Management of the complications of ureterointestinal reimplantation in urinary diversion

OBJECTIVE: To analyze our experience in the management of complications of ureteroenteric reimplantation in patients undergoing urinary diversion by endourological techniques or open surgery, in order to identify a useful algorithm that takes the oncologic prognosis into account, as well as the probability of success. METHODS: A retrospective study was conducted on 136 patients who had undergone urinary diversion from 1987-1998. Of these, 126 had transitional cell carcinoma, two had infiltrating carcinoma, two had a benign condition and 6 had undergone urinary diversion for patient comfort without cystectomy. The following techniques were utilized: cutaneous ureteroileostomy or Bricker technique (104 patients), Mainz neobladder (10 patients), ileal neobladder (15 patients), colonic conduit (5 patients) and cutaneous ureter (2 patients). RESULTS: Overall, 56 patients (41%) had some type of alteration at the ureteroenteric reimplantation site, but only 36 (26%) required intervention. The reimplantation techniques utilized were: the Bricker direct ureteroileostomy (26 patients), Le Duc (6 patients), Leadbetter (3 patients), and the direct cutaneous technique (1 patient). Patient mean age was 67 years (range 53-80). There were 35 males and one female. Seven patients required immediate reimplantation due to a persistent urinary fistula and 29 had late obstruction (more than 3 months), accounting for 21.3% of the cases undergoing urinary diversion. The antegrade endourological approach was utilized in 24 patients (5 nephrostomy alone and 19 stent or balloon dilatation). Dilatation was performed palliatively in 6 cases with extensive tumor spread. Permanent success was achieved in 5 cases (38%) and in spite of the initial success, there were 4 reobstructions. Open surgery was performed in 24 patients (66% of the complicated reimplantations); 5 of these patients had another pathology that warranted laparotomy, 7 required reimplantation early due to a fistula and two patients with a nonfunctioning kidney underwent nephrectomy. Ureteral replacement using the ileum was performed in 4 patients and direct reimplantation to the primary loop was performed in 6 patients. Good surgical results were consistently achieved. CONCLUSIONS: The complication rate of ureteral reimplantation is high in patients undergoing urinary diversion. Endourology has an important role in these cases, particularly in patients with a poor prognosis. Surgery achieves the best results. Although they may entail difficulty, complex cases such as extensive ureteral necrosis can be managed successfully.     

VLSI Implementation of a Neural Model Using Spikes

The paper presents a VLSI approach to approximate thereal-time dynamics of a neuron model inspired from the classicalmodel of Hodgkin and Huxley, in which analog inputs and outputsare represented by short spikes. Both the transient and the steady-statebehaviours of these circuits depend only on process-independentlocal ratios, thus enabling single or multiple-chip VLSI implementationsof very large analog neural networks in which parallelism, asynchronyand temporal interactions are kept as important neural processingfeatures. Measurements on an integrated CMOS prototype confirmexperimentally the expected electrical and temporal behavioursof the proposed neural circuits and illustrate some outstandingfunctional features of the neural model: spike-mediated modulationof the neural activity, self-regulation of the total activityin neural groups, and emulation of temporal interaction mechanismswith well controlled time constants at different scales.     

Intratumor and retroperitoneal massive hemorrhage caused by retroperitoneal liposarcoma]

It is now widely accepted that snoring causes significant social dysfunction. In the absence of obstructive sleep apnoea syndrome, palatal surgery offers a very good chance of eliminating or reducing snoring. The traditional operation of uvulopalatopharyngoplasty remains the 'gold standard', but may be complicated by velopharyngeal incompetence, severe post-operative pain and even nasopharyngeal stenosis. A newer technique to reduce snoring caused by palatal flutter by using a neodymnium:yttrium aluminum garnet laser to stiffen the soft palate has been introduced recently by another unit. We show that this procedure can be carried out using a CO2 laser, and present the initial results of the first 29 patients operated on at The Royal National Throat, Nose and Ear Hospital.     

Lipopolysaccharide induction of MARCKS-related protein and cytokine secretion are differentially impaired in microglia from LPS-nonresponsive (C3H/HeJ) mice

Many events involved in activation of microglia and leukocytes by lipopolysaccharide (LPS) are mediated by protein kinase C (PKC), and we have recently demonstrated that a major PKC substrate, MARCKS-related protein (MRP), is selectively induced by LPS in murine microglia. In microglia from LPS-nonresponsive (C3H/HeJ) mice, induction of MRP and secretion of CSF-1 required much higher LPS concentrations (> or = 100 ng/ml) than in normal (C3H/OuJ) microglia (< or = 10 ng/ml). By contrast, TNF alpha production was not significantly increased in C3H/HeJ microglia even at 1 microgram LPS/ml. Microglia expressed PKC isoforms alpha, beta, delta, and zeta (but not gamma and epsilon); PKC isoform levels were similar in both normal and C3H/HeJ microglia and no significant change in response to LPS was noted. Our results indicate that LPS alters PKC substrate (rather than kinase) expression, and that the Lpsd mutation in C3H/HeJ mice differentially affects regulation of several gene products implicated in microglial function.     

Bitext Generation Through Rich Markup

This paper reports on a method for exploiting a bitext as the primary linguistic information source for the design of a generation environment for specialized bilingual documentation. The paper discusses such issues as Text Encoding Initiative (TEI), proposals for specialized corpus tagging, text segmentation and alignment of translation units and their allocation into translation memories, Document Type Definition (DTD), abstraction from tagged texts, and DTD deployment for bilingual text generation. The parallel corpus used for experimentation has two main features:     

Effect of exfoliated graphite nanoplatelets’ size on the phase structure,electrical, and barrier properties of poly(trimethylene terephthalate)‐based nanocomposites

This article describes the preparation process of two series of poly(trimethylene terephthalate) (PTT) nanocomposites with an addition of exfoliated graphite nanoplatelets with two different platelets’ size (50 and 500 μm). The influence of their size on processing, physicochemical properties, morphology and, most importantly, electrical conductivity and barrier properties of thin polymer films has been studied. It was clearly found that smaller platelets enabled to obtain conductive thin polymer films with a nanoplatelet content of 0.3‐0.5 wt.%. However, nanocomposite based on PTT with 0.5 wt% of EG with the flake size of 500 μm proved to be nonconductive. At the same time smaller EG platelets demonstrated a more uniform distribution in the PTT matrix, which was confirmed by means of scanning and transmission electron microscopies, thus giving the samples in question barrier properties with respect to CO₂ and O₂. Moreover, it has been shown that both nanofillers did not have a significant influence on the phase transition temperatures and on the long period. They caused however a slight decrease of crystallinity which is an evidence of an antinucleating character of those nanoplatelets in the PTT matrix. POLYM. ENG. SCI., 55:2222–2230, 2015. © 2015 Society of Plastics Engineers     

Curitiba Revisited: Five Decades of Transformation

Heralded worldwide as an exemplar of sustainable development, Curitiba now has a history of over half a century of enlightened urban planning. Curitiba born Maria do Rocio Rosário , who is the Head of the São Paulo-based Urban Development Strategies (UDS), reflects on whether Curitiba has actually delivered on its ambitious ideals and where the future challenges might lie for metropolitan integration.     

Iterative scenario based reduction technique for stochastic optimization using conditional value-at-risk

In the last decades, several tools for managing risks in competitive markets, such as the conditional value-at-risk, have been developed. These techniques are applied in stochastic programming models primarily based on scenarios and/or finite sampling, which in case of large-scale models increase considerably their size according to the number of scenarios, sometimes resulting in intractable problems. This shortcoming is solved in the literature using (i) scenario reduction methods, and/or (ii) speeding up optimization techniques. However, when reducing the number of scenarios, part of the stochastic information is lost. In this paper, an iterative scheme is proposed to get the solution of a stochastic problem representing the stochastic processes via a set of scenarios and/or finite sampling, and modeling risk via conditional value-at-risk. This iterative approach relies on the fact that the solution of a stochastic programming problem optimizing the conditional value-at risk only depends on the scenarios on the upper tail of the loss distribution. Thus, the solution of the stochastic problem is obtained by solving, within an iterative scheme, problems with a reduced number of scenarios (subproblems). This strategy results in an important reduction in the computational burden for large-scale problems, while keeping all the stochastic information embedded in the original set of scenarios. In addition, each subproblem can be solved using speeding-up optimization techniques. The proposed method is very easy to implement and, as numerical results show, the reduction in computing time can be dramatic, and more pronounced as the number of initial scenarios or samples increases.