Direct loss-based seismic design of reinforced concrete frame and wall structures

This paper presents a procedure to design reinforced concrete (RC) buildings to achieve an acceptable target level of earthquake-induced loss (e.g., deaths, dollars, downtime) under a site-specific hazard profile. The procedure is called “direct” since the target loss level is specified at the first step of the process, and virtually no iteration is required. The procedure is based on a simplified loss assessment involving a surrogate model for the seismic demand (i.e., probability distribution of peak horizontal deformation given ground-motion intensity) and simplified loss models for direct and indirect losses. For an arbitrarily-selected target loss level and structural geometry, the procedure provides the force-displacement curve of the corresponding equivalent single degree of freedom system. The principles of displacement-based design are adopted to provide member detailings (beams, columns, walls) consistent with such force-displacement curve. The procedure is applied to 16 realistic RC case studies with a lateral resisting system composed of frames in one direction and cantilever walls in the perpendicular one. They show different geometries, hazard profiles, and target values of direct economic expected annual loss. A benchmark loss estimation is obtained using cloud-based non-linear time-history analyses of multi-degree of freedom models. The procedure is conservative since the benchmark loss levels are always smaller than the targets. Such discrepancy is within 10% for 12 out of 32 case studies, between 10% and 20% for 13, between 20% and 31% for the remaining six. Therefore, the proposed procedure is deemed dependable for preliminary design

Up-to-date on erectile dysfunction and treatment

Erection is a haemodynamic event that involves the central nervous system and local factors and is the recurrent or persistent inability to achieve and or maintain an erection to allow satisfactory intercourse. The ED is a disease of great social impact: it is estimated that in Italy, 11-13% of men, or about 3 million are affected in part by ED. Main risk factors are: age, education level, anxiety, reactive depression, diabetes, heart disease, high blood pressure; disorders (hepatic failure, chronic renal failure, obesity, dyslipidemia); hormonal disorders (hypogonadism, hyperprolactinemia, hypo/hyperthyroidism); neuropathies (Alzheimer’s disease, Parkinson’s disease, degenerative diseases); urologic surgery, colorectal and vascular. Regarding therapy first and most important form of treatment for a patient suffering from erectile dysfunction is to identify and possibly modify or remove all hazardous conditions for sexual health. First line treatments are selective inhibitors of 5-phosphodiesterase; second-line treatments essentially include intracavernous injection of vasoactive substances and third line treatments include revascularization of the penis and prostesis implants

T1G3 high-risk NMIBC (non-muscle invasive bladder cancer): conservative treatment versus immediate cystectomy

Background The management of stage T1 poorly differentiated G3 bladder cancer invading the lamina propria continues to be debated. These tumours are associated with a high risk of recurrence and progression; concomitant carcinoma in situ and/or multifocality are negative prognostic factors. Choosing between a preserving approach such as transurethral resection of the bladder (TURB) followed by maintenance bacillus Calmette-Guerin (BCG) and an invasive approach like cystectomy is critical. Patients and methods Overall, 80 patients underwent TURB and RE-TURB followed by intra-vesical induction treatment with BCG plus maintenance (Group A) while 72 patients underwent immediate radical cystectomy with extended lymphadenectomy (Group B). Patients were divided into 3 subgroups: uni-focal tumours, multi-focal tumours and carcinoma in situ associated lesions. In Group A, time to first recurrence and time to progression were analysed. A comparison was made between Group A and Group B regarding progression-free survival, cancerspecific survival and overall survival with a median follow-up time of 8.3 years. Results As far as concerns Group A patients, 42 recurrences (52.5%) were reported in a median time of 10.4 months (range 3–26) and 25 progressions (31.2%) in a median time of 25 months (range 3–68). As far as concerns time to first recurrence and time to progression, both the Kaplan–Meier survival curves obtained are significant and P values are, respectively, 0.0263 and 0.0011. Comparing Groups A and B patients, 25 progressions (31.2%) in a median time of 25 months (range 3–68) and 18 progressions (25%) in a median time of 25.9 months (range 4–72), respectively, were recorded. Regarding overall survival, at 10 years, 24 deaths (42.5%) occurred in a median time of 55.4 months (range 12–94) in Group A and 42 deaths (58.3%) in a median time of 54.9 months (10–100) in Group B. Cancer-specific survival was evaluated in Group A with a total of 18 deaths (22.5%) in a median time of 47.5 months (range 16–78), and in Group B with a total of 16 deaths (22.2%) in a median time of 45.7 months (range 16–88). The progression-free survival Kaplan– Meier curve is not significant, the P value being 0.3801; the overall survival curve is significant with a P value of 0.0487 while the cancer-specific survival curve is not significant with a P value of 0.9762. Discussion In Group A, considering ‘‘time to first recurrence’’, the difference is greater between unifocal lesions and multifocal or Cis-associated lesions. Conversely, for ‘‘time to progression’’, there is a greater difference between unifocal and multifocal tumours and Cis-associated tumours. Looking at ‘‘progression-free survival’’ in Group A and Group B patients, there is no statistically significant difference, like in cancer-specific survival. A statistically significant difference was observed in overall survival being in favour of conservative treatment thus reflecting that conservative treatment is not burdened by all the surgical and post-operative complications of cystectomy. Conclusions Although NMIBC invading the lamina propria, stage G3, with or without Cis-associated lesions are burdened both by a high volume of recurrences and progressions, cystectomy could be considered an aggressive approach. New biological markers are now needed which are able to predict the behaviour of the cancer and to guide the decisionmaking process between conservative or aggressive treatment

Knotless "three-U-stitches" technique for urethrovesical anastomosis during laparoscopic radical prostatectomy

We describe a new technique for urethrovesical anastomosis that consists of placing three “U” stitches of Monocryl 2-0 to connect the bladder neck and urethral stump together. The margins are united by a double passage of the suture, without tying any knots. The sutures are tied on the bladder’s surface using Lapra-Ty clips fixed at a certain distance from where to two mucosal margins have been joined. We carried out this technique on 90 patients who underwent laparoscopic extraperitoneal radical prostatectomy. The good joining of the margins, the absence of knots and the minimum trauma to the urethral wall together enable to create an anastomosis that is both “sealed” and “tension free”, allowing a quick “welding” of the margins and an early catheter removal. Regarding urinary continence, 56.6% (51) of patientswere continent at catheter removal, 87.6% (78) were continent 3 months later and 98.9% (89) were continent after 6 months. In nine patients (10%), an episode of acute urinary retention occurred within 24 h after the removal of the catheter. We did not encounter any cases of vesicourethral anastomosis stenosis

Prospective open-label study on the efficacy and tolerability of a combination of nutritional supplements in primary infertile patients with idiopathic astenoteratozoospermia

Aim of the study: To evaluate with an open-label study the efficacy and safety of a complex of nutritional supplements with antioxidant activity (L-carnitine, acetyl-L-carnitine, fructose, citric acid, selenium, coenzyme Q10, zinc, ascorbic acid, cyanocobalamin, folic acid) in primary infertile patients with idiopathic astenoteratozoospermia. Methods: The study was conducted in a population of 114 infertile men (96 completed the study) diagnosed with idiopathic astenoteratozoospermia since at least 18 months. Patients orally received a formulation (Proxeed - Sigma-Tau) containing L-carnitine 145 mg, acetyl-L-carnitine 64 mg, fructose 250 mg, citric acid 50 mg, selenium 50 mcg, coenzyme Q10 20 mg, zinc 10 mg, ascorbic acid 90 mg, cyanocobalamin 1.5 mcg, folic acid 200 mcg in combination once a day for 4 months. Results: At the end of study, the mean sperm progressive motility showed a statistically significant increase from 18.3 ± 3.8 to 42.1 ± 5.5. Sixteen patients achieved pregnancy during the study. No significant improvement were observed for sperm density and rate of morphologically normal forms. The treatment was well tolerated. Conclusions: Carnitines in association with others functional substances can improve the most important parameters of sperm quality

Electrocardiographic RR Interval Dynamic Analysis to Identify Acute Stroke Patients at High Risk for Atrial Fibrillation Episodes During Stroke Unit Admission

Patients at short-term risk of paroxysmal atrial fibrillation (PAF) often exhibit increased RR interval variability during sinus rhythm. We studied if RR dynamic analysis, applied in the first hours after stroke unit (SU) admission, identified acute ischemic stroke patients at higher risk for subsequent PAF episodes detected within the SU hospitalization. Acute ischemic stroke patients underwent continuous cardiac monitoring (CCM) using standard bedside monitors immediately after SU admission. The CCM tracks from the first 48\ua0h were analyzed using a telemedicine service (SRA clinic, Apoplex Medical, Germany). Based on the RR dynamics, the stroke risk analysis (SRA) algorithm stratified the risk for PAF as follows: low risk for PAF, high risk for PAF, presence of manifest AF. The subsequent presence/absence of PAF during the whole SU hospitalization was ruled out using all available CCMs, standard ECGs, or 24-h Holter ECGs. Two hundred patients (40% females, mean age 71\u2009\ub1\u200916\ua0years) were included. According to the initial SRA analysis, 111 patients (56%) were considered as low risk for PAF, 52 (26%) as high risk while 37 patients (18%) had manifest AF. A low-risk level SRA was associated with a reduced probability for subsequent PAF detection (1/111, 0.9%, 95% CI 0-4.3%) while a high-risk level SRA predicted an increased probability (20/52, 38.5% (95% CI 25-52%). RR dynamic analysis performed in the first hours after ischemic stroke may stratify patients into categories at low or high risk for forthcoming paroxysmal AF episodes detected within the SU hospitalization

Reduced intraoperative bleeding during transurethral resection of the prostate: Evaluation of finasteride, vascular endothelial growth factor, and CD34

Finasteride is an antiandrogen that inhibits 5-α- reductase, an enzyme that converts testosterone to dihydrotestosterone. Finasteride significantly reduces intraoperative bleeding when 10 mg/d is administered for 60 days before transurethral resection of the prostate. Our double-blind, randomized, placebo-controlled study evaluated 200 patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate. We compared a placebo group (n = 100) with a group (n = 100) administered 5 mg of finasteride twice a day for 8 weeks. We intended to demonstrate the mechanisms and effects of finasteride compared with those of vascular endothelial growth factor, and to evaluate CD34, an immunohistochemical marker of blood vessel density in the prostate. Our results indicated a lower average microvascular density and vascular endothelial growth factor index for hypertrophic prostate in the finasteride group than in the placebo group

Very early onset of ATTRE89Q amyloidosis in a homozygous patient

Case Presentarion: Hereditary transthyretin amyloidosis is a progressive, fatal disease that generally involves the peripheral nervous system, the autonomic nervous system, and the heart. It is autosomal dominant with different penetrance depending on the mutation and the genetic background. Many other missense mutations of the TTR gene may cause the disease. Being an overall rare disease is very rare to observe the condition of homozygosity. In particular, cases of homozygosity have been described in patients with ATTRV30M and ATTRV122I amyloidosis. In the former, the phenotype does not seem to be aggravated, having an age of onset and disease course that does not appear to differ from those of heterozygotes, while in the latter, the onset appears to be earlier. Conclusion: We report the first case of ATTRE89Q amyloidosis in a patient that was homozygous for the E89Q mutation in the TTR gene. The clinical phenotype resulted in the earlier disease onset reported in this form of amyloidosis, suggesting that the homozygous condition may be prognostically negative

Penile prosthesis implant for erectile dysfunction: A new minimally invasive infrapubic surgical technique

Erectile dysfunction, the most common male sexual disorder after premature ejaculation, with its important impact on man and partner’s sexuality and quality of life is a persistent inability to obtain and maintain an erection sufficient to permit satisfactory sexual performance. Non-surgical treatments with controversial results are usually applyed before surgical treatment that has reached high levels of satisfaction. We describe a new surgical technique to implant three-pieces penile prosthesis in patients suffering from erectile dysfunction (ED) not responding to conventional medical therapy or reporting side effects with such a therapy. Implantation of an inflatable prosthesis, for treatment of ED, is a safe and efficacious approach with high satisfaction reported by patients and partners. Surgical technique should be minimally invasive and latest technology equipment should be implanted in order to decrease common complications and to obtain a better aesthetic result