This review addresses the practical usage of intravenous etomidate as a medical therapy in Cushing's syndrome. We reviewed the relevant literature, using search terms 'etomidate', 'Cushing's ...syndrome', 'adrenocortical hyperfunction', 'drug therapy' and 'hypercortisolaemia' in a series of public databases. There is a paucity of large randomised controlled trials, and data on its use rely only on small series, case study reports and international consensus guideline recommendations. Based on these, etomidate is an effective parenteral medication for the management of endogenous hypercortisolaemia, particularly in cases with significant biochemical disturbance, sepsis and other serious complications such as severe psychosis, as well as in preoperative instability. We suggest treatment protocols for the safe and effective use of etomidate in Cushing's syndrome.
In the context of recent developments in the field of energy, the aspect related to energy consumption is of great importance for specialists. Many industries rely on refrigeration technologies, a ...great challenge being expressed by attempts in energy savings in this sector. In this respect, efforts oriented towards efficient industrial refrigeration systems have revealed the necessity of a proper design. The most commonly used method of cooling is based on vapor compression cycles. Compared to vapor compression refrigeration systems, an ejector refrigeration system shows an inferior performance, indicated by the Coefficient of Performance of the cycle, but it is more attractive from energy saving point of view. In this respect, the present study deals with a theoretically analysis of an Ejector Refrigeration System, started with the presentation of the typical ejector design. It is stated that ejector refrigeration is a thermally driven system which requires low grade thermal energy for its working. After a short description of the analyzed system, are given equations for thermal loads and Coefficient of Performance calculation, on First Law basis. The working fluid considered in this research is Freon R134a. The developed study is focused on the effect of generating temperature variation on the Coefficient of Performance (COP) and on the work input to the pump when the cooling effect, the condensation temperature, the evaporation temperature and the reference state temperature are kept constant. Are obtained results in the following conditions: the condensation temperature is tc = 33°C, the evaporation temperature is te = 3°C, the reference state temperature is to = 23°C. The generating temperature varies in the range 82 ÷ 92°C and the cooling effect is 1 kW. Also, are known the isentropic efficiencies of the ejector, which are 0.90, and the isentropic efficiency of the pump, which is 0.75. Calculation will reveal that the Coefficient of Performance is increasing together with the increase of the generating temperature values, the best COP value being 0.178, in the considered range for the mentioned temperature. In the same time, the generating temperature increase leads to the increase of the work input to the pump.
Introduction: Auditory hallucinations or voices are experienced by 75% of people diagnosed with schizophrenia. We presumed that auditory cortex of schizophrenia patients who experience hallucinations ...is tonically "tuned" to internal auditory channels, at the cost of processing external sounds, both speech and nonspeech. Accordingly, we predicted that patients who hallucinate would show less auditory cortical activation to external acoustic stimuli than patients who did not. Methods: At 9 Functional Imaging Biomedical Informatics Research Network (FBIRN) sites, whole-brain images from 106 patients and 111 healthy comparison subjects were collected while subjects performed an auditory target detection task. Data were processed with the FBIRN processing stream. A region of interest analysis extracted activation values from primary (BA41) and secondary auditory cortex (BA42), auditory association cortex (BA22), and middle temporal gyrus (BA21). Patients were sorted into hallucinators (n = 66) and nonhallucinators (n = 40) based on symptom ratings done during the previous week. Results: Hallucinators had less activation to probe tones in left primary auditory cortex (BA41) than nonhallucinators. This effect was not seen on the right. Discussion: Although "voices" are the anticipated sensory experience, it appears that even primary auditory cortex is "turned on" and "tuned in" to process internal acoustic information at the cost of processing external sounds. Although this study was not designed to probe cortical competition for auditory resources, we were able to take advantage of the data and find significant effects, perhaps because of the power afforded by such a large sample.
The evolution of COVID-19 is a controversial topic in cancer patients. They have been designated by international organizations as a vulnerable population at greater risk for contracting SARS-CoV-2 ...and having a more severe clinical outcome.
Active screening at our institution became routine early in the pandemic. We have examined the clinical data of 341 cancer patients, with a positive RT-PCR SARS-CoV-2 test between April 2020 and February 2021, in the prevaccination era.
During the infection, 40.5% remained asymptomatic, 27.6% developed a mild form, 20.5% had a moderate form, and 11.4% a severe/critical form of COVID-19 that led to death in 7.6% of cases. Treatment was adapted to disease severity according to national guidelines. In our series, the incidence of COVID-19 infection was lower in cancer patients compared with the general population (P < 0.001), however, the mortality rate was higher in cancer patients in comparison with the general population (7.6% versus 2.9%, P < 0.001). The prognostic factors were assessed by three distinct univariate and multivariate analyses: (i) evolution to a moderate or severe/critical clinical manifestation, (ii) clinical worsening (severe/critical form or death), and (iii) overall survival. In the multivariate analysis, the prognostic factors associated with the evolution to a moderate or severe/critical clinical manifestation were: performance status (PS) (P < 0.0001) and no active treatment in the previous 3 months (P = 0.031). Factors associated with clinical worsening were: PS (P < 0.0001), peripheral arterial disease (P = 0.03), and chronic liver disease (P = 0.04). Factors associated with impaired overall survival were PS (P < 0.0001), ischemic cardiac disease (P = 0.0126), chronic liver disease (P = 0.001), and radiotherapy (P = 0.0027).
Our series confirms a more severe evolution for COVID-19 infection in cancer patients, with PS as the most prominent prognostic factor in all three multivariate analyses. By active screening, efforts should be in place to keep cancer units as coronavirus-free sanctuaries.
•This is the first comprehensive study addressing the impact of COVID-19 in a large cohort of cancer patients in Romania.•Oncological patients had a higher death rate after COVID-19 infection in comparison with the general population.•Decreased PS was the prominent prognostic factor correlated with worse outcomes and death in multiple multivariate analysis.
This paper refers to the description of the way in which can be presented to future marine engineers the analyzis of the performance of an Otto cycle, in a manner which is beyond the classic approach ...of the course of thermodynamics in Constanta Maritime University. The conventional course of thermodynamics is dealing with the topic of performance analysis of the cycle of the internal combustion engine with isochoric combustion for the situation in which the working medium is treated as such a perfect gas. This type of approach is viable only when are considered relatively small temperature differences. But this is the situation when specific heats are seen as constant. Instead, the practical experience has shown that small temperature differences are not viable, resulting the need for variable specific heat evaluation. The presentation bellow is available for the adiabatic exponent written as a liniar function depending on temperature. In the section of this paper dedicated to methods and materials, the situation in which the specific heat is taken as constant is not neglected, additionaly being given the algorithm for variable specific heat.For the both cases it is given the way in which it is assessed the work output. The calculus is based on the cycle shown in temperature- entropy diagram, in which are also indicated the irreversible adiabatic compression and expansion. The experience achieved after understanding this theory will allow to future professionals to deal successfully with the design practice of internal combustion engines.
Many studies have shown that schizophrenia patients have aberrant functional network connectivity (FNC) among brain regions, suggesting schizophrenia manifests with significantly diminished (in ...majority of the cases) connectivity. Schizophrenia is also associated with a lack of hemispheric lateralization. Hoptman et al. (
2012
) reported lower inter-hemispheric connectivity in schizophrenia patients compared to controls using voxel-mirrored homotopic connectivity. In this study, we merge these two points of views together using a group independent component analysis (gICA)-based approach to generate hemisphere-specific timecourses and calculate intra-hemisphere and inter-hemisphere FNC on a resting state fMRI dataset consisting of age- and gender-balanced 151 schizophrenia patients and 163 healthy controls. We analyzed the group differences between patients and healthy controls in each type of FNC measures along with age and gender effects. The results reveal that FNC in schizophrenia patients shows less hemispheric asymmetry compared to that of the healthy controls. We also found a decrease in connectivity in all FNC types such as intra-left (L_FNC), intra-right (R_FNC) and inter-hemisphere (Inter_FNC) in the schizophrenia patients relative to healthy controls, but general patterns of connectivity were preserved in patients. Analyses of age and gender effects yielded results similar to those reported in whole brain FNC studies.
To highlight the heat exchange taking place between seawater as primary agent and the working fluid (water, glycol or Freon) as secondary agent, I have used the Simulink softwear in order to creat a ...new sequence for numerical calculation of heat exchanging. For optimum heat transfer we opted for a counter movement. The model developed to view the dynamic behavior of the exchanger consists of four interconnected levelsess. In the simulations was found that a finer mesh of the whole exchanger lead to results much closer to reality. There have been various models meshing, starting from a single cell and then advancing noticed an improvement in resultsSimulations were made in both the summer and the winter, using as a secondary agent process water and glycol solution. Studying heat transfer that occurs in the primary exchanger of a heat pump, having the primary fluid sea water with this program, we get the data plausible and worthy of consideration. Inserting into the program, the seasonal water temperatures of Black Sea water layers, we get a encouraging picture about storage capacity and heat transfer of sea water.
Abstract Background Urological complications such as ureteral strictures and ureteral leakage can affect the outcome of kidney transplantation by increasing morbidity and mortality, including graft ...loss. Controversy still exists regarding the role of stents in renal transplantation. The aim of this study was to evaluate the role of ureteral stenting in kidney transplantation. Methods We performed a retrospective study on a series of 798 consecutive renal transplants performed in our center between January 1, 2004, and December 31, 2011. Ureteral stents were used in 152 cases (19.1%) of the total (stent group) and were removed 2 weeks postoperatively. Donor and recipient age, sex, type of ureteroneocystostomy, stent and non-stent patients, cold and warm ischemia time, and urological complications were analyzed. Results The overall incidence of urological complications was 7.8% (62 cases). Ureteral stenosis (3.1%) and ureteral leakage (2.4%) were the most common complications; 39.7% (25 cases) of complications were recorded in the first month after transplantation. Major urological complication rate was 3.3% in the stent group compared with 8.8% in the non-stent group ( P = .04). However, stent use was associated with the increase of urinary tract infections rate in the stent group (51.3%) compared with the non-stent group (17.9%) ( P = .03). Conclusions In our study, the use of ureteral stents significantly decreased urological complications in kidney transplant recipients but increased the risk for development of urinary tract infections.
In order to have a better visualization of the heat transfer that might occur in a tubular seawater heat exchanger, I have created a simulation using Ansysy Fluent program. The first stage of the ...simulation is the representation of the subject in the Geometry. The next step is the mesh in a finite number of cells. All settings and information defined in the first two phases are taken in the third (Setup), where are imposed boundary conditions (the input and output). The next step is the calculation (Solutions) where the problem is solved iteratively using one of the methods of calculation selected. The software can solve numerical equations of Navier-Stokes flow, continuity equation, energy conservation etc. that are available in the database of the program. The last part is especially designed for the analysis and interpretation of results (distribution of speeds, temperatures, pressures etc.). Due to the fact that many types of heat pump used as working fluid water, a mixture of water and glycol or Freon, I have required two ways of calculation: the first in which the working fluid is water and the second in where water is replaced by a solution consisting of 50% glycol and 50% water.
PDF
