Positive- and Negative-Pressure Ventilation Characterized by Local and Global Pulmonary Mechanics.

Rationale: There is continued debate regarding the equivalency of positive-pressure ventilation (PPV) and negative-pressure ventilation (NPV). Resolving this question is important because of the different practical ramifications of the two paradigms. Objectives: We sought to investigate the parallel between PPV and NPV and determine whether or not these two paradigms cause identical ventilation profiles by analyzing the local strain mechanics when the global tidal volume (Vt) and inflation pressure was matched. Methods: A custom-designed electromechanical apparatus was used to impose equal global loads and displacements on the same ex vivo healthy porcine lung using PPV and NPV. High-speed high-resolution cameras recorded local lung surface deformations and strains in real time, and differences between PPV and NPV global energetics, viscoelasticity, as well as local tissue distortion were assessed. Measurements and Main Results: During initial inflation, NPV exhibited significantly more bulk pressure-volume compliance than PPV, suggestive of earlier lung recruitment. NPV settings also showed reduced relaxation, hysteresis, and energy loss compared with PPV. Local strain trends were also decreased in NPV, with reduced tissue distortion trends compared with PPV, as revealed through analysis of tissue anisotropy. Conclusions: Apparently, contradictory previous studies are not mutually exclusive. Equivalent changes in transpulmonary pressures in PPV and NPV lead to the same changes in lung volume and pressures, yet local tissue strains differ between PPV and NPV. Although limited to healthy specimens and ex vivo experiments in the absence of a chest cavity, these results may explain previous reports of better oxygenation and less lung injury in NPV.

An International Delphi Consensus on Diagnostic Criteria for Buerger's Disease.

BACKGROUND: Buerger's disease (BD) remains a debilitating condition. Despite multiple published diagnostic criteria for BD, none is universally accepted as a gold standard. METHODS: We conducted a 2-round modified Delphi consensus study to establish a consensus on the diagnostic. The questionnaire included statements from several commonly used diagnostic criteria for BD. Qualitative and quantitative analysis methods were performed. An agreement level of 70% was applied. RESULTS: Twenty nine experts from 18 countries participated in this study. Overall, 75 statements were circulated in Round 1. Of these, 28% of statements were accepted. Following comments, 21 statements were recirculated in Round 2 and 90% were accepted. Although more than 90% of the experts did not agree that the diagnosis of BD can be based only on clinical manifestation, none of the nonclinical manifestations of BD were agreed as a part of the diagnostic criteria. There was an agreement that a history of tobacco consumption in any form, not necessarily confined to the current use, should be a part of the diagnostic criteria of BD. The history of thrombophlebitis migrans, even if not present at presentation, was accepted as a clue for BD diagnosis. It was also agreed that discoloration of the toes or fingers could be included in the diagnostic criteria of BD. Experts agreed that histology results could differentiate BD from atherosclerosis obliterans and other types of vasculitis. The presence of corkscrew collaterals on imaging and burning pain reached the agreement at the first round but not at the second. There was no consensus regarding age cut-off, the requirement of normal lipid profile, and normal blood glucose for BD diagnosis. CONCLUSIONS: The present study demonstrated discrepancies in the various published diagnostic criteria for BD and their selective utilization in routine clinical practice worldwide. We propose that all published diagnostic criteria for BD be re-evaluated for harmonization and universal use.

Artificial Intelligence, Machine Learning and Smart Technologies for Nondestructive Evaluation.

Nondestructive evaluation (NDE) techniques are used in many industries to evaluate the properties of components and inspect for flaws and anomalies in structures without altering the part's integrity or causing damage to the component being tested. This includes monitoring materials' condition (Material State Awareness (MSA)) and health of structures (Structural Health Monitoring (SHM)). NDE techniques are highly valuable tools to help prevent potential losses and hazards arising from the failure of a component while saving time and cost by not compromising its future usage. On the other hand, Artificial Intelligence (AI) and Machine Learning (ML) techniques are useful tools which can help automating data collection and analyses, providing new insights, and potentially improving detection performance in a quick and low effort manner with great cost savings. This paper presents a survey on state of the art AI-ML techniques for NDE and the application of related smart technologies including Machine Vision (MV) and Digital Twins in NDE.

Sharp Guarantees and Optimal Performance for Inference in Binary and Gaussian-Mixture Models.

We study convex empirical risk minimization for high-dimensional inference in binary linear classification under both discriminative binary linear models, as well as generative Gaussian-mixture models. Our first result sharply predicts the statistical performance of such estimators in the proportional asymptotic regime under isotropic Gaussian features. Importantly, the predictions hold for a wide class of convex loss functions, which we exploit to prove bounds on the best achievable performance. Notably, we show that the proposed bounds are tight for popular binary models (such as signed and logistic) and for the Gaussian-mixture model by constructing appropriate loss functions that achieve it. Our numerical simulations suggest that the theory is accurate even for relatively small problem dimensions and that it enjoys a certain universality property.

Cholesteryl Ester Transfer Protein Inhibitors and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Cholesteryl ester transfer protein (CETP) inhibitors increase serum high-density lipoprotein cholesterol (HDL-c) concentration; however, their impact on cardiovascular outcomes is not clear. This systematic review examines the effect of CETP inhibitors on serum lipid profiles, cardiovascular events, and all-cause mortality. METHODS: We searched MEDLINE, Embase, and the Cochrane Library of Clinical Trials for placebo-controlled randomized controlled trials (RCTs) that examined the effect of a CETP inhibitor (dalcetrapib, anacetrapib, evacetrapib, or TA-8995) on all-cause mortality, major adverse cardiovascular events (MACE), or the components of MACE at ≥6 months. Data were pooled using random-effects models. RESULTS: A total of 11 RCTs (n = 62,431) were included in our systematic review; 4 examined dalcetrapib (n = 16,612), 6 anacetrapib (n = 33,682), and 1 evacetrapib (n = 12,092). Compared to dalcetrapib, ana-cetrapib and evacetrapib were more efficacious at raising HDL-c levels (∼100-130 vs. ∼30%). Anacetrapib and evacetrapib also decreased low-density lipoprotein cholesterol (LDL-c) by approximately 30% while dalcetrapib did not affect the LDL-c level. Overall, CETP inhibitors were not associated with the incidence of MACE (pooled relative risk [RR]: 0.97; 95% confidence interval [CI]: 0.91-1.04). CETP inhibitors may decrease the risks of nonfatal myocardial infarction (MI) (RR: 0.93; 95% CI: 0.87-1.00) and cardiovascular death (RR: 0.92; 95% CI: 0.83-1.01), though these trends did not reach statistical significance. CONCLUSIONS: CETP inhibitors are not associated with an increased risk of MACE or all-cause mortality. There is a trend towards small reductions in nonfatal MI and cardiovascular death, though the clinical im-portance of such reductions is likely modest.

Quartic dissipative solitons in optical Kerr cavities.

Solitons, ubiquitous in nonlinear sciences, are wavepackets which maintain their characteristic shape upon propagation. In optics, they have been observed and extensively studied in optical fibers. The spontaneous generation of a dissipative Kerr soliton (DKS) train in an optical microresonator pumped with continuous wave (CW) coherent light has placed solitons at the heart of optical frequency comb research in recent years. The commonly observed soliton has a "sech"-shaped envelope resulting from resonator cubic nonlinearity balanced by its quadratic anomalous group velocity dispersion (GVD). Here we exploit the Lagrangian variational method to show that CW pumping of a Kerr resonator featuring quartic GVD forms a pure quartic soliton (PQS) with Gaussian envelope. We find analytical expressions for pulse parameters in terms of experimentally relevant quantities and derive an area theorem. Analytical predictions are validated with extensive numerical simulations and apply also to fiber-based and spatial Kerr resonators. Broader bandwidth with flatter spectral envelope of a PQS, compared to a DKS of the same pulse width and peak power, make it superior for applications requiring small frequency comb line-to-line power variation.

Unexpected inflammation in the sympathetic ganglia in thromboangiitis obliterans: more likely sterile or infectious induced inflammation?

INTRODUCTION: The aim of this study was to determine if the inflammation of the sympathetic ganglia (SG) in thromboangiitis obliterans (TAO) is induced by an infectious pathogen inside or if it is a reactive sterile inflammation. METHODS: For the purpose of this study, the gene expression of high-mobility group box 1 (HMGB1), toll-like receptor 4 (TLR4), toll-like receptor 9 (TLR9), and the receptor for advanced glycation end-products (RAGE) were evaluated on the complementary DNA (cDNA) of the SG tissues of 24 TAO patients and two controls with hyperhidrosis by real-time polymerase chain reaction (PCR) and analysed by the Pfaffl method. RESULTS: The gene expression of HMGB1 and TLR9 increased by about 25- and 2-fold changes in the SG of the TAO patients, respectively. However, there was no change in the gene expression of TLR4 or RAGE. CONCLUSION: It appears that the inflammation in the SG of TAO patients is more likely a sterile inflammation, and its trigger may be mitochondrial DNA (mtDNA). Cadmium in cigarettes could be responsible for the induction of mtDNA release to the cell cytoplasm. In addition, the high expression of HMGB1 may play a role in the pathogenesis of TAO and may be responsible for both clinical manifestation of the disease and the imaging findings. Moreover, HMGB1 may be a target for treatment protocols for TAO. Further studies are highly recommended.

Extending chip-based Kerr-comb to visible spectrum by dispersive wave engineering.

Anomalous group velocity dispersion is a key parameter for generating bright solitons, and thus wideband Kerr frequency combs. Extension of the frequency combs spectrum to visible wavelengths has been a major challenge because of the strong normal dispersion of conventional photonic materials at these wavelengths. In this paper, we numerically demonstrate a wideband frequency comb extending from near-infrared to visible wavelengths (∼1200 nm to 650 nm). The proposed frequency comb micro-resonator takes advantage of a wideband blue-shifted anomalous dispersion, achieved in an optimized over-etched silicon nitride waveguide and strong power transfer to shorter wavelengths through radiative dispersive waves, achieved by modulating the dispersion in a coupled resonator architecture. We show the possibility of obtaining a close to visible dispersive Cherenkov radiation peak that is only 10 dB below the overall comb peak and can be tuned by adjusting the coupling structure in the coupled resonator architecture.

Design and preliminary evaluation of the FINGER rehabilitation robot: controlling challenge and quantifying finger individuation during musical computer game play.

BACKGROUND: This paper describes the design and preliminary testing of FINGER (Finger Individuating Grasp Exercise Robot), a device for assisting in finger rehabilitation after neurologic injury. We developed FINGER to assist stroke patients in moving their fingers individually in a naturalistic curling motion while playing a game similar to Guitar Hero. The goal was to make FINGER capable of assisting with motions where precise timing is important. METHODS: FINGER consists of a pair of stacked single degree-of-freedom 8-bar mechanisms, one for the index and one for the middle finger. Each 8-bar mechanism was designed to control the angle and position of the proximal phalanx and the position of the middle phalanx. Target positions for the mechanism optimization were determined from trajectory data collected from 7 healthy subjects using color-based motion capture. The resulting robotic device was built to accommodate multiple finger sizes and finger-to-finger widths. For initial evaluation, we asked individuals with a stroke (n = 16) and without impairment (n = 4) to play a game similar to Guitar Hero while connected to FINGER. RESULTS: Precision design, low friction bearings, and separate high speed linear actuators allowed FINGER to individually actuate the fingers with a high bandwidth of control (-3 dB at approximately 8 Hz). During the tests, we were able to modulate the subject's success rate at the game by automatically adjusting the controller gains of FINGER. We also used FINGER to measure subjects' effort and finger individuation while playing the game. CONCLUSIONS: Test results demonstrate the ability of FINGER to motivate subjects with an engaging game environment that challenges individuated control of the fingers, automatically control assistance levels, and quantify finger individuation after stroke.

Correlation between human clusterin in seminal plasma with sperm protamine deficiency and DNA fragmentation.

Seminal proteins can be considered as factors that control fertilization. Clusterin is one such protein that has been implicated in many activities, including apoptosis inhibition, cell cycle control, DNA repair, and sperm maturation. In this study, the relationship between human secretory clusterin (sCLU) in seminal plasma with sperm parameters, protamine deficiency, and DNA fragmentation was investigated. Semen samples were collected from 63 Iranian men, and semen analysis was performed according to World Health Organization criteria and computer aided semen analysis (CASA). The concentration of sCLU in seminal plasma was measured by enzyme-linked immunosorbant assay (ELISA), protamine deficiency was determined by chromomycin A3 staining (CMA3 ), and sperm DNA fragmentation was checked by sperm chromatin dispersion (SCD) assay. The level of sCLU in seminal fluid of fertile patients was 48.3 ± 38.6 ng/ml and in infertile patients was 15.5 ± 9.7 ng/ml; this difference was significant (P < 0.001). sCLU correlated negatively with protamine deficiency, sperm DNA fragmentation, and abnormal morphology. In conclusion, seminal clusterin can be considered as a marker for the quick assessment of semen quality in male infertility studies.

Impact of Using Standard and High-Resolution Exposure Modalities of Cone-Beam Computed Tomography (CBCT) System for Dental Implants Dimension Measurements.

Background: This study aimed to analyze the effects of standard and high-resolution exposures on the diagnostic accuracy of CBCT in the evaluation of dental implant dimensions. Materials and Methods: A descriptive-analytical study was carried out on 40 dry human mandibles with appropriate ridge quality based on panoramic radiography. CBCT (Soredex, Cranex 3D, Finland) with a large field of view (FOV) and CMOS flat panel detector were used. CBCT with standard and a high resolution was performed in each mandible. Axial images, reconstructed by OnDemand 3D software, were processed to prepare cross-sectional images from the areas marked by gutta-percha, and then measured by a ruler with an accuracy of 0.01 millimeter in the computer. Measurements were recorded by two observers and the obtained data were compared with the real ones. Results: The results showed suitable repeatability in radiologic measurements (r = 0.971), which is indicative of the high reliability of intraobserver measurement. The measurement of width with high-resolution exposure indicated a significant difference with the real condition (P < 0.001); however, this difference was not significant in the case of standard resolution (P > 0.05). Measurement of height with high resolution showed a significant difference with the real condition in the right mandible (P = 0.04) and left mandible (P = 0.05); however, this difference was not significant in standard resolution (P > 0.05). Conclusion: Based on our findings, the standard CBCT resolution modality is suggested for dental implant images due to its higher accuracy than high-resolution methods for diagnosing the implant dimensions.

Asymptotic Behavior of Adversarial Training in Binary Linear Classification.

Adversarial training using empirical risk minimization (ERM) is the state-of-the-art method for defense against adversarial attacks, that is, against small additive adversarial perturbations applied to test data leading to misclassification. Despite being successful in practice, understanding the generalization properties of adversarial training in classification remains widely open. In this article, we take the first step in this direction by precisely characterizing the robustness of adversarial training in binary linear classification. Specifically, we consider the high-dimensional regime where the model dimension grows with the size of the training set at a constant ratio. Our results provide exact asymptotics for both standard and adversarial test errors under general lq -norm bounded perturbations ( q ≥ 1 ) in both discriminative binary models and generative Gaussian-mixture models with correlated features. We use our sharp error formulae to explain how the adversarial and standard errors depend upon the over-parameterization ratio, the data model, and the attack budget. Finally, by comparing with the robust Bayes estimator, our sharp asymptotics allow us to study the fundamental limits of adversarial training.

Evaluation of Using Panoramic Radiography and Ultrasonography for Diagnosing Carotid Artery Calcifications.

Background: The aim of this study was to determine the reliability of panoramic radiograph (PR) as a screening tool for the detection of calcified carotid atheroma (CCA) in comparison with Doppler ultrasonography (DU) examination. Materials and Methods: In this study, DU was performed for 52 patients who had carotid calcification or other differential diagnoses of carotid calcification on PR routine screening. The data relating to the presence or absence of calcified atheroma in DU and PR were evaluated using SPSS software. Results: In the 52 stated patients, CCA of 9 (18%) patients was diagnosed in the PR. Significant differences in CCA between the two sexes were not found. Also, considerable differences between the left and right sides (P = 0/906) were not found. Moreover, the positive cases who are diagnosed using ultrasonography and PR were 2.25% and 6.5%, respectively. Conclusion: PR method is not a good choice for the primary diagnosis method for the carotid artery calcifications due to its less positive diagnosing ratio compared to DU.

Recent Studies of Membranes for Liquids Separation and Water Treatment.

Rapid urbanization and industrialization in the past decades have resulted in vast amounts of wastewater containing pollutants such as inorganic chemicals, pathogens, pharmaceuticals, plant nutrients, petrochemical products, and microplastics [...].

Diffusion-Weighted MRI Monitoring of Embolic Brain Stroke for COVID-19 Patients.

Background: Coronavirus disease (COVID-19) pandemic around the world has some adverse effects on the human body, and there is limited data about the impacts of this pandemic disease on embolic brain stroke. Materials and Methods: Fifty-two COVID-19 patients with embolic brain stroke were included in this study. The COVID-19 patients were diagnosed according to their clinical findings. The patients underwent diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) values of different points of their brain were calculated using MRIcro software. Results: The embolic strokes were mostly diagnosed in the medial temporal lobe for both COVID-19 and others. In addition, a combination of COVID-19 with other inflammations and infections was not diagnosed in the studied patients. The mean ADC values of the central region were significantly lower than other regions of the brain stroke for the COVID-19 and other patients. Moreover, the maximum and minimum ADC values of the central region for COVID-19 and other patients were significantly different compared to the other regions. Whereas, the mean and minimum ADC values of the brain's normal regions were not significantly different in the edge regions for both groups, while in the COVID-19 and other patients the maximum ADC value of the edge regions was considerably lower compared to the normal regions. Conclusion: The embolic stroke of COVID-19 patients is likely to occur in the medial temporal lobe of the brain. Moreover, the ADC and relative ADC (rADC) values of embolic brain stroke in COVID-19 patients are not significantly different compared to others.

Effect of Shields in Radiation Dose and Secondary Biological Risk of Gonads in Lumbosacral Digital and Computerized Radiography.

Background: The purpose of this study was to evaluate the effect of shields in imposed radiation dose to gonads in anterior-posterior (AP) and lateral views of lumbosacral radiography using digital radiography (DR) and computerized radiography (CR) methods. Materials and Methods: Sixty patients who were suspected to AP and lateral view of lumbosacral radiography were included in this study. The patients were exposed with and without shields which have 0.25 mm thickness. This study also compared the imposed dose to gonads for one and two plates of shields with none shields situation. Measurement of the radiation dose was performed using thermo luminescence dosimeters on the surface of the gonads. Furthermore, the absolute and excess relative risk (ERR) of biological abnormalities was estimated in the above-mentioned method using the BEIR VII model. Results: The mean dose of the DR method (10.14 ± 0.27) for the AP view was significantly lower than CR (32.43 ± 0.17) with and without shields. In addition, the imposed dose to gonads in the lateral view of DR (6.41 ± 0.47) was lower compared to CR (9.38 ± 0.14). Furthermore, the mean imposed dose to gonads for one and two pate shields of DR was lower than CR. Moreover, the excess relative risk to gonads in the AP for DR was lower compared to CR in all mentioned situations. Conclusion: Lumbosacral radiography is suggested to be performed by DR systems, due to the lower imposed dose and ERR to the gonads. Moreover, using shields may lead to decrease of scatter rays and also ERR of the gonads.

Diagnostic criteria for Buerger's disease: International Consensus of VAS - European Independent Foundation in Angiology/Vascular Medicine.

Buerger's disease (BD) remains a debilitating condition and early diagnosis is paramount for its effective management. Despite many published diagnostic criteria for BD, selective criteria have been utilized in different vascular centers to manage patients with BD worldwide. A recent international Delphi Consensus Study on the diagnostic criteria of BD showed that none of these published diagnostic criteria have been universally accepted as a gold standard. Apart from the presence of smoking, these published diagnostic criteria have distinct differences between them, rendering the direct comparison of patient outcomes difficult. Hence, the expert committees from the Working Group of the VAS-European Independent Foundation in Angiology/Vascular Medicine critically reviewed the findings from the Delphi study and provided practical recommendations on the diagnostic criteria for BD, facilitating its universal use. We recommend that the 'definitive' diagnosis of BD must require the presence of three features (history of smoking, typical angiographic features and typical histopathological features) and the use of a combination of major and minor criteria for the 'suspected' diagnosis of BD. The major criterion is the history of active tobacco smoking. The five minor criteria are disease onset at age less than 45 years, ischemic involvement of the lower limbs, ischemic involvement of one or both of the upper limbs, thrombophlebitis migrans and red-blue shade of purple discoloration on edematous toes or fingers. We recommend that a 'suspected' diagnosis of BD is confirmed in the presence of a major criterion plus four or more minor criteria. In the absence of the major criterion or in cases of fewer than four minor criteria, imaging and laboratory data could facilitate the diagnosis. Validation studies on the use of these major and minor criteria are underway.

All-optical dissipative discrete time crystals.

Time crystals are periodic states exhibiting spontaneous symmetry breaking in either time-independent or periodically-driven quantum many-body systems. Spontaneous modification of discrete time-translation symmetry in periodically-forced physical systems can create a discrete time crystal (DTC) constituting a state of matter possessing properties like temporal rigid long-range order and coherence, which are inherently desirable for quantum computing and information processing. Despite their appeal, experimental demonstrations of DTCs are scarce and significant aspects of their behavior remain unexplored. Here, we report the experimental observation and theoretical investigation of DTCs in a Kerr-nonlinear optical microcavity. Empowered by the self-injection locking of two independent lasers with arbitrarily large frequency separation simultaneously to two same-family cavity modes and a dissipative Kerr soliton, this versatile platform enables realizing long-awaited phenomena such as defect-carrying DTCs and phase transitions. Combined with monolithic microfabrication, this room-temperature system paves the way for chip-scale time crystals supporting real-world applications outside sophisticated laboratories.

Secondary Infertility: A Neglected Aspect of Buerger's Disease.

Background: During the gathering of demographic data for the biobank on Buerger's Disease (BD), we found that, after the clinical manifestation of BD, the patients usually became infertile, and the age of their last child was compatible with the time of disease diagnosis. The aim of this study was to evaluate the underlying cause of secondary infertility in BD patients. Methods: Anti-sperm antibodies (ASA), testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in the sera of 39 male BD patients were measured and compared with 39 age-matched Caucasian male controls. Results: Six patients declared that they suffered from impotency. The ASA level was positive in 25.6% of the patients and 2.4% of the controls (p= 0.003, CC= 6.96). The mean levels of testosterone in the patients and controls were 393.12±32.9 ng/dl and 354.37±30.9 ng/dl, respectively. The mean levels of LH in the patients and controls were 0.88±0.12 mIU/r and 0.85±0.1 mIU/r, respectively. The mean levels of FSH in the patients and controls were 4.1± 0.35 mIU/r and 3.56±0.33 mIU/r, respectively. No significant difference in the serum levels of testosterone, LH, or FSH was found between the patients and controls (p> 0.05). The spermograms of three ASA-negative patients demonstrated impaired sperm motility. Discussion: Anti-sperm antibodies, disturbed genital circulation, autonomic dysfunction and sperm motility may be responsible for secondary infertility in Buerger's Disease.

On Smart Geometric Non-Destructive Evaluation: Inspection Methods, Overview, and Challenges.

Inspection methods, also known as non-destructive evaluation (NDE), is a process for inspecting materials, products, and facilities to identify flaws, imperfections, and malfunctions without destruction or changing the integrity of materials, structures, and mechanisms. However, detecting those defects requires test conducting and results inferring, which is highly demanding in terms of analysis, performance, and time. New technologies are therefore needed to increase the efficiency, probability of detection, and interpretability of NDE methods to establish smart inspection. In this context, Artificial intelligence (AI), as a fundamental component of the Industry 4.0, is a well-suited tool to address downsides associated with the current NDE methods for analysis and interpretation of inspection results, where methods integrating AI into their inspection process become automated and are known as smart inspection methods. This article sheds a light on the conventional methods and the smart techniques used in defects detection. Subsequently, a comparison between the two notions is presented. Furthermore, it investigates opportunities for the integration of non-destructive evaluation (NDE) methods and Industry 4.0 technologies. In addition, the challenges hindering the progress of the domain are mentioned as the potential solutions. To this end, along with Industry 4.0 technologies, a virtual inspection system has been proposed to deploy smart inspection.