Miracle-dz/UniFAR-FTUs huggingface dataset:
Symmetries of quantum evolutions

A cornerstone of quantum mechanics is the characterisation of symmetries provided by Wigner’s theorem. Wigner’s theorem establishes that every symmetry of the quantum state space must be either a unitary transformation, or an antiunitary transformation. Here we extend Wigner’s theorem from quantum states to quantum evolutions, including both the deterministic evolution associated with the dynamics of closed systems, and the stochastic evolutions associated with the outcomes of quantum measurements. We prove that every symmetry of the space of quantum evolutions can be decomposed into two state space symmetries that are either both unitary or both antiunitary. Building on this result, we show that it is impossible to extend the time reversal symmetry of unitary quantum dynamics to a symmetry of the full set of quantum evolutions. Our no-go theorem implies that any time symmetric formulation of quantum theory must either restrict the set of the allowed evolutions, or modify the operational interpretation of quantum states and processes. Here we propose a time symmetric formulation of quantum theory where the allowed quantum evolutions are restricted to a suitable set, which includes both unitary evolution and projective measurements, but excludes the deterministic preparation of pure states. The standard operational formulation of quantum theory can be retrieved from this time symmetric version by introducing an operation of conditioning on the outcomes of past experiments.
Analytical Aircraft State and IMU Signal Generator from Smoothed Reference Trajectory

This work presents a method for generating position, attitude, and velocity states for an aircraft following a smoothed reference trajectory. The method also generates accelerometer and gyro measurements consistent with the aircraft states. This work describes three corner smoothing algorithms for generating a smoothed reference trajectory from a series waypoints that accounts for limitations in the physical system. The smoothed reference trajectory, and curvilinear motion theory are used to generate the lower-order states. A coordinated turn maneuver is then applied to generate accelerometer and gyro measurement estimates.
An initial learning experience of tracheal intubation with video laryngoscope

Abstract Tracheal intubation is an essential technique for many healthcare professionals and one of the mega code simulations in advanced cardiac life support. In recent years, video laryngoscopy (VL) has provided a rescue for difficult airways during intubation and has proven to have higher success rates. Moreover, VL facilitates a more rapid learning curve for inexperienced doctors. In this article, we report 16 cases intubated with VL by a novice doctor of postgraduate year 1, who shared the learning experience and the difficulties encountered in this case series. We also conducted a statistical analysis to evaluate the learning outcomes of the trainee after 1 month. Our results showed that the overall first-shot success rate was 81.3% for the 16 objectives. Over time, improvements in intubation performance measures, including shortened duration and lower Intubation Difficulty Scale score, have been observed. In this learning project, we found that limitation of mouth opening (<2.5 fingers wide) is an important risk factor for predicting the initial difficulty of tracheal intubation on the novice trainee. For inexperienced doctors, VL produces high first-shot success rates for tracheal intubation and may be useful for training their performance in a short period of time. In addition, mouth opening <3 fingers wide may result in difficult intubation by novice doctors.
A Machine Learning Classifier Improves Mortality Prediction Compared With Pediatric Logistic Organ Dysfunction-2 Score: Model Development and Validation

Supplemental Digital Content is available in the text. Objectives: To determine whether machine learning algorithms can better predict PICU mortality than the Pediatric Logistic Organ Dysfunction-2 score. Design: Retrospective study. Setting: Quaternary care medical-surgical PICU. Patients: All patients admitted to the PICU from 2013 to 2019. Interventions: None. Measurements and Main Results: We investigated the performance of various machine learning algorithms using the same variables used to calculate the Pediatric Logistic Organ Dysfunction-2 score to predict PICU mortality. We used 10,194 patient records from 2013 to 2017 for training and 4,043 patient records from 2018 to 2019 as a holdout validation cohort. Mortality rate was 3.0% in the training cohort and 3.4% in the validation cohort. The best performing algorithm was a random forest model (area under the receiver operating characteristic curve, 0.867 [95% CI, 0.863–0.895]; area under the precision-recall curve, 0.327 [95% CI, 0.246–0.414]; F1, 0.396 [95% CI, 0.321–0.468]) and significantly outperformed the Pediatric Logistic Organ Dysfunction-2 score (area under the receiver operating characteristic curve, 0.761 [95% CI, 0.713–0.810]; area under the precision-recall curve (0.239 [95% CI, 0.165–0.316]; F1, 0.284 [95% CI, 0.209–0.360]), although this difference was reduced after retraining the Pediatric Logistic Organ Dysfunction-2 logistic regression model at the study institution. The random forest model also showed better calibration than the Pediatric Logistic Organ Dysfunction-2 score, and calibration of the random forest model remained superior to the retrained Pediatric Logistic Organ Dysfunction-2 model. Conclusions: A machine learning model achieved better performance than a logistic regression-based score for predicting ICU mortality. Better estimation of mortality risk can improve our ability to adjust for severity of illness in future studies, although external validation is required before this method can be widely deployed.
Functional Properties of a Purified Reconstituted Bilayer Matrix Design Support Natural Wound Healing Activities

Background: Biomaterial engineering has produced numerous matrices for use in tissue repair, utilizing various materials and processing methods, which can impact the ability of the products to encourage wound healing. Recently, we observed favorable clinical outcomes, using a novel purified reconstituted bilayer matrix (PRBM; Geistlich Derma-Gide) to treat chronic diabetic foot ulcers. Methods: Evaluations of the structural and functional characteristics of PRBM in vitro were performed to assess how this biomaterial may affect the favorable clinical results observed by influencing the wound environment and key physiologic mechanisms necessary for the healing process. Investigations included scanning electron microscopy, cell culture analyses, gene expression assays, matrix metalloproteinase activity assessment, and pH measurement. Results: Cross-sectional scanning electron microscopy demonstrated a distinct bilayer structure with porous and compact layers. The PRBM structure allowed cell types involved in wound healing to bind and proliferate. Expression analysis of growth factor-responsive genes demonstrated binding and preservation of bioactive growth factors TGF-β1, bFGF, and VEGF by PRBM. Boyden chamber migration assays revealed increased cellular migration compared with controls. In the presence of PRBM, the activity of MMP-1, MMP-2, and MMP-9 was significantly lower compared with control samples. pH of the PRBM in solution was slightly acidic. Conclusions: Based on in vitro evaluations, it appears that the PRBM processing without deleterious chemical crosslinking results in a suitable ECM possessing characteristics to aid natural wound healing, including cell attachment, migration, proliferation, differentiation, and angiogenesis. These in vitro data support the promising healing rate observed clinically when chronic DFUs are treated with PRBM.
RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure

Supplemental Digital Content is available in the text. Objectives: The transfusion of stored RBCs decreases nitric oxide bioavailability, which may have an adverse effect on vascular function. We assessed the effects of RBC transfusion on coronary vascular function by evaluating the relationship between myocardial oxygen delivery and demand as evidenced by ST segment variability. Design: Retrospective case-control study. Setting: Nine-hundred seventy-three–bed pediatric hospital with a 54-bed cardiovascular ICU. Patients: Seventy-three neonates with hypoplastic left heart syndrome following the Norwood procedure, 38 with a Blalock-Taussig shunt and 35 with a right ventricle to pulmonary artery shunt. Interventions: RBC transfusion. Materials and Main Results: High-frequency physiologic data were captured 30 minutes prior to the initiation of (baseline) and during the 120 minutes of the transfusion. A rate pressure product was calculated for each subject and used as an indicator of myocardial oxygen demand. Electrocardiogram leads (aVL, V1, II) were used to construct a 3D ST segment vector to assess ST segment variability and functioned as a surrogate indicator of myocardial ischemia. One-hundred thirty-eight transfusions occurred in the Blalock-Taussig shunt group and 139 in the right ventricle to pulmonary artery shunt group. There was no significant change in the rate pressure product for either group; however, ST segment variability progressively increased for the entire cohort during the transfusion, becoming statistically significant by the end of the transfusion. Upon subgroup analysis, this finding was noted with statistical significance in the Blalock-Taussig shunt group and trending toward significance in the right ventricle to pulmonary artery shunt group. Conclusions: We found a significant increase in the ST segment variability and evidence of myocardial ischemia temporally associated with RBC transfusions in neonates following the Norwood procedure, specifically among those in the Blalock-Taussig shunt group, which may impact immediate and long-term outcomes.
Outcomes of Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome Following Traumatic Injury: A Propensity-Matched Analysis

Supplemental Digital Content is available in the text. OBJECTIVES: The purpose of this study is to evaluate the overall occurrence of inhospital mortality in trauma patients who were placed on extracorporeal membrane oxygenation following the complication of the acute respiratory distress syndrome. DESIGN: Observational cohort study. SETTING: The data of all patients who were traumatically injured and developed the complication of acute respiratory distress syndrome were accessed from the Trauma Quality Improvement Program database from the calendar years of 2013 to 2016. PATIENTS: Patients 16 years old and less than 90 years old were included in the study. Variables included patient demography, Injury Severity Score, Glasgow Coma Scale score, Abbreviated Injury Scale score, and outcomes. INTERVENTIONS: Extracorporeal membrane oxygenation. MEASUREMENTS AND MAIN RESULTS: Propensity-matched analysis was performed between two groups: patients placed on extracorporeal membrane oxygenation and patients placed on conventional mode of ventilation. The primary outcome was inhospital mortality. Out of 6,121 patients who developed acute respiratory distress syndrome, 118 patients (1.93%) were placed on extracorporeal membrane oxygenation. The pair matched analysis showed significant difference between the two groups (extracorporeal membrane oxygenation vs conventional mode of ventilation) for overall inhospital mortality (35.6% vs 14.4%; p < 0.001). There were significant differences found between the two groups for the median hospital length of stay (41 [35–49] vs 27 [24–33]), ICU days (35 [30–41] vs 19 [17–24]), and ventilator days (30 [27–34] vs 15 [13–18]). All p values are less than 0.001. CONCLUSIONS: Approximately 2% of acute respiratory distress syndrome patients were placed on extracorporeal membrane oxygenation. The overall inhospital mortality remained high despite patients being placed on extracorporeal membrane oxygenation.
Severity of Sleep Apnea and COVID-19 Illness

Objective To characterize the relationship between severity of sleep apnea and coronavirus disease 2019 (COVID-19) hospitalization and severe illness. Study Design Retrospective cohort study. Setting Montefiore Health System in the Bronx, New York. Methods The data set consisted of adult patients with an active diagnosis of obstructive sleep apnea in the past 2 years and a positive severe acute respiratory syndrome coronavirus 2 quantitative polymerase chain reaction test at our institution between March 16, 2020, and May 26, 2020. Sleep apnea severity and continuous positive airway pressure compliance data were abstracted from the electronic medical record. The International Classification of Diseases, 10th Revision was used to classify comorbidities. Results A total of 461 patients with sleep apnea tested positive for COVID-19, of whom 149 were excluded for missing data in the electronic medical record. Patients with moderate and severe sleep apnea had higher rates of COVID-19 hospitalization compared to those with mild sleep apnea (P = .003). This association was reduced when accounting for confounders, most notably the Charlson Comorbidity Index, a measure of comorbid illness burden. Moderate and severe sleep apnea were associated with increased Charlson Comorbidity Indices, compared to mild sleep apnea (P = .01). Sleep apnea severity was not associated with a composite outcome of mechanical ventilation, intensive care unit admission, and death. Conclusion Sleep apnea severity was associated with the Charlson Comorbidity Index and may be a risk factor for COVID-19 hospitalization. We found no evidence that sleep apnea severity among hospitalized patients was associated with a composite outcome of mechanical ventilation, intensive care unit admission, and death.
Thermosensitive Chitosan-β-Glycerophosphate Hydrogels as Targeted Drug Delivery Systems: An Overview on Preparation and Their Applications

Today, with the advances in technology and science, more advanced drug delivery formulations are required. One of these new systems is an intelligent hydrogel. These systems are affected by the environment or conditions that become a gel, stay in the circumstance for a certain period, and slowly release the drug. As an advantage, only a lower dose of the drug is required, and it provides less toxicity and minor damage to other tissues. Hydrogels are of different types, including temperature-sensitive, pH-sensitive, ion change-sensitive, and magnetic field-sensitive. In this study, we investigated a kind of temperature-sensitive smart hydrogel, which has a liquid form at room temperature and becomes gel with increasing temperature. Chitosan-β-glycerophosphate hydrogels have been researched and used in many studies. This study investigates the various factors that influence the gelation mechanism, such as gel formation rates, temperature, pH, time, and gel specificity. Hydrogels are used in many drug delivery systems and diseases, including nasal drug delivery, vaginal drug delivery, wound healing, peritoneal adhesion, ophthalmic drug delivery, tissue engineering, and peptide and protein delivery. Overall, the chitosan-β-glycerophosphate hydrogel is a suitable drug carrier for a wide range of drugs. It shows little toxicity to the body, is biodegradable, and is compatible with other organs. This system can be used in different conditions and different medication ways, such as oral, nasal, and injection.
Identifying Biological Signatures of N-Acetylcysteine for Non-Suicidal Self-Injury in Adolescents and Young Adults

The prevalence of non-suicidal self-injury (NSSI) is high in adolescents and young adults. However, there is a paucity of evidence-based treatments to address this clinical problem. An open-label, pilot study in the target population showed that treatment with oral N-acetylcysteine (NAC), a widely available dietary supplement, was associated with reduction in NSSI frequency. In preparation for a biologically informed design of an efficacy trial, a critical preliminary step is to clarify NAC’s biological signatures, or measures of the mechanisms underlying its clinical effects. Toward that end, we propose a 2-stage project to investigate NAC’s biological signatures (changes in glutathione (GSH) and/or glutamate (Glu)) in women with NSSI. The first stage; a double-blind randomized placebo-controlled study will focus on identifying the optimal dose to achieve meaningful change in GSH and Glu during short-term (4 weeks) NAC treatment in 36 women aged 16–24 years with NSSI. Go/No-go criteria to determine if the study will progress to the second stage include pre-specified changes in brain and blood measures of GSH. Changes in the brain GSH are measured through magnetic resonance spectroscopy (MRS). The dose for the stage 2 will be selected based on the biological changes and the tolerability observed in the stage 1. The stage 2 will seek to replicate the biological signature findings in an 8-week trial in a new patient cohort, and examine the relationships among biological signatures, NAC pharmacokinetics and clinical response. This 2-stage project is unique as it unifies clinical psychiatric measurements, quantitative MRS and pharmacological approaches in the first placebo-controlled clinical trial of NAC in young women with NSSI. Trial registration: The stage 1 trial protocol has been registered on https://clinicaltrials.gov/ with ClinicalTrials.gov ID “NCT04005053” (Registered on 02 July 2019. Available from: https://clinicaltrials.gov/ct2/show/NCT04005053).
Heterozygous GJA1 variants with ocular phenotype: Missense in domain but truncation out of domain

Purpose Oculodentodigital dysplasia (ODDD) is a group disorder caused by GJA1 variants, of which glaucoma leading to blindness is a frequent complication of the ocular phenotype. In this study, the correlation of the GJA1 genotype with the ocular phenotype was analyzed systematically. Methods GJA1 variants were collected from in-house whole-exome sequencing data of 5,307 individuals. Potentially pathogenic variants (PPVs) were defined based on prediction of multiple in silico tools, related phenotypes, and previously established evidence. The characteristics of GJA1 PPVs were evaluated based on our data, gnomAD, and HGMD. Results In total, 21 rare variants in GJA1 were detected in 32 subjects from the study cohort. Four of the 21 variants were classified as PPVs, including two frameshift, one missense, and one in-frame deletion. The four PPVs were detected in four probands with microcornea or high hyperopia; two developed glaucoma. A systematic review of GJA1 variants in literature suggested that most heterozygous missense PPVs are located inside the connexin domain. All truncations downstream of the connexin domain are associated with autosomal dominant disease, while most truncations within the domain are associated with autosomal recessive ODDD. Ocular signs were present in 80.0% (116/145) of patients with GJA1 PPVs. Of the 116 patients, glaucoma was observed in 26.7% (31/116), among whom 77.4% (24/31) of cases occurred in patients ≥10 years old. Conclusions Eye abnormalities are the most common signs associated with GJA1 PPVs, and they carry a high risk of developing glaucoma. The identification of GJA1 PPVs needs further attention and clarification.
Frailty and Kidney Transplantation: A Systematic Review and Meta-analysis

Background. Frailty is a multidimensional condition and is the result of the body’s age-associated decline in physical, cognitive, physiological, and immune reserves. The aim of this systematic review is to assess the quality of evidence of the included studies, determine the prevalence of frailty among kidney transplant candidates, and evaluate the relationship between frailty and associated patient characteristics and outcomes after kidney transplantation. Methods. A systematic search was performed for relevant literature on frailty and kidney transplantation. This was followed by a meta-analysis for patient characteristics and outcomes reported by a minimum of 2 studies including mean age, gender, mean body mass index, type of kidney transplantation, dialysis, previous kidney transplantation, comorbidities, hypertension, race, preemptive kidney transplantation, delayed graft function, and length of stay. Results. A total of 18 studies were included in the systematic review and 14 of those studies were suitable for meta-analysis. The overall pooled prevalence of frailty before transplantation was estimated at 17.1% (95% confidence interval [CI], 15.4-18.7). Frailty was significantly associated with higher age (mean difference, 3.6; 95% CI, 1.4-5.9), lower rate of preemptive transplantation (relative risk, 0.60; 95% CI, 0.4-0.9), longer duration of delayed graft function (relative risk, 1.80; 95% CI, 1.1-3.0), and length of stay longer than 2 wk (odds ratio, 1.64; 95% CI, 1.2-2.3). Conclusions. One in 6 kidney transplant recipients is frail before transplantation. The presence of frailty is associated with lower rates of preemptive transplantation, older recipient age, higher rates of delayed graft function, and longer length of stay. Future research is required to explore the association of frailty with other adverse outcomes after kidney transplantation and the effects of intervention programs to improve the different frailty domains.
Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS (r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores (P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.