Bilateral deep brain stimulation: the placement of the second electrode is not necessarily less accurate than that of the first one.

BACKGROUND: Deep brain stimulation (DBS) is recognized as an effective treatment for movement disorders. We recently changed our technique, limiting the number of brain penetrations to three per side. OBJECTIVES: The first aim was to evaluate the electrode precision on both sides of surgery since we implemented this surgical technique. The second aim was to analyse whether or not the electrode placement was improved with microrecording and macrostimulation. METHODS: We retrospectively reviewed operation protocols and MRIs of 30 patients who underwent bilateral DBS. For microrecording and macrostimulation, we used three parallel channels of the 'Ben Gun' centred on the MRI-planned target. Pre- and post-operative MRIs were merged. The distance between the planned target and the centre of the implanted electrode artefact was measured. RESULTS: There was no significant difference in targeting precision on both sides of surgery. There was more intra-operative adjustment of the second electrode positioning based on microrecording and macrostimulation, which allowed to significantly approach the MRI-planned target on the medial-lateral axis. CONCLUSION: There was more electrode adjustment needed on the second side, possibly in relation with brain shift. We thus suggest performing a single central track with electrophysiological and clinical assessment, with multidirectional exploration on demand for suboptimal clinical responses.

Reconstruction of Fresnel Holograms using partial wave front information

n this work we analyze the behavior of complex information in Fresnel domain taking into account the limited capability to display complex transmittance values of current liquid crystal devices, when used as holographic displays. In order to do this analysis we compute the reconstruction of Fresnel holograms at several distances using the different parts of the complex distribution (real and imaginary parts, amplitude and phase) as well as using the full complex information adjusted with a method that combines two configurations of the devices in an adding architecture. The RMS error between the amplitude of these reconstructions and the original amplitude is used to evaluate the quality of the information displayed. The results of the error analysis show different behavior for the reconstructions using the different parts of the complex distribution and using the combined method of two devices. Better reconstructions are obtained when using two devices whose configurations densely cover the complex plane when they are added. Simulated and experimental results are also presented.

Meesauunin polttovyöhykkeen lämmönsiirron ja palamisen mallinnus

Tälle diplomityölle on antanut alkusysäyksen tarve kehittää käytössä olevaa meesauunin simulointiohjelmaa. Simulointiohjelma mallintaa meesauunin stationaaritilan toimintaa. Sillä voidaan tutkia uunin konstruktion muutosten vaikutuksia uunin toimintaan. Ohjelma on tehty 1980-luvun alkupuolella. Sen aikaisten tietokoneiden laskentatehojen vuoksi ohjelman käyttämään laskentamalliin on jouduttu tekemään joukko erilaisia yksinkertaistuksia laskenta-ajan lyhentämiseksi. Tässä diplomityössä keskityttiin tutkimaan meesauunin polttovyöhykkeen lämmönsiirron ja palamisen mallinnusta. Työssä luotiin aluksi tarvittavat massa- ja energiataseet sekä esitettiin tarvittavat lämmönsiirtoyhtälöt. Sen jälkeen kehitettiin uusi polttoaineen 1D-palamismalli. Palamismalli tehtiin VTT:n tekemien 3D-mallinnusten perusteella. Polttoaineina käytettiin maakaasua ja polttoöljyä. Uusi palamismalli lisättiin simulointiohjelmaan. Lisäksi simulointiohjelmasta muutettiin savukaasun emissiviteetin laskenta ja lämmönsiirto uunin ulkopinnasta ympäristöön. Tuloksena saatiin aikaan uusi tarkempi kuvaus lämmönsiirrosta ja palamisesta meesauunissa.

Voimalaitoskattilan pyörivän regeneratiivisen ilman esilämmittimen suorituskyky ja mitoitus

Diplomityön tarkoituksena oli kehittää laskentaohjelma pyörivälle regeneratiiviselle lämmönsiirtimelle. Työ tehtiin Foster Wheeler Energia Oy:n Varkauden toimipisteessä. Työn ensimmäisessä osuudessa tutkittiin kirjallisuuden avulla regeneraattoreihin liittyvää teoriaa. Tämä osuus sisältää regeneratiivisen lämmönsiirron perusteita, regeneraattoreiden luokittelua, sektorijakoja, vuotoja, lämpöpintojen geometriaa ja likaantumista. Soveltavassa osassa tehtiin laskentaohjelma, jonka avulla voidaan laskea pyörivän regeneraattorin mitoitus- ja suorituskykylaskuja. Lisäksi ohjelman avulla voidaan laskea regeneraattorin lämpötilaprofiili.

Characterization Method for Comminution Behavior of Limestone and Fuel Ash in a Circulating Fluidized Bed Boiler

Työn tavoite oli kehittää karakterisointimenetelmät kalkkikiven ja polttoaineen tuhkan jauhautumisen ennustamiselle kiertoleijukattilan tulipesässä. Kiintoainekäyttäytymisen karakterisoinnilla ja mallintamisella voidaan tarkentaa tulipesän lämmönsiirron ja tuhkajaon ennustamista. Osittain kokeelliset karakterisointimenetelmät perustuvat kalkkikiven jauhautumiseen laboratoriokokoluokan leijutetussa kvartsiputkireaktorissa ja tuhkan jauhatumiseen rotaatiomyllyssä. Karakterisointimenetelmät ottavat huomioon eri-laiset toimintaolosuhteet kaupallisen kokoluokan kiertoleijukattiloissa. Menetelmät kelpoistettiin kaupallisen kokoluokan kiertoleijukattiloista mitattujen ja fraktioittaisella kiintoainemallilla mallinnettujen taseiden avulla. Kelpoistamistaseiden vähäisyydestä huolimatta karakterisointimenetelmät arvioitiin virhetarkastelujen perusteella järkeviksi. Karakterisointimenetelmien kehittämistä ja tarkentamista tullaan jatkamaan.

TMP- laitoksen mallinnus ja simulointi

Diplomityössä tehtiin Balas- simulointimalli Stora Enso Publication Papers Oy Ltd Varkauden tehtaiden kuumahierrelaitoksesta, johon sovitettiin tehtaan lämpö-, kuitu- ja kiertovesivirtaukset sekä kiertovesissä olevien liuenneiden ja kolloidisten aineiden virtaukset. Kirjallisuusosassa perehdyttiin simulaattorimallin luontiin ja käyttötarkoituksiin. Siinä käsitellään Balas- simulaattorin ominaisuuksia ja laiteparametrointia. Tarkastellaan kuumahierreprosessin eri vaiheita, olosuhteita ja laitteiden toimintaa. Perehdytään prosessin energian kulutukseen ja talteenottoon sekä kiertovesien liuenneiden ja kolloidisten aineiden mittaussuureisiin ja vaikutuksiin prosessissa. Simulaattorimallin tekemiseen kuului tehtaan virtauskaavion ja simulaattorimallin tekeminen, mittauskoesuunnittelu, tehdasmittaukset, simulaattorin parametrointi, mittaus- ja simulaattoritulosten yhteensovittaminen sekä mallin kelpoistaminen. Tehtaan virtauskaavion piirtämisessä käytettiin apuna tehtaan prosessi- ja instrumentointikaavioita, joiden pohjalta mittauskoesuunnitelma ja simulaattorimalli tehtiin. Koesuunnitelman mittaussuureiksi valittiin virtaukset, sakeudet, lämpötilat sekä kiertovesien kiintoaineen-, kokonaisorgaanisen hiilen- ja liuenneen orgaanisen aineen pitoisuuksien määritykset. Mittauksilla saatiin tietoja prosessivirtausten taseista, joita käytettiin simulaattorimallin keskeisempien laiteparametriarvojen määrityksessä. Exceliä hyödynnettiin mittaus- ja simulaattoritulosten taulukoinnissa, laiteparametrien laskemisessa sekä arvojen syötössä ja vastaanotossa Excelin ja simulaattorin välillä. Sitä käytettiin myös graafisessa mittaus- ja simulaattoritulosten yhteensovittamisessa, jolla pystyttiin havainnollisesti näkemään eri syöttöparametrien muutoksien vaikutukset simulaattorin laskemissa virtaustuloksissa. Mallin antamien arvojen ja todellisten prosessimittausarvojen yhteensovittamisen ja mallista varmistumisen tuloksista voidaan todeta mallin korreloivan todellista prosessia melko hyvin.

Digitalización del sistema de control de nivel en calentadores y tanques de drenaje de una Central Nuclear

Contexto Una central nuclear, al igual que cualquier otro tipo de central generadora de energía eléctrica, mediante turbinas de vapor, está basada en un proceso termodinámico. El rendimiento de las mismas es función del salto entálpico del vapor, para mejorarlo las centrales están constituidas por un ciclo compound formado por turbina de alta presión y turbinas de baja presión, y un ciclo regenerativo consistente en calentar el agua de alimentación antes de su introducción a los generadores de vapor. Un ciclo regenerativo está basado en etapas de calentadores o cambiadores de calor para aprovechar al máximo la energía térmica del vapor, este proyecto está basado en la mejora y optimización del proceso de control de estos para contribuir a mejorar el rendimiento de la central. Objetivo Implementar un sistema de control que nos permita modernizar los clásicos sistemas basados en controles locales y comunicaciones analógicas. Mejorar el rendimiento del ciclo regenerativo de la central, aprovechando las mejoras tecnológicas que ofrece el mercado, tanto en el hardware como en el software de los sistemas de instrumentación y control. Optimizar el rendimiento de los lazos de control de cada uno de los elementos del ciclo regenerativo mediante estrategias de control. Procedimiento Desarrollo de un sistema de control actualizado considerando, como premisa principal, la fiabilidad del sistema, el análisis de fallos y la jerarquización del riesgo. Análisis y cálculo de los lazos de control considerando las premisas establecidas. Configuración de los lazos mediante estrategias de control que nos permitan optimizar y minimizar los efectos del fallo. Para ello se han utilizado parámetros y datos extraídos de la Central Nuclear de Ascó. Conclusiones Se ha modernizado y optimizado el sistema de control mejorando el rendimiento del ciclo regenerativo. Se ha conseguido un sistema más fiable, reduciendo el riesgo del fallo y disminuyendo los efectos de los mismos. El coste de un proyecto de estas características es inferior al de un sistema convencional y ofrece más posibilidades. Es un sistema abierto que permite utilizar e interconectar equipos de diferentes fabricantes, lo que favorece tanto el mantenimiento como las posibles ampliaciones futuras del sistema.

Wavefront reconstruction by adding modulation capabilities of two liquid crystal devices

We analyze the behavior of complex information in the Fresnel domain, taking into account the limited capability to display complex values of liquid crystal devices when they are used as holographic displays. To do this analysis we study the reconstruction of Fresnel holograms at several distances using the different parts of the complex distribution. We also use the information adjusted with a method that combines two configurations of the devices in an adding architecture. The results of the error analysis show different behavior for the reconstructions when using the different methods. Simulated and experimental results are presented.

Fluoroscopic-Guided Radial Endobronchial Ultrasound Without Guide Sheath For Peripheral Pulmonary Lesions: A Safe And Efficient Combination.

BACKGROUND: Several guidelines recommend computed tomography scans for populations with high-risk for lung cancer. The number of individuals evaluated for peripheral pulmonary lesions (PPL) will probably increase, and with it non-surgical biopsies. Associating a guidance method with a target confirmation technique has been shown to achieve the highest diagnostic yield, but the utility of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance without a guide sheath has not been reported. METHODS: We conducted a retrospective analysis of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy procedures for the investigation of PPL performed by experienced bronchoscopists with no specific previous training in this particular technique. Operator learning curves and radiological predictors were assessed for all consecutive patients examined during the first year of application of the technique. RESULTS: Fifty-one PPL were investigated. Diagnostic yield and visualization yield were 72.5 and 82.3% respectively. The diagnostic yield was 64.0% for PPL ≤20mm, and 80.8% for PPL>20mm. No false-positive results were recorded. The learning curve of all diagnostic tools showed a DY of 72.7% for the first sub-group of patients, 81.8% for the second, 72.7% for the third, and 81.8% for the last. CONCLUSION: Bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance is safe and simple to perform, even without specific prior training, and diagnostic yield is high for PPL>and ≤20mm. Based on these findings, this method could be introduced as a first-line procedure for the investigation of PPL, particularly in centers with limited resources.

An outcome and cost analysis of anal fistula plug insertion vs endorectal advancement flap for complex anal fistulae.

AIM: The study aimed to compare the rate of success and cost of anal fistula plug (AFP) insertion and endorectal advancement flap (ERAF) for anal fistula. METHOD: Patients receiving an AFP or ERAF for a complex single fistula tract, defined as involving more than a third of the longitudinal length of of the anal sphincter, were registered in a prospective database. A regression analysis was performed of factors predicting recurrence and contributing to cost. RESULTS: Seventy-one patients (AFP 31, ERAF 40) were analysed. Twelve (39%) recurrences occurred in the AFP and 17 (43%) in the ERAF group (P = 1.00). The median length of stay was 1.23 and 2.0 days (P < 0.001), respectively, and the mean cost of treatment was euro5439 ± euro2629 and euro7957 ± euro5905 (P = 0.021), respectively. On multivariable analysis, postoperative complications, underlying inflammatory bowel disease and fistula recurring after previous treatment were independent predictors of de novo recurrence. It also showed that length of hospital stay ≤ 1 day to be the most significant independent contributor to lower cost (P = 0.023). CONCLUSION: Anal fistula plug and ERAF were equally effective in treating fistula-in-ano, but AFP has a mean cost saving of euro2518 per procedure compared with ERAF. The higher cost for ERAF is due to a longer median length of stay.

A digital holography technique for generating beams with arbitrary polarization and shape

A method for generating beams with arbitrary polarization and shape is proposed. Our design requires the use of a Mach-Zehnder set-up combined with translucent liquid crystal displays in each arm of the interferometer; in this way, independent manipulation of each transverse beam components is possible. The target of this communication is to develop a numerical procedure for calculating the holograms required for dynamically encode any amplitude value and polarization state in each point of the wavefront. Several examples demonstrating the capabilities of the method are provided.

Development and evaluation of double locus sequence typing for molecular epidemiological investigations of Clostridium difficile.

Despite the development of novel typing methods based on whole genome sequencing, most laboratories still rely on classical molecular methods for outbreak investigation or surveillance. Reference methods for Clostridium difficile include ribotyping and pulsed-field gel electrophoresis, which are band-comparing methods often difficult to establish and which require reference strain collections. Here, we present the double locus sequence typing (DLST) scheme as a tool to analyse C. difficile isolates. Using a collection of clinical C. difficile isolates recovered during a 1-year period, we evaluated the performance of DLST and compared the results to multilocus sequence typing (MLST), a sequence-based method that has been used to study the structure of bacterial populations and highlight major clones. DLST had a higher discriminatory power compared to MLST (Simpson's index of diversity of 0.979 versus 0.965) and successfully identified all isolates of the study (100 % typeability). Previous studies showed that the discriminatory power of ribotyping was comparable to that of MLST; thus, DLST might be more discriminatory than ribotyping. DLST is easy to establish and provides several advantages, including absence of DNA extraction [polymerase chain reaction (PCR) is performed on colonies], no specific instrumentation, low cost and unambiguous definition of types. Moreover, the implementation of a DLST typing scheme on an Internet database, such as that previously done for Staphylococcus aureus and Pseudomonas aeruginosa ( http://www.dlst.org ), will allow users to easily obtain the DLST type by submitting directly sequencing files and will avoid problems associated with multiple databases.

Single Heartstring aortotomy for multiple off-pump venous bypass grafts.

Off-pump coronary bypass grafting may decrease the rate of stroke, due to minimal aortic manipulation. For venous grafts, clampless hemostasis when performing the proximal anastomosis can be achieved using the Heartstring device. We describe a technique using a single device to suture two veins to one aortotomy. This technique requires less space and could be advantageous in very short, small, and calcified aortas. In to our experience, this technique is rapid, simple, easy to reproduce, and cost-saving.

Improving coronary artery bypass graft durability: use of the external saphenous vein graft support.

Coronary bypass grafting remains the best option for patients suffering from multivessel coronary artery disease, and the saphenous vein is used as an additional conduit for multiple complete revascularizations. However, the long-term vein graft durability is poor, with almost 75% of occluded grafts after 10 years. To improve the durability, the concept of an external supportive structure was successfully developed during the last years: the eSVS Mesh device (Kips Bay Medical) is an external support for vein graft made of weft-knitted nitinol wire into a tubular form with an approximate length of 24 cm and available in three diameters (3.5, 4.0 and 4.5 mm). The device is placed over the outer wall of the vein and carefully deployed to cover the full length of the graft. The mesh is flexible for full adaptability to the heart anatomy and is intended to prevent kinking and dilatation of the vein in addition to suppressing the intima hyperplasia induced by the systemic blood pressure. The device is designed to reduce the vein diameter of about 15-20% at most to prevent the vein radial expansion induced by the arterial blood pressure, and the intima hyperplasia leading to the graft failure. We describe the surgical technique for preparing the vein graft with the external saphenous vein graft support (eSVS Mesh) and we share our preliminary clinical results.