La néphropathie ischémique par athérosclérose aortorénale : acquisitions thérapeutiques [Atherosclerotic renal artery disease management update]

In the case of atherosclerotic renal artery disease, the best conclusive results lie principally not in the degree of the stenosis but rather in the degree the renal parenchymal disease beyond the stenosis itself. These determining factors involve the controlling of the patients blood pressure, the improvement in the renal function and the beneficial results to the cardiovascular system. Besides the indispensable medical treatment, a revascularisation by angioplasty may be indicated. This procedure with or without vascular stent often allows satisfactory angiographic results. A treatment by surgical revascularisation is only recommended in the case of extensive atherosclerotic lesions of the aorta, complex lesions of the latter or an abdominal aortic aneurism. Although the frequency of restenosis of angioplasty with stent remains extremely low, the risk of cholesterol emboli due to the diffuse atherosclerotic lesions of the abdominal aorta, must be considered at the time of each aortic catheterization. The therapeutic approach of atherosclerotic renal artery disease must be dictated by the whole cardiovascular risk factors and by the threat of target organs. The control of the blood pressure and the maintenance of the renal function must be integrated in the decisional algorithm as well as the possible risks in carrying out an eventual revascularisation procedure. Finally, the renal angioplasty should in numerous situations be integrated in the overall assumption of responsibility of the atherosclerotic vascular diseases, and should be part of the medical treatment. Several questions still do exist; at what moment an atherosclerotic renal artery stenosis should and e considered critical, and which procedure should be considered for which patient? The purpose of this review is to propose a decisional tool for individualized treatments in the light of results from randomized and controlled studies.

Crescimento, digestibilidade e resistência à infecção por patógeno em tilápia-do-nilo alimentada com probióticos

O objetivo deste trabalho foi avaliar o efeito da suplementação da dieta com os probióticos Lactobacillus plantarum e Saccharomyces cerevisiae, no desempenho zootécnico, digestibilidade e na resistência à infecção por patógeno, em alevinos de tilápia-do-nilo. Foram realizados três ensaios. No primeiro, durante 55 dias, seis grupos de 30 alevinos (2,4±0,5 g) receberam suplementação com probióticos, e outros três grupos não receberam suplementação. No final desse período, no segundo ensaio, os peixes foram desafiados com Aeromonas hydrophila, e a sobrevivência foi avaliada por 96 horas. No terceiro ensaio, com oito peixes por tanque (230,0±10,0 g), avaliou-se a digestibilidade da dieta após a suplementação com os probióticos. A suplementação probiótica melhora significativamente o ganho de peso, a conversão alimentar, as taxas de retenção proteica e energética, assim como a resistência dos animais a Aeromonas hydrophila, após a infecção. A suplementação com Saccharomyces cerevisiae à dieta de tilápia-do-nilo melhora significativamente a digestibilidade da proteína, energia e matéria seca.

In vivo Structural Imaging of the Cerebellum, the Contribution of Ultra-High Fields.

This review covers some of the contributions to date from cerebellar imaging studies performed at ultra-high magnetic fields. A short overview of the general advantages and drawbacks of the use of such high field systems for imaging is given. One of the biggest advantages of imaging at high magnetic fields is the improved spatial resolution, achievable thanks to the increased available signal-to-noise ratio. This high spatial resolution better matches the dimensions of the cerebellar substructures, allowing a better definition of such structures in the images. The implications of the use of high field systems is discussed for several imaging sequences and image contrast mechanisms. This review covers studies which were performed in vivo in both rodents and humans, with a special focus on studies that were directed towards the observation of the different cerebellar layers.

Performance of noninvasive ventilation algorithms on ICU ventilators during pressure support: a clinical study.

To evaluate the impact of noninvasive ventilation (NIV) algorithms available on intensive care unit ventilators on the incidence of patient-ventilator asynchrony in patients receiving NIV for acute respiratory failure. Prospective multicenter randomized cross-over study. Intensive care units in three university hospitals. Patients consecutively admitted to the ICU and treated by NIV with an ICU ventilator were included. Airway pressure, flow and surface diaphragmatic electromyography were recorded continuously during two 30-min periods, with the NIV (NIV+) or without the NIV algorithm (NIV0). Asynchrony events, the asynchrony index (AI) and a specific asynchrony index influenced by leaks (AIleaks) were determined from tracing analysis. Sixty-five patients were included. With and without the NIV algorithm, respectively, auto-triggering was present in 14 (22%) and 10 (15%) patients, ineffective breaths in 15 (23%) and 5 (8%) (p = 0.004), late cycling in 11 (17%) and 5 (8%) (p = 0.003), premature cycling in 22 (34%) and 21 (32%), and double triggering in 3 (5%) and 6 (9%). The mean number of asynchronies influenced by leaks was significantly reduced by the NIV algorithm (p < 0.05). A significant correlation was found between the magnitude of leaks and AIleaks when the NIV algorithm was not activated (p = 0.03). The global AI remained unchanged, mainly because on some ventilators with the NIV algorithm premature cycling occurs. In acute respiratory failure, NIV algorithms provided by ICU ventilators can reduce the incidence of asynchronies because of leaks, thus confirming bench test results, but some of these algorithms can generate premature cycling.

Associations between online pornography and sexual behavior among adolescents: myth or reality?

This study aimed to compare the sexual behavior of adolescents who were or were not exposed to online pornography, to assess to what extent the willingness of exposure changed these possible associations, and to determine the profiles of youths who were exposed to online pornography. Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a self-administered cross-sectional, paper and pencil questionnaire. From the 7529 adolescents aged 16-20 years, 6054 (3283 males) used the Internet during the previous month and were eligible for our study. Males were divided into three groups (wanted exposure, 29.2%; unwanted exposure, 46.7%; no exposure, 24.1%) whereas females were divided into two groups (exposure, 35.9%; no exposure, 64.1%). The principal outcome measures were demographic characteristics, Internet use parameters and risky sexual behaviors. Risky sexual behaviors were not associated with online pornography exposure in any of the groups, except that males who were exposed (deliberately or not) had higher odds of not having used a condom at last intercourse. Bi/homosexual orientation and Internet use parameters were not associated either. Additionally, males in the wanted exposure group were more likely to be sensation-seekers. On the other hand, exposed girls were more likely to be students, higher sensation-seekers, early maturers, and to have a highly educated father. We conclude that pornography exposure is not associated with risky sexual behaviors and that the willingness of exposure does not seem to have an impact on risky sexual behaviors among adolescents.

Derivation of traceable and transplantable photoreceptors from mouse embryonic stem cells.

Retinal degenerative diseases resulting in the loss of photoreceptors are one of the major causes of blindness. Photoreceptor replacement therapy is a promising treatment because the transplantation of retina-derived photoreceptors can be applied now to different murine retinopathies to restore visual function. To have an unlimited source of photoreceptors, we derived a transgenic embryonic stem cell (ESC) line in which the Crx-GFP transgene is expressed in photoreceptors and assessed the capacity of a 3D culture protocol to produce integration-competent photoreceptors. This culture system allows the production of a large number of photoreceptors recapitulating the in vivo development. After transplantation, integrated cells showed the typical morphology of mature rods bearing external segments and ribbon synapses. We conclude that a 3D protocol coupled with ESCs provides a safe and renewable source of photoreceptors displaying a development and transplantation competence comparable to photoreceptors from age-matched retinas.

Stage fright: its experience as a problem and coping with it.

PURPOSE AND METHOD: This questionnaire survey of 190 university music students assessed negative feelings of music performance anxiety (MPA) before performing, the experience of stage fright as a problem, and how closely they are associated with each other. The study further investigated whether the experience of stage fright as a problem and negative feelings of MPA predict the coping behavior of the music students. Rarely addressed coping issues were assessed, i.e., self-perceived effectiveness of different coping strategies, knowledge of possible risks and acceptance of substance-based coping strategies, and need for more support.RESULTS: The results show that one-third of the students experienced stage fright as a problem and that this was only moderately correlated with negative feelings of MPA. The experience of stage fright as a problem significantly predicted the frequency of use and the acceptance of medication as a coping strategy. Breathing exercises and self-control techniques were rated as effective as medication. Finally, students expressed a strong need to receive more support (65%) and more information (84%) concerning stage fright.CONCLUSION: Stage fright was experienced as a problem and perceived as having negative career consequences by a considerable percentage of the surveyed students. In addition to a desire for more help and support, the students expressed an openness and willingness to seriously discuss and address the topic of stage fright. This provides a necessary and promising basis for optimal career preparation and, hence, an opportunity to prevent occupational problems in professional musicians. [Authors]

Lämmöntalteenotto kosteasta poistoilmasta prosessiteollisuudessa

Tämän diplomityön päämääränä on tehdä prosessiteollisuuden tarpeisiin Excel-taulukkolaskentaohjelmassa toimiva putkilämmönsiirtimen mitoitusohjelma. Prosessiteollisuudessa lämmönvaihtimien toimintaympäristöt ja olosuhteet vaihtelevat merkittävästi ja niinpä jokaisen vaihtimen suunnittelu ja mitoitus on toteutettava tapauskohtaisesti. Työssä käsitellään rekuperatiivisen ristivirtaputkilämmönvaihtimen yleinen lämpötekninen mitoitus sisältäen putken sisäpinnalle tapahtuvan mahdollisen lauhtumisen. Mitoitettava vaihdinkoostuu pystysuorista putkista, joissa lämmin ja kostea ilma virtaa putkien sisäpuolella ja kylmä kuiva ilma vaippapuolella vaakasuoraan. Vaihdinmateriaalina käytetään ruostumatonta AISI 304 -tai haponkestävää AISI 316 terästä. Kuuman ilman tila vaihtelee tarkasteltavan kohteen mukaan. Paperiteollisuuden kuivausyksiköiltä poistuva ilma on usein lämmintä ja kosteaa, ja infrakuivaimilta poistuva ilma on kuumaa. Mitoitettavalle lämmönvaihtimelle tulevan kuuman ilman lämpötila tapauksesta riippuen voi vaihdella 30°C, maksimissaan +300°C:een saakka, vesisisällön ollessa välillä 0,010...0,200 kg/kg ki tai jopa tämän ylikin. Vaihtimen mitoitus perustuu energiataseyhtälöiden käyttöön. Laskennassa määritetään vaihtimen pintalämpötila sekä mahdollinen kostean ilman lauhtuminen putken sisäpinnalle. Lisäksi teoria käsittää molempien virtausten tilanmuutosten laskennan. Työssä on esitetty esimerkkilaskelma, jossa on laskettu ilma- kostea ilma lämmönsiirrinkonstruktio. Esimerkissä on tarkasteltu vaihtimen hyötysuhdetta, virtausten lämpö- ja kosteuskäyttäytymistä ulkoilman lämpötilan funktiona. Ohjelmasta saadaan tulostettua mitoitettavanvaihtimen dimensiot; putkien lukumäärät syvyys- ja pituussuunnassa sekä kokonaisputkilukumäärä, putkien väliset etäisyydet toisiinsa nähden sekä syvyys, että pituussuunnassa, putkipituus ja putken sisä- ja ulkohalkaisijat. Nämä tiedot suunnittelija itse syöttää ohjelmalle alkuarvoina. Laskettuna tietona ohjelma antaa molempien virtausten poistolämpötilat, kuuman ilman poistuvan absoluuttisen kosteuden, kondenssivesimäärän, vaihtimen tehon ja painehäviöt vaippa- ja putkipuolelle. Lisäksi ohjelma laskee kuuman ilman ominaisentalpiat vaihtimen sisään- ja ulostulossa. Tämä mahdollistaa ilman tilapisteiden piirtämisen Mollier-piirrokseen.

Assessment of glenoid inclination on routine clinical radiographs and computed tomography examinations of the shoulder.

BACKGROUND: Accurate assessment of glenoid inclination is of interest for a variety of conditions and procedures. The purpose of this study was to develop an accurate and reproducible measurement for glenoid inclination on standardized anterior-posterior (AP) radiographs and on computed tomography (CT) images. MATERIALS AND METHODS: Three consistently identifiable angles were defined: Angle α by line AB connecting the superior and inferior glenoid tubercle (glenoid fossa) and the line identifying the scapular spine; angle β by line AB and the floor of the supraspinatus fossa; angle γ by line AB and the lateral margin of the scapula. Experimental study: these 3 angles were measured in function of the scapular position to test their resistance to rotation. Conventional AP radiographs and CT scans were acquired in extension/flexion and internal/external rotation in a range up to ±40°. Clinical study: the inter-rater reliability of all angles was assessed on AP radiographs and CT scans of 60 patients (30 with proximal humeral fractures, 30 with osteoarthritis) by 2 independent observers. RESULTS: The experimental study showed that angle α and β have a resistance to rotation of up to ±20°. The deviation from neutral position was not more than ±10°. The results for the inter-rater reliability analyzed by Bland-Altman plots for the angle β fracture group were (mean ± standard deviation) -0.1 ± 4.2 for radiographs and -0.3 ± 3.3 for CT scans; and for the osteoarthritis group were -1.2 ± 3.8 for radiographs and -3.0 ± 3.6 for CT scans. CONCLUSION: Angle β is the most reproducible measurement for glenoid inclination on conventional AP radiographs, providing a resistance to positional variability of the scapula and a good inter-rater reliability.

A frequency distribution approach to hotspot identification

We present a new global method for the identification of hotspots in conservation and ecology. The method is based on the identification of spatial structure properties through cumulative relative frequency distributions curves, and is tested with two case studies, the identification of fish density hotspots and terrestrial vertebrate species diversity hotspots. Results from the frequency distribution method are compared with those from standard techniques among local, partially local and global methods. Our approach offers the main advantage to be independent from the selection of any threshold, neighborhood, or other parameter that affect most of the currently available methods for hotspot analysis. The two case studies show how such elements of arbitrariness of the traditional methods influence both size and location of the identified hotspots, and how this new global method can be used for a more objective selection of hotspots.

Cyclicity versus center problem

We prove that there are one-parameter families of planar differential equations for which the center problem has a trivial solution and on the other hand the cyclicity of the weak focus is arbitrarily high. We illustrate this phenomenon in several examples for which this cyclicity is computed.

Valuing equity-linked death benefits in jump diffusion models

The paper is motivated by the valuation problem of guaranteed minimum death benefits in various equity-linked products. At the time of death, a benefit payment is due. It may depend not only on the price of a stock or stock fund at that time, but also on prior prices. The problem is to calculate the expected discounted value of the benefit payment. Because the distribution of the time of death can be approximated by a combination of exponential distributions, it suffices to solve the problem for an exponentially distributed time of death. The stock price process is assumed to be the exponential of a Brownian motion plus an independent compound Poisson process whose upward and downward jumps are modeled by combinations (or mixtures) of exponential distributions. Results for exponential stopping of a Lévy process are used to derive a series of closed-form formulas for call, put, lookback, and barrier options, dynamic fund protection, and dynamic withdrawal benefit with guarantee. We also discuss how barrier options can be used to model lapses and surrenders.

An alternative approach to the prevention of doping in cycling

The article proposes an alternative approach to policies for preventing doping in cycling, based on in-depth analysis of the functioning of nine of the 40 world professional teams and the careers of the 2,351 riders who were or have been professionals since 2005. The first part shows that the instruments of prevention have been based on a questionable understanding of doping as an individual moral fault, and have not produced the expected results. The second part proposes to analyse the ways in which teams and riders produce their achievments, so as to put forward an alternative to the anti-doping policies used hitherto, which have little impact on riders. The study shows that it is more pertinent to examine the forms of employment and the business models, because these have important effects on cycling professionals' conditions of work. It makes it possible to identify three dimensions of the risk of doping on which organisations can act in their antidoping policies: team organisation, riders' preparation and workload, and the precarity of employment.

Conservação de uvas "Crimson Seedless" e "Itália", submetidas a diferentes tipos de embalagens e dióxido de enxofre (SO2)

Estudaram-se o efeito de diferentes tipos de embalagens e a ação do dióxido de enxofre (SO2) na conservação pós-colheita de uvas finas de mesa var. "Crimson Seedless" e "Itália". Os frutos, colhidos em propriedade agrícola situada no município de Boa Vista-RR (Lat. 2º 50' 06" N e Long. 60º 40' 28" W), apresentavam, no momento da colheita, sólidos solúveis (SS) médios de 16,50 e 14,80°Brix, para as variedades "Crimson Seedless" e "Itália", respectivamente. Antes da confecção dos tratamentos, os cachos foram higienizados em solução de hipoclorito de sódio (NaOCl) a 100 mg.L-1, previamente acidificada, por dez minutos. Utilizaram-se, para a atmosfera modificada passiva, sacolas de polietileno de baixa densidade (PEBD), sem perfuração, com 0,010; 0,015 e 0,020mm de espessura,e acondicionadas em embalagens secundárias de papelão (4kg) e de madeira (7,5kg). Para a geração do SO2, foram utilizados papéis Kraft de liberação rápida, com 3 e 8g de metabissulfito de sódio (Na2S2O5). Após a confecção dos tratamentos, os frutos foram armazenados em câmara frigorífica a 4 ± 1°C e 95 ± 3% de umidade relativa (U.R.). As avaliações foram realizadas no momento da colheita e, 7; 21; 35; 42 e 56 dias de armazenamento refrigerado, quanto à porcentagem de perda de massa fresca, taxa de desgrana e de bagas deterioradas, qualidade do engaço e teor de SS dos frutos. Após oito semanas, foi realizado teste de preferência para as duas variedades. Verificou-se, em ambas as variedades, que as uvas submetidas à ação do gerador de SO2 , contendo 3g de metabissulfito de sódio e acondicionamento em embalagens de PEBD de 0,020mm de espessura, independentemente do tipo de embalagem secundária, apresentaram a menor perda de massa fresca, menor taxa de desgrana e de bagas deterioradas, e melhor qualidade do engaço. Os resultados da análise sensorial concordaram com os resultados das análises físico-químicas. Não foram detectadas diferenças nos teores de SS entre os tratamentos, em ambas as variedades. (Apoio: Roraima Agrofrutas).