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El artículo presenta una solución tecnológica para mejorar un proceso en la terminal marítima petrolera Pozos Colorados. El objetivo de la solución es automatizar el lavado de los filtros tipo canastilla y malla del sistema de filtrado Buquetanque empleado en el recibo de hidrocarburos. El propósito de la solución es mejorar las condiciones de seguridad industrial y salud ocupacional de los trabajadores que realizan esta función de forma manual, y optimizar el proceso de recepción de hidrocarburos al mejorar los tiempos de operación. Para la elaborar la propuesta se emplea la metodología fundamenta en la ingeniería básica y de detalle, aplicada a la ingeniería de automatización, contemplando la narrativa: de proceso, de diseño y de evaluación. La propuesta entrega el diseño de: el sistema hidráulico, el sistema eléctrico y el sistema de control. La solución contempla: captar el agua de la piscina de almacenamiento, y por medio de una electrobomba de presión controlada transportar el fluido hasta la zona del filtrado; y posteriormente limpiar los filtros utilizando un ramal de aspersores ubicados dentro la canasta. El proceso de lavado es manipulado por medio de electroválvulas y un variador de velocidad, estos están gobernadas por un controlador lógico programable, este recibe información de las variables involucradas por medio de sensores. El modelado, simulación y evaluaciones de la propuesta sustentan la posibilidad de implementar la automatización realizando algunas adecuaciones a la infraestructura existente y adicionando unos elementos eléctricos, mecánicos y electrónicos

Spread of nonindigenous organisms by shipping is one of the largest threats to coastal ecosystems. Limited monitoring and understanding of this phenomenon currently hinder development of effective prevention policies. Surveying ports in North America, South America, Europe, Southeast Asia, and Australia we explored environmental DNA community profiles evident of ship-born species spread. We found that community similarities between ports increased with the number of ship voyages, particularly if the ports had similar environments, and when indirect stepping-stone connections were considered. We also found 57 known non-indigenous taxa, some in hitherto unreported locations. We demonstrate the usefulness of eDNA-based tools for global biodiversity surveys, and highlight that shipping homogenizes biodiversity in predictable that could inform policy and management.

The study considers the most important livestock regions of Argentina and the correlation between livestock and climate units. The conceptual scheme designed to understand these effects of climate elements on cattle describes a basic direct action by the air temperature in the environment in which they develop, considering temperature as the limit for the distribution of breeds and other action through its effects on vegetation and forage resources that will be available. The work done here shows a shift of the livestock regions southward and eastward simultaneously in the region under consideration. This is a consequence of the displacement towards the south of the isotherm of 26 °C and towards the east of the humidity indices, co-incidentally with the displacement of the isohyets of 600 and 1200 mm. As a consequence of the climate change, according to the CCSM4 climate model, in the near and far future under two emission scenarios, the regions suitable for tropical livestock (breeds with high heat tolerance as the Bos indicus) will extend to the southeast, displacing and reducing the regions suitable for European breed cattle. The displacement of the higher rainfall area mainly to the east could benefit livestock production by increasing forage and reducing livestock feed requirements. Fil: Rolla, Alfredo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Centro de Investigaciones del Mar y la Atmósfera. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones del Mar y la Atmósfera; Argentina Fil: Nuñez, Mario Nestor. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Centro de Investigaciones del Mar y la Atmósfera. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones del Mar y la Atmósfera; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Centro de Investigaciones del Mar y la Atmósfera; Argentina Fil: Ramayón, Jorge J.. No especifíca; Fil: Ramayón, Martín E.. No especifíca

Objectives Obesity in Europe, and worldwide, has been an increasing epidemic during the past decades. Moreover, obesity has important implications regarding technical issues and the risks associated with surgical interventions. Nevertheless, there is a lack of evidence assessing the influence of obesity on video-assisted thoracic surgery (VATS) lobectomy results. Our study aimed to assess the impact of morbid obesity on perioperative clinical and oncological outcomes after VATS lobectomy using a prospectively maintained nationwide registry. Methods The Italian VATS lobectomy Registry was used to collect all consecutive cases from 55 Institutions. Explored outcome parameters were conversion to thoracotomy rates, complication rates, intra-operative blood loss, surgical time, hospital postoperative length of stay, chest tube duration, number of harvested lymph-node, and surgical margin positivity. Results From 2016 to 2019, a total of 4412 patients were collected. 74 patients present morbid obesity (1.7%). Multivariable-adjusted analysis showed that morbid obesity was associated with a higher rate of complications (32.8% vs 20.3%), but it was not associated with a higher rate of conversion, and surgical margin positivity rates. Moreover, morbid obesity patients benefit from an equivalent surgical time, lymph-node retrieval, intraoperative blood loss, hospital postoperative length of stay, and chest tube duration than non-morbid obese patients. The most frequent postoperative complications in morbidly obese patients were pulmonary-related (35%). Conclusion Our results showed that VATS lobectomy could be safely and satisfactorily conducted even in morbidly obese patients, without an increase in conversion rate, blood loss, surgical time, hospital postoperative length of stay, and chest tube duration. Moreover, short-term oncological outcomes were preserved.

Climate change is expected to impact considerably on viticultural zoning. In this work, impacts of future climate on Argentinean winegrowing regions are assessed using climatic projections from the IPSL-CM5A-MR model for the near (2015–2039) and the far (2075–2099) future under two emission scenarios (RCP4.5, RCP8.5). Four bioclimatic indices were assessed for exploring possible geographical shifts and suitability changes of Argentinean winegrowing regions. These geographical and suitability changes, assessed in terms of changes in vineyards location, varieties selection, and quality and quantity of grapevines, were considered as challenges and/or opportunities depending on the winegrowing region, the temporal horizon and the emission scenario. Results show a significant southwestward and higher altitude displacement of winegrowing regions, mainly for 2075–2099 under RCP8.5 scenario. Accordingly, the Argentinean viticulture may face both opportunities and/or challenges due to projected warmer climate conditions. Winegrowing regions of cold climates could be favoured, while winegrowing regions of warm climates could be disadvantaged, mainly for 2075–2099 under RCP8.5. Therefore, warmer climate conditions might be beneficial for maintaining the current grapevine varieties with their current grape quality or for cultivating new grapevine varieties in the new projected winegrowing areas; or they might be harmful for maintaining the current grapevine varieties with their yields and quality over most of current grapevine growing areas, but especially in the projected warmest ones. Summarizing, the results allow for understanding how temperature and precipitation changes could affect the future geographical distribution of Argentinean winegrowing areas and their suitability characteristics, useful information for planning adaptation in the coming decades.

Scientists who observe and distribute oceanographic data require a process to ensure high-quality data. This process includes quality assurance, quality control, quality assessment, standards, and best practices. In this paper, quality assurance is widely regarded as actions taken prior to instrument deployment to improve the probability of generating good data, while quality control is the effort made to examine the resultant data. Herein we focus on quality assurance and strive to guide the oceanographic community by identifying existing quality assurance best practices preferred by the five entities represented by the authors – specifically, the Alliance for Coastal Technology, the AtlantOS project, the Integrated Marine Observing System, the Joint Technical Commission for Oceanographic and Marine Meteorology, and the U.S. IOOS Quality Assurance/Quality Control of Real-Time Oceanographic Data project. The focus has been placed on QA in response to suggestions from the AtlantOS and QARTOD communities. We define the challenges associated with quality assurance, which include a clear understanding of various terms, the overlap in meaning of those terms, establishment of standards, and varying program requirements. Brief, “real-world” case-studies are presented to demonstrate the challenges. Following this is a description of best practices gathered by the authors from hundreds of scientists over the many years or decades the aforementioned entities have been in place. These practices address instrument selection, preparation, deployment, maintenance, and data acquisition. Varying resources and capabilities are considered, and corresponding levels of quality assurance efforts are discussed. We include a comprehensive description of measurement uncertainty with a detailed example of such a calculation. Rigorous estimates of measurement uncertainty are surprisingly complex, necessarily specific, and not provided as often as needed. But they are critical to data users who may have applications not envisioned by the data provider, to ensure appropriate use of the data. The guidance is necessarily generic because of the broad expanse of oceanographic observations. Further, it is platform-agnostic and applies to most deployment scenarios. We identify the recently created Ocean Best Practice System as one means of developing, sharing, documenting, and curating more specific QA processes. Ultimately, our goal here is to foster their development and harmonization.

Malignant pilomatrixoma or pilomatrix carcinoma is a rare, locally aggressive malignant neoplasm, derived from the hair follicle with a high propensity for local recurrence. Only a few cases of metastatic pilomatrixoma have been described in the literature. Till date, only 17 cases have been reported in the English-language medical literature, most commonly occurring associated with local recurrence in adults. We report the first case in children of a metastatic malignant pilomatrixoma in an 8-year-old girl presenting with a recurrent pilomatrix carcinoma of the forehead with metastases in cervical and parotid lymph nodes.

Beam steering in phased array antennas for some demanding terrestrial and space applications needs ultra-wide band true-time tunable delay lines preventing the beam squint phenomenon. Recent advances in the field of integrated microphotonics have allowed the demonstration of compact chip-scale delay lines with fast and low-power tuning mechanisms. For the tuning, several approaches have been theoretically and experimentally investigated and among them, very promising results have been obtained by using graphene in resonant delay lines based on the slow light effect. In this paper, after a brief review on resonant microphotonic tunable delay lines, some selected recent results on an ultra-compact graphene-based optical delay line including a silicon Bragg grating, are proposed.

Given the societal importance of reliable and accurate ocean observations, the wave monitoring community (including academic researchers, agency scientists, resource managers, and representatives from wave instrument manufacturers) came together to develop a set of protocols for the test and evaluation of wave measurement systems in support of the 2009 National Operational Wave Observation Plan. These protocols are focused on a wide range of wave measurement instruments and their respective performance in successfully recovering the “First-5” Fourier components of the incident wave field. Performance is determined by comparing each system’s output with a verifiable reference method over a predetermined range of wave frequencies. It is recommended that permanent wave test facilities are created on the West Coast (Monterey Bay, CA—deep water) and the East Coast (Duck, NC—shallow water) for continued evaluations of existing and new technologies. It was recognized that no absolute standard exists for the determination of the “First-5” across all spatial domains. Therefore, it was agreed that the Directional Waverider DWR-MkIII system was the best available reference/standard for the deep and intermediate water wave evaluations as verified by the laser array (LASAR) at the ConocoPhillips Ekofisk offshore platform complex in the North Sea. The long linear array at the U.S. Army Corps of Engineers’ Field Research Facility could be used as the standard for shallow water wave evaluations. Finally, given the significance of wave measurements, an appropriate level of quality assurance and quality control procedures must be included as part of any test and evaluation effort. The details of the proposed protocols for the verification of wave measurement systems are described.

OBJECTIVES: This study evaluated if triple oral therapy can be useful in improving glycemic control compared with metformin monotherapy and with a metformin and pioglitazone combination. Furthermore, we also compared a triple metformin+pioglitazone+glibenclamide combination with a metformin+pioglitazone+sitagliptin one. SUBJECTS AND METHODS: After a 2-year run-in therapy-augmenting phase with metformin and pioglitazone, 453 overweight, type 2 diabetes patients were randomized to 1 year of sitagliptin versus 1 year of glibenclamide to evaluate, as the primary outcome, the variation of β-cell function both in a fasting state and after an euglycemic hyperinsulinemic and hyperglycemic clamp. As secondary outcomes we evaluated glycemic control and insulin resistance. RESULTS: Both the triple therapy combinations were more effective in reducing glycated hemoglobin compared with metformin monotherapy and with dual therapy metformin+pioglitazone. Fasting plasma insulin level and the homeostasis model assessment insulin resistance index were significantly increased by triple therapy with glibenclamide and decreased by the one with sitagliptin. Although sitagliptin did not change the homeostasis model assessment β-function index, this value was significantly increased by glibenclamide. The fasting plasma proinsulin level was decreased by sitagliptin. Triple therapy with sitagliptin greatly improved β-cell function measures compared with the glibenclamide one and also compared with metformin monotherapy and with the metformin+pioglitazone combination. CONCLUSIONS: Dual combination therapy is more effective than monotherapy in improving glycemic control. When double therapy is not enough to reach an adequate glycemic control, sitagliptin should be preferred to glibenclamide as the third agent because of its positive effect on β-cells.

Este artigo apresenta o contexto científico nacional e internacional com foco na trajetória das atividades de ciência, tecnologia e inovação no Brasil ao longo dos últimos anos e na perspectiva que pode ser inferida a partir do histórico traçado. Demonstra-se que o País não pode mais depender apenas do sucesso alcançado no indicador de produção científica indexada. Precisa, urgentemente e de forma ágil, mudar de patamar no desenvolvimento tecnológico e na inovação. O artigo mostra que é possível melhorar a competitividade nacional com base numa política séria e consistente de valorização do trinômio ciência, tecnologia e inovação como pilares para garantir o desenvolvimento social e econômico sustentável do País. Essa política requer, entre outros elementos, um investimento perene e robusto e um arcabouço legal adequado que permita o avanço da pesquisa e da inovação. O artigo apresenta recomendações que poderão por um lado, indicar os gargalos a serem resolvidos e por outro, ajudar a elaboração de uma política consistente para o desenvolvimento nacional.

To determine the effect of surgical technique on outcomes from ruptured middle cerebral artery aneurysms (RMCAA).A retrospective review was performed of patients with RMCAA, who were treated at the authors' institutions. The study compares the clipping efficacy, the postoperative CT findings as well as the clinical outcome in 87 acute operated patients. Forty patients who underwent a surgical adapted technique to the preoperative radiological findings in the last 2 ½ years were included in Group 1, and 47 previously operated cases who underwent a standardized pterional approach with aneurysm preparation from proximal to distal were included in Group 2.Angiographically assessed clip efficacy confirmed aneurysm occlusion in 87.5% of the patients in Group 1 and in 70.2% for Group 2 (p 0.05). In 13 cases (32.2%) of Group 1 versus 27 cases (57.4%) of Group 2, postoperative CT scan showed hypodense brain areas (p 0.05). In 2 cases of Group 1 versus 8 cases of Group 2, a residual haematoma was found. Three months after bleeding, 25 cases in Group 1 showed a good recovery, 10 a moderate disability, and 5 severe disability or death. In Group 2, 26 patients showed a good recovery, 9 a moderate disability, and 12 severe disability or death. There was a difference for patients with severe disability/death between both groups (p 0.001).Individually adapted surgical technique in patients with RMCAA improves the efficacy of aneurysm clipping and clot removal, reduces postoperative hypodense brain areas and improves the patients' outcome.

BACKGROUND: While standards for the treatment of newly diagnosed glioblastomas exist, therapeutic regimens for tumor recurrence remain mostly individualized. The role of a surgical resection of recurrent glioblastomas remains largely unclear at present. This study aimed to assess the effect of repeated resection of recurrent glioblastomas on patient survival. METHODS: In a multicenter retrospective-design study, patients with primary glioblastomas undergoing repeat resections for recurrent tumors were evaluated for factors affecting survival. Age, Karnofsky performance status (KPS), extent of resection (EOR), tumor location, and complications were assessed. RESULTS: Five hundred and three patients (initially diagnosed between 2006 and 2010) undergoing resections for recurrent glioblastoma at 20 institutions were included in the study. The patients' median overall survival after initial diagnosis was 25.0 months and 11.9 months after first re-resection. The following parameters were found to influence survival significantly after first re-resection: preoperative and postoperative KPS, EOR of first re-resection, and chemotherapy after first re-resection. The rate of permanent new deficits after first re-resection was 8%. CONCLUSION: The present study supports the view that surgical resections of recurrent glioblastomas may help to prolong patient survival at an acceptable complication rate.

Introduction: Collagen VI expression was tested in peripheral blood macrophages from patients with collagen VI–related myopathies and compared with muscle biopsy. Methods: RNA and protein studies were performed in blood macrophages from 5 patients previously diagnosed with either Ullrich congenital muscular dystrophy (UCMD) or Bethlem myopathy (BM). The full spectrum of possible genotypes was considered, including both dominant and recessive UCMD and BM cases. Results: In the dominant BM patient, no collagen VI alterations were detectable in macrophages or muscle biopsy. In the remaining patients, the protein defect caused by the selected mutations, as well as the transcriptional abnormalities, were readily detectable in macrophages, at levels comparable to those observed in muscle biopsy samples and cultured skin fibroblasts. Conclusions: Our data support the suitability of peripheral blood macrophages as a reliable, minimally invasive tool for supplementing or replacing muscle/skin biopsies in the diagnosis and monitoring of collagen VI–related myopathies. Muscle Nerve 44: 80–84, 2011.

The Alliance for Coastal Technologies (ACT) has been established to support innovation and to provide the information required to select the most appropriate tools for studying and monitoring coastal and ocean environments. ACT is a consortium of nationally prominent ocean science and technology institutions and experts who provide credible performance data of these technologies through third-party, objective testing. ACT technology verifications include laboratory and field tests over short- and long-term deployments of commercial technologies in diverse environments to provide unequivocal, unbiased confirmation that technologies meet key performance requirements. ACT demonstrations of new technologies validate the technology concept and help eliminate performance problems before operational introduction. ACT’s most recent demonstration of pCO2 sensors is an example of how ACT advances the evolution of ocean observing technologies, in this case to address the critical issue of ocean acidification, and promotes more informed decision making on technology capabilities and choices.

To assess the influence of configuration and location of ruptured distal cerebral anterior artery aneurysms on their treatment modality and results.The influence of the aneurysm configuration (basic or complex configuration) and location (infracallosal or supracallosal) on the treatment-related radiological results (partial or complete aneurysm occlusion) and clinical outcome (favorable or unfavorable) was retrospectively analysed in all admitted patients with ruptured pericallosal aneurysms within the last 10 years. The expected benefit from each form of treatment was individually discussed.During this period, 21 patients with ruptured pericallosal aneurysms (three previously coiled in other departments) had been admitted to our department. Within the endovascular group (ten patients), five infracallosal basic aneurysms presented a complete occlusion and favorable patient outcome. Three patients with infracallosal complex aneurysms presented a favorable outcome (two aneurysms were partially occluded and a frustrated procedure was replaced by clipping). Two supracallosal basic aneurysms showed a complete occlusion with one unfavorable outcome and one frustrated procedure followed by clipping and favorable outcome. In the surgical group (11 patients), five infracallosal complex aneurysms presented a complete occlusion with four favorable and one unfavorable outcomes. One patient with a supracallosal basic aneurysm presented a complete occlusion with a favorable outcome, and five patients with supracallosal complex aneurysms presented a complete occlusion in four cases and favorable outcome in all of them.The results of this study suggest that patients with infracallosal basic configured aneurysms are expected to benefit from endovascular procedures, whereas better radiological and clinical results can be obtained in surgically treated patients harboring supra- or infracallosal aneurysms of complex configuration.

To review the angiographic and clinical outcomes from acute (first 6 hours after bleeding) interdisciplinary treated patients with ruptured intracranial aneurysm.An interventional neuroradiologist and a neurosurgeon set the emergent treatment of 100 consecutive patients with subarachnoid hemorrhage (SAH) harboring 111 cerebral aneurysms. Decisions were based on the patient's clinical condition, aneurysm's morphology and location, presence of intracranial mass-occupying process (IMOP), angiographic flow distribution patterns and treatment-related risk profit. The benefits of a joined case assessment were retrospectively analyzed, comparing our clinical and radiological results with those of the averaged literature series.Initially, 39 aneurysms in 34 patients were endovascularly (EV) treated and 68 aneurysms in 66 patients were surgically (S) treated. Four nonruptured aneurysms remain under control. Complete radiological aneurysm occlusion was initially achieved in 35 (89.7%) EV and 62 (95.4%) S treated aneurysms. Twenty-six patients in poor clinical condition with IMOP as well as ten patients with distally located, 18 with EV unfavorable and 12 with highly expected recanalization rate aneurysms required S treatment. Four aneurysm remnants (two EV and two S) remain unchanged. Two EV treated aneurysms grew and were surgically occluded, and another three patients required an additional coiling procedure after recanalization. Favorable evolution was observed in 27 (79.4%) EV and 55 (83.3%) S treated patients. Computed tomography-documented rebleedings (7:1), angiographic vasospasm (3:5) and occlusion of main vessels (2:2) were the method-related complications in the EV and S groups, respectively.After comparing the literature data, acute interdisciplinary treatment of patients with SAH increases the rate of aneurysm occlusion, improves patient's evolution and reduces the number of complications.

The Continuous Glucose Monitoring System (CGMS) (Medtronic Minimed, Northridge, CA) provides an opportunity to better understand abnormalities in glucose metabolism in both healthy subjects and those with diabetes. The aims of our study were to assess the reliability of CGMS compared to self-monitoring of blood glucose (BG) and to analyze the graphs obtained in a sample of healthy free-living subjects in order to establish the suitability of CGMS in physiological studies.Eighteen healthy adults, 12 women and six men, were enrolled in this study. Each subject performed 24-h CGMS and inserted 24 glycemic values, measured through a glucose meter, during their common daily activities. Three subjects were excluded from the analysis since they did not meet accuracy criteria. None of the participants received any advice as regard diet and physical activity. Means and standard deviations were used to summarize quantitative data. Normal distribution of data was tested with the Shapiro-Wilk W test. Differences over time and association between glucose levels with other variables were evaluated with linear regression models for repeated measures.We did not find statistically significant differences between CGMS measures and meter readings. In the subjects studied the mean glucose levels increase according to age, and we found a mean increase in glucose concentration of 0.50 mg/dL for every year of age. As regards gender, men presented a 4.63% higher mean glucose concentration than women. A 1.16% higher glucose concentration for every unit (kg/m(2)) of body mass index (BMI) was observed in both groups. All subjects presented glucose concentrations within the established range of normal glucose levels for 91% of the total duration of CGMS.Our results suggest that long-term studies on larger groups of healthy subjects performing CGMS would be useful in order to better understand if BMI, daily stressors due to work or psychological stress, or other factors can influence daily BG variability and if these nonpathological alterations are related to development of glucose metabolism disorders.

Objective: Metformin is the drug of choice to treat obese type 2 diabetes patients because it reduces either insulin-resistance and body weight. We aimed to comparatively test the efficacy and tolerability of pioglitazone and sibutramine in metformin-intolerant obese type 2 diabetic patients treated with sibutramine. Materials and Methods: Five hundred and seventy-six consecutive Caucasian obese type 2 diabetic patients were evaluated during a 12-months period and fifty-two patients were resulted intolerant to metformin at maximum dosage (3,000 mg/day). All intolerant patients to metformin received a treatment with pioglitazone (45 mg/day) and sibutramine (10 mg/day) and they were compared with fifty-three patients treated with metformin (3,000 mg/day) and sibutramine (10 mg/day) for 6 months in a single-blind controlled trial. We assessed body mass index, waist circumference, glycated hemoglobin, Fasting Plasma glucose, postprandial plasma glucose, fasting plasma insulin, postprandial plasma insulin, lipid profile, systolic blood pressure, diastolic blood pressure and heart rate at baseline and after 3, and 6 months. Results: No body mass index change was observed at 3, and 6 months in pioglitazone + sibutramine group, while a significant reduction of body mass index and waist circumference was observed after 6 months in metformin + sibutramine group (p

To assess the volume of large intracranial meningiomas and analyse their different microsurgical and clinical managements.The volume of 45 large meningiomas treated in our department during the last 9.5 years was retrospectively assessed using recorded neuronavigation data. The seven most employed microsurgical strategies and five important factors influencing the patient's outcome (tumor location, grade of peritumoral brain swelling, grade of brain atrophy, entrapment of neurovascular structures and the management of the vascular infused fluid volume) were individually analysed. The follow-up ranged from 14 to 84 months.The assessed volumes exceed 100 cm(3) in 38 supratentorial and 45 cm(3) in seven infratentorial tumors. The highest averaged volume in this series was assessed by tuberculum sellae and olfactory meningiomas (174 cc). A complete resection was achieved in 39 patients and was not influenced by the tumor volume. However, an averaged volume difference of 60 cc was observed between anterior skull base tumors in which their averaged greatest diameter variation was only 1.5 cm. Twelve of 24 patients with deep located tumors and entrapped neurovascular structures presented accentuated brain swelling. A new permanent post-operative neurological deficit was observed only in two patients. In the other patients, cranial nerve deficits, pre-operative hemiparesis and superior cerebral functions improved to varying degrees. Four cases with subtotal resection showed stable residual volumes after 4.5 year follow-up. Three cases underwent additional radiosurgery.Tumor volume assessment allows an improved meningioma size differentiation. Despite the large volume of the tumors in this series, satisfactory resection was still possible using single-stage procedures. Individual microsurgical strategies and fluids management contributed to reducing patient's morbi-mortality.

To assess intracranial aneurysms clipping efficacy (CE) employing different angiographic techniques in relation to the case difficulty.In the past 6 years, 152 patients harboring 179 aneurysms who underwent surgical clipping in our department were angiographically examined to confirm aneurysm occlusion. Intraoperative angiography (IA), post-operative conventional (PCA) and three-dimensional angiography were single or sequentially performed based on the surgeon's concern about case difficulty. The percentage of visualized angiographic abnormalities (PVAA) assessing CE and their impact on corrective treatment were retrospectively analysed.The PVAA of IA was 67.8% (19 of 28 aneurysms). Eighteen of them (eight aneurysm remnants, four parent vessel stenosis, two distal branch occlusions and five clip slippage phenomena) underwent immediate corrective treatment (clip reposition in 11 cases, complementary clipping in three cases and combined treatment in four cases). The impact on corrective treatment was 94.7%. The PVAA of PCA was 18.4% (33 of 179 aneurysms). Fifteen patients presented aneurysm remnants, six presented parent vessel stenosis, five presented distal branch occlusions and seven presented clip slippage phenomena. The impact of this technique on corrective treatment was 15.1% (five of 33 angiographic abnormalities). In only one case, PCA demonstrated an aneurysm remnant which was missed on IA. Twenty patients were additionally examined with three-dimensional angiography. The impact on corrective treatment of three-dimensional angiography was 25% (five of 20 examined patients with angiographic abnormalities).In pre-selected difficult cases, IA provides high PVAA and increased impact on corrective treatment. In non-selected patients, PCA shows low PVAA and reduced impact on corrective treatment. The complementary assessment with multiplanar three-dimensional angiography increases the impact on corrective treatment and facilitates decisions about the final case management.

The authors hypothesized that matrix metalloproteinase (MMP)-2, -9, and tissue inhibitor metalloproteinase (TIMP)-1, -2 would be abnormal in acute coronary syndromes (ACSs). MMP-2, -9, and TIMP-1, -2 plasma levels were measured in diabetic patients with ACSs compared to nondiabetic patients with ACSs. A total of 46 diabetic and 78 nondiabetic patients with ACSs were enrolled. The following parameters were measured: body mass index (BMI), glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), fasting plasma insulin (FPI), homeostasis model assessment index (HOMA index), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (Tg), lipoprotein(a) [Lp(a)], plasminogen activator inhibitor-1 (PAI-1), homocysteine (Hct), fibrinogen (Fg), high-sensitivity C-reactive protein (hs-CRP), and plasma levels of MMP-2, MMP-9, TIMP-1, and TIMP-2. Significant HbA1c, FPG, FPI, HOMA index, DBP, Tg, Hct, and Fg increases were present in the diabetic group with ACSs, whereas hs-CRP was lower in these patients compared to nondiabetic patients with ACSs. MMP-9, TIMP-1, and TIMP-2 plasma levels were higher in diabetic patients with ACSs compared to nondiabetic patients with ACSs. MMP-9, TIMP-1, and TIMP-2 plasma levels were increased in diabetic patients with ACSs, which may reflect abnormal extracellular matrix metabolism in diabetes during acute event.

Background: There are conflicting data in the literature regarding both the expression pattern of the vascular metalloproteinase (MMP) system and its tissue inhibitors (TIMPs) in human hypertension and the effect of antihypertensive drugs in modifying the MMP/TIMP system. This study was designed to test the hypothesis that MMP-2, MMP-9 and TIMP-1 are altered in hypertension reflecting alterations in extracellular matrix turnover. Moreover, the aim of the study was to assess whether chronic antihypertensive treatment with doxazosin would normalise these alterations. Materials and results: We measured plasma levels and activities of MMP-2, MMP-9 and TIMP-1 in 44 hypertensive patients before and after 4 months of doxazosin treatment. MMP-2 levels and activity were significantly lower in the hypertensive group after treatment (p < 0.0001) compared with respective values before treatment. Significant decrease was also observed for MMP-9 level and activity (p < 0.0001) and for TIMP-1 (p < 0.0001) in hypertensive patients after antihypertensive treatment. Conclusions: Plasma levels and activities of MMP-2, MMP-9 and TIMP-1 are decreased in hypertensive patients after treatment compared with respective values before treatment. This may demonstrate that antihypertensive drugs modify the MMP/TIMP system, contributing to the mechanisms of vascular remodelling.

There are conflicting data in the literature regarding the expression pattern of the vascular matrix metalloproteinase (MMP) system and their inhibitors (TIMPs) in human hypertension. The authors hypothesized that MMP-2, MMP-9, and TIMP-1 would be abnormal in hypertension, reflecting alterations in extracellular matrix (ECM) turnover. The authors measured plasma levels and activities of MMP-2, MMP-9, and TIMP-1 in 44 hypertensive patients and 44 controls. MMP-2 levels and activity were significantly higher in hypertensive group (p < .0001). Significant increase was also observed for MMP-9 level and activity (p < .0001) and for TIMP-1 (p < .0001) in hypertensive patients. Plasma levels and activities of MMP-2, MMP-9, and TIMP-1 are increased in hypertensive patients, which may reflect abnormal ECM metabolism.

Objective: The aim of this paper is to analyse and summarize the main advances in experimental research on cerebral arteriovenous fistulas. Methods: A detailed analysis of the literature and my own research experience were employed to outline the methodology whereby experimental cerebral arteriovenous fistulas are created and further studied. Results: The analysis and quantification of the anatomical and functional variables in different experimental cerebral arteriovenous fistula models make it possible to develop more appropriate and individual ways of treatment in affected patients. Conclusion: Experimental research on cerebral arteriovenous fistulas helps physicians to understand and predict more accurately the future evolution of arteriovenous malformations in humans.

The aim of this study was to evaluate the invasiveness and efficacy of 2 different keyhole approaches to large basal ganglia hematomas (LBGHs).The invasiveness and efficacy of the temporal (15 cases) and the frontal (15 cases) microsurgical keyhole approach were retrospectively evaluated in 30 early-operated patients with LBGH, using recorded neuronavigation data. Invasiveness was assessed calculating the angles of brain retraction and the volume of brain exposed to surgery. Reduced invasiveness was related to a fall of these values. Efficacy was evaluated by comparing the volume of microscopically visualized clot and the largest hemorrhage diameter exposed with the 2 different keyhole approaches. Increased efficacy was related to a rise in these parameters. All estimations were correlated to the volume of residual clot detected on postoperative computed tomography scan.The comparison between both approaches revealed a significant reduction of invasiveness (smaller angles of brain retraction [P.001] and reduced brain exposition [P.001]), as well as a raised efficacy (increased volume of visualized clot [P.001] and largest hemorrhage diameter exposed to surgery [P.001]) for frontally approached LBGH. These patients showed less postoperative residual hematomas (P.05). Residual clots were correlated to the evaluated brain retraction (P.001) and volume of brain (P.001), as well as volume of clot surgically exposed (P.05).We conclude that the frontal approach to LBGH leads to less invasiveness and higher efficacy as evaluated by using neuronavigation data. This approach shows a reduced number of patients with residual postoperative clots.

Study Objective. To evaluate the differential effect on coagulation and fibrinolysis parameters of combination therapy with glimepiride-metformin and with rosiglitazone-metformin beyond their effect on glucose metabolism in patients with type 2 diabetes and metabolic syndrome. Design. Multicenter, double-blind, randomized, controlled trial. Setting. Two university-affiliated medical centers in Italy. Patients. Ninety-five patients with type 2 diabetes for at least 6 months without glycemic control by diet and oral hypoglycemic agents to their maximum tolerated dosage and who also had metabolic syndrome. Intervention. All 95 patients received metformin 1500 mg/day In a randomized manner, 47 patients received glimepiride 2 mg/day and 48 patients received rosiglitazone 4 mg/day. Measurements and Main Results. Body mass index (BMI), glycemic control, and coagulation and fibrinolysis parameters were evaluated at 3, 6, 9, and 12 months of treatment. Compared with baseline values, significant decreases in BMI, fasting plasma glucose, postprandial plasma glucose, and hemoglobin A1c were observed at 12 months in both the glimepiride and rosiglitazone groups (p

Objective: Low-molecular weight (MW) apolipoprotein(a) [apo(a)] isoforms are closely associated with an increased incidence of atherothrombotic disease, prevalence of which is higher in obese individuals, particularly in women. The hypothesis of this study was to assess whether there are differences in the distribution of apo(a) phenotypes between obese patients and healthy controls. Research Methods and Procedures: One hundred three obese Italian women (BMI ≥ 30.0 kg/m2) were enrolled in the study, and apo(a) phenotyping was performed in all subjects. The prevalence of low-MW apo(a) isoforms, detected in plasma samples of our obese women, was compared with that found in a control group of 84 normal-weight, never-obese (BMI < 25.0 kg/m2), age-matched women. Results: The distribution of apo(a) isoforms in the population of obese women was significantly different from that found in normal-weight female subjects. In particular, the percentage of subjects in the obese group with at least one apo(a) isoform of low MW was significantly higher than that in the control group (51.4% vs. 32.1%, p = 0.0079). Discussion: Our results seem to suggest the possibility that small-sized apo(a) isoforms may be used together with other traditional risk factors to better assess the overall predisposition to atherothrombotic disease in obese women.

Glimepiride is approved as monotherapy and in combination with metformin or with insulin, whereas the combination of glimepiride with other antihyperglycemic drugs is under investigation.The aim of this study was to assess the differential effect on glucose and lipid variables and tolerability of the combination of glimepiride plus pioglitazone or rosiglitazone in patients with type 2 diabetes mellitus (DM) and metabolic syndrome.This 12-month, multicenter, double-blind, randomized, controlled, parallel-group trial was conducted at 3 study sites in Italy. We assessed patients with type 2 DM (duration,or =6 months) and with metabolic syndrome. All patients were required to have poor glycemic control with, or to have experiencedor =1 adverse effect (AE) with, diet and oral hypoglycemic agents such as sulfonylureas or metformin, both given up to the maximum tolerated dose. All patients received a fixed oral dose of glimepiride, 4 mg/d divided into 2 doses, self-administered for 12 months. Patients also were randomized to receive oral pioglitazone (15 mg once daily) (G + P group) or oral rosiglitazone (4 mg once daily) (G + R group), self-administered for 12 months. We assessed body mass index (BMI), glycemic control (glycosylated hemoglobin [HbA(1c)], fasting and postprandial plasma glucose and insulin levels [FPG, PPG, FPI, and PPI, respectively], and homeostasis model assessment index), lipid profile (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides [TG]), and lipoprotein variables (apolipoprotein [apo] A-I and apo B) at baseline and at 3, 6, 9, and 12 months of treatment. Treatment tolerability was assessed at each study visit using a thorough interview of patients, and comparisons of clinical and laboratory values to baseline levels.A total of 91 patients were enrolled in the study; 87 patients completed it (G + P group: 24 women, 21 men; mean [SD] age, 53 [6] years; G + R group: 20 women, 22 men; mean [SD] age, 54 [5] years). Patients in the G + P and G + R groups experienced significant increases in mean BMI at 12 months compared with baseline (4.92% and 6.17%, respectively; both, P0.05). The combination of glimepiride with pioglitazone or rosiglitazone significantly improved glycemic control in the study patients. At 12 months, we observed a 1.3% improvement in mean values for plasma HbA(1c) concentration (P0.01) 19.3% in FPG (P0.01), 16.3% in PPG (P0.01), 42.4% in FPI ), and 23.3% in PPI (P0.05); no significant differences were found between treatment groups. Although the G + P group experienced a significant improvement at 12 months in almost all variables of lipid metabolism from baseline (TC, - 11%; LDL-C, -12%; HDL-C, 15%; and apo B, - 10.6% [all, P , 0.05]), the G + R group experienced a significant increase in mostly the lipid risk factors for cardiovascular disease (TC, 14.9%; LDL-C, 16.5%; TG, 17.9%; and apo B, 10.3% [all, P , 0.05]). Overall, no statistically significant changes in plasma aminotransferase activities were observed. Of the 87 patients who completed the study, 6.7% (3/45) of patients in the G + P group and 11.9% (5/42) of patients in the G + R group had transient, mild to moderate AEs that did not cause withdrawal from the trial.In this study of patients with type 2 DM and metabolic syndrome who did not respond adequately to, or experienced AEs with, diet and either a sulfonylurea or metformin previously, the combination of glimepiride plus pioglitazone was associated with a significant improvement in lipid and lipoprotein variables, whereas the combination of glimepiride plus rosiglitazone appears to not have had any clinically significant effect on lipid metabolism.

Carvi y Nievas M, Haas E, Hollerhage H-G, Lorey T, Klein P-J. Cerebral vein thrombosis associated with aneurysmal subarachnoid bleeding: implications for treatment. Surg Neurol 2004;61:95–8 Background Cerebral vein thrombosis associated with aneurysmal subarachnoid bleeding is an uncommon event rarely described in the literature. We report here a case and summarize the problems in the management of this patient. Case description A 48-year-old female suffered from two episodes of severe headache and vomiting 7 days before and on the day of admission. She was deeply somnolent with mild paresis of her right leg. Computed tomography (CT) scans revealed diffuse basal subarachnoid bleeding and a left parietal subcortical hemorrhagic area. A cerebral angiogram demonstrated an anterior communicating artery aneurysm. The angiographic late venous phase showed nonopacification of the cortical veins on the hemorrhagic area compatible with cerebral vein thrombosis. She underwent successful aneurysm clipping combined with moderate systemic anticoagulation. After 7 days of gradual clinical improvement she presented acute bilateral cerebral herniation signs and died 48 hours later. CT scan showed a generalized brain swelling. Postmortem examination confirmed the correct occlusion of the ruptured aneurysm sac and the presence of a postthrombotic subcortical left parietal hemorrhage as well as a complete obstruction of the superior sagittal sinus extended into both transverse sinus. Conclusion The fatal outcome with the documented extended thrombosis, despite careful anticoagulation therapy, indicates the necessity of closely meshed follow-up studies examining the sinus patency in such complicated cases with associated pathology.

Clinical experience about the management of patients with an unruptured intracranial aneurysm (UIA) presenting transient cerebral ischemic attacks (TIAs) is usually restricted to a few case reports. Some authors assume that it is safe to perform an endarterectomy without acutely increasing the risk of aneurysm rupture while others reported a post-operative aneurysmal bleeding even for aneurysms smaller than 10 mm between some days and several months after endarterectomy. The aim of this paper is to analyse the factors involved in the particular ischemic episodes, the examination methods to be employed, and the optional management for each individual case on a literature review and own experience-based data.

This report describes a patient with abdominal pain at presentation, which on angiography was found to be caused by vasculitis limited to the superior mesenteric artery. He was treated with oral glucocorticoids after an initial 5-day course of pulse therapy and obtained excellent relief of symptoms. Steroids were tapered over 8 months. Repeat angiography revealed complete resolution of the vasculitis with a residual aneurysm of a branch of the left gastric artery, which was resected to avoid the risk of rupture. Histologic analysis revealed thickened intima with myxoid degeneration and no evidence of active vasculitis. Extensive laboratory and clinical investigations did not reveal an underlying connective tissue disorder to account for the gastrointestinal vasculitis. This report of an angiographically defined regional vasculitis involving the superior mesenteric artery with complete clinical as well as radiologic resolution on treatment with glucocorticoids alone emphasizes the need to differentiate between an isolated or regional vasculitis, which has an excellent prognosis, to avoid subjecting the patient to cytotoxic therapy with significant toxicities.

Current literature indicates poor survival and limb salvage rates in renal failure diabetic patients who present with ulcerated or gangrenous lower extremities. Even in those limbs that were successfully revascularized, the amputation rate was as high as 37 percent. This has led some to advocate immediate amputation when treating the threatened limb of a renal failure diabetic patient. The authors reviewed all renal failure diabetic patients in their wound registry to determine whether such pessimism was warranted. The authors then analyzed the relative roles of revascularization and aggressive wound care on long-term limb salvage. Forty-five consecutive renal failure diabetic patients with 71 wounds in 54 limbs were identified. Twenty-seven patients had chronic renal insufficiency, 15 patients had end-stage renal disease, and three patients received kidney transplants. The revascularization procedures (46 percent of all limbs) included angioplasty, femoral-popliteal, femoral-distal, and popliteal-distal bypasses. Forty-three amputations in combination with 67 soft-tissue repairs (delayed primary wound closure, skin grafts, local flaps, pedicled flaps, and free flaps) were necessary to close the defects. After a mean follow-up of over 3 years, the data indicate that 79 percent of wounds healed, 89 percent of all limbs were salvaged, and 49 percent of patients survived. Revascularization improved the threatened limb's salvage rate from negligible to a level similar to that of the adequately vascularized limb. Fifteen out of 71 wounds did not heal because of the patient's early postoperative death, ischemia not amenable to revascularization, or noncompliance. Six below-knee amputations were performed (one despite a patent bypass and five in adequately vascularized patients). The average time for wounds to heal in the revascularized patients was 79 days versus 71 days in adequately vascularized patients. There was an overall 43 percent complication rate. Of the patients who were alive after the 3-year follow-up, 73 percent were independently ambulating, whereas 27 percent were bound to wheelchair or bed. Eighty-two percent of patients were very satisfied with the salvage attempt, 18 percent were moderately satisfied, and all patients said they would go through the process again. The authors believe that salvaging the threatened extremity in the renal failure diabetic patient is justified whether or not the limb requires revascularization. Revascularization improved the limb salvage rate, patient survival, and days for wounds to heal to a level comparable to that of the adequately vascularized limb. The key to subsequently achieving high salvage rates is the quality of perioperative wound care (e.g., serial debridements, antibiotics, dressings) and the timing and selection of appropriate soft-tissue coverage.

Intravascular fasciitis is one of the benign myofibroblastic pseudosarcomatous proliferations, among which nodular fasciitis is the prototype. These lesions are important as they may mimic a variety of sarcomas and other lesions on both clinical and pathologic grounds. This report describes the features of one such lesion that arose within the brachial artery and invested nerve trunks of the brachial plexus. The patient presented with symptoms of arm fatigue and hand numbness. There were no neurological or vascular findings on physical examination. The clinicopathologic differential diagnosis is discussed. Also, surgeons are cautioned to involve a vascular etiology in their differential diagnosis and seek the help of a vascular surgeon when the lesion juxtaposes the axillary artery or vein.

UNLABELLED A double-lumen endobronchial tube (DLT) bronchial cuff inflation technique that reliably ensures effective water-tight isolation of the two lungs has not been determined. In this study, 20 patients undergoing thoracic surgery requiring a left DLT had the bronchial cuff of the DLT inflated by one of two techniques. In Group 1, the cuff was inflated to produce an air-tight seal of the left bronchus using the underwater seal technique. In Group 2, the cuff was inflated to a pressure of 25 cm H2O. After bronchial cuff inflation in both groups, water-tight bronchial seal was tested by instilling 2 mL of 0.01% methylene blue (MB) above the bronchial cuff of the DLT. Fifteen minutes later, fiberoptic bronchoscopy was performed via the bronchial lumen of the DLT to determine whether MB had seeped past the bronchial cuff. Cuff volume was 0.75+/-0.64 and 0.76+/-0.46 mL, cuff pressure was 30.1+/-27.0 and 25.0+/-0.0 cm H2O (mean+/-SD), and MB was positively identified in two and five patients in Groups 1 and 2, respectively. The difference in cuff volume and pressure and the higher MB seepage in Group 2 compared with Group 1 was not statistically significant. In both groups, MB seepage occurred only when the bronchial cuff volume was

The term “pulmonary tumorlets” describes multiple microscopic nests of neuroendocrine cells in the lungs.1 Like bronchial carcinoid tumors and small-cell carcinomas, pulmonary tumorlets arise from Kulchitsky's cells. In the lung the abnormalities in these cells range from hyperplasia to malignant transformation, since control over cellular growth is lost.2 Both bronchial carcinoid tumors and small-cell lung carcinomas may secrete corticotropin in sufficient quantities to cause Cushing's syndrome. We describe a patient with Cushing's syndrome due to ectopic secretion of corticotropin in whom the source of the excess corticotropin was ultimately found to be hundreds of tumorlets in one lobe of the . . .

Solitary fibrous tumor (SFT) is a rare neoplasm that, in addition to its classic presentation as a pleural-based mass, can also be encountered in unusual sites. The main difficulty in making the diagnosis of SFTs results from the unfamiliarity with its diverse clinical and pathologic features. This series of SFTs, some with unusual clinicopathologic presentation, included nine women and two men, ranging in age from 28 years to 74 years (five in pleura, one in lung parenchyma, one in breast, and four in mediastinum). The tumors were locally excised in eight cases and were resected along with portions of lung parenchyma in three. A panel of immunohistochemical stains was used to characterize these tumors. They were all vimentin-positive and, with the exception of one case, CD34-positive. Tumors were negative with antibodies directed against cytokeratin, factor VIII-related antigen, S-100 protein, muscle-specific actin, and smooth-muscle actin. Various diagnoses were initially rendered for these clinically and pathologically diverse lesions by the examining pathologists. Awareness of the various gross and microscopic patterns of these tumors, the possibility of occurring in unusual sites, and the use of immunohistochemical stains, particularly CD34, should eliminate most of the difficulties in arriving at a correct diagnosis. One patient died of metastatic breast cancer; all other patients were alive and well with a median follow-up of 17 months.

Nanotechnology research is an enabling field and is closely aligned with advances in neuromorphic architectures, energy efficient computing, and autonomy efforts. The development of neuromorphic circuits leverages a mixture of proven CMOS technologies with experimental devices and architectures that pose significant challenges for integration and fabrication. This chapter examines the pressures pushing the development of unconventional computing designs for size, weight, and power constrained environments and briefly reviews some of the trends that are influencing the development of solid-state neuromorphic systems. Later sections provide high level examples of selected approaches to hardware design and fabrication.

Study Objective To evaluate the effects of exenatide on some inflammatory markers and to quantify the effect of exenatide on β-cell function. Design A randomized, double-blind, placebo-controlled trial. Setting Seven hospitals in Italy. Patients A total of 174 white treatment-naive adults with type 2 diabetes and a glycated hemoglobin (HbA1c) level higher than 7.5%. Intervention After an open-label run-in period of 8 ± 2 months with metformin, patients were randomized to take exenatide (5 μg twice/day for the first 4 weeks, 10 μg twice/day thereafter) or a placebo volume equivalent for 12 months. Measurements and Main Results Body mass index, HbA1c, fasting plasma glucose, postprandial plasma glucose, fasting plasma insulin (FPI), homeostasis model assessment insulin resistance index, homeostasis model assessment β-cell function index (HOMA-β), fasting plasma proinsulin (FPPr), proinsulin-to-fasting plasma insulin ratio (Pr:FPI ratio), C-peptide, glucagon, vaspin, chemerin, and resistin were evaluated at baseline, at randomization, and at 3, 6, 9, and 12 months. Patients also underwent a combined euglycemic, hyperinsulinemic, and hyperglycemic clamp with subsequent arginine stimulation to assess insulin sensitivity and insulin secretion. HbA1c was significantly improved with exenatide plus metformin compared with placebo plus metformin. Exenatide plus metformin was also significantly more effective than placebo plus metformin in increasing HOMA-β C-peptide, and all measures of β-cell function after the euglycemic hyperinsulinemic and hyperglycemic clamp. We observed that exenatide plus metformin also reduced resistin compared with placebo plus metformin. No variations in vaspin and chemerin were noted in group-to-group comparisons. We observed a significant correlation between M value increase, an index of insulin sensitivity, and a decrease in inflammatory parameters in the exenatide plus metformin group. Conclusions The combination of exenatide plus metformin was more effective than metformin alone in improving glycemic control, β-cell function, and inflammatory parameters.

Background: To fully evaluate patients with esophageal cancer by endoscopic ultrasonography (EUS), the transducer must pass through the entire tumor to the cardia to scan the celiac axis. Dilation may be necessary. Published information suggests that dilation with EUS carries a sizeable risk. Methods: In order to assess the complication rate associated with dilation prior to EUS in patients with esophageal cancer and the clinical significance of dilation for complete EUS staging, we reviewed the records of all patients who had undergone EUS for esophageal cancer. Results: Sixty-three patients underwent EUS staging of esophageal cancer. Thirty-nine (62%) had lesions through which the EUS scope was passable (Group I). Ten (16%) patients (Group II) had lesions through which an EUS scope (diameter 13 mm) was unable to pass even after dilation. Fourteen patients (22%) had lesions that were dilated to allow passage of the EUS scope (Group III). All patients in Groups II and III had confirmation of EUS staging by CT and/or surgery. In Group II, five patients had tumors defined as T4 (50%) and five as T3 (50%). In Group III, nine (64%) had T4 tumors, four (29%) had T3, and one (7.7%) had T2. No complications were encountered in any group. Conclusion: EUS, either alone or after dilation, is a safe procedure and the complete EUS examination with celiac node visualization adds prognostically significant information. (Gastrointest Endosc 1995;41:540-6.)

The use of unsecure foundries has allowed and is still providing a pathway for counterfeit microelectronics into U.S. defense systems. As a result, the Warfighter has been put at risk and a solution is needed. To counter this dilemma, this study looks into the feasibility of creating a Department of Defense (DoD) - wide design cloud that would provide circuit designers with a more secure and economical way of designing and fabricating circuits. The design cloud would include secure communication to trusted foundries along with needed circuit design software. Factors such as security, costs, benefits, and issues are taken into consideration in determining whether the use of the cloud would actually aid the integrated circuit design process.Copyright © 2012 by ASME

Background: To assess the treatment of posthemorrhagic hydrocephalus with accentuated lateral ventricles dilatation by employing a single biventricular neuronavigation-assisted transseptal-implanted catheter with programmable valve and distal peritoneal derivation. Methods: A neuronavigation-assisted single transseptal biventricular catheter implantation with distal peritoneal shunt system was performed in 11 patients with posthemorrhagic hydrocephalus and accentuated lateral ventricles dilatations between 2001 and 2010. Patients with concomitant third ventricle dilatation were excluded. Several sequential frustrated attempts of temporary drainage occlusion on both sides confirmed the isolation of the lateral ventricles. Neuronavigation was employed to accurately establish the catheter surgical corridor (trajectory) across the lateral ventricles and throughout the septum pellucidum. The neurological and radiological outcomes were assessed at least 6 months after the procedure. Results: Catheter implantation was successfully performed in all patients. Only one catheter was found to be monoventricular on delayed computer tomography controls. Procedure-related complications (bleeding of infections) were not observed. No additional neurological deficits were found after shunt surgery. Six months after procedure, none required additional ventricular catheter implantations or shunt revisions. Radiological and clinical controls confirmed the shunt function and the improved neurological status of all patients. Conclusion: Single neuronavigation-assisted transseptal-implanted biventricular catheter is a valid option for the treatment of posthemorrhagic hydrocephalus with accentuated lateral ventricles dilatation. This technique reduces the number of catheters and minimizes the complexity and timing of the surgical procedure as well as potential infection's risks associated with the use of multiple shunting systems.