European Resuscitation Council Guidelines for Resuscitation.

Introduction to linear and nonlinear programming

Mathematica--A System for Doing Mathematics by Computer.

BACKGROUND
There is much uncertainty about the effects of early lowering of elevated blood pressure (BP) after acute intracerebral haemorrhage (ICH). Our aim was to assess the safety and efficiency of this treatment, as a run-in phase to a larger trial.


METHODS
Patients who had acute spontaneous ICH diagnosed by CT within 6 h of onset, elevated systolic BP (150-220 mm Hg), and no definite indication or contraindication to treatment were randomly assigned to early intensive lowering of BP (target systolic BP 140 mm Hg; n=203) or standard guideline-based management of BP (target systolic BP 180 mm Hg; n=201). The primary efficacy endpoint was proportional change in haematoma volume at 24 h; secondary efficacy outcomes included other measurements of haematoma volume. Safety and clinical outcomes were assessed for up to 90 days. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00226096.


FINDINGS
Baseline characteristics of patients were similar between groups, but mean haematoma volumes were smaller in the guideline group (12.7 mL, SD 11.6) than in the intensive group (14.2 mL, SD 14.5). From randomisation to 1 h, mean systolic BP was 153 mm Hg in the intensive group and 167 mm Hg in the guideline group (difference 13.3 mm Hg, 95% CI 8.9-17.6 mm Hg; p<0.0001); from 1 h to 24 h, BP was 146 mm Hg in the intensive group and 157 mm Hg in the guideline group (10.8 mm Hg, 95% CI 7.7-13.9 mm Hg; p<0.0001). Mean proportional haematoma growth was 36.3% in the guideline group and 13.7% in the intensive group (difference 22.6%, 95% CI 0.6-44.5%; p=0.04) at 24 h. After adjustment for initial haematoma volume and time from onset to CT, median haematoma growth differed between the groups with p=0.06; the absolute difference in volume between groups was 1.7 mL (95% CI -0.5 to 3.9, p=0.13). Relative risk of haematoma growth >or=33% or >or=12.5 mL was 36% lower (95% CI 0-59%, p=0.05) in the intensive group than in the guideline group. The absolute risk reduction was 8% (95% CI -1.0 to 17%, p=0.05). Intensive BP-lowering treatment did not alter the risks of adverse events or secondary clinical outcomes at 90 days.


INTERPRETATION
Early intensive BP-lowering treatment is clinically feasible, well tolerated, and seems to reduce haematoma growth in ICH. A large randomised trial is needed to define the effects on clinical outcomes across a broad range of patients with ICH.


FUNDING
National Health and Medical Research Council of Australia.

Intensive blood pressure reduction in acute cerebralhaemorrhage trial (INTERACT): a randomised pilot trial

PURPOSE: The bowel and sexual function of colorectal cancer patients undergoing either sphincter-saving or sphincter-sacrificing surgical procedures may be impaired. A legitimate question is how these different surgical techniques affect the patients' quality of life. METHODS: Seventeen studies were identified that compared at least one of four aspects of patient functioning (i.e.,physical, psychologic, social, and sexual) between stoma patients and non-stoma patients. RESULTS: Although the literature does not yield entirely consistent findings, some long-term effects of surgery can be identified: 1) both patient groups are troubled by frequent or irregular bowel movements and diarrhea; 2) stoma patients report higher levels of psychologic distress than do nonstoma patients; 3) although both stoma patients and nonstoma patients report restrictions in their level of social functioning, such problems are more prevalent among patients with a colostomy; 4) sexual functioning of male and female stoma patients is consistently more impaired than that of male and female patients with intact sphincters. Results of the current review were compared with those of other, related areas. CONCLUSIONS: Although nonstoma patients generally fare better than do stoma patients, they also suffer from physical impairments induced by sphincter-saving procedures (e.g.,impaired bowel and sexual function). These impairments may become more prevalent as ultralow anastomosis is more frequently applied, resulting in bowel and sexual dysfunction and related psychologic distress. Well-designed studies are needed that examine whether quality-of-life benefits are to be gained by use of ultralow anastomosis compared with colostomy.

Quality of life in colorectal cancer. Stoma vs. nonstoma patients

Constitutive boundary conditions and paradoxes in nonlocal elastic nanobeams

Nonlocal elasticity in nanobeams: the stress-driven integral model

In the strain-driven model of nonlocal elasticity proposed by Eringen , the elastic strain is defined by a Fredholm integral equation in which the stress is the output of a convolution between the local response to an elastic strain and a smoothing kernel dependent on a nonlocal parameter. In the wake of this proposal, size effects in nano-beams were investigated in literature by adopting a differential formulation considered to be equivalent to the integral one. Recent improvements have however revealed that equivalence requires also the fulfilment of constitutive boundary conditions. Moreover, this strain-driven nonlocal elastic problem has been shown to be ill-posed, being conflicting with equilibrium requirements. A stress-driven integral constitutive law provides the natural way to get well-posed nonlocal elastic problems for application to nano-structures. The new integral constitutive law is formulated with explicit reference to plane and straight nano-beams according to the standard Bernoulli - Euler structural model. The solution procedure based on the stress-driven nonlocal law is described and adopted for the solution of a simple statically indeterminate scheme, thus showing effectiveness of the new model for the structural design of nano-devices.

Stress-driven versus strain-driven nonlocal integral model for elastic nano-beams

On nonlocal integral models for elastic nano-beams

Comment on the paper “Exact solution of Eringen’s nonlocal integral model for bending of Euler–Bernoulli and Timoshenko beams” by Meral Tuna & Mesut Kirca

Giovanni Romano

Papers

Constitutive boundary conditions and paradoxes in nonlocal elastic nanobeams

Nonlocal elasticity in nanobeams: the stress-driven integral model

Stress-driven versus strain-driven nonlocal integral model for elastic nano-beams

On nonlocal integral models for elastic nano-beams

Comment on the paper “Exact solution of Eringen’s nonlocal integral model for bending of Euler–Bernoulli and Timoshenko beams” by Meral Tuna & Mesut Kirca