Final Closure Research Articles

EVFAM-BR: Sharing experiences and closure

Abstract This activity will last 20 minutes. After Role Play, participants will sit in large circle and the ones that assumed the observer role will share their experiences of using EVFAM-BR. Subsequently, other participants will be invited to share their experiences and impressions about EVFAM-BR. Based on the participants’ impressions and a review of the main points covered throughout the workshop, a final discussion and closure of the workshop will be facilitated.

Continental crustal growth in the post-collisional setting: Insights from the Late Triassic high-Mg andesites in the eastern Central Asian Orogenic Belt

The Central Asian Orogenic Belt represents the most important site of crustal growth in the Phanerozoic. However, the intricate evolution of multi-ocean regimes has given rise to uncertainties surrounding the processes of Mesozoic tectonic evolution and the dynamics of crustal growth. In this study, we conducted detailed geochronological and geochemical analyses of andesites collected from the eastern Central Asian Orogenic Belt. Zircon U-Pb dating results show that these andesites formed during the Late Triassic (ca. 235 Ma), and the Ti-in-zircon thermometer reveals high magma temperatures (>1100 °C) during their genesis. The elevated Mg# values at moderate SiO2 content of these Late Triassic andesites indicate an affinity with high-Mg andesites (HMAs). Notably, the andesites exhibit relatively low K2O/Na2O ratios, high Sr/Y ratios, significant depletion of Nb and Ta, and trace element patterns resembling typical HMAs from the western Aleutian Islands. These characteristics suggest that they likely originated from the partial melting of subducted eclogite. Furthermore, the HMAs display relatively high zircon εHf(t) values and depleted whole-rock Sr-Nd isotopic compositions, which is indicative of a depleted mantle source. Therefore, we propose that these andesites were generated through the interaction of the subducting slab−derived melts and overlying mantle wedge. Considering that the final closure of the Paleo-Asian Ocean took place before the Late Triassic, these andesites probably erupted in a post-collisional setting. The formation of these HMAs could be best explained by the upwelling asthenosphere triggered by the break-off of the oceanic slab, which also contributed to continental crustal growth in Northeast China.

Primary delayed sternal closure in adult cardiac surgery: a systematic review of protocols.

Primary delayed sternal closure (DSC) is a useful tool in the management of certain critically unstable patients after cardiac surgery, but there is a paucity of consensus management guidelines. This review aimed to identify critical key areas in DSC management. Systematic literature search was conducted in January 2023 and performed using Embase and PubMed. For original research articles were included that described outcomes and/or protocols for primary adult DSC patients, excluding articles on pediatric patients and secondary DSC. Eleven retrospective review original articles examined protocols for adult patients undergoing DSC. Hemodynamic instability and uncontrolled bleeding/coagulopathy were the two most common indications. Time to chest closure ranged 22 hours - 8.7 days. A range of dressings were employed, including Esmark and VAC dressings, with about half of authors not disclosing details. VAC was endorsed by several authors specifically for management of uncontrolled hemorrhage/coagulopathy. There was no consensus regarding irrigation solution for mediastinal prepping, with or without antibiotic solution. There was a lack of consensus on antibiotic selection and duration, varying from 2 and 3 multidrug regimens of broad-spectrum antibiotics, with/without antifungals. Mediastinal re-exploration varied from undefined intervals to regimented 24-48-hour interval re-explorations, with final closures in the OR or ICU. The optimum care for the patient with an open chest is evolving, and although there is a lack of a consensus DSC protocol, this review identifies mediastinal management, antimicrobial prophylaxis, and mediastinal re-exploration schedules/protocols as key areas for study to determine optimal care for DSC patients.

Provenance and tectonic evolution of the forearc basin along the northwestern Central Qilian belt, northeastern Tibet

The age and properties of detrital zircon grains in a forearc basin provide crucial information on the history of convergent plate margins. These data can be used to constrain provenance dispersal patterns, establish source-to-sink relationships, and reveal the tectonic framework and subduction history. The Qilian orogen in the northeastern margin of the Tibetan Plateau records the tectonic history of the Proto-Tethys Ocean from its initial spreading and subduction to final closure. However, the timing of subduction initiation and the subduction polarity of the Proto-Tethys Ocean remain controversial. The Qilian orogen includes the North Qilian, Central Qilian, and South Qilian belts. A succession of sedimentary rocks along the northwestern margin of the Central Qilian belt, previously considered to be Precambrian in age, has been redefined based on detailed field investigation and geochronology. U-Pb analysis of detrital zircon grains from metasedimentary rocks of the Gongcha Group of the northwestern Central Qilian belt yielded Paleozoic ages between 530 and 470 Ma, with prominent Mesoproterozoic and Paleoproterozoic ages between 1800 and 1000 Ma. In contrast, the overlying Duoruonuoer Group yielded predominantly early Paleozoic ages between 465 and 434 Ma, with a few older age populations. This change in source is reflected in a substantial increase in volcanic detritus within the Duoruonuoer Group as compared to the Gongcha Group. The detrital zircon age spectra and lithologic characteristics indicate the Gongcha and Duoruonuoer Groups constitute the lower and upper volcanic-sedimentary strata in the forearc basin. Based on resemblances of statistical ages and εHf(t) values of zircon, we interpret that the early Paleozoic intrusive and volcanic units and Precambrian basement rocks of the Central Qilian belt were the main source of the Gongcha and Duoruonuoer Groups, verifying the southward subduction of the North Qilian Ocean, a portion of the larger Proto-Tethys Ocean, beneath the Central Qilian belt. The detrital zircon ages reveal that the initial subduction of the Proto-Tethys Ocean in the Qilian orogen occurred ca. 530 Ma and closed ca. 435 Ma. These forearc sedimentary units constitute the tectonic boundaries between the Central Qilian belt and North Qilian belt.

Tympanic Membrane Regeneration Therapy for Pediatric Tympanic Membrane Perforation.

To evaluate tympanic membrane regeneration therapy (TMRT) for pediatric tympanic membrane perforations (TMPs). Intervention study. Research institute hospital. In this study, 20 patients with chronic TMP (M/F: 13/7, 13/8 ears, age 0-15 years) treated with TMRT were evaluated. As comparison, 20 pediatric patients with chronic TMP who underwent myringoplasty/tympanoplasty were included. For the TM repair procedure, the edge of the TMP was disrupted mechanically, and gelatin sponge immersed in basic fibroblast growth factor was placed inside and outside the tympanic cavity and covered with fibrin glue. The TMP was examined 4 ± 1 weeks later. The protocol was repeated up to four times until closure was complete. Closure of the TMP and hearing improvement were evaluated at 16 weeks after the final regenerative procedure. Adverse events were monitored. The mean follow-up period was 427.1 days. The TM regenerated in all cases, but pinhole reperforation occurred in two cases, and the final closure rate was 90.5% (19 of 21). Hearing improved to 24.9 ± 7.6 dB on average before surgery and to 13.8 ± 5.4 dB after surgery. The AB gap improved from 12.9 ± 8.0 to 5.2 ± 3.5 dB.The myringoplasty/tympanoplasty group had significantly lower AB gap improvement compared with the TMRT group. There were no adverse events. TMRT can be expected to regenerate near-normal TMs with a high closure ratio, resulting in better-hearing improvement compared with the myringoplasty/tympanoplasty group, and is an effective treatment for children with long life expectancy.

Permo-Triassic source-to-sink systems of the Turpan basin: insights into three tectonic evolutionary episodes and their implications for the formation rhythm of the Central Asian Orogenic Belt

ABSTRACT The Tianshan Orogenic Belt underwent a series of complex tectonic changes from the Late Palaeozoic to the Cenozoic, providing key insights into the evolution of the Central Asian Orogenic Belt (CAOB). The continuous Permo-Triassic sedimentary records of the Turpan Basin are among the best archives of the tectonic evolution of the Tianshan Orogenic Belt. However, the evolution of the Turpan Basin during this period is poorly understood. Using detrital zircon U-Pb chronology and geochemistry, we reconstructed the source-to-sink system changes and the basinal tectonic evolution in the Permo-Triassic, thus providing new evidence of its tectonic evolution. Our results show that the Early-Middle Permian source-to-sink systems of the Turpan Basin were mainly proximal and constrained by horst and graben landforms due to internal extension formed in the back-arc setting during accretionary orogenesis in Central Asia. In the Late Permian-Early Triassic, exotic sources, including the North Tianshan and Yili Block-Central Tianshan, dominated the source-to-sink system, which suggests that rifts were infilled and expanded across the entire thermal sag basin. In the Middle-Late Triassic, the sediment sources diversified, with external and internal provenances revealing that a foreland basin formed with thrusting at the southern margin, and the intraplate-associated Bogda forebulge experienced initial uplift, signifying that the CAOB gradually changed from an accretionary to an extrusive orogeny. The three evolutionary episodes of the Turpan Basin implicated the long-lasting effect of the orogenic process from the final closure of Palaeo-Asian Ocean to the following build-up of the CAOB.

Coal Ash Triggers an Elevated Temperature Landfill Development: Lessons from the Bristol Virginia Solid Waste Landfill Neighboring Community

Landfills for disposing of solid waste are designed, located, managed, and monitored facilities expected to comply with government regulations to prevent contamination of the surrounding environment. After the average life expectancy of a typical landfill (30 to 50 years), a large investment in the construction, operation, final closure, and 30-year monitoring of a new site is needed. In this case study, we provide a holistic explanation of the unexpected development of elevated temperature landfills (ETLFs), such as that in the city of Bristol (United States) on the border of the states of Virginia and Tennessee, including the initial role played by coal ash. Despite the increasing frequency of ETLF occurrence, there is limited knowledge available about their associated environmental problems. The study uses mixed (qualitative, quantitative, and mapping) methods to analyze (1) the levels of odoriferous reduced sulfur compounds, ammonia, and volatile organic compounds (VOCs) emitted, (2) the ratio of methane to carbon dioxide concentrations in five locations, which dropped from unity (normal landfill) to 0.565, (3) the location of gas well heads with gradients of elevated temperatures, and (4) the correlation of the filling rate (upward of ~12 m y−1) with depth for registered events depositing coal ash waste. The work identifies spatial patterns that support the conclusion that coal ash served as the initiator for an ETLF creation. The case of the city of Bristol constitutes an example of ETLFs with elevated temperatures above the regulatory United States Environmental Protection Agency (EPA) upper threshold (65 °C), having alongside low methane emissions, large production of leachate, land subsidence, and a large production of organic compounds. Such landfills suffer abnormal chemical reactions within the waste mass that reduce the life expectancy of the site. Residents in such communities suffer intolerable odors from fugitive emissions and poor air quality becomes prominent, affecting the well-being and economy of surrounding populations. Conclusive information available indicates that the Bristol landfill has been producing large amounts of leachate and hazardous gases under the high pressures and temperatures developed within the landfill. A lesson learned, which should be used to prevent this problem in the future, is that the early addition of coal ash into the landfill would have catalyzed the process of ETLF creation. The work considers the public health risks and socioeconomic problems of residents exposed to emissions from an ETLF and discusses the efforts needed to prevent further incidents in other locations.

The Flip and Fix internal limiting flap technique versus the classic temporal flap for macular hole repair.

To describe a novel technique of macular hole (MH) repair and compare it to the perfluorocarbon liquid (PFCL)-assisted temporal internal limiting membrane (ILM) flap technique. Twenty-two eyes of 22 patients with MH were randomized on a 1:1 basis into two groups. Group A cases were treated using the Flip and Fix technique, in which the single-layer ILM flap was flipped, flattened over the macula using PFCL, and fixed in place using two drops of autologous nonheparinized blood over the superonasal and inferonasal edges of the flap (away from the MH center). Group B patients had the classic temporal ILM flap technique without using the PFCL or autologous blood. All patients were followed up for a period of 6 months after the surgery. No significant difference was observed in initial and final visual acuities between Groups A and B. Intraoperative flap displacement did not occur in Group A and occurred in two eyes in Group B (18.2%). One of them showed failed MH closure and required reoperation. These two cases had a final (W shape) MH closure and a worse final vision than the remaining cases, which had either a U shape or V shape final MH closure. The study results show that the Flip and Fix technique is as effective as the PFCL-assisted temporal ILM flap technique and is associated with less ILM flap displacement risk for the repair of macular holes.

Compartment Syndrome in Association with Tibial Plateau Fracture: Standardized Protocols Ensure Optimal Outcomes.

The purpose of this study was to report on the treatment, results, and longer-term outcomes of patients who sustained a tibial plateau fracture with an associated leg compartment syndrome (CS). A total of 766 patients who sustained 766 tibial plateau fractures met inclusion criteria. Fourteen patients (1.8%) were diagnosed with CS in association with a tibial plateau fracture during their initial hospitalization, 13 at the time of presentation and 1 delayed. The treatment protocol consisted of initial external fixation and fasciotomy, followed by irrigation and debridement, and eventual closure. Fasciotomy cases included 2/14 (14.3%) single incision approaches and 12/14 (85.7%) dual incision approaches. Operative treatment of the tibial plateau fracture was performed at the time of final closure or once soft tissues were permitted. One case of CS that developed following definitive fixation was treated with fasciotomy and delayed primary closure after initial stabilization. Ten (71.4%) were available at 1-year follow-up. We compared these 10 cases to the patients with operative tibial plateau fractures without CS to assess for surgical, radiographic, clinical, and functional outcomes. We used a propensity match based on age, body mass index, sex, Charleson comorbidity index, and fracture type to reduce the presence of confounding biases. Standard statistical methods were employed. Those in the CS cohort were younger males (p < 0.05). At latest follow-up, function did not differ between those in the CS group compared with the non-CS cohort (p > 0.05). Clinically, knee flexion (130.7 vs. 126; p = 0.548), residual depression (0.5 vs. 0.2; p = 0.365), knee alignment (87.7 vs. 88.3; p = 0.470), and visual analog scale pain scores (3.0 vs. 2.4; p = 0.763) did not differ between the cohorts. Although infection was higher in the CS cohort, the overall complication rates did not differ between the CS patients and non-CS cohort (p > 0.05). Early identification and standardized treatment protocols for the management of CS that develops in association with a tibial plateau fracture lead to outcome scores that were not significantly different from patients who did not develop CS.

Growth of the Central Orogenic Belt, North China Craton through accretion of different Neoarchean arc terranes: Perspective from the Linshan complex

The onset of plate tectonics and crustal growth processes in the early Earth have been controversial scientific issues in the geoscience. The North China Craton (NCC) preserves widespread 3.8–2.5 Ga rocks, providing an ideal place to understand early continent formation and evolution. The Linshan complex located in the southern segment of the Central Orogenic Belt (COB) of the NCC, is mainly composed of TTG (tonalite-trondhjemite-granodiorite)-diorite gneisses and metamorphic volcanic-sedimentary units dominated by gabbro, basalt, basaltic andesite and biotite-plagioclase gneiss. Detailed mapping on the scale of 1:100 of a structural transect shows that the Linshan complex has mainly experienced two major deformation events including top-to-the-SE thrust faults and late NE-trending high-angle normal faults. Detailed zircon U-Pb dating shows that gabbro, basaltic andesite, and TTG gneiss mainly formed at ca. 2.52–2.50 Ga. Gabbros and basalts display enrichment of LREE and negative Nb and Ta anomalies, and basaltic andesites display mixed MORB-IAT geochemical affinities. Basalts and basaltic andesites are members of the Nb-enriched basalt series with high absolute Nb contents (>6 ppm). TTG gneisses are geochemically divided into high-pressure and low-pressure TTGs. High-pressure TTGs are characterized by high ratios of La/Ybcn (26.29–45.73) and fall into the adakitic region in the La/Ybcn-Ybcn diagram. Considering the close contact with Nb-enriched basaltic series, it is proposed that high-pressure TTGs may have formed by partial melting of a subducting oceanic slab with garnet and amphibole and/or rutile as residues. Low-pressure TTGs are characterized by low ratios of La/Ybcn and Sr/Y with marked negative Eu anomalies, indicating partial melting at shallow crustal levels. Regional tectonic relations have defined the Neoarchean Dengfeng island arc-forearc accretionary complex to the east of the Linshan complex. Thus, we propose that the gabbros-basalts-basaltic andesites in the Linshan complex mostly formed in a Neoarchean suprasubduction back-arc basin by rifting of a TTG-dominated island arc terrane. The final closure of the back-arc basin resulted in their tectonic juxtaposition forming thrust-imbricated structures. There may have been several Neoarchean “forearc-island-arc-backarc” systems in the NCC that are similar to modern accretionary tectonic orogens, indicating that plate tectonics has been in operation since at least 2.55–2.50 Ga.

Nutrient Shift in the Yucatan Basin during the late Early Miocene: Evidence from calcareous nannofossils and stable isotopes at ODP Leg 165 Site 998 Hole A

Paleoceanographic reconstructions in the Caribbean Sea during past climate transitions, namely the Late Oligocene to Early Miocene (up to the Miocene Climatic Optimum and Monterey Excursion) are crucial to understanding the effects of the Eastern Pacific interchange with the Atlantic Ocean. Studies of the planktonic domain in the Yucatan Basin during the Early Miocene are limited, with most Caribbean research focused on reconstructing the series of events that precede the final closure of the Isthmus of Panama in the Early Pliocene. Furthermore, paleoceanography of the Yucatan Basin is largely unrefined during this time, even though it is an important transition for ocean gateways, and development of Atlantic deepwater and Atlantic Meridional Overturning Current (AMOC), driving global ocean circulation. Here we conduct a relative percent abundance analysis of calcareous nannofossils and stable isotopes from bulk sediment of drill cores spanning the Upper Oligocene to Lower Miocene in the central Yucatan Basin, collected by the Ocean Drilling Program Leg 165 at Site 998 Hole A. Nannofossil assemblage data record a shift from a eutrophic to oligotrophic system ∼19.2–17.65 Ma. Eutrophic taxa (Reticulofenestra spp. and Cyclicargolithus floridanus) decline at ∼20.23 Ma, while oligotrophic taxa (discoasters and sphenoliths) increase as stable carbon isotope values decline. The palaeoecological turnover coincides with a possible restriction in the Central American Seaway (CAS) ∼20.7–21 Ma. Population dynamics of the Hole 998 A nannofossil assemblage track with global declines in C. floridanus relative abundance between ∼20.2 to ∼20.5 Ma, followed by a subsequent decrease in Reticulofenestra spp. These data suggest water mass stratification in the Yucatan Basin during the Early Miocene ∼19.2–17.65 Ma, likely due to restriction of the CAS.

An embryonic intra-oceanic subduction in the Bangong−Nujiang Meso-Tethys: insights from Late Jurassic Nd[sbnd]Hf isotopic decoupling adakitic granodiorites in the Dongco ophiolite of central Tibet

Subduction of the Bangong−Nujiang Meso-Tethys not only bred world-class Cu − Au polymetallic deposits in central Tibet but also created the initial elevation of the Tibetan Plateau during the Late Cretaceous following its final closure. Consequently, the Meso-Tethys carry critical codes for the evolution of Tethyan realm and the development of the Tibetan Plateau but some fundamental aspects still remain poorly explored. Here we proposed an embryonic intra-oceanic subduction event in the Bangong−Nujiang Meso-Tethys during the Late Jurassic based on investigations of adakitic granodiorites intruded within the Dongco ophiolite suite, central Tibet. These granodiorites were dated at 150–156 Ma by zircon UPb isotopes and geochemically display an affinity with high-silica adakite (Sr/Y = 24–47; La/Yb = 6–16), specifically marked by high SiO2, Al2O3 and Na2O contents but low MgO, CaO + Na2O contents as well as extremely low Yb and Y contents. They have (87Sr/86Sr)i ratios varying from 0.7061 to 0.7069, εNd(t) values of −0.83 to 0.50, and εHf(t) values of 3.3 to 8.9 (with one exception at −5.0), showing a distinct NdHf isotopic decoupling (ΔεHf(t) = 2.1–7.6; ΔεHf(t) = εHf(t)–1.55 × εNd(t)–1.21). Geochemical modeling indicates that they were derived from partial melting of subducted Meso-Tethyan oceanic crust and moderate amounts of sediments. Residual plagioclases in the source region likely resulted in relatively lower Sr and La contents than typical high-silica adakite. Combined with previous studies, we suggest that the Dongco granodiorites formed in the early stage of an intra-oceanic subduction zone in the Bangong−Nujiang Meso-Tethys where subsidence of colder lithosphere inductively commenced along an active transform fault bounded by younger lithosphere during the Late Jurassic. This embryonic intra-oceanic subduction possibly occurred locally and was very short-lived.

Topology Testing and Demographic Modeling Illuminate a Novel Speciation Pathway in the Greater Caribbean Sea Following the Formation of the Isthmus of Panama.

Recent genomic analyses have highlighted the prevalence of speciation with gene flow in many taxa and have underscored the importance of accounting for these reticulate evolutionary processes when constructing species trees and generating parameter estimates. This is especially important for deepening our understanding of speciation in the sea where fast moving ocean currents, expanses of deep water, and periodic episodes of sea level rise and fall act as soft and temporary allopatric barriers that facilitate both divergence and secondary contact. Under these conditions, gene flow is not expected to cease completely while contemporary distributions are expected to differ from historical ones. Here we conduct range-wide sampling for Pederson's cleaner shrimp (Ancylomenes pedersoni), a species complex from the Greater Caribbean that contains three clearly delimited mitochondrial lineages with both allopatric and sympatric distributions. Using mtDNA barcodes and a genomic ddRADseq approach, we combine classic phylogenetic analyses with extensive topology testing and demographic modeling (10 site frequency replicates x 45 evolutionary models x 50 model simulations/replicate = 22,500 simulations) to test species boundaries and reconstruct the evolutionary history of what was expected to be a simple case study. Instead, our results indicate a history of allopatric divergence, secondary contact, introgression, and endemic hybrid speciation that we hypothesize was driven by the final closure of the Isthmus of Panama and the strengthening of the Gulf Stream Current ~3.5 million years ago. The history of this species complex recovered by model-based methods that allow reticulation differs from that recovered by standard phylogenetic analyses and is unexpected given contemporary distributions. The geologically and biologically meaningful insights gained by our model selection analyses illuminate what is likely a novel pathway of species formation not previously documented that resulted from one of the most biogeographically significant events in Earth's history.

Combined 41- gauge surgically induced macular detachment and free internal limiting membrane flap technique for management of refractory full-thickness macular hole.

To report a case of anatomic closure and functional improvement in a patient affected by refractory full-thickness macular hole (FTMH) undergone a combined 41-gauge (g) surgically induced macular detachment and free internal limiting membrane (ILM) flap technique. This is a retrospective case-report of a 70-years-olded woman affected by refractory FTMH who referred to Ophthalmology Unit of Guglielmo da Saliceto Hospital, Piacenza (Italy) in April 2023. The patient underwent a combined 41-g surgically induced macular detachment and free ILM flap. Macular detachment was induced by multiple subretinal injections of balanced salt solution (BSS) by 41-g needle through three retinotomies. Spectral-domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA) were performed preoperatively and postoperatively at 7th day, 1st and 6th month. On 7th postoperative day, FTMH showed complete closure. BCVA improved from preoperative 20/400 to 20/70 at 6th postoperative month. BSS subretinal injection allowed the mobilization and relaxation of retina at the posterior pole. Although the edges of the hole were still detectable, their diameters were inferior to preoperative measurements. Autologous free ILM flap allowed to fill the residual gap into the hole. The final anatomic closure, and the postoperative functional improvement demonstrated the effectiveness of this approach, supporting its indication for refractory FTHM.

Intraoperative MRI without an intraoperative MRI suite: a workflow for glial tumor surgery

BackgroundIntraoperative MRI (iMRI) has emerged as a useful tool in glioma surgery to safely improve the extent of resection. However, iMRI requires a dedicated operating room (OR) with an integrated MRI scanner solely for this purpose. Due to physical or economical restraints, this may not be feasible in all centers. The aim of this study was to investigate the feasibility of using a non-dedicated MRI scanner at the radiology department for iMRI and to describe the workflow with special focus on time expenditure and surgical implications.MethodsIn total, 24 patients undergoing glioma surgery were included. When the resection was deemed completed, the wound was temporarily closed, and the patient, under general anesthesia, was transferred to the radiology department for iMRI, which was performed using a dedicated protocol on 1.5 or 3 T scanners. After performing iMRI the patient was returned to the OR for additional tumor resection or final wound closure. All procedural times, timestamps, and adverse events were recorded.ResultThe median time from the decision to initiate iMRI until reopening of the wound after scanning was 68 (52–104) minutes. Residual tumors were found on iMRI in 13 patients (54%). There were no adverse events during the surgeries, transfers, transportations, or iMRI-examinations. There were no wound-related complications or infections in the postoperative period or at follow-up. There were no readmissions within 30 or 90 days due to any complication.ConclusionPerforming intraoperative MRI using an MRI located outside the OR department was feasible and safe with no adverse events. It did not require more time than previously reported data for dedicated iMRI scanners. This could be a viable alternative in centers without access to a dedicated iMRI suite.

Constraints on the subduction and closure of the Hegenshan Ocean: Magmatic and sedimentary records from central Inner Mongolia, China

Petrological, geochronological, and geochemical data from the volcano-sedimentary sequences, granitoids, and ophiolite relics of central Inner Mongolia, China, were used to reconstruct the subduction and final closure of the Hegenshan Ocean. Geochronological dating and compilation reveal four phases (ca. 360−355 Ma, 348−320 Ma, 320−310 Ma, and 310−275 Ma) of magmatism in the Uliastai continental margin. The ca. 356 Ma I-type Halatumiao granodiorite and Amanwusu ophiolite relics are subduction-related, and the Halatumiao granodiorite provides solid evidence of the northward subduction of the Hegenshan Ocean beneath the Uliastai continental margin at ca. 360−355 Ma. The ca. 348−320 Ma and 320−310 Ma volcanic rocks and granitoids constitute two linear magmatic belts roughly parallel to the Erenhot-Hegenshan ophiolite belt, which record two phases of continental arc magmatism in the Uliastai continental margin. Overall, the ca. 360−310 Ma arc magmatism shows landward migration and then oceanward migration in the Uliastai continental margin, which indicates advancing subduction and subsequent slab steepening of the Hegenshan Ocean. By contrast, the ca. 310−275 Ma magmatic rocks are dominated by I- and A-type felsic volcanic rocks, granites, and dikes, which are post-accretionary, extension-related, and pervasive in the Uliastai continental margin and Erenhot-Hegenshan ophiolite belt. A provenance shift was identified between the Benbatu and Amushan formations of the Amanwusu area of the Erenhot-Hegenshan ophiolite belt. The early detritus was derived from the early Paleozoic rocks in the Sonid Zuoqi arc belt, whereas the late detritus originated from the Early Carboniferous ophiolite relics in the Erenhot-Hegenshan ophiolite belt. The provenance shift and emplacement of pervasive extension-related magmatic rocks imply a Late Carboniferous closure of the Hegenshan Ocean. The Late Carboniferous oceanic closure event in the north of the southeast Central Asian Orogenic Belt is also evidenced by the transition of Hf isotopic composition of zircons dated between ca. 360−310 Ma and 310−275 Ma.

Cutaneous Wound Healing and the Effects of Cannabidiol.

Cutaneous wounds, both acute and chronic, begin with loss of the integrity, and thus barrier function, of the skin. Surgery and trauma produce acute wounds. There are 22 million surgical procedures per year in the United States alone, based on data from the American College of Surgeons, resulting in a prevalence of 6.67%. Acute traumatic wounds requiring repair total 8 million per year, 2.42% or 24.2 per 1000. The cost of wound care is increasing; it approached USD 100 billion for just Medicare in 2018. This burden for wound care will continue to rise with population aging, the increase in metabolic syndrome, and more elective surgeries. To heal a wound, an orchestrated, evolutionarily conserved, and complex series of events involving cellular and molecular agents at the local and systemic levels are necessary. The principal factors of this important function include elements from the neurological, cardiovascular, immune, nutritional, and endocrine systems. The objectives of this review are to provide clinicians engaged in wound care and basic science researchers interested in wound healing with an updated synopsis from recent publications. We also present data from our primary investigations, testing the hypothesis that cannabidiol can alter cutaneous wound healing and documenting their effects in wild type (C57/BL6) and db/db mice (Type 2 Diabetes Mellitus, T2DM). The focus is on the potential roles of the endocannabinoid system, cannabidiol, and the important immune-regulatory wound cytokine IL-33, a member of the IL-1 family, and connective tissue growth factor, CTGF, due to their roles in both normal and abnormal wound healing. We found an initial delay in the rate of wound closure in B6 mice with CBD, but this difference disappeared with time. CBD decreased IL-33 + cells in B6 by 70% while nearly increasing CTGF + cells in db/db mice by two folds from 18.6% to 38.8% (p < 0.05) using a dorsal wound model. We review the current literature on normal and abnormal wound healing, and document effects of CBD in B6 and db/db dorsal cutaneous wounds. CBD may have some beneficial effects in diabetic wounds. We applied 6-mm circular punch to create standard size full-thickness dorsal wounds in B6 and db/db mice. The experimental group received CBD while the control group got only vehicle. The outcome measures were rate of wound closure, wound cells expressing IL-33 and CTGF, and ILC profiles. In B6, the initial rate of wound closure was slower but there was no delay in the time to final closure, and cells expressing IL-33 was significantly reduced. CTGF + cells were higher in db/bd wounds treated with CBD. These data support the potential use of CBD to improve diabetic cutaneous wound healing.

Damage Control Resuscitation and Damage Control Surgery

Trauma triggers complex physiological responses with primary and secondary effects vital to understanding and managing trauma impact. "Damage Control" (DC), a concept adapted from naval practices, refers to abbreviated initial surgical care focused on controlling bleeding and contamination, critical for the survival of severely compromised patients. This impacts anaesthesia procedures and intensive care. "Damage Control Resuscitation" (DCR) is an interdisciplinary approach aimed at reducing mortality in severely injured patients, despite potentially increasing morbidity and ICU duration. Current medical guidelines incorporate DC strategies.DC is most beneficial for patients with severe physiological injury, where surgical trauma ("second hit") poses greater risks than delayed treatment. Patient assessment for DC includes evaluating injury severity, physiological reserves, and anticipated surgical and treatment strain. Inadequate intervention can worsen trauma-induced complications like coagulopathy, acidosis, hypothermia, and hypocalcaemia.DCR focuses on rapidly restoring homeostasis with minimal additional burden. It includes rapid haemostasis, controlled permissive hypotension, early blood transfusion, haemostasis optimization, and temperature normalization, tailored to individual patient needs."Damage Control Surgery" (DCS) involves phases like rapid haemostasis, contamination control, temporary wound closure, intensive stabilization, planned reoperations, and final wound closure. Each phase is crucial for managing severely injured patients, balancing immediate life-saving procedures and preparing for subsequent surgeries.Intensive care post-DCS emphasizes stabilizing patients hemodynamically, metabolically, and coagulopathically while restoring normothermia. Decision-making in trauma care is complex, involving precise patient assessment, treatment prioritization, and team coordination. The potential of AI-based decision support systems is noted for their ability to analyse patient data in real-time, aiding in decision-making through evidence-based recommendations.

New P-T path of Huwan high-pressure unit from Hong'an orogen, Central China Orogenic Belt: Implications for oceanic to continental subduction and exhumation in the subduction zones

Oceanic to continental subduction is a pivotal process in plate tectonics, yet characterizing this tectonic transition and subsequent exhumation remains a challenging task. This study integrates our novel pressure-temperature (P-T) estimates on a metabasite lens and its hosting metasedimentary rock in the Xiongdian area of the Huwan high-pressure unit of the Hong'an orogen, Central China Orogenic Belt, with existing geochronological data from the same and neighboring outcrops. Our preliminary but comprehensive findings reveal the evolution of this subduction transition process. After the opening at ca. 430–400 Ma the Paleotethyan ocean subducted northward and formed a warm oceanic subduction zone at ca. 400–385 Ma, marked by relatively low P and high T conditions (∼610–740 °C and ∼1.5–1.8 GPa; M1 stage). Subsequently, the Paleotethyan oceanic plate continued its subduction and cooled the overlying mantle until its final closure during ca. 385–300 Ma. This phase led to the subduction of South China Block (SCB) and the formation of a cold continental subduction zone at ca. 300–270 Ma, featured by relatively high P and low T conditions (∼570–610 °C and ∼2.1–2.7 GPa; M2 stage). Following the delamination from the subducted SCB continental lithospheric mantle, the detached high-pressure rocks experienced a two-stage accelerated exhumation process, i.e., early slow exhumation (∼0.7 ± 0.4 mm/a) to shallower mantle depth (∼610–730 °C and ∼1.5–2.1 GPa; M3 stage) at ca. 270–243 Ma and later rapid exhumation (>2.5 ± 0.9 mm/a) to approximately the Moho depth (∼550–600 °C and ∼0.8–1.3 GPa; M4 stage) at ca. 243–233? Ma. To facilitate the buoyancy-driven exhumation of eclogite blocks from their maximum depth (M2 stage), a minimum of ∼16–25 vol% of low-density metasedimentary rock is required. The increasing buoyancy caused by decreasing densities of the high-pressure rocks with exhumation (from M2 to M4 stage), slab break-off induced rebound forces, and other tectonic factors may jointly explain the accelerated exhumation pattern. Our density results also emphasize that, partly owing to a stronger contribution from a buoyancy-driven mechanism, the high-pressure rocks would be preferentially exhumed in warm to extremely warm oceanic subduction zones compared to their intermediate to cold counterparts.

Initial sedimentation after the closure of the Sumdo Paleo-Tethys Ocean: Implications for early Mesozoic tectonics in the East Tethys domain

The closure of the Paleo-Tethys Ocean and subsequent collisional orogenesis in the early Mesozoic played an important role in the formation of the Qinghai–Tibetan Plateau. However, the final closure of the southernmost Paleo-Tethys branching ocean basin in the Qinghai–Tibetan Plateau—known as Sumdo Paleo-Tethys Ocean—and collision between Central and Southern Lhasa terranes remain controversial. In particular, the tectonic significance of early Mesozoic volcanism and sedimentation in the Lhasa terrane is unknown, but crucial for understanding the final stages of ocean closure. Here, we investigate the depositional ages and provenance of detrital zircon in clastic sedimentary rocks, as well as the petrogenesis of the interbedded andesite from the volcano-sedimentary sequence of the Late Triassic to Early Jurassic Xionglai Formation in the Tangjia-Sumdo area. Detrital zircon dates from the Xionglai Formation define five age peaks at 180–200 Ma, 230–340 Ma, 500–620 Ma, 1000–1240 Ma, and 1600–1800 Ma. Detrital zircon trace elements and Hf isotopic characteristics are interpreted to represent derivation from an accretionary wedge and later magmatism related to oceanic slab break-off as well as a minor component from coeval magmatic rocks in the Nyainrong-Nang area in northern Lhasa terrane. Interbedded andesite has a magnesian andesite signature and yields ages of 192–184 Ma with zircon εHf(t) values that range from −3 to +1. We interpret these data as the andesite being sourced from sediment-derived melts that interacted with the overlying mantle wedge in a post-collision extensional setting. Our study suggests that the closure of the Sumdo Paleo-Tethys Ocean and subsequent collision between Central Lhasa and Southern Lhasa terrane may have happened in Late Triassic-Early Jurassic. The final closure of the multi-Paleo-Tethys Ocean and subsequent collision in the Qinghai–Tibetan Plateau may have induced initial subduction of the Meso-/Neo-Tethys Ocean, representing the tectonic transition from collision/post-collision to subduction/accretion in the Qinghai–Tibetan Plateau during the Late Triassic to Early Jurassic.