Predicting early postoperative PONV using multiple machine-learning- and deep-learning-algorithms.

OBJECTIVE: PONV reduces patient satisfaction and increases hospital costs as patients remain in the hospital for longer durations. In this study, we build a preliminary artificial intelligence algorithm model to predict early PONV in patients. METHODS: We use R for statistical analysis and Python for the machine learning prediction model. RESULTS: Average characteristic engineering results showed that haloperidol, sex, age, history of smoking, and history of PONV were the first 5 contributing factors in the occurrence of early PONV. Test group results for artificial intelligence prediction of early PONV: in terms of accuracy, the four best algorithms were CNNRNN (0.872), Decision Tree (0.868), SVC (0.866) and adab (0.865); in terms of precision, the three best algorithms were CNNRNN (1.000), adab (0.400) and adab (0.868); in terms of AUC, the top three algorithms were Logistic Regression (0.732), SVC (0.731) and adab (0.722). Finally, we built a website to predict early PONV online using the Streamlit app on the following website: ( https://zhouchengmao-streamlit-app-lsvc-ad-st-app-lsvc-adab-ponv-m9ynsb.streamlit.app/ ). CONCLUSION: Artificial intelligence algorithms can predict early PONV, whereas logistic regression, SVC and adab were the top three artificial intelligence algorithms in overall performance. Haloperidol, sex, age, smoking history, and PONV history were the first 5 contributing factors associated with early PONV.

Challenging coronary sinus lead placement for CRT: A modified "Anchoring balloon" technique.

An 80-year-old man with a history of complete heart block underwent dual chamber pacemaker implantation about a year ago. He returned to the hospital due to de novo heart failure caused by pacing-induced cardiomyopathy; hence, we planned to upgrade his pacemaker to a biventricular device. The initial strategy was to perform left bundle branch area pacing-optimized cardiac resynchronization therapy (LOT-CRT) with left bundle branch area pacing (LBBAP) combined with a coronary sinus (CS) lead. In this challenging case, the successful placement of a CS lead was hindered by a complicated combination of a large CS body linked to the left superior vena cava and a winding CS branch. However, utilizing readily available tools, such as the coronary balloon and Guide Plus II ST catheter, proved instrumental in overcoming these obstacles. As a result, LOT-CRT provided the patient with a safe alternative to surgical LV lead placement.

Superior vena cava tear during transvenous lead extraction: Medical management in hemodynamically stable patients.

INTRODUCTION: Superior vena cava (SVC) tear is the most lethal complication during transvenous lead extraction (TLE) with a mortality rate as high as 50%. Treatment involves aggressive attempts to maintain cardiac output and immediate sternotomy to localize and repair the vascular tear. Occlusion balloons have been developed to provisionally occlude the lacerated SVC and to provide hemodynamic stability allowing time for surgery. In case of mediastinal hematoma without hemodynamic instability, the strategy remains unclear. METHODS AND RESULTS: We describe two cases of SVC tear during TLE. The first case was a 60-year-old man who presented with a right ventricular single-chamber defibrillator lead fracture and innominate vein stenosis. The RV lead was removed using a laser sheath causing a mediastinal hematoma with no active bleeding during surgical exploration few hours later. The second case was a 28-year-old man that presented with a right atrial (RA) lead fracture and RV lead insulation failure in a dual-chamber defibrillator (ICD). CONCLUSION: Both the RA and RV leads were removed with mechanical sheaths, and a mediastinal hematoma was medically managed.

Spectroradiometer Calibration for Radiance Transfer Measurements.

Optical remote sensing and Earth observation instruments rely on precise radiometric calibrations which are generally provided by the broadband emission from large-aperture integrating spheres. The link between the integrating sphere radiance and an SI-traceable radiance standard is made by spectroradiometer measurements. In this work, the calibration efforts of a Spectra Vista Corporation (SVC) HR-1024i spectroradiometer are presented to study how these enable radiance transfer measurements at the Calibration Home Base (CHB) for imaging spectrometers at the Remote Sensing Technology Institute (IMF) of the German Aerospace Center (DLR). The spectral and radiometric response calibrations of an SVC HR-1024i spectroradiometer are reported, as well as the measurements of non-linearity and its sensitivity to temperature changes and polarized light. This achieves radiance transfer measurements with the calibrated spectroradiometer with relative expanded uncertainties between 1% and 3% (k=2) over the wavelength range of 380 nm to 2500 nm, which are limited by the uncertainties of the applied radiance standard.

Effects of sous vide cooking combined with ultrasound pretreatment on physicochemical properties and microbial communities of Russian sturgeon meat (Acipenser gueldenstaedti).

BACKGROUND: The production of Russian sturgeon is expanding rapidly in China but it is necessary to adopt measures to extend the shelf life of sturgeon meat. Previous studies found that sous vide cooking (SVC) at 60 °C increased the protein and lipid oxidation. The addition of antioxidant substances reduced the acceptance of the product. The effect of combination SVC and ultrasound pretreatment was therefore investigated. RESULTS: Results showed that SVC at 50 °C combined with ultrasound effectively restrained the growth of total viable counts (TVC) in samples. Meanwhile, the main dominant genera changed from Pseudomonas to Carnobacterium and the number of microbial species decreased. The odor profile of Russian sturgeon meat was more stable and the lipoxygenase (LOX) activity decreased more rapidly after treating with SVC and ultrasound. Importantly, more stable protein aggregates were formed in samples treated by SVC 50 °C together with ultrasound pretreatment, so the protein and lipid oxidation were slowed during storage. Higher springiness values were obtained and the color of sturgeon meat was lighter under these conditions. CONCLUSION: The combination of SVC 50 °C and ultrasound pretreatment effectively inhibited the microbial growth of Russian sturgeon meat at lower oxidation levels. These findings theoretically support the preservation and development of sturgeon meat, and the application of SVC technology. © 2022 Society of Chemical Industry.

The History of Flow Chemistry at Eli Lilly and Company.

Flow chemistry was initially used for speed to early phase material delivery in the development laboratories, scaling up chemical transformations that we would not or could not scale up batch for safety reasons. Some early examples included a Newman Kwart Rearrangement, Claisen rearrangement, hydroformylation, and thermal imidazole cyclization. Next, flow chemistry was used to enable safe scale up of hazardous chemistries to manufacturing plants. Examples included high pressure hydrogenation, aerobic oxidation, and Grignard formation reactions. More recently, flow chemistry was used in Small Volume Continuous (SVC) processes, where highly potent oncolytic molecules were produced by fully continuous processes at about 10 kg/day including reaction, extraction, distillation, and crystallization, using disposable equipment contained in fume hoods.

Rapid calculation of static magnetic field perturbation generated by magnetized objects in arbitrary orientations.

PURPOSE: Most previous work on the calculation of susceptibility-induced static magnetic field (B0 ) inhomogeneity has considered strictly unidirectional magnetic fields. Here, we present the theory and implementation of a computational method to rapidly calculate static magnetic field vectors produced by an arbitrary distribution of voxelated magnetization vectors. THEORY AND METHODS: Two existing B0 calculation methods were systematically extended to include arbitrary orientations of the magnetization and the magnetic field; they are (1) Fourier-domain convolution with k-space-discretized (KD) dipolar field, and (2) generalized susceptibility voxel convolution (gSVC). The methods were tested on an analytical ellipsoid model and a tilted human head model, as well as against experimentally measured B0 fields induced by a stainless-steel implant located in an inhomogeneous region of a clinical 3T MRI magnet. RESULTS: Both methods were capable of correctly calculating B0 fields inside a magnetized ellipsoid in all tested orientations. The KD method generally required a larger grid and longer computation time to achieve accuracy comparable to gSVC. Measured B0 fields due to the implant showed a good match with the gSVC-calculated fields that accounted for the spatial variation of the applied magnetic field including the radial components. CONCLUSION: Our method can provide a reliable and efficient computational tool to calculate B0 perturbation by magnetized objects under a variety of circumstances, including those with inhomogeneous magnetizing fields, anisotropic susceptibility, and a rotated coordinate system.

Not Feeling Swell: Superior Vena Cava (SVC) Syndrome Falsely Attributed to COVID-19 Vaccine Reaction.

BACKGROUND: The mass immunization campaign against Coronavirus disease 2019 (COVID-19) has resulted in more patients presenting to the emergency department (ED) with concern for a vaccine reaction. CASE REPORT: A 68-year-old man presented to the ED reporting an allergic reaction to the COVID-19 vaccine. He initially noted swelling of his face, neck, and right arm after receiving the first dose of the vaccine. After his second dose of the vaccine, the swelling became more pronounced and prompted him to seek care. On examination, he had fullness of the neck and engorgement of the left external jugular vein, which were exacerbated when the patient raised his arms above his head, consistent with Pemberton's sign. Apart from the swelling of the head and neck, there were no other findings consistent with an allergic reaction. The presence of Pemberton's sign prompted a computed tomography scan of the chest with contrast, which revealed a paratracheal mass measuring 4.5 × 2.0 cm with marked narrowing of the superior vena cava (SVC). The patient was admitted to the hospital for SVC syndrome, and further workup revealed a non-small cell lung cancer. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients may misattribute their symptoms to a COVID vaccine reaction when they are, in fact, experiencing a more serious underlying disease. This case highlights the importance of a thorough physical examination and maintaining a broad differential diagnosis. In this case, the presence of Pemberton's sign raised suspicion for SVC syndrome, and prompted further workup.

Multi-Objective Real-Time Tuning of SVC Used in Electrified Traction Systems.

Electric train system is a very large load for the power network. This load consumes a large amount of reactive power. In addition, it causes a massive unbalance to the network, which results in many problems such as voltage drops, high transmission losses, reduction in the transformer output ability, negative sequence current, mal-operation of protective relays, etc. In this paper, a novel real-time optimization approach is presented to adjust the static VAR compensator (SVC) for the traction system to realize two objectives; current unbalance reduction and reactive power compensation. A multi-objective optimization technique entitled non-dominated sorting genetic algorithm (NSGA-II) is used to fulfill the regarded objectives simultaneously. A comprehensive simulator has been designed for electric train network modeling that is able to adjust the parameters of SVC in an optimum manner at any time and under any circumstances. The results illustrate that the provided method can efficiently reduce the unbalancing in current as well as supply the demanded reactive power with acceptable precision.

Potential of Snapshot-Type Hyperspectral Imagery Using Support Vector Classifier for the Classification of Tomatoes Maturity.

It is necessary to convert to automation in a tomato hydroponic greenhouse because of the aging of farmers, the reduction in agricultural workers as a proportion of the population, COVID-19, and so on. In particular, agricultural robots are attractive as one of the ways for automation conversion in a hydroponic greenhouse. However, to develop agricultural robots, crop monitoring techniques will be necessary. In this study, therefore, we aimed to develop a maturity classification model for tomatoes using both support vector classifier (SVC) and snapshot-type hyperspectral imaging (VIS: 460-600 nm (16 bands) and Red-NIR: 600-860 nm (15 bands)). The spectral data, a total of 258 tomatoes harvested in January and February 2022, was obtained from the tomatoes' surfaces. Spectral data that has a relationship with the maturity stages of tomatoes was selected by correlation analysis. In addition, the four different spectral data were prepared, such as VIS data (16 bands), Red-NIR data (15 bands), combination data of VIS and Red-NIR (31 bands), and selected spectral data (6 bands). These data were trained by SVC, respectively, and we evaluated the performance of trained classification models. As a result, the SVC based on VIS data achieved a classification accuracy of 79% and an F1-score of 88% to classify the tomato maturity into six stages (Green, Breaker, Turning, Pink, Light-red, and Red). In addition, the developed model was tested in a hydroponic greenhouse and was able to classify the maturity stages with a classification accuracy of 75% and an F1-score of 86%.

Relationship between Effective Refractory Period and Inducibility of Atrial Fibrillation from the Superior Vena Cava after Pulmonary Vein Isolation.

In terms of the pulmonary vein (PV), atrial fibrillation (AF) patients have a shorter effective refractory period (ERP) than those without AF and a large dispersion of the ERP. Although the frequency of AF from the superior vena cava (SVC) was the highest among non-PV foci, the characteristics of the ERP in the SVC (SVC-ERP) were unclear. The purpose of this study was to elucidate the relationship between SVC-ERP and the inducibility of AF after PV isolation (PVI).Consecutive 28 patients who underwent PVI were included. After successful PVI, the SVC-ERP was measured at three positions in SVC. Rapid electrical stimuli were delivered at the shortest SVC-ERP to induce AF. Patients in whom AF was induced were assigned to the SVC-induced group (SIG), and the remaining patients were the non-SVC-induced group (non-SIG). The size of the SVC sleeve was evaluated via three-dimensional electroanatomic mapping.The SIG had a significantly shorter average SVC-ERP (236.0 ± 25.2 versus 294.8 ± 36.8 ms, P < 0.001), whereas SVC-ERP dispersion was not significantly different (30.0 ± 25.4 versus 33.3 ± 20.1 ms, P = 0.56). Although the longer SVC diameter was significantly longer in the SIG (27.4 ± 4.3 versus 22.9 ± 4.6 mm, P = 0.03), the SVC-ERP was significantly associated with pacing inducibility of AF after adjustment for the longer SVC diameter (odds ratio: 0.96 [1 ms increments], P = 0.01).The SIG had a shorter SVC-ERP, whereas the dispersion was not significantly different between the two groups. The SVC-ERP can be one of the mechanisms of arrhythmogenicity for AF originating from the SVC.

A rare case of hypoplastic coronary sinus partially draining into right superior vena cava: A case report.

BACKGROUND: The hypoplastic coronary sinus (CS) is a rare anomaly of the cardiac venous system, wherein some of the tributaries fail to join the CS. These tributaries usually drain into atrial chambers through dilated thebesian channels. We report the first case where the tributaries are draining into the right superior vena cava (SVC). CASE SUMMARY: A case of ischemic cardiomyopathy with severe LV systolic dysfunction with NYHA class III symptoms was taken for CRTD implantation. CS venogram after direct cannulation from left subclavian access revealed a hypoplastic CS. The part of CS beyond the attachment of the oblique vein of the left atrium to CS (distal to the posterolateral vein) formed a common channel and was draining into the right-sided SVC. The posterolateral vein was of sufficient caliber so that an left ventricle (LV) lead could be implanted, and the CRTD procedure could be completed. DISCUSSION: Hypoplastic CS though has no pathological significance in the normal population but for CRT it can become a significant limitation. Tributaries of CS draining into right SVC are the rarest of the finding, the channel draining most likely is a remnant of the splanchnic plexus around the embryonic foregut that usually has a temporary communication with cardinal veins during intrauterine growth. This communication somehow has persisted and resulted in a channel between coronary vein and the SVC, which may be referred to as coronary veno-cardinal vein.

Superior vena cava syndrome during veno-venous extracorporeal membrane oxygenation for COVID-19.

Superior vena cava (SVC) syndrome is typically associated with malignant tumors obstructing the SVC, but as many as 40% of cases have other etiologies. SVC obstruction was previously described during veno-venous extracorporeal membrane oxygenation therapy (VV ECMO) in children. In this report, we describe a woman with adult respiratory distress syndrome resulting from infection with coronavirus-19 who developed SVC syndrome during VV ECMO. A dual-lumen ECMO cannula was inserted in the right internal jugular vein, but insufficient ECMO circuit flow, upper body edema, and signs of hypovolemic shock were observed. This clinical picture resolved when the right internal jugular vein was decannulated in favor of bilateral femoral venous cannulae. Our report demonstrates that timely recognition of clinical signs and symptoms led to the appropriate diagnosis of an uncommon ECMO complication.

Classification of Greek Olive Oils from Different Regions by Machine Learning-Aided Laser-Induced Breakdown Spectroscopy and Absorption Spectroscopy.

In the present work, the emission and the absorption spectra of numerous Greek olive oil samples and mixtures of them, obtained by two spectroscopic techniques, namely Laser-Induced Breakdown Spectroscopy (LIBS) and Absorption Spectroscopy, and aided by machine learning algorithms, were employed for the discrimination/classification of olive oils regarding their geographical origin. Both emission and absorption spectra were initially preprocessed by means of Principal Component Analysis (PCA) and were subsequently used for the construction of predictive models, employing Linear Discriminant Analysis (LDA) and Support Vector Machines (SVM). All data analysis methodologies were validated by both "k-fold" cross-validation and external validation methods. In all cases, very high classification accuracies were found, up to 100%. The present results demonstrate the advantages of machine learning implementation for improving the capabilities of these spectroscopic techniques as tools for efficient olive oil quality monitoring and control.

Percutaneous paraspinal access to the azygos vein to create a neo-vena cava.

We present the case of a child with congenital heart disease repaired in infancy with diffuse central venous occlusions resulting in central venous insufficiency, superior vena cava (SVC) syndrome, and intracranial bleeds. He presented to the catheterization laboratory for multiple transcatheter interventions to recanalize central venous channels which were unsuccessful by conventional methods. Therefore, extravascular venous channels were created to decompress his upper body by creation of a neo-SVC and his lower body with a neo-azygos vein to the neo-SVC. The latter procedure required direct percutaneous access from a paraspinal approach in order to obtain continuity with the azygos vein. At latest follow-up the patient is clinically well and asymptomatic.

Superior vena cava thrombosis and dilated cardiomyopathy as initial presentations of Behcet's disease.

BACKGROUND: Bechet's disease (BD) is a relatively rare disease that causes recurrent oral and genital ulcers in addition to a variety of systemic manifestations. Concomitant superior-vena-cava (SVC) thrombosis and cardiac involvement with dilated cardiomyopathy (DCM) as initial presentations for BD is considered rare. CASE PRESENTATION: A 32-year-old-man presenting with intractable headaches and dyspnea. He was later diagnosed with SVC thrombosis and DCM. A diagnosis of BD was made after detailed history-taking. CONCLUSIONS: Cardiovascular manifisations can be the initial presentation of BD. We aim to highlight the importance of early clinical recognition of BD as a cause of DCM and SVC thrombosis.

CT validation of SVC-RA junction location for pediatric central line placement: is vertebral bodies below the carina accurate?

PURPOSE: The key landmark for tip position of a central venous catheter (CVC) is the SVC-RA junction. In adults, localization of the SVC-RA junction may be assessed as a function of vertebral body units (VBU) below the carina during CVC placement. We investigated the relationship between the SVC-RA junction and the carina in children. MATERIALS AND METHODS: 584 CT scans of 0-18 years were analyzed. The carina was marked automatically by software while the SVC-RA junction and vertebrae were marked manually. The SVC-RA junction to carina (JC) distance was the primary study measurement reported in both VBU and mm. RESULTS: The data show an average JC distance of 1.25 VBU for 0-1 year, 1.27 VBU for 1-4 years, 1.34 VBU for 4-9 years, 1.53 VBU for 9-15 years, and 1.64 VBU for 15-18 years. A positive relationship between weight and JC distance was also demonstrated. CONCLUSION: JC distance is a useful predictor of SVC-RA junction location in children. Significant relationships were shown between JC distance and both age and weight. Due to small differences between age groups, however, average JC distance for all comers (1.48 VBU, 95% CI 0.7 - 2.3) can be used for SVC-RA junction identification in CVC placement.

Oral levosimendan in amyotrophic lateral sclerosis: a phase II multicentre, randomised, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of oral levosimendan in patients with amyotrophic lateral sclerosis (ALS). This phase II, randomised, double-blind, placebo-controlled, crossover, three-period study with 6 months open-label follow-up enrolled adults with ALS and sitting slow vital capacity (SVC) 60%-90 % of predicted from 11 sites in four countries. METHODS: Patients received levosimendan 1 mg daily, 1 mg two times a day or placebo during three 14-day crossover periods and levosimendan 1-2 mg daily during open-label follow-up. Primary endpoint was sitting SVC; secondary endpoints included supine SVC, ALS Functional Rating Scale-Revised (ALSFRS-R), tolerability and safety. RESULTS: Of 66 patients randomised, 59 contributed to the double-blind results and 50 entered open-label follow-up. Sitting SVC was not significantly different between the treatments. In post hoc analysis using period-wise baselines, supine SVC favoured levosimendan over placebo, estimated mean differences from baseline being -3.62% on placebo, +0.77% on levosimendan 1 mg daily (p=0.018) and +2.38% on 1 mg two times a day (p=0.001). Headache occurred in 16.7% of patients during levosimendan 1 mg daily (p=0.030), 28.6% during 1 mg two times a day (p=0.002) and 3.3% during placebo. The respective frequencies for increased heart rate were 5.1% (p=0.337), 18.5% (p=0.018) and 1.7%. No significant differences between the treatments were seen for other adverse events. CONCLUSIONS: Levosimendan did not achieve the primary endpoint of improving sitting SVC in ALS. Headache and increased heart rate were increased on levosimendan, although it was otherwise well tolerated. A phase III study to evaluate the longer term effects of oral levosimendan in ALS is ongoing.

Predictive models of aqueous solubility of organic compounds built on A large dataset of high integrity.

Aqueous solubility is one of the most important properties in drug discovery, as it has profound impact on various drug properties, including biological activity, pharmacokinetics (PK), toxicity, and in vivo efficacy. Both kinetic and thermodynamic solubilities are determined during different stages of drug discovery and development. Since kinetic solubility is more relevant in preclinical drug discovery research, especially during the structure optimization process, we have developed predictive models for kinetic solubility with in-house data generated from 11,780 compounds collected from over 200 NCATS intramural research projects. This represents one of the largest kinetic solubility datasets of high quality and integrity. Based on the customized atom type descriptors, the support vector classification (SVC) models were trained on 80% of the whole dataset, and exhibited high predictive performance for estimating the solubility of the remaining 20% compounds within the test set. The values of the area under the receiver operating characteristic curve (AUC-ROC) for the compounds in the test sets reached 0.93 and 0.91, when the threshold for insoluble compounds was set to 10 and 50 µg/mL respectively. The predictive models of aqueous solubility can be used to identify insoluble compounds in drug discovery pipeline, provide design ideas for improving solubility by analyzing the atom types associated with poor solubility and prioritize compound libraries to be purchased or synthesized.