Symptomatic subclavian steal syndrome four decades after operation for dysphagia lusoria

Congenital abnormalities of the aortic arch may lead to signs and symptoms of tracheal and esophageal obstruction secondary to a restrictive vascular ring. There are many case reports and monographs concerning the surgical management of dysphagia lusoria. This case provides the first example of long-term follow-up of surgical intervention for relief of dysphagia lusoria. A 45-year-old laborer presented with a several year history of episodic bilateral blindness and a more recent onset of "drop attacks." Notably this patient had presented at the age of 18 months with difficulty breathing and eating since birth. The patient also had frequent upper respiratory infections and episodes of pneumonia. Workup revealed a right-sided aortic arch with a left ligamentum arteriosum. When he was first seen in our clinic, history and physical examination revealed claudication and diminished pulses in the left upper extremity. Arteriography and duplex studies confirmed reversal of flow in the patient's left vertebral artery. The arteriogram demonstrated the presence of a right-sided aortic arch and descending aorta along with the proximal stump of the previously ligated left subclavian artery. He underwent left carotid to left axillary artery bypass for the treatment of symptomatic subclavian steal syndrome. His symptoms have resolved with return of antegrade vertebral flow and the presence of normal pulses in the left arm. Congenital aortic abnormalities that lead to tracheal and esophageal compromise are numerous and varied. Surgical management requires a thorough understanding of the person's anatomy and preoperative planning. The life expectancy of patients with dysphagia lusoria necessitates consideration of the long-term consequences of surgical intervention.     

The synthesis of pixelated metamaterial cross polarizer using binary wind driven optimization algorithm

Microsystem Technologies - In this paper synthesis of two wideband Metamaterial Cross Polarizer (MCPs) is proposed. The synthesis of proposed MCPs is done by using Binary Wind Driven Optimization...     

A systematic mapping of semi-formal and formal methods in requirements engineering of industrial Cyber-Physical systems

Journal of Intelligent Manufacturing - The requirements engineering of Industrial Cyber-Physical Systems is extremely challenging due to large system sizes, component heterogeneity, involvement of...     

Development,optimization, and characterization of a novel tea tree oil nanogel using response surface methodology

Purpose: To develop and optimize nanoemulsion (NE)-based emulgel (EG) formulation as a potential vehicle for topical delivery of tea tree oil (TTO).

Methodology: Central composite design was adopted for optimizing the processing conditions for NE preparation by high energy emulsification method viz. surfactant concentration, co-surfactant concentration, and stirring speed. The optimized NE was developed into emulgel (EG) using pH sensitive polymer Carbopol 940 and triethanolamine as alkalizer. The prepared EG was evaluated for its pH, viscosity, and texture parameters, ex vivo permeation at 37?°C and stability. Antimicrobial evaluation of EG in comparison to conventional gel and pure TTO was also carried out against selected microbial strains.

Results and discussion: Optimized NE had particle size and zeta potential of 16.23?±?0.411?nm and 36.11?±?1.234?mV, respectively. TEM analysis revealed the spherical shape of droplets. The pH of EG (5.57?±?0.05?) was found to be in accordance with the range of human skin pH. EG also illustrated efficient permeation (79.58?μL/cm²) and flux value (J_SS) of 7.96?μL cm²/h through skin in 10?h. Viscosity and texture parameters, firmness (9.3?±?0.08?g), spreadability (2.26?±?0.06?mJ), extrudability (61.6?±?0.05?mJ), and adhesiveness (8.66?±?0.08?g) depict its suitability for topical application. Antimicrobial evaluation of EG with same amount of TTO as conventional gel revealed broader zones of growth inhibitions against all the selected microbial strains. Moreover, EG was also found to be nonirritant (PII 0.0833). These parameters were consistent over 90 d.

Conclusion: TTO EG turned out to be a promising vehicle for the topical delivery of TTO with enhanced therapeutic efficacy.     

The unanticipated difficult airway with recommendations for management

PURPOSE: To review the current literature and generate recommendations on the role of newer technology in the management of the unanticipated difficult airway. METHODS: A literature search using key words and filters of English language and English abstracted publications from 1990-96 contained in the Medline, Current Contents and Biological Abstracts databases was carried out. The literature was reviewed and condensed and a series of evidence-based recommendations were evolved. CONCLUSIONS: The unanticipated difficult airway occurs with a low but consistent incidence in anaesthesia practice. Difficult direct laryngoscopy occurs in 1.5-8.5% of general anaesthetics and difficult intubation occurs with a similar incidence. Failed intubation occurs in 0.13-0.3% general anaesthetics. Current techniques for predicting difficulty with laryngoscopy and intubation are sensitive, non-specific and have a low positive predictive value. Assessment techniques which utilize multiple characteristics to derive a risk factor tend to be more accurate predictors. Devices such as the laryngeal mask, lighted stylet and rigid fibreoptic laryngoscopes, in the setting of unanticipated difficult airway, are effective in establishing a patient airway, may reduce morbidity and are occasionally lifesaving. Evidence supports their use in this setting as either alternatives to facemask and bag ventilation, when it is inadequate to support oxygenation, or to the direct laryngoscope, when tracheal intubation has failed. Specifically, the laryngeal mask and Combitube have proved to be effective in establishing and maintaining a patent airway in "cannot ventilate" situations. The lighted stylet and Bullard (rigid) fibreoptic scope are effective in many instances where the direct laryngoscope has failed to facilitate tracheal intubation. The data also support integration of these devices into strategies to manage difficult airway as the new standard of care. Training programmes should ensure graduate physicians are trained in the use of these alternatives. Continuing medical education courses should allow physicians in practice the opportunity to train with these alternative devices.     

Neural-network-based classification of Space Acceleration Measurement Systems (SAMS) data via supervised learning

This paper illustrates the applicability of neural networks in classifying events using Space Acceleration Measurement System (SAMS) data. Computer programs have been written in the MATLAB environment for the following purposes: automatic retrieval of SAMS data from NASA CDROM disks, computation of power spectral densities for SAMS data and construction of input patterns for the training of a multi-layer neural network (MNN). The MNN has been trained using the backpropagation learning algorithm and the SAMS data collected on the STS-50 Space Shuttle mission for three crew exercise events. It is found that the trained MNN is highly successful in classifying events. In addition, the performance of MNN is found to be better than that of the nearest neighbor classifier.     

The role of protein kinase in C ischemic/reperfused preconditioned isolated rat hearts

Protein kinase C (PKC) has been implicated in the preconditioning-induced cardiac protection in ischemic/reperfused myocardium. We studied the effect of PKC inhibition with calphostin C (25, 50, 100, 200, 400, and 800 nM), a potent and specific inhibitor of PKC, in isolated working nonpreconditioned and preconditioned ischemic/reperfused hearts. In the nonpreconditioned groups, all hearts underwent 30 min of normothermic global ischemia followed by 30 min of reperfusion. In the preconditioned groups, hearts were subjected to four cycles of ischemic preconditioning by using 5 min of ischemia followed by 10 min reperfusion, before the induction of 30 min ischemia and reperfusion. At low concentrations of calphostin C (25, 50, and 100 nM), the PKC inhibitor had no effect on the incidence or arrhythmias or postischemic cardiac function in the nonpreconditioned ischemic/reperfused groups. With 200 and 400 nM of calphostin C, a significant increase in postischemic function and a reduction in the incidence of arrhythmias were observed in the nonpreconditioned ischemic/reperfused groups. Increasing the concentration of calphostin C to 800 NM, the recovery of postischemic cardiac function was similar to that of the drug-free control group. In preconditioned hearts, lower concentrations (< 100 nM) of calphostin C did not change the response of the myocardium to ischemia and reperfusion in comparison to the preconditioned drug-free myocardium. Two hundred and 400 nM of the PKC inhibitor further reduced the incidence of ventricular fibrillation (VF) from the preconditioned drug-free value of 50% to 0 (p < 0.05) and 0 (p < 0.05), respectively, indicating that the combination of the two, preconditioning and calphostin C, affords significant additional protection. Increasing the concentration of calphostin C to 800 nM blocked the cardioprotective effect of preconditioning (100% incidence of VF). The recovery of cardiac function was similarly improved at calphostin C doses of 200 and 400 nM and was reduced at 800 nM (p < 0.05). With 200 and 400 nM of calphostin C, both cytosolic and particulate PKC activity were reduced by approximately 40 and 60%, respectively, in both preconditioned and preconditioned/ischemic/reperfused hearts. The highest concentration of calphostin C (800 nM) resulted in almost a complete inhibition of cytosolic (100%) and particulate (85%) PKC activity correlated with the abolition of preconditioning-induced cardiac protection. In conclusion, calphostin C protects the ischemic myocardium obtained from intact animals, provides significant additional protection to preconditioning at moderate doses, and blocks the protective effect of preconditioning at high concentrations. The dual effects of calphostin C appear to be strictly dose and "enzyme inhibition" related.     

Feature tracking and matching in video using programmable graphics hardware

This paper describes novel implementations of the KLT feature tracking and SIFT feature extraction algorithms that run on the graphics processing unit (GPU) and is suitable for video analysis in real-time vision systems. While significant acceleration over standard CPU implementations is obtained by exploiting parallelism provided by modern programmable graphics hardware, the CPU is freed up to run other computations in parallel. Our GPU-based KLT implementation tracks about a thousand features in real-time at 30 Hz on 1,024 × 768 resolution video which is a 20 times improvement over the CPU. The GPU-based SIFT implementation extracts about 800 features from 640 × 480 video at 10 Hz which is approximately 10 times faster than an optimized CPU implementation.     

Receptive field structures for recognition

Localized operators, like Gabor wavelets and difference-of-gaussian filters, are considered useful tools for image representation. This is due to their ability to form a sparse code that can serve as a basis set for high-fidelity reconstruction of natural images. However, for many visual tasks, the more appropriate criterion of representational efficacy is recognition rather than reconstruction. It is unclear whether simple local features provide the stability necessary to subserve robust recognition of complex objects. In this article, we search the space of two-lobed differential operators for those that constitute a good representational code under recognition and discrimination criteria. We find that a novel operator, which we call the dissociated dipole, displays useful properties in this regard. We describe simple computational experiments to assess the merits of such dipoles relative to the more traditional local operators. The results suggest that nonlocal operators constitute a vocabulary that is stable across a range of image transformations.     

Distribution of lead between copper and matte and the activity of PbS in copper-saturated mattes

The distribution coefficients of lead between copper and matte phases have been measured at 1405 and 1505 K and correlated with lead and iron concentrations in metallic copper and matte. Experiments covered the ranges of 0.009 to 1.8 and 0 to 11 wt pct lead and iron in matte, respectively. Distribution coefficients of lead between copper and iron-free matte, at infinite dilution of lead, have been determined to be 3.60 and 4.06 at 1505 and 1405 K, respectively. From the measured values of distribution coefficients, the Raoultian activity coefficients of PbS in copper-saturated matte have been calculated. At the temperatures and matte compositions investigated, activities of PbS deviate negatively from Temkin's ideality. At infinite dilution, the following equation correlating the Raoultian activity coefficients of PbS, , with matte composition and temperature has been obtained: In , whereN _FeS , is the mole fraction of FeS in the Cu₂S-FeS-PbS matte. The present values of γ _PbS ^o must be used exclusively in conjunction with the following Gibbs free energy of formation: Pb(l) + 1/2S₂(g) = PbS(l); ΔGℴ = −26730 + 12.20T (cal/mol). M. NAGAMORI, Formerly Associate Professor of Metallurgy at The University of Utah,