground magnetic disturbance are observed which we infer are due to changes in ionospheric flow. Cross correlation of the data obtained from two ground stations at 73.5° magnetic latitude, but separated by ∼2 hours in MLT, shows that changes in the flow are initiated in the prenoon sector (∼10 MLT) and then spread outward toward dawn and dusk with a phase speed of ∼5 km s−1 over the longitude range ∼8 to 12 MLT, slowing to ∼2 km s−1 outside this range. Cross correlating the data from these ground stations with IMP 8 IMF Bz records produces a MLT variation in the ground response delay relative to the IMF which is compatible with these deduced phase speeds. We interpret these observations in terms of the ionospheric response to the onset, expansion and decay of magnetic reconnection at the dayside magnetopause.

Vertical structure and physical processes of the Madden-Julian oscillation: Biases and uncertainties at short range

An analysis of diabatic heating and moistening processes from 12-36 hour lead time forecasts from 12 Global Circulation Models are presented as part of the "Vertical structure and physical processes of the Madden-Julian Oscillation (MJO)" project. A lead time of 12-36 hours is chosen to constrain the large scale dynamics and thermodynamics to be close to observations while avoiding being too close to the initial spin-up for the models as they adjust to being driven from the YOTC analysis. A comparison of the vertical velocity and rainfall with the observations and YOTC analysis suggests that the phases of convection associated with the MJO are constrained in most models at this lead time although the rainfall in the suppressed phase is typically overestimated. Although the large scale dynamics is reasonably constrained, moistening and heating profiles have large inter-model spread. In particular, there are large spreads in convective heating and moistening at mid-levels during the transition to active convection. Radiative heating and cloud parameters have the largest relative spread across models at upper levels during the active phase. A detailed analysis of time step behaviour shows that some models show strong intermittency in rainfall and differences in the precipitation and dynamics relationship between models. The wealth of model outputs archived during this project is a very valuable resource for model developers beyond the study of the MJO. In addition, the findings of this study can inform the design of process model experiments, and inform the priorities for field experiments and future observing systems.

Interactions between nutrition and infections with Haemonchus contortus and related gastro-intestinal nematodes in small ruminants

Interactions between host nutrition and feeding behaviour are central to understanding the pathophysiological consequences of infections of the digestive tract with parasitic nematodes. The manipulation of host nutrition provides useful options to control gastrointestinal nematodes as a component of an integrated strategy. Focused mainly on the Hameonchus contortus infection model in small ruminants, this chapter (i) illustrates the relationship between quantitative (macro- and micro-nutrients) and qualitative (plant secondary metabolites) aspects of host nutrition and nematode infection, and (ii) shows how basic studies aimed at addressing some generic questions can help provide solutions, despite the considerable diversity of epidemiological situations and breeding systems.

Modelos de estimativa de radiação solar para elaboração de mapas solarimétricos

O objetivo fundamental desta dissertação foi desenvolver modelos de estimativa da radiação solar no intuito de complementar a base de dados visando o traçado de mapas de radiação solar para o Rio Grande do Sul. Inicialmente foi realizada uma pesquisa na literatura sobre as metodologias desenvolvidas para a estimativa da radiação solar para locais onde inexistem dados medidos desta variável. Foi feito um levantamento das técnicas estatísticas utilizadas na previsão de valores de variáveis. As metodologias pesquisadas foram aplicadas ao banco de dados SAMSON (Solar and Meteorological Surface Observational Network). Entre as variáveis deste banco de dados estão a radiação solar, a umidade relativa, a temperatura, a latitude, a altitude e a nebulosidade. A metodologia dos modelos de estimativa aplicada neste trabalho baseia-se no Método dos Mínimos Quadrados. Foram realizadas correlações mensais e anuais entre as variáveis acima citadas e seus resultados validados através de validação cruzada. Resultou apropriada, na disponibilidade de dados climatológicos, a aplicação de modelos com parâmetros mensais de regressão linear múltipla envolvendo as variáveis explicativas: insolação, temperatura média e umidade relativa. Este modelo, entre outros, foi aplicado aos dados do Rio Grande do Sul. A metodologia acima descrita aplicada aos dados medidos no Rio Grande do Sul, resultou eficaz. Foram pesquisadas técnicas de interpolação para traçado de mapas e estabelecidas regras para o traçado dos mesmos. Foram utilizados dados periféricos para a Argentina, Uruguai e Santa Catarina. Foram feitos mapas mensais de médias mensais de radiação solar global horizontal diária bem como um mapa da média anual de radiação solar global horizontal diária. Observou-se que o modelo de Ångström–Prescott apresenta bons resultados quando se dispõe apenas da insolação Os mapas serão úteis para a pesquisa e implementação de sistemas empregando Energia Solar no Estado do Rio Grande do Sul. Finalmente, a principal conclusão é a de que modelos de correlações obtidos com dados de cada mês e produzindo parâmetros mensais são mais adequados do que um único modelo de correlação com parâmetros de validade anual utilizado nas estimativas mensais.