Aspiration thrombectomy is often performed in patients with acute myocardial infarction with high thrombus burden. Current guidelines, however, recommend against it because of stroke risk. We report a case of embolic stroke complicating coronary thrombus aspiration by an extremely rare mechanism.

In order to quantify the site-dependent correlation strengths in terms of the quasi-particle weights and the occupation numbers of 5f electrons in alpha phase plutonium metal with eight crystallographically nonequivalent atomic sites Pun (n=1~8), we perform a first principles calculation by using a many-body method merging density functional theory (DFT) with dynamical mean-field theory (DMFT) plus the relativistic and correlation effects. The quasi-particle weight, the electronic spectrum function, the hybridization function, as well as the occupation number of Pu 5f electrons all suggest that Pu1 and Pu8 atoms have the most itinerant and the most localized 5f electrons, respectively, while the other atoms Pun (n=2~7) exhibit an intermediate correlation strength. The quasi-particle weights demonstrate that only the jj or intermediate coupling scheme is more appropriate for Pu 5f electrons in comparison with the Russel-Saunders (LS) scheme. The electronic spectrum function and the occupation analysis establish that Pu 5f electrons simultaneously have dual itinerant and localized regimes with average 5f occupation numbers of nf between 4.8994 and 4.9628, which are mainly composed of 5f4, 5f5 and 5f6 configurations, irrespective of different atomic sites. Finally, we also estimate the so-called quasi-particle band structure to directly compare with an experimental angle-resolved photoemission spectrum (ARPES).

Being able to perform surgery first-hand represents the backbone of every training program and the key to successful development of the new generation of skilful surgeons. In this issue of the Journal, Comanici et al. presented a thorough systematic summary of the current evidence on the outcomes of cardiothoracic operations performed by trainees.1 Taking for granted the importance of training young surgeons, it is paramount to identify and tackle any potential obstacles hindering the surgical growth of a trainee.

In this paper we prove several optimal inequalities involving the hyperbolicity constant of complementary prisms networks. Moreover, we obtain bounds and closed formulas for the general topological indices A(G)=∑uv∈E(G) a(du,dv) and B(G)=∑u∈V(G)b(du) of complementary prisms networks.

The Colombian Andean Mountains host the headwaters of the main basins of the country. However, the interactions between high-mountain ecosystems and the isotopic composition of water in this region has been poorly studied. Here we present and analyze the first set of stable isotopes data collected in the Central Andes of Colombia. Stable isotopic composition of stream water and precipitation was determined for a period between 2017 and 2018 in the Upper Claro River Basin. The driving factors influencing the spatial and temporal variability of δ 2H, δ 18O and d-excess were identified and compared to daily air temperature and precipitation at seven meteorological stations. A Local Meteoric Water Line was defined as δ²H = 8.13 δ 18O + 12.5, R 2=0.98. δ 2H, δ 18O and d-excess values of precipitation were more negative during the rainy season and changes were more related to precipitation events and amounts than to temperature. An altitude effect of -0.11 ‰ / 100 m and -0.18 ‰ / 100 m was estimated for stream water and precipitation, respectively, where the latter showed a non-linear behavior. The data set was compared to stations of the Global Network of Isotopes in Precipitation (GNIP) database in Colombia and a back-trajectory analysis of air masses was conducted to compare with d-excess. δ 18O weighted means changed with respect to the position of the Central Andes and the altitudinal range 2,100 to 3,100 m a.s.l.. High d-excess can be attributed to moisture recycling enhanced by the local ecosystems and the travel of precipitable water from the Amazon basin across the northern Andes. The results showed a high range of variation due to the differences in elevation, seasonality and atmospheric circulation patterns across the year. The present study contributes to fill the gap of spatial and temporal isotopic composition data in the northern Andes as well as to the implementation of the first “National Network for Isotopes” in Colombia.

To date, there is no established treatment of facial numbness or dysaesthesia of unspecified causes. Herein, we report a case of unexplained facial numbness and confirmed hypaesthesia that achieved clinical response to stellate ganglion blockade (SGB). SGB might be an effective treatment of psychological-stress-related facial numbness of unknown origin.

Background: The hemodynamics of most prosthetic valves are often inferior to that of the normal native valve, and a significant proportion of patients undergoing surgical (SAVR) or transcatheter aortic valve replacement (TAVR) have high residual transaortic pressure gradients due to prosthesis–patient mismatch (PPM). Since the experience with TAVR has increased and long-term outcomes are reported, a close look at the PPM literature is required in light of new evidence. Methods: For this review, we searched the Embase, Medline, and Cochrane databases from 2000 to 2022. Articles reporting PPM as an outcome following aortic valve replacements were identified and reviewed. Results: The impact of PPM on clinical outcomes aortic valve replacement has not been clear since multiple studies failed to report PPM incidence. However, the PPM after SAVR vary greater than after TAVR, ranging from 8% to almost 80% in SAVR and from 24%-35% in TAVR. Incidence of severe PPM following redo SAVR is ranging from 2 to 9% and following valve-in-valve TAVR is from 14 to 33%, however, while PPM is higher in valve-in-valve TAVR, patients had better survival rates. Conclusions: The gap between valve performance and clinical outcomes in TAVR and SAVR could be reduced by carefully selecting patients for either treatment option. Understanding predictors of PPM can add to the safety, effectiveness, and increased survival benefit of both TAVR and SAVR.

The Vasoactive-Inotropic Score at 48 hours is a good surrogate marker for adverse postoperative events in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass and is limited by its ability to delineate the underlying cause for an unfavourable clinical course. Thus, other predictors such as the Technical Performance Score are likely to highlight the underlying cause and can be used to improve outcomes. However, patients with a high postoperative VIS score at 48 hours may benefit from closer longer-term follow for outcomes such as late survival, functional class, and need for reoperation.

Background: The most worrisome complications in patients supported by left ventricular assist device (LVAD) are pump thrombosis, embolism, and bleeding. The actual rate of these events in patients with sickle-cell disease (SCD) has not well investigated. The aim of our study is to evaluate the outcomes of LVAD implantation in patients with sickle-cell hemoglobinopathy at our institution. Methods: This retrospective, observational, single-center study was conducted on patients with sickle-cell trait (SCT), who underwent LVAD implantation using the HeartMate3 LVAD. Results: LVAD devices were implanted in four patients with SCT. All procedures were performed successfully. All patients had uneventful post-implant course. Overall, the mean follow-up time was 25 months (range 21-28 months) and showed an unremarkable post-implant course. There was a significant improvement in hematological markers over the follow-up period. Conclusions: Despite the limited numbers of patients enrolled in this study, our findings indicate that LVAD surgery is safe in SCD patients and offers remarkable clinical improvement. Further studies are needed to provide more evidence regarding this type of patients undergoing LVAD implantation.

A new approach is proposed to analysis the non-Gaussian random vibration of hyperbolic tangential package. Firstly, the non-Gaussian vibration noise of specified mean, variance, skewness and kurtosis is developed by Hermite polynomial, and verified by Gaussian mixture model (GMM) theory. Secondly, next to analyzing an analytical and numerical response of the two degrees of freedom (TDOF) linear package, the acceleration response of the TDOF hyperbolic tangential package system (HTPS) under non-Gaussian vibration excitation is obtained though the Hermite polynomial and Runge-Kutta method, and the effects of the external excitation and system parameters are investigated. Finally, on the basis of the first-passage probability of the acceleration response, the reliability analysis method is introduced. The analysis provides a guidance to the vibration reliability analysis and packaging optimization design.

A theorem on the maximum regularity of solutions of the nonlinear Sturm-Liouville equation with greatly growing and rapidly oscillating potential in the space $L_2(R)\,(R=(-\infty,\infty))$ is proved in this paper. Two-sided estimates of the Kolmogorov widths of the sets associated with solutions of the nonlinear Sturm-Liouville equation are also obtained. As is known, the obtained estimates given the opportunity to choose approximation apparatus that guarantees the maximum possible error.

Motivated by important applications in materials science and biology, we consider a non-stationary coagulation equation with in-flux and out-flux of particles (cargo). An exact analytical solution to this integrodifferential equation is found in a parametric form. This solution behaves as a decaying exponent with respect to the particle volume (fluorescence intensity in the case of coagulation of endosomes). We demonstrate that our exact solution substantially depends on coagulation kernels (fusion and fission rates) as well as the in-flux and out-flux processes of cargo.

Objective: To investigate the compatibility of oxytocin and tranexamic acid injection products when mixed for the purpose of co-administration by intravenous infusion. Population or Sample: Oxytocin and tranexamic acid were collected from hospitals taking part in a multicentre postpartum haemorrhage treatment (E-MOTIVE) trial in Kenya, Nigeria, Tanzania, and South Africa. Methods: The compatibility of two sentinel products of oxytocin injection and tranexamic acid injection in 200mL infusion bags of both 0.9%w/v saline and Ringer’s Lactate was assessed. We analysed all tranexamic acid -oxytocin combinations, and each evaluation was conducted for up to 6hrs. Subsequently, the compatibility of multiple tranexamic acid products with reference oxytocins products when mixed in 0.9%w/v saline over a period of 1 hour was investigated. Results: We found a significant interaction between certain oxytocin and tranexamic acid products after mixing them in vitro and observing for 1 hour. The interaction substantially impacted oxytocin content leading to reduction in concentration (14.8% - 29.0%) immediately on mixing (t=0 minutes). In some combinations, the concentration continued to decline throughout the stability assessment period. Oxytocin loss was observed in 7 out of 22 (32%) combinations tested. Conclusions: In a clinical setting, mixing oxytocin and tranexamic acid may result in an underdosing of oxytocin, compromising care in an emergency life-threatening situation. The mixing of oxytocin and tranexamic acid injection products for co-administration with IV infusion fluids should be avoided until the exact nature of the interaction and its implications are understood.

The effect of antenatal depressive and anxious symptoms on the rate of physiological birthsA comment on the recently published article by Hulsbosch et al:Association between high levels of comorbid anxiety and depressive symptoms and decreased likelihood of birth without intervention: A longitudinal prospective cohort study

Hemorrhagic cystitis is a common complication following the use of cyclophosphamide. Associated dysuria can be painful and there are few good options to relive pain. Phenazopyridine has historically been utilized for dysuria and is available over the counter. However, it is associated with hematologic side effects with prolonged use.

An accurate medication history prevents medication errors during transitions of care, whereas an inaccurate medication history may lead to unnecessary tests or prolonged hospitalization. We describe the case of a patient with chronic hypothyroidism who presented to the hospital with severe hypothyroidism and reported strict adherence to her home levothyroxine.

Acute Lymphoblastic Leukemia of the Central Nervous System Presenting with Rapid Weight GainConnor P. Hall1 and Alan D. Friedman11Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USACorrespondence: Alan D. Friedman, MDJohns Hopkins UniversityCRB I, Rm. 253 1650 Orleans St. Baltimore, Maryland 21231 Phone: 410-955-2095; Fax: 410-955-8897 Email: [email protected] Count: 863Number of Figures: 1Running Title: Rapid Weight Gain in ALLKey Words: acute lymphoblastic leukemia/ relapse/ weight gain/ central nervous systemAbbreviations:

Wolves (Canis lupus) can exert top-down pressure and shape ecological communities through selective predation of ungulates and beavers (Castor Canadensis). Considering their ability to shape communities through predation, understanding wolf foraging decisions is critical to predicting their ecosystem level effects. Specifically, if wolves are optimal foragers, consumers that optimize tradeoffs between cost and benefits of prey acquisition, changes in these factors may lead to prey switching or negative-density dependent selection with potential consequences for community stability. For wolves, factors affecting cost and benefits include prey vulnerability, risk, reward, and availability which can vary temporally. We described wolf diet in by frequency of occurrence and percent biomass and characterized diet in relation to optimal foraging using prey remains found in wolf scats on Isle Royale National Park, Michigan, USA during May–October 2019–2020. We used logistic regression to estimate prey consumption over time. We predicted prey with temporal variation in cost (vulnerability and/or availability) such as adult and calf moose (Alces alces) and beaver to vary in wolves’ diet. We analyzed 206 scats and identified 62% of remains as beaver, 26% as and moose, and 12% as other (birds, smaller mammals, and wolves). Adult moose were more likely to occur in wolf scat in May, when moose are in poor condition following winter. Similarly, the occurrence of moose calves peaked June–mid July following parturition but before their vulnerability declined as they matured. In contrast, beaver occurrence in wolf scat did not change over time, possibly reflecting the importance of low handling cost prey items for recently introduced lone or paired wolves. Our results demonstrate that wolf diet is plastic and responsive to temporal changes in prey acquisition cost as predicted by optimal foraging theory. Temporal fluctuation in diet may influence wolves’ ecological role if prey respond to increased predation risk by altering their foraging or breeding behavior.