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1.
Sci Rep ; 9(1): 5506, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940873

RESUMO

Al-alloys with Si as the main alloying element constitute the vast majority of Al castings used commercially today. The eutectic Si microstructure in these alloys can be modified from plate-like to coral-like by the addition of a small amount of a third element to improve ductility and toughness. In this investigation the effects of Eu and Yb are studied and their influence on the microstructure is compared to further understand this modification. The two elements impact the alloy differently, where Eu modifies Si into a coral-like structure while Yb does not. Atom probe tomography shows that Eu is present within the Si phase in the form of ternary compound Al2Si2Eu clusters, while Yb is absent in the Si phase. This indicates that the presence of ternary compound clusters within Si is a necessary condition for the formation of a coral-like structure. A crystallographic orientation relationship between Si and the Al2Si2Eu phase was found, where the following plane normals are parallel: 011Si//0001Al2Si2Eu, 111Si//6[Formula: see text]10Al2Si2Eu and 011Si//6[Formula: see text]10Al2Si2Eu. No crystallographic relationship was found between Si and Al2Si2Yb. The heterogeneous formation of coherent Al2Si2Eu clusters inside the Si-phase is suggested to trigger the modification of the microstructure.

2.
Rev Sci Instrum ; 88(6): 063306, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28667984

RESUMO

For the synthesis of high-quality thin films, ion-beam assisted deposition (IBAD) is a frequently used technique providing precise control over several substantial film properties. IBAD typically relies on the use of a broad-beam ion source. Such ion sources suffer from the limitation that they deliver a blend of ions with different ion masses, each of them possessing a certain distribution of kinetic energy. In this paper, a compact experimental setup is presented that enables the separate control of ion mass and ion kinetic energy in the region of hyperthermal energies (few 1 eV - few 100 eV). This ion energy region is of increasing interest not only for ion-assisted film growth but also for the wide field of preparative mass spectrometry. The setup consists of a constricted glow-discharge plasma beam source and a tailor-made, compact quadrupole system equipped with entry and exit ion optics. It is demonstrated that the separation of monoatomic and polyatomic nitrogen ions (N+ and N2+) is accomplished. For both ion species, the kinetic energy is shown to be selectable in the region of hyperthermal energies. At the sample position, ion current densities are found to be in the order of 1 µA/cm2 and the full width at half maximum of the ion beam profile is in the order of 10 mm. Thus, the requirements for homogeneous deposition processes in sufficiently short periods of time are fulfilled. Finally, employing the described setup, for the first time in practice epitaxial GaN films were deposited. This opens up the opportunity to fundamentally study the influence of the simultaneous irradiation with hyperthermal ions on the thin film growth in IBAD processes and to increase the flexibility of the technique.

3.
J Orofac Orthop ; 76(2): 164-74, 2015 Mar.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-25744094

RESUMO

OBJECTIVES: Permanent retention is currently the method of choice to stabilize orthodontic treatment results. Frequently, permanent retention schemes are adopted to prevent posttreatment changes in the esthetic zone of the anterior teeth. With increasingly prolonged times of intraoral device use, and retention to be provided in the maxilla despite limited space, the demands placed on well-planned and precise retainer positioning are becoming more exacting. The aim of the present study was to analyze the intraoral precision of lingual retainers made using computer-aided design and machining (CAD/CAM). MATERIALS AND METHODS: A custom manufacturer (Retaintechnology; Cologne, Germany) employing innovative CAD/CAM technology was commissioned to fabricate 16 lingual retainers. Following intraoral insertion using the manufacturer's recommended transfer system, impressions of the intraoral situations were taken and scanned for digitization. On this basis, the intraoral retainer positions were compared to the preceding virtual setups by superimposition with the manufacturer's datasets. Three-dimensional processing software (Geomagic Qualify 2012; Geomagic) was used to analyze the retainers, based on a total of 80 interproximal sites, for deviations from their planned positions along the horizontal (x-), sagittal (y-), and vertical (z-) axes. These deviations of the achieved from the intended positions were considered clinically relevant if ≥ 0.5 mm and, based on this premise, were subjected to a t-test with statistical software (Prism; GraphPad). RESULTS: The intraoral retainer positions were found to correlate closely with the preceding virtual setups (i.e., the positions as they had been planned by the custom manufacturer). Positional deviations were significantly less than 0.5 mm. They were very small in the horizontal and sagittal planes and moderately larger in the vertical plane. CONCLUSION: Highly precise intraoral results may be achieved by transferring three-dimensional virtual setups for lingual retainers to the actual patients. This CAD/CAM strategy of making retainers can offer high predictability even in anatomically demanding regions and in the presence of limited space.


Assuntos
Desenho Assistido por Computador , Retenção em Prótese Dentária/instrumentação , Desenho de Aparelho Ortodôntico/métodos , Contenções Ortodônticas , Ajuste de Prótese/métodos , Simulação por Computador , Análise de Falha de Equipamento/métodos , Imageamento Tridimensional/métodos , Modelos Teóricos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Língua
4.
Urologe A ; 53(12): 1812-4, 2014 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-25406371

RESUMO

In Germany, overactive bladder (OAB) syndrome affects around 6.5 million people over the age of 40. The primary treatment consists of anticholinergics or beta-3-receptor agonists. After an anticholinergic treatment period of around 4 months, compliance is around 40%, which is probably due a larger proportion of nonresponders. One condition of an efficient medication treatment is the presence of detrusor overactivity (DO). However, the detection rate of DO during standard urodynamics is very low. The primary goal in the future is to target OAB treatment by detection of DO. Using the Wille Capsule (WiCa) in an in vitro model, DO could be detected over a time period of 72 h, which would ensure a higher compliance to the OAB treatment in a positive way.


Assuntos
Antagonistas Colinérgicos/uso terapêutico , Técnicas de Diagnóstico Urológico/instrumentação , Monitoramento de Medicamentos/instrumentação , Manometria/instrumentação , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/tratamento farmacológico , Monitoramento de Medicamentos/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Estudos Longitudinais , Manometria/métodos , Monitorização Ambulatorial/instrumentação , Avaliação de Resultados em Cuidados de Saúde/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do Tratamento , Urodinâmica
6.
Br J Anaesth ; 111(2): 264-70, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23482999

RESUMO

BACKGROUND: Ilioinguinal (IL) and iliohypogastric (IH) nerve blocks are used in patients with chronic postherniorrhaphy pain. The present study tested the hypothesis that our method, previously developed in cadavers, blocks the nerves separately and selectively in human volunteers. METHODS: We blocked the IL and the IH nerves in 16 volunteers in a single-blinded randomized cross-over setting under direct ultrasound visualization, by injecting two times the ED95 volume of 1% mepivacaine needed to block a peripheral nerve. The anaesthetized skin areas were tested by pinprick and marked on the skin. A digital photo was taken. For further analysis, the parameterized picture data were transformed into a standardized and unified coordinate system to compare and calculate the overlap of the anaesthetized skin areas of the two nerves on each side. An overlap <25% was defined as selective block. RESULTS: Fifty nerve blocks could be analysed. The mean volume injected to block a single nerve was 0.9 ml. Using ultrasound, we observed spread from one nerve to the other in 12% of cases. The overlap of the anaesthetized skin areas of the nerves was 60.3% and did not differ after exclusion of the cases with visible spread of local anaesthetic from one nerve to the other. CONCLUSIONS: The IL and IH nerves cannot be selectively blocked even if volumes below 1 ml are used. The most likely explanation is the spread of local anaesthetic from one nerve to the other, although this could not be directly observed in most cases.


Assuntos
Plexo Hipogástrico/diagnóstico por imagem , Bloqueio Nervoso/métodos , Nervos Periféricos/efeitos dos fármacos , Nervos Periféricos/diagnóstico por imagem , Adolescente , Adulto , Anestésicos Locais/administração & dosagem , Estudos Cross-Over , Feminino , Humanos , Canal Inguinal/diagnóstico por imagem , Canal Inguinal/inervação , Plexo Lombossacral/diagnóstico por imagem , Masculino , Mepivacaína/administração & dosagem , Pessoa de Meia-Idade , Método Simples-Cego , Ultrassonografia , Adulto Jovem
7.
Br J Anaesth ; 111(2): 197-208, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23512864

RESUMO

BACKGROUND: In open TCI and anaesthesia display systems, the choice of pharmacokinetic (PK) parameter sets of opioids is clinically relevant. Accuracy and bias of the PK models may be affected by administration mode and the co-administered hypnotic drug. We retrospectively evaluated the performance of eight PK parameter sets for alfentanil in two data sets (infusion and bolus application). METHODS: With the dosing history from two studies in orthopaedic patients anaesthetized with propofol or inhalation anaesthetics the alfentanil plasma concentration over time was calculated with eight PK parameter sets. Median absolute performance error (MDAPE), log accuracy, median performance error (MDPE), log bias, Wobble, and Divergence were computed. Mann-Whitney rank test with Bonferroni correction was used for comparison between bolus and infusion data, repeated measures analysis of variance on ranks was used for comparison among parameter sets. RESULTS: The parameters by Scott (original and weight adjusted) and Fragen had a MDAPE ≤30% and a median log accuracy <0.15 independent of the administration mode, while MDPE was within ±20% and log bias nearly within ±0.1, respectively. The sets by Maitre and Lemmens were within these limits only in the bolus data. All other parameter sets were outside these limits. CONCLUSIONS: In healthy orthopaedic patients, the PK parameters by Scott and by Maitre were equally valid when alfentanil was given as repeated boluses. When given as infusion, the Maitre parameters were less accurate and subject to a significant bias. We cannot exclude that the difference between bolus and infusion is partially because of the different hypnotics used.


Assuntos
Alfentanil/farmacocinética , Anestesia Intravenosa/métodos , Anestésicos Intravenosos/farmacocinética , Terminais de Computador , Adulto , Idoso , Idoso de 80 Anos ou mais , Alfentanil/administração & dosagem , Alfentanil/sangue , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/sangue , Feminino , Humanos , Bombas de Infusão , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
8.
Bone Marrow Transplant ; 47(6): 791-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21946379

RESUMO

HLA class I molecules participate in natural killer cell regulation by acting as ligands for inhibitory killer cell Ig-like receptors (KIRs). One individual may express one or more inhibitory KIR lacking the corresponding HLA ligand. The role of this 'missing KIR ligand' constellation in hematopoietic SCT (HSCT) remains controversial and depends on incompletely defined transplant variables. We have retrospectively analyzed the effects of missing HLA-C group 1/2 and Bw4 KIR ligands in the recipients on the outcome in 382 HSCT, comparing 118 BMT to 264 PBSC transplants (PBSCT). In the multivariate Cox analysis of PBSCT, poor PFS was observed in homozygous HLA-C group 2 (C2/2) recipients (risk ratio (RR), 1.59; P=0.026). In contrast, C2 homozygosity was not unfavorable after BMT (RR, 0.68; P=0.16). C2 homozygous recipients (n=68) had better PFS after BMT than after PBSCT (RR, 0.17; P=0.001), due to fewer relapses (RR, 0.27; P=0.018). Missing Bw4 favorably influenced PFS after BMT (RR, 0.56; P=0.04), but not after PBSCT. These data suggest opposite effects of missing KIR ligands in BMT vs PBSCT. Larger studies are required to reassess whether BMT should be preferred to PBSCT as an option for C2/C2 recipients.


Assuntos
Transplante de Medula Óssea , Medula Óssea , Antígenos HLA-C , Receptores KIR , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Ligantes , Masculino , Pessoa de Meia-Idade , Transplante de Células-Tronco de Sangue Periférico , Estudos Retrospectivos , Transplante Homólogo
9.
Anaesthesia ; 66(8): 715-20, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21692759

RESUMO

We evaluated a novel, sled-mounted needle guide for ultrasound-guided vessel cannulation. Fifty medical students were randomly assigned to use ultrasound with the sled (sled group, n = 23) or ultrasound without the sled (control group, n = 27) for vessel cannulation in a phantom. For each of 15 attempts we recorded cannulation time and designated a successful cannulation as 1 and a failure as 0. Our primary outcome was the mean overall success rate. The median (IQR [range]) number of successes in the sled group and control group were 15.0 (13.0-15.0 [11.0-15.0]) and 11.0 (9.0-13.0 [6.0-15.0]), respectively (p < 0.001). Cannulation time decreased from the first to the last attempt in the sled group from 7.0 s (6.0-10.0 [4.0-16]) s to 4.0 s (3.0-4.0 [1.0-6.0]) s and in the control group from 35.0 s (27.0-35.0 [11.0-35.0]) s to 7.0 s (5.0-10.0 [3.0-25.0]) s. The sled group demonstrated a shorter cannulation time at each attempt (p < 0.001). The novel sled improved the success rate and efficiency of ultrasound-guided phantom vessel cannulation.


Assuntos
Cateterismo Periférico/instrumentação , Ultrassonografia de Intervenção/instrumentação , Adulto , Anestesiologia/educação , Cateterismo Periférico/métodos , Competência Clínica , Educação de Graduação em Medicina/métodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Agulhas , Imagens de Fantasmas , Adulto Jovem
11.
Ann Hepatol ; 9(1): 23-32, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20308719

RESUMO

OBJECTIVE: To evaluate the survival benefit of multimodal therapy for the treatment of HCC. BACKGROUND: Orthotopic liver transplantation (OLT) is considered the treatment of choice for selected patients with hepatocellular carcinoma (HCC). However, donor organ shortages and patients whose HCCs exceed OLT criteria require consideration of alternate therapeutic options such as hepatic resection, radiofrequency ablation (RFA), ethanol injection (EI), transarterial chemoembolization (TACE), and chemotherapy (CTX). This study was performed to evaluate the survival benefit of multimodal therapy for treatment of HCC as complementary therapy to OLT. METHODS: A retrospective review was conducted of HCC patients undergoing therapy following multidisciplinary review at our institution from 1996 . 2006 with a minimum of a 2 year patient follow-up. Data were available on 247/252 patients evaluated. Relevant factors at time of diagnosis included symptoms, hepatitis B (HBV) and C (HCV) status, antiviral therapy, Child-Pugh classification, portal vein patency, and TNM staging. Patients underwent primary treatment by hepatic resection, RFA, EI, TACE, CTX, or were observed (best medical management). Patients with persistent or recurrent disease following initial therapy were assessed for salvage therapy. Survival curves and pairwise multiple comparisons were calculated using standard statistical methods. RESULTS: Mean overall survival was 76.8 months. Pairwise comparisons revealed significant mean survival benefits with hepatic resection (93.2 months), RFA (66.2 months), and EI (81.1 months), compared with TACE (47.4 months), CTX (24.9 months), or observation (31.4 months). Shorter survival was associated with symptoms, portal vein thrombus, or Child-Pugh class B or C. HCV infection was associated with significantly shorter survival compared with HBV infection. Antiviral therapy was associated with significantly improved survival in chronic HBV and HCV patients only with earlier stage disease. CONCLUSION: Multimodal therapy is effective therapy for HCC and may be used as complementary treatment to OLT.


Assuntos
Carcinoma Hepatocelular/terapia , Terapias Complementares , Neoplasias Hepáticas/terapia , Transplante de Fígado , Idoso , Carcinoma Hepatocelular/mortalidade , Ablação por Cateter , Quimioembolização Terapêutica , Terapia Combinada , Tratamento Farmacológico , Etanol/administração & dosagem , Feminino , Hepatectomia , Humanos , Injeções , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
12.
Ann Hepatol ; 8(4): 396-9, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20009144

RESUMO

Hepatic artery thrombosis (HAT) is relatively infrequent, but possibly a devastating complication of orthotopic liver transplantation (OLT). It often requires urgent retransplantation. Two main forms of HAT are recognized as early and late HAT (diagnosis within or after 30 days following LT). Early HAT typically results in graft failure. Late HAT features biliary obstruction, cholangitis, and hepatic abscess formation. We report here the case of a patient of Wilson's disease who presented twelve years post-liver transplant symptoms typical of acute HAT and hepatic infarction. On diagnostic imaging, celiac axis and hepatic artery were thrombosed, resulting in ischemic necrosis of the left hepatic lobe. The resulting sepsis and transient hepatic insufficiency were managed conservatively, and repeat OLT was avoided. The patient remains stable more than one year later. To the best of our knowledge this case report is unique in the literature for the unusually long interval between OLT and late acute HAT, as well as celiac and portal vein occlusion. The acute presentation of sub massive hepatic necrosis is also uncharacteristic of late HAT and more typical of acute HAT. This report describes our experience in managing this and a literature review of the topic.


Assuntos
Artéria Celíaca , Artéria Hepática , Infarto/etiologia , Transplante de Fígado , Fígado/irrigação sanguínea , Veia Porta , Trombose/complicações , Adulto , Humanos , Infarto/diagnóstico , Fígado/diagnóstico por imagem , Masculino , Trombose/diagnóstico , Tomografia Computadorizada por Raios X
13.
Surg Endosc ; 23(6): 1198-203, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19263133

RESUMO

BACKGROUND: Over the past decade there has been an increasing trend toward minimally invasive liver surgery. Initially limited by technical challenges, advances in laparoscopic techniques have rendered this approach safe and feasible. However, as health care costs approach 50% of some provincial budgets, surgical innovation must be justifiable in costs and patient outcomes. With introduction of standardized postoperative liver resection guidelines to optimize patient hospital length of stay, the advantages of laparoscopic liver resection (LLR) compared with open liver resection (OLR) measured by perioperative outcomes and resource utilization are not well defined. It remains to be established whether LLR is superior to OLR by these measurements. METHODS: Eighteen LLRs performed at the Vancouver General Hospital from 2005 to 2007 were prospectively analyzed. These data were compared with an equivalent group of 12 consecutive OLRs undertaken immediately prior to the introduction of LLR. Outcomes were evaluated for differences in perioperative morbidity, hospital length of stay, and operative costs. RESULTS: There were no differences between LLRs and OLRs in demographics, pathology, cirrhosis, tumour location or extent of resection. There were no deaths. LLRs had significantly decreased intraoperative blood loss (287 ml versus 473 ml, p = 0.03), postoperative complications (6% versus 42%, p = 0.03), and length of stay (4.3 versus 5.8 days, p = 0.01) compared with OLRs. There were no differences in operating time for LLRs compared to OLRs (135 min versus 138 min, respectively), total time in the operating theatre (214 min versus 224 min), or costs related to stapler/trocar devices (CA $1267 versus CA $1007). CONCLUSIONS: LLR is associated with decreased morbidity and decreased resource utilization compared with OLR. Perioperative patient outcomes and cost-effectiveness justify LLR despite introduction of standardized postoperative liver resection guidelines and decreased length of stay for OLR.


Assuntos
Hepatectomia/métodos , Laparoscopia/métodos , Laparotomia/métodos , Hepatopatias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Hepatectomia/economia , Humanos , Laparoscopia/economia , Laparotomia/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
14.
Bone Marrow Transplant ; 43(10): 787-91, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19079312

RESUMO

Activated cytotoxic T lymphocytes and natural killer cells, which are involved in the pathogenesis of GVHD and viral infections after SCT produce granzymes (Grs). This study performed an ELISA in the serum of 86 patients at various time points before and after Allo-SCT to investigate GrA and GrB levels as potential markers for these serious complications. The increase in Gr levels from the day of transplantation until the appearance of the complication was highly predictive. If GrA increased to three times its pretransplant level, the cumulative incidence of developing acute GVHD was 73% and for CMV infection 68%, in comparison with 45 and 35%, respectively, for patients without these complications. A strong increase in GrA level correlated with clinical severity of acute GVHD. No correlation was observed with early relapse or long-term overall survival. In addition to clinical parameters, a strong increase in GrA levels was identified as an independent marker for the occurrence of acute GVHD as well as for CMV infection. Similar effects were observed with GrB. In conclusion, Gr protein levels can also be used as a marker for complications after Allo-SCT.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Doença Enxerto-Hospedeiro/diagnóstico , Granzimas/sangue , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Valor Preditivo dos Testes , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Infecções por Citomegalovirus/sangue , Doença Enxerto-Hospedeiro/sangue , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/terapia , Humanos , Incidência , Pessoa de Meia-Idade , Fatores de Tempo , Transplante Autólogo , Adulto Jovem
15.
Clin Exp Immunol ; 148(3): 520-8, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17493020

RESUMO

To define the role of quantitative graft composition and donor killer-cell immunoglobulin-like receptor (KIR) genotype in clinical outcome following unmanipulated peripheral blood stem cell transplantation (PBSCT) from human leucocyte antigen (HLA)-identical siblings, 43 consecutive transplants for haematological malignancies were analysed retrospectively. Twenty-four patients underwent myeloablative conditioning and 19 received busulphan/fludarabine-based reduced intensity conditioning (RIC). In patients with acute myelogenous leukaemia or myelodysplastic syndrome (AML/MDS; n = 18), no relapse occurred following transplants meeting both a high (above median) natural killer (NK) cell count and missing HLA-ligand(s) to donor's KIR(s), compared to all other AML/MDS patients (0% versus 44%; P = 0.049). Missing HLA-B and/or HLA-C ligand combined with missing HLA-A3/11 (KIR3DL2 unblocked) predicted for reduced relapse incidence regardless of diagnosis or conditioning type (P = 0.028). Moreover, in AML/MDS patients, this constellation predicted superior overall survival (OS) (P = 0.046). Transplants with more than two different activating donor KIRs were associated with an increased risk for non-relapse mortality (NRM), both by univariate and multivariate analysis. Quantitative graft composition had a significant impact exclusively in RIC transplants. Here, a trend towards reduced relapse incidence was found in patients receiving high numbers of NK cells (16% versus 54%; P = 0.09). In patients receiving high versus low T cell numbers, OS was superior (83% versus 37%; P = 0.01), due mainly to reduced NRM (0% versus 33%; P = 0.046). By multivariate analysis, relapse risk was decreased significantly in patients receiving high NK cell numbers (P = 0.039). These data suggest that both the number of transplanted NK cells and the donor KIR genotype play a role in graft-versus-malignancy mechanisms in HLA-identical PBSCT.


Assuntos
Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/métodos , Células Matadoras Naturais/transplante , Receptores Imunológicos/genética , Doença Aguda , Doença Crônica , Infecções por Citomegalovirus/imunologia , Feminino , Genótipo , Doença Enxerto-Hospedeiro/imunologia , Doença Enxerto-Hospedeiro/terapia , Efeito Enxerto vs Tumor/genética , Neoplasias Hematológicas/imunologia , Teste de Histocompatibilidade , Humanos , Ligantes , Contagem de Linfócitos , Masculino , Infecções Oportunistas/imunologia , Receptores KIR , Receptores KIR3DL2 , Recidiva , Estudos Retrospectivos , Análise de Sobrevida , Condicionamento Pré-Transplante/métodos , Resultado do Tratamento
16.
Eur J Anaesthesiol ; 23(8): 691-9, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16805935

RESUMO

BACKGROUND: Short-acting agents for neuromuscular block (NMB) require frequent dosing adjustments for individual patient's needs. In this study, we verified a new closed-loop controller for mivacurium dosing in clinical trials. METHODS: Fifteen patients were studied. T1% measured with electromyography was used as input signal for the model-based controller. After induction of propofol/opiate anaesthesia, stabilization of baseline electromyography signal was awaited and a bolus of 0.3 mg kg-1 mivacurium was then administered to facilitate endotracheal intubation. Closed-loop infusion was started thereafter, targeting a neuromuscular block of 90%. Setpoint deviation, the number of manual interventions and surgeon's complaints were recorded. Drug use and its variability between and within patients were evaluated. RESULTS: Median time of closed-loop control for the 11 patients included in the data processing was 135 [89-336] min (median [range]). Four patients had to be excluded because of sensor problems. Mean absolute deviation from setpoint was 1.8 +/- 0.9 T1%. Neither manual interventions nor complaints from the surgeons were recorded. Mean necessary mivacurium infusion rate was 7.0 +/- 2.2 microg kg-1 min-1. Intrapatient variability of mean infusion rates over 30-min interval showed high differences up to a factor of 1.8 between highest and lowest requirement in the same patient. CONCLUSIONS: Neuromuscular block can precisely be controlled with mivacurium using our model-based controller. The amount of mivacurium needed to maintain T1% at defined constant levels differed largely between and within patients. Closed-loop control seems therefore advantageous to automatically maintain neuromuscular block at constant levels.


Assuntos
Anestesiologia/instrumentação , Sistemas de Liberação de Medicamentos/instrumentação , Isoquinolinas/administração & dosagem , Modelos Teóricos , Bloqueio Neuromuscular/instrumentação , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Adulto , Sistemas de Liberação de Medicamentos/efeitos adversos , Eletromiografia , Desenho de Equipamento , Feminino , Fentanila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Mivacúrio , Bloqueio Neuromuscular/métodos , Piperidinas/administração & dosagem , Propofol/administração & dosagem , Remifentanil , Reprodutibilidade dos Testes , Segurança , Fatores de Tempo , Resultado do Tratamento
17.
Anaesthesist ; 54(10): 1021-31, 2005 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-15977038

RESUMO

Contrary to the situation in "classical" clinical pharmacology, non-steady state phenomena play a fundamental role for clinical pharmacology in anesthesia. Their understanding is of tantamount importance for the safe and efficient application of drugs relevant to anesthesia. Concepts like optimised target-controlled infusion (TCI), effect compartment targeting and the small margin of error tolerable during maintained spontaneous ventilation, force the anesthesiologist to acquire a firm understanding of the difference between the concentration time course at the effect side vs. time course of the plasma concentration. The underlying concepts, their application for the rational use of muscle relaxants, propofol with TCI systems, volatile anaesthetics and opioids will be discussed.


Assuntos
Anestésicos/farmacologia , Anestésicos/farmacocinética , Algoritmos , Anestesia , Anestésicos/efeitos adversos , Animais , Sistemas de Liberação de Medicamentos , Meia-Vida , Humanos , Infusões Intravenosas
18.
Br J Anaesth ; 92(6): 800-7, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15096447

RESUMO

BACKGROUND: We developed a model-based control system using end-tidal carbon dioxide fraction (FE'(CO(2))) to adjust a ventilator during clinical anaesthesia. METHODS: We studied 16 ASA I-II patients (mean age 38 (range 20-59) yr; weight 67 (54-87) kg) during i.v. anaesthesia for elective surgery. After periods of normal ventilation the patients were either hyper- or hypoventilated to assess precision and dynamic behaviour of the control system. These data were compared with a previous group where a fuzzy-logic controller had been used. Responses to different clinical events (invalid carbon dioxide measurement, limb tourniquet release, tube cuff leak, exhaustion of carbon dioxide absorbent, simulation of pulmonary embolism) were also noted. RESULTS: The model-based controller correctly maintained the setpoint. No significant difference was found for the static performance between the two controllers. The dynamic response of the model-based controller was more rapid (P<0.05). The mean rise time after a setpoint increase of 1 vol% was 313 (sd 90) s and 142 (17) s for fuzzy-logic and model-based control, respectively, and after a 1 vol% decrease was 355 (127) s and 177 (36) s, respectively. The new model-based controller had a consistent response to clinical artefacts. CONCLUSION: A model-based FE'(CO(2)) controller can be used in a clinical setting. It reacts appropriately to artefacts, and has a better dynamic response to setpoint changes than a previously described fuzzy-logic controller.


Assuntos
Modelos Biológicos , Monitorização Intraoperatória/métodos , Respiração Artificial/instrumentação , Adolescente , Adulto , Anestesia Intravenosa , Artefatos , Dióxido de Carbono/fisiologia , Criança , Desenho de Equipamento , Retroalimentação , Feminino , Lógica Fuzzy , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Respiração Artificial/métodos
19.
J Hematother Stem Cell Res ; 11(1): 119-25, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11847008

RESUMO

Angiogenesis is of prognostic importance not only in solid tumors but also in malignant blood diseases. We measured levels of vascular endothelial growth factor (VEGF), angiogenin (ANG), and basic fibroblast growth factor (bFGF) in peripheral blood samples from 65 patients with myelodysplastic syndrome (MDS), from 25 patients with de novo acute myeloid leukemia (AML), and from 50 healthy donors. In matched samples, VEGF levels in serum were substantially higher than VEGF levels in plasma (380.7 +/- 56 pg/ml vs. 45.3 +/- 4.5 pg/ml, mean +/- SEM, p < 0.001), whereas serum and plasma levels of ANG were comparable and significantly correlated (r = 0.8; p < 0.01). Compared to normal controls (1.3 +/- 0.09 pg), serum levels of VEGF corrected for the peripheral blood platelet count (VEGF/10(6) platelets, VEGF(PLT)) were elevated in patients with refractory anemia (RA; 3.1 +/- 0.8 pg, p < 0.01), and reached maximal values in patients with advanced stage MDS (RAEB, RAEB-t) (3.5 +/- 0.6 pg, p < 0.001), de novo AML (3.6 +/- 1.1 pg, p < 0.05), and chronic myelomonocytic leukemia (CMML; 3.7 +/- 0.9 pg; p < 0.001). Levels of soluble ANG were elevated in RA (351 +/- 25.7 ng/ml, p < 0.001), in RAEB/RAEB-t (402 +/- 17.9 ng/ml; p < 0.001), in CMML (413.8 +/- 29.5 ng/ml; p < 0.001), and in patients with AML (305.1 +/- 17.1 ng/ml; p < 0.01, controls 255.4 +/- 8.1 ng/ml). Serum bFGF was neither elevated in MDS nor in AML patients. These results suggest that VEGF(PLT) is a marker of disease progression in MDS. Moreover, we show for the first time that elevated blood levels of ANG can be found in patients with myeloid malignancies, suggesting a role of ANG in the pathogenesis of these diseases.


Assuntos
Fatores de Crescimento Endotelial/sangue , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Leucemia Mieloide/sangue , Linfocinas/sangue , Síndromes Mielodisplásicas/sangue , Ribonuclease Pancreático/sangue , Doença Aguda , Estudos de Casos e Controles , Progressão da Doença , Fatores de Crescimento Endotelial/metabolismo , Feminino , Fator 2 de Crescimento de Fibroblastos/sangue , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Leucemia Mieloide/diagnóstico , Leucemia Mieloide/etiologia , Linfocinas/metabolismo , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/diagnóstico , Síndromes Mielodisplásicas/etiologia , Proteínas de Neoplasias/sangue , Proteínas de Neoplasias/metabolismo , Solubilidade , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio Vascular
20.
Plant Physiol ; 127(2): 416-25, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11598217

RESUMO

Elucidation of the mechanisms involved in long-distance water transport in trees requires knowledge of the water distribution within the sapwood and heartwood of the stem as well as of the earlywood and latewood of an annual ring. X-ray computed tomography is a powerful tool for measuring density distributions and water contents in the xylem with high spatial resolution. Ten- to 20-year-old spruce (Picea abies L. KARST.) and oak (Quercus robur) trees grown in the field were used throughout the experiments. Stem and branch discs were collected from different tree heights, immediately deep frozen, and used for the tomographic determinations of spatial water distributions. Results are presented for single-tree individuals, demonstrating heartwood and sapwood distribution throughout their entire length as well as the water relations in single annual rings of both types of wood. Tree rings of the sapwood show steep water gradients from latewood to earlywood, whereas those of the heartwood reflect water deficiency in both species. Although only the latest two annual rings of the ringporous species are generally assumed to transport water, we found similar amounts of water and no tyloses in all rings of the oak sapwood, which indicates that at least water storage is important in the whole sapwood.


Assuntos
Picea/fisiologia , Quercus/fisiologia , Transporte Biológico , Densitometria , Modelos Biológicos , Caules de Planta/fisiologia , Tomografia Computadorizada por Raios X/métodos , Árvores/fisiologia , Água/metabolismo
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