Relationship of arterial and exhaled CO2 during elevated artificial pneumoperitoneum pressure for introduction of the first trocar.

The present study evaluated the correlation between arterial CO2 and exhaled CO2 during brief high-pressure pneumoperitoneum. Patients were randomly distributed into two groups: P12 group (n=30) received a maximum intraperitoneal pressure of 12mmHg, and P20 group (n=37) received a maximum intraperitoneal pressure of 20mmHg. Arterial CO2 was evaluated by radial arterial catheter and exhaled CO2 was measured by capnometry at the following time points: before insufflation, once intraperitoneal pressure reached 12mmHg , 5 minutes after intraperitoneal pressure reached 12mmHg for the P12 group or 20mmHg for the P20 group, and 10 minutes after intraperitoneal pressure reached 12mmHg for the P12 group or when intraperitoneal pressure had decreased from 20mmHg to 12mmHg, for the P20 group. During brief durations of very high intraperitoneal pressure (20mmHg), there was a strong correlation between arterial CO2 and exhaled CO2. Capnometry can be effectively used to monitor patients during transient increases in artificial pneumoperitoneum pressure

Invasive monitoring of the clinical effects of high intra-abdominal pressure for insertion of the first trocar.

Background: To analyze the effects of transitory, high intra-abdominal pressure on clinical, hemodynamic, blood gas and metabolic parameters.

Methods: Sixty-seven laparoscopic patients were divided into groups P12 (n = 30, maximum intra-abdominal pressure of 12 mmHg) and P20 (n = 37, maximum intra-abdominal pressure of 20 mmHg). Through radial artery cannulation, mean arterial pressure (MAP) was assessed and blood gas analysis – pH, arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), bicarbonate (HCO3) and base excess (BE) – was performed. These parameters were evaluated in both groups at time point zero, before CO2 insufflation; at time point one (TP1), when intra-abdominal pressure of 12 mmHg was reached in both groups; at time point two (TP2), 5 minutes after reaching intra-abdominal pressure of 12 mmHg in group P12 and of 20 mmHg in group P20; and at time point three (TP3), 10 minutes after reaching intra-abdominal pressure of 12 mmHg in group P12 and 10 minutes after TP1 in group P20, when intra-abdominal pressure decreased from 20 mmHg to 12 mmHg. Values out of the normal range or the occurrence of atypical phenomena suggestive of organic disease indicated clinical changes.

Results: Significant variations in MAP, pH, HCO3 and BE were observed in group P20; these changes, however, were within normal limits. Clinical changes were also within normal limits, and no pathological phenomena were observed.

Conclusions: Brief, intra-abdominal hypertension for the insertion first trocar insertion causes variations in MAP, pH, HCO3 and BE without adverse effects, and it may protect from iatrogenic injury

Épocas de vedação e utilização de capineiras de capim-elefante (Pennisetum purpureum Schum. cv. Cameroon) no nordeste paraense.

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Enterprise risk management in Portugal

The present chapter tries to assess the state of art of Enterprise Risk Management (ERM) among Portuguese non-financial companies regarding two main aspects: the ERM background in Portugal and the level of disclosure of ERM practices by non-financial listed companies. Since the analysis of disclosures is useful to understand the level of evolution and adoption of ERM framework we tried to assess the ERM practices disclosed by 26 Portuguese non-financial listed companies at the Euronext Lisbon Stock Exchange regulated market, during the period of 2006-2016. Main findings indicate that regulation on ERM in Portugal emanates from three main Codes (The Portuguese Companies Code, The Stock Exchange Code, and The Corporate Governance Code). The ERM professionalization in Portugal is its infancy and has been promoted mainly by the Institute of Portuguese Internal Auditors. Moreover, research on topics such as risk reporting and risk management/ERM is very scarce. Overall, findings of prior literature are consistent with results from our exploratory study. We conclude that Portuguese non-financial listed companies still disclose very little information on ERM activities. However, over the period of analysis, the disclosure practices evolved positively. Findings show that ERM disclosure can still be extensively improved in the future.info:eu-repo/semantics/acceptedVersio

Management of von Willebrand disease type 3 during pregnancy - 2 cases reports.

BACKGROUND: von Willebrand disease type 3, is an extremely rare condition. It can be severe and potentially life-threatening, particularly in pregnant women during labor and subsequently during early puerperium. Due to its rarity, there is no optimal treatment/management during pregnancy. CASE: We describe two cases of pregnant women with von Willebrand disease type 3, and its successful surveillance and treatment with Haemate P FVIII (human plasma-derived von Willebrand Factor-ristocetin co-factor associated with human coagulation factor VIII), during pregnancy, partum and puerperium. CONCLUSIONS: Daily prophylaxis with Haemate P FVIII in women with von Willebrand disease type 3, starting 2 hours before caesarean section until the 7th day of puerperium, associated with close analytical and clinical surveillance seems to be a safe clinical option

Active Learning Metamodels for ATM Simulation Modeling

Transportation systems are particularly prone to exhibiting overwhelming complexity on account of the numerous involved variables and their interrelationships, unknown stochastic phenomena, and ultimately human behavior. Simulation approaches are commonly used tools to describe and study such intricate real-world systems. Despite their obvious advantages,simulation models can still end up being quite complex themselves. The field of Air Traffic Management (ATM) modeling is no stranger to such concerns, as it traditionally involves laborious and systematic analyses built upon computationally heavy simulation models. This rather frequent shortcoming can be addressed by employing simulation metamodels combined with active learning strategies to approximate the input-output mappings inherently defined by the simulation models in an efficient way. In this work, we propose an exploration framework that integrates active learning and simulation metamodeling in a single unified approach to address recurrent computational bottlenecks typically associated with intense performance impact assessments within the field of ATM. Our methodology is designed to systematically explore the simulation input space in an efficient and self-guided manner, ultimately providing ATM practitioners with meaningful insights concerning the simulation models under study. Using a fully developed state-of-the-art ATM simulator and employing a Gaussian Process as a metamodel, we show that active learning is indeed capable of enhancing both the modeling and performances of simulation metamodeling by strategically avoiding redundant computer experiments and predicting simulation outputs values

Produção forrageira e valor nutritivo dos capins: quicuio-da-amazônia, marandu, tobiatã, andropógon e tanzânia-1 em quatro idades de corte.

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