bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-task learning for arousal and sleep stage detection using fully convolutional networks
Authors: Zan Hasan , Yildiz Abdulnasır
Published: September 2023

Objective. Sleep is a critical physiological process that plays a vital role in maintaining physical and mental health. Accurate detection of arousals and sleep stages is essential for the diagnosis of sleep disorders, as frequent and excessive occurrences of arousals disrupt sleep stage patterns and lead to poor sleep quality, negatively impacting physical and mental health. Polysomnography is a traditional method for arousal and sleep stage detection that is time-consuming and prone to high variability among experts. Approach. In this paper, we propose a novel multi-task learning approach for arousal and sleep stage detection using fully convolutional neural networks. Our model, FullSleepNet, accepts a full-night single-channel EEG signal as input and produces segmentation masks for arousal and sleep stage labels. FullSleepNet comprises four modules: a convolutional module to extract local features, a recurrent module to capture long-range dependencies, an attention mechanism to focus on relevant parts of the input, and a segmentation module to output final predictions. Main results. By unifying the two interrelated tasks as segmentation problems and employing a multi-task learning approach, FullSleepNet achieves state-of-the-art performance for arousal detection with an area under the precision-recall curve of 0.70 on Sleep Heart Health Study and Multi-Ethnic Study of Atherosclerosis datasets. For sleep stage classification, FullSleepNet obtains comparable performance on both datasets, achieving an accuracy of 0.88 and an F1-score of 0.80 on the former and an accuracy of 0.83 and an F1-score of 0.76 on the latter. Significance. Our results demonstrate that FullSleepNet offers improved practicality, efficiency, and accuracy for the detection of arousal and classification of sleep stages using raw EEG signals as input.
Schrödinger dynamics in length-scale hierarchy: from spatial rescaling to Huygens-like proliferation of Gaussian wavepackets
Authors: Takatsuka Kazuo
Published: September 2023

Studying possible laws, rules, and mechanisms of time-evolution of quantum wavefunctions leads to deeper understanding about the essential nature of the Schrödinger dynamics and interpretation on what the quantum wavefunctions are. As such, we attempt to clarify the mechanical and geometrical processes of deformation and bifurcation of a Gaussian wavepacket of the Maslov type from the viewpoint of length-scale hierarchy in the wavepacket size relative to the range of relevant potential functions. Following the well-known semiclassical view that (1) Newtonian mechanics gives a phase space geometry, which is to be projected onto configuration space to determine the basic amplitude of a wavefunction (the primitive semiclassical mechanics), our study proceeds as follows. (2) The quantum diffusion arising from the quantum kinematics makes the Gaussian exponent complex-valued, which consequently broadens the Gaussian amplitude and brings about a specific quantum phase. (3) The wavepacket is naturally led to bifurcation (branching), when the packet size gets comparable with or larger than the potential range. (4) Coupling between the bifurcation and quantum diffusion induces the Huygens-principle like wave dynamics. (5) All these four processes are collectively put into a path integral form. We discuss some theoretical consequences from the above analyses, such as (i) a contrast between the δ-function-like divergence of a wavefunctions at focal points and the mesoscopic finite-speed shrink of a Gaussian packet without instantaneous collapse, (ii) the mechanism of release of the zero-point energy to external dynamics and that of tunneling, (iii) relation between the resultant stochastic quantum paths and wave dynamics, and so on.
A new method for finding global solutions to Synge’s electromagnetic problem
Authors: Silva Rodrigo R , Figueiredo Annibal
Published: September 2023

Synge’s problem consists in determining the dynamics of two point electrical charges interacting through their electromagnetic fields, without taking into account the radiation terms due to the self-forces in each charge. We discuss how this problem is related to the question on to establish initial conditions for the electromagnetic fields that are compatible with the two point charges system in isolation, that is, the charges are free from the action of external forces. This problem stems from the existence of inter-temporal constraints for the charges trajectories, which implies that the relativistic Newton equations for the charges is not a system of ordinary differential equations (ODEs), but rather a system of functional differential equations (FDEs). We developed a new method to obtain global solutions that satisfies this system of FDEs and a given initial condition for the charges positions and velocities. This method allows the construction of a recursive numerical algorithm that only use integration methods for ODEs systems. Finally, we apply this algorithm to obtain numerical approximations for the quasi-circular solutions that are predicted in Synge’s problem.
On the reproducibility of extrusion-based bioprinting: round robin study on standardization in the field
Authors: Grijalva Garces David , Strauß Svenja , Gretzinger Sarah , Schmieg Barbara , Jüngst Tomasz , Groll Jürgen , Meinel Lorenz , Schmidt Isabelle , Hartmann Hanna , Schenke-Layland Katja , Brandt Nico , Selzer Michael , Zimmermann Stefan , Koltay Peter , Southan Alexander , Tovar Günter E M , Schmidt Sarah , Weber Achim , Ahlfeld Tilman , Gelinsky Michael , Scheibel Thomas , Detsch Rainer , Boccaccini Aldo R , Naolou Toufik , Lee-Thedieck Cornelia , Willems Christian , Groth Thomas , Allgeier Stephan , Köhler Bernd , Friedrich Tiaan , Briesen Heiko , Buchholz Janine , Paulus Dietrich , von Gladiss Anselm , Hubbuch Jürgen
Published: September 2023

The outcome of three-dimensional (3D) bioprinting heavily depends, amongst others, on the interaction between the developed bioink, the printing process, and the printing equipment. However, if this interplay is ensured, bioprinting promises unmatched possibilities in the health care area. To pave the way for comparing newly developed biomaterials, clinical studies, and medical applications (i.e. printed organs, patient-specific tissues), there is a great need for standardization of manufacturing methods in order to enable technology transfers. Despite the importance of such standardization, there is currently a tremendous lack of empirical data that examines the reproducibility and robustness of production in more than one location at a time. In this work, we present data derived from a round robin test for extrusion-based 3D printing performance comprising 12 different academic laboratories throughout Germany and analyze the respective prints using automated image analysis (IA) in three independent academic groups. The fabrication of objects from polymer solutions was standardized as much as currently possible to allow studying the comparability of results from different laboratories. This study has led to the conclusion that current standardization conditions still leave room for the intervention of operators due to missing automation of the equipment. This affects significantly the reproducibility and comparability of bioprinting experiments in multiple laboratories. Nevertheless, automated IA proved to be a suitable methodology for quality assurance as three independently developed workflows achieved similar results. Moreover, the extracted data describing geometric features showed how the function of printers affects the quality of the printed object. A significant step toward standardization of the process was made as an infrastructure for distribution of material and methods, as well as for data transfer and storage was successfully established.
Finite element analysis of elliptical shaped stem profile of hip prosthesis using dynamic loading conditions
Authors: Corda John Valerian , K N Chethan , Bhat N Shyamasunder , Shetty Sawan , Shenoy B Satish , Zuber Mohammad
Published: September 2023

Patient-specific dynamic loadings are seldom considered during the evaluation of hip implants. The primary objective of this study is to check for the feasibility of the use of UHMWPE as the material for an acetabular cup o CoCr Alloy that is reported to produce a squeaking sound after replacement. An elliptical shaped stem with three different cross-sectional profiles is considered for simulation. Using a commercial finite element method, patient-specific dynamic forces were applied for the quantitative analysis. The loading and boundary conditions are used as per ISO and ASTM standards. The walking gait cycle is used with two widely used biocompatible materials: titanium and cobalt-chromium. Initially, only the stem is considered for the analysis to finalize the best out of the three profiles, along with the better material for the stem. Later the complete implant is used for the analysis. Profile 1 exhibits 1.25 and 1.17 times greater stress than Profile 2 for CoCr Alloy and Ti–6Al–4V, respectively. Similarly, Profile 3 displays stresses 1.26 and 1.25 times greater than Profile 2 for CoCr Alloy and Ti–6Al–4V, respectively. Comparatively, displacement in stem Profile 2 is 1.75 times higher in Ti–6Al–4V than CoCr Alloy. The full implant displacement at 14% gait cycle is 1.15% higher for the CoCr-acetabular column material combination when compared to UHMWPE. It can be concluded that UHMWPE can be used as the acetabular cup material instead of CoCr for the Profile 2 elliptical shaped hip implant to prevent squeaking after replacement.
High-dimensional quantum key distribution using energy-time entanglement over 242 km partially deployed fiber
Authors: Liu Jingyuan , Lin Zhihao , Liu Dongning , Feng Xue , Liu Fang , Cui Kaiyu , Huang Yidong , Zhang Wei
Published: September 2023

Entanglement-based quantum key distribution (QKD) is an essential ingredient in quantum communication, owing to the property of source-independent security and the potential on constructing large-scale quantum communication networks. However, implementation of entanglement-based QKD over long-distance optical fiber links is still challenging, especially over deployed fibers. In this work, we report an experimental QKD using energy-time entangled photon pairs that transmit over optical fibers of 242 km (including a section of 19 km deployed fibers). The QKD is realized through the protocol of dispersive-optics QKD (DO-QKD) with high-dimensional encoding to utilize coincidence counts more efficiently. A reliable, high-accuracy time synchronization technology for long-distance entanglement-based QKD is developed based on the distribution of optical pulses in quantum channels. Our system operates continuously for more than 7 d without active polarization or phase calibration. We ultimately generate secure keys with secure key rates of 0.22 bps and 0.06 bps in the asymptotic and finite-size regimes, respectively. It shows that entanglement-based DO-QKD is reliable for long-distance realization in the field if its high requirement on time synchronization is satisfied.
Sequence learning in a spiking neuronal network with memristive synapses
Authors: Bouhadjar Younes , Siegel Sebastian , Tetzlaff Tom , Diesmann Markus , Waser Rainer , Wouters Dirk J
Published: September 2023

Brain-inspired computing proposes a set of algorithmic principles that hold promise for advancing artificial intelligence. They endow systems with self learning capabilities, efficient energy usage, and high storage capacity. A core concept that lies at the heart of brain computation is sequence learning and prediction. This form of computation is essential for almost all our daily tasks such as movement generation, perception, and language. Understanding how the brain performs such a computation is not only important to advance neuroscience, but also to pave the way to new technological brain-inspired applications. A previously developed spiking neural network implementation of sequence prediction and recall learns complex, high-order sequences in an unsupervised manner by local, biologically inspired plasticity rules. An emerging type of hardware that may efficiently run this type of algorithm is neuromorphic hardware. It emulates the way the brain processes information and maps neurons and synapses directly into a physical substrate. Memristive devices have been identified as potential synaptic elements in neuromorphic hardware. In particular, redox-induced resistive random access memories (ReRAM) devices stand out at many aspects. They permit scalability, are energy efficient and fast, and can implement biological plasticity rules. In this work, we study the feasibility of using ReRAM devices as a replacement of the biological synapses in the sequence learning model. We implement and simulate the model including the ReRAM plasticity using the neural network simulator NEST. We investigate two types of ReRAM memristive devices: (i) a gradual, analog switching device, and (ii) an abrupt, binary switching device. We study the effect of different device properties on the performance characteristics of the sequence learning model, and demonstrate that, in contrast to many other artificial neural networks, this architecture is resilient with respect to changes in the on-off ratio and the conductance resolution, device variability, and device failure.
Scripting a life: The early years
Authors: Boehmer Elleke
Published: September 2023

This chapter looks into the life of Nelson Mandela, which largely correlates to the operations of the South African state. Mandela’s story exhibits recognizable typicality and representativeness, underpinned by a teleology of political growth with liberation as its goal. By recounting a steady progression towards freedom and modernity, the life-story runs in parallel with the largely masculine, one-directional narrative of resistance and overcoming as it has been played out in Africa. The chapter highlights how Mandela’s leadership skills, formal legal training, and gift of forging friendships across colour divisions were in constant demand. It notes how Mandela recommended socialist redistribution to allow African people to catch up with the advanced nation.
Mandela’s legacy
Authors: Boehmer Elleke
Published: September 2023

This chapter covers the legacy left by Nelson Mandela as an inspiring symbol of humanism, perseverance, and hope, and possibly a beacon of creative inspiration itself. In 1994, Mandela and his Government of National Unity founded the new South African republic based on racial reconciliation and a new humanism. However, Mandela’s ethical republic was built on a fragile foundation since South African citizens were unused to the democratic structure and the economy remained unreconstructed. The chapter considers Mandela’s attempts to set himself as a model of justice, non-racialism, and social understanding. Even though South Africans confronted a future without Mandela, he remains a governing national myth, a model of personal sacrifice and reconciliation.
Film Music: A Very Short Introduction
Authors: Kalinak Kathryn
Published: September 2023

Film Music: A Very Short Introduction focuses on the most central issues in the practice of film music. What is film music? How is it composed? How does film music work? Why does film music work? The rich and deeply moving sounds of film music are as old as cinema. The very first projected moving images were accompanied by music around the globe as a variety of performers—from single piano players to small orchestras—brought images to life. Film music has since become its own industry, an aesthetic platform for expressing creative visions, and a commercial vehicle for generating increased revenue. The second edition updates coverage to 2022 and includes attention to recent developments in global film music, women in film music, and African American and minority composers.
The chief justice
Authors: Greenhouse Linda
Published: September 2023

The chief justice is not mentioned in the judicial article of the Constitution (Article III), but “The chief justice” demonstrates how the role has grown in importance over time. It is a multifaceted role, like that of a chief executive of a company. A traditional legal background is not necessarily the best preparation. Some chief justices believed that casting one of the nine votes in a case is still one of their most useful functions. It was a chief justice, William Howard Taft, who decided that the Supreme Court’s caseload should be decided on a discretionary basis, putting the Court in a position to dictate America’s legal agenda.
The Court and the world
Authors: Greenhouse Linda
Published: September 2023

When the Framers set the Supreme Court in motion, they had no template for what they were about to create. “The Court and the world” demonstrates that other countries were able to use the Supreme Court for inspiration, and many have done so. What they have chosen to take and leave from the Court’s example is instructive. Lifetime tenure is exceedingly rare outside the United States, with most European courts preferring nine- or ten-year appointments and aiming for unanimity rather than majority. While specific knowledge about the Court is limited, the U.S. Supreme Court still holds a place in the public imagination.
Association of Pulse Pressure Fluctuation During Hospitalization With Adverse Outcomes Within 3 Months After Ischemic Stroke
Authors: Wang Yu , Zhang Jintao , Zhu Zhengbao , Peng Yanbo , Liu Yang , Wang Ruirui , Shi Mengyao , Wang Aili , Xu Tian , Peng Hao , Xu Tan , Chen Jing , Zhang Yonghong , He Jiang
Published: September 2023

BACKGROUND

Pulse pressure (PP) depends on heart function and arterial wall elasticity, which is closely related to the incidence of ischemic stroke. However, the association of PP fluctuation during hospitalization with adverse outcomes after ischemic stroke remains unclear.

METHODS

The present study included 3,971 patients with ischemic stroke. The primary outcome was the composite outcome of death or vascular events within 3 months after ischemic stroke. PP fluctuation was reflected by successive variation of PP (PP-SV).

RESULTS

The cumulative incidence rates of the primary outcome were the highest in the patients in the highest quartiles of PP-SV (P < 0.05). The multivariable-adjusted hazard ratios (95% confidence intervals) of the primary outcome in the highest quartiles were 1.86 (1.03–3.38) for death or vascular events, and 2.15 (1.06–4.37) for vascular events (all Ptrend < 0.05). Multivariable-adjusted restricted cubic spline analyses showed linear associations of PP-SV during hospitalization with the primary outcome (P for linearity <0.05).

CONCLUSIONS

Large PP fluctuation during hospitalization was associated with increased risks of adverse outcomes within 3 months after ischemic stroke, which provided valuable new insight for blood pressure management in the acute phase of ischemic stroke. Controlling PP fluctuation may be contributing to improving prognosis after ischemic stroke.
Is there evidence of convergent displacement of characters in the release calls of Cuban species of the genus Peltophryne (Anura: Bufonidae)?
Authors: del Castillo Domínguez Sergio L , Alonso Bosch Roberto
Published: September 2023

Anuran release calls are produced by females and males in response to mating attempts by other males. The efficiency of the release signal to initiate dismount ensures that amplexus is not prolonged, avoiding exposure to predation and increasing the time available for breeding opportunities. Convergent character displacement of release calls may facilitate interspecific communication. In this contribution, we described and compared the release calls of sexually active males of four endemic species of Cuban toads of the genus Peltophryne in allopatric and sympatric conditions, exploring possible evidence of convergent displacement in areas of sympatry. One of these species, Peltophryne peltocephala, is widely distributed in the Cuban archipelago, with contact areas with two other species of large toads. Convergent character displacement requires that the allopatric character states of the species are significantly different from each other, and the sympatric character states are not significantly different. Although significant differences were detected between pairs of different species, in terms of duration of call sequence, call duration, interval between calls and dominant frequency, we did not find a robust pattern consistent with the expected pattern of convergent displacement of acoustic characters. Almost all call variability of allopatric populations fell inside the variability of sympatric populations.
Phosphatases modified by LH signaling in ovarian follicles: testing their role in regulating the NPR2 guanylyl cyclase
Authors: Egbert Jeremy R , Silbern Ivan , Uliasz Tracy F , Lowther Katie M , Yee Siu-Pok , Urlaub Henning , Jaffe Laurinda A
Published: September 2023

In response to luteinizing hormone (LH), multiple proteins in rat and mouse granulosa cells are rapidly dephosphorylated, but the responsible phosphatases remain to be identified. Because the phosphorylation state of phosphatases can regulate their interaction with substrates, we searched for phosphatases that might function in LH signaling by using quantitative mass spectrometry. We identified all proteins in rat ovarian follicles whose phosphorylation state changed detectably in response to a 30-min exposure to LH, and within this list, identified protein phosphatases or phosphatase regulatory subunits that showed changes in phosphorylation. Phosphatases in the phosphoprotein phosphatase (PPP) family were of particular interest because of their requirement for dephosphorylating the natriuretic peptide receptor 2 (NPR2) guanylyl cyclase in the granulosa cells, which triggers oocyte meiotic resumption. Among the PPP family regulatory subunits, PPP1R12A and PPP2R5D showed the largest increases in phosphorylation, with 4–10 fold increases in signal intensity on several sites. Although follicles from mice in which these phosphorylations were prevented by serine-to-alanine mutations in either Ppp1r12a or Ppp2r5d showed normal LH-induced NPR2 dephosphorylation, these regulatory subunits and others could act redundantly to dephosphorylate NPR2. Our identification of phosphatases and other proteins whose phosphorylation state is rapidly modified by LH provides clues about multiple signaling pathways in ovarian follicles.
Targeted mutation and inactivation of the kinesin light chain 3 protein-encoding gene have no impact on mouse fertility
Authors: Daniel-Carlier Nathalie , Castille Johan , Passet Bruno , Vilotte Marthe , Le Danvic Christelle , Jaffrezic Florence , Beauvallet Christian , Péchoux Christine , Capitan Aurélien , Vilotte Jean-luc
Published: September 2023

The kinesin light chain 3 protein (KLC3) is the only member of the kinesin light chain protein family that was identified in post-meiotic mouse male germ cells. It plays a role in the formation of the sperm midpiece through its association with both spermatid mitochondria and outer dense fibers (ODF). Previous studies showed a significant correlation between its expression level and sperm motility and quantitative semen parameters in humans, while the overexpression of a KLC3-mutant protein unable to bind ODF also affected the same traits in mice. To further assess the role of KLC3 in fertility, we used CRISPR/Cas9 genome editing in mice and investigated the phenotypes induced by the invalidation of the gene or of a functional domain of the protein. Both approaches gave similar results, i.e. no detectable change in male or female fertility. Testis histology, litter size and sperm count were not altered. Apart from the line-dependent alterations of Klc3 mRNA levels, testicular transcriptome analysis did not reveal any other changes in the genes tested. Western analysis supported the absence of KLC3 in the gonads of males homozygous for the inactivating mutation and a strong decrease in expression in males homozygous for the allele lacking one out of the five tetratricopeptide repeats. Overall, these observations raise questions about the supposedly critical role of this kinesin in reproduction, at least in mice where its gene mutation or inactivation did not translate into fertility impairment.
Quality of DNA extracted from freshwater fish scales and mucus and its application in genetic diversity studies of Perca fluviatilis and Rutilus rutilus
Authors: Ignatavičienė Ieva , Ragauskas Adomas , Rakauskas Vytautas , Butkauskas Dalius
Published: September 2023

Studies on genetic diversity require biological material containing a reliable source of DNA that can be extracted and analyzed. Recently, non-invasive sampling has become a preferred sampling method of biological material. The suitability of a less invasive approach that involves obtaining samples by swabbing the fish skin (including live, non-anesthetized fish) should be considered. In this study, we compared the efficiency of DNA extraction, amplification, and sequencing of mtDNA fragments of two fish species Perca fluviatilis and Rutilus rutilus based on DNA collected from the scales and mucus using the modified Aljanabi and Martinez method. The results revealed a higher quality of DNA extracted from the mucus; however, the mean DNA concentration obtained from the scales of both fish species was higher. We verified the method suitable for amplification and sequencing of mtDNA fragments of both fish species using newly designed markers (D-loop, ATP6) and examined the potential risk of intraspecific cross-contamination. The DNA sequence alignment analysis revealed identical sequences attributed to the same individual when DNA, extracted from two different sources (scales and mucus), was used. We demonstrated that the quantity and quality of DNA extracted from the scales and mucus using the proposed method were high enough to carry out genetic diversity studies based on sampling of live fish with the possibility to release it after collecting samples.
Invariant natural killer T cells and incidence of first-time coronary events: a nested case-control study
Authors: Tomas Lukas , Katra Pernilla , Badn Wiaam , Andersson Linda , Nilsson Jan , Schiopu Alexandru , Engelbertsen Daniel , Gonçalves Isabel , Bengtsson Eva , Björkbacka Harry
Published: September 2023

Aims

Invariant natural killer T (iNKT) cells, a T cell subset that is CD1d-restricted and expresses a semi-invariant T cell receptor, have been proposed to contribute to dyslipidaemia-driven cardiovascular disease due to their ability to specifically recognize lipid antigens. Studies in mice have attributed pro-atherogenic properties to iNKT cells, but studies in humans investigating associations of iNKT cells with incident coronary events (CE) are lacking.

Methods and results

Here, we used flow cytometry to enumerate circulating iNKT cells (CD3+ CD1d-PBS57-Tetramer+) in a case-control cohort nested within the prospective population-based Malmö Diet and Cancer Study (n = 416) to explore associations with incident first-time CE during a median follow-up of 14 years. We found a significant inverse association between CD4− and CD8− double negative (DN) iNKT cells and incident CE, with an odds ratio of 0.62 [95% confidence interval (CI) 0.38–0.99; P = 0.046] comparing the highest vs. the lowest tertile of DN iNKT cells. The association remained significant after adjustment for cardiovascular risk factors with an odds ratio of 0.57 (95% CI 0.33–0.99; P = 0.046). In contrast, total iNKT cells were not significantly associated with incident CE after adjustment, with an odds ratio of 0.74 (95% CI 0.43–1.27; P = 0.276).

Conclusion

Our findings indicate that animal studies suggesting an atherosclerosis-promoting role for iNKT cells may not translate to human cardiovascular disease as our data show an association between high circulating numbers of DN iNKT cells and decreased risk of incident CE.
The Boss is Watching: How Monitoring Decisions Hurt Black Workers
Authors: Cavounidis Costas , Lang Kevin , Weinstein Russell
Published: September 2023

African Americans face shorter employment durations than similar Whites. We hypothesise that employers discriminate in acquiring or acting on ability-relevant information. In our model, monitoring Black, but not White, workers is self-sustaining. New Black hires were more likely fired by previous employers after monitoring. This reduces firms’ beliefs about ability, incentivising discriminatory monitoring. We confirm our predictions that layoffs are initially higher for Black than non-Black workers, but that they converge with seniority and decline more with the Armed Forces Qualification Test for Black workers. Two additional predictions, lower lifetime incomes and longer unemployment durations for Black workers, have known empirical support.
Early and long-term outcomes of young adult patients ≤30 years old with acute type A aortic dissection
Authors: Xie Qiang , Zhong Yongliang , Xu Qinfeng , Wang Jianji , Ge Yipeng , Li Chengnan , Sun Lizhong , Zhu Junming
Published: September 2023

OBJECTIVES

The aim of this study was to investigate the early and long-term outcomes after total arch replacement (TAR) and frozen elephant trunk (FET) implantation in adult patients ≤30 years with acute type A aortic dissection (ATAAD).

METHODS

All young adult patients (≤30 years) with ATAAD who underwent TAR and FET between 2009 and 2017 were enrolled. The end points were major organ morbidity and mortality, aortic-related events and reoperation.

RESULTS

The mean age of all 83 patients was 25.9 (standard deviation, 3.3) years. The in-hospital mortality was 9.64% (8/83), and 9 (10.8%) patients required re-exploration for bleeding. The aortic-related events risk was 42.7% (32/75) and the aortic reoperation risk was 17.3% (13/75). Overall survival was 85.5% [95% confidence interval (CI), 75.9–91.5%] at 5 years and 75.9% (95% CI, 63.3–84.7%) at 10 years. The cumulative incidence of aortic-related events was 35% (95% CI, 24–47%) at 5 years and 58% (95% CI, 36–75%) at 10 years; the cumulative reoperation rate was 15% (95% CI, 7.9–24%) at 5 years and 17% (95% CI, 9.2–27%) at 10 years. Marfan syndrome significantly increased the aortic-related events (P = 0.036) and reoperation (P = 0.041) risks.

CONCLUSIONS

Despite extensive repair in young ATAAD patients, the late aortic dilatation and reoperation risk remain high. The TAR and FET procedures achieved satisfactory early outcomes and reduced late aortic dilatation and reoperation in young patients compared with other records. Close follow-up and aggressive early reintervention are essential for patients with aortic-related risk factors early in life.
A sandwich resonant bar method with transfer matrices for measuring the elastic parameters of rock at low frequency
Authors: Li Jiahui , Chen Dehua , Wang Yu , Chen Hao
Published: September 2023

Rocks and other geological materials have appreciable dispersion in their elastic properties. Rock elastic parameters within the same frequency range as the logging frequency band (1–20 kHz) should be determined to facilitate reservoir prediction and interpretation of logging data. This study suggests a technique for determining the elastic characteristics of rock cores at low frequencies using a sandwich resonant bar by integrating transfer matrices into the one-dimensional transmission model. The frequency response expression of the sandwich resonant bar is derived analytically and then the response is simulated accurately based on this expression. Numerical results show that the first two-order longitudinal resonance frequencies are approximately linearly related to the inverse of the sample's Young's modulus and the density, respectively. In addition, an inversion algorithm based on Gauss–Newton iteration, which converges faster and more efficiently, is proposed in this paper. The residuals between the model's first two resonant frequencies and the simulated results are used as the error function, and the elasticity parameters that minimize the error function are the best estimate for creating the model. This research is valuable for measuring rock elastic parameters accurately in the kilohertz range, which is of practical significance in dispersion-related studies relating to rock cores.
Airway Fire
Authors: Balduyeu Pavel , Loeb Robert G.
Published: September 2023

An airway fire is a surgical fire that occurs in a patient’s airway and may or may not include a fire in the attached breathing circuit. It is estimated that 217 to 650 operating room fires occur each year in the United States, with as many as 5% to 10% associated with serious injury or death. Airway fires are particularly harmful to patients, constituting approximately 21% of all surgical fires and the majority of surgical fires that result in death. A fire requires three components known as the “fire triad”: an oxidizer, an ignition source, and a fuel. The earliest signs of a fire are seeing a flash, hearing a pop, or smelling smoke. The major steps in the management of an airway fire are to extinguish the fire, stabilize the patient, and assess the patient’s airway for fire damage to decide whether the patient needs to be intubated and remain intubated.
One-Lung Ventilation
Authors: Nwajuaku Patricia , Hegland Dustin L. , Goldstein Joseph C.
Published: September 2023

One-lung ventilation is required in a variety of thoracic, cardiac, gastrointestinal, and neurological spine surgeries. It is important to be aware of the relative and absolute indications for lung isolation, and it is prudent to individualize the technique to the patient and surgery. Successfully initiating and maintaining one-lung isolation can be accomplished through a variety of techniques, all of which require nuanced procedural skill and insightful troubleshooting. Knowledge of the tracheal-bronchial anatomy and a sound understanding of ventilation and perfusion concepts, as well as a methodical approach to troubleshooting, are required when faced with challenging clinical circumstances. Common problems include difficulties with placement of double-lumen tubes or endobronchial blocking devices with or without the added challenges of a difficult airway. Achieving and maintaining adequate functional placement of the selected device requires a certain knowledge of the tracheal-bronchial anatomy and its variations. During one-lung ventilation, hypoxemia (usually defined as desaturation with SpO2 values of less than 90% and/or PaO2 values of less than 60 mmHg), hypercarbia, and hemodynamic instability frequently require swift intervention to ensure optimal care.
Management of Ventricular Tachycardia and Ventricular Fibrillation
Authors: Redding Amanda , Hassid Marc , Smith Ryan
Published: September 2023

While intraoperative arrhythmias are common, ventricular tachycardia and ventricular fibrillation are potentially life-threatening arrhythmias that originate in ventricular structures. Ventricular tachycardia is defined as three or more consecutive ventricular premature contractions (VPCs) with a rate of at least 100 beats per minute, and may present with stable or unstable physiology. It is considered sustained if it persists for at least 30 seconds. Stable or asymptomatic ventricular tachycardia affords the caregiver time for diagnosis, consultation, and formulation of a treatment plan, while unstable or symptomatic ventricular tachycardia requires emergent intervention. Unstable ventricular tachycardia is diagnosed by signs of decreased cardiac output and will typically present with a heart rate of at least 150 beats per minute. Ventricular fibrillation and pulseless ventricular tachycardia should be treated immediately with defibrillation and advanced cardiac life support (ACLS) to try to achieve return of spontaneous circulation (ROSC).
Tension Pneumothorax
Authors: Desmond Matthew , Zasimovich Yury
Published: September 2023

Tension pneumothorax is an emergency that requires timely diagnosis and management to prevent mortality. Any procedure that may violate the pleura can cause a pneumothorax, such as nerve blocks and surgical procedures in that area. Others are prone to pneumothorax simply due to their anatomy and physiology, including neonates undergoing mechanical ventilation, tall adolescents, and older patients with chronic obstructive pulmonary disease. Every anesthesiologist should be familiar with tension pneumothorax, which may present after the initiation of artificial, positive pressure ventilation. Here the approach is presented, including step-by-step guidance for needle decompression and definitive drain placement. The use of ultrasound is emphasized. Ultrasound is extremely useful for both diagnostic and therapeutic purposes. The rapid, sequential decision-making necessary to treat the disease in an optimal manner is presented chronologically. Thus, the latest thinking regarding ultrasound guidance; small-bore and conventional, open thoracostomy tube placement; and postprocedure management—and the reasoning underlying the treatment options—is discussed.
Post-Tonsillectomy Bleeding
Authors: Battles Rhae , Ching Adrian , Gonzalez Sandra , Mehta Sonia
Published: September 2023

Post-tonsillectomy hemorrhage is a potentially life-threatening complication after tonsillectomy and/or adenoidectomy that can be challenging to manage for even the most experienced anesthesia providers. The problem of post-tonsillectomy hemorrhage is multifaceted, and the anesthesiologist is often tasked with coordinating the management of the difficult airway, airway obstruction and respiratory compromise, potential aspiration, fluid resuscitation, hemodynamic instability, and maintaining effective lines of communication between the anesthesia team, surgeons, emergency department providers, nursing, and operating room staff. While the problem of post-tonsillectomy hemorrhage primarily presents in the pediatric population, we will also address management in adult patients and highlight the steps wherein the diagnostic and therapeutic options diverge. In reviewing this chapter, the reader should be provided with a concise yet detailed approach to managing the patient presenting with post-tonsillectomy hemorrhage.
Perioperative Complications of Neuraxial Anesthesia
Authors: Wardhan Richa , Adaralegbe Adejuyigbe Olusegun
Published: September 2023

Spinal and epidural anesthesia is commonly referred to as neuraxial anesthesia. Neuraxial anesthesia is a routinely performed anesthetic procedure for a variety of surgical procedures. There are numerous advantages of neuraxial anesthesia including decreased bleeding, lower risk of deep vein thrombosis, decreased risk of nausea and vomiting, and minimal risk of postoperative cognitive dysfunction. However, neuraxial anesthesia can be associated with some major and minor complications. The major complications are high/total spinal, systemic toxicity, and epidural hematoma. High/total spinal can lead to cardiac arrest and death, while epidural hematoma can result in debilitating paraplegia. The goal of this chapter is to review the life-threatening complications of neuraxial anesthesia and discuss ways to treat and avoid them.
Malignant Hyperthermia
Authors: Smith Cameron R.
Published: September 2023

Malignant hyperthermia (MH) is a rare but life-threatening condition that manifests almost exclusively as a result of exposure to volatile anesthetics such as sevoflurane or isoflurane, or succinylcholine. It is, at its core, a situation of hypermetabolism intrinsic to the muscle, resulting in signs and symptoms such as tachycardia, hypercapnia, increasing oxygen consumption, muscle rigidity, dark-colored urine, and rising core temperature. Successful treatment requires prompt action. A large number of people will be required, so help should be called for early. Early focus should be directed at preparation and administration of dantrolene, the only treatment available for MH, as each 30-minute delay in administration nearly doubles the rate of complications including death. Once this has been completed, care shifts to more supportive measures, such as correcting lab abnormalities and cooling. Additional support with diagnosis and treatment can and should be sought from the MH Hotline, which is staffed by MH experts at all times. Lastly, once the acute event is complete, one should consider contacting the MH registry so that the event can be added to the data repository, helping further MH research and understanding.
Anesthetic Management of Emergency Cesarean Delivery
Authors: Cometa M. Anthony , Wendling Adam L.
Published: September 2023

Cesarean delivery has increased in recent years. A classification system for urgency of cesarean delivery has been described to assist with communication and clinical decision-making surrounding the time of delivery. This system rated urgency on a 1 to 4 scale: Category 1—immediate threat to life of woman or fetus; Category 2—maternal or fetal compromise that is not immediately life-threatening; Category 3—needing early delivery but no maternal or fetal compromise; and Category 4—elective. Such a system can assist the anesthesiologist in clinical decision-making surrounding allocating resources (prioritizing/delaying other surgical care, calling in more help from outside the hospital) and anesthetic options. One of the most impactful factors associated with performing general anesthesia for cesarean section is the Category 1 indication for delivery. Considerations for the safe management of emergency abdominal delivery will be discussed.
Anesthesia Machine Failures
Authors: Luria Isaac , Loeb Robert G.
Published: September 2023

Anesthesia machine failures can be confusing for anesthesia providers. It can be difficult in some cases to distinguish a patient’s medical problems from a failure of equipment. Under general anesthesia the anesthesia machine functions as a life support system for the operative patient. While anesthesia machine or infrastructure failures are rare, they do happen. Their rarity can make them difficult to diagnose, but the correct diagnosis cannot be made if it is not even on the list of considerations. The steps outlined in this chapter are important in their own right, but an important overarching lesson is to include equipment malfunction in the differential diagnosis of any intraoperative problem. Caring for the safety of the patient first and foremost is vital when trying to diagnose what could be a machine problem. Resolving anesthesia machine failures should only be attempted after the safety of the patient has been otherwise secured. Such safety measures may include switching to a self-inflating rescue breathing device, also known as a bag-valve mask; calling for help; or using a portable oxygen tank to completely remove the anesthesia machine variable from patient care. A complete pre-use check will prevent many anesthesia machine problems, but the focus in this chapter is on failures that can appear during anesthesia despite a thorough pre-use check. This chapter provides an approach to the diagnosis and management of low breathing circuit pressure, breathing circuit obstruction, oxygen pipeline failure, hypoxic oxygen pipeline mixture, and anesthesia machine power failure.
Motivational Interviewing and Dietetics
Authors: Douaihy Antoine , Kelly Thomas M. , Bermudez Augusto , Bell David
Published: September 2023

This chapter focuses on the relationship between unhealthy diet, low activity level and associated morbidity. A review of recent literature indicates that MI can be integrated with nutrition counselling to help patients increase physical activity, e.g., walking while decreasing cholesterol levels, risk for cardiovascular illness, depression, and type 2 diabetes. The chapter discusses the importance of avoiding scare tactics and the “righting reflex” in nutrition counselling.
Intraventricular SHH inhibition proves efficient in SHH medulloblastoma mouse model and prevents systemic side effects
Authors: Kresbach Catena , Holst Lea , Schoof Melanie , Leven Tara , Göbel Carolin , Neyazi Sina , Tischendorf Jacqueline , Loose Carolin , Wrzeszcz Antonina , Yorgan Timur , Rutkowski Stefan , Schüller Ulrich
Published: September 2023

Background

Medulloblastoma (MB) is the most common malignant brain tumor in children and requires intensive multimodal therapy. Long-term survival is still dissatisfying and, most importantly, survivors frequently suffer from severe treatment-associated morbidities. The sonic hedgehog pathway (SHH) in SHH MB provides a promising target for specific therapeutic agents. The small molecule Vismodegib allosterically inhibits SMO, the main upstream activator of SHH. Vismodegib has proven effective in the treatment of MB in mice and in clinical studies. However, due to irreversible premature epiphyseal growth plate fusions after systemic application to infant mice and children, its implementation to pediatric patients has been limited. Intraventricular Vismodegib application might provide a promising novel treatment strategy for pediatric medulloblastoma patients.

Methods

Infant medulloblastoma-bearing Math1-cre::Ptch1Fl/Fl mice were treated with intraventricular Vismodegib in order to evaluate efficacy on tumor growth and systemic side effects.

Results

We show that intraventricular Vismodegib treatment of Math1-cre::Ptch1Fl/Fl mice leads to complete or partial tumor remission only 2 days after completed treatment. Intraventricular treatment also significantly improved symptom-free survival in a dose-dependent manner. At the same time, intraventricular application prevented systemic side effects in the form of anatomical or histological bone deformities.

Conclusions

We conclude that intraventricular application of a SHH pathway inhibitor combines the advantages of a specific treatment agent with precise drug delivery and might evolve as a promising new way of targeted treatment for SHH MB patients.
HER2-Low Status Was Associated With Better Breast Cancer-Specific Survival in Early-Stage Triple-Negative Breast Cancer
Authors: Ma Youzhao , Jiao Dechuang , Zhang Jingyang , Lv Minhao , Chen Xiuchun , Liu Zhenzhen
Published: September 2023

Background

Based on the association between the hormone receptor and the status of human epidermal growth factor receptor 2 (HER2)-low, we investigated the clinicopathological and prognostic characteristics of the HER2-low status in early-stage triple-negative breast cancer (TNBC).

Methods

We collected the data of patients with TNBC who received treatment at our hospital and compared the pathological complete response (pCR) rate, overall survival (OS), and breast cancer-specific survival (BCSS) between the HER2-0 and HER2-low subtypes.

Results

A total of 1445 patients were included in the study, of which 698 patients (48.3%) showed HER2-low status. A similar pCR rate was observed between HER2-0 and HER2-low patients (34.9% vs. 37.4%; P = .549). T staging, N staging, and HER2 status were associated with BCSS, whereas T staging and N staging were associated with OS. Patients with the HER2-low status showed better BCSS than those with the HER2-0 status (96.6% vs. 93.7%; log-rank P = .027). In patients with non-pCR, the BCSS of the HER2-low subgroup was better than that of the HER2-0 subgroup (log-rank P = .047); however, no similar result was observed in patients with pCR. In patients with stage III, the BCSS and OS of the HER2-low subgroup were better than those of the HER2-0 subgroup (BCSS, log-rank P = .010; OS, log-rank P = .047). No similar results were observed in patients with stages I and II.

Conclusion

The HER2-low expression was associated with better BCSS in TNBC, especially in the high-risk groups, suggesting that HER2-low breast cancer is a potential independent biological subtype.