Delirium complications in post-general anesthesia: An observational study in China

Purpose: To evaluate emergence agitation and delirium signs in general anesthesia (GA) and postanesthesia care units (PACUs), and associated risk factors.Methods: Adult patients (n = 380) exposed to GA were recruited over a period of 1 year and five months for this study, and were assessed for emergence delirium (ED) using Richmond Agitation- Sedation Scale (RASS). Confusion Assessment Method for Intensive Care Unit (CAM-ICU) was used to assess delirium signs on admission to, and during stay in PACU at 30 min, 1 h, and at discharge. Signs consistent with delirium were classified as hyperactive or hypoactive based on a positive CAM-ICU assessment and RASS score. Multivariable logistic regression was used to assess potential risk factors for delirium such as age, American Society of Anesthesiologists (ASA) classification, and opioid and benzodiazepine (BZD) exposure during stay in PACU.Results: Emergence delirium (ED) occurred in 69 (18.2 %) patients out of which 41 (59.4 %) were also CAM-ICU +ve on admission to PACU, with 22 (31.9 %), 11 (15.9 %), and 6 (8.7 %) CAM-ICU +ve at 30 min, 1 h, and at discharge from PACU, respectively. Therefore, 28 (7.4 %) patients had ED with no associated signs of delirium. A total of 117 (30.8 %) patients had signs of delirium (CAM-ICU +ve) during admission to PACU, 58.1 % of whom had hypoactive features based on their RASS scores. Signs of delirium during stay in PACU were observed in 64 (16.8 %) patients, while 61 (16.1 %), 28 (7.4 %), and 14 (3.7 %) patients were CAM-ICU +ve at 30 min, 1 h, and at discharge from PACU, respectively. The results of multivariate logistic regression showed that total perioperative opioid administration (fentanyl equivalent) was independently associated with signs of delirium during stay in PACU, after relevant covariate adjustment (p = 0.03). However, age, BZD exposure (midazolam equivalent), and ASA classification did not show significant association with signs of delirium during stay at PACU. The result of sensitivity analysis showed that duration of anesthesia was independently associated with signs of delirium during stay in PACU.Conclusion: The results of this study suggest that in patients undergoing GA, signs of delirium are common in the immediate postoperative period, with incidence highest on arrival at the PACU and decreasing gradually during stay in PACU. Hypoactive features are common and more prominent during stay in PACU, when compared to hyperactive features.Keywords: Emergence delirium, Anesthesia, Post-anesthesia care unit, Hypoactive features, Associatio

An edge grafting theorem on the energy of unicyclic and bipartite graphs

AbstractThe energy of a graph is the sum of the absolute values of the eigenvalues of its adjacency matrix. The edge grafting operation on a graph is certain kind of edge moving between two pendant paths starting from the same vertex. In this paper we show how the graph energy changes under the edge grafting operations on unicyclic and bipartite graphs. We also give some applications of this result on the comparison of graph energies between unicyclic or bipartite graphs

Diaqua­(5-methyl-1H-pyrazole-3-carboxyl­ato)(4-nitro­benzoato)copper(II)

In the title complex, [Cu(C7H4NO4)(C5H5N2O2)(H2O)2], the CuII ion is coordinated in a slightly distorted square-pyramidal enviroment. The basal plane is formed by an N atom and an O atom from a 5-methyl-1H-pyrazole-3-carboxyl­ate ligand and by two O atoms from two water ligands. The apical position is occupied by a carboxylate O atom from a 4-nitro­benzoate ligand. In the crystal structure, inter­molecular O—H⋯O and N—H⋯O hydrogen bonds link complex moleclues, forming extended chains parallel to the a axis

China

Economic development processes in post-1949 China can be divided into two periods. In the first, 1950-70, the economy was extensively and intensively controlled by the state with a priority for developing heavy industries. In the second, since the 80s and known as the \u27reform period,\u27 the Chinese economy has increasingly been integrated with the world economy and relying on light (rural) industries as the prime motor of economic growth. Yet, in both these periods, Chinese policymakers shared the same \u27developmental\u27 philosophy in which social costs, that is the reproduction costs of human labour and nature, are largely ignored. The following is a critical sketch of government policies and their impact on the domestic population in these two periods

Local-to-Global Registration for Bundle-Adjusting Neural Radiance Fields

Neural Radiance Fields (NeRF) have achieved photorealistic novel views synthesis; however, the requirement of accurate camera poses limits its application. Despite analysis-by-synthesis extensions for jointly learning neural 3D representations and registering camera frames exist, they are susceptible to suboptimal solutions if poorly initialized. We propose L2G-NeRF, a Local-to-Global registration method for bundle-adjusting Neural Radiance Fields: first, a pixel-wise flexible alignment, followed by a frame-wise constrained parametric alignment. Pixel-wise local alignment is learned in an unsupervised way via a deep network which optimizes photometric reconstruction errors. Frame-wise global alignment is performed using differentiable parameter estimation solvers on the pixel-wise correspondences to find a global transformation. Experiments on synthetic and real-world data show that our method outperforms the current state-of-the-art in terms of high-fidelity reconstruction and resolving large camera pose misalignment. Our module is an easy-to-use plugin that can be applied to NeRF variants and other neural field applications. The Code and supplementary materials are available at https://rover-xingyu.github.io/L2G-NeRF/.Comment: arXiv admin note: text overlap with arXiv:2104.06405 by other author

SadTalker: Learning Realistic 3D Motion Coefficients for Stylized Audio-Driven Single Image Talking Face Animation

Generating talking head videos through a face image and a piece of speech audio still contains many challenges. ie, unnatural head movement, distorted expression, and identity modification. We argue that these issues are mainly because of learning from the coupled 2D motion fields. On the other hand, explicitly using 3D information also suffers problems of stiff expression and incoherent video. We present SadTalker, which generates 3D motion coefficients (head pose, expression) of the 3DMM from audio and implicitly modulates a novel 3D-aware face render for talking head generation. To learn the realistic motion coefficients, we explicitly model the connections between audio and different types of motion coefficients individually. Precisely, we present ExpNet to learn the accurate facial expression from audio by distilling both coefficients and 3D-rendered faces. As for the head pose, we design PoseVAE via a conditional VAE to synthesize head motion in different styles. Finally, the generated 3D motion coefficients are mapped to the unsupervised 3D keypoints space of the proposed face render, and synthesize the final video. We conduct extensive experiments to show the superior of our method in terms of motion and video quality.Comment: Project page: https://sadtalker.github.i

建構中小學初任輔導人員職前培訓機制：戴明循環觀點之應用

The purpose of this study applied the Deming Cycle perspective on evaluating the pre-service training mechanism. First, a pilot study and field observation were conducted, then we purposively selected seven experts who are in charge of the training programs or service as lectures (Mean of relevant working experience = 20.3 years, SD = 11.1 years) in years of 2015 to 2017. All of them were individually interviewed for collecting deep information, total interview hours up to 715 minutes. An initial result found that the current programs rarely conducted assessment and setting goals, the implementations were mixed with different background of participants, the lack of inspection for training results and curriculum planning, and need to strengthen the system cooperation and learning gap. We suggested: (1) The pre-service training program’s "Plan" should pay more attention on overall thinking and expert team, assess the needs of organizations and individuals, and set training objectives from learners and practitioners; (2) The pre-service training program’s "Do" should establish a dedicated unit and a single contact window, design two-track and blended learning modules, flexible adjustment of curriculum structure and using case teaching methods; (3) The pre-service training program should "Check" training program and training effectiveness; (4) The pre-service training program’s "Act" will be able to develop a standardized mechanism and actively creates a cycle of cooperation through systematic cooperation. This study provides an additional insight of pre-service training program

Enhancement of cisplatin sensitivity in lewis lung carcinoma by liposome-mediated delivery of a survivin mutant

<p>Abstract</p> <p>Background</p> <p>A high concentration of cisplatin (CDDP) induces apoptosis in many tumor cell lines. CDDP has been administered by infusion to avoid severe toxicity. Recently, it has been reported that changes in survivin expression or function may lead to tumor sensitization to chemical and physical agents. The aim of this study was to determine whether a dominant-negative mouse survivin mutant could enhance the anti-tumor activity of CDDP.</p> <p>Methods</p> <p>A plasmid encoding the phosphorylation-defective dominant-negative mouse survivin threonine 34→alanine mutant (survivin T34A) complexed to a DOTAP-chol liposome (Lip-mS) was administered with or without CDDP in Lewis Lung Carcinoma (LLC) cells and in mice bearing LLC tumors, and the effects on apoptosis, tumor growth and angiogenesis were assessed. Data were analyzed using one-way analysis of variance(ANOVA), and a value of <it>P </it>< 0.05 was considered to be statistically significant.</p> <p>Results</p> <p>LLC cells treated with a combination of Lip-mS and CDDP displayed increased apoptosis compared with those treated with Lip-mS or CDDP alone. In mice bearing LLC tumors and treated with intravenous injections of Lip-mS and/or CDDP, combination treatment significantly reduced the mean tumor volume compared with either treatment alone. Moreover, the antitumor effect of Lip-mS combined with CDDP was greater than their anticipated additive effects.</p> <p>Conclusion</p> <p>These data suggest that the dominant-negative survivin mutant, survivin T34A, sensitized LLC cells to chemotherapy of CDDP. The synergistic antitumor activity of the combination treatment may in part result from an increase in the apoptosis of tumor cells, inhibition of tumor angiogenesis and induction of a tumor-protective immune response.</p

NOFA: NeRF-based One-shot Facial Avatar Reconstruction

3D facial avatar reconstruction has been a significant research topic in computer graphics and computer vision, where photo-realistic rendering and flexible controls over poses and expressions are necessary for many related applications. Recently, its performance has been greatly improved with the development of neural radiance fields (NeRF). However, most existing NeRF-based facial avatars focus on subject-specific reconstruction and reenactment, requiring multi-shot images containing different views of the specific subject for training, and the learned model cannot generalize to new identities, limiting its further applications. In this work, we propose a one-shot 3D facial avatar reconstruction framework that only requires a single source image to reconstruct a high-fidelity 3D facial avatar. For the challenges of lacking generalization ability and missing multi-view information, we leverage the generative prior of 3D GAN and develop an efficient encoder-decoder network to reconstruct the canonical neural volume of the source image, and further propose a compensation network to complement facial details. To enable fine-grained control over facial dynamics, we propose a deformation field to warp the canonical volume into driven expressions. Through extensive experimental comparisons, we achieve superior synthesis results compared to several state-of-the-art methods

Differences in ocular high order aberrations before and after small incision lenticule extraction for correction of myopia: a systematic review and meta-analysis

ObjectiveTo examine the causes and factors that lead to high order aberration (HOA) during the treatment of myopia using small incision lenticule extraction (SMILE), as well as the differences between SMILE and other corneal refractive surgeries through a systematic review and meta-analysis.MethodsA systematic search was conducted from January 2015 to February 2023 in Pubmed, Embase, Web of Science, and Google Scholar databases to gather relevant studies on SMILE and HOA. Studies meeting specific criteria were chosen, and clinical data was retrieved for analysis.ResultsThis meta-analysis resulted in the inclusion of 19 studies involving 1,503 eyes. Pooled results showed significant induction of total HOA (tHOA, d = −0.21, p &lt; 0.001), spherical aberration (SA, d = −0.11, p &lt; 0.001) and coma aberration (CA, d = −0.18, p &lt; 0.001) after SMILE compared to pre-SMILE, while no significant change in trefoil aberration (TA) was observed (d = −0.00, p = 0.91). There was a significantly lower induction of tHOA after SMILE compared to femtosecond laser-assisted in situ keratomileusis (FS-LASIK, d = 0.04, p &lt; 0.001), and no significant difference was observed compared to wavefront aberration-guided (WFG) refractive surgery (d = 0.00, p = 0.75). There was also a significant association between different levels of myopia and astigmatism, duration of follow-up, lenticule thickness, and preoperative central corneal thickness (CCT) on the induction of tHOA after SMILE (p &lt; 0.05), while the higher preoperative myopia group (sphere &gt; -5D), lower preoperative astigmatism group (cylinder ≤ -1D), larger lenticule thickness group (lenticule thickness &gt; 100 μm), shorter follow-up group (follow-up 1 month postoperatively) and the thicker CCT group (CCT &gt; 550 μm) brought a significant induction of tHOA compared to the opposite comparison group (p &lt; 0.001).ConclusionWhile SMILE can induce HOA significantly, it induces less HOA than FS-LASIK. Postoperative HOA following SMILE can be affected by factors such as myopia, astigmatism, lenticule thickness, CCT, and duration of follow-up. Future research should continue to explore techniques to decrease the induction of HOA by using this methodology.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/