Subsequent Insertion Research Articles

Laryngeal Mask Airway Method for Minimally Invasive Surfactant Therapy in Neonates with Pneumothorax Complicating Respiratory Distress Syndrome

Background/Objectives: Pneumothorax is a common complication of neonatal respiratory distress syndrome, which is decreased by surfactant therapy. Rescue administration of surfactant in neonates with severe RDS complicated by pneumothorax requires management of the pneumothorax to optimize surfactant distribution while avoiding positive pressure ventilation to minimize iatrogenic exacerbation of the air leak. Methods: We retrospectively reviewed our center’s experience with neonates who had clinically significant pneumothorax complicating RDS, in whom we used a novel technique to administer surfactant through a laryngeal mask/supraglottic airway device without applying positive pressure ventilation. Results: In 13 of the 20 neonates in our cohort, subsequent invasive ventilation and chest tube insertion were avoided. There were no major complications or unfavorable outcomes. We describe our experience with this method and suggest an approach to individualize the management of neonates with pneumothorax preceding surfactant therapy. Conclusions: In our setting, laryngeal mask airway devices are now the preferred method to deliver surfactant in neonates with RDS and pre-existing pneumothorax. We believe this approach is readily applicable in most neonatal care settings.

Strained Dehydro‐[2,2]‐paracyclophane Enabled Planar Chirality Construction and [2.2]Paracyclophane Functionalization

Planar chirality found tremendous use in many fields, such as chemistry, optics, and materials science. In particular, planar chiral [2.2]paracyclophanes (PCPs) are a type of structurally interesting and practically useful chiral compounds bearing unique electronic and photophysical properties and thus have been widely used in π‐stacking polymers, organic luminescent materials, and as a valuable toolbox for developing chiral ligands or organocatalysts. However, the synthesis of chiral PCP derivatives remains a longstanding challenge. Current synthetic methods primarily rely on chiral preparative liquid chromatography separation or chemical and kinetic resolution reactions. Here, we report an enantioconvergent alkynylation of an in situ‐formed dehydro‐[2,2]‐paracyclophane intermediate by asymmetric copper(I) catalysis. This approach enables the efficient synthesis of valuable planar chiral PCP building blocks and heterocycles with good yields and excellent enantioselectivity. The success of this reaction lies in the development of a practical route to access strained dehydro‐[2,2]‐paracyclophane intermediates, which can also be utilized in various strain‐release nucleophilic or cycloaddition reactions to synthesize diverse functionalized PCPs. DFT calculations of this reaction suggest that the enantioselectivity is determined by the aryne complexation with chiral copper(I) acetylide and the subsequent insertion reaction.

Strained Dehydro-[2,2]-paracyclophane Enabled Planar Chirality Construction and [2.2]Paracyclophane Functionalization.

Planar chirality found tremendous use in many fields, such as chemistry, optics, and materials science. In particular, planar chiral [2.2]paracyclophanes (PCPs) are a type of structurally interesting and practically useful chiral compounds bearing unique electronic and photophysical properties and thus have been widely used in π-stacking polymers, organic luminescent materials, and as a valuable toolbox for developing chiral ligands or organocatalysts. However, the synthesis of chiral PCP derivatives remains a longstanding challenge. Current synthetic methods primarily rely on chiral preparative liquid chromatography separation or chemical and kinetic resolution reactions. Here, we report an enantioconvergent alkynylation of an in situ-formed dehydro-[2,2]-paracyclophane intermediate by asymmetric copper(I) catalysis. This approach enables the efficient synthesis of valuable planar chiral PCP building blocks and heterocycles with good yields and excellent enantioselectivity. The success of this reaction lies in the development of a practical route to access strained dehydro-[2,2]-paracyclophane intermediates, which can also be utilized in various strain-release nucleophilic or cycloaddition reactions to synthesize diverse functionalized PCPs. DFT calculations of this reaction suggest that the enantioselectivity is determined by the aryne complexation with chiral copper(I) acetylide and the subsequent insertion reaction.

Long-term reoperation risk of thoracic to pelvis instrumentation for spinal deformity: a longitudinal study of 7,062 patients.

To perform a large-scale assessment of reoperation risk among spine deformity patients undergoing thoracic to pelvis surgery. The PearlDiver database was queried for spinal deformity patients (scoliosis, kyphosis, spondylolisthesis, sagittal plane deformity) undergoing at minimum, a T12-pelvis operation (2010-2020). CPT codes identified lumbar arthrodesis procedures that included pelvic fixation and ≥ 7 levels of posterior instrumentation on the same day. Minimum follow-up was 2 years. Reoperations included subsequent arthrodesis, decompression, osteotomy, device insertion, and pelvic fixation procedures. Multivariable regression analysis described associations between variables and reoperation risk. 7,062 patients met criteria. Overall reoperation rate was 23.2%. Reoperation rate at 2- and 5-year was 16.9% and 22.1% respectively. 10-year reoperation-free probability was 73.7% (95% CI: 72.4-74.9%). Multivariable analysis revealed higher reoperation risk for patients with kyphosis and ≥ 13 levels of posterior instrumentation. Patients who received interbody cages had a lower reoperation risk. No association was found between the presence or absence of osteotomy procedures and reoperation risk. Lastly, linear regression analyses revealed no significant relationship between age or ECI and risk for subsequent operations did not independently influence reoperation. This study, representing a real-world cohort of over six times the largest current prospective data set, found a 2-year reoperation rate of 17%, similar to previous studies, suggesting study group findings are applicable to a broader population. Preoperative kyphosis and ≥ 13 levels of posterior instrumentation was associated with higher reoperation risk, while the use of interbody cages was protective. Age, medical comorbidities, and osteotomies did not predict reoperations.

Accuracy of thick and thin intraocular lens power formulas using paraxial vergence calculation.

To compare the prediction errors of several thick IOL formulas to a thin lens approach using variations of the same paraxial vergence calculation formula. Department of Ophthalmology, Randers Regional Hospital, Denmark. Prospective, non-interventional study. We prospectively and consecutively performed optical low coherence reflectometry biometry in 132 eyes with subsequent phacoemulcification and insertion of the same aspherical IOL model. Clinical refraction was performed two months postoperatively. We retrospectively used the same paraxial vergence formula and varied only the methods for calculating the postoperative IOL position, thickness, and curvatures to construct four formulas: Næser I formula based on thick lens calculation using the manufacturer´s cutting card information; Næser II formula based on thick lens calculation using calculated IOL data from open sources; Næser III formula based on thick lens calculation and a fixed IOL thickness of 0.62 mm; Næser IV formula based on thin lens calculation with fixed IOL position 0.31 mm anterior to the postoperative capsule. Each formula was optimized separately, hereby assuring a mean error of zero. The prediction error (PE) was defined as the difference between the measured and predicted spherical equivalent refraction. Mean absolute error amounted to 0.30 (±0.26) D for all four formulas with no statistically significant difference. PE averaged zero for short, normal, and long eyes. The additional optical information provided by thick IOL calculations appears insignificant compared to other sources of error, related to the accuracy of IOL manufacturing, natural lens refractive index, and postoperative refraction.

Dealuminated H–Y zeolites generate, stabilize and catalytically insert carbenes from diazocarbonyl compounds

Carbenes are among the most powerful reactants in organic synthesis, with capacity to insert into a variety of otherwise stable bonds, and generate two new bonds in a straightforward manner. However, the intrinsic instability of such carbenes makes them to be catalytically generated, in–situ, from precursors such as diazocarbonyl compounds, and the catalyst, in turn, also controls the subsequent insertion reaction. The catalyst is generally a metal complex in solution, mainly Cu, Ag or Rh, but also others, including protons in rare cases. Here we show that carbenes are generated, stabilized and inserted into C–C, C–H, O–H, N–H, Si–H and O–O bonds after reacting diazocarbonyl compounds with catalytic amounts of metal–free, commercially available dealuminated H–Y zeolites. These results open the way to design carbene–mediated organic reactions on readily available and reusable catalytic solids without involving metals.

Metal-Free Oxidation of Acceptor-Donor Acylhydrazones into Diazo Compounds Using Phenyl Iododiacetate.

Aryl-ester acylhydrazones readily react with phenyl iododiacetate (PIDA) in methanol to produce the corresponding α-diazoesters with good to excellent yields (30 examples). The conditions have also been proven to be efficient in the synthesis of triazolopyridines. The crude mixture containing the diazo compound and acetic acid was also irradiated with low-energy blue LED light for a subsequent one-pot insertion of the in situ-generated carbene with AcOH to afford the respective acetates in high yields.

Towards the genomic sequence code of DNA fragility for machine learning.

Genomic DNA breakages and the subsequent insertion and deletion mutations are important contributors to genome instability and linked diseases. Unlike the research in point mutations, the relationship between DNA sequence context and the propensity for strand breaks remains elusive. Here, by analyzing the differences and commonalities across myriads of genomic breakage datasets, we extract the sequence-linked rules and patterns behind DNA fragility. We show the overall deconvolution of the sequence influence into short-, mid- and long-range effects, and the stressor-dependent differences in defining the range and compositional effects on DNA fragility. We summarize and release our feature compendium as a library that can be seamlessly incorporated into genomic machine learning procedures, where DNA fragility is of concern, and train a generalized DNA fragility model on cancer-associated breakages. Structural variants (SVs) tend to stabilize regions in which they emerge, with the effect most pronounced for pathogenic SVs. In contrast, the effects of chromothripsis are seen across regions less prone to breakages. We find that viral integration may bring genome fragility, particularly for cancer-associated viruses. Overall, this work offers novel insights into the genomic sequence basis of DNA fragility and presents a powerful machine learning resource to further enhance our understanding of genome (in)stability and evolution.

Triflate Salts as Alternative Non-Chlorinated Oxidants for the Oxidative Chemical Vapor Deposition and Electronic Engineering of Conjugated Polymers.

Oxidative chemical vapor deposition (oCVD) stands as an attractive approach for the synthesis, engineering, and integration of conjugated polymers for advanced electronic and optoelectronic applications. In oCVD, the oxidant significantly influences the conformational and optoelectronic properties of the resulting conjugated polymer thin films. In this work, triflate salts of iron(III) and copper(II) (Fe(OTf)3 and Cu(OTf)2, respectively) are investigated for the first time as suitable alternative oxidants to the widely used iron(III) chloride (FeCl3) for the oCVD of conjugated polymers. Structural and compositional characterizations of the resulting thin films evidenced the successful polymerization of cobalt(II) 5,15-diphenyl porphyrin using either Fe(OTf)3 or Cu(OTf)2. Along with an intermolecular dehydrogenative C-C coupling reaction, the occurrence of side reactions, such as the inclusion of -CF3 groups and demetalation and subsequent insertion of copper(II) in the porphyrin macrocycle when using Cu(OTf)2, were evidenced. Interestingly, the inclusion of -CF3 groups into the polymer backbone when using triflate salts results in a deepening of the frontier energy levels, while the insertion of copper(II) contributes to a reduction in the band gap energy. This work demonstrates that the careful selection of the oxidant agent in oCVD enables fine-tuning the optoelectronic properties of conjugated polymers to suit specific application requirements.

The safety and effectiveness of the treatment of refractory post-intubation subglottic stenosis using short bronchial Dumon stent: a pilot study.

Post-intubation subglottic stenosis (PI-SGS) is a fatal disease which could result in partial or complete narrowing of the airway. Although airway stenting is commonly used as an alternative treatment for PI-SGS patients unsuitable for surgery, complications including stent migration and excessive granulation tissue formation are frequently encountered. Additionally, tracheotomy is necessary in patients undergoing T-tube placement. Therefore, it is necessary to further enhance the effectiveness of airway stenting in refractory PI-SGS. In this study, we aimed to evaluate the safety and effectiveness of utilizing short bronchial Dumon (BD) stents in managing refractory PI-SGS. PI-SGS patients who were not suitable for surgery and in whom previous interventional treatments had proven ineffective were enrolled. Short BD stents were inserted via rigid bronchoscopy under general anesthesia. Complications and outcomes were assessed by follow-ups. Fourteen patients were included and successful stent insertion was achieved in all cases. The median diameter and length of stents was 12 (0.25) and 33.5 (5) mm, respectively. During the 6-month follow-up period, complications were reported in five patients. Granulation tissue formation was the most frequently observed complication (4 in 14 patients, 28.57%), followed by stent migration (2 in 14 patients, 14.29%). Out of the total participants, 11 patients (78.57%) demonstrated good tolerance to the stent, while 3 (21.43%) required stent removal. Among these three patients, two finally underwent subsequent T-tube insertion after the removal. Twelve patients (85.71%) avoided the tracheotomy and T-tube insertion. The utilization of short BD stents appears to be a safe and effective approach for managing refractory PI-SGS. The complications and tolerability are acceptable.

Ultrasound-Guided Peripheral Intravenous Access Training: A Prospective Observational Study of Emergency Nurses.

Background Ultrasound-guided peripheral intravenous (USGPIV) placement is more successful, comfortable, and longer lasting than traditional landmark-based IVs. While many hospitals have protocols for becoming credentialed in this skill, there is little information available about the USGPIV success rate during and after training. Objectives This pilot study aimed to quantify USGPIV attempts by emergency nurses undergoing USGPIV training and to determine if 10 successful USGPIVs predicted success in the next USGPIV. The secondary aims were to determine failure points for unsuccessful USGPIVs and the time to complete training. Methods Sixteen emergency nurses with no prior USGPIV experience were enrolled. Participants completed a one-hour didactic session and one hour of hands-on training with vein simulators. Participants had direct observation of all USGPIV attempts up until 10 successful cannulations. Each attempt was recorded along with reasons for USGPIV attempt failure and the time required to become credentialed. Results Participants attempted 200 USGPIVs with a success rate of 80% (160/200). Fourteen participants completed 10 successful USGPIVs, requiring a median of 11 attempts (IQR 10-13) and a success rate of 92.9% (13/14) on subsequent USGPIV attempts. Participants required a median observation time of 4.13 hours (IQR: 3.94-4.75). The most common point of failure was using dynamic ultrasound guidance to maintain needle tip visualization. Conclusions USGPIVs are a valuable skill that requires time and practice. Emergency nurses with no prior USGPIV experience can achieve the requirements for hospital credentialing and success on subsequent USGPIV insertion by completing 10 successful USGPIVs after a two-hour training session and four hours of direct observation.

A Dual Cobalt-Photoredox Catalytic Approach for Asymmetric Dearomatization of Indoles with Aryl Amides via C-H Activation.

In this study, we unveil a novel method for the asymmetric dearomatization of indoles under cobalt/photoredox catalysis. By strategically activating C-H bonds of amides and subsequent migratory insertion of π-bonds present in indole as reactive partner, we achieve syn-selective tetrahydro-5H-indolo[2,3-c]isoquinolin-5-one derivatives with excellent yields and enantiomeric excesses of up to >99 %. The developed method operates without a metal oxidant, relying solely on oxygen as the oxidant and employing an organic dye as a photocatalyst under irradiation. Control experiments and stoichiometric studies elucidate the reversible nature of the enantiodetermining C-H activation step, albeit not being rate-determining. This study not only expands the horizon of cobalt-catalyzed asymmetric C-H bond functionalization, but also showcases the potential synergy between cobalt and photoredox catalysis in enabling asymmetric synthesis of complex molecules.

Resolving the interactions between hydrophilic CdTe quantum dots and positively charged membranes at the nanoscale

The use of quantum dot nanoparticles (QDs) in bio-applications has gained quite some interest and requires a deep understanding of their interactions with model cell membranes. This involves assessing the extent of nanoparticle disruption of the membrane and how it depends on both nanoparticle and membrane physicochemical properties. Surface charge plays an important role in nanoparticle adsorption, which is primarily driven by electrostatic interactions; yet, once adsorbed, most reported works overlook the subsequent spatial nanoparticle insertion and location within the membrane. There is therefore a need for studies to assess the mutual role of membrane and nanoparticle charge into membrane structure and stability at the nanoscale, with a view to better design and control the functionality of these nanomaterials. In this work, we have resolved the extent of the interactions between hydrophilic, negatively charged CdTe QDs and positively charged lipid bilayers. A multiscale combination of surface-sensitive techniques enabled probing how surface charge mediates QD adsorption and membrane reorganization. Increasing membrane surface charge results into a larger adsorption of oppositely charged QDs, concomitantly inducing structural changes. Hydration of the membrane hydrophobic parts by QDs goes deeper into the inner leaflet with increasing membrane charge, resulting in supported lipid bilayers with decreased nanomechanical stability.

Preoperative Impella therapy in patients with ventricular septal rupture and cardiogenic shock: haemodynamic and organ function outcomes.

We examined the effects of preoperative Impella treatment on haemodynamic stability, organ recovery and postoperative outcomes in patients with postinfarction ventricular septal rupture (PIVSR) and cardiogenic shock (CS). Between April 2018 and February 2024, the data of 10 of 15 patients with PIVSR and CS who underwent Impella therapy were analysed. Emergency surgery was contingent on haemodynamic stability with the Impella/ECpella, except in the presence of organ failure. We utilized a generalized linear mixed model to evaluate organ ischaemia through changes in blood parameters upon admission and at subsequent intervals post-Impella insertion. Preoperative Impella or combined Impella and ECpella (5 patients each) support was provided, with diagnoses and operations occurring at an average of 4 days (interquartile range: 2-5) and 8 days (interquartile range: 2-14) after myocardial infarction, respectively. Treatment significantly reduced lactate, alanine aminotransferase, creatine kinase-MB and troponin I levels (P ≤ 0.05 for all). Conversely, no significant change was noted in the aspartate aminotransferase level or the estimated glomerular filtration rate. Haemoglobin and platelet counts decreased despite transfusions (P < 0.001). No surgical deaths occurred; however, 70% of the patients required prolonged mechanical ventilation, and 80% were transferred to other facilities for rehabilitation. Impella or ECpella treatment can improve haemodynamic and organ failure outcomes in patients with PIVSR and CS. However, the risks of prolonged support, including haemorrhagic events and the need for extended rehabilitation, point to a need for comparative studies to optimize support duration.

Nickel/Photoredox-Catalyzed Carbonylative Cross-Electrophile Coupling of Organohalides and Carboxylic Acid Esters with Phenyl Formate.

A photoinduced nickel-catalyzed reductive carbonylative coupling from organohalides and N-(acyloxy)phthalimide esters with phenyl formate as the carbonyl source has been developed. This reaction could perform smoothly under mild conditions, and a series of aryl-alkyl and alkyl-alkyl unsymmetrical ketones were produced without the need of stoichiometric metal reductants. Mechanistic studies indicate that this reaction was initiated from radical capture by Ni(I)-carbonyl species and subsequent rapid carbonyl insertion.

FairScene: Learning unbiased object interactions for indoor scene synthesis

In this paper, we propose an unbiased graph neural network learning method called FairScene for indoor scene synthesis. Conventional methods directly apply graphical models to represent the correlation of objects for subsequent furniture insertion. However, due to the object category imbalance in dataset collection and complex object entanglement with implicit confounders, these methods usually generate significantly biased scenes. Moreover, the performance of these methods varies greatly for different indoor scenes. To address this, we propose a framework named FairScene which can fully exploit unbiased object interactions through causal reasoning, so that fair scene synthesis is achieved by calibrating the long-tailed category distribution and mitigating the confounder effects. Specifically, we remove the long-tailed object priors subtract the counterfactual prediction obtained from default input, and intervene in the input feature by cutting off the causal link to confounders based on the causal graph. Extensive experiments on the 3D-FRONT dataset show that our proposed method outperforms the state-of-the-art indoor scene generation methods and enhances vanilla models on a wide variety of vision tasks including scene completion and object recognition.

A Dual Cobalt‐Photoredox Catalytic Approach for Asymmetric Dearomatization of Indoles with Aryl Amides via C‐H Activation

In this study, we unveil a novel method for the asymmetric dearomatization of indoles under cobalt/photoredox catalysis. By strategically activating C‐H bonds of amides and subsequent migratory insertion of p‐bonds present in indole as reactive partner, we achieve syn‐selective tetrahydro‐5H‐indolo[2,3‐c]isoquinolin‐5‐one derivatives with excellent yields and enantiomeric excesses of up to &gt;99%. The developed method operates without a metal oxidant, relying solely on oxygen as the oxidant and employing an organic dye as a photocatalyst under irradiation. Control experiments and stoichiometric studies elucidate the reversible nature of the enantiodetermining C‐H activation step, albeit not being rate‐determining. This study not only expands the horizon of cobalt‐catalyzed asymmetric C‐H bond functionalization, but also showcases the potential synergy between cobalt and photoredox catalysis in enabling asymmetric synthesis of complex molecules.

QM-DLA: an efficient qubit mapping method based on dynamic look-ahead strategy

Quantum computing has already demonstrated great computational potential across multiple domains and has received more and more attention. However, due to the connectivity limitations of Noisy Intermediate-Scale Quantum (NISQ) devices, most of the quantum algorithms cannot be directly executed without the help of inserting SWAP gates. Nevertheless, more SWAP gates lead to a longer execution time and, inevitably, lower fidelity of the algorithm. To this end, this paper proposes an optimized qubit mapping algorithm based on a dynamic look-ahead strategy to minimize the number of SWAP gates inserted. Firstly, a heuristic algorithm is proposed based on maximizing physical qubit connectivity to generate the optimal initial qubit mapping, which reduces the need for logical qubit shifts during subsequent SWAP gate insertion. Secondly, in the form of directed acyclic graphs, we identify quantum gates that violate the constraints of physical coupling and insert SWAP gates to remap qubits, thereby overcoming the limitations of qubit interactions. Finally, the optimal SWAP gate insertion strategy is built by comparing the cost of different SWAP gate insertion strategies through a multi-window look-ahead strategy to reduce the number of SWAP gates inserted. The experimental results show that the strategy in this paper decreases the number of SWAP gate insertions and significantly reduces the depth of quantum circuits when performing qubit mapping compared with state-of-the-art methods.

Quasi-static mechanical evaluation of canine cementless total hip replacement broaches: effect of tooth design on broach and stem insertion

BackgroundBiomedtrix BFX® cementless total hip replacement (THR) requires the use of femoral broaches to prepare a press-fit envelope within the femur for subsequent stem insertion. Current broaches contain teeth that crush and remove cancellous bone; however, they are not particularly well-suited for broaching sclerotic (corticalized) cancellous bone. In this study, three tooth designs [Control, TG1 (additional V-grooves), TG2 (diamond tooth pattern)] were evaluated with a quasi-static testing protocol and polyurethane test blocks simulating normal and sclerotic bone. To mimic clinical broaching, a series of five sequential broach insertions were used to determine cumulative broaching energy (J) and peak loads during broach insertion. To determine the effect of broach tooth design on THR stem insertion, a BFX® stem was inserted into prepared test blocks and insertion and subsidence energy and peak loads were determined.ResultsBroach tooth design led to significant differences in broaching energy and peak broaching loads in test blocks of both densities. In low density test blocks, TG1 required the lowest cumulative broaching energy (10.76 ±0.29 J), followed by Control (12.18 ±1.20 J) and TG2 (16.66 ±0.78 J) broaches. In high density test blocks, TG1 required the lowest cumulative broaching energy (32.60 ±2.54 J) as compared to Control (33.25 ±2.16 J) and TG2 (59.97 ±3.07 J). During stem insertion and subsidence testing, stem insertion energy for high density test blocks prepared with Control broaches was 14.53 ± 0.81 J, which was significantly lower than blocks prepared with TG1 (22.53 ± 1.04 J) or TG2 (19.38 ± 3.00 J) broaches. For stem subsidence testing in high density blocks, TG1 prepared blocks required the highest amount of energy to undergo subsidence (14.49 ± 0.49 J), which was significantly greater than test blocks prepared with Control (11.09 ±0.09 J) or TG2 (12.57 ± 0.81 J) broaches.ConclusionsThe additional V-grooves in TG1 broaches demonstrated improved broaching performance while also generating press-fit envelopes that were more resistant to stem insertion and subsidence. TG1 broaches may prove useful in the clinical setting; however additional studies that more closely simulate clinical broach impaction are necessary prior to making widespread changes to THR broaches.

Use of Guidewires of Bioradmedisys in Urology

Use of Guidewires of Bioradmedisys in Urology