The effect of cardiovascular morbidity on clinical response provided by tadalafil in patients with erectile dysfunction

We aimed to investigate the association between erectile dysfunction and severity of cardiovascular morbidity and to assess clinical responses to tadalafil of patients in different cardiovascular risk groups. Between November 2019 and August 2020, a total of 258 male patients aged 45–70 years with ED were included. They were divided into three groups according to the Framingham risk score: low-risk (n: 86, 33.3%), intermediate-risk (n: 103, 39.9%) and high-risk (n: 69, 26.8%). At admission, all domains of the International Index of Erectile Function score were worse in high-risk group compared to other risk groups (p < .001). After a 12-week follow-up, a more significant improvement was observed in all domains of erectile function in all risk groups, but high-risk group had lower sexual scores (p < .001). The lowest rate for complete responsiveness to tadalafil was observed in the high-risk group (37.7%). The rate of failure in complete responsiveness was found to be 4.127 times greater with higher Framingham score and 3.102 times greater with higher erectile dysfunction severity at admission. Our preliminary findings show that more severe sexual disorders are observed in high-risk patients with cardiovascular morbidity. Individualised treatment may be important in high-risk group since they may benefit less from tadalafil, and failure in complete responsiveness can be more common in this group.     

Mesoatrial shunt in Budd-Chiari syndrome

BACKGROUND: The operations with proven effects on survival in Budd-Chiari syndrome are shunt operations and liver transplantation. PATIENTS AND METHODS: Between 1993 and 1999 (June), 13 cases of Budd-Chiari syndrome have been treated surgically. Four cases had concomitant thrombosis of the inferior vena cava; the others had marked narrowing of the lumen due to the enlarged caudate lobe. Mesoatrial (n = 12) or mesosuperior vena caval (n = 1) shunts were constructed with ringed polytetrafluoroethylene grafts. RESULTS: The median portal pressure fell from 45 (range 32 to 55) to 20 (range 11 to 27) cm H(2)O (P <0.001). Two patients died in the early postoperative period. One patient who did not comply with anticoagulant treatment had a shunt thrombosis in the second postoperative year. The other 10 patients are alive without problems during a median 42 (range 1 to 76) months of follow-up. CONCLUSION: Mesoatrial shunt with a ringed polytetrafluoroethylene graft is effective in Budd-Chiari syndrome cases with thrombosis or significant stenosis in the inferior vena cava.     

Contact-Free Support Structures for the Direct Metal Laser Melting Process

Although Direct Metal Laser Melting (DMLM), a powder bed fusion (PBF) Additive Manufacturing (AM) for metallic materials, provides many advantages over conventional manufacturing such as almost unlimited design freedom, one of its main limitations is the need for support structures beneath overhang surfaces. Support structures are generally in contact with overhang surfaces to physically prop them up; therefore, they need to be removed after manufacturing due to not constituting a part of the main component design. The removal of supports is a process sequence adding extra time and cost to the overall manufacturing process and could result in damaging the main component. In this study, to examine the feasibility of contact-free supports for overhang surfaces in the DMLM process, coupons with these novel types of supports were prepared from CoCrMo alloy powder. This study aims to understand the effect of two parameters: the gap distance between supports and overhang surfaces and the inclination angle of overhang surfaces, on the surface topography and microstructural properties of these surfaces. Visual inspection, roughness measurements, and optical microscopy were utilized as characterization methods The roughness parameters (Ra, Rq, and Rz) were obtained using the focus variation method, and optical microscope analysis was performed on the cross-sections of the overhang surfaces to investigate the sub-surface microstructure and surface topology. Results showed that contact-free supports have a positive effect on decreasing surface roughness at all build angles when the gap distance is correctly set to avoid sintering of the powder in between the overhang and supports or to avoid too large gaps eliminating the desired effect of the higher thermal conductivity.