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Resuscitation Plus Sep 2024Minimizing cardiac arrest times is critical in extracorporeal cardiopulmonary resuscitation (ECPR). Pre-primed extra corporeal membrane oxygenator (ECMO) is used for...
AIM
Minimizing cardiac arrest times is critical in extracorporeal cardiopulmonary resuscitation (ECPR). Pre-primed extra corporeal membrane oxygenator (ECMO) is used for this, but knowledge is limited to experimental studies. We prospectively investigated oxygenator function and sterility in dry plus wet pre-priming in a clinical setting.
METHODS
This prospective clinical study included 107 ECMO circuits used at Sahlgrenska University Hospital between October 2019 and December 2021. Circuits underwent dry set-up, followed by wet priming when the previous wet-primed circuit was used. Sterility was assessed by culturing the priming solution. Oxygenator function parameters, including sweep gas flow, fraction of oxygen (FiO), and oxygenator resistance, were analyzed at ECMO initiation and during treatment using linear mixed models.
RESULTS
Median total set-up time was 14 days (range 0-97), with a median wet prime time of 6 days (range 0-57). 103 of 105 circuits with culture results were negative, two showed bacterial growth (coagulase-negative staphylococci and ). Wet prime time did not significantly affect initial oxygenator function. Oxygenator resistance and FiO increased during ECMO treatment (0.035 mmHg/L min (95 % confidence interval (CI) 0.015-0.055) < 0.001, and 2.19 % (0.92-3.46) = 0.009), but these changes were unrelated to wet prime time.
CONCLUSION
Wet pre-priming of ECMO circuits for up to 57 days did not affect oxygenator function. The low incidence of bacterial growth (1.9 %) suggests that pre-primed ECMO generally maintain sterility and can facilitate rapid ECPR initiation. However, bacterial growth highlights the need for caution in non-urgent cases. Culturing the circuit at initiation can mitigate this risk.
PubMed: 38912528
DOI: 10.1016/j.resplu.2024.100680 -
The Indian Journal of Radiology &... Jul 2024: Despite documented correlation between glioma grades and dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion-derived parameters, and its inherent...
Diagnostic Utility of Integration of Dynamic Contrast-Enhanced and Dynamic Susceptibility Contrast MR Perfusion Employing Split Bolus Technique in Differentiating High-Grade Glioma.
: Despite documented correlation between glioma grades and dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion-derived parameters, and its inherent advantages over dynamic susceptibility contrast (DSC) perfusion, the former remains underutilized in clinical practice. Given the inherent spatial heterogeneity in high-grade diffuse glioma (HGG) and assessment of different perfusion parameters by DCE (extravascular extracellular space volume [Ve] and volume transfer constant in unit time [k-trans]) and DSC (rCBV), integration of the two into a protocol could provide a holistic assessment. Considering therapeutic and prognostic implications of differentiating WHO grade 3 from 4, we analyzed the two grades based on a combined DCE and DSC perfusion. : Perfusion sequences were performed on 3-T MR. Cumulative dose of 0.1 mmol/kg of gadodiamide, split into two equal boluses, was administered with an interval of 6 minutes between the DCE and DSC sequences. DCE data were analyzed utilizing commercially available GenIQ software. : Of the 41 cases of diffuse gliomas analyzed, 24 were WHO grade III and 17 grade IV gliomas (2016 WHO classification). To differentiate grade III and IV gliomas, Ve cut-off value of 0.178 provided the best combination of sensitivity (88.24%) and specificity (87.50%; AUC: 0.920; < 0.001). A relative cerebral blood volume (rCBV) of value 3.64 yielded a sensitivity of 70.59% and specificity of 62.50% ( = 0.018). The k-trans value, although higher in grade III than in grade IV gliomas, did not reach statistical significance ( = 0.108). : Uniqueness of employed combined perfusion technique, treatment naïve patients at imaging, user-friendly postprocessing software utilization, and ability of Ve and rCBV to differentiate between grade III and IV gliomas ( < 0.05) are the strengths of the present study, contributing to the existing literature and moving a step closer to achieving accurate MR perfusion-based glioma grading.
PubMed: 38912247
DOI: 10.1055/s-0043-1777742 -
The Indian Journal of Radiology &... Jul 2024Arterial spin labeling (ASL) perfusion imaging is widely used since its main advantage is that no intravenous contrast is needed. Given that perfusion is a crucial...
Arterial spin labeling (ASL) perfusion imaging is widely used since its main advantage is that no intravenous contrast is needed. Given that perfusion is a crucial biological characteristic for identifying tumor lesions, the qualitative noncontrast perfusion characteristics of these lesions were examined. We attempted utilizing the three-dimensional (3D) ASL technique to characterize skull base lesions and to highlight its crucial role in differentiating lesions. 3D ASL imaging of 20 patients with posterior skull base lesions was performed in a 3-T magnetic resonance (MR) system (Siemens Healthineers, Skyra, Erlangen, Germany). The common differential diagnoses of skull base lesions could be distinguished based on this qualitative evaluation. Glomus tumor has a strikingly increased perfusion when compared to meningiomas. The perfusion characteristics of metastasis depends on the primary tumor. Chondrosarcomas have a heterogeneously increased perfusion. Chordomas have variable perfusion, which helps in prognosticating the tumors. ASL benefits pediatric patients and in renal failure as well since it avoids the ethical ambiguity associated with contrast agents.
PubMed: 38912234
DOI: 10.1055/s-0044-1778727 -
Clinical Interventions in Aging 2024Postoperative cognitive dysfunction (POCD) is a neurological complication associated with surgery and anesthesia that is commonly observed in older patients, and it can... (Review)
Review
Postoperative cognitive dysfunction (POCD) is a neurological complication associated with surgery and anesthesia that is commonly observed in older patients, and it can significantly affect patient prognosis and survival. Therefore, predicting and preventing POCD is important. Regional cerebral oxygen saturation (rSO) reflects cerebral perfusion and oxygenation, and decreased intraoperative cerebral oxygen saturation has been reported to increase the risk of POCD. In this review, we elucidated the important relationship between the decline in rSO2 and risk of POCD in older patients. We also emphasized the importance of monitoring rSO2 during surgery to predict and prevent adverse perioperative cognitive outcomes. The findings reveal that incorporating intraoperative rSO2 monitoring into clinical practice has potential benefits, such as protecting cognitive function, reducing perioperative adverse outcomes, and ultimately improving the overall quality of life of older adults.
Topics: Humans; Postoperative Cognitive Complications; Aged; Cerebrovascular Circulation; Oxygen Saturation; Brain; Quality of Life; Oxygen; Cognitive Dysfunction
PubMed: 38911674
DOI: 10.2147/CIA.S462471 -
Frontiers in Physiology 2024This study was undertaken to explore the potential therapeutic effects of Tongyang Huoxue Granules (TYHX) on sinoatrial node (SAN) dysfunction, a cardiac disorder...
INTRODUCTION
This study was undertaken to explore the potential therapeutic effects of Tongyang Huoxue Granules (TYHX) on sinoatrial node (SAN) dysfunction, a cardiac disorder characterized by impaired impulse generation or conduction. The research question addressed whether TYHX could positively influence SAN ion channel function, specifically targeting the sodium-calcium exchanger ( ) and L-type calcium channel ( ) of the SAN.
METHODS
Sinoatrial node cells (SANCs) were isolated and cultured from neonatal Japanese big-eared white rabbits within 24 h of birth. The study encompassed five groups: Control, H/R (hypoxia/reoxygenation), H/R+100 μg/mL TYHX, H/R+200 μg/mL TYHX, and H/R+400 μg/mL TYHX. The H/R model, simulating hypoxia/reoxygenation stress, was induced within 5 days of culture. Whole-cell patch clamp technique was employed to record currents following a 3-min perfusion and stabilization period with TYHX.
RESULTS
TYHX administration demonstrated improvements in the ignition phase of impaired SANCs. The half-maximal effective dose of TYHX, as determined by SANC beating frequency, was found to be 323.63 μg/mL. Inward current density of increased in response to TYHX (200 and 400 μg/mL), while TYHX enhanced current density in H/R SANCs, with 400 μg/mL exhibiting greater efficacy. Additionally, TYHX regulated the gating mechanisms of by right-shifting the steady-state inactivation curve and accelerating recovery from inactivation. Notably, TYHX increased the activation time constant under 200 and 400 μg/mL, prolonged the fast inactivation time constant τ1 with 400 μg/mL, and extended the slow inactivation time constant τ2 with 100 and 400 μg/mL.
DISCUSSION AND CONCLUSION
The findings suggest that TYHX may hold promise as a therapeutic intervention for sinus node dysfunction, offering potential avenues for drug development aimed at safeguarding SAN function.
PubMed: 38911325
DOI: 10.3389/fphys.2024.1402478 -
Nature and Science of Sleep 2024Mental stress induced myocardial ischemia (MSIMI) is regarded as the primary cause of the angina with no obstructive coronary artery disease (ANOCA). Obstructive sleep...
PURPOSE
Mental stress induced myocardial ischemia (MSIMI) is regarded as the primary cause of the angina with no obstructive coronary artery disease (ANOCA). Obstructive sleep apnea (OSA) is autonomously linked to obstructive coronary heart disease, hypertension, and sudden cardiac death. Similar to the impact of psychological stress on the cardiovascular system, individuals with OSA experience periodic nocturnal hypoxia, resulting in the activation of systemic inflammation, oxidative stress, endothelial dysfunction, and sympathetic hyperactivity. The contribution of OSA to MSIMI in ANOCA patients is unclear. To explore the prevalence of OSA in ANOCA patients and the correlation between OSA and MSIMI, a prospective cohort of female ANOCA patients was recruited.
PATIENTS AND METHODS
We recruited female patients aged 18 to 75 years old with ANOCA and evaluated MSIMI using positron emission tomography-computed tomography. Subsequently, Level III portable monitors was performed to compare the relationship between OSA and MSIMI.
RESULTS
There is higher REI (7.8 vs 2.6, =0.019), ODI (4.7 vs 9.2, =0.028) and percentage of OSA (67.74% vs 33.33%, =0.004) in MSIMI patients. The patients diagnosed with OSA demonstrated higher myocardial perfusion imaging scores (SSS: 1.5 vs 3, = 0.005, SDS: 1 vs 3, P = 0.007). Adjusted covariates, the risk of developing MSIMI remained 3.6 times higher in OSA patients (β=1.226, OR = 3.408 (1.200-9.681), = 0.021).
CONCLUSION
Patients with MSIMI exhibit a greater prevalence of OSA. Furthermore, the myocardial blood flow perfusion in patients with OSA is reduced during mental stress.
PubMed: 38911317
DOI: 10.2147/NSS.S445219 -
Hepatobiliary Surgery and Nutrition Jun 2024
PubMed: 38911200
DOI: 10.21037/hbsn-24-144 -
Transplant International : Official... 2024Optimizing graft preservation is key for ex-situ split grafts in pediatric liver transplantation (PSLT). Hypothermic Oxygenated Perfusion (HOPE) improves... (Comparative Study)
Comparative Study
Optimizing graft preservation is key for ex-situ split grafts in pediatric liver transplantation (PSLT). Hypothermic Oxygenated Perfusion (HOPE) improves ischemia-reperfusion injury (IRI) and post-operative outcomes in adult LT. This study compares the use of HOPE in ex-situ partial grafts to static cold storage ex-situ partial grafts (SCS-Split) and to the gold standard living donor liver transplantation (LDLT). All consecutive HOPE-Split, SCS-Split and LDLT performed between 2018-2023 for pediatric recipients were included. Post-reperfusion syndrome (PRS, drop ≥30% in systolic arterial pressure) and reperfusion biopsies served as early indicators of IRI. We included 47 pediatric recipients (15 HOPE-Split, 17 SCS-Split, and 15 LDLT). In comparison to SCS-Split, HOPE-Split had a significantly shorter cold ischemia time (CIT) (470min vs. 538 min; =0.02), lower PRS rates (13.3% vs. 47.1%; = 0.04) and a lower IRI score (3 vs. 4; = 0.03). The overall IRI score (3 vs. 3; = 0.28) and PRS (13.3% vs. 13.3%; = 1) after HOPE-Split were comparable to LDLT, despite a longer CIT (470 min vs. 117 min; < 0.001). Surgical complications, one-year graft, and recipient survival did not differ among the groups. In conclusion, HOPE-Split mitigates early IRI in pediatric recipients in comparison to SCS-Split, approaching the gold standard of LDLT.
Topics: Humans; Liver Transplantation; Reperfusion Injury; Living Donors; Male; Female; Child; Child, Preschool; Organ Preservation; Perfusion; Adolescent; Infant; Cold Ischemia; Graft Survival; Retrospective Studies; Liver
PubMed: 38911062
DOI: 10.3389/ti.2024.12686 -
APL Bioengineering Jun 2024Previous lung-on-chip devices have facilitated significant advances in our understanding of lung biology and pathology. Here, we describe a novel lung-on-a-chip model in...
Previous lung-on-chip devices have facilitated significant advances in our understanding of lung biology and pathology. Here, we describe a novel lung-on-a-chip model in which human induced pluripotent stem cell-derived alveolar epithelial type II cells (iAT2s) form polarized duct-like lumens alongside engineered perfused vessels lined with human umbilical vein endothelium, all within a 3D, physiologically relevant microenvironment. Using this model, we investigated the morphologic and signaling consequences of the KRAS mutation, a commonly identified oncogene in human lung adenocarcinoma (LUAD). We show that expression of the mutant KRAS isoform in iAT2s leads to a hyperproliferative response and morphologic dysregulation in the epithelial monolayer. Interestingly, the mutant epithelia also drive an angiogenic response in the adjacent vasculature that is mediated by enhanced secretion of the pro-angiogenic factor soluble uPAR. These results demonstrate the functionality of a multi-cellular platform capable of modeling mutation-specific behavioral and signaling changes associated with lung adenocarcinoma.
PubMed: 38911024
DOI: 10.1063/5.0207228 -
Journal of Radiology Case Reports 2024Traumatic intracranial ICA dissections are not commonly seen in children. Dissection resulting in perfusion deficit warrants intervention. Here we encountered a patient...
BACKGROUND
Traumatic intracranial ICA dissections are not commonly seen in children. Dissection resulting in perfusion deficit warrants intervention. Here we encountered a patient who experienced traumatic ICA dissection, treated by endovascular stenting.
METHODS
A 10-year-old female presented with aphasia and right sided weakness following trauma. Imaging showed deficit in the left MCA territory without core. Further imaging showed dissection of the left supraclinoid ICA, confirmed by digital subtraction angiography.
RESULTS
A Neuroform Atlas stent was placed without complication. All dysarthria and weakness had resolved on follow-up 5 months post-stenting.
CONCLUSIONS
Acute stroke symptoms in children can result in lasting deficits if not treated quickly. Medical management is regarded to be first line, depending on presentation. Endovascular stenting may provide a promising means to treat pediatric ICA dissections involving perfusion deficits and mitigate permanent ischemic changes.
Topics: Humans; Female; Stents; Child; Carotid Artery, Internal, Dissection; Endovascular Procedures; Angiography, Digital Subtraction; Cerebral Infarction; Reperfusion
PubMed: 38910586
DOI: 10.3941/jrcr.v18i1.5217