bluuebunny/crossref_metadata_2025 huggingface dataset:
The Influence of Sampling Technique on ACT Plus® Results
Authors: Brouwer Monique E. , Miraziz Ramen , Agbulos Grace , Steel Rona , Hales Peter , Klineberg Peter
Published: July 2023

The manufacturer of the ACT Plus® Automated Coagulation Timer, Medtronic Inc., recommends that test cartridges be prewarmed and the activating reagent resuspended (tapped/mixed) before patient testing. In a busy clinical environment, these recommendations may be overlooked or disregarded. In this study, the impact of sampling technique on ACT Plus® test results was investigated. In Series 1, two test cartridges were split into four individual chambers. Two ACT Plus® machines were used, allowing for three separate comparisons to be made. The sample results from test Chambers 2 (cold/tapped), 3 (warmed/not tapped), and 4 (cold/not tapped) were compared individually against the result from test Chamber 1, the recommended technique (warm/tapped). In Series 2, the manufacturer’s recommendations were tested using a single double cartridge (warm/tapped). Results were interpreted using the Bland-Altman method of analysis. The prewarming and tapping of cartridges before use independently influenced the agreement of results when compared with cartridges that were not prewarmed and tapped. Each factor (temperature and mixing) when excluded was found to affect the standard deviation and decrease the agreement of results. By following the manufacturer’s recommendations to standardize the sampling technique, ACT Plus® test results are more accurate.
Extracorporeal Life Support during Cardiac Arrest Resuscitation in a Porcine Model of Ventricular Fibrillation
Authors: Reynolds Joshua C. , Salcido David D. , Sundermann Matthew L. , Koller Allison C. , Menegazzi James J.
Published: July 2023

Implementation barriers for extracorporeal life support in out-of-hospital cardiac arrest (OHCA) include initiation delay and candidate selection. We explored ischemia duration, cardiopulmonary resuscitation (CPR) duration, and physiologic variables that discriminated animals with return of spontaneous circulation (ROSC). We instrumented eight female swine (31.9 ± 9.8 kg) with femoral artery and external jugular vein cannula. After 8 (n = 4) or 15 (n = 4) minutes ventricular fibrillation (VF), animals received 30, 40, 50, or 60 minutes of CPR and then drugs (.6 U/kg vasopressin, .1 mg/kg epinephrine, .1 mg/kg propranolol, sodium bicarbonate as indicated) after 5 minutes of CPR. Extracorporeal membrane oxygenation (ECMO) flow rate was 3 L/min ≤2 hours and then 1.5 L/min ≤2 hours before weaning. Animals were defibrillated (150 J biphasic) ≥15 minutes ECMO. Primary outcome for successful resuscitation was ROSC (organized rhythm with systolic blood pressure >80 mmHg). We measured arterial blood gas, electrolytes, mean arterial pressure (MAP), coronary perfusion pressure (CPP), and five quantitative VF waveform measures at key intervals. Continuous variables were compared with two-sample t test. All 8-minute VF animals were successfully resuscitated and had ROSC. MAP was higher at the beginning (27.0 ± 7.1 vs. 15.0 ± 4.4; p = .03) and end (31.3 ± 12.8 vs. 11.5 ± 7.3; p = .03) of CPR in animals successfully resuscitated. CPP was higher at the beginning of CPR (11.9 ± 4.6 vs. 3.3 ± 2.2; p = .01) and the end of CPR (18.5 ± 12.1 vs. .9 ± 1.4; p = .03) among animals with ROSC. Amplitude spectrum area (AMSA) was superior at the end of CPR (–2.0 ± 1.8 vs. –5.0 ± 1.4; p = .04) in animals successfully resuscitated. In a porcine OHCA model, MAP and CPP at the beginning and end of CPR were higher in animals successfully resuscitated. AMSA was superior at the end of CPR in animals successfully resuscitated.
Correlation of a Novel Noninvasive Tissue Oxygen Saturation Monitor to Serum Central Venous Oxygen Saturation in Pediatric Patients with Postoperative Congenital Cyanotic Heart Disease
Authors: Yadlapati Ajay , Grogan Tristan , Elashoff David , Kelly Robert B.
Published: July 2023

Using a novel noninvasive, visible-light optical diffusion oximeter (T-Stat VLS Tissue Oximeter; Spectros Corporation, Portola Valley, CA) to measure the tissue oxygen saturation (StO2) of the buccal mucosa, the correlation between StO2 and central venous oxygen saturation (ScvO2) was examined in children with congenital cyanotic heart disease undergoing a cardiac surgical procedure. Paired StO2 and serum ScvO2 measurements were obtained postoperatively and statistically analyzed for agreement and association. Thirteen children (nine male) participated in the study (age range, 4 days to 18 months). Surgeries included Glenn shunt procedures, Norwood procedures, unifocalization procedures with Blalock-Taussig shunt placement, a Kawashima/Glenn shunt procedure, a Blalock-Taussig shunt placement, and a modified Norwood procedure. A total of 45 paired StO2-ScvO2 measurements was obtained. Linear regression demonstrated a Pearson’s correlation of .58 (95% confidence interval [CI], .35–.75; p < .0001). The regression slope coefficient estimate was .95 (95% CI, .54–1.36) with an interclass correlation coefficient of .48 (95% CI, .22–.68). Below a clinically relevant average ScvO2 value, a receiver operator characteristic analysis yielded an area under the curve of .78. Statistical methods to control for repeatedly measuring the same subjects produced similar results. This study shows a moderate relationship and agreement between StO2 and ScvO2 measurements in pediatric patients with a history of congenital cyanotic heart disease undergoing a cardiac surgical procedure. This real-time monitoring device can act as a valuable adjunct to standard noninvasive monitoring in which serum ScvO2 sampling currently assists in the diagnosis of low cardiac output after pediatric cardiac surgery.
Has the New USP Assay for Heparin Affected Dosage for Patients Undergoing Cardiopulmonary Bypass?
Authors: Anderson Daniel A. , Holt David W.
Published: July 2023

In October 2009, the U.S. Pharmacopoeia (USP) changed the monograph for heparin to bring USP units in line with international units for heparin. The result was a 10% decrease in potency as measured by in vitro laboratory tests. This decrease led to questions regarding dosing guidelines. There existed a need for an in vivo study to determine the practical changes that may need to be implemented in regard to heparin administration for cardiopulmonary bypass in the clinical setting. A retrospective study was conducted to determine the heparin dose administered and the corresponding effect on patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass. The study compared the heparin dose requirements and activated clotting time (ACT) results using the heparin before and after the USP changes. An analysis of the data was performed to determine the increased heparin dose required to achieve the same effect as before the USP change. This new heparin dosing protocol was instituted at Concord Hospital, Concord, NH. A prospective study was then preformed to verify the effects of the dosing change. In the new heparin group, the postheparin ACT fell by 9.1% (p = .028) and the patients achieving an ACT > 479 seconds fell by 12.8% as compared with the old heparin group. After adjustment of the loading dose calculation for heparin, the prospective study demonstrated the postheparin ACT (p = .684) and the percentage of patients achieving an ACT > 479 seconds (p = 1.000) to be similar to the values obtained before the USP change. An increase of the loading dose of approximately 12% is needed to achieve the patient effects seen before the UPS change.
Vacuum-Assisted Venous Drainage, Angel or Demon: PRO?
Authors: Durandy Yves
Published: July 2023

Vacuum-assisted venous drainage (VAVD) was proposed to optimize venous drainage during bypass through femoral venous cannulation. It is currently used in both adult and pediatric surgery when siphon gravity venous drainage is suboptimal. In pediatric surgery, the major advantages of VAVD are a significant decrease in cardiopulmonary bypass prime volume and an improved drainage with all collateral benefits. To limit gravity drainage, we use a two-level heart–lung machine dedicated to pediatric perfusion. The top level of the cardiotomy reservoir is positioned at the patient atrial level, making it possible to downsize the length and diameter of venous and arterial lines. Since 2008, a negative pressure of approximately −30 mmHg has been used for all patients. Initiation of bypass is performed in a classical way with a cardiotomy reservoir open; vacuum is added as soon as the maximal gravity drainage is reached. During bypass, when the blood level in the reservoir decreases to the safety limit level, a small increase in negative pressure is used to improve venous drainage. For weaning from bypass, the negative pressure is gradually decreased to zero, then the reservoir is opened and the venous line progressively closed. Prime volumes were significantly reduced to 100 mL for small neonates, 125 mL for infants, and 175 mL for older children with flow up to 1.5 L/min−1. A low prime volume is expected to improve blood conservation and decrease donor exposure, prevent drawbacks of transfusion (immunomodulation, infection), increase the incidence of blood-free surgery in smaller babies, and decrease whole body systemic inflammation by decreasing surface of foreign material in contact with blood and inflammation associated with blood transfusion. The main drawbacks described have been retrograde flow in the venous line with cerebral air embolus and an increased incidence of gaseous microemboli. These drawbacks are avoidable through appropriate training of perfusionists. When negative pressure is “reasonable,” complications are more theoretical than significant in clinical practice. A technique with a benefit/drawback ratio of 1:0 is utopian, but the advantages of VAVD far outweigh any potential drawbacks when applied properly.
Cardiac Surgery, the Brain, and Inflammation
Authors: Scott David A. , Evered Lisbeth A. , Silbert Brendan S.
Published: July 2023

Cognitive deterioration can reliably be measured after procedures requiring anesthesia and surgery. Cardiac surgery has had the spotlight because of the high reported incidence of postoperative cognitive dysfunction in early studies, but such effects occur after other surgical procedures as well. “Early” postoperative cognitive dysfunction should be considered as a different phenomenon, relating to acute pharmacological, physiological, and stress-related recovery. The focus should be on what is affecting patients at 3 months, 12 months, and 5 years later. Like with many other aspects of perioperative risk, a significant element is the patient’s preoperative cognitive status. We now know that up to one-third of overtly “normal” elective cardiac surgical patients enter surgery with some degree of pre-existing cognitive impairment or, when applying psychogeriatric measures, mild cognitive impairment. The latter is a known prodrome or early stage of the amyloid associated Alzheimer’s disease dementia. Inflammatory responses during cardiac surgery have been recognized for years, but our understanding of the complexity of systemic inflammatory response has grown significantly with the ability to assay neurohumoral markers such as interleukins. The blood–brain barrier is made vulnerable by both pre-existing disorders (mild cognitive impairment/amyloid; vascular disease) and by the inflammatory response to surgery and cardiopulmonary bypass. Inflammation affecting the brain at this time may set in motion accelerated neurological and hence cognitive decline that, despite an initial recovery and even functional improvement, may proceed to further long-term decline at an accelerated rate in susceptible individuals. Clinical data are emerging from longer-term studies to support this concern, but evidence for effective preventive or therapeutic strategies is limited.
Developing and Executing Quality Improvement Projects (concept, methods, and evaluation)
Authors: Likosky Donald S.
Published: July 2023

Continuous quality improvement, quality assurance, cycles of change—these words of often used to express the process of using data to inform and improve clinical care. Although many of us have been exposed to theories and practice of experimental work (e.g., randomized trial), few of us have been similarly exposed to the science underlying quality improvement. Through the lens of a single-center quality improvement study, this article exposes the reader to methodology for conducting such studies. The reader will gain an understanding of these methods required to embark on such a study.
Initial Experience with Recombinant Antithrombin to Treat Antithrombin Deficiency in Patients on Extracorporeal Membrane Oxygenation
Authors: Niimi Kevin S. , Fanning Jeffrey J.
Published: July 2023

Acquired antithrombin (AT) deficiency has been associated with patients on extracorporeal membrane oxygenation (ECMO) as a result of hemodilution, blood coagulation activation, and the use of heparin. Replacement of AT has been typically utilized through the use of fresh-frozen plasma or AT concentrate. Antithrombin alfa (ATryn®) is a recombinant form of AT (rAT) with an identical amino acid sequence as that of plasma-derived antithrombin. The primary objective of this study is to examine the relationship of rAT dose to measured plasma antithrombin activity in a small series of patients who received rAT while on ECMO. A retrospective chart review was performed of all patients at Medical City Children’s Hospital who received ATryn while supported on ECMO between December 2011 and April 2012. Five patients were identified and the patients’ weight, bolus dose of ATryn, drip rate of ATryn, and AT blood levels were collected for analysis. The median age of these patients was 1 month (range, 1 day to 3.75 years). Because no dosing guidelines exist for pediatric ECMO, a starting dose of ATryn was chosen based on the manufacturer’s labeled indication (prevention of thromboembolic events in patients with AT hereditary deficiency). The median dose of rAT was 368 IU/kg/day (range, 104–520 IU/kg/day) to obtain AT activity level of 80–120%. The average time to reach the targeted AT activity level (80–120%) was 12.7 hours (range, 11–17 hours). Our findings suggest that the published ATryn dose may be inadequate to reach desired AT activity concentrations for pediatric patients on ECMO. Difference in patient population, use of extracorporeal circuits, and the use of heparin are likely explanations for this finding. We would also recommend frequent checking of AT levels while delivering this drug because making timely adjustments is necessary for achieving and maintaining the target AT activity level.
Prevention of Lung Injury in Cardiac Surgery: A Review
Authors: Young Robert W.
Published: July 2023

Inflammatory lung injury is an inevitable consequence of cardiac surgery with cardiopulmonary bypass. The lungs are particularly susceptible to the effects of the systemic inflammatory response to cardiopulmonary bypass. This insult is further exacerbated by a pulmonary ischemia–reperfusion injury after termination of bypass. Older patients and those with pre-existing lung disease will clearly be less tolerant of any lung injury and more likely to develop respiratory failure in the postoperative period. A requirement for prolonged ventilation has implications for morbidity, mortality, and cost of treatment. This review contains a summary of recent interventions and changes of practice that may reduce inflammatory lung injury after cardiac surgery. The review also focuses on a number of general aspects of perioperative management, which may exacerbate such injury, if performed poorly.
Embolic Activity During In Vivo Cardiopulmonary Bypass
Authors: DeFoe Gordon R. , Dame Norman A. , Farrell Mark S. , Ross Cathy S. , Langner Craig W. , Likosky Donald S.
Published: July 2023

Neurologic injury after cardiac surgery is principally associated with emboli. Although much work has focused on surgical sources of emboli, less attention has been focused on emboli associated with the heart–lung machine. We tested whether emboli are associated with discrete processes during cardiopulmonary bypass (CPB). One hundred patients undergoing cardiothoracic surgery were enrolled between April 2008 and May 2011 at a single medical center. During each surgical procedure, emboli were counted in three CPB locations: the venous side (Channel 1), before the arterial line filter (Channel 2), and after the arterial line filter (Channel 3). We used prespecified event markers to identify perfusionist interventions. Identical circuits were used on all patients. Of the 100 patients enrolled, 62 underwent isolated coronary artery bypass grafting (CABG), 17 underwent isolated valve operations, and 21 underwent CABG plus valve. Median counts across Channels 1, 2, and 3 were 69,853, 3,017, and 1,251, respectively. The greatest contributor to emboli in Channels 1, 2, and 3, respectively, were achieving the calculated CPB flow, opening of the electronic arterial line clamp, and introducing a hemofilter. The circuit technology was efficient in reducing total emboli counts from Channels 1–2 irrespective of the size of the emboli. Nearly 71% of all emboli 30–100 mm in size were removed from the circuit between Channels 2 and 3. No significant association was found between emboli counts and S100B release. Emboli occur frequently during CPB and are predominantly associated with the initiation of bypass, operation of the electronic arterial line clamp, and the initiation of a hemofilter. Continued work to reduce the occurrence of emboli is warranted.
Hemolysis-Associated Nitric Oxide Dysregulation during Extracorporeal Membrane Oxygenation
Authors: Sulkowski Jason P. , Cooper Jennifer N. , Pearson Erik G. , Connelly James T. , Rintoul Natalie , Kilbaugh Todd J. , Deans Katherine J. , Minneci Peter C.
Published: July 2023

Acute intravascular hemolysis during extracorporeal membrane oxygenation (ECMO) leads to increased levels of cell-free hemoglobin (FHb). Our aim was to investigate whether FHb levels are associated with nitric oxide (NO) consumption and clinical outcomes. A prospective observational study was performed involving pediatric patients on ECMO. Blood samples were collected before, during, and after the ECMO run, and plasma was evaluated for FHb, oxyhemoglobin, and NO consumption. Clinical data were collected including baseline patient characteristics, indications for ECMO, circuit changes, and mortality. Correlations between laboratory measures and associations between laboratory measures and clinical observations were evaluated. Twenty-three patients (11 male, 17 neonates) were enrolled with a median weight of 3.1 kg (interquartile range, 2.8–14.0 kg) and median ECMO run of 12 days (interquartile range, 5–19 day). There was a significant increase in FHb over time on ECMO (p = .007), and significant correlations were present between NO consumption and both FHb (r = .41, p = .01) and oxyhemoglobin levels (r = .98, p < .0001). Patients on ECMO for sepsis (n = 6) had lower average levels of oxyhemoglobin (mean [standard deviation {SD}] 14.5 [4.4] versus 19.0 [5.0] μM, p = .07) and NO consumption (mean [SD] 15.8 [4.1] versus 19.8 [3.7] μM, p = .04) during ECMO than patients with other indications. In the 3 days leading up to a circuit change, there were increases in mean total cell-free hemoglobin levels (24%/day, p = .08), oxyhemoglobin (37%/day, p = .005), and NO consumption (40%/day, p = .006) (n = 5). There were no significant associations identified between peak or average plasma measures of hemolysis and type of ECMO (venovenous versus venoarterial) or mortality. For children on ECMO, we observed a strong correlation between increased levels of plasma FHb and elevations in oxyhemoglobin and NO consumption; however, these changes were not associated with increased mortality. Increased hemolysis before circuit changes may be both a marker and a contributor to circuit failure.
An Evaluation Trial of The National Perfusion Registry
Authors: Hibiya Makoto , Kamei Tetsuya , Yoshida Kiyoshi , Kubota Shoji , Kano Hiroya , Nakamura Tomohiro , Ishida Saori , Saito Chihiro , Kemmoku Kyoichi
Published: July 2023

The International Consortium for Evidence-Based Perfusion (ICEBP) is a collaborative group whose mission is to improve, continuously, the delivery of care and outcomes for patients undergoing cardiac surgery. To achieve this end, the ICEBP supports the development of perfusion registries to evaluate clinical practices and has established evidence-based guidelines for perfusion. The Japanese Society of Extra-Corporeal Technology in Medicine (JaSECT) developed a perfusion registry to examine variation in perfusion practice in Japan. A pilot study was designed to determine the rate and accuracy of data extraction from patients’ medical records and perfusion practice records and the subsequent entry of data into the registry form. We designed an input matching test using medical records and perfusion records from a sample of patients. Five institutions participated in data extraction and entry from 10 randomly selected case records. Perfusionists entered data in the registry form in accordance with the instruction manual prepared by the JaSECT guideline committee. The time taken to input every case in the registry was measured. An interview-based survey was carried out across institutions after the completion of the pilot. The time required for data entry stabilized after approximately five cases to a rate that was 40% of the first case entry time. Data entered into the registry by perfusionists for multiple-choice items were accurate 65% of the time and accurate 25% of the time for numerical data. The interview-based survey identified a total of 38 opportunities for improvement in the input form and 58 recommended changes for the instruction manual. The accuracy of data may be improved by developing a method allowing the objective detection of deficient data when present in the perfusion case record by developing automatic data acquisition from the automatic perfusion recording system currently in use, and by changing as many numerical value input items as possible to multiple-choice items.
Failure of Intraoperative Red Cell Salvage: A Patient with Sickle Cell Disease and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) Syndrome
Authors: Schott Nicholas J. , Yazer Mark H. , Krohner Robert , Waters Jonathan H.
Published: July 2023

Cell salvage is a process whereby the bloodshed from the operative field is collected and returned to the patient. It can be especially useful when allogeneic red blood cell (RBC) units are not readily available such as when the recipient has multiple alloantibodies. We report on the anesthesia and transfusion strategies for managing a pregnant patient with sickle cell disease (SCD) with HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome. A pregnant patient with twins at 30 weeks of gestation was admitted in an SCD crisis. She subsequently developed HELLP syndrome and required urgent cesarean delivery; however, she had multiple RBC antibodies complicating the immediate provision of crossmatched RBC units. Cell salvage was used to capture the blood shed during her procedure while the blood bank was searching for compatible RBCs units. Despite multiple interventions designed to optimize the cell salvage procedure for the unique challenges of a patient with SCD, the salvaged RBCs hemolyzed and could not be reinfused. Cell salvage in an obstetric patient with SCD in an acute crisis and superimposed HELLP was unable to recover intact and useable RBCs. Further studies into methods of optimizing the procedure for use in this context are warranted. Close communication between the clinical teams treating the patient and the transfusion service is required so that the RBC transfusion requirements can be anticipated; this is especially important when the patient has multiple antibodies.
Effects of Early Clozapine Treatment on Remission Rates in Acute
Schizophrenia (The EARLY Trial): Protocol of a Randomized-Controlled
Multicentric Trial
Authors: Wagner Elias , Strube Wolfgang , Görlitz Thomas , Aksar Aslihan , Bauer Ingrid , Campana Mattia , Moussiopoulou Joanna , Hapfelmeier Alexander , Wagner Petra , Egert-Schwender Silvia , Bittner Robert , Eckstein Kathrin , Nenadić Igor , Kircher Tilo , Langguth Berthold , Meisenzahl Eva , Lambert Martin , Neff Sigrid , Malchow Berend , Falkai Peter , Hirjak Dusan , Böttcher Kent-Tjorben , Meyer-Lindenberg Andreas , Blankenstein Christiane , Leucht Stefan , Hasan Alkomiet
Published: July 2023

Background Quick symptomatic remission after the onset of psychotic
symptoms is critical in schizophrenia treatment, determining the subsequent
disease course and recovery. In this context, only every second patient with
acute schizophrenia achieves symptomatic remission within three months of
initiating antipsychotic treatment. The potential indication extension of
clozapine—the most effective antipsychotic—to be introduced at
an earlier stage (before treatment-resistance) is supported by several lines of
evidence, but respective clinical trials are lacking.

Methods Two hundred-twenty patients with acute non-treatment-resistant
schizophrenia will be randomized in this double-blind, 8-week parallel-group
multicentric trial to either clozapine or olanzapine. The primary endpoint is
the number of patients in symptomatic remission at the end of week 8 according
to international consensus criteria (‘Andreasen criteria’).
Secondary endpoints and other assessments comprise a comprehensive safety
assessment (i. e., myocarditis screening), changes in psychopathology,
global functioning, cognition, affective symptoms and quality of life, and
patients’ and relatives’ views on treatment.

Discussion This multicentre trial aims to examine whether clozapine is
more effective than a highly effective second-generation antipsychotics (SGAs),
olanzapine, in acute schizophrenia patients who do not meet the criteria for
treatment-naïve or treatment-resistant schizophrenia. Increasing the
likelihood to achieve symptomatic remission in acute schizophrenia can improve
the overall outcome, reduce disease-associated burden and potentially prevent
mid- and long-term disease chronicity.
Lithium Therapy in Old Age: Recommendations from a Delphi
Survey
Authors: Christl Julia , Müller-Oerlinghausen Bruno , Bauer Michael , Kamp Daniel , Fußer Fabian , Benninghoff Jens , Fehrenbach Rosa A. , Lange-Asschenfeldt Christian , Rapp Michael , Ibach Bernd , Schaub Rainer , Wollmer Axel , Strotmann-Tack Timm , Hüll Michael , Biermann Susanne , Roscher Katharina , Meissnest Bernd , Menges Alexander , Weigel Bernd , Maliszewski-Makowka Dorothee , Mauerer Christian , Schaefer Martin , Joachimsmeier Beate , Kayser Sarah , Rump Lars Christian , Supprian Tillmann
Published: July 2023

Introduction While lithium (Li) has been well established for the
treatment of bipolar disorder, geriatric patients require special attention when
it comes to issues of drug safety. Declining renal function, amongst other
medical conditions, and polypharmacy may pose increased risks. Only a few
previous studies have addressed the management of Li in geriatric patients.

Methods Twenty-four German medical experts on geriatric medicine and Li
treatment participated in a Delphi survey, consisting of two rounds of
questionnaires and a final formulation of treatment recommendations. Three major
issues of Li therapy were outlined: initiation of treatment, monitoring of
ongoing therapy, and withdrawal due to medical reasons. Final recommendations
were consented to at a threshold of at least 80% expert agreement.

Results Final consensus was achieved on 21 clinical recommendations. The
approved recommendations covered aspects of necessary laboratory checks,
concomitant medication, and target Li serum concentration in geriatric patients.
Concerning the termination of Li therapy, an agreement was reached on the
appropriate time span for tapering and on potential alternatives to Li. No
consensus was achieved on whether concomitant dementia or frailty should be
considered contraindications for Li treatment and the appropriate threshold of
the estimated glomerular function rate for withdrawing Li.

Conclusion According to the view of German experts, Li may be used in
geriatric patients, but it should be monitored carefully. However, the lack of
consent in several specific treatment situations underlines the need for
research on specific issues of Li therapy.
Factors of Central Lymph Node Metastasis in Papillary Thyroid Cancer
Based on C-TIRADS Analysis
Authors: Huang Weijun , Chen Deli , Zhong Minying , Ye Jieyi , Zhi Zhiyuan , Xiao Yanyan , Zhong Yuan
Published: July 2023

To study risk factors for central lymph node metastasis (CLNM) in papillary
thyroid cancer (PTC) using the Chinese Thyroid Imaging Reporting and Data System
(C-TIRADS). We retrospectively analysed patients who underwent PTC surgery and
central lymph node dissection at First People’s Hospital of Foshan City.
The clinical and ultrasonic data of the patients from 1150 cases were analysed
by multivariate regression to evaluate the correlation between grayscale
ultrasound (US) features, C-TIRADS score, and the classification of thyroid
nodules and CLNM of PTCs. The C-TIRADS score was 3.0±1.0 in the CLNM
group, which was higher than that in the non-CLNM group (p<0.001). Sex
(male) (OR=1.586, 95% CI 1.232–2.042, p<0.001),
age (≤45 years) (OR=1.508, 95% CI 1.184–1.919,
p=0.001), location of nodes (lower pole) (OR=2.193, 95%
CI 1.519–3.166, p<0.001), number (multifocal) (OR=2.204,
95% CI 1.227–2.378, p<0.001), microcalcification
(OR=1.610, 95% CI 2.225–4.434, p=0.002),
extrathyroidal extension (OR=2.204, 95% CI 1.941–3.843,
p<0.001), maximum diameter of nodule (≥20 mm)
(OR=3.211, 95% CI 2.337–4.411, p<0.001), and
C-TIRADS score (OR=1.356, 95% CI 1.204–1.527,
p<0.001) were PTC in independent risk factors for CLNM. The C-TIRADS
score of PTC combined with the location, number, size, and ultrasound features
of the lesion and the patient’s sex and age are important in predicting
whether they present with CLNM and provide a reference basis for the clinical
formulation of a reasonable surgical treatment plan.
Neuroendoscopic Lavage and Third Ventriculostomy for the Treatment of Intraventricular Hemorrhage and Hydrocephalus in Neonates. A Prospective Study with 18 Months of Follow-Up
Authors: Islas-Aguilar Mario Alberto , Torrez-Corzo Jaime Gerardo Alberto , Chalita-Williams Juan Carlos , Cervantes Dominic Shelby , Vinas-Rios Juan
Published: July 2023

Background Neonatal intraventricular hemorrhage (IVH) may evolve into posthemorrhagic hydrocephalus and cause neurodevelopmental impairment, becoming a common complication of premature infants, occurring in up to 40% of preterm infants weighing less than 1,500 g at birth. Around 10 to 15% of preterm infants develop severe (grades III–IV) IVH. These infants are at high risk of developing posthemorrhagic hydrocephalus. Neuroendoscopic lavage (NEL) is a suitable alternative for the management of this pathology. In this study, an endoscopic surgical approach directed toward the removal of intraventricular hematoma was evaluated for its safety and efficacy.

Methods Between August 2016 and December 2019 (29 months), 14 neonates with posthemorrhagic hydrocephalus underwent NEL for removal of intraventricular blood by a single senior neurosurgeon. Complications such as reintervention and ventriculoperitoneal (VP) shunt placement were evaluated prospectively with an 18-month follow-up on average.

Results In total, 14 neonates with IVH grades III and IV were prospectively recruited. Of these, six neonates did not need a VP shunt in the follow-up after neuroendoscopy (group 1), whereas eight neonates underwent a VP shunt placement (group 2). Nonsignificant difference between the groups was found concerning days after neuroendoscopy, clot extraction, third ventriculostomy, lamina terminalis fenestration, and septum pellucidum fenestration. In group 2, there was shunt dysfunction in five cases with shunt replacement in four cases.

Conclusion NEL is a feasible technique to remove intraventricular blood degradation products and residual hematoma in neonates suffering from posthemorrhagic hydrocephalus. In our series, endoscopic third ventriculostomy (ETV) + NEL could be effective in avoiding hydrocephalus after hemorrhage (no control group studied). Furthermore, patients without the necessity of VP-shunt had a better GMFCS in comparison with shunted patients.
PEEK Cages versus Titanium-Coated PEEK Cages in Single-Level Anterior Cervical Fusion: A Randomized Controlled Study
Authors: Schröder Johannes , Kampulz Thomas , Bajaj Sonunandita K. , Hellwig Arnd Georg , Winking Michael
Published: July 2023

Background The implantation of a spacer is a common practice after anterior diskectomy in cervical spine. Polyether ether ketone (PEEK) cages have replaced titanium implants due to their better radiologic visibility and appearance in postoperative magnetic resonance imaging (MRI) scans. However, PEEK showed apparently higher nonunion rates than titanium cages. The aim of the study was to evaluate the fusion behavior of plain PEEK cages in comparison to titanium-coated PEEK (TiPEEK) cages.

Method We randomized 104 patients with single-level cervical radiculopathy or mild myelopathy. They were divided into two groups of 52 patients each, receiving either a PEEK cage or the titanium-coated variant of the same cage type. The 1- and 2-year follow-ups were completed by 43 patients in the PEEK group and by 50 patients in the TiPEEK group. Fusion was determined by plain X-ray and lateral functional X-ray.

Results Two years after surgery, a complete fusion was observed in 37 patients of the PEEK group (86%). Six cases were considered as nonunions. In the TiPEEK group, we found 41 fusions (82%) and 9 nonunions at this time. The difference was not considered significant (p = 0.59). The clinical evaluation of the two groups showed no difference in the neurologic examination as well in the pain scores over the time period.

Conclusions Despite some assumptions about an advantage of TiPEEK over PEEK cages for fusion in cervical spine surgery, this prospective randomized controlled study did not find an accelerated or improved fusion using TiPEEK for anterior cervical diskectomy.
Postoperative Complications of True Dropless Cataract Surgery versus Standard Topical Drops
Authors: Wotipka Evan K. , Wright Alex J. , Fan James Z. , Fuhriman David , Chuang Alice Z. , Lindhorst Grace C. , Feldman Robert M. , Crowell Eric L.
Published: July 2023

Purpose Compare postoperative outcomes in cataract surgery between eyes with standard drop regimen versus dropless protocol by residents.

Design Retrospective cohort study between April 1, 2018 and March 31, 2020.

Methods The study was performed at Lyndon B. Johnson General Hospital in Houston, Harris County, Texas. A total of 547 eyes (234 dropless vs. 313 standard) with phacoemulsification cataract surgery and minimum of 1-month follow-up with best-corrected visual acuity (BCVA) were included. Dropless received 40 mg sub-Tenon's triamcinolone and intracameral moxifloxacin. Patients were followed at postoperative day 1 (POD1), week 1 (POW1), and month 1 (POM1). Postoperative rate of BCVA better than 20/40 (Good vision) and rate of complications were compared between groups.

Results Good vision on POM1 in dropless (77.8%) was noninferior to standard (75.1%, p = 0.80). Complication rate in dropless (28.6%) was noninferior to standard (24.0%, p = 0.13). Intraocular pressure (IOP) elevation on POD1 (p = 0.041) and anterior chamber (AC) cells on POW1 and POM1 (p < 0.001) were more frequent in dropless. Mean spherical equivalent at POM1 was better in dropless (−0.37 D [±0.81 D]) compared with standard (−0.61D [±0.77 D], p = 0.001). Early posterior capsular opacification (early PCO) was more frequent in dropless (p = 0.042).

Conclusions Postoperative rate of BCVA better than 20/40 and rate of postoperative complications were noninferior, although dropless had higher rates of AC inflammation, IOP elevation, and early PCO.
Ischemic Stroke in Cancer: Mechanisms, Biomarkers, and Implications for Treatment
Authors: Costamagna Gianluca , Navi Babak B. , Beyeler Morin , Hottinger Andreas F. , Alberio Lorenzo , Michel Patrik
Published: July 2023

Ischemic stroke is an important cause of morbidity and mortality in cancer patients. The underlying mechanisms linking cancer and stroke are not completely understood. Long-standing and more recent evidence suggests that cancer-associated prothrombotic states, along with treatment-related vascular toxicity, such as with chemotherapy and immunotherapy, contribute to an increased risk of ischemic stroke in cancer patients. Novel biomarkers, including coagulation, platelet and endothelial markers, cell-free DNA, and extracellular vesicles are being investigated for their potential to improve risk stratification and patient selection for clinical trials and to help guide personalized antithrombotic strategies. Treatment of cancer-related stroke poses unique challenges, including the need to balance the risk of recurrent stroke and other thromboembolic events with that of bleeding associated with antithrombotic therapy. In addition, how and when to restart cancer treatment after stroke remains unclear. In this review, we summarize current knowledge on the mechanisms underlying ischemic stroke in cancer, propose an etiological classification system unique to cancer-related stroke to help guide patient characterization, provide an overview of promising biomarkers and their clinical utility, and discuss the current state of evidence-based management strategies for cancer-related stroke. Ultimately, a personalized approach to stroke prevention and treatment is required in cancer patients, considering both the underlying cancer biology and the individual patient's risk profile.
Symptomatic Heterotopic Bone Formation after 1,2 ICSRA in Scaphoid Nonunions
Authors: Ghijsen S. C. , Heeg E. , Teunis T. , den Hollander V. E. C. , Schuurman A. H.
Published: July 2023

Background We observed several cases of heterotopic bone formation after a 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) distal radius vascularized bone graft (VBG) for the treatment of scaphoid nonunion. This adverse event seems underreported. Knowledge about factors associated with the formation of heterotopic bone after VBGs might help reduce this adverse event.

Purpose What factors are associated with resected heterotopic bone formation after 1,2 ICSRA distal radius graft for the treatment of scaphoid nonunion?

Patients and Methods We retrospectively reviewed all patients with a scaphoid nonunion treated with a 1,2 ICSRA distal radius graft between 2008 and 2019 in an urban level 1 trauma center in the Netherlands. We included 42 scaphoid nonunions in 41 people treated with the 1,2 ICSRA graft. We assessed potential correlation with patient, fracture, and treatment demographics.

Results Heterotopic bone developed in 23 VBGs (55% [23/42]), of which 5 (12% [5/42]) were resected. Heterotopic bone was located radially (at the pedicle side) in all participants. Except a longer follow-up time (p = 0.028), we found no variables associated with the development of heterotopic bone formation.

Conclusion The location of the heterotopic bone at the pedicle site in all cases suggests a potential association with the periosteal strip. Surgeons might consider not to oversize the periosteal strip as a potential method to prevent heterotopic ossification after VBG.

Level of Evidence Level II, prognostic study.
Predictive value of adiposity index in identifying depression in individuals with type 2 diabetes mellitus in Indian population
Authors: Singh Jiya , Singh Praveen Kumar , Nain Rashmi , Kant Ravi , Das Anindya , Mirza Anissa Atif , Saha Sarama
Published: July 2023

Objectives:

Type 2 diabetes mellitus (T2DM) patients are four times more prone to develop depression. Common subjective tool to evaluate depression is Patient Health Questionnaire-9 (PHQ-9). Depression in T2DM remains unaddressed because of lack of objective tools resulting in poor treatment compliance. Both obesity and metabolic disturbances could influence mental health status. Therefore, this study was designed to determine the better adiposity index to predict depression in T2DM.

Materials and Methods:

In this clinic-based cross-sectional study, 400 individuals (260 = T2DM and 140 = healthy) were recruited. Based on PHQ-9, T2DM patients were divided into T2DM + Dep (PHQ-9 ≤ 10) and T2DM-Dep (PHQ-9 < 10). The relationship between the PHQ-9 score and adiposity indices was examined by Pearson’s/Spearman’s correlation. The receiver-operating characteristic curve analysis was used to identify the cutoff value.

Statistical Analysis:

Statistical analysis was performed using SPSS 22.0 version (IBM Corp., Armonk, New York, United States).

Results:

Female diabetic patients showed significant correlation only in lipid accumulation product index (LAPI) and visceral adiposity index (VAI) (r = 0.206 and r = 0.0.237, respectively), while male diabetic patients did not show any significant association. Interestingly, T2DM + Dep group showed significant association between LAPI (r = 0.248) with PHQ-9 score, while T2DM-Dep group did not show significant association. VAI had maximum area under the curve in T2DM patients (0.619, p = 0.002) as well as in female diabetic patients (0.684, p = 0.002). The cutoff value for identifying depression among diabetic individuals was 5.60, with 70.3% sensitivity and 48.2% specificity, while in diabetic females, it was 6.612, with 70% sensitivity and 61.4% specificity.

Conclusions:

VAI might be the best adiposity index to predict depression among diabetic individuals.
Design of a fast and low-noise front-end electronics developed for the measurements of low- and medium-energy charged particles in space plasma environments
Authors: Berthomé E. , Devoto P. , André N.
Published: July 2023

A fast and low-noise front-end electronics for amplifying and filtering the signal generated by a silicon detector has been designed, simulated, developed, and characterized as the main part of the detection chain for an instrument devoted to the measurements of low- and medium-energy charged particles in space plasma environments. The targeted low energy threshold is 10 keV with a 10% resolution. The simulated performances of the developed electronics reach a gain bandwidth of up to 16.1 GHz, a noise level at the input of 0.96 nV/Hz−1/2, and an equivalent noise charge of 4.62 keV. The experimental measurements with injection testing show resolution below 5 keV and a low threshold of 31.46 keV. Radioactive testing shows a resolution of 30.9 keV because the detector capacitance is larger than expected (21 vs 10 pF). A good agreement between simulation with a 21 pF detector capacitance and experimental measurement is achieved within 18%.
A cryogenic sapphire resonator oscillator with 10−16 mid-term fractional frequency stability
Authors: Fluhr C. , Dubois B. , Calosso C. E. , Vernotte F. , Rubiola E. , Giordano V.
Published: July 2023

We report in this Letter the outstanding frequency stability performance of an autonomous cryogenic sapphire oscillator (CSO) presenting a flicker frequency noise floor below 2×10−16 near 1000 s of integration time and a long-term Allan deviation limited by a random walk process of ∼1×10−18τ. The frequency stability qualification at this level called for the implementation of sophisticated instrumentation associated with ultra-stable frequency references. This result is technologically sound as it demonstrates the potentiality of the CSO technology. From the physical point of view, it sets an upper limit to the ultimate noise floor of the cryogenic microwave resonator that is competitive to that of the ultra-stable optical Fabry–Pérot cavities.
Photocatalytic water splitting in the gap between plasmonic gold nanoclusters
Authors: Feng Qingying , Zhang Ying , Feng Hao , Liu Dong , Li Qiang
Published: July 2023

Plasmon-mediated photocatalytic water splitting holds promise for efficient solar energy harvesting. Experimental studies have shown that “hot spots” in an assembly of plasmonic nanoclusters, which is the real case for practical applications, are beneficial for photocatalysis, but the interactions between different nanoclusters are difficult to observe by experimental techniques. Theoretical studies, however, have employed the model with a water molecule adsorbed on a single plasmonic metal nanocluster. Here, we employed the representative model of a water molecule placed in the gap between two gold nanoclusters and computationally investigated the effects of the configurations of plasmonic nanoclusters on plasmon-mediated water splitting. Results show that the hot electron transfer mode can be tuned by the plasmonic configurations. Compared to the configuration with only one gold nanocluster, more significant contribution of direct charge transfer was observed for the configuration with two gold nanoclusters, which is attributed to a stronger field enhancement; as a result, the water splitting rate was also enhanced. Results also demonstrate a charge transfer chain from one gold nanocluster to the water molecule and then to the other gold nanocluster, which is tunable by the distances between the water molecule and the gold nanoclusters. This charge transfer chain significantly affected the amount of hot electrons accumulated on the water molecule. Caused by this, the configuration where the water molecule was placed right at the center of the two gold nanoclusters, i.e., the configuration corresponding to the strongest field enhancement, was surprisingly not the most favorable one for the reaction.
Descriptors for binding energies at clusters: The case of nanosilicates as models of interstellar dust grains
Authors: Andersen Mie , Slavensky Andreas Møller
Published: July 2023

Binding energies of radicals and molecules at dust grain surfaces are important parameters for understanding and modeling the chemical inventory of interstellar gas clouds. While first-principles methods can reliably be used to compute such binding energies, the complex structure and varying sizes and stoichiometries of realistic dust grains make a complete characterization of all adsorption sites exposed by their surfaces challenging. Here, we focus on nanoclusters composed of Mg-rich silicates as models of interstellar dust grains and two adsorbates of particular astrochemical relevance; H and CO. We employ a compressed sensing method to identify descriptors for the binding energies, which are expressed as analytical functions of intrinsic properties of the clusters, obtainable through a single first-principles calculation of the cluster. The descriptors are identified based on a diverse training dataset of binding energies at low-energy structures of nanosilicate clusters, where the latter structures were obtained using a first-principles-based global optimization method. The composition of the descriptors reveals how electronic, electrostatic, and geometric properties of the nanosilicates control the binding energies and demonstrates distinct physical origins of the bond formation for H and CO. The predictive performance of the descriptors is found to be limited by cluster reconstruction, e.g., breaking of internal metal–oxygen bonds, upon the adsorption event, and strategies to account for this phenomenon are discussed. The identified descriptors and the computed datasets of stable nanosilicate clusters along with their binding energies are expected to find use in astrochemical models of reaction networks occurring at silicate grain surfaces.