Orthoptic Sequelae Following Conservative Management of Pure Blowout Orbital Fractures: Anecdotal or Clinically Relevant?

The aim of this study was to prospectively assess the prevalence of orthoptic anomalies following conservative management of pure blowout orbital fractures and to evaluate their clinical relevance. Clinical and radiologic data of patients with unilateral conservatively managed pure blowout orbital fractures with a minimum follow-up of 6 months were reviewed. Eligible patients were contacted and invited to undergo an extended ophthalmologic examination as follows: distance and near visual acuities, Hertel exophthalmometry, corneal light reflex (Hirschberg test), ductions and versions in the 6 cardinal fields of gaze, eye deviation with prisms and alternate cover test in all of the 9-gaze directions with Maddox rod, degrees of incyclo/excyclotorsion with right and left eye fixation, horizontal and vertical deviation with Hess-Weiss coordimetry, degree of horizontal/vertical and incyclo/excyclotorsion deviation with Harms wall deviometry, and vertical deviation with Bielschowsky head-tilt test. Of the 69 patients contacted, 49 declined to participate given that they were asymptomatic. Twenty patients agreed to undergo the examination. One patient complained of minimal double vision limited to the extreme downgaze. Four patients had asymptomatic ocular motility disturbances limited to the extreme gaze. Seven patients had asymptomatic horizontal heterophoria. These disturbances did not interfere with daily or professional activities in any of the patients. The current study demonstrated that conservative management of pure orbital blowout fractures can result in orthoptic anomalies. These sequelae were restricted to a very limited portion of the binocular field of the vision and were not found to be clinically relevant.

Les maladies rénales chroniques ne sont pas toutes silencieuses [Chronic kidney diseases do not always pass unnoticed].

Kidney diseases are frequent, but most of the time, they develop unnoticed. This paucity of symptoms may lead to delayed diagnosis with important consequences on their outcome. Nevertheless, specific systemic signs such as skin lesions, joint pain or electrolytes disturbances may sometimes alert the clinician and direct the diagnosis to an underlying nephropathy. A high awareness of clinicians is warranted to recognize these red flags and diagnose these diseases early, as illustrated by two clinical cases discussed in this article.

Vulnerability of stream biota to climate change in mediterranean climate regions: a synthesis of ecological responses and conservation challenges

Freshwater species worldwide are experiencing dramatic declines partly attributable to ongoing climate change. It is expected that the future effects of climate change could be particularly severe in mediterranean climate (med-) regions, which host many endemic species already under great stress from the high level of human development. In this article, we review the climate and climate-induced changes in streams of med-regions and the responses of stream biota, focusing on both observed and anticipated ecological responses. We also discuss current knowledge gaps and conservation challenges. Expected climate alterations have already been observed in the last decades, and include: increased annual average air temperatures; decreased annual average precipitation; hydrologic alterations; and an increase in frequency, intensity and duration of extreme events, such as floods, droughts and fires. Recent observations, which are concordant with forecasts built, show stream biota of med-regions when facing climate changes tend to be displaced towards higher elevations and upper latitudes, communities tend to change their composition and homogenize, while some life-history traits seem to provide biota with resilience and resistance to adapt to the new conditions (as being short-lived, small, and resistant to low streamflow and desiccation). Nevertheless, such responses may be insufficient to cope with current and future environmental changes. Accurate forecasts of biotic changes and possible adaptations are difficult to obtain in med-regions mainly because of the difficulty of distinguishing disturbances due to natural variability from the effects of climate change, particularly regarding hydrology. Long-term studies are needed to disentangle such variability and improve knowledge regarding the ecological responses and the detection of early warning signals to climate change. Investments should focus on taxa beyond fish and macroinvertebrates, and in covering the less studied regions of Chile and South Africa. Scientists, policy makers and water managers must be involved in the climate change dialogue because the freshwater conservation concerns are huge.

Further insights in trichothiodistrophy: a clinical, microscopic, and ultrastructural study of 20 cases and literature review

Background: Trichothiodistrophy (TTD) is a rare autosomal recessive condition that is characterized by a specific congenital hair shaft dysplasia caused by deficiency of sulfur associated with a wide spectrum of multisystem abnormalities. In this article, we study clinical, microscopic, and ultrastructural findings of 20 patients with TTD with the aim to add further insights regarding to this rare condition. Additionally, analyses of our results are compared with those extracted from the literature in order to enhance its comprehensibility. Materials and Methods: Twenty cases of TTD were included: 7 from Mexico and 14 from Spain. Clinical, microscopic, scanning electron microscopy (SEM) studies and X-ray microanalysis (XrMa) were carried out in all of them. Genetic studies were performed in all seven Mexican cases. Patients with xeroderma pigmentosum and xeroderma pigmentosum/TTD-complex were excluded. Results: Cuticular changes and longitudinal crests of the hair shaft were demonstrated. These crests were irregular, disorganized, following the hair longest axis. Hair shaft sulfur deficiency was disposed discontinuously and intermittently rather than uniformly. This severe decrease of sulfur contents was located close to the trichoschisis areas. Only five patients did not show related disturbances. Micro-dolichocephaly was observed in five cases and represented the most frequent facial dysmorphism found. It is also remarkable that all patients with urologic malformations also combined diverse neurologic disorders. Moreover, three Mexican sisters demonstrated the coexistence of scarce pubic vellus hair, developmental delay, onychodystrophy, and maxillar/mandibullar hypoplasia. Conclusions: TTD phenotype has greatly varied from very subtle forms to severe alterations such as neurologic abnormalities, blindness, lamellar ichthyosis and gonadal malformations. Herein, a multisystem study should be performed mandatorily in patients diagnosed with TTD.

Further insights in trichothiodistrophy: a clinical, microscopic, and ultrastructural study of 20 cases and literature review

Background: Trichothiodistrophy (TTD) is a rare autosomal recessive condition that is characterized by a specific congenital hair shaft dysplasia caused by deficiency of sulfur associated with a wide spectrum of multisystem abnormalities. In this article, we study clinical, microscopic, and ultrastructural findings of 20 patients with TTD with the aim to add further insights regarding to this rare condition. Additionally, analyses of our results are compared with those extracted from the literature in order to enhance its comprehensibility. Materials and Methods: Twenty cases of TTD were included: 7 from Mexico and 14 from Spain. Clinical, microscopic, scanning electron microscopy (SEM) studies and X-ray microanalysis (XrMa) were carried out in all of them. Genetic studies were performed in all seven Mexican cases. Patients with xeroderma pigmentosum and xeroderma pigmentosum/TTD-complex were excluded. Results: Cuticular changes and longitudinal crests of the hair shaft were demonstrated. These crests were irregular, disorganized, following the hair longest axis. Hair shaft sulfur deficiency was disposed discontinuously and intermittently rather than uniformly. This severe decrease of sulfur contents was located close to the trichoschisis areas. Only five patients did not show related disturbances. Micro-dolichocephaly was observed in five cases and represented the most frequent facial dysmorphism found. It is also remarkable that all patients with urologic malformations also combined diverse neurologic disorders. Moreover, three Mexican sisters demonstrated the coexistence of scarce pubic vellus hair, developmental delay, onychodystrophy, and maxillar/mandibullar hypoplasia. Conclusions: TTD phenotype has greatly varied from very subtle forms to severe alterations such as neurologic abnormalities, blindness, lamellar ichthyosis and gonadal malformations. Herein, a multisystem study should be performed mandatorily in patients diagnosed with TTD.

Forecasting the maximum compensation offer in the automobile BI claims negotiation process

Most motor bodily injury (BI) claims are settled by negotiation, with fewer than 5% of cases going to court. A well-defined negotiation strategy is thus very useful for insurance companies. In this paper we assume that the monetary compensation awarded in court is the upper amount to be offered by the insurer in the negotiation process. Using a real database, a log-linear model is implemented to estimate the maximal offer. Non-spherical disturbances are detected. Correlation occurs when various claims are settled in the same judicial verdict. Group wise heteroscedasticity is due to the influence of the forensic valuation on the final compensation amount. An alternative approximation based on generalized inference theory is applied to estimate confidence intervals on variance components, since classical interval estimates may be unreliable for datasets with unbalanced structures.

How are riparian plants distributed along the riverbank topographic gradient in Mediterranean rivers? Application to minimally altered river stretches in Southern Spain.

Species structure and composition in Mediterranean riparian forests are determined by hydrological features, longitudinal zonation, and riverbank topography. This study assesses the distribution of four native riparian plants along the riverbank topographic gradient in three river stretches in southern Spain, with special emphasis on the occupation of adult and young feet of each species. The studied stretches suffered minimal human disturbances, displayed semi-arid conditions, and had wide riparian areas to allow the development of the target species: black alder (Alnus glutinosa), salvia leaf willow (Salix salviifolia), narrow-leafed ash (Fraxinus angustifolia), and oleander (Nerium oleander). Thalweg height was used to define the riverbank topographic gradient. The results showed a preferential zone for black alder and salvia leaf willow in the range of 0-150 cm from the channel thalweg, with adult alders and willows being more common between 51 and 150 cm and young alders being more common under 50 cm. Conversely, narrow-leafed ash and oleander were much more frequent, and showed greater development, in the ranges of 151-200 cm and 201-250 cm, respectively, whereas the young feet of both species covered the entire topographic range. Adult feet of the four species were spatially segregated along the riverbank topographic gradient, indicating their differential ability to cope with water stress from the non-tolerant alders and willows to more tolerant narrow-leafed ash trees and oleanders. Young feet, however, showed a strategy more closely linked to the initial availability of colonisation sites within riparian areas to the dispersion strategy of each species and to the distribution of adult feet. In Mediterranean areas, where riparian management has traditionally faced great challenges, the incorporation of species preferences along riverbank gradients could improve the performance of restoration projects.

Hydrology, light and the use of organic and inorganic materials as structuring factors of biological communities in Mediterranean streams

Hydrological disturbances, light availability and nutrients are the most relevant factors determining the structure of the biological communities in Mediterranean rivers. While some hydrological disturbances are able to induce catastrophic effects, which may cause a complete reset in physical and biological conditions, continued enrichment or changes in light availability are factors leading to the progressive shift in the communities of autotrophs and heterotrophs in the systems. Primary production in Mediterranean streams shows relevant seasonal changes which mainly follows the variations in light availability. In most forested streams, the algal community is shade-adapted. Nutrient enrichment (especially phosphorus) leads to marked increases in primary production, but this increase is not lineal and there is a saturation of algal biomass even in the most enriched systems. The heterotrophs (bacteria, fungi) are related to the pattern of DOC availability (which most depends on the seasonal discharge and leaf fall dynamics) and to the available substrata in the stream. It has been repeatedly observed that shorttime increases of extracellular enzyme activities are related to the accumulation of autochthonous (algal) and/or allochthonous (leaves) organic matter on the streambed during spring and summer, this being more remarkable in dry than in wetter years. Flow reduction favours detritus concentration in pools, and the subsequent increase in the density and biomass of the macroinvertebrate community. In Mediterranean streams collectors are accounting for the highest density and biomass, this being more remarkable in the least permanent systems, in accordance with the effect of floods on the organic matter availability. Nutrients, through the effect on the primary producers, also affect the trophic food web in the streams by favouring the predominance of grazers

Effects of Weight Loss on Adipose Tissue, Liver and Heart Metabolism in Humans

Obesity has become the leading cause of many chronic diseases, such as type 2 diabetes and cardiovascular diseases. The prevalence of obesity is high in developed countries and it is also a major cause of the use of health services. Ectopic fat accumulation in organs may lead to metabolic disturbances, such as insulin resistance.Weight loss with very-low-energy diet is known to be safe and efficient. Weight loss improves whole body insulin sensitivity, but its effects on tissue and organ level in vivo are not well known. The aims of the studies were to investigate possible changes of weight loss in glucose and fatty acid uptake and perfusion and fat distribution at tissue and organ level using positron emission tomography and magnetic resonance imaging and spectroscopy in 34 healthy obese subjects. The results showed that whole-body insulin sensitivity increased after weight loss with very-low-energy diet and this is associated with improved skeletal muscle insulin-stimulated glucose uptake, but not with adipose tissue, liver or heart glucose uptake. Liver insulin resistance decreased after weight loss. Liver and heart free fatty acid uptakes decreased concomitantly with liver and heart triglyceride content. Adipose tissue and myocardial perfusion decreased. In conclusion, enhanced skeletal muscle glucose uptake leads to increase in whole-body insulin sensitivity when glucose uptake is preserved in other organs studied. These findings suggest that lipid accumulation found in the liver and the heart in obese subjects without co-morbidies is in part reversible by reduced free fatty acid uptake after weight loss. Reduced lipid accumulation in organs may improve metabolic disturbances, e.g. decrease liver insulin resistance. Keywords: Obesity, weight loss, very-low-energy diet, adipose tissue metabolism, liver metabolism, heart metabolism, positron emission tomography

Arinakattilan lämmönsiirron laskentamallin kehittäminen

Kattilalaitosten polttoaineen syötössä ilmenevät häiriöt ja biopolttoaineiden laatuvaihtelut aiheuttavat epävakaata palamista ja tekevät prosessin hallinnasta vaikeampaa. Polttoaineen laatuvaihtelut vaikuttavat koko prosessiin ja näkyvät lopulta myös höyryntuotannossa. Kompensoinnilla pyritään estämään häiriöiden suuret vaikutukset höyryn tuotantoon. Tarkoituksena on saada kattilan toiminta ja tehon tuotanto tasaisemmaksi ja helpommin hallittavaksi. Tässä diplomityössä tarkastellaan polttoaineen ominaisuuksien, säteilylämmönsiirron sekä säätöjen vaikutusta toisiinsa ja merkitystä kattilan toiminnan kannalta. Työssä muodostetaan säteilylämmönsiirron laskentamalli arinakattilan tulipesälle käyttäen hyväksi hyvin sekoittuneen tulipesän menetelmää. Menetelmällä voidaan määrittääsavukaasujen keskimääräinen lämpötila tulipesässä, lämpövirta tulipesän seiniin tai poltossa vapautuva lämpöteho. Mallin avulla voidaan paremmin ymmärtää prosessin käyttäytymistä polttoaineen laadun muuttuessa sekä helpottaa ja nopeuttaa kattilan käyttäytymisen ennustamista. Laskentamalli tehtiin Excel –laskentaohjelmaan, jossa se testataan. Verifioinnin jälkeen malli on tarkoitus siirtää toimimaan apros –simulointiympäristöön.

Language recovery and evidence of residual deficits after nonthalamic subcortical stroke: A 1 year follow-up study

A variety of language disturbances including aphasia have been described after subcortical stroke but less is known about the factors that influence the long-term recovery of stroke-induced language dysfunction. We prospectively examined the role of the affected hemisphere and the lesion site in the occurrence and recovery of language deficits in nonthalamic subcortical stroke. Forty patients with unilateral basal gangliastroke underwent language assessment within 1 week, 3 months and 1 year after stroke. Disturbances in at least one language domain were observed in 35 patients during the first week post stroke including aphasia diagnosed in 11 patients. Importantly, the appearance of deficits after stroke onset and the improvement of language function were not determined by the site of subcortical lesion, but instead were critically influenced by the affected hemisphere. In fact, the language impairments following left and right basal ganglia stroke mirrored the language dysfunction observed after cortical lesions in the same hemisphere. A significant overall language improvement was observed at 3 months after stroke, although residual deficits in languageexecutive function were the most commonly observed impairment at 1 year follow-up. Although a substantial improvement of language function can be expected after nonthalamic subcortical stroke, our findings suggest that language recovery may not be fully achieved at 1 year post

Improving Cross Direction Basis Weight Profile in a Fourdrinier Paper Machine

The purpose of this study was to improve PM7’s basis weight CD profile in Stora Enso’s Berghuizer mill and to search mechanical defects which affect to the formation of the basis weight CD profile. In the theoretical part PM7’s structure was presented and the formation of the basis weight and caliper CD profiles was examined as well as disturbances which are affecting to the formation. The function of the control system was scrutinised for the side of CD profiles as well as the formation of the measured CD profiles. Tuning of the control system was examined through the response model and filtering. Specification of the response model and filtering was explained and how to determine 2sigma statistical number. In the end of the theoretical part ATPA hardware and a new profile browser were introduced. In the experimental part focus was in the beginning to search and remove mechanical defects which are affecting to CD profiles. The next step was to verify the reliability of the online measurements, to study the stability of the basis weight CD profile and to find out so called fingerprint, a basis weight CD profile which is unique for each paper machine. New response model and filtering value for basis weight CD profile was determined by bump tests. After a follow up period the affect of the new response model and filtering was analysed.

Tuhojen vaikutus Euroopan metsävarojen kehitykseen : mallitarkasteluja puu- ja metsikkötasolta alueellisiin skenaarioihin

Seloste väitöskirjasta: Impacts of natural disturbances on the development of European forest recources : application of model approaches from tree and stand levels to large-scale scenarios. Dissertationes Forestales 56.

Impedanssisovituksen tarkkailu jännitevälipiirillisessä taajuusmuuttajakäytössä

Invertterikäyttöjen pitkissä kuormakaapeleissa jännitteen aaltomuodossa on havaittavissa ylijännitteitä. Ylijännitteet johtuvat invertterikäytön käyttämien kytkinten ohjaamisesta pulssinleveysmodulaatiolla, niiden nopeista kytkeytymisistä ja itse järjestelmästä. Ylijännitteet ovat haitallisia järjestelmässä, joten niitä pyritään estämään esim. suodattamalla. Yksi käytännön sovellus sähkökoneen suotimena on RC-suodin. RC-suotimen toimintakyvyn aleneminen on kuitenkin oletettavaa, joten sähkökone altistuu tällöin ylijännitteille. Mittaamalla RC-suotimen kuntoa voidaan valvoa generaattorin kokemia ylijännitteitä. Työssä tarkastellaan järjestelmän häiriöitä ja ylijännitteitä, RC-suodinta sekä suotimen vajaatoimintatiloja, ja kehitetään mittaus tarkkailemaan vajaatoimintaa.

Frequency converter protection against supply network phenomena

This master’s thesis is focused on power supply network disturbances and their effects on the frequency converter – one of the components of modern process crane electrical system. The most critical disturbance types, their causes and the effect they bring to crane electrical system was determined in this work. Variety of protective devices used for mitigation of disturbances is investigated. Device protection solutions for the frequency converter used in crane applications are presented. Analyses of the power supply requirements for frequency converter and various components of crane electrical system were carried out and as a result the crane power supply requirements list that guarantees normal crane operation was built. This list is to be included in crane projects for troubleshooting purposes in order to determine potentially dangerous network.