This cross-sectional multicentre study aimed at investigating frequency and features of painful diabetic polyneuropathy. We consecutively enrolled 816 patients attending hospital diabetic outpatient ...clinics. We first definitely diagnosed diabetic polyneuropathy and pure small-fibre polyneuropathy using clinical examination, nerve conduction study, and skin biopsy or quantitative sensory testing. Adhering to widely agreed criteria, we then identified neuropathic pain and diagnosed painful polyneuropathy using a combined approach of clinical examination and diagnostic tests. Of the 816 patients, 36% had a diabetic polyneuropathy associated with male sex, age, and diabetes severity; 2.5% of patients had a pure small-fibre polyneuropathy, unrelated to demographic variables and diabetes severity. Of the 816 patients, 115 (13%) suffered from a painful polyneuropathy, with female sex as the only risk factor for suffering from painful polyneuropathy. In this large study, providing a definite diagnosis of diabetic polyneuropathy and pure small-fibre polyneuropathy, we show the frequency of painful polyneuropathy and demonstrate that this difficult-to-treat complication is more common in women than in men.
This paper describes an Itanium processor implemented in 65 nm process with 8 layers of Cu interconnect. The 21.5 mm by 32.5 mm die has 2.05B transistors. The processor has four dual-threaded cores, ...30 MB of cache, and a system interface that operates at 2.4 GHz at 105degC . High speed serial interconnects allow for peak processor-to-processor bandwidth of 96 GB/s and peak memory bandwidth of 34 GB/s.
•A realistic, robust computational framework to support TEVAR planning is provided.•Structural analysis of stent-graft deployment is performed.•A distance-image approach is adopted to build the CFD ...mesh.•Post-TEVAR hemodynamics is studied by CFD.•Two patient-specific clinical cases are studied in detail.
Although Thoracic EndoVascular Aortic Repair (TEVAR) is a consolidated procedure to treat thoracic aortic diseases, it still has relevant complications mainly related to suboptimal wall apposition of the stent-graft, impairing the post-operative hemodynamics and the clinical outcomes. Accurate stent-graft sizing and patient selection are the key aspects to minimize drawbacks. Unfortunately, current TEVAR planning is only based on geometrical measurements performed on static images, completely neglecting the biomechanical interplay between the stent-graft and the aorta. Despite an extensive literature dealing with bioengineering simulation of endovascular implants, studies on the prediction of the post-TEVAR hemodynamics based on both pre-operative patient-specific aortic anatomy and stent-graft mechanical features are still missing.
The present study aims at providing a realistic and robust computational framework to support TEVAR planning in the clinical practice by predicting the post-operative hemodynamics given a selected stent-graft model and pre-operative medical images of the aorta to be treated. A novel approach based on a distance image aimed at transforming the result of the structural analysis of stent-graft deployment in a volume mesh suitable for a computational study of the post-TEVAR hemodynamics is presented. The study discusses two clinical cases as illustrative examples of the framework application and, for one of the two cases, a comparison of the predicted hemodynamics with a simulation based on real post-operative images is shown.
Such a comparison proves that the proposed computational framework is able to capture the main hemodynamic aspects related to the stent-graft implant. In particular, the use of simulations has confirmed the unsuitability for the endovascular repair of one of the two patients due to the short proximal landing zone, leading to a high risk of the so-called bird-beak.
The proposed computational framework is shown to be a useful tool to support planning of elective TEVAR, especially in those borderline cases when the sole geometrical analysis of static images is not exhaustive.
Abstract
The health monitoring of mechanical components and systems is a technique known and applied for decades in almost all fields of engineering since it allows a drastic reduction of the risks ...associated with any unexpected failure of components and at the same time allows reducing the plant maintenance and management costs. Several monitoring techniques exists and all of them are based on the acquisition and processing on-field measurements aimed to evaluate possible changes in the behavior of the component. Among these, in recent years a method able to monitor in real-time the fatigue damage or the potential damage of a structure with few information has been developed. In this paper, this method, implemented and tested only numerically, has been implemented in an acquisition board, expressly developed, and its ability to operate in real-time by monitoring the failure of a real component subjected to random vibrations has been tested.
The safety and efficacy of treatment with self-expandable braided stents (LEO and LVIS) required further investigation.
Our aim was to analyze the outcomes after treatment with braided stents.
A ...systematic search of 3 databases was performed for studies published from 2006 to 2017.
According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting patients treated with LEO or LVIS stents.
Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and neurologic outcomes.
Thirty-five studies evaluating 1426 patients treated with braided stents were included in this meta-analysis. Successful stent delivery and complete aneurysm occlusion were 97% (1041/1095; 95% CI, 95%-98%) (I
= 44%) and 88.3% (1097/1256; 95% CI, 85%-91%) (I
= 72%), respectively. Overall, treatment-related complications were 7.4% (107/1317; 95% CI, 5%-9%) (I
= 44%). Ischemic/thromboembolic events (48/1324 = 2.4%; 95% CI, 1.5%-3.4%) (I
= 27%) and in-stent thrombosis (35/1324 = 1.5%; 95% CI, 0.6%-1.7%) (I
= 0%) were the most common complications. Treatment-related morbidity was 1.5% (30/1324; 95% CI, 0.9%-2%) and was comparable between the LEO and LVIS groups. Complication rates between the anterior (29/322 = 8.8%; 95% CI, 3.4%-12%) (I
= 41%) versus posterior circulation (10/84 = 10.5%; 95% CI, 4%-16%) (I
= 0%) and distal (30/303 = 8%; 95% CI, 4.5%-12%) (I
= 48%) versus proximal aneurysms (14/153 = 9%; 95% CI, 3%-13%) (I
= 46%) were comparable (
> .05).
Limitations were selection and publication biases.
In this analysis, treatment with the LEO and LVIS stents was relatively safe and effective. The most common complications were periprocedural thromboembolisms and in-stent thrombosis. The rate of complications was comparable among anterior and posterior circulation aneurysms, as well as for proximal and distally located lesions.
ALMA observations of AGN fuelling Maccagni, F. M.; Morganti, R.; Oosterloo, T. A. ...
Astronomy and astrophysics (Berlin),
06/2018, Letnik:
614
Journal Article
Recenzirano
Odprti dostop
We present ALMA observations of the 12CO (2–1) line of the newly born (tradio ~ 102 years) active galactic nucleus (AGN), PKS B1718–649. These observations reveal that the carbon monoxide in the ...innermost 15 kpc of the galaxy is distributed in a complex warped disk. In the outer parts of this disk, the CO gas follows the rotation of the dust lane and of the stellar body of the galaxy hosting the radio source. In the innermost kiloparsec, the gas abruptly changes orientation and forms a circumnuclear disk (r ≲ 700 pc) with its major axis perpendicular to that of the outer disk. Against the compact radio emission of PKS B1718–649 (r ~ 2 pc), we detect an absorption line at red-shifted velocities with respect to the systemic velocity (Δv = +365 ± 22 km s−1). This absorbing CO gas could trace molecular clouds falling onto the central super-massive black hole. A comparison with the near-infrared H2 1-0 S(1) observations shows that the clouds must be close to the black hole (r ≲ 75 pc). The physical conditions of these clouds are different from the gas at larger radii, and are in good agreement with the predictions for the conditions of the gas when cold chaotic accretion triggers an active galactic nucleus. These observations on the centre of PKS B1718–649 provide one of the best indications that a population of cold clouds is falling towards a radio AGN, likely fuelling its activity.
•Salvage radiotherapy effectively treats biochemical recurrence of prostate cancer regardless of PET imaging result.•Salvage radiotherapy should be initiated in a timely manner in patients without ...PET correlate.•Biochemical progression-free survival significantly depended on age and prostate-specific antigen-doubling time.•In patients with locally positive lesions, pathology and dose to the fossa influenced biochemical progression-free survival.
The present study aimed to assess whether SRT to the prostatic fossa should be initiated in a timely manner after detecting biochemical recurrence (BR) in patients with prostate cancer, when no correlate was identified with prostate-specific membrane antigen positron emission tomography (PSMA-PET).
This retrospective, multicenter analysis included 1222 patients referred for PSMA-PET after a radical prostatectomy due to BR. Exclusion criteria were: pathological lymph node metastases, prostate-specific antigen (PSA) persistence, distant or lymph node metastases, nodal irradiation, and androgen deprivation therapy (ADT). This led to a cohort of 341 patients. Biochemical progression-free survival (BPFS) was the primary study endpoint.
The median follow-up was 28.0 months. The 3-year BPFS was 71.6% in PET-negative cases and 80.8% in locally PET-positive cases. This difference was significant in univariate (p = 0.019), but not multivariate analyses (p = 0.366, HR: 1.46, 95%CI: 0.64–3.32). The 3-year BPFS in PET-negative cases was significantly influenced by age (p = 0.005), initial pT3/4 (p < 0.001), pathology scores (ISUP) ≥ 3 (p = 0.026), and doses to fossa > 70 Gy (p = 0.027) in univariate analyses. In multivariate analyses, only age (HR: 1.096, 95%CI: 1.023–1.175, p = 0.009) and PSA-doubling time (HR: 0.339, 95%CI: 0.139–0.826, p = 0.017) remained significant.
To our best knowledge, this study provided the largest SRT analysis in patients without ADT that were lymph node-negative on PSMA-PET. A multivariate analysis showed no significant difference in BPFS between locally PET-positive and PET-negative cases. These results supported the current EAU recommendation to initiate SRT in a timely manner after detecting BR in PET negative patients.
To evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC).
A multicenter retrospective ...analysis on 514 patients with PDAC (T1-4; N0-1; M0) treated with surgical resection with macroscopically negative margins (R0-1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1: < 45 Gy, group 2: ≥ 45 and < 50 Gy, group 3: ≥ 50 and < 55 Gy, group 4: ≥ 55 Gy). Adjuvant chemotherapy was prescribed to 141 patients. Survival functions were plotted using the Kaplan-Meier method and compared through the log-rank test.
Median follow-up was 35 months (range: 3-120 months). At univariate analysis, a worse OS was recorded in patients with higher preoperative Ca 19.9 levels (≥ 90 U/ml; p < 0.001), higher tumor grade (G3-4, p = 0.004), R1 resection (p = 0.004), higher pT stage (pT3-4, p = 0.002) and positive nodes (p < 0.001). Furthermore, patients receiving increasing doses of CRT showed a significantly improved OS. In groups 1, 2, 3, and 4, median OS was 13.0 months, 21.0 months, 22.0 months, and 28.0 months, respectively (p = 0.004). The significant impact of higher dose was confirmed by multivariate analysis.
Increasing doses of CRT seems to favorably impact on OS in adjuvant setting. The conflicting results of randomized trials on adjuvant CRT in PDAC could be due to < 45 Gy dose generally used.
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