Modelling physiology of haemodynamic adaptation in short-term microgravity exposure and orthostatic stress on Earth

Cardiovascular haemodynamics alters during posture changes and exposure to microgravity. Vascular auto-remodelling observed in subjects living in space environment causes them orthostatic intolerance when they return on Earth. In this study we modelled the human haemodynamics with focus on head and neck exposed to different hydrostatic pressures in supine, upright (head-up tilt), head-down tilt position, and microgravity environment by using a well-developed 1D-0D haemodynamic model. The model consists of two parts that simulates the arterial (1D) and brain-venous (0D) vascular tree. The cardiovascular system is built as a network of hydraulic resistances and capacitances to properly model physiological parameters like total peripheral resistance, and to calculate vascular pressure and the related flow rate at any branch of the tree. The model calculated 30.0 mmHg (30%), 7.1 mmHg (78%), 1.7 mmHg (38%) reduction in mean blood pressure, intracranial pressure and central venous pressure after posture change from supine to upright, respectively. The modelled brain drainage outflow percentage from internal jugular veins is 67% and 26% for supine and upright posture, while for head-down tilt and microgravity is 65% and 72%, respectively. The model confirmed the role of peripheral veins in regional blood redistribution during posture change from supine to upright and microgravity environment as hypothesized in literature. The model is able to reproduce the known haemodynamic effects of hydraulic pressure change and weightlessness. It also provides a virtual laboratory to examine the consequence of a wide range of orthostatic stresses on human haemodynamics

Plethysmography system to monitor the jugular venous pulse: A feasibility study

Cerebral venous outflow is investigated in the diagnosis of heart failure through the monitoring of jugular venous pulse, an indicator to assess cardiovascular diseases. The jugular venous pulse is a weak signal stemming from the lying internal jugular vein and often invasive methodolo-gies requiring surgery are mandatory to detect it. Jugular venous pulse can also be extrapolated via the ultrasound technique, but it requires a qualified healthcare operator to perform the exami-nation. In this work, a wireless, user-friendly, wearable device for plethysmography is developed to investigate the possibility of monitoring the jugular venous pulse non-invasively. The proposed device can monitor the jugular venous pulse and the electrocardiogram synchronously. To study the feasibility of using the proposed device to detect physiological variables, several measurements were carried out on healthy subjects by considering three different postures: supine, sitting, and upright. Data acquired in the experiment were properly filtered to highlight the cardiac oscillation and remove the breathing contribution, which causes a considerable shift in the amplitude of signals. To evaluate the proper functioning of the wearable device for plethysmography, a comparison with the ultrasound technique was carried out. As a satisfactory result, the acquired signals resemble the typical jugular venous pulse waveforms found in literature

Score Test for Conditional Independence Between Longitudinal Outcome and Time to Event Given the Classes in the Joint Latent Class Model

Latent class models have been recently developed for the joint analysis of a longitudinal quantitative outcome and a time to event. These models assume that the population is divided in  G  latent classes characterized by different risk functions for the event, and different profiles of evolution for the markers that are described by a mixed model for each class. However, the key assumption of conditional independence between the marker and the event given the latent classes is difficult to evaluate because the latent classes are not observed. Using a joint model with latent classes and shared random effects, we propose a score test for the null hypothesis of independence between the marker and the outcome given the latent classes versus the alternative hypothesis that the risk of event depends on one or several random effects from the mixed model in addition to the latent classes. A simulation study was performed to compare the behavior of the score test to other previously proposed tests, including situations where the alternative hypothesis or the baseline risk function are misspecified. In all the investigated situations, the score test was the most powerful. The methodology was applied to develop a prognostic model for recurrence of prostate cancer given the evolution of prostate-specific antigen in a cohort of patients treated by radiation therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79185/1/j.1541-0420.2009.01234.x.pd

Validation of a hemodynamic model for the study of the cerebral venous outflow system using MR imaging and echo- Color doppler data

BACKGROUND AND PURPOSE: A comprehensive parameter model was developed to investigate correlations between cerebral hemodynamics and alterations in the extracranial venous circulation due to posture changes and/or extracranial venous obstruction (stenosis). The purpose of this work was to validate the simulation results by using MR imaging and echo-color Doppler experimental blood flow data in humans. MATERIALS AND METHODS: To validate the model outcomes, we used supine average arterial and venous extracerebral blood flow, obtained by using phase-contrast MR imaging from 49 individuals with stenosis in the acquisition plane at the level of the disc between the second and third vertebrae of the left internal jugular vein, 20 with stenosis in the acquisition plane at the level of the disc between the fifth and sixth vertebrae of the right internal jugular vein, and 38 healthy controls without stenosis. Average data from a second group of 10 healthy volunteers screened with an echo-color Doppler technique were used to evaluate flow variations due to posture change. RESULTS: There was excellent agreement between experimental and simulated supine flows. Every simulated CBF fell inside the standard error from the corresponding average experimental value, as well as most of the simulated extracerebral arterial flow (extracranial blood flow from the head and face, measured at the level of the disc between second and third vertebrae) and venous flows. Simulations of average jugular and vertebral blood flow variations due to a change of posture from supine to upright also matched the experimental data. CONCLUSIONS: The good agreement between simulated and experimental results means that the model can correctly reproduce the main factors affecting the extracranial circulation and could be used to study other types of stenotic conditions not represented by the experimental data

Robotics in uro-oncologic surgery

In urology, the main use for the robotic technique has been in radical prostatectomy for prostate cancer. Robotic surgery for other organs, such as the kidneys and bladder, has been less explored. However, partial nephrectomy or radical nephroureterectomy can be difficult for inexperienced laparoscopic surgeons. The advent of the da Vinci robot, with multijointed endowristed instruments and stereoscopic vision, decreases the technical difficulty of intracorporeal suturing and improves the reconstructive steps. The objective of this article is to offer an overview of all robotic procedures recently developed in the field of urology. We evaluate the feasibility of these procedures and their potential advantages and disadvantages. We also describe perioperative, postoperative, and oncologic outcomes of robot-assisted surgery as well as perform a comparison with open and laparoscopic techniques. Comparative data and an adequate follow-up are needed to demonstrate equivalent oncologic outcomes in comparison with traditional open or laparoscopic procedures. Copyright

Moving Alps. Le conseguenze sociali della dismissione industriale nello spazio alpino europeo.

Presentazione dei risultati del progetto trAIL

A Mechatronic Cardiovascular Simulation System for Jugular Venous Echo-Doppler Training

Echo-doppler examination of the jugular vessel is a powerful tool for the early diagnosis of cardiovascular disorders that can be further related to central nervous system diseases. Unfortunately, the ultrasound technique is strongly operator-dependent, so the quality of the scan, the accuracy of the measurement, and therefore the rapidity and robustness of the diagnosis reflect the degree of training. The paper presents the development of a mechatronic simulation system for improving the skill of novice physicians in echo-doppler procedures. The patient is simulated by a silicone manikin whose materials are designed to have a realistic ultrasound response. Two tubes allow blood-mimicking fluid to flow inside the manikin, simulating the hemodynamics of the internal jugular vein. The mechatronic system is designed for controlling the flow waveform, to reproduce several clinical cases of interest for diagnosis. The experiments investigate the accuracy of the echo-doppler measurements performed on the proposed system by novice operators using a real ultrasound scanner

The Infrared Behavior of Gluon and Ghost Propagators in Landau Gauge QCD

A solvable systematic truncation scheme for the Dyson-Schwinger equations of Euclidean QCD in Landau gauge is presented. It implements the Slavnov-Taylor identities for the three-gluon and ghost-gluon vertices, whereas irreducible four-gluon couplings as well as the gluon-ghost and ghost-ghost scattering kernels are neglected. The infrared behavior of gluon and ghost propagators is obtained analytically: The gluon propagator vanishes for small spacelike momenta whereas the ghost propagator diverges stronger than a massless particle pole. The numerical solutions are compared with recent lattice data for these propagators. The running coupling of the renormalization scheme approaches a fixed point, $\alpha_c \simeq 9.5$, in the infrared.Comment: 4 pages, 2 figures, Revtex; revised version accepted for publication in Physical Review Letter

Coordinated analysis of age, sex, and education effects on change in MMSE scores

Objectives. We describe and compare the expected performance trajectories of older adults on the Mini-Mental Status Examination (MMSE) across six independent studies from four countries in the context of a collaborative network of longitudinal studies of aging. A coordinated analysis approach is used to compare patterns of change conditional on sample composition differences related to age, sex, and education. Such coordination accelerates evaluation of particular hypotheses. In particular, we focus on the effect of educational attainment on cognitive decline.Method. Regular and Tobit mixed models were fit to MMSE scores from each study separately. The effects of age, sex, and education were examined based on more than one centering point.Results. Findings were relatively consistent across studies. On average, MMSE scores were lower for older individuals and declined over time. Education predicted MMSE score, but, with two exceptions, was not associated with decline in MMSE over time.Conclusion. A straightforward association between educational attainment and rate of cognitive decline was not supported. Thoughtful consideration is needed when synthesizing evidence across studies, as methodologies adopted and sample characteristics, such as educational attainment, invariably differ. © 2012 The Author

Hydride transfer made easy in the oxidation of alcohols catalyzed by choline oxidase

Choline oxidase (E.C. 1.1.3.17) catalyzes the two-step, four-electron oxidation of choline to glycine betaine with betaine aldehyde as enzyme-associated intermediate and molecular oxygen as final electron acceptor (Scheme 1). The gem-diol, hydrated species of the aldehyde intermediate of the reaction acts as substrate for aldehyde oxidation, suggesting that the enzyme may use similar strategies for the oxidation of the alcohol substrate and aldehyde intermediate. The determination of the chemical mechanism for alcohol oxidation has emerged from biochemical, mechanistic, mutagenetic, and structural studies. As illustrated in the mechanism of Scheme 2, the alcohol substrate is initially activated in the active site of the enzyme by removal of the hydroxyl proton. The resulting alkoxide intermediate is then stabilized in the enzyme-substrate complex via electrostatic interactions with active site amino acid residues. Alcohol oxidation then occurs quantum mechanically via the transfer of the hydride ion from the activated substrate to the N(5) flavin locus. An essential requisite for this mechanism of alcohol oxidation is the high degree of preorganization of the activated enzyme-substrate complex, which is achieved through an internal equilibrium of the Michaelis complex occurring prior to, and independently from, the subsequent hydride transfer reaction. The experimental evidence that support the mechanism for alcohol oxidation shown in Scheme 2 is briefly summarized in the Results and Discussion section