Spontaneous Intracranial Hypotension and Multi-Level Cervical and Lumbar Epidural Blood Patches: A Case Report

Spontaneous intracranial hypotension (SIH) is a neurologic condition where the intracranial pressure is reduced due to a loss of cerebrospinal fluid from its reservoir, the intrathecal space, to surrounding tissues. It is commonly characterized by an incapacitating headache, phono-photophobia, nausea, and vomiting, commonly refractory to medical treatment and requires further investigation. We describe the case of a healthy young man who presented to the emergency room with a postural headache, accompanied by nausea, vomiting, and phono-photophobia. Brain computed tomography (CT) imaging study was unremarkable and he was initially treated symptomatically. Because of persisting pain even on medical treatment, additional imaging studies, including a myelo-CT scan, were performed and a diagnosis of multi-level cerebrospinal fluid fistulas was made. To treat the underlying cause, a first epidural blood patch (EBP) was initially performed at C7-T1 with 20 mL of autologous blood, but failed to provide complete symptomatic relief. Months later, a second EBP was conducted at C6-C7 with higher volume (30 mL) but as in the first EBP this procedure too did not result in total resolution of the headache and accompanying symptoms. Since there was no surgical indication from Orthopedics and Neurosurgery and the symptoms persisted, a third EBP was carried out, this time at a lumbar level (L2-L3) with infusion of 60 mL of blood so the upper dorsal and cervical epidural space was reached. This resulted in a better symptom relief, allowing the patient to now carry out his normal activities with only residual pain. The need for repeat procedures is one of the pitfalls of the blood patching technique. If possible, it should be performed at the level of the documented fistula, but always with safety in mind and by experienced hands, especially when cervical levels are concerned. A consensus has not been reached regarding the blood volume to be administered; however, any discomfort or pain reported by the patient should be seen as warning sign and the procedure should be interrupted. Although not being a perfect solution, EBP can completely or partially resolve SIH symptoms, without the need for surgical intervention.info:eu-repo/semantics/publishedVersio

Mechanical and wear behaviours of nano and microfilled polymeric composite: effect of filler fraction and size

The addition of ceramic reinforced material, SiC particles, to resin matrices, results in the improvement of the overall performance of the composite, allowing the application of these materials as tribo-materials in industries such as: automotive, aeronautical and medical. Particle-reinforced polymeric composites are widely used as biomaterials, for example as dental filler materials and bone cements. These reinforced composites have improved mechanical and tribological performance and have higher values of elastic modulus and hardness, and also reduce the shrinkage during the polymerisation compared with resin matrices. However, the effect of the filler level in mechanical and tribological behaviour is not quite understood. The aim of this work is to determine the influence of the particle volume fraction and particle size in the wear loss of the composites and their antagonists. Reciprocating wear tests were conducted using a glass sphere against resin polyester silica reinforced composite in a controlled medium, with an abrasive slurry or distilled water. For 6 μm average particle dimension, seven particles contents were studied ranging from 0% to 46% of filler volume fraction (FVF). Afterwards, filler volume fractions of 10% and 30% were selected; and, for these percentages, 7 and 4 average particle dimensions were tested and were evaluated regarding their wear behaviour, respectively. The reinforcement particle dimensions used ranged from 0.1 μm to 22 μm with the 10% filler fraction, and for 30% of filler content the range extended from 3 μm to 22 μm. The results allow us to conclude that in an abrasive slurry medium the composite abrasion resistance decreases with the increase of the particle volume fraction, in spite of the accompanying rise in hardness and elastic modulus. With constant FVF, and abrasive slurry, the composite wear resistance increases with increasing average particle dimension. In a distilled water medium and with several FVF values, the minimum wear was registered for a median particle content of 24%. In this medium and with constant FVF the highest wear resistance occurred for average reinforcement particles of 6 μm. The removal mechanisms involved in the wear process are discussed, taking into account the systematic SEM observations to evaluate the wear mechanisms

European women’s views on specialist counselling for female survivors of domestic violence and abuse

Counselling for female survivors of domestic violence as practiced in five European countries (United Kingdom - UK, Bulgaria, Italy, the Netherlands and Latvia) was qualitatively explored by researchers in the UK, Germany and Portugal over two years. The effectiveness of current practice was analysed using data from 60 face-to-face interviews with clients who had received counselling. Findings revealed that regardless of which counselling model or approach is used, the effectiveness of specialist domestic violence counselling is dependent upon a positive therapeutic alliance built on mutual trust and respect and, crucially, an understanding of the dynamics of domestic violence and abuse provided by highly qualified counsellors who have received domestic violence training. This article concludes by offering recommendations to inform future funding and policy decisions and avenues for future research

Three-Dimensional CFD modelling and analysis of the thermal entrainment in open refrigerated display cabinets

This study presents a three-dimensional Computational Fluid Dynamics (CFD) simulation of the air flow pattern and the temperature distribution in a refrigerated display cabinet. The thermal entrainment is evaluated by the variations of the mass flow rate and thermal power along and across the air curtain considering the numerical predictions of abovementioned properties. The evaluation on the ambient air velocity for the three-dimensional (3D) effects in the pattern of this type of turbulent air flow is obtained. Additionally, it is verified that the longitudinal air flow oscillations and the length extremity effects have a considerable influence in the overall thermal performance of the equipment. The non uniform distribution of the air temperature and velocity throughout the re-circulated air curtain determine the temperature differences in the linear display space and inside the food products, affecting the refrigeration power of display cabinets. The numerical predictions have been validated by comparison with experimental tests performed in accordance with the climatic class n.º 3 of EN 441 Standard (Tamb = 25 ºC,φamb = 60%; vamb = 0,2 m s-1). These tests were conducted using the point measuring technique for the air temperature, air relative humidity and air velocity throughout the air curtain, the display area of conservation of food products and nearby the inlets/outlets of the air mass flow.info:eu-repo/semantics/publishedVersio

Detailed CFD modelling of open refrigerated display cabinets

A comprehensive and detailed computational fluid dynamics (CFDs) modelling of air flow and heat transfer in an open refrigerated display cabinet (ORDC) is performed in this study. The physical-mathematical model considers the flow through the internal ducts, across fans and evaporator, and includes the thermal response of food products. The air humidity effect and thermal radiation heat transfer between surfaces are taken into account. Experimental tests were performed to characterize the phenomena near physical extremities and to validate the numerical predictions of air temperature, relative humidity, and velocity. Numerical and experimental results comparison reveals the predictive capabilities of the computational model for the optimized conception and development of this type of equipments. Numerical predictions are used to propose geometrical and functional parametric studies that improve thermal performance of the ORDC and consequently food safety.info:eu-repo/semantics/publishedVersio