bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlations between histopathologic findings, serum biomarker levels, and clinical outcomes in Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)
Authors: Chuenwipasakul Donlaporn , Washrawirul Chanudda , Panpruk Rawiphan , Wititsuwannakul Jade , Charoenchaipiyakul Kridipop , Buranapraditkun Supranee , Puangsricharern Vilavun , Klaewsongkram Jettanong , Rerknimitr Pawinee
Published: August 2023

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatological emergencies. The role of cytokines and chemokines in the pathogenesis, progression of the disease, and histopathologic features is not fully elucidated. To address this gap, we conducted a retrospective study examining the associations between 42 serum biomarkers, histopathologic findings, and clinical outcomes in SJS/TEN patients. We reviewed the medical records of 23 patients diagnosed with SJS/TEN. Regarding histopathology, our study did not reveal any significant associations between the degree of epidermal necrosis, dermal mononuclear cell infiltration, and clinical outcomes. However, an intriguing observation was made regarding the degree of dermal infiltration of CD8 + cells, which showed a negative correlation with the severity of acute ocular complications. Notably, serum levels of IFN-γ positively correlated with the number of CD8 + cells in dermal infiltration. Additionally, higher serum levels of myeloperoxidase were associated with greater degrees of epidermal necrosis, while serum Fas ligand and stem cell factor levels were elevated in individuals with increased dermal mononuclear cell infiltration. Furthermore, the levels of S100A8/A9 were significantly correlated with the SCORTEN and mortality rate. These findings provide insights into the intricate pathogenesis of the disease.
Synergetic-PI controller based on genetic algorithm for DPC-PWM strategy of a multi-rotor wind power system
Authors: Benbouhenni Habib , Gasmi Hamza , Colak Ilhami , Bizon Nicu , Thounthong Phatiphat
Published: August 2023

This work designs a powerful new nonlinear control technique using synergetic control (SC), proportional-integral (PI) controller, and genetic algorithm (GA) for multi-rotor wind energy (MRWE) conversion systems, whereby an asynchronous generator (AG) is used to achieve optimal energy extraction. The direct power control (DPC) technique is used based on the proposed SC-PI-GA (SPI-GA) technique to control the AG-based MRWE system, where this new nonlinear control technique is used to achieve stable control characteristics under random changes in wind speed and to provide great robustness against modeling uncertainties. Moreover, the pulse width modulation (PWM) technique is used to control the AG inverter due to its simplicity and ease of implementation. In this proposed DPC-SPI-GA technique, we need to measure current and voltage to estimate the active power and the reactive power. Also, inner loops are not used in this proposed DPC-SPI-GA technique as is the case in the field-oriented control (FOC) technique, where the proposed system in this work is characterized by an integrated structure. Three different tests are proposed to study and verify the behavior of the designed DPC-SPI-GA strategy compared to the traditional DPC technique.
Identification of diagnostic biomarkers via weighted correlation network analysis in colorectal cancer using a system biology approach
Authors: Ghafouri-Fard Soudeh , Safarzadeh Arash , Taheri Mohammad , Jamali Elena
Published: August 2023

Colorectal cancer (CRC) is the third most frequent cancer to be diagnosed in both females and males necessitating identification of effective biomarkers. An in-silico system biology approach called weighted gene co-expression network analysis (WGCNA) can be used to examine gene expression in a complicated network of regulatory genes. In the current study, the co-expression network of DEGs connected to CRC and their target genes was built using the WGCNA algorithm. GO and KEGG pathway analysis were carried out to learn more about the biological role of the DEmRNAs. These findings revealed that the genes were mostly enriched in the biological processes that were involved in the regulation of hormone levels, extracellular matrix organization, and extracellular structure organization. The intersection of genes between hub genes and DEmRNAs showed that DKC1, PA2G4, LYAR and NOLC1 were the clinically final hub genes of CRC.
Identification and validation of tumor microenvironment-related signature for predicting prognosis and immunotherapy response in patients with lung adenocarcinoma
Authors: Li Chunhong , Yuan Yixiao , Jiang Xiulin , Wang Qiang
Published: August 2023

Mounting evidence has found that tumor microenvironment (TME) plays an important role in the tumor progression of lung adenocarcinoma (LUAD). However, the roles of tumor microenvironment-related genes in immunotherapy and clinical outcomes remain unclear. In this study, 6 TME-related genes (PLK1, LDHA, FURIN, FSCN1, RAB27B, and MS4A1) were identified to construct the prognostic model. The established risk scores were able to predict outcomes at 1, 3, and 5 years with greater accuracy than previously known models. Moreover, the risk score was closely associated with immune cell infiltration and the immunoregulatory genes including T cell exhaustion markers. In conclusion, the TME risk score can function as an independent prognostic biomarker and a predictor for evaluating immunotherapy response in LUAD patients, which provides recommendations for improving patients’ response to immunotherapy and promoting personalized tumor immunotherapy in the future.
Measuring sustainable urban development in residential areas of the 20 biggest Finnish cities
Authors: Ala-Mantila Sanna , Kurvinen Antti , Karhula Aleksi
Published: August 2023

As a result of the ongoing urbanization megatrend, cities have an increasingly critical role in the search for sustainability. To create sustainable strategies for cities and to follow up if they induce desired effects proper metrics on the inter and intra-urban development is needed. In this paper, we analyze the sustainability development in the 20 largest cities in Finland through a residential area classification framework. The results based on high-quality register data show concerning trends in some sustainability measures, and divergent trends between cities and residential areas within. Overall, while densities have increased modestly, we see no clear signs of decreasing car ownership rates. Further, also manifestations of social sustainability seem to be insufficient in many locations–especially in residential mid-rise areas from the '60s and '70s, and '80s and '90s.
Saliva sampling strategies affecting the salivary glucose measurement
Authors: Qian Xia , Ko Anthony , Li Haifeng , Liao Caizhi
Published: August 2023

Salivary glucose measurement (SGM) has increasingly become a non-invasive alternative to traditional blood glucose testing for diabetes. To resolve remaining issues, we here thoroughly explored sampling strategies' impacts on SGM.
Biomechanical characterization of a fibrinogen–blood hydrogel for human dental pulp regeneration
Authors: Piglionico Sofia Silvia , Varga Bela , Pall Orsolya , Romieu Olivier , Gergely Csilla , Cuisinier Frédéric , Levallois Bernard , Panayotov Ivan Vladislavov
Published: August 2023

Biomechanical characterization of a fibrinogen–blood hydrogel for human dental pulp regeneration.
An anti-inflammatory chondroitin sulfate-poly(lactic-co-glycolic acid) composite electrospinning membrane for postoperative abdominal adhesion prevention
Authors: Gao Rui , Li Fenghui , Zhang Yushan , Kong Pengxu , Gao Yu , Wang Jingrong , Liu Xiang , Li Shuangyang , Jiang Liqin , Zhang Ju , Zhang Chuangnian , Feng Zujian , Huang Pingsheng , Wang Weiwei
Published: August 2023

A promising drug-/cytokine-free anti-inflammatory PLGA/CS electrospinning membrane barrier was developed for post-surgery abdominal adhesion prevention by alleviating the local inflammatory response and activating the fibrinolytic system.
Xanthine derivatives inhibit FTO in an l-ascorbic acid-dependent manner
Authors: Tanaka Kamui , Suda Akiyo , Uesugi Motonari , Futaki Shiroh , Imanishi Miki
Published: August 2023

An activity-based screening for FTO inhibitor identified xanthine derivatives as specific FTO inhibitors with an l-ascorbic acid-dependent mode of inhibition.
Aerobic oxidative C–H phosphorylation of quinoxalines under catalyst-free conditions
Authors: Gan Qiaoyu , Liu Haibo , Jiang Zeqi , Xia Junmei , Gao Zhenhua , Guo Yongbiao , Wen Hongliang
Published: August 2023

We report an easily handled and environmentally friendly protocol for highly efficient phosphorylation of quinoxalines under mild and metal-free conditions employing air as the green oxidant via a dearomatization–rearomatization strategy.
Structural dimension engineering and high-temperature dielectric–optical switching in fluorine-substituted lead bromide hybrid perovskites
Authors: Gan Tian , Xu Zhe-Kun , Gan Jia-Qi , Wang Zhong-Xia
Published: August 2023

We have reported the realization of structural dimension engineering and high-temperature phase transition properties of lead bromide hybrid perovskites showing dielectric–optical switching by fluorine substitution.
Tuning the heterophase junction in Bi2O3 hybrid crystals with enhanced photocatalytic activity
Authors: Liang Yuan-Chang , Liang Keng-Wei
Published: August 2023

The β/γ-Bi2O3 heterophase hybrids show higher photocatalytic activity than β- or γ-Bi2O3.
Hydrogen atoms in supramolecular chemistry: a structural perspective. Where are they, and why does it matter?
Authors: Thompson Amber L. , White Nicholas G.
Published: August 2023

This Tutorial Review discusses the opportunities and challenges of locating hydrogen atoms in X-ray crystal structures, particularly those of supramolecular systems.
Sulfur-doped carbonized bacterial cellulose as a flexible binder-free 3D anode for improved sodium ion storage
Authors: Wang Xiangmei , Xiao Xin , Chen Chuntao , Sun Bianjing , Chen Xinyu , Hu Jiacheng , Zhang Lei , Sun Dongping
Published: August 2023

Schematic illustration of the synthesis of CBC and S-CBC.
From gut to skin: exploring the potential of natural products targeting microorganisms for atopic dermatitis treatment
Authors: Zhao Hang , Ma Xin , Song Jiankun , Jiang Jingsi , Fei Xiaoya , Luo Yue , Ru Yi , Luo Ying , Gao Chunjie , Kuai Le , Li Bin
Published: August 2023

Under the action of natural products, microorganisms participate in a complete cycle of the “gut-brain-skin” axis linkage mechanism, thereby regulating the development of atopic dermatitis.
Pterostilbene alleviated cerebral ischemia/reperfusion-induced blood–brain barrier dysfunction via inhibiting early endothelial cytoskeleton reorganization and late basement membrane degradation
Authors: Yang Zhi-hong , Liu Ye-ju , Ban Wei-kang , Liu Hai-bo , Lv Ling-juan , Zhang Bao-yue , Liu Ai-lin , Hou Zi-yu , Lu Juan , Chen Xi , You Yu-yang
Published: August 2023

Pterostilbene inhibits the cytoskeleton reorganization of hBMECs by regulating actin polymerization in the early stage and inhibits the degradation of BM by activating Wnt pathway and inhibiting MMP-9 in the late stage, jointly protecting BBB.
Water extract of goji berries improves neuroinflammation induced by a high-fat and high-fructose diet based on the bile acid-mediated gut–brain axis pathway
Authors: Dong Wei , Huang Yujie , Shu Yifan , Fan Xia , Tian Xinyi , Yan Yamei , Mi Jia , Lu Lu , Zeng Xiaoxiong , Cao Youlong
Published: August 2023

Water extract of Goji berries ameliorated neuroinflammation and cognitive impairment in HFFD-induced mice, which might be due to the regulation of bile acids (BAs) homeostasis and gut microbiota.
Machine learning-assisted optimization of multi-metal hydroxide electrocatalysts for overall water splitting
Authors: Lim Carina Yi Jing , I Made Riko , Khoo Zi Hui Jonathan , Ng Chee Koon , Bai Yang , Wang Jianbiao , Yang Gaoliang , Handoko Albertus D. , Lim Yee-Fun
Published: August 2023

Development of electrocatalysts may be aided by machine learning integration into experimental workflows.
3D-printed epidermal sweat microfluidic systems with integrated microcuvettes for precise spectroscopic and fluorometric biochemical assays
Authors: Yang Da Som , Wu Yixin , Kanatzidis Evangelos E. , Avila Raudel , Zhou Mingyu , Bai Yun , Chen Shulin , Sekine Yurina , Kim Joohee , Deng Yujun , Guo Hexia , Zhang Yi , Ghaffari Roozbeh , Huang Yonggang , Rogers John A.
Published: August 2023

3D-printed microfluidic systems that incorporate rigid polymeric structures in soft elastomeric encapsulation layers gently bond to the skin, to capture sweat and provide the basis for accurate, spectroscopic measurements of sweat biomarkers.
Preparation and application of sodium alginate/PHMB/Ca2+ high-strength and high-antibacterial hydrogel
Authors: Deng Liumi , Zhou Xiang , Wu Mengyun , Fu Lu , Huang Zhiyu , Liao Meng , Wang Hua , Chen Shaohua , Tang Xu , Wang Luoxin
Published: August 2023

Wound infection caused by skin injury is the most common medical problem, and wound dressings can provide an appropriate healing environment for the injured skin and control wound inflammation during healing and treatment.
Modulating the Schottky barriers of metal–2D perovskite junctions through molecular engineering of spacer ligands
Authors: Xu Zhuo , Luo Weidong , Guo Songyan , Liu Shengzhong Frank
Published: August 2023

This work revealed another effective way to tune the contact properties of metal–2D perovskite junctions by spacer ligand engineering.
Theoretical mechanistic insights into the electrophilic addition of hydrogen halides to alkynes
Authors: Chen Yixiang , Cheng Shi , Su Chongjie , Chen Ning , Xu Jiaxi
Published: August 2023

Mechanistic and stereoselective insights into the hydrohalogenation of alkynes were investigated by DFT calculations and the stereoselectivity depends on the alkyl/aryl substituents of alkynes and the absence or presence of halides.
A0.5H2C6N7O3·4H2O (A = Ca2+, Sr2+) iso-cyamelurates with ultra-large π-conjugated group and excellent nonlinear optical properties
Authors: Du Xiaoguang , Wang Fangyan , Liang Fei , Hu Zhanggui , Wu Yicheng , Zhang Xinyuan
Published: August 2023

Two isocyamelurates of A0.5H2C6N7O3·4H2O (A= Ca2+, Sr2+) were successfully synthesized. Both of them showed excellent properties of wide band gap, large birefringence, and strong second order harmonic generation response.
Photocatalytic oxidative cleavage of aryl alkene CC bonds using a uranyl cation
Authors: Tang Song-Bai , Zhang Shu-Yun , Li Wen-Jing , Jiang Yan-Xin , Wang Zi-Xin , Long Bo , Su Jing
Published: August 2023

Ketones and carboxylic acids were easily obtained via uranyl photocatalysis. And based on DFT calculations, the uranyl-organic intermediates were suggested.
Photo-induced stereo- and regiospecific sulfonylation of C–C multiple bonds exploiting the dual reactivity of sulfonium iodate(i) species
Authors: Gurawa Aakanksha , Kumar Nitin , Kashyap Sudhir
Published: August 2023

The visible-light-directed stereospecific radical sulfonylation featuring the dual-reactivity of electrophilic reagent Me3SI(OAc)2 is realized for vinyl-sulfonyl functionalization of the C(sp)-H and C(sp2)-H π bond in alkynes and alkenes.
Effect of granulation on chlorine-release behavior during municipal solid waste incineration
Authors: Xie Xinlei , Wu Wei , Fu Jiali , Di Linwen , Bu Changsheng , Xu Guiling , Meng Junguang , Piao Guilin , Wang Xinye
Published: August 2023

Granulation (pressure and additives) has great effect on chlorine-release behavior during municipal solid waste incineration.
New insights into the oxidation process from neutron and X-ray crystal structures of an O2-sensitive [NiFe]-hydrogenase
Authors: Hiromoto Takeshi , Nishikawa Koji , Inoue Seiya , Ogata Hideaki , Hori Yuta , Kusaka Katsuhiro , Hirano Yu , Kurihara Kazuo , Shigeta Yasuteru , Tamada Taro , Higuchi Yoshiki
Published: August 2023

We report the first neutron structure of [NiFe]-hydrogenase in its oxidized state. This study leads to new insights into the oxidized active site and visualization of the protons characteristic of the oxidized enzyme.
Correction: A visible-light-driven molecular motor based on barbituric acid
Authors: Kuntze Kim , Pooler Daisy R. S. , Di Donato Mariangela , Hilbers Michiel F. , van der Meulen Pieter , Buma Wybren Jan , Priimagi Arri , Feringa Ben L. , Crespi Stefano
Published: August 2023

Correction for ‘A visible-light-driven molecular motor based on barbituric acid’ by Kim Kuntze et al., Chem. Sci., 2023, 14, 8458–8465, https://doi.org/10.1039/D3SC03090C.
Supramolecular nanostructures of coil–rod–coil molecules containing a 9,10-distyrylanthracene group in aqueous solution and their optical properties of assemblies
Authors: Gou Xiaoliang , Lu Jie , Zhao Hui-Yu , Pei Yi-Rong , Jin Long Yi
Published: August 2023

Rod–coil amphiphiles with DSA derivatives self-assemble into various nanoobjects through donor–acceptor interactions and these assemblies are suitable organic dyes for information encryption and anti-counterfeiting applications.
Reinforcement learning-based design of shape-changing metamaterials
Authors: Oliva Sergi Bernaus , Bölle Felix T. , Las A. T. , Xia Xiaoxing , Castelli Ivano E.
Published: August 2023

We have implemented a new reinforcement learning method able to rationally design unique metamaterial structures, which change shape during operational conditions. We have applied this to design nanostructured silicon anodes for Li-ion batteries.
In-depth understanding the temperature-dependent reversible phase transition in CsPbI3−xBrx perovskites and its associated photophysical properties
Authors: Yuan Songyang , Deng Jiahuan , Xiong Hui , Wu Wenwen , Ma Zhipeng , Wang Mengqi , Li Wenzhe , Fan Jiandong
Published: August 2023

Temperature-dependent phase transition of CsPbI3−x Brx perovskite is synchronously observed in a reciprocal space, and its photophysical properties are systematically studied by exploring the carrier–phonon coupling and excitons transport.
Tetrathiafulvalene (TTF) derivatives as catholytes for dual-type redox flow batteries: molecular engineering enables high energy density and cyclability
Authors: Wang Xiao , Lashgari Amir , Siwakoti Rabin , Gautam Rajeev K. , McGrath Jack J. , Sarkar Prasenjit , Naber Grace , Chai Jingchao , Jiang Jianbing Jimmy
Published: August 2023

Redox flow batteries (RFBs) have received increasing attention on large-scale energy storage owing to their ability to decouple energy and power.
Data analytics accelerates the experimental discovery of Cu1−xAgxGaTe2 based thermoelectric chalcogenides with high figure of merit
Authors: Zhong Yaqiong , Hu Xiaojuan , Sarker Debalaya , Su Xianli , Xia Qingrui , Xu Liangliang , Yang Chao , Tang Xinfeng , Levchenko Sergey V. , Han Zhongkang , Cui Jiaolin
Published: August 2023

Employing an artificial intelligence (AI) approach, we have predicted and experimentally synthesized several high-performing p-type thermoelectric (TE) chalcogenides, Cu1−xAgxGaTe2, with the peak TE figure of merit (zT) of ∼1.90 at 770 K and x = 0.45.
Correction: Pseudo-bilayered inverted organic solar cells using the Marangoni effect
Authors: Jo Jihwan , Jeong Seonju , Lee Dongchan , Lee Seungjin , Kim Bumjoon J. , Cho Shinuk , Lee Jung-Yong
Published: August 2023

Correction for ‘Pseudo-bilayered inverted organic solar cells using the Marangoni effect’ by Jihwan Jo et al., J. Mater. Chem. A, 2023, https://doi.org/10.1039/D3TA03236A.
Wet-adhesive γ-PGA/ε-PLL hydrogel loaded with EGF for tracheal epithelial injury repair
Authors: Hu Chuang , Ji Haoran , Gong Yan , Yang Xuhui , Jia Yunxuan , Liu Yuanhao , Ji Guangyu , Wang Xiansong , Wang Mingsong
Published: August 2023

An epidermal growth factor (EGF)-loaded gamma-polyglutamic acid (γ-PGA)/epsilon-poly-l-lysine (ε-PLL) hydrogel (PP), abbreviated as EGF@PP, promotes the repair of tracheal epithelial injury.
2D MXene interface engineering for organic solar cells
Authors: Aftab Sikandar , Iqbal Muhammad Zahir , Hussain Sajjad , Kabir Fahmid , Kumar Sunil , Hegazy H. H. , Sravanthi Goud Burragoni
Published: August 2023

Organic solar cells (OSCs) have several advantages over conventional inorganic solar cells, including lower cost and greater flexibility.
Beyond cadmium yellow: CdS photonic crystal pigments with vivid structural colors
Authors: Wei Wuke , Wu Chengcai , Fang Qianyao , Zhao Zhongwen , Su Xin
Published: August 2023

This paper reports a method for fabricating CdS photonic crystal pigments through a microfluidic process. The vivid angle-independent structural colors make CdS pigments beyond the traditional cadmium yellow as new pigments towards applications.
Dose-related relationship between ergothioneine concentrations and risk of preeclampsia
Authors: Ho Kwok M.
Published: August 2023

The study by Kenny et al. is of considerable importance. They concluded that there was a weak association between the ergothioneine levels and maternal age, and if a threshold was set at the 90th percentile of the reference range in the control population (≥462 ng/ml), only one of these 97 women (1%) developed preeclampsia, versus 96/397 (24.2%) whose ergothioneine level was below this threshold. These results suggest that there might be a dichotomized association between ergothioneine concentrations and preeclampsia; and only a high ergothioneine level over 90th percentile of the control population could be protective against preeclampsia. With the kind supply of the dataset from the authors, further analysis using univariable as well as multivariable analyses were performed while allowing for non-linearity between ergothioneine concentrations and risk of preeclampsia using a 3-knot restricted cubic spline function. The univariable results showed that ergothioneine had a significant non-linear association with preeclampsia and it would start to offer protective effect from 300 ng/ml onward. The results were similar to the multivariable analysis. In addition, the analysis also confirmed that body mass index was significantly associated with an increased risk of preeclampsia.
Coordinated optimization model for solar PV systems integrated into DC distribution networks
Authors: Achiluzzi Eleonora , Venkatesh Bala
Published: August 2023

Solar photovoltaic (PV) systems will drive deep electrification of energy systems leading to clean energy 2050. However, connecting large amounts of solar PV systems on direct current (DC) networks, like solar farms and potential future DC distribution systems, would lead to over voltages and loss of solar PV power output due to voltage issues. Further, current PV integration within distribution networks operate exclusively to maximize output using maximum power point tracking algorithms, without network coordination, which may lead to reduced solar output due to voltage issues. Here, a coordinated optimization model for solar PV systems and distribution network voltage regulators is presented. The proposed model optimally controls the settings of voltage controllers (DC‐DC converters), placed at the outputs of solar PV units and selected distribution lines, while maximizing solar power output and minimizing substation power (i.e. system losses). The solar PV systems are modelled using a trained neural network. Testing various systems against uncoordinated situations revealed that the proposed model yielded an increase in solar power of up to 60.06%, in the 28‐bus case. The proposed method will be an excellent tool enabling deep electrification using solar PV system and it overcomes limitations of uncoordinated systems used in practice today.
Sublimation of refractory minerals in the gas envelopes of accreting rocky planets
Authors: Steinmeyer Marie-Luise , Woitke Peter , Johansen Anders
Published: August 2023

Protoplanets growing within the protoplanetary disk by pebble accretion acquire hydrostatic gas envelopes. Due to accretion heating, the temperature in these envelopes can become high enough to sublimate refractory minerals which are the major components of the accreted pebbles. Here we study the sublimation of different mineral species and determine whether sublimation plays a role during the growth by pebble accretion. For each snapshot in the growth process, we calculate the envelope structure and the sublimation temperature of a set of mineral species representing different levels of volatility. Sublimation lines are determined using an equilibrium scheme for the chemical reactions responsible for destruction and formation of the relevant minerals. We find that the envelope of the growing planet reaches temperatures high enough to sublimate all considered mineral species when M ≳ 0.4 M⊕. The sublimation lines are located within the gravitationally bound envelope of the planet. We make a detailed analysis of the sublimation of FeS at around 720 K, beyond which the mineral is attacked by H2 to form gaseous H2S and solid Fe. We calculate the sulfur concentration in the planet under the assumption that all sulfur released as H2S is lost from the planet by diffusion back to the protoplanetary disk. Our calculated values are in good agreement with the slightly depleted sulfur abundance of Mars, while the model over predicts the extensive sulfur depletion of Earth by a factor of approximately 2. We show that a collision with a sulfur-rich body akin to Mars in the moon-forming giant impact lifts the Earth’s sulfur abundance to approximately 10% of the solar value for all impactor masses above 0.05 Earth masses.
Perfusion Techniques of Profound Hypothermia and Circulatory Arrest for Pulmonary Thromboendarterectomy
Authors: Winkler Mary H. , Rohrer Charlene H. , Ratty Susan C. , Jamieson Stuart , Dembitsky Walter , Moser Kenneth , Auger William
Published: August 2023

One hundred ninety-five patients with the diagnosis of chronic pulmonary thromboembolic pulmonary hypertension have been operated on utilizing a standardized protocol involving profound hypothermia and circulatory arrest. A small subgroup, nine, were identified preoperatively as having heparinassociated thrombocytopenia (HAT). This challenging subgroup of patients was treated during heparin exposure with an investigational, “platelet disaggregating” agent, Iloprost.

The surgical procedure of pulmonary thromboendarterectomy requires multiple periods of circulatory arrest under profound hypothermia. Perfusion management of this procedure involves cerebral and myocardial protection, cooling, reperfusion at hypothermia, and rewarming; treatment with Iloprost when appropriate; and methods of hemodilution.
In Vitro Comparison Tests of Three LV Vent Valves
Authors: Lewis Gregory S. , Czaplicka Chet
Published: August 2023

Many surgical teams employ a sump pump to vent the left ventricle (LV). The problems associated with this technique are related to safety and convenience. If the flow is accidentally reversed in the LV vent line, air embolism accidents and subsequent litigation may be the result. If the cannula is occluded, it is inconvenient to juggle pump speed to prevent the line from collapsing while maintaining gentle but adequate suction.

In this study we in vitro tested three commercially available LV vent valves (RLV-2100 "B," VRV-200 B, H-130) (GLV did not wish to send samples for comparison at the time of this study). Each valve was designed to:

Regulate suction in the LV vent line;

Prevent the flow of air towards the heart; and

Vent downstream pressure to the atmosphere.

Each valve was tested for suction at various flow rates, pressure heads, and for the presence of air leakage during reversed flow conditions.

The results of pressure and suction tests during normal flow and occluded line conditions have been tabulated. We found the RLV-2100 "B" offers the safest combination of suction control and pressure relief. The most astonishing fact learned was the RLV-2100 "B" was the only valve which prevented the flow of air towards the heart during reversed flow. As a result, we elected to use only this valve in our clinical practice.
Platelet Rich Plasma (PRP) Sequestration Why, When, How?
Authors: Page Paul A.
Published: August 2023

Reduction in the amount of blood products transfused during and following any surgery is vitally important because of the risk of blood-transmitted diseases and the increasing costs associated with any transfusion. During the 1970s, a technique of sequestering (drawing off and storing) a patient's blood in the operating room evolved in cardiac surgery. This procedure involved the removal of one or two units of whole blood into anticoagulated storage bags prior to going on cardiopulmonary bypass. This autologous blood was stored in the operating room at room temperature until the patient was brought off cardiopulmonary bypass and stabilized. The blood was then reinfused into the patient. It was theorized that the blood withdrawn contained fresh platelets, red cells, and coagulation factors required to help restore hemostasis rapidly. Furthermore, oxygen carrying capacity following the operation was improved, thereby reducing the need for homologous blood product transfusions following the operation.

An entirely new approach to reduction in the use of blood products involves the preoperative collection of Platelet Rich Plasma (PRP) and the subsequent reinfusion of the PRP containing fresh, undamaged platelets and clotting factors following the operation.

This paper will document why the technique of utilizing Platelet Rich Plasma Sequestration is beneficial for the patient, when and where platelet rich plasma sequestration can be performed and, how the PRP procedure is technically performed.
Moderate Hypothermic Versus Normothermic Total Cardiopulmonary Bypass for Coronary Artery Surgery: A Retrospective Study
Authors: Massimino R.J. , Stearns G.T. , Gough J.D. , Martin J. , Singh A.K.
Published: August 2023

A retrospective analysis of 200 patients who underwent coronary artery bypass surgery between 1987 and 1990 was performed to ascertain whether there was any difference in morbidity or mortality with normothermic versus moderate hypothermic perfusion. Total cardiopulmonary bypass was used in all patients. 100 patients (Group H) were perfused using moderate (28-32°C) hypothermia and the remaining 100 patients (Group N) were perfused at normothermia (37°C). Both groups were comparable for age, weight, BSA, and perfusion time (Group Hmean 64 years, 82 Kg., 1.92 m2 , 94 minutes; Group Nmean 63 years, 82 Kg., 1.90 m2, 90 minutes). Mean perfusate temperature in Group H was 31°C, while the normothermic group was maintained at 37°c. Both groups were perfused to maintain a venous oxygen saturation between 65-70 percent and arterial pressure between 60-70 mmHg. The cardiac index during bypass for Group H was lower (2.32 ± .19 Ll m2 I min) than Group N (2.55 ± .11 Ll m2 I min) (p< 0.001). Mean arterial pressure for Group H was 69 ± 12.4 mmHg and for Group N was 63 ± 7.8 mmHg (p< 0.001). Oxygen transfer for Group N (159 ± 43 ccl min) was higher than Group H (113 + 31cclmin) (p< .001). Metabolic acidosis was not observed in either group. Group H required vasodilators while Group N required vasoconstriction to maintain pressures on total bypass between 60-70 mmHg. Six patients in Group H and 13 patients in Group N required blood transfusion during bypass to maintain a hematocrit above 20 percent.
The Effect of Hyperoxia During Cardiopulmonary Bypass on Blood Cell Rheology and Postoperative Morbidity Associated with Cardiac Surgery
Authors: Belboul A. , Al-khaja N. , Ericson C. , Lofgren C. , Thornbolm C. , Kurdi S. , Roberts D. , William-Oisson G.
Published: August 2023

In a prospective randomized open study, 48 patients underwent coronary bypass operation using cardiopulmonary bypass (CPB), with the same type of membrane oxygenator. Twenty-fout,IJatients were oxygenated during CPB by high PO2 level between 190 and 300 mmHg (H-POz) and in the remaining patients the PO2 was maintained low between 75 and 112 mmHg (L-PO2.) The groups were comparable regarding age, sex, perfusion time, aortic occlusion time and preoperative blood cell rheological status.

The effect of possible oxygen toxicity was assessed by monitoring blood cell rheology and analyzing the postoperative complications. Blood cell rheology was studied using standard microfiltration methods and samples were taken regularly during CPB.

There was a significant reduction in blood cell rheology in both groups during CPB in a time-dependent manner. The L-PO2 group had significantly better rheology than the H-PO2 group, which was first noted at 60 min for red cells (p<0.01).

Following operation, the time spent on the respirator was significantly lower in the L-PO2 compared to the H-PO2 (5.3 h ± 1.8 h vs. 7.2 h ± 2.5 h, p<0.0l).

There was significantly more bleeding in the H-PO2 group (p<0.05) and the use of blood products was significantly raised (p<0.0l). The total number of complications requiring treatment (arrhythmias, myocardial infarction, cardiovascular accidents and respiratory insufficiency) showed a significantly higher frequency in the H-PO2 (16/24 vs. 6 /24; p<0.01) compared to the L-PO2• There were three cases of mild renalfailure in the HPO2 group which was managed with conservative treatment. A significantly higher liver enzymes (p<0.01) and creatinine levels (p<0.05) were seen in the H-PO2 group.

This study suggests that the use of high PO2 levels during CPB might lead to increased morbidity postoperatively and should be avoided.
A Technique To Give Clinical Relevance to Parameters from the Thromobelastograph
Authors: Riley Jeffrey B. , Stammers Alfred H.
Published: August 2023

The thromobelastograph (TEG) is a photokymographic device to measure the dynamics of clot formation in vitro. The TEG graphic parameters offer clinical information regarding clotting factor function.

Graphic values from 88 open heart and liver transplantation patient TEGs were correlated to bleeding time, PT, aPTT, FIB, PLT, ACT, TT, ionized Ca++ and D-Dimer (DD) concentration. Linear and multiple regression demonstrated significant (r > .40 or r < -.4, p < .10) relationships between the following parameters.

A Basic algorithm was created to employ TEG parameters to predict the clotting function study parameter values. The TEG blood study is much less expensive than a clotting function screen, may be used to predict some of the routine clotting function study values, and whole blood coagulation information is available patient-side in 20 to thirty minutes.
Electric Impedance Recording - A Noninvasive Method of Rejection Diagnosis
Authors: Mueller Johannes , Warnecke Henning , Grauhan Onnen , Nelson Birgit , Cohnert Tatjana , Hetzer Roland
Published: August 2023

The recording of electric tissue impedance reflects membrane function and changes of volume and electrolytes in intra-and extra-cellular space. The purpose of this study was to determine if acute cardiac allograft rejection can be diagnosed from alteration of electric transmyocardial impedance (ETMI). Nine Beagle dogs received a heterotopic neck heart transplant. The animals were immunosuppressed with cyclosporine and steroids for the first three postoperative days. ETMI was recorded twice daily. Transcutaneous biopsies were performed whenever the impedance varied by more than 10%. All hearts showed a uniform impedance decrease immediately after transplantation, reaching a stable plateau after three days. A subsequent increase of impedance by 12.4 +/-2.9% was accompanied by a histological diagnosis of mild rejection. A further increase of 23.2 +/-2.6% histologically showed acute moderate rejection. After treatment with steroids the impedance reached the basic plateau again. Compared with the biopsy the sensitivity and specificity were 100%. The results indicate that the inflammatory process of cardiac allograft rejection can be detected with this method. This technique will be clinically applicable when an implantable telemetric device for recording the impedance and its transmission will be developed.
Is Blood Conservation Optimally Utilized?
Authors: DeBois William J. , Gold Jeffrey P. , Wayne Isom O.
Published: August 2023

Blood conservation and the subsequent prevention of transfusion have assumed an increasingly important role in cardiac surgery. The concern is one of preventing transmission of transfusion related diseases and of conserving an extremely valuable resource (1,2). Cardiac surgery with cardiopulmonary bypass has become the most common operation performed, thus attracting much analysis of transfusion practices. It is estimated that of the approximately 250,000 cardiopulmonary bypass procedures done in the United States each year, the majority require transfusion of blood products (3). It has been calculated that the cardiac surgery services throughout the United States use somewhat over 10% of all the blood product resources that are transfused in this country (4,5). Many methods of blood conservation have been described (Table 1), but there still exists a wide variance in blood product utilization for adult patients undergoing cardiopulmonary bypass procedures. A review of the literature reveals average packed red blood cell transfusion rates from 0.3 up to 8 units per patient (4,6-8). If we further add the transfusion of platelets, fresh frozen plasma, and cryoprecipitate, the total donor exposure to the patient goes up substantially more. A varied patient population has been cited as the reason for these discrepancies but it has been demonstrated in similarly matched groups of patients receiving transfusions, that the patterns were based to some extent upon "prevailing practice" rather than on need (9,10).

The purpose of this study was to identify which methods of blood conservation were being practiced in a major metropolitan area within the United States where the risk of transfusion related disease is relatively high. Secondly, to stratify the frequency of use of particular blood conservation methods in order to estimate how often a particular method was utilized and by what percentage of respondents. Finally, to increase the awareness of the options and difficulties associated with current modalities of transfusion practice and blood conservation.
Use of the Constrained Vortex Pump in Children Under 20 kg
Authors: Chui Betty S. , Shapiro Jay H. , Buckley Klayton , Allen E. Lanier , Lofland Gary
Published: August 2023

Since the inception of the constrained vortex pump, much controversy has arisen over its use during cardiopulmonary bypass (CPB). Centrifugal pumps used during pediatric perfusion requiring low flow rates have been cited with increased hemolysis and fluctuating flow rates. At the Medical College of Virginia Hospitals, 209 children weighing <20 kg have been placed on CPB utilizing the BioMedicus BP 50 pump. This study describes the technique and evaluates pump induced hemolysis by measuring plasma free hemoglobin (PFH) production. Five consecutive pediatric patients, age 0.2-48 months, (2.8-12.8 kg.) undergoing CPB for repair of heart defects at MCVH were studied using the BioMedicus BP 50 pump head. Potential for stagnant areas of flow were avoided during weaning from CPB by decreasing rpms to a minimum of 1800 and controlling flows with screw clamps on both arterial and venous lines to further reduce and terminate CPB. Plasma free hemoglobin samples were drawn prior to bypass, 30 minutes, 8 hrs, and 24 hrs post-CPB. PFH was determined by the Perkins-Elmer Spectrophotometer method. Results showed an expected rise in PFH immediately post-CPB, and all but one patient returned to baseline levels within 8 hrs. None of the 209 pediatric patients managed thus far at MCV utilizing the BP 50 pump head have exhibited clinical evidence of renal damage due to generation of plasma free hemoglobin. The authors conclude that pediatric patients requiring CPB for repair of congenital heart lesions can be safely perfused using a constrained vortex pump.
Bloodless Prime in Pediatric Cardiopulmonary Bypass Circuits
Authors: Conley James C. , Zografos Carol A.
Published: August 2023

Hemodilution during cardiopulmonary bypass is a well established practice. In pediatric cardiac surgery the volume of the prime may cause excessive hemodilution. In most institutions hemodilution in pediatric patients is controlled by adding blood to the prime. This case involves a female patient weighing 15.4 kilograms who received no blood other than that recovered during her surgery. The blood was processed in a cell washing device. A 968 milliliter clear prime was utilized. The data collected during and post bypass was examined and demonstrated the adequacy of perfusion in this patient. Parameters utilized to demonstrate the adequacy of perfusion include pH, urine output and venous oxygen saturation.
The Use of a Hemoconcentrator for Management of Sudden Acute Hyperkalemia During Hypothermic Cardiopulmonary Bypass
Authors: Cross David A.
Published: August 2023

A case is presented of a 64-year-old male undergoing saphenous vein coronary artery grafting. With application of the aortic cross-clamp and infusion of antegrade cardioplegia, unexpectedly severe aortic insufficiency caused the majority of the cardioplegic solution to enter the left ventricle and be returned to the oxygenator reservoir via the left ventricular sump. A total of 5,600 ml of cold blood cardioplegic (1,120 ml of crystalloid-K+=100 meq/L) solution was infused. Because of the inability to obtain electrical silence of the myocardium with cardioplegia, myocardial protection was obtained by total body hypothermia. The resultant serum potassium was 7.4 meq/L at a blood temperature of 16°C. Because of the possibility of even higher serum potassium levels with rewarming, the hemoconcentrator was used to remove potassium with the ultrafiltrate. Volume was replaced with normal saline and packed red cells. Post-bypass, a cell saver was used to decrease the total volume returned to the patient, while further raising the hemoglobin concentration. The rationale for using the hemoconcentrator, and the potential consequences of untreated hyperkalemia accompanying severe hypothermia are discussed.
Multi-Center Trial with a Modified Design of the Sarns Membrane Oxygenator
Authors: Bearss Mark G. , Bolles Roy , Brennan Kevin
Published: August 2023

A redesigned hollow fiber bundle was incorporated into an existing oxygenator that underwent clinical trials at seven cardiovascular surgery centers. Clinical investigators were asked to assess gas transfer performance under clinical conditions that could be considered challenging to any microporous membrane oxygenator, i.e., with large body weight patients, long bypass times, or normothermic bypass and surgery. Sixty-six patients, ranging in weight from 54.5 kg to 143 kg, constituted the initial evaluation population. Enhanced oxygen transfer was noted by all of the investigators. FiO2 requirements for patients weighing 100 kg or more never exceeded .85, despite oxygen consumption levels reaching as high as 396. mL/min. Two centers documented a 15% to 18% reduction in FiO2 requirements compared to their standard oxygenator.
Right Ventricular Support after Implantation of a NOVACOR Left Ventricular Assist Device
Authors: Whittington Robert , Waybright Susan , Gasior Thomas , Kormos Robert , Armitage John , Hardesty Robert , Griffith Bartley
Published: August 2023

The objective was to determine which factors might help to predict the need for mechanical right ventricular support following insertion of a left ventricular assist device (LVAD). A retrospective analysis was performed on 24 patients with cardiomyopathies who had insertion of a LV AD as a bridge to heart transplantation at Presbyterian University Hospital during the period 1987 to 1991. Group 1 consisted of 18 patients who could be adequately supported with the LVAD alone, while Group 2 consisted of 6 patients who required additional support with a right ventricular assist device. Group 2 exhibited longer periods of hypotension on cardiopulmonary bypass, increased inotropic support and decreased right ventricular ejection fraction at time of chest closure postLVAD.
The Effects of Heparin Bound Surface Modification (Carmeda® Bioactive Surface) on Human Platelet Alterations During Simulated Extracorporeal Circulation
Authors: Stenach Nina , Korn Robert L. , Fisher Carol A , Jeevanandam Valluvan , Addonizio V. Paul
Published: August 2023

To determine if treatment with covalently bound heparin (Carmeda Bioactive Surface (CBAS))a to the synthetic surface of the extracorporeal circuit (ECC) would alter the stereotypic pattern of adverse platelet alterations, 450 ml of heparinized blood (lU/ml) was recirculated at a flow rate of twice the circulating volume (L/min) for 2 hrs at 37°C through either untreated (CONT,n=7) or treated (CBAS,n=7)circuits constructed of identical components including a pediatric (0.8m2) reversed hollow fiber membrane oxygenator. In CONT circuits, platelet count maintained 88+1% (x±SEM) of its initial level in the circuit prime sample, dropped to 36±6% after 5 min, and returned to 56±2% following 2 hrs of ECC. In CBAS circuits, platelet count in the circuit prime sample demonstrated 90±4%, decreased to 68±10% after 5 min (p<0.05) and declined further to 45±5% after 2 hrs (NS).

Although platelets from both groups retained reactivity to ADP after priming the circuit, only at 5 min of recirculation did CBAS circuits significantly preserve this responsiveness. In CONT circuits, baseline plasma levels of platelet factor 4 rose from 24±3 to 581±82 ng/ml in the primed circuit and continued to rise to 2933±27 6 ng/ml by 2 hrs of ECC. In contrast, CBAS circuits markedly reduced this release after 2 hrs (577±165 ng/ml). Furthermore, by 2 hrs of ECC, plasma levels of thromboxane B2 in the CBAS circuits were significantly reduced when compared to CONT circuits (3035±1529 vs 29916±16293 pg/ml, respectively). We conclude that CBAS modification of the simulated extracorporeal circuit preserved the initial circulating platelet count with retained ADP reactivity and markedly decreased release of platelet factor 4 and thromboxane B2.
Rewarming, Ultraprofound Hypothermia and Cardiopulmonary Bypass
Authors: Elrifai Amr M. , Bailes Julian E. , Shih Shou-Ren , Maroon Joseph C. , Leavitt Marc L. , Teeple Edward , Loesch Daniel V. , Cottington Eric M. , Taylor Michael J. , Bazmi Babak , Devenyi Cecilia , Ciongoli Kimberly A.
Published: August 2023

Rewarming, a key event in resuscitation from accidental, experimental and clinical hypothermia, is sometimes followed by neurologic, cardiac, and respiratory sequelae and may lead to death. The rate of rewarming has been implicated but not quantified as etiologic in these sequelae. Under anesthesia fifteen dogs were cannulated and connected to an extracorporeal circuit for oxygenation, core cooling and rewarming. They were subjected to ultra-profound hypothermia with a core (esophageal) temperature as low as 1.3°C, cardiac arrest, blood substitution, and continuous low flow perfusion. After 2-3 hours of cardiac arrest, rewarming began. Mechanical activity of the heart was seen between 10° and 28°C and respiration resumed at 29°C. The rewarming rates of the 15 dogs were retrospectively studied. They were placed into three categories (G) based on the outcome. G-I (N = 2): no neurological complications, G-II (N=8): transient neurological problems, and G-III (N=5): death, mainly from cardiovascular and respiratory complications confirmed at death by autopsy. Heat gain by each animal was recorded as a function of time for all experiments. The time it took each dog to reach 35°C was determined and a mean was calculated (rewarming rate). Normal body temperature for a dog is 37.8°C. Statistical analysis (ANOV A) was performed ex post facto to determine the relationship between rewarming rate and outcome. Our data contradicts the notion that slow core rewarming from nadir to normal temperature offers better outcome. During rewarming metabolic needs change at different temperatures and our laboratory observations appear to provide an explanation for complications that may occur upon rewarming from profound hypothermia.