Is Favorable Outcome Possible After Prolonged Refractory Status Epilepticus?

When status epilepticus (SE) remains refractory to appropriate therapy, it is associated with high mortality and with substantial morbidity in survivors. Many outcome predictors such as age, seizure type, level of consciousness before treatment, and mostly, etiology, are well-established. A longer duration of SE is often associated with worse outcome, but duration may lose its prognostic value after several hours. Several terms and definitions have been used to describe prolonged, refractory SE, including "malignant SE," "prolonged" SE, and more recently, "super refractory" SE, defined as "SE that has continued or recurred despite 24 hours of general anesthesia (or coma-inducing anticonvulsants)." There are few data available regarding the outcome of prolonged refractory SE, and even fewer for SE remaining refractory to anesthetic drugs. This article reviews reports of outcome after prolonged, refractory, and "super refractory" SE. Most information detailing the clinical outcome of patients surviving these severe illnesses, in which seizures can persist for days or weeks (and especially those concerning "super-refractory" SE) come from case reports and retrospective cohort studies. In many series, prolonged, refractory SE has a mortality of 30% to 50%, and several studies indicate that most survivors have a substantial decline in functional status. Nevertheless, several reports demonstrate that good functional outcome is possible even after several days of SE and coma induction. Treatment of refractory SE should not be withdrawn from younger patients without structural brain damage at presentation solely because of the duration of SE.

Multicomutação e amostragem binária em análise química em fluxo: determinação espectrofotométrica de ortofosfato em águas naturais

A flow system based on multicommutation and binary sampling process was developed to implement the sample zone trapping technique in order to increase the spectrophotometric analytical range and to improve sensitivity. The flow network was designed with active devices in order to provide facilities to determine sequentialy analyte with a wide concentration range, employing a single pumping channel to propel sample and reagents solutions. The procedure was employed to determine ortophosphate ions in water samples of river and waste. Profitable features such as an analytical throughput of 60 samples determination per hour, relative standard deviation (r.s.d.) of 2% (n = 6) for a typical sample with concentration of 2.78 mg/L were achieved. By applying the paired t-test no significant difference at 95% confidence level was observed between the results obtained with the proposed system and those of the usual flow injection system.

Eletrodissolução de ligas de latão empregando sistemas de análise em fluxo para a determinação de cobre, zinco e chumbo por ICP-AES

An on-line electrodissolution procedure implemented in a flow injection system for determination of copper, zinc and lead in brasses alloys by ICP-AES is described. Sample dissolution procedure was carried out by using a PTFE chamber and a DC power supply with constant current. Solid sample was attached to chamber as anode and a gold tubing coupled in the chamber was used as cathode. An electrolytic solution flowing through the gold tubing closed the electric circuit with sample, in order to provide condition for electric dissolution when the DC power supply was switched on. The best results were achieved by using a 1.5 mol l-1 nitric acid solution as electrolyte and a 2.5 A current intensity. The procedure presented a good performance characterized by a relative standard deviation better than < 5% (n=5) and a sample throughput of 180 determinations per hour for Cu, Zn and Pb. Results were in agreement with those obtained by conventional acid dissolution (99% confidence level).

Construção de uma cela de fluxo para medidas por espectrofotometria em fase sólida

A simple and low cost flow cell is proposed for measurements by solid-phase spectrophotometry employing a conventional spectrophotometer. The flow cell geometry allows the employment of a large amount of the solid support without causing both excessive attenuation of the radiation beam and increasing of the back-pressure. The adaptation of the flow cell in the optical path of the spectrophotometer in order to increase the precision is discussed. The flow cell characteristics were demonstrated by measurements of Co(II), employing 1-(2-tiazolylazo)-2-naphthol (TAN) immobilized on C18 bonded silica as solid support. The apparent molar absorptivity and coefficient of variation were estimated as 1.86 x 10(5) L mol-1 cm-1 and 1.4 % (n=15). A sample throughput of 40 determinations per hour and a detection limit of 15 mug L-1 (99.7 % confidence level) were achieved.

Sistema em fluxo para determinação espectrofotométrica de uréia em plasma de sangue animal empregando leguminosa como fonte natural da enzima urease

A spectrophotometric flow injection analysis (FIA) procedure employing natural urease enzyme source for the determination of urea in animal blood plasma was developed. Among leguminous plants used in the Brazilian agriculture, the Cajanus cajan specie was selected as urease source considering its efficiency and availability. A minicolumn was filled with leguminous fragments and coupled to the FIA manifold, where urea was on-line converted to ammonium ions and subsequently it was quantified by spectrophotometry. The system was employed to determine urea in animal plasma samples without any prior treatment. Accuracy was assessed by comparison results with those obtained employing the official procedure and no significant difference at 90 % confidence level was observed. Other profitable features such as an analytical throughput of 30 determinations per hour, a reagent consumption of 19.2 mg sodium salicylate, 0.5 mg sodium hipochloride and a relative standard deviation of 1.4 % (n= 12) were also obtained.

Deposição eletrolítica catódica e anódica simultâneas para minimizar interferências de cobre e chumbo na determinação espectrofotométrica de cádmio em água e alimentos via reação com Verde de Malaquita e iodeto

Simultaneous electrolytic deposition is proposed for minimization of Cu2+ and Pb2+ interferences on automated determination of Cd2+ by the Malachite Green-iodide reaction. During electrolysis of sample in a cell with two Pt electrodes and a medium adjusted to 5% (v/v) HNO3 + 0.1% (v/v) H2SO4 + 0.5 mol L-1 NaCl, Cu2+ is deposited as Cu on the cathode, Pb2+ is deposited as PbO2 on the anode while Cd2+ is kept in solution. With 60 s electrolysis time and 0.25 A current, Pb2+ and Cu2+ levels up to 50 and 250 mg L-1 respectively, can be tolerated without interference. With on-line extraction of Cd2+ in anionic resin minicolumn, calibration graph in the 5.00 - 50.0 µg Cd L-1 range is obtained, corresponding to twenty measurements per hour, 0.7 mg Malachite Green and 500 mg KI and 5 mL sample consumed per determination. Results of the determination of Cd in certified reference materials, vegetables and tap water were in agreement with certified values and with those obtained by GFAAS at 95% confidence level. The detection limit is 0.23 µg Cd L-1 and the RSD for typical samples containing 13.0 µg Cd L-1 was 3.85 % (n= 12).

Determinação espectrofotométrica por injeção em fluxo de paracetamol (acetaminofeno) em formulações farmacêuticas

A flow injection spectrophotometric procedure is proposed for the determination of paracetamol (acetaminophen) in pharmaceutical formulations. Powdered and liquid samples were previously dissolved/diluted in 0.05 mol L-1 hydrochloric acid solution and a volume of 250 µL was injected directly into a carrier stream of this same acid solution, flowing at 2.5 mL min-1. Paracetamol reacts with sodium hypochlorite forming N-acetyl-p-benzoquinoneimine which then reacts with sodium salicylate in sodium hydroxide solution yielding a blue indophenol dye which was measured at 640 nm in the pH range of 9.5-10.0. Paracetamol was determined in pharmaceutical products in the 1.0 to 100.0 mg L-1 (3.3x10-6 a 6.6x10-4 mol L-1) concentration range, with a detection limit of 0.5 mg L-1 (1.6x10-6 mol L-1). The recovery of this analyte in five samples ranged from 98.0 to 103.6 %. The analytical frequency was 80 determinations per hour and the RSDs were less than 1% for paracetamol concentrations of 25.0, 50.0 and 75.0 mg L-1 (n=10). A paired t-test showed that all results obtained for paracetamol in commercial formulations using the proposed flow injection procedure and a spectrophotometric batch procedure agree at the 95% confidence level.

Determinação espectrofotométrica de dipirona em produtos farmacêuticos por injeção em fluxo pela geração de íons triiodeto

A flow injection spectrophotometric procedure was developed for the determination of metamizol in pharmaceutical formulations. The system is based on the reaction between metamizol and triiodide generated in the system by mixing iodate and iodide-starch solutions. The absorbance of triiodide-starch complex giving a steady-state baseline value which was monitored at 580 nm. The inverse peaks caused by metamizol samples were measured and there was a direct relationship between absorbance decreasing and metamizol concentration from 1.4 x 10-4 to 7.0 x 10-4 mol L-1. The RSD was 0.45 % for a metamizol solution 4.2 x 10-4 mol L-1 (n = 10) with a detection limit (three-fold blank standard deviation/slope) of 6.0 x 10-5 mol L-1 The feasibility of the system was demonstrated for the determination of metamizol in commercial samples with sixty results obtained per hour. The results obtained for metamizol in pharmaceutical formulations using the proposed flow procedure and those obtained using an iodimetric procedure are in agreement at the 95% confidence level and within an acceptable range of error.

Análise de suspensões de argilas por espectrometria de emissão óptica com plasma induzido com configuração axial

The goal of this study was to evaluate the feasibility of direct introduction of clay slurries in an inductively coupled plasma optical emission spectrometer with axial view configuration. Calibration was performed using a certified reference material with a mean particle size of 13 µm (IPT-42) and the analytical curve was applied for quantification of two others reference materials (IPT-28 and IPT-32) and four samples. It was demonstrated that the analytical curve thus obtained was not completely suitable for IPT-28 and samples due to different mineralogical phases determined by X-ray diffraction. After considering this effect, it was possible for most elements to obtain results in agreement with certified values or with values obtained by a conventional technique at a 95% confidence level. It was demonstrated that the ICP-OES with axial view configuration did not present any incompatibility with the direct introduction of a complex inorganic suspension.

Determinação de paracetamol em produtos farmacêuticos usando um biossensor de pasta de carbono modificado com extrato bruto de abobrinha (Cucurbita pepo)

Crude extracts of several vegetables such as peach (Prunus persica), yam (Alocasia macrorhiza), manioc (Manihot utilissima), artichoke (Cynara scolymus L), sweet potato (Ipomoea batatas (L.) Lam.), turnip (Brassica campestre ssp. rapifera), horseradish (Armoracia rusticana) and zucchini (Cucurbita pepo) were investigated as the source of peroxidase (POD: EC 1.11.1.7). Among those, zucchini (Cucurbita pepo) crude extract was found to be the best one. This enzyme in the presence of hydrogen peroxide catalyses the oxidation of paracetamol to N-acetyl-p-benzoquinoneimine which the electrochemical reduction back to paracetamol was obtained at a peak potential of ¾0.10V. A cyclic voltammetric study was performed by scanning the potential from + 0.5 to ¾ 0.5 V. The recovery of paracetamol from two samples ranged from 97.3 to 106% and a rectilinear calibration curve for paracetamol concentration from 1.2x10-4 to 2.5x10-3 mol L-1 (r=0.9965) were obtained. The detection limit was 6.9x10-5 mol L-1 and the relative standard deviation was less than 1.1% for a solution containing 2.5x10-3 mol L-1 paracetamol and 2.0x10-3 mol L-1 hydrogen peroxide (n=12). The results obtained for paracetamol in pharmaceutical products using the proposed biosensor and Pharmacopoeial procedures are in agreement at the 95% confidence level.

Emprego de padrão único para a construção de curvas analíticas em sistema de análise por injeção em fluxo associado à espectrofotometria em fase sólida

In this work two procedures were proposed for analytical curves construction using a single standard solution employing a flow injection system with solid phase spectrophotometric detection (FI-SPS). A flow cell contends the chromogenic reagent 1-(2-tiazolylazo)-2-naphtol was positioned on the optical path. The first procedure was based on controlled concentration of analyte on solid phase and the relations between absorbance and the total volume of injected allowed the calculation of analyte concentration. The second procedure was developed employing controlled dispersion/retention in flow system where analyte concentration was obtained by exploiting the relation between transient signals of samples and single standard solution at equivalent reading time. The procedures were successfully applied for zinc determination in synthetic solutions with good precision and accuracy at 95% confidence level.

Desenvolvimento de um micro-aquecedor para sistemas de análise química em fluxo: determinação espectrofotométrica de manganês em plantas

In this work a micro-heater device to be used as an integral part of the flow analysis manifold is described. The usefulness of the device was demonstrated using it in the development of a multicommutated flow analysis procedure for the spectrophotometric determination of manganese in plant digest. The method was based on the manganese oxidation by periodate in phosphoric acid medium to form the permanganate anion. The reaction development is dependent on the temperature and it was observed that at 25 °C a time interval of ca. 15 min was necessary for the reaction to attain equilibrium. Setting the temperature to 70 ºC, this time interval could be decreased to ca. 30 s. This condition was easily attained employing the proposed micro-heater device coupled to the manifold. The procedure was applied to manganese determination in soybean digests and results compared with those obtained by inductively coupled argon plasma optical emission spectrometry (ICP-OES). No significant difference at 90% confidence level was observed. A linear response for sample concentrations ranging from 5.0 to 30.00 mg L-1 Mn2+; a relative standard deviation of 1.3% (n = 6) for a typical sample containing 6.3 mg L-1 Mn2+; a sampling rate of 22 determinations per hour; a low reagent consumption, of 12.0 mg NaIO4 per determination; and a detection limit of 1.2 mg L-1 were achieved.

Decomposição de argilas em forno de microondas e determinação simultânea dos seus constituintes principais por espectrometria de emissão óptica em plasma indutivamente acoplado

In this work a closed-vessel microwave-assisted acid decomposition procedure for clays was developed. Aluminum, Ca, Fe, K, Mg, Na, Si, and Ti were determined in clay digestates by inductively coupled plasma optical emission spectrometry. The most critical parameter for total decomposition of clays was the composition of the reagent mixture. The applied power and the heating time exerted a less critical influence. Best decomposition conditions were attained using a reagent mixture containing 4 mL aqua regia plus 3 mL HF and the heating program was implemented in 12 min. The accuracy of the results was demonstrated using two standard reference materials and a paired t-test showed a good agreement between determined and certified values at a 95% confidence level.

Size Effect and Notch Size Effect in Metal Fatigue

It is a well known phenomenon that the constant amplitude fatigue limit of a large component is lower than the fatigue limit of a small specimen made of the same material. In notched components the opposite occurs: the fatigue limit defined as the maximum stress at the notch is higher than that achieved with smooth specimens. These two effects have been taken into account in most design handbooks with the help of experimental formulas or design curves. The basic idea of this study is that the size effect can mainly be explained by the statistical size effect. A component subjected to an alternating load can be assumed to form a sample of initiated cracks at the end of the crack initiation phase. The size of the sample depends on the size of the specimen in question. The main objective of this study is to develop a statistical model for the estimation of this kind of size effect. It was shown that the size of a sample of initiated cracks shall be based on the stressed surface area of the specimen. In case of varying stress distribution, an effective stress area must be calculated. It is based on the decreasing probability of equally sized initiated cracks at lower stress level. If the distribution function of the parent population of cracks is known, the distribution of the maximum crack size in a sample can be defined. This makes it possible to calculate an estimate of the largest expected crack in any sample size. The estimate of the fatigue limit can now be calculated with the help of the linear elastic fracture mechanics. In notched components another source of size effect has to be taken into account. If we think about two specimens which have similar shape, but the size is different, it can be seen that the stress gradient in the smaller specimen is steeper. If there is an initiated crack in both of them, the stress intensity factor at the crack in the larger specimen is higher. The second goal of this thesis is to create a calculation method for this factor which is called the geometric size effect. The proposed method for the calculation of the geometric size effect is also based on the use of the linear elastic fracture mechanics. It is possible to calculate an accurate value of the stress intensity factor in a non linear stress field using weight functions. The calculated stress intensity factor values at the initiated crack can be compared to the corresponding stress intensity factor due to constant stress. The notch size effect is calculated as the ratio of these stress intensity factors. The presented methods were tested against experimental results taken from three German doctoral works. Two candidates for the parent population of initiated cracks were found: the Weibull distribution and the log normal distribution. Both of them can be used successfully for the prediction of the statistical size effect for smooth specimens. In case of notched components the geometric size effect due to the stress gradient shall be combined with the statistical size effect. The proposed method gives good results as long as the notch in question is blunt enough. For very sharp notches, stress concentration factor about 5 or higher, the method does not give sufficient results. It was shown that the plastic portion of the strain becomes quite high at the root of this kind of notches. The use of the linear elastic fracture mechanics becomes therefore questionable.

Toimitustäsmällisyyden suunnittelumenetelmä

Tutkimuksen ongelma on toimitusten ajallisen täsmällisyyden heikkeneminen kuljetuspolkujen pidentyessä ja erillisten suoritteitten lukumäärän kasvaessa. Näin usein tapahtuu toiminnan kansainvälistyessä. Tutkimuksen tavoitteena on kehittää menetelmä, jolla toimitusten ajallista täsmällisyyttä voidaan suunnitella ja ohjata sekä sen tavoitteet saavuttaa yllä todetusta kehityksestä huolimatta. Aluksi tutkimuksessa on jäsennetty toimitustäsmällisyyden nivoutumista yritys ja markkinointistrategioiden sekä tavoitteiden kokonaisuuteen. Täsmällisyyden merkitystä on myös tarkasteltu yleisesti yritysten kilpailutekijänä. Seuraavaksi on kehitetty interaktiivinen menetelmä, jonka avulla voidaan suunnitella yksittäisen toimituksen ajallista täsmällisyyttä. Toimituksen suoritteet ja niiden vaihtoehdot on kuvattu kvantifioituna, suunnattuna graafina eli verkkona. Ensin on tarkasteltu tilannetta, jossa suoritteiden kestot ovat vakiot ja sitten suoritteiden keston hajonnan huomioon ottavaa menetelmää, jonka avulla on löydettävissä kustannuksiltaan halvin, riittävän täsmällinen ja luotettava ratkaisu. Menetelmän soveltamista on tarkasteltu yleisesti sekä tulo että lähtölogistiikassa, dynaamisessa toimitussuoritetta koskevassa paatoksen teossa ja erilaisissa erityistapauksissa. Täsmällisyystavoitteitten asettamista ja muuttujia on tarkasteltu yleisesti ja käytännön soveltamisen kannalta. Käytännön soveltamista on kokeiltu valitun kohdeyrityksen esimerkkitilanteessa. Menetelmän toimivuutta on testattu simuloimalla sen ja perinteisesti suunniteltujen tehdastoimitusten sekä paikallisvarastosta tehtävien toimitusten tuloksia ja kustannuksia sekä vertaamalla niitä keskenään. Analyysin lopuksi on tarkasteltu esimerkkitilannetta logistisena kokonaisuutena lisäämällä vertailuun muitten kustannuskomponenttien ja lisäarvon vaikutus. Lopussa on käsitelty menetelmän käytännön soveltuvuusprofiilia ja jatkotutkimusaiheita. Yhteenvetona on todettu kehitetyn menetelmän tekevän täsmällisyyttä korostavan toimitusstrategian luotettavan toteuttamisen mahdolliseksi. Sen on taas todettu voivan olla edullinen vaihtoehto, jos täsmällisyydellä on markkina arvoa ja merkitystä pitkän tähtäimen menestystekijänä.