Inhaled nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis

OBJECTIVES: To evaluate the use of inhaled nitric oxide (NO) in the management of persistent pulmonary hypertension of the newborn. METHODS: Computerized bibliographic search on MEDLINE, CURRENT CONTENTS and LILACS covering the period from January 1990 to March 1998; review of references of all papers found on the subject. Only randomized clinical trials evaluating nitric oxide and conventional treatment were included. OUTCOMES STUDIED: death, requirement for extracorporeal membrane oxygenation (ECMO), systemic oxygenation, complications at the central nervous system and development of chronic pulmonary disease. The methodologic quality of the studies was evaluated by a quality score system, on a scale of 13 points. RESULTS: For infants without congenital diaphragmatic hernia, inhaled NO did not change mortality (typical odds ratio: 1.04; 95% CI: 0.6 to 1.8); the need for ECMO was reduced (relative risk: 0.73; 95% CI: 0.60 to 0.90), and the oxygenation was improved (PaO2 by a mean of 53.3 mm Hg; 95% CI: 44.8 to 61.4; oxygenation index by a mean of -12.2; 95% CI: -14.1 to -9.9). For infants with congenital diaphragmatic hernia, mortality, requirement for ECMO, and oxygenation were not changed. For all infants, central nervous system complications and incidence of chronic pulmonary disease did not change. CONCLUSIONS: Inhaled NO improves oxygenation and reduces requirement for ECMO only in newborns with persistent pulmonary hypertension who do not have diaphragmatic hernia. The risk of complications of the central nervous system and chronic pulmonary disease were not affected by inhaled NO.

Laparoscopic versus open splenectomy in the management of hematologic diseases

Splenectomy is the best available treatment for severe forms of hereditary spherocytosis, idiopathic thrombocytopenic purpura, and other hematologic conditions when these prove refractory to conservative management. It has been employed for many decades with low mortality and favorable remission rates. The use of laparoscopic splenectomy in recent years has been rapidly and even enthusiastically adopted in this field. However, the exact role of laparoscopic versus open surgery for hematologic diseases is still debated. In this study of 58 adult patients, laparoscopic procedures were compared with conventional splenectomies for similar indications. METHODS: All patients were operated on within an 8-year period. Subjects underwent similar procedures under the supervision of the same surgical school and were compared regarding age, gender, body mass index, and diagnosis. Laparoscopically managed cases (Group I, n = 30) were prospectively followed according to a written protocol, whereas the same investigation was retrospectively done with regard to traditional laparotomy (Group II, n = 28). Methods included general and demographic findings, duration and technical steps of operation, blood loss, weight of spleen, need for conversion (in minimally invasive subjects), intraoperative and postoperative complications, time until realimentation, postoperative hospitalization, mortality, and late follow-up including recurrence rate. RESULTS: Idiopathic thrombocytopenic purpura was the surgical indication in over 50% of the patients in both groups, but familial spherocytosis, thalassemia, myelodysplasia, and lymphomas were also represented in this series. Laparoscopic procedures took more time to perform (P = 0.004), and postoperative hospitalization was 2 days shorter, but this difference was not statistically significant. Postoperative hematocrit and volume of blood transfusions was equivalent, although the laparoscopic cases had a somewhat lower preoperative hematocrit (NS) and displayed better recovery for this measurement (P = 0.03). More patients in Group I were able to accept oral food on the first day than subjects undergoing conventional operations (P < 0.05). Relatively few conversions were necessary during the minimally invasive surgeries (13.3%), and postoperative early and late complications as well as recurrences occurred in similar proportions. Also, the mean weight of the spleen was not statistically different between the groups, although there was a marked numerical tendency toward larger masses in conventional procedures. No spleen in Group I exceeded 2.0 kg, whereas in Group II values up to 4.0 kg occurred, and the mean weight was 50% higher in the latter group. CONCLUSIONS: 1) Minimally invasive splenectomy was essentially comparable to open surgery with regard to safety, efficacy, and late results; 2) Advantages concerning shorter postoperative hospitalization could not be shown, despite earlier food intake and a non-significant tendency toward earlier discharge; 3) This new modality should be considered an option in cases of hematologic conditions whenever the spleen is not hugely enlarged.

Definition, implementation and management of m.commerce apps and services

This report aims to analyse the Definition, Implementation and Management of Vodafone Portugal’s Apps and Services, so that possible ways of improvement can be suggested. To do so, Vodafone’s strategy regarding the development/ implementation of specific Apps and Services, as well as the strategy of its competitors are going to be analysed. This analysis is going to be complemented with insights from some key-persons of Vodafone’s Consumer Business Unit team in Portugal. Findings suggest that Vodafone is ahead of its competitors when it comes to developing the most innovative Apps and Services, but there is always room for improvements, especially when it comes to communication.

Aggregating community resources of care and assistance services for the elderly population

Changes in population age structure are a major concern and represent a priority in the agendas and policies of the developed world, which are demanding for renewed models of social and healthcare as well as assistance services to the elderly population. Studies indicate that as far as possible these types of services should desirably be provided at the user’s home, and that ICT-based solutions can have tremendous impact on the delivery of new services. This paper highlight and discusses some of the main results of a project undertaken in a Portuguese Municipality that demonstrates the potential contribution of an e-Marketplace of care and assistance services to the well-being of elderly people. Studies undertaken allowed identifying the main services that should be provided by such e-Marketplace (termed GuiMarket), the relevance that the population grant to this platform and, conversely, the fact that the Digital Divide phenomena influences the potential utilization of this project (and alike projects). The findings support that there is a strong relation between age and qualifications, and between access to ICT and the intended use of GuiMarket.

An automated framework for the management of P2P traffic in ISP infrastructures

Peer-to-Peer (P2P) is nowadays a widely used paradigm underpinning the deployment of several Internet services and applications. However, the management of P2P traffic aggregates is not an easy task for Internet Service Providers (ISPs). In this perspective, and considering an expectable proliferation in the use of such ap- plications, future networks require the development of smart mechanisms fostering an easier coexistence between P2P applications and ISP infrastructures. This paper aims to contribute for such research efforts presenting a framework incorporating useful mechanisms to be activated by network administrators, being also able to operate as an automated management tool dealing with P2P traffic aggregates.

Spawning habitat selection by Octopus vulgaris: new insights for a more effective management of this resource

The selection of spawning habitat of a population of Octopus vulgaris that is subject to a small-scale exploitation was studied in the Cíes Islands within the National Park of the Atlantic Islands of Galicia (NW Spain). The technique used was visual censuses by scuba diving. We conducted 93 visual censuses from April 2012 to April 2014. The total swept area was 123.69 ha. Habitat features (season, depth, zone, bottom temperature, swept area, bottom substrate type, and creels fishing impact) were evaluated as predictors of the presence/absence of spawning dens using GAM models. O. vulgaris has a noteworthy preference for spawning in areas with hard bottom substrate and moderate depth (approximately 20 m). The higher density of spawning dens (1.08ha−1) was found in a surveyed area of 50.14ha located in the northeastern part of the northern Cíes Island. We propose to protect the area comprised from Punta Escodelo to Punta Ferreiro between 5 and 30 m depth. This area has a surface of 158 ha equivalent to 5.98% of the total marine area of the Cíes islands. The strengths and weaknesses of a management strategy based on the protection of the species’ spawning habitat are discussed.

Safety management of cranes on construction sites in Portugal: Critical factors of safety

The evolution of the construction caused a need to use more effective equipments, capable of meeting the increasingly demanding deadlines for the completion of works. In this context, the safety and efficiency of equipment have become key aspects in order to optimize the execution time of the works, as well as reducing labor costs and loss of materials. With the evolution of construction and construction processes, cranes have come to represent a signal of the construction of buildings, revealing to be, in most of the cases, the main equipment of construction sites. Currently, some engineers revels some apprehension regarding the use and handling of cranes which is natural and acceptable, since an equipment failure can lead to serious or fatal accidents. The factors affecting safety management of the cranes in construction sites were investigated, identified, classified and evaluated according to their degree of importance, through interviews with representatives of the general contractors of a set of selected construction sites.

Does a Role Exist for Tilting-Guided Therapy in the Management of Neurocardiogenic Syncope?

PURPOSE: Upright tilt-table testing (UTT) is an useful method for identifying patients with neurocardiogenic syncope, but its role in the evaluation of therapeutic efficacy is controversial. The aim of this study was to determine the correlation between negative UTT after therapy introduction (acute efficacy) and symptom recurrence during follow-up (chronic efficacy). METHODS: We studied 56 severely symptomatic patients (age 27±19 years) with recurrent (7±12 episodes) neurocardiogenic syncope (positive UTT). Once empirical pharmacological therapy was initiated, all patients underwent another UTT (therapeutic evaluation test - TET). Therapy was not modified after TET results. The probability of symptom recurrence was analyzed with the Kaplan-Meier method and compared by log-rank test in patients with negative and positive TET. RESULTS: Negative UTT after therapy was related to a significantly lower probability of recurrence during follow-up (4.9 versus 52.4% in 12 months, P<0.0001). CONCLUSION: A good correlation exists between acute and long-term efficacy of pharmacological therapy for neurocardiogenic syncope, so that serial UTT may be considered a good method for identifying an effective therapeutic strategy.

Aproximación al manejo de Nemátodos Fitófagos de los genéros nacobbus y meloidogyne en la Provincia de Córdoba: cultivos hortícolas y aromáticos. Approach to the management of phytophagous nematodes of de genera nacobbus and meloidogyne in the province of Córdoba: horticultural and aromatic crops.

El proyecto que se propone es continuación de investigaciones relacionadas con dos géneros de nematodos fitófagos de interés para cultivos hortícolas (Nacobbus y Meloidogyne) y plantas aromáticas (Meloidogyne) en la Provincia de Córdoba. Hasta el momento, los conocimientos sobre estos parásitos son limitados, de allí la justificación del tema propuesto. Se realizarán muestreos de los citados cultivos, desarrollados a campo y bajo cubierta, para identificar poblaciones de esos nematodos perjudiciales. Se caracterizará morfológicamente poblaciones de N. aberrans con el objeto de consolidar criterios que permitan su reconocimiento. Se llevarán a cabo estudios de relaciones nematodo-hospedador poniendo énfasis en aspectos para los cuales no existen antecedentes en el país. Por un lado, se evaluará el grado de susceptibilidad de diferentes cultivares de pimiento a la agresión de poblaciones de N. aberrans de reconocida patogenicidad para el cultivo. Por otro, se estudiará el efecto de la colonización de micorrizas arbusculares en raíces de tomate y pimiento, como agente que brindaría resistencia al ataque de N. aberrans. Cabe hacer notar que con respecto a la interacción del complejo representado por N. aberrans-planta-micorrizas no ha sido publicada información alguna a nivel mundial. La importancia del proyecto reside en la posibilidad de obtener datos originales, transferibles al sector de producción agrícola. Al mismo tiempo, contribuirá a definir estrategias alternativas de manejo de problemas ocasionados por nematodos fitófagos, basadas en aspectos biológicos y no en la utilización sistemática de agroquímicos contaminantes.

La biodiversidad microbiana del suelo y su rol en el manejo de enfermedades causadas por hongos de suelo en soja. Soil microbial diversity and its key role in the management of soybean diseases caused by fungi.

Las poblaciones microbianas juegan un rol fundamental en la estabilidad de los sistemas agrícolas e indican los niveles de salud de un suelo, tanto que pueden ser utilizadas como indicadores de sustentabilidad de un agroecosistema. Los microorganismos reflejan el efecto que tienen las prácticas agrícolas sobre el suelo a través de modificaciones en la abundancia (biodiversidad estructural) y actividades de sus poblaciones (como control biológico de los patógenos, entre otras). Al cuantificarse la biodiversidad microbiana nativa se puede conocer la riqueza de un agroecosistema y utilizarla para el manejo sustentable de hongos patógenos. En este trabajo se evaluará el efecto de la rotación de cultivo (soja-maíz y soja en monocultivo) y los sistemas de labranza (siembra directa y labranzas reducida) sobre la biodiversidad microbiana. Se cuantificarán a partir de suelo: poblaciones de hongos y bacterias totales; agentes potenciales de biocontrol de como Trichoderma spp., Gliocladium spp. y micorrizas vesículo arbusculares (mediante la cuantificación de glomalina), biomasa y respiracion microbiana, y la biodiversidad de comunidades de microorganismos que habitan en el suelo mediante el análisis de perfiles de ácidos grasos (PLFA). Al final del ciclo de cultivo de soja se cuantificará la incidencia de enfermedades causadas por hongos de suelo. Dada la gran abundancia y diversidad de los microorganismos del suelo, las metodologías que se emplearán permitirán obtener información global de la riqueza microbiana de un agro-ecosistema. Se relacionará la biodiversidad microbiana con la incidencia de enfermedades por hongos de suelo, en respuesta a diferentes prácticas de manejo. Esto permitirá aprender a combinar las tecnologías para mejorar los beneficios de la produccion y preservar el agroecosistema en el marco de una agricultura sustentable, y no de una agricultura sostenida por insumos.