The role of multimodal neuromonitoring during anesthesia for ablation of giant endocranial tumors

Catedra de anesteziologie și reanimatologie nr.2, Catedra de anesteziologie și reanimatologie nr.1 „Valeriu Ghereg”, Catedra de neurochirurgie, USMF „Nicolae Testemițanu”, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Material şi metode. În studiu au fost incluse 2 loturi de pacienţi: I lot– 6 pacienţi cărora li s-a administrat anestezie combinată (i/v + pivot inhalator cu sevofluran); lotul II– 5 pacienţi cărora li s-a administrat anestezie totală intravenoasă (propofol+fentanil). Monitoring: TAs, TAd, TAm (invaziv), PVC, echilibru acidobazic, gazos (arteră şi venă periferică, bulbul jugular), electrolitic, acidul lactic, diurezei orară, PESS. Discuţii. În lotul pacienţilor cu anestezie inhalatorie s-a determinat o incidenţă înaltă a depresiei hemodinamice profunde (Tam - 74,3 mmHg, p= 0,02). Tot aici s-a determinat: utilizarea dozelor mai mici de analgetice şi miorelaxante (sol. atracurium bromid 0,35-0,4mg/kg) , trezire mai rapidă, incidenţă mai scăzută a greții şi tremorului postoperator. S-a reuşit efectuarea mai veridică a neuromonitorigului, datorită cantităţii mai mici de miorelaxante utilizate. La pacienţii cu anestezie intravenoasă s-a determinat o stabilitate hemodinamică (Tam - 82,7 mmHg, p ≤ 0,05), hemoragie intraoperatorie nesemnificativă. În lotul dat s-a reuşit efectuarea neuromonitorigului, cu doze obişnuite de miorelaxante (sol. atracurium bromid 0,5 mg/kg). Concluzii. Tehnicile descrise pot fi utilizate pentru neuromonitorizare multimodală în ablaţia de tumori endocraniene. Tehnica de anestezie inhalatorie, respectând farmacocinetica preparatelor, ar putea fi de preferat, din cauza evitării riscurilor de supra - sau sub dozare de medicamente anestezice, oferind o trezire mai rapidă, cu o evaluarea neurologică imediată, care este extrem de importantă.Materials and methods. The study included two groups of patients: I-st group - 6 patients receiving combined anesthesia (i / v + inhaled sevoflurane); II-nd group - 5 patients who received intravenous anesthesia (propofol + fentanyl).Monitoring: sBP, dBP, mBP (invasive), CVP, acid-base, gas (peripheral artery and vein, jugular bulb) and electrolytic balances, lactic acid, hourly diuresis, neurology evoked potentials. Discussion. In the group of patients with inhalation anesthesia was determined a higher incidence of hemodynamic depression (Tam - 74,3 mmHg, p= 0,02). Also it was determined: use of lower doses of analgetics and muscle relaxants (sol. atracurium bromid 0,35-0,4mg/kg), faster awakening, lower incidence of postoperative nausea and tremors. We managed a more accurate recording of evoked potentials due to the small amount of muscle relaxant used. In patients with intravenous anesthesia was determined a more stable BP (mBP - 82,7 mmHg, p ≤ 0,05), less intraoperative bleeding. In the group given was carrying neuromonitorigului managed with dose of muscle relaxant common (ground. atracurium aromide 0.5 mg / kg). Conclusions. The techniques described can be used for multimodal neuromonitoring in ablation of tumor endocranial. Inhalational anesthesia technique, respecting the pharmacokinetics preparations could be preferable because avoid the risks of over - or under dosage of anesthetic agents, providing an awakening faster with immediate neurological evaluation, which is extremely important

Effects of cold-rolling deformation on texture evolution and mechanical properties of Ti-29Nb-9Ta-10Zr alloy

International audienceThe crystallographic texture of Ti-29Nb-9Ta-10Zr alloy is studied after cold-rolling with different amounts of thickness reduction, up to 60%. The major texture components developed during cold-rolling were: γ-fibre components: {111}〈View the MathML source〉, {111}〈View the MathML source〉, {111}〈View the MathML source〉 and {111}〈View the MathML source〉; texture component: {112}〈View the MathML source〉 and texture components: {001}〈View the MathML source〉 and {010}〈001〉. Besides crystallographic texture the resulted mechanical properties were studied by nanoindentation. It was showed that the decrease in Young's modulus after different cold-rolling stages is mainly attributed to the stress-induced α″-Ti phase formation. At 60% cold-rolling thickness reduction obtained an elastic modulus close to 45.29±3.81 GPa, coupled with an average Vickers microhardness close to 279.83±4.28 HV

Acute kidney injury in patients with tetralogy of Fallot who have undergone surgical correction

Catedra de anesteziologie și reanimatologie nr.2, USMF „Nicolae Testemițanu”, Departamentul Reanimare și Terapie Intensivă, Spitalul Clinic Republican, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Leziunea renală acută (LRA) este una dintre cele mai frecvente și severe complicații în chirurgia cardiacă. Aplicarea criteriilor de clasificare RIFLE (risc, injurie, insuficiență și stadiul final al bolii renale) au fost validate la populațiile pediatrice. Scop. De a determina, retrospectiv apariția LRA în grupul de pacienți până la 18 ani, utilizând criteriile RIFLE modificate, validate la copii (pRIFLE), relația dintre LRA cu alte complicații după corecția chirurgicală a tetralogiei Fallot. Materiale și metode. Din baza de date a IMSP Spitalul Clinic Republican, au fost selectați 45 de copii, supuși corecției chirurgicale a tetralogiei Fallot între iunie 2010 și decembrie 2015. Leziunea renală acută a fost definită ca o scădere a cantității clearance-ului estimat al creatininei pe baza criteriilor pediatrice modificate pentru RIFLE (pRIFLE). Rezultate. Douăzeci și două de pacienți (48,9%) au avut LRA în funcție de categoriile pRIFLE. Dintre cei 45 pacienți, 15 (33,3%) au corespuns criteriilor pRIFLE de risc; 6 (13,3%) au atins criteriile de injurie și 1 (2,2%) au întrunit criteriile de insuficiență. Trei pacienți (6,7%) au decedat. Apariția MODS s-a întâlnit la 19 (42,2%) pacienți, sepsis s-a întîlnit la 3 (6,7%) pacienți. Durata de ventilație mecanică (p <0,001) și durata de ședere în unitatea de terapie intensivă ( p <0,001) au fost semnificativ mai mare în comparație cu grupul de pacienți care nu au dezvoltat semne de leziune renală acută. Concluzii. Disfuncția renală acută a fost asociată în mod independent, cu o apariție crescută a complicațiilor postoperatorii, dar cu o mortalitate redusă după corecția chirurgicală a tetralogiei Fallot.Introduction. Acute kidney injury (AKI) is one of the most common and severe complications in cardiac surgery. Application of the classification RIFLE (risk, injury, failure and end stage renal disease) have been validated in pediatric populations. Purpose. To determine AKI appearance in the patients up to 18 years, using modified RIFLE criteria, validated in children (pRIFLE), the relationship between AKI with other complications after surgical correction of Fallot's tetralogy. Materials and methods. From the database of the Republican Clinical Hospital, were selected 45 children undergoing surgical correction of Fallot's tetralogy between June 2010 and December 2015. acute kidney injury was defined as a decrease in estimated creatinine clearance based on criteria pediatric modified RIFLE (pRIFLE). Results. Twenty-two patients (48,9%) had AKI by pRIFLE category. Of the 45 patients, 15 (33.3%) met the criteria pRIFLE risk; 6 (13.3%) corresponded to the criteria of injury and one (2.2%) met criteria for failure. Three patients (6.7%) died. The occurrence of MODS was encountered in 19 (42.2%) patients, sepsis was met in 3 (6.7%) patients. Duration of mechanical ventilation (p <0.001) and length of stay in the intensive care unit p <0.001) were significantly higher compared with the group of patients who did not develop signs of acute kidney injury. Conclusions. Acute kidney dysfunction was independently associated with an increased occurrence of postoperative complications, but with reduced mortality after surgical correction of Fallot's tetralogy

Insuficienţa respiratorie acută şi disfuncţia multiplă de organe la gravide cu complicatii pulmonare de etiologie virală

Catedra Anesteziologie şi Reanimatologie N2, Catedra Anesteziologie şi Reanimatologie N1 USMF „Nicolae Testemiţanu”In the study have been included 26 pregnant women and lying-in women with severe pulmonary complications associated with pandemic influenza virus a new type A (H1N1) -2009. Average age were about 28.2 ± 1.7 years, most pregnant women (84.62%) were in the second period of pregnancy, of which 65.38% in the last weeks of pregnancy. The most frequent pulmonary complications in pregnant women with influenza pandemic were viral pneumonia, bacterial pneumonia, acute lung injury/acute respiratory distress syndrome, spontaneous pneumotorax, pneumomediastinum, pleural effusion, passive regurgitation. Intensive care was complex and multi-faceted based on general principles and specific treatment, one of the main criteria is application of respiratory therapy carried out well and conduct begun on time. Pregnancy resolution in a timely manner is an important factor contributing to improved clinical outcomes in pregnant women with intensive pulmonary complications of pandemic influenza. În studiu au fost incluse 26 de gravide cu complicatii pulmonare severe pe fondal de Gripă pandemică cu virusul de tip nou A (H1N1) - 2009. Majoritatea gravidelor (84,62%) au fost în a doua perioadă a sarcinii, dintre care 65,38% în ultimele săptămâni ale gravidităţii. Cele mai frecvente complicaţii pulmonare la gravidele cu gripă pandemică au fost pneumonii virale, pneumonii bacteriene, leziune pulmonară acută /sindrom de detresa respiratorie acută, pneumotorace spontan, pneumomediastinum, pleurezie, regurgitare pasivă. Terapia intensivă efectuată a fost complexă şi multidirecţională, bazată pe principii generale şi speciale de tratament, unul din criteriile de baza fiind aplicarea unei terapii respiratorii bine conduita si începuta la momentul oportun. Rezolvare sarcinii în timp util este un factor important ce contribue la ameliorarea rezultatelor tratamentului intensiv la gravide cu complicaţii pulmonare ale Gripei Pandemice

Romanian ancient gold objects provenance studies using micro-beam methods: the case of "Pietroasa" hoard

Abstract Five fragments of ancient gold objects belonging to Pietroasa "Closca cu Puii de Aur" ("The Golden Brood Hen with Its Chickens") Romanian hoard were analysed using the micro-PIXE (particle induced X-ray emission) technique. The purpose of the study was to gain some more knowledge regarding the metal provenance by determining the presence of PGE (Platinum Group Elements) and other high-temperature melting point trace elements (Ta, Nb, Cr) at a micrometric scale. Ta and Nb inclusions (micrometric areas of composition different from the surroundings) on three samples and Pd inclusions on one sample were found. The measurements led to some conclusions for the possible gold ore sources of Pietroasa treasury: the South-Ural Mountains, Nubia (Sudan) and/or Anatolian deposits and Roman imperial coins

Field Localization and Enhancement of Phase Locked Second and Third Harmonic Generation in Absorbing Semiconductor Cavities

We predict and experimentally observe the enhancement by three orders of magnitude of phase mismatched second and third harmonic generation in a GaAs cavity at 650nm and 433nm, respectively, well above the absorption edge. Phase locking between the pump and the harmonics changes the effective dispersion of the medium and inhibits absorption. Despite hostile conditions the harmonics become localized inside the cavity leading to relatively large conversion efficiencies. Field localization plays a pivotal role and ushers in a new class of semiconductor-based devices in the visible and UV ranges

Comparative analysis of ferroelectric domain statistics via nonlinear diffraction in random nonlinear materials

© 2018 [Optical Society of America]. Users may use, reuse, and build upon the article, or use the article for text or data mining, so long as such uses are for non-commercial purposes and appropriate attribution is maintained. All other rights are reserved.We present an indirect, non-destructive optical method for domain statistic characterization in disordered nonlinear crystals having homogeneous refractive index and spatially random distribution of ferroelectric domains. This method relies on the analysis of the wave-dependent spatial distribution of the second harmonic, in the plane perpendicular to the optical axis in combination with numerical simulations. We apply this technique to the characterization of two different media, Calcium Barium Niobate and Strontium Barium Niobate, with drastically different statistical distributions of ferroelectric domains.Peer ReviewedPostprint (published version

Random to chaotic temperature transition in low-field Fano-Feshbach resonances of cold thulium atoms

Here, we report on the observation of a random to chaotic temperature transition in the spacing of Fano-Feshbach resonances in the ultracold polarized gas of thulium atoms. This transition is due to the appearance of so-called d-resonances, which are not accessible at low temperatures, in the spectra at high temperatures, which drastically changes thulium's overall resonance statistic. In addition to this statistical change, it has been observed that s- and d-resonances experience quite different temperature shifts: s-resonances experience almost no shift with the temperature, while d-resonances experience an obvious positive shift. In addition, careful analysis of the broad Fano-Feshbach resonances enabled the determination of the sign of thulium's background scattering length. A rethermalization experiment made it possible to estimate a length value of a=144+-38a.u.. This proves that thulium atoms are suitable for achieving Bose-Einstein Condensation

Bose-Einstein condensate as a diagnostic tool for an optical lattice formed by 1064 nm laser light

Recently, the thulium atom has been cooled down to the temperature of Bose-Einstein condensation. While the condensate of the thulium atom has a lot of applications in quantum simulations and other areas of physics, it can also serve as a unique diagnostic tool for many atomic experiments. In the present study, the Bose-Einstein condensate of the thulium atom was successfully utilized to diagnose an optical lattice and detect unwanted reflections in the experiments with the 1064 nm optical lattice, which will further be used in a quantum gas microscope experiment