Totally endoscopic robot-assisted transmyocardial revascularization

ObjectiveLaser transmyocardial revascularization is an emerging therapy for intractable angina stemming from diffuse, small-vessel coronary disease not amenable to percutaneous coronary intervention or coronary bypass grafting. Presently, this therapy is delivered through a median sternotomy or left thoracotomy. In this pilot study, we sought to combine the advantages of a dexterous robotic surgical platform with a flexible fiberoptic laser to develop a minimally invasive approach toward transmyocardial revascularization.MethodsA flexible fiberoptic holmium:yttrium-aluminum-garnet laser probe (CardioGenesis Corporation, Foothill Ranch, Calif), deployed with the da Vinci surgical robotic system (Intuitive Surgical, Sunnyvale, Calif), was used to create transmyocardial channels through all left ventricular wall regions in 5 canine subjects. The channels were localized, quantified, and histologically analyzed to assess distribution, dimensions, and transmurality.ResultsTransmyocardial channels were successfully created in all 6 defined left ventricular wall segments by using this minimally invasive approach without port repositioning, instrument exchange, or probe modifications. Gross pathologic and histologic analyses confirmed the uniform distribution of 1.0-mm transmural channels in all left ventricular regions. No direct pressure, topical hemostatic agents, or suture repairs were required for hemostasis. No significant hemodynamic instability or sustained arrhythmias were encountered at any time during the procedures.ConclusionsWe report the first use of a prototype flexible fiberoptic laser probe deployed by the da Vinci surgical robotic system to successfully perform totally endoscopic off-pump transmyocardial revascularization in a canine model, demonstrating the feasibility, precision, and safety of this approach. Refinement of this minimally invasive technique may reduce the morbidity of open-chest transmyocardial revascularization and facilitate its use as sole therapy or as an adjunct to percutaneous coronary interventions

Eye Movements, Strabismus, Amblyopia, and Neuro-Ophthalmology Vertical Vergence Adaptation Produces an Objective Vertical Deviation That Changes With Head Tilt

PURPOSE. To document the cyclovertical ocular motor mechanism used for vertical fusion in healthy subjects, and to explore whether vertical vergence training in healthy individuals can produce objectively confirmed vertical deviations that change with head tilt, revealing a basic mechanism that can produce a pattern of misalignment in an otherwise normal ocular motor system that is similar to superior oblique muscle paresis (SOP). METHODS. Seven subjects with normal orthoptic examinations were adapted to vertical image disparities using our tilting haploscopic eye-tracking apparatus presenting concentric circle targets without torsional cues. Static eye positions were recorded with head straight and when tilted 45 degrees to the left and right, during both binocular and monocular viewing. RESULTS. Vertical fusional vergence was accompanied by a cycloversion, with the downwardmoving eye intorting and the upward-moving eye extorting, implicating primary involvement of the oblique extraocular muscles. After adaptation to the slowly increasing vertical target separation, all subjects developed a temporary vertical deviation in the straight ahead position that increased with head tilt to one side and decreased with head tilt to the other side. CONCLUSIONS. These results not only show that head-tilt-dependent changes in vertical deviation are not necessarily pathognomonic for SOP, but also, and more importantly, suggest mechanisms that can mimic SOP and suggest a possible role for vertical vergence training in reducing deviations and thus the amount of head tilt required for fusion. Ultimately, vertical vergence training may provide an adjunct or alternative to extraocular muscle surgery in selected cases

Race, Slavery, and the Expression of Sexual Violence in Louisa Picquet, The Octoroon

Historically, victims of sexual violence have rarely left written accounts of their abuse, so while sexual violence has long been associated with slavery in the United States, historians have few accounts from formerly enslaved people who experienced it first-hand. Through a close reading of the narrative of Louisa Picquet, a survivor of sexual violence in Georgia and Louisiana, this article reflects on the recovery of evidence of sexual violence under slavery through amanuensis-recorded testimony, the unintended evidence of survival within the violent archive of female slavery, and the expression of “race” as an authorial device through which to demonstrate the multigenerational nature of sexual victimhood

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Delineating the molecular and phenotypic spectrum of the SETD1B-related syndrome

Purpose: Pathogenic variants in SETD1B have been associated with a syndromic neurodevelopmental disorder including intellectual disability, language delay, and seizures. To date, clinical features have been described for 11 patients with (likely) pathogenic SETD1B sequence variants. This study aims to further delineate the spectrum of the SETD1B-related syndrome based on characterizing an expanded patient cohort. Methods: We perform an in-depth clinical characterization of a cohort of 36 unpublished individuals with SETD1B sequence variants, describing their molecular and phenotypic spectrum. Selected variants were functionally tested using in vitro and genome-wide methylation assays. Results: Our data present evidence for a loss-of-function mechanism of SETD1B variants, resulting in a core clinical phenotype of global developmental delay, language delay including regression, intellectual disability, autism and other behavioral issues, and variable epilepsy phenotypes. Developmental delay appeared to precede seizure onset, suggesting SETD1B dysfunction impacts physiological neurodevelopment even in the absence of epileptic activity. Males are significantly overrepresented and more severely affected, and we speculate that sex-linked traits could affect susceptibility to penetrance and the clinical spectrum of SETD1B variants. Conclusion: Insights from this extensive cohort will facilitate the counseling regarding the molecular and phenotypic landscape of newly diagnosed patients with the SETD1B-related syndrome

Diagnosing the DARHT Electron Beam-Target Interaction and Hydrodynamic Expansion

Quantitative electron beam-target interaction studies on the Dual-Axis Radiographic Hydrodynamic Test (DARHT) electron linear induction accelerators have only been performed recently. This includes characterization of the temperature, density, pressure, extent, and expansion velocity of the plasma plume. The results presented in this dissertation present a detailed and unified overview of the accelerator systems, target heating physics, beam transport, and diagnostic tools. Additional information includes calibration sources, radiation hydrodynamics, spectroscopic-qual-ity radiation transport modeling, experimental measurements, and analyses of electron beam driven aluminum experiments. The first set of spatially and temporally resolved spectroscopic measurements of electron beam driven aluminum are presented. Contamination quantification analyses are used to understand the origin of the strong Na-I 3p-3s lines that are observed in absorption within the aluminum plasma continuum. These results inform the creation of the first spectroscopic-quality radiation transport model that links several atomic physics codes to interpret the conditions from which the Na-I lines originate. A good agreement is found between the surface analysis results and the model which confirms the concentration of the sodium present within the aluminum alloy foil material. It also demonstrates, for the first time on electron beam-driven target experiments, the ability to interpret plasma conditions from measured absorption lines. In a second experimental campaign which focuses on pure aluminum, the Al-I 3p-4s and 3p-3d doublets are both measured in emission. A detailed analysis of the Al-I 3p-4s doublet reveals that the lines undergo moderate self-absorption. A simple model of the self-absorption effect is successfully used to match measured spectra at various temperature/density/plasma scale length combinations. These measurements led to the realization of the minimum density that can be resolved by the spectrometers for the Al-I 3p-4s lines due to the large slit width required to observe a signal on aluminum. These measurements also demonstrate the sensitivity of visible and long wave UV spectroscopy to minor changes in both temperature and density. The simple self-absorption model will be useful for analysis of other beam-target interaction experiments with spectra exhibiting either self-absorption or full self-reversal. Substantial headway has been made on the modeling front by linking together several codes needed to model both the energy deposition, hydrodynamic motion, and atomic kinetics to produce synthetic spectral calculations that are compared with experimental measurements. There exists ample space for improvement, especially with benchmarking the hydrodynamics codes and equation-of-state tables with experimental measurements. The X-ray diagnostics required to make these new measurements along with the simulation capabilities required to interpret the results are under development and will be the subject of future studies.PHDNuclear Engineering & Radiological SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/174500/1/nramey_1.pd

The Duke Manual of Oculoplastic Surgery

Description based upon print version of record.1 online resource (536 p.