Antiagregación y anticoagulación en síndromes coronarios agudos: niveles de evidencia

Management of acute coronary syndromes (ACS) has moved rapidly in parallel with our understanding of the pathophysiological basis of the disease. In the eighties, the demonstration of the pivotal role of coronary thrombosis in the etiology of a ACS led to administration of aspirin and unfractionated heparin. In recent years, new medical and invasive therapies have been developed: anti-platelets (thienopyridines and glycoprotein Ilb/IlIa inhibitors), antithrombins (low molecularweight heparins) and most recently, factor Xa inhibitors (pentasaccharides). As new treatments are rapidly added, clinicians are constantly challenged to incorporate new information and guidelines into their practices in a timely fashion

Photospheric structure of an extended penumbra

The photospheric structure of an extended penumbra belonging to a complex spot observed near disk center is investigated by means of the inversion of the full Stokes vector of two Fe I lines at 1.56 μm. An attempt is made to classify the observed Stokes V profiles in terms of their shapes. It turns out that about 28% of the profiles have abnormal shapes indicative of two different magnetic-field components within the resolution element. The spatial distribution of abnormal Stokes V profiles is studied. It is found that such profiles are evenly distributed in the penumbra, without any particular tendency to concentrate near the so-called neutral line. Anomalous profiles are not only seen in the outer penumbra and beyond, but also in the middle part of it. A Milne-Eddington–like inversion is carried out first, revealing a smooth picture of the spatial distribution of magneticfield vector and velocities along the line of sight. In particular, dark spines with stronger and more vertical magnetic fields are seen to coexist with nearly horizontal magnetic fields throughout the penumbra. A full inversion allowing for gradients of the atmospheric parameters along the line of sight indicates the existence of cool magnetic tubes returning back to the solar surface (inclination angles greater than 90◦) and carrying the largest material flows

In Silico Exploration of Mycobacterium tuberculosis Metabolic Networks Shows Host-Associated Convergent Fluxomic Phenotypes

Mycobacterium tuberculosis, the causative agent of tuberculosis, is composed of several lineages characterized by a genome identity higher than 99%. Although the majority of the lineages are associated with humans, at least four lineages are adapted to other mammals, including different M. tuberculosis ecotypes. Host specificity is associated with higher virulence in its preferred host in ecotypes such as M. bovis. Deciphering what determines the preference of the host can reveal host-specific virulence patterns. However, it is not clear which genomic determinants might be influencing host specificity. In this study, we apply a combination of unsupervised and supervised classification methods on genomic data of ~27,000 M. tuberculosis clinical isolates to decipher host-specific genomic determinants. Host-specific genomic signatures are scarce beyond known lineage-specific mutations. Therefore, we integrated lineage-specific mutations into the iEK1011 2.0 genome-scale metabolic model to obtain lineage-specific versions of it. Flux distributions sampled from the solution spaces of these models can be accurately separated according to host association. This separation correlated with differences in cell wall processes, lipid, amino acid and carbon metabolic subsystems. These differences were observable when more than 95% of the samples had a specific growth rate significantly lower than the maximum achievable by the models. This suggests that these differences might manifest at low growth rate settings, such as the restrictive conditions M. tuberculosis suffers during macrophage infection

Diagnóstico y tratamiento de la trombosis venosa profunda

Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. Currently, an algorithm strategy combining pretest probability, D-dimer testing and compression ultrasonography imaging allows for safe and convenient estimation of suspected lower-limb thrombosis. The mainstay of treatment is anticoagulation therapy. The use of low-molecular-weight heparin or pentasaccharide (fondaparinux) allows for outpatient management of most patients with DVT. The duration of anticoagulation depends on whether the primary event was idiopathic or secondary to a transient risk factor. Interventions such as thrombolysis and placement of inferior vena cava filter are reserved for special situations

Thermal impact from a thermoelectric power plant on a tropical coastal lagoon

Tropical coastal areas are sensitive ecosystems to climate change, mainly due to sea level rise and increasing water temperatures. Furthermore, they may be subject to numerous stresses, including heat releases from energy production. The Urias coastal lagoon (SE Gulf of California), a subtropical tidal estuary, receives cooling water releases from a thermoelectric power plant, urban and industrial wastes, and shrimp farm discharges. In order to evaluate the plant thermal impact, we measured synchronous temperature time series close to and far from the plant. Furthermore, in order to discriminate the thermal pollution impact from natural variability, we used a high-resolution hydrodynamic model forced by, amongst others, cooling water release as a continuous flow (7.78 m3 s?1) at 6 °C overheating temperature. Model results and field data indicated that the main thermal impact was temporally restricted to the warmest months, spatially restricted to the surface layers (above 0.6 m) and distributed along the shoreline within ?100 m of the release point. The methodology and results of this study can be extrapolated to tropical coastal lagoons that receive heat discharges.<br/

Analytical model for the prediction of permeability of triply periodic minimal surfaces

Triply periodic minimal surfaces (TPMS) are mathematically defined cellular structures whose geometry can be quickly adapted to target desired mechanical response (structural and fluid). This has made them desirable for a wide range of bioengineering applications; especially as bioinspired materials for bone replacement. The main objective of this study was to develop a novel analytical framework which would enable calculating permeability of TPMS structures based on the desired architecture, pore size and porosity. To achieve this, computer-aided designs of three TPMS structures (Fisher-Koch S, Gyroid and Schwarz P) were generated with varying cell size and porosity levels. Computational Fluid Dynamics (CFD) was used to calculate permeability for all models under laminar flow conditions. Permeability values were then used to fit an analytical model dependent on geometry parameters only. Results showed that permeability of the three architectures increased with porosity at different rates, highlighting the importance of pore distribution and architecture. The computed values of permeability fitted well with the suggested analytical model (R2>0.99, p<0.001). In conclusion, the novel analytical framework presented in the current study enables predicting permeability values of TPMS structures based on geometrical parameters within a difference <5%. This model, which could be combined with existing structural analytical models, could open new possibilities for the smart optimisation of TPMS structures for biomedical applications where structural and fluid flow properties need to be optimised

Cape Sable Seaside Sparrow Habitat Monitoring and Assessment - 2010 Final Report

For the last two decades, the Cape Sable seaside sparrow (CSSS), a federally endangered species, has been a pivot point for water management operations in the Everglades, primarily because a decline in sparrow population in the early 1990s was attributed in part to managementinduced alterations in hydrologic regimes. With a goal of understanding the response of landscape-level processes to hydrological restoration and its interaction with fire, a study intended to monitor vegetation structure and composition throughout the marl prairie landscape has been conducted since 2003 with funding from U.S. Army Corps of Engineers (USACE). In the first three years (2003-2005), vegetation structure and composition was characterized in relation to the existing hydrologic regime and fire history. During 2006-2010, vegetation was resampled to assess vegetation change within the sparrow habitat. This document summarizes the vegetation change pattern observed between the two sampling periods in sub-population A, C, E and F, emphasizing the work accomplished in FY 2010

In silico assessment of the bone regeneration potential of complex porous scaffolds.

Mechanical environment plays a crucial role in regulating bone regeneration in bone defects. Assessing the mechanobiological behavior of patient-specific orthopedic scaffolds in-silico could help guide optimal scaffold designs, as well as intra- and post-operative strategies to enhance bone regeneration and improve implant longevity. Additively manufactured porous scaffolds, and specifically triply periodic minimal surfaces (TPMS), have shown promising structural properties to act as bone substitutes, yet their ability to induce mechanobiologially-driven bone regeneration has not been elucidated. The aim of this study is to i) explore the bone regeneration potential of TPMS scaffolds made of different stiffness biocompatible materials, to ii) analyze the influence of pre-seeding the scaffolds and increasing the post-operative resting period, and to iii) assess the influence of patient-specific parameters, such as age and mechanosensitivity, on outcomes. To perform this study, an in silico model of a goat tibia is used. The bone ingrowth within the scaffold pores was simulated with a mechano-driven model of bone regeneration. Results showed that the scaffold's architectural properties affect cellular diffusion and strain distribution, resulting in variations in the regenerated bone volume and distribution. The softer material improved the bone ingrowth. An initial resting period improved the bone ingrowth but not enough to reach the scaffold's core. However, this was achieved with the implantation of a pre-seeded scaffold. Physiological parameters like age and health of the patient also influence the bone regeneration outcome, though to a lesser extent than the scaffold design. This analysis demonstrates the importance of the scaffold's geometry and its material, and highlights the potential of using mechanobiological patient-specific models in the design process for bone substitutes

Multiobjective simulation optimization in software project management

Traditionally, simulation has been used by project managers in optimising decision making. However, current simulation packages only include simulation optimisation which considers a single objective (or multiple objectives combined into a single fitness function). This paper aims to describe an approach that consists of using multiobjective optimisation techniques via simulation in order to help software project managers find the best values for initial team size and schedule estimates for a given project so that cost, time and productivity are optimised. Using a System Dynamics (SD) simulation model of a software project, the sensitivity of the output variables regarding productivity, cost and schedule using different initial team size and schedule estimations is determined. The generated data is combined with a well-known multiobjective optimisation algorithm, NSGA-II, to find optimal solutions for the output variables. The NSGA-II algorithm was able to quickly converge to a set of optimal solutions composed of multiple and conflicting variables from a medium size software project simulation model. Multiobjective optimisation and SD simulation modeling are complementary techniques that can generate the Pareto front needed by project managers for decision making. Furthermore, visual representations of such solutions are intuitive and can help project managers in their decision making process