Analysis of the hydrodynamic profile in different roller pumps models used in cardiopulmonary bypass

OBJECTIVE: Among the equipments used in cardiopulmonary bypass the roller pumps have great importance with various models available from several manufacturers. The calibration is an important factor in hemolysis rates and its potential is different in each. Researchers do not always approach details on the pump bed profiles assuming that the standardized calibration settings ensure equal and comparable values for all models of roller pumps. We have mainly two methods for calibration of pumps which also interferes on the hemolytic potential. In both of them, the characteristics of fluid impulsion defined by the pump bed design are not considered. The aim of this study is to compare the hydrodynamic profile of three models of roller pumps available in the Brazilian market. METHODS: The rollers occlusion was performed by measures of drop and dynamic calibration. Two different silicone diameter tubes were used (3/8 x 1/16 and 1/2 x 3/32 inches). RESULTS: The profiles showed differences in their variances, P<0.01 for drop rate measures and P<0.0001 for dynamic calibration. Different changes in pressure were found between the pumps analyzed (P<0.002). CONCLUSION: The measures of occlusion are dependent on the design of the pump bed and comparisons involving roller pumps should be performed with caution. Blood tests should be performed to verify the influence of changes in hemolysis pressure.OBJETIVO: Dentre os equipamentos utilizados em circulação extracorpórea, as bombas de rolete têm grande importância, com diversos modelos disponíveis de vários fabricantes. A calibração é um fator importante nas taxas de hemólise e o seu potencial difere em cada uma delas. Pesquisadores nem sempre abordam detalhes sobre os perfis do leito rígido, supondo que as formas padronizadas de calibração garantem valores iguais e comparáveis para todos os modelos de bombas de rolete. Dispomos principalmente de dois métodos para a calibração das bombas, o que também interfere com o potencial hemolítico. Nenhum dos métodos considera as características de impulsão do fluído, definido pela forma construtiva do leito rígido. O objetivo é avaliar o perfil hidrodinâmico de três modelos de bombas de roletes disponíveis no mercado brasileiro. MÉTODOS: A oclusão dos roletes foi feita por medidas de velocidade de queda e calibração dinâmica. Foram utilizados dois diferentes diâmetros de tubos de silicone (3/8 x 1/16 e 1/2 x 3/32 polegadas). RESULTADOS: Os perfis apresentaram diferenças em suas variâncias. P<0,01 para medidas de velocidade de queda e P<0,0001 para medidas de calibração dinâmica. Foram encontradas diferenças nas variações de pressão entre as bombas analisadas (P<0,002). CONCLUSÃO: As medidas de oclusão são dependentes da forma do leito rígido e comparações envolvendo bombas de rolete devem ser feitas com cautela. Testes com sangue deveriam ser realizados para verificar a influência das variações de pressão na hemólise.18819

Hemodynamic Disorders Related To Beating Heart Surgery Using Cardiac Stabilizers: Experimental Study.

To study in swine the hemodynamic changes secondary to the use of stabilizers for off-pump coronary artery bypass graft surgeries by means of both a suction device Octopus and a compression device (Speroni). Ten swine underwent median sternotomy. Monitoring of ECG, continuous cardiac output, mean arterial pressure, mean pulmonary artery pressure, mean right and left atrial pressures, and right and left ventricular diastolic pressure were performed. Stroke volume and systemic vascular resistance were calculated. Both stabilizers were studied placed on three vessels: anterior interventricular branch, posterior interventricular branch, and marginal branch of the circumflex branch. Each animal was randomly designed to application regarding the type of stabilizer and the target artery. The measurements were carried out 5 minutes before and after the stabilizer application. In the anterior interventricular branch changes have occurred only with the compression device, thus reducing cardiac output, stroke volume, and mean arterial pressure, but increasing the systemic vascular resistance. In the posterior interventricular branch changes have occurred with the compression device (Speroni), reducing cardiac output and stroke volume, but increasing the heart rate. With the suction device (octopus) there was an increase of both heart rate and systemic vascular resistance, but a decrease in stroke volume. In the marginal branch of the circumflex branch there was a decrease of cardiac output, stroke volume, and mean arterial pressure with both stabilizers. Also, there was a decrease in the mean pulmonary artery pressure and an increase in the mean right atrial pressure with the compression device (Speroni). Both stabilizers have caused hemodynamic changes. The compression device (Speroni) is more associated with changes than the suction device (Octopus).22407-1

Mediastinite: complicação pós operatória em cirurgia torácica

A mediastinite é uma das mais graves complicações de cirurgias torácicas, podendo ocorrer até o 30° dia de pós-operatório e ocasionar grande morbimortalidade. Apesar da etiopatogenia ainda pouco compreendida, grande importância é atribuída à contaminação da ferida operatória durante o procedimento cirúrgico. O presente estudo tem como objetivo atenuar os fatores de risco relativos ao paciente, preparar adequadamente a pele, aplicar as técnicas antissépticas preconizadas e esclarecer a importância acerca das medidas profiláticas, além de fornecer prontamente o tratamento correto para os pacientes acometidos. Trata-se de uma revisão bibliográfica de caráter exploratório, tendo como base teórica o Google Acadêmico, Scielo e Medline

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.&nbsp; Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities. &nbsp; Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.&nbsp; The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.&nbsp; The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.&nbsp; &nbsp;&nbsp; Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.&nbsp;&nbsp;&nbsp; Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

Operation and performance of the ATLAS Tile Calorimeter in Run 1

The Tile Calorimeter is the hadron calorimeter covering the central region of the ATLAS experiment at the Large Hadron Collider. Approximately 10,000 photomultipliers collect light from scintillating tiles acting as the active material sandwiched between slabs of steel absorber. This paper gives an overview of the calorimeter’s performance during the years 2008–2012 using cosmic-ray muon events and proton–proton collision data at centre-of-mass energies of 7 and 8TeV with a total integrated luminosity of nearly 30 fb−1. The signal reconstruction methods, calibration systems as well as the detector operation status are presented. The energy and time calibration methods performed excellently, resulting in good stability of the calorimeter response under varying conditions during the LHC Run 1. Finally, the Tile Calorimeter response to isolated muons and hadrons as well as to jets from proton–proton collisions is presented. The results demonstrate excellent performance in accord with specifications mentioned in the Technical Design Report

Combination of searches for heavy spin-1 resonances using 139 fb−1 of proton-proton collision data at s = 13 TeV with the ATLAS detector

A combination of searches for new heavy spin-1 resonances decaying into different pairings of W, Z, or Higgs bosons, as well as directly into leptons or quarks, is presented. The data sample used corresponds to 139 fb−1 of proton-proton collisions at = 13 TeV collected during 2015–2018 with the ATLAS detector at the CERN Large Hadron Collider. Analyses selecting quark pairs (qq, bb, , and tb) or third-generation leptons (τν and ττ) are included in this kind of combination for the first time. A simplified model predicting a spin-1 heavy vector-boson triplet is used. Cross-section limits are set at the 95% confidence level and are compared with predictions for the benchmark model. These limits are also expressed in terms of constraints on couplings of the heavy vector-boson triplet to quarks, leptons, and the Higgs boson. The complementarity of the various analyses increases the sensitivity to new physics, and the resulting constraints are stronger than those from any individual analysis considered. The data exclude a heavy vector-boson triplet with mass below 5.8 TeV in a weakly coupled scenario, below 4.4 TeV in a strongly coupled scenario, and up to 1.5 TeV in the case of production via vector-boson fusion

Measurement of the Higgs boson width and evidence of its off-shell contributions to ZZ production

Since the discovery of the Higgs boson in 2012, detailed studies of its properties have been ongoing. Besides its mass, its width—related to its lifetime—is an important parameter. One way to determine this quantity is to measure its off-shell production, where the Higgs boson mass is far away from its nominal value, and relating it to its on-shell production, where the mass is close to the nominal value. Here we report evidence for such off-shell contributions to the production cross-section of two Z bosons with data from the CMS experiment at the CERN Large Hadron Collider. We constrain the total rate of the off-shell Higgs boson contribution beyond the Z boson pair production threshold, relative to its standard model expectation, to the interval [0.0061, 2.0] at the 95% confidence level. The scenario with no off-shell contribution is excluded at a p-value of 0.0003 (3.6 standard deviations). We measure the width of the Higgs boson as $\Gamma$$_H$=3.2$^{+2.4}_{−1.7}$MeV, in agreement with the standard model expectation of 4.1 MeV. In addition, we set constraints on anomalous Higgs boson couplings to W and Z boson pairs

Search for new particles in an extended Higgs sector with four b quarks in the final state at √s = 13 TeV

A search for a massive resonance X decaying to a pair of spin-0 bosons ϕ that themselves decay to pairs of bottom quarks, is presented. The analysis is restricted to the mass ranges from 25 to 100 GeV and from 1 to 3 TeV. For these mass ranges, the decay products of each ϕ boson are expected to merge into a single large-radius jet. Jet substructure and flavor identification techniques are used to identify these jets. The search is based on CERN LHC proton-proton collision data at , collected with the CMS detector in 2016–2018, corresponding to an integrated luminosity of 138 . Model-specific limits, where the two new particles arise from an extended Higgs sector, are set on the product of the production cross section and branching fraction for as a function of the resonances' masses, where both the and branching fractions are assumed to be 100%. These limits are the first of their kind on this process, ranging between 30 and 1 fb at 95% confidence level for the considered mass ranges