Creutzfeldt-Jakob disease in a husband and wife

A 53-year-old man died of sporadic Creutzfeldt-Jakob disease (CJD) after a 1.5-year clinical course. Four and a half years later, his then 55-year-old widow died from CJD after a 1-month illness. Both patients had typical clinical and neuropathologic features of the disease, and pathognomonic proteinase-resistant amyloid protein ("prion" protein, or PrP) was present in both brains. Neither patient had a family history of neurologic disease, and molecular genetic analysis of their PrP genes was normal. No medical, surgical, or dietary antecedent of CJD was identified; therefore, we are left with the unanswerable alternatives of human-to-human transmission or the chance occurrence of sporadic CJD in a husband and wife.     

The "first generation" of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta

OBJECTIVE: Our goal was to determine whether endovascular stent-grafting is feasible and effective for patients with aneurysms of the descending thoracic aorta. METHODS: Starting in July 1992, we conducted a prospective, uncontrolled clinical trial in 103 patients (mean age 69 years [range 34-89 years]) who underwent endovascular treatment of aneurysms of the descending thoracic aorta using a custom-fabricated, self-expanding stent-graft device. Follow-up was 100% complete and averaged 22 months. Sixty-two patients (60%) were judged not to be reasonable candidates for a conventional "open" surgical procedure. RESULTS: Complete thrombosis of the aneurysm was ultimately achieved in 86 (83%) patients. The early mortality rate was 9% +/- 3% (+/- 70% CL). Multivariable analysis revealed that myocardial infarction or stroke was linked with a higher likelihood of early death (P = .001). Early serious complications included paraplegia in 3% +/- 2% and stroke in 7% +/- 3%. Actuarial survival estimates at 1 year and 2 years were 81% +/- 4% and 73% +/- 5% (+/- 1 SE), respectively; being judged not to be a surgical candidate portended a higher probability of death (P = .003). According to the intent-to-treat principle, "treatment failure" (including all late sudden unexplained deaths) occurred in 38 patients; 53% +/- 10% of patients were free from treatment failure at 3.7 years. Stent-graft related complications occurred commonly and were linked with several anatomic, technical, and patient-related risk factors. CONCLUSIONS: This 5-year clinical trial involving use of a "first generation" device indicates that endovascular stent-grafting of descending thoracic aortic aneurysms is feasible with acceptable medium-term results. More refined, commercially developed devices available today offer less traumatic and more precise stent-graft deployment; these major technical advantages, coupled with important lessons we have learned over time and better patient selection, should be associated with more salutary clinical results in the future.     

Arachidonic acid potentiates the duration of the metabotropic, protein kinase C-mediated, suppression of the inhibitory adenosine A1 receptor pathway in glutamatergic nerve terminals from rat cerebral cortex

Percutaneous US guided nephrostomy is the simplest and most direct technique to drain an obstructed kidney. The indications are included in two groups: temporary drainage and permanent drainage; the former is indicated in the non endoscopically superable ureteral obstruction, in pyonephrosis, in pregnant women and in transplanted kidneys (due to the easier access), the latter is exclusively reserved to neoplastic obstructions. The only real contraindication to the method, besides a documented allergy to local anaesthetics, is represented by a severe coagulopathy. Positioning techniques are the "one shot" technique, in which dilation and positioning are synchronous (it can avoid fluoroscopy but it is more traumatic) and angiographic derived Seldinger's technique, that utilizes fluoroscopy and an instrumentation including a guidewire and a set of Amplatz dilators. Complications are due to the access route; the choice of an intercostal access is always inadvisable, due to the risk of pneumothorax or pulmonary injury; the most frequent complications are vascular (hemorrhage, retroperitoneal hematoma) and usually well controlled; more severe lesions (renal artery laceration and arteriovenous fistula) may require intervention or embolization, but the incidence of nephrectomies due to vascular injury accounts for one per thousand.     

Hepatectomy with hypothermic perfusion of the liver

Whereas most liver resections can be performed within 60 min, the period of vascular clamping and resulting ischemia may prove too short to allow complex major liver resections (MLR) especially on diseased livers. To overcome this problem, cooling of the liver with 4 degrees C preservations solution routinely used in liver transplantation may be used in three different approaches to MLR: I "In situ": the liver remains in the abdomen and integrity of afferent and efferent vessels is conserved. II "Ex situ-in vivo": the liver exteriorized from the abdomen by transecting all hepatic veins, remains connected to the porta hepatis. III "Ex vivo": the liver being removed from the abdomen, the MLR is performed extracorporeally. Of 15 MLR reported here, 11 were performed "in situ" and 4 "ex situ-in vivo"/Nowadays, the liver surgeon's "toolbox" must contain hypothermic liver perfusion. In carefully selected cases, these techniques allow MLR on diseases livers or mandating complex vascular procedures.     

DuD Recht

DuD Recht

DuD Recht     

A fully integrated 1‐in. AMOLED display using current feedback based on a five‐mask LTPS CMOS process

Abstract— In the past, a five‐mask LTPS CMOS process requiring only one single ion‐doping step was used. Based on that process, all necessary components for the realization of a fully integrated AMOLED display using a 3T1C current‐feedback pixel circuit has recently been developed. The integrated data driver is based on a newly developed LTPS operational amplifier, which does not require any compensation for Vth or mobility variations. Only one operational amplifier per column is used to perform digital‐to‐analog conversion as well as current control. In order to achieve high‐precision analog behavior, the operational amplifier is embedded in a switched capacitor network. In addition to circuit verification by simulation and analytic analysis, a 1‐in. fully integrated AMOLED demonstrator was successfully built. To the best of the authors' knowledge, this is the first implementation of a fully integrated AMOLED display with current feedback.     

Physics-Based Person Tracking Using the Anthropomorphic Walker

We introduce a physics-based model for 3D person tracking. Based on a biomechanical characterization of lower-body dynamics, the model captures important physical properties of bipedal locomotion such as balance and ground contact. The model generalizes naturally to variations in style due to changes in speed, step-length, and mass, and avoids common problems (such as footskate) that arise with existing trackers. The dynamics comprise a two degree-of-freedom representation of human locomotion with inelastic ground contact. A stochastic controller generates impulsive forces during the toe-off stage of walking, and spring-like forces between the legs. A higher-dimensional kinematic body model is conditioned on the underlying dynamics. The combined model is used to track walking people in video, including examples with turning, occlusion, and varying gait. We also report quantitative monocular and binocular tracking results with the HumanEva dataset.     

Design and implementation of the Node Identity Internetworking Architecture

The Internet Protocol (IP) has been proven very flexible, being able to accommodate all kinds of link technologies and supporting a broad range of applications. The basic principles of the original Internet architecture include end-to-end addressing, global routeability and a single namespace of IP addresses that unintentionally serves both as locators and host identifiers. The commercial success and widespread use of the Internet have lead to new requirements, which include Internetworking over business boundaries, mobility and multi-homing in an untrusted environment. Our approach to satisfy these new requirements is to introduce a new Internetworking layer, the node identity layer. Such a layer runs on top of the different versions of IP, but could also run directly on top of other kinds of network technologies, such as MPLS and 2G/3G PDP contexts. This approach enables connectivity across different communication technologies, supports mobility, multi-homing, and security from ground up. This paper describes the Node Identity Architecture in detail and discusses the experiences from implementing and running a prototype.