Fatal Complications during Anaesthesia in Moebius Syndrome: A Case Report and Brief Discussion of Relevant Precautions and Preoperative Assessments

We present a case of a 23-year-old male with Moebius syndrome admitted with sigmoid volvulus. Moebius Syndrome is a very rare complex congenital disorder characterised by uni- or bilateral facial paralysis resulting in orofacial abnormalities that in some individuals make tracheal intubation very difficult. In the present case, complications during the anaesthetic procedure caused a fatal outcome for the patient, as difficulties intubating was followed by an unexpected circulatory collapse, which could not be counteracted in the current setting. The case emphasises the importance of handling patients with Moebius Syndrome and other patients with a difficult airway with utmost caution during anaesthetic care, particularly in the emergent setting where other complications might be present. A thorough preanaesthetic evaluation with specific attention to airway management and circulatory status is mandatory and all measures must be taken to optimise patient safety

Cost-sensitive learning classification strategy for predicting product failures

In the current era of Industry 4.0, sensor data used in connection with machine learning algorithms can help manufacturing industries to reduce costs and to predict failures in advance. This paper addresses a binary classification problem found in manufacturing engineering, which focuses on how to ensure product quality delivery and at the same time to reduce production costs. The aim behind this problem is to predict the number of faulty products, which in this case is extremely low. As a result of this characteristic, the problem is reduced to an imbalanced binary classification problem. The authors contribute to imbalanced classification research in three important ways. First, the industrial application coming from the electronic manufacturing industry is presented in detail, along with its data and modelling challenges. Second, a modified cost-sensitive classification strategy based on a combination of Voronoi diagrams and genetic algorithm is applied to tackle this problem and is compared to several base classifiers. The results obtained are promising for this specific application. Third, in order to evaluate the flexibility of the strategy, and to demonstrate its wide range of applicability, 25 real-world data sets are selected from the KEEL repository with different imbalance ratios and number of features. The strategy, in this case implemented without a predefined cost, is compared with the same base classifiers as those used for the industrial problem

Bony metastases from breast cancer - a study of foetal antigen 2 as a blood tumour marker

Background : Foetal antigen 2 (FA-2), first isolated in the amniotic fluid, was shown to be the circulating form of the aminopropeptide of the alpha 1 chain of procollagen type I. Serum concentrations of FA-2 appeared to be elevated in a number of disorders of bone metabolism. This paper is the first report of its role as a marker of bone metabolism in metastatic breast cancer. Methods: Serum FA-2 concentrations were measured by radioimmunoassay in 153 women with different stages of breast cancer and in 34 normal controls. Results: Serum FA-2 was significantly elevated in women with bony metastases (p < 0.015). Its levels were not significantly different among women with non-bony metastases, with non-metastatic disease, as well as among normal controls. Conclusions: FA-2 is a promising blood marker of bone metabolism. Further studies to delineate its role in the diagnosis and management of bony metastases from breast cancer are required

Virtuality in human supervisory control: Assessing the effects of psychological and social remoteness

Virtuality would seem to offer certain advantages for human supervisory control. First, it could provide a physical analogue of the 'real world' environment. Second, it does not require control room engineers to be in the same place as each other. In order to investigate these issues, a low-fidelity simulation of an energy distribution network was developed. The main aims of the research were to assess some of the psychological concerns associated with virtual environments. First, it may result in the social isolation of the people, and it may have dramatic effects upon the nature of the work. Second, a direct physical correspondence with the 'real world' may not best support human supervisory control activities. Experimental teams were asked to control an energy distribution network. Measures of team performance, group identity and core job characteristics were taken. In general terms, the results showed that teams working in the same location performed better than team who were remote from one another

Spreading, Nonergodicity, and Selftrapping: a puzzle of interacting disordered lattice waves

Localization of waves by disorder is a fundamental physical problem encompassing a diverse spectrum of theoretical, experimental and numerical studies in the context of metal-insulator transitions, the quantum Hall effect, light propagation in photonic crystals, and dynamics of ultra-cold atoms in optical arrays, to name just a few examples. Large intensity light can induce nonlinear response, ultracold atomic gases can be tuned into an interacting regime, which leads again to nonlinear wave equations on a mean field level. The interplay between disorder and nonlinearity, their localizing and delocalizing effects is currently an intriguing and challenging issue in the field of lattice waves. In particular it leads to the prediction and observation of two different regimes of destruction of Anderson localization - asymptotic weak chaos, and intermediate strong chaos, separated by a crossover condition on densities. On the other side approximate full quantum interacting many body treatments were recently used to predict and obtain a novel many body localization transition, and two distinct phases - a localization phase, and a delocalization phase, both again separated by some typical density scale. We will discuss selftrapping, nonergodicity and nonGibbsean phases which are typical for such discrete models with particle number conservation and their relation to the above crossover and transition physics. We will also discuss potential connections to quantum many body theories.Comment: 13 pages in Springer International Publishing Switzerland 2016 1 M. Tlidi and M. G. Clerc (eds.), Nonlinear Dynamics: Materials, Theory and Experiment, Springer Proceedings in Physics 173. arXiv admin note: text overlap with arXiv:1405.112

The effects of childbirth on the pelvic-floor

Basically, vaginal delivery is associated with the risk of pelvic floor damage. The pelvic floor sequelae of childbirth includes anal incontinence, urinary incontinence and pelvic organ prolapse. Pathophysiology, incidence and risk factors for the development of the respective problems are reviewed. Where possible, recommendations for reducing the risk of pelvic floor damage are given

Biomarkers of Cerebral Injury for Prediction of Postoperative Cognitive Dysfunction in Patients Undergoing Cardiac Surgery

OBJECTIVES: To assess the ability of the biomarkers neuron-specific enolase (NSE), tau, neurofilament light chain (NFL), and glial fibrillary acidic protein (GFAP) to predict postoperative cognitive dysfunction (POCD) at discharge in patients who underwent cardiac surgery. DESIGN: Post hoc analyses (with tests being prespecified before data analyses) from a randomized clinical trial. SETTING: Single-center study from a primary heart center in Denmark. PARTICIPANTS: Adult patients undergoing elective or subacute on-pump coronary artery bypass grafting and/or aortic valve replacement. INTERVENTIONS: Blood was collected before induction of anesthesia, after 24 hours, after 48 hours, and at discharge from the surgical ward. The International Study of Postoperative Cognitive Dysfunction test battery was applied to diagnose POCD at discharge and after three months. Linear mixed models of covariance were used to assess whether repeated measurements of biomarker levels were associated with POCD. Receiver operating characteristic (ROC) curves were applied to assess the predictive value of each biomarker measurement for POCD. MEASUREMENTS AND MAIN RESULTS: A total of 168 patients had biomarkers measured at baseline, and 47 (28%) fulfilled the POCD criteria at discharge. Patients with POCD at discharge had significantly higher levels of tau (p = 0.02) and GFAP (p = 0.01) from baseline to discharge. The biomarker measurements achieving the highest area under the ROC curve for prediction of POCD at discharge were NFL measured at discharge (AUC, 0.64; 95% confidence interval [CI], 0.54-0.73), GFAP measured 48 hours after induction (AUC, 0.64; 95% CI, 0.55-0.73), and GFAP measured at discharge (AUC, 0.64; 95% CI, 0.54-0.74), corresponding to a moderate predictive ability. CONCLUSIONS: Postoperative serum levels of tau and GFAP were elevated significantly in patients with POCD who underwent cardiac surgery at discharge; however, the biomarkers achieved only modest predictive abilities for POCD at discharge. Postoperative levels of NSE were not associated with POCD at discharge

Logarithmic operators in the SL(2,R) WZNW model

We find some exact solutions of the Knizhnik-Zamolodchikov equation for the four point correlation functions that occur in the SL(2,R) WZNW model. They exhibit logarithmic behaviour in both the Kac-Moody and Virasoro parts. We discuss their implication for the operator product expansion. We also observe the appearance of several symmetries of the correlation functions.Comment: 23 pages, LATEX, Revised Version. More references adde

Schmallenberg virus pathogenesis, tropism and interaction with the innate immune system of the host

Schmallenberg virus (SBV) is an emerging orthobunyavirus of ruminants associated with outbreaks of congenital malformations in aborted and stillborn animals. Since its discovery in November 2011, SBV has spread very rapidly to many European countries. Here, we developed molecular and serological tools, and an experimental in vivo model as a platform to study SBV pathogenesis, tropism and virus-host cell interactions. Using a synthetic biology approach, we developed a reverse genetics system for the rapid rescue and genetic manipulation of SBV. We showed that SBV has a wide tropism in cell culture and “synthetic” SBV replicates in vitro as efficiently as wild type virus. We developed an experimental mouse model to study SBV infection and showed that this virus replicates abundantly in neurons where it causes cerebral malacia and vacuolation of the cerebral cortex. These virus-induced acute lesions are useful in understanding the progression from vacuolation to porencephaly and extensive tissue destruction, often observed in aborted lambs and calves in naturally occurring Schmallenberg cases. Indeed, we detected high levels of SBV antigens in the neurons of the gray matter of brain and spinal cord of naturally affected lambs and calves, suggesting that muscular hypoplasia observed in SBV-infected lambs is mostly secondary to central nervous system damage. Finally, we investigated the molecular determinants of SBV virulence. Interestingly, we found a biological SBV clone that after passage in cell culture displays increased virulence in mice. We also found that a SBV deletion mutant of the non-structural NSs protein (SBVΔNSs) is less virulent in mice than wild type SBV. Attenuation of SBV virulence depends on the inability of SBVΔNSs to block IFN synthesis in virus infected cells. In conclusion, this work provides a useful experimental framework to study the biology and pathogenesis of SBV

Inference of population splits and mixtures from genome-wide allele frequency data

Many aspects of the historical relationships between populations in a species are reflected in genetic data. Inferring these relationships from genetic data, however, remains a challenging task. In this paper, we present a statistical model for inferring the patterns of population splits and mixtures in multiple populations. In this model, the sampled populations in a species are related to their common ancestor through a graph of ancestral populations. Using genome-wide allele frequency data and a Gaussian approximation to genetic drift, we infer the structure of this graph. We applied this method to a set of 55 human populations and a set of 82 dog breeds and wild canids. In both species, we show that a simple bifurcating tree does not fully describe the data; in contrast, we infer many migration events. While some of the migration events that we find have been detected previously, many have not. For example, in the human data we infer that Cambodians trace approximately 16% of their ancestry to a population ancestral to other extant East Asian populations. In the dog data, we infer that both the boxer and basenji trace a considerable fraction of their ancestry (9% and 25%, respectively) to wolves subsequent to domestication, and that East Asian toy breeds (the Shih Tzu and the Pekingese) result from admixture between modern toy breeds and "ancient" Asian breeds. Software implementing the model described here, called TreeMix, is available at http://treemix.googlecode.comComment: 28 pages, 6 figures in main text. Attached supplement is 22 pages, 15 figures. This is an updated version of the preprint available at http://precedings.nature.com/documents/6956/version/