Absolute values of regional ventilation-perfusion mismatch in patients with ARDS monitored by electrical impedance tomography and the role of dead space and shunt compensation.

BACKGROUND: Assessment of regional ventilation/perfusion (V'/Q) mismatch using electrical impedance tomography (EIT) represents a promising advancement for personalized management of the acute respiratory distress syndrome (ARDS). However, accuracy is still hindered by the need for invasive monitoring to calibrate ventilation and perfusion. Here, we propose a non-invasive correction that uses only EIT data and characterized patients with more pronounced compensation of V'/Q mismatch. METHODS: We enrolled twenty-one ARDS patients on controlled mechanical ventilation. Cardiac output was measured invasively, and ventilation and perfusion were assessed by EIT. Relative V'/Q maps by EIT were calibrated to absolute values using the minute ventilation to invasive cardiac output (MV/CO) ratio (V'/Q-ABS), left unadjusted (V'/Q-REL), or corrected by MV/CO ratio derived from EIT data (V'/Q-CORR). The ratio between ventilation to dependent regions and perfusion reaching shunted units ( V D ' /QSHUNT) was calculated as an index of more effective hypoxic pulmonary vasoconstriction. The ratio between perfusion to non-dependent regions and ventilation to dead space units (QND/ V DS ' ) was calculated as an index of hypocapnic pneumoconstriction. RESULTS: Our calibration factor correlated with invasive MV/CO (r = 0.65, p < 0.001), showed good accuracy and no apparent bias. Compared to V'/Q-ABS, V'/Q-REL maps overestimated ventilation (p = 0.013) and perfusion (p = 0.002) to low V'/Q units and underestimated ventilation (p = 0.011) and perfusion (p = 0.008) to high V'/Q units. The heterogeneity of ventilation and perfusion reaching different V'/Q compartments was underestimated. V'/Q-CORR maps eliminated all these differences with V'/Q-ABS (p > 0.05). Higher V D ' / Q SHUNT correlated with higher PaO2/FiO2 (r = 0.49, p = 0.025) and lower shunt fraction (ρ = - 0.59, p = 0.005). Higher Q ND / V DS ' correlated with lower PEEP (ρ = - 0.62, p = 0.003) and plateau pressure (ρ = - 0.59, p = 0.005). Lower values of both indexes were associated with less ventilator-free days (p = 0.05 and p = 0.03, respectively). CONCLUSIONS: Regional V'/Q maps calibrated with a non-invasive EIT-only method closely approximate the ones obtained with invasive monitoring. Higher efficiency of shunt compensation improves oxygenation while compensation of dead space is less needed at lower airway pressure. Patients with more effective compensation mechanisms could have better outcomes.

Application of Radio Environment Map Reconstruction Techniques to Platoon-based Cellular V2X Communications.

Vehicle platoons involve groups of vehicles travelling together at a constant inter-vehicle distance, with different common benefits such as increasing road efficiency and fuel saving. Vehicle platooning requires highly reliable wireless communications to keep the group structure and carry out coordinated maneuvers in a safe manner. Focusing on infrastructure-assisted cellular vehicle to anything (V2X) communications, the amount of control information to be exchanged between each platoon vehicle and the base station is a critical factor affecting the communication latency. This paper exploits the particular structure and characteristics of platooning to decrease the control information exchange necessary for the channel acquisition stage. More precisely, a scheme based on radio environment map (REM) reconstruction is proposed, where geo-localized received power values are available at only a subset of platoon vehicles, while large-scale channel parameters estimates for the rest of platoon members are provided through the application of spatial Ordinary Kriging (OK) interpolation. Distinctive features of the vehicle platooning use case are explored, such as the optimal patterns of vehicles within the platoon with available REM values for improving the quality of the reconstruction, the need for an accurate semivariogram modeling in OK, or the communication cost when establishing a centralized or a distributed architecture for achieving REM reconstruction. The evaluation results show that OK is able to reconstruct the REM in the platoon with acceptable mean squared estimation error, while reducing the control information for REM acquisition in up to 64% in the best-case scenario.

Combined effect of turbulence and aerosol on free-space optical links.

Despite the benefits of free-space optical (FSO) communications, their full utilization is limited by the influence of atmospheric weather conditions, such as fog, turbulence, smoke, snow, etc. In urban environments, additional environmental factors such as smog and dust particles due to air pollution caused by industry and motor vehicles may affect FSO link performance, which has not been investigated in detail yet. Both smog and dust particles cause absorption and scattering of the propagating optical signal, thus resulting in high attenuation. This work investigates the joint impact of atmospheric turbulence and dust particle-imposed scattering on FSO link performance as part of the last-mile access network in urban areas. Propagation of an optical wave is at first analyzed based on the microphysic approach, and the extinction caused by small particles is determined. An experimental measurement campaign using a dedicated test chamber is carried out to assess FSO link performance operating wavelengths of 670 nm and 830 nm and under dust and turbulent conditions. The measured attenuation and the Q factor in terms of the velocity of particle flow and turbulence strength are analyzed. We show that for an airflow of 2 m/s, the Q factor is almost 3.5 higher at the wavelength of 830 nm than at 670 nm. However, for a wavelength of 670 nm, the FSO link is less affected by the increase in airflow compared to 830 nm. The Q factor reduces with turbulence. Under similar turbulence conditions, for ash particles, the Q factor is higher than that of sand particles.

Emotion-Bracelet: A Web Service for Expressing Emotions through an Electronic Interface.

The mechanisms to communicate emotions have dramatically changed in the last 10 years with social networks, where users massively communicate their emotional states by using the Internet. However, people with socialization problems have difficulty expressing their emotions verbally or interpreting the environment and providing an appropriate emotional response. In this paper, a novel solution called the Emotion-Bracelet is presented that combines a hardware device and a software system. The proposed approach identifies the polarity and emotional intensity of texts published on a social network site by performing real-time processing using a web service. It also shows emotions with a LED matrix using five emoticons that represent positive, very positive, negative, very negative, and neutral states. The Emotion-Bracelet is designed to help people express their emotions in a non-intrusive way, thereby expanding the social aspect of human emotions.

Surgical management of appendiceal adenocarcinoid. Case report and literature review.

Adenocarcinoid tumour of the appendix is a rare entity characterised by the presence of a double component (neuroendocrine and glandular). It originates in the neuroendocrine cells of the appendicular mucosa. A preoperative diagnosis of a primary appendiceal tumour is uncommon and more so one suggesting an adenocarcinoid pathology. Optimal treatment is debated between a simple appendectomy and a more extensive resection, which occasionally includes hysterectomy and bilateral ovariectomy. Our aim is to report this rare entity and conduct a review of the literature on the different treatment options.

MWP phase shifters integrated in PbS-SU8 waveguides.

We present new kind of microwave phase shifters (MPS) based on dispersion of PbS colloidal quantum dots (QDs) in commercially available photoresist SU8 after a ligand exchange process. Ridge PbS-SU8 waveguides are implemented by integration of the nanocomposite in a silicon platform. When these waveguides are pumped at wavelengths below the band-gap of the PbS QDs, a phase shift in an optically conveyed (at 1550 nm) microwave signal is produced. The strong light confinement produced in the ridge waveguides allows an improvement of the phase shift as compared to the case of planar structures. Moreover, a novel ridge bilayer waveguide composed by a PbS-SU8 nanocomposite and a SU8 passive layer is proposed to decrease the propagation losses of the pump beam and in consequence to improve the microwave phase shift up to 36.5° at 25 GHz. Experimental results are reproduced by a theoretical model based on the slow light effect produced in a semiconductor waveguide due to the coherent population oscillations. The resulting device shows potential benefits respect to the current MPS technologies since it allows a fast tunability of the phase shift and a high level of integration due to its small size.

A Data Preparation Methodology in Data Mining Applied to Mortality Population Databases.

It is known that the data preparation phase is the most time consuming in the data mining process, using up to 50% or up to 70% of the total project time. Currently, data mining methodologies are of general purpose and one of their limitations is that they do not provide a guide about what particular task to develop in a specific domain. This paper shows a new data preparation methodology oriented to the epidemiological domain in which we have identified two sets of tasks: General Data Preparation and Specific Data Preparation. For both sets, the Cross-Industry Standard Process for Data Mining (CRISP-DM) is adopted as a guideline. The main contribution of our methodology is fourteen specialized tasks concerning such domain. To validate the proposed methodology, we developed a data mining system and the entire process was applied to real mortality databases. The results were encouraging because it was observed that the use of the methodology reduced some of the time consuming tasks and the data mining system showed findings of unknown and potentially useful patterns for the public health services in Mexico.

Chemical, rheological and mechanical evaluation of maize dough and tortillas in blends with cassava and malanga flour.

Masa or dough from nixtamalized maize with cassava (Cf) and malanga flour (Mf) addition at 20, 30 and 40 % (w/w) were prepared making seven treatments. The produced masas or doughs were subjected to chemical analysis, rheological and mechanical tests. Tortillas were manufactured from these doughs and mechanical tests were undertaken. Doughs from tubers had less protein and lipid content but higher nitrogen free extract than the control. All doughs presented weak viscoelastic gel-like behavior, with those of Mf behaving mainly as viscous systems. Doughs with Cf showed lower decrease in both the elastic (G') and viscous (G") moduli than those with Mf. The adhesiveness and cohesiveness of doughs with Mf showed a higher reduction of maximum force than those with Cf. Tortillas with Cf were more elastic with higher tensile strength than those with Mf. Using Cf as partial substitution of maize might lower production costs, but Mf is not particularly suitable as maize substitute in tortilla production. Tortillas with 40 % (w/w) cassava flour, presented the highest preference on a sensory test.

Glutathione reductase-mediated synthesis of tellurium-containing nanostructures exhibiting antibacterial properties.

Tellurium, a metalloid belonging to group 16 of the periodic table, displays very interesting physical and chemical properties and lately has attracted significant attention for its use in nanotechnology. In this context, the use of microorganisms for synthesizing nanostructures emerges as an eco-friendly and exciting approach compared to their chemical synthesis. To generate Te-containing nanostructures, bacteria enzymatically reduce tellurite to elemental tellurium. In this work, using a classic biochemical approach, we looked for a novel tellurite reductase from the Antarctic bacterium Pseudomonas sp. strain BNF22 and used it to generate tellurium-containing nanostructures. A new tellurite reductase was identified as glutathione reductase, which was subsequently overproduced in Escherichia coli. The characterization of this enzyme showed that it is an NADPH-dependent tellurite reductase, with optimum reducing activity at 30°C and pH 9.0. Finally, the enzyme was able to generate Te-containing nanostructures, about 68 nm in size, which exhibit interesting antibacterial properties against E. coli, with no apparent cytotoxicity against eukaryotic cells.

Experimental characterization and mitigation of turbulence induced signal fades within an ad hoc FSO network.

Optical beams propagating through the turbulent atmospheric channel suffer from both the attenuation and phase distortion. Since future wireless networks are envisaged to be deployed in the ad hoc mesh topology, this paper presents the experimental laboratory characterization of mitigation of turbulence induced signal fades for two ad hoc scenarios. Results from measurements of the thermal structure constant along the propagation channels, changes of the coherence lengths for different turbulence regimes and the eye diagrams for partially correlated turbulences in free space optical channels are discussed. Based on these results future deployment of optical ad hoc networks can be more straightforwardly planned.

eFisioTrack: a telerehabilitation environment based on motion recognition using accelerometry.

The growing demand for physical rehabilitation processes can result in the rising of costs and waiting lists, becoming a threat to healthcare services' sustainability. Telerehabilitation solutions can help in this issue by discharging patients from points of care while improving their adherence to treatment. Sensing devices are used to collect data so that the physiotherapists can monitor and evaluate the patients' activity in the scheduled sessions. This paper presents a software platform that aims to meet the needs of the rehabilitation experts and the patients along a physical rehabilitation plan, allowing its use in outpatient scenarios. It is meant to be low-cost and easy-to-use, improving patients and experts experience. We show the satisfactory results already obtained from its use, in terms of the accuracy evaluating the exercises, and the degree of users' acceptance. We conclude that this platform is suitable and technically feasible to carry out rehabilitation plans outside the point of care.

Thermoplastic polymers as water substitutes.

Background. New applications of 3D printing have recently appeared in the fields of radiotherapy and radiology, but the knowledge of many radiological characteristics of the compounds involved is still limited. Therefore, studies are needed to improve our understanding about the transport and interaction of ionizing radiation in these materials.Purpose. The purpose of this study is to perform an analysis of the most important radiation interaction parameters in thermoplastic materials used in Fused Deposition Modeling 3D printing. Additionally, we propose improvements to bring their characteristics closer to those of water and use them as water substitutes in applications such as radiodiagnosis, external radiotherapy, and brachytherapy.Methods. We have calculated different magnitudes as mass linear attenuation, mass energy absorption coefficients, as well as stopping power and electronic density of several thermoplastic materials along with various compounds that have been used as water substitutes and in a new proposed blend. To perform these computations, we have used the XCOM and ESTAR databases from NIST and the EGSnrc code for Montecarlo simulations.Results. From the representation of the calculated interaction parameters, we have been able to establish relationships between their properties and the proportion of certain chemical elements. In addition, studying these same characteristics in different commercial solutions used as substitutes for water phantoms allows us to extrapolate improvements for these polymers.Conclusion. The radiological characteristics of the analyzed thermoplastic materials can be improved by adding some chemical elements with atomic numbers higher than oxygen and by using polyethylene in new blends.

Route diversity analyses for free-space optical wireless links within turbulent scenarios.

Free-Space Optical (FSO) communications link performance is highly affected when propagating through the time-spatially variable turbulent environment. In order to improve signal reception, several mitigation techniques have been proposed and analytically investigated. This paper presents experimental results for the route diversity technique evaluations for a specific case when several diversity links intersects a common turbulent area and concurrently each passing regions with different turbulence flows.

Biological safety studies of gemifloxacin mesylate and related substances.

PURPOSE: The aim of this study was to evaluate the cytotoxic, phototoxic, genotoxic and photogenotoxic potential of gemifloxacin mesylate (GFM), its main synthetic impurity (SI) and one isolated and structurally elucidated degradation product (DP). METHODS: The neutral red uptake (NRU) and reduction of 2,5-diphenyl-3,-(4,5-dimethyl-2-thiazolyl)tetrazolium bromide (MTT) assays were performed as in vitro endpoints to evaluate cytotoxicity and phototoxicity in a 3T3 cell line, and predict toxicity and/or phototoxicity after systemic administration of the drug. The in vitro alkaline single-cell electrophoresis (comet) assay was used to evaluate the genotoxic and photogenotoxic potential of the substances using the same cell line. RESULTS: The results showed that the SI and the DP are more cytotoxic and phototoxic than the drug GFM using the 3T3 cell line. In the comet assay, the drug GFM was found to be more genotoxic and photogenotoxic than its related substances. CONCLUSIONS: Our findings highlight the relevance of the biological safety studies to increase the knowledge regarding the toxic potential of the related substances, which can be associated with the drug side effects and toxicity.

Airway and Transpulmonary Driving Pressure by End-Inspiratory Holds During Pressure Support Ventilation.

BACKGROUND: The precision of quasi-static airway driving pressure (ΔP) assessed in pressure support ventilation (PSV) as a surrogate of tidal lung stress is debatable because persistent muscular activity frequently alters the readability of end-inspiratory holds. In this study, we used strict criteria to discard excessive muscular activity during holds and assessed the accuracy of ΔP in predicting global lung stress in PSV. Additionally, we explored whether the physiological effects of high PEEP differed according to the response of respiratory system compliance (CRS). METHODS: Adults with ARDS undergoing PSV were enrolled. An esophageal catheter was inserted to calculate lung stress through transpulmonary driving pressure (ΔPL). ΔP and ΔPL were assessed in PSV at PEEP 5, 10, and 15 cm H2O by end-inspiratory holds. CRS was calculated as tidal volume (VT)/ΔP. We analyzed the effects of high PEEP on pressure-time product per minute (PTPmin), airway pressure at 100 ms (P0.1), and VT over PTP per breath (VT/PTPbr) in subjects with increased versus decreased CRS at high PEEP. RESULTS: Eighteen subjects and 162 end-inspiratory holds were analyzed; 51/162 (31.5%) of the holds had ΔPL ≥ 12 cm H2O. Significant association between ΔP and ΔPL was found at all PEEP levels (P < .001). ΔP had excellent precision to predict ΔPL, with 15 cm H2O being identified as the best threshold for detecting ΔPL ≥ 12 cm H2O (area under the receiver operating characteristics 0.99 [95% CI 0.98-1.00]). CRS changes from low to high PEEP corresponded well with lung compliance changes (R2 0.91, P < .001) When CRS increased, a significant improvement of PTPmin and VT/PTPbr was found, without changes in P0.1. No benefits were observed when CRS decreased. CONCLUSIONS: In subjects with ARDS undergoing PSV, high ΔP assessed by readable end-inspiratory holds accurately detected potentially dangerous thresholds of ΔPL. Using ΔP to assess changes in CRS induced by PEEP during assisted ventilation may inform whether higher PEEP could be beneficial.

Adolescent Behaviours and Their Relationship to the Risk of Developing Eating Disorders.

Eating disorders (ED) in adolescents represent a significant problem in today's society, with multiple factors influencing them, such as predisposing factors, precipitating factors and perpetuating factors. OBJECTIVE: This paper aimed to determine the relationships between some of the factors considered to be predisposing and precipitating in terms of the development of ED in adolescents and to relate them to the SCOFF index. PARTICIPANTS: The sample was made up of 264 subjects aged between 15 and 19 (48.8% females and 51.1% males). METHODS: This study was conducted in two phases. In the first study phase, a descriptive analysis of the sample was performed, encompassing the frequencies of the independent variables and dependent variable (ED). In the second phase of study, we created several linear regression models. RESULTS: A total of 11.7% of adolescents are at high risk for ED, and the variables that predict the variability of manifesting the danger of ED are the following: physical self-conception and family relationships. CONCLUSIONS: This work shows the need to approach eating disorders in a multidisciplinary way (biological and social), since this will enable the disease to be better conceptualized and prevention guidelines to be more effective.

Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19.

OBJECTIVES: To describe the rate of failure of the first transition to pressure support ventilation (PSV) after systematic spontaneous awakening trials (SATs) in patients with acute hypoxemic respiratory failure (AHRF) and to assess whether the failure is higher in COVID-19 compared with AHRF of other etiologies. To determine predictors and potential association of failure with outcomes. DESIGN: Retrospective cohort study. SETTING: Twenty-eight-bedded medical-surgical ICU in a private hospital (Argentina). PATIENTS: Subjects with arterial pressure of oxygen (AHRF to Fio2 [Pao2/Fio2] < 300 mm Hg) of different etiologies under controlled mechanical ventilation (MV). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We collected data during controlled ventilation within 24 hours before SAT followed by the first PSV transition. Failure was defined as the need to return to fully controlled MV within 3 calendar days of PSV start. A total of 274 patients with AHRF (189 COVID-19 and 85 non-COVID-19) were included. The failure occurred in 120 of 274 subjects (43.7%) and was higher in COVID-19 versus non-COVID-19 (49.7% and 30.5%; p = 0.003). COVID-19 diagnosis (odds ratio [OR]: 2.22; 95% CI [1.15-4.43]; p = 0.020), previous neuromuscular blockers (OR: 2.16; 95% CI [1.15-4.11]; p = 0.017) and higher fentanyl dose (OR: 1.29; 95% CI [1.05-1.60]; p = 0.018) increased the failure chances. Higher BMI (OR: 0.95; 95% CI [0.91-0.99]; p = 0.029), Pao2/Fio2 (OR: 0.87; 95% CI [0.78-0.97]; p = 0.017), and pH (OR: 0.61; 95% CI [0.38-0.96]; p = 0.035) were protective. Failure groups had higher 60-day ventilator dependence (p < 0.001), MV duration (p < 0.0001), and ICU stay (p = 0.001). Patients who failed had higher mortality in COVID-19 group (p < 0.001) but not in the non-COVID-19 (p = 0.083). CONCLUSIONS: In patients with AHRF of different etiologies, the failure of the first PSV attempt was 43.7%, and at a higher rate in COVID-19. Independent risk factors included COVID-19 diagnosis, fentanyl dose, previous neuromuscular blockers, acidosis and hypoxemia preceding SAT, whereas higher BMI was protective. Failure was associated with worse outcomes.