The surgical treatment of acute myocardial infarct in the 90s]

At present, the treatment for acute myocardial infarction is revascularization during the critical initial period of six hours after the beginning of coronary occlusion. Despite the fact that surgery performed within this time period presents a hospital of mortality around 2%, and with excellent results in the long term, it is seldom used due to logistic limitations and capabilities of hospital infrastructures, high costs and the possibility of the surgical team initiating surgery inside the useful time period. Surgery is thus limited to the patients with suitable anatomy, who are not candidates or had failure of thrombolytic/angioplasty therapy and are in the six-hour period after initiation of symptoms. Surgery performed at a later stage has good results if performed in a non emergency situation, specially after the first 72 hours. Surgery continues to be the only treatment for the mechanical complications of infarction, and good results have recently been shown in ventricular septal ruptures, with hospital mortality of 14%, due to the use of an endoventricular patch in patients operated early, before the consequences of low cardiac output develop at systemic level. In the surgical treatment of mitral regurgitation, the tendency has been to use repair techniques whenever possible, but still with hospital mortality up to 15%. The recent advances of the techniques and tactics of myocardial preservation during surgery have made a very significant contribution to the better results we see today.     

Inter-observer agreement in analysis of basal body temperature graphs from infertile women

In this study, we evaluated the reproducibility of analysis of basal body temperature graphs under optimized conditions for agreement. A total of 160 recordings were selected from spontaneous cycles of infertile women and analysed by three experienced clinicians using uniform criteria. Agreement at the various stages of analysis was assessed by the 'proportions of agreement' with 95% confidence intervals. Agreement in identification of the thermal nadir was clearly superior to that reported in previous publications. Reproducibility of 'ovulatory' graph features (i.e. biphasic graphs and adequate thermal shifts) was excellent. Agreement in classification of monophasic graphs and inadequate thermal shifts, although lower, was still good. Thus, with experienced observers and uniform criteria, a good agreement can be achieved in analysis of the most important parameters of the basal body temperature graph. We believe that an effort should be made to generalize the use of uniform analysis criteria, because only then can results from different institutions be compared and the remaining clinical evaluation of the method be performed.     

Gain‐scheduled dynamic output feedback control for discrete‐time LPV systems

This paper presents synthesis conditions for the design of gain‐scheduled dynamic output feedback controllers for discrete‐time linear parameter‐varying systems. The state‐space matrix representation of the plant and of the controller can have a homogeneous polynomial dependency of arbitrary degree on the scheduling parameter. As an immediate extension, conditions for the synthesis of a multiobjective ??_∞ and ??₂ gain‐scheduled dynamic feedback controller are also provided. The scheduling parameters vary inside a polytope and are assumed to be a priori unknown, but measured in real‐time. If bounds on the rate of parameter variation are known, they can be taken into account, providing less conservative results. The geometric properties of the uncertainty domain are exploited to derive finite sets of linear matrix inequalities based on the existence of a homogeneous polynomially parameter‐dependent Lyapunov function. An application of the control design to a realistic engineering problem illustrates the benefits of the proposed approach. Copyright © 2011 John Wiley & Sons, Ltd.     

Analysis of weakly guiding cladded acoustic fibers of hexagonal crystal symmetry

An approximate analysis of the weakly guiding cladded acoustic fiber consisting of a core and infinite thick cladding both with hexagonal crystal symmetry is presented. The crystalline Z axis is parallel to the fiber axis. Weak guidance conditions require that the stiffness constants of the core are slightly less than those of the cladding, and the density of the core and cladding are almost the same. Approximate dispersion and cutoff equations are derived for all pure guided modes. Dispersion curves of several lower-order guided torsional, radial-axial and flexural modes are evaluated using both exact and approximate formulas and they are in good agreement. A simple approximate dispersion equation for leaky (longitudinal-type) modes is also obtained.     

Visceral Adipose Tissue Displays Unique Metabolomic Fingerprints in Obesity,Pre-Diabetes and Type 2 Diabetes

Visceral adipose tissue (VAT) metabolic profiling harbors the potential to disentangle molecular changes underlying obesity-related dysglycemia. In this study, the VAT exometabolome of subjects with obesity and different glycemic statuses are analyzed. The subjects (n = 19) are divided into groups according to body mass index and glycemic status: subjects with obesity and euglycemia (Ob+NGT, n = 5), subjects with obesity and pre-diabetes (Ob+Pre-T2D, n = 5), subjects with obesity and type 2 diabetes under metformin treatment (Ob+T2D, n = 5) and subjects without obesity and with euglycemia (Non-Ob, n = 4), used as controls. VATs are incubated in culture media and extracellular metabolite content is determined by proton nuclear magnetic resonance (¹H-NMR). Glucose consumption is not different between the groups. Pyruvate and pyroglutamate consumption are significantly lower in all groups of subjects with obesity compared to Non-Ob, and significantly lower in Ob+Pre-T2D as compared to Ob+NGT. In contrast, isoleucine consumption is significantly higher in all groups of subjects with obesity, particularly in Ob+Pre-T2D, compared to Non-Ob. Acetate production is also significantly lower in Ob+Pre-T2D compared to Non-Ob. In sum, the VAT metabolic fingerprint is associated with pre-diabetes and characterized by higher isoleucine consumption, accompanied by lower acetate production and pyruvate and pyroglutamate consumption. We propose that glucose metabolism follows different fates within the VAT, depending on the individuals’ health status.     

Hepatic damage produced by long-term alcohol consumption in well-nourished rats

A study of the effect of long-term alcohol consumption on the liver of well-nourished rats is described. Rats fed for 16 weeks on a semipurified diet supplemented with high levels of vitamins and lipotropic factors and alcohol corresponding to 35% of the total caloric intake developed marked fatty changes of the liver. Mild fatty changes were observed in pair-fed controls receiving as isoenergetic equivalent of sucrose instead of alcohol. Intracellular hyaline bodies, corresponding ultrastructurally to giant mitochondria were abundantly found in the hepatocytes of alcoholic rats, while in the controls they were not seen. Te findings in this investigation are postulated to provide further evidence that the long-term intake of alcohol exerts a direct causative role in the pathogenesis of liver damage.     

Engineering plastics from lignin. XVI. Starlike macromers with propylene oxide

Starlike macromers were prepared from hydroxypropyl organosolv lignin by reaction with propylene oxide, and they were analyzed by a combination of conventional analysis techniques. The average number of arms per macromer was controlled by partial capping with an alkoxy group; and the average length of arms by the degree of chain extension with propylene oxide. Analysis methods included treatment with hydriodic acid followed by gas chromatographic separation of alkyl iodides (HI/GC), UV spectroscopy, H-NMR spectroscopy, and thermal analysis. The results were consistent with a hypothetical pentameric model structure having between two and six radiating arms, each with a length of between 1 and 4 propylene oxide units. The UV method was best qualified to determine degree of chain extension, while HI/GC was best suited for analyzing average number of arms per macromer fragment. The synthesis and analysis of starlike macromers from lignin is viewed as an important stepping stone for the formulation of lignin-based engineering plastics and multiphase materials.     

Comparative analysis of methods for determining the metabolic rate in order to provide a balance between man and the environment

The incorrect determination of metabolic rate can be linked to discrepancies between the model of the PMV (Predicted Mean Vote) and real thermal sensation collected in field studies. Aiming to improve the correlation of the PMV model and the real thermal sensation, this work established new values for the metabolic rate: one way being called “calculated” using Newton's Method and the other called "measured" using a metabolic analyzer. Welder's activities were evaluated, through the measurements of environmental and personal variables. New values of metabolic rate were determined for this activity. The values found for the calculated form and the measured one were, respectively, 178.63 and 145.46 W/m², different from the range provided by the table of ISO 8996 (2004) for this activity (75–125 W/m²). In order to verify which of the values of the metabolic rate was closer to the real thermal sensation of PMV, a linear regression was made between the PMV and the real thermal sensation in three ways: S × PMV_tabulated (R² = 0.1749), S × PMV_calculated (R ² = 0.7481) and S × PMV_measured (R² = 0.7854). It was found that the values measured by the instrument gave a higher coefficient of determination which was chosen for the correction of the table. The correction of the table provides a value of M_predicted, that is a value of metabolic rate that corrects the values provided by the tables of ISO 8996 (2004), by means of a correction coefficient. For the welder's activities in a metal-mechanics industry, tabulated values can be multiplied by the correction coefficient 1.4648 in order to minimize inaccuracies. The PMV_predicted, obtained through the M_predicted, when related to the actual thermal sensation, provides a coefficient of determination of 0.7511, thereby improving the model of the PMV.     

Development and implementation of clinical guidelines: An artificial intelligence perspective

Clinical practice guidelines in paper format are still the preferred form of delivery of medical knowledge and recommendations to healthcare professionals. Their current support and development process have well identified limitations to which the healthcare community has been continuously searching solutions. Artificial intelligence may create the conditions and provide the tools to address many, if not all, of these limitations.. This paper presents a comprehensive and up to date review of computer-interpretable guideline approaches, namely Arden Syntax, GLIF, PROforma, Asbru, GLARE and SAGE. It also provides an assessment of how well these approaches respond to the challenges posed by paper-based guidelines and addresses topics of Artificial intelligence that could provide a solution to the shortcomings of clinical guidelines. Among the topics addressed by this paper are expert systems, case-based reasoning, medical ontologies and reasoning under uncertainty, with a special focus on methodologies for assessing quality of information when managing incomplete information. Finally, an analysis is made of the fundamental requirements of a guideline model and the importance that standard terminologies and models for clinical data have in the semantic and syntactic interoperability between a guideline execution engine and the software tools used in clinical settings. It is also proposed a line of research that includes the development of an ontology for clinical practice guidelines and a decision model for a guideline-based expert system that manages non-compliance with clinical guidelines and uncertainty.     

The effect of cooling rate on the impact performance and dynamic mechanical properties of rotationally molded metallocene catalyzed linear low density polyethylene

This article examines changes to the morphology of rotationally molded metallocene catalyzed linear low density polyethylene brought about by varying the cooling rate during processing. These changes in morphology lead to variations in the impact performance, which is reflected in the dynamic mechanical characteristics of the materials. Various analytical techniques are used in an attempt to explain the differences in impact behavior. Slow cooling is shown to result in high crystallinity, and in the formation of large spherulites, which in turn is detrimental to the impact performance of the material, particularly at low temperatures. The high crystallinity corresponds with a shift in the β transition of the material to a higher temperature, and is shown to result in a higher brittle–ductile transition. A case study was also carried out on samples from a finished part provided by an industrial molder, one section of which failed in a brittle manner when impact tested while the other failed in a ductile manner. Microscopy results showed that the brittle material had large spherulites at the inside surface, while the ductile material showed incipient degradation at this surface, which has previously been shown to be of benefit to impact strength in rotationally molded parts. Dynamic mechanical studies again showed a β transition at a higher temperature in the brittle samples. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 101: 1963–1971, 2006