Hypotension Prediction Index software for management of hypotension during moderate- to high-risk noncardiac surgery: protocol for a randomized trial

BACKGROUND

Hypotension is associated with serious complications, including myocardial infarction, acute kidney injury, and mortality. Consequently, predicting and preventing hypotension may improve outcomes. We will therefore determine if use of a novel hypotension prediction tool reduces the duration and severity of hypotension in patients having non-cardiac surgery.

METHODS/DESIGN

We will conduct a two-center, pragmatic, randomized controlled trial (N = 213) in noncardiac surgical patients > 45 years old who require intra-arterial blood pressure monitoring. All participating patients will be connected to a Flortrac IQ sensor and EV1000 platform (Edwards Lifesciences, Irvine). They will be randomly assigned to blinded or unblinded arms. The Hypotension Prediction Index (HPI) and advanced hemodynamic information will be universally recorded, but will only be available to clinicians when patients are assigned to unblinded monitoring. The primary outcome will be the effect of HPI software guidance on intraoperative time-weighted average mean arterial pressure under a threshold of 65 mmHg, which will be assessed with a Wilcoxon-Mann-Whitney 2-sample, two-tailed test.

DISCUSSION

Our trial will determine whether the Hypotension Prediction Index and associated hemodynamic information substantively reduces hypotension during non-cardiac surgery.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03610165 . Registered on 1 August 2018.

Hayabusa2 arrives at the carbonaceous asteroid 162173 Ryugu-A spinning top-shaped rubble pile

The Hayabusa2 spacecraft arrived at the near-Earth carbonaceous asteroid 162173 Ryugu in 2018. We present Hayabusa2 observations of Ryugu's shape, mass, and geomorphology. Ryugu has an oblate "spinning top" shape, with a prominent circular equatorial ridge. Its bulk density, 1.19 ± 0.02 grams per cubic centimeter, indicates a high-porosity (>50%) interior. Large surface boulders suggest a rubble-pile structure. Surface slope analysis shows Ryugu's shape may have been produced from having once spun at twice the current rate. Coupled with the observed global material homogeneity, this suggests that Ryugu was reshaped by centrifugally induced deformation during a period of rapid rotation. From these remote-sensing investigations, we identified a suitable sample collection site on the equatorial ridge.

The geomorphology, color, and thermal properties of Ryugu: Implications for parent-body processes

The near-Earth carbonaceous asteroid 162173 Ryugu is thought to have been produced from a parent body that contained water ice and organic molecules. The Hayabusa2 spacecraft has obtained global multicolor images of Ryugu. Geomorphological features present include a circum-equatorial ridge, east-west dichotomy, high boulder abundances across the entire surface, and impact craters. Age estimates from the craters indicate a resurfacing age of [Formula: see text] years for the top 1-meter layer. Ryugu is among the darkest known bodies in the Solar System. The high abundance and spectral properties of boulders are consistent with moderately dehydrated materials, analogous to thermally metamorphosed meteorites found on Earth. The general uniformity in color across Ryugu's surface supports partial dehydration due to internal heating of the asteroid's parent body.

A Case of Feline T-cell Lymphoma with Tropism for Striated Muscle and Peripheral Nerve

An 11-year-old female American shorthair cat was presented with a 3-month history of hindlimb ataxia and knuckling of the left forelimb. Clinical abnormalities included weight loss, hyperaesthesia of the neck and back, cardiac murmur and systemic muscle atrophy. The cat died 10 days after the initial presentation and a necropsy examination was performed. Grossly, extensive pale lesions were seen in the wall of the left ventricle and the septum of the heart. There were no detectable masses in the heart, skeletal muscles or peripheral nerves. Histopathological examination revealed diffuse, extensive infiltration of atypical lymphoid cells in the heart; the cardiac muscles were markedly degenerate and atrophic and were replaced by the neoplastic cells. Neoplastic cells with similar morphology were seen in all specimens of the skeletal muscles and peripheral nerves. Clonality analysis of the paraffin wax-embedded heart tissue revealed a monoclonal rearrangement of the gene encoding the T-cell receptor γ chain. Based on these findings, the case was diagnosed as T-cell lymphoma with tropism for striated muscle and peripheral nerve.

Transient Pulmonary Interstitial Lesions in Aquaporin-4-positive Neuromyelitis Optica Spectrum Disorder

We herein report the case of a 76-year old man with aquaporin-4-Immunoglobulin-G (AQP4-IgG)-positive neuromyelitis optica spectrum disorder (NMOSD), in whom transient interstitial pulmonary lesions developed at the early stage of the disease. Chest X-ray showed multiple infiltrative shadows in both upper lung fields, and computed tomography revealed abnormal shadows distributed randomly in the lungs. Surgical lung biopsy showed features of unclassifiable interstitial pneumonia, characterized by various types of air-space organization, which resulted in obscure lung structure. This is the first report to describe the pathological findings of interstitial pneumonia, which may represent a rare extra-central nervous system complication of NMOSD.

Optical Humidity Sensing Using Transparent Hybrid Film Composed of Cationic Magnesium Porphyrin and Clay Mineral

A transparent hybrid film composed of cationic magnesium porphyrin and clay mineral was developed, and its chromic behavior depending on relative humidity (RH) was investigated. The hybrid film was obtained via intercalation of magnesium porphyrin into clay film; magnesium porphyrin was intercalated into the interlayer spaces of the clay mineral without aggregation. The absorption spectra of the hybrid film showed red shifts compared to the aqueous solution of magnesium porphyrin because of the π-conjugated system extension with coplanarization of the meso-substituted pyridinium group and porphyrin ring. The absorption maximum of the hybrid film was gradually shifted to a shorter wavelength, and the color of the hybrid film was changed with increasing RH. The X-ray diffraction measurement suggested that the basal space of clay was expanded with increasing RH, indicating that the interlayer space of clay was expanded by water adsorption, and the spectral shift was induced by the change in coplanarization degree between the porphyrin ring and meso-substituted pyridinium groups.

Photoluminescence by Intercalation of a Fluorescent β-Diketone Dye into a Layered Silicate

A β-diketone dye was packed into the two-dimensional nanospace of a synthetic smectite (Sumecton SA), which is a cation-exchangeable layered silicate, to induce strong emission owing to molecular packing of the dye. An emissive dye, 1-(4-methoxyphenyl)-3-(4-pyridyl)-1,3-propandione, was prepared through a Claisen condensation reaction; the dye exhibited aggregation-induced emission, which is enhanced emission owing to clustering of molecules to form aggregates in poor solvents or in the solid state. The dye was nonemissive in solution. However, strong green emission was observed because of the restriction of molecular motion when the protonated dye was accommodated into the interlayer nanospace of the silicate layers through cation-exchange reactions. The restricted motion was confirmed by the smaller nonradiative relaxation rate constant obtained by time-resolved luminescence and quantum yield measurements. A moderate dye packing (0.11 mmol/g) in the interlayer space is important to obtain enhanced emission, whereas the intercalation of a large amount of dye (0.27 mmol/g) resulted in concentration quenching. Therefore, the interlayer space of the layered silicate used here was responsible for the strong emission because of moderate packing of the accommodated β-diketones.