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

A review on power electronics technologies for power quality improvement

Nowadays, new challenges arise relating to the compensation of power quality problems, where the introduction of innovative solutions based on power electronics is of paramount importance. The evolution from conventional electrical power grids to smart grids requires the use of a large number of power electronics converters, indispensable for the integration of key technologies, such as renewable energies, electric mobility and energy storage systems, which adds importance to power quality issues. Addressing these topics, this paper presents an extensive review on power electronics technologies applied to power quality improvement, highlighting, and explaining the main phenomena associated with the occurrence of power quality problems in smart grids, their cause and effects for different activity sectors, and the main power electronics topologies for each technological solution. More specifically, the paper presents a review and classification of the main power quality problems and the respective context with the standards, a review of power quality problems related to the power production from renewables, the contextualization with solid-state transformers, electric mobility and electrical railway systems, a review of power electronics solutions to compensate the main power quality problems, as well as power electronics solutions to guarantee high levels of power quality. Relevant experimental results and exemplificative developed power electronics prototypes are also presented throughout the paper.This work has been supported by FCT-Fundação para a Ciência e Tecnologia within the R&D Units Project Scope: UIDB/00319/2020. This work has been supported by the FCT Project DAIPESEV PTDC/EEI-EEE/30382/2017 and by the FCT Project newERA4GRIDs PTDC/EEIEEE/30283/2017

Surveillance of active human cytomegalovirus infection in hematopoietic stem cell transplantation (HLA sibling identical donor): search for optimal cutoff value by real-time PCR

<p>Abstract</p> <p>Background</p> <p>Human cytomegalovirus (CMV) infection still causes significant morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Therefore, it is extremely important to diagnosis and monitor active CMV infection in HSCT patients, defining the CMV DNA levels of virus replication that warrant intervention with antiviral agents in order to accurately prevent CMV disease and further related complications.</p> <p>Methods</p> <p>During the first 150 days after allogeneic HSTC, thirty patients were monitored weekly for active CMV infection by <it>pp65 </it>antigenemia, nested-PCR and real-time PCR assays. Receiver operating characteristic (ROC) plot analysis was performed to determine a threshold value of the CMV DNA load by real-time PCR.</p> <p>Results</p> <p>Using ROC curves, the optimal cutoff value by real-time PCR was 418.4 copies/10⁴PBL (sensitivity, 71.4%; specificity, 89.7%). Twenty seven (90%) of the 30 analyzed patients had active CMV infection and two (6.7%) developed CMV disease. Eleven (40.7%) of these 27 patients had acute GVHD, 18 (66.7%) had opportunistic infection, 5 (18.5%) had chronic rejection and 11 (40.7%) died - one died of CMV disease associated with GVHD and bacterial infection.</p> <p>Conclusions</p> <p>The low incidence of CMV disease in HSCT recipients in our study attests to the efficacy of CMV surveillance based on clinical routine assay. The quantification of CMV DNA load using real-time PCR appears to be applicable to the clinical practice and an optimal cutoff value for guiding timely preemptive therapy should be clinically validated in future studies.</p

f(R) theories

Over the past decade, f(R) theories have been extensively studied as one of the simplest modifications to General Relativity. In this article we review various applications of f(R) theories to cosmology and gravity - such as inflation, dark energy, local gravity constraints, cosmological perturbations, and spherically symmetric solutions in weak and strong gravitational backgrounds. We present a number of ways to distinguish those theories from General Relativity observationally and experimentally. We also discuss the extension to other modified gravity theories such as Brans-Dicke theory and Gauss-Bonnet gravity, and address models that can satisfy both cosmological and local gravity constraints.Comment: 156 pages, 14 figures, Invited review article in Living Reviews in Relativity, Published version, Comments are welcom

(I)Migrantes, diversidades e desigualdades no sistema educativo português : balanço e perspectivas

O objectivo do presente artigo consiste em procurar transmitir um olhar sociologicamente informado no que concerne à situação portuguesa no domínio das políticas educativas públicas e investigações produzidas relacionadas com o sistema educativo e a (i)migração, ou seja, com a tentativa de construção de uma educação intercultural. Neste sentido, será realizada uma análise descritiva e compreensivo-interpretativa da evolução desta problemática em Portugal desde que a mesma se tornou objecto de reflexão por parte de investigadores/as e políticos nos finais da década de oitenta, início da década de noventa do século XX. Nesta análise, será dada ênfase às investigações e quadros teóricos produzidos e às medidas legislativas e políticas educativas no domínio do tratamento da diferença cultural dentro do sistema educativo português.The aim of this article consists in attempting to transmit a sociologically informed view in what the Portuguese situation in the field of public policies and research related to the educational system and (im)migration are concerned, that is, in attempting to construct an intercultural education. In this way, a descriptive and comprehensiveinterpretative analysis of the evolution of this problem in Portugal will be realized, since the latter became an object of reflection on the part of researchers and politicians towards the end of the 80s, the beginning of the 90s of the XXth century. In this analysis, emphasis will be given on the research and theoretical frameworks produced and on the legislative measures and educational policies in the field of treating cultural difference in the Portuguese educational system

Masculinidades e práticas de saúde na região metropolitana de Belo Horizonte - MG

O objetivo desta investigação foi identificar e analisar as representações sociais de saúde e de doença e as práticas de saúde masculina junto a homens residentes na Região Metropolitana de Belo Horizonte-MG. Foram entrevistados 100 sujeitos com idade entre 45 e 55 anos. Os dados foram submetidos às análises de evocação e de conteúdo. RESULTADOS: elementos centrais da Representação Social (RS) de saúde: "bem-estar", "cuidado" e "importante". Elementos periféricos próximos: "alegria/felicidade" e "alimentação". Elementos centrais da RS de doença: "tristeza" e "dor". Elementos periféricos próximos: "sofrimento" e "morte". Definição de "cuidar da saúde": "cuidar da alimentação" (17,25% das respostas) e "praticar atividades físicas" (11,11%). Dos sujeitos, 52% afirmaram que cuidam da própria saúde e 34% que o fazem "às vezes". Quem contribui para o cuidado com a própria saúde: "eu mesmo" (29,63%), "esposa" (25,93%). Busca por atendimento médico: "às vezes" no Hospital (69% dos sujeitos; motivo principal: "dor forte/persistente", 13,87% das respostas) ou nos consultórios (72% dos sujeitos; motivo principal: "exames de rotina", 22,22% das respostas). A análise dos resultados indica a percepção mais geral do cuidar da saúde como um conjunto de práticas individuais objetivando o "bem-estar". Os resultados também indicam considerável quantidade de ações objetivando os cuidados com a saúde, o que contraria parte das percepções tradicionais quanto à fraca associação entre masculinidades e cuidado de si

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

BACKGROUND: Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen's behavioural model. METHODS: Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. RESULTS: Predisposing (OR = 0.89; 95% CI 0.81-0.97) and enabling (OR = 0.90; 95% CI 0.85-0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. CONCLUSIONS: Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services