Neuropathological changes in the brain of pigs with acute liver failure.

Abstract Objective. Cerebral edema is a serious complication of acute liver failure (ALF), which may lead to intracranial hypertension and death. An accepted tenet has been that the blood-brain barrier is intact and that brain edema is primarily caused by a cytotoxic etiology due to hyperammonemia. However, the neuropathological changes in ALF have been poorly studied. Using a well characterized porcine model we aimed to investigate ultrastructural changes in the brain from pigs suffering from ALF. Materials and methods. Sixteen female Norwegian Landrace pigs weighing 27-35 kg were randomised into two groups: ALF (n = 8) and sham operated controls (n = 8). ALF was induced with an end-to-side portacaval shunt followed by ligation of the hepatic arteries. Biopsies were harvested from three different areas of the brain (frontal lobe, cerebellum, and brain stem) following eight hours of ALF and analyzed using electron microscopy. Results. Profound perivascular and interstitial edema were found in all three areas. Disruption of pericytic and astrocytic processes were seen, reflecting breakdown/lesion of the blood-brain barrier in animals suffering from ALF. Furthermore, neurons and axons were edematous and surrounded by vesicles. Severe damage to Purkinje neuron (necrosis) and damaged myelin were seen in the cerebellum and brain stem, respectively. Biopsies from sham operated animals were normal. Conclusions. Our data support the concept that vasogenic brain edema plays an important role in the development of intracranial hypertension in pigs with ALF.

Nerve grafts prevent paraplegic pressure ulcers

We present an optimistic neural solution to the depressing challenge of decubitus pressure ulcers in the paraplegic patient. This is a limited study of two paraplegic men followed for several years. Sural nerve grafts, performed end-to-side, successfully bridged the sciatic nerve to intercostal nerves with surprising benefits for both men.

Estudo comparativo com diferentes números de pontes na neurorrafia término-lateral em ratos

Pós-graduação em Bases Gerais da Cirurgia - FMB

Efeito da estimulação do músculo tibial cranial após neurorrafia término-lateral do nervo fibular em ratos

Pós-graduação em Bases Gerais da Cirurgia - FMB

Neurorrafia término-lateral com neurotização muscular direta associada à neurorrafia término-terminal, visando à recuperação funcional do músculo alvo: estudo em ratos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Dupla inervação muscular com neurorrafia término-lateral: estudo em ratos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Análise do exercício físico e eletroestimulção do músculo tibial cranial após neurorrafia término-lateral do nervo fibular em ratos

Pós-graduação em Bases Gerais da Cirurgia - FMB

Ureteroileal Strictures After Urinary Diversion with an Ileal Segment—Is There a Place for Endourological Treatment at All?

Purpose We compared the long-term results of minimally invasive endourological intervention and open surgical revision in patients with a nonmalignant ureteroileal stricture. Materials and Methods We retrospectively evaluated the records of 74 patients (85 renal units) treated for unilateral or bilateral nonmalignant ureteroileal strictures. Overall, 96 endourological and 35 open surgical procedures were performed. Balloon dilatation and Acucise® or Ho:YAG laser endoureterotomy were used as minimally invasive endourological interventions. Open surgical revision with stricture resection and open ureteroileal end-to-side-reanastomosis was the alternate therapy. Treatment success was defined as radiological normalization or improvement of upper urinary tract morphology combined with absent flank pain, infection, ureteral stents or percutaneous nephrostomies. Results Median followup was 29 months (range 2 to 177). The overall success rate was 26% (25 of 96 cases) for endourological intervention vs 91% (32 of 35) for open surgical revision (p <0.001). Subgroup analysis showed a significant difference in the success rate of minimally invasive endourological interventions vs open surgical revision for strictures greater than 1 cm (3 of 52 cases or 6% vs 19 of 22 or 86%, p <0.001). The success rate of endourological and open surgical procedures for strictures 1 cm or less was 50% (22 of 44 cases) and 100% (13 of 13), respectively. After adjusting for multiple preoperative stricture characteristics, only stricture length was strongly and inversely associated with a successful outcome (p <0.001). Conclusions Open surgical revision produces better results than minimally invasive endourological intervention for ureteroileal strictures, particularly those greater than 1 cm. The success rate of endourological intervention is acceptable only for ureteroileal strictures 1 cm or less. Therefore, ureteroileal strictures greater than 1 cm should be primarily managed by open surgical revision.

Evaluation of the Hepa Wash® treatment in pigs with acute liver failure

BACKGROUND Mortality of patients with acute liver failure (ALF) is still unacceptably high. Available liver support systems are still of limited success at improving survival. A new type of albumin dialysis, the Hepa Wash® system, was newly introduced. We evaluated the new liver support system as well as the Molecular Adsorbent Recycling System (MARS) in an ischemic porcine model of ALF. METHODS In the first study animals were randomly allocated to control (n=5) and Hepa Wash (n=6) groups. In a further pilot study, two animals were treated with the MARS-system. All animals received the same medical and surgical procedures. An intraparenchymal intracranial pressure was inserted. Hemodynamic monitoring and goal-directed fluid therapy using the PiCCO system was done. Animals underwent functional end-to-side portacaval shunt and ligation of hepatic arteries. Treatment with albumin dialysis was started after fall of cerebral perfusion pressure to 45 mmHg and continued for 8 h. RESULTS All animals in the Hepa Wash group survived the 13-hour observation period, except for one that died after stopping treatment. Four of the control animals died within this period (p=0.03). Hepa Wash significantly reduced impairment of cerebral perfusion pressure (23±2 vs. 10±3 mmHg, p=0.006) and mean arterial pressure (37±1 vs. 24±2 mmHg, p=0.006) but had no effect on intracranial pressure (14±1 vs. 15±1 mmHg, p=0.72). Hepa Wash also enhanced cardiac index (4.94±0.32 vs. 3.36±0.25 l/min/m2, p=0.006) and renal function (urine production, 1850 ± 570 vs. 420 ± 180 ml, p=0.045) and eliminated water soluble (creatinine, 1.3±0.2 vs. 3.2±0.3 mg/dl, p=0.01; ammonia 562±124 vs. 1382±92 μg/dl, p=0.006) and protein-bound toxins (nitrate/nitrite 5.54±1.57 vs. 49.82±13.27 μmol/l, p=0.01). No adverse events that could be attributed to the Hepa Wash treatment were observed. CONCLUSIONS Hepa Wash was a safe procedure and improved multiorgan system failure in pigs with ALF. The survival benefit could be the result of ameliorating different organ functions in association with the detoxification capacity of water soluble and protein-bound toxins.

3-D acoustic analysis of elliptical chamber mufflers having an end-inlet and a side-outlet: An impedance matrix approach

The acoustical behavior of an elliptical chamber muffler having an end-inlet and side-outlet port is analyzed semi-analytically. A uniform piston source is assumed to model the 3-D acoustic field in the elliptical chamber cavity. Towards this end, we consider the modal expansion of acoustic pressure field in the elliptical cavity in terms of angular and radial Mathieu functions, subjected to rigid wall condition, whereupon under the assumption of a point source, Green's function is obtained. On integrating this function over piston area of the side or end port and dividing it by piston area, one obtains the acoustic field, whence one can find the impedance matrix parameters characterizing the 2-port system. The acoustic performance of these configurations is evaluated in terms of transmission loss (TL). The analytical results thus obtained are compared with 3-D HA carried on a commercial software for certain muffler configurations. These show excellent agreement, thereby validating the 3-D semi-analytical piston driven model. The influence of the chamber length as well as the angular and axial location of the end and side ports on TL performance is also discussed, thus providing useful guidelines to the muffler designer. (c) 2011 Elsevier B.V. All rights reserved.

Design and Testing of a Control System for Supply Side Electrical Load Management

India's energy demand is increasing rapidly with the intensive growth of economy. The electricity demand in India exceeded the availability, both in terms of base load energy and peak availability. The efficient use of energy source and its conversion and utilizations are the viable alternatives available to the utilities or industry. There are essentially two approaches to electrical energy management. First at the supply / utility end (Supply Side Management or SSM) and the other at the consumer end (Demand Side Management or DSM). This work is based on Supply Side Management (SSM) protocol and consists of design, fabrication and testing of a control device that will be able to automatically regulate the power flow to an individual consumer's premise. This control device can monitor the overuse of electricity (above the connected load or contracted demand) by the individual consumers. The present project work specially emphasizes on contract demand of every consumer and tries to reduce the use beyond the contract demand. This control unit design includes both software and hardware work and designed for 0.5 kW contract demand. The device is tested in laboratory and reveals its potential use in the field.

A New End-User Composition Model to Empower Knowledge Workers to Develop Rich Internet Applications

Enabling real end-user programming development is the next logical stage in the evolution of Internetwide service-based applications. Even so, the vision of end users programming their own web-based solutions has not yet materialized. This will continue to be so unless both industry and the research community rise to the ambitious challenge of devising an end-to-end compositional model for developing a new age of end-user web application development tools. This paper describes a new composition model designed to empower programming-illiterate end users to create and share their own off-the-shelf rich Internet applications in a fully visual fashion. This paper presents the main insights and outcomes of our research and development efforts as part of a number of successful European Union research projects. A framework implementing this model was developed as part of the European Seventh Framework Programme FAST Project and the Spanish EzWeb Project and allowed us to validate the rationale behind our approach.

End-User Development Success Factors and their Application to Composite Web Development Environments

The Future Internet is expected to be composed of a mesh of interoperable Web services accessed from all over the Web. This approach has not yet caught on since global user-service interaction is still an open issue. Successful composite applications rely on heavyweight service orchestration technologies that raise the bar far above end-user skills. The weakness lies in the abstraction of the underlying service front-end architecture rather than the infrastructure technologies themselves. In our opinion, the best approach is to offer end-to-end composition from user interface to service invocation, as well as an understandable abstraction of both building blocks and a visual composition technique. In this paper we formalize our vision with regard to the next-generation front-end Web technology that will enable integrated access to services, contents and things in the Future Internet. We present a novel reference architecture designed to empower non-technical end users to create and share their own self-service composite applications. A tool implementing this architecture has been developed as part of the European FP7 FAST Project and EzWeb Project, allowing us to validate the rationale behind our approach.

An evaluation of TCP over wired-to-wireless networks

To exploit the popularity of TCP as still the dominant sender and protocol of choice for transporting data reliably across the heterogeneous Internet, this thesis explores end-to-end performance issues and behaviours of TCP senders when transferring data to wireless end-users. The theme throughout is on end-users located specifically within 802.11 WLANs at the edges of the Internet, a largely untapped area of work. To exploit the interests of researchers wanting to study the performance of TCP accurately over heterogeneous conditions, this thesis proposes a flexible wired-to-wireless experimental testbed that better reflects conditions in the real-world. To exploit the transparent functionalities between TCP in the wired domain and the IEEE 802.11 WLAN protocols, this thesis proposes a more accurate methodology for gauging the transmission and error characteristics of real-world 802.11 WLANs. It also aims to correlate any findings with the functionality of fixed TCP senders. To exploit the popularity of Linux as a popular operating system for many of the Internet’s data servers, this thesis studies and evaluates various sender-side TCP congestion control implementations within the recent Linux v2.6. A selection of the implementations are put under systematic testing using real-world wired-to-wireless conditions in order to screen and present a viable candidate/s for further development and usage in the modern-day heterogeneous Internet. Overall, this thesis comprises a set of systematic evaluations of TCP senders over 802.11 WLANs, incorporating measurements in the form of simulations, emulations, and through the use of a real-world-like experimental testbed. The goal of the work is to ensure that all aspects concerned are comprehensively investigated in order to establish rules that can help to decide under which circumstances the deployment of TCP is optimal i.e. a set of paradigms for advancing the state-of-the-art in data transport across the Internet.

Planning and implementing trajectories for autonomous underwater vehicles to track evolving ocean processes based on predictions from a regional ocean model

Path planning and trajectory design for autonomous underwater vehicles (AUVs) is of great importance to the oceanographic research community because automated data collection is becoming more prevalent. Intelligent planning is required to maneuver a vehicle to high-valued locations to perform data collection. In this paper, we present algorithms that determine paths for AUVs to track evolving features of interest in the ocean by considering the output of predictive ocean models. While traversing the computed path, the vehicle provides near-real-time, in situ measurements back to the model, with the intent to increase the skill of future predictions in the local region. The results presented here extend prelim- inary developments of the path planning portion of an end-to-end autonomous prediction and tasking system for aquatic, mobile sensor networks. This extension is the incorporation of multiple vehicles to track the centroid and the boundary of the extent of a feature of interest. Similar algorithms to those presented here are under development to consider additional locations for multiple types of features. The primary focus here is on algorithm development utilizing model predictions to assist in solving the motion planning problem of steering an AUV to high-valued locations, with respect to the data desired. We discuss the design technique to generate the paths, present simulation results and provide experimental data from field deployments for tracking dynamic features by use of an AUV in the Southern California coastal ocean.