Wisdom Tooth Surgery Complications—Local Anaesthesia versus General Anaesthesia

Purpose: To compare the complication rates arising from surgical removal of lower third molars (L3M) under general anaesthesia (GA) versus local anaesthesia (LA) in the Oral and Maxillofacial Surgery (OMFS) Department, Hospital Sultanah Nora Ismail (HSNI), Batu Pahat, Johor, Malaysia. Materials and methods: This is a retrospective clinical audit of patients who underwent L3M removal under LA or GA from 1/1/2013 to 31/3/2018, with recorded complications such as surgical site infection (SSI), wound breakdown, severe pain, trismus, retained tooth structure, nerve injury and dry socket evaluated at different time intervals. Results: A total of 313 patients with 375 L3M were included in this study (male: 160, 51.1%;female: 153, 48.9%) with an age range of 18 to 40 years (mean = 27.43 years). 79 L3M were removed under GA (34.2% were classified as mild;65.8% were moderate), whereas 296 L3M were removed under LA, (31.4% were mild impaction, 63.9% moderate and 4.7% severe. Preoperative antibiotics were given before all L3M removal under GA, while only 23 out of 296 L3M removal under LA had antibiotics. 15.2% of L3M removal under GA and 16.6% of those done under LA were associated with complications. Generally, patient with GA had lesser complications;however only SSI outcome was significant (p = 0.034). Conclusion: L3M removal under LA may have a higher risk of SSI when compared to GA. This raises the possibility that a single prophylactic antibiotic dose may prevent SSI in LA procedures.

Thyroidectomy under Local Anaesthesia: A Viable Option in a Resource Limited Community

Background: In most centers worldwide, thyroidectomy is performed under general anaesthesia as a result of advances in anaesthetic technique, consideration for patients’ safety and surgeons’ convenience. However, in some developing countries such as Nigeria, facilities and expertise for general anaesthesia are not equitably distributed. As such, they are not available in some health centers especially in the rural communities. Hence, the need to explore other suitable alternatives such as operating under local anaesthesia. Aim: This study aims to highlight the feasibility and safety of thyroidectomy under local anaesthesia at a surgical outreach in a rural community in Nigeria. Patients and Methods: The study site was conducted at Bethany Medical Centre, Gboko, Benue State, Nigeria. It was a one-week surgical outreach. Neck infiltration with local anaesthesia was carried out using 2% xylocaine with adrenaline 1:200,000 and a standard open technique was used to carry out all thyroidectomies. Results: Out of seventy (70) patients that presented during the study period, 31 (44.3%) met the inclusion criteria and were operated within the seven (7) days period. There were 3 (10.7%) males and 28 (89.3%) females. There ages ranged between 22 to 65 years, average was 43 years. The average duration of surgery was 90 minutes, and 3 days’ hospital stay. Those followed up two weeks post-operation recuperated well with no notable complications. Conclusion: Thyroidectomy under local anaesthesia is safe and feasible in our rural communities and in selected cases can be a suitable alternative to general anaesthesia.

Adult Cleft Lip Repair under Local Anaesthesia: The Ghana Experience

Background: Unlike developed countries where adult primary cleft lip and palate cases are barely nonexistent, developing countries still have a backlog of adults with unrepaired cleft lip and palate. Method: A retrospective review of adult/adolescent cleft lip repair under local anesthesia was performed between 2012 and 2015. Results: Fifty six (56) adolescent and adults were seen comprising 35 females and 21 males. Forty two patients presented with unrepaired unilateral cleft lip of which only 6 were complete;4 were unrepaired bilateral cleft lip and 10 were revisions. The lowest age was 13 years (two patients) and the highest age was 66 years (one patient). The mean weight was 54 kg. The mean anaesthetic time including waiting time was 12.94 minutes and mean operation time was 56.52 minutes. Majority of the patients were discharged same day except for five who needed to stay overnight because of distance from their home. There were no reported early postoperative complications and wound healing was uneventful for all the patients. Conclusion: Cleft lip repair in adults under local anesthesia is safe, effective and less expensive. A modification in technique with minimal dissection and efficiency is essential in such cases.

CLINICAL OBSERVATION ON AURICULAR ACUPUNCTURE COMBINED WITH LOCAL ANAESTHESIA IN CERVICAL LAMINOPLASTY FOR CERVICAL SPONDYLISIS

Auricular acupuncture combined with local anaesthesia in cervical larninoplasty was studied. The aim of the study was to observe the analgesic action of this anaesthesia and the effects on respiratory and circulatory function. 70 patients were included in the study. There were 55 male and 15 female patients, aged between 39 and 67 years old. The unilateral otopoints including Shenmen, cervical vertebrae, sympathetic, subcortex, external lung and kidney points were used. The sterilized filiform needle of 1 - 1. 5 cm were inserted into each otopoint and connected to 57 - 6 electrcrpulse stimulator being stimulated with continuous wave. Local infiltration anaesthesia was also used with 1 - 2 g/L Lignocaine. The results showed that all the patients were conscious, quiet and co-operative with doctors.The respiration, blood pressure and heart rate were all stable. Analgesie action was rather definite. All the patients recovered quickly after operation. We consider that this anaesthesia is a very simple and effective method for cervical laminoplasty.

Day Case Haemorrhoidectomy under Local Anaesthesia and Conscious Sedation

Background: Excisional haemorrhoidectomy engenders considerable pain and has popularly been managed as an in-patient procedure. There has been anxiety over a major complication occurring in the community instead of in the hospital which is still pervasive in the developing world despite evidence to the contrary. Aim: It compared the post operative complications, time to bowel action, and post-operative pain scores in patients who had open haemorrhoidectomy either under spinal anaesthesia as in-patient or under local anaesthesia as day case procedure. Materials and Methods: The study involved two populations of patients who underwent open haemorrhoidectomy either under spinal anesthesia or under local anaesthesia with conscious sedation at the Korle Bu Teaching Hospital between 2008 and 2013. Results: It involved 275 patients made up of 145 and 130 in the spinal and local aneasthesia groups respectively. Their mean age was 43.1, SD ± 13.2 and median 41 years. Complications occurred in 44 patients (16%), 24 and 20 in the spinal and local aneasthesia groups respectively, with bleeding being the most frequent [11/44, (25%)] and significant. More wound bleeding occurred in the spinal than the local anaesthesia group, 7 vs. 2 patients. Except one day only (p = 0.0001) the mean pain scores on days 2, 3, 5 and 7 were statistically significantly lower in the spinal group than in the local group. The median time to bowel motion was 4 days in both groups. Conclusion: The post operative outcomes in the two populations were similar except the more frequent bleeding noted in the spinal anaesthesia group. Day case haemorrhoidectomy is safe in centres where day case surgery is routinely performed.

Surgical Management of Fracture Neck of Femur in a Medically Unfit ASA3/4 Patient Selection Using Direct Infiltration Local Anaesthesia

Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia;that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty);twenty-three procedures were completed (82.14%);no patient required conversion to another form of anaesthesia either general or spinal;five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.

Navigating the pathways:TAR-DNA-binding-protein-43 aggregation,axonal transport,and local synthesis in amyotrophic lateral sclerosis pathology

Neurons are highly polarized cells with axons reaching over a meter long in adult humans.To survive and maintain their proper function,neurons depend on specific mechanisms that regulate spatiotemporal signaling and metabolic events,which need to be carried out at the right place,time,and intensity.Such mechanisms include axonal transport,local synthesis,and liquid-liquid phase separations.Alterations and malfunctions in these processes are correlated to neurodegenerative diseases such as amyotrophic lateral sclerosis(ALS).

Anaesthesia in chronic dialysis patients:A narrative review

The provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This narrative review summarizes the important principles of sedation and anaesthesia for individuals on long-term dialysis,with reference to the best available evidence.Topics covered include the pharmacology of anaesthetic agents,the impacts of patient characteristics upon the pre-anaesthetic assessment and critical illness,and the fundamentals of dialysis access procedures.

Assessment of earthquake location uncertainties for the design of local seismic networks

The ability to estimate earthquake source locations,along with the appraisal of relevant uncertainties,is paramount in monitoring both natural and human-induced micro-seismicity.For this purpose,a monitoring network must be designed to minimize the location errors introduced by geometrically unbalanced networks.In this study,we first review different sources of errors relevant to the localization of seismic events,how they propagate through localization algorithms,and their impact on outcomes.We then propose a quantitative method,based on a Monte Carlo approach,to estimate the uncertainty in earthquake locations that is suited to the design,optimization,and assessment of the performance of a local seismic monitoring network.To illustrate the performance of the proposed approach,we analyzed the distribution of the localization uncertainties and their related dispersion for a highly dense grid of theoretical hypocenters in both the horizontal and vertical directions using an actual monitoring network layout.The results expand,quantitatively,the qualitative indications derived from purely geometrical parameters(azimuthal gap(AG))and classical detectability maps.The proposed method enables the systematic design,optimization,and evaluation of local seismic monitoring networks,enhancing monitoring accuracy in areas proximal to hydrocarbon production,geothermal fields,underground natural gas storage,and other subsurface activities.This approach aids in the accurate estimation of earthquake source locations and their associated uncertainties,which are crucial for assessing and mitigating seismic risks,thereby enabling the implementation of proactive measures to minimize potential hazards.From an operational perspective,reliably estimating location accuracy is crucial for evaluating the position of seismogenic sources and assessing possible links between well activities and the onset of seismicity.

Analyzing the Impact of Scene Transitions on Indoor Camera Localization through Scene Change Detection in Real-Time

Real-time indoor camera localization is a significant problem in indoor robot navigation and surveillance systems.The scene can change during the image sequence and plays a vital role in the localization performance of robotic applications in terms of accuracy and speed.This research proposed a real-time indoor camera localization system based on a recurrent neural network that detects scene change during the image sequence.An annotated image dataset trains the proposed system and predicts the camera pose in real-time.The system mainly improved the localization performance of indoor cameras by more accurately predicting the camera pose.It also recognizes the scene changes during the sequence and evaluates the effects of these changes.This system achieved high accuracy and real-time performance.The scene change detection process was performed using visual rhythm and the proposed recurrent deep architecture,which performed camera pose prediction and scene change impact evaluation.Overall,this study proposed a novel real-time localization system for indoor cameras that detects scene changes and shows how they affect localization performance.

SNR and RSSI Based an Optimized Machine Learning Based Indoor Localization Approach:Multistory Round Building Scenario over LoRa Network

In situations when the precise position of a machine is unknown,localization becomes crucial.This research focuses on improving the position prediction accuracy over long-range(LoRa)network using an optimized machine learning-based technique.In order to increase the prediction accuracy of the reference point position on the data collected using the fingerprinting method over LoRa technology,this study proposed an optimized machine learning(ML)based algorithm.Received signal strength indicator(RSSI)data from the sensors at different positions was first gathered via an experiment through the LoRa network in a multistory round layout building.The noise factor is also taken into account,and the signal-to-noise ratio(SNR)value is recorded for every RSSI measurement.This study concludes the examination of reference point accuracy with the modified KNN method(MKNN).MKNN was created to more precisely anticipate the position of the reference point.The findings showed that MKNN outperformed other algorithms in terms of accuracy and complexity.

Survey of Indoor Localization Based on Deep Learning

This study comprehensively examines the current state of deep learning (DL) usage in indoor positioning.It emphasizes the significance and efficiency of convolutional neural networks (CNNs) and recurrent neuralnetworks (RNNs). Unlike prior studies focused on single sensor modalities like Wi-Fi or Bluetooth, this researchexplores the integration of multiple sensor modalities (e.g.,Wi-Fi, Bluetooth, Ultra-Wideband, ZigBee) to expandindoor localization methods, particularly in obstructed environments. It addresses the challenge of precise objectlocalization, introducing a novel hybrid DL approach using received signal information (RSI), Received SignalStrength (RSS), and Channel State Information (CSI) data to enhance accuracy and stability. Moreover, thestudy introduces a device-free indoor localization algorithm, offering a significant advancement with potentialobject or individual tracking applications. It recognizes the increasing importance of indoor positioning forlocation-based services. It anticipates future developments while acknowledging challenges such as multipathinterference, noise, data standardization, and scarcity of labeled data. This research contributes significantly toindoor localization technology, offering adaptability, device independence, and multifaceted DL-based solutionsfor real-world challenges and future advancements. Thus, the proposed work addresses challenges in objectlocalization precision and introduces a novel hybrid deep learning approach, contributing to advancing locationcentricservices.While deep learning-based indoor localization techniques have improved accuracy, challenges likedata noise, standardization, and availability of training data persist. However, ongoing developments are expectedto enhance indoor positioning systems to meet real-world demands.

Improved PSO-Extreme Learning Machine Algorithm for Indoor Localization

Wi Fi and fingerprinting localization method have been a hot topic in indoor positioning because of their universality and location-related features.The basic assumption of fingerprinting localization is that the received signal strength indication(RSSI)distance is accord with the location distance.Therefore,how to efficiently match the current RSSI of the user with the RSSI in the fingerprint database is the key to achieve high-accuracy localization.In this paper,a particle swarm optimization-extreme learning machine(PSO-ELM)algorithm is proposed on the basis of the original fingerprinting localization.Firstly,we collect the RSSI of the experimental area to construct the fingerprint database,and the ELM algorithm is applied to the online stages to determine the corresponding relation between the location of the terminal and the RSSI it receives.Secondly,PSO algorithm is used to improve the bias and weight of ELM neural network,and the global optimal results are obtained.Finally,extensive simulation results are presented.It is shown that the proposed algorithm can effectively reduce mean error of localization and improve positioning accuracy when compared with K-Nearest Neighbor(KNN),Kmeans and Back-propagation(BP)algorithms.

RSSI-Based 3D Wireless Sensor Node Localization Using Hybrid T Cell Immune and Lotus Optimization

Wireless Sensor Network(WSNs)consists of a group of nodes that analyze the information from surrounding regions.The sensor nodes are responsible for accumulating and exchanging information.Generally,node local-ization is the process of identifying the target node’s location.In this research work,a Received Signal Strength Indicator(RSSI)-based optimal node localization approach is proposed to solve the complexities in the conventional node localization models.Initially,the RSSI value is identified using the Deep Neural Network(DNN).The RSSI is conceded as the range-based method and it does not require special hardware for the node localization process,also it consumes a very minimal amount of cost for localizing the nodes in 3D WSN.The position of the anchor nodes is fixed for detecting the location of the target.Further,the optimal position of the target node is identified using Hybrid T cell Immune with Lotus Effect Optimization algorithm(HTCI-LEO).During the node localization process,the average localization error is minimized,which is the objective of the optimal node localization.In the regular and irregular surfaces,this hybrid algorithm effectively performs the localization process.The suggested hybrid algorithm converges very fast in the three-dimensional(3D)environment.The accuracy of the proposed node localization process is 94.25%.

Local dimming原理及在车载中的应用

Local dimming(局部调光)是一种低成本提升车载显示器对比度和清晰度的技术。在目前OLED技术尚无法突破严苛的汽车环境要求的状况下,局部调光是一种首选的成本和性能兼顾的技术。在满足汽车环境要求的同时,大幅提升了显示器的清晰度,提高了显示内容的辨识度,同时成本的上升也在合理范围内。它能给客户带来更好的体验,使驾驶更为安全。本文对它的工作原理以及如何应用进行了阐述,给读者提供了一种思路和方法来提升车载显示器的对比度。

关于Locale范畴反射子范畴的注解

利用Locale中的完全正则元和零维元构造性地给出了任意Locale的完全正则反射以及零维反射的描述,并且对于满足‘(?)’关系插入性的Locale,特别地,对正规Locale,证明了全体正则元构成的Locale是其正则反射.进而,利用平稳(flat)子Locale的扩张引理给出了Locale的紧完全正则反射,紧零维反射以及紧正则反射的构造性描述.

弱空间式Locale

空间式locale范畴SLoc是locale范畴Loc的余反射满子范畴,但对locale乘积不封闭．本文引入弱空间式locale,证明弱空间式locale范畴WSloc为范畴Loc的余反射满子范畴,且对locale秉积封闭．还证明了一个locale A是空间式的当且仅当它的枝映射localeN(A)是弱空间式的;一个空问式locale的每一个子locale都是空间式的当且仅当它的每一个子locale是弱空间式的．最后,证明了弱空间式性在定向函子下保持不变．

A study of the effect of local scour on the flow field near the spur dike

The flow field near a spur dike such as down flow and horseshoe vortex system(HVS)are susceptible to the topographic changes in the local scouring process,resulting in variation of the sediment transport with time.In this study,large eddy simulations with fixed-bed at different scouring stages were conducted to investigate the changes in flow field.The results imply that the bed deformation leads to an increase in flow rate per unit area,which represent the capability of sediment transportation by water,in the scour hole.Moreover,the intensity of turbulent kinetic energy and bimodal motion near the sand bed induced by the HVS were also varied.However,the peak moments between the two sediment transport mechanisms were different.Hence,understanding the complex feedback mechanism between topography and flow field is essential for the local scour problem.

Genome-wide investigation to assess copy number variants in the Italian local chicken population

Background Copy number variants(CNV)hold significant functional and evolutionary importance.Numerous ongoing CNV studies aim to elucidate the etiology of human diseases and gain insights into the population structure of livestock.High-density chips have enabled the detection of CNV with increased resolution,leading to the identification of even small CNV.This study aimed to identify CNV in local Italian chicken breeds and investigate their distribution across the genome.Results Copy number variants were mainly distributed across the first six chromosomes and primarily associated with loss type CNV.The majority of CNV in the investigated breeds were of types 0 and 1,and the minimum length of CNV was significantly larger than that reported in previous studies.Interestingly,a high proportion of the length of chromosome 16 was covered by copy number variation regions(CNVR),with the major histocompatibility complex being the likely cause.Among the genes identified within CNVR,only those present in at least five animals across breeds(n=95)were discussed to reduce the focus on redundant CNV.Some of these genes have been associated to functional traits in chickens.Notably,several CNVR on different chromosomes harbor genes related to muscle development,tissue-specific biological processes,heat stress resistance,and immune response.Quantitative trait loci(QTL)were also analyzed to investigate potential overlapping with the identified CNVR:54 out of the 95 gene-containing regions overlapped with 428 QTL associated to body weight and size,carcass characteristics,egg production,egg components,fat deposition,and feed intake.Conclusions The genomic phenomena reported in this study that can cause changes in the distribution of CNV within the genome over time and the comparison of these differences in CNVR of the local chicken breeds could help in preserving these genetic resources.

Present situation and prospect of immunotherapy for unresectable locally advanced esophageal cancer during peri-radiotherapy

Four major studies(Checkmate577,Keynote-590,Checkmate649 and Attraction-4)of locally advanced esophageal cancer published in 2020 have established the importance of immunotherapy,represented by anti-programmed death protein(PD)-1 in postoperative adjuvant treatment and advanced first-line treatment of locally advanced or advanced esophageal cancer and esophagogastric junction cancer,from the aspects of proof of concept,long-term survival,overall survival rate and progression-free survival.For unresectable or inoperable nonmetastatic esophageal cancer,concurrent radiotherapy and chemotherapy is the standard treatment recommended by various guidelines.Because its curative effect is still not ideal,it is necessary to explore radical radiotherapy and chemotherapy in the future,and it is considered to be promising to combine them with immunotherapeutic drugs such as anti-PD-1.This paper mainly discusses how to combine radical concurrent radiotherapy and chemotherapy with immunotherapy for unresectable local advanced esophageal cancer.