bluuebunny/crossref_metadata_2025 huggingface dataset:
Heparin Therapy during Extracorporeal Circulation: Deriving an Optimal Activated Clotting Time during Cardiopulmonary Bypass for Isolated Coronary Artery Bypass Grafting
Authors: Palmer Kenneth , Ridgway Tim , Al-Rawi Omar , Poullis Michael
Published: July 2023

Bull’s seminal work on heparin therapy during cardiopulmonary bypass (CPB) was carried out over 30 years ago and has not been updated in the modern era. No correlation with postoperative blood loss was performed. The optimal activated clotting time (ACT) with regard to blood loss has not been established for patients undergoing CPB. A minimum ACT of 400 is based on the lack of visible formation of clots in the CPB circuit. The effect of heparin dose, sensitivity, metabolism, patient size, elective/urgent, protamine reversal regime, returned pump blood volume and heparin content, and average ACT during CPB with regard to postoperative blood loss and resternotomy was examined in a consecutive series of patients undergoing isolated coronary artery bypass surgery. One hundred forty-four patients undergoing isolated CABG were studied. Resternotomy was too infrequent an event to analyze. Univariate analysis revealed that an average ACT less than 500 or greater than 700 was associated with significantly increased postoperative blood loss (p = .001).Multivariate analyses revealed that body mass index (p < .0001) and total loading dose of heparin (p = .0031) were also significant factors affecting postoperative blood loss. We extended his work by analyzing postoperative blood loss. An average ACT between 500 and 700 in our series was associated with significantly lower blood loss than an ACT higher or lower. We hypothesize that an ACT below 500 is probably associated with a low-grade coagulopathy but notmacroscopic clot formation in the CPB circuit, and above 700 heparin rebound may become important. Each unit should evaluate blood loss and determine the optimal ACT target for their program.
International Pediatric Perfusion Practice: 2011 Survey Results
Authors: Harvey Brian , Shann Kenneth G. , Fitzgerald David , Mejak Brian , Likosky Donald S. , Puis Luc , Baker Robert A. , Groom Robert C. ,   for the American Society of ExtraCorporeal Technology’s International Consortium for Evidence-Based Perfusion and Pediatric Perfusion Committee
Published: July 2023

New cardiopulmonary bypass devices and new innovative methods are frequently reported in the literature; however, the actual extent to which they are adopted into clinical practice is not well known. We distributed an electronic survey to 289 domestic and international pediatric congenital surgery centers in an effort to measure attributes of current clinical practice. The survey consisted of 107 questions relating to program demographics, equipment, and techniques. Responses were received from 146 (51%) of queried centers and were stratified into five distinct geographic regions (North America, Central and South America, Oceana, Europe, and Asia). Most of the responding centers reported use of hard shell venous reservoirs. Closed venous systems were used at 50% of reporting centers in Central and South America as compared with only 3% in North America and 10% in Asia. Seventy-one percent of the programs used some form of modified ultrafiltration. Use of an arterial bubble detection system varied between 50% use (Central and South America) vs. 100% (North America and Oceana). “Del Nido” cardioplegia is more common in North America (32%) than any other continent, whereas Custodial® HTK solution is much more prevalent in Europe (31%). Wide variation in practice was evident across geographic regions, suggesting opportunities for further investigation and improvement.
Computational Fluid Dynamic Analysis to Prevent Aortic Root and Valve Clots during Left Ventricular Assist Device Support
Authors: Poullis Michael
Published: July 2023

Aortic root and valve clots are rare but well described in patients on maximal left ventricular assist device (LVAD) support. We performed a theoretical analysis using computational fluid dynamic analyses in two dimensions to try and ascertain if inflow cannula design/orientation/placement affect aortic root flow dynamics. Two-dimensional computational fluid dynamics using easy CFD-G was performed. The effect of a curved inflow cannula, a straight cannula, and one with a hole in the outer curve was analyzed. In addition, the effect of inflow conduit angulation on the ascending aorta was studied. Computational fluid dynamic (CFD) analysis predicts that stagnant blood exists in the aortic root when little or no cardiac ejection is taking place. Coronary flow is too small to affect the root flow streamlines. A hole on the root side of a curved inflow aortic cannula increases the flow in the aortic root and may decrease the incidence of root and valve thrombosis. The angle of the inflow conduit attachment to the ascending aorta was also found to be crucial with regard to aortic root blood stasis. In addition, a baffle at the tip of the inflow cannula may prove to be beneficial. Theoretical analysis using the technique of CFD predicts that inflow cannula position and design may affect the incidence of aortic root thrombosis during LVAD support when minimal cardiac ejection is occurring.
Psychological Depression and Cardiac Surgery: A Comprehensive Review
Authors: Tully Phillip J.
Published: July 2023

The psychological and neurological impact of cardiac surgery has been of keen empirical interest for more than two decades although reports showing the prognostic influence of depression on adverse outcomes lag behind the evidence documented in heart failure, myocardial infarction, and unstable angina. The paucity of research to date is surprising considering that some pathophysiological mechanisms through which depression is hypothesized to affect coronary heart disease (e.g., platelet activation, the inflammatory system, dysrhythmias) are known to be substantially influenced by the use of cardiopulmonary bypass. As such, cardiac surgery may provide a suitable exemplar to better understand the psychiatric mechanisms of cardiopathogenesis. The extant literature is comprehensively reviewed with respect to the deleterious impact of depression on cardiac and neuropsychological morbidity and mortality. Research to date indicates that depression and major depressive episodes increase major cardiovascular morbidity risk after cardiac surgery. The association between depressive disorders and incident delirium is of particular relevance to cardiac surgery staff. Contemporary treatment intervention studies are also described along with suggestions for future cardiac surgery research.
Development of the Orpheus Perfusion Simulator for Use in High-fidelity Extracorporeal Membrane Oxygenation Simulation
Authors: Lansdowne William , Machin David , Grant David J.
Published: July 2023

Despite its life-sustaining potential, extracorporeal membrane oxygenation (ECMO) remains a complex treatment modality for which close teamwork is imperative with a high risk of adverse events leading to significant morbidity and mortality. The provision of adequate training and continuing education is key in mitigating these risks. Traditional training for ECMO has relied predominantly on didactic education and hands-on water drills. These methods may overemphasize cognitive skills while underemphasizing technical skills and completely ignoring team and human factor skills. These water drills are often static, lacking the time pressure, typical alarms, and a sense of urgency inherent to actual critical ECMO scenarios. Simulation-based training provides an opportunity for staff to develop and maintain technical proficiency in high-risk, infrequent events without fear of harming patients. In addition, it provides opportunities for interdisciplinary training and improved communication and teamwork among team members (1). Although simulation has become widely accepted for training of practitioners from many disciplines, there are currently, to our knowledge, no commercially available dedicated highfidelity ECMO simulators. Our article describes the modification of the Orpheus Perfusion Simulator and its incorporation into a fully immersive, high-fidelity, point-of-care ECMO simulation model.
Use of del Nido Cardioplegia Solution and a Low-Prime Recirculating Cardioplegia Circuit in Pediatrics
Authors: Ginther Richard M. , Gorney Ronald , Forbess Joseph M.
Published: July 2023

The evolution of myocardial protection techniques has been both the source of milestone advancements and controversial debate in cardiac surgery. Our institution has modified a low-prime cardioplegia system (CPS) and adopted a single-dose cardioplegia solution (del Nido cardioplegia) for our congenital heart disease population. The goal of this article is to describe our CPS and outline our myocardial protection protocol. These techniques have allowed us to minimize circuit surface area, operate uninterrupted, and safely protect the myocardium during extended ischemic periods.
Regional Perfusion During Venoarterial Extracorporeal Membrane Oxygenation: A Case Report and Educational Modules on the Concept of Dual Circulations
Authors: Alwardt Cory M. , Patel Bhavesh M. , Lowell Amelia , Dobberpuhl Jeff , Riley Jeffrey B. , DeValeria Patrick A.
Published: July 2023

A challenging aspect of managing patients on venoarterial extracorporeal membrane oxygenation (V-A ECMO) is a thorough understanding of the relationship between oxygenated blood from the ECMO circuit and blood being pumped from the patient’s native heart. We present an adult V-A ECMO case report, which illustrates a unique encounter with the concept of “dual circulations.” Despite blood gases from the ECMO arterial line showing respiratory acidosis, this patient with cardiogenic shock demonstrated regional respiratory alkalosis when blood was sampled from the right radial arterial line. In response, a sample was obtained from the left radial arterial line, which mimicked the ECMO arterial blood but was dramatically different from the blood sampled from the right radial arterial line. A retrospective analysis of patient data revealed that the mismatch of blood gas values in this patient corresponded to an increased pulse pressure. Having three arterial blood sampling sites and data on the patient’s pulse pressure provided a dynamic view of blood mixing and guided proper management, which contributed to a successful patient outcome that otherwise may not have occurred. As a result of this unique encounter, we created and distributed graphics representing the concept of “dual circulations” to facilitate the education of ECMO specialists at our institution.
Method to Calculate the Protamine Dose Necessary for Reversal of Heparin as a Function of Activated Clotting Time in Patients Undergoing Cardiac Surgery
Authors: Cuenca Javier Suárez , Diz Pilar Gayoso , Sampedro Francisco Gude , Zincke J. Marcos Gómez , Acuña Helena Rey , Fontanillo M. Manuela Fontanillo
Published: July 2023

Activated clotting time (ACT) has been used to monitor coagulation and guide management of anticoagulation control in patients undergoing cardiac surgery for decades. However, reversal of heparin with protamine is typically empirically based on total heparin administered. Dose-related adverse effects of protamine are well described. The aim of this study was to evaluate a heparin reversal strategy based on calculation of the protamine dose based on ACT measurements. We present a method using a mathematical formula based on the dose–response line (1). To check the formula, we performed a retrospective observational cohort study of 177 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The study group of 80 patients was administered the dose of protamine obtained using our formula, and the control group of 97 patients was administered the empirically calculated dose. The ACT returned to normal values in patients who were given doses of protamine that were calculated using our formula; all but two had a final ACT of 141. The application of the formula resulted in a significant reduction in the dose of protamine (p< .023). The formula we present is a valid method for calculating the dose of protamine necessary to neutralize heparin. This same method can be used working with a target ACT to adjust the dose of heparin. As a result of its functionality, it allows application on a daily basis standardizing the process. We believe that the formula we developed can be applied in all those procedures in which it is necessary to anticoagulate patients with heparin and later neutralization (cardiac surgery with or without CPB, vascular surgery, procedures of interventional cardiology, and extracorporeal depuration procedures).
Plasma Fatty Acid Levels in Children during Extracorporeal Membrane Oxygenation Support—A Pilot Study
Authors: Zhang Liyan , Yu Xiaoyang , Cheypesh Andriy , Rebeyka Ivan M. , Granoski Don , Lopaschuk Gary D. , Li Jia
Published: July 2023

Plasma fatty acids levels are markedly elevated in patients with myocardial ischemic–reperfusion injury including those after cardiopulmonary bypass (CPB). High levels of fatty acids have detrimental effects on myocardial function. Extracorporeal membrane oxygenation (ECMO) is like CPB, but much longer, to provide a life-saving support for patients with cardiac arrest. We measured plasma fatty acid levels in children during ECMO support. Five children (aged .3–36 months, median 20 months) receiving venoarterial ECMO support after cardiac arrest in 2010 and 2011 were enrolled. The study was initiated at 32–56 hours after the start of ECMO support as a result of the complicated clinical scenario. Fatty acids were measured at 8-hour intervals for 1–3 days. The dosage of inotropes and vasoactive agents was recorded concurrently. The duration of ECMO ranged from 70 to 240 hours (median 177 hours). Four patients were successfully weaned off ECMO support. One died after termination of ECMO. Levels of fatty acids were elevated compared with the normal values. Overall, fatty acid levels continuously decreased over time (p < .0001), the mean being 1.03 ± .33 mmol/L in 30–50 hours, 1.01 ± .57 in 50–70 hours, .81 ± .32 in 70–90 hours, and .63 ± .23 hours. No correlation was found between fatty acid levels and other clinical variables, including age, dosage of inotropes and vasoactive agents, or ECMO duration. Plasma fatty acids levels are elevated in children during ECMO support and continuously decrease over time. Fatty acid levels may be markedly higher in the immediate hours after the initiation of ECMO. Data from more patients are needed to understand the profiles of fatty acids and the correlations with clinical variables. Metabolic manipulations to decrease fatty acids might improve myocardial recovery in patients undergoing ECMO support.
Clinical Microsystems: A Critical Framework for Crossing the Quality Chasm
Authors: Likosky Donald S.
Published: July 2023

Patients, payers, and the public have increased expectations concerning the quality, safety and costs of our health care delivery systems. Whether or not to redesign our complex delivery systems is no longer in question. In order to succeed in optimizing care and outcomes (clinical and financial) for our stakeholders, we must design and evaluate tests of change. This journey will require a fundamental shift in our traditional thinking about healthcare delivery systems, including how: (1) each of us relates (effectively or not) to one another, and (2) the value of our patient’s care is impacted accordingly. With this challenge in mind, this article will provide insight to the reader concerning clinical microsystems, small groups of professionals who work together on a regular basis to provide care to discrete populations of patients. The reader will learn how to leverage these microsystems to meet our stakeholders’ expectations, namely to optimize the quality, safety and costs of our health care delivery systems.
Predicting Adult Perfusion Practice Trends and the Adoption of Evidence-Based Practice
Authors: Relle Margaret A. , Hutchinson Jennifer M. , Mattison Adam , Sievert Alicia , Shackelford Anthony G.
Published: July 2023

In an effort to provide optimal patient care, perfusionists should rely on information provided by current research. Present statistics, however, document a substantial underuse of evidence-based clinical practice and therapies not only in perfusion, but throughout the entire medical field. This investigation applied a statistical method—binomial proportion analysis—to aid in uncovering the trends in perfusion practice from 2004 to 2011. Through the analysis of national adult perfusion practice surveys, the feasibility of using binomial proportion statistical analysis is assessed in its ability to track adult perfusion practice proportional differentials over time and evaluate the adoption and attitudes toward the compliance of evidence-based practice within the field of perfusion. Surveys conducted in 2004 and 2006 on adult perfusion practice in the United States—although not published—are compared with data obtained by a similar survey distributed in 2011 through an international perfusion network system and perfusion mailing system, Perflist and Perfmail. The increase of perfusionists who practice retrograde and antegrade autologous priming (R/A AP) seen from 2004 to 2006 (35–50%) was statistically significant (Zcalc= −2.30,p< .05) and from 2006 to 2011 (Zcalc= −5.23;p< .05). Although the increase in biocompatible circuit (BC) use by perfusionists from 2004–2006 (53–64%) was not statistically significant (Zcalc= −1.69,p< .05), the use of BCs did continue to increase (86%) significantly from 2006 to 2011 (Zcalc= −9.15,p< .05). Other trends were observed; however, statistical significance was variable. This investigation demonstrates that binomial proportion statistical analysis is an effective method of evaluating perfusion practice trends and adoptions based on increasing or decreasing perfusion population proportion compliance over time.
Does Removing Mannitol and Voluven from the Priming Fluid of the Cardiopulmonary Bypass Circuit Have Clinical Effects?
Authors: Haydock Matthew D. , Kruger Cornelis , Willcox Timothy , Haydock David A.
Published: July 2023

The Auckland Hospital cardiothoracic unit recently removed Mannitol and Voluven from its Plasma-lyte-based cardiopulmonary bypass (CPB) priming fluid. Like with any change to practice, a comprehensive audit should be performed to identify positive or negative effects. The aim of this retrospective analysis was to investigate the effect of changing the CPB prime constituents on fluid balance and clinical outcome parameters. Clinical records were reviewed for 100 consecutive patients undergoing primary, isolated coronary artery bypass grafting (CABG), 50 patients before the prime change and 50 after. All data were collated into a central database for analysis. Mean arterial pressure while on bypass was higher in the new prime group (61.5 mmHg versus 57.5 mmHg, p = .002). There was no significant difference in hematocrit, hemoglobin, serum sodium, serum potassium, or creatinine postoperatively between groups. In regard to important outcomes such as postoperative weight and fluid balance, time on ventilation, length of stay in the intensive care unit (ICU) or hospital, and mortality, there were no significant differences. Interestingly, new prime group spent a smaller proportion of their time in the ICU on mechanical ventilation (23% versus 36%, p = .022). Mannitol and Voluven, like with all drugs, carry their own potential adverse effects. This study demonstrates that removing Mannitol and Voluven from priming fluid did not have any detrimental effect on electrolytes, fluid status, and other important outcomes in this consecutive series of patients having primary isolated CABG surgery. The risk–benefit balance combined with the obvious economic benefit clearly favors removing Mannitol and Voluven from priming fluids.
Gastrointestinal Complications and Cardiac Surgery
Authors: Allen Sara J.
Published: July 2023

Gastrointestinal (GI) complications are an uncommon but potentially devastating complication of cardiac surgery. The reported incidence varies between .3% and 5.5% with an associated mortality of .3–87%. A wide range of GI complications are reported with bleeding, mesenteric ischemia, pancreatitis, cholecystitis, and ileus the most common. Ischemia is thought to be the main cause of GI complications with hypoperfusion during cardiac surgery as well as systemic inflammation, hypothermia, drug therapy, and mechanical factors contributing. Several nonischemic mechanisms may contribute to GI complications, including bacterial translocation, adverse drug reactions, and iatrogenic organ injury. Risk factors for GI complications are advanced age (>70 years), reoperation or emergency surgery, comorbidities (renal disease, respiratory disease, peripheral vascular disease, diabetes mellitus, cardiac failure), perioperative use of an intra-aortic balloon pump or inotrope therapy, prolonged surgery or cardiopulmonary bypass, and postoperative complications. Multiple strategies to reduce the incidence of GI complications exist, including risk stratification scores, targeted inotrope and fluid therapy, drug therapies, and modification of cardiopulmonary bypass. Currently, no single therapy has consistently proven efficacy in reducing GI complications. Timely diagnosis and treatment, while tailored to the specific complication and patient, is essential for optimal management and outcomes in this challenging patient population.
Interhospital Air Transport of a Blind Patient on Extracorporeal Life Support with Consecutive and Successful Left Ventricular Assist Device Implantation
Authors: Bauer Adrian , Schaarschmidt Jan , Grosse F. Oliver , Al Alam Nidal , Hausmann Harald , Krämer Klaus , Strüber Martin , Mohr Friedrich W.
Published: July 2023

The use of extracorporeal life support systems (ECLS) in patients with postcardiotomy low cardiac output syndrome (LCO) as a bridge to recovery and bridge to implantation of ventricular assist device (VAD) is common nowadays. A 59-year-old patient with acute myocardial infarction received a percutaneous transluminal angioplasty and stenting of the circumflex artery. During catheterization of the left coronary artery (LAD), the patient showed ventricular fibrillation and required defibrillation and cardiopulmonary resuscitation. After implantation of an intra-aortic balloon pump, the patient immediately was transmitted to the operating room. He received emergency coronary artery bypass grafting in a beating heart technique using pump-assisted minimal extracorporeal circulation circuit (MECC). Two bypass grafts were performed to the LAD and the right posterior descending artery. Despite initial successful weaning off cardiopulmonary bypass with high-dose inotropic support, the patient presented postcardiotomy LCO and an ECLS was implanted. The primary setup of the heparin-coated MECC system was modified and used postoperatively. As a result of the absence of an in-house VAD program, the patient was switched to a transportable ECLS the next day and was transferred by helicopter to the nearest VAD center where the patient received a successful insertion of a left VAD 3 days later.
Successful Management of Thrombosis of the Proximal Aorta after Implantation with a Biventricular Assist Device
Authors: Russo Mark J. , Gidea Claudia , Karanam Ravi , Baran David , Saunders Craig R. , Zucker Mark J. , Camacho Margarita T.
Published: July 2023

Continuous-flow ventricular assist devices (CVADs) are associated with a significant complication profile that includes thrombosis of the ascending aorta and aortic valve, thromboembolism, and stroke. Despite an increasing number of reports of thromboembolic complications related to CVADs, there is little in the literature to guide their management. This report describes successful management strategies used during two cases of thrombosis of the ascending aorta during biventricular CentriMag (Levitronix LLC, Waltham, MA) support, including using pre-existing cannulas to initiate cardiopulmonary bypass.
The potential effect of temulawak (Curcuma xanthorrhiza Roxb.) and garlic (Allium sativum L.) as a radioprotective agent against 6 Gy total body irradiation in rats
Authors: Kisnanto T. , Tetriana D. , Yusuf D. , Lusiyanti Y. , Surniyantoro H.N.E , Hasan Basri I.K.
Published: July 2023

The main impact of gamma radiation on a biological system is the formation of Reactive Oxygen Species (ROS) and free radicals. The study aimed to explore the potential effect of temulawak (Curcuma xanthorrhiza Roxb.) and garlic (Allium sativum L.) against 6 Gy total body irradiation (TBI) in rats by observing malondialdehyde (MDA), glutathione (GSH) and comet assay. Twenty male rats were divided into five groups: control, 6 Gy, temulawak extract + 6 Gy, garlic extract + 6 Gy, and n-acetyl cysteine (NAC) + 6 Gy. MDA and GSH were measured on liver and spleen tissue homogenates, while comet assay was on lymphocyte cells. Gamma irradiation at 6 Gy significantly increased the MDA level and comet assay compared to the control group, while the GSH level decreased (p < 0.05). Temulawak extract significantly reduced MDA levels and comet assay compared to the 6 Gy group while increasing GSH levels in the liver. Garlic extract significantly drops comet assay while increasing GSH levels in the liver. NAC decreases MDA levels in the liver and comet assay while increasing GSH levels in the spleen. It could be concluded that temulawak extract has a better radioprotective agent than garlic extract and is almost identical to NAC as a standard antioxidant.
Russell Viper Venom: A Journey from the Bedside to the Bench and Back to the Bedside
Authors: Thachil Jecko
Published: July 2023

Russell Viper Venom (RVV) is widely used as a diagnostic test for antiphospholipid syndrome (APS). But the history of how this venom came to be discovered is well known. Dr Patrick Russell is responsible for the identification of the venom during his work on snake bites in India while Dr Robert Macfarlane used it to staunch bleeding in persons with haemophilia. The ability to directly activate factor X led RVV to the laboratory diagnosis of APS. More recently, it has come back to clinical world with a potential for an engineered factor X activator from RVV to be used in the treatment of haemophilia.
Hair Restoration Techniques
Authors: Shehan Jennifer Nicole , Spiegel Jeffrey Howard
Published: July 2023

Hair restoration is an essential topic in the current management of facial plastic surgery concerns and queries. Advances in hair restoration include oral and topical medications and compounded preparations, injections including platelet-rich plasma, light therapy, and follicular unit extraction methods. This article provides a review of current techniques.
Outcomes of Composite Grafts for Pediatric Fingertip Amputations: A Systematic Review
Authors: Jester Noemi , Han Seunghee , Singh Manwi , Rao Avula Aishwarya , Sokhal Balamrit , Ma Yangmyung , Jester Andrea
Published: July 2023

Introduction The aim of this study was to explore the outcomes of composite grafts in fingertip amputations in children as well as the contributing factors that may affect outcomes.

Methods Literature search was conducted across six databases in March 2022 to select studies on the use of composite grafts on fingertip amputations in the pediatric population.

Results Twelve articles with 735 composite grafts were identified for review. Most fingertip injuries occurred in the less than 5-year age group and were due to crush type injuries. In studies that reported “complete” graft take as a separate outcome measure, 17.3% of fingertips with this result were observed. In the studies that reported “complete” and “partial” graft take together as an outcome measure, 81.6% of fingertips achieved this outcome. A lower proportion of failed graft take was observed in more distal fingertip amputations. Infection (3.8%) and nail abnormalities (3.4%) were the most common complications following composite grafting.

Conclusion Composite grafting can be considered as a useful method of treatment in this population. Clinicians should be aware of the potential complications following this method of treatment such as infection and nail abnormalities. More proximal fingertip amputations may warrant other surgical interventions (beyond Level II on the modified Ishikawa/Ishikawa classification). Significant heterogeneity was observed within the studies, mainly due to lack of standardization in assessment and reporting of outcomes.
Volar Locking Plating of Extra-articular Distal Radius Fracture: A Retrospective Clinical Study Comparing Locking Screws versus Smooth Locking Pegs
Authors: Tordjman Daniel , Younis Mohammad , Factor Shai , Eisenberg Gilad , Atlan Franck , McBeth Jessica , Pritsch Tamir , Rosenblatt Yishai
Published: July 2023

Background Open reduction and internal fixation of distal radius fractures is one of the most common procedures performed in wrist surgery. The use of volar locking plate has gained increasing interest in the past decade. Epiphyseal fixation can be done either with locking screws or smooth locking pegs, with no evidence supporting the use of one rather than the other.

Purpose The aim of this study is to compare the stability of distal radius fixation by volar locking plate using locking screws or smooth locking pegs.

Methods Adult patients with A2–A3 AO fractures treated with a volar plate with locking screws only or smooth locking pegs only were retrospectively included. Radiographic assessment was performed to evaluate extra-articular parameters in the intraoperative postreduction and fixation period and after bony healing. Forty-seven distal radius fractures were included.

Results Twenty-four fractures had fixation with locking screws and 23 had fixation with smooth locking pegs. For both groups, all radiographic parameters measured showed a statistically significant difference between the intraoperative postreduction and fixation period and the remote postoperative period after union of the fracture (p < 0.05) attesting a slight loss of reduction. Nevertheless, there were no significant differences between the groups in radiographic extra-articular parameters.

Conclusion This clinical study shows that there is no difference in stability fixation between locking screws or smooth locking pegs in A2–A3 distal radius fractures.

Clinical Relevance The use of smooth locking pegs only for epiphyseal fixation appears to be safe in volar plating of A2–A3 distal radius fractures in adult patients and could be an alternative to locking screws. More clinical data are needed to confirm these results.

Level of Evidence Level III; retrospective comparative study.
Assessing Fluid Responsiveness Using Noninvasive Hemodynamic Monitoring in Pediatric Shock: A Review
Authors: Shah Nikhil R. , Patel Radha B. , Awadhare Pranali , McCallin Tracy , Bhalala Utpal S.
Published: July 2023

Noninvasive hemodynamic monitoring devices have been introduced to better quantify fluid responsiveness in pediatric shock; however, current evidence for their use is inconsistent. This review aims to examine available noninvasive hemodynamic monitoring techniques for assessing fluid responsiveness in children with shock. A comprehensive literature search was conducted using PubMed and Google Scholar, examining published studies until December 31, 2022. Articles were identified using initial keywords: [noninvasive] AND [fluid responsiveness]. Inclusion criteria included age 0 to 18, use of noninvasive techniques, and the emergency department (ED) or pediatric intensive care unit (PICU) settings. Abstracts, review papers, articles investigating intraoperative monitoring, and non-English studies were excluded. The methodological index for nonrandomized studies (MINORS) score was used to assess impact of study bias and all study components were aligned with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Our review yielded 1,353 articles, 17 of which met our inclusion criteria, consisting of 618 patients. All were prospective observational studies performed in the ED (n = 3) and PICU (n = 14). Etiologies of shock were disclosed in 13/17 papers and consisted of patients in septic shock (38%), cardiogenic shock (29%), and hypovolemic shock (23%). Noninvasive hemodynamic monitors included transthoracic echocardiography (TTE) (n = 10), ultrasonic cardiac output monitor (USCOM) (n = 1), inferior vena cava ultrasonography (n = 2), noninvasive cardiac output monitoring (NICOM)/electrical cardiometry (n = 5), and >2 modalities (n = 1). To evaluate fluid responsiveness, most commonly examined parameters included stroke volume variation (n = 6), cardiac index (CI) (n = 6), aortic blood flow peak velocity (∆V
peak) (n = 3), and change in stroke volume index (n = 3). CI increase >10% predicted fluid responsiveness by TTE in all ages; however, when using NICOM, this increase was only predictive in children >5 years old. Additionally, ∆SV of 10 to 13% using TTE and USCOM was deemed predictive, while no studies concluded distensibility index by transabdominal ultrasound to be significantly predictive. Few articles explore implications of noninvasive hemodynamic monitors in evaluating fluid responsiveness in pediatric shock, especially in the ED setting. Consensus about their utility remains unclear, reiterating the need for further investigations of efficacy, accuracy, and applicability of these techniques.
Comprehensive Clinical and Neuroimaging Review of Posterior Fossa Hemorrhage in Preterm and Term Newborns
Authors: Hsu Mandy , Zhu Zahra , Islam Sirajul , Chang Ryan J. , Hammad Nouran , Bonda Kalyan C. , Aliu Ermal , Gandhi Chintan , Mainali Gayatra , Thamburaj Krishnamoorthy , Naik Sunil
Published: July 2023

Posterior fossa hemorrhage (PFH) is a highly morbid condition in preterm and term infants. In this article, we aim to first describe a case of PFH, and using this example, provide a comprehensive narrative review of the pathophysiology, risk factors, diagnosis, and management of PFH. Management may differ depending on the etiology and based on careful consideration of the risks and benefits of surgical versus conservative management.
Writing trauma: aesthetic experience, projection and the mechanics of representation
Authors: Cârstea Daniela
Published: July 2023

Edgar Allan Poe’s tales represent one of the most finely-wrought conjurings up of trauma-generated fears in literature. Like the writings of Melanie Klein, Poe’s fiction offers a way of getting inside dread, of writing it, re-creating it, and of transforming it into a beautiful thing. In Klein’s intensely lived dramas of objects transformed through destruction and reparation, dread—of persecutors from outside, of fragmentation from within—is experienced with devastating rawness. Viewed in this light, Poe’s discourse of trauma can be seen to re-figure, over and over again, the painful struggle of acknowledging disintegration in the aftermath of a traumatic experience. By plunging the narrator so completely into the subjective viewpoint of his narrator, Poe dramatises uniquely phantasies of omnipotence and the struggle, not only to acknowledge that which lies outside the self, but to preserve the ego from the threat of internal disintegration.
Flatbands in frustrated lattice X3MnN3 (X = Ca, Sr, Ba): A first-principles study
Authors: Ye Jiefeng , Guo Wen-Ti , Yang Ningjing , Zhang Jian-Min
Published: July 2023

Frustrated lattices with dispersionless band structures and fully localized states are an exciting platform for exploring many-body physics. In this work, we identify X3MnN3 (X= Ca, Sr, Ba) as a frustrated lattice and investigate its physical properties in the ferromagnetic (FM) and antiferromagnetic (AFM) states based on first-principles calculations. Our results show that all three materials in FM and A-type AFM configurations have flatbands with band touching in the kz∼0 and kz∼π planes with bandwidths less than 0.2 eV. Intriguingly, the flatband is tuned to the Fermi level when X3MnN3 is transformed into the FM state. Furthermore, we find the two-dimensional dice model hidden in X3MnN3 by treating the coupled Mn and N atoms as a basic site, revealing that the compact localized state is generated by destructive interferences between the hopping amplitudes, and the dice models stack the system staggered along the c-axis. Our work provides new candidate materials for exploring strong correlation physics and reveals the mechanism of their localized state.
A novel rolling bearing fault diagnosis method based on parameter optimization variational mode decomposition with feature weighted reconstruction and multi-target attention convolutional neural networks under small samples
Authors: Hu Chaoqun , Li Yonghua , Chen Zhe , Men Zhihui
Published: July 2023

To enhance the precision of rolling bearing fault diagnosis, an intelligent hybrid approach is proposed in this paper for signal processing and fault diagnosis in small samples. This approach is based on advanced techniques, combining parameter optimization variational mode decomposition weighted by multiscale permutation entropy (MPE) with maximal information coefficient and multi-target attention convolutional neural networks (MTACNN). First, an improved variational mode decomposition (VMD) is developed to denoise the raw signal. The whale optimization algorithm was used to optimize the penalty factor and mode component number in the VMD algorithm to obtain several intrinsic mode functions (IMFs). Second, separate MPE calculations are performed for both the raw signal and each of the IMF components obtained from the VMD decomposition; the results are used to calculate the maximum information coefficient (MIC). Subsequently, each MIC is normalized and converted to a weight coefficient for signal reconstruction. Ultimately, the reconstructed signals serve as input to the MTACNN for diagnosing rolling bearing faults. Results demonstrate that the signal processing approach exhibits superior noise reduction capability through simple processing. Furthermore, compared to several similar approaches, The method proposed for fault diagnosis achieves superior performance levels in the fault pattern recognition target and the fault severity recognition target.
Prediction of aqueous solubility of a strongly soluble solute from molecular simulation
Authors: Carruthers James , Ferrario Mauro , Anwar Jamshed
Published: July 2023

The prediction of solubilities of compounds by means of molecular simulation has been receiving increasing attention due to the key role played by solubility in countless applications. We have predicted the aqueous solubility of urea at 300 K from chemical potential calculations for two urea model combinations: Özpinar/TIP3P and Hölzl/(TIP4P/2005). The methodology assumes that the intramolecular contribution of the urea molecule to the chemical potentials is identical in the crystal and in solution and, hence, cancels out. In parallel to the chemical potential calculations, we also performed direct coexistence simulations of a urea crystal slab in contact with urea-water solutions with the aim to identify upper and lower bounds to the solubility value using an independent route. The chemical potential approach yielded similar solubilities for both urea models, despite the actual chemical potential values showing a significant dependence on the force field. The predicted solubilities for the two models were 0.013–0.018 (Özpınar) and 0.008–0.012 (Hölzl) mole fraction, which are an order of magnitude lower than the experimental solubility that lies in a range of 0.125–0.216 mole fraction. The direct coexistence solubility bounds were relatively wide and did not encompass the chemical potential based solubilities, although the latter were close to the lower bound values.
Systematising experts’ understanding of traditional burning in Portugal: a mental model approach
Authors: Souza Mayara Emilia Barbosa , Pacheco Abílio Pereira , Teixeira Jorge Grenha
Published: July 2023

Background Traditional burning is a practice with social and ecological value used worldwide. However, given the often improper and negligent use of fire, this practice is often associated with rural fire ignitions. Aims Systematise experts’ understanding of traditional burning and identify its challenges in the Portuguese context. Methods Twenty-eight Portuguese experts from industry, academia, NGOs and public entities with in-depth involvement in fire and forest management were interviewed to create a mental model of traditional burning in Portugal. Key results Eight dimensions were identified: motivations behind traditional burning, alternative solutions, risks before a traditional burn, risks during a traditional burn, underlying causes of risk, exogenous elements and factors, potential impacts, and activities leading to a successful traditional burn. Conclusions This study provides a comprehensive understanding of traditional burn practice in the Portuguese context and offers a baseline to support stakeholders and policymakers in managing traditional burning’s social and environmental impacts in the future. Implications This research offers several implications across the eight dimensions identified, including the need to improve regulations on the use of fire and fuel reduction policies, promote fire use education and feasible and affordable alternatives to traditional burning, and increase communities’ commitment to mitigation actions.
Phonon Focusing Effect in an Atomic Level Triangular Structure
Authors: Jiang Jian-Hui , Lu Shuang , Chen Jie
Published: July 2023

The rise of artificial microstructures has made it possible to modulate propagation of various kinds of waves, such as light, sound and heat. Among them, the focusing effect is a modulation function of particular interest. We propose an atomic level triangular structure to realize the phonon focusing effect in single-layer graphene. In the positive incident direction, our phonon wave packet simulation results confirm that multiple features related to the phonon focusing effect can be controlled by adjusting the height of the triangular structure. More interestingly, a completed different focusing pattern and an enhanced energy transmission coefficient are found in the reverse incident direction. The detailed mode conversion physics is discussed based on the Fourier transform analysis on the spatial distribution of the phonon wave packet. Our study provides physical insights to achieving phonon focusing effect by designing atomic level microstructures.
On thermodynamics of compact objects
Authors: Aydemir Ufuk , Ren Jing
Published: July 2023

With the recent progress in observations of astrophysical black holes, it has become more important to understand in detail the physics of strongly gravitating horizonless objects. If the objects identified in the observations are indeed horizonless and ultracompact, high curvature effects may become important, and their explorations may be intimately related to new physics beyond General Relativity (GR). In this paper, we revisit the concept of statistical thermodynamics in curved spacetime, focusing on self-gravitating compact systems without event horizons. In the literature, gravitational field equations are in general assumed a priori in the thermodynamic treatment, which may lead to difficulties for theories of modified gravity, given the more complicated structure of field equations. Here, we consider thermodynamic behavior of the matter source, instead of the physical mass, hence avoiding the explicit input of field equations in the derivation of thermodynamic laws. We show that the conventional first law of thermodynamics is retrieved once the thermodynamic volume, which is in general different from the geometric volume, is appropriately identified. For demonstrations of our approach, we consider familiar examples of self-gravitating gas in GR, where the connection to previous studies becomes clear. We also discuss 2-2-holes in quadratic gravity, a novel example of black hole mimickers that features super-Planckian curvatures in the interior. These objects exhibit universal high curvature effects in thermodynamics, which happen to be conveniently encoded in the thermodynamic volume. Interesting connections to black hole thermodynamics also emerge when the physical mass is treated as the total internal energy.
High-performance flexible UV-photodetector via self-assembled ZnO films
Authors: Zhang Qifan , Li Qiang , Fang Wannian , Zhang Mingyin , Chen Ransheng , Chen Youwei , Li Jiaxing , Yun Feng
Published: July 2023

Zinc oxide (ZnO) is one of the most attractive materials for the preparation of ultraviolet photodetectors (UV PDs). However, the high leakage current and slow response speed significantly limit the practical applications of ZnO-based PDs. In this study, the fabrication of UV PDs based on self-assembled ZnO film has been proposed. The device has an ultra-low dark current (25 pA@10 V) and exhibits fast response speed (190 ms/68.6 ms) and high detectivity (1.91 × 1014 Jones) for 360 nm light. The high performance can be attributed to the operating mechanism of ‘light-induced reduction of junction barrier height’. The analysis based on the thermionic emission theory indicates that illumination can significantly reduce both the Schottky barrier height and series resistance of the device. The prepared flexible PD based on the self-assembled film not only maintains excellent detection performance but also has strong durability and mechanical robustness. After 1000 bending-recovery cycles, the flexible device exhibits excellent repeatable on/off photo-switching behaviors. The measured time-response curves of the flexible PD under five different bending states show unaffected photocurrent, demonstrating excellent flexibility and stability.
An optical scheme of on-chip matrixing by phase-change based tunable weighting of photonic tensor unit
Authors: Ye Ziyang , Yang Junbo , Sun Jigeng , Hu Bo , Zhou Shaolin
Published: July 2023

In this paper, we propose an optical scheme of on-chip matrixing for matrix-vector multiplications (MVMs) by configuring each matrix element into a photonic tensor processing unit (TPU) with wavelength division multiplexing and the actively tunable weighting for scalar multiplication. The low loss chalcogenide phase change material of Ge2Sb2Se4Te (GSST) is employed and modeled with intermediate states for multilevel tunable weighting of each TPU. The dynamic electro-thermal process of GSST phase transition using ITO for electrical heating is simulated and well confirms the switchable weighting of TPUs. Simulation results reveal that a 7 V voltage pulse of 500 ns duration followed by a 9 V voltage pulse of 1500 ns duration and another pulse of 14 V voltage and 500 ns duration can set data value of ‘0’ and ‘1’ for each TPU. Taking a set of incident light with varied wavelengths and powers as input vectors, the quantized MVM outputs of photocurrents with varied amplitude are obtained after photoelectric conversion. Finally, the photonic integrated circuit level simulations by Lumerical INTERCONNECT perfectly confirm our scheme of on-chip matrixing for optical MVMs and computing.
Radiative B to tensor meson decays at NLO in SCET
Authors: Sikandar Arslan , Aslam M Jamil
Published: July 2023

The radiative B to tensor

K

2

*

(
1430
)
,

f

2

(
1270
)
,

a

2

(
1320
)

meson decays are studied at next-to-leading order in soft-collinear effective theory (SCET). The SCET allows the systematic treatment of factorizable and non-factorizable contributions along with the resummation of large perturbative logarithms. We performed a two-step matching and determined the soft-overlap function

ζ

T

⊥

and branching ratios for these B to tensor meson decays. In the case of

B
→

K

2

*

(
1430
)
γ

, the numerical value of the branching ratio lies close to its experimental measurements. The estimated values of the branching ratios of Cabibbo–Kobayashi–Maskawa suppressed decays

B
→

a

2

(
1320
)
,

f

2

(
1270
)

γ

are significantly small compared to that of

B
→

K

2

*

(
1430
)
γ

, but still could be measured in some ongoing and future B physics experiments.