Search results for: congenitally corrected transposition of great arteries

Authors: Arun C. Gulani, Aaishwariya A. Gulani, Amanda Southall

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Background: Laser Corneoplastique™ as a least interventional, visually promising technique for patients with vision disability from corneal scars of varied causes has been retrospectively reviewed and proves to cause a paradigm shift in mindset and approach towards corneal scars as a Refractive surgery aiming for emmetropic, unaided vision of 20;/20 in most cases. Three decades of work on this technique has been compiled in this 15-year study. Subject and Methods: The objective of this study was to determine the success of Laser Corneoplastique™ surgery as a treatment of corneal scar cases. A survey of corneal scar cases caused by various medical histories that had undergone Laser Corneoplastique™ surgery over the past twenty years by a single surgeon Arun C. Gulani, M.D. were retrospectively reviewed. The details of each of the cases were retrieved from their medical records and analyzed. Each patient had been examined thoroughly at their preoperative appointments for stability of refraction and vision, depth of scar, pachymetry, topography, pattern of the scar and uncorrected and best corrected vision potential, which were all taken into account in the patients' treatment plans. Results: 64 eyes of 53 patients were investigated for scar etiology, keratometry, visual acuity, and complications. There were 25 different etiologies seen, with the most common being a Herpetic scar. The average visual acuity post-op was, on average, 20/23.55 (±7.05). Laser parameters used were depth and pulses. Overall, the mean Laser ablation depth was 30.67 (±19.05), ranging from 2 to 73 µm. Number of Laser pulses averaged 191.85 (±112.02). Conclusion: Refractive Laser Corneoplastique™ surgery, when practiced as an art, can address all levels of ametropia while reversing complex corneas and scars from refractive surgery complications back to 20/20 vision.

Keywords: corneal scar, refractive surgery, corneal transplant, laser corneoplastique

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Authors: Eva Kirzner

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Based on outcome studies published over the past two decades, in 2018, the ACC/AHA published new guidelines for the management of hypercholesterolemia that incorporate the use of coronary artery calcium (CAC) scanning as a decision tool for ascertaining which patients may benefit from statin therapy. This use is based on the recognition that the absence of calcium on CAC scanning (i.e., a CAC score of zero) usually signifies the absence of significant atherosclerotic deposits in the coronary arteries. Specifically, in patients with a high risk for atherosclerotic cardiovascular disease (ASCVD), initiation of statin therapy is generally recommended to decrease ASCVD risk. However, among patients with intermediate ASCVD risk, the need for statin therapy is less certain. However, there is a need for new outcome studies that provide evidence that the management of hypercholesterolemia based on these new ACC/AHA recommendations is safe for patients. Based on a Pub-Med and Google Scholar literature search, four relevant population-based or patient-based cohort studies that studied the relationship between CAC scanning, risk assessment or mortality, and statin therapy that were published between 2017 and 2021 were identified (see references). In each of these studies, patients were assessed for their baseline risk for atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohorts Equation (PCE), an ACC/AHA calculator for determining patient risk based on assessment of patient age, gender, ethnicity, and coronary artery disease risk factors. The combined findings of these four studies provided concordant evidence that a zero CAC score defines patients who remain at low clinical risk despite the non-use of statin therapy. Thus, these new studies confirm the use of CAC scanning as a safe tool for reducing the potential overuse of statin therapy among patients with zero CAC scores. Incorporating these new data suggest the following best practice: (1) ascertain ASCVD risk according to the PCE in all patients; (2) following an initial attempt trial to lower ASCVD risk with optimal diet among patients with elevated ASCVD risk, initiate statin therapy for patients who have a high ASCVD risk score; (3) if the ASCVD score is intermediate, refer patients for CAC scanning; and (4) and if the CAC score is zero among the intermediate risk ASCVD patients, statin therapy can be safely withheld despite the presence of an elevated serum cholesterol level.

Keywords: cholesterol, cardiovascular disease, statin therapy, coronary calcium

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Authors: Fanniyah Anis, Bram Kilapong

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Myocardial reperfusion injury is defined as the cellular damage that results from a period of ischemia, followed by the reestablishment of the blood supply to the infarcted tissue. Ventricular tachycardia is one of the most commonly encountered reperfusion arrhythmia as one of the types of myocardial perfusion injury. Prompt and early treatment can reduce mortality, despite limited resources of the hospital in high risk patients with history of triple vessel disease. Case report, Male 53 years old has been diagnosed with NSTEMI with 3VD and comorbid disease of Hypertension and has undergone revascularization management with Percutaneous coronary intervention. Ventricular tachycardia leading to cardiac arrest occurred right after the stent was inserted. Resuscitation was performed for almost 2 hours until spontaneous circulation returned. Patient admitted in ICU with refractory cardiac shock despite using combination of ionotropic and vasopressor agents under standard non-invasive monitoring due to the limitation of the hospital. Angiography was performed again 5 hours later to exclude other possibilities of blockage of coronary arteries and conclude diagnosis of myocardial reperfusion injury. Patient continually managed with combination of antiplatelet agents and maintenance dose of anti-arrhythmia agents. The handling of the patient was to focus more on supportive and preventive from further deteriorating of the condition. Patient showed clinically improvement and regained consciousness within 24 hours. Patient was successfully discharged from ICU within 3 days without any neurological sequela and was discharge from hospital after 3 days observation in general ward. Limited Resource of hospital did not refrain the physician from attaining a good outcome for this myocardial reperfusion injury case and angiography alone can be used to confirm the diagnosis of myocardial reperfusion injury.

Keywords: limited resources hospital, myocardial reperfusion injury, prolonged resuscitation, refractory cardiogenic shock, reperfusion arrhythmia, revascularization, triple-vessel disease

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Authors: Mohanad Hammad

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Port institutions serve as a link connecting the land areas that receive the goods and the areas from where ships sail. These areas hold great significance for the conversion of goods into commodities of economic value, capable of meeting the needs of the society. Development of ports constitutes a fundamental component of the comprehensive economic development process. Recognizing this fact, developing countries have always resorted to this infrastructural element to resolve the numerous problems they face, taking into account its contribution to the reformation of their economic conditions. Iraqi ports have played a major role in boosting the commercial movement in Iraq, as they are the starting point of its oil exports and a key constituent in fulfilling the consumer and production needs of the various economic sectors of Iraq. With the Gulf wars and the economic blockade, Iraqi ports have continued to deteriorate and become unable to perform their functions as first-generation ports, prompting Iraq to use the ports of neighboring countries such as Jordan's Aqaba commercial port. Meanwhile, Iraqi ports face strong competition from the ports of neighboring countries, which have achieved progress and advancement as opposed to the declining performance and efficiency of Iraqi ports. The great developments in the economic conditions of Iraq lay a too great burden on the Iraqi maritime transport and ports, which require development in order to be able to meet the challenges arising from the fierce international and regional competition in the markets. Therefore, it is necessary to find appropriate solutions in support of the role that can be played by Iraqi ports in serving Iraq's foreign trade transported by sea and in keeping up with the development of foreign trade. Thus, this research aims at tackling the current situation of the Iraqi ports and their commercial activity and studying the problems and obstacles they face. The research also studies the future prospects of these ports, the potentials of maritime openness to Iraq under the fierce competition of neighboring ports, and the possibility of enhancing Iraqi ports’ competitiveness. Among the results produced by this research is the future scenario it proposes for Iraqi ports, mainly represented in the establishment of Al-Faw Port, which will contribute to a greater openness of maritime transport in Iraq, and the rehabilitation and expansion of existing ports. This research seeks to develop solutions to Iraq ports so that they can be repositioned as a vital means of promoting economic development.

Keywords: maritime transport, port, future prospects, regional integration

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Authors: Fauzik Lendriyono, Isbandi Rukminto Adi

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Muhammadiyah is an Islamic-based organization taking care to human suffering. The existence of Muhammadiyah organization is strong supported by its members. Muhammadiyah as the oldest Islamic organization in Indonesia, since its establishment has had main activities, such as in the fields of education, health, and social services, one of the form is Orphanage. However, at present, Muhammadiyah orphanage was in a dilemma because of differences in orientation and commitment of the caretaker-managers. This research on Muhammadiyah orphanage is very important because it is able to know the problem identification and to find the ideal concept for the better management of an orphanage in Muhammadiyah. This research is a phenomenology study by research subjects: caretaker of the orphanage in Muhammadiyah at Great Malang. The research data was obtained after the observation, in-depth interviews, review of documentation and the discussion focused. Data were analyzed with interpretative phenomenological analysis. Basic problems for causes of differences in orientation and commitment administrators of Muhammadiyah orphanage is the influence of organizational culture and organizational environment factors. Organizational culture factors include the Islamic-based value and organization ideology, so that the Islamic values and the values of Muhammadiyah are used as guidelines in the orphanage. Environmental factors include the demand for its organization sustainability as characterized by economically productive activities organized by Orphanage and a program to produce a cadre of Muhammadiyah. To support the social welfare of Muhammadiyah, the ideal Orphanage concept for Muhammadiyah is a missionary and self-sufficient orphanage.

Keywords: orphanage, Muhammadiyah, misionary, Great Malang

Procedia PDF Downloads 186

Authors: Wissam Aljundi, Loay Daas, Yaser Abu Dail, Barbara Käsmann-Kellner, Berthold Seitz, Alaa Din Abdin

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Purpose: To investigate the effectiveness of nonsteroidal anti-inflammatory eye drops (NSAIDs) combined with oral acetazolamide for postoperative macular edema (PME) after uncomplicated phacoemulsification (PE) and to identify predictors of non-response. Methods: We analyzed data of uncomplicated PE and identified eyes with PME. First-line therapy included topical NSAIDs combined with oral acetazolamide. In case of non-response, triamcinolone was administered subtenonally. Outcome measures included best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: 94 eyes out of 9750 uncomplicated PE developed PME, of which 60 eyes were included. Follow-ups occurred 6.4±1.8, 12.5±3.7, and 18.6±6.0 weeks after diagnosis. BCVA and CMT improved significantly in all follow-ups. 40 eyes showed response to first-line therapy at first follow-up (G1). The remaining 20 eyes showed no response and required subtenon triamcinolone (G2), of which 11 eyes showed complete regression at the second follow-up and 4 eyes at the third follow-up. 5 eyes showed no response and required intravitreal injection. Multivariate linear regression model showed that diabetes mellitus (DM) and increased cumulative dissipated energy (CDE) are predictors of non-response. Conclusion: Topical NSAIDs with acetazolamide resulted in complete regression of PME in 67% of all cases. DM and increased CDE might be considered as predictors of nonresponse to this treatment.

Keywords: postoperative macular edema, intravitreal injection, cumulative energy, irvine gass syndrome, pseudophakie

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Authors: Shorena Pharjiani

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The Present empirical paper investigates the relationship between FDI and economic growth by 10 selected industries in 10 Central and Eastern European countries from the period 1995 to 2012. Different estimation approaches were used to explore the connection between FDI and economic growth, for example OLS, RE, FE with and without time dummies. Obtained empirical results leads to some main consequences: First, the Central and East European countries (CEEC) attracted foreign direct investment, which raised the productivity of industries they entered in. It should be concluded that the linkage between FDI and output growth by industries is positive and significant enough to suggest that foreign firm’s participation enhanced the productivity of the industries they occupied. There had been an endogeneity problem in the regression and fixed effects estimation approach was used which partially corrected the regression analysis in order to make the results less biased. Second, it should be stressed that the results show that time has an important role in making FDI operational for enhancing output growth by industries via total factor productivity. Third, R&D positively affected economic growth and at the same time, it should take some time for research and development to influence economic growth. Fourth, the general trends masked crucial differences at the country level: over the last 20 years, the analysis of the tables and figures at the country level show that the main recipients of FDI of the 11 Central and Eastern European countries were Hungary, Poland and the Czech Republic. The main reason was that these countries had more open door policies for attracting the FDI. Fifth, according to the graphical analysis, while Hungary had the highest FDI inflow in this region, it was not reflected in the GDP growth as much as in other Central and Eastern European countries.

Keywords: central and East European countries (CEEC), economic growth, FDI, panel data

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Authors: Alina Murtishcheva

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The development of an effective system of administrative supervision is a prerequisite for the functioning of local self-government on the basis of the rule of law. Administrative supervision of local self-government is of particular importance in the EU countries due to the influence of integration processes. The central authorities act on the international level; however, subnational authorities also have to implement European legislation in order to strengthen integration. Therefore, the central authority, being the connecting link between supranational and subnational authorities, should bear responsibility, including financial responsibility, for possible mistakes of subnational authorities. Consequently, the state should have sufficient mechanisms of control over local and regional authorities in order to correct their mistakes. At the same time, the control mechanisms do not deny the autonomy of local self-government. The paper analyses models of administrative supervision of local self-government in Ukraine, Poland, Lithuania, Belgium, Great Britain, Italy, and France. The research methods used in this paper are theoretical methods of analysis of scientific literature, constitutions, legal acts, Congress of Local and Regional Authorities of the Council of Europe reports, and constitutional court decisions, as well as comparative and logical analysis. The legislative basis of administrative supervision was scrutinized, and the models of administrative supervision were classified, including a priori control and ex-post control or their combination. The advantages and disadvantages of these models of administrative supervision are analysed. Compliance with Article 8 of the European Charter of Local Self-Government is of great importance for countries achieving common goals and sharing common values. However, countries under study have problems and, in some cases, demonstrate non-compliance with provisions of Article 8. Such non-conformity as the endorsement of a mayor by the Flemish Government in Belgium, supervision with a view to expediency in Great Britain, and the tendency to overuse supervisory power in Poland are analysed. On the basis of research, the tendencies of administrative supervision of local authorities’ activities in selected European countries are described. Several recommendations for Ukraine as a country that had been granted the EU candidate status are formulated. Having emphasised its willingness to become a member of the European community, Ukraine should not only follow the best European practices but also avoid the mistakes of countries that have long-term experience in developing the local self-government institution. This project has received funding from the Research Council of Lithuania (LMTLT), agreement № P-PD-22-194

Keywords: administrative supervision, decentralisation, legality, local authorities, local self-government

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Authors: Harsimran Kaur Chadha, Preeti Onkar

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Tourism has grown into one of the world’s largest industries in the last two decades all over the world. It is an important sector of Indian economy as it contributes substantially to the foreign exchange earnings of the country. The tourism policies of India aim to position tourism as a major engine of economic growth. These policies work towards utilizing tourism’s direct and multiplier effect on employment and poverty eradication in a sustainable manner. India is blessed with a great ancient and living civilization that gave rise to four of the world’s great religions and philosophies. Diverse religions, castes, languages, culture of India build a tremendous potential for religious tourism in India. Religious Tourism facilitates development of basic infrastructural facilities, generates income for the local community as well as the government, balances regional development, and fosters peace and socio-cultural harmony. However, tourism development needs to be regulated to prevent the negative impacts. The main challenge towards Sustainable Tourism development is to balance limits and usage of natural resources. The uncontrollable growth of tourism should not lead to resource degradation. Since tourism growth is inevitable, the challenge is to manage it sustainably within environmental, social and economic constraints. This paper tries to explore both the benefits and costs of Religious Tourism Development, using the example of Simhasth Kumbh Mahaparv at Ujjain. Finally it concludes by putting forth the notion that heavy investments for temporary infrastructure development incurred during these large spiritual gatherings need to be sustainable in the long run.

Keywords: challenges, religious, sustainable, tourism

Procedia PDF Downloads 333

Authors: Amatulraheem Al-Abassi, K. Khanafer, Ibrahim Deiab

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The coronary artery stent is a promising technology that can treat various coronary diseases. Materials used for manufacturing medical stents should have high biocompatible properties. Stent alloys, in particular, are remarkably promising good clinical outcomes, however, there is threaten of restenosis (reoccurring of artery narrowing due to fatty plaque), stent recoiling, or in long-term the occurrence of stent fracture. However, stents that are made of Nickel-titanium (Nitinol) can bare extensive plastic deformation and resist restenosis. This shape memory alloy has outstanding mechanical properties. Nitinol is a unique shape memory alloy as it has unique mechanical properties such as; biocompatibility, super-elasticity, and recovery to original shape under certain loads. Stent failure may cause complications in vascular diseases and possibly blockage of blood flow. Thus, studying the behaviors of the stent under different medical conditions will help the doctors and cardiologists to predict when it is necessary to change the stent in order to prevent any severe morbidity outcomes. To the best of our knowledge, there are limited published papers that analyze the stent behavior with regards to the contact surfaces of plaque layer and blood vessel. Thus, stent material properties will be discussed in this investigation to highlight the mechanical and clinical differences between various stents. This research analyzes the performance of Nitinol stent in well-known stent design to determine its bearing with stress and its dislocation in blood vessels, in comparison to stents made of different biocompatible materials. In addition, a study of its performance will be represented in the system. Finite Element Analysis is the core of this study. Thus, a physical representative model will be discussed to show the distribution of stress and strain along the interaction surface between the stent and the artery. The reaction of vascular tissue to the stent will be evaluated to predict the possibility of restenosis within the treated area.

Keywords: shape memory alloy, stent, coronary artery, finite element analysis

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Authors: Mariia Zhuldybina, Ahmed Moulay, Mirko Torres, Mike Rozel, Ngoc-Duc Trinh, Chloé Bois

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To reduce the global waste of perishable goods, a solution for monitoring and traceability of their environmental conditions is needed. Temperature is the most controllable environmental parameter determining the kinetics of physical, chemical, and microbial spoilage in food products. To store the time-temperature information, time-temperature indicator (TTI) is a promising solution. Printed electronics (PE) has shown a great potential to produce customized electronic devices using flexible substrates and inks with different functionalities. We propose to fabricate a hybrid printed TTI using environmentally friendly materials. The real-time TTI profile can be stored and transmitted to the smartphone via Near Field Communication (NFC). To ensure environmental performance, Canadian Green Electronics NSERC Network is developing green materials for the ink formulation with different functionalities. In terms of substrate, paper-based electronics has gained the great interest for utilization in a wide area of electronic systems because of their low costs in setup and methodology, as well as their eco-friendly fabrication technologies. The main objective is to deliver a prototype of TTI using small-scale printed techniques under typical printing conditions. All sub-components of the smart labels, including a memristor, a battery, an antenna compatible with NFC protocol, and a circuit compatible with integration performed by an offsite supplier will be fully printed with flexography or flat-bed screen printing.

Keywords: NFC, printed electronics, time-temperature indicator, hybrid electronics

Procedia PDF Downloads 141

Authors: Mei-Ying Liao

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The main purpose of this study was to examine the requirements of a successful concert for young children in preschool in Taiwan. This study reports a case study of a preschool’s experience which undertook ten concerts for young children. The main audiences were young children who were two to six years of age. The performers, including children’s family, amateurs and professional performers, were invited to perform music instruments or singing twice a week. The performers participated in these concerts separately, as a solo or ensemble performance. There were totally ten concerts. The structure of concert included the performance, musical activities, questions and answers, song requests, and exploration of instruments. Data collection included interviews with children, teachers and performers, concert observations, and footnotes. Results showed that the requirements of a successful and meaningful concert for young children were suggested to include concert preparation, concert, and post activities. The concert organizer, host and classroom teachers played vital roles for a successful concert. The organizer had to organize the programs and prepared for the concerts based on the needs and interests of their audience of young children, engage their attention and offer the potential to expand their musical worlds. The hosts had to build a bridge between performers and young children who had to know how they could delight and educate children. Concerts combined games, storytelling, instrument exploration and great music had great effects. Finally, the classroom teachers had to do the extension activities after the concerts so that the children will involve more and get more enthusiasm in concerts.

Keywords: case study, concert, music education, performance

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Authors: Anuradha Gupta, Neelam Bansal, Varinder Uppal

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The present investigation was made on 35 Indian buffalo fetuses ranging from 0.9 cm to 104 cm curved crown rump length (CVRL). The gross anatomical study revealed that all structures were developed at 13 cm CVRL (87 days) in group I. At 0.9 cm CVRL (32 days) the heart was unseptated and tubular and was clearly divided into common atrial chamber dorsally and primitive ventricle in 1.2 cm CVRL fetus (34 days). Septum primum appeared at 1.9 cm CVRL (37 days), truncal ridges at 2.5 cm CVRL (39 days) and foramen ovale in 3.0 cm CVRL (42 days) buffalo foetuses. At 7.6 cm CVRL (62 days) endocardial cushions fused to form left and right atrioventricular openings and four chambered heart was formed in 8.7 cm CVRL (66 days). Endocardium and epicardium was thicker in atria as compared to ventricles in all the age groups. Myocardium of atria was thin as compared to ventricles in all the age groups and was loosely arranged. Immature hyaline cartilage was first appeared at base of aorta in 62 cm CVRL (213 days) fetuses. Intercalated discs were seen in group III and aorta, pulmonary artery, coronary artery were well appreciated in 3.2 cm CVRL (43 days). Neutral and acid mucopolysaccharides were comparatively more in atria than ventricles. Basic proteins showed strong reaction in atrium and ventricle, and intense in conduction system. Lipids and phospholipids were more in myocardium and conduction system than endocardium and epicardium. All the histochemical moieties were comparatively more in tunica intima than media and adventitia of all the great vessels of heart.

Keywords: buffalo, fetal development, histochemistry, heart

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Authors: Ummi Sholihah Pertiwi Abidin, Eva Fadhilah

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Social changes are more and more growing and having many different forms as the time passed and thought methods in the society. One of many forms of that social changes is the emancipation of women that is flourishing by the inception of gender equality perception between men and women in all aspects including education. It’s not anymore found the distinction between genders in learning and the education achieving right at this globalized era. But, it is still many perceptions which are against that equality of education achieving right, either come from the women’s selves or many external factors. They assumed that they are going to be a mother in the future, and a wife, someone with responsible for taking care of the household and everything inside, while the husband is the one who has the responsible for looking for the living. So comes from this kind of assumption, the perception against the education equality between genders, which means there is no need for them –women- to achieve the high education because they will still end up as housewives. Except those working or career women that need high education to support their works. These women are not aware that even a mother needs the high and capable education. Because, as the 'mother to be,' they surely need broad knowledge from the education to educate their children in the future. It is such a big fault to say the kind of thing, 'It is no matter that I am not educated, in case I’m just a housewife. The important thing is my children get a great education'. Unfortunately, it is still often found, saying 'A housewife job is not a big deal to do with high education.' This qualitative method paper raises a theme about the importance of education for women, no matter what will they be in the future. Because however, and whatever is the woman’s career outside the house, or even not working outside, she’s still a mother for her children, and 'educational provision' is a great need. And so forth, this educational provision is a big deal to do with future generation’s foredoom, regarding the first source of children’s knowledge and the first school for them is their mother.

Keywords: women education, mother to be, educational provision, first school, future generation’s foredoom

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Authors: Elena Listo Ubeda, Miguel Marchamalo Sacristan

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The demand for water doubles every twenty years, at a rate which is twice as fast as the world´s population growth. Despite it´s great importance, water is one of the most degraded natural resources in the world, mainly because of the reduction of natural vegetation coverage, population growth, contamination and changes in the soil use which reduces its capacity to collect water. This situation is especially serious in Central America, as reflected in the Human Development reports. The objective of this project is to assist in the improvement of water production and quality in Central America. In order to do these two watersheds in Costa Rica were selected as experiments: that of the Virilla-Durazno River, located in the extreme north east of the central valley which has an Atlantic influence; and that of the Jabillo River, which flows directly into the Pacific. The Virilla river watershed is located over andisols, and that of the Jabillo River is over alfisols, and both are of great importance for water supply to the Greater Metropolitan Area and the future tourist resorts respectively, as well as for the production of agriculture, livestock and hydroelectricity. The hydrological reaction in different soil-cover complexes, varying from the secondary forest to natural vegetation and degraded pasture, was analyzed according to the evaluation of the properties of the soil, infiltration, soil compaction, as well as the effects of the soil cover complex on erosion, calculated by the C factor of the Revised Universal Soil Loss Equation (RUSLE). A water balance was defined for each watershed, in which the volume of water that enters and leaves were estimated, as well as the evapotranspiration, runoff, and infiltration. Two future scenarios, representing the implementation of reforestation and deforestation plans, were proposed, and were analyzed for the effects of the soil cover complex on the water balance in each case. The results obtained show an increase of the ground water recharge in the humid forest areas, and an extension of the study of the dry areas is proposed since the ground water recharge here is diminishing. These results are of great significance for the planning, design of Payment Schemes for Environmental Services and the improvement of the existing water supply systems. In Central America spatial planning is a priority, as are the watersheds, in order to assess the water resource socially and economically, and securing its availability for the future.

Keywords: Costa Rica, infiltration, soil, water

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Authors: Rana Daneshvar Salehi

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In many Iranian cities including ‎‎Mashhad‎, the capital of ‎‎‎‎Razavi Khorasan Province‏‎, ‎ordinary samples of domestic architecture ‎on a ‎‏small scale is not ‎‎‎considered as ‎heritage. ‎While the ‎principals of house formation are ‎‎respected in all ‎‎traditional Iranian ‎‎‎‎houses‎; ‎from moderate to great ones. During the past decade, Mashhad has lost its identity, and has become a modern city. Identifying it as the capital of the Islamic Culture in 2017 by ISESCO and consequently looking for new developments and transfiguration caused to demolish a large ‎number ‎of ‎traditional modest habitation. ‎For this ‎reason, the present paper aims to introduce ‎the three ‎undiscovered houses with the ‎historical and monumental values located in the ‎oldest ‎neighborhoods of Mashhad which have been neglected in the cultural ‎heritage field. The preliminary phase of this approach will be a measured survey to identify the significant characteristics ‎of ‎selected dwellings and understand the challenges through focusing on building ‎form, orientation, ‎‎room function, space proportion and ornamental elements’ details. A comparison between the ‎‎case studies and the wealthy domestically buildings ‎presents that a house belongs to inhabitants ‎with an average income could introduce the same accurate, regular, harmonic and proportionate ‎design which can be found in the great mansions. It reveals that an ordinary traditional house can ‎be regarded as valuable construction not only for its historical characteristics but also ‎for its ‎aesthetical and architectural features that could avoid further destructions in the future.

Keywords: traditional ordinary house, architectural characteristic, proportion, heritage

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Authors: Matthias Banholzer, Hagen Müller, Michael Pfitzner

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Gas internal combustion engines are widely used as propulsion systems or in power plants to generate heat and electricity. While there are different types of injection methods including the manifold port fuel injection and the direct injection, the latter has more potential to increase the specific power by avoiding air displacement in the intake and to reduce combustion anomalies such as backfire or pre-ignition. During the opening process of the injector, multiple flow regimes occur: subsonic, transonic and supersonic. To cover the wide range of Mach numbers a compressible pressure-based solver is used. While the standard Pressure Implicit with Splitting of Operators (PISO) method is used for the coupling between velocity and pressure, a high-resolution non-oscillatory central scheme established by Kurganov and Tadmor calculates the convective fluxes. A blending function based on the local Mach- and CFL-number switches between the compressible and incompressible regimes of the developed model. As the considered operating points are well above the critical state of the used fluids, the ideal gas assumption is not valid anymore. For the real gas thermodynamics, the models based on the Soave-Redlich-Kwong equation of state were implemented. The caloric properties are corrected using a departure formalism, for the viscosity and the thermal conductivity the empirical correlation of Chung is used. For the injector geometry, the dimensions of a diesel injector were adapted. Simulations were performed using different nozzle and needle geometries and opening curves. It can be clearly seen that there is a significant influence of all three parameters.

Keywords: high pressure gas injection, hybrid solver, hydrogen injection, needle opening process, real-gas thermodynamics

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Authors: Johnson C. Y. Pang, Amy S. N. Fu, Ryan K. L. Lee, Allan C. L. Fu

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Dry needling (DN) is one of the puncturing methods that involves the insertion of needles into the tender spots of the human body without the injection of any substance. DN has long been used to treat the patient with knee pain caused by knee osteoarthritis (KOA) and patellofemoral pain syndrome (PFPS), but the effectiveness is still inconsistent. This study aimed to conduct a systematic review and meta-analysis to assess the intervention methods and effects of DN with and without ultrasound guidance for treating pain and dysfunctions in people with KOA and PFPS. Design: This systematic review adhered to the PRISMA reporting guidelines. The registration number of the study protocol published in the PROSPERO database was CRD42021221419. Six electronic databases were searched manually through CINAHL Complete (1976-2020), Cochrane Library (1996-2020), EMBASE (1947-2020), Medline (1946-2020), PubMed (1966-2020), and Psychinfo (1806-2020) in November 2020. Randomized controlled trials (RCTs) and controlled clinical trials were included to examine the effects of DN on knee pain, including KOA and PFPS. The key concepts included were: DN, acupuncture, ultrasound guidance, KOA, and PFPS. Risk of bias assessment and qualitative analysis were conducted by two independent reviewers using the PEDro score. Results: Fourteen articles met the inclusion criteria, and eight of them were high-quality papers in accordance with the PEDro score. There were variations in the techniques of DN. These included the direction, depth of insertion, number of needles, duration of stay, needle manipulation, and the number of treatment sessions. Meta-analysis was conducted on eight articles. DN group showed positive short-term effects (from immediate after DN to less than 3 months) on pain reduction for both KOA and PFPS with the overall standardized mean difference (SMD) of -1.549 (95% CI=-0.588 to -2.511); with great heterogeneity (P=0.002, I²=96.3%). In subgroup analysis, DN demonstrated significant effects in pain reduction on PFPS (p < 0.001) that could not be found in subjects with KOA (P=0.302). At 3-month post-intervention, DN also induced significant pain reduction in both subjects with KOA and PFPS with an overall SMD of -0.916 (95% CI=-0.133 to -1.699, and great heterogeneity (P=0.022, I²=95.63%). Besides, DN induced significant short-term improvement in function with the overall SMD=6.069; 95% CI=8.595 to 3.544; with great heterogeneity (P<0.001, I²=98.56%) when analyzed was conducted on both KOA and PFPS groups. In subgroup analysis, only PFPS showed a positive result with SMD=6.089, P<0.001; while KOA showed statistically insignificant with P=0.198 in short-term effect. Similarly, at 3-month post-intervention, significant improvement in function after DN was found when the analysis was conducted in both groups with the overall SMD=5.840; 95% CI=9.252 to 2.428; with great heterogeneity (P<0.001, I²=99.1%), but only PFPS showed significant improvement in sub-group analysis (P=0.002, I²=99.1%). Conclusions: The application of DN in KOA and PFPS patients varies among practitioners. DN is effective in reducing pain and dysfunction at short-term and 3-month post-intervention in individuals with PFPS. To our best knowledge, no study has reported the effects of DN with ultrasound guidance on KOA and PFPS. The longer-term effects of DN on KOA and PFPS are waiting for further study.

Keywords: dry needling, knee osteoarthritis, patellofemoral pain syndrome, ultrasound guidance

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Authors: Abdul Fatah, Naveenchandra Acharya, Vamshi Krishna, T. Shivaprasad, Ramesh Ramayya

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Background: Significant number of patients with bladder outlet obstruction due to BPH are on anti-platelets and anticoagulants. Prostate surgery in this group of patients either in the form of TURP or Open prostatectomy is associated with increased risk of bleeding complications requiring transfusions, packing of the prostatic fossa or ligation or embolization of internal iliac arteries. Withholding of antiplatelets and anticoagulants may be associated with cardiac and other complications. Efficacy of Thulium Laser in the above group of patients was evaluated in terms of peri-operative, postoperative and delayed bleeding complications as well as cardiac events in peri-operative and immediate postoperative period. Methods: 217 patients with a mean age of 68.8 years were enrolled between March 2009 and March 2013 (36 months), and treated for BPH with ThuLEP. Every patient was evaluated at base line according to: Digital Rectal Examination (DRE), prostate volume, Post-Voided volume (PVR), International Prostate Symptoms Score (I-PSS), PSA values, urine analysis and urine culture, uroflowmetry. The post operative complications in the form of drop in hemoglobin level, transfusion rates, post –operative cardiac events within a period of 30 days, delayed hematuria and events like deep vein thrombosis and pulmonary embolism were noted. Results: Our data showed a better post-operative outcome in terms of, postoperative bleeding requiring intervention 7 (3.2%), transfusion rate 4 (1.8%) and cardiac events within a period of 30 days 4(1.8%), delayed hematuria within 6 months 2(0.9 %) compared other series of prostatectomies. Conclusion: The thulium LASER prostatectomy is a safe and effective option for patients with cardiac comorbidties and those patients who are on antiplatelet agents and anticoagulants. The complication rate is less as compared to larger series reported with open and transurethral prostatectomies.

Keywords: thulium laser, prostatectomy, antiplatelet agents, bleeding

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Authors: Runlian Miao, Wei Xie, Hong Zhang

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In China, Beijing-Tianjin-Hebei is regarded as a strategically important region because itenjoys highest development in economic development, opening up, innovative capacity and andpopulation. Integrated development of Beijing-Tianjin-Hebei region is increasingly emphasized by the government recently years. In 2014, it has ascended to one of the national great development strategies by Chinese central government. In 2015, Coordinated Development Planning Compendium for Beijing-Tianjin-Hebei Region was approved. Such decisions signify Beijing-Tianjin-Hebei region would lead innovation-driven economic development in China. As an essential factor to achieve national innovation-driven development and significant part of regional industry chain, the optimization of science and technology resources allocation will exert great influence to regional economic transformation and upgrading and innovation-driven development. However, unbalanced distribution, poor sharing of resources and existence of information isolated islands have contributed to different interior innovation capability, vitality and efficiency, which impeded innovation and growth of the whole region. Under such a background, to integrate and vitalize regional science and technology resources and then establish high-end, fast-responding and precise innovation service system basing on regional resources, would be of great significance for integrated development of Beijing-Tianjin-Hebei region and even handling of unbalanced and insufficient development problem in China. This research uses the method of literature review and field investigation and applies related theories prevailing home and abroad, centering service path of science and technology resources for innovation. Based on the status quo and problems of regional development of Beijing-Tianjin-Hebei, theoretically, the author proposed to combine regional economics and new economic geography to explore solution to problem of low resource allocation efficiency. Further, the author puts forward to applying digital map into resource management and building a platform for information co-building and sharing. At last, the author presents the thought to establish a specific service mode of ‘science and technology plus digital map plus intelligence research plus platform service’ and suggestion on co-building and sharing mechanism of 3 (Beijing, Tianjin and Hebei ) plus 11 (important cities in Hebei Province).

Keywords: Beijing-Tianjin-Hebei, science and technology resources, innovation service, digital platform

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Authors: P. Amarnath, Albert Thomas

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Buildings qualify to be the major consumer of energy and resources thereby urging the designers, architects and policy makers to place a great deal of effort in achieving and implementing sustainable building strategies in construction. Green building rating systems help a great deal in this by measuring the effectiveness of these strategies along with the escalation of building performance in social, environmental and economic perspective, and construct new sustainable buildings. However, for a country like India, enormous population and its rapid rate of growth impose an increasing burden on the country's limited and continuously degrading natural resource base, which also includes the land available for construction. In general, the number of sustainable rated buildings in India is very minimal primarily due to the complexity and obstinate nature of the assessment systems/regulations that restrict the stakeholders and designers in proper implementation and utilization of these rating systems. This paper aims to introduce a data driven and user-friendly framework which cross compares the present prominent green building rating systems such as LEED, BREEAM, and GRIHA and subsequently help the users to rate their proposed building design as per the regulations of these assessment frameworks. This framework is validated using the input data collected from green buildings constructed globally. The proposed system has prospects to encourage the users to test the efficiency of various sustainable construction practices and thereby promote more sustainable buildings in the country.

Keywords: BREEAM, GRIHA, green building rating systems, LEED, sustainable buildings

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Authors: Tien S. H. Pham, Peter J. Mahon, Aimin Yu

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The detection of drug molecules by voltammetry has attracted great interest over the past years. However, many drug molecules exhibit poor electrochemical signals at common electrodes which result in low sensitivity in detection. An efficient way to overcome this problem is to modify electrodes with functional materials. Since discovered in 2004, graphene (or reduced graphene oxide) has emerged as one of the most studied two-dimensional carbon materials in condensed matter physics, electrochemistry, and so on due to its exceptional physicochemical properties. Additionally, the continuous development of technology has opened the new window for the successful fabrications of many novel graphene-based nanomaterials to serve in electrochemical analysis. This research aims to synthesize and characterize gold nanoparticle coated beta-cyclodextrin functionalized reduced graphene oxide (Au NP–β-CD–RGO) nanocomposites with highly conductive and strongly electro-catalytic properties as well as excellent supramolecular recognition abilities for the modification of electrodes. The electrochemical responses of ciprofloxacin at the as-prepared nanocomposite modified electrode was effectively amplified was much higher in comparison with that at the bare electrode. The linear concentration range was from 0.01 to 120 µM, with a detection limit of 2.7 nM using differential pulse voltammetry. Thus, Au NP–β-CD–RGO nanocomposite has great potential as an ideal material to construct sensitive sensors for the electrochemical determination of ciprofloxacin or similar antibacterial drugs in the future based on its excellent stability, selectivity, and reproducibility.

Keywords: Au nanoparticles, β-CD, ciprofloxacin, electrochemical determination, graphene based nanomaterials

Procedia PDF Downloads 177

Authors: Joonha Park

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This essay examines the Soviet Artist Pavel Korin’s artistic pursuit towards his life-long project, “Requiem/Passing of the Rus,” framing the funeral of Tikhon, the last great defender of the Russian orthodox Church during the Great purge, as the final moment of “Rus,” which is the identity of the Russian people that built up in the 1000 year of history behind Russian Orthodoxy. Korin’s project remains in the form of a series of 29 man-sized portraits and a monumental blank canvas. Born in a family dedicated to iconography, Korin witnessed the historic drama during Stalin’s terror; therefore, he tried to convey the nation’s mourning for the disappearance of “Rus” and disapproval of the Soviet notion of atheism. Yet, due to Korin’s success as a state artist, many believed that the political pressure led Korin to give up his belief and controversy arose over the fact that Korin left the canvas blank. The empty 40-square-meter canvas, which remains untouched in his studio since 1930, supports this theory to an extent. However, resources such as Korin’s notes, primary accounts from his fellow Soviet Artists, and testimonies from his wife suggested that this assumption is incorrect. Moreover, Korin’s uninterrupted relationship with the church and the religious attributes in his commissioned works were brought up as evidence of Korin’s continued belief. The empty canvas not only represents Korin’s discontentment towards the repression and the hardships that the Orthodox Church experienced, but also depicts the identity that coexisted with the Church in order to bequeath this idea to future generations. The faultless canvas surrounded by the striking 29 portraits is a symbol of the highest spirit, similar to that of the iconography paintings placed in every Russian house that unites the Russian people till this day, therefore one can deduce that the legacy of “Requiem” is still relevant to the Russian people even under freedom of religious expression. Consequently, “Requiem” was on display at the Tretyakov Gallery for the first time in public in 2013 even though Korin started creating this piece in 1925, extolling Korin not only as an artist but also as a historian; by recording the turmoil of the Great Oppression, Korin exhibited the social responsibility universal to artists across time and space. In this essay, the legacy Korin left behind, both to his contemporaries and his posterity is reevaluated through the lens of his works, unfinished as they were.

Keywords: Pavel Korin, Art History, Art, Russia, Soviet Union, Requiem, Russian orthodox church, Treytyakov gallery, contemporary art, socialist realism, Maxim Gorky

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Authors: Zong-Xian Qiu, Ta-Wui Cheng, Wei-Hao Lee, Yung-Chin Ding

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The greenhouse effect is an important issue since it has been responsible for global warming. Carbon dioxide plays an important part of role in the greenhouse effect. Therefore, human has the responsibility for reducing CO₂ emissions in their daily operations. Except iron making and power plants, another major CO₂ production industry is cement industry. According to the statistics by EPA of Taiwan, production 1 ton of Portland cement will produce 520.29 kg of CO₂. There are over 7.8 million tons of CO₂ produced annually. Thus, trying to development low CO₂ emission green concrete is an important issue, and it can reduce CO₂ emission problems in Taiwan. The purpose of this study is trying to use marble wastes and slag as the raw materials to fabricate geopolymer green concrete. The result shows the marble based geopolymer green concrete have good workability and the compressive strength after curing for 28 days and 365 days can be reached 44MPa and 53MPa in indoor environment, 28MPa and 40.43MPa in outdoor environment. The acid resistance test shows the geopolymer green concrete have good resistance for chemical attack. The coefficient of permeability of geopolymer green concrete is better than Portland concrete. By comparing with Portland cement products, the marble based geopolymer not only reduce CO₂ emission problems but also provides great performance in practices. According to the experiment results shown that geopolymer concrete has great potential for further engineering development in the future, the new material could be expected to replace the Portland cement products in the future days.

Keywords: marble, slag, geopolymer, green concrete, CO₂ emission

Procedia PDF Downloads 121

Authors: Hafiz Muhammad Adeel Sharif, Tian Li, Changping Li

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Recently, the emission of nitrogen-sulphur oxides (NOₓ, SO₂) has become a global issue and causing serious threats to health and the environment. Catalytic reduction of NOx and SOₓ gases into friendly gases is considered one of the best approaches. However, regeneration of the catalyst, higher bond-dissociation energy for NOx, i.e., 150.7 kcal/mol, escape of intermediate gas (N₂O, a greenhouse gas) with treated flue-gas, and limited activity of catalyst remains a great challenge. Here, a cheap, binderless naturally-extracted bass-wood thin carbon electrode (TCE) is presented, which shows excellent catalytic activity towards NOx reduction. The bass-wood carbonization at 900 ℃ followed by thermal activation in the presence of CO2 gas at 750 ℃. The thermal activation resulted in an increase in epoxy groups on the surface of the TCE and enhancement in the surface area as well as the degree of graphitization. The TCE unique 3D strongly inter-connected network through hierarchical micro/meso/macro pores that allow large electrode/electrolyte interface. Owing to these characteristics, the TCE exhibited excellent catalytic efficiency towards NOx (~83.3%) under ambient conditions and enhanced catalytic response under pH and sulphite exposure as well as excellent stability up to 168 hours. Moreover, a temperature-dependent activity trend was found where the highest catalytic activity was achieved at 80 ℃, beyond which the electrolyte became evaporative and resulted in a performance decrease. The designed electrocatalyst showed great potential for effective NOx-reduction, which is highly cost-effective, green, and sustainable.

Keywords: electrocatalyst, NOx-reduction, bass-wood electrode, integrated wet-scrubbing, sustainable

Procedia PDF Downloads 57

Authors: Norah Al Hokbany, Ibrahim Al Jammaz, Basem Al Otaibi, Yousif Al Malki, Subhani M. Okarvi

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Objective: The folate receptor is over-expressed in a wide variety of human tumors. Conjugates of folate have been shown to be selectively taken up by tumor cells via the folate receptor. In an attempt to develop new folate radiotracers with favorable biochemical properties for detecting folate receptor-positive cancers. Methods: we synthesized ⁶⁴Cu-NOTA- and ⁶⁴Cu-NOTAM-folate conjugates using a straightforward and simple one-step reaction. Radiochemical yields were greater than 95% (decay-corrected) with a total synthesis time of less than 20 min. Results: Radiochemical purities were always greater than 98% without high-performance liquid chromatography (HPLC) purification. These synthetic approaches hold considerable promise as a rapid and simple method for ⁶⁴Cu-folate conjugate preparation with high radiochemical yield in a short synthesis time. In vitro tests on the KB cell line showed that significant amounts of the radio conjugates were associated with cell fractions. Bio-distribution studies in nude mice bearing human KB xenografts demonstrated a significant tumor uptake and favorable bio-distribution profile for ⁶⁴Cu-NOTA- and ⁶⁴Cu-NOTAM-folate conjugate. The uptake in the tumors was blocked by the excess injection of folic acid, suggesting a receptor-mediated process. Conclusion: These results demonstrate that the ⁶⁴Cu-NOTAM-folate conjugate may be useful as a molecular probe for the detection and staging of folate receptor-positive cancers, such as ovarian cancer and their metastasis, as well as monitoring tumor response to treatment.

Keywords: folate, receptor, tumor imaging, ⁶⁴Cu-NOTA-folate, PET

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Authors: Oscar Guerra

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Educational technologies have great potential as tools for student empowerment, particularly for members of a marginalized population such as immigrant Latino children in the American public education system. It is not merely a matter of access to the necessary technological devices; rather, it is development and implementation under a critical lens that may prompt a positive change.

Keywords: education, critical technologies, minorities, higher education

Procedia PDF Downloads 291

Authors: Adebiyi Sunday Adeyanju, Kola Benson Ajeigbe, Fortune Ganda

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In the past three decades, there has been a notable increase in the number of firms delisting from the Johannesburg Stock Exchange (JSE) in South Africa. The recent increasing rate of delisting waves of corporate listed firms motivated this study. This study aims to explore the influence of institutional investor perceptions on the financial distress experienced by delisted firms within the South African market. The study further examined the impact of financial distress on the corporate performance of delisted firms. Using the data of delisted firms spanning from 2000 to 2023 and the FGLS (Feasible Generalized Least Squares) for the short run and PCSE (Panel-Corrected Standard Errors) for the long run effects of the relationship. The finding indicated that a decline in institutional investors’ perceptions was associated with the corporate financial distress of the delisted firms, particularly during the delisting year and the few years preceding the announcement of the delisting. This study addressed the importance of investor recognition in corporate financial distress and the delisting wave among listed firms- a finding supporting the stakeholder theory. This study is an insight for companies’ managements, investors, governments, policymakers, stockbrokers, lending institutions, bankers, the stock market, and other stakeholders in their various decision-making endeavours. Based on the above findings, it was recommended that corporate managements should improve their governance strategies that can help companies’ financial performances. Accountability and transparency through governance must also be improved upon with government support through the introduction of policies and strategies and enabling an easy environment that can help companies perform better.

Keywords: delisting wave, institutional investors, financial distress, corporate performance, investors’ perceptions

Procedia PDF Downloads 31

Authors: Wiesława Klimek-Piotrowska, Mateusz K. Hołda, Mateusz Koziej, Katarzyna Piątek, Jakub Hołda

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Introduction: The coronary sinus venous system (CSVS), which has always been overshadowed by the coronary arterial tree, has recently begun to attract more attention. Since it is a target for clinicians the knowledge of its anatomy is essential. Cardiac resynchronization therapy, catheter ablation of cardiac arrhythmias, defibrillation, perfusion therapy, mitral valve annuloplasty, targeted drug delivery, and retrograde cardioplegia administration are commonly used therapeutic methods involving the CSVS. The great variability in the course of coronary veins and tributaries makes the diagnostic and therapeutic processes difficult. Our aim was to investigate detailed anatomy of most common clinically used CSVS`s structures: the coronary sinus with its ostium, great cardiac vein, posterior vein of the left ventricle, middle cardiac vein and oblique vein of the left atrium. Methodology: This is a prospective study of 70 randomly selected autopsied hearts dissected from adult humans (Caucasian) aged 50.1±17.6 years old (24.3% females) with BMI=27.6±6.7 kg/m2. The morphology of the CSVS was assessed as well as its precise measurements were performed. Results: The coronary sinus (CS) with its ostium was present in all hearts. The mean CS ostium diameter was 9.9±2.5mm. Considered ostium was covered by its valve in 87.1% with mean valve height amounted 5.1±3.1mm. The mean percentage coverage of the CS ostium by the valve was 56%. The Vieussens valve was present in 71.4% and was unicuspid in 70%, bicuspid in 26% and tricuspid in 4% of hearts. The great cardiac vein was present in all cases. The oblique vein of the left atrium was observed in 84.3% of hearts with mean length amounted 20.2±9.3mm and mean ostium diameter 1.4±0.9mm. The average length of the CS (from the CS ostium to the Vieussens valve) was 31.1±9.5mm or (from the CS ostium to the ostium of the oblique vein of the left atrium) 28.9±10.1mm and both were correlated with the heart weight (r=0.47; p=0.00 and r=0.38; p=0.006 respectively). In 90.5% the ostium of the oblique vein of the left atrium was located proximally to the Vieussens valve, in remaining cases was distally. The middle cardiac vein was present in all hearts and its valve was noticed in more than half of all the cases (52.9%). The posterior vein of the left ventricle was observed in 91.4% of cases. Conclusions: The CSVS is vastly variable and none of basic hearts parameters is a good predictor of its morphology. The Vieussens valve could be a significant obstacle during CS cannulation. Caution should be exercised in this area to avoid coronary sinus perforation. Because of the higher incidence of the presence of the oblique vein of the left atrium than the Vieussens valve, the vein orifice is more useful in determining the CS length.

Keywords: cardiac resynchronization therapy, coronary sinus, Thebesian valve, Vieussens valve

Procedia PDF Downloads 282

Authors: Nicholas Bayfield, Liam Bibo, Kaushelandra Rathore, Lucas Sanders, Mark Newman

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INTRODUCTION: Surgical pulmonary embolectomy is an established therapy for acute pulmonary embolism causing right heart dysfunction and haemodynamic instability. Massive intraoperative airway haemorrhage is a rare complication of pulmonary embolectomy. We present our institutional experience with massive airway haemorrhage complicating pulmonary embolectomy and discuss optimal therapeutic strategies. METHODS: A retrospective review of emergent surgical pulmonary embolectomy patients was undertaken. Cases complicated by massive intra-operative airway haemorrhage were identified. Intra- and peri-operative management strategies were analysed and discussed. RESULTS: Of 76 patients undergoing emergent or salvage pulmonary embolectomy, three cases (3.9%) of massive intraoperative airway haemorrhage were identified. Haemorrhage always began on weaning from cardiopulmonary bypass. Successful management strategies involved intraoperative isolation of the side of bleeding, occluding the affected airway with an endobronchial blocker, institution of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) and reversal of anticoagulation. Running the ECMO without heparinisation allows coagulation to occur. Airway haemorrhage was controlled within 24 hours of operation in all patients, allowing re-institution of dual lung ventilation and decannulation from ECMO. One case in which positive end-expiratory airway pressure was trialled initially was complicated by air embolism. Although airway haemorrhage was controlled successfully in all cases, all patients died in-hospital for reasons unrelated to the airway haemorrhage. CONCLUSION: Massive intraoperative airway haemorrhage during pulmonary embolectomy is a rare complication with potentially catastrophic outcomes. Re-perfusion alveolar and capillary injury is the likely aetiology. With a systematic approach to management, airway haemorrhage can be well controlled intra-operatively and often resolves within 24 hours. Stopping blood flow to the pulmonary arteries and support of oxygenation by the institution of VA ECMO is important. This management has been successful in our 3 cases.

Keywords: pulmonary embolectomy, cardiopulmonary bypass, cardiac surgery, pulmonary embolism

Procedia PDF Downloads 162