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Abstract Background Due to the distinctive nature of cardiac surgery, patients suffering from hereditary spherocytosis (HS) are potentially at a high risk of perioperative complications resulting from hemolysis. Despite being the most prevalent cause of hereditary chronic hemolysis, the standards of surgical management are based solely on expert opinion. Objective We analyze the risk of hemolysis in HS patients after cardiac surgery based on a systematic review of the literature. We also describe a case of a patient with hereditary spherocytosis who underwent aortic valve repair. Methods This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42023417666) and included records from Embase, MEDLINE, Web of Science, and Google Scholar databases. The case study investigates a 38-year-old patient who underwent surgery for an aortic valve defect in mid-2022. Results Of the 787 search results, 21 studies describing 23 cases of HS undergoing cardiac surgery were included in the final analysis. Hemolysis was diagnosed in five patients (one coronary artery bypass graft surgery, two aortic valve bioprosthesis, one ventricular septal defect closure, and one mitral valve plasty). None of the patients died in the perioperative period. Also, no significant clinical hemolysis was observed in our patient during the perioperative period. Conclusions The literature data show that hemolysis is not common in patients with HS undergoing various cardiac surgery techniques. The typical management of a patient with mild/moderate HS does not appear to increase the risk of significant clinical hemolysis. Commonly accepted beliefs about factors inducing hemolysis during cardiac surgery may not be fully justified and require further investigation.

The Drosophila egg chamber (EC) starts as a spherical tissue at the beginning. With maturation, the outer follicle cells of EC collectively migrate in a direction perpendicular to the anterior-posterior axis, to shape EC from spherical to ellipsoidal. Filamentous actin (F-actin) plays a significant role in shaping individual migratory cells to the overall EC shape, like in every cell migration. The primary focus of this article is to unveil the function of different Actin Binding Proteins (ABPs) in regulating mature Drosophila egg shape. We have screened 66 ABPs, and the genetic screening data revealed that individual knockdown of Arp2/3 complex genes and the “capping protein β” (cpb) gene have severely altered the egg phenotype. Arpc1 and cpb RNAi mediated knockdown resulted in the formation of spherical eggs which are devoid of dorsal appendages. Studies also showed the role of Arpc1 and cpb on the number of laid eggs and follicle cell morphology. Furthermore, the depletion of Arpc1 and cpb resulted in a change in F-actin quantity. Together, the data indicate that Arpc1 and cpb regulate Drosophila egg shape, F-actin management, egg-laying characteristics and dorsal appendages formation. [ABSTRACT FROM AUTHOR]

Background: Due to the distinctive nature of cardiac surgery, patients suffering from hereditary spherocytosis (HS) are potentially at a high risk of perioperative complications resulting from hemolysis. Despite being the most prevalent cause of hereditary chronic hemolysis, the standards of surgical management are based solely on expert opinion. Objective: We analyze the risk of hemolysis in HS patients after cardiac surgery based on a systematic review of the literature. We also describe a case of a patient with hereditary spherocytosis who underwent aortic valve repair. Methods: This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42023417666) and included records from Embase, MEDLINE, Web of Science, and Google Scholar databases. The case study investigates a 38-year-old patient who underwent surgery for an aortic valve defect in mid-2022. Results: Of the 787 search results, 21 studies describing 23 cases of HS undergoing cardiac surgery were included in the final analysis. Hemolysis was diagnosed in five patients (one coronary artery bypass graft surgery, two aortic valve bioprosthesis, one ventricular septal defect closure, and one mitral valve plasty). None of the patients died in the perioperative period. Also, no significant clinical hemolysis was observed in our patient during the perioperative period. Conclusions: The literature data show that hemolysis is not common in patients with HS undergoing various cardiac surgery techniques. The typical management of a patient with mild/moderate HS does not appear to increase the risk of significant clinical hemolysis. Commonly accepted beliefs about factors inducing hemolysis during cardiac surgery may not be fully justified and require further investigation. [ABSTRACT FROM AUTHOR]

BackgroundIncreased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).MethodsAfter IRB approval, we reviewed charts of 9,518 patients who underwent cardiac surgery with CPB at three medical centers between July 2001 and June 2015. The relationship between perioperative lipid-lowering treatment and postoperative outcome was investigated. 3,988 patients who underwent CABG met inclusion criteria and were analyzed. Patients were divided into lipid-lowering or non-lipid-lowering treatment groups.ResultsA total of 3,988 patients were included in the final analysis. Compared to the patients without lipid-lowering medications, the patients with lipid-lowering medications had lower postoperative neurologic complications and overall mortality (P

The ventilatory strategy to adopt during cardiopulmonary bypass is still being debated. The rationale for using continuous positive airway pressure or mechanical ventilation would be to counteract alveolar collapse and improve ischemia phenomena and passive alveolar diffusion of oxygen. Although there are several studies supporting the hypothesis of a positive effect on oxygenation and systemic inflammatory response, the real clinical impact of ventilation during cardiopulmonary bypass is controversial. Furthermore, the biases present in the literature make the studies' results nonunique in their interpretation. [ABSTRACT FROM AUTHOR]

There is a global upsurge in the use of cemented paste backfill (CPB) for various mining functions. However, the cost of the Portland cement binder is prohibitive, thus warranting strategies to reduce cement usage without overly diminishing the CPB quality. Since carbon dioxide is used for patented sand moulding processes, this study is premised on that physicochemical ability of CO2 to enhance the curing of consolidated inorganic materials. It evaluated the impact of carbon dioxide on the uniaxial compressive strength UCS and preparation cost of CPB standard samples (ASTM C109). The preparation cost was delimited to the purchase cost of the Portland cement. The backfill material was silica sand tailings with 4.5 wt.% Portland cement binder and a water-cement ratio of 7.6. Distilled water of pH 5.4 was used for the control samples while variable amounts of carbon dioxide were dissolved in distilled water to generate carbonated mixing water with pH values of 3.8; 4 and 4.2. The lower the carbonated water pH, the higher is the CO2 concentration. UCS tests were conducted on the samples after curing for 3, 7, 28, and 90 days. There was an observable increase in the UCSs and reduction in curing time with increasing carbon dioxide. Samples prepared with carbonated water of pH 3.8 had almost double the strength of those prepared with pure distilled water of pH 5.4, implying that more dissolved CO2 corresponds to higher CPB strength. This is supported by the trendline equations for the graphical simulation of strength on curing time. Thus, CPB with much less binder can be expected to attain the requisite UCS if carbon dioxide is incorporated. The average reduction in Portland cement consumption was 0.61 %, which translates to a cost saving of the same percentage points. If calculated over the operational life of a mine, this is a massive saving of millions of dollars.

Simple Summary: Hypoglycemia has not been previously reported as a postoperative complication of mitral valve repair in dogs. However, the authors encountered cases of hypoglycemia after mitral valve repair in dogs. Therefore, this study aimed to determine the incidence of hypoglycemia in dogs after mitral valve repair and investigate its causes. This study revealed that the incidence of hypoglycemia after mitral valve repair was 14.2%, and plasma glucagon concentrations increased in these dogs, whereas serum insulin concentrations decreased compared with preoperative levels. Therefore, hyperinsulinemia or hypoglucagonemia does not appear to be the cause of postoperative hypoglycemia. Furthermore, the results of this study indicate that the risk factors for hypoglycemia were low body weight and asymptomatic myxomatous mitral valve disease. Monitoring blood glucose levels after mitral valve repair should be included in the standard hospitalization plan to prevent hypoglycemic emergencies in dogs. Hypoglycemia has not been previously reported as a postoperative complication of mitral valve repair (MVR) in dogs; however, the authors have encountered cases of hypoglycemia after MVR. This study aimed to determine the incidence of hypoglycemia in dogs after MVR and investigate its causes. Blood glucose levels were measured at multiple timepoints in dogs undergoing MVR. Simultaneously, insulin and glucagon blood concentrations in dogs with hypoglycemia preoperatively and postoperatively were compared to verify the physiological responses to hypoglycemia. Furthermore, risk factors for hypoglycemia, using variables selected based on the characteristics of MVR and dogs undergoing MVR, were examined prospectively. The incidence of hypoglycemia after MVR was 14.2%, and plasma glucagon concentrations increased in these dogs (mean: 260 pg/mL and 644 pg/mL pre- and postoperatively, p < 0.001), whereas serum insulin concentrations decreased (median: 0.50 ng/mL and 0.29 ng/mL pre- and postoperatively, p = 0.002). Therefore, hyperinsulinemia or hypoglucagonemia is unlikely to be the cause of postoperative hypoglycemia. The identified risk factors for hypoglycemia included low body weight and asymptomatic myxomatous mitral valve disease. Monitoring blood glucose levels after MVR should be included in the standard hospitalization plan to prevent hypoglycemic emergencies in dogs. [ABSTRACT FROM AUTHOR]

Background: Postoperative atrial fibrillation (POAF) is frequently observed after cardiac surgery, and duration of Bypass Time (CPB) is an independent risk factor for postoperative atrial fibrillation (POAF). The main objective of the current study was to compare new onset Postoperative Atrial Fibrillation (POAF) in patients undergoing coronary artery bypass graft with and without long CPB time. Methods: A prospective comparative study design was used and conducted at the Cardiac Surgery Department in Bahawalpur- Pakistan which is a tertiary care health centre for the period of April 2020 to February 2021, a total of 110 patients were enrolled after getting institutional approval and informed consent from patients. The ethical protocol was followed throughout the study period. Data was entered and analyzed using SPSS version 25.0 and p-value <0.05 taking the level of significance. Results: A total of 110 patients were enrolled for the research, the average age of patients was 48.56±3.11 (age range 30-70), and there were 38 (34.55%) & 72 (65.45%) male and female patients observed respectively. The atrial fibrillation developed in 3 (5.45) patients in without a long CPB time group as compared with the long CPB time group as 8(14.54%) with a statistically significant p-value of 0.043, postoperative IABP support with an insignificant p-value of 0.234. Conclusion: Postoperative atrial fibrillation in patients undergoing coronary artery bypass graft is significantly higher with long CPB time as compared with without long CPB time. [ABSTRACT FROM AUTHOR]

Mitral valve replacement (MVR) is a surgical procedure to treat mitral regurgitation (MR). As there is an increase in the afterload in the postoperative period, patients tend to have low cardiac output syndrome. This condition may limit oxygen delivery to body tissues. Improved venous saturation has been linked to positive neurological outcomes. Near-infrared spectroscopy (NIRS) is the new technique to monitor regional oxygenation in real time. This study reports on four patients who underwent MVR due to a combination of severe mitral stenosis (MS) and mild MR. All patients had complaints of dyspnea on exertion to unbearable chest pain. Physical and work-up examination led to a diagnosis of decompensated heart failure, concomitant valve disorder, fluid overload, and cardiomegaly. Preoperative catheterization to stratify the risks of the procedure was done on all four patients. The surgery planned was cardiopulmonary bypass (CPB) with standard monitoring and additional NIRS measurement. The measurement of mean arterial pressure (MAP) and NIRS were tightly monitored and maintained in each patient, with the use of vasoactive agents. All four patients suffered unstable hemodynamics and were admitted to intensive care unit with the support of mechanical ventilation and other supportive therapies. Cerebral perfusion can reach the baseline normal value even though in low cardiac output syndrome, and NIRS can predict the outcome of the patients better than the conservative monitoring. [ABSTRACT FROM AUTHOR]

The potato chloroplast was transformed with codon optimized synthetic hybrid cry gene (SN19) to mitigate crop losses by Colorado potato beetle (CPB). The bombarded explants (leaves and internode) were cultured on MS medium supplemented with BAP (2.0 mg/l), NAA (0.2 mg/l), TDZ (2.0 mg/l) and GA3 (0.1 mg/l); spectinomycin 50 mg/l was used as a selection agent in the medium. Leaf explants of cultivar Kuroda induced highest percentage (92%) of callus where cultivar Santae produced the highest percentage (85.7%) of transplastomic shoots. Sante and Challenger showed 9.6% shoot regeneration efficiency followed by cultivar Simply Red (8.8%). PCR amplification yielded 16 postive transplastomic plantlets out of 21 spectinomycin resistant ones. Target gene integration was confirmed by PCR and Southern blot, whereas RT-qPCR was used to assess the expression level of transgene. The localization of visual marker gene gfp was tracked by laser scanning confocal microscopy which confirmed its expression in chloroplasts of leaf cells. The transplastomic plants ensured high mortality to both larvae and adult CPB. Foliage consumption and weight gain of CPB fed on transplastomic leaves were lower compared to the control plants. Sucessful implementation of current research findings can lead to a viable solution to CPB mediated potato losses globally. [ABSTRACT FROM AUTHOR]

Background: Shedding of glycocalyx is relevant to worse prognosis in surgical patients, and elevated levels of serum matrix metalloproteinase-9 (MMP-9) are associated with this phenomenon. This study aimed to investigate the dynamic alterations of serum glycocalyx components and MMP-9 during cardiopulmonary bypass (CPB), and evaluate their predictive capacities for prolonged intensive care unit (ICU) stay, as well as their correlation with coagulation dysfunction. Methods: This retrospective study analyzed serum levels of syndecan-1, heparan sulfate (HS), and MMP-9 at different time points during CPB, and assessed their association with prolonged ICU stay and coagulation dysfunction. Results: Syndecan-1, HS, and MMP-9 exhibited divergent changes during CPB. Serum levels of syndecan-1 (AUC = 78.0 %) and MMP-9 (AUC = 78.4 %) were validated as reliable predictors for prolonged ICU stay, surpassing the predictive value of creatinine (AUC = 70.0 %). Syndecan-1 (rho = 0.566, P

Purpose: Investigate inhaled nitric oxide's influence on mortality rates, mechanical ventilation and cardiopulmonary bypass duration, and length of stay in the intensive care unit and hospital when administered during cardiopulmonary bypass. Methods: Following the PRISMA guidelines, we searched four electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) up to 4th March 2023. The protocol was registered in the PROSPERO database with ID: CRD42023423007. Using Review Manager software, we reported outcomes as risk ratios (RRs) or mean difference (MD) and confidence intervals (CIs). Results: The meta-analysis included a total of 17 studies with 2897 patients. Overall, there were no significant differences in using nitric oxide over control concerning mortality (RR = 1.03, 95% CI 0.73 to 1.45; P = 0.88) or cardiopulmonary bypass duration (MD = −0.14, 95% CI − 0.96 to 0.69; P = 0.74). The intensive care unit days were significantly lower in the nitric oxide group than control (MD = −0.80, 95% CI − 1.31 to −0.29; P = 0.002). Difference results were obtained in terms of the length of stay in the hospital according to sensitivity analysis (without sensitivity [MD = −0.41, 95% CI − 0.79 to −0.02; P = 0.04] vs. with sensitivity [MD = −0.31, 95% CI − 0.69 to 0.07; P = 0.11]. Subgroup analysis shows that, in children, nitric oxide was favored over control in significantly reducing the duration of mechanical ventilation (MD = −4.58, 95% CI − 5.63 to −3.53; P < 0.001). Conclusion: Using inhaled nitric oxide during cardiopulmonary bypass reduces the length of stay in the intensive care unit, and for children, it reduces the duration of mechanical ventilation. [ABSTRACT FROM AUTHOR]

Phosphogypsum (PG) cementitious paste backfill (CPB) was prepared by using PG and fly ash (FA) as the main raw materials, red mud (RM) as the alkaline activator, Portland cement (OPC) as the binder, and silica fume (SF) as the additive, and its properties were investigated to achieve the objective of "treating harm with waste." The results showed that the addition of OPC facilitated the flowability of the slurry, while the addition of RM and SF had the opposite effect. The slurry presented ideal flowability when the water/binder ratio was 0.2 and the superplasticizer (SP) content was 0.7%. The mechanical properties and water resistance were improved significantly with increasing OPC, RM, and SF doping. The strength of the CPB material exceeded 22 MPa after curing at room temperature for 28 days, which met the mine filling requirements. Changes in the ion concentrations of the solution were first monitored during immersion. The dissolution rules of Ca2+ and SO42− at different immersion ages confirmed that RM promoted the continuous hydration of CPB, which was the key to improve water resistance. Microstructural analysis showed that the main hydration products were AFt and C-S-H, which played an important role in the strength development of the material. The leaching results demonstrated that the metal ion content satisfied the requirements of the III categories of Chinese environmental standards (GB/T 14848-2017), indicating that the technology is a reliable and environmentally friendly technology for PG, FA, and RM recovery that can simultaneously support safe mining. [ABSTRACT FROM AUTHOR]

Study objective: Antithrombin (AT) activity is reduced during cardiopulmonary bypass (CPB) surgery. Guidelines has demonstrated that perioperative AT supplementation contributed to blood conservation and prevent perioperative thrombotic complications and target organ injury owing to its role in reducing thrombin generation. But these recommends is lack of support of meta-analysis in the guidelines. This meta-analysis aims to include all the relevant randomized controlled trails (RCT) on patients who experienced cardiac surgeries with CPB and investigate the effect of perioperative AT on blood conservation and complications after cardiac surgery. Methods: Standard published RCTs were searched from bibliographic databases to identify all evidence reporting perioperative AT supplementation for patients undergoing cardiovascular surgeries. The primary outcome was postoperative blood loss, the secondary outcomes were blood component transfusion (red blood cell (RBC), fresh frozen plasma (FFP), platelet and autologous blood), postoperative morbidity and in hospital mortality. The relative risk (RR) for dichotomous outcomes and the standardized mean difference (SMD) for continuous outcomes were estimated using a random-effects model. Trial sequential analysis (TSA) was performed using TSA software 0.9.5.10. Results: 13 RCTs with 996 participants undergoing different cardiovascular surgeries were included. Meta-analysis showed AT did not decrease postoperative blood loss (SMD -0.01, 95%CI -0.2 to 0.19). Subgroup analysis showed the effect of AT on postoperative blood loss was not associated with age, RCT type, surgery type, injection time of AT and AT deficiency. TSA further suggested that no additional studies were required for the stable result. Perioperative AT also did not reduce RBC ((SMD 0.10, 95%CI -0.66 to 0.85), (RR 0.99, 95%CI 0.83 to 1.19)), FFP ((SMD 0.11, 95%CI -0.19 to 0.41), (RR 1.30, 95%CI 0.90 to 1.87)), platelet (RR 1.10, 95%CI 0.83 to 1.46) and autologous blood (SMD 0.46, 95%CI -0.12 to 1.8504) transfusions. Perioperative AT significantly increased in hospital mortality (RR 2.53, 95%CI 1.02 to 6.28) and acute kidney injury (AKI) (RR 3.72, 95%CI 1.73 to 8.04) incidence. There was no significant difference in postoperative reexploration, thromboembolism, ECMO/IABP support, and stroke incidence between AT and non-AT group. Conclusions: With the improvement of AT level and heparin sensitivity, perioperative AT has no significant effect on blood conservation. And it is noteworthy that the treatment increased in hospital mortality and the incidence of AKI after cardiac surgery.

BackgroundPostoperative delirium (POD) is a significant complication observed in cardiac surgery patients, characterized by acute cognitive decline, fluctuating mental status, consciousness impairment, and confusion. Despite its impact, POD often goes undiagnosed. Postoperative fever, a common occurrence after cardiac surgery, has not been comprehensively studied in relation to delirium. This study aims to identify perioperative period factors associated with POD in patients undergoing cardiopulmonary bypass, with the potential for implementing preventive interventions.MethodsIn a prospective observational study conducted between February 2023 and April 2023 at the Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, a total of 232 patients who underwent cardiac surgery were enrolled. POD assessment utilized the Confusion Assessment Method for the ICU (CAM-ICU), while high fever was defined as a bladder temperature exceeding 39°C. Statistical analysis included univariate and multivariate analyses, logistic regression, nomogram development, and internal validation.ResultThe overall incidence of postoperative delirium was found to be 12.1%. Multivariate analysis revealed that postoperative lactate levels [odds ratio (OR) = 1.787], maximum temperature (OR = 11.290), and cardiopulmonary bypass time (OR = 1.015) were independent predictors of POD. A predictive nomogram for POD was developed based on these three factors, demonstrating good discrimination and calibration. The prediction model exhibited a C-statistic value of 0.852 (95% CI, 0.763–0.941), demonstrating excellent discriminatory power. Sensitivity and specificity, based on the area under the receiver operating characteristic (AUROC) curve, were 91.2% and 67.9%, respectively.ConclusionThis study underscores the high prevalence of POD in cardiac surgery patients and identifies postoperative lactate levels, cardiopulmonary bypass duration, and postoperative fever as independent predictors of delirium. The association between postoperative fever and POD warrants further investigation. These findings have implications for implementing preventive strategies in high-risk patients, aiming to mitigate postoperative complications and improve patient outcomes.

Plant preference in agricultural pests is a prerequisite for expansion onto cultivated crops, but there has been limited research on how an insect determines host plant suitability. We investigated Colorado potato beetle Leptinotarsa decemlineata (CPB) performance on various populations of the wild potato Solanum jamesii (jam), with which it has overlapping natural range in the southwest USA. Herbivory was measured in no-choice feeding assays in the greenhouse and common garden field plots in Wisconsin. The jam populations were categorized according to whether CPB had been observed to be present in the wild in germplasm collection records. Herbivory on all jam populations was very low compared to the tuberosum cultivar control. In the no-choice greenhouse assay, all jam were equally consumed by CPB. But in field plots where choice was allowed, CPB were significantly more attracted to jam populations on which CPB had been observed in the wild. Although documenting the presence of CPB on wild jam populations was non-systematic and qualitative in germplasm collecting expeditions over multiple years, that observation does appear to have some value in predicting which jam will be more attractive to CPB in Wisconsin field conditions. [ABSTRACT FROM AUTHOR]

The development of low-traumatic surgical drains aimed at maximum possible separation of blood and air, is an important trend in modern medicine. The objective of this work is to create an inexpensive, user-friendly and low-traumatic dynamic blood aspiration system (DBAS). The system allows effective separation of blood and air when drawing blood from a wound under vacuum conditions required for blood aspiration. The operating principle of the system is to separate liquid and gas fractions of the blood-air mixture by modifying the blood intake cannula. The effect is achieved by applying the principles of centrifugal forces of a rotating blood-air flow combined with Archimedes lift forces.

Widya Istanto Nurcahyo,1 Suharyo Hadisaputro,2 Zainal Muttaqin,3 Cindy Elfira Boom,4 Chandra Hermawan Manapa,1 Taufan Pramadika,1 Dodik Tugasworo5 1Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia; 2Postgraduate Faculty of Medicine, Diponegoro University, Semarang, Central Java, Indonesia; 3Neurosurgery Department, Faculty of Medicine, Diponegoro University/Kariadi General Hospital, Semarang, Central Java, Indonesia; 4Anaesthesiology Department and Intensive Therapy, National Cardiovascular Center, Harapan Kita Hospital, Jakarta, Indonesia; 5Neurology Department, Faculty of Medicine, Diponegoro University/Kariadi General Hospital, Semarang, Central Java, IndonesiaCorrespondence: Widya Istanto Nurcahyo, Anaesthesiology Department and Intensive Therapy, Faculty of Medicine, Diponegoro University, Semarang, Central Java, 50725, Indonesia, Fax +62 2476928010, Email widya_istanto2@yahoo.com; widya.instanto.dr@gmail.comIntroduction: On-pump, coronary artery bypass grafting (CABG) is the most common cause of postoperative cognitive dysfunction (POCD) after cardiac surgery. Previous studies showed that the incidence of POCD after cardiac surgery was 60%, higher than non-cardiac surgery with 11.7%. Glial fibrillary acid protein (GFAP) is one of the sensitive biomarkers of brain damage. Previous studies have found that elevated GFAP serum is associated with cognitive impairment. This study aims to measure the difference in GFAP levels in POCD and non-POCD patients after CABG on-pump surgery.Methods: This study is a retrospective cohort design study. The data were obtained from 56 subjects undergoing elective CABG on the pump surgery enrolled into two groups consisting of 28 POCD as a case group and 28 non-POCD as a control group. In this study, the ELISA method measured the levels of GFAP biomarkers within 24 hours after surgery. After 72 hours, the patient received a MoCA-INA examination to determine cognitive impairment. Data analysis was carried out by SPSS 23.00 software.Results: The mean age of patients in both groups was 60 years and was dominated by males (> 85%). POCD patients were found to have a significantly longer duration of cardiopulmonary bypass (CPB) and cross-clamp surgery than non-POCD patients (p = 0.002 and p = 0.004). Postoperative GFAP levels in POCD patients were significantly higher than in non-POCD patients (12.95 ± 7.47 vs 3.80 ± 2.77, p < 0.001). There was a significant increase in GFAP levels compared with non-POCD (8.28 ± 7.24 vs − 1.5 ± 3.03, p < 0.001). The area under the curve (AUC) value of GFAP against POCD was 0.887, cut-off GFAP 4.750 with a sensitivity of 92.9% and a specificity of 71.4%.Conclusion: POCD patients had higher GFAP levels than non-POCD patients. There are differences in GFAP levels in patients with POCD and non-POCD post-CABG surgery.Keywords: GFAP, POCD, CPB, MoCa-INA

Leishmania (L.) infantum strains, isolated from varying hosts and clinical manifestations (cutaneous, visceral and canine leishmaniasis), were investigated in order to understand the genetic polymorphisms within this species in Algeria and Tunisia. Two DNA‐based typing methods were tested in order to evaluate their effectiveness against Multilocus enzyme electrophoresis (MLEE), widely considered as the reference method for Leishmania parasite typing. On the other hand, MLEE is cumbersome, high‐cost, time consuming and frequently does not detect intra‐species genetic polymorphisms. In this work, we used two molecular target regions to discriminate L. infantum strains, Internal transcribed spacer 1 (ITS1) and the cysteine proteinase B (cpb). The ITS1 region offers good resolution for Leishmania discrimination but does not spotlight intra‐species polymorphisms. In contrast, cpbE and cpbF PCR‐Sequencing demonstrated a certain variability within CL and VL Algerian and Tunisian L. infantum isolates. Following phylogenetic analyses of 44 L. infantum isolates, two main groups were identified, a group with 39 bp deletion in the cpb sequence, composed of cutaneous, visceral and canine isolates from both countries with no significant clinical or geographic distribution; these samples were typed as MON‐1, MON‐24, and MON‐80 zymodemes. A second group which presents a clear clusterization of Tunisian cutaneous strains belonging to the L. infantum MON‐24. This group, with no deletion in the mature domain of the cpb gene sequence, should be further explored with a higher number of samples. [ABSTRACT FROM AUTHOR]

Objectives: Patients with Tetralogy of Fallot (TOF) undergoing corrective surgery experience a vast majority of pulmonary, cardiac, and renal dysfunction due to the effect of cardiopulmonary bypass (CPB). Tumor necrosis factor-α (TNF-α) is a pro-inflammatory cytokine that has been shown to play a major role in systemic inflammatory response syndrome secondary to CPB. The rise of level of inflammatory mediator may serve as a clue for post-operative organ dysfunction and may determine the post-operative course of the patient. They may enable us to detect morbidity earlier, thereby taking steps to decrease the same. We have done this study with the aim to evaluate changes in serum concentration of TNF-α in patients with TOF undergoing intracardiac repair (ICR) on CPB and correlate changes in its level with correlate them with clinical outcome and mortality. Material and Methods: TOF patients divided into two groups (< and >15 years) after approval from the ethics committee and written informed consent were enrolled in this prospective and observational study with ICR on CPB. Routine anesthesia and CPB as per AIIMS protocol were performed on all the patients. Routine arterial blood gas, heart rate, mean arterial pressure, temperature, and urine output monitoring were done in all cases. Arterial blood samples were collected at three time intervals - T1, T2, and T3 and processed for biomarker level detection by Enzyme-linked immunosorbent assay method. Appropriate statistical analysis was done for the correlation between biomarkers and clinical variables. Results: There were no significant differences between the two groups in terms of gender distribution, CPB time, and aortic cross-clamp time. Duration of mechanical ventilation, inotropes use, intensive care unit stay, and hospital stay were all significantly prolonged (P < 0.001) in Group 1 (age <15 years) when compared to Group II (age more than 15 years). Conclusion: Level of TNF-α correlated significantly with duration of mechanical ventilation, ionotrope use, intensive care unit stay, and hospital stay in children <15 years. However, a larger study population is required to further prove this hypothesis. [ABSTRACT FROM AUTHOR]

Aim: Long non-coding RNA (lncRNA) can be used as a biological marker for the diagnosis and treatment of various diseases. The study aimed to detect changes in the expression of lncRNA for urothelial carcinoma associated 1 (UCA1) in patients with cardiopulmonary bypass (CPB)-induced acute respiratory distress syndrome (ARDS). Clinical values and cell function in ARDS were explored.Method: In total, 195 patients without CPB-induced ARDS were included in the control group, and 85 patients with ARDS were included in the ARDS group. Serum UCA1 levels were measured by quantitative real-time polymerase chain reaction. A549 was used for the cell experiments by establishing oxygen-glucose deprivation/reperfusion (OGD/R) cell models, and the cell viability and apoptosis were tested. The concentration of inflammatory factors was tested by an enzyme-linked immunosorbent assay. A luciferase reporting assay was applied for target gene analysis.Results: Quantitative real-time polymerase chain reaction revealed a gradual increase in serum UCA1 in both control and ARDS cases, and patients with ARDS had higher levels of UCA1 than those in the control group. Serum UCA1 was positively correlated with serum tumour necrosis factor-α and interleukin-6 concentration in patients with ARDS. UCA1 had the ability to distinguish patients with ARDS from those without it. UCA1 inhibition protected against lung injury and inhibited cell inflammation in vitro. MicroRNA (miR-182-5p) was downregulated in OGD/R-induced cell models and sponged by UCA1.Conclusions: Elevated expression of UCA1 may be associated with the occurrence of ARDS after CPB surgery. The regulatory role of UCA1 in ARDS might be related to inflammation and downregulated miR-182-5p in alveolar epithelial cells. [ABSTRACT FROM AUTHOR]

The overall survival rate of extracorporeal life support (ECLS) remains at 60%. Research and development has been slow, in part due to the lack of sophisticated experimental models. This publication introduces a dedicated rodent oxygenator ("RatOx") and presents preliminary in vitro classification tests. The RatOx has an adaptable fiber module size for various rodent models. Gas transfer performances over the fiber module for different blood flows and fiber module sizes were tested according to DIN EN ISO 7199. At the maximum possible amount of effective fiber surface area and a blood flow of 100 mL/min, the oxygenator performance was tested to a maximum of 6.27 mL O2/min and 8.2 mL CO2/min, respectively. The priming volume for the largest fiber module is 5.4 mL, while the smallest possible configuration with a single fiber mat layer has a priming volume of 1.1 mL. The novel RatOx ECLS system has been evaluated in vitro and has demonstrated a high degree of compliance with all pre-defined functional criteria for rodent-sized animal models. We intend for the RatOx to become a standard testing platform for scientific studies on ECLS therapy and technology. [ABSTRACT FROM AUTHOR]

Bone marrow (BM)-derived polymorphonuclear leukocytes (PMNs) and monocytes (MO) induced by cardiopulmonary bypass (CPB) are highly proteolytic and cause postoperative lung injury. Although CCL23/Myeloid progenitor inhibitory factor-1 is a human CC chemokine with potent suppressor effects on myeloid progenitor cells, in vivo inhibitory effects on BM-derived leukocyte kinetics associated with CPB are unknown. Two-hour CPB was surgically performed in cynomolgus monkeys and BM-derived leukocytes kinetics were monitored postoperatively by flow cytometry with 5'-bromo-2'-deoxyuridine (BrdU) and cytokine ELISA. Monkeys were given CCL23 (n=5) or saline (control, n=5) intravenously daily for 3 days before BrdU labelling and peripheral blood/bronchoalveolar lavage fluid (BALF) timepoint sampling to reveal BrdU-labelled cells. Levels of cytokines, CD11b, and L-selectin were considered leukocytic activation markers. The CCL23 treatment significantly prolonged BM transit of leukocytes (PMNs, 118.4±11.7–95.5±4.1 hours [control]; MO, 91.6±5.0–62.0±3.0 hours [control]) and reduced their alveolar appearance. The BM pool size of MO was decreased by CCL23 but PMNs were unaffected. CD11b, L-selectin expression of PMNs and MO during CPB, and post-surgical increases of interleukin (IL)-6, IL-8, TNF-α, MCP-1, and PMN elastase in the BALF were not suppressed. CCL23 treatment slows turnover of PMN and MO progenitors in BM and suppresses their circulatory release and lung recruitment. CCL23 has inhibitory effects specifically on the CPB-induced BM response and could hold value for preventing CPB-induced lung injury. [ABSTRACT FROM AUTHOR]

Aerodynamics, vital to voice production forms an important correlate of voice. The study aimed to compare subjective vocal aerodynamic measures in teachers and nonteachers and verify the effects of a few known occupational risk factors on the voice of teachers. Group 1 consisted 264 female and 42 male teachers, teaching languages and/or core subjects for a minimum of 5 years, between 30 and 45 years from the local schools of the city and surrounding nine taluks. Group 2 had 100 female and 33 male nonteachers aged 30–45 years. Audio-recordings were done individually during the midweek and in the middle of the day in a quiet environment at schools (school library) using portable digital audio recorder. Tasks: (a) Maximum Phonation time (MPT): maximum sustained productions of vowels /a/, /i/, /u/ and fricatives /s/, /z/ at comfortable pitch and loudness were noted in seconds, (b) s/z ratio computed from phonations of /s/ and /z/ sounds, and (c) Counts per Breath (CPB): counting of maximum numbers either in Kannada or English languages in a single breath. Results confirmed statistically significant increased mean values for all the measured parameters in male compared to the female participants in both groups. However, Nonteachers showed better results in almost all measured parameters compared to the teachers. Effects of known ooccupational risk factors showed mixed results and the details are discussed. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary bypass may cause malfunction in the myocardium. Cuproptosis is a novel cell death aggregating mitochondrial proteins. However, the research on cardiopulmonary bypass‐caused heart tissue injury in immune infiltration and cuproptosis is limited. Method: Immune infiltration, enrichment analysis, protein−protein interaction network, and medication prediction are applied to reanalysis differentially expressed genes and cuproptosis‐related genes in gene expression omnibus data set GSE132176. Results: Seven cuproptosis related genes (PDHA1, LIPT1, LIAS, DLST, DLD, DLAT, and DBT) and dendritic cells and Th1 cells are involved in heart tissue injury in response to surgery with cardiopulmonary bypass. Conclusions: Immune infiltration and cuproptosis are potential mechanisms by which cardiopulmonary bypass surgery may cause damage to heart tissue, which may be a new therapeutic target. [ABSTRACT FROM AUTHOR]

Objectives: Cardiopulmonary bypass (CPB) is a major part of cardiac surgery that provokes systemic inflammatory reactions, myocardial ischemia, and ischemia and reperfusion damage. The aim of this study is to summarize the available evidence and evaluate whether exogenous nitric oxide administered via CPB circuits can improve recovery after cardiac surgery in children. Method: A comprehensive search of the PubMed Medline, Ovid, Cochrane Library and Embase databases was conducted in September 2022. Only randomized controlled trials that compared nitro oxide with placebo or standard care were included. Results: This pooled analysis included 5 RCTs containing 1642 patients. There were significant differences in the duration of postoperative mechanical ventilation between the nitric oxide group and the control group (mean difference −5.645 h; 95% CL = −9.978, −1.313; P = 0.01). Meta-analysis of the length of ICU stay and hospital stay showed no significant differences. Conclusion: Delivering nitric oxide via CPB in pediatric cardiac surgery has an effect on reducing the duration of mechanical ventilation. Considering the small effect size, we should be cautious and think comprehensively in clinical practice.

Hypoglycemia has not been previously reported as a postoperative complication of mitral valve repair (MVR) in dogs; however, the authors have encountered cases of hypoglycemia after MVR. This study aimed to determine the incidence of hypoglycemia in dogs after MVR and investigate its causes. Blood glucose levels were measured at multiple timepoints in dogs undergoing MVR. Simultaneously, insulin and glucagon blood concentrations in dogs with hypoglycemia preoperatively and postoperatively were compared to verify the physiological responses to hypoglycemia. Furthermore, risk factors for hypoglycemia, using variables selected based on the characteristics of MVR and dogs undergoing MVR, were examined prospectively. The incidence of hypoglycemia after MVR was 14.2%, and plasma glucagon concentrations increased in these dogs (mean: 260 pg/mL and 644 pg/mL pre- and postoperatively, p < 0.001), whereas serum insulin concentrations decreased (median: 0.50 ng/mL and 0.29 ng/mL pre- and postoperatively, p = 0.002). Therefore, hyperinsulinemia or hypoglucagonemia is unlikely to be the cause of postoperative hypoglycemia. The identified risk factors for hypoglycemia included low body weight and asymptomatic myxomatous mitral valve disease. Monitoring blood glucose levels after MVR should be included in the standard hospitalization plan to prevent hypoglycemic emergencies in dogs.

Abstract Background Cardiopulmonary bypass may cause malfunction in the myocardium. Cuproptosis is a novel cell death aggregating mitochondrial proteins. However, the research on cardiopulmonary bypass‐caused heart tissue injury in immune infiltration and cuproptosis is limited. Method Immune infiltration, enrichment analysis, protein−protein interaction network, and medication prediction are applied to reanalysis differentially expressed genes and cuproptosis‐related genes in gene expression omnibus data set GSE132176. Results Seven cuproptosis related genes (PDHA1, LIPT1, LIAS, DLST, DLD, DLAT, and DBT) and dendritic cells and Th1 cells are involved in heart tissue injury in response to surgery with cardiopulmonary bypass. Conclusions Immune infiltration and cuproptosis are potential mechanisms by which cardiopulmonary bypass surgery may cause damage to heart tissue, which may be a new therapeutic target.

Background: In addition to its role in the digestive system, the peritrophic membrane (PM) provides a physical barrier protecting the intestine from abrasion and against pathogens. Because of its sensitivity to RNA interference (RNAi), the notorious pest insect, the Colorado potato beetle (CPB, Leptinotarsa decemlineata), has become a model insect for functional studies. Previously, RNAi‐mediated silencing of Mannosidase‐Ia (ManIa), a key enzyme in the transition from high‐mannose glycan moieties to paucimannose N‐glycans, was shown to disrupt the transition from larva to pupa and the metamorphosis into adult beetles. While these effects at the organismal level were interesting in a pest control context, the effects at the organ or tissue level and also immune effects have not been investigated yet. To fill this knowledge gap, we performed an analysis of the midgut and PM in ManIa‐silenced insects. Results: As marked phenotype, the ManIaRNAi insects, the PM pore size was found to be decreased when compared to the control GFPRNAi insects. These smaller pores are related to the observation of thinner microvilli (Mv) on the epithelial cells of the midgut of ManIaRNAi insects. A midgut and PM proteome study and reverse transcription quantitative polymerase chain reaction (RT‐qPCR) analysis with a selection of marker genes was performed to characterize the midgut cells and understand their response to the silencing of ManIa. In agreement with the loss of ManIa activity, an accumulation of high‐mannose N‐glycans was observed in the ManIa‐silenced insects. As a pathogen‐associated molecular pattern (PAMP), the presence of these glycan structures could trigger the activation of the immune pathways. Conclusion: The observed decrease in PM pore size could be a response to prevent potential pathogens to access the midgut epithelium. This hypothesis is supported by the strong increase in transcription levels of the anti‐fungal peptide drosomycin‐like in ManIaRNAi insects, although further research is required to elucidate this possibility. The potential immune response in the midgut and the smaller pore size in the PM shed a light on the function of the PM as a physical barrier and provide evidence for the relation between the Mv and PM. © 2022 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Abstract Background Increased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods After IRB approval, we reviewed charts of 9,518 patients who underwent cardiac surgery with CPB at three medical centers between July 2001 and June 2015. The relationship between perioperative lipid-lowering treatment and postoperative outcome was investigated. 3,988 patients who underwent CABG met inclusion criteria and were analyzed. Patients were divided into lipid-lowering or non-lipid-lowering treatment groups. Results A total of 3,988 patients were included in the final analysis. Compared to the patients without lipid-lowering medications, the patients with lipid-lowering medications had lower postoperative neurologic complications and overall mortality (P

Introduction: Acute Kidney Injury (AKI) is a significant cause of morbidity and mortality following common cardiac surgery. The most common cardiac surgery performed at Dr Soetomo General Academic Hospital Surabaya is coronary artery bypass grafting (CABG). Along with the increasing number of these procedures performed on subjects, Cardiopulmonary Bypass (CPB) has also grown in popularity, which is frequently associated with postoperative AKI. Objective: To investigate the incidence of postoperative AKI in subjects who had undergone a CABG procedure using the CPB technique. Materials and Methods: A retrospective study was conducted at Dr. Soetomo General Academic Hospital in Surabaya. All subjects who had CABG with CPB in 2019 were included in the study. The incidence of AKI was determined by comparing the creatinine serum level before and after surgery on days 0, 1, 2, 3, and >3 according to the AKIN criteria. Results and Discussion: The 68 subjects who underwent the CABG with CPB procedure were made up of 53 males (77.9%) and 15 females (22.1%). The average age of the subjects was 58.209.07. This study included 63 subjects (five subjects could not be evaluated due to incomplete data), and AKI was diagnosed in 44 of them using the AKIN criteria (69.8%). Postoperative AKI was reported in 14 subjects (22.2%) on day 0, 18 subjects (28.6%) on day 1 post-operation, and the same number of 6 subjects (9.5%) on day 2 and day 3 post-operation. None of them had AKI after the third post-operative day. Conclusion: More than 50 % of cases of post-CABG Acute Kidney Injury (AKI) occur at Dr. Soetomo General Academic Hospital, with the majority occurring on the first day after surgery.

Objective: To assess the occurrence of acute kidney injury (AKI) in dogs undergoing cardiac surgery under cardiopulmonary bypass (CPB) and explore associations between traditional and novel serum and urinary biomarkers. Design: Prospective cohort study conducted between July 2018 and April 2019. Setting: University teaching hospital. Animals: Nineteen dogs undergoing cardiac surgery under CPB with preoperative serum creatinine <140 μmol/L (<1.6mg/dl). Interventions: Blood and urine samples were obtained at 4 time points: preoperatively following general anesthesia induction, immediately postoperatively, and 2 and 4 days postoperatively (T1, T2, T3, and T4). AKI was defined as an increase in serum creatinine ≥26.4 μmol/L (≥0.3 mg/dl) above baseline within 48 hours. Serum creatinine, C-reactive protein (CRP), symmetric dimethylarginine (SDMA), inosine, beta-aminoisobutyric acid (BAIB), urinary clusterin (uClus), and urinary cystatin B (uCysB) were measured. Data were log-transformed (log10) when appropriate and assessed using linearmixed-effects models. Measurements and Main Results: AKI occurred in 3 of 19 dogs (15.8%, 95% confidence interval: 0.047-0.384). Inosine increased at T2 (adjusted mean ± standard error: 53 ± 5.6) in all dogs, and then gradually decreased. Log10uCysB increased at T2 (2.3 ± 0.1) in all dogs and remained high. Log10CRP and log10uClus increased significantly at T3 (1.9 ± 0.1 and 3.6 ± 0.1, respectively) in all dogs and remained increased. There was a significant positive association between serum creatinine and SDMA (P < 0.001, estimate ± standard error: 0.06 ± 0.00), between log10CRP and log10uClus (P < 0.001, 0.35 ± 0.08), between SDMA and creatinine as well as between SDMA and BAIB (P < 0.001, 11.1 ± 0.83 and P < 0.001, 1.06 ± 0.22, respectively) for all dogs at all time points. Conclusions: Inosine and uCysB concentrations changed in all dogs immediately following a surgery under CPB and may indicate tubular injury. Further studies are required to ascertain the usefulness of those biomarkers in early detection of AKI. [ABSTRACT FROM AUTHOR]

Interest in simulation has grown substantially, as has enthusiasm for team-based approaches to surgical training. In cardiothoracic surgery, the dynamic ability of the entire team is critical to emergent events. We developed innovative, interprofessional simulation events to improve team confidence. Two separate simulations event replicating critical steps and potential crises of cardiopulmonary bypass (CPB) were attended by members of the multidisciplinary cardiothoracic team. Standard CPB equipment, echocardiography, an app to control vital signs, and typical operating room tools for cannulation were all used. Participant started at their typical roles, then rotated into unfamiliar roles for subsequent simulations. Survey and Likert scale self-assessment tools were used to determine outcomes. Statistical analysis compared results. Two separate events were attended by a total of 37 team members (17 facilitators and 20 participants). Participants rotated roles through 12 routine and high-risk scenarios for instituting and separating from CPB. Participant evaluation results were highly favorable, with requests for further similar events. Objectively, the mean score for self-assessment rose significantly comparing the pre- and post-simulation assessments. Despite a small sample size, these differences did reach statistical significance in two categories: iatrogenic dissection (p 0.008), and emergent return to CPB (p 0.016). In our experience, high-fidelity interprofessional simulation promoted team communication and confidence for key scenarios related to institution of and separation from CPB. [ABSTRACT FROM AUTHOR]

Because of exception properties, inorganic halide perovskites are promising materials for numerous applications. The efficiency of these materials are evaluated based on their photoluminescence quantum yield, which is the key indicator and proportional to the stability of the perovskite. Hence, to limit the instability of the perovskites, addition of surfactant as ligand has been applied during synthesis of nanoparticle based inorganic perovskite CsPbBr 3 . As far as we know, only a few researchers have studied the impact of hexadecylpyridinium bromide (CPB) on the stability of the crystal structure of CsPbBr 3 . In this work, we present a novel approach for lead halide perovskites by incorporating CPB to primarily maintain the perovskite's crystal structure, and later on to enhance the stability of CsPbBr 3 NPs while boosting its photoluminescence quantum yield (PLQY). Results showed that CPB enhanced the thermal stability and boosted the PLQY to 90 %. Moreover, CPB had proven its efficiency as a capping agent preventing the exchange of anion between bromide and iodide ions in presence of lead iodide., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Abstract Background Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear afterwards, it is crucial to estimate the reserve of gas exchange in each lung before and during surgery. Altering conditions of gas exchange require adaptation in circulatory system as well. In some of the cases the use of extracorporeal life support appears to be necessary to undergo the transplantation successfully. Cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) used during operation allow to replace the function of heart and lung, but they are also related to complications in the form of acute kidney failure, bleeding, heart arrhythmias or thromboembolic complications. Methods We reviewed 77 LuTx from 2009 to 2020 performed at the Department of Thoracic Surgery and Transplantation. 40/77 (51%) patients required intraoperative extracorporeal assistance: 8 required CBP and 32 required ECMO. In the ECMO group 14/32 (44%) patients had peripheral cannulation and 18/32 (56%) had central one. We have calculated the survival rates and reviewed postoperative complications after lung transplantations. Cumulative Kaplan–Meier survival curves were calculated. Differences between the groups were evaluated by the Chi- square analysis for discontinuous variables and t-test for continuous variables. Results The use of intraoperative central extracorporeal membrane oxygenator was associated with increased survival rates comparing to patients without external support (30-days, 1-year, 3-years, 5-years rates: 78%, 66%, 66%, 66% vs 83%, 65%, 59%, 44% respectively). Furthermore, survival was enhanced comparing to peripheral ECMO or cardiopulmonary bypass as well (50%, 41%, 41%, 33%; 75%, 50%, 50%, 38% respectively). Acute kidney injury and thromboembolic complications occurred statistically more often in case of patients that underwent lung transplantation with support devices (p = 0.005, p = 0.02 respectively). Frequency of other complications was comparable among groups. Conclusions The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx. Trial registration Not applicable.

[Display omitted] To review studies that assessed systemic hypothermia as an organ protection strategy in adults undergoing cardiac surgery with cardiopulmonary bypass. A systematic review and meta-analysis. Randomized controlled trials, irrespective of blinding, language, publication status, and date of publication, were identified by searching the Cochrane Central register of Controlled Trials, MEDLINE, and Embase until November 2020. Risk of bias assessment was performed according to Cochrane methodology. Treatment effects were expressed as risk ratios and 95% confidence intervals. Heterogeneity was expressed as I2. Systemic hypothermia. Forty-eight trials enrolling 6,690 patients were included in the analysis. Methodologic quality of the studies included was low, mostly due to insufficient allocation concealment or blinding. Random-effects meta-analysis did not resolve uncertainty as to the risks and benefits for hypothermia versus normothermia for key primary and secondary outcomes, including mortality (1.21, 0.94 to 1.56, I2 = 0%) and brain injury (0.87, 0.67 to 1.14, I2 = 0%). Sensitivity analyses restricted to trials at low risk of important bias demonstrated higher mortality with hypothermia (1.70, 1.05 to 2.75, I2 = 0%), with little or no treatment effect on brain injury (1.01, 0.69 to 1.49, I2 = 0%). There was no interaction between cardioplegia temperature and the effects of cardiopulmonary bypass temperature on outcomes. There was insufficient evidence to assess the effects of hypothermia in noncoronary artery bypass graft surgery. The existing evidence for an organ-protective effect of hypothermia in adult cardiac surgery is of low quality and inconsistent. [ABSTRACT FROM AUTHOR]

Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. Here we describe the anesthetic management of an 18-year-old woman with a mature teratoma who presented with progressive exertional dyspnea that was aggravated in the supine position in the operating room. After tracheal intubation, the tidal volume decreased, airway pressure increased, and pet CO2 grew beyond 105 mmHg without oxygen desaturation, prompting a femoro-femoral cardio-pulmonary bypass. Cardio-pulmonary bypass (CPB) can facilitate tumor dissection by safely deflating the lungs and retracting the heart, enhancing exposure and reducing risks of hemodynamic or respiratory complications. However, systemic heparinization may increase complications, necessitating a preoperative risk assessment. Preoperative management of large mediastinal masses requires careful attention to tumor anatomical details and relationships with surrounding structures. Preoperative preparation includes multimodality imaging and multidisciplinary team discussions to assess MMS risk, requiring specialized center management. • Resection is necessary for compression, intrathoracic structures, and malignant tumors in the mediastinum, suitable for both symptomatic and non-clinical patients. • Cardio-pulmonary bypass (CPB) assists in tumor dissection by safely deflating the lungs and withdrawing the heart, which reduces difficulties. However, it necessitates preoperative risk assessment due to potential heightened hazards. • Cardiopulmonary bypass may be required when dealing with mediastinal tumors to offer respiratory assistance if the tumor is blocking the airways. [ABSTRACT FROM AUTHOR]

• Creative Self-Efficacy (CSE) and Creative Performance Behaviors (CPB) across males and females in terms of furthering their Open Government Data (OGD) adoption and usage are investigated (adapted Unified Theory of Acceptance and Use of Technology (UTAUT) model). • CSE and CPB differ across males and females as far as their behavioral intention to adopt and use OGD is concerned. • Clinches the gender differentials in OGD adoption and usage in terms of creativity dimensions thereby contributing to the creativity and OGD literature corpus. Open Government Data (OGD) has been considered as a potent instrument for value creation and innovation by a range of stakeholders. Given that individual ingenuity is a function of individual and environmental factors, it is important to understand how the OGD adoption and usage is a factor of creative performance behaviors (CPB), viz., Problem Identification (PI), Information Search (IS), Idea Generation (IG) and Idea Promotion (IP) as well as creative self-efficacy (CSE). Invoking the adapted Unified Theory of Acceptance and Use of Technology (UTAUT) constructs alongside the moderating effects of CPB and CSE constructs and also gender, the present study seeks to underline the behavioural intention towards OGD adoption and usage among 362 undergraduate and postgraduate university students in India. The guiding research question is: "Is there any difference among the males and females in terms of their OGD adoption and usage as far as their creative propensities are concerned?" Findings from the PLS-SEM (Partial Least Squares-Structural Equation Modeling) procedures show that there are gender differences across the CPB and CSE constructs. The study's contribution lies in furthering our understanding of OGD adoption and use with the additional determinants of creativity literature. [ABSTRACT FROM AUTHOR]

To assess predictive factors of postoperative stroke in cardiac surgery using cardiopulmonary bypass (CPB). This study was a retrospective observational study. This study was conducted at a single institution (Liverpool Hospital, NSW, Australia). All patients with CPB treated surgically at Liverpool Hospital, NSW, between January 2016 and December 2018 Patients underwent cardiac surgery with CPB. The primary outcome was cerebrovascular accident, or stroke. Univariate and multivariate analyses via Firth's logistic regression with regard to stroke were performed. The study comprised 1,092 patients over a three-year period. In this cohort, the stroke rate was 3.1%. Via univariate analysis of factors in relation to stroke post-CPB, recent or past stroke (odds ratio [OR] 5.43 v 2.32), diabetes mellitus (OR 1.92), dialysis dependence (OR 5.67), elective procedures (OR 0.34), aortic procedures (OR 4.02), bypass and cross-clamp times (OR 1.02 and 1.04), postoperative atrial fibrillation (OR 2.28), and hypoperfusion times all reached the significance level of p ≤ 0.1 to be included in the multivariate analysis. Multivariate analysis to find independent factors in relation to stroke yielded diabetes mellitus (OR 2.49; p = 0.025), dialysis dependence (OR 3.82; p = 0.03), aortic procedures (OR 3.93; p = 0.014), and elective procedures (OR 0.24; p = 0.026) as independently predictive or protective with regard to postoperative stroke. Independent predictors of stroke in this single center cohort included dialysis dependence, diabetes, and aortic procedures. Elective procedures were shown to be an independent protective factor. [ABSTRACT FROM AUTHOR]

Background Heater–cooler devices (HCD) have been implicated in a cardiosurgical contamination scenario causing prosthetic valve endocarditis. Aim We characterized contamination of new HCDs and assessed the risk of intraoperative microorganism transmission from the HCD to the operating field. Methods We initially acquired four new FlexTherm and then four new Maquet HCU40 HCDs and assessed occurrence and speed of microbial contamination (including mycobacteria) assessing swab and water samples from the device. In parallel, we collected repeated samples from different sites in the operating room either by swab sticks or by exposing different sample plates to room air. We also reviewed microbiological results from the hospital and compared them to cardiosurgical wound infections and endocarditis cases. Finally, we simulated cardiosurgical conditions and assessed the devices' ability to expel air to the operative field. Results All new HCDs were clean before first use. Despite authority-mandated decontamination procedures, microbial growth (Fusarium solani , Sphingomonas paucimobilis , Pseudomonas aeruginosa , Mycobacterium chelonae , and gordonae) was identified in all HCDs over time and could not be permanently eliminated. Four of these mircoorganisms were also found in tap water. However, none of the HCD-organisms were found inside the laminar airflow operating area. Importantly, except for P. aeruginosa , none of the HCD organisms were found in patients with surgical wound infections or endocarditis. HCD-expelled air did not rise more than 40 cm above ground. Conclusion HCDs cannot be expected to remain sterile despite extensive decontamination procedures. However, airborne transmission of microorganisms directly from the HCD to the operating field appears unlikely. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of aging on postoperative neurocognitive decline (NCD) in cardiac surgery patients. Methods: Patients undergoing coronary artery bypass graft or open aortic valve replacement were administered the Repeatable Battery for the Assessment of Neuropsychological Status at preoperative, postoperative day (POD) 4, and 1 month. Blood samples were collected at preoperative, 6 hours postoperative, and POD 4. Plasma interleukin (IL)-6, tumor necrosis factor-α, and C-reactive protein (CRP) levels were quantified. Quality of life was measured with the 12-Item Short Form Health Survey. Data were analyzed using paired ratio and unpaired t tests with Welch's correction, and linear regression for cytokine levels. Results: NCD occurred in 15 patients (N = 33, 45.5%). Dichotomized at age extremes (

Pericardial–esophageal fistula and/or atrial–esophageal fistula after cardiac ablation is nearly universally fatal if not detected and treated expeditiously. This condition should be assumed and ruled out in anyone with a recent history of cardiac ablation presenting with signs of sepsis, pneumomediastinum, pneumopericardium, or chest pain. Computed tomography scan of the chest is a rapid and a sensitive diagnostic modality. Tenets of treatment and repair consist of preventing an air embolism, repairing the esophageal perforation and atrial defect, and interposing autologous tissue between the esophagus and heart.

Background: Chronic obstructive pulmonary disease, cystic fibrosis and usual interstitial pneumonia are three most common indications for lung transplantation (LuTx) in Poland. As a result of irreversible destruction of pulmonary parenchyma and extended respiratory insufficiency that appear afterwards, it is crucial to estimate the reserve of gas exchange in each lung before and during surgery. Altering conditions of gas exchange require adaptation in circulatory system as well. In some of the cases the use of extracorporeal life support appears to be necessary to undergo the transplantation successfully. Cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO) used during operation allow to replace the function of heart and lung, but they are also related to complications in the form of acute kidney failure, bleeding, heart arrhythmias or thromboembolic complications.Methods: We reviewed 77 LuTx from 2009 to 2020 performed at the Department of Thoracic Surgery and Transplantation. 40/77 (51%) patients required intraoperative extracorporeal assistance: 8 required CBP and 32 required ECMO. In the ECMO group 14/32 (44%) patients had peripheral cannulation and 18/32 (56%) had central one. We have calculated the survival rates and reviewed postoperative complications after lung transplantations. Cumulative Kaplan-Meier survival curves were calculated. Differences between the groups were evaluated by the Chi- square analysis for discontinuous variables and t-test for continuous variables.Results: The use of intraoperative central extracorporeal membrane oxygenator was associated with increased survival rates comparing to patients without external support (30-days, 1-year, 3-years, 5-years rates: 78%, 66%, 66%, 66% vs 83%, 65%, 59%, 44% respectively). Furthermore, survival was enhanced comparing to peripheral ECMO or cardiopulmonary bypass as well (50%, 41%, 41%, 33%; 75%, 50%, 50%, 38% respectively). Acute kidney injury and thromboembolic complications occurred statistically more often in case of patients that underwent lung transplantation with support devices (p = 0.005, p = 0.02 respectively). Frequency of other complications was comparable among groups.Conclusions: The use of central extracorporeal membrane oxygenation should be favorized over peripheral cannulation or cardiopulmonary bypass. CPB should be no longer used during LuTx. Trial registration Not applicable. [ABSTRACT FROM AUTHOR]

Colorado potato beetle (CPB, Leptinotarsa decemlineata) is a major pest of potato and other solanaceous vegetables in the Northern Hemisphere. The insect feeds on leaves and can completely defoliate crops. Because of the repeated use of single insecticide classes without rotating active ingredients, many chemicals are no longer effective in controlling CPB. Ledprona is a sprayable double-stranded RNA biopesticide with a new mode of action that triggers the RNA interference pathway. Laboratory assays with second instar larvae fed Ledprona showed a dose–response where 25×10−6g/L of dsPSMB5 caused 90% mortality after 6days of initial exposure. We also showed that exposure to Ledprona for 6h caused larval mortality and decreased target messenger RNA (mRNA) expression. Decrease in PSMB5 protein levels was observed after 48h of larval exposure to Ledprona. Both PSMB5 mRNA and protein levels did not recover over time. Ledprona efficacy was demonstrated in a whole plant greenhouse trial and performed similarly to spinosad. Ledprona, currently pending registration at EPA, represents a new biopesticide class integrated pest management and insecticide resistance management programs directed against CPB. [ABSTRACT FROM AUTHOR]