Dungeons and Data: A Large-Scale NetHack Dataset

Recent breakthroughs in the development of agents to solve challenging sequential decision making problems such as Go [50], StarCraft [58], or DOTA [3], have relied on both simulated environments and large-scale datasets. However, progress on this research has been hindered by the scarcity of open-sourced datasets and the prohibitive computational cost to work with them. Here we present the NetHack Learning Dataset (NLD), a large and highly-scalable dataset of trajectories from the popular game of NetHack, which is both extremely challenging for current methods and very fast to run [23]. NLD consists of three parts: 10 billion state transitions from 1.5 million human trajectories collected on the NAO public NetHack server from 2009 to 2020; 3 billion state-action-score transitions from 100,000 trajectories collected from the symbolic bot winner of the NetHack Challenge 2021; and, accompanying code for users to record, load and stream any collection of such trajectories in a highly compressed form. We evaluate a wide range of existing algorithms including online and offline RL, as well as learning from demonstrations, showing that significant research advances are needed to fully leverage large-scale datasets for challenging sequential decision making tasks

Repeated operations in aorto-ilio-femoral segment in the late period

Secția Chirurgie Vasculară, IMSP Spitalul Clinic Republican „Timofei Moșneaga”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Progresia procesului aterosclerotic nu rar provoacă tromboza bypass-urilor aplicate în segmentul aorto-femural și, de asemnea, formarea anevrismelor la nivelul anastamozelor. Tratamentul chirurgical al acestor pacienți este foarte complicat și se explică prin prezența unui process aderențial pronunțat, explorarea vaselor fiind insoțită de un risc major de hemoragie și alte complicații. Material și metode: În perioada anilor 2009-2018 s-au efectuat 328 intervenții repetate de revascularizare a membrelor inferioare, în perioada tardivă la 302 pacienți. De preferință au fost trombectomiile cu reprotezare distal profundă. În cazul ineficienței acestora se aplicau bypass-uri ilio-femurale extra anatomice. Numai în cazul imposibilității efectuării acestor intervenții se efectua laparotomie și aplicarea unui nou bypass. Rezultate: La majoritatea pacienților s-a obținut o revascularizare adecvată a membrelor inferioare. Letalitatea fiind de 2,7%, rata amputațiilor de 5,3 % cazuri. În 5 cazuri postoperator s-a recurs la tratament endovascular a segmentului proximal stenozat. Concluzii: Folosirea tehnicilor de minimalizare a traumei chirurgicale – trombectomie cu reprotezare distal a arterei femurale profunde, bypassurile ilio-femurale extra anatomice și folosirea tehnicilor endovasculare, permit revascularizarea adecvată a membrelor și scăderea ratei complicațiilor.Introduction: The progression of the atherosclerotic process frequently causes thrombosis of bypasses applied in the aorto-femoral segment as well as the formation of anastomotic aneurysms. The surgical treatment of these patients is extremely complicated due to the presence of a pronounced adhesion process, vascular exploration being associated with a high risk of bleeding and other complications. Material and methods: 328 repeated surgeries for inferior limb revascularization in the late postoperative period have been performed in 302 patients. Preferred interventions were thrombectomies with deep graft interposition. In case of failure, extra anatomical iliofemoral bypasses were applied. Only when the last mentioned were impossible to perform, laparatomy was carried out and a new bypass was applied. Results: The majority of patients received an adequate revascularization of inferior limbs. Lethality was 2,7%, amputation rate – 5.3%. In 5% of cases, endovascular repair of proximal segment stenosis was performed. Conclusions: The techniques of surgical trauma minimalization – thrombectomy with graft interposition on the a. femoralis profunda, extra anatomical ilio-femoral bypasses and the usage of endovascular treatment allow adequate limb revascularization and complication rate decrease

Surgical revascularisation of infragenual popliteal and tibial arteries in peripheral arterial disease

Secția Chirurgie Vasculară, IMSP Spitalul Clinic Republican ”Timofei Moșneaga”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: În pofida implimentării pe scară largă a tehnicilor endovasculare în tratamentul proceselor ocluziv-stenotice în segmentul infrapopliteu, rata intervențiilor chirurgicale deschise rămâne la un nivel înalt. Scopul: Este studierea rezultatelor precoce ale revascularizării chirurgicale a segmentului arterial infrapopliteu în procesele ocluzivstenotice. Material și metode: Pe parcursul anilor 1995- 2018 s-au efectuat 846 intervenții chirurgicale pentru revascularizarea treimei inferioare a arterei poplitee și arterelor tibiale. Intervențiile de preferință au constituit bypass-urile cu grefon safen inversat, endarterectomiile din arterele poplitee și tibiale cu plastie cu petec din autovenă, de asemenea s-au aplicat si petice din material sintetic, mai rar bypassurile cu aloproteză și bypass-urile compozite. Rezultate: Rata salvării membrelor inferioare a fost 93,7 %. În 53 cazuri postoperator s-a recurs la amputația coapsei sau gambei. Concluzii: Conform datelor noastre revascularizarea deschisă a segmentului arterial infrapopliteu în procesele ocluziv stenotice este posibilă în 93,7 % cazuri. Intervențiile de elecție au constituit bypass-urile cu folosirea venei safene interne și trombendarterectomiile cu folosirea peticilor din vena proprie sau material sintetic. Bypass-urile din material sintetic atât cât și cele compozite au o rată mai înaltă de tromboză.Introduction: Despite large-scale implementation of endovascular techniques in the treatment of peripheral arterial disease, the number of conventional surgeries tends to be high. Aim: The purpose of the study is the assessment of early results of surgical revascularization of infragenual popliteal and tibial arteries in peripheral arterial disease. Material and methods: 846 surgical interventions for revascularisation of infragenual popliteal and tibial arteries have been carried out during 1995 – 2018. The surgeries of preference were infragenual bypasses with reversed saphenous vein grafts, popliteal and tibial endarterectomy with venous patch plasty, as well as synthetic patch plasty. In rare cases, synthetic graft and composite bypasses were applied. Results: Inferior limb salvage rate was 93,7 %. Above or below knee amputation was necessary in 53 cases. Conclusions: According to our information, infragenual revascularisation was possible in 93,7 %. Interventions of election were infragenual bypasses with reversed saphenous vein grafts, endarterectomy with venous or synthetic patch plasty. Synthetic graft and composite bypasses were applied below knee have a high failure rate

Our experience in vascular trauma treatment

Secția Chirurgie Vasculară, IMSP Spitalul Clinic Republican ”Timofei Moșneaga”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Complexitatea tratamentului traumatismelor vasculare constă nu numai în efectuarea intervenției propriu-zise, cât și în diagnosticul și aprecierea tacticii optimale. Scopul: Este de a elabora un algoritm al tratamentului traumatismelor vasculare bazat pe experiența secției chirurgie vasculară SCR. Material și metode: În timpul activității secției chirurgie vasculară (1977-2018), tratamentul chirurgical a pacienților cu traumatisme vasculare a suferit schimbări esențiale în special în privința calității. Rezultate: Intervențiile de preferință au fost suturarea marginală a vasului lezat sau protezarea lui cu grefon safen. În caz de distrugere importantă a țesuturilor înconjurătoare au fost folosite diferite bypass-uri extraanatomice (21 cazuri), iar la 76 pacienți s-a folosit metoda de plagă deschisă. De asemenea 3 pacienți au fost tratați cu ajutorul tehnicilor endovasculare.Letalitatea postoperatorie a fost de 3,2%. Rata amputațiilor (în cazul traumatismelor arteriale ale membrelor) a fost de 4,3 %. Concluzii: În tratamentul complex a traumatismelor vasculare o importanță deosebită reprezintă diagnosticul precoce și aprecierea tacticii intervenționale optimale.Introduction: The complexity of vascular trauma treatment consists not only in the surgery itself, but also in diagnosis and proper tactical choice. Aim: Is to establish an algorithm for vascular trauma treatment based on the experience of Vascular Surgery Department, Republican Clinical Hospital. Material and methods: Throughout the years of activity of our department (1977 – 2018) surgical treatment of patients with vascular trauma suffered essential modifications in terms of quality. Results: Preferred interventions were marginal suture of affected vessel or saphenous vein interposition. In case of major adjacent tissue destruction, extraanatomical bypasses were applied in 21 cases and in 76 open wound procedure was applied. Also, 3 patients were treated by means of endovascular techniques. Postoperatory mortality was 3,2 % . Amputation rate (in case of arterial trauma of limbs) was 4,3%. Conclusions: Early diagnosis and optimal assessment of surgical tactics have an utmost importance in the complex treatment of vascular trauma

Illness perception in tuberculosis by implementation of the Brief Illness Perception Questionnaire : a TBNET study

How patients relate to the experience of their illness has a direct impact over their behavior. We aimed to assess illness perception in patients with pulmonary tuberculosis (TB) by means of the Brief Illness Perception Questionnaire (BIPQ) in correlation with patients’ demographic features and clinical TB score. Our observational questionnaire based study included series of consecutive TB patients enrolled in several countries from October 2008 to January 2011 with 167 valid questionnaires analyzed. Each BIPQ item assessed one dimension of illness perceptions like the consequences, timeline, personal control, treatment control, identity, coherence, emotional representation and concern. An open question referred to the main causes of TB in each patient’s opinion. The over-all BIPQ score (36.25 ± 11.054) was in concordance with the clinical TB score (p ≤ 0.001). TB patients believed in the treatment (the highest item-related score for treatment control) but were unsure about the illness identity. Illness understanding and the clinical TB score were negatively correlated (p < 0.01). Only 25% of the participants stated bacteria or TB contact as the first ranked cause of the illness. For routine clinical practice implementation of the BIPQ is convenient for obtaining fast and easy assessment of illness perception with potential utility in intervention design. This time saving effective personalized approach may improve communication with TB patients and contribute to better behavioral strategies in disease control

Evidence of West Nile virus (WNV) circulation in wild birds and WNV RNA negativity in mosquitoes of the Danube Delta Biosphere Reserve, Romania, 2016

West Nile virus (WNV) is a zoonotic flavivirus whose transmission cycle in nature includes wild birds as amplifying hosts and ornithophilic mosquito vectors. Bridge vectors can transmit WNV to mammal species potentially causing West Nile Fever. Wild bird migration is a mode of WNV introduction into new areas. The Danube Delta Biosphere Reserve (DDBR) is a major stopover of wild birds migrating between Europe and Africa. The aim of this study was to investigate the presence of WNV in the DDBR during the 2016 transmission season in wild birds and mosquitoes. Blood from 68 wild birds (nine different species) trapped at four different locations was analyzed by competitive ELISA and Virus Neutralization Test (VNT), revealing positive results in 8/68 (11.8%) of the wild birds by ELISA of which six samples (three from juvenile birds) were confirmed seropositive by VNT. Mosquitoes (n = 6523, 5 genera) were trapped with CDC Mini Light traps at two locations and in one location resting mosquitoes were caught. The presence of WNV RNA was tested in 134 pools by reverse transcription quantitative PCR (RT-qPCR). None of the pools was positive for WNV-specific RNA. Based on the obtained results, WNV was circulating in the DDBR during 2016

Surgical treatment of acute limb ischaemia

Secția Chirurgie Vasculară, IMSP Spitalul Clinic Republican, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Ischemia acută periferică (IAP) reprezintă o suprimare bruscă a fluxului sangvin arterial al membrului ce cauzează un pericol iminent al viabilității lui. Conform experienței, o parte importantă a rezultatelor negative a tratamentului sunt impuse atât de greșeli diagnostice cât și tactice. Material și metodă: A fost analizată experiența tratamentului chirurgical a emboliilor și trombozelor arteriale acute a membrelor în ultimii 10 ani (2009-2018) în secția chirurgie vasculară SCR și în cadrul Aviației Sanitare. Menționăm că pacienții la care nu s-au făcut tentative de revascularizare nu au fost incluși în studiu. Embolectomia a fost efectuate în 906 cazuri. Reconstrucții arteriale în caz de tromboză acută, pe fondalul unui proces aterosclerotic cronic – în 306 cazuri. La 3 pacienți după intervenție chirurgicală au fost efectuate revascularizări endovasculare a segmentului proximal stenozat. Rezultate: În caz de embolie, rata amputațiilor postoperatorii a fost de 5,3%, letalitatea generală de 4,9%. După intervențiile reconstructive amputațiile au survenit in 6% cazuri, letalitatea fiind de 2%. Atât în caz de embolie cât și de tromboză acută rezultatele negative au fost cauzate de patologiile asociate și diagnostic tardiv. Concluzie: Numai revascularizarea adecvată, corect aleasă și cât mai precoce este cheia succesului în tratamentul pacienților cu IAP. Este necesară sensibilizarea specialiștilor tuturor domeniilor și a pacienților din grupa de risc în privința IAP.Background: Acute limb ischaemia is defined as a sudden decrease in limb perfusion causing a potential threat to limb viability. According to our experience, a great majority of bad outcomes are attributed to diagnostic as well as tactical mistakes. Material and methods: The experience of surgical treatment of acute arterial thrombosis and thrombembolism during the last 10 years (2009 - 2018) in Vascular Surgery Department, Republican Clinical Hospital has been studied. We outline that the patients that had not received surgical attempt of revascularisation were not included in the study. Thrombembolectomy was performed in 906 patients. Arterial reconstruction in case of thrombosis due to chronic atherosclerotic lesions was performed in 306 cases. 3 pacients underwent afterwards endovascular repair of proximal segment stenotic lesions. Results: In case of thrombembolism, amputation rate was 5,3% and general mortality was 4,9%. After reconstructive surgery, amputation rate was 6%, general letality being 2%. In both situations, poor outcome is linked toassociated pathology and delayed diagnosis. Conclusion: Only adequate revascularisation, correctly chosen and applied as early as possible is the key to the treatment of acute limb ischaemia. It is important that specialists of all fields, as well as pacients from risk groups be properly informed

Insights from the NeurIPS 2021 NetHack Challenge

In this report, we summarize the takeaways from the first NeurIPS 2021 NetHack Challenge. Participants were tasked with developing a program or agent that can win (i.e., ‘ascend’ in) the popular dungeon-crawler game of NetHack by interacting with the NetHack Learning Environment (NLE), a scalable, procedurally generated, and challenging Gym environment for reinforcement learning (RL). The challenge showcased community-driven progress in AI with many diverse approaches significantly beating the previously best results on NetHack. Furthermore, it served as a direct comparison between neural (e.g., deep RL) and symbolic AI, as well as hybrid systems, demonstrating that on NetHack symbolic bots currently outperform deep RL by a large margin. Lastly, no agent got close to winning the game, illustrating NetHack’s suitability as a long-term benchmark for AI research

Repeated revascularization in the aorto-femoral segment

Scopul lucrării. În ultimii ani structura intervențiilor repetate în segmentul aorto-ilio- femural a suferit schimbări esențiale datorită implementării metodelor endovasculare pe scara largă. Intervențiile primare au putut fi bypass-uri și/sau angioplastii cu stentare, iar intervențiile repetate pot fi deschise, endovasculare sau hibride. Scopul lucrării este aprecierea posibilităților metodelor chirurgicale clasice, endovasculare și hibride cu implementarea unor gesturi chirurgicale noi pentru îmbunătățirea rezultatelor. Materiale și metode. În perioada anilor 2009-2022 s-au efectuat 439 intervenții de revascularizare repetată în segmentul aorto-iliofemural la 378 pacienți cu ocluzii sau stenoze severe ale segmentului revascularizat în antecedente, cât și cu anevrisme anastomotice. Rezultate. Letalitatea postoperatorie a fost de 2,7 %, iar rata amputațiilor înalte de 5%. Concluzii. Datorită implementării metodelor endovasculare și hibride apar noi posibilități în revascularizarea repetată în segmentul aorto-femural. La minimalizarea traumatismului chirurgical și a ratei complicațiilor contribuie și folosirea bypass-urilor extraanatomice, protezarea distală a a. femurale profunde și anume perfectarea acestor tehnici.Aim of study. In recent years, the structure of repeated interventions in the aorto-ilio-femoral segment has undergone significant changes due to the widespread implementation of endovascular methods. Primary interventions can involve bypasses and/or angioplasty with stenting, while repeated interventions can be open, endovascular, or hybrid. The objective of the study is to assess the possibilities of classical surgical, endovascular, and hybrid methods with the implementation of new surgical techniques to improve outcomes. Materials and methods. Between 2009 and 2022, 439 repeated revascularization procedures were performed in the aorto-iliofemoral segment on 378 patients with previous severe occlusions or stenoses of the revascularized segment, as well as anastomotic aneurysms. Results. The postoperative mortality rate was 2.7%, and the rate of major amputations was 5%. Conclusions. Due to the implementation of endovascular and hybrid methods, new possibilities arise for repeated revascularization in the aorto-femoral segment. Minimizing surgical trauma and complication rates is facilitated by the use of extra-anatomic bypasses, distal prosthetic grafting of the deep femoral artery, and the refinement of these techniques