Perioperative Risk in Adults with Congenital Heart Disease Undergoing Non-Cardiac Surgery: Challenges and Tailored Strategies.

Advances in surgical and medical management of congenital heart disease have improved survival rates, leading to a growing population of adult congenital heart disease (ACHD) patients requiring specialized perioperative care. Studies indicate that ACHD patients undergoing non-cardiac surgery (NC surgery) have increased mortality and morbidity risks compared to the general population, with complication rates particularly high in those with complex defects, such as Fontan circulation, Eisenmenger syndrome, or cyanotic congenital heart disease. Key perioperative concerns include hemodynamic instability, arrhythmias, thromboembolic events, and bleeding risks. Additionally, comorbidities, such as frailty, chronic inflammation, or respiratory disease, further complicate perioperative management. Multidisciplinary collaboration is critical, involving cardiologists, anesthesiologists, and surgeons to optimize preoperative preparation and perioperative monitoring. Preoperative risk stratification is essential, integrating congenital heart lesion complexity, functional status, and procedural risk. This review underscores the importance of structured preoperative assessment, appropriate risk evaluation, and individualized perioperative strategies to improve surgical outcomes in ACHD patients undergoing NC surgery. Further research is needed to refine risk prediction models and optimize perioperative protocols tailored to this unique patient population

Analysis of genetic diversity of the critically endangered Onobrychis conferta subsp. conferta using cross-genera transferability of SSR markers developed from related legume species

The use of transferable cross-species/genera SSR markers is an alternative strategy to ensure availability of markers in genomic resources-limited crops, such as critically endangered species. Eighteen microsatellite markers derived from the genomes of Medicago truncatula Gaertn., Phaseolus vulgaris L. and Onobrychis viciifolia Scop. were tested for transferability and used to study the genetic diversity of the three remaining populations of the critically endangered species Onobrychis conferta subsp. conferta, collected from their natural habitats. All pairs of primers tested were found to be polymorphic and reproducible. A total of 257 alleles were obtained from 134 loci, resulting in an average of 1.93 alleles per locus. The average number of alleles per accession was 51.4, yielding an average of 14.27 alleles per SSR marker and accession. The lowest number of alleles was recorded in O. conferta from Aïn Dyssa, with 37 alleles, while the highest was observed in O. viciifolia, with 63 alleles. Each SSR amplified 3-16 alleles. The MTIC343 primer yielded the highest number of loci (16 loci). The mean Polymorphism Information Content (PIC), Marker Index (MI), and Resolving Power (Rp) were 0.36, 2.22, and 4.58, respectively, indicating a high level of polymorphism in the studied SSR markers. UPGMA cluster analysis grouped genotypes into two main clusters in corroboration with the morphological distinction of sections. Our study demonstrated that O. conferta subsp. conferta genomes could be successfully examined using other legume SSR markers, providing a valuable tool to detect polymorphism for future genetic studies, breeding programs, and conservation strategies, addressing the lack of available SSR markers in this genus. These microsatellite loci may help to further survey the adaptive evolution and genetic variation of Onobrychis conferta conservation

Hierarchical algorithms on hierarchical architectures

A traditional goal of algorithmic optimality, squeezing out flops, has been superseded by evolution in architecture. Flops no longer serve as a reasonable proxy for all aspects of complexity. Instead, algorithms must now squeeze memory, data transfers, and synchronizations, while extra flops on locally cached data represent only small costs in time and energy. Hierarchically low-rank matrices realize a rarely achieved combination of optimal storage complexity and high-computational intensity for a wide class of formally dense linear operators that arise in applications for which exascale computers are being constructed. They may be regarded as algebraic generalizations of the fast multipole method. Methods based on these hierarchical data structures and their simpler cousins, tile low-rank matrices, are well proportioned for early exascale computer architectures, which are provisioned for high processing power relative to memory capacity and memory bandwidth. They are ushering in a renaissance of computational linear algebra. A challenge is that emerging hardware architecture possesses hierarchies of its own that do not generally align with those of the algorithm. We describe modules of a software toolkit, hierarchical computations on manycore architectures, that illustrate these features and are intended as building blocks of applications, such as matrix-free higher-order methods in optimization and large-scale spatial statistics. Some modules of this open-source project have been adopted in the software libraries of major vendors. This article is part of a discussion meeting issue 'Numerical algorithms for high-performance computational science'. © 2020 The Authors. Published by the Royal Society under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, provided the original author and source are credited

Efficient Indirect Interatomic Coulombic Decay Induced by Photoelectron Impact Excitation in Large He Nanodroplets

Ionization of matter by energetic radiation generally causes complex secondary reactions which are hard to decipher. Using large helium nanodroplets irradiated by XUV photons, we show that the full chain of processes ensuing primary photoionization can be tracked in detail by means of high-resolution electron spectroscopy. We find that elastic and inelastic scattering of photoelectrons efficiently induces interatomic Coulombic decay (ICD) in the droplets. This type of indirect ICD even becomes the dominant process of electron emission in nearly the entire XUV range in large droplets with radius $\gtrsim40~$nm. Indirect ICD processes induced by electron scattering likely play an important role in other condensed phase systems exposed to ionizing radiation as well, including biological matter

Effect of Enhanced Recovery After Surgery (ERAS) Implementation on Postoperative Atrial Fibrillation in Cardiac Surgery.

Background/Objectives: Postoperative atrial fibrillation (POAF) is the most frequent arrhythmic complication following cardiac surgery and is associated with increased morbidity and prolonged recovery. This study aimed to evaluate the impact of an enhanced recovery after surgery (ERAS) program on the incidence of POAF and broader perioperative outcomes. Methods: In this monocentric, observational cohort study, we compared a retrospective pre-ERAS cohort (n = 162) with a prospective ERAS cohort (n = 321). The primary outcome was the incidence of POAF, assessed using two definitions: (1) the American Association for Thoracic Surgery (AATS) 2014 clinical definition, identifying POAF as atrial fibrillation requiring treatment; and (2) the European Society of Cardiology (ESC) 2024 definition, describing new-onset atrial fibrillation occurring immediately after surgery. Secondary outcomes included compliance with POAF prophylaxis measures, length of hospital stay, and the occurrence of postoperative complications. Statistical analyses included propensity score matching and multivariate logistic regression to identify independent predictors of POAF. Results: ERAS implementation was associated with a significant reduction in POAF incidence across both definitions. According to the AATS 2014 definition, POAF occurred in 20% of ERAS patients vs. 39% in the pre-ERAS group (p = 0.001), and 23% vs. 39% in the matched cohort (p = 0.004). Using the ESC 2024 definition, POAF was observed in 21% vs. 37% (p = 0.001) in unmatched and 20% vs. 36% (p = 0.005) in matched populations. Compliance with POAF prophylaxis improved markedly in the ERAS group (70% vs. 21%, p = 0.001). ERAS patients also experienced shorter hospital stays and fewer postoperative complications (26% vs. 38% in the matched cohort, p = 0.033). Conclusions: The implementation of a structured ERAS protocol significantly reduced POAF incidence, improved compliance with preventive strategies, and enhanced key aspects of postoperative recovery

Enhanced Recovery After Surgery (ERAS) Protocols in Cardiac Surgery: Impact on Opioid Consumption.

Background: Enhanced Recovery After Surgery (ERAS) protocols have been implemented in various surgical specialties to improve patient outcomes and reduce opioid consumption. In cardiac surgery, the traditionally high-dose opioid use is associated with prolonged ventilation, intensive care unit (ICU) stays, and opioid-related adverse drug events (ORADEs). This study evaluates the impact of an ERAS <sup>®</sup> Society-certified program on opioid consumption in patients undergoing elective cardiac surgery at Lausanne University Hospital. Methods: A retrospective, monocentric observational study was conducted comparing two patient cohorts: one treated with ERAS protocols (2023-2024) and a retrospective control group from 2019. Data were collected from the hospital's electronic medical records and the ERAS program database. The primary outcome was total opioid consumption, measured intraoperatively and postoperatively (postoperative day (POD) 0-3). Secondary outcomes included pain control, length of stay, complications, and recovery parameters. Statistical analyses included multivariate logistic regression to identify factors associated with reduced opioid consumption. Results: Patients in the ERAS group demonstrated significantly lower total opioid consumption, whether intraoperatively (median sufentanil: 40 mcg vs. 51 mcg, p < 0.0001) or postoperatively (POD 0-3: p < 0.001). The ERAS group had faster extubation times, earlier mobilization and pain control with non-opioid analgesics, fewer complications, and shorter hospital stays (9 vs. 12 days, p < 0.001). Logistic regression identified fast-track extubation and absence of complications as strong predictors of reduced opioid use. Conclusions: The implementation of an ERAS protocol in cardiac surgery significantly reduces opioid consumption while enhancing recovery