Spectroscopic observation of neutral carbon during photodissociation of explosive-related compounds in the vapor phase.

We perform time-resolved laser-induced fluorescence measurements of mononitrotoluenes (MNTs) and dinitrotoluenes (DNTs) in nitrogen and air. We observe the multipeak emission spectrum of NO and find that the emission peak intensity in the 247-248 nm range is stronger than expected compared to the other NO emission peak intensities. This increased emission intensity is believed to be due to neutral carbon [C(I)], which has a strong emission peak at 247.85 nm. By comparing the ratios of integrated emission peak intensities with those expected from the Franck-Condon factors for NO, we are able to identify samples that exhibit C(I) emission. We show that the DNTs exhibit C(I) emission for gate delays of 1500 ns and beyond, while the MNTs exhibit C(I) emission for gate delays of only up to about 500 ns. Carbon deposits in the analysis chamber confirm the presence of C. Ambient NO in air enhances the observed NO+C(I) signal from MNTs and DNTs.

Logistics and strategy of multiorgan procurement involving total face allograft.

The face is the latest body structure to be added to the field of transplantation and the learning curve is ongoing. In the scenario of multiorgan recovery, the face is a nonvital 'organ' structure compared with other life-saving organs. To date, the face has been the first 'organ' to be procured in a multiorgan procurement. A technique for simultaneous recovery of the whole face, heart, lungs, liver, pancreas and kidneys is described. Thirty professionals participated in the procedure, of whom 13 were surgeons. No tracheotomy was performed. A mask of the donor's face was made from a mold impression. Duration of the procedure from skin incision to the end of surgery was 7.3 h. The face was perfused with Wisconsin solution through a cannula inserted into the aortic arch between the origin of the brachiocephalic arterial trunk and the left subclavian artery. Blood requirements consisted of 4 units of packed red blood cells. After the procedure, the mask was placed on the donor's face. All recovered grafts functioned immediately. In summary, simultaneous multiorgan procurement including the whole face is feasible, effective and saves time without jeopardizing life-saving organs and without the need for tracheotomy.

Treatment of symptomatic epiblepharon with Botulinum toxin type A in patients under 2years of age. / Experiencia del uso de la toxina botulínica tipo A para el tratamiento sintomático del epiblefaron en pacientes menores de 2 años.

INTRODUCTION: Epiblepharon is a congenital eyelid malposition due to a horizontal skin fold and a redundant orbicular muscle, resulting in the inward positioning of the eyelashes. OBJECTIVE: Personal experience is presented of the non-surgical correction of symptomatic epiblepharon using a pretarsal injection of 5 IU of botulinum toxin type A (BoNT-A) into the orbicular muscle. MATERIAL AND METHODS: Patients with epiblepharon younger than 2 year were included in the study. A review was made of their clinical charts and the symptoms and signs of epiblepharon were evaluated before and after treatment with BoNT-A. RESULTS: A total of 40 patients were included (28 girls [70%]). The mean age at treatment was 11 months (range, 4-24 months). A total of 76 eyelids were treated with BoNT-A. A statistically significant improvement in symptoms, lash-corneal touch, and punctate corneal epitheliopathy were reported after the treatment with 5IU BoNT-A. The mean final follow-up was 25.5 weeks (range, 4-92 months). CONCLUSIONS: The present study provides evidence that a pretarsal BoNT-A injection is an effective and safe treatment for the correction of symptomatic epiblepharon in patients younger than 2 years of age.

Vibrational fundamental and overtone spectra of C2H4 in cryogenic liquid solutions.

Vibrational Fundamental and overtone transitions of C2H4 around the Δυ = 1-3 in liquid Ar, Kr, Xe and N2 solutions have been obtained using a low temperature cryostat and a Fourier transform infrared spectrophotometer for wavenumbers between 800 and 10,000 cm-1. The visible CH spectra for Δυ = 6 of ethylene in cryogenic solutions of the same solvents and liquid ethane have been measured with a low temperature cell and the thermal lens technique. Spectra in solutions show great simplification of the bands with respect to gas phase absorption bands. Assignments have been made based on gas phase transitions. Peak positions (ν), wavenumber shifts (Δν), and full widths at half maximum (Δω1/2) are reported. Changes of C2H4 frequencies in liquid Ar, Kr, and Xe seem to correlate with an increase in molar volume, dielectric constant, temperature, and polarizability of the solvents. Influence of the solvent on some fundamental vibrational frequencies are explored using the Onsager model and the polarizable continuum model (PCM). When used in conjunction with calculated anharmonic frequencies, the PCM model shows qualitative agreement with frequency shifts.

Use of emergency medical transport and impact on time to care in patients with ischaemic stroke. / Utilización de transporte sanitario urgente por los pacientes con ictus isquémico e impacto en los tiempos de atención.

INTRODUCTION: According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays. OBJECTIVES: To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care. METHODS: We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively. Data were obtained from the patients' medical histories and interviews with the patients themselves or their companions. We studied the following variables: previous health status, stroke symptoms and severity (NIHSS), type of transport, and time to medical care. Univariate and multivariate analyses were performed to identify factors associated with use of EMS and care delays. RESULTS: Patients transported to hospital by the EMS accounted for 47.2% of the total. Greater stroke severity, arriving at the hospital at night, and poor functional status at baseline were found to be independently associated with use of EMS. Use of EMS was linked to earlier arrival at the hospital. Door-to-imaging times were shorter in the EMS group; however, this association disappeared after adjusting for stroke severity. Revascularisation was more frequent among patients transported by the EMS. CONCLUSIONS: EMS transport was associated with shorter prehospital delays. Effective health education programmes should be developed to promote EMS transport for patients with stroke symptoms. In-hospital stroke management should also be improved to reduce time to medical care.

[Relationship between level of education and one-year survival after ischaemic stroke]. / Relacion del nivel de estudios con la supervivencia en el primer año tras un ictus isquemico.

INTRODUCTION: The relationship between socioeconomic status and incidence or stroke mortality rates is well established. The evidence of an association between this variable and survival is less conclusive. Level of education is a widely-used measure of socioeconomic status in elderly people. AIM: To assess the relationship between one-year survival after stroke and level of education. PATIENTS AND METHODS: We analysed data on 544 consecutively recruited patients admitted for acute ischaemic stroke in one the public hospitals of Bizkaia (Spain). Data were obtained through interviews with patients or accompanying persons and from medical records. We studied variables concerning previous functional status, stroke severity, cardiovascular risk factors and stroke care provided. Patients were followed up for 12 months and the dates of any deaths were recorded. Univariate and multivariate analyses were carried out to assess the relationship between level of education and survival. RESULTS: A total of 203 (86%) women and 273 (88.6%) men were alive at 12 months. In both sexes, individuals with a lower level of education had poorer previous functional status, more severe strokes and higher mortality rates. In the multivariate analysis, the association between level of education and survival remained significant in the adjusted model in men. CONCLUSIONS: In our setting, there are differences in the survival of patients with ischaemic stroke as a function of level of education. The impact of this factor was greater in men than women.

TITLE: Relacion del nivel de estudios con la supervivencia en el primer año tras un ictus isquemico.Introduccion. La relacion del nivel socioeconomico con las tasas de incidencia y de mortalidad por ictus esta bien establecida. La evidencia de la relacion con la supervivencia de los pacientes tras el ictus es menos concluyente. El nivel educativo es una medida de nivel socioeconomico muy utilizada en estudios con personas de edad avanzada. Objetivo. Estudiar la relacion de la supervivencia en el primer año tras el ictus con el nivel de estudios. Pacientes y metodos. Se analizaron los datos de 544 pacientes con ictus isquemico agudo ingresados en los hospitales publicos de Bizkaia (España), seleccionados consecutivamente. Se obtuvieron datos por entrevista a pacientes o acompañantes y de historia clinica. Se estudiaron variables sobre situacion funcional previa, gravedad del ictus, factores de riesgo cardiovascular y de atencion al ictus. Se hizo un seguimiento de 12 meses para registrar, en su caso, la fecha de fallecimiento. Se realizo un analisis univariado y multivariado para identificar la relacion del nivel de estudios con la supervivencia. Resultados. Tras 12 meses, sobrevivian 203 mujeres (86%) y 273 hombres (88,6%). En ambos sexos, las personas con menos estudios tuvieron peor situacion funcional previa, mayor gravedad y fallecieron en mayor proporcion. En el analisis multivariado, el nivel de estudios se mantuvo asociado con la supervivencia en el modelo ajustado para los hombres. Conclusiones. La diversidad de nivel educativo marca diferencias en la supervivencia de los pacientes con ictus isquemico en nuestro entorno. El impacto de este factor fue mayor en los hombres que en las mujeres.

[Multidrug-resistant tuberculosis in the pediatric age group]. / Tuberculosis mutirresistente en la edad pediátrica.

AIMS: To study the clinical and epidemiological features in eight pediatric patients with multidrug-resistant tuberculosis (MDR-TB) diagnosed from 1994 to 2005 in three hospitals in Madrid (Spain). METHODS: A retrospective study was performed in patients aged less than 15 years old with positive culture for multidrug-resistant Mycobacterium tuberculosis and patients with negative cultures diagnosed after contact with MDR-TB. RESULTS: Pulmonary tuberculosis was diagnosed in seven patients and arthritis in one. Fifty percent of the patients were immigrants and an adult source case was found in four (50%). M. tuberculosis was isolated in gastric juice in four patients and in synovial biopsy in one. In three patients cultures were negative but these patients had previously been in contact with MDR-TB. Two strains were resistant to isoniazid and rifampicin, four were resistant to isoniazid, rifampicin and streptomycin, one was resistant to isoniazid, rifampicin, streptomycin and pyrazinamide, and one was resistant to 11 drugs. Six patients initially received conventional treatment without improvement. Patients received therapy for 15 months (range: 12 to 18) with 3 to 5 drugs according to the sensitivity study. The following adverse effects were observed: creatine phosphokinase increase (one patient), tendinitis (one patient), alteration of visual evoked responses (one patient) and transitory psychosis (one patient). One patient required pulmonary lobectomy. All patients responded satisfactorily to medical treatment. CONCLUSIONS: MDR-TB should be suspected in patients not responding to TB treatment, especially those from countries with high resistance rates. In patients with negative cultures, treatment should rely on the results of a sensitivity study in the adult source case. MDR-TB requires the use of second-line anti-TB drugs for prolonged periods with possible toxic effects.

C-H Infrared Absorption and Solubility of Ethylene, Propyne, 2-methyl-2-butene, and 2-methyl-1, 3-butadiene (Isoprene) in Liquid Argon Solutions.

The solubility of ethylene (H2C=CH2), propyne (CH3-C≡C-H), 2-methyl-2-butene (CH3-CH=C(CH3)2), and isoprene or 2-methyl-1, 3-butadiene (H2C=C(CH3)-CH=CH2) in liquid argon has been measured using mid-infrared and near-infrared (NIR) absorption. Spectra were recorded in the C-H infrared (IR) region. Spectra were obtained at increasing solution composition until the magnitude of the integrated absorption band reached a maximum value, indicating a saturated solution. The approximate experimental solubilities are: (600 ± 100) ppm at 92 K for ethylene, (22 ± 9) ppm at 100 K for propyne, (9 ± 5) ppm at 100 K for 2-methyl-2-butene, and (12 ± 2) ppm at 86 K for isoprene. The experimental solubility values at the corresponding temperature were used with solubility parameters of two separate models: the perturbed-chain statistical associating fluid theory (PC-SAFT) and the regular solution theory. Solvent-solute interaction parameters k12 (PC-SAFT) and [Formula: see text] (RST) were obtained for each solute in the presence of argon as the solvent. Data from experimental measurements are important for more realistic simulations of solubility of solids in cryogenic liquids.

Improved Automatic Detection of New T2 Lesions in Multiple Sclerosis Using Deformation Fields.

BACKGROUND AND PURPOSE: Detection of disease activity, defined as new/enlarging T2 lesions on brain MR imaging, has been proposed as a biomarker in MS. However, detection of new/enlarging T2 lesions can be hindered by several factors that can be overcome with image subtraction. The purpose of this study was to improve automated detection of new T2 lesions and reduce user interaction to eliminate inter- and intraobserver variability. MATERIALS AND METHODS: Multiparametric brain MR imaging was performed at 2 time points in 36 patients with new T2 lesions. Images were registered by using an affine transformation and the Demons algorithm to obtain a deformation field. After affine registration, images were subtracted and a threshold was applied to obtain a lesion mask, which was then refined by using the deformation field, intensity, and local information. This pipeline was compared with only applying a threshold, and with a state-of-the-art approach relying only on image intensities. To assess improvements, we compared the results of the different pipelines with the expert visual detection. RESULTS: The multichannel pipeline based on the deformation field obtained a detection Dice similarity coefficient close to 0.70, with a false-positive detection of 17.8% and a true-positive detection of 70.9%. A statistically significant correlation (r = 0.81, P value = 2.2688e-09) was found between visual detection and automated detection by using our approach. CONCLUSIONS: The deformation field-based approach proposed in this study for detecting new/enlarging T2 lesions resulted in significantly fewer false-positives while maintaining most true-positives and showed a good correlation with visual detection annotations. This approach could reduce user interaction and inter- and intraobserver variability.

Evaluating the effects of white matter multiple sclerosis lesions on the volume estimation of 6 brain tissue segmentation methods.

BACKGROUND AND PURPOSE: The accuracy of automatic tissue segmentation methods can be affected by the presence of hypointense white matter lesions during the tissue segmentation process. Our aim was to evaluate the impact of MS white matter lesions on the brain tissue measurements of 6 well-known segmentation techniques. These include straightforward techniques such as Artificial Neural Network and fuzzy C-means as well as more advanced techniques such as the Fuzzy And Noise Tolerant Adaptive Segmentation Method, fMRI of the Brain Automated Segmentation Tool, SPM5, and SPM8. MATERIALS AND METHODS: Thirty T1-weighted images from patients with MS from 3 different scanners were segmented twice, first including white matter lesions and then masking the lesions before segmentation and relabeling as WM afterward. The differences in total tissue volume and tissue volume outside the lesion regions were computed between the images by using the 2 methodologies. RESULTS: Total gray matter volume was overestimated by all methods when lesion volume increased. The tissue volume outside the lesion regions was also affected by white matter lesions with differences up to 20 cm(3) on images with a high lesion load (≈50 cm(3)). SPM8 and Fuzzy And Noise Tolerant Adaptive Segmentation Method were the methods less influenced by white matter lesions, whereas the effect of white matter lesions was more prominent on fuzzy C-means and the fMRI of the Brain Automated Segmentation Tool. CONCLUSIONS: Although lesions were removed after segmentation to avoid their impact on tissue segmentation, the methods still overestimated GM tissue in most cases. This finding is especially relevant because on images with high lesion load, this bias will most likely distort actual tissue atrophy measurements.

[Do age and service influence on diagnostic quality of ischemic stroke?]. / ¿Influyen la edad y servicio en la calidad diagnóstica de los ictus isquémicos?

BACKGROUND: The ischemic stroke represents a very important cause of death in the hospitals. The clinic changes of this disease and the frequent morphological evidence in necropses motived the study of the clinicopathological concordance taking as reference two institutions of the secondary attention. The two medical centers were our study was conducted were: Dr. Gustavo Alderegu a Lima Hospital in Cienfuegos and Camilo Cienfuegos in Sancti Spiritus. These two Cuban hospital have showed necropses indicators higher than 80%. OBJECTIVES: To determine the clinicopathological correlation of the ischemic stroke as evidence of the quality of the diagnoses. The influence of the age of the patient and kind of care received by the patient. PATIENTS AND METHODS: A retrospective, descriptive, and correlational study where 1556 death with necropsy were evaluated. As main variables were studied the age and services where demise took place, as well as, the following indicators: observed concordance, kappa index, sensitivity, specificity, positive and negative predictive values, positive and negative similarity reasons. RESULTS: At ischemic cerebrovascular lesions the concordance was significant with kappa values which were not higher than 0.66 in both facilities; nevertheless, sensitivity and positive predictive value were higher in Sancti Spiritus (75.5% and 63.5%, respectively). Overall, being aged was not a motive for diagnostic discordance on cerebrovascular damages, significantly the Sancti Spiritus values in the ages group were substantial: kappa (0.70), sensitivity (80.4%), and positive predictive value (19.0). Among death from 15 thought 60 years old from Sancti Spiritus province the results of measurements of diagnostic quality were reduced comparative with Cienfuegos and overall for this age group: kappa (0.37), sensitivity (42.8%), positive predictive value (37.5%). Analysis of each services evidence reductions of sensibility up to (59.1%) at clinic services of Cienfuegos with respect to (73.6%) progressive care for ischemic cerebrovascular lesions, besides a positive predictive value of (49.4%) in progressive care, lower than the results obtained for Sancti Spiritus. CONCLUSIONS: The clinicopathological concordance and the rest of the quality indicators were higher in Camilo Cienfuegos Hospital in Sancti Spiritus. The age below 60 years old favoreced the diagnostic discordance in the above mentioned center. Nevertheless, patients with age over 60 years old didn t show important changes in the concordance. The quality indicators were higher in unit f intensive care respect to the clinical services. The quality in the results in the Sancti Spiritus Hospital are determined by the existence of a stroke unit