Comparación del efecto de sevoflurano versus propofol sobre la saturación regional cerebral de oxígeno

Programa de doctorado: Avances en Traumatología. Medicina del deporte. Cuidado de heridas

Salute orale del figlio disabile in età evolutiva e sintomatologia depressiva della madre

Relationships between oral health status in children with disability and their mothers’ depressive symptoms Aim. The purpose of the present study was to evaluate the relationships between oral health status in children with chronic medical conditions and their mothers’ depressive symptoms. Methods. Fifty-one children (25 male and 26 female, ranging from 2 to 18 years) affected by chronic systemic diseases followed at the Sant’Orsola-Malpighi Hospital in Bologna, ,and, were referred with their mothers at the Dental Department of Bologna. Children were subclassified in 3 groups according to the ASA classification and orally examined for hygiene status, gingival condition and dental caries. The indexes used were O’Leary plaque Index (PI), bleeding on probing index (BOP), dmft/DMFT. Mothers were interviewed on knowledge about oral diseases prevention for their children and daily management (hygiene habits, sugared aliments consumption). Statistical analysis was performed through the use of linear regression. Results. The relationships between ASA and IP as well as between ASA and BOP are statistically significant (α = 0,01). Seventy percent of patients and their relatives in ASA groups 3 and 4 never received information on oral health and prevention of oral diseases by paediatricians and/or dentists. The 53% of mothers present depressive symptoms. The relationships between degree of depressive symptoms and dmft/DMFt as well as between degree of depressive symptoms and sugared aliments daily consumption are statistically significant (α = 0,05). Conclusion. Our results give support to the hypothesis of an association between degree of systemic disease and oral hygiene status. The psychological mothers condition seams to play a role on the oral conditions of their sons. Our analysis shows the needs for an interdisciplinar approach in order to promote the oral health of children with disability.

In-situ-Hochtemperatur-Mössbauer-Spektroskopie und Bandstruktur-Rechnungen an Eisennitriden und gemischtvalenten Verbindungen

Zusammenfassung

Die stöchiometrischen Eisennitride g'-Fe₄N, e-Fe₃N und z-Fe₂N sind durchRöntgen- und Neutronenstreuung gut charakterisiert. Allerdings weist das Fe/N-Phasendiagramm noch vieleungeklärte Stellen auf. So konnten im Bereich von alpha-Fe bis g'-Fe₄N noch keine weiterenNitride isoliert werden. Die Verbindung a''-Fe₁₆N₂ konntenoch nicht rein darzustellen werden.

Besonderes Interesse besteht in der Aufklärung desMechanismus der Entstehung der Eisennitride bei derUmsetzung von a-Eisen mitAmmoniak. Diese Reaktion wird großtechnisch zurNitridierhärtung von Eisenwerkstücken genutzt.

Als Messmethode wurde die⁵⁷Fe-Mößbauer-Spektroskopiegewählt, die auf Kernspinübergängen von⁵⁷Fe beruht. Um in situ-Nitridierungen von Eisenproben mit Ammoniak mitder ⁵⁷Fe-Mößbauer-Spektroskopieverfolgen zu können, wurde eineHochtemperatur-Messzelle entwickelt, die es erlaubt,Messungen bis 1100 K durchzuführen. Die Messzelle wurde durch Messungen an Eisennitriden mitbekannter Stöchiometrie, wie z.B. g'-Fe₄N und e-Fe₃N, durchgeführt.

Neben ⁵⁷Fe-Mößbauer-Messungen wurdenim Rahmen des DFG-Schwerpunkt-Programms Reaktivitätin Festkörpern weitere Messungen (u.a.Hochtemperatur-Leitfähigkeitsmessungen)durchgeführt.

Die experimentellen Methoden wurden durchBandstruktur-Rechnungen ergänzt. Mit Hilfe der TB-LMTO-ASA-Methode erfolgten Rechnungen anÜbergangsmetallnitriden M₃N (M = Mn, Fe, Co,Ni, Cu) der 3d-Reihe. Hierbei konnte der experimentell bestimmte strukturelleÜbergang von hexagonalem Ni₃N zu kubischemCu₃N bestätigt werden.

Farbkonstanz und Farbkontrast – eine Untersuchung mit Hilfe der farbigen Schatten

Zusammenfassung der Dissertation von Anatol Julian Kallmann Farbkonstanz und Farbkontrast – eine Untersuchung mit Hilfeder farbigen Schatten Die farbigen Schatten werden als ein Spezialfall dessimultanen Farbkontrastes angesehen. Um herauszufinden,warum die farbigen Schatten im Vergleich zur gewöhnlichenDarstellung des simultanen Farbkontrastes so intensiv farbigerscheinen, wurde das Phänomen hinsichtlich derFarbparameter Helligkeit, Sättigung und Farbton analysiert. Der Induktionseffekt scheint weniger von der Sättigung desUmfeldes als vom Leuchtdichtekontrast zwischen dem Umfeldund dem Infeld abhängig zu sein.Das farbig beleuchtete Umfeld wurde von den Versuchspersonenmit einer geringeren Farbsättigung im Verhältnis zurtatsächlichen Umfeldsättigung eingestellt. Die Farbe desUmfeldes wurde unterschiedlich wahrgenommen, wenn keinzentrales Testfeld präsentiert wurde.Dichromaten nahmen das physikalisch weiße Infeld ebenfallsfarbig wahr. Sie stellten Farben auf dem Abgleichbildschirmein, deren Farborte in der CIE-Farbtafel auf denVerwechslungslinien liegen und somit denen der Trichromatenentsprechen. Die Farbbenennungen wichen jedoch von denen derTrichromaten ab. Das Phänomen der farbigen Schatten scheint ein Spezialfallder Farbkonstanz zu sein: Vermutlich dient das Umfeld alshellste Fläche im Gesichtsfeld dem visuellen System alsReferenz. Wenn die Helligkeit des zentralen Infeldeszunimmt, so dass dieses letztlich im visuellen Felddominiert, dann ist das visuelle System in der Lage, es als'weiß' wahrzunehmen. Es verwendet dann wahrscheinlich diesesFeld als Weißreferenz, welches die übrigen Farben imGesichtsfeld bestimmt.

Structural and elastic properties of DNA and chromatin

We investigate a chain consisting of two coupled worm-like chains withconstant distance between the strands. The effects due todouble-strandedness of the chain are studied. In a previous analyticalstudy of this system an intrinsic twist-stretch coupling and atendency of kinking is predicted. Even though a local twist structureis observed the predicted features are not recovered. A new model for DNA at the base-pair level is presented. Thebase-pairs are treated as flat rigid ellipsoids and thesugar-phosphate backbones are represented as stiff harmonic springs.The base-pair stacking interaction is modeled by a variant of theGay-Berne potential. It is shown by systematic coarse-graininghow the elastic constants of a worm-like chain are related to thelocal fluctuations of the base-pair step parameters. Even though a lotof microscopic details of the base-pair geometry is neglected themodel can be optimized to obtain a B-DNA conformation as ground stateand reasonable elastic properties. Moreover the model allows tosimulate much larger length scales than it is possible with atomisticsimulations due to the simplification of the force-field and inparticular due to the possibility of non-local Monte-Carlo moves. Asa first application the behavior under stretching is investigated. Inagreement with micromanipulation experiments on single DNA moleculesone observes a force-plateau in the force-extension curvescorresponding to an overstretching transition from B-DNA to aso-called S-DNA state. The model suggests a structure for S-DNA withhighly inclined base-pairs in order to enable at least partialbase-pair stacking. Finally a simple model for chromatin is introduced to study itsstructural and elastic properties. The underlying geometry of themodeled fiber is based on a crossed-linker model. The chromatosomesare treated as disk-like objects. Excluded volume and short rangenucleosomal interaction are taken into account by a variant of theGay-Berne potential. It is found that the bending rigidity and thestretching modulus of the fiber increase with more compact fibers. Fora reasonable parameterization of the fiber for physiologicalconditions and sufficiently high attraction between the nucleosomes aforce-extension curve is found similar to stretching experiments onsingle chromatin fibers. For very small stretching forces a kinkedfiber forming a loop is observed. If larger forces are applied theloop formation is stretched out and a decondensation of the fibertakes place.

Strukturierte halbleitende Thiophene

In dieser Arbeit wurden neue, ionische Oligo- und Poly-thiopene synthetisiert. Diese Verbindungen wurden unterAnwendung der Multischichttechnik von Decher zwei- unddreidimensional strukturiert. Zur Synthese der Verbindungen wurde die Stille-Kupplung vonThiophenbromiden und -zinnorganylen eingesetzt. Als ionischeGruppen fanden Sulfonium- und Phosphoniumsalze Verwendung. Bei optischen Untersuchungen konnte die effektive Kon-jugations länge der Substanzen bestimmt werden. MittelsCyclovoltammetrie wurden ihre Redoxeigenschaften untersucht.Die Polymere wurden mittels GPC, DSC und TGA charak-terisiert. Die Charakterisierung des Polythiophen-Multischichtaufbausdurch UV-Spektroskopie bewies die Gleichförmigkeit desSchichtaufbaus. Der Schichtaufbau unter Verwendung vonBolaamphiphilen verlief ebenfalls erfolgreich. Elektrochemische Untersuchungen an den Multischichtenergaben ein reversibles Verhalten, ebenfalls durchgeführteImpedanz-Messungen bewiesen das reversible Verhalten derRedox-Reaktion. Polyelektrolytschichten wurden ebenfalls auf ionisch imMikrometerbereich vorstrukturierten Substraten aufgebaut, umeine dreidimensionale Struktur zu erhalten. Ionischfunktionalisierte Polymerlatices wurden ebenfalls alsTemplat zum Aufbau dreidimensionaler Strukturen eingesetzt. Es wurden Gelbildner auf Terthiophenbasis synthetisiert,deren Struktur durch Röntgenmessungen untersucht wurde. DerGelbildner konnte ab 4% Massenanteil organische Lösungs-mittel vergelen.

Die Rolle der Globalstrahlung im Klimasystem Südwestdeutschlands

Die Untersuchungen umfassen die Periode 1981 – 2000 und basieren hauptsächlich auf Daten des Deutschen Wetterdienstes (DWD). Relativwerte der Globalstrahlung beziehen sich auf die Rayleigh-Atmosphäre. Das Regressionsmodell nach Angström ermöglicht die Erweiterung des Meßnetzes. In linearer und nichtlinearer Regression und Korrelation ist die Globalstrahlung entweder abhängige (Sonnenscheindauer, Bewölkung) oder unabhängige Variable (Lufttemperatur, Bodentemperatur). Ihre Intensität in Abhängigkeit von Großwetterlagen, Großwettertypen und Luftmassen wird diskutiert. Diesbezüglich werden mit der Linearen Diskriminanzanalyse ähnliche Großwetterlagen und Stationen in signifikant unterschiedenen Gruppen zusammengefaßt, getrennt nach Sommer- und Winterhalbjahr. Abhängig von der Zeit betrachtet, enthalten Globalstrahlung, direkte und diffuse Sonnenstrahlung, Lufttemperatur, Bewölkung und Niederschlag signifikante zyklische Variationen, die gegebenenfalls klimatologisch relevant sind. Weiteren Aufschluß ergeben deshalb die Zeitreihenanalysen. Autokorrelation-Spektralanalysen (ASA) der genannten Variablen werden in integrierten Spektren dargestellt. Hinweise auf die zeitliche Konstanz signifikanter Varianzmaxima enthalten die Spektren der dynamischen (gleitenden) ASA.

Studio osservazionale sulle complicanze della fibrillazione atriale nell'area di Bologna.

Premesse: Gli eventi ischemici (EI) e le emorragie cerebrali (EIC) sono le più temute complicanze della fibrillazione atriale (FA) e della profilassi antitrombotica. Metodi: in 6 mesi sono stati valutati prospetticamente i pazienti ammessi in uno dei PS dell’area di Bologna con FA associata ad EI (ictus o embolia periferica) o ad EIC. Risultati: sono stati arruolati 178 pazienti (60 maschi, età mediana 85 anni) con EI. Il trattamento antitrombotico in corso era: a) antagonisti della vitamina K (AVK) in 31 (17.4%), INR all’ingresso: <2 in 16, in range (2.0-3.0) in 13, >3 in 2; b) aspirina (ASA) in 107 (60.1%); c) nessun trattamento in 40 (22.5%), soprattutto in FA di nuova insorgenza. Nei 20 pazienti (8 maschi; età mediana 82) con EIC il trattamento era: a)AVK in 13 (65%), INR in range in 11 pazienti, > 3 in 2, b) ASA in 6 (30%). La maggior parte degli EI (88%) ed EIC (95%) si sono verificati in pazienti con età > 70 anni. Abbiamo valutato l’incidenza annuale di eventi nei soggetti con età > 70 anni seguiti neo centri della terapia anticoagulante (TAO) e nei soggetti con FA stimata non seguiti nei centri TAO. L’incidenza annuale di EI è risultata 12% (95%CI 10.7-13.3) nei pazienti non seguiti nei centri TAO, 0.57% (95% CI 0.42-0.76) nei pazienti dei centri TAO ( RRA 11.4%, RRR 95%, p<0.0001). Per le EIC l’incidenza annuale è risultata 0.63% (95% CI 0.34-1.04) e 0.30% (95% CI 0.19-0.44) nei due gruppi ( RRA di 0.33%/anno, RRR del 52%/anno, p=0.040). Conclusioni: gli EI si sono verificati soprattutto in pazienti anziani in trattamento con ASA o senza trattamento. La metà dei pazienti in AVK avevano un INR sub terapeutico. L’approccio terapeutico negli anziani con FA deve prevedere un’ adeguata gestione della profilassi antitrombotica.

Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial

OBJECTIVE: Dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid (ASA) is superior to ASA alone in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention. We sought to determine whether clopidogrel plus ASA conferred benefit on limb outcomes over ASA alone in patients undergoing below-knee bypass grafting. METHODS: Patients undergoing unilateral, below-knee bypass graft for atherosclerotic peripheral arterial disease (PAD) were enrolled 2 to 4 days after surgery and were randomly assigned to clopidogrel 75 mg/day plus ASA 75 to 100 mg/day or placebo plus ASA 75 to 100 mg/day for 6 to 24 months. The primary efficacy endpoint was a composite of index-graft occlusion or revascularization, above-ankle amputation of the affected limb, or death. The primary safety endpoint was severe bleeding (Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries [GUSTO] classification). RESULTS: In the overall population, the primary endpoint occurred in 149 of 425 patients in the clopidogrel group vs 151 of 426 patients in the placebo (plus ASA) group (hazard ratio [HR], 0.98; 95% confidence interval [CI], 0.78-1.23). In a prespecified subgroup analysis, the primary endpoint was significantly reduced by clopidogrel in prosthetic graft patients (HR, 0.65; 95% CI, 0.45-0.95; P = .025) but not in venous graft patients (HR, 1.25; 95% CI, 0.94-1.67, not significant [NS]). A significant statistical interaction between treatment effect and graft type was observed (P(interaction) = .008). Although total bleeds were more frequent with clopidogrel, there was no significant difference between the rates of severe bleeding in the clopidogrel and placebo (plus ASA) groups (2.1% vs 1.2%). CONCLUSION: The combination of clopidogrel plus ASA did not improve limb or systemic outcomes in the overall population of PAD patients requiring below-knee bypass grafting. Subgroup analysis suggests that clopidogrel plus ASA confers benefit in patients receiving prosthetic grafts without significantly increasing major bleeding risk.

Dual low response to acetylsalicylic acid and clopidogrel is associated with myonecrosis and stent thrombosis after coronary stent implantation

Impaired response to antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel (CLO) has been associated with an increased risk of stent thrombosis and ischemic events after coronary stent implantation. We sought to investigate whether patients with a low response (LR) to ASA or CLO are at increased risk for periprocedural and short-term ischemic events after coronary stent implantation.

A randomised determination of the effect of fluvastatin and atorvastatin on top of dual antiplatelet treatment on platelet aggregation after implantation of coronary drug-eluting stents. The EFA-Trial

Drug-drug interaction between statins metabolised by cytochrome P450 3A4 and clopidogrel have been claimed to attenuate the inhibitory effect of clopidogrel. However, published data regarding this drug-drug interaction are controversial. We aimed to determine the effect of fluvastatin and atorvastatin on the inhibitory effect of dual antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel. One hundred one patients with symptomatic stable coronary artery disease undergoing percutaneous coronary intervention and drug-eluting stent implantation were enrolled in this prospective randomised study. After an interval of two weeks under dual antiplatelet therapy with ASA and clopidogrel, without any lipid-lowering drug, 87 patients were randomised to receive a treatment with either fluvastatin 80 mg daily or atorvastatin 40 mg daily in addition to the dual antiplatelet therapy for one month. Platelet aggregation was assessed using light transmission aggregometry and whole blood impedance platelet aggregometry prior to randomisation and after one month of receiving assigned statin and dual antiplatelet treatment. Platelet function assessment after one month of statin and dual antiplatelet therapy did not show a significant change in platelet aggregation from 1st to 2nd assessment for either statin group. There was also no difference between atorvastatin and fluvastatin treatment arms. In conclusion, neither atorvastatin 40 mg daily nor fluvastatin 80 mg daily administered in combination with standard dual antiplatelet therapy following coronary drug-eluting stent implantation significantly interfere with the antiaggregatory effect of ASA and clopidogrel.

Randomized clinical trial comparing percutaneous closure of patent foramen ovale (PFO) using the Amplatzer PFO Occluder with medical treatment in patients with cryptogenic embolism (PC-Trial): rationale and design

Background Several studies have shown an association of cryptogenic stroke and embolism with patent foramen ovale (PFO), but the question how to prevent further events in such patients is unresolved. Options include antithrombotic treatment with warfarin or antiplatelet agents or surgical or endovascular closure of the PFO. The PC-Trial was set up to compare endovascular closure and best medical treatment for prevention of recurrent events. Methods The PC-Trial is a randomized clinical trial comparing the efficacy of percutaneous closure of the PFO using the Amplatzer PFO occluder with best medical treatment in patients with cryptogenic embolism, i.e. mostly cryptogenic stroke. Warfarin for 6 months followed by antiplatelet agents is recommended as medical treatment. Randomization is stratified according to patients age (<45 versus ≥45 years), presence of atrial septal aneurysm (ASA yes or no) and number of embolic events before randomization (one versus more than one event). Primary endpoints are death, nonfatal stroke and peripheral embolism. Discussion patients were randomized in 29 centers of Europe, Canada, and Australia. Randomization started February 2000. Enrollment of 414 patients was completed in February 2009. All patients will be followed-up longitudinally. Follow-up is maintained until the last enrolled patient is beyond 2.5 years of follow-up (expected in 2011).