Rui Carlos Mendes de Oliveira

INTERMEDIATE‐TERM RESULTS, UP TO 4 YEARS, OF A BONE‐ANCHORED MALE PERINEAL SLING FOR TREATING MALE STRESS URINARY INCONTINENCE AFTER PROSTATE SURGERY

To examine the intermediate‐term outcome (up to 4 years) of a bone‐anchored perineal sling (InVanceTM, American Medical Systems, Minnetonka, MN, USA) in men with stress urinary incontinence (SUI) after prostate surgery.

Partial replication in the Database State Machine

This paper investigates the use of partial replication in the Database State Machine approach introduced earlier for fully replicated databases. It builds on the order and atomicity properties of group communication primitives to achieve strong consistency and proposes two new abstractions: Resilient Atomic Commit and Fast Atomic Broadcast. Even with atomic broadcast, partial replication requires a termination protocol such as atomic commit to ensure transaction atomicity, With Resilient Atomic Commit our termination protocol allows the commit of a transaction despite the failure of some of the participants. Preliminary performance studies suggest that the additional cost of supporting partial replication can be mitigated through the use of Fast Atomic Broadcast.

Optimistic total order in wide area networks

Total order multicast greatly simplifies the implementation of fault-tolerant services using the replicated state machine approach. The additional latency of total ordering can be masked by taking advantage of spontaneous ordering observed in LANs: A tentative delivery allows the application to proceed in parallel with the ordering protocol. The effectiveness of the technique rests on the optimistic assumption that a large share of correctly ordered tentative deliveries offsets the cost of undoing the effect of mistakes. This paper proposes a simple technique which enables the usage of optimistic delivery also in WANs with much larger transmission delays where the optimistic assumption does not normally hold. Our proposal exploits local clocks and the stability of network delays to reduce the mistakes in the ordering of tentative deliveries. An experimental evaluation of a modified sequencer-based protocol is presented, illustrating the usefulness of the approach in fault-tolerant database management.

Exploratory Study Assessing Efficacy and Complications of TVT-O, TVT-Secur, and Mini-Arc: Results at 12-Month Follow-Up

BACKGROUND Contemporary surgical treatment of female stress urinary incontinence (SUI) includes retropubic and transobturator (TO) midurethral slings (MUS). Case series of single-incision slings (SIS) have shown similar outcomes with lower morbidity. OBJECTIVE Our aim was to assess the cure rates, complications, and quality-of-life impact of one standard TO MUS and two SIS. DESIGN, SETTING, AND PARTICIPANTS Ninety consecutive patients with clinically and urodynamically proven SUI were enrolled in an exploratory randomised phase 2 trial. Patients with previous SUI surgery, major pelvic organ prolapse, mixed incontinence, or detrusor overactivity were excluded. INTERVENTIONS Patients were treated randomly with TVT-O, TVT-Secur, or Mini-Arc. MEASUREMENTS Postoperative visits were scheduled at 6 and 12 mo. The Kings Health Questionnaire (KHQ) was repeated at 6 mo. Cure was defined as the absence of urine leakage, no pad use, and a negative cough test at 12 mo. Pain and other complications were also investigated. RESULTS AND LIMITATIONS Cure rate was 83% after TVT-O, 67% after TVT-Secur, and 87% after Mini-Arc. Improvement was found in 10%, 13%, and 7% of the patients, respectively. Failures were 7% after TVT-O and Mini-Arc and 20% after TVT-Secur. TVT-O and Mini-Arc improved at least 15 points in >80% of the patients in six KHQ domains, whereas TVT-Secur could only achieve improvement in three of the nine domains. The pain score was lower in the Mini-Arc group. Complications were more numerous after TVT-O. This study has the limitations inherent in a phase 2 trial with a follow-up limited to 12 mo. CONCLUSIONS Mini-Arc offers cure and improvement rates similar to TVT-O, whereas TVT-Secur may yield an inferior outcome. These findings recommend the urgent launch of large randomised phase 3 studies comparing conventional MUS with SIS, with Mini-Arc the advised option.

Short-term assessment of a tension-free vaginal tape for treating female stress urinary incontinence

To evaluate the short‐term surgical complications and results of a tension‐free vaginal tape (TVT) system (TVT‐SecurTM, Gynecare, Ethicon, Somerville, NJ, USA) in the treatment of female stress urinary incontinence (SUI).

Intraprostatic Botulinum Toxin Type A injection in patients with benign prostatic enlargement: duration of the effect of a single treatment

BackgroundBotulinum Toxin Type-A (BoNT/A) intraprostatic injection can induce prostatic involution and improve LUTS and urinary flow in patients with Benign Prostatic Enlargement (BPE). However, the duration of these effects is unknown. The objective of this work was to determine the duration of prostate volume reduction after one single intraprostatic injection of 200U of Botulinum Toxin Type-A.MethodsThis is an extension of a 6 month study in which 21 frail elderly patients with refractory urinary retention and unfit for surgery were submitted to intraprostatic injection of BoNT/A-200U, by ultrasound guided transrectal approach. In spite of frail conditions, eleven patients could be followed during 18 months. Prostate volume, total serum PSA, maximal flow rate (Qmax), residual volume (PVR) and IPSS-QoL scores were determined at 1, 3, 6, 12 and 18 months post-treatment.ResultsMean prostate volume at baseline, 82 ± 16 ml progressively decreased from month one coming to 49 ± 9,5 ml (p = 0,003) at month six. From this moment on, prostate volume slowly recovered, becoming identical to baseline at 18 months (73 ± 16 ml, p = 0.03). Albeit non significant, serum PSA showed a 25% decrease from baseline to month 6. The 11 patients resumed spontaneous voiding at month one. Mean Qmax was 11,3 ± 1,7 ml/sec and remained unchanged during the follow-up period. PVR ranged from 55 ± 17 to 82 ± 20 ml and IPSS score from10 to 12 points.ConclusionIntraprostatic BoNT/A injection is safe and can reduce prostate volume for a period of 18 months. During this time a marked symptomatic improvement can be maintained.

Emergent Structure in Unstructured Epidemic Multicast

In epidemic or gossip-based multicast protocols, each node simply relays each message to some random neighbors, such that all destinations receive it at least once with high probability. In sharp contrast, structured multicast protocols explicitly build and use a spanning tree to take advantage of efficient paths, and aim at having each message received exactly once. Unfortunately, when failures occur, the tree must be rebuilt. Gossiping thus provides simplicity and resilience at the expense of performance and resource efficiency. In this paper we propose a novel technique that exploits knowledge about the environment to schedule payload transmission when gossiping. The resulting protocol retains the desirable qualities of gossip, but approximates the performance of structured multicast. In some sense, instead of imposing structure by construction, we let it emerge from the operation of the gossip protocol. Experimental evaluation shows that this approach is effective even when knowledge about the environment is only approximate.

Semantically reliable multicast protocols

Reliable multicast protocols can strongly simplify the design of distributed applications. However it is hard to sustain a high multicast throughput when groups are large and heterogeneous. In an attempt to overcome this limitation, previous work has focused on weakening reliability properties. The authors introduce a novel reliability model that exploits semantic knowledge to decide in which specific conditions messages can be purged without compromising application correctness. This model is based on the concept of message obsolescence: a message becomes obsolete when its content or purpose is overwritten by a subsequent message. We show that message obsolescence can be expressed in a generic way and can be used to configure the system to achieve higher multicast throughput.

Semantically reliable multicast: definition, implementation, and performance evaluation

Semantic reliability is a novel correctness criterion for multicast protocols based on the concept of message obsolescence: A message becomes obsolete when its content or purpose is superseded by a subsequent message. By exploiting obsolescence, a reliable multicast protocol may drop irrelevant messages to find additional buffer space for new messages. This makes the multicast protocol more resilient to transient performance perturbations of group members, thus improving throughput stability. This paper describes our experience in developing a suite of semantically reliable protocols. It summarizes the motivation, definition, and algorithmic issues and presents performance figures obtained with a running implementation. The data obtained experimentally is compared with analytic and simulation models. This comparison allows us to confirm the validity of these models and the usefulness of the approach. Finally, the paper reports the application of our prototype to distributed multiplayer games.

Single-incision sling system as primary treatment of female stress urinary incontinence: prospective 12 months data from a single institution.

Study Type – Therapy (case series)