Korkean teknologian tuotteen lanseeraus terveydenhuollon markkinoille

Uuden tuotteen lanseeraus on tärkeä liikkeenjohdollinen toimi. Se on tärkeä askel uuden innovatiivisen tuotteen markkinoille saattamisessa ja tähän liittyvässä prosessissa. Uuden tuotteen kehitysprosessin tässä vaiheessa markkinat saavat kokemusta uudesta tuotteesta ensimmäistä kertaa. Korkean teknologian ympäristössä valmistajalla on usein vain pieni ja hetkellinen mahdollisuus tavoittaa markkinansa, sillä yhä globaalimmassa maailmassa seuraajia ja imitoijia ilmaantuu nopeasti. Tämän johdosta markkinaoperaatioiden tulee olla oikeita ensimmäisellä kertaa. Korkean teknologian ympäristö ei tee tästä tehtävästä helppoa, sillä uutta teknologista laitetta ja uutta teknologiaa kohtaa koetaan suurta epävarmuutta, sekä ostajan että valmistajan puolelta. Tutkimuksen tarkoituksena on selvittää pienelle ja uudelle korkean teknologian valmistajalle sopiva lanseerausprosessi, sekä tämän prosessin eri tasoilla käytettävissä olevat taktiikat ja niiden soveltuvuus esimerkkiyritykselle ja sen tuotteelle. Tutkielmassa perehdytään terveydenhuollon ja korkean teknologian markkinoiden erityispiirteisiin ja näiden vaikutukseen lanseerausprosessiin. Tutkimuksen tulokset osoittavat, että korkean teknologian markkinoijan tulee tuntea potentiaalinen asiakaskuntansa ja markkina-alueensa erittäin hyvin. Tällöin hän kykenee etenemään teknologisen omaksumisen elinkaaren käyrää kilpailijoita joustavammin, koska hän tietää kehen kannattaa kullakin hetkellä panostaa ja millaisia taktiikoita käyttää. Lanseeraustaktiikoiden sopivuus riippuu yrityksen ja sen teknologisen tuotteen ominaisuuksien lisäksi myös markkinoiden tilanteesta ja potentiaalisesta asiakaskunnasta. Tutkimuksessa esitetään neljätasoinen lanseerausprosessi ja esimerkkiyritykselle soveltuvat taktiikat.

Movilidad intergeneracional y emparejamiento selectivo en España

This paper examines the role of assortative mating in the intergenerational economic mobility in Spain. Sons and daughters usually marry individuals with similar characteristics, which may lower mobility. Our empirical strategy employs the Two-sample two-stage least squares estimator to estimate the intergenerational income elasticity in absence of data for two generations not residing in the same household. Our findings suggest that assortative mating plays an important role in the intergenerational transmission process. On average about 50 per 100 of the covariance between parents’ income and child family’s incomecan be accounted for by the person the child is married to

Lifetime enhancement of scroll rings by spatiotemporal fluctuations

The dynamics of three-dimensional scroll rings with spatiotemporal random excitability is investigated numerically using the FitzHugh-Nagumo model. Depending on the correlation time and length scales of the fluctuations, the lifetime of the ring filament is enlarged and a resonance effect between the time scale of the scroll ring and the time correlation of the noise is observed. Numerical results are interpreted in terms of a simplified stochastic model derived from the kinematical equations for three-dimensional excitable waves.

Lifetime enhancement of scroll rings by spatiotemporal fluctuations

The dynamics of three-dimensional scroll rings with spatiotemporal random excitability is investigated numerically using the FitzHugh-Nagumo model. Depending on the correlation time and length scales of the fluctuations, the lifetime of the ring filament is enlarged and a resonance effect between the time scale of the scroll ring and the time correlation of the noise is observed. Numerical results are interpreted in terms of a simplified stochastic model derived from the kinematical equations for three-dimensional excitable waves.

Modeling the transport phenomena within arterial wall: porous media approach

The transport of macromolecules, such as low-density lipoprotein (LDL), and their accumulation in the layers of the arterial wall play a critical role in the creation and development of atherosclerosis. Atherosclerosis is a disease of large arteries e.g., the aorta, coronary, carotid, and other proximal arteries that involves a distinctive accumulation of LDL and other lipid-bearing materials in the arterial wall. Over time, plaque hardens and narrows the arteries. The flow of oxygen-rich blood to organs and other parts of the body is reduced. This can lead to serious problems, including heart attack, stroke, or even death. It has been proven that the accumulation of macromolecules in the arterial wall depends not only on the ease with which materials enter the wall, but also on the hindrance to the passage of materials out of the wall posed by underlying layers. Therefore, attention was drawn to the fact that the wall structure of large arteries is different than other vessels which are disease-resistant. Atherosclerosis tends to be localized in regions of curvature and branching in arteries where fluid shear stress (shear rate) and other fluid mechanical characteristics deviate from their normal spatial and temporal distribution patterns in straight vessels. On the other hand, the smooth muscle cells (SMCs) residing in the media layer of the arterial wall respond to mechanical stimuli, such as shear stress. Shear stress may affect SMC proliferation and migration from the media layer to intima. This occurs in atherosclerosis and intimal hyperplasia. The study of blood flow and other body fluids and of heat transport through the arterial wall is one of the advanced applications of porous media in recent years. The arterial wall may be modeled in both macroscopic (as a continuous porous medium) and microscopic scales (as a heterogeneous porous medium). In the present study, the governing equations of mass, heat and momentum transport have been solved for different species and interstitial fluid within the arterial wall by means of computational fluid dynamics (CFD). Simulation models are based on the finite element (FE) and finite volume (FV) methods. The wall structure has been modeled by assuming the wall layers as porous media with different properties. In order to study the heat transport through human tissues, the simulations have been carried out for a non-homogeneous model of porous media. The tissue is composed of blood vessels, cells, and an interstitium. The interstitium consists of interstitial fluid and extracellular fibers. Numerical simulations are performed in a two-dimensional (2D) model to realize the effect of the shape and configuration of the discrete phase on the convective and conductive features of heat transfer, e.g. the interstitium of biological tissues. On the other hand, the governing equations of momentum and mass transport have been solved in the heterogeneous porous media model of the media layer, which has a major role in the transport and accumulation of solutes across the arterial wall. The transport of Adenosine 5´-triphosphate (ATP) is simulated across the media layer as a benchmark to observe how SMCs affect on the species mass transport. In addition, the transport of interstitial fluid has been simulated while the deformation of the media layer (due to high blood pressure) and its constituents such as SMCs are also involved in the model. In this context, the effect of pressure variation on shear stress is investigated over SMCs induced by the interstitial flow both in 2D and three-dimensional (3D) geometries for the media layer. The influence of hypertension (high pressure) on the transport of lowdensity lipoprotein (LDL) through deformable arterial wall layers is also studied. This is due to the pressure-driven convective flow across the arterial wall. The intima and media layers are assumed as homogeneous porous media. The results of the present study reveal that ATP concentration over the surface of SMCs and within the bulk of the media layer is significantly dependent on the distribution of cells. Moreover, the shear stress magnitude and distribution over the SMC surface are affected by transmural pressure and the deformation of the media layer of the aorta wall. This work reflects the fact that the second or even subsequent layers of SMCs may bear shear stresses of the same order of magnitude as the first layer does if cells are arranged in an arbitrary manner. This study has brought new insights into the simulation of the arterial wall, as the previous simplifications have been ignored. The configurations of SMCs used here with elliptic cross sections of SMCs closely resemble the physiological conditions of cells. Moreover, the deformation of SMCs with high transmural pressure which follows the media layer compaction has been studied for the first time. On the other hand, results demonstrate that LDL concentration through the intima and media layers changes significantly as wall layers compress with transmural pressure. It was also noticed that the fraction of leaky junctions across the endothelial cells and the area fraction of fenestral pores over the internal elastic lamina affect the LDL distribution dramatically through the thoracic aorta wall. The simulation techniques introduced in this work can also trigger new ideas for simulating porous media involved in any biomedical, biomechanical, chemical, and environmental engineering applications.

Acute Infection in Total Knee Arthroplasty: Diagnosis and Treatment

Infection is one of the most serious complications after total knee arthroplasty (TKA). The current incidence of prosthetic knee infection is 1-3%, depending on the series(.) For treatment and control to be more cost effective, multidisciplinary groups made up of professionals from different specialities who can work together to eradicate these kinds of infections need to be assembled. About the microbiology, Staphylococcus aureus and coagulase-negative staphylococcus were among the most frequent microorganisms involved (74%). Anamnesis and clinical examination are of primary importance in order to determine whether the problem may point to a possible acute septic complication. The first diagnosis may then be supported by increased CRP and ESR levels. The surgical treatment for a chronic prosthetic knee infection has been perfectly defined and standardized, and consists in a two-stage implant revision process. In contrast, the treatment for acute prosthetic knee infection is currently under debate. Considering the different surgical techniques that already exist, surgical debridement with conservation of the prosthesis and polythene revision appears to be an attractive option for both surgeon and patient, as it is less aggressive than the two-stage revision process and has lower initial costs. The different results obtained from this technique, along with prognosis factors and conclusions to keep in mind when it is indicated for an acute prosthetic infection, whether post-operative or haematogenous, will be analysed by the authors.

Assessment of total cardiovascular risk in hypertensive subjects

Valtimotautiriskin arviointi verenpainepotilailla Valtimotaudit ovat yleisin kuolinsyy koko maailmassa. Väestön elintapojen muuttuminen ja ikääntyminen uhkaavat edelleen lisätä valtimotautien esiintyvyyttä. Kokemäenjokilaakson valtimotautien ehkäisyprojektin tavoitteena oli löytää 45–70-vuotiaasta väestöstä henkilöt, joilla on kohonnut riski sairastua valtimotauteihin. Kaksivaiheisen seulontamenetelmän avulla voitiin terveydenhoitajan antama elintapaneuvonta kohdistaa riskihenkilöihin ja rajoittaa lääkärin vastaanoton tarve niihin potilaisiin, jotka todennäköisesti hyötyvät ennaltaehkäisevästä lääkityksestä. Suomalainen tyypin 2 diabeteksen sairastumisriskin arviointikaavake ja hoitajan toteama kohonnut verenpaine osoittautuivat käytännöllisiksi menetelmiksi seuloa väestöstä riskihenkilöitä. Valtimotautien ehkäisyprojektissa Harjavallassa ja Kokemäellä todettiin verenpainetauti 1 106 henkilöllä, jotka eivät sairastaneet valtimotautia tai aiemmin todettua diabetesta. Heidän tutkimustulostensa avulla voidaan arvioida kohonneen verenpaineen vaikutusta sokeriaineenvaihduntaan ja verenpaineen aiheuttamiin kohde-elinvaurioihin. Sokeriaineenvaihdunnan häiriöt ovat verenpainetautia sairastavilla yleisempiä kuin väestössä muutoin. Käyttämällä metabolisen oireyhtymän kriteerejä sokerirasituskokeen suorittamisen edellytyksenä voidaan tutkimusten määrää vähentää kolmanneksella ja silti löytää lähes kaikki diabetesta tai sen esiastetta sairastavat verenpainepotilaat. Verenpainepotilaista etenkin metabolista oireyhtymää sairastavilla naisilla on suurentunut munuaisten vajaatoiminnan riski. Jos verenpainepotilaan munuaisten toimintaa arvioidaan pelkästään plasman kreatiniini -arvon perusteella, kolme neljästä munuaisten vajaatoimintaa potevasta jää toteamatta verrattuna laskennallisen glomerulusten suodattumisnopeuden määritykseen seulontamenetelmänä. Joka kolmannella verenpainetautia sairastavalla voidaan todeta alaraajavaltimoiden kovettumista; useammin niillä, joiden ylä- ja alaverenpaineen erotus, pulssipaine on yli 65 mmHg. Verenpainetauti on itsenäinen perifeerisen valtimotaudin vaaratekijä. Tutkimuksessa käytetty menetelmä nilkka-olkavarsipainesuhteen määrittämiseksi soveltunee hyvin perusterveydenhuollon käyttöön riskihenkilöiden löytämiseksi. Valtimotautien kokonaisriskin arviointimenetelmät tai uuden riskitekijän, herkän C-reaktiivisen proteiinin määritys eivät voi korvata kohde-elinvaurioiden mittaamista verenpainepotilaan valtimotautiriskin huolellisessa arvioinnissa.

Tuotannon tuotetiedonhallintajärjestelmän kehittäminen monitehdasyritykselle

Tämän työn tavoitteena oli kehittää monitehdasympäristöön siirtyneen pk-yrityksen tuotannon tuotetiedonhallintaa. Hajautettu tuotanto ja verkostoituminen oli luonut uusia haasteita ja vaatimuksia tuotetiedonhallinnalle. Teoriaosassa selvitettiin mitä tuotannon tuotetiedoilla tarkoitetaan, mitä osa-alueita on hallittava sekä miten niitä voitaisiin hallita kansainvälisesti verkostoituneen yrityksen näkökulmasta. Näiden lisäksi kartoitettiin ja vertailtiin erilaisia kehittämisvaihtoehtoja. Teorioista luotiin itsearviointityökalu kohdeyrityksen tuotannon tuotetiedon nykytilan kuvausta ja –analyysia varten. Löydetyt kehittämistarpeet priorisoitiin ja valituille kehityskohteille pohdittiin ratkaisuehdotuksia kaksivaiheisen kehittämismallin mukaisesti.

Solo contaminado com cádmio: extratibilidade do metal e cinética química de degradação da matéria orgânica de torta de filtro

The chemical kinetics of sugarcane filter cake (FC) organic matter degradation at rates (0, 40, 80, and 120 t ha-1) in non-contaminated and different degrees of cadmium-contaminated Oxisol (0.19, 28, 56, 112 and 200 mg Cd kg-1) and DTPA-extractable Cd was studied. FC degradation was determined by quantifying CO2 emitted from soil samples during 72 days of incubation. DTPA-extractable Cd was performed after the incubation period. FC degradation was described by a two-stage equation of chemical kinetics. FC degradation rates were between 15 and 33%. Total CO2 emitted from FC declined with increasing degree in Cd-contamination and the DTPA-extractable Cd declined with FC rates.

Idea- ja innovaatioporfolion hallinta

Tässä kandidaatintyössä tarkastellaan idea- ja innovaatioportfolion hallintaa, portfoliojohtamista sekä näihin soveltuvia erilaisia menetelmiä yrityksen näkökulmasta. Tavoitteena on luoda yleiskatsaus yleisimpiin käytettyihin menetelmiin ja viitekehyksiin. Lähteinä työssä on käytetty sähköisiä tietokantoja ja alan kirjallisuutta. Käytetyimmät portfolion hallintamenetelmät voidaan jakaa neljään ryhmään: taloudelliset ja rahamääräiset mittarit, liiketoimintastrategiat, portfoliokartat tai kupla-diagrammit, scorecard:it eli pisteytystaulukot sekä tarkistuslistat. Idea- ja innovaatioportfolion hallinnan tavoitteena on luoda yrityksen kannalta mahdollisimman tehokas ja tuottava portfolio, joka on kuitenkin linjassa yrityksen strategian kanssa. Portfolion projekteille jaettavissa olevat resurssit ovat niukat, joten resurssien jakoon ja tehokkaaseen hyödyntämiseen tulee kiinnittää huomiota. Portfolion tasapainottamiseksi on hyvä tarkastella kehitys- ja tutkimusprojektien määrää, kokoa ja riskiä. Teknologiatiekartta on yrityksen strateginen työkalu, jolla se voi suunnata toimintaansa kohti sen visiota. Teknologiatiekartta koostuu yrityksen valitsemista markkinoista, niille suunnatuista tuotteista tai palveluista, sekä näiden vaatimista tuotekehitysprojekteista ja teknologioista. Projektien etenemistä voidaan tarkastella stage-gate -mallin avulla. Stage-gate jakaa projektin porteilla eri vaiheisiin. Jokaisen portin läpäistäkseen projektin tulee täyttää sille asetetut vaatimukset. Menetelmät eivät takaa menestystä, vaan yrityksen on valittava itselleen sopivat menetelmät siten, että ne tukevat portfoliojohtamista ja sopivat yhteen yrityskulttuurin kanssa. Pelkkä mittareihin tuijottaminen ei riitä, vaan niiden taakse on myös osattava katsoa ja huomioida yrityksen strategia.

Methods and Models for Accelerating Dynamic Simulation of Fluid Power Circuits

The objective of this dissertation is to improve the dynamic simulation of fluid power circuits. A fluid power circuit is a typical way to implement power transmission in mobile working machines, e.g. cranes, excavators etc. Dynamic simulation is an essential tool in developing controllability and energy-efficient solutions for mobile machines. Efficient dynamic simulation is the basic requirement for the real-time simulation. In the real-time simulation of fluid power circuits there exist numerical problems due to the software and methods used for modelling and integration. A simulation model of a fluid power circuit is typically created using differential and algebraic equations. Efficient numerical methods are required since differential equations must be solved in real time. Unfortunately, simulation software packages offer only a limited selection of numerical solvers. Numerical problems cause noise to the results, which in many cases leads the simulation run to fail. Mathematically the fluid power circuit models are stiff systems of ordinary differential equations. Numerical solution of the stiff systems can be improved by two alternative approaches. The first is to develop numerical solvers suitable for solving stiff systems. The second is to decrease the model stiffness itself by introducing models and algorithms that either decrease the highest eigenvalues or neglect them by introducing steady-state solutions of the stiff parts of the models. The thesis proposes novel methods using the latter approach. The study aims to develop practical methods usable in dynamic simulation of fluid power circuits using explicit fixed-step integration algorithms. In this thesis, twomechanisms whichmake the systemstiff are studied. These are the pressure drop approaching zero in the turbulent orifice model and the volume approaching zero in the equation of pressure build-up. These are the critical areas to which alternative methods for modelling and numerical simulation are proposed. Generally, in hydraulic power transmission systems the orifice flow is clearly in the turbulent area. The flow becomes laminar as the pressure drop over the orifice approaches zero only in rare situations. These are e.g. when a valve is closed, or an actuator is driven against an end stopper, or external force makes actuator to switch its direction during operation. This means that in terms of accuracy, the description of laminar flow is not necessary. But, unfortunately, when a purely turbulent description of the orifice is used, numerical problems occur when the pressure drop comes close to zero since the first derivative of flow with respect to the pressure drop approaches infinity when the pressure drop approaches zero. Furthermore, the second derivative becomes discontinuous, which causes numerical noise and an infinitely small integration step when a variable step integrator is used. A numerically efficient model for the orifice flow is proposed using a cubic spline function to describe the flow in the laminar and transition areas. Parameters for the cubic spline function are selected such that its first derivative is equal to the first derivative of the pure turbulent orifice flow model in the boundary condition. In the dynamic simulation of fluid power circuits, a tradeoff exists between accuracy and calculation speed. This investigation is made for the two-regime flow orifice model. Especially inside of many types of valves, as well as between them, there exist very small volumes. The integration of pressures in small fluid volumes causes numerical problems in fluid power circuit simulation. Particularly in realtime simulation, these numerical problems are a great weakness. The system stiffness approaches infinity as the fluid volume approaches zero. If fixed step explicit algorithms for solving ordinary differential equations (ODE) are used, the system stability would easily be lost when integrating pressures in small volumes. To solve the problem caused by small fluid volumes, a pseudo-dynamic solver is proposed. Instead of integration of the pressure in a small volume, the pressure is solved as a steady-state pressure created in a separate cascade loop by numerical integration. The hydraulic capacitance V/Be of the parts of the circuit whose pressures are solved by the pseudo-dynamic method should be orders of magnitude smaller than that of those partswhose pressures are integrated. The key advantage of this novel method is that the numerical problems caused by the small volumes are completely avoided. Also, the method is freely applicable regardless of the integration routine applied. The superiority of both above-mentioned methods is that they are suited for use together with the semi-empirical modelling method which necessarily does not require any geometrical data of the valves and actuators to be modelled. In this modelling method, most of the needed component information can be taken from the manufacturer’s nominal graphs. This thesis introduces the methods and shows several numerical examples to demonstrate how the proposed methods improve the dynamic simulation of various hydraulic circuits.

Anaerobic-aerobic treatment of swine wastewater in uasb and batch reactors in series

In this work it was evaluated the performance of two systems of swine wastewater treatment consisting of two-stage upflow anaerobic sludge blanket (UASB) reactors, with and without post-treatment in sequencing batch reactor (SBR), fed continuously, with aerobic phase. The UASB reactors in the first stage had 908 L in the sets I and II, and in the second stage 350 and 188 L, respectively. In the set II the post-treatment was performed in a SBR of 3,000 L. The hydraulic detention times in the anaerobic treatment systems were 100, 75 and 58 h in the set I; 87, 65 and 51 h in the set II; and 240 and 180 h in the SBR. The volumetric organic load applied in the first stage UASB reactors ranged from 6.9 to 12.6 g total COD (L d)-1 in the set I and 7.5 to 9.8 g total COD (L d)-1 in the set II. The average removal efficiencies of total COD, total phosphorus (Ptotal), and Kjeldahl and organic nitrogen (KN and Norg) in the anaerobic treatment systems were similar and reached maximum values of 97%, 64%, 68%, and 98%. In the SBR, the removal efficiencies of total COD and thermotolerant coliforms were up to 62 and 92% resulting, respectively, in effluent concentrations of 135 mg L-1 and 2x10(4)MPN (100 mL)-1. For Ptotal, total nitrogen (TN) and Norg, the average removal efficiencies in the SBR were up to 58, 25 and 73%, respectively.

Resection of liver metastasis from neuroendocrine tumors: evaluation of results and prognostic factors

OBJECTIVES: to determine the prognostic factors that may impact on morbidity and mortality and survival of patients undergoing surgical treatment of liver metastases from neuroendocrine tumors. METHODS: We studied 22 patients undergoing liver resection for metastases from neuroendocrine tumors between 1997 and 2007. Epidemiological and clinical data were correlated with morbidity and mortality and overall and disease-free survivals. RESULTS: twelve patients were male and ten female, with a mean age of 48.5 years. Bilobar disease was present in 17 patients (77.3%). In ten patients (45.5%) the primary tumor originated in the pancreas, terminal ileum in eight, duodenum in two, rectum in one and jejunum in one. Complete surgical resection (R0) was achieved in 59.1% of patients. Eight patients (36.3%) developed complications in the immediate postoperative period, one of them dying from septicemia. All patients undergoing re-hepatectomy and/or two-stage hepatectomy had complications in the postoperative period. The overall survival at one and five years was 77.3% and 44.2%. The disease-free survival at five years was 13.6%. The primary pancreatic neuroendocrine tumor (p = 0.006) was associated with reduced overall survival. Patients with number of metastatic nodules < 10 (p = 0.03) and asymptomatic at diagnosis (p = 0.015) had higher disease-free survival. CONCLUSION: liver metastases originating from pancreatic neuroendocrine tumors proved to be a negative prognostic factor. Symptomatic patients with multiple metastatic nodules showed a significant reduction in disease-free survival.

"Fuzzy front end" ja sen menestyksekäs johtaminen teollisuusyrityksessä

Työssä käsitellään innovaatioprosessin ensimmäistä ”fuzzy front end” -vaihetta, jota työssä kutsutaan front end -vaiheeksi. Front end -vaihe on innovaatioprosessin alustava tutkimus ja suunnittelu vaihe ennen teknistä kehittämisvaihetta. Front end -vaihetta on tutkittu innovaatioprosessin osista vähiten, sekä se on useimmille yrityksillä sumea ja vaikeasti käsitettävä. Tutkimusten mukaan front end -vaiheen osaaminen on kuitenkin erittäin merkittävä tekijä yrityksen innovatiivisuudelle. Työssä avataan innovaatioprosessin sisältöä ja tavoitteita, sekä vertaillaan käytössä olevia malleja front end -vaiheen rakenteesta. Työssä selvitetään avaintekijöitä front end -vaiheen menestykseen ja tehokkuuteen. Lisäksi käsitellään johtamisen tekijöitä, jotka edesauttavat onnistumaan front end -vaiheessa.

Diclofenac plasma protein binding: PK-PD modelling in cardiac patients submitted to cardiopulmonary bypass

Twenty-four surgical patients of both sexes without cardiac, hepatic, renal or endocrine dysfunctions were divided into two groups: 10 cardiac surgical patients submitted to myocardial revascularization and cardiopulmonary bypass (CPB), 3 females and 7 males aged 65 ± 11 years, 74 ± 16 kg body weight, 166 ± 9 cm height and 1.80 ± 0.21 m2 body surface area (BSA), and control, 14 surgical patients not submitted to CPB, 11 female and 3 males aged 41 ± 14 years, 66 ± 14 kg body weight, 159 ± 9 cm height and 1.65 ± 0.16 m2 BSA (mean ± SD). Sodium diclofenac (1 mg/kg, im Voltaren 75® twice a day) was administered to patients in the Recovery Unit 48 h after surgery. Venous blood samples were collected during a period of 0-12 h and analgesia was measured by the visual analogue scale (VAS) during the same period. Plasma diclofenac levels were measured by high performance liquid chromatography. A two-compartment open model was applied to obtain the plasma decay curve and to estimate kinetic parameters. Plasma diclofenac protein binding decreased whereas free plasma diclofenac levels were increased five-fold in CPB patients. Data obtained for analgesia reported as the maximum effect (EMAX) were: 25% VAS (CPB) vs 10% VAS (control), P<0.05, median measured by the visual analogue scale where 100% is equivalent to the highest level of pain. To correlate the effect versus plasma diclofenac levels, the EMAX sigmoid model was applied. A prolongation of the mean residence time for maximum effect (MRTEMAX) was observed without any change in lag-time in CPB in spite of the reduced analgesia reported for these patients, during the time-dose interval. In conclusion, the extent of plasma diclofenac protein binding was influenced by CPB with clinically relevant kinetic-dynamic consequences