Analysis of spurious peaks at series resonance in solidly mounted resonators by combined BVD-Mason modelling

Solidly Mounted Resonators (SMRs) for high frequency RF filters and sensing applications often display spurious resonances that distort their frequency response. In this work, we try to identify the origin of spurious resonances accompanying the main series resonances in AlN-based SMRs with the help of modified Butterworth Van Dyke (BVD) and Mason's models. By manufacturing SMRs of different sizes and shapes and studying the influence of the position of the electrical probing spot, we have demonstrated both theoretically and experimentally that devices with larger areas are more likely to display these additional peaks. Our updated models accurately simulate the frequency response of the SMRs, revealing that spurious peaks are mostly related to the resistance of the electrodes. Our study clarifies the origin of the spurious resonances and offers solutions for both, the optimal design and measurement method of SMRs.

Development and validation of a minimally invasive and image-guided tape stripping method to sample atopic skin in children

BACKGROUND

Molecular skin profiling techniques, typically performed on skin samples taken by punch biopsy, have enhanced the understanding of the pathophysiology of atopic dermatitis (AD), thereby enabling the development of novel targeted therapeutics. However, punch biopsies are not always feasible or desirable, and novel minimally invasive methods such as skin tape stripping have been developed.

AIM

To develop, optimize and validate a novel tape stripping method guided by noninvasive in vivo skin imaging to sample atopic skin in children.

METHODS

Skin tape stripping-based procedures were compared and optimized using data from 30 healthy controls (HCs: 5 adults, 25 children) and 39 atopic children. Evaluations were guided by high-resolution photography, reflectance confocal microscopy, optical coherence tomography and transepidermal water loss measurements. We assessed and compared adverse events (AEs), the time needed to perform the sampling and the cDNA levels obtained from the tapes.

RESULTS

Tape stripping methods based on previously described protocols resulted in erosions in all participants and required a median time of 65 min to perform (range 60-70 min), but provided good cDNA yield. Shorter durations appeared less invasive but provided lower cDNA yield. The final optimized tape stripping protocol, using 11 tapes of 22 mm in diameter, each applied twice for 5 s with 90° rotation, did not produce significant AEs, was completed within a median time of 7 min (range 5-15 min) and provided good cDNA yield both in HCs and atopic children.

CONCLUSION

Our minimally invasive method is safe and reliable, and provides reproducible acquisition of cDNA in atopic children. In addition, it enables rapid sample collection, a crucial factor in clinical practice.

DNA Repair and Immune Response Pathways Are Deregulated in Melanocyte-Keratinocyte Co-cultures Derived From the Healthy Skin of Familial Melanoma Patients

Familial melanoma accounts for 10% of cases, being CDKN2A the main high-risk gene. However, the mechanisms underlying melanomagenesis in these cases remain poorly understood. Our aim was to analyze the transcriptome of melanocyte-keratinocyte co-cultures derived from healthy skin from familial melanoma patients vs. controls, to unveil pathways involved in melanoma development in at-risk individuals. Accordingly, primary melanocyte-keratinocyte co-cultures were established from the healthy skin biopsies of 16 unrelated familial melanoma patients (8 CDKN2A mutant, 8 CDKN2A wild-type) and 7 healthy controls. Whole transcriptome was captured using the SurePrint G3 Human Microarray. Transcriptome analyses included: differential gene expression, functional enrichment, and protein-protein interaction (PPI) networks. We identified a gene profile associated with familial melanoma independently of CDKN2A germline status. Functional enrichment analysis of this profile showed a downregulation of pathways related to DNA repair and immune response in familial melanoma (P < 0.05). In addition, the PPI network analysis revealed a network that consisted of double-stranded DNA repair genes (including BRCA1, BRCA2, BRIP1, and FANCA), immune response genes, and regulation of chromosome segregation. The hub gene was BRCA1. In conclusion, the constitutive deregulation of BRCA1 pathway genes and the immune response in healthy skin could be a mechanism related to melanoma risk.

Azithromycin resistance levels and mechanisms in Escherichia coli

Despite azithromycin being used in some countries to treat infections caused by Gram-negative pathogens, no resistance breakpoint for Escherichia coli exists. The aim of this study was to analyse the levels and mechanisms of azithromycin resistance in E. coli. The presence of chromosomal (rplD, rplV and 23S rRNA) mutations, 10 macrolide resistance genes (MRGs) and efflux pump overexpression was determined in 343 E. coli isolates. Overall, 89 (25.9%) isolates had MICs ≥ 32 mg/L to azithromycin, decreasing to 42 (12.2%) when assayed in the presence of Phe-Arg-β-Napthylamide, with 35 of these 42 possessing at least one MRG. Efflux pumps played a role in azithromycin resistance affecting the Minimal Inhibitory Concentration (MIC) levels of 91.2% isolates whereas chromosomal alterations seem to have a minimal role. At least one MRG was found in 22.7% of the isolates with mph(A) being the most commonly found gene. The mph(A) gene plays the main role in the development of azithromycin resistance and 93% of the mph(A)-carrying isolates showed a MIC of 32 mg/L. In the absence of a specific resistance breakpoint our results suggest a MIC of 32 mg/L to be considered in order to detect isolates carrying mechanisms able to confer azithromycin resistance.

Estimating Respiratory Pattern Variability by Symbolic Dynamics

Objectives: The traditional techniques of data analysis are often not sufficient to characterize the complex dynamics of respiration. In this study the respiratory pattern variability was analyzed using symbolic dynamics.

Methods: A group of 20 patients on weaning trials from mechanical ventilation were studied at two different pressure support ventilation levels. Breath duration (TTOT) time series and the relation TI/TTOT, that contains the influence of inspiratory time (TI), were considered. Length-3 words and 3 different symbols were proposed. The incidence of the overlapping τ and the parameter α were analyzed.

Results: From the breath duration time series, the distribution of words with probability of occurrence higher than 6% was concentrated on one word for low respiratory variability, whereas high variability was characterized by 4 words, presenting a statistically significant difference (p ≤ 0.0005). The probability occurrence of words “110” and “111” was also significantly different (p ≤ .0005) when comparing both variabilities.

Conclusion: The analysis carried out obtained discriminant functions able to correctly classify all the testing set series. These results permit the consideration of symbolic dynamics as a promising methodology to study the respiratory pattern variability.

Virulence factors profiles and ESBL production in Escherichia coli causing bacteremia in Peruvian children

The presence of 25 virulence genes (VGs), genetic phylogroups, quinolone-resistance and Extended Spectrum β-lactamase (ESBL)-production was assessed in 65 Escherichia coli isolates from blood cultures in children <5 years in Peru. The most frequent VGs were fimA (89.2%), iutA (83.1%), agn43 (72.3%), iucA (67.7%), and fyuA (49.2%). The isolates belonged to D (47.7%), A (26.1%), B1 (21.5%), and B2 (4.6%) phylogroups. D + B2 isolates presented a high number of fimA, hly, papC, sat, and fyuA genes. Quinolone-susceptible (22 isolates - 33.8%) and ESBL-negative (31 isolates - 47.7%) isolates carried more VGs that their respective counterparts (5.7 vs. 4.7 and 5.3 vs. 4.4 respectively); the frequency of the fyuA, aat, aap, and hly genes significantly differed between quinolone-resistant and quinolone-susceptible isolates. Neonatal sepsis isolates tended to be more quinolone-resistant (P = 0.0697) and ESBL-producers (P = 0.0776). Early-onset neonatal sepsis isolates possessed a high number of VGs (5.2 VGs), especially in neonates of ≤1 day (5.9 VGs).

A spatial pattern analysis of the halophytic species distribution in an arid coastal environment

Obtaining information about the spatial distribution of desert plants is considered as a serious challenge for ecologists and environmental modeling due to the required intensive field work and infrastructures in harsh and remote arid environments. A new method was applied for assessing the spatial distribution of the halophytic species (HS) in an arid coastal environment. This method was based on the object-based image analysis for a high-resolution Google Earth satellite image. The integration of the image processing techniques and field work provided accurate information about the spatial distribution of HS. The extracted objects were based on assumptions that explained the plant-pixel relationship. Three different types of digital image processing techniques were implemented and validated to obtain an accurate HS spatial distribution. A total of 2703 individuals of the HS community were found in the case study, and approximately 82% were located above an elevation of 2 m. The micro-topography exhibited a significant negative relationship with pH and EC (r = -0.79 and -0.81, respectively, p < 0.001). The spatial structure was modeled using stochastic point processes, in particular a hybrid family of Gibbs processes. A new model is proposed that uses a hard-core structure at very short distances, together with a cluster structure in short-to-medium distances and a Poisson structure for larger distances. This model was found to fit the data perfectly well.

[Breast reconstruction with TRAM flap after selective embolization of the deep inferior epigastric artery (series of 69 patients)]

Vascular complications of the unipedicled TRAM flap pointed out the need for solutions to decrease such occurrences. The flap surgical delay before transfer has been advocated to improve the blood supply but, at the same time, it increases the risk of wound infection at the donor site and imposes a general anesthesia. The DIEP and the free TRAM flap are more complex procedures and need heavy structural resources. Preferential use of the ipsilateral muscular pedicle suggests a lower partial flap necrosis rate. Selective embolization of the deep inferior epigastric arteries prior to surgery realizes an alternative delay and brings a decrease in the vascular complication rate as shown in a study of 40 patients by Scheufler in 2000. We present a series of 69 patients who were reconstructed by means of a delayed pedicled TRAM flap with selective embolization and a predominant use of the ispsilateral pedicle. Sonographic studies performed in 48 patients prior to surgery showed no significative difference in the diameter of the superior epigastic arteries, with or without previous radiotherapy. The mean interval between embolization and surgery was 30 days; the embolization was performed bilateraly in five patients (4 %), and unilaterally in 64 patients (96 %). The mean age of patients was 54 years, radiotherapy was applied in 43 patients (62 %), smoking patients: 11 (16 %), obesity: five (7 %). The ispsilateral pedicled was used in 67 patients (97 %), controlateral pedicle in two patients (3 %). Postoperative flap complications were comprised of partial flap necrosis in two cases (2,9 %), fat necrosis in six cases (8,7 %), impaired wound healing in three cases (4,3 %), abdominal wall weakness in two cases (2,9 %). We compared the present study of ispsilateral delayed pedicled flap to a study from the same authors concerning controlateral pedicled flaps without delay. It has been demonstrated that the complications rate of partial necrosis was divided by four in the first study compared to the second. The preoperative selective embolization of the deep inferior epigastric artery in association with the use of ipsilateral pedicule in TRAM flap decrease the complications rate significatively compared to the controlateral pedicled flap in TRAM flaps.

Use of the modified BCR three-step sequential extraction procedure for the study of trace element dynamics in contaminated soils

The modified BCR three-step sequential extraction procedure was used to examine the temporal dynamics of trace elements in soils contaminated by an accidental spill from an opencast mine in south-west Spain. Soils were mainly contaminated with pyritic sludge and acidic wastewater, whereas some soils were affected only by acidic wastewater. The distributions obtained for both some major (Ca, Fe and Mn) and trace elements (As, Cd, Cu, Pb and Zn) in the sludge and soil samples taken at different times after the accident, 1-3 months and 21 months, were compared. Sequential extractions were useful in identifying different sources of contamination, and in obtaining additional information on the solubility of secondary minerals formed by pyrite oxidation. Thus, the effectiveness of the BCR procedure has proved to be a useful tool for predicting short- and long-term mobility of trace elements, even in complex environmental scenarios.

El género Antoinella Jeannel, 1937 (Coleoptera, Carabidae, Trechinae) tres especies nuevas de Marruecos: A. espanyoli sp. n., A. iblanensis sp. n. y A. fadriquei sp. n

Genera Antoinella Jeannel, 1937 (Coleoptera, Carabidae, Trechinae) three new species from Morocco: A. espanyoli n. sp. , A. iblanensis n. sp. y A. fadriquei n. sp. Three new species of the genus Antoinella Jeannel (Carabidae, Trechinae) are described from the region of Taza in Morocco: A. espanyoli n. sp. (the smallest of all Antoniella), A. iblanensis n. sp. (with the end of aedeagus truncate) and A. fadriquei n. sp. (with the aedeagus rather similar to that of A. iblanensis n. sp. but end not trunacte). A brief summary on the geographical dispersion of the genus is given. The most distinctive taxonomic characteristics concern the male genitalia; the accompanying drawings contribute further to the identification of the new taxa.

[Clinical assessment of a new anesthetic system: the Temel Supra (II)]

OBJECTIVES

To assess the clinical performance of a new anesthetic system developed to provide novel advantages in ventilating the anesthetized patient.

PATIENTS AND METHOD

The clinical performance of the Temel Supra was evaluated in 100 adult patients who were anesthetized and ventilated using the device.

RESULTS

The patients were adequately oxygenated and ventilated; no adverse events were observed. An open circuit, low flow, or closed circuit could be chosen freely. Ventilation was fully monitored: among the variables measured were rebreathed volume; leaks while the patient was connected; consumption of oxygen, nitrous oxide and anesthetic agents; and cardiac output (noninvasively).

CONCLUSIONS

Ventilation and gas exchange were satisfactory in all cases even though some patients developed considerable respiratory impedance. The monitoring of oxygen and other gases consumed and of carbon dioxide produced provided very valuable information about metabolism and pharmacokinetics. The noninvasive monitoring of cardiac output seems to us to be a useful feature for aiding hemodynamic control. The independence of the open and closed circuits means that expired gases do not pass through the canister when the open circuit is used, resulting in savings on soda lime for drying. During pressure-control ventilation, the system maintains a plateau to guarantee better distribution of inspired gases. Other important features are warnings, constant monitoring of leaks, the 100% efficacy of the circuit, and the low internal volume.

Estimating respiratory pattern variability by symbolic dynamics

OBJECTIVES

The traditional techniques of data analysis are often not sufficient to characterize the complex dynamics of respiration. In this study the respiratory pattern variability was analyzed using symbolic dynamics.

METHODS

A group of 20 patients on weaning trials from mechanical ventilation were studied at two different pressure support ventilation levels. Breath duration (T(TOT)) time series and the relation T(I)/T(TOT), that contains the influence of inspiratory time (T(I)), were considered. Length-3 words and 3 different symbols were proposed. The incidence of the overlapping tau and the parameter alpha were analyzed.

RESULTS

From the breath duration time series, the distribution of words with probability of occurrence higher than 6% was concentrated on one word for low respiratory variability, whereas high variability was characterized by 4 words, presenting a statistically significant difference (p </= 0.0005). The probability occurrence of words "110" and "111" was also significantly different (p</= 0.0005) when comparing both variabilities.

CONCLUSION

The analysis carried out obtained discriminant functions able to correctly classify all the testing set series. These results permit the consideration of symbolic dynamics as a promising methodology to study the respiratory pattern variability.

Thoracic epidural analgesia in coronary artery bypass graft surgery: seven years' experience

OBJECTIVE

To evaluate the risk of neurologic complications caused by an epidural hematoma in a series of patients who had coronary artery bypass graft surgery with cardiopulmonary bypass under combined general and thoracic epidural anesthesia (TEA).

DESIGN

Prospective observational study.

SETTING

General hospital associated with a university.

PARTICIPANTS

Seven hundred fourteen patients who had coronary artery bypass grafting surgery over a 7-year period.

INTERVENTIONS

An epidural catheter was inserted at T(1)-T(3) as soon as the patient was in the operating room and local anesthetic was administered as a bolus and then as a continuous infusion throughout the operation and postoperatively. A set of safety guidelines was routinely followed. A protocol for postoperative neurologic evaluation was used to rule out any signs of spinal compression.

MEASUREMENTS AND MAIN RESULTS

Preoperatively, a battery of coagulation tests was systematically performed including APTT, platelet count, and prothrombin time. Antiplatelet drugs (aspirin) were stopped at least 7 days before surgery. No patient required parenteral opiates postoperatively. Seventy-five percent of the patients were extubated in the operating room. No clinical epidural hematomas were detected.

CONCLUSION

In this study, some of the benefits previously reported during cardiac surgery under TEA, such as excellent analgesia and early extubation, were confirmed. In addition, the series adds further evidence that adherence to a set of standard safety measures, in this setting, averts the occurrence of symptomatic epidural hematomas.

Toxicity to topical dimethyl sulfoxide (DMSO) when used as an extravasation antidote

DMSO is a dipolar, aprotic, hygroscopic solvent for which a large number of pharmacologic properties have been claimed. Topical DMSO is considered an effective and safe antidote to be used with topical cooling after extravasations of vesicant drugs. A case of toxicity after its use as an antidote is described. Furthermore, the increasing importance of DMSO pharmacology, as its use in haematologic patients is spreading, is reviewed.

[Ornidazole in the treatment of liver dysfunction associated to long-term parenteral nutrition]

AIM

to reduction the TPN-related hepatic toxicity with an anaerobicidal therapy (ornidazole in our case).

PATIENT

a 24-year-old male surgically treated for intestinal occlusion. He had been treated with abdominal radiotherapy for rabdomyosarcoma of embryonic urogenital sinus when he was five months old. It was found a great abdominal radiotherapy sequelae and occluded and perforated small-bowel loop that was resected. Postoperative time developed pelvic abscess and reoperation was performed. Severe intraabdominal inflammatory-adhesive process was noticed which included all the intestinal loops with multiple perforations. Attempts to release this situation was unsuccessful and several anastomoses, with some loop exclusions and a diverting loop jejunostomy were performed. In postoperative period he developed an enterocutaneous fistula and TPN was initiated. Higher and higher hepatic marker values were detected suggesting a progressive hepatotoxicity.

METHODS

anaerobicidal agent (ornidazole) and cyclic total parenteral nutrition as a therapy design were prescribed.

RESULTS

there were satisfactory showing a reduction in hepatic marker values (72.5% fall in alanine aminotransferase).

CONCLUSIONS

bearing in mind that some theories suggest that total parenteral nutrition may cause atrophic changes in the gut mucosa so giving rise to bacterial translocation, this anaerobicidal treatment designed could be assumed effective for attenuating TPN-related liver damage.

Monitoring of antimicrobial therapy by an integrated computer program

OBJECTIVE

To assess the impact of the setting-up of a computer program designed by the Hospital Pharmacy Department as a tool that provides information for the antimicrobial therapy monitoring. To assess its influence on pharmaceutical costs.

MATERIAL AND METHOD

The computer application for the follow-up of antimicrobial treatments integrates information from the Pharmacy Department and the Microbiology Laboratory and selects all patients to whom some controlled antibiotic has been prescribed. The pharmacist reviews all the controlled antibiotic treatments, suggests any change to the physician if needed and quantifies the economic impact of the accepted interventions.

RESULTS

On average, 12.5% of controlled antibiotic treatments warranted a pharmaceutical intervention, and 92% of them were accepted. The most frequent interventions related to prescriptions were change of dosage and administration route and related to the disease were in respiratory and urinary tract infections. From the economic point of view, the accepted interventions represented a saving of 12,087,029 pesetas (83,359 $)/year, on average.

CONCLUSION

The applied computer program resulted a useful tool for a clinical pharmacist to reach more correct antibiotical therapeutics and better cost-effectiveness relation. It also helped to achieve favorable clinical outcomes.

Treatment of extravasation from parenteral nutrition solution

OBJECTIVE

To report two cases of parenteral nutrition extravasation and their treatment in adult patients.

CASE SUMMARIES

Case 1: A 23-year old white woman was admitted to our hospital diagnosed with a gastrointestinal infection by Salmonella paratyphi sv. B. The treatment included peripheral parenteral nutrition (osmolarity 652 mOsm/L). After 4 days an extravasation of parenteral nutrition was detected in the left antecubital fossa. The affected area soon became inflamed. Chondroitinsulfatase 150 turbidity-reducing units (TRUs), diluted in 3 mL of NaCl 0.9% and administered in six subcutaneous applications around the area, was prescribed. The treatment was successful. The patient was discharged several days later with no sequelae of the extravasation. Case 2: A 33-year-old white woman was admitted to the intensive care unit after surgery for a necrohemorrhagic pancreatitis. The treatment included parenteral nutrition via a central catheter (osmolarity 2130 mOsm/L). Two days later the patient presented a parenteral nutrition subcutaneous extravasation in her left hemithorax around the catheter access site. Chondroitinsulfatase 200 TRUs, diluted in 2 mL of NaCl 0.9% and administered in eight subcutaneous applications around the area, was prescribed. No sequelae of the incident remained. The patient was discharged home 2 months later.

DISCUSSION

Parenteral nutrition solution can cause tissue harm after extravasation. Both patients presented an intense inflammatory reaction after the accident. Three treatments have been used in extravasation of parenteral nutrition, but in our patients hyaluronidase was the only applicable treatment. As this enzyme is not commercially available in Spain, chondroitinsulfatase, an enzyme very similar to hyaluronidase, was used.

CONCLUSIONS

Chondroitinsulfatase was useful in treating extravasation of parenteral nutrition in two adult patients.

Methods of Assessing and Achieving Normality Applied to Environmental Data

/ It has been recognized for a long time that data transformation methods capable of achieving normality of distributions could have a crucial role in statistical analysis, especially towards an efficient application of techniques such as analysis of variance and multiple regression analysis. Normality is a basic assumption in many of the statistical methods used in the environmental sciences and is very often neglected. In this paper several techniques to test normality of distributions are proposed and analyzed. Confidence intervals and nonparametric tests are used and discussed. Basic and Box-Cox transformations are the suggested methods to achieve normal variables. Finally, we develop an application related to environmental data with atmospheric parameters and SO2 and particle concentrations. Results show that the analyzed transformations work well and are very useful to achieve normal distributions.KEY WORDS: Normal distribution; Kurtosis; Skewness; Confidence intervals; Box-Cox transformations; Nonparametric tests