Pancreatic cystosis in cystic fibrosis. Sometimes a bike ride can help you decide

Pancreatic cystosis (PC) is an uncommon manifestation of pancreas involvement in cystic fibrosis (CF), characterized by the presence of multiple macrocysts partially or completely replacing pancreas. Only few reports are available from literature and management (surgery vs follow up) is commonly based on the presence of symptoms or complications due to local mass effect, although evidence-based recommendations are still not available. We here report the case of a young adult CF patient with PC, in which cardiopulmonary exercise testing (CPET) provided important information to be integrated to the radiological finding of inferior vena cava compression by the multicystic pancreas complex. Through the analysis of oxygen kinetic cardiodynamic phase pattern, CPET may be helpful to safely exclude significant mass effects on blood venous return and to improve the decision-making process on whether to consider surgery or not in patients with PC

Unexpected death of a ventilator-dependent amyotrophic lateral sclerosis patient

Background: Amyotrophic lateral sclerosis (ALS) is a fatal, progressive, neurodegenerative disease and most patients affected die of respiratory compromise and/or pneumonia within 2â3 years of diagnosis. As ALS progresses, ventilator assistance is required. In the end stages of the disease, patients suffer from respiratory failure and may become ventilator-dependent. Deaths due to malfunction of mechanical ventilators are reported but there are very few forensic autopsy records. We report the case of a 69-year-old ALS female ventilator-dependent, trachostomised patient who was found dead by her husband, with the ventilator in âstand-byâ mode. Method: A forensic autopsy was performed. Samples of internal organs were taken for histological and toxicological examination. The ventilator internal memory was also analysed and tested in order to find possible malfunction. Results: Gross examination did not reveal any sign of trauma but showed brain and lung congestion. Pulmonary histological examination revealed thickening of peribronchial interstitial space, alveolar over-distension, break of inter-alveolar walls and diffuse alveolar haemorrhages. Focal microhemorrhages were also detected in other organs. Analysis of the ventilator internal memory showed that during the night of death, there had been several voltage drops. Specific tests revealed malfunction of the internal battery which was unable to provide the necessary voltage, as a consequence the ventilator switched off, stopping ventilation. Battery malfunction reduced the volume of the ventilator alarm, which was not heard by the caregiver. Conclusion: Histological pattern, with acute pulmonary emphysema and focal polivisceral haemorrhages, is strongly suggestive of a death due to âacuteâ asphyxia. The authors also discuss the need for strict supervision and follow up of these ventilatory dependent patients and their devices. Resumo: Introdução: A Esclerose Lateral Amiotrófica (ELA) é uma doença fatal, progressiva e neurodegenerativa e a maioria dos doentes afectados morrerão de falha respiratória e/ou pneumonia 2 ou 3 anos após o diagnóstico. à medida que a ELA progride torna-se necessária a assistência ventilatória. Nos estágios finais da doença, os doentes sofrem de insuficiência respiratória e podem tornar-se dependentes do ventilador. São conhecidas mortes devido ao mau funcionamento de ventiladores mecânicos mas existem poucos registos forenses de tal situação. Relatamos o caso de uma doente de 69 anos com ELA, traqueostomizada e dependente do ventilador, que foi encontrada morta pelo seu marido com o ventilador em modo de espera («stand-by»). Método: Foi realizada uma autópsia forense. Foram recolhidas amostras dos órgãos internos para exame toxicológico e histológico. A memória interna do ventilador foi também analisada e testada de modo a descobrir uma possível avaria. Resultados: O exame macroscópico não revelou qualquer sinal de trauma mas indicou congestão cerebral e pulmonar. O exame pulmonar histológico revelou o espessamento do espaço intersticial peribrônquico, sobredistensão alveolar, quebra de paredes interalveolares e hemorragias alveolares difusas. Foram detetadas micro-hemorragias focais noutros órgãos. A análise da memória interna do ventilador mostrou que, durante a noite da morte, houve diversas quedas de tensão. Testes específicos revelaram o mau funcionamento da bateria interna que não conseguiu fornecer a tensão necessária, consequentemente o ventilador desligou-se, parando a ventilação. O mau funcionamento da bateria reduziu o volume do alarme do ventilador, que não foi ouvido pelo prestador de cuidados. Conclusão: O padrão histológico, com enfisema pulmonar agudo e hemorragias focais poliviscerais, é fortemente indicador de morte devido a asfixia «aguda». Os autores discutem também a necessidade de uma supervisão rigorosa e seguimento destes doentes dependentes do ventilador e dos seus equipamentos. Keywords: Amyotrophic lateral sclerosis, Acute respiratory failure, Home mechanical ventilation, Palavras-chave: Esclerose lateral amiotrófica, Insuficiência respiratória aguda, Ventilação mecânica doméstic

Combined effects of electromagnetic fields on immune and nervous responses.

In technologically developed countries, there is concern about hazards from electromagnetic fields (EMFs). Several studies have reported that immune and neuroendocrine systems exert an integrated response to EMF exposure. The aim of this review is to summarize the results of studies on the effect of low and high frequency EMF on immune and neuroendocrine systems on which our research group has been working for several years

Digital, memory and mixed-signal test engineering education: five centres of competence in Europe

The launching of the EuNICE-Test project was announced two years ago at the first DELTA Conference. This project is now completed and the present paper describes the project actions and outcomes. The original idea was to build a long-lasting European Network for test engineering education using both test resource mutualisation and remote experiments. This objective is fully fulfilled and we have now, in Europe, five centres of competence able to deliver high-level and high-specialized training courses in the field of test engineering using a high-performing industrial ATE. All the centres propose training courses on digital testing, three of them propose mixed-signal trainings and three of them propose memory trainings. Taking into account the demand in test engineering, the network is planned to continue in a stand alone mode after project end. Nevertheless a new European proposal with several new partners and new test lessons is under construction

A chart review on the feasibility and safety of the Vincristine Irinotecan Pazopanib (VIPaz) association in children and adolescents with resistant or relapsed sarcomas

Background: Pediatric patients with relapsed or refractory sarcomas have poor outcome and need novel therapies that provide disease control while maintaining an acceptable quality of life. The safety of vincristine, irinotecan, and pazopanib (VIPaz) association has not yet been published in this population. Methods: A chart review was conducted in children and adolescents with relapsed or refractory bone and soft tissue sarcomas who received VIPaz in our institution. Results: One hundred sixty-six patients with a diagnosis of soft or bone sarcoma were admitted to our hospital in the period between March 2015 and August 2018, 30 were relapsed or resistant. Seventeen out of 30 resistant or relapsed patients (median age, 14 years) received 114 VIPaz cycles (median six cycles per patient, range 1–17). Sixteen courses (15%) resulted in gastrointestinal toxicity with Grade two diarrhea; 35 courses (30%) resulted in Grade ≥3 neutropenia. One patient presented Grade two hypothyroidism after nine courses, and another one had Grade two hyperbilirubinemia after 12 courses. Two and five patients required a 25% dose reduction of irinotecan (because of diarrhea) and pazopanib (because of neutropenia four and hyperbilirubinemia 1), respectively. No patient experienced heart failure, hypertension, nor posterior reversible encephalopathy syndrome. Pneumothorax was not reported in any case even in lung metastatic patients. After two and four VIPaz cycles, we observed one complete response (CR), five partial responses (PRs), seven stable diseases (SDs), and four progressive diseases (PDs). With a median follow-up of 15 months (range 3–32), five out of 17 (29%) patients were alive, and four patients were in continuous CR after 12 VIPaz cycles. Conclusions: The VIPaz regimen might be a safe option in children and adolescents with relapsed or refractory sarcomas otherwise unable to be enrolled in other clinical trials; on the other hand, the efficacy of pazopanib observed cannot be sustained from the current study

Electron Gun and Magnetic Systems Studies for a 36 GHz Klystron Amplifier

Self consistent analytic and numeric design for a set of innovative electron guns suitable for Ka-band klystrons is proposed in this paper. The proposed electron sources are designed to produces narrow beam with high currents that can be used in devices with critical dimensions. The proposed set of electron gun is destined to high power klystrons to be used as power sources for accelerating structures operating in Ka-Band. This family of accelerators is foreseen to achieve energy gradients around 150 MV/m. A klystron amplifier is being investigated in order to feed a linearizer structure. In this paper different electron gun and beam focusing channel designs are presented

Spatially embedded random networks

Many real-world networks analyzed in modern network theory have a natural spatial element; e.g., the Internet, social networks, neural networks, etc. Yet, aside from a comparatively small number of somewhat specialized and domain-specific studies, the spatial element is mostly ignored and, in particular, its relation to network structure disregarded. In this paper we introduce a model framework to analyze the mediation of network structure by spatial embedding; specifically, we model connectivity as dependent on the distance between network nodes. Our spatially embedded random networks construction is not primarily intended as an accurate model of any specific class of real-world networks, but rather to gain intuition for the effects of spatial embedding on network structure; nevertheless we are able to demonstrate, in a quite general setting, some constraints of spatial embedding on connectivity such as the effects of spatial symmetry, conditions for scale free degree distributions and the existence of small-world spatial networks. We also derive some standard structural statistics for spatially embedded networks and illustrate the application of our model framework with concrete examples

Test engineering education in Europe: the EuNICE-Test project

The paper deals with a European experience of education in industrial test of ICs and SoCs using remote testing facilities. The project addresses the problem of the shortage in microelectronics engineers aware with the new challenge of testing mixed-signal SoCs far multimedia/telecom market. It aims at providing test training facilities at a European scale in both initial and continuing education contexts. This is done by allowing the academic and industrial partners of the consortium to train engineers using the common test resources center (CRTC) hosted by LIRMM (Laboratoire d'Informatique, de Robotique et de Microelectronique de Montpellier, France). CRTC test tools include up-to-date/high-tech testers that are fully representative of real industrial testers as used on production testfloors. At the end of the project, it is aimed at reaching a cruising speed of about 16 trainees per year per center. Each trainee will have attend at least one one-week training using the remote test facilities of CRTC

high energy x ray emission driven by high voltage circuit system

The x-rays are produced by high voltage discharge applied inside plasma source interaction chamber; the control circuit system of high voltage is composed of a power supply and a LC-inverter. The goal of the project is based on the production of x-rays by a plasma to increase the efficiency of a classic x-ray tube with hot filament. Preliminary results of high energy x-rays emission, the layout and simulation with p-spice of the high voltage system are presented

Outpatient prescription writing quality in a paediatric general hospital

Introduction The writing of prescriptions is an important aspect of medical practice. Since 2006, the Swiss authorities have decided to impose incentives to prescribe generic drugs. The objectives of this study were 1) to determine the evolution of the outpatient prescription practice in our paediatric university hospital during 2 periods separated by 5 years; 2) to assess the writing quality of outpatient prescriptions during the same period.Materials & Methods Design: Copies of prescriptions written by physicians were collected twice from community pharmacies in the region of our hospital for a 2-month period in 2005 and 2010. They were analysed according to standard criteria regarding both formal and pharmaceutical aspects. Drug prescriptions were classified as a) complete when all criteria for safety were fulfilled, b) ambiguous when there was a danger of a dispensing error because of one or more missing criteria, or c) containing an error.Setting: Paediatric university hospital.Main outcome measures: Proportion of generic drugs; outpatient prescription writing quality.Results: A total of 651 handwritten prescriptions were reviewed in 2005 and 693 in 2010. They contained 1570 drug prescriptions in 2005 (2.4 ± 1.2 drugs per patient) and 1462 in 2010 (2.1 ± 1.1). The most common drugs were paracetamol, ibuprofen, and sodium chloride. A higher proportion of drugs were prescribed as generic names or generics in 2010. Formal data regarding the physicians and the patients were almost complete, except for the patients' weight. Of the drug prescriptions, 48.5% were incomplete, 11.3% were ambiguous, and 3.0% contained an error in 2005. These proportions rose to 64.2%, 15.5% and 7.4% in 2010, respectively.Discussions, Conclusion This study showed that physicians' prescriptions comprised numerous omissions and errors with minimal potential for harm. Computerized prescription coupled with advanced decision support is eagerly awaited.Disclosure of Interest None Declare