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BACKGROUND CONTEXT : Pulmonary complications in patients age 75 years and older who undergo spinal fusion may have catastrophic consequences. The use of augmentation techniques with polymethylmethacrylate (PMMA) have been associated with pulmonary damage. The use of fenestrated pedicle screws augmented with PMMA may increase the risk of lung injury in this population. PURPOSE : To investigate whether the use of PMMA-augmented screws is correlated with increased lung injury in patients undergoing instrumented lumbar spinal fusion. STUDY DESIGN : A nonrandomized, prospective, case-controlled clinical study was carried out. PATIENT SAMPLE : We included 50 consecutive patients: 25 classified as patients who required PMMA-augmented screws in lumbar spinal fusion, and 25 classified as control participants because they underwent uncemented instrumented spinal fusion. OUTCOME MEASURES : We compare the incidence of the event, lung damage, in both groups by measuring a series of parameters: arterial blood gas, transesophageal echocardiography, urinary desmosine, and chest radiograph. The epidemiological parameters analyzed were age, sex, body mass index, status as a smoker, and number of cement leaks. METHODS : Changes in pulmonary damage markers were described in both groups of patients, comparing post-surgery values with baseline values. In control participants, each change was evaluated for the total number of patients. All changes are indicated in this report by mean differences for quantitative variables and by differing proportions for qualitative variables, with 95% confidence intervals provided for all values. RESULTS There was an increase in post-instrumentation PaO2 (arterial partial pressure of oxygen) in both groups, probably related to the use of mechanical ventilation and recruitment maneuvers. Even though the group that required augmentation had lower baseline levels, the difference between groups was not statistically significant. On transesophageal echocardiographs, we observed scattered small, snowflake-like emboli, and bright echo signals appeared in the right atrium during PMMA injection. Signal density was constant but gradually faded away when PMMA injection ended. No participants in the group without augmentation had radiological complications. Overall, desmosine levels increased in both groups, and the rise was similar in both. There was a slight average increase in urine desmosine levels after instrumentation and progressively continues to rise until 24 hours after instrumentation, with a subsequent decrease at 72 hours. Comparing the two groups, we found no statistically significant differences at any time. CONCLUSIONS We were not able to identify a significant difference in urine desmosine levels associated with the augmentation of with fenestrated pedicle screws with PMMA. Despite comparing patients age 75 years or older with a younger group, we found no clinical, analytical, or gasometric data indicating lung damage in patients who had augmentation.

Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis, is caused by dematiaceous fungi, the most frequently implicated are Fonsecaea, Phialophora, Cladophialophora, Rhinocladiella and Exophiala.We report a woman who was treated before with mycological cure, but she experience a relapse requiring treatment again. Direct microscopic examination and skin biopsy with culture were necessary to identify a Exophiala psychrophila, and for our knowledge this is the first case reported. Keywords: Chromoblastomycosis, Exophiala salmonis-clade, Subcutaneous mycosis

Background Decreased plasma fibrinogen concentration shortly after injury is associated with higher blood transfusion needs and mortality. In North America and the UK, cryoprecipitate transfusion is the standard-of-care for fibrinogen supplementation during acute haemorrhage, which often occurs late during trauma resuscitation. Alternatively, fibrinogen concentrate (FC) can be beneficial in trauma resuscitation. However, the feasibility of its early infusion, efficacy and safety remain undetermined. The objective of this trial was to evaluate the feasibility, effect on clinical and laboratory outcomes and complications of early infusion of FC in trauma. Methods Fifty hypotensive (systolic arterial pressure ≤100 mm Hg) adult patients requiring blood transfusion were randomly assigned to either 6 g of FC or placebo, between Oct 2014 and Nov 2015 at a tertiary trauma centre. The primary outcome, feasibility, was assessed by the proportion of patients receiving the intervention (FC or placebo) within one h of hospital arrival. Plasma fibrinogen concentration was measured, and 28-day mortality and incidence of thromboembolic events were assessed. Results Overall, 96% (43/45) [95% CI 86–99%] of patients received the intervention within one h; 95% and 96% in the FC and placebo groups, respectively (P=1.00). Plasma fibrinogen concentrations remained higher in the FC group up to 12 h after admission with the largest difference at three h (2.9 mg dL − 1 vs. 1.8 mg dL − 1; P Conclusions Early infusion of FC is feasible and increases plasma fibrinogen concentration during trauma resuscitation. Larger trials are justified.

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This work shows the results of high frequency force measurement for micro milling operations on hardened steel with rotational speeds up to 110,000 rpm using a modified high frequency dynamometer with optimally reduced pre-located mass between sensor and workpiece. This development allows for a significant increase of the natural frequency both in shear direction (aprox. 9 kHz) as well as in longitudinal direction (up to 25 kHz). Additionally, a completely new developed hexapod dynamometer with extremely high sensitivity (up to 115 pC/N) for micro processing forces will be shown as well. Further on, aiming to expand the knowledge on EDM process forces, results of measurements using two different force sensors (aprox. 20 kHz and 200 kHz) with micro-electrodes down to 0.4 mm in diameter will also be shown and analysed with the aid of high speed camera images of the discharge gap region. Those experimentations made simultaneously with the single discharge force measurements will help identifying the characteristical behavior of the measured signal proving their suitability to monitor an unconventional process such as EDM.

Rapidly involuting congenital haemangioma (RICH) may present with thrombocytopenia, low fibrinogen and elevated fibrin degradation products and D-dimers. Such complications have rarely been reported. We wished to define the clinical characteristics of the thrombocytopenia and coagulopathy associated with RICH, to emphasize the transient nature of this haematological complication and to distinguish these abnormalities from true Kasabach-Merritt phenomenon (KMP). We present a case series of seven patients with large RICH who presented with thrombocytopenia and coagulopathy during the first week of life. Clinical and haematological characteristics were recorded retrospectively. Two of the patients were treated with embolization due to early signs of high-output cardiac failure; four patients received oral corticosteroids in the range of 2 mg kg(-1) daily; one patient did not receive any treatment in the neonatal period, although the tumour was excised at 6 months of age. Two patients with platelet counts lower than 10 x 10(9) L(-1) received a platelet transfusion. There were no bleeding complications and only one patient presented with petechiae. In all seven patients, platelet counts started to increase at > 2 weeks of age and the coagulopathy resolved. We conclude that RICH may present with thrombocytopenia and coagulopathy similar to mild KMP early in the neonatal period. However, in contrast to true KMP, these abnormal laboratory findings are self-limited and are usually not complicated by bleeding problems.

The computer game Defend and Gather was created to evaluate two neural-based agents' ability to learn how to play and win the game. The agents navigate an environment to find resources and defeat enemies. Traditional game agents are often neither challenging enough to human opponents over time, nor scalable to environments not anticipated at the time the agents were originally programmed. We show that neural- based agents have the ability to learn from their human counterparts or from the environment, thus remaining competitive over time. The neural-based agents developed for Defend and Gather have the ability to formulate tactics within increasingly difficult environments involving more sophisticated enemies and can win the game over seventy-five percent of the time.

Implementation of Power Amplifiers, based on MMIC technology, requires a method for summing the power from several active devices like F.E.T's and H.B.T's. This paper addresses the practical benefits and limitations of several in-phase summing topologies. The application for each power summing method is related to the device technology as well as to the performance goal. The decision strategy among the options yields a compromise among performance, size and circuit complexity. The methodology is a function of the technological parameters of the specific choosen device, the manufacturing process, as well as the assets and limitations of the summing topology. The approach discussed in the paper has been developed in order to provide evaluation quality criteria for the required performance.

This article reviews the experience of the US Food for Peace Program (PL 480) under Title III, with the objective of identifying some of the limitations and possibilities of using food aid as a development tool. It will argue that while multi-year agreements are inflexible, the settings in which the agreements are to be implemented are turbulent and uncertain. Combining food aid with development also makes severe demands upon the administrative capacity of both field missions and recipients, resulting in a reluctance on the part of both to initiate agreements.