Extracorporeal support prognostication-time to move the goal posts?

Advances in extracorporeal membrane oxygenation (ECMO) technology are associated with expanded indications, increased utilization and improved outcome. There is growing interest in developing ECMO prognostication scores to aid in bedside decision making. To date, the majority of available scores have been limited to mostly registry-based data and with mortality as the main outcome of interest. There continues to be a gap in clinically applicable decision support tools to aid in the timing of ECMO cannulation to improve patients\u27 long-term outcomes. We present a brief review of the commonly available adult and pediatric ECMO prognostication tools, their limitations, and future directions

Comprehensive assessment of a nationwide simulation-based course for artificial life support

BACKGROUND: Successful implementation of medical technologies applied in life-threatening conditions, including extracorporeal membrane oxygenation (ECMO) requires appropriate preparation and training of medical personnel. The pandemic has accelerated the creation of new ECMO centers and has highlighted continuous training in adapting to new pandemic standards. To reach high standards of patients\u27 care, we created the first of its kind, National Education Centre for Artificial Life Support (NEC-ALS) in 40 million inhabitants\u27 country in the Central and Eastern Europe (CEE). The role of the Center is to test and promote the novel or commonly used procedures as well as to develop staff skills on management of patients needing ECMO. METHOD: In 2020, nine approved and endorsed by ELSO courses of Artificial Life Support with ECMO were organized. Physicians participated in the three-day high-fidelity simulation-based training that was adapted to abide by the social distancing norms of the COVID-19 pandemic. Knowledge as well as crucial cognitive, behavioral and technical aspects (on a 5-point Likert scale) of management on ECMO were assessed before and after course completion. Moreover, the results of training in mechanical chest compression were also evaluated. RESULTS: There were 115 participants (60% men) predominantly in the age of 30-40 years. Majority of them (63%) were anesthesiologists or intensivists with more than 5-year clinical experience, but 54% had no previous ECMO experience. There was significant improvement after the course in all cognitive, behavioral, and technical self-assessments. Among aspects of management with ECMO that all increased significantly following the course, the most pronounced was related to the technical one (from approximately 1.0 to more 4.0 points). Knowledge scores significantly increased post-course from 11.4 ± SD to 13 ± SD (out of 15 points). The quality of manual chest compression relatively poor before course improved significantly after training. CONCLUSIONS: Our course confirmed that simulation as an educational approach is invaluable not only in training and testing of novel or commonly used procedures, skills upgrading, but also in practicing very rare cases. The implementation of the education program during COVID-19 pandemic may be helpful in founding specialized Advanced Life Support centers and teams including mobile ones. The dedicated R&D Innovation Ecosystem established in the ECMO for Greater Poland program, with developed National Education Center can play a crucial role in the knowledge and know-how transfer but future research is needed

Association between aortic sclerosis and coronary artery disease

Background: Although there is a recognized link between cardiovascular hazards and coronary artery disease (CAD), it is still unknown whether aortic sclerosis and CAD are linked.Objective: This study aimed to check whether if there is a link between aortic sclerosis and the existence and severity of coronary artery disease .Patients and methods: 204 individuals were enrolled in the study, transthoracic echocardiographic, and coronary angiography were done. Aortic leaflets were tested for the amount of thickness in the short axis view. The involvement of coronary arteries represented by the gensini score and the association between aortic valve sclerosis score and the degree and severity of coronary affection was investigated using the Gensini score.Results: The individuals were divided into 2 groups grounded on the severity of aortic valve sclerosis. Group A (GP A) included patients with aortic valve sclerosis (AVS) ≥ 2 and group B (GP B) included patients with AVS < 2. In GP A, the right coronary cusp was the most afflicted one, whereas the LAD was the most affected in coronaries. The degree and severity of CAD were more significant in GP A, as evidenced by a higher Gensini score value of 39.27 versus 28.84 in GP B.Conclusion: AVS has been found to be correlated with the presence and severity of CAD and could be used as a potential surrogate marker for the illness

CXCR3 renal expression in glomerulonephritis in children: is there a connection with the course of the disease?

Background: Glomerulonephritis (GN) is a common childhood disease that may represent a significant cause of chronic kidney disease at one point of its course. The role of chemokines in glomerulonephritis, has been long anticipated and studied and the possible link between certain chemokines and different renal pathologies, if proved, can pave the road for future use of such markers for early prognosis and possible therapies for this common disease.Objective: in this study, we aimed at detecting CXCR3 in the renal biopsies done for children with glomerulonephritis and to correlate it to the nature of renal pathology and response to therapy.Methods: The glomerular and interstitial expression of CXCR3 in renal biopsies done for 22 patients with glomerulonephritis was studied using immunohistochemical staining. Pathologies already diagnosed in these biopsies were proliferative GN (mesangioproliferative GN, diffuse proliferative GN, focal proliferative GN, IgA nephropathy and crescentic GN) as well as non-proliferative GN (Minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, diffuse mesangial sclerosis and advanced hypertensive nephrosclerosis). History, clinical findings and laboratory investigations in the initial presentation and at the time of the study were obtained.Results: The degree of glomerular and interstitial CXCR3 expression did not vary with gender, age of presentation, response to steroids, or cumulative doses of steroids. Percentage of strong glomerular CXCR3 expression was much higher in proliferative GN compared to non-proliferative GN although the difference was not statistically significant, percentage of renal dysfunction was more among strong glomerular and mild/moderate interstitial CXCR3 expression with no statistically significant difference from the counterparts.Conclusion: Our study revealed that enhanced CXCR3 renal expression on glomerular and interstitial levels did not affect the response to steroids along the course of the disease and so can probably act as a therapeutic target rather than a prognostic marker.Keywords: glom. CXCR3, int. CXCR3, glomerulonephritis, renal biops

Mitigation Measures for Gaza Coastal Erosion

Coastal erosion is an ongoing hazard affecting Gaza beach, but is worsening due to a wide range of human activities such as the construction of Gaza fishing harbor in 1994-1998. The net annual alongshore sediment transport is about 190×103 m3, but can vary significantly depending on the severity of winter storms. According to the observed wave heights and directions, the net waves are cross-shore, therefore vast quantities of sediments may transfer to deep sea. The main objective of this study is to mitigate the erosion problem of Gaza coast. Change detection analysis was used to compute the spatial and temporal change of Gaza shoreline between 1972 and 2010. The results show negative rates in general, which means that the erosion was the predominant process. Gaza fishing harbor caused a serious damage to the Beach Camp shoreline. Consequently, several mitigation measures were considered in this study, which are: relocation of Gaza fishing harbor to offshore, groins, detached breakwaters, wide-crested submerged breakwaters and beach nourishment. Several numerical model tests associated with coastal structures are conducted to investigate the influence on morphodynamics. The results show that the relocation of the harbor is the best alternative to stop trapping of the sediments. If for any reason the relocation was not carried out, the wide-crested submerged breakwater alternative is an effective structure for preventing sandy beach erosion. The artificial reef type of submerged breakwaters with beach nourishment is recommended for Gaza beach, because it is an environmentally friendly and improving the ecosystem of marine life

The Impact of Gaza Fishing Harbour on the Mediterranean Coast of Gaza

The Mediterranean coast of Gaza strip, which is covered about 40 km in length, is rich by coastal resources. The development that occurred along the coastal lines has led to the host of problems such as increased erosion, siltation, loss of coastal resources and the destruction of the fragile marine habitats. In order to conserve the depleting coastal resources, the changes due to development and associated activities must be monitored. Studying the temporal pattern of shoreline change is considered one of the most effective means of monitoring the cumulative effects of different activities. An attempt was made to study the impact of Gaza harbour on shoreline displacement along 6 km. This paper was intended to detect changes of coastal area in Gaza city to provide future database in coastal management studies. The analysis was carried out using image processing technique (ERDAS) and Geographical Information System platform. The variation during 38 years in the shoreline along the Gaza coast was determined by analyzing MSS, TM and ETM Landsat images from 1972 to 2010. The analyses identified the erosion and accretion patterns along the coast. The shoreline was advanced south of the Gaza fishing harbor, where the wave-induced littoral transport was halted by southern breakwater and the annual beach growth rate was 15,900 m2. On the downdrift side of the harbor, the shoreline was retreating and beaches erode at an annual rate of -14,000 m2. This study was emphasized that the coastal band is considered as a critical area, it is therefore necessary to monitor coastal zone changes because of the importance of environmental parameter and human disturbance. In particular, the projections of future shoreline erosion and accretion rates are considered important for long-term planning and environmental assessment for a variety of projects, including the construction and tourism facilities

Enhancing the drilling efficiency through the application of machine learning and optimization algorithm.

This article presents a novel Artificial Intelligence (AI) workflow to enhance drilling performance by mitigating the adverse impact of drill-string vibrations on drilling efficiency. The study employs three supervised machine learning (ML) algorithms, namely the Multi-Layer Perceptron (MLP), Support Vector Regression (SVR), and Regression Decision Tree (DTR), to train models for bit rotation (Bit RPM), rate of penetration (ROP), and torque. These models combine to form a digital twin for a drilling system and are validated through extensive cross-validation procedures against actual drilling parameters using field data. The combined SVR - Bit RPM model is then used to categorize torsional vibrations and constrain optimized parameter selection using the Particle Swarm Optimisation block (PSO). The SVR-ROP model is integrated with a PSO under two constraints: Stick Slip Index (SSI<0.05) and Depth of Cut (DOC<5 mm) to further improve torsional stability. Simulations predict a 43% increase in ROP and torsional stability on average when the optimized parameters WOB and RPM are applied. This would avoid the need to trip in/out to change the bit, and the drilling time can be reduced from 66 to 31 hours. The findings of this study illustrate the system's competency in determining optimal drilling parameters and boosting drilling efficiency. Integrating AI techniques offers valuable insights and practical solutions for drilling optimization, particularly in terms of saving drilling time and improving the ROP, which increases potential savings

Spare Opioid Use Protocol Improved the Outcomes of the Enhanced Recovery after Surgery Protocol for Patients Undergoing Laparoscopic Sleeve Gastrectomy for Morbid Obese Patients

Background: Obesity and intraoperative (IO) opioid are risk-factors during bariatric surgery and require certain manipulations to deal with. Enhanced recovery after surgery (ERAS) and spare-opioid use protocol (SOUP) might aid to bypass these risk factors Objectives: Evaluation of the outcomes of ERAS protocol with SOUP application for morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). Patients and methods: 60 obese patients were allocated into Group-C received conventional opioid-based anaesthesia and postoperative (PO) analgesia and Group-E received the ERAS protocol with SOUP application. All patients received balanced sevoflurane anesthesia 2% in oxygen 100% and rocuronium and 4-ports LSG. The study outcome is the efficacy of the applied protocol to provide IO and PO opioid-free analgesia during major surgeries for risky patients. Results: All surgeries were conducted without a shift to laparotomy or conventional opioid-based anesthesia. Group-E patients had significantly shorter PACU stays (P=0.035) and higher Aldrete scores at time of PACU discharge (P=0.023). Among Group-E patients, 5 required IO fentanyl shots and 3 patients received PO morphine shots. Group-E patients showed significantly lower PO nausea (P=0.032) and need for antiemetic therapy (P=0.005), earlier ambulation (P=0.020) and oral intake (P=0.034) and hospital discharge (P=0.014). Conclusion: Implementation of ERAS with SOUP protocols is a feasible, effective and safe anesthetic policy for high-risk patients undergoing major surgeries. The applied SOUP spared the need for opioid analgesia in about 90% of patients. The applied anesthetic policy improved immediate surgical outcomes, and reduced times for PACU discharge, ambulation, oral intake and PO hospital stay with cost reductions