Angiographic embolization in the treatment of arterial pelvic hemorrhage: evaluation of prognostic mortality-related factors

PURPOSE: The control of arterial bleeding associated with pelvic ring and acetabular fractures (PRAF) remains a challenge for emergency trauma care. The aim of the present study was to uncover early prognostic mortality-related factors in PRAF-related arterial bleedings treated with transcatheter angiographic embolization (TAE). METHODS: Forty-nine PRAF patients (46 pelvic ring and three acetabular fractures) with arterial pelvic bleeding controlled with TAE (within 24 h) were evaluated. RESULTS: All large arterial disruptions (n = 7) were seen in type C pelvic ring injuries. The 30-day mortality in large vessel (iliac artery) bleeding was higher (57 %) than in medium- or small-size artery bleeding (24 %). Overall 30-day mortality was 29 %. No statistically significant difference in the first laboratory values between the survivors and nonsurvivors was found. However, after excluding patients dying of head injuries (n = 5), a reasonable cut-off value was identified for the base excess (BE; lower than −10 mmol/l) obtained on admission. CONCLUSIONS: PRAF patients with exsanguinating bleeding from the large pelvic artery have the worst prognosis. Very low BE values (<−10.0 mmol/l) on admission for exsanguinating patients have a negative predictive value for survival, thus anticipating a poor outcome in bleeding controlled with TAE only and an increased risk of death. In critical cases, an aggressive bleeding control protocol prompts extraperitoneal pelvic packing prior to TAE. PRAF-related rupture of the external iliac artery is rare and indicates surgical techniques in controlling and restoring blood supply to the lower leg

Implementing Shor's algorithm on Josephson Charge Qubits

We investigate the physical implementation of Shor's factorization algorithm on a Josephson charge qubit register. While we pursue a universal method to factor a composite integer of any size, the scheme is demonstrated for the number 21. We consider both the physical and algorithmic requirements for an optimal implementation when only a small number of qubits is available. These aspects of quantum computation are usually the topics of separate research communities; we present a unifying discussion of both of these fundamental features bridging Shor's algorithm to its physical realization using Josephson junction qubits. In order to meet the stringent requirements set by a short decoherence time, we accelerate the algorithm by decomposing the quantum circuit into tailored two- and three-qubit gates and we find their physical realizations through numerical optimization.Comment: 12 pages, submitted to Phys. Rev.

Comparative Hepatic and Intestinal Metabolism and Pharmacodynamics of Statins

The study aimed to comprehensively investigate the in vitro metabolism of statins. The metabolism of clinically relevant concentrations of atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin, and their metabolites were investigated using human liver microsomes (HLMs), human intestine microsomes (HIMs), liver cytosol, and recombinant cytochrome P450 enzymes. We also determined the inhibitory effects of statin acids on their pharmacological target, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase. In HLMs, statin lactones were metabolized to a much higher extent than their acid forms. Atorvastatin lactone and simvastatin (lactone) showed extensive metabolism [intrinsic clearance (CLint) values of 3700 and 7400 mu l/min per milligram], whereas the metabolism of the lactones of 2-hydroxyatorvastatin, 4-hydroxyatorvastatin, and pitavastatin was slower (CLint 20-840 mu l/min per milligram). The acids had CLint values in the range SIGNIFICANCE STATEMENT The present comparison of the in vitro metabolic and pharmacodynamic properties of atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin and their metabolites using unified methodology provides a strong basis for further application. Together with in vitro drug transporter and clinical data, the present findings are applicable for use in comparative systems pharmacology modeling to predict the pharmacokinetics and pharmacological effects of statins at different dosages.Peer reviewe

Extending scientific computing system with structural quantum programming capabilities

We present a basic high-level structures used for developing quantum programming languages. The presented structures are commonly used in many existing quantum programming languages and we use quantum pseudo-code based on QCL quantum programming language to describe them. We also present the implementation of introduced structures in GNU Octave language for scientific computing. Procedures used in the implementation are available as a package quantum-octave, providing a library of functions, which facilitates the simulation of quantum computing. This package allows also to incorporate high-level programming concepts into the simulation in GNU Octave and Matlab. As such it connects features unique for high-level quantum programming languages, with the full palette of efficient computational routines commonly available in modern scientific computing systems. To present the major features of the described package we provide the implementation of selected quantum algorithms. We also show how quantum errors can be taken into account during the simulation of quantum algorithms using quantum-octave package. This is possible thanks to the ability to operate on density matrices

Scalar Ambiguity and Freeness in Matrix Semigroups over Bounded Languages

There has been much research into freeness properties of finitely generated matrix semigroups under various constraints, mainly related to the dimensions of the generator matrices and the semiring over which the matrices are defined. A recent paper has also investigated freeness properties of matrices within a bounded language of matrices, which are of the form M1M2 · · · Mk ⊆ F n×n for some semiring F [9]. Most freeness problems have been shown to be undecidable starting from dimension three, even for upper-triangular matrices over the natural numbers. There are many open problems still remaining in dimension two. We introduce a notion of freeness and ambiguity for scalar reachability problems in matrix semigroups and bounded languages of matrices. Scalar reachability concerns the set {ρ TMτ |M ∈ S}, where ρ, τ ∈ F n are vectors and S is a finitely generated matrix semigroup. Ambiguity and freeness problems are defined in terms of uniqueness of factorizations leading to each scalar. We show various undecidability results

Does Selective Migration Explain the Hispanic Paradox?: A Comparative Analysis of Mexicans in the U.S. and Mexico

Latino immigrants, particularly Mexican, have some health advantages over U.S.-born Mexicans and Whites. Because of their lower socioeconomic status, this phenomenon has been called the epidemiologic “Hispanic Paradox.” While cultural theories have dominated explanations for the Paradox, the role of selective migration has been inadequately addressed. This study is among the few to combine Mexican and U.S. data to examine health selectivity in activity limitation, self-rated health, and chronic conditions among Mexican immigrants, ages 18 and over. Drawing on theories of selective migration, this study tested the “healthy migrant” and “salmon-bias” hypotheses by comparing the health of Mexican immigrants in the U.S. to non-migrants in Mexico, and to return migrants in Mexico. Results suggest that there are both healthy migrant and salmon-bias effects in activity limitation, but not other health aspects. In fact, consistent with prior research, immigrants are negatively selected on self-rated health. Future research should consider the complexities of migrants’ health profiles and examine selection mechanisms alongside other factors such as acculturation

A guideline for placement of an infra-acetabular screw based on anatomic landmarks via an intra-pelvic approach

Background: Due to demographic changes, more and more fracture patterns involving anterior acetabular structures occur. The infra-acetabular screw is seen a useful tool to increase stability in fixation of the acetabular cup. However, the exact position of this screw in relation to anatomic landmarks which are intra-operatively palpable via an intra-pelvic approach has not yet been determined. Methods: This biomorphometric experimental study references the ideal screw position of an infra-acetabular screw to anatomic landmarks palpable via an intra-pelvic approach. Therefore, we created a computer tomography-based 3D-model of 40 patients (20 women, 20 men) who received a computer tomography (CT) scan of the pelvis for any other reason than an acetabular fracture. Results: The entry point of an ideal infra-acetabular was of high constancy. At mean, this point was 10.2 mm caudal and 10.4 mm medial of the ilio-pubic/ilio-pectineal eminence. This reference is independent of age, gender, or physical dimensions. However, we found gender-dependent differences for the angulation and the length of the screw. Conclusions: This study provides a comprehensive guideline to determine the ideal entry point for an infra-acetabular screw via an intra-pelvic approach. The entry point is located 10.2 mm caudal and 10.4 mm medial of the ilio-pubic/ilio-pectineal eminence