bluuebunny/crossref_metadata_2025 huggingface dataset:
Autologous Thrombin: Intraoperative Production From Whole Blood
Authors: Kumar Vijay , Chapman John R.
Published: July 2023

Thrombin is routinely combined in surgical practice with a fibrinogen source to prepare fibrin sealant to promote hemostasis or with platelet concentrates to prepare platelet gels to enhance wound healing. The purpose of this study was to evaluate the robustness and reproducibility of a new sterile handheld disposable thrombin-processing device (TPD) to generate autologous human thrombin in the intraoperative setting, using whole blood as the starting source material. By using whole blood instead of plasma as the starting material, it is possible to eliminate the plasma separation step from whole blood and reduce the thrombin production time and increase its availability to the surgical team intraoperatively. Active thrombin was prepared by combining 4 mL of thrombin reagent (a mixture of calcium chloride and ethanol) to 11 mL of blood in a reaction chamber containing negatively charged particles. The whole blood, reagent and particle mixture was incubated for 25 minutes at either 18°C or 24°C (n= 25/group) to assess stability of the thrombin activity. The mean activity of the thrombin produced at 18°C and 24°C was 52 ± 14 (n= 25) and 61 ± 12.2 IU/mL (n= 25), respectively. The average volume of thrombin harvested from each aliquot of blood at 18°C and 24°C was 10 ± 0.4 and 9 ± 0.6 mL, respectively. The thrombin concentration generated was shown to rapidly (<5 seconds) coagulate fibrinogen concentrate and retained clotting activity for 1 hour at room temperature (18–26°C) and up to 4 hours when stored on ice. The results show that the TPD is able to consistently generate high thrombin activity from human whole blood. The device offers a robust and rapid approach for preparing active thrombin from whole blood.
Novoseven Use in a Non-Cardiac Pediatric ECMO Patient With Uncontrolled Bleeding
Authors: Preston Thomas J. , Olshove Vincent F. , Ayad Onsy , Nicol Kathleen K. , Riley Jeffrey B.
Published: July 2023

Despite the presence of normal coagulation values, refractory bleeding during extracorporeal membrane oxygenation (ECMO) is encountered. Occasionally, hemostasis is not achieved through traditional techniques including surgical exploration, anti-fibrinolytics, increasing fibrinogen level, increasing platelet counts, and decreasing activated clotting time (ACT). We report the case of an infant on veno-arterial ECMO for respiratory syncytial virus with severe bleeding and the use of recombinant activated factor VII (rFVIIa; NovoSeven; Novo Nordisk, Copenhagen, Denmark). This was a retrospective review of the patient’s medical records, laboratory values, and chest radiographs. rFVIIa was given to this patient on two separate occasions for bleeding unresponsive to traditional bleeding management. On both occasions, the patient’s blood loss returned to zero within 20 minutes of administration and remained there for a minimum of 4 days. Continued bleeding on ECMO unresponsive to current medical management may be an indication for rFVIIa. However, rFVIIa should not be administered without first considering the ECMO circuits conditions to include presence of clot, and documentation of circuit pressures, which, after rFVIIa, may be the first indication of intraoxygenator clot formation. Additionally, rFVIIa should not be a first-line treatment until continued studies allow for approved use in this patient population.
Postoperative Surgical Chest and Leg Incision Sites Using Platelet Gel: A Retrospective Study
Authors: Englert Susan J. , Estep Thomas H. , Ellis-Stoll Cynthia C.
Published: July 2023

The purpose of this study was to determine whether the application of platelet gel (PG) on cardiac surgery wound incisions would promote wound healing and reduce the subsequent incidence of postoperative infections, thereby decreasing the length of hospital stay and hospital costs. Previous work has shown increased incisional healing effect among coronary artery bypass graft patients who received platelet gel. A 1-year retrospective review of 128 cardiac surgery patient charts was performed to determine the clinical impact on those patients whom received platelet gel applications (treatment group) and those whom did not receive platelet gel applications (control group). The outcomes measured were (i) total length of stay, (ii) the incidence of incision wound infection, and (iii) postoperative blood loss. The treatment group had significantly shorter intensive care unit and total length of stays and experienced less postoperative blood loss compared with the control group. In addition, the treatment group had no reported incisional wound infections; however, four patients (3.16%) in the control group experienced incision wound infections. This study was a descriptive chart review and not a controlled study. Our findings support previous research that platelet gel seems to positively influence incisional wound healing among those who undergo cardiac surgery.
Increased Accuracy in Heparin and Protamine Administration Decreases Bleeding: A Pilot Study
Authors: Runge Marx , Møller Christian H. , Steinbrüchel Daniel A.
Published: July 2023

Three to 5 percent of the patients undergoing cardiac surgery are reoperated because of bleeding. When a surgical cause can be excluded, heparin/protamine mismatch may be considered. Insufficient reversal of heparin and overdosing of protamine may cause postoperative bleeding. The purpose of the study was to evaluate whether a heparin–protamine titration system, Hemochron RxDx, could reduce postoperative bleeding and blood transfusion. Fifty-three patients were included prospectively over a 6-month period. The test group (RxDx group; 28 patients) received heparin and protamine doses calculated using the Hemochron RxDx system, which performs a baseline activated clotting time (ACT) value together with a heparin response test. An accurate heparin dose was calculated based on the Bull dose/response curve. Protamine doses were calculated by the same method. In the control group (25 patients), heparin was administered based on weight (3.5 mg/kg) and monitored by ACT. Heparin was reversed with protamine (1 mg/1 mg of total heparin). Postoperative bleeding was significantly lower in the RxDx group (375 mL; range, 125–700 mL) compared with the control group (600 mL; range, 250–1920 mL; p = .018). A reduced number of patients needed blood transfusions in the RxDx group, although this was not statistically significant (19% vs. 38%, respectively; p = .13). Initial heparin dose was significantly reduced in the RxDx group (250 mg; range, 100–375 mg) compared with the control group (300 mg; range, 200–350 mg; p = .04). The additional heparin during cardiopulmonary bypass (CPB) was significantly lower as well 62 (range, 0–185) vs. 100 mg (range, 0–350 mg); p = .04. Initial protamine dose was reduced in the RxDx group 200 (range, 75–340) vs. 350 mg (range, 200–500 mg); p = .0001. Satisfactory end ACT values were obtained in both groups. Using the Hemochron RxDx, we observed a significant reduction in postoperative blood loss, as well as the amount of heparin and initial doses of protamine used during CPB. Individual patient managed anticoagulation during cardiac surgery using dose/response curve techniques based on in vitro analysis of heparin and protamine seems to reduce bleeding.
Post-Arterial Filter Gaseous Microemboli Activity of Five Integral Cardiotomy Reservoirs during Venting: An In Vitro Study
Authors: Myers Gerard J. , Voorhees Cheri , Haynes Rob , Eke Bob
Published: July 2023

During a previously published study on gaseous micro-emboli (GMEs) and perfusionist interventions, it was noted that emboli could be detected after the arterial filter when blood/air challenges entered the membrane oxygenator’s integral cardiotomy. The findings indicated that further study into the oxygenator’s integral cardiotomy reservoir was warranted. This is the first know published report that connects the vent return to GME activity after the arterial filter. To study the air handling ability of the membranes integral cardiotomy, an in vitro study was conducted on five hard shell coated membrane oxygenators (Terumo Capiox SX25, X coated; Sorin Synthesis, phosphorylcholine coated; Gish Vision, GBS coated; Medtronic Affinity NT, trillium coated; Maquet Quadrox, bioline coated). The oxygenators were matched with their own manufacturer’s coated arterial filters (Medtronic 351T Arterial Filter, Sorin Synthesis Integrated Arterial Filter, Terumo CXAF200X Arterial Filter, Gish GAF40GBS-2 Arterial Filter, and Maquet Quart HBF140 Arterial Filter). There were three arms to the study, and three separate oxygenator/filter combinations were used in each arm. The first arm consisted of a pump flow of 4.0 L/min with only the filter purge blood entering the integral cardiotomy. In the second arm, 500 mL/min of simulated vent blood was added to the filter purge blood entering the integral cardiotomy. During the final arm, 200 mL/min of air was added to the vent blood as it entered the integral cardiotomy, to more closely simulate vent return during cardiopulmonary bypass. All GME activity in the oxygenator/filter combinations was examined using the Hatteland CMD20 Microemboli Counter. Placement of the Hatteland probes was 4 in after the hard shell reservoir outlet (PRO) and 12 in after the arterial filter (PAF). When vent blood flow was turned on, there was a significant increase in the PRO microemboli activity detected in all reservoirs. In the PAF position, three of the oxygenator/filter combinations were able to remove 98–99% of the GME, one removed 84.3%, and another removed only 55.5% of the GMEs coming out of the oxygenator’s reservoir. All oxygenators were found to have a dramatic increase in reservoir GME activity when the vent was turned on. Depending on the oxygenator/filter combination, vent return into the oxygenator’s integral cardiotomy resulted in the presence of significant amounts of GMEs after the arterial filter.
Extracorporeal Membrane Oxygenation for the Management of Respiratory Failure Caused by Diffuse Alveolar Hemorrhage
Authors: Guo Zhen , Li Xin , Jiang Li-yan , Xu Ling-feng
Published: July 2023

Extracorporeal membrane oxygenation (ECMO) was developed as a supportive therapy to treat severe respiratory failure. When conventional mechanical ventilation has failed or when there is not enough time to treat the pathology, ECMO has the potential to sustain life. In this report, successful use of ECMO to support an adult patient with antineutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitides complicated by severe respiratory failure caused by diffuse alveolar hemorrhage will be discussed.
Triboelectric Charging and Dissipation Characteristics of the Maquet Quadrox-D Membrane Oxygenator
Authors: Alberts Melissa S. , Niles Scott D. , Wilson Dennis , Ploessl James
Published: July 2023

Triboelectric charging is commonly detected during cardiopulmonary bypass in circuits using roller pumps and PVC tubing. Dissipation of this charging is needed to prevent a spontaneous discharge from occurring. We evaluated the ability of the Quadrox-D (Maquet) to effectively remove the electrostatic charge accumulation, with and without a heater/cooler connection (H/C). A Quadrox-D oxygenator was evaluated using a Stockert SIII pump head, Cincinnati subzero H/E, and a custom adult extracorporeal membrane oxygenation tubing pack with 1/2′ PVC raceway. The circuit was primed and evaluated for triboelectric accumulation with and without H/C use. The results showed a linear relationship between increasing pump flow and static charge build-up when an H/C was not applied. The calculated r2 value was .95. Incorporation of the H/C effectively eliminated charge accumulation. Increasing pump speed increases the amount of static charge created without the use of an H/C. Incorporation of an H/C effectively eliminates charge build-up in the Quadrox-D and is recommended while priming the circuit.
The Effect of Priming Solutions and Storage Time on Plasticizer Migration
in Different PVC Tubing Types—Implications for Wet Storage of ECMO
Systems
Authors: Horne David C. , Torrance Ida , Modine Thomas , Gourlay Terence
Published: July 2023

The wet priming of extracorporeal membrane oxygenation systems and storage of these
systems for rapid deployment is common practice in many clinical centers. This
storage policy is, however, seen by many to be controversial due to the potential
adverse effects associated with the migration of the di(2-ethylhexyl) phthalate
plasticizer (DEHP) from the polyvinyl chloride (PVC) circuit tubing and issues
surrounding the maintenance of sterility. This study was performed to evaluate the
effects of both short and long-term storage and priming fluid type on plasticizer
migration from four commonly used PVC tubes in extracorporeal membrane oxygenation
therapy circuits. The four tubes incorporating three plasticizers, two DEHP, one
tri(2-ethylhexyl) trimellitate (TOTM), and one dioctyl adipate (DOA) were exposed to
each of the three priming fluids for a period of 28 days. Samples were taken at time
intervals of 1, 4, 8, 24, and 48 hours, followed by samples at 7, 14, and 28 days.
Each sample was processed using a spectrophotomer and the concentration of
plasticizer leaching into each solution at each time-point determined. There was a
time dependent increase in plasticizer leached from each tube. The migration was
greatly affected by both the priming fluid and tubing type. The migration of DEHP was
higher than that of TOTM and DOA over both the short and long-term exposure levels.
Plasticizer migration occurs from all of the tubes tested over the long term. The
TOTM and DOA tubes performed better than the DEHP counterparts in the short term.
Selection of priming fluid has a major bearing on plasticizer migration with
significant lipid and protein containing fluids promoting higher migration than
simple sodium chloride .9% solution prime. The results suggest that DOA tubing and
sodium chloride. 9% solution priming fluid should be selected if wet primed perfusion
circuits are to be used over short terms of storage.
Evaluation of Hemodynamic and Regional Tissue Perfusion Effects of Minimized Extracorporeal Circulation (MECC®)
Authors: Bauer Adrian , Diez Claudius , Schubel Jens , El-Shouki Nagi , Metz Dietrich , Eberle T. , Hausmann Harald
Published: July 2023

Minimized extracorporeal circulation (MECC®, Maquet, Cardiopulmonary AG, Hirrlingen, Germany) is an established procedure to perform coronary revascularization. Studies showed positive effects of MECC compared to conventional cardiopulmonary bypass (CCPB) procedures in terms of transfusion requirements, less inflammation reactions, and neurological impairments. Recent retrospective studies showed higher mean arterial pressure (MAP) and a lower frequency of vasoactive drug use. We addressed this issue in this study. The hypothesis was to find a higher MAP during coronary bypass grafting surgery in patients treated with MECC systems. We performed a prospective, controlled, randomized trial with 40 patients either assigned to MECC (n= 18) or CCPB (n= 22) undergoing coronary bypass grafting. Primary endpoints were the perioperative course of mean arterial pressure, and the consumption of norepinephrine. Secondary endpoints were the regional cerebral and renal oxygen saturation (rSO2) as an indicator of area perfusion and the course of hematocrit. Clinical and demographic characteristics did not significantly differ between both groups. Thirty-day mortality was 0%. At four of five time points during extracorporeal circulation (ECC) MAP values were significantly higher in the MECC group compared to CCPB patients (after starting the ECC 60 ± 11 mmHg vs. 49 ± 10 mmHg,p= .002). MECC patients received significantly less norepinephrine (MECC 22.5 ± 35 μg vs. CCPB 60.5 ± 75 μg,p= .045). The rSO2measured at right and left forehead and the renal area was similar for both groups during ECC and significantly higher at CCPB group 1 and 4 hours after termination of CPB. Minimized extracorporeal circulation provides a higher mean arterial pressure during ECC and we found a lower consumption of vasoactive drugs in the MECC group. There was a decrease in regional tissue saturation at 1 and 4 hours post bypass in the MECC group possibly due to increased systemic inflammation and extravascular fluid shift in the CCPB group.
Arterial Filter Bypass Loop: What Occurs in this Area during Cardiopulmonary Bypass and Are There Potential Patient Implications
Authors: Hawkins Justin L. , Myers Gerard J. , Légaré Jean-Francois , Swyer Wilfred
Published: July 2023

The arterial filter is an integral part of bypass circuitry. When introduced, manufacturers suggested a bypass loop for retrograde priming and de-airing, and for uninterrupted blood flow in case of malfunction. Practice has shown antegrade priming and de-airing is possible. This questions the necessity of the loop and presents the question—what occurs in the loop during bypass? After obtaining Human Research Ethics Board approval, eight consecutive patients (n= 8) were chosen for this study. Exclusive exclusion criterion was receiving any transfusions during cardiopulmonary bypass, as this could possibly influence results. The choice of patient numbers was based simply on proof of concept. Investigation involved isolation and collection of loop contents after cardiopulmonary bypass was completed. Testing included complete blood count, prothrombin time, international normalized ratio, partial thromboplastin time, activated clotting time, plasma free hemoglobin, slide photography with analysis for platelet clumping, and debris detection. One perfusionist collected samples, providing uniform collection and isolation technique. Regular blood samples were collected from the bypass circuitry, and from patients’ pre-operative blood work. Analysis of data revealed that platelet counts in the bypass loops were statistically lower than control. Evidence of platelet clumping was present in 3 of 8 bypass loop samples, representing 37.5% of the study population. There was no clumping detected in any of the controls. In patients where platelet clumping was present, a positive correlation was noted between mean bypass time and size of platelet clumps. Prothrombin time and international normalized ratio results were immeasurable. Hemoglobin levels were higher in the loop samples. There was no evidence of debris or fibrin monomer present in any of the samples analyzed. The study results indicate that during “normal” cardiopulmonary bypass with an arterial filter bypass loop, platelet aggregates can accumulate in the loop, therefore opening the arterial bypass loop in any case may subject the patient to micro/macro emboli.
Disconnection of Cobe SMARxT® Tubing from the Venous Outlet of the Terumo Capiox® SX25RX Oxygenator During Cardiopulmonary Bypass
Authors: Ottens Jane , Baker Robert A. , Sanderson Andrew J. , Newland Richard F.
Published: July 2023

The use of surface modified, biocompatible tubing in cardiopulmonary bypass has been reported to decrease the inflammatory responses caused by blood contact with the non endothelial surface of poly vinyl chloride (PVC) tubing. The combination of advances in biocompatible tubing and increased affordability resulted in a change to our cardiopulmonary bypass circuit, with the Terumo Capiox® SX25 oxygenator and Cobe PVC tubing being replaced with a Terumo Capiox® SX25RX (with X coating) and Cobe SMARxT® tubing. Prior to the introduction of the coated oxygenator, no connection problems had been evident. One unrelated disconnection involving coated tubing was reported in June 2005 to the Australian and New Zealand College of Perfusionists Perfusion Incident Reporting System. At this time we revised all of our set up protocols and the recommended actions from manufacturers. We further report three separate incidents of pump boot disconnection from the venous reservoir outlet of the oxygenator during bypass (that occurred within a 13-month period), and an outline of immediate and prospective evaluation of the probable cause. We propose that SMARxT® 3/8″ × 3/32″ tubing should not be used on the venous outlet connector of Terumo Capiox® SX25RX oxygenators. It appears as though the design of the outlet combined with the properties of SMARxT® tubing may contribute to the disconnection.
Is the Air Handling Capability of the Quadrox D Pump Dependent within an ECMO Circuit? An In Vitro Study
Authors: Gill Martin C. , Dando Hayden , Dittmer John
Published: July 2023

The occurrence of gaseous microemboli (GME) within the extracorporeal membrane oxygenation circuit is largely overlooked, as are methods to ameliorate this occurrence. We aimed to determine if the air handling capability of the Quadrox D oxygenator was dependent upon whether it was used in conjunction with a centrifugal or roller pump; and if application of a Pall air eliminating filter (AEF) would prevent circuit air introduction from intravenous infusions. Using a blood primed circuit 1 mL of air was infused pre pump. GME were quantified post pump and post oxygenator using the EDAC® Quantifier. Trials were conducted at 1 and 2 L/min flow. To prevent GME recirculation a Capiox SX18 was used in circuit with negative pressure applied to its oxygenator; an EDAC® cuvette distal to this device quantified GME recirculation. Following air infusion, 3–5 minute data recordings were carried out for each trial. Separate trials were carried out for centrifugal and roller pumps, and for each flow rate. The process was then repeated following the application of the AEF to the air infusion line. More GME were detected post Quadrox D when the centrifugal pump was used in comparison to the roller pump at 1 L/min (p≤ .05), and 2 L/min (p= .05). A greater volume of air was detected post Quadrox D when used in conjunction with the centrifugal device at 1 L/min (p≤ .05), and 2 L/min (p≤ .05). Application of the AEF resulted in zero GME detected at any circuit location. The results of this study confirm that a greater total count and volume of GME are detected distal to the Quadrox D when used in conjunction with a Rotaflow centrifugal pump. Application of a Pall AEF to infusion and drug lines can prevent air introduction from this source.
Diagnosis of Inadvertent Cannulation of the Azygos Vein During Cardiopulmonary Bypass
Authors: Cordisco Michael , Newberger Jordanna , Shann Kenneth G. , Mellas Nicholas B.
Published: July 2023

Cardiac surgery with cardiopulmonary bypass demands diligence and attention to detail to prevent neurologic injury. Arterial and venous cannulae are used to facilitate cardiopulmonary bypass. The assessment of adequate decompression of the venous circulation is an essential duty of the cardiac surgical team. Modalities for the assessment of adequate regional venous drainage are limited, however communication between the team and increased awareness of certain pathologic states can be useful. These modalities include cerebral oximetry and superior vena caval pressure monitoring, which were employed during a case with bicaval venous cannulation. Malposition of the superior vena cava cannula was detected after a series of events alerted the team that superior vena cava drainage may be compromised.
Hyaluronan Based Heparin Free Coated Open and Closed Extracorporeal Circuits for High Risk Coronary Revascularization
Authors: Gunaydin Serdar , Ucar Halil Ibrahim , Serter Tanzer , McCusker Kevin , Ozcelik Gokhan , Salman Nevriye , Yorgancioglu Ali Cem
Published: July 2023

This prospective randomized study compares the inflammatory response and fibrinolytic activation of fully coated/uncoated and open/closed extracorporeal circuits (ECC) in high risk patients. Over a 2-month period, 48 patients with EuroSCOREs 6 or greater undergoing coronary revascularization were pro spectively randomized to one of the four perfusion protocols: Group 1: Closed and totally hyaluronan based heparin free coated (Vision HFO-GBS-HF™, Gish Biomedical, Rancho Santa Margarita, CA) ECC with a soft-shell coated venous reservoir (SVR11S2-HFC™, Gish Biomedical) and a hard-shell cardiotomy (CAPVRF44, Gish Biomedical) (n= 12); Group 2: Closed and totally uncoated identical ECC with soft-shell uncoated venous reservoir and a hard-shell cardiotomy (n= 12); Group 3: Open, totally hyaluronan based heparin free coated ECC (n= 12); and Group 4: Control-open, uncoated ECC (n= 12). Blood samples were collected at T1: Baseline; T2: 15 minutes after cardiopulmonary bypass (CPB) initiation; T3: before cessation of CPB; T4: 15 minutes after protamine reversal, and T5: in the intensive care unit. Serum IL-6 levels were significantly lower at T2 in all study groups, at T3 for coated groups, and T4 for closed+coated group (p< .05 versus control). Creatine kinase M-band (MB) levels in coronary sinus blood demonstrated well preserved myocardium after CPB in both coated groups versus Control (p< .05). Neutrophil CD11b/CD18 levels were significantly lower for all study groups versus control at T2, for both coated groups at T3 and only for closed+coated group at T4 (p< .05). Postoperative hemorrhage (mL) was 510 ± 40 in closed+coated and 536 ± 40 in open+coated groups (control: 784 ± 48,p≤ .05). No significant differences in thrombin-antithrombin complex and free plasma hemoglobin were observed. Desorbed protein amount on ECC (mg/dL) was 1.7 ± .01 in closed+coated, 2.01 ± .01 in open+coated, and 3.3 ± .015 in control groups (p≤ .05). Use of a closed and completely heparin free coated ECC may reduce neutrophil degradation, cytokine release characterized by improved clinical outcomes including reduced blood loss, reduced requirement for inotropes, and reduced atrial fibrillation.
Using Biomarkers to Improve the Preoperative Prediction of Death in Coronary Artery Bypass Graft Patients
Authors: Brown Jeremiah R. , MacKenzie Todd A. , Dacey Lawrence J. , Leavitt Bruce J. , Braxton John H. , Westbrook Benjamin M. , Helm Robert E. , Klemperer John D. , Frumiento Carmine , Sardella Gerald L. , Ross Cathy S. , O’Connor Gerald T. ,   for the Northern New England Cardiovascular Disease Study Group
Published: July 2023

The current risk prediction models for mortality following coronary artery bypass graft (CABG) surgery have been developed on patient and disease characteristics alone. Improvements to these models potentially may be made through the analysis of biomarkers of unmeasured risk. We hypothesize that preoperative biomarkers reflecting myocardial damage, inflammation, and metabolic dysfunction are associated with an increased risk of mortality following CABG surgery and the use of biomarkers associated with these injuries will improve the Northern New England (NNE) CABG mortality risk prediction model. We prospectively followed 1731 isolated CABG patients with preoperative blood collection at eight medical centers in Northern New England for a nested case-control study from 2003–2007. Preoperative blood samples were drawn at the center and then stored at a central facility. Frozen serum was analyzed at a central laboratory on an Elecsys 2010, at the same time for Cardiac Troponin T, N-Terminal pro-Brain Natriuretic Peptide, high sensitivity C-Reactive Protein, and blood glucose. We compared the strength of the prediction model for mortality using multivariable logistic regression, goodness of fit and tested the equality of the receiving operating characteristic curve (ROC) area. There were 33 cases (dead at discharge) and 66 randomly matched controls (alive at discharge). The ROC for the preoperative mortality model was improved from .83 (95% confidence interval: .74–.92) to .87 (95% confidence interval: .80–.94) with biomarkers (p-value for equality of ROC areas .09). The addition of biomarkers to the NNE preoperative risk prediction model did not significantly improve the prediction of mortality over patient and disease characteristics alone. The added measurement of multiple biomarkers outside of preoperative risk factors may be an unnecessary use of health care resources with little added benefit for predicting in-hospital mortality.
The effects of green house gas costs on optimal pricing and production lotsize in an imperfect production system
Authors: Sana Shib Sankar
Published: July 2023

The present article deals with an imperfect production system considering costs for greenhouse gas (GHG) to determine the optimal reserve selling price, sales teams’ efforts and production lotsize. As per government guidelines, the manufacturer used to adopt green practices in supply chain management to meet the customers’ satisfaction regarding fair prices and quality of the products. In this connection, a mathematical model is formulated and analyzed considering various cost factors and interval values of the key parameters. Finally, numerical illustrations are considered to justify the proposed model.
Dedo em gatilho ou tenossinovite de De Quervain após tratamento cirúrgico da síndrome do túnel do carpo
Authors: Kavalco Caroline Mayara , Leonel Letícia de Freitas , Andrade Fernanda Ruiz , Cagnolati Amanda Favaro , Rezende Luis Guilherme Rosifini Alves , Mazzer Nilton
Published: July 2023

Objetivo Avaliar o tratamento cirúrgico aberto da síndrome do túnel do carpo como fator de risco para o desenvolvimento das tenossinovites estenosantes formadoras do dedo em gatilho e da doença de De Quervain.

Materiais e Métodos Estudo retrospectivo com análise dos prontuários de pacientes submetidos a liberação cirúrgica aberta da síndrome do túnel do carpo entre 2010 e 2021 em hospital de níveis secundário e terciário. Os seguintes dados foram coletados: histórico patológico, tempo de acompanhamento após o tratamento cirúrgico da síndrome do túnel do carpo, desenvolvimento de dedo em gatilho ou tenossinovite de De Quervain, dedos acometidos, e tempo decorrido entre o fim da cirurgia e o aparecimento dos sintomas.

Resultados Foram avaliados 802 pacientes de ambos os sexos com média de idade de 50,1 (±12,6) anos. O tempo médio de seguimento foi de 13 (±16,4) meses. O tempo médio de desenvolvimento de dedo em gatilho foi de 61,4 meses, e o da doença de De Quervain, de 73,7 meses. A incidência de desenvolvimento da doença de De Quervain foi de 4,12% e a de dedo em gatilho, de 10,2%. Os dedos mais acometidos foram o polegar (47,6%), o médio (24,4%) e o anular (8,54%). A idade foi único fator que demonstrou associação com o risco de desenvolvimento de dedo em gatilho, com aumento de 2% a cada ano a mais de idade.

Conclusão As taxas de incidência de desenvolvimento de doença de De Quervain (4,12%) e de dedo em gatilho (10,2%) após tratamento cirúrgico da síndrome do túnel do carpo foram semelhantes às descritas na literatura. Apenas a idade se apresentou como fator influenciador no desenvolvimento de dedo em gatilho.
Colorectal Cancer Risk between Mendelian and Non-Mendelian Inheritance
Authors: Hibler Elizabeth A. , Szymaniak Brittany , Abbass Mohammad Ali
Published: July 2023

Hereditary colorectal cancer has been an area of focus for research and public health practitioners due to our ability to quantify risk and then act based on such results by enrolling patients in surveillance programs. The wide access to genetic testing and whole-genome sequencing has resulted in identifying many low/moderate penetrance genes. Above all, our understanding of the family component of colorectal cancer has been improving. Polygenic scores are becoming part of the risk assessment for many cancers, and the data about polygenic risk scores for colorectal cancer is promising. The challenge is determining how we incorporate this data in clinical care.
Liver Interventions in Children
Authors: Srinviasan Abhay , Acord Michael , Lambert Gonzalo , Sierre Sergio , Escobar Fernando
Published: July 2023

This review provides a comprehensive summary of the role of the interventional radiologist in managing liver disorders in children. Interventions are discussed with focus on indications for procedure, technical aspects, and patient management. Recommendations are supported by the most recent evidence and practice experience of the authors in the four subtopics, such as interventions in the post–liver transplant setting, for portal hypertension, for liver tumors, and for vascular anomalies of the liver, with emphasis on congenital portosystemic shunts.
Polymorphous Low-Grade Neuroepithelial Tumor of the Young (PLNTY): A Newly Described Entity of Special Radiological Significance
Authors: Barretto Brendon B. , Mani Jayanti , Venkatraman S. , Kumar Abhaya , Rao Shilpa , Kale Hrishikesh
Published: July 2023

Intracranial granulomas are a major cause of seizures in India, the most common etiologies being neurocysticercosis and tuberculosis. However, other pathologies including rare low-grade tumors may mimic these granulomas on imaging. In this article, we presented the case of a young woman patient with drug-resistant epilepsy. On imaging, there was a small calcified lesion in the brain parenchyma. In view of concordant electroclinical and imaging data on presurgical evaluation, the lesion was excised and the patient was seizure free. On histopathological evaluation, it was found to be a polymorphous low-grade neuroepithelial tumor of the young (PLNTY) – a rare, recently reported entity that can mimic an intracranial granuloma on imaging.
Patient-Related Awareness of Impact of Cancer-Directed Therapy on Fertility in Young Women Diagnosed of Breast Cancer
Authors: Nair Nita S. , Ali Basila Ameer , Siddique Shabina , Maheshwari Amita , Bajpai Jyoti , Parmar Vani , Gulia Seema , Chitkara Garvit , Joshi Shalaka , Hawaldar Rohini , Badwe Rajendra A.
Published: July 2023

Chemotherapeutic agents used in the treatment of breast cancer (BC) adversely impact growing ovarian follicles and can induce permanent premature ovarian failure or reduce ovarian reserve in younger women. As treatments result in improved survival of BC patients, young survivors face quality of life (QOL) issues, including treatment-related infertility. We conducted a survey to evaluate awareness among patients regarding the impact of cancer-directed therapy on fertility and available options of fertility preservation (FP). We interviewed 350 women with BC under 40 years of age at the start of treatment, of which 321 (91.70%) were in varying stages of follow-up, 8 women (2.30%) were scheduled to start treatment, and 21 (6.00%) women were under treatment. All received chemotherapy or hormone therapy with or without ovarian suppression. Of the 350 women who responded to the survey, 321 (91.70%) women were on follow-up, 8 (2.30%) women were due to start treatment, and 21 (6%) women were on treatment. The median age at diagnosis was 35 years, with 12.9% of women aged less than 30 years, 15 (4.28%) were unmarried, 31 (8.85%) were nulliparous, and 98 (28%) had one child. Overall, 271 (77.42%) women were aware (at the start of treatment) of impact of therapy on fertility, but only 48/271(17.71%) women were aware of the options of FP. In this cohort, 94/350 (26.85%) women felt FP was a priority, 64/350 (18.28%) women perceived their family as incomplete, and 17/64 (26.56%) women were willing to consider invasive reproductive assistance (IRA). Reasons for refusal for IRA included cost, risk of relapse, and delay of treatment. There was an association between being unmarried (p = 0.00), having an incomplete family (0.00), considering more children (p = 0.00) and willingness to consider IRA. FP is a priority for women treated for BC and an important QOL domain that needs to be addressed at the start of treatment We found a high level of awareness of impact of cancer-directed therapy to fertility in this cohort, but low awareness and acceptance for options for FP.
Melanotic Neuroectodermal Tumor of Infancy: A Case Report and Literature Review
Authors: Coimbatore Balakrishnan Manu , Das Sauradeep , Lynrah Zareen A. , Mishra Jaya , Kalita Pranjal , Tamuli Prachurya
Published: July 2023

Melanotic neuroectodermal tumor of infancy (MNTI), first described almost a century back, is of neural crest origin, locally aggressive, a rare biphasic neoplasm of infancy with a slightly higher male preponderance. In the last 100 years since the first description of MNTI, only around 500 cases have been described from 32 countries. We present a 7-month-old female child with 3 × 2 cm hard swelling in the oral cavity and right-side facial region for 3 months. Contrast-enhanced computed tomography scan and contrast-enhanced magnetic resonance imaging scan revealed a hypodense lesion of size 2.5 × 2 × 1.6 cm with relatively well-corticated walls. The lesion appeared to arise from the right maxillary alveolus with erosion of the floor of the maxillary sinus. A 7 × 5 mm tooth was visualized within the lesion. There was minimal enhancement in the postcontrast study. With the following provisional diagnoses—odontogenic keratocyst, dentigerous cyst, and unicystic ameloblastoma—the child underwent excision of the lesion. Intraoperatively, Hopkin's rigid endoscope 4 mm was used to ensure complete tumor removal in the maxillary sinus. Histopathological and immunohistochemistry examination resulted in the diagnosis of MNTI. On 1-year follow-up, the child did not show any signs of recurrence. A high index of suspicion, early diagnosis, and timely treatment are needed to diagnose such a rare tumor, to avoid morbidity, and to plan effective management when an infant presents with facial swelling. It should be complemented with close follow-up to identify recurrence early. Use of endoscope whenever feasible is encouraged by the authors to ensure adequate tumor removal.
Hematological and Extra-Hematological Manifestations of Parvovirus B19 Disease
Authors: Zeybek Cengiz , Bolat Ahmet , Gürsel Orhan , Eker İbrahim , Kürekçi Ahmet Emin
Published: July 2023

Objective Parvovirus B19 (PVB19) is a virus that can present with many hematological and extra-hematological findings. Its prognosis is relatively good in immunocompetent patients, but severe disease may develop in immunocompromised patients. We retrospectively reviewed a series of children who presented with PVB19 during a 6-year period at our institution.

Methods Nine children with positive polymerase chain reaction and serological test results for PVB19 were studied. Their demographic data, atypical clinical and laboratory findings, treatment regiments, clinical course, and prognosis were noted.

Results The hematological abnormalities associated with PVB19 were anemia, neutropenia, and thrombocytopenia, and the extra-hematological abnormalities were systemic lupus erythematosus-like syndrome, hemophagocytic lymphohistiocytosis, and acute kidney injury. All patients had good outcomes with no significant sequelae.

Conclusion This case review suggests that clinicians should not consider PVB19 only as a cause of hematological events; they should also be alert to the possibility that it may cause extra-hematological diseases.
Spatial double dividend from China’s main grain-producing areas policy: total factor productivity and the net carbon effect
Authors: Ye Deping , Zhen Shangsong , Wang Wei , Liu Yunqiang
Published: July 2023

Because of the reductions in China’s cultivated land area and the significant impact on the agricultural market, the main grain-producing areas (MGPA) policy has become vitally important for ensuring China’s food security. However, guaranteed food security and sustainability require ecological security, which raises the question of whether food production should come at the expense of the environment. This study used 1998–2020 panel data from 30 Chinese provinces and a spatial difference-in-differences model (SDID) to explore the MGPA policy effects and mechanism paths on agricultural total factor productivity (ATFP) and the net carbon effect (NCS). It was found that economically, the MGPA policy promoted local ATFP improvements and had positive spillover effects on surrounding provinces through factor diffusion, and environmentally, the MGPA policy had a positive effect in the MGPA policy implementation areas but inhibited the NCS in surrounding provinces. Further explorations of the environmental performances revealed that the MGPA policy promoted growth in agricultural carbon sinks and agricultural carbon emissions, with the environmental performances being primarily reflected in an increase in carbon sinks and a decline in the carbon emissions density. The mechanism test showed that the MGPA policy’s local environmental performance was achieved through economic performance. The ATFP was refined into technical innovation (TI), technology adoption (TA), and business scale (OS), with the mechanistic roles of these three refining paths being OS > TI > TA. A further mechanism test revealed that the MGPA policy effects on the ATFP were influenced by the various adjustment of production support, government support, and collaborative support. Based on the above analysis, this study gives policy recommendations to ensure food security and the realization of China’s dual carbon target.
Interpreter visibility in press conferences: a multimodal conversation analysis of speaker–interpreter interactions
Authors: Li Ruitian , Liu Kanglong , Cheung Andrew K. F.
Published: July 2023

This study offers a novel perspective on interpreter visibility by exploring speaker references to interpreters, which differs from previous research that primarily focused on interpreter visibility through their own discourse contributions. Employing a multimodal conversation analysis approach, the study examined the verbal and nonverbal resources utilized by speakers and interpreters in 98 selected excerpts taken from press conference interpreting sessions at the American Institute in Taiwan (AIT). The analysis revealed six distinct topics that denoted the ways in which interpreters were rendered noticeable to the audience through the speaker’s references. These references were context dependent, leading to subsequent speaker–interpreter interactions where interpreters became highly visible. In addition to verbal cues, nonverbal semiotics played a crucial role in demonstrating how interpreters working in rigidly structured press conferences could function as active co-participants of discourse, and how the speaker and interpreter could collaborate to facilitate the interpreter’s visibility and promote a relaxed communicative environment. These findings shed new light on the interpreter’s role, underscoring that it is a dynamic phenomenon requiring analysis in relation to the specific communicative context. This study demonstrated the efficacy of utilizing multimodal conversation analysis as a methodology to explore interactions between speakers and interpreters and to gain a deeper understanding of the complex and nuanced aspects of conference interpreting.
Hydrology education at Chinese universities: a comparative case study between Hohai University and the University of Arizona
Authors: Ke Xintong , Fang Zhongzheng , Wang Fang
Published: July 2023

Hydrology education for hydrological professionals is an important field due to the complex and multifaceted water issues that hydrologists face. Currently, hydrology education at Chinese universities is mainly focused on hydrological engineering, which leads to inadequate scientific and professional training from the perspective of an interdisciplinary educational framework. In this context, the knowledge and skills of future hydrologists cannot be systematically prepared. In this study, we explore the challenges and constraints that hinder the advancement of hydrology education at Chinese universities by conducting an inductive analysis in which we compare the hydrology education that occurs in China with that of the United States. The result suggests that a lack of adequate financial support is the main constraint and that it leads to inevitable problems such as a high student-teacher ratio, insufficiently qualified educators, and poor teaching materials and equipment. To address this issue, financial support for this program should be increased. In addition, collaborative programs based on online learning can effectively resolve the inadequacy of teaching resources. Assessing the hydrological education system in American universities carries a certain significance for Chinese universities in creating a reasonable interdisciplinary hydrological educational system by emulating traditional engineering hydrological education.
Hybrid approach for graphene modeling in numerical simulations of graphene based plasmonic devices with COMSOL
Authors: Kim Kum-Dong , Han Chong-Chang , Im Song-Jin , Song Kil-Song , Ri Chol-Song , Pae Ji-Song , Ho Kum-Song , Han Yong-Ha
Published: July 2023

We present a hybrid approach for graphene modeling in the finite element method numerical simulations of graphene based plasmonic devices with COMSOL. The surface conductivity approach for modeling graphene or other two-dimensional materials needs less number of meshing elements if compared to the volumetric permittivity approach; however, it is less intuitive and less compatible with the boundary mode analysis, which provides a very efficient way for the excitation of boundary ports. We adopt the surface conductivity approach in the scattering domain and the volumetric permittivity approach in the boundary ports. A triangular connector with a spatially varying permittivity is introduced to achieve reflection-less coupling between the surface conductivity and the volumetric permittivity. The hybrid model enables the numerical simulation of graphene based devices with COMSOL to be benefited from less storage and calculation time, keeping compatibility with the boundary mode analysis.
Local sensitivity informed anisotropic sparse grid method for uncertainty quantification of chemical kinetics
Authors: Li Linying , Zhang Bin , Liu Hong
Published: July 2023

The determination of rate coefficient parameters in detailed chemical kinetic mechanisms through experiments often suffers from avoidable aleatory uncertainty, while the use of reduced mechanisms, based on various reduction methods, introduces epistemic uncertainty. Both sources of uncertainty pose significant challenges for modeling and numerical simulation, highlighting the need for calibrating these uncertain parameters to achieve robust chemical mechanisms in the next generation. However, the high-dimensional parameter space of chemical kinetic mechanisms remains a significant obstacle in uncertainty computing. The Anisotropic Sparse Grid (ASG) technique has been successful in dealing with high-dimensional uncertainty problems, but it lacks prior knowledge of anisotropy. To address this issue, we propose the Local Sensitivity-Informed Anisotropic Sparse Grid (LSIASG) method, which utilizes local sensitivity as prior information for the ASG method, thereby accelerating the entire uncertainty quantification process. We test the LSIASG method on a theoretical model, a detailed hydrogen kinetic mechanism, and a methane mechanism and demonstrate that it can capture high-dimensional uncertainty characteristics, including expectation and deviation.
2022 update shows Western Australia’s mammals continue to decline
Authors: McKenzie N. L. , Burbidge A. A. , Baynes A. , Gibson L. A. , Travouillon K. J. , Bullen R. D. , Turpin J. M.
Published: July 2023

We update the list of indigenous mammals known from each of Western Australia’s mainland bioregions since European settlement, assess their regional status in terms of extent of occurrence, then compare these regional status lists and derived faunal attrition values with those published in 2006. Seven bioregions show substantially more faunal attrition since 2006, including the Avon Wheatbelt, Victoria Bonaparte and Northern Kimberley. The status of 27 species has worsened in at least one bioregion, an average of 1.7 species per bioregion across the 26 bioregions. We also examine potential explanatory factors associated with faunal attrition across the bioregions using beta regression and AIC-based model selection. Faunal attrition was strongly associated with low average annual rainfall, a low proportion of species that shelter in rockpile habitat, high environmental change, a high proportion of species in the ‘Critical Weight Range’ and, to a lesser degree, a high proportion of omnivorous species. Only conservation management outside of havens can reverse this downward trend.