bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Heparin Bound Surface Modification (Carmeda® Bioactive Surface) on Human Platelet Alterations During Simulated Extracorporeal Circulation
Authors: Stenach Nina , Korn Robert L. , Fisher Carol A , Jeevanandam Valluvan , Addonizio V. Paul 
Published: August 2023

To determine if treatment with covalently bound heparin (Carmeda Bioactive Surface (CBAS))a to the synthetic surface of the extracorporeal circuit (ECC) would alter the stereotypic pattern of adverse platelet alterations, 450 ml of heparinized blood (lU/ml) was recirculated at a flow rate of twice the circulating volume (L/min) for 2 hrs at 37°C through either untreated (CONT,n=7) or treated (CBAS,n=7)circuits constructed of identical components including a pediatric (0.8m2) reversed hollow fiber membrane oxygenator. In CONT circuits, platelet count maintained 88+1% (x±SEM) of its initial level in the circuit prime sample, dropped to 36±6% after 5 min, and returned to 56±2% following 2 hrs of ECC. In CBAS circuits, platelet count in the circuit prime sample demonstrated 90±4%, decreased to 68±10% after 5 min (p<0.05) and declined further to 45±5% after 2 hrs (NS).
Although platelets from both groups retained reactivity to ADP after priming the circuit, only at 5 min of recirculation did CBAS circuits significantly preserve this responsiveness. In CONT circuits, baseline plasma levels of platelet factor 4 rose from 24±3 to 581±82 ng/ml in the primed circuit and continued to rise to 2933±27 6 ng/ml by 2 hrs of ECC. In contrast, CBAS circuits markedly reduced this release after 2 hrs (577±165 ng/ml). Furthermore, by 2 hrs of ECC, plasma levels of thromboxane B2 in the CBAS circuits were significantly reduced when compared to CONT circuits (3035±1529 vs 29916±16293 pg/ml, respectively). We conclude that CBAS modification of the simulated extracorporeal circuit preserved the initial circulating platelet count with retained ADP reactivity and markedly decreased release of platelet factor 4 and thromboxane B2.
Trouble Shooting the Extracorporeal Membrane Oxygenator Circuit and Patient
Authors: Faulkner Sherry C. , Chipman Carl W. , Baker Lorrie L. 
Published: August 2023

Patients requiring extracorporeal membrane oxygenation (ECMO) often become totally dependent on the mechanical life support. The Extracorporeal Life Support Organization (ELSO) reports 2486 incidents of mechanical complications in 5905 ECMO supports. To help decrease the number of mechanical complications, an active quality assurance program was initiated at our institution. This resulted in identification of only 14 incidents of mechanical complications in 100 patients (neonate, pediatric, adult, and cardiac). Techniques for dealing with problems such as loss of roller pump occlusion, changing out of the membrane lung or heat exchanger without interrupting ECMO support, venous air lock, tamponade, emergency transfusion, and other situations were generated into written policies and procedures.
We routinely review and practice problem solving techniques with specific emphasis on monitoring patient hemodyanmics and appearance.
We conclude that written policies and procedures, “water drills,” and continuing education can be beneficial in early recognition, intervention, and/or prevention of ECMO mechanical complications.
The Influence of Heparin-Coated and Uncoated Extracorporeal Circuits on Blood Rheology During Cardiac Surgery
Authors: Belboul Ali , AI-Khaja Najib , Gudmundsson Magnus , Karlsson Hans , Uchino Takashi , Liu Bo , EI-Gatit Abdusalam , Bjell Anders , Roberts Donald , William-Oisson Goran 
Published: August 2023

The effect of heparin-coated perfusion circuits on blood trauma during clinical cardiopulmonary bypass (CPB) was studied in order to find out if traumatic changes in the blood could be minimized. Twenty-four patients undergoing coronary artery bypass surgery were randomized prospectively to CPB with heparin-coated circuits (HCC) or non-coated circuits (NCC). The trauma to blood was assessed by measuring damage to blood cells by estimating red and white cell rheology changes. These were measured as red cell filtration rate (RFR) and white cell filtration rate (WFR) using standard microfiltration methods. Furthermore, changes in plasma hemoglobin (P-Hb), whole blood and plasma viscosity were simultaneously assessed. The RFR was significantly reduced in both groups during CPB by 10% in the HCC and 32% in the NCC groups (p<0.01). When comparing the HCC and NCC groups, a significant difference was first seen after 30 minutes ofbypass (p<0.05) and increased at the end ofCPB (p<0.01). Similar results were seen regarding WFR (15% and 36%, p<0.01). After 30 minutes ofbypass, a significant difference was seen between HCC and NCC groups (p<0.05). Furthermore, a significant increase in P-Hb levels were seen during CPB in both patient groups. At the end of CPB, there was a significant difference in P-Hb levels (HCC 305±90 mg/L; NCC 455±78 mg/L, p<0.01) when comparing the two groups.
When comparing HCC and NCC regarding corrected blood viscosity at shear rate 92 s-1, there were significantly higher viscosity values in the NCC group starting at 30 minutes of bypass (p<0.05). Plasma viscosity (PV) at shear rate 583 s-1 , showed similar results (p<0.05).
This study suggests that heparin-coated extracorporeal circuits are less damaging to the rheological properties of blood and would therefore be better suited for clinical use during cardiac surgery using CPB.
Case Study: Use of Two Parallel Oxygenators in a 159 Kilogram Patient during Normothermic Cardiopulmonary Bypass
Authors: Hamilton Carole 
Published: August 2023

There have been few reports describing the perfusion of large patients with relevance to oxygen transfer and oxygen consumption (1,2). This report describes the technique of two oxygenators connected in parallel on a 33 year old male who presented to the operating room for repair of an acute dissecting type A ascending aortic aneurysm. The patient's weight was 159 kg, height 189 cm, and BSA 2.88 m2. The calculated blood flow, using a cardiac index of 2.4 L/min/m2 was 6.9 L/min. The theoretical oxygen consumption was calculated as 375 ml/min. The oxygen transfer of the oxygenator is rated at 350 ml/min at a flowrate of 6 L/min. To deal with the possibility of inadequate oxygenation in this large patient, due to insufficient oxygenator surface area, the decision was made to use a second oxygenator in parallel.
The pump was set-up in the usual fashion and the second oxygenator was connected into the existing circuit and de-aired. It was then clamped out of the circuit, ready for future use. Cardiopulmonary bypass was instituted via femoral arterial and right atrial cannulation. Standard normothermic bypass and warm cardioplegia techniques were used after initiation of cardiopulmonary bypass. Venous oxygen saturation indicated insufficient oxygenation within three minutes on pump. The second oxygenator was immediately brought into use resulting in normal physiologic levels within ninety seconds. The patient underwent a successful Cabral procedure, with a total cardiopulmonary bypass time of one hundred and ten minutes. There were no problems separating the patient from bypass.
Heparin Dose Response in Pediatric Cardiopulmonary Bypass
Authors: Olshove Vincent F. , Langwell James , Burnside Jeff , Bennett Denise 
Published: August 2023

Heparin dosing for cardiopulmonary bypass is frequently based on empirical loading doses. Most cite this heparin loading dose as 3 mg/kg (300 units/kg) for both adults and pediatric patients. The purpose of this study was to retrospectively evaluate the heparin dose response (HDR) in a pediatric population.
The HDR of 268 pediatric patients presenting for repair of congenital heart defects at Children's Hospital, Columbus, Ohio, was gathered retrospectively from May 1992 to October 1993. The HDR was gathered for the entire population and divided into four groups based on patient weight: Group I ≤ 5.0 kg; Group II 5.1 to 10.0 kg; Group III 10.1 to 20.0 kg; Group IV > 20 kg.
The HDR is reported as mean (SD, range) in mg/kg. For the entire population (n = 268) the HDR was 3.5 mg/kg (1.20, 1.0 to 7.3). For patients > 20 kg (group IV, n =58) the HDR was 3.0 mg/kg (0.8, 1.0 to 4.9); Group III (10.1 to 20.0 kg, n = 80) HDR was 3.5 mg/kg (1.1, 2.0 to 7.3). Group II (5.1 to 10.0 kg, n = 66) HDR was 3.8 mg/kg (1.2, 1.8 to 7.3). Group I(≤ 5.0 kg, n = 64) HDR was 3.9 mg/kg (1.3, 1.5 to 7.3). Twenty-seven percent of the total population had a HDR > 4.0 mg/kg. When compared by weight, 10% of the patients > 20.0 kg had a HDR > 4.0 mg/kg compared to 45% of the patients < 5.1 kg.
The heparin dose required by children becomes greater as the patient weight (size) decreases with more patients requiring > 400 units/kg. The use of a fixed dose protocol of heparin in the pediatric patient becomes increasingly inadequate as the patient size decreases. Heparin administration in the pediatric patient should be specific to the individual patient with a heparin dose response calculated for each patient.
Blick über die Grenze: Was können wir von der Schweiz
lernen?
Authors: Beck Konstantin 
Published: August 2023

ZusammenfassungDas Gesundheitssystem der Schweiz orientiert sich wie Deutschland an Enthovens
Konzept von Managed Competition. Obwohl es grossmehrheitlich von
sozialdemokratischen, wettbewerbskritischen Amtsinhabern geführt worden
ist, zeigen sich besonders dort, wo die Regulierungsdichte gering blieb (bei
Managed Care) und wo wettbewerbsfördernde Regulierung eingeführt
worden sind (beim Risikoausgleich) die gewünschten Effekte. Daneben
bleiben zahlreiche Bereiche, die regulatorisch optimiert werden
könnten.
Patellaosteotomie kombiniert mit modifizierter Trochleaplastik und Tuberositasmedialisierung als Therapie der permanenten Patellaluxation in Beugung
Authors: Dickschas Jörg , Schmeling Arno , Perl Mario , Simon Michael 
Published: August 2023

ZusammenfassungPatellaluxationen in Flexion stellen die schwerste Form der patellofemoralen Dysbalance dar. Sie treten bei jeder Beugung auf, und die meisten bisherigen operativen Therapieversuche zeigten sich frustran. In einem neuen therapeutischen Ansatz wird die konkave Rückfläche der Patella, die auf dem hypoplastischen lateralen Kondylus wie auf Schienen nach lateral gleitet, in den Fokus gerückt. Die operative Therapie besteht aus einer Kombination aus lateral erweiternder Retinakuloplastik, Trochleaplastik, Patellaosteotomie, Tuberositasversetzung und MPFL-Plastik. In dem hier als OP-Video präsentierten Fall konnte bei einer 13-jährigen Patientin mit permanenter Patellaluxation in Beugung auf beiden Seiten ein physiologischer Patellalauf ohne Luxationstendenz bei schmerzfreien Kniegelenken erreicht werden.
Gestaltungsbedarf eines funktionsfähigen Wettbewerbs in der
sozialen Krankenversicherung
Authors: Cassel Dieter , Jacobs Klaus 
Published: August 2023

ZusammenfassungBehandelt werden Funktionsbedingungen wettbewerblicher Steuerung der
Gesundheitsversorgung in einem sozialen Krankenversicherungssystem wie der
gesetzlichen Krankenversicherung (GKV). Eine ihrer konstitutiven Besonderheiten
ist das Solidarprinzip. Danach erhalten Versicherte Leistungen nach dem
medizinischen Bedarf, tragen jedoch zur Finanzierung nach ihrer wirtschaftlichen
Leistungsfähigkeit bei. Das kann mit Wettbewerb konfligieren, der streng
dem Leistungsprinzip folgt. Wie können wettbewerbliche Prozesse im
Krankheitsfall zu hoher Qualität und Wirtschaftlichkeit der Versorgung
beitragen, ohne das Solidarprinzip zu gefährden? Irenische
Lösungen hierfür werden theoretisch-deskriptiv anhand des
Beziehungsgeflechts zwischen dem Versicherungs-, Leistungs- und Behandlungsmarkt
aufgezeigt. Hieraus ergeben sich die Gestaltungserfordernisse für
Selektivverträge, die mehr Wettbewerb zum Wohle der Versicherten und
Patienten in weiten Teilen der GKV ermöglichen würden.
Frequency of serrated polyposis syndrome recognition by community endoscopists
Authors: McWhinney Connor D. , Lahr Rachel E. , Rex Douglas K. 
Published: August 2023

Abstract
Background and study aims Some data indicate serrated polyposis syndrome (SPS) is underdiagnosed. We determined the frequency of SPS diagnosis by community endoscopists prior to referral to a tertiary center.
Patients and methods We performed a retrospective analysis of a
prospectively collected database of SPS patients at a tertiary academic hospital. There were
212 patients who were referred to our center for resection of one or more lesions detected at
a prior colonoscopy and who had records available that allowed determination of whether SPS
was diagnosed before referral.
Results Only 25 of 212 patients (11.8%) had a diagnosis or
suspicion of a polyposis syndrome prior to referral, and only 12 patients (5.7%) had a
specific SPS diagnosis made prior to referral. Among 187 patients diagnosed at our center, 39
had sufficient serrated lesions removed and documented in outside records to meet SPS criteria
prior to referral, but the diagnosis was not made by the referring physician despite adequate
numbers of lesions resected. The remaining cases required lesions removed at our center to
meet SPS diagnostic criteria. Limitations were a single center, single expert
endoscopist.
Conclusions SPS is the most common colorectal polyposis syndrome, but it remains underdiagnosed by community endoscopists. Underdiagnosis may contribute to post-colonoscopy colorectal cancer in patients with SPS.
Green Synthesis of Five-Membered Hetarene N-Oxides: A Designed Approach to the Synthesis of Substituted Chromeno[3,4-c]pyrrole-2-oxides
Authors: Alizadeh Abdolali , Rostampoor Azar , Hasanpour Hamidreza 
Published: August 2023

AbstractAn efficient and chemoselective synthesis of biologically valuable chromeno[3,4-c]pyrrole 2-oxides containing one chiral stereocenter is described. In this method, by using a sequential nucleophilic addition reaction involving coumarins (α,β-unsaturated coumarins or 3-acetylcoumarins), activated acetylenic compounds, triphenylphosphine as a catalyst, and hydroxylammonium chloride (HAC) as an NO source, substituted chromeno[3,4-c]pyrrole 2-oxides were prepared with excellent efficiency. Readily available starting materials, absence of a metal catalyst, green and mild conditions, chemoselectivity, easy purification (the products can be purified by simple filtration and washing with EtOH), and synthetically useful yields are some highlighted advantages of this unprecedented transformation.
Mid-Term Outcomes of Modular Dual Mobility Bearings in Total Hip Arthroplasty
Authors: Arraut Jerry , Ward Spencer , Oakley Christian T. , Schwarzkopf Ran , Macaulay William 
Published: August 2023

AbstractModular dual mobility (MDM) prostheses in which a cobalt–chromium liner is inserted into a titanium acetabular shell have the potential for corrosion. This has raised concern. While these constructs have been shown to effectively reduce the risk of dislocation in revision and high-risk primary total hip arthroplasty (THA), previous studies have been limited by the length of follow-up. The purpose of the study is to review the mid-term clinical outcomes of MDM implants with a minimum of 5-year follow-up. A retrospective, observational study was conducted on all consecutive patients who underwent THA with a MDM implant from June 2011 and March 2017 at an urban, tertiary academic medical center. Descriptive statistics were used to describe baseline patient characteristics. Primary endpoints included revision rates, dislocations rates, and implant component survivorship. Implant survival was analyzed using the Kaplan–Meier method. A total of 92 cases (61 primary, 31 revision) underwent THA with a MDM implant at an average follow-up of 6.90 ± 1.48 years (range: 5.01–10.53 years). The mean patient age at the time of surgery was 58.20 ± 11.85 years. Six patients were revised (6.5%, 6/92), two for periprosthetic joint infection (2.2%, 2/92), one due to aseptic loosening (1.1%, 1/92), one due to periprosthetic fracture (1.1%, 1/92), and the remaining two for metallosis (2.2%, 2/92). Kaplan–Meier survivorship analysis showed a 93.5% survival rate for all-cause revisions and 98.9% survival for acetabular component revision. MDM components reliably decrease the risk of dislocation after THA. However, the occurrence of two revisions due to metallosis demonstrates the necessity for continued surveillance in this cohort. Larger trials with long-term follow-up may be required to further elucidate the long-term outcomes and performance of these bearings.
Engaging Patients and Caregivers to Develop a Patient-Centered Agenda for Comparative Effectiveness Research Focused on the Treatment of Complex Knee Problems
Authors: Royse Lisa A. , Strother Sandi , Trachsel Matt , Mehr David R. , Hoffman Kimberly , Cook James L. 
Published: August 2023

AbstractComplex articular cartilage loss in the knee is being diagnosed more frequently and earlier in life, and patients are faced with major decisions regarding invasive surgical interventions at increasingly younger ages. There is a critical unmet need to provide patient-centered comparative effectiveness research for the hundreds of thousands of patients faced with these treatment decisions each year. Toward filling the need, we developed the Patient AdvisoR Team iN Orthopaedic ReSearch (PARTNORS) program. We recruited a diverse group of patients and caregivers with lived experiences in dealing with complex knee problems to define patient-centered research priorities for comparative biological and artificial knee surgery research for middle-aged adults. Adapting the Stakeholder Engagement in Question Development and Prioritization Method, PARTNORS defined a 20-question list of patient-centered research questions of factors influencing a patients' choice between biological and artificial knee surgeries. The highest prioritized research question related to functional level postsurgery as it relates to daily activities and recreational activities. The second highest prioritized research questions related to insurance coverage and financial costs. Other prioritized research areas included caregiving needs, implant longevity, recovery and rehabilitation time, patient satisfaction and success rates, individual characteristics, and risks. By engaging a group of patients and caregivers and including them as members of a multidisciplinary research team, comparative effectiveness research that includes patient-centered factors that go beyond typical clinical success indicators for knee surgery can be designed to allow physicians and patients to work together toward evidence-based shared decisions. This shared decision-making process helps to align patients' and health care team's goals and expectations to improve outcomes.
Expanding and protecting human rights from space
Authors: Bales Kevin 
Published: August 2023

AbstractThe area of surveillance of human activities from above is fraught with concerns and controversy. Such surveillance is clearly being used in ways that invade human lives and often put those lives in danger. At the same time, there is an argument for more oversight, and the need to support more surveillance, in a controlled and monitored way, to expose and render access to sites of criminal activity, and particularly those of the most egregious crimes—slavery, genocide, environmental destruction, and the operation of ‘rebel’ military gangs or national militaries run by rogue states. If nature can be harried, harmed, and turned against human existence, it is also true that humans have now brought increasingly powerful diagnostic techniques to bear so that oceans, land, forests, fields, plains—all ecosystems—can be monitored for health as well as the scars of exploitation—including that of the human within the monitored ecosystem. The field of human rights now stretches far beyond humans to all life and nature—since useful and meaningful human rights can’t truly exist in a physical and natural world that is hostile to homo sapiens. Earth observation can be, and often is, a force for good.
Heterostructure formation of group-III sesquioxides via cation-exchange reactions with metal chloride gases
Authors: Goto Ken , Ueno Tomo , Kumagai Yoshinao 
Published: August 2023

Thermodynamic analyses and experimental demonstrations were performed to investigate whether cation-exchange reactions (CERs) with metal chloride gases are a feasible technique for forming heterostructures of group-III sesquioxides. The thermodynamic analyses revealed the possibility of formation of aluminum oxide (Al2O3) layers on gallium oxide (Ga2O3) or indium oxide (In2O3) substrates via CERs with aluminum chloride gases, as well as formation of Ga2O3 layers on In2O3 substrates via CERs with gallium chloride gases, in a practical temperature range. However, CERs with gallium chloride gases or indium chloride gases did not occur on Al2O3 substrates, suggesting that heterostructures were not formed. On the basis of the results of the thermodynamic analyses, a CER was performed by the reaction of n-type β-Ga2O3(2̄01) substrates with aluminum trichloride gas, resulting in the formation of Al2O3 layers. Under optimal conditions, a dense (001)-oriented κ-Al2O3 layer with a thickness of 30 nm was formed and served as an excellent gate oxide in metal–oxide–semiconductor devices. The relative dielectric constant of κ-Al2O3 was obtained via capacitance–voltage measurements, and a high value of ∼22 was obtained in the several tens of kHz band. CERs using metal chloride gases open a new method for forming heterostructures of group-III sesquioxides.
Morphology, size control, and photocatalytic activities of titanium dioxide nanoparticles synthetized by microemulsion method
Authors: Bakhtiari Farhad , Foruhar Nasim , Zelati Amir , Amouamouha Mitra 
Published: August 2023

In the present work, we successfully synthesized titanium dioxide nanoparticles (TiO2-NPs) by reverse microemulsion method using cyclohexane, aqueous ammonia materials, and various ratios of surfactants. Using this method, nanoparticles of various morphologies, such as filamentous, sheet, and spherical morphologies, were synthesized. In addition, NPs in very small size (i.e., 4–7 nm for spherical morphology) were obtained. The as-prepared samples showed light absorption in the range of 200–300 nm, indicating their potential application as an UV light induced photocatalyst. The obtained TiO2-NPs were amorphous and can be converted to anatase by heating at 600–750 °C and to rutile by heating above 900 °C. In addition, TiO2-NPs with sheet morphology showed the highest activity on photocatalytic decomposition of methyl orange relative to spherical and filamentous morphologies. We also showed that doping of tin (Sn) atoms in TiO2-NPs causes a significant increase in the photocatalytic activity of NPs and the time needed for photocatalytic decomposition decreases to around one-fifth of the time needed for nondoped NPs. The results of the present research indicated that the microemulsion process is an effective/potential method for the synthesis of some new functional materials.