Nonlinear dynamics of the patient’s response to drug effect during general anesthesia

In today’s healthcare paradigm, optimal sedation during anesthesia plays an important role both in patient welfare and in the socio-economic context. For the closed-loop control of general anesthesia, two drugs have proven to have stable, rapid onset times: propofol and remifentanil. These drugs are related to their effect in the bispectral index, a measure of EEG signal. In this paper wavelet time–frequency analysis is used to extract useful information from the clinical signals, since they are time-varying and mark important changes in patient’s response to drug dose. Model based predictive control algorithms are employed to regulate the depth of sedation by manipulating these two drugs. The results of identification from real data and the simulation of the closed loop control performance suggest that the proposed approach can bring an improvement of 9% in overall robustness and may be suitable for clinical practice.

Entwicklung einer Methode zur Bewertung von Innenstrahlverfahren

[s.c.]

Congenital heart disease in pregnancies complicated by maternal diabetes mellitus. An international clinical collaboration, literature review, and meta-analysis.

PURPOSE: Investigation of the incidence and distribution of congenital structural cardiac malformations among the offspring of mothers with diabetes type 1 and of the influence of periconceptional glycemic control. METHODS: Multicenter retrospective clinical study, literature review, and meta-analysis. The incidence and pattern of congenital heart disease in the own study population and in the literature on the offspring of type 1 diabetic mothers were compared with the incidence and spectrum of the various cardiovascular defects in the offspring of nondiabetic mothers as registered by EUROCAT Northern Netherlands. Medical records were, in addition, reviewed for HbA(1c) during the 1st trimester. RESULTS: The distribution of congenital heart anomalies in the own diabetic study population was in accordance with the distribution encountered in the literature. This distribution differed considerably from that in the nondiabetic population. Approximately half the cardiovascular defects were conotruncal anomalies. The authors' study demonstrated a remarkable increase in the likelihood of visceral heterotaxia and variants of single ventricle among these patients. As expected, elevated HbA(1c) values during the 1st trimester were associated with offspring fetal cardiovascular defects. CONCLUSION: This study shows an increased likelihood of specific heart anomalies, namely transposition of the great arteries, persistent truncus arteriosus, visceral heterotaxia and single ventricle, among offspring of diabetic mothers. This suggests a profound teratogenic effect at a very early stage in cardiogenesis. The study emphasizes the frequency with which the offspring of diabetes-complicated pregnancies suffer from complex forms of congenital heart disease. Pregnancies with poor 1st-trimester glycemic control are more prone to the presence of fetal heart disease.

Suomen käsikartta Handkarta öfver Finland /

1 kartta :, vär. ;, 70,1 x 51,5 cm, lehti 78,8 x 58,2 cm

Suomen käsikartta /

1 kartta :, vär. ;, 70,4 x 52 cm, lehti 74,5 x 55,3 cm

Suomen suuriruhtinanmaan kartta /

1 kartta neljällä lehdellä :, vär. ;, lehdet n. 69,2 x 51,3 cm

Suomen suuriruhtinanmaan kartta /

1 kartta neljällä lehdellä :, vär. ;, lehdet n. 69,2 x 51,3 cm

Suomenmaan käsikartta Handkarta öfver Finland /

1 kartta :, vär. ;, 50 x 33,8 cm, lehti 58,2 x 40,7 cm

Suomen käsikartta Handkarta över Finland /

1 kartta :, vär. ;, 70 x 51,6 cm, lehti 78,4 x 58,3 cm, kansi 21 x 15 cm

Suomen käsikartta Handkarta över Finland /

1 kartta :, vär. ;, 70 x 51,6 cm, lehti 78,2 x 58,2 cm, kansi 21 x 15 cm

Suomen käsikartta Handkarta över Finland /

1 kartta :, vär. ;, 70 x 51,5 cm, lehti 77,8 x 58 cm, kansi 21 x 15 cm

Suomen suuriruhtinanmaan kartta /

1 kartta neljällä lehdellä :, vär. ;, lehdet n. 69,2 x 51,3 cm

Suomen suuriruhtinanmaan kartta /

1 kartta neljällä lehdellä :, vär. ;, lehdet n. 69,2 x 51,3 cm

Suomenmaan kartasto / koulujen tarpeeksi tehnyt vuonna 1878 I. J. Inberg

1 kartasto (12 s.) : 8 karttaa, vär. ; 129 x 93 cm