Interruption Of Flow Research Articles

Myocardial protection in cardiac surgery-hindsight from the 2020s.

Myocardial protection and specifically cardioplegia have been extensively investigated in the beginnings of cardiac surgery. After cardiopulmonary bypass had become routine, more and more cardiac operations were possible, requiring reliable and reproducible protection for times of blood flow interruptions to the most energy-demanding organ of the body. The concepts of hypothermia and cardioplegia evolved as tools to extend cardiac ischaemia tolerance to a degree considered safe for the required operation. A plethora of different solutions and delivery techniques were developed achieving remarkable outcomes with cross-clamp times of up to 120 min and more. With the beginning of the new millennium, interest in myocardial protection research declined and, as a consequence, conventional cardiac surgery is currently performed using myocardial protection strategies that have not changed in decades. However, the context, in which cardiac surgery is currently performed, has changed during this time. Patients are now older and suffer from more comorbidities and, thus, other organs move more and more into the centre of risk assessment. Yet, systemic effects of cardioplegic solutions have never been in the focus of attention. They say hindsight is always 20-20. We therefore review the biochemical principles of ischaemia, reperfusion and cardioplegic extension of ischaemia tolerance and address the concepts of myocardial protection with 'hindsight from the 2020s'. In light of rising patient risk profiles, minimizing surgical trauma and improving perioperative morbidity management becomes key today. For cardioplegia, this means accounting not only for cardiac, but also for systemic effects of cardioplegic solutions.

Insulin infusion sets associated with adverse events: strategies for improved diabetes education

IntroductionInsulin Infusion Sets (IIS) play a crucial role in ensuring the safe delivery of insulin through a Continuous Subcutaneous Insulin Infusion (CSII) for individuals with Type 1 Diabetes (T1D). Recent advancements in therapy have highlighted the need to address issues such as unexplained hyperglycemia and IIS occlusion.ObjectiveTo investigate the adverse events (AEs) associated with IIS that impact the treatment of T1D, with a specific focus on promoting effective educational practices.MethodsOne hundred and eighteen patients under treatment at the Diabetes Center Insulin Pump Ambulatory, Federal University of São Paulo responded to a semi-structured questionnaire. Over 6 months, a nurse researcher interviewed them via video calls.ResultsCatheter-related adverse events (AEs) included catheter knots, folding, and accidental traction. AEs associated with cannula use were mainly related to cannula fixation adhesive, insulin leakage, bleeding episodes, and skin problems. The cannula patch tends to detach easily in hot conditions or when used for more than 3 days, leading to local itching. Adhesive glue can cause redness and pain. Insulin leakage typically occurs after the catheter disconnects from the cannula, accidental cannula traction, or beneath the cannula patch. Bleeding has been reported inside the cannula or at the insertion site, resulting in local pain and, in some cases, obstruction of insulin flow. When accidental cannula traction occurs, it is recommended to replace the entire IIS system. In situations involving bleeding, leakage, insulin odor, or unsuccessful attempts to correct hyperglycemic episodes with a “bolus” of insulin, it is advisable to change the IIS system and evaluate appropriate techniques for handling and infusing the device. Moreover, regular inspections of the device and reservoir/cartridge are essential.ConclusionSerious AEs can occur even in cases where the occlusion alarm is not activated, leading to interruptions in insulin flow. Conversely, in less severe situations, alarm activation can occur even in the absence of insulin flow interruption. Accidental catheter traction and catheter bending are commonly encountered in everyday situations, while issues related to the cannula directly affect blood glucose levels. AEs related to the IIS cannula often involve insulin leakage into the skin, bleeding, and skin events attributed to adhesive issues with the cannula.

AGE CHARACTERISTICS OF CHANGES IN THE LYMPHOID POPULATION STRUCTURE OF THE RATS’ THYMUS AFTER ACUTE DISTURBANCE OF CEREBRAL BLOOD FLOW IN THE BASIN OF CAROTID ARTERIES

Abstract. Today, the most common causes of disability and mortality on the planet include acute disorders of cerebral blood circulation, the spectrum of which is dominated by ischemic lesions. Advances in neuroimmunology and neuroimmunopathology have made it possible to attribute cerebral blood circulation disorders to immune- dependent diseases of the nervous system, therefore, the emphasis in the search of new approaches to the eff ectiveness increase of stroke therapy has shifted from the correction of local changes in the brain itself to the reaction of the immune system organs, as a possible target of pharmacological eff ects, that will make it possible to reduce the secondary death of neurons as a result of infl ammation.The purpose of the work. to investigate the age-specifi c changes in the structure of the lymphoid population of the thymus after acute disruption of cerebral blood fl ow in the basin of the carotid arteries in six- and ninemonth-old rats.Material and methods. Acute cerebrovascular accident was simulated in 6- and 9-month-old white nonlinear laboratory rats by bilateral carotid artery clamping for 20 min. followed by reperfusion. The thymus was taken on the 12th day of the postischemic period, it was fi xed in Buen’s solution, after standard histological processing, serial sections with a thickness of 5 μm were made, stained with hematoxylin- eosin. In the subcapsular, deep cortical zones, intralobular perivascular spaces and the medullary zone of the thymus, the structure of the lymphoid population (density of diff erent classes of thymocytes per 1 mm2) was studied in the digital image analysis system VIDAS-386 (Kontron Electronik, Germany) with a fl uorescent microscope AXIOSKOP (Zeiss, Germany) in automatic mode.The results. In the structure of the lymphoid population of all structural and functional zones of the thymus, small lymphocytes predominate. Age-related diff erences in the structure of the lymphoid population of the thymus of the control groups consist of lower indicators of the density of medium and small thymocytes in all investigated zones of the gland of animals of the older age group, with the exception of the subcapsular, in which the density of small thymocytes is higher in nine-month-old rats. On the 12th day after simulation of ischemia- reperfusion of the brain injury the number of destructive thymocytes and thymocytes with the signs of apoptosis increases in the subcapsular and deep cortical zones of the thymus of six-month-old rats, but in nine-month-old rats in all zones of the gland, except the brain, the density of destructive and apoptotic cells decreases.Conclusions. Ischemic- reperfusion injury of the brain modifi es the structure of the lymphoid population of the thymus of rats, and the nature of these modifi cations is determined by age and structural and functional zones of the gland.

Identifying Impacts of School-Escorted Trips on Traffic Congestion and the Countermeasures in Bangkok: An Agent-Based Simulation Approach

The often-discussed issue of parental escorting of children to school and its potential disruption of traffic flow has been extensively examined in the literature. Still, the specific effects of traffic congestion remain understudied. To fill this gap, this study addresses the impacts of school trips on traffic congestion. An agent-based model is applied to simulate various scenarios and assess their impact. Our findings indicate that the traffic speed without school trips is higher speed during peak hours by around 8% and average travel time in the city is reduced significantly. We examine countermeasures: Firstly, flexible working hours can lead to a morning traffic speed improvement of approximately 1.9%. Secondly, staggered school schedules can result in a 6.9% increase in traffic speed at 7 a.m. Optimizing school loading spaces can also enhance road capacity, mitigating road lane blockages during drop-off and pick-up periods. This research sheds light on the impact of parent-escorting travel existence and offers potential solutions to alleviate traffic congestion.

Integration of Planova filters in manufacturing processes of biologicals improve the virus safety effectively: A review of publicly available data.

The capacity to remove viruses by Planova filters produced by Asahi Kasei, primarily by small virus-retentive filters, were compiled from data in peer-reviewed publications and, partly, publicly available data from presentations at conferences (Planova workshops). Data from more than 100 publications and presentations at conferences covering Planova filters were assessed. The data were grouped according to the different virus filters regarding mean pore sizes and viruses of different sizes for plasma and cell culture derived products. Planova 15N and 20N filters removed parvoviruses below the limit of detection of viruses in the filtrate in approx. 50% of all studies and mean LRFs (log reduction factors) for viruses detected in the filtrate were above 4, demonstrating effective parvovirus reduction. Parvovirus removal capacity increased for Planova BioEX filters as well as for 2 Planova 20N in series. Large viruses as retroviruses (e.g., HIV and MuLV), herpesviruses, flaviviruses and togaviruses were removed effectively by Planova 15N, 20N and BioEX filters and also by Planova 35N filters. Flow interruption, transmembrane pressure, volume and protein concentration per filter area had had no substantial impact on virus removal capacity at manufacturing specification. In conclusion, the incorporation of Planova filters in manufacturing processes of biologicals remove, depending on the filter pore size, small and large viruses from the feed stream reliably. This virus reduction step with an orthogonal mechanism integrated in the manufacturing processes of biologicals, based primarily on size exclusion of viruses, improves the virus safety of these biopharmaceutical products considerably.

Obesity-induced Ly6CHigh and Ly6CLow monocyte subset changes abolish post-ischemic limb conditioning benefits in stroke recovery

Remote limb conditioning (RLC), performed by intermittent interruption of blood flow to a limb, triggers endogenous tolerance mechanisms and improves stroke outcomes. The underlying mechanism for the protective effect involves a shift of circulating monocytes to a Ly6CHigh proinflammatory subset in normal metabolic conditions. The current study investigates the effect of RLC on stroke outcomes in subjects with obesity, a vascular comorbidity. Compared to lean mice, obese stroke mice displayed significantly higher circulating monocytes (monocytosis), increased CD45High monocytes/macrophages infiltration to the injured brain, worse acute outcomes, and delayed recovery. Unlike lean mice, obese mice with RLC at 2 hours post-stroke failed to shift circulating monocytes to pro-inflammatory status and nullified RLC-induced functional benefit. The absence of the monocyte shift was also observed in splenocytes incubated with RLC serum from obese mice, while the shift was observed in the cultures with RLC serum from lean mice. These results showed that the alteration of monocytosis and subsets underlies negating RLC benefits in obese mice and suggest careful considerations of comorbidities at the time of RLC application for stroke therapy.

Efficiency of the Crile Procedure in the Removal of Thyroid Malignancies Invaded into the Internal Jugular Vein

Aim: This work aims to determine the effectiveness of the Crile procedure for optimizing the diagnosis and treatment of patients with locally advanced thyroid malignancies.
 Objects: The objects of the study were the results of treatment of patients with thyroid cancer using two techniques: Crile procedure and vein resection with sealing and preservation of blood flow.
 Materials and Methods: The research was carried out experimentally using Crile surgical intervention and vein resection with sealing and preservation of blood flow. The effectiveness of the treatment was assessed by observing the recurrence and mortality rates. The patient’s quality of life was assessed through the conversation and questionnaire survey.
 Results and Findings: It was found that Doppler ultrasonography of the main vessels in the neck helps to establish the internal jugular vein invasion, as well as its tumour thrombosis at the preoperative stage in clinical cases of suspected extrathyroidal extension of thyroid tumours in addition to radiological methods. A thyroid gland with a tumour invaded into the internal jugular vein must be radically removed with simultaneous resection of the affected part of the vein. We proved that the Crile procedure — resection of a vein with sealing of stumps and interruption of blood flow on one side of the neck — is a safe technique. It reduces the trauma and duration of the operation and reduces the likelihood of recurrence as it does not require further plastic surgery or vascular shunting with the restoration of blood flow. At the same time, bilateral interruption of blood flow in cases of resection of both internal jugular veins can lead to serious complications and requires a blood flow restoration operation from the side of the smaller tumour invasion.

The Heart-Brain Relationship :Cardio-Cerebral Axis

Cardiovascular and cerebral systems are integral components of the human body, each performing vital functions to ensure optimal physiological functioning. Recent advancements in medical research have shed light on the intricate interplay between the heart and the brain, revealing a complex web of interactions that go beyond traditional perspectives. Cardio-cerebral interactions refer to the dynamic and complex relationship between the cardiovascular and central nervous systems. The intricate interplay between the heart and the brain plays a pivotal role in maintaining homeostasis and ensuring optimal functioning of the entire organism. The autonomic nervous system, comprising the sympathetic and parasympathetic branches, plays a pivotal role in coordinating cardiovascular and cerebral activities. Sympathetic activation stimulates the release of norepinephrine, increasing heart rate and cardiac output. This response is closely linked to changes in cerebral blood flow, influencing cognitive functions such as attention and memory.The sympathetic and parasympathetic branches of the ANS play a crucial role in regulating heart rate, blood pressure, and cardiac output. Additionally, Neurotransmitters and hormones released by the cardiovascular and nervous systems further contribute to the intricate interplay.The interruption of blood flow to the brain not only results in acute neuronal injury but also triggers secondary mechanisms that may impact the heart, creating a cycle of cardio-cerebral dysfunction. Conversely, neurological disorders can influence cardiac function. Conditions such as autonomic dysregulation, epilepsy, and certain neurodegenerative diseases can impact the autonomic control of the heart, leading to arrhythmias, sudden cardiac death, and other cardiovascular complications.This essay aims to explore the multifaceted relationship between the cardiovascular and cerebral systems, emphasizing the bidirectional communication, shared regulatory mechanisms, and implications for overall health. The discussion delves into neuro-cardiology and brain science, offering insights into the underlying physiological processes and potential clinical applications. As research progresses, further insights into these mechanisms will undoubtedly pave the way for innovative therapeutic strategies that address both cardiovascular and neurological aspects of human health.Adopting a heart-healthy lifestyle, encompassing regular exercise, a balanced diet, and stress management, emerges as a key preventive strategy. These interventions not only promote cardiovascular health but also positively influence neuroplasticity and cognitive function.

Application of Machine Learning Models to Biomedical and Information System Signals From Critically Ill Adults

Machine learning (ML)-derived notifications for impending episodes of hemodynamic instability and respiratory failure events are interesting because they can alert physicians in time to intervene before these complications occur. Do ML alerts, telemedicine system (TS)-generated alerts, or biomedical monitors (BMs) have superior performance for predicting episodes of intubation or administration of vasopressors? An ML algorithm was trained to predict intubation and vasopressor initiation events among critically ill adults. Its performance was compared with BM alarms and TS alerts. ML notifications were substantially more accurate and precise, with 50-fold lower alarm burden than TS alerts for predicting vasopressor initiation and intubation events. ML notifications of internal validation cohorts demonstrated similar performance for independent academic medical center external validation and COVID-19 cohorts. Characteristics were also measured for a control group of recent patients that validated event detection methods and compared TS alert and BM alarm performance. The TS test characteristics were substantially better, with 10-fold less alarm burden than BM alarms. The accuracy of ML alerts (0.87-0.94) was in the range of other clinically actionable tests; the accuracy of TS (0.28-0.53) and BM (0.019-0.028) alerts were not. Overall test performance (F scores) for ML notifications were more than fivefold higher than for TS alerts, which were higher than those of BM alarms. ML-derived notifications for clinically actioned hemodynamic instability and respiratory failure events represent an advance because the magnitude of the differences of accuracy, precision, misclassification rate, and pre-event lead time is large enough to allow more proactive care and has markedly lower frequency and interruption of bedside physician work flows.

Abstract 163: Total Spinal Cord Infarction, An Underrecognized Postoperative Complication

Introduction Spinal cord infarctions (SCI) are scarce entities, constituting only 0.3‐1% of all strokes, with complete or posterior spinal cord involvement detailed in the case below being even rarer. Often caused by sudden interruption of blood flow to the spinal cord due to embolic phenomena, intrinsic factors such as connective tissue disease, and due to intra/post‐operative hypotension leading to ischemia or infarction. The resultant acute spinal cord dysfunction manifests as; motor weakness, loss of senses of pain and temperature, altered proprioception, bowel and bladder dysfunction Spinal blood supply comprises of the anterior spinal artery (ASA) and the two posterior spinal arteries, with supply to the spinal arteries being derived from various regional arteries: C1‐T3 is supplied by the vertebral arteries, T3‐T7 is served by a branch from the intercostal arteries, and the Adamkiewicz artery supplies T8 to the medullary conus. The thoracolumbar level is primarily supplied by only a small number of radicular arteries, originating from segmental branches of the aorta, specifically the posterior intercostal and lumbar branches, which extend towards the intervertebral foramina where they split into the anterior and posterior radicular arteries. The largest radicular artery, commonly referred to as the arteria radicularis magna of Adamkiewicz (or main anterior radicular artery), typically arises on the left between T9 and T12, but may be located on the right or emerge anywhere from T5 to L4 in approximately 17% of cases. This extensive segment of the spinal cord only is typically supplied by only two or three small radicular branches, occuring between the lower cervical and mid‐to‐lower thoracic levels, making it a watershed zone. Methods Case report and literature review Results 73‐year‐old woman with history of hypertension, long‐term smoking, extensive peripheral vascular disease, R lung cancer (in remission after 3 rounds of radiation, and newly diagnosed calcified heterogeneous left renal mass concerning for malignancy status‐post right femoral access with embolization of left lumbar arteries at the level of L1‐L3 with 800 micrometer particles and tungsten‐platinum coils on 12/19/22), transferred from a surgical center on 12/21/22 for post‐operative paraparesis (R›L), paresthesia , urinary retention, and constipation initially thought to be post‐anesthetic effects. MRI T and L spine with and without contrast demonstrated diffusion restriction from the level of T10 to the conus suggestive of anterior and posterior spinal cord infarct, thought to be in the setting of recent embolization with extensive atherosclerotic burden. Neurological exam significant for lower extremity paraparesis ( R 2/5 , L 3/5) with T10 sensory level to pin‐prick and temperature, hyporeflexia, and absent proprioception in bilateral lower extremities. Full dose aspirin and high intensity statin was started with patient managed conservatively due to presentation outside window for thrombolysis. Conclusion Spinal cord infarcts typically present with motor weakness due to ASA occlusion however, sensory level and proprioceptive loss as accompanying factors are important considerations to rule in total cord (anterior + posterior) infarcts, especially in post‐op patients undergoing thoraco‐lumbar access/embolization as earlier recognition may make them eligible for treatments such as thrombolysis.

Bilateral Free Deep Inferior Epigastric Artery Perforator Flaps for Reconstruction following Mastectomy in Poland Syndrome Patients.

Poland syndrome is classically described as symbrachydactyly, with hypoplasia of the pectoralis major and other upper thoracic musculoskeletal structures. It is thought to be caused by intrauterine interruption in subclavian arterial flow and often includes breast hypoplasia. Affected vasculature can pose a challenge for reconstruction with free flaps because inflow may not be reliable in this patient population. We present the rare case of a 28-year-old woman with left-sided Poland syndrome, significant family history of breast cancer, and BRCA1+ mutation who underwent bilateral prophylactic nipple-sparing mastectomies with successful immediate bilateral deep inferior epigastric artery perforator free flap reconstruction. The surgical literature in this clinical scenario is also reviewed. Preoperative computed tomography angiography of the chest successfully demonstrated the patency and quantified the caliber of the internal mammary vessels to support free flap breast reconstruction. Free tissue transfer is a viable option for breast reconstruction in patients with Poland syndrome undergoing mastectomy guided by preoperative computed tomography angiography to characterize the internal mammary vasculature.

Ecological flow research and optimal selection of the most ecologically relevant hydrologic indicators at the Jingjiang River's three outlets

Abstract Scientific ecological hydrological indicators provide constraints that contribute to the healthy operation and restoration of river ecosystems. Daily flow data from three Jing River outlets (SongZiKou (SZK), TaiPingKou (TPK), and OuChiKou (OCK)) spanning 1955–2019 were used. We employed innovative methods, such as IHA–RVA and annual distribution, to establish ecological flow thresholds. Surplus and deficit indicators were used to analyze annual and seasonal runoff dynamics. The PCA/RVA method identified relevant hydrological indicators and assessed hydrological changes influenced by the Three Gorges Reservoir (TGR). Key findings include suitable ecological flow thresholds for the flood season (SZK/TPK/OCK – 218.6/94.5, 51.7/96.0, and 60.9–4,494.5 m3/s, respectively). The TGR impacted the flow duration curve, causing deficits during the flood season (up to 0.99, OCK) and surpluses in non-flood seasons (up to 5.04, OCK). The study assessed the Jing River watershed's response to hydrological changes, notably due to the reservoir's water storage and flow interruption during the dry season, revealing declining low pulse count (SDG) and duration (MTS) and increasing high pulse duration (GJP). This research employs innovative methods and hydrological indicators, enhancing understanding of Jing River watershed ecological hydrology, and offering essential data for water resource management and ecosystem health.

Rodent Model of Intestinal Ischemia-Reperfusion Injury via Occlusion of the Superior Mesenteric Artery.

Intestinal ischemia-reperfusion injury (IRI) is associated with a myriad of conditions in both veterinary and human medicine. Intestinal IRI conditions, such as gastric dilatation volvulus (GDV), mesenteric torsion, and colic, are observed in animals such as dogs and horses. An initial interruption of blood flow causes tissues to become ischemic. Although necessary to salvage viable tissue, subsequent reperfusion can induce further injury. The main mechanism responsible for IRI is free radical formation upon reperfusion and reintroduction of oxygen into damaged tissue, but there are many other components involved. The resulting local and systemic effects often impart a poor prognosis. Intestinal IRI has been the subject of extensive research over the past 50 years. An in vivo rodent model in which the base of the superior mesenteric artery (SMA) is temporarily ligated is currently the most common method used to study intestinal IRI. Here, we describe a model of intestinal IRI utilizing isoflurane anesthesia in 21% O2 medical air that yields reproducible injury, as demonstrated by consistent histopathology of the small intestines. Tissue injury was also assessed in the colon, liver, and kidneys.

Efeito da fisioterapia aquática na marcha e no equilíbrio em pacientes com acidente vascular cerebral: uma revisão de literatura

Stroke is one of the leading causes of death and physical disabilities in Brazil and worldwide. Being caused by an interruption of vascular cerebral flow, it is able to lead the individual to death or generate functional disabilities. Aquatic physiotherapy has shown great results for the rehabilitation of these patients, which is provided by the physical properties of water, which are able to provide pain relief and muscle relaxation, thus facilitating ambulation. Thus, this study aimed to review published articles in order to report the effects of hydrotherapy as a physical therapy resource in gait and the balance of stroke patients. For this, a review of articles was performed in the electronic databases PubMed and PEDro and eight articles were chosen, after considering the inclusion and exclusion criteria. The results showed that this physical therapy resource provides benefits in functional aspects, gait quality, speed, static and dynamic balance. Also, the bibliographic research allowed to observe that the technique has effects when used to replace or add to conventional methods of soil therapy. In view of the good results obtained, it appears that the technique can be used to treat a patient with stroke.

Targeting Neurogenesis in Seeking Novel Treatments for Ischemic Stroke.

The interruption of cerebral blood flow leads to ischemic cell death and results in ischemic stroke. Although ischemic stroke is one of the most important causes of long-term disability and mortality, limited treatments are available for functional recovery. Therefore, extensive research has been conducted to identify novel treatments. Neurogenesis is regarded as a fundamental mechanism of neural plasticity. Therefore, therapeutic strategies targeting neurogenesis are thought to be promising. Basic research has found that therapeutic intervention including cell therapy, rehabilitation, and pharmacotherapy increased neurogenesis and was accompanied by functional recovery after ischemic stroke. In this review, we consolidated the current knowledge of the relationship between neurogenesis and treatment for ischemic stroke. It revealed that many treatments for ischemic stroke, including clinical and preclinical ones, have enhanced brain repair and functional recovery post-stroke along with neurogenesis. However, the intricate mechanisms of neurogenesis and its impact on stroke recovery remain areas of extensive research, with numerous factors and pathways involved. Understanding neurogenesis will lead to more effective stroke treatments, benefiting not only stroke patients but also those with other neurological disorders. Further research is essential to bridge the gap between preclinical discoveries and clinical implementation.

Structural and functional state of bone in patients with arteriovenous malformations of the lower extremities

Background. Disruption of regional blood flow in patients with arteriovenous malformations (AVMs) of the lower extremities changes the conditions of bone tissue functioning. The purpose was to study the structural and functional state of bone tissue and its metabolism in patients with AVMs of the lower extremities using dual-energy X-ray absorptiometry and the markers of bone turnover. Materials and methods. Fifteen patients with AVMs had been examined. The clinical class of chronic venous disease (CVD) was evaluated according to CEAP; patients were divided into 2 subgroups: the first one was with CVD C1-C3 and the second one was with CVD C4-C6. Bone mineral density (BMD) was studied based on the X-ray absorptiometry. The level of bone metabolism markers, such as procollagen type 1 N-terminal propeptide (P1NP), C-terminal cross-linking telopeptide of type 1 collagen (β-CTx) and osteocalcin, 25-hydroxyvitamin D (25(ОН)D) and parathyroid hormone were studied. Results. Disturbances of the bone tissue indices of the affected limb were found in 70 % of the patients. Also, the statistically significant difference in BMD of the affected limb compared to the healthy limb was established (р = 0.005). A multidirectional level of P1NP was detected; β-CTx exceeded norm in 80 % of the patients; osteocalcin exceeded norm in 33 % of the cases. In 67 % of the patients, a decrease in serum level of 25(OH)D was noted. Increase of the β-CTx level in the first subgroup and its decrease in the second one was associated with stabilization of the AVMs course and age-related changes in the hormonal background of the patients. Conclusions. Disturbances in the structural state of bone tissue of the affected limb were found in 70 % of the patients; statistically significant difference between the BMD of the affected and healthy limb obviously caused by the influence of regional hemodynamic disturbances. Various deviations of the metabolism markers were found, which indicates the need to develop a system of drug therapy.

Presence of underlying cirrhosis is associated with increased in-hospital mortality and length of stay following pancreatoduodenectomy

BackgroundPatient- and hospital-level factors associated with outcomes following pancreatoduodenectomy (PD) are well established. However, despite theoretical disruption in hepatopetal flow, the impact of cirrhosis on in-hospital mortality following PD is not well-studied. The objective of this study was to evaluate in-hospital mortality, length of stay (LOS), and post-discharge disposition in patients with cirrhosis undergoing PD. MethodsA retrospective analysis of the National Inpatient Sample (January 2002–August 2015) was conducted identifying patients undergoing PD. Using previously validated ICD-9-CM codes, patients were stratified into presence and absence of cirrhosis. Factors associated with in-hospital mortality following PD were analyzed adjusting for patient- and hospital-level factors. Following PD were analyzed after adjusting for patient- and hospital-level factors. ResultsIn 16,344 patients that underwent PD, 203 (1.2 %) patients had underlying cirrhosis prior to resection. Overall in-hospital mortality following PD was significantly worse in the cirrhosis cohort (11.3 % vs. 3.6 %, p < 0.001). Patients with underlying cirrhosis were less likely to be discharged home (73.9 % vs. 83.2 %, p < 0.001) and had a longer median LOS (12.0 vs. 10.0 days, p = 0.001). ConclusionThe presence of underlying cirrhosis is associated with increased in-hospital mortality, longer LOS, and decreased likelihood of home discharge following PD. Given the prohibitive risks, PD should not be performed in patients with underlying cirrhosis.

Flow Piracy and Percolation in a Hydropower Watershed: Interceptions of Indigenous Languages in Upland Laos

This article draws on findings of long-term field research in upland central Laos, examining the rapidly changing dynamics of language among multilingual Indigenous communities in the upper reaches of Laos’s massive Nam Theun 2 Hydropower Project. The case study of sudden language shift in the context of new transport infrastructure finds disruption of distributional flow at multiple levels, from natural forces to built networks to the circulation of communicative norms and social encounters. This is understood in terms of layered infrastructures, which are distinguished at three main, interarticulated levels: natural (e.g., river systems), technological (e.g., transport networks), and institutional (e.g., language ecologies). A key finding is that linked infrastructures are causally interdependent through mechanisms of flow piracy (intercepting flows and transforming them for new purposes) and percolation (denuding networks and critically reconfiguring them). The case study from Laos of rapid change in the context of a hydropower dam not only refines our conception of infrastructure, but the idea of language itself as an infrastructure helps us to better understand its spatialized dynamics, foregrounding language as a new empirical domain in the study of infrastructure and other socially spatialized networks.

Cerebral perfusion in post-stroke aphasia and its relationship to residual language abilities.

Stroke alters blood flow to the brain resulting in damaged tissue and cell death. Moreover, the disruption of cerebral blood flow (perfusion) can be observed in areas surrounding and distal to the lesion. These structurally preserved but suboptimally perfused regions may also affect recovery. Thus, to better understand aphasia recovery, the relationship between cerebral perfusion and language needs to be systematically examined. In the current study, we aimed to evaluate (i) how stroke affects perfusion outside of lesioned areas in chronic aphasia and (ii) how perfusion in specific cortical areas and perilesional tissue relates to language outcomes in aphasia. We analysed perfusion data from a large sample of participants with chronic aphasia due to left hemisphere stroke (n = 43) and age-matched healthy controls (n = 25). We used anatomically defined regions of interest that covered the frontal, parietal, and temporal areas of the perisylvian cortex in both hemispheres, areas typically known to support language, along with several control regions not implicated in language processing. For the aphasia group, we also looked at three regions of interest in the perilesional tissue. We compared perfusion levels between the two groups and investigated the relationship between perfusion levels and language subtest scores while controlling for demographic and lesion variables. First, we observed that perfusion levels outside the lesioned areas were significantly reduced in frontal and parietal regions in the left hemisphere in people with aphasia compared to the control group, while no differences were observed for the right hemisphere regions. Second, we found that perfusion in the left temporal lobe (and most strongly in the posterior part of both superior and middle temporal gyri) and inferior parietal areas (supramarginal gyrus) was significantly related to residual expressive and receptive language abilities. In contrast, perfusion in the frontal regions did not show such a relationship; no relationship with language was also observed for perfusion levels in control areas and all right hemisphere regions. Third, perilesional perfusion was only marginally related to language production abilities. Cumulatively, the current findings demonstrate that blood flow is reduced beyond the lesion site in chronic aphasia and that hypoperfused neural tissue in critical temporoparietal language areas has a negative impact on behavioural outcomes. These results, using perfusion imaging, underscore the critical and general role that left hemisphere posterior temporal regions play in various expressive and receptive language abilities. Overall, the study highlights the importance of exploring perfusion measures in stroke.

Application of metaheuristics in multi-product polymer production scheduling: A case study

Chemical manufacturers produce a range of polymer product families on a large scale within complex and dispersed manufacturing plants. These plants are connected through pipelines and are highly dependent on each other. Such a group of connected plants is referred to as a value chain. The process involves the continuous flow of raw materials known as feedstock, from one plant to another, enabling the continuous production of polymers. When the flow of feedstock through the value chain is interrupted due to unexpected events or planned maintenance at a plant, it results in irreversible losses. Consequently, prompt decision support is required to manage these disruptions and ensure the continuity of the flow. This paper evaluates several metaheuristics for effectively scheduling the flow between the plants within the value chain of a chemical manufacturer. These metaheuristics aim to provide near-optimal solutions after disrupting events occur and for the scheduling of periodic production. Sixteen diverse algorithms were considered – including greedy search, tabu search, simulated annealing, and the genetic algorithm – for the profitability of new schedules in the shortest computational time after flow interruption. Moreover, subject-matter experts tested and evaluated several scenario disturbances in the value chain process. The genetic algorithm and variations like local search, tabu search, and greedy search produced the best results. The contribution of this study includes evidence to show that inter-plant scheduling in a multi-product polymer production chain can be done within a reasonable time to ensure continuous process flow. In addition, a novel encoding scheme of decision variables is presented, allowing for scheduling over short or longer time horizons. Finally, the study shows that the performance results of the metaheuristics can guide practitioners on which to select for future implementation; this study showed that the genetic algorithm with population sizes of 50 to 120 and more than 100 generations proved to be best, while results can be obtained in less than 10 minutes.