Anatomía de la pared torácica : Implicancia para la realización de las toracotomías laterales

El objetivo del trabajo se basa en la descripción detallada de la anatomía de los músculos ánterolaterales del tórax, sus pedículos vásculonerviosos y la importancia que implica en el abordaje quirúrgico del tórax. Se procede a la disección de 8 preparados formalizados de ambos sexos en los cuales se realiza una disección minuciosa de los músculos ánterolaterales de la pared torácica y de sus pedículos vásculonerviosos. Se procedió posteriormente a realizar la movilización del músculo dorsal ancho y la disección del pedículo del músculo serrato mayor.Facultad de Ciencias Médica

Anatomía de la pared torácica : Implicancia para la realización de las toracotomías laterales

El objetivo del trabajo se basa en la descripción detallada de la anatomía de los músculos ánterolaterales del tórax, sus pedículos vásculonerviosos y la importancia que implica en el abordaje quirúrgico del tórax. Se procede a la disección de 8 preparados formalizados de ambos sexos en los cuales se realiza una disección minuciosa de los músculos ánterolaterales de la pared torácica y de sus pedículos vásculonerviosos. Se procedió posteriormente a realizar la movilización del músculo dorsal ancho y la disección del pedículo del músculo serrato mayor.Facultad de Ciencias Médica

Design and performance evaluation of a lightweight wireless early warning intrusion detection prototype

The proliferation of wireless networks has been remarkable during the last decade. The license-free nature of the ISM band along with the rapid proliferation of the Wi-Fi-enabled devices, especially the smart phones, has substantially increased the demand for broadband wireless access. However, due to their open nature, wireless networks are susceptible to a number of attacks. In this work, we present anomaly-based intrusion detection algorithms for the detection of three types of attacks: (i) attacks performed on the same channel legitimate clients use for communication, (ii) attacks on neighbouring channels, and (iii) severe attacks that completely block network's operation. Our detection algorithms are based on the cumulative sum change-point technique and they execute on a real lightweight prototype based on a limited resource mini-ITX node. The performance evaluation shows that even with limited hardware resources, the prototype can detect attacks with high detection rates and a few false alarms. © 2012 Fragkiadakis et al

Ubiquitous robust communications for emergency response using multi-operator heterogeneous networks

A number of disasters in various places of the planet have caused an extensive loss of lives, severe damages to properties and the environment, as well as a tremendous shock to the survivors. For relief and mitigation operations, emergency responders are immediately dispatched to the disaster areas. Ubiquitous and robust communications during the emergency response operations are of paramount importance. Nevertheless, various reports have highlighted that after many devastating events, the current technologies used, failed to support the mission critical communications, resulting in further loss of lives. Inefficiencies of the current communications used for emergency response include lack of technology inter-operability between different jurisdictions, and high vulnerability due to their centralized infrastructure. In this article, we propose a flexible network architecture that provides a common networking platform for heterogeneous multi-operator networks, for interoperation in case of emergencies. A wireless mesh network is the main part of the proposed architecture and this provides a back-up network in case of emergencies. We first describe the shortcomings and limitations of the current technologies, and then we address issues related to the applications and functionalities a future emergency response network should support. Furthermore, we describe the necessary requirements for a flexible, secure, robust, and QoS-aware emergency response multi-operator architecture, and then we suggest several schemes that can be adopted by our proposed architecture to meet those requirements. In addition, we suggest several methods for the re-tasking of communication means owned by independent individuals to provide support during emergencies. In order to investigate the feasibility of multimedia transmission over a wireless mesh network, we measured the performance of a video streaming application in a real wireless metropolitan multi-radio mesh network, showing that the mesh network can meet the requirements for high quality video transmissions

Compliance and persistence with osteoporosis medications: A critical review of the literature

It is widely acknowledged that compliance and persistence with oral osteoporosis medications, particularly with bisphosphonates, is poor. Several excellent reviews have been written on compliance and persistence with osteoporosis medications and have discussed improvements seen with extended dosing intervals. This review begins with studies on extended dosing intervals to examine the limitations of administrative claims data. It also looks at compliance and persistence across multiple medical conditions, examining the importance of prescription fulfillment, intentional choice, causation and possible interventions

Using clinical risk factors and bone mineral density to determine who among patients undergoing bone densitometry should have vertebral fracture assessment

Vertebral fracture assessment (VFA) is a new method for imaging thoracolumbar spine on bone densitometer. Among patients referred for bone densitometry, the selection of patients for VFA testing can be optimized using an index derived from clinical risk factors and bone density measurement. VFA, a method for imaging thoracolumbar spine on bone densitometer, was developed because vertebral fractures, although common and predictive of future fractures, are often not clinically diagnosed. The study objective was to develop a strategy for selecting patients for VFA. A convenience sample from a university hospital bone densitometry center included 892 subjects (795 women) referred for bone mineral density (BMD) testing. We used questionnaires to capture clinical risk factors and dual-energy X-ray absorptiometry to obtain BMD and VFA. Prevalence of vertebral fractures was 18% in women and 31% in men (p = 0.003 for gender difference). In women, age, height loss, glucocorticoid use, history of vertebral and other fractures, and BMD T-score were significantly and independently associated with vertebral fractures. A multivariate model which included above predictors had an area under the receiver operating curve of 0.85 with 95% confidence interval (CI) of 0.81 to 0.89. A risk factor index was derived from the above multivariate model. Using a level of 2 as a cut-off yielded 93% sensitivity (95% CI 87, 96) and 48% specificity (95% CI 69, 83). Assuming a 15% prevalence of vertebral fractures, this cut-off value had a 24% positive and 97% negative predictive value and required VFA scanning of three women at a cost of $60 (assuming a$20 cost/VFA scan) to detect one with vertebral fracture(s). Selecting patients for VFA can be optimized using an index derived from BMD measurement and easily obtained clinical risk factors

Management of osteoporosis in central and eastern Europe (CEE): conclusions of the “2nd Summit on Osteoporosis—CEE”, 21–22 November 2008, Warsaw, Poland

In November 2008, the “2nd Summit on Osteoporosis—Central and Eastern Europe (CEE)” was held in Warsaw, Poland. Discussions at this meeting focused on the identification and discussion of diagnostic, preventive, and therapeutic measures used in CEE. Evaluated information was used to identify issues regarding diagnosis and therapy of osteoporosis in these countries to facilitate the subsequent setup of appropriate support and development strategies. The main debate was structured according to the following five subjects: (1) present status and future perspectives for implementation of FRAX® into local (CEE) diagnostic algorithms, (2) principles of drug selection in osteoporosis treatment in CEE countries, (3) nonpharmacological interventions in osteoporosis treatment and prophylaxis in CEE countries, (4) treatment benefit evaluation, and (5) cost–effectiveness and evaluation of reimbursement policies in CEE countries. The most important and substantial comments of the delegates are summarized in the present article. The multinational panel of experts with representatives from many CEE countries as well as Austria and Switzerland made the “2nd Summit on Osteoporosis—CEE” a perfect platform to identify issues and needs regarding diagnosis and therapy of osteoporosis as well as the cost–effectiveness of osteoporosis management in CEE countries. The information gained will serve as a basis for the development of strategies to resolve the identified issues at the “3rd Summit on Osteoporosis—CEE” in November 2009

Periferne osteoporotske frakture osim kuka - epidemiologija i značenje

Fractures are the most serious consequence of osteoporosis. Non-vertebral and non-hip fractures are seldom recognised as important, even though they account for the majority of all fractures. The most prevalent localisations are distal radius, proximal humerus, ribs, clavicle, and the pelvis. According to the results from large phase III clinical trials for placebo groups, their incidence ranges from 4.9 % to 12.0 %. Hospital morbidity data in Croatia in 2006 show that peripheral non-hip fractures ranked among the leading fifteen injuries, accounting for 23.7 % of all injuries in patients aged 60 years and above. Risk factors for non-hip and non-vertebral fractures are similar to other osteoporotic fractures, and the main are low bone mineral density and earlier fractures. Quality of life is considerably affected by these fractures, and medical costs are very high, soaring as high as 36.9 % of all national medical costs in the USA. Nonvertebral non-hip fractures need more attention, which was also recognised by the European regulatory bodies that approve use of anti-osteoporotic drugs.Prijelomi su najozbiljnija posljedica osteoporoze. Iako čine većinu svih fraktura, nevertebralne frakture osim kuka rijetko se prepoznaju kao značajne. Najčešće lokalizacije tih prijeloma su: distalni dio radijusa, proksimalni dio humerusa, rebra, klavikula i zdjelica. Prema rezultatima iz placebo-grupa III. faze velikih kliničkih ispitivanja raspon njihove incidencije iznosi između 4,9 % i 12,0 %. Prema podacima bolničkog pobolijevanja za 2006. g. u Hrvatskoj, među 15 vodećih ozljeda u dobnoj grupi 60 i više godina 23,7 % bile su periferne frakture osim kuka. Čimbenici rizika za nevertebralne frakture osim onih kuka slični su kao i za druge osteoporotske frakture gdje središnje mjesto imaju niska mineralna gustoća kosti i prethodne frakture. Ove frakture imaju velik utjecaj na kvalitetu `ivota, a njihovi su troškovi vrlo visoki, tako da u SAD-u iznose čak 36.9 % svih nacionalnih medicinskih troškova. Nevertebralne frakture osim kuka zahtijevaju veću pozornost, što su i prepoznala europska regulatorna tijela koja odobravaju upotrebu antiosteoporotskih lijekova