Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis

Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS: Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS: The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5%). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8%) 1 year after ileal pouch-anal anastomosis, 9 (14.8%) after 3 years, 13 (21.3%) after 5 years, and 16 (26.2%) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later. CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.

Prognostic factors in locally advanced colon cancer treated by extended resection

The impact of clinical, pathologic, and surgical variables on the postoperative morbidity, mortality, and survival of patients undergoing extended resections of colon carcinoma were evaluated. METHODS: The medical records of 95 patients who underwent extended resections for colon carcinoma between 1953 and 1996 were reviewed. In all cases, in addition to colectomy, 1 or more organs and/or structures were resected en bloc due to a macroscopically based suspicion of tumor invasion. The clinical, pathologic, and surgical parameters were analyzed. Overall survival rates were analyzed according to the method of Kaplan and Meier. Multivariate analysis was performed using the Cox proportional hazards model. RESULTS: Eighty-six patients were treated by curative surgeries and the remaining by palliative resections. Invasion of the organs and/or adjacent structures and regional lymph nodes was found microscopically in 48 and 31 patients, respectively. The median follow-up without postoperative mortality was 47.7 months. The 5-year overall survival rates was 52.6%. The 5-year overall survival rates for patients undergoing curative and palliative surgeries was 58.3% and 0%, respectively. The mean survival time in the palliative surgery group was 3.1 months. Multivariate analysis showed that Karnofsky performance status was strongly related to the risk of postoperative complications (P = .01), and postoperative deaths were associated with the type of surgery and Karnofsky performance status at the time of admission (P = .001). CONCLUSIONS: Some patients with locally advanced colon adenocarcinomas undergoing extended resections have a 5-year overall survival rates of 58.3%. Patients could benefit from palliative-intent procedures, but these measures should cautiously be indicated and avoided in patients with low Karnofsky performance status due to high rates of postoperative mortality and poor survival.

Survey and dynamic behaviour of the Our Lady of Conception Church, Portugal

The Our Lady of Conception church is located in village of Monforte (Portugal) and is not in use nowadays. The church presents structural damage and, consequently, a study was carried out. The study involved the survey of the damage, dynamic identification tests under ambient vibration and the numerical analysis. The church is constituted by the central nave, the chancel, the sacristy and the corridor to access the pulpit. The masonry walls present different thickness, namely 0.65 m in the chancel, 0.70 m in the sacristy, 0.92 in the central nave and 0.65 m in the corridor. The masonry walls present 8 buttresses with different dimensions. The total longitudinal and transversal dimensions of the church are equal to 21.10 m and 14.26 m, respectively. The survey of the damage showed that, in general, the masonry walls are in good conditions, with exception of the transversal walls of the nave, which present severe cracks. The arches of the vault presents also severe cracks along the central nave. As consequence, the infiltrations have increased the degradation of the vault and paintings. Furthermore, the foundations present settlements in the Southwest direction. The dynamic identification test were carried out under the action of ambient excitation of the wind and using 12 piezoelectric accelerometers of high sensitivity. The dynamic identification tests allowed to estimate the dynamic properties of the church, namely frequencies, mode shapes and damping ratios. A FEM numerical model was prepared and calibrated, based on the first four experimental modes estimated in the dynamic identification tests. The average error between the experimental and numerical frequencies of the first four modes is equal to 5%. After calibration of the numerical model, pushover analyses with a load pattern proportional to the mass, in the transversal and longitudinal direction of the church, were performed. The results of the analysis numerical allow to conclude that the most vulnerable direction of the church is in the transversal one and the maximum load factor is equal to 0.35.

Seismic vulnerability of existing masonry buildings: Nonlinear parametric analysis

Existing masonry structures are usually associated to a high seismic vulnerability, mainly due to the properties of the materials, weak connections between floors and load-bearing walls, high mass of the masonry walls and flexibility of the floors. For these reasons, the seismic performance of existing masonry structures has received much attention in the last decades. This study presents the parametric analysis taking into account the deviations on features of the gaioleiro buildings - Portuguese building typology. The main objective of the parametric analysis is to compare the seismic performance of the structure as a function of the variations of its properties with respect to the response of a reference model. The parametric analysis was carried out for two types of structural analysis, namely for the non-linear dynamic analysis with time integration and for the pushover analysis with distribution of forces proportional to the inertial forces of the structure. The Young's modulus of the masonry walls, Young's modulus of the timber floors, the compressive and tensile non-linear properties (strength and fracture energy) were the properties considered in both type of analysis. Additionally, in the dynamic analysis, the influences of the vis-cous damping and of the vertical component of the earthquake were evaluated. A pushover analysis proportional to the modal displacement of the first mode in each direction was also carried out. The results shows that the Young's modulus of the masonry walls, the Young's modulus of the timber floors and the compressive non-linear properties are the pa-rameters that most influence the seismic performance of this type of tall and weak existing masonry structures. Furthermore, it is concluded that that the stiffness of the floors influences significantly the strength capacity and the collapse mecha-nism of the numerical model. Thus, a study on the strengthening of the floors was also carried out. The increase of the thickness of the timber floors was the strengthening technique that presented the best seismic performance, in which the reduction of the out-of-plane displacements of the masonry walls is highlighted.

Density, size and distribution of stomata in 35 rainforest tree species in Central Amazonia

Stomata are turgor-operated valves that control water loss and CO2 uptake during photosynthesis, and thereby water relation and plant biomass accumulation is closely related to stomatal functioning. The aims of this work were to document how stomata are distributed on the leaf surface and to determine if there is any significant variation in stomatal characteristics among Amazonian tree species, and finally to study the relationship between stomatal density (S D) and tree height. Thirty five trees (>17 m tall) of different species were selected. Stomatal type, density (S D), size (S S) and stomatal distribution on the leaf surface were determined using nail polish imprints taken from both leaf surfaces. Irrespective of tree species, stomata were located only on the abaxial surface (hypostomaty), with large variation in both S D and S S among species. S D ranged from 110 mm-2 in Neea altissima to 846 mm-2 in Qualea acuminata. However, in most species S D ranges between 271 and 543 mm-2, with a negative relationship between S D and S S. We also found a positive relationship between S D and tree height (r² = 0.14, p < 0.01), but no correlation was found between S D and leaf thickness. The most common stomatal type was anomocytic (37%), followed by paracytic (26%) and anisocytic (11%). We conclude that in Amazonian tree species, stomatal distribution on the leaf surface is a response most likely dependent on the genetic background of every species, rather than a reaction to environmental changes, and that somehow S D is influenced by environmental factors dependent on tree height.

Mineralogical and geochemical influences on sediment color of Amazon wetlands analyzed by visible spectrophotometry

Based on sedimentological and geochemical data, this work relates spectrophotometric measurements with sediment composition and its application in palaeoecological studies of Amazon wetlands. The CIELAB values are directly related to mineralogical and chemical composition, mostly involving quartz, iron oxyhydroxides and sulfides (e.g. pyrite), and total organic carbon. Total organic carbon contents between 0.4-1%, 1-2%, 3-5% and 15-40% were related to L* (lightness) data of 27, 26-15, 7-10 and 7 or less, respectively. The CIELAB values of a deposit in Marabá, Pará, were proportional to variations in quartz and total organic carbon contents, but changes in zones of similar color, mainly in the +a* (red) and +b* (yellow) values of deposits in Calçoene, Amapá and Soure, Pará, indicate a close relationship between total organic carbon content and iron oxyhydroxides and sulfides. Furthermore, the Q7/4 diagram (ratio between the % re?ectance value at 700 nm to that at 400 nm, coupled with L*) indicated iron-rich sediments in the bioturbated mud facies of the Amapá deposit, bioturbated mud and bioturbated sand facies of Soure deposit, and cross-laminated sand and massive sand facies of the Marabá core. Also, organic-rich sediments were found in the bioturbated mud facies of the Amapá deposit, lenticular heterolithic and bioturbated mud facies of the Soure deposit, and laminated mud and peat facies of the Marabá deposit. At the Marabá site, the data suggest an autochthonous influence with peat formation. The coastal wetland sites at Marajó and Amapá represent the development of a typical tidal flat setting with sulfide and iron oxyhydroxides formation during alternated flooding and drying.

Spatial-temporal variation of dissolved inorganic material in the Amazon basin

The Amazon River basin is important in the contribution of dissolved material to oceans (4% worldwide). The aim of this work was to study the spatial and the temporal variability of dissolved inorganic materials in the main rivers of the Amazon basin. Data from 2003 to 2011 from six gauging stations of the ORE-HYBAM localized in Solimões, Purus, Madeira and Amazon rivers were used for this study. The concentrations of Ca2+, Na+, K+, Mg2+, Cl-, SO4 -2, HCO3 - and SiO2 were analyzed. At the stations of Solimões and Amazon rivers, the concentrations of Ca2+, Mg2+, HCO3 - and SO4 -2 had heterogeneous distribution over the years and did not show seasonality. At the stations of Madeira river, the concentration of these ions had seasonality inversely proportional to water discharge (dilution-concentration effect). Similar behavior was observed for the concentrations of Cl- and Na+ at the stations of the Solimões, Amazon and Madeira rivers, indicating almost constant release of Cl- and Na+ fluxes during the hydrological cycle. K+ and SiO2 showed almost constant concentrations throughout the years and all the stations, indicating that their flows depend on the river discharge variation. Therefore, the temporal variability of the dissolved inorganic material fluxes in the Solimões and Amazon rivers depends on the hydro-climatic factor and on the heterogeneity of the sources. In the Madeira and Purus rivers there is less influence of these factors, indicating that dissolved load fluxes are mainly associated to silicates weathering. As the Solimões basin contributes approximately 84% of the total flux of dissolved materials in the basin and is mainly under the influence of a hydro-climatic factor, we conclude that the temporal variability of this factor controls the temporal variability of the dissolved material fluxes of the Amazon basin.

Vanishing spin stiffness in the spin-1/2 Heisenberg chain for any nonzero temperature

Whether at the zero spin density m = 0 and finite temperatures T > 0 the spin stiffness of the spin-1/2 XXX chain is finite or vanishes remains an unsolved and controversial issue, as different approaches yield contradictory results. Here we explicitly compute the stiffness at m = 0 and find strong evidence that it vanishes. In particular, we derive an upper bound on the stiffness within a canonical ensemble at any fixed value of spin density m that is proportional to m2L in the thermodynamic limit of chain length L → ∞, for any finite, nonzero temperature, which implies the absence of ballistic transport for T > 0 for m = 0. Although our method relies in part on the thermodynamic Bethe ansatz (TBA), it does not evaluate the stiffness through the second derivative of the TBA energy eigenvalues relative to a uniform vector potential. Moreover, we provide strong evidence that in the thermodynamic limit the upper bounds on the spin current and stiffness used in our derivation remain valid under string deviations. Our results also provide strong evidence that in the thermodynamic limit the TBA method used by X. Zotos [Phys. Rev. Lett. 82, 1764 (1999)] leads to the exact stiffness values at finite temperature T > 0 for models whose stiffness is finite at T = 0, similar to the spin stiffness of the spin-1/2 Heisenberg chain but unlike the charge stiffness of the half-filled 1D Hubbard model.

Válvula rotativa inovadora para motores a 2 tempos possibilitando sobre-expansão

Dissertação de mestrado integrado em Engenharia Mecânica

Joint modelling of longitudinal and survival data on breast cancer

Tese de Doutoramento em Ciências (Especialidade em Matemática)

Aproveitamento de energia em sistemas de abastecimento de água

Dissertação de mestrado integrado em Engenharia Civil

Concise server-wide causality management for eventually consistent data stores

Large scale distributed data stores rely on optimistic replication to scale and remain highly available in the face of net work partitions. Managing data without coordination results in eventually consistent data stores that allow for concurrent data updates. These systems often use anti-entropy mechanisms (like Merkle Trees) to detect and repair divergent data versions across nodes. However, in practice hash-based data structures are too expensive for large amounts of data and create too many false conflicts. Another aspect of eventual consistency is detecting write conflicts. Logical clocks are often used to track data causality, necessary to detect causally concurrent writes on the same key. However, there is a nonnegligible metadata overhead per key, which also keeps growing with time, proportional with the node churn rate. Another challenge is deleting keys while respecting causality: while the values can be deleted, perkey metadata cannot be permanently removed without coordination. Weintroduceanewcausalitymanagementframeworkforeventuallyconsistentdatastores,thatleveragesnodelogicalclocks(BitmappedVersion Vectors) and a new key logical clock (Dotted Causal Container) to provides advantages on multiple fronts: 1) a new efficient and lightweight anti-entropy mechanism; 2) greatly reduced per-key causality metadata size; 3) accurate key deletes without permanent metadata.

Influência do fator visão do céu na propagação do ruído em zonas urbanas

Dissertação de mestrado integrado em Engenharia Civil

Dynamic three-dimensional reconstruction of the heart by transesophageal echocardiography

OBJECTIVE: To evaluate echocardiography accuracy in performing and obtaining images for dynamical three-dimensional (3D) reconstruction. METHODS: Three-dimensional (3D) image reconstruction was obtained in 20 consecutive patients who underwent transesophageal echocardiography. A multiplanar 5 MHz transducer was used for 3D reconstruction. RESULTS: Twenty patients were studied consecutively. The following cardiac diseases were present: valvar prostheses-6 (2 mitral, 2 aortic and 2 mitral and aortic); mitral valve prolapse- 3; mitral and aortic disease - 2; aortic valve disease- 5; congenital heart disease- 3 (2 atrial septal defect- ASD - and 1 transposition of the great arteries -TGA); arteriovenous fistula- 1. In 7 patients, color Doppler was also obtained and used for 3D flow reconstruction. Twenty five cardiac structures were acquired and 60 reconstructions generated (28 of mitral valves, 14 of aortic valves, 4 of mitral prostheses, 7 of aortic prostheses and 7 of the ASD). Fifty five of 60 (91.6%) reconstructions were considered of good quality by 2 independent observers. The 11 reconstructed mitral valves/prostheses and the 2 reconstructed ASDs provided more anatomical information than two dimensional echocardiography (2DE) alone. CONCLUSION: 3D echocardiography using a transesophageal transducer is a feasible technique, which improves detection of anatomical details of cardiac structures, particularly of the mitral valve and atrial septum.

Immediate and long term evolution of valve replacement in children less than 12 years old

OBJECTIVE: The aim of this work was the follow-up and evaluation of valve replacement in children under 12 years of age. METHODS: Forty-four children less than 12 years old were underwent valve replacement at INCOR-HCFMUSP between January 1986 and December 1992. Forty (91%) were rheumatic, 39 (88.7%) were in functional classes II or IV, 19 (43.2%) were operated upon on an emergency basis, and 6 (13.6%) had atrial fibrillation. Biological prostheses (BP) were employed in 26 patients (59.1%), and mechanical prostheses (MP) in 18 (40.9%). Mitral valves were replaced in 30 (68.7%), aortic valves in 8 (18.2%), a tricuspid valve in 1 (2.3%), and double (aortic and mitral) valves in 5 (11.4) of the patients. RESULTS: Hospital mortality was of 4.5% (2 cases). The mean follow-up period was 5.8 years. Re-operations occurred in 63.3% of the patients with BP and in 12.5% of those with MP (p=0.002). Infectious endocarditis was present in 26.3% of the BP, but in none of the cases of MP (p=0.049). Thrombosis occurred in 2 (12.5%) and hemorrhage in one (6.5%) of the patients with a MP. Delayed mortality occurred in 5 (11.9%) of the patients over a mean period of 2.6 years; four had had BP and one had a MP (NS). Actuarial survival and re-operation-free curves after 10 years were respectively, 82.5±7.7 (SD)% and 20.6±15.9%. CONCLUSION: Patients with MP required fewer re-operation, had less infectious endocarditis and lower late mortality rates compared with patients with bioprostheses. The former, therefore, appear to be the best valve replacement for pediatric patients.