Mobility and Congestion in Dynamical Multilayer Networks with Finite Storage Capacity.

Multilayer networks describe well many real interconnected communication and transportation systems, ranging from computer networks to multimodal mobility infrastructures. Here, we introduce a model in which the nodes have a limited capacity of storing and processing the agents moving over a multilayer network, and their congestions trigger temporary faults which, in turn, dynamically affect the routing of agents seeking for uncongested paths. The study of the network performance under different layer velocities and node maximum capacities reveals the existence of delicate trade-offs between the number of served agents and their time to travel to destination. We provide analytical estimates of the optimal buffer size at which the travel time is minimum and of its dependence on the velocity and number of links at the different layers. Phenomena reminiscent of the slower is faster effect and of the Braess' paradox are observed in our dynamical multilayer setup.

Reduced productivity among confined laying hens infested by Allopsoroptoides galli (Mironov, 2013).

The mite Allopsoroptoides galli has recently been identified parasitizing commercial chickens, São Paulo State/Brasil, causing severe dermatitis on all parts of the animal's body and a significant decline in productivity, particularly in egg production. The aim of the present study in A. galli infestation was to investigate the impact on laying hens' performance and egg quality. A total of 100 56-week-old Hy-line white laying hens were used. The birds were divided into 2 groups, with 10 replicates of 5 birds in each group. The experimental groups consisted of a non-infested group (hens free of theA. galli) and an infested group (hens presenting A. galli). The infestation with A. galli did not significantly influence feed intake but caused a significant reduction in the body weight of the hens and caused a decrease in egg production, therefore promoting worse feed conversion. The egg weight was reduced; however, the infestation did not significantly affect the internal quality of the eggs, which was measured according to the yolk color, albumen height, and Haugh units, or the quality of the shell, based on its percentage, thickness, and strength. It can be concluded that anA. galli infestation promotes a reduction in body weight, egg production, and egg weight in laying hens, therefore worsening feed conversion.

Juxtarenal aortic aneurysms: preliminary experience with fenestrated E-vita abdominal stent-graft.

Endovascular aneurysm repair (EVAR) offers a minimally invasive treatment to patients with improved short-term and similar mid-term results compared to conventional, open repair. Approximately 20% of patients have an aneurysm neck morphology inadequate for a standard stent-graft and requires an endograft to cross vital aortic side branches to achieve a seal. This work describes the promising single center preliminary results in the management of juxtarenal aortic aneurysm using E-vita stent-graft.

Double renal chimney graft using only femoral approach.

Endovascular aneurysm repair (EVAR) is a minimally invasive treatment that can be offered to most patients with an aortic aneurysm. Patients who are rejected from standard EVAR often have more extensive aortic pathology and more medical comorbidities. The advent of fenestrated and branched stent grafts gives us an opportunity to treat the most demanding aortic aneurysms endovascularly. Fenestrated stent-grafts, however, are costly and time-consuming to manufacture, which limits their applicability, especially in the emergency setting. The chimney graft is a stent placed parallel to the aortic stent-graft to preserve flow to a vital aortic branch that was overstented to obtain an adequate seal. The technique can be used as a planned operation but also as a rescue procedure to salvage a side branch unintentionally covered during EVAR. As visceral branches of the aorta are usually directed caudally these vessels are, therefore, preferably catheterized from a brachial approach. We describe a case of a successful positioning of the chimney graft using only the femoral approach. The only femoral approach to position a renal chimney graft isn't recommended for the routine procedure but it is proved to be useful in selected case and when other treatment options are excluded.

The effect of a new finishing process on the torsional resistance of twisted nickel-titanium rotary instruments.

AIM: The process of twisting has been used for decades to fabricate stainless steel instruments, but it was previously thought to be an impractical method for nickel-titanium (Ni-Ti) instrument manufacture A manufacturing method of twisting Nickel-Titanium wire to produce Ni-Ti files has been recently developed: the twisted files (TF). Theoretically, this new manufacturing process should overcome the problems associated with a grinding process, which previously limited instrument strength. Since TF manufacturing process is new and different from grinding, the aim of the present study was to evaluate the effects of a final deoxidation process (Deox) on torsional resistance of TF instruments. METHODS: Testing was performed in accordance with the International Standard (ISO 3630-1) by comparing 20 TF instruments versus 20 TF prototype instruments produced without the final deoxidation process. Data were collected and statistically analyzed (t-test). RESULTS: Results show that TF instruments withstood 90% more torque (max. torque) than TF prototype instruments manufactured without the deoxidation process (88.7 vs. 53.3 g/cm). This difference was found to be statistically significant at the 0.05 level of significance. CONCLUSION: Since design and dimensions of tested instruments were the same, the deoxidation process could be the only explanation of the improvement in torsional resistance.

Development of Dermanyssus gallinae (Acari: Dermanyssidae) at different temperatures.

The development, viability, and life cycle parameters of Dermanyssus gallinae at five different temperatures (15, 20, 25, 30 and 35 degrees C), and at relative humidity 70-85% were evaluated. Life cycle duration was 690.75 h (28 days) at 15 degrees C, 263.12h (11 days) at 20 degrees C, 164.63 h (7 days) at 25 degrees C, 140.69 h (6 days) at 30 degrees C and 172.04 h (7 days) at 35 degrees C. The optimal development temperature for D. gallinae was 30 degrees C, with the greatest survival in all stages and the shortest development time. High mortality at 35 degrees C indicated that this temperature had adverse effects on development of D. gallinae, and that in field conditions D. gallinae populations may decrease or even disappear due to the negative impact of high temperature on development. There were no significant differences in the pre-oviposition period among the four temperatures 20-35 degrees C, indicating that temperature did not affect this part of the life cycle.

Localized bacillary angiomatosis in the oral cavity: observations about a neoplasm with atypical behavior. Description of a case and review of the literature.

Bacillary angiomatosis is a rather frequent infectious pathology appearing mainly in the skin but can also affect the liver, spleen, heart, bones, lungs, muscles, central nervous system and other organs. The localization of the lesion in the oral cavity is rather rare, as it is evident in the literature. Bacillary angiomatosis can be clinically similar to the Kaposi's sarcoma and histologically confused with angiosarcoma, epitheloid hemangioma and pyogenic granuloma. A case of bacillary angiomatosis of the oral cavity in an immuno-competent patient is described. The high tendency to relapse, the capability in migration and to involve several localizations at the same time have induced the authors to deepen the research to exclude the possibility that it could be a Kaposi's sarcoma or a pyogenic granuloma and to get to an accurate diagnosis in order to resolve the disease.

Subantral filling by deantigenated heterologous bone and immediate fixture placement.

AIM: A successful implant therapy depends on sufficient quantity of available bone. Latero-posterior maxillary area often represents a hardly useful zone for routine implant therapy in long time edentulous patients. Standard procedures of maxillary sinus lifting are the goals of implant-prosthetic rehabilitation. Among different grafting materials used in this kind of procedures, the deantigenated heterologous bone reliability has been tested. METHODS: In a clinical case of maxillary bone atrophy (Misch classification, SA3) a deantigenated heterologous bone grafting and immediate fixture placement has been performed; before prosthetic finalization a biopsy in the grafting site has been carried out in order to obtain an histological evaluation of the graft integration. RESULTS: The histological analysis and X-ray at 1 year follow-up show the formation of osteoid tissue integrated with the surrounding bone tissue, reaching bone maturity by calcification. In spite of a longer time for grafting integration, the advantages of a single-time surgery and the reduction of surgical timing are stressed. CONCLUSIONS: X-rays and histological results lead authors to consider the tested heterologous bone as a valid alternative to autologous bone, especially in those patients where it is preferable to avoid a second surgical site in order to take an inlay graft.

[Enucleation of a pleomorphic adenoma of the palate: a conservative choice]. / Enucleazione di un adenoma pleomorfo del palato: una scelta conservativa.

The benign mixed tumor (pleomorphic adenoma) is the most common intraoral salivary gland tumor: more than 50% occurs on the hard and soft palate. The epidemiological data, histopathological and clinical features, preoperative diagnostic methodologies, treatment options, recurrence rates and prediction published in the literature for this neoplasm are discussed. A case of minor salivary gland tumor of the palate in a 26 year old man is reported. The therapy chosen was a surgical conservative enucleation of the lesion. Histological examination showed pleomorphic adenoma; there is no recurrence after 2 years.

Surgical treatment of abdominal aortic aneurysms associated with aortic valve incompetence: strategies and outcomes.

BACKGROUND: The exact incidence of associated aortic valve incompetence (AVI) and abdominal aortic aneurysm (AAA) in the general population is not known. In recent years, we have observed this association with increasing frequency. This observation is probably due to the extensive preoperative screening of the cardiac and vascular status of patients who are candidates for surgical procedures. The choice of the optimal surgical strategy is needed to achieve low operative morbidity and mortality. The present study reviews our experience with a subset of patients suffering the association of AVI and large AAA. Surgical strategy, clinical management and outcome are presented. METHODS: Between January 1982 and May 2000, 76 patients with the association of AAA and AVI have been evaluated in our institution. Forty-four patients have been treated for both AAA and aortic valve (AV) regurgitation. These patients have been divided into three groups on the basis of the surgical strategy adopted. Group 1: combined procedure (16 patients); group 2: AAA repair prior to AV surgery (nine patients); group 3: AV surgery prior to aneurysm repair (19 patients). RESULTS: Hospital mortality was 4.5% (two patients); overall mortality was 6.8% (three patients). CONCLUSIONS: In patients with AAA and AVI, an accurate and complete preoperative evaluation is essential. Surgical strategy should be individualized on the basis of the cardiac preoperative status.

Perioperative use of tirofiban hydrochloride (Aggrastat) does not increase surgical bleeding after emergency or urgent coronary artery bypass grafting.

BACKGROUND: The platelet glycoprotein IIb/IIIa inhibitor tirofiban hydrochloride improves outcome in patients with acute coronary syndrome. Nevertheless, a considerable number of patients require emergency or urgent coronary artery bypass grafting and may be at increased risk of postoperative bleeding after treatment with this molecule. The aim of this study is to evaluate the incidence of bleeding complications among patients undergoing bypass grafting after treatment with tirofiban. METHODS: We investigated the influence of the molecule on postoperative bleeding after cardiac surgery, comparing 2 groups of patients undergoing emergency or urgent coronary artery bypass grafting: group A (n = 20) received tirofiban, and group B (n = 68) received conventional therapy with intravenous heparin up until the operation. A total of 88 patients underwent coronary artery bypass surgery within 2 hours of ceasing the hemodynamic study. Clinical outcome, chest tube outputs, bleeding complications, transfusion requirements, platelet and hemoglobin counts, and clinical complications were examined. RESULTS: Bleeding differences were noted between the 2 groups at 8, 16, and 24 hours postoperatively. The incidence of blood, platelet, and fresh frozen plasma transfusions was higher in the control group. Postoperative thrombocytopenia was preserved in group A (199.5 +/- 70.4 vs 150.6 +/- 33.4 10(3)/mL, P <.01). No significant differences were noted between the 2 groups in the incidence of perioperative myocardial infarction, but significant differences were noted in enzyme levels, length of stay in the intensive care unit, and length of stay in the hospital. No deaths were observed. Hospital morbidity was increased in group B because of factors that were not apparently linked with tirofiban infusion. CONCLUSIONS: Patients may safely undergo coronary artery bypass surgery after treatment with tirofiban hydrochloride. This molecule, administered in the immediate preoperative period, has no adverse clinical effects and does not seem to negatively influence the incidence of perioperative myocardial infarction. Although extracorporeal circulation can modify platelet numbers and function, our ongoing data could show significant reduction in the loss of platelets induced by cardiopulmonary bypass, minor postoperative bleeding, and a minor transfusion requirement in general.

Acute dissecting aneurysm of the ascending thoracic aorta causing obstruction and thrombosis of the right pulmonary artery.

We present the case of a 69-year-old man with a history of hypertension and a recent pelvic fracture who presented with acute chest pain, shortness of breath, and severe hypotension. The history of recent pelvic fracture and the clinical manifestations, including the sudden onset of acute respiratory distress, hypotension, and hypoxemia, indicated pulmonary embolism; however, at surgery the patient was found to have an acute dissection of the ascending aorta with obstruction and thrombosis of the right pulmonary artery. This case emphasizes the need to consider such a diagnosis in patients who have unilateral absence of perfusion to the right lung.

Prediction of lymph node status by analysis of prognostic factors and possible indications for elective axillary dissection in T1 breast cancers.

OBJECTIVE: To identify those patients with T1 breast cancers with lower risk of nodal metastases who can safely be spared axillary dissection. DESIGN: Retrospective study. SETTING: University hospital, Italy. SUBJECTS: Review of clinical records and histopathological slides of 547 patients with T1 breast cancer, operated on between 1984 and 1997. MAIN OUTCOME MEASURES: Incidence of axillary metastases in relation to age, menopausal status, diameter and grade of tumour, vascular invasion, DNA ploidy, S-phase fraction and hormone receptor state, by univariate and multivariate analysis. RESULTS: Axillary metastases were present in 159 patients (29%). On univariate analysis, diameter of tumour 10 mm or less (pT1a/pT1b cancers), no vascular invasion, and grade 1 tumour were significantly correlated with a lower risk of nodal metastases, but only vascular invasion (p = 0.0001, odds ratio = 3.1) and diameter of tumour (p = 0.04, odds ratio = 1.6) were independent predictors on multivariate analysis. Among 34 pT1a/pT1b cancers, with low grade of tumour and no vascular invasion, only 2 (6%) had axillary metastases. When only one favourable predictive factor was associated with diameter of tumour of 10 mm or less, the incidence of axillary metastases ranged from 12% for 43 patients with grade 1 cancers to 13% for 76 patients with no vascular invasion. CONCLUSIONS: Axillary dissection may be avoided in pT1a and pT1b breast cancers (< or = 10 mm), with low grade of tumour or no vascular invasion. T1 breast cancers 10 mm or less in diameter should be treated by a two-step approach, first wide excision of the tumour and then axillary dissection or not depending on pathological examination of the primary tumour.

Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome.

BACKGROUND: Acute myocardial ischemia and infarction due to retrograde dissection of the aortic root reaching the coronary ostia is a potentially fatal condition. Surgical treatment of these patients relies on the re-establishment of an adequate coronary blood flow and on the rescue of jeopardized myocardium. This article reports the results of a selected group of 24 patients with type A acute aortic dissection and coronary artery dissection. We review our experience and illustrate our approach to this condition, which evolved over a 15-year period. METHODS: Between July 1985 and March 2000, 24 patients from a total of 211 (11.3%) treated for acute type A aortic dissection had dissection of at least one of the coronary ostia. There were 14 men and 10 women. The mean age was 65.5 years (median 61.7; range 41-78 years). The right coronary artery was involved in 11 patients, the left in 4 patients, and both coronary arteries in 9 patients. At admission, 16 patients had Q waves (66%), inferior in 6 (25%) and anterior, lateral, septal, or posterior in 10 (41%). All procedures were done on an emergency basis within 10 hours (median 4 hours) after initial chest pain and within 2 hours after the patient's arrival. RESULTS: Hospital mortality was 20% (5 patients); 3 patients could not be weaned from cardiopulmonary bypass and died intraoperatively, and 2 patients died postoperatively of low cardiac output. CONCLUSIONS: As illustrated in this study, direct coronary repair is a safe alternative to bypass grafting. Aggressive myocardial resuscitation together with early operation is a key factor in the management of these patients.

Operation for acute type A aortic dissection in octogenarians: is it justified?

BACKGROUND: With the progressive aging of Western populations, cardiac surgeons are faced with treating an increasing number of elderly patients. Controversy exists as to whether the expenditure of health care resources on the growing elderly populations represents a cost-effective approach to resource management. The potential to avoid surgery in patients with little chance of survival and poor quality of life would spare unnecessary suffering, reduce operative mortality, and enhance the use of scarce resources. METHODS: We reviewed the records of 24 consecutive patients aged 80 years or older (mean age 83 years, range 80-93 years) who underwent operations for acute type A dissection from 1985 through 1999. No patient with acute type A dissection was refused surgery because of age or concomitant disease. Seventeen patients were men. Preoperatively, none of the patients was moribund, although 66% had hemodynamic instability and 41% experienced cerebral ischemia. All patients had one or more associated pathologic conditions. Hospital mortality and morbidity models, based on our overall experience with 197 patients operated on for acute type A aortic dissection during the period of the study, were developed by means of multivariate logistic regression with preoperative and intraoperative variables used as independent predictors of outcome. RESULTS: Overall hospital mortality was 83%. Intraoperative mortality was 33%. All patients who survived the operation had one or more postoperative complications. Mean hospital stay was 37 days with a total of 314 days in the intensive care unit (average 19 days, median 17 days). None of the survivors (4 patients) discharged from the hospital was able to function independently and their survival at 6 months was 0%. Statistical analysis of the overall experience with operations for type A acute aortic dissection confirmed that age in excess of 80 years is the most important independent patient risk factor associated with 30-day mortality and morbidity. CONCLUSIONS: Operations for acute type A dissection performed on octogenarians involve increased hospital mortality and morbidity. Short-term survival is unfavorable and is associated with a poor quality of life. Without additional corroborative studies to endorse the present findings, the use of age as a parameter to limit access of patients to expensive medical resources remains an unsubstantiated concept. In the context of acute type A aortic dissection, however, the hypothesis that older patients should be denied such a complicated surgical intervention to conserve resources is supported by the presented data.

Dramatic improvement of LV function after coronary sinus thromboembolectomy.

We present the case of a 79-year-old man suffering from chronic atrial fibrillation, severe left ventricular dysfunction, massive right atrial thrombosis, and pulmonary hypertension. Complete coronary sinus thrombosis was found incidentally during preoperative screening. Successful coronary sinus, right atrial, and pulmonary operative embolectomy was followed soon after by a dramatic improvement of cardiac performance; the patient's left ventricular function recovery, in particular, suggests that cardiac venous system played an important role in the genesis of myocardial impairment.

FEC (5-fluorouracil, epidoxorubicin and cyclophosphamide) versus EM (epidoxorubicin and mitomycin-C) with or without lonidamine as first-line treatment for advanced breast cancer. A multicentric randomised study. Final results.

From May 1991 to December 1996, 326 patients with advanced metastatic breast cancer were enrolled in a multicentre, randomised, phase III clinical trial with four arms. Patients were randomised to receive chemotherapy according to the FEC regimen (5-fluorouracil (5-FU) 500 mg/m2, epidoxorubicin (EPI) 75 mg/m2 and cyclophosphamide (CFA) 500 mg/m2, intravenously (i.v.). every 3 weeks) or the EM regimen (EPI 75 mg/m2, i.v. every 3 weeks; mitomycin C (MMC) 10 mg/m2, i.v. every 6 weeks) or the same regimens with the addition of lonidamine (LND) until disease progression (orally, thrice daily, 150+150+300 mg); a maximum of eight chemotherapy cycles were planned. The aim of the trial was 2-fold: to compare the EM regimen with the commonly used FEC regimen and to evaluate the possible role of the addition of LND. Patients were eligible if they had histologically proven breast carcinoma, metastatic or locoregional relapse with measurable and/or evaluable disease and were aged between 18 and 70 years: 318 patients were considered eligible. Patients with previous anthracycline-based adjuvant chemotherapy or those who relapsed within 6 months after any adjuvant chemotherapy regimen were excluded. Chemotherapy-related toxicity of grade > or = 3 was manageable and there was no significant difference between the arms in terms of haematological side-effects. The impact on heart function was mild. No increased toxicity was observed in the LND arms (apart from myalgias in 27-30% of the cases). A significant increase in the complete response rate was observed for the FEC/EM + LND group (20.4%) versus the FEC/EM group (10.8%). The median survival time and the median time to progression for the overall series were 608 days and 273 days, respectively; EM+/-LND achieved significantly improved survival and time to progression versus FEC+/-LND (P=0.01). This result was confirmed also when the analysis was restricted to patients previously treated with adjuvant CMF schedules. On the basis of these results, we conclude that EM may represent a valuable alternative to FEC for patients requiring a first-line regimen for advanced/ metastatic breast carcinoma, especially in patients previously treated with CMF in an adjuvant setting. Furthermore, we conclude that, in spite of a better complete response rate in the LND arms, as there was no clear advantage in time to progression or survival resulting from the addition of LND to the FEC or EM regimens, the routine use of LND is not warranted outside a clinical trial.

Localized dissection and delayed rupture of the abdominal aorta after extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy (ESWL) represents the preferred treatment for most upper ureteric and renal calculi. Complication rates associated with ESWL are low, justifying the enthusiasm and acceptance of this treatment modality. As the technique has become more widely available, some deleterious effects on the kidneys and the surrounding tissues are increasingly recognized. We report on the rupture of a severely calcified abdominal aorta in a 65-year-old man who underwent 3 months of ESWL treatment earlier for renal calculi. The patient was seen with an acute recrudescence of a long-standing abdominal and left flank pain, which began immediately after the last of the three sessions of ESWL and was associated with an episode of hypotension that occurred an hour before admission. Patient history and chronologic course of events strongly suggest the role of ESWL in the genesis of abdominal aorta rupture.

Ifosfamide, cisplatin and etoposide combination in locally advanced inoperable non-small-cell lung cancer: a phase II study.

From March 1993 to February 1997, 43 eligible patients with inoperable stage IIIA (ten patients) and stage IIIB (33 patients), histologically confirmed NSCLC received 3 courses of the ICE combination (ifosfamide 1.5 g m(-2) and mesna 750 mg m(-2) two times a day, cisplatin 25 mg m(-2) and etoposide 100 mg m(-2), all administered intravenously (i.v.) on days 1-3 every 3 weeks) with G-CSF support. After three cycles, patients were submitted to radical surgery or received two additional courses of the ICE regimen and/or curative radiotherapy. Grade 3-4 neutropenia occurred in 21% of 114 evaluable courses, but was of short duration, leading to neutropenic fever in 5% of the courses. Severe thrombocytopenia and anaemia were observed in 13% and 3% of the courses respectively. Non-haematological toxicity was generally mild with only two episodes of reversible renal impairment. The overall response rate after three chemotherapy courses was 69% (28 partial responses, one complete response). Ten patients (8/10 patients in stage IIIA, 2/33 patients in stage IIIB) underwent radical surgery. Median TTP for patients not undergoing surgery (n = 33) was 8 months (range 3-34+); median DFS for patients rendered NED by surgery (n = 10) was 26 months (range 1-54+). Median OS for the entire group was 12.5 months (range 2-57+). The ICE regimen is active in locally advanced NSCLC with acceptable toxicity and warrants further exploration as induction chemotherapy in larger series.