Continuous rate infusion of dexmedetomidine vs subcutaneous administration in anaesthetized horses undergoing MRI examination

Up to 2005, dexmedetomidine use had not been reported in equine. Since then, several experimental and clinical studies have been published. The main reason for this increase relies on its beneficial pharmacological profile, including short half-life and rapid redistribution (1). The aim of the study is to compare the clinical effects and recovery quality after continuous rate infusion (CRI) or subcutaneous administration of dexmedetomidine in horses undergoing general anaesthesia. Fourteen horses scheduled for MRI examination were included. All horses were sedated with acepromazine 0.03 mg kg-1 intravenously (IV) and detomidine 10 \ub5g kg-1 (IV). Anaesthesia was induced with ketamine 3 mg kg-1 (IV) and diazepam 0.04 mg kg-1 (IV) and maintained with isofluorane in 60% oxygen; end-tidal isoflurane concentration was maintained between 1.3-1.4 %. Horses were randomly divided in two groups. Group \u201cDex CRI\u201d received dexmedetomidine intravenously at 1 \ub5g kg-1 hour-1, group \u201cDex SC\u201d received 2 \ub5g kg-1 of dexmedetomidine subcutaneously every 60 minutes. If nystagmus or incessant fighting against ventilator occurred, ketamine rescue at 0.1 mg kg-1 was given. In case of sudden movements, thiopental 0.5-1.0 mg kg-1 IV was given. Ringer\u2019s lactate was given at 3 mL kg-1 hour-1, dobutamine was administered IV and the rate adjusted to maintain MAP>70 mmHg. Controlled mechanical ventilation using intermittent positive pressure ventilation was adjusted to maintain arterial carbon dioxide partial pressure between 38-45 mmHg. Heart rate, invasive arterial blood pressure, arterial blood gases, total dose of dobutamine administered, ketamine rescue needed, urine production were recorded. Time required until extubation and time to attain sternal and standing position were noted. The main anaesthesiologist assessed recovery quality graded on a standard scoring 5-point scale with a score of 1 representing the best recovery (2). Mann-Whitney U test was applied for non-parametric data and T-test for parametric data (p 640.05). There was no statistically differences in physiological intra-anaesthetic parameters, in body weight (kg) (CRI 521\ub153; SC 506\ub176), age (years) (CRI 10.7\ub12.1; SC 10.8\ub14.1), anaesthesia duration (min) (CRI 139\ub19.,7; SC 144\ub116.2), number of ketamine rescue needed (CRI 1\ub11.15; SC 0.5\ub11.13), recovery score (CRI 1.8\ub11,2; SC 1.5\ub10,5). Also time until extubation (min) (CRI 11.5\ub15.0; SC 9.7\ub12.6), time to attain sternal (min) (CRI 41.5\ub112.2; SC 49.7\ub16.0) and standing position (min) (CRI 50.7\ub114.6; SC 57.2\ub16.,0) were not statistically different. There was statistical significance in urine production (L) (CRI 8.0\ub13.5; SC 11.1\ub14.4) and total dobutamine mcg/kg/min (CRI 0.89\ub10.35; SC 0.56\ub10.18). Subcutaneous administration of dexmedetomidine has product similar clinical effects to those achieved with CRI. It has permitted a significative reduction in dobutamine administration and a more stable depth of anaesthesia confirmed by the lower number of rescue ketamine boluses required even if not statistically different. Further studies are required to evaluate different dosages both in CRI and subcutaneous administration

Higher Prostate Weight Is Inversely Associated With Gleason Score Upgrading In Radical Prostatectomy Specimens

Background. Protective factors against Gleason upgrading and its impact on outcomes after surgery warrant better definition. Patients and Methods. Consecutive 343 patients were categorized at biopsy (BGS) and prostatectomy (PGS) as Gleason score, ≤6, 7, and ≥8; 94 patients (27.4%) had PSA recurrence, mean followup 80.2 months (median 99). Independent predictors of Gleason upgrading (logistic regression) and disease-free survival (DFS) (Kaplan-Meier, log-rank) were determined. Results. Gleason discordance was 45.7% (37.32% upgrading and 8.45% downgrading). Upgrading risk decreased by 2.4% for each 1 g of prostate weight increment, while it increased by 10.2% for every 1 ng/mL of PSA, 72.0% for every 0.1 unity of PSA density and was 21 times higher for those with BGS 7. Gleason upgrading showed increased clinical stage (P = 0.019), higher tumor extent (P = 0.009), extraprostatic extension (P = 0.04), positive surgical margins (P < 0.001), seminal vesicle invasion (P = 0.003), less "insignificant" tumors (P < 0.001), and also worse DFS, χ 2 = 4.28, df = 1, P = 0.039. However, when setting the final Gleason score (BGS ≤ 6 to PGS 7 versus BGS 7 to PGS 7), avoiding allocation bias, DFS impact is not confirmed, χ 2 = 0.40, df = 1, P = 0.530. Conclusions. Gleason upgrading is substantial and confers worse outcomes. Prostate weight is inversely related to upgrading and its protective effect warrants further evaluation. © 2013 Leonardo Oliveira Reis et al.Pinthus, J.H., Witkos, M., Fleshner, N.E., Sweet, J., Evans, A., Jewett, M.A., Krahn, M., Trachtenberg, J., Prostate Cancers Scored as Gleason 6 on Prostate Biopsy are Frequently Gleason 7 Tumors at Radical Prostatectomy: Implication on Outcome (2006) Journal of Urology, 176 (3), pp. 979-984. , DOI 10.1016/j.juro.2006.04.102, PII S0022534706011645King, C.R., McNeal, J.E., Gill, H., Presti Jr., J.C., Extended prostate biopsy scheme improves reliability of Gleason grading: Implications for radiotherapy patients (2004) International Journal of Radiation Oncology Biology Physics, 59 (2), pp. 386-391. , DOI 10.1016/j.ijrobp.2003.10.014, PII S0360301603021187Chun, F.K., Steuber, T., Erbersdobler, A., Currlin, E., Walz, J., Schlomm, T., Haese, A., Karakiewicz, P.I., Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology (2006) European Urology, 49 (5), pp. 820-826. , 2-s2.0-33645760008 10.1016/j.eururo.2005.11.007Gonzalgo, M.L., Bastian, P.J., Mangold, L.A., Trock, B.J., Epstein, J.I., Walsh, P.C., Partin, A.W., Relationship between primary Gleason pattern on needle biopsy and clinicopathologic outcomes among men with Gleason score 7 adenocarcinoma of the prostate (2006) Urology, 67 (1), pp. 115-119. , DOI 10.1016/j.urology.2005.07.037, PII S0090429505011337Kvåle, R., Møller, B., Wahlqvist, R., Fosså, S.D., Berner, A., Busch, C., Kyrdalen, A.E., Halvorsen, O.J., Concordance between Gleason scores of needle biopsies and radical prostatectomy specimens: A population-based study (2009) BJU International, 103 (12), pp. 1647-1654. , 2-s2.0-67149126604 10.1111/j.1464-410X.2008.08255.xBillis, A., Magna, L.A., Ferreira, U., Correlation between tumor extent in radical prostatectomies and preoperative PSA, histological grade, surgical margins, and extraprostatic extension: Application of a new practical method for tumor extent evaluation (2003) International Braz J Urol, 29 (2), pp. 113-120Epstein, J.I., Allsbrook Jr., W.C., Amin, M.B., Egevad, L.L., Bastacky, S., Lopez Beltran, A., Berner, A., Young, R.H., The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma (2005) American Journal of Surgical Pathology, 29 (9), pp. 1228-1242. , DOI 10.1097/01.pas.0000173646.99337.b1Cookson, M.S., Aus, G., Burnett, A.L., Canby-Hagino, E.D., D'Amico, A.V., Dmochowski, R.R., Eton, D.T., Thompson, I., Variation in the Definition of Biochemical Recurrence in Patients Treated for Localized Prostate Cancer: The American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel Report and Recommendations for a Standard in the Reporting of Surgical Outcomes (2007) Journal of Urology, 177 (2), pp. 540-545. , DOI 10.1016/j.juro.2006.10.097, PII S0022534706028576Colleselli, D., Pelzer, A.E., Steiner, E., Ongarello, S., Schaefer, G., Bartsch, G., Schwentner, C., Upgrading of Gleason score 6 prostate cancers on biopsy after prostatectomy in the low and intermediate tPSA range (2010) Prostate Cancer and Prostatic Diseases, 13 (2), pp. 182-185. , 2-s2.0-77952543434 10.1038/pcan.2009.54Montironi, R., Mazzucchelli, R., Scarpelli, M., Lopez-Beltran, A., Mikuz, G., Algaba, F., Boccon-Gibod, L., Prostate carcinoma II: Prognostic factors in prostate needle biopsies (2006) BJU International, 97 (3), pp. 492-497. , 2-s2.0-33645000123 10.1111/j.1464-410X.2006.05973.xFitzsimons, N.J., Presti Jr., J.C., Kane, C.J., Terris, M.K., Aronson, W.J., Amling, C.L., Freedland, S.J., Is Biopsy Gleason Score Independently Associated With Biochemical Progression Following Radical Prostatectomy After Adjusting for Pathological Gleason Score? (2006) Journal of Urology, 176 (6), pp. 2453-2458. , DOI 10.1016/j.juro.2006.08.014, PII S0022534706019665Müntener, M., Epstein, J.I., Hernandez, D.J., Gonzalgo, M.L., Mangold, L., Humphreys, E., Walsh, P.C., Nielsen, M.E., Prognostic significance of Gleason score discrepancies between needle biopsy and radical prostatectomy (2008) European Urology, 53 (4), pp. 767-776. , 2-s2.0-39549100371 10.1016/j.eururo.2007.11.016Serkin, F.B., Soderdahl, D.W., Cullen, J., Chen, Y., Hernandez, J., Patient risk stratification using Gleason score concordance and upgrading among men with prostate biopsy Gleason score 6 or 7 (2010) Urologic Oncology, 28 (3), pp. 302-307. , 2-s2.0-77951607370 10.1016/j.urolonc.2008.09.030Freedland, S.J., Kane, C.J., Amling, C.L., Aronson, W.J., Terris, M.K., Presti Jr., J.C., Upgrading and Downgrading of Prostate Needle Biopsy Specimens: Risk Factors and Clinical Implications (2007) Urology, 69 (3), pp. 495-499. , DOI 10.1016/j.urology.2006.10.036, PII S0090429506024502Sved, P.D., Gomez, P., Manoharan, M., Kim, S.S., Soloway, M.S., Limitations of biopsy Gleason grade: Implications for counseling patients with biopsy Gleason score 6 prostate cancer (2004) Journal of Urology, 172 (1), pp. 98-102. , DOI 10.1097/01.ju.0000132135.18093.d6Ozden, C., Oztekin, C.V., Ugurlu, O., Gokkaya, S., Yaris, M., Memis, A., Correlation between upgrading of prostate biopsy and biochemical failure and unfavorable pathology after radical prostatectomy (2009) Urologia Internationalis, 83 (2), pp. 146-150. , 2-s2.0-70349276002 10.1159/000230014Hong, S.K., Han, B.K., Lee, S.T., Kim, S.S., Min, K.E., Jeong, S.J., Jeong, H., Lee, S.E., Prediction of Gleason score upgrading in low-risk prostate cancers diagnosed via multi (≥12)-core prostate biopsy (2009) World Journal of Urology, 27 (2), pp. 271-276. , 2-s2.0-63649106008 10.1007/s00345-008-0343-3Dong, F., Jones, J.S., Stephenson, A.J., Magi-Galluzzi, C., Reuther, A.M., Klein, E.A., Prostate cancer volume at biopsy predicts clinically significant upgrading (2008) Journal of Urology, 179 (3), pp. 896-900. , 2-s2.0-39149109597 10.1016/j.juro.2007.10.060Liu, J.J., Brooks, J.D., Ferrari, M., Nolley, R., Presti Jr., J.C., Small prostate size and high grade disease-biology or artifact? (2011) Journal of Urology, 185 (6), pp. 2108-2111. , 2-s2.0-79955796559 10.1016/j.juro.2011.02.053Ngo, T.C., Conti, S.L., Shinghal, R., Presti Jr., J.C., Prostate size does not predict high grade cancer (2012) Journal of Urology, 187 (2), pp. 477-480. , 2-s2.0-84855603087 10.1016/j.juro.2011.10.042Rahmouni, A., Yang, A., Tempany, C.M., Frenkel, T., Epstein, J., Walsh, P., Leichner, P.K., Zerhouni, E., Accuracy of in-vivo assessment of prostatic volume by MRI and transrectal ultrasonography (1992) Journal of Computer Assisted Tomography, 16 (6), pp. 935-940. , 2-s2.0-0026481087Varma, M., Morgan, J.M., The weight of the prostate gland is an excellent surrogate for gland volume (2010) Histopathology, 57 (1), pp. 55-58. , 2-s2.0-77954546284 10.1111/j.1365-2559.2010.03591.

A GEO-DATABASE FOR 3D-AIDED MULTI-EPOCH DOCUMENTATION OF BRIDGE INSPECTIONS

The recent collapse of bridges in Italy has prompted numerous studies on monitoring and maintenance. Many structures in Italy have been in service for over 50 years, necessitating new approaches to ensure their safety. To address this issue, Italy's Consiglio Superiore dei Lavori Pubblici (Superior Council of Public Works) has developed the Guidelines for Risk Classification and Management, proposing a multi-level approach to bridge management within a complex geomorphological environment. The guidelines outline a multi-level process that includes surveying the structures, conducting detailed inspections, and assigning risk classes based on hazard, exposure, and vulnerability. Current inspection processes are time-consuming and costly. Therefore, alternative monitoring technologies are crucial. Unmanned aerial vehicles equipped with cameras, laser technologies, and GPS systems offer flexible and cost-effective solutions for visual inspection. These technologies enable the collection of both quantitative and qualitative data, such as size, material properties, and overall condition. In this context, efficient data management and exploration systems are necessary to handle the vast amount of geo-referenced information. Multi-epoch databases play a crucial role in documenting the conditions of bridges and supporting a maintenance and structural health monitoring workflow. These databases can be utilized within a Bridge Management System to aid road managers in decision-making processes. Additionally, 3D exploration platforms provide visual analysis and highlight areas of interest within the structure. This work presents a multi-epoch geo-database that adheres to the Italian guidelines, offering optimized data management and queryability for 2D and 3D information. The entire process is designed using open-source and reproducible solutions

Acepromazione, detomidine and morphine: &#8220;the wooden horse&#8221; evaluation of standing sedation protocols in the equine patients undergoing bone scintigraphy

In equine practice standing sedation has became increasingly popular. Many protocols have been investigated permitting to restrain patients avoiding general anaesthesia and the risk associated by increasing the threshold to all external stimuli and partially providing analgesia (Muir W. 1981; Dodman N. 1980). The target of standing sedation protocols during diagnostic imaging procedures is to reduce all the reaction of the patients to external stimuli, and to diminish physiological movements. No studies have been published establishing a standard protocol, and the decision of which protocol use is based on anaesthetist preferences and not on evidence-based medicine.The aim of the study is to evaluate two sedative protocols, focusing not only on the lack of response to stimuli and the reduction of physiological movements but also on the immobility of the patient that is mandatory for diagnostic imaging procedures.Thirteen horses referred to perform bone scintigraphy were enrolled in the study. Patients were randomly divided in two groups; both groups received same dose of acepromazine (0.003 mg/kg) and detomidine (10 \uf06d/kg), MOR group received morphine (0.25 mg/kg), the BTF group received butorphanol (0.01 mg/kg). During the procedure to evaluate the horse sedation a simple descriptive scale (Taylor P. et al. 2014) was used; respiratory and hearth rate were recorded and if needed adjunctive boluses of detomidine were administrated. To evaluate the reduction of voluntary and involuntary movements the parameter chosen was the number of retake necessary to obtain an image with excellent diagnostic quality. This parameter was evaluated each time by the same radiologist that was unaware of which protocol was administered. Statistical analysis with T-Test was performed.Heart rate resulted not statistically different (MOR=27.1\ub12,4;BTF 26.8\ub13.7); respiratory rate in the MOR group resulted statistically diminished (MOR=9.9\ub12.3; BTF 13.4\ub13.1). The sedation score was statistically higher in the MOR group (MOR= 1.6\ub10.5; BTF 1.0\ub10.3) and moreover in the total body examinations. The total dose of detomidine used in the two groups resulted non statistically different (MOR=23.7; BTF 23.2). The total number of retake did not result statistically significant even if the clinical difference was relevant (MOR=7.1; BTF=16.2), but the number of retake for each region investigated resulted statistically diminished in the MOR group (MOR=0.4\ub10.5; BTF 0.8\ub10.8). The results of this study demonstrate the supremacy of the MOR sedation protocol to perform bone scintigraphy in horses. Further studies are recommended to evaluate the administration of detomidine constant rate infusion to maintain a required sedation degree. The \u201cWooden Ho se\u201d could by applied in ot e diagnostic imaging tec niques suc as CT o MRI and also for various standing surgeries. Other parameters that could be considered are the duration of the exams and also the number of urinations of the patient during the exam to evaluate operators exposure to radiations

Numerical modeling of bifacial PV string performance: Perimeter effect and influence of uniaxial solar trackers

The bifacial photovoltaic (PV) systems have recently met large interest. The performance of such systems heavily depends on the installation conditions and, in particular, on the albedo radiation collected by the module rear side. Therefore, it is of crucial importance to have an accurate performance model. To date, in the scientific literature, numerous models have been proposed and experimental data collected to study and optimize bifacial PV system performance. Currently, 3D and 2D models of bifacial PV devices exist. Though the former are more mathematically complex, they can lead to more accurate results, since they generally allow to fully consider the main aspects influencing a bifacial PV system performance. Recently, we have proposed and validated through experimental data a 3D model tested as a function of module height, tilt angle, and ground albedo. In this work, through such a model, we studied the role played by the perimeter zones surrounding the PV string, by considering PV strings of 30 or 60 modules. We considered the cases of fixed installation with optimal PV module tilt and of installation with uniaxial horizontal solar tracker. We evaluated the PV energy yield as a function of the size of the perimeter zones for the two cases, i.e., both with and without the solar tracker. In optimal perimeter conditions, we then studied the behavior of bifacial and mono-facial PV strings by varying the geographical location in a large latitude range

Pituitary chromophobe carcinoma in a dog: clinical, tomographic and hispopathological findings

A 9 year old, male mixed-breed dog was presented for evaluation of oral dysphagia and progressive aggressiveness towards the owner and the operators. The aim of this work is to describe clinical, tomographic and histopathologic features of pituitary chromophobe carcinoma in a dog. At the clinical examination the patient was normothermic, polypnoic (>50 apm) and tachycardic (>140 bpm). The neurological evaluation revealed normal postural reaction and normal cranial/spinal reflexes, mental depression, aggressiveness and crotaphyte muscles atrophy. Due to the impossibility to establish a specific neuronal localization, the diagnostic procedure included blood analysis with leukocyte formula, chest x-rays and abdominal ultrasound, with no relevant findings detected. Due to the aggressiveness and the mental depression after five days the patient was referred for brain Magnetic Resonance Imaging (MRI). MRI revealed an intense ventricular asymmetry, discrete left deviation of the falx cerebri, enlargement of the third ventricle and the presence of a large (18x20x15mm) spheroidal mass in the sellar/parasellar region charcterized by isointense on T1 weighted images and discretely hyperintense on T2 weighted and FLAIR. In the dorso-lateral portion of the mass, a circular lesion (6 mm diameter) characterized by intense signal hyperintensity on T2 weighted images was detected After intravenously paramagnetic contrast medium administration, the mass showed dishomogeneous intense enhancement. A pituitary macroadenoma (invasive adenoma/adenocarcinoma) characterized by the presence of a necrotic/cystic lesion was suspected. Because of the invasive natur of the lesion the owner decided to euthanize the patient. Brain histopathology was performed, confirming the presence of a pituitary chromophobe carcinoma. Pituitary carcinomas have been rarely observed in old dogs, moreover, cases of pituitary neoplasm with intense cellular pleomorphism and elevate mitotic index in absence of metastatic lesions are extremely rare. These neoplasms can cause serious functional disorders due to the destruction of the pars distalis of the neurohypophysis. In humans the distinction between invasive adenoma and pituitary adenocarcinoma is based on the finding of intracranial or systemic metastasis .It is believed that adenocarcinoma originate from malignant transformation of pre-existing adenoma, after a variable latency period. In the presented case, despite the absence of systemic and intracranial metastasis, the infiltrating growth pattern and the presence of neoplastic cells that arrive and surround the third ventricle, together with the intense cellular pleomorphism, guided the diagnosis to a malignant transformation of the neoplasm

Thermal and Economic Efficiency of Progressive Retrofit Strategies for School Buildings by a Statistical Analysis based Tool

Design alternatives in air conditioned buildings may be easily compared just by summing the hourly consumption of primary energy, while quantitative approachs for bioclimatic design strategies are difficult to be assessed and compared. A actively heated and passively cooled school building is considered as an application field of a novel methodology to promote an informed choice about the retrofit strategies to be adopted for buildings, defined as the Gained Comfort Cost (GCC). A functional and significant unit (i.e. a classroom), is used to test different energy retrofit solutions and their performances were compared with a baseline, in terms of the capacity to reduce the indoor air temperature variation. The novel methodology is a visual tool allowing to understand the “distance” of indoor conditions from comfort; the retrofit strategies are promoted to reduce this distance considering however the associated costs (LCC) to deal with actual feasibility

Demonstration and Comparison of Operation of Photomultiplier Tubes at Liquid Argon Temperature

Liquified noble gases are widely used as a target in direct Dark Matter searches. Signals from scintillation in the liquid, following energy deposition from the recoil nuclei scattered by Dark Matter particles (e.g. WIMPs), should be recorded down to very low energies by photosensors suitably designed to operate at cryogenic temperatures. Liquid Argon based detectors for Dark Matter searches currently implement photo multiplier tubes for signal read-out. In the last few years PMTs with photocathodes operating down to liquid Argon temperatures (87 K) have been specially developed with increasing Quantum Efficiency characteristics. The most recent of these, Hamamatsu Photonics Mod. R11065 with peak QE up to about 35%, has been extensively tested within the R&D program of the WArP Collaboration. During these testes the Hamamatsu PMTs showed superb performance and allowed obtaining a light yield around 7 phel/keVee in a Liquid Argon detector with a photocathodic coverage in the 12% range, sufficient for detection of events down to few keVee of energy deposition. This shows that this new type of PMT is suited for experimental applications, in particular for new direct Dark Matter searches with LAr-based experiments