Simultaneous quantitation of serum HBV DNA and HBeAg can distinguish between slow and fast viral responses to antiviral therapy in patients with chronic hepatitis B

BACKGROUND: The quantitation of serum HBeAg is not commonly used to monitor viral response to therapy in chronic hepatitis B. METHODS: In this study, 21 patients receiving varying therapies were followed and their viral response monitored by concomitant viral load and HBeAg quantitation in order to study the meaning and the kinetics of both parameters. RESULTS: It was possible to distinguish between three different patterns of viral response. The first was characterized by a simultaneous decrease in serum HBV DNA and HBeAg. The second pattern was characterized by a decrease in serum HBeAg but persistent detection of HBV DNA. The third pattern was characterized by undetectable HBV DNA with persistent HBeAg positivity, which points to a non-response (Pattern III-B) except when HBeAg levels showed a slow but steady drop, characterizing a "slow responder" patient (Pattern III-A). CONCLUSIONS: The first pattern is compatible with a viral response. A long-term HBeAg seropositivity with a slow and persistent decrease (Pattern III-A) is also compatible with a viral response and calls for a prolongation of anti-viral treatment.

A Comparative Study of Cardiovascular Tolerability with Slow Extended Dialysis Versus Continuous Haemodiafiltration in the Critical Patient

Background: In the haemodynamically unstable patient the method of treatment of acute renal failure is still largely controversial. The purpose of our study was to compare slow extended dialysis with continuous haemodiafiltration in the critical patient with indication for renal replacement therapy and haemodynamic instability. Patients and Methods: This is a cohort study comparing in 63 ventilated critical patients a 12 month period when only continuous haemodiafiltration was used (n=25) with an equal period of slow extended dialysis (n=38). Our primary objective was to evaluate the impact of the dialytic procedure on cardiovascular stability in those patients. As secondary aims we considered system coagulation/thrombosis and predictors of mortality. In the two groups we analysed the first session performed, the second session performed and the average of all the sessions performed in each patient. Results: In these patients, mortality in the intensive care unit was high (68% in the continuous haemodiafiltration group and 63% in the slow extended dialysis group). We did not find any association between the dialytic technique used and death; only the APACHE score was a predictor of death. Slow extended dialysis was a predictor of haemodynamic stability, a negative predictor of sessions that had to be interrupted for haemodynamic instability, and a predictor of achieving the volume removal initially sought. Slow extended dialysis was also associated with less coagulation of the system. Conclusions: Our data suggested that slow extended dialysis use was not inferior to continuous haemodiafiltration use in terms of cardiovascular tolerability.

Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients

INTRODUCTION: In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV. METHODS: This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil. RESULTS: At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects. HIV-positive patients had lower median blood lymphocyte counts (686/mm³ versus 948/mm³p = 0.004) and lower values of alanine aminotransferase (ALT) (48IU/L versus 75.6IU/L p = 0.016) than HIV-negative patients. HIV-positive status (hazard ratio = 0.423, p = 0.023) and anemia (HR = 0.205, p = 0.002) were independent negative predictors of complete clinical response following antileishmanial treatment initiation. CONCLUSIONS: This study reinforces that all patients with VL should be tested for HIV infection, regardless of their clinical picture. This practice would allow early recognition of coinfection with initiation of antiretroviral therapy and, possibly, reduction in treatment failure.

Potentially viable solar powered appliances cooling and distillation

Stand alone solar powered refrigeration and water desalination, two of the most popular and sought after applications of solar energy systems, have been selected as the topic of research for the works presented in this thesis. The water desalination system based on evaporation and condensation was found to be the most suitable one to be powered by solar energy. It has been established that highoutput fast-response solar heat collectors used to achieve high rates of evaporation and reliable solar powered cooling system for faster rates of condensation are the most important factors in achieving increased outputs in solar powered desalination systems. Comprehensive reviews of Solar powered cooling/refrigeration and also water desalination techniques have been presented. In view of the fact that the Institute of Technology, Sligo has a well-established long history of research and development in the production of state of the art high-efficiency fast-response evacuated solar heat collectors it was decided to use this know how in the work described in this thesis. For this reason achieving high rates of evaporation was not a problem. It was, therefore, the question of the solar powered refrigeration that was envisaged to be used in the solar powered desalination tofacilitate rapid condensation of the evaporated water that had to be addressed first. The principles of various solar powered refrigeration techniques have also been reviewed. The first step in work on solar powered refrigeration was to successfully modify a conventional refrigerator working on Platen-Munters design to be powered by highoutput fast-response evacuated solar heat collectors. In this work, which was the first ever successful attempt in the field, temperatures as low as —19°C were achieved in the icebox. A new approach in the use of photovoltaic technology to power a conventional domestic refrigerator was also attempted. This was done by modifying a conventional domestic refrigerator to be powered by photovoltaic panels in the most efficient way. In the system developed and successfully tested in this approach, the power demand has been reduced phenomenally and it is possible to achieve 48 hours of cooling power with exposure to just 7 hours of sunshine. The successful development of the first ever multi-cycle intermittent solar powered icemaker is without doubt the most exciting breakthrough in the work described in this thesis. Output of 74.3kg of ice per module with total exposure area of 2.88 m2, or 25.73kg per m2, per day is a major improvement in comparison to about 5-6kg of ice per m2 per day reported for all the single cycle intermittent systems. This system has then become the basis for the development of a new solar powered refrigeration system with even higher output, named the “composite” system described in this thesis. Another major breakthrough associated with the works described in this thesis is the successful development and testing of the high-output water desalination system. This system that uses a combination of the high-output fast-response evacuated solar heat collectors and the multi-cycle icemaker. The system is capable of producing a maximum of 141 litres of distilled water per day per module which has an exposure area of 3.24m2, or a production rate of 43.5 litres per m2 per day. Once again when this result is compared to the reported daily output of 5 litres of desalinated water per m per day the significance of this piece of work becomes apparent. In the presentation of many of the components and systems described in this thesis CAD parametric solid modelling has been used instead of photographs to illustrate them more clearly. The multi-cycle icemaker and the high-output desalination systems are the subject of two patent applications.

To determine if the ‘NIMBY’ phenomenon explains the slow progress of wind farm development or do institutional factors need to be taken in to consideration?

The threats posed by climate change are placing governments under increasing pressure to meet electricity demand from low carbon sources. Wind energy has been has been identified as one of the main technologies to help in meeting these demands. The public in general favour wind energy yet proposed targets for generation capacity lag behind proposed goals. The N IM B Y phenomenon has been suggested as one of the reasons why we are behind our wind generation capacity targets. It is a common mistake to take general support for granted and expect the public to support developments when confronted with them in their local area. In many cases it is not unheard of that governing bodies whether social, political, regulatory, environmental, or cultural can overrule general public support and halt developments. Motives to halt developments will vary depending on the institutional body involved. The problem with the term N IM B Y is that it is too basic a term to describe the broad spectrum of complex motives that various institutions including the public may have against a development. This research focuses on a case study where the developer had major problems with the local county council and its wind energy policies when he was erecting a wind turbine despite having gained planning permission. A survey questionnaire was also used as part o f the research to seek the perception a rural community had on wind energy. The research findings and results are discussed with respect to the literature review highlighting a general public support for wind energy and the influence institutional bodies have over the progress of developments.

Anxiety, Depression, and General Psychological Distress in Patients with Coronary Slow Flow

AbstractBackground:The relationship between psychiatric illness and heart disease has been frequently discussed in the literature. The aim of the present study was to investigate the relationship between anxiety, depression and overall psychological distress, and coronary slow flow (CSF).Methods:In total, 44 patients with CSF and a control group of 50 patients with normal coronary arteries (NCA) were prospectively recruited. Clinical data, admission laboratory parameters, and echocardiographic and angiographic characteristics were recorded. Symptom Checklist 90 Revised (SCL-90-R), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scales were administered to each patient.Results:The groups were comparable with respect to age, sex, and atherosclerotic risk factors. In the CSF group, BAI score, BDI score, and general symptom index were significantly higher than controls (13 [18.7] vs. 7.5 [7], p = 0.01; 11 [14.7] vs. 6.5 [7], p = 0.01; 1.76 [0.81] vs. 1.1[0.24], p = 0.01; respectively). Patients with CSF in more than one vessel had the highest test scores. In univariate correlation analysis, mean thrombolysis in myocardial infarction (TIMI) frame counts were positively correlated with BAI (r = 0.56, p = 0.01), BDI (r = 0.47, p = 0.01), and general symptom index (r = 0.65, p = 0.01). The psychiatric tests were not correlated with risk factors for atherosclerosis.Conclusion:Our study revealed higher rates of depression, anxiety, and overall psychological distress in patients with CSF. This conclusion warrants further studies.

novel reactive distillation process for the production of cyclohexanol from cyclohexene

Magdeburg, Univ., Fak. für Verfahrens- und Systemtechnik, Diss., 2010

Envelhecimento das aguardentes

1 - Colour, by itself, does not constitute a solid ground for judging of the age of a brandy because the more or less pronounced colour it acquires through aging can also be obtained by the addition of oack essence to newly distilled brandy. 2 - Urder the same conditions, colour intensity of a brandy wiU depend upon the nature of the wood and the condition of the storage. 3 - In accordance with the experimental results obtained by the present writers it rests no doubt that fermentation facility ferment resistence, produce and quality of the brendy all are factors depending upon the variety of the sugar cane. In addition, the authors presume that the variety of sugar cane has also influence upon the alteration of composition of the brandy submitted to aging. 4 - All aging phenomena of the brandy are accompanied by volume decreasing, what happens in a slow and continuous manner depending upon storage and environment conditions 5 - During brandy aging the alcoholic degree is greatly af- fected by evaporation, increasing or decreasing in accordance to the hygrometric state of the air and the teriperature in the place where the tuns are stored. 6 - The specific weight of the brandy is inversely proportio- nal to its alcoholic degree, but directly proportional to the extracts since the latter indicates the amount of dissolved residues. 7 - Brandy which shows high specific weight together with high alcoholic degree cannot be considered as aged. It may, however, be takens for brandy artificially coloved in order to conceal its actual age. 8 - The amount of extracts increases with aging, since it is the result of the solvent action of the brandy upon the soluble extractive substances of the wood. Notwithstanding that the extract, considered alone, has no value in determining the age of a brandy, since nothing easier is ohan to nake it change artificially. 9 -During aging the brandy get acidity in physiological as well as in physical way, but never by the action of microorganisms. 10 - The estturs produced during aging by the action of acids upon alcohols are the mean factors of the savour (bouquet) of a brandy and therefore every thing shall be done tor fhr estherification of a preserved brandy being not limited. 11 - Aeration increases esther formation, reduces the aging- time and turn better the taste qualities of the brandy. 12 - Due to the great proportion of high alcohols ordinarily found in the brandy, their analytical discrimination will be greatly important. 13 - The high alcohols are not responsable for the disastrous consequences of the alcoholism, but the high percentage of uthyl alcohol present in the brandy. 14 - The aldehydes appear always in high rate in the brazilian brandys in consequence of some intermediary products of the oxydation of the alcohols being left in the brandys during aging. 15 - The age has little or no influence on the quantity of phurphurol present in a brandy whose amount varies greatly the manner in which the wines to be distilled are treated. Wines centrifugalized or filtered before distillation always give rise to brandys poorer in phurphurol as compared with those distilled without these treatments. 16 - Though greatly variable, brandys of good qualities generally show a high residues coefficient, never under 200 mmg 17 - Lusson - Rocques oxydation coefficient cannot be indis- criminately applied to any brandy class, being, on the contrary, specifically destined to cognacs.

Long-term outcome after cognitive and behavioral regression in nonlesional epilepsy with continuous spike-waves during slow-wave sleep.

PURPOSE: To present the long-term follow-up of 10 adolescents and young adults with documented cognitive and behavioral regression as children due to nonlesional focal, mainly frontal, epilepsy with continuous spike-waves during slow wave sleep (CSWS). METHODS: Past medical and electroencephalography (EEG) data were reviewed and neuropsychological tests exploring main cognitive functions were administered. KEY FINDINGS: After a mean duration of follow-up of 15.6 years (range, 8-23 years), none of the 10 patients had recovered fully, but four regained borderline to normal intelligence and were almost independent. Patients with prolonged global intellectual regression had the worst outcome, whereas those with more specific and short-lived deficits recovered best. The marked behavioral disorders resolved in all but one patient. Executive functions were neither severely nor homogenously affected. Three patients with a frontal syndrome during the active phase (AP) disclosed only mild residual executive and social cognition deficits. The main cognitive gains occurred shortly after the AP, but qualitative improvements continued to occur. Long-term outcome correlated best with duration of CSWS. SIGNIFICANCE: Our findings emphasize that cognitive recovery after cessation of CSWS depends on the severity and duration of the initial regression. None of our patients had major executive and social cognition deficits with preserved intelligence, as reported in adults with early destructive lesions of the frontal lobes. Early recognition of epilepsy with CSWS and rapid introduction of effective therapy are crucial for a best possible outcome.

Pharmacokinetic profile of two different pharmaceutical forms of theophylline (a slow release tablet and a syrup) after multiple dose administration to healthy human volunteers

Due to the narrow therapeutic range of theophyline, plasma concentrations of this drug are monitored in patients undergoing chronic therapy. Slow-release preparations avoid the fluctuations in plasma levels and improve patient compliance. In this study, we have compared the pharmacokinetic profiles of a theophylline slow-release tablet and a syrup form, when administered in multiple doses to healthy adult volunteers. The classification based upon releasing patterns is confirmed.

Does the mechanical work in running change during the VO2 slow component?

PURPOSE: The origin of the slow component is not fully understood. The mechanical hypothesis is one of the potential factors, because an increase in external mechanical work with fatigue was previously reported for a constant velocity run. The purpose of this study was to determine whether a change in mechanical work could occur during the development of the VO2 slow component under the effect of fatigue. METHODS: Twelve regional-level competitive runners performed a square-wave transition, corresponding to 95% of the speed associated with peak VO2 obtained during an incremental test. The VO2 response was fit with a classical model including two exponential functions. A specific treadmill with three-dimensional force transducers was used to measure the ground reaction force. Kinetic work (W(kin)), potential work (W(pot)), external work (W(ext)), and an index of internal work (W(int)) per unit of distance were quantified continuously. RESULTS: During the slow component of VO2, a significant increase in W (P< 0.01), no change in W, and a significant decrease in W and W index (P< 0.05, P< 0.001, respectively) were observed. CONCLUSION: The present study showed that the slow component of VO2 did not result partly from a change in mechanical work under the effect of fatigue. Nevertheless, the decrease in stride frequency (P< 0.001) and contact time (P< 0.001) suggested an alternative mechanical explanation. The slow component during running may be due to the cost of generating force or to alterations in the storage and recoil of elastic energy, and not to the external mechanical work.

Effects of two types of fatigue on the VO(2) slow component.

The aim of the study was to test the hypothesis of the involvement of type II fibres in the V.O (2) slow component phenomenon by using two prior fatiguing protocols on the knee extensor muscles. Nine subjects performed three constant-load cycling exercises at a work rate corresponding to 80 % of their V.O (2) max: (i) preceded by a 20-min fatiguing protocol using electromyostimulation (EMS), (ii) preceded by a 20-min fatiguing protocol using voluntary contractions (VOL), and (iii) without fatiguing protocol (NFP). Voluntary and evoked neuromuscular properties of the knee extensor muscles were tested before (PRE) and after (POST) the two fatiguing protocols. Results show a significant reduction in voluntary force after both fatiguing protocols (-19.9 % and -11.8 %, in EMS and VOL, respectively p<0.01). After EMS, this decrease was greater than after VOL (p<0.05) and was combined with a slackening of muscle contractile properties which was absent after VOL (p<0.05). Regarding the effects on oxygen uptake kinetics, the appearance of the slow component was delayed after EMS and its amplitude was lower than those obtained in VOL and NFP conditions (0.48+/-0.07 vs. 0.75+/-0.09 and 0.69+/-0.08 L . min (-1), respectively; p<0.05). It can thus be concluded that exercises dedicated to preferentially fatiguing type II fibres may alter V.O (2) kinetics.

Addition of inspiratory resistance increases the amplitude of the slow component of O2 uptake kinetics.

The contribution of respiratory muscle work to the development of the O(2) consumption (Vo(2)) slow component is a point of controversy because it has been shown that the increased ventilation in hypoxia is not associated with a concomitant increase in Vo(2) slow component. The first purpose of this study was thus to test the hypothesis of a direct relationship between respiratory muscle work and Vo(2) slow component by manipulating inspiratory resistance. Because the conditions for a Vo(2) slow component specific to respiratory muscle can be reached during intense exercise, the second purpose was to determine whether respiratory muscles behave like limb muscles during heavy exercise. Ten trained subjects performed two 8-min constant-load heavy cycling exercises with and without a threshold valve in random order. Vo(2) was measured breath by breath by using a fast gas exchange analyzer, and the Vo(2) response was modeled after removal of the cardiodynamic phase by using two monoexponential functions. As anticipated, when total work was slightly increased with loaded inspiratory resistance, slight increases in base Vo(2), the primary phase amplitude, and peak Vo(2) were noted (14.2%, P < 0.01; 3.5%, P > 0.05; and 8.3%, P < 0.01, respectively). The bootstrap method revealed small coefficients of variation for the model parameter, including the slow-component amplitude and delay (15 and 19%, respectively), indicating an accurate determination for this critical parameter. The amplitude of the Vo(2) slow component displayed a 27% increase from 8.1 +/- 3.6 to 10.3 +/- 3.4 ml. min(-1). kg(-1) (P < 0.01) with the addition of inspiratory resistance. Taken together, this increase and the lack of any differences in minute volume and ventilatory parameters between the two experimental conditions suggest the occurrence of a Vo(2) slow component specific to the respiratory muscles in loaded condition.

Ultra-fast recovery from right neglect after 'awake surgery' for slow-growing tumor invading the left parietal area

It is now possible to perform resections of slow-growing tumors in awake patients. Using direct electrical stimulation, real-time functional mapping of the brain can be used to prevent the resection of essential areas near the tumor. Simple clinical observations of patients with a resection of slow-growing tumors have demonstrated substantial recovery within a few days of such 'awake surgery'. The aim of this study was to investigate the kinetics of recovery following the resection of slow-growing tumors invading the left parietal area and to focus mainly on its rapidity. Two patients were assessed by standard line bisection tests and compared with eight healthy individuals. Independently of the pure nature of the symptoms, we report that the patients rapidly and substantially recovered from pronounced right neglect. They were tested 48 hours after the surgery and the recovery was significant for both patients after less than 4 hours. Strikingly, for one patient, recovery was ultra fast and substantial in the first practice session within less than 7 minutes: it occurred without verbal feedback and was substantially retained during the following testing session. Its rapidity suggests a process of unmasking redundant networks. With the slow growth of the lesion, the contralesional hemisphere is probably progressively prepared for rapid unmasking of homologue networks. These results have major clinical implications. For patients with an invading left-side tumor, it is now clear that line bisections are required before, during, and after awake surgery to: plan the surgery, control the quality of the resection, and also optimize the rehabilitation of the patient