Piperacillin/tazobactam‐induced neurotoxicity in a hemodialysis patient: A case report

Antibiotics are potentially a cause of neurotoxicity in dialysis patients, the most common are the beta‐lactams as ceftazidime and cefepime, and few cases have been reported after piperacillin/tazobactam use. This report presents a case of a hypertensive and diabetic 67‐year‐old woman in regular hemodialysis, which previously had a stroke. She was hospitalized presenting pneumonia, which was initially treated with cefepime. Two days after treatment, she presented dysarthria, left hemiparesis, ataxia, and IX and X cranial nerves paresis. Computed tomography showed no acute lesions and cefepime neurotoxicity was hypothesized, and the antibiotic was replaced by piperacillin/tazobactam. The neurologic signs disappeared; however, 4 days after with piperacillin/tazobactam treatment, the neurological manifestations returned. A new computed tomography showed no new lesions, and the second antibiotic regimen withdrawn. After two hemodialysis sessions, the patient completely recovered from neurological manifestations. The patient presented sequentially neurotoxicity caused by two beta‐lactams antibiotics. This report meant to alert clinicians that these antibiotics have dangerous neurological effects in chronic kidney disease patients.     

In vivo formation of 8-Epi-prostaglandin F2 alpha is increased in hypercholesterolemia

F2-isoprostanes are bioactive prostaglandin (PG)-like compounds that are produced from arachidonic acid through a nonenzymatic process of lipid peroxidation catalyzed by oxygen free-radicals. 8-Epi-PGF2 alpha may amplify the platelet response to agonists, circulates in plasma, and is excreted in urine. We examined the hypothesis that the formation of 8-epi-PGF2 alpha is altered in patients with hypercholesterolemia and contributes to platelet activation in this setting. Urine samples were obtained from 40 hypercholesterolemic patients and 40 age- and sex-matched control subjects for measurement of immunoreactive 8-epi-PGF2 alpha. Urinary excretion of 11-dehydro-thromboxane (TX) B2, a major metabolite of TXA2, was measured as an in vivo index of platelet activation. Low-dose aspirin, indobufen, and vitamin E were used to investigate the mechanism of formation and effects of 8-epi-PGF2 alpha on platelet activation. Urinary 8-epi-PGF2 alpha was significantly (P = .0001) higher in hypercholesterolemic patients than in control subjects: 473 +/- 305 versus 205 +/- 95 pg/mg creatinine. Its rate of excretion was inversely related to the vitamin E content of LDL and showed a positive correlation with urinary 11-dehydro-TXB2. Urinary 8-epi-PGF2 alpha was unchanged after 2-week dosing with aspirin and indobufen despite complete suppression of TX metabolite excretion. Vitamin E supplementation was associated with dose-dependent reductions in both urinary 8-epi-PGF2 alpha and 11-dehydro-TXB2 by 34% to 36% and 47% to 58% at 100 and 600 mg daily, respectively. We conclude that the in vivo formation of the F2-isoprostane 8-epi-PGF2 alpha is enhanced in the vast majority of patients with hypercholesterolemia. This provides an aspirin-insensitive mechanism possibly linking lipid peroxidation to amplification of platelet activation in the setting of hypercholesterolemia. Dose-dependent suppression of enhanced 8-epi-PGF2 alpha formation by vitamin E supplementation may contribute to the beneficial effects of antioxidant treatment.     

The influence of magnetron sputtered silver and titanium coatings on the compaction and properties of surface modified PM Ti-48Al powders

Thin layers of silver and titanium were deposited onto commercial Ti–₄₈Al particles by magnetron sputtering prior to their consolidation by hot isostatic pressing and subsequent heat treatment. Based on picnometry and electron probe microanalysis results, average values of 1.5 and 2.5 at.%, respectively, were obtained for the silver and titanium contents in the coated particles. The surface modified Ti–₄₈Al particles exhibited improved sintering ability than the unmodified ones. The consolidated samples have duplex microstructures formed by γ-TiAl and γ-TiAl + α₂-Ti₃Al grains. Ag-rich nanoprecipitates were detected in the microstructure of the compacted Ti-₄₈Al + Ag sample. The coatings are no longer visible at the grains boundaries after a subsequent homogenization heat treatment at 1200°C. The highest values of hardness and Young’s modulus were obtained for the Ti–₄₈Al + Ag sample, associated with a higher density and a lower percentage of pores.     

Evaluation of the thermal and mechanical properties of poly(ε‐caprolactone), low‐density polyethylene,and their blends

The thermal and mechanical properties of low‐density polyethylene (LDPE), poly(ε‐caprolactone) (PCL), and their blends were evaluated. Differential scanning calorimetry showed that increasing the PCL content of the blend did not change the LDPE melting temperature, but reduced the crystallinity by up to 16.8%. This behavior was related to interactions between the PCL chains and the crystalline phase of LDPE. Tensile strength and elongation at break values for the blends were lower than those for the pure polymers, which suggested an incompatibility between the polymers. The values for Young's modulus under tensile increased when PCL was added to LDPE. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 91:3909–3914, 2004     

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.     

Enhancing thermal and dynamic-mechanical properties of epoxy reinforced by amino-functionalized microcrystalline cellulose

In this study, microcrystalline cellulose (MCC) was chemically modified with 3-(aminopropyl)triethoxysilane and added to epoxy to improve chemical, thermal and dynamic-mechanical characteristics of the composites. The composites were manufactured aided by sonication with 1.0%, 2.5%, or 5.0% wt/wt of untreated MCC or amino-functionalized MCC (MCC-Si). The epoxy/MCC-Si composites showed a decrease in the ─OH band by Fourier-transform infrared spectroscopy, and X-ray diffraction analysis indicated better dispersion. The incorporation of MCC-Si in epoxy resin decreased the heat of reaction, increased activation energy values (E_a) and pre-exponential factor (A), and did not affect thermal degradation. All conversion degree (α) versus temperature curves for the composites showed a sigmoidal shape. MCC-Si composites showed better dynamic-mechanical properties than the MCC counterparts, and the functionalization effect was evidenced in storage modulus (E') and loss modulus (E"). At 2.5% wt/wt of MCC-Si content an increase of 119% in E' at the glassy region, 127% in E' at the rubbery region and 173% in E" was observed compared to the neat resin, whereas the T_g barely changed among samples. Good adhesion between the amino-functionalized MCC and the epoxy matrix was observed at the fracture surface, evidencing that surface modification of MCC improves their chemical interaction.     

Interactive smart battery storage for a PV and wind hybrid energy management control based on conservative power theory

This paper presents interactive smart battery-based storage (BBS) for wind generator (WG) and photovoltaic (PV) systems. The BBS is composed of an asymmetric cascaded H-bridge multilevel inverter (ACMI) with staircase modulation. The structure is parallel to the WG and PV systems, allowing the ACMI to have a reduction in power losses compared to the usual solution for storage connected at the DC-link of the converter for WG or PV systems. Moreover, the BBS is embedded with a decision algorithm running real-time energy costs, plus a battery state-of-charge manager and power quality capabilities, making the described system in this paper very interactive, smart and multifunctional. The paper describes how BBS interacts with the WG and PV and how its performance is improved. Experimental results are presented showing the efficacy of this BBS for renewable energy applications.     

Hand gesture recognition from depth and infrared Kinect data for CAVE applications interaction

This paper presents a real-time framework that combines depth data and infrared laser speckle pattern (ILSP) images, captured from a Kinect device, for static hand gesture recognition to interact with CAVE applications. At the startup of the system, background removal and hand position detection are performed using only the depth map. After that, tracking is started using the hand positions of the previous frames in order to seek for the hand centroid of the current one. The obtained point is used as a seed for a region growing algorithm to perform hand segmentation in the depth map. The result is a mask that will be used for hand segmentation in the ILSP frame sequence. Next, we apply motion restrictions for gesture spotting in order to mark each image as a ‘Gesture’ or ‘Non-Gesture’. The ILSP counterparts of the frames labeled as “Gesture” are enhanced by using mask subtraction, contrast stretching, median filter, and histogram equalization. The result is used as the input for the feature extraction using a scale invariant feature transform algorithm (SIFT), bag-of-visual-words construction and classification through a multi-class support vector machine (SVM) classifier. Finally, we build a grammar based on the hand gesture classes to convert the classification results in control commands for the CAVE application. The performed tests and comparisons show that the implemented plugin is an efficient solution. We achieve state-of-the-art recognition accuracy as well as efficient object manipulation in a virtual scene visualized in the CAVE.     

A Bayesian solution to the multiple composite hypothesis testing for fault diagnosis in dynamic systems

This paper is concerned with model-based isolation and estimation of additive faults in discrete-time linear Gaussian systems. The isolation problem is stated as a multiple composite hypothesis testing on the innovation sequence of the Kalman filter (KF) that considers the system operating under fault-free conditions. Fault estimation is carried out, after isolating a fault mode, by using the Maximum a Posteriori (MAP) criterion. An explicit solution is presented for both fault isolation and estimation when the parameters of the fault modes are assumed to be realizations of specific random variables (RV).     

Randomization can be a healer: consensus with dynamic omission failures

Wireless ad-hoc networks are being increasingly used in diverse contexts, ranging from casual meetings to disaster recovery operations. A promising approach is to model these networks as distributed systems prone to dynamic communication failures. This captures transitory disconnections in communication due to phenomena like interference and collisions, and permits an efficient use of the wireless broadcasting medium. This model, however, is bound by the impossibility result of Santoro and Widmayer, which states that, even with strong synchrony assumptions, there is no deterministic solution to any non-trivial form of agreement if n ? 1 or more messages can be lost per communication round in a system with n processes. In this paper we propose a novel way to circumvent this impossibility result by employing randomization. We present a consensus protocol that ensures safety in the presence of an unrestricted number of omission faults, and guarantees progress in rounds where such faults are bounded by ${f \,{\leq}\,\lceil \frac{n}{2} \rceil (n\,{-}\,k)\,{+}\,k\,{-}\,2}$ , where k is the number of processes required to decide, eventually assuring termination with probability 1.