Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival: A Planned Subanalysis of the ENIGMA-II Trial.

BACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk. The primary outcome was mortality within 1 postoperative year. We defined 4 separate types of postoperative adverse events. Major adverse cardiac events (MACEs) included myocardial infarction (MI), cardiac arrest, and myocardial revascularization with or without troponin elevation. MI was defined using the third Universal Definition and was blindly adjudicated. A second cohort consisted of patients with isolated troponin increases who did not meet the definition for MI. We also considered a cohort of patients who experienced major adverse postoperative events (MAPEs), including unplanned admission to intensive care, prolonged mechanical ventilation, wound infection, pulmonary embolism, and stroke. From this cohort, we identified a group without troponin elevation and another with troponin elevation that was not judged to be an MI. Multivariable Cox proportional hazard models for death at 1 year and assessments of proportionality of hazard functions were performed and expressed as an adjusted hazard ratio (aHR) and 95% confidence intervals (CIs). RESULTS: MACEs were observed in 469 patients, and another 754 patients had isolated troponin increases. MAPEs were observed in 631 patients. Compared with control patients, patients with a MACE were at increased risk of mortality (aHR, 3.36 [95% CI, 2.55-4.46]), similar to patients who suffered a MAPE without troponin elevation (n = 501) (aHR, 2.98 [95% CI, 2.26-3.92]). Patients who suffered a MAPE with troponin elevation but without MI had the highest risk of death (n = 116) (aHR, 4.29 [95% CI, 2.89-6.36]). These 4 types of adverse events similarly affected 1-year disability-free survival. CONCLUSIONS: MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability.

Distributed video coding for wireless video sensor networks: a review of the state-of-the-art architectures.

Distributed video coding (DVC) is a relatively new video coding architecture originated from two fundamental theorems namely, Slepian-Wolf and Wyner-Ziv. Recent research developments have made DVC attractive for applications in the emerging domain of wireless video sensor networks (WVSNs). This paper reviews the state-of-the-art DVC architectures with a focus on understanding their opportunities and gaps in addressing the operational requirements and application needs of WVSNs.

Location estimation in wireless sensor networks using spring-relaxation technique.

Accurate and low-cost autonomous self-localization is a critical requirement of various applications of a large-scale distributed wireless sensor network (WSN). Due to its massive deployment of sensors, explicit measurements based on specialized localization hardware such as the Global Positioning System (GPS) is not practical. In this paper, we propose a low-cost WSN localization solution. Our design uses received signal strength indicators for ranging, light weight distributed algorithms based on the spring-relaxation technique for location computation, and the cooperative approach to achieve certain location estimation accuracy with a low number of nodes with known locations. We provide analysis to show the suitability of the spring-relaxation technique for WSN localization with cooperative approach, and perform simulation experiments to illustrate its accuracy in localization.

On the performance of telemedicine system using 17-GHz orthogonally polarized microwave links under the influence of heavy rainfall.

This paper describes the design of a telemedicine system based on next-generation wireless local area networks (WLANs) operating at 17 GHz. Seventeen gigahertz is proposed for next-generation WLAN services offering numerous advantages over traditional IEEE 802.11 networks that operate in the range of 2.4-5 GHz. Orthogonal polarization is often used to increase spectrum efficiency by utilizing signal paths of horizontal and vertical polarization. Radio waves exceeding 10 GHz are particularly vulnerable to signal degradation under the influence of rain which causes an effective reduction in isolation between polarized signal paths. This paper investigates the influence of heavy rain in a tropical region on wide-band microwave signals at 17 GHz using two links provided by a fixed broad-band wireless access system for two-way data exchange between paramedics attending an accident scene and the hospital via microwave equipment installed in the ambulance. We also study the effects of cross polarization and phase rotation due to persistent heavy rainfall in tropical regions.