High-risk patients and high-risk grafts in infrainguinal bypass for critical limb ischaemia

The main purpose of revascularization procedures for critical limb ischaemia (CLI) is to preserve the leg and sustain the patient s ambulatory status. Other goals are ischaemic pain relief and healing of ischaemic ulcers. Patients with CLI are usually old and have several comorbidities affecting the outcome. Revascularization for CLI is meaningless unless both life and limb are preserved. Therefore, the knowledge of both patient- and bypass-related risk factors is of paramount importance in clinical decision-making, patient selection and resource allocation. The aim of this study was to identify patient- and graft-related predictors of impaired outcome after infrainguinal bypass for CLI. The purpose was to assess the outcome of high-risk patients undergoing infrainguinal bypass and to evaluate the usefulness of specific risk scoring methods. The results of bypasses in the absence of optimal vein graft material were also evaluated, and the feasibility of the new method of scaffolding suboptimal vein grafts was assessed. The results of this study showed that renal insufficiency - not only renal failure but also moderate impairment in renal function - seems to be a significant risk factor for both limb loss and death after infrainguinal bypass in patients with CLI. Low estimated GFR (PIENEMPI KUIN 30 ml/min/1.73 m2) is a strong independent marker of poor prognosis. Furthermore, estimated GFR is a more accurate predictor of survival and leg salvage after infrainguinal bypass in CLI patients than serum creatinine level alone. We also found out that the life expectancy of octogenarians with CLI is short. In this patient group endovascular revascularization is associated with a better outcome than bypass in terms of survival, leg salvage and amputation-free survival especially in presence of coronary artery disease. This study was the first one to demonstrate that Finnvasc and modified Prevent III risk scoring methods both predict the long-term outcome of patients undergoing both surgical and endovascular infrainguinal revascularization for CLI. Both risk scoring methods are easy to use and might be helpful in clinical practice as an aid in preoperative patient selection and decision-making. Similarly than in previous studies, we found out that a single-segment great saphenous vein graft is superior to any other autologous vein graft in terms of mid-term patency and leg salvage. However, if optimal vein graft is lacking, arm vein conduits are superior to prosthetic grafts especially in infrapopliteal bypasses for CLI. We studied also the new method of scaffolding suboptimal quality vein grafts and found out that this method may enable the use of vein grafts of compromised quality otherwise unsuitable for bypass grafting. The remarkable finding was that patients with the combination of high operative risk due to severe comorbidities and risk graft have extremely poor survival, suggesting that only relatively fit patients should undergo complex bypasses with risk grafts. The results of this study can be used in clinical practice as an aid in preoperative patient selection and decision-making. In the future, the need of vascular surgery will increase significantly as the elderly and diabetic population increases, which emphasises the importance of focusing on those patients that will gain benefit from infrainguinal bypass. Therefore, the individual risk of the patient, ambulatory status, outcome expectations, the risk of bypass procedure as well as technical factors such as the suitability of outflow anatomy and the available vein material should all be assessed and taken into consideration when deciding on the best revascularization strategy.

Impedance parameters and the state-of-charge. III. Zinc-manganese dioxide and magnesium-manganese dioxide dry batteries

The problem of non-destructive determination of the state-of-charge of zinc- and magnesium-manganese dioxide dry batteries is examined experimentally from the viewpoint of internal impedance and open-circuit voltage at equilibrium. It is shown that the impedance is mainly charge-transfer controlled at relatively high states-of-charge and progressively changes over to diffusion control as the state-of-charge decreases in the case of zinc-manganese dioxide dry batteries. On the other hand, the impedance is mainly diffusion controlled for undischarged batteries but becomes charge-transfer controlled as soon as there is some discharge in the case of magnesium-manganese dioxide batteries. It is concluded that the determination of state-of-charge is not possible for both types of batteries by the measurement of impedance parameters due to film-induced fluctuations of these parameters. The measurement of open-circuit voltage at equilibrium can be used as a state-of-charge indicator for Zn-MnO2 batteries but not for Mg-MnO2 batteries.

Impedance parameters and the state-of-charge. II. Lead-acid battery

The determination of the state-of-charge of the lead-acid battery has been examined from the viewpoint of internal impedance. It is shown that the impedance is controlled by charge transfer and to a smaller extent by diffusion processes in the frequency range 15–100 Hz. The equivalent series/parallel capacitance as well as the a.c. phase-shift show a parabolic dependence upon the state-of-charge, with a maximum or minimum at 50% charge. These results are explained on the basis of a uniform transmission-line analog equivalent circuit for the battery electrodes.

Experimental evaluation of the aeroacoustic characteristics of a source of pulsating gas flow

Amongv arioums ethodtsh,e t ransmissliionne o r thei mpedantcueb em ethohda sb eenm ospt opulafro r thee xperimenetavla luatioonf thea cousticiaml pedanocef a terminatioTnh. ee xistinmg ethodisn,c luding theo nesre porteeda rlierb, y thea uthorrse quirleo catioonf thes oundp ressumrei nima nd/orm axima, or elsem akeu se0 f somei terativep rocedureTsh. e presenpt aperd ealsw ith a methodo f analysios f standinwga vews hichd oesn otd epenodn anyo f thesein volvepdr ocedureIts i.s applicabtloe thec aseo f stationarays w ella sm ovingm ediaI.t enableosn to evaluatteh e impedancoef anyp assivbel ackb ox,a s well as the aeroacoustcich aracteristicosf a sourceo f pulsatingg asf low, with the leaste xperimentawl ork andc omputatiotinm ea ndw itht hee xtraa dvantagoef usinga givenim pedanctueb ef or wavelengtahss largea s fourt imesit s lengthA. methodo f externaml easuremenntost, involvinugs eo f anyi mpedance tubef, or evaluatintgh ea eroacouscthica racteristoicf as sourcoef pulsatingga sf lowi s alsod ealtw ith, based on the definition of attenuation or insertion loss of a muffler.

The crystal structure of the dipotassium salt of uridine 5'-diphosphate

C9H12N2Ot2P22-. 2K + .3H20 is orthorhombic, P2~2~2p with a = 18.977 (5), b - 22.597 (6), c = 8.995 (2) A, Z = 8. The structure was refined to R = 0.059 for 2587 observed reflexions. The two molecules of the asymmetric unit have very similar conformations with a 2'- endo sugar pucker and a folded pyrophosphate chain. They form a dimer, coordinated by the K + ions but without direct bridging between the base and the pyrophosphate within each individual molecule. One uracil base has the keto-enol and the other the diketo form. The extended structure shows alternating hydrophobic and hydrophilic regions.

Ability of human chorionic gonadotropin beta-subunit to inhibit the steroidogenic response to lutropin.

Ability of the beta-subunit of human chorionic gonadotropin to inhibit the response to lutropin (luteinizing hormone, LH) was tested in the immature rat ovarian system and pregnant-mare-serum-gonadotropin-primed rat ovarian system with progesterone production being used as the response. Human chorionic gonadotropin beta-subunit was found to inhibit human and ovine lutropin-stimulated progesterone production. At a constant dose of lutropin, inhibition was dependent on the concentration of beta-subunit. When concentration of the beta-subunit was kept constant at 5.0 microgram/ml and the concentration of lutropin was varied, the inhibition was maximum at the saturating concentration of the native hormone. The alpha-subunit of the human chorionic gonadotropin did not inhibit the response to lutropin. The lutropin/beta-subunit ratio required to produce an inhibition of response was much lower than that required to bring about an observable inhibition of binding.

Impedance parameters and the state-of charge. I. Nickel-cadmium battery

The problem of nondestructive determination of the state-of-charge of nickel-cadmium batteries has been examined experimentally as well as theoretically from the viewpoint of internal impedance. It is shown that the modulus of the impedance is mainly controlled by diffusion at all states of charge. Even so, a prediction of the state of charge is possible if the equivalent series/parallel capacitance or the alternating current phase shift is measured at a sufficiently low a.c. test frequency (5–30 Hz) which also avoids inductive effects. These results are explained on the basis of a uniform transmission-line analog equivalent circuit for the battery electrodes.

Kampylobakteerit Korkeasaaren eläintarhan eläimissä

Kampylobakteerit on tunnistettu vasta viimeisten 30 vuoden aikana merkittäviksi ihmisten tautien aiheuttajiksi. Termofiiliset kampylobakteerit Campylobacter jejuni ja C. coli ovat yleisin bakteeriperäisten suolistoinfektioden syy maailmanlaajuisesti. Pääasiallinen oire on ripuli. C. jejuni voi aiheuttaa myös jälkitauteja, kuten reaktiivista niveltulehdusta, nokkosihottumaa tai kyhmyruusua (erytema nodosum). Näitä kuitenkin ilmaantuu harvoin (<1 %). Tärkein jälkitauti on Guillain-Barrén syndrooma, joka on akuutti ääreishermoja demyelinisoiva sairaus. Kesällä 2008 Helsingin yliopistossa toteutettiin tutkimus, jonka tarkoituksena oli kartoittaa kampylobakteerien esiintymistä Korkeasaaren eläintarhassa ja tunnistaa löytyneet kampylobakteerit lajitasolle. Aineisto koostui 196 tarhaeläimen ulostenäytteestä, kahdeksasta Korkeasaaressa vapaana olleen valkoposkihanhen ulostenäytteestä sekä 12 ympäristönäytteestä (vesinäytteitä). Vesinäytteet olivat eläinten kahluualtaista tai häkeissä kulkevista puroista. Ulostenäytteet olivat peräisin kaikkiaan 71 eläinlajista. Tutkituista eläinlajeista 40 oli nisäkkäitä, 26 oli lintuja ja viisi oli matelijoita. Näytteistä eristettyjen isolaattien tulosten perusteella ulostenäytteistä 21 (10,7 %) oli positiivisia kampylobakteerien suhteen. Eläinlajeja tarkasteltaessa kampylobakteerien suhteen positiivisia oli 17 (23,9 %) eläinlajia. Näistä kymmenen oli lintuja, kuusi nisäkkäitä ja yksi matelija. Positiiviseksi C. jejunin suhteen osoittautui 18 ulostenäytettä. Yhdestä emun näytteestä löytyi C. jejunin lisäksi myös C. coli. Kahdessa näytteessä, rubiini-ibis ja kannuskilpikonna, kasvoi jokin muu kampylobakteeri kuin C. jejuni tai C. coli. Eläinlajeja tarkasteltaessa voidaan todeta, että 15 (21,1 %) todettiin positiivisiksi C. jejunin suhteen. Näistä kymmenen oli lintuja ja viisi nisäkkäitä. C. coli löytyi vain yhdestä (1,4 %) eläinlajista (linnusta) sekä jokin muu kampylobakteeri kuin C. jejuni tai C. coli löytyi kahdesta (2,8 %) eläinlajista (yksi lintu ja yksi matelija). Vain yksi ulostenäyte osoittautui positiiviseksi arkobakteerin suhteen. Kyseessä oli rubiini-ibiksen näyte. Samasta näytteestä löydettiin myös C. jejuni. Kahdesta valkoposkihanhien näytteestä löytyi sekä helikobakteeri että C. jejuni. Viisi ympäristönäytettä osoittautui positiiviseksi arkobakteerien suhteen. Kolme positiivista näytettä oli lintualtaista ja kaksi nisäkkäiden altaista. Rubiini-ibiksen altaasta löytyi arkobakteerin lisäksi myös C. jejuni. Lähes kaikissa vesinäytteissä (9/12) oli koliformisia bakteereja Colilert® testillä yli määritysrajan (>2419,6 bakteeria 100 ml:ssa näytettä). Suurimmasta osasta vesinäytteitä (8/12) saatiin tulokseksi myös yli menetelmän määritysrajan E. colia. Kaikenkaikkiaan tulosten perusteella voi päätellä, että vierailijoiden riski saada kampylobakterioosi Korkeasaaren eläintarhassa on suhteellisen pieni. Ainoana suurempana riskitekijänä voisi pitää valkoposkihanhien ulostetta. Sitä on maassa runsaasti ja sitä saattaa myös kulkeutua kenkien mukana jopa kotiin asti. Eläintarhan työntekijöiden tulee muistaa hyvä käsihygienia oltuaan kosketuksissa joko eläimien kanssa tai käytyään näiden tarhoissa. Työntekijät saattavat myös levittää eläintarhan eläinten ulostetta saappaissaan vierailijoidenkin kulkureiteille.

Effect of wall thickness on the end corrections of the extended inlet and outlet of a double-tuned expansion chamber

Simple expansion chambers, the simplest of the muffler configurations, have very limited practical application due to the presence of periodic troughs in the transmission loss spectrum which drastically lower the overall transmission loss of the muffler. Tuned extended inlet and outlet can be designed to nullify three-fourths of these troughs, making use of the plane wave theory. These cancellations would not occur unless one altered the geometric lengths for the extended tube in order to incorporate the effect of evanescent higher-order modes (multidimensional effect) through end corrections or lumped inertance approximation at the area discontinuities or junctions. End corrections of the extended inlet and outlet have been studied by several researchers. However the effect of wall thickness of the inlet/outlet duct on end correction has not been studied explicitly. This has significant effect on the tuning of an extended inlet/outlet expansion chamber. It is investigated here experimentally as well as numerically (through use of 3-D FEM software) for stationary medium. Crown Copyright (C) 2010 Published by Elsevier Ltd. All rights reserved.

A Genetic Study of Immunoglobulin E and Atopic Disease Based on Families Ascertained through Asthmatic Children

In order to investigate the modes of inheritance of serum immunoglobulin E (IgE) levels and atopic disease, serum IgE levels and data on allergic disease were obtained from 42 families ascertained through asthmatic children visiting an allergy clinic. Although the mean IgE levels were elevated (mean 637 U/ml), the prevalence of atopic disease in this population was surprisingly low. When the data were analyzed using complex segregation analysis, no major locus could be detected. Moreover, the polygenic heritability was unexpectedly small even though the correlation between serum IgE levels and the liability to atopic disease was around 0.4. Given this unusual set of findings, it is postulated that parasitic infections in this population have (in accordance with well-established results of parasitic disease) caused both elevated levels of serum IgE and a decreased prevalence of allergic disease with the possible masking of the various genetic components of serum IgE levels and atopic disease.

Harvesting undelimbed Scots pine (Pinus sylvestris L.) from first thinnings for integrated production of kraft pulp and energy

The present study evaluates the feasibility of undelimbed Scots pine (Pinus sylvestris L.) for integrated production of pulp and energy in a kraft pulp mill from the technical, economic and environmental points of view, focusing on the potential of bundle harvesting. The feasibility of tree sections for pulp production was tested by conducting an industrial wood-handling experiment, laboratory cooking and bleaching trials, using conventional small-diameter Scots pine pulpwood as a reference. These trials showed that undelimbed Scots pine sections can be processed in favourable conditions as a blend with conventional small-diameter pulpwood without reducing the pulp quality. However, fibre losses at various phases of the process may increase when using undelimbed material. In the economic evaluation, both pulp production and wood procurement costs were considered, using the relative wood paying capability of a kraft pulp mill as a determinant. The calculations were made for three Scots pine first-thinning stands with the breast-height diameter of the removal (6 12 cm) as the main distinctive factor. The supply chains included in the comparison were based on cut-to-length harvesting, whole-tree harvesting and bundle harvesting (whole-tree bundling). With the current ratio of pulp and energy prices, the wood paying capability declines with an increase in the proportion of the energy fraction of the raw material. The supply system based on the cut-to-length method was the most efficient option, resulting in the highest residual value at stump in most cases. A decline in the pulp price and an increase in the energy price improved the competitiveness of the whole-tree systems. With short truck transportation distances and low pulp prices, however, the harvesting of loose whole trees can result in higher residual value at stump in small-diameter stands. While savings in transportation costs did not compensate for the high cutting and compaction costs by the second prototype of the bundle harvester, an increase in transportation distances improved its competitiveness. Since harvesting undelimbed assortments increases nutrient export from the site, which can affect soil productivity, the whole-tree alternatives included in the present study cannot be recommended on infertile peatlands and mineral soils. The harvesting of loose whole trees or bundled whole trees implies a reduction in protective logging residues and an increase in site traffic or payloads. These factors increase the risk of soil damage, especially on peat soils with poor bearing capacity. Within the wood procurement parameters which were examined, the CO2 emissions of the supply systems varied from 13 27 kg m3. Compaction of whole trees into bundles reduced emissions from transportation by 30 39%, but these reductions were insufficient to compensate for the increased emissions from cutting and compaction.

Random-Restart Reactive Tabu Search Algorithm for Detection in Large-MIMO Systems

We present a low-complexity algorithm based on reactive tabu search (RTS) for near maximum likelihood (ML) detection in large-MIMO systems. The conventional RTS algorithm achieves near-ML performance for 4-QAM in large-MIMO systems. But its performance for higher-order QAM is far from ML performance. Here, we propose a random-restart RTS (R3TS) algorithm which achieves significantly better bit error rate (BER) performance compared to that of the conventional RTS algorithm in higher-order QAM. The key idea is to run multiple tabu searches, each search starting with a random initial vector and choosing the best among the resulting solution vectors. A criterion to limit the number of searches is also proposed. Computer simulations show that the R3TS algorithm achieves almost the ML performance in 16 x 16 V-BLAST MIMO system with 16-QAM and 64-QAM at significantly less complexities than the sphere decoder. Also, in a 32 x 32 V-BLAST MIMO system, the R3TS performs close to ML lower bound within 1.6 dB for 16-QAM (128 bps/Hz), and within 2.4 dB for 64-QAM (192 bps/Hz) at 10(-3) BER.

Purification and properties of xylanase from the thermophilic fungus, Humicola lanuginosa (Griffon and Maublanc) Bunce

An extracellular xylanase was purified to homogeneity from the culture filtrate of the thermophilic fungus, Humicola lanuginosa (Griffon and Maublanc) Bunce and its properties were studied. A fourfold purification and a yield of 8% were achieved. The molecular-weight of the protein was found to be 22,500 based on electrophoretic mobility and 29,000 by gel filtration behavior. The protein is rich in acidic amino acids, glycine and tyrosine, and poor in sulfur-containing amino acids. The kinetic properties of the enzyme are similar to those of other fungal xylanases. The enzyme shows high affinity toward larchwood xylan (Km = 0.91 mg/ml) and hydrolyzes only xylan. The enzyme becomes inactivated when stored for more than 2 months at −20 °C in the dry state. Such an inactivation has not been reported so far for any xylanase. Using chromatographic techniques, one species of protein differing from the native protein in charge but enzymatically active was isolated in low yields. However, a large molecular-weight species of the protein devoid of enzyme activity was isolated in substantial quantities and further characterized. Based on ultracentrifugation and gel electrophoretic studies, it was concluded that this species may be an aggregate of the native protein and that such an aggregation might be taking place on storage in the dry state at −20 °C, leading to loss in activity.

Analytical solution of the laminar mean flow wave equation in a lined or unlined two-dimensional rectangular duct

The prediction of the sound attenuation in lined ducts with sheared mean flow has been a topic of research for many years. This involves solving the sheared mean flow wave equation, satisfying the relevant boundary condition. As far as the authors' knowledge goes, this has always been done using numerical techniques. Here, an analytical solution is presented for the wave propagation in two-dimensional rectangular lined ducts with laminar mean flow. The effect of laminar mean flow is studied for both the downstream and the upstream wave propagation. The attenuation values predicted for the laminar mean flow case are compared with those for the case of uniform mean flow. Analytical expressions are derived for the transfer matrices.