Understanding the Role of Surface Charge on Nanobubble Capillary Bridging during Particle-Particle Interaction

The interactions between particles due to long-range hydrophobic forces have been extensively investigated. The hydrophobic force is likely a capillary force that arises from the formation of capillary bridges due to the merging of nanobubbles. In this study, we aim to investigate the impact of the nanobubble surface charge on the capillary bridge and, subsequently, the interaction between particles. The surface charge of the nanobubbles was altered in the presence of various surfactants (cationic, anionic, and nonionic) and salts (mono-, di-, and trivalent). The particle-particle interaction was quantified by measuring the aggregate size of the hydrophobized glass particles. Both experimental and theoretical findings confirm that the interaction between particles was enhanced when the surface potential of the nanobubble was around the neutral regime. This is probably because, when the surface potential was close to neutral, the interaction between two surface-deposited nanobubbles dominated over electrostatic repulsion, which was more conducive to the formation of the nanobubble capillary bridge. The estimation of the constrained Gibbs potential also showed the capillary bridge to be more stable when surface charge density along the bridge gas-liquid interface was minimal.

Public-Private Partnership for Treatment of Congenital Heart Diseases: Experiences From an Indian State

Background: Treatment of congenital heart disease (CHD), being the most common congenital anomaly, puts immense financial burden in low- and middle-income countries (LMICs) and contributes significantly to infant mortality. We report experiences of treatment of CHD in the Indian state of West Bengal by a public-private partnership (PPP) model. Methods: Under the Rashtriya Bal Swasthya Karyakram, the government of the state of West Bengal in India launched a program called the "Sishu Sathi Scheme" to provide free treatment to children who need heart surgeries, irrespective of economic status. Treatment was provided in selected private hospitals and some public hospitals in a reimbursement model where government compensated the hospitals. Data were collected on such procedures from 2013 to 2022 and analyzed. Results: A total of 27,844 patients with CHD received treatment under the Sishu Sathi Scheme from August 2013 to December 2022. The average number of patients per year was 3,093. Detailed data of procedures from January 2016 to December 2022 showed a total of 22,572 procedures (6,249 device interventions, 4,840 cardiac catheterizations, and 11,483 surgical interventions). The in-hospital mortality of surgical procedures and catheterization lab procedures were 5.2% and 0.9%, respectively. Conclusions: A large number of patients with CHD were successfully treated under a PPP in the state of West Bengal in India. In spite of its inherent challenges, this model is of special relevance in LMICs where access and affordability for treatment of CHD always remain a challenge.

Use of cardiopulmonary bypass machine in intensive care unit as a short term mechanical circulatory support for recovery of cardiac function

INTRODUCTION

Extracorporeal Membrane Oxygenation (ECMO) is used as a bridge to recovery of cardiac function following completion of congenital cardiac surgeries where there is failure to wean from cardiopulmonary bypass (CPB) or severe low cardiac output states in the post operative periods. Although ECMO is a well-established form of mechanical circulatory support, the associated cost can be a huge financial burden on families. We are an ECMO center and use the same in post operative congenital cardiac surgeries for mechanical cardiovascular support if needed. However, a significant proportion of the children, whom we operate, are funded by government aides. The resources are limited in such circumstances. If needed, we use the same CPB circuit and cannulae used in the Operating Room (OR) and support them at a significantly lower cost compared to ECMO.

METHODS

We report our experience of using conventional CPB machine as a short-term bridge to recovery of cardiac function in Intensive Care Unit where there was limitation of funds. Essentially same CPB circuit with roller pump is retained, by omitting cardiotomy suckers. We use D901 Lilliput 1 Oxygenator (Sorin, Italy) for children <5 kg and D902 Lilliput 2 (Sorin, Italy) Oxygenator for children >5 Kg.

RESULTS

We supported nine patients on CPB between March 2019 and December 2021. During this time, 1392 congenital cardiac surgeries were performed. We could wean off three patients (33.3%) and discharge two patients (22.2%). Our support time ranged from 21 h to 60 h with a median of 48 h. Beyond 48 h of support, we experienced several CPB induced complications in our cohort.

CONCLUSION

In resource-limited settings, conventional CPB machines can be used for short-term cardiac support. Although results may not be comparable to using ECMO, some patients can be definitely salvaged, who would otherwise die in the absence of institution of mechanical circulatory support.

Novel strategies to enhance hydrodynamic cavitation in a circular venturi using RANS numerical simulations

Hydrodynamic cavitation is a popular advanced oxidation technique and it has received wide range of applications from waste water treatment to the nanoparticles synthesis in recent years. The enhancement of the intensity of the hydrodynamic cavitation is always been an emerging field of research. Within this framework, we have proposed and investigated three distinct strategies to enhance the intensity of cavitation in a circular venturi, namely, (1) by introducing the surface roughness on the wall (2) single or multiple circular hurdles in the diverging section (3) By modifying the diverging section from planer to the trumpet shape. RANS (Reynolds Averaged Navier-Stokes) based numerical simulations are carried out the over wide range of conditions: 2≤PR≤6 (pressure ratio), 6.2^∘≤β≤10^∘ (half divergent angle), 15^∘≤α≤20^∘ (half convergent angle), and 1≤l/d≤3 (throat length). An extensive numerical and experimental validation with the literature have been presented to ensure the reliability and accuracy of present work. Detailed results on velocity fields, local and average volume fraction, pressure loss coefficients, cavitation number, discharge coefficient and pressure distribution are reported as function of dimensionless parameters. Five designs of various combinations of surface roughness, circular hurdles, and trumpet diverging section have been compared. The effect of surface roughness on trumpet diverging wall has been observed to be more pronounced than the other designs. Trumpet diverging wall with surface roughness is found to be optimum for the practical applications.

Surgical repair of total anomalous pulmonary venous connection: Lateral approach

We describe the lateral approach to the surgical repair of a total anomalous pulmonary venous connection in this video tutorial. The goal of the operation is to create an unobstructed anastomosis between the pulmonary confluence and the left atrium, ligate the systemic venous connections, and close the atrial septal defect. After a median sternotomy and initial dissection of the structures surrounding the heart, cardiopulmonary bypass is initiated by aortobicaval cannulation. The patient is then cooled to attain mild hypothermia (30°C). The heart is arrested by a dose of antegrade cold cardioplegia. The right pleural cavity is opened widely. The heart is retracted and pushed into the right pleural cavity. The vertical vein is ligated near its connection with the innominate vein. An incision is made along the length of the confluence, stopping short of the individual pulmonary veins. The left atrial appendage is retracted, and the left atrium is opened in alignment with the opening in the confluence. The left atrium and the pulmonary confluence are anastomosed widely with 7-0 polypropylene suture material. The heart is put back into the mediastinum. Rewarming is started. The atrial septal defect is closed through the right atrium using a large untreated autologous pericardium patch. The patient is then weaned off cardiopulmonary bypass.

A systematic approach to epicardial echocardiography in pediatric cardiac surgery: An important but underutilized intraoperative tool

Intraoperative echocardiography is an integral component of the peri-operative management of pediatric heart disease. It confirms the adequacy of surgery, identifies residual lesions, and can provide useful hemodynamic data. It, therefore, helps to decide on the need for revision of repair and guides the postoperative management strategy. Intraoperative echocardiography is done with the use of either an epicardial probe or a transesophageal probe. Epicardial echocardiography is a simple, useful modality and has the ability to perform imaging in cases where transesophageal echocardiography cannot be easily performed, for example, in low birth weight babies. We attempt to describe in detail the technique of epicardial echocardiography and the various views that we have found useful for a complete postsurgical evaluation. The limitations of the technique are also discussed in detail.

A case of partial anomalous systemic venous drainage and perioperative detection of cerebral arteriovenous malformations

We report a case of 8-year-old boy with unexplained desaturation and clubbing. Echocardiography showed anomalous drainage of right superior vena cava into left atrium. He did not have any neurological symptoms preoperatively. Some perioperative observations and subtle postoperative behavioral changes prompted us to investigate him further. He was found to have extensive cerebral arteriovenous malformations and hemiatrophy of brain.

Basics of extra corporeal membrane oxygenation: a pediatric intensivist's perspective

Extra Corporeal membrane oxygenation (ECMO) is one of the most advanced forms of life support therapy in the Intensive Care Unit. It relies on the principle where an external artificial circuit carries venous blood from the patient to a gas exchange device (oxygenator) within which blood becomes enriched with oxygen and has carbon dioxide removed. The blood is then returned to the patient via a central vein or an artery. The goal of ECMO is to provide a physiologic milieu for recovery in refractory cardiac/respiratory failure. The technology is not a definitive treatment for a disease, but provides valuable time for the body to recover. In that way it can be compared to a bridge, where patients are initiated on ECMO as a bridge to recovery, bridge to decision making, bridge to transplant or bridge to diagnosis. The use of this modality in children is not backed by a lot of randomized controlled trials, but the use has increased dramatically in our country in last 10 years. This article is not intended to provide an in-depth overview of ECMO, but outlines the basic principles that a pediatric intensive care physician should know in order to manage a kid on ECMO support.

Mid-Term Follow-Up of Neonatal Neochordal Reconstruction of Tricuspid Valve for Perinatal Chordal Rupture Causing Severe Tricuspid Valve Regurgitation

BACKGROUND

Papillary muscle rupture in the perinatal period is a rare event that leads to severe mitral or tricuspid insufficiency due to a flail leaflet. Neonatal tricuspid chordal reconstruction for this condition is rarely reported. Early recognition and treatment have the potential to be lifesaving. We present our surgical experience with five such patients, along with their midterm follow-up.

METHODS

Between August 2010 and November 2012, five neonates (aged 1-30 days) underwent surgery for severe atrioventricular valve regurgitation. All neonates had severe tricuspid regurgitation due to ruptured chordae. In addition, two had moderate mitral regurgitation; one due to ruptured chordae of the posterior mitral leaflet and the other due to prolapse of the anterior mitral leaflet. All underwent emergent surgery where the ruptured chordae to the anterior tricuspid leaflet were replaced with neochordae made with expanded polytetrafluoroethylene (ePTFE) suture. The mitral valve was repaired in two patients.

RESULTS

All patients survived surgery without the need for postoperative mechanical circulatory assist. Predischarge echocardiograms showed good coaptation of tricuspid and mitral leaflets with minimal regurgitation in all. At follow-up between 75 months to 102 months, four patients had excellent outcomes with less than mild tricuspid regurgitation. One child with flail tricuspid and mitral leaflets developed progressive tricuspid and mitral regurgitation requiring surgical re-repair at 20 months following the initial surgery.

CONCLUSION

Repair of chordal rupture of the tricuspid valve in neonates using ePTFE neo-chordae can provide acute salvage and gratifying midterm results in the management of this potentially fatal condition.

Total circulatory arrest as a support modality in congenital heart surgery: review and current evidence

The use of total circulatory arrest (TCA)/deep hypothermic circulatory arrest (DHCA) as a support modality in congenital heart surgery is a time-tested strategy. However, with technological advances, the widespread use of this technique has decreased. Adjunctive cerebral perfusion with continuous cardiopulmonary bypass (CPB) gradually has become more popular with a view to reduce the complications related to DHCA. In addition, better neuromonitoring and neuroprotective strategies have made DHCA much safer. However, the level of evidence to support the best way to protect the brain during congenital heart surgery is insufficient. This review analyzes the history, physiology, techniques of DHCA, as well as other alternative strategies like selective cerebral perfusion and presents the current available evidence.

Utility of late pulmonary artery banding in single-ventricle physiology: A mid-term follow-up

Background:

The standard first stage palliation for univentricular heart with unrestricted pulmonary blood flow (PBF) is surgical pulmonary artery (PA) banding for which the ideal age is within the first 8 weeks of life. This study aimed to look for the utility of PA band done beyond 3 months of age for patients presenting beyond the stipulated period.

Materials and Methods:

This is a retrospective analysis of the outcome of twenty patients with single ventricle (SV) physiology with unrestricted PBF who presented late and were selected on the basis of clinical, radiological, and echocardiographic parameters for PA banding.

Results:

The median age of the patients was 5.5 months (3.5–96 months), and the median body weight was 4.7 kg (3.2–22.0 kg). The patients were divided into three groups as follows: ten patients between 3 and 6 months of age (Group A), seven patients between 6 months to 1 year of age (Group B), and three patients > 1 year of age with additional features of pulmonary venous hypertension (Group C). The mean reduction of PA pressures following PA band was 60.9%, 48.8%, and 58.3% and the mean fall in oxygen saturation was 10.4%, 8.0%, and 6.6% in the three groups, respectively. The postoperative mortality rate was 10%. The mean follow up duration was 13.5 months (7–23 months). There was a statistically significant improvement in weight for age Z scores following PA band (P = 0.0001). On follow up cardiac catheterization, the mean PA pressures were 16.6 (±3.6), 22.7 (±5.7), and 33.3 (±12.4) mmHg, respectively, in the three groups, and the mean pulmonary vascular resistance index was 1.86 (±0.5), 2.45 (±0.7), and 3.5 (±1.6) WU.m2, respectively. Subsequently, seven patients in Group A, three patients in Group B, and one patient from Group C underwent successful bidirectional Glenn (BDG) surgery.

Conclusions:

Late PA band in selected patients with SV physiology can have definite benefit in terms of correction of heart failure symptoms and subsequent conversion to BDG and can potentially change the natural history of disease both in terms of survival and quality of life.

Congenital right ventricular diverticulum: An atypical presentation

Congenital ventricular diverticulum is a rare congenital malformation of the heart. It remains mostly asymptomatic unless associated with other congenital cardiac defects. We present a case of a 4-month-old child who had dextrocardia, large inlet ventricular septal defect, amounting to single ventricle, and severe pulmonary artery hypertension. There was a right ventricular diverticulum which passed through the foramina of Morgagni to give rise to a pulsating lump in the epigastrium. Right ventricular diverticulum presenting with a pulsating mass in the abdomen is a rare entity. The confirmation of diverticulum was made with histopathology.

Complete sternal cleft with tetralogy of Fallot

Complete sternal cleft is a very rare congenital midline defect of the sternum. It is not uncommonly associated with intracardiac defects. We report a case of a 2-year-old child with complete sternal cleft and tetralogy of Fallot who presented with cyanotic spells. The child underwent total correction, followed by chest wall reconstruction on the next day.

Arterial Switch Operation With Neoaortic Valve Replacement in a 13-Year Old Patient With Transposition of Great Arteries With Ventricular Septal Defect and Left Ventricular Outflow Tract Obstruction-A Case Report

The surgical management of d-transposition of great arteries (d-TGAs) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) is ever evolving and still remains a challenge because of wide anatomic variability, age of presentation, surgical options available, and their variable long-term results in different series. We describe a patient with d-TGA, VSD, and LVOTO who presented to us at 13 years of age and underwent an arterial switch operation along with neoaortic valve replacement with a mechanical prosthesis. The postoperative course was uneventful, and at hospital discharge, the echocardiogram was satisfactory. We present the pros and cons of this hitherto undescribed treatment option.

Left Superior Vena Cava Draining Into Left Atrium in Tetralogy of Fallot-Four Cases of a Rare Association

Persistent left superior vena cava is a common congenital anomaly of the thoracic venous system. Left superior vena cava draining into left atrium is a malformation of sinus venosus and caval system. The anomaly may be a cause of unexplained hypoxia even in adults. It may give rise to various diagnostic and technical challenges during cardiac catheterization and open-heart surgery. It is often detected serendipitously during diagnostic workup. Isolated left superior vena cava opening into left atrium is very commonly associated with other congenital heart defects. But tetralogy of Fallot is very rarely associated with persistent left superior vena cava which drains into left atrium. We report four such cases who underwent surgical correction successfully.

Atypical Left Ventricular Myxoma: Unusual Echocardiographic and Histopathological Features

Cardiac myxomas are the most common primary cardiac tumors and are typically attached to the interatrial septum. Left ventricular myxomas are exceedingly rare and presentation in children is all the more uncommon. We report a case of left ventricular myxoma with very atypical cystic appearance raising an initial suspicion of a hydatid cyst. Subsequently, cardiac magnetic resonance imaging was done, which ruled out the diagnosis of hydatid cyst. Complete surgical excision was done through transaortic and transmitral route. Histopathological examination revealed it to be a cardiac myxoma with vascular proliferation, which on echocardiography had appeared as a polycystic lesion. This is a very unusual histopathological presentation of cardiac myxoma.

Electrical and thermal tuning of quality factor and free spectral range of optical resonance of nematic liquid crystal microdroplets

We experimentally study the effect of temperature and electric field on the quality (Q) factor and free spectral range (FSR) of whispering-gallery-mode optical resonance of dye-doped nematic liquid crystal microdroplets. Both the Q factor and the FSR are highly sensitive to the temperature and electric field and are tunable. The Q factor decreases, whereas the FSR increases substantially, with increasing temperature and electric field. The variation of the Q factor and FSR is understood based on the change in the effective refractive index and the dynamic size of the microdroplets.

In-vitro fermentation characteristics and methane reduction potential of mustard cake (Brassica juncea L.)

Aim:

To assess the effect of mustard cake (Brassica juncea L.) levels in concentrate mixtures and in composite feed mixtures (CFMs) on in-vitro fermentation characteristics and methane production.

Materials and Methods:

Five concentrate mixtures were prepared with containing 30% oil cake, where linseed cake was replaced by mustard cake at the rate of 0%, 7.5%, 15.0%, 22.5%, and 30% in concentrate mixture. Mustard cake contained glucosinolate 72.58 µmol/g oil free dry matter (DM) and contents in diet were 0, 5.4, 10.9, 16.3, and 21.8 µmol/g of concentrate mixture, respectively. Concentrate mixture containing 15.0% mustard cake was found to produced minimum methane which was then used for the preparation of CFM containing 0%, 25%, 50%, and 75% levels with gram straw.

Result:

Increased levels of mustard cake in concentrate mixtures had a linear decrease (p<0.05) in the total gas production, and the 15% inclusion showed lowest methane concentration (quadratic, p<0.01). The degradability of DM and organic matter (OM) of concentrate mixtures did not change, however, pH and NH₃-N concentrations of the fermentation medium showed linear (p<0.05) reductions with increased mustard cake levels. Increased levels of 15% mustard cake containing concentrate mixture in CFMs exhibited a trend (p=0.052) of increased gas production, whereas methane concentration in total gas, methane produced and degradability of DM and OM were also displayed a linear increase (p<0.05). However, the pH, NH₃-N, and total volatile fatty acid levels decreased linearly (p<0.05) with increased levels of concentrate in CFMs.

Conclusion:

Reduction in methane production was evidenced with the inclusion of mustard cake in concentrate mixture at 15% level, and the CFMs with 25% concentrate, which contained 15% mustard cake, exhibited an improved fermentation and reduced methane production.

Large Right Ventricular Clot in Pulmonary Atresia With Intact Ventricular Septum: In Defense of Biventricular Approach

Thrombus formation within the right ventricle (RV) in the setting of pulmonary atresia with intact ventricular septum (PAIVS) is not a very common occurrence and can be catastrophic. We present the case of a seven-month-old child with PAIVS and RV clot who successfully underwent biventricular repair. We discuss the interesting case and the rationale for management by means of biventricular repair over single ventricle repair when feasible in such a setting.

Effect of Simulated Heat Stress on Digestibility, Methane Emission and Metabolic Adaptability in Crossbred Cattle

The present experiment was conducted to evaluate the effect of simulated heat stress on digestibility and methane (CH₄) emission. Four non-lactating crossbred cattle were exposed to 25°C, 30°C, 35°C, and 40°C temperature with a relative humidity of 40% to 50% in a climatic chamber from 10:00 hours to 15:00 hours every day for 27 days. The physiological responses were recorded at 15:00 hours every day. The blood samples were collected at 15:00 hours on 1st, 6th, 11th, 16th, and 21st days and serum was collected for biochemical analysis. After 21 days, fecal and feed samples were collected continuously for six days for the estimation of digestibility. In the last 48 hours gas samples were collected continuously to estimate CH₄ emission. Heat stress in experimental animals at 35°C and 40°C was evident from an alteration (p<0.05) in rectal temperature, respiratory rate, pulse rate, water intake and serum thyroxin levels. The serum lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase activity and protein, urea, creatinine and triglyceride concentration changed (p<0.05), and body weight of the animals decreased (p<0.05) after temperature exposure at 40°C. The dry matter intake (DMI) was lower (p<0.05) at 40°C exposure. The dry matter and neutral detergent fibre digestibilities were higher (p<0.05) at 35°C compared to 25°C and 30°C exposure whereas, organic matter (OM) and acid detergent fibre digestibilities were higher (p<0.05) at 35°C than 40°C thermal exposure. The CH₄ emission/kg DMI and organic matter intake (OMI) declined (p<0.05) with increase in exposure temperature and reached its lowest levels at 40°C. It can be concluded from the present study that the digestibility and CH₄ emission were affected by intensity of heat stress. Further studies are necessary with respect to ruminal microbial changes to justify the variation in the digestibility and CH₄ emission during differential heat stress.

Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: age-specific rates and associated factors, mortality and re-admission

OBJECTIVES

We aimed to determine age-specific rates of delirium and associated factors in acute medicine, and the impact of delirium on mortality and re-admission on long-term follow-up.

DESIGN

Observational study. Consecutive patients over two 8-week periods (2010, 2012) were screened for delirium on admission, using the confusion assessment method (CAM), and reviewed daily thereafter. Delirium diagnosis was made using the Diagnostic and Statistical Manual Fourth Edition (DSM IV) criteria. For patients aged ≥65 years, potentially important covariables identified in previous studies were collected with follow-up for death and re-admission until January 2014.

PARTICIPANTS

503 consecutive patients (age median=72, range 16-99 years, 236 (48%) male).

SETTING

Acute general medicine.

RESULTS

Delirium occurred in 101/503 (20%) (71 on admission, 30 during admission, 17 both), with risk increasing from 3% (6/195) at <65 years to 14% (10/74) for 65-74 years and 36% (85/234) at ≥75 years (p<0.0001). Among 308 patients aged >65 years, after adjustment for age, delirium was associated with previous falls (OR=2.47, 95% CI 1.45 to 4.22, p=0.001), prior dementia (2.08, 1.10 to 3.93, p=0.024), dependency (2.58, 1.48 to 4.48, p=0.001), low cognitive score (5.00, 2.50 to 9.99, p<0.0001), dehydration (3.53, 1.91 to 6.53, p<0.0001), severe illness (1.98, 1.17 to 3.38, p=0.011), pressure sore risk (5.56, 2.60 to 11.88, p<0.0001) and infection (4.88, 2.85 to 8.36, p<0.0001). Patients with delirium were more likely to fall (OR=4.55, 1.47 to 14.05, p=0.008), be incontinent of urine (3.76, 2.15 to 6.58, p<0.0001) or faeces (3.49, 1.81-6.73, p=0.0002) and be catheterised (5.08, 2.44 to 10.54, p<0.0001); and delirium was associated with stay >7 days (2.82, 1.68 to 4.75, p<0.0001), death (4.56, 1.71 to 12.17, p=0.003) and an increase in dependency among survivors (2.56, 1.37 to 4.76, p=0.003) with excess mortality still evident at 2-year follow-up. Patients with delirium had fewer re-admissions within 30-days (OR=0.32, 95% CI 0.09 to 1.1, p=0.07) and in total (median, IQR total re-admissions=0, 0-1 vs 1, 0-2, p=0.01).

CONCLUSIONS

Delirium affected a fifth of acute medical admissions and a third of those aged ≥75 years, and was associated with increased mortality, institutionalisation and dependency, but not with increased risk of re-admission on follow-up.

Surgical repair of a submitral aneurysm in a three-year-old child

Submitral aneurysm (SMA) is a rare anomaly occurring adjacent to the posterior leaflet of the mitral valve. It usually presents in young adults and it is uncommon in the pediatric age group. We report one case of SMA in a three-year-old child and its successful surgical management.

Cardiac myxomas: experience over one decade

BACKGROUND

This single-center study reviews our experience with cardiac myxomas over the past decade.

METHODS

Sixty-two patients (23 male) with median age 38 years (range: 8 to 69 years) underwent excision of primary or recurrent cardiac myxomas between 2000 and 2009. Patients were evaluated with echocardiography preoperatively and annually postoperatively. Follow-up is current for all survivors (range 13 months to 10 years).

RESULTS

Fifty-two patients had left atrial myxomas, seven right atrial, two biatrial, and one right ventricular. Three cases were familial. Maximum number of myxomas in a single patient was four. Symptom duration ranged from two to eight months. Two early deaths were due to low cardiac output and embolic cerebrovascular accident; one late death was due to a noncardiac cause. Actuarial survival was 96.8 ± 1.8% at 10 years. Most patients were asymptomatic following surgery. No sporadic, multiple, or biatrial myxomas recurred. Recurrence occurred in two familial cases, both with single, left atrial myxoma. Freedom from reoperation was 98.4 ± 1.3% at five years and 96.8 ± 1.8% at 10 years.

CONCLUSIONS

Biatrial involvement or multiplicity of myxomas does not mandate recurrence. Surgical excision has excellent overall survival and freedom from reoperation rates, but annual follow-up including echocardiographic surveillance is recommended as familial cases tend to recur. 

Psychological changes of children surviving terrorist shock in Indian Kashmir

This study was undertaken with the objectives to assess psychological responses in children surviving terrorist attack and to observe relationships between various risk factors and subsequent psychological changes. Assessment of psychological changes was done on 131 children who were directly exposed to terrorist attack. Achenbach Child Behavior Checklist was used to assess victimized children for analysis purpose. Possible risk factors were assessed by questionnaire to the parents. What has emerged as the most interesting aspect of this research is that, whereas for adults, pretraumatic risk factors are extremely important predictors of chronic posttraumatic symptoms, for children, the most important consideration appears to be the death of the mother and number of stressors.

All-optical XOR and XNOR operations at86.4 Gb/s using a pair of semiconductor optical amplifier Mach-Zehnder interferometers

We propose a method for increased-speed all-optical XOR operation using semiconductor optical amplifiers. We demonstrate XOR and XNOR operations at 86.4 Gb/s using a pair of photonic-integrated semiconductor optical amplifier Mach-Zehnder interferometers.

Comparative digestibility of amino acids of maize, sorghum, finger millet and pearl millet in cockerels and Japanese quails

1. The objective of the present study was to determine the apparent digestibilities of amino acids of maize, low tannin sorghum, pearl millet and finger millet in adult cockerels and Japanese quails. 2. Adult White Leghorn cockerels (25 weeks of age) and adult Japanese quails (15 weeks of age) were used to determine the apparent digestibilities of amino acids in cereal grains. 3. The digestibilities of amino acids in sorghum determined with quails were similar to cockerels, with the exception of histidine, which was significantly lower in quails. 4. In finger millet, the digestibilities of methionine and leucine were significantly higher, while that of histidine and cystine were significantly lower in adult quails than in adult cockerels. 5. The digestibilities of pearl millet amino acids were similar in quails and cockerels, except for that of histidine, which was significantly lower in quails. 6. Almost all the amino acids in maize, except histidine, had significantly higher digestibility values in quails than in cockerels. Histidine digestibility of all the 4 cereal grains was significantly lower in quails than in cockerels. 7. The amino acid digestibility values for certain cereal grains determined with cockerels do not support their use in formulating practical quail diets. The amino acid digestibility values of maize were underestimated by using cockerels while that of finger millet was overestimated.

XOR performance of a quantum dot semiconductor optical amplifier based Mach-Zehnder interferometer

The performance of all-optical XOR gate based on quantum-dot (QD) SOA MZI has been simulated. The saturation power, optical gain and phase response of a QD SOA has been analyzed numerically using a rate equation model of quantum dots embedded in a wetting layer. The calculated response is used to model the XOR performance. For the parameters used here, XOR operation at ~ 250 Gb/s is feasible using QD based Mach-Zehnder interferometers. The speed is limited by the relaxation time from wetting layer to the quantum dots.

80Gb/s clock recovery with phase locked loop based on LiNbO3 modulators

In this paper, we present a scheme for extracting a 10GHz clock from the 80Gb/s optical time division multiplexed (OTDM) return to zero (RZ) data stream. The proposed clock recovery is based on the offset locking technique. By using the input data composed of a repeating "10100000" pattern, residue jitter free operation for clock recovery is demonstrated. The method utilizes a LiNbO3 Mach-Zehnder (MZ) intensity modulator for cross-correlation detections.

Replacement value of undecorticated sunflower meal as a supplement for milk production by crossbred cows and buffaloes in the northern plains of India

The replacement value of undecorticated sunflower meal (SFM) in the diets of dairy animals was assessed on-station and on-farm. Eighteen primiparous crossbred (Bos taurus x Bos indicus) cows (350.4 +/- 8.84 kg), randomly allocated to three groups, were used in the on-station study. The animals were fed on either a conventional concentrate supplement (control) or on an experimental concentrate, in which SFM replaced 25% (SFM-25) or 50% (SFM-50) of the CP in the control supplement. Green oats (Avena sativa) were supplied ad libitum. A metabolism trial conducted following 60 days of experimental feeding revealed that the intakes of DM, DCP and TDN were similar among the groups. The digestibilities of OM, CP, EE, NDF and ADF were also without significant differences. All the groups were in positive nitrogen balance. Inclusion of SFM at either level had no effect on the intake, excretion or retention of nitrogen. The daily milk yield and its composition did not differ among the dietary treatments. Moreover, the efficiency of utilization of DOM and TDN for FCM production tended to reflect, although non-significantly, increasing levels of SFM inclusion. In the on-farm study, seven multiparous milking buffaloes belonging to six farmers were used to assess the effect of replacing 20% of the CP of the conventional supplement with SFM, in a predominantly crop residue-based diet. The study continued for 4 months and revealed that the average daily feed intake and milk production was similar in the control and SFM-fed groups. It was concluded that SFM can be effectively utilized as a cheaper replacement for costly oil cakes and wheat bran for economic milk production by smallholder farmers.