Case Report: Bradycardia in neonatal lupus: differential diagnosis between atrioventricular block and premature atrial contractions with block

Neonatal lupus may be associated with severe cardiac conduction problems, including high-degree or complete atrioventricular (AV) block, necessitating immediate pacemaker implantation during the neonatal period. However, cardiac manifestations of neonatal lupus may extend beyond AV block. Our case was a full-term female neonate, who presented with fetal arrhythmia and bradycardia with a heart rate of approximately 70–75 beats per minute after birth. Neonatal lupus was diagnosed later due to positive maternal and neonatal anti-SSA/Ro antibody. High-degree AV block was considered initially but bigeminy premature atrial contractions (PACs) with block was confirmed through a detailed evaluation of an electrocardiogram, which demonstrated unfixed PP intervals and fixed RR intervals. Atrial tachycardia (AT) developed when the neonate was 23 days old. The key point that differentiates high-degree AV block from PACs with block is the PP interval. The PP interval is fixed in high-degree AV block and unfixed in PACs with block. Careful differential diagnosis is required in neonates with bradycardia because it may lead to very different management. Our case presents a good illustration of why these arrhythmias need to be differentiated. Furthermore, our case may be the first of neonatal lupus with AT

Prevalent Hallucinations during Medical Internships: Phantom Vibration and Ringing Syndromes

Background: Phantom vibration syndrome is a type of hallucination reported among mobile phone users in the general population. Another similar perception, phantom ringing syndrome, has not been previously described in the medical literature. Methods: A prospective longitudinal study of 74 medical interns (46 males, 28 females; mean age, 24.8±1.2 years) was conducted using repeated investigations of the prevalence and associated factors of phantom vibration and ringing. The accompanying symptoms of anxiety and depression were evaluated with the Beck Anxiety and Depression Inventories before the internship began, and again at the third, sixth, and twelfth internship months, and two weeks after the internship ended. Results: The baseline prevalence of phantom vibration was 78.1%, which increased to 95.9% and 93.2% in the third and sixth internship months. The prevalence returned to 80.8% at the twelfth month and decreased to 50.0% 2 weeks after the internship ended. The baseline prevalence of phantom ringing was 27.4%, which increased to 84.9%, 87.7%, and 86.3% in the third, sixth, and twelfth internship months, respectively. This returned to 54.2% two weeks after the internship ended. The anxiety and depression scores also increased during the internship, and returned to baseline two weeks after the internship. There was no significant correlation between phantom vibration/ringing and symptoms of anxiety or depression. The incidence of both phantom vibration and ringing syndromes significantly increased during the internship, and subsequent recovery. Conclusion: This study suggests that phantom vibration and ringing might be entities that are independent of anxiety or depression during evaluation of stress-associated experiences during medical internships

Why Attention? Analyze BiLSTM Deficiency and Its Remedies in the Case of NER

BiLSTM has been prevalently used as a core module for NER in a sequence-labeling setup. State-of-the-art approaches use BiLSTM with additional resources such as gazetteers, language-modeling, or multi-task supervision to further improve NER. This paper instead takes a step back and focuses on analyzing problems of BiLSTM itself and how exactly self-attention can bring improvements. We formally show the limitation of (CRF-)BiLSTM in modeling cross-context patterns for each word -- the XOR limitation. Then, we show that two types of simple cross-structures -- self-attention and Cross-BiLSTM -- can effectively remedy the problem. We test the practical impacts of the deficiency on real-world NER datasets, OntoNotes 5.0 and WNUT 2017, with clear and consistent improvements over the baseline, up to 8.7% on some of the multi-token entity mentions. We give in-depth analyses of the improvements across several aspects of NER, especially the identification of multi-token mentions. This study should lay a sound foundation for future improvements on sequence-labeling NER. (Source codes: https://github.com/jacobvsdanniel/cross-ner)Comment: In proceedings of AAAI 202

Modification of Vertical Earth Pressure Formulas for High Fill Cut-and-Cover Tunnels Experimental and Numerical Methods

Te high-flled cut-and-cover tunnel (HFCCT) is a solution to reclaim more useable lands due to the unique landforms of Loess Plateau in northwestern China. Because of the ultrahigh backfll, the estimation of vertical earth pressure will signifcantly afect the design and safety of the cut-and-cover tunnel (CCT). Te current methods for estimating the vertical earth pressure are either to overestimate or underestimate the vertical earth pressure on the top of HFCCT. To more precisely estimate the vertical earth pressure distribution, the vertical earth pressure based on the soil column pressure, �h (h: the height of backfll above the CCT), needs to be properly modifed. Considering diferent infuential factors, four corresponding coefcients are proposed: �0: crosssectional shape of CCT efect, �1: stifness of backfll efect, �2: width of CCT efect, and �3: coupling efect of slope angle, �, and the ratio of B/D. It is found that �0 has little infuence; the �3 and �1 reduce and �2 amplifes the �h. Te corresponding general forms for these coefcients are determined based on fnite element analysis results. A general equation for estimating vertical earth pressure for the HFCCT including these four coefcients is proposed. Meanwhile, this general form is verifed by the numerical analysis results and experimental results for diferent cases. Terefore, this proposed equation is applicable to estimate the vertical earth pressure for existing or newly designed HFCCT. Furthermore, this proposed method can signifcantly reduce the computational work in engineering analysis

Motor neuron-derived Thsd7a is essential for zebrafish vascular development via the Notch-dll4 signaling pathway.

BackgroundDevelopment of neural and vascular systems displays astonishing similarities among vertebrates. This parallelism is under a precise control of complex guidance signals and neurovascular interactions. Previously, our group identified a highly conserved neural protein called thrombospondin type I domain containing 7A (THSD7A). Soluble THSD7A promoted and guided endothelial cell migration, tube formation and sprouting. In addition, we showed that thsd7a could be detected in the nervous system and was required for intersegmental vessels (ISV) patterning during zebrafish development. However, the exact origin of THSD7A and its effect on neurovascular interaction remains unclear.ResultsIn this study, we discovered that zebrafish thsd7a was expressed in the primary motor neurons. Knockdown of Thsd7a disrupted normal primary motor neuron formation and ISV sprouting in the Tg(kdr:EGFP/mnx1:TagRFP) double transgenic zebrafish. Interestingly, we found that Thsd7a morphants displayed distinct phenotypes that are very similar to the loss of Notch-delta like 4 (dll4) signaling. Transcript profiling further revealed that expression levels of notch1b and its downstream targets, vegfr2/3 and nrarpb, were down-regulated in the Thsd7a morphants. These data supported that zebrafish Thsd7a could regulate angiogenic sprouting via Notch-dll4 signaling during development.ConclusionsOur results suggested that motor neuron-derived Thsd7a plays a significant role in neurovascular interactions. Thsd7a could regulate ISV angiogenesis via Notch-dll4 signaling. Thus, Thsd7a is a potent angioneurin involved in the development of both neural and vascular systems

Performance evaluation on the implementation of Pre-established Medical Processes for nurse practitioners in the hospitals

In 2015, Taiwan announced the establishment of “Pre-established Medical Processes” and related regulations to assist nurse practitioners in the clinical tasks, maintain medical quality and patient safety, and provide protection in clinical practice. However, the effectiveness of implementation still needs to be improved and strengthened. This study adopts the TAM and the TTF as the research framework, and a cross-sectional design. The questionnaires are administered to the professional nurse practitioners in the hospitals of central Taiwan. A total of 300 questionnaires were distributed, and Smart PLS 3.0 and SPSS 24.0 were both applied to verify interpretability. The questionnaire recovery rate was 88.3%, and the overall predictive power was 65.2%. Technological characteristics and TTF had a significant impact on perceived usefulness

De-wetting of evaporating drops on regular patterns of triangular posts

Directional wicking and spreading of liquids can be achieved by regular micro-patterns of specifically designed topographic features that break the reflection symmetry of the underlying pattern. The present study aims to understand the formation and stability of wetting films during the evaporation of volatile liquid drops on surfaces with a micro-pattern of triangular posts arranged in a rectangular lattice. Depending on the density and aspect ratio of the posts, we observe either spherical-cap shaped drops with a mobile three-phase contact line or the formation of circular or angular drops with a pinned three-phase contact line. Drops of the latter class eventually evolve into a liquid film extending to the initial footprint of the drop and a shrinking cap-shaped drop sitting on the film. The drop evolution is controlled by the density and aspect ratio of the posts, while no influence of the orientation of the triangular posts on the contact line mobility becomes evident. Our experiments corroborate previous results of systematic numerical energy minimization, predicting that conditions for a spontaneous retraction of a wicking liquid film depend weakly on the orientation of the film edge relative to the micro-pattern