bluuebunny/crossref_metadata_2025 huggingface dataset:
Inspection of Adiabatic Shear Bands in High Manganese TRIP Steels
Authors: Wang Hui Zhen , Sun Xiu Rong , Yang Ping , Mao Wei Min
Published: March 2013

Adiabatic shear bands (ASBs) develop generally during high strain rates. This paper investigates the transformation induced plasticity (TRIP) effect during ASBs formation at high strain rates in high manganese TRIP steels containing initial austenite and ferrite by EBSD technique. Results show that TRIP effect takes place mainly before the formation of ASBs. After ASBs formation, TRIP effect is strongly restricted by the size effect, the increase of stacking fault energy (SFE) and even inverse martensitic transformation due to the rise of temperature. The TRIP effect before ASBs formation contributes to the resistance of adiabatic shear failure. Dynamic recrystallization driven by subgrains rotation occurs within ASBs, and ultrafine grains often show strong shear textures with twin relationship owing to slip mechanism.
Effect of Substructure Characteristics on the Dislocation Annihilation Process during Post-Deformation Annealing
Authors: Beladi Hossein , Cizek Pavel , Taylor Adam S. , Hodgson Peter
Published: March 2013

Two distinct substructures were produced in a Ni-30Fe austenitic model alloy by different thermomechanical processing routes. The first substructure largely displayed organized, banded subgrain arrangements with alternating misorientations, resulting from the deformation at a strain just before the initiation of dynamic recrystallization (DRX). By contrast, the second substructure was more random in character and exhibited complex subgrain/cell arrangements characterized by local accumulation of misorientations, formed through DRX. During the post-deformation annealing, the latter substructure revealed a rapid disintegration of dislocation boundaries leading to the formation of dislocation-free grains within a short holding time, though the former largely preserved its characteristics till becoming replaced by growing statically recrystallized grains.
The Relationship between Grain Boundary Energy, Grain Boundary Complexion Transitions, and Grain Size in Ca-Doped Yttria
Authors: Bojarski Stephanie A. , Knighting Jocelyn , Ma Shuai Lei , Lenthe William , Harmer Martin P. , Rohrer Gregory S.
Published: March 2013

The thermal groove technique has been used to measure relative grain boundary energies in two 100 ppm Ca-doped yttria samples. The first has a normal grain size distribution and the boundaries have a bilayer of segregated Ca. In the second sample, there is a combination of large grains and small grains. The boundaries around the large grains are known to have an intergranular film. The results show that the relative energies of boundaries in the sample with normal grain growth and the boundaries around small grains far from larger grains in the second sample are similar. Also, boundaries surrounding the largest grains and small grains immediately adjacent to them have the same and significantly lower energies. The results indicate that grain boundaries with an intergranular film have a lower energy than those with bilayer segregation and that the intergranular film extends beyond the periphery of the largest grains, but not throughout the entire sample.
NADPH Oxidase Limits Lipopolysaccharide-Induced Lung Inflammation and Injury in Mice through Reduction-Oxidation Regulation of NF-κB Activity
Authors: Han Wei , Li Hui , Cai Jiyang , Gleaves Linda A. , Polosukhin Vasiliy V. , Segal Brahm H. , Yull Fiona E. , Blackwell Timothy S.
Published: March 2013

Although reactive oxygen species (ROS) produced by NADPH oxidase are known to regulate inflammatory responses, the impact of ROS on intracellular signaling pathways is incompletely understood. In these studies, we treated wild-type (WT) and p47phox-deficient mice with LPS to investigate mechanisms by which NADPH oxidase regulates signaling through the NF-κB pathway. After intratracheal instillation of LPS, ROS generation was impaired in p47phox−/− mice, whereas these mice had increased neutrophilic alveolitis and greater lung injury compared with WT controls. In mice interbred with transgenic NF-κB reporters (HIV-long terminal repeat/luciferase [HLL]), we found exaggerated LPS-induced NF-κB activation and increased expression of proinflammatory cytokines in lungs of p47phox−/−/HLL mice compared with controls. Both lung macrophages and bone marrow–derived macrophages (BMDMs) isolated from p47phox−/−/HLL mice showed enhanced LPS-stimulated NF-κB activity compared with controls. Although nuclear translocation of NF-κB proteins was similar between genotypes, EMSAs under nonreducing conditions showed increased DNA binding in p47phox−/−/HLL BMDMs, suggesting that ROS production reduces NF-κB binding to DNA without affecting nuclear translocation. Increased intracellular reduced glutathione/glutathione disulfide ratio and greater nuclear redox factor 1 (Ref-1) levels were present in p47phox−/−/HLL compared with WT BMDMs, pointing to NADPH oxidase modulating intracellular redox status in macrophages. Treatment with the Ref-1–specific inhibitor E3330 or hydrogen peroxide inhibited LPS-induced NF-κB activation in p47phox−/−/HLL BMDMs but not in WT/HLL cells. Consistent with these findings, small interfering RNA against Ref-1 selectively reduced NF-κB activity in LPS-treated p47phox−/−/HLL BMDMs. Together, these results indicate that NADPH oxidase limits LPS-induced NF-κB transcriptional activity through regulation of intracellular redox state.
CRTAM Receptor Engagement by Necl-2 on Tumor Cells Triggers Cell Death of Activated Vγ9Vδ2 T Cells
Authors: Dessarthe Benoît , Thedrez Aurélie , Latouche Jean-Baptiste , Cabillic Florian , Drouet Aurélie , Daniel Pascale , de La Pintière Cécile Thomas , Catros Véronique , Toutirais Olivier
Published: March 2013

Human Vγ9Vδ2 T cells exert potent in vitro and in vivo antitumor activities, making them promising candidates for immunotherapy strategies. Recognition of tumor cells by Vγ9Vδ2 T cells requires engagement of the TCR and/or NK receptors. Recently, one of the novel NK receptors, the class I–restricted T cell–associated molecule (CRTAM), has been described to promote cytotoxic function of NK cells and to lead to IFN-γ secretion by CD8+ T cells through interaction with its ligand, Necl-2. A better understanding of the role of CRTAM in Vγ9Vδ2 T cell functions is highly relevant to optimize innate-like T cell–based cancer immunotherapy. In this article, we report that CRTAM is transiently expressed on activated Vγ9Vδ2 T lymphocytes following TCR engagement. However, CRTAM–Necl-2 interaction does not modify the cytotoxic function or IFN-γ secretion of Vγ9Vδ2 T cells. The expression of CRTAM in activated Vγ9Vδ2 T cells is quickly downregulated following interaction with Necl-2 on tumor cells. Of interest, CRTAM is concurrently acquired at the cell surface of Necl-2+ tumor cells through Vγ9Vδ2 T cell membrane capture. Finally, we highlight that coculture experiments with tumor cells expressing Necl-2 result in significant cell death of CRTAM+ Vγ9Vδ2 T cells. CRTAM-mediated cell death is dependent on an autophagic process, but not on apoptosis or necroptosis, as attested by the expression of characteristic markers and blocking experiments with specific inhibitors. On the basis of these findings, we propose that Necl-2 on tumor cells represents a new tumor counterattack mechanism and a potential target to improve efficiency of γδ T cell–based immunotherapy.
Kenōsis in sexuality
Authors: Williams David T.
Published: March 2013

Recent decades have witnessed both a shift in sexual standards, and the loss of the Biblical authority which has traditionally motivated them. This has been the case even with Christians. It is therefore necessary to suggest a new motive for morality, especially in this area. A possibility is the idea of the imitation of Christ, adopting the principles on which he acted, which can be summed up as kenōsis, or self-limitation. Jesus was fundamentally limited through being incarnate; human beings are likewise limited, also with regard to their sexuality. Jesus adopted the practice of self-limitation, seen in his humility; Christians, in imitation of him, likewise should practise self-limitation. Indeed, the manifestation and practice of sexuality is fundamentally limited in any case by its very nature. If the principle of kenōsis is applied in the areas of marriage and divorce, and in related issues such as homosexuality or chastity, it serves to underpin what is a traditional set of practices in a way consistent with a Christian world-view.
A Comprehensive Profile of ChIP-Seq-Based STAT1 Target Genes Suggests the Complexity of STAT1-Mediated Gene Regulatory Mechanisms
Authors: Satoh Jun-ichi , Tabunoki Hiroko
Published: March 2013

Interferon-gamma (IFNγ) plays a key role in macrophage activation, T helper and regulatory cell differentiation, defense against intracellular pathogens, tissue remodeling, and tumor surveillance. The diverse biological functions of IFNγ are mediated by direct activation of signal transducer and activator of transcription 1 (STAT1) as well as numerous downstream effector genes. Because a perturbation in STAT1 target gene networks is closely associated with development of autoimmune diseases and cancers, it is important to characterize the global picture of these networks. Chromatin immunoprecipitation followed by deep sequencing (ChIP-Seq) provides a highly efficient method for genome-wide profiling of DNA-binding proteins. We analyzed the STAT1 ChIP-Seq dataset of IFNγ-stimulated HeLa S3 cells derived from the ENCODE project, along with transcriptome analysis on microarray. We identified 1,441 stringent ChIP-Seq peaks of protein-coding genes. They were located in the promoter (21.5%) and more often in intronic regions (72.2%) with an existence of IFNγ-activated site (GAS) elements. Among the 1,441 STAT1 target genes, 212 genes are known IFN-regulated genes (RGs) and 194 genes (13.5%) are actually upregulated in response to IFNγ by transcriptome analysis. The panel of upregulated genes constituted IFN-signaling molecular networks pivotal for host defense against infections, where interferon-regulatory factor (IRF) and STAT transcription factors serve as a hub on which biologically important molecular connections concentrate. The genes with the peak location in intronic regions showed significantly lower expression levels in response to IFNγ. These results indicate that the binding of STAT1 to GAS is not sufficient to fully activate target genes, suggesting the high complexity of STAT1-mediated gene regulatory mechanisms.
Trials of Improved Practices (TIPs): A Strategy for Making Long-Lasting Nets Last Longer?
Authors: Harvey Steven A. , Paredes Olórtegui Maribel , Leontsini Elli , Ramal Asayag César , Scott Kerry , Winch Peter J.
Published: March 2013

Long-lasting insecticidal net (LLIN) use is a proven malaria prevention method. Mass distribution has greatly expanded LLIN access in sub-Saharan Africa, but a gap remains between LLIN ownership and use. Furthermore, LLINs wear out more quickly than anticipated. This paper suggests a participatory research strategy—trials of improved practices (TIPs)—that could identify locally appropriate approaches to prolonging net life and increasing effective use. We used TIPs to overcome barriers to optimal net use in the Peruvian Amazon. Working with 15 families in three villages, we tested home treatment of cotton nets, use of an alternative netting fabric, and alternative washing and care instructions. TIPs helped confirm feasibility of these interventions. Although our findings are time- and context-specific, TIPs could help improve consistency and effectiveness of current LLIN use and prolong net lifespan in sub-Saharan Africa and elsewhere. This would help maximize the value of shrinking donor resources for malaria.
Acute Schistosomiasis in Travelers: 14 Years' Experience at the Hospital for Tropical Diseases, London
Authors: Logan Sarah , Armstrong Margaret , Moore Elinor , Nebbia Gaia , Jarvis Joseph , Suvari Muhiddin , Bligh John , Chiodini Peter L. , Brown Michael , Doherty Tom
Published: March 2013

We report 79 cases of acute schistosomiasis. Most of these cases were young, male travelers who acquired their infection in Lake Malawi. Twelve had a normal eosinophil count at presentation and 11 had negative serology, although two had neither eosinophilia nor positive serology when first seen. Acute schistosomiasis should be considered in any febrile traveler with a history of fresh water exposure in an endemic area once malaria has been excluded.
An In vivo Drug Screening Model Using Glucose-6-Phosphate Dehydrogenase Deficient Mice to Predict the Hemolytic Toxicity of 8-Aminoquinolines
Authors: Zhang Peng , Gao Xiugong , Ishida Hiroshi , Amnuaysirikul Jack , Weina Peter J. , Grogl Max , O'Neil Michael T. , Li Qigui , Caridha Diana , Ohrt Colin , Hickman Mark , Magill Alan J. , Ray Prabhati
Published: March 2013

Anti-malarial 8-aminoquinolines drugs cause acute hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase deficiency (G6PDD). Efforts to develop non-hemolytic 8-aminoquinolines have been severely limited caused by the lack of a predictive in vivo animal model of hemolytic potential that would allow screening of candidate compounds. This report describes a G6PDD mouse model with a phenotype closely resembling the G6PDD phenotype found in the African A-type G6PDD human. These G6PDD mice, given different doses of primaquine, which used as a reference hemolytic drug, display a full array of hemolytic anemia parameters, consistently and reproducibly. The hemolytic and therapeutic indexes were generated for evaluation of hemotoxicity of drugs. This model demonstrated a complete hemolytic toxicity response to another known hemolytic antimalarial drug, pamaquine, but no response to non-hemolytic drugs, chloroquine and mefloquine. These results suggest that this model is suitable for evaluation of selected 8-AQ type candidate antimalarial drugs for their hemolytic potential.
A Panoramic View of Blood and Blood Product: Use in the Past Half Century
Authors: Lucas Charles E
Published: March 2013

Background

Many changes regarding the use of blood and blood products for resuscitation of severely injured patients have occurred in the past 50 years. This study presents these changes.

Study design

A review of resuscitation regimens over 50 years is presented.

Results

During the 1960s, hemorrhage shock (HS) was treated with whole blood (WB) and balanced electrolyte solution (BES); fresh WB restored the labile factors (FV and FVIII) during massive transfusion (MT). When component therapy with red cells (RBC) was started, plasma (FFP) had to be added; patients with MT received a 2/5 RBC/FFP ratio. Platelets were reserved for oozing or counts below 50,000. During the Vietnam conflict, many recommended supplemental albumin therapy. A large prospective randomized study showed that albumin therapy caused many adverse effects including coagulopathy. During the 1980s, the National Institute of Health (NIH) responded to a shortage of FFP by initiating a consensus development conference (CDC) which concluded that FFP was not indicated without an established coagulopathic bleeding; animal HS models showed FFP was beneficial. During the 1990s, military surgeons recommended a 1/1 FFP/RBC ratio. Studies, herein, demonstrated that a 0.3/1 FFP/RBC ratio effectively restored procoagulants; whereas, ratios above 0.45/1 FFP/RBC caused increased BES needs and longer stays.

Conclusion

Initial therapy for HS should be BES followed by RBC to maintain hemoglobin, perfusion and urine output. FFP should be supplemented after 5 units RBC using a 0.5 FFP/ RBC until hemostasis is obtained. Platelets should be added for ‘medical’ oozing and thrombocytopenia.

How to cite this article

Lucas CE. A Panoramic View of Blood and Blood Product: Use in the Past Half Century. Panam J Trauma Critical Care Emerg Surg 2012;1(3):139-145.
Utilidad del índice de presión arterial usando dispositivos oscilométricos en la Evaluación de Pacientes con Trauma de Miembros Inferiores y Sospecha de Lesión Vascular
Authors: Mojica Olman Esteban , Ángel Laura Isabel Valencia , Cadena Juan Carlos Castillo
Published: March 2013

Introducción y objetivos

Las lesiones de causa externa son una de las principales causas de morbilidad y mortalidad en Colombia. El trauma vascular puede alcanzar el 3,7% de todos los traumas civiles. El índice de presión arterial (IPA) usando el Doppler portátil fue implementado como método sensible y específico para diagnosticar el compromiso vascular en miembros inferiores. Sin embargo, la baja disponibilidad de estos equipos en hospitales de baja complejidad nos motivó a evaluar la utilidad del IPA usando los monitores oscilométricos de presión arterial, disponibles en los diferentes centros.

Materiales y métodos

Estudio de validación de tecnología diagnóstica realizado en el Hospital Universitario de Santander entre mayo-2011 y febrero-2012. Se incluyeron pacientes que con trauma de extremidades y signos blandos de lesión vascular. Se determinó el IPA usando Doppler y monitores oscilométricos, se calcularon la sensibilidad y especificidad de las mediciones con cada método y su concordancia.

Resultados

Se incluyeron 50 pacientes con trauma en extremidades, 66% con lesión en miembros inferiores. La edad promedio fue 28.6 años (DE 11,3), 95% fueron hombres, el mecanismo de lesión fue corto-punzante en el 52% y arma de fuego en el 46%. En la totalidad de los casos se presentaron lesiones en trayecto vascular, 32% hematoma estable, 16% antecedente de sangrado o choque, 12% pulso disminuido y 4% déficit neurológico como signos blandos. El IPA < 0.9 clasificó correctamente los 3 casos con y los 26 casos sin lesión vascular. Las diferencias promedio de la presión arterial entre los dos métodos tomada en el brazo, el tobillo derecho y el tobillo izquierdo fueron –7,3, 1,02 y 1,08 mm Hg, respectivamente, evidenciando una buena concordancia entre los métodos.

Conclusiones

El IPA con el método oscilométrico representa una medición sencilla, no invasiva, económica, valida y útil en la evaluación de pacientes con sospecha de trauma vascular.
Comportamiento del Proceso Prehospitalario Ante la Llamada de Auxilio Por Trauma, Csc-911, 2011
Authors: Ortiz Gabriel Sarmiento , León Vanessa Sarmiento , Reyes Fray Martínez , Molina Juan Carlos Salamea
Published: March 2013

Se reportó 4,665 llamadas reales que son el 5% del total de llamadas de emergencia; 46% Trauma. 69,90% sexo masculino, relación 2,3:1. Grupo más afectado 20-29 años 30,47%. Traídos por el Cuerpo de Bomberos 72,71%. Presencia de aliento etílico 6,42%.Muertes 1,54%. Accidente de tránsito 49,22%; caídas 28,56%; violencia 18,19%; accidentes laborales 2,81% y quemaduras 1,22%. Como politraumatismo 34,88%, trauma de miembros 24,99%, trauma de encéfalo-craneal 16,41%, trauma maxilo-facial 12,40%, trauma de columna 4,55%, trauma torácico 4,55%, trauma de abdomen 1,73% y trauma pélvico 0,75%. Trauma contuso 73,14% y penetrante 26,86%. Las instituciones públicas recibieron el 68,90%. La media de transporte PH desde que sale fue 11’55”; medina 05’; moda 04’. Tiempo desde la llamada hasta la llegada al hospital la media fue 17’30”; media 9’, moda 8’. El tiempo de respuesta de la unidad intra-institucional es 7’06”; media 3’; moda 2’. Los resultados obtenidos concuerdan con la accidentalidad de una ciudad desarrollada. Existe un uso inadecuado del sistema 911 lo que retarda el servicio de las unidades e emergencia. El cuerpo de bomberos juega un papel fundamental en atención PH por trauma. Este trabajo será determinante para tomar directrices para mejorar la atención PH del trauma.
Preventive Peer-educational Activities: What can Medical Students do to Potentially Save Lives?
Authors: Nasr Adonis , Abreu-Reis Phillipe , Tomasich Flávio , Pinto Bruno Eduardo Scheffer , Manfrinato Marília França Madeira , Oliveira Luísa Bordignon , Slongo Helena , Cruz Juliana Boni , Collaço Iwan
Published: March 2013

Background

Traffic injuries are among the main causes of death worldwide. Even with the advances in technology, there are still 50% of deaths that cannot be reduced by medical care improvement. These important injuries can though be reduced by prevention of trauma. One of the best ways to address this issue is through incorporating preventive measures to the daily routine of schools. It is the aim of this study to assess children's perception on traumatic events and to introduce a cost-effective peer-education preventive action.

Study design

A prospective interventional comparative study with children from a basic school in South Brazil. A questionnaire with 9 decision-making questions about traffic scenarios was applied by volunteer medical students from May to June 2012, before and after a peer-educational lecture on prevention of traffic injuries. There were 20 epidemiological questions as well. Data collected was compared between the pre and the posttests of the same students. Statistical analysis was performed using the Chi-square for discrete, and the students’ t-test for continuous variables.

Results

Among 246 students answered the questionnaires. The mean age was 10.19 years old. 21% reported that always crosses the street alone, while 47% only cross with an adult. Most of the students said they always cross-streets in the zebra-crossing and look to both sides before crossing (60.71 and 84.9% respectively). Impressively, 12.55% said they often/ sometimes drive a car or a motorcycle. Also, 30.76% ride a bike in between the cars. Furthermore, 77.48% of the students use the front seat of the car. Regarding safety issues, only one-third have a horn in their bikes, and less than half use helmet when playing. When comparing their assessments, there was a higher number of correct answers in the decision-making section in the post-test (5.21 vs 3.93, p = 0.000001161). The estimated overall cost was 45 dollars.

Conclusion

Preventive measures urge to be incorporated to schools curricula. Peer-educational actions are a cost-effective for spreading medical knowledge among children and youth.

How to cite this article

Abreu-Reis P, Tomasich F, Pinto BES, Manfrinato MFM, Oliveira LB, Nasr A, Slongo H, Cruz JB, Collaço I. Preventive Peer-educational Activities: What can Medical Students do to Potentially Save Lives? Panam J Trauma Critical Care Emerg Surg 2012;1(3):182-185.
Fatores Associados à Alta Carga de Trabalho de Enfermagem em Vítimas de Trauma na UTI
Authors: de Alencar Domingues Cristiane , de Sousa Regina Márcia Cardoso , de Souza Nogueira Lilia
Published: March 2013

Introducción

Muitas vítimas de trauma necessitam de tratamento intensivo e a análise da carga de trabalho de enfermagem nessa população é escassa na literatura.

Objetivo

Identificar os fatores associados à alta carga de trabalho de enfermagem requerida por vítimas de trauma no primeiro dia de internação na UTI.

Método

Estudo prospectivo, de abordagem quantitativa, realizado em uma UTI, localizada em São Paulo, Brasil, especializada no atendimento às vítimas de trauma. A carga de trabalho de enfermagem foi mensurada pelo Nursing Activities Score (NAS). A categorização dos valores do NAS em tercis permitiu identificar os dois grupos da investigação: média/baixa carga (1° e 2° tercis) e alta carga (3° tercil). Primeiramente, foi realizada análise univariada para cada uma das variáveis independentes do estudo e a comparação dos grupos foi feita por meio dos testes Qui-Quadrado, Exato de Fisher e Mann-Whitney. Para a construção do modelo de regressão logística múltipla, foram selecionadas todas as variáveis que apresentaram p < 0,20 na análise univariada e testadas no método de seleção stepwise backward.

Resultados

A casuística foi composta por 200 pacientes, a maioria vítima de trauma contuso (94,5%) e submetida à cirurgia não programada (66,5%). As quedas (31%) e os acidentes motociclísticos (27,5%) prevaleceram. A média do risco de morte calculado pelo APACHE II, SAPS II e LODS foi 25,6, 22,9 e 21,1%, respectivamente. Quanto à gravidade do trauma, o ISS médio foi de 19,3 e o NISS, 27,1. Gênero, presença de insuficiência pulmonar, número de regiões corpóreas acometidas e risco de morte segundo SAPS II foram os fatores associados à alta carga de trabalho de enfermagem (NAS > 75) na admissão da UTI.

Conclusão

Estes achados subsidiam a equipe da unidade crítica no planejamento das atividades de enfermagem e correto dimensionamento dos profissionais visando à qualidade da assistência ao traumatizado.
Herida Por Arma de Fuego Como Predictor Independiente de Mortalidad en Trauma de Tórax
Authors: Badiel Marisol , Tejada Jorge , Cepeda Magda C , Pino Luis F , Scavo David A , Salamea John C
Published: March 2013

Antecedentes

El abordaje quirúrgico en el trauma penetrante de tórax con herida pulmonar requiere del conocimiento de las técnicas quirúrgicas. Se presenta una experiencia de 4 años en el manejo de las heridas pulmonares y se representa que la cirugía en trauma pulmonar se asocia a una mayor mortalidad.

Métodos

Los datos corresponde a un centro de trauma de nivel IV, con revisión de forma prospectiva desde 2008 hasta 2011. Los resultados de las intervenciones quirúrgicas correlacionando las lesiones pulmonares traumáticas. Obtenemos los resultados demográficos, quirúrgicos y mortalidad institucional.

Resultados

El total de los pacientes con trauma son 638, con intervención quirúrgica en trauma de tórax es de 134 pacientes, y por lesiones pulmonares 77 pacientes. el genero masculino es del 93% y edad promedio de 28 años de edad. corresponde con el 73,13% de causa por HAF. Las Intervenciones quirúrgicas incluidas son neumonorrafia n (46%), tractotomía n (25%), resección en cuña, lobectomía o neumonectomia en el (0%), y la toracotomía de reanimación n (31%). Con puntaje de ISS en 20 promedio, la mortalidad global fue del 28%.

Conclusiones

La mayoría de las heridas pulmonares en los hombre jóvenes, por un trauma de torax penetrante. Rápida evaluación intraoperatoria y el control adecuado de la lesión es fundamental para el éxito de la gestión de la lesión pulmonar traumática.
Distal Intestinal Obstruction Syndrome requiring Laparotomy and Instillation of N-Acetylcysteine
Authors: Parrish Dan W , Hermann Michael D , Anand Rahul J
Published: March 2013

A 25-year-old female with long-standing CF and history of previous abdominal operation presented for sinus surgery. Postoperatively, she developed abdominal distention and was initially diagnosed with opiate-induced bowel dysfunction versus adhesive small bowel obstruction (SBO). Subsequent CT-scan and surgical consultation established the diagnosis of distal intestinal obstruction syndrome (DIOS). Conservative management consisting of trial of NPO, fluids, nasogastric suction and polyethylene glycol failed. The patient was taken to the operating room where findings were significant for decompressed distal small bowel starting in mid jejunum. An angiocatheter needle was inserted into proximal dilated bowel after placement of silk purse-string suture. 4% N-acetylcysteine (NAC) solution was made with dilution with normal saline. 120 ml of NAC was injected into the bowel, resulting in immediate softening of the obstructing mucus plug. This allowed for the plug to be milked into the colon, and for mucus to be suctioned out of a proximal enterotomy. Postoperatively, the patient received 10 ml of 10% NAC through nasogastric tube every 6 hours. She was transferred to pediatric pulmonology on postoperative day eight and discharged postoperative day fifteen.

How to cite this article

Parrish DW, Hermann MD, Ivatury RR, Anand RJ. Distal Intestinal Obstruction Syndrome requiring Laparotomy and Instillation of N-Acetylcysteine. Panam J Trauma Critical Care Emerg Surg 2012;1(3):204-205.
Step-up Approach for Pancreatic Necrosis: A Case Report and Review of the Technique and Literature
Authors: Anand Rahul J
Published: March 2013

Necrotizing pancreatitis carries a very high rate of mortality and complications for these sick patients. Recent literature supports the delay in operative procedures as long as possible to decrease morbidity and mortality. Minimally invasive procedures can avoid laparotomy, but also introduce specific complications requiring immediate or secondary open operative treatment. Minimally invasive procedures require unique expertise and therefore should only be performed at specialized centers. This is a case report that describes a complicated patient with acute pancreatitis, necrotizing infection of a pseudocyst, intrusion of the pseudocyst to the common bile duct, among other complications. We describe the clinical and operative approach.

How to cite this article

Ferrada PA, Anand RJ. Step-up Approach for Pancreatic Necrosis: A Case Report and Review of the Technique and Literature. Panam J Trauma Critical Care Emerg Surg 2012;1(3):206-209.
Long-term variations in Iceland–Scotland overflow strength during the Holocene
Authors: Thornalley D. J. R. , Blaschek M. , Davies F. J. , Praetorius S. , Oppo D. W. , McManus J. F. , Hall I. R. , Kleiven H. , Renssen H. , McCave I. N.
Published: March 2013

Abstract. The overflow of deep water from the Nordic Seas into the North Atlantic plays a critical role in global ocean circulation and climate. Approximately half of this overflow occurs via the Iceland–Scotland (I–S) overflow, yet the history of its strength throughout the Holocene (~0–11 700 yr ago, ka) is poorly constrained, with previous studies presenting apparently contradictory evidence regarding its long-term variability. Here, we provide a comprehensive reconstruction of I–S overflow strength throughout the Holocene using sediment grain size data from a depth transect of 13 cores from the Iceland basin. Our results reveal weaker I–S overflow during the early and late Holocene, with maximum overflow strength occurring at ~7 ka, the time of a regional climate thermal maximum. Climate model simulations suggest a shoaling of deep convection in the Nordic Seas during the early and late Holocene, consistent with our evidence for weaker I–S overflow during these intervals. Whereas the reduction in I–S overflow strength during the early Holocene likely resulted from melting remnant glacial ice-sheets, the decline throughout the last 7000 yr was caused by an orbitally-induced increase in the amount of Arctic sea-ice entering the Nordic Seas. Although the flux of Arctic sea-ice to the Nordic Seas is expected to decrease throughout the next century, model simulations predict that under high emissions scenarios, competing effects, such as warmer sea surface temperatures in the Nordic Seas, will result in reduced deep convection, likely driving a weaker I–S overflow.
Coupled climate model simulations of Mediterranean winter cyclones and large-scale flow patterns
Authors: Ziv B. , Kushnir Y. , Nakamura J. , Naik N. H. , Harpaz T.
Published: March 2013

Abstract. The study aims to evaluate the ability of global, coupled climate models to reproduce the synoptic regime of the Mediterranean Basin. The output of simulations of the 9 models included in the IPCC CMIP3 effort is compared to the NCEP-NCAR reanalyzed data for the period 1961–1990. The study examined the spatial distribution of cyclone occurrence, the mean Mediterranean upper- and lower-level troughs, the inter-annual variation and trend in the occurrence of the Mediterranean cyclones, and the main large-scale circulation patterns, represented by rotated EOFs of 500 hPa and sea level pressure. The models reproduce successfully the two maxima in cyclone density in the Mediterranean and their locations, the location of the average upper- and lower-level troughs, the relative inter-annual variation in cyclone occurrences and the structure of the four leading large scale EOFs. The main discrepancy is the models' underestimation of the cyclone density in the Mediterranean, especially in its western part. The models' skill in reproducing the cyclone distribution is found correlated with their spatial resolution, especially in the vertical. The current improvement in model spatial resolution suggests that their ability to reproduce the Mediterranean cyclones would be improved as well.
Precipitation dominates fire occurrence in Greece (1900–2010): its dual role in fuel build-up and dryness
Authors: Xystrakis F. , Kallimanis A. S. , Dimopoulos P. , Halley J. M. , Koutsias N.
Published: March 2013

Abstract. Historical fire records and meteorological observations spanning over one century (1894–2010), were assembled in a database to collect long-term fire and weather data in Greece. Positive/negative events of fire occurrence on an annual basis were considered the years where the annual values of the examined parameters were above (positive values) or below (negative values) the 95% confidence limits around the trend line of the corresponding parameter. To analyze the association of positive/negative events of fire occurrence and meteorological extremes, we proceeded with a cross-tabulation analysis based on a Monte Carlo randomization. Positive/negative values of total annual precipitation were randomly associated with the corresponding values of burned areas, and significant associations were observed for seasonal precipitation totals (spring and fire season). Fire season precipitation is the dominant factor coinciding with negative values of area burned, while years with high spring precipitation coincide with large burnt area burned. These results demonstrate the dual role of precipitation in controlling a fire's extent through fuel build-up and dryness. Additionally, there is a clear outperformance of precipitation-related against temperature-related weather variables revealing that, at least in Greece, fire spread is controlled by precipitation totals rather than air temperature.
Urine Cytology and New Markers. Are there any Advantages in Terms of Cost-Effectiveness?
Authors: Campodonico Fabio
Published: March 2013

Bladder cancer has the highest lifetime treatment and surveillance costs per patients for all cancers. New diagnostic tools, and ancillary tests, such as urine markers, have been developed to enhance the sensitivity for detecting cancer cells exfoliated from the urinary tract, and to reduce the discomfort of repeated cystoscopies. Several markers have been studied, and others are under investigation; a few provide some advantage, only in selected cases, in terms of detection rate and cost-effectiveness for the patient as well as the health service. This paper provides a concise update of the most promising urinary markers (nuclear matrix protein 22, ImmunoCyt, and fluorescence in situ hybridization) acting as non-invasive tests which help to identify urothelial cancers. Cystoscopy remains the most consistent examination for diagnosis and follow-up of non-muscle-invasive bladder cancer. However, some markers can be useful in understanding atypical cytology due to urinary tract phlogosis, infection, or treatment with chemotherapy or intravesical bacillus Calmette-Guérin. Moreover, in centers with clinical experience, selected patients may benefit from the use of urinary markers to achieve prognostic information at the specific time of individual follow-up.
Safety Notice for the Use of Drugs for Intravesical Instillations and Cost Analysis
Authors: Zanni Giuseppe
Published: March 2013

Among the objectives outlined in the National Health Plan 1998-2000 are some interventions to improve the safety of public and private health-care facilities.

One of the significant risks in the health sector is the one resulting from exposure to chemotherapy drugs.

The Health Surveillance must take into account that anticancer drugs are cytotoxic compounds, which can cause cancer.

It is necessary that occupational exposure to antineoplastic agents be kept within the lowest possible level.

The potential absorption due to exposure to chemotherapy may be significantly reduced by adopting preventive measures specific to particular concern in a centralization of structures and activities.

To ensure an adequate system of protection for people who use these substances in professional health-care settings, there should be the establishment of a specific “Anticancer Drugs Unit” to entrust the working cycle.

The places reserved for the preparation of cytotoxic chemotherapy must be equipped with floor and walls up to heights of appropriate plastic material easily washable.

Inside the room there must be a “point of decontamination” for washing hands and eyes.

The preparation of antineoplastic agents should be performed under hoods positioned away from heat sources and any air currents.

It is advisable to use disposable surgical gowns with long sleeves with elastic cuffs or knitted sleeve to allow the gloves sticking above the gown itself.

In the preparation of drugs the vial opening procedure must be implemented after verifying that no liquid is left at the top, and by wrapping the neck of the vial with a sterile gauze.

Any accidental contamination must be reported to the Physician.

All waste materials produced from the handling of cytotoxic chemotherapy should be considered as special hospital waste.

To achieve high standards of safety and prevention for the personnel exposed to antineoplastic agents, it is necessary that workers are adequately informed about the risks and proper handling and disposal of anticancer drugs and contaminated materials.
How to Apply follow-up in Relation to Risk Group
Authors: Montanaro Vittorino , Di Girolamo Antonio , Ferro Matteo , Altieri Vincenzo
Published: March 2013

The term ‘Non-muscle invasive bladder cancer’ identifies a heterogeneous disease due to different natural history of its various appearances. T1 stage represents a non-predictable population, which might respond to non-operative treatment strategies or to the need of a more aggressive treatment, in order to avoid the progression to invasive, and possibly to metastatic stages.

In the first year following transurethral resection of bladder (TURB), tumor recurrence is seen in up to 45% of the population; of this, 15% may progress to muscle invasive or metastatic disease, or both. In order to control the recurrence and progression and identify invasive tumors at the earliest possible stage, it is strongly necessary to define individual patient risk assessment follow-up.

To obtain exact staging, besides a proper transurethral resection of bladder, a restaging transurethral resection of bladder should be performed in T1 patients. Data from literature support the immediate postoperative intravesical instillation of different chemotherapeutic agents in low-risk patients.

Multifocal papillary lesions might require a more intensive adjuvant regimen, whereas intravesical immunotherapy using Bacillus Calmette-Guérin is recommended in patients at high risk of progression. Early cystectomy should be considered in patients with recurrent T1 tumors or refractory carcinoma in situ to avoid unfavorable tumor progression.
STATISTICAL ANALYSIS OF THE LOCAL STRUT THICKNESS OF OPEN CELL FOAMS
Authors: Liebscher André , Redenbach Claudia
Published: March 2013

Open cell foams are formed by an interconnected network of struts whose thickness varies locally. These variations were shown to have an impact on the elastic and thermal properties of the foam. In this paper we quantify the local strut thickness by means of micro computed tomography (µCT) imaging. We introduce a skeletonization based topological decomposition of the foam structure into its vertices and struts. This allows to estimate the thickness of individual strut segments by the Euclidean distance transform, where an appropriate correction for struts with nonspherical cross-sectional shape is applied. Conflating these estimates based on the strut lengths results in a strut thickness profile for the entire foam. Polynomial models for the strut thickness profile are investigated by means of a regression analysis.
AUTOMATIC SEGMENTATION AND STRUCTURAL CHARACTERIZATION OF LOW DENSITY FIBREBOARDS
Authors: Lux Jérôme
Published: March 2013

In this paper, a new skeleton-based algorithm for the segmentation of individual fibres in 3D tomographic images is described. The proposed method is designed to deal with low density materials featuring fibres with varied sizes, shapes and tortuosities, like composite fibreboards used for buildings insulation. To this end the paths of the skeleton are first classified according to their connectivity, the connectivity of their adjacent nodes, their orientation, their average radius and the variation of the distance transform along each path. This allows for the identification of spurious paths and paths linking two fibres. Reconstruction of the path of the fibres is done thanks to an optimal pairing algorithm which joins paths that show the most similar orientation and radius at each node/link. The segmented skeleton is finally dilated by means of a growing algorithm ordonned by the average radius of the fibres in order to reconstruct each identified fibres. As an application, the algorithm is used to segment a 3D tomographic image of hemp/polymer fibreboard for buildings insulation. Information such as the number of contacts, tortuosity, length, average radius, orientation of fibres are finally measured on both the segmented skeleton and reconstructed image, which allow for a thorough characterization of the fibre network.
EXTRACTION OF CURVED FIBERS FROM 3D DATA
Authors: Gaiselmann Gerd , Manke Ingo , Lehnert Werner , Schmidt Volker
Published: March 2013

A segmentation algorithm is proposed which automatically extracts single fibers from tomographic 3D data of fiber-based materials. As an example, the algorithm is applied to a non-woven material used in the gas diffusion layer of polymer electrolyte membrane fuel cells. This porous material consists of a densely packed system of strongly curved carbon fibers. Our algorithm works as follows. In a first step, we focus on the extraction of skeletons, i.e., center lines of fibers. Due to irregularities like noise or other data artefacts, it is only possible to extract fragments of center lines. Thus, in a second step, we consider a stochastic algorithm to adequately connect these parts of center lines to each other, with the general aim to reconstruct the complete fibers such that the curvature properties of real fibers are reflected correctly. The quality of the segmentation algorithm is validated by applying it to simulated test data.
AS RELAÇÕES ENTRE O ALUNO COM ALTAS HABILIDADES/SUPERDOTAÇÃO E O PROFESSOR DO ENSINO COMUM
Authors: Carvalho da Veiga Elizabeth , Grande Diogo , Grochoski Simone
Published: March 2013

O presente artigo tem como tema a relação que se estabelece entre o aluno com altas habilidadese seu professor do Ensino Comum, com o objetivo de compreender o que o aluno com altashabilidades pensa de si mesmo e como o professor qualifica e trabalha com esse aluno com característicasespecíficas. Com a finalidade de analisar esse relacionamento, foram entrevistados, a partir de questionário estruturado, quatro alunos com diagnóstico de Altas Habilidades, onze professores do Ensino Fundamental que atuam com esses alunos e os pais desses alunos. Dentre os resultados destacam-se como os alunos percebem dificuldades no relacionamento com seus professores – principalmente envolvendo falta de compreensão – e como a escola é pouco atrativa a seus interesses. Quanto aos professores, nota-se que a maioria percebe que esses alunos necessitam de atendimento diferenciado. Porém, a escola ainda não tem conseguido garantir esse atendimento.
A QUEIXA ESCOLAR: REFLEXÕES SOBRE O ATENDIMENTO PSICOLÓGICO
Authors: Rafaelly Martins Cruz Danilly , Cavalcante Borges Lucivanda
Published: March 2013

Historicamente, a atuação do psicólogo na escola é caracterizada por uma prática diagnóstica, em que são utilizados testes ou laudos com o objetivo de identificar os principais aspectos relacionados ao fracasso escolar e, consequentemente, emitir um parecer sobre os alunos avaliados. Consequentemente, na maioria dos casos, os alunos ou seus familiares eram considerados os únicos responsáveis pelo não aprendizado e passavam a vivenciar a exclusão. Este estudo teve como objetivo conhecer o modelo de atuação dos psicólogos que atendem crianças com dificuldades no processo de escolarização. Foi realizada uma pesquisa qualitativa, com um roteiro semiestruturado e o uso de um gravador. Foram entrevistados oito sujeitos, deinstituições públicas de Petrolina (PE), sendo seis psicólogos e dois estagiários de Psicologia. Constatou-se que a maioria dos profissionais realiza uma avaliação breve da criança e a encaminha para exames e consultas médicas, ou emitem laudos psicológicos. Boa parte dos sujeitos relatou não realizar qualquer tipo de intervenção nesses casos, e quando necessário, realizam apenas psicoterapia.
DOENÇAS TERMINAIS, CONHECIMENTO ESSENCIAL PARA O PROFISSIONAL DA SAÚDE
Authors: Graciela da Silva Carolini , Indalêncio Cota Lucas , Ortega Vieira Rodrigo , Debacher de Arrazão Vanessa , Arthur Rangel Cyrino Luiz
Published: March 2013

Saber lidar com paciente em fase terminal é, ainda, extremamente difícil, mesmo com os avanços na tecnologia e da medicina, na medida em que a morte é enfrentada como um tabu pela sociedade, as probabilidades de reversão da doença são mínimas e os profissionais da saúde carecem detreinamento para lidar com essa questão. Esse último fator é preocupante, porque os indivíduos que se encontram nessa fase vivenciam diversos conflitos, entre eles sentimentos de impotência, angústia e temor em relação à vida e necessitam de um suporte ativo por parte da família e daequipe médica. O presente artigo visa desse este assunto, enfatizando a atuação desses profissionais que devem estar atentos para as questões presentes na vivência cotidiana de seus pacientes. Inicialmente serão expostos alguns conceitos de “paciente terminal” e a problematização do tema, que sustentam uma discussão importante para entender o assunto com clareza e cientificidade. Serão apresentados também alguns métodos bastante discutidos e questionados na área de saúde como a eutanásia e a distanásia, sem deixar de abordar durante todo o trabalho a parte do paciente terminal, “sujeito” central de todo o processo. Por fim, esta pesquisa tem como intuito enriquecer conhecimentos para futuros profissionais da saúde, já que essa preparação se faz necessária para oferecer auxílio aos envolvidos nessa questão
INFÂNCIA E ADOLESCÊNCIA E REDUÇÃO DE DANOS/INTERVENÇÃO PRECOCE: DIRETRIZES PARA INTERVENÇÃO
Authors: Teresinha da Silva Araújo Anelize , Cristina da Silva Josiéle , Motta de Oliveira Fernanda
Published: March 2013

O presente artigo visa discutir a articulação de três noções que entendemos ser de fundamental importância no que se refere ao problema do uso de álcool e outras drogas por crianças e adolescentes. Nesse sentido, será discutida a noção de violência estrutural como agente propagadorda violação dos direitos da população citada; esta relacionada ao conceito de desenvolvimento no território. Em seguida, será trabalhada a introdução da noção de intervenção precoce como um modo de se alcançar a estratégia da Redução de Danos como direção de trabalho para os dispositivos assistenciais e de saúde que acolhem esse público. E, por fim, será abordada a própria estratégia da Redução de Danos e o modo como ela se insere no contexto das políticas públicas. Assim, objetivamos apresentar uma reflexão acerca de um determinado contexto – de exclusão, vulnerabilidade e desassistência – em que tais crianças e adolescentes em envolvimento com drogas estão inseridos.