#Perfusion system

[octopusmedical01]

Sorin Stockert 3T Heater-Cooling System manufacturer & supplier in India: Octopus Med Pvt Ltd. 

In the realm of medical technology, innovations play a pivotal role in enhancing patient care and outcomes. Among the many advancements, the Sorin Stockert 3T Heater-Cooler System stands out as a crucial component in cardiac surgeries, ensuring optimal temperature management during procedures. As a trusted manufacturer and supplier of Sorin Stockert 3T Heater-Cooler System in India, Octopus Med brings you the Sorin Stockert 3T Heater-Cooler System, delivering unparalleled performance and reliability. 

About the Sorin Stockert 3T Heater-Cooler System 

The Sorin Stockert 3T Heater-Cooler System is a sophisticated medical device designed to regulate the temperature of patient's blood and organs during cardiac surgeries. It consists of advanced heating and cooling components that maintain precise temperatures, critical for the success of complex procedures. Octopus Med offers the Sorin 3T Heater Cooler Systems, recognized for their superior quality and performance in the medical community. 

Key Features of Sorin Stockert 3T Heater-Cooler System: 

Precision Temperature Control: The Sorin Stockert 3T Heater-Cooler System ensures precise temperature management, allowing surgeons to maintain optimal conditions throughout the surgical procedure. 

Reliable Performance: With its robust design and advanced technology, the Sorin 3T Heater Cooler guarantees reliable performance, contributing to seamless surgical experiences and positive patient outcomes. 

Enhanced Safety Features: Sorin Stockert 3T Heater-Cooler Systems are equipped with enhanced safety features to mitigate risks and ensure patient safety during cardiac surgeries. 

User-Friendly Interface: The intuitive interface of the Sorin Stockert 3T Heater-Cooler System facilitates ease of use for healthcare professionals, enabling efficient operation and monitoring during procedures. 

Buy SORIN Stockert 3T at Best Price in India 

Octopus Med offers the Sorin Stockert 3T Heater-Cooler System at the best price in India, making advanced medical technology accessible to healthcare facilities nationwide. Our commitment to affordability and quality ensures that healthcare providers can procure essential equipment without compromising on performance or budget. 

Why Choose Octopus Med for Sorin Stockert 3T Heater-Cooler System? 

Quality Assurance: Octopus Med is dedicated to delivering products of the highest quality, backed by rigorous quality assurance processes and adherence to international standards. 

Expertise and Experience: With years of experience in the healthcare industry, Octopus Med has established itself as a trusted name, offering innovative solutions and unparalleled customer service. 

Customer Satisfaction: At Octopus Med, customer satisfaction is paramount. We strive to exceed expectations by providing timely support, seamless transactions, and personalized service to our clients. 

Nationwide Reach: Octopus Med's extensive distribution network ensures prompt delivery of Sorin Stockert 3T Heater-Cooler Systems to healthcare facilities across India, enabling timely access to essential medical equipment. 

In conclusion, the Sorin Stockert 3T Heater-Cooler System from Octopus Med India represents a paradigm shift in cardiac surgery technology, empowering healthcare providers to deliver superior patient care. With its advanced features, reliability, and affordability, the Sorin Stockert 3T Heater-Cooler System is a valuable addition to any cardiac surgery suite. Contact Octopus Med today to buy SORIN Stockert 3T at the best price in India and elevate your surgical capabilities to new heights. 

[qyresearchmedica]

The global Organ Perfusion System market was valued at USD 1.06 billion in 2023 and is expected to reach USD 1.46 billion by year 2032, at a CAGR of 4.1%.

[neha24blog]

Perfusion System Market Trends Analysis Report By Application, Region And Forecast To 2030 : Grand View Research Inc.

Perfusion System Market Trends Analysis Report By Application, Region And Forecast To 2030 : Grand View Research Inc.

San Francisco, 21 Nov 2022: The Report Perfusion System Market Size, Share & Trends Analysis Report By Application (Cardiopulmonary Perfusion System, Cell Perfusion System, Ex-vivo Organ Perfusion System), By Region, And Segment Forecasts, 2022 – 2030 The global perfusion system market size is projected to reach USD 1.54 billion by 2030, according to a new report by Grand View Research, Inc.…

[lilyrachelcassidy]

'Accident'

Felix Catton x Reader

Summary: Where Felix inadvertently fingers his estranged cousin.

TW: well... yeah, som pretty strong sex references (and graphics); language; unpremeditated incest

WC: 1.7k

xoxoxxoxoxooxoxoxoxo

"He's been eye-fucking you for the past 15 minutes," muttered your friend, Camilla, next to your ear. At first, you merely winced at her coarse choice of language, but the interest got better of you.

"Who?" you asked, acting as if her words didn't evoke a spark of excitement in your system.

"Felix fucking Catton."

At the mention of the name, you choked on the bubbly champagne that moments before you had got a sip of.

'It was surely not gracious,' you thought.

Not very discreetly, you craned your head, taking in the surrounding while trying to localize... well, you know who. At first, all you could merely distinguish were some voguish gowns mingled with a black-and-white pallet of overpriced tuxes. It was a soiree orchestrated by Elspeth Catton herself. In your society, you knew that when an envelop with the invitation stated "a casual get-together," it was probably just a mock test to see who wasn't acquainted with the social code and etiquette well enough -- Saltburn parties always meant a great deal and you knew this customary footnote by heart.

That's why, a few days before the event, you had made a special reminder in your calendar to venture for some de rigueur gown that what you surely hadn't owned in your wardrobe. Once in the shop, your choice was something relatively simple -- a silky loose black dress on the very thin straps (at the end of the day, it was still August and even the nights were heckishly sweltering) and the elegant pair of heels of the same hue to match the top. Just enough to blend with the rest of the guests. Or so you thought.

"Over here, you dummy." Your friend poked you with her strangely bony elbow, making you gasp slightly but look in the same direction as she did. It required a 180 degree swirl of you to position in the same line as she did, so you were not very obscure with what the two of you were talking about.

That, however, finally allowed you to observe Felix, a two meter sweet little giant who was scrutinizing your every move while pretending to talk to one of the prolix guests. Upon discerning your line of sight, he took it as a silent cue to finally end a chit-chat with the stranger and approach you.

"Hey." He beamed. He made an almost instinctive move of extending his hand as a courteous way of meeting someone, but then rapidly withdrew it, presumably deciding that this kind of pretense was far too official for someone of his own age.

You couldn't help yourself but snort at this swift change of mind. For a moment, you thought that he was going to be offended by your reaction but he shortly joined you in laughter.

"Hey."

"I saw you over there and... God, I'm sorry to say, but you look ravishing."

You could feel an intense blush creeping on your face. "Thank you."

"Felix, by the way," he introduced himself, shoving his hands in the pockets while graciously dwarfing over you. There was something very causal about him; as though he couldn't be affected by the idea of embarrassment. He just innately had his way with other people, perfusing an aura of affability about him.

"I know who you are." You smiled. "Y/N."

He gave you a nod, his sight never abandoning your face. At such intense stare, you couldn't help it but feel scrutinized. With these eyes as your surveillance, you didn't mind though.

You didn't know how long the two of you had been gaping at one another, but it was enough to make your well-forgotten friend grunt beside you a couple of times.

"Camilla, pleased to meet ya," she exclaimed with the feigned enthusiasm and the theatrical hand waving near her face. "And now I'm going to fix myself a drink."

With that, she began to walk fluidly through the cobblestone pavement of the lawn, in the direction of the mansion, but not before twisting her head over her shoulder and mouthing to you 'use protection' with a wink.

You mentally shook your head with humiliation. Many people could have catalogued you as a rather old-fashioned person, if old-fashioned corresponded to not sleeping with guys after just a few hours of acquaintance.

But you also couldn't deny the way of your body reacted to the presence of the brunette beside you. In your head, you compared the size of your hands and how big his were in contrast to yours; you pictured the easiness with which he could pick you up and pin you to the wall; you imagined the softness of his lips which would be juxtaposed with the hungry, parched quality of the kisses that would turn you on...

Call it whatever, but he evoked some new types of kinks in you of which you hadn't been hitherto aware of.

It didn't mean that all of the sudden you were going to ditch the itinerary of your personal rules just because of some attractive, rangy, charismatic, mesmerizing, cute guy. Not to mention his enchanting brown eyes which were doing things to you. But, no, you were going to abide.

Probably.

No! Totally!

Or probably...

xoxoxxoxoxooooxoxox

It took a few hours of a conversation and several more glasses of champagne for you to give in to the utter charm of Felix Catton and his delectable aftershave.

Just as you had thought, Felix was a perfect kind of kisser. At first, he started a tad more slowly, smoothly devouring and exploring every taste bud in your mouth, his tongue graciously dancing in your mouth. For sake of whetting more action from him, you took the matters in your own hands -- one of your hands was gradually working on disheveling his hair, whereas the other one was stroking a chiseled line of his jaw.

The sweet kind kisses ultimately morphed into something of a ravenous nature; Felix was wolfish in his movements, one of his palms already cupping one of your breasts and circling your nipple with his thumb, and the other pinioning both of your arms to the wall. While his mouth was interchangeably traveling from your lips to your neck, leaving the silk tracks of saliva on your neckline, you felt as the surplus amount of pure want and rapture implode within you.

You arched your back, longing to be as close to the heat of Felix's body as possible. One of your legs proceeded around his torso, forcibly bringing him forth to you; surprised by your desperate actions, Felix grunted to which you moaned into his mouth. He smiled at that, never disturbing the kiss. At this point, your hair, which was previously tied in a messy bun, was now soaring in every direction due to the vigor of your movements.

Honestly, you couldn't care less.

"You like that, huh?" breathed Felix through the kisses. While saying so, he made a point of applying extra pressure in molding your breast in his hand.

In response, you merely moaned, Felix attempting his best to subdue the noise with another ferocious kiss. Out of nowhere, he removed one of his palms from your upper body and you were about to protest until you felt him touching the waistband of your lacy panties and then venturing even further. At first, he massaged your already swollen clit with his fingers through the material, simultaneously inspecting the extent of wetness that had pooled underneath.

Entirely relishing the sensation, you began moaning and moaning ever so loudly, eventually even ending up in pleads on how much you needed to feel him inside of you.

Felix solely smirked at your sudden vulnerability but decided to comply after a few more strokes across your sodden line of panties. His index finger started teasing with you but upon hearing your annoyed huffs, he finally put two fingers inside of you. And...

Oh boy. Oh boy, did it feel amazing.

He began with a steady pace but eventually started pumping his fingers faster and faster until you were loudly chanting his name and he too was moaning at your somatic responses to him. While gradually increasing the speed, you had a series of different reactions -- throwing your head backwards, your eyeballs rolling to the back of your head in elation, arching your back to the impossible angles, or incongruously trying to reflect the pace with your hips. Felix's lips were still planting parched kisses on your neck and now slowly descending to-

"Felix." A sonorous female voice echoed in front of you. The two of you instantly broke off, quickly trying to rearrange into a sufficiently seemly state.

"Mom!"

Holy fuck.

She raised her hand on the same level as her face, which was an evident signal to not interrupt her. "I do not care for your sexual affairs, son." She sounded unflappable and so was her expression. Almost too unflappable for a parent who had just caught her child working somebody up. The only evidence that the scene impacted her in the slightest was a scant quality of perturbance in her eyes. "Should it not pertain to your cousin."

Both you and Felix furrowed, and you were pretty sure that your brows reached the level of your hairline for a second. Your reactions would have been purely comical when disregarding the tragic setting of the situation.

"C-cousin?" Felix managed to choke out though the horror of the news.

"Yes," she said. "Although Y/N is not your closest relative, I hope you do realize that there are the family bonds between the two of you..." She then went on with explaining how the two of you happened to be connected, but -- truth to be told -- the whole bubble deeply confused you. And it's not like it mattered anyways.

Felix was your family. He was off-limits.

"I hope that the news of this escapade never comes to the light." With that matter-of-fact manner, she disappeared off the horizon, leaving the two of you throughly mortified.

The only thought that seemed to accompany you at that moment was that you were mutually screwed and there was no taking it back.

Perfect...

[geluckgk]

Here are some of the anecdotes Etoiles told on Radio Deter

He told the story when a girl aggressed him because she taught he had a bomb ( he already told it during the qsmp Halloween event).

Little more about that his perfusion in general :

"Since then when I have the perfusion I'm a little bit scared when people get close. It happened once in a party were, same, a drunk girl taught it was a worm and she ripped it off."

Billy asked if it was a issue for police control : "I got slammed to the ground in a burger king[…], I just take out my perfusion and I got jumped. It was right after the awful stuff of November (terrorist's attack in Paris for context), so they attacked directly, they apologized after"

And for context he also explained he don't use a perfusion anymore he have another system now.

The second anecdotes is how, as a kid, he was really scared of water to the point of vomiting, being terrified if he closed his eyes in the bathtub, etc. His mom being really rational couldn't understand where it was coming from and when he was around 9 registered him for swimming classes. And slowly he started getting more confident, did 8 years of natation and some competition and now it completely went away. AND THEN in a family's lunch, when talking about how no one understand where that fear came from, the aunt confessed. When etoiles was two and under his aunt surveillance, he was swimming with is little swimming armbands and they deflated and he started drowning and almost died until his aunt finally realized and saved him. The "fun" part is that when told the story it matched all of his buried fear.

And they attributed each other Pokémon and apparently etoiles M. Mime...

(By the way this is is outfit and Billy said he was dressed like Toji from Jujutsu Kaisen)

[expertacademicassignmenthelp]

 How Does The Brain Work?

The brain stands as a marvel of biological engineering, Composing of a multitude of bodily functions ranging from cognition and memory to emotions and sensory perception. Together with the spinal cord, it constitutes the central nervous system (CNS), the command center of the human body.

Composition of the Brain

Weighing approximately 3 pounds in adults, the brain’s main structure comprises about 60% fat, interspersed with water, protein, carbohydrates, and salts. Unlike muscles, it houses a complex network of blood vessels and nerves, including neurons and glial cells.

a) Gray and White Matter

Within the central nervous system, gray matter and white matter occupies distinct regions. In the brain, gray matter forms the outer layer, rich in neuron somas, while white matter constitutes the inner section, primarily composed of axons unsheathed in myelin. Conversely, in the spinal cord, this arrangement is reversed.

b) Brain Functionality

 The brain operates by transmitting and receiving chemical and electrical signals throughout the body. These signals regulate a myriad of processes, with the brain disseminating each input. Some signals remain confined within the brain, while others traverse the spinal cord and nerves, disseminating information across the body’s expanse. This composes neural network relies on billions of interconnected neurons.

Major Brain Regions and Their Functions

1.Cerebrum

Dominating the brain’s landscape, the cerebrum encompasses the cerebral cortex and underlying white matter. It governs a spectrum of functions, including motor coordination, temperature regulation, language processing, emotional regulation, and sensory perception.

2. Brainstem

 Serving as the bridge between the cerebrum and spinal cord, the brainstem comprises the midbrain, pons, and medulla. It regulates vital autonomic functions such as heart rate, breathing, and reflexive responses.

3. Cerebellum

Nestled at the posterior aspect of the brain, the cerebellum coordinates voluntary muscle movements, posture, balance, and motor learning.

 Brain Coverings

a) Meninges

 Three layers of protective membranes, collectively known as meninges, enshroud the brain and spinal cord. These layers — dura mater, arachnoid mater, and pia mater — shield the delicate neural tissue from physical trauma and infection.

b) Lobes of the Brain

 Each hemisphere of the brain comprises four lobes, each harboring distinct functional domains:

Frontal Lobe: Governing executive functions, motor control, and higher cognitive processes.

Parietal Lobe: Integrating sensory information, spatial awareness, and perception of pain and touch.

Occipital Lobe: Specialized for visual processing and perception.

Temporal Lobe: Involved in auditory processing, language comprehension, and memory consolidation.

Deeper Brain Structures

 These encompass important structures such as the pituitary gland, hypothalamus, amygdala, hippocampus, and pineal gland, orchestrating hormone secretion, emotional regulation, memory consolidation, and circadian rhythms.

Blood Supply

The brain receives its oxygenated blood supply through the vertebral and carotid arteries, ensuring adequate perfusion of neural tissue. The main network of blood vessels, including the Circle of Willis, safeguards against ischemic insults and facilitates intraarterial communication.

Cranial Nerves 

The twelve pairs of cranial nerves, originating from the brainstem, mediate a diverse array of sensory and motor functions, encompassing olfaction, vision, facial expression, and auditory perception.

Comprehending the anatomy and functionality of the brain fosters a deeper appreciation of its complexity and facilitates advances in neuroscientific research and therapeutic interventions aimed at diminishing neurological disorders.

Understanding the detailed anatomy and functionality of the brain is crucial for medical students embarking on their journey of study. Expert Academic Assignment Help offers invaluable assistance in navigating the complexities of neuroscience and related subjects. By leveraging expert guidance and support, students can excel in their medical education and contribute to advancements in the field of Medicine. Email us at expertassignment46@gmail.com to embark on your path to scholarly excellence and professional competency.

[andmaybegayer]

Last Monday of the Week 2024-04-01

Boopin' Monday

Listening: Sometimes you go a while without listening to a performer well understood to be solidly good and you forget that they're solidly good and then you listen to them and you're like yeah this is good. Daft Punk's Human After All album.

A positively wet album.

Reading: Finished Glory In The Thunder, by 0xabad1dea. A very strange book to read, like, it's a peculiar mix of extremely by the book fantasy and the peculiar "teen queer perfusion" style that 0xabad1dea was aiming for. A lot of plotlines but very well plotted, they weave in and out very neatly and intersect at the right times. It's a satisfying book to read but also I get the feeling that 0xabad1dea is having more fun writing it than I could ever have reading it.

If nothing else I should understand more of her posts now, since many of them are notebook sketches of these characters. I'll get to the sequel another time but I'm busy digging through my book list for what to read next.

Watching: Not much! A lot of short web stuff most notably the new Antimemetics Division short film, which has part 2 coming out in a couple days! Exciting stuff.

Playing: Forza Horizon 5, the Audi Quattro Rally S1 is up as a reward this month and I was like hey I want one of those, although I ended up scoring one through the rally DLC quests. I did wrap up the rally DLC storylines though so I'm caught back up with all the big quests, still haven't finished a ton of the ones that came out since I kind of stopped playing it as much as I used to because I was wasting a lot of my time in that game. It's too easy to get sucked into just cruising between races idly for hours.

Making: Started poking at LÖVR in detail, started writing a boids simulation but I fell down the rabbit hole of locomotion methods in VR, dealing with the dual coordinate spaces of the headset position in space and the virtual space positioning transforms is a little daunting, I expect I'll have to write some helpers to simplify it. Slowly relearning how Lua works.

Also sat and sanded the NAS case, I was planning on painting it this weekend but I was a little sick so that is on hold until probably Friday when the workshop opens again. Also need to go finish signing up for a library card so I can use the library system's shared workshop for smaller things, it looks cool.

Tools and Equipment: I have been responsible for rescuing a dying storage server at work, and I would like to pitch mdadm. If you're still using hardware RAID, stop that. It is a bad idea. You are setting yourself up for problems. CPU's are fast enough now that software RAID is perfectly performant and it makes sure that you don't end up in the situation where something silently goes wrong with your RAID card and you don't realize that your data has turned into giblets.

mdadm is actually really nice when you aren't dealing with inscrutable bugs that I see because I'm in the bugfixing division. Very simple to manage, good documentation, comprehensible metaphors, handles itself when possible, and has several sets of instructions that are basically guaranteed not to break anything that was no already broken, which is handy if you are dealing with an already fragile system.

[soapgraves]

hanahaki connverse teehee. (Warning! Its a long one. And poorly written. Because i needed this down and done.)

Because of stevens bpd its really hard to convince himself that connie loves him 100% of the time and paired with that awful proposal its safe to safe that he probably could develop it in a spiral thinking she doesn't love him & holes himself up until she forces him to speak & he coughs all those rose petals up.

Obviously thats not how it fully happens, because he has to speak to the gems! But he doesn't stay long to chat, earning their concern. (Along with those petals around.)

Following his spiral, hes definitely not talking to connie like he usually does. Quick responses, not initiating, which in turn makes connie response similarly. (Shes tired with school, now her boyfriend isn't responding to her? Or checking in? she gets a lil tired and thinks he'll get over it.) With this, steven doesn't think shes trying enough to respond. (So she doesn't love him, right? Obviously she'd fight harder if she did. And she's not! Why doesn't she love him anymore?) That leads to steven not talking to anyone at all.

That Segways into greg trying to talk to steven (the gems are trying to figure it out, and steven won't talk to them!) So he goes to try and help with some fatherly advice, steven lays in bed coughing but not responding a ton, hes under the covers away from gregs sight. Once he flips those covers though- petals, full roses, everywhere. Ans his son freaks out, triggers a coughing fit of more- freaking greg out, and he doesn't know whats wrong- steven doesn't know whats wrong- thats when the gems finally try to help.

Obviously the gems dont know whats wrong (p: "gems dont cough out flowers- do they? It cant be a gem thing!") So they take him to Priyanka, who doesn't get it either.

Finally, thats when connie is called to step in. (Her boyfriend hasnt called her in weeks, has barely texted her- he hasn't even mailed her anything!) Now shes worried. Especially after lion arrived with just petals in his fur- more worrying!

When she shows up, steven goes into a panic attack- full coughing attack and those thorns and vines hurt. He doesn't know whats wrong- its worse when connies there. And when did looking at connie hurt? (Once they finally meet each others eyes, his full of tears, hers full of concern- it clicks.)

Connie understands whats wrong, what may be causing it- and apologizes perfusely. Its not really her fault, but she feels bad because she didn't do enough to check in. She validates his feelings, tells him its okay- shes there, and she still loves him. (Something in his eyes gave it away- it had to. He wasn't speaking, he wasn't coughing anymore, just crying, how did she know?)

The vines stopped scratching, the roses stopped growing, the petals finally out of his system with his last coughs. Was that it? A love confession? Was that all he needed? Reassurance, and love, and reality.

They're fine by the end, he's definitely going to have biweekly therapy appointments though-

[entheognosis]

More from Quanta Magazine

The Year in Biology

‘Social’ Mitochondria, Whispering Between Cells, Influence Health

Scientists Find Vital Genes Evolving in Genome’s Junkyard

Extract:

“When cells are no longer needed, they die with what can only be called great dignity,” Bill Bryson wrote in A Short History of Nearly Everything. The received wisdom has long been that this march toward oblivion, once sufficiently advanced, cannot be reversed. But as science charts the contours of cellular function in ever-greater detail, a more fluid conception of cellular life and death has begun to gain the upper hand.

Perhaps the most dramatic proof of this emerged in April of 2019, when a team at the Yale School of Medicine drew global attention for briefly restoring cellular activity in dead brains. The neuroscientists Nenad Sestan, Zvonimir Vrselja and their colleagues developed a system called BrainEx that can perfuse a brain with a hemoglobin-based solution to nourish cells while promoting their recovery from oxygen deprivation, a condition that is usually lethal for neurons after 10 minutes or so. They tested it on brains extracted from slaughtered pigs, deprived of blood and kept at room temperature for as long as four hours — making them quite thoroughly dead by any conventional standard.

Yet after being perfused with the experimental solution for six hours, many of those deteriorating and seemingly lifeless brain cells regained — at least temporarily — some of their normal structure and metabolic activity. Slices of neural tissue were even able to...Click above to read more

[lilacs-and-memes]

The Left 4 Dead wiki says that there's no biological explanation for a Tank dying after not finding a player for a while.

And I'm sitting here like ☝️🤓 bodybuilders and heavy lifters are more likely to die of a heart attack.

Edit: I didn't know why actually so after a brief search the common factors are dehydration and steroid side effects.

I also wondered why the heart didn't keep up despite it being a muscle as well. And I found this:

"The heart wall does thicken and the vascular system has to run a higher blood pressure to get blood to the farthest reaches of the body. Unfortunately this increases the likelihood of a heart attack or stroke. The heart doesn’t know what the blood is going to - it just has to deal with a lot more mass to keep perfused."

More muscles needs more blood flow but the dehydration makes blood thick so. Death.

And this is why Tanks die of frustration.

[bbharmacist]

📧: an email

Outbound Email sent 01/07/2022

To: Peony Steele

From: Hesper Fòghnan

Subject: Re: Port-to-Life-Support Observation for Oct 2022 - March 2023 Expedition Season

Body: Chief Peony,

I'd like to thank you again for the opportunity to serve as field medic for the upcoming Antarctic Expedition. I wanted to reach out to you one last time to touch base on the data recorded during the trial period from my prototypical Port-to-Life-Support (PtLS) system.

Despite the PtLS's multi-vessel perfusion, there has been no statistically significant raise in factors indicating infection or implant rejection, similar to the Port-o-Cath it was modeled after. I was able to have clinicians blind to the experiment diagnose my intentional Vit C deficiency, along with a few other unintentional micronutritional discrepancies, and then clear those diagnoses after administering supplements via the PtLS.

In short, with my Expedition-Mates' signed approval, this system is ready for phase 2 of testing. I understand that you were hoping to at least have the PtLS system in testing phase 4 or 5 for the expedition, and I am happy to confirm that testing is right on track to be at stage 5 by the end of Sep.

Please reach back out if you need any further clarification regarding any of the results on this test, or anything else.

To our future adventures,

Hesper Fòghnan,

PhD candidate, Hammerlocke University

[populationpensive]

Shock

Time for the learning! A quick breakdown of the 4 types of shock so all you students getting pimped on rounds will be freakin' bosses. In all seriousness, this is vital to understand and if you're thinking of emergency medicine or critical care, it is extremely important to get this down pat. Remember, septic shock and hemorrhagic shock are SUBCATEGORIES, not one of the 4 main types.

When you think about shock, generally think about someone who (usually) has a reversible problem that causes enough hemodynamic instability that they require vasopressors. Essentially, cardiac output is reduced. Depending on the etiology of the shock, the symptoms can very. Before thinking about shock, it's important to understand cardiac output.

Stroke volume is defined as the volume of blood (in L/min) that exits the left ventricle per heart beat. More specifically, this is EDV-ESV of the left ventricle. You've learned about the Frank Starling Curve - I'm choosing to explain it a little differently without using the curve.

I think of heart rate as being a response to a certain change in stroke volume. Two of the three components of SV are proportional.

When preload increases, stroke volume increases. When afterload increases, stroke volume decreases.

Preload is referred to as end-diastolic volume, i.e. the amount of blood in the ventricle at the end of diastole and prior to ejection through the aortic valve.

Contractility is the amount of cardiac muscle stretch prior to ejection.

Afterload is the amount of pressure the left ventricle must overcome to eject blood through the aortic valve. You can think of this as systemic vascular resistance.

When thinking about shock, think about what components of stroke volume are possibly being effected.

General symptoms of shock: hypotension, tachycardia, bradycardia, confusion, delirium, LOC, dizziness, lightheadedness, general malaise, febrile, sweating, pallor, shortness of breath

In the treatment sections below, please consider your ABCs first.

Hypovolemic

Main problem: there isn't enough volume in circulation to support normal hemodynamic function. Not enough preload.

Examples: dehydration (vomiting, diarrhea), hemorrhage (loooooong list of etiology), pancreatitis, severe insensible fluid loss (big burns, open abdomens), etc

Subcategory: hemorrhagic shock

Treatment: fluid or product resuscitation, stopping the source of bleeding

Obstructive

Main problem: something is compressing the heart or creating a circulatory blockage which disrupts normal hemodynamics/heart function. Afterload is increased.

Examples: tamponade, tension pneumothorax, PE, severe STEMI.

Treatment: reduce the afterload. Dependent on cause - pericardiocentesis, needle decompression, chest tube insertion, anticoagulation/ thrombectomy, cardiac angio/catheterization.

Distributive

Main problem: something is causing volume to be dispersed in places that it should not via severe vasodilation. Blood vessels are so vasodilated that adequate tissue perfusion doesn't occur. Disruption in preload via reduced afterload (systemic vascular resistance). This type of shock is also referred to as vasodilatory shock.

Examples: bacteremia, large burns, polytraumatic injury (or anything particularly inflammatory like anaphylaxis), spinal cord injury, TBI

Subcategory: septic shock, neurogenic shock, anaphylactic shock, shock due to adrenal crisis.

Treatment: increasing systemic vascular resistance with use of vasoconstricting drugs, +/- treating the infection, reducing inflammation (steroids)

Septic shock is tricky because CO can be maintained for a time. The heart will compensate by increasing the rate, which is why septic patients routinely have HRs well over 120 bpm. But the increased HR is a sign that SOMETHING ISN'T right. If you have a patient with a new, increased HR, do NOT simply treat with a beta blocker (you'll probs code them if they are septic). Think WHY is the HR increased? If you need a vasopressor for a septic patient, norepinephrine is ALWAYS the first choice per Surviving Sepsis Guidelines.

Neurogenic shock presents itself differently because the etiology of the vasodilation is decreased sympathetic tone. Because of this, you'll have a hypotensive patient who is also bradycardic. Seen in patients with new spinal cord injury most commonly and sometimes new TBIs. These patients need MAP goals, usually over >80, with the help of a vasopressor to keep them out of a shock state. Any pressor will do, generally if my patients aren't excessively bradycardic I'll use phenylephrine.

Anaphylactic shock is unique due to it's rapid development and more immediate risk to the airway. Intubating these patients is the first priority. The vasopressor of choice is epinephrine.

Shock due to adrenal crisis should first be treated with high dose hydrocortisone. Any pressor will do (though to be honest, I have never had a patient in adrenal crisis myself, so suggestions welcome). This type of shock has some secondary concerns like sodium and calcium loss that need to be corrected immediately. It's most commonly triggered by dehydration so fluids are a must.

Cardiogenic

Main problem: pathology within the heart is causing disturbed hemodynamics. Increased afterload OR increased preload (think right heart failure). Reduced contractility. It's the one form of shock that is less likely to be reversible, ie. if you have structural heart disease of any kind, that's not reversible.

Examples: chronic heart failure (left or right), cardiomyopathy, severe aortic stenosis, Takasubo's, STEMI, ventriculoseptal defect, ventricular outflow obstruction (LVOT obstruction).

Treatment: depends on etiology but generally involves increasing contractility by adding an inotrope like dobutamine, milirinone, etc. Correcting or improving the underlying issue can improve things. These patients often need vasodilating agents to reduce afterload. If they are too sick for an intervention, they may need ECMO, IABP, or LVAD/RVAD to bridge them to improve enough for a procedure.

Overall Message

When you have a patient with low blood pressure requiring vasopressors, think about the underlying etiology to figure out the differential. Don't look at clinical symptoms separately - there is often a bigger picture at play. Also worth nothing that multiple kinds of shock can exist in the same patient OR treatment for one type causes another.

Good luck!

[spade-riddles]

https://www.tumblr.com/spade-riddles/737797349452218368/im-at-the-table-with-him-but-the-hand-that-he

Regarding this clue -

I’m getting a strong connection to “you’re losing me” - he reaches for an icy hand (poorly perfused, my heart won’t start anymore).

Where are you? I need your warmth — needs the warmth of her support system

I personally interpret this as her public persona dying and asking for warmth from what she loves most-her fans.

Just my thoughts. Hugs to you spade 💕

[soleilady]

Glassfrog photographed during sleep and while active, using a flash, showing the difference in red blood cell perfusion within the circulatory system.

[reasoningdaily]

On Jan. 20, President Joe Biden became the first in U.S. history to explicitly name “the sting of systemic racism” in his inaugural address. With this deliberate and specific use of the term, Biden was drawing attention to the deep-seated racial inequities in America.

Racism describes the marginalization or oppression of individuals because of their race. Systemic racism provides another dimension to that; it describes what happens when cultural institutions and systems reflect that individual racism. As Dr. Crystal Fleming writes in "How To Be Less Stupid About Race": “The major insight about systemic and institutional racism is that there is no such thing as ‘a little bit of racism’ or ‘pockets of racism’ or ‘random incidents of racism’ isolated from the rest of society. Whether you realize it or not, racism is systemic, pervasive and embedded within the core of all of our major institutions.”

Systemic racism is “this ever-present force, kind of like gravity. You can't see it, but you can experience its effects and it ‘holds’ the world together."

Jo Persad

"Systemic racism" describes how discriminatory actions show up in the American educational system, the economic system, the health care system, the criminal justice system and more. It's when individual attitudes of prejudice and bigotry are baked into the operations of cultural institutions. And as Fleming writes, “The consequences of systemic racism are vast — from the burgeoning racial wealth gap, political disenfranchisement, mass incarceration and racist immigration policies to microaggressions, racial profiling, racist media imagery and disparities in health, education, employment and housing.”

Jo Persad, a Boston-based high school science teacher and a student at the Harvard Graduate School of Education, describes systemic racism as “this ever-present force, kind of like gravity. You can't see it, but you can experience its effects and it ‘holds’ the world together. When you drop a pen, you see the effects of gravity. But the laws of gravity become more complex as they are used to explain phenomena at a planetary and galactical scale. Systemic racism can be likened to the latter. It is not (isolated racist acts), person to person; it is the intricate infiltration of racism into policies and the execution of said policies so that racist practices are perfused into everyday interactions.”

A heartbreaking example of systemic racism is that health outcomes for Black women are dismal compared to their white counterparts. A 2015 study from the Department of Health and Human Services reported that a baby is more than twice as likely to die during childbirth if the birth mother is Black. Furthermore, a Black mother is 3 to 4 times more likely to die during childbirth than a white mother. A 2016 study reported that Black people were significantly less likely to receive adequate pain management medication, because of the false belief (held by almost 75% of medical professional participants in the study) that Black people have a higher pain tolerance than other races.

And most recently, a 2020 study on racial disparities among COVID-19 patients found that Black people were more than 3 times as likely to die from the disease. These statistics are not because Black people are genetically predisposed to particular conditions, nor because they are somehow fundamentally “unhealthier” than other racial groups. These statistics are a result of institutional racism in the health care industry. They show what happens when medical professionals as a group make biased or prejudiced choices that dictate the level of care for people from different races, even if the medical professionals are unaware that they are acting in a prejudiced manner. When individual racist attitudes intersect with institutional practices (such as those in the health care sector), it results in vastly different treatments, systems of care and outcomes for different racial groups. In other words, systemic racism.

Educator Beverly Daniel Tatum likens racism to a “smog” that we breathe in almost every day of our lives. We absorb racialized messages about the world from our youngest days: It comes from our parents, our teachers, our classmates, our colleagues and our media. Regardless of how much individuals want to believe that they are not racist (or that they’re antiracist), the racialized biases and prejudices we’ve absorbed show up in both conscious and unconscious ways in our actions.

“Systemic racism is so embedded in our societal interactions that racism has become normalized and rendered nearly invisible. So invisible that people deny its existence and instead cast blame on the individual. This is by design,” Persad said. In other words, systemic racism describes how the racial inequities that we see today — the under-enrollment of minority students in higher education, higher incarceration rates for Black individuals, lower life expectancies for Black mothers, as a few examples — are not the result of individual shortcomings or "personality flaws," but are instead the result of centuries of disenfranchising people of color.

Systemic racism also describes the connections between racist policies of the past and present-day inequities. A striking example is the impact of racial discrepancies in the post-World War II GI Bill, which, among other benefits, provided low-cost mortgages to returning white veterans and paid their tuition if they wanted to attend college or university. While approximately 125,000 Black servicemen fought in World War II, the benefits afforded under the GI Bill were not extended to them. This meant that white servicemen were able to purchase low-cost homes that would build generational equity, and they could access a free college education that would increase their job prospects and net worth. Black servicemen received no such benefit. The wealth of white servicemen, who were able to build home equity and access high-paying jobs, has accumulated over generations, resulting in a racial wealth gap today where the average white family has approximately 10 times the net worth of a Black family. The racial wealth gap shows the effects of centuries of racism intersecting with societal systems.

“We have to remember that although systemic racism appears invisible, its effects are clear to see," Persad said. "When we look at the results across racial lines, we start to see a pattern. We start to question the validity of exclusively blaming the person, and we look deeper into what the system is doing to certain populations of people. Through the acknowledgment of its existence and taking action (with the oppressed communities), we can be the force that dismantles and breaks through these racist systems.”

Kate Slater

Kate Slater is a white anti-racist educator and scholar, and the creator of the Anti-Racist Roadmap. She is the assistant dean of student affairs at Brandeis University’s Graduate School of Arts & Sciences. Previously, she worked at the Institute for Recruitment of Teachers, a nonprofit that promotes racial justice and diversity in the American education sector. To learn more about Kate’s work, visit her website at http://kateaslater.com.

[bpod-bpod]

Printing Vessels

Animal models are vital for biomedical research. But efforts are underway to reduce our dependency on them using lab-grown tissues called organoids. However, organoids are often small and mature slowly as they lack the dense network of blood vessels needed for efficient tissue growth, without which cells die. Researchers now use microfluidic technology to 3D-print artificial networks of tiny vessels onto which neural tissue made from human stem cells were grown. Fluorescence microscopy of these organoids (pictured) revealed much lower levels of a marker for cell death (green) in organoids grown on artificial vessels perfused with nutritional liquid (right) compared with organoids grown on unperfused artificial vessels (middle) or without vessels at all (left). They also found organoids grown on perfused vessels developed complex structures, persisted for weeks and matured into neural tissue (red, white). This artificial blood vessel system can therefore produce larger, more complex human tissues for research.

Written by Lux Fatimathas

Image adapted from work by Sergei Grebenyuk and colleagues

Laboratory of Bioengineering and Morphogenesis, Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium

Image originally published with a Creative Commons Attribution 4.0 International (CC BY 4.0)

Published in Nature Communications, January 2023

You can also follow BPoD on Instagram, Twitter and Facebook