Blood Management Strategies in Total Knee Arthroplasty

David Liu,Michael Dan,Sara Martinez Martos,Elaine Beller 대한슬관절학회 2016 대한슬관절학회지 Vol.28 No.3

A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

The TOP-SCOPE Survey of <i>Planck</i> Galactic Cold Clumps: Survey Overview and Results of an Exemplar Source, PGCC G26.53+0.17

Liu, Tie,Kim, Kee-Tae,Juvela, Mika,Wang, Ke,Tatematsu, Ken’ichi,Francesco, James Di,Liu, Sheng-Yuan,Wu, Yuefang,Thompson, Mark,Fuller, Gary,Eden, David,Li, Di,Ristorcelli, I.,Kang, Sung-ju,Lin, Yuxin Published by the University of Chicago Press for t 2018 The Astrophysical journal Supplement series Vol.234 No.2

<P>The low dust temperatures (< 14 K) of Planck Galactic cold clumps (PGCCs) make them ideal targets to probe the initial conditions and very early phase of star formation. 'TOP-SCOPE' is a joint survey program targeting similar to 2000 PGCCs in J = 1-0 transitions of CO isotopologues and similar to 1000 PGCCs in 850 mu m continuum emission. The objective of the 'TOP-SCOPE' survey and the joint surveys (SMT 10 m, KVN 21 m, and NRO 45 m) is to statistically study the initial conditions occurring during star formation and the evolution of molecular clouds, across a wide range of environments. The observations, data analysis, and example science cases for these surveys are introduced with an exemplar source, PGCC G26.53+0.17 (G26), which is a filamentary infrared dark cloud (IRDC). The total mass, length, and mean line mass (M/L) of the G26 filament are similar to 6200 M-circle dot, similar to 12 pc, and similar to 500 M-circle dot pc(-1), respectively. Ten massive clumps, including eight starless ones, are found along the filament. The most massive clump as a whole may still be in global collapse, while its denser part seems to be undergoing expansion owing to outflow feedback. The fragmentation in the G26 filament from cloud scale to clump scale is in agreement with gravitational fragmentation of an isothermal, nonmagnetized, and turbulent supported cylinder. A bimodal behavior in dust emissivity spectral index (beta) distribution is found in G26, suggesting grain growth along the filament. The G26 filament may be formed owing to large-scale compression flows evidenced by the temperature and velocity gradients across its natal cloud.</P>

Blood Management Strategies in Total Knee Arthroplasty

( David Liu Fracs ),( Michael Dan Mbbs ),( Sara Martinez Martos Mbbs ),( Elaine Beller Bsc Mappstat ) 대한슬관절학회 2016 대한슬관절학회지 Vol.28 No.3

A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

The femoral intercondylar notch is an accurate landmark for the resection depth of the distal femur in total knee arthroplasty

( David W. Liu ),( Sara Martinez Martos ),( Yifei Dai ),( Elaine M. Beller ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Introduction: Conventionally, the depth of distal femoral resection in total knee arthroplasty is referenced from the most prominent distal femoral condyle. This surgical technique does not consider pathological alterations of articular surfaces or severity of knee deformity. It has been hypothesized that the femoral intercondylar notch is a clinically reliable and more accurate alternative landmark for the resection depth of the distal femur in primary total knee arthroplasty. Methods: The resection depths of the distal femur at the medial and lateral femoral condyles and intercondylar notch were measured using computer navigation in 406 total knee arthroplasties. Variability between the bone resection depths was analyzed by standard deviation, 95% confidence interval and variance. Clinical follow-up of outcome to a minimum of 12 months was performed to further inform and validate the analysis. Results: Mean resection depth of the medial condyle was 10.7 mm, of the lateral condyle 7.9 mm and of the femoral intercondylar notch 1.9 mm. The femoral intercondylar notch had the lowest variance in resection depth among the three landmarks assessed, with a variance of 1.7 mm2 compared to 2.8 mm² for the medial femoral condyle and 5.1 mm² for the lateral femoral condyle. The intercondylar notch reference had the lowest standard deviation and 95% confidence interval. The resection depth referencing the notch was not sensitive to the degree of flexion contracture pre-operatively, whereas the medial and lateral condyles were. For varus deformed knees, distal femoral resection depth at the notch averaged 2 mm, which corresponds to the femoral prosthesis thickness at the intercondylar region, while for valgus deformed knees, the resection was flush with the intercondylar notch. Conclusions: The femoral intercondylar notch is a clinically practical and reproducible landmark for appropriate and accurate resection depth of the distal femur in primary total knee arthroplasty. Level of evidence: Level III: Retrospective cohort study.

Effects of Tourniquet Use on Quadriceps Function and Pain in Total Knee Arthroplasty

( David Liu Fracs ),( David Graham Mbbs ),( Kim Gillies M Hlth. Sc ),( R. Mark Gillies ) 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.4

purpose: A pneumatic tourniquet is commonly used in total knee arthroplasty (TKA) to improve surgical field visualisation but may result in quadriceps muscle ischaemia. We performed this study to analyse the effect of the tourniquet on recovery following TKA. materials and methods: A prospective randomised single-blinded trial was undertaken to examine the effect of the tourniquet on post-operative pain, swelling, blood loss, quadriceps function and outcome following TKA. Twenty patients with osteoarthritis of the knee were randomised to tourniquet or no tourniquet groups. Quadriceps function was assessed using surface electromyography (EMG) during active knee extension. results: The no tourniquet group had significantly less pain in the early post-operative period compared to the tourniquet group. There was no difference in Oxford knee score, range of motion, or thigh and knee swelling up to 12 months post-operatively. Quadriceps function, measured by surface EMG, was compromised for the first six months post-surgery by tourniquet use. The radiological cement mantle at the bone prosthesis interface at 12-month follow-up was not affected by the absence of a tourniquet. conclusions: We believe that it is safe and beneficial for our patients to routinely perform TKA without a tourniquet.

Decentralized Neural Network-based Excitation Control of Large-scale Power Systems

Wenxin Liu,Jagannathan Sarangapani,Ganesh K. Venayagamoorthy,Li Liu,Donald C. Wunsch II,Mariesa L. Crow,David A. Cartes 대한전기학회 2007 International Journal of Control, Automation, and Vol.5 No.5

This paper presents a neural network based decentralized excitation controller design for large-scale power systems. The proposed controller design considers not only the dynamics of generators but also the algebraic constraints of the power flow equations. The control signals are calculated using only local signals. The transient stability and the coordination of the subsystem control activities are guaranteed through rigorous stability analysis. Neural networks in the controller design are used to approximate the unknown/imprecise dynamics of the local power system and the interconnections. All signals in the closed loop system are guaranteed to be uniformly ultimately bounded. To evaluate its performance, the proposed controller design is compared with conventional controllers optimized using particle swarm optimization. Simulations with a three-machine power system under different disturbances demonstrate the effectiveness of the proposed controller design.

A Chromosome-centric Human Proteome Project (C-HPP) to Characterize the Sets of Proteins Encoded in Chromosome 17

Liu, Suli,Im, Hogune,Bairoch, Amos,Cristofanilli, Massimo,Chen, Rui,Deutsch, Eric W.,Dalton, Stephen,Fenyo, David,Fanayan, Susan,Gates, Chris,Gaudet, Pascale,Hincapie, Marina,Hanash, Samir,Kim, Hoguen American Chemical Society 2013 JOURNAL OF PROTEOME RESEARCH Vol.12 No.1

<P>We report progress assembling the parts list for chromosome 17 and illustrate the various processes that we have developed to integrate available data from diverse genomic and proteomic knowledge bases. As primary resources, we have used GPMDB, neXtProt, PeptideAtlas, Human Protein Atlas (HPA), and GeneCards. All sites share the common resource of Ensembl for the genome modeling information. We have defined the chromosome 17 parts list with the following information: 1169 protein-coding genes, the numbers of proteins confidently identified by various experimental approaches as documented in GPMDB, neXtProt, PeptideAtlas, and HPA, examples of typical data sets obtained by RNASeq and proteomic studies of epithelial derived tumor cell lines (disease proteome) and a normal proteome (peripheral mononuclear cells), reported evidence of post-translational modifications, and examples of alternative splice variants (ASVs). We have constructed a list of the 59 “missing” proteins as well as 201 proteins that have inconclusive mass spectrometric (MS) identifications. In this report we have defined a process to establish a baseline for the incorporation of new evidence on protein identification and characterization as well as related information from transcriptome analyses. This initial list of “missing” proteins that will guide the selection of appropriate samples for discovery studies as well as antibody reagents. Also we have illustrated the significant diversity of protein variants (including post-translational modifications, PTMs) using regions on chromosome 17 that contain important oncogenes. We emphasize the need for mandated deposition of proteomics data in public databases, the further development of improved PTM, ASV, and single nucleotide variant (SNV) databases, and the construction of Web sites that can integrate and regularly update such information. In addition, we describe the distribution of both clustered and scattered sets of protein families on the chromosome. Since chromosome 17 is rich in cancer-associated genes, we have focused the clustering of cancer-associated genes in such genomic regions and have used the ERBB2 amplicon as an example of the value of a proteogenomic approach in which one integrates transcriptomic with proteomic information and captures evidence of coexpression through coordinated regulation.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/jprobs/2013/jprobs.2013.12.issue-1/pr300985j/production/images/medium/pr-2012-00985j_0009.gif'></P><P><A href='http://pubs.acs.org/doi/suppl/10.1021/pr300985j'>ACS Electronic Supporting Info</A></P>

A technical note on anterolateral mobilization in vertebrobasilar dolichoectasia for relief of brainstem compression

Liu Jesse J,O’Neill Brannan E,Mazur-Hart David,Uluc Kutluay,Dogan Aclan,Cetas Justin S 대한뇌혈관외과학회 2022 Journal of Cerebrovascular and Endovascular Neuros Vol.24 No.3

Vascular compression of neural tissue causing neurological symptoms is a wellknown phenomenon. This is commonly seen in trigeminal neuralgia and, less commonly, in hemifacial spasm by small arteries, which can be treated by microvascular decompression. Rarely, larger arteries, such as the vertebral arteries, may compress the brainstem. This can lead to symptoms of pontine or medullary distress like hemiparesis, dysphagia, or respiratory distress. This is treated by macrovascular decompression. Due to the rare and heterogenous nature of this disease, there is no standardized approach. We describe a novel technique whereby the vertebrobasilar system is mobilized anterolaterally towards the occipital condyle with a sling to decompress the brainstem.<br/>We report two cases of vertebrobasilar dolichoectasia causing brainstem compression. A carotid patch graft sling with anterolateral mobilization to the occipital condyle is described as a surgical nuance to macrovascular decompressive surgery. Briefly, the vertebral artery was identified and dissected away from the brainstem and the bulbar cranial nerves. Bovine pericardium graft was used to create a sling around the artery by suturing the two ends together. The sling was then fixed either to the occipital condyle using cranial plating screws or suturing to the dura of the occipital condyle.<br/>A novel surgical technique for management of vertebrobasilar dolichoectasia causing brainstem compression with progressive neurological deterioration is reported. Anatomical location and the offending vessel should guide neurosurgeons to select the best surgical option to achieve complete decompression of the involved neural structures.

Origins of the Stokes Shift in PbS Quantum Dots: Impact of Polydispersity, Ligands, and Defects

Liu, Yun,Kim, Donghun,Morris, Owen P.,Zhitomirsky, David,Grossman, Jeffrey C. American Chemical Society 2018 ACS NANO Vol.12 No.3

<P>Understanding the origins of the excessive Stokes shift in the lead chalcogenides family of colloidal quantum dots (CQDs) is of great importance at both the fundamental and applied levels; however, our current understanding is far from satisfactory. Here, utilizing a combination of <I>ab initio</I> computations and UV-vis and photoluminescence measurements, we investigated the contributions to the Stokes shift from polydispersity, ligands, and defects in PbS CQDs. The key results are as follows: (1) The size and energetic disorder of a polydisperse CQD film increase the Stokes shift by 20 to 50 meV compared to that of an isolated CQD; (2) Franck-Condon (FC) shifts increase as the electronegativities of the ligands increase, but the variations are small (<15 meV). (3) Unlike the aforementioned two minor factors, the presence of certain intrinsic defects such as V<SUB>Cl</SUB><SUP>+</SUP> (in Cl-passivated CQDs) can cause substantial electron density localization of the band edge states and consequent large FC shifts (100s of meV). This effect arising from defects can explain the excessive Stokes shifts in PbS CQDs and improve our understanding of the optical properties of PbS CQDs.</P> [FIG OMISSION]</BR>

Influence of Gd Doping on the Structure and Electrochemical Behavior of UO₂

Liu, Nazhen,Kim, Jandee,Lee, Jeongmook,Youn, Young-Sang,Kim, Jong-Goo,Kim, Jong-Yun,Noë,l, James J.,Shoesmith, David W. Elsevier 2017 ELECTROCHIMICA ACTA Vol.247 No.-

<P><B>Abstract</B></P> <P>A series of (U<SUB>1−<I>y</I> </SUB>Gd<I> <SUB>y</SUB> </I>)O<SUB>2</SUB> materials (<I>y</I> =0, 0.01, 0.03, 0.05, 0.07 and 0.10) were characterized by X-ray diffractometry and Raman spectroscopy to determine the influence of Gd<SUP>III</SUP> doping on the structure of (U<SUB>1−<I>y</I> </SUB>Gd<I> <SUB>y</SUB> </I>)O<SUB>2</SUB> solid solutions. The XRD results show that, while the fluorite structure is maintained, Gd doping up to 10% leads to a contraction of the fluorite lattice. Raman spectroscopy shows Gd<SUP>III</SUP> doping distorts the fluorite lattice structure due to the formation of oxygen vacancies (O<SUB>v</SUB>) and, possibly, MO<SUB>8</SUB>-type complexes, as a consequence of the differences in both the oxidation state and the ionic radius of Gd<SUP>3+</SUP> compared to that of the U<SUP>4+</SUP>. The influence of Gd doping on the electrochemical reactivity of the (U<SUB>1−<I>y</I> </SUB>Gd<I> <SUB>y</SUB> </I>)O<SUB>2</SUB> specimens was shown to be minor, possibly due to a competition between the increase in the number of O<SUB>v</SUB> and the contraction of the lattice.</P>