When the arterial switch operation includes the Lecompte maneuver, the arterial trunks are reconnected in parallel, rather than the spiral fashion observed in the normal heart. Thus, although the ...ventriculo–arterial connections are hemodynamically corrected, the anatomic arrangement cannot be considered normal. We hypothesized that, if feasible, it would be advantageous to restore a spiral configuration for the arterial trunks. In 58 patients, we reconstructed the arterial trunks such that, postoperatively, the pulmonary channel spirals round the aorta, passing to either the right or the left, and branches posteriorly. We compared the outcomes with those in 95 patients undergoing a standard non-spiraling operation over the same period. Average follow-up was 8.2 ± 4.5 years. The estimated 10-year survival was similar in the cohorts, at 94.7 % for those with spiraling trunks, as compared to 90.4 % for those with parallel outflow tracts. Reoperation-free survival at 10 years was not significantly different (87.6 vs. 90.5 %). Supravalvar pulmonary stenosis, aortic neo-coarctation, or left bronchial stenosis, however, was encountered in one-eighth of those undergoing a standard operation. None of these complications occurred in those patients who, postoperatively, had spiraling outflow tracts (
P
= 0.002). Reconstruction of spiraling trunks after the arterial switch has, thus far, avoided the complications of supravalvar pulmonary stenosis, neo-aortic kinking, or bronchial stenosis. The spiraling arrangement prevents compression of the pulmonary vessels and bronchial tree by the aorta, since it provides a wide window in the new aortic arch.
This work develops a three-dimensional (3D) weak formulation, based on the consistent couple stress theory (CCST), for analyzing the size-dependent dynamic instability behavior of simply-supported, ...functionally graded (FG) cylindrical microshells that are subjected to combinations of periodic axial compression and external pressure. In our formulation, the microshells are artificially divided into
layers. The displacement components of each individual layer are selected as the primary variables, which are expanded as a double Fourier series in the in-plane domain and are interpolated with Hermitian
polynomials in the thickness direction. Incorporating the layer-wise displacement models into our weak formulation, we develop a Hermitian
finite layer method (FLM) for addressing the current issue. The accuracy and the convergence rate of our Hermitian
FLM are validated by comparing the solutions it produces with the accurate two-dimensional solutions of critical loads and critical pressures of FG cylindrical macroshells and single-walled carbon nanotubes, which were reported in the literature. The numerical results show the effects of the material length-scale parameter, the inhomogeneity index, the radius-to-thickness and length-to-radius ratios, the load magnitude ratio, and the static and dynamic load factors on the first principal and first secondary instability regions of parametric resonance of simply-supported FG cylindrical microshells are significant.
This work develops a three-dimensional (3D) weak formulation, based on the consistent couple stress theory (CCST), for analyzing the size-dependent dynamic instability behavior of simply-supported, ...functionally graded (FG) cylindrical microshells that are subjected to combinations of periodic axial compression and external pressure. In our formulation, the microshells are artificially divided into nl layers. The displacement components of each individual layer are selected as the primary variables, which are expanded as a double Fourier series in the in-plane domain and are interpolated with Hermitian Csup.2 polynomials in the thickness direction. Incorporating the layer-wise displacement models into our weak formulation, we develop a Hermitian Csup.2 finite layer method (FLM) for addressing the current issue. The accuracy and the convergence rate of our Hermitian Csup.2 FLM are validated by comparing the solutions it produces with the accurate two-dimensional solutions of critical loads and critical pressures of FG cylindrical macroshells and single-walled carbon nanotubes, which were reported in the literature. The numerical results show the effects of the material length-scale parameter, the inhomogeneity index, the radius-to-thickness and length-to-radius ratios, the load magnitude ratio, and the static and dynamic load factors on the first principal and first secondary instability regions of parametric resonance of simply-supported FG cylindrical microshells are significant.
Objectives: Coronary artery (CA) anatomy of anatomically corrected malposition of the great arteries (ACM) has not been well elucidated. We studied the CA pattern and their association with the ...aortopulmonary rotation (APR). Methods: CA anatomy and APR of ACM were identified by image or surgical intervention. The degree of APR was defined by the pattern of the aortic sinus of Valsalva on the lateral angiogram or computed tomography (CT). Results: Four CA types were presented in 10 patients and literatures. Six patients had the same CA type as the usual pattern in transposition of the great arteries (type 1); and two had left anterior descending (LAD) from the left-hand facing sinus that also gave rise to the right CA (RCA) (type 0). One patient had LAD from the left-hand facing sinus while RCA and circumflex artery from the right-hand facing sinus (type 10); and single CA from the anterior left-hand sinus (type 3c) was identified in another. APR was left anterior in type 1 and more lateral in types 0 and 3c; and left posterior in type 10 (p = 0.001). The usual pulmonary trans-annular incision can only be performed in case of type 10 CA after posterior APR (10%, 1/10). In the majority (90%, 9/10 with the CA type 1, 0, and 3c), the RCA is in front of the pulmonary annulus, and the atrioventricular groove patch plasty posterior to the RCA had to be adopted for a trans-annular patch. Conclusions: The observed CA pattern was correlated with APR. APR identified by the aortic sinus pattern could implicate the CA patterns and the surgical options in ACM.
Objectives: The great arteries are in a non-spiral relationship in their transposition, even after arterial switch operation (ASO) with the Lecompte manoeuvre. We aim to restore the natural spiral ...great arteries and compare such ASO with conventional ASO with the Lecompte manoeuvre to clarify the functional implications of the spiral great arteries. Methods: The early survivors of ASO (n = 130) were included in this retrospective study. In spiral ASO (n = 48), the main pulmonary artery ran alongside the aorta and gave rise to its branches posteriorly. Patients who underwent non-spiral ASO with the manoeuvre (n = 82) were compared. The survival, re-operation-free ratio and the anatomic details for re-intervention after ASO were reviewed. Results: Average follow-up was 5.6 ± 3.4 years (range: 2 months to 11 years). The estimated 10-year survival was similar (92.6% spiral vs 92.1% non-spiral, respectively). Significant pulmonary stenosis (PS) (>40 mmHg) was noted in five (10.4%) in the spiral group and seven patients (9.7%) in the non-spiral (p = NS). The re-operation-free survival at 10 years was not significantly different (87.4% vs 90.1%). The reasons for re-operation were subvalvular PS (n = 3) and residual defect (n = 2) in the spiral group, while supravalvular PS (n = 3), neo-aortic regurgitation (n = 1) and aortic neo-coarctation (n = 2) in the non-spiral group. Supravalvular PS and aortic neo-coarctation that occurred in the non-spiral group were not seen after spiral ASO. Conclusions: Intermediate-term results of spiral ASO were satisfactory. Transposition is not a mere reversal of the great arteries; therefore, recognition of non-spiral relationship should be appreciated. Spiral reconstruction would be beneficial to reduce supravalvular PS and neo-aortic kinking. Further recognition of spiral function and refined modification might justify the application of spiral ASO in the future.
Background Reoperation is usually inevitable for congenital cardiac patients after insertion of an extracardiac valved conduit. We sought to verify that a transannular patch on the autologous ...posterior wall with the common wall between the aorta and pulmonary artery can replace the conventional operation using an extracardiac conduit. Methods From August 1997 to October 2007, 31 patients (age 15 days to 19.3 years) underwent a procedure of autologous pulmonary floor with common wall between the great arteries and transannular patch to correct a right ventricle to pulmonary artery discontinuity at our hospital. The posterior pulmonary pathways were reconstructed by direct or indirect ventriculoarterial connection using tissue in situ or donated from the dominant aorta or truncus in all cases. The aorta or truncus was tailored transversely or longitudinally to donate the inner or outer wall to the pulmonary pathway as needed. Results There was no surgical mortality, and late noncardiac death occurred in 1 patient (3%). The postoperative systolic right ventricular to aortic pressure ratio was 0.48 ± 0.11 in the operating theater, and the central venous pressure was 9 ± 2 mm Hg. The follow-up duration was 5.5 ± 3.3 years (range, 6 months to 10.6 years). In the follow-up echocardiography, significant pulmonary stenosis (pressure gradient > 40 mm Hg) was noted in 4 patients (13%). Follow-up computerized tomograms (n = 9) showed growth of the common wall. Conclusions The tissue deficiency of the pulmonary outflow tract could be recruited from the outer wall or inner wall of the large aorta or truncus in this disease category. We recommend such an operation to correct a right ventricle to pulmonary artery discontinuity without using an extracardiac conduit.
Recent years, computer-aided penalty prediction have been promoted to gain people's trust to the judicial systems, especially in developing Chinese region. In this paper, we propose machine learning ...based models to predict the legal penalty of criminal cases. Particularly, we focus on drunk driving cases as they are frequent, and the regulations are clear. Unlike western text which words are separated by spaces, words in Chinese text are continuum. In our proposed method, we first use a word segmentation method to separate the Chinese words in text and apply a pre-trained model to convert words into vectors. In the vector space, words with similar meanings have short distance with each other. As the amount of each penalty varies greatly, resulting a data imbalance problem. Therefore, we adapt the Synthetic Minority Oversampling Technique (SMOTE) algorithm as a solution. Finally, we apply deep learning-based models, including Bi-GRU and TextCNN to perform penalty prediction, and compare their advantages and disadvantages.In the experimental result, for drunk driving case penalty prediction, our propose SMOTE + TextCNN solution can reach 73.96% of accuracy. If we allow the prediction to be plus or minus one month from the actual, the accuracy is 95.60%. As for the computation time, our proposed method can predict the penalty of 1,524 drunk driving cases per second.
Photography is the activity of recording precious moments which are often difficult to make up afterwards. Therefore, taking the correct picture under proper guidance assistance is important. ...Although there are many factors that can determine a good photo, in general, photos that do not follow the composition rules usually look bad that make the viewer feel uncomfortable. Acting as a solution, in this paper, we propose an intelligent photographing guidance system using machine learning. The guidance is based on a tree-based interpretable machine learning model that can give reasons for decisions. There are two categories of features for guidance, which are traditional image features and deep features. Traditional features include prominent lines and image maps, such as saliency map and sharpness map, each of which exists in a multi-scale Gaussian pyramid. Deep features are extracted during the establishment of a CNN-based image composition classifier. We use these two categories of features as inputs for the interpretable machine learning model to establish a feasible photographing guidance system. The guidance system references our composition classifier with precision rate of 94.8%, and recall rate of 95.0% where the comprising tree-based interpretable model is capable of guiding camera users to alter image contents for obtaining better aesthetical compositions to take photos of good quality.
Many modern cities have their public bicycle rental systems. The bicycle rental system does not only provide convenience for short distance traveling but also gives an opportunity for the predictions ...of people in the city, and brings efficiency for government as well as enterprises. Some bicycle rental systems are connected to the Internet and the rental status of each bicycles are available, and huge amount of data are produced every day for analysis. In this research, several data mining approaches including the data processing, feature selection, frequent pattern mining are used to predict user behaviors. The data are cleaned and clustered for more accurate analysis. The processed data can be used to extract frequent patterns and built decision tree of user behaviors. According to the method proposed in this research, a full scheme for the public bicycle rental system is provided to make better strategies for government and commercial use.
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