The treatment of penetrating wounds of the inferior vena cava

During the last 5 years, 10 gunshot and 2 stab wounds of the inferior vena cava have been treated, with 11 survivals and 1 death. The lacerations were above the renal veins in 4 cases and below in the others. All patients had other serious visceral injuries. Treatment consisted of suture repair in 11 cases and ligation in the twelfth. Upon exploration, free intraperitoneal bleeding from the caval wound had ceased in every case. The signal finding was a retroperitoneal hematoma which was often deceptively small. Commonly, the surgeon explored the retroperitoneal space in order to treat other visceral injuries, only to be confronted with unexpected massive hemorrhage when the hematoma was entered. Difficulties in controlling the bleeding are often related to the well-developed collateral system by which different segments of the inferior vena cava are freely connected. When a hematoma is found in the vicinity of the great vessels and the retroperitoneal space is to be explored, certain precautions should be observed. These include provision for adequate exposure, procurement of blood, and adjustment of lighting. Additional help can be summoned and vascular instruments should be brought to the operating table. A large-bore needle or cut-down should be placed in an arm vein. The posterior peritoneal incision should be planned for maximum and rapid exposure, so that hemorrhage can be quickly controlled when the plane of the hematoma is entered. © 1962

Evaluating Patient Preferences of Maintenance Therapy for the Treatment of Chronic Obstructive Pulmonary Disease: A Discrete Choice Experiment in the UK, USA and Germany.

Introduction: With increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE). Methods: Qualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs). Results: Overall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p<0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p<0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p<0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers. Conclusion: When selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients' preferences are considered may encourage treatment compliance

The treatment of penetrating wounds of the inferior vena cava

During the last 5 years, 10 gunshot and 2 stab wounds of the inferior vena cava have been treated, with 11 survivals and 1 death. The lacerations were above the renal veins in 4 cases and below in the others. All patients had other serious visceral injuries. Treatment consisted of suture repair in 11 cases and ligation in the twelfth. Upon exploration, free intraperitoneal bleeding from the caval wound had ceased in every case. The signal finding was a retroperitoneal hematoma which was often deceptively small. Commonly, the surgeon explored the retroperitoneal space in order to treat other visceral injuries, only to be confronted with unexpected massive hemorrhage when the hematoma was entered. Difficulties in controlling the bleeding are often related to the well-developed collateral system by which different segments of the inferior vena cava are freely connected. When a hematoma is found in the vicinity of the great vessels and the retroperitoneal space is to be explored, certain precautions should be observed. These include provision for adequate exposure, procurement of blood, and adjustment of lighting. Additional help can be summoned and vascular instruments should be brought to the operating table. A large-bore needle or cut-down should be placed in an arm vein. The posterior peritoneal incision should be planned for maximum and rapid exposure, so that hemorrhage can be quickly controlled when the plane of the hematoma is entered. © 1962

Fast physical models for Si LDMOS power transistor characterization

A new nonlinear, process-oriented, quasi-two-dimensional (Q2D) model is described for microwave laterally diffused MOS (LDMOS) power transistors. A set of one-dimensional energy transport equations are solved across a two-dimensional cross-section in a “current-driven” form. The model accounts for avalanche breakdown and gate conduction, and accurately predicts DC and microwave characteristics at execution speeds sufficiently fast for circuit simulation applications

Visual search in ecological and non-ecological displays: Evidence for a non-monotonic effect of complexity on performance

Copyright @ 2013 PLoSThis article has been made available through the Brunel Open Access Publishing Fund.Considerable research has been carried out on visual search, with single or multiple targets. However, most studies have used artificial stimuli with low ecological validity. In addition, little is known about the effects of target complexity and expertise in visual search. Here, we investigate visual search in three conditions of complexity (detecting a king, detecting a check, and detecting a checkmate) with chess players of two levels of expertise (novices and club players). Results show that the influence of target complexity depends on level of structure of the visual display. Different functional relationships were found between artificial (random chess positions) and ecologically valid (game positions) stimuli: With artificial, but not with ecologically valid stimuli, a “pop out” effect was present when a target was visually more complex than distractors but could be captured by a memory chunk. This suggests that caution should be exercised when generalising from experiments using artificial stimuli with low ecological validity to real-life stimuli.This study is funded by Brunel University and the article is made available through the Brunel Open Access Publishing Fund

Gravitational Energy Loss and Binary Pulsars in the Scalar Ether-Theory of Gravitation

Motivation is given for trying a theory of gravity with a preferred reference frame (``ether'' for short). One such theory is summarized, that is a scalar bimetric theory. Dynamics is governed by an extension of Newton's second law. In the static case, geodesic motion is recovered together with Newton's attraction field. In the static spherical case, Schwarzschild's metric is got. An asymptotic scheme of post-Minkowskian (PM) approximation is built by associating a conceptual family of systems with the given weakly-gravitating system. It is more general than the post-Newtonian scheme in that the velocity may be comparable with $c$. This allows to justify why the 0PM approximation of the energy rate may be equated to the rate of the Newtonian energy, as is usually done. At the 0PM approximation of this theory, an isolated system loses energy by quadrupole radiation, without any monopole or dipole term. It seems plausible that the observations on binary pulsars (the pulse data) could be nicely fitted with a timing model based on this theory.Comment: Text of a talk given at the 4th Conf. on Physics Beyond the Standard Model, Tegernsee, June 2003, submitted to the Proceedings (H. V. Klapdor-Kleingrothaus, ed.

Approximate probabilistic verification of hybrid systems

Hybrid systems whose mode dynamics are governed by non-linear ordinary differential equations (ODEs) are often a natural model for biological processes. However such models are difficult to analyze. To address this, we develop a probabilistic analysis method by approximating the mode transitions as stochastic events. We assume that the probability of making a mode transition is proportional to the measure of the set of pairs of time points and value states at which the mode transition is enabled. To ensure a sound mathematical basis, we impose a natural continuity property on the non-linear ODEs. We also assume that the states of the system are observed at discrete time points but that the mode transitions may take place at any time between two successive discrete time points. This leads to a discrete time Markov chain as a probabilistic approximation of the hybrid system. We then show that for BLTL (bounded linear time temporal logic) specifications the hybrid system meets a specification iff its Markov chain approximation meets the same specification with probability $1$. Based on this, we formulate a sequential hypothesis testing procedure for verifying -approximately- that the Markov chain meets a BLTL specification with high probability. Our case studies on cardiac cell dynamics and the circadian rhythm indicate that our scheme can be applied in a number of realistic settings

Simultaneous quantification of 12 different nucleotides and nucleosides released from renal epithelium and in human urine samples using ion-pair reversed-phase HPLC

Nucleotides and nucleosides are not only involved in cellular metabolism but also act extracellularly via P1 and P2 receptors, to elicit a wide variety of physiological and pathophysiological responses through paracrine and autocrine signalling pathways. For the first time, we have used an ion-pair reversed-phase high-performance liquid chromatography ultraviolet (UV)-coupled method to rapidly and simultaneously quantify 12 different nucleotides and nucleosides (adenosine triphosphate, adenosine diphosphate, adenosine monophosphate, adenosine, uridine triphosphate, uridine diphosphate, uridine monophosphate, uridine, guanosine triphosphate, guanosine diphosphate, guanosine monophosphate, guanosine): (1) released from a mouse renal cell line (M1 cortical collecting duct) and (2) in human biological samples (i.e., urine). To facilitate analysis of urine samples, a solid-phase extraction step was incorporated (overall recovery rate ? 98 %). All samples were analyzed following injection (100 ?l) into a Synergi Polar-RP 80 Å (250 × 4.6 mm) reversed-phase column with a particle size of 10 ?m, protected with a guard column. A gradient elution profile was run with a mobile phase (phosphate buffer plus ion-pairing agent tetrabutylammonium hydrogen sulfate; pH 6) in 2-30 % acetonitrile (v/v) for 35 min (including equilibration time) at 1 ml min(-1) flow rate. Eluted compounds were detected by UV absorbance at 254 nm and quantified using standard curves for nucleotide and nucleoside mixtures of known concentration. Following validation (specificity, linearity, limits of detection and quantitation, system precision, accuracy, and intermediate precision parameters), this protocol was successfully and reproducibly used to quantify picomolar to nanomolar concentrations of nucleosides and nucleotides in isotonic and hypotonic cell buffers that transiently bathed M1 cells, and urine samples from normal subjects and overactive bladder patients

Chemo- and Thermosensory Responsiveness of Grueneberg Ganglion Neurons Relies on Cyclic Guanosine Monophosphate Signaling Elements

Neurons of the Grueneberg ganglion (GG) in the anterior nasal region of mouse pups respond to cool temperatures and to a small set of odorants. While the thermosensory reactivity appears to be mediated by elements of a cyclic guanosine monophosphate (cGMP) cascade, the molecular mechanisms underlying the odor-induced responses are unclear. Since odor-responsive GG cells are endowed with elements of a cGMP pathway, specifically the transmembrane guanylyl cyclase subtype GC-G and the cyclic nucleotide-gated ion channel CNGA3, the possibility was explored whether these cGMP signaling elements may also be involved in chemosensory GG responses. Experiments with transgenic mice deficient for GC-G or CNGA3 revealed that GG responsiveness to given odorants was significantly diminished in these knockout animals. These findings suggest that a cGMP cascade may be important for both olfactory and thermosensory signaling in the GG. However, in contrast to the thermosensory reactivity, which did not decline over time, the chemosensory response underwent adaptation upon extended stimulation, suggesting that the two transduction processes only partially overlap. Copyright (C) 2011 S. Karger AG, Base