ABSTRACT
OBJECTIVE: Many techniques are available for the intraoperative assessment of brain perfusion during carotid endarterectomy, such as carotid stump pressure, near-infrared spectroscopy, somatosensory evoked potentials, transcranial Doppler, electroencephalography, and clinical assessment. The decision for selective carotid shunt insertion is dependent on clinical deterioration or the detection of cerebral hypoperfusion after cross-clamping of the internal carotid artery. Monitoring cerebral oximetry using near-infrared spectroscopy is a noninvasive technique for cerebral oxygen saturation measurement, reflecting changes in cerebral blood flow during carotid endarterectomy. The aim of this study was to evaluate the reliability of near-infrared spectroscopy as a predictor of selective shunting during carotid endarterectomy. METHODS: In total, 47 conventional carotid endarterectomy surgeries were performed at our hospital between March 2016 and December 2021. All surgeries were performed under a regional cervical block supplemented with local infiltration anesthesia. All patients were monitored by cerebral oximetry using bilateral near-infrared spectroscopy probes and clinical assessment through communication with the patient (numerical, visual, and verbal) to indicate a selective shunt. Near-infrared spectroscopy values were recorded before and after internal carotid cross-clamping and after declamping. Any decrease in ipsilateral cerebral oximetry-near-infrared spectroscopy values equal to or more than 20% from the pre-clamping baseline reading associated with deterioration in neurological status (hemiparesis, aphasia, or deterioration in level of consciousness) after internal carotid artery cross-clamping was considered an indication for intraluminal carotid shunting. RESULTS: After internal carotid artery cross-clamping, 5 of 47 patients (10.6%) developed a significant drop in cerebral oxygen saturation associated with obvious clinical assessment deterioration in verbal communication and weakness in contralateral arm power. A Pruitt-Inahara carotid shunt was subsequently inserted, and 42 patients remained stable throughout surgery. The average decline in ipsilateral near-infrared spectroscopy values was 23.8% in patients with clinical deterioration. The average decline was 8.6% in patients who remained stable. CONCLUSIONS: Monitoring ipsilateral cerebral oximetry using near-infrared spectroscopy is an easy and reliable method for indicating selective shunting during carotid endarterectomy. A 20% decrease in ipsilateral brain tissue oximetry after internal carotid artery cross-clamping provides a reliable cut-off value for selective intraluminal carotid shunting during carotid endarterectomy.
ABSTRACT
This paper presents a new trend in biometric security systems, which is cancelable multi-biometrics. In general, traditional biometric systems depend on a single biometric for identification. These traditional systems are subject to different types of attacks. In addition, a biometric signature may be lost in hacking scenarios; for example, in the case of intrusion, biometric signatures can be stolen forever. To reduce the risk of losing biometric signatures, the trend of cancelable biometrics has evolved by using either deformed or encrypted versions of biometrics for verification. In this paper, several biometric traits for the same person are treated to obtain a single cancelable template. First, optical scanning holography (OSH) is applied during the acquisition of each biometric. The resulting outputs are then compressed simultaneously to generate a unified template based on the energy compaction property of the discrete cosine transform (DCT). Hence, the OSH is used in the proposed approach as a tool to generate deformed versions of human biometrics in order to get the unified biometric template through DCT compression. With this approach, we guarantee the possibility of using multiple biometrics of the same user to increase security, as well as privacy of the new biometric template through utilization of the OSH. Simulation results prove the robustness of the proposed cancelable multi-biometric approach in noisy environments.
