Extracorporeal membrane oxygenation support after heart explantation: a proposal on how to deal with hyperacute rejection of heart transplant

Purpose: In extreme situations, such as hyperacute rejection of heart transplant or major bleeding per-operating complications, an urgent heart explantation might be the only means of survival. The aim of this experimental study was to improve the surgical technique and the hemodynamics of an Extracorporeal Membrane Oxygenation (ECMO) support through a peripheral vascular access in an acardia model. Methods: An ECMO support was established in 7 bovine experiments (59±6.1 kg) by the transjugular insertion to the caval axis of a self-expanded cannula, with return through a carotid artery. After baseline measurements of pump flow and arterial and central venous pressure, ventricular fibrillation was induced (B), the great arteries were clamped, the heart was excised and right and left atria remnants, containing the pulmonary veins, were sutured together leaving an atrial septal defect (ASD) over the cannula in the caval axis. Measurements were taken with the pulmonary artery (PA) clamped (C) and anastomosed with the caval axis (D). Regular arterial and central venous blood gases tests were performed. The ANOVA test for repeated measures was used to test the null hypothesis and a Bonferroni t method for assessing the significance in the between groups pairwise comparison of mean pump flow. Results: Initial pump flow (A) was 4.3±0.6 L/min dropping to 2.8±0.7 L/min (P B-A= 0.003) 10 minutes after induction of ventricular fibrillation (B). After cardiectomy, with the pulmonary artery clamped (C) it augmented not significantly to 3.5±0.8 L/min (P C-B= 0.33, P C-A= 0.029). Finally, PA anastomosis to the caval axis was followed by an almost to baseline pump flow augmentation (4.1±0.7 L/min, P D-B= 0.009, P D-C= 0.006, P D-A= 0.597), permitting a full ECMO support in acardia by a peripheral vascular access. Conclusions: ECMO support in acardia is feasible, providing new opportunities in situations where heart must urgently be explanted, as in hyperacute rejection of heart transplant. Adequate drainage of pulmonary circulation is pivotal in order to avoid pulmonary congestion and loss of volume from the normal right to left shunt of bronchial vessels. Furthermore, the PA anastomosis to the caval axis not only improves pump flow but it also permits an ECMO support by a peripheral vascular access and the closure of the chest.

Various pyrethroids on bednets and curtains

Verandah trap huts in Tanzania village were used to assess the effectiveness if impregnated bednets and curtains in preventing hut entry and feeding by, and in killing of, Anopheles gambiae and An. funestus. Permethrin, deltamethrin, lambdacyhalothrin and pyrethrum were used for impregnation of damaged or undamaged bednets, sisal eaves curtains or bed curtains made of polypropylene fibre. The performance of the synthetic pyrethroids did not differ statistically significantly, except that on a damage net permethrin was better at preventing feeding. sisal eaves curtains deterred mosquitoes from hut entry but did not kill those that had entered. In assessing damaged nets and curtains it must be recognised that anything less than the best vector control may have no appreciable impact on holoendemic malaria.

Simple steps to a healthy heart

The number of deaths from coronary heart disease in Northern Ireland has dropped significantly, according to recent figures. However, the Public Health Agency is urging everyone to take steps to protect their heart and reduce their chances of developing the disease during National Heart Month (February).Despite the number of deaths dropping significantly in recent years, coronary heart disease is still the number one killer across the country. Over 2,200 people died in Northern Ireland from coronary heart disease in 2010 compared to just over 2,300 people in 2009 - an overall reduction of 100 province-wide. The latest figure reveals the positive downward trend is continuing - in 2008, there were 2,410 deaths, 2,493 in 2007 and 2,554 in 2006, while in 1979 there were nearly 5,000 deaths. Throughout National Heart Month in February, the PHA is calling for people to follow a number of steps in a bid to reduce their chances of developing the disease.Smoking is a major risk factor and, the more cigarettes you smoke, the higher the risk, according to Dr Christine McMaster, Consultant in Public Health Medicine, with responsibility for cardiovascular disease in the PHA."The reduction in smoking over the past number of years through public education, stop smoking programmes and smoke free legislation has had a major impact on reducing deaths from heart disease. However, 24% of the population in Northern Ireland still smoke, putting them at risk of developing the disease."People who suffer from high blood pressure also run an increased risk of developing coronary heart disease. High blood pressure is a silent, but treatable condition. In order to minimise the risk, I would urge everyone over the age of 45 to have their blood pressure measured every five years by their GP," said Dr McMaster.Simple lifestyle changes will also reduce the risk of heart disease, including eating at least five servings of fruit and vegetables a day, avoiding saturated fats, limiting alcohol intake and taking at least 30 minutes of exercise a day, five days a week.Dr McMaster described the reduction in deaths from coronary heart disease over the past few years as "a big success story". "It shows that people can take very positive steps to reduce their risk of heart disease by getting their blood pressure checked and adopting a healthier lifestyle; in particular by not smoking," he added. "The message is clear during National Heart Month - you only have one heart and you can take steps to keep it healthy."

Benznidazole vs benznidazole in multilamellar liposomes: how different they interact with blood components?

In spite of its widespread use, benznidazole's (BNZ) toxicity and low efficacy remains as major drawbacks that impair successful treatments against Chagas disease. Previously, attempting to increase the selectivity and reduce its toxicity on infected tissues, multilamellar liposomes (MLV) composed of hydrogenated soybean phosphatidylcholine (HSPC): distearoyl-phosphatidylglycerol (DSPG): cholesterol (CHOL) 2:1:2 mol:mol loaded with BNZ (MLV-BNZ) were designed. In this work we compared different properties of MLV-BNZ with those of BNZ. Opposite to other hydrophobic drugs, the results indicated that slight changes of BNZ×s association degree to proteins and lipoproteins should not modify the percentage of unbound drug available to exert pharmacological action. On the other hand, when loaded in MLV, BNZ reduced its association to plasma proteins in 45% and became refractory to the sinking effect of blood, dropping 4.5 folds. Additionally, when loaded in MLV, BNZ had higher volume distribution (160 ± 20 vs 102 ± 15 ml/kg) and total clearance (35.23 ± 2.3 vs 21.9 ± 1.4 ml/h.kg), and lower concentration-time curve (7.23 ± 0.2 vs 9.16 ± 0.5 µg.h/ml) than BNZ. Hence, these studies showed that for MLV-BNZ, the amount of BNZ can be substantially increased, from 25 to 70%, being this formulation more rapidly cleared from circulation than free drug; also due to the lower interaction with blood components, lower side effects can be expected.

Tendencias de la mortalidad por enfermedades cardiovasculares en Andalucía entre 1975 y 2004

Background: Cardiovascular diseases are ranked among the leading causes of death in the industrialized countries. This study is aimed at ascertaining the mortality trends by ischemic heart disease (IHD) and cerebrovascular diseases (CVD) in Andalusia within the 1975-2004 period. Method: Based on the official IHD and CVD death statistics and the related populations, the gross rates (GR) and age-adjusted rates (TS) and the Potential Years of Life Lost (PYLL) were calculated. To quantify the trends and their change points, a joinpoint regression analysis was made. Results: The number of IHD deaths for females rose from 2,086 deaths in 1975 to 3,336 in 2004, the TS having dropped from 74.29 to 50.94 deaths/100,000 females, the PYLL having dropped from 173.65 years to 90.56 years/100,000 females. The number of deaths for males rose from 2,854 deaths in 1975 to 4,085 in 2004, the TS having dropped from 147, 67 to 104.96 deaths /100,000 males. The PYLL showed a like behaviour from the first to the last year of the series, showing values of 716.46 and 460.04 years / 100,000 males. For the IHD in females, the number of deaths in absolute numbers dropped from 4,712 to 4,221, the TS having dropped from 166.00 to 62.08 deaths in females, and the PYLL from 338.08 to 87.63 years / 100,000 females. For males, the number of deaths dropped from 3,714 to 2,951, the TS from 206.88 deaths /100,000 males in 1975 to 76.12 /100,000 males in 2004, and the PYLL dropping from 533.12 to 182.38 years / 100,000 males. Conclusions: The trend in mortality due to IHD was not constant either among females or males, although it has always been a downward trend, the drop being statistically significant. The drop in the CVD has been such a major one that both the absolute numbers and the gross rates are lower for the most recent years that the first years in the series studied despite the aging of Andalusia’s population.

El fracàs escolar lligat necessàriament a un QI baix? Estudi del fracàs escolar d'un grup classe de l'Escola Pit-Roig

Davant la diversitat de teories que acompanyen al concepte de fracàs escolar i a la seva relació amb la intel·ligència, a continuació es presenta un estudi d'un grup classe de primària en un centre escolar de Barcelona ciutat, enfocat a verificar o rebutjar algunes de les teories clàssiques que parlen sobre l'èxit i/o el fracàs escolar i els factors predictius d'aquest, en concret el quocient intel·lectual, a l'igual que d'altres factors determinants amb aquest rendiment escolar. D'aquest grup classe, han estat tres els subjectes que han estat sotmesos a un estudi més profund per ser els que presenten fracàs escolar. Els materials utilitzats han estat diferents tests psicomètrics per valorar la intel·ligència de tot el grup classe, i les conductes adaptatives i la part emocional i relacional d'aquests tres alumnes, i un qüestionari per obtenir informació dels hàbits d'estudi de tot el grup classe. Les activitats realitzades han inclòs el passar aquests tests, observacions a l'aula del grup classe, a l'aula de reforç i al pati, passar el qüestionari a tot el grup classe, entrevistes amb aquests tres alumnes en concret, amb les seves famílies, amb la tutora del grup classe i amb la monitora de reforç. Els resultats obtinguts en aquest estudi ens han permès rebutjar les teories que correlacionen directament el quocient intel·lectual amb un predictor del rendiment escolar i de les conductes adaptatives, i a reafirmar que la metodologia d'ensenyament-aprenentatge influeix de forma directa en la motivació de l'alumnat en els seus estudis, en la comprensió de la nova informació, en l'atribució d'un significat a l'aprenentatge i en rendiment escolar.

Performance in post-compulsory education: evidence from vocational and academic tracks

This paper investigates the factors in_uencing grade performance in two different high school tracks (academic and vocational), including the effect of the amount of work achieved while studying. The empirical strategy analyzes grade progression through the outcomes, passing, repeating and dropping out, conditioning on previous outcomes, and dealing with the endogeneity introduced by the working variable. The analysis is based on a unique Spanish data with information on schooling and labor histories. Findings show that working reduces performance in both tracks, mainly during the first year, although the ffects are less detri- mental in the vocational path. Additionally, good performance in compulsory education, at- tending a private high school, or having high-educated parents improve outcomes, particularly in academic high school.

Temporo-Parietal Junction encodes the Embodied Self: Neuro-Robotics, fMRI, and Lesion mapping.

Introduction: Neuroimaging of the self focused on high-level mechanisms such as language, memory or imagery of the self. Recent evidence suggests that low-level mechanisms of multisensory and sensorimotor integration may play a fundamental role in encoding self-location and the first-person perspective (Blanke and Metzinger, 2009). Neurological patients with out-of body experiences (OBE) suffer from abnormal self-location and the first-person perspective due to a damage in the temporo-parietal junction (Blanke et al., 2004). Although self-location and the first-person perspective can be studied experimentally (Lenggenhager et al., 2009), the neural underpinnings of self-location have yet to be investigated. To investigate the brain network involved in self-location and first-person perspective we used visuo-tactile multisensory conflict, magnetic resonance (MR)-compatible robotics, and fMRI in study 1, and lesion analysis in a sample of 9 patients with OBE due to focal brain damage in study 2. Methods: Twenty-two participants saw a video showing either a person's back or an empty room being stroked (visual stimuli) while the MR-compatible robotic device stroked their back (tactile stimulation). Direction and speed of the seen stroking could either correspond (synchronous) or not (asynchronous) to those of the seen stroking. Each run comprised the four conditions according to a 2x2 factorial design with Object (Body, No-Body) and Synchrony (Synchronous, Asynchronous) as main factors. Self-location was estimated using the mental ball dropping (MBD; Lenggenhager et al., 2009). After the fMRI session participants completed a 6-item adapted from the original questionnaire created by Botvinick and Cohen (1998) and based on questions and data obtained by Lenggenhager et al. (2007, 2009). They were also asked to complete a questionnaire to disclose the perspective they adopted during the illusion. Response times (RTs) for the MBD and fMRI data were analyzed with a 3-way mixed model ANOVA with the in-between factor Perspective (up, down) and the two with-in factors Object (body, no-body) and Stroking (synchronous, asynchronous). Quantitative lesion analysis was performed using MRIcron (Rorden et al., 2007). We compared the distributions of brain lesions confirmed by multimodality imaging (Knowlton, 2004) in patients with OBE with those showing complex visual hallucinations involving people or faces, but without any disturbance of self-location and first person perspective. Nine patients with OBE were investigated. The control group comprised 8 patients. Structural imaging data were available for normalization and co-registration in all the patients. Normalization of each patient's lesion into the common MNI (Montreal Neurological Institute) reference space permitted simple, voxel-wise, algebraic comparisons to be made. Results: Even if in the scanner all participants were lying on their back and were facing upwards, analysis of perspective showed that half of the participants had the impression to be looking down at the virtual human body below them, despite any cues about their body position (Down-group). The other participants had the impression to be looking up at the virtual body above them (Up-group). Analysis of Q3 ("How strong was the feeling that the body you saw was you?") indicated stronger self-identification with the virtual body during the synchronous stroking. RTs in the MBD task confirmed these subjective data (significant 3-way interaction between perspective, object and stroking). fMRI results showed eight cortical regions where the BOLD signal was significantly different during at least one of the conditions resulting from the combination of Object and Stroking, relative to baseline: right and left temporo-parietal junction, right EBA, left middle occipito-temporal gyrus, left postcentral gyrus, right medial parietal lobe, bilateral medial occipital lobe (Fig 1). The activation patterns in right and left temporo-parietal junction and right EBA reflected changes in self-location and perspective as revealed by statistical analysis that was performed on the percentage of BOLD change with respect to the baseline. Statistical lesion overlap comparison (using nonparametric voxel based lesion symptom mapping) with respect to the control group revealed the right temporo-parietal junction, centered at the angular gyrus (Talairach coordinates x = 54, y =-52, z = 26; p>0.05, FDR corrected). Conclusions: The present questionnaire and behavioural results show that - despite the noisy and constraining MR environment) our participants had predictable changes in self-location, self-identification, and first-person perspective when robotic tactile stroking was applied synchronously with the robotic visual stroking. fMRI data in healthy participants and lesion data in patients with abnormal self-location and first-person perspective jointly revealed that the temporo-parietal cortex especially in the right hemisphere encodes these conscious experiences. We argue that temporo-parietal activity reflects the experience of the conscious "I" as embodied and localized within bodily space.

Estudio sobre las causas del abandono de los estudiantes de economía de la Universidad Oberta de Catalunya entre los años 1998 y 2008

Estudio de minería de datos sobre las causas del abandono de los estudiantes de una carrera de la UOC

Avoiding crimes of obedience: A comparative study of the autobiographies of M. K. Gandhi, N. Mandela and M. L. King

This research aims to provide a contribution towards understanding how and why certain people can display disobedience behaviors, to overcome unjust situations, and withstand persecutions deployed by authority. The paper presents a hermeneutic content analysis of the autobiographical speeches and texts of Gandhi, M. L. King and Mandela. Our results show that parents' value orientation, experience of injustice during childhood and exploration of alternative viewpoints during adolescence play a crucial role in structuring prosocial disobedience. Findings show also that social responsibility and ingroup communication are important conditions for facing persecutions without dropping original goals.

How to improve flow during cardiopulmonary bypass in an acardia experimental model.

OBJECTIVES In extreme scenarios, such as hyperacute rejection of heart transplant, an urgent heart explantation might be necessary. The aim of this experimental study was to determine the feasibility and to improve the haemodynamics of a venoarterial cardiopulmonary bypass after cardiectomy. METHODS A venoarterial cardiopulmonary bypass was established in seven calves (56.4 ± 7 kg) by the transjugular insertion to the caval axis of a self-expanding cannula, with a carotid artery return. After baseline measurements (A), ventricular fibrillation was induced (B), great arteries were clamped (C), the heart was excised and the right and left atria remnants, containing the pulmonary veins, were sutured together leaving an atrial septal defect over the cannula in the caval axis (D). Measurements were taken with the pulmonary artery clamped and declamped. RESULTS Initial pump flow was 4.16 ± 0.75 l/min dropping to 2.9 ± 0.63 l/min (P(AB )< 0.001) 10 min after induction of ventricular fibrillation. After cardiectomy with the pulmonary artery clamped, the pump flow increased non-significantly to 3.20 ± 0.78 l/min. After declamping, the flow significantly increased close to baseline levels (3.61 ± 0.73 l/min, P(DB )= 0.009, P(DC )= 0.017), supporting the notion that full cardiopulmonary bypass in acardia is feasible only if adequate drainage of pulmonary circulation is assured to avoid pulmonary congestion and loss of volume from the left-to-right shunt of bronchial vessels.

Beneficial Effects of Selected Additives on Asphalt Cement Mixes, HR-278, 1987

Effects of polyolefins, neoprene, styrene-butadiene-styrene (SBS) block copolymers, styrene-butadiene rubber (SBR) latex, and hydrated lime on two asphalt cements were evaluated. Physical and chemical tests were performed on a total of 16 binder blends. Asphalt concrete mixes were prepared and tested with these modified binders and two aggregates (crushed limestone and gravel), each at three asphalt content levels. Properties evaluated on the modified binders (original and thin-film oven aged) included: viscosity at 25 deg C, 60 deg C and 135 deg C with capillary tube and cone-plate viscometer, penetration at 5 deg C and 25 deg C, softening point, force ductility, and elastic recovery at 10 deg C, dropping ball test, tensile strength, and toughness and tenacity tests at 25 deg C. From these the penetration index, the viscosity-temperature susceptibility, the penetration-viscosity number, the critical low-temperature, long loading-time stiffness, and the cracking temperature were calculated. In addition, the binders were studied with x-ray diffraction, reflected fluorescence microscopy, and high-performance liquid chromatography techniques. Engineering properties evaluated on the 72 asphalt concrete mixes containing additives included: Marshall stability and flow, Marshall stiffness, voids properties, resilient modulus, indirect tensile strength, permanent deformation (creep), and effects of moisture by vacuum-saturation and Lottman treatments. Pavement sections of varied asphalt concrete thicknesses and containing different additives were compared to control mixes in terms of structural responses and pavement lives for different subgrades. Although all of the additives tested improved at least one aspect of the binder/mixture properties, no additive was found to improve all the relevant binder/mixture properties at the same time. On the basis of overall considerations, the optimum beneficial effects can be expected when the additives are used in conjunction with softer grade asphalts.

Physiological changes during postharvest senescence of broccoli

The objective of this work was to determine the early physiological changes throughout shelf life of fresh broccoli (Brassica oleracea L. var. italica) cv. Piracicaba Precoce at 25ºC and relative humidity of 96% in the dark until complete senescence. Head inflorescences showed lack of turgidity and commercial value when weight loss reached up to 5%, coinciding with 48 hour after harvest. Chlorophyll content was stable until 24 hours after harvesting; afterwards, an intense degradation phase took place. At 72 hours, total head yellowing was observed when chlorophyll content dropped to 30% of its initial content. Peroxidase activity increased by 1.4 fold during the first six hours, dropping to its lowest level approximately 24 hours after harvesting. However, from this time on, an increment of activity was observed until 72 hours. At 24 hours after harvesting, respiration was reduced by 50%. At later stages of senescence, respiration of florets was stable, but in a lower level than that determined at harvest. Sharp reduction of starch and reducing sugars was observed within 24 hours after harvesting, followed by continuous period of decline in starch and non-reducing sugars.

Model development for capercaillie (Tetrao urogallus) habitat in the Jura Mountains (Western Switzerland)

Capercaillie, Tetrao urogallus, is a threatened species in central Europe, and Swiss populations declined 40 to 50 % between 1970 and 1985. Capercaillie are sensitive to forest structure, and loss of habitat is a major cause of their decline. Knowledge of habitat characteristics is therefore essential for capercaillie conservation. Here, we present models predicting capercaillie probability of occurrence, based on relevant structural habitat variables. Models were built using multiple logistic regression analyses on capercaillie presence/absence data. Vegetation survey was carried out in July 1999 in a 170-km2 forested area (Jura mountains, canton de Vaud, western Switzerland) inhabited by capercaillie and presence/absence of the species was assessed according to dropping presence/absence. The survey was based on 10-m-radius sample plots each in a 1-km2 forest patch (n = 76 with capercaillie droppings, n = 80 without). A first model included seven out of 27 measured habitat variables and a second model only four. The latter model best represents practical needs. It includes three variables which had a negative impact on capercaillie presence: tree and shrub covers and spruce, Picea excelsa, shrub cover, and one which had a positive effect: bilberry, Vaccinium myrtillus, cover, highlighting that capaercaillie selected open forest with high bilberry abundance. The model can be used to map potential capercaillie habitat distribution and to manage the habitat in favour of capercaillie (protection and adapted forestry practices) in the Swiss Jura mountains.

Preparació física específica en l'esport col·lectiu del futbol. Estudi de la millora i el manteniment del valor del VO2màx

En el treball que es mostra a continuació podrem observar un estudi sobre la preparació física aplicada a l’esport del futbol. A més, farem un estudi dels nivells del volum màxim d’Oxigen (Vo2màx) a través d’un procés d’obtenció de resultats indirecte (Test de Course Navette) tenint present el nombre de sessions setmanals. Observarem les diferències en la definició del paràmetre segons Zintl (1991), Diéguez (1997), Gómez, Aranda i Ferrer (2010), entre d’altres. També observarem els nivells que s’han de tenir a partir d’autors com Zintl (1991), Rivera i Avella (1992), Sánchez i Salas (2008). Per dur-ho a terme, farem un estudi hipotètic-deductiu a través d’un mostreig no probabilístic. Observarem els valors del Vo2màx. assolits en el període preparatori, comparats amb el manteniment, la millora o la pèrdua d’aquest després d’un període d’entrenament diferenciat entre una i tres sessions. Un cop realitzat el procés, hem pogut veure que els nivells assolits després del període preparatori (60.87+ 8.81 ml/kg/min) són majors respecte l’inici del període (44.38 +8.92 ml/kg/min.). Posteriorment, al observar les diferències entre els dos grups de la mostra, podem afirmar que amb tres sessions realitzades no es poden mantenir els nivells anteriors (57.80 +10.16) respecte els (56.73 +9.24) de l’últim test. Per últim, el grup 2, amb una única sessió setmanal els valors baixen més, es passa dels (63.93 + 6.24 ml/kg/min.) als (56.50 + 7.52 ml/kg/min)