Miracle-dz/UniFAR-FTUs huggingface dataset:
been shown to predict fluid responsiveness in a wide range of surgical and septic patients (5–10). Thus, those parameters seem to represent useful clinical tools for more rational perioperative fluid management in mechanically ventilated patients

References 1. Grocott MPW, Mythen MG, Gan TJ. Perioperative fluid management and clinical outcomes in adults. Anesth Analg 2005;100:1093–106. 2. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of evidence: Chest 2002;121:2000–8. 3. Cheung AT, Savino JS, Weiss SJ, et al. Echocardiographic and hemodynamic indexes of left ventricular preload in patients with normal and abnormal ventricular function. Anesthesiology 1994;81:376–87. 4. Della Rocca G, Costa MG, Coccia C, et al. Preload index: pulmonary artery occlusion pressure versus intrathoracic blood volume monitoring during lung transplantation. Anesth Analg 2002;95:835–43. 5. Coriat P, Vrillon M, Perel A, et al. Correlation of systolic pressure variations and echocardiographic estimates of end-diastolic left ventricular size in patients after aortic surgery. Anesth Analg 1994;78:46–53. 6. Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg 2001;92: 984–9. 7. Reuter DA, Felbinger TW, Kilger E, et al. Optimising fluid therapy in mechanically ventilated patients after cardiac surgery by on-line monitoring of left ventricular stroke volume variations a comparison to aortic systolic pressure variations. Br J Anaesth 2002;88:124–6. 8. Reuter DA, Kirchner A, Felbinger TW, et al. Usefulness of left ventricular stroke volume variations to assess fluid responsiveness in patients with reduced left ventricular function. Crit Care Med 2003;31:1399–404. 9. Tavernier B, Makhotine O, Lebuffe G, et al. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 1998;89: 1313–21. 10. Marx G, Cope T, McCrossan L, et al. Assessing fluid responsiveness by stroke volume variation in mechanically ventilated patients with severe sepsis. Eur J Anaesth 2004; 21:132–8.
Trauma Anesthesia

A lmost one out of every 10 deaths in the world is the result of injury. In the United States, trauma is the leading cause of death among children, adolescents, and young adults, and accounts for more years of potential life lost than cancer and heart disease combined. Although few anesthesiologists care exclusively for trauma patients, most care for trauma patients at one time or another in their clinical practice. This chapter provides a concise review of the essential elements in the management of the severely injured trauma patient and identifies new trends in trauma and anesthesiology practice that impact their care. INITIAL EVALUATION AND MANAGEMENT
During Coronary Artery Bypass Surgery: Thromboelastograph Versus Coagulation Screen

In light of the potential morbidity associated with transfusion of blood products, a reliable preoperative screening test to identify cardiothoracic surgical patients who are at potential risk for increased intraoperative blood loss would be useful. Accordingly, we examined the efficacy of a variety of coagulation tests to predict intraoperative blood loss in 60 patients presenting for coronary artery bypass surgery (CABG). A complete coagulation screen, activated clotting time (ACT), and thromboelastograph (TEG) were performed before surgery. Intraoperative blood loss was determined by weighing sponges and measuring the quantity of blood in suction canisters. The duration of cardiopulmonary bypass was 100 2 4 min, and total surgery time was 5.0 2 0.1 h. Total crystalloid and colloid requirements were 5.5 2 0.2 and 1.4 2 0.1 L. Fortyeight percent of the patients required blood with an average requirement of 2.5 2 0.5 units. Total intraoperative blood loss averaged 1590 2 95 mL with a range from 640 to 3928 mL. Using multiple linear regression, all coagulation and TEG variables were used to model perioperative blood loss. Results showed that all components of the TEG failed to predict blood loss ( I < 0.25, P > 0.78). However, three components of the routine coagulation assay, including bleeding time, prothrombin time, and platelet count could be modeled to predict perioperative blood loss (I = 0.75, P < 0.05). Although TEG has been shown to have potential in identifying postcardiopulmonary bypass coagulopathies, these results suggest that it does not appear to be useful in determining the coagulation status of CABG patients preoperatively. However, several components of the routine coagulation profile can be used as a predictive tool for intraoperative bleeding, and may be utilized preoperatively as a screen to identify patients with an elevated risk for increased blood loss. (Anesth Analg 1993;76:694-700)
Perineural Concentration of Lidocaine Is More Relevant to Spinal Neurotoxicity than the Concentration Administered

costs of inhaled drugs and IV adjuvants required during the maintenance period did not differ among the four treatment groups. ” However, they then state, also in the Results section, that “if fresh gas flow (FGF) rates of less than or equal to 1 L/min were used, there would have been significantly lower costs in the methohexital desflurane group compared with the other three anesthetic groups. ” It is inappropriate to cite this latter statement in the Results section because it represents speculation rather than an actual result. Second, the authors state in the Results section that “even with FGF rates of 2 L/min, the costs of intraoperative anesthetic drugs were significantly lower in the methohexital-desflurane group compared with the propofol-sevoflurane group. ” This statement is also inappropriate because the proper comparison should have been between the methohexital-desflurane and methohexital-sevoflurane groups (no difference). Finally, in perhaps the most egregiously inappropriate statement, the authors state in the discussion section that “the induction of anesthesia with methohexital, followed by maintenance with desflurane, was associated with decreased total costs from the perspectives of both the pharmacy and the healthcare institution, particularly when low flow rates (,1 L/min) were used. ” In this case, there was in fact no difference in costs between the methohexitaldesflurane and methohexital-sevoflurane groups studied; as mentioned above, the low flow rate condition was not studied, and no data are provided regarding the speculation as to the low flow rate condition. In the final analysis, the above concerns by themselves may be (the editorial inaccuracy notwithstanding) of minor importance. However, the offending statements do represent just the type of citation that may be taken out of context by an entity promoting one or another drug to inaccurately ascribe a quality (in this case cost effectiveness) to that drug that is not supported by the data.
A Multicenter Comparison of Maintenance and Recovery with Sevoflurane or Isoflurane for Adult Ambulatory Anesthesia

Sevoflurane was compared with isoflurane in 246 adult ASA class I-III patients undergoing ambulatory surgery. After administration of midazolam 1-2 mg and fentanyl 1 micro gram/kg, anesthesia was induced with propofol 2 mg/kg and maintained with either sevoflurane or isoflurane in 60% nitrous oxide to maintain arterial blood pressure at +/- 20% of baseline. Fresh gas flows were 10 L/min during induction and 5 L/min during maintenance. Times to eye opening, command response, orientation, and ability to sit without nausea and/or dizziness were significantly faster after sevoflurane. Significantly more sevoflurane patients met Phase 1 of postanesthesia care unit (PACU) Aldrete recovery criteria (>or=to8) at arrival, 95% vs 81%. Also, significantly more sevoflurane patients were able to complete psychomotor recovery tests during the first 60 min postanesthesia. Discharge times were not different. Sevoflurane patients had significantly lower incidences of postoperative somnolence (15% vs 26%) and of nausea both in the PACU (36% vs 51%) and in the 24-h postdischarge period (9% vs 24%). Patient satisfaction was high overall (sevoflurane 97%, isoflurane 93%). We conclude that sevoflurane is a useful inhaled anesthetic for maintenance of ambulatory anesthesia. (Anesth Analg 1996;83:314-9)
of Appropriately Modeling Procedure and Duration in Logistic Regression Studies of Perioperative Morbidity and Mortality

Multiple logistic regression studies frequently are performed with duration (e.g., operative time) included as an independent variable. We use narrative review of the statistical literature to highlight that when the association between duration and outcome is presumptively significant, the procedure itself (e.g., video-assisted thoracoscopic lobectomy or thoracotomy lobectomy) needs to be tested for inclusion in the logistic regression. If the procedure is a true covariate but excluded in lieu of category of procedure (e.g., lung resection), estimates of the odds ratios for other independent variables are biased. In addition, actual durations are sometimes used as the independent variable, rather than scheduled (forecasted) durations. Only the scheduled duration is known when a patient would be randomized in a trial of preoperative or intraoperative intervention and/or meets with the surgeon and anesthesiologist preoperatively. By reviewing the literature about logistic regression and about predicting case duration, we show that the use
Tracheal Wall Collapse Produced by Esophageal Detector Devices in a Porcine Cardiac Arrest Model

In Response We agree with Jaigirdar et al. that insertion of an epidural catheter and the timing of its removal in patients undergoing liver resection remain controversial and largely unstudied. The dilemma for anesthesiologists is of course the risk of epidural hematoma when the epidural catheter is positioned or removed versus the potential risk of hepatotoxicity and excessive sedation associated with systemic opioids. One study does find a significant correlation between postoperative coagulation derangement and blood loss, suggesting that the coagulapathy observed immediately after surgery may be mostly related to the dilutional effect of the intraoperative fluids. Matot’s study, as was mentioned, concluded that epidural anesthesia used in conjunction with minor hepatic surgery is quite safe because only brief changes in coagulation occurred. On the other hand, in patients undergoing major hepatic surgery and in whom an epidural catheter was placed, removal of the catheter should be delayed until laboratory values are normal. In our trial, the mean blood loss volume was about 300 mL, hepatic function and measures of coagulation were maintained before surgery, and epidural catheters were not inserted if prothrombin time was longer than 15 seconds or blood platelet count was 80 10/mm, an indication more stringent than that in other studies. Hence, we believe that the thoracic epidural catheters removed at the end of surgery was quite safe in our patients.
Obstetric anesthesia

Obstetric practice is very rewarding by giving access to a field of professional activity which encompasses some unique opportunities. Taking the responsibility for more than just one living being at a time represents an essential part of obstetric anaesthesia in as far as the well-being of a pregnant woman can never be separated from that of her baby. Whereas the course of pregnancy usually is uncomplicated for the vast majority of healthy women, there is another patient population in whom sigruficant preexisting medical disease is associated with a high risk of exacerbation sometime during pregnancy that may result in maternal and foetal morbidity and, in the worst case scenario, even in maternal and foetal mortality (1).
Medical students volunteering in hospital: a novel method of exploring and recording the patient experience

Background: Patient experience is increasingly recognised as an important feature of healthcare quality improvement. However, many of the methods implemented for its collection have significant limitations and reliability issues. This article describes how a UK healthcare organisation worked with medical student volunteers to build capacity for the collection of patient feedback in evidence-informed ways, and summarises student reflections on this process. Aims: To improve the quantity and quality of inpatient feedback, and in doing so provide new learning opportunities for medical students. Conclusions: Patient feedback gathered by volunteers is beneficial to the service and to medical student volunteers. As the feedback gathered is ward-specific, opportunities are created for practice improvements to be identified and acted on. It is feasible for medical students to be trained effectively as volunteers in gathering patient care experiences with adequate support mechanisms in place. Implications for practice: • Healthcare services should consider the use of personnel independent of the care team for thecollection of patient feedback • Patient feedback needs to be shared with practitioners in a timely manner • Medical schools should consider this type of volunteering as a unique opportunity for medicalstudents to improve understanding of patients’ experiences of healthcare, and of how care canbe person-centred
T-cell mediated immune responses in children at risk of HIV infection

This study set out to describe the changes in T-cell immune responses in a cohort of HIV-1infected children. The responses were investigated in relation to their clinical progression for up to four years. The main response studied was cytotoxic T lymphocyte (CTL) activity which, in adults, is thought to be one of the major mechanisms by which primary HIV-l-viraemia is cleared and clinical stability maintained. CTL activity was measured against four HIV gene products (gag, tat, pol, env). Three patterns of CTL activity were seen in the HIV-1-infected children: (i) CTL activity against HTV-pol, -gag and/or -env; (ii) CTL activity against HIV-tat and/or -poi, (iii) no CTL activity detected. These different patterns appear to relate to different patterns of clinical disease progression. CTL activity was also detected in children born to HIV-1-infected mothers, who were presumed to have been exposed, but are uninfected. The the specificity of response in these children was predominantly to HIV-env. Stimulation of PBMCs with peptides of specific CTL epitopes of HIV-1 resulted in a change in specificity of CTL recognition. These data suggest that the specificity of the CTL response may be related to clinical progression of the child, and that different CTL responses are obtained by different methods of stimulation of PBMCs. Changes in lymphocyte surface marker expression in peripheral blood were investigated to see if any phenotype was related to CTL activity, or was indicative of the infection status of the child, or disease progression. Activated and memory CD8 cell subpopulations were markedly increased soon after birth in HIV-1-infected children and remained so throughout infection. An increase in the proportion of activated or memory CD4 cells may indicate an imminent and accelerated CD4 cell loss, and subsequent progression to AIDS. The lymphocyte phenotypes in HIV-1-uninfected children remained within normal ranges. CTL activity was not related to any population in peripheral blood, but was related to by a further expansion of memory, activated, CD8 cells in culture. Proliferative responses were also studied, using tetanus toxoid, PHA and a combination of recombinant HIV-1 proteins as stimuli. Proliferation to tetanus and PHA in the HIV-1infected children did not differ from responses seen in exposed uninfected children, donor and
Tourniquet Injuries , Implied Causality , Babies , and Bathwater

erative analgesia. All other purported clinical benefits (decreased atrial fibrillation, decreased pulmonary complications, etc.) have yet to be proven. As “enhanced postoperative analgesia” (obtained by any means) has never been linked to improved outcome, “how important is postoperative pain following cardiac surgery? ”. (2) Cardiac surgery has risks (neurologic dysfunction, myocardial dysfunction, renal dysfunction, coagulation abnormalities, etc.) not associated with noncardiac surgery. For example, how important is it to obtain “high-quality” postoperative analgesia in an 80-yr-old patient with preoperative myocardial dysfunction, renal dysfunction, and a heavily calcified aorta, after doublevalve replacement? It could be argued that factors other than quality of postoperative analgesia will determine clinical outcome in this patient. Conversely, how important is it to obtain high-quality postoperative analgesia in an otherwise healthy 50-yrold patient after routine coronary artery bypass grafting? It is likely that this patient’s clinical outcome will be satisfactory, even if postoperative analgesia is suboptimal. Are the benefits of “enhanced analgesia” (which can be attained in a simpler and safer fashion with IV opioids) with thoracic epidural techniques worth the trouble/risks associated with it? Although the results have not been published, epidural hematomas (with permanent paralysis) have occurred. A recently published clinical investigation (3) provides additional evidence that thoracic epidural techniques offer no real clinical benefits to patients undergoing cardiac surgery. This relatively large (113 patients) prospective trial randomized patients undergoing elective cardiac surgery to receive either patientcontrolled thoracic epidural analgesia (catheter inserted the day prior to surgery: bupivacaine, fentanyl, and adrenalin used) or patient-controlled IV morphine analgesia during the immediate postoperative period. Perioperative care was standardized (all patients underwent general anesthesia and received a median sternotomy). The only difference between groups was a shorter time to postoperative tracheal extubation in patients receiving thoracic epidural analgesia (2.3 h versus 7.3 h). No differences were observed in postoperative analgesia (at rest and during cough), degree of sedation, lung volumes (forced vital capacity, forced vital capacity at one second, peak expiratory flow), degree of ambulation, global quality of recovery score (including all five domains), cardiac morbidity, renal morbidity, neurologic outcome, length of intensive care unit stay or hospital stay. For patients undergoing cardiac surgery, anesthesiologists should choose analgesic options that focus more on minimizing risk than maximizing the potential of unproven benefits.
The Role of Health Care Workers and Environment on Transmission of Methicillin-Resistant Staphylococcus aureus among Patients in a Medical Intensive Care Unit in a Saudi Hospital

As methicillin -resistant Staphylococcus aureus (MRSA) is a virulent pathogen responsible for health care-associated onset disease. In the present study, we have investigated the impact of carriage by health care workers (HCWs) and environment on patient transmission of MRSA in a Medical Intensive Care Unit (MICU), Fahd hospital, Al-Madinah Al-Munawarah, KSA. MRSA isolates from 117 patients, 25 HCWs and 12 environmental sites were collected. Antibiotyping and pulsed-field gel electrophoresis (PFGE) analysis were done to determine the clonal relationship between isolates and potential routes of transmission. The average nosocomial infection rate of MRSA was 5.98 % (7/117), the overall carriage rate of HCWs was 36% (9/25). Two MRSA was isolated from the 12 environmental sites samples. All MRSA isolates showed multidrug resistance. However, isolates with reduced susceptibility to vancomycin were not detected. Four major MRSA clusters were identified based on the PFGE patterns. Several HCWs were carrying MRSA isolates with the same PFGE patterns (pulsotype A3 and pulsotype C2) as those of isolates from patients (P2, 3, 7), thereby establishing the transmission of MRSA between patients and HCWs. Furthermore, the environmental isolates had PFGE pattern (pulsotype A3) indistinguishable from that of some patients isolates (P2, 7); ensuring that environment may serve as a reservoir for MRSA. The presence of MRSA among HCWs and environment has been associated with increased risk of MRSA nosocomial infection.
Object Detection Using a Deformable Parts Model

We implemented the deformable parts model described in [3]. We first give a brief high-level description of the deformable in part model and the histogram of gradients (HoG) features including some of the key insights upon which they rely. In Section 3.1 we give a detailed description of the model in [3]. In Section 3.2 we note some of the ways in which our model differs from that presented in the original paper. Next, we give a detailed description of our code in Section 4. We then present our results and evaluate the trade-offs of various design decisions in Section 5. Finally, we discuss some of the implementation constraints we encountered during for this project and give suggestions for improvement in Section 6.
Consistent Outdoor Environment Mapping with a 3D Laser Scanner

Simultaneous Localization and Mapping(SLAM) is an essential prerequisite for various automated systems, such as self-driving cars, and planetary rovers. These autonomous machines acquire the knowledge of the environment through building a map while exploring an unknown area. Without this knowledge, they are not able to make right decisions. We used a 3D laser scanner with 16 channels, and encoders to collect the internal and external information. Then we estimate the trajectory that the robot has been to and build a consistent map upon sensor data. In this project, we studied and proposed several ways to improve the existing registration and optimization methods. By adding odometry information to predict the initial estimation as the input for Normal Distribution Transform(NDT), the performance is proved to be boosted. And the result witnessed a satisfying change after we distribute the error before inputing the registration result into g2o optimization framework. Besides, we proposed a method to increase the weight of certain voxels to improve the performance of NDT. We also experimented with different configurations of NDT and g2o to see how they impact the results. We conducted and analyzed the experiment on two datasets, urban dataset and forest dataset. The mapping is considered successful in the urban dataset.
Knockdown of PLAT enhances the anticancer effect of gefitinib in non-small cell lung cancer

Background Tyrosine kinase inhibitors (TKIs), such as gefitinib, are widely used as standard treatments for non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations. However, the subsequent inevitable drug resistance has become a major challenge in clinical treatment. The aim of this study was to investigate the role of tissue-type plasminogen activator (PLAT) in gefitinib resistance in NSCLC. Methods The function of PLAT was determined using gefitinib-resistant cells and a nude mouse model. The gene knockdown was achieved by Lentivirus based RNA silence technique. Expression of relevant genes and proteins, cell viability, proliferation, apoptosis, cell cycle, reactive oxygen species levels, mitochondrial membrane potential and differential gene expression was detected by RT-qPCR, western blot, cell counting kit-8 assay, EdU incorporation, flow cytometry, JC-1 dye assay and complementary DNA arrays. The effects of PLAT knockdown on tumorigenesis was analyzed in vivo. Results Gefitinib-resistant cells expressed higher levels of PLAT and that knockdown of PLAT in resistant cells restored gefitinib sensitivity. Tumor proliferation was limited in vivo following PLAT knockdown. Moreover, PLAT knockdown affected mitochondrial function, caused caspase activation and cell cycle arrest, and activated TNF-α signaling, leading to apoptosis of gefitinib-resistant PC9 cells. Conclusions Our results suggest that PLAT reduces apoptosis of NSCLC cells and knockdown of PLAT enhances anticancer effect of gefitinib by upregulating TNF-α signaling.