bluuebunny/crossref_metadata_2025 huggingface dataset:
An improved discrete Fourier transformation channel estimation algorithm with low complexity for orthogonal frequency division multiplexing‐based power line carrier communication systems
Authors: Fan Gao , Yu Zhou , Shuangshuang Zhao , Yue Li , Xiao Chen , Chao Zhou , Xiang Wang , Zhen Zhang
Published: July 2023

Orthogonal frequency division multiplexing (OFDM) technology has been increasingly applied to power line carrier communication (PLC). Discrete Fourier Transformation (DFT)‐based channel estimation algorithm is suitable for OFDM‐based PLC due to its low complexity. In view of the problem that the traditional DFT channel estimation does not consider the influence of noise inside cyclic prefix (CP), an improved DFT channel estimation based on signal‐to‐noise ratio (SNR) estimation is proposed. First, least‐square (LS) algorithm is performed and the frequency domain channel estimation is converted to the time domain through inverse DFT, and the average SNR of the system is estimated according to the pilot sequence. Second, the substitute SNR for each sample point inside CP is defined and used to filter impulse noise inside CP. Third, the average SNR is converted into the threshold of the useful signal energy inside CP, and the widespread background noise inside CP is filtered. The simulation results show that the proposed algorithm can obtain more accurate channel estimation than other DFT channel estimation algorithms because it can effectively filter out noise inside CP. In addition, compared with other similar algorithms, the proposed algorithm dose not result in a significant increase in complexity.
Towards the application of renewable energy technologies in green ports: Technical and economic perspectives
Authors: Parhamfar Mohammad , Sadeghkhani Iman , Adeli Amir Mohammad
Published: July 2023

With growing concerns over environmental degradation and climate change, the shipping industry is under increasing pressure to reduce its environmental impact. This has led to the development of green port initiatives in the field of maritime transport and logistics, which aim to promote sustainable practices and reduce the environmental footprint of ports and their operations. One of the key strategies for achieving this goal is the use of renewable energy technologies (RETs). This paper summarizes the potentials, challenges, and economic analysis of RETs applications in green ports, emphasizing those that require aquatic environments for operation, including floating photovoltaic systems, offshore wind turbines, and ocean energy. The paper investigates the concept of green ports and explores the feasibility of integrating RETs into these facilities. Also, the potential of the various RETs is presented in terms of technical and economic aspects and installed capacity. Additionally, due to high flexibility in electrical systems and compatibility with maritime transportation, the use of fuel cells in green ports has been discussed as a feasible solution for supplying power to ports (either as the primary or backup source). The findings of this study show that RETs can significantly contribute to achieving sustainable goals in the maritime industry and pave the way for the creation of more efficient and environmentally friendly ports.
SPICE point spread function correction: General framework and capability demonstration
Authors: Plowman J. E. , Hassler D. M. , Auchère F. , Aznar Cuadrado R. , Fludra A. , Mandal S. , Peter H.
Published: July 2023

We present a new method of removing point spread function (PSF) artifacts and improving the resolution of multidimensional data sources, including imagers and spectrographs. Rather than deconvolution, which is translationally invariant, the method we present is based on sparse matrix solvers. This allows it to be applied to spatially varying PSFs as well as to combined observations from instruments with radically different spatial, spectral, or thermal response functions (e.g., SDO/AIA and RHESSI). The method was developed to correct PSF artifacts in Solar Orbiter Spectral Imaging of the Coronal Environment, so the motivation, presentation of the method, and the results revolve around this type of application. However, it can be used as a more robust (e.g., with respect to spatially varying PSFs) alternative to deconvolution of 2D image data, as well as similar problems, and is also relevant to more general linear inversion problems.
Variability of the slow solar wind: New insights from modelling and PSP-WISPR observations
Authors: Poirier Nicolas , Réville Victor , Rouillard Alexis P. , Kouloumvakos Athanasios , Valette Emeline
Published: July 2023

Aims. We analyse the signature and origin of transient structures embedded in the slow solar wind, and observed by the Wide-Field Imager for Parker Solar Probe (WISPR) during its first ten passages close to the Sun. WISPR provides a new in-depth vision on these structures, which have long been speculated to be a remnant of the pinch-off magnetic reconnection occurring at the tip of helmet streamers.

Methods. We pursued the previous modelling works of Réville et al. (2020, ApJ, 895, L20; 2022, A&A, 659, A110) that simulate the dynamic release of quasi-periodic density structures into the slow wind through a tearing-induced magnetic reconnection at the tip of helmet streamers. Synthetic WISPR white-light (WL) images are produced using a newly developed advanced forward modelling algorithm that includes an adaptive grid refinement to resolve the smallest transient structures in the simulations. We analysed the aspect and properties of the simulated WL signatures in several case studies that are typical of solar minimum and near-maximum configurations.

Results. Quasi-periodic density structures associated with small-scale magnetic flux ropes are formed by tearing-induced magnetic reconnection at the heliospheric current sheet and within 3 − 7 R⊙. Their appearance in WL images is greatly affected by the shape of the streamer belt and the presence of pseudo-streamers. The simulations show periodicities on ≃90 − 180 min, ≃7 − 10 h, and ≃25 − 50 h timescales, which are compatible with WISPR and past observations.

Conclusions. This work shows strong evidence for a tearing-induced magnetic reconnection contributing to the long-observed high variability of the slow solar wind.
Study of factors affecting the pathogenic microbiota growth on the surface of thermophilic sourdough and development of methods for its inhibition
Authors: Kuznetsova Lina , Savkina Olesia , Burykina Maria , Lokachuk Marina , Parakhina Olga , Pavlovskaya Elena , Lavrenteva Natalia
Published: July 2023

Sourdough is an important ingredient in the breadmaking. In the Baltic countries, Belarus, Ukraine and Russia, thermophilic rye sourdough are widely used, which are prepared using saccharified flour scald (scalded flour) and fermented at elevated temperatures (>35 °C). Pure cultures of L. amylolyticus 76 are widely used for thermophilic sourdough preparation. The aim of the research was to identify the causes of the spore-forming bacteria germination and the appearance of an unpleasant odor at the end of the first step of thermophilic sourdough preparation when thermophilic strain L. amylolyticus is used, as well as to develop methods for suppressing the development of unwanted microorganisms. Using the 16S rRNA sequencing method, it was established that the isolated bacteria belong to the species Bacillus licheniformis. Water at a temperature of 58-60 to 77-78 °C and steam inhibit the development of spore-forming bacteria, while water at a temperature above 97°C activates spores. The effect physiological activity of pure cultures L. amylolyticus 76 on the sourdough quality and the undesirable microflora growth was investigated. The influense of anaerobic conditions on the sourdough surface, for example, by creating a protective film of vegetable oil, also as acidifying of sourdough by lactic acid or glacial acetic acid was established.
Effectiveness of extracts of medicinal plants included in poultry diet
Authors: Bagno Olga , Shevchenko Sergey , Shevchenko Antonina , Prokhorov Oleg , Nikulin Vladimir
Published: July 2023

A large number of papers have explored the use of phytobiotics in the diet of farm animals and poultry in recent years. This study area is much addressed, since vegetable feed additives can be an alternative to feed antibiotics. They have a pronounced growth-stimulating and immune-modulating effect on the body of young birds, and are essential for manufacturing organic products of animal origin. The aim of our study was to evaluate the effect of water-ethanol extracts of sarepta mustard on chicken meat performance, and the effect of mountain ash extracts on egg performance of laying hens. A scientific and economic experiment was performed, where broilers from the experimental groups received the sarepta mustard extract at doses of 10, 30, 50, 70, and 90 mg/kg of feed, and laying hens received the mountain ash extract at doses of 30, 40, 50, 60 and 70 mg/kg of body weight. It was found that the optimal dose of the sarepta mustard extract for broiler chickens was 70 mg/kg of feed. The average daily weight gain exceeded the control indicators by 3.0%, and the European production efficiency factor and the Russian production efficiency factor for chicken meat by 33.2 and 7.2 units, respectively. For laying hens, the optimal dose of the mountain ash extract attained 70 mg/kg of body weight. It increased the egg production rates for the hen housed and middle hen by 12.2 and 10.4%, respectively, compared to the control, and exceeded that of the European egg production index and the Russian egg production factor for laying hens by 1.53 and 10.34 units, respectively.
Orthogonal Experimental Study on Crack Resistance of Biochar and Sisal Fiber Composite Improved Expansive Soil
Authors: Mu Rongxue , Chen Aijun , Li Weiliang , Lin Shijie , Ling Long
Published: July 2023

Desiccation shrinkage is a key factor contributing to the engineering hazards in expansive soil. To inhibit the initiation and expansion of cracks, a composite improvement approach using biochar and sisal fibers was applied to expansive soil from Nanning, Guangxi. An orthogonal test method was employed to conduct desiccation cracking tests on the improved soil, investigating the effects of biochar and sisal fibers on crack length, crack ratio and crack width. The results indicate that different proportions of sisal fibers and biochar can effectively inhibit soil crack development. The biochar content is the primary factor affecting crack length, while sisal fibers mainly inhibit the development of crack ratio and average crack width. The optimal proportion for composite improvement approach was found to be 6‰ of 3 cm sisal fibers and 4% biochar. The study findings can provide a new approach for the expansive soil improvement and for controlling engineering problems caused by soil cracking.
Per- and polyfluoroalkyl Substances (PFAS) In China’s Groundwater Resources: Concentration, Composition, and Human Health Risk
Authors: He Ying
Published: July 2023

As an important class of emerging contaminants, per-and polyfluoroalkyl substances (PFAS) in water resources has been extensively studied. In this study, PFAS contamination in Chinese groundwater was systematically analyzed according to the reported literature. The research on PFAS in groundwater was concentrated in the eastern regions of China and that the concentrations of PFAS in groundwater ranged from N.D. to 26700 ng/L. The detected PFAS were PFBS, PFOA, PFBA, PFHxA, PFHxS, PFHpA, PFOS, PFPeA, PFUnA, PFTeDA, and PFNA. Among them, PFOA, PFBA, and PFBS showed higher concentrations. The concentration and composition of PFAS in groundwater varied significantly across different regions, often attributable to local industrial activities and urbanization. PFOA was the most commonly detected PFAS in the samples and also the primary contaminant in 14 sites. Additionally, PFPeA, PFBA, PFOS, and PFHxA also occupied a significant proportion of the total concentration level. The human health risk of various PFAS was assessed by the value of the predicted no effect concentration (PNEChum). The PNEChum value for PFOS, PFOA, and PFNA is relatively low, indicating a high risk to human health. Combined with the actual detection concentration, PFOS and PFOA are the two highest risk pollutants, which need attention and control. For the last decade, the concentration of PFOS has decreased, but the situation of PFOA was not encouraging. This study reviewed the PFAS contamination in groundwater in China, identified the high-risk substances, confirmed the need for regulation and control, and highlighted the importance of protecting public health during economic development.
Research on Power IoT System Based City Block Air Pollutant Emission Prediction
Authors: Liu Siyang , Nie Yongjie , Li Bo , Zhu Mengyao , Li Zhengxing , Li Ting , Cao Min , Chang Yanping , Xu Hua , Yan Hongfeng , Jin Hui , Wang Hongyu
Published: July 2023

In order to constantly improve city environmental air quality, it is necessary to accurately control the major pollutants emissions such as air fine particulate matter. By adopting the proposed iterative update framework of air pollutant emission inventory, combined with block-level real-time electricity consumption data acquired by the smart city power IoT, and utilizing station-level and hourly environmental air quality monitoring data in specific areas of Yuxi and Dali in Yunnan Province from 2020 to 2021, the iterative update of emission inventory and prediction of air pollutant emission are studied. The experimental results shows that the prediction of the monthly average major air pollutants emissions such as NO2/PM10/PM2.5 in specific neighbourhoods of the two cities mentioned above reaches the same accuracy level as using numerical simulation prediction methods, but the prediction computational power requirements are greatly reduced, making it more suitable for the application requirements of the power IoT. This study provides a new idea for improving the regulatory capacity of intelligent environment and achieving higher urban air quality based on the smart city power IoT.
Evidence of Systemic Cytokine Release in Patients Undergoing Cardiopulmonary Bypass
Authors: Halter Jeffrey , Steinberg Jay , Fink Gregory , Lutz Charles , Picone Anthony , Maybury Rubie , Fedors Nathan , DiRocco Joseph , Lee Hsi-Ming , Nieman Gary
Published: July 2023

Cardiopulmonary bypass (CPB) causes a systemic inflammatory response syndrome (SIRS), which can progress to an acute lung inflammation known as postperfusion syndrome. We developed a two-phase hypothesis: first, that SIRS, as indicated by elevated cytokines post-CPB, would be correlated with postoperative pulmonary dysfunction (Phase I), and second, that the cytokine interleukin-6 (IL-6) is predominantly released from the heart in CPB patients (Phase II). Blood samples were collected from patients undergoing CPB for elective cardiac surgery. In seven patients (Phase I), arterial samples were drawn before, during (5 minutes and 60 minutes), and after CPB. In 14 patients (Phase II), samples were collected from the coronary sinus, superior vena cava, and a systemic artery at the times indicated previously. Samples were analyzed with enzyme-linked immunosorbent assay: IL-1, IL-6, IL-8, IL-10, and tumor necrosis factor-α were assessed in Phase I and IL-6 assessed in Phase II. In Phase I, IL-6, IL-8, and IL-10 were elevated after CPB, but only IL-6 concentrations correlated with lung function. In summary, Phase I data demonstrate that increased IL-6 levels at the end of CPB correlate with reduced lung function postoperatively. In Phase II, IL-6 elevation was similar at all sample sites suggesting that the heart is not the major source of IL-6 production. We suggest that IL-6 be implemented as a prognostic measure in patient care, and that patients with elevated IL-6 after CPB be targeted for more aggressive anti-inflammatory therapy to protect lung function.
Improved Coagulation and Blood Conservation in the Golden Hours After Cardiopulmonary Bypass
Authors: Beckmann Scott R. , Carlile Dee , Bissinger Randall C. , Burrell M. , Winkler Thomas , Shely William W.
Published: July 2023

The Hemobag (HB) technique allows the open-heart team to safely concentrate the residual cardiopulmonary bypass (CPB) circuit contents and return a high volume of concentrated clotting factors and blood cells back to the patient as autotransfusion. Hematocrit, platelet count, fibrinogen concentration ([Fib]), prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR) were compared between two prospective convenience groups of cardiac surgical patients whose residual circuit blood was processed by the HB (n= 10) or by the Cell Saver (CS;n= 10) at two times after CPB: (a) after acute normovolemic hemodilution (ANH) infusion and protamine administration and (b) after admission to the intensive care unit (ICU), ∼1 hour after CPB and HB content infusion. Minimal cell processing was also used in the HB patients to conserve blood. “Golden hours” is defined as the first few hours after CPB and protamine sulfate administration and extend into the ICU, when maintaining hemostasis is vital during cardiac surgery and is the most susceptible period for blood product administration and the opportunity to improve patient outcome. Except for PTT, all parameters changed significantly from the ANH infusion and protamine administration to ∼1 hour after HB blood infusion and arrival in the ICU. Fibrinogen (p= .048) and hematocrit (p= .046) were significantly higher in the HB group compared with the CS group at the end of the golden hour despite infusion of significantly more allogeneic blood products (p= .070) and more washed red blood cells (RBCs;p= .001) in the CS group. All but one of the HB patients did not receive any allogeneic blood products during the golden hours. Use of the HB technique for salvaging blood is associated with significant increases in the patient’s protein and cellular concentrations and lowered coagulation times in the important, first few golden hours after CPB, and except for one patient, without the addition of expensive and precarious allogeneic blood products.
Improving Cardiopulmonary Bypass: Does Continuous Blood Gas Monitoring Have a Role to Play?
Authors: Ottens Jane , Tuble Sigrid C. , Sanderson Andrew J. , Knight John L. , Baker Robert A.
Published: July 2023

The CDI™500 (Terumo Cardiovascular Systems, Ann Arbor, MI) is an in-line blood gas monitoring device that has been used in clinical practice for over a decade. Few randomized studies have evaluated the value of this device with respect to improved perfusion management. We routinely use automated continuous quality indicator programs to assess perfusion management. The aim of this study is to investigate in a prospective randomized trial the role of in-line blood gas monitoring in the improvement of blood gas management during cardiopulmonary bypass (CPB) utilizing continuous quality indicators. Patients were randomized into two groups (Control, CDI). Patients in the Control group received our standard CPB blood gas management, with intermittent blood gas results. Continuous blood gas measurements from the CDI™500 were recorded at 20-second intervals, with the perfusionist blinded to these measurements. Patients in the CDI group received standard CPB blood gas management, in addition to continuous blood gas measurements visible on the CDI™500, the alarm system activated, and the data recorded. Perfusion management for all cases was guided by institutional protocols. One hundred patients (50 in each group) were included in the study. No significant difference existed between the groups on demographic, surgical, or clinical outcomes. Blood gas levels of patients in the CDI group were able to be maintained in accordance to protocol a greater percentage of the time, e.g., pCO2management was 2% versus 20% (p= .008); this was most notable for differences between the Control and the CDI group for pCO2> 45 mmHg (p= .003). Practice variation determined via statistical control charts improved for both pH and pCO2, represented by a decrease in the variation associated with practice. Continuous blood gas monitoring with the CDI™500 results in significantly improved blood gas management as determined by adherence to institutional protocols.
Severe Thrombotic and Bleeding Complications in a Baby with Heterozygous Factor V Leiden and Acquired von Willebrand Disease on ECMO
Authors: Bilen Ozlem , Loftis Laura , Teruya Jun
Published: July 2023

We aim to present the case of a 5-week-old girl with severe respiratory failure placed on veno-venous extracorporeal membrane oxygenation (ECMO) that was then switched to veno-arterial ECMO. She required up to 60 units/kg/hr of heparin to keep her heparin level within the target range at .3–.7 units/mL. During the ECMO course, substantial thrombus formation was observed within the venous site of the ECMO cannula, which led to two circuit changes on ECMO day 9 and day 20. On ECMO day 15, she was noticed to have purpuric lesions on her chest and her right hand with no obvious arterial or venous clot detected by Doppler ultrasound. She was also noted to have remarkable hemolysis as the plasma free hemoglobin levels were substantially elevated up to 700 mg/dL. She was noted to have continuous oozing from the catheter insertion sites despite adequate underlying coagulation status. Her subsequent platelet function analysis, the thromboelastography, and thromboelastography platelet mapping suggested substantial platelet dysfunction. Her von Willebrand panel revealed absence of high molecular weight multimers. Further coagulation workup was prompted which revealed heterozygosity for factor V Leiden. The patient developed severe pulmonary hemorrhages and ECMO was discontinued on day 40.
Comparison of Point-of-Care Activated Clotting Time Systems Utilized in a Single Pediatric Institution
Authors: Ojito Jorge W. , Hannan Robert L. , Burgos Michelle Moore , Lim Hyunsoo , Huynh Monique , Velis Evelio , Arocha Marino , Tirotta Christopher F. , Burke Redmond P.
Published: July 2023

This study compares four different activated clotting time (ACT) point-of-care (POC) testing systems used at our institution for the management of patients undergoing heparin therapy. We evaluated these systems under identical conditions to determine their accuracy, reproducibility, ease of use, and cost. Two separate testing stations containing four ACT systems were used. The testing order was randomized for every sample and performed by two trained individuals. Samples of fresh heparinized whole blood were taken at regular intervals and distributed to each station. Each operator tested 50 samples, totaling 400 ACT tests. The ACT value was significantly affected by the type of machine used at both stations 1 and 2 (p < .001). Compared with all systems, the Medtronic ACT Plus Automated Coagulation Timer System (ACT Plus) resulted in the most consistent ACT values (median = 171, Interquartile Range (IQR): 169–175) and least variability (172.17 ± 5.24). The Hemochron Signature Elite Whole Blood Microcoagulation System had the most variability (221.10 ± 14.78) and yielded consistently higher ACT values (median = 220, IQR: 210–229.5) compared with other systems. The ACT values reported by the i-STAT Handheld and Test Cartridge Blood Analysis System (153.30 ± 7.87) were consistently lower (median = 154, IQR: 147–161) in comparison to the ACT Plus and Medtronic HMS Plus Hemostasis Management System (180.60 ± 7.60, median = 181, IQR: 175–186). There was no statistical difference in results between the two testing sites (p > .05) or the operators (p >.05). The significant finding of this study was the affect each system has on the ACT value. This investigation demonstrates the variability that exists among different ACT monitoring systems at our institution. The discrepant variation in ACT values that exists with the Hemochron system questions the reliability of its use in the management of patients undergoing heparin therapy.
Developing a Benchmarking Process in Perfusion: A Report of the Perfusion Downunder Collaboration
Authors: Baker Robert A. , Newland Richard F. , Fenton Carmel , McDonald Michael , Willcox Timothy W. , Merry Alan F. ,   for the Perfusion Downunder Collaboration
Published: July 2023

Improving and understanding clinical practice is an appropriate goal for the perfusion community. The Perfusion Downunder Collaboration has established a multi-center perfusion focused database aimed at achieving these goals through the development of quantitative quality indicators for clinical improvement through benchmarking. Data were collected using the Perfusion Downunder Collaboration database from procedures performed in eight Australian and New Zealand cardiac centers between March 2007 and February 2011. At the Perfusion Downunder Meeting in 2010, it was agreed by consensus, to report quality indicators (QI) for glucose level, arterial outlet temperature, and pCO2management during cardiopulmonary bypass. The values chosen for each QI were: blood glucose ≥4 mmol/L and ≤10 mmol/L; arterial outlet temperature ≤37°C; and arterial blood gas pCO2≥ 35 and ≤45 mmHg. The QI data were used to derive benchmarks using the Achievable Benchmark of Care (ABC™) methodology to identify the incidence of QIs at the best performing centers. Five thousand four hundred and sixty-five procedures were evaluated to derive QI and benchmark data. The incidence of the blood glucose QI ranged from 37–96% of procedures, with a benchmark value of 90%. The arterial outlet temperature QI occurred in 16–98% of procedures with the benchmark of 94%; while the arterial pCO2QI occurred in 21–91%, with the benchmark value of 80%. We have derived QIs and benchmark calculations for the management of several key aspects of cardiopulmonary bypass to provide a platform for improving the quality of perfusion practice.
Bloodless Extracorporeal Membrane Oxygenation in the Jehovah’s Witness Patient
Authors: Preston Thomas J. , Olshove Vincent F. , Chase Margaret
Published: July 2023

The successful use of prolonged extracorporeal life support with a heart-lung machine was first performed in 1972, as described by Hill et al., on a young man with post-traumatic respiratory failure. The first successful use of extracorporeal membrane oxygenation (ECMO) was 1976 by Bartlett et al. Since this time, the use of ECMO for neonatal and pediatric pulmonary support has become a standard of care in many children’s hospitals. The use of ECMO, being a very invasive procedure, is not without risk. In our experience, most patients require multiple transfusions of the different blood components (packed red blood cells, plasma, platelets, and cryoprecipitate). Exposure to one or more blood products often occurs with connection to the ECMO circuit, as the circuit is generally primed with blood products or whole blood. Jehovah’s Witnesses (JWs) are known best in the medical community for their refusal of blood products, even at the risk of death, which presents challenges for health care providers. This belief stems from the biblical passages that have been quoted as forbidding transfusion: Genesis 9:3–4, Leviticus 17:13–14, and Acts 15:19–21. This refusal of blood poses even greater challenges when treating the pediatric JW population. When a blood product is deemed medically necessary for the JW patient, the healthcare provider must either seek legal intervention, or support the patient’s/family’s wishes and associated outcome. This ethical dilemma may be further complicated in the setting of therapies, which may pose additional risks and potentially less clear benefit such as with ECMO. Bloodless cardiac surgery with cardiopulmonary bypass has been reported in the JW population in adults and pediatrics, including neonates. After a thorough search of the literature, no published report of a JW patient being supported on ECMO without blood or blood component utilization was identified. This case report will present our experience with multiple day, bloodless ECMO support of a 17-year-old male patient of the JW faith.
Vacuum Assist: Angel or Demon CON
Authors: Willcox Timothy W.
Published: July 2023

Vacuum-assisted venous drainage (VAVD) to enhance venous return during cardiopulmonary bypass (CPB) was described as early as 1958 but was not widely used until the late 1990s. VAVD was initially used to facilitate the use of smaller cannulas with ministernotomy but was increasingly used to allow reduction in CPB circuit size while maintaining CPB flow rates. This innovation was made without planned consideration to CPB circuit design, most critically that of the venous reservoir. Clinical reports of prime reduction facilitated by VAVD in both adult and pediatric CPB were associated with reduced nadir hematocrit and rates of transfusion that encouraged the proliferation of VAVD in CPB. Concomitantly, investigators have reported both in vitro and in vivo significantly increased arterial emboli associated with the use of VAVD, mostly related to accelerated venous air entrainment. In vitro studies continue to confirm this association and likely underestimate the resulting embolic load as a result of flawed study design. While the evidence for VAVD is equivocal, our understanding of the clinical impact of gaseous microemboli in CPB is similarly limited, most likely confined to blood–brain barrier disruption. It is only after two decades that CPB component design is receiving serious attention in terms of air handling. The ethics of innovation in the field of CPB warrant careful consideration. The application of VAVD is not without consequence.
Bloodless Surgery in a Pediatric Jehovah’s Witness
Authors: Allen Jerry , Berrios Lindsay , Solimine Mike , Knott-Craig Christopher J.
Published: July 2023

Pediatric cardiac surgery in Jehovah’s Witness patients who refuse the use of blood products remains a challenge because of the extreme hemodilution caused by priming the circuit and subsequent cardiopulmonary bypass. We report our successful strategy for reducing the prime volume for a 2-year-old Jehovah’s Witness patient who required open heart surgery. We modified our conventional bypass circuit requirements for this size child by incorporating a lower prime oxygenator and reducing the size of the venous line and circuit, which decreased the circuit prime volume. We managed to reduce our initial sanguineous prime volume from 315 to 210 mL. The prime was further reduced to 160 mL by minimizing circuit length at the field and with venous prime sequestration prebypass. The postbypass hematocrit was 31%. Bloodless pediatric cardiac surgery in Jehovah’s Witness patients can be performed safely. Incorporating a lower prime oxygenator into a revised circuit alleviated the need for blood transfusion and allowed us to achieve our calculated flow rate of 2.6 L/min/m2 while maintaining a hematocrit of 31%.
A Safe and Flexible Cardiopulmonary Bypass Technique for Complex Aortic Surgery without the Requirement for Deep Hypothermic Circulatory Arrest
Authors: Machin David , Tams Gemma , Bingham Helen , Abid Qamar , Adem Ahmed
Published: July 2023

This article describes an adaptable technique of full-body perfusion during complex aortic surgery, which was performed on six consecutive patients, at a nasopharyngeal temperature of 28–34°C for a mean duration of 5 hours. A modified perfusion system was used to provide upper and lower body perfusion through axillary and femoral artery cannulation. The option of selective antegrade cerebral perfusion was also available if required. A simple custom-made circuit and application of additional monitoring such as cerebral oximetry makes this technique a safe and flexible method of providing continuous whole-body perfusion at moderate hypothermia and above. We found that these patients all had no major coagulopathies after the procedure and demonstrated no observable neurological, renal, or gastrointestinal dysfunction on recovery.
Influence of Two Colloidal Extracorporeal Primes on Coagulation of Cardiac Surgical Patients: A Prospectively Randomized Open-Label Pilot Trial
Authors: Bethlehem Irene , Wierda Korry , Visser Cornelis , Jekel Lilian , Koopmans Matty , Kuiper Michael A.
Published: July 2023

The search for the ideal priming fluid continues as more evidence is discovered about side effects of volume expanders. With the availability of modern, balanced hydroxyethyl starch (HES) solutions with less side effects than former HES solutions, we considered to replace our gelatin- (modified gelatin) based extracorporeal circuit prime for a HES (130/.42) prime. Therefore, we studied the influence of two colloidal priming fluids on postoperative coagulation in patients undergoing cardiac surgery. The primary endpoint was to compare clot formation time between the HES group and the gelatin group with rotational thromboelastometry (ROTEM). Additionally we compared colloid osmotic pressure and fluid balance of both groups. Forty patients, undergoing elective first time coronary artery bypass grafting or single-valve surgery, were included in this prospectively randomized open-label pilot study. Laboratory data and ROTEM data were collected and analyzed for differences between the two groups. ROTEM data show significantly more prolongation in Extem clot formation time and significant more decrease in Extem alpha in the HES group. Fibtem maximum clot firmness was significantly smaller in the HES group; this was consistent with fibrinogen concentration measurement, which decreased more in the HES group than in the gelatin group and recovered more over time in the gelatin group. We found no significant difference in colloid osmotic pressure between the groups. In this trial, HES (130/.42) impairs coagulation significantly more compared with gelatin. These differences in influence on coagulation did not lead to a difference in blood loss or fluid balance, so clinical relevance could not be proven.
Using Daily Plasma-Free Hemoglobin Levels for Diagnosis of Critical Pump Thrombus in Patients Undergoing ECMO or VAD Support
Authors: Neal James R. , Quintana Eduard , Pike Roxann B. , Hoyer James D. , Joyce Lyle D. , Schears Gregory
Published: July 2023

Patients supported with extracorporeal membrane oxygenation (ECMO) or short-term centrifugal ventricular assist devices (VADs) are at risk for potential elevation of plasma-free hemoglobin (pfHb) during treatment. The use of pfHb testing allows detection of subclinical events with avoidance of propagating injury. Among 146 patients undergoing ECMO and VAD from 2009 to 2014, five patients experienced rapid increases in pfHb levels over 100 mg/dL. These patients were supported with CardioHelp, Centrimag, or Pedimag centrifugal pumps. Revolutions per minute of the pump head and flow in the circuit in three of the patients did not change, to maintain patient flow during the period that pfHb level spiked. Two patients had unusual vibrations originating from the pump head during the pfHb spike. Four patients had pump head replacement. Following intervention, trending pfHb levels demonstrated a rapid decline over the next 12 hours, returning to baseline within 48 hours. Two of the three patients who survived to discharge also experienced acute kidney injury, which was attributed to pfHb elevations. The kidney injury resolved over time. The architecture of centrifugal pumps may have indirectly contributed to red blood cell damage due to thrombus, originally from the venous line or venous cannula, being snared in the pump fins or pump head.
The Early Postoperative Course of Cognitive Function and Preoperative Cerebrovascular Reserve
Authors: Ikota Masashi , Ishikawa Mami , Kusaka Gen
Published: July 2023

Background Patients with severe steno-occlusive disease of a main cerebral artery without causative lesions on magnetic resonance imaging (MRI) often develop cognitive impairment. However, the effects of revascularization surgery and the source of the cognitive impairment remain unclear. Therefore, we investigated the early postoperative course of cognitive function and its association with cerebral blood flow (CBF), cerebrovascular reserve (CVR), white matter disease (WMD), lacunar infarction, and cerebrovascular risk factors.

Methods Cognitive function was examined using neurobehavioral cognitive status examination (COGNISTAT) in 52 patients with steno-occlusive disease of a main cerebral artery before and at 6 months after superficial temporal artery–middle cerebral artery (STA–MCA) anastomosis. We examined how cognition changed before and at 1, 3, and 6 months after STA–MCA anastomosis in 27 of 52 patients. CVR and CBF were calculated from 123I-N-isopropyl-p-iodoamphetamine single photon emission computed tomography, in addition to other cerebrovascular risk factors in 34 of 52 patients. Cerebral infarction and WMD (periventricular hyperintensity [PVH] and deep subcortical white matter hyperintensity) were also evaluated preoperatively by MRI.

Results COGNISTAT scores improved at 1 month after STA–MCA anastomosis in patients with severe steno-occlusive disease of a main cerebral artery. Multiple stepwise regression analysis revealed that CVR (regression coefficient = –2.237, p = 0.0020) and PVH (regression coefficient = 2.364, p = 0.0029) were the best predictors of postoperative improvement in COGNISTAT scores (R
2 = 0.415; p = 0.0017).

Conclusion Cognitive function improves in relation to preoperative CVR and PVH early after STA–MCA anastomosis in patients with steno-occlusive disease of a main cerebral artery.
Aesthetic Surgery Training and Practice in India: A Survey
Authors: Kapadia Abizer , Nair Mahesh
Published: July 2023

Introduction Aesthetic surgery is a rapidly evolving subspecialty in high demand worldwide. To be considered a fully trained plastic surgeon, all the requirements of the curriculum must be met through to successful completion, including aesthetic surgery. At present, a disparity exists between the demand and provision of aesthetic surgery training in India. This survey evaluation highlights the responses, concerns, and possible solutions regarding training and practice of cosmetic surgery in India.

Methods A meticulously crafted survey comprising of 19 questions discussing the background, training, and practice of cosmetic plastic surgery, was sent across to all accessible plastic surgeons trained or training in India. A total of 506 responses were received. The responses were analyzed and have been presented in this study.

Results The survey was completed with all participants answering all the questions. Pertinent questions regarding practice setup, percentage of aesthetic work in practice, exposure of trainees to aesthetic procedures, and merits of an aesthetic fellowship revealed a lot about aesthetic training in India. The participants also expressed their level of satisfaction with their principal plastic surgery training. Summarizing these findings, suggestions for improvements in training were made.

Conclusion Plastic surgery residency programs need to ensure that residents receive comprehensive exposure to both surgical and nonsurgical cosmetic procedures to ensure maintenance of service standards and optimum patient care. The information collected can help us formulate strategies to improvise the current cosmetic surgery training across India. Steps taken toward the same are also highlighted in the study.
Expression of PD-L1 in malignant soft tissue neoplasm and their correlation with clinicopathological parameters
Authors: Mishra Ashutosh , Singh Anurag , Kumar Madhu , Sagar Mala , Kumari Malti , Qayoom Sumaira , Kumar Vijay
Published: July 2023

Objectives:

Programmed death ligand-1 (PD-L1) expression in malignant epithelial neoplasms has been the subject of numerous studies; however, less data on its application to sarcomas are available. This research focused on the expression of PD-L1 and how it correlated with clinicopathological characteristics in soft tissue sarcomas.

Materials and Methods:

The anti-PD-L1 antibody and Ki-67 were stained in 50 cases of sarcoma that had been confirmed by biopsy and immunohistochemistry. The tumor cell percentage with complete or incomplete membrane staining was calculated. Sarcomas were categorized as positive (>1% of tumor cells with complete or incomplete membrane staining) or negative (≤1% of tumor cells with complete or incomplete membrane staining). The data were analyzed using Statistical Package for Social Sciences version 21.0.

Statistical Analysis:

Data were analyzed using Statistical Package for Social Sciences (SPSS, IBM Inc., United States), version 21.0. The independent sample t-test for continuous variables and the chi-square test for discrete variables were used to investigate the relationships between PD-L1 expression and clinicopathologic factors. A p-value less than 0.05 was considered statistically significant.

Results:

The soft tissue sarcomas showing marked pleomorphic morphology were significantly linked to positive PD-L1 expression than other subtypes of sarcomas (p = 0.042). Proliferation index grade III accounts for 62.5% of cases with positive PD-L1 expression, followed by proliferation index grade II with 25% cases and grade I with 12.5% cases. On comparing statistically, this difference was found to be significant (p = 0.013). A significant association was found between PD-L1 expression and the poor outcome of follow-up (p = 0.024).

Conclusions:

Our study showed a significant relationship between malignant soft tissue tumor positivity for PD-L1 and pleomorphic morphology, a higher proliferation index grade, and a poorer prognosis.
The Contribution of Argentine Neurologists to the Description of Infantile Epileptic Spasms Syndrome and Related Epileptic and Nonepileptic Neurological Conditions
Authors: Espeche Alberto , Valenzuela Gabriela Reyes , Caraballo Roberto
Published: July 2023

In the latest report of the International League against Epilepsy Task Force on Nosology and Definitions on the methodology for classification of epilepsy syndromes, the term infantile epileptic spasms syndrome (IESS) was chosen for what were previously called infantile spasms, including West syndrome and infantile epileptic spasms without hypsarrhythmia.

Different Argentine groups have contributed to the description of IESS and related epileptic and nonepileptic syndromes. Here we aimed to review studies by different Argentine authors that contributed to the development of the definitions of IESS and its most important benign differential diagnosis.

In 1949, Vazquez and Turner from Argentina first recognized a clinical-electroencephalographic correlate of the entity described by Dr. West defining the triad of epileptic spasms, diffuse paroxysmal cerebral dysrhythmia, and psychomotor impairment. Subsequently, in 1976 Fejerman first reported 10 neurologically normal infants with recurrent spells that resembled epileptic spasms. As neurological status, electroencephalogram (EEG), and outcomes were normal, these infants were clearly different from those with West syndrome or epileptic spasms without hypsarrhythmia.

Since 2003, Caraballo et al have published different series of patients with epileptic spasms in clusters without hypsarrhythmia occurring in infancy. Before the onset of the epileptic spasms in clusters, these infants were often normal and they had focal or generalized EEG abnormalities.

Publication in local journals in languages other than English may lead to the loss of important data found by colleagues from different geographic areas. Therefore, this should be followed by publication in English in peer-reviewed journals.
The Development and Preliminary Exploratory Validation of the PEdiatric Delirium Scale: Assessing the Feasibility and Accessibility of a Novel Delirium Scale
Authors: Dodenhoff Emily C. , Gupta Neha , Craig Lauren , Pate Marjorie L. , Petrusnek Sarah D. , Yang Nianlan , Smith Kimberly , Woolley Allison , Yoon Yesie , Mehta Tapan , Hayes Leslie W.
Published: July 2023

Delirium screening and identification in the pediatric intensive care unit (PICU) can be a diagnostic challenge. Primarily, the burden of screening falls on the bedside nurses, who are juggling countless tasks throughout their shift. The nursing staff at the researcher's institution were concerned that the existing screen, Cornell Assessment for Pediatric Delirium (CAPD), detracted from workflow. The PEdiatric Delirium Scale (PEDS) was developed to accurately identify delirium in children of all developmental abilities and improve nursing workflow. This is a single-center, double-blinded, preliminary exploratory validation study that assesses the feasibility and accessibility of PEDS. This study was performed in a busy 24-bed quaternary PICU serving a diverse, noncardiac patient population. Enrolled patients underwent screening for delirium using the CAPD and PEDS. These results were compared to the gold standard psychiatric evaluation to determine the validity of the novel screen. Finally, the surveyed nurses reviewed their experience with CAPD and PEDS. The primary outcome was to explore the validation of PEDS in the PICU. Using the Youden index, an overall sensitivity of 79% for the detection of delirium (95% confidence interval [CI]: 0.61–0.91) and a specificity of 68% (95% CI: 0.64–0.73) were achieved with an optimal cut-point of 4, on a scale of 0 to 10. PEDS demonstrated a higher predictive value compared to CAPD. Elicited nursing feedback favored PEDS over CAPD, with 86% of respondents citing a shorter time to perform the screen. PEDS is a streamlined tool that can be used to detect pediatric delirium regardless of developmental abilities. Nursing surveys revealed improved workflow when comparing PEDS to CAPD.
The Medial Triquetrohamate Portal: A New Portal in Wrist Arthroscopy. Anatomical Study
Authors: Lucas Francisco J. , Carratalá Vicente , Miranda Ignacio , Pombo Alonso Sergio
Published: July 2023

Introduction Continuing advances in wrist arthroscopy and better understanding of carpal conditions have created the need to design new wrist access portals that facilitate the implementation of new surgical techniques. The aim of this study was to define and verify the safety of the medial triquetrohamate (MTH) portal.

Description of the technique The MTH portal is located about 5-10 mm ulnar and 2-3 mm distal to the midcarpal ulnar portal, ulnar to the extensor digitorum communis (EDC) tendon of the fourth and fifth fingers, and radial to the extensor digiti quinti (minimi) (EDQ) tendon.

Methods An anatomical study was performed on 15 upper limb specimens from 15 human cadavers. Iatrogenic injuries to potentially at-risk neurovascular and tendinous structures were assessed, and the distance from the portal to these structures was measured.

Results There were no iatrogenic injuries to the structures at risk. Mean distances from the MTH portal to the EDC tendon of the fourth and fifth fingers and to the EDQ tendon were 4.67 ± 0.35 mm and 7.27 ± 0.18 mm, respectively. No differences were observed between the left and right wrists. The distance from the MTH portal to the dorsal sensory branch of the ulnar nerve was 15.07 ± 0.44 mm. The structure with the highest risk of injury was the EDC tendon of the fourth and fifth fingers, with a distance of less than 5 mm.

Conclusions The MTH portal is safe, reproducible and facilitates the implementation of various techniques related to midcarpal pathology.