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.     

3D Motion recovery via affine Epipolar geometry

Algorithms to perform point-based motion estimation under orthographic and scaled orthographic projection abound in the literature. A key limitation of many existing algorithms is that they operate on the minimum amount of data required, often requiring the selection of a suitable minimal set from the available data to serve as a local coordinate frame. Such approaches are extremely sensitive to errors and noise in the minimal set, and forfeit the advantages of using the full data set. Furthermore, attention is seldom paid to the statistical performance of the algorithms.We present a new framework that allowsall available features to be used in the motion computations, without the need to select a frame explicitly. This theory is derived in the context of theaffine camera, which preserves parallelism and generalises the orthographic, scaled orthographic and para-perspective models. We define the affine epipolar geometry for two such cameras, giving the fundamental matrix in this case. The noise resistant computation of the epipolar geometry is discussed, and a statistical noise model constructed so that confidence in the results can be assessed.The rigid motion parameters are then determineddirectly from the epipolar geometry, using the novel rotation representation of Koenderink and van Doorn (1991). The two-view partial motion solution comprises the scale factor between views, the projection of the 3D axis of rotation and the cyclotorsion angle, while the addition of a third view allows the true 3D rotation axis to be computed (up to a Necker reversal). The computed uncertainties in these parameters permit optimal estimates to be obtained over time by means of a linear Kalman filter. Our theory extends work by Huang and Lee (1989), Harris (1990), and Koenderink and van Doorn (1991), and results are given on both simulated and real data.     

An octree-based,cartesian navier–stokes solver for modern cluster architectures

The Journal of Supercomputing - Adaptive Cartesian mesh approaches have proven useful for multi-scale applications where particular features can be finely resolved within a large solution domain....     

In-process monitoring and prediction of droplet quality in droplet-on-demand liquid metal jetting additive manufacturing using machine learning

Journal of Intelligent Manufacturing - In droplet-on-demand liquid metal jetting (DoD-LMJ) additive manufacturing, complex physical interactions govern the droplet characteristics, such as size,...     

Psychosexual development of women with congenital adrenal hyperplasia

Women with congenital adrenal hyperplasia (CAH) (N = 31) and their unaffected sisters or female cousins (N = 15) participated in a study of psychosexual development. All participants were > or = 18 years of age (mean age, 25 years; range, 18-40). Comparisons were also made between the CAH women with the salt-wasting (SW) form of the disorder and those with simple virilization (SV). A psychosexual assessment protocol examined six variables: (1) sex assignment at birth (probands only); (2) recalled sex-typed behavior during childhood; (3) gender identity and gender role identification in adulthood; (4) relationship status; (5) sexual orientation in fantasy; and (6) sexual orientation in behavior. Salt-wasting status and sex assignment at birth were also ascertained for the CAH women who either refused to participate in the study (N = 10) or could not be traced (N = 13). Compared to the controls, the women with CAH recalled more cross-gender role behavior and less comfort with their sense of "femininity" during childhood. The two groups did not differ in degree of gender dysphoria in adulthood, although the probands showed more cross-gender role identification. Three of the nonparticipant probands were living, as adults, in the male social role (2 reared from birth as boys and 1 who changed from the female to the male social role during adolescence). The CAH women and the controls did not differ in relationship status (married/cohabiting vs. single). The CAH women had lower rates of exclusive heterosexual fantasy and fewer sexual experiences with men than the controls; however, the CAH women did not have more sexual experiences with women than the controls. Comparisons between the SW and SV revealed several differences: the SW were less likely to be assigned to the female sex at birth, recalled more cross-gender role behavior during childhood, were less likely to be married or cohabiting, and had lower rates of sexual experiences with men. The results were discussed in relation to the effects of prenatal androgens on psychosexual differentiation.     

Linear Least-Squares Algorithms for Temporal Difference Learning

We introduce two new temporal difference (TD) algorithms based on the theory of linear least-squares function approximation. We define an algorithm we call Least-Squares TD (LS TD) for which we prove probability-one convergence when it is used with a function approximator linear in the adjustable parameters. We then define a recursive version of this algorithm, Recursive Least-Square TD (RLS TD). Although these new TD algorithms require more computation per time-step than do Suttons TD() algorithms, they are more efficient in a statistical sense because they extract more information from training experiences. We describe a simulation experiment showing the substantial improvement in learning rate achieved by RLS TD in an example Markov prediction problem. To quantify this improvement, we introduce the TD error variance of a Markov chain, TD, and experimentally conclude that the convergence rate of a TD algorithm depends linearly on TD. In addition to converging more rapidly, LS TD and RLS TD do not have control parameters, such as a learning rate parameter, thus eliminating the possibility of achieving poor performance by an unlucky choice of parameters.     

Analysis of sperm concentration and motility in a microfluidic device

A home-use device that allows rapid and quantitative sperm quality analysis is desirable but not yet fully realized. To aid this effort, this article presents a microfluidic device capable of quantifying sperm quality in terms of two critical fertility-related parameters—motile sperm concentration and motility. The microdevice produces flow field for sperms to swim against, and sperms that overcame the flow within a specified time are propelled along in a separate channel and counted via resistive pulse technique. Data are compared to two control methods clinically utilized for sperm quality exam—hemocytometer and the sperm quality analyzer. Results reveal the numbers of pulses generated by passage of sperms correlates strongly with the two control methods: pulse number from 0 to 335 corresponds to progressively motile sperm concentrations from 0 to 19 × 10⁶/ml (hemocytometer) and Sperm Motility Index from 0 to 204 (sperm quality analyzer). The microdevice should be applicable to facilitate self-assessment of sperm quality at home.     

Greedy algorithms for generalized k-rankings of paths

A k-ranking of a graph is a labeling of the vertices with positive integers 1,2,…,k so that every path connecting two vertices with the same label contains a vertex of larger label. An optimal ranking is one in which k is minimized. Let Pn be a path with n vertices. A greedy algorithm can be used to successively label each vertex with the smallest possible label that preserves the ranking property. We seek to show that when a greedy algorithm is used to label the vertices successively from left to right, we obtain an optimal ranking. A greedy algorithm of this type was given by Bodlaender et al. in 1998 [1] which generates an optimal k-ranking of Pn. In this paper we investigate two generalizations of rankings. We first consider bounded (k,s)-rankings in which the number of times a label can be used is bounded by a predetermined integer s. We then consider kt-rankings where any path connecting two vertices with the same label contains t vertices with larger labels. We show for both generalizations that when G is a path, the analogous greedy algorithms generate optimal k-rankings. We then proceed to quantify the minimum number of labels that can be used in these rankings. We define the bounded rank number to be the smallest number of labels that can be used in a (k,s)-ranking and show for n?2, where i=⌊log₂(s)⌋+1. We define the kt-rank number, to be the smallest number of labels that can be used in a kt-ranking. We present a recursive formula that gives the kt-rank numbers for paths, showing for all an−1<j?an where {an} is defined as follows: a₁=1 and an=⌊((t+1)/t)an−1⌋+1.