bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on Combined Sewer Overflow (CSO) Pollution and Its Control Method Based on Sewage Interception Along Rivers
Authors: Zhang Baohua , Lin Xiaohu , Li Maolin , Fang Haifeng , Li Shiyi , Fu Shengjie , Zhou Wenming
Published: July 2023

Combined sewer overflow (CSO) pollution is the main factor that plagues the water environment in the area with combined sewer system in most cities of China. This paper analyzed CSO pollution, and reviewed the measures to solve CSO pollution and the latest research progress. The problems of traditional river interception projects were analyzed, and optimization and improvement ideas were proposed. Finally, a combined optimization scheme of source reduction-process control-end storage was proposed to control CSO pollution, which could provide reference for urban CSO pollution control in China.
Configuration of Submerged Plants for Plain River Networks Based on Transparency Improvement
Authors: Zhang Xi , Zhang Jing , Xie Yangcun , Chen Tianpeng , Zhao Jinyong
Published: July 2023

The configuration of submerged plants plays an important role in the restoration of river networks. In this study, the Sudong River, a typical plain river network in southern China, was selected for submerged plant configuration research to improve water transparency. Analysis of historical and field research data of Sudong River showed that most of the water was in a state of eutrophication. The main factors affecting transparency were water temperature, ammonia nitrogen, chlorophyll a, total phosphorus, and permanganate index, which were identified through correlation analysis using SPSS. Submerged plants are important for water ecological restoration, and a plant selection evaluation system was constructed to screen six suitable local submerged plants in Suzhou for ecological restoration based on secondary indicators divided into five segments. Each plant was evaluated and scored. Finally, a combination of three submerged plants, Ceratophyllum demersum, Watermifoil, and Foxtail algae, was selected based on their scores. This combination effectively improved the eutrophication status of water and increased water transparency while adhering to the laws of submerged plant succession and facilitating the construction of a stable aquatic ecosystem.
SO3 Migration and Emission Characteristics of CFB Boilers
Authors: Zhu Yujie , Han Yuan
Published: July 2023

In order to study the migration and transformation of SO3 from circulating fluidized bed boiler (CFB) in the air preheater and flue gas treatment facilities, 10 circulating fluidized bed boilers with installed capacities between 150 MW and 330 MW were measured by controlled condensation method. Ten circulating fluidized bed boilers with installed capacities ranging from 150 MW to 330 MW were measured using the controlled condensation method. It is showed that the SO3 removal rate of the air preheater was affected by the air preheater flue gas exit temperature, which ranged from 6.7 % to 36.5 %, and the SO3 removal rate of the rotary air preheater was higher than that of the tubular air preheater. The SO3 removal rate of cloth bag filter and electric bag filter is above 40 %; the SO3 removal rate of electrostatic precipitator is between 6.1 % and 10.8 %. The SO3 removal rate of wet desulfurization method ranges from 41.7 % to 73.4 %, with the highest SO3 removal rate of double tower double cycle. The SO3 removal rate of off-furnace CFB semi-dry desulfurization reached 89.7 %~97.9 %, and the dry process inside the furnace + off-furnace CFB semi-dry process could reduce the SO3 at the desulfurization outlet to below 0.3 mg/m3 under the tested conditions. The conclusions of the test analysis in this paper can provide reference for SO3 control in circulating fluidized bed boilers and related policy formulation.
Calculation and Analysis of Carbon Emissions in the Construction Industry of Zhejiang Province
Authors: Wang Hanyun , Tan Chen , Wang Tao , Wang Shengteng , Huang Jihua , Xu Hao
Published: July 2023

High rise buildings with large volume, high energy consumption, and high carbon emission base have become the focus of emission reduction work in public building types. The key issue of reducing carbon emissions throughout the entire lifecycle of high-rise buildings is how to predict their carbon emissions during the design phase, which is also a current research hotspot. As a developed province in southern China, Zhejiang bears important emission reduction tasks and responsibilities in the construction industry. This article applies the carbon emission factor method to calculate the carbon dioxide emissions in the construction sector of Zhejiang Province from 2005 to 2022. Based on Kaya’s identity, a carbon emission calculation model is established. Combined with scenario analysis method, the carbon emissions in the construction sector of Zhejiang Province from 2023 to 2060 are predicted and compared under different scenarios. The results show that under the scenario of technological breakthrough, the construction field can achieve the carbon peak goal by 2025, but in order to achieve the carbon neutrality goal by 2060, the existing energy conservation measures and carbon reduction technologies need to be strengthened.
Risk Assessment of Flood Disaster in Sichuan Province Based on GIS
Authors: Guo Jin , Wang Jian , Zhao Xiaochen
Published: July 2023

In the context of global climate change, flood disaster has become one of the significant disasters endangering human life. Sichuan Province has more annual precipitation and complex landforms, which suffer from yearly floods. To reveal the spatial distribution and spatiotemporal dynamic change characteristics, we developed a risk assessment model based on geographic information systems and natural disaster risk assessment theory. Considering both natural and human factors, precipitation, terrain, climate type, population, and GDP are selected as evaluation indexes. We Used the expert score-AHP method to obtain the annual flood disaster risk regionalization from 2017 to 2021. In the end, the results were compared with the entropy weight method in the objective weighting method. The results showed that the comprehensive flood disaster risk in Sichuan Province is higher in the east and lower in the west. The flood disaster risk in the eastern hill area, Panxi area, and northeast Sichuan Basin is generally higher. In contrast, that in the west Sichuan Plateau is lower. Based on the evaluation results, it is found that the risk assessment of flood disasters based on expert scoring-AHP method is more in line with the actual situation.
A Study on Risk Assessment of Geological Disasters in Pingba District of Guizhou Province Based on GIS
Authors: Zhu Qirong , Yuan Haosen , Wang Lin , Zeng Canghai
Published: July 2023

To conduct regional geological disaster risk evaluation zoning in a scientific and reasonable manner, and provide a decision basis for local territorial spatial planning, geological disaster risk prevention and control, and disaster prevention and mitigation work. This study, on the basis of collecting relevant data sources and field investigation, comprehensively analyzed and studied the geological environmental conditions of disaster pregnancy and the development and distribution pattern of current disasters in Pingba District, built an information volume model for susceptibility evaluation based on the influence factors of known disaster areas, and also reasonably determined the hazard and vulnerability evaluation model by combining the characteristics within Pingba District, thus making the risk evaluation of the county highly accurate, operable and scientific, and the results of its risk evaluation zone zoning are more consistent with he reality within the county. The risk evaluation methods and processes described above are synthesized with a view to providing reference and guidance for their application in similar work.
A Study on the Planting Effect of Highway Ecological Slope Protection
Authors: Liu Ying , Song Zixuan , Ma Lijie
Published: July 2023

An analysis of the current situation of ecological slope protection is conducted to obtain a more optimized ecological slope protection scheme, in which major factors influencing the effect of ecological slope protection constitute the object of analysis. Based on optimum grass seed combination, grass and legume plant matching with better growth effects are chosen, and the mix proportion of plant-growing medium which is the best for plant growth is determined, reflecting the application of plants in ecological slope protection and providing reference for subsequent slope protection projects.
Accuracy of Temperature Measurement in the Cardiopulmonary Bypass Circuit
Authors: Newland Richard F. , Sanderson Andrew J. , Baker Robert A.
Published: July 2023

Oxygenator arterial outlet blood temperature is routinely measured in the cardiopulmonary bypass (CPB) circuit as a surrogate for the temperature of the arterial blood delivered to sensitive organs such as the brain. The aim of this study was to evaluate the accuracy of the temperature thermistors used in the Terumo Capiox® SX25 oxygenator and to compare the temperature measured at the outlet of the oxygenator using the Capiox® CX*TL Luer Thermistor with temperatures measured at distal sites. Five experimental stages were performed in vitro to achieve this aim. Under our experimental conditions, the luer thermistors accurately measured the temperature as referenced by a precision thermometer. In the CPB circuit, the difference between arterial outlet and reference thermometer temperature varied with outlet temperature over-reading at low temperatures and under reading at high temperatures. There was negligible heat loss (−0.4 ± 0.1°C) measured at 4.5 m from the arterial outlet. The Terumo Capiox® CX*TL Luer Thermistor is an accurate and reliable instrument for measuring temperature when incorporated into the Capiox Oxygenator. The accuracy in the measurement of temperature using these thermistors is affected by the thermistor immersion depth. Under reading of the arterial blood temperature by approximately 0.5°C should be considered at normothermic temperatures, to avoid exceeding the maximum arterial blood temperature as described by institutional protocols. The accuracy of blood temperature measurements should be considered for all oxygenator arterial outlet temperature probes.
Predicting Blood Usage in Cardiac Surgery—The Transfusion Predictor Product
Authors: McDonald Michael B. , McMillan James
Published: July 2023

Blood cross-matched for patients undergoing cardiac surgery is used infrequently and represents a significant cost. We investigated the ability to predict the need for intraoperative transfusion. We hypothesized that red blood cell volume is a predictor because dilution is the primary cause for transfusion requirement intraoperatively. A total of 401 consecutive patients having cardiothoracic surgery requiring the use of cardiopulmonary bypass were retrospectively analyzed by revision of their perfusion record. This sample included 82% elective, 17% urgent, and 1% emergency procedures. The product of body surface area and preoperative hemoglobin gave us gHb/l/m2, which are the units of the Transfusion Predictor Product (TPPu). Mean patient age was 66.9 ± 10.7 years, and 112 (28%) were women. Mean TPP was 257.2 ± 45.5u. 52 patients (13%) received red blood cells intraoperatively. At less than TPP 211.7u, one standard deviation below the mean value, 32 patients of 69 (46%) received blood transfusion intraoperatively (p < 0.001). At a TPP greater than 211.7u, 20 patients of 322 (6%) had blood transfusion intraoperatively. Patients with a TPP > 211.7u do not require routine cross-matching of blood. Cross-matching for these patients should be individualized on the basis of predicted duration of CPB and/or other types of patient comorbidity.
Autologous Platelet Concentrate and Vacuum-Assisted Closure Device Use in a Nonhealing Total Knee Replacement
Authors: Klayman Myra H. , Trowbridge Cody C. , Stammers Alfred H. , Wolfgang Gary L. , Zijerdi David A. , Bitterly Thomas J.
Published: July 2023

Following a total knee replacement surgery, a 51-year-old insulin-dependent patient presented with complications of impaired healing and postoperative trauma to the wound site. The inability of this leg wound to heal placed this patient at risk of amputation. Vacuum-assisted closure therapy was initiated at postoperative day 53; after 100 days of protracted wound history a series of treatments with topical platelet concentrates were added to the vacuum assisted closure therapy and conventional wound care therapy. The previous nonhealing wound presented with good granulation and margination that enabled a skin graft with good take on postoperative day 150.
Heparin Monitoring During Cardiopulmonary Bypass Surgery Using the One-Step Point-of-Care Whole Blood Anti-Factor-Xa Clotting Assay Heptest-POC-Hi
Authors: Hellstern Peter , Bach Juergen , Simon Melanie , Saggau Werner
Published: July 2023

The activated clotting time (ACT) generally used for monitoring heparinization during cardiopulmonary bypass (CPB) surgery does not specifically measure heparin anticoagulant activities. This may result in heparin over- or under-dose and subsequent severe adverse events. A new point-of-care whole blood clotting assay (Heptest POC-Hi [HPOCH]) for quantifying heparin anticoagulant activity specifically was compared with ACT and anti-factor Xa (anti-Xa) heparin plasma levels (Coatest heparin) in 125 patients undergoing CPB surgery. The analytical reliability of the HPOCH and the influence of preanalytical variables on assay results were also examined. The ACT and HPOCH clotting times determined throughout the entire observation period correlated closely (n= 683;r= 0.80;p< .0001). Similarly, there was a significant linear correlation between HPOCH and Coatest anti-Xa levels (n= 352;r= 0.87;p< .0001). Pre- and post-CBP values of HPOCH, ACT, and anti-Xa plasma levels correlated closely with each other (correlation coefficients betweenr= 0.90 andr= 0.99;p< .0001). During CPB, there was no significant relationship between ACT and whole blood or plasma heparin levels determined by HPOCH (n= 157;r= 0.19) and the chromogenic anti-Xa assay (n= 157;r= 0.04), respectively. In contrast, HPOCH and anti-Xa plasma levels correlated strongly during CPB (n= 157;r= 0.57;p< .0001). However, bias analysis showed that the HPOCH and Coatest heparin could not be used interchangeably. The HPOCH was well reproducible and not influenced by aprotinin, hemodilution, or other factors affecting ACT. The HPOCH seems to be a promising new tool for specific on-site measurement of heparin activities in whole blood during CPB.
Autologous Platelet Gel and Platelet-Poor Plasma Reduce Pain With Total Shoulder Arthroplasty
Authors: Zavadil Douglas P. , Satterlee C. Craig , Costigan Jaime M. , Holt David W. , Shostrom Valerie K.
Published: July 2023

The recovery of patients undergoing total shoulder arthroplasty (TSA) can be adversely affected by a number of complications. Autologous platelet gel (APG), produced by activating platelet-rich plasma (PRP), has been shown to improve hemostasis and wound healing and reduce infections in some surgical procedures. Activated platelet-poor plasma (PPP) has also been used as a hemostatic agent. This study examines the effects of APG and PPP treatment on TSA patients postoperatively. After Institutional Review Board (IRB) approval, 40 patients undergoing TSA at our institution were prospectively enrolled in our study. They were randomized into either a control (n= 20) or study (n= 20) group, with the study group receiving APG and PPP treatment. Preoperative demographic data, pre- and postoperative laboratory data, pain scores, pain medication, complications, pre- and postoperative range of motion measurements, and postoperative lengths of stay were recorded for each group. The preoperative internal rotation index was significantly higher in the control group compared with treatment patients (4.64 ± 4.46 vs. 1.88 ± 2.44,p< .05). The percent hemoglobin retained postoperatively was higher in the treatment group at 24 (84.54 ± 5.32 vs. 79.87 ± 8.73) and 72 hours (87.46 ± 16.03 vs. 76.70 vs. 5.96), but neither difference reached statistical significance. The treatment group had significantly lower pain scores (p= .007) and total fentanyl requirements (p< .05) compared with control patients. The internal rotation index improvement factor (postoperative internal rotation index/preoperative internal rotation index) was significantly higher in the treatment group vs. the control group (p< .05). Although it did not reach statistical significance, the treatment group was discharged almost 9 hours earlier than the control group (64.44 ± 15.23 vs. 73.39 ± 15.37). APG and PPP treatment decreased pain and provided a greater increase in internal rotation measurements postoperatively.
Antifibrinolytic Therapy: Evidence, Bias, Confounding (and Politics!)
Authors: Myles Paul
Published: July 2023

Cardiac surgery can be complicated by postoperative bleeding and a need for blood transfusion and surgical re-exploration. Anti-fibrinolytic drugs such as aprotinin and tranexamic acid may reduce bleeding risks but could possibly increase thrombotic complications. Aprotinin, in particular, has recently been implicated in at least two large observational studies, but this could be because it is more widely used in high-risk cardiac surgical patients. Observational studies are prone to several important sources of bias, in particular, confounding by indication (high-risk patients are more likely to receive aprotinin and more likely to have postoperative complications, irrespective of their exposure to aprotinin). Although multivariate adjustment and propensity score-matching can adjust for confounding, there is no certainty that it removes all such bias. For all anti-fibrinolytic drugs, it remains unclear as to whether the beneficial effect on reduced bleeding outweighs a possible increased risk of thrombotic complications. Debate will continue until we have the results of definitive large randomized trials powered to detect a clinically important effect on outcome.
The Perfusion Downunder Collaborative Database Project
Authors: Newland Richard , Baker Robert A. , Stanley Rebecca , Place Katherine , Willcox Timothy W. ,   on behalf of the Perfusion Downunder Collaboration
Published: July 2023

The Perfusion Downunder Collaboration provides research infrastructure and support to the Australian and New Zealand perfusion community, with the objective of determining best practices and producing relevant research publications. The Perfusion Downunder Collaborative Database (PDUCD) has been created for the purpose of collecting a dataset for cardiopulmonary bypass (CPB) procedures that includes integration with commercially available CPB data collection software. Initial testing of the PDUCD involved collection of data from four Australian and New Zealand hospitals from March to July 2007. Data from 513 procedures were compared with the concurrent Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) database report to assess the validity of the collected data. Demographic, preoperative, and procedural variables were comparable between databases. Perfusion variables showed a median nasopharyngeal temperature of 36.7°C at separation from CPB (range, 35.3–37.5°C), which was similar to maximum nasopharyngeal temperature (median, 36.8°C). Median arterial flow and mean arterial pressure were 4.2 L/min and 57.2 mmHg, respectively. Control charts indicate a central tendency of 12.5 minutes for mean arterial pressure <50 mmHg and 3.5 minutes for arterial flow <1.6 L/min/m2 (cumulative time). There was no difference in median minimum and maximum blood glucose between diabetic and nondiabetic patients during CPB with 40% of patients receiving insulin. Median minimum and maximum activated clotting time (ACT) during CPB was 581 and 692 seconds, respectively. Outcome data for isolated coronary artery bypass grafting were similar for mortality (only) (both 1.8%). Initial data collection showed concurrent validity compared with the ASCTS database. The inclusion of a large quantity of calculated CPB variables in the dataset highlights the benefits of electronic data collection as a research tool within a collaborative research network and the potential for the evaluation of the relationships between patient risk factors, perfusion practice, and patient outcomes.
Aggressive Zero Balance Ultrafiltration on CPB in Patients with Renal Failure May Cause Cerebral Edema: A Theoretical Analysis
Authors: Fontaine Eustace J. , Warwick Richard , Sastry Priya , Poullis Michael
Published: July 2023

The objective of this study was to determine the brain volume changes that occur secondary to hemofiltration during cardiopulmonary bypass in patients with renal failure. We hypothesized that in patients with elevated urea levels, quick aggressive hemofiltration could be associated with cerebral edema. We constructed a simple two-compartment model similar to the urea kinetic model developed by Depner. Intracellular urea exit was assumed to be minimal based on known urea redistribution times. Calculations were based on a 70-kg patient, with an intracellular volume of 25 L, extracellular volume of 15 L, and a preoperative urea of 40 mmol/L filtered to a post-procedure urea of 6 mmol/L. Analysis showed that a standard size 1500-mL human brain filtered from a preoperative urea of 40 to 6 mmol/L over a short period will expand by 59 mL secondary to the osmotic disequilibrium secondary to hemofiltration (p < .05). The higher the preoperative urea, the larger the fluid shift. This figure does not include the cerebral edema component that is known to arise secondary to cardiopulmonary bypass. Significant cerebral edema theoretically occurs secondary to hemofiltration during cardiopulmonary bypass. More detailed mathematical urea kinetic analysis and clinical correlation are needed.
Use of Recombinant Factor VIIa (NovoSeven) in Pediatric Cardiac Surgery
Authors: Niles Scott D. , Burkhart Harold M. , Duffey David A. , Buhrman Keri , Burzynski Jeffrey , Holt David W.
Published: July 2023

Significant post-operative bleeding can be encountered in a small population of pediatric surgical patients requiring cardiopulmonary bypass (CPB). Recombinant factor VIIa (Novo-Seven) has been advocated as a possible off-label rescue therapy for these individuals when conventional blood component therapy alone is inadequate. This study retrospectively evaluates rFVIIa administration for the treatment of severe bleeding in pediatric patients immediately after cardiac surgical procedures requiring CPB. The records of 15 patients receiving rFVIIa for excessive rates of bleeding refractory to conventional blood component therapy were studied. Blood product utilization, rates of blood loss, and evidence of pathologic sequelae were compared with matched historical controls in retrospective fashion. NovoSeven doses ranged from 76 to 282 μg/kg (group 1 <30 kg) and 26 to 956 μg/kg (group 2 >30 kg). Blood product administration patterns were not significantly different (p > .05) in the intensive care unit (ICU) between patient groups receiving rFVIIa and those not treated. Bleeding rates (mL/kg/h) for the first 2 hours after admission to the ICU remained statistically unchanged but were significantly increased for those time periods >3 hours in patients <30 kg treated with NovoSeven. Patients >30 kg did not exhibit statistical differences in the rate of bleeding or the administration of blood products compared with matched controls. A significant reduction in prothrombin time (p = .001) and partial thromboplastin time (p = .02) was noted in patients <30 kg receiving rFVIIa. There were no pathologic sequelae directly attributed to the administration of rFVIIa in any patients treated. Trends in the improvement of bleeding disturbances were noted in the ICU in patients <30 kg treated with rFVIIa, subsequent to blood component therapy. The rate of bleeding (mL/kg/h) was improved in patients <30 kg for the first 2 hours in the ICU. For individuals >30 kg, there was no apparent benefit from the administration of rFVIIa.
Long-term Extracorporeal Circulation Management: The Role of Low- and High-range Heparin ACT Tests
Authors: Herbst Daniel , Najm Hani K. , Jha Kumar Neerod
Published: July 2023

Modern management of extracorporeal circulation, especially during long-term support of post-cardiac surgical patients, remains challenging and requires optimal care of the patient’s fluid balance and coagulation hemostasis for its successful outcome. The activated clotting time assay is one of the tests used to manage extracorporeal circulation and is available in a low- and high-range level. The question of which assay is more appropriate for procedures that require low to moderate heparin dosing is still unclear. We report our experience with a neonate diagnosed with hypoplastic left heart syndrome who needed emergent extracorporeal membrane oxygenation support for 13 days after Norwood stage I palliation using a Sano shunt. Although successful, bleeding complications prompted us to review our strategy for management of coagulation hemostasis.
Mitral Valve Replacement in a Patient with Sickle Cell Disease Using Perioperative Exchange Transfusion
Authors: Chabot David , Sutton Robin
Published: July 2023

Sickle cell disease is a genetic hemoglobinopathy in which a significant number of red blood cells carry hemoglobin-S as opposed to normal red blood cells that contain hemoglobin-A. Under certain conditions such as hypoxia, acidosis, and hypothermia, the red blood cells containing hemoglobin-S will sickle, leading to occlusion of the microvasculature. As such, patients with sickle cell disease present unique challenges during heart surgery using cardiopulmonary bypass (CPB). After conducting a literature review, we discovered that the exact hemoglobin-S level for conducting cardiac surgery with CPB is not known. However, a hemoglobin-S level <30% is considered safe for conducting CPB. The following case report will discuss these challenges and present a patient with sickle cell disease undergoing a mitral valve repair. Management of this patient involved exchange transfusions both preoperatively and intraoperatively.
Carotid Artery Diameter, Plaque Morphology, and Hematocrit, in Addition to Percentage Stenosis, Predict Reduced Cerebral Perfusion Pressure during Cardiopulmonary Bypass: A Mathematical Model
Authors: Warwick Richard , Sastry Priya , Fontaine Eustace , Poullis Michael
Published: July 2023

Cerebral complications after cardiac surgery are a significant cause of morbidity, mortality, and financial cost. Numerous risk factors have been proposed to explain the risk of cerebral damage. Carotid artery disease has an important role. Percentage carotid artery stenosis is the only measure of carotid artery disease that is used by cardiac surgeons to determine the need for either a carotid endarterectomy and/or a higher pump perfusion pressure. Identification of patients through their carotid plaque morphology who might benefit from higher pump perfusion pressures or concomitant carotid endarterectomy may reduce cerebral morbidity and mortality. A mathematical model using finite element analysis was created to model the carotid artery vessel and its stenotic plaque. Analysis showed that the degree of carotid artery stenosis, the length of the carotid artery plaque, the diameter of the carotid artery, and the blood hematocrit all independently significantly affect the required pump perfusion pressure to main tain adequate cerebral perfusion during cardiopulmonary bypass (CPB). The results from a mathematical model showed that carotid artery dia meter, carotid artery plaque length, and hematocrit, in addition to percentage stenosis, should be included in any thought process involving carotid artery stenosis and cardiac surgery. Estimating cerebral risk during CPB should no longer rely on only the percentage stenosis.
Virtual Patient Simulator for the Perfusion Resource Management Drill
Authors: Ninomiya Shinji , Tokaji Megumi , Tokumine Asako , Kurosaki Tatsuya
Published: July 2023

Perfusionists require a detailed understanding of a patient’s physiological status while comprehending the mechanics and engineering of the cardiopulmonary bypass system, so it is beneficial for them to obtain relevant practical skills using extra-corporeal circulation technology and educational physiological simulators. We designed a perfusion simulator system (ECCSIM: Extracorporeal Circulation SIMulator system) based on a hybrid of a simple hydraulic mock circulation loop linked to a computer simulation model. Patient physiological conditions (height, weight, and cardiac indices) were determined by a parameter estimation procedure and used to accurately reproduce hemodynamic conditions. Extracorporeal circulation trainees in pre-clinical education were able to maintain venous oxygen saturation levels above 50%, except during cardiac standstill and a brief resumption of pulsation. Infant amplitudes of reservoir volume oscillation and flow rate were greatly increased compared with adult cardiovascular parameters, this enabled the instructor to control the difficulty level of the operation using different hemodynamic variations. High-fidelity simula tor systems with controllable difficulty levels and high physiological reproducibility are useful in constructing a perfusion resource management environment that enable basic training and periodic crisis management drills to be performed.
Defining the Late Implementation of Extracorporeal Membrane Oxygenation (ECMO) by Identifying Increased Mortality Risk Using Specific Physiologic Cut-Points in Neonatal and Pediatric Respiratory Patients
Authors: Grist Gary , Whittaker Carrie , Merrigan Kellie , Fenton Jason , Pallotto Eugenia , Lofland Gary
Published: July 2023

There is no reliable clinical indicator showing how long extracorporeal membrane oxygenation (ECMO) implementation can be delayed before the risk of death becomes unacceptably high in neonatal and pediatric respiratory patients. However, the late use of ECMO may be defined by the elevation of specific physiologic markers separate from pulmonary function and hemodynamic assessments that indicate when the optimal time for implementation of ECMO has past, resulting in a higher than normal mortality, possibly due to reperfusion injury. Neonatal patients were reviewed retrospectively to determine if later implementation of ECMO correlated to increased mortality. Neonatal and pediatric respiratory patients placed on ECMO were reviewed retrospectively to determine if the first adjusted anion gap (AGc), the first venoarterial CO2gradient (p[v-a] CO2), or the first Viability Index (AGc + p[v-a]CO2= INDEX) on ECMO could be used to identify a cut-point for increased mortality. Expired neonates (n= 31) were placed on ECMO an average of 2 days later than neonatal survivors (n= 163). The review of 210 respiratory neonatal and pediatric ECMO patients with an overall survival of 82% showed that all three markers were elevated in the expired patients (n= 38,p< .05). Cut-points were an AGc ≥ 23 mEq/L, the p[v-a]CO2≥ 16 mmHg, and the INDEX ? 28. These values correlated with a significantly higher risk of mortality (p< .05); survival to discharge being 43% or less. Patients under the cut-points had survival rates of 84% or higher. Starting ECMO too late may cause reperfusion injury that reduces survival. This study describes specific physiologic markers taken soon after ECMO initiation that correlate with mortality. These markers, if assessed earlier, may allow for a more timely ECMO implementation and higher survival.
Clinical Evaluation of the Terumo Capiox ® FX05 Hollow Fiber Oxygenator with Integrated Arterial Line Filter
Authors: Deptula Joseph , Valleley Melinda , Glogowski Kimberly , Detwiler John , Hammel James , Duncan Kim
Published: July 2023

Perfusion techniques and equipment in pediatric open heart surgery have continued to focus on decreasing prime volumes and lowering surface areas of the cardiopulmonary bypass circuit. While this has improved drastically over the last 20 years, greater demand is being placed on the perfusionist to reduce the deleterious effects of bypass without compromising safety or efficiency. Specifically, manufacturers of disposable perfusion equipment have focused on providing pediatric perfusionists with oxygenators that provide the smallest prime and surface area possible while attempting to maximize performance. Recently,Terumo Cardiovascular has introduced the Capiox® FX05, a neonatal hollow fiber oxygenator that includes an integrated arterial line filter. The FX05 provides a blood flow range of 0.1–1.5 L/min and a low priming volume of 43 mL. Additionally, it is coated with X Coating”, a biocompatible, hydrophilic polymer surface coating that reduces platelet adhesion and protein denaturation. The purpose of this study was to test the FX05 for gas transfer, blood path resistance, and blood handling characteristics in a standardized clinical setting. Heat exchange coefficients were also calculated during the cooling and warming period. Other data analyzed includes bypass circuit prime volumes and initial patient hematocrit along with the total operative homologous blood donor exposures. In summary, the FX05 offers good gas exchange capabilities and a low pressure drop during normal cardiopulmonary bypass parameters along with the safety of an integrated arterial line filter. Furthermore, the FX05 with integrated filter allows a reduction in overall bypass prime volume and surface area while promoting the reduction of homologous blood transfusions, optimizing hemostasis.
Clinical Gaseous Microemboli Assessment of an Oxygenator with Integral Arterial Filter in the Pediatric Population
Authors: Preston Thomas J. , Gomez Daniel , Olshove Vincent F. , Phillips Alistair , Galantowicz Mark
Published: July 2023

The use of an arterial line filter (ALF) within the pediatric cardiopulmonary bypass (CPB) circuit is not a new concept. It has always presented the perfusionist with a circuit component that while valuable, increased prime volume. The purpose of this study was to evaluate the change in prime volume and emboli between a conventional oxygenator with separate ALF and a new generation oxygenator with integral arterial filter (AF). We performed a clinical, non-randomized retrospective evaluation of the Terumo Capiox® RX15 (Terumo Cardiovascular Systems Corporation, Ann Arbor, MI) (n= 10) in conjunction with the Terumo Capiox® AF125X ALF or the Capiox ® AF02 vs. the Terumo Capiox® FX15 oxygenator with integral AF (n= 10). The above circuit components, in combination with the LUNA EDAC® (emboli detection and classification) Quantifier (LUNA Innovations, Blacksburg, VA) were placed at various locations within each patient’s CPB circuit to establish and quantify the presence and volume of gaseous emboli during all phases of cardiopulmonary bypass. The EDAC® system is available/used for all patients undergoing CPB at this institution. When compared to a more conventional CPB circuit, the Capiox® FX15 primes more easily as it does not require a carbon dioxide flush while still providing a 32 μ AF. There was no statistical difference in air handling between the tested oxygenators and their associated circuits. During this review it was determined that use of the Capiox® FX15 simplifies the arterial limb of the pediatric CPB circuit. Removal of the separate ALF led to the removal of several, now unnecessary, arterial connectors and additional tubing (arterial line filter bypass). Removal of these components led to a reduction in prime volume and decreased the hemodilutional effect. The FX15 provided a safe, simplified pediatric CPB circuit and was as effective in gaseous microemboli removal as was the more traditional RX15 with separate ALF during this review.
Patient Directed Perfusion Pressure on Bypass, an Analogy from Electrical Engineering—A New Concept
Authors: Warwick Richard , Poole Robert , Palmer Kenneth , Johnson Ian , Poullis Michael
Published: July 2023

Organ ischemia, particularly mesenteric and renal, can occur despite a seemingly adequate perfusion flow and pressure during a period of cardiopulmonary bypass. The blood pressure to run bypass at remains a contentious issue. We present the concept that perfusion pressure during cardiopulmonary bypass should be patient specific, depending on an individual’s resting pre-procedural blood pressure. Four simulated arterial traces with variable morphology, but identical systolic and diastolic blood pressures, were analyzed to calculate the medical mean, arithmetic mean, and root mean square of the blood pressure tracing. Using the standard medical formula for calculation of mean blood pressure, you can potentially underestimate perfusion pressure by 12 mmHg in a normotensive subject. The root mean square pressure calculates the equivalent non pulsatile pressure that will deliver the same hydraulic power to the circulation as its pulsatile equivalent. Patient specific perfusion pressures, calculated via root mean square may potentially help reduce the incidence of organ ischemia during cardiopulmonary bypass. Clinical trials are needed to confirm or refute this concept.
The Children’s Hospital Boston Non-Routine Event Reporting Program
Authors: Matte Gregory S. , Riley Daniel , LaPierre Robert , Howe Robert , Anderson Mark , Boyle Sharon , Durham Linda , Regan William , Pigula Frank
Published: July 2023

Several authors have described methods to track perfusion and cardiac surgical morbidity and mortality as well as perfusion accidents. There is currently not a standard definition of a perfusion accident nor is there a standard reporting threshold for events which do not directly cause known morbidity. We propose the term non-routine events (NREs) instead of accidents, and provide a working definition and reporting threshold for such. This paper describes the program which we developed to track perfusion NREs within the Cardiovascular Program at Children’s Hospital, Boston. NREs are categorized by type (technique, equipment, or patient-related) and bypass period (pre-cardiopulmonary bypass, bypass, or post-cardiopulmonary). NRE outcomes are also classified by the level of discussion or change in perfusion practice after multidisciplinary review. We have documented during a 44 month interval that 42% (29/69) of reported NREs occur during the bypass period and are equipment related and thus, efforts to improve practice should focus there. We have also seen a generally decreasing incidence of NREs requiring either a change in perfusion practice or a new protocol during this time period. We believe that our regular multidisciplinary meetings to discuss NREs have increased awareness among the entire team about potential problems in the program and that intuitively, it has improved patient safety.
Novel Multi-Functional Life Support System
Authors: Webb David P. , Jackson Darren , Kasasbeh Ehab S. , Bagai Jayant , Zhao David X.
Published: July 2023

Concepts of cardiopulmonary support (CPS), extra-corporeal membrane oxygenation (ECMO), and ventricular support (VS) have been thoroughly studied and refined. These perfusion adjuncts often require multiple devices, skill sets, and significant financial burden to purchase, maintain, deploy, and use. We describe a novel system that is rapidly deployable, user-friendly, portable, safe, and economical. Over a 1-year period we have used a multi-functional life support system (MLS) in the cardiac catheterization laboratory, cardiovascular intensive care unit, and cardiac surgical suites. Further, we have conducted multiple transports within the hospital and one to an alternate facility. Applications have included ECMO, cardiopulmonary resuscitation-supported cardiogenic shock, high risk percutaneous coronary intervention (PCI), valvuloplasty, right ventricular assist device transition to ECMO post cardiotomy, left ventricular assist device transition to ECMO, ventricular septal defect closure, and ECMO transition to conventional cardiopulmonary bypass (CPB). Duration of support has ranged from approximately 39 minutes to several days.
Patient Directed Bypass: Cooling for Aortic Surgery – A Preliminary Concept
Authors: Palmer Kenneth , Ridgway Tim , Al-Rawi Omar , Johnson Ian , Poullis Michael
Published: July 2023

No consensus exists as to the temperature to cool to on bypass for surgery involving the aortic arch. Excluding normothermic surgery, which is rarely performed for arch work, circulatory arrest, anterograde, and retrograde cerebral perfusion either in isolation or in combination remain the techniques of “cerebral protection.” To date, no account of individual patient body or cerebral function variation is involved. Utilizing an electronic perfusion database we retrospectively analyzed 10 patients undergoing aortic arch work with regard to mixed venous saturations during cooling. Perfusion related variables were registered and uploaded to www.perfsort.net. We regarded a saturation of 100% as being indicative of no oxygen extraction, implying no metabolic activity—the theoretical goal prior to a circulatory arrest period. There is enormous variation in the temperature at which metabolic activity of the body stops. We had a range from 17–25 degrees. Patients were cooled for an average of 6 (SD 3.4) degrees below which oxygen extraction had ceased to occur. Potentially we are adding 111 minutes (SD 62) of unnecessary bypass time. This may imply that excessive cooling is occurring in some individuals undergoing arch surgery. Patient directed cooling for aortic arch surgery may help to reduce the morbidity/physical insult associated with severe hypothermia. This work is very preliminary but may help us to depart from the one size fits all paradigm that exists in current clinical practice. Correlation with bispectral index, electroencephalogram monitoring and neurological outcomes is needed.
Klinische Anwendungsbeispiele einer Next-Generation-Sequencing-basierten Multi-Genpanel-Analyse
Authors: Enko Dietmar , Schaflinger Erich , Müller Daniel J.
Published: July 2023

Dieser Übersichtsartikel bietet einen Überblick über klinisch sinnvolle Anwendungsgebiete einer Next-Generation-Sequencing-basierten (NGS) Multi-Genpanel-Teststrategie in den Bereichen Onkologie, hereditärer Tumorsyndrome und Hämatologie. Bei soliden Tumoren (z.B. Lungenkarzinom, Kolonrektalkarzinom) trägt die Detektion somatischer Mutationen nicht nur zu einer besseren diagnostischen, sondern auch therapeutischen Stratifizierung der Betroffenen bei. Die zunehmende genetische Komplexität hereditärer Tumorsyndrome (z.B. Brust- und Ovarialkarzinom, Lynchsyndrom/Polypose) erfordert in betroffenen Familien eine Multi-Genpanel-Analyse von Keimbahnmutationen. Ein weiteres sinnvolles Indikationsgebiet einer Multi-Genpanel-Diagnostik und Prognoseabschätzung sind akute und chronische myeloische Erkrankungen. Die Kriterien der WHO-Klassifikation und des „European LeukemiaNet“-Prognosesystems der akuten myeloischen Leukämie können nur durch eine Multi-Genpanel-Teststrategie erfüllt werden.
Microwave-Assisted Synthesis of Poly[bis(4-phenyl)(2,4,6-trimethylphenyl)amine] (PTAA) with Well-Defined End Groups and Narrow Dispersity
Authors: Beck Christian , Strohriegl Peter
Published: July 2023

A series of PTAA (poly[bis(4-phenyl)(2,4,6-trimethylphenyl)amine]) polymers were synthesized using a Ni(0)-mediated Yamamoto coupling. Polymers with different molecular weights and only one series of well-defined end groups were obtained with various amounts of a tailormade endcapper. This level of structural uniformity has not yet been described for PTAA. By using microwave heating, it was possible to shorten the reaction time from at least 1 day to 30 min. The synthetic strategy allows the separation of single PTAA oligomers with up to 6 repeating units and polymer fractions with low dispersities from 1.06 to 1.17 by using preparative size exclusion chromatography. The carrier mobilities of the PTAA oligomers and polymers were derived from organic field-effect transistors. Mobilities increase with increasing molecular weight of the PTAAs and are higher compared to commercially available PTAA samples.
Efficient Syntheses of (S)- and (R)-β-Proline
Authors: Chandra Shambhu Deo , Fung Ethan W. F. , Perrin David M.
Published: July 2023

A facile, efficient, and economical synthesis of both β-proline enantiomers starting from trans-4-hydroxy-l-proline is reported. Light-promoted radical Barton decarboxylation and nitrile introduction at C4 followed by hydrolysis gives the desired products in high optical purity. These routes should be of interest to those seeking economical access to β-proline for multiple applications.
Bio-Banding in Handball: Academy Players’ Perceptions Based
on Maturity Status and Gender
Authors: de la Rubia Alfonso , Lorenzo-Calvo Jorge , Rojas-Valverde Daniel , Mon-López Daniel , Radnor John , Kelly Adam L.
Published: July 2023

The purpose of this study was to evaluate young male and female handball
players’ perceptions of the bio-banding concept. The estimated
biological maturity status was assessed in a sample of 46 male and 40 female
handball players (aged 14.06±1.40 years), who competed in both an annual
age-group and bio-banded tournament. To test the players’ perception of
bio-banding, a post-competition questionnaire was conducted. A series of ANOVA
and one-sample t-tests were used in order to examine the differences in
perception between the different maturity groups. An inductive thematic analysis
of the qualitative data recorded in the open-ended questions was also carried
out. The results showed that early-maturing boys enjoyed the bio-banding
tournament more than late-maturing boys (p<0.05). Conversely, no
differences were found in girls (p>0.05). Furthermore,
discussions were conducted based on the qualitative analysis of the
players’ written comments regarding their overall experience, finding
individual variance in biological maturity may be less relevant in female sports
contexts due to gender-related differences. Thus, a greater influence on play
and leadership in late maturing boys and early maturing girls, a greater
physical challenge in early maturing boys and an opportunity to express
themselves technically and tactically in late maturing boys and on-time maturing
girls were observed. Therefore, stakeholders must consider the different
consequences of bio-banding in order to maximize the athlete’s sport
development process.
Uma causa atípica de claudicação infantil: Síndrome de Gorham-Stout com quadril fantasma
Authors: Ferjani Hanene Lassoued , Makhlouf Yasmin , Ben Nessib Dorra , Maatallah Kaouther , Kaffel Dhia , Hamdi Wafa
Published: July 2023

A síndrome de Gorham-Stout (SGS) é uma doença óssea rara caracterizada pela proliferação anormal de vasos endoteliais e destruição do osso acometido. Por ser comum em crianças e adultos jovens, causa morbidade e mortalidade significativas. Até o momento, não há estratégia terapêutica estabelecida para a SGS.

Relatamos um caso raro de SGS no quadril e na crista ilíaca de uma criança.