bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Surface Modification and Aprotinin on Cellular Injury during Simulated Cardiopulmonary Bypass
Authors: Greenfield Benjamin L. , Brinkman Kelly R. , Koziol Kelly L. , McCann Martin W. , Merrigan Kellie A. , Steffen Lee P. , Woods Kylie A. , Stammers Alfred H. , Hock Lynette M.
Published: August 2023

Cardiopulmonary bypass (CPB) elicits derangements to the formed elements of blood because of the physical stresses of extracorporeal flow. Methods of reducing the impact of CPB include circuit surface modification and pharmacological supplementation. The purpose of this study was to examine the effects of aprotinin in combination with surface modification during simulated CPB. Fresh whole bovine blood was used to prime standard CPB circuits divided into four groups (N = 3): control (CTR), aprotinin 300 KIU/mL (APR), Poly (2-methoxyethylacrylate) coating (PMEA), and APR with PMEA (APR–PMEA). Physical stresses included venous reservoir negative pressure (−85 mmHg), arterial line pressure of 150 mmHg at 5 LPM, and air–blood interface, applied over a 90-minute period. Samples were drawn at the following times: 0, 10, 45, and 90 minutes. Endpoints included platelet count (PLT), plasma-free hemoglobin (PFHb), and thromboelastography (TEG). PLT did not change (138.9 ± 15.0 vs. 102.9 ± 21.0, p = ns) throughout the 90-minute experimental periods in any group. PFHb increased significantly (mean of 19- fold) throughout the experiment, but was not affected by any treatment. The TEG index declined in the CTR (3.6 ± 0.4 vs. −16.2 ± 2.9, p < .0003), PMEA (5.9 ± 0.8 vs. −2.7 ± 3.8, p < .02), and APR–PMEA (4.6 ± 1.0 vs. −2.8 ± 0.3 p < .0003) groups, but not in the APR group (3.6 ± 2.2 vs. −1.3 ± 3.3 p = .10). In conclusion, neither APR nor PMEA had an effect on either red cell hemolysis or PLT, but APR treatment alone significantly attenuated the derangements in coagulation induced in this extracorporeal model.
Pulsatile Mechanical Cardiac Assistance in Pediatric Patients with the Berlin Heart Ventricular Assist Device
Authors: Merkle Frank , Boettcher Wolfgang , Stiller Brigitte , Hetzer Roland
Published: August 2023

Mechanical cardiac assistance for neonates, infants, children and adolescents may be accomplished with pulsatile ventricular assist devices (VAD) instead of extracorporeal membrane oxygenation or centrifugal pumps. The Berlin Heart VAD consists of extracorporeal, pneumatically driven blood pumps for pulsatile univentricular or biventricular assistance for patients of all age groups. The blood pumps are heparin-coated. The stationary driving unit (IKUS) has the required enhanced compressor performance for pediatric pump sizes. The Berlin Heart VAD was used in a total number of 424 patients from 1987 to November 2001 at our institution. In 45 pediatric patients aged 2 days–17 years the Berlin Heart VAD was applied for long-term support (1–111 days, mean 20 days). There were three patient groups: Group I: "Bridge to transplantation" with various forms of cardiomyopathy (N = 21) or chronic stages of congenital heart disease (N = 9); Group II: "Rescue" in intractable heart failure after corrective surgery for congenital disease (N = 7) or in early graft failure after heart transplantation (N = 1); and Group III: “Acute myocarditis” (N = 7) as either bridge to transplantation or bridge to recovery. Seventeen patients were transplanted after support periods of between 4 and 111 days with 12 long-term survivors, having now survived for up to 10 years. Five patients (Groups I and III) were weaned from the system with four long-term survivors. In Group II only one patient survived after successful transplantation. Prolonged circulatory support with the Berlin Heart VAD is an effective method for bridging until cardiac recovery or transplantation in the pediatric age group. Extubation, mobilization, and enteral nutrition are possible. For long-term use, the Berlin Heart VAD offers advantages over centrifugal pumps and ECMO in respect to patient mobility and safety.
The Effects of Preprimed Oxygenators on Gas Transfer Efficiency
Authors: Gao Chen , Stammers Alfred H. , Ahlgren Rebecca L. , Ellis Tunisia A. , Holcomb Hunter B. , Nutter Bernadette T. , Schmer Ryan G. , Hock Lynette
Published: August 2023

Cancellation of on-pump coronary artery bypass grafting after the circuit is primed may result in the discarding of unused circuits. In some off-pump cases, a surgeon may request that the circuit be primed, but complete the surgical procedure without utilizing the circuit. The major concerns about the unused circuit are its sterility and the performance of the oxygenator after it has been primed for a long period of time. The goal of this study is to determine whether prepriming of the circuit with and without albumin has an effect on the gas transfer efficiency of oxygenators during simulated cardiopulmonary bypass. Monolyth integrated membrane lungs (Sorin Biomedical, Arvada, CO) were used to deoxygenate and oxygenate the bovine blood. Oxygenators were preprimed for 72 (N = 6) and 24 (N = 6) hours before testing. In control group (N = 6), oxygenators were tested immediately (0 h) after they were primed. Three different priming solutions were used: physiological saline solution (Group A); 1.25% of human albumin (Group B); and 5% human albumin (Group C). The blood was modified to the American Association of Medical Instrumentation Standards before testing. The blood flow through the oxygenators was set at 2 Lpm and 4 Lpm, with gas (FiO2 at 1.0) to blood flow ratio at 1:1. Cultures were also obtained from preprimed oxygenators to test circuit sterility. Oxygen transfer in oxygenators primed for 0 h at blood flow of 4 Lpm were 203 mL/min ± 9.7 (Group A), 263.1 mL/min ± 52.9 (Group B), and 270.5 mL/min ± 13.1(Group C, p < .01 vs. Group A). In oxygenators preprimed for 72 h, the CO2 transfers were 135.0 mL/min ± 21.8 (Group A), 104.9 mL/ min ± 2.4 (Group B), and 148.9 ± 26.6 (Group C, p < .006 vs. Group B). In addition, the pressure drops were 56.5 mmHg ± 5.5 (Group A), 82.6 mmHg ± 13.4 (Group B), and 67.6 mmHg ± 15.3 (Group C, p < .05 vs. Group B). In group A, O2 transfer were 203.5 mL/min ± 9.7 (0 h), 272.4 mL/min ± 66.6 (24 h), and 260.8 mL/min ± 31.1 (72 h, p < .01 vs. 0 h). In group B, O2 transfer were 263.1 mL/min ± 52.0 (0 h), 302.7 mL/min ± 77.4 (24 h), and 235.2 mL/min ± 16.5 (72 hr, p < .02 vs. 24 hr). Cultures obtained from 12 preprimed oxygenators presented no organism growth for up to 5 days. In conclusion, oxygen transfer increases in oxygenators preprimed with albumin immediately after they were primed. However, gas transfer decreased after they were primed with albumin for 72 h. Oxygenators preprimed for 24 h and 72 h with 0.9% saline had better O2 transfer than those primed for 0 h.
Perfusion Treatment Algorithm: Methods of Improving the Quality of Perfusion
Authors: Holcomb Hunter B. , Stammers Alfred H. , Gao Chen , Nutter Bernadette , Ellis Tina , Ahlgren Rebecca L. , Schmer Ryan G. , Hock Lynette M.
Published: August 2023

The pathophysiological consequence associated with cardiopulmonary bypass (CPB) has generated a movement away from this technology in the treatment of heart disease. The negative outcomes are multifactorial in origin and may be associated both with the conduct of CPB and the instrumentation of extracorporeal flow. The purpose of this study was twofold. First, to develop a bedside patient risk assessment to aid in the development of a perfusion care plan. Second, to identify the controllable variables used during CPB that contribute to overall morbidity. Controllable perfusion-related variables that were positively linked to improved patient outcomes were identified from randomized, peer-reviewed human studies. Such variables as hematocrit, mean arterial pressure, thermic perfusion, blood lactate, colloid osmotic pressure, pulsatile perfusion, acid base homeostasis, oxygenation, and coated circuitry were included. Patient risk assessment was developed using the Society of Thoracic Surgeon database, where 61 variables affecting postoperative morbidity were identified. These variables were used to develop a bedside tool, Mortality Assessment Perfusion Score (MAPS), to guide the perfusion patient care plan. The MAPS generates a specific value that may predict patient morbidity and mortality based on past mortalities. In conclusion, the improvement in patient outcome may be associated with both the change in conduct of CPB and the quantitative assessment of patient risk stratification and a patient treatment algorithm.
Improving Cardiopulmonary Bypass: Heparin-Coated Circuits
Authors: Vocelka Craig , Lindley Gina
Published: August 2023

Heparin-coated circuits have been repeatedly proven to reduce the inflammatory response and foreign surface activation triggered upon initiation of cardiopulmonary bypass (CPB). In recent years, increasing numbers of studies are proving significant reductions in postoperative blood loss and transfusion requirements and improvements in clinical outcomes as a result of heparin-coated circuits. These results are promising steps in our efforts to improve CPB, as our patient population gets older and more complicated.
Should Air Bubble Detectors Be Used to Quantify Microbubble Activity during Cardiopulmonary Bypass?
Authors: Newland Richard F. , Baker Robert A. , Mazzone Annette L. , Valiyapurayil Vijaykumar N.
Published: August 2023

Air bubble detectors (ABDs) are utilized during cardiopulmonary bypass (CPB) to protect against massive air embolism. Stockert (Munich, Germany) ABD quantify microbubbles >300 μm; however, their reliability has not been reported. The aim of this study was to assess the reliability of the microbubble data from the ABD with the SIII and S5 heart–lung machines. Microbubble counts from the ABD with the SIII (SIII ABD) and S5 (S5 ABD) were measured simultaneously with the emboli detection and classification (EDAC) quantifier in 12 CPB procedures using two EDAC detectors and two ABDs in series in the arterial line. Reliability was assessed by the Spearman correlation co-efficient (r) between measurements for each detector type, and between each ABD and EDAC detector for counts >300 μm. No correlation was found between the SIII ABD (r= .008,p= .793). A weak negative correlation was found with the S5 ABD (r= −.16,p< .001). A strong correlation was found between the EDAC detectors (SIII;r= .958,p< .001), (S5;r= .908,p< .001). With counts >300 μm, the SIII ABDs showed a correlation of small–medium effect size between EDAC detectors and ABD1 (r= .286,p< .001 [EDAC1],r= .347,p< .001 [EDAC2]). There was no correlation found between ABD2 and either EDAC detector (r= .003,p= .925 (EDAC1),r= .003,p= .929 [EDAC2]). A correlation between EDAC and the S5 ABD, was not able to be determined due to the low bubble count detected by the EDAC >300 μm. Both SIII ABD and S5 ABD were found to be unreliable for quantification of microbubble activity during CPB in comparison with the EDAC. These results highlight the importance of ensuring that data included in the CPB report is accurate and clinically relevant, and suggests that microbubble counts from devices such as the SIII ABD and S5 ABD should not be reported.
Survival Following Veno-Venous Extracorporeal Membrane Oxygenation and Mortality in a Diverse Patient Population
Authors: Mosca Matthew S. , Narotsky David L. , Liao Ming , Mochari-Greenberger Heidi , Beck James , Mongero Linda , Bacchetta Matthew
Published: August 2023

Racial and ethnic disparities in cardiovascular disease are well established; however, there is limited information about survival differences following veno-venous extracorporeal membrane oxygenation (VV-ECMO) in contemporary adult populations. The purpose of this study was to assess survival at discharge, 30 days, and at 1 year following institution of VV-ECMO in an ethnically diverse population, and to examine potential risk factors for mortality. This was a single-center study of 41 patients (49% female, 27% minorities, 7% > 65 years) who received VV-ECMO between the years 2004 and 2013 at an academic medical center. Kaplan–Meier estimates were calculated to assess survival up to 1 year, and cox proportional hazard models were used to evaluate the association between risk factors, mortality, and confounders. Overall, 76% (n = 31) of VV-ECMO patients survived to discharge and 30 days and 71% (n = 29) survived to 1 year. Whites (n = 30) had a higher survival at 1 year compared to minorities (n = 11) (83% vs. 36%, respectively, p = .01). Minorities had a significantly increased risk of mortality at 30 days (hazard ratio [HR] = 5.07, 95% confidence interval [CI] = 1.42–18.09) and at 1 year (HR = 5.19, 95% CI = 1.63–16.55). Race/ethnicity remained a significant independent predictor of survival at 30 days except when history of shock or lung transplantation was included in adjusted regression models. VV-ECMO was associated with an excellent overall survival up to 1 year. Racial/ethnic minorities had a 5-fold increased risk for 30-day mortality, which was largely explained by a lower likelihood of lung transplantation and increased risk of shock.
Apicoaortic Valve Conduit for a Patient with Aortic Valve Stenosis and Patent Coronary Bypass Grafts Using Cardiopulmonary Bypass
Authors: Shackelford Anthony G. , Relle Margaret A. , Lombardi Sarah A.
Published: August 2023

In adults over 65 years of age, aortic valve stenosis has been found to be present in 2–9% within this group. Furthermore, aortic valve replacements in patients whom have had a previous coronary artery bypass grafting surgery have a mortality rate as high as 18%. A non-conventional effective surgical approach of bypassing the aortic valve by inserting an apicoaortic valve conduit (AVC) connecting the left ventricular apex to the descending thoracic aorta has been previously documented. We describe the case of a successful implantation of an AVC in a 64-year-old Caucasian male using cardiopulmonary bypass.
Bivalirudin Anticoagulation for a Pediatric Patient with Heparin-Induced Thrombocytopenia and Thrombosis Requiring Cardiopulmonary Bypass for Ventricular Assist Device Placement
Authors: Faella Katie H. , Whiting David , Fynn-Thompson Francis , Matte Gregory S.
Published: August 2023

The direct thrombin inhibitor bivalirudin is an option for anticoagulation in patients with heparin induced thrombocytopenia (HIT) requiring cardiopulmonary bypass (CPB). There are a limited number of reports of pediatric patients in which bivalirudin has been used for anticoagulation for CPB. We present the case of an 11 year old male with acute onset heart failure secondary to idiopathic dilated cardiomyopathy that developed heparin induced thrombocytopenia with thrombosis (HITT). The patient was anticoagulated in the operating room with bivalirudin and placed on CPB for insertion of a HeartWare® Ventricular Assist Device (Heartware®). Modified techniques were utilized. This included use of the Terumo CDI 500 (Terumo Cardiovascular Systems, Inc.) in-line blood gas monitor which contains a heparin coated arterial shunt sensor. We flushed this sensor with buffered saline preoperatively and noted no significant decrease in platelet count postoperatively. The patient was successfully placed on the ventricular assist device and was subsequently listed for heart transplantation.
La photonique en région Grand Est
Authors: Sciamanna Marc , Lecler Sylvain
Published: August 2023

La région Grand Est a été le berceau de plusieurs découvertes majeures de la photonique, notamment la fabrication et la caractérisation des matériaux optiques non-linéaires, les applications industrielles de l’holographie ou encore le développement de la nano-optique. Forte de cette histoire et de sa position stratégique européenne, la région Grand Est s’inscrit demain dans la création de l’Institut de la Photonique, sous la forme d’un consortium large d’acteurs publics et privés en France et au Luxembourg animé depuis un bâtiment principal à Metz.
« Le Rayon Extraordinaire »… quand la polarisation inspire l’art
Authors: Murie Fred , Théry Flavien , Fade Julien
Published: August 2023

Le projet de création Art & Sciences et l’exposition « Le Rayon Extraordinaire » visent à croiser des recherches artistiques et scientifiques autour du phénomène de polarisation de la lumière. À l’issue d’une résidence d’artistes de deux ans à l’Institut Foton (Univ. Rennes), une vingtaine d’oeuvres originales proposent une expérience sensible d’une réalité d’ordinaire imperceptible à nos yeux, explorant aussi bien ses aspects fondamentaux que ses liens avec nos technologies du quotidien ou encore le vivant…
Spectroscopie à deux peignes de fréquences électro-optiques pour la mesure de rapports isotopiques
Authors: Parriaux Alexandre , Hammani Kamal , Millot Guy
Published: August 2023

Nous montrons que la spectroscopie à double peignes électro-optiques permet de mesurer le rapport isotopique 13C/12C avec une précision meilleure que 2‰ pour un temps d’enregistrement de quelques dizaines de secondes. Les résultats sont compatibles avec des mesures obtenues à l’aide d’un spectromètre de masse.
Comprendre les processus raman cohérents
Authors: Rigneault Hervé , Heuke Sandro
Published: August 2023

Nous présentons les bases physiques pour comprendre les processus Raman cohérents qui sont à l’origine de nombreuses applications en spectroscopie et en imagerie. Ces processus de mélange d’ondes sont résonnants avec les niveaux vibratoires des molécules et rapportent une information chimique sur la matière sondée par les ondes optiques. Ils se développent dans les domaines fréquentiel et spatial avec des spécificités que nous précisons.
Visually Impaired Children with Special Educational Needs: Identifying Suitable Tactile Graphics Learning Materials
Authors: Rong Anqi , Li Guanyu
Published: August 2023

How to design and generate tactile graphics that have clear semantic meaning and are easy for visually impaired children to recognise using their sense of touch in special education is currently a challenge in China. This study summarises the advantages and disadvantages in different technologies for tactile graphics generation by analysing 12 papers in the last ten years on tactile graphics in education field. The insight from this work will help researchers, design professionals, visually impaired children and educators in China to make informed decisions about what they should focus on, how they should do it, and why they should do so.
Teaching Chinese characters to non-native speakers: A scoping review
Authors: Chen Yixuan
Published: August 2023

The complexity of Chinese characters and the differences in learners’ cultural backgrounds make the process of teaching Chinese characters to non-native speakers of Chinese challenging. This review provides a comprehensive examination of five key strategies used in this instructional context: individualized instruction, contextualized instruction, technology-assisted instruction, innovative materials and resource development, and interdisciplinary integration. The ultimate approach to teaching non-native speakers of Chinese may come from the effective integration of these five strategies, so future research should focus on developing integrated instructional models that effectively combine these strategies. Further empirical research is also needed to verify the effectiveness of these strategies and to refine their implementation in different educational contexts.
The Factors Affecting Students’ Satisfaction with Online Course at Guangxi Logistics Vocational and Technical College
Authors: Li Songa , Tosati Sirikorn
Published: August 2023

The purposes of this research are 1) to identify the factors that influence students’ satisfaction with online courses at Guangxi Logistics Vocational and Technical College and 2) to provide guidelines for the development of online courses at the college based on the factors affecting students’ satisfaction. The population for this research primarily consists of 1600 university students enrolled at Guangxi Logistics Vocational and Technical College in China. The sample group, following Krejcie and Morgan (1970), comprised 310 students who were selected based on their participation in online courses and completion of an online survey. The research instruments used in this study include an online survey questionnaire that assessed students’ satisfaction levels across four dimensions: Course Content, Teaching Quality, Learning Experience, and Evaluation Mechanism. The statistics used to analyze the data were descriptive statistics, including mean values (M) and regression Analysis.The results of this research contribute to achieving the objectives as follows:1.Factors influencing students’ satisfaction with online courses: The study found that Teaching Quality received the highest average value (M) and ranked first, indicating that students were highly satisfied with the quality of teaching in online courses. Course Content ranked second, suggesting that it largely meets the professional development needs of students. The Learning Experience dimension ranked third, highlighting the importance of optimizing platform management and technical aspects to enhance students’ overall learning experience. The Evaluation Mechanism dimension ranked fourth, indicating that students were less satisfied with the current evaluation mechanism and desired a more scientifically designed and personalized evaluation system.2.Guidelines for the development of online courses: Based on the factors identified, the research provides valuable guidelines for the development of online courses at Guangxi Logistics Vocational and Technical College. These guidelines emphasize the importance of maintaining high teaching quality, addressing the professional development needs of students through course content, optimizing the platform management and technical aspects to enhance the learning experience, and implementing a scientifically designed and personalized evaluation system to improve student satisfaction.
A Discussion on the Humanistic Orientation and Mission of Science and Technology
Authors: Hui Liu , Yan Zhang
Published: August 2023

Science and technology are the key driving forces for promoting productivity progress. The original intention and fundamental goal of the emergence and development of science and technology is to continuously improve and optimize the environment for the production, life, and development of the public, providing a material and spiritual foundation for human society to move towards a higher form of civilized society. The development of science and technology is closely linked to the enhancement of social public interests. If we overly focus on the economic efficiency of science and technology and neglect its social efficiency, science and technology will inevitably deviate from its original intention of emergence and development, and become a tool for capital to pursue efficiency. Dealing with the efficiency relationship between science and technology at the micro and macro levels, grasping the rhythm of scientific and technological innovation and progress, is conducive to helping us walk out of the Western style scientific and technological innovation and development path of “capital replacing labor”, and returning scientific and technological innovation and development to the original path of “people-oriented”. Only when scientific and technological innovation and progress are highly consistent with the public interest can science and technology reflect its due social value, avoiding it ultimately becoming a value tool for private capital to pursue profits.
Testing the Flâneur Image in Roberto Bolaño’s Exile Writings: A Study of the Theory through the Example of B in “Vagabond in France and Belgium”
Authors: Lin Jingjing
Published: August 2023

Flâneur, in Walter Benjamin’s essays on the Second Empire of France, refers to the image of a wandering intellectual or petty bourgeoisie who indulges himself in the modern phantasmagoria on the streets of Paris. The complexity and fluidity contained in this concept make possible its denotative expansion in later literary texts. Chilean writer Roberto Bolaño’s short story “Vagabond in France and Belgium” can serve to test and develop the theory, for the protagonist B inherits the basic characters of a flâneur, and meanwhile, the exile background endows him with some new faces in terms of the identity of places, the drive of behaviours, and attitude towards the void of (post-) modern life. By expanding the notion of flâneur into a Latin American post-modern context, this paper not only clarifies the relationship between flânerie and exile in Bolaño’s works but also contributes to the expansion and enrichment of the denotation of flâneur on a critical basis.
The Female identity being performed -- Gender rebellion in Cindy Sherman’s photography
Authors: Chen Liangfei
Published: August 2023

Cindy Sherman is a post-modernist artist who uses photography to question and deconstruct traditional images of women. Sherman’s Untitled Film Stills is a female self-portrait “parody”, showing the performative characteristics of “female behavior” in many places. Judith Butler pointed out that the construction of female gender identity comes from “performativity”, which has a connection to Sherman’s work. Based on Judith Butler’s gender theory, this paper analyzes Sherman’s artistic techniques and the content of her works, pointing out how women’s identities and bodies are subtly constructed and disciplined by behavioral language and symbolic chains in the media. In addition, this paper tries to prove that Sherman’s critique of female identity is not radical but derived from a revision of the problem. Starting from the source, she distorts the details of traditional works to make the audience feel dissonance and realize the problem independently, finally achieving the purpose of deconstruction. Cindy Sherman attempts to use the method of parody and distortion (by creating dissonance) to illustrate that the discourse construction process of “gender” features is dominated by lots of symbolic features that people are used to performing, and what Sherman wants to deconstruct is not only the concept and characteristics of female identity, but also the limitations of female identity under the background of “performance”, and more the process of how “performance” culture establishes this concept.
Essentialism and Self-Identity Construction in Toni Morrison’s “Sula”-Take Sula and Shadrack as an Example
Authors: Zhang Hanwen
Published: August 2023

From around the end of the First World War to the mid-1960s, as the voices of the exploited and oppressed black groups were drowned out by white supremacist ideas, black people generally suffered from racial discrimination, and the stereotypes brought about by social essentialism impact of impressions. The construction of identities of marginalized black groups becomes a matter of concern. For Toni Morrison’s novel “Sula”, the existing research has obtained the image analysis of the characters in “Sula”, the symbolic meaning in the novel, the construction of character identity, and the embodiment of traditional culture in “Sula”. However, few studies have combined essentialism and identity construction and Sula’s and Shadracket’s analyses. Therefore, this thesis explores the embodiment of essentialism in “Sula”, as well as Sula and Shadrack’s resistance to essentialism and self-identity construction and combines theoretical analysis and textual analysis. Sula used her unique and heterogeneous behavior to break through the shackles of social essentialism on black women. In contrast to most black women, she constructed her self-identity in a different way from most black women, which can be better understood using Plato’s “cave theory”. Shadrack created “World Suicide Day” to resist the uncertainty of death and the prejudice brought by social essentialism and used Sula as a “mirror” to re-construct his identity, which can be used in Lacan’s “mirror stage” theory to explain.
Research on the Employment Promotion Countermeasures of post-00s college students
Authors: Jianfang Liu , Zhiyong Hu , Lin Gui , Peng Zhang
Published: August 2023

The post-00s (the Generation after 00s) college students in the new era show the characteristics of slow employment. In order to promote the employment of contemporary college students, this paper analyzes the psychological and ideological problems of slow employment of post-00s college students through questionnaire survey on the dynamic employment thought, value orientation, employment location, professional satisfaction and other issues of contemporary college students. A series of employment promotion strategies adapted to the characteristics of college students under the new situation are put forward from the aspects of perfecting the curriculum system of employment guidance, improving the guidance ability of employment guidance teachers, perfecting the employment guidance and service system of graduates.
Role of Adrenal Vein Sampling in Guiding Surgical Decision in Primary
Aldosteronism
Authors: Younes Nada , Larose Stéphanie , Bourdeau Isabelle , Therasse Eric , Lacroix André
Published: August 2023

Adrenal vein sampling (AVS) is recommended for subtyping primary aldosteronism
(PA) to identify lateralized or bilateral sources of aldosterone excess,
allowing for better decision-making in regard to medical or surgical management
on a case-by-case basis. To date, no consensus exists on protocols to be used
during AVS, especially concerning sampling techniques, the timing of sampling,
and whether or not to use adrenocorticotropic hormone (ACTH) stimulation.
Interpretation criteria for selectivity, lateralization, and contralateral
suppression vary from one expert center to another, with some favoring strict
cut-offs to others being more permissive. Clinical and biochemical
post-operative outcomes can also be influenced by AVS criteria utilized to
indicate surgical therapy.

In this review, we reanalyze studies on AVS highlighting the recent pathological
findings of frequent micronodular hyperplasia adjacent to a dominant
aldosteronoma (APA) overlapping with bilateral idiopathic hyperaldosteronism
(IHA) etiologies, as opposed to the less frequent unilateral single
aldosteronoma. The variable expression of melanocortin type 2 receptors in the
nodules and hyperplasia may explain the frequent discordance in lateralization
ratios between unstimulated and ACTH- stimulated samples. We conclude that
aldosterone values collected during simultaneous bilateral sampling, both at
baseline and post-ACTH stimulation, are required to adequately evaluate
selectivity, lateralization, and contralateral suppression during AVS, to better
identify all patients with PA that can benefit from a surgical indication.
Recommended cut-offs for each ratio are also presented.
Die Urinuntersuchung bei Hund und Katze, Teil 1: Physikalische und
chemische Urinuntersuchung
Authors: Seigner Sandra , Weber Karin , Dorsch Roswitha
Published: August 2023

Die Urinuntersuchung bei Hunden und Katzen ist ein wichtiger Baustein bei der
Diagnostik von Erkrankungen des Harntrakts und systemischen Erkrankungen. Eine
Routine-Urinuntersuchung besteht aus einer physikalischen und chemischen
Urinuntersuchung sowie der Urinsedimentanalyse. Es stehen mehrere
Urinsammelmethoden (Auffangen, Katheterisierung, Zystozentese) zur
Verfügung, welche mit verschiedenen Vor- und Nachteilen verbunden sind.
Je nach Untersuchungsschwerpunkt muss für jeden Patienten individuell
die geeignete Methode gewählt werden. Die Urinuntersuchung sollte im
besten Fall innerhalb von 30 Minuten nach der Gewinnung durchgeführt
werden, da Urin anfällig für zeit- und lagerungsbedingte
Veränderungen ist. Die physikalische Urinuntersuchung gliedert sich in
die Bestimmung von Urinfarbe und -trübung sowie die Messung des
urinspezifischen Gewichts, welches Auskunft über die Konzentration des
Urins gibt. Letzteres wird mittels Refraktometrie bestimmt und ist stets im
Zusammenhang mit dem Hydratationsstatus des Patienten zu beurteilen. Bei der
chemischen Urinuntersuchung werden neben dem pH-Wert des Urins die
Präsenz von Blut/Hämoglobin/Myoglobin, Protein,
Glukose, Bilirubin, Urobilinogen, Nitrit und Ketonen bestimmt. Hierfür
werden meist handelsübliche Urinteststreifen verwendet, die stets
gemäß der Herstellerempfehlungen gelagert und verwendet werden
sollten und bei deren Auswertung veterinärmedizinische Besonderheiten
beachtet werden sollten. Die physikalische und chemische Urinuntersuchung ist
einfach und schnell durchführbar und liefert wichtige Informationen, die
für die Diagnose oder den Ausschluss von vielen Erkrankungen
unverzichtbar sind.
Gallbladder torsion in an 11-month-old Labrador
Retriever
Authors: Theurer Jannina , Himmelsbach Peter , Sinzinger Wolfgang , Hartmann Antje
Published: August 2023

An intact male Labrador Retriever was presented with signs of an acute abdomen
and generalized weakness. Abdominal ultrasonography revealed a distended,
horizontally orientated and caudally displaced gallbladder with a thickened
wall. Computed tomography (CT) showed an abrupt tapering of the cystic duct in
addition to the displacement of the gallbladder.

On laparotomy a complete gallbladder torsion was diagnosed. After cholecystectomy
the dog made a full recovery. Gallbladder torsion should be considered as a
rare, potential differential diagnosis in dogs with an acute abdomen.
Novel approach for the treatment of canine elbow hygroma with
extracorporeal shockwaves
Authors: Verhoeven Anika , Huels Nikolaus , Harms Oliver
Published: August 2023

A hygroma is a fluid filled cavity, which appears due to repetitive traumata over
bony prominences. For canine elbow hygroma there is no satisfactory treatment
option available. Small hygromas should not be treated at all. Larger hygromas
that restrict the dog in daily life, are infected, painful, or ulcerated should
be treated surgically with drainage or total excision. Surgical treatment of
hygromas results in long rehabilitation times and is associated with a high
complication rate. Extracorporeal shockwave therapy (ESWT) is widely used in
human and veterinary rehabilitation medicine since several years. Even the
mechanisms of action are not fully understood it has a wide range of
indications. ESWT provides anti-inflammatory effects, promotes microcirculation,
and is used for pain relief. In this case series of 4 consecutive cases in 3
dogs we treated hygromas with extracorporeal shockwaves each for 3 to 6 times
usually on a weekly basis. All hygromas regressed completely and no
complications were noted. Overall ESWT seems to provide a safe, easy-to-use, as
well as cost-effective alternative treatment option for canine elbow
hygroma.
Change in Subfoveal Choroidal Thickness following Cataract Surgery Imaged with Enhanced Depth Imaging Optical Coherence Tomography
Authors: Mackenbrock Lars H. B. , Weindler Jan N. , Labuz Grzegorz , Baur Isabella D. , Auffarth Gerd U. , Khoramnia Ramin
Published: August 2023

Background Due to its invasive nature, cataract surgery can lead to inflammatory processes in the posterior segment, which can result in prolonged recovery times, reduced functional
outcomes, and late-onset complications. The aim of the current study was to identify wherever phacoemulsification parameters play a role in choroidal thickness change following cataract
surgery.

Methods This prospective single-center study enrolled 31 patients (31 eyes) scheduled to undergo routine cataract surgery. Patients with previous ocular surgeries, pathologies or
general disorders affecting vision were excluded. Patients were examined preoperatively, as well as 1, 4, and 12 weeks after surgery. Corrected distance visual acuity (CDVA), intraocular
pressure (IOP) as well as cumulative dissipated energy (CDE), ultrasound time (UT), and fluids used during surgery were recorded. Subfoveal choroidal thickness was measured manually by two
masked independent experts using enhanced depth imaging (EDI) optical coherence tomography (OCT). Furthermore, cataract density was automatically calculated using a custom MATLAB script and
an anterior segment OCT.

Results Subfoveal choroidal thickness increased significantly (p < 0.001, Studentʼs paired sample t-test) and continuously during the 12-week-long follow-up period. Both the
nuclear lens density and the improvement in CDVA correlated significantly with this increase (r = 0.413, p = 0.021 and r = 0.421, p = 0.018, respectively). Neither the CDE (r = 0.334,
p = 0.071), the UT (r = 0.102, p = 0.629), the amount of fluid used (r = 0.237, p = 0.27) nor the decrease in IOP (r = − 0.197, p = 0.288) showed any significant correlation with the
choroidal swelling.

Conclusion Cataract surgery leads to an increase in subfoveal choroidal thickness. While no statistically significant correlation to the phacoemulsification parameters could be
established, this might be because of a selection bias due to the technological constraints of the OCT. Nevertheless, the choroid might play a central role in early- and late-onset
complications.
Higher Subjective Burden in Psychiatric Compared to Somatic
Healthcare Workers in Germany During the first wave of the COVID-19
Pandemic
Authors: Halms Theresa , Thoma Andreas , Kramer Victoria , Kunz Miriam , Falkai Peter , Schneider-Axmann Thomas , Hierundar Anke , Wagner Elias , Hasan Alkomiet , Papazova Irina
Published: August 2023

The COVID-19 pandemic has posed unprecedented challenges for health care workers
(HCWs) worldwide. While the adverse effects of the pandemic on the well-being of
HCWs in general have now been established, little is known about the impact on
HCWs of psychiatric hospitals (PHCWs). PHCWs are of special interest, given that
they faced both an increase in infection rates among psychiatric patients as
well as in mental strain of the general public due to consequences of the
pandemic. The aim of the present study was to investigate how the pandemic
affected PHCWs as well as possible differences between PHCWs and other health
care workers (OHCWs) in Germany during the first wave of the pandemic. We
conducted a country-wide anonymous online survey early during the first pandemic
wave between April 15th and May 1st, 2020, to assess different aspects of
subjective burden and perceived stress using 5-point Likert-scale questions. We
analysed data of 1530 PHCWs and 2114 OHCWs and showed that PHCWs reported higher
subjective burden and stress compared to OHCWs (p<0.001). Overall,
nurses from both groups of HCWs showed higher ratings in subjective burden and
stress than physicians. These higher ratings for subjective burden were even
more pronounced for nurses working in psychiatric hospitals. Future research is
needed to investigate the causes for PHCWs’ increased stress and
subjective burden, especially when taking into account the long-term effects of
the pandemic, which may lead to further challenges and an ever-increasing
workload, especially for PHCWs.
Cannabislegalisierung in Deutschland – Implikationen aufgrund
der Erfahrungen aus Uruguay, Kanada und den USA: ein narratives
Review
Authors: Neu Peter
Published: August 2023

Die Regierungskoalition (SPD, Grüne und FDP) haben sich im
Koalitionsvertrag auf eine Legalisierung von Cannabis zu Genusszwecken
für Erwachsene verständigt. Dieses Ziel soll 2023 umgesetzt
werden. Die Diskussion um eine Cannabislegalisierung wurde und wird von
verschiedenen Gruppierung aus Gesellschaft und Wissenschaft höchst
kontrovers diskutiert. Dieser Artikel soll übersichtsartig die
Regularien und Erfahrungen dreier Länder (Uruguay, Kanada und die USA)
mit bereits erfolgter Legalisierung vorstellen und mögliche
Implikationen für Deutschland diskutieren.
The Management of Posttraumatic Nasal Deformities
Authors: Kao W. Katherine , Ho Tang
Published: August 2023

Nasal bone fractures are the most common fractures of the facial skeleton and are often accompanied by bony, cartilaginous, and soft tissue injuries. These injuries are often complex, and when untreated or inadequately treated, can lead to posttraumatic nasal deformity. The most common deformities are the crooked nose and the saddle nose. Both deformities may result in significant cosmetic and functional concerns. The treatment of these deformities can be complex, requiring careful evaluation of the nose and thoughtful planning to correct the cosmetic deformity and restore functional integrity. The rhinoplasty surgeon will benefit from having a large repertoire of techniques to achieve these repairs. In this article, we discuss the options and concepts for the management of nasal bone fractures as well as complicated posttraumatic nasal deformity. Level of evidence is not available.
Hypoxia Due to a Large Right to Left Interatrial Shunt with Normal Right-Sided Filling Pressures in the Setting of a Separation between the Septum Primum and Secundum: A Case Report
Authors: Shammas Nicolas W. , Keyes Kathleen , Witcik William , Robken Jon , Coyne Edmund , Wong Humphrey
Published: August 2023

Hypoxia secondary to right to left interatrial shunting in the setting of normal right-sided filling pressure is an uncommon clinical presentation. We present a case of persistent hypoxia irrespective of body position in a patient with a wide separation between the septum primum and secundum, creating a tunnel channeling flow from the right to the left atrium. Hypoxia resolved instantly following closure of the defect with an Amplatzer occluder under intracardiac echocardiography guidance. Although platypnea-orthodeoxia leads to hypoxia in the setting of normal right-sided filling pressures, the finding of a coexisting wide gap between the septum primum and secundum is likely to have worsened the hypoxia making it severe irrespective of body position. Closure of the interatrial septal defect led to immediate and sustained resolution of the hypoxia.
Role of Lateral Pelvic Node Dissection in Rectal Cancer Surgery
Authors: Ozgur Ilker , Gorgun Emre
Published: August 2023

The role of lateral pelvic lymph node dissection in the treatment of patients with locally advanced rectal cancer is a matter of controversy. Surgical practices in Korea and Japan have accepted this approach and are widely utilized; however, it is not routinely incorporated in the practice of countries in the Western hemisphere. This review will examine the role of lateral pelvic lymph node dissection.
Blood Gas Transport: Carriage of Oxygen and Carbon Dioxide in Blood
Authors: Wagner Peter D.
Published: August 2023

The ways in which oxygen (O2) and carbon dioxide (CO2) are carried in the blood are well known and well understood, with a plethora of textbooks, both general and lung specific, all presenting the topic in a very similar manner. This first of two companion chapters similarly summarizes this information. First, carriage of gases by physical solution is described, followed by discussion of O2, carbon monoxide, and CO2 transport in that order. However, what available texts have not emphasized is why knowing how gases are carried in blood matters, and the second, companion, chapter specifically addresses that critical aspect of gas exchange physiology. In fact, each of the chapters in this volume describes physiological behavior that depends more or less directly on the dissociation curves of O2 and CO2.
Blood Gas Transport: Implications for O2 and CO2 Exchange in Lungs and Tissues
Authors: Wagner Peter D.
Published: August 2023

The well-known ways in which O2 and CO2 (and other gases) are carried in the blood were presented in the preceding chapter. However, what the many available texts about O2 and CO2 transport do not emphasize is why knowing how gases are carried in blood matters, and this second, companion, article specifically addresses that critical aspect of gas exchange physiology. During gas exchange, both at the lungs and in the peripheral tissues, it is the shapes and the slopes of the O2 and CO2 binding curves that explain almost all of the behaviors of each gas and the quantitative differences observed between them. This conclusion is derived from first principle considerations of the gas exchange processes. Dissociation curve shape and slope differences explain most of the differences between O2 and CO2 in both diffusive exchange in the lungs and tissues and convective exchange/transport in, and between, the lungs and tissues. In fact, each of the chapters in this volume describes physiological behavior that depends more or less directly on the dissociation curves of O2 and CO2.
Ischemic stroke risk factors not included in the CHADS-VASC score in patients with non-valvular atrial fibrillation
Authors: Le Goff Laurine , Demuth Stanislas , Fickl Andreas , Muresan Lucian
Published: August 2023

Background In patients with atrial fibrillation, the CHA2DS2-VASC score guides stroke prevention using anticoagulants, but it is an imperfect score. Other potential risk factors such as renal failure, the type of atrial fibrillation, active smoking, cancer, sleep apnea or systemic inflammation have less well been investigated.

Objective To assess the impact of these factors on ischemic stroke risk in patients with non-valvular atrial fibrillation.

Methods On a population of 248 patients (124 patients with acute ischemic stroke and 124 controls), we performed a logistic regression to assess the impact of multiple non-classic risk factors for the prediction of acute ischemic stroke. Their impact on mortality was assessed by performing a survival analysis.

Results A high CHA2DS2-VASc score (OR 1.75; 95% CI 1.13–2.70; p = 0.032), treatment with anticoagulants (OR 0.19; 95% CI 0.07–0.51; p < 0.001) and permanent atrial fibrillation (OR 6.31; 95% CI 2.46–16.19; p < 0.001) were independently associated with acute ischemic stroke. Renal failure and chronic obstructive pulmonary disease predicted a higher mortality. After adjusting for age, sex, the CHA2DS2-VASc score and the use of anticoagulants, the only risk factor predictive for acute ischemic stroke was the permanent type of AF (OR: 8.0 [95% CI 2.5–25.5], p < 0.001).

Conclusions The CHA2DS2-VASc score, the absence of anticoagulants and the permanent type of atrial fibrillation were the main predictive factors for the occurrence of acute ischemic stroke. Larger studies are necessary for conclusive results about other factors.
Clinical Trials in Facial Plastic and Reconstructive Surgery
Authors: Okifo Oghenefejiro , Brown Taylor , Boyd Charles
Published: August 2023

Many facial plastic and reconstructive surgery providers are interested in incorporating clinical trials into their own practice. Clinical trials in facial plastics have made key contributions to current practices. Clinical trials range from investigating the safety and efficacy of Juvederm filler to reducing pain associated with injecting Juvederm. This article summarizes landmark clinical trials in facial plastic and reconstructive surgery and provides a framework for providers to get involved in clinical trials.