A component-efficient design for parallel optical crossbar switches, which utilises the idle ports as extra input or output ports, is described for the first time. It is observed that conventional ...parallel crossbar switches composed of 2 × 2 basic switch elements have a significant number of unused internal routes between the idle ports. Two distinctive types of parallel crossbar switches with augmented input and output ports are introduced to yield a switch-element count of 3N2/4 + 3N, where N is the switch size. The first type of switch is unidirectional and requires rearrangements. The second is bidirectional and strictly non-blocking and have a switch control complexity of O(1).
A component-efficient design for optical multi/demultiplexers (OMDPXs) relying on 2 x 2 switch elements (SEs) with a bidirectional property is described for the first time. First, the observation is ...made that some 2 x 1 or 1 x 2 SEs used in conventional OMDPXs have been implemented with part of a 2 x 2 SE. A novel design of OMDPXs fully utilising the connection capability of 2 x 2 SEs is presented. The SE count in the design becomes virtually half of that in the conventional design because a 2 x 2 SE is equivalent to a pair of 2 x 1 and/or 1 x 2 SEs. Other basic characteristics such as insertion loss and cross-talk are also approximated. Finally, the design provides an N x N optical switch composed of N(N- 1)/2 2 x 2 SEs instead of N super(2) for conventional optical cross-bar switches, keeping the strictly non-blocking capability unlike N-stage planar switches, which are rearrangeably non-blocking while composed of the same number of SEs as the design.
A component-efficient design for optical multi/demultiplexers (OMDPXs) relying on 2 × 2 switch elements (SEs) with a bidirectional property is described for the first time. First, the observation is ...made that some 2 × 1 or 1 × 2 SEs used in conventional OMDPXs have been implemented with part of a 2 × 2 SE. A novel design of OMDPXs fully utilising the connection capability of 2 × 2 SEs is presented. The SE count in the design becomes virtually half of that in the conventional design because a 2 × 2 SE is equivalent to a pair of 2 × 1 and/or 1 × 2 SEs. Other basic characteristics such as insertion loss and cross-talk are also approximated. Finally, the design provides an N × N optical switch composed of N(N − 1)/2 2 × 2 SEs instead of N2 for conventional optical cross-bar switches, keeping the strictly non-blocking capability unlike N-stage planar switches, which are rearrangeably non-blocking while composed of the same number of SEs as the design.
The national cancer registration project that began in January 2016 requires medical institutions to submit medical cases and makes it possible to collect what would be universal information on ...cancer. However, such medical institutions have a hard time being efficient in finding registered cancer cases in many outpatients and admitted patients that they have. Therefore, this research developed the statistical model that discriminates registered cancer cases in clinical data from several institutions and evaluated its discrimination abilities. The discrimination model, developed based on retrievable data from a medical accounting system, had AUC of 0.953. The discrimination ability (95％ confidence interval) of the model using evaluation datasets had a 92.0％ (90.5％-93.3％) sensitivity and an 89.1％ (88.7％-89.6％) specificity with accuracy. It excluded 82.2％ of cases that are subject to a search for cancer registration. This discrimination model can be used in many hospitals that provide healthcare services through insurance and has the potential to increase efficiency in operations related to registered cancer case searches.
Primary infected aneurysms of the abdominal aorta and iliac arteries are potentially life-threatening. However, because of the rarity of the disease, its pathogenesis and optimal treatment strategy ...remain poorly defined.
A nationwide retrospective cohort study investigated patients who underwent surgical treatment for a primary infected abdominal aortic and/or common iliac artery (CIA) aneurysm between 2011 and 2017 using a Japanese clinical registry. The study evaluated the relationships between preoperative factors and postoperative outcomes including 90-day and 3-year mortality, and persistent or recurrent aneurysm-related infection. Propensity score matching was used to compare survival between patients who underwent in situ prosthetic grafting and those who had endovascular aneurysm repair (EVAR).
Some 862 patients were included in the analysis. Preceding infection was identified in 30.2 per cent of the patients. The median duration of postoperative follow-up was 639 days. Cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years and 5 years were 94.0, 89.7, 82.6, 74.9 and 68.5 per cent respectively. Age, preoperative shock and hypoalbuminaemia were independently associated with short-term and late mortality. Compared with open repair, EVAR was more closely associated with persistent or recurrent aneurysm-related infection (odds ratio 2.76, 95 per cent c.i. 1.67 to 4.58; P < 0.001). Propensity score-matched analyses demonstrated no significant differences between EVAR and in situ graft replacement in terms of 3-year all-cause and aorta-related mortality rates (P = 0.093 and P =0.472 respectively).
In patients undergoing surgical intervention for primary infected abdominal aortic and CIA aneursyms, postoperative survival rates were encouraging. Eradication of infection following EVAR appeared less likely than with open repair, but survival rates were similar in matched patients between EVAR and in situ graft replacement.
In the World Health Organization Western Pacific Region, the high rates of births attended by skilled health personnel (SHP) do not equal access to quality maternal or newborn care. ‘A healthy start ...for every newborn’ for 23 million annual births in the region means that SHP and newborn care providers give quality intrapartum, postpartum and newborn care. WHO and the UNICEF Regional Action Plan for Healthy Newborn Infants provide a platform for countries to scale‐up Early Essential Newborn Care (EENC). The plan emphasises the creation of an enabling environment for the practice of EENC; thereby, preventing 50 000 newborn deaths annually.
Emerging problems in uterus transplantation Kisu, I; Kato, Y; Obara, H ...
BJOG : an international journal of obstetrics and gynaecology,
October 2018, Letnik:
125, Številka:
11
Journal Article
Long-term placement of prophylactic drains may result in retrograde infections.
To investigate the association between the timing of drain removal and clinical outcomes.
This retrospective, ...single-centre cohort study evaluated 110 patients who underwent elective gastrointestinal or hepatopancreatobiliary surgery and developed subsequent organ/space surgical site infection (SSI) between 2016 and 2020. The difference between the culture-positive species of prophylactic drains and direct aspiration was evaluated; whether the prophylactic drains functioned effectively at the time of SSI diagnosis; and whether the empirical antibiotics administered before drainage were effective against all the detected bacteria. Finally, clinical outcomes were compared between early (i.e. cases wherein the prophylactic drain had already been removed or replaced at the time of SSI diagnosis) and late (removal after diagnosis) drain removal.
The prophylactic drains functioned effectively in only 27 (25%) patients at the time of SSI diagnosis. Due to the results of direct aspiration cultures, 43% of patients required antibiotic escalation. The median time to drain removal or first replacement was seven postoperative days. The early removal group included 43 patients (39%). Compared with early removal, late removal resulted in a higher frequency of vancomycin use (7.0% vs 22.4%; P = 0.037).
Prolonged prophylactic drain placement is associated with complicated infections requiring vancomycin; therefore, the drains should be removed as soon as possible. Additionally, obtaining the cultures of direct aspiration should be actively considered, as escalation of antimicrobial therapy is often performed based on culture results.
Machine perfusion (MP) techniques are expected to prove useful for preserving the organ viability and recovering organ function for organ transplantation. Furthermore, an accurate assessment of organ ...viability using MP is important for expanding the donor criteria. In this study, an ex vivo reperfusion model (ERM) simulating transplantation using diluted autologous blood under normothermic conditions was evaluated for its utility of MP under subnormothermic conditions for livers donated after cardiac death (DCD).
The liver preservation methods for DCD porcine livers were evaluated using the ERM. This investigation was performed using a novel perfusion system developed by our research group. Porcine livers were procured with a warm ischemia time (WIT) of 60 minutes. The organs were then preserved using subnormothemic machine perfusion (SNMP) or static cold storage (CS) for 4 hours. We also compared these tissues with SNMP livers procured under a WIT of 0 minutes. After the preservation, the livers were reperfused for 2 hours using the ERM with diluted autologous blood oxygenated by a membrane oxygenator under NMP conditions. Reperfusion was evaluated based on perfusion flow dynamics and outflow of deviating enzymes.
In the early stages of reperfusion, pressure in the blood vessels increased sharply in the CS group. Furthermore, the amount of aspartate aminotransferase accumulation was lower in the SNMP group than in the other groups. These results suggest ischemia-reperfusion injury is suppressed in SNMP conditions.
An ERM has use in evaluating the utility of MP for the DCD liver.
•An ex vivo reperfusion model was suggested using diluted blood under normothermic conditions.•Subnormothermic machine perfusion may reduce ischemia-reperfusion injury.•An ex vivo reperfusion model could evaluate function in a short period of time.
Subnormothermic machine perfusion (SNMP) shows some advantages for the preservation of grafts donated after cardiac death (DCD) and improvements in machine perfusion (MP) technology are important to ...enhance organ preservation outcomes for liver transplantation. In this study, we focused on purified subnormothermic machine perfusion (PSNMP) and volumes of perfusate removed to substitute for purification and replaced by modified University of Wisconsin-gluconate after the start of perfusion and investigated, in particular, the optimum perfusate purification volume. Several purification volumes under SNMP were compared. In addition, the perfusate purification during MP was indicated as a potential technique to enhance the organ quality of DCD grafts and extended-criteria donors.
The PSNMP at several volumes (0.5 L, 1.5 L, and 3 L) were compared with regular SNMP without any purification treatment (untreated control). In the PSNMP group, all perfusate was removed to substitute for purification of the perfusate by modified University of Wisconsin-gluconate solution after the start of perfusion. After removing the perfusate, new perfusate with the same components was perfused to preserve the porcine livers obtained under warm ischemia for 60 minutes using SNMP at 22°C porcine liver for 4 hours.
The concentrations of aspartate aminotransferase and lactate dehydrogenase in the untreated group were significantly higher during perfusion compared to those of the intervention group. There are no significant differences among the volume conditions of the purification groups.
The optimal volume of perfusate purification was confirmed with a simple experimental comparison between untreated and PSNMP conditions.
•Purified subnormothermic machine perfusion (PSNMP) has been suggested to enhance the organ quality of grafts donated after cardiac death (DCD) and extended-criteria donors. This technique removes perfusate and replaces it with modified University of Wisconsin-gluconate after the start of perfusion as a means of purification.•The PSNMP is a promising preservation technique for DCD with regard to its ability to eliminate accumulated humoral factors and subsequently improve functional recovery of the liver during reperfusion.•The optimal volume of perfusate purification was confirmed with a simple experimental comparison between untreated and PSNMP groups of porcine livers.
