Use of the caffeine-halothane contracture test for the diagnosis of malignant hyperthermia in Brazil

Malignant hyperthermia (MH) is a pharmacogenetic disease triggered by volatile anesthetics and succinylcholine. Deaths due to MH have been reported in Brazil. The first Malignant Hyperthermia Diagnostic and Research Center in Latin America was inaugurated in 1993 at the Federal University of Rio de Janeiro, Brazil. The center followed the diagnostic protocols of the North America MH Group, in which the contractures of biopsies from the vastus lateralis muscle are analyzed after exposure to caffeine and halothane (CHCT). CHCT was performed in individuals who survived, their relatives and those with signs/symptoms somewhat related to MH susceptibility (MHS). Here, we report data from 194 patients collected over 16 years. The Southeast (N = 110) and South (N = 71) represented the majority of patients. Median age was 25 (4-70) years, with similar numbers of males (104) and females (90). MHS was found in 90 patients and 104 patients were normal. Abnormal responses to both caffeine and halothane were observed in 59 patients and to caffeine or halothane in 20 and 11 patients, respectively. The contracture of biopsies from MHS exposed to caffeine and halothane was 1.027 ± 0.075 g (N = 285) and 4.021 ± 0.255 g (N = 226), respectively. MHS was found in patients with either low or high blood creatine kinase and also, with a low score on the clinical grading scale. Thus, these parameters cannot be used with certainty to predict MHS. We conclude that the CHCT protocol described by the North America MH Group contributed to identification of MHS in suspected individuals at an MH center in Brazil with 100% sensitivity and 65.7% specificity.

A simple test of muscle coactivation estimation using electromyography

In numerous motor tasks, muscles around a joint act coactively to generate opposite torques. A variety of indexes based on electromyography signals have been presented in the literature to quantify muscle coactivation. However, it is not known how to estimate it reliably using such indexes. The goal of this study was to test the reliability of the estimation of muscle coactivation using electromyography. Isometric coactivation was obtained at various muscle activation levels. For this task, any coactivation measurement/index should present the maximal score (100% of coactivation). Two coactivation indexes were applied. In the first, the antagonistic muscle activity (the lower electromyographic signal between two muscles that generate opposite joint torques) is divided by the mean between the agonistic and antagonistic muscle activations. In the second, the ratio between antagonistic and agonistic muscle activation is calculated. Moreover, we computed these indexes considering different electromyographic amplitude normalization procedures. It was found that the first algorithm, with all signals normalized by their respective maximal voluntary coactivation, generates the index closest to the true value (100%), reaching 92 ± 6%. In contrast, the coactivation index value was 82 ± 12% when the second algorithm was applied and the electromyographic signal was not normalized (P < 0.04). The new finding of the present study is that muscle coactivation is more reliably estimated if the EMG signals are normalized by their respective maximal voluntary contraction obtained during maximal coactivation prior to dividing the antagonistic muscle activity by the mean between the agonistic and antagonistic muscle activations.

Reliability and validity of heart rate variability threshold assessment during an incremental shuttle-walk test in middle-aged and older adults

Studies on the assessment of heart rate variability threshold (HRVT) during walking are scarce. We determined the reliability and validity of HRVT assessment during the incremental shuttle walk test (ISWT) in healthy subjects. Thirty-one participants aged 57 ± 9 years (17 females) performed 3 ISWTs. During the 1st and 2nd ISWTs, instantaneous heart rate variability was calculated every 30 s and HRVT was measured. Walking velocity at HRVT in these tests (WV-HRVT1 and WV-HRVT2) was registered. During the 3rd ISWT, physiological responses were assessed. The ventilatory equivalents were used to determine ventilatory threshold (VT) and the WV at VT (WV-VT) was recorded. The difference between WV-HRVT1 and WV-HRVT2 was not statistically significant (median and interquartile range = 4.8; 4.8 to 5.4 vs4.8; 4.2 to 5.4 km/h); the correlation between WV-HRVT1 and WV-HRVT2 was significant (r = 0.84); the intraclass correlation coefficient was high (0.92; 0.82 to 0.96), and the agreement was acceptable (-0.08 km/h; -0.92 to 0.87). The difference between WV-VT and WV-HRVT2 was not statistically significant (4.8; 4.8 to 5.4 vs 4.8; 4.2 to 5.4 km/h) and the agreement was acceptable (0.04 km/h; -1.28 to 1.36). HRVT assessment during walking is a reliable measure and permits the estimation of VT in adults. We suggest the use of the ISWT for the assessment of exercise capacity in middle-aged and older adults.

Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension

Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) has been considered to be a risk factor for hypertension. The relationship of polymorphisms of the renin-angiotensin system gene with hypertension has not been established. Our objective was to evaluate whether EBPR during exercise is a clinical marker for hypertension. The study concerned a historical cohort of normotensive individuals. The exposed individuals were those who presented EBPR. At the end of the observation period (41.7 months = 3.5 years), the development of hypertension was analyzed within the two groups. Genetic polymorphisms and blood pressure behavior were assessed as independent variables, together with the classical risk factors for hypertension. The I/D gene polymorphism of the angiotensin-converting enzyme and M235T of angiotensinogen were ruled out as risk factors for hypertension. EBPR during ETT is not an independent influence on the chances of developing hypertension. No differences were observed between the hypertensive and normotensive individuals regarding gender (P = 0.655), skin color (P = 0.636), family history of hypertension (P = 0.225), diabetes mellitus (P = 0.285), or hypertriglyceridemia (P = 0.734). The risk of developing hypertension increased with increasing body mass index (BMI) and advancing age. The risk factors, which independently influenced the development of hypertension, were age and BMI. EBPR did not constitute an independent risk factor for hypertension and is probably a preclinical phase in the spectrum of normotension and hypertension.

Antidepressant-like effect of Hoodia gordonii in a forced swimming test in mice: evidence for involvement of the monoaminergic system

Hoodia gordonii is a plant species used traditionally in southern Africa to suppress appetite. Recently, it has been associated with a significant increase in blood pressure and pulse rate in women, suggesting sympathomimetic activity. The present study investigated the possible antidepressant-like effects of acute and repeated (15 days) administration of H. gordonii extract (25 and 50 mg/kg, po) to mice exposed to a forced swimming test (FST). Neurochemical analysis of brain monoamines was also carried out to determine the involvement of the monoaminergic system on these effects. Acute administration of H. gordonii decreased the immobility of mice in the FST without accompanying changes in general activity in the open-field test during acute treatment, suggesting an antidepressant-like effect. The anti-immobility effect of H. gordonii was prevented by pretreatment of mice with PCPA [an inhibitor of serotonin (5-HT) synthesis], NAN-190 (a 5-HT1A antagonist), ritanserin (a 5-HT2A/2C antagonist), ondansetron (a 5-HT3A antagonist), prazosin (an α1-adrenoceptor antagonist), SCH23390 (a D1 receptor antagonist), yohimbine (an α2-adrenoceptor antagonist), and sulpiride (a D2 receptor antagonist). A significant increase in 5-HT levels in the striatum was detected after acute administration, while 5-HT, norepinephrine and dopamine were significantly elevated after chronic treatment. Results indicated that H. gordonii possesses antidepressant-like activity in the FST by altering the dopaminergic, serotonergic, and noradrenergic systems.

Association between anaerobic components of the maximal accumulated oxygen deficit and 30-second Wingate test

The purpose of this study was to analyze the relationship between the anaerobic components of the maximal accumulated oxygen deficit (MAOD) and of the 30-second Wingate anaerobic test (30-WAnT). Nine male physical education students performed: a) a maximal incremental exercise test; b) a supramaximal constant workload test to determine the anaerobic components of the MAOD; and c) a 30-WAnT to measure the peak power (PP) and mean power (MP). The fast component of the excess post-exercise oxygen consumption and blood lactate accumulation were measured after the supramaximal constant workload test in order to determine the contributions made by alactic (ALMET) and lactic (LAMET) metabolism. Significant correlations were found between PP and ALMET (r=0.71; P=0.033) and between MP and LAMET(r=0.72; P=0.030). The study results suggested that the anaerobic components of the MAOD and of the 30-WAnT are similarly applicable in the assessment of ALMET and LAMET during high-intensity exercise.

Intensity and physiological responses to the 6-minute walk test in middle-aged and older adults: a comparison with cardiopulmonary exercise testing

The 6-minute walk test (6MWT) is a simple field test that is widely used in clinical settings to assess functional exercise capacity. However, studies with healthy subjects are scarce. We hypothesized that the 6MWT might be useful to assess exercise capacity in healthy subjects. The purpose of this study was to evaluate 6MWT intensity in middle-aged and older adults, as well as to develop a simple equation to predict oxygen uptake ( V ˙ O 2 ) from the 6-min walk distance (6MWD). Eighty-six participants, 40 men and 46 women, 40-74 years of age and with a mean body mass index of 28±6 kg/m2, performed the 6MWT according to American Thoracic Society guidelines. Physiological responses were evaluated during the 6MWT using a K4b2 Cosmed telemetry gas analyzer. On a different occasion, the subjects performed ramp protocol cardiopulmonary exercise testing (CPET) on a treadmill. Peak V ˙ O 2 in the 6MWT corresponded to 78±13% of the peak V ˙ O 2 during CPET, and the maximum heart rate corresponded to 80±23% of that obtained in CPET. Peak V ˙ O 2 in CPET was adequately predicted by the 6MWD by a linear regression equation: V ˙ O 2 mL·min-1·kg-1 = -2.863 + (0.0563×6MWDm) (R2=0.76). The 6MWT represents a moderate-to-high intensity activity in middle-aged and older adults and proved to be useful for predicting cardiorespiratory fitness in the present study. Our results suggest that the 6MWT may also be useful in asymptomatic individuals, and its use in walk-based conditioning programs should be encouraged.

Energy system contribution in a maximal incremental test: correlations with pacing and overall performance in a 10-km running trial

This study aimed to verify the association between the contribution of energy systems during an incremental exercise test (IET), pacing, and performance during a 10-km running time trial. Thirteen male recreational runners completed an incremental exercise test on a treadmill to determine the respiratory compensation point (RCP), maximal oxygen uptake (V˙O2max), peak treadmill speed (PTS), and energy systems contribution; and a 10-km running time trial (T10-km) to determine endurance performance. The fractions of the aerobic (WAER) and glycolytic (WGLYCOL) contributions were calculated for each stage based on the oxygen uptake and the oxygen energy equivalents derived by blood lactate accumulation, respectively. Total metabolic demand (WTOTAL) was the sum of these two energy systems. Endurance performance during the T10-km was moderately correlated with RCP, V˙O2maxand PTS (P<@0.05), and moderate-to-highly correlated with WAER, WGLYCOL, and WTOTAL (P<0.05). In addition, WAER, WGLYCOL, and WTOTAL were also significantly correlated with running speed in the middle (P<0.01) and final (P<0.01) sections of the T10-km. These findings suggest that the assessment of energy contribution during IET is potentially useful as an alternative variable in the evaluation of endurance runners, especially because of its relationship with specific parts of a long-distance race.

Use of the Wasserman equation in optimization of the duration of the power ramp in a cardiopulmonary exercise test: a study of Brazilian men

This study aimed to analyze the agreement between measurements of unloaded oxygen uptake and peak oxygen uptake based on equations proposed by Wasserman and on real measurements directly obtained with the ergospirometry system. We performed an incremental cardiopulmonary exercise test (CPET), which was applied to two groups of sedentary male subjects: one apparently healthy group (HG, n=12) and the other had stable coronary artery disease (n=16). The mean age in the HG was 47±4 years and that in the coronary artery disease group (CG) was 57±8 years. Both groups performed CPET on a cycle ergometer with a ramp-type protocol at an intensity that was calculated according to the Wasserman equation. In the HG, there was no significant difference between measurements predicted by the formula and real measurements obtained in CPET in the unloaded condition. However, at peak effort, a significant difference was observed between oxygen uptake (V˙O2)peak(predicted)and V˙O2peak(real)(nonparametric Wilcoxon test). In the CG, there was a significant difference of 116.26 mL/min between the predicted values by the formula and the real values obtained in the unloaded condition. A significant difference in peak effort was found, where V˙O2peak(real)was 40% lower than V˙O2peak(predicted)(nonparametric Wilcoxon test). There was no agreement between the real and predicted measurements as analyzed by Lin’s coefficient or the Bland and Altman model. The Wasserman formula does not appear to be appropriate for prediction of functional capacity of volunteers. Therefore, this formula cannot precisely predict the increase in power in incremental CPET on a cycle ergometer.

Thick Section Laser Beam Welding of Structural Steels: Methods for Improving Welding Efficiency

Laser beam welding (LBW) is applicable for a wide range of industrial sectors and has a history of fifty years. However, it is considered an unusual method with applications typically limited to welding of thin sheet metal. With a new generation of high power lasers there has been a renewed interest in thick section LBW (also known as keyhole laser welding). There was a growing body of publications during 2001-2011 that indicates an increasing interest in laser welding for many industrial applications, and in last ten years, an increasing number of studies have examined the ways to increase the efficiency of the process. Expanding the thickness range and efficiency of LBW makes the process a possibility for industrial applications dealing with thick metal welding: shipbuilding, offshore structures, pipelines, power plants and other industries. The advantages provided by LBW, such as high process speed, high productivity, and low heat input, may revolutionize these industries and significantly reduce the process costs. The research to date has focused on either increasing the efficiency via optimizing process parameters, or on the process fundamentals, rather than on process and workpiece modifications. The argument of this thesis is that the efficiency of the laser beam process can be increased in a straightforward way in the workshop conditions. Throughout this dissertation, the term “efficiency” is used to refer to welding process efficiency, specifically, an increase in efficiency refers an increase in weld’s penetration depth without increasing laser power level or decreasing welding speed. These methods are: modifications of the workpiece – edge surface roughness and air gap between the joining plates; modification of the ambient conditions – local reduction of the pressure in the welding zone; modification of the welding process – preheating of the welding zone. Approaches to improve the efficiency are analyzed and compared both separately and combined. These experimentally proven methods confirm previous findings and contribute additional evidence which expand the opportunities for laser beam welding applications. The focus of this research was primarily on the effects of edge surface roughness preparation and pre-set air gap between the plates on weld quality and penetration depth. To date, there has been no reliable evidence that such modifications of the workpiece give a positive effect on the welding efficiency. Other methods were tested in combination with the two methods mentioned above. The most promising - combining with reduced pressure method - resulted in at least 100% increase in efficiency. The results of this thesis support the idea that joining those methods in one modified process will provide the modern engineering with a sufficient tool for many novel applications with potential benefits to a range of industries.

The role of auditors in the Finnish limited liability companies as to solvency test in the context of asset distribution

Suomen osakeyhtiölain mukaan varoja ei saa jakaa, jos jaosta päätettäessä tiedetään tai pitäisi tietää yhtiön olevan maksukyvytön tai jaon aiheuttavan maksukyvyttömyyden. Ongelmallista on, että maksukykyä ei ole selvästi määritelty laissa tai hallituksen esityksessä. Tilintarkastuslain mukaan tilintarkastajan on siten huomautettava, jos maksukykytestiä on rikottu, mutta tilintarkastaja joutuu yleensä määrittelemään tällaiset huomauttamista vaativat tilanteet itse. Maksukykytestistä on kirjoitettu suomalaisessa yhtiöoikeuden ja laskentatoimen kirjallisuudessa melko kattavasti. Kuitenkin tilintarkastajaa koskeva näkökulma on saanut osakseen suhteellisen vähän huomiota. Tästä näkökulmasta on kirjoitettu vain joitakin korkeakoulujen tutkielmia sekä lyhyehköjä ammatillisia seminaariesityksiä. Tämän tutkielman tavoitteena on ollut koota laaja yleiskuva siitä, miten tilintarkastajat itse kokevat asemansa ja tehtävänsä yllä kuvatuissa tilanteessa. Tutkielmassa on käyty läpi aikaisempaa yhtiöoikeuden ja laskentatoimen kirjallisuudessa ja seminaariesityksissä esitettyä aineistoa. Lisäksi tutkielmaa varten tehtiin suomalaisille tilintarkastajille kohdennettu Internet-pohjainen kysely. Tutkielma selkeyttää kuvaa siitä, miten tilintarkastajat toimivat yllä kuvatussa tilanteessa ja miten he ovat sopeuttaneet toimiaan yhteiskunnan institutionaalisen asetelman muututtua. Kirjallisuuden pohjalta tapahtuva teoreettinen analyysi on yhdistetty kyselyyn siitä, miten tilintarkastajat käytännössä toimivat. Tutkimuksen perustana olevaa tietoa on analysoitu pääosin kyselytutkimuksen menetelmin, mutta myös tilastollisen tutkimuksen menetelmiä on käytetty. Tutkielman tuloksena tutkielmassa selvitetään tilintarkastajan tehtäviä maksukykytestin yhteydessä. Tuloksena voidaan myös todeta, että tilintarkastaja ei suorita varojenjaossa tarvittavan maksukyvyn arvioinnin kannalta keskeisiä tarkastustoimenpiteitä ainoastaan tilikauden päättymisen jälkeen. Päinvastoin, tällaisia tarkastustoimenpiteitä suoritetaan enemmän tai vähemmän koko tilintarkastuksen aikana. Lisäksi vaikuttaisi siltä, että tilintarkastajan oma suhtautuminen maksukykytestiin on ainakin jossain määrin merkityksellinen sen kannalta, kuinka paljon tarkastustoimenpiteitä tehdään ja kuinka paljon maksukyvystä ja siihen liittyvistä puutteista raportoidaan yhtiön johdolle.

Kuparin hitsaus kattavilla laatuvaatimuksilla

Kuparin ja kupariseosten hitsaus eroaa merkittävästi esimerkiksi terästen hitsauksesta. Suuri lämmönjohtavuus, lämpölaajeneminen, pehmeneminen ja kuparin taipumus liuottaa kaasuja sulaan asettavat hitsaukselle haasteita. Kuparia on perinteisesti hitsattu kaasuhitsaamalla ja kaasukaarihitsausprosesseilla, mutta uudemmat menetelmät kuten laserhitsaus, elektronisuihkuhitsaus ja FSW-hitsaus tarjoavat uudenlaisia käyttökohteita korkealla laadulla. ISO 3834-2 asettaa noudatettavat vaatimukset hitsaustoiminnalle laatuvaatimusten ollessa kattavia. Ydinvoimalaitoksella hitsauksessa tulee lisäksi noudattaa Säteilyturvakeskuksen YVL-ohjeita, joissa on määritetty lisävaatimuksia liitosten materiaalivalinnoille, pätevöittämiselle ja tarkastamiselle. Tässä työssä tutkittiin kuparimetallien hitsauksen mahdollisuutta Loviisan ydinvoimalaitoksella juottamisen sijasta siten, että kattavat laatuvaatimukset täyttyisivät. Hitsauskokeissa ja laboratoriotutkimuksissa testattiin hitsausta erilaisilla hitsausaineilla ja hitsausprosesseilla. Koetulosten pohjalta toteutettiin hitsausmenetelmä deoksidoidun kupariputken ja tinapronssilaipan TIG-hitsaukselle.

Investigation of cytotoxic and mutagenic effects of Malpighia glabra L. (barbados cherry) fruit pulp and vitamin C on plant and animal test systems

Fruits are important sources of nutrients in human diet, and Barbados Cherry (Malpighia glabra L.) is of particular interest due to its high content of antioxidants. Diets rich in fruits and vegetables protect individuals against diseases and cancer, but excessive intake of vitamins may act as pro-oxidant and generate changes in DNA. To evaluate the effect of different in natura (BAN) and frozen (BAF) Barbados Cherry pulp concentrations and synthetic vitamin C in liquid form (VC) on the chromosome level and the cell cycle division, root meristeme cells of Allium cepa L. and bone marrow cells of Wistar rats Rattus norvegicus, were used as test system. In Allium cepa L., BAN, at the highest concentration (0.4 mg.mL-1) and BAF, at the lowest concentration (0.2 mg.mL-1), inhibited cell division, and there was recovery of cell division after the recovery period in water only for BAN. In the Wistar rats, all treatments with Barbados Cherry, either acute or subchronic, were not cytotoxic or mutagenic; only the highest concentration of VC increased significantly the rate of chromosomal abnormalities. The data obtained are important to reinforce the use of Barbados Cherry fruit in the diet.

Dynamic Competitor Analysis Model Of Welding Quality Management Software

Tämä diplomityö arvioi hitsauksen laadunhallintaohjelmistomarkkinoiden kilpailijoita. Kilpailukenttä on uusi ja ei ole tarkkaa tietoa siitä minkälaisia kilpailijoita on markkinoilla. Hitsauksen laadunhallintaohjelmisto auttaa yrityksiä takaamaan korkean laadun. Ohjelmisto takaa korkean laadun varmistamalla, että hitsaaja on pätevä, hän noudattaa hitsausohjeita ja annettuja parametreja. Sen lisäksi ohjelmisto kerää kaiken tiedon hitsausprosessista ja luo siitä vaadittavat dokumentit. Diplomityön teoriaosuus muodostuu kirjallisuuskatsauksesta ratkaisuliike-toimintaan, kilpailija-analyysin ja kilpailuvoimien teoriaan sekä hitsauksen laadunhallintaan. Työn empiriaosuus on laadullinen tutkimus, jossa tutkitaan kilpailevia hitsauksen laadunhallintaohjelmistoja ja haastatellaan ohjelmistojen käyttäjiä. Diplomityön tuloksena saadaan uusi kilpailija-analyysimalli hitsauksen laadunhallintaohjelmistoille. Mallin avulla voidaan arvostella ohjelmistot niiden tarjoamien primääri- ja sekundääriominaisuuksien perusteella. Toiseksi tässä diplomityössä analysoidaan nykyinen kilpailijatilanne hyödyntämällä juuri kehitettyä kilpailija-analyysimallia.

Underwater Remote Welding Technology for Offshore Structures

The construction of offshore structures, equipment and devices requires a high level of mechanical reliability in terms of strength, toughness and ductility. One major site for mechanical failure, the weld joint region, needs particularly careful examination, and weld joint quality has become a major focus of research in recent times. Underwater welding carried out offshore faces specific challenges affecting the mechanical reliability of constructions completed underwater. The focus of this thesis is on improvement of weld quality of underwater welding using control theory. This research work identifies ways of optimizing the welding process parameters of flux cored arc welding (FCAW) during underwater welding so as to achieve desired weld bead geometry when welding in a water environment. The weld bead geometry has no known linear relationship with the welding process parameters, which makes it difficult to determine a satisfactory weld quality. However, good weld bead geometry is achievable by controlling the welding process parameters. The doctoral dissertation comprises two sections. The first part introduces the topic of the research, discusses the mechanisms of underwater welding and examines the effect of the water environment on the weld quality of wet welding. The second part comprises four research papers examining different aspects of underwater wet welding and its control and optimization. Issues considered include the effects of welding process parameters on weld bead geometry, optimization of FCAW process parameters, and design of a control system for the purpose of achieving a desired bead geometry that can ensure a high level of mechanical reliability in welded joints of offshore structures. Artificial neural network systems and a fuzzy logic controller, which are incorporated in the control system design, and a hybrid of fuzzy and PID controllers are the major control dynamics used. This study contributes to knowledge of possible solutions for achieving similar high weld quality in underwater wet welding as found with welding in air. The study shows that carefully selected steels with very low carbon equivalent and proper control of the welding process parameters are essential in achieving good weld quality. The study provides a platform for further research in underwater welding. It promotes increased awareness of the need to improve the quality of underwater welding for offshore industries and thus minimize the risk of structural defects resulting from poor weld quality.