Perioperative Stroke Following General Surgery

AbstractPerioperative stroke is rare; however, patients undergoing cardiovascular surgery are considered to be at high risk for perioperative stroke. Here, we outline a case where perioperative stroke occurred following total hip replacement surgery. The risk factors and possible causes of the stroke in this patient are discussed. In addition, we reiterate the appropriate management approaches needed to prevent perioperative stroke. Briefly, the importance of precise preoperative evaluation and of proper intraoperative and postoperative management should not be overlooked. Finally, it is important to realize that decreasing perioperative strokes and the disabilities associated with them will lower the financial burden on families and the community

Comparisons of the GlideScope and Macintosh Laryngoscope in Tracheal Intubation by Medical Students on Fresh Human Cadavers

AbstractObjectiveThe GlideScope Video Laryngoscope (GS) is an intubating device that provides equal or better glottic views than conventional laryngoscopes, but correct tube placement is more time-consuming, even when performed by experienced operators. The aim of this study was to investigate the use of the GS compared with the more conventional Macintosh laryngoscope in easy and difficult tracheal intubation when performed by inexperienced medical students on fresh human cadaversPatients and MethodsForty-one medical students were assigned to perform tracheal intubation using the direct Macintosh laryngoscope (DL) and the GS. Each student was given four attempts, with a maximum of 180 seconds for each attempt, to successfully intubate the trachea with a 6.5-mm tracheal tube in each of two scenarios, one with an easy airway and the other with a difficult airway cadaver.ResultsThe total time of intubation for the easy airway cadaver was significantly longer in the GS group (61.4 ± 4.8 seconds vs. 40.6 ± 5.3 seconds; p < 0.001) despite the modified Cormack-Lehane scores showing no difference between the two groups. In the difficult airway cadaver, total time of intubation was significant shorter in the GS group (64.3 ± 6.5 seconds vs. 98.7 ± 10.2 seconds; p < 0.001)ConclusionMost inexperienced operators found the GS to be more time-consuming for tracheal intubation than DL in the easy airway cadaver. However, an obvious advantage was demonstrated when the GS was used for the difficult airway

Tension Pneumoperitoneum Following Upper Gastrointestinal Endoscopy

Tension pneumoperitoneum is a potentially lethal complication of numerous iatrogenic procedures, including upper gastrointestinal (UGI) endoscopy. We report a 69-year-old man with UGI bleeding who developed tension pneumoperitoneum and cardiac arrest after UGI endoscopy. He was successfully resuscitated with needle decompression. Emergency surgery revealed a perforated gastric ulcer, and subtotal gastrectomy with Billroth II anastomosis was performed. Recovery was smooth and he was discharged from the hospital 18 days later. Tension pneumoperitoneum should be suspected in all patients who develop circulatory collapse with acutely distended abdomen after UGI endoscopy. Early identification relies on a high index of suspicion. Prompt treatment with needle decompression should not be delayed for confirmatory radiography once the clinical diagnosis is made

A two-way linear piezoelectric vibratory conveyor actuated by a composite sinusoidal voltage input

Piezoelectric vibratory conveyors are widely used in many industrial fields such as factory automation. However, there is still a limitation for most cases that the vibratory conveyor can only feed in the designed direction. In today's multitasking intelligent machinery, how to sort different parts from the same feed source and convey them efficiently in different directions remains a challenge to be overcome. This study proposes an innovative design that uses a composite sinusoidal control signal to drive a linear two-stage piezoelectric vibratory feeder. By simply tuning the amplitude and phase of the input composite signal, the conveying velocity and direction can be altered easily. The dynamic characteristics of this feeder were both investigated by theoretical formulation and experimental measurement. It is found that the conveying performance of this feeder is better suited for using the composite signal with two sinusoidal components of double frequency. With the composite control signal synthesized by two sinusoidal components of 237.5 Hz and 475.0 Hz, which were close to the feeder’s first two resonance frequencies to increase the response gain of the structure, and the input voltage of 60 V, which corresponded to the trough’s displacement amplitude of 54.5 m, the measured conveying speeds were +30.8 mm/s and –33.3 mm/s for setting the phase angles 180° and 0°, respectively. The result demonstrates the feasibility of the proposed two-way vibratory feeder design

TREATING PEDIATRIC ASTHMA WITH HOLISTIC APPROACHES OF TRADITIONAL CHINESE MEDICINE: A RETROSPECTIVE STUDY

Background: Asthma is a chronic disease increasingly found in children. To find more economical and efficient alternatives to treat pediatric asthma, the Bureau of National Health Insurance of Taiwan launched the Traditional Chinese Medicine Holistic Treatment Program (TCMHTP). The effect of traditional Chinese medicine (TCM) holistic treatments on pediatric asthma was evaluated based on data collected from the program. Materials and Methods: A retrospective study was performed by analyzing a dataset from Changhua Christian Hospital, Taiwan, between January 1st, 2006 and December 31st, 2010. Patients aged between 2 and 15 years, who had been diagnosed with asthma, and had participated in the TCMHTP were recruited, whereas those with other severe diseases were excluded. We analyzed the frequency of emergency department visits (EDV), inpatient admission rate (IAR), and length of hospitalization (LH) of the patients, before and after TCM treatments. Spectral analysis of heart rate variability (HRV) was also conducted. Results: Fifty-eight patients were recruited. The average age of the patients receiving TCM treatments was 5.67±3.03 years. The frequency of EDV decreased from 0.94±0.85 to 0.67±1.19 times annually (p=0.095), the annual IAR decreased from 0.62±0.78 to 0.26±0.67 (p=0.002) and the average LH decreased from 3.32±4.25 to 0.80±1.64 (p=0.000) days per year. Parasympathetically mediated HRV decreased significantly from 60.42±15.33 to 54.89±16.45 nu (p=0.016). Conclusion: The present study revealed that an appropriate period of TCM holistic treatment intervention can not only significantly lower exacerbations and hospitalization frequency but also reduce vagal tone in asthmatic children

Learning Fine-Grained Visual Understanding for Video Question Answering via Decoupling Spatial-Temporal Modeling

While recent large-scale video-language pre-training made great progress in video question answering, the design of spatial modeling of video-language models is less fine-grained than that of image-language models; existing practices of temporal modeling also suffer from weak and noisy alignment between modalities. To learn fine-grained visual understanding, we decouple spatial-temporal modeling and propose a hybrid pipeline, Decoupled Spatial-Temporal Encoders, integrating an image- and a video-language encoder. The former encodes spatial semantics from larger but sparsely sampled frames independently of time, while the latter models temporal dynamics at lower spatial but higher temporal resolution. To help the video-language model learn temporal relations for video QA, we propose a novel pre-training objective, Temporal Referring Modeling, which requires the model to identify temporal positions of events in video sequences. Extensive experiments demonstrate that our model outperforms previous work pre-trained on orders of magnitude larger datasets.Comment: BMVC 2022. Code is available at https://github.com/shinying/des

Effects of mycophenolate mofetil on cutaneous lupus erythematosus in (NZB × NZW) F1 mice

AbstractBackgroundFew studies have evaluated the effects and precise molecular mechanism of mycophenolate mofetil (MMF) in the treatment of human cutaneous lupus erythematosus (CLE). Our findings shed light on the therapeutic effects of MMF in a UVB-induced NZB × NZW (NZBW) F1 CLE mouse model.MethodsContinuous MMF treatment (60 mg/kg/day) was administered up to Day 50 from the beginning of UVB induction (Day 0; 20 weeks old), as the pathologic features of CLE are present after 50 days. The therapeutic effects of MMF treatment in NZBW lupus mice were examined by comparing histopathological changes, lupus band test (deposition of immune complexes at the dermal–epidermal junction) and colocalization of autoantibodies with a dermal autoantigen Dsg3, and by evaluating the associations of local matrix metalloprotease activities.ResultsMMF improved survival in the NZBW lupus mice from 35.7% to 81.8%. The proteinuria, blood urea nitrogen, and interleukin 6 levels were significantly reduced after MMF treatment. The dermal lymphocytic infiltration, deposition of immune complexes at the dermal–epidermal junction, colocalized autoantibodies with Dsg3, and epidermal matrix metalloprotease activity were also attenuated in MMF-treated NZBW F1 mice.ConclusionThe results confirmed that MMF could substantially attenuate skin damage due to CLE in the NZBW F1 mouse model

Use of sodium bicarbonate for acute dizziness after minor head injury

AbstractObjectiveDizziness after minor head injury (mHI) is common. In some eastern countries, it is treated with 7% sodium bicarbonate solution (SB). This prospective study evaluated the clinical efficacy of SB compared with normal saline (NS).Material and methodsFrom April 2009 to April 2010, we performed a prospective observational study on 228 patients (68% female, 32% male) with acute dizziness after mHI. At the emergency physician’s discretion, intravenous SB (1 mL/kg) in NS (250 mL) or NS (250 mL) was administered to 166 patients and 62 patients, respectively, as empiric antidizziness therapy. Outcome measures were severity of dizziness and treatment response, which were measured by a visual analog scale. Various characteristics were compared between treatment groups. Any continued dizziness of the patients during follow-up was also compared with their pre-injury condition, such as prior psychiatric disorders and the presence of vertigo.ResultsThe SB group had their visual analog scale scores reduced by 25.4% compared with 24.6% in the NS group. Both groups showed a statistically significant reduction in dizziness (p < 0.001); however, the dizziness improvement did not differ significantly between the two treatment groups (p = 0.699). Sixty-four patients (28.1%) suffered from continued dizziness during follow-up (mean period, 22.4 ± 28.9 days). The prevalence of continued dizziness was higher in patients with prior psychiatric disorders, although this was not statistically significant (40% vs. 27.2%, p = 0.276), whereas patients with prior vertigo did not experience a higher dizziness relapse rate (27% vs. 28.2%).ConclusionsSB and NS administrations are both effective individually when treating patients with acute dizziness from mHI; however, both results may be attributable to the placebo effect. Therefore more research is necessary to understand the complex conditions that determine the effects of SB on this disorder

D2ADA: Dynamic Density-aware Active Domain Adaptation for Semantic Segmentation

In the field of domain adaptation, a trade-off exists between the model performance and the number of target domain annotations. Active learning, maximizing model performance with few informative labeled data, comes in handy for such a scenario. In this work, we present D2ADA, a general active domain adaptation framework for semantic segmentation. To adapt the model to the target domain with minimum queried labels, we propose acquiring labels of the samples with high probability density in the target domain yet with low probability density in the source domain, complementary to the existing source domain labeled data. To further facilitate labeling efficiency, we design a dynamic scheduling policy to adjust the labeling budgets between domain exploration and model uncertainty over time. Extensive experiments show that our method outperforms existing active learning and domain adaptation baselines on two benchmarks, GTA5 -> Cityscapes and SYNTHIA -> Cityscapes. With less than 5% target domain annotations, our method reaches comparable results with that of full supervision.Comment: 14 pages, 5 figure