The safety and necessity of Sugammadex in neuromuscular blockade reversal

Sugammadex, a gamma cyclodextrin discovered in 2007, provides a safe and effective alternative to drugs currently used in surgery by anesthesiologists. A problem in the current practice of anesthesia is the use of Succinylcholine, a neuromuscular blocking agent used for the cessation of the patient's skeletal muscle movement. Succinylcholine is used due to its unique fast onset and short duration, ideal for short procedures, difficult intubation scenarios, and rapid sequence intubation. However, it is used cautiously due to several risks such as causing myalgia, hyperkalemia, fasciculations, and increasing intracranial, intragastric, and intraocular pressure. Sugammadex provides a safer alternative to Succinylcholine because it allows immediate reversal of a neuromuscular blockade through a different mechanism, which does not lead to harmful adverse effects. Sugammadex works by encapsulating its target muscle relaxant, Rocuronium. Rocuronium is a relatively safer drug than Succinylcholine with a similar time of onset, but a very long duration of action. Since Sugammadex is able to immediately reverse the effects of Rocuronium, this combination of Rocuronium and Sugammadex provides the same desired effect as Succinylcholine but without the harmful side effects. The current most widely used reversal agent for muscle relaxation is Neostigmine. The problems with Neostigmine are that it can lead to residual paralysis and recurarisation if under dosed. It also produces unwanted cholinergic side effects that lead to cardiovascular instability. Due to this, the medical community is in need for a better reversal agent that can both quickly and completely reverse muscle paralysis without the need to manage unwanted side effects. Sugammadex is able to address both the problems of Succinylcholine and Neostigmine. Studies have shown Sugammadex to provide a faster, safer, and more predictable reversal of Rocuronium - induced neuromuscular blockade than Neostigmine. Sugammadex has shown to also achieve faster recovery from Rocuronium - induced muscle paralysis than the fast spontaneous recovery of Succinylcholine. With no serious adverse effects observed in these studies, the data supports the use of Sugammadex and its potential to replace the current standards of practice with Succinylcholine and Neostigmine. Furthermore, high dosage of Sugammadex has shown to be capable of immediately reversing profound neuromuscular blockades, an ability that no reversal drug currently in the market possesses. This enables the anesthesiologist to provide optimal muscle relaxation for the surgeon throughout the operation without the concern of being unable to reverse the patient in a timely manner. Studies on multiple patient population groups do not show any serious adverse effects are linked to using Sugammadex. There have been incidences of drug induced QTc prolongation in cardiac patients, but its cause was not determined to be related solely with Sugammadex. Sugammadex has shown to be the safer reversal agent compared to Neostigmine in cardiac, pulmonary, and renal patients. One problem that prevents the routine use of Sugammadex is its cost. The cost is significantly higher than Neostigmine. This cost is justified, however, due to staff costs saved from a faster patient recovery and shorter stay in the hospital. Therefore, while Sugammadex is definitely warranted over Succinylcholine due to its safety profile, its use over Neostigmine is dependent on each healthcare facility. While Sugammadex is currently under review by the Food and Drug Administration, it will evolve the practice of anesthesia if allowed into the United States market

Distributed Relay Selection for Heterogeneous UAV Communication Networks Using A Many-to-Many Matching Game Without Substitutability

This paper proposes a distributed multiple relay selection scheme to maximize the satisfaction experiences of unmanned aerial vehicles (UAV) communication networks. The multi-radio and multi-channel (MRMC) UAV communication system is considered in this paper. One source UAV can select one or more relay radios, and each relay radio can be shared by multiple source UAVs equally. Without the center controller, source UAVs with heterogeneous requirements compete for channels dominated by relay radios. In order to optimize the global satisfaction performance, we model the UAV communication network as a many-to-many matching market without substitutability. We design a potential matching approach to address the optimization problem, in which the optimizing of local matching process will lead to the improvement of global matching results. Simulation results show that the proposed distributed matching approach yields good matching performance of satisfaction, which is close to the global optimum result. Moreover, the many-to-many potential matching approach outperforms existing schemes sufficiently in terms of global satisfaction within a reasonable convergence time.Comment: 6 pages, 4 figures, conferenc

A Stackelberg Solution to Joint Optimization Problems: A Case Study of Green Design

AbstractDesign of complex engineered systems often involves optimization of multiple competing problems that are supposed to compromise to arrive at equilibrium optima, entailing a joint optimization problem. This paper reveals the leader-follower decision structure inherent in joint optimization problems. A Stackelberg game solution is formulated to model a leader-follower joint optimization problem as a two-level optimization problem between two decision makers, implicating a mathematical program that contains sub-optimization problems as its constraints. A case study of coffee grinder green design demonstrates the potential of Stackelberg solution to joint optimization of modularity subject with conflicting goals

Understanding the Distillation Process from Deep Generative Models to Tractable Probabilistic Circuits

Probabilistic Circuits (PCs) are a general and unified computational framework for tractable probabilistic models that support efficient computation of various inference tasks (e.g., computing marginal probabilities). Towards enabling such reasoning capabilities in complex real-world tasks, Liu et al. (2022) propose to distill knowledge (through latent variable assignments) from less tractable but more expressive deep generative models. However, it is still unclear what factors make this distillation work well. In this paper, we theoretically and empirically discover that the performance of a PC can exceed that of its teacher model. Therefore, instead of performing distillation from the most expressive deep generative model, we study what properties the teacher model and the PC should have in order to achieve good distillation performance. This leads to a generic algorithmic improvement as well as other data-type-specific ones over the existing latent variable distillation pipeline. Empirically, we outperform SoTA TPMs by a large margin on challenging image modeling benchmarks. In particular, on ImageNet32, PCs achieve 4.06 bits-per-dimension, which is only 0.34 behind variational diffusion models (Kingma et al., 2021)

Medicinal plants used by Tibetans in Shangri-la, Yunnan, China

<p>Abstract</p> <p>Background</p> <p>Medicinal plants used by the local people in Xizang (Tibet) have been investigated since the 1960s. The others out of Xizang, however, have been less understood, although they may be easily and strongly influenced by the various local herbal practices, diverse environments, local religious beliefs and different prevalent types of diseases. In 2006, two ethnobotanical surveys were organized in the county of Shangri-la, Yunnan Province, SW China, to document the traditional medicinal plants used by the Tibetan people.</p> <p>Methods</p> <p>After literature surveying, four local townships were selected to carry out the field investigation. Three local healers were interviewed as key informants. The methods of ethnobotany, anthropology and participatory rural appraisal (PRA) were used in the field surveys. Plant taxonomic approach was adopted for voucher specimen identification.</p> <p>Results</p> <p>Sixty-eight medicinal plant species in 64 genera of 40 families were recorded and collected. Among them, 23 species were found to have medicinal values that have not been recorded in any existing Tibetan literatures before, and 31 species were recorded to have traditional prescriptions. Moreover, the traditional preparations of each species and some folk medicinal knowledge were recorded and analyzed. These traditional prescriptions, preparations, new medicinal plants and folk medicinal knowledge and principles were discovered and summarized by local traditional Tibetan healers through times of treatment practices, and were passed down from generation to generation.</p> <p>Conclusion</p> <p>As a part of the cultural diversity of Tibetan community, these traditional medicinal knowledge and experiences may provide data and information basis for the sustainable utilization and development of Tibetan medicine, and may contribute to the local economic development. However, for many reasons, they are disappearing gradually as time goes by. Our study showed that there were abundant traditional Tibetan medicinal prescriptions and using methods. It implies that more Tibetan medicinal plants and traditional knowledge can be discovered. Further research should be done to save the wealth of these traditional medicinal knowledge and experiences before they are dying out.</p