Analog MIMO Radio-over-Copper: Prototype and Preliminary Experimental Results

Analog Multiple-Input Multiple-Output Radio-over-Copper (A-MIMO-RoC) is an effective all-analog FrontHaul (FH) architecture that exploits any pre-existing Local Area Network (LAN) cabling infrastructure of buildings to distribute Radio-Frequency (RF) signals indoors. A-MIMO-RoC, by leveraging a fully analog implementation, completely avoids any dedicated digital interface by using a transparent end-to-end system, with consequent latency, bandwidth and cost benefits. Usually, LAN cables are exploited mainly in the low-frequency spectrum portion, mostly due to the moderate cable attenuation and crosstalk among twisted-pairs. Unlike current systems based on LAN cables, the key feature of the proposed platform is to exploit more efficiently the huge bandwidth capability offered by LAN cables, that contain 4 twisted-pairs reaching up to 500 MHz bandwidth/pair when the length is below 100 m. Several works proposed numerical simulations that assert the feasibility of employing LAN cables for indoor FH applications up to several hundreds of MHz, but an A-MIMO-RoC experimental evaluation is still missing. Here, we present some preliminary results obtained with an A-MIMO-RoC prototype made by low-cost all-analog/all-passive devices along the signal path. This setup demonstrates experimentally the feasibility of the proposed analog relaying of MIMO RF signals over LAN cables up to 400 MHz, thus enabling an efficient exploitation of the LAN cables transport capabilities for 5G indoor applications.Comment: Part of this work has been accepted as a conference publication to ISWCS 201

Apport de l’IRM et de la tomodensitométrie dans le diagnostic des affections de l’oreille chez les carnivores domestiques

Les données actuelles rapportent que les affections de l’oreille chez les carnivores domestiques sont communes et représentent 2% à 16.5% des pathologies rencontrées. Cependant on pense que ces affections sont sous-évaluées par manque d’outils diagnostics appropriés. L’oreille est l’organe vestibulo-cochléaire responsable à la fois de l’ouïe et de l’équilibre. Elle possède une structure extrêmement complexe, contenue en quasi totalité au sein de l’os temporal. Un examen complet et précis de cet organe nécessite l’utilisation d’outils d’imagerie de dernière génération que sont l’IRM et la tomodensitométrie. L’étude détaillée de l’anatomie de l’oreille est nécessaire à la compréhension et à l’interprétation des images obtenues avec les appareils d’IRM et de tomodensitométrie. C’est donc l’objet de la première partie de cette thèse. Les principes physiques ainsi que le fonctionnement de l’IRM et de la tomodensitométrie sont décrits en deuxième partie. Une étude détaillée de l’image normale de l’oreille des carnivores domestique y est inclue. Enfin les pathologies de l’oreille des carnivores domestiques, les plus communes et nécessitant l’utilisation de l’IRM et de la tomodensitométrie pour l’établissement de leur diagnostic, sont rapportées en troisième partie de cette thèse

experience of percutaneous access under ultrasound guidance in renal transplant patients with allograft lithiasis

Objective: Urolithiasis of the transplanted kidney has an incidence of 0.2 to 1.7%, it increases the risk of infection in immunosuppressed patients and it can lead to ureteral obstruction that is often associated with deterioration of renal function. Urolithiasis of the transplanted kidney has different characteristics compared to the native kidney, due to the absence of innervation, which does not lead to colic pain. Percutaneous approach is an optimal choice in transplant patients. Material and methods: Here we report our experience in two cadaveric transplant patients with urolithiasis. The first case was a patient of 68 years with a 20 mm stone located in the transplanted kidney pelvis and another smaller in a lower calyx. The second case was a patient of 65 years with a 15 mm stone in the distal part of the transplanted ureter. In both cases the patients were asymptomatic, but they had a reduction in urine output associated with worsening of the transplanted kidney function. The diagnosis was performed in both cases with ultrasound study, showing a severe hydronephrosis and it was confirmed by computed tomography scan. In both cases, we performed a Percutaneous Nephrolithotomy (PCNL). Access was made after targeting the stone, through a lower pole puncture under ultrasound guidance. The first case was treated with pneumatic and laser energy, breaking stones through a nephroscope. In the second case we performed a laser lithotripsy of the ureteral stone, using a flexible videoureteroscope. At the end of both procedures a Double-J stent and a 14 Fr Malecot nephrostomy were positioned, that were removed at 6 weeks and 10 days, respectively. Results: Both patients achieved a resolution of the worsening of renal function, recovering the spontaneous diuresis. The surgical procedure using ultrasound guidance was safe and allowed quick access to the renal pelvis. Both patients experienced no bleeding or infection during hospitalization. Conclusions: Percutaneous Nephrolithotomy (PCNL) is an established safe and effective surgical treatment option for larger renal calculi in renal allografts. The ultrasound guided access to the transplanted kidney in percutaneous treatment of urolithiasis is useful and fast, minimizing patient exposure to ionizing radiation

A challenging surgical approach to locally advanced primary urethral carcinoma: A case report and literature review

Primary urethral carcinoma (PUC) is a rare and aggressive cancer, often underdetected and consequently unsatisfactorily treated. We report a case of advanced PUC, surgically treated with combined approaches. A 47-year-old man underwent transurethral resection of a urethral lesion with histological evidence of a poorly differentiated squamous cancer of the bulbomembranous urethra. Computed tomography (CT) and bone scans excluded metastatic spread of the disease but showed involvement of both corpora cavernosa (cT3N0M0). A radical surgical approach was advised, but the patient refused this and opted for chemotherapy. After 17 months the patient was referred to our department due to the evidence of a fistula in the scrotal area. CT scan showed bilateral metastatic disease in the inguinal, external iliac, and obturator lymph nodes as well as the involvement of both corpora cavernosa. Additionally, a fistula originating from the right corpus cavernosum extended to the scrotal skin. At this stage, the patient accepted the surgical treatment, consisting of different phases. Phase I: Radical extraperitoneal cystoprostatectomy with iliac-obturator lymph nodes dissection. Phase II: Creation of a urinary diversion through a Bricker ileal conduit. Phase III: Repositioning of the patient in lithotomic position for an overturned Y skin incision, total penectomy, fistula excision, and "en bloc" removal of surgical specimens including the bladder, through the perineal breach. Phase IV: Right inguinal lymphadenectomy. The procedure lasted 9-and-a-half hours, was complication-free, and intraoperative blood loss was 600 mL. The patient was discharged 8 days after surgery. Pathological examination documented a T4N2M0 tumor. The clinical situation was stable during the first 3 months postoperatively but then metastatic spread occurred, not responsive to adjuvant chemotherapy, which led to the patient's death 6 months after surgery. Patients with advanced stage tumors of the bulbomembranous urethra should be managed with radical surgery including the corporas up to the ischiatic tuberosity attachment, and membranous urethra in continuity with the prostate and bladder. Neo-adjuvant treatment may be advisable with the aim of improving the poor prognosis, even if the efficacy is not certain while it can delay the radical treatment of the disease

Riprogettare il servizio insieme all'utente : un caso in sanità

LAUREA MAGISTRALEDall’analisi dell’attuale contesto sanitario, emerge la necessità di un suo riordino, per ottimizzare le risorse a disposizione. E’ in questo panorama, che è opportuno gestire in maniera efficiente i principali fenomeni in corso, tra cui la crescente incidenza delle patologie croniche. Queste ultime infatti richiedono un elevato consumo di risorse e a lungo andare impattano sull’economia dei paesi. Secondo le best practices queste patologie andrebbero gestite con approcci integrati e primary care based, che prevedono un coinvolgimento attivo del paziente, che diventa un interlocutore attivo e diretto e che per questo può collaborare con lo staff sanitario. Attraverso la collaborazione con i pazienti, si comprendono le loro principali esigenze e i problemi che devono affrontare durante il loro percorso sanitario e in base a questi si cerca di migliorare i servizi sanitari presenti o di crearne degli altri, sostituendo quelli poco adatti. La letteratura emergente indica che le tecniche di co-design, utilizzate per la collaborazione tra staff sanitario e pazienti, possono portare alla comprensione delle principali esigenze e per questo ad un ridisegno dei servizi sanitari, incrementando la loro efficacia ed efficienza, anche in termini di valore percepito dai pazienti. Tuttavia, al momento questo tipo di approcci trova applicazione soprattutto in contesti ospedalieri. La tecnica più utilizzata nel contesto sanitario è l’Experience Based Co-design, che focalizza le attività sulle esperienze dei pazienti per capire le loro esigenze e i loro problemi. L’analisi dei casi reali, presenti in letteratura, ha permesso di indagare sui principali strumenti utilizzati per organizzare attività di co-design. Si è notato quindi come nella maggior parte dei casi siano usati dapprima questionari esplorativi, che i pazienti compilano per fornire le prime informazioni, e poi siano svolte sessioni di focus group per interagire con i partecipanti e permettere loro di confrontarsi. Il presente lavoro di tesi si propone di valutare l’applicazione di tecniche di co-design in un contesto extra-ospedaliero, nello specifico della sperimentazione CReG, attuata da Regione Lombardia per la gestione dei pazienti cronici. E’ stato quindi sviluppato un questionario per valutare la propensione dei pazienti a partecipare ad iniziative di questo tipo, che ha permesso di conoscere il contesto e la soddisfazione in generale nei confronti dei servizi considerati, erogati grazie alla sperimentazione CReG. In seguito sono state svolte sessioni di focus group con i pazienti arruolati nella sperimentazione, durante le quali si è fatto svolgere ai partecipanti un esercizio che ha previsto l’utilizzo dell’emotional map, mappa che individua i punti in cui il paziente entra a contatto con i sevizi erogati e aiuta a capire la qualità delle esperienze vissute e le emozioni provate durante il percorso sanitario. Si è capito che pazienti con età e complessità di gestione delle loro patologie diverse, presentano caratteristiche e abitudini di vita differenti, a causa delle quali percepiscono diversamente i problemi e i bisogni e ciò influisce sulle tipologie di servizi da offrire loro. Infine, grazie a questa collaborazione con i pazienti, sono stati proposti miglioramenti nei servizi sanitari offerti, disegnati in base alle principali esigenze emerse dagli incontri svolti, ad alto valore aggiunto, ma a basso costo, se non a costo zero. I pazienti sono stati classificati in quattro categorie, in base alla loro età e alla complessità di gestione delle patologie che presentano. La classificazione è servita ad individuare i servizi adatti alle diverse richieste, causate dai driver presi in considerazione, che caratterizzano i pazienti arruolati nella sperimentazione. In questo modo sarebbe possibile ottimizzare le risorse ed erogare servizi in linea con i bisogni dei pazienti.From the analysis of the current health context, it emerges the need for a reorganization, to optimize the available resources. In this view, the main phenomena in progress, including the increasing incidence of chronic diseases, should be efficiently managed. The chronic diseases in fact require a high amount of resources and, in the long run, they impact on the economy of the countries. According to the best practices, chronic diseases should be managed with integrated and primary care based approaches, with an active involvement of the patient, who becomes an active and direct interlocutor and who can collaborate with the healthcare team. Through collaboration with patients, their main needs and problems are understood and in this way health services are improved or new ones are created, replacing those not fitting general needs. The emerging litterature indicates that the co-design techniques, used to increase the collaboration between medical staff and patients, may lead to the understanding of the main requirements and, through this, to a redesign of the services, by increasing their efficiency and effectiveness, in terms of perceived value by patients. However, this type of approaches is mainly applied to hospital settings. In the specific health field, Experience Based Co-design is the most used technique. It focuses its activities on the patients’ experiences to understand their needs and their problems. The analysis of some real cases, allowed to investigate the main tools most frequently used to organize co-design activities. In most cases, patients fill in questionnaires to provide the first information, and then focus group sessions are conducted to interact with the participants and to allow them to compare each other. The present thesis work aims at evaluating the application of co-design techniques in a primary care based setting, specifically the experimentation CReG, implemented by the Lombardy Region for the management of chronic patients. A questionnaire was developed to estimate the inclination of patients to take part to such initiatives. Thanks to these surveys it’s possible to know the context and the overall satisfaction with the services, made available through the experimentation CReG. In the light of the results we gathered, we contucted some focus group sessions with the patients enrolled in the trial. During these sessions, patients used Emotional Map, a graphical method that helps to understand the quality of experiences made through description of different phases and the emotions felt along the health path. We realized that patients of different ages, having different characteristics don’t perceive problems and needs in exactly the same way. Moreover the complexity of managing their diseases influences the type of services to be offered them and especially their delivery method. Finally, thanks to this cooperation with patients, improvements have been proposed in the services offered. These changes were designed according to the main needs emerging from the focus groups. The value attribuited by the patients to these improvements is high, while the costs for implementation is slow, if not even null. Patients were classified into four categories according to their ages and to the complexity of managing their diseases. Classification has been used to identify the right services for different demands, identified by the drivers taken into consideration, that characterize the patients involved in the trial. In this way, resources could be optimize and it could be possible to deliver services in line with the patients’ needs

Apport de l’IRM et de la tomodensitométrie dans le diagnostic des affections de l’oreille chez les carnivores domestiques

Recent studies show that ear diseases are common in dogs and cats and their frequency range from 2% to 16.5%. However we believe that we are under-estimating the frequency of those affections due to lack of appropriate diagnostic tools. The ear is known to be the vestibulo-cochlear organ, responsible for balance and hearing. Its structure is extremely complex and is hidden, for most part, in the temporal bone. To fully explore and examine this organ, it is necessary to use advanced imaging techniques that are MRI and computed tomography scanning (CT-scan). A detailed anatomical description of the ear is given in first part of this thesis; as it is necessary to fully comprehend and correctly analyze the radiologic images obtain using MRI and CT-scan. The physical and technical basics of MRI and Ct-scan techniques are described in a second part. A complete study of the images of the normal ear of dogs and cats is included here. Finally the ear diseases of the dog and cat that are most common and require the use of MRI and CT-scan are discussed in the third and final part of this thesis.Les donnés actuelles rapportent que les affections de l’oreille chez les carnivores domestiques sont communes et représentent 2% à 16.5% des pathologies rencontrées. Cependant on pense que ces affections sont sous-évaluées par manque d’outils diagnostics appropriés. L’oreille est l’organe vestibulo-cochléaire responsable à la fois de l’ouïe et de l’équilibre. Elle possède une structure extrêmement complexe, contenue en quasi totalité au sein de l’os temporal. Un examen complet et précis de cet organe nécessite l’utilisation d’outils d’imagerie de dernière génération que sont l’IRM et la tomodensitométrie. L’étude détaillée de l’anatomie de l’oreille est nécessaire à la compréhension et à l’interprétation des images obtenues avec les appareils d’IRM et de tomodensitométrie. C’est donc l’objet de la première partie de cette thèse. Les principes physiques ainsi que le fonctionnement de l’IRM et de la tomodensitométrie sont décrits en deuxième partie. Une étude détaillée de l’image normale de l’oreille des carnivores domestique y est inclue. Enfin les pathologies de l’oreille des carnivores domestiques, les plus communes et nécessitant l’utilisation de l’IRM et de la tomodensitométrie pour l’établissement de leur diagnostic, sont rapportées en troisième partie de cette thèse

Pseudobulbar Affect: Burden of Illness in the USA

Pseudobulbar affect (PBA) is characterized by involuntary and uncontrollable laughing and/or crying episodes, occurring secondary to neurological disease or injury. The impact of PBA on social and occupational function, health status, quality of life (QOL), and quality of relationships (QOR) is not well studied.This US survey conducted by Harris Interactive compared health status and daily function of patients with and without PBA. Eligible respondents were Harris Panel Online registrants previously diagnosed with stroke, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, traumatic brain injury, or amyotrophic lateral sclerosis, or primary, nonpaid caregivers for such patients who were too debilitated to participate. PBA was identified by a Center for Neurologic Study lability scale score of 13 or greater. Measures included the 36-item short form health survey (SF-36), the work productivity and impairment (WPAI) questionnaire, visual analog scales (VAS) for impact of PBA symptoms on QOL and QOR, and customized questions related to burden and impact of involuntary laughing/crying episodes on patients’ lives. Survey responses were weighted to adjust for the relative proportion of the primary neurological conditions in the overall population and between group differences in patient age and gender. PBA and non-PBA group responses were compared using two-tailed t tests adjusted for severity of the primary neurological conditions.The 1,052 respondents included 399 PBA group participants and 653 controls. The PBA group showed significantly worse scores versus non-PBA controls on component and summary SF-36 scores (P < 0.05 for all), VAS scores (P < 0.05 for both), and WPAI scores (P < 0.05). Among PBA group respondents, PBA contributed a great deal to or was the main cause of patients becoming housebound for 24% and being moved to supervised living placement for 9% of respondents.PBA is associated with considerable burden incremental to that of the underlying neurological conditions, affecting QOL, QOR, health status, and social and occupational functioning