Aquatic therapies in patients with compromised left ventricular function and heart failure

With water immersion, gravity is partly eliminated, and the water exerts a pressure on the body surface. Consequently there is a blood volume shift from the periphery to the central circulation, resulting in marked volume loading of the thorax and heart. This paper presents a selection of published literature on water immersion, balneotherapy, aqua exercises, and swimming, in patients with left ventricular dysfunction (LVD) and/or stable chronic heart failure (CHF). Based on exploratory studies, central hemodynamic and neurohumoral responses of aquatic therapies will be illustrated. Major findings are: 1. In LVD and CHF, a positive effect of therapeutic warm-water tub bathing has been observed, which is assumed to be from afterload reduction due to peripheral vasodilatation caused by the warm water. 2. In coronary patients with LVD, at low-level water cycling the heart is working more efficiently than at lowlevel cycling outside of water. 3. In patients with previous extensive myocardial infarction, upright immersion to the neck resulted in temporary pathological increases in mean pulmonary artery pressure (mPAP) and mean pulmonary capillary pressures (mPCP). 4. Additionally, during slow swimming (20-25m/min) the mPAP and/or PCP were higher than during supine cycling outside water at a 100W load. 5. In CHF patients, neck- deep immersion resulted in a decrease or no change in stroke volume. 6. Although patients are hemodynamically compromised, they usually maintain a feeling of well-being during aquatic therapy. Based on these findings, clinical indications for aquatic therapies are proposed and ideas are presented to provoke further research.

About the role of visual field defects in pure alexia

Pure alexia is an acquired reading disorder characterized by a disproportionate prolongation of reading time as a function of word length. Although the vast majority of cases reported in the literature show a right-sided visual defect, little is known about the contribution of this low-level visual impairment to their reading difficulties. The present study was aimed at investigating this issue by comparing eye movement patterns during text reading in six patients with pure alexia with those of six patients with hemianopic dyslexia showing similar right-sided visual field defects. We found that the role of the field defect in the reading difficulties of pure alexics was highly deficit-specific. While the amplitude of rightward saccades during text reading seems largely determined by the restricted visual field, other visuo-motor impairments-particularly the pronounced increases in fixation frequency and viewing time as a function of word length-may have little to do with their visual field defect. In addition, subtracting the lesions of the hemianopic dyslexics from those found in pure alexics revealed the largest group differences in posterior parts of the left fusiform gyrus, occipito-temporal sulcus and inferior temporal gyrus. These regions included the coordinate assigned to the centre of the visual word form area in healthy adults, which provides further evidence for a relation between pure alexia and a damaged visual word form area. Finally, we propose a list of three criteria that may improve the differential diagnosis of pure alexia and allow appropriate therapy recommendations.

PyGirl Generating Whole-System VMs from high-level models using PyPy

Virtual machines emulating hardware devices are generally implemented in low-level languages and using a low-level style for performance reasons. This trend results in largely difficult to understand, difficult to extend and unmaintainable systems. As new general techniques for virtual machines arise, it gets harder to incorporate or test these techniques because of early design and optimization decisions. In this paper we show how such decisions can be postponed to later phases by separating virtual machine implementation issues from the high-level machine-specific model. We construct compact models of whole-system VMs in a high-level language, which exclude all low-level implementation details. We use the pluggable translation toolchain PyPy to translate those models to executables. During the translation process, the toolchain reintroduces the VM implementation and optimization details for specific target platforms. As a case study we implement an executable model of a hardware gaming device. We show that our approach to VM building increases understandability, maintainability and extendability while preserving performance.

PyGirl: Generating Whole-System VMs from High-Level Prototypes Using PyPy

Virtual machines (VMs) emulating hardware devices are generally implemented in low-level languages for performance reasons. This results in unmaintainable systems that are difficult to understand. In this paper we report on our experience using the PyPy toolchain to improve the portability and reduce the complexity of whole-system VM implementations. As a case study we implement a VM prototype for a Nintendo Game Boy, called PyGirl, in which the high-level model is separated from low-level VM implementation issues. We shed light on the process of refactoring from a low-level VM implementation in Java to a high-level model in RPython. We show that our whole-system VM written with PyPy is significantly less complex than standard implementations, without substantial loss in performance.

Analysis of ⁸⁵Kr: a comparison at the 10-14 level using micro-liter samples

The isotopic abundance of 85Kr in the atmosphere, currently at the level of 10−11, has increased by orders of magnitude since the dawn of nuclear age. With a half-life of 10.76 years, 85Kr is of great interest as tracers for environmental samples such as air, groundwater and ice. Atom Trap Trace Analysis (ATTA) is an emerging method for the analysis of rare krypton isotopes at isotopic abundance levels as low as 10−14 using krypton gas samples of a few micro-liters. Both the reliability and reproducibility of the method are examined in the present study by an inter-comparison among different instruments. The 85Kr/Kr ratios of 12 samples, in the range of 10−13 to 10−10, are measured independently in three laboratories: a low-level counting laboratory in Bern, Switzerland, and two ATTA laboratories, one in Hefei, China, and another in Argonne, USA. The results are in agreement at the precision level of 5%.

[Helminth control in the adult horse: the need for a re-orientation].

The epidemiological situation of strongyle infections in adult horses in Switzerland is characterized by a strong dominance of small strongyles (Cyathostominae) and an overall low level of egg shedding in the faeces. The prevailing attitude towards anthelmintic therapy considers neither husbandry conditions nor pasture hygiene measures. Instead, calendar-based routine medication, comprising usually 3 to 4 annual treatments, is the typical strategy. Such an approach, however, often results in an excessive administration of anthelmintics. With respect to the continuous spread of drug resistant cyathostomins a change of strategy seems inevitable. A consensus has been agreed on between equine parasitologists and clinicians of the Vetsuisse Faculty in Zurich and Berne to focus on the concept of a selective control approach, based on individual faecal egg counts as the central element. It is now recommended that clinically healthy horses (> 4 y) are treated only when their strongyle egg count is equal to or higher than 200 eggs per gram of faeces. A regular analysis of the strongyle population based on larval cultures, the control of drug efficacy, and quarantine measures for incoming horses are mandatory components of the concept. Recent experiences in several pilot farms have indicated that only 4 % of the McMaster analyses resulted in a deworming treatment. For horses that did not receive any nematicidal anthelmintic during the current season, a "safety" treatment is recommended at the end of the grazing period.

Effectiveness of non-conventional methods for accelerated orthodontic tooth movement: a systematic review and meta-analysis.

OBJECTIVES To assess the available evidence on the effectiveness of accelerated orthodontic tooth movement through surgical and non-surgical approaches in orthodontic patients. METHODS Randomized controlled trials and controlled clinical trials were identified through electronic and hand searches (last update: March 2014). Orthognathic surgery, distraction osteogenesis, and pharmacological approaches were excluded. Risk of bias was assessed using the Cochrane risk of bias tool. RESULTS Eighteen trials involving 354 participants were included for qualitative and quantitative synthesis. Eight trials reported on low-intensity laser, one on photobiomodulation, one on pulsed electromagnetic fields, seven on corticotomy, and one on interseptal bone reduction. Two studies on corticotomy and two on low-intensity laser, which had low or unclear risk of bias, were mathematically combined using the random effects model. Higher canine retraction rate was evident with corticotomy during the first month of therapy (WMD=0.73; 95% CI: 0.28, 1.19, p<0.01) and with low-intensity laser (WMD=0.42mm/month; 95% CI: 0.26, 0.57, p<0.001) in a period longer than 3 months. The quality of evidence supporting the interventions is moderate for laser therapy and low for corticotomy intervention. CONCLUSIONS There is some evidence that low laser therapy and corticotomy are effective, whereas the evidence is weak for interseptal bone reduction and very weak for photobiomodulation and pulsed electromagnetic fields. Overall, the results should be interpreted with caution given the small number, quality, and heterogeneity of the included studies. Further research is required in this field with additional attention to application protocols, adverse effects, and cost-benefit analysis. CLINICAL SIGNIFICANCE From the qualitative and quantitative synthesis of the studies, it could be concluded that there is some evidence that low laser therapy and corticotomy are associated with accelerated orthodontic tooth movement, while further investigation is required before routine application.

Retinal Laser Lesion Visibility in Simultaneous Ultra-High Axial Resolution Optical Coherence Tomography

Ex vivo porcine retina laser lesions applied with varying laser power (20 mW–2 W, 10 ms pulse, 196 lesions) are manually evaluated by microscopic and optical coherence tomography (OCT) visibility, as well as in histological sections immediately after the deposition of the laser energy. An optical coherence tomography system with 1.78 um axial resolution specifically developed to image thin retinal layers simultaneously to laser therapy is presented, and visibility thresholds of the laser lesions in OCT data and fundus imaging are compared. Optical coherence tomography scans are compared with histological sections to estimate the resolving power for small optical changes in the retinal layers, and real-time time-lapse scans during laser application are shown and analyzed quantitatively. Ultrahigh-resolution OCT inspection features a lesion visibility threshold 40–50 mW (17 reduction) lower than for visual inspection. With the new measurement system, 42 of the lesions that were invisible using state-of-the-art ophthalmoscopic methods could be detected.

Clay mineraology and grain size composition of surface sediments from South Pacific Ocean

The reconstruction of low-latitude ocean-atmosphere interactions is one of the major issues of (paleo-)environmental studies. The trade winds, extending over 20° to 30° of latitude in both hemispheres, between the subtropical highs and the intertropical convergence zone, are major components of the atmospheric circulation and little is known about their long-term variability on geological time-scales, in particular in the Pacific sector. We present the modern spatial pattern of eolian-derived marine sediments in the eastern equatorial and subtropical Pacific (10°N to 25°S) as a reference data set for the interpretation of SE Pacific paleo-dust records. The terrigenous silt and clay fractions of 75 surface sediment samples have been investigated for their grain-size distribution and clay-mineral compositions, respectively, to identify their provenances and transport agents. Dust delivered to the southeast Pacific from the semi- to hyper-arid areas of Peru and Chile is rather fine-grained (4-8 µm) due to low-level transport within the southeast trade winds. Nevertheless, wind is the dominant transport agent and eolian material is the dominant terrigenous component west of the Peru-Chile Trench south of ~ 5°S. Grain-size distributions alone are insufficient to identify the eolian signal in marine sediments due to authigenic particle formation on the sub-oceanic ridges and abundant volcanic glass around the Galapagos Islands. Together with the clay-mineral compositions of the clay fraction, we have identified the dust lobe extending from the coasts of Peru and Chile onto Galapagos Rise as well as across the equator into the doldrums. Illite is a very useful parameter to identify source areas of dust in this smectite-dominated study area.

Towards high-level execution primitives for and-parallelism: preliminary results

Most implementations of parallel logic programming rely on complex low-level machinery which is arguably difflcult to implement and modify. We explore an alternative approach aimed at taming that complexity by raising core parts of the implementation to the source language level for the particular case of and-parallelism. Therefore, we handle a signiflcant portion of the parallel implementation mechanism at the Prolog level with the help of a comparatively small number of concurrency-related primitives which take care of lower-level tasks such as locking, thread management, stack set management, etc. The approach does not eliminate altogether modiflcations to the abstract machine, but it does greatly simplify them and it also facilitates experimenting with different alternatives. We show how this approach allows implementing both restricted and unrestricted (i.e., non fork-join) parallelism. Preliminary experiments show that the amount of performance sacriflced is reasonable, although granularity control is required in some cases. Also, we observe that the availability of unrestricted parallelism contributes to better observed speedups.

Improved adenovirus packaging cell lines to support the growth of replication-defective gene-delivery vectors.

Adenovirus (Ad) vectors have been extensively used to deliver recombinant genes to a great variety of cell types in vitro and in vivo. Ad-based vectors are available that replace the Ad early region 1 (E1) with recombinant foreign genes. The resultant E1-deleted vectors can then be propagated on 293 cells, a human embryonal kidney cell line that constitutively expresses the E1 genes. Unfortunately, infection of cells and tissues in vivo results in low-level expression of Ad early and late proteins (despite the absence of E1 activity) resulting in immune recognition of virally infected cells. The infected cells are subsequently eliminated, resulting in only a transient expression of foreign genes in vivo. We hypothesize that a second-generation Ad vector with a deletion of viral genes necessary for Ad genome replication should block viral DNA replication and decrease viral protein production, resulting in a diminished immune response and extended duration of foreign gene expression in vivo. As a first step toward the generation of such a modified vector, we report the construction of cell lines that not only express the E1 genes but also constitutively express the Ad serotype 2 140-kDa DNA polymerase protein, one of three virally encoded proteins essential for Ad genome replication. The Ad polymerase-expressing cell lines support the replication and growth of H5ts36, an Ad with a temperature-sensitive mutation of the Ad polymerase protein. These packaging cell lines can be used to prepare Ad vectors deleted for the E1 and polymerase functions, which should facilitate development of viral vectors for gene therapy of human diseases.

Avaliação in vivo e in vitro de diferentes protocolos no tratamento da hipersensibilidade dentinária cervical

Este estudo possui duas partes distintas: 1. in vivo (randomizado e longitudinal) que teve como objetivo avaliar protocolos de tratamento para hipersensibilidade dentinária com laser de baixa potência (com diferentes dosagens), laser de alta potência e agente dessensibilizante, por um período de 12 e 18 meses; e 2. in vitro que teve como objetivo analisar a perda de estrutura de dois dentifrícios distintos (Colgate Total 12 e Colgate Pró Alívio) e analisar a permeabilidade dentinária dos tratamentos da etapa 01, associados aos dentifrícios, após diferentes ciclos de abrasão. Na parte in vivo, as lesões cervicais não cariosas de 32 voluntários, previamente submetidos aos critérios de elegibilidade ou exclusão, foram divididas em nove grupos (n=10): G1: Gluma Desensitizer (Heraeus Kulzer), G2: Laser de baixa potência com baixa dosagem (Photon Lase, DMC) (três pontos de irradiação vestibulares e um ponto apical: 30 mW, 10 J/cm2, 9 seg por ponto com o comprimento de onda de 810nm). Foram realizadas três sessões com um intervalo de 72 horas), G3: Laser de baixa potência com alta dosagem (um ponto cervical e um ponto apical: 100 mW, 90 J/cm2, 11 seg por ponto com o comprimento de onda de 810nm. Foram realizadas três sessões com um intervalo de 72 horas), G4: Laser de baixa potência com baixa dosagem + Gluma Desensitizer, G5: Laser de baixa potência com alta dosagem + Gluma Desensitizer, G6: Laser de Nd:YAG (Power LaserTM ST6, Lares Research®), em contato com a superfície dental: 1,0W, 10 Hz e 100 mJ, ? 85 J/cm2, com o comprimento de onda de 1064nm, G7: Laser de Nd:YAG + Gluma Desensitizer, G8: Laser de Nd:YAG + Laser de baixa potência com baixa dosagem, G9: Laser de Nd:YAG + Laser de baixa potência com alta dosagem. O nível de sensibilidade de cada voluntário foi avaliado através da escala visual analógica de dor (VAS) com auxílio do ar da seringa tríplice e exploração com sonda após 12 e 18 meses do tratamento. Na parte 02, in vitro, foram utilizados terceiros molares humanos não irrompidos e recém-extraídos. Todos foram limpos e tiveram suas raízes separadas das coroas. As raízes foram seccionadas em quadrados de dentina com dimensões de 4x4x2 mm, os quais foram embutidos em resina Epoxi e devidamente polidos até uma curvatura de 0,3 ?m, analisados em perfilometria ótica. Estes foram imersos em solução de EDTA 17% por 2min para abertura dos túbulos e armazenados em uma solução de Soro Fetal Bovino diluído em salina tamponada com fosfato. Os espécimes foram divididos aleatoriamente em 12 grupos (n=10) G1: Sem tratamento de superfície, sem dentifrício; G2: Nd:YAG/sem dentifrício; G3: Gluma/sem dentifrício; G4: Nd:YAG + Gluma/sem dentifrício; G5: Sem tratamento de superfície/Colgate Total 12; G6: Nd:YAG/Colgate Total 12; G7: Gluma/Colgate Total 12; G8: Nd:YAG + Gluma/Colgate Total 12; G9: Sem tratamento de superfície/Colgate Pró Alívio; G10: Nd:YAG/Colgate Pró Alívio; G11: Gluma/Colgate Pró Alívio; G12: Nd:YAG + Gluma/Colgate Pró Alívio. Em seguida, as superfícies receberam a aplicação de fitas adesivas nas duas margens, mantendo uma área central de teste exposta de 4 x 1 mm, onde foram realizados os tratamentos de superfície e os ciclos de abrasão correspondentes a 1, 7, 30 e 90 dias de escovação (52 ciclos, 210 segundos de contato com o slurry; 361 ciclos, 1470 segundos de contato com o slurry; 1545 ciclos, 6300 segundos de contato com o slurry; 4635 ciclos, 18900 segundos de contato com o slurry, respectivamente). A cada etapa de abrasão, foi realizada análise em Perfilometria Ótica. Para as analises de permeabilidade e Microscopia Eletrônica de Varredura, foram utilizadas amostras circulares de 6 mm de diâmetro e 1 mm de espessura de dentina obtidas das coroas dentais. Estas foram divididas aleatoriamente nos mesmos grupos já descritos anteriormente, sendo que 120 espécimes foram utilizados para permeabilidade (n=10) e 36 para MEV (n=3). Ambas as análises foram realizadas após imersão no EDTA; após tratamentos para a sensibilidade; pós 1 dia, 7 dias, 30 dias e 90 dias de escovação. Após análise estatística pode-se concluir que, in vivo, todos os tratamentos foram eficazes para a redução da hipersensibilidade dentinária. Ainda que o nível da sensibilidade dos pacientes aumentou numericamente, estes não são considerados estatisticamente diferentes a partir de 12 meses. Portanto, até a avaliação de 18 meses, podemos concluir que não houve um aumento na sensibilidade dentinária desde a sua diminuição pós-tratamento. In vitro, pode-se concluir que todos os tratamentos foram capazes de diminuir a permeabilidade dentinária. O dentifrício Total 12 apresentou-se como o mais abrasivo em comparação com o dentifrício Pro Alivio, pois este último promoveu uma perda de estrutura menor, porém ambos não apresentaram aumento na permeabilidade nos tempos de escovação. As microscopias eletrônicas de varredura mostram a formação da smear layer, obliterando os túbulos para ambos os dentifricios. Como conclusão, pode-se afirmar que todos os agentes dessensibilizantes foram efetivos, mesmo apresentando estratégias de ação diferentes. Os dentifrícios são igualmente interessantes para o uso caseiro por ocasionarem oclusão tubular e a associação de tratamentos (caseiro e de consultório) parece ser uma alternativa eficaz no tratamento da hipersensibilidade dentinária.

The assessment of the level of knowledge about dietary fibre among the portuguese population

The aim of this work was to assess the degree of knowledge about dietary fibre (DF), as influenced by factors such as age, gender, level of education and living environment. For this, a descriptive cross- sectional study was undertaken by means of a questionnaire and the total number of respondents was 382. The results revealed that the participants had a not satisfying global level of knowledge (3.59 ± 0.64, on a scale from 1 to 5). The overall knowledge was found lower for young adults aged 19 to 30 years, when compared to adults aged over 31 and up to 65 years, being this difference statistically significant (p=0.030). However, no statistical significant differences were found between genders, levels of education or living environments. The low level of knowledge demonstrated by the enquired alerts for the need to plan some additional actions to further inform the Portuguese population about dietary fibre.

Lichtheimia Infection in a Lymphoma Patient: Case Report and a Brief Review of the Available Diagnostic Tools

We describe the case of a patient with a T-lymphoblastic lymphoma whose disseminated mucormycosis was diagnosed with delay, and we address the diagnostic and therapeutic decision-making process and review the diagnostic workup of patients with potential IFD. The diagnosis was delayed despite a suggestive radiological presentation of the patient's pulmonary lesion. The uncommon risk profile (T-lymphoblastic lymphoma, short neutropenic phases) wrongly led to a low level of suspicion. The diagnosis was also hampered by the lack of indirect markers for infections caused by Mucorales, the low sensitivity of both fungal culture and panfungal PCR, and the limited availability of species-specific PCR. A high level of suspicion of IFD is needed, and aggressive diagnostic procedures should be promptly initiated even in apparently low-risk patients with uncommon presentations. The extent of the analytical workup should be decided on a case-by-case base. Diagnostic tests such as the galactomannan and β-D-glucan test and/or PCR on biological material followed by sequencing should be chosen according to their availability and after evaluation of their specificity and sensitivity. In high-risk patients, preemptive therapy with a broad-spectrum mould-active antifungal agent should be started before definitive diagnostic findings become available.

Why is Coccidoxenoides perminutus, a mealybug parasitoid, ineffective as a biocontrol agent - Inaccurate measures of parasitism or low adult survival?

Coccidoxenoides perminutus achieves only low levels of parasitism of its host Planococcus citri in southeast Queensland citrus. Two possible causes were investigated. Adult survival under natural conditions was assessed to determine whether providing adult food sources could enhance survival. Behavioural changes of hosts, induced by C perminutus parasitism, was also investigated to establish if parasitised P. citri move from their feeding site to seek protected shelters some distance away and are thus not accounted for in field assessments of parasitism rates. Unparasitised mealybugs placed in the field for two periods were retrieved before the effects of parasitism were manifested and parasitism rates were still low (0.3% at 5 days and 1.2% at 10 days). Levels of locomotion of P. citri exposed to C perminutus were compared with those of unexposed ones. Parasitised mealybugs, regardless of instar, undergo behavioural changes. In comparison to unparasitised controls, the mealybugs become highly active 7-14 days after exposure to wasps. All parasitised mealybugs undergo physical changes, their body becomes cylindrical, their legs go so rigid that the mealybugs become immobile, and this signifies the typical mummy appearance. All mealybugs that became mummies eventually fell from the host lemon fruit because of impaired locomotion and were caught on sticky traps that had been placed beneath the lemons. Consequently, their final site of mummification was not established. C perminutus adults provided with nectar or honey survived longer (about 5 days) in the field than those without food (about a day). Nectar from two plant species, Alpinia zerumbet and Datura candida, proved to be good sources of food for the adult wasps, and were comparable in quality to honey. The low level of parasitism achieved by C perminutus in southeast Queensland citrus thus appears to be a consequence of the short adult life and the negative effects of a harsh environment. Provision of a suitable food source (e.g., nectar) may well enhance levels of parasitism in the field. (c) 2005 Elsevier Inc. All rights reserved.