Dead space ratio as a tool in nitric oxide weaning: a study in pulmonary hypertensive disease

Objectives: To describe the association between successful weaning of inhaled nitric oxide and trends in dead space ratio during such weans in patients empirically initiated on nitric oxide therapy out of concern of pulmonary hypertensive crisis. Patients: Children in a cardiac intensive care unit initiated on inhaled nitric oxide out of clinical concern for pulmonary hypertensive crisis retrospectively over 2 years. Measurements and Main Results: Twenty-seven patients were included, and nitric oxide was successfully discontinued in 23/27. These patients exhibited decreases in dead space ratio (0.18 versus 0.11, p = 0.047) during nitric oxide weaning, and with no changes in dead space ratio between pre- and post-nitric oxide initiation (p = 0.88) and discontinuation (p = 0.63) phases. These successful patients had a median age of 10 months [4.0, 57.0] and had a pre-existent diagnosis of CHD in 6/23 and pulmonary hypertension in 2/23. Those who failed nitric oxide discontinuation trended with a higher dead space ratio at presentation (0.24 versus 0.10), were more likely to carry a prior diagnosis of pulmonary hypertension (50% versus 8.7%), and had longer mechanical ventilation days (5 versus 12). Conclusions: Patients empirically placed on nitric oxide out of concern of pulmonary hypertensive crisis and successfully weaned off showed unchanged or decreased dead space ratio throughout the initiation to discontinuation phases of nitric oxide therapy. Trends in dead space ratio may aid in determining true need for nitric oxide and facilitate effective weaning. Further studies are needed to directly compare trends between success and failure groups.

Impacts of the Microclimate of a Large Urban Park on Its Surrounding Built Environment in the Summertime

The cooling effect of green spaces as an ecological solution to mitigate urban climate change is well documented. However, the factors influencing the microclimate in the built environment around forest parks, diurnal variations of their impact and their degree of importance have not been explicitly addressed. We attempted to quantify how much various landscape parameters, including land cover and spatial location, impact the ambient air and surface temperature in the area around Beijing’s Olympic Forest Park. Data were taken along strategically located traverses inside and outside the park. We found: (1) The air temperature during the day was 1.0–3.5 °C lower in the park than in the surrounding area; the surface temperature was 1.7–4.8 °C lower; air humidity in the park increased by 8.7–15.1%; and the human comfort index reduced to 1.8–6.9, all generating a more comfortable thermal environment in the park than in the surrounding area. (2) The distance to the park and the green space ratio of the park’s surrounding area are significant factors for regulating its microclimate. A 1 km increase in distance to the park caused the temperature to increase by 0.83 °C; when the green space ratio increased by 10%, the temperature dropped by 0.16 °C on average. The impact of these two parameters was more obvious in the afternoon than in the middle of the day or in the morning. The green space ratio could be used for designing a more stable thermal environment. (3) Land cover affects surface temperature more than it does air temperature. Our data suggest that an urban plan with an even distribution of green space would provide the greatest thermal comfort.

How to prevent graft resorption or breakage in shelf acetabuloplasty for Perthes disease with hinge abduction – A modified Staheli technique successful in 31 hips in midterm results

BACKGROUND: Shelf acetabuloplasty covers the hip and allows remodeling in hips with Legg-Calv-Perthes disease and hinge abduction. Graft resorption or breakage is a bad complication that necessitate another surgical procedure. AIM: Our report evaluates a modified Staheli technique for graft resorption or breakage. MATERIALS AND METHODS: Case series study of 31 hips (29 patients) with mean age at operation was 8.1 (range 6-14 years). Duration of complaint ranged between one year and up to three years with the mean duration 1.52 0.76 years. The different parameters evaluating the hip as: Tnnis angle, Sharp angle, center-edge angle, and acetabular coverage percentage were measured. For unilateral cases only, medial joint space ratio and epiphyseal height ratio were evaluated. RESULTS: The mean postoperative follow-up was 47.8 9.8 months. All studied joints had Catterall type IV, Salter-Thompson classification type B. Seven joints were in Fragmentation stage whereas 24 joints were in re-ossification stage. Based on Lateral Pillar classification; only two joints were classified as B/C and 29 joints were classified as C. Final follow up internal rotation, abduction, center-edge angle, and acetabular coverage percentage were found to be significantly higher. In contrast, Tnnis angle and Sharps angle were significantly decreased. For unilateral cases, it was found that medial joint space ratio and epiphyseal height ratio were significantly decreased. None of the hips had resorbed or broken graft till final follow up. CONCLUSIONS: This modified Staheli technique prevent graft resorption or breakage. Shelf provides a good acetabular coverage for the deformed aspherical head with Legg-Calv-Perthes disease and hinge abduction to improve hip clinical and radiological outcome.

Flow-Induced Vibration in a Single Row of Cylinders With p/D = 1.26

Crossflow over a row of cylinders with a close space ratio presents an asymmetric configuration with large and narrow wakes behind the cylinders. The wake interaction can impact the vibration response of the cylinders. In tube banks, the impact results in damages to the equipment. The present experimental study aims to analyze the influence of close space observed in a single row of cylinders on the flow-induced vibration. The study compares a single row with fixed cylinders and a single row with one cylinder free to vibrate. The cylinder free to vibrate is tested in four configurations. The study was conducted with an aerodynamic channel with a cross-section of 0.193 × 0.146 m and smooth cylinders with a diameter of 25.1 mm, space ratio is 1.26. The measurements are executed with hot-wire anemometry and accelerometers, for the cases with one cylinder free to vibrate and with hot-wire anemometry and microphones for the case with all fixed cylinders. The Reynolds number ranges between 1.0 × 104 and 4.5 × 104, obtained with the reference flow velocity, measured with a Pitot tube, and the cylinder diameter. The comparison between the wake response for single row fixed and single row and free to vibrate are executed using Fourier transform and Wavelet Transform. The comparison of the results with the models presented in the literature to predict the elastic instability of the fluid in a single row of cylinders is performed.

Relationship between hip joint medial space ratio and collapse of femoral head in non-traumatic osteonecrosis: a retrospective study

ABSTRACT To retrospectively analyze the medial space ratio (MSR) of the hip joint to evaluate its efficacy in predicting osteonecrosis of femoral head (ONFH)-induced collapse and its impacts on the mechanical environment of necrotic femoral head. In this retrospective analysis of traditional Chinese medicine, non-traumatic ONFH (NONFH) patients from January 2008 to December 2013 were selected. The patients were divided into collapse group and non-collapse group based on whether the femoral head collapsed. The anatomical parameters including center–edge (CE) angle, sharp angle, acetabular depth ratio and MSR were evaluated. Receiver operating characteristic curves were estimated to evaluate the sensitivity and specificity of MSR and CE angle in collapse prediction. The results showed that 135 patients (151 hips) were included in this study. The differences in CE angle and MSR between collapse group and non-collapse group were statistically significant. The mean survival time of the hips of patients with MSR <20.35 was greater (P < 0.001) than that of patients with MSR >20.35. The ONFH patients with MSR >20.35 were prone to stress concentration. We could conclude that the hip joint MSR and CE angle strongly correlated with the collapse of NONFH. The specificity of MSR is higher than that of CE angle. When MSR is >20.35, the collapse rate of ONFH will increase significantly.

The Morphological and Anatomical Traits of the Leaf in Representative Vinca Species Observed on Indoor- and Outdoor-Grown Plants

Morphological and anatomical traits of the Vinca leaf were examined using microscopy techniques. Outdoor Vinca minor and V. herbacea plants and greenhouse cultivated V. major and V. major var. variegata plants had interspecific variations. All Vinca species leaves are hypostomatic. However, except for V. minor leaf, few stomata were also present on the upper epidermis. V. minor leaf had the highest stomatal index and V. major had the lowest, while the distribution of trichomes on the upper epidermis was species-specific. Differentiated palisade and spongy parenchyma tissues were present in all Vinca species’ leaves. However, V. minor and V. herbacea leaves had a more organized anatomical aspect, compared to V. major and V. major var. variegata leaves. Additionally, as a novelty, the cellular to intercellular space ratio of the Vinca leaf’s mesophyll was revealed herein with the help of computational analysis. Lipid droplets of different sizes and aspects were localized in the spongy parenchyma cells. Ultrastructural characteristics of the cuticle and its epicuticular waxes were described for the first time. Moreover, thick layers of cutin seemed to be characteristic of the outdoor plants only. This could be an adaptation to the unpredictable environmental conditions, but nevertheless, it might influence the chemical composition of plants.

The influence of K-wire transfixation on proximalization of the first metacarpal after resection suspension interposition arthroplasty

Introduction Osteoarthritis of the first carpometacarpal joint is a common degenerative disease and surgical treatment includes resection suspension interposition arthroplasty (RSIA) with or without temporary transfixation of the first metacarpal. One major drawback includes proximalization of the first metacarpal during the postoperative course. Specific data comparing different transfixation techniques in this context is sparse. Materials and methods In this retrospective study, we measured the trapezial space ratio (TSR) in 53 hands before and after RSIA to determine the proximalization of the first metacarpal depending on the type of Kirschner (K)-wire transfixation. We, therefore, compared transfixation of the first metacarpal to the scaphoid with one K-wire (1K) to transfixation of the first metacarpal with two K-wires (2K), either to the carpus (2Ka), or to the second metacarpal (2Kb), or to both second metacarpal and carpus (2Kc). Results While preoperative TSR did not differ between group 1K and 2K (p = 0.507), postoperative TSR was significantly higher in group 2K compared to 1K (p = 0.003). Comparing subgroups, postoperative TSR was significantly higher in group 2Kc than 1K (p = 0.046), while we found no significant difference comparing either group 2Ka or 2Kb to 1K (p = 0.098; p = 0.159). Neither did we find a significant difference within 2K subgroups, comparing group 2Ka and 2Kb (p = 0.834), 2Ka and 2Kc (p = 0.615), or 2Kb and 2Kc (p = 0.555). Conclusions The results of our study suggest that transfixation with two K-wires should be preferred to transfixation with one K-wire after RSIA. Specifically, transfixation from first to second metacarpal and from first metacarpal to carpus resulted in least proximalization of the first metacarpal postoperatively.