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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.

Droplet pairs interact when exposed to electric fields, being crucial parameters in this process the initial droplet separations and the electric field intensity. We present an algorithm for the evolution of perfectly conducting and non-viscous fluids using a level set technique. Topological changes of the free boundary are automatically included in the formulation and passing through singular times is computationally possible. Numerical results on electro-hydrodynamic droplet pairs reveal three different types of droplets evolution: droplets do not coalesce, droplets coalesce, and droplets recoil after contact failing to coalesce. A comparison of numerical results with laboratory experiments is also addressed.

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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.

A 3D axisymmetric Galerkin boundary integral formulation for modeling the motion of one inviscid fluid enclosed inside another is described. The interface variables are the velocity potential and the normal velocity, and they can be solved for separately, the second linear system being symmetric. The algorithm is validated by comparing with the analytic solutions for a static interior spherical drop, over a range of values for the relative densities D = ρE/ρI of exterior and interior fluids, and various boundary conditions. For time dependent simulations utilizing a Level Set method for the interface tracking, the accuracy has been checked by comparing against the known oscillation frequency of the sphere. Pinch-off profiles corresponding to an initial two lobe geometry drop and D = 6 are also presented. Copyright c © 0000 John Wiley & Sons, Ltd.

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.

Current immunosorbent assays for gluten detection suffer from a number of drawbacks including lack of specificity (e.g. cross-reaction with coeliac disease non-toxic prolamins, detection of total gluten and not specifically coeliac disease toxic gluten) and an inability to detect quantitatively hydrolysates and prolamins present in rye, barley and, possibly, oats. Additionally, the extraction methods employed involve the use of strong reducing agents that are not compatible with enzyme-linked immunosorbent assay. This work reports on the development of a novel competition assay based on the use of a monoclonal antibody raised against a 19-mer peptide recognised in vivo to be coeliac disease toxic. This assay is specific to those cereal prolamins that exacerbate coeliac disease, is capable of the detection of hydrolysate forms and is compatible with typical extraction agents. The optimal assay format is highly sensitive with a detection limit of 0.128 ppm and good reproducibility is obtained with intra-plate and inter-plate relative standard deviation of 3.21% ( n = 6) and 3.57% ( n = 3) being obtained, respectively. The reported system is the first of several systems under development that aim to address the drawbacks that current assays suffer and meet the sensitivity requirements outlined by the World Health Organisation and Codex Alimentarius.

A cubic Hermite approximation for two-dimensional boundary integral analysis is presented. The method differs from previous Hermite interpolation algorithms in that the gradient equations are sparse, significantly reducing the computational cost, and in that information about the surface normals is incorporated to effect a cubic interpolation of the geometry. A motivation for the development of this approximation is in the solution of moving boundary problems, as high accuracy and surface gradients are required for these simulations.

We validate, extend, and empirically and theoretically criticize the cultural dimension of humane orientation of the project GLOBE (Global Leadership and Organizational Behavior Effectiveness Research Program). Theoretically, humane orientation is not just a one-dimensionally positive concept about being caring, altruistic, and kind to others as discussed by Kabasakal and Bodur (2004), but there is also a certain ambivalence to this concept. We suggest differentiating humane orientation toward in-group members from humane orientation toward out-group members. A multicountry construct validation study used student samples from 25 countries that were either high or low in humane orientation (N = 876) and studied their relation to the traditional GLOBE scale and other cultural-level measures (agreeableness, religiosity, authoritarianism, and welfare state score). Findings revealed a strong correlation between humane orientation and agreeableness, welfare state score, and religiosity. Out-group humane orientation proved to be the more relevant subfacet of the original humane orientation construct, suggesting that future research on humane orientation should make use of this measure instead of the vague original scale. The ambivalent character of out-group humane orientation is displayed in its positive correlation to high authoritarianism. Patriotism was used as a control variable for noncritical acceptance of one's society but did not change the correlations. Our findings are discussed as an example of how rigid expectations and a lack of tolerance for diversity may help explain the ambivalent nature of humane orientation. © The Author(s) 2012.

A decade ago, we identified a novel gene, glomulin (GLMN) in which mutations cause glomuvenous malformations (GVMs). GVMs are bluish-purple cutaneous vascular lesions with characteristic glomus cells in the walls of distended venous channels. The discovery of the genetic basis for GVMs allowed the definition of clinical features to distinguish GVMs from other venous anomalies. The variation in phenotype was also highlighted: from a single punctate blue dot to a large plaque-like lesion. In this study, we screened GLMN in a large cohort of patients to broaden the spectrum of mutations, define their frequency and search for possible genotype-phenotype correlations. Taking into account 6 families published by others, a mutation in GLMN has been found in 162 families. This represents 40 different mutations; the most frequent one being present in almost 45% of them. Expressivity varies largely, without a genotype/phenotype relationship. Among 381 individuals with a mutation, we discovered 37 unaffected carriers, implying a penetrance of 90%. As nonpenetrant individuals may transmit the disease to their descendants, knowledge on the mutational status is needed for appropriate genetic counseling.

Epidermolytic hyperkeratosis (EHK; bullous congenital ichthyosiform erythroderma) is a genodermatosis resulting from mutations in either the keratin 1 (K1) or keratin 10 (K10) genes. It is characterized by erythroderma and blistering at birth, and the development of ichthyotic hyperkeratosis and palmoplantar keratoderma. A wide variety of mutations within the highly conserved helix initiation and termination motifs of the central rod domains of the K1 or K10 genes correlate with the highly variable phenotypic severity observed in EHK. We report a novel missense mutation designated L214P in a large Hispanic pedigree with EHK. The mutation is located in the highly conserved 1A segment of the alpha-helical rod domain. The presence of this mutation underscores the importance of sequence alterations located in the central rod domain in the pathogenesis of EHK.

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.

Infantile hemangiomas occur in 10% of children and are 3 times more common in female infants. The majority of hemangiomas are small, superficial tumors that require little, if any, treatment. During the last several years, new information regarding the classification, presentation, associations, and differential diagnosis of hemangioma has emerged and altered the management of these tumors. The purpose of this article is to briefly review some of these clinically relevant findings. A discussion of the pathogenesis and management of these potentially problematic tumors is beyond the scope of this article, but these topics have been addressed in several excellent reviews.

Epidermolytic hyperkeratosis (EHK; bullous congenital ichthyosiform erythroderma) is a genodermatosis resulting from mutations in either the keratin 1 (K1) or keratin 10 (K10) genes. It is characterized by erythroderma and blistering at birth, and the development of ichthyotic hyperkeratosis and palmoplantar keratoderma. A wide variety of mutations within the highly conserved helix initiation and termination motifs of the central rod domains of the K1 or K10 genes correlate with the highly variable phenotypic severity observed in EHK. We report a novel missense mutation designated L214P in a large Hispanic pedigree with EHK. The mutation is located in the highly conserved 1A segment of the alpha-helical rod domain. The presence of this mutation underscores the importance of sequence alterations located in the central rod domain in the pathogenesis of EHK.

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.

The Atlantic region contains 20% of Colombia's population, including 1.4 million women aged 15-49. 2/3 of the population is urban. Despite an increase in contraceptive usage from 39% in 1978 to 52% in 1986, the region still has the lowest prevalence of any of Colombia's major regions. PROFAMILIA has planned campaigns to increase contraceptive usage in the Atlantic region and to encourage the use of temporary methods for birth spacing. The 1st survey of the Atlantic Coast was conducted in 1988 to obtain information on contraceptive use and attitudes as the basis for a campaign to promote use of Microgynon 21 oral contraceptives (OCs) and Tahiti condoms. 59% of women in union were using a method at the time of the survey. In urban and rural areas respectively, 17.9% and 12.2% used pills, 25.8% and 23.8% used female sterilization, 4.9% and 2.8% used IUDs, and 2.5% and 2.8% used injectables. Only .9% and 1.1% used vaginal methods, and .6% and .2% used condoms. No men in rural areas and .2% in urban areas chose vasectomy. 91% of OC users reported taking a pill each day, but some users took one only when they had sexual relations or 1 each week. 70% of users waited an incorrect number of days before starting a new cycle. Over half responded correctly that if they forgot a pill they should take another immediately and follow the regular cycle. Over half of current pill users had thought of changing methods, with over half of those considering sterilization, 28% the IUD, and 12% injectables. 38% of OC users thinking of changing methods would do so because of side effects and 36% because they were tired of taking a pill each day. All users of vaginal methods reported using them correctly. Condoms are usually purchased by men, who prefer to buy them at the drug store. All urban condom users reported having considered changing methods, 3/4 to female sterilization and 1.4 to an IUD. 65% of sterilized women reported undergoing the operation because they wanted no more children, 28% on the recommendation of a physician, and 4% because of economic problems. Over 95% of sterilized women reported satisfaction with the operation.

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.

Distributed neural networks in the brain sustain generation of wakefulness and two sleep states: non-REM sleep and REM sleep. These three behavioral states are jointly ingrained in a rhythmic sequence that constitutes the sleep-wakefulness cycle. This paper reviews and updates knowledge about the involvement of the histaminergic system in sleep-wakefulness cycle organization. Histaminergic neurons are exclusively located in the hypothalamic tuberomammillary nucleus, but are the source of a widespread projection system to many brain regions. Histamine neurons are active during waking, especially with high attention need, and remain silent in both non-REM and REM sleep. There have been described four metabotropic histamine receptors, of which H1R, H2R and H3R are present in the nervous system. H1R and H2R are mainly postsynaptic heteroreceptors, whereas H3R is thought to be mostly a presynaptic auto- and hetero-receptor. Histaminergic neurons are excited by hypocretinergic neurons and most of the arousing hypocretin effects are thought to depend on histaminergic actions. Interactions among histaminergic axons and cholinergic nuclei within forebrain and brainstem are particularly important for cortical activation. In contrast, histaminergic tuberomammillary neurons, similarly to other aminergic neurons in locus coeruleus or dorsal raphe nucleus, are inhibited by non-REM sleep-promoting neurons of the preoptic region. Further inhibitory actions on histamine neurons come from adenosine release on tuberomammillary region. Finally, histaminergic neurons inhibit REM-on hypothalamic neurons containing melanine-concentrating hormone, thus supporting a permissive role of tuberomammillary nucleus in REM sleep. Actually, knockout mice for histidine decarboxylase, the enzyme synthetizing histamine, show a significant REM sleep increase.Regulacion de las fases del ciclo vigilia-sueño por la histamina.Redes neurales distribuidas en el encefalo sustentan la generacion de la vigilia y dos estados de sueño: sueño no REM y sueño REM. Estos tres estados comportamentales se engranan conjuntamente en una secuencia regular que constituye el ciclo vigilia-sueño. Este trabajo revisa y actualiza el conocimiento sobre la implicacion del sistema histaminergico en la organizacion del ciclo vigilia-sueño. Las neuronas histaminergicas se localizan exclusivamente en el nucleo tuberomamilar hipotalamico, pero son el origen de proyecciones extensas a numerosas regiones encefalicas. Las neuronas histaminergicas estan activas durante la vigilia, especialmente con alta demanda atencional, y permanecen silentes en sueño no REM y sueño REM. Se han descrito cuatro receptores histaminergicos metabotropicos, de los cuales H1R, H2R y H3R estan presentes en el sistema nervioso. H1R y H2R son fundamentalmente heterorreceptores postsinapticos, mientras que se piensa que H3R es mayormente un auto y heterorreceptor presinaptico. Las neuronas histaminergicas son activadas por las neuronas hipocretinergicas y se cree que muchos de los efectos activadores de las hipocretinas se deben a acciones histaminergicas. Las interacciones entre los axones histaminergicos y los nucleos colinergicos en el prosencefalo y el troncoencefalo son particularmente importantes para la activacion cortical. Por el contrario, las neuronas histaminergicas tuberomamilares, al igual que otras neuronas aminergicas del locus coeruleus o del nucleo dorsal del rafe, son inhibidas por las neuronas del area preoptica promotoras de sueño no REM. Acciones inhibidoras adicionales sobre las neuronas histaminergicas proceden de la liberacion de adenosina en la region tuberomamilar. Finalmente, las neuronas histaminergicas inhiben a las neuronas hipotalamicas REM-on que contienen hormona concentradora de melanina, apoyando asi un papel permisivo del nucleo tuberomamilar en el sueño REM. De hecho, ratones deficientes para descarboxilasa de histidina, la enzima de sintesis de la histamina, muestran un aumento significativo de sueño REM.