Multi-objective utilization of wood waste recycled from construction and demolition (C&D): Products and characterization.

Producing energy and higher value bio-products from waste materials has been proposed as an economically viable opportunity in the renewable energy sector. However, several challenges associated with the integrated biomass conversion processes remain to be resolved. The present study introduces a multi-faceted plant production of thermal energy and biochar from construction and demolition (C&D) wood chips. The overarching objective of the study is to reduce waste materials while simultaneously producing a self-independent clean thermal energy resource along with value-added co-products such as biochar, biogases and/or activated carbon. The combined thermal energy and slow pyrolysis unit relies on 95% of its energy from waste wood chips to produce thermal energy and high value carbon products. The system not only supplies the energy required for the indirect pyrolysis unit but also provides a major portion of thermal energy demanded for the site. A multi-purpose objective of wood waste management, energy production from waste material, high-quality biochar from waste wood (over 80% carbon), and carbon offsets is demonstrated through the utilization of this plant by addressing some of the major previously problems and challenges faced. The information is useful for techno-economic and life cycle analysis in the next study.

Unveiling a Scaling and Universal Behavior for the Magnetocaloric Effect in Cubic Crystal Structures: A Monte Carlo Simulation.

The magnetocaloric effect and the universal character for the magnetic entropy change regarding the cubic crystal structures (SC, BCC, FCC) were investigated, in a qualitative way, using Monte Carlo simulations. A classical Heisenberg Hamiltonian with nearest neighbors, and next nearest neighbors interactions was implemented. In order to compute the critical temperature of the system depending on the coordination number, it was calculated the dependence of the magnetization and magnetic susceptibility as a function of temperature. Magnetic field dependence on the magnetization for isothermal processes was performed considering a magnetocrystalline anisotropy term. In this way, the magnetic entropy change (ΔSm) was computed. Results show that the rescaled ΔSm as well as the exponent (n) characterizing the field dependence of the magnetic entropy change curves, collapse onto a single curve for the studied crystal structures. By this reason, it can be assured that ΔSm exhibits a universal behavior regarding the strength and contribution of the magnetic exchange energy to the total magnetic energy.

La consulta médica, su tiempo y duración / Medical consultation, time and duration

Resumen: Este es un ensayo en el cual se hace la reflexión sobre el tiempo y la duración de la consulta médica, vistos como procesos sociales que están determinados por macro estructuras, siguiendo la lógica productiva y las demandas del tiempo moderno. La duración de la consulta médica es heterogénea a nivel mundial. Por el contrario, si hay algo en común es la percepción tanto de los profesionales como de los pacientes que el tiempo de interacción es breve, lo cual permea en la relación médico-paciente, perpetuando un ciclo de insatisfacción-tensión-ansiedad en ambos actores. Bajo la premisa de una sociología del tiempo y apelando a los principios éticos de la medicina, proponemos que la estimación en la duración de una consulta considere este recurso como indispensable para una adecuada interacción, teniendo presente las opiniones tanto de los pacientes como de los profesionales en cuanto a sus necesidades de dignidad para la atención y para la prestación de un servicio profesional, ya que ambos tienen derechos y obligaciones a respetarse. Además, las instituciones deberán garantizarlas a fin de preservar una adecuada relación médico-paciente-institución. La organización en los horarios de las jornadas laborales no basta. Es necesario realizar las asignaciones de consulta y tareas correlativas con los tiempos de dedicación necesarios con el objeto de humanizar los procesos, considerando las lógicas sociales y económicas sin ignorar la otredad y la alteridad de los sujetos involucrados.

Abstract: This essay is a reflection of the time and duration of the medical consultation, seen as a social process that is determined by macro structures following the productive logic and the demands of modern time. The length of the medical discussion is heterogeneous worldwide; in contrast, what is standard is the perception of the professionals and the patients that the time for interaction is short. Such a perception pervades the doctor-patient relationship, perpetuating a cycle of dissatisfaction-tension-anxiety in these actors. Under the premise of the sociology of time and appealing to the ethical principles of medicine, we propose that the estimation in the length of a medical consultation must be considered. Time is indispensable for an adequate interaction to account for the needs of patients and professionals in a dignified manner since both have rights and obligations to be respected.

[Resident of emergency attitude towards patients-physician relationship at the Hospital de Clínicas- Asunción, Paraguay]. / Actitud de residentes de urgencias hacia la relación médico-paciente en el Hospital de Clínicas- Asunción, Paraguay.

INTRODUCTION: The doctor-patient relationship is reaching great importance in recent times, is highlighted their importance in areas as varied as satisfaction, compliance, perception of professional competence, the frequency of legal issues relating to malpractice and even the prognosis of the disease or the general health of the patient. OBJECTIVE: To evaluate the doctor-patient relationship from the point of view of residents of emergency unit. METHODS: An observational, descriptive study. The sample consisted of 36 doctors from different areas of the Emergency Rooms of the Hospital de Clínicas- Asunción, Paraguay. The patient-physician relationship was evaluated using an instrument developed by RA Chavarria-Islas et al. with four indicators: Respect, Information, Consent and Dedication. RESULTS: 69.4% of residents have a regular patient-physician relationship; despite the 2.78% has a good relationship, 25% bad relationship and 2.78% a very bad relationship. CONCLUSION: Gaps in doctor-patient relationship were found in this study.. It is interesting to invest greater efforts to enhance the doctor-patient relationship as one of the edges to improve health care, which is vital in emergency care.

Se estudiaron retrospectivamente pacientes con diagnóstico de lupus eritematoso sistémico (LES) de acuerdo a criterios ACR 1982, con nefritis lúpica (NL) durante el período comprendido desde 2005 al 2012 y que fueran sometidos a una biopsia renal repetida. El número total de pacientes con NL atendidos fue de 120, de los cuales 18 (15%) pacientes fueron sometidos a biopsia renal repetida, 18 con 2 biopsias renales y 6 con 3 biopsias. 3 (16,7%) de los pacientes fueron fumadores; 1 (5,6%) poseía antecedentes de DBT previa, 2 (11,1%) poseían antecedentes de HTA; y 3 (16,7%) pacientes tenían obesidad previa. El tiempo de diagnóstico de LES al momento del estudio fue de 96 meses ± 15; el tiempo transcurrido entre la 1° y la 2° biopsia fue de 45 ± 11 meses y el tiempo entre la 2° y 3° biopsia fue de 56 ± 12 meses. Las indicaciones de la biopsia repetida fueron proteinuria en 10 biopsias (41,6%); proteinuria con alteración de la función renal en 2 biopsias (8,3%); proteinuria con sedimento patológico en 8 biopsias (33,3%); y proteinuria con sedimento patológico y alteración de la función renal en 4 biopsias (16,6%). Los cambios histológicos más frecuentes encontrados entre las primeras y las biopsias repetidas fueron: de clase IV a clase III: 2 (8,2%); clase IV a clase IV: 8 (33,3%), clase IV a clase III+V: 2 (8,2%); clase IV a clase IV+V: 3 (12,5%); clase IV a clase V: 2 (8,2%). Los cambios en las biopsias de NL proliferativas con índices de actividad y cronicidad (A/C) fueron: de A a A/C: 7 (29,1%), A/C a A/C: 7 (29,1%). La intensidad de la terapia inmunosupresora aumentó en 79,1%, se mantuvo el tratamiento inmunosupresor en 16.6%. Con respecto al cambio de medicación 7 (20%) pacientes recibieron Ciclofosfamida 1 gr cada 30 días, 9 (26%) Ciclofosfamida 500 mg cada 15 días, 8 (23%) tratamiento de reinducción con Micofenolato mofetil; Rituximab 8 (23%); y 3 (8%) Ciclosporina A. El tratamiento de mantenimiento se realizó con micofenolato mofetil en 23 casos (55%); con azatioprina en 11 (26%) casos; ciclosporina en 3 (7%) oportunidades y rituximab en 5 (12%). En todos los casos se utilizó hidroxicloroquina.

miRNA-155 controls mast cell activation by regulating the PI3Kγ pathway and anaphylaxis in a mouse model.

BACKGROUND: Mast cells (MCs) play a central role in allergic and inflammatory disorders by rapid degranulation and release of inflammatory mediators upon antigen-driven engagement of the FcεRI. Receptor-mediated MC responses are controlled by the activation of different isoforms of phosphoinositide-3-kinase (PI3K) and the downstream signaling processes. Recent evidence suggests that miRNAs are important molecular players regulating the PI3K/Akt pathway. METHODS: The role of miR-155 in the regulation of MC functions in vivo was studied in the passive cutaneous anaphylaxis (PCA) MC-dependent model. WT and miR-155(-/-) mice were injected intradermally with anti-DNP-IgE and intravenously with the antigen DNP-HSA. Ear swelling was assessed to evaluate the anaphylactic response. All investigations, to characterize miR-155 specific activities in MCs, were conducted comparing WT and miR-155(-/-) bone marrow-derived MCs (BMMCs). RESULTS: We report that miR-155(-/-) mice display enhanced anaphylaxis reactions. Although miR-155(-/-) BMMCs show normal development, proliferation, and survival, miR-155 deficiency enhances FcεRI-mediated degranulation and release of TNF-α, IL-13, and IL-6. Interestingly, the level of Akt phosphorylation on both of its regulatory residues Thr308 and Ser473 was increased in miR-155(-/-) compared to WT BMMCs. Gene expression profiling showed that miR-155(-/-) BMMCs exhibited significantly increased expression of the adapter PI3Kγ subunits Pik3r5 (p101) and Pik3r6 (p84, p87(PIKAP) ). Furthermore, selective blockade of the PI3Kγ pathway inhibited degranulation in miR-155(-/-) BMMCs. CONCLUSIONS: Thus, we suggest that miR-155 plays a critical role in FcεRI-mediated MC responses by modulating components of the PI3Kγ pathway. This newly identified mechanism of miRNA-controlled MC activation may affect the initiation and maintenance of allergic disorders.

Vibrios in hatchery cultures of the razor clam, Solen marginatus (Pulteney).

Hatchery culture of the razor clam, Solen marginatus (Pulteney), has recently been developed in Galicia (NW Spain). However, recurrent episodes of mortalities of larval and post-larval cultures have been recorded during the course of various studies. The disease signs were similar to those described for other bivalve species in outbreaks caused by bacteria of the genus Vibrio. In this article, we present the results of microbiological monitoring of two batches of razor clams with different survival rates. All fermentative isolates were identified as members of the Splendidus clade within the genus Vibrio. Some of these isolates, identified as Vibrio splendidus-like, were clearly associated with the batch suffering mortalities, indicating their possible role as pathogens. Similar strains were found in the broodstock, suggesting vertical transmission of these bacteria. This is the first study of the microbiota associated with hatchery culture of S. marginatus, and the results will provide useful information for the optimization of a protocol for hatchery culture of this bivalve species.

La re-resección transuretral puede no ser necesaria en todos los tumores vesicales no músculo-invasivos de alto grado / A Second Transurethral Resection Could Be not Necessary in All High Grade Non-muscle-invasive Bladder Tumors

Objetivo: Evaluar la tasa de persitencia, infraestadificación y complicaciones perioperatorias en pacientes con tumor no músculo-invasivo de alto grado que han sido sometidos a re-resección transuretral (re-RTU). Material y métodos: Revisión retrospectiva de 47 pacientes con estadio clínico de tumor vesical de alto grado no músculo-invasivo sometidos a re-RTU entre enero de 2007 y diciembre de 2009 en nuestro centro. Evaluamos la tasa de tumor residual (persistencia) y de infraestadificación, así como las complicaciones quirúrgicas y el coste de la re-RTU. Resultados: En 22 casos se indicó la re-RTU por ausencia de muscular propia en el espécimen (cTx). Observamos tumor residual en 8/47 pacientes (17%) e infraestadificación en 2 casos (4,2%), en los 2 únicos pacientes infraestadificados no se había observado muscular propia en el espécimen de la RTU inicial. Los 20 cTx restantes (90%), fueron cT0 en la re-RTU. No observamos ningún caso de cT1 en los que en la re-RTU apareciera infraestadiaje (igual o mayor cT2). Seis pacientes (12,6%) presentaron complicaciones secundarias a la re-RTU (una estenosis uretral, 2 reintervenciones por sangrado, una infección urinaria febril y 2 perforaciones vesicales). Conclusiones: En nuestro estudio la ausencia de muscular en el espécimen de la RTU es el único factor de riesgo de infraestadificación. Es por ello que en estos casos consideramos que la re-RTU es obligatoria. Por el contrario, en los casos donde la RTU ha sido completa y la muscular se encuentra libre de tumor (cTa-T1) creemos que la re-RTU sistemática es innecesaria, solo indicada en casos concretos y más no estando exenta de complicaciones (AU)

Objectives: Evaluate the rate of residual tumor, understaging and perioperative complications in patients with high grade non-muscle-invasive bladder cancer who underwent second transurethral resection (re-TUR). Material and methods: A retrospective review of 47 patients with high grade non-muscle-invasive bladder cancer who underwent second TUR from January 2007 to December 2009 at our institution. We evaluated the rate of residual tumor and understaging detected by re-TUR, complications, and the cost of the surgery. Results: Twenty-two patients underwent second TUR because of the absence of muscle in the initial resection specimen (cTx). We observed residual disease in 8/47 patients (17%) and understaging in 2 cases (4.2%), the only 2 patients understaged muscularis propria was not present in the sample of initial TUR. The other 20 cTx (90%) were cT0 in the re-TUR. We did not identify any case of cT1 understaged in the re-TUR (major cT2). Six patients (12.6%) reported complications related with the second TUR (one urethral stricture, two patients required reintervention because of bleeding, one febrile urinary infection and two bladder perforations). Conclusions: Our findings show that the absence of muscle in the initial resection specimen is the only risk factor for understaging. Therefore, we consider re-TUR is mandatory in these cases. On the other hand, when complete TUR has been performed and the muscularis propria is present and tumor free (cTa-T1), we consider systematic re-TUR is not necessary and only indicated in selected patients, even more if we consider that re-TUR is not exempt from complications (AU)

[A second transurethral resection could be not necessary in all high grade non-muscle-invasive bladder tumors]. / La re-resección transuretral puede no ser necesaria en todos los tumores vesicales no músculo-invasivos de alto grado.

OBJECTIVES: Evaluate the rate of residual tumor, understaging and perioperative complications in patients with high grade non-muscle-invasive bladder cancer who underwent second transurethral resection (re-TUR). MATERIAL AND METHODS: A retrospective review of 47 patients with high grade non-muscle-invasive bladder cancer who underwent second TUR from January 2007 to December 2009 at our institution. We evaluated the rate of residual tumor and understaging detected by re-TUR, complications, and the cost of the surgery. RESULTS: Twenty-two patients underwent second TUR because of the absence of muscle in the initial resection specimen (cTx). We observed residual disease in 8/47 patients (17%) and understaging in 2 cases (4.2%), the only 2 patients understaged muscularis propria was not present in the sample of initial TUR. The other 20 cTx (90%) were cT0 in the re-TUR. We did not identify any case of cT1 understaged in the re-TUR (≥cT2). Six patients (12.6%) reported complications related with the second TUR (one urethral stricture, two patients required reintervention because of bleeding, one febrile urinary infection and two bladder perforations). CONCLUSIONS: Our findings show that the absence of muscle in the initial resection specimen is the only risk factor for understaging. Therefore, we consider re-TUR is mandatory in these cases. On the other hand, when complete TUR has been performed and the muscularis propria is present and tumor free (cTa-T1), we consider systematic re-TUR is not necessary and only indicated in selected patients, even more if we consider that re-TUR is not exempt from complications.

Cardiac electrophysiological effects of remifentanil: study in a closed-chest porcine model.

BACKGROUND: Remifentanil has been implicated as causing intraoperative bradyarrhythmias, but little information is available regarding its cardiac electrophysiological effects. Thus, we evaluated the cardiac electrophysiological properties before and after remifentanil in a closed-chest porcine model. METHODS: Eighteen Landrace-Large pigs were premedicated with ketamine and anaesthetized with propofol (4.5 mg kg(-1) bolus followed by 13 mg kg(-1) h(-1)). After instrumentation, an electrophysiological evaluation was performed under propofol and repeated after remifentanil (bolus of 1 microg kg(-1), followed by an infusion of 0.5 microg kg(-1) min(-1)). We evaluated sinus node function [sinus node recovery time (SNRT) and sinoatrial conduction time (SACT)], atrioventricular (AV) nodal function [AH intervals during sinus rhythm (SR) and atrial pacing, Wenckebach cycle length (WCL), and effective refractory periods (ERP)], atrial, His-Purkinje, and ventricular conduction and refractoriness. Significant changes between 'propofol protocol' and 'propofol+remifentanil protocol' were evaluated. RESULTS: Remifentanil caused a significant increase in sinus cycle length (21%, P=0.001) and a significant prolongation of SNRT (43%, P=0.001), corrected SNRT (136%, P=0.003), SACT (40%, P=0.005), AH interval during SR (17%, P=0.02), AH interval during atrial pacing (25%, P=0.01), and ventricular ERP (12%, P=0.004). There was a tendency towards a prolongation of WCL and AV nodal refractoriness. Similar significant changes were observed in a reference group of seven animals in which sevoflurane was used instead of propofol. No significant changes were observed in atrial parameters, His-Purkinje function, parameters of intraventricular conduction, and QT intervals. CONCLUSIONS: Remifentanil depresses sinus node function and most parameters of AV nodal function. This contributes to an explanation for clinical observations of remifentanil-related severe bradyarrhythmias.