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

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

info:eu-repo/semantics/publishedVersio

Neoplasia Blástica de Células Dendríticas Plasmocitóides

Blastic plasmacytoid dendritic cell neoplasm is a rare and aggressive hematodermic neoplasia with frequent cutaneous involvement and leukemic dissemination. We report the case of a 76-year-old man with a 2 month history of violaceous nodules and a tumor with stony consistency, located on the head, and mandibular, cervical and supraclavicular lymphadenopathies. Multiple thoracic and abdominal adenopathies were identified on computerized tomography. Flow cytometry analysis of the skin, lymph node and bone marrow biopsies demonstrated the presence of plasmocytoid dendritic cell neoplastic precursor cells (CD4+, CD45+, CD56+ and CD123+ phenotype). After initial clinical and laboratorial complete remission with chemotherapy, the patient died due to relapse of the disease associated with the appearance of a cervical mass with medullary compromise

Geography & Entrepreneurship: Managing Growth and Change

This introduction to the special issue “Geography & Entrepreneurship: Managing Growth and Change” in the Journal of The Knowledge Economy includes a collection of seven papers. Through theoretical and empirical research, this special issue aims to clarify the connection between geography and entrepreneurship. In doing so, growth strategies and change trajectories of countries, regions, and firms are analyzed. The papers use extensive data that enable the models to provide a rich picture of how academic institutions, companies, and regional governments contribute to regional development. As a result, these studies provide new perspectives on regional entrepreneurial transformation. Theoretical perspectives, methodologies, and their application to several contexts provide an advancement of our understanding about Geography and Entrepreneurship. Perspectives on R&D and knowledge, internationalization strategies, high-growth businesses, technological entrepreneurs, university spin-offs, transnational entrepreneurship, and entrepreneurial networks are dominant themes included in this special issue. A brief description of the authors’ contributions is offered to attract a broader readership.info:eu-repo/semantics/publishedVersio

Impact of etches on thin-film single-crystal niobium resonators

A single crystal niobium thin film was grown using molecular beam epitaxy on a c-plane sapphire wafer. Several samples were fabricated into dc resistivity test devices and coplanar waveguide resonator chips using the same microfabrication procedures and solvent cleans. The samples were then subject to different acid cleaning treatments using different combinations of piranha, hydrofluoric acid, and buffered oxide etch solutions. The different samples expressed changes in dc resistivity in the normal and superconducting states such that the low temperature resistivities changed by more than 100\%, and the residual resistivity ratio dropped by a factor of 2. The internal quality factor of coplanar waveguide resonators measured near 5~GHz also showed significant variation at single photon powers ranging from 1.4$\times 10^6$ to less than 60$\times 10^3$. These changes correlate with the formation of surface crystallites that appear to be hydrocarbons. All observations are consistent with hydrogen diffusing into the niobium film at levels below the saturation threshold that is needed to observe niobium hydrides

Welfare of rainbow trout at slaughter: integrating behavioural, physiological, proteomic and quality indicators and testing a novel fast-chill stunning method

A critical point in the life of a captive fish is the final stages of production, not only in welfare terms but also due to effects on meat quality, carcass appearance and derived economic impacts. The most common method to slaughter fish is by asphyxia either in ice-water or in the open air. In humane slaughter procedures, however, a stunning method needs to be implemented to render the fish immediately unconscious (within one second) until death. The objective of this research was to evaluate and compare the effectiveness and welfare effects of four types of stunning methods in rainbow trout (O. mykiss): cold shock by fast-chilling as a novel method, where the fish were immersed in liquid water at −8 °C, asphyxia (as the currently used method), electrical stunning, and anaesthesia with MS-222. We used a total of 176 trout (mean weight 524 ± 138 g), combining behavioural (individual swimming activity, equilibrium, opercular movement and eye-roll), physiological (heart rate and electrocardiogram amplitude) and circulating (plasma cortisol and osmolality) indicators with brain proteomic signatures. We also analysed the effects on fillet shelf-life and quality in each method (rigor mortis, water content, fillet colour, pH and ATP degradation). Anaesthesia effectively induced unconsciousness, with regular and strong heartbeat and low cortisol. Quality indicators were the best among all the methods assessed. Electric shock was found to be an effective and irreversible method for inducing unconsciousness, with strong heartbeat and large variation in cortisol response and quality indicators similar to anaesthesia. On the contrary, asphyxia presented indicators of poor welfare (e.g., long-lasting consciousness throughout the slaughter process, high cortisol levels), with very low flesh quality parameters. Fast-chilling also resulted in extreme signs of stress (intense mucus release, haemorrhage and no loss of consciousness), low ATP content and the worst proteomic signatures, along with an early onset and resolution of rigor mortis (6 and 48 h, respectively). Our results reinforce the idea that electric stunning is a promising humane method to stun farmed trout. In contrast, the fast-chilling method showed very poor results both in welfare and in quality, indicating that it is not a viable humane alternative to asphyxia. Moreover, the proteome analysis provided valuable insights into the brain mechanisms of rainbow trout at slaughter, offering potential fine-scale biomarkers of welfare.Provincia Autonoma di Trento; Fundação para a Ciência e a Tecnologiainfo:eu-repo/semantics/acceptedVersio

Development and Validation of the Metric-Based Assessment of a Robotic Vessel Dissection, Vessel Loop Positioning, Clip Applying and Bipolar Coagulation Task on an Avian Model

The evolution of robotic technology and its diffusion does not seem to have been adequately accompanied by the development and implementation of surgeon training programs that ensure skilled and safe device use at the start of the learning curve. The objective of the study is to develop and validate performance metrics for vessel dissection, vessel loop positioning, clip applying and bipolar coagulation using an avian model. Three robotic surgeons and a behavioral scientist characterized the performance metrics of the task according to the proficiency-based progression methodology. Fourteen experienced robotic surgeons from different European countries participated in a modified online Delphi consensus. Eight experienced surgeons and eight novices performed the robotic task twice. In the Delphi meeting, 100% consensus was reached on the performance metrics. Novice surgeons took 26 min to complete the entire task on trial 1 and 20 min on trial 2. Experts took 10.1 min and 9.5 min. On average the Expert Group completed the task 137% faster than the Novice Group. The amount of time to reach the vessel part of the task was also calculated. Novice surgeons took 26 min on trial 1 and 20 min on trial 2. Experts took 5.5 min and 4.8 min. On average the experts reached the vessel 200% faster than the novices. The Expert Group made 155% fewer performance errors than the Novice Group. The mean IRR of video-recorded performance assessments for all metrics was 0.96 (95% confidence intervals (CI) lower = 0.94-upper = 0.98). We report the development and validation for a standard and replicable basic robotic vessel dissection, vessel loop positioning, clip applying and bipolar coagulation task on an avian model. The development of objective performance metrics, based on a transparent and fair methodology (i.e., PBP), is the first fundamental step toward quality assured training. This task developed on the avian model proved to have good results in the validation study.info:eu-repo/semantics/publishedVersio

Assessment of Treatment Response after Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) for Appendiceal Peritoneal Metastases

Background The aim of this study was to analyse survival and surrogates for oncological response after PIPAC for appendiceal tumours. Methods This retrospective cohort study included consecutive patients with appendiceal peritoneal metastases (PM) treated in experienced PIPAC centers. Primary outcome measure was overall survival (OS) from the date of diagnosis of PM and from the start of PIPAC. Predefined secondary outcome included radiological response (RECIST criteria), repeat laparoscopy and peritoneal cancer index (PCI), histological response assessed by the Peritoneal regression grading system (PRGS) and clinical response. Results Final analysis included 77 consecutive patients (208 PIPAC procedures) from 15 centres. Median OS was 30 months (23.00–46.00) from time of diagnosis and 19 months (13.00–28.00) from start of PIPAC. 35/77 patients (45%) had ≥3 procedures (pp: per protocol). Objective response at PIPAC3 was as follows: RECIST: complete response 4 (11.4%), 11 (31.4%) partial/stable; mean PRGS at PIPAC3: 1.8 ± 0.9. Median PCI: 21 (IQR 18–27) vs. 22 (IQR 17–28) at baseline (p = 0.59); 21 (60%) and 18 (51%) patients were symptomatic at baseline and PIPAC3, respectively (p = 0.873). Median OS in the pp cohort was 22.00 months (19.00–NA) from 1st PIPAC. Conclusion Patients with PM of appendiceal origin had objective treatment response after PIPAC and encouraging survival curves call for further prospective evaluation

Fragility functions for tall URM buildings around early 20th century in Lisbon. Part 1: Methodology and application at building level

The article proposes a procedure for the derivation of fragility functions for unreinforced masonry buildings considering the in-plane and out-of-plane response. Different approaches are considered for the generation of the corresponding fragility functions and for the evaluation of the propagation of uncertainties. The contributions for the dispersion of the fragility functions account for the variability in the definition of the capacity, the aleatory uncertainty in the definition of the seismic demand and the aleatory uncertainty in the definition of the modified/floor response spectrum, when the local mechanisms are located in the upper level of the building. In the end, the individual fragility curves are properly combined in order to define a single fragility curve for the class of buildings. As a case study, the procedure is applied to the assessment of one of the most vulnerable unreinforced masonry buildings constructed in the early 20th century in Lisbon, considering a typical prototype building with five storeys high. Results for a seismic event, as defined in the earthquake-resistant code for Lisbon, indicate that the typical building has about 50% probability of having heavy damage and about 30% probability of collapse.The first author would like to acknowledge the financial support of Fundação para a Ciência e a Tecnologia (FCT, Ministério da Educação e Ciência, Portugal) through the scholarship PD/BD/106076/2015 through the FCT Doctoral Program: Analysis and Mitigation of Risks in Infrastructures, INFRARISK- (http://infrarisk.tecnico.ulisboa.pt)

Development of cross-resistance by Aspergillus fumigatus to clinical azoles following exposure to prochloraz, an agricultural azole

Background: The purpose of this study was to unveil whether azole antifungals used in agriculture, similar to the clinical azoles used in humans, can evoke resistance among relevant human pathogens like Aspergillus fumigatus, an ubiquitous agent in nature. Additionally, cross-resistance with clinical azoles was investigated. Antifungal susceptibility testing of environmental and clinical isolates of A. fumigatus was performed according to the CLSI M38-A2 protocol. In vitro induction assays were conducted involving daily incubation of susceptible A. fumigatus isolates, at 35°C and 180 rpm, in fresh GYEP broth medium supplemented with Prochloraz (PCZ), a potent agricultural antifungal, for a period of 30 days. Minimal inhibitory concentrations (MIC) of PCZ and clinical azoles were monitored every ten days. In order to assess the stability of the developed MIC, the strains were afterwards sub-cultured for an additional 30 days in the absence of antifungal. Along the in vitro induction process, microscopic and macroscopic cultural observations were registered. Results: MIC of PCZ increased 256 times after the initial exposure; cross-resistance to all tested clinical azoles was observed. The new MIC value of agricultural and of clinical azoles maintained stable in the absence of the selective PCZ pressure. PCZ exposure was also associated to morphological colony changes: macroscopically the colonies became mostly white, losing the typical pigmentation; microscopic examination revealed the absence of conidiation. Conclusions: PCZ exposure induced Aspergillus fumigatus morphological changes and an evident increase of MIC value to PCZ as well as the development of cross-resistance with posaconazole, itraconazole and voriconazole.IFR and IMM are supported by FCT (Fundação Ciência e Tecnologia). IFR is supported by FCT PhD grant (SFRH/BD/91155/2012). I.MM is supported by FCT, Ciência 2008 and co-financed by the European Social Fund. The authors would like to thank Isabel Santos for the excellent technical assistance. Part of the results was presented at the 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy, ICAAC, held San Francisco, USA, September 2012.info:eu-repo/semantics/publishedVersio