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This study aimed to observe the protective effects of sufentanil pretreatment on rat cerebral injury during cardiopulmonary bypass (CPB) and to explore the underlying mechanism. Twenty-four male adult Sprague Dawley (SD) rats were divided into 4 groups. Then, the rat CPB model was established. A 14G trocar was inserted into the atrium dextrum. For rats in S1 and S5 groups, sufentanil (1 µgKg(-1) and 5 µgKg(-1)) were applied before CPB process. After the operation, rat brain samples were harvested for measurement of the water content of the brains, total calcium in brain tissue and the level of serum S100β. Compared with the Sham group, the water content and the total calcium of the brain tissue, and the expression of S100β in serum were significantly increased in the CPB group (P0.05). Compared with the CPB group, sufentanil treatment significantly reduced the water content of the brains, the total calcium and S100β expression (P0.05). The blood pressure and heart rate were significantly decreased in groups CPB, S1, and S5 compared with Sham group during CPB. Compared with the Sham group, the levels of pH and blood lactate in other groups were decreased and increased, respectively, in the post-CPB period. During the CPB and post-CPB periods, the hematocrit levels were significantly down-regulated in groups CPB, S1, and S5 compared with Sham group. In conclusion, sufentanil pretreatment was effective in reducing the cerebral injury during CPB. Reduction in calcium overload may be a potential mechanism in such process.

Perinatal asphyxia (PA) still constitutes a common complication involving a large number of infants with or without congenital heart diseases (CHD). PA affects 0.2-0.6% of full-term neonates, 20% of which suffer mortal hypoxic-ischemic encephalopathy, and among survivors 25% exhibit permanent consequences at neuropsychological level. Each year, about one third of 1000 live births underwent to surgical intervention in early infancy and/or are at risk for ominous outcome. Advances in brain monitoring, in anesthetic and cardiothoracic surgical techniques, including selective or total body cooling, cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest, have essentially reduced mortality expanding the possibility to address functional neurologic and cardiac outcomes in long-term survivors. However, open-heart surgery constitutes a time-frame of planned ischemia-reperfusion injury, which is a price to pay in the treatment or palliation of CHD. Infants who underwent heart surgery and non-CHD infants complicated by PA share similarities in their neurodevelopmental profile and a common form of brain damage due to hypoxic-ischemic injury. The purpose of the present review was to evaluate different mechanisms implicated in brain injury following CPB and PA and how it is possible to monitor such injury by means of available biomarkers (S100B protein, Activin A, Adrenomedullin).

Background: Extracorporeal membrane oxygenation (ECMO) is a complex treatment. Despite this, there are a lack of training programs designed to develop relevant clinical and nonclinical skills required for ECMO specialists. The aim of the current study was to describe the design, implementation and evaluation of a 1-day simulation course for delivering training in ECMO. Methods: A 1-day simulation course was developed with educational and intensive care experts. First, the delegates received a lecture on the principles of simulation training and the importance of human factors. This was, followed by a practical demonstration and discussion of the ECMO circuit, console components, circuit interactions effects and potential complications. There were then five ECMO simulation scenarios with debriefing that covered technical and nontechnical issues. The course culminated in a knowledge-based assessment. Course outcomes were assessed using purpose-designed questionnaires. Results: We held 3 courses with a total of 14 delegates (9 intensive care nurses, 3 adult intensive care consultants and 2 ECMO technicians). Following the course, 8 (57%) gained familiarity in troubleshooting an ECMO circuit, 6 (43%) increased their familiarity with the ECMO pump and circuit, 8 (57%) perceived an improvement in their communication skills and 7 (50%) perceived an improvement in their leadership skills. At the end of the course, 13 (93%) delegates agreed that they felt more confident in dealing with ECMO. Conclusions: Simulation-training courses may increase knowledge and confidence in dealing with ECMO emergencies. Further studies are indicated to determine whether simulation training improves clinical outcomes and translates to reduced complication rates in patients receiving ECMO.

Increasing numbers of adult patients with complex congenital heart conditions are presenting for noncardiac surgery later in life. These disorders can present challenges for surgical and anesthesia providers. Specifically, single ventricle lesions offer anatomic and physiologic concerns during the perioperative period. Single ventricle physiology represents a delicate balance between systemic and pulmonary blood flow. Any alterations in blood flow through these systems can produce undesirable hemodynamic changes, especially during the perioperative period. We present a case of an adult patient with a single left ventricle who presented for laparoscopic total colectomy due to inflammatory bowel disease. His abnormal anatomy coupled with the hemodynamic disruptions caused by laparoscopy presented significant anesthetic challenges. We highlight the anesthetic concerns of single ventricle physiology, specifically pertaining to laparoscopic surgery. We provide recommendations for safely managing these patients perioperatively. With detailed preoperative evaluation and close hemodynamic monitoring during the perioperative period, these patients can experience successful surgical and anesthetic outcomes.

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.

Cocoa pod borer (CPB), Conopomorpha cramerella Snellen (Lepidoptera: Gracillariidae) is a major pest of cocoa. Detection of the pest infestation using sex pheromone traps in the early growth and development of cocoa pods is important for an early warning system programme. In order to prevent the pest infestation the young pods were wrapped with plastic bags. A research to study the CPB incidence was conducted at cocoa plantations in Banjarharjo and Banjaroya villages, District of Kalibawang; Hargotirto and Hargowilis villages, District of Kokap; and Pagerharjo village, District of Samigaluh, Yogyakarta. The experiments design used RCBD with four treatments (sex pheromone trap, combination of sex pheromone trap and pod wrapping, pod wrapping, and control) and five replications. As many as 6 units/ha pheromone traps were installed with a distance of 40 m in between. Results showed that one month prior to the trap installation in the experimental plots there were ripen cocoa pods as many as 9-13%, which were mostly infested by CPB. During the time period of introducting research on August to Desember 2016 there was not rambutan fruits as the CPB host, hence the CPB resource was from infested cocoa pods. The CPB moth trapped as many as 0−7 (1.13 ± 0.14) moths/6 traps/12 observations. The seed damage due to CPB larvae in the pheromone trap treatments (23.98%) was relatively similar with the control (20.25%). Seed damage rate in combination treatment of pheromone trap and pod wrapping (0.59%) was relatively the same with the pod wrapping (0.20%). The pheromone trap was more usefull for monitoring tool rather than for control, meanwhile pod wrapping was an effective control measure of CPB. IntisariPenggerek Buah Kakao (PBK), Conopomorpha cramerella Snellen (Lepidoptera: Gracillariidae) merupakan salah satu hama utama kakao. Deteksi serangan hama PBK dengan perangkap feromon seks pada awal pertumbuhan dan perkembangan buah kakao penting dilakukan sebagai sistem peringatan dini. Dalam upaya pencegahan serangan hama tersebut dilakukan pembrongsongan buah muda. Penelitian dilakukan di kebun kakao rakyat di Desa Banjarharjo dan Banjaroya, Kecamatan Kalibawang, Desa Hargotirto dan Hargowilis, Kecamatan Kokap, serta kebun PT Pagilaran di Desa Pagerharjo, Kecamatan Samigaluh, Yogyakarta. Percobaan dengan empat perlakuan (perangkap feromon, kombinasi perangkap feromon dan brongsong, brongsong, kontrol) dan lima ulangan menggunakan rancangan RCBD. Perangkap feromon sebanyak 6 unit/ha dipasang dengan jarak antar perangkap sekitar 40 m. Hasil percobaan menunjukkan bahwa satu bulan sebelum pemasangan perangkap terdapat buah tua sebanyak 9−13 % dan umumnya terserang PBK. Selama kajian berlangsung tidak terdapat buah rambutan sebagai inang PBK sehingga sumber PBK diduga hanya dari buah kakao yang terserang. Ngengat PBK yang tertangkap yaitu sebanyak 0−7 (1,13±0,14) ekor/6 perangkap/12 pengamatan. Intensitas kerusakan biji akibat ulat PBK pada perlakuan perangkap feromon (23,98%) relatif sama dengan kontrol (20,25%). Kerusakan biji kakao pada perlakuan kombinasi perangkap feromon dan pembrongsongan (0,59%) relatif sama dengan pembrongsongan saja (0,20%). Perangkap feromon lebih berfungsi sebagai alat monitoring daripada alat pengendalian PBK, sedangkan pembrongsongan buah merupakan teknologi pengendalian PBK yang efektif.

The expression of insecticidal genes must be induced at appropriate time and in sufficient amount to confer protection against targeted pests. However, the increased scientific reports of resistance development in insect pest against insecticidal delta-endotoxins, produced by Bacillus thuringiensis, provide impetus for the development of alternative insect management strategies. The present study was conducted to investigate the importance of targeted expression of a hybrid insecticidal gene (SN19) in potatoes. For this purpose, two plant expression vectors were constructed by cloning hybrid SN19 gene (cry1Ba-domain I–III and cry1Ia-domain II) under the control of a wound-inducible promoter isolated from Asparagus officinalis (AoPR1) and CaMV 35S promoter, and were transferred to Agrobacterium tumefaciens strain EHA 105. Four potato genotypes (Marabel, Innovator, Tokat 10/1 and Tokat 6/24) were transformed with EHA 105 strain harboring pTF101.1 35S–SN19 and pTF101.1 AoPR1–SN19 constructs. Phosphinothricin (PPT) was used at concentration of 1 mg/l for selection of primary transformants. PCR results showed the presence of both introduced SN19 and bar genes in 43 plants out of total 154 putative transgenics. Expression of SN19 protein in primary transformants was confirmed by Western blot assays. The mechanical wounding of transgenic plants exhibited more accumulated levels of SN19 proteins during post wounding period. Leaf biotoxicity assays with Colorado potato beetle (Coleoptera) and tomato leafminer (Lepidoptera) exhibited 100% mortality of the pests in primary transformants. Based on our mortality results with both constructs, we concluded that the potato transgenic lines exhibited targeted expression of insecticidal gene under the control of AoPR1 promoter upon insect wounding with eliminated toxicity of Cry protein and hence can be further used effectively in potato breeding programme. © 2017, Korean Society for Plant Biotechnology and Springer Japan KK. 111T816 Türkiye Bilimsel ve Teknolojik Araştirma Kurumu, TÜBITAK Genetic Engineering and Biotechnology Institute, Scientific and Technological Research Council of Turkey, Gebze, Kocaeli, Turkey Funding The research project was supported by a Grant from Scientific and Technological Research Council of Turkey (TÜBİTAK) Project # 111T816.

There has been a growing interest in off-pump coronary artery bypass (OPCAB) grafting in recent years. Beating-heart surgery is believed to be less invasive as it allows the side effects of extracorporeal circulation to be avoided.The aim of the study was to compare blood product transfusion rates between two groups of patients undergoing surgery for ischemic heart disease with either the off-pump technique or using cardiopulmonary bypass (CPB).There were 152 patients enrolled in the prospective randomized study. All procedures were elective. There were 84 patients (62 men and 20 women) at the mean age of 63.74 ± 7 years who underwent OPCAB (group I), and 68 patients (54 men and 14 women) at the mean age of 63.51 ± 6 years who underwent cardiopulmonary bypass (group II).There were no perioperative deaths. The mean number of grafts was 2.27 ± 0.3 (OPCAB group) and 2.63 ± 0.6 (CPB group) (p0.05). The mean number of packed red blood cells transfused in the OPCAB group was 2.31 ± 0.18 units/patient and 3.94 ± 0.30 units/patient in the CPB group (p0.05). The mean number of fresh frozen plasma units transfused was 1.13 ± 0.13 in the OPCAB group vs. 1.57 ± 0.15 in the CPB group (p0.05). There were 12 patients (14%) in the OPCAB group who had no transfusion.One of the most important advantages of the OPCAB technique is that it makes it possible to reduce the rate of blood product transfusions.W ostatnich latach coraz częściej wprowadza się do leczenia chirurgicznego choroby wieńcowej zabieg pomostowania aortalno-wieńcowego bez użycia krążenia pozaustrojowego (Celem badania było porównanie ilości przetaczanych preparatów krwi w dwóch grupach pacjentów operowanych z powodu choroby niedokrwiennej serca przy użyciu techniki pomostowania aortalno-wieńcowego bez użycia krążenia pozaustrojowego lub z użyciem krążenia pozaustrojowego (Do prospektywnego badania z randomizacją zakwalifikowano 152 pacjentów. Wszystkie zabiegi przeprowadzono w trybie elektywnym. Grupa I składała się z 84 osób (64 mężczyzn i 20 kobiet), w średnim wieku 63,74 ± 7 lat, które poddano zabiegowi z użyciem techniki OPCAB, a grupę II tworzyło 60 osób (54 mężczyzn i 14 kobiet), w średnim wieku 63,51 ± 6 lat, które poddano zabiegowi z użyciem płucoserca (CPB).Śródoperacyjnie i we wczesnym okresie pooperacyjnym nie obserwowano przypadków śmiertelnych. Średnia liczba wykonanych pomostów wyniosła 2,27 ± 0,3 (grupa OPCAB) i 2,63 ± 0,6 (grupa operacji w krążeniu pozaustrojowym/grupa CPB) (Istotną zaletą techniki OPCAB jest związana z nią możliwość zmniejszenia częstości transfuzji preparatów krwi.

Despite substantial financial aid from international donors for procurement of health products, stockouts of life-saving drugs related to prevalent infectious diseases are still widespread in Africa. Rigorous research to understand the underlying causes of these stockouts is lacking. To this end, we study the relationship between The Global Fund to Fight AIDS, Tuberculosis and Malaria and its grant recipients. Specifically, we leverage historical fund disbursement and drug procurement data from 2002 to 2013 to build a discrete-event simulation model predicting the joint impact of procurement and grant disbursement processes on national drug availability for the Global Fund's recipient countries in Africa. This model is validated against cumulative stockout levels inferred from historical grant implementation lengths, and used to evaluate potential high-level modifications in the disbursement or procurement process. Results show the existence of significant intrinsic stockout risks in most African countries, with particularly high levels in East Africa, due to the unpredictability of fund disbursements and the frequency of grant performance monitoring performed by the Global Fund. Interventions shifting some fund disbursements upfront to protect against disbursement timing uncertainty are predicted to be more effective than others that include regional buffer stocks and bridge financing.

Cilj. Osnovni cilj studije je utvrditi razlike izmeĊu vrednosti pokazatelja oksidativno-stresnog statusa kod bolesnika kojima hirurška revaskularizacija miokarda uraĊena na kucajućem srcu (Off-Pump Coronary Artery Bypass-OPCAB grupa) i bolesnika kojima je revaskularizacija miokarda uraĊena uz pomoć pumpe za vantelesnu cirkulaciju (Cardio-Pulmonary Bypass pump-CPB grupa). Da bi se ostvario osnovni cilj, bilo je potrebno odrediti koncentracije markera oksidativnog stresa-prooksidanasa ili produkata njihovog delovanja na biomolekule, kao i koncentracije ĉinilaca antioksidativne zaštite kod dve grupe bolesnika. TakoĊe, jedan od bitnih ciljeva studije je bio ispitati da li postoji korelacija izmeĊu vremena provedenog na respiratoru, broja dana provedenih na odeljenju intezivne nege, broja dana provedenih u bolnici nakon operacije, broja jedinica primenjene transfuzije krvi, smanjenja telesne teţine nakon operacije (kg), broja bolniĉkih infekcija, kao i brzine i kvaliteta oporavka u obe grupe bolesnika. Jedna od glavnih ideja studije je bila sagledavanje biohemijskih pokazatelja oksidativnog stresa u svetlu kliniĉkih parametara kod OPCAB hirurgije, kao i primena rezultata ove studije u svakodnevnoj kliniĉkoj praksi. Sa tim u vezi, osnovna ideja i koncept studije su bili vezani za reevaluaciju indikacija kod hirurške revaskularizacije miokarda u smislu svakodnevne rutinske primene OPCAB procedura, kao metode izbora. Materijal i metode. Istraţivanje je sprovedeno u vidu kohortne studije, koja je obuhvatila 107 bolesnika podvrgnutih hirurškoj revaskularizaciji miokarda. Bolesnici su bili podeljeni u dve grupe (CPB i OPCAB grupa). U prvoj grupi bolesnika, kojima je revaskularizacija miokarda uraĊena uz pomoć pumpe za vantelesnu cirkulaciju (CPB grupa), je bilo 60 bolesnika. U drugoj grupi bolesnika, kojima je revaskularizacija miokarda uraĊena na kucajućem srcu, je bilo 47 bolesnika... Objective. The main objective of the study is to determine the difference between the value of the oxidative stress status indicators in patients whom surgical revascularization was performed on the beating heart (Off-Pump Coronary Artery Bypass-OPCAB group) and patients who underwent revascularization with the help of pumps for artificial circulation (Cardio-Pulmonary Bypass pump-CPB group). In order to achieve the main objective, it was necessary to determine the concentrations of markers of oxidative stress-prooxidants or products of their action on biomolecules, as well as the concentration of antioxidant protection factors in two groups of patients. Also, one of the essential objectives of the study was to examine whether there is a correlation between the time spent on a ventilator, the number of days spent on the intensive care unit, the number of days spent in the hospital after the surgery, the number of units applied blood transfusion, weight loss after surgery (kg ), the number of hospital infections, as well as the speed and quality of recovery in both groups of patients. One of the main ideas of the study was assessment of biochemical indicators of oxidative stress in the terms of clinical parameters in OPCAB surgery, as well as the application of the results of this study in everyday clinical practice. In this regard, the basic idea and the concept of the study were related to the re-evaluation of indications in coronary artery bypass surgery in terms of the everyday routine application of OPCAB procedures, as a method of choice. Materials and Methods. The study was carry out in the form of cohort study, which included 107 patients undergoing surgical myocardial revascularization...

Laat de economen van het Centraal Planbureau het debat in ons land niet domineren, betogen Peter Ester en Esther-Mirjam Sent.

Laat de economen van het Centraal Planbureau het debat in ons land niet domineren, betogen Peter Ester en Esther-Mirjam Sent.

Background: Several factors have been historically advocated to explain the coagulative and inflammatory disorders following cardiopulmonary bypass (CPB). In this paper, we describe the presence of circulating non-hematological cells, introduced within the bloodstream during CPB. We defined the origin of the cells and tested their impact on coagulation. Methods: We collected peripheral arterial blood samples in twenty consecutive coronary artery bypass graft cases at four different surgical moments and assessed the presence and nature of circulating cells with the use of the CELLSEARCH® Test, immunocytochemistry and immunofluorescence, evaluating the expression of cytokeratin and calretinin. The effect of the circulating non-hematological cells on coagulation was tested in vitro, using the ROTEM assay. Results: A mean of 263.85 ± 57.5 (median 258.5) cells were present in the samples following the suction of blood from the surgical field while all the other samples were negative (zero cells) (pConclusion: The presence of circulating non-hematological cells during CPB with a mesothelial immunophenotype alters in vitro coagulation assays. This finding can help to further understand the pathophysiology of CPB.

Cardiopulmonary bypass (CPB) leads to systemic and cardiac inflammation. Although the intraoperative blood measurement of some inflammatory cytokines has been recognized as an useful tool in clinical setting, postoperative management still represents a major problem; hence, knowledge about additional possible mediator(s) in time of this process would potentially turn in a clinical benefit. CXCL10 has been shown to be involved in cardiac immune-inflammatory processes. Herein, we aimed to investigate whether and how this chemokine could be a possible early mediator and indicator of inflammation development during CPB. Since cardiac, endothelial and immune cells are all sources of CXCL10, our purpose was also to investigate in vitro CXCL10 secretion pattern in time by those cell types. In thirteen patients undergoing CPB, CXCL10, CXCL9, IL-6, IL-8 and IL-10 have been measured by Elisa in serum withdrawn at eight different perioperative times. Sera from healthy subjects have been tested for comparison. The same cytokines have been measured by Elisa in time-course experiments onto human isolated cardiomyocytes, endothelial and CD4+ T cells under inflammatory stimuli. TaqMan Real-Time RT-PCR and immunocytochemistry were used for endothelial cell characterization. CXCL10 level was higher in CPB patients before surgery as compared to healthy subjects; CXCL10 level raises earliest in serum of CPB patients and in isolated cardiomyocytes under inflammatory stimuli as compared to other cytokines. CXCL10 might represent a critical early factor in mediating systemic and local cardiac inflammatory response in subjects undergoing CPB, offering opportunity for future monitoring or therapeutic interventions.

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.

Leishmania infantum is the causative agent of infantile visceral leishmaniasis (IVL) in the Mediterranean Basin and, based on isoenzyme typing of the parasite isolated from dogs; this parasite was considered to predominate in the all foci of IVL in Iran. However, based on PCR detection and sequencing of parasite Cysteine Protease B (CPB), only one out of seven sandfly infections in Phlebotomus perfiliewi transcaucasicus was found to be L. infantum in the current investigation. The six other infections were haplotypes of Leishmania donovani, the causative agent of anthroponotic visceral leishmaniasis (AVL) in West Africa and India. The deduced amino acid of the L. donovani haplotype was found to be novel and the shortest CPB protein reported within the Leishmania spp. Circulation of both L. donovani and L. infantum by P. perfiliewi transcaucasicus, in addition to previous data indicating its ability to circulate L. tropica, suggests that this species, like other vectors of VL, is a permissive vector. Finding L. donovani infecting P. perfiliewi transcaucasicus in the area demands extensive and intensive typing of natural Leishmania infections in epidemiological investigations in Iran and the Mediterranean Basin in general.

Summary Hypomagnesaemia is a common complication after cardiopulmonary bypass (CPB) and predisposes to the development of cardiac arrhythmias. Previous studies showed that intravenous magnesium reduces the incidence of postoperative cardiac arrhythmias but it also inhibits platelet function. Our aim was to compare the postoperative blood loss in patients not receiving magnesium after CPB with the group who received magnesium and to compare the requirement of blood, fresh frozen plasma (FFP) and platelets within 24 hours after surgery. This prospective randomized controlled study was conducted in 80 adult patients on oral aspirin undergoing elective CABG requiring CPB. Group A patients had not received magnesium infusion after recovery from CPB. Group B patients received magnesium infusion after recovery from CPB. Postoperative bleeding was assessed in both the groups. All the data were statistically analyzed. There was a insignificant increase in 24 hours postoperative drainage in magnesium recipient group compared to control group (p>0.05). Requirements of blood and blood products to maintain haematocrit and coagulation profile revealed insignificant (p > 0.05). Increase in requirement of PRC, FFP and platelets in magnesium recipient patients than the control group. Incidence of atrial fibrillation (Gr A 2.5%, Gr B 2.5%) and atrial extrasystoles (Gr A 2.5%, Gr B 10%) revealed comparable (p > 0.05) between the groups, but incidence of ventricular arrhythmias were significantly (p

Surgery and anaesthesia are known to cause stress response. Attenuation of stress response can decrease morbidity, postoperative hospital length of stay and, thus, cost. Intrathecal and epidural techniques produce reliable analgesia in patients undergoing surgery along with stress response attenuation. The present study was undertaken to evaluate the efficacy of caudal sufentanil and bupivacaine combination on perioperative stress response in paediatric patients undergoing open heart surgery. Thirty patients (ASA grade II-III) undergoing elective corrective cardiac surgery for acyanotic congenital heart disease, were randomly allocated to two groups. In group GA ( n = 15), patients received balanced general anaesthesia. In group GC ( n = 15), in addition to general anaesthesia, caudal block with bupivacaine and sufentanil combination was given after endotracheal intubation. Monitoring included electrocardiography, invasive arterial pressure, end-tidal carbon dioxide, pulse oximetry, arterial blood gases including serum electrolytes, blood glucose, serum cortisol, urine output, central venous pressure and temperature. Haemodynamic responses in both groups were statistically similar. Serum cortisol levels were significantly lower in GC group than GA group ( P < 0.05) after sternotomy (9.8±7.5 vs. 34.74±27.35), on cardiopulmonary bypass (CPB) (12.17 ± 6.2 vs. 35.36 ± 24.15), after sternal closure (14.03 ± 5.1 vs. 37.62 ± 20.69), 4 hours (26.64 ± 14.61 vs. 37.62 ± 9.13) and 24 hours (14.30 ± 8.11 vs. 28.12 ± 16.31) after intubation. Blood glucose levels were significantly higher in GA group as compared to GC group at sternal closure (277.46 ± 77.25 vs.197.73 ± 42.17) and 4 hours (255.26 ± 73.73 vs. 185.26 ± 57.41) after intubation ( P < 0.05). To conclude, supplementation of caudal epidural bupivacaine and sufentanil could effectively attenuate the stress response in paediatric patients undergoing cardiac surgery under CPB in acyanotic congenital heart anomaly.

Activation of inflammatory response during cardiopulmonary bypass (CPB) may lead to considerable post-operative mortality. Recently, pentoxifylline (PTX), a methylxanthine derivative, has been reported to be effective in inhibiting proinflammatory cytokine production. This study aimed to determine whether or not PTX prevented CPB-induced systemic inflammatory response syndrome (SIRS) in patients undergoing cardiovascular surgery. Thirty adult patients were randomly separated into 2 experimental groups and 1 control group of 10 patients each. The experimental group received peroral PTX administration (Group 1: 600 mg/day, Group 2: 900 mg/day), while the control group did not. In Group 1 and Group 2, PTX administration was started on preoperative day 5 and continued for 5 days. Serum levels of PTX and IL-6 were measured just before and at 4 h after CPB using HPLC and ELISA, respectively. Respiratory index (RI) before and at 4 h after CPB was calculated, and serum levels of C-reactive protein (CRP) and fibrinogen on postoperative day 1 were also determined. There were no significant differences in age, body weight, sex, surgical procedures, CPB time, haemodynamics or risk factors among the 3 groups. Serum IL-6 level and RI index after CPB in Group 2 were significantly decreased compared with those in Group 1 and the control group. These results, therefore, suggested that preoperative daily administration of 900 mg/day PTX contributed to the attenuation of CPB-induced SIRS and had a beneficial effect on the postoperative course after cardiovascular surgery.

Mestrado em Engenharia Química Apesar da sua grande importância e necessidade em diferentes áreas cientificas e industriais, existe ainda uma falta de dados experimentais de coeficientes de difusão em dióxido de carbono supercrítico (SC-CO2) e outros solventes. Por esta razão, o principal objetivo deste trabalho foi a medição de difusividades, D12, de complexos acetilacetonato metálicos em SC-CO2 e em etanol, recorrendo a dois métodos cromatográficos. A medição experimental de D12 do acetilacetonato de crómio, Cr(acac)3, em SCCO2 foi efetuada pelo método de Resposta a um Impulso Cromatográfico, CIR. Esta metodologia foi até agora explorada unicamente pelo grupo do Professor Funazukuri no Japão, e com esta dissertação tornamo-nos no segundo grupo a implementá-la a nível mundial. A validação do equipamento e do procedimento experimental foi feita medindo difusividades de Pd(acac)2 e de fenol em SC-CO2, para os quais há valores de D12 publicados na literatura; para o efeito foram preparadas misturas de fenol em acetona e de Pd(acac)2 em clorofórmio. As difusividades do Cr(acac)3 em SC-CO2 foram determinadas no intervalo de temperaturas 308.15–333.15 K e no intervalo de pressões 125–250 bar, encontrando-se os seus valores entre 0.570×10−4 cm2/s e 1.529×10−4 cm2/s. Numa segunda parte do trabalho experimental, as medições de D12 do Cr(acac)3, Pd(acac)2, Ni(acac)2 e VO(acac)2 em etanol líquido foram feitas à pressão atmosférica, entre 308.15 e 333.15 K, pelo método de Abertura do Pico Cromatográfico, CPB. Em termos teóricos, realizou-se um estudo detalhado dos dados obtidos, analisando-se as suas dependências com a temperatura, pressão, densidade do solvente e coordenadas de Stokes-Einstein. Compararam-se ainda os valores obtidos com os de outros complexos acetilacetonato metálicos reportados na literatura. Seguidamente estimaram-se as difusividades dos vários solutos com vários modelos. Verificou-se que os diversos modelos em estudo produziram genericamente bons resultados em SC-CO2 (erros médios entre 1.95 e 3.8 %), `a exceção ao da correlação de Reddy-Doraiswamy (erro de 98.0 %), de Tyn-Calus (erro de 13.2%), Wilke-Chang (erro de 8.9 %) e Catchpole-King (erro de 7.81 %) . No caso dos dados em etanol os melhores resultados foram fornecidos pelas equações de Magalhães et al.. Em termos mecanísticos, confirmou-se que as difusividades seguem um comportamento hidrodinâmicos e são bem interpretadas pela teoria do volume livre. Mostrou-se ainda que os diâmetros efetivos dos solutos estudados dependem apenas da temperatura. Por último, com o objetivo de superar as limitações das expressões da literatura, trabalhou-se no desenvolvimento de um modelo estatístico para D12, e para tal completou-se uma base de dados já existente, constituída por 156 sistemas e 4425 pontos, tendo-se acrescentado vários descritores moleculares dos solutos e solventes. Despite their importance and necessity in different scientific and industrial areas, there is a lack of experimental diffusion coefficients in supercritical carbon dioxide (SC CO2) and other solvents. For this reason, the main objective of this work was the measurement of diffusivities, D12, of metallic acetilacetonate complexes in SC-CO2 and ethanol, by two chromatographic methods. The D12 experimental measurements of chromium acetilacetonate, Cr(acac)3, in SCCO2 were performed by Chromatographic Impulse Response method , CIR. This methodology has been, so far, solely explored by Professor Funazukuri’s group in Japan, us becoming the second group to implement it at a worldwide level with this dissertation. The validation of experimental equipment and procedure was carried out by measuring the diffusivities of Pd(acac)2 and phenol in SC-CO2, for which various D12 data are published in the literature; for this, solutions of phenol in acetone and Pd(acac)2 in chloroform were prepared. The diffusivities of Cr(acac)3 in SC-CO2 were determined in the temperature range of 308.15-333.15 K and pressure range of 125-250 bar, providing D12 values between 0.570×10−4 cm2/s and 1.529×10−4 cm2/s. On the second part of this experimental work, the D12 measurements of the Cr(acac)3, Pd(acac)2, Ni(acac)2 e VO(acac)2 in ethanol liquid were performed at atmospheric pressure, between 308.15 and 333.15 K, by the Chromatographic Peak Broadening method, CPB. In theoretical terms, a detailed study to the dependencies of D12 upon temperature, pressure, density and Stokes Einstein coordinates was performed. Additionally, a com parison of the obtained values with other metal acetylacetonate complexes, reported in the literature, was made. Then, the diffusivities of the different solutes were estimated with various models. It was found that the models provided good results for SC-CO2 data (average error between 1.95 and 3.6 %) with the exception of ReddyDoraiswamy (error 98.0 %), the Tyn-Calus (error 13.2%), Wilke-Chang (error 8.9 %) and e Catchpole-King (error 7.81 %). Regarding ethanol’s data, the best results were achieved by the equations of Magalh˜aes et al.. In mechanistic terms, it was confirmed the diffusivities follow a hydrodynamic behaviour and are well interpreted by the free volume theory. It was also shown that the effective diameters of the studied solutes depend solely on the temperature. Finally, in order to overcome the literature expressions limitations, work was made on developing a D12 statistical model, for which a data base comprised of 156 systems and 4425 points was completed with the molecular descriptors of solutes and solvents.

Background: The primary objective of the study was to evaluate the effect of nitoglycerine (NTG) and sodium nitroprusside (SNP) on serum lactate (S. lactate), mixed venous oxygen saturation (SvO2), and mixed venous arterial carbon dioxide difference (V-ACO2) during cardiopulmonary bypass (CPB). The secondary objectives included the effect on mortality, end organ dysfunction, requirement of vasopressors, duration of mechanical ventilation (MV), intensive care unit (ICU) stay and hospital stay. Materials and Methods: A prospective randomized single blinded study was conducted in 40 patients aged between 20 years and 70 years who underwent cardiac surgery on CPB. The patients were randomly divided into Group N (n = 20) receiving NTG (0.5–2 mic/kg/min) and group S (n = 20) receiving SNP (0.5–2 mic/kg/min) from the commencement of total CPB up to complete rewarming (nasopharyngeal temperature >36.5°C). Arterial blood gases and S. lactate were measured at baseline, after institution of total bypass, after completion of cooling and rewarming, at weaning off CPB and admission to ICU. Venous blood gas (VBG) was sampled from the venous reservoir immediately after institution of total bypass and completion of rewarming. Urine output, dose of rescue vasodilator, use of inotropes and vasopressor after CPB, end organ dysfunction, duration of MV, ICU, and hospital stay were noted. Results: Though the SvO2at the end of CPB decreased significantly from the baseline (P < 0.05), it was similar between the groups. There was no difference in V-ACO2too. The S. lactate markedly increased (P = 0.00) from the baseline; however, only the S. lactate at admission to ICU was significantly lower in Group S (P = 0.034). There was no difference in mortality, end organ dysfunction, requirement of vasopressors, duration of MV, ICU, and hospital stay. Conclusion: The authors showed that S. lactate increased with CPB and this increase did not correlate with SvO2and V-ACO2. NTG and SNP were comparable in their effect on indices of tissue perfusion.

Rationale: Ebstein anomaly is a common congenital heart disease that may induce severe tricuspid regurgitation and dilation of the “atrialized” portion of the right ventricle. Patients who undergo surgery to correct Ebstein anomaly are at high risk of postoperative right-sided heart failure, yet little is known about what pre-, peri-, or postoperative procedures may help reduce this risk. Patient concerns: Here, we describe 3 cases of adults with Ebstein anomaly who underwent corrective surgery and in whom right-sided heart failure occurred with severe tricuspid regurgitation detected by transesophageal echocardiography. Diagnoses: Ebstein anomaly. Intervention: Various approaches were applied to prevent right heart failure: perioperative control of atrial and ventricle arrhythmia, protection of myocardium, reduction of right-side cardiac workload after cardiopulmonary bypass, and mechanical support for right heart. Outcomes: One of the 3 patients died, another experienced kidney failure despite postoperative support on extracorporeal membrane oxygenation, and the third patient survived without complications. Lessons: Our case series suggests that surgical prognosis can be improved through aggressive preoperative treatment, vasoactive and anti-arrhythmia medications, and comprehensive measures designed to reduce myocardial injury, prevent myocardial edema, and reduce pre- and afterload on the right ventricle.

We aim to evaluate in-hospital events and long-term clinical outcomes in patients over 60 years of age with stable coronary artery disease and preserved left ventricular ejection fraction undergoing off-pump or on-pump coronary artery bypass grafting. The MASS III was a single-center randomized trial that evaluate 308 patients with stable coronary artery disease and preserved ventricular function assigned for: 155 to off-pump and 153 to on-pump CABG. Of this, 176 (58.3%) patients were 60 years or older at the time of randomization (90 of-pump and 86 on-pump). The primary short-term end point was a composite of myocardial infarction, stroke, and overall mortality occurring within 30 days after surgery or before discharge, whichever was later. The primary long-term end point was death from any cause within 5 years, non-fatal myocardial infarction between 30 days and 5 years, or additional revascularization between 30 days and 5 years. On-pump CABG had a higher incidence of 30-day composite outcome than off-pump CABG (15,1% and 5.6%, respectively; P = 0.036). However, after the multivariate analysis, this association lost statistical significance, P = 0.05. After 5-year follow-up, there were no significant differences between both strategies of CABG in the composite end points 16.7% and 15.1%; Hazard Ratio 1.07; CI 0.41 – 1.82; P = 0.71, for off-pump and on-pump CABG respectively. On-pump and off-pump CABG achieved similar results of combined events at short-term and 5-year follow-up. Clinical Trial Registration Information—URL: http://www.controlled-trials.com . Registration number: ISRCTN59539154 .

Purpose:High intensity transient signals (HITS) by transcranial Doppler (TCD) have been reported to reflect micro-embolus in cerebral artery. HITS are frequently detected during cardiopulmonary bypass (CPB), however the clinical significance of HITS during CPB is still unknown. In experiments, micro-bubble presented high frequency HITS more than 400 Hz. The present study is designed to elucidate how many HITS with more than 400 Hz were detected during CPB and whether CPB event is associated with the number of those HITS. Methods:Subjects were 4 patients with mitral valve disease and 2 with left atrial myxoma. All the patients underwent open heart surgery with CPB. HITS were detected by TC2020 with 2.0 MHz pulsed Doppler at the middle cerebral artery. Transesophageal echocardiography was undertaken during the surgery and cardiac and aortic microbubbles were observed. Results:The number of HITS during CPB was 1707±1392 (mean±SD). 88.1% of the HITS during CPB had more than 400 Hz. The HITS count rate at the aortic unclamp (105±107/min) and at the bignning of re-beating (117±139/min) was significantly higher (p