Triple Cannulation ECMO

Extracorporeal membrane oxygenation (ECMO) has emerged as an invaluable tool for bridging severe isolated or combined failure of lung and heart. Due to massive technical improvements, the application of ECMO is growing fast. While historically ECMO was initiated and maintained by cardiac surgeons, in recent times interventional cardiologists and intensive care specialists increasingly run ECMO systems independently with great success. Percutaneous ECMO circuits are usually set up in a dual cannulation mode, either as veno-venous or as veno-arterial configuration. A novel advanced strategy is the cannulation of three large vessels (triple cannulation), resulting in veno-veno-arterial or veno-arterio-venous cannulation. Both veno-venous and veno-arterio-venous cannulation may further be upgraded to veno-pulmonary-arterial or veno-arterial-pulmonary arterial cannulation, respectively. Triple cannulation expands the field of ECMO application but substantially increases the complexity of ECMO circuits. In this chapter, we review percutaneous dual and triple cannulation strategies, featuring a recently proposed unifying nomenclature. This unequivocal code universally applies to both dual and triple cannulation strategies (VV, VPa, VA, VVA, VAV, VAPa). The technical evolution of ECMO is growing fast, but it has to be noted that current knowledge of ECMO support is mainly based on observation. Thus controlled trials are urgently needed to prospectively evaluate different ECMO modes

Ruminant pestiviruses in North Africa

Ruminant pestiviruses are widely distributed worldwide, causing congenital disease and massive economic losses. Although ruminant production is an important economic sector in North Africa, the knowledge about pestiviruses is scarce. The present study aimed at assessing the presence of Pestivirus in cattle in Algeria, and to review the data available on ruminant pestiviruses in North Africa. A cross-sectional study was conducted on dairy farms from North-Western Algeria. Blood samples from 234 dairy cattle from 31 herds were collected. All sera were analysed for the presence of antibodies using a commercial iELISA. The presence of Pestivirus RNA was also assessed by using a Reverse Transcription-PCR, and PCR-positive samples were sequenced. Risk factors related to Pestivirus infection were also analysed. The review of the presence of ruminant pestiviruses in North Africa was performed using a systematic search and compilation methodology of the peer-reviewed literature available in order to identify gaps of knowledge for future research. The seroprevalence at population and farm levels obtained in the present study (59.9% and 93.5%, respectively) concur with data reported in neighbouring countries. Risk factors associated with Pestivirus infection in cattle were the presence of sheep in the herd and the animal category (cow vs heifer). Furthermore, we confirmed the presence of BVDV-1a in Algeria. The scarce data suggest an endemic epidemiological scenario of pestivirus in livestock. The lack of studies about the epidemiology and molecular variability of ruminant pestiviruses in livestock and wildlife in North Africa is of concern for animal health and wildlife conservation, and needs to be addressed.info:eu-repo/semantics/acceptedVersio

Efficient classical simulation of random shallow 2D quantum circuits

Random quantum circuits are commonly viewed as hard to simulate classically. In some regimes this has been formally conjectured, and there had been no evidence against the more general possibility that for circuits with uniformly random gates, approximate simulation of typical instances is almost as hard as exact simulation. We prove that this is not the case by exhibiting a shallow circuit family with uniformly random gates that cannot be efficiently classically simulated near-exactly under standard hardness assumptions, but can be simulated approximately for all but a superpolynomially small fraction of circuit instances in time linear in the number of qubits and gates. We furthermore conjecture that sufficiently shallow random circuits are efficiently simulable more generally. To this end, we propose and analyze two simulation algorithms. Implementing one of our algorithms numerically, we give strong evidence that it is efficient both asymptotically and, in some cases, in practice. To argue analytically for efficiency, we reduce the simulation of 2D shallow random circuits to the simulation of a form of 1D dynamics consisting of alternating rounds of random local unitaries and weak measurements -- a type of process that has generally been observed to undergo a phase transition from an efficient-to-simulate regime to an inefficient-to-simulate regime as measurement strength is varied. Using a mapping from quantum circuits to statistical mechanical models, we give evidence that a similar computational phase transition occurs for our algorithms as parameters of the circuit architecture like the local Hilbert space dimension and circuit depth are varied

Chemotherapy versus supportive care in advanced non-small cell lung cancer: improved survival without detriment to quality of life

BACKGROUND: In 1995 a meta-analysis of randomised trials investigating the value of adding chemotherapy to primary treatment for non-small cell lung cancer (NSCLC) suggested a small survival benefit for cisplatin-based chemotherapy in each of the primary treatment settings. However, the metaanalysis included many small trials and trials with differing eligibility criteria and chemotherapy regimens. METHODS: The aim of the Big Lung Trial was to confirm the survival benefits seen in the meta-analysis and to assess quality of life and cost in the supportive care setting. A total of 725 patients were randomised to receive supportive care alone (n = 361) or supportive care plus cisplatin-based chemotherapy (n = 364). RESULTS: 65% of patients allocated chemotherapy (C) received all three cycles of treatment and a further 27% received one or two cycles. 74% of patients allocated no chemotherapy (NoC) received thoracic radiotherapy compared with 47% of the C group. Patients allocated C had a significantly better survival than those allocated NoC: HR 0.77 (95% CI 0.66 to 0.89, p = 0.0006), median survival 8.0 months for the C group v 5.7 months for the NoC group, a difference of 9 weeks. There were 19 (5%) treatment related deaths in the C group. There was no evidence that any subgroup benefited more or less fromchemotherapy. No significant differences were observed between the two groups in terms of the pre-defined primary and secondary quality of life end points, although large negative effects of chemotherapy were ruled out. The regimens used proved to be cost effective, the extra cost of chemotherapy being offset by longer survival. CONCLUSIONS: The survival benefit seen in this trial was entirely consistent with the NSCLC meta-analysis and subsequent similarly designed large trials. The information on quality of life and cost should enablepatients and their clinicians to make more informed treatment choices

The contribution of non-CO2 greenhouse gas mitigation to achieving long-term temperature goals

In the latest (fifth) assessment from the Intergovernmental Panel on Climate Change (IPCC) non-CO2 emssions accounted for 28% of total GHG emissions in 2010, when measured on the basis of their global warming potential (relative to CO2) over a 100-year and nitrous oxide (N2O) accounting for about half of all non-CO2 GHGs. With population and incomes increasing, especially in emerging economies, these emissions could grow significantly in the future. Other major sources of non-CO2 GHGs are fugitive CH4 from the extraction and distribution of fossil fuels, N2O from industrial production of nitric and adipic acid, as well as fluorinated gases (F-gases) from a range of industrial manufacturing and product uses. This paper analyses the emissions and cost impacts of mitigation of non-CO2 greenhouse gases (GHGs) at a global level, in scenarios which are focused on meeting a range of long-term temperature goals (LTTGs). The paper demonstrates how an integrated assessment model (TIAM-Grantham) representing CO2 emissions (and their mitigation) from the fossil fuel combustion and industrial sectors is coupled with a model covering non-CO2 emissions (GAINS) in order to provide a complete picture of GHG emissions in a reference scenario in which there is no mitigation of either CO2 or non-CO2 gases, as well as in scenarios in which both CO2 and non-CO2 gases are mitigated in order to achieve different LTTGs

Protected percutaneous coronary intervention with Impella CP in a patient with left main disease, severe left ventricular systolic dysfunction and established hemolysis

bstract: The use of the Impella device in patients with left ventricular (LV) systolic impairment undergoing left main (LM) percutaneous coronary intervention (PCI) has been growing exponentially. Data from observational studies and registries demonstrate that Impella-assisted high-risk PCI is safe and effective with a low rate of peri-procedural complications. Hemolysis is a potential limitation of virtually all mechanical circulatory support devices and a small incidence of hemolysis has been associated with Impella use. The safety and feasibility of Impella use in patients with established hemolysis has not been previously evaluated. We report the first described case in the literature of Impella-assisted left main stem (LMS) PCI in a patient with severe LV systolic dysfunction and autoimmune hemolytic anemia (AIHA). Despite the patient's high bleeding risk (active hemolysis, thrombocytopenia, impaired renal function, use of steroids), Impella placement and PCI were successfully performed without complication. Haemoglobin, bilirubin and lactate dehydrogenase (LDH) levels were closely monitored peri-procedurally with no evidence of exacerbation of the patient’s hemolysis. We briefly discuss the mechanism of Impella-induced hemolysis and factors that can exacerbate hemolysis