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How to cite this article Savio RD. Procalcitonin (in COVID-19) The Incessant Quest. Indian J Crit Care Med 2021;25(1)1-2.Deep hypothermic circulatory arrest (DHCA) technique has been an important armamentarium in the correction of congenital heart diseases. There have been many controversies and concerns associated with DHCA, particularly neurological damage. Selective ante grade cerebral perfusion (SACP) was introduced as an adjunct to DHCA with the objective of limiting the neurologic injury during aortic arch repairs. Over the past two decades, various aspects of cardiopulmonary bypass and DHCA have been studied and modified such as optimisation of flows, anti-inflammatory interventions, haematocrit, and temperature to improve neurologic outcomes. With the changes in practice of DHCA, outcomes have significantly improved but SACP intuitively appears attractive to offer better neuroprotection. The strategy of conduct of SACP is evolving and needs to be standardised for comparing outcomes. In this review we have discussed the various physiological and technical factors involved in conduct of SACP in paediatric cardiac surgery and outcomes with SACP.Transposition of great arteries (TGA) or double-outlet right ventricle (DORV) with ventricular septal defect (VSD) and pulmonary stenosis (PS) is a complex congenital cardiac malformation, which can be treated by both univentricular and biventricular pathways. Biventricular repair includes Rastelli operation, reparation a l'etage ventriculaire (REV), pulmonary root translocation, and Nikaidoh procedures. PKC inhibitor Double-root translocation (DRT) technique and half-turned truncal switch technique (HTTS) are being considered as useful alternatives. In this review, we will see in detail about DRT and HTTS.

Complex congenital heart defects that present earlier in life are sometimes channelled in the single ventricle pathway, because of anatomical or logistic challenges involved in biventricular correction. Given the long-term functional and survival advantage, and with the surgeons' improved understanding of the cardiac anatomy, we have consciously explored the feasibility of a biventricular repair in these patients when they presented later for Fontan completion. We present a single institution's 10-year experience in achieving biventricular septation of prior univentricular repairs, the technical and physiological challenges and the surgical outcomes.

Between June 2010 and December 2019, 246 patients were channelized in the single ventricle pathway, of which 32 patients were identified as potential biventricular candidates at the time of evaluation for Fontan palliation, considering their anatomic feasibility. PKC inhibitor The surgical technique involves routing of the left ventricle to the aorta across the ventricular and this 'borderline' substrate is often recognized at the time of evaluation for the Fontan completion. A comprehensive preoperative imaging and planning helps in achieving the surgical septation and reconnection to achieve the desired physiological circulation. Though technically challenging, the surgery has excellent short- and mid-term outcomes as evidenced by our 10-year experience.Nearly 50 years back, Francis Fontan pioneered an operation for tricuspid atresia that bears his name today. The operation has since undergone numerous modifications and continues to be widely applied to an array of single ventricles. Despite restoring normal oxygen levels in the body, the operation creates a neoportal system where adequate cardiac output can be generated only at the expense of increased systemic venous congestion. This results in slow but relentless damage to the end organ systems especially the liver. Continuous surveillance of the patient to monitor this circulation, that will ultimately fail, is of paramount importance. Timely medical and cardiac catheterization and surgical intervention can extend the life span of Fontan patients. Ultimately a change of the hemodynamic circuit in the form of heart transplantation or ventricular assist device will be required to salvage the failing Fontan circuit.Heterotaxy syndrome (HS) constitutes a spectrum of anomalies arising from embryological errors that result in abnormalities of lateralization involving thoraco-abdominal viscera and culminate in loss of normal asymmetric arrangement of these organs. Besides the unique challenges involved in planning and execution of surgical procedures aimed at correction or palliation of these anomalies, they have the potential to cause profound physiological and immunological consequences in the individual patient due to their cardiac and extra-cardiac manifestations. This article aims to review the literature on this rare and extraordinary subset of developmental anomalies with the intention of familiarizing the reader on the modes of presentation, manifestations, and the variations thereof while dealing with this anomaly. In our institutional experience with HS, 75 consecutive patients were seen between January 2011 and September 2018. Of these, 48 (64%) were confirmed to have isomerism of right atrial appendages (IRAA) and the rest had isomerism of left atrial appendages (ILAA). The cardiac and extra-cardiac manifestations of these patients were listed out. Fifty-four patients (34 with IRAA and 20 with ILAA) underwent 83 surgical procedures. link2 While 49 patients were palliated on the univentricular pathway, 5 underwent biventricular repair. The in-hospital mortality was 7 (13%) in both groups combined (5 for patients with IRAA and 2 for ILAA). In conclusion, the surgical management of HS is associated with satisfactory outcomes in current era.Patients with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction are managed by various techniques. Traditional techniques include intracardiac baffling with a right ventricle to pulmonary artery conduit (Rastelli procedure) and the "reparation a l'etage ventriculaire" (REV) procedure. PKC inhibitor However, other techniques such as aortic root translocation (Bex-Nikaidoh procedure), pulmonary root translocation, and double root translocation are equivalent or in fact provide better results than the traditional techniques. link2 In this review we will have a detailed discussion about aortic root translocation which allows a more normal and anatomically aligned left ventricular outflow tract. However, the operation is technically demanding, and coronary translocation remains one of the major challenges for successful root translocation.Ebstein's anomaly is a rare congenital heart defect characterized by apical displacement of the tricuspid valve and reduced volume of the true functional right ventricle. In its most severe form, the disease presents as right heart failure and cyanosis in the neonate. Although many of these neonates can be managed conservatively, surgical intervention may become necessary in the sickest of them. Surgical intervention in this subgroup can be challenging and requires meticulous appreciation of the anatomy and physiology on a case to case basis. Multicenter studies are required to define a uniform algorithm and approach towards these patients.We directly exploit the stochasticity of the internal variability, and the linearity of the forced response to make global temperature projections based on historical data and a Green's function, or Climate Response Function (CRF). To make the problem tractable, we take advantage of the temporal scaling symmetry to define a scaling CRF characterized by the scaling exponent H, which controls the long-range memory of the climate, i.e. how fast the system tends toward a steady-state, and an inner scale τ ≈ 2 years below which the higher-frequency response is smoothed out. An aerosol scaling factor and a non-linear volcanic damping exponent were introduced to account for the large uncertainty in these forcings. We estimate the model and forcing parameters by Bayesian inference which allows us to analytically calculate the transient climate response and the equilibrium climate sensitivity as 1 . 7 - 0.2 + 0.3 K and 2 . link3 4 - 0.6 + 1.3 K respectively (likely range). Projections to 2100 according to the RCP 2.6, 4.5 and 8.5 scenarios yield warmings with respect to 1880-1910 of 1 . 5 - 0.2 + 0.4 K , 2 . 3 - 0.5 + 0.7 K and 4 . 2 - 0.9 + 1.3 K. These projection estimates are lower than the ones based on a Coupled Model Intercomparison Project phase 5 multi-model ensemble; more importantly, their uncertainties are smaller and only depend on historical temperature and forcing series. The key uncertainty is due to aerosol forcings; we find a modern (2005) forcing value of [ - 1.0 , - 0.3 ] Wm - 2 (90 % confidence interval) with median at - 0.7 Wm - 2 . Projecting to 2100, we find that to keep the warming below 1.5 K, future emissions must undergo cuts similar to RCP 2.6 for which the probability to remain under 1.5 K is 48 %. RCP 4.5 and RCP 8.5-like futures overshoot with very high probability.Low-rank parity-check (LRPC) codes are rank-metric codes over finite fields, which have been proposed by Gaborit et al. link2 (Proceedings of the workshop on coding and cryptography WCC, vol 2013, 2013) for cryptographic applications. Inspired by a recent adaption of Gabidulin codes to certain finite rings by Kamche et al. (IEEE Trans Inf Theory 65(12)7718-7735, 2019), we define and study LRPC codes over Galois rings-a wide class of finite commutative rings. We give a decoding algorithm similar to Gaborit et al.'s decoder, based on simple linear-algebraic operations. We derive an upper bound on the failure probability of the decoder, which is significantly more involved than in the case of finite fields. The bound depends only on the rank of an error, i.e., is independent of its free rank. Further, we analyze the complexity of the decoder. We obtain that there is a class of LRPC codes over a Galois ring that can decode roughly the same number of errors as a Gabidulin code with the same code parameters, but faster than the currently best decoder for Gabidulin codes. However, the price that one needs to pay is a small failure probability, which we can bound from above.The data throughput of massive spectroscopic surveys in the course of each observation is directly coordinated with the number of optical fibers which reach their target. In this paper, we evaluate the safety and the performance of the astrobots coordination in SDSS-V by conducting various experimental and simulated tests. We illustrate that our strategy provides a complete coordination condition which depends on the operational characteristics of astrobots, their configurations, and their targets. Namely, a coordination method based on the notion of cooperative artificial potential fields is used to generate safe and complete trajectories for astrobots. link3 Optimal target assignment further improves the performance of the used algorithm in terms of faster convergences and less oscillatory movements. Both random targets and galaxy catalog targets are employed to observe the coordination success of the algorithm in various target distributions. The proposed method is capable of handling all potential collisions in the course of coordination. Once the completeness condition is fulfilled according to initial configuration of astrobots and their targets, the algorithm reaches full convergence of astrobots. Should one assign targets to astrobots using efficient strategies, convergence time as well as the number of oscillations decrease in the course of coordination. link3 Rare incomplete scenarios are simply resolved by trivial modifications of astrobots swarms' parameters.