Abstract
Initially developed for large and giant wide-necked aneurysms of the internal carotid artery, flow diverter devices are now used in almost every location safely and with effectiveness.1-5 ...This video demonstrates a unique case of a giant aneurysm of the right petrous internal carotid artery in a 20-yr-old patient. This is an extremely rare location, and most of patients are asymptomatic.3-6 Signs of compression of the seventh and eight cranial nerves can be present and even Horner syndrome and lower cranial nerves neuropathies. Nevertheless, rupture can lead to epistaxis and otorrhagia, and ultimately to hemorrhagic shock. The patient in the current report was otherwise healthy but presented with lightheadedness and dizziness for 10 d. The patient consented to the procedure. There was no history of major trauma or head and neck infection.
A transradial endovascular flow diversion embolization of a giant aneurysm of the petrous internal carotid artery is herein demonstrated in a stepwise manner. A triaxial system was used to deploy 3 overlapping devices. Concepts of J-wire technique, multiple coverage,1 and the so-called weld technique are emphasized. The role of adjunctive coiling and main reasons for failure are also discussed.7,8 Brief cases of flow diversion embolization of aneurysms of different morphologies at different locations are used to highlight the importance of assessing vessel wall apposition and follow-up imaging.
Background: Scarce reports exist of permanent deployment of Solitaire FR™ devices for arterial steno-occlusive disease as it is primarily indicated for temporary deployment for thrombectomy in ...large-vessel, anterior-circulation ischemic strokes. Even more scarce are reports describing permanent deployment of the Solitaire device for posterior circulation strokes. Summary: We present 2 cases where the Solitaire device was electrolytically detached to re-establish flow in an occluded or stenotic basilar artery in acutely symptomatic patients. In both cases, a 4 × 15 mm Solitaire device was positioned across the stenotic or occluded portion of the basilar artery and electrolytically detached to maintain vessel patency. Both cases had good clinical outcomes with a National Institutes of Health Stroke Scale (NIHSS) score of 1 (from 24) on 90-day follow-up and an NIHSS score of 2 (from 7) on 30-day follow-up. Key Messages: Permanent deployment of the Solitaire device may potentially be a safe and effective means of maintaining vessel patency in an occluded or stenotic basilar artery.
We present Jamba, a new base large language model based on a novel hybrid Transformer-Mamba mixture-of-experts (MoE) architecture. Specifically, Jamba interleaves blocks of Transformer and Mamba ...layers, enjoying the benefits of both model families. MoE is added in some of these layers to increase model capacity while keeping active parameter usage manageable. This flexible architecture allows resource- and objective-specific configurations. In the particular configuration we have implemented, we end up with a powerful model that fits in a single 80GB GPU. Built at large scale, Jamba provides high throughput and small memory footprint compared to vanilla Transformers, and at the same time state-of-the-art performance on standard language model benchmarks and long-context evaluations. Remarkably, the model presents strong results for up to 256K tokens context length. We study various architectural decisions, such as how to combine Transformer and Mamba layers, and how to mix experts, and show that some of them are crucial in large scale modeling. We also describe several interesting properties of these architectures which the training and evaluation of Jamba have revealed, and plan to release checkpoints from various ablation runs, to encourage further exploration of this novel architecture. We make the weights of our implementation of Jamba publicly available under a permissive license.
We present Jamba-1.5, new instruction-tuned large language models based on our Jamba architecture. Jamba is a hybrid Transformer-Mamba mixture of experts architecture, providing high throughput and ...low memory usage across context lengths, while retaining the same or better quality as Transformer models. We release two model sizes: Jamba-1.5-Large, with 94B active parameters, and Jamba-1.5-Mini, with 12B active parameters. Both models are fine-tuned for a variety of conversational and instruction-following capabilties, and have an effective context length of 256K tokens, the largest amongst open-weight models. To support cost-effective inference, we introduce ExpertsInt8, a novel quantization technique that allows fitting Jamba-1.5-Large on a machine with 8 80GB GPUs when processing 256K-token contexts without loss of quality. When evaluated on a battery of academic and chatbot benchmarks, Jamba-1.5 models achieve excellent results while providing high throughput and outperforming other open-weight models on long-context benchmarks. The model weights for both sizes are publicly available under the Jamba Open Model License and we release ExpertsInt8 as open source.
Summary Objectives To assess the effect of prolonging antibiotic prophylaxis in cardiac surgery. Methods Prospective before–after cohort study. In 2004, cefazolin was given pre- and intraoperatively ...at 1 g doses while in 2007 it was continued after surgery for 24 h. All consecutive adult patients undergoing coronary artery bypass graft, valve, and/or aortic operations during the study periods were included. The primary outcomes were deep sternal wound infection (DSWI) and mortality. Univariate and multivariate analyses were conducted to assess risk factors for DSWI. Results 954 patients between 1/2004 and 12/2004 were compared to 424 patients between 1/2007 and 6/2007. In 2007, there were significantly more patients >60 yrs., emergency and combined operations and the mean logistic EuroSCORE was higher compared to 2004 (8.53% vs. 6.92%, p = 0.006). The rate of DSWI decreased non-significantly from 3.8% (36/954) in 2004 to 2.6% (11/424) in 2007, p = 0.27. The adjusted odds ratio of the study period for DSWI was 0.89 (95% confidence interval 0.70–1.13). There was no difference in 30-day (5.2% vs. 5.4%) or 6-month mortality (9.2% in both periods), despite increasing patients' risk. Conclusions Increasing the duration of antibiotic prophylaxis did not result in a significant decrease in DSWI. The value of prolonging antibiotic prophylaxis after cardiac operations should be further evaluated.
The linkage between internal ribosomal symmetry and transfer RNA (tRNA) positioning confirmed positional catalysis of amino-acid polymerization. Peptide bonds are formed concurrently with tRNA-3
′end ...rotatory motion, in conjunction with the overall messenger RNA (mRNA)/tRNA translocation. Accurate substrate alignment, mandatory for the processivity of protein biosynthesis, is governed by remote interactions. Inherent flexibility of a conserved nucleotide, anchoring the rotatory motion, facilitates chirality discrimination and antibiotics synergism. Potential tRNA interactions explain the universality of the tRNA CCA-end and P-site preference of initial tRNA. The interactions of protein L2 tail with the symmetry-related region periphery explain its conservation and its contributions to nascent chain elongation.
Newborns with congenital short small bowel associated with malrotation and intestinal dysmotility have a uniformly bad prognosis. However, few long-term survivors have been reported, suggesting that ...the disorder is not invariably fatal. The majority of cases previously reported were familial. We report on six affected siblings in three related families. The aim of this report is to assess the mode of inheritance, the expression of this disorder, and to point to the correlation between the onset of gastrointestinal symptoms and the outcome.
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