Endothelial, but not smooth muscle, peroxisome proliferator-activated receptor β/δ regulates vascular permeability and anaphylaxis.

BACKGROUND: Remodeling of quiescent vessels with increases in permeability, vasodilatation, and edema are hallmarks of inflammatory disorders. Factors involved in this type of remodeling represent potential therapeutic targets. OBJECTIVES: We investigated whether the nuclear hormone receptor peroxisome proliferator-activated receptor (PPAR) β/δ, a regulator of metabolism, fibrosis, and skin homeostasis, is involved in regulation of this type of remodeling. METHODS: Wild-type and various Pparb/d mutant mice were used to monitor dermal acute vascular hyperpermeability (AVH) and passive systemic anaphylaxis-induced hypothermia and edema. PPARβ/δ-dependent kinase activation and remodeling of endothelial cell-cell junctions were addressed by using human endothelial cells. RESULTS: AVH and dilatation of dermal microvessels stimulated by vascular endothelial growth factor A, histamine, and thrombin are severely compromised in PPARβ/δ-deficient mice. Selective deletion of the Pparb/d-encoding gene in endothelial cells in vivo similarly limits dermal AVH and vasodilatation, providing evidence that endothelial PPARβ/δ is the major player in regulating acute dermal microvessel remodeling. Furthermore, endothelial PPARβ/δ regulatory functions are not restricted to the skin vasculature because its deletion in the endothelium, but not in smooth muscle cells, also leads to reduced systemic anaphylaxis, the most severe form of allergic reaction, in which an acute vascular response plays a key role. PPARβ/δ-dependent AVH activation likely involves the activation of mitogen-activated protein kinase and Akt pathways and leads to downstream destabilization of endothelial cell-cell junctions. CONCLUSION: These results unveil not only a novel function of PPARβ/δ as a direct regulator of acute vessel permeability and dilatation but also provide evidence that antagonizing PPARβ/δ represents an important strategy to consider for moderating diseases with altered endothelial integrity, such as acute inflammatory and allergic disorders.

Liikuntasaumaproblematiikan selvittäminen laivan runkorakenteissa

Nykyään laivan kansirakenteet suunnitellaan pääosin kantaviksi rakenteiksi, mikä edellyttää niiltä suurta lujuutta. Jatkuvasti kasvavissa risteilijöissä ja muissa suurissa aluksissa ongelmaksi muodostuu kansirakenteiden suuret jännitykset. Kansirakenteet sijaitsevat kauimpana laivan neutraaliakselilta, jolloin niissä syntyy suuria venymiä. Kansirakenteista pitää näin ollen suunnitella hyvin kestäviä tai vaihtoehtoisesti tarpeeksi lyhyitä rakenteita. Liikuntasaumojen avulla on 1950 -luvulle asti laivoissa katkaistu pitkät kansirakenteet, mutta hitsausmenetelmien kehittyessä kansirakennukset on tehty yhtenäisiksi kansirakenteiksi. Tämä on tähänastisissa risteilijöissäkin toiminut hyvin, mutta laivojen koon kasvaessa on etsittävä keinoja mahdollisiin runkorakenteiden ja varustelun lujuus- ja väsymisongelmiin. Tavoitteena oli saada aikaan työ, joka olisi hyvä ”työkalu” tuleville tutkimuksille liikuntasaumojen soveltamisessa laivarakenteisiin sekä niihin liittyviin varusteluosiin ja -rakenteisiin. Työssä tutustutaan kirjallisuustutkimuksen avulla liikuntasaumasovelluksiin ja esitellään sovelluksia eri aloilta. Kirjallisuusosuuden päätteeksi esitellään muutama laivarakennesovellus, joita löytyy hieman vanhemmista laivarakenteista. FE analyysiosuudessa tutkitaan liikuntasauman pohjan muodon vaikutusta pohjan jännitystasoihin ja liikuntasaumojen vaikutusta laivan kansirakenteiden jännitystasoihin kolmella eri liikuntasaumojen lukumäärällä. Lisäksi kansirakenteiden jännitystasoja tutkittiin kolmella kansirakenteen leveydellä. Esimerkkejä liikuntasaumoista löytyy monelta eri aloilta, joiden ominaisuuksia yhdistelemällä saavutetaan oikea ratkaisu liikuntasaumojen soveltamisessa laivojen kansirakenteisiin. Lisäksi FE -analyysistä voidaan nähdä, että liikuntasaumat laskevat jännitystasoja laivojen kansirakenteissa. Liikuntasaumojen oikea lukumäärä riippuu hyvin paljon siitä, kuinka paljon kansirakenteen jännityksiä halutaan laskea. Liikuntasauman pohjan muotoa on kehitettävä ja se on otettava myös huomioon yhtenä tärkeänä seikkana suunniteltaessa liikuntasaumoja laivojen kansirakenteisiin. Esimerkiksi vahvistelevyillä saadaan jännityksiä laskettua liikuntasauman pohjan läheisyydessä tehokkaasti.

Prenatal Risk Factors and Outcomes in Gastroschisis: A Meta-Analysis.

BACKGROUND AND OBJECTIVE: Gastroschisis is a congenital anomaly with increasing incidence, easy prenatal diagnosis and extremely variable postnatal outcomes. Our objective was to systematically review the evidence regarding the association between prenatal ultrasound signs (intraabdominal bowel dilatation [IABD], extraabdominal bowel dilatation, gastric dilatation [GD], bowel wall thickness, polyhydramnios, and small for gestational age) and perinatal outcomes in gastroschisis (bowel atresia, intra uterine death, neonatal death, time to full enteral feeding, length of total parenteral nutrition and length of in hospital stay). METHODS: Medline, Embase, and Cochrane databases were searched electronically. Studies exploring the association between antenatal ultrasound signs and outcomes in gastroschisis were considered suitable for inclusion. Two reviewers independently extracted relevant data regarding study characteristics and pregnancy outcome. All meta-analyses were computed using individual data random-effect logistic regression, with single study as the cluster unit. RESULTS: Twenty-six studies, including 2023 fetuses, were included. We found significant positive associations between IABD and bowel atresia (odds ratio [OR]: 5.48, 95% confidence interval [CI] 3.1-9.8), polyhydramnios and bowel atresia (OR: 3.76, 95% CI 1.7-8.3), and GD and neonatal death (OR: 5.58, 95% CI 1.3-24.1). No other ultrasound sign was significantly related to any other outcome. CONCLUSIONS: IABD, polyhydramnios, and GD can be used to an extent to identify a subgroup of neonates with a prenatal diagnosis of gastroschisis at higher risk to develop postnatal complications. Data are still inconclusive on the predictive ability of several signs combined, and large prospective studies are needed to improve the quality of prenatal counseling and the neonatal care for this condition.

Tratamiento de una bifurcación vertebral-subclavia. «La técnica del anillo de bodas» para una reestenosis intrastent asociada a fractura del stent

This report describes a solution for a restenosis and for the fracture of a stent in the vertebral artery in a patient suffering from vertebrobasilar symptoms. Angiography demonstrates restenosis of a vertebral stent as well as its fracture and migration into the subclavian artery. This complication was managed percutaneously by passing a guide wire through the fractured stent. Pre-dilatation and kissing balloon techniques were applied in both the vertebral and subclavian arteries to modify the stent's dimensions and shape it into the form of a "ring." Postprocedural angiography demonstrated an excellent final result with the assistance of StentBoost visualization. Control angiography at six months also utilized StentBoost imaging and confirmed the patency of the bifurcation and that the stent was not displaced.

Ventricularisation of the left atrium: a rare cause of left ventricular dysfunction in a patient with mitral valve prolapse

Case: A 11 yo girl with Marfan syndrome was referred to cardiac MR (CMR) to measure the size of her thoracic aorta. She had a typical phenotype with arachnodactyly, abnormally long arms, and was tall and slim (156 cm, 28 kg, body mass index 11,5 kg/m2). She complained of no symptoms. Cardiac auscultation revealed a prominent mid-systolic click and an end-systolic murmur at the apex. A recent echocardiogram showed a moderately dilated left ventricle with normal function and a mitral valve prolapse with moderate mitral valve regurgitation. CMR showed a dilatation of the aortic root (38 mm, Z-score 8.9) and a severe prolapse of the mitral valve with regurgitation. The ventricular cavity was moderately dilated (116 ml/m2) and its contraction was hyperdynamic (stroke volume (SV): 97 ml; LVEF 72%, with the LV volumes measured by modified Simpson method from the apex to the mitral annulus). In this patient however, the mitral prolapse was characterized by a severe backward movement of the valve toward the left atrium (LA) in systole and the dyskinetic movement of the atrioventricular plane caused a ventricularisation of a part of the LA in systole (Figure). This resulted in a significant reduction of LVEF: more than ¼ of the apparent SV was displaced backwards into the ventricularized LA volume, reducing the effective LVEF to 51% (effective SV 69ml). Moreover, by flow measurement, the SV across the ascending aorta was 30 ml (cardiac index 2.0 l/min/m2) allowing the calculation of a regurgitant fraction across the mitral valve of 56%, which was diagnostic for a severe mitral valve insufficiency. Conclusion: This case illustrates the phenomenon of a ventricularisation of the LA where the severe prolapse gives the illusion of a higher attachement of the mitral leaflets within the atrial wall. Besides the severe mitral regurgitation, this paradoxical backwards movement of the valve causes an intraventricular unloading during systole reducing the apparent LVEF of 72% to an effective LVEF of only 51%. In addition, forward flow fraction is only 22% after accounting for the regurgitant volume, as well. This combined involvement of the mitral valve could explain the discrepancy between a low output state and an apparently hyperdynamic LV contraction. Due to its ability to precisely measure flows and volumes, CMR is particularly suited to detect this phenomenon and to quantify its impact on the LV pump function.

Aortic root morphology: a paradigm for successful reconstruction.

Aortic root (AoR) components provide synchronous and precise 3D deformation of the aortic root during the cardiac cycle in order to ensure closure and opening of the three leaflets over a lifetime. Any deviation from the natural 3D morphology, such as with AoR annulus dilatation, enlarged sinuses and/or dilatation of the sinotubular junction, as in the case of ascending aortic dilatation, may result in disruption of the natural AoR function. Surgical treatment of AoR pathology has two modalities: the replacement of the aortic valve by artificial prosthesis or by preservation of the three leaflets and reconstruction of the aortic root components. Currently, there are two basic aortic root reconstruction procedures: aortic root sparing and aortic valve reimplantation techniques. Regardless of the technique used, the restoration of adequate cusp coaptation, is from a technical point of view, the most important element to consider. To achieve this, there are two requirements that need to be met: (i) the valve coaptation should be superior to the level of the aortic root base by at least 8 mm and (ii) the coaptation height per se has to be ≥5 mm. Successful restoration of the aortic root requires adequate technical skills, detailed knowledge of aortic root anatomy and topography, and also knowledge of the spatial pattern of AoR elements. Recently, there has been growing interest in aortic root reconstructive procedures as well their modifications. As such, the aim of this review is to analyse aortic root topography and 3D anatomy from a surgical point of view. The review also focuses on potential risk regions that one should be aware of before the surgical journey into the 'deep waters area' of the AoR begins.

Implementació d’un sistema SCADA a la cèl·lula de fabricació flexible MPS+2000C

L’Escola Politècnica Superior de la Universitat de Vic disposa d’una cèl·lula de fabricació flexible del fabricant Festo, que simula un procés d’emmagatzematge automàtic, aquesta cèl·lula esta composta per quatre estacions de muntatge diferenciades i independents, l’estació palets, l’estació plaques, l’estació magatzem intermedi i l’estació transport. Cada una d’aquestes estacions està formada per sensors i actuadors elèctrics i pneumàtics del fabricant Festo que van connectats a un PLC SIEMENS S7-300.Els quatre PLC’s (un per cada estació) estan connectats entre ells mitjançant el bus de comunicacions industrials Profibus. L’objectiu d’aquest treball consisteix en l’adaptació de la programació dels PLC’s i la realització d’un SCADA per tal de controlar el funcionament del conjunt de la cèl·lula de fabricació a través del software Vijeo Citect, d’aquesta manera es coneixerà el funcionament de la cèl·lula i permetrà treure’n rendiment per la docència. Aquest projecte ha estat realitzat en quatre fases principals. 1. Estudi i coneixement de les estacions, en aquesta fase s’han estudiat els manuals de funcionament de les estacions i s’han interpretat els codis de programació dels seus PLCs, amb l’objectiu de conèixer bé el programa per tal de interaccionar-hi més endavant amb el sistema SCADA 2. Disseny i programació del sistema SCADA, en aquesta fase s’ha realitzat tot el disseny gràfic de les pantalles de la interfície SCADA així com la programació dels objectes, la connexió amb els PLCs i la base de dades. 3. Posada en marxa del sistema complert, quan es coneixia abastament el funcionament de les estacions i el sistema SCADA estava completat s’ha fet la posada en marxa del conjunt i s’ha comprovat el correcte funcionament i interacció dels sistemes. 4. Realització de la memòria del projecte, en aquesta ultima fase s’ha realitzat la memòria del projecte on s’expliquen les característiques i funcionament de totes les estacions i del sistema SCADA. La conclusió més rellevant obtinguda en aquest treball, és la clara visualització de la potència i simplicitat que han aportat els sistemes SCADA al món de l’automatització, anys enrere per la supervisió de l’estat d’un sistema automatitzat era necessari disposar d’un gran espai amb grans panells de control formats per una gran quantitat de pilots lluminosos, potenciòmetres, interruptors, polsadors, displays i sobretot un voluminós i complexa cablejat, gràcies als sistemes SCADA avui en dia tot això pot quedar reduït a un PC o terminal tàctil, amb pantalles gràfiques clares i una gran quantitat d’opcions de supervisió control i configuració del sistema automatitzat.

Improving coronary artery bypass graft durability: use of the external saphenous vein graft support.

Coronary bypass grafting remains the best option for patients suffering from multivessel coronary artery disease, and the saphenous vein is used as an additional conduit for multiple complete revascularizations. However, the long-term vein graft durability is poor, with almost 75% of occluded grafts after 10 years. To improve the durability, the concept of an external supportive structure was successfully developed during the last years: the eSVS Mesh device (Kips Bay Medical) is an external support for vein graft made of weft-knitted nitinol wire into a tubular form with an approximate length of 24 cm and available in three diameters (3.5, 4.0 and 4.5 mm). The device is placed over the outer wall of the vein and carefully deployed to cover the full length of the graft. The mesh is flexible for full adaptability to the heart anatomy and is intended to prevent kinking and dilatation of the vein in addition to suppressing the intima hyperplasia induced by the systemic blood pressure. The device is designed to reduce the vein diameter of about 15-20% at most to prevent the vein radial expansion induced by the arterial blood pressure, and the intima hyperplasia leading to the graft failure. We describe the surgical technique for preparing the vein graft with the external saphenous vein graft support (eSVS Mesh) and we share our preliminary clinical results.

Portal cholangiopathy: case report

The present report describes the case of a child that after blunt abdominal trauma presented with portal thrombosis followed by progressive splenomegaly and jaundice. Ultrasonography and percutaneous cholangiography revealed biliary dilatation secondary to choledochal stenosis caused by dilated peribiliary veins, characterizing a case of portal biliopathy. The present case report is aimed at presenting an uncommon cause of this condition.

Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy

AbstractObjective:Longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes.Materials and Methods:Twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum.Results:Findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients.Conclusion:Alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant.

Détermination du coût direct lors d'une procédure de cathétérisation d'une angioplastie avec ou sans pose de stent au CHUV

Cette étude consiste à comparer les coûts de deux procédures de dilatation artérielle coronaire (angioplastie par ballonet et angioplastie avec pose de stent) uniquement lors de la phase de cathérisation (et non pas de l'ensemble des coûts du séjour hospitalier). La première partie traite de l'importance de la maladie coronarienne, de ses traitements et des objectifs de l'étude. La deuxième partie explique les éléments et la méthode qui composent le calcul des coûts, illustre les résultats et compare les résultats des deux procédures. La troisième partie analyse les résultats en identifiant quels types de coûts sont à l'origine de la différence du coût total et en explicitant les limites et les compléments nécessaires à l'étude.

Emprego de nebulizador pneumático de ICP-MS como câmara de diluição em sistemas de injeção em fluxo para determinações multielementares

An automatic dispenser based on a flow-injection system used to introduce sample and analytical solution into an inductively coupled plasma mass spectrometer through a spray chamber is proposed. Analytical curves were constructed after the injection of 20 to 750 µL aliquots of a multielement standard solution (20.0 µg L-1 in Li, Be, Al, V, Cr, Mn, Ni, Co, Cu, Zn, As, Se, Sr, Ag, Cd, Ba, Tl, Pb) and the acquisition of the integrated transient signals. The linear concentration range could be extended to ca. five decades. The performance of the system was checked by analyzing a NIST 1643d reference material. Accuracy could be improved by the proper selection of the injected volume. Besides good precision (r.s.d. < 2%), the results obtained with the proposed procedure were closer to the certified values of the reference material than those obtained by direct aspiration or by injecting 125 µL of several analytical solutions and samples.

Combinación de sistemas de flujo de baja y alta presion para la determinacion de Mg, Ca y Sr en salmueras por espectrofotometria de absorcion atomica con llama

This article describes the combination of low- and high-pressure flow systems for the determination of Magnesium, Calcium and Strontium by flame atomic absorption spectrometry (FAAS). In the low-pressure system a short C-18 RP column (length 0,5 cm) was utilized for the preconcentration/matrix separation step, xylenol orange was used as chelating agent and tetrabutylamonium acetate for ion pair formation. The hydraulic high pressure nebulization (HHPN) was used for sample transport and sample introduction in the high pressure system. The repeatabilities and detection limits for Mg, Ca and Sr were determined and compared with those obtained by pneumatic nebulization (PN). The results show that the detection limits obtained using the HHPN for Mg, Ca and Sr are between 1.5 to 2 times better than those obtained by PN when the signal transient was measured in area. The system presented a sampling frequency of 130 h-1 for direct determination of Mg, Ca or Sr in samples of saturated sodium chloride used in the production of chlorine and sodium hydroxide.

Propulsor pneumático versátil e isento de pulsação para sistemas de análise em fluxo

Aquarium air pumps are proposed and evaluated as pneumatic liquid propulsion devices for flow injection and continuos flow analysis (FIA and CFA) systems. This kind of pump is widely available at a very low cost and it can sustain a pressure around of 4 psi (0.28 bar) indefinitely. By applying this air pressure onto a solution contained in a reservoir flask, it is possible to reach flow rates of up to 12.5 mL min-1 for circuits comprising reactors, made from 0.8 i.d. tubing with a length of 100 cm. The precise adjustment of flow rate below the maximum one can be made with a simplified needle valve or inserting in series a short length of capillary tube. The absence of flow pulsation is a definite advantage in comparison with peristaltic pumps, especially when amperometric detection is elected, as confirmed experimentally in FIA and CF applications.

Bile duct stones, strictures and iatrogenic lesions: studies on early diagnosis and treatment.

Aims: This study was carried out to investigate the role of common liver function tests, and the degree of common bile duct dilatation in the differential diagnosis of extrahepatic cholestasis, as well as the occurrence, diagnosis and treatment of iatrogenic bile duct injuries. In bile duct injuries, special attention was paid to gender and severity distribution and long-term results. Patients and methods: All consecutive patients with diagnosed common bile duct stones or malignant strictures in ERCP between August 2000 and November 2003. Common liver function tests were measured in the morning before ERCP on all of these 212 patients, and their common bile duct diameter was measured from ERCP films. Between January 1995 and April 2002, 3736 laparoscopic cholecystectomies were performed and a total of 32 bile duct injuries were diagnosed. All pre-, per-, and postoperative data were collected retrospectively; and the patients were also interviewed by phone. Results: Plasma bilirubin proved to be the best discriminator between CBD stones and malignant strictures (p≤0.001 compared to other liver function tests and degree of common bile duct dilatation). The same effect was seen in Receiver Operating Characteristics curves (AUC 0.867). With a plasma bilirubin cut-off value of 145 μmol/l, four out of five patients could be classified correctly. The degree of common bile duct dilatation proved to be worthless in differential diagnostics. After laparoscopic cholecystectomy the total risk for bile duct injury was 0.86%, including cystic duct leaks. 86% of severe injuries and 88% of injuries requiring operative treatment were diagnosed in females. All the cystic duct leakages and 87% of the strictures were treated endoscopically. Good long-term results were seen in 84% of the whole study population. Conclusions: Plasma bilirubin is the most effective liver function test in differential diagnosis between CBD stones and malignant strictures. The only value of common bile duct dilatation is its ability to verify the presence of extrahepatic cholestasis. Female gender was associated with higher number of iatrogenic bile duct injuries, and in particular, most of the major complications occur in females. Most of the cystic duct leaks and common bile duct strictures can be treated endoscopically. The long-term results in our institution are at an internationally acceptable level.