A curva de regress��o da gonadotrofina cori��nica humana �� ��til no diagn��stico precoce da neoplasia trofobl��stica gestacional p��s-molar?

OBJETIVO: avaliar a utilidade da curva de regress��o normal da gonadotrofina cori��nica humana (hCG) no diagn��stico precoce de neoplasia trofobl��stica gestacional p��s-molar (NTG). M��TODOS: estudo longitudinal, incluindo 105 pacientes com mola hidatiforme completa (MHC) acompanhadas no Centro de Doen��as Trofobl��sticas de Botucatu, entre 1998 e 2005. Os t��tulos da hCG s��rica foram mensurados quinzenalmente em todas as pacientes. Curvas individuais de regress��o da hCG das 105 pacientes foram estabelecidas. A compara����o entre a curva de regress��o normal estabelecida em nosso servi��o com as curvas individuais da hCG foi usada no rastreamento e diagn��stico (plat��/ascens��o) de NTG. O n��mero de semanas p��s-esvaziamento quando a hCG excedeu o limite normal foi comparado com o n��mero semanas em que a hCG apresentou plat��/ascens��o. RESULTADOS: das 105 pacientes com MHC, 80 apresentaram remiss��o espont��nea (RE) e 25 desenvolveram NTG. Das 80 pacientes com RE, 7 (8,7%) apresentaram, inicialmente, dosagem da hCG acima do normal, mas, no devido tempo, alcan��aram a remiss��o. Todas as 25 pacientes com NTG apresentaram desvio da curva normal da hCG em 3,8&plusmn;2,5 semanas e mostraram plat�� ou ascens��o em 8,4&plusmn;2,9 semanas (p<0,001). CONCLUS��ES: a curva de regress��o normal da hCG p��s-molar pode ser ��til para diagn��stico de NTG.

Obstetric outcomes in the second birth of women with a previous caesarean delivery: a retrospective cohort study from Peru

PURPOSE: To examine obstetric outcomes in the second birth of women who had undergone a previous cesarean delivery. METHODS: This was a large hospital-based retrospective cohort study. We included pregnant women who had a previous delivery (vaginal or cesarean) attending their second birth from 2001 to 2009. Main inclusion criteria were singleton pregnancies and delivery between a gestation of 24 and 41 weeks. Two cohorts were selected, being women with a previous cesarean delivery (n=7,215) and those with a vaginal one (n=23,720). Both groups were compared and logistic regression was performed to adjust for confounding variables. The obstetric outcomes included uterine rupture, placenta previa, and placental-related complications such as placental abruption, preeclampsia, and spontaneous preterm delivery. RESULTS: Women with previous cesarean delivery were more likely to have adverse outcomes such as uterine rupture (OR=12.4, 95%CI 6.8-22.3), placental abruption (OR=1.4, 95%CI 1.1-2.1), preeclampsia (OR=1.4, 95%CI 1.2-1.6), and spontaneous preterm delivery (OR=1.4, 95%CI 1.1-1.7). CONCLUSIONS: Individuals with previous cesarean section have adverse obstetric outcomes in the subsequent pregnancy, including uterine rupture, and placental-related disorders such as preeclampsia, spontaneous preterm delivery, and placental abruption.

Correlation between placental thickness in the second and third trimester and fetal weight

PURPOSE: To investigate relationship between placental thickness during the second and third trimesters and placental and birth weights. METHODS: From January 2011 to June 2012, a total of 250 singleton pregnant women presented at our antenatal clinic were enrolled in this prospective study. All recruited women were assessed at the 1st trimester screening for baseline demographic and obstetric data. The placental thickness was measured trans-abdominally by placing the ultrasound transducer perpendicularly to the plane of the placenta, in the area of the cord insertion at second and third trimester. Pearson's correlation analysis was used to establish the degree of relationship between placental thickness and birth and placental weights. RESULTS: Of 250 recruited participants, 205 women were able to complete the study. The mean age of cases was 26.4��5.1. Values of mean birth and placental weights were 305.56��657.0 and 551.7��104.8 grams respectively. Ultrasonographic measures of placental thickness in second and third trimester and changes between them were 21.68��4.52, 36.26��6.46 and 14.67��5.67 mm respectively. There was a significant positive correlation between placental thickness and birth weight in the second and third trimesters (r=0.15, p=0.03; r=0.14, p=0.04 correspondingly). CONCLUSION: According to our study, birth weight has a positive relation with both second and third trimester placental thickness; however, placental thickness change could not predict low birth weight.

Uterine Doppler velocimetry of the uterine arteries in the second and third trimesters for the prediction of gestational outcome

PURPOSE: The aim of this longitudinal study was to investigate the value of uterine artery Doppler sonography during the second and third trimesters in the prediction of adverse pregnancy outcome in low-risk women. METHODS: From July 2011 to August 2012, a total of 205 singleton pregnant women presenting at our antenatal clinic were enrolled in this prospective study and were assessed for baseline demographic and obstetric data. They underwent ultrasound evaluation at the time of second and third trimesters, both included Doppler assessment of bilateral uterine arteries to determine the values of the pulsatility index (PI) and resistance index (RI) and presence of early diastolic notch. The endpoint of this study was assessing the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Doppler ultrasonography of the uterine artery, for the prediction of adverse pregnancy outcomes including preeclampsia, stillbirth, placental abruption and preterm labor. RESULTS: The mean age of cases was 26.4&#177;5.11. The uterine artery PI and RI values for both second (PI: 1.1&#177;0.42 versus 1.53&#177;0.59, p=0.002; RI: 0.55&#177;0.09 versus 0.72&#177;0.13, p=0.000 respectively) and third-trimester (PI: 0.77&#177;0.31 versus 1.09&#177;0.46, p=0.000; RI: 0.46&#177;0.10 versus 0.60&#177;0.14, p=0.010 respectively) evaluations were significantly higher in patients with adverse pregnancy outcome than in normal women. Combination of PI and RI >95th percentile and presence of bilateral notch in second trimester get sensitivity and specificity of 36.1 and 97% respectively, while these measures were 57.5 and 98.2% in third trimester. CONCLUSIONS: According to our study, it seems that uterine artery Doppler may be a valuable tool for the prediction of a variety of adverse outcomes in second and third trimesters.

Risco da ocorr��ncia de neoplasia trofobl��stica gestacional ap��s a normaliza����o da gonadotrofina cori��nica humana no seguimento p��s-molar

Disserta����o apresentada ao Curso de Mestrado Profissional em Sa��de Materno-Infantil da Universidade Federal Fluminense, como requisito para obten����o do grau de Mestre em Sa��de Materno-Infantil. ��rea de Concentra����o: Sa��de da Mulher e da Crian��a, em 16 de maio de 2014.OBJETIVO: avaliar o risco da ocorr��ncia de neoplasia trofobl��stica gestacional (NTG) ap��s a normaliza����o da gonadotrofina cori��nica humana (hCG) no seguimento p��s-molar. PACIENTES E M��TODOS: trata-se de estudo retrospectivo, tipo coorte n��o concorrente, colaborativo interinstitucional, realizado nos Centros de Refer��ncia em Doen��a Trofobl��stica Gestacional da SCMRJ, HUAP-UFF, ME-UFRJ, HC-UNESP e HC-UFG. Foram analisados dos prontu��rios m��dicos de pacientes acompanhadas nesses Servi��os, entre os anos de 2002 e 2013. Esse projeto foi aprovado pelo Comit�� de ��tica em Pesquisa. RESULTADOS: entre as pacientes que cursaram com remiss��o espont��nea, 10 (0,4% - 1 em cada 201 casos de MH) evolu��ram com NTG ap��s a normaliza����o de hCG (p<0,0001; IC95% 0,2&#8211;0,7). Quando se analisa o risco de NTG ap��s a normaliza����o de hCG nos diferentes tipos de gravidez molar, observou-se sua ocorr��ncia em 9/2016 (0,4% - 1 em cada 224 casos) dentre as pacientes com mola hidatiforme completa - MHC (p<0,0001; IC95% 0,2&#8211;0,7), de 1/982 (0,1% - 1 em cada 985 casos) dentre as pacientes com mola hidatiforme parcial - MHP (p<0,0001; IC95% 0,02&#8211;0,5) e em nenhuma das pacientes com gravidez molar gemelar - GMG. Consoante o tempo de normaliza����o de hCG, a ocorr��ncia de NTG foi observada em 1/1595 (0,06% - 1 em cada 1595 casos de MH) das pacientes cujo hCG normalizou com menos de 56 dias (p<0,0001; IC95% 0,01&#8211;0,3), enquanto que entre aquelas cujo hCG normalizou com mais de 56 dias a NTG ocorreu em 9/1416 (0,6% - 1 em cada 157 casos de MH) das pacientes (p<0,0001; IC95% 0,3&#8211;1,1), exibindo um OR de 10,19 (p=0,02; IC95% 1,29&#8211;80,58). CONCLUS��ES: o risco de NTG ap��s a normaliza����o de hCG �� ��nfimo. Parece-nos razo��vel que seja dada alta para a paciente com MHP ap��s a primeira dosagem normal de hCG. Nos casos de MHC e GMG, esse seguimento deve ser mantido por 6 meses.

Identification of Some Additional Loss Components in High-Power Low-Voltage Permanent Magnet Generators

Permanent magnet generators (PMG) represent the cutting edge technology in modern wind mills. The efficiency remains high (over 90%) at partial loads. To improve the machine efficiency even further, every aspect of machine losses has to be analyzed. Additional losses are often given as a certain percentage without providing any detailed information about the actual calculation process; meanwhile, there are many design-dependent losses that have an effect on the total amount of additional losses and that have to be taken into consideration. Additional losses are most often eddy current losses in different parts of the machine. These losses are usually difficult to calculate in the design process. In this doctoral thesis, some additional losses are identified and modeled. Further, suggestions on how to minimize the losses are given. Iron losses can differ significantly between the measured no-load values and the loss values under load. In addition, with embedded magnet rotors, the quadrature-axis armature reaction adds losses to the stator iron by manipulating the harmonic content of the flux. It was, therefore, re-evaluated that in salient pole machines, to minimize the losses and the loss difference between the no-load and load operation, the flux density has to be kept below 1.5 T in the stator yoke, which is the traditional guideline for machine designers. Eddy current losses may occur in the end-winding area and in the support structure of the machine, that is, in the finger plate and the clamping ring. With construction steel, these losses account for 0.08% of the input power of the machine. These losses can be reduced almost to zero by using nonmagnetic stainless steel. In addition, the machine housing may be subjected to eddy current losses if the flux density exceeds 1.5 T in the stator yoke. Winding losses can rise rapidly when high frequencies and 10���15 mm high conductors are used. In general, minimizing the winding losses is simple. For example, it can be done by dividing the conductor into transposed subconductors. However, this comes with the expense of an increase in the DC resistance. In the doctoral thesis, a new method is presented to minimize the winding losses by applying a litz wire with noninsulated strands. The construction is the same as in a normal litz wire but the insulation between the subconductors has been left out. The idea is that the connection is kept weak to prevent harmful eddy currents from flowing. Moreover, the analytical solution for calculating the AC resistance factor of the litz-wire is supplemented by including an end-winding resistance in the analytical solution. A simple measurement device is developed to measure the AC resistance in the windings. In the case of a litz-wire with originally noninsulated strands, vacuum pressure impregnation (VPI) is used to insulate the subconductors. In one of the two cases studied, the VPI affected the AC resistance factor, but in the other case, it did not have any effect. However, more research is needed to determine the effect of the VPI on litz-wire with noninsulated strands. An empirical model is developed to calculate the AC resistance factor of a single-layer formwound winding. The model includes the end-winding length and the number of strands and turns. The end winding includes the circulating current (eddy currents that are traveling through the whole winding between parallel strands) and the main current. The end-winding length also affects the total AC resistance factor.

Tooth-Coil Permanent Magnet Synchronous Machine Design for Special Applications

This doctoral thesis presents a study on the design of tooth-coil permanent magnet synchronous machines. The electromagnetic properties of concentrated non-overlapping winding permanent magnet synchronous machines, or simply tooth-coil permanent magnet synchronous machines (TC-PMSMs), are studied in details. It is shown that current linkage harmonics play the deterministic role in the behavior of this type of machines. Important contributions are presented as regards of calculation of parameters of TC-PMSMs,particularly the estimation of inductances. The current linkage harmonics essentially define the air-gap harmonic leakage inductance, rotor losses and localized temporal inductance variation. It is proven by FEM analysis that inductance variation caused by the local temporal harmonic saturation results in considerable torque ripple, and can influence on sensorless control capabilities. Example case studies an integrated application of TC-IPMSMs in hybrid off-highway working vehicles. A methodology for increasing the efficiency of working vehicles is introduced. It comprises several approaches ��� hybridization, working operations optimization, component optimization and integration. As a result of component optimization and integration, a novel integrated electro-hydraulic energy converter (IEHEC) for off-highway working vehicles is designed. The IEHEC can considerably increase the operational efficiency of a hybrid working vehicle. The energy converter consists of an axial-piston hydraulic machine and an integrated TCIPMSM being built on the same shaft. The compact assembly of the electrical and hydraulic machines enhances the ability to find applications for such a device in the mobile environment of working vehicles.Usage of hydraulic fluid, typically used in working actuators, enables direct-immersion oil cooling of designed electrical machine, and further increases the torque- and power- densities of the whole device.

Design and testing of an armature-reaction-compensated permanent magnet synchronous generator for island operation

At present, permanent magnet synchronous generators (PMSGs) are of great interest. Since they do not have electrical excitation losses, the highly efficient, lightweight and compact PMSGs equipped with damper windings work perfectly when connected to a network. However, in island operation, the generator (or parallel generators) alone is responsible for the building up of the network and maintaining its voltage and reactive power level. Thus, in island operation, a PMSG faces very tight constraints, which are difficult to meet, because the flux produced by the permanent magnets (PMs) is constant and the voltage of the generator cannot be controlled. Traditional electrically excited synchronous generators (EESGs) can easily meet these constraints, because the field winding current is controllable. The main drawback of the conventional EESG is the relatively high excitation loss. This doctoral thesis presents a study of an alternative solution termed as a hybrid excitation synchronous generator (HESG). HESGs are a special class of electrical machines, where the total rotor current linkage is produced by the simultaneous action of two different excitation sources: the electrical and permanent magnet (PM) excitation. An overview of the existing HESGs is given. Several HESGs are introduced and compared with the conventional EESG from technical and economic points of view. In the study, the armature-reaction-compensated permanent magnet synchronous generator with alternated current linkages (ARC-PMSG with ACL) showed a better performance than the other options. Therefore, this machine type is studied in more detail. An electromagnetic design and a thermal analysis are presented. To verify the operation principle and the electromagnetic design, a down-sized prototype of 69 kVA apparent power was built. The experimental results are demonstrated and compared with the predicted ones. A prerequisite for an ARC-PMSG with ACL is an even number of pole pairs (p = 2, 4, 6, ���) in the machine. Naturally, the HESG technology is not limited to even-pole-pair machines. However, the analysis of machines with p = 3, 5, 7, ��� becomes more complicated, especially if analytical tools are used, and is outside the scope of this thesis. The contribution of this study is to propose a solution where an ARC-PMSG replaces an EESG in electrical power generation while meeting all the requirements set for generators given for instance by ship classification societies, particularly as regards island operation. The maximum power level when applying the technology studied here is mainly limited by the economy of the machine. The larger the machine is, the smaller is the efficiency benefit. However, it seems that machines up to ten megawatts of power could benefit from the technology. However, in low-power applications, for instance in the 500 kW range, the efficiency increase can be significant.

Modeling and Parameter Estimation of Double-Star Permanent Magnet Synchronous Machines

The power rating of wind turbines is constantly increasing; however, keeping the voltage rating at the low-voltage level results in high kilo-ampere currents. An alternative for increasing the power levels without raising the voltage level is provided by multiphase machines. Multiphase machines are used for instance in ship propulsion systems, aerospace applications, electric vehicles, and in other high-power applications including wind energy conversion systems. A machine model in an appropriate reference frame is required in order to design an efficient control for the electric drive. Modeling of multiphase machines poses a challenge because of the mutual couplings between the phases. Mutual couplings degrade the drive performance unless they are properly considered. In certain multiphase machines there is also a problem of high current harmonics, which are easily generated because of the small current path impedance of the harmonic components. However, multiphase machines provide special characteristics compared with the three-phase counterparts: Multiphase machines have a better fault tolerance, and are thus more robust. In addition, the controlled power can be divided among more inverter legs by increasing the number of phases. Moreover, the torque pulsation can be decreased and the harmonic frequency of the torque ripple increased by an appropriate multiphase configuration. By increasing the number of phases it is also possible to obtain more torque per RMS ampere for the same volume, and thus, increase the power density. In this doctoral thesis, a decoupled d���q model of double-star permanent-magnet (PM) synchronous machines is derived based on the inductance matrix diagonalization. The double-star machine is a special type of multiphase machines. Its armature consists of two three-phase winding sets, which are commonly displaced by 30 electrical degrees. In this study, the displacement angle between the sets is considered a parameter. The diagonalization of the inductance matrix results in a simplified model structure, in which the mutual couplings between the reference frames are eliminated. Moreover, the current harmonics are mapped into a reference frame, in which they can be easily controlled. The work also presents methods to determine the machine inductances by a finite-element analysis and by voltage-source inverters on-site. The derived model is validated by experimental results obtained with an example double-star interior PM (IPM) synchronous machine having the sets displaced by 30 electrical degrees. The derived transformation, and consequently, the decoupled d���q machine model, are shown to model the behavior of an actual machine with an acceptable accuracy. Thus, the proposed model is suitable to be used for the model-based control design of electric drives consisting of double-star IPM synchronous machines.

Selectivity of glyphosate in tank mixtures for RR soybean in sequential applications with mixtures only in the first or second application

Tank mixtures among herbicides of different action mechanisms might increase weed control spectrum and may be an important strategy for preventing the development of resistance in RR soybean. However, little is known about the effects of these herbicide combinations on soybean plants. Hence, two experiments were carried out aiming at evaluating the selectivity of glyphosate mixtures with other active ingredients applied in postemergence to RR soybean. The first application was carried out at V1 to V2 soybean stage and the second at V3 to V4 (15 days after the first one). For experiment I, treatments (rates in g ha-1) evaluated were composed by two sequential applications: the first one with glyphosate (720) in tank mixtures with cloransulam (30.24), fomesafen (125), lactofen (72), chlorimuron (12.5), flumiclorac (30), bentazon (480) and imazethapyr (80); the second application consisted of isolated glyphosate (480). In experiment II, treatments also consisted of two sequential applications, but tank mixtures as described above were applied as the second application. The first one in this experiment consisted of isolated glyphosate (720). For both experiments, sequential applications of glyphosate alone at 720/480, 960/480, 1200/480 and 960/720 (Expt. I) or 720/480, 720/720, 720/960 and 720/1200 (Expt. II) were used as control treatments. Applications of glyphosate tank mixtures with other herbicides are more selective to RR soybean when applied at younger stages whereas applications at later stages might cause yield losses, especially when glyphosate is mixed with lactofen and bentazon.

Benzodiazepines and Cognitive Functioning in Older Adults. With Emphasis on Long-Term Use and Withdrawal

Benzodiazepines (BZD) and benzodiazepine related drugs (RD) are the most commonly used psychotropics among the aged. The use of other psychotropics taken concomitantly with BZD/ RD or their cognitive effects with BZD/RD have not been studied frequently. The aim of this academic thesis was to describe and analyse relationships between the use of BZD/RD alone or concomitantly with antipsychotics, antidepressants, opioids, antiepileptics, opioids and anticholinergics in the aged and their health. Especially, the relationships between long-term use of BZD/RD and cognitive decline were studied. Additionally, the effect of melatonin on BZD/RD withdrawal and the cognitive effects of BZD/RD withdrawal were studied. This study used multiple data sets: the first study (I) was based on clinical data containing aged patients (���65 years; N=164) admitted to Pori City Hospital due to acute disease. The second data set (Studies II and III) was based on population-based data from the Lieto Study, a clinico-epidemiological longitudinal study carried out among the aged (���65 years) in the municipality of Lieto. Follow-up data was formed by combining the cohort data collected in 1990-1991 (N=1283) and in 1998-1999 (N=1596) from those who participated in both cohorts (N=617). The third data set (Studies IV and V) was based on the Satauni Study���s data. This study was performed in the City of Pori in 2009-2010. In the RCT part of the Satauni Study, ninety-two long-term users of BZD/RD were withdrawn from their drugs using melatonin against placebo. The change of their cognitive abilities was measured during and after BZD/ RD withdrawal. BZD/RD use was related to worse cognitive and functional abilities, and their use may predict worse cognitive outcomes compared with BZD/RD non-users. Hypnotic use of BZD/RD could be withdrawn with psychosocial support in motivated participants, but melatonin did not improve the withdrawal results compared to those with placebo. Cognitive abilities in psychomotor tests did not show, or showed only modest, improvements for up to six months after BZD/RD withdrawal. This suggests that the cognitive effects of BZD/RD may be longlasting or permanent.

Design of a 1 kW 150 rpm permanent-magnet synchronous generator for stand-alone wind-power applications

A program for calculating low-speed low-power synchronous machine is presented. A permanent-magnet synchronous generator for 1 kW 150 rpm is designed. Optimization of magnet���s and coil���s dimensions was made.