Super especialização na cirurgia geral : problema ou solução?

A cirurgia geral atualmente é considerada, por alguns, como uma especialidade cansativa, desinteressante. Acredita-se que o aparecimento de novas tecnologias, a internet, a videocirurgia, a robótica, a telemedicina, a especialização e o desinteresse, dos recém formados, pela cirurgia geral são fatores que contribuem para esta mudança. Neste artigo são discutidas as mudanças no exercício da cirurgia geral que ocorrem no Brasil, no mundo, as suas consequencias na formação do Cirurgião Geral e o reflexo no atendimento à população.

Development of racemization catalysts for dynamic kinetic resolution

Preparation of optically active compounds is of high importance in modern medicinal chemistry. Despite recent advances in the field of asymmetric synthesis, resolution of racemates still remains the most utilized way for preparation of single enantiomers in industrial scale due to its cost-efficiency and simplicity. Enzymatic kinetic resolution (KR) of racemates is a classical method for separation of enantiomers. One of its drawbacks is the limitation of target enantiomer yield to 50%. Dynamic Kinetic Resolution (DKR) allows to reach yields up to 100% by in situ racemization of the less reactive enantiomer. In the first part of this thesis, a number of half-sandwich ruthenium complexes were prepared and evaluated as catalysts for racemization of optically active secondary alcohols. A leading catalyst, Bn5CpRu(CO)2Cl, was identified. The catalyst discovered was extensively characterized by its application for DKR of a broad range of secondary alcohols in a wide range of reaction loadings (1 mmol – 1 mol). Cost-efficient chromatography-free procedure for preparation of this catalyst was developed. Further, detailed kinetic and mechanistic studies of the racemization reactions were performed. Comparison of racemization rates in the presence of Bn5CpRu(CO)2Cl and Ph5CpRu(CO)2Cl catalysts reveals that the performance of the catalytic system can be adjusted by matching of the electronic properties of the catalysts and the substrates. Moreover, dependence of the rate-limiting step from the electronic properties of the reagents was observed. Important conclusions about reaction mechanism were made. Finally, an alternative approach to DKR of amines based on space separated vessels was addressed. This procedure allows the combination of thermolabile enzyme with racemization catalysts active only at high temperatures.

Ohjekirja Essex Super Six

kuv., 14 x 22 cm

Packard Super 8 ja "12" 1939

kuv., 14 x 21 cm

Packard Super 8 och "12" 1939

kuv., 14 x 21 cm

Hudson Super Six

kuv., 19 x 25 cm

1939 Chevrolet Super De Luxe ja Imperial voiteluohjeita

kuv., 18 x 12 cm

“THE PATIENT SURVIVED DESPITE THE TREATMENT”. A study of Finnish health policy and New Public Management. Case: The Government Resolution on the Health 2015 public health programme.

Internationally, Finland has been among the most respected countries during several decades in terms of public health. WHO has had the most significant influence on Finnish health policy and the relationship has traditionally been warm. However, the situation has slightly changed in the last 10-20 years. The objectives of Finnish national health policy have been to secure the best possible health for the population and to minimize disparities in health between different population groups. Nevertheless, although the state of public health and welfare has steadily improved, the socioeconomic disparities in health have increased. This qualitative case study will demonstrate why health is political and why health matters. It will also present some recommendations for research topics and administrative reforms. It will be argued that lack of political interest in health policy leads to absence of health policy visions and political commitment, which can be disastrous for public health. This study will investigate how Finnish health policy is defined and organised, and it will also shed light on Finnish health policy formation processes and actors. Health policy is understood as a broader societal construct covering the domains of different ministries, not just Ministry of Social Affairs and Health (MSAH). The influences of economic recession of the 1990s, state subsidy reform in 1993, globalisation and the European Union will be addressed, as well. There is not much earlier Finnish research done on health policy from political science viewpoint. Therefore, this study is interdisciplinary and combines political science with administrative science, contemporary history and health policy research with a hint of epidemiology. As a method, literature review, semi-structured interviews and policy analysi will be utilised. Institutionalism, policy transfer, and corporatism are understood as the theoretical framework. According to the study, there are two health policies in Finland: the official health policy and health policy generated by industry, media and various interest organisations. The complex relationships between the Government and municipalities, and on the other hand, the MSAH and National Institute for Health and Welfare (THL) seemed significant in terms of Finnish health policy coordination. The study also showed that the Investigated case, Health 2015, does not fulfil all necessary criteria for a successful public health programme. There were also several features both in Health 2015 and Finnish health policy, which can be interpreted in NPM framework and seen having NPM influences.

Mechanisms in anti-inflammation and resolution: the role of lipoxins and aspirin-triggered lipoxins

Multicellular host responses to infection, injury or inflammatory stimuli lead to the formation of a broad range of chemical mediators by the host. The integrated response of the host is essential to health and disease; thus it is important to achieve a more complete understanding of the molecular and cellular events governing the formation and actions of endogenous mediators of resolution that appear to control the duration of inflammation. Lipoxins are trihydroxytetraene-containing lipid mediators that can be formed during cell-cell interactions and are predominantly counterregulators of some well-known mediators of inflammation. Since this circuit of lipoxin formation and action appears to be of physiological relevance for the resolution of inflammation, therapeutic modalities targeted at this system are likely to have fewer unwanted side effects than other candidates and current anti-inflammatory therapies. Here, we present an overview of the recent knowledge about the biosynthesis and bioactions of these anti-inflammatory lipid mediators.

Modelling the super-equilibria in thermal biomass conversion : applications and limitations of the constrained free energy method

Bioenergi ses som en viktig del av det nu- och framtida sortimentet av inhemsk energi. Svartlut, bark och skogsavfall täcker mer än en femtedel av den inhemska energianvändningen. Produktionsanläggningar kan fungera ofullständigt och en mängd gas-, partikelutsläpp och tjära produceras samtidigt och kan leda till beläggningsbildning och korrosion. Orsaken till dessa problem är ofta obalans i processen: vissa föreningar anrikas i processen och superjämviktstillstånd är bildas. I denna doktorsavhandling presenteras en ny beräkningsmetod, med vilken man kan beskriva superjämviktstillståndet, de viktigaste kemiska reaktionerna, processens värmeproduktion och tillståndsstorheter samtidigt. Beräkningsmetoden grundar sig på en unik frienergimetod med bivillkor som har utvecklats vid VTT. Den här så kallade CFE-metoden har tidigare utnyttjats i pappers-, metall- och kemiindustrin. Applikationer för bioenergi, vilka är demonstrerade i doktorsavhandlingen, är ett nytt användingsområde för metoden. Studien visade att beräkningsmetoden är väl lämpad för högtemperaturenergiprocesser. Superjämviktstillstånden kan uppstå i dessa processer och det kemiska systemet kan definieras med några bivillkor. Typiska tillämpningar är förbränning av biomassa och svartlut, förgasning av biomassa och uppkomsten av kväveoxider. Också olika sätt att definiera superjämviktstillstånd presenterades i doktorsavhandlingen: empiriska konstanter, empiriska hastighetsuttryck eller reaktionsmekanismer kan användas. Resultaten av doktorsavhandlingen kan utnyttjas i framtiden i processplaneringen och i undersökning av nya tekniska lösningar för förgasning, förbränningsteknik och biobränslen. Den presenterade metoden är ett bra alternativ till de traditionella mekanistiska och fenomenmodeller och kombinerar de bästa delarna av både. --------------------------------------------------------------- Bioenergia on tärkeä osa nykyistä ja tulevaa kotimaista energiapalettia. Mustalipeä, kuori ja metsätähteet kattavat yli viidenneksen kotimaisesta energian kulutuksesta. Tuotantolaitokset eivät kuitenkaan aina toimi täydellisesti ja niiden prosesseissa syntyy erilaisia kaasu- ja hiukkaspäästöjä, tervoja sekä prosessilaitteita kuluttavia saostumia ja ruostumista. Usein syy näihin ongelmiin on prosessissa esiintyvä epätasapainotila: tietyt yhdisteet rikastuvat prosessissa ja muodostavat supertasapainotiloja. Väitöstyössä kehitettiin uusi laskentamenetelmä, jolla voidaan kuvata nämä supertasapainotilat, tärkeimmät niihin liittyvät kemialliset reaktiot, prosessin lämmöntuotanto ja tilansuureet yhtä aikaa. Laskentamenetelmä perustuu VTT:llä kehitettyyn ainutlaatuiseen rajoitettuun vapaaenergiamenetelmään. Tätä niin kutsuttua CFE-menetelmää on aiemmin sovelluttu onnistuneesti muun muassa paperi-, metalli- ja kemianteollisuudessa. Väitöstyössä esitetyt bioenergiasovellukset ovat uusi sovellusalue menetelmälle. Työ osoitti laskentatavan soveltuvan hyvin korkealämpöisiin energiatekniikan prosesseihin, joissa kemiallista systeemiä rajoittavia tekijöitä oli rajallinen määrä ja siten super-tasapainotila saattoi muodostua prosessin aikana. Tyypillisiä sovelluskohteita ovat biomassan ja mustalipeän poltto, biomassan kaasutus ja typpioksidipäästöt. Työn aikana arvioitiin myös erilaisia tapoja määritellä super-tasapainojen muodostumista rajoittavat tekijät. Rajoitukset voitiin tehdä teollisiin mittauksiin pohjautuen, kokeellisia malleja hyödyntäen tai mekanistiseen reaktiokinetiikkaan perustuen. Tulevaisuudessa väitöstyön tuloksia voidaan hyödyntää prosessisuunnittelussa ja tutkittaessa uusia teknisiä ratkaisuja kaasutus- ja polttotekniikoissa sekä biopolttoaineiden tutkimuksessa. Kehitetty menetelmä tarjoaa hyvän vaihtoehdon perinteisille mekanistisille ja ilmiömalleille yhdistäen näiden parhaita puolia.

Methodological approaches to planar and volumetric scintigraphic imaging of small volume targets with high spatial resolution and sensitivity

Single-photon emission computed tomography (SPECT) is a non-invasive imaging technique, which provides information reporting the functional states of tissues. SPECT imaging has been used as a diagnostic tool in several human disorders and can be used in animal models of diseases for physiopathological, genomic and drug discovery studies. However, most of the experimental models used in research involve rodents, which are at least one order of magnitude smaller in linear dimensions than man. Consequently, images of targets obtained with conventional gamma-cameras and collimators have poor spatial resolution and statistical quality. We review the methodological approaches developed in recent years in order to obtain images of small targets with good spatial resolution and sensitivity. Multipinhole, coded mask- and slit-based collimators are presented as alternative approaches to improve image quality. In combination with appropriate decoding algorithms, these collimators permit a significant reduction of the time needed to register the projections used to make 3-D representations of the volumetric distribution of target’s radiotracers. Simultaneously, they can be used to minimize artifacts and blurring arising when single pinhole collimators are used. Representation images are presented, which illustrate the use of these collimators. We also comment on the use of coded masks to attain tomographic resolution with a single projection, as discussed by some investigators since their introduction to obtain near-field images. We conclude this review by showing that the use of appropriate hardware and software tools adapted to conventional gamma-cameras can be of great help in obtaining relevant functional information in experiments using small animals.

Super dialogo Platonis, qui Protagoras inscribitur 1

Painovuosi nimekkeestä.

Super dialogo Platonis, qui Protagoras inscribitur 2

Painovuosi nimekkeestä.

A clinical gamma camera-based pinhole collimated system for high resolution small animal SPECT imaging

The main objective of the present study was to upgrade a clinical gamma camera to obtain high resolution tomographic images of small animal organs. The system is based on a clinical gamma camera to which we have adapted a special-purpose pinhole collimator and a device for positioning and rotating the target based on a computer-controlled step motor. We developed a software tool to reconstruct the target’s three-dimensional distribution of emission from a set of planar projections, based on the maximum likelihood algorithm. We present details on the hardware and software implementation. We imaged phantoms and heart and kidneys of rats. When using pinhole collimators, the spatial resolution and sensitivity of the imaging system depend on parameters such as the detector-to-collimator and detector-to-target distances and pinhole diameter. In this study, we reached an object voxel size of 0.6 mm and spatial resolution better than 2.4 and 1.7 mm full width at half maximum when 1.5- and 1.0-mm diameter pinholes were used, respectively. Appropriate sensitivity to study the target of interest was attained in both cases. Additionally, we show that as few as 12 projections are sufficient to attain good quality reconstructions, a result that implies a significant reduction of acquisition time and opens the possibility for radiotracer dynamic studies. In conclusion, a high resolution single photon emission computed tomography (SPECT) system was developed using a commercial clinical gamma camera, allowing the acquisition of detailed volumetric images of small animal organs. This type of system has important implications for research areas such as Cardiology, Neurology or Oncology.

Classification of brain tumor extracts by high resolution ¹H MRS using partial least squares discriminant analysis

High resolution proton nuclear magnetic resonance spectroscopy (¹H MRS) can be used to detect biochemical changes in vitro caused by distinct pathologies. It can reveal distinct metabolic profiles of brain tumors although the accurate analysis and classification of different spectra remains a challenge. In this study, the pattern recognition method partial least squares discriminant analysis (PLS-DA) was used to classify 11.7 T ¹H MRS spectra of brain tissue extracts from patients with brain tumors into four classes (high-grade neuroglial, low-grade neuroglial, non-neuroglial, and metastasis) and a group of control brain tissue. PLS-DA revealed 9 metabolites as the most important in group differentiation: γ-aminobutyric acid, acetoacetate, alanine, creatine, glutamate/glutamine, glycine, myo-inositol, N-acetylaspartate, and choline compounds. Leave-one-out cross-validation showed that PLS-DA was efficient in group characterization. The metabolic patterns detected can be explained on the basis of previous multimodal studies of tumor metabolism and are consistent with neoplastic cell abnormalities possibly related to high turnover, resistance to apoptosis, osmotic stress and tumor tendency to use alternative energetic pathways such as glycolysis and ketogenesis.