Independent Risk Factors and Economic Burden Associated With Delayed Extubation Following Pediatric Liver Transplantation.

Background: Successful early extubation (EE) after liver transplant (LT) has been shown to reduce intensive care unit (ICU) and hospital length of stay and infectious, vascular, and sedation-related complications in adults. EE may not always be feasible in children, and many may require prolonged mechanical ventilation. Limited data exists regarding the candidacy of EE, risk factors, consequences, and hospital costs of delayed extubation (DE) in pediatric LT.

Feasibility of Achieving Nutritional Adequacy in Critically Ill Children with Critical Neurological Illnesses (CNIs)?-A Quaternary Hospital Experience.

The literature on the nutritional needs and outcomes of critically ill children is scarce, especially on those with critical neurological illnesses (CNIs). Current evidence shows a lower mortality in patients who achieve two-thirds of their nutritional needs during the first week of pediatric intensive care unit (PICU) admission. We hypothesized that achieving 60% of the recommended dietary intake during the first week of a PICU stay is not feasible in patients with CNI.

An In-Depth Look at Nutrition Support and Adequacy for Critically Ill Children with Organ Dysfunction.

Patients admitted to a pediatric intensive care unit (PICU) need individualized nutrition support that is tailored to their particular disease severity, nutritional status, and therapeutic interventions. We aim to evaluate how calories and proteins are provided during the first seven days of hospitalization for children in critical condition with organ dysfunction (OD). A single-center retrospective cohort study of children aged 2-18 years, mechanically ventilated > 48 h, and admitted > 7 days to a PICU from 2016 to 2017 was carried out.

Postoperative outcomes of acute-on-chronic liver failure in infants and children with biliary atresia.

Introduction: Acute-on-chronic liver failure (ACLF) is associated with increased mortality and morbidity in patients with biliary atresia (BA). Data on impact of ACLF on postoperative outcomes, however, are sparse.

Method: We performed a retrospective analysis of patients with BA aged <18 years who underwent LT between 2011 and 2021 at our institution.

Reliability and validity of the medial standing overhead arm reach (SOAR) test as a measure of functional hip adduction motion.

Objective: The Posterior Standing Overhead Arm Reach (SOAR) test has been previously reported as a reliable clinical measure of closed chain hip extension motion. The proposed Medial SOAR test expands on that testing approach to provide a similar measure of functional hip adduction motion. This was a preliminary intrarater and interrater reliability and validity study of the Medial SOAR test as a measure of functional hip adduction.

Estimating risk of prolonged mechanical ventilation after liver transplantation in children: PROVE-ALT score.

Background: Children at high risk for prolonged mechanical ventilation (PMV) after liver transplantation (LT) need to be identified early to optimize pulmonary support, allocate resources, and improve surgical outcomes. We aimed to develop and validate a metric that can estimate risk for Prolonged Ventilation After LT (PROVE-ALT).

Methods: We identified preoperative risk factors for PMV by univariable analysis in a retrospective cohort of pediatric LT recipients between 2011 and 2017 (n = 205; derivation cohort).

A quantum engine in the BEC-BCS crossover.

Heat engines convert thermal energy into mechanical work both in the classical and quantum regimes. However, quantum theory offers genuine non-classical forms of energy, different from heat, which so far have not been exploited in cyclic engines. Here we experimentally realize a quantum many-body engine fuelled by the energy difference between fermionic and bosonic ensembles of ultracold particles that follows from the Pauli exclusion principle.

Sinus Arrest Related to Dexmedetomidine Infusion in an Infant; a Case Report and Review of Current Literature.

Dexmedetomidine, an alpha 2 agonist, has emerged as a desirable sedative agent in the pediatric intensive care unit due to its minimal effect on respiratory status and reduction in delirium. Bradycardia and hypotension are common side effects, however there are emerging reports of more serious cardiovascular events, including sinus arrest and asystole. These case reports have been attributed to high vagal tone or underlying cardiac conduction dysfunction.

Management of Extensive Central Nervous System Cladophialophora bantiana Infection in a 9-Year-Old Child.

Background: Pediatric central nervous system (CNS) phaeohyphomycosis is a rare invasive fungal infection associated with high mortality.

Methods: We describe a child with progressive neurologic symptoms whose ultimate diagnosis was Cladophialophora bantiana -associated CNS phaeohyphomycosis. We discuss her clinical presentation, medical and surgical management and review the current literature.

Self-Pinning Transition of a Tonks-Girardeau Gas in a Bose-Einstein Condensate.

We show that a Tonks-Girardeau (TG) gas that is immersed in a Bose-Einstein condensate can undergo a transition to a crystal-like Mott state with regular spacing between the atoms without any externally imposed lattice potential. We characterize this phase transition as a function of the interspecies interaction and temperature of the TG gas, and show how it can be measured via accessible observables in cold atom experiments. We also develop an effective model that accurately describes the system in the pinned insulator state and which allows us to derive the critical temperature of the transition.

Hemodynamic instability during connection to continuous kidney replacement therapy in critically ill pediatric patients.

Background: Emerging data suggest evidence of organ hypoperfusion during continuous kidney replacement therapy (CKRT). To facilitate kidney and global recovery, we must understand the hemodynamic risks associated with CKRT. We aimed to investigate frequency of hemodynamic instability and association with patient outcomes in pediatric CKRT.

The use of tracheostomy to support critically ill children receiving orthotopic liver transplantation: a single-center experience.

Background: Children with end-stage liver disease and multi-organ failure, previously considered as poor surgical candidates, can now benefit from liver transplantation (LT). They often need prolonged mechanical ventilation (MV) post-LT and may need tracheostomy to advance care. Data on tracheostomy after pediatric LT are lacking.

In Situ Thermometry of a Cold Fermi Gas via Dephasing Impurities.

The precise measurement of low temperatures is a challenging, important, and fundamental task for quantum science. In particular, in situ thermometry is highly desirable for cold atomic systems due to their potential for quantum simulation. Here, we demonstrate that the temperature of a noninteracting Fermi gas can be accurately inferred from the nonequilibrium dynamics of impurities immersed within it, using an interferometric protocol and established experimental methods.

Orthogonality Catastrophe as a Consequence of the Quantum Speed Limit.

A remarkable feature of quantum many-body systems is the orthogonality catastrophe that describes their extensively growing sensitivity to local perturbations and plays an important role in condensed matter physics. Here we show that the dynamics of the orthogonality catastrophe can be fully characterized by the quantum speed limit and, more specifically, that any quenched quantum many-body system, whose variance in ground state energy scales with the system size, exhibits the orthogonality catastrophe. Our rigorous findings are demonstrated by two paradigmatic classes of many-body systems-the trapped Fermi gas and the long-range interacting Lipkin-Meshkov-Glick spin model.

Noninvasive stereotactic radioablation for the treatment of atrial fibrillation: First-in-man experience.

Purpose: Catheter ablation is an effective therapy for atrial fibrillation (AF). However, risks remain, and improved efficacy is desired. Stereotactic body radiotherapy (SBRT) is a well-established therapy used to noninvasively treat malignancies and functional disorders with precision.

A pilot study of venous flow augmentation using a novel mechanical graded intermittent sequential compression device for venous insufficiency.

Background: Guidelines as well as multiple RTCs support the use of intermittent pneumatic compression (IPC) for the treatment of venous leg ulcers when conservative measures fail. Unfortunately, the clinical usefulness of IPC is significantly limited by the physical limitations of pneumatic motors, which leads to bulky devices with slow inflation cycles, uncomfortable sleeves, lack of patient mobility, and ultimately poor patient compliance with therapy. A novel mechanical device for lower leg graded intermittent sequential compression was designed to address these limitations of IPC therapy for venous leg ulcer treatment by providing rapid compression cycles in a truly wearable device that offers the additional benefit of monitoring compression dose and patient compliance.

Safety and efficacy of stereotactic radioablation targeting pulmonary vein tissues in an experimental model.

Background: Stereotactic radioablation (SR), a commonly used therapy to treat malignant tumors, has been used to treat refractory ventricular tachycardia, but the feasibility of treating atrial fibrillation with SR is unknown.

Objective: We evaluated the safety and efficacy of SR targeting pulmonary vein (PV) antral tissues as a potential therapy for atrial fibrillation.

Methods: Seventeen adult canines and 2 adult swine underwent surgical fiducial marker placement, 3-dimensional anatomic rendering computed tomography angiogram of the left atrium, and creation of a treatment plan targeting the right superior PVs.

Radiosurgical Ablation of the Renal Nerve in a Porcine Model: A Minimally Invasive Therapeutic Approach to Treat Refractory Hypertension.

Background: Hypertension is strongly associated with cardiovascular diseases such as heart failure, stroke, kidney disease, and has been correlated with an increased risk for heart attack. Current treatment regimens for hypertension are highly inadequate, with reports indicating that only 50.1% of the clinical population with the disease has their blood pressure under control.

Cost-Effectiveness of Cardiac Radiosurgery for Atrial Fibrillation: Implications for Reducing Health Care Morbidity, Utilization, and Costs.

In the United States (U.S.), atrial fibrillation (AF) is the second-most common cardiovascular condition after hypertension, affecting four million Americans each year.

Noninvasive stereotactic radiosurgery (CyberHeart) for creation of ablation lesions in the atrium.

Background: A variety of catheter-based energy modalities are used for cardiac ablation to treat arrhythmias. Robotic radiosurgery is increasingly being utilized to successfully accomplish precise tissue ablation in anatomically remote areas.

Objective: The purpose of this study was to examine the experimental feasibility of a noninvasive method using stereotactic robotic radiosurgery (SRS) to create cardiac lesions.