Use of extracorporeal membrane oxygenation and cerebral oximetry in a stage 1 norwood repair for hypoplastic left heart syndrome.

The role of extracorporeal membrane oxygenation (ECMO) and its indications in stage I Norwood palliation are controversial. The decision to initiate ECMO and its timing remains difficult with no definitive cut-off points or evidence-based guidelines. It varies on a case-to-case basis. We report a case where the use of ECMO was beneficial after stage I Norwood palliation with severe ventricular dysfunction. The systemic-to-pulmonary artery shunt was kept open to balance the systemic and pulmonary circulations. Cerebral oximetry can be useful as an additional monitoring modality to guide management, monitor cerebral perfusion, and help detect cerebral steal.

Integrative study of Permian coal-bearing horizons: biostratigraphy, palaeovegetation, and palaeoclimate in the South Karanpura Basin.

The article deals with the integrated and comprehensive study of the coal-bearing horizons from the South Karanpura Basin to delineate the biostratigraphy, palaeovegetation, palaeodepositional settings, and palaeoclimate in and around the investigated area during the deposition of Permian sediments. Highly diversified megafloral assemblages consist 13 genera and 72 species of order Glossopteridales, Cordaitales and Equisetales are documented among which 37 taxa are newly reported from Barakar and Raniganj formations of the area. Palynoassemblages-I and -II are recovered, which demonstrate the biostratigraphic age as Kungurian and Wordian-Capitanian, respectively. Overall the vegetation represents a luxuriant forest subjugated by arborescent deciduous trees bearing Glossopteris foliage with some conifers, cordaites, filicales, and peltaspermales. The biomarker study of the basin illustrates the unimodal distribution of n-alkanes in the sample set ranges from C14 to C29 which suggests major input from a single source of organic matter. The involvement of microbial activity and algal input is suggested for the basin. A relatively moderate-to-high water level condition can be inferred from elevated n-C25. The high CIA, PIA values and A-CN-K plot suggest intense weathering conditions in the source area. The source rocks are characterized by mature clayey type with abundant clay mineral, i.e., kaolinite. The current study portrays that the Permian climate was cooler in initial phase, which later on became warm temperate with high humidity. The palaeofloral entities and geochemical parameters suggest absolute diversification of Permian flora, the existence of continental freshwater setting in the vicinity and oxic to anoxic environment with fluctuating ground water conditions during the deposition of sediments.

Lower Permian Gondwana sequence of Rajhara (Daltonganj Coalfield), Damodar Basin, India: floristic and geochemical records and their implications on marine ingressions and depositional environment.

Early Permian floral diversity and palaeodepositional environment of the Lower Permian Rajhara sequence of Damodar Basin have been studied based on mega-, microfossil and geochemical proxies. Even though Gondwana sediments are generally considered as fluvio-lacustrine deposits, recent studies indicate marine inundations with patchy records. Here in the present study, an attempt has been made to address the changeover from fluviatile to shallow marine conditions and also to address the palaeodepositional aspects. Luxuriant vegetation during deposition of the Lower Barakar Formation generated thick coal seams. The macroplant fossil assemblage shows Glossopteridales, Cordaitales and Equisetales comprising one palynoassemblage with the dominance of bisaccate pollen grains having glossopterid affinities. However, Lycopsids are absent in the megafloral record and are represented in megaspore assemblage. The present floral assemblage led to envisage the presence of dense forest with swampy conditions and prevalence of warm and humid climate during the deposition of Barakar sediments. Correlation with the coeval Indian assemblages and those from other Gondwanan continents also supports an Artinskian age and reveals a stronger affinity with flora of Africa than that of South America. Biomarker analysis reveals low pristane/phytane values (0.30-0.84), noticeable absence of hopanoid triterpenoids and long-chain n-alkanes that is attributed to the obliteration of organic compounds and subsequent alteration of composition due to thermal effect. The high chemical index of alteration, A-CN-K plot and PIA also suggest severe denudation under a warm/humid climate. The V/Al2O3 and P2O5/Al2O3 indicated freshwater-near-shore conditions. However, signature of possible marine influence is identified from Th/U and Sr/Ba ratios resulted from the eustatic fluctuations during Permian.