The internet of things (IoT) requires an efficient management of all devices. Operation in potentially insecure environments, limited processing capability of the IoT devices and unreliable ...connectivity create the need of suitable Device Management (DM) solutions. But with the IoT being complex and diverse, the criteria for finding the right DM solution differ depending on the application-specific requirements of the given IoT system. In this paper, we develop a rating system for IoT DM solutions, which can be easily adapted. The criteria are represented with the FCAPS and the life cycle management models. Additionally, we conduct an evaluation of open source IoT platforms in contrast to commercial solutions.
Smart cities will be significantly shaped by their modes of mobility. For the blend of public and individual transport, smart mobility will introduce autonomous vehicles on a large scale, which often ...heavily rely on communication. As the capabilities of autonomous vehicles are still limited nowadays, driver-less vehicles have to be able to be remotely monitored and controlled in real-time. This creates high performance demands for the vehicle's communication link, especially regarding latency and uplink, which can easily exceed the limits of communication standards like Long Term Evolution (LTE). Therefore, the development of the communication system for the newly developed autonomous monorail vehicle MONOCAB aims towards the use of the 5G standard. This paper presents experiences and measurements from a first outdoor field test conducted in the context of monitoring and remotely controlling the MONOCAB via 5G. Previously, all communication services were subjected to ITU-T Y.1564 compliant tests for the network planning and the deployment of a 5G Non-Public Network (NPN). This deployed 5G NPN was then used to test remote monitoring the MONOCAB, at it's first public presentation on the 3rd of October 2022, by transmitting video streams and telemetry data from the vehicle to a central control station. Additionally, a glass-to-glass latency measurement of a video stream transmitted via 5G was conducted, to point out the latency impact of 5G.
Objectives Chronic transplant dysfunction after kidney transplantation is a major reason of kidney graft loss and is caused by immunological and non-immunological factors. There is evidence that ...mycophenolate mofetil (MMF) may exert a positive effect on renal damage in addition to immunosuppression, by its direct antifibrotic properties. The aim of our study was to retrospectively investigate the role of MMF doses on progression of chronic allograft dysfunction and fibrosis and tubular atrophy (IF/TA). Setting Retrospective, cohort study. Participants Patients with kidney transplant in a tertiary care institution. This is a retrospective cohort study that included 79 patients with kidney and kidney–pancreas transplantation. Immunosuppression consisted of anti-interleukin 2 antibody induction, MMF, a calcineurin inhibitor±steroids. Primary outcome measures An association of average MMF doses over 1 year post-transplant with progression of interstitial fibrosis (Δci), tubular atrophy (Δct) and estimated-creatinine clearance (eCrcl) at 1 year post-transplant was evaluated using univariate and multivariate analyses. Results A higher average MMF dose was significantly independently associated with better eCrcl at 1 year post-transplant (b=0.21±0.1, p=0.04). In multiple regression analysis lower Δci (b=−0.2±0.09, p=0.05) and Δct (b=−0.29±0.1, p=0.02) were independently associated with a greater average MMF dose. There was no correlation between average MMF doses and incidence of acute rejection (p=0.68). Conclusions A higher average MMF dose over 1 year is associated with better renal function and slower progression of IF/TA, at least partly independent of its immunosuppressive effects.
Nutritional support has been recognised as an important part in the treatment of acute pancreatitis. Acute pancreatitis varies in its severity from mild inflammatory process within pancreatic tissue ...to severe necrotic pancreatitis with involvement of regional tissues and remote organs leading to the multi organ dysfunction syndrome. Acute pancreatitis results in hypermetabolic, highly catabolic state and negative nitrogen balance, the degree of which is directly related to the severity of the disease and high mortality (up to 40%). The aim of nutritional support is to establish positive nitrogen balance without stimulating pancreatic secretion ofproteolytic enzymes and auto-digestion. Traditionally, fasting ("putting the pancreas at rest") with or without total parenteral nutrition was considered as standard of care. Current knowledge regarding the importance of integrity of intestinal mucosal barrier suggests that early enteral feeding should be implemented. Despite several randomised controlled trials comparing total parenteral with enteral nutrition, some guidelines and recommendations, there are still unsolved questions regarding the type and amount of fluids and calories that should be provided as well the use of the immune-enhancing diets.
Velike epidemiološke studije upućuju na veliku učestalost sepse u općoj populaciji. Usprkos napretku kirurgije, kirurški pacijenti
sa sepsom čine gotovo trećinu svih slučajeva sepse. Sepsa je vodeći ...uzrok pobola i smrtnosti među kirurškim bolesnicima, a intrabdominalne infekcije glavno su izvorište sepse. Prema mišljenju nekih autora, sepsa u kirurških pacijenata razlikuje se od one u nekirurških zbog modulacije imunološke funkcije koja se javlja kao posljedica kirurškog zahvata i primijenjene anestezije te bi stoga te dvije skupine trebalo pratiti odvojeno. U liječenju sepse ključnu ulogu imaju rano prepoznavanje sepse, brza dijagnostika i agresivno liječenje koje uključuje i izbor intervencije s najmanjim fi ziološkim inzultom s ciljem kontrole izvora infekcije. Značajan naglasak treba staviti i na prevenciju sepse koja se provodi u svim dijelovima perioperacijskog razdoblja. Liječenje kirurškog septičnog bolesnika je kompleksno i zahtijeva multidisciplinarni pristup.
To perform an external validation of the original Simplified Acute Physiology Score II (SAPS II) system and to assess its performance in a selected group of patients in major Croatian hospitals.
A ...prospective, multicenter study was conducted in five university hospitals and one general hospital during a six-month period between November 1, 2007 and May 1, 2008. Standardized hospital mortality ratio (SMR) was calculated from the mean predicted mortality of all the 2756 patients and the actual mortality for the same group of patients. The validation of SAPS II was made using the area under receiver operating characteristic curve (AUC), 2×2 classification tables, and Hosmer-Lemeshow tests.
The predicted mortality was as low as 14.6% due to a small proportion of medical patients and the SMR being 0.89 (95% confidence interval CI, 0.78-0.98). The SAPS II system demonstrated a good discriminatory power as measured by the AUC (0.85; standard error SE=0.012; 95% CI=0.840-0.866; P<0.001). This system significantly overestimated the actual mortality (Hosmer-Lemeshow goodness-of-fit H statistic: χ(2) =584.4; P<0.001 and C statistics: χ(2)(8) =313.0; P<0.001) in the group of patients included in the study.
The SAPS II had a good discrimination, but it significantly overestimated the observed mortality in comparison with the predicted mortality in this group of patients in Croatia. Therefore, caution is required when an evaluation is performed at the individual level.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aim of this study was to evaluate level of analgesia and hemodynamic response to spinal anesthesia obtained by administering 15 mg 0.5% isobaric bupivacaine at L2-3 vs. L3-4 interspace for inguinal ...herniorrhaphy, since studies comparing analgesia and hemodynamic response at the L2-3 vs. L3-4 interspaces are lacking. In a prospective, randomized clinical study that encountered 72 patients undergoing elective inguinal herniorrhaphy randomly allocated in to two equal groups L2-3 (N = 36) and L3-4 (N = 36) according to lumbar interspace where intrathecal injection of bupivacaine was administered. Analgesia was evaluated by intraoperative "rescue" fentanyl requirements, the absence of pain and the maximal visual analogue scale (VAS) scores reached per patient during the operation. The severity of intraoperative pain was quantified by a 10 cm VAS scale (VAS 0: no pain to 10: worst pain imaginable) every 5 minutes after skin incision until the end of the operation. VAS > 3 was treated with intravenous fentanyl 25 microg. Hemodynamic response was monitored and evaluated, heart rate was continuously monitored as well as, baseline systolic, diastolic and mean arterial pressure prior to induction and every 5 minute after applying spinal anesthesia until surgical completion. Intraoperative fentanyl requirements were significantly higher in group L3-4 (L2-3 0%, 97.5% confidence interval CI 0.0-0.11 vs. L3-4 17%, 95% CI 0.07-0.32, p = 0.025). Absence of pain was significantly higher in L2-3 group at the beginning of the operation (L2-3 89%, 95% CI 0.74-0.96 vs. L3-4 67%, 95% CI 0.50-0.79, p = 0.047). The maximal VAS scores reached per patient during the operation in L2-3 group were lower then in L3-4 group (L2-3 median M 0, range R 0-3, L3-4 M 0, R 0-8, p = 0.014). There were no significant differences (p > 0.05) in the incidence of hypotension (L2-3 19%, 95% CI 0.09-0.35 vs. L3-4 17%, 95% CI 0.07-0.32) and bradycardia (L2-3 19%, 95% CI 0.09-0.35 vs. L3-4 8%, 95% CI 0.02-0.23). Spinal anesthesia with isobaric bupivacaine administered in L2-3 interspace for inguinal herniorrhaphy provides superior analgesia and equal hemodynamic stability as compared to neuroaxial anesthesia administered in the L3-4 interspace.
Presented here is a case of human parvovirus B19 (PVB19) induced pure red-cell aplasia (PRCA) in immunocompromised patient after orthotopic liver transplantation (OLT). PVB19 is a small, ...single-stranded DNA whose target cell is the erythroid progenitor in bone marrow. Manifestations of PVB19 infection vary with the immunologic status of the patient, ranging from asymptomatic to severe infections and PRCA. Post-transplant PRCA is induced either by immunosuppressive agents or PVB19. In the presented case, bone marrow aspiration characterized by the absence of mature erythroid precursors and detection of PVB19 DNA in blood led to treatment with high-dose intravenous human immunoglobulins (IVIG) and subsequent recovery of erythropoiesis. Due to insufficient antibody response in immunocompromised patients, suppression of the PVB19 infection is delayed and repetitive treatments may be administrated in attempt of reversing PRCA.
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