Carotid angioplasty and stenting (CAS) was developed to be a less invasive and complex procedure compared to carotid endarterectomy (CEA). It has emerged as an alternative for patients who are considered to have high ...Carotid angioplasty and stenting (CAS) was developed to be a less invasive and complex procedure compared to carotid endarterectomy (CEA). It has emerged as an alternative for patients who are considered to have high surgical risks due to medical comorbidities or anatomical high-risk features [1]. The procedure is usually done under local anesthesia with light sedation, with the subsequent expectation of less neurologic injury, venous thromboembolisms, and myocardial infarctions—all well-known clinical risks of undergoing surgical procedures under general anesthesia. CAS, however, carries some increased risks of arterial dissection, dislocation of atherothrombotic debris and embolization to the brain or eye, late embolization due to thrombus formation on the damaged plaque, and bradycardia and hypotension as a result of carotid sinus stimulation. Electroencephalography can detect cerebral ischemia and hypoxia along with measuring hypnotic effects, but has not been reported to be used during CAS to signal impending neurological deficit and allow for intervention to prevent stroke. We report on the use of patient state index (PSI), an electroencephalographic (EEG) derived variable used by SEDLine monitor (Masimo Inc., San Diego, CA) to monitor changes in cerebral blood flow during carotid angioplasty and stenting in an awake patient under local anesthesia. PSI was developed to measure the level of hypnosis and sedation during anesthesia and in the ICU. The PSI is based on quantitative electroencephalogram features, recorded from anterior and posterior scalp sites, as input to a multivariate algorithm that quantifies the most probable level of anesthesia or sedation. The PSI is reported as a range from 0 to 100, with decreasing values indicating increasing levels of anesthesia or sedation. Adequate depth of anesthesia is reflected by PSI value of 25 - 50, and a fully awake state by a PSI of 100 [2]. Other EEG analysis techniques have been explored to detect changes in cerebral blood flow during carotid surgery [3], such as entropy described by Khan and Ozcan in his recent work entitled Disagreement in Bilateral State Entropy Values in Carotid Artery Disease [4], but there are no previous reports of the use of PSI during procedural sedation in carotid angioplasty and stenting in an awake patient.展开更多
Shape irregularity,a sub-factor of parcel fragmentation is a problem that hinders sustainable agriculture and is solved using land consolidation projects.Determination of the parcel shape degree contributes significan...Shape irregularity,a sub-factor of parcel fragmentation is a problem that hinders sustainable agriculture and is solved using land consolidation projects.Determination of the parcel shape degree contributes significantly to spatial prioritization where there is also a high probability of achieving positive effects of consolidation projects.This study aims to determine the shape degree of the agricultural parcels both at singular and rural county scales in Tekirdag Province,Turkey in 2020 by combining the parcel shape index(PSI) with the minimum bounding geometry index(MBG) to improve parcel scores.Hot-spot zones of the highly irregular and near optimum parcels were also determined using Getis-Ord G_(i)^(*) statistic.The parcel degrees were classified into four categories,namely highly irregular,irregular,regular and near optimum.The obtained unweighted scores of the parameters exhibit deviations from the expected values.After weighting by pairwise comparison,the values approached ideal scores.Among 346 740 parcels,53% were highly irregular and irregular and 47% were regular and near optimum shapes after weighting whereas these were 70% and 30%,respectively before weighting.The average parcel degree of 63 rural counties was regular while the average parcel degree of the remaining 264 rural counties was irregular.The combined use of PSI and MBG index improved the correctness of the parcel shape score.It could be suggested to use as a tool in land consolidation prioritization.展开更多
文摘Carotid angioplasty and stenting (CAS) was developed to be a less invasive and complex procedure compared to carotid endarterectomy (CEA). It has emerged as an alternative for patients who are considered to have high surgical risks due to medical comorbidities or anatomical high-risk features [1]. The procedure is usually done under local anesthesia with light sedation, with the subsequent expectation of less neurologic injury, venous thromboembolisms, and myocardial infarctions—all well-known clinical risks of undergoing surgical procedures under general anesthesia. CAS, however, carries some increased risks of arterial dissection, dislocation of atherothrombotic debris and embolization to the brain or eye, late embolization due to thrombus formation on the damaged plaque, and bradycardia and hypotension as a result of carotid sinus stimulation. Electroencephalography can detect cerebral ischemia and hypoxia along with measuring hypnotic effects, but has not been reported to be used during CAS to signal impending neurological deficit and allow for intervention to prevent stroke. We report on the use of patient state index (PSI), an electroencephalographic (EEG) derived variable used by SEDLine monitor (Masimo Inc., San Diego, CA) to monitor changes in cerebral blood flow during carotid angioplasty and stenting in an awake patient under local anesthesia. PSI was developed to measure the level of hypnosis and sedation during anesthesia and in the ICU. The PSI is based on quantitative electroencephalogram features, recorded from anterior and posterior scalp sites, as input to a multivariate algorithm that quantifies the most probable level of anesthesia or sedation. The PSI is reported as a range from 0 to 100, with decreasing values indicating increasing levels of anesthesia or sedation. Adequate depth of anesthesia is reflected by PSI value of 25 - 50, and a fully awake state by a PSI of 100 [2]. Other EEG analysis techniques have been explored to detect changes in cerebral blood flow during carotid surgery [3], such as entropy described by Khan and Ozcan in his recent work entitled Disagreement in Bilateral State Entropy Values in Carotid Artery Disease [4], but there are no previous reports of the use of PSI during procedural sedation in carotid angioplasty and stenting in an awake patient.
文摘Shape irregularity,a sub-factor of parcel fragmentation is a problem that hinders sustainable agriculture and is solved using land consolidation projects.Determination of the parcel shape degree contributes significantly to spatial prioritization where there is also a high probability of achieving positive effects of consolidation projects.This study aims to determine the shape degree of the agricultural parcels both at singular and rural county scales in Tekirdag Province,Turkey in 2020 by combining the parcel shape index(PSI) with the minimum bounding geometry index(MBG) to improve parcel scores.Hot-spot zones of the highly irregular and near optimum parcels were also determined using Getis-Ord G_(i)^(*) statistic.The parcel degrees were classified into four categories,namely highly irregular,irregular,regular and near optimum.The obtained unweighted scores of the parameters exhibit deviations from the expected values.After weighting by pairwise comparison,the values approached ideal scores.Among 346 740 parcels,53% were highly irregular and irregular and 47% were regular and near optimum shapes after weighting whereas these were 70% and 30%,respectively before weighting.The average parcel degree of 63 rural counties was regular while the average parcel degree of the remaining 264 rural counties was irregular.The combined use of PSI and MBG index improved the correctness of the parcel shape score.It could be suggested to use as a tool in land consolidation prioritization.
