bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assisted Venous Drainage, Venous Air, and Gaseous Microemboli Transmission into the Arterial Line: An In-Vitro Study
Authors: Rider Sean P. , Simon Lorri V. , Rice Billy J. , Poulton Chad C. 
Published: August 2023

The objective of this study was to examine the interaction of cardiopulmonary bypass venous air with assisted venous drainage, focusing on its production of gaseous microemboli in the arterial line.
An in-vitro recirculating cardiopulmonary bypass circuit containing fresh whole bovine blood was monitored with a pulsed-doppler microbubble detector. Air of specific amounts was injected into the venous line and gaseous microemboli counts were obtained distal to the arterial filter. Data was recorded for unassisted drainage, vacuum-assisted drainage, and centrifugal pump-assisted drainage.
Centrifugal pump-assisted drainage produced over 300 microbubbles in one minute distal to the arterial filter when venous air was introduced into the circuit. Of these, 220 were greater than 80 μm in size. Vacuum-assisted drainage produced no microbubbles when the same amount of venous air was introduced into the circuit. However, vacuum-assisted drainage did produce some microbubbles in the arterial line when a stopcock was left open on the venous line for 30 seconds. Unassisted drainage produced no microbubbles at all levels of venous air entrainment.
Air becomes entrained in the venous line from a variety of sources. In a typical gravity-drained situation, the air remains whole and is dissipated in the venous reservoir by buoyancy and filtration. In an assisted-drainage situation, the air is subjected to additional forces. The air is subjected to a greater degree of negative pressure and, with centrifugal pump assisted drainage, is subjected to kinetic energy imparted by the cones or vanes of the pump. The kinetic energy from the centrifugal pump appears to break the air into small bubbles which become suspended in the blood, passing through the reservoir, oxygenator, and arterial filter. In a clinical setting, these bubbles would be passed into a patient's arterial system.
The Additive Effects of Antifibrinolytics: Dangers in the OR
Authors: Sistino Joseph J. , Richards Carolyn 
Published: August 2023

The use of antifibrinolytic agents in recent years had been heralded as a major breakthrough in the prevention of postoperative bleeding. However, whenever the delicate balance between coagulation and fibrinolysis is altered, the potential exists for disaster. There have been a number of complications reported in the literature related to the use of antifibinolytics.
With the availability of oral epsilon aminocaproic acid (EACA) as treatment for the symptoms of hemophilia and other secondary bleeding disorders, the possibility exists that a patient presenting for heart surgery may already be receiving antifibrinolyic therapy.
A 72 year-old female underwent double valve replacement which was complicated by postoperative bleeding. Her medical history included gastrointestinal bleeding which was being treated with oral EACA. The patient was heparin resistant with a dose response of 55 sec/unit/ml. Heparin was administered during cardiopulmonary bypass to maintain the ACT between 400–500 seconds using a heparin-coated bypass circuit. In spite of this, the patient became thrombocytopenic and bled excessively in the postoperative period.
Administration of additional antifibrinolyic agents in the operating room may be contraindicated when the patient is receiving this therapy preoperatively, and may contribute to the development of a procoagulant state during bypass.
Removal of Hepatocarcinoma Cells From Blood via Cell Washing and Filtration Techniques
Authors: Jones Clinton C. , Stammers Alfred H. , Fristoe Lance W. , Jones Kimberly T. , Beck Daniel J. , Pierce Michelle L. , Dickes Melinda S. 
Published: August 2023

Utilization of autotransfusion during tumor resection remains controversial due to viability of carcinoma cells remaining in collected blood. The purpose of this study was to evaluate autotransfusion techniques combined with leukocyte depleting filters (LDF) for removal of hepatocarcinoma cells from autotransfusate.
An in vitro model was created by contaminating expired human erythrocytes with cultured hepatocarcinoma (HEP G2) cells. Autotransfusion devices evaluated were Cobe BRAT2, Sorin STAT-P, and Fresenius CATS. Autotransfusate collected from varying processing conditions were filtered using the Pall Leukoguard RS or Pall Purecell RCQ LDF. Carcinoma concentrations were quantified via Coulter Counter technology.
The CATS exhibited higher concentrations of cancer cells in the autotransfusate prior to washing, a 449% increase. This was significantly higher than either the BRAT2 or STAT-P, 350% and 315% respectively. Post washing HEP G2 concentrations in the BRAT2 were significantly higher than the STAT-P and CATS. Doubled wash volumes removed more HEP G2 cells in all trials, reaching statistical significance only in the CATS. LDF resulted in a significant 75% reduction of HEP G2 cells, with no difference between filters.
While combination use of autotransfusion devices and leukocyte depleting filters did result in a product with concentrated hematocrit, no technique removed all hepatocarcinoma cells.
Effect of Autotransfusion on Fibrinolysis in Open Heart Patients
Authors: Warsaw David S. , Niewiarowska Ana , Theman Terrill 
Published: August 2023

Autotransfused blood is often used as an alternative to banked blood. The fibrinolytic consequences of autotransfused blood are undefined. This prospective study was designed to determine the effect of intraoperative autotransfused blood on fibrinolysis and other coagulation parameters.
Ten consecutive patients undergoing cardiopulmonary bypass (CPB) for open-heart procedures were studied. All patients received autotransfused blood intraoperatively and tolerated the procedure. Blood samples were taken preoperatively, intraoperatively, and at 6, 12, and 24 hours postoperatively. Coagulation parameters including prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products, and D-dimer levels were measured at each time point. In addition, the quantity of autotransfused blood and additional standard blood products were recorded. Nonparametric repeated measures analyses with post hoc tests adjusted using the Bonferroni correction were used to analyze the data.
Mean PT increased from 13.9 ± 3.0 seconds preoperatively to 15.7 ± 1.6 seconds intraoperatively, but then gradually declined to 14.5 ± 1.1 seconds 24 hours postoperatively. A similar temporal pattern was observed for PTT, which reached a peak of 55.7 ± 33.0 seconds intraoperatively from a preoperative baseline of 44.0 ± 15.3 seconds. Adjusted post hoc comparisons of fibrinogen levels indicated a statistically significant difference between preoperative and 6 hour postoperative medians, (p < .0083). Fibrin degradation products had a modest and nonsignificant decrease over the 24-hour study period, (from 12.6 ± 6.7 mcg/mL preoperatively to 9.0 ± 1.6 mcg/ml 24 hours postoperatively), while D-dimer levels rose from a baseline of 0.54 ± 0.09 mcg/mL to 0.98 ± 0.48 mcg/mL 6 hours postoperatively, but declined nearly to baseline by 24 hours postoperatively, (0.62 ± 0.11 mcg/mL). We conclude that although autotransfused blood may activate the fibrinolytic pathway, its use remains safe and does not require the use of additional banked blood products.
The Effects of Continuous Blood Gas Monitoring During Cardiopulmonary Bypass: A Prospective, Randomized Study—Part II
Authors: Trowbridge Cody C. , Vasquez Marco , Stammers Alfred H. , Glowgowski Kimberly , Tremain Kimberly , Niimi Kevin , Muhle Michelle , Yiang Tianyu 
Published: August 2023

The impact of blood gas management during cardiopulmonary bypass (CPB) on patient care has not been examined and remains controversial. The purpose of this study was to determine whether precise blood gas management during CPB influences patient outcome.
Fifty-nine patients were enrolled in an Institutional Review Board-approved, prospective, randomized study. An in-line blood gas monitor (CDI 500) was placed into the arterial and venous lines for all patients. Blood gas monitoring in the control group was managed by intermittent sampling (every 20–30 min), while the treatment group was managed with continuous monitoring. Blood gas control and measured parameters were as follows: pH 7.40 ± 0.05, PaCO2 40 ± 5 mmHg, PaO2 200 ± 50 mmHg. The treatment group had the CDI 500 guide clinical decisions.
Compared to the control group, the treatment group consisted of significantly more diabetic (7% vs. 47%, p ≤ 0.001), renal failure (3% vs. 13%, p ≤ 0.01), and chronic obstructive pulmonary disease patients (7% vs. 20%, p ≤ 0.01). Internal thoracic artery utilization was higher in treatment patients than control patients (67% vs. 95%, p ≤ 0.02). No other differences existed in demographic, pharmacological, surgical, or anesthetic parameters.
In the perioperative period, the control group required antiarrythmic support more frequently than the treatment group (10% vs. 0%, p ≤ 0.05). Compared to the control group, the treatment group required antiarrythmic (18% vs. 10%, p ≤ 0.05) and cardiac glycoside therapy (11% vs. 0%, p ≤ 0.05) less frequently in the postoperative period. Although treatment patients required less intraoperative pacing and cardioversion and spent less time on mechanical ventilation, in the intensive care unit (ICU), and in the hospital than control patients, statistical significance was not achieved.
In conclusion, the use of continuous, in-line blood gas monitoring resulted in improvement in a number of postoperative outcome variables, although ICU and hospital stay was not effected.
Evaluation of Post-Cardiopulmonary Bypass Coagulation Disorders by Differential Diagnosis with a Multichannel Modified Thromboelastogram: A Pilot Investigation
Authors: Koster Andreas , Kukucka Marian , Fischer Thomas , Hetzer Roland , Kuppe Herman 
Published: August 2023

We assessed a modified multichannel thromboelastogram for differentiation of the causes of coagulopathy after cardiopulmonary bypass and its suitability as a therapy guide. Thirty adult patients undergoing surgery with cardiopulmonary bypass, who revealed a coagulopathy as observed by a prolonged activated clotting time of >150 sec after the application of protamine, were enrolled. Therapy was based on the results obtained by the computerized four-channel thromboelastogram with baseline, heparinase (2 IU/mL), heparinase/abciximab (5 µg/mL), and heparinase/fresh frozen plasma (25%) channels.
The mean activated clotting time before therapy was 162.2 ± 7.8 sec. Based on differential diagnosis with the modified multichannel thromboelastogram, two patients received protamine (30 mg), five desmopressin (0.4 µg/kg), 19 patients three units of fresh frozen plasma, two patients platelet transfusions, and two patients both protamine (30 mg) and three units of fresh frozen plasma. After therapy, there was a significant (p < .01) decrease of the activated clotting time to a mean value of 127 ± 8.3 sec. Therapy based on the synoptic modified multichannel thromboelastogram analysis provides a guide for effective therapy of coagulopathy. However, elaboration is desirable, and larger clinical trials are necessary for a final evaluation of the protocol.
Early Prediction of Gestational Diabetes Mellitus Using Placental
Strain Elastography and Subcutaneous Adipose Tissue Thickness
Authors: Şengül Mustafa , Selim Halime Şen 
Published: August 2023

Abstract
Aim The aim of this study is to investigate the efficacy of placental
strain ratio values measured by real-time sonoelastography and maternal
subcutaneous adipose tissue thickness measured by two-dimensional
ultrasonography in predicting gestational diabetes mellitus in the first
trimester.
Materials and methods The population of the study consisted of the first
210 consecutive singleton pregnant women who applied for routine first-trimester
screening between the 11th and 14th week of gestation.B-mode subcutaneous
adipose tissue thickness sonography and real-time placental strain elastography
scanning were performed.All patients underwent 75 g oral glucose
tolerance test between the 24th and 28th week of gestation. American Diabetes
Association criteria were used in the diagnosis of gestational diabetes
mellitus.
Results It was observed that body mass index (p<0.001),
first-trimester fasting blood sugar (p<0.001), subcutaneous adipose
tissue thickness (p<0.001), and placental strain ratio value
(p<0.001) affected the development of gestational diabetes mellitus
statistically. The multivariate analysis shown that subcutaneous adipose tissue
thickness (odds ratio=1.271, 95% CI=1.142–1.416,
p<0.001) and placental strain ratio value (odds ratio=3.664,
95% CI=1.927–6.969, p<0.001) were the
independent risk factors affecting the development of gestational diabetes
mellitus.
Conclusions The findings of this study indicated a positive correlation
between 75 g oral glucose tolerance test application and first trimester
subcutaneous adipose tissue thickness and placental strain ratio. Using the
cut-off values of>11.5 mm for subcutaneous adipose tissue
and>0.986 for placental strain ratio, the development of gestational
diabetes mellitus may be predicted in the early weeks of pregnancy.
Patient Adherence Following Knee Surgery: Evidence-Based Practices to Equip Patients for Success
Authors: Rucinski Kylee , Njai Abdoulie , Stucky Renée , Crecelius Cory R. , Cook James L. 
Published: August 2023

AbstractPatient adherence with postoperative wound care, activity restrictions, rehabilitation, medication, and follow-up protocols is paramount to achieving optimal outcomes following knee surgery. However, the ability to adhere to prescribed postoperative protocols is dependent on multiple factors both in and out of the patient's control. The goals of this review article are (1) to outline key factors contributing to patient nonadherence with treatment protocols following knee surgery and (2) to synthesize current management strategies and tools for optimizing patient adherence in order to facilitate efficient and effective implementation by orthopaedic health care teams. Patient adherence is commonly impacted by both modifiable and nonmodifiable factors, including health literacy, social determinants of health, patient fear/stigma associated with nonadherence, surgical indication (elective vs. traumatic), and distrust of physicians or the health care system. In addition, health care team factors, such as poor communication strategies or failure to follow internal protocols, and health system factors, such as prior authorization delays, staffing shortages, or complex record management systems, impact patient's ability to be adherent. Because the majority of factors found to impact patient adherence are nonmodifiable, it is paramount that health care teams adjust to better equip patients for success. For health care teams to successfully optimize patient adherence, focus should be paid to education strategies, individualized protocols that consider patient enablers and barriers to adherence, and consistent communication methodologies for both team and patient-facing communication.
TransOrbital NeuroEndoscopic Surgery for Biopsy of the Left Cavernous Sinus: A Literature Review, Case Report, and Cadaveric Proof of Concept
Authors: Frontera Natasha L. , Rosado-Philippi Julio , Díaz Francisco Del Valle , Díaz Alejandra Santiago , Medina Adriana Vázquez , Figueroa Arnaldo , González Natalia , Pradilla Gustavo , Garzón Tomas , Rodríguez Julio , Tarrats Luisam , Valle Miguel Mayol del 
Published: August 2023

AbstractThe aim of this report is to describe TransOrbital NeuroEndoscopic Surgery (TONES) as a safe alternative for obtaining a cavernous sinus (CS) biopsy. We describe this technique in a patient with a diffuse large B cell lymphoma mimicking Tolosa–Hunt's syndrome. Articles were gathered querying PubMed, Embase, and Scopus databases with terms related to a “transorbital neuroendoscopic approach.” The literature search was performed by two independent authors (N.L.F. and J.R.), with inconsistencies resolved by the senior author (M.M.D.V.). After screening abstracts for relevance, full-length articles were reviewed for pertinent variables. A comparison was conducted with the illustrative case of a 69-year-old woman who presented to the emergency department with vertigo, ophthalmoplegia, and diplopia for 2 months. A brain magnetic resonance imaging revealed an infiltrative lesion at the left CS. A presumptive diagnosis of Tolosa–Hunt syndrome was made, but a confirmatory biopsy was performed using TONES. Based on our cadaveric study, literature review, and case report, the TONES approach was safe, effective for tissue diagnosis, and associated with minor morbidity and reduced hospital stay. Additional prospective studies are required to study its viability and safety in a larger group of patients.
Zinc-Mediated C–H Metalations in Modern Organic Synthesis
Authors: Barker Graeme , Wanic Daria K. , Melvin Rebecca 
Published: August 2023

AbstractC–H Deprotometalations have long occupied a key role in modern organic synthesis in both the research laboratory and pharmaceutical and fine chemical manufacture, thanks to readily accessible reagents and well-established procedures. Typically, organolithiums are the reagent of choice thanks to high reactivity and ease of use but these are incompatible with base- and nucleophile-sensitive functional groups. In comparison, organozinc base complexes offer a milder approach to deprotonative C–H functionalisations, and compatibility with a wide range of functionalities which would be problematic when using the alternative organolithium or organomagnesium reagents has now been demonstrated. Here, we review the current state of the art in zinc-mediated C–H metalations at substituted arenes, heteroarenes, and Csp3–H sites.1	Introduction2	Csp2–H Functionalisation Using Zinc Bases2.1	Functionalised Arenes2.2	Heterocycles3	Csp3–H Functionalisation Using Zinc Bases3.1	Zinc Enolate Formation: Traditional Approach3.2	Zinc Enolate Formation via Zinc Bases3.3	Non-Enolic Csp3–H Zincations4	Conclusion
Recent Developments on the Synthesis of Sulfoxides via Sulfenate Anions
Authors: Saito Fumito 
Published: August 2023

AbstractSince the early 2000s, novel synthetic methods for the preparation of sulfoxides have emerged that involve sulfenate anions as sulfur nucleophiles. This short review showcases key advances in these sulfenate protocols, including catalytic enantioselective alkylation and arylation, and provides future directions for this research field.1	Introduction2	Precursors of Sulfenate Anions3	Organocatalytic Enantioselective Alkylation of Sulfenate Anions4	Palladium-Catalyzed Arylation of Sulfenate Anions5	Coupling of Sulfenate Anions with Hypervalent Iodine Reagents6	Conclusions and Outlook
Recent Advances on High-Order Dipolar Annulations of Donor–Acceptor Cyclopropanes/Cyclobutanes
Authors: Peng Shiyong , Yang Liangliang , Wang Haiyang , Lang Ming 
Published: August 2023

AbstractThis short review summarizes the recent impressive developments on the high-order dipolar annulations (HODAs) of donor–acceptor cyclopropanes (DACs) and donor–acceptor cyclobutanes (DABs) to afford medium-sized (hetero)cycles.1	Introduction2	(3+m) (m > 3) Annulations of Donor–Acceptor Cyclopropanes2.1	(3+4) Annulations2.2	(3+5) Annulations3	(4+m) (m > 2) Annulations of Donor–Acceptor Cyclobutanes4	Conclusion
Photoredox-Catalyzed Radical–Radical Coupling of Potassium Trifluoroborates with Acyl Azoliums
Authors: Rourke Michael J. , McGill Matthew J. , Scheidt Karl A. , Yang Daniel , Farnam Emelia J. , Zhu Joshua L. 
Published: August 2023

AbstractPotassium trifluoroborates have gained significant utility as coupling partners in organic synthesis, particularly in the Suzuki–Miyaura coupling reaction. Recently, they have also been used as radical precursors under oxidative conditions to generate carbon-centered radicals. These versatile reagents have found new applications in photoredox catalysis, including radical substitution, conjugate-addition reactions, and transition-metal dual catalysis. In addition, this photomediated redox-neutral process has enabled radical–radical coupling with persistent radicals in the absence of a metal, and this process remains to be fully explored. In this study, we report the radical–radical coupling of potassium benzylic trifluoroborate salts with isolated acyl azolium triflates, which are persistent-radical precursors. The reaction is catalyzed by an organic photocatalyst and forms isolable tertiary alcohol species. These products can be transformed into a range of substituted ketone products by simple treatment with a mild base.
The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Percutaneous Endoscopic Interlaminar Diskectomy: A Retrospective Study
Authors: Zhang Yu , Zhao Wenjie , Hu Man , Liu Xin , Peng Qing , Meng Bo , Yang Sheng , Feng Xinmin , Zhang Liang 
Published: August 2023

Abstract
Background Tranexamic acid (TXA) is safe and effective in preventing bleeding during spinal surgery. However, there is currently no relevant research on the efficacy and safety of adding TXA to the saline irrigation fluid in percutaneous endoscopic interlaminar diskectomy (PEID). This study aimed to evaluate the efficacy and safety of topical saline irrigation with TXA for PEID in the treatment of lumbar disk herniation.
Methods In this single-center, retrospective cohort study, patients who underwent PEID for L5–S1 lumbar disk herniation were included and allocated to two groups according to whether they had been administered TXA. PEID was performed with saline irrigation fluid containing 0.33 g of TXA per 1 L of saline in the TXA group (n = 38). In the control group (n = 51), the saline irrigation fluid was injected with the same volume of normal saline. All PEIDs were performed by the same spine surgery team. The hidden blood loss (HBL), intraoperative blood loss (IBL), total blood loss (TBL), amount of fluid used, operation time, visual clarity, hospital stay, blood transfusion rate, coagulation index, and complication rate were compared between the two groups.
Results The TBL, HBL, and IBL in the TXA group were significantly lower than those of the control group. The postoperative hemoglobin in the TXA group was significantly higher than that of the control group. Visual clarity was significantly better and the operation time was significantly shorter in the TXA group. However, there was no significant difference in postoperative hematocrit, blood coagulation function, amount of fluid used, blood transfusion rate, and perioperative complications between the two groups.
Conclusion In PEID, the addition of TXA to topical saline irrigating fluid can significantly reduce the HBL, IBL, and TBL. The addition of TXA to topical saline irrigating fluid can improve visual clarity in the surgery and reduce operation time, but it does not change the coagulation function or the complication rate.