Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support A Practical Approach

© 2023 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolysis. A standardized approach to the prevention, detection, and treatment of these complications is mandatory to improve outcomes. The risk for hemolysis is mostly influenced by pump instability, resulting from patient- or device-related factors. Upfront echocardiographic assessment, frequent monitoring, and prompt intervention are essential. The precarious hemostatic balance during pVAD support results from the combination of a procoagulant state, due to critical illness and contact pathway activation, together with a variety of factors aggravating bleeding risk. Preventive strategies and appropriate management, adapted to the impact of the bleeding, are crucial. This review offers a guide to physicians to tackle these device-related complications in this critically ill pVAD-supported patient population.Peer reviewe

TBX2 is a neuroblastoma core regulatory circuitry component enhancing MYCN/FOXM1 reactivation of DREAM targets

Chromosome 17q gains are almost invariably present in high-risk neuroblastoma cases. Here, we perform an integrative epigenomics search for dosage-sensitive transcription factors on 17q marked by H3K27ac defined super-enhancers and identify TBX2 as top candidate gene. We show that TBX2 is a constituent of the recently established core regulatory circuitry in neuroblastoma with features of a cell identity transcription factor, driving proliferation through activation of p21-DREAM repressed FOXM1 target genes. Combined MYCN/TBX2 knockdown enforces cell growth arrest suggesting that TBX2 enhances MYCN sustained activation of FOXM1 targets. Targeting transcriptional addiction by combined CDK7 and BET bromodomain inhibition shows synergistic effects on cell viability with strong repressive effects on CRC gene expression and p53 pathway response as well as several genes implicated in transcriptional regulation. In conclusion, we provide insight into the role of the TBX2 CRC gene in transcriptional dependency of neuroblastoma cells warranting clinical trials using BET and CDK7 inhibitors

Die entwicklungspolitische Tagung in der Krise. Ketzerische Bemerkungen zu einer gängigen Praxis

Immer wieder hört man darüber klagen, daß entwicklungspolitische Seminare mangels Teilnehmer/innen ausfallen, und daß diese sich stattdessen zunehmend "unpolitischen" Themen wie "Bioenergetik", "Astrologie" oder "Makrobiotik" zuwenden und dafür auch noch horrende Teilnahmebeiträge auf den Tisch blättern. Ist das der Verfall der politischen (Gegen)Kultur? (DIPF/Orig.

Boundary Layer Separation and Reattachment Detection on Airfoils by Thermal Flow Sensors

A sensor concept for detection of boundary layer separation (flow separation, stall) and reattachment on airfoils is introduced in this paper. Boundary layer separation and reattachment are phenomena of fluid mechanics showing characteristics of extinction and even inversion of the flow velocity on an overflowed surface. The flow sensor used in this work is able to measure the flow velocity in terms of direction and quantity at the sensor’s position and expected to determine those specific flow conditions. Therefore, an array of thermal flow sensors has been integrated (flush-mounted) on an airfoil and placed in a wind tunnel for measurement. Sensor signals have been recorded at different wind speeds and angles of attack for different positions on the airfoil. The sensors used here are based on the change of temperature distribution on a membrane (calorimetric principle). Thermopiles are used as temperature sensors in this approach offering a baseline free sensor signal, which is favorable for measurements at zero flow. Measurement results show clear separation points (zero flow) and even negative flow values (back flow) for all sensor positions. In addition to standard silicon-based flow sensors, a polymer-based flexible approach has been tested showing similar results