Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome

Background Endoscopic laser coagulation of placental anastomoses is the first-line treatment for severe twin-to-twin transfusion syndrome. A recent randomized controlled trial reported that laser coagulation along the entire vascular equator was associated with a similar dual survival and survival of at least 1 twin compared with the group that was treated with the selective technique. In addition, there was a significantly lower incidence of postoperative recurrence of twin-to-twin transfusion syndrome and the development of twin anemia-polycythemia sequence in the equatorial group. Objective The purpose of this study was to report on neonatal survival in twin-to-twin transfusion syndrome pregnancies that were treated with endoscopic laser therapy with the use of the equatorial technique and to examine the relationship between preoperative factors and twin loss. Study Design Endoscopic equatorial laser therapy was carried out as the primary treatment for twin-to-twin transfusion syndrome in all consecutive monochorionic diamniotic twin pregnancies that were referred at a single fetal surgery Center over a 4-year period. All visible placental anastomoses were coagulated; additional laser ablation of the placental tissue between the coagulated vessels was carried out. Pre-laser ultrasound data, periprocedural complications, pregnancy outcome, and postnatal survival at hospital discharge were recorded and analyzed. Results A total of 106 pregnancies were treated during the study period. Median gestational age at laser therapy was 19.7 weeks (range, 15.1-27.6 weeks). There was postoperative recurrence of twin-to-twin transfusion syndrome or the development of twin anemia-polycythemia sequence in 2 (1.9%) and 2 (1.9%) cases, respectively. The survival rates of both and at least 1 twin were 56.6% and 83.0%, respectively. Donor survival was significantly lower compared with the recipient co-twin (64.2% vs 75.5%, respectively; P <.05). The rate of fetal death, which was the most common cause of twin loss, was significantly higher in donors compared with recipient fetuses (23.6% vs 10.4%, respectively; P <.05). In cases with absent or reversed end-diastolic velocity in the donor umbilical artery, dual and donor survival rates were significantly lower compared with the remaining twin-to-twin transfusion syndrome pregnancies (40.0% vs 64.8% and 40.0% vs 76.1%, respectively; P <.05). There were no significant differences between the 2 groups in the survival of at least 1 twin and in the recipient survival. Conclusions Endoscopic equatorial laser therapy was associated with a survival of both and at least 1 twin of approximately 55% and 83%, respectively, with a low rate of recurrent twin-to-twin transfusion syndrome and twin anemia-polycythemia sequence. In addition, the preoperative finding of abnormal donor umbilical artery Doppler on ultrasound identified a subgroup of twin-to-twin transfusion syndrome pregnancies with a lower dual survival rate caused by increased intrauterine deaths of donor twins

Phase-Field Approach for Faceted Solidification

We extend the phase-field approach to model the solidification of faceted materials. Our approach consists of using an approximate gamma-plot with rounded cusps that can approach arbitrarily closely the true gamma-plot with sharp cusps that correspond to faceted orientations. The phase-field equations are solved in the thin-interface limit with local equilibrium at the solid-liquid interface [A. Karma and W.-J. Rappel, Phys. Rev. E53, R3017 (1996)]. The convergence of our approach is first demonstrated for equilibrium shapes. The growth of faceted needle crystals in an undercooled melt is then studied as a function of undercooling and the cusp amplitude delta for a gamma-plot of the form 1+delta(|sin(theta)|+|cos(theta)|). The phase-field results are consistent with the scaling law "Lambda inversely proportional to the square root of V" observed experimentally, where Lambda is the facet length and V is the growth rate. In addition, the variation of V and Lambda with delta is found to be reasonably well predicted by an approximate sharp-interface analytical theory that includes capillary effects and assumes circular and parabolic forms for the front and trailing rough parts of the needle crystal, respectively.Comment: 1O pages, 2 tables, 17 figure

ABOT: an open-source online benchmarking tool for machine learning-based artefact detection and removal methods from neuronal signals

Brain signals are recorded using different techniques to aid an accurate understanding of brain function and to treat its disorders. Untargeted internal and external sources contaminate the acquired signals during the recording process. Often termed as artefacts, these contaminations cause serious hindrances in decoding the recorded signals; hence, they must be removed to facilitate unbiased decision-making for a given investigation. Due to the complex and elusive manifestation of artefacts in neuronal signals, computational techniques serve as powerful tools for their detection and removal. Machine learning (ML) based methods have been successfully applied in this task. Due to ML’s popularity, many articles are published every year, making it challenging to find, compare and select the most appropriate method for a given experiment. To this end, this paper presents ABOT (Artefact removal Benchmarking Online Tool) as an online benchmarking tool which allows users to compare existing ML-driven artefact detection and removal methods from the literature. The characteristics and related information about the existing methods have been compiled as a knowledgebase (KB) and presented through a user-friendly interface with interactive plots and tables for users to search it using several criteria. Key characteristics extracted from over 120 articles from the literature have been used in the KB to help compare the specific ML models. To comply with the FAIR (Findable, Accessible, Interoperable and Reusable) principle, the source code and documentation of the toolbox have been made available via an open-access repository

Microstructure and hard magnetic properties in bulk rods of Nd 60Fe 30Al 10 glass forming alloys

The Nd60Fe30Al10 alloy exhibits a large glass forming ability which allows to obtain relatively thick cast rods containing large volume fractions of amorphous phases. In this work the microstructure and the hard magnetic properties of as-cast rods are characterized. The alloy is processed by suction casting into a chilled copper mould to obtain cylinders 5 mm diameter and 50 mm length. This diameter is selected because it is an upper limit for this processing route, beyond which the hard properties largely deteriorate. A room temperature coercivity of 0.34 T is obtained. The sample microstructure is heterogeneous, with very different size scales near the surface and along the central zone. However, in both regions a large fraction of an amorphous ferromagnetic phase is observed; it is found that paramagnetic nanocrystalline phases, mainly Nd or Nd-rich particles embedded in the amorphous matrix, are somewhat coarser in the central zone. These larger nanocrystals, less efficient to pin domain walls, are proposed to be responsible for the lower coercive fields observed, as compared with those found in cylinders 1 to 3 mm diameter where no inhomogeneities are found. This conclusion is supported by microstructure, calorimetric and magnetic observations.Fil: Levingston, J. M.. Universidad Nacional de Córdoba. Facultad de Matemática, Astronomía y Física; ArgentinaFil: Valente, R.. Comisión Nacional de Energía Atómica. Gerencia del Área de Investigación y Aplicaciones No Nucleares. Gerencia de Física (Centro Atómico Bariloche); Argentina. Comisión Nacional de Energía Atómica. Gerencia del Área de Energía Nuclear. Instituto Balseiro; ArgentinaFil: Ghilarducci, Ada Albertina. Comisión Nacional de Energía Atómica. Gerencia del Área de Investigación y Aplicaciones No Nucleares. Gerencia de Física (Centro Atómico Bariloche); Argentina. Comisión Nacional de Energía Atómica. Gerencia del Área de Energía Nuclear. Instituto Balseiro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; ArgentinaFil: Fabietti, Luis Maria Rodolfo. Universidad Nacional de Córdoba. Facultad de Matemática, Astronomía y Física. Sección Física; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Física Enrique Gaviola. Universidad Nacional de Córdoba. Instituto de Física Enrique Gaviola; ArgentinaFil: Salva, Horacio Ramon. Comisión Nacional de Energía Atómica. Gerencia del Área de Investigación y Aplicaciones No Nucleares. Gerencia de Física (Centro Atómico Bariloche); Argentina. Comisión Nacional de Energía Atómica. Gerencia del Área de Energía Nuclear. Instituto Balseiro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; ArgentinaFil: Urreta, S. E.. Universidad Nacional de Córdoba. Facultad de Matemática, Astronomía y Física; Argentin

Control of HVAC Systems via Scenario-based Explicit MPC

Improving energy efficiency of Heating, Ventilation and Air Conditioning (HVAC) systems is a primary objective for the society. Model Predictive Control (MPC) techniques for HVAC systems have recently received particular attention, since they can naturally account for several factors, such as weather and occupancy forecasts, comfort ranges and actuation constraints. Developing effective MPC based control strategies for HVAC systems is nontrivial, since buildings dynamics are nonlinear and affected by various uncertainties. Further, the complexity of the MPC problem and the burden of on-line computations can lead to difficulties in integrating this scheme into a building management system. We propose to address this computational issue by designing a scenario-based explicit MPC strategy, i.e., a controller that is simultaneously based on explicit representations of the MPC feedback law and accounts for uncertainties in the occupancy patterns and weather conditions by using the scenarios paradigm. The main advantages of this approach are the absence of a-priori assumptions on the distributions of the uncertain variables, the applicability to any type of building, and the limited on-line computational burden, enabling practical implementations on low-cost hardware platforms. We illustrate the practical implementation of the proposed explicit MPC controller on a room of a university building, showing its effectiveness and computational tractability

Evidences of +896 A/G TLR4 Polymorphism as an Indicative of Prevalence of Complications in T2DM Patients

T2DMis today considered as world-wide health problem, with complications responsible of an enhanced mortality and morbidity. Thus, new strategies for its prevention and therapy are necessary. For this reason, the research interest has focused its attention on TLR4 and its polymorphisms, particularly the rs4986790. However, no conclusive findings have been reported until now about the role of this polymorphism in development of T2DM and its complications, even if a recent meta-analysis showed its T2DM association in Caucasians. In this study, we sought to evaluate the weight of rs4986790 polymorphism in the risk of the major T2DMcomplications, including 367 T2DMpatients complicated for the 55.6%. Patients with A/A and A/G TLR4 genotypes showed significant differences in complication\u2019s prevalence. In particular, AG carriers had higher risk prevalence for neuropathy (P = 0.026), lower limb arteriopathy (P = 0.013), and the major cardiovascular pathologies (P = 0.017). Their cumulative risk was significant (P = 0.01), with a threefold risk to develop neuropathy, lower limb arteriopathy, and major cardiovascular events in AG cases compared to AA cases.The adjusted OR for the confounding variables was 3.788 (95% CI: 1.642\u20138.741).Thus, the rs4986790 polymorphism may be an indicative of prevalence of complications in T2DM patients

Dynamics of a faceted nematic-smectic B front in thin-sample directional solidification

We present an experimental study of the directional-solidification patterns of a nematic - smectic B front. The chosen system is C_4H_9-(C_6H_{10})_2CN (in short, CCH4) in 12 \mu m-thick samples, and in the planar configuration (director parallel to the plane of the sample). The nematic - smectic B interface presents a facet in one direction -- the direction parallel to the smectic layers -- and is otherwise rough, and devoid of forbidden directions. We measure the Mullins-Sekerka instability threshold and establish the morphology diagram of the system as a function of the solidification rate V and the angle theta_{0} between the facet and the isotherms. We focus on the phenomena occurring immediately above the instability threshold when theta_{0} is neither very small nor close to 90^{o}. Under these conditions we observe drifting shallow cells and a new type of solitary wave, called "faceton", which consists essentially of an isolated macroscopic facet traveling laterally at such a velocity that its growth rate with respect to the liquid is small. Facetons may propagate either in a stationary, or an oscillatory way. The detailed study of their dynamics casts light on the microscopic growth mechanisms of the facets in this system.Comment: 12 pages, 19 figures, submitted to Phys. Rev.

SANTIA: a Matlab-based open-source toolbox for artifact detection and removal from extracellular neuronal signals

Neuronal signals generally represent activation of the neuronal networks and give insights into brain functionalities. They are considered as fingerprints of actions and their processing across different structures of the brain. These recordings generate a large volume of data that are susceptible to noise and artifacts. Therefore, the review of these data to ensure high quality by automatically detecting and removing the artifacts is imperative. Toward this aim, this work proposes a custom-developed automatic artifact removal toolbox named, SANTIA (SigMate Advanced: a Novel Tool for Identification of Artifacts in Neuronal Signals). Developed in Matlab, SANTIA is an open-source toolbox that applies neural network-based machine learning techniques to label and train models to detect artifacts from the invasive neuronal signals known as local field potentials

A maChine and deep Learning Approach to predict pulmoNary hyperteNsIon in newbornS with congenital diaphragmatic Hernia (CLANNISH): Protocol for a retrospective study

Introduction Outcome predictions of patients with congenital diaphragmatic hernia (CDH) still have some limitations in the prenatal estimate of postnatal pulmonary hypertension (PH). We propose applying Machine Learning (ML), and Deep Learning (DL) approaches to fetuses and newborns with CDH to develop forecasting models in prenatal epoch, based on the integrated analysis of clinical data, to provide neonatal PH as the first outcome and, possibly: Favorable response to fetal endoscopic tracheal occlusion (FETO), need for Extracorporeal Membrane Oxygenation (ECMO), survival to ECMO, and death. Moreover, we plan to produce a (semi)automatic fetus lung segmentation system in Magnetic Resonance Imaging (MRI), which will be useful during project implementation but will also be an important tool itself to standardize lung volume measures for CDH fetuses. Methods and analytics Patients with isolated CDH from singleton pregnancies will be enrolled, whose prenatal checks were performed at the Fetal Surgery Unit of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (Milan, Italy) from the 30th week of gestation. A retrospective data collection of clinical and radiological variables from newborns' and mothers' clinical records will be performed for eligible patients born between 01/01/2012 and 31/12/2020. The native sequences from fetal magnetic resonance imaging (MRI) will be collected. Data from different sources will be integrated and analyzed using ML and DL, and forecasting algorithms will be developed for each outcome. Methods of data augmentation and dimensionality reduction (feature selection and extraction) will be employed to increase sample size and avoid overfitting. A software system for automatic fetal lung volume segmentation in MRI based on the DL 3D U-NET approach will also be developed. Ethics and dissemination This retrospective study received approval from the local ethics committee (Milan Area 2, Italy). The development of predictive models in CDH outcomes will provide a key contribution in disease prediction, early targeted interventions, and personalized management, with an overall improvement in care quality, resource allocation, healthcare, and family savings. Our findings will be validated in a future prospective multicenter cohort study