Unit Length Research Articles

Revealing the pinning landscape and related vortex pattern evolution in granular superconducting films

Most superconducting electronics based on films exhibit granular structures. It has been suggested that grain boundaries form a network with relatively weak superconductivity, potentially acting as pinning centers. Yet, so far, detailed microscopic studies of the pinning landscape and its relation to vortex behavior remain scarce. Here, we imaged the vortex lattices (VL) in granular Nb films using magnetic force microscopy over large scanning areas at various magnetic fields. A non-monotonic evolution in the degree of vortex lattice ordering was observed with increasing vortex density, driven by a combination of vortex-vortex interactions and pinning effects. The spatial distribution of pinning potential within the film was directly mapped using a recently developed scanning quantum vortex microscope (SQVM). Instead of the network formed by grain boundaries, the pinning landscape presents a network-like structure, yet with domains significantly larger than the individual grains. The results of numerical simulations based on pinning landscape revealed by SQVM well reproduce our experiments. The pinning force per unit length at low magnetic fields was calculated. The critical current density, estimated from the relative positions of vortices, aligns well with the critical state model. Our work illustrates the relationship between the evolution of the vortex lattice with magnetic field and the structural features of granular Nb film, providing new insights into the design of high-performance superconducting electronic devices.

Improving Real-Scene 3D Model Quality of Unmanned Aerial Vehicle Oblique-Photogrammetry with a Ground Camera

In UAV (unmanned aerial vehicle) oblique photogrammetry, the occlusion of ground objects, particularly at their base, often results in low-quality real-scene 3D models. To address this issue, we propose a method to enhance model quality by integrating ground-based camera images. This innovative image acquisition method allows the rephotographing of areas in the 3D model that exhibit poor quality. Three critical parameters for reshooting are the reshooting distance and the front- and side-overlap ratios of reshooting images. The proposed method for improving 3D model quality focuses on point accuracy, dimensional accuracy, texture details, and the triangular mesh structure. Validated by a case study involving a complex building, this method demonstrates that integrating ground camera photos significantly improves the overall quality of the 3D model. The findings show that optimal settings for reshooting include a distance (in meter units) of 1.5–1.6 times the camera’s focal length (in millimeter units), a front overlap ratio of 30%, and a side overlap ratio of 20%. Furthermore, we conclude that an overlap rate of 20–30% in reshooting is a usable value.

Effect of glucose-insulin-potassium on lactate levels at the end of surgery in patients undergoing cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: study protocol for a randomized controlled trial

IntroductionCytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been established as an effective treatment for peritoneal cancer (PC). However, this kind of combination therapy is associated with a high lactate level. Moreover, studies have suggested that the rate of complications early after surgery directly increased with elevated lactate levels. Glucose-insulin-potassium (GIP), a potent cardioprotective intervention, has been demonstrated to adjust blood glucose (BG) levels and reduce lactate levels. However, the insulin-glucose ratio should be adjusted according to the surgery performed. Here, we aimed to evaluate the advantages of using modified GIP during CRS/HIPEC to reduce the lactate level at the end of surgery and further reduce the incidence of early postoperative complications.Methods and analysisThe modified GIP versus conventional management during surgery study is a single-center, randomized, single-blinded outcome assessment clinical trial of 80 patients with PC who are between 18 and 64 years old and undergoing CRS/HIPEC. Participants will be randomly allocated to receive modified GIP or conventional treatment (1:1). The primary outcome will be the plasma lactate level at the end of surgery. The secondary outcomes will include the highest levels and fluctuation ranges of lactate and BG during surgery, extubation time, APACHE-II score 24 h after surgery, postoperative defecation and exhaust time, postoperative lactate clearance time, postoperative liver and kidney function, incidence of complications within 7 days after surgery, length of intensive care unit stay (LIS), length of hospital stay (LHS), and total cost of hospitalization.Ethics and disseminationThe trial protocol was approved by the Scientific Research Ethics Committee of Beijing Shijitan Hospital Affiliated with Capital Medical University, approval number sjtky11-1x-2022(118). The results will be published in international peer-reviewed journals.Trial registrationChiCTR2200057258. Registered on March 5, 2022.

CO2 delivery techniques in mini-sternotomy surgery and neurological events: a multicentric study

BackgroundThe impact of air bubbles into the cerebral circulation after open heart surgery has been a topic of discussion since the introduction of the heart-lung machine. The aim of the study was to evaluate whether the use of a dedicated commercial sponge diffuser is better than a custom-made narrow section cannula or the absence of CO2 in preventing neurological events after aortic valve replacement via J mini-sternotomy.MethodsThree cohorts of J-shaped mini-sternotomy performed at three different centers were prospectively compared: CO2 supplied via sponge diffuser, CO2 supplied via cannula, and no CO2 supply. Propensity matching was used to obtain comparable groups. The primary endpoints were postoperative stroke, transitory ischemic attack, convulsions, and dizziness. Secondary endpoints were 30-day mortality, duration of mechanical ventilation, and intensive care unit length of stay.Results275 patients were enrolled in the study. After propensity matching, the sponge diffuser cohort had a significantly lower duration of mechanical ventilation (P < 0.001) and 30-day mortality (P = 0.05) when compared to the cannula cohort and the no-CO2 cohort, a lower incidence of all neurological events (P = 0.03) and dizziness (P = 0.05) when compare to the no-CO2 cohort, and a lower intensive care unit length of stay when compared to the cannula cohort (P = 0.001).ConclusionsThe sponge diffuser used to deliver the CO2 into the surgical field during aortic valve replacement via J mini-sternotomy has been demonstrated to guarantee better neurological outcomes compared to a custom-made narrow section cannula or the absence of CO2.

Determination of Lubrication Layer Thickness and Its Effect on Concrete Pumping Pressure.

The flow of six kinds of fresh concrete under different flow rates and lubrication layer thickness (TLL) values in the horizontal pipe was numerically simulated. The influence of the TLL on the pressure per unit length (PL) was analyzed. It was determined that the formation of the lubrication layer (LL) significantly reduces the PL in concrete pumping. As the TLL increased, the PL decreased. However, the degree of reduction in the PL gradually decreased as the TLL increased. Relating the simulated PL with the experimental PL, the size of the TLL was obtained, which was between 1 and 3 mm. The minimum and maximum were 1.23 and 2.58 mm, respectively, and the average value was 1.97 mm. The strength (S24, S50), the size of the aggregate (A10, A20, A25), and the flow rate of pumping all affected the TLL. The type of fresh concrete and the flow rate of pumping significantly affected the PL, which impacted the TLL. However, the TLL also impacted the PL. Finally, this made the TLL change within a certain range. When PL > 14,000 Pa/m, 2 mm < TLL< 3 mm; on the other hand, 1 mm < TLL< 2 mm. Therefore, we can use CFD to simulate the flow of all types of concrete in the actual pumping pipeline with a TLL of 2 mm to obtain their pumping pressure and guide the actual construction.

The sevoflurane concentration for light sedation in critically ill patients: A protocol for experimental study

Background: Deep-inhaled sedation is increasingly used in Thai ICUs. However, there is a lack of information regarding the level of end-tidal sevoflurane concentration during light sedation. Objectives: The study aims to determine the effective dose (ED50 and ED95) of sevoflurane concentration for light sedation (RASS score -1 to 0) in mechanically ventilated critically ill patients. Methods: This is a prospective experimental single-center study. Mechanically ventilated patients with RASS ≥ 1 who required sedation in the medical and surgical intensive care unit were enrolled. Using an up-and-down sequential allocation technique, the inhaled sevoflurane level of each patient was allocated based on the previous patient’s response. RASS score and hemodynamic parameters were monitored. The primary outcome was the ED50 and ED 95 of end-tidal sevoflurane concentration. The secondary outcomes included the length of intensive care unit stay, duration of ventilator day, the incidence of delirium, hemodynamic status, and respiratory variables changed during the study period. Hypothesis: There exist specific end-tidal sevoflurane concentrations (ED50 and ED95) that will reliably induce a target RASS score of -1 to 0 in critically ill patients who are mechanically ventilated. Conclusion: This study will provide an effective dose of inhaled sevoflurane sedation for achieving targeted light sedation levels in critically ill patients, which may have minimal effects on hemodynamics. Ethics and dissemination: This study has been approved by the Office of Human Research Ethics Committee, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand, on 22nd May 2023 (COA.MURA2023/390). Trial registration: TCTR20230825001

Optimal timing for video assisted thoracic surgery decortication for improved survival in chronic empyema

BackgroundVideo-assisted thoracic surgery decortication for phase 3 thoracic empyema is widely accepted, but its optimal timing has not been established. We aim to investigate and assess this timing, in terms of overall survival, for chronic empyema.MethodsTwo hundred four patients with pneumonia-caused phase 3 empyema were treated with video-assisted thoracic surgery decortication over 10-years at Changhua Christian Hospital. The 90-day post-operative survival status was analyzed, and we compared the survivor group versus the non-survivor group. A receiver operating characteristic curve was used to identify the optimal decortication timing.ResultsA comparison between survivors and non-survivors showed statistical differences among age (p=0.004), presence of cardiovascular disease (p=0.018), presence of end-stage renal disease (p=0.002), duration to surgery (p=0.013), length of intensive care unit stay (p=0.010), and overall length of hospital stay (p=0.015). ROC curve analysis determined the cut-off for video-assisted thoracic surgery decortication, based on optimal 90-day post-operative survival, to be 7.5 days after hospitalization; mortality increases threefold thereafter (14.2% vs 44.6%, p<0.001). Multivariate analysis revealed that age, end-stage renal disease, pleural effusion pH≦7.2 and duration to surgery >7.5 days negatively impacted 90-day post-operative survival.ConclusionsPatients receiving decortication surgery within 7.5 days of hospital admission had better overall survival.

Use of a two-bag fluid administration protocol in the treatment of paediatric diabetic ketoacidosis: A retrospective review

ABSTRACT Objectives The ‘two-bag method’ for the treatment of diabetic ketoacidosis (DKA) uses two intravenous fluid bags, only one of which contains 10% dextrose. The bags are run concurrently with rates adjusted according to a rate change table to allow the relative amount of dextrose administered to be adjusted over time, without the need for bag replacements. The Children’s Hospital at London Health Sciences Centre (CHLHSC) two-bag protocol is a simplified version of that used by other centres. The objective of this study was to ensure implementation of the CHLHSC two-bag protocol continues to provide safe and effective treatment of paediatric DKA and decreases resource utilization. Methods This retrospective chart review compared treatment pre- and post-protocol implementation. Results A total of 22 admissions were included. No significant differences in efficacy or safety outcomes were found between the protocol groups. There was no statistically significant difference between the two and one-bag protocols in time to normalization of serum bicarbonate (13.80 ± 7.68 versus 15.01 ± 7.53 h, P = 0.714), blood glucose correction (8.75 ± 4.86 versus 11.85 ± 4.92 h, P = 0.152), and critical care unit length of stay (24.26 ± 9.94 versus 32.30 ± 13.36, P = 0.399). The nursing staff appeared to appropriately implement the rate change table, but the chart documentation was poor. Conclusions The CHLHSC simplified two-bag protocol provides a safe and effective alternative to the one-bag protocol for DKA correction in paediatric patients and may also result in decreased resource utilization.

A prospective cohort study comparing monitored anesthesia care and intubated general anesthesia in cardiac surgery involving cardiopulmonary bypass

BackgroundThe aim of this study is to assess the feasibility and safety of monitored anesthesia care (MAC) versus intubated general anesthesia (IGA) for patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).MethodsThis prospective observational study included patients scheduled for cardiac surgery involving CPB at our institution between April 2012 and February 2017. The enrolled patients were categorized into MAC and IGA groups. MAC involved local anesthesia at the sternotomy site, sedation with dexmedetomidine, analgesia with remifentanil/sufentanil, and electroacupuncture (EA). Eleven patients underwent MAC, and 13 patients received IGA. There were no instances of conversion from MAC to IGA, and both groups exhibited no major complications. The demographic characteristics, baseline parameters, and operative variables were comparable between the two groups.ResultsIntraoperative opioid consumption was significantly lower in the MAC group compared to the IGA group (P < 0.001). The time to oral intake of liquids was significantly shorter in the MAC group (2.14 ± 0.90 h) compared to the IGA group (22.31 ± 3.33 h) (P < 0.001). Furthermore, the intensive care unit length of stay (ICU-LOS) and perioperative vasoactive-inotropic score (VIS) were significantly reduced in the MAC group compared to the IGA group (P < 0.001).ConclusionsMAC emerges as a safe and viable alternative to general anesthesia for specific patient groups undergoing cardiac surgery with CPB. Furthermore, it may enhance postoperative recovery and minimize postoperative complications compared to IGA.

Association between postoperative atrial fibrillation after coronary artery bypass grafting and short-term clinical outcomes

BackgroundDespite advances in prevention and treatment, postoperative atrial fibrillation (POAF) is the most common type of complication undergoing cardiac surgery. This study aimed to identify the relationship between POAF and clinical outcomes after coronary artery bypass graft.MethodsIn this cross-sectional study, we retrospectively reviewed the medical records of 324 patients who had undergone coronary artery bypass grafting in an intensive care unit between 2010 and 2019 at a tertiary hospital in Korea. Propensity score matching was used to estimate a 1:1 match (without: with POAF) using seven covariates to overcome selection bias. Kaplan–Meier survival analysis and Cox proportional hazards modeling were performed to determine the effect on intensive care unit readmission and length of hospital stay.ResultsAfter controlling for covariates, 1:1 matching was performed for 91 patients in each group. The occurrence of postoperative atrial fibrillation was found to increase the probability of readmission to the intensive care unit, with a 23% reduced probability of readmission for every 10% increase in left ventricular ejection fraction. Multivariate analysis indicated that postoperative atrial fibrillation, chronic obstructive pulmonary disease as a comorbidity, and preoperative hemoglobin were factors affecting the length of hospitalization after surgery. The Kaplan–Meier survival analysis results indicated that the without POAF group had a higher survival rate than the with POAF group.ConclusionsHealthcare professionals should recognize negative factors such as postoperative atrial fibrillation and abnormal hematologic parameters that impact major clinical outcomes in patients and may require closer monitoring before and after coronary artery bypass grafting.

"Look Who's Talking": Language Patterns in Autistic and Non-Autistic Youth Across Different Conversation Partners.

Autistic individuals have varying levels of verbal fluency which can impact social outcomes. Although 70-75% of autistic individuals have functional language, findings regarding language patterns (syntax and semantics) in autistic adolescents remain inconclusive. Additionally, previous studies of language complexity use narrative samples, which do not capture autistic language in conversation. The current study examined language patterns in autistic (n = 20) and non-autistic (n = 17) youth aged 9-16 years during a conversation with a familiar versus unfamiliar adult. The study aimed to address gaps in the literature regarding autistic youth's language patterns, particularly in conversation, and the impact of speaking partners. Recordings of the conversation task were transcribed using SALT software conventions to yield measures of language production. Average length of communication units was higher among autistic compared to non-autistic youth, and among all youth when talking with familiar compared to unfamiliar partners. Youth speech also reflected greater linguistic diversity with familiar interlocutors, with no differences between autistic and non-autistic youth. Additionally, familiar interlocutors used more speech elicitation strategies (i.e., questions, prompts) than unfamiliar interlocutors across groups and interlocutors speaking with autistic youth used more speech elicitation strategies. These findings identify important similarities and differences between autistic and non-autistic youth and interlocutor speech that provide a better understanding of language patterns in autism. Importantly, this study can increase understanding and enhance support of autistic youth by highlighting that some aspects of autistic youth's language patterns in the context of conversation may be currently underestimated.

Effects of Chronic Obstructive Pulmonary Disease on the Outcomes of Fenestrated-Branched Endovascular Aortic Aneurysm Repair.

Chronic obstructive pulmonary disease (COPD) is common in patients with aortic aneurysms. Severe COPD is associated with an increased risk of aneurysm rupture and perioperative complications. This study assesses the outcomes of COPD and non-COPD patients after fenestrated-branched endovascular aortic aneurysm repair (FBEVAR). A single institution, retrospective study of FBEVAR patients between 2011 and 2020 compared outcomes between COPD and non-COPD patients. COPD patients were stratified by Global Initiative for Chronic Obstructive Lung Disease criteria and oxygen dependence. Outcome measures included 30-day mortality, pulmonary complications, major adverse events (MAE), and mid-term survival. 387 patients (71% male, age 72 years, interquartile range [68-79]) underwent FBEVAR. 181 patients (47%) had COPD. Smoking history was more frequent in COPD patients (P = .022). Among COPD patients, 20.4% were oxygen-dependent. Technical success, defined as successful delivery of the main aortic endograft and all intended side branches, was 98.4%. 30-day mortality (P = .83) and MAE rates (P = .87) were similar between groups. While not statistically significant, COPD patients had more frequent pulmonary complications (6.1% vs. 2.4%, P = .13) and were more frequently discharged on oxygen (P = .002). There were no differences in intensive care unit or hospital length of stay between groups (P = .29; P = .85, respectively). 5-year survival was similar between groups (P = .10). Oxygen-dependent COPD and severe-very severe COPD were associated with decreased mid-term survival (Hazard Ratio 2.39, P = .048). FBEVAR is safe and effective for treating complex aortic pathology in COPD patients, including oxygen-dependent patients. Patients with more severe COPD were more frequently discharged on oxygen. Mid-term survival was slightly reduced in patients with oxygen-dependent and severe-very severe COPD. Level 3, non-randomized controlled cohort/follow-up study.

Erector spinae plane block versus intravenous opioid for analgesia in pediatric cardiac surgery: A systematic review and meta-analysis.

The erector spinae plane block (ESPB) has recently emerged as a regional anesthesia technique for perioperative pain management in pediatric cardiac surgery. However, evidence comparing its effectiveness with intravenous (IV) opioid-based analgesia is limited. We aimed to evaluate and compare the analgesic efficacy of ESPB versus IV opioids in this setting. We systematically reviewed and meta-analyzed studies comparing ESPB with IV opioid analgesia in pediatric cardiac surgeries with midline sternotomy. Primary outcomes were intraoperative fentanyl consumption and intensive care unit (ICU) length of stay (LOS). Secondary outcomes included postoperative opioid consumption, time to first rescue analgesia, pain scores, postoperative vomiting and other complications, extubation time, and hospital LOS. Statistical analyses were performed using RStudio version 4.2.3. Five studies with 384 patients were included, with 178 receiving ESPB. ESPB significantly reduced intraoperative fentanyl use (MD -1.90 μg.kg-1; 95% CI -3.15 to -0.66 μg.kg-1; p = .003; I2 = 58%) and ICU LOS (MD -3.50 h; 95% CI -4.32 to -2.69 h; p < .0001; I2 = 0%). No significant differences were found in the remaining outcomes. Our findings suggest the ESPB might be an important adjunct to enhancing analgesia for midline sternotomies in pediatric cardiac surgery, potentially reducing intraoperative opioid requirements and ICU LOS. CRD 42024526961.

High-energy blunt pelvic ring injuries and pre-hospital pelvic binder applications – A retrospective assessment based on a prospective registry

IntroductionApplication of a pelvic binder in the pre-hospital settings is a crucial step of high-energy blunt pelvic ring injury (PRI) management protocols. The aim of this retrospective cohort study was to evaluate the percentage of pre-hospital pelvic binder's applications in high-energy blunt type B or C PRI patients managed at a single level I trauma center, and to assess its impact on the medical resource requirements and patients' outcomes. MethodsThe institutional Severely Injured Patients’ Registry was screened for patients meeting the following inclusion criteria: (1) high-energy blunt PRI; (2) admission between 2014.01.01 and 2022.12.31; (3) age ≥16 years; and (4) available computed tomography of the pelvis. Exclusion criteria were: (1) death before admission; (2) low-energy injury; (3) penetrating, blast and electrical injuries; and (4) secondary transfers. Study variables, including pre-hospital application of a pelvic binder and demographic, clinical, management and outcome data were extracted from the registry. Additionally, AO/OTA classifications were determined. ResultsA consecutive series of 262 patients was included into the final analysis. Of these, 58.8 % received a pre-hospital pelvic binder (PPB), increasing from type A (45.1 %) to type B (57.8 %) and type C (73.7 %). Pre-hospital hemodynamic instability was a major factor triggering the use of PPB in high-energy blunt type B PRI patients with PPB in 76.9 % of the cases with hemodynamic instability vs. 51.3 % of the cases without hemodynamic instability (p = 0.009). This difference was not statistically significant for high-energy blunt type C PRI patients (82.8 % vs. 64.3 %, p = 0.200). The presence of a physician on the trauma site contributed to the increased percentage of PRI managed with PPB from 43.5 % to 67.3 % in type B PRI (p = 0.011), and from 50 % to 77.1 % in type C PRI (p = 0.257).This study showed an increased need for packed red blood cells (PRBC) transfusions in subgroups treated with PPB and no statistically significant differences in term of intensive care unit (ICU) and total hospital length of stay and complications between high-energy blunt type B or C PRI patients with or without PPB.Comparison of mortality rates in patients with and without PPB showed a trend towards lower mortality rates with PPB in patients with AIS extremity participating in at least 50 % of the total ISS. ConclusionIn the ideal pre-hospital scenario, every high-energy blunt type B or C PRI patient should be managed with a PPB. Continuous pre-hospital team training and information is crucial to achieve this goal. The preparation of Emergency Department and ICU who admit a patient with PPB should include a sufficient number of PRBC ready for transfusion. Mortality rates did not seem to be affected by PPB, except for a trend towards lower mortality rates in patients in whom their PRI was the major component of the global severity of their injury. This might point out the critical and positive effect of PPB in high-energy blunt PRI patients.

Distribution of flow characteristics and productivity evaluation of herringbone wells in bottom water reservoirs

Abstract With the characteristics of large drainage area and low drilling cost, the herringbone wells have become an important way to increase the well production, delay the coning and ridge of bottom water and improve the development effect. Due to the complexity of the herringbone wells flow characteristics, results that exists certain gap between the current production prediction and the actual production, so it is of great significance to study the flow and productivity of herringbone wells. In this paper, taking bottom-water reservoir as the research object, considering the interference between branch wellbore and perforations, analysis the flow characteristics and the productivity sensitivity factors of herringbone wells. The results show that the transient flow time in the reservoir is short, the closer to the wellbore, the greater the pressure changes. With the increases of the branches number, branches length and branch angle, the per unit length of the wellbore radial inflow decreases, and the decrease slows down after exceeding 3 branches. In the high anisotropy reservoirs, the phase angle has greater impact on the productivity of the herringbone well when the perforation density is low, at 180°, phase angle is best; when the perforation density exceeds 16 shots/m, the increase of productivity degree decreases. This study provides important guiding significance for the actual application in oil fields to optimizing the herringbone wells shape, rational production allocation, specifying reasonable work systems and enhance oil recovery in the bottom water reservoirs.

An Ultra-Broadband Conductor-Backed Coplanar Waveguide with Sine Edges

In this paper, a conductor-backed coplanar waveguide with sine edges (CBCPW-SE), consisting of a conductor-backed coplanar with periodic sine edges supported by a dielectric substrate, is proposed as a promising new transmission line (TL) at millimeter-wave and terahertz frequencies. This configuration offers a distinct advantage by maintaining a constant input impedance of 50 Ω across a broad frequency spectrum, eliminating the necessity for any additional impedance matching transitions, thereby enhancing the overall efficiency and simplicity of the transmission system. To verify the design, the CBCPW-SE was fabricated and measured. The measurement results demonstrate that, from 10 MHz to 100 GHz, the insertion loss is less than 0.1 dB/mm and the reflection coefficient is better than −10 dB. The measured S21 (dB) for a 50 mm-long CBCPW-SE section is less than −5 dB from 10 MHz to 100 GHz. The measured group delay per unit length of the trace is 3.4–5 ps, ranging from 10 MHz to 100 GHz. Moreover, the measured group velocity dispersion (GVD) approaches zero, signifying the minimal temporal spreading of the signal components, a crucial aspect for maintaining signal integrity and facilitating high-speed data transmission.

Prehabilitation Interventions for Cardiac Surgery to Prevent Postoperative Pulmonary Complications: Systematic Review and Meta-Analysis

Background: Postoperative pulmonary complications (PPCs) are associated with a higher risk of morbidity and mortality in patients undergoing cardiac surgery. We aimed to investigate the effect of preoperative interventions on PPCs and length of intensive care unit and hospital stay in patients undergoing cardiac surgery. Methods: A systematic review and meta-analysis was conducted on randomized or quasi-randomized trials by searching PubMed, Medline, ISI Web of Science, Science Direct, Physiotherapy Evidence Database (PEDro), and the Cochrane Library for all available years until December 2023. Our primary outcomes were PPCs including atelectasis and Pneumonia and secondary outcomes were length of intensive care unit and hospital stay. Results: Twenty-one included trials provide data on 2895 participants. The preoperative intervention of inspiratory muscle training (IMT) significantly reduced the PPCs including atelectasis (OR: 0.49, 95%CI: 0.28, 0.86) and Pneumonia (OR: 0.41, 95%CI: 0.25, 0.67) in cardiac patients compared with the control group. Preoperative exercise training intervention is significantly associated with a lower risk (OR: 0.15, 95%CI: 0.06, 0.38) of composite PPCs (i.e. atelectasis and Pneumonia) in the intervention group. Preoperative IMT significantly reduced the postoperative hospital stay by -1.57 days (95% CI: -2.33, -0.81) in the intervention group. Preoperative exercise training significantly decreased the postoperative intensive care unit stay by -2.22 hours (95% CI: -3.05, -1.38) and hospital stay by -1.82 days (95% CI: -3.38, -0.27) in the intervention group. Conclusion: Preoperative intervention of IMT and exercise training significantly reduce PPCs and hospital stay in patients undergoing cardiac surgery.

Sharing Stories Versus Explaining Facts: Comparing African American Children's Microstructure Performance Across Fictional Narrative, Informational, and Procedural Discourse.

Both fictional oral narrative and expository oral discourse skills are critical language competencies that support children's academic success. Few studies, however, have examined African American children's microstructure performance across these genres. To address this gap in the literature, the study compared African American children's microstructure productivity and complexity across three discourse contexts: fictional narratives, informational discourse, and procedural discourse. The study also examined whether there were age-related differences in microstructure performance by discourse type. Participants were 130 typically developing African American children, aged 59-95 months old, enrolled in kindergarten through second grades in a Midwestern U.S. public school district. Wordless children's books were used to elicit fictional narratives, informational, and procedural discourse. Indicators of microstructure performance included measures of productivity (i.e., number of total words and number of different words) and complexity (i.e., mean length of communication unit and complex syntax rate). The effects of genre and age on microstructure performance were assessed using linear mixed-effects regression models. Children produced longer discourse and used a greater diversity of words for their fictional stories compared to their informational or procedural discourse. Grammatical complexity was greater for fictional narratives and procedural discourse than informational discourse. Results showed greater productivity and complexity among older children compared to younger children, particularly for fictional and informational discourse. African American children exhibit variation in their microstructure performance by discourse context and age. Understanding this variation is key to providing African American children with support to maximize their oral language competencies.

Medical and social factors associated with prolonged length of stay for chronically ventilated children.

This study seeks to determine the overall and post-intensive care unit (ICU) length of stay (LOS) for children with tracheostomies and chronic mechanical ventilation. We hypothesized that medical and social factors would be associated with prolonged LOS. This single-center retrospective review included children who were discharged after initiation of chronic ventilation via tracheostomy over an 8-year period (2015-2022). Patients were divided into two groups for analysis, those who had been previously home before admission (HBA) and those who had not (Not HBA). Medical and social determinants of health (SDOH) data were obtained from the electronic medical record for univariate and multivariable analyses. A total of 161 patients were included. HBA subjects (n = 52) were expectedly older at the time of tracheostomy. Not HBA subjects (n = 109) were more likely to be born prematurely and have sequelae of premature birth. Overall and post-ICU LOS increased for both groups during the study period. In the HBA subgroup, congenital heart disease and younger age were associated with longer overall LOS with these factors and the absence of gastric fundoplication being associated with longer post-ICU LOS. For Not HBA patients, younger age, pulmonary hypertension, seizures, and several SDOH were associated with longer overall LOS, whereas only SDOH were associated with a longer post-ICU LOS. Overall and post-ICU LOS for all children hospitalized for tracheostomy and chronic mechanical ventilation are increasing. Prolonged LOS is significantly associated with several medical factors and SDOH.

Efficacy and Safety of Andexanet Alfa Versus Four Factor Prothrombin Complex Concentrate for Emergent Reversal of Factor Xa Inhibitor Associated Intracranial Hemorrhage: A Systematic Review and Meta-Analysis.

Factor Xa inhibitors (FXaI) are increasingly used for anticoagulation therapy, yet their association with intracranial hemorrhage poses a significant challenge. Although andexanet alfa (AA) and four-factor prothrombin complex concentrate (4F-PCC) have shown promise in reversing FXaI effects, their comparative efficacy and safety remain uncertain. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a literature search on electronic databases to obtain the relevant studies until May 16, 2024. Our primary outcomes were successful anticoagulation reversal, overall mortality (including 30-day and in-hospital mortality), and thromboembolic events. Secondary outcomes were length of hospital and intensive care unit stay and hematoma volume expansion. Data were pooled using a random-effects model. We included 16 eligible studies with a total of 2,977 patients. A statistically significant improvement in hemostatic efficacy rates was in favor of the AA group (risk ratio [RR] 1.10, 95% confidence interval [CI] 1.01-1.20, P = 0.02). Lower overall mortality rates were found in the AA group (RR 0.67, 95% CI 0.51-0.88, P = 0.004). However, no difference was found in 30-day mortality rates (RR 0.82, 95% CI 0.58-1.16, P = 0.26). In terms of thromboembolic events, more events were found in the AA group (RR 1.47, 95% CI 1.01-2.15, P = 0.046). AA was associated with a longer duration of hospital stay compared to 4F-PCC (mean difference [MD] 0.64, 95% CI 0.07-1.22, P = 0.03). Neither a significant difference in length of intensive care unit stay (MD 0.25, 95% CI - 0.36 to 0.86, P = 0.41) nor a significant difference in hematoma volume expansion was reported (MD - 0.89, 95% CI - 3.11 to 1.34, P = 0.435). Our results suggest that AA is superior to 4F-PCC in enhancing the hemostatic efficacy and reducing the overall and in-hospital mortality rates. More thromboembolic events are thought to be associated with the use of AA. However, more studies are required to validate whether the better results of AA in improving hemostatic efficacy are enough to make up for their higher cost and their possible risk of thromboembolic events.