bluuebunny/crossref_metadata_2025 huggingface dataset:
Synthesis, crystal structures and semiconductor properties of 2-(thiopyran-4-ylidene)-1,3-benzodithioles with an aryl substituent
Authors: Nishimoto Hiroshi , Kawase Takeshi , Nishida Jun-ichi
Published: July 2023

We report the synthesis of aryl-substituted TP-BT derivatives and their OFET properties. 4-Pyridyl substituted TP-BT shows switching characteristics by photo-irradiation.
Interactions with amyloid beta peptide and acetylcholinesterase increase alkaline phosphatase activity
Authors: Bhide Ashlesha , Sen Ayusman
Published: July 2023

Increase in activity of alkaline phosphatase during Alzheimer's disease (AD) is due to its interaction with key components of AD such as amyloid beta peptide and acetylcholinesterase.
FeII complexes supported by an iminophosphorane ligand: synthesis and reactivity
Authors: Tannoux Thibault , Mazaud Louis , Cheisson Thibault , Casaretto Nicolas , Auffrant Audrey
Published: July 2023

FeII complexes incorporating mixed phosphine–iminophosphorane ligands have rarely been investigated; synthesis and reactivity studies of phosphine–lutidine–iminophosphorane iron complexes are reported.
Revolutionizing microfluidics with artificial intelligence: a new dawn for lab-on-a-chip technologies
Authors: Goda Keisuke , Lu Hang , Fei Peng , Guck Jochen
Published: July 2023

Keisuke Goda, Hang Lu, Peng Fei, and Jochen Guck introduce the AI in Microfluidics themed collection, on revolutionizing microfluidics with artificial intelligence: a new dawn for lab-on-a-chip technologies.
The modulation of the electrical and optical properties of Cs2TiBr6 by doping
Authors: Wei Jianwei , Wu Junhua , Wang Yunyun , Zhang Yuze , Ma Zengwei , Qiao Chenkai , Zeng Hui
Published: July 2023

The systematically studied about the doped Cs2TiBr6 with Si, Ge, Cl or I show that Cs2Ti(Br0.75I0.25)6 have the best optical performance. The possible direction of improving the optical properties of Cs2TiBr6 were shown by this work.
Metabolomic analysis reveals stress tolerance mechanisms in common bean (Phaseolus vulgaris L.) related to treatment with a biostimulant obtained from Corynebacterium glutamicum
Authors: da Silva Stephanie Nemesio , de Oliveira Luis Fernando , Repke Rodrigo Alberto , Pereira Alana Kelyene , Barbosa Luidy Darlan , Nunes Rafael Leiria , Sussulini Alessandra , Pinheiro Fabio , Fill Taicia Pacheco
Published: July 2023

Microbial biostimulants have emerged as a sustainable alternative to increase the productivity and quality of important crops.
Polyoxometalate-based metal–organic supramolecular architectures derived from two new pyrimidine-amide ligands as supercapacitors and multifunctional electrochemical sensors
Authors: Wang Xiu-Li , Lu Jun-Jun , Lin Hong-Yan , Liu Qian-Qian , Chen Ke-Ke
Published: July 2023

Two polyoxometalate (POM)-based metal–organic supramolecular architectures based on two new pyrimidine-amide ligands were prepared. Both of them possess high specific capacitance, good sensitivity and low detection limit for Cr(vi) and Fe(iii) ions.
ZIF-67@PA membranes based on deep permeation for rapid removal of a radionuclide: Th(iv)
Authors: Tang Yaling , Chen Chunyan , Zhou Jian , Liu Qian , Xiao Guoqing , Chen Chunlin , Liu Yuheng , Chen Wanxin , Shang Shuyi
Published: July 2023

The safety and sustainability of the nuclear industry have become the focus of attention; therefore, it is important to develop adsorbents with high selectivity and high adsorption capacity to remove thorium Th(iv) from nuclear waste liquid.
Highly dispersed Pd nanoparticles anchored on carbon nitride for hydrogen production from formic acid
Authors: Deng Qing-Fang , Qian Kun , Zhang Jingyu , Ma Shangkun , Xin Jianjiao , Cui Fengjuan , Zuo Chunling , Jia Lihua
Published: July 2023

A carbon nitride supported Pd catalyst was prepared by a wet reduction method. The addition of water can change the type and content of N-containing groups. The catalytic activity is dependent on the surface electronic properties of Pd.
Hot off the press
Authors: Hill Robert A. , Sutherland Andrew
Published: July 2023

A personal selection of 32 recent papers is presented, covering various aspects of current developments in bioorganic chemistry and novel natural products, such as clavirolide L from Clavularia viridis.
Organic compound-based nanozymes for agricultural herbicide detection
Authors: Lee Dong Hoon , Kamruzzaman Mohammed
Published: July 2023

Illustrated summary of the OC nanozyme and glyphosate detection with it.
Stereoselective oxidative O-glycosylation of disarmed glycosyl iodides with alcohols using PIDA as the promoter
Authors: Boulogeorgou Maria A. , Toskas Alexandros , Gallos John K. , Stathakis Christos I.
Published: July 2023

“Disarmed” glycosyl iodides as glycosyl donors in PIDA promoted stereoselective O-glycosylations. An extremely mild alternative to existing methodologies.
Furin-targeting activity-based probes with phosphonate and phosphinate esters as warheads
Authors: Ji Shanping , Verhelst Steven H. L.
Published: July 2023

Novel phosphonate and phosphinate ester activity-based probes allow covalent labeling of furin in cells.
CuAAC–methacrylate interpenetrating polymer network (IPN) properties modulated by visible-light photoinitiation
Authors: Kabra Mukund , Kloxin Christopher J.
Published: July 2023

Photo-CuAAC–methacrylate IPNs: choose light intensity, choose morphology.
Insight into the melt-processed polylimonene oxide/polylactic acid blends
Authors: Palenzuela Miguel , Vega Juan F. , Souza-Egipsy Virginia , Ramos Javier , Rentero Christian , Sessini Valentina , Mosquera Marta E. G.
Published: July 2023

The addition of a small amount of PLO to PLA by melt processing leads to a decrease in the PLA's Tg, Tm and degree of crystallinity as well as a remarkable increase in PLA films flexibility. The strong interactions between PLO and PLA is unveiled.
Lite‐weight semantic segmentation with AG self‐attention
Authors: Liu Bing , Gao Yansheng , Li Hai , Zhong Zhaohao , Zhao Hongwei
Published: July 2023

Due to the large computational and GPUs memory cost of semantic segmentation, some works focus on designing a lite weight model to achieve a good trade‐off between computational cost and accuracy. A common method is to combined CNN and vision transformer. However, these methods ignore the contextual information of multi receptive fields. And existing methods often fail to inject detailed information losses in the downsampling of multi‐scale feature. To fix these issues, we propose AG Self‐Attention, which is Enhanced Atrous Self‐Attention (EASA), and Gate Attention. AG Self‐Attention adds the contextual information of multi receptive fields into the global semantic feature. Specifically, the Enhanced Atrous Self‐Attention uses weight shared atrous convolution with different atrous rates to get the contextual information under the specific different receptive fields. Gate Attention introduces gating mechanism to inject detailed information into the global semantic feature and filter detailed information by producing “fusion” gate and “update” gate. In order to prove our insight. We conduct numerous experiments in common semantic segmentation datasets, consisting of ADE20 K, COCO‐stuff, PASCAL Context, Cityscapes, to show that our method achieves state‐of‐the‐art performance and achieve a good trade‐off between computational cost and accuracy.
Time‐varying long‐range navigation signal channel modelling based on Dirichlet process mixtures method
Authors: Ma Hongyu , Pu Yurong , Zhao Zhenzhu , Du Zhonghong , Du Yongxing , Zhao Yuchen , Xi Xiaoli
Published: July 2023

A model of the LOng‐RAnge Navigation signal can provide a mathematical model for the development of related technology research. The propagation variations of the signal exhibit non‐stationary and non‐linear characteristics due to the time‐varying nature of the atmospheric dielectric constant in the channel. A Dirichlet process mixtures method is used by the authors to model the statistical properties of radio wave attenuation, and the Gibbs sampling method is used to flexibly estimate the parameters of the model. The model as a non‐parametric model can be applied to capture the dynamics of time‐varying signals with the parameters being adaptively inferred. A receiver is used as a measurement device to obtain real propagation data to check the performance of the model. Kullback–Leibler Divergence (KL‐Div) was used to evaluate different datasets. The results showed that the model's statistical properties were consistent. Its flexibility allows it to represent complex distributions without prior knowledge.
Induction heating of planetary interiors in white dwarf systems
Authors: Kislyakova K. G. , Noack L. , Sanchis E. , Fossati L. , Valyavin G. G. , Golabek G. J. , Güdel M.
Published: July 2023

Context. White dwarfs are the last evolutionary stage for the majority of main-sequence stars. With nuclear burning having ceased, these stars are slowly cooling. There is observational evidence indicating that planetary remnants, and possibly even planets, orbit a considerable fraction of the known white dwarf population. These objects are interesting targets for transit observations due to their large planet-to-star radius ratio. Especially interesting is the possible outgassing from such objects and their eventual observational prospects.

Aims. Here, we investigate whether electromagnetic induction heating can drive additional volcanic outgassing from small planetary remnants orbiting white dwarfs. This mechanism can be important for such bodies in addition to tidal heating due to the extremely strong magnetic fields of some white dwarfs and close orbital distances of planets to their host stars.

Methods. We calculated the heating and related magmatic effects for a Moon-sized body around a magnetized white dwarf using an analytical model for induction heating and a numerical model for interior processes. We also calculated induction heating inside asteroid-sized bodies.

Results. We show that induction heating can melt the mantle of a Moon-sized object within a geologically short time and contribute to desiccation of small asteroids on extremely tight orbits. These findings can have important implications for the evolution of rocky bodies orbiting white dwarfs and the potential detection of their outgassing.
Cracking the puzzle of CO2 formation on interstellar ices
Authors: Molpeceres G. , Enrique-Romero J. , Aikawa Y.
Published: July 2023

Context. Carbon dioxide (CO2) is one of the dominant components of interstellar ices. Recent observations show CO2 exists more abundantly in polar (H2O-dominated) ice than in apolar (H2O-poor) ice. Formation of CO2 ice is primarily attributed to the reaction between CO and OH, which has a barrier.

Aims. We investigate the title reaction in H2O ice and CO ice to quantify the efficiency of the reaction in polar ice and apolar ice.

Methods. Highly accurate quantum chemical calculations were employed to analyze the stationary points of the potential energy surfaces of the title reaction in the gas phase on H2O and CO clusters. Microcanonical transition state theory was used as a diagnostic tool for the efficiency of the reaction under interstellar medium conditions. We simulated the kinetics of ice chemistry, considering different scenarios involving non-thermal processes and energy dissipation.

Results. The CO + OH reaction proceeds through the remarkably stable intermediate HOCO radical. On the H2O cluster, the formation of this intermediate is efficient, but the subsequent reaction leading to CO2 formation is not. Conversely, HOCO formation on the CO cluster is inefficient without external energy input. Thus, CO2 ice cannot be formed by the title reaction alone either on an H2O cluster or a CO cluster.

Conclusions. In the polar ice, CO2 ice formation is possible via CO + OH → HOCO followed by HOCO + H → CO2 + H2, as demonstrated by abundant experimental literature. In apolar ice, CO2 formation is less efficient because HOCO formation requires external energy. Our finding is consistent with the JWST observations. Further experimental work using low-temperature OH radicals is encouraged.
Effect of long, low-temperature fermentation on properties of dough and quality of rich bakery products made from wheat flour
Authors: Kostyuchenko Marina , Kolotova Natalia , Tyurina Irina , Golubko Natalia , Tyurina Olga
Published: July 2023

The paper reports the findings obtained in the study of the effect of long, low-temperature fermentation on properties of dough and quality of rich bakery products made from wheat flour. This technological solution is one of the promising and generally accepted approaches used for production of bakery products in many countries. The study objects were samples of semi-finished bakery products and rich bakery products with a sugar and fat content of 17% by flour weight made in accordance with the baking formula. We studied the effect of long fermentation of dough for 8, 16, 24, and 48 h at low temperatures of +5, +10, +15 °C on the moisture content, acidity, shape stability and the duration of its proofing, and on acidity, the moisture content, porosity, shape stability, the content of aromatic substances and the mass fraction of sugar, as well as on the organoleptic quality indicators of bakery products. During fermentation, the acidity of dough pieces increased under all temperature conditions. The moisture content in all the dough samples was similar in value to that in the control and ranged from 40.2 to 40.8%. The shape stability of all dough pieces decreased during fermentation at temperatures of +5, +10, and +15 °C. The porosity and shape stability of rich bakery products were less compared to the control. The moisture content in all rich bakery products was similar in value to that in the control and ranged from 39.2 to 39.8%. The mass fraction of sugar in the test samples of rich bakery products was found to decrease during dough fermentation for 8 to 48 h under all temperature conditions. The maximum decrease in the sugar mass fraction was revealed in products made from dough fermented for 16, 24 and 48 h at +15 °C; it amounted to 2.5, 2 and 1.1% in terms of dry matter, respectively, which was 35.9–71.8% less compared to that in the control. The study showed the optimal duration of fermentation for sweet dough, which attained 8 and 16 h at +5 and +10 °C, and 8 h at +15 ºС.
Immobilized cellulase: Interactions between cellulase and nanostructured supports
Authors: Sulman Aleksanrina , Grebennikova Olga , Tikhonov Boris , Molchanov Vladimir , Matveeva Valentina
Published: July 2023

In this review, we will analyze the main aspects of immobilization of cellulase - an enzyme for processing cellulosic biomass waste - on nanostructured supports. Such substrates provide a large surface area, increased enzymatic load and a favorable environment for increasing the efficiency of cellulase and its stability, which leads to the creation of nanobiocatalysts for the production of biofuels and chemicals with added value. Here we will discuss nanostructured supports, methods of cellulase immobilization, the interaction between the enzyme and the support, as well as factors affecting the activity of the enzyme to achieve maximum conversion of cellulose biowaste into fermentable sugars.
The dehydrator parameters for convective drying of food products
Authors: Korotkiy Igor , Neverov Evgeny , Gorelkina Alyona , Korotkaya Elena , Zadesenets Alexander
Published: July 2023

When developing dehydration processes, special attention should be paid to the latest achievements in the field of equipment for drying agricultural products, as well as energy-saving processes used in this area. The article presents the parameters of the drying cabinet operation obtained by the authors and data on the time and efficiency of drying products of the agro-industrial complex. The material in the article may be of interest to specialists involved in drying food products, as well as to those designing and developing systems for drying. The research focuses on a RAWMID drying cabinet and samples of the extra class bananas. The research was carried out at the “Scientific and Educational Center of Refrigeration, Cryogenic Equipment, and Technology” of Kemerovo State University. The research resulted in thermograms of temperature changes in the working volume of the drying cabinet, as well identifying the temperature and mass of the dried product. The velocity field in the working volume of the dehydrator was also determined, which was found out to have a significant degree of unevenness. The results make it possible to significantly optimize the drying process, as well as to obtain a dried product of a more stable quality.
Thromboelastograph Guided Management of a Patient Requiring Abiomed Biventricular Support with Consumptive Coagulopathy
Authors: Gandhi Darshit Atul , Shrewsberry Timothy
Published: July 2023

A 69-year-old male, who underwent cardio-pulmonary bypass surgery, required biventricular support using the Abiomed. The patient subsequently developed a consumptive coagulopathy. The thromboelastograph was used to administer NovoSeven and guide allogenic transfusions to achieve a hematocrit of greater than 30% and a platelet count greater than 100,000 per μL. Disseminated intravascular coagulation was resolved and the patient was transported to a tertiary care center within 72 hours. The Abiomed BVS 5000 provided a bridge to the native heart recovery and was successfully explanted.
Variation in Arterial Inflow Temperature: A Regional Quality Improvement Project
Authors: Warren Craig S. , DeFoe Gordon R. , Groom Robert C. , Pieroni John W. , Groski Candace S. , Morse Catherine B. , Connors Ellen M. , Lataille Peter J. , Ross Cathy S. , Likosky Donald S. ,   for the Northern New England Cardiovascular Disease Study Group
Published: July 2023

Peer-reviewed evidence (Class IIa, Level B) suggests that arterial blood temperature should be limited to 37°C during cardiopulmonary bypass. We implemented a regional quality improvement initiative to reduce regional variability in our performance around this recommendation at four northern New England medical centers between January 2006 and June 2010. Cardiovascular perfusionists at four medical centers collaborated by conference calls regarding blood temperature management. Evidence from the recommendations were reviewed at each center, and strategies to prevent hyperthermia and to improve performance on this quality measure were discussed. Centers submitted data concerning highest arterial blood temperatures among all isolated coronary artery bypass grafting procedures between 2006 through June 2010. Scope and focus of local practice changes were at the discretion of each center. The timing of each center’s quality improvement initiatives was recorded, and adherence to thresholds of 37°C and 37.5°C were analyzed. Data were collected prospectively through our regional per-fusion registry. Data were available for 4909 procedures (1645 before interventions, 3264 after interventions). Prior to the quality improvement interventions, 90% of procedures had elevated arterial line temperatures (37°C or more), and afterwards it was 69% (p< .001) for an absolute difference of 21%. Prior to the intervention, 53% of procedures had temperatures beyond a threshold of 37.5°C versus 19% subsequent to interventions, for an absolute difference of 34% (p< .001). This regional effort to reduce patient exposure to elevated arterial line temperatures resulted in a significant sustained reduction in high arterial outflow temperatures at three of the four centers. A regional registry provides a means for assessing performance against evidence-based recommendations, and evaluating short and long-term success of quality improvement initiatives.
Massive Air Embolism in a Fontan Patient
Authors: Matte Gregory S. , Kussman Barry D. , Wagner Joseph W. , Boyle Sharon L. , Howe Robert J. , Pigula Frank A. , Emani Sitaram M.
Published: July 2023

Most institutions performing cardiopulmonary bypass for congenital heart disease patients use an integrated hard shell cardiotomy and venous reservoir attached to an oxygenator. It is of paramount importance that the integrated reservoir be vented so as not to cause pressurization. A pressurized sealed cardiotomy has been reported to occur secondary to issues with vacuum assisted venous drainage systems as well as improper venting in general. We report a case of air embolus caused by retrograde propulsion of air through the venous line secondary to a pressurized cardiotomy reservoir in a patient with Fontan circulation. The mechanism of cardiotomy pressurization is described, and the scenario simulated in a mock circuit.
Technical Description of the Use of Selective Perfusion Techniques During the Norwood Procedure for Hypoplastic Left Heart Syndrome
Authors: Chabot David Leonard , Polimenakos Anastasios C.
Published: July 2023

Since the introduction of the Norwood procedure for surgical palliation of hypoplastic left heart syndrome in 1983, refinements have been made to the original procedure to improve patient outcomes while still accomplishing the original goals of the procedure. One of these refinements has been the introduction of regional selective perfusion to limit the duration of circulatory arrest times and optimize the regional flow distribution. In this paper we describe our technique for performing selective cerebral and lower body perfusion during the Norwood procedure.
Development of a New Arterial-Line Filter Design Using Computational Fluid Dynamics Analysis
Authors: Herbst Daniel P. , Najm Hani K.
Published: July 2023

Arterial-line filters used during extracorporeal circulation continue to rely on the physical properties of a wetted micropore and reductions in blood flow velocity to affect air separation from the circulating blood volume. Although problems associated with air embolism during cardiac surgery persist, a number of investigators have concluded that further improvements in filtration are needed to enhance air removal during cardiopulmonary bypass procedures. This article reviews theoretical principles of micropore filter technology and outlines the development of a new arterial-line filter concept using computational fluid dynamics analysis. Manufacturer-supplied data of a micropore screen and experimental results taken from an ex vivo test circuit were used to define the inputs needed for numerical modeling of a new filter design. Flow patterns, pressure distributions, and velocity profiles predicted with computational fluid dynamics softwarewere used to inform decisions on model refinements and how to achieve initial design goals of ≤225 mL prime volume and ≤500 cm2of screen surface area. Predictions for optimal model geometry included a screen angle of 56° from the horizontal plane with a total surface area of 293.9 cm2and a priming volume of 192.4 mL. This article describes in brief the developmental process used to advance a new filter design and supports the value of numerical modeling in this undertaking.
A Novel Technique for Intra-aortic Balloon Positioning in the Intensive Care Unit
Authors: Venugopal Vijish
Published: July 2023

Proper positioning of the intra-aortic balloon catheter is very important as an improperly placed balloon can cause problems. A balloon placed too high can block off the arch vessels, whereas one placed too low can block the renal and splanchnic vessels. We propose a simple and reliable technique to properly position the intra-aortic balloon pump (IABP) catheter without the use of any sophisticated or expensive equipment in the intensive care unit if the catheter has migrated from the previously placed desired position. In this technique, we rely on the left radial arterial trace obliteration as the IABP catheter is pushed in along a guidewire as a marker for tip positioning.
More for Less: Best Patient Outcomes in a Time of Financial Restraint
Authors: Merry Alan F. , Hamblin Richard
Published: July 2023

In many countries, expenditure on health care has increased dramatically over recent years. There have been parallel improvements in many indicators of population health, but too many patients continue to be harmed by health care or receive care that is supply-sensitive, ineffective, or poorly aligned with their needs and values. In addition to human costs, this translates into substantial waste of resource. The world has recently faced economic challenges unseen since the great depression of the 1930s. The financial situation of a country can, like a business, be expressed in three sets of accounts: statements of financial position, financial performance, and cash flow. A key test of solvency is the ability to pay debts as they become due (whether from current account or further borrowing). In general, this is a function of public debt, which for many countries has become very high. However, private debt and net financial position are also relevant to a country’s financial prospects. Ultimately, borrowing is not sustainable indefinitely and given limited prospects for growth in income in the coming years, most countries will likely need to reduce or at least constrain expenditure on health care. This implies obtaining better value from the resources that are available, and we suggest that the key to this lies in improving the quality of care and, in particular, reducing variation in health care. In the United States, new legislation promoting accountable care organizations may help to do this. Cardiac surgery can be particularly effective in extending patients’ lives and in improving the quality of their lives. Our ability to continue to provide cardiac surgery in the face of constrained economic times will depend on engaging more actively in ensuring that what we do is the right thing: that our operations are effective and that they truly meet the needs and values of our patients. It will also depend on doing these operations right the first time.
Novel Biomarkers for Cardiac Surgery-Associated Acute Kidney Injury: A Skeptical Assessment of Their Role
Authors: Sidebotham David
Published: July 2023

Cardiac surgery-associated acute kidney injury (AKI) is common and is associated with a high mortality rate. Traditional biomarkers of AKI (creatinine and urea) increase slowly in response to renal injury, are insensitive to mild degrees of AKI, and are influenced by nonrenal factors. There is considerable interest in novel biomarkers of AKI such as neutrophil gelatinase-associated lipocalin that increase rapidly after renal injury, detect mild degrees of AKI, and are less subject to nonrenal factors. It has been postulated that the early diagnosis of cardiac surgery-associated AKI using novel biomarkers will result in improved outcomes. However, there is little evidence that interventions started early in the course of evolving AKI enhance renal recovery. Until effective therapies are developed that significantly improve the outcome from AKI, there is little benefit from early diagnosis using novel biomarkers.
Magnitude of Arterial Carbon Dioxide Change at Initiation of Extracorporeal Membrane Oxygenation Support Is Associated with Survival
Authors: Bembea Melania M. , Lee Ramon , Masten Desiree , Kibler Kathleen K. , Lehmann Christoph U. , Brady Kenneth M. , Easley R. Blaine
Published: July 2023

Many patient factors have been associated with mortality from extracorporeal membrane oxygenation (ECMO) therapy. Pre-ECMO patient pH and arterial carbon dioxide (paCO2) have been associated with poor outcome and can be significantly altered by ECMO initiation. We hypothesized that the magnitude of change in paCO2and pH with ECMO initiation could be associated with survival. We designed a retrospective observational study from a single tertiary care center and included all pediatric patients (age younger than 18 years) undergoing ECMO between 2002 and 2010. Electronic records were queried for demographics and clinical characteristics, including the arterial blood gas (ABG) pre- and post-ECMO initiation. Bivariate analysis compared ECMO course characteristics by outcome (survivor vs. nonsurvivor). Multivariable logistic regression was performed on factors associated with the outcome in the bivariate analysis at the significance level ofp< .1. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported. We identified 201 patients with a median age of 10 days (range, 1 day to 16 years). Indications for ECMO were: respiratory failure (51%), cardiac failure (23%), extracorporeal cardiopulmonary resuscitation (21%), and sepsis (5%). Mortality, defined by death before discharge, was 37% (74 of 201). ABG data pre- and post-ECMO initiations were available in 84% (169 of 201). Age, pH, paCO2, indication, and intracranial hemorrhage were significantly associated with mortality (p< .05). After adjusting for potential confounders (age, use of epinephrine, volume of fluid administered, year of ECMO, ECMO indication, and duration of ECMO) by multivariable logistic regression, the magnitude of paCO2change (≥25 mmHg) was associated with mortality (adjusted OR, 2.21; 95% CI, 1.06–4.63;p= .036). The decrease in paCO2with ECMO initiation was associated with mortality. Although this change in paCO2is multifactorial, it represents a modifiable element of clinical management involving pre-ECMO ventilation, ECMO circuit priming, CO2administration/removal, and may represent a future therapeutic target that could improve survival in pediatric ECMO.
Anatomical Advantage to Percutaneous Insertion of the Intra-Aortic Balloon through the Left Brachial Artery over the Right Brachial Artery
Authors: Datt Bharat , Miner Steve
Published: July 2023

Off-label use of the intra-aortic balloon (IAB) is not recommended in ideal situations and certainly not a Food and Drug Administration-approved activity. The instruction-for-use manual for the IAB recommends percutaneous insertion. However, there are certain extreme situations where “thinking outside the box” appears necessary. We have successfully inserted a transthoracic IAB (TIAB) in the operating room where an open sternum is an option. This has been instituted whenever severe peripheral vascular disease (PVD) precludes a percutaneous attempt or when attempted insertion fails. An open chest is not a choice in the catheterization laboratory or the postoperative setting. We have successfully inserted the IAB through the brachial/axillary artery in a patient with bilateral aortofemoral grafts, with a history of severe PVD, in the cardiac catheterization laboratory. A left-sided approach is advisable for brachial artery insertion and an axillary approach is also possible under sedation. This case report details our experience with transbrachial insertion of the IAB and establishes counterpulsation through this route as a viable option, where an open chest is not available and a percutaneous femoral approach has failed.
Microbubble Transmission during Cardiotomy Infusion of a Hardshell Venous Reservoir with Integrated Cardiotomy versus a Softshell Venous Reservoir with Separated Cardiotomy: An In Vitro Comparison
Authors: Potger Kieron C. , McMillan Darryl , Ambrose Mark
Published: July 2023

An important mechanism for postoperative cognitive impairment after cardiac surgery using cardiopulmonary bypass (CPB) is microemboli. One component of the CPB circuit—the cardiotomy—is a major source of gaseous microemboli because it aspirates significant volumes of air with blood from the operative field and intracardiac chambers. Cardiotomies are either integrated within an open hardshell venous reservoir (IC-HSVR) or are a separate canister attached to a softshell collapsible venous reservoir bag (SC-SSVR). The purpose of this study was to compare the Medtronic IC-HSVR (Affinity NT CVR) with Medtronic’s SC-SSVR (CB 1351, CBMVR 1600) in terms of relative microbubble transmission during cardiotomy infusion. A recirculating in vitro circuit primed with blood was used to compare the two cardiotomy-reservoir systems with the venous reservoir in the SC-SSVR further assessed in a fully closed or partially open state (SC-SSVR-closed; SC-SSVR-open). Microbubbles were detected using a GAMPT BC100 Doppler system in the outflow line of the venous reservoir. Measurements were taken before (baseline) and after aerated prime was pumped into the cardiotomy while altering pump flow rates (3 L/min; 5 L/min) and reservoir prime volumes (400 mL; 900 mL). Infusing cardiotomy blood into the venous reservoir was associated with an increase in microbubbles and bubble volume transmitted by both cardiotomy-reservoir systems with the magnitude rising with reduced prime volumes. The effect was markedly greater with the IC-HSVR. The IC-HSVR also transmitted larger bubbles, particularly with reduced prime volumes. There was no significant difference in microbubble transmission seen between the SC-SSVR-closed and SC-SSVR-open. The SC-SSVR transmits fewer microbubbles than the IC-HSVR during cardiotomy infusion and should be considered as the preferential system. Because both cardiotomy-reservoir systems transmitted microbubbles during cardiotomy infusion, particularly at the lower venous reservoir volume, it is important to use strategies to minimize cardiotomy microbubble infusion.
Brain Protection during Cardiac Surgery: Circa 2012
Authors: Hammon John W.
Published: July 2023

Brain injury during cardiac surgery can cause a potentially disabling syndrome consisting mainly of cognitive dysfunction but can manifest itself as symptoms and signs indistinguishable from frank stroke. The cause of the damage is mainly the result of emboli consisting of solid material such as clots or atherosclerotic plaque, fat, and/or gas. These emboli enter the cerebral circulation from the cardiopulmonary bypass machine, break off the aorta during manipulation, and enter the circulation from cardiac chambers. This damage can be prevented or at least minimized by avoiding aortic manipulation, filtering aortic inflow from the pump, preventing air from entering the pump plus careful deairing of the heart. Shed blood from the cardiotomy suction should be processed by a cell saver whenever possible. By doing these maneuvers, inflammation of the brain can be avoided. Long-term neurocognitive damage has been largely prevented in large series of patients having high-risk surgery, which makes these preventive measures worthwhile.
Emergent Cardiopulmonary Bypass for a 180 Kilogram Patient: Support with a Single Oxygenator
Authors: Hunter Kyler T. , Lopez Angela R. , Yun Kwok L.
Published: July 2023

As obesity increases in prevalence, so will cases in which patients present at the boundaries of care. We report the support of a class III obese man, having a body mass index of 60.8 kg/m2and in acute renal failure, with a single Trillium™-coated Affinity® NT Hollow Fiber oxygenator in cardiopulmonary bypass for an emergent aortic valve replacement secondary to infective endocarditis. A maximum oxygen delivery of 807.51 mL of oxygen per minute is reported for this oxygenator in this case report.
Role of Cytokine Hemoadsorption in Cardiopulmonary Bypass-Induced Ventricular Dysfunction in a Porcine Model
Authors: Vocelka Craig R. , Jones Krystal M. , Mikhova Krasimira M. , Ebisu Ryan M. , Shar Ashley , Kellum John A. , Verrier Edward D. , Rabkin David G.
Published: July 2023

Little is known about the effect of cardiopulmonary bypass alone on cardiac function; in an attempt to illuminate this relationship and test a possible mechanism, we used Cytosorb™, a device capable of removing virtually all types of circulating cytokines to test the hypothesis that hemoadsorption of cytokines during bypass attenuates bypass-induced acute organ dysfunction. Twelve Yorkshire pigs (50–65 kg) were instrumented with a left ventricular conductance catheter. Baseline mechanics and cytokine expression (tumor necrosis factor [TNF], interleukin-6 [IL-6], and interleukin-10) were measured before and hourly after 1 hour of normothermic cardiopulmonary bypass. Animals underwent bypass without (cardiopulmonary bypass [CPB], n = 6) or with (CPB+HA, n = 6) the Cytosorb™ device. Data were compared with “historical” controls (n = 6) that were similarly instrumented but underwent observation instead of bypass. Five hours after separation from bypass (or observation), animals were euthanized. Myocardial water content was determined postmortem. Neither TNF nor IL-6 was significantly elevated in either experimental group versus controls at any time point. Preload recruitable stroke work and dP/dtmax were significantly depressed immediately after separation from bypass in both CPB+HA and CPB and remained depressed for the duration of the experiment. Although Tau remained unchanged, dP/dTmin was significantly diminished in both bypass groups at all time points after separation from bypass. Cytokine hemoadsorption had no effect on any measurable index of function. Differences in postmortem data were not evident between groups. One hour of normothermic CPB results in a significant and sustained decline in left ventricular function that appears unrelated to changes in cytokine expression. Because we did not appreciate a significant change in cytokine concentrations postbypass, the capacity of cytokine hemoadsorption to attenuate CPB-induced ventricular dysfunction could not be assessed.
Teamwork, Communication, Formula-One Racing and the Outcomes of Cardiac Surgery
Authors: Merry Alan F. , Weller Jennifer , Mitchell Simon J.
Published: July 2023

Most cardiac units achieve excellent results today, but the risk of cardiac surgery is still relatively high, and avoidable harm is common. The story of the Green Lane Cardiothoracic Unit provides an exemplar of excellence, but also illustrates the challenges associated with changes over time and with increases in the size of a unit and the complexity of practice today. The ultimate aim of cardiac surgery should be the best outcomes for (often very sick) patients rather than an undue focus on the prevention of error or adverse events. Measurement is fundamental to improving quality in health care, and the framework of structure, process, and outcome is helpful in considering how best to achieve this. A combination of outcomes (including some indicators of important morbidity) with key measures of process is advocated. There is substantial evidence that failures in teamwork and communication contribute to inefficiency and avoidable harm in cardiac surgery. Minor events are as important as major ones. Six approaches to improving teamwork (and hence outcomes) in cardiac surgery are suggested. These are: 1) subspecialize and replace tribes with teams; 2) sort out the leadership while flattening the gradients of authority; 3) introduce explicit training in effective communication; 4) use checklists, briefings, and debriefings and engage in the process; 5) promote a culture of respect alongside a commitment to excellence and a focus on patients; 6) focus on the performance of the team, not on individuals.
Can the Oxygenator Screen Filter Reduce Gaseous Microemboli?
Authors: Johagen Daniel , Appelblad Micael , Svenmarker Staffan
Published: July 2023

Gaseous microemboli (GME) define small bubbles as <200 μm in size. GME are reported to increase morbidity after cardiopulmonary bypass (CPB) and cardiac surgery. To prevent intrusion of GME into the systemic circulation during CPB, arterial line filtration is generally recommended. New trends in oxygenator design promote location of arterial filtration as an integral part of the oxygenator housing. The present experimental study aimed to evaluate the GME removal properties of an integrated arterial screen filter in a standard microporous oxygenator. The GME properties of Terumo Capiox® FX25 with an integrated arterial screen filter was assessed in an experimental setup and compared with Capiox® RX25, in which no arterial screen filter is present. A blood analog prime solution was recirculated using a roller pump at 4 and 6 L per minute flow rate, respectively, through a customized CPB circuit comprising oxygenator, reservoir, and connecting tubing. A controlled volume of air was introduced into the circuit. The GME activity was measured and computed using a Gampt BCC200® ultrasonic device placing one probe at the venous inlet and one other at the arterial outlet of the oxygenator. Transmembrane delta values of GME activity were used to calculate the removal efficacy based on counts and volume of GME. Use of screen filtration reduced the GME volume by 99.1% ± .1% compared with 98.0% ± .1% for controls at 4 L/min flow rate (p< .001). At 6 L/min, the reduction was 97.9% ± .1% compared with 97.0% ± .1% (p< .001). In contrast, the reduction of GME counts was less effective after screen filtration compared with controls: 89.6 ± .6% versus 91.4 ± .4% at 4 L/min and 55.6% ± 1.6% versus 76.0% ± 1.4% at 6 L/min, respectively (p< .001). The tested oxygenator with incorporated arterial screen filter reduced GME activity based on the calculated volume at the same time as counts of GME increased.
Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base
Authors: Landis R. Clive , Brown Jeremiah R. , Fitzgerald David , Likosky Donald S. , Shore-Lesserson Linda , Baker Robert A. , Hammon John W.
Published: July 2023

A wide range of pharmacological, surgical, and mechanical pump approaches have been studied to attenuate the systemic inflammatory response to cardiopulmonary bypass, yet no systematically based review exists to cover the scope of anti-inflammatory interventions deployed. We therefore conducted an evidence-based review to capture “self-identified” anti-inflammatory interventions among adult cardiopulmonary bypass procedures. To be included, trials had to measure at least one inflammatory mediator and one clinical outcome, specified in the “Outcomes 2010” consensus statement. Ninety-eight papers satisfied inclusion criteria and formed the basis of the review. The review identified 33 different interventions and approaches to attenuate the systemic inflammatory response. However, only a minority of papers (35 of 98 [35.7%]) demonstrated any clinical improvement to one or more of the predefined outcome measures (most frequently myocardial protection or length of intensive care unit stay). No single intervention was supported by strong level A evidence (multiple randomized controlled trials [RCTs] or meta-analysis) for clinical benefit. Interventions at level A evidence included off-pump surgery, minimized circuits, biocompatible circuit coatings, leukocyte filtration, complement C5 inhibition, preoperative aspirin, and corticosteroid prophylaxis. Interventions at level B evidence (single RCT) for minimizing inflammation included nitric oxide donors, C1 esterase inhibition, neutrophil elastase inhibition, propofol, propionyl-L-carnitine, and intensive insulin therapy. A secondary analysis revealed that suppression of at least one inflammatory marker was necessary but not sufficient to confer clinical benefit. The most effective interventions were those that targeted multiple inflammatory pathways. These observations are consistent with a “multiple hit” hypothesis, whereby clinically effective suppression of the systemic inflammatory response requires hitting multiple inflammatory targets simultaneously. Further research is warranted to evaluate if combinations of interventions that target multiple inflammatory pathways are capable of synergistically reducing inflammation and improving outcomes after cardiopulmonary bypass.
Effect of New Heparin Potency on Activated Clotting Time during Pediatric Cardiac Surgery: A Retrospective Chart Review
Authors: Thompson Kiley , Allred Jenn , Deyo Amanda , Sievert Alicia N. , Sistino Joseph J.
Published: July 2023

In 2009, the U.S Food and Drug Administration (FDA) announced a two-phase change in unfractionated heparin to reduce contamination and create a new potency reference. The FDA announced the change would bring about a 10% decrease in potency from the old heparin (OH) to new heparin (NH). The purpose of this article is to compare heparin in pediatric patients undergoing cardiac surgery before and after the FDA changes. After Institutional Review Board approval, a retrospective chart review was conducted with pediatric patients (n = 266) undergoing cardiac surgery. All patients received a heparin loading dose of 400 IU/kg and data collected included patient demographics, baseline activated clotting time (ACT), ACT after initial heparin dose, and heparin dose–response. These data were then further broken down into age blocks consisting of neonates (<1 month), 1–12 months, 1–5 years old, and older than 5 years old. In 17.3% of cases in the NH group, the ACT after the initial heparin dose did not reach the critical value of 400 seconds necessary for initiation of cardiopulmonary bypass (CPB). This is significantly higher than the 8.9% of cases in the OH group (p < .05). There was an overall trend among age groups that the NH was less potent than OH. However, only the 1–5 years of age group showed significance at p < .05. Given the median ACTs 591 seconds for OH and 484 seconds for NH, the calculated percentage difference was 18.1%. The results from this retrospective pediatric chart review indicate that the change in heparin potency greatly deviates from the 10% change reported by the FDA. In conclusion, NH has a trend of lower potency and frequent monitoring is necessary to maintain a safe level of anticoagulation during CPB.
Cardiopulmonary Bypass in a Patient with Factor XII Deficiency
Authors: Cronbaugh Robert D. , Fuller Lori A. , Miller Scott D.M. , Richenbacher Wayne E.
Published: July 2023

The performance of cardiopulmonary bypass (CPB) in the factor XII-deficient patient is challenging in that the normal method for monitoring anticoagulation is ineffective as a result of an impaired contact activation system. We report the case of a factor XII-deficient patient who underwent surgical revascularization on CPB. His factor XII level was replenished with fresh-frozen plasma immediately before surgery. This management strategy lowered the baseline activated clotting time (ACT) to near normal, providing a meaningful ACT value for CPB. Factor XII is also a key component in the fibrinolytic system and its deficiency is associated with increased thrombosis. Because the factor XII level quickly returns to baseline postoperatively, perioperative care must include strategies to avoid postoperative thromboembolic events.
Use of del Nido Cardioplegia for Adult Cardiac Surgery at the Cleveland Clinic: Perfusion Implications
Authors: Kim Kuna , Ball Clifford , Grady Patrick , Mick Stephanie
Published: July 2023

Cardiac arrest by cardioplegia provides a reproducible and safe method to induce and maintain electromechanical cardiac quiescence. Techniques of intraoperative myocardial protection are constantly evolving. For the past three decades, modified Buckberg cardioplegia solution has been used for adult cardiac surgery at the Cleveland Clinic. This formulation serves as the crystalloid component, which is delivered 4:1 with oxygenated patient’s blood to crystalloid. Meanwhile, our use of the del Nido cardioplegia solution in adult patients, heretofore primarily used in pediatric cardiac surgical centers, has been increasing over the past several years. Single-dose, cold blood del Nido cardioplegia can be delivered antegrade if the duration of the operation will be limited and if there is no significant coronary artery disease or aortic insufficiency that would limit the distribution of cardioplegia. The addition of del Nido cardioplegia to our cardioplegia armamentarium allows us to customize our myocardial protection strategies for different surgical needs. This article aims to provide information on technical aspects of del Nido cardioplegia in adult cardiac surgery and its use at the Cleveland Clinic in the adult surgical population.