Veno-arterial ECMO ventricular assistance as a direct bridge to heart transplant: A single center experience in a low-middle income country.

INTRODUCTION: The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a direct bridge to heart transplantation (BTT) is not common in adults worldwide. BTT with ECMO is associated with increased early/mid-term mortality compared with other interventions. In low- and middle-income countries (LMIC), where no other type of short-term mechanical circulatory support is available, its use is widespread and increasingly used as rescue therapy in patients with cardiogenic shock (CS) as a direct bridge to heart transplantation (HT). OBJECTIVE: To assess the outcomes of adult patients using VA-ECMO as a direct BTT in an LMIC and compare them with international registries. METHODS: We conducted a single-center study analyzing consecutive adult patients requiring VA-ECMO as BTT due to refractory CS or cardiac arrest (CA) in a cardiovascular center in Argentina between January 2014 and December 2022. Survival and adverse clinical events after VA-ECMO implantation were evaluated. RESULTS: Of 86 VA-ECMO, 22 (25.5%) were implanted as initial BTT strategy, and 52.1% of them underwent HT. Mean age was 46 years (SD 12); 59% were male. ECMO was indicated in 81% for CS, and the most common underlying condition was coronary artery disease (31.8%). Overall, in-hospital mortality for VA-ECMO as BTT was 50%. Survival to discharge was 83% in those who underwent HT and 10% in those who did not, p < .001. In those who did not undergo HT, the main cause of death was hemorrhagic complications (44%), followed by thrombotic complications (33%). The median duration of VA-ECMO was 6 days (IQR 3-16). There were no differences in the number of days on ECMO between those who received a transplant and those who did not. In the Spanish registry, in-hospital survival after HT was 66.7%; the United Network of Organ Sharing registry estimated post-transplant survival at 73.1% ± 4.4%, and in the French national registry 1-year posttransplant survival was 70% in the VA-ECMO group. CONCLUSIONS: In adult patients with cardiogenic shock, VA-ECMO as a direct BTT allowed successful HT in half of the patients. HT provided a survival benefit in listed patients on VA-ECMO. We present a single center experience with results comparable to those of international registries.

Static and dynamic magnetic properties of circular and square cobalt nanodots in hexagonal cells.

In this work we performed a detailed numerical analysis to investigate the static and dynamic magnetic properties of hexagonal cells of square and circular cobalt nanodots as a function of the distance between them and the external magnetic field to which they are subjected. By simulating hysteresis curves with the external magnetic field applied parallel and perpendicular to the plane of these nanostructures, we can conclude that the cobalt nanodots presented a significant perpendicular magnetic anisotropy. We also obtained that the coercivity increases with decreasing volume, which implies that the circular dots have a higher coercivity than the square dots. Furthermore, we studied the dynamic susceptibility of these systems and found that it is possible to control both the position and the number of resonance peaks by controlling the geometry and the distance between the magnetic nanodots. This work provides useful information on the behaviour of cobalt nanodot arrays, opening paths for the design and improvement of two-dimensional technological devices.

Rapid, recurring, structured survey versus bioblitz for generating biodiversity data and analysis with a multispecies abundance model.

A bioblitz inexpensively and quickly generates biodiversity data, but bioblitzes are often conducted with haphazard, unreplicated sampling. Results tend to be taxonomically, geographically, or temporally biased, lack metadata, and consist of lists of observed taxa that do not enable further analyses or correction for imperfect detection. A rapid, recurring, structured survey (RRSS) uses a structured sampling design and temporal and spatial replication to survey randomly selected sites on a conservation property. We participated in a loosely structured bioblitz and a subsequent RRSS at Big Canoe Creek Nature Preserve in Springville (St. Clair County), Alabama (USA) to compare observed richness derived from the 2 survey approaches. The RRSS data structure enabled us to fit models that accounted for imperfect detection to estimate abundances, occupancy probabilities, and habitat associations. The loosely structured bioblitz data could not be used in such models. We present a new integrated multispecies abundance model that we applied to avian RRSS data. Our model extension enables estimation for the community, employs data augmentation to estimate the number of undetected species, and incorporates covariates. The RRSS generated a more comprehensive and less biased list of observed taxonomic richness than the loosely structured bioblitz (e.g., 73 vs. 45 bird species and 104 vs. 63 insect families from the RRSS vs. loosely structured bioblitz, respectively). Models fit to the RRSS data identified seasonal patterns in avian community composition and allowed for estimation of habitat-occupancy relationships for insect taxa. The RRSS protocol has potential for broad transferability as a standardized, quick, and inexpensive way to inventory biodiversity and estimate ecological parameters while providing an outreach opportunity.

Un bioblitz genera información sobre la biodiversidad de manera rápida y económica, pero con frecuencia se realizan con muestreos irregulares e irrepetibles. Además, los resultados tienden a estar sesgados taxonómica, geográfica o temporalmente, carecen de metadatos y consisten en una lista de taxones observados que no permiten análisis más profundos o la corrección de las detecciones imperfectas. Un censo rápido, recurrente y estructurado (CRRE) usa un diseño de muestreo estructurado y la replicación temporal y espacial para censar los sitios seleccionados al azar en una propiedad de conservación. Participamos en un bioblitz ligeramente estructurado y en un CRRE subsecuente en la reserva natural Big Canoe Creek en Springville, condado St. Clair, Alabama, EUA, para comparar la riqueza observada derivada de las dos estrategias de censo. La estructura de datos del CRRE nos permitió ajustar los modelos que explicaban la detección imperfecta para estimar abundancias, probabilidades de ocupación y asociaciones de hábitat. No pudimos usar los datos del bioblitz en dichos modelos. Presentamos un nuevo modelo de abundancia multiespecie que aplicamos a los datos ornitológicos del CRRE. Nuestra extensión del modelo permite la estimación de la comunidad, usa el aumento de datos para estimar el número de especies no detectadas e incorpora las covariables. El CRRE generó una lista más completa y menos sesgada de la riqueza taxonómica observada que el bioblitz (73 especies de aves versus 45 y 104 familias de insectos versus 63, respectivamente). Los modelos ajustados a los datos del CRRE identificaron patrones estacionales en la composición de la comunidad ornitológica y permitieron la estimación de las relaciones de ocupación de hábitat de los taxones de insectos. El protocolo del CRRE tiene potencial para usarse de manera general como un método de inventario de la biodiversidad estandarizado, rápido y económico y para estimar los parámetros ecológicos a la vez que proporciona una oportunidad de divulgación.

Spectrally separable photon-pair generation in dispersion engineered thin-film lithium niobate.

Existing nonlinear-optic implementations of pure, unfiltered heralded single-photon sources do not offer the scalability required for densely integrated quantum networks. Additionally, lithium niobate has hitherto been unsuitable for such use due to its material dispersion. We engineer the dispersion and the quasi-phasematching conditions of a waveguide in the rapidly emerging thin-film lithium niobate platform to generate spectrally separable photon pairs in the telecommunications band. Such photon pairs can be used as spectrally pure heralded single-photon sources in quantum networks. We estimate a heralded-state spectral purity of >94% based on joint spectral intensity measurements. Further, a joint spectral phase-sensitive measurement of the unheralded time-integrated second-order correlation function yields a heralded-state purity of (86±5)%.

Experimental Demonstration of Conjugate-Franson Interferometry.

Franson interferometry is a well-known quantum measurement technique for probing photon-pair frequency correlations that is often used to certify time-energy entanglement. We demonstrate, for the first time, the complementary technique in the time basis called conjugate-Franson interferometry. It measures photon-pair arrival-time correlations, thus providing a valuable addition to the quantum toolbox. We obtain a conjugate-Franson interference visibility of 96±1% without background subtraction for entangled photon pairs generated by spontaneous parametric down-conversion. Our measured result surpasses the quantum-classical threshold by 25 standard deviations and validates the conjugate-Franson interferometer (CFI) as an alternative method for certifying time-energy entanglement. Moreover, the CFI visibility is a function of the biphoton's joint temporal intensity, and is therefore sensitive to that state's spectral phase variation: something that is not the case for Franson interferometry or Hong-Ou-Mandel interferometry. We highlight the CFI's utility by measuring its visibilities for two different biphoton states: one without and the other with spectral phase variation, observing a 21% reduction in the CFI visibility for the latter. The CFI is potentially useful for applications in areas of photonic entanglement, quantum communications, and quantum networking.

Resolving Photon Numbers Using a Superconducting Nanowire with Impedance-Matching Taper.

Time- and number-resolved photon detection is crucial for quantum information processing. Existing photon-number-resolving (PNR) detectors usually suffer from limited timing and dark-count performance or require complex fabrication and operation. Here, we demonstrate a PNR detector at telecommunication wavelengths based on a single superconducting nanowire with an integrated impedance-matching taper. The taper provides a kΩ load impedance to the nanowire, making the detector's output amplitude sensitive to the number of photon-induced hotspots. The prototyping device was able to resolve up to four absorbed photons with 16.1 ps timing jitter and <2 c.p.s. device dark count rate. Its exceptional distinction between single- and two-photon responses is ideal for high-fidelity coincidence counting and allowed us to directly observe bunching of photon pairs from a single output port of a Hong-Ou-Mandel interferometer. This detector architecture may provide a practical solution to applications that require high timing resolution and few-photon discrimination.

Application of target repositioning and in silico screening to exploit fatty acid binding proteins (FABPs) from Echinococcus multilocularis as possible drug targets.

Fatty acid binding proteins (FABPs) are small intracellular proteins that reversibly bind fatty acids and other hydrophobic ligands. In cestodes, due to their inability to synthesise fatty acids and cholesterol de novo, FABPs, together with other lipid binding proteins, have been proposed as essential, involved in the trafficking and delivery of such lipophilic metabolites. Pharmacological agents that modify specific parasite FABP function may provide control of lipid signalling pathways, inflammatory responses and metabolic regulation that could be of crucial importance for the parasite development and survival. Echinococcus multilocularis and Echinococcus granulosus are, respectively, the causative agents of alveolar and cystic echinococcosis (or hydatidosis). These diseases are included in the World Health Organization's list of priority neglected tropical diseases. Here, we explore the potential of FABPs from cestodes as drug targets. To this end, we have applied a target repurposing approach to identify novel inhibitors of Echinococcus spp. FABPs. An ensemble of computational models was developed and applied in a virtual screening campaign of DrugBank library. 21 hits belonging to the applicability domain of the ensemble models were identified, and 3 of the hits were assayed against purified E. multilocularis FABP, experimentally confirming the model's predictions. Noteworthy, this is to our best knowledge the first report on isolation and purification of such four FABP, for which initial structural and functional characterization is reported here.

Large-alphabet encoding for higher-rate quantum key distribution.

The manipulation of high-dimensional degrees of freedom provides new opportunities for more efficient quantum information processing. It has recently been shown that high-dimensional encoded states can provide significant advantages over binary quantum states in applications of quantum computation and quantum communication. In particular, high-dimensional quantum key distribution enables higher secret-key generation rates under practical limitations of detectors or light sources, as well as greater error tolerance. Here, we demonstrate high-dimensional quantum key distribution capabilities both in the laboratory and over a deployed fiber, using photons encoded in a high-dimensional alphabet to increase the secure information yield per detected photon. By adjusting the alphabet size, it is possible to mitigate the effects of receiver bottlenecks and optimize the secret-key rates for different channel losses. This work presents a strategy for achieving higher secret-key rates in receiver-limited scenarios and marks an important step toward high-dimensional quantum communication in deployed fiber networks.

Indistinguishable single-mode photons from spectrally engineered biphotons.

We use pulsed spontaneous parametric down-conversion in KTiOPO 4, with a Gaussian phase-matching function and a transform-limited Gaussian pump, to achieve near-unity spectral purity in heralded single photons at telecommunication wavelength. Theory shows that these phase-matching and pump conditions are sufficient to ensure that a biphoton state with a circularly symmetric joint spectral intensity profile is transform limited and factorable. We verify the heralded-state spectral purity in a four-fold coincidence measurement by performing Hong-Ou-Mandel interference between two independently generated heralded photons. With a mild spectral filter we obtain an interference visibility of 98.4±1.1% which corresponds to a heralded-state purity of 99.2%. Our heralded photon source is potentially an essential resource for measurement-based quantum information processing and quantum network applications.

Revealing hidden scenes by photon-efficient occlusion-based opportunistic active imaging.

The ability to see around corners, i.e., recover details of a hidden scene from its reflections in the surrounding environment, is of considerable interest in a wide range of applications. However, the diffuse nature of light reflected from typical surfaces leads to mixing of spatial information in the collected light, precluding useful scene reconstruction. Here, we employ a computational imaging technique that opportunistically exploits the presence of occluding objects, which obstruct probe-light propagation in the hidden scene, to undo the mixing and greatly improve scene recovery. Importantly, our technique obviates the need for the ultrafast time-of-flight measurements employed by most previous approaches to hidden-scene imaging. Moreover, it does so in a photon-efficient manner (i.e., it only requires a small number of photon detections) based on an accurate forward model and a computational algorithm that, together, respect the physics of three-bounce light propagation and single-photon detection. Using our methodology, we demonstrate reconstruction of hidden-surface reflectivity patterns in a meter-scale environment from non-time-resolved measurements. Ultimately, our technique represents an instance of a rich and promising new imaging modality with important potential implications for imaging science.

Efficient generation and characterization of spectrally factorable biphotons.

Spectrally unentangled biphotons with high single-spatiotemporal-mode purity are highly desirable for many quantum information processing tasks. We generate biphotons with an inferred heralded-state spectral purity of 99%, the highest to date without any spectral filtering, by pulsed spontaneous parametric downconversion in a custom-fabricated periodically-poled KTiOPO4 crystal under extended Gaussian phase-matching conditions. To efficiently characterize the joint spectral intensity of the generated biphotons at high spectral resolution, we employ a commercially available dispersion compensation module (DCM) with a dispersion equivalent to 100 km of standard optical fiber and with an insertion loss of only 2.8 dB. Compared with the typical method of using two temperature-stabilized equal-length fibers that incurs an insertion loss of 20 dB per fiber, the DCM approach achieves high spectral resolution in a much shorter measurement time. Because the dispersion amount and center wavelengths of DCMs can be easily customized, spectral characterization in a wide range of quantum photonic applications should benefit significantly from this technique.

Unity-Efficiency Parametric Down-Conversion via Amplitude Amplification.

We propose an optical scheme, employing optical parametric down-converters interlaced with nonlinear sign gates (NSGs), that completely converts an n-photon Fock-state pump to n signal-idler photon pairs when the down-converters' crystal lengths are chosen appropriately. The proof of this assertion relies on amplitude amplification, analogous to that employed in Grover search, applied to the full quantum dynamics of single-mode parametric down-conversion. When we require that all Grover iterations use the same crystal, and account for potential experimental limitations on crystal-length precision, our optimized conversion efficiencies reach unity for 1≤n≤5, after which they decrease monotonically for n values up to 50, which is the upper limit of our numerical dynamics evaluations. Nevertheless, our conversion efficiencies remain higher than those for a conventional (no NSGs) down-converter.

SiGe layer thickness effect on the structural and optical properties of well-organized SiGe/SiO2 multilayers.

In this work, we report on the production of regular (SiGe/SiO2)20 multilayer structures by conventional RF-magnetron sputtering, at 350 °C. Transmission electron microscopy, scanning transmission electron microscopy, raman spectroscopy, and x-ray reflectometry measurements revealed that annealing at a temperature of 1000 °C leads to the formation of SiGe nanocrystals between SiO2 thin layers with good multilayer stability. Reducing the nominal SiGe layer thickness (t SiGe) from 3.5-2 nm results in a transition from continuous SiGe crystalline layer (t SiGe ∼ 3.5 nm) to layers consisting of isolated nanocrystals (t SiGe ∼ 2 nm). Namely, in the latter case, the presence of SiGe nanocrystals ∼3-8 nm in size, is observed. Spectroscopic ellipsometry was applied to determine the evolution of the onset in the effective optical absorption, as well as the dielectric function, in SiGe multilayers as a function of the SiGe thickness. A clear blue-shift in the optical absorption is observed for t SiGe ∼ 2 nm multilayer, as a consequence of the presence of isolated nanocrystals. Furthermore, the observed near infrared values of n = 2.8 and k = 1.5 are lower than those of bulk SiGe compounds, suggesting the presence of electronic confinement effects in the nanocrystals. The low temperature (70 K) photoluminescence measurements performed on annealed SiGe/SiO2 nanostructures show an emission band located between 0.7-0.9 eV associated with the development of interface states between the formed nanocrystals and surrounding amorphous matrix.

Computational multi-depth single-photon imaging.

We present an imaging framework that is able to accurately reconstruct multiple depths at individual pixels from single-photon observations. Our active imaging method models the single-photon detection statistics from multiple reflectors within a pixel, and it also exploits the fact that a multi-depth profile at each pixel can be expressed as a sparse signal. We interpret the multi-depth reconstruction problem as a sparse deconvolution problem using single-photon observations, create a convex problem through discretization and relaxation, and use a modified iterative shrinkage-thresholding algorithm to efficiently solve for the optimal multi-depth solution. We experimentally demonstrate that the proposed framework is able to accurately reconstruct the depth features of an object that is behind a partially-reflecting scatterer and 4 m away from the imager with root mean-square error of 11 cm, using only 19 signal photon detections per pixel in the presence of moderate background light. In terms of root mean-square error, this is a factor of 4.2 improvement over the conventional method of Gaussian-mixture fitting for multi-depth recovery.

Entanglement-enhanced sensing in a lossy and noisy environment.

Nonclassical states are essential for optics-based quantum information processing, but their fragility limits their utility for practical scenarios in which loss and noise inevitably degrade, if not destroy, nonclassicality. Exploiting nonclassical states in quantum metrology yields sensitivity advantages over all classical schemes delivering the same energy per measurement interval to the sample being probed. These enhancements, almost without exception, are severely diminished by quantum decoherence. Here, we experimentally demonstrate an entanglement-enhanced sensing system that is resilient to quantum decoherence. We employ entanglement to realize a 20% signal-to-noise ratio improvement over the optimum classical scheme in an entanglement-breaking environment plagued by 14 dB of loss and a noise background 75 dB stronger than the returned probe light. Our result suggests that advantageous quantum-sensing technology could be developed for practical situations.

Low power laser stimulation of the bone consolidation in tibial fractures of rats: a radiologic and histopathological analysis.

The objective of this study is to analyze the effectiveness of low power laser irradiation in the bone consolidation of tibial fractures in rats. An experimental, comparative, prospective study with control group was designed. Twenty Wistar rats were grouped into control (n = 10) and experimental groups (n = 10). A tibial fracture, with a mechanical drill, was inflicted in all rats. The experimental group received ten days of low power arsenide-gallium laser irradiation of 850 nm (KLD, Sao Paulo, Brasil)-100 mW, 8 J/cm(2), 64 s. Before and after the laser treatment, a radiologic analysis was carried out in both groups, in which the rats were graded from 0 to IV according the Montoya scale of bone consolidation. Also, we histopathologically analyzed the bone to estimate the proliferation of fibroblasts, bone matrix, and angiogénesis with a microscopy, which were graded as I (thin layer of fibroblasts and osteoid matrix), II (thick layer of fibroblasts and osteoid matrix), or III (thick layer of fibroblasts and osteoid matrix and new blood vessels). Radiologic data showed that the experimental group had a higher bone consolidation of Montoya scale after ten days of laser irradiation compared to control group (P < 0.004). Histopathologic data showed more fibroblasts and angiogenesis presence in the group receiving laser irradiation, compared to control group (P < .002). The low power laser radiation therapy may expedite the bone repair after tibial fractures in rats, according to radiologic and histopathologic analysis.

Unconditional security of time-energy entanglement quantum key distribution using dual-basis interferometry.

High-dimensional quantum key distribution (HDQKD) offers the possibility of high secure-key rate with high photon-information efficiency. We consider HDQKD based on the time-energy entanglement produced by spontaneous parametric down-conversion and show that it is secure against collective attacks. Its security rests upon visibility data-obtained from Franson and conjugate-Franson interferometers-that probe photon-pair frequency correlations and arrival-time correlations. From these measurements, an upper bound can be established on the eavesdropper's Holevo information by translating the Gaussian-state security analysis for continuous-variable quantum key distribution so that it applies to our protocol. We show that visibility data from just the Franson interferometer provides a weaker, but nonetheless useful, secure-key rate lower bound. To handle multiple-pair emissions, we incorporate the decoy-state approach into our protocol. Our results show that over a 200-km transmission distance in optical fiber, time-energy entanglement HDQKD could permit a 700-bit/sec secure-key rate and a photon information efficiency of 2 secure-key bits per photon coincidence in the key-generation phase using receivers with a 15% system efficiency.

Training in intensive care medicine. A challenge within reach.

The medical training model is currently immersed in a process of change. The new paradigm is intended to be more effective, more integrated within the healthcare system, and strongly oriented towards the direct application of knowledge to clinical practice. Compared with the established training system based on certification of the completion of a series or rotations and stays in certain healthcare units, the new model proposes a more structured training process based on the gradual acquisition of specific competences, in which residents must play an active role in designing their own training program. Training based on competences guarantees more transparent, updated and homogeneous learning of objective quality, and which can be homologated internationally. The tutors play a key role as the main directors of the process, and institutional commitment to their work is crucial. In this context, tutors should receive time and specific formation to allow the evaluation of training as the cornerstone of the new model. New forms of objective summative and training evaluation should be introduced to guarantee that the predefined competences and skills are effectively acquired. The free movement of specialists within Europe is very desirable and implies that training quality must be high and amenable to homologation among the different countries. The Competency Based training in Intensive Care Medicine in Europe program is our main reference for achieving this goal. Scientific societies in turn must impulse and facilitate all those initiatives destined to improve healthcare quality and therefore specialist training. They have the mission of designing strategies and processes that favor training, accreditation and advisory activities with the government authorities.

Untethered soft magnetic pump for microfluidics-based Marangoni surfer.

Microfluidics has enabled the miniaturization of fluidic systems for various biomedical and industrial applications, including small-scale robotic propulsion. One mechanism for generating propulsive force through microfluidics is by exploiting the solutal Marangoni effect via releasing surfactant on the air-water interface. Surfactants locally reduce the surface tension, which leads to a surface stress that can propel the floating robot, called Marangoni surfer. However, so far the release of the surfactant is not controllable. In this study, we combine microfluidics-based Marangoni propulsion with a novel untethered magnetic pumping mechanism to enhance its controllability. The proposed magnetic micropump capitalizes on the interaction force between two soft magnets, which can generate a pumping force of 4.64 mN to actuate a membrane, and achieve a deformation of 450 µm. Net flow is achieved using a nozzle/diffuser flow rectifier whose efficacy as a function of the channel geometry is numerically studied. We investigate the flow rate of the pump with regard to the actuation frequency. Finally, we demonstrate its ability to control the motion of the Marangoni surfer.

Plumage microorganism communities of tidal marsh sparrows.

Microorganism communities can shape host phenotype evolution but are often comprised of thousands of taxa with varied impact on hosts. Identification of taxa influencing host evolution relies on first describing microorganism communities and acquisition routes. Keratinolytic (keratin-degrading) microorganisms are hypothesized to be abundant in saltmarsh sediments and to contribute to plumage evolution in saltmarsh-adapted sparrows. Metabarcoding was used to describe plumage bacterial (16S rRNA) and fungal (ITS) communities in three sparrow species endemic to North America's Atlantic coast saltmarshes. Results describe limited within-species variability and moderate host species-level patterns in microorganism diversity and community composition. A small percentage of overall microorganism diversity was comprised of potentially keratinolytic microorganisms, warranting further functional studies. Distinctions between plumage and saltmarsh sediment bacteria, but not fungal, communities were detected, suggesting multiple bacterial acquisition routes and/or vertebrate host specialization. This research lays groundwork for future testing of causal links between microorganisms and avian host evolution.