Update on the Diagnostic Pitfalls of Autopsy and Post-Mortem Genetic Testing in Cardiomyopathies

Inherited cardiomyopathies are frequent causes of sudden cardiac death (SCD), especially in young patients. Despite at the autopsy they usually have distinctive microscopic and/or macroscopic diagnostic features, their phenotypes may be mild or ambiguous, possibly leading to misdiagnoses or missed diagnoses. In this review, the main differential diagnoses of hypertrophic cardiomyopathy (e.g., athlete’s heart, idiopathic left ventricular hypertrophy), arrhythmogenic cardiomyopathy (e.g., adipositas cordis, myocarditis) and dilated cardiomyopathy (e.g., acquired forms of dilated cardiomyopathy, left ventricular noncompaction) are discussed. Moreover, the diagnostic issues in SCD victims affected by phenotype-negative hypertrophic cardiomyopathy and the relationship between myocardial bridging and hypertrophic cardiomyopathy are analyzed. Finally, the applications/limits of virtopsy and post-mortem genetic testing in this field are discussed, with particular attention to the issues related to the assessment of the significance of the genetic variants.     

The usefulness of the timeliness of endoscopic sphincterotomy in severe acute pancreatitis of biliary origin

There are evidence indicating that endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP+S) reduces the rate of complications in patients with severe acute biliary pancreatitis (ABP). The aim of this study was to analyze our experience in the treatment of severe ABP with ERCP+S and compare the evolution of the patients treated early (3 days or less following admission) with those treated late (after the 3rd day). A retrospective review of the clinical histories of the 16 patients with severe ABP treated with ERCP+S over the last two years is presented, analyzing their clinical features on admission and evolution. Biliary stones or biliary sludge was observed in 11 cases (69%). Nine patients had undergone early, and 7 late, ERCP+S. The patients of the latter group presented a greater number of complications during evolution than the former group (43% vs 0%; p = 0.025). The mortality of the patients of the late ERCP+S was also greater although without statistical significance (28.6% vs 0%; p = 0.15). No complication secondary to ERCP+S was detected. These findings confirm the fact that ERCP+S performed early in severe ABP significantly reduces the number of complications and is associated with a lower mortality.     

Mining data from intensive care patients

In this paper we describe the application of data mining methods for predicting the evolution of patients in an intensive care unit. We discuss the importance of such methods for health care and other application domains of engineering. We argue that this problem is an important but challenging one for the current state of the art data mining methods and explain what improvements on current methods would be useful. We present a promising study on a preliminary data set that demonstrates some of the possibilities in this area.     

On bisymmetric operators on a finite chain

The bisymmetry property is studied for operators defined on a finite chain. In particular, a characterization of all bisymmetric, commutative and smooth binary operators is given. It is deduced from this characterization that bisymmetry and associativity are equivalent for finite chains, under these additional conditions.     

Content of carbohydrates and trace elements in a group of non-alcoholic drinks

BACKGROUND: In order to elaborate recommendations for the dietetic care of diabetic patients and other clinical disorders we have measured the concentration of carbohydrates and trace elements in a group of non alcoholic refreshments of current use in Spain. MATERIAL AND METHODS: Thirty refreshments were classified into 10 groups. Glucose and phosphate were measured by hexokinase and reduction of phospho-molybdate methods respectively in an autoanalyzer Dax-72. Glucose and fructose were analyzed by cellulose thin-layer chromatography; glucose, fructose and sucrose by gas chromatographys. Sodium and potassium by emission spectrophotometry and calcium, magnesium, iron, copper and zinc by atomic absorption spectrophotometry. RESULTS: Light refreshments and soft drinks have no carbohydrates. Isotonic beverages, fruit juices, cool tea and non alcoholic beers had less than 10 g/dl. Tonic waters, Fanta, different coles, non alcoholic bitter and others had more than 10 g/dl. Sodium levels between 15-20 mEq/l were found in the isotonic beverages and 7-Up and levels of 7 mEq/l in the others. Potassium values between 15-40 mEq/l were found in the fruit juices, 3-4 mEq/l in Gatorade and less than 1 mEq/l in the others. CONCLUSIONS: Light refreshments and soft drinks contain low concentrations of carbohydrates and sodium. Fruit juices have high potassium concentration. Such information can be especially useful for dietetic care of diabetic patients.     

Robustness of VS-MRAC with respect to unmodelled dynamics and external disturbances

A variable structure model reference adaptive controller (VS-MRAC) using only input and output measurements was recently proposed and shown to be globally asymptotically stable with superior transient behaviour and disturbance rejection properties. In this paper a singular perturbation approach is used in order to establish the robustness of the controller in the presence of unmodelled dynamics (parasitics) and disturbances. We develop a new Lyapunov-based technique to analyse the overall system and show that for sufficiently small parasitics the system remains stable and the output error is small in some sense.     

A computational study of LP-based heuristic algorithms for two-dimensional guillotine cutting stock problems

In this paper we develop and compare several heuristic methods for solving the general two-dimensional cutting stock problem. We follow the Gilmore-Gomory column generation scheme in which at each iteration a new cutting pattern is obtained as the solution of a subproblem on one stock sheet. For solving this subproblem, in addition to classical dynamic programming, we have developed three heuristic procedures of increasing complexity, based on GRASP and Tabu Search techniques, producing solutions differing in quality and in time requirements. In order to obtain integer solutions from the fractional solutions of the Gilmore-Gomory process, we compare three rounding procedures, rounding up, truncated branch and bound and the solution of a residual problem. We have coded and tested all the combinations of algorithms and rounding procedures. The computational results obtained on a set of randomly generated test problems show their relative efficiency and allow the potential user to choose from among them, according to the available computing time. Rceived: January 9, 2001 / Accepted: December 10, 2001     

An iterative penalty method for the finite element solution of the stationary Navier-Stokes equations

The objective of this paper is to analyse an iterative procedure for the finite element solution of the Stokes and Navier-Stokes stationary problems. For the latter case, the usual condition on the viscosity and the data that ensures uniqueness is assumed. The method is based on the iterative imposition of the incompressibility condition via penalization. Theoretical and numerical results show that this constraint can be approximated iteratively within the same iterative loop used to deal with the nonlinear term of the equations. Two particular iterative schemes are analysed, namely those based on the Picard and Newton-Raphson algorithms.