Cardiopulmonary support and extracorporeal membrane oxygenation for cardiac assist.

BACKGROUND: Use of cardiopulmonary bypass for emergency resuscitation is not new. In fact, John Gibbon proposed this concept for the treatment of severe pulmonary embolism in 1937. Significant progress has been made since, and two main concepts for cardiac assist based on cardiopulmonary bypass have emerged: cardiopulmonary support (CPS) and extracorporeal membrane oxygenation (ECMO). The objective of this review is to summarize the state of the art in these two technologies. METHODS: Configuration of CPS is now fairly standard. A mobile cart with relatively large wheels allowing for easy transportation carries a centrifugal pump, a back-up battery with a charger, an oxygen cylinder, and a small heating system. Percutaneous cannulation, pump-driven venous return, rapid availability, and transportability are the main characteristics of a CPS system. Cardiocirculatory arrest is a major predictor of mortality despite the use of CPS. In contrast, CPS appears to be a powerful tool for patients in cardiogenic shock before cardiocirculatory arrest, requiring some type of therapeutic procedures, especially repair of anatomically correctable problems or bridging to other mechanical circulatory support systems such as ventricular assist devices. CPS is in general not suitable for long-term applications because of the small-bore cannulas, resulting in significant pressure gradients and eventually hemolysis. RESULTS: In contrast, ECMO can be designed for longer-term circulatory support. This requires large-bore cannulas and specifically designed oxygenators. The latter are either plasma leakage resistent (true membranes) or relatively thrombo-resistant (heparin coated). Both technologies require oxygenator changeovers although the main reason for this is different (clotting for the former, plasma leakage for the latter). Likewise, the tubing within a roller pump has to be displaced and centrifugal pump heads have to be replaced over time. ECMO is certainly the first choice for a circulatory support system in the neonatal and pediatric age groups, where the other assist systems are too bulky. ECMO is also indicated for patients improving on CPS. Septic conditions are, in general, considered as contraindications for ECMO. CONCLUSIONS: Ease of availability and moderate cost of cardiopulmonary bypass-based cardiac support technologies have to be balanced against the significant immobilization of human resources, which is required to make them successful.

Analizador de red (sniffer) en entorno GNU

Aquest projecte mira de reflectir els coneixements adquirits en les assignatures pròpies de la carrera, com ara Fonaments de programació, Sistemes operatius i Ampliació de sistemes operatius, Xarxes, Estructura de xarxes de computadors i Seguretat en xarxes de computadors.

Usabilitat en entorns mòbils

En aquest treball analitzarem la facilitat d'us dels dispositius mòbils. En particular una aplicació que ja incorporenmolts d'aquests dispositius com és l'agenda de contactes i el dietari.

El joc del TERCETI : una unitat didàctica multimèdia sobre GNU/LINUX amb suport DVB-MHP i SCORM.

Fent ús del programari lliure s'ha generat la unitat didàctica del joc del terceti per a la televisió digital interactiva i s'ha desada en format SCORM. La facilitat d'ús del comandament a distància fa possible practicar un tipus de t-learning fonamentat en l'edutainment (education+entertaiment) i provoca que el teleespectador passiu passi a ser un "teleusuari" més actiu.

Estudi d'usabilitat : Aplicació a la web de la Conselleria de Sanitat

Aquest treball mira de definir i situar la facilitat d'ús web. Per tal d'aconseguir-ho, fa un recull de les definicions de facilitat d'ús fetes pels principals experts, recull els principis que regulen la facilitat d'ús i revisa les principals tècniques associades.

Usabilitat en entorns de telèfons mòbils

Aquí es reuneix la documentació tècnica actual per a fer-ne un anàlisi de facilitat d'ús des del punt de vista de l'usuari. Se centra en les funcionalitats, les tecnologies actuals i les interfícies. La metodologia emprada per a fer les anàlisis i arribar a les conclusions consta de tres fases: fer un recull de la tecnologia i les funcionalitats necessàries i analitzar-ne la facilitat d'ús; establir grups d'usuaris amb necessitats comunes o perfils d'usuari, i definir els paràmetres de facilitat d'ús que fem servir en els tests d'usuaris-dispositius i en els dissenys de tests.

Diseño de un sistema de control de proyectos

El projecte es basa en la gestió de dades d'una empresa dedicada a la creació de programari per al sector immobiliari. Aquesta empresa té seu a diverses ciutats o centres, dividits en departaments, els quals inclouen els seus respectius treballadors. Els clients sol·liciten projectes a aquests centres i els assignen els corresponents caps de projecte i treballadors juntament amb les despeses que el projecte comporta. Totes aquestes dades seran emmagatzemades i gestionades per la base de dades.

Diseño e implementación de un framework de persistencia

Los Frameworks constituyen el nuevo paradigma en cuanto al desarrollo de software se refiere. Entre sus principales características se encuentran la facilidad para la reutilización de código. En este marco específico proporcionados por la tecnología usaremos la tecnología JAVA y su extensión en cuanto a la persistencia de datos. El Framework de persistencia es el responsable de gestionar la lógica de acceso a los datos en un SGBD (Sistema de Gestión de Bases de Datos), ya sea de entrada o salida, y ocultando los detalles más pesados relativos a la estructura propia de la Base de Datos utilizada, de manera completa y transparentemente. En conclusión, este proyecto se basa en un análisis del los Frameworks existentes, analizando sus características y profundizando en los detalles concretos de su actividad y manejo en cuanto a la persistencia.

Aplicación de un estudio de usabilidad en bibliotecas digitales : la Biblioteca Virtual de la UOC

The Open University of Catalonia (UOC) has conducted a study of operability of its user interfaces, creating for this purpose different work groups that have analyzed different casuistries. One of these groups focused on the study and analysis of the usability of the Virtual Library's website, with the objective of obtaining benefits for our users. As a result of this analysis, an important qualitative jump is occurring in the new implementation of the website of the UOC's Virtual Library, prioritizing the role of users from different points of view: ease of navigation, management of profiles and the services associated to these and the restructuring of the information architecture, with the final aim of facilitating access to the resources and the services offered from the Library, advocating in this way for their quality and improvement.

El mètode APT (Auto Adjusting Perturbation Theory) de diagonalització de matrius

Es presenta un nou algorisme per a la diagonalització de matrius amb diagonal dominant. Es mostra la seva eficàcia en el tractament de matrius no simètriques, amb elements definits sobre el cos complex i, fins i tot, de grans dimensions. Es posa de manifest la senzillesa del mètode així com la facilitat d'implementació en forma de codi de programació. Es comentenels seus avantatges i característiques limitants, així com algunes de les millores que es poden implementar. Finalment, es mostren alguns exemples numèrics

Self-Navigation with Compressed Sensing for 2D Translational Motion Correction in Free-Breathing Coronary MRI: A Feasibility Study.

PURPOSE: Respiratory motion correction remains a challenge in coronary magnetic resonance imaging (MRI) and current techniques, such as navigator gating, suffer from sub-optimal scan efficiency and ease-of-use. To overcome these limitations, an image-based self-navigation technique is proposed that uses "sub-images" and compressed sensing (CS) to obtain translational motion correction in 2D. The method was preliminarily implemented as a 2D technique and tested for feasibility for targeted coronary imaging. METHODS: During a 2D segmented radial k-space data acquisition, heavily undersampled sub-images were reconstructed from the readouts collected during each cardiac cycle. These sub-images may then be used for respiratory self-navigation. Alternatively, a CS reconstruction may be used to create these sub-images, so as to partially compensate for the heavy undersampling. Both approaches were quantitatively assessed using simulations and in vivo studies, and the resulting self-navigation strategies were then compared to conventional navigator gating. RESULTS: Sub-images reconstructed using CS showed a lower artifact level than sub-images reconstructed without CS. As a result, the final image quality was significantly better when using CS-assisted self-navigation as opposed to the non-CS approach. Moreover, while both self-navigation techniques led to a 69% scan time reduction (as compared to navigator gating), there was no significant difference in image quality between the CS-assisted self-navigation technique and conventional navigator gating, despite the significant decrease in scan time. CONCLUSIONS: CS-assisted self-navigation using 2D translational motion correction demonstrated feasibility of producing coronary MRA data with image quality comparable to that obtained with conventional navigator gating, and does so without the use of additional acquisitions or motion modeling, while still allowing for 100% scan efficiency and an improved ease-of-use. In conclusion, compressed sensing may become a critical adjunct for 2D translational motion correction in free-breathing cardiac imaging with high spatial resolution. An expansion to modern 3D approaches is now warranted.

Novel murine dendritic cell lines: a powerful auxiliary tool for dendritic cell research.

Research in vitro facilitates discovery, screening, and pilot experiments, often preceding research in vivo. Several technical difficulties render Dendritic Cell (DC) research particularly challenging, including the low frequency of DC in vivo, thorough isolation requirements, and the vulnerability of DC ex vivo. Critically, there is not as yet a widely accepted human or murine DC line and in vitro systems of DC research are limited. In this study, we report the generation of new murine DC lines, named MutuDC, originating from cultures of splenic CD8α conventional DC (cDC) tumors. By direct comparison to normal WT splenic cDC subsets, we describe the phenotypic and functional features of the MutuDC lines and show that they have retained all the major features of their natural counterpart in vivo, the splenic CD8α cDC. These features include expression of surface markers Clec9A, DEC205, and CD24, positive response to TLR3 and TLR9 but not TLR7 stimuli, secretion of cytokines, and chemokines upon activation, as well as cross-presentation capacity. In addition to the close resemblance to normal splenic CD8α cDC, a major advantage is the ease of derivation and maintenance of the MutuDC lines, using standard culture medium and conditions, importantly without adding supplementary growth factors or maturation-inducing stimuli to the medium. Furthermore, genetically modified MutuDC lines have been successfully obtained either by lentiviral transduction or by culture of DC tumors originating from genetically modified mice. In view of the current lack of stable and functional DC lines, these novel murine DC lines have the potential to serve as an important auxiliary tool for DC research.

Accelerated publication versus usual publication in 2 leading medical journals.

BACKGROUND: A number of medical journals have developed policies for accelerated publication of articles judged by the authors, the editors or the peer reviewers to be of special importance. However, the validity of these judgements is unknown. We therefore compared the importance of articles published on a "fast track" with those published in the usual way. METHODS: We identified 12 "case" articles--6 articles from the New England Journal of Medicine that were prereleased on the journal's Web site before publication in print and 6 "fast-tracked" articles from The Lancet. We then identified 12 "control" articles matched to the case articles according to journal, disease or procedure of focus, theme area and year of publication. Forty-two general internists rated the articles, using 10-point scales, on dimensions addressing the articles' importance, ease of applicability and impact on health outcomes. RESULTS: For each dimension, the mean score for the case articles was significantly higher than the mean score for the control articles: importance to clinical practice 7.6 v. 7.1 respectively (p = 0.001), importance from a public health perspective 6.5 v. 6.0 (p < 0.001), contribution to advancement of medical knowledge 6.2 v. 5.8 (p < 0.001), ease of applicability in practice 7.0 v. 6.5 (p < 0.001), potential impact on health outcomes 6.5 v. 5.9 (p < 0.001). Despite these general findings, in 5 of the 12 matched pairs of articles the control article had a higher mean score than the case article across all the dimensions. INTERPRETATION: The accelerated publication practices of 2 leading medical journals targeted articles that, on average, had slightly higher importance scores than similar articles published in the usual way. However, our finding of higher importance scores for control articles in 5 of the 12 matched pairs shows that current journal practices for selecting articles for expedited publication are inconsistent.

Extended bottom-up proteomics with secreted aspartic protease Sap9.

We investigate the benefits and experimental feasibility of approaches enabling the shift from short (1.7kDa on average) peptides in bottom-up proteomics to about twice longer (~3.2kDa on average) peptides in the so-called extended bottom-up proteomics. Candida albicans secreted aspartic protease Sap9 has been selected for evaluation as an extended bottom-up proteomic-grade enzyme due to its suggested dibasic cleavage specificity and ease of production. We report the extensive characterization of Sap9 specificity and selectivity revealing that protein cleavage by Sap9 most often occurs in the vicinity of proximal basic amino acids, and in select cases also at basic and hydrophobic residues. Sap9 is found to cleave a large variety of proteins in a relatively short, ~1h, period of time and it is efficient in a broad pH range, including slightly acidic, e. g., pH5.5, conditions. Importantly, the resulting peptide mixtures contain representative peptides primarily in the target 3-7kDa range. The utility and advantages of this enzyme in routine analysis of protein mixtures are demonstrated and the limitations are discussed. Overall, Sap9 has a potential to become an enzyme of choice in an extended bottom-up proteomics, which is technically ready to complement the traditional bottom-up proteomics for improved targeted protein structural analysis and expanded proteome coverage. BIOLOGICAL SIGNIFICANCE: Advances in biological applications of mass spectrometry-based bottom-up proteomics are oftentimes limited by the extreme complexity of biological samples, e.g., proteomes or protein complexes. One of the reasons for it is in the complexity of the mixtures of enzymatically (most often using trypsin) produced short (<3kDa) peptides, which may exceed the analytical capabilities of liquid chromatography and mass spectrometry. Information on localization of protein modifications may also be affected by the small size of typically produced peptides. On the other hand, advances in high-resolution mass spectrometry and liquid chromatography have created an intriguing opportunity of improving proteome analysis by gradually increasing the size of enzymatically-derived peptides in MS-based bottom-up proteomics. Bioinformatics has already confirmed the envisioned advantages of such approach. The remaining bottle-neck is an enzyme that could produce longer peptides. Here, we report on the characterization of a possible candidate enzyme, Sap9, which may be considered for producing longer, e.g., 3-7kDa, peptides and lead to a development of extended bottom-up proteomics.

The Smartcanula: a new tool for remote access perfusion in limited access cardiac surgery.

Devices for venous cannulation have seen significant progress over time: the original, rigid steel cannulas have evolved toward flexible plastic cannulas with wire support that prevents kinking, very thin walled wire wound cannulas allowing for percutaneous application, and all sorts of combinations. In contrast to all these rectilinear venous cannula designs, which present the same cross-sectional area over their entire intravascular path, the smartcanula concept of "collapsed insertion and expansion in situ" is the logical next step for venous access. Automatically adjusting cross-sectional area up to a pre-determined diameter or the vessel lumen provides optimal flow and ease of use for both, insertion and removal. Smartcanula performance was assessed in a small series of patients (76 +/- 17 kg) undergoing redo procedures. The calculated target pump flow (2.4 L/min/m2) was 4.42 +/- 61 L/ min. Mean pump flow achieved during cardiopulmonary bypass was 4.84 +/- 87 L/min or 110% of the target. Reduced atrial chatter, kink resistance in situ, and improved blood drainage despite smaller access orifice size, are the most striking advantages of this new device. The benefits of smart cannulation are obvious in remote cannulation for limited access cardiac surgery, but there are many other cannula applications where space is an issue, and that is where smart cannulation is most effective.