bluuebunny/crossref_metadata_2025 huggingface dataset:
African youth movements put to the test of citizenship, democracy and development
Authors: Toure Ibrahima
Published: August 2023

Y’en a marre (Senegal), Filimbi and Lucha (Democratic Republic of Congo), Balai citoyen (Burkina Faso), Tournons la page (Burundi), SOFAS (Mali), Stop à la mauvaise gouvernance (Guinea) and Ça suffit comme ça (Gabon) are Africa’s new dissident and citizenship movements. Led by young people from diverse social backgrounds, these movements have become major political and social players in public life in Africa, breaking away from traditional ideologies and the classical political class. They are at the heart of the social and historical dynamics running through the continent’s countries. For a long time socially excluded, then confronted with the exhaustion of the post-colonial state model and the extreme precariousness of their living conditions, young people are today increasingly multiplying the forms of civic engagement, dialogue and reconciliation in the political arena and in the development processes of their respective countries. The importance of this increased role for youth movements can be illustrated by the numerous mobilizations around the issues of democratic changeover, climate change, the high cost of living, improved purchasing power, the plundering of national resources, the contestation of the European presence on the continent and the denunciation of its negative effects through the CFA franc currency and extroverted development. Young people no longer hesitate to act retroactively to deconstruct their culture and identity, using linguistic figures close to the cultures of their respective working-class backgrounds and based on values centered on pan-Africanism, the African renaissance, the continent’s growing independence and references to historical leaders such as Thomas Sankara, Kwame Nkrumah, AmilcarCabral, Nelson Mandela, Patrice Lumumba and Cheikh Anta Diop. They take advantage of the opportunities offered by the new information and communication technologies (Facebook, Twitter, Instagram, WhatsApp, YouTube), not only to interact with each other, but also to make themselves known to the outside world, bypassing the various obstacles placed in their path by those in power. The data analysed here come from a literature review and a qualitative survey of youth citizen movements.
The potential of digital tools to foster production, and thus availability, of healthy diets for city dwellers in secondary cities
Authors: Speich Cornelia , Pannatier Marnie , Berlin Robert , Freymond Mathilda , Monroy-Gomez Jimena , Chigemezu Nwokoro Charles , Tshering Puja P. , Imbo Elizabeth , Habumugisha Straton , Barjolle Dominique , Prytherch Helen
Published: August 2023

Urban population growth and strong rural-urban migration are continuing in sub-Saharan Africa. Similarly, traditional farming is no longer attractive to many young people despite its importance for food security. Digitalization can be an ally to make the agri-food system more attractive. The Nutrition in City Ecosystems (NICE) project aims to increase and better link the production and demand of safe and healthy foods in two secondary cities each in Bangladesh, Kenya and Rwanda. Two digital tools called Soluta-ag and GATE are introduced in NICE. Soluta-ag keeps records of business transactions in online and offline mode and provides marketplace facilities and automated business analytics in real-time for Farmers’ Hubs, the social business model implemented in NICE. GATE, on the other hand, serves as a selection, screening and validation platform as well as repository for climate smart agri-food system innovations. Preliminary experiences from NICE show that digital tools can A) attract youth for farming, B) connect farmers’ produce to market, and C) facilitate the delivery of contextadapted innovations. Ensuring ways of production are modern and efficient and sufficient employment opportunities are available in urban agri-food systems are crucial to maintain food sovereignty and adequate, diversified nutrition for all city dwellers.
The Role of von Willebrand factor in Coagulation
Authors: Pepin Eric B. , Larson Douglas F.
Published: August 2023

Perfusionists should be able to verify diagnosis and recognize the forms of von Wille brand disease (vWD) which may require specific coagulation management during open heart procedures. von Willebrand factor (vWF) plays two distinct and important roles in clot formation subsequent to vascular injury. First, it promotes platelet binding to subendothelial surfaces and other platelets (platelet aggregation). Secondly, it also functions as a transport molecule for factor VIII, protecting factor VIII from proteolysis, thus preserving its catalytic role in the coagulation cascade. von Willebrand disease is a heterogeneous group of bleeding disorders which vary in molecular basis, symptomatology, and diagnostic parameters. The great majority of vWD patients will not greatly complicate management of hemostasis during cardiac surgery. Type I vWD patients, comprising 75% of cases, require only intraoperative DDAVP infusion, with cryoprecipitate available if necessary post-surgically. Type II patients vary in response to DDAVP, and may require infusion of cryoprecipitate or purified concentrates of vWF and factor VIII. DDAVP is contraindicated in vWD Type IIB since it has been shown to induce severe thrombocytopenia.
Clinical Comparison of Patient-Side Fibrinogen Assay and Common Laboratory Analyzer in Pediatric Cardiopulmonary Bypass
Authors: Matthews Dorothy R. , Ecklund Jodie M. , Hennein Hani
Published: August 2023

The coagulation status of infant and pediatric patients can be severely compromised during the course of cardiopulmonary bypass due primarily to hemodilution and hypothermia. Fibrinogen level is one source of information necessary to assess the coagulation status of a patient. An accurate and expedient method to determine the fibrinogen level would allow for earlier initiation of coagulation therapy to prevent excessive postoperative bleeding. The purpose of this study was to compare two methods of determining fibrinogen level: a patient-side assay and a common laboratory analyzer. The patient-side test utilized the HemoChron Fibrinogen Assay and was performed in the operating room. The MLA 1000C was the laboratory method utilized in the hospital's coagulation laboratory. Simultaneous testing was conducted pre bypass and intraoperatively on 26 infant and pediatric patients undergoing cardiopulmonary bypass for palliation and correction of congenital heart defects. The resulting values were compared using paired t-test, regression and correlation analysis, and descriptive analysis. The values obtained by the two methods were significantly different (p<.05) at each collection time. Further analysis revealed that other variables, such as hematocrit and platelet count, affected the differences between the results of the methods. The HemoChron Fibrinogen Assay may not be a viable tool for the assessment of fibrinogen level on infant and pediatric patients undergoing cardiopulmonary bypass surgery. Further studies should be done in this patient population incorporating other confounding variables.
Hemofiltration: Determinants of Drug Loss and Concentration
Authors: Clar Alexander , Larson Douglas F.
Published: August 2023

Ultrafiltration has proven to be an effective method of reducing post-cardiopulmonary bypass edema and the inflammatory response associated with activation of the complement cascade. Recently, a modified ultrafiltration process has been developed which allows further hemoconcentration after weaning from bypass. Both of these procedures can have an effect upon the concentrations of many of the pharmaceutical agents being used either pre- or perioperatively. Based upon work done by other investigators in the field of dialysis, we have developed sieving coefficients for many cardiovascular drugs in order to provide an estimation of their loss during extended periods of hemofiltration. Our study utilized the pharmacological and physical characteristics for volume of distribution and protein binding to determine the movement of drugs through a hemofilter. Our results demonstrated that concentrations of certain drugs used during open heart surgery may be significantly increased or decreased with the use of hemofiltration techniques.
A Technique For Separation of Perfluorocarbons From Blood Used in Cardiopulmonary Bypass Laboratory Procedures
Authors: Ybarra José R.
Published: August 2023

Eliminating from physiologic circulation a significant amount of unnecessary perfluorocarbons (PFC) is advantageous since little is known about long-term effects of PFC in the circulatory system. The basic circuitry, cell-washer, mechanical manipulations, and overall concept revealed that a significant amount ofPFC can be retrieved and estimated in volume and compared to initial volumes. A method of separating a certain PFC blood substitute from blood following laboratory cardiopulmonary bypass is described.
Management Considerations for a Heterozygous Protein C Deficient Patient Undergoing Open Heart Surgery with Cardiopulmonary Bypass
Authors: Lawson D. Scott , Darling Edward M. , Ware Russell E. , Kern Frank H. , Ungerleider Ross M. , Shearer Ian R.
Published: August 2023

The protein C system is an important anti thrombotic pathway that regulates the coagulation system by inactivating procoagulant factors Va and VIIIa and enhancing clot lysis by inhibiting the activity of plasminogen activator inhibitor. Protein C deficiency, therefore, is a hypercoaguable state characterized by increased risk of thromboembolic events such as stroke, pulmonary embolism, and venous thrombosis. Extra caution would be warranted in patients with protein C deficiency who undergo cardiopulmonary bypass and are naturally predisposed to hypercoaguability. To our knowledge, however, the management considerations of a patient with protein C deficiency undergoing cardiopulmonary bypass have not been published. This case report presents a pediatric patient with heterozygous protein C deficiency and a prior history of venous thrombosis after open heart surgery who underwent repeat open heart surgery with cardiopulmonary bypass. Initiation of anticoagulation therapy upon admission to reduce procoagulant levels, the use of plasma replacement therapy to increase protein C levels prior to cardiopulmonary bypass, and the careful reinstatement of anticoagulation therapy once postoperative bleeding is controlled, are preliminary suggestions to decrease the risk of thrombotic events in this unusual patient population.
Lipoprotein(a) and Coronary Heart Disease
Authors: Basile-Borgia Annette , Abel John A.
Published: August 2023

The physiological role of lipoprotein(a) (Lp[a]) has yet to be established, though its structure is well known; it is a low density lipoprotein-like particle with structural homology to plasminogen. It is considered to be linked to atherosclerotic vascular disease, associated with atherothrombotic lesions and an acute phase reactant. The purpose of this paper is to review these three aspects of Lp(a), and to discuss recent observations of Lp(a) in the patient with coronary heart disease. Of particular interest is the application of lipoprotein removal.
A Modified Collection and Rapid Infusion System for Shed Whole Blood Autotransfusion During Aortic Aneurysm Surgery
Authors: Dekkers René J. , Rizzo Robert J. , Fitzgerald Daniel J. , Cohn Lawrence H.
Published: August 2023

We describe our experience in 10 patients (5 males) undergoing resection of a descending thoracic aortic aneurysm or a thoracoabdominal aortic aneurysm in which a modified shed whole blood collection and autotransfusion system was used. This modification allows several options for the processing and autotransfusion of shed blood: use of the cell saving device or the ultrafiltration of collected blood, and the autotransfusion of unprocessed shed whole blood. Either low dose heparin or sodium citrate was used for anticoagulation.

All 10 patients underwent autotransfusion and volume resuscitation with the modified rapid infusion device. Total autotransfusion ranged from 1400 ml to 7843 ml. Ultrafiltration volumes ranged from 600 ml to 1100 ml. There were no intraoperative deaths and no patient reoperations for bleeding. Arterial blood gases, potassium, and platelet counts were all within the normal laboratory ranges. This modification enables the clinician to process poor quality shed blood and reinfuse whole blood, in an attempt to decrease the need for homologous blood products.
Pumpless Arterial-Venous Extracorporeal CO2 Removal During Acute Lung Injury
Authors: Cappellett Dominic D. , Olshove Vincent , Tallman Richard D.
Published: August 2023

Acute Respiratory Distress Syndrome (ARDS) is associated with high morbidity and mortality. It has been shown that extracorporeal CO2 removal (ECCO2R) can be used to supplement mechanical ventilatory support for ARDS patients. This makes it possible to reduce the amount of positive pressure ventilation, thus reducing cardiovascular compromise and barotrauma, promoting lung rest and healing.

We have been evaluating a pumpless arterial-venous ECCO2R circuit with a priming volume of approximately 150 ml. A 0.8 m2 hollow fiber membrane oxygenator was studied in 5 dogs (average weight= 27.8 kg) anesthetized with sodium pentobarbital. A femoral artery and vein were cannulated with 17 Fr cannulae. The blood flow through this circuit averaged 1.11 1/min or approximately 23% of the animal's cardiac output. Acute lung injury was induced with oleic acid, (100 mg/kg). Following lung injury, the pulmonary shunt increased by 69% over baseline, while the pulmonary artery pressure increased from 12.7 to 18.7 mmHg. Despite this lung injury, pump less arterial-venous ECCO2R was able to support all of the animal's CO2 exchange without ventilating the native lungs, which were held inflated with oxygen at 5 cmH2O.

The results of this study indicate that a small, highly efficient, low resistance gas exchanger can completely supplant the need for artificial ventilation during pumpless arterial-venous bypass, even with severe respiratory distress. This simple method of ventilatory support should prove to be an important adjunct to positive pressure ventilation.
Amphotericin B Pharmacokinetics During Extracorporea/Membrane Oxygenation: A Case Report
Authors: Hertzog James H. , Brackett Ellen , Sale Mark , Hauser Gabriel J. , Dalton Heidi J.
Published: August 2023

Amphotericin B treatment during extracorporeal membrane oxygenation is at times necessary for the treatment of secondary fungemia or, less commonly, to treat a primary fungal infection. The impact of the extracorporeal circuit on the pharmacokinetics of amphotericin B have not been described in vivo. This case report describes the pharmacokinetics of amphotericin B in a patient receiving extracorporeal membrane oxygenation support for respiratory failure secondary to Blastomyces dermatitidis pneumonia. Amphotericin B concentrations were established and maintained at therapeutic levels with standard dosing despite the presence of a membrane oxygenator and intermittent replacement of extracorporeal circuit components. This suggests that no adjustments in the dosing of amphotericin B are necessary during extracorporeal membrane oxygenation.
Centrifugal Pump Failures
Authors: Kolff Jacob , Ankney Raymond N. , Wurzel David , Devineni Rajsekhar
Published: August 2023

Centrifugal pumps will not pass gross quantities of gaseous emboli due to the nonocclusive nature of the pump. However, retrograde flow can occur under circumstances that include: product malfunctions, low flows, and human errors. Negative pressure created by falling arterial perfusate can draw air into the cannula. Food and Drug Administration (FDA) records about centrifugal pump malfunctions were obtained. Out of 350,000 cases completed with centrifugal pumps over a 23 month period, the FDA received reports of 68 malfunctions, 22 electrical burning smells, and three speed surges, yielding a failure rate of 1 in 3,763 cases. FDA records revealed five death reports and three serious injury reports. A survey was sent to 2,424 Society of Thoracic Surgeons' members to obtain more information; 285 who use centrifugal pumps responded. Sixty surgeons (21%) reported 108 malfunctions, including 46 complete pump failures. Fiftyone of 243 surgeons (21%) who use centrifugal pumps for bypass reported that perfusionists have forgotten to clamp the pump line, resulting in backflow. We conclude centrifugal pumps are generally safe, but malfunctions, low flows, and human errors can lead to retrograde flow and occasionally air embolization. There are valves that can be added to the bypass circuitry to prevent this risk.
Ultrafiltration of the Waste Plasma Effluent from Cardiopulmonary Bypass Circuit Contents Processed with a Cell-Washing Device
Authors: Stammers Alfred H. , Morrow John F. , Brady Chad P. , Deptula Joseph J. , Huffman Suzanne M. , Bonness Andrew S. , Galbraith Timothy A. , Alonso Anselmo
Published: August 2023

Blood conservation methods are commonly practiced throughout most hospitals that conduct cardiothoracic surgery. In an effort to reduce patients' exposure to homologous blood products and due to cost effectiveness of blood conservation techniques, this present study combines autotransfusion of the remaining blood in the extracorporeal circuit and ultrafiltration of the plasma effluent, and describes the resulting product.

Seven patients, greater than 19 years of age, requiring cardiopulmonary bypass (CPB) were incorporated into this study. Exclusion criteria included age limitation. At termination of CPB, the remaining blood in the circuit was transferred to an autotransfusion machine and processed. Plasma (1054 ± 206 ml) effluent was collected directly from the centrifugal bowl and processed through a ultrafiltrator, with a constant flow rate and negative pressure, until the plasma effluent concentrated down to an end processed volume of approximately 150 ml. The following variables were either measured or calculated: plasma-concentrate volumes per three minute interval, inlet/outlet pressures of an ultrafiltrator, transmembrane pressure (TMP), plasma free hemoglobin, fibrinogen, total protein, and colloid osmotic pressure.

The average ultrafiltrate volume taken off from the plasma effluent was 828 ± 237 ml, with an average ultrafiltrate volume of 115 ml in every three minute interval. The TMP did not change over the first 15 minutes of processing but became significantly elevated at the 18th minute interval and continued to increase and reach a maximum TMP of 286.5 ± 2.1 mmHg at the end of concentration. Fibrinogen levels increased from pre-concentration values of 118.2 ± 64 to 317 ± 177 mg/dl (p=.03) along with increases in plasma free hemoglobin from 97.7 ± 46 to 402.1 ± 180 mg/dl (p=.0002). The total protein concentration increased by over 330% from baseline values.

Ultrafiltrating plasma effluent from autotransfused cell salvaged CPB circuit contents could prove beneficial, but further study is required to discover ways to separate unfavorable products, such as activated platelet-leukocyte products and reduced plasma free hemoglobin, and to lower heparin concentrations of the plasma-concentrate.
Whole Body Extracorporeal Low Flow Hyperthermia in a Canine Model
Authors: Cyr John St. , Kelly T , Shecterle Linda M.
Published: August 2023

Whole body hyperthermia (WBH) has not gained significant clinical acceptance, though extensive experimentation since the early 1980's has revealed its potential merits in the treatment of various cancers, and currently WBH is in clinical feasibility trials for Acquired Immune Deficiency Syndrome (AIDS). Using a new device and methodology, could canines serve as an appropriate test model for this device and methodology? Five dogs underwent one treatment each or the 42°C whole body hyperthermia using a low flow veno-venous approach. All animals were kept at the desired temperature for 90 minutes. There were no clinically significant acute or long term sequlae. Every animal was subjected to necropsy. Findings of this study showed that the canine was an adequate model to assess the initial safety of this new device.
Successful Support of the Right Ventricle Following Orthotopic Heart Transplantation Using the Abiomed BVS 5000 System: A Case Report
Authors: Samuels Louis E. , Sharma Sameer , DiSesa Verdi J. , Morris Rohinton J. , Kuretu M.L. Ray , Brozena Susan C. , Fitzpatrick Jane M.
Published: August 2023

Acute right ventricular failure following orthotopic heart transplantation can occur in patients with elevated pulmonary artery pressure with high pulmonary vascular resistance. The result can lead to graft dysfunction and patient death if not managed aggressively. Successful restoration of cardiac hemodynamics was observed with reduction in pulmonary artery pressure and central venous pressure following right ventricular assist device placement. We describe the successful support of the right ventricle following orthotopic heart transplantation using the pneumatically driven Abiomed BVS 5000 system.
Evaluation of a Variable Ratio Cardioplegia System
Authors: Deptula Joseph J. , Zavadil Douglas P. , Christensen Kevin A. , Sydzyik R. Troy , Stammers Alfred H.
Published: August 2023

Gish Biomedical has designed a blood cardioplegia delivery system (MyoManagerTM) which is purported to provide rapid control of blood and crystalloid solution ratios for myocardial preservation. The present study was designed to evaluate the ability of this device to provide cardioplegia solutions of specific hematocrit and potassium ion concentrations ([K+]).

An in vitro circuit was designed whereby a blood perfusate with a [K+] of 5 mEq/L was mixed with a base crystalloid solution containing 210 mEq/L of K+. Data was collected at several blood to crystalloid ratios (1: 1,4: 1,8: 1, 16: 1, 25: 1), and at four delivery rates (100, 150, 200, 250 ml/min). Predicted and observed values of total cardioplegia volume. hematocrit, crystalloid volume, and [K+] were statistically (ANOV A) analyzed. and statistical significance accepted at p 0.05.

There were no statistically significant differences observed at any flows or ratios in hematocrit. However, at 100 ml/min flow rates, the crystalloid delivery volume difference of 2.4±2.0 ml was significantly higher than that observed at 250 ml/min, 1.5± 1.5 ml (p<0.02) and at 200 ml/min flow rates, 1.5± 1.6 ml (p<0.02). There was no statistical significance in [K+] difference between flows across all ratios. However. within ratios, a significant difference in [K+] at 100 ml/min, 1:1 blood to crystalloid ratio, was observed (p<0.0001) versus all other ratios and flows. The only statistically significant difference that was shown in total cardioplegia delivery volume was observed between 100 and 200 ml/min (p<0.04) when analyzed across all ratios.

The data suggests that the MyoManagerTM effectively provides precise control of [K+] and hematocrit at cardioplegia flows greater than 100 ml/min.
Single Hospital Experience with Emergency Cardiopulmonary Bypass Using the Portable CPS® (Bard) System
Authors: Wittenmyer Barbara L. , Pomerants B.J. , Duff Steven B. , Watson William D. , Blackford James M.
Published: August 2023

One hundred four patients were placed emergently on the Bard CPS® portable femoro-femoral bypass system over a 4 year period. Thirty-two patients (31%) were discharged from the hospital. Seventy-six of these patients (73%) required emergency bypass following cardiac arrest, and twenty-eight patients (26%) were in cardiogenic shock or respiratory failure. In the arrest group, no one survived an unwitnessed arrest and those with cardiopulmonary resuscitation times less than 30 minutes had a better survival rate. The highest survival rate was in those patients who did not arrest prior to bypass. Fifty-two percent of these patients were released.

The 74 patients receiving interventional therapy on bypass had a higher survival rate than those unable to be treated. Of the thirty patients receiving no intervention, only three (10%) were eventually discharged. For the 19 patients receiving treatment only in the cardiovascular laboratory, the discharge rate was 26%. Of the 55 patients taken to the operating room for surgical correction, 24 (44%) were discharged from the hospital.

No patients placed on bypass at an outlying hospital or treated using CPS® within 72 hours of a previous open heart procedure survived.
Determining When a Clinical Activity Should be Classified as Research Requiring Institutional Review Board Review
Authors: Prentice Ernest D. , Gordon Bruce G. , Lin Melody H.
Published: August 2023

The boundary between therapy and research may at times be difficult to distinguish, and it is, therefore, important for health care professionals to recognize when a clinical activity should be properly classified as research. Research may be subject to federal regulations which require advance review and approval by an Institutional Review Board (IRB) in order to protect the rights and welfare of patients who serve as human subjects. This paper will discuss the criteria health care professionals can use to distinguish between therapy, innovative therapy, and therapeutic or clinical research.
The Antiinflammatory Effects of Aprotinin in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass
Authors: Stammers Alfred H. , Huffman Suzanne , Alonso Anselmo , Fristoe Lance W. , Hill Gary , Casebeer Dana , Diego Robert P. , Song Zuorui
Published: August 2023

Aprotinin has been shown to effectively attenuate cardiopulmonary bypass (CPB) induced coagulopathies. Because aprotinin is a serine protease inhibitor, it may exert additional properties that reduce the risks associated with extracorporeal flow. The purpose of this study was to prospectively evaluate the antiinflammatory effects of aprotinin with specific emphasis on pulmonary function.

After Institutional Review Board approval, 20 patients undergoing first time coronary artery bypass grafting were randomly assigned to receive either a full dose regimen of aprotinin (APR, n=8), or volumetric equal control (CTR, n= 12). Biological markers of inflammation and coagulation were measured at 3 time periods: immediately prior to drug administration, at chest closure, and at 24 hours post cardiotomy, and included total complement, polymorphonuclear neutrophil (PMN) elastase, Factor XII, protein C, protein S, fibrin split products (FSP), D-dimers. Pulmonary function was assessed throughout intensive care unit (ICU) stay.

There were no differences observed between groups in either preoperative, surgical, anesthesia or perfusion parameters. Twenty-four hour chest tube drainage in the APR group was significantly less than that observed in CTR patients (435.1±169.6 vs. 944.0±585.1, p<.02). Patients receiving aprotinin received significantly lower transfusions of red blood cells, platelets, and fresh frozen plasma. Upon entry into the ICU the CTR group had significantly higher mean airway pressures (8.3±1.5 vs. 10.8±2.9 em H2O, p<.03), higher PaCO2 levels (37.1±4.8 vs. 43.3±7.1 mmHg, p<.04), and higher FIO2 settings (0.63±0.18 vs. 0.75±0.20, p=.l6). Postoperative FSP and D-dimers were significantly lower in the APR treated patients.

In conclusion, the use of aprotinin resulted in significant improvements to postoperative patient outcomes as assessed by transfusion requirements, blood loss, coagulation markers and pulmonary function.
Successful Bi-Ventricular Abiomed Support in a Coronary Artery Bypass/Mitral Valve Replacement Patient
Authors: Swoyer Katharine D. , Martin Michael M. , Illes Richard W.
Published: August 2023

The Abiomed Bi-Ventricular Support System is recommended for patients with post-cardiotomy ventricular dysfunction who have undergone successful cardiac surgery, and then subsequently develop low cardiac output, impairing hemodynamic stability. Stagnant blood flow from ventricular unloading increases the potential for thrombus formation on artificial surfaces of ventricular assist devices and mechanical valves. This case discusses the management of a patient successfully weaned from Abiomed bi-ventricular support following coronary artery bypass and mitral valve replacement with a mechanical prosthesis. We will also describe the management of a console failure that occurred before device explantation.
Platelet-Rich Plasmapheresis: A Meta-Analysis of Clinical Outcomes and Costs
Authors: Mahoney Chris Brown
Published: August 2023

Platelet-rich plasmapheresis (PRP) just prior to cardiopulmonary bypass (CPB) surgery is used to improve post CPB hemostasis and to minimize the risks associated with exposure to allogeneic blood and its components.

Meta-analysis examines evidence of PRP's impact on clinical outcomes by integrating the results across published research studies. Data on clinical outcomes was collected from 20 published studies. These outcomes, DRG payment rates, and current national average costs were used to examine the impact of PRP on costs.

This study provides evidence that the use of PRP results in improved clinical outcomes when compared to the identical control groups not receiving PRP. These improved clinical outcomes result in subsequent lower costs per patient in the PRP groups. All clinical outcomes analyzed were improved: blood product usage, length of stay, intensive care stay, time to extubation, incidence of cardiovascular accident, and incidence of reoperation. The most striking differences occur in use of all blood products, particularly packed red blood cells.

This study provides an example of how initial expenditure on technology used during CPB results in overall cost savings. Estimated cost savings range from $2,505.00 to $4,209.00. More importantly, patients benefit from improved clinical outcomes.
Fiber Manufacturing, Membrane Classification, and Winding Technologies Associated with Membrane Oxygenators
Authors: Schaadt Jennifer
Published: August 2023

Fiber bundling refers to the process of winding hollow polypropylene fibers onto the central core of a membrane oxygenator. Identifying the various bundling techniques serves to facilitate the clinician's understanding of unique device characteristics and the subsequent manufacturing process. This technical information has been voluntarily provided by the product managers and engineers of current membrane manufacturers. Currently the industry employs four primary bundling techiques: single strand, mat configuration, tape and helical.

Single strand wraps one fiber at a time, up and down a central core to create the fiber bundle. A modification of the single strand technique is the single strand multi toe, where multiple fibers are wound at a time. Mat technology wraps a large, woven sheet consisting of uniformly placed fibers and spacing filaments, around the oxygenator core. A modification is the double mat, where two sheets of fibers oriented at a specific bias to each other, are wrapped to yield a fiber bundle. Tape technology involves evenly spaced fibers, 5 to 10 fibers wide, wrapped up and down the length of the core. Helical utilizes a spacing filament that is spiraled around each individual fiber and then around the core of the device.
Do Different Heparin Brands Influence Activated Clotting Times?
Authors: Dyck Louise , Friesen Robert M.
Published: August 2023

A change in brand suppliers of heparin at our institution resulted in a number of anecdotal reports of possible differences in potency. Both products are marketed as heparin sodium extracted from porcine intestinal mucosa. Heparin Leo® is 1000 international units (British Pharmacopeia) per ml. while Hepalean® is 10000 United States Pharmacopeia (U.S.P) units per ml.

Perfusion records were retrospectively reviewed for one month periods when Heparin Leo® (n=52) or Hepalean® (n=61) were used to provide anticoagulation therapy for cardiopulmonary bypass.

Heparin Leo® was found to be less clinically potent than Hepalean®. While increasing the initial loading dose of Heparin Leo® by 5% (378 vs 395 units/kg−1), the initial post load activated clotting time (ACT) was 17% lower (556 vs 666 seconds). Heparin units required per kilogram per minute of cardiopulmonary bypass were 23% higher for Heparin Leo®. Additionally 8 of 52 Heparin Leo® patients did not achieve an initial post load ACT of greater than 400 sees while this occurred in 2 of 61 patients treated with Hepalean®. These results were statistically significant.

British Pharmacopeia and United States Pharmacopeia heparin reference standards differences are insufficient to explain the discrepancies observed in this study.
Hematological Abnormalities in Neonatal Patients Treated with Extracorporeal Membrane Oxygenation (ECMO)
Authors: Zavadil Douglas P. , Stammers Alfred H. , Willett Lynne D. , Deptula Joseph J. , Christensen Kevin A. , Sydzyik R. Troy
Published: August 2023

The physical process of extracorporeal membrane oxygenation (ECMO) results in derangement of the hemostatic mechanism, which may lead to increased morbidity, secondary to the disease process. The purpose of this study was to evaluate the hematological status of neonates undergoing ECMO therapy, and to evaluate coagulation tests in predicting hemorrhagic risk.

Following Institutional Review Board approval, 30 patients undergoing ECMO treatment were retrospectively entered into this study. Medical records were reviewed and indicators of hemostasis, transfusion, morbidity, and outcomes recorded. Assessment of coagulation was determined through serial analysis of platelet count, fibrinogen concentration, prothrombin time (PT), activated partial thromboplastin time (aPTT), antithrombin III, fibrin split products, D-dimers, plasma free hemoglobin, activated clotting time, ionized calcium, and thrombelastography (TEG).

Median total transfusion requirements for all patients were 1.79 ml/kg/ECMO hr. Fifty-seven percent of the 30 patients were diagnosed as coagulopathic according to Extracorporeal Life Support Organization standards. Patients were separated into either a hemorrhagic group (HEM, >2.0 ml/kg/ECMO hr, n=13) or a nonhemorrhagic group (N-HEM, n=17), with HEM patients requiring twice the transfusion volume of N-HEM (p<0.0001). Hemorrhagic complications were reported in 53.8% of the HEM patients vs. 35.3% in the N-HEM group. HEM patients were transfused with significantly greater quantities of platelets on days 1,3,5, and 8 and packed red blood cells on day 7 when compared to N-HEM (p<0.05). TEG determination showed significant differences between groups on days 3 and 6 (p<0.005), and 8 (p<0.05).

Derangements in hemostasis resulting from ECMO are profound, with methods of assessing coagulation complicated by both the variability in patient condition and lack of specificity of laboratory tests. Interpretation of TEG data has shown to be a valuable supplement for managing this challenging patient population.
Successful Bridge to Transplantation with the Abiomed BVS 5000 Ventricular Assist Device Following Double Valve Replacement: A Case Report
Authors: Samuels Louis E. , Kauffman Marla S. , Morris Rohinton J. , Strong Michael D. , Brockman Stanley K.
Published: August 2023

We report the successful use of the Abiomed BVS 5000 to provide myocardial support following double valve replacement. Discontinuation of cardiopulmonary bypass (CPB) following aortic and mitral valve replacement was unsuccessful because of severe left ventricular dysfunction and ventricular arrhythmia. Insertion of an intra-aortic balloon pump, initiation of inotropic drugs, and institution of anti-arrhythmic agents were unable to reverse the situation. The Abiomed BVS 5000 ventricular assist device was implanted. The patient was easily weaned from CPB with maximal assist (5.0 L/min) and minimal inotropic (dobutamine 5 mcg/kg/min) support. Orthotopic heart transplantation took place on the fifth postoperative day. The explanted native heart was examined and found to have heavy thrombus deposition on the mechanical valves despite high dose anticoagulation.
Patientenzufriedenheit nach minimalinvasiver Trichterbrustkorrektur (MIRPE)
Authors: Staubach Raphael , Glosse Helen , Skandul Martina , Alazki Ammar , Loff Steffan
Published: August 2023

Die Nuss-OP ist eine sichere Variante zur Korrektur einer Trichterbrust mit einer sehr guten Patientenakzeptanz und einer sehr hohen Patientenzufriedenheit. Allerdings setzt die operative Korrektur viel Erfahrung des Operateurs voraus und sollte deshalb nur in entsprechenden chirurgischen Abteilungen mit hoher Expertise durchgeführt werden 10.
Klimawandel – eine Gefahr für die Gesundheit und Zukunft unserer Kinder
Authors: Knüpfer Matthias
Published: August 2023

Der Klimawandel ist mit dem Gesundheitswesen in Deutschland auf zwei Ebenen eng verwoben, zum einen ist das Gesundheitswesen mit ca. 5–9 % vom Gesamtvolumen ein erheblicher Emittent von CO2-Äquivalenten, zum anderen wird die Gesundheit auch hierzulande schon durch den Klimawandel belastet. Zahlreichen Publikationen weisen auf die Bedeutung des Klimawandels für die Gesundheit pädiatrischer Patienten hin: Verlängerte Hitzeperioden sind assoziiert mit mehr angeborenen Fehlbildungen, einer erhöhten Frühgeburtenrate und mit mehr Adipositas. Eine klimawandelbedingte erhöhte Luftverschmutzung führt zu mehr Frühgeburten und einer erhöhten Allergierate bei Kindern. Bei höheren Temperaturen steigt die Rate von Vektor-assoziierten Infektionskrankheiten und Kinder sind dabei besonders gefährdet. Kindergesundheit spielt für die Zukunft dieser Welt naturgemäß eine existenzielle Rolle. Der Einsatz für mehr Nachhaltigkeit schützt die Gesundheit ALLER Kinder dieser Welt. Diese Aufgabe ist wichtig für uns alle, besonders aber für Kinderärzt:innen. Wir haben eine Verantwortung für die Gesundheit der Kinder, und zwar heute und auch morgen.
Internet Health Resources on Nocturnal Enuresis: A Readability, Quality, and Accuracy Analysis
Authors: Fung Adrian C.H. , Lee Matthew H.L. , Leung Jessie L. , Chan Ivy H.Y. , Wong Kenneth K.Y.
Published: August 2023

Introduction Nocturnal enuresis is a common yet quality-of-life-limiting pediatric condition. There is an increasing trend for parents to obtain information on the disease's nature and treatment options via the internet. However, the quality of health-related information on the internet varies greatly and is largely uncontrolled and unregulated. With this study, a readability, quality, and accuracy evaluation of the health information regarding nocturnal enuresis is carried out.

Materials and Methods A questionnaire was administered to parents and patients with nocturnal enuresis to determine their use of the internet to research their condition. The most common search terms were determined, and the first 30 websites returned by the most popular search engines were used to assess the quality of information about nocturnal enuresis. Each site was categorized by type and assessed for readability using the Gunning fog score, Simple Measure of Gobbledygook (SMOG) index, and Dale–Chall score; for quality using the DISCERN score; and for accuracy by comparison to the International Children's Continence Society guidelines by three experienced pediatric urologists and nephrologists.

Results A total of 30 websites were assessed and classified into five categories: professional (n = 13), nonprofit (n = 8), commercial (n = 4), government (n = 3), and other (n = 2). The information was considered difficult for the public to comprehend, with mean Gunning fog, SMOG index, and Dale–Chall scores of 12.1 ± 4.3, 14.1 ± 4.3, and 8.1 ± 1.3, respectively. The mean summed DISCERN score was 41 ± 11.6 out of 75. Only seven (23%) websites were considered of good quality (DISCERN score > 50). The mean accuracy score of the websites was 3.2 ± 0.6 out of 5. Commercial websites were of the poorest quality and accuracy. Websites generally scored well in providing their aims and identifying treatment benefits and options, while they lacked references and information regarding treatment risks and mechanisms.

Conclusion Online information about nocturnal enuresis exists for parents; however, most websites are of suboptimal quality, readability, and accuracy. Pediatric surgeons should be aware of parents' health-information-seeking behavior and be proactive in guiding parents to identify high-quality resources.
Peroral Endoscopic Myotomy in Pediatric Patients with Achalasia up to 12 Years of Age: A Pilot Study in a Single-Center Experience in Japan
Authors: Samejima Yoshitomo , Yoshimura Shohei , Okata Yuichi , Sakaguchi Hiroya , Abe Hirofumi , Tanaka Shinwa , Kodama Yuzo , Bitoh Yuko
Published: August 2023

Introduction Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic procedure for achalasia; its indication has expanded from adults to children. We aimed to evaluate the postoperative efficacy and antireflex status of POEM in young children with achalasia aged 12 years or younger.

Patients
and Methods Pediatric patients with achalasia aged 18 years or younger who underwent POEM in our hospital between 2016 and 2021 were included and divided into two age groups: group A (≤ 12 years) and group B (13–18 years). The success rate (Eckardt score ≤ 3), endoscopic reflux findings, and antiacid use at 1 year postoperatively were compared between the groups.

Results Ten patients (four boys and six girls; Chicago classification type I: five, type II: four, and unclassified: one) were included. Mean age and preoperative Eckardt scores in groups A (n = 4) and B (n = 6) were 9.2 ± 3.0 versus 15.6 ± 0.6 years (p = 0.001) and 5.5 ± 3.9 versus 7.2 ± 3.7 (p = 0.509), respectively, and mean operative time and myotomy length were 51.3 ± 16.6 versus 52.5 ± 13.2 minutes (p = 0.898) and 10.8 ± 4.6 versus 9.8 ± 3.2 cm (p = 0.720), respectively. The 1-year success rate was 100% in both groups. Mild esophagitis (Los Angeles classification B) was endoscopically found in one patient in each group (16.7 vs. 25.0%, p = 0.714), and antiacid use was required in three patients (group A, two; group B, one; 50.0 vs. 16.7%, p = 0.500).

Conclusion The success rate of POEM within 1 year in young children with achalasia aged 12 years or younger was equal to that in adolescent patients. However, young children tended to require antiacids 1 year postoperatively; therefore, long-term follow-up is necessary.
Vascular Repair for Iatrogenic Injury during Microsurgical Procedures: Clinical Investigation and Review of 18 Cases at a Single Institution
Authors: Yokoya Shigeomi , Hino Akihiko , Oka Hideki
Published: August 2023

Background Intracranial vascular injury (VI) due to surgery is a critical complication that can lead to serious neurologic deficits. To our knowledge, only a few review articles on VI during an operation have been published so far. We retrospectively investigated the type, cause, and measurement of VI during surgery at our institution.

Methods Unexpected VI cases occurred in 18 of 2,228 craniotomy procedures, including 794 aneurysm clippings and 357 tumor resections. We investigated the causes and coping techniques of the VI cases, as well as their full details.

Results There were six cases of aneurysm neck tear, one case of sylvian vein injury, and one case of superior trunk perforation during direct clipping. Regarding tumor resection procedures, nine cases of arterial injury and one case of cortical vein injury were extracted. Almost all VIs were caused by carelessness or basic manipulation mistakes. We repaired all these cases with simple placement of suture threads with or without pinch clips, flow alteration using bypass techniques, and in 16 cases no neurologic deficit or deterioration on imaging occurred; however, 3 patients were verified to have ischemic changes on postoperative imaging.

Conclusions Most VIs were directly caused by a simple error and carelessness of an operator or an assistant. Many of these injuries can be avoided if a basic set of rules are followed and remembered during the surgical procedure. However, the surgical procedure involves human work, and errors cannot be eradicated even upon maximum concentration levels. Neurosurgeons should be prepared for an eventual quick repair of an unexpected cerebral VI.
Synthesis of Pyrido[2,3-d]pyrimidines Catalyzed by 2,3-Dichloro-5,6-dicyano-1,4-benzoquinone (DDQ)/tert-Butyl Nitrite (TBN)/O2
Authors: Cheng Dongping , Li Jing-Hua , Xu Xiaoliang , Xia Hongshuang , Gu Huafang , Wang Yawei
Published: August 2023

Catalyzed by 2,3-dichloro-5,6-dicyano-1,4-benzoquinone (DDQ)/tert-butyl nitrite (TBN)/O2, an efficient tandem oxidative reaction of uracils/thiouracil with 1,3-diarylpropenes is disclosed. It undergoes oxidative coupling, intramolecular cyclization, and dehydro-aromatization to provide multi-substituted pyrido[2,3-d]pyrimidines/thiopyrido[2,3-d]pyrimidines in moderate to excellent yields. It has the advantages of high atom economy, green terminal oxidant, and metal-free conditions.
What Is the Evidence for Endovascular Thrombectomy in Posterior Circulation Stroke?
Authors: Räty Silja , Nguyen Thanh N. , Nagel Simon , Puetz Volker , Alemseged Fana , Abdalkader Mohamad , Schonewille Wouter J. , Strbian Daniel
Published: August 2023

Posterior circulation infarcts comprise approximately 25% of ischemic strokes but are less often treated with recanalization therapy and have longer treatment delays compared with anterior circulation strokes. Among posterior circulation strokes, basilar artery occlusion is associated with the most severe deficits and the worst prognosis. Endovascular thrombectomy is a standard of care for patients with anterior circulation large vessel occlusion, but not until recently were the first randomized controlled trials on endovascular thrombectomy in basilar artery occlusion published. Two of the trials were neutral, whereas two others showed better functional outcome after thrombectomy up to 24 hours of symptom onset compared with best medical treatment, which in most cases had low rates of intravenous thrombolysis. According to observational data, thrombectomy seems to be safe also in isolated posterior cerebral artery occlusions and might be an option for selected patients, even if its outcome benefit is yet to be demonstrated.
Clinical Characteristics and Outcomes of a High-grade Endometrial Cancer Cohort Treated at Instituto Nacional de Câncer, Brazil
Authors: Paulino Eduardo , Melo Andreia Cristina de
Published: August 2023

Objective To analyze the outcomes of a cohort of patients with high-risk histologies of endometrial cancer (EC) treated at Instituto Nacional de Câncer (National Cancer Institute, INCA, in Portuguese), in Brazil.

Materials and Methods We reviewed the medical records of patients with high-risk histologies of EC in any stage registered at INCA between 2010 and 2016 to perform a clinical and demographic descriptive analysis and to evaluate the outcomes in terms of recurrence and survival.

Results From 2010 to 2016, 2,145 EC patients were registered and treated at INCA, and 466 had high-grade histologies that met the inclusion criteria. The mean age of the patients was 65 years, 44.6% were Caucasian, and 90% had a performance status of 0 or 1. The most common histology was high-grade endometrioid (31.1%), followed by serous carcinoma (25.3%), mixed (20.0%), carcinosarcoma (13.5%), and clear cell carcinoma (9.4%). Considering the 2018 Fédération Internationale de Gynécologie et d'Obstétrique (International Federation of Gynecology and Obstetrics, FIGO, in French) staging system, 44.8%, 12.4%, 29.8%, and 12.9% of the patient were in stages I, II, III or IV respectively. Age (> 60 years), more than 50% of myoinvasion, higher stage, poor performance status, serous and carcinosarcoma histologies, and adjuvant treatment were independent factors associated with recurrence-free survival (RFS) and overall survival (OS) in the multivariate analysis.

Conclusion The current findings reinforced the international data showing poor outcomes of these tumors, especially for serous and carcinosarcomas and tumors with advanced stages, with shorter survival and high recurrence rates in distant sites, independently of the FIGO stage. Adjuvant therapy was associated with better survival.