bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the role of crosslink density and linear viscoelasticity on the shear failure of pressure-sensitive-adhesives
Authors: Arrowood Anthony , Ansari Mohammad A. , Ciccotti Matteo , Huang Rui , Liechti Kenneth M. , Sanoja Gabriel E.
Published: July 2023

Entangled and chemically crosslinked polymer networks can resist instantaneous debonding by dissipating strain energy, and sustain shear loads by evolving a stable stress concentration at the peel front.
An efficient deep multi‐task learning structure for covid‐19 disease
Authors: Kordnoori Shirin , Sabeti Maliheh , Mostafaei Hamidreza , Banihashemi Saeed Seyed Agha
Published: July 2023

COVID‐19 has had a profound global impact, necessitating the development of infection detection systems based on machine learning. This paper presents a Multi‐task architecture that addresses the classification and segmentation tasks for COVID‐19 detection. The model comprises an encoder for feature representation, a decoder for segmentation, and a multi‐layer perceptron for classification. Evaluations conducted on two datasets demonstrate the model's performance in both classification and segmentation. To enhance efficiency and diagnosis accuracy, CT‐scan images undergo pre‐processing using image processing algorithms like histogram equalization, median filtering, and mathematical morphology operations. The combination of the median filter pre‐processing and the proposed model yields impressive results in the classification task, achieving high accuracy, sensitivity, and specificity, with values of 0.97, 0.97, and 0.96, respectively, for dataset 1, and 0.96 in mentioned metrics for dataset 2. For segmentation, the proposed model, particularly with the average morphology pre‐processing, exhibits excellent performance with high accuracy, low mean squared error, high peak signal‐to‐noise ratio, high structural similarity index, and a mean dice coefficient of 88.86 ± 0.05 for dataset 1, and 87.97 ± 0.02 for dataset 2. Furthermore, the pre‐trained models consistently demonstrate the superiority of the median filter and proposed model in the classification task on the same datasets. In conclusion, the proposed multi‐task model, incorporating image processing techniques, achieves remarkable results in both classification and segmentation. The utilization of pre‐processing algorithms and the multi‐task framework significantly contribute to superior performance metrics. This study encourages further exploration of combining diverse image processing algorithms to advance infection diagnosis and treatment.
Distributed predictive control design to achieve economically optimal power flow for DC microgrid clusters
Authors: Liu Sucheng , Ma Jin , Zhou Taohu , Zhang Qianjin , Fang Wei , Liu Xiaodong
Published: July 2023

DC microgrid clusters are a collection of interconnected microgrids that allow for flexible power flow, leading to economic benefits and improved resilience from distributed generation. However, managing power flow among interconnected microgrids with different components such as photovoltaic, wind turbine, and battery energy storage systems, as well as various dynamic operation scenarios, presents a significant challenge for proportional‐integral (PI)‐based controllers. To address this challenge, this paper proposes a distributed predictive control design in the hierarchical control paradigm that aims to achieve economically optimal power flow (EOPF) for DC microgrid clusters. The predictive controller considers multiple objectives optimisation, including generation cost models, converter losses, and transmission losses over both local lines and tie‐lines, and design and implementation of the two‐layer tertiary control for the EOPF of DCMGCs are presented. Hardware‐in‐the loop (HIL) experimental results demonstrate the effectiveness of the controller design.
JADES: Probing interstellar medium conditions at z ∼ 5.5–9.5 with ultra-deep JWST/NIRSpec spectroscopy
Authors: Cameron Alex J. , Saxena Aayush , Bunker Andrew J. , D’Eugenio Francesco , Carniani Stefano , Maiolino Roberto , Curtis-Lake Emma , Ferruit Pierre , Jakobsen Peter , Arribas Santiago , Bonaventura Nina , Charlot Stephane , Chevallard Jacopo , Curti Mirko , Looser Tobias J. , Maseda Michael V. , Rawle Tim , Rodríguez Del Pino Bruno , Smit Renske , Übler Hannah , Willott Chris , Witstok Joris , Egami Eiichi , Eisenstein Daniel J. , Johnson Benjamin D. , Hainline Kevin , Rieke Marcia , Robertson Brant E. , Stark Daniel P. , Tacchella Sandro , Williams Christina C. , Willmer Christopher N. A. , Bhatawdekar Rachana , Bowler Rebecca , Boyett Kristan , Circosta Chiara , Helton Jakob M. , Jones Gareth C. , Kumari Nimisha , Ji Zhiyuan , Nelson Erica , Parlanti Eleonora , Sandles Lester , Scholtz Jan , Sun Fengwu
Published: July 2023

We present emission-line ratios from a sample of 27 Lyman-break galaxies from z ∼ 5.5 − 9.5 with −17.0 < M1500 < −20.4, measured from ultra-deep JWST/NIRSpec multi-object spectroscopy from the JWST Advanced Deep Extragalactic Survey (JADES). We used a combination of 28 h deep PRISM/CLEAR and 7 h deep G395M/F290LP observations to measure, or place strong constraints on, ratios of widely studied rest-frame optical emission lines including Hα, Hβ, [O II] λλ3726, 3729, [Ne III] λ3869, [O III] λ4959, [O III] λ5007, [O I] λ6300, [N II] λ6583, and [S II] λλ6716, 6731 in individual z > 5.5 spectra. We find that the emission-line ratios exhibited by these z ∼ 5.5 − 9.5 galaxies occupy clearly distinct regions of line-ratio space compared to typical z ∼ 0 − 3 galaxies, instead being more consistent with extreme populations of lower-redshift galaxies. This is best illustrated by the [O III]/[O II] ratio, tracing interstellar medium (ISM) ionisation, in which we observe more than half of our sample to have [O III]/[O II] > 10. Our high signal-to-noise spectra reveal more than an order of magnitude of scatter in line ratios such as [O II]/Hβ and [O III]/[O II], indicating significant diversity in the ISM conditions within the sample. We find no convincing detections of [N II] λ6583 in our sample, either in individual galaxies, or a stack of all G395M/F290LP spectra. The emission-line ratios observed in our sample are generally consistent with galaxies with extremely high ionisation parameters (log U ∼ −1.5), and a range of metallicities spanning from ∼0.1 × Z⊙ to higher than ∼0.3 × Z⊙, suggesting we are probing low-metallicity systems undergoing periods of rapid star formation, driving strong radiation fields. These results highlight the value of deep observations in constraining the properties of individual galaxies, and hence probing diversity within galaxy population.
Biomodifying chicken stomachs for manufacturing ham product
Authors: Patshina Marina , Gurinovich Galina , Patrakova Irina , Seregin Sergey
Published: July 2023

A deeper processing of secondary meat raw materials determines the profitability and cost-effectiveness of production. The larger volume of poultry meat is produced, the more organ meat is obtained as a by-product. A higher share of collagen-containing by-products in high-grade meat products becomes possible due to the preliminary biomodification of raw materials, in particular enzymatic processing. The paper suggests using chicken stomachs as part of ham after they were subjected to enzymatic collagenase treatment. This biomodification method makes it possible to produce ham with high organoleptic characteristics from poultry meat and chicken stomachs in a ratio of 60% and 40%.
Development of gluten-free bread biotechnology using fermented scald
Authors: Parakhina Olga , Kuznetsova Lina , Savkina Olesia , Lokachuk Marina , Kostyuchenko Marina , Pavlovskaya Elena , Gavrilova Tamara
Published: July 2023

The article is devoted to the development of gluten-free bread technology with scalded flour, fermented by lactic acid bacteria and yeast isolated previously from samples of good quality gluten-free sourdough. The species affiliation of new strains of lactic acid bacteria and yeast isolated from samples of good quality gluten-free starter cultures was established. The antagonistic and acid-forming activity of lactic acid bacteria and the fermentation activity of yeasts were investigated. An increase in the content of volatile acids in fermented scald and the acidity of finished products was established when using scald fermented with a heterofermentative strain L.brevis E139. As a result of the research, a biotechnology of fermented scald was developed, which makes it possible to obtain gluten-free bread with increased physical, chemical, organoleptic quality indicators and safety for diet therapy for celiac disease. The influence of the sourdough with a new microbial composition on the physico-chemical, organoleptic quality indicators of finished products and their resistance to mold and potato disease was studied.
Formation of phytocoenotypes in soils of different degree of erosion
Authors: Bedareva Olga , Troyan Tatiana , Iusov Alexander
Published: July 2023

The paper focuses on issues related to problems of eroded soils and subsequent processes of development of serial communities aimed at formation of a stable climax phytocoenosis. A series is considered as a set of species that briefly inhabit a given territory replacing each other. Soil erosion development is caused by anthropogenic and natural factors; hence, this process is of a mixed natural-anthropogenic type. Soil erosion on slopes with elemental landscapes of any exposure affects the environmental conditions for the formation of phytocoenotypes and species composition of plant communities due to secondary successions and variation in dominants and subdominants. In this case, plant communities of herbaceous phytocoenoses of eroded soils exhibit both sequential and rapid changes in species composition with the appearance of species adapted to decreased soil fertility. The orientation, rate and number of successional changes depend on the intensity of erosion development. Severely eroded soils significantly increase the heterogeneity of the soil environment, creating optimal conditions for introduction of species that are often nontypical of the considered phytocoenoses; the number of assectators therefore increases in soils of this type. In case weakly eroded soils are used as the control, the number of assectators in severely eroded soils increases two to three fold, with possible fluctuation changes aimed at reducing assectators due to ecotopic and phytocoenobiotic selections.
Questioning carbonate facies model definition with reference to the Lower Cretaceous Urgonian platform (SE France Basin)
Authors: Michel Julien , Lanteaume Cyprien , Massonnat Gérard , Borgomano Jean , Tendil Anthony J.-B. , Bastide Fanny , Frau Camille , Léonide Philippe , Rebelle Michel , Barbier Mickael , Danquigny Charles , Rolando Jean-Paul
Published: July 2023

Designing carbonate facies models requires the integration, correlation and conceptual interpretation of multiple geological data sets. Potential significant errors are sourced from uncertain stratigraphic correlations, speculative palaeoecological interpretations and poorly recorded palaeotopographic profiles. The present study explores a methodological workflow to define a well-supported facies model. An exhaustive literature review is presented on sedimentary facies and depositional profiles of Urgonian carbonate platform from SE France and Switzerland (Barremian–Aptian interval). The historical evolution of Urgonian facies models and related sedimentological concepts is investigated to contextualise published models. The presented conceptual model and table of depositional facies shows a consistent, process-based organization of specific elementary facies, facies associations and carbonate system. Within the chronostratigraphic framework, the study of synchronous strata correlations provides quantitative analyses of facies-belt extents and palaeobathymetric estimations. The resulting depositional profile is based on general palaeoecological and sedimentological concepts, facies distribution on palaeogeographic maps and stacking trends. In rare locations in the field, direct lateral facies belt transitions are recorded. Proximal (i.e. emersive and peloidal-foraminiferal) depositional facies are rarely observed; most outcrops record the (i) rudist facies association, which corresponds to distal parts of the inner platform, (ii) coral, ooidal and bioclastic facies associations, which are interpreted to occur on the outer platform, and (iii) calcisiltite, slope and basinal deposits. Key data and concepts allow for the building up of a robust, harmonised facies model that can be used to properly interpret palaeoenvironmental changes, stacking trends and stratigraphic sequence evolution, the resolution of which depends on the available chronostratigraphic framework.
Microbubble Generation and Transmission of Medtronic’s Affinity Hardshell Venous Reservoir and Collapsible Venous Reservoir Bag: An In-Vitro Comparison
Authors: Potger Kieron C. , McMillan Darryl , Ambrose Mark
Published: July 2023

Microemboli are implicated in neurological injury; therefore, the extracorporeal circuit (ECC) should not generate microbubbles or transmit introduced air. The venous reservoir is the first component in the ECC designed to remove introduced air. The purpose of this study was to investigate the relative safety of two kinds of adult venous reservoirs—the closed soft-shell venous reservoir (SSVR [Medtronic CBMVR 1600]) and the open hard-shell venous reservoir (HSVR [Affinity NT CVR])—in terms of microbubble generation and introduced air transmission. A recirculating in-vitro circuit was used to compare the two reservoirs with the SSVR further assessed in a fully closed or partially open state. Microbubbles were counted using a Hatteland CMD10 Doppler in the outflow of the reservoirs before (microbubble generation) and after infusing 20 mL/min of air into the venous line (microbubble transmission) while altering pump flow rates (3 L/min; 5 L/min) and reservoir prime (200 mL; 700 mL). Negligible bubble generation was noted in the SSVRs at both flow rates and either reservoir volume. However, microbubble generation was significant in the HSVR at the higher flow rate of 5 L/min and lower reservoir volume of 200 mL. When infusing air, a flow of 3 L/min was associated with insignificant to small increases in microbubble transmission for all reservoirs. Conversely, infusing air while flowing at 5 L/min was associated with significantly more microbubble transmission for all reservoirs at both low and high reservoir volumes. The SSVR is as safe as the HSVR in microbubble handling as the generation and transmission of microbubbles by the SSVR is not more than the HSVR over a range of prime volumes and flow rates. As both reservoirs transmitted microbubbles at higher pump flow rates regardless of reservoir volumes, it is important to eliminate venous air entrainment during cardiopulmonary bypass.
In-Vitro Quantification of Gaseous Microemboli in Two Extracorporeal Life Support Circuits
Authors: Burnside Jeffrey , Gomez Daniel , Preston Thomas J. , Olshove Vincent F. , Phillips Alistair
Published: July 2023

During the course of extracorporeal membrane oxygenation, patients are at constant risk of exposure to air emboli. Air emboli may enter the circuit during routine lab sampling, medication administration, air entrainment through the venous cannula, or via a circuit disruption. Circuit components have been designed and positioned to minimize the quantity of air that travels through the arterial line to the patient. The purpose of this study was to assess the air handling of a newer generation extracorporeal life support circuit. The extracorporeal life support circuit consisted of an open hard-shell venous reservoir, Better Bladder (BB14) or silicone bladder (R-14), and Quadrox D® oxygenator or 0800 silicone oxygenator. Air emboli detection sensors were placed in the extracorporeal life support circuit: post bladder, post oxygenator, and post heat exchanger if applicable. Air was injected as a 1 mL/min for 5 minutes injection or as a single 5 mL bolus. Emboli detection was recorded continuously during and for 3 minutes post air injection at two blood flow rates (Qb) (.5 and 1.2 L/min). All tests were performed in triplicate with each condition. All tested components reduced the embolic volume transmitted through the circuit. The quantity of this reduction was dependent on both the Qband the air injection condition. During this in-vitro testing, air emboli passing through any of the components tested was decreased. Furthermore, the emboli delivery was reduced post component with the slower Qb(.5 L/min).
Extracorporeal Bioartificial Liver for Treating Acute Liver Diseases
Authors: Kumar Ashok , Tripathi Anuj , Jain Shivali
Published: July 2023

Liver is a vital organ of the human body performing myriad of essential functions. Liver-related ailments are often life-threatening and dramatically deteriorate the quality of life of patients. Management of acute liver diseases requires adequate support of various hepatic functions. Thus far, liver transplantation has been proven as the only effective solution for acute liver diseases. However, broader application of liver transplantation is limited by demand for lifelong immunosuppression, shortage of organ donors, relative high morbidity, and high cost. Therefore, research has been focused on attempting to develop alternative support systems to treat liver diseases. Earlier attempts have been made to use nonbiological therapies based on the use of conventional detoxification procedures such as filtration and dialysis. However, the absence of liver cells in such techniques reduced the overall survival rate of the patients and led to inadequate essential liver-specific functions. As a result, there has been growing interest in the development of biological therapy-based extracorporeal liver support systems as a bridge to liver transplantation or to support the ailing liver. A bioartificial liver support is an extracorporeal device through which plasma is circulated over living and functionally active hepatocytes packed in a bioreactor with the aim to aid the diseased liver until it regenerates or until a suitable graft for transplantation is available. This review article gives a brief overview of efficacy of various liver support systems that are currently available. Also, the development of advanced liver support systems, which has been analyzed for improving the important system component such as cell source and other culture and circulation conditions for the maintenance of the liver-specific functions, have been described.
The Correlation of Fluid Balance Changes During Cardiopulmonary Bypass to Mortality in Pediatric and Congenital Heart Surgery Patients
Authors: Grist Gary , Whittaker Carrie , Merrigan Kellie , Fenton Jason , Worrall Elizabeth , O’Brien James , Lofland Gary
Published: July 2023

Edema acquired during the perioperative period has long been associated with increased mortality. Edema acquired during cardiopulmonary bypass (CPB) may contribute to this mortality. The intent of this retrospective study was to test the premise that edema in the form of a positive fluid balance change (FBC) acquired during CPB correlated to mortality. If so, FBC from the beginning of CPB (baseline; FBC = 0) to the end of CPB may need to be monitored, measured, and controlled on CPB with the same ardor as blood pressure and pH. This retrospective analysis reviewed the FBC of 1540 pediatric and congenital heart surgery patients at the end of CPB. Additions and subtractions of fluid to the combined patient/CPB circuit were routinely quantified during CPB procedures and during periods of modified ultrafiltration (MUF). The primary outcome assessed was mortality during hospitalization. The overall mortality of the 1540 patients was 5.65%from all causes. Eighty percent (n = 1226, mortality = 4.65%) of the patients had a zero or negative FBC immediately after CPB/MUF. Twenty percent (n = 314, mortality = 9.55%) had a positive FBC. Positive FBC patients tended to be in higher risk categories, weighed more, and had longer pump times (p < .05) with an adjusted odds ratio for mortality of 1.73 (1.01–2.96, 95% confidence interval). There is a correlation between edema acquired during CPB and increased mortality in pediatric and congenital heart surgery patients. The potential exists for the perfusionist to optimize the fluid balance changes while on CPB to reduce mortality rates.
Effects of Health Disparities on Survival after Neonatal Heart Surgery: Why Should Racial, Ethnic, Gender, and Socioeconomic Status Be Included in the Risk Analysis?
Authors: Sistino Joseph J. , Ellis Charles
Published: July 2023

Health disparities are “differences in the quality of health and health care across different populations.” Potential disparities associated with race, ethnicity, gender, and socioeconomic status should be considered when attempting to develop models for survival and neurodevelopmental outcomes in neonates undergoing congenital heart surgery. Each of the aforementioned sociodemographic factors is related to postsurgical mortality because they are frequently linked to measures of access to care in addition to location of care (geographically) and the type of institution (teaching vs. nonteaching) where patients receive care. Traditionally these factors have not been considered in models of surgical treatment outcomes in conditions such as hypoplastic left heart syndrome. However, we believe these factors should at least be included in risk analysis models to help explain their impact on outcomes and in predicting outcomes. Therefore, the purpose of this article is to highlight some of the nonsurgical influences that affect survival after neonatal heart surgery such as race, ethnicity, gender, and socioeconomic status.
Impact of a Phosphorylcholine-Coated Cardiac Bypass Circuit on Blood Loss and Platelet Function: A Prospective, Randomized Study
Authors: Marguerite Sandrine , Levy François , Quessard Astrid , Dupeyron Jean-Pierre , Gros Cécile , Steib Annick
Published: July 2023

Platelet dysfunction due to cardiopulmonary bypass (CPB) surgery increases the risk of bleeding. This study analyzed the effect of a phosphorylcholine (PC)-coated CPB circuit on blood loss, transfusion needs, and platelet function. We performed a prospective, randomized study at Strasbourg University Hospital, which included 40 adults undergoing coronary artery bypass graft surgery (CABG) (n= 20) or mitral valve repair (n= 20) using CPB. Patients were randomized either to PC-coated CPB or uncoated CPB (10 CABG patients and 10 mitral valve repair patients in each group). Blood loss and transfusion needs were evaluated intra- and postoperatively. Markers of platelet activation and thrombin generation were measured at anesthesia induction, at the beginning and end of CPB, on skin closure, and on days 0, 1, and 5. Comparisons were made by Student’sttest or covariance analysis (significance thresholdp≤ .05). Blood loss was significantly lower in the PC group during the first 6 postoperative hours (171 ± 102 vs. 285 ± 193 mL,p= .024), at the threshold of significance from 6–24 hours (p= .052), and similar in both groups after 24 hours. During CPB, platelet count decreased by 48% in both groups. There was no difference in markers of platelet activation, thrombin generation, or transfusion needs between the two groups. Norepinephrine use was more frequent in the control group (63% vs. 33%) but not significantly. PC-coating of the CPB surface reduced early postoperative bleeding, especially in CABG patients, but had no significant effect on platelet function because of large interindividual variations that prevented the establishment of a causal relationship.
A Meta-Analysis of Renal Benefits to Pulsatile Perfusion in Cardiac Surgery
Authors: Sievert Alicia , Sistino Joseph
Published: July 2023

Multiple studies have evaluated the efficacy of pulsatile flow during cardiopulmonary bypass (CPB) showing controversial results. Suggested benefits to pulsatile perfusion include reducing the systemic inflammatory response syndrome associated with bypass, decreased need for inotropic support, shortened hospital stay, and superior organ preservation. This study aims to compare prior studies to determine if there is a significant difference in post-operative renal function with pulsatile perfusion compared to non-pulsatile perfusion during cardiac surgery. Studies included in the analysis were identified by searching keywords - pulsatile perfusion, pulse, pulsatile flow, cardiopulmonary bypass, and cardiac surgery. To maintain a homogenous sample, manuscripts were included if they met the following criteria: research was prospective in nature, subjects were human, paper contained documented baseline demographics, outcome data included markers of renal function. A meta-analysis was performed to compare post-op renal function between pulsatile and non-pulsatile perfusion groups. A total of 298 articles were screened. Ten articles met the criteria, of these, 477 patients underwent non-pulsatile perfusion while 708 received pulsatile perfusion during CPB. There was insufficient evidence to show a difference in mean postoperative creatinine or BUN between the groups, however, the pulsatile perfusion group had significantly higher creatinine clearance (standardized difference in means = 2.48, p = .004) and lower serum lactate levels (standardized difference in means = −2.08, p = .012) in the intensive care unit. This study found that there is great variability among pulsatile perfusion research. The methods to create and assess effective pulsatility on bypass varied widely among manuscripts. This analysis suggests that pulsatile perfusion during CPB is beneficial in renal preservation and should be considered.
High Flow and High Dose Neosynephrine are Effective to Maintain Perfusion Pressure for the Patient with Preoperative Angiotensin Converting Enzyme Inhibitor during Cardiopulmonary Bypass
Authors: Ren Yajun , Lindemann Dean C. , Thomas Robert C. , Baghelai Kourosh , Durham Samuel J.
Published: July 2023

Angiotensin converting enzyme inhibitors (ACEIs) are widely used in the treatment of hypertension, myocardial infarction, and congestive heart failure. They have a known adverse effect of unresponsiveness to vasoconstrictors resulting in hypotension for the patients undergoing cardiac surgery. We report a case of a 43-year-old female patient with preoperative lisinopril (2.5 mg per day for a week prior to cardiac surgery), who was diagnosed with severe mitral and tricuspid valve regurgitation. She underwent both a mitral and tricuspid valve replacement operation using cardiopulmonary bypass (CPB). To address her ACEI-associated hypotension on cardiopulmonary bypass, bypass flows were as high as cardiac index of greater than 3 (3.1 ± .2) L/min/m2 to provide sufficient perfusion indicated by cerebral oxymetry monitoring and adequate urine on pump. In addition, due to unresponsiveness to regular concentration of neosynephrine (neo), boluses of higher concentrations up to 320 μg/mL of neo were administered to maintain the perfusion pressure on pump. The patient was weaned from CPB uneventfully and was discharged home on postoperative day 7. Additional therapeutic treatment to ACEI-associated hypotension and unresponsiveness to neo for the patients undergoing cardiac surgery using CPB is reviewed as well in this paper.
Endogenous Gas Formation—An In Vitro Study with Relevance to Gas Microemboli during Cardiopulmonary Bypass
Authors: Lindholm Lena , Engström Karl Gunnar
Published: July 2023

Gas embolismis an identified problemduring cardiopulmonary bypass (CPB). Our aim was to analyze the potential influence from gas solubility based on simple physical laws, here called endogenous gas embolism. Gas solubility decreases at higher temperature and gas bubbles are presumably formed at CPB warming. An experimental model to measure gas release was designed. Medium (water or blood retrieved from mediastinal drains, 14.6 mL) was incubated and equilibrated with gas (air, 100% oxygen, or 5% carbon dioxide in air) at low temperature (10°C or 23°C). At warming to 37°C, gas release was digitally measured. Also, the effect of fluid motion was evaluated. At warming, the medium became oversaturated with dissolved gas. When fluid motion was applied, gas was released to form bubbles. This was exemplified by a gas release of .45% (.31/.54, medians and quartile range, volume percent, p = .007) and 1.26% (1.14/1.33, p = .003) when blood was warmed from 23°C or 10°C to 37°C, respectively (carbon dioxide 5% in air). Consistent findings were seen for water and with the other types of gas exposure. The theory of endogenous gas embolization was confirmed with gas being released at warming. The endogenous gas formation demonstrated a dynamic pattern with oversaturation and with rapid gas released at fluid motion. The gas release at warming was substantial, in particular when the results were extrapolated to full-scale CPB conditions. The interference from endogenous gas formation should be considered in parallel to external sources of gas microemboli.
Extracorporeal Membrane Oxygenation Clinical Dilemmas
Authors: Sidebotham David
Published: July 2023

Three scenarios are presented, based on real patients, illustrating various clinical dilemmas involving critical illness and extracorporeal membrane oxygenation (ECMO). The scenarios are outlined in the form of questions and answers. In most cases there is no single correct answer to the dilemmas presented. The pros and cons of particular interventions are discussed along with the actual treatment provided. In all cases, the ECMO circuit consisted of a polymethylpentene oxygenator (Quadrox PLS; MAQUET Cardiovascular, Hirlingen, Germany) and a centrifugal pump (Rotaflow; MAQUET Cardiovascular). Case 2 has been previously published as a letter to the editor (1).
Report from AmSECT’s International Consortium for Evidence-Based Perfusion: American Society of ExtraCorporeal Technology Standards and Guidelines for Perfusion Practice: 2013
Authors: Baker Robert A. , Bronson Shahna L. , Dickinson Timothy A. , Fitzgerald David C. , Likosky Donald S. , Mellas Nicholas B. , Shann Kenneth G. ,   on behalf of the International Consortium for Evidence-Based Perfusion for the American Society of ExtraCorporeal Technology
Published: July 2023

One of the roles of a professional society is to develop standards and guidelines of practice as an instrument to guide safe and effective patient care. The American Society of Extracorporeal Technology (AmSECT) first published its Essentials for Perfusion Practice, Clinical Function: Conduct of Extracorporeal Circulation in 1993. The International Consortium for Evidence-Based Perfusion (ICEBP), a committee within AmSECT, was tasked with updating this document in 2010. The aim of this report is to describe the method of development and content of AmSECT’s new professional standards and guidelines. The ICEBP committee independently evaluated and provided input regarding the current “Essentials and Guidelines.” Structural changes were made to the entire document, and a draft document was developed, presented, and circulated to the AmSECT Board of Directors and broader membership for comment. Informed by these reviews, a revised document was then presented to the Society for a membership vote. The final document consists of 15 areas of practice covered by 50 Standards and 38 Guidelines (see Appendix 1) with the first standard focusing on the development of institutional protocols to support their implementation and use. A majority of the membership voted to accept the document (81.2% of the voting membership accepting, 18.8% rejecting). After an audit of the balloting process by AmSECT’s Ethics Committee, the results were reported to the membership and the document was officially adopted on July 24, 2013. The Standards and Guidelines will serve as a useful guide for cardiac surgical teams that wish to develop institution-specific standards and guidelines to improve the reliability, safety, and effectiveness of adult cardiopulmonary bypass. The ICEBP recognizes that the development of a Standards and Guidelines statement alone will not change care. Safe, reliable, and effective care will be best served through the development and implementation of institutional protocols based on these standards. AmSECT’s Standards and Guidelines for Perfusion Practice reflect the changing landscape of our profession as we work toward a safer and optimal provision of cardiopulmonary bypass for all our patients as well as a work environment that is supportive of delivering this care.
Prescriptive Patient Extracorporeal Circuit and Oxygenator Sizing Reduces Hemodilution and Allogeneic Blood Product Transfusion during Adult Cardiac Surgery
Authors: Bronson Shahna L. , Riley Jeffrey B. , Blessing Joshua P. , Ereth Mark H. , Dearani Joseph A.
Published: July 2023

The goal of this cardiopulmonary bypass (CPB) quality improvement initiative was to maximize hemoglobin nadir concentration by minimizing hemodilution and, in turn, eliminating allogeneic blood product transfusion. The effects of transitioning from “one-size-fits-all” to “right-sized” oxygenators, reservoirs, and arterial–venous tubing loops were evaluated through a 2-year retrospective review of 3852 patient perfusion records. Using a sizing algorithm, derived from manufacturers’ recommendations, we were able to create individualized “right-sized” extracorporeal circuits based on patient body surface area, cardiac index, and target blood flows. Use of this algorithm led to an increase in the percent of algorithm-recommended smaller oxygenators being used from 39% to 63% (p< .01) and an increase in average hemoglobin nadir from 8.38 to 8.76 g/dL (p< .01). Decreased priming volumes led to increased hemoglobin nadir and decreases in allogeneic blood transfusion (p= .048). Patients with similar body surface areas who previously were exposed to larger oxygenators, reservoirs, and arterial–venous loops were now supported with smaller circuits as a result of the use of the right-sized algorithm. Adjustments to the algorithm were made for unique patients and procedural situations including age, gender, and length and type of procedure. Larger heat exchanger surface area oxygenators were used for circulatory arrest procedures as a result of the need for increased heat exchange capability. Despite the generally higher costs of smaller circuits, reduced transfusion-related expenditures and decreased exposure risks justify the use of smaller circuit components. This quality improvement initiative demonstrated that as an integral part of a multidisciplinary, multimodal blood conservation effort, the use of the “right-sized” circuit algorithm can help to elevate hemoglobin nadir during CPB and eliminate allogeneic blood transfusions to patients undergoing CPB.
Fluid Therapy and Outcome: Balance Is Best
Authors: Allen Sara J.
Published: July 2023

The use of intravenous fluids is routine in patients undergoing surgery or critical illness; however, controversy still exists regarding optimum fluid therapy. Recent literature has examined the effects of different types, doses, and timing of intravenous fluid therapy. Each of these factors may influence patient outcomes. Crystalloids consist of isotonic saline or balanced electrolyte solutions and widely distribute across extracellular fluid compartments, whereas colloids contain high-molecular-weight molecules suspended in crystalloid carrier solution and do not freely distribute across the extracellular fluid compartments. Colloids vary in composition and associated potential adverse effects. Recent evidence has highlighted safety and ethical concerns regarding the use of colloid solutions in critically ill patients, particularly the use of synthetic starch solutions. which have been associated with increased morbidity and mortality. Crystalloid solutions with a chloride-rich composition (e.g., isotonic saline) have been associated with metabolic acidosis, hyperchloremia, increased incidence of acute kidney injury, and increased requirement for renal replacement therapy. An optimum dose of intravenous fluids remains controversial with no definitive evidence to support restrictive versus liberal approaches. Further high-quality trials are needed to elucidate the optimum fluid therapy for patients, but currently a balanced approach to type, dose, and timing of fluids is recommended.
Bivalirudin in Venovenous Extracorporeal Membrane Oxygenation
Authors: Jyoti Aman , Maheshwari Arun , Daniel Elvin , Motihar Amit , Bhathiwal Rajpal Singh , Sharma Deevakar
Published: July 2023

Optimal anticoagulation plays a pivotal role in successful outcome of extracorporeal membrane oxygenation (ECMO). Heparin has been the anticoagulant of choice owing to its advantages like easy monitoring and reversibility. However, if heparin resistance is encountered, one has to decide whether to treat heparin resistance with fresh-frozen plasma or antithrombin concentrates or to choose one of the heparin alternatives for anticoagulation. We report a case of heparin resistance resulting from antithrombin III deficiency in a patient on venovenous ECMO, in which anticoagulation was managed with bivalirudin. The dose of bivalirudin for anticoagulation in ECMO has not been standardized and different authors have reported different doses. We found a bivalirudin dose of .1–.2 mg/kg/h to be adequate to maintain a target activated clotting time of 200–220 seconds. Platelet counts were stable throughout and no major bleeding or thrombotic complications took place. We found bivalirudin to be a feasible and effective anticoagulant and safe to use for long durations in ECMO without any major complications.
Use of Bivalirudin for Anticoagulation during Implantation of Total Artificial Heart
Authors: Federman Myke , Dragomer Douglas , Grant Stuart , Reemtsen Brian , Biniwale Reshma
Published: July 2023

Heparin-induced thrombocytopenia presents a challenge for anticoagulation techniques during cardiac surgery and ventricular assist device implantation. Bivalirudin is currently recommended for use during cardiopulmonary bypass for patients with heparin-induced thrombocytopenia but requires the use of special techniques to avoid blood stagnation. We report the successful use of bivalirudin during cardiopulmonary bypass for implantation of the Total Artificial Heart with late operative bleeding likely resulting from heavy cell saver use.
Bloodless Pediatric Cardiopulmonary Bypass for a 3.2-kg Patient Whose Parents are of Jehovah’s Witness Faith
Authors: Ratliff Todd M. , Hodge Ashley B. , Preston Thomas J. , Galantowicz Mark , Naguib Aymen , Gomez Daniel
Published: July 2023

Patients and parents of Jehovah’s Witness (JW) faith present multiple challenges to a medical team, especially in the neonatal and pediatric population. The medical team must balance honoring the parents’ request of not receiving blood products and fulfilling our commitment as advocates for the child’s wellbeing. A multidisciplinary approach to cardiac surgery must be embraced for bloodless cardiopulmonary bypass (CPB) to be successful. At our institution, we have developed strategies and techniques for blood conservation that are used preoperatively, intraoperatively, and postoperatively for every CPB case with the goal of a bloodless procedure. These protocols include: preoperative erythropoietin, preoperative iron administration, selection of a CPB circuit specific to the patient’s height and weight, acute normovolemic hemodilution, retrograde autologous prime and venous autologous prime, tranexamic acid administration, zerobalance ultrafiltration, flushing of the pump suckers post-CPB, modified ultrafiltration, and cell salvage. We present an 8-day-old, 3.2-kg patient of JW faith with aortic valve stenosis and regurgitation and a patent foramen ovale who underwent a bloodless left ventricle-to-aorta tunnel repair and aortic valve repair on CPB.
Extracorporeal Membrane Oxygenation as a Bridge through Chemotherapy in B-Cell Lymphoma
Authors: Worku Berhane , DeBois William , Sobol Irina , Gulkarov Iosif , Horn Evelyn M. , Salemi Arash
Published: July 2023

A 41-year-old female presented with a large anterior mediastinal mass adjacent to the heart. Biopsy demonstrated lymphoma. Upon administration of chemotherapy, she developed cardiogenic shock requiring a 5-day course of extracorporeal membrane oxygenation (ECMO) as a bridge through her treatment. After one cycle of chemotherapy, ECMO was discontinued and the patient completed her course of chemotherapy and recovered to hospital discharge.
Impairment of Venous Drainage on Extracorporeal Membrane Oxygenation Secondary to Air Trapping in Acute Asphyxial Asthma
Authors: Niimi Kevin S. , Lewis Leslie S. , Fanning Jeffrey J.
Published: July 2023

The inability to adequately support a patient on extracorporeal membrane oxygenation (ECMO) due to impaired drainage is not an uncommon occurrence during support. Typically, the causes include hypovolemia, kinks in the circuit, cannula malposition, or inadequate cannula size. In this report we present an uncommon etiology of this problem. A 3-year-old female presented to our hospital in status asthmaticus and pulseless electrical activity (PEA). This was a result of dynamic hyperinflation of the lungs causing physical obstruction of venous return to the heart. Upon initiating venoarterial (VA) ECMO, we experienced inadequate drainage that did not improve despite multiple interventions. This resolved with the addition of an inhaled anesthetic gas to treat this patient’s severe bronchospasm. This case illustrates the importance of considering a patient’s physiology or disease state and how that may affect the mechanics of ECMO support.
Degree conditions for the existence of a {P2, P5}-factor in a graph
Authors: Wang Sufang , Zhang Wei
Published: July 2023

A subgraph of a graph G is spanning if the subgraph covers all vertices of G. A path- factor of a graph G is a spanning subgraph H of G such that every component of H is a path. In this article, we prove that (i) a connected graph G with δ(G) ≥ 5 admits a {P2, P5}-factor if G satisfies δ(G) > 3α(G)-1/4; (ii) a connected graph G of order n with n ≥ 7 has a {P2, P5}-factor if G satisfies max{dG(x), dG(y)} ≥ 3n/7 for any two nonadjacent vertices x and y of G.
Brauchen wir mehr Ehrenamt in der Medizin? Projektbeispiele aus der Unfallchirurgie
Authors: Prokop Axel , Reinauer Karl-Michael , Koebler Manfred , Stojinov L. , Prokop Jan , Chmielnicki Marc
Published: July 2023

Der Pflegemangel, gesetzliche Vorgaben und die Finanzierungsdefizite führen zu einer
zunehmend schlechteren Patientenversorgung in deutschen Krankenhäusern.

Ehrenamtliche Patientenbegleiter können hier eine sinnvolle Unterstützung bei der
Unterhaltung und Betreuung der Patienten sein. Durch die Betreuung der Patienten wird auf den
Stationen das medizinische Fachpersonal entlastet und den Patienten Ängste und Sorgen
genommen.

Die Begleiter besuchten ausgesuchte, einsame und somit delirgefährdete Patienten auf den
Stationen und verbrachten ca. 1 h Zeit mit Gesprächen, spielen, vorlesen oder meistens nur
zuhören. Zusätzlich wurde eine OP-Begleitung angeboten, bei der die Patienten am Vortag den
Begleiter kennenlernten, der sie dann bis in den OP und später vom Aufwachraum wieder auf die
Station begleitete. Zur Unterstützung nach der Entlassung wurden Übergangsbegleiter
eingesetzt. Sie nahmen vor der Entlassung Kontakt zu den Patienten auf und unterstützten die
Patienten bei der Organisation des häuslichen Umfeldes und der weiteren sozialen und
medizinischen Betreuung.

Vom 01.07.2017 bis 01.04.2023 wurden 12000 Patientenbegleitungen in 4 Krankenhäusern in 14
Stationen durchgeführt. Die Bewertung der Ehrenamtlichen nach Schulnoten zum Erfolg ihrer
Arbeit lag im Mittel bei 1,3, die Bewertung der Patienten betrug im Mittel 1,2. Seit November
2020 wurden in der Unfallchirurgie 120 OP-Begleitungen durch Ehrenamtliche vorgenommen, die so
erfolgreich waren, dass wir dies bei allen alten Patienten auch grundsätzlich bei einem
Familienangehörigen anbieten. Seit 2022 konnten in einem Pilotprojekt 30 Übergangsbegleiter
die Patienten erfolgreich zu Hause unterstützen.

Ehrenamtliches Engagement im und um das Krankenhaus ist eine wichtige Unterstützung bei
alten und alleinstehenden Patienten und entlastet das medizinische Personal im Krankenhaus. Es
ist eine „Win-win-win-win-Situation“ für die Patienten, Begleiter, Personal und
Geschäftsführung.
The Pattern of Nutritional and Inflammatory Parameters in Children with Acute Appendicitis
Authors: Atef Abdelsattar Ibrahim Hoda , Kaddah Sherif , El-Asheer Osama M. , Mahmoud Manal , Wishahy Ahemd
Published: July 2023

Background Surgical procedures in children with overweight and obesity have many difficulties due to the high incidence of postoperative complications. This impact on comorbidity has a great interest in various surgical pathologies, such as acute appendicitis, since it is the most frequent surgical emergency in all age and sex groups. However, there are few studies assessing the effect of body mass index (BMI) and other parameters like the Glasgow Prognostic Score (GPS) and C-reactive protein (CRP)/albumin ratio on the course of acute appendicitis in children.

Objectives Identify the impact of BMI and other biomarkers like CRP/albumin ratio and GPS on the clinical course of acute appendicitis in children.

Patients (Materials) and Methods This is a prospective study conducted on 90 pediatric patients of acute appendicitis (30 high BMI and 60 non-high BMI) admitted at Pediatric Surgery Department, Children Hospital Cairo University (CHCU) during the period from March 2022 to September 2022. All patients had preoperative laboratory tests, intraoperative assessment regarding the type of surgery, duration of surgery, and type of appendicitis, then the postoperative assessment.

Results Among the 90 patients, the mean age of participants was 8.74 (2.23) years and there was a male predominance. Frequencies of open surgeries were higher in overweight and obese children (children with high BMI). There was a significant positive correlation between the preoperative CRP/albumin ratio and GPS, and an inverse significant correlation of preoperative albumin with the postoperative hospital length of stay, duration of surgery (operation time), and duration of postoperative fever.

Conclusion There is a significant relationship between the preoperative inflammatory and nutritional markers and postoperative hospital length of stay, duration of surgery (operation time), and duration of postoperative fever.
A New Clinical Classification for Gynecomastia Management and Predictive Outcome
Authors: Punia Sudhanshu , Gupta Amit
Published: July 2023

Aim and objectives The aim of this study is to propose a new clinical classification for gynecomastia management based on our experience.

Introduction We believe that the prevalent gynecomastia classifications need to be more detailed. Several key aspects that we noticed have either been incompletely represented or not mentioned at all, leaving them unclassified.

Materials and Methods This study was conducted at the authors' center over 24 months from May 2020 to May 2022, and included 1,571 patients who were classified and treated as per our new classifications and small iterations were done to strengthen the classification.

Results We were able to better classify our patients and previously unclassified situations. Skin sagging or a potential for skin sagging and puffy nipples were managed better. This classification allowed recommendation of each step of the procedure, resulting in high patient satisfaction, as all problem areas were sorted and outcome that was explained to them preoperatively was clearly visible postoperatively.

Conclusion The new clinical classification for gynecomastia is a simple, clinical, straightforward, comprehensive, grading system, the use of which has helped the authors and the team in achieving precise and predictable results while ensuring patient satisfaction.