Glaucoma Assessment from Fundus Images with Fundus to OCT Feature Space Mapping

Early detection and treatment of glaucoma is of interest as it is a chronic eye disease leading to an irreversible loss of vision. Existing automated systems rely largely on fundus images for assessment of glaucoma due to their fast acquisition and cost-effectiveness. Optical Coherence Tomographic ( OCT ) images provide vital and unambiguous information about nerve fiber loss and optic cup morphology, which are essential for disease assessment. However, the high cost of OCT is a deterrent for deployment in screening at large scale. In this article, we present a novel CAD solution wherein both OCT and fundus modality images are leveraged to learn a model that can perform a mapping of fundus to OCT feature space. We show how this model can be subsequently used to detect glaucoma given an image from only one modality (fundus). The proposed model has been validated extensively on four public andtwo private datasets. It attained an AUC/Sensitivity value of 0.9429/0.9044 on a diverse set of 568 images, which is superior to the figures obtained by a model that is trained only on fundus features. Cross-validation was also done on nearly 1,600 images drawn from a private (OD-centric) and a public (macula-centric) dataset and the proposed model was found to outperform the state-of-the-art method by 8% (public) to 18% (private). Thus, we conclude that fundus to OCT feature space mapping is an attractive option for glaucoma detection.

Improved Thermoeconomic Energy Efficiency Analysis for Integrated Energy Systems

The structure of an integrated energy system is complex. Thermoeconomics can play a significant role in the analysis of IES because it makes up for the deficiency of traditional thermodynamic analysis and provides new information on the cost and energy conversion efficiency. When using thermoeconomics to analyze the energy efficiency of an IES, one key issue that needs to be solved is how to transfer irreversible loss across thermal cycles, so that the mechanism of system performance degradation can be fully revealed. To this end, an irreversible cost and exergy cost integrated analysis method based on improved thermoeconomics is proposed, in which the cumulative and transmission impact of irreversible loss across thermal cycles is evaluated using linear transformation of <KP> matrix. A case study on a 389MW combined cooling, heating, and power IES demonstrates the effectiveness of the proposed approach. The proposed approach can reveal the key links impairing the overall energy efficiency and transfer of irreversible loss across thermal cycles. The approach can be extended to various types of IES to provide directions for the assessment and optimization of the system.

From Eastern European Rooted Immigrant Circle to the Mainstream of American Culture – an Alfred Kazin’s Transition

Tracing the process of immigrants’ transition, it appears that in the twentieth century children of Eastern European, mainly Jewish immigrants were trying to get rid of the European past of their parents as quickly as possible in order to take the full advantage of American culture. This attitude brought serious changes in family values, social ties, and religious traditions among immigrants’ children, which was vividly presented in Kazin’s works. Moving straight toward their American future often meant leaving the Old World heritage and language behind. Many of the immigrant children regarded this type of attitude as another logical step in their development. But although this incorporation into the mainstream of the American culture was fruitful, some of them experienced a deep sense of irreversible loss over their past.

Determination of Death: Ethical and Biomedical Update with International Consensus

Humanity has been confronted with the concept and criteria of death for millennia and the line between life and death sustains to be debated. The profound change caused by life support technology and transplantation continues to challenge our notions of life and death. Despite scientific progress in the previous few decades, there remain big variations in diagnosis criteria applied in each country. Death is a process involving cessation of physiological function and determination of death is the final event in that process. Legally, a patient could be declared dead due to lack of brain function, and still may have a heartbeat when on a mechanical ventilator. Though there is no point in supporting ventilation in a dead person, withdrawing a ventilator before the legal criteria for death may involve the physician in both civil and criminal proceedings. To identify the moment of death is vital to avoid the use of unnecessary medical intervention on a patient who has already died and to ensure the organ donation process, clear and transparent. The age-old standard of determination of death is somatic standard and cardiopulmonary standard. Harvard report (1968) defines irreversible coma as a replacement criterion for death and prescribed clinical criteria for the permanently nonfunctioning brain. The current unifying concept of death: irreversible loss of the capacity for consciousness combined with irreversible loss of the capacity to breathe. WHO (2014) adopted minimum determinant death criteria, acceptable for medical practice globally, achieving international consensus on clinical criteria to maintain public trust and promote ethical practices that respect fundamental rights of individuals and minimize philosophical and biomedical debate in human death. AAN (2019) endorses that the brain death is the irreversible loss of all functions of the entire brain and equivalent to circulatory death.

The intractable problems with brain death and possible solutions

Brain death has been accepted worldwide medically and legally as the biological state of death of the organism. Nevertheless, the literature has described persistent problems with this acceptance ever since brain death was described. Many of these problems are not widely known or properly understood by much of the medical community. Here we aim to clarify these issues, based on the two intractable problems in the brain death debates. First, the metaphysical problem: there is no reason that withstands critical scrutiny to believe that BD is the state of biological death of the human organism. Second, the epistemic problem: there is no way currently to diagnose the state of BD, the irreversible loss of all brain functions, using clinical tests and ancillary tests, given potential confounders to testing. We discuss these problems and their main objections and conclude that these problems are intractable in that there has been no acceptable solution offered other than bare assertions of an ‘operational definition’ of death. We present possible ways to move forward that accept both the metaphysical problem - that BD is not biological death of the human organism - and the epistemic problem - that as currently diagnosed, BD is a devastating neurological state where recovery of sentience is very unlikely, but not a confirmed state of irreversible loss of all [critical] brain functions. We argue that the best solution is to abandon the dead donor rule, thus allowing vital organ donation from patients currently diagnosed as BD, assuming appropriate changes are made to the consent process and to laws about killing.

Feasibility of intraoperative motor evoked potential monitoring during tethered cord surgery in infants younger than 12 months

Purpose Feasibility, reliability, and safety assessment of transcranial motor evoked potentials (MEPs) in infants less than 12 months of age. Methods A total of 22 patients with a mean age of 33 (range 13–49) weeks that underwent neurosurgery for tethered cord were investigated. Data from intraoperative MEPs, anesthesia protocols, and clinical records were reviewed. Anesthesia during surgery was maintained by total intravenous anesthesia (TIVA). Results MEPs were present in all patients for the upper extremities and in 21 out of 22 infants for the lower extremities. Mean baseline stimulation intensity was 101 ± 20 mA. If MEPs were present at the end of surgery, no new motor deficit occurred. In the only case of MEP loss, preoperative paresis was present, and high baseline intensity thresholds were needed. MEP monitoring did not lead to any complications. TIVA was maintained with an average propofol infusion rate of 123.5 ± 38.2 µg/kg/min and 0.46 ± 0.17 µg/kg/min for remifentanil. Conclusion In spinal cord release surgery, the use of intraoperative MEP monitoring is indicated regardless of the patient’s age. We could demonstrate the feasibility and safety of MEP monitoring in infants if an adequate anesthetic regimen is applied. More data is needed to verify whether an irreversible loss of robust MEPs leads to motor deficits in this young age group.

Retinopathy of Prematurity. Review

Retinopathy of prematurity (RP) is a complex pathology among prematurely born children, which requires a comprehensive approach, including both prevention of the development of more severe stages of the disease, leading to poor vision and irreversible loss of visual functions, and the organization of dispensary observation and rehabilitation. Modern organization of dispensary observation, which is based on a detailed study of the etiology, pathogenesis, as well as the interaction of local and systemic factors on visual functions, can significantly reduce the visual disability of children as a result of this disease.

Correlation of manganese in hairs with some biochemical parameters in blood serum of pigs

Currently, along with an in-depth study of the gene pool and the phenotype pool of farm animals of different breeds and species in the zones of their breeding, special attention is paid to the production of environmentally friendly and safe products of the agro-industrial complex for the end consumer. Therefore, water, feed, soil, animal organs and tissues are carefully monitored for the content of chemical elements. Manganese, like magnesium and other divalent ions, is a non-specific activator of enzymes: hydrolases, kinases, decarboxylases, etc. The absolute need for Mn is confirmed by the metalloenzymes pyruvate carboxylase of the liver mitochondria and muscle oxaloacetate carboxylase. The first contains four manganese atoms and four biotin molecules and catalyzes the carboxylation of pyruvic acid to oxaloacetic acid. The removal of Mn leads to the irreversible loss of enzyme activity, which is not restored with the subsequent introduction of the endogenous metal. The purpose of the research was to establish the correlations of the accumulation of manganese in the hairs with some biochemical parameters in the blood of pigs of Kemerovskaya breed. During the work the correlations of manganese in the hairs with some biochemical parameters of blood serum of pigs have been studied. When comparing the obtained data with the studies of other scientists, all the correlations were described except for the content of manganese in the hairs with serum chlorides (r=–0,43), since this correlation was not confirmed by the data of the scientific literature. A positive correlation has been established between the level of Mn with cholesterol and Mg at the level of 0,542 and 0,417, respectively. The change in the magnitude and direction of the correlation between the concentration of Mn in the hairs and the biochemical composition of the blood can be caused by some animal diseases.

Study of the Alkaloid Polyneuridine as a Drug Candidate for Therapy of Alzheimer's Disease

Alzheimer's disease is characterized by the progressive and irreversible loss of natural cognitive functions in most elderly people. There is currently no cure for this neurodegenerative disorder, but there are therapies available on the market based on substances that inhibit acetylcholinesterase and cognitive symptoms as a way to improve cholinergic hypofunction. Polyneuridine is the main indole alkaloid extracted from the bark and leaves of Aspidosperma polyneuron, a brazilian plant species popularly known as peroba-rosa. The objective of this work is to investigate, through a scientific prospection, the polyneuridine alkaloid, as well as its anticholinesterase property, since it is known that the therapy of this disease is based on cholinesterase inhibitors. To carry out the study, two of the main publication databases of journals such as PubMed and Web of Science were analyzed. To search for scientific production, we inserted the following keywords combined with the terms in english to carry out the search in international databases: “Polyneuridine”, “Polyneuridine AND anticholinesterase properties”, “Polyneuridine AND Alzheimer's disease”. The need for studies on this alkaloid is urgent, especially since Brazil holds the plant species that produces the most polyneuridine, but the plant species Aspidosperma polyneuron is on the red line of extinction due to the unbridled exploitation of its wood. It is concluded that if this exploration scenario continues, Brazil will lose a very important pharmacological genetic resource of its plant flora.