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The aim of this study was to evaluate the efficacy of ultrasound-guided multiple injection costotransverse block (MICB) and compare it with erector spinae plane block (ESPB) for poststernotomy pain relief in pediatric cardiac surgical patients. A prospective, randomized, double-blind, comparative study. At a single institution tertiary referral cardiac center. A total of 90 children with acyanotic congenital heart disease requiring surgery via sternotomy. Children were allocated randomly to 1 of the 3 following groups: ESPB (group 1), MICB (group 2), or Control (group 3). Participants in groups 1 and 2 received 4 mg/kg of 0.2% ropivacaine for bilateral ultrasound-guided block after induction of anesthesia. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl/tramadol was used for rescue analgesia. The modified objective pain score (MOPS) was evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours postextubation. After all exclusions, 84 patients were analyzed. The MOPS score was found to be significantly lower in ESPB and MICB groups compared to the control group until 10 hours postextubation (p < 0.05), with no statistically significant difference at the 12th hour (p = 0.2198). The total intraoperative fentanyl consumption (p = 0.0005), need for fentanyl supplementation on incision (p < 0.0001), and need for rescue opioid requirement in the postoperative period (p = 0.034) were significantly lower in both the ESPB and MICB groups than the control group. There were no statistically significant differences in both primary and secondary outcomes between the ESPB and MICB groups. Ultrasound-guided MICB was effective and comparable to ESPB for post-sternotomy pain management in pediatric cardiac surgical patients. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of incisional ropivacaine infiltration by presternal multi-orifice catheter to manage poststernotomy pain in pediatric cardiac surgery. A prospective, randomized, and double-blind comparative study. At a single-institution tertiary referral cardiac center. The study comprised 200 children undergoing cardiac surgeries through a midline sternotomy. Children were allocated randomly to 1 of 3 groups. Group A (n = 65) and group B (n = 64) received 0.375% ropivacaine infusion and intermittent bolus, respectively, by presternal multi-orifice catheter, whereas Group C (n = 64) did not receive any local anesthetic (LA) drug. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl was given as rescue analgesia, respectively. Pain was assessed by a Modified Objective Pain Score (MOPS) for 48 hours postextubation. Group B had significantly lower early MOPS at the first hour, but in the later period, the mean MOPS was lower in group A. The requirement of the first rescue analgesia was 3 ± 1.51, 6.1 ± 2.26, and 2.6 ± 0.87 hours for groups A (n = 60), B (n = 60), and C (n = 60), respectively. The 48-hour fentanyl consumption was significantly lower (p < 0.001) in group A (0.5 ± 0.68 µg/kg) and group B (0.7 ± 0.86 µg/kg) than the control group (3.4 ± 0.68 µg/kg). The length of intensive care unit stay was lower (p < 0.001) in groups A and B than in group C; however, the length of hospital stay was comparable (p = 0.07). LA bolus and infusion through presternal multi-orifice catheter provided effective analgesia postoperatively. However, the bolus was more efficacious in the early phase but equivalent in later periods. Therefore, bolus and LA infusion can be used for steady poststernotomy pain relief in children undergoing cardiac surgeries. [ABSTRACT FROM AUTHOR]

We applied a holistic, sustainable, and green approach to develop an effective multipurpose adsorbent from whole pine needles (PNs), a forest waste lignocellulosic biomass. The PNs were oxidized and modified with phenylhydrazine-4-sulphonic acid (ɸHSO 3 H) to OPN-ɸHSO 3 H. The latter was characterized and tested as an adsorbent for cationic dyes, malachite green (MG), methylene blue (MB), crystal violet (CV), and metal ions (Hg2⁺ and Pb2⁺). The adsorption followed different kinetic models: Elovich for MG and MB, pseudo-second-order for CV, and pseudo-first-order for Hg2⁺ and Pb2⁺. Langmuir isotherm indicated maximum adsorption capacities of 303.4 ± 8.91 mgg−1 (MG), 331.4 ± 17.50 mgg−1 (MB), 376.6 ± 22.47 mgg−1 (CV), 210.8 ± 28.86 mgg−1 (Hg2⁺), and 172.9 ± 20.93 mgg−1 (Pb2⁺) within 30 min. Maximum removal efficiencies were 99.0% (MG), 98.0% (MB), 96.04% (CV), 95.5% (Hg2⁺), and 89.8% (Pb2⁺). The adsorbent demonstrated significant regeneration and reusability over ten cycles, proving highly efficient for both cationic dyes and metal ions, with wide potential for practical applications where more than one adsorbate is present. [Display omitted] • Pine needles (PN) were oxidized in two steps with TEMPO, and NaIO 4. • -CHO of OPN reacted with phenylhydrazine-4-sulphonic acid to form Schiff-base. • Schiff-base proved selective adsorbent for MB, CV, MG, Hg2+, and Pb2+ ions. • Adsorption was highly rapid and efficient with high adsorption capacity. • High adsorption capacity even after ten cycles of regeneration and reusability. [ABSTRACT FROM AUTHOR]

To compare the changes in thoracic fluid content, PaO 2 /F I O 2 ratio, plateau pressure, compliance, and postoperative ventilation duration in off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (ONCAB). Prospective observational study. Tertiary-care cardiac center. Over an 18-month period, from December 2019 to May 2021, 111 patients who underwent CAB grafting were enrolled. Group I constituted OPCAB patients and Group II the ONCAB patients. After induction, the authors measured thoracic fluid content (TFC), pulmonary compliance, airway pressures, and the PaO 2 /F I O 2 ratio before skin incision (T 1) and after skin closure (T 2). The input, output, as well as the duration of postoperative ventilation, also were recorded. At T 2 , the ONCAB group had a significantly higher change in TFC than the OPCAB group (5.4 ± 1.86 kOhm−1 v 4.32 ± 1.84 kOhm−1, p = 0.012). The fluid balance was significantly higher in the OPCAB group compared with the ONCAB group (2,159.21 ± 108.73 mL v 1,792.50 ± 151.88 mL, p = 0.0001). The decrease in PaO 2 /F I O 2 ratio was significantly lower in the OPCAB group compared with the ONCAB group (–71.34 ± 23.42 v –123.65 ± 36.81, p = 0.000). The increase in plateau pressure, decrease in compliance, and postoperative ventilation period were significantly higher in the patients who underwent ONCAB than the patients who underwent OPCAB (p < 0.05). The change in TFC was greater in the ONCAB group, despite the fact that the fluid balance was higher in the OPCAB group. A higher TFC in ONCAB led to lower PaO 2 /F I O 2 ratio, lower compliance, higher plateau pressures, and longer postoperative ventilation. [ABSTRACT FROM AUTHOR]

To determine the dosage of bivalirudin as the anticoagulant for cardiac surgery in neonates and infants. Pilot study. Tertiary-care hospital. Twenty-five neonates and infants with congenital heart disease (CHD) undergoing cardiac surgery. The children received a 1 mg/kg bivalirudin bolus followed by a 2.5 mg/kg/h infusion as the anticoagulant for cardiac surgery. The dose was adjusted subsequently to maintain an activated clotting time (ACT) >480 s. The mean age and weight were 5.3 months and 5.2 kg, respectively. Out of the 25 children, 16 were cyanotic. Baseline rotational thromboelastometry (ROTEM) (Tem Innovations GmbH, Munich, Germany) analysis revealed an underlying coagulation defect across EXTEM, INTEM, FIBTEM, and ADPTEM parameters. The dose of anticoagulant required was 1 mg/kg, followed by a 2.2 ± 0.4 mg/kg/h infusion. Only 1 child required an additional bolus dose. The ACT remained elevated for 4 hours after discontinuation of infusion. The mean 24-h postoperative chest tube drainage was 92 ± 36 mL. Excessive bleeding occurred in 4 children, 1 of whom required re-exploration. The platelet count remained low for 5 days, and, postoperatively, the prothrombin time and activated partial thromboplastin time remained low for 2 days. Effective anticoagulation was achieved with bivalirudin in the neonates and infants undergoing cardiac surgery. The dose required to maintain an ACT >480 s was 1.0 mg/kg, followed by 2.2 ± 0.4 mg/kg/h. The ACT remained elevated for 4 h after the discontinuation of bivalirudin infusion, resulting in an increased chest-tube output in some patients. Randomized, controlled trials are needed to further evaluate the safety of bivalirudin in the neonates and infants with complex congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]

Diabetes is a chronic metabolic disease that lasts a person's life and the estimation of blood glucose concentration is one of the main diagnostic criteria for this disease. The past decade has witnessed a huge demand for new biocompatibility and high-performance glucose biosensors. Non-enzymatic optical glucose sensing using nano/microscaled materials has surged significantly as it provides a direct visualized and cost-effective way to measure glucose concentrations. This review, in a non-exhaustive way, considers some of the recent most important achievements in the glucose-sensitive optical biosensors based upon nano/microscaled materials. Such materials are capable of mimicking the activities of the enzymes which oxidize glucose to release H 2 O 2. The overall framework of the review can be divided into three parts. The first part describes the colorimetric glucose sensing using nano/microscaled materials as enzyme mimics for the oxidation of different chromogenic substrates. In the second part, some recent developments in chromogenic substrate-free fluorescence glucose sensing facilitated by nano/microscaled materials are elaborated. The third part reviews the glucose-sensing through Förster resonance energy transfer (FRET) based assays. Finally, some current challenges, gaps in fundamental understanding and future improvements in the field of optical glucose biosensors are discussed. [Display omitted] ▪ [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of pectointercostal fascial block in relieving postoperative pain in patients undergoing cardiac surgery. Design: Single-blinded, prospective, randomized controlled trial. Setting: Single-center tertiary care teaching hospital. Participants: A total 40 participants undergoing cardiac surgery aged 18 to 80 years. Interventions: Subjects were categorized into 2 groups of 20 each. In group 2 participants (interventional group), bilateral pectointercostal fascial block was given using ropivacaine injection 0.25% after completion of surgery, before shifting to the intensive care unit. Measurements and Main Results: Postoperative pain was measured after extubation at 0, 3, 6, and 12 hours, using a numeric rating scale. Pain in group 2 was significantly less and lasted for a longer duration than in group 1. Fentanyl requirement was significantly higher in group 1 (1.06 ± 0.12 µ/kg) than in group 2 (0.82 ± 0.19 µ/kg). Conclusions: Pectointercostal fascial block is an easy and efficient technique to reduce postoperative pain after cardiac surgery. [ABSTRACT FROM AUTHOR]

Regional analgesia continues to evolve with the introduction of ultrasound-guided fascial plane blocks. Erector spinae plane block (ESPB) is a novel technique gaining recent acceptability as a perioperative modality of analgesia in various thoracic and abdominal surgeries. However, literature on the use of ESPB in pediatric cardiac surgery is limited. A prospective, randomized, single-blind, comparative study. Single-institution tertiary referral cardiac center. Eighty children with acyanotic congenital heart disease undergoing cardiac surgery through midline sternotomy. The subjects were allocated randomly into 2 groups: ESPB (group B, n = 40) received ultrasound-guided bilateral ESPB at the level of T 3 transverse process and control (group C, n = 40) receiving no block. The postoperative pain was assessed using Modified Objective Pain Scores (MOPS) which were evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours after extubation. Group B demonstrated significantly reduced MOPS as compared with group C until the 10th postoperative hour (p < 0.0001), with comparable MOPS at the 12th hour. The consumption of postoperative rescue fentanyl was also significantly less in group B in comparison to group C (p < 0.0001) with a longer duration to first rescue dose requirement in group B. In addition, the group B showed lower postoperative sedation scores and intensive care unit stay in contrast to group C. Ultrasound-guided bilateral ESPB presents a simple, innovative, reliable, and effective postoperative analgesic modality for pediatric cardiac surgeries contemplated through a midline sternotomy. [ABSTRACT FROM AUTHOR]

Augmentation of coronary artery flow by surgical grafting increases coronary sinus blood flow (CSBF), which can be quantified on transesophageal echocardiography (TEE). However, transit time flowmetry (TTF) technology remains the most used intraoperative technique for coronary artery graft assessment. The purpose of the present pilot study was to evaluate the predictive value of TEE-based CSBF estimation for identifying favorable TTF graft measurements. Prospective observational study. Single university hospital. Forty patients undergoing triple vessel coronary artery bypass grafting. CSBF was assessed on TEE examination before and after revascularization, estimating the percentage increase in CSBF (∆CSBF). Postoperative TTF graft measurements were averaged to compute mean diastolic filling (DF) and pulsatility index (PI). Subjects were grouped based on favorable (PI ≤ 3, DF ≥ 50%) and unfavorable (PI > 3, DF < 50%) parameters. The group with PI ≤ 3 (n = 32) had significantly higher ∆CSBF compared with the group with PI > 3 (n = 8) (38.22% ± 12.05%, 13.75% ± 3.37%, p < 0.001). ∆CSBF was higher in the DF ≥ 50% group (n = 35) (36.40 ± 12.99) in contrast to DF < 50% group (n = 5) (11.80 ± 2.59%). A strong negative and significantly positive correlation was observed between ∆CSBF with PI, DF (r = –0.903, 0.571, respectively, p < 0.001). A ∆CSBF ≥15.5% was found to predict a mean PI ≤ 3 and DF ≥ 50% with sensitivity and specificity of 100% and 62.5% for PI and 100% and 100% for DF. A ∆CSBF ≥19% demonstrated a sensitivity and specificity of 100% and 100%, 100% and 91.4% for prediction of PI ≤ 3 and DF ≥ 50%, respectively. TEE-based demonstration of an augmented CSBF can ensure favorable TTF graft parameters, guiding the adequacy of surgical revascularization. [ABSTRACT FROM AUTHOR]

To evaluate the role of echocardiographic right ventricular function parameters in predicting postoperative vasoactive inotrope requirement after tetralogy of Fallot repair. Prospective observational study. A tertiary care hospital. Fifty-two children undergoing elective intracardiac repair. Comprehensive transesophageal echocardiography was performed before and after surgery. Fractional shortening, fractional area change, tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index, tricuspid annular velocities (S', E', A'), and right ventricular global longitudinal strain and strain rate (RV Gls and RV Glsr) were measured. The ratio of peak systolic pressure of the right and left ventricles (P rv/lv) was measured directly from the surgical field pre- and post-repair. The inotrope requirement during first 24 postoperative hours was calculated using the mean Vasoactive-Inotropic Score (VIS). Pearson correlation analysis was used to study the relation between echocardiographic parameters and VIS as well as P rv/lv and VIS. Receiver operating characteristic analysis was used to study the predictive strength of parameters. Among the measured parameters, both pre- and post-repair TAPSE had significant negative correlation with the mean VIS (p < 0.05). Both pre- and post-repair right ventricular myocardial performance index and S', E', A', RV Gls, RV Glsr, P rv/lv also had significant correlation with the mean VIS (p < 0.05). Of these, TAPSE, RV Gls, RV Glsr, and P rv/lv had significant predictive strength (p < 0.05) and reasonable sensitivity and specificity (area under the curve > 0.6) for predicting high mean VIS (VIS > 20). Tricuspid annular plane systolic excursion, RV Gls, RV Glsr, and P rv/lv could predict a postoperative high mean VIS with significant strength and reasonable sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Objective To know the effects of psychological preparation on perioperative stress, anxiety, and mood in children undergoing cardiac surgery and their parents. Design Prospective randomized control nonblinded trial. Setting Single-center tertiary teaching hospital. Participants A total of 60 children aged 5 to 15 years undergoing cardiac surgery were included in the study. One of the parents, preferably the father, was selected from the respective children. Interventions Subjects were randomized into 2 groups: noninterventional (group 1) and interventional (group 2). Intervention was in the form of toys and video games in children, and counseling and information in parents. Preoperative and postoperative anxiety in parents was measured using the State-Trait Anxiety Inventory (STAI), stress using the Index of Clinical Stress (ICS) scale by Abell, and the Ottawa mood scale. In children, the STAI-C (child version of STAI), Ottawa mood and Ottawa stress scales, and Wong-Baker faces pain scale were applied and serum cortisol was measured. Measurements and Main Results Group 2 children had significantly less (p < 0.001) stress, anxiety, and pain and improved mood. Group 2 parents had a significant reduction in state anxiety (42 ± 4.4 v 54.5 ± 7.8; p < 0.001) and ICS score (68.1±9.6 v 84.2 ± 9.2; p < 0.001) and an improvement in mood (7.5 ± 0.7 v 5.9 ± 1; p < 0.001) compared with group 1. Postoperatively, cortisol levels in group 2 were lower than group 1 (571.3 nmol/L [123.3 -1247.14] v 718.9 nmol/L [53-1642.0]). Conclusion Providing video games and toys preoperatively reduced postoperative stress and anxiety and improved mood in children undergoing congenital cardiac surgery. Parents were relieved of anxiety and stress with proper counseling and information. [ABSTRACT FROM AUTHOR]

Abstract Purpose To study the varied presentations and the outcomes in children with Type 2 Abernethy malformation following shunt ligation. Material and methods Children with Type 2 Abernethy who had had been operated between 2013 and 2017 were included in the study. The diagnosis had been confirmed on ultrasonography, CECT or angiography. All patients underwent laparotomy. The shunt was identified, clamped and the bowel congestion was noted. The shunt was ligated if the bowel congestion was not significant or had improved. Relevant follow-up investigations were done to document the resolution or amelioration of symptoms and the patency of the shunt. Results Five patients were included in the study with a median age of 6 years. Hepatopulmonary syndrome was the presentation in 4 patients while one patient presented with liver tumor. Ultrasonography and CECT were able to diagnose Type 2 malformation in 4 patients whereas in 1 patient the distal portal vein was not seen. The postoperative period was complicated in 3 patients. At the median follow up at 14 months, good intrahepatic portal flow in all patients. All patients demonstrated improvement/ resolution of symptoms. Conclusion Abernethy is rare malformation which can have a varied presentation. Additional investigations may be needed to confirm the diagnosis of Type 2 variety. Most patients have gradual improvement of symptoms. Level of evidence Level IV/ Treatment study. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to compare the relative efficacy of ultrasound-guided serratus anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for the management of post-thoracotomy pain in pediatric cardiac surgery. Design A prospective, randomized, single-blind, comparative study. Setting Single-institution tertiary referral cardiac center. Participants The study comprised 108 children with congenital heart disease requiring surgery through a thoracotomy. Interventions Children were allocated randomly to 1 of the 3 groups: SAPB, Pecs II, or ICNB. All participants received 3 mg/kg of 0.2% ropivacaine for ultrasound-guided block after induction of anesthesia. Postoperatively, intravenous paracetamol was used for multimodal and fentanyl was used for rescue analgesia. Measurements and Main Results A modified objective pain score (MOPS) was evaluated at 1, 2, 4, 6, 8, 10, and 12 hours post-extubation. The early mean MOPS at 1, 2, and 4 hours was similar in the 3 groups. The late mean MOPS was significantly lower in the SAPB group compared with that of the ICNB group (p < 0.001). The Pecs II group also had a lower MOPS compared with the ICNB group at 6, 8, and 10 hours (p < 0.001), but the MOPS was comparable at hour 12 (p = 0.301). The requirement for rescue fentanyl was significantly higher in ICNB group in contrast to the SAPB and Pecs II groups. Conclusion SAPB and Pecs II fascial plane blocks are equally efficacious in post-thoracotomy pain management compared with ICNB, but they have the additional benefit of being longer lasting and are as easily performed as the traditional ICNB. [ABSTRACT FROM AUTHOR]

Objectives To examine the analgesic efficacy of bilateral erector spinae plane (ESP) block compared with conventional treatment for pain after cardiac surgery in adult patients. Design A prospective, randomized, controlled, single-blinded study. Setting Single-center tertiary teaching hospital. Participants One hundred and six adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. Interventions Patients were randomized into 2 groups. Patients in group 1 (ESP block group, n = 53) received ultrasound-guided bilateral ESP block with 3 mg/kg of 0.375% ropivacaine before anesthesia induction at the T6 transverse process level. Patients in group 2 (paracetamol and tramadol group, n = 53) received paracetamol (1 gm every 6 hours) and tramadol (50 mg every 8 hours) intravenously in the postoperative period. The primary study outcome was to evaluate pain at rest using an 11-point numeric rating scale (NRS). Mann-Whitney U test was used for comparing NRS scores. Measurements and Main Results The postoperative pain level after extubation and duration of analgesia during which NRS was < 4 of 10 was compared between the groups. The median pain score at rest after extubation in group 1 was 0 of 10 until hour 6, 3 of 10 at hour 8, and 4 of 10 at hours 10 and 12 postextubation. These were significantly less in comparison with group 2 (p = 0.0001). Patients in group 1 had a significantly higher mean duration of analgesia (8.98 ± 0.14 hours), during which NRS was < 4 of 10, compared with group 2 (4.60 ± 0.12 hours) (p = 0.0001). Conclusion ESP block safely provided significantly better pain relief at rest for longer duration as compared to intravenous paracetamol and tramadol. [ABSTRACT FROM AUTHOR]

Objective To determine the safety and efficacy of bivalirudin as an anticoagulant for pediatric open heart surgery (OHS) and to determine its appropriate dosage for this purpose. Design Prospective, randomized controlled trial. Setting Tertiary care hospital. Participants Fifty acyanotic children aged 1-12 years undergoing OHS. Interventions The children were randomized to receive either 4 mg/kg of heparin (n = 25, group H) or 1 mg/kg of bivalirudin bolus followed by 2.5 mg/kg/h infusion (n = 25, group B) as the anticoagulant. The doses were adjusted to maintain activated clotting time (ACT) above 480 seconds. At the conclusion of surgery, protamine (1.3 mg/100 U of heparin) was administered to children in group H. Measurements and Main Results The children were comparable in both groups with regard to demographic characteristics. The mean age and weight were 51.5 months and 13.4 kg in group H, and 59.3 months and 13.4 kg in group B. The dose of anticoagulant required was 4.0 ± 0.2 mg/kg in group H and 1.7 ± 0.2 mg/kg followed by 3.0 ± 0.7 mg/kg/h infusion in group B (p < 0.001). One child in group H required an additional dose compared to 13 (54.2%) children in group B. Intraoperatively, the ACT achieved was higher in group H compared to group B (p < 0.05). The ACT returned to baseline value after protamine administration in group H, but it remained elevated for 2 hours after termination of cardiopulmonary bypass (CPB) in group B (p < 0.01). The ACT was higher in group B compared to group H for 6 hours after termination of CPB (p < 0.05). Heparin prolonged the onset of clotting, decreased the rate and strength of thrombus formation, and inhibited platelet function to a greater extent than bivalirudin on viscoelastic coagulation testing. The total duration of surgery was prolonged in group B. The postoperative chest tube drainage was similar in group B (4.9 mL/kg) as in group H (5.9 mL/kg) in spite of higher ACT. The transfusion requirements were similar. No adverse event occurred in any patient. Conclusion Bivalirudin is a safe and effective anticoagulant for pediatric OHS. Though it is not suitable as a routine anticoagulant for this purpose, it may be used as a heparin alternative in instances when heparin cannot be used. The dose required to maintain ACT for more than 480 seconds was 1.7 ± 0.2 mg/kg followed by 3.0 ± 0.7 mg/kg/h infusion. The ACT remained elevated for 2 hours after stopping the infusion. Bivalirudin did not increase postoperative bleeding and transfusion requirement. [ABSTRACT FROM AUTHOR]

Objectives Diastolic strain and strain rate, combined with E (peak transmitral velocity), have been proposed as novel noninvasive predictors of left ventricle (LV) filling pressures, avoiding angulation errors inherent to tissue Doppler indices (TDI). The primary objective was to study the correlation of strain-based indices (SBI) and TDI with pulmonary artery catheter–derived LV end-diastolic pressures (LVEDP). The secondary aim was to determine appropriate cut-off of indices to predict LVEDP ≥15 mmHg. Design A prospective observational clinical study. Setting Single university hospital. Participants One hundred twenty adults with preserved ejection fraction (EF) undergoing coronary artery bypass grafting. Interventions None. Measurements and Main Results Two-dimensional speckle-tracking echocardiography estimated global longitudinal diastolic strain (Ds) and strain rate (DSr) at peak mitral filling to compute E/Ds and E/10DSr. TDI was measured as the ratio of E and e’ (mitral annular diastolic velocity). E/e’, E/Ds, and E/10DSr were significantly higher (p < 0.001) in patients with LVEDP ≥15 mm Hg (31/120). Correlation of E/Ds, E/10DSr with LVEDP was R = 0.86 and 0.88 (p < 0.001), respectively, compared with a correlation of R = 0.63 (p < 0.001) for E/e’. SBI correlated well with LVEDP ≥15 mm Hg compared with TDI. E/Ds ≥11 and E/10DSr ≥12 had higher sensitivity and specificity (96.77%, 93.26%; 100%, 96.63%, respectively; area under the curve [AUC] = 0.99) than E/e’≥13 (74%,75%; AUC = 0.84) for prediction of LVEDP ≥15 mmHg. SBI accurately predicted elevated LVEDP in the indeterminate zone of 8

Objective Comparison of cardiac output (CO) obtained using electric cardiometry (EC) and pulmonary artery catheterization (PAC) in pediatric patients with congenital structural heart disease. Design Prospective, observational study. Setting A tertiary hospital. Participants The study comprised 50 patients scheduled to undergo cardiac catheterization. Interventions CO data triplets were obtained simultaneously from the cardiometry device ICON (Osypka Medical, Berlin, Germany) and PAC at the following predefined time points—(1) T1: 5 minutes after arterial and venous cannulation and (2) T2: 5 minutes postprocedure; the average of the 3 readings was calculated. Reliability analysis and Bland-Altman analysis were performed to determine the limits of agreement, mean bias, and accuracy of the CO measured with EC. Measurements and Main Results The measured EC-cardiac index 4.22 (3.84-4.60) L/min/m 2 and PAC-cardiac index 4.26 (3.67-4.67) L/min/m 2 were statistically insignificant (p value>0.05) at T1. Bland-Altman analysis revealed a mean bias of 0.0051 L/min/m 2 and precision limits of±0.4927 L/min/m 2 . The intraclass correlation coefficient was 0.789 and Cronbach’s alpha was 0.652, indicating good reproducibility and internal consistency between the two techniques. Postcatheterization analysis also revealed strong agreement and reliability between the two techniques. Conclusions This study demonstrated that cardiac indices measured in children with a variety of structural heart diseases using EC reliably represent absolute values obtained using PAC. EC technology is simple and easy to use and offers noninvasive beat-to-beat tracking of CO and other hemodynamic parameters in children with structurally abnormal hearts. [ABSTRACT FROM AUTHOR]

Background: Unicompartmental knee arthroplasty (UKA) is an underutilized implant for medial tibiofemoral arthritis despite proven benefits in performance and reduced complications. This is likely related to registry recorded higher revision rates compared with total knee arthroplasty. It is our feeling that better component alignment resulting from the usage of computer-assisted surgery should improve longer-term functional results and survival of UKAs.Methods: Between August 2003 and June 2007, 265 medial UKAs were performed in 264 consecutive patients using navigation.Results: Eighty-eight women and 176 men with an average age of 51.7 (±4.63) years were assessed for function and survival over a follow-up period of 92.6 (63-120) months (7.7 years). The final survival rate over 5 years for this cohort was 97.6% at 5 years.Conclusion: We conclude that computer-assisted UKA, to treat medial tibiofemoral joint arthritis, produces 5-year survival rates that are comparable with total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Objectives The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients. Design Prospective observational study Setting Single university hospital Participants Forty patients with severe LV systolic dysfunction undergoing isolated on-pump CABG Interventions None Measurements and Main Results Comprehensive transesophageal echocardiographic examination was performed to obtain the indices of systolic and diastolic LV function after induction of anesthesia. A poor postoperative outcome was defined as patient death or vasoactive inotropic score≥20 for at least 6 hours and/or requiring intra-aortic balloon counterpulsation and/or mechanical ventilation for≥24 hours. Poor postoperative outcome was observed in 40% (16/40) of patients. Patients with poor postoperative outcomes had a significantly higher systolic dyssynchrony index, septal-lateral delay with a significantly lower global longitudinal strain and isovolumic acceleration, end-diastolic volume, end-systolic volume, and lateral and medial mitral annulus systolic velocity. In a binary logistic regression model, global longitudinal strain (odds ratio, 1.5, confidence interval [CI] 95%, 1.19-1.88, p = 0.001), septal-lateral delay (odds ratio, 1.02, 95% CI, 1.01-1.03; p = 0.001) and systolic dyssychrony index (odds ratio, 1.3, 95% CI, 1.13-1.48; p = 0.000) were found to be predictors of poor postoperative outcome. Conclusion Global longitudinal strain, systolic dyssynchrony index, and septal-lateral delay were reliable and accurate predictors of adverse outcomes in patients with severe LV systolic dysfunction undergoing on-pump CABG. [ABSTRACT FROM AUTHOR]

Computer Aided Surgery has consistently shown superior alignment of components when compared to non-navigated jig based techniques. The aim of this study is to assess the mid-term clinical outcome of TKA performed by a consultant orthopedic surgeon, compared to trainee surgeons. Ninety-two patients were matched and randomly allocated to have CAS surgery performed by either a consultant or trainee and followed up prospectively for 5-years. Knee society scores, mechanical axis, tourniquet time and blood loss data were collected. Our study demonstrated that trainees were able to achieve equal coronal alignment (P=0.15), blood loss (P=0.45) and functional scores (P=0.15). The Consultant group had a significantly (P<0.001) shorter tourniquet time. We confirm that CAS can assist less experienced surgeons to reliably achieve good mid-term outcomes in TKA. [ABSTRACT FROM AUTHOR]

Objective: Concerns have been raised about differences in the safety profile of potato- versus waxy maize-derived hydroxyethyl starch (HES). The objective of this study was to compare 2 HES solutions derived from 2 different source materials (potato versus waxy maize) for their dose-related effects on hemostasis and organ function when used to prime the cardiopulmonary bypass circuit (CPB). Design: A prospective, randomized, controlled study. Setting: Tertiary care center. Participants: Eighty patients undergoing coronary artery bypass grafting (CABG) on CPB. Interventions: For priming the CPB circuit, the HESPRL group received 1000 mL of potato-derived balanced 6% HES 130/0.42 along with 500 mL of Ringer’s lactate; the HESP group received 1,500 mL of potato-derived balanced 6% HES 130/0.42; the HESMRL group received 1000 mL of waxy maize-derived balanced 6% HES 130/0.4 along with 500 mL of Ringer’s lactate, and the HESM group received 1500 mL of waxy maize-derived balanced 6% HES 130/0.4. Measurements and Main Results: There were no significant differences in 24-hour mediastinal drainage, rate of re-exploration, blood product usage, coagulation parameters, and measures of pulmonary, renal, and hepatic function with respect to plant source of HES, when equivalent doses were used. Sonoclot activated clotting time (SonACT) was significantly higher and clot rate (CR) significantly lower at end of surgery (T1) and 24 hours after surgery (T2) in the HESP and HESM groups compared with the HESPRL and HESMRL groups. Compared with baseline, CR and platelet function were significantly lower at T1, PaO2/FIO2 ratio decreased significantly at T1 and T2, and serum bilirubin and transaminases increased significantly at T2 in all 4 groups. Conclusions: There was no significant difference in cumulative 24-hour mediastinal drainage when potato-derived balanced 6% HES 130/0.42 or waxy maize-derived balanced 6% HES 130/0.4 was used to prime the CPB circuit in patients undergoing CABG. In equal doses, both starches exerted the same effect on blood coagulation and pulmonary, renal, and hepatic function. [Copyright &y& Elsevier]

Background: The unique series arrangement of the cerebral and pulmonary circulation in bidirectional superior cavopulmonary anastomosis (BCPA) makes the pulmonary blood flow dependent upon the cerebral blood flow. Until now, several investigators have tried to correct post-BCPA hypoxemia with various methods such as induced hyperventilation, the addition of carbon dioxide, and inhaled nitric oxide with variable success rates. Methods: We prospectively studied 25 children with univentricular physiology undergoing BCPA surgery at 5 different time points in the preoperative (1 time point) and postoperative period (4 time points, each separated by at least 3 mm Hg changes in the superior vena cava [SVC] pressure). Intravenous fluids were administered in the postoperative period to raise the SVC pressure. Results: The systemic arterial oxygen saturation (Sao 2 ) increased significantly (p = 0.000) from a preoperative value of 80% ± 7% to 86% ± 7%, 91% ± 3% and 95% ± 4% at SVC pressures of 9 ± 1.6 mm Hg, 13 ± 1.3 mm Hg, and 16 ± 1.4 mm Hg, respectively, and then decreased to 94% ± 4% at SVC pressure of 20 ± 1.7 mm Hg. Systolic and diastolic blood pressure increased significantly and simultaneously with SVC pressure from 71 ± 8 mm Hg and 42 ± 6 mm Hg to 89 ± 11 mm Hg and 52 ± 7 mm Hg, respectively (p = 0.000). Conclusions: Administration of intravenous fluids improves the SVC pressure, possibly due to an increase in the cerebral blood flow and the SVC flow, and thus raises the arterial oxygen tension (Pao 2) and Sao 2. Each patient has a unique SVC pressure where the Sao 2 and the Pao 2 are maximum; beyond that limit, the Sao 2 does not improve. [Copyright &y& Elsevier]

Objective: The objective of this study was to assess the effectiveness of 0.5% ropivacaine used for parasternal intercostal blocks for postoperative analgesia in pediatric patients undergoing cardiac surgery. Design: A randomized, controlled, prospective, double-blind study. Setting: A tertiary care teaching hospital. Participants: Thirty children scheduled for cardiac surgery with a median sternotomy. Interventions: A 0.5% ropivacaine injection with 5 doses of 0.5 to 2.0 mL on each side in the 2nd to 6th parasternal intercostal space with a total dose of ropivacaine below 5 mg/kg or the same volume of saline before sternal wound closure. Measurements and Main Results: The time to extubation was significantly lower in patients administered the parasternal blocks with ropivacaine than in the control group; the mean values were 2.66 hours and 5.31 hours, respectively (p < 0.001). The pain scores were lower in the ropivacaine group compared with the saline group; mean values were 2.20 for the ropivacaine group and 4.83 for the saline group on a scale of 10. The cumulative fentanyl dose requirement over a 24-hour period was higher in the saline group than the ropivacaine group (p < 0.001). Conclusions: Parasternal blocks with ropivacaine appear to be a simple, safe, and useful technique of supplementation of postoperative analgesia in pediatric patients undergoing cardiac surgery with a median sternotomy. [ABSTRACT FROM AUTHOR]

Objective: The authors investigated the effects of intravenous etomidate on hemodynamics in children with congenital cardiac shunts. Design: Prospective observational study. Setting: Catheterization laboratory in tertiary referral cardiac center. Participants: Thirty children with congenital cardiac shunt lesions. Interventions: Fifteen children having congenital right to left shunts (group A) and 15 children with left to right shunts (group B) were studied. Systemic mean arterial pressure (SMAP), mean pulmonary artery pressures (MPAP), right atrial pressures (RAP), and pulmonary artery wedge pressure (PAWP) were recorded. Systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), and pulmonary-to-systemic blood flow ratio (Qp/Qs) were calculated on room air at baseline and following a single dose of 0.3 mg/kg of etomidate. Measurements and Main Results: Heart rate (HR), SMAP, RAP, systemic blood flow (Qs), Qp/Qs, and SVRI did not show any significant change; whereas systemic arterial saturation increased from 77.3% to 79.3%, which was statistically but not clinically significant in the authors'' opinion following etomidate in group A. No significant differences in HR, SMAP, MPAP, PAWP, PVRI, SVRI, Qs, pulmonary blood flow (Qp), and Qp/Qs ratio were seen; whereas RAP, systemic, and pulmonary artery saturation decreased in group B after etomidate. Although statistically significant, the decreases were not clinically significant. Conclusion: Etomidate at 0.3 mg/kg produces very minimal changes in hemodynamic parameters and shunt fraction in children with congenital shunt lesions. [Copyright &y& Elsevier]

Objective: The purpose of this study was to compare the effects of continuation versus discontinuation of the angiotensin-converting enzyme (ACE) inhibitor ramipril and assess the efficacy of prophylactic vasopressin infusion on hemodynamic stability and vasoactive drug requirements in patients undergoing coronary artery bypass graft (CABG) surgery. Design: A prospective, randomized, double-blinded, single-center clinical study. Setting: Tertiary care hospital. Participants: Forty-seven patients on the ACE inhibitor ramipril for 6 weeks before undergoing elective primary CABG surgery on cardiopulmonary bypass (CPB). Interventions: Patients were randomly divided into 3 groups: group A (n = 16), patients discontinued ramipril 24 hours before surgery; group B (n = 16), patients continued ramipril until the morning of surgery; and group C (n = 15), patients continued ramipril until the morning of surgery and received vasopressin infusion (0.03 U/min) from the onset of rewarming until the hemodynamics were stable without vasopressor agents. The anesthetic technique and conduct of CPB were standardized for all the groups. Hemodynamic parameters and vasoactive drug requirements were recorded for 3 days postoperatively. Measurements and Main Results: Patients in group A maintained stable mean arterial pressure (MAP) and systemic vascular resistance (SVR). In group B, MAP and SVR decreased after the induction of anesthesia and remained so throughout surgery (p < 0.05). In group C, MAP and SVR decreased upon the induction of anesthesia (p < 0.05) but normalized after CPB. Conclusions: Preoperative ACE inhibitor continuation predisposed to hypotension upon the induction of anesthesia and in the post-CPB period. Prophylactic low-dose vasopressin infusion prevented post-CPB hypotension. Low-dose vasopressin can be considered as potential therapy in these patients. [Copyright &y& Elsevier]

Objective: Hypothermia followed by rewarming during cardiopulmonary bypass can lead to cerebral hyperthermia, which has been implicated as 1 of the causes for postoperative deterioration in neurocognitive function in patients undergoing coronary revascularization. Hence, the authors studied the effects of 2 different rewarming strategies on postoperative neurocognitive function in adult patients undergoing coronary artery bypass graft surgery with the aid of cardiopulmonary bypass. Design: This was a randomized clinical trial. Setting: A cardiothoracic center of a tertiary level referral, teaching hospital. Participants: A total of 80 adult patients aged 45 to 70 years undergoing elective primary isolated coronary artery bypass graft surgery with cardiopulmonary bypass under moderate hypothermia at 30°C were included in this study. Interventions: The patients were randomly allocated into 2 groups of 40 each. In group A, patients were rewarmed to a nasopharyngeal temperature of 37°C; whereas, in group B, patients were rewarmed to a nasopharyngeal temperature of 33°C before weaning off bypass. The anesthetic and bypass management were standardized for both groups. Measurements: All patients were assessed for neurocognitive function preoperatively and on the fifth postoperative day using the Post Graduate Institute Memory Scale. The amount of blood loss and need for blood and blood product transfusion postoperatively, the need for pacing, increased inotrope or vasodilator use, and time to extubation were also noted. Serum S100β levels were measured after anesthetic induction and at 24 hours postoperatively. The jugular venous oxygen saturation and oxygen tension were noted at 30°C and at the end of full rewarming (ie, at 37°C or 33°C, respectively, in the 2 groups). Results: There was a significant deterioration in neurocognitive function postoperatively as compared with preoperative function in patients of group A (37°C). This was associated with higher S100β levels 24 hours postoperatively in group A (37°C) compared with group B (33°C) patients. Also, there was a significant decrease in jugular venous oxygen saturation in group A (37°C) as compared with group B (33°C) at the end of rewarming. The time to extubation was longer in group B (33°C). No significant differences were noted in the amount of postoperative blood loss, blood and blood product use, inotrope or vasodilator use, and the need for pacing. Conclusion: Weaning from CPB at 33°C may be a simple and useful strategy to lower the postoperative impairment of neurocognitive function and may be used as a tool to decrease morbidity after coronary revascularization. [Copyright &y& Elsevier]

Novel supports for use as cation and anion adsorbents were prepared from lignocellulosics using pine needles and their carboxymethylated forms by network/hydrogel formation with acrylamide and N,N-methylene bisacrylamide. The hydrogels thus prepared were further functionalized by partial alkaline hydrolysis with 0.5N NaOH and were characterized by FTIR, SEM and nitrogen analysis. Adsorption of Fe2+ on these hydrogels was carried as a function of time, temperature, pH and ionic strength. The hydrogel having the maximum adsorption capacity was loaded with Fe2+ at the conditions those afforded maximum uptake and was used as novel anionic adsorbent for . The water uptake capacities and biodegradability of the hydrogels before and after the ion loading was studied to evaluate the possible end-uses of these hydrogels as alternate materials in the removal of ionic species from water. [Copyright &y& Elsevier]

Objective: Cyanotic congenital heart diseases (CCHD) with secondary polycythemia and hyperviscosity state are associated with a reduction in blood flow, stagnation of blood, and thrombosis. Sufficient hemodilution in cyanotic children results in higher blood flow and significant reductions in perioperative blood loss. The aim of this study was to investigate similar beneficial effects of hemodilution in preventing shunt thrombosis and decreasing postoperative blood loss after modified Blalock-Taussig (BT) shunt operations in children with CCHD. Design: Prospective, randomized, controlled study. Setting: Cardiac center of a tertiary care, referral hospital. Participants: Fifty children with CCHD undergoing modified BT shunt operations. Interventions: Patients were randomized into 2 groups. The study group (n = 25) received a calculated amount of 6% hydroxyethyl starch (200/0.5) solution to bring down the hematocrit to 45%, whereas the control group (n = 25) received 5% dextrose solution intraoperatively as per the authors’ normal protocol. Measurements and Main Results: Effects of hemodilution on shunt patency, postoperative blood loss at 24 hours, blood and blood component usage, and re-exploration rates were recorded. The shunt patency rate was significantly higher in the study group than the control group (100% and 84%, respectively, p < 0.05). Postoperative blood loss at 24 hours was significantly higher in the control group than in the study group (14.4 ± 11.8 mL/kg and 9.9 ± 8 mL/kg, respectively, p < 0.05). The number of recipients and the amount of blood and blood components administered were higher in the control group, but they were not statistically significant. The re-exploration rate (for excessive postoperative chest-tube drainage) was significantly higher in the control group than the study group (12% and 0%, respectively, p < 0.05). Conclusion: Hemodilution in CCHD patients undergoing modified BT shunt surgery has beneficial effects including improved shunt patency because of higher blood flow through the graft and less postoperative blood loss, which may be attributed to the lower viscosity produced by hemodilution. [Copyright &y& Elsevier]

Abstract: Ionic bifunctional membranes have been synthesized by grafting binary mixture of methacrylic acid (MAAc) and 4-vinyl pyridine (4-VP) onto Teflon-FEP film by pre-irradiation method. Optimum conditions pertaining to maximum percentage of grafting were evaluated as a function of different reaction parameters. Maximum percentage of grafting of binary mixture (MAAc-co-4-VP) (71.29%) was obtained at an optimum total dose of 54.48kGy and the total concentration was 9.49mol/L ([4-VP]=0.07mol/L and [MAAc ]=9.42mol/L) in 5ml of water. The effect of alcohols as additives to the reaction medium on percent grafting of the binary mixture has also been studied. The membranes were characterized by FTIR spectroscopy, scanning electron microscopy and thermogravimetric analysis. Swelling studies of the membranes were performed in different solvents such as water, benzene, carbon tetrachloride and dimethyl formamide (DMF). Maximum swelling was observed in DMF with minimum swelling in benzene. Metal ion (Cu2+, Ni2+ and Fe2+) uptake studies show better affinity for Fe2+ ions. Conductance measurements in different aqueous salt solution showed that these membranes have affinity for Na+/K+ ions and Cl− ions and hence can be used in desalination/separation processes for the separation of both type of cationic and anionic ions. [Copyright &y& Elsevier]

Pine needles and their carboxymethyl forms were functionalized by network formation with 2-acrylamido-2-methylpropanesulphonic acid (AAmPSA) in the presence of N,N-methylene bisacrylamide. N-Tetramethylethylene diamine and ammonium persulfate were used as accelerator-initiator systems to prepare these hydrogels. The hydrogels were characterized by FTIR, SEM, and nitrogen analysis and for water uptake capacities before and after metal ion sorption with a view to evaluating their use in the removal of toxic ionic species from waste water. A detailed study of Cr6+ adsorption was carried out as a function of time, temperature, pH, and ionic strength. The thermodynamic parameters of adsorption such as ΔH 0, ΔS 0, and ΔG 0 have been evaluated to understand the underlying mechanism of adsorption. In order to understand their reusability in possible technological applications, biodegradability of these hydrogels and their precursors was studied. [Copyright &y& Elsevier]