Explore the vast range of titles available.

Background Hepatic cyst disease is often asymptomatic, but treatment is warranted if patients experience symptoms. We describe our management approach to these patients and review the technical nuances of the laparoscopic approach. Methods Medical records were reviewed for operative management of hepatic cysts from 2012 to 2019 at a single, tertiary academic medical center. Results Fifty-three patients (39 female) met the inclusion criteria with median age at presentation of 65 years. Fifty cases (94.3%) were performed laparoscopically. Fourteen patients carried diagnosis of polycystic liver disease. Dominant cyst diameter was median 129 mm and located within the right lobe (30), left lobe (17), caudate (2), or was bilobar (4). Pre-operative concern for biliary cystadenoma/cystadenocarcinoma existed for 7 patients. Operative techniques included fenestration (40), fenestration with decapitation (7), decapitation alone (3), and excision (2). Partial hepatectomy was performed in conjunction with fenestration/decapitation for 15 cases: right sided (7), left sided (7), and central (1). One formal left hepatectomy was performed in a polycystic liver disease patient. Final pathology yielded simple cyst (52) and one biliary cystadenoma. Post-operative complications included bile leak (2), perihepatic fluid collection (1), pleural effusion (1), and ascites (1). At median 7.1-month follow-up, complete resolution of symptoms occurred for 34/49 patients (69.4%) who had symptoms preoperatively. Reintervention for cyst recurrence occurred for 5 cases (9.4%). Conclusions Outcomes for hepatic cyst disease are described with predominantly laparoscopic approach, approach with minimal morbidity, and excellent clinical results.

The transport of excess protons in water is central to acid–base chemistry, biochemistry and energy production. However, elucidating its mechanism has been challenging. Recent nonlinear vibrational spectroscopy experiments could not be explained by existing models. Here we use both vibrational spectroscopy calculations and neural-network-based molecular dynamics simulations that account for nuclear quantum effects for all atoms to determine the proton transport mechanism. Our simulations reveal an equilibrium between two stable proton-localized structures with distinct Eigen-like and Zundel-like hydrogen-bond motifs. Proton transport follows a three-step mechanism gated by two successive hydrogen-bond exchanges: the first reduces the proton-acceptor water coordination, leading to proton transfer, and the second, the rate-limiting step, prevents rapid back-transfer by increasing the proton-donor coordination. This sequential mechanism is consistent with experimental characterizations of proton diffusion, explaining the low activation energy and the prolonged intermediate lifetimes in vibrational spectroscopy. These results are crucial for understanding proton dynamics in biochemical and technological systems. Recent vibrational spectroscopy experiments suggested that excess proton transport in water is more complex than previously thought. Now the proton transport mechanism has been explored using neural-network-based simulations and related to experimental measurements through vibrational spectra calculations. It was observed to be a three-step process gated by two successive hydrogen-bond exchanges.

This article is a critical review of published data from the earliest evidence of pressure knapped microblade technology from various regions in Northeast Asia (Siberia, Korea, China, Mongolia, Japan, Sakhalin, and Russian Far East), including discussions not only on published dates, but also on published artifacts (drawings and photos) relating to these assemblages. The issue concerning the geographical and chronological origin of microblade technology in Northeast Asia remains a widely debated concern, not only as new data emerge, but also due to researchers having different definitions of the term “microblade” and “microblade core”. In this case, by microblade technology, I refer to the systematic production of microblades using the pressure knapping technique. I therefore review the data in light of this defining feature and conclude that, based on the present state of research, pressure knapping microblade technology probably emerged in the Far East (China, Korea, or Japan) around 30,000–25,000 cal BP, in spite of most authors considering that microblade technology emerged in southern Siberia 40,000–35,000 years ago. In the discussion section, I argue about the potential role of obsidian in the emergence of pressure knapped microblade technology.

Swan Point in central Alaska contains the oldest recognized human occupation in Alaska (Cultural Zone 4b [CZ4b]), dating to circa 14,000 cal BP. This component consists of a microblade and burin industry with clear technological ties to the Siberian Upper Paleolithic Diuktai Culture. Through the systematic use of the Yubetsu method for the production of microblades, Swan Point is technologically more similar to Siberian microblade sites than to later-age (Denali complex) microblade sites in Alaska. The Yubetsu method is the hallmark of the Diuktai Culture, and in Alaska, Swan Point CZ4b is the only component with systematic production of microblades using the Yubetsu method. Other late Pleistocene and Holocene microblade sites in Alaska have an industry based on Campus-style, conical, or tabular microblade cores. Analysis of the collection furthers our understanding of how CZ4b relates to previous Siberian Diuktai-related assemblages and to later Alaskan Denali-related sites. We interpret the CZ4b component as representing a brief single event that has major cultural and technological implications for the early colonization process of North America. Swan Point, dans la région centrale de l'Alaska, contient la plus ancienne occupation humaine en Alaska (Zone Culturelle 4b [CZ4b]) datant de circa 14 000 cal BP. Cette composante est constituée d'une industrie à lamelle et de burins avec de claires parentés technologiques avec la Culture de Dyuktaï du Paléolithique supérieur sibérien. Grâce à l'utilisation systématique de la méthode Yubetsu pour la production de lamelles, Swan Point est technologiquement plus proche des sites à lamelles de Sibérie que des sites à lamelles d'Alaska (complexe Dénali) qui suivront. La méthode de Yubetsu est la signature de la Culture de Dyuktaï, alors qu'en Alaska, Swan Point CZ4b est le seul site avec une production systématique de lamelles en utilisant la méthode Yubetsu. En effet, d'autres sites à lamelles du Pléistocène supérieur et de l'Holocène en Alaska ont une industrie basée sur des nucléus à lamelles de type Campus, coniques ou tabulaires. L'analyse de la collection peut ainsi nous aider à comprendre comment ce site se rapporte aux plus anciens assemblages liés à Dyuktaï en Sibérie et à ceux plus tardifs des sites Dénali en Alaska. Nous interprétons la composante CZ4b comme un événement unique de courte durée, ce qui a des implications culturelles et technologiques majeures pour le peuplement de l'Amérique du Nord.

Flaked-tool technology can provide insights into social and cultural changes and interregional connections. This study of changing tool production covers the Upper Palaeolithic to the Late Neolithic in the Yakutia region of eastern Siberia. This region is home to the Palaeolithic Dyuktai complex, the Mesolithic Sumnagin complex and Neolithic traditions; it thus enables a better understanding of the material culture of these societies in Siberia and improves our knowledge of the complex migration processes towards the New World.

Archaeoentomological research at the precontact site of Nunalleq (sixteenth and seventeenth centuries AD), Southwest Alaska, has identified hundreds of lice and fleas that infested both the human inhabitants of the site and their canine companions. As lice are host specific, staying attached to the host’s hair or fur during the totality of their lifecycle, they are generally considered excellent indicators of activity areas. Fleas, however, are relatively less common in archaeological contexts and, since they are mobile and able to infest several different host species, their potential use in the spatial reconstruction of activities is more limited. At Nunalleq, the study of insects from the most recent archaeological contexts produced very different spatial distribution patterns for human lice, fleas, and dog lice. This article compares these archaeoentomological data with other datasets available for the site (carrion-feeding flies, human hair, fur, coprolites, projectile points, and pieces of clothing) with the aim of establishing the phenomena that produced the distinct spatial distributions observed.

The pressure knapping technique develops circa 25,000 cal BP in Northeast Asia and excels at producing highly standardized microblades. Microblade pressure knapping spreads throughout most of Northeast Asia up to the Russian Arctic, and Alaska, in areas where the human presence was unknown. Swan Point CZ4b is the earliest uncontested evidence of human occupation of Alaska, at around 14,000 cal BP. It yields a pressure microblade component produced with the Yubetsu method, which is widespread in Northeast Asia during the Late Glacial period. Through the techno-functional analysis of 634 lithic pieces from this site, this study seeks to identify the techno-economical purposes for which the Yubetsu method was implemented. Data show that the microblade production system is related to an economy based on the planning of future needs, which is visible through blanks standardization, their overproduction, their functional versatility, and the segmentation of part of the chaîne opératoire. This expresses the efficiency and economic value of the microblade production system. The flexible use of pressure microblades identified at Swan Point CZ4b is also found in Japan, Korea, Kamchatka, and the North Baikal region, suggesting that their modes of use accompany the spread of early microblade pressure knapping over an immense territory across Beringia.

This work proposes an open and flexible environment for the interaction of relevant technologies within the framework of Industry 4.0. In this work, a discrete event simulation was developed using open-source software, which enables seamless integration with communication protocols, optimization tools, and a graphical user interface that works in augmented reality. The discrete event simulation runs locally but can obtain the input parameters through a request to a web app stored in the cloud. The proposed environment was tested through numerical experiments adapted from a real manufacturing process, which was parametrized and generalized to be represented in the discrete event simulation. Among the numerical experiments presented were a baseline scenario and 5 variations. An optimization in the parameters of the process is presented which demonstrated the capacity of the developed discrete event simulation to be integrated with external software. An augmented reality app was developed and installed in a smartphone to provide a graphical interface with the user and provide a spatial representation of the machine linked with the studied process. This work represents a step towards the creation of a Digital Twin of a manufacturing process and the implementation of a Digital Thread that transport the information of different platforms.

Background There is mounting evidence of the long‐term benefits of multiple versus single arterial grafts (MAG vs. SAG) during coronary artery bypass grafting (CABG). However, the adoption of MAG has been low in nonfederal institutions as reported by the Society of Thoracic Surgeons Database, and adoption and results from lower volume federal institutions have rarely been reported. Here, we report our long‐term clinical outcomes of MAG in a veteran population. Methods We collected data on 521 consecutive CABG patients from 2013 to 2023. The decision for MAG was at the discretion of the operating surgeon with use of skeletonized bilateral internal mammary arteries (BIMAs) when applicable and procedures included both on‐pump and off‐pump CABG. The Fisher exact test was used to compare categorical variables, and the Wilcoxon rank sum test was used to compare continuous variables. A Mann–Kendall statistical test was used to test the trend of MAG use over time, and a Cox proportional hazards model was used to compare mortality between the groups after adjusting for confounders. Results Our patients had a mean (SD) age of 67.3 (7.2) years with 2.72 (0.68) diseased coronary vessels. Over the course of the study, 58% of the patients received MAG. There was a significant increase of MAG over time (p = 0.03), with 0% prior to 2013, 69.1% by 2015, and settling at 80.0% utilization in 2022. Patients who received MAG had a lower prevalence of chronic kidney disease and history of myocardial infarction. Patients who received MAG received significantly more total bypass grafts. Right internal mammary artery was utilized 69.4% and radial artery 32.9% of the time in MAG cases. There were no differences in short‐term mortality or sternal wound infections between the two groups. However, there was improved long‐term mortality seen as early as 5 years with MAG. Conclusions In a lower‐volume federal center, there was a significant increase in MAG utilization over time and improved long‐term survival for patients receiving MAG than SAG with no differences in short‐term mortality or sternal wound infection.

The Amakomanak site (AMR-00095), dated around 7500 BC, is located in the Noatak National Preserve in northwestern Alaska and presents an important microblade component (microblade cores, core tablets, and microblades) made of local chert. During the late Pleistocene and the early Holocene, microblade technology is widespread in central Alaska, dominated by Campus-style microblade cores (wedge-shaped microblade cores). The Amakomanak assemblage is primarily composed of larger prismatic microblade cores, similar to assemblages from other northwestern Alaskan sites compared here. This paper argues that raw material available in each area may have played a major role in the different microblade core variants described. Indeed, raw material availability in the northwestern region could be one of the major reasons behind the production of larger prismatic cores, as opposed to central Alaska Campus-style cores usually made on smaller river cobbles. The paper also presents the results of a morphometric analysis of microblade cores and microblades from the Amakomanak site, comparing the data to both experimentally derived data sets on microblade-flaking modes, as well as other microblade assemblages in Alaska and Siberia.