bluuebunny/crossref_metadata_2025 huggingface dataset:
Argatroban in Adult Extracorporeal Membrane Oxygenation
Authors: Johnston Nicklett , Wait Michael , Huber Lynne
Published: August 2023

This case report addresses the use of Argatroban, an anticoagulant and thrombin inhibitor for treatment of thrombocytopenia in an adult patient on extracorporeal membrane oxygenation (ECMO). After 5 days on ECMO, the patient showed signs of heparin-induced thrombocytopenia (HIT) with a platelet count of 20K. Argatroban was initiated to decrease progression of HIT and continue treatment with ECMO proved to be successful. Given the occurrence of HIT with heparin therapy, a need for alternate drug therapy is required for patients requiring treatment with ECMO. The use of Argatroban in adult ECMO is outlined and includes dosage, monitoring, and patient treatment.
Effects of Albumin Supplementation during Cardioplegia Administration: An In Vitro Analysis
Authors: Knox Rebecca , Stammers Alfred H. , Ellis Tunisia , Gao Chen , Nutter Bernadette , Holcomb Hunter , Schmer Ryan , Hock Lynette M.
Published: August 2023

Increasing, the colloid osmotic pressure (COP) of blood cardioplegia (BCP) may reduce myocardial edema and preserve cardiac function following cardiopulmonary bypass (CPB). The purpose of this study was to quantify the effects of albumin (ALB) supplementation on cardioplegia COP through an in vitro analysis. A self-contained cardioplegia delivery system administered supplemental ALB to four BCP ratios (1:1, 4:1, 8:1, and 20:1). In Group A, 25% ALB was combined with BCP at four delivery rates (0,13, 25, and 50 mL ALB/L BCP), with a delivery rate of 0 mL ALB/L BCP serving as the control for all groups. Twenty-five percent ALB was added to crystalloid to create carrier solutions containing 12.5, 25, or 50 g ALB/L in Group B, while Group C combined an ALB delivery rate of 50 mL ALB/L BCP with each of the three carrier solutions. Endpoints included initial and post-supplementation hematocrit, total serum protein (TSP), and COP. Without supplemental ALB, TSP was less affected with increasing blood to crystalloid ratios (1:1-81.7 ± 6.2%, 4:1-40.6 ± 5.1%, 8:1-20.6 ± 4.1%, 20:1-6.0 ± 5.7%). The TSP of 1:1 and 4:1 BCP increased (p < .0003 and p < .02) across all methods of supplementation, while 8:1 BCP was similarly increased (p < .008), except with 12.5 and 25 g ALB/L carrier solutions. The greatest change from baseline COP was seen with the lower blood to crystalloid ratios (1:1-64.3 ± 5.0% and 4:1-39.5 ± 10.5%). In higher ratios, the effects of dilution were less profound (14.6 ± 4.2 ± 4.2% and 20:1-6.0 ± 1.9%). COP of 1:1 BCP increased (p < .008) whenever ALB was added. In conclusion, TSP and COP of blood cardioplegic solutions is increased by supplemental albumin administration with quantitative enhancement dependent upon the dilutional effects of the blood to crystalloid ratio.
Use of Aprotinin During Cardiopulmonary Bypass in a Patient with Protein C Deficiency
Authors: Sievert Alicia , McCall Mary , Blackwell Mindy , Bradley Scott
Published: August 2023

This case study reviews cardiopulmonary bypass (CPB) management in a Protein C deficient patient undergoing reoperation for an atrioventricular (AV) valve replacement with the use of aprotinin. Protein C inhibits factors Va and VIIIa in the coagulation cascade and inactivates tissue plasminogen activator inhibitor, thus maintaining hemostasis. Protein C deficiency can cause hypercoagulability and may result in thrombotic episodes, especially in areas of low blood flow or during activation of the coagulation cascade. A 17-year-old male presented with a functional single ventricle and AV valve regurgitation. The patient had a history of three previous AV valve replacements. Protein C deficiency was first diagnosed after thrombosis of the first valve prosthesis. Other case studies in protein C deficient patients suggested the use of fresh frozen plasma (FFP) before bypass to restore protein C levels, ATIII replacement before heparin administration, and avoidance of aprotinin because of its known competitive inhibition of activated protein C. Two units of FFP were given by anesthesia before the administration of aprotinin, and two units of FFP were added to the pump prime. The full Hammersmith loading dose of aprotinin was administered just before initiation of CPB. The same dose of aprotinin was added to the pump prime just before initiation of CPB. Additional heparin (100 U/kg) was administered every hour during bypass. Activated clotting time tests (ACTs) were performed every 15 min, and thromboelastographs (TEGs) were performed every hour. The patient recovered from surgery without major complications, and there were no perioperative thrombotic events. The patient was discharged on day 41 and is doing well. Postoperative atrial arrhythmias were a contributing factor to his delayed discharge. The use of aprotinin in a protein C deficient patient undergoing open-heart surgery may be safe if protein C levels are restored before administration of aprotinin, and anticoagulation is carefully monitored.
Effects of Leukocyte Depletion Filters on Matrix Metalloproteinase Activation in an Extracorporeal Circulation Circuit
Authors: Schneider Susan , Gunasinghe Himali , Sistino Joseph , Blackwell Mindy , Spinale Francis
Published: August 2023

Matrix metalloproteinases (MMPs) are a family of endopeptidases that function to remodel tissue during both normal physiology and pathology. Research performed by the Medical University of South Carolina found an increased release of several MMP species during cardiopulmonary bypass (CPB), including the subtype MMP-9, but whether and to what degree the extracorporeal circulation circuit (ECC) induces the release of MMPs has yet to be determined. Human bank whole blood scheduled for discard was obtained and exposed to an ECC. The first set of studies (N = 8) was performed with a loop circuit using a standard arterial line filter. A leukoreduction filter was incorporated during the first 30 min of the pump run for the second set of trials; the leukoreduction filter was then bypassed and a standard arterial filter used for the remaining 60 minutes on pump (N = 8). Blood samples were drawn at four time points for analysis (baseline, 30, 60, and 90 min). Data were analyzed using repeated measures analysis of variance with betweensubjects factors, and a p value of less than .1 was considered statistically significant. The MMP-9 level increased by 130.44% at 90 min on pump in the standard arterial filter group and decreased by 34.62% at 90 min on pump in the leukoreduction group. There was a significant difference between the baseline MMP-9 level and the MMP-9 concentrations at 30, 60, and 90 min for both groups (p = .0348); there was a significant difference in MMP-9 levels between the two filter groups (p = .0611). The present study found a significant increase in MMP-9 levels when blood was exposed to an ECC with a standard arterial filter. The use of a leukoreduction filter significantly reduced MMP-9 concentrations as compared to baseline levels in this study. Leukocyte depletion filtration may serve to benefit CPB patients by attenuating the inflammatory response and disrupting pathways that govern such mediators as the MMPs.
Selective Deep Spinal Hypothermia with Vacuum-Assisted Cerebral Spinal Fluid Drainage for Thoracoabdominal Aortic Surgery
Authors: Trowbridge Cody , Bruhn Thad , Arends Beth
Published: August 2023

Recent experiences from several centers indicate that the overall risk of spinal cord ischemia during thoracoabdominal aortic aneurysm repair has decreased to 5–8%. The results from these centers are rather consistent, despite the use of a variety of spinal protection strategies. An alternative to the various distal aortic perfusion techniques is selective spinal cooling by cold saline lavage. The principle advantage of selective hypothermia is the avoidance systemic heparinization and extracorporeal bypasses, while affording comparable spinal protection. The primary method of spinal cooling was pioneered by Cambria et al. at Massachusetts General Hospital. In their experience, paraplegia or paresis occurred in 6.9% of patients (5-year period, 170 cases). An alternative to the Cambria method utilizes readily available perfusion supplies and offers the potential advantages of lower cerebral spinal fluid-systemic blood pressure differences, more expedient cooling, and deeper spinal hypothermia. This report describes this method and the clinical course of a patient treated with it.
Factor V Leiden and Cardiopulmonary Bypass
Authors: Uppal Victor , Rosin Mark , Marcoux Jo-Anne , Olson Marnie , Bezaire Jennifer , Dalshaug Gregory
Published: August 2023

We present a case of a patient with factor V Leiden with an antithrombin III activity of 67% who received a successful aortic valve replacement supported by cardiopulmonary bypass (CPB). A safe level of anticoagulation was achieved by monitoring activated clotting time (ACT) and heparin concentration ensuring adequate anticoagulation throughout the procedure. Results from ACT, heparin dose response, heparin protamine titration, and thrombelastography are given. Factor V Leiden patients can be safely anti-coagulated using heparin for CPB procedures when monitored with ACT, heparin protamine titration, and thrombelastography. Postoperative chest tube losses were 360 mL, less than half our institutional average. Anticoagulation for the pre-and post-operative phase is also discussed.
Implementation of a Multidisciplinary Bleeding and Transfusion Protocol Significantly Decreases Perioperative Blood Product Utilization and Improves Some Bleeding Outcomes
Authors: Timpa Joseph G. , O’Meara L. Carlisle , Goldberg Kellen G. , Phillips Jay P. , Crawford Jack H. , Jackson Kimberly W. , Alten Jeffrey A.
Published: August 2023

Perioperative transfusion of blood products is associated with increased morbidity and mortality after pediatric cardiac surgery. We report the results of a quality improvement project aimed at decreasing perioperative blood product administration and bleeding after pediatric cardiopulmonary bypass (CPB) surgery. A multidisciplinary team evaluated baseline data from 99 consecutive CPB patients, focusing on the variability in transfusion management and bleeding outcomes, to create a standardized bleeding and transfusion management protocol. A total of 62 subsequent patients were evaluated after implementation of the protocol: 17 with single pass hemoconcentrated (SPHC) blood transfusion and 45 with modified ultrafiltration (MUF). Implementation of the protocol with SPHC blood led to significant decrease in transfusion of every blood product in the cardiovascular operating room and first 6 hours in cardiovascular intensive care unit ([CVICU] p < .05). Addition of MUF to the protocol led to further decrease in transfusion of all blood products compared to preprotocol. Patients <2 months old had 49% decrease in total blood product administration: 155 mL/kg preprotocol, 117 mL/kg protocol plus SPHC, and 79 mL/kg protocol plus MUF (p < .01). There were significant decreases in postoperative bleeding in the first hour after CVICU admission: 6 mL/kg preprotocol, 3.8 mL/kg protocol plus SPHC, and 2 mL/kg protocol plusMUF (p = .02). There was also significantly decreased incidence of severe postoperative bleeding (>10 mL/kg) in the first CVICU hour for protocol plus MUF patients (p < .01). Implementation of a multidisciplinary bleeding and transfusion protocol significantly decreases perioperative blood product transfusion and improves some bleeding outcomes.
Removal of Gross Air Embolization from Cardiopulmonary Bypass Circuits with Integrated Arterial Line Filters: A Comparison of Circuit Designs
Authors: Reagor James A. , Holt David W.
Published: August 2023

Advances in technology, the desire to minimize blood product transfusions, and concerns relating to inflammatory mediators have lead many practitioners and manufacturers to minimize cardiopulmonary bypass (CBP) circuit designs. The oxygenator and arterial line filter (ALF) have been integrated into one device as a method of attaining a reduction in prime volume and surface area. The instructions for use of a currently available oxygenator with integrated ALF recommends incorporating a recirculation line distal to the oxygenator. However, according to an unscientific survey, 70% of respondents utilize CPB circuits incorporating integrated ALFs without a path of recirculation distal to the oxygenator outlet. Considering this circuit design, the ability to quickly remove a gross air bolus in the blood path distal to the oxygenator may be compromised. This in vitro study was designed to determine if the time required to remove a gross air bolus from a CPB circuit without a path of recirculation distal to the oxygenator will be significantly longer than that of a circuit with a path of recirculation distal to the oxygenator. A significant difference was found in the mean time required to remove a gross air bolus between the circuit designs (p = .0003). Additionally, There was found to be a statistically significant difference in the mean time required to remove a gross air bolus between Trial 1 and Trials 4 (p = .015) and 5 (p =.014) irrespective of the circuit design. Under the parameters of this study, a recirculation line distal to an oxygenator with an integrated ALF significantly decreases the time it takes to remove an air bolus from the CPB circuit and may be safer for clinical use than the same circuit without a recirculation line.
Spectroscopie et imagerie raman : des matériaux quantiques à la matière vivante
Authors: Gallais Yann , Alekhin Alexandr , Devineau Stéphanie
Published: August 2023

La spectroscopie Raman a déjà une longue histoire dans les études vibrationnelles des structures moléculaires et cristallines. Après une brève introduction historique, nous décrivons quelques développements récents de cette technique dans l’étude des matériaux quantiques comme les supraconducteurs. Nous abordons ensuite l’extension de cette technique à l’imagerie Raman confocale qui est maintenant devenue son application principale et que nous illustrons sur l’exemple des matériaux 2D et du vivant.
Teaching Reform of Finance and Economics Colleges--A Case of Shandong Technology and Business University
Authors: Jiang Zhen , Liyan
Published: August 2023

Higher education institutions in finance and economics in China bear the responsibility of cultivating high-quality financial workers with new thinking, digitalization, compound, innovative, and applied abilities for society in order to meet the needs of industrial change, commercial innovation, and production mode transformation in the new economy. This article takes Shandong Technology and Business University as an example, to explore the path of teaching reform and innovation in finance and economics colleges from three aspects: innovating traditional teaching models, strengthening entrepreneurship education, and implementing practical teaching links.
Status and improvements of transforming scientific research achievements into teaching resources in universities
Authors: Yang Fengling , Wang Shu
Published: August 2023

There are many practical difficulties in the concrete implementation of transforming scientific research results into teaching resources. Through analyzing the existing transformation forms and problems, a comprehensive transformation model is discussed, and a comprehensive evaluation system covering teachers and students is established. Establish a guarantee mechanism from multiple channels such as capital investment, system guarantee, and performance reward, escort the transformation of scientific research results into teaching resources, and promote universities to strengthen the talents training.
Exploration on Talent Ttraining of Digital Media Art under New Engineering
Authors: Zhang Yingfang
Published: August 2023

New engineering is a supply-side structural reform of talent training driven by industrial structure adjustment and transformation and upgrading in China’s higher education. It includes emerging disciplines and majors corresponding to new business forms, as well as application-oriented talent training models, emphasizing interdisciplinary integration, social practicability and comprehensive ability training. Digital media art, which relies on technology, keeps up with technological innovation, and has the dual characteristics of art and engineering, needs to explore an effective talent training model suitable for the characteristics of this major. Taking the International College of Creative Design of Shanghai University of Engineering Science as an example, this paper investigates and analyzes the curriculum system of digital media art major in typical colleges and universities at home and abroad, as well as the demand for talents from industrial enterprises, from the current situation of talent training for digital media art majors, combined with the content of new engineering construction and digital media interaction technology as the core. Then construct the course group system to strengthen the training of computational thinking and Internet thinking ability, and pay attention to the organic integration with other horizontal course groups. In the setting of interactive technology course group, we pay attention to engineering thinking, set up courses with the nature of engineering design, and emphasize the cultivation of engineering thinking and practical ability.
Research on rapid generation of 3D models based on art and design cognitive models
Authors: Wu Jiajia
Published: August 2023

Human-computer interaction interfaces based on hand-drawing are currently being used more and more widely. Hand-drawing is a natural and easy way for designers to do this. Most interfaces currently provide designers with only one smoothly drawn stroke, rather than the multiple strokes they are more accustomed to using. This paper is based on an algorithm for hand-drawn interfaces, which analyses multiple strokes and replaces them with a single stroke in order to rationalise the designer’s creative intent. The space is subdivided recursively until only one stroke remains or a suitable order is achieved using principal component analysis, then the subdivided space is reconnected and a large list of points is produced; finally, because the curve is very noisy, the algorithm uses reverse subdivision to find control points to fit a smooth B spline curve.
Effect of fracture level on the residual fracture gap during tibial intramedullary nailing for tibial shaft fractures
Authors: Albayrak Kutalmis , Misir Abdulhamit , Alpay Yakup , Buyuk Abdul Fettah , Akpinar Evren , Gursu Sukru Sarper
Published: August 2023

Introduction: The development of fracture gap during intramedullary nailing in tibial fractures is associated with poor fracture fragment contact and increased time to union and complications. This study aimed to evaluate the effect of the fracture level in the development of the fracture gap and the effect of the fracture gap on pain, radiologic and functional outcomes, and complication rate. Material and method: A total of 45 patients who underwent reamed intramedullary nailing due to closed transverse or short oblique tibial shaft fractures were divided into the proximal fracture group and the distal fracture group. The correlations between the visual analog scale (VAS) score, modified radiograph union score for tibias (RUST), and postoperative 1-year lower extremity functional scale scores, residual fracture gap, and time to union were evaluated. Results: The mean fracture gap amounts in the immediate postoperative anteroposterior and lateral radiographs were 5.6 ± 1.7 and 6.0 ± 1.7 mm in proximal fractures and 0.3 ± 2.4 mm and 0.4 ± 2.3 mm in distal fractures, respectively (p < 0.001 and p < 0.001, respectively). The mean time to union was 21.9 ± 2.9 weeks in the proximal fracture group and 16.7 ± 2.4 weeks in the distal fracture group (p < 0.000). The residual fracture gap amount significantly correlated with the level of fracture (r = 0.811, p < 0.001). Discussion: Tibial shaft fractures proximal to the isthmus level tend to develop significantly larger fracture gaps than distal fractures. It is associated with increased time to union and radiographic union scores as well as slightly higher complication and reoperation rates.
Retrospective evaluation of surgical site infection after open
splenectomies with and without perioperative prophylactic antibiotic
coverage
Authors: Husi Benjamin Andrea , Arnaldi Laura , Roitner Moritz , Nolff Mirja Christine
Published: August 2023

Objectives Perioperative prophylactic antibiotics (PPA) are widely used in
veterinary medicine to prevent surgical site infections (SSI). Current
guidelines advocate the use in clean procedures only if surgeries exceed
90 minutes, or in patients with an ASA score ≥3. Procedure
specific recommendations are currently lacking. The following study aimed to
analyze the protective effect of PPA in dogs undergoing open splenectomy.

Methods The electronic database of our institution was searched for dogs
that underwent splenectomy between 10/2017 and 01/2023. Data
collection included age at presentation, breed, weight, reason for splenectomy,
diagnosis, ASA class, PPA regime, surgery time, anesthesia time, lowest blood
oxygen concentration during anesthesia, lowest body temperature, and lowest
blood pressure during surgery as well as duration of hospitalization. Dogs were
included if a follow-up of 30 days after surgery was available, or if death
occurred within this timeframe.

Results A total of 112 dogs were included. Of these, 46 dogs received PPA,
and 66 did not. Most dogs were classified ASA 3 or higher (PPA 87%,
non-PPA 80.3%). One SSI (1.5% SSI rate) occurred in the non-PPA
group (overall SSI rate 0.9%). Due to the low SSI rate, statistical
analysis of risk factors for SSI development was not possible.

Conclusion The described infection rate of 1.5% without PPA
indicates, that splenectomy does not qualify as high-risk surgery for SSI, even
in patients with ASA class 3 or higher.

Clinical Relevance As splenectomies are frequently performed, the findings
of the current study could have a major impact on the overall antimicrobial
burden in routine veterinary practice.
Surgical removal of an atypical histiocytic cell proliferation in a
bearded dragon (Pogona vitticeps)
Authors: Digwa Kathrin , Wittenberg-Voges Liza , Hansmann Florian , Fehr Michael
Published: August 2023

A 4-year-old female bearded dragon (Pogona vitticeps) was referred to the
Clinic for Small Mammals, Reptiles and Birds of the University of Veterinary
Medicine, Hannover, Germany for diagnostics and treatment of a growing mass in
the right cervical region. The owner reported that the mass had grown over the
past 4 weeks with only little alteration in the lizard´s behavior when
the animal started rubbing its neck against the cage equipment. Physical
examination as well as ultrasonographic and computed tomographic diagnostics
revealed a highly vascularized mass, which allowed for the hypothesis of an
aneurysm or a neoplasia. Complete surgical resection of the mass could be
performed uneventfully. The bearded dragon recovered well from anesthesia and
the surgical procedure. The microbiological sample of the excised mass revealed
Group F-67 Salmonella. Histopathological examination of the excised mass
revealed a histiocytic cell proliferation with centrally located blood filled
cavities, hemorrhages and granulation tissue resembling features of a
pseudoaneurysm. This report describes the diagnosis of an atypical growing mass
in a bearded dragon and its successful removal.
A Real-World Molecular Epidemiological Study of Non-Small-Cell Lung Cancer (NSCLC) Patients from Western India
Authors: Joshi Ashish , Korgavkar Reshma , Joshi Kshitij , Maniar Vashishth , Kalaskar Pritam , Kendre Pradip , Maheshwari Udip Dilip , Pethe Chandrashekhar , Sheth Smith , Dhande Sonal
Published: August 2023

Background The molecular characterization of advanced non-small-cell lung cancer (NSCLC) has unveiled genomic alterations such as EGFR gene mutations, KRAS gene mutations, ROS1 gene rearrangements, EML4-ALK rearrangements, and altered MET signaling. The objective of this molecular epidemiological study was to report the clinical, pathological, and molecular profile of NSCLC patients from western India.

Materials and Methods This real-world study of NSCLC patients was performed at a chemotherapy day-care center in western India. The clinical, pathological, and molecular data were collected from the patient's medical records after obtaining the Ethics Committee permission for the study. The study was conducted according to the ethical principles stated in the latest version of Helsinki Declaration, and the applicable guidelines for good clinical practice.

Results A total of 182 (58.7%) men and 128 (41.3%) women with a median age of 63 years (range: 22–93 years) were included in the study. Of the total 310 patients, 195 (62.9%) were nonsmokers whereas 81 (26.1%) had a past history of smoking. EGFR, EML4-ALK Fusion Gene, KRAS, ROS1 gene rearrangement, and PD-L1 were positive in 42 (22.3%), 12 (9%), 2 (28.6%), 3 (12.5%), and 3 (25%) patients, respectively. One patient had concurrent EGFR mutation along with ROS1 gene rearrangement.

Conclusion Oncogenic driver mutations are present in Indian NSCLC patients. Molecular testing should be performed for all patients of advanced NSCLC to identify those that can benefit from newer generation of targeted or immunotherapies.
Primary Intraosseous Synovial Sarcoma: Experience from a Tertiary Cancer Center
Authors: Ramanujan Vishnu , Soma Srikanth , Krishnan Chandra Kumar , Malik Kanuj , Radhakrishnan Venkatraman , Raja Anand
Published: August 2023

Introduction Primary intraosseous synovial sarcoma (PISS) is a rare cancer of the bone, with few reported cases across literature. Data from our institute reveals seven indigenous cases. This study aims to evaluate these PISS diagnoses, and to further investigate any histopathological findings and prognostic factors associated with patient survival.

Materials and Methods Data from patients diagnosed with PISS at the institute were obtained from January 1995 to December 2016, in the form of a retrospective study. Patient demographics, pathology locations, histological findings, surgical margins, and treatment modalities were audited as variables that can impact patient survival.

Results This research identified seven cases which fulfilled the diagnostic criteria and were subsequently classified as PISS of the bone. There were five men and two women among the cases, with ages ranging from 16 to 46 years, with a mean of 29.6 years. The study found that the lower limb was the most affected site in PISS, followed by the pelvis. Limb salvage was performed in six patients and one patient underwent amputation. Of these patients, six received adjuvant chemotherapy and four received adjuvant radiation as per institution guidelines. The study found that the 5-year disease-free and overall survival rate was 80 and 61%, respectively.

Conclusion PISS is a rare malignancy with limited cases in literature, and hence, there is no evidence for a standardized management protocol. The survival rates were similar between soft tissue and intraosseous synovial sarcoma among the case series.
Phase 1/2 Study of the Timing and Efficacy of 3 mg Peg-GCSF in Neo/Adjuvant Dose Dense Breast Cancer Treatment Protocols
Authors: Patel Amol , Pathak Abhishek , Sarin Arti , Shelly Divya , Ranjan Richa , Singh Arashdeep , Kala Tripti , PV Babitha
Published: August 2023

Background Peg-GCSF has similar efficacy at a dose of 60 µg/kg and 100 µg/kg. The conventional 6 mg SC dose was based on the maximum tolerable dose. In Japan, 3.6 mg dose was approved on the basis of dose finding studies. Peg-GCSF is an integral part of dose-dense chemotherapy protocols. Dose finding and scheduling study of peg-GCSF have not been conducted in Indian patients.

Materials and Methods We conducted two-center phase 1/2 clinical study addressing the timing and efficacy of peg-GCSF in Indian breast cancer patients (CTRI no: 2021/07/034751). Three groups of timing administration were studied, namely 1, 6, and 24 hours post chemotherapy. The phase 2 part was the expansion of the best timing group. The primary objective was dose density, which was defined as receiving chemotherapy on < 3 days of scheduled date. Adriamycin/epirubicin cyclophosphamide (AC/EC) was administered q2 weeks. The total leucocyte (TLC) and absolute neutrophil (ANC) kinetics were studied. Other outcomes were incidence of grade 4 neutropenia, febrile neutropenia (FN), and requirement of additional doses of G-CSF. Bone pain, fever, and myalgia were studied for adverse effects.

Results From November 20 to December 21, 36 patients were enrolled. Patient characteristics are depicted in Table 1. Initially, three patients received the peg-GCSF in each timing group. One patient in each 1-hour and 6 hours needed G-CSF support for maintaining the dose density. The 24-hour group was carried to phase 2 part. Dose density was maintained in 97% of patients. None of the patient in 24-hour group had FN. Also, 4/30 patients had grade 4 neutropenia and required an additional dose of GCSF. Grade 3 or 4 bone pain was not noticed by any of the patients. During the first cycle, the mean ANC (cells/μL) was 5284, 20704, 3010, 6954 on D0, D + 3, D + 7, and D + 13, respectively (Fig. 1A-TLC and 1B-ANC). The mean ANC (cells/μL) rise on D + 3 in cycles 1, 2, 3, 4 was 23810, 29209, 32428,22455, respectively.

Conclusion Dose density of AC/EC breast cancer protocol is maintained with peg-GCSF 3 mg. Post chemotherapy 24-hour timing of peg-GCSF administration remains as the standard. A phase 3 trial of 6 mg versus 3 mg is warranted.
Survival Outcome and Predictors of Survival in Elderly Breast Cancer Patients following Curative Treatment
Authors: T.M Anoop , Joseph P Rona , K.R Rajeev , Soman Saikumar , Mathew Mintu , Chacko Steffi , Kumar Bhavya S.
Published: August 2023

Objectives The lack of data on management of elderly breast cancer patients' population makes most oncologists reluctant to treat them with the standard treatment protocols as advised for the younger patients. This study was done to identify the survival outcome and predictors of survival in elderly breast cancer patients treated with curative intent.

Materials and Methods Newly diagnosed patients with breast cancer aged more than 65 years who received treatment with curative intent were included. Disease-free survival (DFS) and overall survival were estimated using the Kaplan–Meier method. Survival curves were compared using log-rank test. Cox regression analysis was done to find out the predictors of DFS.

Results This study included 112 elderly breast cancer patients. In our patient population, 79 (70.5%) were less than or equal to 70 years of age and 33 (29.5%) were more than or equal to 70 years. Median age was 68 years. Charlson comorbidity index score was six and above in 31 (28.1) patients. Median DFS in our study was 46 months. Median DFS was not reached in patients less than or equal to 70 years of age, whereas it was 50 months (47–53) among patients more than or equal to 70 years of age, p-value-0.009. In univariate analysis, age more than or equal to 70 years and locally advanced breast cancer were the predictors of DFS with hazard ratio (HR) of 2.8 (1.2–6.69), p-value 0.013 and 2.9 (1.12–7.6), and 0.027, respectively. In multivariate analysis, age more than or equal to 70 years was the only significant predictors of DFS with HR of 2.8 (1.2–6.5) and p-value of 0.015.

Conclusion Standard curative intent treatment was well tolerable among elderly patents. Elderly age more than 70 years was a unique predictor of DFS. We need to incorporate tools to assess life expectancy and functional status that will help us predict toxicity of treatment and survival advantage more precisely.
Polymorphism of XRCC7 Gene and Risk of Glioma: A Prospective Case–Control Study
Authors: Choudhary Deepak , Mahajan Bhawna , Sumi Mamta , Dholakia Binita , Bhandari Sumit , Ghimire Niraj , Saluja Sundeep , Bodeliwala Shaam , Wani Wajid Nazir , Jagetia Anita
Published: August 2023

Objective The aim of this study is to determine association between polymorphism of XRCC7 gene and glioma.

Materials and Methods A case–control study was designed to analyze the prevalence of the various XRCC7 genotypes in 30 cases of histologically proven glioma and 30 age- and sex matched controls.

Result There is significantly higher prevalence of the GT and the TT genotypes of XRCC7 gene in cases of glioma as compared with control. The prevalence was significantly pronounced in two subgroups–middle aged and male gender. The presence of the XRCC7 GT or TT genotype conferred a significantly higher risk of developing glioma (odds ratio: 13.021,2.114–80.213).

Conclusion The presence of the T allele in XRCC7 polymorphism may increase the susceptibility to glioma.
Bilateral Inferior Turbinate Flaps for Salvage Reconstruction after Proton Beam Radiotherapy for Clival Chordoma
Authors: Crawford Kayva L. , Saripella Megana , DeConde Adam S. , Beaumont Thomas L.
Published: August 2023

Clival chordoma is a rare, aggressive, notochord-derived tumor primarily managed with surgery via an endoscopic endonasal approach (EEA) and adjuvant proton beam radiotherapy. Reconstruction is commonly performed with a nasoseptal flap (NSF) at the time of initial surgery. While failures of the NSF are rare, they can occur following the initial surgery or in the setting of osteoradionecrosis. Salvage repair typically requires transfer of alternative vascularized tissues outside of the previously radiated field including regional scalp flaps such as pericranial or temporoparietal fascial flaps, or free vascularized tissue transfer. Here we describe the case of a 29-year-old woman with a history of clival chordoma with widespread skull base osteomyelitis secondary to NSF necrosis after proton beam radiotherapy. We describe successful skull base reconstruction with intranasal bilateral inferior turbinate flaps based on the sphenopalatine artery with lateral nasal wall extension, despite prior proton beam therapy and a failed prior vascularized intranasal reconstruction.
A systematic review of investment indicators and economic growth in Nigeria
Authors: Abdulkarim Yusuf
Published: August 2023

Most developing countries, including Nigeria, are stuck in a vicious cycle of low investment caused by insufficient domestic savings, resulting in inadequate capital formation and a large savings-investment gap. Given the significance of investment in poverty alleviation and economic growth, the study conducted a disaggregated analysis on the impact of various measures of investment on economic growth in Nigeria from 1981 to 2020. Using the conventional and structural break stationarity tests, as well as the autoregressive distributed lag (ARDL) approach, the epistemological findings confirm a compelling co-integrating relationship among the study variables and show that credit to the private sector, domestic investment, economic liberalization, foreign portfolio investment, and interest rate have a significant positive impact on long-term growth, whereas foreign direct investment, capital expenditure, and inflation rate retarded growth substantially in the long-run. Furthermore, the short-run results revealed that economic liberalization, private-sector credit, and portfolio investment all correlate positively with growth. In contrast, foreign direct investment, infrastructure spending, and inflation rate are profoundly negative. The study therefore advocated for effective fiscal and monetary policy coordination to lower the cost of doing business, incentivize and open up opportunities for domestic and foreign investors, increase infrastructure spending to create jobs, reduce poverty and sustain growth.
Fatigue damage stiffness degradation modeling of right circular flexure hinges
Authors: Wang Qiliang , Long Yiping , Wei Jianming
Published: August 2023

Flexure hinges are susceptible to fatigue damage under cyclic loading, resulting in performance degradation. This paper investigates the stiffness degradation of the right circular flexure hinges (RCFHs) under cyclic loading. Fatigue damage experiments are conducted to obtain the stiffness degradation curves, which can be divided into several stages by feature points. A relationship between feature lives and alternating stress amplitudes is established. A fatigue damage stiffness degradation piecewise curve model for RCFHs is proposed. The effect of notch stress concentration on fatigue damage is analyzed. Fatigue damage experiments under non-zero mean stress are conducted, and an equivalent fatigue stress equation is obtained. Finally, a generalized fatigue damage stiffness degradation model for RCFHs is developed, which establishes a relationship between residual stiffness and cycle number. On this basis, a fatigue damage performance modeling method for flexure hinge mechanisms is proposed. The fatigue damage performance of a compliant bridge mechanism was modeled and tested. The experimental results of input stiffness degradation are generally in agreement with the predicted results, which verify the validity of the method.
Machine learning methods for fission product identification from Bragg curves
Authors: Lyons S. M. , Britt C. G. , Wood L. S. , Duke D. L. , Fulsom B. G. , Moore M. E. , Snyder L.
Published: August 2023

A fission time projection chamber (fission-TPC) was developed to provide precise neutron-induced fission measurements for several major actinides. As fission fragments lose energy in one of the gas volumes of the fission-TPC, energy loss information is captured and may be used to determine fission product yields as the stopping power of an ion is dependent on the atomic number. The work presented here demonstrates the ability to apply machine learning techniques for Bragg curve classification. A set of one million energy loss curves for 24 different fission-fragment elements was generated using common stopping power software. A ResNet architecture optimized for 1D data was used to train, test, and validate a model for light and heavy fission fragments using the simulated data. The resultant classification accuracy for the light and heavy fragments indicates that this could be a viable method for elemental classification of data from the fission-TPC.
Electromagnetic Doppler effect in non-reciprocal medium
Authors: Baney Douglas M.
Published: August 2023

Reflected light from a moving object, such as a mirror, is frequency-shifted via the Doppler effect. This well-known phenomenon is used to determine the speed and direction of an object due to the red or blue shifting of the received electromagnetic radiation frequency. To date, the Doppler theory has focused on the propagation of electromagnetic radiation through reciprocal media where the transiting photons have the same speed, regardless of direction. However, optical birefringence exists in solid-state, liquid, and gas media, which results in spatially dependent, and vector field-dependent, propagation velocities. When combined with the Faraday effect, which is employed routinely in laboratory setups and present at galactic scales, non-reciprocal Doppler effects may occur. A non-reciprocal Doppler effect theory is derived showing frequency shift dependencies on the object velocity and the directional speed of light in the medium. This general Doppler theory is shown to simplify the canonical relations for the Doppler effect in systems without a directional dependence on light. In non-reciprocal systems, when the mirror velocity is much less than the speed of light, the general frequency shift relation simplifies to a dependency on the roundtrip average speed of light. This theory provides a basis for the application of the Doppler effect to estimate the velocity of moving objects in non-reciprocal systems.
Exploration of cross-beam energy transfer mitigation constraints for designing an ignition-scale direct-drive inertial confinement fusion driver
Authors: Colaïtis A. , Follett R. K. , Dorrer C. , Seaton A. G. , Viala D. , Igumenshchev I. , Turnbull D. , Goncharov V. , Froula D. H.
Published: August 2023

The compression of direct-drive inertial confinement fusion (ICF) targets is strongly impacted by cross-beam energy transfer (CBET), a laser-plasma instability that limits ablation pressure by redirecting laser energy outward and that is projected to be mitigated by laser bandwidth. Here, we explore various CBET mitigation constraints to guide the design of future ICF facilities. First, we find that the flat, Gaussian, and Lorentzian spectral shapes have similar CBET mitigation properties, and a flat shape with nine spectral lines is a good surrogate for what can be obtained with other spectral shapes. Then, we conduct a comprehensive study across energy scales and ignition designs. 3D hydrodynamic simulations are used to derive an analytical model for the expected CBET mitigation as a function of laser and plasma parameters. From this model, we study the bandwidth requirements of conventional and shock ignition designs across four different energy scales and find that they require between 0.5 and 3±0.2% relative bandwidth. Best mitigation is achieved when the beam radius over critical radius Rb/Rc is kept low during the drive while the plasma temperature is kept high. In a steady state, we find that the bandwidth required to mitigate 85% of CBET scales as (Rb/Rc)2.15Ln−0.58I0.7, where Ln is the density scale length, and I the laser intensity. Finally, we find that the chamber beam port layout does not influence CBET mitigation. In the case of a driver using many monochromatic beamlets, we find that ∼10 beamlets per port is required, with diminishing returns above ∼20.
Circular dichroism enhancement induced by surface plasmons in the structure of a metallic grating coated by chiral TDBCs
Authors: Zou Yunfei , Song Gang , Jin Hongbin
Published: August 2023

We investigate the enhancement of the circular dichroism (CD) spectrum in a metallic grating by coating it with chiral TDBCs. Using the finite difference time domain method, we obtain reflection spectra and CD spectra. The amplification of TDBCs chirality is achieved through the excitation of both surface plasmon polaritons (SPPs) and localized surface plasmons (LSPs) in the Ag grating structure. Our results indicate that, compared to chiral TDBCs alone, the enhancement factor of chiral TDBCs coated on the metallic grating can reach up to 200 times. The coupling between chiral TDBCs and electromagnetic fields induced by SPPs and LSPs is tuned by both the period and groove thickness of the grating structure. Under certain conditions, strong coupling phenomena are observed, demonstrating a competitive relationship between the dissipation of our proposed structure and the coupling of electromagnetic fields and chiral TDBCs. The substantial amplification of the CD spectra suggests that our proposed structure provides a novel method to enhance the chirality of TDBCs experimentally.
Laser-driven electrodynamic implosion of fast ions in a thin shell
Authors: Gus’kov S. Yu. , Korneev Ph. , Murakami M.
Published: August 2023

Collision of laser-driven subrelativistic high-density ion flows provides a way to create extremely compressed ion conglomerates and study their properties. This paper presents a theoretical study of the electrodynamic implosion of ions inside a hollow spherical or cylindrical shell irradiated by femtosecond petawatt laser pulses. We propose to apply a very effective mechanism for ion acceleration in a self-consistent field with strong charge separation, based on the oscillation of laser-accelerated fast electrons in this field near the thin shell. Fast electrons are generated on the outer side of the shell under irradiation by the intense laser pulses. It is shown that ions, in particular protons, may be accelerated at the implosion stage to energies of tens and hundreds of MeV when a sub-micrometer shell is irradiated by femtosecond laser pulses with an intensity of 1021–1023 W cm−2.
Flow simulation around square cylinder with inclined corner gap at low Reynolds number
Authors: Haque Md. Naimul
Published: August 2023

In this paper, an investigation of the effects of inclined corner gaps of varying widths and lengths on the static aerodynamic force coefficients and flow features of a square cylinder at low Reynolds number (Re of 100) by comparing with an unmodified square cylinder is discussed. The width of the corner gap (x/D) was varied between 0.02 and 0.24, with two different lengths of it (l/D), namely, 0.05 and 0.11. The open-source code OpenFOAM was used as a solver. A second-order accuracy level was ensured for both time and space during the numerical set up of the model. Validation and verification studies were conducted to ensure the authenticity of the results. The mean and rms values of the static force coefficients of these cylinders were compared and important flow features were explored. Even at a low Re, the proposed corner modification was found to be effective in improving the static aerodynamic performance. For different gap widths, the static force parameters evidenced some patterns, with an optimum width for which the mean drag value reached the minimum value identified. Furthermore, the mean and fluctuating pressure and velocity contour were analyzed to understand the underlying flow mechanism.
Adsorption study of SF6 molecules on Pt-doped two-dimensional material Ti3C2Tx Mxene
Authors: Wang Xiangyu , Zeng Fuping , Qiu Hao , Guo Xinnuo , Yao Qiang , Li Long , Tang Ju
Published: August 2023

In this paper, the effects of transition metal atom Pt doping on the structural parameters and electronic properties of the two-dimensional material Ti3C2Tx MXene (T = OH, O or F) as well as the adsorption interaction between the doped material and SF6 are investigated based on density functional theory calculations. To investigate the SF6 adsorption mechanism, the adsorption structure, adsorption energy, charge transfer, and density of states of Pt atom-doped Ti3C2Tx after the adsorption of SF6 molecules were analyzed. The results showed that the electronic properties and chemical activity of the doped Ti3C2Tx changed significantly compared to those before doping. In addition, Pt-doped Ti3C2(OH)2 has good adsorption ability on SF6 molecules, and its adsorption type is chemisorption; in the relevant sites, SF6 undergoes chemical bond breaking, and the doping of Pt improves the catalytic effect of Ti3C2(OH)2. The adsorption capacity of Pt-doped Ti3C2O2 and Ti3C2F2 for SF6 molecules is much weaker than that of Pt-doped Ti3C2(OH)2, physical adsorption occurred, and there was almost no degradation of SF6; the doping of Pt did not improve the catalytic effect of Ti3C2O2 and Ti3C2F2.
Global strong solutions for the multi-dimensional compressible viscoelastic flows with general pressure law
Authors: Liu Yu , Meng Song , Wu Jiayan , Zhang Ting
Published: August 2023

In this paper, we mainly focus on the compressible viscoelastic flows of Oldroyd type with the general pressure law, with one of the non-Newtonian fluids exhibiting the elastic behavior. For the viscoelastic flows of Oldroyd type with the general pressure law, P′(ρ̄)+α>0, with α > 0 being the elasticity coefficient of the fluid, we prove the global existence and uniqueness of the strong solution in the critical Besov spaces when the initial data u⃗0 and the low frequency part of ρ0, τ0 are small enough compared to the viscosity coefficients. In particular, when the viscosity is large, the part of the initial data can be large. The proof we display here does not need any compatible conditions. In addition, we also obtain the optimal decay rates of the solution in the Besov spaces.