Both patients had an eventful outcome. Epidemiologic characteristics, clinical presentation, diagnostic workup, surgical treatment, and morbidity-mortality rates of small-bowel volvulus have been reviewed and thoroughly discussed.
In wireless networks relay nodes can be used to assist the users transmissions to reach their destination. Work on relay cooperation, from a physical layer perspective, has up to now yielded well-known results. This paper takes a different stance focusing on network-level cooperation. Extending previous results for a single relay, we investigate here the benefits from the deployment of a second one. We assume that the two relays do not generate packets of their own and the system employs random access to the medium; we further consider slotted time and that the users have saturated queues. We obtain analytical expressions for the arrival and service rates of the queues of the two relays and the stability conditions. We investigate a model of the system, in which the users are divided into clusters, each being served by one relay, and show its advantages in terms of aggregate and throughput per user. We quantify the above, analytically for the case of the collision channel and through simulations for the case of multi-packet reception (MPR), and we provide insight on when the deployment of a second relay in the system can yield significant advantages.
The authors aimed to investigate the association between glucose metabolism measures and the exaggerated blood pressure response (EXBPR) to exercise testing in normotensive nondiabetic patients. One hundred and forty‐two consecutive patients underwent office blood pressure (BP) measurements, 24‐hour BP monitoring, echocardiography, and treadmill exercise test according to the Bruce protocol. The population was divided into 2 groups according to EXBPR at a submaximal workload level. Furthermore, blood samples were obtained for fasting glucose (FG), fasting insulin (FI), and lipid profile assessment. Measures of insulin resistance (homeostasis model assessment of insulin resistance [HOMA‐IR], quantitative insulin sensitivity check index [QUICKI], and McAuley index) were also estimated, and a standardized oral glucose tolerance test was performed to evaluate glucose levels at 120 minutes (G120). Patients with EXBPR (n=40; 27 men) compared with those without EXBPR (n=102; 66 men) were older by 4±6 years (P<.001). FG, FI, G120, HOMA‐IR, QUICKI, and McAuley index differed in patients with EXBPR compared with those without EXBPR (P<.001 for all). Logistic multivariable regression models revealed that the studied glucose metabolism measures, duration of exercise, and 24‐hour systolic BP remained determinants of EXBPR (P<.05 for all) after adjustment. Impaired glucose measures are significant determinants of EXBPR to exercise testing in normotensive nondiabetic patients, suggesting that impaired glucose metabolism may contribute to adverse cardiovascular prognosis including new‐onset hypertension.
INTRODUCTIONMixed large cell neuroendocrine neoplasms of the rectum are rare and aggressive neoplasms. Survival is poor due to the high rate of lymph node metastases and distant metastases at the time of diagnosis.PRESENTATION OF CASEWe report a case of a 50-year-old male patient with a mixed large cell neuroendocrine carcinoma with squamous cell carcinoma of the rectum located 8 cm from the anal verge, treated with low anterior resection and total mesorectal excision with free surgical margins. There were lymph nodes metastases but no distant metastases at the time of diagnosis. The patient refused to receive adjuvant chemotherapy and died 6 months later due to liver failure as a result of multiple hepatic metastases.DISCUSSIONThere are not known predisposing factors for the development of neuroendocrine rectal carcinoma. A neuroendocrine carcinoma of the rectum is a rare tumor with an incidence of less than 0.1% of all colorectal malignancies. The median survival ranges from 5 to 10.4 months in several studies and there are not sufficient data in bibliography about ideal adjuvant therapy after resection of mixed squamous large cell neuroendocrine carcinoma of the rectum.CONCLUSIONLow anterior resection and total mesorectal excision with free surgical margins in the presence of lymph nodes metastasis is not a sufficient treatment for rectal neuroendocrine carcinoma. More studies should be done in order to determine the ideal adjuvant treatment of these rare and aggressive tumors.
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