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The rate of bleeding complications following arterial switch operation is too low to independently justify a prospective randomised study for benefit from recombinant factor VIIa. We aimed to evaluate factor VIIa in a pilot study.
We performed a retrospective cohort study of patients undergoing arterial switch operation from 2012 to 2017. Nearest-neighbour propensity score matching on age, gender, weight, and associated cardiac defects was used to match 27 controls not receiving recombinant factor VIIa to 30 patients receiving recombinant factor VIIa. Fisher’s exact test was performed to compare categorical variables. Wilcoxon’s rank-sum test was used to compare continuous variables between cohorts.
Post-operative thrombotic complications were not associated with factor VIIa administration (Odds Ratio (OR) 0.28, 95% CI 0.005–3.77, p = 0.336), nor was factor VIIa administration associated with any re-explorations for bleeding. No intraoperative transfusion volumes were different between the recombinant factor VIIa cohort and controls. Post-operative prothrombin time (10.8 [10.3–12.3] versus 15.9 [15.1–17.2], p < 0.001) and international normalised ratio (0.8 [0.73–0.90] versus 1.3 [1.2–1.4], p < 0.001]) were lower in recombinant factor VIIa cohort relative to controls.
In spite of a higher post-bypass packed red blood cell transfusion requirement, patients receiving recombinant factor VIIa had a similar incidence of bleeding post-operatively. With no difference in thrombotic complications, and with improved post-operative laboratory haemostasis, a prospective randomised study is warranted to evaluate recombinant factor VIIa.
Review a single-centre experience with pulmonary artery sling repair and evaluate risk factors for re-intervention.
Patients with surgically repaired pulmonary artery sling at a single institution between 1996 and 2018 were retrospectively reviewed. A univariate Cox regression analysis was used to evaluate variables for association with freedom from re-intervention.
Eighteen patients had pulmonary artery sling repair. At operation, median age and weight were 6.9 months (interquartile range 4.1–18.1) and 9.5 kg (interquartile range 6.5–14.5), respectively. A median hospital length of stay was 12 days (interquartile range 5.8–55.3). Twelve patients (67%) had complete tracheal rings, of whom six (50%) underwent tracheoplasty (five concurrently with pulmonary artery sling repair). Airway re-intervention was required in five (83%) of the six patients who underwent tracheoplasty. One patient had intraoperative diagnosis and repair of pulmonary artery sling during unrelated lesion repair and required tracheoplasty 24 days post-operatively. One patient died 55 days after pulmonary artery sling repair and tracheoplasty following multiple arrests and re-interventions. Median post-operative follow-up for surviving patients was 6.3 years (interquartile range 11 months–13 years), at which time freedom from re-intervention was 61%. When controlling for patient and tracheal size, initial tracheoplasty was associated with decreased freedom from re-intervention (hazard ratio 21.9, 95% confidence interval 1.7–284.3, p = 0.018).
In patients with pulmonary artery sling, tracheoplasty is associated with decreased freedom from re-intervention. In select patients with pulmonary artery sling and complete tracheal rings, conservative management without tracheoplasty is feasible. Further study is necessary to delineate objective indications for tracheoplasty.
The resection of a subaortic membrane remains far from a curative operation. We sought to examine factors associated with reoperation and the degree of aortic valve regurgitation as a potential long-term source for reoperation.
All patients who underwent resection of an isolated subaortic membrane between 1995 and 2018 were included. Patients who underwent other procedures were excluded. Paired categorical data were compared using McNemar’s test. Univariate time-to-event analyses were performed using Kaplan–Meier methods with log-rank tests for categorical variables and univariate Cox models for continuous variables.
A total of 84 patients (median age 6.6, 31% females) underwent resection of isolated subaortic membrane. At a median follow-up of 9.3 years (interquartile range 0.6–22.5), 12 (14%) patients required one reoperation and 1 patient required two reoperations. Median time to first reoperation was 4.6 years. The degree of aortic valve regurgitation improved post-operatively from pre-operatively (p = 0.0007); however, the degree of aortic valve regurgitation worsened over the course of follow-up (p = 0.010) to equivalence with pre-operative aortic valve regurgitation (p = 0.18). Performance of a septal myectomy was associated with longer freedom from reoperation (p = 0.004).
In patients with isolated subaortic membranes, performance of a septal myectomy can minimise risk for reoperation. Patients should be serially monitored for degradation of the aortic valve, even if aortic regurgitation is not present post-operatively.
This study described prescribing trends before and after implementing a provincial strategy aimed at improving osteoporosis and fracture prevention in Ontario long-term care (LTC) homes. Data were obtained from a pharmacy provider for 10 LTC homes in 2007 and 166 homes in 2012. We used weighted, multiple linear regression analyses to examine facility-level changes in vitamin D, calcium, and osteoporosis medication prescribing rates between 2007 and 2012. After five years, the estimated increase in vitamin D, calcium, and osteoporosis medication prescribing rates, respectively, was 38.2 per cent (95% confidence interval [CI]: 29.0, 47.3; p < .001), 4.0 per cent (95% CI: –3.9, 12.0; p = .318), and 0.2 per cent (95% CI: –3.3, 3.7; p = .91). Although the study could not assess causality, findings suggest that wide-scale knowledge translation activities successfully improved vitamin D prescribing rates, although ongoing efforts are needed to target homes with low uptake.
Four microseconds long Ar3+ beam with injection energy of 15 keV/u has been injected into the Digital Accelerator of the High-Energy Accelerator Research Organization. Beam production, transportation, and injection are described as well as machine properties. Results of a free running experiment under static magnetic field and longitudinal confinement and acceleration under a fast ramping magnetic field are presented in detail with a brief discussion on the beam lifetime.
In this study, ZnO f ilms heavily doped with Al or Ga were grown on a polarity-controlled buffer layer using pulsed laser deposition. The films prepared using a 1 mol% Al-doped target with the buffer layer grown at 700 °C had the c(+)-face, whereas the films with the buffer layer grown at 400 °C had the c(-)-face, which means that the polarity control can be successfully carried out using the buffer layer. However, the films prepared using targets doped with more than 1 mol% Al or Ga had the c(+)-face regardless of the polarity of the buffer layer. The 1 mol% Al-doped ZnO film with the c(+)-face had lower electron concentration and higher growth rate than the film with the c(-)-face. This result indicates that the Al content in the film with the c(-)-face was larger than that in the film with the c(+)-face.
A unified physically-based representation of the microstructure in martensitic steels is developed to investigate its effects on the initiation and evolution of failure modes at different physical scales that occur due to a myriad of factors, such as texture, grain size and shape, grain heterogeneous microstructures, and grain boundary (GB) misorientations and distributions. The microstructural formulation is based on a dislocation-density based multiple-slip crystal plasticity model that accounts for variant distributions, orientations, and morphologies. This formulation is coupled to specialized finite-element methods to predict the scale-dependent heterogeneous microstructure, and failure phenomena such as shearstrain localization, and void coalescence.
The mechanical properties and deformation behavior of each constituent layer of multilayered steel composites were examined using microtensile testing. Three-layered integrated steels consisting of SUS420 and SPCC (cold-reduced carbon steel sheets) were fabricated by a cold-rolling process. Different heat treatment processes were used to prepare three types of specimens (as-rolled, 823K-2 min heat-treated, and 823K-500 min heat-treated), and the effect of heat treatment on their mechanical properties was investigated. In the as-rolled specimens, the average tensile strengths in the SUS420 and SPCC layers were 1063 and 606 MPa, respectively, while in the specimens heat-treated for 500 min, they were 680 and 451 MPa, respectively. The tensile strength decreased with the increase in the heat treatment time. The tensile strength of the specimens was also calculated by using the rule of mixture. For the as-rolled specimens and the 823K-2 min heat-treated specimens, the calculated value was consistent with the measured value; however, for the 823K-500 min heat-treated specimens, the calculated value was lower than the measured value. This result suggests that the necking of this layered structure was effectively obstructed by the outer ductile layer. The micromechanical characterization technique used in this study is useful not only for investigating deformation behavior but also for designing multilayered steel composites with superior mechanical properties.
Human rotavirus strains from Kenya, from children with gastroenteritis in an urban area (Nairobi) and three rural areas were characterized by antigenic and genomic analysis. While in all areas strains with subgroups II and G serotype 1 antigens were most common, two unusual strains were detected. One strain (NK59: subgroup II. G serotype 4) possessed an additional RNA band on polyacrylamide gel electrophoresis, the other (D202) which had antigenic specificity of subgroup II and G serotype 1 showed a ‘short’ RNA pattern. The latter strain was adapted to growth in cell culture.
White OLED consisting of a fluorescent blue emissive layer combined with a phosphorescent green and a phosphorescent red emissive layer were processed by means of Organic Vapor Phase Deposition (OVPD). Different concepts to tune the color coordinates of the device are discussed with respect to the luminous efficiency. Furthermore, the influence of device aging on the emitted spectrum is being investigated by means of spectrally resolved lifetime measurements.
To investigate two clusters of diarrhoea cases observed in our geriatric hospital wards, the faecal specimens were analysed. Reversed passive latex agglutination assay revealed that 63·2% and 41·7% of the faecal specimens from each cluster were positive for Clostridium perfringens enterotoxin. PCR assay revealed that 71·4% and 68·8% of C. perfringens isolates from each cluster were positive for the enterotoxin gene (cpe). These observations suggested that both the clusters were outbreaks caused by enterotoxigenic C. perfringens. Subsequent pulsed-field gel electrophoresis analysis revealed that the two outbreaks were caused by different C. perfringens isolates. However, these outbreak isolates as well as other sporadic diarrhoea isolates shared a 75-kb plasmid on which the cpe gene and the tcp locus were located. The 75-kb plasmid had horizontally spread to various C. perfringens isolates and had caused outbreaks and sporadic infections. However, the site and time of the plasmid transfer are unclear.
Hot-wire chemical vapor deposition (HWCVD) technique was used to deposit nanocrystalline silicon (nc-Si) thin film transistors (TFT) on thin polyimide sheets. Two straight tantalum filaments at 1850°C with a substrate to filament distance of 4 cm was used to deposit HWCVD nc-Si with no thermal damage to plastic sheet. Top-gate staggered TFTs were fabricated at 150°C and 250°C using a HWCVD nc-Si channel, PECVD silicon nitride gate dielectric, and microcrystalline n+ drain/source contacts. Leakage current of 3.3×10-12 A, switching current ratio of 3×106, and sub threshold swing of 0.51 V/decade were obtained for TFTs with aspect ratio of 1400 µm / 100 µm fabricated at 150°C. The highest electron field effect mobility was found to be 0.3 cm2/V.s observed for TFTs deposited at lower substrate temperature. Measurements showed superior threshold voltage stability of HW nc-Si TFTs over their amorphous silicon (a-Si) counterparts.
The propagation of intense laser pulses and the generation of high-energy electrons from underdense plasmas are investigated using two-dimensional particle-in-cell simulations. It is shown that quasi-monoenergetic electron beams are generated in the regime where the laser pulse length is much longer than the plasma wavelength, when the condition of the focusing is appropriately controlled.
Three-dimensional electron motion in a linearly polarized tightly focused laser field is numerically calculated. A high-intensity laser pulse focused on the free electrons in vacuum generates relativistic electron bunches whose length is shorter than the laser wavelength. The extremely short electron bunches with low-energy spread less than 1% are generated for a wide range of the laser parameters.
Positive surgical indications for an only hearing ear were evaluated in order to improve patients' quality of life. Fifteen cases of surgery involving an only hearing ear over the past eight years were retrospectively reviewed. Of eight perforated chronic otitis media cases, seven underwent type one tympanoplasty and one underwent simple underlay myringoplasty regardless of otorrhoea at the time of surgery. Of six cholesteatoma cases, two received the canal wall up method and four received the canal wall down method. Ossiculoplasty was carefully performed in six cases. Hearing was improved in seven cases, whereas it remained unchanged in seven cases and deteriorated in one case. Of nine patients, two did not need a hearing aid after surgery. Five patients with severe combined hearing loss (>90 dB) were able to communicate with a hearing aid, alleviating their anxiety regarding hearing loss. Only hearing ears with chronic otitis media and cholesteatoma can be successfully treated by tympanoplasty with or without ossiculoplasty.
We have demonstrated the acceleration of a monoenergetic electron beam
by a laser-produced wakefield. Experiments were performed by focusing 2-TW
laser pulses of 50 fs on supersonic gas-jet targets. The focused intensity
was 5 × 1018 W/cm2 (a0
= 1.5). At an electron density of 1.5 × 1020
cm−3, the clear monoenergetic electron beam from the
plasma was obtained at 7 to 15 MeV. The Stokes satellite peak in the
forward scattering explained the energy spectra of electrons at various
plasma densities well. Although the wakefield propagated 500 microns,
which was far beyond the dephasing length, monoenergetic electron beams
We successfully measured the mechanoluminesence (ML) from a single ML nanoparticle at the first time. In order to measure the weak light emission from a single nanoparticle induced by applying a micro force, we developed an AFM-based new apparatus with a photomultiplier. Interestingly, the emission (ML) intensity from a nanoparticle was approximately proportional to the load, the phenomena is similar to the macroscopic ML emission properties.
The crystallographic orientation distribution, and its change accompanied with tilting γ/γ boundaries in Ni-based single crystal superalloys have been investigated by a theoretical elastic-plastic calculation, X-ray diffractometry and SEM-EBSD analysis. The distribution of the crystallographic orientation has significantly broadened by creep deformations. The broadening can be explained by an unbalance of the amount of creep dislocations of each slip system, which agrees with the result of elastic-plastic calculations. Creep strain of superalloys crept at a condition forming the raft structure can be estimated by the measurement of the width of rocking curve of a diffraction peak.