Analysis of flow dynamics in right ventricular outflow tract.

BACKGROUND: The mechanism behind early graft failure after right ventricular outflow tract (RVOT) reconstruction is not fully understood. Our aim was to establish a three-dimensional computational fluid dynamics (CFD) model of RVOT to investigate the hemodynamic conditions that may trigger the development of intimal hyperplasia and arteriosclerosis. METHODS: Pressure, flow, and diameter at the RVOT, pulmonary artery (PA), bifurcation of the PA, and left and right PAs were measured in 10 normal pigs with a mean weight of 24.8 ± 0.78 kg. Data obtained from the experimental scenario were used for CFD simulation of pressure, flow, and shear stress profile from the RVOT to the left and right PAs. RESULTS: Using experimental data, a CFD model was obtained for 2.0 and 2.5-L/min pulsatile inflow profiles. In both velocity profiles, time and space averaged in the low-shear stress profile range from 0-6.0 Pa at the pulmonary trunk, its bifurcation, and at the openings of both PAs. These low-shear stress areas were accompanied to high-pressure regions 14.0-20.0 mm Hg (1866.2-2666 Pa). Flow analysis revealed a turbulent flow at the PA bifurcation and ostia of both PAs. CONCLUSIONS: Identified local low-shear stress, high pressure, and turbulent flow correspond to a well-defined trigger pattern for the development of intimal hyperplasia and arteriosclerosis. As such, this real-time three-dimensional CFD model may in the future serve as a tool for the planning of RVOT reconstruction, its analysis, and prediction of outcome.

Congenital tracheal anomalies.

Congenital tracheal lesions are rare, but important, causes of morbidity in infants and children. Consequently, experience in their management is limited and dispersed. Given its small diameter, the juvenile trachea is obstructed easily by various natural causes, or following a surgical intervention. The diagnosis of a congenital, tracheal, obstructive anomaly is based on a high degree of suspicion in infants and children with respiratory distress accompanied by retraction. In this article, the authors discuss the various causes of these conditions, their diagnostic features, and the treatment possibilities.

Continuing Medical Education Self-Assessment Questions Vol. 50, No. 1 - January 2014. Actual evidence in the medical approach to adolescents with idiopathic scoliosis

Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and trunk. The most common form involve ado- lescents (AIS). The prevalence for AIS is 2-3% of the population, with 1 out of 6 patients requiring treatment of which 25% progress to surgery. Physical and rehabilitation medicine (PRM) plays a primary role in the so-called conservative treatment of adolescents with AIS, since all the therapeutic tools used (exercises and braces) fall into the PRM domain. According to a Cochrane systematic review there is evidence in favor of bracing, even if it is of low quality. Another shows that there is evidence in favor of exercises as an adjunctive treatment, but of low quality. Three meta-analysis have been published on bracing: one shows that bracing does not reduce surgery rates, but studies with bracing plus exercises were not included and had the highest effectiveness; another shows that full time is better than part-time bracing; the last focuses on observational studies following the SRS criteria and shows that not all full time rigid bracing are the same: some have the highest effectiveness, others have less than elastic and nighttime bracing. Two very important RCTs failed in recruitment, showing that in the field of bracing for scoliosis RCTs are not accepted by the patients. Consensuses by the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) show that there is no agree- ment among experts either on the best braces or on their biomechanical action, and that compliance is a matter of clinical more than patients' behavior (there is strong agreement on the management criteria to achieve best results with bracing). A systematic review of all the existing studies shows effectiveness of exercises, and that auto-correction is the main goal of exercises. A systematic review shows that there are no studies on manual treatment. Research on conservative treat- ment of AIS has continuously decreased since the 1980s, but this trend changed only recently. The SOSORT Guidelines offers the actual standard of conservative care.

Pulmonary valve stenosis due to undifferentiated pleomorphic sarcoma

Pulmonary artery sarcomas are uncommon intracardiac tumours with poor prognosis. We report the case of a 69-year-old woman in good health presenting with rapidly progressive dyspnoea and an unfamiliar systolic murmur. Echocardiography revealed pulmonary valve stenosis due to an obstructing mobile mass. Imaging studies confirmed the presence of a contrast-enhancing lesion adherent to the valve, extending into the pulmonary trunk and right ventricular outflow tract, and suggestive of malignancy. Endovascular biopsy was attempted with no success. Surgical resection with autologous graft valve replacement and pulmonary artery reconstruction was performed. Postoperative histological examination confirmed the diagnosis of an undifferentiated pleomorphic sarcoma. Pulmonary artery sarcoma should be considered as a rare differential diagnosis in patients presenting with dyspnoea and a crescendo-decrescendo systolic murmur increasing with inspiration. Echocardiography is a useful first diagnostic approach but multi-imaging assessment is almost always necessary for definite diagnosis. Our case provides insights into the challenges met by cardiologists, radiologists and cardiac surgeons in the management of such cases.

Celiac plexus block: an anatomical study and simulation using computed tomography

Objective: To analyze anatomical variations associated with celiac plexus complex by means of computed tomography simulation, assessing the risk for organ injury as the transcrural technique is utilized. Materials and Methods: One hundred eight transaxial computed tomography images of abdomen were analyzed. The aortic-vertebral, celiac trunk (CeT)-vertebral, CeT-aortic and celiac-aortic-vertebral topographical relationships were recorded. Two needle insertion pathways were drawn on each of the images, at right and left, 9 cm and 4.5 cm away from the midline. Transfixed vital organs and gender-related associations were recorded. Results: Aortic-vertebral - 45.37% at left and 54.62% in the middle; CeT-vertebral - T12, 36.11%; T12-L1, 32.4%; L1, 27.77%; T11-T12, 2.77%; CeT-aortic - 53.7% at left and 46.3% in the middle; celiac-aortic-vertebral - L-l, 22.22%; M-m, 23.15%; L-m, 31.48%; M-l, 23.15%. Neither correspondence on the right side nor significant gender-related associations were observed. Conclusion: Considering the wide range of abdominal anatomical variations and the characteristics of needle insertion pathways, celiac plexus block should not be standardized. Imaging should be performed prior to the procedure in order to reduce the risks for injuries or for negative outcomes to patients. Gender-related anatomical variations involved in celiac plexus block should be more deeply investigated, since few studies have addressed the subject.

The "Abdominal Circulatory Pump": An Auxiliary Heart during Exercise?

Apart from its role as a flow generator for ventilation the diaphragm has a circulatory role. The cyclical abdominal pressure variations from its contractions cause swings in venous return from the splanchnic venous circulation. During exercise the action of the abdominal muscles may enhance this circulatory function of the diaphragm. Eleven healthy subjects (25 ± 7 year, 70 ± 11 kg, 1.78 ± 0.1 m, 3 F) performed plantar flexion exercise at ~4 METs. Changes in body volume (ΔVb) and trunk volume (ΔVtr) were measured simultaneously by double body plethysmography. Volume of blood shifts between trunk and extremities (Vbs) was determined non-invasively as ΔVtr-ΔVb. Three types of breathing were studied: spontaneous (SE), rib cage (RCE, voluntary emphasized inspiratory rib cage breathing), and abdominal (ABE, voluntary active abdominal expiration breathing). During SE and RCE blood was displaced from the extremities into the trunk (on average 0.16 ± 0.33 L and 0.48 ± 0.55 L, p < 0.05 SE vs. RCE), while during ABE it was displaced from the trunk to the extremities (0.22 ± 0.20 L p < 0.001, p < 0.05 RCE and SE vs. ABE respectively). At baseline, Vbs swings (maximum to minimum amplitude) were bimodal and averaged 0.13 ± 0.08 L. During exercise, Vbs swings consistently increased (0.42 ± 0.34 L, 0.40 ± 0.26 L, 0.46 ± 0.21 L, for SE, RCE and ABE respectively, all p < 0.01 vs. baseline). It follows that during leg exercise significant bi-directional blood shifting occurs between the trunk and the extremities. The dynamics and partitioning of these blood shifts strongly depend on the relative predominance of the action of the diaphragm, the rib cage and the abdominal muscles. Depending on the partitioning between respiratory muscles for the act of breathing, the distribution of blood between trunk and extremities can vary by up to 1 L. We conclude that during exercise the abdominal muscles and the diaphragm might play a role of an "auxiliary heart."

Pulmonary 64-MDCT angiography with 50 mL of iodinated contrast material in an unselected patient population: a feasible protocol

Abstract Objective: To propose a protocol for pulmonary angiography using 64-slice multidetector computed tomography (64-MDCT) with 50 mL of iodinated contrast material, in an unselected patient population, as well as to evaluate vascular enhancement and image quality. Materials and Methods: We evaluated 29 patients (22-86 years of age). The body mass index ranged from 19.0 kg/m2 to 41.8 kg/m2. Patients underwent pulmonary CT angiography in a 64-MDCT scanner, receiving 50 mL of iodinated contrast material via venous access at a rate of 4.5 mL/s. Bolus tracking was applied in the superior vena cava. Two experienced radiologists assessed image quality and vascular enhancement. Results: The mean density was 382 Hounsfield units (HU) for the pulmonary trunk; 379 and 377 HU for the right and left main pulmonary arteries, respectively; and 346 and 364 HU for the right and left inferior pulmonary arteries, respectively. In all patients, subsegmental arteries were analyzed. There were streak artifacts from contrast material in the superior vena cava in all patients. However, those artifacts did not impair the image analysis. Conclusion: Our findings suggest that pulmonary angiography using 64-MDCT with 50 mL of iodinated contrast can produce high quality images in unselected patient populations.

Controle de autenticidade de óleos de copaíba comerciais por cromatografia gasosa de alta resolução

Copaiba oil is a resin extracted from the trunk of trees of Copaifera species which grow in Brazil where it is widely used in popular medicine as an anti-inflammatory, antiseptic anti-bactericidal, diuretic, dermatological, expectorant, and anti-infective. The comparative study of the composition of commercial copaiba oils was carried out by high resolution gas chromatography (HRGC) and high resolution gas chromatography-mass spectrometry (HRGC-MS) analysis. The commercial oils were compared with authentic oils, collected from the southeast and northern regions of Brazil. Sixteen commercial oils were analysed and two of them revealed adulterations with fatty acids. Using the chromatographic profile of authentic copaiba species oils, it is possible to analyse commercial oils and determine the authenticity of these materials.

Metabólitos secundários de Protium heptaphyllum march

Phytochemical investigation of the resin, fruits, leaves, and trunk of Protium heptaphyllum led to the isolation of the monoterpene p-menth-3-ene-1,2,8-triol, alpha and beta amyrin, quercetin, brein, quercetin-3-O-rhamnosyl, (-) catechin and scopoletin. Their structures were established by 1D and 2D NMR spectroscopy and comparison with published data.

Constituintes químicos da casca do caule de Amburana cearensis A.C. Smith

The phytochemical analysis of the ethanol extract trunk bark of Amburana cearensis allowed the isolation and identification of twelve constituents: coumarin, sucrose, two phenol acids (vanillic acid and protocatechuic acid), five flavonoids (afrormosin, isokaempferide, kaempferol, quercetin and 4'-methoxy-fisetin), a phenol glucoside (amburoside A) and a mixture of glucosilated b-sitosterol and stigmasterol. Their structures were elucidated by spectroscopic methods such as IR, MS, ¹H and 13C NMR, including uni and bidimensional techniques, in addition to comparison with literature data.

Novos constituintes químicos das cascas do caule de Tabebuia heptaphylla

A new triterpene, 3beta,6beta,21beta-trihydroxyolean-12-ene and a new iridoid, 8alpha-methyl-8beta-hydroxy-6beta-(3',4'-dimethoxy)benzoyloxy-1 alpha,3alpha-dimethoxy-octahydro-cyclopenta[c]pyran were isolated from the trunk bark of a specimen of Tabebuia heptaphylla (Bignoniaceae) collected in the "Pantanal" of Mato Grosso do Sul, Brazil. Twelve known compounds were also obtained in this work, comprising four iridoids, 6-O-p-hydroxybenzoylajugol, 6-O-p-methoxybenzoylajugol, 6-O-3",4"-dimethoxybenzoylajugol, 8alpha-methyl-8beta-hydroxy-6beta-(4'-hydroxy)benzoyloxy-1alpha,3 alpha-dimethoxy-octahydro-cyclopenta[c]pyran, a cyclopentene dialdehyde, 2-formyl-5-(3',4'-dimethoxybenzoyloxy)-3-methyl-2-cyclopentene-1-acetaldehyde, a phenylethanoid glycoside, verbascoside and three benzoic acid derivatives, p-hydroxybenzoic, p-methoxybenzoic and 3,4-dimethoxybenzoic acids, in addition to squalene, sitostenone and sitosterol. The antioxidant properties of the isolated compounds were also evaluated in this work.

Fenilpropanóides e outros constituintes bioativos de Nectandra megapotamica

From the trunk bark of Nectandra megapotamica (Lauraceae) four phenylpropanoids, elemicin, isoelemicin, (±)-erythro-1-(3,4,5-trimethoxyphenyl)-1,2-propanediol and (±)-threo-1-(3,4,5-trimetoxyphenyl)-1,2-propanediol have been isolated, in addition to 3,4,5-trimethoxybenzoic acid, (-)-epicatechin and trans-1(10)-epoxy-4(15)-caryophyllene. The diastereoisomeric erythro- and threo- phenylpropanoids are being reported for the first time in a plant taxon as well as the occurrence of the other compounds in Nectandra. The structures of the isolated compounds have been established on the basis of 1D and 2D NMR spectroscopic techniques. Their in vitro antifungal activities against standard strains of Candida albicans, C. krusei, C. tropicalis and Cryptococcus neoformans and antioxidant properties were also evaluated in this work.

Estudo fitoquímico de espécimens cultivados de cumaru (Amburana cearensis A. C. Smith)

Due to the threat of extinction of Amburana cearensis, a tree of medicinal importance for the Northeastern Brazil, a phytochemical analysis was performed with specimens obtained by seed germination. Ten compounds were isolated and identified by spectroscopic methods and comparison with literature data. p-Hydroxybenzoic acid, ayapin, (E/Z)-melilotosides are being reported for the first time for the genus, besides coumarin, isokaempferide, vanillic acid, protocatechuic acid, amburosides A and B which have already been found in the trunk bark. Based on physical and NMR spectroscopy evidences the structures of several melilotosides already described in the literature have been suggested to be revised.

Eudesmane and rearranged eudesmane sesquiterpenes from Nectandra cissiflora

Four eudesmane-type sesquiterpenes, costic acid (1), 12-carboxyeudesman-3,11(13)-diene (2), viscic acid (3), 3-oxo-γ-costic acid (4) and two rearranged eudesmane derivatives, 3α-hydroxyisoiphion-11(13)-en-12-oic acid (5) and 5β-hydroxy-4-oxo-11(13)-dehydroiphionan-12-oic acid (6), in addition to (-)-epicatechin, have been isolated from the trunk bark of Nectandra cissiflora. This is the first reported occurrence in the Lauraceae of 3-6. The structures of the isolated compounds have been established on the basis of 1D and 2D NMR spectroscopic techniques. The 13C NMR assignments of 3, 5 and 6 are given here for the first time, as well as some corrections to the previously reported chemical shift assignments of 4.

Dry biomass distribution in a cerrado sensu stricto site in Brazil central

The Cerrado has been the main source of firewood and charcoal in Brazil, but despite being one of the hot spots for conservation of the world's biodiversity, neither plantations of native species nor sustainable management has been adopted in the region. The aim of this work was to investigate the biomass distribution and the potential for energy production of the cerrado species. The study was conducted in a cerrado sensu stricto site at the Água Limpa Farm (15º 56'14'' S and 47º 46'08'' W) in the Cerrado Biosphere Reserve. An area of 63.54ha was divided in 20 x 50m plots and, a random sample consisting of ten of these plots, representing 1.56% of the study-site, was assessed. All woody individuals from 5 cm diameter at 30 cm above ground level were identified and measured. Each individual was felled, the twigs thinner than 3cm were discarded while the larger branches and the trunks, both with bark, were weighted separately. After that, 2.5cm transverse sections of the trunk with bark were taken at 0, 25, 50, 75 and 100% of the length. A similar sample was also taken at the base of each branch. A total of 47 species in 35 genera and 24 families were found, with an average density of 673 individuals per ha. The diameter distribution showed a reversed-J shape with 67% of the individuals up to 13cm, while the maximum diameter was 32.30cm. Seven species represented 72% of the total biomass. In general, the species with higher production per tree were among those with higher production per ha. This content was distributed by diameter classes, reaching a maximum of 2.5ton/ha between 9 to 13cm and then, decreasing to 0.96 ton/ha between 29 to 33cm diameter. Carbon sequestering was 6.2ton/ha (until the actual stage of cerrado) based on an average 50% carbon content in the dry matter. The heat combustion of the wood varied from 18,903kj/kg to 20,888kj/kg with an average of 19,942kj/kg. The smaller diameter classes fix more carbon due to the large number of small plants per ha. But, for a species that reached larger dimensions and contained individuals in all diameter classes, Vochysia thyrsoidea, one can verify an increase in carbon fixation from 1.41 kg/ha in the first class (5 to 9cm) to 138,3kg/ha in the last (25 to 33cm). That indicates that it is possible to select species that reach larger size with a higher capacity of carbon accumulation per plant. The species that reached larger dimensions, with a production per tree above average and had high calorific power values were Dalbergia miscolobium, Pterodon pubescens and Sclerolobium paniculatum. These species have potential for use in fuelwood plantations and sustainable management.