Tremendous bleeding complication after vacuum-assisted sternal closure

Vacuum-assisted closure (VAC) of complex infected wounds has recently gained popularity among various surgical specialties. The system is based on the application of negative pressure by controlled suction to the wound surface. The effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation are proved. No contraindications for the use in deep sternal wounds in cardiac surgery are described. In our case report we illustrate a scenario were a patient developed severe bleeding from the ascending aorta by penetration of wire fragments in the vessel. We conclude that all free particles in the sternum have to be removed completely before negative pressure is used

An articulatory feature-based tandem approach and factored observation modeling

The so-called tandem approach, where the posteriors of a multilayer perceptron (MLP) classi�er are used as features in an automatic speech recognition (ASR) system has proven to be a very effective method. Most tandem approaches up to date have relied on MLPs trained for phone classi�cation, and appended the posterior features to some standard feature hidden Markov model (HMM). In this paper, we develop an alternative tandem approach based on MLPs trained for articulatory feature (AF) classi�cation. We also develop a factored observation model for characterizing the posterior and standard features at the HMM outputs, allowing for separate hidden mixture and state-tying structures for each factor. In experiments on a subset of Switchboard, we show that the AFbased tandem approach is as effective as the phone-based approach, and that the factored observation model signi�cantly outperforms the simple feature concatenation approach while using fewer parameters

The effect of videokeratoscope faceplate design on radius of curvature maps

A computer model using finite ray tracing methods was developed to simulate a videokeratoscope analysing an average cornea. Different faceplate designs were tested using five points in the faceplate subtending angles between 15 and 75 in 15 intervals at the corneal vertex. Image quality was assessed by adding the geometrical blurs of the 5 image points. Differences (error) between accurate sagittal radius of curvature and sagittal radius of curvature calculated by the van Saarloos algorithm were calculated for selected surfaces at the same corneal points. The calculations were repeated for the tangential radius of curvature. Differences equal or bigger than 0.02 mm were regarded as clinically significant. The surface that provided the sharpest image for an average cornea was a cylinder with the base 120 mm away from the corneal vertex and a diameter of 26 mm. Changing the faceplate design results in clinically significant differences for an average cornea

Generation and physiological roles of linear ubiquitin chains

Ubiquitination now ranks with phosphorylation as one of the best-studied post-translational modifications of proteins with broad regulatory roles across all of biology. Ubiquitination usually involves the addition of ubiquitin chains to target protein molecules, and these may be of eight different types, seven of which involve the linkage of one of the seven internal lysine (K) residues in one ubiquitin molecule to the carboxy-terminal diglycine of the next. In the eighth, the so-called linear ubiquitin chains, the linkage is between the amino-terminal amino group of methionine on a ubiquitin that is conjugated with a target protein and the carboxy-terminal carboxy group of the incoming ubiquitin. Physiological roles are well established for K48-linked chains, which are essential for signaling proteasomal degradation of proteins, and for K63-linked chains, which play a part in recruitment of DNA repair enzymes, cell signaling and endocytosis. We focus here on linear ubiquitin chains, how they are assembled, and how three different avenues of research have indicated physiological roles for linear ubiquitination in innate and adaptive immunity and suppression of inflammation

Effects of Compression and Collective Expansion on Particle Emission from Central Heavy-Ion Reactions

Conditions under which compression occurs and collective expansion develops in energetic reactions of heavy nuclei, are analyzed, together with their effects on emitted light baryons and pions. Within transport simulations, it is shown that shock fronts perpendicular to beam axis form in head-on reactions. The fronts separate hot compressed matter from normal. As impact parameter increases, the angle of inclination of the fronts relative to beam axis decreases, and in-between the fronts a weak tangential discontinuity develops. Hot matter exposed to the vacuum in directions perpendicular to shock motion (and parallel to fronts), starts to expand sideways, early within reactions. Expansion in the direction of shock motion follows after the shocks propagate through nuclei, but due to the delay does not acquire same strength. Expansion affects angular distributions, mean-energy components, shapes of spectra and mean energies of different particles emitted into any one direction, and further particle yields. Both the expansion and a collective motion associated with the weak discontinuity, affect the magnitude of sideward flow within reaction plane. Differences in mean particle energy components in and out of the reaction plane in semicentral collisions, depend sensitively on the relative magnitude of shock speed in normal matter and speed of sound in hot matter.Comment: 71 pages, 33 figures (available on request), report MSUCL-94

Directed flow in Au+Au, Xe+CsI and Ni+Ni collisions and the nuclear equation of state

We present new experimental data on directed flow in collisions of Au+Au, Xe+CsI and Ni+Ni at incident energies from 90 to 400A MeV. We study the centrality and system dependence of integral and differential directed flow for particles selected according to charge. All the features of the experimental data are compared with Isospin Quantum Molecular Dynamics (IQMD) model calculations in an attempt to extract information about the nuclear matter equation of state (EoS). We show that the combination of rapidity and transverse momentum analysis of directed flow allow to disentangle various parametrizations in the model. At 400A MeV, a soft EoS with momentum dependent interactions is best suited to explain the experimental data in Au+Au and Xe+CsI, but in case of Ni+Ni the model underpredicts flow for any EoS. At 90A MeV incident beam energy, none of the IQMD parametrizations studied here is able to consistently explain the experimental data.Comment: RevTeX, 20 pages, 30 eps figures, accepted for publication in Phys. Rev. C. Data files available at http://www.gsi.de/~fopiwww/pub

Study of intermediate velocity products in the Ar+Ni collisions between 52 and 95 A.MeV

Intermediate velocity products in Ar+Ni collisions from 52 to 95 A.MeV are studied in an experiment performed at the GANIL facility with the 4$\pi$ multidetector INDRA. It is shown that these emissions cannot be explained by statistical decays of the quasi-projectile and the quasi-target in complete equilibrium. Three methods are used to isolate and characterize intermediate velocity products. The total mass of these products increases with the violence of the collision and reaches a large fraction of the system mass in mid-central collisions. This mass is found independent of the incident energy, but strongly dependent on the geometry of the collision. Finally it is shown that the kinematical characteristics of intermediate velocity products are weakly dependent on the experimental impact parameter, but strongly dependent on the incident energy. The observed trends are consistent with a participant-spectator like scenario or with neck emissions and/or break-up.Comment: 37 pages, 13 figure

Differential directed flow in Au+Au collisions

We present experimental data on directed flow in semi-central Au+Au collisions at incident energies from 90 to 400 A MeV. For the first time for this energy domain, the data are presented in a transverse momentum differential way. We study the first order Fourier coefficient v1 for different particle species and establish a gradual change of its patterns as a function of incident energy and for different regions in rapidity.Comment: 5 pages, Latex, 5 eps figures, accepted for publication in Phys. Rev. C (Rapid Communications). Data files available at http://www-linux.gsi.de/~andronic/fopi/v1.htm

Conceptualizing pathways linking women's empowerment and prematurity in developing countries.

BackgroundGlobally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity.MethodsThe key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors.ResultsThere is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving access to and receipt of recommended health services during pregnancy and delivery to help prevent prematurity and improve survival of premature babies.ConclusionsWomen's empowerment is an important distal factor that affects prematurity through several intervening factors. Improving women's empowerment will help prevent prematurity and improve survival of preterm babies. Research to empirically show the links between women's empowerment and prematurity is however needed

Long term survival after coronary endarterectomy in patients undergoing combined coronary and valvular surgery – a fifteen year experience

<p>Abstract</p> <p>Background</p> <p>Coronary Endarterectomy (CE) in patients undergoing coronary artery bypass graft (CABG) surgery has been shown to be beneficial in those with diffuse coronary artery disease. There are no published data on its role and benefit in patients undergoing more complex operations. We present our experience with CE in patients undergoing valve surgery with concomitant CABG.</p> <p>Materials and methods</p> <p>Between 1989 and 2003, 237 patients underwent CABG with valve surgery under a single surgeon at our institution. Of these, 41 patients needed CE. Data was retrospectively obtained from hospital records and database. Further follow-up was obtained by telephone interview. All variables were analyzed by univariate analysis for significant factors relating to hospital mortality. Morbidity and long term survival was also studied. There were 29 males and 12 females with a mean age of 67.4 ± 8.1 and body mass index of 26.3 ± 3.3. Their mean euroscore was 7.6 ± 3.2 and the log euro score was 12.2 ± 16.1.</p> <p>Results</p> <p>Thirty-two patients were discharged from the intensive therapy unit within 48 hours after surgery. Average hospital stay was 12.7 ± 10.43 days. Thirty day mortality was 9.8%. Six late deaths occurred during the 14 year follow up. Ten year survival was 57.2% (95% CL 37.8%–86.6%). Three of the survivors had Class II symptoms, with one requiring nitrates. None required further percutaneous or surgical intervention. We compared the result with the available mortality figure from the SCTS database.</p> <p>Conclusion</p> <p>Compared to the SCTS database for these patients, we have observed that CE does not increase the mortality in combined procedures. By accomplishing revascularization in areas deemed ungraftable, we have shown an added survival benefit in this group of patients.</p