Ultrasound-guided laser ablation for local control of neck recurrences of medullary thyroid cancer. A feasibility study.

Surgery is the standard treatment for cervical metastases of medullary thyroid cancer (MTC) diagnosed after initial surgical treatment. Repeated neck dissections, however, carry an elevated risk of complications, have an adverse impact on the quality of life, and sometimes do not achieve cure of the disease Clinical case: In a patient who had undergone two cervical neck dissections complicated by accessory nerve injury, an US-guided laser ablation (LA) of a lymph node metastasis of MTC was performed. LA was performed with two treatments during a five month period. The procedure was carried out with one optical fiber and an energy delivery of 3300 and 360 Joules. Treatments were well tolerated and resulted in complete structural and biochemical cure during a 12 month follow-up. No major complication was registered.LA is a promising tool for the management of relapsing cervical metastases that are localized in non- critical areas and are characterized by low progression rate. Advantages of LA are the outpatient setting, the absence of general anesthesia, the tolerability and the safety of the procedure. Thus, LA may be considered as an alternative approach to surgery or active surveillance for the management of local recurrences of MTC in selected patients

Simulation of real world circuits: Extending conventional analysis methods to circuits described by heterogeneous languages

Circuit simulation is seen by some people as a well established discipline, where there remains little or no space for improvement. Yet, no steady state and stability analysis methods are available for circuits described by a combination of analog, digital and behavioral parts. Recently, the theory necessary for development of such simulators was proposed and a circuit simulator incorporating these theoretical developments has been presented. It manages analog, digital and behavioral components, while retaining all the classical "spice-like" features. This was possible by importing some mathematical concepts from the hybrid dynamical systems realm. Such tools represent the interface between the conventional analog world and the more contemporary digital/behavioral one. The reviewed simulation framework is appealing not only for people interested in circuit analysis and design, but for all researches and engineers working in the wider field of system simulation where the analog mixed signal concept is absolutely pervasive

How to Drive Innovation Within Outsourcing Relations: The Role of Performance Evaluation and Management Control Systems

The themes of performance and outsourcing have been the subjects of extensive studies in academic literature for a long time. Literature has explored a variety of control structures and practices, as archetypes of management control within and between organizations, with the aim of identifying the optimal control design. The design of management control in ITO becomes part of a general problem of effective governance structures and the role of accounting information. However, many accounting related aspects remain unexplored. We explore in this paper the “lateral processing of information” [1], trying to move beyond the static concept of control, adopting a dynamic view, with the aim of better taking into account both the evolution and change of the outsourcing relationship as well as the factors that have influenced this process. Our empirical study focuses on the outsourcing relationship between a public healthcare organization, in Italy, and its supplier. This case highlights how a management control system acts as a mechanism that facilitates to mediate, shape and construct outsourcing relations through self-regulating and orchestration mechanisms

Extension of the variational equation to analog/digital circuits: numerical and experimental validation

Conventional shooting methods cannot be used to determine the steady-state solution of circuits whose model is characterised by a vector field exhibiting zero order discontinuities. In the analysis of circuits working on a stable limit cycle, this limitation prevents the use of methods that exploit Floquet theory to compute the variational model and thus the properties of the fundamental matrix and, for example, phase noise in oscillators. In this paper, we use an improved shooting method that solves this drawback by resorting to saltation matrices and show how this method makes possible the correct computation of the first left eigenfunction (known as ppv) of the fundamental matrix. ppvs are a key aspect in determining phase noise. The results obtained through numerical simulations are compared with measurements on a relaxation oscillator serving as a simple but significant comparison vehicle