In the past decade,several efforts around the world were started with the goal of introducing "smart metering" capabilities into the power grid.These efforts have spurred renewed interest in the design of ne...In the past decade,several efforts around the world were started with the goal of introducing "smart metering" capabilities into the power grid.These efforts have spurred renewed interest in the design of next generation Narrowband Power Line Communications(NB-PLC) transceivers.In the past few years,ITU-T and IEEE have standardized a family of next generation OFDM-based NB-PLC transceivers some of which are today being considered for massive deployments in Europe and Asia.This paper addresses the important role that PLC has not only for smart metering but also for many other Smart Grid applications,and also gives an overview of the main differences between these next generation NB-PLC standards.展开更多
Sacral neuromodulation(SNM)therapy has revolutionized the management of many forms of anal incontinence,with an expanded use and a medium-term efficacy of 75%overall.This review discusses the technique of SNM therapy,...Sacral neuromodulation(SNM)therapy has revolutionized the management of many forms of anal incontinence,with an expanded use and a medium-term efficacy of 75%overall.This review discusses the technique of SNM therapy,along with its complications and troubleshooting and a discussion of the early data pertaining to peripheral posterior tibial nerve stimulation in incontinent patients.Future work needs to define the predictive factors for neurostimulatory success,along with the likely mechanisms of action of their therapeutic action.展开更多
The authors have provided a novel hybrid approach in a selected group of locally advanced ultra-low rectal cancers,using neoadjuvant chemoradiation followed by local excision in responders and a delayed Total Mesorect...The authors have provided a novel hybrid approach in a selected group of locally advanced ultra-low rectal cancers,using neoadjuvant chemoradiation followed by local excision in responders and a delayed Total Mesorectal Excision(TME)and restorative proctectomy,showing that mediumterm survival is possible with acceptable functional outcome[1].Although it is clear that the neoadjuvant approach has acceptable toxicity—with the majority of patients showing significant tumor downsizing and creating a better chance for sphincter preservation—the selection criteria for these patients still remain subjective.Here,the alternatives in those showing a partial clinical response(pCR)include radical resection,transanal local excision and a‘wait and see’policy but the data are contradictory in the matter of assisting individual patient management[2].One problem is that some data show relatively high recurrence rates in clinical complete responders when a‘wait and see’strategy is followed,while studies are heterogeneous in their staging and inclusion criteria and there are differences in what constitutes a pCR.In this respect,there is only partial agreement between pcR and complete clinical response(cCR)cases[3].This inconsistency of cCR diagnosis most probably also explains some reportedly high rates of local perirectal lymph node metastases in some series,which precludes either a‘wait and see’plan of action or one combined with local excision[4].展开更多
Patients may present with anal incontinence(AI)following repair of a congenital anorectal anomaly years previously,or require total anorectal reconstruction(TAR)following radical rectal extirpation,most commonly for r...Patients may present with anal incontinence(AI)following repair of a congenital anorectal anomaly years previously,or require total anorectal reconstruction(TAR)following radical rectal extirpation,most commonly for rectal cancer.Others may require removal of their colostomy following sphincter excision for Fournier’s gangrene,or in cases of severe perineal trauma.Most of the data pertaining to antegrade continence enema(the ACE or Malone procedure)comes from the pediatric literature in the management of children with AI,but also with supervening chronic constipation,where the quality of life and compliance with this technique appears superior to retrograde colonic washouts.Total anorectal reconstruction requires an anatomical or physical supplement to the performance of a perineal colostomy,which may include an extrinsic muscle interposition(which may or may not be‘dynamized’),construction of a neorectal reservoir,implantation of an incremental artificial bowel sphincter or creation of a terminal,smooth-muscle neosphincter.The advantages and disadvantages of these techniques and their outcome are presented here.展开更多
Anal incontinence(AI)reflects the final common pathway of a multitude of aetiological factors and,as an underestimated clinical problem,it represents a major social and economic burden.Its epidemiology and objective a...Anal incontinence(AI)reflects the final common pathway of a multitude of aetiological factors and,as an underestimated clinical problem,it represents a major social and economic burden.Its epidemiology and objective assessment of the severity of the problem are discussed in this Special Edition by Nevler from Israel.In the 1980s,the management of AI included some form of sphincter repair or scaffold,as discussed by Pescatori and Pescatori,with the construction of a colostomy as the only other surgical option.The development of a series of complicated muscle transposition procedures ensued and was supplemented by electrical stimulation,following an improvement in our understanding of the basic functioning of the voluntary myocyte.These procedures are discussed by Barisˇic′and Krivokapic′.This approach was followed by the adoption,from urological practice,of an artificial bowel sphincter that could be used to augment a perineal colostomy,in some cases of total anorectal reconstruction,and in patients with complex congenital anomalies after failed reconstruction.Neither of these more complex approaches has effectively stood the test of time,resulting in high complication rates,and the frequent need for operative revision and ultimate explantation of the device.展开更多
文摘In the past decade,several efforts around the world were started with the goal of introducing "smart metering" capabilities into the power grid.These efforts have spurred renewed interest in the design of next generation Narrowband Power Line Communications(NB-PLC) transceivers.In the past few years,ITU-T and IEEE have standardized a family of next generation OFDM-based NB-PLC transceivers some of which are today being considered for massive deployments in Europe and Asia.This paper addresses the important role that PLC has not only for smart metering but also for many other Smart Grid applications,and also gives an overview of the main differences between these next generation NB-PLC standards.
文摘Sacral neuromodulation(SNM)therapy has revolutionized the management of many forms of anal incontinence,with an expanded use and a medium-term efficacy of 75%overall.This review discusses the technique of SNM therapy,along with its complications and troubleshooting and a discussion of the early data pertaining to peripheral posterior tibial nerve stimulation in incontinent patients.Future work needs to define the predictive factors for neurostimulatory success,along with the likely mechanisms of action of their therapeutic action.
文摘The authors have provided a novel hybrid approach in a selected group of locally advanced ultra-low rectal cancers,using neoadjuvant chemoradiation followed by local excision in responders and a delayed Total Mesorectal Excision(TME)and restorative proctectomy,showing that mediumterm survival is possible with acceptable functional outcome[1].Although it is clear that the neoadjuvant approach has acceptable toxicity—with the majority of patients showing significant tumor downsizing and creating a better chance for sphincter preservation—the selection criteria for these patients still remain subjective.Here,the alternatives in those showing a partial clinical response(pCR)include radical resection,transanal local excision and a‘wait and see’policy but the data are contradictory in the matter of assisting individual patient management[2].One problem is that some data show relatively high recurrence rates in clinical complete responders when a‘wait and see’strategy is followed,while studies are heterogeneous in their staging and inclusion criteria and there are differences in what constitutes a pCR.In this respect,there is only partial agreement between pcR and complete clinical response(cCR)cases[3].This inconsistency of cCR diagnosis most probably also explains some reportedly high rates of local perirectal lymph node metastases in some series,which precludes either a‘wait and see’plan of action or one combined with local excision[4].
文摘Patients may present with anal incontinence(AI)following repair of a congenital anorectal anomaly years previously,or require total anorectal reconstruction(TAR)following radical rectal extirpation,most commonly for rectal cancer.Others may require removal of their colostomy following sphincter excision for Fournier’s gangrene,or in cases of severe perineal trauma.Most of the data pertaining to antegrade continence enema(the ACE or Malone procedure)comes from the pediatric literature in the management of children with AI,but also with supervening chronic constipation,where the quality of life and compliance with this technique appears superior to retrograde colonic washouts.Total anorectal reconstruction requires an anatomical or physical supplement to the performance of a perineal colostomy,which may include an extrinsic muscle interposition(which may or may not be‘dynamized’),construction of a neorectal reservoir,implantation of an incremental artificial bowel sphincter or creation of a terminal,smooth-muscle neosphincter.The advantages and disadvantages of these techniques and their outcome are presented here.
文摘Anal incontinence(AI)reflects the final common pathway of a multitude of aetiological factors and,as an underestimated clinical problem,it represents a major social and economic burden.Its epidemiology and objective assessment of the severity of the problem are discussed in this Special Edition by Nevler from Israel.In the 1980s,the management of AI included some form of sphincter repair or scaffold,as discussed by Pescatori and Pescatori,with the construction of a colostomy as the only other surgical option.The development of a series of complicated muscle transposition procedures ensued and was supplemented by electrical stimulation,following an improvement in our understanding of the basic functioning of the voluntary myocyte.These procedures are discussed by Barisˇic′and Krivokapic′.This approach was followed by the adoption,from urological practice,of an artificial bowel sphincter that could be used to augment a perineal colostomy,in some cases of total anorectal reconstruction,and in patients with complex congenital anomalies after failed reconstruction.Neither of these more complex approaches has effectively stood the test of time,resulting in high complication rates,and the frequent need for operative revision and ultimate explantation of the device.
