500 penile prostheses implanted by a surgeon in Italy in the last 30 years

OBJECTIVES: The aim of our study was to report our experience with patients affected by Erectile Dysfunction (ED) and undergoing penile prosthetic implantation (PPI) in a single center by a single surgeon. MATERIAL AND METHODS: We retrospectively evaluated the clinical outcome of 500 patients (mean age: 51.5 years, range: 20-86 years) affected by ED and referred to our private andrological center from January 1984 to December 2013 who underwent penile prosthesis implantation, including the reported level of patient satisfaction. RESULTS: 182 silicone, 180 malleable, 18 monocomponent hydraulic and 120 multicomponents hydraulic prostheses were implanted by the same experienced surgeon. All patients were hospitalized for the procedure. All patients were evaluated immediately, 1 month (496 patients) and, for the great majority, every year after implantation. One hundred twenty five patients were lost to follow-up. Twenty two patients underwent revision surgery for complications in the postoperative period. The most serious postoperative complications were mechanical problems (45 patients, 9.0%) and infection (15 patients, 3%). Forty two (8.4%) prostheses were explanted. Overall, 80% (400/500) of patients were able to have sexual intercourse and were fully satisfied with the results. CONCLUSIONS: In our experience prosthetic surgery should be considered a good solution for men affected by ED and not responsive to other therapeutic solutions. Prosthetic surgery can be performed not only in large public hospitals but also in smaller private facilities

Robustness Analysis of Historical Timber Roofs: A Case Study of the Gaggiandre Shipyard at the Arsenale of Venice

In this work, a deterministic approach is adopted to analyze the robustness of the timber roof of the Gaggiandre shipyard at the Arsenale of Venice. The capacity of the traditional timber truss to withstand the design loads as a result of the damage in the strut-tie node is evaluated according to the alternative load path method. Two layouts of the trusses are analyzed and compared: before and after the Austrian retrofitting intervention, performed in the late 1800s. For both configurations, robustness analyses are carried out by using linear 2D numerical models that consider the effective rotational capacity of the structural nodes in relation to the construction methods of the timber joints. For the configuration subject to the 19th-century restoration, the 3D response of the roof is also analyzed to verify the additional contribution provided by the longitudinal bracing system to the activation of alternative load paths (bridge effect). The results obtained with the differentanalyses are thoroughly evaluated, providing an indication of the deterministic robustness index of the roofing system based on different assumptions. The outcomes of this work allow to draw some general considerations on the method that could be used for the robustness assessment of historical wood systems

The woman and the penile prosthetic implant. Primary or secondary role? Personal experiences on 355 implanted patients.

In a group of 355 pts submitted to Penile Prosthesis Implant (PPI) we recorded data on their relationships with the woman (wife, partner, girlfriend, lover); the aspects of their sexual life; if they were married, divorced or widowed; if they had a lover; if they frequented brothels; if they were satisfied of their actual couple's life; after operation we recorded data concerning if they had some difficulties utilizing the PPI and their level of satisfaction. After operation most pts (93%) confirmed their satisfaction. Relational aspects: Unmarried pts: 6 pts (21-30 years old) who weren't able to penetrate their girlfriends managed to have regular sex with PPI and could marry. 42/46 unmarried pts after PPI decided to marry. In the group of married pts 3 pts weren't able to penetrate their wives; after PPI they managed to have regular intercourses and pregnancies. 15 widowers and 23 divorced pts decided to have a PPI for possible sexual encounters or stable relationships. 96/271 (28,2%) married pts declared a stable extramarital relation that could represent the main reason for having a PPI. The results of PPI are commonly accepted. Until now PPI may re-establish penile rigidity and maintenance. In our opinion the simple act of penetrate and ejaculate in vagina, without considering the importance of personal, relational, emotional factors often well linked to the specific woman, cannot be considered the ideal target of PPI

FlexState: Flexible State Management of Network Functions

Network function (NF) developers have traditionally prioritized performance when creating new packet processing capabilities. This was usually driven by a market demand for highly available solutions with differentiating features running at line rate, even at the expense of flexibility and tightly-coupled monolithic designs. Today, however, the market advantage is achieved by providing more features in shorter development cycles and quickly deploying them in different operating environments. In fact, network operators are increasingly adopting continuous software delivery practices as well as new architectural styles (e.g., microservices) to decouple functionality and accelerate development. A key challenge in revisiting NF design is state management, which is usually highly optimized for a deployment by carefully selecting the underlying data store. Therefore, migrating to a data store that suits a different use case is time-consuming as it requires code refactoring and adaptation to new application programming interfaces, APIs. As a result, refactoring NF software for different environments can take up to months, reducing the pace at which new features and upgrades can be deployed in production networks. In this paper, we demonstrate experimentally that it is feasible to introduce an abstraction layer to decouple NF state management from the data store adopted while still approaching line-rate performance. We present FlexState, a state management system that exposes data store functionality as configuration options, which reduces code refactoring efforts. Experiments show that FlexState achieves significant flexibility in optimizing the state management, and accelerates deployment on new scenarios while preserving performance and scalability.Peer reviewe

On Reconfiguring 5G Network Slices

The virtual resources of 5G networks are expected to scale and support migration to other locations within the substrate. In this context, a configuration for 5G network slices details the instantaneous mapping of the virtual resources across all slices on the substrate, and a feasible configuration satisfies the Service-Level Objectives (SLOs) without overloading the substrate. Reconfiguring a network from a given source configuration to the desired target configuration involves identifying an ordered sequence of feasible configurations from the source to the target. The proposed solutions for finding such a sequence are optimized for data centers and cannot be used as-is for reconfiguring 5G network slices. We present Matryoshka, our divide-and-conquer approach for finding a sequence of feasible configurations that can be used to reconfigure 5G network slices. Unlike previous approaches, Matryoshka also considers the bandwidth and latency constraints between the network functions of network slices. Evaluating Matryoshka required a dataset of pairs of source and target configurations. Because such a dataset is currently unavailable, we analyze proof of concept roll-outs, trends in standardization bodies, and research sources to compile an input dataset. On using Matryoshka on our dataset, we observe that it yields close-to-optimal reconfiguration sequences 10X faster than existing approaches.Peer reviewe

Seismic risk assessment of a new RC-framed skin technology for integrated retrofitting interventions on existing buildings

A RC-framed-skin technology for the integrated seismic and thermal retrofitting interventions on existing buildings, recently proposed by some of the authors, is thoroughly investigated. By means of numerical analyses, its effectiveness and suitability within the framework of seismic risk class assessment is proved. The system is composed of a RC-framed structure with an external reinforced plaster layer that does not offer a structural contribution to the capacity of the system in ultimate conditions, but which can be effective by increasing the lateral stiffness in serviceability conditions. The system is realized from the outside of the existing building so guaranteeing limited invasiveness of the intervention and preventing the interruption of the building use by their occupants. An existing RC building, representative of a typical example of the Italian building stock, is analyzed as a case study, and its seismic risk class upgrade, obtained by the proposed strengthening intervention, is assessed by non-linear static analysis. The numerical models are developed within the OpenSees framework. The Expected Annual Loss (EAL) parameter, together with the Life Safety Index (LS-I), are chosen as synthetic measures that include both aspects related to Ultimate Limit state (ULS) and Serviceability Limit State (SLS) conditions. The risk class accounting for or disregarding the contribution of the external reinforced plaster are finally compared

Orbital floor reconstruction with high density polyethylene

Surgical interventions in blow out fractures are generally indicated in cases of alterations in orbital function (e.g. diplopia)and for aesthetic reasons (e.g. enophthalmos). In assessing the severity of the injury, the clinician often uses parameterssuch as changes in visual acuity, patient-reported diplopia, changes in globe position and evaluation of the extraocularmuscles in association with imaging exams. Computed tomography has been the modality of choice for detailed imagingdiagnosis and surgical planning of orbital trauma. High density polyethylene may be successfully used in orbital floorreconstruction to restore function and esthetics. Taking into account the follow up of six months, the availability and theadvantages of high density polyethylene implants, it can be concluded that their use in reconstruction of orbital floordefects is a good choice

Reconstrução de assoalho orbital com polietileno de alta densidade

Surgical interventions in blow out fractures are generally indicated in cases of alterations in orbital function (e.g. diplopia)and for aesthetic reasons (e.g. enophthalmos). In assessing the severity of the injury, the clinician often uses parameterssuch as changes in visual acuity, patient-reported diplopia, changes in globe position and evaluation of the extraocularmuscles in association with imaging exams. Computed tomography has been the modality of choice for detailed imagingdiagnosis and surgical planning of orbital trauma. High density polyethylene may be successfully used in orbital floorreconstruction to restore function and esthetics. Taking into account the follow up of six months, the availability and theadvantages of high density polyethylene implants, it can be concluded that their use in reconstruction of orbital floordefects is a good choice.Justifica-se intervir cirurgicamente em fraturas do tipo blow out naqueles casos em que haja alterações da função orbital,como a diplopia, ou mesmo por razões estéticas, como a enoftalmia. Clinicamente, as fraturas do tipo blow out revelamalterações estéticas e funcionais que, associadas aos exames complementares por imagem, como a tomografiacomputadorizada, indicam o procedimento cirúrgico reparador. A utilização do polietileno de alta densidade (PAD) nareconstrução do assoalho orbital reduz a morbidade do enxerto autógeno, apresentando estabilidade e biocompatibilidade.Este artigo discute um caso cirúrgico de evolução favorável após seis meses de reconstrução do assoalho orbital com PAD

Percepção de enfermeiros-líderes sobre o gerenciamento de conflitos no ambiente hospitalar

Aim: to know the perception of nurse leaders about managing conflicts in the hospital enviroment. Method: qualitative and descriptive research, which was attended by ten nurses who worked in a hospital in southern Brazil. The data collection was conducted from October to November 2014 through semistructured interviews and analyzed according to the Operative Proposal. Results: the relationship conflicts were the most experienced by the participants. Those conflicts were caused by the lack of continuity of the activities performed by the nursing staff and by overwork. Dialogue and meetings were mentioned as the main strategies adopted to minimize them. Final thoughts: to be competent, the conflict management requires greater investment in education, during the graduationObjetivo: conocer la percepción de enfermeros-líderes sobre la gestión de conflictos en el hospital. Método: investigación cualitativa y descriptiva, en que participaron diez enfermeros trabajadores de un hospital del sur de Brasil. La recolección de datos ocurrió entre octubre/noviembre de 2014, a través de entrevistas semiestructuradas analizadas según la Propuesta Operativa. Resultados: los conflictos de relacionamiento fueron los más vivenciados pelos participantes siendo causados por la falta de continuidad de las actividades realizadas por el equipo de enfermería y el exceso de trabajo. Diálogo y reuniones fueron las principales estrategias adoptadas para minimizarlos. Consideraciones finales: para ser resolutivo, el gerenciamiento de conflictos necesita de mayores investimentos en la educación, durante la graduación.Objetivo: conhecer a percepção de enfermeiros-líderes sobre o gerenciamento de conflitos no ambiente hospitalar. Método: pesquisa qualitativa e descritiva, em que participaram dez enfermeiros que trabalhavam em um hospital da região sul do Brasil. A coleta de dados foi realizada nos meses de outubro a novembro de 2014, por meio de entrevistas semiestruturadas e analisadas conforme Proposta Operativa. Resultados: os conflitos de relacionamento foram os mais relatados pelos participantes, sendo causados pela falta de continuidade das atividades desempenhadas pela equipe de enfermagem e excesso de trabalho. O diálogo e a realização de reuniões foram as principais estratégias adotadas para minimizá-los. Considerações finais: para ser resolutivo, o gerenciamento de conflitos carece de maiores investimentos no ensino, durante a graduação