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Fragility analysis aims to compute the probabilities of a system exceeding certain damage conditions given different levels of hazard intensity. Fragility analysis is therefore a key process of performance-based earthquake engineering, with a number of approaches developed and widely recognized, including Incremental Dynamic Analysis (IDA), Multiple Stripe Analysis (MSA), and cloud analysis. Additionally, extended fragility analysis has recently been shown to possess important attributes of mathematical consistency and extensibility. This work provides a critical review of the different fragility methods by explaining the underlying probabilistic models and assumptions, as well as their connections to the extended fragility method. It is proven that IDA-based fragility curves provide an upper bound of the actual fragility, and cloud analysis manifests suboptimality issues arising from its underlying assumptions. MSA is identified to be a probit-linked Bernoulli regression model, similar to the one proposed by Shinozuka and coworkers. The latter, in turn, is shown to be a limiting subcase of the generalized linear model framework introduced within the extended fragility analysis. The paper first presents a simple case of one intensity measure and two damage condition states, and the discussion is subsequently extended to more general cases of multiple intensity measures and damage states. The discussed attributes are demonstrated in several numerical applications. Overall, this work aims to provide new insights on fragility methods, enabling efficient, accurate, and consistent estimations of structural performance, as well as promoting new research directions in earthquake engineering and other related fields.

Intraperitoneal chemotherapy (IPC) administration has been added to the therapeutic protocols of cancers, confined to the abdominal cavity. Since, a survival benefit in patients treated with adjuvant IPC has been demonstrated, fertility questions are raised in these patients. A comprehensive search of the English literature of PubMed/MEDLINE, EmBase and Google Scholar databases was conducted, from their inception until April 2021, following the MOOSE guidelines. Twelve out of 473 studies were included in the final review and analysis. After treatment with IPC for peritoneal carcinomatosis, 19 women, who underwent fertility-sparing surgery, with 20 successful pregnancies were reported. The mean interval time between IPC and pregnancy was 38.4 months (range 9–168 months). In 16 cases, conception was spontaneous, three required in vitro fertilisation, whereas one pregnancy was achieved through intrauterine insemination. Mean disease-free survival was 76 months (range 24–177 months). Childbearing is a feasible approach in selected patients, after treatment with IPC. When future pregnancy is desirable, a multidisciplinary team of surgeons, gynaecologists, oncologists and reproductive specialists is required, to inform the patient thoroughly about the fertility preservation alternatives, without endangering patient’s survival. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Infected coronary artery aneurysms present high mortality and surgical management is the treatment of choice in most cases. We present a case of a giant infected aneurysm of the mid right coronary artery complicated with purulent pericarditis in an 83-year-old male patient. It is unknown whether the aneurysm or purulent pericarditis preceded. The patient underwent urgent aneurysm resection and coronary artery distal bypass grafting. He died 24 hours after the operation. When purulent pericarditis and ICAA co-exist the riddle of the chicken and the egg becomes apparent.

Budesonide (BUD) is a glucocorticoid (GC) widely used in therapeutics. In sports, the World Anti-doping Agency (WADA) controls the use of GCs, and WADA-accredited laboratories use a reporting level of 30 ng/mL for 6ß-hydroxy-budesonide (6ßOHBUD) to detect the systemic administration of BUD. In the present work, we examined the urinary excretion profile of 6ßOHBUD, BUD, and 16a-hydroxy-prednisolone (16aOHPRED) after intranasal (INT), inhaled (INH) (at high doses) and oral administrations in male and female volunteers. BUD was administered to healthy volunteers using INT route (256 µg/day for three days, n = 4 males and 4 females), INH route (800 µg/day for three days, n = 4 males and 4 females, and 1600 µg/day for three days, n = 4 males) or oral route (3 mg, n = 8 females). Urine samples were collected before and after administration at different time periods, and were analyzed by liquid chromatography-tandem mass spectrometry. 6ßOHBUD and BUD concentrations were very low after INT treatment (0.0-7.1 and 0.0-8.1 ng/mL, respectively), and higher after INH treatments (0.0-35.4 and 0.0-48.3 ng/mL, respectively). For 16aOHPRED, elevated concentrations were detected after INT and INH treatments (2.6-66.4 and 3.4-426.5 ng/mL, respectively). Concentrations obtained following oral administration were higher than after therapeutic administrations (2.8-80.6, 1.5-36.1, and 10.4-532.2 ng/mL for 6ßOHBUD, BUD, and 16aOHPRED, respectively). After all administrations, concentrations were higher in males than in females. Results demonstrated that 6ßOHBUD is the best discriminatory marker and a reporting level of 40 ng/mL was found to be the best criterion to distinguish allowed from forbidden administrations of BUD.

Traumatic tricuspid insufficiency, a rare complication of blunt chest trauma, has been reported with increasing frequency during the last 40 years. Automobile accidents are the leading cause of traumatic tricuspid valve regurgitation. The most frequently reported injury is chordal rupture, followed by rupture of the anterior papillary muscle and leaflet tear, primarily of the anterior leaflet. In the acute phase of the injury, the traumatic lesion may go undetected. In the chronic phase many patients remain asymptomatic and others exhibit symptoms and signs of moderate to severe right heart failure. Clinically overt right heart failure has been the traditional indication for surgery, which usually consisted of tricuspid valve replacement. More recently, a more aggressive strategy, with surgical repair of the valve performed before deterioration of the right ventricular function occurs, has been advocated.

Sensor technology is becoming pervasive in our everyday lives, measuring the real world around us. The Internet of Things enables sensor devices to become active citizens of the Internet, while the Web of Things envisions interoperability between these devices and their services. An important problem remains the need for discovering these devices and services globally, ad hoc in real-time, within acceptable time delays. Attempting to solve this problem using the existing Internet infrastructure, we explore the exploitation of the Domain Name System (DNS) as a scalable and ubiquitous directory mechanism for embedded devices. We examine the feasibility of this approach by performing a simulation involving up to one million embedded devices, to test system performance and scalability. Finally, we discuss practical issues and the overall potential of this approach. © 2014 IEEE. 100 105 Sponsors: Conference code: 105101 Cited By :8

Objective. To investigate the alterations of maternal antepartum and postpartum plasma levels of sE-selectin and VE-cadherin in normotensive pregnant women, women with preeclampsia (PE), gestational hypertension (GH), and gestational proteinuria (GP). Methods. A total of 37 pregnant women were included in the present study; 12 with PE, 10 with GH, 5 with GP, and 10 controls. sE-selectin and VE-cadherin levels were assessed in maternal plasma at three periods; before delivery, 36 days after delivery, and 1214 weeks postpartum. Results. Women with severe preeclampsia (SPE) and GP had significantly higher plasma sE-selectin levels as compared to controls in all three periods of sampling. In the GH group, sE-selectin levels did not differ from controls. During the study, even after 12 weeks postpartum, the plasma sE-selectin levels remained unchanged in all preeclamptic groups (PE, GH, and GP). There was no difference in VE-cadherin levels between women with preeclampsia (PE, GH, and GP) and normal pregnancies. Conclusions. We found no changes in VE-cadherin levels in preeclamptic groups. Increased antepartum and postpartum levels of sE-selectin in women with SPE and GP suggest that endothelial dysfunction may be one of the key processes in the pathogenesis of PE and the underlying mechanism, as well, that links PE with cardiovascular disease in later life. GP, also, appears to be a mild variant of PE. © 2011 Informa UK, Ltd.

Metastases of ovarian or fallopian tube carcinomas to the breast and axillary lymph nodes are quite uncommon and usually occur in advanced stages. These metastases may represent a pitfall for the pathologist, because they may mimic primary breast carcinoma. A 56-year-old woman was admitted to the hospital with a left-sided pelvic tumor, redness and swelling of the right breast and palpable right axillary nodes and left lower neck and supraclavicular lymphadenopathy. The imaging, surgical and pathologic findings were those of a papillary serous carcinoma of the fallopian tube with metastases to the breast, axillary and neck lymph nodes. It is important that metastasis to the breast be differentiated accurately from primary breast cancer, because prognosis and treatment differ significantly. Imaging, immunohistochemical analysis and pathology can help in making the correct diagnosis.

Choledochal cysts are rare congenital cystic dilatations of the biliary tree. Choledochal cysts in pregnancy are a rare entity and represent a diagnostic and therapeutic challenge. The authors present a case of two full-term pregnancies in a woman who underwent multiple hepatobiliary operations for a choledochal cyst. The patient had two major problems: a type IV a choledochal cyst with atrophy of the left side of the liver and a congenitally dilated pancreatic duct in the head of the gland. She underwent a drainage surgical procedure using a Roux loop of jejunum and a revision surgery in which complete excision of the cyst and hepaticojejunostomy was performed. The surgical management was completed by a left lateral hepatic segmentectomy. During her first pregnancy, she experienced an episode of cholangitis, most probably due to the remaining congenitally dilated pancreatic duct. In succeeding years, the patient presented with recurrent pancreatitis and finally she underwent a Whipple operation. After that, the patient had a second pregnancy without any complications from the biliary tract system. Although choledochal cysts rarely occur in pregnancy, clinicians should be aware of this condition, as delayed or inappropriate therapy may be catastrophic for both the mother and the fetus. © 2008 The Authors.

Background: Extragenital carcinomas secondarily involving the uterus are very rare and they usually occur as a manifestation of widespread disease. When the metastases involve the endometrium in a diffuse, permeative pattern, sparing the glands, they may cause problems in the diagnosis. Case: A case of metastatic carcinoma to the endometrium with a decidua-like pattern is reported. The patient had a history of breast carcinoma and presented with vaginal bleeding. The pathologic findings in the uterine curettings raised the differential diagnosis between metastatic breast carcinoma and non-neoplastic stromal lesions. The presence of nuclear atypia and mitotic activity along with the appropriate immunohistochemical findings revealed the neoplastic nature of the endometrial lesion and confirmed its origin from the breast. Conclusion: Unusual uterine bleeding in a patient with breast cancer should alert the gynecologist to the possibility of metastatic breast disease. Furthermore, the metastasis to the uterus and to other organs of the genital tract can be considered as a preterminal event. © 2008 Springer-Verlag.

Objectives: To evaluate the accuracy of visual examination of myometrial invasion and the involvement of the cervix in the hysterectomy specimen and to explore the role of tumor grade and size in the accuracy of gross estimation of myometrial invasion. Methods: In 142 patients with apparent early endometrial cancer the uterus was opened after its removal and inspected. The size of the tumor (≤ or > 2 cm), the depth of myometrial invasion (less or greater than 50%) and the involvement of the cervix (as positive or negative) were visually estimated and recorded. All patients underwent surgical staging. The gross findings were compared with the final histological results. Estimations of myometrial invasiveness were analyzed according to the tumor grade and size. Accuracy, specificity, sensitivity, positive and negative predictive values were calculated. Results: The overall accuracy rate for myometrial invasion was 81.7% (116/142). False positive and false negative results noted in 17/101 (17%) and 9/41 (21.9%) of patients. Sensitivity, specificity, positive and negative predictive values were 78%, 83.2%, 65.3% and 90.3% respectively. Gross estimation of invasion was more often successful in patients with smaller (≤ 2 cm) than in those with grater tumors (accuracy 88.9% vs. 79.2%). Increasing tumor grade found to diminish the rate of correct prediction. The accuracy for grade I tumors was 93.5%, for grade II 80.4% and only 58.6% for grade III lesions. Cervical involvement was correctly evaluated in 138/142 patients with one false positive and 3 false negative results. Conclusion: These data show that gross estimation of myometrial invasion is highly accurate in small (≤ 2 cm) and grade I tumors. Visual evaluation of cervical involvement is also reliable. However, prediction of myometrial invasion is lower in tumors with higher grade, being poor in grade III lesions. Inaccuracies of preoperative histology may decrease the sensitivity of intraoperative assessment based on final grade. © 2008 Elsevier Inc. All rights reserved.