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Background: Technical skill is essential for good outcomes in cardiac surgery. However, no objective methods exist to measure dexterity while performing surgery. The purpose of this study was to validate sensor-based hand motion analysis (HMA) of technical dexterity while performing a graft anastomosis within a validated simulator., Methods: Surgeons at various training levels performed an anastomosis while wearing flexible sensors (BioStamp nPoint, MC10 Inc) with integrated accelerometers and gyroscopes on each hand to quantify HMA kinematics. Groups were stratified as experts (n = 8) or novices (n = 18). The quality of the completed anastomosis was scored using the 10 Point Microsurgical Anastomosis Rating Scale (MARS10). HMA parameters were compared between groups and correlated with quality. Logistic regression was used to develop a predictive model from HMA parameters to distinguish experts from novices., Results: Experts were faster (11 ± 6 minutes vs 21 ± 9 minutes; P = .012) and used fewer movements in both dominant (340 ± 166 moves vs 699 ± 284 moves; P = .003) and nondominant (359 ± 188 moves vs 567 ± 201 moves; P = .02) hands compared with novices. Experts' anastomoses were of higher quality compared with novices (9.0 ± 1.2 MARS10 vs 4.9 ± 3.2 MARS10; P = .002). Higher anastomosis quality correlated with 9 of 10 HMA parameters, including fewer and shorter movements of both hands (dominant, r = -0.65, r = -0.46; nondominant, r = -0.58, r = -0.39, respectively)., Conclusions: Sensor-based HMA can distinguish technical dexterity differences between experts and novices, and correlates with quality. Objective quantification of hand dexterity may be a valuable adjunct to training and education in cardiac surgery training programs., (Copyright © 2024 The Society of Thoracic Surgeons. All rights reserved.)

Background: Frailty represents a state of multisystem impairment that may adversely impact people presenting with chronic limb-threatening ischemia (CLTI) and diabetes-related foot ulcers (DFUs). The aim of this systematic review was to explore the association between frailty and outcomes from CLTI and DFUs., Methods: We performed a systematic literature search of electronic databases to find studies using a validated measure of frailty in individuals with CLTI and/or DFUs. The primary outcomes were the impact of frailty on the severity of initial clinical presentation and unfavorable follow-up outcomes including readmissions, major limb amputation, cardiovascular events, revascularization, and wound healing., Results: Ten cohort studies were included. Two studies had a low risk of bias, 1 was unable to be assessed, 5 had moderate risk of bias, and 2 high risk of bias. The prevalence of frailty in people presenting with CLTI ranged from 27% to 88% and was 71% in people with DFUs. The presence of frailty in both people with CLTI and DFUs was associated with substantially increased severity at presentation (severity of ischemia and tissue loss) and poorer outcomes at follow-up (risk of readmission, limb amputation, and all-cause mortality)., Conclusions: The presence of frailty in both people with CLTI and DFUs is likely associated with substantially higher complexity at presentation followed by a greater risk for readmission, amputation, and death during follow-up. Heterogeneity in the tools used to screen for frailty, poor definition of frailty, and unclear evaluation of exposure and outcomes limit further interpretation of findings., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Predictive PI (PPI) controllers have demonstrated to exceed traditional PID controllers when they are applied to systems with long delays. This work proposes a new controller structure and tuning that we call Generalized Predictive PI (GPPI) controller which provides greater design flexibility than PI and PPI strategies. To realize a fair comparison, the design and tuning rules for discrete PI and PPI controllers were developed using optimal arguments based on the root-locus, for critically damped response before a step change in the reference. Experimental results, using industrial equipment, have illustrated the tuning methodology and the performance of the proposed controller under real conditions. Flow and water level process in a laboratory flume were considered. For these processes, First Order Plus Time Delay (FOPTD) models are used. The GPPI control results are encouraging, reducing the settling time plus a very small overshoot before step change in the reference regarding the PI and PPI strategies, up to 41.03% for the flow control loop and up to 54.21% for the level control loop. The discrete analysis of the strategies in the Z plane was performed, allowing for a direct translation to recursive equations that can then be programmed into a Programmable Logic Controller (PLC), other industrial controllers such as Distributed Control Systems (DSC), or microcontrollers, such as Arduino, Raspberry or FPGA. This is an important result, since it demonstrates that the increased complexity of the proposed controller does not hamper its implementation in industrial controller systems. In this work, we used a Rockwell ControlLogix \protect \relax \special {t4ht=®}  PLC with Structured Text programming language., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 ISA. Published by Elsevier Ltd. All rights reserved.)

This study aimed to perform a molecular survey and identification of hemotropic Mycoplasma spp. in domestic South American Camelids from Southern Chile. Conventional PCR (cPCR) for hemotropic Mycoplasma spp. based on 16S rRNA gene (620bp fragment) was performed in 87 EDTA-blood samples taken from 48 llamas (Lama glama) and 39 and alpacas (Vicugna pacos) from to Temuco, La Araucanía region and Valdivia, Los Rios region, Southern Chile. 16S rRNA hemotropic Mycoplasma PCR-positive were sequenced for species identification, phylogenetic and haplotype analyses, and further tested by cPCR targeting a fragment (160-210 bp) of the RNaseP (rnpB) gene. Based upon 16S rRNA cPCR results, the overall hemotropic Mycoplasma spp. occurrence in Southern camelids was 9.2% (8/87 [95% CI (4.0-17.3%)]), with five positive alpacas (12.8%; 5/39 [95% CI (4.3-27.4%)]) and three llamas (6.3%; 3/48 [95% CI (1.7-17.2%)]). All 16S rRNA PCR-positive samples were negative for the rnpB gene. Obtained 16S sequences presented high identity (99-100%) by BLASTn analysis to 'Candidatus Mycoplasma haemolamae' from an alpaca in the United Kingdom. Phylogenetic and haplotype analyses of the 16s rRNA gene showed high similarity among 'Candidatus M. haemolamae' sequences of this study and the ones from North America, Europe, and Asia evidencing a low diversity of Chilean samples, with only one haplotype detected (#1). Haplotype #1 from South American Camelids in Chile was worldwide distributed and observed in North America, Europe, and Asia. 'Candidatus M. haemolamae' detected for the first time in South American camelids in Southern Chile had low diversity and was worldwide spread., (Copyright © 2021. Published by Elsevier B.V.)

Background: The aim of this study was to describe the applicability of the Society for Vascular Surgery (SVS) objective performance goals (OPGs) as a tool to evaluate results in the context of endovascular management of noncomplex and complex patients (i.e., end stage renal disease/history of prosthetic conduit) with chronic limb-threatening ischemia (CLTI)., Methods: Patients diagnosed with CLTI undergoing endovascular procedures from March 2016 to April 2017 were included, and medical records were examined. Patients were categorized as OPG risk (OPGR) and non-OPG risk (nOPGR) groups in accordance with the SVS performance criteria. We compared clinical events between the two groups and then further to the SVS OPGs. Thirty-day outcomes (safety) were major amputation (AMP), major adverse limb events (MALEs), and major adverse cardiovascular events (MACEs), and 1-year outcomes (efficacy) were limb salvage, MALE + 30-day perioperative death (MALE + POD), and survival. Mortality was demonstrated using Kaplan-Meier analysis., Results: A total of 72 patients were included (OPGR = 58.3% vs. nOPGR = 41.7%). Mean follow-up was 20 months (range, 1-40 months). Retrograde pedal access was used in 65.2% of patients. The overall AMP rate was 2.7% (OPGR = 4.7%, nOPGR = 0%, P = 0.225, vs. SVS OPG<3%), MALE was 4.1% (OPGR = 7.1%, nOPGR = 0%, P = 0.135, vs. SVS OPG<8%), and MACE was 6.9% (OPGR = 2.3%, nOPGR = 13.3%, P = 0.071, vs. SVS OPG<8%). The limb salvage was 90.3% (OPGR = 88%, nOPGR = 93.3%, P = 0.46, vs. SVS OPG>84%), MALE + POD was 76.4% (OPGR = 78.6%, nOPGR = 73.4%, P = 0.606, vs. SVS OPG>71%), and survival was 77.7% (OPGR = 83.3%, nOPGR = 70%, P = 0.18, vs. SVS OPG>80%)., Conclusions: The SVS OPGs set appropriate safety and efficacy standards as a bar for new technologies. In this series, endovascular therapy in all-comers exceeded the safety and efficacy endpoints proposed by the limited risk OPG panel., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The explicit consideration of a communication channel model in a feedback control loop is known to be constrained by a fundamental limitation for stabilizability on the channel signal-to-noise ratio (SNR) when the linear time invariant (LTI) plant model is unstable. The LTI modelling approach for real, usually nonlinear, processes compromises accuracy versus complexity of the resulting model. This in turn introduces a gap between the proposed model and the real process, which is known as the model uncertainty. In this paper we then study SNR limitations by considering the continuous-time scenario and the case of an additive coloured Gaussian noise (ACGN) channel with bandwidth limitation, for which we then quantify the infimal SNR subject to the simultaneous presence of plant, channel and noise model uncertainties. We observe, for the special case of memoryless additive white Gaussian noise (AWGN) channels, that the obtained SNR limitation subject to plant model uncertainty can be redefined as a channel capacity limitation for stabilization., (Copyright © 2019 ISA. Published by Elsevier Ltd. All rights reserved.)

Although gemcitabine is an effective chemotherapeutic for pancreatic cancer, severe side effects often accompany its use. Since we have discovered that locally administered C1B domain peptides effectively control tumor growth without any side effects, the efficacy of co-treatment with this peptide and a low dose of gemcitabine on the growth of pancreatic cancer was examined. Two- and three-dimensional cell culture studies clarified that a co-treatment with C1B5 peptide and gemcitabine significantly attenuated growth of PAN02 mouse and PANC-1 human pancreatic cancer cells in 2D and 3D cultures. Although treatment with the low dose of gemcitabine alone (76%) or the C1B5 peptide alone (39%) inhibited tumor growth moderately, a co-treatment with C1B5 peptide and a low dose of gemcitabine markedly inhibited the growth of PAN02 autografts in the mouse peritoneal cavity (94% inhibition) without any noticeable adverse effect. The number of peritoneal cavity-infiltrating neutrophils and granzyme B + lymphocytes was significantly higher in the co-treatment group than in the control group. A significant increase of granzyme B mRNA expression was also detected in human T cells by the co-treatment. Taken together, the current study suggests that C1B5 peptide offers a remarkably effective combination treatment strategy to reduce side effects associated with gemcitabine, without losing its tumoricidal effect., (Copyright © 2017 Elsevier Inc. All rights reserved.)

In this paper we apply independent component analysis (ICA) followed by second order blind identification (SOBI) to an atrial fibrillation (AF) 12-lead electrocardiogram (ECG) recording in order to extract the source that represents atrial activity (AA) (ICA-SOBI method). Still, there is no assurance that only one source obtained from this method will contain AA, and thus we aim to select the most representative source of AA. The novelty in this paper is the proposal of three parameters to select the most representative source of AA. These parameters are correlation coefficient with lead V1 (CV1), peak factor (PF) and spectral concentration (SC). The first two parameters are introduced as new indicators, addressing features overlooked by the SC even when they are present in AA during AF. For synthesized data, at least two of the three parameters select the same representation of AA in 93.3% of the cases. For real data (218 ECG recordings), we observe that PF presents, in 89.5% of the cases, values between 2 and 4.5 for the selected sources, ensuring a well-defined range of values for AA. The actual values of CV1 and SC were scattered throughout their possible ranges (0-1 for CV1 and 0.08-0.7 for SC), and the correlation coefficient between these variables was found to be ρ=0.58. We compared our results with three known algorithms: QRST cancellation, principal components analysis (PCA) and ICA-SOBI. The results obtained from this comparison show that our proposed methods to select the best representation of AA in general outperform the three above-mentioned algorithms., (© 2013 Elsevier Ltd. All rights reserved.)

Cryopreservation of oocytes by vitrification is a promising new technique for assisted human reproduction. Any new technical development must be accompanied with data concerning obstetric and perinatal outcome. This study analysed the obstetric and perinatal outcomes in 165 pregnancies and 200 infants conceived following oocyte vitrification cycles in three assisted reproduction centres. The results indicate that the mean birth weight and the incidence of congenital anomalies are comparable to that of spontaneous conceptions in fertile women or infertile women undergoing in-vitro fertilization treatment. These preliminary findings may provide reassuring evidence that pregnancies and infants conceived following oocyte vitrification are not associated with increased risk of adverse obstetric and perinatal outcomes.