Safety of combined heat and moisture exchanger filters in long-term mechanical ventilation.

STUDY OBJECTIVE: To evaluate the safety of a combined heat and moisture exchanger filter (HMEF) for the conditioning of inspired gas in long-term mechanical ventilation (MV). DESIGN: Randomized controlled trial. SETTING: Medical ICU in a large teaching hospital. PATIENTS: One hundred fifteen consecutive patients who required > or = 48 h of MV. INTERVENTIONS: Patients were randomized at intubation time (day 1) to receive inspired gas conditioned either by a water-bath humidifier heated at 32 degrees C (HWBH) or by an HMEF (Hygroster; DAR; Mirandola, Italy). MEASUREMENTS AND MAIN RESULTS: The two study groups were comparable in terms of primary pathologic condition at the time of hospital admission, disease severity as measured by the Simplified Acute Physiology Score, and ICU mortality. They did not differ with respect to ventilator days per patient (mean +/- SD: HMEF, 7.6 +/- 6.5; HWBH, 7.8 +/- 5.8), incidence of endotracheal tube obstruction (HMEF, 0/59; HWBH, 1/56), and incidence of hypothermic episodes (HMEF, five; HWBH, two). In 41 patients receiving MV for > or = 5 days, the morphologic integrity of respiratory epithelium was evaluated on day 1 and day 5, using a cytologic examination of tracheal aspirate smears. The state of ciliated epithelium was scored on a scale from 0 (poorest integrity) to 1,200 (maximum integrity), according to a well-described method. In both patient groups, the scores slightly but significantly decreased from day 1 to day 5 (mean +/- SD: HWBH, from 787 +/- 104 to 745 +/- 88; HMEF, from 813 +/- 79 to 739 +/- 62; p < 0.01 for both groups); there were no statistically significant differences between groups. CONCLUSIONS: These data indicate acceptable safety of HMEFs of the type used in the present study for long-term mechanical ventilation.

Repeated sprinting on natural grass impairs vertical stiffness but does not alter plantar loading in soccer players.

This study aimed to determine changes in spring-mass model (SMM) characteristics, plantar pressures, and muscle activity induced by the repetition of sprints in soccer-specific conditions; i.e., on natural grass with soccer shoes. Thirteen soccer players performed 6 × 20 m sprints interspersed with 20 s of passive recovery. Plantar pressure distribution was recorded via an insole pressure recorder device divided into nine areas for analysis. Stride temporal parameters allowed to estimate SMM characteristics. Surface electromyographic activity was monitored for vastus lateralis, rectus femoris, and biceps femoris muscles. Sprint time, contact time, and total stride duration lengthened from the first to the last repetition (+6.7, +12.9, and +9.3%; all P < 0.05), while flight time, swing time, and stride length remained constant. Stride frequency decrease across repetitions approached significance (-6.8%; P = 0.07). No main effect of the sprint number or any significant interaction between sprint number and foot region was found for maximal force, mean force, peak pressure and mean pressure (all P > 0.05). Center of mass vertical displacement increased (P < 0.01) with time, together with unchanged (both P > 0.05) peak vertical force and leg compression. Vertical stiffness decreased (-15.9%; P < 0.05) across trials, whereas leg stiffness changes were not significant (-5.9%; P > 0.05). Changes in root mean square activity of the three tested muscles over sprint repetitions were not significant. Although repeated sprinting on natural grass with players wearing soccer boots impairs their leg-spring behavior (vertical stiffness), there is no substantial concomitant alterations in muscle activation levels or plantar pressure patterns.

Hepatic amyloidosis increases liver stiffness measured by transient elastography.

Liver stiffness values in transient elastography (TE) have to be interpreted with caution. Steatosis, congestion, acute inflammation and extrahepatic cholestasis can indeed influence measurements. Obtained stiffness values in the cirrhotic range can also be present in the absence of fibrosis as in hepatic amyloidosis. Here we report two cases of systemic amyloidosis with hepatic involvement where high stiffness values were measured at TE. In fact, deposits of amyloid may increase the rigidity of the liver parenchyma resulting in higher liver stiffness values. Therefore, results of TE should always be interpreted in their clinical context and if inconsistent, the performance of a liver biopsy might be necessary.

Performance of a reciprocal shaker in mechanical dispersion of soil samples for particle-size analysis

The dispersion of the samples in soil particle-size analysis is a fundamental step, which is commonly achieved with a combination of chemical agents and mechanical agitation. The purpose of this study was to evaluate the efficiency of a low-speed reciprocal shaker for the mechanical dispersion of soil samples of different textural classes. The particle size of 61 soil samples was analyzed in four replications, using the pipette method to determine the clay fraction and sieving to determine coarse, fine and total sand fractions. The silt content was obtained by difference. To evaluate the performance, the results of the reciprocal shaker (RSh) were compared with data of the same soil samples available in reports of the Proficiency testing for Soil Analysis Laboratories of the Agronomic Institute of Campinas (Prolab/IAC). The accuracy was analyzed based on the maximum and minimum values defining the confidence intervals for the particle-size fractions of each soil sample. Graphical indicators were also used for data comparison, based on dispersion and linear adjustment. The descriptive statistics indicated predominantly low variability in more than 90 % of the results for sand, medium-textured and clay samples, and for 68 % of the results for heavy clay samples, indicating satisfactory repeatability of measurements with the RSh. Medium variability was frequently associated with silt, followed by the fine sand fraction. The sensitivity analyses indicated an accuracy of 100 % for the three main separates (total sand, silt and clay), in all 52 samples of the textural classes heavy clay, clay and medium. For the nine sand soil samples, the average accuracy was 85.2 %; highest deviations were observed for the silt fraction. In relation to the linear adjustments, the correlation coefficients of 0.93 (silt) or > 0.93 (total sand and clay), as well as the differences between the angular coefficients and the unit < 0.16, indicated a high correlation between the reference data (Prolab/IAC) and results obtained with the RSh. In conclusion, the mechanical dispersion by the reciprocal shaker of soil samples of different textural classes was satisfactory. The results allowed recommending the use of the equipment at low agitation for particle size- analysis. The advantages of this Brazilian apparatus are its low cost, the possibility to simultaneously analyze a great number of samples using ordinary, easily replaceable glass or plastic bottles.

Major impact of body position on arterial stiffness indices derived from radial applanation tonometry in pregnant and non pregnant woman

Pendant la grossesse, la pression artérielle reste stable malgré une nette augmentation du volume d'éjection systolique et du débit cardiaque. Cette stabilité vient d'un côté d'une vasodilatation périphérique entraînant une diminution des résistances périphériques et d'un autre côté d'une moindre rigidité des principales artères notamment l'aorte. En conséquence, l'amplitude des ondes de pouls est atténuée, de même que leur vitesse de propagation dans le sens tant antérogade que rétrograde (ondes réfléchies). Les ondes réfléchies tendent ainsi à atteindre l'aorte ascendante plus tard durant la systole, voire durant la diastole, ce qui peut contribuer à diminuer la pression puisée. La prééclampsie perturbe massivement ce processus d'adaptation. Il s'agit d'une maladie hypertensive de la grossesse engendrant une importante morbidité et mortalité néonatale et maternelle. Il est à remarquer que la diminution de la rigidité artérielle n'est pas observée chez les patientes atteintes avec pour conséquence une forte augmentation de la pression systolique centrale (aortique) par les ondes réfléchies. Ce fait a été établi grâce à l'existence de la tonométrie d'aplanation, une méthode permettant l'évaluation non invasive de l'onde de pouls centrale. Dans cette méthode, un senseur de pression piézo-électrique permet de capter l'onde de pouls périphérique, le plus souvent sur l'artère radiale. Par la suite, un algorithme validé permet d'en déduire la forme de l'onde de pouls centrale et de visualiser à quel moment du cycle cardiaque s'y ajoutent les ondes réfléchies. Plusieurs études font état d'une forte augmentation de la pression systolique centrale par les ondes réfléchies chez les patientes atteintes de prééclampsie, suggérant l'utilisation de cette méthode pour le diagnostic et le monitoring voire pour le dépistage de ces patientes. Pour atteindre ce but, il est nécessaire d'établir des normes en rapport notamment avec l'âge gestationnel. Dans la littérature, les données pertinentes actuellement disponibles sont variables, voire contradictoires. Par exemple, les ondes réfléchies proéminentes dans la partie diastolique de l'onde de pouls centrale disparaissaient chez des patientes enceintes au 3eme trimestre comparées à des contrôles non enceintes dans une étude lausannoise, alors que deux autres études présentent l'observation contraire. Autre exemple, certains auteurs décrivent une diminution progressive de l'augmentation systolique jusqu'à l'accouchement alors que d'autres rapportent un nadir aux environs du 6ème mois, suivi d'un retour à des valeurs plus élevées en fin de grossesse. Les mesures effectuées dans toutes ces études différaient dans leur exécution, les patientes étant notamment dans des postions corporelles différentes (couchées, semi-couchées, assises, en décubitus latéral). Or nous savons que le status hémodynamique est très sensible aux changements de position, particulièrement durant la grossesse où l'utérus gravide est susceptible d'avoir des interactions mécaniques avec les veines et possiblement les artères abdominales. Ces différences méthodologiques pourraient donc expliquer, au moins en partie, l'hétérogénéité des résultats concernant l'onde de pouls chez la femme enceinte, ce qui à notre connaissance n'a jamais été exploré. Nous avons mesuré l'onde de pouls dans les positions assise et couchée chez des femmes enceintes, au 3eme trimestre d'une grossesse non compliquée, et nous avons effectué une comparaison avec des données similaire obtenues chez des femmes non enceintes en bonne santé habituelle. Les résultats montrent que la position du corps a un impact majeur sur la forme de l'onde de pouls centrale. Comparée à la position assise, la position couchée se caractérise par une moindre augmentation systolique et, par contraste, une augmentation diastolique plus marquée. De manière inattendue, cet effet s'observe aussi bien en présence qu'en l'absence de grossesse, suggérant que la cause première n'en réside pas dans les interactions mécaniques de l'utérus gravide avec les vaisseaux sanguins abdominaux. Nos observations pourraient par contre être expliquées par l'influence de la position du corps, via un phénomène hydrostatique simple, sur la pression transmurale des artères éloignées du coeur, tout particulièrement celles des membres inférieurs et de l'étage abdominal. En position verticale, ces vaisseaux augmenteraient leur rigidité pour résister à la distension de leur paroi, ce qui y accroîtrait la vitesse de propagation des ondes de pression. En l'état, cette explication reste hypothétique. Mais quoi qu'il en soit, nos résultats expliquent certaines discordances entre les études conduites à ce jour pour caractériser l'influence de la grossesse physiologique sur la forme de l'onde de pouls central. De plus, ils indiquent que la position du corps doit être prise en compte lors de toute investigation utilisant la tonométrie d'applanation pour déterminer la rigidité des artères chez les jeunes femmes enceintes ou non. Il sera aussi nécessaire d'en tenir compte pour établir des normes en vue d'une utilisation de la tonométrie d'aplanation pour dépister ou suivre les patientes atteintes de prééclampsie. Il serait enfin intéressant d'évaluer si l'effet de la position sur la forme de l'onde de pouls central existe également dans l'autre sexe et chez des personnes plus âgées.

Depinning transition of dislocation assemblies: Pileups and low-angle grain boundaries

We investigate the depinning transition occurring in dislocation assemblies. In particular, we consider the cases of regularly spaced pileups and low-angle grain boundaries interacting with a disordered stress landscape provided by solute atoms, or by other immobile dislocations present in nonactive slip systems. Using linear elasticity, we compute the stress originated by small deformations of these assemblies and the corresponding energy cost in two and three dimensions. Contrary to the case of isolated dislocation lines, which are usually approximated as elastic strings with an effective line tension, the deformations of a dislocation assembly cannot be described by local elastic interactions with a constant tension or stiffness. A nonlocal elastic kernel results as a consequence of long-range interactions between dislocations. In light of this result, we revise statistical depinning theories of dislocation assemblies and compare the theoretical results with numerical simulations and experimental data.

MODELING OF SOIL LOAD-BEARING CAPACITY AS A FUNCTION OF SOIL MECHANICAL RESISTANCE TO PENETRATION

Estimation of soil load-bearing capacity from mathematical models that relate preconsolidation pressure (σp) to mechanical resistance to penetration (PR) and gravimetric soil water content (U) is important for defining strategies to prevent compaction of agricultural soils. Our objective was therefore to model the σp and compression index (CI) according to the PR (with an impact penetrometer in the field and a static penetrometer inserted at a constant rate in the laboratory) and U in a Rhodic Eutrudox. The experiment consisted of six treatments: no-tillage system (NT); NT with chiseling; and NT with additional compaction by combine traffic (passing 4, 8, 10, and 20 times). Soil bulk density, total porosity, PR (in field and laboratory measurements), U, σp, and CI values were determined in the 5.5-10.5 cm and 13.5-18.5 cm layers. Preconsolidation pressure (σp) and CI were modeled according to PR in different U. The σp increased and the CI decreased linearly with increases in the PR values. The correlations between σp and PR and PR and CI are influenced by U. From these correlations, the soil load-bearing capacity and compaction susceptibility can be estimated by PR readings evaluated in different U.

Statistical mechanical theory of an oscillating isolated system: The relaxation to equilibrium

In this Contribution we show that a suitably defined nonequilibrium entropy of an N-body isolated system is not a constant of the motion, in general, and its variation is bounded, the bounds determined by the thermodynamic entropy, i.e., the equilibrium entropy. We define the nonequilibrium entropy as a convex functional of the set of n-particle reduced distribution functions (n ? N) generalizing the Gibbs fine-grained entropy formula. Additionally, as a consequence of our microscopic analysis we find that this nonequilibrium entropy behaves as a free entropic oscillator. In the approach to the equilibrium regime, we find relaxation equations of the Fokker-Planck type, particularly for the one-particle distribution function.

Least Limiting Water Range and Load Bearing Capacity of Soil under Types of Tractor-Trailers for Mechanical Harvesting of Green Sugarcane

ABSTRACT The expansion of the sugarcane industry in Brazil has intensified the mechanization of agriculture and caused effects on the soil physical quality. The purpose of this study was to evaluate the limiting water range and soil bearing capacity of a Latossolo Vermelho distroférrico típico (Rhodic Hapludox) under the influence of different tractor-trailers used in mechanical sugarcane harvesting. The experiment was arranged in a randomized block design with five replications. The treatments consisted of green sugarcane harvesting with: harvester without trailer (T1); harvester with two trailers with a capacity of 10 Mg each (T2); harvester with trailer with a capacity of 20 Mg (T3) and harvester and truck with trailer with a capacity of 20 Mg (10 Mg per compartment) (T4). The least limiting water range and soil bearing capacity were evaluated. The transport equipment to remove the harvested sugarcane from the field (trailer) at harvest decreased the least limiting water range, reducing the structural soil quality. The truck trailer caused the greatest impact on the soil physical properties studied. The soil load bearing capacity was unaffected by the treatments, since the pressure of the harvester (T1) exceeded the pre-consolidation pressure of the soil.

Analog circuit for real-time computation of respiratory mechanical impedance in sleep studies

The aim of this work was to develop a low-cost circuit for real-time analog computation of the respiratory mechanical impedance in sleep studies. The practical performance of the circuit was tested in six patients with obstructive sleep apnea. The impedance signal provided by the analog circuit was compared with the impedance calculated simultaneously with a conventional computerized system. We concluded that the low-cost analog circuit developed could be a useful tool for facilitating the real-time assessment of airway obstruction in routine sleep studies.

Moving from a Mechanical Microkeratome to a Femtosecond Laser for LASIK to Correct Astigmatic Patients: Clinical Outcomes of a Retrospective, Consecutive, Comparative Study.

Background: To evaluate outcomes after optimized laser in situ keratomileusis (LASIK) for astigmatism correction with flap created by a mechanical microkeratome or a femtosecond laser. Patients and Methods: In this retrospective study, a total of 102 eyes of 71 consecutive patients were enrolled undergoing optimized LASIK treatments using the Allegretto laser system (WaveLight Laser Technologie AG, Erlangen, Germany). A mechanical microkeratome for flap creation was used (One Use, Moria®) in 46 eyes (31 patients, spherical equivalent [SE] -4.44 D ± 2.4) and a femtosecond laser was used (LDV, Ziemer®) in 56 eyes (40 patients, spherical equivalent [SE] -3.07 D ± 3.3). The two groups were matched for inclusion criteria and were operated under similar conditions by the same surgeon. Results: Overall, the preoperative spherical equivalent was -9.5 diopters (D) to +3.37 D; the preoperative manifest astigmatism was between -1.5 D and -3.5 D. At 6 months postoperatively, the mean postoperative uncorrected distance visual acuity (UDVA) was 0.93 ± 0.17 (range 0.4 to 1.2) in the Moria group and 1.0 ± 0.21 (range 0.6 to 1.6) in the Femto group, which was statistically significant (p = 0.003). Comparing the cylinder power there was a statistical difference between the two groups (p = 0.0015). Conclusions: This study shows that the method of flap creation has a significant impact on postoperative astigmatism with a significantly better postoperative UDVA in the Femto group. These findings suggest that the femtosecond laser provides a better platform for LASIK treatment of astigmatism than the commonly used microkeratome.

Mechanical ventilation in the newborn; a simplified approach. Part 1: Intermittent positive pressure ventilation.

Positive pressure ventilation (PPV) is a frequent intervention in the neonatal intensive care unit. This article is directed towards paediatricians in training and attempts to cover the basics of PPV without being too technical. To do so we have employed an extensive use of graphics to illustrate the underlying principles.