bluuebunny/crossref_metadata_2025 huggingface dataset:
Cerebral Blood Flow During Cardiopulmonary Bypass
Authors: Murkin John M.
Published: August 2023

This article reviews the development of cerebral blood flow techniques as used both clinically and experimentally formeasurementofcerebralbloodflow(CBF)andcerebral metabolic rate for oxygen (CMRO2) during cardiopulmonary bypass (CPB). The limitations associated with the various techniques for measurement of CBF during cardiopulmonary bypass are discussed, as well as considering the influence of some of the management options, including pH management and use of pulsatile or non pulsatile perfusion, on CBF and CMRO2 The impact of various perfusion techniques on neurological outcome following cardiopulmonary bypass is also considered.
Clinical Evaluation of a New Saturation/Hematocrit Monitor
Authors: Miller Mark F. , Luckenbach Jeff , Chen Chao
Published: August 2023

The purpose of this study was to evaluate the utility of the Cobe SAT/HCT Monitor, an in-line device which continuously displays hematocrit and venous oxygen saturation. A fiber optic cable was used to connect the monitor to a “window” on the blood inlet of a venous reservoir (Cobe CML). Sixty venous blood samples were drawn from 20 patients undergoing cardiopulmonary bypass. Statistical correlations were performed comparing monitorreadings with controls measured by an IL 482 co-oximeter and a TRIAC centrifuge. Results showed a high degree of correlation between the monitor and control values for both venous saturation (r = .96) and for hematocrit (r= .94). Although this device has some minor deficiencies, it is a useful tool which enables the perfusionist to monitor two important components of oxygen consumption.
Blood Substitution: An Experimental Study
Authors: Elrifai Amr M. , Bailes Julian E. , Leavitt Marc L. , Teeple Edward , Shih Shou-Ren , Taylor Michael J. , Maroon Joseph C. , Ciongoli Kimberly A. , Bazmi Babak , Devenyi Cecilia , Rosenberg Ian
Published: August 2023

Priming fluids for cardiopulmonary bypass have been extremely varied, with resultant hemodilution. Furthermore, major surgeries utilizing cardiopulmonary bypass require multiple postoperative transfusions of blood and blood products. The appeal of having a readily available blood substitute for major cardiovascular and neurosurgical operations could prove to be a life saver, while also eliminating the risk of diseases transmitted by transfusion. Blood substitutes could also lessen the reported complications resulting from blood damage due to prolonged circulation of the blood by the extracorporeal pump. A technique was examined in 15 dogs using hypothermia for maximum metabolic suppression, incorporating an aqueous blood substitute (Cryomedical Sciences, Inc., Rockville, MD). The anesthetized animals were cannulated for extracorporeal pump oxygenation. As temperature was lowered the dogs were exsanguinated and volume replaced with blood substitute to lower the hematocrit to <1 %. After 3 hours of cardiac arrest and continuous perfusion at a core temperature < 10°C, rewarming began. When temperature reached ≥ 10°C, the blood substitute was drained and the animals were autotransfused. The heart was started at l5°C and spontaneous respiration resumed at 29°C. Using the first generation blood substitute the survival rate was maximal (100%) at 2.5 hrs under 10°C and 3 hours of cardiac arrest. Research is underway on a new blood substitute, which is to serve as a universal hypothermic preservation solution (in situ organ preservation). When perfected, combining total blood substitution and cooling to ultraprofound (< 10°C) levels may prove beneficial in sustaining cerebral ischemia for prolonged time periods, without incurring major metabolic debt. This may provide significant benefits for neurovascular surgery by prolonging the safe limits of cardiac arrest for several hours, rendering currently inoperable tumors and aneurysms more approachable, as well as a multitude of cardiovascular applications. In addition, this technique could find application in other interventional techniques, including systemic trauma resuscitation and transplantation cases.
Motivating Adult Learners with Effective feedback
Authors: Dake Sue Boettcher , Taylor James A.
Published: August 2023

Although students are ultimately responsible for their own motivation, instructors can use techniques of goalsetting and clear, constructive negative and positive feedback to give learners an accurate sense of their own competence and to help stimulate them to reach their full potential. Many perfusion technology instructors fail to use these techniques effectively.

Clinical objectives are devised in such a way to make it immediately clear whether the student’s performance measures up. The learner, the instructor or both can develop these job-oriented objectives.

Some believe that feedback is the number one motivator of people. Negative and positive feedback techniques and ways to defuse defensiveness are discussed. Feedback should be objective, timely, accurate and based on first-hand data. Feedback should be focused on the behavior, not the person. “Gunnysacking,” “pimping” and other destructive feedback should be avoided because evidence suggests that it de-motivates adult learners. Any emotional response on the part of the instructor should be communicated in an “I message.” Feedback provided to students should deal with specific behaviors, not generalizations. Self-assessment and life-long learning skills can be fostered in learners by asking them to appraise their own performance and suggest ways they think such performance might be improved.
Heparin Washout in the Pediatric Cell Saver® Bowl
Authors: Sistino Joseph J. , Owitz David , Mongero Linda B.
Published: August 2023

The possibility of residual heparin in washed red cells transfused to neonatal or pediatric cardiac patients following bypass prompted a measurement of heparin concentrations. Samples were taken during 10 adult and 10 neonatal and pediatric bypass cases. Sample A was from the bypass circuit, Sample B from the Haemonetics Cell Saver bowl inlet before washing, Sample C from the Cell Saver bowl outlet after washing, and Sample D from the patient ten minutes after protamine. Heparin concentrations were measured by a chromogenic assay using activated Factor X.

There was no significant difference between the adult and pediatric groups in the levels of heparin concentration on bypass, pre-washing and post-washing, and in the patients following protamine. In the pediatric group, only .002% of the pre-washed heparin remained after washing. This extremely low level of heparin (.0027 units/ml) is only 0.34 units in a 125 ml pediatric unit of Cell Saver blood. Based on post bypass patient samples, this has no clinical significance. Therefore, the Cell Saver can be used safely with neonates and pediatric patients without concern regarding residual heparin when properly processed.
How to Do It: Utilizing Risk Stratification to Evaluate Outcomes in Adult Open-Heart Operations
Authors: Dickinson Timothy A.
Published: August 2023

The purpose of this study is to demonstrate that by using a proven method of stratifying open-heart operations into levels of predicted mortality, hospitals can closely monitor trends of their open-heart programs and possibly improve the health planning decisions for their institution. A proven method of uniform risk stratification utilizing objective and readily available preoperative patient data was implemented at our institution for a 12 month period (September I, 1991 through August 31, 1992). A total of 367 patients were included in this study. The patients were categorized into four risk ranges (0 to 4% good risk, 5 to 9% fair risk, 10 to 14% poor risk, and ≥ 15% high risk) indicating a predictive percent probability of operative mortality. The number patients categorized as either 0 to 4% good risk, 5 to 9% fair risk, 10 to 14% poor risk, and ≥ 15% high risk were46, 74, 84and 163, respectively. The patient's average post -operative length of stay in each risk tegory was 7.6 days, 8.2 days, 10 days and 12 days, respectively.

The patient's average total hospital charges in each risk category were $48,241,$53,531,$60,416 and $75,555, respectively. This information has helped our hospital administration make relevant and objective decisions concerning our open-heart program. Uniform risk stratification( outcomes research) should be incorporated into all adult open-heart surgery programs because it is simple, inexpensive, and can evaluate the outcomes and cost of open-heart surgery.
Safety of Heparin-Coated Circuits in Primates During Deep Hypothermic Cardiopulmonary Bypass
Authors: Sistino Joseph J. , Michler Robert E. , Mongero Linda B. , Schwartz Arthur , Marboe Charles , Geiman Richard , Kwiatkowski Pawel
Published: August 2023

The purpose of this study is to evaluate the biologic impact of heparin-coated circuits without systemic heparinization during deep hypothermia. Baboons (n=6) were placed on a heparin-coated pediatric closed-circuit cardiopulmonary bypass (CPB) system and cooled to l8°C. A control group (n=7) underwent similar protocol with a non heparin-coated circuit and received systemic heparin. Either low flow at 0.5 L/min/m2 (n=8; 4 in each group) or circulatory arrest (n=5; 2 in experimental group and 3 in control group) was used during deep hypothermia. Samples for complete blood count (CBC), hepatic and renal function tests, activated clotting time (ACT) and thrombelastogram (TEG) were obtained before, during, and after bypass. Cerebral blood flow was measured using Xenon-133 and autopsies were performed to assess end-organ damage.

The ACT returned to baseline in both groups, and renal and hepatic function were within normal limits. There was no significant difference between the TEG values between the groups post bypass. Fibrin split products were absent and fibrinogen levels were normal in both groups following bypass. Cerebral blood flows were equivalent in both groups before and after bypass, although in the heparin-coated group cerebral blood flows were significantly higher during CPB.

There were no brain histologic changes in the heparin-coated group and one focal cortical infarct in the control group. This study suggests that hypothermia induced a state of anticoagulation that did not result in thrombus formation or end organ dysfunction during CPB with a heparin-coated circuit. Safe use of these circuits without any systemic anticoagulation should be limited to conditions where the patient’s coagulation time is prolonged such as hypothermia.
The Effects of Platelet-Rich-Plasma on Post-Cardiopulmonary Bypass Fibrinolysis
Authors: Stammers Alfred H. , Rasmussen Caroline , Kratz John M.
Published: August 2023

Postoperative hemorrhage associated with cardiac surgery continues to be a major source of significant patient morbidity. Cardiopulmonary bypass (CPB) induces a number of hemostatic alterations which include platelet defects and coagulation factor imbalances. In addition, the fibrinolytic system is stimulated by CPB, adversely affecting the stability of the fibrin network, leading to early clot dissolution. Various techniques for reducing post-CPB bleeding have been studied, and have included plasmapheresis and the collection of autologous platelet-rich-plasma (PRP). The present study examined the effects of autotransfusing PRP in cardiac surgery patients and the associated effects on fibrinolysis.

Twenty-six patients were diagnosed with fibrinolysis by whole blood elastokinetic monitoring (thrombelastography- TEG). The diagnosis of fibrinolysis was determined from the post-CPB TEG profile when clot dissolution exceeded 50% of the developed clot 30 minutes following protamine administration. Thirteen patients had been treated with PRP and 13 had not (Control- CTR).

There were no differences seen in preoperative or operative parameters between the two groups, nor were there differences in routine laboratory coagulation tests. Total platelet yeild in the PRP group was 1.2 ± 0.6 X 1011. Patients in the CTR group had a total blood exposure of 39.4 ± 43.4 units compared to 8.6 ± 11.2 in the PRP patients (p<.02). This study supports the finding that CPB induces a fibrinolytic state, causing significant postoperative hemorrhage, which can be partially ameliorated by the infusion of autologous platelet-rich-plasma.
Clinical Comparisons of Continuous Venous Oxygen Saturation and Hematocrit Monitors in Pediatric Surgery
Authors: Bennett Denise , Burnside Jeff , Langwell Jim , Beckley Philip D.
Published: August 2023

Continuous venous oxygen saturation and hematocrit values are important parameters in assessing patient status while on cardiopulmonary bypass. Two devices used to measure continuous venous oxygen saturation while on cardiopulmonary bypass were compared to a control. The Bentley Oxysat meter and the Medtronic MX2 Oxygen Saturation and Hematocrit System were compared to the ABL500 blood gas monitor. The continuous hematocrit readings from the MX2 system were compared to spun hematocrits. Twenty-nine pediatric patients ranging from 2.3kg - 43.3kg were randomly selected. In-line optical transmission cells used were 1/4" or 3/8" depending upon the patient's blood tlow requirements. A total of 163 data points were analyzed at different blood flow rates, temperatures, and hematocrits. The venous oxygen saturation values obtained from the Oxysat and the MX2 devices correlated well with the ABL500 over the entire range of blood flows, temperatures, and hematocrits. All correlation coefficients were greater than 0.89. The correlation betweeen the MX2 device and the spun hematocrit varied with temperature ranges. The correlation coefficient tended to decrease with decreasing temperature. We conclude that these devices are important adjuncts to bypass as long as their limitations are understood.
A Modification of the Sarns Conducer Heat Exchanger as a Low Prime Pediatric Cardioplegia System
Authors: Gorney Ronald , Molina Jorge , Reynolds Timothy
Published: August 2023

Cardioplegia deli very systems require significant modifications to accommodate the small pediatric patient. This new system employs the combination of a low prime heat exchanger, recirculation line systems and an open reservoir for use in both blood and crystalloid cardioplegia circuits. This modification is designed to minimize priming volume to approximately 50 ml, making it suitable for the very small patient. Simple tubing and reservoir variations can be made for the larger patient while still demonstrating excellent cooling, mixing and blood flow capability while safely delivering cardioplegia to the pediatric patient.
Isolated Coronary Graft Perfusion Prior to Cardiopulmonary Bypass During Cardiac Reoperations: A Case Report
Authors: Komorowski Benjamin , Mantell Peter , Kron Irving , Sprinkle Linda , Zacour Richard
Published: August 2023

A 67 year old male presented to our service with angina, syncope, and dyspnea on exertion. He had had a three vessel coronary artery bypass ten years ago and had been asymptomatic until this time. A repeat cardiac catheterization revealed aortic valvular stenosis, left carotid artery stenosis, and restenosis of the left circumflex, anterior descending, and right coronary artery vein grafts.

During sternal reentry, the left circumflex graft was inadvertently divided. Shortly thereafter, antero-lateral wall ischemia became evident on the electrocardiogram. The transesophageal echocardiogram revealed acute akinesis of the lateral ventricular wall. The divided graft was cannulated with a 3 mm vessel cannula and secured with a tie. The 4:1 blood cardioplegia system was flushed with a balanced electrolyte solution to remove all cardioplegia solution. Autologous washed red blood cells and homologous packed red blood cells were added to the pump prime. The blood cardioplegia system was used to deliver warm, oxygenated blood to the graft. Graft perfusion was performed for a total of 28 minutes prior to cardiopulmonary bypass. After completion of the surgery the patient was weaned from cardiopulmonary bypass without incident. He had an uncomplicated post-operative course and was discharged from the hospital in good condition.
Predicting Oxygenator Clinical Performance from Laboratory In-Vitro Testing
Authors: Griffith Kevin E. , Vasquez Marco R. , Beckley Philip D. , Lalone Brian J.
Published: August 2023

Knowledge and predictability of oxygenator performance is vital to safe and effective conduct of cardiopulmonary bypass. The determination of oxygenator performance in the laboratory, however, is carried out under a strict set of conditions established by the Association for the Advancement of Medical Instrumentation (AAMI). This performance data is oflimited value in the clinical setting where the perfusionist generally operates outside this set of parameters. This study (1) reports the laboratory performance characteristics of a hollow fiber membrane oxygenator (Sorin Monolyth), (2) uses this data to develop a model to predict performance under a wide range of clinical conditions, (3) compares predicted performance with clinical data collected at two open heart centers, and (4) reviews the complexities of comparing laboratory and clinical performance.

An in-vitro "oxygenator-deoxygenator" circuit was utilized to determine O2 and CO2 gas exchange, blood path pressure drop, and heat exchanger efficiency at a variety of blood and gas flows, under standard (AAMI) blood inlet conditions:

BF
02(a)
02(b)
02(c)
CO2(a)
CO2(b)
CO2(c)
PD
Che

3.0
210±7
196±8
177±6
109±4
186±8
237±8
29±8
0.67±0.03

4.0
264±13
241±18
226±10
147±8
246±13
300±17
44±10
0.59±0.04

5.0
326±15
307±10
272±7
174±4
285±7
356±7
48±10
0.55±0.02

where BF = blood flow rate (L/min); O2(a) = O2 transfer at FiO2 1.0 and Qg:Qb 1.0; O2(b) = O2 transfer at FiO2 0.8 and Qg:Qb 1.0;O2(c) = O2 transfer at FiO2 0.6 and Qg:Qb 1.0; CO2(a) = CO2 transfer at FiO2 1.0 and Qg:Qb 0.5; CO2(b) = CO2 transfer at Qg:Qb 1.0 and FiO2 1.0; CO2(c) = CO2 transfer at FiO2 1.0 and Qg:Qb 1.5 (all transfer values in ml/min); PD = blood path pressure drop (mmHg); Che = warming coefficient of heat exchange; values expressed as mean ± 1 SD

This laboratory performance data was compared to hospital and computer modeling data. Simple numerical comparison and analysis of variance of regression coefficients over groups indicated that some clinical parameters of performance (oxygen transfer and coefficient of heat exchange) were not predicted with the laboratory data. It is concluded that the laboratory performance data determined under strict controlled conditions may be of limited value in predicting clinical performance unless modeled to allow for variances in operating conditions.
Modified Ultrafiltration in Pediatric Cardiopulmonary Bypass
Authors: Darling Edward M. , Shearer Ian R. , Nanry Katharine , Kern Frank H. , Greeley William J. , Ungerleider Ross M. , Gaynor J. William
Published: August 2023

Cardiopulmonary bypass in children is frequently associated with increased capillary permeability resulting in increased total body water, tissue edema, and organ dysfunction. Hemodilution also occurs and may require transfusion. Modified ultrafiltration utilizes the extracorporeal circuit to perform hemofiltration of the patient immediately following cardiopulmonary bypass and has been shown to significantly reduce total body water and to improve hemodynamics. The circuit contents can be concentrated to reverse hemodilution without transfusion. This report describes circuit modifications, management, and preliminary results of modified ultrafiltration in 23 infants and children following cardiopulmonary bypass.
Indikation und operative Verfahren bei MEN1-assoziierten duodenopankreatischen neuroendokrinen Neoplasien
Authors: Manoharan Jerena , Albers Max , Bartsch Detlef K
Published: August 2023

Die optimale Therapie von duodenopankreatischen neuroendokrinen Neoplasien (dpNEN), die im Rahmen der multiplen endokrinen Neoplasie Typ 1 auftreten, stellt nach wie vor eine große
Herausforderung dar und wird teilweise kontrovers diskutiert. Aufgrund der Rarität der Erkrankung fehlen prospektiv randomisierte Studien, sodass die meisten Empfehlungen bez. der
Operationsindikation und des -verfahrens auf retrospektiven Fallserien basieren. Prinzipiell ist eine operative Therapie bei nicht funktionellen dpNEN > 2 cm, bei Malignitätsverdacht und
bei funktionell aktiven dpNEN indiziert. Hierbei kommen eine Enukleation oder formale Pankreasresektionen mit oder ohne Lymphadenektomie in Betracht. Ziel der Therapie sollte es sein,
hormonassoziierte Symptome zu beseitigen und einem aggressiven metastasierenden Verlauf vorzubeugen. Zugleich sollte bei den zumeist jungen Patienten die Pankreasfunktion und Lebensqualität
durch möglichst parenchymsparende Resektionen erhalten werden.
Predictors and Trends in First-Trimester Hemoglobin A1c Screening in New York City, 2009 to 2017
Authors: Vieira Luciana , McCarthy Katharine , Liu Shelley H. , Huynh Mary , Kennedy Joseph , Chan Hiu Tai , Mayer Victoria L. , Tabaei Bahman , Howell Frances , Wye Gretchen Van , Howell Elizabeth A. , Janevic Teresa
Published: August 2023

Glycated hemoglobin is an adjunct tool in early pregnancy to assess glycemic control. We examined trends and maternal predictors for those who had A1c screening in early pregnancy using hospital discharge and vital registry data between 2009 and 2017 linked with the New York City A1C Registry (N = 798,312). First-trimester A1c screening increased from 2.3% in 2009 to 7.7% in 2017. The likelihood of screening became less targeted to high-risk patients over time, with a decrease in mean A1c values from 5.8% (95% confidence interval [CI]: 5.8, 5.9) to 5.3 (95% CI: 5.3, 5.4). The prevalence of gestational diabetes mellitus increased while testing became less discriminate for those with high-risk factors, including pregestational type 2 diabetes, chronic hypertension, obesity, age over 40 years, as well as Asian or Black non-Hispanic race/ethnicity.

Key Points
Risk of Preterm Delivery in Very Advanced Maternal Age Parturients Utilizing In Vitro Fertilization
Authors: Newman Rachel A. , Naqvi Mariam , Levian Candace , Smithson Sarah D. , Esakoff Tania
Published: August 2023

Objective Among patients ≥45 years, the birth rate in the United States continues to increase. As fertility declines with age, this cohort often utilizes assisted reproductive technology, specifically in vitro fertilization (IVF). While both advancing maternal age and IVF are independently associated with adverse maternal outcomes, data regarding their additive effect are scant. This article aims to determine if patients who conceive via IVF are at increased risk for preterm birth (PTB) compared to patients with non-IVF pregnancies in a very advanced maternal age (vAMA) cohort (≥45 years).

Study Design Retrospective cohort study of all pregnant patients ≥45 years old who delivered at a single institution (2014–2021). Those with incomplete delivery/neonatal records or multiples beyond twins were excluded. We compared individuals who conceived via IVF to those who conceived without IVF. The primary outcome was preterm delivery <37 weeks gestation. Secondary outcomes included other adverse perinatal outcomes. Using multivariable logistic regression, we adjusted for multiple gestation as well as confounders found to be significantly different in the univariable analysis and other known risk factors for PTB.

Results In our study cohort of 420 vAMA patients, individuals who underwent IVF were more likely to be older, privately insured, nulliparous, and with a twin gestation. The PTB rate in vAMA patients who underwent IVF was 24.4 compared to 8.4% in patients who did not use IVF (p < 0.001). After adjusting for confounders, IVF was an independent risk factor for PTB <37 weeks in vAMA patients (adjusted odds ratio {aOR] = 4.3, 95% confidence interval [CI]: 1.7–10.4, p = 0.001). In vitro fertilization was also associated with a composite of adverse maternal outcomes (hypertensive disorder of pregnancy, postpartum hemorrhage, blood transfusion, and unplanned hysterectomy) (aOR = 1.7, 95% CI: [1.1–2.9], p = 0.03).

Conclusion In the vAMA population, conception via IVF is associated with an increased risk of PTB <37 weeks.

Key Points
A novel concept of passive loop-forming wire-guided biliary cannulation using an ultra-deep angled tip guidewire (with video)
Authors: Ban Tesshin , Kubota Yoshimasa , Takahama Takuya , Sasoh Shun , Tanida Satoshi , Ando Tomoaki , Nakamura Makoto , Joh Takashi
Published: August 2023

Background and study aims Wire-guided biliary cannulation (WGBC) is a standard technique during endoscopic retrograde cholangiopancreatography-related interventions. However, no dedicated guidewire is available. We investigated a novel “passive loop-forming WGBC” concept using a 0.035-inch ultra-deep angled tip guidewire.

Patients and methods This single-arm, single-center, retrospective study included consecutive 111 patients who underwent passive loop-forming WGBC as the first biliary intervention between October 2021 and December 2022.

Results WGBCs were completed within 5 minutes and overall were performed at a median papillary negotiation time of 81 seconds (interquartile range [IQR], 39–170) and 114 seconds (IQR, 49–303) in 83 (74.8%) and 106 (95.5%) cases, respectively. Logistic regression analysis identified age ≥ 80 years (odds ratio [OR]: 3.56, 95% confidence interval [CI]: 1.12–11.31) and unintentional pancreatic guidewire insertion (OR: 17.67, 95% CI: 5.75–54.31) as significant risk factors for failed WGBC within 5 minutes. Among the 106 obtained cannulations, the guidewire leading part formed a small-looped tip and wide-looped body in 83 (78.3%) and 23 (21.7%) cases, respectively. Adverse events included post-procedure pancreatitis (2/111 [1.8%]) and guidewire penetration (3/111 [2.7%]).

Conclusions Passive loop-forming WGBC using an ultra-deep angled tip guidewire is a feasible procedure.
Improved Synthesis of Unsymmetrical Ureas via Carbamates
Authors: Gill Manjinder Singh , Prachi Ramteke , Tanwar Dinesh Kumar
Published: August 2023

An efficient, cost-effective, easy and green method is reported for the preparation of N,N′-alkyl aryl ureas and N,N′-dialkylureas via carbamates. This improved procedure is devoid of any hazardous reagents such as phosgene and isocyanates, and shows broad substrate scope with good to excellent yields. As compared to previous reports, this procedure offers an operationally simple, potentially scalable, and, significantly, benign way to synthesize these important urea motifs.
Efficient Synthesis of Chirally Enriched 1H-Imidazo[1,2-b]pyrazole- and 4H-Imidazo[1,2-b][1,2,4]triazole-Based Bioactive Glycohybrids
Authors: Sagar Ram , Mishra Vinay Kumar , Tiwari Ghanshyam , Khanna Ashish , Tyagi Rajdeep
Published: August 2023

Carbohydrates, traditionally known for their energy-providing role, have gained significant attention in drug discovery due to their diverse bioactivities and stereodiversity. However, pure carbohydrate molecules often exhibit limited bioactivity and suboptimal chemical and physical characteristics. To address these challenges, bioactive scaffolds have been incorporated into carbohydrate to enhance their bioactivity and improve their overall properties. Among the various heterocyclic structural motifs known for their pharmacological properties, imidazo-pyrazole and imidazo-triazole skeleton have gained larger attention among synthetic and medicinal chemists as they possess good biological and pharmacological properties. The incorporation of these bioactive scaffolds with carbohydrates adopting developed efficient synthetic protocol to synthesize new class of imidazo-pyrazole and imidazo-triazole glycohybrid molecules is reported. The carbohydrate-derived α-iodo-2,3-dihydro-4H-pyran-4-ones have been identified as suitable precursors, which were coupled with various aminopyrazoles and aminotriazoles to obtain designed glycohybrids. Thus, various imidazo-pyrazole and imidazo-triazole based glycohybrids have been prepared efficiently in good to excellent yields. These new glycohybrids were evaluated for their anticancer activity and selected compounds were found to possess submicromolar anticancer activity against MCF-7 breast cancer cell line. These molecules could potentially be developed as new chemical entities in pharmaceutical chemistry and may encourage the use of carbohydrates in stereo-divergent synthesis and drug discovery processes.
Total Hip Arthroplasties in Polio Survivors: A Systematic Review
Authors: Akadiri Michael , Smith Christian , Wong Fabian , Davidson Jerome
Published: August 2023

There is a paucity of evidence regarding outcomes of post-polio patients following total hip arthroplasty (THA). This systematic review examines the evidence regarding implant choice, surgical planning, outcomes, and complications for post-polio patients undergoing THA. A multidatabase literature search was performed. Included articles were assessed for methodological quality using the abridged Downs and Black's criteria. Data was extracted regarding patient demographics, intraoperative details, outcome measures, and postoperative complications. Six articles were included in this review; all were retrospective case series. One hundred and six hips in 97 patients underwent THA. There was no consensus regarding the optimal approach or implant fixation. Patient-reported outcome measures (PROMs) showed a demonstrable improvement following THA. Postoperative dislocation was more common compared with patients without post-polio syndrome. Patients with post-polio syndrome who undergo THA have beneficial outcomes as determined by improvements in PROMs. Higher quality research may not be possible due to the increasing rarity of patients suffering from polio.
Cystatin A Down-regulation in Head and Neck Squamous Cell Carcinoma Cell Lines Decreases Cancer Hallmark Signatures
Authors: Boora Geeta S. , Chauhan Anshika , Bal Amanjeet , Verma Roshan K. , Pal Arnab
Published: August 2023

Background

Cystatin A (CSTA), an endogenous inhibitor of lysosomal cysteine protease, is expressed primarily in epithelial tissues. The expression of CSTA was found to be dysregulated in various cancers and associated with cancer pathogenesis, but its role is reported to be contradictory. Our previous preliminary study found CSTA to be upregulated in the saliva and tissues of patients with head and neck squamous cell carcinoma (HNSCC). In this current study, we have explored the role of CSTA in the pathophysiology of HNSCC.

Methods

First, we confirmed the upregulation of CSTA in CAL 27 (p = 0.0242) and FaDu (p = 0.0014), two HNSCC cell lines, compared to the normal gingival epithelium. CSTA was then stably knocked down in CAL 27 and FaDu using the lentiviral short hairpin RNA pLKO vector transduction to study the effects of CSTA knockdown on various cancer hallmarks such as cell proliferation ability, invasion, migration, colony formation, and chemotherapy-induced apoptosis.

Results

CSTA knockdown significantly decreased cell viability, cell migration, transwell invasion, and colony formation in both cell lines. CSTA downregulation also enhanced cisplatin-induced apoptosis.

Conclusion

Overall, this study suggests the protumorigenic role of CSTA in HNSCC.
Customized Elastics Fabricated from Foley's Catheter for Traction in Maxillofacial Trauma
Authors: Kumar Jitendra , Lal Babu , Rai Anshul J. , Verma Dinesh K. , Alagarsamy Ragavi , Shakti Prateek
Published: August 2023

Like in orthopaedics, many maxillofacial fracture cases require elastic traction to control the muscle spasms, pain and aid in reduction of the fractured segments to achieve acceptable occlusion before the definitive management. In trauma and emergency hospital setup, sometimes conventional stock elastic bands are not readily available for the traction (non-rigid maxillo–mandibular fixation). In such cases, customized elastic bands, made from Foley's catheter, can be a better alternative. The current technique is hassle free and has ease of customization as per individual case due to easy availability of Foley's catheter in hospital setup.
Pediatric Renovascular Hypertension: A Pediatric Interventional Radiologist's Perspective
Authors: Goyal Kanav , Yadav Taruna , Garg Pawan Kumar , Khera Pushpinder , Tiwari Sarbesh , Rajagopal Rengarajan
Published: August 2023

Renovascular hypertension (RVH) contributes close to one-fourth of the secondary etiologies of hypertension in children and a delay in diagnosis can result in adverse clinical outcomes. RVH in children is clinically silent with elevations in blood pressure measurements sometimes as its sole manifestation. Only a high index of suspicion by the clinician can prompt its detection. Despite the availability of other imaging modalities like ultrasound, computed tomography, and magnetic resonance imaging, digital subtraction angiography is still considered the gold standard to make a diagnosis of RVH. Angioplasty is considered the treatment of choice in appropriately selected patients. In this article, we shall focus on the various imaging findings, and management of RVH in children, which requires a multidisciplinary approach with a special focus on the role of interventional radiology.
Rhinoplasty with Concurrent Repair of Septal Perforation
Authors: Jones Evan A. , Olson Krista L.
Published: August 2023

Concurrently performing septal perforation repair and rhinoplasty is challenging. Successful management of patients who require or desire these procedures performed simultaneously can be achieved with appropriate preoperative workup and optimization, thoughtful surgical planning, masterful execution, and diligent postoperative care. Consideration of perforation etiology and status of the perforation along with overall nasal health are the foundation upon which surgery may be planned. Preoperative evaluation to determine locations of obstruction, aesthetic goals, and feasibility of procedure is required. Rhinoplasty techniques and perforation closure techniques may share common maneuvers making concurrent surgery possible. Surgical techniques to achieve perforation closure often influence rhinoplasty considerations, and vice versa. Care must be taken to account and possibly even to capitalize on these influences. Perforation closure techniques that may be readily combined with rhinoplasty include interposition grafting and intranasal mucosal rotational advancement flaps, which may exert forces upon the nose with aesthetic or functional consequences. Rhinoplasty techniques targeting any third of the nose also can impact tension or available mucosa for perforation closure techniques. Combining these procedures can be very rewarding for the patient and provider but should be considered responsibly and thoughtfully.
Krankenhausreform: Einigung auf den kleinsten Nenner
Authors: Doelfs Guntram
Published: August 2023

Nach langwierigen Diskussionen haben sich Bund und Länder auf ein Eckpunktepapier zur Krankenhausreform verständigt, nur Bayern lehnte ab. Trotz der Einigung sind viele Details weiterhin unklar, die Kritik am Kompromiss ist groß. Weiterer Streit ist in Sicht.
7. MaRisk-Novelle: Nachhaltigkeit beeinflusst die Kreditvergabe
Authors: Kalden Ruth
Published: August 2023

Die Kreditwürdigkeit eines Krankenhauses orientiert sich seit Ende Juni nicht mehr nur an den wirtschaftlichen Zahlen, sondern auch an Nachhaltigkeitsfaktoren. Gesundheitseinrichtungen sollten daher eine Nachhaltigkeitsstrategie entwickeln und ihre Aktivitäten auf diesem Gebiet dokumentieren.
Universitätsklinikum Frankfurt: Echtzeit-Visualisierung in der ZNA
Authors: Kucera Martin
Published: August 2023

Seit Jahren steigen die Behandlungszahlen in den Notaufnahmen. Um dem Andrang Herr zu werden, nutzt das Universitätsklinikum Frankfurt ein System, mit dem sich der Patientenstrom in Echtzeit abbilden lässt. Das sorgt dafür, dass sich Prozessabläufe viel besser analysieren, steuern und optimieren lassen.
Introducing Bayesian belief updating as a method to counter improvised explosive devices: a qualitative case study on identifying human behaviours associated with explosive chemical precursor diversion
Authors: Collett Gareth , Ladyman Melissa , Temple Tracey , Hazael Rachael , McNaught Ken
Published: August 2023

Countering improvised explosive devices (C-IED) is a significant theme of the twenty-first century, particularly in regions with limited governance and a fragile rule of law. Many strands of activity are involved, with human interaction proving difficult to predict. However, Bayesian belief updating (used across several academic fields to provide insight into human behaviours) has never been considered. Given the breadth of C-IED, this research focusses on a state affected by conflict, and where illicit diversion of explosive chemical precursors (ECP) for IED manufacture is supported by the population. It aims to represent (both visually and probabilistically) a methodology by which human relationships could be better understood, thereby promoting belief updating as new evidence becomes available. Such belief updating would refine focus and improve resource mobilisation.
The heterotopia of the palace in Abdo Khal’s Throwing Sparks (2009)
Authors: Althagafy Raid
Published: August 2023

This article endeavors to negotiate Michel Foucault’s concept of heterotopia in Abdo Khal’s Booker-Award winning novel Throwing Sparks (2009). The central premise of this article is to offer a new understanding of spatiality, constituted by the simultaneous existences of ‘other’ spaces, which can be viewed in their relations as proximate to, contradictory to, or even reflective of each other. In this novel, the Palace is a real and symbolic space and/or place which oscillates between oppressive homogeneity and individualized depravity. The Palace in Throwing Sparks is a representational temporality that embodies the demarcation and relation between the ‘private’ and the ‘public’, allowing for a new site of material spatiality. The rise of an interstitial (heterotopic) space to fill in between the public and the private is what characterizes the Palace in the novel. It allows for the emergence of a whole landscape of power politics driven by the ramifications of the space and affecting its inhabitants. Since this space is analyzable, its inhabitants are overshadowed by its grander aura. In the Palace, the body does not belong to the individual and his/her own will. It rather belongs to the ‘institutionalized’ volition of the Palace in which ‘docility’ rather than subjectivity and agency is what remains as a performative practice for the survival of its inhabitants.
Information dissemination evolution under group feedback
Authors: Yang Y. , Nian F. Z. , Liu J. S.
Published: August 2023

In this paper, based on the feedback mechanism from the perspective of network groups, the evolutionary characteristics and laws of group networks under information dissemination are studied. First, the network is divided into groups of different sizes, and each group is given a dynamically changing group activity and a positive degree of response to different categories of information. Second, a feedback-based model of information dissemination in group networks is developed, which takes into account the differences between same-group and cross-group dissemination of information. Next, the model is applied to a scale-free network and a small-world network for simulation experiments. The experimental results show that, under the feedback mechanism, the main factor affecting the final evolutionary results of each group size in the small-world network is group positivity, which has little relationship with the initial size; similarly, the main factor affecting the average degree of each group in the scale-free network is also group positivity, which has nothing to do with the initial average degree. Finally, the method is applied to a real network to verify the rationality and effectiveness of the proposed model.
Multi-objective optimization of a muzzle brake to enhance overall performance
Authors: Zhao Xinyi , Lu Ye
Published: August 2023

The structure of a muzzle brake has a significant effect on the overall technical performance of an automatic weapon. This paper presents a multi-objective optimization of a muzzle brake that enhances the overall performance, that is, it increases the muzzle brake efficiency and simultaneously decreases the noise emanating from the rifle upon discharge. A standard impact-reaction muzzle brake was selected as the research object. The optimal values of four structural parameters were established through multi-objective optimization. The process consists of design of experiments, coupled computational fluid dynamics and computational acoustics calculations, an approximation model, and a multi-objective genetic algorithm. Based on the results, the correlation and sensitivity between the structural parameters and the objectives were investigated. Moreover, the reaction force and noise directivity of the optimized muzzle brake were compared with those of the original design. The results show that the disk angle of the side holes was the most sensitive design variable for both efficiency and noise. The optimized muzzle brake had a remarkable improvement in brake efficiency accompanied by only a small increase in the sound pressure level, so it showed better overall performance. The optimization method proposed in this paper is practical and effective for engineering design.
Improved method for simultaneous determination of thermal properties
Authors: Nagasawa Mitsuharu , Inoue Ryuunosuke , Nakanishi Takeshi , Morita Kengo
Published: August 2023

An improved method to simultaneously determine the heat capacity, thermal diffusivity, and thermal conductivity of a small-sized material is described. In this method, the heat of a square wave with a superimposed constant component is applied to one side of a plate-shaped sample using a thin-film heater, which is thermally linked to a heat reservoir. The response temperature is measured by a thermometer attached to the heater. In contrast to a previously reported method, the amplitude of the temperature oscillation detected by the thermometer is enhanced by the internal thermal relaxation in the improved method. This feature is advantageous for determining thermal properties with low-heat modulation. We theoretically analyzed the proposed method using a one-dimensional model and demonstrated the method on synthetic quartz (SiO2) and poly(methyl methacrylate) plates in the temperature range of 80–300 K. The thermal properties obtained for both samples using the proposed method were consistent with values reported in the literature. The deviations from the data for the specific heat capacity, thermal diffusivity, and thermal conductivity were estimated to be ∼1%, 2%, and 2%, respectively.
Method for estimating elastic modulus of doped semiconductors by using ab initio calculations—Doping effect on Young’s modulus of silicon crystal
Authors: Kamiyama Eiji , Sueoka Koji
Published: August 2023

A novel method for estimating the elastic modulus of doped semiconductors using ab initio calculation is demonstrated for a Si crystal. The elastic modulus of various materials basically depends on lattice constants on which dependence is shown by ab initio calculation and actually depends on the temperature, species, and concentration of doped atoms. This paper focuses on the dependences of species and concentrations of doped atoms at room temperature and shows the simplest procedure within Vegard’s law for estimating the elastic modulus of doped semiconductors.
Numerical investigation of non-planarity and relative motion for bionic slotted wings
Authors: Liu Dan , Cheng Jiaao , Song Bifeng , Yang Wenqing , Xue Dong
Published: August 2023

Bird wings have split primary feathers that extend out from the wing surface. This structure is called the wingtip slot, which is recognized as a product of bird evolution to improve flight performance. In this paper, numerical simulations based on RANS (Reynolds-averaged Navier–Stokes) equations are conducted to examine and understand the influence of wingtip slots on six wings at Re = 100 000. The overlapping grid method, driven by an in-house UDF (User Defined Function), is used to model the motion of the bionic slotted wings. The motion law of the winglets is improved based on the law extracted from a level-flying bald eagle. Then the aerodynamic force, pressure distribution, vorticity contours, wake stream, and other flow structures of the slotted wings with different layouts were compared and analyzed. The results show a significant increase in aerodynamic force when the slotted wingtips are employed. The maximum lift-to-drag ratio is also improved in our designed wing model with a non-planar wingtip by a maximum of 34% from the base wing. Each winglet works as a single wing due to the existence of slots, with a chordwise pressure distribution similar to that of the main wing. The vortex structures of slotted wings show expressive changes in the tip vortex as compared with the base wing. Additionally, an innovative bionic slotted wing is proposed with a dynamic wingtip that forms varying gaps between winglets. Due to the collective mechanism of aerodynamic interaction among multiple winglets for the innovative wing, it acquires the optimal time-averaged force during a flapping period. As expected, the slotted wingtip reduces the main wingtip vortex intensity and creates weaker vortices. The non-planarity and relative motion of the wingtip strengthen its weakening effect on the wingtip vortex and wake.
Designing spiking neural networks for robust and reconfigurable computation
Authors: Börner Georg , Schittler Neves Fabio , Timme Marc
Published: August 2023

Networks of spiking neurons constitute analog systems capable of effective and resilient computing. Recent work has shown that networks of symmetrically connected inhibitory neurons may implement basic computations such that they are resilient to system disruption. For instance, if the functionality of one neuron is lost (e.g., the neuron, along with its connections, is removed), the system may be robustly reconfigured by adapting only one global system parameter. How to effectively adapt network parameters to robustly perform a given computation is still unclear. Here, we present an analytical approach to derive such parameters. Specifically, we analyze k-winners-takes-all (k-WTA) computations, basic computational tasks of identifying the k largest signals from a total of N input signals from which one can construct any computation. We identify and characterize different dynamical regimes and provide analytical expressions for the transitions between different numbers k of winners as a function of both input and network parameters. Our results thereby provide analytical insights about the dynamics underlying k-winner-takes-all functionality as well as an effective way of designing spiking neural network computing systems implementing disruption-resilient dynamics.
Generalized element-node complete model and its implementation for the optimal design of a piezo-actuated compliant amplifier
Authors: Wang Kaijie , Huang Peng , Liu Qiang , Zhu LiMin , Zhu Zhiwei
Published: August 2023

Compliant amplification mechanisms are widely applied to extend the stroke of stacked piezoelectric actuators. Accurate modeling of static and dynamic performances is crucial for the optimal design of complex compliant mechanisms. By generalizing the planar element-node model-based finite element method, this paper proposes a new modeling method capable of describing the spatial complete kinetostatics and dynamics for compliant mechanisms. On the basis of the widely reported complete compliance models for flexure hinges, a versatile stiffness model is established for the hinge with an arbitrary notch shape through the force equilibrium model. The generalized model is then demonstrated by applying for modeling and optimizing a compliant mechanism with dual-stage amplification. The verification through finite element simulations suggests that the maximum modeling error for the kinetostatic and first six resonant frequencies for the mechanisms with and without structural optimizations is less than 20%. Finally, the open-loop and closed-loop performance tests on the prototype with optimized parameters are conducted, demonstrating the effectiveness of the developed modeling and optimization methods.