Systemic capillary leak syndrome : is methylene blue the silver bullet?

Background. Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by unexplained, recurrent episodes of transient, abrupt increase in endothelial permeability, leading to severe hypotension, generalized edema, and hemoconcentration. Case Report. We report the case of a patient suffering from systemic capillary leak syndrome and present a possible interpretation of the pathophysiology of this condition. Besides the classical triad of hypotension, edema, and hemoconcentration, we recorded increased levels of methemoglobin, an index of NO overproduction. We present a possible interpretation of the pathophysiology of this condition based on the fast and complete reversal of symptoms after methylene blue administration (which opposes NO-induced effects) and speculate that increased NO levels could be implicated in the pathophysiology of the capillary leak phase. Why should an emergency physician be aware of this? The safety of this treatment and its fluid- and cathecolamine-sparing effect deserve consideration and further research

Manipulating thermal light via displaced-photon subtraction

Thermal radiation played a pivotal role in the preliminary development of quantum physics where it helped resolve the apparent incongruity of the ultraviolet catastrophe. In contemporary physics, thermal state generation and manipulation finds new application in fields such as quantum imaging and quantum illumination and as a practical realization of Maxwell's demon. These applications often go hand in hand with photon subtraction operations which probabilistically amplify the mean photon number (MPN) of thermal light as a result of its super-Poissonian photon statistics. In this article, we introduce an operation for thermal states of light based on a generalized photon subtraction scheme. Displaced-photon subtraction (DPS) makes use of coherent state displacement followed by a subsequent anti-displacement in combination with single-photon detection to probe the MPN of a thermal state. We find regimes in which the output of a successful DPS is amplified, unchanged, or attenuated relative to the unconditioned output state. The regime of operation is controlled via the magnitude of the coherent displacement. A theoretical description of generalized photon subtraction of a displaced thermal state is derived via a two-mode moment-generating function (MGF) and used to describe generalized DPS. We perform a proof of principle experimental implementation of DPS for the case of a balanced beam splitter for which results demonstrate good agreement with the model

A comprehensive clinical approach for patients requiring a temporary open abdomen treatment (OA) in the ICU

Objective We report an intensive-clinical approach in OA-treatments. Patients-and-methods 28 ICU-admissions (1996-2010): Clean-OA(3), contaminated OA(25). Blunt/penetrating trauma(1), aortic surgery(1), acute pancreatitis(15), primary or secondary peritonitis(11). Age 61\ub113; SAPS-II median-(IQR) 41(33-49); SOFA median-(IQR) 8(7-9)

Prevalência parasitária de Piaractus mesopotamicus Holmberg, 1887 produzidos na região da Grande Dourados, MS.

A intensificação dos sistemas de produção com intuito de aumentar a produtividade pode levar a uma maior prevalência parasitária e consequente perdas econômicas decorrentes destas parasitoses. Parasitas é uma grande preocupação nas pisciculturas, pois resultam em perdas diretas e indiretas. O controle eficaz da doença depende de manejo sanitário integrado, que considera o hospedeiro, o meio ambiente, os parasitas e as práticas de criação. Objetivou-se estudar a prevalência parasitária de P. mesopotamicus de pisciculturas e sua relação com o ambiente e o manejo sanitário

Online Learning Adaptation Strategy for DASH Clients

In this work, we propose an online adaptation logic for Dynamic Adaptive Streaming over HTTP (DASH) clients, where each client selects the representation that maximize the long term expected reward. The latter is defined as a combination of the decoded quality, the quality fluctuations and the rebuffering events experienced by the user during the playback. To solve this problem, we cast a Markov Decision Process (MDP) optimization for the selection of the optimal representations. System dynamics required in the MDP model are a priori unknown and are therefore learned through a Reinforcement Learning (RL) technique. The developed learning process exploits a parallel learning technique that improves the learning rate and limits sub-optimal choices, leading to a fast and yet accurate learning process that quickly converges to high and stable rewards. Therefore, the efficiency of our controller is not sacrificed for fast convergence. Simulation results show that our algorithm achieves a higher QoE than existing RL algorithms in the literature as well as heuristic solutions, as it is able to increase average QoE and reduce quality fluctuations

New System for the Acceleration of the Airflow in Wind Turbines

Background: This patent is based on the wind industry technology called Diffuser Augmented Wind Turbines (DAWTs). This technology consists of a horizontal axis wind turbine, which is housed inside a duct with diverging section in the direction of the free air stream. In this paper, a review of preceding patents related to this technology is carried out. Objective: This paper presents an innovative patent to improve the performance of horizontal axis wind turbines. In particular, this system is aimed at improving the performance of those turbines that otherwise might not be installed due to the low wind resource existing at certain locations. Methods: The most innovative elements of this patent are: (1) the semi-spherical grooves, which are mechanized on the surface of the two diffusers in order to guarantee a more energetic boundary layer; (2) the coaxial diffuser, which is located downwind following the first diffuser in order to increase the suction effect on the air mass close to the inlet; (3) the coaxial rings located around the first diffuser outlet, which are used to deflect the external airflow toward the turbine wake; and (4), the selforientating system to orientate the system by the prevailing wind direction. Results: An application of the patent for increasing the power generated by a horizontal axis wind turbine with three blades is presented. The patent is designed and its performance is evaluated by using a Computational Fluid Dynamics code. The numerical results show that this system rises the airflow going through the rotor of the turbine. Conclusion: The patented device is an original contribution aimed at enabling a more profitable installation of wind turbines in places where the wind resource is insufficient because of the wind shear caused both by the proximity of the earth and the obstacles on the earth surface.This work was supported by the OASIS Research Project that was cofinanced by CDTI (Spanish Science and Innovation Ministry) and developed with the Spanish companies: Iridium, OHL Concesiones, Abertis, Sice, Indra, Dragados, OHL, Geocisa, GMV, Asfaltos Augusta, Hidrofersa, Eipsa, PyG, CPS, AEC and Torre de Comares Arquitectos S.L and 16 research centres. The authors also acknowledge the partial funding with FEDER funds under the Research Project FC-15-GRUPIN14-004. Finally, we also thank Swanson Analysis Inc. for the use of ANSYS University Research programs as well as the Workbench simulation environment

Atypical pathogens in hospitalized patients with community-acquired pneumonia: A worldwide perspective

Background: Empirical antibiotic coverage for atypical pathogens in community-acquired pneumonia (CAP) has long been debated, mainly because of a lack of epidemiological data. We aimed to assess both testing for atypical pathogens and their prevalence in hospitalized patients with CAP worldwide, especially in relation with disease severity. Methods: A secondary analysis of the GLIMP database, an international, multicentre, point-prevalence study of adult patients admitted for CAP in 222 hospitals across 6 continents in 2015, was performed. The study evaluated frequency of testing for atypical pathogens, including L. pneumophila, M. pneumoniae, C. pneumoniae, and their prevalence. Risk factors for testing and prevalence for atypical pathogens were assessed through univariate analysis. Results: Among 3702 CAP patients 1250 (33.8%) underwent at least one test for atypical pathogens. Testing varies greatly among countries and its frequency was higher in Europe than elsewhere (46.0% vs. 12.7%, respectively, p < 0.0001). Detection of L. pneumophila urinary antigen was the most common test performed worldwide (32.0%). Patients with severe CAP were less likely to be tested for both atypical pathogens considered together (30.5% vs. 35.0%, p = 0.009) and specifically for legionellosis (28.3% vs. 33.5%, p = 0.003) than the rest of the population. Similarly, L. pneumophila testing was lower in ICU patients. At least one atypical pathogen was isolated in 62 patients (4.7%), including M. pneumoniae (26/251 patients, 10.3%), L. pneumophila (30/1186 patients, 2.5%), and C. pneumoniae (8/228 patients, 3.5%). Patients with CAP due to atypical pathogens were significantly younger, showed less cardiovascular, renal, and metabolic comorbidities in comparison to adult patients hospitalized due to non-atypical pathogen CAP. Conclusions: Testing for atypical pathogens in patients admitted for CAP in poorly standardized in real life and does not mirror atypical prevalence in different settings. Further evidence on the impact of atypical pathogens, expecially in the low-income countries, is needed to guidelines implementation