Abstract Context Erectile dysfunction (ED) is the complication associated with radical prostatectomy (RP) for clinically localized prostate cancer that has the most negative impact. Currently, ...several therapeutic options are available to improve sexual health after surgical treatment. Objective To critically analyze the factors affecting erectile function after RP and to evaluate the evidence suggesting the role of pharmacologic prophylaxis and treatment of ED after surgery. Evidence acquisition This article is based on the proceeding of the Risk Evaluation and Mitigation Strategy (REMS) meeting held in Madrid, Spain, in 2007. Evidence synthesis Several basic science reports have highlighted a potential role of phosphodiesterase type 5 inhibitors (PDE5-Is) in the prevention of endothelial damage related to ischemia–reperfusion and/or denervation following surgery. However, patient selection and preservation of both nerves and vascular supply integrity are the major determinants of postoperative erectile function. Pharmacologic treatment of postoperative ED, using either oral or local approaches, is effective and safe. Moreover, recent studies have shown that pharmacologic prophylaxis early after RP can significantly improve the rate of erectile function recovery after surgery. Use of on-demand treatments for treatment of ED in post-RP patients has been shown to be highly effective. In this context, pharmacologic prophylaxis may potentially have a significant expanding role in future strategies aimed at preserving postoperative erectile function. Conclusions Administration of pro-erectile drugs is the key factor of erectile function recovery after RP. Use of on-demand PDE5-Is in post-RP patients has been shown to be effective and safe, with better results seen in select young patients treated with a bilateral nerve-sparing approach. Pharmacologic prophylaxis may have a role in the future. Large, multicentric, placebo-controlled trials are urgently needed in order to identify the best regimen for treating postsurgery ED.
Event choice datalog Greco, Gianluigi; Guzzo, Antonella; Saccà, Domenico ...
International Conference on Principles and Practice of Declarative Programming: Proceedings of the 6th ACM SIGPLAN international conference on Principles and practice of declarative programming; 24-26 Aug. 2004,
08/2004
Conference Proceeding
This paper presents a rule-based declarative database language which extends DATALOG to express events and nondeterministic state transitions, by using the choice construct to model uncertainty in ...dynamic rules. The proposed language, called Event Choice DATALOG (DATALOG!ev for short), provides a powerful mechanism to formulate queries on the evolution of a knowledge base, given a sequence of events envisioned to occur in the future. A distinguished feature of this language is the use of multiple spatio-temporal dimensions in order to model a finer control of evolution. A comprehensive study of the computational complexity of answering DATALOG!ev queries is reported.
Acute myocardial infarction may result from rupture or fissuring of atherosclerotic plaque in a coronary artery. Sometimes a different pathogenesis occurs like microembolization following lysis from ...ulcerated plaque or during pharmacological or interventional procedures. We describe a patient with anterior myocardial infarction treated with alteplase + abciximab (TIMI 14). At the end of thrombolytic therapy administration, we observed a marked reduction of anterior ST elevation associated with a simultaneous occurrence of ST elevation in the inferior leads, later followed by inferior Q waves. The coronary angiogram demonstrated an isolated 60% stenosis on the left anterior descending artery. This case raises the question on whether the very effective and aggressive thrombolytic treatment was paradoxically responsible for microembolization resulting in myocardial infarction extension.
To determine the role of insulin and free fatty acid (FFA) concentration in the regulation of FFA metabolism, forearm FFA fluxes were quantified in 16 healthy volunteers by combining the forearm ...perfusion technique with the infusion of 3Hpalmitate. Three groups of studies were performed. In study 1 (n = 6), a systemic insulin infusion (1.2 mU/kg.min) was performed for 120 min while euglycemia was maintained by a variable glucose infusion. In Study 2 (n = 5), insulin (0.05 mU/kg.min) was infused into the brachial artery to expose the forearm tissues to the same insulin level as in study 1. In study 3 (n = 5), heparin was infused to raise plasma FFA concentration to 1-1.5 mmol/L. At 60 min, an intrabrachial insulin infusion was added as in study 2 and maintained for 60 min. During systemic insulin infusion, plasma FFA concentration fell to 0.09 +/- 0.02 mmol/L. Forearm FFA uptake (FFA-U) decreased from the basal value of 2.54 +/- 0.52 to 0.95 +/- 0.10 mumol/L.min (P < 0.05). Likewise, forearm FFA release (FFA-R) fell to 1.0 +/- 0.31 mumol/L.min (P < 0.05). With local insulin administration, both FFA levels and FFA-U remained unchanged, whereas FFA-R was markedly inhibited (from 1.78 +/- 0.23 to 1.04 +/- 0.24 mumol/L.min; P < 0.05). In study 3 (heparin infusion), FFA levels rose to 1.17 +/- 0.12 mmol/L due to a 4-fold increase in FFA-R (from 1.18 +/- 0.36 to 6.92 +/- 2.40 mumol/L.min; P < 0.05). FFA-U rose from the basal value of 2.50 +/- 0.82 to 6.92 +/- 1.95 mumol/L.min (P < 0.05). Addition of intrabrachial insulin did not modify FFA-U, whereas heparin activation of FFA-R was only partially antagonized (4.53 +/- 2.40 mumol/L.min; 0.01 < P < 0.05 vs. heparin alone). The data demonstrate that plasma FFA concentration is the main determinant of forearm FFA transport. Insulin exerts a direct inhibitory effect on FFA release and affects tissue FFA transport only indirectly through the fall in circulating FFA.
Fifteen cases of ventricular parasystole were analyzed to determine whether the interectopic intervals were regular, as expressed by long intervals being exact multiples of the short ones, or not. ...The regularity of the interectopic intervals was assessed by means of the variation index: the ratio of the maximal difference between various measurements of the parasystolic cycle length and the mean parasystolic cycle length. Three out of 15 cases had a variation index less than 5, and were classified as "regular parasystole." Twelve cases were associated with a variation index greater than 7.5, and were classified as "irregular parasystole." The cases of irregular parasystole were then analyzed to determine whether the variability of the interectopic intervals was casual or dependent on action of the sinus beats. A parasystolic resetting by critically timed sinus impulses (a form of intermittent parasystole) was evident in three cases. The irregularity in the remaining nine cases was due to modulation (viz., due to electrotonic influence exerted by the sinus beats on the parasystolic focus). In every case of modulated parasystole a phase-response curve was constructed, which enabled an analysis of all the interectopic intervals on the basis of a time-dependent effect exerted by the sinus impulses on an otherwise rhythmic parasystolic focus.
Erectile Dysfunction and Radical Prostatectomy: An Update Briganti, Alberto; Salonia, Andrea; Zanni, Giuseppe ...
EAU update series : official journal of the European Association of Urology,
06/2004, Letnik:
2, Številka:
2
Journal Article
Objective:
As radical prostatectomy remains a commonly used procedure in the treatment of clinically localized prostate cancer, we critically analyzed the current strategies for preventing and ...managing postoperative erectile dysfunction.
Methods:
Systematic literature review using Medline and CancerLit from January 1997 to March 2004. Abstracts published in the journals
European Urology,
The Journal of Urology and the
International Journal of Impotence Research as official proceedings of internationally known scientific societies held in the same time period were also assessed.
Results:
Patient selection and surgical technique are the major determinants of postoperative erectile function. Intracavernosal hypoxia following radical prostatectomy seems to be one of the major determinants of post-operative erectile dysfunction. Pharmacological prophylaxis and treatment of postoperative erectile dysfunction is effective and safe, although no general agreement regarding timing and dosing of its clinical application has been assessed yet.
Conclusions:
In the hands of experienced surgeons, properly selected patients undergoing a nerve sparing radical prostatectomy should achieve unassisted or medically assisted erections postoperatively.
The problem of recovering (count and sum) range queries over multidimensional
data only on the basis of aggregate information on such data is addressed. This
problem can be formalized as follows. ...Suppose that a transformation T producing
a summary from a multidimensional data set is used. Now, given a data set D, a
summary S=T(D) and a range query r on D, the problem consists of studying r by
modelling it as a random variable defined over the sample space of all the data
sets D' such that T(D) = S. The study of such a random variable, done by the
definition of its probability distribution and the computation of its mean
value and variance, represents a well-founded, theoretical probabilistic
approach for estimating the query only on the basis of the available
information (that is the summary S) without assumptions on original data.
Histograms are used to summarize the contents of relations into a number of
buckets for the estimation of query result sizes. Several techniques (e.g.,
MaxDiff and V-Optimal) have been proposed in ...the past for determining bucket
boundaries which provide accurate estimations. However, while search strategies
for optimal bucket boundaries are rather sophisticated, no much attention has
been paid for estimating queries inside buckets and all of the above techniques
adopt naive methods for such an estimation. This paper focuses on the problem
of improving the estimation inside a bucket once its boundaries have been
fixed. The proposed technique is based on the addition, to each bucket, of
32-bit additional information (organized into a 4-level tree index), storing
approximate cumulative frequencies at 7 internal intervals of the bucket. Both
theoretical analysis and experimental results show that, among a number of
alternative ways to organize the additional information, the 4-level tree index
provides the best frequency estimation inside a bucket. The index is later
added to two well-known histograms, MaxDiff and V-Optimal, obtaining the
non-obvious result that despite the spatial cost of 4LT which reduces the
number of allowed buckets once the storage space has been fixed, the original
methods are strongly improved in terms of accuracy.
The problem of recovering (count and sum) range queries over multidimensional data only on the basis of aggregate information on such data is addressed. This problem can be formalized as follows. ...Suppose that a transformation T producing a summary from a multidimensional data set is used. Now, given a data set D, a summary S=T(D) and a range query r on D, the problem consists of studying r by modelling it as a random variable defined over the sample space of all the data sets D' such that T(D) = S. The study of such a random variable, done by the definition of its probability distribution and the computation of its mean value and variance, represents a well-founded, theoretical probabilistic approach for estimating the query only on the basis of the available information (that is the summary S) without assumptions on original data.
