Prognostic Importance of the Cuse of Renal Failure in Patients With Cirrhosis

BACKGROUND & AIMS: The prognostic value of the different causes of renal failure in cirrhosis is not well established. This study investigated the predictive value of the cause of renal failure in cirrhosis. METHODS: Five hundred sixty-two consecutive patients with cirrhosis and renal failure (as defined by serum creatinine 1.5 mg/dL on 2 successive determinations within 48 hours) hospitalized over a 6-year period in a single institution were included in a prospective study. The cause of renal failure was classified into 4 groups: renal failure associated with bacterial infections, renal failure associated with volume depletion, hepatorenal syndrome (HRS), and parenchymal nephropathy. The primary end point was survival at 3 months. RESULTS: Four hundred sixty-three patients (82.4%) had renal failure that could be classified in 1 of 4 groups. The most frequent was renal failure associated with infections (213 cases; 46%), followed by hypovolemia-associated renal failure (149; 32%), HRS (60; 13%), and parenchymal nephropathy (41; 9%). The remaining patients had a combination of causes or miscellaneous conditions. Prognosis was markedly different according to cause of renal failure, 3-month probability of survival being 73% for parenchymal nephropathy, 46% for hypovolemia-associated renal failure, 31% for renal failure associated with infections, and 15% for HRS (P .0005). In a multivariate analysis adjusted for potentially confounding variables, cause of renal failure was independently associated with prognosis, together with MELD score, serum sodium, and hepatic encephalopathy at time of diagnosis of renal failure. CONCLUSIONS: A simple classification of patients with cirrhosis according to cause of renal failure is useful in assessment of prognosis and may help in decision making in liver transplantation.

The avocado fruit borer, Stenoma catenifer (wals.) (Lepidoptera: elachistidae): egg and damage distribution and parasitism

The avocado fruit borer, Stenoma catenifer (Wals.) has been a limiting factor in growing avocados over the last years in many Brazilian states. This is a result of the lack of safe and feasible management practices to minimize the fruit borer damage. The aim of this study was to obtain information on the pest biology and ecology as well as on the role of natural enemies to define strategies to control the pest. Samples were taken biweekly and consisted of 20 fruits collected randomly (10 from the upper half and 10 from the lower half of the plant) in ten plants, cv. Margarida, in a commercial avocado grove in Arapongas and Cambé regions, PR, from October/2001 to September/2002. Laboratory determinations of the percentage of damaged fruit per plant region, location and number of bored fruit sites, and the number and location of the fruit borer eggs, including parasitized ones, were performed. The results showed that S. catenifer preferred to oviposit and attack fruits located on the upper half of the trees. The majority of the eggs were laid on the fruit pedicel whereas the damage was mainly located on the lower half of the fruits. Trichogrammatids were the most constant and abundant parasitoids found in both localities throughout the study period.

Residues of carbosulfan and its carbofuran metabolites and 3-hydroxy-carbofuran in oranges

The objectives of this study were to evaluate the residues of the insecticide carbosulfan and its carbofuran metabolites and 3-hydroxy-carbofuran in orange compartments (whole fruit, bagasse and juice) and comparison between the residual levels found in fruits with the maximum residue level and the safety interval established by the Brazilian legislation. Two field experiments were carried out, both with the following treatments: a-check; b-one application of 10 g of carbosulfan . 100 L-1 of water; c-one application with twice the rate applied in treatment b; d-four applications with the same rate applied in treatment b. Samples were taken at (-1), zero, 1, 3, 7, 14, 21 and 28 days after the last or unique application. The quantitative determinations were done by gas chromatography technique, using a nitrogen-phosphorus detector. The carbosulfan metabolism to its carbofuran metabolite was rapid (3 days), being both analytes concentrated in the bagasse (peel + flavedo + albedo). However, the metabolism of carbofuran to 3-hydroxy-carbofuran was of low intensity or this metabolite was quickly dissipated. Carbosulfan residues and its metabolites did not penetrate into the fruit, thus not contaminating the juice. The use of the pesticide was adequate, with respect to fruit consumption, in relation to the Brazilian legislation.

Jauhatuspiirin ilmakierron optimointi

Luokittuminen erilaisine mekanismeineen aiheuttaa yleisesti ongelmia, kun on kysymyksessä kiintoaineen väliaikainenkin varastointi siilossa. Sitä voidaan vähentää kiintoaineiden, prosessin ja laitesuunnittelun muutoksilla. Tässä työssä tutkittiin mahdollisuuksia vähentää ilmeniitin luokittumista sen jauhatuspiirin ilmakiertoa optimoimalla. Suljetun kuivajauhatuspiirin keskeisimmäksi laitteeksi voitaisiin ajatella siinä oleva luokitin, joka voi olla esim. sykloni. Tässä piirissä tapahtuva kiintoaineen liikkuminen voidaan saada aikaiseksi esim. pneumaattisella kuljetuksella. Ilmeniitin jauhatus tapahtuu suljetussa kuivajauhatuspiirissä, jonka ajavana voimana on siinä oleva ilmakierto. Piirin oleellisia laitteita ovat kuulamylly, luokitin, erotussykloni ja pölykaappi sekä kiertoilma- ja poistoilmapuhaltimet. Ilmakierron optimointia varten suoritettiin kahden vastaavan jauhatuspiirin ainetasemääritykset. Lisäksi määritettiin yhden isomman piirin perustila. Jauhatuspiirien ainetasemäärityksissä määritettiin niiden massa- ja ilmavirrat sekä kiertokuorma ja luokittimen erotusterävyys, kuten myös ilmeniitin hiukkaskokojakaumat. Perustilamittauksissa määritettiin ainoastaan piirin ilmavirrat ja ilmeniitin hiukkaskokojakaumat. Optimointimittauksissa pienennettiin pikkumyllypiirin ilmamäärät vastaamaan kutakuinkin vastaavan toisen piirin määriä. Tällä yritettiin selvittää näiden toisiaan vastaavien piirien ilmamäärien ja varsinkin kiertokuormien eroavuutta. Tämä ilmamäärien pienentäminen ei tuottanut mainittavampaa muutosta piirin ainetaseisiin, joten voitaneen todeta, että piirin ilmamääriä pienentämällä saadaan aikaiseksi säästöjä, lähinnä kiertoilmapuhaltimen tehon alennuksen kautta.

Trace element monitoring in the ICU: quality and economic impact of a change in sampling practice.

BACKGROUND & AIMS: Trace elements (TE) are involved in the immune and antioxidant defences which are of particular importance during critical illness. Determining plasma TE levels is costly. The present quality control study aimed at assessing the economic impact of a computer reminded blood sampling versus a risk guided on-demand monitoring of plasma concentrations of selenium, copper, and zinc. METHODS: Retrospective analysis of 2 cohorts of patients admitted during 6 months periods in 2006 and 2009 to the ICU of a University hospital. INCLUSION CRITERIA: to receive intravenous micronutrient supplements and/or to have a TE sampling during ICU stay. The TE samplings were triggered by computerized reminder in 2006 versus guided by nutritionists in 2009. RESULTS: During the 2 periods 636 patients met the inclusion criteria out of 2406 consecutive admissions, representing 29.7% and 24.9% respectively of the periods' admissions. The 2009 patients had higher SAPS2 scores (p = 0.02) and lower BMI compared to 2006 (p = 0.007). The number of laboratory determinations was drastically reduced in 2009, particularly during the first week, despite the higher severity of the cohort, resulting in à 55% cost reduction. CONCLUSIONS: The monitoring of TE concentrations guided by a nutritionist resulted in a reduction of the sampling frequency, and targeting on the sickest high risk patients, requiring a nutritional prescription adaptation. This control leads to cost reduction compared to an automated sampling prescription.

Nesteseosten liukoisuuksien mittaaminen

Diplomityön tarkoituksena on tarkastella isobuteenin dimeroitumisprosessin neste-nestetasapainoja. Tavoitteena on määrittää prosessissa esiintyvien komponenttien väliset neste-nestetasapainot. Työn kirjallisuusosassa on tarkasteltu neste-nestetasapainojen teoriaa. Erityisesti on tarkasteltu mittausmenetelmiä sekä kirjallisuudesta löytyneitä laitteistoja binääristen ja ternääristen systeemien neste-nestetasapainojen määritystä varten. Menetelmät ja laitteistot on esitetty erikseen matalassa ja korkeassa paineessa suoritettaville mittauksille. Lisäksi on tarkasteltu näytteenottoa sekä näytteiden analysointimenetelmiä. Kirjallisuusosassa on myös sivuttu kaasu-neste-nestetasapainojen määritystä, mutta työn varsinainen kohde on neste-nestetasapainojen määritys. Työn kokeellisessa osassa määritettiin iso-oktaaniprosessissa esiintyvien komponenttien välisiä binäärisiä ja ternäärisiä neste-nestetasapainoja. Mitattavien komponenttiparien määrää karsittiin ja jäljellejääneiden parien välillä suoritettavat mittaukset jaoteltiin matalassa ja korkeassa paineessa suoritettaviin määrityksiin. Ternääriset mittaukset tulivat kyseeseen sellaisten komponenttiparien kohdalla, joissa toisiinsa täysin liukenevien nesteiden systeemiin kolmatta komponenttia lisättäessä saatiin aikaiseksi kaksi nestefaasia. Tällaisesta mittaustiedosta voidaan määrittää neste-nestetasapainomallien parametrejä. Mittausten lisäksi kokeellisessa osassa tarkasteltiin näytteenottoa sekä näytteiden analysointia.

Puumassapesurin suotautumisolojen kartoitus ja simulointi

Työn tavoitteena oli tutkia sellumassan suotautumiseen liittyviä tekijöitä Ahlstrom Machineryn Drum Displacer™ -puumassapesurissa (DD-pesuri). Teoriaosassa tarkasteltiin aluksi suotautumisen teoriaa kuitu-vesi-suspensiossa, minkä jälkeen esiteltiin suotautumisnopeuteen vaikuttavia fysikaalisia ja kemiallisia vaikutusmekanismeja. Seuraavaksi kuvattiin massan pesun yleisiä perusteita sekä teoriaa puumassapesureissa. Lopuksi tarkasteltiin pesurien kytkeytymistä muuhun kuitulinjaan sekä prosessista johtuvia pesun toiminnan ulkoisia häiriötekijöitä. Kokeellisen osan aluksi tarkasteltiin paine- ja lämpötilamittauksien avulla massapesurissa vallitsevia prosessioloja. Mittaustulosten perusteella pumppausolot pesurin suodoslinjoissa ovat vaikeahkot ja häiriötilanteita voi esiintyä, mutta käytäntö on osoittanut tästä olevan vain harvoin haittaa prosessin toiminnalle. Pesureissa toteutuneet syrjäytysnopeudet laskettiin ja niitä verrattiin syrjäytystestien antamiin tuloksiin. Kuitulinjasta riippuen testin vastaavuus tehdasprosessiin vaihteli suuresti. Syrjäytystesteillä kokeiltiin myös tehdasprosesseissa usein esiintyvien muuttujien vaikutusta sellukakun syrjäytettävyyteen. Kakun paksuus ja syrjäytyslämpötila vaikuttivat syrjäytysnopeuteen Darcyn lain mukaisesti. Alipaineen massakakun alapuolella havaittiin huonontavan syrjäytysnopeutta verrattuna tilanteeseen, jossa kakun alla vallitsi ilmanpaine. Tämä havainto on selvästi ristiriidassa suotautumisen teorian kanssa. Massakakun muodostumis-pH osoittautui ratkaisevaksi lopulliselle syrjäytysnopeudelle, sillä alkalisissa oloissa muodostetun kuitukakun syrjäytysnopeus ei enää parantunut happamalla syrjäytysnesteellä. Happamissa oloissa muodostetun kakun syrjäytysnopeus oli alkalisista parempi, mutta se alkoi hitaasti alentua, kun syrjäytysneste vaihtui alkaliseen. Massan laimentaminen ennen syrjäytystä alkalisella tehdassuodoksella puhtaan veden sijasta alensi ligniinipitoisella massalla lopullista syrjäytysnopeutta. Shirato-Tillerin mallilla ja Jönssonin staattisella mallilla simuloitiin numeerisesti syrjäytystestiä kahdessa eri pH:ssa, ja simulointituloksia verrattiin vastaavissa oloissa tehtyihin syrjäytystesteihin. Shirato-Tillerin mallin antamien syrjäytysnopeuksien havaittiin olevan lähellä syrjäytystestien nopeuksia, kun Jönssonin mallin antamat tulokset jäivät huomattavasti testituloksia alemmiksi. Herkkyystarkastelussa havaittiin mallien olevan varsin herkkiä parametrien virheille. Hajonta vaadittavien kuituparametrien määrityksissä ja menetelmien työläys rajoittavat numeerisen simuloinnin käytettävyyttä, sillä kuituparametrien määrityksen vaatima työmäärä on ainakin toistaiseksi syrjäytystestiä suurempi. Lopuksi todettiin, että oikeiden syrjäytysolosuhteiden käyttö on ensiarvoisen tärkeää oikeiden tulosten saamiseksi sekä kokeellisessa että numeerisessa simuloinnissa. Nykyinen syrjäytystestilaitteisto on pienin muutoksin käyttökelpoinen, kun massan testaus prosessioloissa tulee rutiininomaiseksi.

Impact of the introduction of real-time therapeutic drug monitoring on empirical doses of carbapenems in critically ill burn patients.

PURPOSE: Adequate empirical antibiotic dose selection for critically ill burn patients is difficult due to extreme variability in drug pharmacokinetics. Therapeutic drug monitoring (TDM) may aid antibiotic prescription and implementation of initial empirical antimicrobial dosage recommendations. This study evaluated how gradual TDM introduction altered empirical dosages of meropenem and imipenem/cilastatin in our burn ICU. METHODS: Imipenem/cilastatin and meropenem use and daily empirical dosage at a five-bed burn ICU were analyzed retrospectively. Data for all burn admissions between 2001 and 2011 were extracted from the hospital's computerized information system. For each patient receiving a carbapenem, episodes of infection were reviewed and scored according to predefined criteria. Carbapenem trough serum levels were characterized. Prior to May 2007, TDM was available only by special request. Real-time carbapenem TDM was introduced in June 2007; it was initially available weekly and has been available 4 days a week since 2010. RESULTS: Of 365 patients, 229 (63%) received antibiotics (109 received carbapenems). Of 23 TDM determinations for imipenem/cilastatin, none exceeded the predefined upper limit and 11 (47.8%) were insufficient; the number of TDM requests was correlated with daily dose (r=0.7). Similar numbers of inappropriate meropenem trough levels (30.4%) were below and above the upper limit. Real-time TDM introduction increased the empirical dose of imipenem/cilastatin, but not meropenem. CONCLUSIONS: Real-time carbapenem TDM availability significantly altered the empirical daily dosage of imipenem/cilastatin at our burn ICU. Further studies are needed to evaluate the individual impact of TDM-based antibiotic adjustment on infection outcomes in these patients.

Nuclear Symmetry Energy Probed by Neutron Skin Thickness of Nuclei

We describe a relation between the symmetry energy coefficients csym(ρ) of nuclear matter and asym(A) of finite nuclei that accommodates other correlations of nuclear properties with the low-density behavior of csym(ρ). Here, we take advantage of this relation to explore the prospects for constraining csym(ρ) of systematic measurements of neutron skin sizes across the mass table, using as example present data from antiprotonic atoms. The found constraints from neutron skins are in harmony with the recent determinations from reactions and giant resonances.

The Sottunga-Jurmo shear zone : structure and deformation history of a crustal-scale ductile shear zone in SW Finland

The aim of this study is to gain a better understanding of the structure and the deformation history of a NW-SE trending regional, crustal-scale shear structure in the Åland archipelago, SW Finland, called the Sottunga-Jurmo shear zone (SJSZ). Approaches involving e.g. structural geology, geochronology, geochemistry and metamorphic petrology were utilised in order to reconstruct the overall deformation history of the study area. The study therefore describes several features of the shear zone including structures, kinematics and lithologies within the study area, the ages of the different deformation phases (ductile to brittle) within the shear zone, as well as some geothermobarometric results. The results indicate that the SJSZ outlines a major crustal discontinuity between the extensively migmatized rocks NE of the shear zone and the unmigmatised, amphibolite facies rocks SW of the zone. The main SJSZ shows overall dextral lateral kinematics with a SW-side up vertical component and deformation partitioning into pure shear and simple shear dominated deformation styles that was intensified toward later stages of the deformation history. The deformation partitioning resulted in complex folding and refolding against the SW margin of the SJSZ, including conical and sheath folds, and in a formation of several minor strike-slip shear zones both parallel and conjugate to the main SJSZ in order to accommodate the regional transpressive stresses. Different deformation phases within the study area were dated by SIMS (zircon U-Pb), ID-TIMS (titanite U-Pb) and 40Ar/39Ar (pseudotachylyte wholerock) methods. The first deformation phase within the ca. 1.88 Ga rocks of the study area is dated at ca. 1.85 Ga, and the shear zone was reactivated twice within the ductile regime (at ca. 1.83 Ga and 1.79 Ga), during which the strain was successively increasingly partitioned into the main SJSZ and the minor shear zones. The age determinations suggest that the orogenic processes within the study area did not occur in a temporal continuum; instead, the metamorphic zircon rims and titanites show distinct, 10-20 Ma long breaks in deformation between phases of active deformation. The results of this study further imply slow cooling of the rocks through 600-700ºC so that at 1.79 Ga, 2 the temperature was still at least 600ºC. The highest recorded metamorphic pressures are 6.4-7.1 kbar. At the late stages or soon after the last ductile phase (ca. 1.79 Ga), relatively high-T mylonites and ultramylonites were formed, witnessing extreme deformation partitioning and high strain rates. After the rocks reached lower amphibolite facies to amphibolite-greenschist facies transitional conditions (ca. 500-550ºC), they cooled rapidly, probably due to crustal uplift and exhumation. The shear zone was reactivated at least once within the semi-brittle to brittle regime between ca. 1.79 Ga and 1.58 Ga, as evidenced by cataclasites and pseudotachylytes. In summary, the results of this study suggest that the Sottunga-Jurmo shear zone (and the South Finland shear zone) defines a major crustal discontinuity, and played a central role in accommodating the regional stresses during and after the Svecofennian orogeny.

Comparing Etest and Broth Microdilution for Antifungal Susceptibility Testing of the Most-Relevant Pathogenic Molds.

Invasive mold infections are life-threatening diseases for which appropriate antifungal therapy is crucial. Their epidemiology is evolving, with the emergence of triazole-resistant Aspergillus spp. and multidrug-resistant non-Aspergillus molds. Despite the lack of interpretive criteria, antifungal susceptibility testing of molds may be useful in guiding antifungal therapy. The standard broth microdilution method (BMD) is demanding and requires expertise. We assessed the performance of a commercialized gradient diffusion method (Etest method) as an alternative to BMD. The MICs or minimal effective concentrations (MECs) of amphotericin B, voriconazole, posaconazole, caspofungin, and micafungin were assessed for 290 clinical isolates of the most representative pathogenic molds (154 Aspergillus and 136 non-Aspergillus isolates) with the BMD and Etest methods. Essential agreements (EAs) within ±2 dilutions of ≥90% between the two methods were considered acceptable. EAs for amphotericin B and voriconazole were >90% for most potentially susceptible species. For posaconazole, the correlation was acceptable for Mucoromycotina but Etest MIC values were consistently lower for Aspergillus spp. (EAs of <90%). Excellent EAs were found for echinocandins with highly susceptible (MECs of <0.015 μg/ml) or intrinsically resistant (MECs of >16 μg/ml) strains. However, MEC determinations lacked consistency between methods for strains exhibiting mid-range MECs for echinocandins. We concluded that the Etest method is an appropriate alternative to BMD for antifungal susceptibility testing of molds under specific circumstances, including testing with amphotericin B or triazoles for non-Aspergillus molds (Mucoromycotina and Fusarium spp.). Additional study of molecularly characterized triazole-resistant Aspergillus isolates is required to confirm the ability of the Etest method to detect voriconazole and posaconazole resistance among Aspergillus spp.

Prognostic Importance of the Cuse of Renal Failure in Patients With Cirrhosis

BACKGROUND & AIMS: The prognostic value of the different causes of renal failure in cirrhosis is not well established. This study investigated the predictive value of the cause of renal failure in cirrhosis. METHODS: Five hundred sixty-two consecutive patients with cirrhosis and renal failure (as defined by serum creatinine 1.5 mg/dL on 2 successive determinations within 48 hours) hospitalized over a 6-year period in a single institution were included in a prospective study. The cause of renal failure was classified into 4 groups: renal failure associated with bacterial infections, renal failure associated with volume depletion, hepatorenal syndrome (HRS), and parenchymal nephropathy. The primary end point was survival at 3 months. RESULTS: Four hundred sixty-three patients (82.4%) had renal failure that could be classified in 1 of 4 groups. The most frequent was renal failure associated with infections (213 cases; 46%), followed by hypovolemia-associated renal failure (149; 32%), HRS (60; 13%), and parenchymal nephropathy (41; 9%). The remaining patients had a combination of causes or miscellaneous conditions. Prognosis was markedly different according to cause of renal failure, 3-month probability of survival being 73% for parenchymal nephropathy, 46% for hypovolemia-associated renal failure, 31% for renal failure associated with infections, and 15% for HRS (P .0005). In a multivariate analysis adjusted for potentially confounding variables, cause of renal failure was independently associated with prognosis, together with MELD score, serum sodium, and hepatic encephalopathy at time of diagnosis of renal failure. CONCLUSIONS: A simple classification of patients with cirrhosis according to cause of renal failure is useful in assessment of prognosis and may help in decision making in liver transplantation.

Análise potenciométrica de redissolução com ultramicroeletrodos: fundamentos e aplicações na determinação de metais traços

The Potentiometric Stripping Analysis (PSA) is described with emphasis on ultramicroelectrode applications with a laboratory developed computer based instrumentation. The technique potentialities as compared with the voltammetric approach are pointed out based on the current literature. Some results of trace metals analysis including zinc, cadmium, lead and copper in vinegar and canned food samples are presented. The mainly advantage found in our laboratory was the technique capability to analyse natural samples with minimum matrix interference and the low level of noise found in our determinations.

Determinação espectrofotométrica de ácido ascórbico em fármacos empregando amostragem binária em fluxo

A flow system procedure for spectrophotometric determination of ascorbic acid in drugs based on [Fe3+(SCN-)n]+3-n complex decomposition by reduction is described. The flow network was constituted by a set of three-way solenoid valves, controlled by a microcomputer running a software wrote in QuickBasic 4.5 language. The feasibility of the procedure was ascertained by determining ascorbic acid in drug samples with mass ranging from 0.0018 up to 0.0180 g. The results showed an agreement of about 7% when compared with recommended method. Other profitable features such as a standard deviation of 1.5% (n = 7) and a throughput of 120 determinations per hour was also achieved.

Aquisição de tempos de vida de fosforescência com resolução de fase e sua aplicação ao estudo de relaxações em polímeros

We describe in this work a simple experimental set up to perform time dependent luminescence experiments in time scales from mili-seconds to seconds, based on the phase resolution of the emission signal. This system is composed by modulation of a continuous light source with an external chopper controlled by a lock-in amplifier. We exemplified the utility of the system in studies of phosphorecence emission using benzophenone dissolved in polystyrene and since the phosphorescence intensity and lifetime are temperature-dependent processes, we also studied polymer relaxation processes in the temperature range from 20 to 400K. A software that drives the spectrofluorimeter and controls both the cryosystem and the lock-in amplifier was developed.