bluuebunny/crossref_metadata_2025 huggingface dataset:
High-entropy alloy nanocrystal assembled by nanosheets with d–d electron interaction for hydrogen evolution reaction
Authors: Wei Min , Sun Yuyan , Zhang Junyu , Ai Fei , Xi Shibo , Wang Jike
Published: July 2023

Unique PtMoPdRhNi high-entropy alloy nanocrystals (NCs) catalysts assembled by radial nanosheets with multiple active sites with different local chemical environments and the interaction of d–d electron for superior HER performance.
One-step ethylene purification from ternary mixtures by an ultramicroporous material with synergistic binding centers
Authors: Li Xingye , Ding Qi , Liu Jia , Dong Lihui , Qin Xingzhen , Zhou Liqin , Zhao Zhenxia , Ji Hongbing , Zhang Sui , Chai Kungang
Published: July 2023

Developing advanced porous materials with industrial potential to separate multicomponent gas mixtures that are structurally similar is a crucial but challenging task.
An I2–DMSO catalytic manifold enabled aromatization for C-ring editing of podophyllotoxone
Authors: Yuan Peng , Liu Rui , Zhu Hui-Min , Liao Zhixin , Xiang Jia-Chen , Wu An-Xin
Published: July 2023

Effective dehydrogenative aromatization and dehydrogenative amination of podophyllotoxone derivatives have been realized using an I2–DMSO catalytic system.
Rapid synthesis of functional poly(ester amide)s through thiol–ene chemistry
Authors: Qu Taoguang , West Kevin N. , Rupar Paul A.
Published: July 2023

Poly(ester amide)s with tunable properties were synthesized via post-polymerization thiol–ene modification of a bio-sourced vinylidene containing poly(ester amide).
Biodegradable Gg-cl-poly(NIPAm-co-AA)/-o-MWCNT based hydrogel for combined drug delivery system of metformin and sodium diclofenac: in vitro studies
Authors: Dave Pragnesh N. , Macwan Pradip M. , Kamaliya Bhagvan
Published: July 2023

In the present study Gg-cl-poly(NIPA-co-AA) and Gg-cl-poly(NIPA-co-AA)/-o-MWCNT hydrogels were synthesized using free radical polymerization.
Lipase-mediated flow synthesis of nature-inspired phenolic carbonates
Authors: Vicinanza Sara , Annunziata Francesca , Pecora Desirèe , Pinto Andrea , Tamborini Lucia
Published: July 2023

A facile and convenient lipase-catalyzed flow approach for the chemoselective synthesis of tyrosol and hydroxytyrosol methyl carbonates has been developed. Then, value-added symmetrical tyrosol and hydroxytyrosol carbonates were prepared.
Chalcogen-doped, (seco)-hexabenzocoronene-based nanographenes: synthesis, properties, and chalcogen extrusion conversion
Authors: Li Ranran , Ma Bin , Li Shengtao , Lu Chongdao , An Peng
Published: July 2023

A series of chalcogen-doped nanographenes were obtained by insertion of different chalcogens into the HBC orseco-HBC backbone. The chalcogen-dependent photophysical properties and chalcogen-extrusion reactions were investigated.
Transition-metal (oxy)nitride photocatalysts for water splitting
Authors: Chen Kaihong , Xiao Jiadong , Hisatomi Takashi , Domen Kazunari
Published: July 2023

This perspective highlights recent advances and challenges in transition-metal (oxy)nitrides, which are promising photocatalysts for overall water splitting, and discusses opportunities to upgrade the solar-to-hydrogen energy conversion efficiency.
Unlocking the sensing potential of phenyl-substituted perylene diimides under extreme conditions
Authors: Ratajczyk Paulina , Sobczak Szymon , Woźny Przemysław , Wcisło Angelika , Poręba Tomasz , Katrusiak Andrzej
Published: July 2023

The exceptionally strong optoelectronic sensitivity of PTCDI-Ph have been correlated with its structure and unconventional elasticity, offering an opportunity for developing new multimodal sensors with exceptional stability towards external stimuli.
Integrating 2D elasticity and elastoplasticity into a multi-stimuli-responsive crystal through phase transitions
Authors: Hou Yihang , Yang Pengpeng , Zhao Jingjing , Fu Jinqiu , Wang Chiyi , Shi Yuzhong , Zhuang Wei , Zhang Keke , Ying Hanjie
Published: July 2023

The conversion of mechanical properties from 2D elasticity to elastoplasticity in an organic crystal is implemented through phase transitions accompanied by multi-stimuli-responsive behaviors.
Rapid growth of a 24 mm2 scale hexagonal boron nitride crystal in Ni–Cr solution
Authors: Zhao Jianguo , Wang Haichao , Yu Yue , Yang Minhui , Xu Ru , Zhang Hui , Pan Jiangyong , Li Yuanyuan , Liu Xiang , Tao Tao , Zhuang Zhe , Liu Bin , Chang Jianhua
Published: July 2023

A 24 mm2 exfoliated hBN film is achieved within a total growth time of 49.17 hours. A signal-to-noise ratio of 2 orders of magnitude is reported for a metal–semiconductor–metal type photodetector based on hBN.
Deprivation based inequality in NOxemissions in England
Authors: Gray Nathan R. , Lewis Alastair C. , Moller Sarah J.
Published: July 2023

Deprivation based inequality in NOxemissions in England, based on index of multiple deprivation decile and mean emissions per lower layer super output area.
Functions and mechanisms of the GPCR adaptor protein Norbin
Authors: Chetwynd Stephen A. , Andrews Simon , Inglesfield Sarah , Delon Christine , Ktistakis Nicholas T. , Welch Heidi C. E.
Published: July 2023

Norbin (Neurochondrin, NCDN) is a highly conserved 79 kDa adaptor protein that was first identified more than a quarter of a century ago as a gene up-regulated in rat hippocampus upon induction of long-term potentiation. Most research has focussed on the role of Norbin in the nervous system, where the protein is highly expressed. Norbin regulates neuronal morphology and synaptic plasticity, and is essential for normal brain development and homeostasis. Dysregulation of Norbin is linked to a variety of neurological conditions. Recently, Norbin was shown to be expressed in myeloid cells as well as neurons. Myeloid-cell specific deletion revealed an important role of Norbin as a suppressor of neutrophil-derived innate immunity. Norbin limits the ability of neutrophils to clear bacterial infections by curbing the responsiveness of these cells to inflammatory and infectious stimuli. Mechanistically, Norbin regulates cell responses through binding to its interactors, in particular to a wide range of G protein-coupled receptors (GPCRs). Norbin association with GPCRs controls GPCR trafficking and signalling. Other important Norbin interactors are the Rac guanine-nucleotide exchange factor P-Rex1 and protein kinase A. Downstream signalling pathways regulated by Norbin include ERK, Ca2+ and the small GTPase Rac. Here, we review the current understanding of Norbin structure, expression and its roles in health and disease. We also explore Norbin signalling through its interactors, with a particular focus on GPCR trafficking and signalling. Finally, we discuss avenues that could be pursued in the future to increase our understanding of Norbin biology.
What do cancer-specific CD8+ T cells see? The contribution of immunopeptidomics
Authors: Nicholas Ben , Skipp Paul
Published: July 2023

Immunopeptidomics is the survey of all peptides displayed on a cell or tissue when bound to human leukocyte antigen (HLA) molecules using tandem mass spectrometry. When attempting to determine the targets of tumour-specific CD8+ T cells, a survey of the potential ligands in tumour tissues is invaluable, and, in comparison with in-silico predictions, provides greater certainty of the existence of individual epitopes, as immunopeptidomics-confirmed CD8+ T-cell epitopes are known to be immunogenic, and direct observation should avoid the risk of autoreactivity which could arise following immunisation with structural homologues. The canonical sources of CD8+ T-cell tumour specific epitopes, such as tumour associated antigens, may be well conserved between patients and tumour types, but are often only weakly immunogenic. Direct observation of tumour-specific neoantigens by immunopeptidomics is rare, although valuable. Thus, there has been increasing interest in the non-canonical origins of tumour-reactive CD8+ T-cell epitopes, such as those arising from proteasomal splicing events, translational/turnover defects and alternative open reading frame reads. Such epitopes can be identified in silico, although validation is more challenging. Non-self CD8+ T-cell epitopes such as viral epitopes may be useful in certain cancer types with known viral origins, however these have been relatively unexplored with immunopeptidomics to date, possibly due to the paucity of source viral proteins in tumour tissues. This review examines the latest evidence for canonical, non-canonical and non-human CD8+ T-cell epitopes identified by immunopeptidomics, and concludes that the relative contribution for each of these sources to anti-tumour CD8+ T-cell reactivity is currently uncertain.
Oxidoreductases and metal cofactors in the functioning of the earth
Authors: Hay Mele Bruno , Monticelli Maria , Leone Serena , Bastoni Deborah , Barosa Bernardo , Cascone Martina , Migliaccio Flavia , Montemagno Francesco , Ricciardelli Annarita , Tonietti Luca , Rotundi Alessandra , Cordone Angelina , Giovannelli Donato
Published: July 2023

Life sustains itself using energy generated by thermodynamic disequilibria, commonly existing as redox disequilibria. Metals are significant players in controlling redox reactions, as they are essential components of the engine that life uses to tap into the thermodynamic disequilibria necessary for metabolism. The number of proteins that evolved to catalyze redox reactions is extraordinary, as is the diversification level of metal cofactors and catalytic domain structures involved. Notwithstanding the importance of the topic, the relationship between metals and the redox reactions they are involved in has been poorly explored. This work reviews the structure and function of different prokaryotic organometallic–protein complexes, highlighting their pivotal role in controlling biogeochemistry. We focus on a specific subset of metal-containing oxidoreductases (EC1 or EC7.1), which are directly involved in biogeochemical cycles, i.e., at least one substrate or product is a small inorganic molecule that is or can be exchanged with the environment. Based on these inclusion criteria, we select and report 59 metalloenzymes, describing the organometallic structure of their active sites, the redox reactions in which they are involved, and their biogeochemical roles.
Physical layer security of single‐input multiple‐out relay networks over Beaulieu‐Xie fading channels
Authors: Li Junxia , Ma Xuexue , Ye Faxin , Sun Jiangfeng
Published: July 2023

With the progress of communication technology, the increasing wireless devices are hooked up the networks, and the consequent security problems cannot be ignored. At present, the solutions mainly include secret key system and physical layer security (PLS). However, secret key system that relies on highly complex algorithms for encryption and decryption still has the risk of being cracked by powerful computers. In this paper, the PLS of Beaulieu‐Xie fading channels is studied. To improve the transmission quality and support higher speed data transmission, the single‐input multiple‐out (SIMO) system considered is the Wyner eavesdropper model with decoding and forwarding (DF) relay over Beaulieu‐Xie fading. The closed‐form theoretical formulas for secure outage probability (SOP) and strictly positive secrecy capacity (SPSC) are obtained by complex unified functional representation, which includes two cases: and . Moreover, the theoretical formulas are verified by Monte Carlo results. By comparing the simulation results with the theoretical analysis, the authors discussed the factors to improve the secure performance. Experiments show that the larger ratio of , the smaller ratio of , smaller signal‐to‐noise ratio (SNR) of eavesdropping channels, smaller threshold and more legitimate antennas are beneficial to the improvement of anti‐interference capability for the relay networks with Beaulieu‐Xie distributions when the legal channel link R→D is in a state of high SNR.
Dust giant: Extended and clumpy star-formation in a massive dusty galaxy at z = 1.38
Authors: Kokorev Vasily , Jin Shuowen , Gómez-Guijarro Carlos , Magdis Georgios E. , Valentino Francesco , Lee Minju M. , Daddi Emanuele , Liu Daizhong , Sargent Mark T. , Trebitsch Maxime , Weaver John R.
Published: July 2023

We present NOEMA CO (2–1) line and ALMA 870 µm continuum observations of a main-sequence galaxy at z = 1.38. The galaxy was initially deemed a “gas giant” based on the gas mass derived from sub-mm continuum (log(Mgas/M⊙) = 11.20 ± 0.20), however, the gas mass derived from CO (2−1) luminosity brings the gas mass value down to a level that is consistent with typical values for star-forming galaxies at that redshift (log(Mgas/M⊙) = 10.84 ± 0.03). Meanwhile, the dust-to-stellar mass ratio remains elevated above the scaling relations by a factor of 5. In this work, we explore the potential physical picture and consider an underestimated stellar mass and optically thick dust as possible explanations. Based on the updated gas-to-stellar mass ratio, we can rule out the former; while the latter may indeed contribute to the overestimation of the dust mass, it is not sufficient enough to explain the observed physical picture overall. Instead, other plausible explanations include enhanced HI reservoirs, an unusually high metallicity, or the presence of an optically dark, dusty contaminant. Using the ALMA data at 870 µm coupled with HST/ACS imaging, we find an extended morphology in dust continuum and clumpy star-formation in rest-frame UV in this galaxy. In addition, a tentative ~10 kpc dusty arm is found to be bridging the galaxy center and a clump in F814W image. The galaxy shows levels of dust obscuration similar to the so-called HST-dark galaxies at higher redshifts, thus falling into the optically faint and dark JWST color-color selection at z > 2. It is therefore possible that our object may stand as a low-z analog of the HST-dark populations. This galaxy serves as a caveat to the gas masses based on the continuum alone, with a larger sample required to unveil the full picture.
Biosensors in Food Industry
Authors: Kryuk Roman , Mukhsin Mukhim-Zade , Kurbanova Marina , Kryuk Viktoria
Published: July 2023

One of the main challenges the food industry has to deal with is the growing need for fast and cost-effective methods of detecting allergens and pathogens in foods. Biosensors provide an express method of detecting pathogens, allergens, and pesticide residues in food products. In addition, they can detect contaminants, verify food composition, and define its freshness. As a rule, only qualified experts in food science and agriculture can conduct chemical and microbiological analyses, which are expensive and time-consuming because of long sampling or pre-treatment procedures. Biosensors can optimize this process: they are fast, non-destructive, and affordable. In general, biosensors can advance digital agriculture and food production. This article provides an overview of biosensors used in the food industry and their prospects.
Experimental Mixed Refrigerant Low-Temperature System: Development and Trial
Authors: Usov Andrey , Korotkiy Igor , Tyunin Arkadiy , Korotkaya Elena
Published: July 2023

The article introduces a low-temperature system operating on a mix of refrigerants R134a/R23, as well as its operating scheme, structural diagram, and appearance. The design proved operable, reliable, and efficient. The system needed three hours for the temperature to drop as low as -70°C. The operating temperatures and pressures endowed the system with a reliable, stable, and long-time performance. The device can be used for low-temperature processing and storage of biotechnological materials, as well as in pharmacy and environment testing.
Functional and technological properties of hydrocolloids: A comparative analysis
Authors: Kurbanova Marina , Voroshylin Roman , Zubenko Sofya
Published: July 2023

Hydrocolloids render certain properties to food products. Hydrocolloids are different in nature, but all of them can form colloidal solutions with designed properties. The market offers a wide range of animal and vegetable hydrocolloids. For instance, gelatin is in high demand in the food industry because its functional and technological properties make it possible to develop foods with particular technological characteristics. Gelatin is also used in pharmacy and biotechnology. This article introduces a comparative analysis of functional and technological properties of animal hydrocolloids obtained by different technologies in Tajikistan and Russia. Both samples demonstrated good water-binding capacity and viscosity. The resulting gels had the best foaming at pH 4.8 and a whipping temperature of 10°C. The foam resistance was about 98-100%. A higher whipping temperature resulted in unstable foam with poor foaming performance. The best quality profile belonged to the Halal collagen hydrocolloid from Tajikistan. Its technology was different from the methods used in Russia.
How bakery industry is changing to comply with new consumer trends on sustainability and eco-consciousness
Authors: Shaposhnikov Igor , Kosovan Anatoliy , Vedernikov Andrey , Sergeev Sergey , Tagiev Nikolai
Published: July 2023

The paper provides the main features of the requirements of sustainable development for baking industry to comply with new trend of consumer demand, especially in cohorts of millenials and zoomers, The authors analyzed the best practices of market leaders in the development of a corporate strategy for sustainability. It has been established that the sustainable development strategy is based on the principle of life cycle assessment of bakery products (LSA) and has to be comprehensive, including economic, social, political and environmental aspects: the use of natural capital, assessment of the carbon and environmental footprint, minimization of waste of food raw materials and final products and the use of environmentally friendly packaging, traceability and transparency, the health of consumers and staff support, the use of local raw materials and recipes, concern for the development of local communities and the preservation of the biosphere in the places where products and consumed plant raw materials are produced, intensive communications with consumers to explain sustainable development issues. Bakery products should be positioned as traditional, natural, friendly for the planet and a man. The authors conclude that for successful bakery business has good foundation to be positioned for consumers as really sustainable
Methodology of instrumental control of bakery crumb characteristics
Authors: Chernykh Valery , Baluyan Khachatur
Published: July 2023

The article uses a comprehensive approach to instrumental control of the parameters of the texture of the crumb of bakery products: hardness, hardness index, elasticity, strength, cohesion, as well as the amount of mechanical energy expended during the deformation of the crumb sample. Measured texture indicators allow you to evaluate the degree of staleness and the rate of staleness of bakery products during storage. The use of the texture analyzer “Strukturometr ST-2” makes it possible to control the hardness of the crumb, its strength and cohesion by methods of reversible and irreversible deformation. When using reversible deformation, the relative change in the height of the crumb sample occurs within 25%, and when using irreversible - 75-80%. A dimensionless cohesion criterion has been developed, which is the result of division of the amount of mechanical energy spent on the plastic deformation of the crumb during secondary compression by the amount of mechanical energy spent on the plastic deformation of the crumb during primary compression. Such cyclic pressure on the crumb simulates the determination by the taster of cohesive properties during chewing.
Test of low-alkaloid lupine with multi enzyme complex in compound feed as an alternative to soybean in feeding quails
Authors: Fedorova Zinaida , Volkov Vladimir , Mishcheryakova Olga , Verkhoturov Vasiliy
Published: July 2023

The article presents data from a study conducted to study the effect of a protein component from low-alkaloid lupine with multi enzyme complex as part of mixed feed on the yield of products when feeding quails from birth to the 45th day. It was established that the possibility of using the lupine component and the level of its inclusion (up to 29%) in the compound feed for birds, completely replacing expensive soybeans in the diet, reducing the cost per 1 kg of feed by 7-8%. The lupine component can be used not only in feeding poultry, but also fish, monogastric animals, due to the reduction in fiber content to 2.3% and the fermentation process, which contributes to a more complete absorption of feed components.
Thrombography Reveals Thrombin Generation Potential Continues to Deteriorate Following Cardiopulmonary Bypass Surgery Despite Adequate Hemostasis
Authors: Wong Raymond K. , Sleep Joseph R. , Visner Allison J. , Raasch David J. , Lanza Louis A. , DeValeria Patrick A. , Torloni Antonio S. , Arabia Francisco A.
Published: July 2023

The intrinsic and extrinsic activation pathways of the hemostatic system converge when prothrombin is converted to thrombin. The ability to generate an adequate thrombin burst is the most central aspect of the coagulation cascade. The thrombin-generating potential in patients following cardiopulmonary bypass (CPB) may be indicative of their hemostatic status. In this report, thrombography, a unique technique for directly measuring the potential of patients’ blood samples to generate adequate thrombin bursts, is used to characterize the coagulopathic profile in post-CPB patients. Post-CPB hemostasis is typically achieved with protamine reversal of heparin anticoagulation and occasionally supplemented with blood product component transfusions. In this pilot study, platelet poor plasma samples were derived from 11 primary cardiac surgery patients at five time points: prior to CPB, immediately post-protamine, upon arrival to the intensive care unit (ICU), 3 hours post-ICU admission, and 24 hours after ICU arrival. Thrombography revealed that the Endogenous Thrombin Potential (ETP) was not different between [Baseline] and [PostProtamine] but proceeded to deteriorate in the immediate postoperative period. At the [3HourPostICU] time point, the ETP was significantly lower than the [Baseline] values, 1233 ± 591 versus 595 ± 379 nM.min (mean ± SD; n = 9, p < .005), despite continued adequacy of hemostasis. ETPs returned to baseline values the day after surgery. Transfusions received, conventional blood coagulation testing results, and blood loss volumes are also presented. Despite adequate hemostasis, thrombography reveals an underlying coagulopathic process that could put some cardiac surgical patients at risk for postoperative bleeding. Thrombography is a novel technique that could be developed into a useful tool for perfusionists and physicians to identify coagulopathies and optimize blood management following CPB.
Technical Considerations in Percutaneous Hepatic Perfusion—A Multi-Center Experience
Authors: Antoine Radcliffe A.
Published: July 2023

Patients diagnosed with primary or metastatic liver cancer face a daunting future that is complicated by limited treatment options. Percutaneous hepatic perfusion is a novel approach to chemotherapy delivery that offers significant benefits over contemporary modalities. Percutaneous hepatic perfusion is a procedure in which a chemotherapeutic agent is administered at high doses via the hepatic artery where it perfuses the liver, is extracted and filtered using a veno-veno bypass circuit, a fenestrated multi-lumen double-balloon catheter, and two biocompatible hemoperfusion filters. Venous access is gained at the groin through the femoral vein after which the catheter is advanced and positioned in the inferior vena cava just below the right atrium. The catheter’s proximal and distal balloons are inflated to occlude the inferior vena cava above and below the hepatic veins. The occlusion isolated the chemo-rich venous outflow of the liver from the systemic venous circulation. This maneuver also diverts venous blood returning to the heart from lower extremities of the azygos vein. Once the patient is on bypass, the agent is infused through the hepatic artery where it saturates the liver. The chemorich venous outflow is extracted through the double-balloon catheter by the bypass circuit. The blood is continuously filtered and cleared of the agent as it passes through the filters and returned to the patient through a catheter placed in the right internal jugular vein. A phase I study demonstrated efficacy with an overall radiographic response rate of 30% observed in treated patients. In 10 patients with ocular melanoma, a 50% overall response rate was observed, including two complete responses. The technique is minimally invasive and can be performed safely by a well-trained multi-disciplinary team. It offers significant benefits including multiple procedures without risks commonly associated with open abdominal surgery.
Successful Use of Venovenous Extracorporeal Membrane Oxygenation for Complicated H1N1 Pneumonia Refractory to Mechanical Ventilation
Authors: Patel Sachit A. , DeMare Jeffrey S. , Truemper Edward J. , Deptula Joseph J.
Published: July 2023

In April 2009, novel H1N1 influenza A pneumonia was initially identified in young adults by the Mexican Health Ministry. Previously healthy patients progressing to multisystem organ failure were common. Worldwide, hospitals reported surges in intensive care admissions during the initial phase of the pandemic. In patients with H1N1 pneumonia refractory to mechanical ventilation, centers were initially reporting low survival rates despite the use of extracorporeal membrane oxygenation (ECMO). The initial poor outcomes and protracted ECMO treatment epochs resulted in centers limiting or withholding the use of ECMO in this population. With respect to children with H1N1 infection there was uncertainty concerning optimal incorporation of ECMO as a therapeutic option. In children with rapidly progressive pneumonia and hypoxia refractory to mechanical ventilation, venovenous (VV) ECMO has been successfully used with survival ranging from 40–60% depending on the etiology. We report the successful use of VV ECMO in two children with confirmed novel H1N1 complicated by bacterial pneumonia or morbid obesity. Our Institutional Review Board waived the need for consent. Prompt initiation of VV ECMO resulted in rapid clinical improvement, radiographic resolution of diffuse consolidation, and return of full neurocognitive function. For children with rapidly progressive respiratory distress on conventional ventilation, VV ECMO can be used to improve outcomes when initiated early in the disease process even in children with a significant co-morbidity.
In Vitro Evaluation of Gaseous Microemboli Handling of Cardiopulmonary Bypass Circuits with and without Integrated Arterial Line Filters
Authors: Liu Saifei , Newland Richard F. , Tully Phillip J. , Tuble Sigrid C. , Baker Robert A.
Published: July 2023

The delivery of gaseous microemboli (GME) by the cardiopulmonary bypass circuit should be minimized whenever possible. Innovations in components, such as the integration of arterial line filter (ALF) and ALFs with reduced priming volumes, have provided clinicians with circuit design options. However, before adopting these components clinically, their GME handling ability should be assessed. This study aims to compare the GME handling ability of different oxygenator/ALF combinations with our currently utilized combination. Five commercially available oxygenator/ALF combinations were evaluated in vitro: Terumo Capiox SX25RX and Dideco D734 (SX/ D734),Terumo Capiox RX25R and AF125 (RX/AF125),Terumo FX25R (FX), Sorin Synthesis with 102 μm reservoir filter (SYN102), and Sorin Synthesis with 40 μm reservoir filter (SYN40). GME handling was studied by introducing air into the venous return at 100 mL/min for 60 seconds under two flow/ pressure combinations : 3.5 L/min, 150 mmHg and 5 L/min, 200 mmHg. Emboli were measured at three positions in the circuit using the Emboli Detection and Classification (EDAC®) Quantifier and analyzed with the General Linear Model. All circuits significantly reduced GME. The SX/D734 and SYN40 circuits were most efficient in GME removal whilst the SYN102 handled embolic load (count and volume) least efficiently (p< .001). A greater number of emboli <70 μm were observed for the SYN102, FX and RX/AF125 circuits (p< .001). An increase in embolic load occurred with higher flow/pressure in all circuits (p< .001). The venous reservoir significantly influences embolic load delivered to the oxygenator (p< .001). The majority of introduced venous air was removed; however, significant variation existed in the ability of the different circuits to handle GME. Venous reservoir design influenced the overall GME handling ability. GME removal was less efficient at higher flow and pressure, and for smaller sized emboli. The clinical significance of reducing GME requires further investigation.
Does Tight Glucose Control Prevent Myocardial Injury and Inflammation?
Authors: Brown Jeremiah R. , Furnary Anthony P. , Mackenzie Todd A. , Duquette Dennis , Helm Robert E. , Paliotta Marco , Ross Cathy S. , Malenka David J. , O’Connor Gerald T. ,   for the Northern New England Cardiovascular Disease Study Group
Published: July 2023

Hyperglycemia has been postulated to be cardiotoxic. We addressed the hypothesis that uncontrolled blood glucose induces myocardial damage in diabetic patients undergoing isolated coronary artery bypass graft surgery receiving continuous insulin infusion in the immediate postoperative period. Our primary aim was to assess the degree of tight glycemic control for each patient and to link the degree of glycemic control to intermediate outcome of myocardial damage. We prospectively enrolled 199 consecutive patients with diabetes undergoing isolated coronary artery bypass graft surgery from October 2003 through August 2005. Preoperative hemoglobin A1c and glucose measures were collected from the surgical admission. We measured biomarkers of myocardial damage (cardiac troponin I) and metabolic dysfunction (blood glucose and hemoglobin A1c) to identify a difference among patients under tight (90–100% of glucose measures ≤150 mg/dL) or loose (<90%) glycemic control. All patients received continuous insulin infusion in the immediate postoperative period. We discovered 45.6% of the patients were in tight control. We found tight glycemic control resulted in no significant difference in troponin I release. Mean cardiac troponin I for tight and loose control was 4.9 and 8.5 (ng/mL), p value .3. We discovered patients varied with their degree of control, even with established protocols to maintain glucose levels within the normal range. We were unable to verify tight glycemic control compared to loose control was significantly associated with decreased cardiac troponin I release. Future studies are needed to evaluate the cardiotoxic mechanisms of hyperglycemia postulated in this study.
Optimizing Venous Drainage Using an Ultrasonic Flow Probe on the Venous Line
Authors: Walker Joshua L. , Young Haven A. , Lawson D. Scott , Husain S. Adil , Calhoon John H.
Published: July 2023

The use of smaller cannulae for minimally invasive surgery techniques and/or aggressive miniaturization of the cardiopulmonary bypass (CPB) circuitry has necessitated the need to augment venous drainage to achieve adequate flow rates. Vacuum assisted venous drainage (VAVD) has become the dominant method to augment venous drainage. VAVD, however, has been associated with a number of known side effects including increased transmission of gaseous microemboli to the patient, venous line chatter, and increased arterial to venous shunts in the circuit. Historically, our practice has been to monitor the arterial output flow rate and to monitor VAVD by observing venous line chatter and changes in the venous reservoir level. In 2008 our pediatric cardiothoracic service began monitoring venous line flow rates by using a second ultrasonic flow probe placed on the venous line. After 12 months, our staff perfusionists reviewed the impact of monitoring venous line flow rates on VAVD and its known side effects on daily clinical practice. When monitoring venous line flow rates, empiric observation revealed that less overall vacuum pressure was needed for our CPB cases. This novel approach to monitoring venous drainage has aided us in providing optimal vacuum levels and therefore, may reduce some of the known side effects experienced with excessive VAVD.
Blood Component Therapy in Trauma Guided with the Utilization of the Perfusionist and Thromboelastography
Authors: Walsh Mark , Thomas Scott G. , Howard Janet C. , Evans Edward , Guyer Kirk , Medvecz Andrew , Swearingen Andrew , Navari Rudolph M. , Ploplis Victoria , Castellino Francis J.
Published: July 2023

25–35% of all seriously injured multiple trauma patients are coagulopathic upon arrival to the emergency department, and therefore early diagnosis and intervention on this subset of patients is important. In addition to standard plasma based tests of coagulation, the thromboelastogram (TEG®) has resurfaced as an ideal test in the trauma population to help guide the clinician in the administration of blood components in a goal directed fashion. We describe how thromboelastographic analysis is used to assist in the management of trauma patients with coagulopathies presenting to the emergency department, in surgery, and in the postoperative period. Indications for the utilization of the TEG® and platelet mapping as point of care testing that can guide blood component therapy in a goal directed fashion in the trauma population are presented with emphasis on the more common reasons such as massive transfusion protocol, the management of traumatic brain injury with bleeding, the diagnosis and management of trauma in patients on platelet antagonists, the utilization of recombinant FVIIa, and the management of coagulopathy in terminal trauma patients in preparation for organ donation. The TEG® allows for judicious and protocol assisted utilization of blood components in a setting that has recently gained acceptance. In our program, the inclusion of the perfusionist with expertise in performing and interpreting TEG® analysis allows the multidisciplinary trauma team to more effectively manage blood products and resuscitation in this population.
The Prognostic Value of Using the Duration of Acute Kidney Injury in Cardiac Surgery: An Example Using Two Antifibrinolytics
Authors: Brown Jeremiah R. , Kramer Robert S. , Coca Steven G. , Parikh Chirag R.
Published: July 2023

Previously, we reported that the addition of duration to the Acute Kidney Injury Network (AKIN) definition of acute kidney injury (AKI) is a marker for more severe kidney injury and predicts long-term mortality. We aimed to evaluate an example of the utility of adding AKI duration to the AKIN definition by comparing the historical use of aprotinin with Amicar. In a single-center observational study, we followed 4987 consecutive patients undergoing cardiac surgery between 2002 and 2007 for postsurgery AKI. Patients with a history of hemodialysis were excluded. Duration of AKI was calculated by the number of days AKI was present as defined by a ≥0.3 (mg/dL) or a ≥50% increase in serum creatinine from baseline or new onset of acute dialysis. Kaplan-Meier and Cox’s proportional hazard modeling was conducted to evaluate 5-year mortality. Fifty-three percent of patients received Amicar (n = 2333) and 47% received high-dose aprotinin (n = 2093). Patients receiving aprotinin had evidence of more advanced disease and comorbidity and were more likely to develop AKI and have longer durations of AKI than Amicar (p < .001): 7.0 ± 11.5 vs. 3.8 ± 6.0 days (p < .001). Nearest-neighbor propensity matching demonstrated aprotinin had significantly worse 5-year mortality compared with Amicar (relative risk [RR] = 2.09, 95% confidence interval [CI] = 1.65–2.65). AKI duration added to the AKIN definition of AKI may provide the necessary sensitivity and specificity for evaluating renal outcomes in clinical trials.
Stage 1 Palliation for Hypoplastic Left Heart Syndrome Without the Use of Allogeneic Tissue, with Reduced Allogeneic Blood Product Exposure: A Case Report
Authors: Deptula Joseph , Hammel James , George Kari , Detwiler John , Glogowski Kimberly , Valleley Melinda , Duncan Kim
Published: July 2023

In the 30 years since Norwood described the palliative procedure for hypoplastic left heart syndrome (HLHS), many modifications have been described which have increased the survival rate of children born with this lesion. We describe further modifications which result in reduced cardiopulmonary bypass time, no cooling or circulatory arrest time, and decreased banked blood exposure. A 16-day-old infant with HLHS undiagnosed during pregnancy presented for stage 1 palliation incorporating the Mee modification, Sano right ventricle to pulmonary artery conduit, dual arterial cannulation of the innominate artery and descending aorta, single venous cannulation of the right atrium, and a bypass prime volume of 130 mL. Anticoagulation and hemostasis were monitored with the Hepcon HMS Plus Hemostasis Management System (Medtronic USA, Minneapolis, MN). Bypass commenced at normothermia. A 5.0 Gore-Tex shunt was placed for the Sano Shunt, and the aortic arch was repaired without use of homologous tissue or synthetic material using a modification of the Mee technique. Bypass time was 92 minutes with a 10 minutes cardiac ischemic time. Modified ultrafiltration (MUF) was performed for 12 minutes and heparinization was reversed with protamine. There was no significant bleeding and no indication to transfuse clotting factors. The patient’s only allogeneic donor exposure was 350 mL of red blood cells during bypass necessary to achieve a post MUF hematocrit of 50% per our current institution policy for cyanotic infants. Using modified surgical and perfusion techniques along with low prime bypass circuits can result in reduced cross clamp and bypass times as well as a decrease in blood donor exposure. Hypothetical benefits include reduced operating room, ventilation, intensive care unit, and hospital times, improved neurodevelopmental outcomes, and an overall reduction in the cost of care for infants with HLHS.
Changes in Mechanical Fragility and Free Hemoglobin Levels after Processing Salvaged Cardiopulmonary Bypass Circuit Blood with a Modified Ultrafiltration Device
Authors: Harm Sarah K. , Waters Jonathan H. , Lynn Pamela , Dyga Robert , Raval Jay S. , DiMarco Ross F. , Yazer Mark H.
Published: July 2023

Modified ultrafiltration (MUF) is available for the salvage of post-cardiopulmonary bypass circuit blood. This study evaluated the extent of hemolysis, the mechanical fragility index (MFI), and the amount of plasma free hemoglobin (PFHb) created after processing with the MUF device. Several RBC parameters were measured on pre- and post-MUF device processed samples of blood from 12 patients undergoing cardiac surgery. The MFI and total amount of PFHb did not change significantly between the pre- and post-processing samples: MFI, pre: .19 ± .06 versus post: .19 ± .06,p= .76; total amount of PFHb, pre: .24 ± .21 g versus post: .20 ± .12 g,p= .42. There was significantly more hemolysis in the post-processing samples compared with the pre-processing samples, .33 ± .24% versus .96 ± .48%, respectively,p< .001. Although percent hemolysis was increased following processing with the MUF device, the total amount of PFHb and RBC sublethal injury were not increased. The clinical significance of these findings needs to be determined.
Timely Bolus Insulin for Glucose Control during Cardiopulmonary Bypass
Authors: Kruger Cornelis , Sidebotham David , Brown Alan J. , Singh Harjot , Merry Alan F.
Published: July 2023

Hyperglycemia during cardiopulmonary bypass (CPB) with glucose containing cardioplegia is common; normoglycemia is difficult to maintain and failure to do so may result in worse outcomes. The purpose of this quality improvement initiative was to show that a simple timely insulin bolus is more effective for glucose control during CPB with glucose containing cardioplegia than conventional (not standardized) glucose management in historical case-matched controls. A single bolus of insulin (.2 international units per kilogram; iu/kg) was administered, at the time of aortic cannulation, to 211 consecutive patients undergoing cardiac surgery with CPB and glucose containing cardioplegia. A further .1 iu/kg bolus of insulin was given for blood glucose (BG) measurements greater than 10.0 mmol/L (180 mg/dL) during CPB. The control group of 211 historical case-matched patients had glucose management according to anesthesiologist preference (insulin as a bolus, bolus plus infusion, infusion only, or no insulin). The frequency of hyperglycemia (BG > 11.0 mmol/L; 198 mg/dL) during CPB was significantly less in the study group (22; 10.5%) than in the control group (117; 55.5%) (p < .0001). Hyperglycemia in the first 6 hours in the intensive care unit was also significantly less frequent in the study group (5; 2.4%) than in the control group (14; 6.6%) (p = .03). Severe hypoglycemia (BG < 2.8 mmol/L; 50.4 mg/dL) occurred in one patient (.47%) in the timely bolus insulin group and five patients (2.3%) in the control group (p = .09). The timely bolus insulin method is more efficacious, but equally safe, in preventing hyperglycemia during CPB with glucose containing cardioplegia, compared with conventional (not standardized) insulin treatment in historical case-matched controls.
Alternative Anticoagulation during Cardiovascular Procedures in Pediatric Patients with Heparin-Induced Thrombocytopenia
Authors: Argueta-Morales I. Ricardo , Olsen Monica C. , DeCampli William M. , Munro Hamish M. , Felix Donald E.
Published: July 2023

Patients with heparin-induced thrombocytopenia (HIT) that require anticoagulation for cardiovascular procedures represent a challenging and high-risk group. Bivalirudin and argatroban have been successfully used as alternative anticoagulants in adult patients with HIT. There have been few experiences published involving the pediatric population and controversy exists regarding the properties and optimal dosing of these drugs. This report describes the experience of managing two pediatric patients with HIT that underwent cardiovascular procedures requiring anticoagulation. Bivalirudin was used in both cases for anticoagulation during cardiopulmonary bypass, while argatroban was used without complications during cardiac catheterization. A description of perfusion and anticoagulation protocols is included.
History and Use of del Nido Cardioplegia Solution at Boston Children’s Hospital
Authors: Matte Gregory S. , del Nido Pedro J.
Published: July 2023

Cardioplegia is an integral and essential method of myocardial protection for patients of all ages requiring cardiac surgery in which the heart must be stopped. Numerous cardioplegia solutions and delivery methods have been developed. The del Nido cardioplegia solution has been in use for 18 years at Boston Children’s Hospital. This is a unique four parts crystalloid to one part whole blood formulation that is generally used in a single-dose fashion. Although the formulation was originally developed for use in pediatric and infant patients, its use for adult cardiac surgery has been expanding. National and international inquiries to our institution regarding this cardioplegia have been increasing over the last 2 years. We present the developmental history, supporting theory, and current protocol for use of what is now referred to as del Nido cardioplegia.
Our Experience with Two Cardioplegic Solutions: Dextrose versus Non-Dextrose in Adult Cardiac Surgery
Authors: Lessen Ronald , DiCapua John , Pekmezaris Renee , Walia Rajni , Bocchieri Karl , Jahn Lynda , Akerman Meredith , Lesser Martin L. , Hartman Alan
Published: July 2023

Intraoperative hyperglycemia has been observed to be associated with increased morbidity and mortality after cardiac surgery. Dextrose cardioplegia is used for its cardioprotective effects but may lead to intraoperative hyperglycemia and more postoperative complications. This was a retrospective observational study. Patient records (n = 2301) were accessed from a large database at a tertiary care facility. The two groups (dextrose vs. nondextrose) were then matched using preoperative variables of age, sex, body mass index, wound exposure time, preoperative HbA1c levels, renal failure, hypertension, and prior cerebrovascular disease. The following outcomes were recorded: 30-day mortality, sternal wound infection, stroke, and highest glucose level on cardiopulmonary bypass. The dextrose cardioplegia group showed statistically higher intraoperative glucose levels (272.76 ± 55.92 vs. 182.79 ± 45, p value = .0001). There was no difference in postoperative mortality, sternal wound infections or stroke incidence, nor in other secondary outcomes. The type of cardioplegia solution was shown to affect glucose levels; however, there was no effect on postoperative complication rates.
Theoretical Treatise: Arterial Pressure during Aortic Surgery
Authors: Ridgway Tim , Al-Rawi Omar , Palmer Kenneth , Pullan Mark , Poullis Michael
Published: July 2023

The optimum arterial perfusion pressure during cardiopulmonary bypass (CPB) remains uncertain. A correlation in some form with the patients’ resting pressure almost certainly exists. Temperature and hematocrit affect blood viscosity. The optimum perfusion pressure during aortic surgery will vary after the initiation of CPB resulting cooling, heating, and hematocrit changes. Poiseuille’s Law was used in conjunction with the previously published effects of temperature and hematocrit on blood viscosity to determine the perfusion pressure that would result in the same organ blood flow. Two different scenarios were modeled, constant flow and flow as predicted by Q10 to reflect required oxygen delivery. Temperature, hematocrit, and flow all have a large effect on blood viscosity and, thus, through Poiseuille’s Law, blood pressure. As patients are cooled, their blood viscosity goes up through the inherent viscoelastic properties of blood. As temperature drops from 37° to 17°, viscosity doubles. This increased viscosity is offset by a reduction in hematocrit, which is invariably associated with CPB. As the hematocrit drops from 30%to 10%, viscosity of blood halves. These two factors clinically can cancel each other out. The figure demonstrates the effect on blood pressure of a constant flow for various temperature and hematocrits. Reduced need for oxygen delivery, secondary to the principles of Q10, can result in a lower than expected theoretical perfusion pressure. As temperature drops from 37° to 17°, based on Q10, oxygen delivery reduces by 75%. This indicates that flow can be reduced by over 60% if the hematocrit falls from 30% to 20%. This theoretical treatise predicts that blood pressure management should be temperature- and hematocrit-dependent. The target optimal blood pressure will vary during the course of surgery as a result of heating, cooling, and hemodilution. Clinical correlation is needed.