Awareness, Be aware

Introdução: Awareness, refere-se à consciência intra-operatória, bem como à memória explícita de eventos intraoperatórios (cirurgia e/ou procedimentos). Os autores descrevem um caso clínico de um homem proposto para excisão parcial da hipófise, por neoplasia da hipófise, em que ocorreu awareness. Caso Clínico: Homem de 50 anos, IMC = 28,7 Kg/m2, com história de patologia prostática e depressão. Submetido a excisão parcial da hipófise, por via transesfenoidal. A técnica anestésica delineada foi uma anestesia geral intravenosa, com propofol 1% e remifentanil 20ug/ml, sob Target Controled Infusion, associado a rocurónio em bolus. Monitorização com os standards da ASA, pressões arteriais invasivas, train of four e entropia. Indução anestésica realizada sem intercorrências com a entropia a descer do valor basal de 98 para 41, após um bólus inicial de 50 ug de remifentanil e de 80 mg de propofol traduzindo-se para valores de alvo cerebral de remifentanil de 3 ug/ml e de 4,1 ug/ml de propofol. Alguma instabilidade hemodinâmica inicial justificou uma correção dos valores de alvo cerebral para 1,5 ug/ml de remifentanil e para 2 ug/ml de propofol. Durante parte deste período procedeu-se aos cateterismos centrais (CVC e multiorificios na veia subclávia direita), tendo sido efectuados alguns períodos de apneia para minimizar o risco de pneumotórax. Decorrido este espaço de tempo, constatou-se que a entropia teria subido para 80, o que justificou um novo ajuste terapêutico. A intervenção cirúrgica decorreu sem mais intercorrências. No período pos-extubação imediato, o doente evocou espontaneamente memórias relativas ao cateterismo (“picadas dolorosas”) e a períodos de dispneia. Após a verificação das tendências durante o procedimento, foi confirmado que durante os cerca de 30 minutos da colocação dos dois catéteres, foi o único período em que a entropia esteve mais elevado que 60, sendo que a experiência contada pelo doente corresponderia ao que se teria passado na sala operatória. O doente foi entrevistado no recobro, no dia seguinte e duas semanas após a ocorrência do evento, confirmando o caso como awereness não se tendo mostrado afectado psicologicamente pelo sucedido. Discussão: Os autores lançam o alerta para o risco de superficialização anestésica aquando da realização de outro tipo de procedimentos, que requerem uma atenção também importante. Apesar do doente não ter ficado com sequelas psicológicas, isto pode ocorrer em até dois terços desta população

VGCM3D - a 3D rigid particle model for rock fracture following the voronoi tessellation of the grain structure: formulation and validation

Detailed particle models by taking into account the material grain structure explicitly consider the material randomness, including a size limiter for damage localization. A VGMC3D contact model is presented that considers the polyhedral particle shape in an approximate way. The VGCM3D flexible contact model is validated against known experimental data on a granite rock, namely triaxial tests and Brazilian tests

Avaliação de desempenho de protótipo de secador solar passivo para tratamento de efluente de processo de dessalinização por destilação multi-efeito

O projecto AQUASOL-Enhanced Zero Discharge Seawater Desalination using Hybrid Solar Technology (EVK1-CT2001-00102) teve como principais objectivos a melhoria do desempenho económico e a minimização dos impactes ambientais associados a um processo de dessalinização por Destilação Multi-Efeito (MED)(Blanco et al, 2002). No âmbito do projecto, decorre o estudo de um secador solar passivo utilizado no tratamento do efluente produzido no processo de dessalinização, salmoura, através da sua concentração e/ou através da produção directa de sal a partir do efluente. Nesta etapa adicional do processo de dessalinização foi considerada não só a maior concentração do efluente relativamente à concentração da água marinha utilizada no processo MED, mas também a sua possível integração numa salina tradicional, com o potencial de substituir etapas intermédias da evaporação com vantagem face ao processo convencional de produção de sal marinho. Após um estudo das especificidades da produção de sal em Salinas tradicionais e do processo de evaporação de uma camada de salmoura, a construção e avaliação de cinco configurações distintas de um protótipo preliminar de secador solar passivo, permitiu o desenho final de um secador para a recuperação de sal a partir do efluente do processo MED (Collares Pereira et al, 2004), construido numa salina industrial na ilha de Lesvos (Grécia) (Collares Pereira et al, 2005). Neste artigo serão apresentados os primeiros resultados de operação do protótipo, bem como uma avaliação inicial do seu desempenho

Extractive method optimization for Ligustrum lucidum yhat leads to a better free radical scavenging activity

info:eu-repo/semantics/publishedVersio

Grain deformability influence on the fracture behaviour of rock

It is known that the initially proposed circular/spherical rigid particle models are not able to match the ratio of the compressive strength to tensile strength that occurs in rock and the predicted macroscopic friction angle was much lower than the known hard rock experimental values. For this reason, several enhancements have been proposed to address these issues, namely the use of a clumped particle logic, the increase of the number of contacts per particle, the adoption of polygonal/polyhedral grain structures. A flexible 2D DEM based particle model that allows deformable particles to interact in a simplified away is presented. The flexible particle model is tested using biaxial tests and Brazilian tests. The results obtained are compared with those obtained with a rigid particle model with similar contact strength properties and with a flexible particle model, where the flexibility is due to the inner discretization of the grain with smaller particles. The results show that the proposed flexible particle model can predict a behaviour similar to a flexible particle model through inner particle discretization that is more computationally demanding. It is also shown that when compared with a rigid model, the flexible model predicts more reasonable indirect tensile strength to direct tensile strength ratio and requires a smaller value of contact fracture energy to give a good agreement with known experimental data

Emergency right colectomy: which strategy when primary anastomosis is not feasible?

BACKGROUND: Primary anastomosis is considered the standard strategy after right emergency colectomy. The present study aimed to evaluate alternative treatment strategies when primary anastomosis is not possible to prevent definitive ostomy. METHODS: This retrospective study included all consecutive patients who underwent right emergency colectomy between July 2006 and June 2013. Demographics, surgical data, and postoperative outcomes were entered in an anonymized database. Comparative analysis was performed between patients with primary anastomosis (PA group) and those where alternative strategies were employed (no-PA group). Outcomes were 30 days complications rate and rate of bowel continuity restoration. RESULTS: One hundred forty-eight patients (57 % male) with a median age of 65 years (15-96) were included. One hundred and sixteen patients underwent PA (78 %) and 32 were in the no-PA group (22 %). No-PA group patients had more comorbidities (Carlson comorbidity index >3: 98 % vs. 54, p < 0.001). Major complications rate (Dindo-Clavien III to IV) was 24 % in PA group, 88 % in no-PA group (p < 0.001). The 30-day mortality rate was 6 % (n = 7) in PA group versus 25 % (n = 8) in no-PA group (p = 0.004). Fourteen patients in the no-PA group had a split stoma and 18 had a two-staged procedure. Five patients had continuity restoration after initial split stoma (36 %) compared to 10 after a two-staged procedure (55 %; p = 0.265). Anastomotic leak occurred in 10 patients of the PA group (9 %) versus 0 in the no-PA group, where 15 out of 32 patients (47 %) had continuity restoration. CONCLUSION: Eighty percent of patients requiring emergency right colectomy were anastomosed primarily. For the remaining a two-staged procedure might facilitate bowel continuity restoration in the long-term

Feasibility and Safety of Pressurized Intraperitoneal Aerosol Chemotherapy for Peritoneal Carcinomatosis: A Retrospective Cohort Study.

Background. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been introduced as a novel repeatable treatment for peritoneal carcinomatosis. The available evidence from the pioneer center suggests good tolerance and high response rates, but independent confirmation is needed. A single-center cohort was analyzed one year after implementation for feasibility and safety. Methods. PIPAC was started in January 2015, and every patient was entered into a prospective database. This retrospective analysis included all consecutive patients operated until April 2016 with emphasis on surgical feasibility and early postoperative outcomes. Results. Forty-two patients (M : F = 8 : 34, median age 66 (59-73) years) with 91 PIPAC procedures in total (4×: 1, 3×: 17, 2×: 12, and 1×: 12) were analyzed. Abdominal accessibility rate was 95% (42/44); laparoscopic access was not feasible in 2 patients with previous HIPEC. Median initial peritoneal carcinomatosis index (PCI) was 10 (IQR 5-17). Median operation time was 94 min (89-108) with no learning curve observed. One PIPAC application was postponed due to intraoperative intestinal lesion. Overall morbidity was 9% with 7 minor complications (Clavien I-II) and one PIPAC-unrelated postoperative mortality. Median postoperative hospital stay was 3 days (2-3). Conclusion. Repetitive PIPAC is feasible in most patients with refractory carcinomatosis of various origins. Intraoperative complications and postoperative morbidity rates were low. This encourages prospective studies assessing oncological efficacy

Towards an alignment of national research programmes and funding for CST technologies in Europe

ABSTRACT: One of the STAGE-STE project work packages aims to develop relations with public bodies relevant to Concentrating Solar Thermal (CST) research, such as national research funding agencies, ministries and other leading decision making bodies, in order to foster coordination and alignment of research programmes and funding at European level. Working groups have been created in eight European countries and concept notes were prepared regarding each group’s position on national CST research and funding programmes and its possible alignment at European scale. General trends and main conclusions drawn from the concept notes are presented, aiming to provide clues and common themes to the development of aligned CST research and funding programmes. Although the National Working Groups present different approaches there are coincident points, thus a common Research and Technological Development agenda for CST can be achieved at European scale. The alignment of CST research funding represents an harder task and will demand the improvement of available funding schemes or the development of a new one. However, there is some convergence regarding the general characteristics of the scheme and the kind of projects to be funded.info:eu-repo/semantics/publishedVersio