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Maffezzoni M, Bellini V. Con: Mechanical Ventilation During Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2024; 38:1045-1048. [PMID: 38184381 DOI: 10.1053/j.jvca.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
The ventilatory strategy to adopt during cardiopulmonary bypass is still being debated. The rationale for using continuous positive airway pressure or mechanical ventilation would be to counteract alveolar collapse and improve ischemia phenomena and passive alveolar diffusion of oxygen. Although there are several studies supporting the hypothesis of a positive effect on oxygenation and systemic inflammatory response, the real clinical impact of ventilation during cardiopulmonary bypass is controversial. Furthermore, the biases present in the literature make the studies' results nonunique in their interpretation.
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Affiliation(s)
- Massimo Maffezzoni
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Rouabeh W, Chrigui R, Imen M, Nawwar N, Cherif T, Radhia BB. Cardiopulmonary bypass for anesthetic management anterior medistinal teratoma: Case report. Int J Surg Case Rep 2024; 119:109575. [PMID: 38759398 DOI: 10.1016/j.ijscr.2024.109575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. CASE PRESENTATION Here we describe the anesthetic management of an 18-year-old woman with a mature teratoma who presented with progressive exertional dyspnea that was aggravated in the supine position in the operating room. After tracheal intubation, the tidal volume decreased, airway pressure increased, and pet CO2 grew beyond 105 mmHg without oxygen desaturation, prompting a femoro-femoral cardio-pulmonary bypass. CLINICAL DISCUSSION Cardio-pulmonary bypass (CPB) can facilitate tumor dissection by safely deflating the lungs and retracting the heart, enhancing exposure and reducing risks of hemodynamic or respiratory complications. However, systemic heparinization may increase complications, necessitating a preoperative risk assessment. CONCLUSION Preoperative management of large mediastinal masses requires careful attention to tumor anatomical details and relationships with surrounding structures. Preoperative preparation includes multimodality imaging and multidisciplinary team discussions to assess MMS risk, requiring specialized center management.
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Affiliation(s)
- Wissal Rouabeh
- Cardiovascular and Thoracic Surgery Department, Sahloul University Hospital, Tunisia
| | - Raoudha Chrigui
- Department of Aneasthesiology, Sahloul University Hospital, Tunisia
| | - Mgarrech Imen
- Cardiovascular and Thoracic Surgery Department, Sahloul University Hospital, Tunisia
| | - Nizar Nawwar
- Department of Aneasthesiology, Sahloul University Hospital, Tunisia
| | - Taieb Cherif
- Cardiovascular and Thoracic Surgery Department, Sahloul University Hospital, Tunisia
| | - Bechir Ben Radhia
- Cardiovascular and Thoracic Surgery Department, Sahloul University Hospital, Tunisia
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Nii Y, Takahashi E, Tabata M, Furusato S, Katsumata M, Uechi M. Hypoglycemia after Mitral Valve Repair in Dogs. Vet Sci 2024; 11:79. [PMID: 38393097 PMCID: PMC10891857 DOI: 10.3390/vetsci11020079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Hypoglycemia has not been previously reported as a postoperative complication of mitral valve repair (MVR) in dogs; however, the authors have encountered cases of hypoglycemia after MVR. This study aimed to determine the incidence of hypoglycemia in dogs after MVR and investigate its causes. Blood glucose levels were measured at multiple timepoints in dogs undergoing MVR. Simultaneously, insulin and glucagon blood concentrations in dogs with hypoglycemia preoperatively and postoperatively were compared to verify the physiological responses to hypoglycemia. Furthermore, risk factors for hypoglycemia, using variables selected based on the characteristics of MVR and dogs undergoing MVR, were examined prospectively. The incidence of hypoglycemia after MVR was 14.2%, and plasma glucagon concentrations increased in these dogs (mean: 260 pg/mL and 644 pg/mL pre- and postoperatively, p < 0.001), whereas serum insulin concentrations decreased (median: 0.50 ng/mL and 0.29 ng/mL pre- and postoperatively, p = 0.002). Therefore, hyperinsulinemia or hypoglucagonemia is unlikely to be the cause of postoperative hypoglycemia. The identified risk factors for hypoglycemia included low body weight and asymptomatic myxomatous mitral valve disease. Monitoring blood glucose levels after MVR should be included in the standard hospitalization plan to prevent hypoglycemic emergencies in dogs.
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Affiliation(s)
- Yasuyuki Nii
- JASMINE Veterinary Cardiovascular Medical Center, Yokohama 224-0001, Japan; (Y.N.); (E.T.); (S.F.)
- Laboratory of Nutrition of Veterinary Medicine, School of Veterinary Medicine, Azabu University, Sagamihara 252-5201, Japan;
| | - Emi Takahashi
- JASMINE Veterinary Cardiovascular Medical Center, Yokohama 224-0001, Japan; (Y.N.); (E.T.); (S.F.)
- Arsci Inc., Yokohama 224-0001, Japan;
| | | | - Shimon Furusato
- JASMINE Veterinary Cardiovascular Medical Center, Yokohama 224-0001, Japan; (Y.N.); (E.T.); (S.F.)
| | - Masaya Katsumata
- Laboratory of Nutrition of Veterinary Medicine, School of Veterinary Medicine, Azabu University, Sagamihara 252-5201, Japan;
| | - Masami Uechi
- JASMINE Veterinary Cardiovascular Medical Center, Yokohama 224-0001, Japan; (Y.N.); (E.T.); (S.F.)
- Arsci Inc., Yokohama 224-0001, Japan;
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Lin L, Niu M, Gao W, Wang C, Wu Q, Fang F, Wang Y, Wang W. Predictive role of glycocalyx components and MMP-9 in cardiopulmonary bypass patients for ICU stay. Heliyon 2024; 10:e23299. [PMID: 38163126 PMCID: PMC10756997 DOI: 10.1016/j.heliyon.2023.e23299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background Shedding of glycocalyx is relevant to worse prognosis in surgical patients, and elevated levels of serum matrix metalloproteinase-9 (MMP-9) are associated with this phenomenon. This study aimed to investigate the dynamic alterations of serum glycocalyx components and MMP-9 during cardiopulmonary bypass (CPB), and evaluate their predictive capacities for prolonged intensive care unit (ICU) stay, as well as their correlation with coagulation dysfunction. Methods This retrospective study analyzed serum levels of syndecan-1, heparan sulfate (HS), and MMP-9 at different time points during CPB, and assessed their association with prolonged ICU stay and coagulation dysfunction. Results Syndecan-1, HS, and MMP-9 exhibited divergent changes during CPB. Serum levels of syndecan-1 (AUC = 78.0 %) and MMP-9 (AUC = 78.4 %) were validated as reliable predictors for prolonged ICU stay, surpassing the predictive value of creatinine (AUC = 70.0 %). Syndecan-1 (rho = 0.566, P < 0.01 at T1 and rho = 0.526, P < 0.01 at T2) and HS (rho = 0.403, P < 0.05 at T4) exhibited correlations with activated partial thromboplastin time (APTT) ratio beyond the normal range. Conclusions Our findings advocate the potential efficacy of serum glycocalyx components and MMP-9 as early predictive indicators for extended ICU stay following cardiac surgery with CPB. Additionally, we observed a correlation between glycocalyx disruption during CPB and coagulation dysfunction. Further studies with expansive cohorts are warranted to consolidate our findings and explore the predictive potential of other glycocalyx components.
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Affiliation(s)
- Lina Lin
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Mengying Niu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, 100191, China
| | - Wei Gao
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Chundong Wang
- Department of Anesthesiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, 322100, China
| | - Qiaolin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Fuquan Fang
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, China
| | - Yongan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
| | - Weijian Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China
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Hossain MJ, Bakhsh A, Joyia FA, Aksoy E, Gökçe NZÖ, Khan MS. Engineering of insecticidal hybrid gene into potato chloroplast genome exhibits promising control of Colorado potato beetle, Leptinotarsa decemlineata (Coleoptera: Chrysomelidae). Transgenic Res 2023; 32:497-512. [PMID: 37707659 DOI: 10.1007/s11248-023-00366-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
The potato chloroplast was transformed with codon optimized synthetic hybrid cry gene (SN19) to mitigate crop losses by Colorado potato beetle (CPB). The bombarded explants (leaves and internode) were cultured on MS medium supplemented with BAP (2.0 mg/l), NAA (0.2 mg/l), TDZ (2.0 mg/l) and GA3 (0.1 mg/l); spectinomycin 50 mg/l was used as a selection agent in the medium. Leaf explants of cultivar Kuroda induced highest percentage (92%) of callus where cultivar Santae produced the highest percentage (85.7%) of transplastomic shoots. Sante and Challenger showed 9.6% shoot regeneration efficiency followed by cultivar Simply Red (8.8%). PCR amplification yielded 16 postive transplastomic plantlets out of 21 spectinomycin resistant ones. Target gene integration was confirmed by PCR and Southern blot, whereas RT-qPCR was used to assess the expression level of transgene. The localization of visual marker gene gfp was tracked by laser scanning confocal microscopy which confirmed its expression in chloroplasts of leaf cells. The transplastomic plants ensured high mortality to both larvae and adult CPB. Foliage consumption and weight gain of CPB fed on transplastomic leaves were lower compared to the control plants. Sucessful implementation of current research findings can lead to a viable solution to CPB mediated potato losses globally.
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Affiliation(s)
- Md Jakir Hossain
- Department of Agricultural Genetic Engineering, Faculty of Agricultural Sciences and Technologies, Nigde Omer Halisdemir University, 51240, Nigde, Turkey
- Basic and Applied Research on Jute Project, Bangladesh Jute Research Institute, Dhaka, 1207, Bangladesh
| | - Allah Bakhsh
- Department of Agricultural Genetic Engineering, Faculty of Agricultural Sciences and Technologies, Nigde Omer Halisdemir University, 51240, Nigde, Turkey.
- Center of Excellence in Molecular Biology (CEMB), University of Punjab, Lahore, Pakistan.
| | - Faiz Ahmad Joyia
- Center of Agricultural Biochemistry and Biotechnology (CABB), University of Agriculture, Faisalabad, Pakistan
| | - Emre Aksoy
- Department of Biological Sciences, Middle East Technical University, Ankara, Turkey
| | - Neslihan Zahide Özturk Gökçe
- Department of Agricultural Genetic Engineering, Faculty of Agricultural Sciences and Technologies, Nigde Omer Halisdemir University, 51240, Nigde, Turkey
| | - Muhammad Sarwar Khan
- Center of Agricultural Biochemistry and Biotechnology (CABB), University of Agriculture, Faisalabad, Pakistan
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Wang YP, Shen BB, Zhu CC, Li L, Lu S, Wang DJ, Jin H, Liu Q, Wang ZY, Ge M. Unveiling the nexus of postoperative fever and delirium in cardiac surgery: identifying predictors for enhanced patient care. Front Cardiovasc Med 2023; 10:1237055. [PMID: 38028495 PMCID: PMC10667695 DOI: 10.3389/fcvm.2023.1237055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Postoperative delirium (POD) is a significant complication observed in cardiac surgery patients, characterized by acute cognitive decline, fluctuating mental status, consciousness impairment, and confusion. Despite its impact, POD often goes undiagnosed. Postoperative fever, a common occurrence after cardiac surgery, has not been comprehensively studied in relation to delirium. This study aims to identify perioperative period factors associated with POD in patients undergoing cardiopulmonary bypass, with the potential for implementing preventive interventions. Methods In a prospective observational study conducted between February 2023 and April 2023 at the Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, a total of 232 patients who underwent cardiac surgery were enrolled. POD assessment utilized the Confusion Assessment Method for the ICU (CAM-ICU), while high fever was defined as a bladder temperature exceeding 39°C. Statistical analysis included univariate and multivariate analyses, logistic regression, nomogram development, and internal validation. Result The overall incidence of postoperative delirium was found to be 12.1%. Multivariate analysis revealed that postoperative lactate levels [odds ratio (OR) = 1.787], maximum temperature (OR = 11.290), and cardiopulmonary bypass time (OR = 1.015) were independent predictors of POD. A predictive nomogram for POD was developed based on these three factors, demonstrating good discrimination and calibration. The prediction model exhibited a C-statistic value of 0.852 (95% CI, 0.763-0.941), demonstrating excellent discriminatory power. Sensitivity and specificity, based on the area under the receiver operating characteristic (AUROC) curve, were 91.2% and 67.9%, respectively. Conclusion This study underscores the high prevalence of POD in cardiac surgery patients and identifies postoperative lactate levels, cardiopulmonary bypass duration, and postoperative fever as independent predictors of delirium. The association between postoperative fever and POD warrants further investigation. These findings have implications for implementing preventive strategies in high-risk patients, aiming to mitigate postoperative complications and improve patient outcomes.
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Affiliation(s)
- Ya-peng Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
| | - Bei-bei Shen
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Afliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Cui-cui Zhu
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Afliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Li Li
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Afliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Shan Lu
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Afliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Dong-jin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Afliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hua Jin
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Afliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qi Liu
- Department of Critical Care Medicine, Xiangya Hospital of Central South University, Changsha, China
| | - Zhe-yun Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Afliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Min Ge
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Afliated Hospital of Nanjing University Medical School, Nanjing, China
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Li T, Bo F, Meng X, Wang D, Ma J, Dai Z. The effect of perioperative antithrombin supplementation on blood conservation and postoperative complications after cardiopulmonary bypass surgery: A systematic review, meta-analysis and trial sequential analysis. Heliyon 2023; 9:e22266. [PMID: 38053853 PMCID: PMC10694320 DOI: 10.1016/j.heliyon.2023.e22266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023] Open
Abstract
Study objective Antithrombin (AT) activity is reduced during cardiopulmonary bypass (CPB) surgery. Guidelines has demonstrated that perioperative AT supplementation contributed to blood conservation and prevent perioperative thrombotic complications and target organ injury owing to its role in reducing thrombin generation. But these recommends is lack of support of meta-analysis in the guidelines. This meta-analysis aims to include all the relevant randomized controlled trails (RCT) on patients who experienced cardiac surgeries with CPB and investigate the effect of perioperative AT on blood conservation and complications after cardiac surgery. Methods Standard published RCTs were searched from bibliographic databases to identify all evidence reporting perioperative AT supplementation for patients undergoing cardiovascular surgeries. The primary outcome was postoperative blood loss, the secondary outcomes were blood component transfusion (red blood cell (RBC), fresh frozen plasma (FFP), platelet and autologous blood), postoperative morbidity and in hospital mortality. The relative risk (RR) for dichotomous outcomes and the standardized mean difference (SMD) for continuous outcomes were estimated using a random-effects model. Trial sequential analysis (TSA) was performed using TSA software 0.9.5.10. Results 13 RCTs with 996 participants undergoing different cardiovascular surgeries were included. Meta-analysis showed AT did not decrease postoperative blood loss (SMD -0.01, 95%CI -0.2 to 0.19). Subgroup analysis showed the effect of AT on postoperative blood loss was not associated with age, RCT type, surgery type, injection time of AT and AT deficiency. TSA further suggested that no additional studies were required for the stable result. Perioperative AT also did not reduce RBC ((SMD 0.10, 95%CI -0.66 to 0.85), (RR 0.99, 95%CI 0.83 to 1.19)), FFP ((SMD 0.11, 95%CI -0.19 to 0.41), (RR 1.30, 95%CI 0.90 to 1.87)), platelet (RR 1.10, 95%CI 0.83 to 1.46) and autologous blood (SMD 0.46, 95%CI -0.12 to 1.8504) transfusions. Perioperative AT significantly increased in hospital mortality (RR 2.53, 95%CI 1.02 to 6.28) and acute kidney injury (AKI) (RR 3.72, 95%CI 1.73 to 8.04) incidence. There was no significant difference in postoperative reexploration, thromboembolism, ECMO/IABP support, and stroke incidence between AT and non-AT group. Conclusions With the improvement of AT level and heparin sensitivity, perioperative AT has no significant effect on blood conservation. And it is noteworthy that the treatment increased in hospital mortality and the incidence of AKI after cardiac surgery.
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Affiliation(s)
- Tao Li
- Department of Anesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
| | - FengShan Bo
- Department of Anesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
| | - XiangRui Meng
- Department of Anesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
| | - Di Wang
- Department of Internal Medicine, Yantai Haigang Hospital, Yantai, 264000, Shandong, China
| | - Jiahai Ma
- Department of Anesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
| | - Zhao Dai
- Department of Anesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
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Abouzid M, Roshdy Y, Daniel JM, Rzk FM, Ismeal AAA, Hendawy M, Tanashat M, Elnagar M, Daoud N, Ramadan A. The beneficial use of nitric oxide during cardiopulmonary bypass on postoperative outcomes in children and adult patients: a systematic review and meta-analysis of 2897 patients. Eur J Clin Pharmacol 2023; 79:1425-1442. [PMID: 37650923 PMCID: PMC10618325 DOI: 10.1007/s00228-023-03554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Investigate inhaled nitric oxide's influence on mortality rates, mechanical ventilation and cardiopulmonary bypass duration, and length of stay in the intensive care unit and hospital when administered during cardiopulmonary bypass. METHODS Following the PRISMA guidelines, we searched four electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) up to 4th March 2023. The protocol was registered in the PROSPERO database with ID: CRD42023423007. Using Review Manager software, we reported outcomes as risk ratios (RRs) or mean difference (MD) and confidence intervals (CIs). RESULTS The meta-analysis included a total of 17 studies with 2897 patients. Overall, there were no significant differences in using nitric oxide over control concerning mortality (RR = 1.03, 95% CI 0.73 to 1.45; P = 0.88) or cardiopulmonary bypass duration (MD = -0.14, 95% CI - 0.96 to 0.69; P = 0.74). The intensive care unit days were significantly lower in the nitric oxide group than control (MD = -0.80, 95% CI - 1.31 to -0.29; P = 0.002). Difference results were obtained in terms of the length of stay in the hospital according to sensitivity analysis (without sensitivity [MD = -0.41, 95% CI - 0.79 to -0.02; P = 0.04] vs. with sensitivity [MD = -0.31, 95% CI - 0.69 to 0.07; P = 0.11]. Subgroup analysis shows that, in children, nitric oxide was favored over control in significantly reducing the duration of mechanical ventilation (MD = -4.58, 95% CI - 5.63 to -3.53; P < 0.001). CONCLUSION Using inhaled nitric oxide during cardiopulmonary bypass reduces the length of stay in the intensive care unit, and for children, it reduces the duration of mechanical ventilation.
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Affiliation(s)
- Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St., 60-806, Poznan, Poland.
- Doctoral School, Poznan University of Medical Sciences, 60-812, Poznan, Poland.
| | - Yara Roshdy
- Faculty of Medicine, South Valley University, Qena, Egypt
| | | | | | | | - Mohamed Hendawy
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | | | | | - Nada Daoud
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Alaa Ramadan
- Faculty of Medicine, South Valley University, Qena, Egypt
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Pan Z, Pan R, Cao Y, Chen Q, Yang M. Study on application and environmental effect of phosphogypsum-fly ash-red mud composite cemented paste backfill. Environ Sci Pollut Res Int 2023; 30:108832-108845. [PMID: 37755593 DOI: 10.1007/s11356-023-29832-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
Phosphogypsum (PG) cementitious paste backfill (CPB) was prepared by using PG and fly ash (FA) as the main raw materials, red mud (RM) as the alkaline activator, Portland cement (OPC) as the binder, and silica fume (SF) as the additive, and its properties were investigated to achieve the objective of "treating harm with waste." The results showed that the addition of OPC facilitated the flowability of the slurry, while the addition of RM and SF had the opposite effect. The slurry presented ideal flowability when the water/binder ratio was 0.2 and the superplasticizer (SP) content was 0.7%. The mechanical properties and water resistance were improved significantly with increasing OPC, RM, and SF doping. The strength of the CPB material exceeded 22 MPa after curing at room temperature for 28 days, which met the mine filling requirements. Changes in the ion concentrations of the solution were first monitored during immersion. The dissolution rules of Ca2+ and SO42- at different immersion ages confirmed that RM promoted the continuous hydration of CPB, which was the key to improve water resistance. Microstructural analysis showed that the main hydration products were AFt and C-S-H, which played an important role in the strength development of the material. The leaching results demonstrated that the metal ion content satisfied the requirements of the III categories of Chinese environmental standards (GB/T 14848-2017), indicating that the technology is a reliable and environmentally friendly technology for PG, FA, and RM recovery that can simultaneously support safe mining.
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Affiliation(s)
- Zude Pan
- College of Chemistry and Chemical Engineering, Guizhou University, Guiyang, 550025, China
| | - Rongxiang Pan
- College of Chemistry and Chemical Engineering, Guizhou University, Guiyang, 550025, China
| | - Yang Cao
- College of Chemistry and Chemical Engineering, Guizhou University, Guiyang, 550025, China.
| | - Qianlin Chen
- College of Chemistry and Chemical Engineering, Guizhou University, Guiyang, 550025, China
| | - Min Yang
- College of Chemistry and Chemical Engineering, Guizhou University, Guiyang, 550025, China
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Xu F, Li W. Delivery exogenous nitric oxide via cardiopulmonary bypass in pediatric cardiac surgery reduces the duration of postoperative mechanical ventilation-A meta-analysis of randomized controlled trials. Heliyon 2023; 9:e19007. [PMID: 37636442 PMCID: PMC10447988 DOI: 10.1016/j.heliyon.2023.e19007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/21/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives Cardiopulmonary bypass (CPB) is a major part of cardiac surgery that provokes systemic inflammatory reactions, myocardial ischemia, and ischemia and reperfusion damage. The aim of this study is to summarize the available evidence and evaluate whether exogenous nitric oxide administered via CPB circuits can improve recovery after cardiac surgery in children. Method A comprehensive search of the PubMed Medline, Ovid, Cochrane Library and Embase databases was conducted in September 2022. Only randomized controlled trials that compared nitro oxide with placebo or standard care were included. Results This pooled analysis included 5 RCTs containing 1642 patients. There were significant differences in the duration of postoperative mechanical ventilation between the nitric oxide group and the control group (mean difference -5.645 h; 95% CL = -9.978, -1.313; P = 0.01). Meta-analysis of the length of ICU stay and hospital stay showed no significant differences. Conclusion Delivering nitric oxide via CPB in pediatric cardiac surgery has an effect on reducing the duration of mechanical ventilation. Considering the small effect size, we should be cautious and think comprehensively in clinical practice.
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Affiliation(s)
- Fei Xu
- Corresponding author. Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, Chengdu, 610031, Sichuan, China.
| | - Weina Li
- Department of Anesthesiology, Chengdu Women's and Children's Central Hospital, Chengdu, 610031, Sichuan, China
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Houser J, Jendruchova K, Knight A, Piskacek M. The NFkB activation domain is 14-amino-acid-long variant of the 9aaTAD. Biochem J 2023; 480:297-306. [PMID: 36825663 DOI: 10.1042/bcj20220605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 02/25/2023]
Abstract
The nine-amino-acid transactivation domains (9aaTAD) was identified in numerous transcription factors including Gal4, p53, E2A, MLL, c-Myc, N-Myc, and also in SP, KLF, and SOX families. Most of the 9aaTAD domains interact with the KIX domain of transcription mediators MED15 and CBP to activate transcription. The NFkB activation domain occupied the same position on the KIX domain as the 9aaTADs of MLL, E2A, and p53. Binding of the KIX domain is established by the two-point interaction involving 9aaTAD positions p3-4 and p6-7. The NFkB primary binding region (positions p3-4) is almost identical with MLL and E2A, but secondary NFkB binding region differs by the position and engages the distal NFkB region p10-11. Thus, the NFkB activation domain is five amino acids longer than the other 9aaTADs. The NFkB activation domain includes an additional region, which we called the Omichinski Insert extending activation domain length to 14 amino acids. By deletion, we demonstrated that Omichinski Insert is an entirely non-essential part of NFkB activation domain. In summary, we recognized the NFkB activation domain as prolonged 9aaTAD conserved in evolution from humans to amphibians.
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Affiliation(s)
- Josef Houser
- Central European Institute of Technology (CEITEC), Masaryk University Brno, Brno, Czech Republic
- National Centre for Biomolecular Research (NCBR), Faculty of Science, Masaryk University Brno, Brno, Czech Republic
- Core Facility Biomolecular Interactions and Crystallization (CF BIC), Masaryk University Brno, Brno, Czech Republic
| | - Kristina Jendruchova
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University Brno, Kamenice 5, 625 00 Brno, Czech Republic
| | - Andrea Knight
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University Brno, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Piskacek
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University Brno, Kamenice 5, 625 00 Brno, Czech Republic
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Strudthoff LJ, Focke J, Hesselmann F, Kaesler A, Martins Costa A, Schlanstein PC, Schmitz-Rode T, Steinseifer U, Steuer NB, Wiegmann B, Arens J, Jansen SV. Novel Size-Variable Dedicated Rodent Oxygenator for ECLS Animal Models-Introduction of the "RatOx" Oxygenator and Preliminary In Vitro Results. Micromachines (Basel) 2023; 14:800. [PMID: 37421033 DOI: 10.3390/mi14040800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 07/09/2023]
Abstract
The overall survival rate of extracorporeal life support (ECLS) remains at 60%. Research and development has been slow, in part due to the lack of sophisticated experimental models. This publication introduces a dedicated rodent oxygenator ("RatOx") and presents preliminary in vitro classification tests. The RatOx has an adaptable fiber module size for various rodent models. Gas transfer performances over the fiber module for different blood flows and fiber module sizes were tested according to DIN EN ISO 7199. At the maximum possible amount of effective fiber surface area and a blood flow of 100 mL/min, the oxygenator performance was tested to a maximum of 6.27 mL O2/min and 8.2 mL CO2/min, respectively. The priming volume for the largest fiber module is 5.4 mL, while the smallest possible configuration with a single fiber mat layer has a priming volume of 1.1 mL. The novel RatOx ECLS system has been evaluated in vitro and has demonstrated a high degree of compliance with all pre-defined functional criteria for rodent-sized animal models. We intend for the RatOx to become a standard testing platform for scientific studies on ECLS therapy and technology.
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Affiliation(s)
- Lasse J Strudthoff
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Jannis Focke
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Felix Hesselmann
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Andreas Kaesler
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Ana Martins Costa
- Department of Biomechanical Engineering, Faculty of Engineering Technologies, University of Twente, 7522 LW Enschede, The Netherlands
| | - Peter C Schlanstein
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Ulrich Steinseifer
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Niklas B Steuer
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Bettina Wiegmann
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hanover, Germany
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), 30625 Hanover, Germany
- German Center for Lung Research (DLZ), 30625 Hanover, Germany
| | - Jutta Arens
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
- Department of Biomechanical Engineering, Faculty of Engineering Technologies, University of Twente, 7522 LW Enschede, The Netherlands
| | - Sebastian V Jansen
- Institute of Applied Medical Engineering, Department of Cardiovascular Engineering, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
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Yeshoda K, Rajasudhakar R. Effects of Occupational Risk Factors on Subjective Vocal Aerodynamic Measures in Teachers. Indian J Otolaryngol Head Neck Surg 2023; 75:126-139. [PMID: 37007891 PMCID: PMC10050253 DOI: 10.1007/s12070-022-03136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Aerodynamics, vital to voice production forms an important correlate of voice. The study aimed to compare subjective vocal aerodynamic measures in teachers and nonteachers and verify the effects of a few known occupational risk factors on the voice of teachers. Group 1 consisted 264 female and 42 male teachers, teaching languages and/or core subjects for a minimum of 5 years, between 30 and 45 years from the local schools of the city and surrounding nine taluks. Group 2 had 100 female and 33 male nonteachers aged 30-45 years. Audio-recordings were done individually during the midweek and in the middle of the day in a quiet environment at schools (school library) using portable digital audio recorder. Tasks: (a) Maximum Phonation time (MPT): maximum sustained productions of vowels /a/, /i/, /u/ and fricatives /s/, /z/ at comfortable pitch and loudness were noted in seconds, (b) s/z ratio computed from phonations of /s/ and /z/ sounds, and (c) Counts per Breath (CPB): counting of maximum numbers either in Kannada or English languages in a single breath. Results confirmed statistically significant increased mean values for all the measured parameters in male compared to the female participants in both groups. However, Nonteachers showed better results in almost all measured parameters compared to the teachers. Effects of known ooccupational risk factors showed mixed results and the details are discussed.
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Affiliation(s)
- Krishna Yeshoda
- Department of Speech–Language Sciences, All India Institute of Speech and Hearing (AIISH), Naimisham Campus, Manasagangothri, Mysuru, Karnataka 570 006 India
| | - Rathinaswami Rajasudhakar
- Department of Speech–Language Sciences, All India Institute of Speech and Hearing (AIISH), Naimisham Campus, Manasagangothri, Mysuru, Karnataka 570 006 India
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14
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Jing GJ, Sun M, Li J, Lin F. The"Hand as Foot" teaching method in the surgery and cardiopulmonary bypass for acute stanford type A aortic dissection. Asian J Surg 2023; 46:1404-1405. [PMID: 36123211 DOI: 10.1016/j.asjsur.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Guang-Jian Jing
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong Province, 256600, China
| | - Min Sun
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong Province, 256600, China
| | - Jing Li
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong Province, 256600, China
| | - Feng Lin
- Department of Anesthesiology, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong Province, 256600, China.
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Goto Y, Hiramatsu Y, Ageyama N, Mathis BJ, Maki N, Matsubara M, Inoue Y, Sato Y. Myeloid Progenitor Inhibitory Factor-1 (CCL23) Inhibits Lung Leukocyte Recruitment in a Primate Cardiopulmonary Bypass-Induced Pulmonary Ischaemia Model. Heart Lung Circ 2023; 32:424-433. [PMID: 36628657 DOI: 10.1016/j.hlc.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/09/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bone marrow (BM)-derived polymorphonuclear leukocytes (PMNs) and monocytes (MO) induced by cardiopulmonary bypass (CPB) are highly proteolytic and cause postoperative lung injury. Although CCL23/Myeloid progenitor inhibitory factor-1 is a human CC chemokine with potent suppressor effects on myeloid progenitor cells, in vivo inhibitory effects on BM-derived leukocyte kinetics associated with CPB are unknown. METHODS Two-hour CPB was surgically performed in cynomolgus monkeys and BM-derived leukocytes kinetics were monitored postoperatively by flow cytometry with 5'-bromo-2'-deoxyuridine (BrdU) and cytokine ELISA. Monkeys were given CCL23 (n=5) or saline (control, n=5) intravenously daily for 3 days before BrdU labelling and peripheral blood/bronchoalveolar lavage fluid (BALF) timepoint sampling to reveal BrdU-labelled cells. Levels of cytokines, CD11b, and L-selectin were considered leukocytic activation markers. RESULTS The CCL23 treatment significantly prolonged BM transit of leukocytes (PMNs, 118.4±11.7-95.5±4.1 hours [control]; MO, 91.6±5.0-62.0±3.0 hours [control]) and reduced their alveolar appearance. The BM pool size of MO was decreased by CCL23 but PMNs were unaffected. CD11b, L-selectin expression of PMNs and MO during CPB, and post-surgical increases of interleukin (IL)-6, IL-8, TNF-α, MCP-1, and PMN elastase in the BALF were not suppressed. CONCLUSIONS CCL23 treatment slows turnover of PMN and MO progenitors in BM and suppresses their circulatory release and lung recruitment. CCL23 has inhibitory effects specifically on the CPB-induced BM response and could hold value for preventing CPB-induced lung injury.
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Affiliation(s)
- Yukinobu Goto
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naohide Ageyama
- Tsukuba Primate Research Center, National Institute of Biomedical Innovation, Health and Nutrition, Tsukuba, Japan
| | - Bryan J Mathis
- International Medical Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Naoki Maki
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Muneaki Matsubara
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Nurcahyo WI, Hadisaputro S, Muttaqin Z, Boom CE, Manapa CH, Pramadika T, Tugasworo D. Difference in GFAP Levels in POCD and Non-POCD Patients After on Pump CABG. Vasc Health Risk Manag 2022; 18:915-925. [PMID: 36605932 PMCID: PMC9809160 DOI: 10.2147/vhrm.s386791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/16/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction On-pump, coronary artery bypass grafting (CABG) is the most common cause of postoperative cognitive dysfunction (POCD) after cardiac surgery. Previous studies showed that the incidence of POCD after cardiac surgery was 60%, higher than non-cardiac surgery with 11.7%. Glial fibrillary acid protein (GFAP) is one of the sensitive biomarkers of brain damage. Previous studies have found that elevated GFAP serum is associated with cognitive impairment. This study aims to measure the difference in GFAP levels in POCD and non-POCD patients after CABG on-pump surgery. Methods This study is a retrospective cohort design study. The data were obtained from 56 subjects undergoing elective CABG on the pump surgery enrolled into two groups consisting of 28 POCD as a case group and 28 non-POCD as a control group. In this study, the ELISA method measured the levels of GFAP biomarkers within 24 hours after surgery. After 72 hours, the patient received a MoCA-INA examination to determine cognitive impairment. Data analysis was carried out by SPSS 23.00 software. Results The mean age of patients in both groups was 60 years and was dominated by males (>85%). POCD patients were found to have a significantly longer duration of cardiopulmonary bypass (CPB) and cross-clamp surgery than non-POCD patients (p = 0.002 and p = 0.004). Postoperative GFAP levels in POCD patients were significantly higher than in non-POCD patients (12.95 ± 7.47 vs 3.80 ± 2.77, p < 0.001). There was a significant increase in GFAP levels compared with non-POCD (8.28 ± 7.24 vs -1.5 ± 3.03, p < 0.001). The area under the curve (AUC) value of GFAP against POCD was 0.887, cut-off GFAP 4.750 with a sensitivity of 92.9% and a specificity of 71.4%. Conclusion POCD patients had higher GFAP levels than non-POCD patients. There are differences in GFAP levels in patients with POCD and non-POCD post-CABG surgery.
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Affiliation(s)
- Widya Istanto Nurcahyo
- Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia,Correspondence: Widya Istanto Nurcahyo, Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Diponegoro University, Semarang, Central Java, 50725, Indonesia, Fax +62 2476928010, Email ;
| | - Suharyo Hadisaputro
- Postgraduate Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia
| | - Zainal Muttaqin
- Neurosurgery Department, Faculty of Medicine, Diponegoro University/Kariadi General Hospital, Semarang, Central Java, Indonesia
| | - Cindy Elfira Boom
- Anaesthesiology Department and Intensive Therapy, National Cardiovascular Center, Harapan Kita Hospital, Jakarta, Indonesia
| | - Chandra Hermawan Manapa
- Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia
| | - Taufan Pramadika
- Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia
| | - Dodik Tugasworo
- Neurology Department, Faculty of Medicine, Diponegoro University/Kariadi General Hospital, Semarang, Central Java, Indonesia
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Liu D, De Schutter K, Far J, Staes A, Dewettinck K, Quinton L, Gevaert K, Smagghe G. RNAi of Mannosidase-Ia in the Colorado potato beetle and changes in the midgut and peritrophic membrane. Pest Manag Sci 2022; 78:5071-5079. [PMID: 36053804 DOI: 10.1002/ps.7145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/03/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In addition to its role in the digestive system, the peritrophic membrane (PM) provides a physical barrier protecting the intestine from abrasion and against pathogens. Because of its sensitivity to RNA interference (RNAi), the notorious pest insect, the Colorado potato beetle (CPB, Leptinotarsa decemlineata), has become a model insect for functional studies. Previously, RNAi-mediated silencing of Mannosidase-Ia (ManIa), a key enzyme in the transition from high-mannose glycan moieties to paucimannose N-glycans, was shown to disrupt the transition from larva to pupa and the metamorphosis into adult beetles. While these effects at the organismal level were interesting in a pest control context, the effects at the organ or tissue level and also immune effects have not been investigated yet. To fill this knowledge gap, we performed an analysis of the midgut and PM in ManIa-silenced insects. RESULTS As marked phenotype, the ManIaRNAi insects, the PM pore size was found to be decreased when compared to the control GFPRNAi insects. These smaller pores are related to the observation of thinner microvilli (Mv) on the epithelial cells of the midgut of ManIaRNAi insects. A midgut and PM proteome study and reverse transcription quantitative polymerase chain reaction (RT-qPCR) analysis with a selection of marker genes was performed to characterize the midgut cells and understand their response to the silencing of ManIa. In agreement with the loss of ManIa activity, an accumulation of high-mannose N-glycans was observed in the ManIa-silenced insects. As a pathogen-associated molecular pattern (PAMP), the presence of these glycan structures could trigger the activation of the immune pathways. CONCLUSION The observed decrease in PM pore size could be a response to prevent potential pathogens to access the midgut epithelium. This hypothesis is supported by the strong increase in transcription levels of the anti-fungal peptide drosomycin-like in ManIaRNAi insects, although further research is required to elucidate this possibility. The potential immune response in the midgut and the smaller pore size in the PM shed a light on the function of the PM as a physical barrier and provide evidence for the relation between the Mv and PM. © 2022 Society of Chemical Industry.
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Affiliation(s)
- Dongdong Liu
- Laboratory of Agrozoology, Department Plants and Crops, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Kristof De Schutter
- Laboratory of Agrozoology, Department Plants and Crops, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Johann Far
- Mass Spectrometry Laboratory, MolSys Research Unit, University of Liège, Liège, Belgium
| | - An Staes
- VIB Center for Medical Biotechnology, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Koen Dewettinck
- Food Structure and Function Research Group, Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Loic Quinton
- Mass Spectrometry Laboratory, MolSys Research Unit, University of Liège, Liège, Belgium
| | - Kris Gevaert
- VIB Center for Medical Biotechnology, Ghent University, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Guy Smagghe
- Laboratory of Agrozoology, Department Plants and Crops, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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Chen Y, Xue J, Fang D, Tian X. Clinical Value and Mechanism of Long Non-Coding RNA UCA1 in Acute Respiratory Distress Syndrome Induced by Cardiopulmonary Bypass. Heart Lung Circ 2022; 32:544-551. [PMID: 36463076 PMCID: PMC9709611 DOI: 10.1016/j.hlc.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/03/2022]
Abstract
AIM Long non-coding RNA (lncRNA) can be used as a biological marker for the diagnosis and treatment of various diseases. The study aimed to detect changes in the expression of lncRNA for urothelial carcinoma associated 1 (UCA1) in patients with cardiopulmonary bypass (CPB)-induced acute respiratory distress syndrome (ARDS). Clinical values and cell function in ARDS were explored. METHOD In total, 195 patients without CPB-induced ARDS were included in the control group, and 85 patients with ARDS were included in the ARDS group. Serum UCA1 levels were measured by quantitative real-time polymerase chain reaction. A549 was used for the cell experiments by establishing oxygen-glucose deprivation/reperfusion (OGD/R) cell models, and the cell viability and apoptosis were tested. The concentration of inflammatory factors was tested by an enzyme-linked immunosorbent assay. A luciferase reporting assay was applied for target gene analysis. RESULTS Quantitative real-time polymerase chain reaction revealed a gradual increase in serum UCA1 in both control and ARDS cases, and patients with ARDS had higher levels of UCA1 than those in the control group. Serum UCA1 was positively correlated with serum tumour necrosis factor-α and interleukin-6 concentration in patients with ARDS. UCA1 had the ability to distinguish patients with ARDS from those without it. UCA1 inhibition protected against lung injury and inhibited cell inflammation in vitro. MicroRNA (miR-182-5p) was downregulated in OGD/R-induced cell models and sponged by UCA1. CONCLUSIONS Elevated expression of UCA1 may be associated with the occurrence of ARDS after CPB surgery. The regulatory role of UCA1 in ARDS might be related to inflammation and downregulated miR-182-5p in alveolar epithelial cells.
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Affiliation(s)
- Yongliang Chen
- Department of Cardiac Surgery, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Jing Xue
- School of Basic Medicine, Chengde Medical University, Chengde, Hebei, China,Corresponding author at: School of Basic Medicine, Chengde Medical University, Anyuan Road, Shuangqiao District, Chengde, 067000 Hebei, China
| | - Daguang Fang
- Department of Cardiac Surgery, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Xuefei Tian
- Department of Cardiac Surgery, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
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Bian J, Li S, Zhang Q. Experimental Investigation on Red Mud from the Bayer Process for Cemented Paste Backfill. Int J Environ Res Public Health 2022; 19:11926. [PMID: 36231225 PMCID: PMC9565261 DOI: 10.3390/ijerph191911926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Red mud is a by-product of alumina production, and its disposal can have severe environmental consequences. This study experimentally investigates the feasibility of using red mud from the Bayer process for cemented paste backfill (CPB). Different binders and activators were used to improve the mechanical properties, water resistance, and environmental behaviors of red mud-based CPB. In addition, water immersion tests were introduced, for the first time, to evaluate the water resistance of CPB. Furthermore, the environmental behaviors of red mud-based CPB were investigated by conducting leaching experiments. The results showed that the red-mud specimens had an unconfined compressive strength (UCS) of less than 0.2 MPa and disintegrated after being immersed in water. Different binders significantly improved the mechanical properties of red mud-based CPB. In addition, the specimens with different binders showed excellent water resistance, and the softening coefficient of CPB with different binders could exceed 0.7 after being cured for 28 days. The binders exhibited a substantial inhibitory effect on the leaching of hazardous substances in red mud under the solidification and stabilization effects. The leaching concentration of hexavalent chromium, selenium, fluoride, arsenic, lead, and vanadium was reduced by more than 70%. Therefore, this study provides an effective method for the environmental-friendly and large-scale utilization of red mud from the Bayer process.
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Merritt-Genore H, Adams A, Zavala R, Brakke T. Interprofessional Simulation in Cardiothoracic Surgery Improves Team Confidence. J Extra Corpor Technol 2022; 54:250-4. [PMID: 36742219 DOI: 10.1182/ject-250-254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/17/2022] [Indexed: 02/07/2023]
Abstract
Interest in simulation has grown substantially, as has enthusiasm for team-based approaches to surgical training. In cardiothoracic surgery, the dynamic ability of the entire team is critical to emergent events. We developed innovative, interprofessional simulation events to improve team confidence. Two separate simulations event replicating critical steps and potential crises of cardiopulmonary bypass (CPB) were attended by members of the multidisciplinary cardiothoracic team. Standard CPB equipment, echocardiography, an app to control vital signs, and typical operating room tools for cannulation were all used. Participant started at their typical roles, then rotated into unfamiliar roles for subsequent simulations. Survey and Likert scale self-assessment tools were used to determine outcomes. Statistical analysis compared results. Two separate events were attended by a total of 37 team members (17 facilitators and 20 participants). Participants rotated roles through 12 routine and high-risk scenarios for instituting and separating from CPB. Participant evaluation results were highly favorable, with requests for further similar events. Objectively, the mean score for self-assessment rose significantly comparing the pre- and post-simulation assessments. Despite a small sample size, these differences did reach statistical significance in two categories: iatrogenic dissection (p 0.008), and emergent return to CPB (p 0.016). In our experience, high-fidelity interprofessional simulation promoted team communication and confidence for key scenarios related to institution of and separation from CPB.
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21
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Broadwin M, Palmeri M, Kelting T, Groom R, Robich M, Lucas FL, Kramer R. Goal Directed Perfusion Is Not Associated with a Decrease in Acute Kidney Injury in Patients Predicted to Be at High Risk for Acute Renal Failure after Cardiac Surgery. J Extra Corpor Technol 2022; 54:128-134. [PMID: 35928338 PMCID: PMC9302403 DOI: 10.1182/ject-128-134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
Small increases in serum creatinine postoperatively reflect an acute kidney injury (AKI) that likely occurred during cardiopulmonary bypass (CPB). Maintaining adequate oxygen delivery (DO2) during CPB, known as GDP (goal-directed perfusion), improves outcomes. Whether GDP improves outcomes of patients at high risk for acute renal failure (ARF) is unknown. Forty-seven adult patients undergoing cardiac surgery with CPB utilizing GDP with Cleveland Clinic Acute Renal Failure Score of 3 or greater were compared with a matched cohort of patients operated upon using a flow-directed strategy. CPB flow in the GDP cohort was based on a DO2 goal of 260 mL/min/m2. Serum creatinine values were used to determine whether postoperative AKI occurred according to AKIN (Acute Kidney Injury Network) guidelines. We examined the distribution of all variables using proportions for categorical variables and means (standard deviations) for continuous variables and compared treatment groups using t tests for categorical variables and tests for differences in distributions for continuous and count variables. We used inverse probability of treatment weighting to adjust for treatment selection bias. In adjusted models, GDP was not associated with a decrease in AKI (odds ratio [OR]: .97; confidence interval [CI]: .62, 1.52), but was associated with higher odds of ARF (OR: 3.13; CI: 1.26, 7.79), mortality (OR: 3.35; CI: 1.14, 9.89), intensive care unit readmission (OR: 2.59; CI: 1.31, 5.15), need for intraoperative red blood cell transfusion (OR: 2.02; CI: 1.26, 3.25), and postoperative platelet transfusion (OR: 1.78; CI: 1.05, 3.01) when compared with the historic cohort. In patients who are at high risk for postoperative renal failure, GDP was not associated with a decrease in AKI when compared to the historical cohort managed traditionally by determining CPB flows based on body surface area. Surprisingly, the GDP cohort performed significantly worse than the retrospective control group in terms of ARF, mortality, intensive care unit readmission, and RBC and platelet transfusions.
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Affiliation(s)
- Mark Broadwin
- Lehigh Valley Health Network, Department of Surgery, Allentown, Pennsylvania
| | - Monica Palmeri
- Maine Medical Center, Division of Cardiovascular Surgery, Portland, Maine
| | - Tyler Kelting
- Maine Medical Center, Division of Cardiovascular Surgery, Portland, Maine
| | | | - Michael Robich
- Tufts University Medical Center, Department of Cardiac Surgery, Boston, Massachusetts; and
| | - F. Lee Lucas
- Center for OUtcomes Research and Evaluation, Maine Medical Center, Portland, Maine
| | - Robert Kramer
- Maine Medical Center, Division of Cardiovascular Surgery, Portland, Maine
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22
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Shi C, Zhang Z, Goldhammer J, Li D, Kiaii B, Rudriguez V, Boyd D, Lubarsky D, Applegate R, Liu H. Effect of lipid-lowering medications in patients with coronary artery bypass grafting surgery outcomes. BMC Anesthesiol 2022; 22:122. [PMID: 35473580 PMCID: PMC9040242 DOI: 10.1186/s12871-022-01675-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). METHODS After IRB approval, we reviewed charts of 9,518 patients who underwent cardiac surgery with CPB at three medical centers between July 2001 and June 2015. The relationship between perioperative lipid-lowering treatment and postoperative outcome was investigated. 3,988 patients who underwent CABG met inclusion criteria and were analyzed. Patients were divided into lipid-lowering or non-lipid-lowering treatment groups. RESULTS A total of 3,988 patients were included in the final analysis. Compared to the patients without lipid-lowering medications, the patients with lipid-lowering medications had lower postoperative neurologic complications and overall mortality (P < 0.05). Propensity weighted risk-adjustment showed that lipid-lowering medication reduced in-hospital total complications (odds ratio (OR) = 0.856; 95% CI 0.781-0.938; P < 0.001); all neurologic complications (OR = 0.572; 95% CI 0.441-0.739; P < 0.001) including stroke (OR = 0.481; 95% CI 0.349-0.654; P < 0.001); in-hospital mortality (OR = 0.616; 95% CI 0.432-0.869; P = 0.006; P < 0.001); and overall mortality (OR = 0.723; 95% CI 0.634-0.824; P < 0.001). In addition, the results indicated postoperative lipid-lowering medication use was associated with improved long-term survival in this patient population. CONCLUSIONS Perioperative lipid-lowering medication use was associated with significantly reduced postoperative adverse events and improved overall outcome in elderly patients undergoing CABG surgery with CPB.
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Affiliation(s)
- Chunxia Shi
- Department of Anesthesiology, Peking University International Hospital, Beijing, China.,Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Zugui Zhang
- Institute for Research On Equality and Community Health, Christiana Care, Newark, DE, USA
| | - Jordan Goldhammer
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - David Li
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Bob Kiaii
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Victor Rudriguez
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Douglas Boyd
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - David Lubarsky
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Richard Applegate
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA.
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23
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Tabbara MM, Ciancio G. Re: Yuan SM. Surgical treatment of renal cell carcinoma with inferior vena cava tumor thrombus. Surg Today. 2022 Jan 3. doi: 10.1007/s00595-021-02429-9. Surg Today 2022:10.1007/s00595-022-02514-7. [PMID: 35467151 DOI: 10.1007/s00595-022-02514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marina M Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 9th Ave, 7th Floor, Miami, FL, 33136, USA
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. .,Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. .,Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1801 9th Ave, 7th Floor, Miami, FL, 33136, USA.
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24
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Patel K, Ündar A. Impact of a Multidisciplinary Research Team Approach to Prevent Avoidable Mistakes for Neonatal CPB Population. World J Pediatr Congenit Heart Surg 2022; 13:220-230. [PMID: 35238709 DOI: 10.1177/21501351211064182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Significant progress has been made in neonatal cardiopulmonary bypass (CPB) over the years. At Penn State Health Children's Hospital, we have established a multidisciplinary research team that brings clinicians, engineers, scientists, research nurses, neuromonitoring technicians, perfusionists, and students from various departments to help reduce adverse outcomes following CPB in neonates. With the help of this team, we evaluate each CPB component in simulated conditions identical to those used in clinical practice. The objective of this review is to demonstrate the results of these translational projects and present critical mistakes to avoid for neonatal CPB patients.
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Affiliation(s)
- Krishna Patel
- 12310Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- 12310Penn State Health Children's Hospital, Hershey, PA, USA
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25
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Steike DR, Hessler M, Korsching E, Lehmann F, Schmidt C, Ertmer C, Schnekenburger J, Eich HT, Kemper B, Greve B. Digital Holographic Microscopy for Label-Free Detection of Leukocyte Alternations Associated with Perioperative Inflammation after Cardiac Surgery. Cells 2022; 11:755. [PMID: 35203403 DOI: 10.3390/cells11040755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 02/05/2023] Open
Abstract
In a prospective observational pilot study on patients undergoing elective cardiac surgery with cardiopulmonary bypass, we evaluated label-free quantitative phase imaging (QPI) with digital holographic microscopy (DHM) to describe perioperative inflammation by changes in biophysical cell properties of lymphocytes and monocytes. Blood samples from 25 patients were investigated prior to cardiac surgery and postoperatively at day 1, 3 and 6. Biophysical and morphological cell parameters accessible with DHM, such as cell volume, refractive index, dry mass, and cell shape related form factor, were acquired and compared to common flow cytometric blood cell markers of inflammation and selected routine laboratory parameters. In all examined patients, cardiac surgery induced an acute inflammatory response as indicated by changes in routine laboratory parameters and flow cytometric cell markers. DHM results were associated with routine laboratory and flow cytometric data and correlated with complications in the postoperative course. In a subgroup analysis, patients were classified according to the inflammation related C-reactive protein (CRP) level, treatment with epinephrine and the occurrence of postoperative complications. Patients with regular courses, without epinephrine treatment and with low CRP values showed a postoperative lymphocyte volume increase. In contrast, the group of patients with increased CRP levels indicated an even further enlarged lymphocyte volume, while for the groups of epinephrine treated patients and patients with complicative courses, no postoperative lymphocyte volume changes were detected. In summary, the study demonstrates the capability of DHM to describe biophysical cell parameters of perioperative lymphocytes and monocytes changes in cardiac surgery patients. The pattern of correlations between biophysical DHM data and laboratory parameters, flow cytometric cell markers, and the postoperative course exemplify DHM as a promising diagnostic tool for a characterization of inflammatory processes and course of disease.
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26
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Andrási TB, Talipov I, Dinges G, Arndt C, Rastan AJ. Risk factors for postoperative delirium after cardiac surgical procedures with cardioplegic arrest. Eur J Cardiothorac Surg 2022; 62:6509257. [PMID: 35037042 DOI: 10.1093/ejcts/ezab570] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/30/2021] [Accepted: 12/05/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The pathophysiology of delirium after cardiac surgery is complex. The present study aims to determine perioperative risk factors and construct a scoring system for postoperative delirium based on the type of surgery. METHODS Three hundred patients undergoing coronary artery bypass grafting (CABG; n = 150) or valve and/or aortic surgery ± CABG (n = 150) were retrospectively evaluated. RESULTS The incidence of delirium (32%) was similar in subgroups (28.7% and 33.33%, P = 0.384). Delirium patients were older [71.3 (standard deviation: 8.5) vs 66.6 (standard deviation: 9.5), P < 0.001; 70.0 (standard deviation: 9.6) vs 62.5 (standard deviation: 12.6), P < 0.001] and required more packed red blood cell units [2.1 (standard deviation: 2.1) vs 4.2 (standard deviation: 4.0), P < 0.001; 2.4 (standard deviation: 3.3) vs 5.4 (standard deviation: 5.9), P < 0.001] and fresh frozen plasma units [6.1 (standard deviation: 2.9) vs. 8.0 (standard deviation: 4.2), P < 0.001; 6.3 (standard deviation: 3.4) vs 10.8 (standard deviation: 7.2), P < 0.001] in CABG and valve/aortic subgroups, respectively. Delirium was associated with longer operation time [298.3 (standard deviation: 98.4) vs 250.6 (standard deviation: 67.8) min, P < 0.001], cardiopulmonary bypass (CPB) time [171.5 (standard deviation: 54.9) vs 140.98 (standard deviation: 45.8) min, P < 0.001] and cardiac arrest time [112 (standard deviation: 35.9) vs 91.9 (standard deviation: 28.6), P < 0.001] only in the valve/aortic group (versus non-delirium). Multivariate regression analysis identified an association between delirium and age [odds ratio: 1.056 (95% confidence interval: 1.002-1.113), P = 0.041], CPB time [odds ratio: 1.1014 (95% confidence interval: 1.004-1.025), P = 0.007], fresh frozen plasma transfusion [odds ratio: 1.127 (95% confidence interval: 1.006-1.262), P = 0.039] and atrial fibrillation [odds ratio: 4.801 (95% confidence interval: 1.844-12.502), P < 0.001] after valve/aortic surgery (area under the curve 0.835, P < 0.001) and between delirium and age [odds ratio: 1.089 (95% confidence interval: 1.023-1.160), P = 0.007] and ventilation time [odds ratio: 1.068 (95% confidence interval: 1.026-1.113), P = 0.001] after isolated CABG (area under the curve 0.798, P < 0.001). The cross-validation of the results by k-fold logistic regression revealed for the entire patient cohort an overall average accuracy of the prediction model of 0.764, with a false-positive rate of 0.052 and a false-negative rate of 0.18. CONCLUSIONS Age, CPB time, ventilation, transfusion and atrial fibrillation are differently associated with delirium depending on the operative characteristics. Optimization of intraoperative parameters and use of risk calculators may enable early institution of pharmacotherapy and improve overall outcome after cardiac surgery.
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Affiliation(s)
- Terézia B Andrási
- Department of Cardiac Surgery, Philipps University of Marburg, Marburg, Germany
| | - Ildar Talipov
- Department of Cardiac Surgery, Philipps University of Marburg, Marburg, Germany
| | - Gerhard Dinges
- Department of Anesthesiology and Intensive Care Medicine, Phillips University of Marburg, Marburg, Germany
| | - Christian Arndt
- Department of Anesthesiology and Intensive Care Medicine, Phillips University of Marburg, Marburg, Germany
| | - Ardawan J Rastan
- Department of Cardiac Surgery, Philipps University of Marburg, Marburg, Germany
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27
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Starybrat D, Jepson R, Bristow P, Peterson S, Yerramilli M, Yerramilli M, Chang Y, Cortellini S. Prospective evaluation of novel biomarkers of acute kidney injury in dogs following cardiac surgery under cardiopulmonary bypass. J Vet Emerg Crit Care (San Antonio) 2022; 32:733-742. [PMID: 36125401 PMCID: PMC9826260 DOI: 10.1111/vec.13250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/13/2021] [Accepted: 11/12/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the occurrence of acute kidney injury (AKI) in dogs undergoing cardiac surgery under cardiopulmonary bypass (CPB) and explore associations between traditional and novel serum and urinary biomarkers. DESIGN Prospective cohort study conducted between July 2018 and April 2019. SETTING University teaching hospital. ANIMALS Nineteen dogs undergoing cardiac surgery under CPB with preoperative serum creatinine <140 μmol/L (<1.6 mg/dl). INTERVENTIONS Blood and urine samples were obtained at 4 time points: preoperatively following general anesthesia induction, immediately postoperatively, and 2 and 4 days postoperatively (T1 , T2 , T3 , and T4 ). AKI was defined as an increase in serum creatinine ≥26.4 μmol/L (≥0.3 mg/dl) above baseline within 48 hours. Serum creatinine, C-reactive protein (CRP), symmetric dimethylarginine (SDMA), inosine, beta-aminoisobutyric acid (BAIB), urinary clusterin (uClus), and urinary cystatin B (uCysB) were measured. Data were log-transformed (log10 ) when appropriate and assessed using linear mixed-effects models. MEASUREMENTS AND MAIN RESULTS AKI occurred in 3 of 19 dogs (15.8%, 95% confidence interval: 0.047-0.384). Inosine increased at T2 (adjusted mean ± standard error: 53 ± 5.6) in all dogs, and then gradually decreased. Log10 uCysB increased at T2 (2.3 ± 0.1) in all dogs and remained high. Log10 CRP and log10 uClus increased significantly at T3 (1.9 ± 0.1 and 3.6 ± 0.1, respectively) in all dogs and remained increased. There was a significant positive association between serum creatinine and SDMA (P < 0.001, estimate ± standard error: 0.06 ± 0.00), between log10 CRP and log10 uClus (P < 0.001, 0.35 ± 0.08), between SDMA and creatinine as well as between SDMA and BAIB (P < 0.001, 11.1 ± 0.83 and P < 0.001, 1.06 ± 0.22, respectively) for all dogs at all time points. CONCLUSIONS Inosine and uCysB concentrations changed in all dogs immediately following a surgery under CPB and may indicate tubular injury. Further studies are required to ascertain the usefulness of those biomarkers in early detection of AKI.
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Affiliation(s)
- Daria Starybrat
- Department of Clinical Science and Services, The Royal Veterinary CollegeUniversity of LondonLondonUK
| | - Rosanne Jepson
- Department of Clinical Science and Services, The Royal Veterinary CollegeUniversity of LondonLondonUK
| | - Poppy Bristow
- Department of Clinical Science and Services, The Royal Veterinary CollegeUniversity of LondonLondonUK
- Dick White Referrals, Six Mile‐BottomCambridgeshireCB8 0UHUK
| | | | - Maha Yerramilli
- Translation Medicine/BioMarker DevelopmentNovartis Institute of Biomedical Research Inc.CambridgeMassachusettsUSA
| | | | - Yu‐Mei Chang
- Department of Comparative Biomedical Sciences, The Royal Veterinary CollegeUniversity of LondonLondonUK
| | - Stefano Cortellini
- Department of Clinical Science and Services, The Royal Veterinary CollegeUniversity of LondonLondonUK
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28
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Ruszel N, Kiełbowski K, Piotrowska M, Kubisa M, Grodzki T, Wójcik J, Kubisa B. Central, peripheral ECMO or CPB? Comparsion between circulatory support methods used during lung transplantation. J Cardiothorac Surg 2021; 16:341. [PMID: 34838067 PMCID: PMC8627075 DOI: 10.1186/s13019-021-01719-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/06/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear afterwards, it is crucial to estimate the reserve of gas exchange in each lung before and during surgery. Altering conditions of gas exchange require adaptation in circulatory system as well. In some of the cases the use of extracorporeal life support appears to be necessary to undergo the transplantation successfully. Cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) used during operation allow to replace the function of heart and lung, but they are also related to complications in the form of acute kidney failure, bleeding, heart arrhythmias or thromboembolic complications. METHODS We reviewed 77 LuTx from 2009 to 2020 performed at the Department of Thoracic Surgery and Transplantation. 40/77 (51%) patients required intraoperative extracorporeal assistance: 8 required CBP and 32 required ECMO. In the ECMO group 14/32 (44%) patients had peripheral cannulation and 18/32 (56%) had central one. We have calculated the survival rates and reviewed postoperative complications after lung transplantations. Cumulative Kaplan-Meier survival curves were calculated. Differences between the groups were evaluated by the Chi- square analysis for discontinuous variables and t-test for continuous variables. RESULTS The use of intraoperative central extracorporeal membrane oxygenator was associated with increased survival rates comparing to patients without external support (30-days, 1-year, 3-years, 5-years rates: 78%, 66%, 66%, 66% vs 83%, 65%, 59%, 44% respectively). Furthermore, survival was enhanced comparing to peripheral ECMO or cardiopulmonary bypass as well (50%, 41%, 41%, 33%; 75%, 50%, 50%, 38% respectively). Acute kidney injury and thromboembolic complications occurred statistically more often in case of patients that underwent lung transplantation with support devices (p = 0.005, p = 0.02 respectively). Frequency of other complications was comparable among groups. CONCLUSIONS The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx. Trial registration Not applicable.
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Affiliation(s)
- Nikola Ruszel
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland.
| | - Kajetan Kiełbowski
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
| | - Maria Piotrowska
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
| | - Michał Kubisa
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
| | - Tomasz Grodzki
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
| | - Janusz Wójcik
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
| | - Bartosz Kubisa
- Department of Thoracic Surgery and Transplantation, Independent Public Regional Hospital, Pomeranian Medical University, Sokołowskiego 11 Street, Szczecin-Zdunowo, Poland
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29
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Pappalardo F, Potapov E, Loforte A, Morshuis M, Schibilsky D, Zimpfer D, Riebandt J, Etz C, Attisani M, Rinaldi M, Haneya A, Ramjankhan F, Donker D, Jorde UP, Lewin D, Wieloch R, Ayala R, Cremer J, Bertoldi L, Borger M, Lichtenberg A, Gummert J, Saeed D. Left ventricular assist device implants in patients on extracorporeal membrane oxygenation: do we need cardiopulmonary bypass? Interact Cardiovasc Thorac Surg 2021; 34:676-682. [PMID: 34788423 PMCID: PMC8972226 DOI: 10.1093/icvts/ivab311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/12/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita-Salute San Raffaele University, Milan, Italy.,Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Evgenij Potapov
- Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany
| | - Antonio Loforte
- Department of Cardiac Surgery, Bologna University, Bologna, Italy
| | - Michiel Morshuis
- Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - David Schibilsky
- Department of Cardiac and Vascular Surgery, Faculty of Medicine Freiburg University, Freiburg, Germany
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Julia Riebandt
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Christian Etz
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Matteo Attisani
- Department of Cardiac Surgery, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, University of Turin, Turin, Italy
| | - Assad Haneya
- Department of Cardiac Surgery, University Hospital Schleswig Holstein, Campus Kiel, Germany
| | - Faiz Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dirk Donker
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ulrich P Jorde
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Daniel Lewin
- Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany
| | - Radi Wieloch
- Clinic for Cardiovascular Surgery, Dusseldorf University Hospital, Dusseldorf, Germany
| | - Rafael Ayala
- Department of Cardiac and Vascular Surgery, Faculty of Medicine Freiburg University, Freiburg, Germany
| | - Jochen Cremer
- Department of Cardiac Surgery, University Hospital Schleswig Holstein, Campus Kiel, Germany
| | - Letizia Bertoldi
- CardioCenter, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Michael Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Artur Lichtenberg
- Clinic for Cardiovascular Surgery, Dusseldorf University Hospital, Dusseldorf, Germany
| | - Jan Gummert
- Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Clinic for Cardiovascular Surgery, Dusseldorf University Hospital, Dusseldorf, Germany
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30
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Turra J, Wojdyla J, Eisner C. Current Application of NIRS and CPB Initiation Times in German Cardiac Surgery Centers: A Survey. J Extra Corpor Technol 2021; 53:177-80. [PMID: 34658408 DOI: 10.1182/ject-2100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022]
Abstract
Near-infrared spectroscopy (NIRS) has been widely used in cardiac surgery to monitor cerebral oxygen supply. The initiation and perioperative management of cardiopulmonary bypass (CPB) constitute critical events in modifying the normal physiology of adequate blood and oxygen supply to the brain. First, little is known about how frequent NIRS is really used. Second, there are varying practices on how to initiate CPB. We therefore conducted a survey in Germany to get an idea of NIRS usage in cardiac surgery for the duration of initiation of CPB protocols. A web-based e-mail survey using commercial SurveyMonkey® (SurveyMonkey, San Mateo, CA) software was conducted in August 2017 including all German cardiac surgery centers. About 75% of the perfusion departments do not use NIRS as a standard monitoring device. It is usually reserved for clinical scenarios where cerebral perfusion might be impaired such as aortic arch surgery or carotid artery stenosis. Only one-third of the departments use a standardized duration of initiation of CPB despite a common belief of potential harm with fast initiation. The usual applied time to initiate CPB ranges from 30 to 120 seconds. Our survey revealed that the NIRS technology is only used in specific types of cardiac surgery to this date. In addition, there is a clear need for scientific studies on how to initiate CPB in the best way for the patient.
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Datt V, Virmani S, Wadhwa R, Aggarwal S, Malik S, Sharma V. Transesophageal echocardiography probe induced recurrent VF in a child with severe RV dysfunction: Report of a rare case. J Card Surg 2021; 36:3917-3920. [PMID: 34260108 DOI: 10.1111/jocs.15823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
The safety of transesophageal echocardiography (TEE) probes has been documented in pediatric patients (neonates, infants, and small children even < 2.5 kg). The overall safety profile of TEE probe is quite favorable with a reported incidence of complications of 1%-3%. However, insertion of the TEE probe can induce vagal and sympathetic reflexes such as hypertension or hypotension, nonsustained ventricular and supraventricular tachyarrhythmias, or bradyarrhythmias (third degree heart block), and even angina and myocardial infarction. We hereby document a repeated intraoperative ventricular fibrillation precipitated by TEE probe in a 2-year-old, 10 kg pediatric patient diagnosed with ostium secundum-atrial septal defect, supravalvular pulmonary stenosis, and severe right ventricular dysfunction. The international review board approval or waiver and clinical trial registrations are not applicable for this case report publication.
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Affiliation(s)
- Vishnu Datt
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital (GIPMER), New Delhi, India
| | - Sanjula Virmani
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital (GIPMER), New Delhi, India
| | - Rachna Wadhwa
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital (GIPMER), New Delhi, India
| | - Saket Aggarwal
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital (GIPMER), New Delhi, India
| | - Shardha Malik
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital (GIPMER), New Delhi, India
| | - Varun Sharma
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital (GIPMER), New Delhi, India
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Datt V, Wadhhwa R, Sharma V, Virmani S, Minhas HS, Malik S. Vasoplegic syndrome after cardiovascular surgery: A review of pathophysiology and outcome-oriented therapeutic management. J Card Surg 2021; 36:3749-3760. [PMID: 34251716 DOI: 10.1111/jocs.15805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vasoplegic syndrome (VPS) is defined as systemic hypotension due to profound vasodilatation and loss of systemic vascular resistance (SVR), despite normal or increased cardiac index, and characterized by inadequate response to standard doses of vasopressors, and increased morbidity and mortality. It occurs in 9%-44% of cardiac surgery patients after cardiopulmonary bypass (CPB). The underlying pathophysiology following CPB consists of resistance to vasopressors (inactivation of Ca2+ voltage gated channels) on the one hand and excessive activation of vasodilators (SIRS, iNOS, and low AVP) on the other. Use of angiotensin-converting enzyme inhibitor (ACE-I), calcium channel blockers, amiodarone, heparin, low cardiac reserve (EF < 35%), symptomatic congestive heart failure, and diabetes mellitus are the perioperative risk factors for VPS after cardiac surgery in adults. Till date, there is no consensus about the outcome-oriented therapeutic management of VPS. Vasopressors such as norepinephrine (NE; 0.025-0.2 µg/kg/min) and vasopressin (0.06 U/min or 6 U/h median dose) are the first choice for the treatment. The adjuvant therapy (hydrocortisone, calcium, vitamin C, and thiamine) and rescue therapy (methylene blue [MB] and hydroxocobalamin) are also considered when perfusion goals (meanarterial pressure [MAP] > 60-70 mmHg) are not achieved with nor-epinephrine and/or vasopressin. AIMS The aims of this systematic review are to collect all the clinically relevant data to describe the VPS, its potential risk factors, pathophysiology after CPB, and to assess the efficacy, safety, and outcome of the therapeutic management with catecholamine and non-catecholamine vasopressors employed for refractory vasoplegia after cardiac surgery. Also, to elucidate the current and practical approach for management of VPS after cardiac surgery. MATERIAL AND METHODS "PubMed," "Google," and "Medline" weresearched, and over 150 recent relevant articles including RCTs, clinical studies, meta-analysis, reviews, case reports, case series and Cochrane data were analyzed for this systematic review. The filter was applied specificallyusing key words like VPS after cardiac surgery, perioperative VPS following CPB, morbidity, and mortality in VPS after cardiac surgery, vasopressors for VPS that improve outcomes, VPS after valve surgery, VPS after CABG surgery, VPS following complex congenital cardiac anomalies corrective surgery, rescue therapy for VPS, adjuvant therapy for VPS, definition of VPS, outcome in VPS after cardiac surgery, etiopathology of VPS following CPB. This review did not require any ethical approval or consent from the patients. RESULTS Despite the recent advances in therapy, the mortality remains as high as 30%-50%. NE has been recommended the most frequent used vasopressor for VPS. It restores and maintain the MAP and provides the outcome benefits. Vasopressin rescue therapy is an alternative approach, if catecholamines and fluid infusions fail to improve hemodynamics. It effectively increases vascular tone and lowers CO, and significantly decreases the 30 days mortality. Hence, suggested a first-line vasopressor agent in postcardiac surgery VPS. Terlipressin (1.3μg/kg/h), a longer acting and more specific vasoconstrictor prevents the development of VPS after CPB in patients treated with ACE-I. MB significantly reduces morbidity and mortality of VPS. The Preoperative MB (1%, 2mg/kg/30min, 1h before surgery) administration in high risk (on ACE-I) patients for VPS undergoing CABG surgery, provides 100% protection against VPS, and early of MB significantly reduces operative mortality, and recommended as a rescue therapy for VPS. Hydroxocobalamin (5 g) has been recommended as a rescue agent in VPS refractory to multiple vasopressors. A combination of ascorbic acid (6 g), hydrocortisone (200 mg/day), and thiamine (400 mg/day) as an adjuvant therapy significantly reduces the vasopressors requirement, and provides mortality and morbidity benefits. CONCLUSION Currently, the VPS is frequently encountered (9%-40%) in cardiac surgical patients with predisposing patient-specific risk factors and combined with inflammatory response to CPB. Multidrug therapy (NE, MB, AVP, ATII, terlipressin, hydroxocobalamin) targeting multiple receptor systems is recommended in refractory VPS. A combination of high dosage of ascorbic acid, hydrocortisone and thiamine has been used successfully as adjunctive therapyto restore the MAP. We also advocate for the early use of multiagent vasopressors therapy and catecholamine sparing adjunctive agents to restore the systemic perfusion pressure with a goal of preventing the progressive refractory VPS.
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Affiliation(s)
- Vishnu Datt
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital [GIPMER], New Delhi, India
| | - Rachna Wadhhwa
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital [GIPMER], New Delhi, India
| | - Varun Sharma
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital [GIPMER], New Delhi, India
| | - Sanjula Virmani
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital [GIPMER], New Delhi, India
| | - Harpreet S Minhas
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital [GIPMER], New Delhi, India
| | - Shardha Malik
- Department of Cardiac Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital [GIPMER], New Delhi, India
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Abstract
OBJECTIVE Extracorporeal membrane oxygenation (ECMO) has recently replaced cardiopulmonary bypass (CPB) as the preferred option for providing circulatory support during lung transplantation. This review aimed to summarize the previous data and to address the relative use of ECMO and CPB during lung transplantation. METHODS The database was searched in PubMed (Medline) using the following keywords: lung transplantation, extracorporeal membrane oxygenation, and cardiopulmonary bypass, for all relevant reports which were written in English and were published between 2000 and 2020. REVIEW Several reports have revealed that intraoperative use of ECMO is associated with lower blood product transfusion requirements, shorter ventilator support, and shorter length of hospital stay. During recent years, preoperative ECMO has also been used with favorable outcomes as a bridge to lung transplantation in critically ill patients. CONCLUSIONS The use of ECMO during lung transplantation seems to reduce postoperative complications and improve short-term outcomes, relative to CPB. However, additional data should be collected through large multicenter randomized controlled trials. Furthermore, preoperative ECMO as a bridge to lung transplantation appears to provide favorable outcomes, although additional data are also needed from experienced transplant centers.
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Affiliation(s)
- Akihiro Ohsumi
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Lo EYW, Dignan R, French B. Independent Predictors of Postoperative Stroke With Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2021; 36:133-137. [PMID: 33933366 DOI: 10.1053/j.jvca.2021.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess predictive factors of postoperative stroke in cardiac surgery using cardiopulmonary bypass (CPB). DESIGN This study was a retrospective observational study. SETTING This study was conducted at a single institution (Liverpool Hospital, NSW, Australia). PARTICIPANTS All patients with CPB treated surgically at Liverpool Hospital, NSW, between January 2016 and December 2018 INTERVENTIONS: Patients underwent cardiac surgery with CPB. MEASUREMENTS AND MAIN RESULTS The primary outcome was cerebrovascular accident, or stroke. Univariate and multivariate analyses via Firth's logistic regression with regard to stroke were performed. The study comprised 1,092 patients over a three-year period. In this cohort, the stroke rate was 3.1%. Via univariate analysis of factors in relation to stroke post-CPB, recent or past stroke (odds ratio [OR] 5.43 v 2.32), diabetes mellitus (OR 1.92), dialysis dependence (OR 5.67), elective procedures (OR 0.34), aortic procedures (OR 4.02), bypass and cross-clamp times (OR 1.02 and 1.04), postoperative atrial fibrillation (OR 2.28), and hypoperfusion times all reached the significance level of p ≤ 0.1 to be included in the multivariate analysis. Multivariate analysis to find independent factors in relation to stroke yielded diabetes mellitus (OR 2.49; p = 0.025), dialysis dependence (OR 3.82; p = 0.03), aortic procedures (OR 3.93; p = 0.014), and elective procedures (OR 0.24; p = 0.026) as independently predictive or protective with regard to postoperative stroke. CONCLUSIONS Independent predictors of stroke in this single center cohort included dialysis dependence, diabetes, and aortic procedures. Elective procedures were shown to be an independent protective factor.
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Affiliation(s)
- Eric Yu Wei Lo
- Department of Cardiothoracic Surgery, Liverpool Hospital, Liverpool, Australia.
| | - Rebecca Dignan
- Department of Cardiothoracic Surgery, Liverpool Hospital, Liverpool, Australia; University of New South Wales, Liverpool, Australia
| | - Bruce French
- Department of Cardiothoracic Surgery, Liverpool Hospital, Liverpool, Australia; University of Western Sydney, Liverpool, Australia
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Isingoma P, Moon J, May-Newman K. Manual Carotid Compression is a Viable Alternative for Reduction of Cerebral Microemboli. Cardiovasc Eng Technol 2021; 12:353-60. [PMID: 33686541 DOI: 10.1007/s13239-021-00528-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Stroke is a devastating complication of cardiovascular surgeries, and the risk is particularly high for those requiring cardiopulmonary bypass (CPB). Embolic particles generated during the unclamping of the aortic cross-clamp may enter the cerebral circulation, lodging in small vessels. External manual compression of the carotid arteries is a non-invasive technique that has been proposed for cerebral protection during CPB procedures but is not widely deployed. METHODS The aim of this study is to assess the potential for cerebral emboli reduction with carotid compression using an in vitro model. Experiments were performed with a glass aortic arch model in a mock cardiovascular circuit. Small fluorescent particles were released into the circulation with and without carotid compression, and the particles visualized in the aortic midplane. The number of particles in the aorta and arch branch vessels were counted from the images before, during and following the release of carotid compression for durations of 10, 15 and 20 s. A gamma variate function was fit to the data to describe the bolus dynamics. RESULTS Carotid compression for 10 s reduces the number of embolic articles entering the carotid arteries by over 75%. A compression duration of 15-20 s does not result in greater particle reduction than one of 10 s. CONCLUSION Brief compression of the common carotid arteries during cardiovascular interventions has the potential to dramatically reduce the number of cerebral emboli and should be investigated further.
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Rodrigues TB, Mishra SK, Sridharan K, Barnes ER, Alyokhin A, Tuttle R, Kokulapalan W, Garby D, Skizim NJ, Tang YW, Manley B, Aulisa L, Flannagan RD, Cobb C, Narva KE. First Sprayable Double-Stranded RNA-Based Biopesticide Product Targets Proteasome Subunit Beta Type-5 in Colorado Potato Beetle ( Leptinotarsa decemlineata). Front Plant Sci 2021; 12:728652. [PMID: 34887882 PMCID: PMC8650841 DOI: 10.3389/fpls.2021.728652] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/25/2021] [Indexed: 05/10/2023]
Abstract
Colorado potato beetle (CPB, Leptinotarsa decemlineata) is a major pest of potato and other solanaceous vegetables in the Northern Hemisphere. The insect feeds on leaves and can completely defoliate crops. Because of the repeated use of single insecticide classes without rotating active ingredients, many chemicals are no longer effective in controlling CPB. Ledprona is a sprayable double-stranded RNA biopesticide with a new mode of action that triggers the RNA interference pathway. Laboratory assays with second instar larvae fed Ledprona showed a dose-response where 25×10-6g/L of dsPSMB5 caused 90% mortality after 6days of initial exposure. We also showed that exposure to Ledprona for 6h caused larval mortality and decreased target messenger RNA (mRNA) expression. Decrease in PSMB5 protein levels was observed after 48h of larval exposure to Ledprona. Both PSMB5 mRNA and protein levels did not recover over time. Ledprona efficacy was demonstrated in a whole plant greenhouse trial and performed similarly to spinosad. Ledprona, currently pending registration at EPA, represents a new biopesticide class integrated pest management and insecticide resistance management programs directed against CPB.
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Affiliation(s)
- Thais B. Rodrigues
- GreenLight Biosciences, Research Triangle Park, NC, United States
- *Correspondence: Thais B. Rodrigues,
| | - Sambit K. Mishra
- GreenLight Biosciences, Research Triangle Park, NC, United States
| | | | - Ethann R. Barnes
- GreenLight Biosciences, Research Triangle Park, NC, United States
| | | | - Rich Tuttle
- GreenLight Biosciences, Research Triangle Park, NC, United States
| | | | - David Garby
- School of Biology and Ecology, University of Maine, Orono, ME, United States
| | - Nicholas J. Skizim
- School of Biology and Ecology, University of Maine, Orono, ME, United States
| | - Yu-wen Tang
- School of Biology and Ecology, University of Maine, Orono, ME, United States
| | - Brian Manley
- GreenLight Biosciences, Research Triangle Park, NC, United States
| | - Lorenzo Aulisa
- School of Biology and Ecology, University of Maine, Orono, ME, United States
| | | | - Carole Cobb
- School of Biology and Ecology, University of Maine, Orono, ME, United States
| | - Kenneth E. Narva
- GreenLight Biosciences, Research Triangle Park, NC, United States
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Borchert E, de la Fuente R, Guzmán AM, González K, Rolle A, Morales K, González R, Jalil R, Lema G. Biomarkers as predictors of renal damage in neonates undergoing cardiac surgery. Perfusion 2020; 36:825-831. [PMID: 33140691 DOI: 10.1177/0267659120968377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute Kidney Injury is a complication in children with heart disease undergoing cardiac surgery with cardiopulmonary bypass. The aim of this study is to describe the behavior of KIM-1 (Kidney Injury Molecule) and NGAL (Neutrophil Gelatinase Associated Lipocalin) as early predictors of renal damage, comparing them with serum creatinine and creatinine clearance, in neonates undergoing cardiac surgery. METHODS Twenty-one (21) neonates, under 4 kg, with complex congenital heart diseases, RACHS-1 > 3, without preoperative renal failure, were studied. Serum creatinine and creatinine clearance were measured preoperatively and at 24, 48, 72, 96 hours postoperatively. Urinary samples of KIM-1(pg/ml) and NGAL (ng/ml) were collected after induction of anesthesia at 24 and 48 hours post-operatively. RESULTS nRIFLE criteria were used to divide cohorts in "NO AKI" (12 patients) and "AKI" (nine patients). In the AKI group, serum creatinine increased significantly and creatinine clearance decreased significantly at 24, 48, and 72 hours compared with their respective baseline values. There was no difference in KIM-1 and NGAL values between patients who developed AKI and those who did not at any measured time. CONCLUSIONS The deterioration of renal function continues to be one of the most frequent complications in this population. In our study, biomarkers did not show any correlation with the appearance of AKI. It remains to be seen whether this behavior of the biomarkers is linked with the non-consistent release of these types of molecules in immature kidneys. It is likely that a larger panel of biomarkers together with other glomerular filtration rate assessment methods will provide more information about AKI diagnosis.
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Affiliation(s)
- Evelyn Borchert
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - René de la Fuente
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Ana María Guzmán
- Clinical Laboratory,Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Katia González
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Augusto Rolle
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Karina Morales
- Pediatric Intensive Care, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Rodrigo González
- Cardiovascular Surgery, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Roberto Jalil
- Nephrology. Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Guillermo Lema
- Anesthesia Division, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
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Searles B, Darling EM, Riley JB, Wiles JR. Survey of the Routine Practice Limits for Physiologic and Technical Parameters Managed by Clinical Perfusionists during Adult Cardiopulmonary Bypass. J Extra Corpor Technol 2020; 52:165-72. [PMID: 32981953 DOI: 10.1182/ject-2000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/16/2020] [Indexed: 11/20/2022]
Abstract
Cardiopulmonary bypass (CPB) is a highly technical clinical discipline with a recognized variability in practice. Professional standards and guidelines documents help direct clinical practice and reduce variability, but these guidelines are necessarily vague and fall short of providing specific objective recommendations of clinical practice metrics. If clinical practice metrics were known, they would be informative when writing departmental policy manuals, structuring quality improvement initiatives, describing product R&D specifications, and designing educational assessment rubrics. Therefore, to address this gap, we conducted a national survey of clinical practice with the purpose of producing a benchmark of the typical variability of specific technical parameters that are commonly managed during adult CPB procedures. A pool of expert clinical perfusionists collaborated to compile a data set of normal ranges for 41 individual physiologic and technical parameters (pressures, flows, saturation, times, solutions, and temperatures) that are commonly managed during adult CPB procedures. Results were collected using an online survey application. Respondent demographics and measures of central tendency with descriptive quartile statistics and confidence intervals for each parameter are presented. Of the 335 people who participated in the survey, 315 met the inclusion criteria. The geographic demographics of the respondents were representative of the American Board of Cardiovascular Perfusion's distribution of certified clinical perfusionists. Of the 41 parameters investigated, there were 13 hemodynamic parameters, 13 normal flow rates and technical circuit parameters, 10 blood gasses and hematocrit parameters, and five parameters of patient temperatures. The data presented here are informative and provide a consensus-based objective assessment of the standard practice for adult CPB as reported by practicing clinical perfusionists. Based on these survey data, we have identified the typical clinical limits for the 41 parameters that are managed during adult CPB. This information may be incorporated into guiding documents to support the work of clinicians, researchers, and educators.
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Máximo WPF, Howell JL, Mogilicherla K, Basij M, Chereddy SCRR, Palli SR. Inhibitor of apoptosis is an effective target gene for RNAi-mediated control of Colorado potato beetle, Leptinotarsa decemlineata. Arch Insect Biochem Physiol 2020; 104:e21685. [PMID: 32350927 DOI: 10.1002/arch.21685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/20/2020] [Accepted: 04/08/2020] [Indexed: 05/10/2023]
Abstract
The Colorado potato beetle (CPB; Leptinotarsa decemlineata) is one of the most notorious and difficult to control pests of potato and other solanaceous crops in North America. This insect has evolved a remarkable ability to detoxify both plant and synthetic toxins, allowing it to feed on solanaceous plants containing toxic alkaloids and to develop resistance to synthetic chemicals used for its control. RNA interference (RNAi) is a natural mechanism that evolved as an immune response to double-stranded RNA (dsRNA) viruses where dsRNA triggers silencing of target gene expression. RNAi is being developed as a method to control CPB. Here, we evaluated four CPB-specific genes to identify targets for RNAi-mediated control of this insect. Out of the four dsRNAs evaluated in CPB larvae and adults, dsIAP (dsRNA targeting inhibitor of apoptosis, iap gene) performed better than dsActin, dsHSP70, and dsDynamin in inducing larval mortality. However, in adults, the mortality induced by dsActin is significantly higher than the mortality induced by dsIAP, dsHSP70, and dsDynamin. Interestingly, a combination of dsIAP and dsActin performed better than either dsIAP or dsActin alone by inducing feeding inhibition in 24 hr and mortality in 48 hr in larvae. When the dsIAP and dsActin were expressed in the Escherichia coli HT115 strain and applied as a heat-killed bacterial spray on potato plants, it protected the plants from CPB damage. These studies show that the combination of dsIAP and dsActin shows promise as an insecticide to control CPB.
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Affiliation(s)
- Wesley P F Máximo
- Department of Entomology, University of Kentucky, Lexington, Kentucky
| | - Jeffrey L Howell
- Department of Entomology, University of Kentucky, Lexington, Kentucky
| | | | - Moslem Basij
- Department of Entomology, University of Kentucky, Lexington, Kentucky
| | | | - Subba R Palli
- Department of Entomology, University of Kentucky, Lexington, Kentucky
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Anderson K, Ziegler O, Shi G, Sodha N, Ikeda I, Feng J, Sellke F. Younger age is associated with greater early neurocognitive decline postcardiopulmonary bypass. JTCVS Open 2020; 1:1-9. [PMID: 36445369 PMCID: PMC9665169 DOI: 10.1016/j.xjon.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/06/2019] [Accepted: 02/03/2020] [Indexed: 12/14/2022]
Abstract
Objective To examine the effect of aging on postoperative neurocognitive decline (NCD) in cardiac surgery patients. Methods Patients undergoing coronary artery bypass graft or open aortic valve replacement were administered the Repeatable Battery for the Assessment of Neuropsychological Status at preoperative, postoperative day (POD) 4, and 1 month. Blood samples were collected at preoperative, 6 hours postoperative, and POD 4. Plasma interleukin (IL)-6, tumor necrosis factor-α, and C-reactive protein (CRP) levels were quantified. Quality of life was measured with the 12-Item Short Form Health Survey. Data were analyzed using paired ratio and unpaired t tests with Welch's correction, and linear regression for cytokine levels. Results NCD occurred in 15 patients (N = 33, 45.5%). Dichotomized at age extremes (<60 years; ≥75 years), youngest patients had greater preoperative scores (P = .02) with lower scores by POD 4 (P = .03). There was no NCD in the oldest patients, and scores were not different between age groups on POD 4 (P = .08). Regression at 1 month showed NCD scores again declined by age (n = 15), with younger scores returning toward baseline (P = .008). Regression analyses showed decline by age at 6 hours postoperative and POD 4 in plasma CRP levels (P = .05 6 hours, P = .02 POD 4). Dichotomizing IL-6 levels by age (<70 years, ≥70 years) demonstrated that levels were greater in younger versus older patients at 6 hours postoperative (P = .03), but not on POD 4. Conclusions Younger patients tend to have better cognitive scores before surgery but scores at POD 4 are similar to those of older patients, with this trend disappearing at 1 month. IL-6 and CRP upregulation is greater in younger patients, suggesting that a robust perioperative inflammatory response may be associated with reduction in neurocognitive function, and this may be greater in younger versus older patients.
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Key Words
- CABG, coronary artery bypass grafting
- CP, cardioplegia
- CPB
- CPB, cardiopulmonary bypass
- CRP, C-reactive protein
- IL, interleukin
- MCS, mental component summary
- NCD, neurocognitive decline
- PCS, physical component summary
- POD, postoperative day
- QOL, quality of life
- RBANS, Repeatable Battery for the Assessment of Neuropsychological Status
- SF-12, 12-Item Short Form Health Survey
- TNF-α, tumor necrosis factor-α
- age
- cardiothoracic surgery
- inflammation
- neurocognitive decline
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Affiliation(s)
| | - Olivia Ziegler
- Alpert Medical School of Brown University, Providence, RI
| | - Guangbin Shi
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Rhode Island Hospital, Providence, RI
| | - Neel Sodha
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Rhode Island Hospital, Providence, RI
| | - Ian Ikeda
- Alpert Medical School of Brown University, Providence, RI
| | - Jun Feng
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Rhode Island Hospital, Providence, RI
| | - Frank Sellke
- Division of Cardiothoracic Surgery, Cardiovascular Research Center, Rhode Island Hospital, Providence, RI,Address for reprints: Frank Sellke, MD, Division of Cardiothoracic Surgery, 2 Dudley St, MOC 360, Providence, RI 02905).
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Ganta S, Kavarana M. Autologous Patch Angioplasty of a Giant Right Coronary Artery Aneurysm and Coronary Stenosis in Kawasaki Disease. World J Pediatr Congenit Heart Surg 2019; 10:351-354. [PMID: 31084302 DOI: 10.1177/2150135118825265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe our management of a 2-year-old patient with Kawasaki disease with a giant proximal right coronary artery (RCA) aneurysm and a >99% RCA ostial stenosis. After median sternotomy and cardioplegic arrest of the heart, we opened the aorta and cut into the RCA ostium past the stenosis and giant aneurysm. The RCA was reconstructed with an autologous pericardial patch. Cross-clamp and cardiopulmonary bypass times of 84 minutes and 114 minutes, respectively, were required. Our approach avoids mammary harvesting and grafting in such small patients while successfully treating ischemia and hopefully prevents further aneurysmal dilation over time.
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Affiliation(s)
- Srujan Ganta
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina Children's Hospital, Medical University of South Carolina, Columbia, SC, USA
| | - Minoo Kavarana
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina Children's Hospital, Medical University of South Carolina, Columbia, SC, USA
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Vejlstrup A, Møller AM, Nielsen CH, Damgaard D. Release of active peptidylarginine deiminase into the circulation during acute inflammation induced by coronary artery bypass surgery. J Inflamm Res 2019; 12:137-144. [PMID: 31213874 PMCID: PMC6549760 DOI: 10.2147/jir.s198611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/14/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: Peptidylarginine deiminase (PAD) catalyzes citrullination, a post-translational modification that can alter structure, function and antigenicity of proteins. Citrullination in the lungs due to smoking is believed to initiate an anti-citrulline immune response in rheumatoid arthritis. Citrullination in other inflamed organs has also been demonstrated, but it is not known whether smoking or inflammatory processes in general result in release of relevant amounts of PAD into the circulation with potential to cause citrullination of proteins at various anatomical sites. Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) induces an acute systemic inflammation response. In the present study, we investigate whether smoking or acute systemic inflammation causes release of PAD into the circulation. Patients and methods: This study included 36 patients with coronary heart disease (16 smokers and 20 non-smokers) undergoing CABG surgery with CPB. Circulating levels of PAD2 and PAD4, PAD activity, the neutrophil activation markers MPO, MMP-9 and lipocalin-2, the cytokines IL-6 and IL-10, and the chemokine CXCL8 were measured 2 hrs preoperatively and 2 hrs postoperatively. Results: At baseline, serum PAD2 and PAD4 concentration did not differ between smokers and non-smokers. However, serum from non-smokers contained higher PAD activity than serum from smokers. Circulating PAD2 levels and PAD activity increased markedly in both groups after surgery, as did all neutrophil activation markers, cytokines and chemokine. PAD2 levels correlated with neutrophil activation markers, but not with cytokine and chemokine levels. Conclusion: Blood levels of PAD2 did not differ significantly between smokers and non-smokers, but smokers had decreased PAD activity in the circulation. PAD2 levels and PAD activity increased in blood during inflammation induced by CABG with CPB. This suggests that acute inflammation, ischemia or reperfusion, or a combination of these, leads to systemic spreading of enzymatically active PAD, which may affect protein function and induce generation of citrullinated self-antigens.
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Affiliation(s)
- Anne Vejlstrup
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Claus Henrik Nielsen
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Section for Periodontology, Microbiology and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dres Damgaard
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Section for Periodontology, Microbiology and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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43
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Affiliation(s)
- David Bichell
- 1 Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
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44
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Stehouwer MC, de Vroege R. Air removal capacity of two different minimal invasive ECC systems: an in vitro comparison. Perfusion 2019; 34:561-567. [PMID: 30915891 DOI: 10.1177/0267659119837823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Minimally invasive extracorporeal circulation systems are developed to decrease the deleterious effects of cardiopulmonary bypass. For instance, prime volume and foreign surface area are decreased in these systems. However, because of the lack of a venous reservoir in minimized systems, air handling properties of these minimally invasive extracorporeal circulation systems may be decreased as compared to conventional cardiopulmonary bypass systems. The aim of this in vitro study is to compare the air handling properties of two complete minimized cardiopulmonary bypass systems of two manufacturers, of which one system is provided with the air purge control. In an in vitro study, two minimally invasive extracorporeal circulation systems, Inspire Min.I manufactured by Sorin Group Italia, Mirandola, Italy (LivaNova, London, United Kingdom) and minimized extracorporeal circulation manufactured by Maquet, Rastatt, Germany (Getinge, Germany), were challenged with two types of air challenges; a bolus air challenge and a gaseous microemboli challenge. The air removal characteristics of the venous bubble traps and of the complete minimally invasive extracorporeal circulation systems were assessed by measuring the gaseous microemboli volume and number downstream of the venous bubble traps in the arterial line with a bubble counter. No significant differences were observed in air reduction between the venous bubble traps of Getinge (venous bubble traps) and LivaNova (Inspire venous bubble traps 8 in conjunction with the air purge control). Similarly, no significant differences were observed in volume and number of gaseous microemboli in the arterial line of both complete minimally invasive extracorporeal circulation systems. However, the gaseous microemboli load of the Inspire Min.I system was marginally lower after both the bolus air and the gaseous microemboli challenges. Both minimally invasive extracorporeal circulation systems assessed in this study, the LivaNova Inspire Min.I and the Getinge minimized extracorporeal circulation, showed comparable air removal properties, after both bolus and gaseous microemboli air challenges. Besides, air purge control automatic air removal system provided with the LivaNova Inspire Min.I. system may enhance patient's safety with the use of a minimally invasive extracorporeal circulation system. We consider both systems equally safe for clinical use.
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Affiliation(s)
- Marco C Stehouwer
- Department of Extracorporeal Circulation, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Roel de Vroege
- Department of Extracorporeal Circulation, HAGA Hospital, The Hague, The Netherlands
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45
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Brolhorst J, Peterson B, Holt DW. Flow Awareness as a New Safety Device for Cardiopulmonary Bypass. J Extra Corpor Technol 2019; 51:20-25. [PMID: 30936584 PMCID: PMC6436172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
Safety devices such as bubble detectors and level detectors have been in use for more than 40 years and initially reduced the risks associated with gaseous emboli during cardiopulmonary bypass; however, the risks have not been eliminated. This research explored a new safety device designed to further reduce these risks: Flow Awareness Technology. This device visually alerts the perfusionist when the ratio of venous return does not equal the amount of arterial flow. To determine the efficacy of this device, 33 participants with no perfusion background were randomly assigned to Group A (flow awareness only), Group B (level detector only), or Group C (control). These participants were instructed to turn off the arterial pump when they noticed that the fluid in the venous reservoir had begun to drop or if their assigned safety device was triggered. The venous line was fully occluded at times unknown to the participants. These times coincided with before, during, or after times that the participants were expected to paper-chart known values. Each participant's amount of fluid lost (in milliliters) from the reservoir and reaction time (in seconds) to shut off the arterial roller pump were measured. Group A lost an average of 80.8 mL, Group B lost an average of 173.6 mL, and Group C lost an average of 140.3 mL. Average measured time for each group is as follows: Group A took 2.16 seconds, Group B took 4.31 seconds, and Group C took 4.09 seconds to shut off the arterial pump. Statistics support the hypothesis that Flow Awareness Technology significantly reduces the reaction time to an adverse event such as a sudden occlusion of the venous line, thus reducing the amount of fluid lost during such an event.
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46
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Fernandes P, O'Neil M, Del Valle S, Cave A, Nagpal D. A 24-hour perioperative case study on argatroban use for left ventricle assist device insertion during cardiopulmonary bypass and veno-arterial extracorporeal membrane oxygenation. Perfusion 2018; 34:337-344. [PMID: 30583712 DOI: 10.1177/0267659118813043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 44-year-old male with ongoing chest pain and left ventricular ejection fraction <20% was transferred from a peripheral hospital with intra-aortic balloon pump placement following a non-ST-elevation myocardial infarction (STEMI). The patient underwent emergent multi-vessel coronary artery bypass grafting requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) on post-operative day (POD)#9 secondary to cardiogenic shock with biventricular failure. Due to clot formation, an oxygenator change-out was necessary shortly after initiation. Following a positive heparin-induced thrombocytopenia (HIT) assay, a total circuit exchange was required to eliminate all heparin coating and argatroban was deemed the anticoagulant of choice due to acute kidney injury. On POD#24, the decision was made to implant a left ventricle assist device (LVAD) as a bridge to heart transplantation. There was difficulty achieving an activated clotting time (ACT) >400 s: multiple argatroban bolus doses were required, along with accelerated up-titration of infusion dosing. Despite maintaining an ACT >484 s, clot formation was observed in the cardiotomy reservoir prior to separation. Subsequently, the patient developed severe disseminated intravascular coagulopathy, with both intra-cardiac and intravascular thrombi, requiring massive transfusion and continuous cell saving due to severe hemorrhage post cardiopulmonary bypass (CPB). The patient received a total of 105 units of plasma, 74 units of packed red cells, 19 units of platelets, 13 bottles of 5% albumin, 6 units of cryoprecipitate and 2 doses of factor VIIa intraoperatively over the course of 24 hours. A total of 19.7 L of washed red blood cells were returned to the patient from the cell saver. With the LVAD in place, the patient developed transfusion-related acute lung injury and acute respiratory distress syndrome with right ventricular dysfunction requiring VA ECMO once again. On POD#30, ECMO was discontinued and the patient was discharged from the intensive care unit (ICU) on POD 66. After a very complex post-operative stay with numerous surgeries and extensive rehabilitation, the patient was discharged home with the LVAD on POD#112.
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Affiliation(s)
- Philip Fernandes
- 1 Clinical Perfusion Services, London Health Sciences Centre, London, Ontario, Canada
| | - Michael O'Neil
- 1 Clinical Perfusion Services, London Health Sciences Centre, London, Ontario, Canada
| | - Samantha Del Valle
- 1 Clinical Perfusion Services, London Health Sciences Centre, London, Ontario, Canada
| | - Anita Cave
- 2 Cardiac Care, Perioperative Cardiac Anesthesiology, London Health Sciences Centre, London, Ontario, Canada
| | - Dave Nagpal
- 3 Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada.,4 Western University, Lawson Health Research Centre, London, Ontario, Canada
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47
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Forsberg BC, Novick WM, Cervantes C, Lopez J, Cardarelli M. Potential Deleterious Interactions between Certain Chemical Compounds and a Thermoplastic Polyurethane Heat Exchanger Membrane Oxygenator. J Extra Corpor Technol 2018; 50:244-247. [PMID: 30581232 PMCID: PMC6296450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/27/2018] [Indexed: 06/09/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) has become a powerful tool in the race to reverse failure to rescue events. Rapid implementation set the stage for the advent of the 30-day wet-priming storage as a standard practice. A recent alert regarding methylene blue (MB) unidirectional leach from patient's circulation through the oxygenator thermoplastic polyurethane (TPU) heat-exchanger membrane into the heater-cooler unit (HCU) water bath led us to believe that despite reassurances, the reverse process might be possible. To that effect, we performed a pilot in vitro experiment. We tested three adult ECMO sets (Adult Quadrox iD Oxygenator, Getinge, Doral, FL) probing for the transfer of MB between the water bath of a Sarns Dual Heater Cooler (Terumo Corporation, Ann Arbor, MI) and the circuit stored wet-primed for 30 days. In each test, 1,500 mg of reconstituted MB (HiMedia, Mumbai, India) were added to the 7.5 L of water in the HCU, circulated for 6 hours on which the water lines were disconnected and the setup was stored for 30 days. The primed circuit was tested for MB transfer at days 0, 13, and 30 by means of optical density (OD) at 665 nm and 26.5°C. Transference of MB from the HCU water bath into the ECMO circuit could be detected as early as day 13 after setup, achieving significant values by day 30 (median OD .019 (.014-.021). Expected OD if no diffusion present: 0. The complete separation of water interfaces between the patient's circuit and the HCU water bath may prove to be more dogma than fact when certain chemical substances are used in conjunction with TPU membrane oxygenators. Whether the transfer of substances is due to chemical processes or molecular weight needs further evaluation. Meanwhile, the use of chemicals for the cleaning of the HCU should be mindful of potential noxious effects.
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Affiliation(s)
| | | | | | | | - Marcelo Cardarelli
- Novick Cardiac Alliance, Memphis, Tennessee
- Inova Children’s Hospital, Falls Church, Virginia
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48
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Buggeskov KB, Maltesen RG, Rasmussen BS, Hanifa MA, Lund MAV, Wimmer R, Ravn HB. Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Blood Electrolytes and Metabolites-A Randomized Controlled Trial. J Clin Med 2018; 7:E462. [PMID: 30469433 PMCID: PMC6262287 DOI: 10.3390/jcm7110462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 11/16/2022] Open
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) causes an acute lung ischemia-reperfusion injury, which can develop to pulmonary dysfunction postoperatively. This sub-study of the Pulmonary Protection Trial aimed to elucidate changes in arterial blood gas analyses, inflammatory protein interleukin-6, and metabolites of 90 chronic obstructive pulmonary disease patients following two lung protective regimens of pulmonary artery perfusion with either hypothermic histidine-tryptophan-ketoglutarate (HTK) solution or normothermic oxygenated blood during CPB, compared to the standard CPB with no pulmonary perfusion. Blood was collected at six time points before, during, and up to 20 h post-CPB. Blood gas analysis, enzyme-linked immunosorbent assay, and nuclear magnetic resonance spectroscopy were used, and multivariate and univariate statistical analyses were performed. All patients had decreased gas exchange, augmented inflammation, and metabolite alteration during and after CPB. While no difference was observed between patients receiving oxygenated blood and standard CPB, patients receiving HTK solution had an excess of metabolites involved in energy production and detoxification of reactive oxygen species. Also, patients receiving HTK suffered a transient isotonic hyponatremia that resolved within 20 h post-CPB. Additional studies are needed to further elucidate how to diminish lung ischemia-reperfusion injury during CPB, and thereby, reduce the risk of developing severe postoperative pulmonary dysfunction.
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Affiliation(s)
- Katrine B Buggeskov
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.
| | - Raluca G Maltesen
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, 9000 Aalborg, Denmark.
| | - Bodil S Rasmussen
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, 9000 Aalborg, Denmark.
- Department of Clinical Medicine, School of Medicine and Health, Aalborg University, 9000 Aalborg, Denmark.
| | - Munsoor A Hanifa
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, 9000 Aalborg, Denmark.
- Department of Clinical Medicine, School of Medicine and Health, Aalborg University, 9000 Aalborg, Denmark.
| | - Morten A V Lund
- Department of Biomedical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark.
| | - Reinhard Wimmer
- Department of Chemistry and Bioscience, Aalborg University, 9220 Aalborg, Denmark.
| | - Hanne B Ravn
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.
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49
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Maltesen RG, Buggeskov KB, Andersen CB, Plovsing R, Wimmer R, Ravn HB, Rasmussen BS. Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Bronchoalveolar Fluid and Lung Tissue in Cardiac Surgery Patients. Metabolites 2018; 8:metabo8040054. [PMID: 30241409 PMCID: PMC6316472 DOI: 10.3390/metabo8040054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 11/18/2022] Open
Abstract
Pulmonary dysfunction is among the most frequent complications to cardiac surgeries. Exposure of blood to the cardiopulmonary bypass (CPB) circuit with subsequent lung ischemia-reperfusion leads to the production of inflammatory mediators and increases in microvascular permeability. The study aimed to elucidate histological, cellular, and metabolite changes following two lung protective regimens during CPB with Histidine-Tryptophan-Ketoglutarate (HTK) enriched or warm oxygenated blood pulmonary perfusion compared to standard regimen with no pulmonary perfusion. A total of 90 patients undergoing CPB were randomized to receiving HTK, oxygenated blood or standard regimen. Of these, bronchoalveolar lavage fluid (BALF) and lung tissue biopsies were obtained before and after CPB from 47 and 25 patients, respectively. Histopathological scores, BALF cell counts and metabolite screening were assessed. Multivariate and univariate analyses were performed. Profound histological, cellular, and metabolic changes were identified in all patients after CPB. Histological and cellular changes were similar in the three groups; however, some metabolite profiles were different in the HTK patients. While all patients presented an increase in inflammatory cells, metabolic acidosis, protease activity and oxidative stress, HTK patients seemed to be protected against severe acidosis, excessive fatty acid oxidation, and inflammation during ischemia-reperfusion. Additional studies are needed to confirm these findings.
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Affiliation(s)
- Raluca G Maltesen
- Department of Anesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark.
| | - Katrine B Buggeskov
- Department of Cardiothoracic Anesthesia, Heart Centre, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Claus B Andersen
- Department of Forensic Medicine, University of Copenhagen, 2100 Copenhagen, Denmark.
| | - Ronni Plovsing
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark.
- Department of Anesthesiology, Hvidovre Hospital, University of Copenhagen, 2650 Hvidovre, Denmark.
| | - Reinhard Wimmer
- Department of Chemistry and Bioscience, Aalborg University, 9220 Aalborg, Denmark.
| | - Hanne B Ravn
- Department of Cardiothoracic Anesthesia, Heart Centre, Rigshospitalet, 2100 Copenhagen, Denmark.
| | - Bodil S Rasmussen
- Department of Anesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark.
- Department of Clinical Medicine, School of Medicine and Health, Aalborg University, 9220 Aalborg, Denmark.
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50
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D Souza TF, Hoshal SG, Albeiruti R, Zambito MP, Zambito GM, Khan FM, Samuel BP, Crumb TL, Rajasekaran S, Vettukattil JJ. Transient Secondary Hypothyroidism and Thyroid Hormone Replacement Therapy in Pediatric Postoperative Cardiopulmonary Bypass. Curr Cardiol Rev 2018; 14:121-127. [PMID: 29485000 PMCID: PMC6088443 DOI: 10.2174/1573403x14666180226160749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/22/2018] [Accepted: 02/20/2018] [Indexed: 12/02/2022] Open
Abstract
Background: To develop an understanding of current practices in the management of transient secondary hypothyroidism in pediatric postoperative cardiopulmonary bypass (CPB) patients. Methods: Electronic survey comprising a 10-item questionnaire was sent to sixty-four high volume pediatric heart centers in the United States and United Kingdom. Survey participants included cardiologists, intensivists, cardiothoracic surgeons, and advanced practice providers. A retrospective chart review was also performed at a large regional referral center in the Midwest on subjects 0-18 years old who underwent CPB from 2005-2015. Information obtained included a unique identifier, date of birth, age, procedure performed, CPB time, date of surgery and date and type of Thyroid Function Test (TFT) ordered. Results: 1,153 individuals from 64 congenital heart centers were contacted via email to participate in the electronic survey. In the 3-month response window, 129 completed surveys were received from cardiologists (55%), intensivists (17%), surgeons (15%), “other” (8%), and advanced practice providers (5%). This yielded a response rate of 11.2%. Of the 129 respondents, only 10 providers routinely order TFTs prior to (n=7) and after (n=1) CPB or when clinically indicated (n=2). All 10 providers order thyroid stimulating hormone test, 7 order thyroxine, and 3 order triiodothyronine. Only 1 provider routinely treats children with prophylactic thyroid hormone replacement therapy after CPB. Our retrospective review included 502 CPB events with 442 unique patients. Of the events, 20 patients received preoperative TFT testing while 11 received postoperative testing. Conclusions: There is a general lack of uniformity in the evaluation, diagnosis, and treatment of transient secondary hypothyroidism in pediatric postoperative CPB patients.
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Affiliation(s)
- Travis F D Souza
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Steven G Hoshal
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Ridwaan Albeiruti
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Mario P Zambito
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Giuseppe M Zambito
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Faizan M Khan
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Bennett P Samuel
- Congenital Heart Center, Helen DeVos Children`s Hospital, Grand Rapids, MI, United States
| | - Teri L Crumb
- Office of Clinical Research Operations, Offices of Research Administration, Spectrum Health System, Grand Rapids, MI, United States
| | - Surender Rajasekaran
- Pediatric Critical Care Medicine, Helen DeVos Children's Hospital, Grand Rapids, MI, United States
| | - Joseph J Vettukattil
- Congenital Heart Center, Helen DeVos Children`s Hospital, Grand Rapids, MI, United States
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