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Three-dimensional (3D) modeling has become an invaluable tool for operative planning in the continually evolving complex field of adult congenital heart surgery. We present a case of an intra-atrial conduit leak after multiple repairs of common atrium and criss-cross morphology. 3D modeling was critical in preoperative evaluation and operative planning for complicated intracardiac anatomy after an uncommon initial approach to preserve a biventricular circulation. In the setting of complex or rare congenital cardiac anomalies, advanced imaging and 3D modeling are helpful with preoperative planning.

The utility of three-dimensional (3D) printed models for medical education in complex congenital heart disease (CHD) is sparse and limited. The purpose of this study was to evaluate the utility of 3D printed models for medical education in criss-cross hearts covering a wide range of participants with different levels of knowledge and experience, from medical students, clinical fellows up to senior medical personnel. Study participants were enrolled from four dedicated imaging workshops developed between 2016 and 2019. The study design was a non-randomized cross-over study to evaluate 127 participants' level of understanding of the criss-cross heart anatomy. This was evaluated using the scores obtained following teaching with conventional images (echocardiography and magnetic resonance imaging) versus a 3D printed model learning approach. A significant improvement in anatomical knowledge of criss-cross heart anatomy was observed when comparing conventional imaging test scores to 3D printed model tests [76.9% (61.5%–87.8%) vs. 84.6% (76.9%–96.2%), P < 0.001]. The increase in the questionnaire marks was statistically significant across all academic groups (consultants in pediatric cardiology, fellows in pediatric cardiology, and medical students). Ninety-four percent (120) and 95.2% (121) of the participants agreed or strongly agreed, respectively, that 3D models helped them to better understand the medical images. Participants scored their overall satisfaction with the 3D printed models as 9.1 out of 10 points. In complex CHD such as criss-cross hearts, 3D printed replicas improve the understanding of cardiovascular anatomy. They enhanced the teaching experience especially when approaching medical students., The Association for European Pediatric and Congenital Cardiology Junior Research Grant 2015 to support the 3D printing scientific project in the field of pediatric and congenital cardiology in Europe (to Dr. Maria Nieves Velasco Forte), Grant Number: AEPC-IWG-JRG2015

A criss-cross heart is a rare congenital heart disease that is commonly associated with complex cardiac defect. Criss-cross heart is characterized by crossing of the inflow streams of the two ventricles, due to twisting of the heart during development. As a result the axis of the openings of the atrioventricular (AV) valves remain non parallel. We report a case of 2.5 months old baby with criss-cross spatial relationship of the atrioventricular valve with double outlet right ventricle with Pulmonary Artesia and atrial and ventricular septal defect. The diagnosis was confirmed by 2D and color Doppler Echocardiography in subxiphoid long-axis and coronal plane sweeps. Due to the complex structural changes and rarity of the anomaly, the diagnosis is often missed. In this case report we emphasized on diagnosis feature of presentation and surgical techniques required to correct or palliate the defects. Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 214-216

A criss-cross heart is an uncommon congenital rotational anomaly. It accounts for less than 0.1% of all congenital heart defects. The anomaly is characterized by crossing of the atrioventricular connections caused by rotation of the heart about its long axis. It is commonly associated with diverse cardiac defects. Cardiac CT imaging of criss-cross heart is sparse. We present a case of 1-year-old child with chief complaints of bluish discoloration of the body and fast breathing. Cardiac CT revealed atrial situs solitus, criss-cross-atrioventricular connections, atrioventricular discordance, double outlet right ventricle and dextro-malposed great arteries (Van Praagh S,D,D).

Background Outcomes of therapeutic studies in diffuse cutaneous systemic sclerosis (dcSSc) have mainly been measured for specific organs, particularly the skin and lungs. A new composite response index in dcSSc (CRISS) has been developed for clinical trials. The goal of this study was to determine whether, in an observational dcSSc cohort, immunosuppression was associated with global disease improvement measured with the CRISS. Methods We conducted a retrospective cohort study in a multi-centered SSc registry comparing 47 patients newly exposed to immunosuppression for ≥ 1 year to 254 unexposed patients. Inverse probability of treatment weighting (IPTW) was performed to create comparable exposed and unexposed groups by balancing for age, sex, disease duration, modified Rodnan skin score (mRSS), forced vital capacity, patient and physician global assessments, and Health Assessment Questionnaire score. A CRISS score ≥ 0.6 at 1 year was defined as improvement. Results Exposed patients had shorter disease duration (5.5 versus 11.7 years, p p p p = 0.03) while other variables including mRSS were similar. Conclusion Using a composite response measure, immunosuppression was associated with better outcomes at 1 year in a dcSSc cohort. These results provide real-world data that align with clinical trials to support our current use of immunosuppression.

This paper presents an extremely rare and difficult case report of criss-cross heart (CCH) with a combination of cc-TGA and aortic coarctation of the fetal heart at 33 weeks of gestation. Despite very complicated heart anatomy, the proper perinatal care and early cardiac surgery allowed us to observe normal development of the child without any problems during his first six and ten months of postnatal life. The impossibility to: image proper four-chamber view, obtain parallel tricuspid and mitral valve, visualize symmetrical valve motion and laminar flow from the atrium to the ventricle might be the first clues to diagnose CCH.

Criss-cross heart (CCH) is an extremely rare complex congenital heart malformation. It accounts for less than 0.1% of congenital heart diseases. Here, we describe a unique case of CCH with double-outlet right ventricle, huge subpulmonary ventricular septal defect, bicuspid pulmonary valve, and right-hand aortic arch. The anatomic features were observed with echocardiography, and the diagnosis was confirmed at surgery. Many variations of CCH have been described. The present case expands the spectrum of this entity and may provide new insight into this complex anatomy.

Objective To study the echocardiographic features of criss-cross heart (CCH), a congenital cardiac anomaly characterized by crossed ventricular inflow streams, in Indian patients. Methods In this retrospective observational study, all pediatric echocardiograms performed in a single tertiary care institution in South India over a three-year period were scrutinized for a diagnosis of CCH. Demographic, clinical and echocardiographic data were collected from patients’ medical records and echocardiographic database. Crossed ventricular inflow streams was identified when there was inability to visualize both atrio-ventricular valves in a single imaging plane in cardiac four chamber view. Results CCH was diagnosed in five patients from 10,500 pediatric echocardiographic studies. The age at diagnosis ranged from one month to 8 years. Cyanosis was present in all but one of the five cases. Crossed ventricular inflow streams was present by definition in all cases, whereas superior-inferior ventricular relationship was present in only three cases. All cases were associated with ventricular septal defects. Atrio-ventricular discordance was seen in three cases and concordance in two. Ventriculo-arterial discordance was seen in three cases, concordance in one and double outlet right ventricle in one. Three cases had pulmonary stenosis and the other two had pulmonary arterial hypertension. Straddling of AV valve was observed in four cases and hypoplastic aortic arch in one case. Conclusion CCH is an extremely rare congenital cardiac anomaly. Superior-inferior ventricular relationship often co-exists with CCH, but is not necessarily present in all cases. CCH requires early diagnosis because of its common association with diverse cardiac anomalies.

Objective To develop a risk scoring system for prediction of inguinal lymph-node involvement and to suggest a management strategy according to the risk groups based on clinical, radiological and pathological parameters in squamous cell carcinoma (SCC) of penis. Materials and Methods A retrospective analysis of all patients of SCC penis from 2014 to 2020 at our institute was done. The patients were divided into derivation cohort (2014 to 2019) and validation cohort (2019 to 2020). A total of 10 predictors were analysed in univariate analysis and those found significant were further subjected to multivariate analysis to derive regression coefficient for each. CRiSS scores were assigned based on the coefficients and three groups were created which were correlated with nodal metastasis. The predictive accuracy of the model was assessed by ROC analysis of the derivation cohort and validation cohort. Results A total of 102 patients were identified in derivation cohort and 23 patients in validation cohort. Size of the primary >3cm, ulceroinfiltrative growth, involving shaft, ultrasound size of lymph-nodes >1cm, loss of fatty hila, moderate and poor differentiation, and lypmphovascular/perineural invasion were independent predictors of inguinal lymphnode metastasis in multivariate analysis. CRiSS could achieve AUROC of .910 and .887 in derivation and validation cohort respectively. The rate of metastatic lymphadenopathy was 0%, 41.4%, and 89.5% in low, intermediate, and high-risk groups respectively. Conclusions CRiSS can effectively predict inguinal lymph-node metastasis in SCC penis. We suggest a management strategy based on risk groups that will avoid morbidity of groin dissection in many patients.

Criss-cross heart is a rare congenital cardiac anomaly characterized by the crossing of two ventricular inflow streams. We have demonstrated the utility of 4-dimensional color Doppler rendering in diagnosing the criss-cross heart in a fetus. Four-dimensional color Doppler rendering can demonstrate the relative direction of intracardiac blood flows and facilitate recognition of the crossover of inflow streams in the same plane, confirming the criss-cross heart diagnosis in the fetus.

Criss-cross heart (CCH) is a rare congenital cardiac defect defined by crossing of ventricular inflow streams contributing to less than 0.1 % of all congenital heart anomalies. Due to its rarity and complexity, prenatal diagnosis in these patients remains challenging. We sought to describe prenatal findings and postnatal course in eight cases of prenatally diagnosed CCH. This is a retrospective case series of prenatally diagnosed CCH in three centers between 2010-2017. We reviewed fetal echocardiograms as well as postnatal clinical charts and surgical reports. 8 cases of CCH were included. The median gestational age at diagnosis was 27 weeks. 7 patients were found with situs solitus, one fetus with situs ambiguous. In all patients, the four-chamber view was abnormal. There was atrioventricular discordance in half of the patients, while all patients showed ventriculoarterial discordance. All patients were found with additional cardiac anomalies, including ventricular septal defect, double outlet right ventricle, right aortic arch, atrial septal defect and pulmonary stenosis. Three patients underwent amniocentesis without pathological findings. All patients were born alive at a median gestational age of 38 + 2 weeks and survived our median follow-up of 181 days. CCH can be diagnosed prenatally by detailed fetal echocardiography when observing an abnormal four-chamber view with crossing of inflow streams into both ventricles and a lack of parallel orientation of the atrioventricular valve axis due to a clockwise or counterclockwise rotation of the ventricular mass along its axis. With the help of prenatal ultrasound, parental guidance and counselling as well as postnatal pediatric cardiac management can be warranted.ZIEL: Das Criss-cross-Herz (CCH) ist eine seltene angeborene kardiale Fehlbildung, die durch die Kreuzung der Zuflüsse beider Ventrikel definiert ist. Sie macht weniger als 0,1 % aller kongenitalen Herzanomalien aus. Aufgrund dieser Seltenheit und Komplexität stellt die pränatale Diagnose bei den betroffenen Patienten eine Herausforderung dar. Wir möchten die vorgeburtlichen Befunde und den postnatalen Verlauf in 8 Fällen von pränatal diagnostiziertem CCH beschreiben. Dies ist eine retrospektive Fallserie von pränatal diagnostiziertem CCH in 3 Zentren zwischen 2010 und 2017. Wir überprüften fetale Echokardiogramme sowie postnatale Krankenakten und chirurgische Berichte. Eingeschlossen wurden 8 Fälle mit CCH. Bei Diagnose betrug das mediane Alter 27 Gestationswochen. Bei 7 Föten lag ein Situs solitus, bei einem Fötus ein Situs ambiguus vor. Alle Patienten hatten einen abnormalen 4-Kammer-Blick. Bei der Hälfte der Patienten bestand eine atrioventrikuläre Diskordanz, während alle Patienten eine ventrikuloarterielle Diskordanz aufwiesen. Alle Föten wiesen zusätzliche kardiale Anomalien auf, darunter einen Ventrikelseptumdefekt, einen rechten Ventrikel mit doppeltem Auslass, einen rechten Aortenbogen, einen Vorhofseptumdefekt und eine Lungenstenose. Bei 3 Patienten wurde die Amniozentese ohne pathologischen Befund durchgeführt. Alle Patienten wurden in der medianen Gestationswoche 38 + 2 lebend geboren und überlebten unsere mediane Nachbeobachtungsperiode von 181 Tagen. Die CCH kann pränatal durch eine detaillierte fetale Echokardiografie diagnostiziert werden, wenn ein abnormaler 4-Kammer-Blick mit Kreuzung der Zuflüsse beider Ventrikel vorliegt und eine fehlende parallele Orientierung der Atrioventrikularklappen-Achse aufgrund der Rotation der ventrikulären Masse entlang ihrer Achse im oder gegen den Uhrzeigersinn beobachtet wird. Mithilfe der pränatalen Sonografie kann die Betreuung und Beratung der Eltern sowie ein postnatales pädiatrisches Herzmanagement gewährleistet werden.

The criss-cross heart congenital defect (CHD) concomitant with transposition of the great arteries has an incidence of less than 0.1% of all inherited heart anatomy abnormalities. It derives from the anomaly of cardiac rotation around its long axis after ventricular septation, and results in an atypical relation between the ventricles and the atria. Furthermore, such patients may also present with ventricular septal defect (VSD), large vessel malposition, double outflow and/or right ventricular hypoplasia (RV), pulmonary artery stenosis (PA), and tricuspid valve hypoplasia. A 7-month-old patient after a transcatheter pulmonary balloon valvuloplasty and a surgical unilateral modified Blalock-Taussig (BT) shunt was admitted to the paediatric cardiac surgery department for further treatment. CHD had been diagnosed prenatally and confirmed after birth. Echocardiographic study revealed dextrocardia and a criss-cross heart pathology with discordant atrioventricular (AV) and ventriculoarterial relations. Intracardiac pathology was concomitant with transposition of the great arteries [aorta originating from the RV, and PA from above the VSD], subvalvular and valvular pulmonary stenosis (gradient RV/PA approx. 90 mm Hg), and unobstructed BT shunt. Systemic cyanosis was not observed, and the child’s mental and physical development was undisturbed. After diagnostic catheterisation, the patient was referred for further surgery. Using extracorporeal circulation, a bidirectional Glenn anastomosis was performed, and the BT shunt as well as the PA were closed and dissected. The postoperative course was uncomplicated. More than 90% of criss-cross heart co-occur with levocardia and the concomitance with the AV-related transposition of the great arteries and dextrocardia, to the best of our knowledge, is the second described report in the literature. Thus, the diagnosis of a rare congenital heart defect should be always considered, especially in prenatal diagnostics, and precisely defined during qualification for further surgical treatment.

BACKGROUND: Pulmonary exacerbations (PEx) in cystic fibrosis (CF) patients reduce quality of life. Lung function, measured by the percent predicted forced expiratory volume in one second (ppFEV1), is widely used to evaluate PEx treatments. We analyzed the correspondence of ppFEV1 with 8 patient-reported symptom-based questions from the Cystic Fibrosis Respiratory Symptom Diary–Chronic Respiratory Infection Symptom Score (CFRSD-CRISS). METHODS: Data were derived from the observational Standardized Treatment of Pulmonary Exacerbations (STOP) study. CF patients who had CFRSD-CRISS and ppFEV1 measurements on ≥2 timepoints were included: 1) day of initial PEx, 2) 7 days later, and/or 3) end of PEx. We calculated age-stratified Spearman correlation coefficients and 95% confidence intervals (95% CIs) between the change in ppFEV1 and change in CFRSD-CRISS items from index to day 7 and from index to the end of PEx treatment. RESULTS: Lung function and symptom scores improved by the end of treatment; however, correlations between ppFEV1 and the specific CFRSD-CRISS measures were mostly weak to moderate. An exception was that among patients

Text-to-image synthesis aims to generate a visually realistic image according to a linguistic text description. Visual quality and semantic consistency are two key objectives. Although remarkable progress has been made in improving visual resolutions leveraging Generative Adversarial Networks (GANs), guaranteeing the semantic conformity remains challenging. In this paper, we address it by proposing a novel Criss-Cross Attention and Global-Local Discriminator Generative Adversarial Networks(CcGL-GAN). CcGL-GAN exploits a Criss-Cross Attention mechanism to capture the variation of contextual description, which enables back generators to generate images more efficiently. Moreover, it utilizes Global-Local discriminators to project low-resolution images onto global linguistic representations, and high-resolution images onto local linguistic representations, which ensures that our model narrows the gap between images and descriptions. Experiments conducted on two publicly available datasets, the CUB and Oxford-102, demonstrate the effectiveness of the proposed CcGL-GAN model.

This report presents the case of a patient with complex, post-operative congenital heart disease who required an atypical approach for placement of a left ventricular pacing lead to establish biventricular pacing after developing pacemaker-mediated cardiomyopathy. A 42-year-old man with upstairs

During 2016, a joint experimental campaign was carried out by QST and Consorzio RFX on the Negative Ion Test Stand (NITS) at the QST Naka Fusion Institute, Japan, with the purpose of validating some design solutions adopted in MITICA, which is the full-scale prototype of the ITER NBI, presently under construction at Consorzio RFX, Padova, Italy. The main purpose of the campaign was to test a novel technique, for suppressing the beamlet criss-cross magnetic deflection. This new technique, involving a set of permanent magnets embedded in the Extraction Grid, named Asymmetric Deflection Compensation Magnets (ADCM), is potentially more performing and robust than the traditional electrostatic compensation methods. The results of this first campaign confirmed the effectiveness of the new magnetic configuration in reducing the criss-cross magnetic deflection. Nonetheless, contrary to expectations, a complete deflection correction was not achieved. By analyzing in detail the results, we found indications that a physical process, taking place just upstream of the plasma grid, was giving an important contribution to the final deflection of the negative ion beam. This process appears to be related to the drift of negative ions inside the plasma source, in the presence of a magnetic field transverse to the extraction direction, and results in a non-uniform ion current density extracted at the meniscus. Therefore, the numerical models adopted in the design were improved by including this previously disregarded effect, so as to obtain a much better matching with the experimental results. Based on the results of the first campaign, new permanent magnets were designed and installed on the Extraction Grid of NITS. A second QST-Consorzio RFX joint experimental campaign was then carried out in 2017, demonstrating the complete correction of the criss-cross deflection and confirming the validity of the novel magnetic configuration and of the hypothesis behind the new models. This contribution presents the results of the second joint experimental campaign on NITS along with the overall data analysis of both campaigns, and the description of the improved models. A general picture is given of the relation among magnetic field, beam energy, meniscus non-uniformity and beamlet deflection, constituting a useful database for the design of future machines.

Background and Aims Abnormal mineral bone metabolism of chronic kidney disease (CKD-MBD) is the most common CKD complication. However, fewer data concerning the relationship between bone metabolic indexes, such as high serum phosphorus and cardiovascular diseases, bone mass reduction, and fracture, is available in Chinese adult patients. The Chinese Chronic Renal Insufficiency Study: Based on Smartphone Platform (C-CRISS) is established to explore the relationship between bone metabolic markers and other non-traditional risk factors with renal function progression, cardiovascular (CVD), and cerebrovascular diseases (BVD), and bone loss in CKD patients. Method/design The C-CRISS study is a multi-center prospective cohort study in China. It will recruit 3360 pre-dialysis patients aged 18 to 74 years and follow up for at least two years. The individuals with CKD G3b-5ND will account for over 70 percent of the study population. Active glomerulonephritis, rapidly progressing and advanced heart, liver, and tumor diseases will be excluded. The primary composite endpoints include the events of progression to ESRD, cardiovascular events, and death. The participants will undergo the clinical evaluation at baseline and clinic visits at six-monthly intervals in traditional consultation ways. The CVD, BVD, retinopathy, DXR, and other complications will be measured annually. Data on the questionnaire, diet, quality of life, and patients’ status during follow-up will be collected by the smartphone platform developed for this study. The sample size will enable us to have 80% power to detect a 2.0 risk ratio of CVD events in CKD G4 patients compared with CKD G3a patients. Conclusion The C-CRISS study would provide evidence of the potential risk of bone metabolic markers for progressive CKD and CVD/BVD. The study will also provide a new management and complication monitoring model through smartphone communication in chronic kidney disease patients. Trial registration ClinicalTrials.gov Identifier: NCT04229485

We present the first description of successful radiofrequency (RF) ablation of a bidirectional atrioventricular accessory pathway (AP) guided by nonfluoroscopic mapping with use of three-dimensional magnetic resonance imaging integrated into the Nav-X system (MRI/Nav-X fusion) in a 13-year-old boy with remote surgical palliation for cyanotic criss-cross heart with atrioventricular discordance, double-outlet right ventricle, and a large ventricular septal defect. Due to complex anatomy, a unique finding was that the eliminated left lateral AP electrically connected the left atrium to the antero-superior morphologic right ventricle prior to ablation.

Salient object detection (SOD) is a basic research direction in the computer vision task. Its main work is to simulate the human visual system by establishing a visual-aware model. However, most of existing models have suffered from two challenges. First, edge-aware models only use edge feature to improve segmentation features but lack of utilizing the complementarity of them. Second, the problem of losing part of information in the process of extracting features in Convolutional Neural Networks (CNN) leads to the incompleteness of final result. In this paper, we proposed a criss-cross refined salient object detection method based on hybrid attention to solve these problems. Specifically, we applied a Criss-Cross Attention module (CCA) to capture useful contextual information of surrounding pixels from long-range dependencies effectively. Fully considering the complementary between salient detection and edge information, our model simultaneously refines multilevel features of SOD and edge detection by overlapping a Cross Refinement Unit (CRU). And finally we used a U-Net to output the refined result. Extensive experiments conducted on five benchmark datasets demonstrate that our method can significantly improve the performance of low-contrast scenes, optimize the problem of partial missing and error detection of salient objects. Besides, our method achieved state-of-the-art performance in three different indicators.

Nearly 90% of patients with glucose transporter type 1 deficiency syndrome (Glut1 DS; figure) have paroxysmal or constant gait abnormalities, including ataxic, spastic, ataxic-spastic, and dystonic gait.1,2 We report 3 cases of genetically proven Glut1 DS (table) demonstrating a distinctive paroxysmal gait disorder triggered by exertion or fasting, herein named “criss-cross gait” (video 1). It is characterized by lower-body choreo-dyskinesia causing the legs to intersect repeatedly, producing irregular, random steps combined with some loss of balance. Compensatory upper-body movements help maintain balance. In the appropriate clinical context, criss-cross gait should prompt evaluation for the treatable Glut1 DS and not be misinterpreted as functional.

Contextual information is vital in visual understanding problems, such as semantic segmentation and object detection. We propose a Criss-Cross Network (CCNet) for obtaining full-image contextual information in a very effective and efficient way. Concretely, for each pixel, a novel criss-cross attention module harvests the contextual information of all the pixels on its criss-cross path. By taking a further recurrent operation, each pixel can finally capture the full-image dependencies. Besides, a category consistent loss is proposed to enforce the criss-cross attention module to produce more discriminative features. Overall, CCNet is with the following merits: 1) GPU memory friendly. Compared with the non-local block, the proposed recurrent criss-cross attention module requires 11x less GPU memory usage. 2) High computational efficiency. The recurrent criss-cross attention significantly reduces FLOPs by about 85% of the non-local block. 3) The state-of-the-art performance. We conduct extensive experiments on semantic segmentation benchmarks including Cityscapes, ADE20K, human parsing benchmark LIP, instance segmentation benchmark COCO, video segmentation benchmark CamVid. In particular, our CCNet achieves the mIoU scores of 81.9%, 45.76% and 55.47% on the Cityscapes test set, the ADE20K validation set and the LIP validation set respectively, which are the new state-of-the-art results. The source codes are available at \url{https://github.com/speedinghzl/CCNet}., Comment: IEEE TPAMI 2020 & ICCV 2019

Syncope has a broad range of differential diagnoses. Sarcoidosis, a multisystem inflammatory disorder characterized by the formation of noncaseating granulomas, is a rare but important diagnosis to consider while evaluating patients presenting with presyncopal or syncopal symptoms. Although sarcoidosis is most commonly known to affect the lungs, it is estimated that at least 25% of patients with sarcoidosis have myocardial involvement, with only 5% of these patients showing clinical symptoms. Here, we present the rare case of a Caucasian male patient diagnosed with cardiac sarcoidosis after presenting to the hospital with presyncope. The patient had an internal cardioverter-defibrillator placed during hospitalization and was initiated on prednisone and methotrexate in the outpatient setting. He exhibited clinical and radiographical improvement in the six-month follow-up period after treatment was initiated.

A multi-objective optimization approach in order to find the optimal cable overlap length in multi-span cable-stayed bridges with criss-cross cables is presented. The multi-objective optimization is solved by considering three objectives: 1) the cost of the cable system, 2) the displacement at the top of the pylon and 3) the alternate live load on the bridge. An unconventional criss-cross cable system configuration in which cables criss-cross at the center of intermediate spans is used for a bridge with five spans and four pylons. Taking into account both the cable overlap length and the different occurrences of alternate live load, the set of optimal solutions was obtained by the use of genetic algorithms. Results indicate that the optimal cable overlap length corresponds to three criss-crossing cables that corresponds to 0.28 times the length of the central span. Research on multi-span cable-stayed bridges with criss-cross cables allows the analysis of another solution for the problem of stabilizing the displacement of intermediate pylons in this kind of bridge.

The purpose of this work was to describe the results of a technique of simultaneous antegrade and retrograde vascular access (“criss-cross”) to the popliteal vein to achieve venous recanalization in patients with acute, extensive, iliofemoral DVT with concomitant popliteal and calf vein thrombosis. Seven patients were treated using this technique, in three patients as a bailout option after failed posterior tibial vein puncture and in four as a first option. Antegrade popliteal venous access was performed according to the usual technique using duplex ultrasound (DUS) guidance and thrombolysis (CDT), or thrombectomy (PMT) was performed. Following this, the retrograde sheath was placed under DUS guidance, a tibial vein was selectively catheterized and CDT, and/or a PMT was performed. Three patients underwent isolated CDT, another three had associated PMT, and one patient underwent iliofemoral PMT and catheter thromboaspiration of the popliteal and calf veins. Median thrombolysis duration was 72 h (24–72 h). SIR grade III thrombolysis was achieved in six patients and grade II in one patient. All patients underwent subsequent stenting of their iliac vein lesions. Minor complications were observed in two patients (ecchymosis), while one patient developed a hematoma on the popliteal fossa. This “criss-cross” technique represents a safe alternative to the distal (anterior or posterior tibial) vein access both as a bailout option after failed distal venous access as well as a primary approach due to its potential advantage of clearing larger thrombus volume. Experience in ultrasound-guided popliteal vein puncture is crucial to avoid complications. Case series, Level IV.

Background: Congenital heart disease (CHD), still placed first among common birth defects, occurs approximately 1 in 125 live births. Crisscross heart disease (CCHD) is an uncommon cardiac malformation characterized by crossing of the inflow blood streams of the two ventricles due to an apparent longitudinal twisting of the heart [1]. Case Report: We report a case of a 4-month-old infant, a diagnosed case of complex congenital heart disease (CCHD, VSD, pulmonary atresia and mild AR) and was on anti-heart failure treatment, admitted to our hospital for left inguinal herniotomy. Conclusion: The challenge for anaesthetists dealing with CHD patient, coming for other than cardiac surgery depends on the patient’s age, complexity of the heart lesion, coupled with patients’ capacity to compensate, multiple comorbids and surgical urgency.

The band gap and transmission characteristics of the two-dimensional cross-arrangement elliptical aperture cycle structure were studied by finite element analysis. When the aluminum scatter is filled in the elliptical hole, the segmentation of the wide band gap can be realized to form a plurality of transmission channels. According to the theoretical model, the PMMA /A1 material phononic crystals model is implemented, and the results show that the aluminum scatterers can change the band gap distribution of the phononic crystals, realize the regulation of different frequency elastic waves in the periodic structure, which provides an idea for the design of acoustic device.

Criss-cross heart is an extremely rare anomaly, characterized by an abnormal rotation of the ventricular mass along its major axis. It may be associated with any malformation of the heart segments and connections. Due to the complex structural changes and rarity of the anomaly, the rotation of ventricular axis is often misdiagnosed. In this paper, two cases of criss-cross heart are reported, with emphasis on diagnostic and surgical techniques used to corrected the main defects. A literature review on the subject is also presented which, although sparse, emphasized on the morphologic, diagnostic and surgical aspects of the anomaly. Coração entrecruzado (criss-cross heart) é uma anomalia extremamente rara, caracterizada por rotação anormal da massa ventricular ao longo do seu eixo maior e pode estar associada com qualquer malformação dos segmentos e das conexões entre as câmaras cardíacas. Devido às alterações estruturais complexas e à raridade da anomalia, essa anomalia de rotação é muitas vezes mal diagnosticada. Neste trabalho são relatados dois casos de coração entrecruzado com ênfase no diagnóstico morfológico e nas técnicas cirúrgicas utilizadas. Foi também realizada revisão da literatura sobre o assunto, que, embora escassa, foi enfatizada quanto à morfologia, diagnóstico, abordagem cirúrgica e possíveis complicações.

Criss-cross heart is an extremely rare congenital anomaly seen in less than 0.1% of all congenital heart diseases. We present a case of criss-cross heart in a 13-year-old boy. Suspicion of criss-cross heart occurred when all the four chambers of the heart could not be profiled in a single four-chamber view and a vertical septum was noticed in parasternal short-axis view. In this patient there was a ventricular septal defect along with this anomaly. Criss-cross heart usually presents with atrioventricular concordance and ventriculoarterial discordance. This case is unique and rare with atrioventricular and ventriculoarterial concordance.

This paper presents findings from experimental and numerical study of heat and fluid flow in a straight square duct featuring rib turbulators in a criss-cross pattern formed by 45° angled rib turbulators. Two ribbed configurations with criss-cross pattern – Inline and staggered, have been studied where the baseline case was smooth duct with no heat transfer enhancement feature. Detailed heat transfer coefficients were calculated using transient liquid crystal thermography by employing 1-D semi-infinite conduction model. Heat transfer and pressure drop measurements were carried out for Reynolds number ranging from 30,000 to 60,000. For understanding of heat transfer enhancement mechanism, numerical investigations were carried out using SST k-ω turbulence model. Numerical predictions of near-wall fluid dynamics and turbulent transport has been presented in conjunction with experimentally obtained detailed heat transfer coefficients to demonstrate the heat transfer characteristics of ribbed duct. Nusselt numbers normalized with respect to Dittus-Boelter correlation for developed turbulent flow in circular duct varied between 2.7 and 3.1 for inline and staggered configurations and the thermal hydraulic performance varied between 1.2 and 1.5 for the range of Reynolds number investigated.

This article discusses the problem of comparison within comparative and international education research. It pushes back against the algorithmic and computational creep in education, arguing that i...

Criss-cross heart is a rare congenital cardiac anomaly characterized by crossing of the inflow streams of the two ventricles, due to an apparent twisting of the heart about its long axis and when the axes of the openings of the atrioventricular (AV) valves are not parallel. If unrecognized, this leads to incorrect sequential segmental analysis. We report three cases of double-inlet ventricle with a criss-cross spatial relationship of the AV valves detected on prenatal ultrasound examination at 19-23 weeks' gestation. The sequential diagnosis was confirmed at postmortem examination in two cases and by neonatal echocardiography in the other. Antenatal diagnosis of criss-cross effect of the AV valves is feasible, allowing correct fetal diagnosis and appropriate counseling for this rare form of congenital cardiac disease.

Thin-walled tubes have exhibited extraordinary advantages in lightweight and energy absorption for crashing scenarios. Geometric configuration of such tubal structures is of decisive effects on crashing behaviors. In this study, crashing characteristics of conventional square tube and a criss-cross tube were first conducted using both experimental and numerical analyses, through which the finite element (FE) models were well validated. It was also revealed that the energy absorption of the criss-cross sectional tube was about 150% higher than that of square column with the same weight. Further, a range of criss-cross sections were parametrically modeled with spline curves and a parametric study was subsequently performed to explore the effects of different parameterized shapes on crashing characteristics. It was found that the geometric parameters significantly affected crashworthiness of the criss-cross tubes, and the criss-cross tubes with a spline curve (CCT_SPL) surpass the criss-cross tubes with a straight line (CCT_STR) in crashworthiness with the same weight. Finally, to optimize the crashworthiness of parameterized criss-cross tubes, the non-dominated sorting genetic algorithm II (NSGA-II) was adopted to seek optimal criss-cross shapes for improving specific energy absorption (SEA) and reducing the peak crashing force (Fmax), simultaneously. The optimization results indicate that the CCT_SPL profiles with reasonable geometric parameters are superior to the CCT_STR counterparts with an increase of 11.1% in specific energy absorption.