Lateral earth pressure of granular backfills on retaining walls with expanded polystyrene geofoam inclusions under limited surcharge loading

Existing studies have focused on the behavior of the retaining wall equipped with expanded polystyrene(EPS)geofoam inclusions under semi-infinite surcharge loading rather than limited surcharge loading.In this paper,the failure mode and the earth pressure acting on the rigid retaining wall with EPS geofoam inclusions and granular backfills(henceforth referred to as EPS-wall),under limited surcharge loading are investigated through two-and three-dimensional model tests.The testing results show that different from the sliding of almost all the backfill in the EPS-wall under semi-infinite surcharge loading,only an approximately triangular backfill slides in the wall under limited surcharge loading.The distribution of the lateral earth pressure on the EPS-wall under limited surcharge loading is non-linear,and the distribution changes from the increase of the wall depth to the decrease with the increase of the limited surcharge loading.An approach based on the force equilibrium of a differential element is developed to predict the lateral earth pressure behind the EPS-wall subjected to limited surcharge loading,and its performance was fully validated by the three-dimensional model tests.

Compression properties of cost-efficient porous expanded clay reinforced AA7075 syntactic foams fabricated by industrial-oriented die casting technology

In today’s manufacturing industries,hard competition between rival firms makes it compulsory for researchers to design lighter and cheaper machine components due to the megatrends of cost-effectiveness and anti-pollution.At this point,aluminum syntactic foams(ASFs)are new-generation engineering composites and come into the upfront as a problem-solver.Owing to their features like low density,sufficient elongation,and perfect energy absorption ability,these advanced foams have been considerably seductive for many industrial sectors nowadays.In this study,an industrial-oriented automatic die casting technology was used for the first time to manufacture the combination of AA7075/porous expanded clay(PEC).Micro evaluations(optical and FESEM)reveal that there is a homogenous particle distribution in the foam samples,and inspections are compatible with the other ASF studies.Additionally,T6 aging heat treatment was operated on one half of the produced foams to explore the probable impact of aging on the compressive responses.Attained results show that PEC particles can be an alternative to expensive hollow spheres used in the previous works.Besides,a favorable relationship is ascertained between the aging treatment and mechanical properties such as compression strength and plateau strength.

Optimization of Channel Structure of Alkaline Water Electrolyzer by Using an Expanded Mesh as a Bipolar Plate

Alkaline water electrolysis(AWE)is the most mature technology for hydrogen production by water electrolysis.Alkaline water electrolyzer consists of multiple electrolysis cells,and a single cell consists of a diaphragm,electrodes,bipolar plates and end plates,etc.The existing industrial bipolar plate channel is concave-convex structure,which is manufactured by complicated and high-cost mold punching.This structure still results in uneven electrolyte flow and low current density in the electrolytic cell,further increasing in energy consumption and cost of AWE.Thereby,in this article,the electrochemical and flow model is firstly constructed,based on the existing industrial concave and convex flow channel structure of bipolar plate,to study the current density,electrolyte flow and bubble distribution in the electrolysis cell.The reliability of the model was verified by comparison with experimental data in literature.Among which,the electrochemical current density affects the bubble yield,on the other hand,the generated bubbles cover the electrode surface,affecting the active specific surface area and ohmic resistance,which in turn affects the electrochemical reaction.The result indicates that the flow velocity near the bottom of the concave ball approaches zero,while the flow velocity on the convex ball surface is significantly higher.Additionally,vortices are observed within the flow channel structure,leading to an uneven distribution of electrolyte.Next,modelling is used to optimize the bipolar plate structure of AWE by simulating the electrochemistry and fluid flow performances of four kinds of structures,namely,concave and convex,rhombus,wedge and expanded mesh,in the bipolar plate of alkaline water electrolyzer.The results show that the expanded mesh channel structure has the largest current density of 3330 A/m^(2)and electrolyte flow velocity of 0.507 m/s in the electrolytic cell.Under the same current density,the electrolytic cell with the expanded mesh runner structure has the smallest potential and energy consumption.This work provides a useful guide for the comprehensive understanding and optimization of channel structures,and a theoretical basis for the design of large-scale electrolyzer.

Key Factors to Consider When Introducing a New Vaccine in Low-Income Settings: Lessons from Malawi Expanded Program on Immunization

Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate surveillance data, inadequate cold chain capacity, limited safety and efficacy vaccine clinical trials, political influence, and limited funding. Conclusion: Despite several challenges Malawi set a good example of the careful considerations required before introducing a new vaccine. The process involves data review, priority setting, precise planning, and consultation with stakeholders. Low-income countries should invest in vaccine safety, efficacy, and cost-effectiveness trials.

Study of Rice Husks and Expanded Polystyrene Composites for Construction Applications

In the current context of environmental challenges, this study focuses on developing innovative and eco-friendly composites using rice husk and recycled expanded polystyrene. This dual-responsibility approach valorizes a by-product like rice husk, often considered waste, and reuses polystyrene, a plastic waste, thereby contributing to CO2 emission reduction and effective waste management. The manufacturing process involves dissolving recycled polystyrene into a solvent to create a binder, which is then mixed with rice husk and cold-compacted into composite materials. The study examines the impact of two particle sizes (fine and coarse) and different proportions of recycled polystyrene binder. The results show significant variations in the mechanical characteristics of the composites, with Modulus of Rupture (MOR) values varying from 2.41 to 3.47 MPa, Modulus of Elasticity (MOE) ranging from 223.41 to 1497.2 MPa, and Stiffness Coefficient (K) from 5.04 to 33.96 N/mm. These characteristics demonstrate that these composites are appropriate for various construction applications, including interior decoration, panel claddings, and potentially for furniture and door manufacturing when combined with appropriate coatings. This study not only highlights the recycling of agricultural and plastic waste but also provides a localized approach to addressing global climate change challenges through the adoption of sustainable building materials.

Experimental study on thermal and mechanical properties of tailings-based cemented paste backfill with CaCl_(2)·6H_(2)O/expanded vermiculite shape stabilized phase change materials

CaCl_(2)·6H_(2)O/expanded vermiculite shape stabilized phase change materials(CEV)was prepared by atmospheric impregnation method.Using gold mine tailings as aggregate of cemented paste backfill(CPB)material,the CPB with CEV added was prepared,and the specific heat capacity,thermal conductivity,and uniaxial compressive strength(UCS)of CPB with different cement-tailing ratios and CEV addition ratios were tested,the influence of the above variables on the thermal and mechanical properties of CPB was analyzed.The results show that the maximum encapsulation capacity of expanded vermiculite for CaCl_(2)·6H_(2)O is about 60%,and the melting and solidification enthalpies of CEV can reach 98.87 J/g and 97.56 J/g,respectively.For the CPB without CEV,the specific heat capacity,thermal conductivity,and UCS decrease with the decrease of cement-tailing ratio.For the CPB with CEV added,with the increase of CEV addition ratio,the specific heat capacity increases significantly,and the sensible heat storage capacity and latent heat storage capacity can be increased by at least 10.74%and 218.97%respectively after adding 12%CEV.However,the addition of CEV leads to the increase of pores,and the thermal conductivity and UCS both decrease with the increase of CEV addition.When cement-tailing ratio is 1:8 and 6%,9%,and 12%of CEV are added,the 28-days UCS of CPB is less than 1 MPa.Considering the heat storage capacity and cost price of backfill,the recommended proportion scheme of CPB material presents cement-tailing ratio of 1:6 and 12%CEV,and the most recommended heat storage/release temperature cycle range of CPB with added CEV is from 20 to 40℃.This work can provide theoretical basis for the utilization of heat storage backfill in green mines.

ZnO-Embedded Expanded Graphite Composite Anodes with Controlled Charge Storage Mechanism Enabling Operation of Lithium-Ion Batteries at Ultra-Low Temperatures

As lithium(Li)-ion batteries expand their applications,operating over a wide temperature range becomes increasingly important.However,the lowtemperature performance of conventional graphite anodes is severely hampered by the poor diffusion kinetics of Li ions(Li^(+)).Here,zinc oxide(ZnO) nanoparticles are incorporated into the expanded graphite to improve Li^(+)diffusion kinetics,resulting in a significant improvement in lowtemperature performance.The ZnO-embedded expanded graphite anodes are investigated with different amounts of ZnO to establish the structurecharge storage mechanism-performance relationship with a focus on lowtemperature applications.Electrochemical analysis reveals that the ZnOembedded expanded graphite anode with nano-sized ZnO maintains a large portion of the diffusion-controlled charge storage mechanism at an ultra-low temperature of-50℃ Due to this significantly enhanced Li^(+)diffusion rate,a full cell with the ZnO-embedded expanded graphite anode and a LiNi_(0.88)Co_(0.09)Al_(0.03)O_(2)cathode delivers high capacities of 176 mAh g^(-1)at20℃ and 86 mAh g^(-1)at-50℃ at a high rate of 1 C.The outstanding low-temperature performance of the composite anode by improving the Li^(+)diffusion kinetics provides important scientific insights into the fundamental design principles of anodes for low-temperature Li-ion battery operation.

Study on Sustained-Release Pesticides Blended with Fosthiazate-Stearic Acid/Expanded Perlite

The low utilization rate of pesticides makes the migration of pesticides in water and soil,which brings great harm to the ecosystem.The development of pesticide carriers with good drug loading capacity and release control abil-ity is an effective method to realize effective utilization of pesticides and reduce pesticide losses.In this work,fosthiazate-stearic acid/expanded perlite sustained-release particles were successfully prepared by vacuum impregnation using expanded perlite(EP)as carrier,fosthiazate(FOS)as model pesticide and stearic acid(SA)as hydrophobic matrix.The structure and morphology of the samples were studied by BET,FT-IR,TGA,XRD,DSC and SEM.The effects of different mass ratios of FOS to SA on loading capacity and release rate at 24 h were investigated.The sustained release behavior of FOS-SA/EP at different temperatures and pH values was investigated by static dialysis bag method.The results showed that FOS and SA were adsorbed in EP pores by physical interaction.With the mass ratios of FOS to SA decreasing from 7:3 to 3:7,the 24 h release rate of FOS-SA/EP decreased from 18.77%to 8.05%,and the drug loading decreased from 461.32 to 130.99 mg/g.FOS-SA/EP showed obvious temperature response at 25℃,30℃ and 35℃,the cumulative release rate(CRR)of 200 h were 33.38%,41.50%and 51.17%,respectively.When pH=5,the CRR of FOS was higher than that of pH=7,and the CRR of FOS for 200 h were 49.01%and 30.12%,respectively.At different temperatures and pH=5,the release mechanism of FOS-SA/EP belongs to the Fickian diffusion mechanism;When pH=7,the diffusion mechanism is dominant,and the dissolution mechanism is complementary.

Experimental study on lightweight expanded clay at particle level:Breakage of isolated grains

In this study,more than 1500 particles of lightweight expanded clay aggregate(LECA)are individually loaded up to breakage,following different patterns of contact(from 2 to 7)using a purpose-built apparatus.Consequently,a statistical model for predicting the number of fragments into which a grain breaks as a function of the number of contacts and their diameter is proposed.The number of fragments is found to follow a statistical binomial-type distribution function that depends on the number of contacts.In addition,a model based on Bayesian networks,capable of assessing the number of fragments and their size(measured as normalized weight)as a function of the number of contacts,is implemented.The proposed method is applicable when performing discrete element method(DEM)simulations on granular media in which grain breakage plays a relevant role.

Mechanomedicine:From Mechanogenomics to Mechano-Immunoengineering

Mechanobiology is a rapidly growing field that has expanded significantly over the past 40 years.There have been great examples of mechanobiology research on the cardiovascular,musculoskeletal,and respiratory systems.The field has evolved from the system level to the organ and tissue levels,and down to the cellular and molecular levels,benefiting from scientific progress and technological developments in molecular and cell biology,biomaterials,imaging techniques,and computational tools.Additionally,the interdisciplinary integration of mechanobiology with cell engineering,tissue engineering,and drug delivery has led to promising mechanomedicine applications in both therapeutics and diagnostics.Here,I will discuss two examples at the molecular and cellular levels:(1)mechanical regulation of epigenomics for cell reprogramming,and(2)engineering the mechanical properties of artificial antigen-presenting cells(APCs)for immune cell modulation and cancer therapy.Cell memory of its identity is determined by the epigenetic state of the cells.However,how cells control the epigenetic state and thus cell fate is not well understood,and how mechanical factors such as surface topography,cell morphology,mechanical properties of the extracellular matrix(ECM),and the mechanical deformation of cells regulate the epigenetic state is not clear.In an early study,we showed that biophysical cues,in the form of parallel microgrooves on the surface of cell-adhesive substrates,can replace the effects of small-molecule epigenetic modifiers and significantly improve reprogramming efficiency from fibroblasts to induced pluripotent stem cells.The mechanism relies on the mechanomodulation of the cells’epigenetic state through the activity of histone deacetylase and H3 methyltransferase.We also showed that microtopography promotes a mesenchymal-to-epithelial transition in adult fibroblasts.Nanofibrous scaffolds with aligned fiber orientation produce effects similar to those produced by microgrooves,suggesting that changes in cell morphology may be responsible for the modulation of the epigenetic state.The effects of micro/nanopatterned surfaces may be related to the reduction of intracellular tension and cell adhesion.Indeed,the reduction of actin cytoskeletal tension or cell adhesion at the early phase of reprogramming suppresses the expression of mesenchymal genes,promotes a more open chromatin structure,and significantly enhances the efficiency of induced neuronal(i N)conversion.Specifically,the reduction of intracellular tension or cell adhesion not only modulates global epigenetic marks but also decreases DNA methylation and heterochromatin marks while increasing euchromatin marks at the promoter of neuronal genes,thus enhancing the accessibility for gene activation.Finally,micro-and nano-topographic surfaces that reduce cell adhesion enhance i N reprogramming.These novel findings suggest that the actin cytoskeleton and focal adhesions play an important role in epigenetic regulation for cell fate determination,which may lead to biomaterialbased approaches for more effective cell reprogramming.In addition,matrix stiffness also regulates cell reprogramming,which acts as a biphasic regulator of the epigenetic state and fibroblast-to-neuron conversion efficiency,maximized at an intermediate stiffness of 20 k Pa.ATAC sequencing analysis shows the same trend of chromatin accessibility to neuronal genes at these stiffness levels.Concurrently,we observe peak levels of histone acetylation and histone acetyltransferase(HAT)activity in the nucleus on 20 k Pa matrices,and inhibiting HAT activity abolishes matrix stiffness effects.G-actin and cofilin,the co-transporters shuttling HAT into the nucleus,rise with decreasing matrix stiffness;however,reduced importin-9 on soft matrices limits nuclear transport.These two factors result in a biphasic regulation of HAT transport into the nucleus,which is directly demonstrated on matrices with dynamically tunable stiffness.Furthermore,we find that the regulation of the epigenetic state by the viscoelastic matrix is more pronounced on softermatrices.Cells on viscoelastic matrices exhibit larger nuclei,increased nuclear lamina ruffling,loosely organized chromatin,and faster chromatin dynamics compared to those on elastic matrices.These changes are accompanied by a global increase in euchromatic marks and a local increase in chromatin accessibility at the cis-regulatory elements associated with neuronal and pluripotent genes.Consequently,viscoelastic matrices enhance the efficiency of reprogramming fibroblasts into neurons and induced pluripotent stem cells,respectively.Together,our findings demonstrate the key roles of matrix viscoelasticity in regulating the epigenetic state and uncover a new mechanism of biophysical regulation of chromatin and cell reprogramming,with implications for designing smart materials to engineer cell fate.The viscoelasticity of biomaterials not only regulates cell adhesion and the epigenetic state but also modulates other ligand-receptor interactions such as T cell receptor activation.We developed a scalable microfluidic platform to fabricate synthetic viscoelastic activating cells(Syn VACs)with programmable mechanical and chemical properties.We demonstrated that the viscoelastic nature of Syn VACs significantly impacts T cell functionality.Compared to rigid or elastic microspheres,Syn VACs greatly enhance human T cell expansion with drastic CD8+T cell generation while suppressing regulatory T cell formation,resulting in enhanced tumor-killing capability.Notably,expanding chimeric antigen receptor(CAR)-T cells with Syn VACs achieves approximately 90%CAR transduction efficiency and leads to a six-fold increase in T memory stem cells.These engineered CAR-T cells exhibit superior efficacy in eliminating tumor cells,not only in a human lymphoma mouse model but also in a solid tumor xenograft mouse model of ovarian cancer.Additionally,Syn VAC-expanded CAR-T cells persist for longer periods in vivo to suppress tumor growth and recurrence.These findings underscore the crucial role of mechanical signals in T cell engineering and highlight the potential of the Syn VAC platform in CAR-T therapy and broad immunoengineering applications.These examples of mechanical regulation of cells not only unravel the underlying mechanisms of mechanotransduction in various cells,but also have tremendous potential to translate into therapeutic applications.

Outcomes and impact of an advanced clinical ultrasound track in an emergency medicine residency

Point-of-care ultrasound(POCUS)is a core component of emergency medicine(EM)residency training used to guide medical decision making and to enhance procedural competence.[1-3]Many repetitions of POCUS exams are required to achieve competency,and it is difficult to quantify a minimum needed to achieve mastery.[4,5]For EM residents whose career goals require greater depth of knowledge and skill in POCUS,educators can consider expanded training through a professional development track.

Flexible ultrasound arrays with embossed polymer structures for medical imaging

In recent years,the application of flexible electronic technology[1−3]combined with ultrasonic imaging[4]has blossomed,resulting in a shift in the application place of ultrasonic imaging technology from medical institutions to households.The utilization of this application has expanded from the physician’s positioning and guidance to real-time patient monitoring[5],while the range of application scenarios continues to widen.The transformative changes have made possible through the development of flexible transducer arrays[6,7].Prof.Sheng Xu's team at the University of California San Diego has pioneered the development of various flexible transducer arrays based on island-bridge structures[8]and serpentine electrodes[9].These transducer arrays incorporate rigid 1−3 composite piezoelectric transducers on an island,featuring thin electrodes between the islands to provide mechanical flexibility,metallic electrodes of serpentine structure to provide stretchability of the device,and elastomer materials are used to encapsulate the overall structure,ensuring structural stability and impedance matching to the skin tissue[10].These flexible transducer arrays have found extensive applications in human blood pressure detection[11],cardiac imaging[12],blood flow doppler imaging[13],tissue modulus detection[14],and tissue deep hemoglobin detection[15].

Control of Nozzle Flow Using Rectangular Ribs at Sonic and Supersonic Mach Numbers

This study deals with base pressure management in a duct for various values of the Mach number(M),namely,Mach number corresponding to sonic and four supersonic conditions.In addition to the Mach number,the nozzle pressure ratio(NPR),the area ratio,the rib dimension,and the duct length are influential parameters.The following specific values are examined at M=1,1.36,1.64,and 2,and NPRs between 1.5 and 10.The base pressure is determined by positioning ribs of varying heights at predetermined intervals throughout the length of the square duct.When the level of expansion is varied,it is seen that the base pressure initially drops for overexpanded flows and increases for under-expanded flows.When ribs are present,the flow field in the duct and pressure inside the duct fluctuate as the base pressure rises.Under-expanded flows can achieve a base pressure value that is suitably high without experiencing excessive changes in the duct flow in terms of static pressure if a rib height around 10%of the duct height close to the nozzle exit is considered.Rectangular rib passive control does not negatively affect the duct’s flow field.

Heuristic Expanding Disconnected Graph:A Rapid Path Planning Method for Mobile Robots

Existing mobile robots mostly use graph search algorithms for path planning,which suffer from relatively low planning efficiency owing to high redundancy and large computational complexity.Due to the limitations of the neighborhood search strategy,the robots could hardly obtain the most optimal global path.A global path planning algorithm,denoted as EDG*,is proposed by expanding nodes using a well-designed expanding disconnected graph operator(EDG)in this paper.Firstly,all obstacles are marked and their corners are located through the map pre-processing.Then,the EDG operator is designed to find points in non-obstruction areas to complete the rapid expansion of disconnected nodes.Finally,the EDG*heuristic iterative algorithm is proposed.It selects the candidate node through a specific valuation function and realizes the node expansion while avoiding collision with a minimum offset.Path planning experiments were conducted in a typical indoor environment and on the public dataset CSM.The result shows that the proposed EDG*reduced the planning time by more than 90%and total length of paths reduced by more than 4.6%.Compared to A*,Dijkstra and JPS,EDG*does not show an exponential explosion effect in map size.The EDG*showed better performance in terms of path smoothness,and collision avoidance.This shows that the EDG*algorithm proposed in this paper can improve the efficiency of path planning and enhance path quality.

Three-Soliton Interactions and the Implementation of Their All-Optical Switching Function

As a key component in all-optical networks,all-optical switches play a role in constructing all-optical switching.Due to the absence of photoelectric conversion,all-optical networks can overcome the constraints of electronic bottlenecks,thereby improving communication speed and expanding their communication bandwidth.We study all-optical switches based on the interactions among three optical solitons.By analytically solving the coupled nonlinear Schr¨odinger equation,we obtain the three-soliton solution to the equation.We discuss the nonlinear dynamic characteristics of various optical solitons under different initial conditions.Meanwhile,we analyze the influence of relevant physical parameters on the realization of all-optical switching function during the process of three-soliton interactions.The relevant conclusions will be beneficial for expanding network bandwidth and reducing power consumption to meet the growing demand for bandwidth and traffic.

Controllable fabrication of FeCoS_(4) nanoparticles/S-doped bowl-shaped hollow carbon as efficient lithium storage anode

To address the low conductivity and easy agglomeration of transition metal sulfide nanoparticles,FeCoS_(4) nanoparticles embedded in S-doped hollow carbon(FeCoS_(4)@S-HC)composites were successfully fabricated through a combination of hydrothermal processes and sulfidation treatment.The unique bowlshaped FeCoS_(4)/S-HC composites exhibit excellent structural stability with a high specific surface area of 303.7 m^(2)·g^(-1) and a pore volume of 0.93 cm^(3)·g^(-1).When applied as anode material for lithium-ion batteries,the FeCoS_(4)@S-HC anode exhibits efficient lithium storage with high reversible specific capacity(970.2 mA·h·g^(-1) at 100 mA·g^(-1))and enhanced cycling stability(574 mA·h·g^(-1) at 0.2 A·g^(-1) after 350 cycles,a capacity retention of 84%).The excellent lithium storage is attributed to the fact that the bimetallic FeCoS_(4) nanoparticles with abundant active sites can accelerate the electrochemical reaction kinetics,and the bowl-shaped S-HC structure can provide a stable mechanical structure to suppress volume expansion.

Predictors of permanent pacemaker implantation following transcatheter aortic valve replacement-the search is still on!

Several anatomical,demographic,clinical,electrocardiographic,procedural,and valve-related variables can be used to predict the probability of developing con-duction abnormalities after transcatheter aortic valve replacement(TAVR)that necessitate permanent pacemaker(PPM)implantation.These variables include calcifications around the device landing zone and in the mitral annulus;pre-existing electrocardiographic abnormalities such as left and right bundle branch blocks(BBB),first-and second-degree atrioventricular blocks,as well as bifas-cicular and trifascicular blocks;male sex;diabetes mellitus(DM);hypertension;history of atrial fibrillation;renal failure;dementia;and use of self-expanding valves.The current study supports existing literature by demonstrating that type 2 DM and baseline right BBB are significant predictors of PPM implantation post-TAVR.Regardless of the side of the BBB,this study demonstrated,for the first time,a linear association between the incidence of PPM implantation post-TAVR and every 20 ms increase in baseline QRS duration(above 100 ms).After a 1-year follow-up,patients who received PPM post-TAVR had a higher rate of hospital-ization for heart failure and nonfatal myocardial infarction.

Expandable endoprostheses in skeletally immature patients:Where we are

Approximately 45 percent of malignant bone tumors are seen under the age of 16 and one of the important results of growth plate sacrification in patients with immature skeletons is limb inequality.Until the early 1990s,the treatment options for these patients were rotationplasty or amputation.Multimodal approaches that combine imaging,chemotherapy,and surgical techniques have enabled the development of limb-preserving methods with satisfactory results.In order to overcome inequality problems,expandable prostheses have been developed in the 1980s.Extendable endoprosthesis replacements have been improved over the years and are now an established and safe alternative.Noninvasive prostheses appear to be advantageous compared to minimally invasive expandable prostheses that require multiple surgical procedures,but the complication rate remains high.Therefore,although expandable prostheses are not the definitive answer to the treatment of bone sarcomas in skeletally immature children,they are still a suitable interim choice until full adulthood is achieved.Due to reported high complication rates,the procedures require significant experience and are recommended for use only in specialized cancer centers.

Liver transplantation for hepatocellular carcinoma in India: Are we ready for 2040?

BACKGROUND Liver transplantation(LT)for hepatocellular carcinoma(HCC)has been widely researched and is well established worldwide.The cornerstone of this treatment lies in the various criteria formulated by expert consensus and experience.The variations among the criteria are staggering,and the short-and long-term outcomes are controversial.AIM To study the differences in the current practices of LT for HCC at different centers in India and discuss their clinical implications in the future.METHODS We conducted a survey of major centers in India that performed LT in December 2022.A total of 23 responses were received.The centers were classified as high-and low-volume,and the current trend of care for patients undergoing LT for HCC was noted.RESULTS Of the 23 centers,35%were high volume center(>500 Liver transplants)while 52%were high-volume centers that performed more than 50 transplants/year.Approximately 39%of centers had performed>50 LT for HCC while the percent distribution for HCC in LT patients was 5%–15%in approximately 73%of the patients.Barring a few,most centers were divided equally between University of California,San Francisco(UCSF)and center-specific criteria when choosing patients with HCC for LT,and most(65%)did not have separate transplant criteria for deceased donor LT and living donor LT(LDLT).Most centers(56%)preferred surgical resection over LT for a Child A cirrhosis patient with a resectable 4 cm HCC lesion.Positron-emission tomography-computed tomography(CT)was the modality of choice for metastatic workup in the majority of centers(74%).Downstaging was the preferred option for over 90%of the centers and included transarterial chemoembolization,transarterial radioembolization,stereotactic body radiotherapy and atezolizumab/bevacizumab with varied indications.The alphafetoprotein(AFP)cut-off was used by 74%of centers to decide on transplantation as well as to downstage tumors,even if they met the criteria.The criteria for successful downstaging varied,but most centers conformed to the UCSF or their center-specific criteria for LT,along with the AFP cutoff values.The wait time for LT from downstaging was at least 4–6 wk in all centers.Contrast-enhanced CT was the preferred imaging modality for post-LT surveillance in 52%of the centers.Approximately 65%of the centers preferred to start everolimus between 1 and 3 months post-LT.CONCLUSION The current predicted 5-year survival rate of HCC patients in India is less than 15%.The aim of transplantation is to achieve at least a 60%5-year disease free survival rate,which will provide relief to the prediction of an HCC surge over the next 20 years.The current worldwide criteria(Milan/UCSF)may have a higher 5-year survival(>70%);however,the majority of patients still do not fit these criteria and are dependent on other suboptimal modes of treatment,with much lower survival rates.To make predictions for 2040,we must prepare to arm ourselves with less stringent selection criteria to widen the pool of patients who may undergo transplantation and have a chance of a better outcome.With more advanced technology and better donor outcomes,LDLT will provide a cutting edge in the fight against liver cancer over the next two decades.

POLICIES

NDRC Brings Forward Investment Plans China will bring forward part of the investment plans originally set for 2025 to this year while studying the effects in the hopes of expanding the extent to which local government special bonds can be used,as part of the country’s stepped-up efforts to spur on investment and achieve steady economic growth,officials said.