bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrafiltration in Pediatric Cardiac Surgical Procedures
Authors: Han You Qi , Zhu De Ming , Su Zhou Kong , Ding Wen Xiang 
Published: August 2023

Ultrafiltration is an extracorporeal technique that employs the principle of convective solution transport across a semipermeable membrane and by which plasma water is removed from the dilute blood during cardiopulmonary bypass. Ultrafiltration has been used in 40 pediatric cases who underwent corrective surgery for congenital heart disease (TOF 12, VSD 23, ASD 4 and PAVC 1) intraoperatively. The patients' ages ranged from 10months to 9 years (4.9±2.6yrs)and weights from 7 to 28kgs (16.4±5.8 kgs). The ultrafiltrator was interposed in the port of arterial filter of the CPB circuit and performed during the rewarming period. Ultrafiltration blood flow rate was 250-300 ml/ min and negative pressure was less than -250 mmHg. The average ultrafiltrability (total blood flow volume/ultrafiltration fluid volume) was 11.2%(10.7-12.1%). After ultrafiltration HCT increased from 16.1 %(15-18%) to 34.7%(32-40%). In the ICU, 5 cases (TOF 3, VSD 1 and ASD 1) had hemoglobinuria.
The indications of ultrafiltration in pediatric cardiac surgery are: 1. The initial perfusion is conducted with bloodless priming or with blood priming when the HCT value dropped to lower than 17% during CPB. 2. The CPB time is longer than 2 hours. 3. The patient receives digoxin and diuretics preoperatively or has complex anomals.
Our experience showed that ultrafiltration during pediatric CPB is facile, safe, and effective. It may result in a reduced amount of fluid accumulation in extracellular fluid space with hemodilution perfusion which benefits the patients postoperative recovery.
Hemoconcentration of dilute blood during cardiopulmonary bypass(CPB) by plasma water removal is an extracorporeal technique application by ultrafiltration during the pediatric open-heart surgery. Usually after CPB, especially in infant cases, the residual pump blood volume is much more than the acceptable volume for postoperative transfusion. Therefore, the transfusing of large volumes of dilute blood with low colloid oncotic pressure to the patient may cause circulatory overload with normovolumic anemia and result in significant fluid diffusion into interstitial space. In order to save the residual pump blood and reduce such ill effects and complications, we applied ultrafiltration on 40 pediatric cases during open-heart surgical procedures. Our clinical data, ultrafiltration application indications and recommended procedures are now presented.
Estimation of Fibrinogen Concentration During Extracorporeal Circulation in Pediatric Cardiac Surgery
Authors: Ecklund J.M. , Riley J.B. , Sutton R.G. , Crawford F.A. , Sade R.M. 
Published: August 2023

Maintenance of adequate fibrinogen levels during cardiopulmonary bypass (CPB) is important in assuring adequate post-CPB hemostasis. Fresh frozen plasma (FFP) is used in the pediatric CPB circuit as a prime constituent as a source of coagulation factors, including fibrinogen; yet the resultant on-CPB fibrinogen concentration is related to multiple factors.
Accurate formulas for predicting post-dilutional fibrinogen levels and the minimal FFP volume to prime the extracorporeal circuit (ECC) to maintain post-dilutional fibrinogen levels greater than 100 mg/ dL were developed prospectively from seventy-five infant and pediatric patients. The patients weighed less than twenty-five kilograms and underwent CPB for the correction of various congenital cardiac anomalies. Variables expected to affect fibrinogen level were: height, weight, body surface area, pre-dilutional hematocrit, pre-dilutional fibrinogen concentration, patient circulating blood volume, circuit priming volume, FFP volume added to the prime pre-CPB, pre-CPB blood loss, and volume added by anesthesia pre-CPB.
Equations to predict the post-dilutional fibrinogen value and the minimal volume of FFP to add to the ECC prime were formulated using multiple linear regression with the results shown in the tables below.

VARIABLE
REG COEF
STD ERROR
2TAIL SIG

Dependent variable: Post-dilutional fibrinogen value

PRIME VOL
0.06
0.02
0.001

FFP VOL
0.05
0.02
0.011

INTERCEPT
29.37
17.10
0.090

r = 0.477, p = 0.0001, std error = 24.38 mg/dL

Dependent variable: Minimal FFP volume to add to prime

WEIGHT
-17.19
3.38
<0.001

PRE-HCT
5.25
1.54
0.001

PRE-FIB
-1.58
0.24
<0.001

PRIME VOL
0.42
0.11
<0.001

ACTUAL FIB
1.02
0.50
0.044

INTERCEPT
36.80
111.38
0.742

r = 0.777, p < 0.001, std error = 106.04 ml

Utilization of the formula for predicting the quantity of FFP necessary to achieve a minimum circulating fibrinogen concentration revealed no significant difference when compared to actual levels on CPB. The clinical use of formulas which accurately estimate the volume of FFP necessary to optimize the post-dilutional concentration of coagulation factors may reduce patient exposure to unnecessary homologous blood products.
Heparin-Free Cardiopulmonary Support, Utilizing a Carmeda Coated Circuit, for a Patient with Pulmonary Hemorrhage and Multiple Trauma
Authors: Bennett John , Hill Jonathan , Bruhn Pamela , Long William , Parsons James 
Published: August 2023

The emergent use of closed-chest cardiopulmonary support to resuscitate and support moribund patients in cardiac and/ or pulmonary failure has been well documented. However, when massive trauma is associated with this pathology, contraindictaing systemic anticoagulation, this patient population becomes unapproachable utilizing "standard" bypass support equipment.
Studies of heparinized surface coatings have shown a reduction in complement and platelet activation and an increase in thromboresistance when compared to standard cardiopulmonary bypass circuits. To date, heparin-free cardiopulmonary bypass utilizing heparinized surfaces had only been attempted on animal models.
We present the first reported human application of heparin-free cardio pulmonary support utilizing a heparin-coated circuit on a 26-year-old male who developed severe pulmonary hemorrhage after sustaining massive lung contusion and other multiple injuries in an industrial accident.
Motivating Adult Learners with Effective feedback
Authors: Dake Sue Boettcher , Taylor James A. 
Published: August 2023

Although students are ultimately responsible for their own motivation, instructors can use techniques of goalsetting and clear, constructive negative and positive feedback to give learners an accurate sense of their own competence and to help stimulate them to reach their full potential. Many perfusion technology instructors fail to use these techniques effectively.
Clinical objectives are devised in such a way to make it immediately clear whether the student’s performance measures up. The learner, the instructor or both can develop these job-oriented objectives.
Some believe that feedback is the number one motivator of people. Negative and positive feedback techniques and ways to defuse defensiveness are discussed. Feedback should be objective, timely, accurate and based on first-hand data. Feedback should be focused on the behavior, not the person. “Gunnysacking,” “pimping” and other destructive feedback should be avoided because evidence suggests that it de-motivates adult learners. Any emotional response on the part of the instructor should be communicated in an “I message.” Feedback provided to students should deal with specific behaviors, not generalizations. Self-assessment and life-long learning skills can be fostered in learners by asking them to appraise their own performance and suggest ways they think such performance might be improved.
Heparin Washout in the Pediatric Cell Saver® Bowl
Authors: Sistino Joseph J. , Owitz David , Mongero Linda B. 
Published: August 2023

The possibility of residual heparin in washed red cells transfused to neonatal or pediatric cardiac patients following bypass prompted a measurement of heparin concentrations. Samples were taken during 10 adult and 10 neonatal and pediatric bypass cases. Sample A was from the bypass circuit, Sample B from the Haemonetics Cell Saver bowl inlet before washing, Sample C from the Cell Saver bowl outlet after washing, and Sample D from the patient ten minutes after protamine. Heparin concentrations were measured by a chromogenic assay using activated Factor X.
There was no significant difference between the adult and pediatric groups in the levels of heparin concentration on bypass, pre-washing and post-washing, and in the patients following protamine. In the pediatric group, only .002% of the pre-washed heparin remained after washing. This extremely low level of heparin (.0027 units/ml) is only 0.34 units in a 125 ml pediatric unit of Cell Saver blood. Based on post bypass patient samples, this has no clinical significance. Therefore, the Cell Saver can be used safely with neonates and pediatric patients without concern regarding residual heparin when properly processed.
How to Do It: Utilizing Risk Stratification to Evaluate Outcomes in Adult Open-Heart Operations
Authors: Dickinson Timothy A. 
Published: August 2023

The purpose of this study is to demonstrate that by using a proven method of stratifying open-heart operations into levels of predicted mortality, hospitals can closely monitor trends of their open-heart programs and possibly improve the health planning decisions for their institution. A proven method of uniform risk stratification utilizing objective and readily available preoperative patient data was implemented at our institution for a 12 month period (September I, 1991 through August 31, 1992). A total of 367 patients were included in this study. The patients were categorized into four risk ranges (0 to 4% good risk, 5 to 9% fair risk, 10 to 14% poor risk, and ≥ 15% high risk) indicating a predictive percent probability of operative mortality. The number patients categorized as either 0 to 4% good risk, 5 to 9% fair risk, 10 to 14% poor risk, and ≥ 15% high risk were46, 74, 84and 163, respectively. The patient's average post -operative length of stay in each risk tegory was 7.6 days, 8.2 days, 10 days and 12 days, respectively.
The patient's average total hospital charges in each risk category were $48,241,$53,531,$60,416 and $75,555, respectively. This information has helped our hospital administration make relevant and objective decisions concerning our open-heart program. Uniform risk stratification( outcomes research) should be incorporated into all adult open-heart surgery programs because it is simple, inexpensive, and can evaluate the outcomes and cost of open-heart surgery.
Safety of Heparin-Coated Circuits in Primates During Deep Hypothermic Cardiopulmonary Bypass
Authors: Sistino Joseph J. , Michler Robert E. , Mongero Linda B. , Schwartz Arthur , Marboe Charles , Geiman Richard , Kwiatkowski Pawel 
Published: August 2023

The purpose of this study is to evaluate the biologic impact of heparin-coated circuits without systemic heparinization during deep hypothermia. Baboons (n=6) were placed on a heparin-coated pediatric closed-circuit cardiopulmonary bypass (CPB) system and cooled to l8°C. A control group (n=7) underwent similar protocol with a non heparin-coated circuit and received systemic heparin. Either low flow at 0.5 L/min/m2 (n=8; 4 in each group) or circulatory arrest (n=5; 2 in experimental group and 3 in control group) was used during deep hypothermia. Samples for complete blood count (CBC), hepatic and renal function tests, activated clotting time (ACT) and thrombelastogram (TEG) were obtained before, during, and after bypass. Cerebral blood flow was measured using Xenon-133 and autopsies were performed to assess end-organ damage.
The ACT returned to baseline in both groups, and renal and hepatic function were within normal limits. There was no significant difference between the TEG values between the groups post bypass. Fibrin split products were absent and fibrinogen levels were normal in both groups following bypass. Cerebral blood flows were equivalent in both groups before and after bypass, although in the heparin-coated group cerebral blood flows were significantly higher during CPB.
There were no brain histologic changes in the heparin-coated group and one focal cortical infarct in the control group. This study suggests that hypothermia induced a state of anticoagulation that did not result in thrombus formation or end organ dysfunction during CPB with a heparin-coated circuit. Safe use of these circuits without any systemic anticoagulation should be limited to conditions where the patient’s coagulation time is prolonged such as hypothermia.
The Effects of Platelet-Rich-Plasma on Post-Cardiopulmonary Bypass Fibrinolysis
Authors: Stammers Alfred H. , Rasmussen Caroline , Kratz John M. 
Published: August 2023

Postoperative hemorrhage associated with cardiac surgery continues to be a major source of significant patient morbidity. Cardiopulmonary bypass (CPB) induces a number of hemostatic alterations which include platelet defects and coagulation factor imbalances. In addition, the fibrinolytic system is stimulated by CPB, adversely affecting the stability of the fibrin network, leading to early clot dissolution. Various techniques for reducing post-CPB bleeding have been studied, and have included plasmapheresis and the collection of autologous platelet-rich-plasma (PRP). The present study examined the effects of autotransfusing PRP in cardiac surgery patients and the associated effects on fibrinolysis.
Twenty-six patients were diagnosed with fibrinolysis by whole blood elastokinetic monitoring (thrombelastography- TEG). The diagnosis of fibrinolysis was determined from the post-CPB TEG profile when clot dissolution exceeded 50% of the developed clot 30 minutes following protamine administration. Thirteen patients had been treated with PRP and 13 had not (Control- CTR).
There were no differences seen in preoperative or operative parameters between the two groups, nor were there differences in routine laboratory coagulation tests. Total platelet yeild in the PRP group was 1.2 ± 0.6 X 1011. Patients in the CTR group had a total blood exposure of 39.4 ± 43.4 units compared to 8.6 ± 11.2 in the PRP patients (p<.02). This study supports the finding that CPB induces a fibrinolytic state, causing significant postoperative hemorrhage, which can be partially ameliorated by the infusion of autologous platelet-rich-plasma.
Isolated Coronary Graft Perfusion Prior to Cardiopulmonary Bypass During Cardiac Reoperations: A Case Report
Authors: Komorowski Benjamin , Mantell Peter , Kron Irving , Sprinkle Linda , Zacour Richard 
Published: August 2023

A 67 year old male presented to our service with angina, syncope, and dyspnea on exertion. He had had a three vessel coronary artery bypass ten years ago and had been asymptomatic until this time. A repeat cardiac catheterization revealed aortic valvular stenosis, left carotid artery stenosis, and restenosis of the left circumflex, anterior descending, and right coronary artery vein grafts.
During sternal reentry, the left circumflex graft was inadvertently divided. Shortly thereafter, antero-lateral wall ischemia became evident on the electrocardiogram. The transesophageal echocardiogram revealed acute akinesis of the lateral ventricular wall. The divided graft was cannulated with a 3 mm vessel cannula and secured with a tie. The 4:1 blood cardioplegia system was flushed with a balanced electrolyte solution to remove all cardioplegia solution. Autologous washed red blood cells and homologous packed red blood cells were added to the pump prime. The blood cardioplegia system was used to deliver warm, oxygenated blood to the graft. Graft perfusion was performed for a total of 28 minutes prior to cardiopulmonary bypass. After completion of the surgery the patient was weaned from cardiopulmonary bypass without incident. He had an uncomplicated post-operative course and was discharged from the hospital in good condition.
Predicting Oxygenator Clinical Performance from Laboratory In-Vitro Testing
Authors: Griffith Kevin E. , Vasquez Marco R. , Beckley Philip D. , Lalone Brian J. 
Published: August 2023

Knowledge and predictability of oxygenator performance is vital to safe and effective conduct of cardiopulmonary bypass. The determination of oxygenator performance in the laboratory, however, is carried out under a strict set of conditions established by the Association for the Advancement of Medical Instrumentation (AAMI). This performance data is oflimited value in the clinical setting where the perfusionist generally operates outside this set of parameters. This study (1) reports the laboratory performance characteristics of a hollow fiber membrane oxygenator (Sorin Monolyth), (2) uses this data to develop a model to predict performance under a wide range of clinical conditions, (3) compares predicted performance with clinical data collected at two open heart centers, and (4) reviews the complexities of comparing laboratory and clinical performance.
An in-vitro "oxygenator-deoxygenator" circuit was utilized to determine O2 and CO2 gas exchange, blood path pressure drop, and heat exchanger efficiency at a variety of blood and gas flows, under standard (AAMI) blood inlet conditions:

BF
02(a)
02(b)
02(c)
CO2(a)
CO2(b)
CO2(c)
PD
Che

3.0
210±7
196±8
177±6
109±4
186±8
237±8
29±8
0.67±0.03

4.0
264±13
241±18
226±10
147±8
246±13
300±17
44±10
0.59±0.04

5.0
326±15
307±10
272±7
174±4
285±7
356±7
48±10
0.55±0.02

where BF = blood flow rate (L/min); O2(a) = O2 transfer at FiO2 1.0 and Qg:Qb 1.0; O2(b) = O2 transfer at FiO2 0.8 and Qg:Qb 1.0;O2(c) = O2 transfer at FiO2 0.6 and Qg:Qb 1.0; CO2(a) = CO2 transfer at FiO2 1.0 and Qg:Qb 0.5; CO2(b) = CO2 transfer at Qg:Qb 1.0 and FiO2 1.0; CO2(c) = CO2 transfer at FiO2 1.0 and Qg:Qb 1.5 (all transfer values in ml/min); PD = blood path pressure drop (mmHg); Che = warming coefficient of heat exchange; values expressed as mean ± 1 SD
This laboratory performance data was compared to hospital and computer modeling data. Simple numerical comparison and analysis of variance of regression coefficients over groups indicated that some clinical parameters of performance (oxygen transfer and coefficient of heat exchange) were not predicted with the laboratory data. It is concluded that the laboratory performance data determined under strict controlled conditions may be of limited value in predicting clinical performance unless modeled to allow for variances in operating conditions.
Indikation und operative Verfahren bei MEN1-assoziierten duodenopankreatischen neuroendokrinen Neoplasien
Authors: Manoharan Jerena , Albers Max , Bartsch Detlef K 
Published: August 2023

ZusammenfassungDie optimale Therapie von duodenopankreatischen neuroendokrinen Neoplasien (dpNEN), die im Rahmen der multiplen endokrinen Neoplasie Typ 1 auftreten, stellt nach wie vor eine große
Herausforderung dar und wird teilweise kontrovers diskutiert. Aufgrund der Rarität der Erkrankung fehlen prospektiv randomisierte Studien, sodass die meisten Empfehlungen bez. der
Operationsindikation und des -verfahrens auf retrospektiven Fallserien basieren. Prinzipiell ist eine operative Therapie bei nicht funktionellen dpNEN > 2 cm, bei Malignitätsverdacht und
bei funktionell aktiven dpNEN indiziert. Hierbei kommen eine Enukleation oder formale Pankreasresektionen mit oder ohne Lymphadenektomie in Betracht. Ziel der Therapie sollte es sein,
hormonassoziierte Symptome zu beseitigen und einem aggressiven metastasierenden Verlauf vorzubeugen. Zugleich sollte bei den zumeist jungen Patienten die Pankreasfunktion und Lebensqualität
durch möglichst parenchymsparende Resektionen erhalten werden.
Predictors and Trends in First-Trimester Hemoglobin A1c Screening in New York City, 2009 to 2017
Authors: Vieira Luciana , McCarthy Katharine , Liu Shelley H. , Huynh Mary , Kennedy Joseph , Chan Hiu Tai , Mayer Victoria L. , Tabaei Bahman , Howell Frances , Wye Gretchen Van , Howell Elizabeth A. , Janevic Teresa 
Published: August 2023

Glycated hemoglobin is an adjunct tool in early pregnancy to assess glycemic control. We examined trends and maternal predictors for those who had A1c screening in early pregnancy using hospital discharge and vital registry data between 2009 and 2017 linked with the New York City A1C Registry (N = 798,312). First-trimester A1c screening increased from 2.3% in 2009 to 7.7% in 2017. The likelihood of screening became less targeted to high-risk patients over time, with a decrease in mean A1c values from 5.8% (95% confidence interval [CI]: 5.8, 5.9) to 5.3 (95% CI: 5.3, 5.4). The prevalence of gestational diabetes mellitus increased while testing became less discriminate for those with high-risk factors, including pregestational type 2 diabetes, chronic hypertension, obesity, age over 40 years, as well as Asian or Black non-Hispanic race/ethnicity.
Key Points
Risk of Preterm Delivery in Very Advanced Maternal Age Parturients Utilizing In Vitro Fertilization
Authors: Newman Rachel A. , Naqvi Mariam , Levian Candace , Smithson Sarah D. , Esakoff Tania 
Published: August 2023

Objective Among patients ≥45 years, the birth rate in the United States continues to increase. As fertility declines with age, this cohort often utilizes assisted reproductive technology, specifically in vitro fertilization (IVF). While both advancing maternal age and IVF are independently associated with adverse maternal outcomes, data regarding their additive effect are scant. This article aims to determine if patients who conceive via IVF are at increased risk for preterm birth (PTB) compared to patients with non-IVF pregnancies in a very advanced maternal age (vAMA) cohort (≥45 years).
Study Design Retrospective cohort study of all pregnant patients ≥45 years old who delivered at a single institution (2014–2021). Those with incomplete delivery/neonatal records or multiples beyond twins were excluded. We compared individuals who conceived via IVF to those who conceived without IVF. The primary outcome was preterm delivery <37 weeks gestation. Secondary outcomes included other adverse perinatal outcomes. Using multivariable logistic regression, we adjusted for multiple gestation as well as confounders found to be significantly different in the univariable analysis and other known risk factors for PTB.
Results In our study cohort of 420 vAMA patients, individuals who underwent IVF were more likely to be older, privately insured, nulliparous, and with a twin gestation. The PTB rate in vAMA patients who underwent IVF was 24.4 compared to 8.4% in patients who did not use IVF (p < 0.001). After adjusting for confounders, IVF was an independent risk factor for PTB <37 weeks in vAMA patients (adjusted odds ratio {aOR] = 4.3, 95% confidence interval [CI]: 1.7–10.4, p = 0.001). In vitro fertilization was also associated with a composite of adverse maternal outcomes (hypertensive disorder of pregnancy, postpartum hemorrhage, blood transfusion, and unplanned hysterectomy) (aOR = 1.7, 95% CI: [1.1–2.9], p = 0.03).
Conclusion In the vAMA population, conception via IVF is associated with an increased risk of PTB <37 weeks.
Key Points