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We report a 39-year-old male with an aneurysmal subarachnoid hemorrhage without hydrocephalus, in whom a right choroidal aneurysm was early excluded by endovascular coil insertion. Intracranial pressure (PIC) and cerebral oxygenation (PtiO2) sensors for neuromonitoring were installed due to a persistent comatose state. From the 3rd day, neuromonitoring became altered. CT angiography and cerebral angiography showed severe proximal and distal vasospasm (VE) of the middle (ACM) and anterior (ACA) right cerebral arteries. VE was treated with angioplasty and intravenous nimodipine. Forty eight hours later, despite hemodynamic maximization, neuromonitoring became altered again, mainly explained by a decrease in PtiO2 below 15 mmHg. A severe VE in ACM and right ACA was confirmed by angiography. Given the presence of an early and recurrent VE, which was associated with a decrease in cerebral oxygenation, internal carotid micro-catheters for continuous nimodipine infusion were installed. This therapy maintained a normal neuromonitoring for 15 days. During this period, attempts were done to decrease or discontinue the infusion, but the patient presented parallel falls of cerebral oxygenation or decreased cerebral perfusion observed with perfusion CT, interpreted as persistent VE. Finally, the infusion was stopped at day 15 without significant complication. We conclude that intra-arterial nimodipine continuous infusion in refractory VE can be useful and safe in selected patients. Multimodal neuromonitoring is essential.

Resumen: La falla hepática fulminante (FHF) es una patología poco frecuente con una alta mortalidad. Requiere un rápido diagnóstico, manejo etiológico, cuando es posible, y una terapia de soporte adecuada en la Unidad de Cuidados Intensivos en la espera de la recuperación hepática o bien cuando esto no ocurre, en la espera del tratamiento definitivo de rescate que es el trasplante hepático. Es necesario una protocolización del manejo, para realizar una práctica sistemática, reproducible y evaluable de la atención clínica que requieren estos pacientes por un equipo multidisciplinario con el fin de mejorar su pronóstico. Este artículo describe una propuesta de protocolo de manejo de FHF en pacientes adultos que se realiza en Clínica Las Condes. Abstract: Fulminant hepatic failure (FHF) is a rare condition with a high mortality. It requires a prompt diagnosis, etiological management, when possible, and adequate supportive therapy in the Intensive Care Unit in the expectation of liver recovery or when this does not occur, waiting for the definitive rescue treatment that is liver transplantation. A management protocol is necessary to carry out a systematic, reproducible and evaluable practice of the clinical care required by these patients by a multidisciplinary team in order to improve their prognosis. This article describes a proposed protocol for the management of FHF in adult patients that is performed at Clínica Las Condes. Palabras clave: Falla hepática fulminante, Tratamiento, Encefalopatía, Trasplante hepático, Keywords: Acute liver failure, Treatment, Encephalopathy, Liver transplantation

Objectives This comparative study aimed to evaluate intraoral digital photography (IODP) as assessment-tool for DMFT and number of implants (IMPL) compared to clinical diagnosis (CLIN) in an elderly population with high restorative status. Secondary research questions were whether an additional evaluation of panoramic radiographs (PAN-X) or raters’ clinical experience influence the agreement. Methods Fifty patients (70.98±7.60 years) were enrolled for standardized CLIN and IODP. The clinical reference examiner and ten blinded raters evaluated the photographs without and with a PAN-X regarding DMFT and IMPL. CLIN were used as reference standard and differences to IODP and IODP-PAN-X findings were analysed descriptively. To assess intra-rater agreement, pairwise Gwet’s AC1s of the three diagnostic methods CLIN, IODP and IODP+PAN-X were calculated. Results Compared to a DMFT of 22.10±3.75 (CLIN), blinded raters evaluated a DMFT of 21.54±3.40 (IODP) and 22.12±3.45 (IODP+PAN-X). Mean values for “Decayed” were 0.18±0.52 (CLIN), 0.45±0.46 (IODP) and 0.48±0.47 (IODP-PAN-X), while 11.02±5.97 (CLIN), 10.66±5.78 (IODP) and 10.93±5.91 (IODP+PAN-X) were determined for “Missing” and 10.90±5.61 (CLIN), 10.43±4.85 (IODP) and 10.71±5.11 (IODP+PAN-X) for “Filled”. IMPL were 0.78±2.04 (CLIN), 0.58±1.43 (IODP), 0.78±2.04 (IODP+PAN-X). Gwet’s AC1 using the mode of the blinded raters’ assessment of "Decayed", "Missing" and IMPL compared to CLIN ranged from 0.81 to 0.89 (IODP) and 0.87 to 1.00 (IODP+PAN-X), while for "Filled" and DMFT they were 0.29 and 0.36 (IODP) as well as 0.33 and 0.36 (IODP+PAN-X), respectively. Clinical experience did not influence the agreement. Conclusions Assessment of “Decayed”, “Missing” and IMPL by IODP showed almost perfect agreement, whereas of “Filled” and DMFT revealed fair to moderate agreement with clinical findings. Additional PAN-X-evaluation increased agreement compared to IODP-diagnostics alone. IODP for the assessment of DMFT and IMPL might be a suitable method in large-scale epidemiological studies, considering high agreement in total values and miscellaneous agreement at patient-level.

This paper reports the design, fabrication and characterization of bulk acoustic wave (BAW) resonators of the SMR-type (surface mounted resonator) with highly c-axis oriented Al 0.8 Sc 0.2 N thin-films. Various filter topologies have been demonstrated for high frequencies with sharp roll-off, wide bandwidth BW and low insertion loss IL (rel. 3dB-BW up to 9% and min. IL of 0.9 dB to 1.5 dB at 2350 to 2550 MHz). Furthermore, the challenges regarding the integration of $\mathrm{Al}_{1-\mathrm{x}}\mathrm{Sc}_{\mathrm{x}}\mathrm{N}$ for n79 applications (4400 to 5000 MHz) are indicated. The demonstrations show promising results regarding acoustic-only filters at 5G frequencies.

The integration of multiple bands and higher power standards lead to enhanced interference problems and make higher attenuation levels in next-gen RF-Front-Ends necessary. This paper introduces an all-pass based BAW filter design concept for notch, band-stop and band-pass filter topologies to indicate the possibilities and the impact of key parameters like material electromechanical coupling factor $k_{eff}^2$, piezoelectric material quality factor Q m and inductor losses Q L . This work outlines the concept and design aspects. Also various examples will be proposed to show the main benefits of this approach.

Applications using BAW devices benefit from large intrinsic electromechanical coupling materials, e.g. Al 1-x Sc x N. This work reports BAW-SMRs using high piezoelectric Al 1-x Sc x N and investigates the relations between Sc content, crystal morphology and resonator RF performance. Finally, key requirements for high quality Al 1-x Sc x N thin-film growth are analyzed and discussed examplary for x = 20at.-%.

Early identification of vasospasm prior to symptom onset would allow prevention of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH). Dynamic cerebral autoregulation (DCA) is a noninvasive means of assessing cerebral blood flow regulation by determining independence of low-frequency temporal oscillations of systemic blood pressure (BP) and cerebral blood flow velocities (CBFV).Eight SAH patients underwent prospectively a median of 7 DCA assessments consisting of continuous measurements of BCFV and BP. Transfer function analysis was applied to calculate average phase shift (PS) in low (0.07-0.2 Hz) frequency range for each hemisphere as continuous measure of DCA. Lower PS indicated poorer regulatory response. DCI was defined as a 2-point decrease in Glasgow Coma Score and/or infarction on CT.Three subjects developed symptomatic vasospasm with median time-to-DCI of 9 days. DCI was significantly associated with lower PS over the entire recording period (Wald = 4.28; p = 0.039). Additionally, there was a significant change in PS over different recording periods after adjusting for DCI (Wald = 15.66; p = 0.001); particularly, a significantly lower mean PS day 3-5 after bleed (14.22 vs 27.51; p = 0.05).DCA might be useful for early detection of symptomatic vasospasm. A larger cohort study of SAH patients is currently underway.

Background Early identification of vasospasm prior to symptom onset would allow prevention of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH). Dynamic cerebral autoregulation (DCA) is a noninvasive means of assessing cerebral blood flow regulation by determining independence of low-frequency temporal oscillations of systemic blood pressure (BP) and cerebral blood flow velocities (CBFV). Methods Eight SAH patients underwent prospectively a median of 7 DCA assessments consisting of continuous measurements of BCFV and BP. Transfer function analysis was applied to calculate average phase shift (PS) in low (0.07-0.2 Hz) frequency range for each hemisphere as continuous measure of DCA. Lower PS indicated poorer regulatory response. DCI was defined as a 2-point decrease in Glasgow Coma Score and/or infarction on CT. Results Three subjects developed symptomatic vasospasm with median time-to-DCI of 9 days. DCI was significantly associated with lower PS over the entire recording period (Wald = 4.28; p = 0.039). Additionally, there was a significant change in PS over different recording periods after adjusting for DCI (Wald = 15.66; p = 0.001); particularly, a significantly lower mean PS day 3-5 after bleed (14.22 vs 27.51; p = 0.05). Conclusions DCA might be useful for early detection of symptomatic vasospasm. A larger cohort study of SAH patients is currently underway.

We report a 39-year-old male with an aneurysmal subarachnoid hemorrhage without hydrocephalus, in whom a right choroidal aneurysm was early excluded by endovascular coil insertion. Intracranial pressure (PIC) and cerebral oxygenation (PtiO2) sensors for neuromonitoring were installed due to a persistent comatose state. From the 3rd day, neuromonitoring became altered. CT angiography and cerebral angiography showed severe proximal and distal vasospasm (VE) of the middle (ACM) and anterior (ACA) right cerebral arteries. VE was treated with angioplasty and intravenous nimodipine. Forty eight hours later, despite hemodynamic maximization, neuromonitoring became altered again, mainly explained by a decrease in PtiO2 below 15 mmHg. A severe VE in ACM and right ACA was confirmed by angiography. Given the presence of an early and recurrent VE, which was associated with a decrease in cerebral oxygenation, internal carotid micro-catheters for continuous nimodipine infusion were installed. This therapy maintained a normal neuromonitoring for 15 days. During this period, attempts were done to decrease or discontinue the infusion, but the patient presented parallel falls of cerebral oxygenation or decreased cerebral perfusion observed with perfusion CT, interpreted as persistent VE. Finally, the infusion was stopped at day 15 without significant complication. We conclude that intra-arterial nimodipine continuous infusion in refractory VE can be useful and safe in selected patients. Multimodal neuromonitoring is essential.

Temperature management using endovascular catheters is an established therapy in neurointensive care. Nonetheless, several case series have reported a high rate of thrombosis related to the use of endovascular hypothermia catheters. As a result of a pulmonary embolism that developed in a patient after removing an inferior vena cava hypothermia catheter, we designed a clinical protocol for managing and removing these devices. First, an invasive cavography was performed before the removal of the catheter. If there was a thrombus, a cava vein filter was inserted through jugular access. After that, the catheter was removed. The venography found inferior vena cava thrombi in 18 of 20 consecutive patients. A concomitant ultrasonography study showed vena cava thrombosis in only three patients. A vena cava filter was inserted in all patients where thrombi were found, without any significant complication. Anticoagulation was started in all patients. No symptomatic pulmonary embolism was diagnosed until the time of discharge. The frequency of thrombosis related to temperature management catheters is extremely high (90 %). Furthermore, ultrasonography has a very low sensibility to detect cava vein thrombosis (16.7 %). The real meaning of our findings is unknown, but other temperature control systems could be a safer option. More studies are needed to confirm our findings.

There is a growing interest in measuring cerebral autoregulation in patients with acute brain injury. Non-invasive finger photo-plethysmography (Finapres) is the method of choice to relate arterial blood pressure to changes in cerebral blood flow. Among acutely ill patients, however, peripheral vasoconstriction often limits the use of Finapres requiring direct intravascular blood pressure measurement. We evaluated how these two different forms of blood pressure monitoring affect the parameters of dynamic cerebral autoregulation (DCA).We performed 37 simultaneous recordings of BP and cerebral blood flow velocity in 15 patients with acute brain injury. DCA was estimated in the frequency domain using transfer function analysis to calculate phase shift, gain, and coherence. In addition the mean velocity index (Mx) was calculated for assessment of DCA in the time domain.The mean patient age was 58.1 ± 15.9 years, 80 % (n = 12) were women. We found good inter-method agreement between Finapres and direct intravascular measurement using Bland-Altman and correlation analyses. Finapres gives higher values for the efficiency of dynamic CA compared with values derived from radial artery catheter, as indicated by biases in the phase (26.3 ± 11.6° vs. 21.7 ± 10.5°, p = 0.001) and Mx (0.571 ± 0.137 vs. 0.649 ± 0.128, p 0.001). Gain in the low frequency range did not significantly differ between the two arterial blood pressure methods. The average coherence between CBFV and ABP was higher when BP was measured with arterial catheter for frequencies above 0.05 Hz (0.8 vs. 0.73, p 0.001).Overall, both methods yield similar results and can be used for the assessment of DCA. However, there was a small but significant difference for both mean Mx and phase shift, which would need to be adjusted for during monitoring of patients when using both methods. When available, invasive arterial blood pressure monitoring may improve accuracy and thus should be the preferred method for DCA assessment in the ICU.

A method is presented to rapidly and precisely measure the conformation, length, speed, and fluorescence intensity of single DNA molecules constrained by a nanochannel. DNA molecules were driven electrophoretically from a nanoslit into a nanochannel to confine and dynamically elongate them beyond their equilibrium length for repeated detection via laser-induced fluorescence spectroscopy. A single-molecule analysis algorithm was developed to analytically model bursts of fluorescence and determine the folding conformation of each stretched molecule. This technique achieved a molecular length resolution of 114 nm and an analysis time of around 20 ms per molecule, which enabled the sensitive investigation of several aspects of the physical behavior of DNA in a nanochannel. lambda-bacteriophage DNA was used to study the dependence of stretching on the applied device bias, the effect of conformation on speed, and the amount of DNA fragmentation in the device. A mixture of lambda-bacteriophage with the fragments of its own HindIII digest, a standard DNA ladder, was sized by length as well as by fluorescence intensity, which also allowed the characterization of DNA speed in a nanochannel as a function of length over two and a half orders of magnitude.

Markku Kaste ja Filip Scheperjans työryhmän jäsenenä. Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP 90, 60-90, and Outcomes: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Results: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitations: Generalizability issues arising from a clinical trial population. Conclusions: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs. Am J Kidney Dis. 68(1): 94-102. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license.

Nicardipine and labetalol are two commonly used antihypertensives for treating elevated blood pressures in the setting of intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). There are no studies comparing these two agents as continuous infusions. A retrospective chart review was conducted of patients admitted between November 2009 and January 2011 with ICH and SAH to compare effectiveness and safety between both agents. Percent time spent at goal was set as the primary outcome. The secondary outcomes included blood pressure variability, time to goal, incidence of bradycardia, tachycardia, and hypotension. A total of 81 patients were available for analysis, 10 initiated on labetalol (LAB), 57 on nicardipine (NIC), and 14 required the combination of these agents (COMB) to reach goal. We found no difference between NIC, LAB, and the COMB groups in the median percent time at goal [88 % (61–98); 93 % (51–99); 66 % (25–95), (p = NS)]. Median percentage of blood pressure variability, hypotension, and bradycardia were also comparable between groups, however, more tachycardia was observed in the COMB group versus both LAB and NIC groups (45 vs. 0 vs. 3 %; p

Cerebral autoregulation (CA) enables the brain to maintain stable cerebral blood flow (CBF). CA can be assessed noninvasively by determining correlations between CBF velocity (CBFV) and spontaneous changes in blood pressure. Postrecording signal analysis methods have included both frequency- and time-domain methods. However, the test-retest reliability, cross-validation, and determination of normal values have not been adequately established.In 53 healthy volunteers, a transfer function analysis was applied to calculate phase shift (PS) and gain in the low frequency range (.06-.12 Hz) where CA is most apparent. Correlation analysis was used to derive mean velocity index (Mx). Intraclass correlation and bivariate correlation coefficients were applied to assess asymmetry, cross-validity, and test-retest results: The bihemispheric average PS, gain, and Mx means were 45.99+/-14.24°, .62+/-.38 cm/second/mmHg, and .41+/-.13, respectively. Gain exhibited a difference by age (P = .03). PS, gain, and Mx values showed excellent interhemispheric correlation (r.8; P.001). PS and gain showed good reliability (R ICC = .632, L ICC = .576; P.001). PS and Mx showed fair correlation (r = -.37; P.001).CA parameters obtained by time- and frequency-domain methods correlate well, and show good interhemispheric and test-retest reliability. Group means from healthy controls may provide adequate norms for determining abnormal CA in cerebrovascular patients.

Hospitals are reimbursed a greater amount for Medicare patients undergoing prostate surgery who have comorbid and complicating conditions than for patients without these conditions, since the former have been shown to have higher hospital costs and charges. We attempted to determine whether the higher hospital charges are due to duration of hospital stay and/or intensity of services. We analyzed hospital discharge data from 799 patients undergoing radical or transurethral prostatectomy during a 3-year period (1988 to 1991) at 2 major teaching hospitals by examining length of stay (duration), charges per hospital day (intensity) and total charges per stay. Mean lengths of stay were significantly longer for sicker versus healthier patients undergoing radical prostatectomy (7.4 versus 6.8 days at hospital 1 and 8.9 versus 7.8 days at hospital 2, p0.05) and transurethral prostatectomy (3.5 versus 2.8 days at hospital 1 and 3.5 versus 2.5 days at hospital 2, p0.05). Total hospital charges were significantly higher for sicker versus healthier patients undergoing radical prostatectomy ($14,557 versus $13,357 at hospital 1 and $17,864 versus $16,080 at hospital 2, p0.05) and transurethral prostatectomy ($6,446 versus $5,012 at hospital 1 and $5,468 versus $3,710 at hospital 2, p0.05). However, sicker and healthier patients had similar charges per day for radical prostatectomy ($1,959 versus $1,961 at hospital 1 and $2,006 versus $2,073 at hospital 2, p not significant) and for transurethral prostatectomy ($1.839 versus $1,800 at hospital 1 and $1.544 versus $1,488 at hospital 2, p not significant). On specified hospital days the charges per day for room/nursing, medical/surgical supplies, laboratory services and pharmacy services were similar for patients with and without comorbid conditions. Patients who are more ill at admission remain hospitalized longer after prostatectomy. However, they do not receive more intense care during their stays. For these procedures duration and not intensity appears to be the primary determinant of higher hospital charges for sicker patients.

A conically shaped cavity that intrinsically avoids mode-degeneration while maintaining the advantages of cylindrical resonators is presented. The cavity was applied to surface resistance measurements of YBaCuO thin films on MgO substrates at 18 GHz. The lowest measured value was 4.5 m Omega +or-2.1 m Omega for a 10 mm*10 mm laser ablated film at 77 K. An error analysis is carried out which leads to an accuracy of +or-2.1 m Omega for samples with 9 mm diameter and an accuracy of +or-0.5 m Omega for samples with 20 diameter. >

Most studies evaluating the usefulness of intravenous thrombolysis for acute stroke have excluded subjects aged over 80 years. Therefore there is no evidence to support or contraindícate this therapy in this age group. We report a 93 year-old female subjected to intravenous thrombolysis using tissue plasminogen activator (r-tPA), according to the National Institute of Neurological Disorders protocol. The treatment was successful, there were no hemorrhagic complications and three months later, the patient was practically without any disability. Therefore age is not an absolute contraindication for intravenous thrombolysis in elderly subjects.

Most studies evaluating the usefulness of intravenous thrombolysisfor acute stroke have excluded subjects aged over 80 years. Therefore there is no evidence tosupport or contraindicate this therapy in this age group. We report a 93 year-old femalesubjected to intravenous thrombolysis using tissue plasminogen activator (r-tPA), according tothe National Institute of Neurological Disorders protocol. The treatment was successful, therewere no hemorrhagic complications and three months later, the patient was practically withoutany disability. Therefore age is not an absolute contraindication for intravenous thrombolysisin elderly subjects (Rev Med Chile 2008; 136: 502-6).(

Cardiovascular risk factors (CRF) are related to long-term cognitive impairment. Coronary heart disease (CHD) has been associated with bad cognitive performance in an inconsistent way. AIM. To measure the cognitive performance in Chilean patients with diverse CRF, with and without CHD.Cross-sectional study of the cognitive performance of three groups of patients older than sixty years, without history of stroke: with CHD and high CRF (CHD-hCRF) (n = 62), with high CRF but without CHD (hCRF) (n = 57), and non hypertensive non diabetic (NHND) (n = 25).Higher age, lower education and been men were significantly associated with cognitive impairment in the total sample. There were no differences in the proportion of cognitive impairment and age between the groups. The CHD group had a predominance of men and a higher proportion of high cholesterol and periphery vascular disease than the other groups. The NHND group was more educated than the other groups. After adjusting for years of education and sex there were no significant differences in the neuropsychological performance and depression scales between the groups, been the coronary group significantly more functionally impaired.Isolated CHD is not associated with worse cognitive performance in patients, but it is related with greater systemic vascular damage and functional impairment in patients without history of stroke.

Delayed ischemic neurological deficit associated to cerebral vasospasm is the most common cause of sequelae and death that follows the rupture of an aneurysm. The objective of this study was to evaluate the safety and efficacy of intra-arterial Milrinone in patients with symptomatic refractory cerebral vasospasm.Eight patients diagnosed with aneurysmal subarachnoid hemorrhage who developed symptomatic cerebral vasospasm refractory to conventional medical therapy were enrolled. They received an intra-arterial infusion of Milrinone at a rate of 0.25 mg/min, with a total dose of 10-15 mg. Qualitative evaluation of angiographic response, neurological and systemic complications as well as functional outcome at 3 months were documented.All patients had a significant angiographic response. This was evidenced by a pre-treatment vessel stenosis greater than 70%, that improved to less than 50% after the intra-arterial Milrinone infusion. Three patients developed recurrent vasospasm that improved after a second intra-arterial Milrinone infusion. None of the patients developed neurologic or systemic complications attributed to the intervention. At 3 months follow-up all patients were alive and had a mean modified Rankin scale of 2 +/- 1 and a Barthel index of 83 +/- 10.Intra-arterial Milrinone infusion seems to be a safe and effective treatment for patients who develop refractory symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

Stroke is the second specific cause of death in Chile, with a mortality rate of 48.6 per 100.000 inhabitants. It accounts for 6% of all hospitalizations among adults.To study the type of patients hospitalized at a Stroke Unit in a general hospital and the costs and benefits of such unit.A descriptive and retrospective study using a patient registry, developed in Access that included separate sections for ischemic and hemorrhagic stroke. Established diagnostic criteria were used. The mean costs per patient and complications were also calculated.During 2003, 425 stroke patients were admitted to our hospital and 105 (age range 30-89 years, 58% female) were hospitalized at the Stroke Unit. Eighty-three percent had ischemic and 16% had hemorrhagic stroke. The most common etiologies were thrombosis in 41%, embolism in 36%, lacunar in 13%, arterial dissection in 5% and transient ischemic attack in 3%. Fifty eight percent of patients had partial anterior ischemic stroke (PACI), 73% had hypertension and 29.5% diabetes. Only 18% arrived to the Stroke Unit with less of 6 hours of evolution, 7% of patients were admitted within the 3 hours after the onset of symptoms and 18%, from 3 to 6 hours. The mean length of stay in the Stroke Unit was 6.6 days and at the hospital 9.9 days (p0.01). The mean costs per patient at the Stroke Unit and at the hospital were US$ 5.550 and US$ 4.815, respectively (p =ns).The Stroke Unit decreases hospital stay days without raising costs importantly. The inclusion criteria for stroke patients admitted to the Unit were adequate and the stroke registry allowed a good assessment of the Unit operation.

We report a 15 year-old female presenting with behavioral disturbances, headache, left hemiparesis and paresis of the vertical gaze. CAT scan and magnetic resonance showed an involvement of right thalamus, third ventricle and medial temporal lobe suggesting an encephalitis or lymphoma. 201Thalium SPECT suggested a lymphoma. A stereotaxic biopsy showed a subacute demyelinizing lesion, compatible with an acute disseminated encephalomyelitis. The patient was treated with Methylprednisolone with resolution of symptoms. She remains in good condition after one year of follow-up.

Background: Stroke is the second specific cause of death in Chile, with a mortality rate of 48.6 per 100.000 inhabitans. It accounts for 6% of all hospitalizations among adults. Aim: To study the type of patients hospitalized at a Stroke Unit in a general hospital and the costs and benefits of such unit. Material and methods: A descriptive and retrospective study using a patient registry, developed in Access® that included separate sections for ischemic and hemorrhagic stroke. Established diagnostic criteria were used. The mean costs per patient and complications were also calculated. Results: During 2003, 425 stroke patients were admitted to our hospital and 105 (age range 30-89 years, 58% female) were hospitalized at the Stroke Unit. Eighty three percent had ischemic and 16% had hemorrhagic stroke. The most common etiologies were thrombosis in 41%, embolism in 36%, lacunar in 13%, arterial dissection in 5% and transient ischemic attack in 3%. Fifty eight percent of patients had partial anterior ischemic stroke (PACI), 73% had hypertension and 29.5% diabetes. Only 18% arrived to the Stroke Unit with less of 6 hours of evolution, 7% of patients were admitted within the 3 hours after the onset of symptoms and 18%, from 3 to 6 hours. The mean lenght of stay in the Stroke Unit was 6.6 days and at the hospital 9.9 days (p

We report a 15 year-old female presenting with behavioral disturbances, headache, left hemiparesis and paresis of the vertical gaze. CAT scan and magnetic resonance showed an involvement of right thalamus, third ventricle and medial temporal lobe suggesting an encephalitis or lymphoma. 201Thalium SPECT suggested a lymphoma. A stereotaxic biopsy showed a subacute demyelinizing lesion, compatible with an acute disseminated encephalomyelitis. The patient was treated with Methylprednisolone with resolution of symptoms. She remains in good condition after one year of follow-up

We have used the interface between a nanochannel and a microchannel as a tool for applying controlled forces on a DNA molecule. A molecule, with a radius of gyration larger than the nanochannel width, that straddles such an interface is subject to an essentially constant entropic force, which can be balanced against other forces such as the electrophoretic force from an applied electric field. By controlling the applied field we can position the molecule as desired and observe the conformation of the molecule as it stretches, relaxes, and recoils from the nanochannel. We quantify and present models for the molecular motion in response to the entropic, electrophoretic, and frictional forces acting on it. By determining the magnitude of the drag coefficients for DNA molecules in the nanostructure, we are able to estimate the confinement-induced recoil force. Finally, we demonstrate that we can use a controlled applied field and the entropic interfacial forces to unfold molecules, which can then be manipulated and positioned in their simple extended morphology.

We investigated compression and ensuing expansion of long DNA molecules confined in nanochannels. Transverse confinement of DNA molecules in the nanofluidic channels leads to elongation of their unconstrained equilibrium configuration. The extended molecules were compressed by electrophoretically driving them into porelike constrictions inside the nanochannels. When the electric field was turned off, the DNA strands expanded. This expansion, the dynamics of which has not previously been observable in artificial systems, is explained by a model that is a variation of de Gennes's polymer model.

Giant unilamellar lipid vesicles could be perfect systems to study ion channels in the environment of lipid membranes with defined chemical and physical properties. Prerequisite for electrical measurements is an intravesicular electrical contact. We describe the impalement of giant lipid vesicles by glass micropipet electrodes with a tight seal. To avoid displacement or burst during impalement, the vesicles are immobilized in relaxed conditions by microscopic picket fences of polyimide. The outer surface of the pipets is selectively coated with silanes or polylysine. Structurally, the impalement is verified by ejecting a fluorescent solution out of the pipet. For electrical characterization, current pulses are applied to the pipet and voltage transients are recorded. The data are evaluated in terms of the capacitance and effective resistance of the membrane. Directly after impalement, we observe a seal resistance up to 1.2 GOmega that continuously decays within a period of up to 20 min until it suddenly disappears without burst of the vesicle. During impalement, a spreading of the vesicle membrane along the outer surface of the pipets is observed using a fluorescent membrane-bound dye. We assign the tight pipet-vesicle contact to spreading of the lipid bilayer by a rolling mechanism and the loss of resistance to micro- and macropores that are induced by the resulting membrane tension. Limitation of spreading is attempted with barriers on the pipet.

A truncated cone cavity that avoids degeneration between the TE/sub 01n/ and TM/sub 11n/ modes occurring in the most frequently used circular cylindrical cavities for materials measurements is described. Analytical expressions for the field components are given. An error analysis is carried out which yields a sensitivity of 2.3 m Omega for surface resistance measurements at 18 GHz, using samples with a diameter of 9 mm. One cavity was built, and measurement results are given for the surface resistance of various YBa/sub 2/Cu/sub 3/O/sub x/ thin films on MgO substrates. The samples were manufactured by means of laser ablation and magnetron sputtering. >

We assessed changes in hospital costs and resource use among patients undergoing radical prostatectomy following implementation of a clinical care path.A standardized clinical care path for patient management before and after radical prostatectomy was developed and implemented at a large academic medical center in California. All 577 consecutive patients undergoing radical prostatectomy during the 3 years before and 1 year after implementation of the care path were included in the study. Each patient was entered prospectively into a hospital-wide financial data base, which served as the source for observations on hospital costs, hospital charges and length of stay.After implementation of the radical prostatectomy care path hospital costs decreased by 12% ($7,916 versus $6,934, p0.001), hospital charges decreased by 20% ($17,005 versus $13,524, p0.0001) and length of stay decreased by 28% (5 versus 3.6 days, p0.0001). Decreases were noted in all categories of the hospital patient financial profile, except operating room charges.By standardizing preoperative and postoperative management for patients undergoing radical prostatectomy, significant savings can be achieved over and above existing trends toward shorter hospital stays and lower hospital costs.

Background: Early identification of vasospasm prior to symptom onset would allow prevention of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH). Dynamic cerebral autoregulation (DCA) is a noninvasive means of assessing cerebral blood flow regulation by determining independence of low-frequency temporal oscillations of systemic blood pressure (BP) and cerebral blood flow velocities (CBFV).

Miniature high speed label-free cell analysis systems have yet to be developed, but have the potential to deliver fast, inexpensive and simple full blood cell analysis systems that could be used routinely in clinical practice. We demonstrate a microfluidic single cell impedance cytometer that performs a white blood cell differential count. The device consists of a microfluidic chip with micro-electrodes that measure the impedance of single cells at two frequencies. Human blood, treated with saponin/formic acid to lyse erythrocytes, flows through the device and a complete blood count is performed in a few minutes. Verification of cell dielectric parameters was performed by simultaneously measuring fluorescence from CD antibody-conjugated cells. This enabled direct correlation of impedance signals from individual cells with phenotype. Tests with patient samples showed 95% correlation against commercial (optical/Coulter) blood analysis equipment, demonstrating the potential clinical utility of the impedance microcytometer for a point-of-care blood analysis system.

Introduccion. La presencia de factores de riesgo cardiovascular (FRCV) se relaciona con una peor evolucion cognitiva a largo plazo. La cardiopatia coronaria (CC) se ha asociado inconstantemente a mala evolucion cognitiva. Objetivos. Se trata de evaluar el rendimiento cognitivo de pacientes chilenos con distintos grados de FRCV, con y sin CC. Sujetos y metodos. Es un estudio transversal de evaluacion cognitiva en tres grupos de pacientes mayores de 60 anos sin antecedentes de ataques cerebrovasculares: con CC y FRCV elevados (CC-FRCVE) (n = 62), con FRCV elevados sin CC (FRCVE) (n = 57), y sin antecedentes de hipertension arterial (HTA), diabetes ni CC o ?no hipertenso no diabetico? (NHND) (n = 25). Resultados. En la totalidad de la muestra los factores asociados significativamente a deterioro cognitivo fueron: mayor edad, menor escolaridad y ser hombre. No hubo diferencias significativas en la edad ni en la proporcion de pacientes con deterioro cognitivo entre los tres grupos; los NHND tenian significativamente mayor escolaridad que los otros grupos. Los CC-FRCVE tuvieron mayor proporcion de hombres y mayor proporcion de enfermedad arterial oclusiva periferica y dislipidemia que los otros grupos. Los FRCVE tuvieron significativamente mayor cantidad de anos con HTA que los otros grupos. En las escalas cognitivas y de depresion, no se encontraron diferencias estadisticamente significativas en el rendimiento entre los tres grupos despues de ajustar los resultados por escolaridad y sexo, y existio significativamente mayor dependencia funcional en el grupo coronario. Conclusiones. La CC en pacientes sin antecedentes de enfermedad cerebrovascular, en forma aislada, no se asocia a peor rendimiento cognitivo global, pero si a mayor dano vascular sistemico y mayor dependencia funcional.

We report on a single nanofiber field-effect transistor made from electrospun regioregular poly(3-hexylthiophene). Nanofibers, with diameters of 100–500 nm, were deposited by electrospinning from chloroform solution onto electrodes on a SiO2∕Si substrate. The transistor exhibited a hole field-effect mobility of 0.03cm2∕Vs in the saturation regime, and a current on/off ratio of 103 in the accumulation mode. Electrospinning offers a simple means of fabricating one-dimensional polymer transistors.

The temperature dependence of the absorption edge in CuGaS2 is determined by absorption measurements in single crystals and thin films. A linear change of the gap energy Eg with a temperature coefficient of dEg/dT = − (2.2 ± 0.2) × 10−4 eV/K is found in the temperature range from 80 to 300 K. It is shown that the downshift in the absolute values of dEg/dT of the I–III–VI2 and I–VII compounds compared to their II–VI analogs can be explained by the p–d hybridization of the uppermost valence band. Die Temperaturabhangigkeit der Absorptionskante von CuGaS2 wird durch Absorptionsmessungen an Einkristallen und dunnen Schichten bestimmt. Im Temperaturbereich von 80 bis 300 K ergibt sich eine lineare Anderung der Breite der verbotenen Zone Eg mit einem Temperatur-koeffizienten dEg/dT = − (2,2 ± 0,2) × 10−4 eV/K. Es wird gezeigt, das sich die Erniedrigung der Absolutwerte von dEg/dT in den I–III–VI2- und I–VII-Verbindungen gegenuber ihren II–VI-Analoga durch die p–d-Hybridisierung des obersten Valenzbandes erklaren last.

CuGaTe2 thin films with thicknesses in the range of 1000–2000 A have been prepared by flash evaporation of pre-reacted material onto glass and silicon substrates. The films were single phase, polycrystalline and stoichiometric within 1%, as shown by transmission electron diffraction measurements and ion backscattering spectrometry. Four characteristic energy gaps of 1.227, 1.280, 1.97 and 2.67 eV were obtained from an analysis of the optical transmission spectra in the photon energy range from 1 to about 3 eV. A model is proposed for the band structure of CuGaTe2 near the point Γ of the Brillouin zone. Transmission measurements in the far infrared yielded three transverse optical mode frequencies of 166.4 cm−1, 201.4 cm−1 and 209.2 cm−1.

The electrical and optical properties of CuGaTe2 single crystals were investigated by resistivity and Hall effect measurements in the temperatur range T = 77… 300 K and optical transmission measurements in the temperature range T = 20… 300 K at photon energies hν = 1.15…1.50 eV. All samples were p-type conducting due to shallow acceptors with ionization energies EA1 ≈ 10−3 eV and concentrations NA1 ≈ p = (2…4). 1018 cm−3. The absorption spectra could be described by simultaneous consideration of acceptor - to - conduction band transitions with EA2 = 360 meV and NA2 ≈ 1022 cm−3 and valence band - to - conduction band transitions with EG = 1.24 eV at room temperaure. The temperature coefficient of the fundamental edge is dEG/dT = −4.0. 10−4 eV/K. The results are discussed with regard to some general trends found in the Cu-III–VI2 compounds. Die elektrischen und optischen Eigenschaften von CuGaTe2-Einkristallen wurden durch Widerstands- und Hall-Effekt-Messungen im Temperaturbereich T = 77…300 K und optische Transmissionsmessungen im Temperaturbereich T = 20…300 K bei Photoenergien hv = 1.5… 1.50 eV untersucht. Alle Proben waren p-leitend, verursacht durch flache Akzeptoren mit Ionisierungsenergien EA1≈ 10−3 eV und Konzentrationen NA1 ≈ p = (2…4). 1018 cm−3. Die Absorptionsspektren konnten durch gleichzeitige Berucksichtigung von Akzeptor-Leitungsband-Ubergangen mit EA2 = 360 meV und NA2≈ 1022 cm−3 und Valenzband - Leitungsband -Ubergangen mit EG = 1.24 eV bei Zimmertemperatur beschrieben werden. Der Temperaturkoeffizient fur die fundamentale Absorptionskante ist dEG/dT = −4.0. 10−4 eV/K. Die Ergebnisse werden im Hinblick auf einige allgemeine Trends in den Cu-III–VI2-Verbindungen diskutiert.

The temperature dependence of the fundamental absorption edge in CuGaSe2 single crystals was determined in the temperature range from 15 to 300 K. Above about 120 K the gap energy changes linearly with temperature with dEg/dT = − (2.1 ± 0.1) eV K−1. The downshift in dEg/dT of the I–III–VI2 compounds compared to their II–VI analogs is discussed accounting for the p-d hybridization of the uppermost valence band.