Bloodless Arterial Switch Operation in a 2.7-kg Jehovah's Witness Patient.

Bloodless pediatric cardiac surgery requiring the use of cardiopulmonary bypass (CPB) remains a challenge for the entire operating room (OR) team. The amount of circulating blood volume to pump prime volume mismatch of small patients results in hemodilution that frequently results in transfusion of allogeneic blood products. Patients of families of the Jehovah's Witness (JW) faith reject the use of these products because of religious beliefs. Our institution is a referral center for children of JW families because we have developed techniques to minimize blood loss with the hope of performing bloodless pediatric cardiac surgery whenever possible. These techniques include preoperative treatment with erythropoietin, intraoperative acute normovolemic hemodilution, CPB circuit miniaturization, ultrafiltration during and after CPB, limiting blood gas analyses or other unnecessary blood draws, and using hemostatic agents during and after CPB. We present the case of a 4-day-old patient of the JW faith weighing 2.7 kg with transposition of the great arteries and an intact ventricular septum who underwent an arterial switch operation. The patient received no allogeneic blood product administration throughout the entire hospitalization. The patient's first hematocrit in the OR was 43%, lowest hematocrit on bypass was 15%, and first hematocrit in the cardiothoracic intensive care unit post-procedure was 21%. The patient was discharged on post-op day nine with a hematocrit of 36%.

Diversity of Wolbachia Associated with the Giant Turtle Ant, Cephalotes atratus.

Symbiotic relationships between organisms are common throughout the tree of life, and often these organisms share an evolutionary history. In turtle ants (Cephalotes), symbiotic associations with bacteria are known to be especially important for supplementing the nutrients that their herbivorous diets do not provide. However, much remains unknown about the diversity of many common bacterial symbionts with turtle ants, such as Wolbachia. Here, we surveyed the diversity of Wolbachia, focusing on one species of turtle ant with a particularly wide geographic range, Cephalotes atratus. Colonies were collected from the entire range of C. atratus, and we detected the presence of Wolbachia by sequencing multiple individuals per colony for wsp. Then, using the multilocus sequence typing (MLST) approach, we determined each individual's unique sequence type (ST) based on comparison to sequences published in the Wolbachia MLST Database ( https://pubmlst.org/wolbachia/ ). The results of this study suggest that there is a high level of diversity of Wolbachia strains among colonies from different regions, while the diversity within colonies is very low. Additionally, 13 novel variants (alleles) were uncovered. These results suggest that the level of diversity of Wolbachia within species is affected by geography, and the high level of diversity observed among Cephalotes atratus populations may be explained by their wide geographic range.

General surgeon performed emergency craniotomies in regional Queensland hospitals: a 20-year state-wide study on patient outcomes.

BACKGROUND: Traumatic brain injuries account for up to 50% of trauma related deaths and if surgical intervention is indicated, consensus suggests a maximum of 4 hours to surgical decompression. The occurrence and outcomes of craniotomies performed by non-neurosurgeons in regional Queensland hospitals have never been reported previously in the literature. METHODS: A retrospective review was performed at all regional Queensland hospitals without an on-site neurosurgical service from January 2001 to December 2022 to identify patients undergoing emergency craniotomy. Data recorded included basic demographics, history of anti-coagulant use, mechanism of injury, type of haemorrhage, Glasgow Coma Score and Glasgow Outcome Scale (GOS) on discharge. Radiological parameters measured included midline shift and maximal coronal depth of haematoma. The primary aim of this study was to assess the clinical and radiological outcomes of patients who underwent a craniotomy performed by general surgeons. RESULTS: Over the past 20 years there have been 23 emergency decompressive procedures (one excluded) performed in regional Queensland. Preoperative imaging demonstrated 9 extradural haematomas and 13 subdural haematomas. Six of 17 transferred cases required reoperation after transfer to a neurosurgical centre. Survival was observed in 9 of 22 cases, with 'good' functional outcome (GOS ≥3) observed in 7 cases. In no cases were rurally performed burr holes effective. DISCUSSION: Qualitatively, a larger craniotomy may be associated with better clinical and radiological outcomes. Although rare occurrences, our results demonstrate that general surgeon performed craniotomies are frequently efficacious in producing radiological and/or clinical improvement and should be considered as a potentially lifesaving procedure.

Groundwater resources as a global reservoir for antimicrobial-resistant bacteria.

Antimicrobial resistance represents one of our most significant global health threats, with increasing incidences noted in both clinical and environmental settings. As such, identifying and understanding the sources and pathways for antimicrobial-resistant bacteria (ARB) is critical. The current study presents the first systematic review and pooled analysis of ARB occurrence in global groundwater supplies, which are used as primary drinking water sources by 2.2 billion people worldwide and are recurrently linked to significant outbreaks of infection. Seventy peer-reviewed studies were identified and included; findings reveal that 80.2% ± 29.0 and 57.2% ± 36.8 of aggregated groundwater isolates were resistant to ≥1 and ≥3 antimicrobials, respectively. Where bacteria were present, ARB were identified in 76.9% ± 33.7 of individual wells and springs. Our results leave little doubt that groundwater represents a major global reservoir for ARB, however significant research is required to establish environmental determinants and mechanisms mediating their occurrence.

Enhanced ionic conductivity in electroceramics by nanoscale enrichment of grain boundaries with high solute concentration.

The enhancement of oxygen ionic conductivity by over two orders of magnitude in an electroceramic oxide is explicitly shown to result from nanoscale enrichment of a grain boundary layer or complexion with high solute concentration. A series of CaxCe1-xO2-δ polycrystalline oxides with fluorite structure and varying nominal Ca2+ solute concentration elucidates how local grain boundary composition, rather than structural grain boundary character, primarily regulates ionic conductivity. A correlation between high grain boundary solute concentration above ∼40 mol%, and four orders of magnitude increase in grain boundary conductivity is explicitly shown. A correlated experimental approach provides unique insights into fundamental grain boundary science, and highlights how novel aspects of nanoscale grain boundary design may be employed to control ion transport properties in electroceramics.