Treatment for superficial infusion thrombophlebitis of the upper extremity.

BACKGROUND Although superficial thrombophlebitis of the upper extremity represents a frequent complication of intravenous catheters inserted into the peripheral veins of the forearm or hand, no consensus exists on the optimal management of this condition in clinical practice. OBJECTIVES To summarise the evidence from randomised clinical trials (RCTs) concerning the efficacy and safety of (topical, oral or parenteral) medical therapy of superficial thrombophlebitis of the upper extremity. SEARCH METHODS The Cochrane Vascular Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (2015, Issue 3). Clinical trials registries were searched up to April 2015. SELECTION CRITERIA RCTs comparing any (topical, oral or parenteral) medical treatment to no intervention or placebo, or comparing two different medical interventions (e.g. a different variant scheme or regimen of the same intervention or a different pharmacological type of treatment). DATA COLLECTION AND ANALYSIS We extracted data on methodological quality, patient characteristics, interventions and outcomes, including improvement of signs and symptoms as the primary effectiveness outcome, and number of participants experiencing side effects of the study treatments as the primary safety outcome. MAIN RESULTS We identified 13 studies (917 participants). The evaluated treatment modalities consisted of a topical treatment (11 studies), an oral treatment (2 studies) and a parenteral treatment (2 studies). Seven studies used a placebo or no intervention control group, whereas all others also or solely compared active treatment groups. No study evaluated the effects of ice or the application of cold or hot bandages. Overall, the risk of bias in individual trials was moderate to high, although poor reporting hampered a full appreciation of the risk in most studies. The overall quality of the evidence for each of the outcomes varied from low to moderate mainly due to risk of bias and imprecision, with only single trials contributing to most comparisons. Data on primary outcomes improvement of signs and symptoms and side effects attributed to the study treatment could not be statistically pooled because of the between-study differences in comparisons, outcomes and type of instruments to measure outcomes.An array of topical treatments, such as heparinoid or diclofenac gels, improved pain compared to placebo or no intervention. Compared to placebo, oral non-steroidal anti-inflammatory drugs reduced signs and symptoms intensity. Safety issues were reported sparsely and were not available for some interventions, such as notoginseny creams, parenteral low-molecular-weight heparin or defibrotide. Although several trials reported on adverse events with topical heparinoid creams, Essaven gel or phlebolan versus control, the trials were underpowered to adequately measure any differences between treatment modalities. Where reported, adverse events with topical treatments consisted mainly of local allergic reactions. Only one study of 15 participants assessed thrombus extension and symptomatic venous thromboembolism with either oral non-steroidal anti-inflammatory drugs or low-molecular-weight heparin, and it reported no cases of either. No study reported on the development of suppurative phlebitis, catheter-related bloodstream infections or quality of life. AUTHORS' CONCLUSIONS The evidence about the treatment of acute infusion superficial thrombophlebitis is limited and of low quality. Data appear too preliminary to assess the effectiveness and safety of topical treatments, systemic anticoagulation or oral non-steroidal anti-inflammatory drugs.

Does superficial fat affect metabolite concentrations determined by MR spectroscopy with water referencing?

It has recently been reported in this journal that local fat depots produce a sizable frequency-dependent signal attenuation in magnetic resonance spectroscopy (MRS) of the brain. If of a general nature, this effect would question the use of internal reference signals for quantification of MRS and the quantitative use of MRS as a whole. Here, it was attempted to verify this effect and pinpoint the potential causes by acquiring data with various acquisition settings, including two field strengths, two MR scanners from different vendors, different water suppression sequences, RF coils, localization sequences, echo times, and lipid/metabolite phantoms. With all settings tested, the reported effect could not be reproduced, and it is concluded that water referencing and quantitative MRS per se remain valid tools under common acquisition conditions.

Cystoscopy and the development of invasive bladder cancer in patients presenting with superficial urinary bladder cancer

The objective of this study was to determine the impact of different follow-up cystoscopy frequencies on time to development of invasive bladder cancer in a cohort of 3,658 eligible patients 65 and older with an initial diagnosis of superficial bladder cancer between 1994 and 1998. Bladder cancer patients in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database were used as the study population. ^ It was hypothesized that superficial bladder cancer patients receiving less frequent cystoscopy follow-up would develop invasive bladder cancer sooner after initial diagnosis and treatment than patients seen more frequently for cystoscopy follow-up. Cox Proportional Hazard Regression revealed that patients seen for cystoscopy every 3 or more months were 83–89% less likely to develop invasive cancer than patients seen every 1 to 2 months. A comparison of the 2 groups (1 to 2 months vs. 3≥ months) revealed that the 1 to 2 month group may have had more aggressive disease, and they are seen more frequently as a result. ^ These findings suggest that there are two groups of superficial bladder cancer patients: those at high risk of developing invasive bladder cancer and those at low risk. Patients who developed invasive bladder cancer sooner after initial diagnosis and treatment were seen more frequently for cystoscopy follow-up. The recommendation is that cystoscopy should be based on disease status at 3 months. Standardized schedules give all patients the same number of cystoscopies regardless of their risk factors. This could lead to unnecessary cystoscopies in low risk patients, and fewer than optimal cystoscopies in high risk patients. ^

Enfoque superficial y profundo en la lectura de un texto : Relato de una experiencia

Fil: Carbajo, María Rosa. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Enfoque superficial y profundo en la lectura de un texto : Relato de una experiencia

Fil: Carbajo, María Rosa. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Evaluación de la profundidad de la fisuración superficial descendente en pavimentos asfálticos mediante técnicas de ultrasonidos. Validación teórico-práctica y modelos

La fisuración iniciada en la superficie de los pavimentos asfálticos constituye uno de los más frecuentes e importantes modos de deterioro que tienen lugar en los firmes bituminosos, como han demostrado los estudios teóricos y experimentales llevados a cabo en la última década. Sin embargo, este mecanismo de fallo no ha sido considerado por los métodos tradicionales de diseño de estos firmes. El concepto de firmes de larga duración se fundamenta en un adecuado seguimiento del proceso de avance en profundidad de estos deterioros y la intervención en el momento más apropiado para conseguir mantenerlos confinados como fisuras de profundidad parcial en la capa superficial más fácilmente accesible y reparable, de manera que pueda prolongarse la durabilidad y funcionalidad del firme y reducir los costes generalizados de su ciclo de vida. Por lo tanto, para la selección de la estrategia óptima de conservación de los firmes resulta esencial disponer de metodologías que posibiliten la identificación precisa in situ de la fisuración descendente, su seguimiento y control, y que además permitan una determinación fiable y con alto rendimiento de su profundidad y extensión. En esta Tesis Doctoral se presentan los resultados obtenidos mediante la investigación sistemática de laboratorio e in situ llevada a cabo para la obtención de datos sobre fisuración descendente en firmes asfálticos y para el estudio de procedimientos de evaluación de la profundidad de este tipo de fisuras empleando técnicas de ultrasonidos. Dichos resultados han permitido comprobar que la metodología no destructiva propuesta, de rápida ejecución, bajo coste y sencilla implementación (principalmente empleada hasta el momento en estructuras metálicas y de hormigón, debido a las dificultades que introduce la naturaleza viscoelástica de los materiales bituminosos) puede ser aplicada con suficiente fiabilidad y repetibilidad sobre firmes asfálticos. Las medidas resultan asimismo independientes del espesor total del firme. Además, permite resolver algunos de los inconvenientes frecuentes que presentan otros métodos de diagnóstico de las fisuras de pavimentos, tales como la extracción de testigos (sistema destructivo, de alto coste y prolongados tiempos de interrupción del tráfico) o algunas otras técnicas no destructivas como las basadas en medidas de deflexiones o el georradar, las cuales no resultan suficientemente precisas para la investigación de fisuras superficiales. Para ello se han realizado varias campañas de ensayos sobre probetas de laboratorio en las que se han estudiado diferentes condiciones empíricas como, por ejemplo, distintos tipos de mezclas bituminosas en caliente (AC, SMA y PA), espesores de firme y adherencias entre capas, temperaturas, texturas superficiales, materiales de relleno y agua en el interior de las grietas, posición de los sensores y un amplio rango de posibles profundidades de fisura. Los métodos empleados se basan en la realización de varias medidas de velocidad o de tiempo de transmisión del pulso ultrasónico sobre una única cara o superficie accesible del material, de manera que resulte posible obtener un coeficiente de transmisión de la señal (mediciones relativas o autocompensadas). Las mediciones se han realizado a bajas frecuencias de excitación mediante dos equipos de ultrasonidos diferentes dotados, en un caso, de transductores de contacto puntual seco (DPC) y siendo en el otro instrumento de contacto plano a través de un material especialmente seleccionado para el acoplamiento (CPC). Ello ha permitido superar algunos de los tradicionales inconvenientes que presenta el uso de los transductores convencionales y no precisar preparación previa de las superficies. La técnica de autocalibración empleada elimina los errores sistemáticos y la necesidad de una calibración local previa, demostrando el potencial de esta tecnología. Los resultados experimentales han sido comparados con modelos teóricos simplificados que simulan la propagación de las ondas ultrasónicas en estos materiales bituminosos fisurados, los cuales han sido deducidos previamente mediante un planteamiento analítico y han permitido la correcta interpretación de dichos datos empíricos. Posteriormente, estos modelos se han calibrado mediante los resultados de laboratorio, proporcionándose sus expresiones matemáticas generalizadas y gráficas para su uso rutinario en las aplicaciones prácticas. Mediante los ensayos con ultrasonidos efectuados en campañas llevadas a cabo in situ, acompañados de la extracción de testigos del firme, se han podido evaluar los modelos propuestos. El máximo error relativo promedio en la estimación de la profundidad de las fisuras al aplicar dichos modelos no ha superado el 13%, con un nivel de confianza del 95%, en el conjunto de todos los ensayos realizados. La comprobación in situ de los modelos ha permitido establecer los criterios y las necesarias recomendaciones para su utilización sobre firmes en servicio. La experiencia obtenida posibilita la integración de esta metodología entre las técnicas de auscultación para la gestión de su conservación. Abstract Surface-initiated cracking of asphalt pavements constitutes one of the most frequent and important types of distress that occur in flexible bituminous pavements, as clearly has been demonstrated in the technical and experimental studies done over the past decade. However, this failure mechanism has not been taken into consideration for traditional methods of flexible pavement design. The concept of long-lasting pavements is based on adequate monitoring of the depth and extent of these deteriorations and on intervention at the most appropriate moment so as to contain them in the surface layer in the form of easily-accessible and repairable partial-depth topdown cracks, thereby prolonging the durability and serviceability of the pavement and reducing the overall cost of its life cycle. Therefore, to select the optimal maintenance strategy for perpetual pavements, it becomes essential to have access to methodologies that enable precise on-site identification, monitoring and control of top-down propagated cracks and that also permit a reliable, high-performance determination of the extent and depth of cracking. This PhD Thesis presents the results of systematic laboratory and in situ research carried out to obtain information about top-down cracking in asphalt pavements and to study methods of depth evaluation of this type of cracking using ultrasonic techniques. These results have demonstrated that the proposed non-destructive methodology –cost-effective, fast and easy-to-implement– (mainly used to date for concrete and metal structures, due to the difficulties caused by the viscoelastic nature of bituminous materials) can be applied with sufficient reliability and repeatability to asphalt pavements. Measurements are also independent of the asphalt thickness. Furthermore, it resolves some of the common inconveniences presented by other methods used to evaluate pavement cracking, such as core extraction (a destructive and expensive procedure that requires prolonged traffic interruptions) and other non-destructive techniques, such as those based on deflection measurements or ground-penetrating radar, which are not sufficiently precise to measure surface cracks. To obtain these results, extensive tests were performed on laboratory specimens. Different empirical conditions were studied, such as various types of hot bituminous mixtures (AC, SMA and PA), differing thicknesses of asphalt and adhesions between layers, varied temperatures, surface textures, filling materials and water within the crack, different sensor positions, as well as an ample range of possible crack depths. The methods employed in the study are based on a series of measurements of ultrasonic pulse velocities or transmission times over a single accessible side or surface of the material that make it possible to obtain a signal transmission coefficient (relative or auto-calibrated readings). Measurements were taken at low frequencies by two short-pulse ultrasonic devices: one equipped with dry point contact transducers (DPC) and the other with flat contact transducers that require a specially-selected coupling material (CPC). In this way, some of the traditional inconveniences presented by the use of conventional transducers were overcome and a prior preparation of the surfaces was not required. The auto-compensating technique eliminated systematic errors and the need for previous local calibration, demonstrating the potential for this technology. The experimental results have been compared with simplified theoretical models that simulate ultrasonic wave propagation in cracked bituminous materials, which had been previously deduced using an analytical approach and have permitted the correct interpretation of the aforementioned empirical results. These models were subsequently calibrated using the laboratory results, providing generalized mathematical expressions and graphics for routine use in practical applications. Through a series of on-site ultrasound test campaigns, accompanied by asphalt core extraction, it was possible to evaluate the proposed models, with differences between predicted crack depths and those measured in situ lower than 13% (with a confidence level of 95%). Thereby, the criteria and the necessary recommendations for their implementation on in-service asphalt pavements have been established. The experience obtained through this study makes it possible to integrate this methodology into the evaluation techniques for pavement management systems.

Especificación, control de calidad y calidad superficial del hormigón visto autocompactante

Al abordar aspectos de calidad superficial en hormigones vistos nos encontramos con la carencia de clasificación de calidades de superficies que se puedan utilizar como referencia, lo que obliga a establecer patrones propios. Una vez identificados los defectos que van a discriminar entre categorías se plantea el problema de la cuantificación de defectos. Es necesario además establecer si existe relación entre el cumplimiento de las especificaciones de autocompactabilidad y las calidades obtenidas, actividad que se contrastó mediante el control de recepción de hormigón en obra y la tipificación de calidades obtenidas, en una promoción de viviendas. Recientemente la fib (Aesthetics in concrete) y ACHE (hormigón visto) han creado dos grupos de trabajo en esta temática.

Estudio de la influencia del sistema de referencia en la evaluación de parámetros de acabado superficial

In the present paper the influence of the reference system with regard to the characterization of the surface finishing is analyzed. The effect of the reference system’s choice on the most representative surface finishing parameters (e.g. roughness average Ra and root mean square values Rq) is studied. The study can also be applied to their equivalent parameters in waviness and primary profiles. Based on ISO and ASME standards, three different types of regression lines (central, mean and orthogonal) are theoretically and experimentally analyzed, identifying the validity and applicability fields of each one depending on profile’s geometry

Control adaptativo del acabado superficial en la de procesos de torneado automatizados

El objetivo principal de este trabajo es el diseño y desarrollo de un sistema de control on-line del acabado superficial en procesos de torneado automatizado CNC. El sistema de control se divide en dos fases principales: en la primera fase, se diseña un sistema de monitorización del acabado superficial basado en el análisis de las fuerzas de corte del proceso de mecanizado; en la segunda fase, se desarrolla un sistema de control adaptativo en lazo cerrado basado en la información obtenida durante la monitorización del proceso de corte. Este sistema permite mantener el acabado superficial dentro de un rango de valores óptimos mediante el ajuste on-line del avance a través de la comunicación con el PLC del torno CNC. El sistema de control desarrollado logra mantener la rugosidad superficial dentro de los valores preestablecidos en la fase de diseño detectando y corrigiendo errores durante la ejecución del mecanizado.