Sample records for grafting employing cardiopulmonary

  1. Complement activation in coronary artery bypass grafting patients without cardiopulmonary bypass - The role of tissue injury by surgical incision

    Gu, YJ; Mariani, MA; Boonstra, PW; Grandjean, JG; van Oeveren, W


    Study objectives: Complement activation is a trigger in inducing inflammation in patients who undergo coronary artery bypass grafting (CABG) and is usually thought to be induced by the use of cardiopulmonary bypass (CPB), In this study, we examined whether tissue injury caused by chest surgical inci

  2. The Effect of Repeat Cardiopulmonary bypass on Epicardial Microflow and Graft Flow during Intra-operative Heart Failure


    Objective The relationship between graft blood flow, epicardial microflow,mean arterial pressure and hemorheologic changes was studied during intraoperative heart failure.Methods These parameters were done to evaluate the use of repeated cardiopulmonary bypass supportfor the intraoperative heart failure following aorto-coronary bypass surgery. Included in this study were10 patients with a mean age of 7 0 and unstable angina undergoing coronary bypass grafting and suffer-ing from intraoperative heart failure. The epicardiai microflow, graft flow, mean arterial pressureand blood cell filterability were measured. Resluts During heart failure, the mean arterial pressurefell by 41 % ( P < 0. 01 ), graft flow by 67 % ( P < 0. 01 ) and epicardialmicro flow by 64 % ( P <0. 01 ). After 1 5 to 56 min of assisted cardiopulmonary bypass support, the epicardial mioroflow andgraft flow were partially restored, while red cell and white cell filterability was reduced by 31% and644 % respectively ( P < 0. 01 ). There were significant correlations between graft flow, epicardial mi-croflow, blooxd cell filterability and cardiopulmonary bypass time. All patients recovered and were dis-charged from the hospital. Conclusion It is concluded that the use of temporary assisted CPB sup-port to treat intrapoperative heart failure allows the recovery of the myocardium and thereby restores themean arterial pressure. The recovery of graft flow and epicardial flow occurred to a lesser extent. TheCPB support seemed to be suitable for about 60 rain probably because of increasing disturbance to theblood cell filterability, graft flow and the epicardial microcirculation.

  3. Hereditary spherocytosis in a patient undergoing coronary artery bypass grafting with cardiopulmonary bypass--a case report.

    Spegar, J; Riha, H; Kotulak, T; Vanek, T


    Hereditary spherocytosis is a genetically determined abnormality of red blood cells. It is the most common cause of inherited haemolysis in Europe and North America within the Caucasian population. We document a patient who underwent an aortocoronary bypass procedure on cardiopulmonary bypass. In view of the uncertain tolerance of the abnormal red cells in hereditary spherocytosis to cardiopulmonary bypass, we reviewed the patient's chart and analyzed recorded values of these parameters: free plasma haemoglobin, renal parameters, cystatin C, bilirubin, liver tests, urine samples. From the results, we can see that slight haemolysis-elevated bilirubin in the blood sample and elevated bilirubin and urobilinogen in the urine sample occurred on the first postoperative day. The levels of these parameters slowly decreased during the next postoperative days. There was no real clinical effect of this haemolysis on renal functions.

  4. Perioperative pentoxifylline therapy attenuates early postoperative neuro-cognitive decline in patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass

    Sambhunath Das


    Full Text Available Background: Postoperative cognitive decline (POCD after coronary artery bypass grafting (CABG is a common problem. Studies show that pentoxifylline administration reduces inflammation induced by cardiopulmonary bypass and brain injury after ischaemia. Hence the perioperative use of pentoxifylline in attenuating POCD was evaluated in the study. Materials and Methods: Eighty patients were divided randomly into two groups from 106 patients scheduled for CABG surgery. The study group was administered pentoxifylline 400 mg twice daily orally from day of admission to 7th day after surgery, whereas the control group patients received placebo. Neurocognitive assessment was assessed by an independent clinical psychologist one day after admission to hospital and again on 7th postoperative day. The data was analyzed and a P < 0.05 was considered significant results. Results: Pentoxifylline-treated group showed no statistically significant difference in animal naming test scores (10.3 ± 2.2 versus 9.4 ± 2.5, P = 0.07, digit symbol substitution test (26.1 ± 7.47 vs 22.2 ± 6.07, P = 0.09 and 8 subtests of Post Graduate Institute-memory scale. The control group had significant POCD as detected by animal naming test (10.5 ± 3.7 versus 8.6 ± 3.9, P = 0.008, digit symbol substitution test (20.2 ± 8.2 versus 14.7 ± 8.9, P = 0.008 and five subtests of memory scale (P = 0.01, 0.04, 0.003, 0.005 and 0.02. The incidence of POCD was 50% in placebo-treated group compared to 22.5% in pentoxifylline group. Conclusions: The perioperative use of pentoxifylline attenuates the early postoperative neurocognitive decline after CABG using cardiopulmonary bypass.

  5. Pulsatile compared with nonpulsatile perfusion using a centrifugal pump for cardiopulmonary bypass during coronary artery bypass grafting. Effects on systemic haemodynamics, oxygenation, and inflammatory response parameters.

    Driessen, J J; Dhaese, H; Fransen, G; Verrelst, P; Rondelez, L; Gevaert, L; van Becelaere, M; Schelstraete, E


    The present study investigated the influence of pulsatile or nonpulsatile flow delivery with a centrifugal pump for cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) in two randomized groups of 19 patients each. All patients received a standard anaesthetic and surgical protocol. Pulsatile perfusion during CPB was created by accelerating the baseline pump speed of the Sarns centrifugal pump at a rate of 50 cycles per minute. Measurements included perioperative systemic haemodynamics and oxygen exchange, total haemolytic complement (CH50), polymorphonuclear (neutrophil) granulocyte (PMN) count and plasma granulocyte elastase bound to alpha 1-proteinase inhibitor (E-alpha 1-PI). Laboratory measurements were corrected for haemodilution. During and after CPB there were only a few significant differences between the groups in systemic haemodynamics and oxygenation, i.e. a lower mean arterial blood pressure after the end of CPB in the nonpulsatile group (65 mmHg, SD = 11 vs 76 mmHg, SD = 11) and a lower SvO2 during rewarming on CPB in the nonpulsatile group (62%, SD = 8 vs 67%, SD = 8). The decrease in percentage of PMNs in the total white blood cell count during CPB was greater in the nonpulsatile group than in the pulsatile group (from 61 to 46% vs 63 to 53% of prebypass value). The steep increase of PMN count at the end of CPB and postoperatively was comparable in both groups. The maximal decrease of CH50 levels, occurring after surgery, was significantly higher in the nonpulsatile group (70% SD = 15 vs 79%, SD = 16, of baseline value), suggesting a greater complement activation. E-alpha 1-PI levels increased significantly in both groups during and after CPB with higher peak levels, obtained at one hour after admission to an intensive care unit, in the nonpulsatile group (316 micrograms/l, SD = 102) than in the pulsatile group (247 micrograms/l, SD = 106). There was a partly inverse correlation between the peak postoperative elastase levels and

  6. A case report and brief review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting

    Trethowan Brian A


    Full Text Available Abstract Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION, posterior ischaemic optic neuropathy (PION, and central retinal artery occlusion (CRAO. These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass; general surgery; urology; gynaecology; liposuction; liver transplantation and duration of surgery. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone, alteration of venous drainage of the retina, hypertension, smoking, atherosclerosis, hyperlipidaemia, diabetes, hypercoagulability, hypotension, blood loss and large volume resuscitation. Other important cardiac causes are septic emboli from bacterial endocarditis and emboli caused by atrial myxomata. The majority of AION cases occur during CPB followed by head/neck surgery and prone spine surgery. CPB is used to allow coronary artery bypass grafting on a motionless heart. It has many side-effects and complications associated with its use and we report here a case of bilateral retinal infarction during routine coronary artery bypass grafting in a young male patient with multiple risk factors for developing this complication despite steps to minimise its occurrence.

  7. A marked increase in gastric fluid volume during cardiopulmonary bypass

    Hirota, Kazuyoshi; Kudo, Mihoko; Hashimoto, Hiroshi; Kushikata, Tetsuya


    Major physiological stress occurs during cardiac surgery with cardiopulmonary bypass. This is related to hypothermia and artificial organ perfusion. Thus, serious gastrointestinal complications, particularly upper gastrointestinal bleeding, sometimes follow cardiac surgery. We have compared the antisecretory effects of a preanesthetic H2 antagonist (roxatidine, cardiopulmonary bypass-H2 group, n = 15) and a proton pump inhibitor (rabeprazole, cardiopulmonary bypass-PPI group, n = 15) in patients undergoing cardiac surgery with cardiopulmonary bypass, and also compared in patients undergoing a off-pump coronary artery bypass graft surgery (off-pump cardiopulmonary bypass-H2 group, n = 15). Gastric pH (5.14 ± 0.61) and gastric fluid volume (13.2 ± 2.4 mL) at the end of surgery in off-pump cardiopulmonary bypass-H2 groups was significantly lower and higher than those in both cardiopulmonary bypass-H2 (6.25 ± 0.54, 51.3 ± 8.0 mL) and cardiopulmonary bypass-PPI (7.29 ± 0.13, 63.5 ± 14.8 mL) groups, respectively although those variables did not differ between groups after the induction of anesthesia. Plasma gastrin (142 ± 7 pg/mL) at the end of surgery and maximal blood lactate levels (1.50 ± 0.61 mM) in off-pump cardiopulmonary bypass-H2 group were also significantly lower than those in both cardiopulmonary bypass-H2 (455 ± 96 pg/mL, 3.97 ± 0.80 mM) and cardiopulmonary bypass-PPI (525 ± 27 pg/mL, 3.15 ± 0.44 mM) groups, respectively. In addition, there was a significant correlation between gastric fluid volume and maximal blood lactate (r = 0.596). In conclusion, cardiopulmonary bypass may cause an increase in gastric fluid volume which neither H2 antagonist nor PPI suppresses. A significant correlation between gastric fluid volume and maximal blood lactate suggests that gastric fluid volume may predict degree of gastrointestinal tract hypoperfusion. PMID:21765601

  8. Bone grafting: An overview

    D. O. Joshi


    Full Text Available Bone grafting is the process by which bone is transferred from a source (donor to site (recipient. Due to trauma from accidents by speedy vehicles, falling down from height or gunshot injury particularly in human being, acquired or developmental diseases like rickets, congenital defects like abnormal bone development, wearing out because of age and overuse; lead to bone loss and to replace the loss we need the bone grafting. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone graft. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. An ideal bone graft material is biologically inert, source of osteogenic, act as a mechanical support, readily available, easily adaptable in terms of size, shape, length and replaced by the host bone. Except blood, bone is grafted with greater frequency. Bone graft indicated for variety of orthopedic abnormalities, comminuted fractures, delayed unions, non-unions, arthrodesis and osteomyelitis. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. By adopting different procedure of graft preservation its antigenicity can be minimized. The concept of bone banking for obtaining bone grafts and implants is very useful for clinical application. Absolute stability require for successful incorporation. Ideal bone graft must possess osteogenic, osteoinductive and osteocon-ductive properties. Cancellous bone graft is superior to cortical bone graft. Usually autologous cancellous bone graft are used as fresh grafts where as allografts are employed as an alloimplant. None of the available type of bone grafts possesses all these properties therefore, a single type of graft cannot be recomm-ended for all types of orthopedic abnormalities. Bone grafts and implants can be selected as per clinical problems, the equipments available and preference of

  9. Cardiopulmonary bypass in pregnancy

    Mukul Chandra Kapoor


    Full Text Available Cardiac surgery carried out on cardiopulmonary bypass (CPB in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero-placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

  10. Does heparin pretreatment affect the haemostatic system during and after cardiopulmonary bypass?

    Brinks, H.J.; Weerwind, P.W.; Bogdan, S.; Verbruggen, H.W.; Brouwer, M.H.J.


    In this clinical pilot study, the influence of heparin pretreatment on the haemostatic system during and after cardiopulmonary bypass (CPB) was investigated. Thirteen patients scheduled for elective coronary artery bypass grafting (CABG) were divided into two groups: heparin pretreated (HP, n = 6) a

  11. The impact of heparin-coated circuits on hemodynamics during and after cardiopulmonary bypass

    de Vroege, R; Huybregts, R; van Oeveren, W; van Klarenbosch, J; Linley, G; Mutlu, J; Jansen, E; Hack, E; Eijsman, L; Wildevuur, C


    This study was performed to investigate if heparin-coated extracorporeal circuits can reduce the systemic inflammatory reaction with the subsequent release of vasoactive substances during and after cardiopulmonary bypass. Fifty-one patients scheduled for coronary artery bypass grafting were perfused

  12. Cardiac arrest - cardiopulmonary resuscitation

    Basri Lenjani; Besnik Elshani; Nehat Baftiu; Kelmend Pallaska; Kadir Hyseni; Njazi Gashi; Nexhbedin Karemani; Ilaz Bunjaku; Taxhidin Zaimi; Arianit Jakupi


    Objective:To investigate application of cardiopulmonary resuscitation(CPR) measures within the golden minutes inEurope.Methods:The material was taken from theUniversityClinical Center ofKosovo -EmergencyCentre inPristina, during the two(2) year period(2010-2011).The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.Results:During the2010 to2011 in the emergency center of theCUCK inPristina have been treated a total of269 patients with cardiac arrest, of whom159 or59.1% have been treated in2010, and110 patients or40.9% in2011.Of the269 patients treated in the emergency centre,93 or34.6% have exited lethally in the emergency centre, and176 or 65.4% have been transferred to other clinics.In the total number of patients with cardiac arrest, males have dominated with186 cases, or69.1%.The average age of patients included in the survey was56.7 year oldSD±16.0 years.Of the269 patients with cardiac arrest, defibrillation has been applied for93 or34.6% of patients.In the outpatient settings defibrillation has been applied for3 or3.2% of patients.Patients were defibrillated with application of one to four shocks. Of27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home,3 or11.1% of them have suffered cardiac arrest on the street, and24 or88.9% of them have suffered cardiac arrest in the hospital.5 out of27 patients survived have ended with neurological impairment.Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been onMonday with32.0% of cases, and onFriday with24.5% of cases. Conclusions:All survivors from cardiac arrest have received appropriate medical assistance within10 min from attack, which implies that if cardiac arrest occurs near an institution health care(with an opportunity to provide the emergent health care) the rate of survival is higher.

  13. Reconstruction of irradiated mandible after segmental resection of osteoradionecrosis-a technique employing a microvascular latissimus dorsi flap and subsequent particulate iliac bone grafting

    Hillerup, Soren; Elberg, Jens Jorgen; Thorn, Jens Jorgen;


    The fibula osteocutaneous flap has revolutionized the options of mandibular segmental defect bridging in osteoradionecrosis (ORN). In selected cases, however, the fibula flap is not an option because of atherosclerosis or other features that compromise the vascularity of the lower leg and foot...... of uneventful graft healing with restitution of osseous continuity, mandibular height, symmetry and function, and avoidance of reconstruction plate fracture....

  14. Prognosis of hospital survivors after salvage from cardiopulmonary bypass with centrifugal cardiac assist.

    Curtis, J J; Walls, J T; Schmaltz, R A; Boley, T; Landreneau, R; Nawarawong, W


    Since October 1986, 6 hospital survivors who were salvaged from cardiopulmonary bypass (CPB) with the Sarns centrifugal pump were observed. Centrifugal assist was employed only after failure to wean with usual resuscitative measures, including multiple high dose inotropes and intraaortic balloon pumping. There were five men and one woman, 46-59 years of age (mean 61 years). All patients had undergone coronary artery bypass grafting, with two patients having had concomitant left ventricular aneurysmectomy and two aortic valve replacement. Five patients had left ventricular assist only and one had biventricular assist. Duration of assist ranged from 26 to 72 hr (mean 48 hr). Complications were ubiquitous, and the resultant prolonged hospitalization was resource intensive. All hospital survivors remain alive and are in New York Heart Association functional Class II, with an average follow-up of 24 months, (6-41 months). Compared with preoperative values, current left ventricular function is improved in 2 patients, has deteriorated in 3, and is unchanged in 1. Thus, the Sarns centrifugal pump will allow salvage of some patients who otherwise are not weanable from CPB. Survivors can expect a reasonable functional capacity as reflected by this experience.

  15. Evaluation of Acute Ischemic Mitral Regurgitation Following Cardiopulmonary Bypass Assessed by Biplane Transesophageal Echocardiography

    Nakao, Tatsuya; Fujimoto, Keiko; Brodman, Richard F.; Oka, Yasu


    The aim of this study was to evaluate pathogenesis and outcome of acute ischemic mitral regurgitation (MR) in patients undergoing coronary artery bypass grafting (CABG) using biplane transesophageal echocardiography (TEE).   Biplane TEE was continuously monitored in a total of 96 patients who were scheduled for elective CABG surgery. Of 96 patients, 10 with no MR at stages 1 (after anesthetic induction but before skin incision) and 2 (after cardiopulmonary bypass [CPBJ and decannulation) ...

  16. History of the evolution of cardiopulmonary resuscitation


    Cardiopulmonary resuscitation (CPR) is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, hist...

  17. Effects of cardiopulmonary bypass on propofol pharmacokinetics and bispectral index during coronary surgery

    Ricardo Antonio G. Barbosa


    Full Text Available PURPOSE: Cardiopulmonary bypass is known to alter propofol pharmacokinetics in patients undergoing cardiac surgery. However, few studies have evaluated the impact of these alterations on postoperative pharmacodynamics. This study was designed to test the hypothesis that changes in propofol pharmacokinetics increase hypnotic effects after cardiopulmonary bypass. METHODS: Twenty patients scheduled for on-pump coronary artery bypass graft (group, n=10 or off-pump coronary artery bypass graft (group, n=10 coronary artery bypass grafts were anesthetized with sufentanil and a propofol target controlled infusion (2.0 µg/mL. Depth of hypnosis was monitored using the bispectral index. Blood samples were collected from the induction of anesthesia up to 12 hours after the end of propofol infusion, at predetermined intervals. Plasma propofol concentrations were measured using high-performance liquid chromatography, followed by a non-compartmental propofol pharmacokinetic analysis. Data were analyzed using ANOVA, considering p<0.05 as significant. RESULTS: After cardiopulmonary bypass, despite similar plasma propofol concentrations in both groups, bispectral index values were lower in the on-pump coronary artery bypass graft group. Time to extubation after the end of propofol infusion was greater in the on-pump coronary artery bypass graft group (334 ± 117 vs. 216 ± 85 min, p = 0.04. Patients undergoing cardiopulmonary bypass had shorter biological (1.82 ± 0.5 vs. 3.67 ± 1.15h, p < 0.01 and terminal elimination (6.27 ± 1.29 vs. 10.5h ± 2.18, p < 0.01 half-life values, as well as higher total plasma clearance (28.36 ± 11.40 vs.18.29 ± 7.67 mL/kg/min, p = 0.03, compared to patients in the off-pump coronary artery bypass graft group. CONCLUSION: Aside from the increased sensitivity of the brain to anesthetics after cardiopulmonary bypass, changes in propofol pharmacokinetics may contribute to its central nervous system effects.

  18. Multiple dimensions of cardiopulmonary dyspnea

    HAN Jiang-na; XIONG Chang-ming; YAO Wei; FANG Qiu-hong; ZHU Yuan-jue; CHENG Xian-sheng; Karel P Van de Woestijne


    Background The current theory of dyspnea perception presumes a multidimensional conception of dyspnea.However,its validity in patients with cardiopulmonary dyspnea has not been investigated.Methods A respiratory symptom checklist incorporating spontaneously reported descriptors of sensory experiences of breathing discomfort,affective aspects,and behavioral items was administered to 396 patients with asthma,chronic obstructive pulmonary disease (COPD),diffuse parenchymal lung disease,pulmonary vascular disease,chronic heart failure,and medically unexplained dyspnea.Symptom factors measuring different qualitative components of dyspnea were derived by a principal component analysis.The separation of patient groups was achieved by a variance analysis on symptom factors.Results Seven factors appeared to measure three dimensions of dyspnea:sensory (difficulty breathing and phase of respiration,depth and frequency of breathing,urge to breathe,wheeze),affective (chest tightness,anxiety),and behavioral (refraining from physical activity) dimensions.Difficulty breathing and phase of respiration occurred more often in COPD,followed by asthma (R2=0.12).Urge to breathe was unique for patients with medically unexplained dyspnea (R2=0.12).Wheeze occurred most frequently in asthma,followed by COPD and heart failure (R2=0.17).Chest tightness was specifically linked to medically unexplained dyspnea and asthma (R2=0.04).Anxiety characterized medically unexplained dyspnea (R2=0.08).Refraining from physical activity appeared more often in heart failure,pulmonary vascular disease,and COPD (R2=0.15).Conclusions Three dimensions with seven qualitative components of dyspnea appeared in cardiopulmonary disease and the components under each dimension allowed separation of different patient groups.These findings may serve as a validation on the multiple dimensions of cardiopulmonary dyspnea.

  19. History of cardiopulmonary bypass (CPB).

    Hessel, Eugene A


    The development of cardiopulmonary bypass (CPB), thereby permitting open-heart surgery, is one of the most important advances in medicine in the 20th century. Many currently practicing cardiac anesthesiologists, cardiac surgeons, and perfusionists are unaware of how recently it came into use (60 years) and how much the practice of CPB has changed during its short existence. In this paper, the development of CPB and the many changes and progress that has taken place over this brief period of time, making it a remarkably safe endeavor, are reviewed. The many as yet unresolved questions are also identified, which sets the stage for the other papers in this issue of this journal.

  20. Prospective randomized clinical study of arterial pumps used for routine on pump coronary bypass grafting.

    Keyser, Andreas; Hilker, Michael K; Diez, Claudius; Philipp, Alois; Foltan, Maik; Schmid, Christof


    In a number of studies, centrifugal blood pumps--in comparison with roller pumps--have been shown to attenuate trauma to blood components. Nevertheless, the impact of these results on the postoperative course needs to be discussed controversially. In a prospective randomized study, 240 consecutive adult patients underwent elective myocardial revascularization with cardiopulmonary bypass employing five different pumps (Roller, Avecor, Sarns, Rotaflow, Bio-Medicus). We analyzed clinical course, blood loss, damage of blood components, and impairment of the hemostatic system. The study population was homogenous with respect to age, gender, myocardial function, and operative data. No differences were found with respect to time of ventilation, duration of intensive care stay, hospitalization, and laboratory data. The choice of arterial pump during standard extracorporeal bypass for elective coronary artery bypass grafting is no matter of concern.

  1. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Alain Moré Duarte


    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  2. The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS)

    Houlind, Kim; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard;


    BACKGROUND: Coronary Artery Bypass Graft operation for ischemic heart disease provides improved quality of life and, in some patients, prolonged survival. Concern has, however, been raised about complications that may be related to the use of cardiopulmonary by-pass (CPB) and aortic cross-clampin...

  3. Protective role of sevoflurane in the function of myocardium and lung in patients undergoing coronary artery bypass grafting under cardiopulmonary bypass%七氟醚对心肺转流冠状动脉旁路移植术的心肺保护作用

    苏建林; 刘兵; 阳子华; 黄保堂; 冯正义; 龙村


    Objective To compare the protective role of sevoflurane and propofol in the function of myocardium and lung in patients undergoing coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Methods Fifty-two patients with ASA Ⅱ or Ⅲ and cardiac function scale of Ⅱ or Ⅲ scheduled for CABG under CPB were randomized into sevoflurane group (group S) and propofol group (group P) with 26 cases each. After clamping the aorta, patients in the group S received sevoflurane 0. 5%-3% through membrane oxygenator, but in the group P, propofol 2-3 g/kg was given with target-controlled infusion. Arterial blood gas was analyzed at the following time points: immediately before the operation, 2, 4 and 8 h after CPB, and the values of alveolararterial oxygen pressure difference (D(A-a)O2), respiratory index (RI) and oxygenation index (OI) were calculated. Creatine phosphokinase-MB (CK-MB) and cardiac troponin I (cTnI) were detected at the immediate time before operation, 6, 12, 24 and 48 h of after operation. The rates of atrial fibrillation, myocardial ischemia and automatic recovery heart, ejection fraction (EF) and duration of mechanical ventilation were recorded. Results Compared with the group P, patients in the group S had lower D(A-a)O2 and RI (P<0. 05), and OI decreased since 4 h after operation in both groups,but the influence of sevoflurane on OI was smaller than propofol (P<0. 05). CK-MB and cTnl in the group S were significantly lower than those of group P (P<0. 01). The rates of atrial fibrillation and myocardial ischemia in group S were less, and the duration of ventilation was shorter (P<0. 05), and the volume of EF and rate of automatic recovery heart were significantly higher than group P (P< 0. 05). Conclusion Sevoflurane. exerts protective role in the function of myocardium and lung in patients undergoing CAGB under CPB.%目的 比较七氟醚与丙泊酚对心肺转流(CPB)冠状动脉旁路移植术(CAEG)患者心肌与

  4. Radiation-induced grafting of diallyldimethylammonium chloride onto acrylic acid grafted polyethylene

    Francis, Sanju; Dhanawade, B. R.; Mitra, D.; Varshney, Lalit; Sabharwal, Sunil


    Diallyldimethylammonium chloride (DADMAC) was grafted onto polyethylene (PE) films by a double grafting procedure. The PE film was initially modified by grafting acrylic acid (AA), through a mutual irradiation method. AA-g-PE film, thus obtained was subjected to subsequent radiation grafting reaction of DADMAC, to give a DADMAC-g-AA-g-PE film having a comb-type structure. The influence of different conditions, such as the extent of AA grafting, DADMAC concentration, absorbed dose and dose rate, on the grafting yield of DADMAC was investigated. A maximum DADMAC grafting of 30% was achieved. The equilibrium degree of swelling (EDS) of the grafted films were gravimetrically determined. TGA and FT-IR techniques were employed to characterize the grafted PE films.

  5. Radiation-induced grafting of diallyldimethylammonium chloride onto acrylic acid grafted polyethylene

    Francis, Sanju [Radiation Technology Development Section, Bhabha Atomic Research Centre, Trombay, Mumbai 400 085 (India)], E-mail:; Dhanawade, B.R.; Mitra, D.; Varshney, Lalit; Sabharwal, Sunil [Radiation Technology Development Section, Bhabha Atomic Research Centre, Trombay, Mumbai 400 085 (India)


    Diallyldimethylammonium chloride (DADMAC) was grafted onto polyethylene (PE) films by a double grafting procedure. The PE film was initially modified by grafting acrylic acid (AA), through a mutual irradiation method. AA-g-PE film, thus obtained was subjected to subsequent radiation grafting reaction of DADMAC, to give a DADMAC-g-AA-g-PE film having a comb-type structure. The influence of different conditions, such as the extent of AA grafting, DADMAC concentration, absorbed dose and dose rate, on the grafting yield of DADMAC was investigated. A maximum DADMAC grafting of 30% was achieved. The equilibrium degree of swelling (EDS) of the grafted films were gravimetrically determined. TGA and FT-IR techniques were employed to characterize the grafted PE films.

  6. Bone graft

    ... around the area. The bone graft can be held in place with pins, plates, or screws. Why ... Orthopaedic Surgery, San Francosco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the ...

  7. Cardiopulmonary helminths in foxes from the Pyrenees.

    Garrido-Castañé, Ignasi; Ortuño, Anna; Marco, Ignasi; Castellà, Joaquim


    The present survey was carried out to investigate the prevalence of cardiopulmonary helminths in red foxes in Pyrenees area and to evaluate the role of foxes in the eco-epidemiology of these nematodes. Hearts and entire respiratory tracts were obtained from 87 foxes from Vall d'Aran region, Pyrenees, Catalonia, north-eastern Spain. The cardiopulmonary tracts were dissected, flushed and examined for nematodes using sedimented flushing water. Of the 87 examined foxes, 53 (61%) were positive for cardiopulmonary helminths. The identified nematodes were Crenosoma vulpis (44.8%), Eucoleus aerophilus (29.9%) and Angiostrongylus vasorum (3.4%). Statistical differences were observed only on comparing age and C.vulpis prevalence, with young foxes being more infected than adults. The high prevalence of cardiopulmonary nematodes suggested that red foxes may play an important role in their transmission and maintenance in the studied area.

  8. Ethical issues in cardiopulmonary resuscitation.

    Holm, S; Jørgensen, E O


    If patients are to benefit from resuscitation, they must regain consciousness and their full faculties. In recent years, we have acquired important information about the natural history of neurological recovery from circulatory arrest. There are clinical tests that predict the outcome, both during ongoing cardiopulmonary resuscitation (CPR) and in the period after restoration of spontaneous circulation. The ability to predict neurological outcome at this stage offers a basis for certain ethical considerations, which are not exclusively centered on "do-not-attempt-resuscitation" (DNAR)- orders. Instead of being forced to make the decision that "I do not want CPR", the patient should be able to decide that "I want resuscitation to be discontinued, if you predict that I will not recover to a level of neurological function that is acceptable to me". Ideally, no competent patient should be given a DNAR-status without his or her consent. No CPR-attempt should be stopped, and no treatment decision for a patient recovering after CPR should be taken without knowing and assessing the available information. Good ethical decision-making requires reliable facts, which we now know are available.

  9. Successful application of acute cardiopulmonary resuscitation

    Derya ztrk; Erturul Altinbilek; Murat Koyuncu; Bedriye Mge Snmez; ilem altili; Ibrahim Ikzcel; Cemil Kavalci; Glsm Kavalci


    Objective: To compare the quality and correct the deficiencies of cardiopulmonary resuscitation (CPR) procedures performed in patients who developed cardiopulmonary cardiopulmonary arrest before or after Emergency Department admission. Methods: This study was conducted on patients who were applied CPR atŞŞişli Etfal Training and Research and Research Hospital, Emergency Department between 01 January 2012 and 31 December 2012. Chi-square and Mann-Whitney U test were used to compare the patients' data. The study data were analyzed in SPSS 18.0 software package. A P value less than 0.05 was considered statistically significant. Results: A total of 155 patients who were applied CPR were included in the analysis. Among the study patients, seventy eight (50.3%) were brought to Emergency Department after developing cardiopulmonary arrest while 77 (49.7%) developed cardiopulmonary arrest at Emergency Department. The mean age of the study population was (66 ± 16) years and 64%of the patients were male. The initial rhythms of the CPR-applied patients were different (P 0.05). The CPR response time was longer in ED (P Conclusions: The scientific data obtained in this study suggest that an early response and therapy improves outcomes in CPR procedure.

  10. Aortic reconstruction with bovine pericardial grafts

    Silveira Lindemberg Mota


    Full Text Available INTRODUCTION: Glutaraldehyde-treated crimped bovine pericardial grafts are currently used in aortic graft surgery. These conduits have become good options for these operations, available in different sizes and shapes and at a low cost. OBJECTIVE:To evaluate the results obtained with bovine pericardial grafts for aortic reconstruction, specially concerning late complications. METHOD: Between January 1995 and January 2002, 57 patients underwent different types of aortic reconstruction operations using bovine pericardial grafts. A total of 29 (50.8% were operated on an urgent basis (mostly acute Stanford A dissection and 28 electively. Thoracotomy was performed in three patients for descending aortic replacement (two patients and aortoplasty with a patch in one. All remaining 54 underwent sternotomy, cardiopulmonary bypass and aortic resection. Deep hypothermia and total circulatory arrest was used in acute dissections and arch operations. RESULTS: Hospital mortality was 17.5%. Follow-up was 24.09 months (18.5 to 29.8 months confidence interval and complication-free actuarial survival curve was 92.3% (standard deviation ± 10.6. Two patients lately developed thoracoabdominal aneurysms following previous DeBakey II dissection and one died from endocarditis. One "patch" aortoplasty patient developed local descending aortic pseudoaneurysm 42 months after surgery. All other patients are asymptomatic and currently clinically evaluated with echocardiography and CT scans, showing no complications. CONCLUSION: Use of bovine pericardial grafts in aortic reconstruction surgery is adequate and safe, with few complications related to the conduits.

  11. Temporary diabetes insipidus in 2 men after on-pump coronary artery bypass grafting.

    Uyar, Ihsan Sami; Sahin, Veysel; Akpinar, Besir; Yurtman, Volkan; Abacilar, Feyzi; Okur, Faik Fevzi; Ates, Mehmet


    Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used.

  12. 21 CFR 868.6175 - Cardiopulmonary emergency cart.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary emergency cart. 868.6175 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6175 Cardiopulmonary emergency cart. (a) Identification. A cardiopulmonary emergency cart is a device intended to store and...

  13. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting

    Gu, YJ; Mariani, MA; van Oeveren, W; Grandjean, JG; Boonstra, PW


    Background. The aim of this prospective study was to determine whether the inflammation-associated clinical morbidity as well as the subclinical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without cardiopulmonary bypass.

  14. Stent graft placement for dysfunctional arteriovenous grafts

    Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of)


    This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts. Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis. Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency. Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency.

  15. Physiological consequences : Cardiopulmonary, vestibular, and sensory aspects

    Welsch, H.; Albery, W.; Banks, R.D.; Bles, W.


    Discussing the physiological consequences of enhanced fighter manoeuvrability (EFM), aspects of cardiopulmonary reactions will be seen during high G manoeuvres, especially the combination of negative G-load followed by high G-onset manoeuvres ("push-pull"). The aircraft's capability to reach high al

  16. Acute posthypoxic myoclonus after cardiopulmonary resuscitation

    Bouwes, Aline; van Poppelen, Daniel; Koelman, Johannes H. T. M.; Kuiper, Michael A.; Zandstra, Durk F.; Weinstein, Henry C.; Tromp, Selma C.; Zandbergen, Eveline G. J.; Tijssen, Marina A. J.; Horn, Janneke


    Background: Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of

  17. Effects of massage therapy on sleep quality after coronary artery bypass graft surgery

    Flavia Baggio Nerbass


    Full Text Available INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were randomized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0, during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3 using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5%, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m² were randomized into control (n = 20 and massage therapy (n = 20 groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006 and Day 2 (p=0.028 in addition, they reported a more effective sleep during all three days (p=0.019 when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.

  18. Exercises commonly used in rehabilitation of patients with chronic obstructive pulmonary disease: cardiopulmonary responses and effect over time

    Helvoort, H.A.C. van; Boer, R.C. de; Broek, L. van den; Dekhuijzen, R.; Heijdra, Y.F.


    OBJECTIVES: To compare conventional exercise-based assessment of pulmonary rehabilitation (PR) with improvement in training exercises employed during a PR program, and to describe the cardiopulmonary response of different training exercises during PR of patients with chronic obstructive pulmonary di

  19. History of the evolution of cardiopulmonary resuscitation

    George Karlis


    Full Text Available Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references on CPR go back to the era of Ancient Egypt (3100 B.C.. Although the technique for mouth to mouth ventilation was known in ancient times, its efficacy was demonstrated just in 1958. The ease and efficacy of chest compressions were demonstrated in 1960. Electrical defibrillation may have begun in 1775, but it was applied to a victim of cardiac arrest in the 1950s. Conclusion: CPR is currently a rapidly evolving field of medical science. According to latest data, there is evidence that high quality chest compressions, prompt defibrillation if applicable and treatment of reversible causes improve Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references

  20. Stimulation of the cardiopulmonary baroreflex enhances ventricular contractility in awake dogs: a mathematical analysis study.

    Sala-Mercado, Javier A; Moslehpour, Mohsen; Hammond, Robert L; Ichinose, Masashi; Chen, Xiaoxiao; Evan, Sell; O'Leary, Donal S; Mukkamala, Ramakrishna


    The cardiopulmonary baroreflex responds to an increase in central venous pressure (CVP) by decreasing total peripheral resistance and increasing heart rate (HR) in dogs. However, the direction of ventricular contractility change is not well understood. The aim was to elucidate the cardiopulmonary baroreflex control of ventricular contractility during normal physiological conditions via a mathematical analysis. Spontaneous beat-to-beat fluctuations in maximal ventricular elastance (Emax), which is perhaps the best available index of ventricular contractility, CVP, arterial blood pressure (ABP), and HR were measured from awake dogs at rest before and after β-adrenergic receptor blockade. An autoregressive exogenous input model was employed to jointly identify the three causal transfer functions relating beat-to-beat fluctuations in CVP to Emax (CVP → Emax), which characterizes the cardiopulmonary baroreflex control of ventricular contractility, ABP to Emax, which characterizes the arterial baroreflex control of ventricular contractility, and HR to Emax, which characterizes the force-frequency relation. The CVP → Emax transfer function showed a static gain of 0.037 ± 0.010 ml(-1) (different from zero; P < 0.05) and an overall time constant of 3.2 ± 1.2 s. Hence, Emax would increase and reach steady state in ∼16 s in response to a step increase in CVP, without any change to ABP or HR, due to the cardiopulmonary baroreflex. Following β-adrenergic receptor blockade, the CVP → Emax transfer function showed a static gain of 0.0007 ± 0.0113 ml(-1) (different from control; P < 0.10). Hence, Emax would change little in steady state in response to a step increase in CVP. Stimulation of the cardiopulmonary baroreflex increases ventricular contractility through β-adrenergic receptor system mediation.

  1. Emergent cardiopulmonary bypass during pectus excavatum repair

    Ryan Craner


    Full Text Available Pectus excavatum is a chest wall deformity that produces significant cardiopulmonary disability and is typically seen in younger patients. Minimally invasive repair of pectus excavatum or Nuss procedure has become a widely accepted technique for adult and pediatric patients. Although it is carried out through a thoracoscopic approach, the procedure is associated with a number of potential intraoperative and post-operative complications. We present a case of cardiac perforation requiring emergent cardiopulmonary bypass in a 29-year-old male with Marfan syndrome and previous mitral valve repair undergoing a Nuss procedure for pectus excavatum. This case illustrates the importance of vigilance and preparation by the surgeons, anesthesia providers as well as the institution to be prepared with resources to handle the possible complications. This includes available cardiac surgical backup, perfusionist support and adequate blood product availability.

  2. [Clinical relevance of cardiopulmonary reflexes in anesthesiology].

    Guerri-Guttenberg, R A; Siaba-Serrate, F; Cacheiro, F J


    The baroreflex, chemoreflex, pulmonary reflexes, Bezold-Jarisch and Bainbridge reflexes and their interaction with local mechanisms, are a demonstration of the richness of cardiovascular responses that occur in human beings. As well as these, the anesthesiologist must contend with other variables that interact by attenuating or accentuating cardiopulmonary reflexes such as, anesthetic drugs, surgical manipulation, and patient positioning. In the present article we review these reflexes and their clinical relevance in anesthesiology.

  3. Survival after in-hospital Cardiopulmonary Resuscitation

    M Adib Hajbaghery


    Full Text Available Background: During recent years, cardiopulmonary resuscitation (CPR in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. Results: In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Conclusions: Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival. KeyWords: Cardiopulmonary Resuscitation (CPR, Survival rate, Iran

  4. A marked increase in gastric fluid volume during cardiopulmonary bypass


    Major physiological stress occurs during cardiac surgery with cardiopulmonary bypass. This is related to hypothermia and artificial organ perfusion. Thus, serious gastrointestinal complications, particularly upper gastrointestinal bleeding, sometimes follow cardiac surgery. We have compared the antisecretory effects of a preanesthetic H2 antagonist (roxatidine, cardiopulmonary bypass-H2 group, n = 15) and a proton pump inhibitor (rabeprazole, cardiopulmonary bypass-PPI group, n = 15) in patie...

  5. Asymptomatic cardiopulmonary changes caused by adenoid hypertrophy.

    Abdel-Aziz, Mosaad


    Adenoid hypertrophy is the most common cause of pediatric upper airway obstruction, and it can lead to cardiopulmonary complications such as pulmonary hypertension, cor pulmonale, and even heart failure. The aim of this study was to detect the asymptomatic cardiopulmonary changes that could happen in children with adenoid hypertrophy.Eighty children with adenoid hypertrophy were included in this study. Chest x-ray was used to assess the cardiothoracic ratio, whereas echocardiography was used for measuring the pulmonary arterial pressures, right ventricular diastolic filling parameters, and right ventricular end-diastolic diameters. All patients underwent adenoidectomy with or without tonsillectomy, and they were subjected again to echocardiographic assessment 6 months after the operation. No patient showed an increase in the cardiothoracic ratio on x-ray. Preoperative echocardiography showed an increase in pulmonary artery pressure (22.7 [SD, 3.8] mm Hg), a decrease in right ventricular diastolic filling parameters (E/A = 1.03 [SD, 0.17]), and an increase in right ventricular end-diastolic diameters (1.89 [SD, 0.19] cm). Postoperatively, pulmonary artery pressure decreased to 17.2 [SD, 2.1] mm Hg, right ventricular diastolic filling (E/A) increased to 1.25 [SD, 0.11], and right ventricular end-diastolic diameters decreased to 1.68 [SD, 0.12] cm. The comparison between preoperative and postoperative results for each individual parameter was statistically significant. Clinically asymptomatic cardiopulmonary changes due to adenoid hypertrophy are not rare. Early diagnosis and treatment of upper airway obstruction can prevent these serious complications. Echocardiographic examination should be recommended for these patients as a part of preoperative preparation to avoid anesthetic complications.

  6. 21 CFR 870.4240 - Cardiopulmonary bypass heat exchanger.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass heat exchanger. 870.4240... bypass heat exchanger. (a) Identification. A cardiopulmonary bypass heat exchanger is a device, consisting of a heat exchange system used in extracorporeal circulation to warm or cool the blood...

  7. Cardiopulmonary resuscitation: how far have we come?

    Whitcomb, John J; Blackman, Virginia Schmied


    In the 43 years since it was first described, cardiopulmonary resuscitation (CPR) has grown from an obscure medical theory to a basic first aid skill taught to adults and is now the near-universal technique used in CPR instruction. This article provides insight into the history of CPR. We explore the phenomenon of sudden cardiac arrest, the historical roots of CPR, current practice data and recommendations, and the society's role in the development of this life-saving technique. We conclude with a review of CPR's economic impact on the healthcare system and the ethical and policy issues surrounding CPR.

  8. Hydroxyethyl starch versus Ringer solution in cardiopulmonary bypass prime solutions (a randomized controlled trial

    Ozyazıcıoglu Ahmet


    Full Text Available Abstract Background In our study we compared the Ringer solution, which is the standard prime solution of our department, with the HES (Hydroxyethyl starch 130-0.4 solution, which can be a potential alternative prime solution with an indispensable material for the cardio-pulmonary bypass applications. Methods 140 patients undergoing to CABG (Coronary Artery Bypass Graft surgery were electively enrolled to the study. 1500 ml Ringer solution + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution to start cardiopulmonary by-pass in 70 patients which was defined as group 1. On the other hand, 1500 ml HES 130 - 0.4 + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution in 70 patients in group 2. Results INR (International Normalized Ratio, urea levels and blood platelet counts were significantly different between the groups. INR level was higher in group 1, while blood urea and creatinine levels and platelet count were higher in group 2 at the end of the 12th and 24nd hours postoperatively (p = 0.001. In this study, it was shown that the usage of HES 130-0.4 as a prime solution did not have negative effect on postoperative INR level, platelet count, the need for transfusion and the amount of drainage, despite the negative opinions that similar solutions caused coagulation disorders. Another interesting result of the study was that blood platelet count at 24th hour was statistically significantly higher in group 2 (p = 0.001. Conclusion HES 130-0.4 solution is an alternative colloidal solution which can be used as the prime solution or as a mixture with the crystalloids in cardio-pulmonary bypass applications.

  9. Assessing Exercise Limitation Using Cardiopulmonary Exercise Testing

    Michael K. Stickland


    Full Text Available The cardiopulmonary exercise test (CPET is an important physiological investigation that can aid clinicians in their evaluation of exercise intolerance and dyspnea. Maximal oxygen consumption (V˙O2max is the gold-standard measure of aerobic fitness and is determined by the variables that define oxygen delivery in the Fick equation (V˙O2 = cardiac output × arterial-venous O2 content difference. In healthy subjects, of the variables involved in oxygen delivery, it is the limitations of the cardiovascular system that are most responsible for limiting exercise, as ventilation and gas exchange are sufficient to maintain arterial O2 content up to peak exercise. Patients with lung disease can develop a pulmonary limitation to exercise which can contribute to exercise intolerance and dyspnea. In these patients, ventilation may be insufficient for metabolic demand, as demonstrated by an inadequate breathing reserve, expiratory flow limitation, dynamic hyperinflation, and/or retention of arterial CO2. Lung disease patients can also develop gas exchange impairments with exercise as demonstrated by an increased alveolar-to-arterial O2 pressure difference. CPET testing data, when combined with other clinical/investigation studies, can provide the clinician with an objective method to evaluate cardiopulmonary physiology and determination of exercise intolerance.

  10. Surgical results of coronary artery bypass grafting without cardiopulmonary bypass: analysis of 3,410 patients Resultados cirúrgicos na revascularização do miocárdio sem circulação extracorpórea: análise de 3.410 pacientes

    Ricardo de Carvalho Lima


    Full Text Available OBJECTIVES: Over the past few years, great strides have been made in off-pump coronary surgery. This progress is due to a combination of the advances in surgical techniques and the development of instruments that make it possible to perform this procedure in the most varied situations. This is a retrospective study, the purpose of which is to assess our experience with this procedure over the last eleven and a half years. The authors underscore the rapid progress of the method in recent years and report on its indications, contraindications and results. METHODS: In the period from August 1991 to December 2003, 3,410 consecutively patients suffering from angina pectoris were submitted to off-pump coronary surgery. Ages ranged from 13 to 93 years, with a mean of 63 ± 12.0 years. Males accounted for 58% of the cases. The angina was rated according to the criteria of the Canadian Cardiovascular Society, 6.1% of the patients being in Class I, 6.8% in Class II, 46.3% in Class III and 40.8% in Class IV. RESULTS: Intraoperative mortality was low (0.4%. Hospital mortality (30 postoperative days was 2.5%. Mortality and morbidity among the octogenarian patients were extremely low compared with patients operated on with cardiopulmonary bypass (CPB (2.2% versus 12.6% (pOBJETIVO: Nos últimos anos, tem-se observado um grande avanço na cirurgia de revascularização miocárdica sem circulação extracorpórea (RMSCEC. Esse desenvolvimento deveu-se à combinação dos avanços da técnica cirúrgica e ao desenvolvimento de instrumentos que possibilitam a realização deste procedimento nas mais variadas situações. Este é um estudo retrospectivo, que visa avaliar nossa experiência com este procedimento nos últimos 11,5 anos. Os autores enfatizam o rápido progresso do método nos últimos anos, suas indicações, contra-indicações e resultados. MÉTODO: No período de agosto de 1991 e dezembro de 2002, 3.410 pacientes consecutivos, portadores de angina

  11. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.


    ... Devices § 870.4210 Cardiopulmonary bypass vascular catheter, cannula, or tubing. (a) Identification. A cardiopulmonary bypass vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass vascular catheter,...

  12. Coronary artery bypass grafting for Kawasaki disease

    GUO Hong-wei; CHANG Qian; XU Jian-ping; SONG Yun-hu; SUN Han-song; HU Sheng-shou


    Background Kawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5±0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months),clincal angina disappeared or improved. Cardiac function was in Class Ⅰ-Ⅱ (NYHA).Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.

  13. Bone grafts in dentistry

    Prasanna Kumar


    Full Text Available Bone grafts are used as a filler and scaffold to facilitate bone formation and promote wound healing. These grafts are bioresorbable and have no antigen-antibody reaction. These bone grafts act as a mineral reservoir which induces new bone formation.

  14. Associates of Cardiopulmonary Arrest in the Perihemodialytic Period

    Jennifer E. Flythe


    Full Text Available Cardiopulmonary arrest during and proximate to hemodialysis is rare but highly fatal. Studies have examined peridialytic sudden cardiac event risk factors, but no study has considered associates of cardiopulmonary arrests (fatal and nonfatal events including cardiac and respiratory causes. This study was designed to elucidate patient and procedural factors associated with peridialytic cardiopulmonary arrest. Data for this case-control study were taken from the hemodialysis population at Fresenius Medical Care, North America. 924 in-center cardiopulmonary events (cases and 75,538 controls were identified. Cases and controls were 1 : 5 matched on age, sex, race, and diabetes. Predictors of cardiopulmonary arrest were considered for logistic model inclusion. Missed treatments due to hospitalization, lower body mass, coronary artery disease, heart failure, lower albumin and hemoglobin, lower dialysate potassium, higher serum calcium, greater erythropoietin stimulating agent dose, and normalized protein catabolic rate (J-shaped were associated with peridialytic cardiopulmonary arrest. Of these, lower albumin, hemoglobin, and body mass index; higher erythropoietin stimulating agent dose; and greater missed sessions had the strongest associations with outcome. Patient health markers and procedural factors are associated with peridialytic cardiopulmonary arrest. In addition to optimizing nutritional status, it may be prudent to limit exposure to low dialysate potassium (<2 K bath and to use the lowest effective erythropoietin stimulating agent dose.

  15. Anesthetic considerations for the patients with off-pump coronary artery bypass grafting


    New surgical techniques for coronary artery bypass graft (CABG) have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgical expertise can perform the procedures in some high-risk patients such as poor left ventricular function, redo CABG, advanced age and renal dysfunction etc. Intraoperatively there is an obligatory period of myocardial ischemia, which may lead to significant hemodynamic consequences. It is a quite challenge to anesthetist in managing the intraoperative patient.

  16. Endovascular stent-graft management of thoracic aortic diseases

    Dake, Michael D. E-mail:


    The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative care over the last 30 years, the mortality and morbidity of surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of endovascular stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that stent-graft therapy potentially may reduce the operative risk, hospital stay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence.

  17. Long-term graft outcome of pediatric liver transplantation in Copenhagen

    Yamauchi, Yasushi; Yamashita, Yuichi; Wettergren, Andre


    status of the recipients (hospitalization or intensive care unit care before surgery), a retransplanted graft, and a reduced-size graft were independent risk factors for graft failure. With experience, overall graft survival has improved significantly and the differences in graft survival between graft......BACKGROUND: Graft loss after liver transplantation remains a significant problem, especially in pediatric patients. The aim of this study was to assess our initial series of pediatric liver transplantation and to identify the risk factors that influence graft outcome. METHODS: The first 51...... types have disappeared. CONCLUSIONS: To improve graft survival after pediatric liver transplantation, the timely referral of potential recipients to the transplant team and employing a meticulous technique during the operation, particularly for the technical-variant graft, are required....

  18. Effects of sevoflurane on cardiopulmonary function in patients undergoing coronary artery bypass.

    Zhang, J; Wang, S


    The objective of the current study was to investigate effects of sevoflurane on cardiopulmonary function in patients undergoing coronary artery bypass grafting (CABG). In this study, 60 cases of patients with coronary heart disease (CHD) were selected and randomly divided into the sevoflurane group (group S) and the control group C (group C) with 30 cases in each group. The two groups received intravenous anesthesia. The patients of group C were only given oxygen mask and physiological saline to keep vein open; while the patients of group S were administered with 1% sevoflurane immediately after the beginning of cardiopulmonary bypass (CPB) until the end of the treatment. The cardiopulmonary functions at 30 min before operation (T0), postoperative 2 h (T1), 6h (T2), 24h (T3) and 48 (T4) were observed. The mean arterial pressure (MAP) of the group S at T1, T2, T3 was lower than that of the group C, as were the heart rate (HR) and left ventricular ejection fraction (LVEF). The creatine kinase isoenzyme (CK-MB) during T1 to T4 in the group S was less than that of the group C, and there were significant differences between the two groups (P less than 0.05). The tidal volume (Vt), vital capacity (Vc) and oxygenation index (PaO2/FiO2) of the two groups during T1 and T2 were decreased, while respiratory frequency (RR) and alveolar-arterial blood oxygen partial pressure (PA-aO2) were increased and they began to decrease during T3 and T4. Vt and Vc of the group S were higher during T1 and T2 periods than those of the group C, while RR was lower than that of the group C; PaO2 / FiO2 during T1 to T4 period of group S was higher than that of group C, while PA-aO2 was significantly lower than that of the control group (P less than 0.05). In conclusion, although LVEF was not improved in the sevoflurane group, sevoflurane may contribute to stabilizing the cardiopulmonary function and preventing from myocardial injury.

  19. Strategies for cardiopulmonary exercise testing of pectus excavatum patients

    Moh H. Malek


    Full Text Available The purpose of this paper is to provide strategies for cardiopulmonary exercise testing of pectus excavatum patients. Currently, there are no standardized methods for assessing cardiovascular and pulmonary responses in this population; therefore, making comparisons across studies is difficult if not impossible. These strategies are intended for physicians, pulmonary technicians, exercise physiologists, and other healthcare professionals who conduct cardiopulmonary exercise testing on pectus excavatum patients. By using the strategies outlined in this report, comparisons across studies can be made, and the effects of pectus excavatum on cardiopulmonary function can be assessed with greater detail.

  20. Olecranon bone graft: revisited.

    Mersa, Berkan; Ozcelik, Ismail Bulent; Kabakas, Fatih; Sacak, Bulent; Aydin, Atakan


    Autogenous bone grafts are frequently in use in the field of reconstructive upper extremity surgery. Cancellous bone grafts are applied to traumatic osseous defects, nonunions, defects after the resection of benign bone tumors, arthrodesis, and osteotomy procedures. Cancellous bone grafts do not only have benefits such as rapid revascularization, but they also have mechanical advantages. Despite the proximity to the primary surgical field, cancellous olecranon grafts have not gained the popularity they deserve in the field of reconstructive hand surgery. In this study, the properties, advantages, and technical details of harvesting cancellous olecranon grafts are discussed.

  1. Transient Diabetes Insipidus Following Cardiopulmonary Bypass.

    Ekim, Meral; Ekim, Hasan; Yilmaz, Yunus Keser; Bolat, Ali


    Diabetes insipidus (DI) results from inadequate output of Antidiuretic Hormone (ADH) from the pituitary gland (central DI) or the inability of the kidney tubules to respond to ADH (nephrogenic DI). ADH is an octapeptide produced in the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior lobe of the pituitary gland. Cardiopulmonary Bypass (CPB) has been shown to cause a six-fold increased circulating ADH levels 12 hours after surgery. However, in some cases, ADH release may be transiently suppressed due to cardioplegia (cardiac standstill) or CPB leading to DI. We present the postoperative course of a 60-year-old man who developed transient DI after CPB. He was successfully treated by applying nasal desmopressin therapy. Relevant biochemical parameters should be monitored closely in patients who produce excessive urine after open heart surgery.

  2. Automated cardiopulmonary resuscitation: a case study.

    Spiro, Jon; Theodosiou, Maria; Doshi, Sagar


    Rates of survival after cardiac arrest are low and correlate with the quality of cardiopulmonary resuscitation (CPR). Devices that deliver automated CPR (A-CPR) can provide sustained and effective chest compressions, which are especially useful during patient transfer and while simultaneous invasive procedures are being performed. The use of such devices can also release members of resuscitation teams for other work. This article presents a case study involving a man with acute myocardial infarction complicated by cardiogenic shock and pulmonary oedema. It describes how ED nursing and medical teams worked together to deliver A-CPR, discusses the use of A-CPR devices in a tertiary cardiac centre, and highlights the advantages of using such devices.

  3. Cardiopulmonary resuscitation: a review for clinicians.

    Varon, J; Marik, P E; Fromm, R E


    Attempts at cardiopulmonary resuscitation (CPR) date from antiquity, but it is only in the last 50 years that a scientifically-based methodology has been developed. External chest compressions is the standard method for managing circulatory arrest, however, numerous alterations of this technique have been proposed in attempts to improve outcome from CPR. Defibrillation is the single most important therapy for the management of ventricular fibrillation or pulseless ventricular tachycardia. Adrenergic agents used to improve myocardial and cerebral perfusion are also the subject of considerable investigation with new agents entering clinical study. This paper reviews the history, current techniques and pharmacotherapy as well as controversial issues in the management of patients with cardiac arrest.

  4. Evaluation of coma patients after cardiopulmonary resuscitation

    SU Ying-ying; YANG Qing-lin; PANG Ying; LV Xiang-ping


    Background Coma after cardiopulmonary resuscitation (CPR) is commonly seen in daily clinical practice. How to objectively evaluate brain function after CPR is essential to the following treatment. Coma patients after CPR had been studied prospectively at the Neuro-Intensive Care Unit of Xuanwu Hospital since 2002. In this study, we focused on the topic of how to evaluate the severity of coma after CPR .Methods From April 2002 to November 2004, patients in coma 24 hours after CPR were monitored, the evaluation methods included Glasgow coma score (GCS),brain stem reflection, and spinal reflection. Laboratory evaluation included electroencephalography (EEG),brainstem auditory evoked potential (BAEP), short latency somatosensory evoked potential (SLSEP), and transcranial Doppler (TCD) .Results Twenty-four of 35 patients(68.57%)were in deep coma. The GCS was 3 except for 2 patients;EEG was evaluated not less than grade Ⅳ except for 4 patients, BAEP was evaluated as grade Ⅲ except for 3 patients, and SLSEP was evaluated as grade Ⅲ except for 1 patient.Twenty-four patients died within 1 month and 11 of them(45.83%)were determined as brain death. Glasgow outcome score (GOS) was evaluated as grade Ⅰ. Eleven of the 35 patients survived and their consciousness changed from deep coma to coma vigil. EEG was evaluated as gradeⅠin 5 patients, BAEP and SLSEP were evaluated as grade Ⅰ in 3 patients, and GOS was all evaluated as grade Ⅱ among the 11 patients.Two patients(18.18%)regained consciousness in 35 and 90 days after cardiopulmonary resuscitation and GOS was evaluated as grade Ⅳ and Ⅲ, respectively.Conclusion Combined or continuous evaluation of clinical examinations and laboratory tests can accurately and objectively determine brain function after CPR.

  5. Spatial variation in nitrogen dioxide concentrations and cardiopulmonary hospital admissions

    Dijkema, Marieke B A; van Strien, Robert T; van der Zee, Saskia C; Mallant, Sanne F; Fischer, Paul; Hoek, Gerard; Brunekreef, Bert; Gehring, Ulrike


    BACKGROUND: Air pollution episodes are associated with increased cardiopulmonary hospital admissions. Cohort studies showed associations of spatial variation in traffic-related air pollution with respiratory and cardiovascular mortality. Much less is known in particular about associations with cardi

  6. Pediatric Cardiopulmonary Resuscitation: Advances in Science, Techniques, and Outcomes

    Topjian, Alexis A.; Berg, Robert A; Nadkarni, Vinay M.


    More than 25% of children survive to hospital discharge after in-hospital cardiac arrests, and 5% to 10% survive after out-of-hospital cardiac arrests. This review of pediatric cardiopulmonary resuscitation addresses the epidemiology of pediatric cardiac arrests, mechanisms of coronary blood flow during cardiopulmonary resuscitation, the 4 phases of cardiac arrest resuscitation, appropriate interventions during each phase, special resuscitation circumstances, extracorporeal membrane oxygenati...

  7. Gamma radiation grafted polymers for immobilization of Brucella antigen in diagnostic test studies

    Docters, E. H.; Smolko, E. E.; Suarez, C. E.

    The radiation grafting process has a wide field of industrial applications, and in the recent years the immobilization of biocomponents in grafted polymeric materials obtained by means of ionizing radiations is a new and important contribution to biotechnology. In the present work, gamma preirradiation grafting method was employed to produce acrylics hydrogels onto polyethylene (PE), polyvinyl chloride (PVC) and polystyrene (PS). Two monomers were used to graft the previously mentioned polymers: methacrylic acid (MAAc) and acrylamide (AAm), and several working conditions were considered as influencing the degree of grafting. All this grafted polymers were used to study the possibility of a subsequent immobilization of Brucella antigen (BAg) in diagnostic test studies (ELISA).

  8. Tuning the Mechanical Properties of Polymer Nanocomposites Filled with Grafted Nanoparticles by Varying the Grafted Chain Length and Flexibility

    Zixuan Wang


    Full Text Available By employing coarse-grained molecular dynamics simulation, we simulate the spatial organization of the polymer-grafted nanoparticles (NPs in homopolymer matrix and the resulting mechanical performance, by particularly regulating the grafted chain length and flexibility. The morphologies ranging from the agglomerate, cylinder, sheet, and string to full dispersion are observed, by gradually increasing the grafted chain length. The radial distribution function and the total interaction energy between NPs are calculated. Meanwhile, the stress–strain behavior of each morphology and the morphological evolution during the uniaxial tension are simulated. In particular, the sheet structure exhibits the best mechanical reinforcement compared to other morphologies. In addition, the change of the grafted chain flexibility to semi-flexibility leads to the variation of the morphology. We also find that at long grafted chain length, the stress–strain behavior of the system with the semi-flexible grafted chain begins to exceed that of the system with the flexible grafted chain, attributed to the physical inter-locking interaction between the matrix and grafted polymer chains. A similar transition trend is as well found in the presence of the interfacial chemical couplings between grafted and matrix polymer chains. In general, this work is expected to help to design and fabricate high performance polymer nanocomposites filled with grafted NPs with excellent and controllable mechanical properties.

  9. The Cardiopulmonary effect of passive movement

    L. Loram


    Full Text Available Eleven articles were reviewed on the cardiopulmonary effects of passive movements. These included two articles on theneurological effects of passive movements. Of the eleven articles, four were considered to have level II evidence in accordance with Sackett’s rules of evidence. There was little consensus regarding the rate or duration of passive movements. There were some suggestions that upper limb movement produces a greater ventilatory response than lower limb movement. There was a statistically significant increase (p< 0.05 in minute ventilation when the movement was done at a rate of 40 repetitions per minute or more, but this change may not be clinically significant. Passive movements were not detrimental to neurosurgical patients with a normal or slightly elevated intracranial pressure, although the values of the intracranial pressure were not stated.  The studies were limited in that eight of the eleven had small sample sizes and most studies were conducted using normal subjects. Further studies with higher levels of evidence need to be  conducted to verify any results reported to date in the literature. Studies that are relevant to clinical practice also need to be conducted in populations such as sedated intensive care patients.

  10. Cardiopulmonary Exercise Test: Background, Applicability and Interpretation

    Herdy, Artur Haddad; Ritt, Luiz Eduardo Fonteles; Stein, Ricardo; de Araújo, Claudio Gil Soares; Milani, Mauricio; Meneghelo, Romeu Sérgio; Ferraz, Almir Sérgio; Hossri, Carlos; de Almeida, Antonio Eduardo Monteiro; Fernandes-Silva, Miguel Morita; Serra, Salvador Manoel


    Cardiopulmonary exercise test (CPET) has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: ventilation; oxygen consumption (VO2); carbon dioxide production (VCO2); and the other variables of conventional exercise testing. In addition, in specific situations, pulse oximetry and flow-volume loops during and after exertion are measured. The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion, being considered gold standard for cardiorespiratory functional assessment.1-6 The CPET allows defining mechanisms related to low functional capacity that can cause symptoms, such as dyspnea, and correlate them with changes in the cardiovascular, pulmonary and skeletal muscle systems. Furthermore, it can be used to provide the prognostic assessment of patients with heart or lung diseases, and in the preoperative period, in addition to aiding in a more careful exercise prescription to healthy subjects, athletes and patients with heart or lung diseases. Similarly to CPET clinical use, its research also increases, with the publication of several scientific contributions from Brazilian researchers in high-impact journals. Therefore, this study aimed at providing a comprehensive review on the applicability of CPET to different clinical situations, in addition to serving as a practical guide for the interpretation of that test. PMID:27982272

  11. Postoperative abdominal complications after cardiopulmonary bypass

    Dong Guohua


    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  12. Cardiopulmonary exercise testing (CPET) in pulmonary emphysema.

    Paoletti, Patrizia; De Filippis, Francesca; Fraioli, Francesco; Cinquanta, Alessandra; Valli, Gabriele; Laveneziana, Pierantonio; Vaccaro, Francesco; Martolini, Dario; Palange, Paolo


    In patients affected by chronic obstructive pulmonary disease (COPD), cardiopulmonary response to exercise was never related to the severity of emphysema (E) measured by high resolution computed tomography (HRCT). Sixteen patients (age=65±8 yrs; FEV(1)=54±18%pred; RV=160±28%pred) with moderate to severe E (quantified by lung HRCT as % voxels cycle-ergometer to exhaustion. Oxygen uptake (V˙(O2)), carbon dioxide output (V˙(CO2)), ventilation (V˙(E)), tidal volume (V(T)), and end-tidal P(CO2) (PET(CO2)) derived variables were measured breath-by-breath. The % of E correlated with: (1) the ratio V(Tpeak) (r=0.74; p=0.001); (2) the V˙(E)/V˙(CO2) slope (r=-0.77; p=0.0004); (3) PET(CO2) values at peak exercise (r=0.80; p=0.0001). Also, the %E was strongly predicted by the following exercise equation: %E(EST) = 58.1 + 11.9 × ΔV˙(E)/V˙(CO2) (r=0.94; p1 is typically observed in severe E patients; furthermore, the V˙(E)/V˙(CO2) slope and the PET(CO2peak) values decrease and increase respectively as more as the emphysema is severe.

  13. Conflicting perspectives compromising discussions on cardiopulmonary resuscitation.

    Groarke, J


    Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.

  14. Managing the Inflammatory Response after Cardiopulmonary Bypass : Review of the Studies in Animal Models

    Liguori, Gabriel Romero; Kanas, Alexandre Fligelman; Moreira, Luiz Felipe Pinho


    OBJECTIVE: To review studies performed in animal models that evaluated therapeutic interventions to inflammatory response and microcirculatory changes after cardiopulmonary bypass. METHODS: It was used the search strategy ("Cardiopulmonary Bypass" (MeSH)) and ("Microcirculation" (MeSH) or "Inflammat

  15. A 7-year, single-center research and long term follow-up of graft patency of robotic total arterial off-pump coronary artery bypass grafting

    Guo-peng LIU


    Full Text Available Objective  The aim of the study was to explore the long-term benefits of coronary artery bypass grafting (CABG. Methods  From January 2007 to November 2014, 240 patients (187 males and 53 females, average age 59 years received robotic off-pump CABG assisted with da Vinci Surgical System (Intuitive Surgical, USA in our center. Totally endoscopic coronary artery bypass (totally robot-assisted TECAB, n=100 or mini-thoracotomy direct coronary artery bypass (free of internal mammary artery, IMA, by robot, MIDCAB, n=140 grafting was performed. Patients were followed-up regularly, and their graft patency was assessed every 6 months by coronary angiography or 64-multi-slide CT angiography. Results  All the procedures were completed successfully without conversion to median sternotomy or cardiopulmonary bypass , there was no operative mortality. 237 unilateral IMA grafts (98.7% and 3 bilateral IMA grafts (1.3% were used. Hybrid revascularization of non-left anterior descending vessels was performed in 24 patients (10%. In the follow-up of 41.1±12.9 months, no death, stroke or myocardial infarction occurred. All grafts were patent before discharge. The IMA graft patency was 97.1% in TECAB and 96.4 % in MIDCAB over 3 years (up to 91 months after surgery. Conclusions  Robotic off-pump CABG using IMA grafts is a safe and effective surgery method in selected patients. The long-term outcome and patency of IMA grafts are excellent. DOI: 10.11855/j.issn.0577-7402.2016.06.15

  16. Teamwork and leadership in cardiopulmonary resuscitation.

    Hunziker, Sabina; Johansson, Anna C; Tschan, Franziska; Semmer, Norbert K; Rock, Laura; Howell, Michael D; Marsch, Stephan


    Despite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past decades. Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR. This review describes the state of the science linking team interactions to the performance of CPR. Because logistical barriers make controlled measurement of team interaction in the earliest moments of real-life resuscitations challenging, our review focuses mainly on high-fidelity human simulator studies. This technique allows in-depth investigation of complex human interactions using precise and reproducible methods. It also removes variability in the clinical parameters of resuscitation, thus letting researchers study human factors and team interactions without confounding by clinical variability from resuscitation to resuscitation. Research has shown that a prolonged process of team building and poor leadership behavior are associated with significant shortcomings in CPR. Teamwork and leadership training have been shown to improve subsequent team performance during resuscitation and have recently been included in guidelines for advanced life support courses. We propose that further studies on the effects of team interactions on performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients.

  17. Gravity and Development of Cardiopulmonary Reflex

    Nagaoka, Shunji; Eno, Yuko; Ohira, Yoshinobu

    Cardio-pulmonary reflex, which our cardiac activity is synchronized to the respiration by autonomic nervous system regulation, is called as "respiratory sinus arrhythmia" and commonly found in adult. The physiological function of the espiratory sinus arrhythmia is considered to maximize the gas exchange during respiration cycle. This respiration induced heart rate variability (RHRV) is only found in mammals and avian showing a remarkable postnatal development, whereas no RHRV in aquatic species such as fish or amphibian. To elucidate our hypothesis that gravity exposure may plays a key role in the postnatal development of RHRV as well as its evolutional origin in these ground animals, we have studied effects of hypergravity (2G) on the postnatal development of RHRV using rat. Pregnant Wister rats were kept in centrifugal cages system for 38 days from 6th days of pregnant mother to have neonates until 23 days old. Electrocardiograph was recorded from the neonates in 2 to 23 days old in 2G group with simultaneous control (1G) group. The RHRV analysis was performed by calculating a component of Fourier power spectral coincide with the respiration frequency. In both groups, averaged resting heart rate gradually increase from 2 to 23 days old. When comparing the heart rate between the two groups, the 2G group indicated significantly lower (240± 8 bpm) than 1G control (326±21 bpm, p¡0.001) in 2 days old, where as no significance in 23 days old. The RHRV of 2 days old neonates in both groups indicated very small magnitude but significantly lower in 2G group than 1G control (p¡0.01). The RHRV gradually increase during the first 2 weeks and then rapid increased to reached 45 fold of magnitude in 1G control, whereas 69 fold in 2G group. The results strongly suggested that the postnatal innervation from respiration to cardiovascular centers was gravity dependent.

  18. Hantavirus cardiopulmonary syndrome successfully treated with high-volume hemofiltration

    Bugedo, Guillermo; Florez, Jorge; Ferres, Marcela; Roessler, Eric; Bruhn, Alejandro


    Hantavirus cardiopulmonary syndrome has a high mortality rate, and early connection to extracorporeal membrane oxygenation has been suggested to improve outcomes. We report the case of a patient with demonstrated Hantavirus cardiopulmonary syndrome and refractory shock who fulfilled the criteria for extracorporeal membrane oxygenation and responded successfully to high volume continuous hemofiltration. The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within a few hours and may have prompted recovery. In patients with Hantavirus cardiopulmonary syndrome, a short course of high volume continuous hemofiltration may help differentiate patients who can be treated with conventional intensive care unit management from those who will require more complex therapies, such as extracorporeal membrane oxygenation. PMID:27410413

  19. 21 CFR 870.4410 - Cardiopulmonary bypass in-line blood gas sensor.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass in-line blood gas sensor... Cardiopulmonary bypass in-line blood gas sensor. (a) Identification. A cardiopulmonary bypass in-line blood gas sensor is a transducer that measures the level of gases in the blood. (b) Classification. Class...

  20. Engaging Employers?

    Hillier, Yvonne


    A key factor in the successful development of workplace learning is employer engagement (Leitch, 2006; DfES, 2007). However, despite numerous approaches by government in the United Kingdom to bring together employers, providers and learners so that economic success is generated by a skilled and flexible workforce, there continue to be challenges…

  1. The use of VEPs for CNS monitoring during continuous cardiopulmonary bypass and circulatory arrest.

    Keenan, N K; Taylor, M J; Coles, J G; Prieur, B J; Burrows, F A


    Cerebral function was monitored with the use of visual evoked potentials (VEPs) in 16 infants (mean age 9.9 +/- 4.3 months) during surgery for congenital cardiac anomalies. While hypothermia was employed in all patients, half (8) remained on continuous cardiopulmonary bypass (CCB) while the rest were cooled to lower temperatures before the induction of circulatory stasis and venous exsanguination (CA), i.e., profound hypothermic circulatory arrest (PHCA). VEPs were recorded before, during and after surgical intervention. Latency changes occurred in both the N100 and P145 components of the VEP as a function of systemic temperature during cooling in both groups. Differences in the VEPs were found between the two groups post-operatively, with the most interesting result being a greater increase in P145 latency in the CA group after rewarming. To the extent that VEPs reflect neurological status, our findings suggested that CCB was associated with less perturbation in acute neurological status than PHCA, and shorter arrest times and lower temperatures during CA were associated with the most favourable post-operative VEPs. Hence, intraoperative monitoring of VEPs appeared to be useful as an objective measure of the short-term effects of various cardiopulmonary procedures on neurophysiological function.

  2. Temperatura e alterações no equilíbrio ácido-base de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea, sob normotermia e hipotermia Temperatura y alteraciones en el equilibrio ácido-base de pacientes sometidos a cirugía cardíaca con circulación extracorpórea, bajo normotermia e hipotermia Temperature and acid-base balance in coronary bypass grafting with cardiopulmonary bypass, under hypothermia and normothermia

    Hugo Leonardo de Moura Luz


    operados sobre hipotermia, sugiriendo que el transporte de oxígeno para la periferia no fue adecuado durante el período de observación propuesto. La disminución de la temperatura, aun cuando discreta, parece no haber conferido el grado de protección celular esperada al flujo sanguíneo de la CEC.BACKGROUND AND OBJECTIVES: Cardiopulmonary bypass (CPB is related to several changes in normal physiology. The multiple causes of these changes interact and are a potential risk for postoperative organic dysfunction. This study aimed at investigating changes in acid-base and metabolic balance during cardiopulmonary bypass with hypothermia and at comparing them to those observed in patients submitted to normothermal cardiopulmonary bypass. METHODS: Participated in this study 30 adult patients of both genders, aged 41 to 78 years, scheduled for coronary bypass grafting with CPB, under normothermia or hypothermia. The following parameters were evaluated: hemoglobin and blood gases concentration, pH, bicarbonate, base excess, anion gap, lactate ion, tissue oxygenation parameters and flow and systemic vascular resistance. RESULTS: There were no statistically significant differences in arterial pH, arterial bicarbonate, Na+ and Cl- plasma concentrations, anion gap, carbon dioxide partial pressure and arterial oxygen content between Normothermia and Hypothermia Groups. A time-effect was observed for all variables except for base excess and anion gap. Base excess and K+ concentration were lower in the hypothermia group. Serum lactate increased in both groups when comparing time before CPB to after CPB, with higher levels in the hypothermia group. CONCLUSIONS: Mild hypothermia does not seem to substantially change acid-base balance as compared to normal temperature during CPB. Plasma lactate, however, has significantly increased in patients under hypothermia, suggesting inadequate oxygen transport to periphery during the proposed observation period. Low temperature, although mild, does

  3. Numerical Simulation of Coronary Artery Bypass Graft with an Assistant Graft

    WANG Wei; WANG Feng


    The conventional bypass design is to implant a graft on the stenosed host artery allowing blood to flow bypass the stenotic artery. However, restenosis is a challenging problem which finally results in reoperation. The purpose of this paper is to propose a new bypass graft design of coronary artery with an assistant graft for the treatment of coronary artery stenosis. An additional assistant graft was employed in the new design compared with the conventional ETS anastomosis. Numerical simulations were performed by means of finite volume method using computational fluid dynamics (CFD) solver. Results demonstrated that the new anastomoses model provided a more smooth flow at the distal ETS anastomosis without any stagnation point on anastomotic bed and vortex formation in the heel region. Oscillatory shear index (OSI) and time-averaged wall shear stress gradient (TAWSSG) at the artery bed of the distal ETS anastomosis were reduced. The coronary artery bypass graft with an assistant graft is feasible to improve the local hemodynamics and diminish the probability of restenosis in the treatment of coronary artery stenosis.

  4. Polytrimethylsylylpropyne gas separation membranes modified by radiochemical grafting of divinylbenzene

    Vigo, F.; Traverso, M.; Uliana, C. [Univ. of Genoa (Italy); Costa, G. [I.M.A.G.-C.N.R., Genoa (Italy)


    A radiochemical method was employed to obtain poly(1-trimethylsilyl-1-propyne)(PTMSP)-divinylbenzene (DVB) grafted films. DVB monomer vapors were absorbed by the PTMSP, and the grafting reaction was thereafter accomplished by {sup 60}Co {gamma}-irradiation in a nitrogen atmosphere. The films so obtained were tested for nitrogen-oxygen separation. The performances of the membranes were studied as functions of time and percent of grafting. The DVB-grafted membranes show an increased selectivity factor and stability with time. The experimental data and some SEM observations confirm the presence of large voids in the PTMSP matrix. These voids are responsible for permeability changes during operation and disappear after the grafting procedure. 8 refs., 5 figs.

  5. Off-Pump Versus On-Pump Coronary Artery Bypass Grafting

    Møller, Christian H; Steinbrüchel, Daniel A


    Coronary artery bypass grafting (CABG) remains the preferred treatment in patients with complex coronary artery disease. However, whether the procedure should be performed with or without the use of cardiopulmonary bypass, referred to as off-pump and on-pump CABG, is still up for debate....... Intuitively, avoidance of cardiopulmonary bypass seems beneficial as the systemic inflammatory response from extracorporeal circulation is omitted, but no single randomized trial has been able to prove off-pump CABG superior to on-pump CABG as regards the hard outcomes death, stroke or myocardial infarction....... In contrast, off-pump CABG is technically more challenging and may be associated with increased risk of incomplete revascularization. The purpose of the review is to summarize the current literature comparing outcomes of off-pump versus on-pump coronary artery bypass surgery....

  6. 21 CFR 870.4350 - Cardiopulmonary bypass oxygenator.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass oxygenator. 870.4350 Section 870.4350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... gases between blood and a gaseous environment to satisfy the gas exchange needs of a patient during...

  7. Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation

    Isbye, Dan L; Høiby, Pernilla; Rasmussen, Maria B;


    BACKGROUND: Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during indi...

  8. Cardiopulmonary Fitness and Endurance in Children with Developmental Coordination Disorder

    Wu, Sheng K.; Lin, Hsiao-Hui; Li, Yao-Chuen; Tsai, Chia-Liang; Cairney, John


    The purpose of this study was to compare cardiopulmonary fitness and endurance in 9-11-year-old children with DCD against a group of typically developing children in Taiwan. The Movement ABC test was used to evaluate the motor abilities of children. Forty-one participants (20 children with DCD and 21 children without DCD) were recruited for this…

  9. Cardiopulmonary interactions during mechanical ventilation in critically ill patients

    T.G.V. Cherpanath (Thomas); W.K. Lagrand (Wim); M.J. Schultz (Marcus); A.B.J. Groeneveld (Johan)


    textabstractCardiopulmonary interactions induced by mechan-ical ventilation are complex and only partly understood. Ap-plied tidal volumes and/or airway pressures largely mediate changes in right ventricular preload and afterload. Effects on left ventricular function are mostly secondary to changes

  10. Necessity of immediate cardiopulmonary resuscitation in trauma emergency

    Luciano Baitello


    Full Text Available Abstract The ability to respond quickly and effectively to a cardiac arrest situation rests on nurses being competent in the emergency life-saving procedure of cardiopulmonary resuscitation. The objective of the current study was to evaluate the types of trauma and survival of patients that require immediate cardiopulmonary resuscitation in trauma emergencies. A total of 13301 patients treated as accident victims between July 2004 and December 2006 were evaluated in a prospective study. Patients requiring immediate cardiopulmonary resuscitation at admission were identified. The type of injury and the survival of these patients were evaluated. Of the 65 patients included in the study, 30% had suffered from gunshot wounds, 19% had been run over, 18% had been involved in car crashes, 13% in motor cycle accidents, 9% stabbings, 1% by cycle accidents and 10% other types of accidents including burns, hangings and falls. In only 12 of these patients, immediate resuscitation was successful and procedure such as chest drainage, exploratory laparotomy and interventions in the surgical center were performed. However all patients evolved to death; eight within 24 hours, two between 24 and 48 hours and the other 2 after 48 hours. Immediate cardiopulmonary resuscitation after accidents is a sign of high mortality requiring further studies to review indication and the ethical aspects involved.

  11. The influence of biomaterials on inflammatory responses to cardiopulmonary bypass.

    Courtney, J M; Matata, B M; Yin, H Q; Esposito, A; Mahiout, A; Taggart, D P; Lowe, G D


    The nature of cardiopulmonary bypass and the complexity of the inflammatory response make the detection and interpretation of a biomaterial influence difficult. However, if mediation of the inflammatory response is considered to be an appropriate clinical goal, alteration to the biomaterial influence merits further investigation.

  12. Gastrointestinal motility during cardiopulmonary bypass : A sonomicrometric study

    Gu, YJ; de Kroon, TL; Elstrodt, JM; Rakhorst, G


    Cardiopulmonary bypass (CPB) is known to impair the integrity of the gastrointestinal tract. However, little is known about the movement behavior of the gastrointestinal tract during CPB. This study was aimed to assess the gastrointestinal motility with sonomicrometry, a distance measurement using u

  13. Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass

    Whitlock, Richard P; Chan, Simon; Devereaux, P J;


    We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality...

  14. Robotically-Assisted Coronary Artery Bypass Grafting

    Thierry A. Folliguet


    Full Text Available Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB, and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB grafting. Nine patients (16% were converted to open techniques. The mean total operating time for TECAB was 372±104 minutes and for MIDCAB was 220±69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50% in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results.

  15. Employer Branding

    Frimann, Søren; Mønsted, Bolette Rye


    Employer branding er både for den private og den offentlige sektor blevet en måde, de kan imødekomme ændrede arbejdsmarkedsvilkår og organisatoriske udfordringer i en postmoderne og globaliseret verden. Den aktuelle finanskrise har skabt nye udfordringer for organisationer i deres bestræbelser på...... at tiltrække- og fastholde attraktive medarbejdere. Men hvilken betydning har det, når Grundfos siger ”Mennesket er i fokus”, og hvad siger ”mangfoldighed” om Københavns Kommune som arbejdsplads i relation til employer branding? Er der egentlig sammenhæng mellem tankerne bag employer branding og de eksternt...... kommunikerede employer brandprodukter. Eller bliver det unikke ved arbejdspladserne ersattet af buzzwords uden substans og inddragelse af ansatte og interessenter? Artiklen har til formål at vurdere disse spørgsmål på baggrund af analyser af to cases med employer branding....

  16. Evaluation of acute ischemic mitral regurgitation following cardiopulmonary bypass assessed by biplane transesophageal echocardiography.

    Nakao, T; Fujimoto, K; Brodman, R F; Oka, Y


    The aim of this study was to evaluate pathogenesis and outcome of acute ischemic mitral regurgitation (MR) in patients undergoing coronary artery bypass grafting (CABG) using biplane transesophageal echocardiography (TEE). Biplane TEE was continuously monitored in a total of 96 patients who were scheduled for elective CABG surgery. Of 96 patients, 10 with no MR at stages 1 (after anesthetic induction but before skin incision) and 2 (after cardiopulmonary bypass [CPB] and decannulation) were excluded. In the remaining 86 patients with MR between stages 1 and 2, 45 (group A) had an increase in MR, and 41 (group B) had a decrease in MR. An increase in MR at stage 2 in group A was associated with a significant increase in annular diameter (p area (p area (p areas. In 7 patients in group A, MR increased continuously until stage 3 (after sternal closure) despite treatment. In 2 of these 7 patients, pulmonary venous systolic flow (PVSF) decreased during stage 2 and persisted to stage 3. The post operative course of these 2 patients was complicated with atrial fibrillation (AF). The increase in annular diameter and worsening in RWMA in RCA and/or LCX areas are associated with acute ischemic MR following CPB. The majority of acute ischemic MR cases were resolved by pharmacological intervention. Post operative AF was noted in 2 patients with acute ischemic MR associated with persistently decreased PVSF following CPB despite treatment.

  17. Anti-inflammatory effects of propofol during cardiopulmonary bypass: A pilot study

    A Samir


    Full Text Available Introduction: Propofol has been suggested as a useful adjunct to cardiopulmonary bypass (CPB because of its potential protective effect on the heart mediated by a decrease in ischemia-reperfusion injury and inflammation at clinically relevant concentrations. In view of these potentially protective properties, which modulate many of the deleterious mechanism of inflammation attributable to reperfusion injury and CPB, we sought to determine whether starting a low dose of propofol infusion at the beginning of CPB would decrease inflammation as measured by pro-inflammatory markers. Materials and Methods: We enrolled 24 patients undergoing elective coronary artery bypass graft (CABG. The study group received propofol at rate of 120 mcg/kg/min immediately after starting CPB and was maintained throughout the surgery and for the following 6 hours in the intensive care unit (ICU. The control group received propofol dose of 30-50 mcg/kg/min which was started at the time of chest closure with wires and continued for the next 6 hours in the ICU. Interleukins (IL -6, -8 and -10 and tumor necrosis factor alpha (TNFalpha were assayed. Result: The most significant difference was in the level of IL-6 which had a P value of less than 0.06. Starting a low dose propofol early during the CPB was not associated with significant hemodynamic instability in comparison with the control group. Conclusion: Our study shows that propofol may be suitable as an anti-inflammatory adjunct for patients undergoing CABG.

  18. Effects of hypothermia on blood endogenous endotoxin levels during cardiopulmonary bypass.

    Gerçekoglu, H; Tarim, O; Agar, I; Korukçu, A; Karabulut, H; Soydemir, H; Sokullu, O; Toklu, H; Johansson, C B; Yigiter, B; Kopman, E


    Endotoxin activates white blood cells and complement and produces a spectrum of clinical syndromes ranging from fever to septic shock. Although production of endogenous endotoxemia during cardiopulmonary bypass (CPB) has recently been reported, the role of hypothermia on endotoxemia is not clear. In this study, we evaluated the effects of moderate (24-28 degrees C) and mild (32-34 degrees C) hypothermia on blood endotoxin levels. The study population consisted of 20 patients who underwent coronary artery bypass grafting (CABG) with CPB. Moderate systemic hypothermia was applied during aortic cross-clamping in ten patients (group 1) and mild hypothermia in the remaining ten patients (group 2). The mean rectal temperatures were 26.8 +/- 1.2 degrees C in group 1 and 33.8 +/- 0.8 degrees C in group 2. The blood samples for endotoxin level measurements were obtained before CPB, during aortic cross-clamping, immediately after the release of the cross-clamp, 20 minutes after the release of the cross-clamp, after CPB, and 2 hours postoperatively. There were no endotoxins in any of the samples before CPB, but it was detected after CPB in both groups. The endotoxin levels were significantly higher in group 1 than in group 2. The present study suggests that when hypothermia is the technique of choice, the deleterious effects of endotoxemia on patients with comorbidity must be considered.

  19. Earlier application of percutaneous cardiopulmonary support rescues patients from severe cardiopulmonary failure using the APACHE III scoring system.

    Song, Suk-Won; Yang, Hong-Suk; Lee, Sak; Youn, Young-Nam; Yoo, Kyung-Jong


    Percutaneous cardiopulmonary support (PCPS) is a widely accepted treatment for severe cardiopulmonary failure. This system, which uses a percutaneous approach and autopriming devices, can be rapidly applied in emergency situations. We sought to identify the risk factors that could help predict in-hospital mortality, and to assess its outcomes in survivors. During a 2-yr period, 50 patients underwent PCPS for the treatment of severe cardiopulmonary failure, and of those, 22 (44%) were classified as survivors and 28 (56%) as non-survivors. We compared the 2 groups for risk factors of in-hospital mortality and to establish proper PCPS timing. Twenty patients underwent PCPS for acute myocardial infarction, 20 for severe cardiopulmonary failure after cardiac surgery, 7 for acute respiratory distress syndrome, and 3 for acute myocarditis. Multivariate analysis showed that an acute physiology, age, and chronic health evaluation (APACHE) III score >or=50 prior to PCPS was the only significant predictor of in-hospital mortality (P=0.001). Overall 18-month survival was 42.2%. Cox analysis showed patients with APACHE III scores >or=50 had a poor prognosis (P=0.001). Earlier application of PCPS, and other preemptive strategies designed to optimize high-risk patients, may improve patient outcomes. Identifying patients with high APACHE scores at the beginning of PCPS may predict in-hospital mortality. Survivors, particularly those with higher APACHE scores, may require more frequent follow-up to improve overall survival.

  20. [Chickenpox, burns and grafts].

    Rojas Zegers, J; Fidel Avendaño, L


    An outbreak of chickenpox that occurred at the Burns Repair Surgery Unit, Department of Children's Surgery, Hospital R. del Río, between June and November, 1975, is reported. 27 cases of burned children were studied, including analysis of correlations of the stages and outcome of the disease (varicela), the trauma (burns) and the graft (repair surgery). As a result, the authors emphasize the following findings: 1. Burns and their repair are not aggravating factors for varicella. In a small number of cases the exanthema looked more confluent in the graft surgical areas and in the first degree burns healing spontaneously. 2. Usually there was an uneventful outcome of graft repair surgery on a varicella patient, either during the incubation period, the acme or the convalescence. 3. The fact that the outmost intensity of secondary viremia of varicella occurs before the onset of exanthemia, that is, during the late incubation period, is confirmed.

  1. Alveolar bone grafting

    Lilja Jan


    Full Text Available In patients with cleft lip and palate, bone grafting in the mixed dentition in the residual alveolar cleft has become a well-established procedure. The main advantages can be summarised as follows: stabilisation of the maxillary arch; facilitation of eruption of the canine and sometimes facilitation of the lateral incisor eruption; providing bony support to the teeth adjacent to the cleft; raising the alar base of the nose; facilitation of closure of an oro-nasal fistula; making it possible to insert a titanium fixture in the grafted site and to obtain favourable periodontal conditions of the teeth within and adjacent to the cleft. The timing of the ABG surgery take into consideration not only eruption of the canine but also that of the lateral incisor, if present. The best time for bone grafting surgery is when a thin shell of bone still covers the soon erupting lateral incisor or canine tooth close to the cleft.

  2. Arteriovenous shunt graft ulceration with sinus and graft epithelialization

    Pooja Singhal


    Full Text Available Arteriovenous fistula and grafts are used as access sites for patients with chronic kidney disease and are prone for complications. Stent grafts are used to treat access site complications. We report a rare and unusual finding of epithelialization of the sinus tract and the lumen of a polytetrafluoroethylene graft, following ulceration of the overlying skin.

  3. Management of a patient with hyperkalemic periodic paralysis requiring coronary artery bypass grafts

    Sanjay Orathi Patangi


    Full Text Available Hyperkalemic periodic paralysis (HPP is an autosomal-dominant inherited muscle disease characterized by episodes of flaccid weakness and intermittent myotonia. There are no previous reports in the literature about anesthesia for cardiac surgery with cardiopulmonary bypass in this disorder. We describe perioperative anesthetic management for on-pump coronary artery bypass grafting in a 75-year-old man with a history of hyperkalemic periodic paralysis. This case report outlines our management strategy and the issues encountered during the perioperative period.

  4. Management of iatrogenic RV injury - RV packing and CPB through PTFE graft attached to femoral artery.

    Mangukia, Chirantan V; Agarwal, Saket; Satyarthy, Subodh; Aggarwal, Satish Kumar; Datt, Vishnu; Satsangi, Deepak Kumar


    Cardiac injuries during repeat sternotomy are rare. While undergoing debridement for chronic osteomyelitis (post arterial septal defect closure), a 4-year-old girl sustained significant right ventricular (RV) injury. Bleeding from the RV was controlled by packing the injury site, which helped in maintaining stable hemodynamics till arrangements were made for instituting cardiopulmonary bypass (CPB). Since the femoral artery was very small and unsuitable for direct cannulation, a polytetrafluoroethylene (PTFE) graft sutured end-to-side to the femoral artery was used for establishing CPB. The injury was successfully repaired.

  5. Cardiopulmonary Exercise Test: Background, Applicability and Interpretation.

    Herdy, Artur Haddad; Ritt, Luiz Eduardo Fonteles; Stein, Ricardo; Araújo, Claudio Gil Soares de; Milani, Mauricio; Meneghelo, Romeu Sérgio; Ferraz, Almir Sérgio; Hossri, Carlos; Almeida, Antonio Eduardo Monteiro de; Fernandes-Silva, Miguel Morita; Serra, Salvador Manoel


    Cardiopulmonary exercise test (CPET) has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: ventilation; oxygen consumption (VO2); carbon dioxide production (VCO2); and the other variables of conventional exercise testing. In addition, in specific situations, pulse oximetry and flow-volume loops during and after exertion are measured. The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion, being considered gold standard for cardiorespiratory functional assessment.1-6 The CPET allows defining mechanisms related to low functional capacity that can cause symptoms, such as dyspnea, and correlate them with changes in the cardiovascular, pulmonary and skeletal muscle systems. Furthermore, it can be used to provide the prognostic assessment of patients with heart or lung diseases, and in the preoperative period, in addition to aiding in a more careful exercise prescription to healthy subjects, athletes and patients with heart or lung diseases. Similarly to CPET clinical use, its research also increases, with the publication of several scientific contributions from Brazilian researchers in high-impact journals. Therefore, this study aimed at providing a comprehensive review on the applicability of CPET to different clinical situations, in addition to serving as a practical guide for the interpretation of that test. Resumo O teste cardiopulmonar de exercício (TCPE) vem ganhando importância crescente como método de avaliação funcional tanto no Brasil quanto no Mundo. Nas suas aplicações mais frequentes, o teste consiste em submeter o indivíduo a um exercício de intensidade gradativamente crescente até a exaustão ou o

  6. Neuroprotective Strategies during Cardiac Surgery with Cardiopulmonary Bypass

    Salameh, Aida; Dhein, Stefan; Dähnert, Ingo; Klein, Norbert


    Aortocoronary bypass or valve surgery usually require cardiac arrest using cardioplegic solutions. Although, in principle, in a number of cases beating heart surgery (so-called off-pump technique) is possible, aortic or valve surgery or correction of congenital heart diseases mostly require cardiopulmonary arrest. During this condition, the heart-lung machine also named cardiopulmonary bypass (CPB) has to take over the circulation. It is noteworthy that the invention of a machine bypassing the heart and lungs enabled complex cardiac operations, but possible negative effects of the CPB on other organs, especially the brain, cannot be neglected. Thus, neuroprotection during CPB is still a matter of great interest. In this review, we will describe the impact of CPB on the brain and focus on pharmacological and non-pharmacological strategies to protect the brain. PMID:27879647

  7. Dobutamine for inotropic support during emergence from cardiopulmonary bypass.

    Tinker, J H; Tarhan, S; White, R D; Pluth, J R; Barnhorst, D A


    Dobutamine, a recently introduced derivative of dopamine, is reported to retain inotropic properties with less pronounced chronotropic and arrhythmogenic effects than isoproterenol. The drug was evaluated in two doses, 5 mug/kg/min and 10 mug/kg/min, in two groups of ten patients each, during emergence from cardiopulmonary bypass. A third group of five patients was studied similarly with isoproterenol, 0.02 mug/kg/min. Cardiac index increased 16 and 28 per cent eith the two doses of dobutamine, respectively, and 9 per cent with isoproterenol. Heart rate, in contrast, increased 6 and 15 per cent with dobutamine (not significant) and 44 per cent with isoproterenol (significant). Dobutamine seemed to associated with fewer arrhythmias than isoproterenol. It is concluded that dobutamine, 5-10 mug/kg/min, is suitable for use during emergence from cardiopulmonary bypass and may possess advantages over isoproterenol.

  8. Role of cardiopulmonary mechanoreceptors in the postural regulation of renin

    Sanchez, R.A.; Marco, E.J.; Oliveri, C.; Otero, F.J.; Degrossi, O.; Moledo, L.I.; Julius, S.


    To change the stretch on cardiopulmonary mechanoreceptors, large shifts of blood in the capacity space were elicited by tilting and by exerting positive lower body pressure in the tilted position. Twelve volunteers underwent invasive hemodynamic studies and in 10 other subjects cardiac size was determined by radionuclide cardiography. In all 22 subjects tilting caused the expected increase of renin, which was abolished by lower body compression. Decompression caused renin to increase again. Right atrial pressure in invasive studies and end-systolic and end-diastolic counts in noninvasive studies showed a significant and strong negative correlation with renin and norepinephrine levels. Thus, the degree of stretch of the cardiopulmonary mechanoreceptors is a major determinant of reflex regulation of renin release in humans.

  9. [Virtual educational proposal in cardiopulmonary resuscitation for the neonate care].

    Gonçalves, Gilciane Ribeiro; Peres, Heloisa Helena Ciqueto; Rodrigues, Rita de Cássia; Tronchin, Daisy Maria Rizatto; Pereira, Irene Mari


    The purpose of this study was to develop an educational proposal using virtual multimedia resources, to innovate, stimulate and diversify areas of communication and interaction, facilitating nurses' autonomous and reflexive process of teaching and learning. This is an applied research, following the cyclical and interactive phases of designing, planning, developing and implementing. The educational proposal was developed on the TelEduc platform, using specific tools for content organization and communication between students and administrator. The teaching modules were on the following themes: Module 1--Fundamentals of the heart anatomy and physiology in newborns; Module 2--Risk factors for the occurrence of cardiorespiratory arrest in newborns; Module 3--Planning nursing care; Module 4--Medications used in cardiopulmonary arrests in newborns; and Module 5--Cardiorespiratory arrest care in newborns. This study may contribute to innovating teaching in nursing from a virtual educational proposal on the important issue of newborn cardiopulmonary resuscitation care.

  10. Skin grafting in severely contracted socket with the use of ′Compo′

    Betharia S


    Full Text Available The results of split thickness autologous skin grafting along with the use of a dental impression material (Compo, a thermoplastic substance are presented in a series of 11 patients of acquired, severely contracted, anophthalmic sockets. Only the fornix fixation sutures and the central tarsorrhaphy were employed for the proper placement of graft without the use of retention devices. Artificial eyes were successfully fitted and retained subsequently after 6 weeks of grafting.

  11. Clinical Practice Guidelines for Cardiopulmonary and Cerebral Resuscitation.

    Victor Rene Navarro Machado


    Full Text Available Clinical Practice Guidelines for Cardiopulmonary and Cerebral Resuscitation. It is the group of procedures that should be accomplished to restore circulation and ventilation in a patient with cardiac arrest, including actions to reintegrate upper neurological functions after restoring cardiac function. This document includes a review of concepts, aetiology and updates the main clinical aspects related with diagnosis and treatment aimed at the post-resuscitation syndrome. It includes assessment guidelines focused on the most important aspects to be accomplished.

  12. Estimation of cerebral blood flow during cardiopulmonary resuscitation in humans

    Christensen, S F; Stadeager, Carsten Preben; Siemkowicz, E


    /kg/min). The cortical CBF was found between 14 and 211 ml 100 g-1.min-1 with mean 42 ml 100 g-1.min-1 and mean white matter CBF equal to 27 ml 100 g-1.min-1. It is suggested that the external cardiac massage in humans may be of poor efficacy in terms of brain revival. Cortical CBF after long-lasting cardiopulmonary...

  13. Family presence during cardiopulmonary resuscitation and invasive procedures in children

    Ferreira, Cristiana Araujo G.; Flavia Simphronio Balbino; Balieiro,Maria Magda F. G.; Myriam Aparecida Mandetta


    Objective:To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units.Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords family, invasive procedur...

  14. Primary renal graft thrombosis

    Bakir, N; Sluiter, WJ; Ploeg, RJ; van Son, WJ; Tegzess, Adam


    Background. Renal allograft thrombosis is a serious complication of kidney transplantation that ultimately leads to graft loss. Its association with acute and hyperacute rejection is well documented; however, in a large proportion of patients the precise cause remains obscure. The exact incidence an

  15. Cardiopulmonary resuscitation and contrast media reactions in a radiology department

    O' Neill, John M.; McBride, Kieran D


    AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000.

  16. Hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass

    苏肇伉; 周成斌; 张海波; 祝忠群


    Objective To study the hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass.Methods Six pregnant ewes underwent fetal cardiopulmonary bypasses with artificial oxygenators and roller pumps for 30 minutes, which maintained the blood gas value at the fetal physiological level. The fetal blood pressure, heart rate, pH value and blood lactate levels were monitored. The levels of catecholamine, cortisol and insulin were measured pre-bypass and then again 30 minutes later. The blood glucose and free fatty acid levels were monitored continuously during the bypass. Fetal hepatic PAS staining was also carried out.Results There were no changes before and during the bypass in fetal blood pressure, heart rate and blood gas. However, pH values decreased and blood lactate levels increased (P<0.05). The fetal catecholamine and cortisol levels increased significantly (P<0.01), while the levels of insulin did not change. The blood glucose and free fatty acid levels increased at the beginning of the bypass (P<0.01), and then gradually slowed down during the bypass. The fetal hepatic PAS staining showed that hepatic glycogen was consumed in large amounts. After 30 minutes of bypass, the fetal lamb would not survive more than 1 hour.Conclusion The fetal lamb has a strong negative reaction to cardiopulmonary bypass.

  17. Cardiopulmonary Exercise Capacity and Preoperative Markers of Inflammation

    Pervez Sultan


    Full Text Available Explanatory mechanisms for the association between poor exercise capacity and infections following surgery are underexplored. We hypothesized that aerobic fitness—assessed by cardiopulmonary exercise testing (CPET—would be associated with circulating inflammatory markers, as quantified by the neutrophil-lymphocyte ratio (NLR and monocyte subsets. The association between cardiopulmonary reserve and inflammation was tested by multivariable regression analysis with covariates including anaerobic threshold (AT and malignancy. In a first cohort of 240 colorectal patients, AT was identified as the sole factor associated with higher NLR (P=0.03 and absolute and relative lymphopenia (P=0.01. Preoperative leukocyte subsets and monocyte CD14+ expression (downregulated by endotoxin and indicative of chronic inflammation were also assessed in two further cohorts of age-matched elective gastrointestinal and orthopaedic surgical patients. Monocyte CD14+ expression was lower in gastrointestinal patients (n=43 compared to age-matched orthopaedic patients (n=31. The circulating CD14+CD16− monocyte subset was reduced in patients with low cardiopulmonary reserve. Poor exercise capacity in patients without a diagnosis of heart failure is independently associated with markers of inflammation. These observations suggest that preoperative inflammation associated with impaired cardiorespiratory performance may contribute to the pathophysiology of postoperative outcome.

  18. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis.

    Soeda, Rie; Taniguchi, Fumika; Sawada, Maiko; Hamaoka, Saeko; Shibasaki, Masayuki; Nakajima, Yasufumi; Hashimoto, Satoru; Sawa, Teiji; Nakayama, Yoshinobu


    A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.

  19. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis

    Rie Soeda


    Full Text Available A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.

  20. Novel blood sampling method of an artificial endocrine pancreas via the cardiopulmonary bypass circuit.

    Kawahito, Shinji; Higuchi, Seiichi; Mita, Naoji; Kitagawa, Tetsuya; Kitahata, Hiroshi


    We tried to perform continuous blood glucose monitoring during cardiovascular surgery involving cardiopulmonary bypass using an artificial endocrine pancreas (STG-22 or -55; Nikkiso, Tokyo, Japan); however, we often encountered problems during these procedures because insufficient blood was obtained for monitoring. Thus, we started performing the blood sampling via the venous side of the cardiopulmonary bypass circuit. As a result, continuous blood glucose monitoring using an artificial endocrine pancreas was proven to be stable and reliable during cardiovascular surgery involving cardiopulmonary bypass.

  1. New membranes obtained by grafted irradiated PVDF foils

    Mazzei, R. [Unidad de Actividades Tecnologicas y Agropecuarias, Laboratorio de Polimeros, Comision Nacional de Energia Atomica, Buenos Aires (Argentina); Universidad Tecnologica Nacional Facultad Regional, Buenos Aires (Argentina); Garcia Bermudez, G. [Gerencia de Investigacion y Aplicaciones, Laboratorio Tandar, Comision Nacional de Energia Atomica, Buenos Aires (Argentina); Escuela de Ciencia y Tecnologia, Universidad Nacional de General San Martin, Buenos Aires (Argentina); Consejo Nacional de Investigaciones Cientificas y Tecnicas, Buenos Aires (Argentina); Camporotondi, D.E., E-mail: [Unidad de Actividades Tecnologicas y Agropecuarias, Laboratorio de Polimeros, Comision Nacional de Energia Atomica, Buenos Aires (Argentina); Arbeitman, C. [Gerencia de Investigacion y Aplicaciones, Laboratorio Tandar, Comision Nacional de Energia Atomica, Buenos Aires (Argentina); Consejo Nacional de Investigaciones Cientificas y Tecnicas, Buenos Aires (Argentina); and others


    The present work describes a new method to produce membranes of poly(Acrylic-acid-Xmonomer) using the grafting procedure. PVDF foils irradiated with Ar{sup +} beam with energies between 30 and 150 keV were employed as substratum. Different combinations of monomers in water solutions were used: acrylic acid (AAc); acrylic acid-glycidyl methacrylate (AAc-GMA); acrylic acid-styrene (AAc-S), acrylic acid-N-isopropyl acrylamide (AAc-NIPAAm) and acrylic acid-N-isopropyl acrylamide-glycidyl methacrylate (AAc-NIPAAm-GMA). A large percentage of grafting results for specific values of: ion fluence and energy, AAc and sulfuric acid concentration, and different substrata PVDF polymorphous (alpha or beta). At a particular time of the grafting process, the poly(AAc-Xmonomer) membranes detach from the substratum and continue their grafting in the solution. This method is useful to produce increased replicated membranes of the irradiated original surface.

  2. Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes

    Bartholomay Eduardo


    Full Text Available OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58% patients, and 42 (28% were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 months was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95% confidence interval [CI] = 2.7-13.6, when the initial rhythm was VF/VT; 9.4 (95% CI = 4.1-21.3, when the time of cerebral cardiopulmonary resuscitation was 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis.

  3. [Grafting of carotid arteries].

    Belov, Iu V; Stepanenko, A B; Gens, A P; Bazylev, V V; Seleznev, M N; Savichev, D D


    Over 5-years, 167 reconstructive surgeries for stenosis of internal carotid arteries (ICA) were performed in 124 patients. Mean age of the patients was 63.5 years. One hundred and twenty-nine carotid endarterectomies (CEAE) in 86 patients and 38 reconstructive operations of ICA in 38 patients were performed. There were no lethal outcomes in short- and long-term postoperative period. In short-term period after prosthesis of ICA restenosis was revealed in 3% patients, after eversion CEAE in 3% patients the embolism was seen, after standard CEAE restenosis were diagnosed in 8% patients and thrombosis -- in 3%. In long-term period after grafting of ICA the strokes were seen in 3%, stenosis -- in 6% patients, after eversion endarterectomy -- in 0 and 3% patients, and after standard CEAE -- in 3 and 24% patients, respectively. It is concluded that grafting of ICA is adequate surgical method of reconstruction and stroke prevention in specific variants of carotid atherosclerosis.

  4. Buccal Mucosal Graft Urethroplasty

    Angela M. Arlen


    Full Text Available At our institution, the majority of buccal mucosal graft urethroplasties are performed using a two-team approach with an otolaryngologic surgeon. We report our two-surgeon experience with buccal mucosal grafting for reconstruction of all anterior urethral strictures. Twenty-four men underwent autologous buccal mucosal graft urethroplasty between October 2001 and September 2008 for recurrent urethral stricture disease. Twenty-two underwent a single-stage repair and two underwent a two-stage repair. Medical charts were retrospectively reviewed for demographics, comorbidities, etiology, location and length of stricture, and prior interventions in order to identify predictors of buccal urethroplasty success, defined as no evidence of stricture recurrence. All patients underwent retrograde urethrogram and cystoscopy. Operative and anesthesia times were evaluated. We determined an overall success rate of 83.3% (20 of 24 cases. Mean anesthesia time for single-stage urethroplasty was 155 min and mean operative time was 123 min. One of the two two-stage urethroplasties experienced stricture recurrence (50%. The single-stage buccal graft success rate was 86.4% (19 of 22 cases. Two of the four who developed recurrent stricture disease that required intervention had undergone a previous mesh urethroplasty. Complications developed in four of 24 patients (16.6%, including superficial wound infection (one, superficial wound dehiscence (two, and abscess/fistula formation requiring reoperation (one. The buccal mucosa is an ideal tissue for both single- and two-stage substitution urethroplasty for patients with recurrent stricture disease. Our two-surgeon technique minimizes anesthesia and operative times, and contributes to the overall high success rate and relatively low complication rate.

  5. Effect of lornoxicam in lung inflammatory response syndrome after operations for cardiac surgery with cardiopulmonary bypass

    Tsakiridis, Kosmas; Vretzkakis, Giorgos; Mikroulis, Dimitris; Mpakas, Andreas; Kesisis, Georgios; Arikas, Stamatis; Kolettas, Alexandros; Moschos, Giorgios; Katsikogiannis, Nikolaos; Machairiotis, Nikolaos; Tsiouda, Theodora; Siminelakis, Stavros; Beleveslis, Thomas; Zarogoulidis, Konstantinos


    Background The establishment of Extracorporeal Circulation (EC) significantly contributed to improvement of cardiac surgery, but this is accompanied by harmful side-effects. The most important of them is systemic inflammatory response syndrome. Many efforts have been undertaken to minimize this problem but unfortunately without satisfied solution to date. Materials and methods Lornoxicam is a non steroid anti-inflammatory drug which temporally inhibits the cycloxygenase. In this clinical trial we study the effect of lornoxicam in lung inflammatory response after operations for cardiac surgery with cardiopulmonary bypass. In our study we conclude 14 volunteers patients with ischemic coronary disease undergoing coronary artery bypass grafting with EC. In seven of them 16 mg lornoxicam was administered iv before the anesthesia induction and before the connection in heart-lung machine. In control group (7 patients) we administered the same amount of normal saline. Results Both groups are equal regarding pro-operative and intra-operative parameters. The inflammatory markers were calculated by Elisa method. We measured the levels of cytokines (IL-6, IL-8, TNF-a), adhesion molecules (ICAM-1, e-Selectin, p-Selectin) and matrix metaloproteinase-3 (MMP-3) just after anesthesia induction, before and after cardiopulmonary bypass, just after the patients administration in ICU and after 8 and 24 hrs. In all patients we estimated the lung’s inflammatory reaction with lung biopsy taken at the begging and at the end of the operation. We calculated hemodynamics parameters: Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Pulmonary Vascular Resistance Index (PVRI), Left Ventricular Stroke Work Index (LVSWI), Right Ventricular Stroke Work Index (RVSWI), and the Pulmonary arterial pressure, and respiratory parameters too: alveolo-arterial oxygen difference D (A-a), intrapulmonary shunt (Qs/Qt) and pulmonary Compliance. IL-6 levels of lornoxicam group were statistical

  6. Myocardial revascularization in the elderly patient: with or without cardiopulmonary bypass?

    Iglézias José Carlos Rossini


    Full Text Available OBJECTIVE: To verify if there is advantage in myocardial revascularization the elderly without cardiopulmonary bypass (CPB in relation to the use of the same, being considered the viability of complete myocardial revascularization (MR and the hospital morbidity and mortality. METHOD: We prospectively studied a hundred consecutive, no randomized patients, with age > or = 70 years, submitted to the primary and isolated myocardial revascularization between January and December of 2000. The patients were divided in two groups, G1 - 50 patients operated with CPB and G2 - 50 patients operated without CPB. Univariate testing of variables was performed with chi-squared analysis in the SPSS 10.0 Program and a p value less than 0.005 was considered significant. RESULTS: There was no renal failure or myocardial infarction (MI in both groups; the incidence of respiratory failure was identical in the two groups (4%; two patient of G1 they had Strokes, and 12 presented low output syndrome, occurrences not registered in G2. The need of ventilatory support > 24 hs was not significant between groups. Medium time of hospital stay was 21.8 and 11.7 days respectively (NS and the survival after 30 days were similar in the two groups. The patients' of G1 eighty percent had more than two approached arteries, against only 48% of G2 (p < 0.0001. CONCLUSION: Because the largest number of grafts in the patients of G1, we can affirm that the use of CPB can provide a larger probability of complete RM.

  7. Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery.

    Carmona, M J C; Malbouisson, L M S; Pereira, V A; Bertoline, M A; Omosako, C E K; Le Bihan, K B; Auler Jr, J O C; Santos, S R C J


    The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB), resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG) by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 +/- 8 years, mean weight 75.4 +/- 11.9 kg and mean body surface area 1.83 +/- 0.19 m(2)), receiving propranolol before surgery (80-240 mg a day) and postoperatively (10 mg a day). Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9) to 10.6 h (95% CI = 8.2-14.7; P < 0.01) and an increase in volume of distribution from 4.9 (95% CI = 3.2-14.3) to 8.3 l/kg (95% CI = 6.5-32.1; P < 0.05), while total clearance remained unchanged 9.2 (95% CI = 7.7-24.6) vs 10.7 ml min(-1) kg(-1) (95% CI = 7.7-26.6; NS) after surgery. In conclusion, increases in drug distribution could be explained in part by hemodilution during CPB. On the other hand, the increase of biological half-life can be attributed to changes in hepatic metabolism induced by CPB under moderate hypothermia. These alterations in the pharmacokinetics of propranolol after CABG with hypothermic CPB might induce a greater myocardial depression in response to propranolol than would be expected with an equivalent dose during the postoperative period.

  8. Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass

    Rodrigues, R.R.; Sawada, A.Y.; Fukuda, M.J.; Neves, F.H.; Carmona, M.J.; Auler, J.O.; Malbouisson, L.M.S., E-mail: malbouisson@hcnet.usp.b [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Hospital das Clinicas; Pelosi, P. [Universita' degli Studi dell' Insubria, Varese (Italy). Dipt. Ambiente, Salute e Sicurezza; Rouby, J.-J. [University Pierre and Marie Curie, Paris (France). La Pitie Salpetriere Hospital. Dept. of Anesthesiology and Critical Care and Medicine


    Hypoxemia is a frequent complication after coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB), usually attributed to atelectasis. Using computed tomography (CT), we investigated postoperative pulmonary alterations and their impact on blood oxygenation. Eighteen non-hypoxemic patients (15 men and 3 women) with normal cardiac function scheduled for CABG under CPB were studied. Hemodynamic measurements and blood samples were obtained before surgery, after intubation, after CPB, at admission to the intensive care unit, and 12, 24, and 48 h after surgery. Pre- and postoperative volumetric thoracic CT scans were acquired under apnea conditions after a spontaneous expiration. Data were analyzed by the paired Student t-test and one-way repeated measures analysis of variance. Mean age was 63 {+-} 9 years. The PaO{sub 2}/FiO{sub 2} ratio was significantly reduced after anesthesia induction, reaching its nadir after CPB and partially improving 12 h after surgery. Compared to preoperative CT, there was a 31% postoperative reduction in pulmonary gas volume (P < 0.001) while tissue volume increased by 19% (P < 0.001). Non-aerated lung increased by 253 {+-} 97 g (P < 0.001), from 3 to 27%, after surgery and poorly aerated lung by 72 {+-} 68 g (P < 0.001), from 24 to 27%, while normally aerated lung was reduced by 147 {+-} 119 g (P < 0.001), from 72 to 46%. No correlations (Pearson) were observed between PaO{sub 2}/FiO{sub 2} ratio or shunt fraction at 24 h postoperatively and postoperative lung alterations. The data show that lung structure is profoundly modified after CABG with CPB. Taken together, multiple changes occurring in the lungs contribute to postoperative hypoxemia rather than atelectasis alone. (author)

  9. Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery

    Carmona M.J.C.


    Full Text Available The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB, resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 ± 8 years, mean weight 75.4 ± 11.9 kg and mean body surface area 1.83 ± 0.19 m², receiving propranolol before surgery (80-240 mg a day and postoperatively (10 mg a day. Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9 to 10.6 h (95% CI = 8.2-14.7; P < 0.01 and an increase in volume of distribution from 4.9 (95% CI = 3.2-14.3 to 8.3 l/kg (95% CI = 6.5-32.1; P < 0.05, while total clearance remained unchanged 9.2 (95% CI = 7.7-24.6 vs 10.7 ml min-1 kg-1 (95% CI = 7.7-26.6; NS after surgery. In conclusion, increases in drug distribution could be explained in part by hemodilution during CPB. On the other hand, the increase of biological half-life can be attributed to changes in hepatic metabolism induced by CPB under moderate hypothermia. These alterations in the pharmacokinetics of propranolol after CABG with hypothermic CPB might induce a greater myocardial depression in response to propranolol than would be expected with an equivalent dose during the postoperative period.

  10. Kinetics and sites of sequestration of indium 111-labeled human platelets during cardiopulmonary bypass

    Hope, A.F.; Heyns, A.D.; Loetter, M.G.; van Reenen, O.R.; de Kock, F.; Badenhorst, P.N.; Pieters, H.; Kotze, H.; Meyer, J.M.; Minnaar, P.C.


    A new approach for the study of the kinetics and quantification of the in vivo and ex vivo sites of sequestration of platelets during cardiopulmonary bypass (CPB) is described. Autologous platelets of four patients were labeled with /sup 111/In-oxine and reinfused on the day prior to CPB for coronary artery bypass grafting. Changes in blood /sup 111/In-labeled platelet radioactivity and blood platelet counts were monitored during the operation. In vivo /sup 111/In-labeled platelet redistribution was quantified with a scintillation camera and a computer-assisted imaging system before and after CPB. Sequestration of /sup 111/In-labeled platelets in the bubble oxygenator was measured. /sup 111/In-labeled platelet activity in the blood decreased by 46% +/- 5% within 5 minutes of CPB, but this decrease was mostly due to hemodilution; the true loss of platelets from the circulation was 13% +/- 4%. Intraoperatively, whole body /sup 111/In activity decreased by oxygenator 10.8% +/- 1.3% of administered platelets were sequestered, especially in the innermost active layers of the defoaming mesh of the bubble oxygenator. Mean survival time of circulating platelets was 58 +/- 8 hours and fitted an exponential function best. The bleeding time increased to 40 minutes during operation and returned to normal within 24 hours. During operation /sup 111/In-labeled platelets accumulated somewhat in the liver (10.7%) but not in the spleen, thorax, or head. In the 48 hours after operation, platelets were sequestered mainly in the liver. The scintillation camera with computer-assisted imaging allows in vivo quantitative studies of platelet kinetics of a type which has not been possible with previous techniques.

  11. [Serum immune complexes and cardiopulmonary bypass. A review of thirty-four cases (author's transl)].

    Herreman, G; Poisson-Lespassailles, C; Puech, H; Vanetti, A; Delaunay, L; Yvart, J; Fermé, I


    The immunologic status of patients undergoing cardiopulmonary bypass as investigated. Rheumatoid factor, cryoglobulinemia and serum immune complexes were looked for. Studies were performed before the operation and eight or fifteen days later. From the results, it is concluded that the immunologic changes that occur in the immediate postoperative period cannot be interpreted because of the profound modifications resulting from cardiopulmonary bypass.

  12. Chronic and acute effects of coal tar pitch exposure and cardiopulmonary mortality among aluminum smelter workers.

    Friesen, Melissa C; Demers, Paul A; Spinelli, John J; Eisen, Ellen A; Lorenzi, Maria F; Le, Nhu D


    Air pollution causes several adverse cardiovascular and respiratory effects. In occupational studies, where levels of particulate matter and polycyclic aromatic hydrocarbons (PAHs) are higher, the evidence is inconsistent. The effects of acute and chronic PAH exposure on cardiopulmonary mortality were examined within a Kitimat, Canada, aluminum smelter cohort (n = 7,026) linked to a national mortality database (1957-1999). No standardized mortality ratio was significantly elevated compared with the province's population. Smoking-adjusted internal comparisons were conducted using Cox regression for male subjects (n = 6,423). Ischemic heart disease (IHD) mortality (n = 281) was associated with cumulative benzo[a]pyrene (B(a)P) exposure (hazard ratio = 1.62, 95% confidence interval: 1.06, 2.46) in the highest category. A monotonic but nonsignificant trend was observed with chronic B(a)P exposure and acute myocardial infarction (n = 184). When follow-up was restricted to active employment, the hazard ratio for IHD was 2.39 (95% confidence interval: 0.95, 6.05) in the highest cumulative B(a)P category. The stronger associations observed during employment suggest that risk may not persist after exposure cessation. No associations with recent or current exposure were observed. IHD was associated with chronic (but not current) PAH exposure in a high-exposure occupational setting. Given the widespread workplace exposure to PAHs and heart disease's high prevalence, even modest associations produce a high burden.

  13. Popular Hybrid Congenital Heart Procedures without Cardiopulmonary Bypass

    Gupta, Aamisha; Amin, Zahid


    As surgical and catheter interventions advance, patients with congenital heart disease are now offered alternative treatment options that cater to their individual needs. Furthermore, collaboration between interventional cardiologists and cardiac surgeons have led to the development of hybrid procedures, using the best techniques of each respective field to treat these complex cardiac entities from initial treatment in the pediatric patient to repeat intervention in the adult. We present a review of the increased popularity and trend in hybrid procedures in congenital heart disease without the use of cardiopulmonary bypass.

  14. [CPR--guidelines 2000. New international guidelines for cardiopulmonary resuscitation].

    Gervais, H W


    The "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An International Consensus an Science" are the first true international CPR guidelines in the history of resuscitation medicine. Experts from major international resuscitation organizations (International Liaison Committee on Resuscitation, ILCOR) achieved a consensus of recommendations which had to pass a rigorous review procedure applying the tools of evidence-based medicine: all proposed guidelines or guideline changes had to be based on critically appraised pieces of evidence which had to be integrated into a final class of recommendations. The most important changes compared to previous recommendations from either the European Resuscitation Council or the American Heart Association are presented and commented upon.

  15. A method of automatic control procedures cardiopulmonary resuscitation

    Bureev, A. Sh.; Zhdanov, D. S.; Kiseleva, E. Yu.; Kutsov, M. S.; Trifonov, A. Yu.


    The study is to present the results of works on creation of methods of automatic control procedures of cardiopulmonary resuscitation (CPR). A method of automatic control procedure of CPR by evaluating the acoustic data of the dynamics of blood flow in the bifurcation of carotid arteries and the dynamics of air flow in a trachea according to the current guidelines for CPR is presented. Evaluation of the patient is carried out by analyzing the respiratory noise and blood flow in the interspaces between the chest compressions and artificial pulmonary ventilation. The device operation algorithm of automatic control procedures of CPR and its block diagram has been developed.

  16. Extracorporeal membrane oxygenation support in post-traumatic cardiopulmonary failure

    Lin, Chun-Yu; Tsai, Feng-Chun; Lee, Hsiu-An; Tseng, Yuan-His


    Abstract Patients with multiple traumas associated with cardiopulmonary failure have a high mortality rate; however, such patients can be temporarily stabilized using extracorporeal membrane oxygenation (ECMO), providing a bridge to rescue therapy. Using a retrospective study design, we aimed to clarify the prognostic factors of post-traumatic ECMO support. From March 2006 to July 2016, 43 adult patients (mean age, 37.3 ± 15.2 years; 7 females [16.3%]) underwent ECMO because of post-traumatic cardiopulmonary failure. Pre-ECMO demographics, peri-ECMO events, and post-ECMO recoveries were compared between survivors and nonsurvivors. The most common traumatic insult was traffic collision (n = 30, 69.8%), and involved injury areas included the chest (n = 33, 76.7%), head (n = 14, 32.6%), abdomen (n = 21, 48.8%), and fractures (n = 21, 48.8%). Fifteen patients (34.9%) underwent cardiopulmonary resuscitation and 22 (51.2%) received rescue interventions before ECMO deployment. The mean time interval between trauma and ECMO was 90.6 ± 130.1 hours, and the mode of support was venovenous in 26 patients (60.5%). A total of 26 patients (60.5%) were weaned off of ECMO and 22 (51.6%) survived to discharge, with an overall mean support time of 162.9 ± 182.7 hours. A multivariate regression analysis identified 2 significant predictors for in-hospital mortality: an injury severity score (ISS) >30 (odds ratio [OR], 9.48; 95% confidence interval [CI], 1.04–18.47; P = 0.042), and the requirement of renal replacement therapy (RRT) during ECMO (OR, 8.64; 95% CI, 1.73–26.09; P = 0.020). These two factors were also significant for the 1-year survival (ISS >30: 12.5%; ISS ≤30, 48.1%, P = 0.001) (RRT required, 15.0%; RRT not required, 52.2%, P = 0.006). Using ECMO in selected traumatized patients with cardiopulmonary failure can be a salvage therapy. Prompt intervention before shock-impaired systemic organ perfusion and acute

  17. Effect of hydrophilicity of end-grafted polymers on protein adsorption behavior: A Monte Carlo study.

    Han, Yuanyuan; Jin, Jing; Cui, Jie; Jiang, Wei


    Monte Carlo simulation is employed to investigate protein adsorption behavior on end-grafted polymers. The effect of hydrophilicity of end-grafted polymers on protein adsorption behavior is investigated in detail. The simulation results indicate that the hydrophilicity of the end-grafted polymers can affect both the amount and speed of protein adsorption. An increase in the hydrophilicity of the end-grafted polymers can significantly decrease the amount and speed of protein adsorption first. However, a further increase in the hydrophilicity of the end-grafted polymers results in the increase in the amount and speed of protein adsorption. This phenomenon is easier to be observed in the end-grafted polymer systems with lower grafting density and longer chain length. In addition, the investigation of the chain conformation of the end-grafted polymers reveals that the end-grafted polymers with mediate hydrophilicity have relatively small size difference along the parallel and perpendicular directions to the substrate, and these end-grafted polymers have relatively wide height distribution. Such characteristics favor covering the space above the hydrophobic substrate and thus can effectively resist protein adsorption.

  18. [Frenectomy associated with a triangular gingival graft].

    Borghetti, A; Guy, J P; Cesano, B


    In periodontal therapy, frenectomy is indicated when the frenum exerts tension on the gingival margin and interferes with proper oral hygiene. The procedure is also employed when the frenum prevents closure of a diastema during orthodontic therapy. Frenectomy should be done after the canines have erupted and before retention is started to prevent separation of the teeth. For an improved surgical and cosmetic result, the authors propose a triangular-shaped gingival graft after the frenum has been excised. The advantage of the procedure is to create an area of attached gingiva and enhance healing.

  19. Cardiopulmonary exercise testing in the evaluation of high risk patients with lung cancer

    MAO You-sheng; WANG Yong-gang; HUANG Jin-feng; HE Jie; YAN Shao-ping; Dong Jing-si; CHENG Gui-yu; SUN Ke-lin; LIU Xiang-yang; FANG De-kang; LI Jian


    Background It is still unclear whether pulmonary function tests (PFTs) are sufficient for predicting perioperative risk,and whether all patients or only a subset of them need a cardiopulmonary exercise test (CPET) for further assessment.Thus, this study was designed to evaluate the CPET and compare the results of CPET and conventional PFTs to identify which parameters are more reliable and valuable in predicting perioperative risks for high risk patients with lung cancer.Methods From January 2005 to August 2008, 297 consecutive lung cancer patients underwent conventional PFTs (spirometry + single-breath carbon monoxide diffusing capacity of the lungs (DLCOsb) for diffusion capacity) and CPET preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET was retrospectively analyzed using the chi-square test, independent sample t test and binary Logistic regression analysis.Results Of the 297 patients, 78 did not receive operation due to advanced disease stage or poor cardiopulmonary function. The remaining 219 underwent different modes of operations. Twenty-one cases were excluded from this study due to exploration alone (15 cases) and operation-related complications (6 cases). Thus, 198 cases were eligible for evaluation. Fifty of the 198 patients (25.2%) had postoperative cardiopulmonary complications. Three patients (1.5%)died of complications within 30 postoperative days. The patients were stratified into groups based on VO2max/pred respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with cardiopulmonary complications were significantly correlated with age, comorbidities, and poor PFT and CPET results.used to stratify the patients' cardiopulmonary function status and to predict the risk of postoperative cardiopulmonary predicting perioperative risk. If available, cardiopulmonary exercise testing is strongly suggested for high-risk lung cancer patients in

  20. Myocardial contractile function in survived neonatal piglets after cardiopulmonary bypass

    Popov Aron-Frederik


    Full Text Available Abstract Background Hemodynamic function may be depressed in the early postoperative stages after cardiac surgery. The aim of this study was the analysis of the myocardial contractility in neonates after cardiopulmonary bypass (CPB and mild hypothermia. Methods Three indices of left ventricular myocardial contractile function (dP/dt, (dP/dt/P, and wall thickening were studied up to 6 hours after CPB in neonatal piglets (CPB group; n = 4. The contractility data were analysed and then compared to the data of newborn piglets who also underwent median thoracotomy and instrumentation for the same time intervals but without CPB (non-CPB group; n = 3. Results Left ventricular dP/dtmax and (dP/dtmax/P remained stable in CPB group, while dP/dtmax decreased in non-CPB group 5 hours postoperatively (1761 ± 205 mmHg/s at baseline vs. 1170 ± 205 mmHg/s after 5 h; p max and (dP/dtmax/P there were no statistically significant differences between the two groups. Comparably, although myocardial thickening decreased in the non-CPB group the differences between the two groups were not statistically significant. Conclusions The myocardial contractile function in survived neonatal piglets remained stable 6 hours after cardiopulmonary bypass and mild hypothermia probably due to regional hypercontractility.

  1. Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock.

    Motawea, Mohamad; Al-Kenany, Al-Sayed; Hosny, Mostafa; Aglan, Omar; Samy, Mohamad; Al-Abd, Mohamed


    "Electrical shock is the physiological reaction or injury caused by electric current passing through the human body. It occurs upon contact of a human body part with any source of electricity that causes a sufficient current through the skin, muscles, or hair causing undesirable effects ranging from simple burns to death." Ventricular fibrillation is believed to be the most common cause of death after electrical shock. "The ideal duration of cardiac resuscitation is unknown. Typically prolonged cardiopulmonary resuscitation is associated with poor neurologic outcomes and reduced long term survival. No consensus statement has been made and traditionally efforts are usually terminated after 15-30 minutes." The case under discussion seems worthy of the somewhat detailed description given. It is for a young man who survived after 65 minutes after electrical shock (ES) after prolonged high-quality cardiopulmonary resuscitation (CPR), multiple defibrillations, and artificial ventilation without any sequelae. Early start of adequate chest compressions and close adherence to advanced cardiac life support protocols played a vital role in successful CPR.

  2. Gravity and the evolution of cardiopulmonary morphology in snakes.

    Lillywhite, Harvey B; Albert, James S; Sheehy, Coleman M; Seymour, Roger S


    Physiological investigations of snakes have established the importance of heart position and pulmonary structure in contexts of gravity effects on blood circulation. Here we investigate morphological correlates of cardiopulmonary physiology in contexts related to ecology, behavior and evolution. We analyze data for heart position and length of vascular lung in 154 species of snakes that exhibit a broad range of characteristic behaviors and habitat associations. We construct a composite phylogeny for these species, and we codify gravitational stress according to species habitat and behavior. We use conventional regression and phylogenetically independent contrasts to evaluate whether trait diversity is correlated with gravitational habitat related to evolutionary transitions within the composite tree topology. We demonstrate that snake species living in arboreal habitats, or which express strongly climbing behaviors, possess relatively short blood columns between the heart and the head, as well as relatively short vascular lungs, compared to terrestrial species. Aquatic species, which experience little or no gravity stress in water, show the reverse - significantly longer heart-head distance and longer vascular lungs. These phylogenetic differences complement the results of physiological studies and are reflected in multiple habitat transitions during the evolutionary histories of these snake lineages, providing strong evidence that heart-to-head distance and length of vascular lung are co-adaptive cardiopulmonary features of snakes.

  3. Hypothermia and normothermia effects on mortality rate of cardiopulmonary bypass

    Ali Rahdari


    Full Text Available Introduction: Cardiopulmonary bypass is associated with higher risk of mortality and morbidity, thus it should be investigated regarding the major risk factors. Temperature management have a significant role in postoperative cerebral and neurological complications; however the optimum temperature during cardiopulmonary surgery is not certainly detected. This systematic review has investigated the differences between hypothermia and normothermia regarding postoperative mortality. Method: PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding in-hospital patient deaths provided in each article mostly within 30 days after the surgery, were extracted and compared based on relative risk reduction (RRR, absolute risk reduction (ARR, and number needed to treat (NNT.Result: Totally, 28 articles were retrieved and extracted. The mortality rate was zero in hypothermic and normotehrmic groups of 8/28 included studies, thus the RRR, ARR, and NNT could not be calculated. There were no significant differences between investigated groups of each included studies regarding the patients’ age, gender, and preoperative conditions.Conclusions: No significant difference was obtained between two studied groups. Similar prevalence of death observed between hypothermic and normothermic groups might be due to the sample size of studies, or the subsequent cares performed in intensive care units that assist to reduce the postoperative mortality rate. According to the obtained results, both of these procedures might be similarly safe regarding mortality rate.

  4. Postgraduate Education for Physical Therapists at Cardiopulmonary Area in Colombia

    Diana Durán Palomino


    Full Text Available This paper presents the supply of postdegreeprograms in the cardiopulmonary area in Colombiain orden to show its state and sufficiency.Plans of formation, objectives, curricular approach,methodology and profile of performanceare analyzed in terms of costs, duration,supply, location and research capabilities.Our results show problems in regard to supplyas well as unanimous criteria and strategic alliances.There are no Gremial associations thatfavor both discussion and analysis about epidemiologistaspects of respiratory and cardiovasculardiseases in Colombia there is necessityof professionals in this area with experience.Knowledge and appropiated skills in management,administration, laws, agreements andpublic policies that cover the affected population.Also, it is exposed that the Universities whitthis programs require support and pursuit forprofessionals positioning both in national andinternational context.MethodologyA descriptive study was carried out with a datacollection made in a period between April-Decemberof 2006. Cards were done and they allowedto review different aspects such as costs,occupational profile, duration, modality, methodology,practical component and evaluation inthe offering universities of programs of postdegreein the cardiopulmonary area for physiotherapists.Later an analysis was made oncurriculum, profiles, objectives, contents, professionalcompetitions the areas of research.

  5. Effects of resistance exercise on cardiopulmonary factors in sedentary individuals.

    Janyacharoen, Taweesak; Thayon, Methiya; Bushong, Wanwisa; Jaikla, Nussamol; Sawanyawisuth, Kittisak


    [Purpose] This study investigated the effects of resistance exercise on cardiopulmonary functions in young sedentary subjects. [Subjects] Forty-two young and healthy subjects with a sedentary lifestyle were included in this study. [Methods] The subjects were randomly divided into 2 groups: control and experimental. The control group (n=21) received health education and continued with normal activities of daily living. The experimental group (n=21) underwent resistance training, health education, and continued with normal activities of daily living. The resistance exercise program consisted of 3 postural exercises: chest press, dumbbell pullover, and flat-bench dumbbell fly. The subjects received this intervention 3 times/week for 8 weeks. [Results] The baseline characteristics were comparable between the 2 groups. The 6-minute-walk test score, peak expiratory flow, forced vital capacity, forced expiratory volume in 1 second, maximal voluntary ventilation, and chest expansions were significantly improved post-intervention in the experimental group and between the 2 groups. [Conclusion] Cardiopulmonary functions in young sedentary subjects were significantly improved with the 8-week resistance exercise program.

  6. Suction blister grafting - Modifications for easy harvesting and grafting


    Full Text Available Suction blister grafting is a simple modality of treatment of patients with resistant and stable vitiligo. But raising the blisters may be time consuming and transferring to the recipient site may be difficult as the graft is ultrathin. By doing some modifications we can make the technique simpler and easier. We can decrease the blister induction time by intradermal injection of saline, exposure to Wood′s lamp, intrablister injection of saline. By these methods we can decrease the blister induction time from 2-3 hrs to 45-90 minutes. After harvesting the graft, it can be transferred to the recipient area by taking the graft on a sterile glass slide, on the gloved finger, rolling the graft over a sterile syringe and then spreading on the recipient area, or taking on the sterile wrapper of paraffin dressing and then placing over the recipient area.

  7. Graft selection in cerebral revascularization.

    Baaj, Ali A; Agazzi, Siviero; van Loveren, Harry


    Cerebral revascularization constitutes an important treatment modality in the management of complex aneurysms, carotid occlusion, tumor, and moyamoya disease. Graft selection is a critical step in the planning of revascularization surgery, and depends on an understanding of graft and regional hemodynamics, accessibility, and patency rates. The goal of this review is to highlight some of these properties.

  8. Polyether/Polyester Graft Copolymers

    Bell, Vernon L., Jr.; Wakelyn, N.; Stoakley, D. M.; Proctor, K. M.


    Higher solvent resistance achieved along with lower melting temperature. New technique provides method of preparing copolymers with polypivalolactone segments grafted onto poly (2,6-dimethyl-phenylene oxide) backbone. Process makes strong materials with improved solvent resistance and crystalline, thermally-reversible crosslinks. Resulting graft copolymers easier to fabricate into useful articles, including thin films, sheets, fibers, foams, laminates, and moldings.

  9. Impact of the initial classic section during a simulated cross-country skiing skiathlon on the cardiopulmonary responses during the subsequent period of skate skiing.

    Mourot, Laurent; Fabre, Nicolas; Andersson, Erik; Willis, Sarah J; Hébert-Losier, Kim; Holmberg, Hans-Christer


    The aim of this study was to assess potential changes in the performance and cardiorespiratory responses of elite cross-country skiers following transition from the classic (CL) to the skating (SK) technique during a simulated skiathlon. Eight elite male skiers performed two 6 km (2 × 3 km) roller-skiing time trials on a treadmill at racing speed: one starting with the classic and switching to the skating technique (CL1-SK2) and another employing the skating technique throughout (SK1-SK2), with continuous monitoring of gas exchanges, heart rates, and kinematics (video). The overall performance times in the CL1-SK2 (21:12 ± 1:24) and SK1-SK2 (20:48 ± 2:00) trials were similar, and during the second section of each performance times and overall cardiopulmonary responses were also comparable. However, in comparison with SK1-SK2, the CL1-SK2 trial involved significantly higher increases in minute ventilation (V̇E, 89.8 ± 26.8 vs. 106.8 ± 17.6 L·min(-1)) and oxygen uptake (V̇O2; 3.1 ± 0.8 vs 3.5 ± 0.5 L·min(-1)) 2 min after the transition as well as longer time constants for V̇E, V̇O2, and heart rate during the first 3 min after the transition. This higher cardiopulmonary exertion was associated with ∼3% faster cycle rates. In conclusion, overall performance during the 2 time trials did not differ. The similar performance times during the second sections were achieved with comparable mean cardiopulmonary responses. However, the observation that during the initial 3-min post-transition following classic skiing cardiopulmonary responses and cycle rates were slightly higher supports the conclusion that an initial section of classic skiing exerts an impact on performance during a subsequent section of skate skiing.

  10. Techniques for diced cartilage with deep temporalis fascia graft.

    Calvert, Jay; Kwon, Edwin


    Diced cartilage with deep temporalis fascia (DC-F) graft has become a popular technique for reconstruction of the nasal dorsum. Cartilage can be obtained from the septum, ear, or costal cartilage when employing the DC-F technique. The complications seen with DC-F grafts tend to occur early in the surgeon's implementation of this technique. Management of the complications varies depending on the severity of the problem. This article gives an overview of both the technique and the complications commonly encountered.

  11. Radiation grafting on natural films

    Lacroix, M.; Khan, R.; Senna, M.; Sharmin, N.; Salmieri, S.; Safrany, A.


    Different methods of polymer grafting using gamma irradiation are reported in the present study for the preparation of newly functionalized biodegradable films, and some important properties related to their mechanical and barrier properties are described. Biodegradable films composed of zein and poly(vinyl alcohol) (PVA) were gamma-irradiated in presence of different ratios of acrylic acid (AAc) monomer for compatibilization purpose. Resulting grafted films (zein/PVA-g-AAc) had their puncture strength (PS=37-40 N mm-1) and puncture deformation (PD=6.5-9.8 mm) improved for 30% and 50% PVA in blend, with 5% AAc under 20 kGy. Methylcellulose (MC)-based films were irradiated in the presence of 2-hydroxyethyl methacrylate (HEMA) or silane, in order to determine the effect of monomer grafting on the mechanical properties of films. It was found that grafted films (MC-g-HEMA and MC-g-silane) using 35% monomer performed higher mechanical properties with PS values of 282-296 N mm-1 and PD of 5.0-5.5 mm under 10 kGy. Compatibilized polycaprolactone (PCL)/chitosan composites were developed via grafting silane in chitosan films. Resulting trilayer grafted composite film (PCL/chitosan-g-silane/PCL) presented superior tensile strength (TS=22 MPa) via possible improvement of interfacial adhesion (PCL/chitosan) when using 25% silane under 10 kGy. Finally, MC-based films containing crystalline nanocellulose (CNC) as a filling agent were prepared and irradiated in presence of trimethylolpropane trimethacrylate (TMPTMA) as a grafted plasticizer. Grafted films (MC-g-TMPTMA) presented superior mechanical properties with a TS of 47.9 MPa and a tensile modulus (TM) of 1792 MPa, possibly due to high yield formation of radicals to promote TMPTMA grafting during irradiation. The addition of CNC led to an additional improvement of the barrier properties, with a significant 25% reduction of water vapor permeability (WVP) of grafted films.

  12. Cardiopulmonary malformations in the inv/inv mouse.

    McQuinn, T C; Miga, D E; Mjaatvedt, C H; Phelps, A L; Wessels, A


    The inv/inv mouse carries an insertional mutation in the inversin gene, (inv, for inversion of embryonic turning). Previously it had been reported that almost 100% of the homozygous offspring (inv/inv) were characterized by situs inversus totalis. In this report we identify the spectrum of cardiopulmonary anatomical abnormalities in inv/inv mice surviving to birth to determine whether the abnormalities seen are of the categories classically associated with human situs abnormalities. Stillborn mice, offspring that died unexpectedly (within 48 hr after birth), and neonates with phenotypic characteristics of situs inversus (right-sided stomachs, growth failure or jaundice) were processed for standard histological examination. Of 173 offspring, 34 (20%) neonates (11 stillborn, 9 unexpected deaths, and 14 mice with situs inversus phenotype) were examined, 27 of which were genotyped to be inv/inv. Interestingly, three inv/inv mice (11%) were found to have situs solitus. Twenty-four had situs inversus with normal, mirror-image cardiac anatomy (dextrocardia with atrioventricular concordance, ventriculoarterial concordance and a right aortic arch). The overall incidence of cardiovascular anomalies observed was 10 out of 27 (37%). The most frequent severe malformation, identified in 3 out of 27 animals, was a complex consisting of pulmonary infundibular stenosis/atresia with absence of pulmonary valve tissue and a ventricular septal defect. The pulmonary phenotype in inv/inv mice was situs inversus with occasional minor lobar abnormalities. We conclude that 1) cardiopulmonary malformations in inv/inv mice are not rare (37%), 2) the cardiopulmonary malformations observed in inv/inv specimens are not of the spectrum typically associated with human heterotaxia. In particular, inv/inv mice have a propensity for defects in the development of the right ventricular outflow tract and the interventricular septum, and 3) approximately one out of ten inv/inv mice is born with situs

  13. Clinical effectiveness of centrifugal pump to produce pulsatile flow during cardiopulmonary bypass in patients undergoing cardiac surgery.

    Gu, Y John; van Oeveren, Willem; Mungroop, Hubert E; Epema, Anne H; den Hamer, Inez J; Keizer, Jorrit J; Leuvenink, Ron P; Mariani, Massimo A; Rakhorst, Gerhard


    Although the centrifugal pump has been widely used as a nonpulsatile pump for cardiopulmonary bypass (CPB), little is known about its performance as a pulsatile pump for CPB, especially on its efficacy in producing hemodynamic energy and its clinical effectiveness. We performed a study to evaluate whether the Rotaflow centrifugal pump produces effective pulsatile flow during CPB and whether the pulsatile flow in this setting is clinically effective in adult patients undergoing cardiac surgery. Thirty-two patients undergoing CPB for elective coronary artery bypass grafting were randomly allocated to a pulsatile perfusion group (n = 16) or a nonpulsatile perfusion group (n = 16). All patients were perfused with the Rotaflow centrifugal pump. In the pulsatile group, the centrifugal pump was adjusted to the pulsatile mode (60 cycles/min) during aortic cross-clamping, whereas in the nonpulsatile group, the pump was kept in its nonpulsatile mode during the same period of time. Compared with the nonpulsatile group, the pulsatile group had a higher pulse pressure (P centrifugal pump is associated with a small gain of EEP and SHE, which does not seem to be clinically effective in adult cardiac surgical patients.

  14. Dermofat graft in deep nasolabial fold and facial rhytidectomy.

    Hwang, Kun; Han, Jin Yi; Kim, Dae Joong


    Fat and dermis or the combined tissues are used commonly in augmentation of the nasolabial fold. Guyuron obtained the dermofat graft from either the suprapubic or the groin region. The thickness of the preauricular skin was measured in seven Korean cadavers, five male and two female. We used the dermofat graft out of the preauricular skin remnant after facial rhytidectomy to augment the deep nasolabial fold in a patient. The average thickness of the epidermis was 56 +/- 12 microm, the dermis was 1820 +/- 265 microm thick, and the subcutaneous tissue was 4783 +/- 137 microm. More dense connective tissues, such as SMAS, are seen in the preauricular skin. The dermofat graft was easily obtained and prepared from the leftover preauricular skin after dissection of the lax skin in face lifting. This technique could be employed effectively and successfully to alleviate a deep nasolabial fold and concomitant facial rhytidectomy in an Asian with a thick preauricular skin.

  15. Evaluating Employability Skills: Employer and Student Perceptions

    Saunders, Venetia; Zuzel, Katherine


    Graduate employability is a key issue for Higher Education. In this two-part study student employability skills have been evaluated from the perspective of sandwich students and graduates in biomolecular science, and their employers. A strong correlation was found between employer and sandwich student/graduate perceptions of the relative…

  16. Cardiopulmonary resuscitation: a historical perspective leading up to the end of the 19th century.

    Ekmektzoglou, Konstantinos A; Johnson, Elizabeth O; Syros, Periklis; Chalkias, Athanasios; Kalambalikis, Lazaros; Xanthos, Theodoros


    Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open-and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine's most widely used fields.

  17. Graft stability after endothelial keratoplasty

    Jovanović Vesna


    Full Text Available Bacground/Aim. Techniques for replacing the corneal endothelium have been improved. The host-graft interface is the key to graft adhesion and visual recovery. The aim of this study was to establish graft stability after Descemet stripping with endothelial keratoplasty (DSEK, compare it to the graft stability after endothelial keratoplasty with the intact posterior corneal layers (nDSEK in the rabbit cornea, and to investigate the nature of wound healing. Methods. Adult white rabbits (n = 20 were divided in two experimental groups: ten rabbits underwent monocular DSEK, and ten rabbits underwent endothelial keratoplasty without Descemet stripping (nDSEK. On the second postoperative day a horizontal dislocation of the graft was tried using the Lindstrom roller in each animal. Corneas were processed for the light microscopy study. Results. Rolling the Lindstrom instrument over the corneal surface did not cause horizontal dislocation in any of the operated eyes. In the DSEK group light microscopy revealed the lack of inflammation and fibrosis at the clearly distinctive donor-recipient interface (DRI. Retrocorneal membrane was found in two eyes. In nDSEK group, the host Descemet` s membrane (DM was intact without endothelial cells, with good graft apposition, without inflammation, fibrosis, or retrocorneal membrane. Conclusion. This study suggests that there is no difference in graft stability in DSEK compared to nDSEK in rabbit corneas. Wounds healed at DRI by hypocellular scarring only in both experimental groups.

  18. Blood concentrations of cefuroxime in cardiopulmonary bypass surgery

    Bertholee, Daphne; ter Horst, Peter G. J.; Hijmering, Michel L.; Spanjersberg, Alexander J.; Hospes, Wobbe; Wilffert, Bob


    Objectives Patients with coronary artery bypass graft (CABG) surgery are at risk for severe postoperative infections. Prophylactic cefuroxime may help to reduce this risk, however sufficient concentrations, i.e. above the breakpoint (32 mg/L), are mandatory. The aim of this study is to evaluate the

  19. Cardiopulmonary resuscitation in the elderly: a clinical and ethical perspective


    The daily practice of cardiopulmonary resuscitation (CPR) in elderly patients has brought up the attention of outcome research and resource allocation. Determinants to predict survival have been well identified. There has been empirical evidence that CPR is of doubtful utility in the geriatric population, more studies have showed controversial data. Sometimes situations in which CPR needs to be given in the elderly, causes stress to healthcare providers, due to lack of communication of the patient's wishes and the belief that it will not be successful. It is of importance to state that we have the duty to identify on time the patients that will most likely benefit from CPR, and find out the preferences of the same. Whenever it is possible to institute these guidelines, we will avoid patient suffering.

  20. System identification of dynamic closed-loop control of total peripheral resistance by arterial and cardiopulmonary baroreceptors

    Aljuri, A. N.; Bursac, N.; Marini, R.; Cohen, R. J.


    Prolonged exposure to microgravity in space flight missions (days) impairs the mechanisms responsible for defense of arterial blood pressure (ABP) and cardiac output (CO) against orthostatic stress in the post-flight period. The mechanisms responsible for the observed orthostatic intolerance are not yet completely understood. Additionally, effective counter measures to attenuate this pathophysiological response are not available. The aim of this study was to investigate the ability of our proposed system identification method to predict closed-loop dynamic changes in TPR induced by changes in mean arterial pressure (MAP) and right atrial pressure (RAP). For this purpose we designed and employed a novel experimental animal model for the examination of arterial and cardiopulmonary baroreceptors in the dynamic closed-loop control of total peripheral resistance (TPR), and applied system identification to the analysis of beat-to-beat fluctuations in the measured signals. Grant numbers: NAG5-4989. c 2001. Elsevier Science Ltd. All rights reserved.

  1. Comparison of Alloderm and mucosal graft in mandibular vestibuloplasty

    Mahmoodhashemi H.


    Full Text Available "nBackground and Aim: The usage of free gingival grafts for vestibuloplasty is a routine procedure. The free gingival procedure requires harvesting the graft from a donor site which increases morbidity and the risk of surgical complications. In addition, adequate amount of donor tissue may not be available. Acceptable results of Alloderm application as a substitute for autogenous soft tissue grafts are: Not exposing the patient to an additional surgery, no donor site morbidity, unlimited availability, decreasing the bleeding during the surgery, decreasing the surgical complications, and better color match. The aim of this study was to evaluate the maintenance of the vestibular depth in vestibuloplasty with mucosal graft and Alloderm."nMaterials and Methods: Both methods of anterior mandibular vestibuloplasty by Clark, utilizing Alloderm and mucosal grafts, were employed in ten clinical cases. During the surgeries, half the prepared recipient sites received Alloderm, while the remaining half received autografts in a randomized fashion. Immediately, 1, 3, and 6 months postoperatively, the variables of graft rejection, depth of vestibule and the degree of relapse were evaluated. SPSS software was used for analysis of the data and the methods used for "statistical tests" were as follows: Friedman Method, Paired sample t-test, Smirnov-kolmogrove Method. (The statistical significance level was established at P-value<0.05."nResults: The mean difference of the relapse measurements in both methods throughout the survey did not have significant predictive value (P>0.05. Similar results were achieved for the mean difference of depth of the vestibule."nConclusion: In patients undergoing Vestibuloplasty, Alloderm could be material of choice to be utilized as autogenic soft tissue grafts in pre-prosthesis procedures.

  2. Electroencephalography during surgery with cardiopulmonary bypass and hypothermia.

    Bashein, G; Nessly, M L; Bledsoe, S W; Townes, B D; Davis, K B; Coppel, D B; Hornbein, T F


    After more than 30 yr of use, electroencephalographic (EEG) monitoring during cardiopulmonary bypass has not gained wide clinical acceptance. To assess its utility to predict central nervous system injury, two-channel recordings were made from 78 patients undergoing cardiopulmonary bypass and anesthetized with fentanyl/diazepam/enflurane. The perfusion regimen included the use of high pump flow, a bubble oxygenator, and no arterial tubing filter. Target values were 28-32 degrees C for the minimum rectal temperature, 60-80 mmHg for mean arterial pressure, and 20-25% for hematocrit. Eight descriptors of the Fourier power spectra of the EEG were calculated off-line, and outcome comparisons were made with the results from neuropsychological tests. Among 58 patients yielding complete data of acceptable quality, a statistically significant reduction in total power was observed from prebypass to postbypass, accompanied by an increase in the fractional power in the theta and beta frequency bands and in the spectral edge frequency. The shifts in total and theta power were weakly associated with short-term but not with long-term changes in neuropsychological scores. Nearly 40% of the patients' EEGs were corrupted with electrical noise at some time during bypass. In 15 patients selected for having high-quality recordings and no neuropsychological deficit, an extensive statistical analysis failed to reveal any consistent variation in the EEG descriptors with hypothermia. Under the conditions studied, it appears that for other than gross signal dropout, the strong background variability in the EEG makes it have little value for detecting harbingers of brain injury.

  3. Antioxidative effect of propofol during cardiopulmonary bypass in adults

    Shi-hai ZHANG; Shou-yong WANG; Shang-long YAO


    AIM: To investigate the antioxidative potential of propofol (an intravenous anesthetic with a chemical structure similar to phenol-based free radical scavengers such as vitamin E) during cardiopulmonary bypass (CPB). METHODS:Thirty adult patients referred for elective cardiac procedure with CPB were included and randomly allocated to a nously for anesthesia maintenance, whereas those allocated to the control group received fentanyl 10 μg/kg intravenously and inhaled enflurane (1%-1.5 %). Blood samples were collected at 7 time points: before the start of CPB,at 30 and 60 min of CPB, at the conclusion of CPB, 10 min after the administration of protamine, and 12 and 24 h after the cessation of CPB. Plasma levels of free F2-isoprostanes (sensitive markers of free radicals production)and complement C5a were determined by mass-spectrometric assay and enzyme immunoassay, respectively. Neutrophil adhesion to endothelial cells was observed at x200 magnification under a light microscope. RESULTS:Levels of F2-isoprostanes, complement C5a and neutrophil adhesion rate increased significantly during and after CPB in both groups. There were significantly higher levels of F2-isoprostanes, C5a, and more neutrophils adhering to endothelial cells in the control group than those in the propofol group, respectively. CONCLUSION: Cardiopulmonary bypass is associated with a great production of damaging free radicals. Propofol may be beneficial both as an anesthetic and as a potent free radical scavenger in patients presenting pathologies associated with free radical reactions during CPB.

  4. Coronary blood flow during cardiopulmonary resuscitation in swine

    Bellamy, R.F.; DeGuzman, L.R.; Pedersen, D.C.


    Recent papers have raised doubt as to the magnitude of coronary blood flow during closed-chest cardiopulmonary resuscitation. We will describe experiments that concern the methods of coronary flow measurement during cardiopulmonary resuscitation. Nine anesthetized swine were instrumented to allow simultaneous measurements of coronary blood flow by both electromagnetic cuff flow probes and by the radiomicrosphere technique. Cardiac arrest was caused by electrical fibrillation and closed-chest massage was performed by a Thumper (Dixie Medical Inc., Houston). The chest was compressed transversely at a rate of 66 strokes/min. Compression occupied one-half of the massage cycle. Three different Thumper piston strokes were studied: 1.5, 2, and 2.5 inches. Mean aortic pressure and total systemic blood flow measured by the radiomicrosphere technique increased as Thumper piston stroke was lengthened (mean +/- SD): 1.5 inch stroke, 23 +/- 4 mm Hg, 525 +/- 195 ml/min; 2 inch stroke, 33 +/- 5 mm Hg, 692 +/- 202 ml/min; 2.5 inch stroke, 40 +/- 6 mm Hg, 817 +/- 321 ml/min. Both methods of coronary flow measurement (electromagnetic (EMF) and radiomicrosphere (RMS)) gave similar results in technically successful preparations (data expressed as percent prearrest flow mean +/- 1 SD): 1.5 inch stroke, EMF 12 +/- 5%, RMS 16 +/- 5%; 2 inch stroke, EMF 30 +/- 6%, RMS 26 +/- 11%; 2.5 inch stroke, EMF 50 +/- 12%, RMS 40 +/- 20%. The phasic coronary flow signal during closed-chest compression indicated that all perfusion occurred during the relaxation phase of the massage cycle. We concluded that coronary blood flow is demonstrable during closed-chest massage, but that the magnitude is unlikely to be more than a fraction of normal.

  5. A Review on Grafting of Biofibers for Biocomposites

    Liqing Wei


    Full Text Available A recent increase in the use of biofibers as low-cost and renewable reinforcement for the polymer biocomposites has been seen globally. Biofibers are classified into: lignocellulosic fibers (i.e., cellulose, wood and natural fibers, nanocellulose (i.e., cellulose nanocrystals and cellulose nanofibrils, and bacterial cellulose, while polymer matrix materials can be petroleum based or bio-based. Green biocomposites can be produced using both biobased fibers and polymers. Incompatibility between the hydrophilic biofibers and hydrophobic polymer matrix can cause performance failure of resulting biocomposites. Diverse efforts have focused on the modification of biofibers in order to improve the performances of biocomposites. “Grafting” copolymerization strategy can render the advantages of biofiber and impart polymer properties onto it and the performance of biocomposites can be tuned through changing grafting parameters. This review presents a short overview of various “grafting” methods which can be directly or potentially employed to enhance the interaction between biofibers and a polymer matrix for biocomposites. Major grafting techniques, including ring opening polymerization, grafting via coupling agent and free radical induced grafting, have been discussed. Improved properties such as mechanical, thermal, and water resistance have provided grafted biocomposites with new opportunities for applications in specific industries.

  6. Design of a Sapling Branch Grafting Robot

    Qun Sun


    Full Text Available The automatic sapling grafting methods and grafting robot technologies are not comprehensively studied despite the fact that they are urgently required in practice. For this reason, a sapling grafting robot is developed to implement automatic grafting for saplings. The developed grafting robot includes clipping mechanism, moving mechanism, cutting mechanism, binding mechanism, and Arduino MCU based control system, which is capable of clipping, moving, positioning, cutting, grafting, and binding saplings. Experiments show that the stock cutting efficiency is 98.4%, the scion cutting efficiency is 98.9%, the grafting efficiency is 87.3%, and the binding efficiency is 68.9%.

  7. Cardiopulmonary exercise testing – Its application in cardiology and occupational medicine

    Małgorzata Kurpesa


    Full Text Available Cardiopulmonary exercise testing is a method used to assess the exercise capacity. It is used in cardiology to define the diagnostic and prognostic information, the treatment and its effectiveness. This method is also useful in sport medicine and in occupational medicine. The cardiopulmonary exercise test involves measuring of gas exchange during exercise testing. The article presents the main parameters assessed during the test and the indications and contraindications for conducting the test. It also reveals the results of recently published clinical trials on the use of cardiopulmonary exercise test in patients with cardiovascular disease and in the working population. The study included variability of respiratory parameters during the cardiopulmonary exercise test and after its completion, as well as their impact on the prognostic value. In addition, the results of a study involving an optimal choice of interval training on the basis of oxygen consumption at peak exercise are summarized. Med Pr 2014;65(5:665–674

  8. Utilising cardiopulmonary bypass for cancer surgery. Malignancy-induced protein C deficiency and thrombophilia.

    Marshall, C


    Cardiopulmonary bypass has evolved over the last 30 years. It is an important tool for the cardiac surgeon today and also has applications in non-cardiac operations such as surgery to extract tumours. Such patients undergoing surgery for cancer may be at an increased risk of a thromboembolic event post surgery, due to disturbances in the normal clotting pathway leading to hypercoagulability. One such disturbance is malignancy-induced Protein C deficiency. A deficiency of Protein C can cause hypercoagulabitity. Recent studies have examined cardiopulmonary bypass and inherited Protein C deficiency. However, surgery for cancer patients with a malignancy-induced Protein C deficiency involving cardiopulmonary bypass has not been reported. Surgery using CPB in these patients may result in increased morbidity and mortality. The objective of this article is to review the literature in order to discuss the occurrence, the aetiology and possible management of cancer patients with malignancy-induced Protein C deficiencies that require cardiopulmonary bypass for their surgery.

  9. Increased neutrophil priming and sensitization before commencing cardiopulmonary bypass in cardiac surgical patients

    Gu, YJ; Schoen, P; Tigchelaar, [No Value; Loef, BG; Ebels, T; Rankin, AJ; van Oeveren, W


    Background. Neutrophil activation is implicated in postoperative complications in patients having cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to determine the temporal fluctuations in the primability of neutrophils in the preoperative, intraoperative, and postoperative

  10. Changing attitudes to cardiopulmonary resuscitation in older people: a 15-year follow-up study.

    Cotter, P E


    while it is well established that individual patient preferences regarding cardiopulmonary resuscitation (CPR) may change with time, the stability of population preferences, especially during periods of social and economic change, has received little attention.

  11. Wireless System for Continuous Cardiopulmonary Monitoring in a Space Environment Project

    National Aeronautics and Space Administration — We propose to develop the NJM Sense-It system based on small sensor tags, which include a cardiopulmonary MEMS sensor for measuring heartbeat and breath rates...

  12. Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass

    Severdija, E.E.; Vranken, N.P.; Teerenstra, S.; Ganushchak, Y.M.; Weerwind, P.W.


    Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A t

  13. Vascular graft infections with Mycoplasma

    Levi-Mazloum, Niels Donald; Skov Jensen, J; Prag, J;


    Vascular graft infection is one of the most serious complications in vascular surgery. It is associated with mortality rates ranging from 25% to 75% and with morbidity in the form of amputation in approximately 30% of patients. Staphylococcus aureus is the leading pathogen. With conventional...... laboratory techniques, the percentage of culture-negative yet grossly infected vascular grafts seems to be increasing and is not adequately explained by the prior use of antibiotics. We have recently reported the first case of aortic graft infection with Mycoplasma. We therefore suggest the hypothesis...... that the large number of culture-negative yet grossly infected vascular grafts may be due to Mycoplasma infection not detected with conventional laboratory technique....

  14. Lung Transplantation and the Routine Use of Cardiopulmonary Bypass and Median Sternotomy: Experience at the Ochsner Multi-Organ Transplant Institute

    Bates, Michael; Factor, Matthew; Parrino, P. Eugene; Bansal, Aditya; Rampolla, Reinaldo; Seoane, Leonardo; Mena, Jose; Gaudet, Matthew; Smith, William; McFadden, P. Michael


    Background: From 1990-2005 at Ochsner Medical Center in New Orleans, LA, cardiopulmonary bypass (CPB) was used only when necessary during lung transplantation surgeries. Ochsner's lung transplant program was closed for more than 4 years after Hurricane Katrina, and since the program's reestablishment in 2010, the majority of lung transplantation surgeries have been performed with the patient on CPB and with a median sternotomy incision. The purpose of this study was to compare the outcomes of the CPB and non-CPB groups. Methods: After institutional review board approval, we conducted a retrospective review of the entire program using the Ochsner lung transplant database to identify patients in the non-CPB group from 1990-2005 and in the CPB group from 2010-2014. We calculated 1- and 3-year survival rates for each patient and reviewed medical records for evidence of stroke, the need for operative reexploration, and venous stenosis. We also performed a subgroup analysis of the first 20 consecutive patients undergoing lung transplantation on CPB with median sternotomy from February 2010 through April 2011 to examine intraoperative blood product use, the quantity of blood products administered, CPB cannulation and pump complications, ischemic time, and primary graft dysfunction. Results: Of the 208 patients in the non-CPB group, 74% had 1-year graft survival and 55% had 3-year survival following transplantation. After February 2010, 79 patients underwent lung transplantation on CPB with median sternotomy, and 90% of those patients had 1-year graft survival. Of the 46 patients available for 3-year follow-up, 59% were alive with functional grafts. The difference in 1-year survival rates between the 2 cohorts was statistically significant. Two deaths, 3 strokes, and 5 reexplorations of the chest for bleeding occurred during the perioperative time period in the CPB group, but no mortality was associated with these perioperative events. One patient who had perioperative

  15. Is it necessary to stent renal artery stenosis patients before cardiopulmonary bypass procedures?

    ZHENG Bin; YAN Hong-bing; LIU Rui-fang; CHENG Shu-juan; WANG Jian; ZHAO Han-jun; SONG Li


    Background Acute kidney injury (AKI) is associated with poor prognosis after cardiopulmonary bypass. The aim of this retrospective study was to investigate whether stent implantation before cardiopulmonary bypass has beneficial effect on development of AKI in renal artery stenosis (RAS) patients.Methods In this retrospective study, patients with abnormal baseline serum creatinine (SCr, >106 μmol/L) were not included. Included patients (n=69) were divided into two groups. Group 1 included 31 RAS patients receiving no stent implantation before cardiopulmonary bypass. Group 2 included 38 RAS patients having received stent implantation just before cardiopulmonary bypass. To assess AKI after cardiopulmonary bypass, serum urea nitrogen, SCr and creatinine clearance were recorded at baseline, at the end of operation, during the first and second postoperative 24 hours.Results Baseline characteristics were similar between groups. Serum urea nitrogen, SCr, creatinine clearance before and after cardiopulmonary bypass were also similar class groups. Incidence of AKI in group 1 was not significantly different from group 2. In group 1, AKI defined by RIFLE between occurred in 7 (22.6%) patients: 5 (16.1%) with RIFLE-R,2 (6.5%) with RIFLE-I, and no patients with RIFLE-F. In group 2, 10 patients (26.3%) had an episode of AKI during hospitalization: 6 (15.8%) had RIFLE-R, 4 (10.5%) had RIFLE-I, and no patients had RIFLE-F.Conclusions There are no data suggesting that it is necessary to stent RAS patients with normal SCr before cardiopulmonary bypass. However, it cannot be concluded that RAS is not associated with AKI after cardiopulmonary bypass.

  16. Temporary bilateral sensorineural hearing loss following cardiopulmonary bypass -A case report-

    Son, Hyo Jung; Joh, Jung Hwa; Kim, Wook Jong; Chin, Ji Hyun; Choi, Dae Kee; Lee, Eun Ho; Sim, Ji Yeon; Choi, In-Cheol


    Sudden sensorineural hearing loss has been reported to occur following anesthesia and various non-otologic surgeries, mostly after procedures involving cardiopulmonary bypass. Unilateral sensorineural hearing loss resulting from microembolism is an infrequent complication of cardiopulmonary bypass surgery that has long been acknowledged. Moreover, there are few reports on the occurrence of bilateral sensorineural hearing loss without other neurologic deficits and its etiology has also not bee...

  17. Relations between cardiopulmonary function during exercise and exercise tolerance in patients with COPD

    Cuypers, Maarten; Vos, Tine


    Methods: In part 1, a cross-sectional study took place. Sixty COPD patients performed a spirometry and a cardiopulmonary exercise test (CPET). Predictors of exercise tolerance were examined. In part 2, a longitudinal observational study took place. Twelve COPD patients completed an exercise training intervention. A study on relations between changes in cardiopulmonary function and changes in exercise tolerance was performed. Results: Significant predictors of VO2peak are peak carbon d...

  18. Reversibility of cardiopulmonary impairment after laparoscopic repair of large hiatal hernia

    Emanuele Asti


    Full Text Available Giant hiatus hernia with or without intrathoracic gastric volvulus often presents with symptoms suggestive of both cardiac and pulmonary compression. Cardiopulmonary impairment may be reversible in these patients by laparoscopic crural repair and fundoplication as shown in this case report. Cardiac magnetic resonance and the cardiopulmonary exercise test may help selecting patients for surgery. These preliminary findings led us to start a prospective study using this multimodality diagnostic approach.

  19. Transesophageal echocardiography-guided thrombectomy of intracardiac renal cell carcinoma without cardiopulmonary bypass

    Souki, Fouad Ghazi; Demos, Michael; Fermin, Lilibeth; Ciancio, Gaetano


    Advanced renal cell carcinoma (RCC) resection has important anesthetic management implications, particularly when tumor extends, suprahepatic, into the right atrium. Use of transesophageal echocardiogram (TEE) is essential in identifying tumor extension and guiding resection. Latest surgical approach avoids venovenous and cardiopulmonary bypass yet requires special precautions and interventions on the anesthesiologist's part. We present a case of Level IV RCC resected without cardiopulmonary bypass and salvaged by TEE guidance and detection of residual intracardiac tumor. PMID:27716710

  20. The effects of venous cannulation technique and cardioplegia type on plasma potassium concentration and arterial blood pressure during cardiopulmonary bypass.

    Coleman, E T


    The cannulation method and cardioplegia solution used during cardiopulmonary bypass (CPB) may both influence plasma potassium concentrations ([K+]) and mean arterial blood pressure (MAP). Bi-caval or right atrial cannulation methods are routinely used in conjunction with crystalloid or blood cardioplegia. We investigated the influence of cannulation method and cardioplegia solutions on plasma [K+] and MAP during cardiopulmonary bypass. Sixty consecutive patients undergoing elective coronary artery bypass grafting (CABG) using CPB were studied. They were randomly divided into three groups of 20 patients. Patients in Group A underwent bi-caval venous cannulation and received crystalloid cardioplegia. Group B patients underwent right atrial cannulation and received crystalloid cardioplegia. Group C patients underwent right atrial cannulation and received blood cardioplegia. In each case. cardioplegia was administered antegrade via the aortic root. Plasma [K+], MAP. and hemoglobin concentration (Hb) were measured over an 8-min period following cardioplegia administration (pilot studies indicated pressure changes occuring post cardioplegia administration up to this time). The combination of bi-caval cannulation and crystalloid cardioplegia (Group A) was associated with the least increase in plasma [K+] and no decrease in MAP. The maximum [K+] for this Group was 4.2 mmol\\/L (4.6% increase). The minimum mean pressure was 57 mmHg (13.6% increase). Both right atrial cannulation groups (B and C) showed a large rise in plasma [K+] and a decrease in MAP. Group B maximum [K+] was 5.2 mmol\\/L (27.5% increase). Group C was also 5.2 mmol\\/L (26.0% increase). Group C showed the largest pressure decrease, the minimum mean pressure was 45 mmHg (21.3% decrease). The Group B minimum mean pressure was 45 mmHg (8.7% decrease). Our results show that patients undergoing CPB operations who are deemed to be at increased risk of suffering adverse effects from hypotensive episodes may

  1. Increased T cell glucose uptake reflects acute rejection in lung grafts

    Chen, Delphine L.; Wang, Xingan; Yamamoto, Sumiharu; Carpenter, Danielle; Engle, Jacquelyn T.; Li, Wenjun; Lin, Xue; Kreisel, Daniel; Krupnick, Alexander S.; Huang, Howard J.; Gelman, Andrew E.


    Although T cells are required for acute lung rejection, other graft-infiltrating cells such as neutrophils accumulate in allografts and are also high glucose utilizers. Positron emission tomography (PET) with the glucose probe [18F]fluorodeoxyglucose ([18F]FDG) has been employed to image solid organ acute rejection, but the sources of glucose utilization remain undefined. Using a mouse model of orthotopic lung transplantation, we analyzed glucose probe uptake in the graft...

  2. Employer's investments in hospital workers' employability and employment opportunities

    van Harten, E.J.; Knies, E.; Leisink, P.L.M.


    Purpose – The purpose of this paper is to examine the relationship between employer’s investments (through job characteristics and managerial support) and employees’ employment opportunities, with employability, conceptualized as perceived up-to-date expertise and willingness to change, as a mediati

  3. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    Bhavani Shankar Kodali


    Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  4. Cardiopulmonary resuscitation knowledge and attitude among general dentists in Kuwait

    Alkandari, Sarah A.; Alyahya, Lolwa; Abdulwahab, Mohammed


    BACKGROUND: Dentists as health care providers should maintain a competence in resuscitation. This cannot be overemphasized by the fact that the population in our country is living longer with an increasing proportion of medically compromised persons in the general population. This preliminary study aimed to assess the knowledge and attitude of general dentists towards cardiopulmonary resuscitation (CPR). METHODS: A cross-sectional study was carried out among 250 licensed general dental practitioners working in ministry of health. Data were obtained through electronic self-administered questionnaire consisting of demographic data of general dentists, and their experience, attitude and knowledge about CPR based on the 2010 American Heart Association guidelines update for CPR. RESULTS: Totally 208 general dentists took part in the present study giving a response rate of 83.2%. Only 36% of the participants demonstrated high knowledge on CPR, while 64% demonstrated low knowledge. Participants’ age, gender, nationality, years of experience, career hierarchy, and formal CPR training were associated significantly with CPR knowledge. Almost all the participants (99%) felt that dentists needed to be competent in basic resuscitation skills and showed a positive attitude towards attending continuing dental educational programs on CPR. CONCLUSION: This study showed that majority of general dental practitioners in Kuwait had inadequate knowledge on CPR. It was also found that CPR training significantly influenced the CPR knowledge of the participants. Therefore, training courses on CPR should be regularly provided to general dentists in the country. PMID:28123615

  5. Measuring behavioral outcomes in cardiopulmonary rehabilitation: AN AACVPR STATEMENT.

    Verrill, David; Graham, Helen; Vitcenda, Mark; Peno-Green, Laura; Kramer, Valerie; Corbisiero, Teresa


    Outcome measurement in cardiopulmonary rehabilitation is required for optimal assessment of program quality, effectiveness of treatments, and evaluation of patient progress. Recent position statements from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), American College of Cardiology, American Heart Association, American Thoracic Society, and American College of Chest Physicians have provided state-of-the-art information on the importance of assessing performance and outcome measures for optimal program effectiveness. Such measures are also required for AACVPR program certification. To meet current standards of practice, the AACVPR developed an Outcomes Matrix that includes 4 domains: Health, Clinical, Behavioral, and Service. Although the Clinical and Health domains have been most commonly used in outcome reporting (eg, 6-minute walk test, quality-of-life survey scores), behavioral measures have received less attention, primarily because they have been perceived as being more difficult to measure and quantify over time. This statement describes 5 common behavioral outcome measures: smoking cessation, medication use, supplemental oxygen use, exercise habits, and nutritional behaviors. Sample questions and calculations for each of these behavioral measures are also provided. By using these measures at program entry and completion, cardiac and pulmonary rehabilitation practitioners can effectively track and document behavioral changes over time for physicians, third-party insurance providers, or hospital administrators and thus demonstrate the effectiveness of exercise and educational interventions on patient overall health and well-being.

  6. Inhibition of neutrophil activity improves cardiac function after cardiopulmonary bypass

    Grünwald Frank


    Full Text Available Abstract Background The arterial in line application of the leukocyte inhibition module (LIM in the cardiopulmonary bypass (CPB limits overshooting leukocyte activity during cardiac surgery. We studied in a porcine model whether LIM may have beneficial effects on cardiac function after CPB. Methods German landrace pigs underwent CPB (60 min myocardial ischemia; 30 min reperfusion without (group I; n = 6 or with LIM (group II; n = 6. The cardiac indices (CI and cardiac function were analyzed pre and post CPB with a Swan-Ganz catheter and the cardiac function analyzer. Neutrophil labeling with technetium, scintigraphy, and histological analyses were done to track activated neutrophils within the organs. Results LIM prevented CPB-associated increase of neutrophil counts in peripheral blood. In group I, the CI significantly declined post CPB (post: 3.26 ± 0.31; pre: 4.05 ± 0.45 l/min/m2; p 2; p = 0.23. Post CPB, the intergroup difference showed significantly higher CI values in the LIM group (p Conclusion Our data provides strong evidence that LIM improves perioperative hemodynamics and cardiac function after CPB by limiting neutrophil activity and inducing accelerated sequestration of neutrophils in the spleen.

  7. Acute mesenteric ischemia after cardio-pulmonary bypass surgery

    Bassam Abboud; Ronald Daher; Joe Boujaoude


    Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency.Several pathophysiologic events (arterial obstruction,venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow.Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities,leading to multi-organ failure and death.Early diagnosis is difficult because the clinical presentation is subtle,and the biological and radiological diagnostic tools lack sensitivity and specificity.Therapeutic options vary from conservative resuscitation,medical treatment,endovascular techniques and surgical resection and revascularization.A high index of suspicion is required for diagnosis,and prompt treatment is the only hope of reducing the mortality rate.Studies are in progress to provide more accurate diagnostic tools for early diagnosis.AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB).Several factors contribute to the systemic hypo-perfusion state,which is the most frequent pathophysiologic event.In this particular setting,the clinical presentation of AMI can be misleading,while the laboratory and radiological diagnostic tests often produce inconclusive results.The management strategies are controversial,but early treatment is critical for saving lives.Based on the experience of our team,we consider prompt exploratory laparotomy,irrespective of the results of the diagnostic tests,is the only way to provide objective assessment and adequate treatment,leading to dramatic reduction in the mortality rate.

  8. [Cardiopulmonary resuscitation already in Egypt 5,000 years ago?].

    Ocklitz, A


    In light of the medically relevant features of the ancient Egyptian mouth-opening ceremony, the question of the effectiveness of medical practices in Egypt thousands of years ago is examined, whereby the religious and cultural framework also plays a significant role. In the Land on the Nile myth and reality clearly generated special conditions which favoured the systematic treatment of questions of resuscitation. Numerous examples show that this had practical consequences in the area of everyday medicine. In addition, rebirth and resurrection were central elements of the cult of the dead which had exact medical equivalents. These equivalents may demonstrate the advanced state of resuscitation practices in Egypt at that time. In this context, a reconstruction of an ancient Egyptian mouth-opening instrument is presented. In the cult of the dead, this instrument played a role which can be compared to the function of a modern laryngoscope. It appears possible that at the time of the pyramids the Egyptians already had an understanding of the technology required to perform instrument-aided artificial respiration. Whether or not they actually possessed a fundamental knowledge of the principles of cardio-pulmonary resuscitation remains unclear. Nevertheless, the astonishingly functional characteristics of the reconstructed mouth-opening instrument suggest that it was developed for more than purely symbolic purposes.

  9. Rib fractures in infants due to cardiopulmonary resuscitation efforts.

    Dolinak, David


    Although it is widely known that adults may sustain fractures of the anterior and/or lateral aspects of the ribs due to cardiopulmonary resuscitation (CPR) efforts, relatively little is written about the generation of CPR-related rib fractures in the infant age range. In a series of 70 consecutive autopsies in infants ranging in age from 2 weeks to 8 months, with no history or indications of injury, the parietal pleura of the thoracic cage was stripped and the ribs carefully examined for fracture. Subtle fractures of the anterolateral aspects of the ribs were discovered in 8 (11%) of the 70 cases. In 7 of the 8 cases, multiple ribs were fractured (ranging up to 10 rib fractures), and in 5 of these cases, the rib fractures were bilateral. All of the rib fractures were subtle, had little if any associated blood extravasation, and would have been easily missed had the parietal pleura not been stripped. These anterolateral rib fractures in infants are the likely correlate of anterolateral rib fractures that are not uncommonly seen in the adult population, resulting from resuscitation efforts. The rib fractures are subtle and may not be identified unless the parietal pleura is stripped.

  10. The amylase-creatinine clearance ratio following cardiopulmonary bypass.

    Murray, W R; Mittra, S; Mittra, D; Roberts, L B; Taylor, K M


    The incidence of unexplained pancreatitis in patients dying after cardiac operations has been recorded as 16%, with evidence to implicate ischemia in the pathogenesis of the pancreatitis. Increased amylase--to--creatinine clearance ratios (ACCR), suggesting pancreatic dysfunction, have been reported in patients following nonpulsatile cardiopulmonary bypass (CPB). Pulsatile CPB is increasingly recognized to be a more physiological form of perfusion, particularly with respect to capillary blood flow. In this study the ACCR has been determined before, during, and after cardiac operations performed with both nonpulsatile and pulsatile CPB. Twenty patients undergoing elective cardiac operations were studied. Ten patients had nonpulsatile CPB (nonpulsatile group) and 10 had pulsatile CPB (pulsatile group). The two groups were comparable as regards perioperative variables and perfusion parameters. In both groups the ACCR was estimated preoperatively, on three occasions during the operation, and daily on the first 5 postoperative days. A significant elevation in ACCR was observed in nine of 10 patients in the nonpulsatile group but in only one of 10 patients in the pulsatile group (p less than 0.001). The significant improvement of ACCR stability following pulsatile CPB may indicate that this form of perfusion will reduce the risk of pancreatitis following cardiac operations performed with CPB.

  11. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    U. Ayala


    Full Text Available Interruptions in cardiopulmonary resuscitation (CPR compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies.

  12. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    Ayala, U.; Irusta, U.; Ruiz, J.; Eftestøl, T.; Kramer-Johansen, J.; Alonso-Atienza, F.; Alonso, E.; González-Otero, D.


    Interruptions in cardiopulmonary resuscitation (CPR) compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA) designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies. PMID:24895621

  13. The Protective Effect of Propofol on Erythrocytes during Cardiopulmonary Bypass

    张诗海; 姚尚龙


    To evaluate the relationship between erythrocyte injury and intracellular calcium ion overload, and the protective effect of propofol on erythrocytes during cardiopulmonary bypass (CPB), 40 children with congenital heart diseases who underwent surgical repair under CPB were studied. The patients were randomly divided into two groups: control group (group C) and propofol group (group P). Anesthesia was maintained in the patients in group P with 6 mg*kg-1*h-1 propofol, and those in the group C inhaled 1 %-2 % isoflurane. The blood samples were taken before CPB, at the 30th min of CPB, at the end of CPB, and 2 h and 24 h after CPB to measure the content of erythrocyte intracellular calcium ion (E-Ca2+), Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities, index filtration of erythrocytes (IF), mean corpuscular volume (MCV) and the concentration of plasma free hemoglobin (F-HB). Results showed that in the control group, E-Ca2+, IF, MCV and F-Hb were gradually increased and Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities were decreased. The increase of E-Ca2+ was linearly paralleled to IF, MCV and F-Hb. In propofol group, all the above-mentioned parameters were significantly improved (P<0.05). This study suggests that erythrocyte injury is related to elevation of intracellular calcium during CPB and propofol has a protective effect on erythrocyte injury.

  14. The Protective Effect of Propofol on Erythrocytes during Cardiopulmonary Bypass

    张诗海; 姚尚龙


    To evaluate the relationship between erythrocyte injury and intracellular calcium ion overload, and the protective effect of propofol on erythrocytes during cardiopulmonary bypass (CPB). 40 children with congenital heart diseases who underwent surgical repair under CPB were included. The patients were randomly divided into two groups: control group (group C) and propofol group (group P). Anesthesia was maintained in the patients with 6 mg/kg/h propofol in Group P, and those in the Group C inhaled 1 %-2 % isoflurane. The blood samples were taken before CPB, 30 min after CPB, at the end of CPB, and 2 h and 24 h after CPB to measure the content of erythrocyte intracellular calcium ion (E-Ca2+ ), Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities, index filtration of erythrocytes (IF), mean corpuscular volume (MCV) and the concentration of plasma free hemoglobin (F-Hb). Results showed that in the control group, E-Ca2+ , IF, MCV and F-Hb were gradually increased and Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities were decreased. The increase of E-Ca2+ was linearly paralleled to IF, MCV and F-Hb. In propofol group, all the above-mentioned parameters were significantly improved (P<0. 05). This study suggests that erythrocyte injury is related to elevation of intracellular calcium during CPB and propofol has a protective effect on erythrocyte injury.

  15. Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style

    da Silva, Rose Mary Ferreira Lisboa; Silva, Bruna Adriene Gomes de Lima e; Silva, Fábio Junior Modesto e; Amaral, Carlos Faria Santos


    Objective The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. Methods This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. Results The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. Conclusions The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low. PMID:28099640

  16. Increasing the Thermal Conductivity of Graphene-Polyamide-6,6 Nanocomposites by Surface-Grafted Polymer Chains: Calculation with Molecular Dynamics and Effective-Medium Approximation.

    Gao, Yangyang; Müller-Plathe, Florian


    By employing reverse nonequilibrium molecular dynamics simulations in a full atomistic resolution, the effect of surface-grafted chains on the thermal conductivity of graphene-polyamide-6.6 (PA) nanocomposites has been investigated. The interfacial thermal conductivity perpendicular to the graphene plane is proportional to the grafting density, while it first increases and then saturates with the grafting length. Meanwhile, the intrinsic in-plane thermal conductivity of graphene drops sharply as the grafting density increases. The maximum overall thermal conductivity of nanocomposites appears at an intermediate grafting density because of these two competing effects. The thermal conductivity of the composite parallel to the graphene plane increases with the grafting density and grafting length which is attributed to better interfacial coupling between graphene and PA. There exists an optimal balance between grafting density and grafting length to obtain the highest interfacial and parallel thermal conductivity. Two empirical formulas are suggested, which quantitatively account for the effects of grafting length and density on the interfacial and parallel thermal conductivity. Combined with effective medium approximation, for ungrafted graphene in random orientation, the model overestimates the thermal conductivity at low graphene volume fraction (f 10%). For unoriented grafted graphene, the model matches the experimental results well. In short, this work provides some valuable guides to obtain the nanocomposites with high thermal conductivity by grafting chain on the surface of graphene.

  17. Load carriage, human performance, and employment standards.

    Taylor, Nigel A S; Peoples, Gregory E; Petersen, Stewart R


    The focus of this review is on the physiological considerations necessary for developing employment standards within occupations that have a heavy reliance on load carriage. Employees within military, fire fighting, law enforcement, and search and rescue occupations regularly work with heavy loads. For example, soldiers often carry loads >50 kg, whilst structural firefighters wear 20-25 kg of protective clothing and equipment, in addition to carrying external loads. It has long been known that heavy loads modify gait, mobility, metabolic rate, and efficiency, while concurrently elevating the risk of muscle fatigue and injury. In addition, load carriage often occurs within environmentally stressful conditions, with protective ensembles adding to the thermal burden of the workplace. Indeed, physiological strain relates not just to the mass and dimensions of carried objects, but to how those loads are positioned on and around the body. Yet heavy loads must be borne by men and women of varying body size, and with the expectation that operational capability will not be impinged. This presents a recruitment conundrum. How do employers identify capable and injury-resistant individuals while simultaneously avoiding discriminatory selection practices? In this communication, the relevant metabolic, cardiopulmonary, and thermoregulatory consequences of loaded work are reviewed, along with concomitant impediments to physical endurance and mobility. Also emphasised is the importance of including occupation-specific clothing, protective equipment, and loads during work-performance testing. Finally, recommendations are presented for how to address these issues when evaluating readiness for duty.

  18. Epidemiologic Surveillance for Staphylococcus epidermidis infections related to cardiopulmonary bypass.

    Lathrop, G D; Brockett, R M; Blouse, L E


    Epidemiologic investigation of 20 Staphylococcus infections among valvular and aortocoronary bypass graft patients indicated a broad spectrum of clinical illness in these two groups. The highest infection rate (9.3%) and case specific mortality rate (54.5%) were noted among those patients undergoing cardiovalvular replacement surgery with protheses. The median onset of infection was 6 days suggesting infection during the intraoperative period. Using the epidemiologic data from this investigation, a transmission pattern was formulated and a series of control measures designed to interdict the routes of transmission were instituted wigh marked success. These measures significantly reduced the incidence of S. epidermidis infections among these high risk patients.

  19. Off-Pump Triple Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis: Case Presentation and a Brief Review of the Brazilian and the International Experiences

    Karigyo, Carlos Junior Toshiyuki; Batalini, Felipe; Murakami, Alexandre Noboru; Teruya, Rogério Toshio; Gregori Júnior, Francisco


    A 76-year-old man with situs inversus totalis underwent a successful off-pump three-vessel coronary artery bypass surgery. The postoperative course was uneventful, and the patient was discharged 8 days later. At 9-month follow-up a coronary computed tomography angiography confirmed the viability of all of the grafts, and one year after the operation the patient remained asymptomatic. It comprises the fifth Brazilian case of a coronary surgery in a patient with situs inversus totalis and the first one of the country of a coronary artery bypass surgery without the use of the cardiopulmonary bypass in this condition. PMID:27556323

  20. Dopexamine increases internal mammary artery blood flow following coronary artery bypass grafting.

    Flynn, Michael J


    OBJECTIVE: Vasoactive agents and inotropes influence conduit-coronary blood flow following coronary artery bypass grafting (CABG). It was hypothesized that dopexamine hydrochloride, a dopamine A-1 (DA-1) and beta(2) agonist would increase conduit-coronary blood flow. A prospective randomized double blind clinical trial was carried out to test this hypothesis. DA-1 receptors have previously been localized to human left ventricle. METHODS: Twenty-six American Society of Anaesthesiology class 2-3 elective coronary artery bypass graft patients who did not require inotropic support on separation from cardiopulmonary bypass (CPB) were studied. According to a randomized allocation patients received either dopexamine (1 microg\\/kg per min) or placebo (saline) by intravenous infusion for 15 min. Immediately prior to and at 5,10 and 15 min of infusion, blood flow through the internal mammary and vein grafts (Transit time flow probes, Transonic Ltd.), heart rate, cardiac index, mean arterial pressure and pulmonary haemodynamics were noted. The data were analysed using multivariate analysis of variance. RESULTS: Low-dose dopexamine (1 microg\\/kg per min) caused a significant increase in mammary graft blood flow compared to placebo at 15 min of infusion (P=0.028, dopexamine group left internal mammary artery (LIMA) flow of 43.3+\\/-14.2 ml\\/min, placebo group LIMA flow at 26.1+\\/-16.3 ml\\/min). Dopexamine recipients demonstrated a non-significant trend to increased saphenous vein graft flow (P=0.059). Increased heart rate was the only haemodynamic change induced by dopexamine (P=0.004, dopexamine group at 85.2+\\/-9.6 beats\\/min and placebo group at 71.1+\\/-7.6 beats\\/min after 15 min of infusion). CONCLUSION: This study demonstrates that administration of dopexamine (1 microg\\/kg per min) was associated with a significant increase in internal mammary artery graft blood flow with mild increase in heart rate being the only haemodynamic change. Low-dose dopexamine may

  1. Prevention of primary vascular graft infection with silver-coated polyester graft in a porcine model

    Gao, H; Sandermann, J; Prag, J;


    To evaluate the efficacy of a silver-coated vascular polyester graft in the prevention of graft infection after inoculation with Staphylococcus aureus in a porcine model.......To evaluate the efficacy of a silver-coated vascular polyester graft in the prevention of graft infection after inoculation with Staphylococcus aureus in a porcine model....

  2. Mixed venous-arterial CO2 tension gradient after cardiopulmonary bypass.

    Takami, Yoshiyuki; Masumoto, Hiroshi


    Significant venous hypercarbia has been reported in septic shock and circulatory failure. Cardiopulmonary bypass also impairs systemic and pulmonary blood perfusion. The objective of this study was to determine the clinical significance of the increased venous-arterial CO2 tension gradient resulting from venous hypercarbia after cardiopulmonary bypass. On arrival in the intensive care unit, venous and arterial CO2 tensions were measured in the radial and pulmonary arteries in 140 consecutive patients who had undergone coronary (n = 79), valve (n = 34), aortic (n = 20), and other (n = 7) surgery under cardiopulmonary bypass. The mean venous-arterial CO2 tension gradient was 5.0 +/- 3.3 mm Hg (range, 7.7 to 15.7 mm Hg). By linear regression analysis, the factors that significantly correlated with venous-arterial CO2 tension gradient were bypass duration, aortic crossclamp time, initial arterial lactate level, transpulmonary arteriovenous lactate difference, arterial bicarbonate level, base excess, cardiac index, mixed venous O2 saturation, O2 delivery, O2 consumption, and the peak value of creatine kinase. The venous-arterial CO2 tension gradient may reflect impaired perfusion and anaerobic metabolism induced by cardiopulmonary bypass and could be a simple and useful indicator for patient management after surgery under cardiopulmonary bypass.

  3. A systematic review of intensive cardiopulmonary management after spinal cord injury.

    Casha, Steven; Christie, Sean


    Intensive cardiopulmonary management is frequently undertaken in patients with spinal cord injury (SCI), particularly due to the occurrence of neurogenic shock and ventilatory insufficiency and in an attempt to reduce secondary injury. We undertook a systematic review of the literature to examine the evidence that intensive care management improves outcome after SCI and to attempt to define key parameters for cardiopulmonary support/resuscitation. We review the literature in five areas: management of SCI patients in specialized centers, risk in SCI patients of cardiopulmonary complications, parameters for blood pressure and oxygenation/ventilation support following SCI, risk factors for cardiopulmonary insufficiency requiring ICU care after SCI, and preventative strategies to reduce the risks of cardiopulmonary complications in SCI patients. The literature supports that, in light of the significant incidence of cardiorespiratory complications, SCI patients should be managed in a monitored special care unit. There is weak evidence supporting the maintenance of MAP >85 mmHg for a period extending up to 1 week following SCI.

  4. Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary bypass in children

    Aymen N Naguib


    Full Text Available Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1 st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5 th edition. Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF patients scored significantly higher than the low-dose fentanyl (LDF + dexmedetomidine (DEX (LDF + DEX group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046. The bispectral index (BIS value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011. For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R 2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027. Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental



    Objective To evaluate the effect of the cardiopulmonary bypass (CPB) on the pulmonary function in infants with or without pulmonary hypertension in congential ventricular septal defect (VSD). Methods Twenty infants with VSD were enrolled in the study from Jan. to Dec. 2004. They were divided into two groups: pulmonary hypertension group and non-pulmonary hypertension group, ten infants respectively. Pulmonary function parameters were measured before CPB and 3, 6, 9, 12, 15, 18, 21, 24h after CPB, the following data were recorded: duration for mechanical ventilation (Tmv) and staying in the cardiac intensive care unit (Tcicu) after cardiac surgery. Results Before CPB, the pulmonary function parameters in non-pulmonary hypertension group were more superior than in pulmonary hypertension group ( P < 0. 01 ). By contraries, the pulmonary function parameters in every time stage after CPB statistically significant decreased in non-pulmonary hypertension group ( P < 0. 05),especially at 6, 9, and 15h after CPB ( P < 0. 01 ). In pulmonary hypertension group, the pulmonary function parameters in 3h after CPB were more improved than before CPB, though there was no statistical significance. But they had statistically significant decreased at 9, 12, 15h after CPB ( P <0. 05). There was a similar change in pulmonary function between two groups at 21,24h after CPB. Conclusion Exposure to CPB adversely affects pulmonary function after surgical repair of VSD in infants. We consider that the benefits of the surgical correction in infants with pulmonary hypertension outweight the negative effects of CPB on pulmonary function. We should improve cardiac function to avoid the presence of the nadir trough in pulmonary function. The infants with pulomonary hypertension also have ability to wean from mechanical ventilation as soon as possible, if the hemodynamics is stable, and without the responsive pulmonary hypertension or pulmonary hypertension crisis after surgical repair.

  6. Cardiopulmonary function in dogs with serious chronic heartworm disease.

    Kitagawa, H; Kubota, A; Yasuda, K; Hirano, Y; Sasaki, Y


    Cardiopulmonary function was examined in 18 dogs with serious chronic heartworm disease showing ascites, subcutaneous edema, prostration, weakness, jaundice and so on. After surgical heartworm removal from the pulmonary arteries, 10 dogs recovered (surviving group), and 8 dogs died or were euthanatized because of poor prognosis (nonsurviving group). The number of live heartworms residing in the pulmonary arteries of the surviving group tended to be larger than that in the nonsurviving group. At necropsy, severe pulmonary arterial lesions such as thromboembolism including dead heartworms, proliferative and villous lesions and intimal hyperplasia were noticed in all dogs examined, and tended to be severer in the nonsurviving group. Heartworm-coiling around the tricuspid valve chord was found in 1 dog of the surviving group and 4 dogs of the nonsurviving group. Before heartworm removal, there was no significant difference in the mean pulmonary arterial pressure (MPAP) between the surviving and nonsurviving group. Right atrial pressure (v-wave) was higher, and the cardiac index (CI) was lower in the nonsurviving group. Arterial oxygen tension was lower in the surviving group than in the heartworm-free group, and it was lower in the nonsurviving group than in the surviving group. Carbon dioxide tension was lower in the surviving group than in the heartworm-free group. Bicarbonate concentration (HCO3-) was lower both in the surviving and nonsurviving groups than in the heartworm-free group. One week after heartworm removal, MPAP decreased (P less than 0.05), and CI and HCO3- tended to increase in the surviving group.

  7. Hydrogen sulfide improves neural function in rats following cardiopulmonary resuscitation



    The alleviation of brain injury is a key issue following cardiopulmonary resuscitation (CPR). Hydrogen sulfide (H2S) is hypothesized to be involved in the pathophysiological process of ischemia-reperfusion injury, and exerts a protective effect on neurons. The aim of the present study was to investigate the effects of H2S on neural functions following cardiac arrest (CA) in rats. A total of 60 rats were allocated at random into three groups. CA was induced to establish the model and CPR was performed after 6 min. Subsequently, sodium hydrosulfide (NaHS), hydroxylamine or saline was administered to the rats. Serum levels of H2S, neuron-specific enolase (NSE) and S100β were determined following CPR. In addition, neurological deficit scoring (NDS), the beam walking test (BWT), prehensile traction test and Morris water maze experiment were conducted. Neuronal apoptosis rates were detected in the hippocampal region following sacrifice. After CPR, as the H2S levels increased or decreased, the serum NSE and S100β concentrations decreased or increased, respectively (P<0.0w. The NDS results of the NaHS group were improved compared with those of the hydroxylamine group at 24 h after CPR (P<0.05). In the Morris water maze experiment, BWT and prehensile traction test the animals in the NaHS group performed best and rats in the hydroxylamine group performed worst. At day 7, the apoptotic index and the expression of caspase-3 were reduced in the hippocampal CA1 region, while the expression of Bcl-2 increased in the NaHS group; and results of the hydroxylamine group were in contrast. Therefore, the results of the present study indicate that H2S is able to improve neural function in rats following CPR. PMID:26893650

  8. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

    Siminelakis Stavros N


    Full Text Available Abstract During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB, hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.

  9. Extended effects of air pollution on cardiopulmonary mortality in Vienna

    Neuberger, Manfred; Rabczenko, Daniel; Moshammer, Hanns

    BackgroundCurrent standards for fine particulates and nitrogen dioxide are under revision. Patients with cardiovascular disease have been identified as the largest group which need to be protected from effects of urban air pollution. MethodsWe sought to estimate associations between indicators of urban air pollution and daily mortality using time series of daily TSP, PM 10, PM 2.5, NO 2, SO 2, O 3 and nontrauma deaths in Vienna (Austria) 2000-2004. We used polynomial distributed lag analysis adjusted for seasonality, daily temperature, relative humidity, atmospheric pressure and incidence of influenza as registered by sentinels. ResultsAll three particulate measures and NO 2 were associated with mortality from all causes and from ischemic heart disease and COPD at all ages and in the elderly. The magnitude of the effect was largest for PM 2.5 and NO 2. Best predictor of mortality increase lagged 0-7 days was PM 2.5 (for ischemic heart disease and COPD) and NO 2 (for other heart disease and all causes). Total mortality increase, lagged 0-14 days, per 10 μg m -3 was 2.6% for PM 2.5 and 2.9% for NO 2, mainly due to cardiopulmonary and cerebrovascular causes. ConclusionAcute and subacute lethal effects of urban air pollution are predicted by PM 2.5 and NO 2 increase even at relatively low levels of these pollutants. This is consistent with results on hospital admissions and the lack of a threshold. While harvesting (reduction of mortality after short increase due to premature deaths of most sensitive persons) seems to be of minor importance, deaths accumulate during 14 days after an increase of air pollutants. The limit values for PM 2.5 and NO 2 proposed for 2010 in the European Union are unable to prevent serious health effects.

  10. Outcomes of cardiopulmonary resuscitation and predictors of survival in patients undergoing coronary angiography including percutaneous coronary interventions.

    Sprung, Juraj; Ritter, Matthew J; Rihal, Charanjit S; Warner, Mary E; Wilson, Gregory A; Williams, Brent A; Stevens, Susanna R; Schroeder, Darrell R; Bourke, Denis L; Warner, David O


    We studied the outcome of cardiopulmonary resuscitation (CPR) in patients undergoing coronary angiography (CA) and/or percutaneous coronary interventions (PCI). Of 51,985 CA and PCI patients treated between January 1, 1990, and December 31, 2000, 114 required CPR. Records were reviewed for relationships between patient characteristics and various procedures and short-term survival. Long-term survival was compared with that of a matched cohort of patients who did not have an arrest during catheterization and a matched cohort from the general Minnesota population. Over the 11-year period, the overall incidence of CPR was 21.9 per 10,000 procedures. This rate decreased from 33.9 per 10,000 before 1995 to 13.1 per 10,000 after 1995. Overall survival to hospital discharge after CPR was 56.1%. Survival to discharge was less frequent with a history of congestive heart failure, previous coronary artery bypass graft surgery, hemodynamic instability during the procedure, and with prolonged or emergent catheterizations. Pulseless electrical activity (versus asystole or ventricular fibrillation) indicated very poor short-term survival. Interestingly, short-term survival was not related to the extent of coronary artery disease. Long-term survival of patients who survived cardiac arrest was comparable to that of those who did not have arrest during catheterization. In conclusion, the incidence of periprocedural CPR during diagnostic or interventional coronary procedures decreased after 1995. Patients who received CPR in the cardiac catheterization lab have a remarkably frequent survival to hospital discharge rate. Long-term survival of these patients is only minimally reduced.


    Song Chen; Xiao-yu Li


    Exploration and characterization of grafting productions by experimental methods are often cumbersome or sometimes impossible. Therefore, quantum chemistry calculations were performed to characterize the graft sites of epoxy resin. According to the Gibbs free energy criterion of the second law of thermodynamic, the reported graft sites were confirmed, and more important, some unreported graft sites were found. In addition, method of increasing the number of graft sites was studied in this article.

  12. Monopoly, employment and wages


    This paper shows that monopoly in the capital equipment market results in higher productivity and wages but lower employment in comparison with the benchmark of competition. The combined effect on workers' welfare is negative, for expected earnings (defined as the product of the probability of employment and the wage earned when employed) are lowered. Indeed, low skill workers suffer relatively greater declines in employment and expected earnings. Furthermore, the employment and expected earn...

  13. Polyether-polyester graft copolymer

    Bell, Vernon L. (Inventor)


    Described is a polyether graft polymer having improved solvent resistance and crystalline thermally reversible crosslinks. The copolymer is prepared by a novel process of anionic copolymerization. These polymers exhibit good solvent resistance and are well suited for aircraft parts. Previous aromatic polyethers, also known as polyphenylene oxides, have certain deficiencies which detract from their usefulness. These commercial polymers are often soluble in common solvents including the halocarbon and aromatic hydrocarbon types of paint thinners and removers. This limitation prevents the use of these polyethers in structural articles requiring frequent painting. In addition, the most popular commercially available polyether is a very high melting plastic. This makes it considerably more difficult to fabricate finished parts from this material. These problems are solved by providing an aromatic polyether graft copolymer with improved solvent resistance and crystalline thermally reversible crosslinks. The graft copolymer is formed by converting the carboxyl groups of a carboxylated polyphenylene oxide polymer to ionic carbonyl groups in a suitable solvent, reacting pivalolactone with the dissolved polymer, and adding acid to the solution to produce the graft copolymer.


    S. I. Suskov


    Full Text Available The basic variants of cytokines reactions defining type of organ dysfunctions are revealed in the course of car- diopulmonary bypass and in the early postoperative period. Their character and expression, depends on gravity preoperative an immunodeficiency and initial degree of heart insufficiency. Diphasic dynamics of development of system inflammatory reaction is confirmed after cardiopulmonary bypass: increase of levels proinflammatory cytokines is in the first phase and anti-inflammatory cytokines with development immunodepression and cellular anergy in is the second phase. Also, key role IL-1Ra is revealed in restraint of hyperactivation of system inflam- matory reaction. Blood whey levels IL-6, IL-8, G-CSF, TNF-α and IL-1Ra should be defined to cardiopulmonary bypass, in 10–12 hours, 24 hours and 3 days after cardiopulmonary bypass and may be used as prognostic criteria of development of postoperative complications. 

  15. The Effects of Cigarette Smoking on Cardiopulmonary Function and Exercise Tolerance in Teenagers

    Dianna Louie


    Full Text Available Teenagers who smoke are frequently warned that cigarette smoking will have detrimental effects on the function of their cardiopulmonary system and on their ability to perform exercise. However, there is little published evidence to support this statement. Therefore, in the present study, peak expiratory flow was measured as an indicator of lung function, expired carbon monoxide level was measured as an indicator of current smoking and the associated reduction in the oxygen carrying capacity of the blood, and blood pressure and heart rate were measured as indicators of cardiovascular hemodynamics before and after a one-mile run in 27 teenagers. The results show that, even at a young age, cigarette smoking is associated with significant detrimental effects on cardiopulmonary function and exercise tolerance. Objective evidence of an effect of smoking on cardiopulmonary function and exercise tolerance in this age group may assist educators and health care professionals in convincing teenagers to quit smoking.

  16. Report: Heparin-induced thrombocytopenia associated with cardiopulmonary bypass: Preliminary attempt with recombinant human thrombopoietin therapy.

    Yuan, Shi-Min


    Recombinant human thrombopoietin (rhTPO) is popularly used for the treatment of chemotherapy-induced thrombocytopenia. However, rhTPO therapy for heparin-induced thrombocytopenia relating to cardiopulmonary bypass has not been previously described. A young patient developed heparin-induced thrombocytopenia during open-heart surgery. Postoperative rhTPO therapy (15000 units injection hypodermatica once daily for consecutive 3 days) made a quick platelet recovery without any side effects. Heparin-induced thrombocytopenia associated with cardiopulmonary bypass is more likely to be benign, and is curable to rhTPO therapy. The preliminary rhTPO administration of heparin-induced thrombocytopenia in association with cardiopulmonary bypass shows satisfactory pharmaceutical effects with lower dose, shorter duration treatment and shorter platelet increase time and recovery time in comparison with those for the treatment of chemotherapy-induced thrombocytopenia. rhTPO therapy does not produce any side effects and it could avoid or minimize necessary blood product infusions.


    Dawn T. Gulick


    Full Text Available An injury to the ACL can result in significant functional impairment. It has been estimated that more than 100,000 new ACL injuries occur each year. Surgeons employ numerous techniques for reconstruction of the ACL. Of critical importance is the source of the graft to replace the damaged ACL. The graft choices include autografts (the patient's own tissue, allografts (donor tendon, and synthetic/prosthetic ligaments. Tissue harvest sites for autografting include the middle third of the patella tendon, the quadriceps tendon, semitendinosus tendon, gracilis tendon, iliotibial band, tensor fascia lata, and the Achilles tendon. Selection of the type of graft material is predicated upon the tissue's ability to tolerate high levels of stress. Likewise, the clinical presentation and functional outcome is related to the graft material selected. This manuscript specifically examined the patella tendon and hamstring tendon grafts. Numerous manuscripts that studied the outcomes of these graft materials were compiled to help the clinician appreciate the advantages and disadvantages of each of the graft materials. Outcome measures such as thigh circumference, knee range of motion, isokinetic strength, knee stability, pain, and vertical jump/1-leg hop were incorporated. The purpose of this manuscript was to compare and contrast the clinical presentation of patients who underwent an ACL reconstruction using the patella tendon versus the hamstring tendons. This information can be valuable to the clinician when considering the rehabilitation protocol after ACL reconstruction

  18. Carbon dioxide production during cardiopulmonary bypass: pathophysiology, measure and clinical relevance.

    Ranucci, Marco; Carboni, Giovanni; Cotza, Mauro; de Somer, Filip


    Carbon dioxide production during cardiopulmonary bypass derives from both the aerobic metabolism and the buffering of lactic acid produced by tissues under anaerobic conditions. Therefore, carbon dioxide removal monitoring is an important measure of the adequacy of perfusion and oxygen delivery. However, routine monitoring of carbon dioxide removal is not widely applied. The present article reviews the main physiological and pathophysiological sources of carbon dioxide, the available techniques to assess carbon dioxide production and removal and the clinically relevant applications of carbon dioxide-related variables as markers of the adequacy of perfusion during cardiopulmonary bypass.

  19. Development of the roller pump for use in the cardiopulmonary bypass circuit.

    Cooley, D A


    In 1937, John Gibbon proposed his concept of extracorporeal circulation as an aid to cardiac surgery. Subsequently, a number of different types of pumps were tried in the extracorporeal circuit. Today, the pump used most often is a positive displacement twin roller pump, originally patented by Porter and Bradley in 1855. The rotary pump has undergone some minor modifications prior to its use in clinical cardiopulmonary bypass. Cardiovascular surgeons owe much to Porter and Bradley for an invention that has proved both efficient and effective for cardiopulmonary bypass and has allowed operations on an open heart in a relatively dry, bloodless field.

  20. Methylene Blue for Vasoplegia When on Cardiopulmonary Bypass During Double-Lung Transplantation.

    Carley, Michelle; Schaff, Jacob; Lai, Terrance; Poppers, Jeremy


    Vasoplegia syndrome, characterized by hypotension refractory to fluid resuscitation or high-dose vasopressors, low systemic vascular resistance, and normal-to-increased cardiac index, is associated with increased morbidity and mortality after cardiothoracic surgery. Methylene blue inhibits inducible nitric oxide synthase and guanylyl cyclase, and has been used to treat vasoplegia during cardiopulmonary bypass. However, because methylene blue is associated with increased pulmonary vascular resistance, its use in patients undergoing lung transplantion has been limited. Herein, we report the use of methylene blue to treat refractory vasoplegia during cardiopulmonary bypass in a patient undergoing double-lung transplantation.

  1. Posterior repair with perforated porcine dermal graft

    G. Bernard Taylor


    Full Text Available OBJECTIVE: To compare postoperative vaginal incision separation and healing in patients undergoing posterior repair with perforated porcine dermal grafts with those that received grafts without perforations. Secondarily, the tensile properties of the perforated and non-perforated grafts were measured and compared. MATERIALS AND METHODS: This was a non-randomized retrospective cohort analysis of women with stage II or greater rectoceles who underwent posterior repair with perforated and non-perforated porcine dermal grafts (PelvicolTM CR Bard Covington, GA USA. The incidence of postoperative vaginal incision separation (dehiscence was compared. A secondary analysis to assess graft tensile strength, suture pull out strength, and flexibility after perforation was performed using standard test method TM 0133 and ASTM bending and resistance protocols. RESULTS: Seventeen percent of patients (21/127 who received grafts without perforations developed vaginal incision dehiscence compared to 7% (5/71 of patients who received perforated grafts (p = 0.078. Four patients with vaginal incision dehiscence with non-perforated grafts required surgical revision to facilitate healing. Neither tensile strength or suture pull out strength were significantly different between perforated and non-perforated grafts (p = 0.81, p = 0.29, respectively. There was no difference in the flexibility of the two grafts (p = 0.20. CONCLUSION: Perforated porcine dermal grafts retain their tensile properties and are associated with fewer vaginal incision dehiscences.

  2. Starch Modification by Graft Copolymerization of Acrylonitrile

    刘瑞贤; 李莉; 茹宗玲; 张黎明; 高建平; 田汝川


    The graft copolymerization of acrylonitrile (AN) onto starch under the initiation of potassium permanganate was investigated. The effect of various reaction conditions on the graft copolymerization was studied. The relationships between the grafting rate and the initiator concentration of potassium permanganate, monomer acrylonitrile and backbone starch, as well as reaction temperature were established. The oxidation reaction of starch with manganic ions and valence changes of manganic ions during the graft copolymerization were discussed. The results show that manganic ion Mn7+ underwent a series of valence changes during the graft copolymerization: Mn(Ⅶ) → Mn(Ⅳ) → Mn(Ⅲ) → Mn(Ⅱ). The grafting rate of the graft copolymerization of acrylonitrile onto starch is also given.

  3. Dynamics of bone graft healing around implants

    Narayan Venkataraman


    A few questions arise pertaining to the use of bone grafts along with implants are whether these are successful in approximation with implant. Do they accelerate bone regeneration? Are all defects ultimately regenerated with new viable bone? Is the bone graft completely resorbed or integrated in new bone? Does the implant surface characteristic positively affect osseointegration when used with a bone graft? What type of graft and implant surface can be used that will have a positive effect on the healing type and time? Finally, what are the dynamics of bone graft healing around an implant? This review discusses the cellular and molecular mechanisms of bone graft healing in general and in vicinity of another foreign, avascular body, namely the implant surface, and further, the role of bone grafts in osseointegration and/or clinical success of the implants.

  4. Hitos sobre el test cardiopulmonar de ejercicio Cardiopulmonary exercise test



    Full Text Available El test cardiopulmonar de ejercicio TCPE (CPET en la literatura anglosajona evalúa aspectos dinámicos de la la fisiología cardiorespiratoria, en contraste, las pruebas funcionales estáticas no reproducen la condición activa de un individuo. No obstante su complejo montaje e interpretación, en el último decenio ha habido un creciente interés en aplicarlo en la detección de mecanismos de disnea. Al respecto, la curva flujo/volumen dinámica permite demostrar limitación de flujos e hiperinflación dinámica, también esta prueba permite profundizar en el análisis del intercambio gaseoso en ejercicio. La utilidad de estas pruebas en la evaluación funcional pre-operatoria compleja es destacada. Dada su alta reproducibilidad, el TCPE continúa siendo un alto referente en pruebas cardíacas de esfuerzo. Publicaciones cardiológicas enfatizan su valor pronóstico como indicador de sobrevida, seguimiento de terapias y enlistado para trasplante en insuficiencia cardíaca congestiva, utilizando parámetros máximos y submáximos. Entre los primeros el consumo cumbre o punta de oxígeno, y en los submáximos el equivalente ventilatorio de anhídrido carbónico y el consumo de oxígeno en el umbral lácticoCardiopulmonary exercise test (CPET evaluates cardiorespiratory function in dynamic conditions, in contrast to static pulmonary function tests which can not reproduce the dynamic situation of an individual. Despite its complex implementation there has been growing interest in CPET in evaluating the mechanisms of dyspnoea With this respect dynamic flow/volume curve is useful in identifying expiratory airflow limitation and dynamic hyperinflation. Besides gas exchange analysis during exercise deepens the quality of information in that subject. Its utility for decision making in complex perioperative evaluation can not be overemphasized. Considering its high reproducibility, this method is a highly valuable tool in cardiac stress testing. Several

  5. Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

    Chi, Dongmei; Chen, Chan; Shi, Yu; Wang, Wanyu; Ma, Ye; Zhou, Ronghua; Yu, Hai; Liu, Bin


    Abstract Background: Cardiopulmonary bypass (CPB) is necessary for most cardiac surgery, which may lead to postoperative lung injury. The objective of this paper is to systematically evaluate whether ventilation during CPB would benefit patients undergoing cardiac surgery. Methods: We searched randomized controlled trials (RCTs) through PubMed, Embase, and Cochrane Library from inception to October 2016. Eligible studies compared clinical outcomes of ventilation versus nonventilation during CPB in patients undergoing cardiac surgery. The primary outcome includes oxygenation index (PaO2/FiO2 ratio) or alveolar to arterial oxygen tension difference (AaDO2) immediately after weaning from bypass. The secondary outcomes include postoperative pulmonary complications (PPCs), shunt fraction (Qs/Qt), hospital stay, and AaDO2 4 hours after CPB. Results: Seventeen trials with 1162 patients were included in this meta-analysis. Ventilation during CPB significantly increased post-CPB PaO2/FiO2 ratio (mean difference [MD] = 21.84; 95% confidence interval [CI] = 1.30 to 42.37; P = 0.04; I2 = 75%) and reduced post-CPB AaDO2 (MD = –50.17; 95% CI = –71.36 to –28.99; P <0.00001; I2 = 74%). Qs/Qt immediately after weaning from CPB showed a significant difference between groups (MD = –3.24; 95% CI = –4.48 to –2.01; P <0.00001; I2 = 0%). Incidence of PPCs (odds ratio [OR] = 0.79; 95% CI = 0.42 to 1.48; P = 0.46; I2 = 37%) and hospital stay (MD = 0.09; 95% CI = –23 to 0.41; P = 0.58; I2 = 37%) did not differ significantly between groups. Conclusion: Ventilation during CPB might improve post-CPB oxygenation and gas exchange in patients who underwent cardiac surgery. However, there is no sufficient evidence to show that ventilation during CPB could influence long-term prognosis of these patients. The beneficial effects of ventilation during CPB are requisite to be evaluated in powerful and well

  6. Employment and winter construction

    Hansen, Ernst Jan de Place; Larsen, Jacob Norvig


    possibilities exist for reducing seasonal variation in employment? In addition to a literature review related to winter construction, European and national employment and meteorological data were studied. Finally, ministerial acts, ministerial orders or other public policy documents related to winter...

  7. Experimental Study of a Novel Method of Cardiopulmonary Resuscitation Using a Combination of Percutaneous Cardiopulmonary Support and Liposome-encapsulated Hemoglobin (TRM645



    Full Text Available Percutaneous cardiopulmonary support (PCPS has been applied for cardiopulmonary arrest (CPA. We have developed a novel method of cardiopulmonary resuscitation using PCPS combined with liposome-encapsulated hemoglobin (TRM645 to improve oxygen delivery to vital organs. Ventricular fibrillation was electrically induced to an adult goat for 10 min. Next, PCPS (30 ml/kg/min, V/Q: 1 was performed for 20 min. Then, external defibrillation was attempted and observed for 120 min. The TRM group (n5 was filled with 300 mL of TRM645 for the PCPS circuit. The control group (n5 was filled with the same volume of saline. The delivery of oxygen (DO2 and oxygen consumption (VO2 decreased markedly by PCPS after CPA, compared to the preoperative values. DO2 was kept at a constant level during PCPS in both groups, but VO2 slowly decreased at 5, 10, and 15 min of PCPS in the control groups, demonstrating that systemic oxygen metabolism decreased with time. In contrast, the decreases in VO2 were small in the TRM group at 5, 10, and 15 min of PCPS, demonstrating that TRM645 continuously maintained systemic oxygen consumption even at a low flow rate. AST and LDH in the TRM group were lower than the control. There were significant differences at 120 min after the restoration of spontaneous circulation (p<0.05.

  8. Institutionalized Employer Collective Action

    Ibsen, Christian Lyhne; Navrbjerg, Steen Erik


    Recent studies show that employer associations continue to exist in new ways despite internationalisation of the economy, liberalisation of markets and the decline of trade unions. This paradox raises two questions regarding EOs in today’s labour markets: Which employers join employer associations...

  9. Graduate Identity and Employability

    Hinchliffe, Geoffrey William; Jolly, Adrienne


    This paper develops the concept of graduate identity as a way of deepening the understanding of graduate employability. It does this through presenting research in which over 100 employers in East Anglia were asked to record their perceptions of graduates in respect of their employability. The findings suggest a composite and complex graduate…

  10. [Autologous fat grafting in children].

    Baptista, C; Bertrand, B; Philandrianos, C; Degardin, N; Casanova, D


    Lipofilling or fat grafting transfer is defined as a technique of filling soft tissue by autologous fat grafting. The basic principle of lipofilling is based on a harvest of adipose tissue, followed by a reinjection after treatment. Lipofilling main objective is a volume defect filling, but also improving cutaneous trophicity. Lipofilling specificities among children is mainly based on these indications. Complications of autologous fat grafting among children are the same as those in adults: we distinguish short-term complications (intraoperative and perioperative) and the medium and long-term complications. The harvesting of fat tissue is the main limiting factor of the technique, due to low percentage of body fat of children. Indications of lipofilling among children may be specific or similar to those in adults. There are two types of indications: cosmetic, in which the aim of lipofilling is correcting a defect density, acquired (iatrogenic, post-traumatic scar) or malformation (otomandibular dysplasia, craniosynostosis, Parry Romberg syndrom, Poland syndrom, pectus excavatum…). The aim of functional indications is correcting a velar insufficiency or lagophthalmos. In the paediatric sector, lipofilling has become an alternative to the conventional techniques, by its reliability, safety, reproducibility, and good results.

  11. Is there a relationship between serum S-100 beta protein and neuropsychologic dysfunction after cardiopulmonary bypass?

    Westaby, S; Saatvedt, K; White, S; Katsumata, T; van Oeveren, W; Bhatnagar, NK; Brown, S; Halligan, PW


    Objectives: Over the past decade, the glial protein S-100 beta has been used to detect cerebral injury in a number of clinical settings including cardiac surgery. Previous investigations suggest that S-100 beta is capable of identifying patients with cerebral dysfunction after cardiopulmonary bypass

  12. Effects of hypothermic cardiopulmonary bypass on the pharmacodynamics and pharmacokinetics of rocuronium

    Smeulers, NJ; Wierda, MKH; vandenBroek, L; Huet, RCGG; Hennis, PJ


    Objective: To study the influence of hypothermic cardiopulmonary bypass (CPB) on the pharmacodynamics and pharmacokinetics of rocuronium. Design: Prospective, descriptive study. Setting: Operating room at a university hospital. Participants: Ten ASA class III end IV patients, ranging in age from 35

  13. Coronary artery surgery without cardiopulmonary bypass: usefulness of the surgical blower-humidifier.

    Maddaus, M; Ali, I S; Birnbaum, P L; Panos, A L; Salerno, T A


    Coronary artery bypass surgery can be performed without cardiopulmonary bypass (CPB). Bleeding obscuring the operative field and hemodilution of shed blood with irrigating saline are some of the drawbacks of this technique. We report the use of a newly developed surgical blower-humidifier (custom made [Research Medical, Inc.]) for improved visualization and facilitation of coronary artery surgery without CPB.

  14. Accuracy of transcutaneous carbon dioxide tension measurements during cardiopulmonary exercise testing.

    Stege, G.; Elshout, F.J.J. van den; Heijdra, Y.F.; Ven, M.J.T. van de; Dekhuijzen, P.N.R.; Vos, P.J.E.


    BACKGROUND: Measurements of transcutaneous carbon dioxide tension (PtcCO(2)) with current devices are proven to provide clinically acceptable agreement with measurements of partial arterial carbon dioxide tension (PaCO(2)) in several settings but not during cardiopulmonary exercise testing (CPET). O

  15. The effect of pulsatile cardiopulmonary bypass on lung function in elderly patients

    Engels, Gerwin E.; Dodonov, Mikhail; Rakhorst, Gerhard; van Oeveren, Willem; Milano, Aldo D.; Gu, Y. John; Faggian, Giuseppe


    Purpose: Cardiopulmonary bypass is still a major cause of lung injury and delay in pulmonary recovery after cardiac surgery. Although it has been shown that pulsatile flow induced by intra-aortic balloon pumping is beneficial for preserving lung function, it is not clear if the same beneficial effec

  16. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution

    Pope III, C.A.; Burnett, R.T.; Thun, M.J.; Calle, E.E.; Krewski, D.; Ito, K.; Thurston, G.D. [Brigham Young University, Provo, UT (United States)


    A study was conducted to the relationship between long-term exposure to fine particulate air pollution and all-cause, lung cancer, and cardiopulmonary mortality. Vital status and cause of death data were collected by the American Cancer Society as part of the Cancer Prevention II study, an ongoing prospective mortality study, which enrolled approximately 1.2 million adults in 1982. Participants completed a questionnaire detailing individual risk factor data (age, sex, race, weight, height, smoking history, education, marital status, diet, alcohol consumption, and occupational exposures). The risk factor data for approximately 500 000 adults were linked with air pollution data for metropolitan areas throughout the United States and combined with vital status and cause of death data through December 31, 1998. Fine particulate and sulfur oxide-related pollution were found to be associated with all-cause, lung cancer, and cardiopulmonary mortality. Each 10-{mu}g/m{sup 3} elevation in fine particulate air pollution was associated with approximately a 4%, 6%, and 8% increased risk of all-cause, cardiopulmonary, and lung cancer mortality, respectively. Measures of coarse particle fraction and total suspended particles were not consistently associated with mortality. It was concluded that long-term exposure to combustion-related fine particulate air pollution is an important environmental risk factor for cardiopulmonary and lung cancer mortality. 31 refs., 5 figs., 2 tabs.




    The impaired hemostasis of aspirin-treated patients is an annoying problem during and after cardiopulmonary bypass, The hemostatic function of platelets comprises two mechanisms: the shear-induced and the cyclooxygenase pathways, Because the latter is inhibited in aspirin-treated patients, the hemos

  18. Median sternotomy for double lung transplantation with cardiopulmonary bypass in seven consecutive patients

    Kohno, Mitsutomo; Steinbrüchel, Daniel A


    We describe our technique of using median sternotomy to perform double lung transplantations with cardiopulmonary bypass. By sparing the respiratory muscles, median sternotomy is probably less invasive and preserves lung function. Furthermore, it causes less long-term discomfort than intercostal...




    Endotoxin, when released into the systemic circulation during cardiopulmonary bypass (CPB), might induce activation of plasmatic systems and blood cells during CPB, in addition to a material-dependent blood activation during CPB. However, the role of endotoxin in the development of this so-called wh

  20. Endotoxin release in cardiac surgery with cardiopulmonary bypass : pathophysiology and possible therapeutic strategies. An update

    Kats, Suzanne; Schonberger, Jacques P. A. M.; Brands, Ruud; Seinen, Willem; van Oeveren, Wim


    Cardiac surgery with cardiopulmonary bypass provokes a systemic inflammatory response syndrome caused by the surgical trauma itself, blood contact with the non-physiological surfaces of the extracorporeal circuit, endotoxemia, and ischemia. The role of endotoxin in the inflammatory response syndrome

  1. Should blood flow during cardiopulmonary bypass be individualized more than to body surface area?

    Thomassen, Sisse Anette; Larsson, A; Andreasen, Jan Jesper;

    Blood flow during cardiopulmonary bypass (CPB) is calculated on body surface area (BSA). Increasing comorbidity, age and weight of today's cardiac patients question this calculation as it may not reflect individual metabolic requirement. The hypothesis was that a measured cardiac index (CI) prior...... not improve cerebral and systemic oxygenation compared to a blood flow based on BSA....

  2. Effect of cardiopulmonary bypass on leukocyte activation : changes in membrane-bound elastase on neutrophils

    Tang, M; Gu, YJ; Wang, WJ; Xu, YP; Chen, CZ


    Background: Neutrophil elastase is known to be released from the activated leukocytes as a result of cardiopulmonary bypass (CPB). However, its biological effect on organ injury is questionable because it is quickly bound by natural proteinase inhibitors (PIs). Recently, membrane-bound elastase ( MB

  3. Comparative cardiopulmonary toxicity of soy biofuel and diesel exhaust in healthy and hypertensive rats

    Increased use of renewable energy sources raise concerns about health effects of emissions from such sources. We conducted a comprehensive analysis of relative cardiopulmonary health effects of exhausts from 1) 100% soy biofuel (B100), 2) 20% soy biofuel + 80% low sulfur petroleu...

  4. Efficiency and safety of leukocyte filtration during cardiopulmonary bypass for cardiac surgery

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W


    Background. Leukocyte filtration of systemic blood during cardiopulmonary bypass surgery to reduce post-operative morbidity has not yet been established because of the enormous leukocyte release from the third space. This study was designed to examine the efficiency and safety of leukocyte filtratio

  5. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

    Mastenbroek, Mirjam H; van t Sant, Jetske; Versteeg, Henneke; Cramer, MJ; Doevendans, Pieter A; Pedersen, Susanne S; Meine, Mathias


    BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time CRT-defibrilla

  6. Modifying effect of the County Level Health Indices on Cardiopulmonary Effects Associated with Wildfire Exposure

    Background and Aims: Socioeconomic status (SES) is a known risk factor for cardiopulmonary health and some studies suggest SES may be an effect modifier for health effects associated with exposure to air pollution. We investigated the synergistic impact of health disparities on ...




    Various clinical trials have shown that hemostasis is improved by the administration of aprotinin during cardiopulmonary bypass. However, this effect has not been proved for those patients treated preoperatively with aspirin. Therefore, a double-blind, placebo-controlled study was conducted to test

  8. Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support

    Kalz, Marco


    Kalz, M. (2013, 23 September). Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support. Presentation given during the 6th World Congress on Social Media, Mobile Apps and Internet/Web 2.0 in Medicine, Health, and Biomedical Research, London, UK.

  9. Cardiopulmonary manifestations of isolated pulmonary valve infective endocarditis demonstrated with cardiac CT.

    Passen, Edward; Feng, Zekun


    Right-sided infective endocarditis involving the pulmonary valve is rare. This pictorial essay discusses the use and findings of cardiac CT combined with delayed chest CT and noncontrast chest CT of pulmonary valve endocarditis. Cardiac CT is able to show the full spectrum of right-sided endocarditis cardiopulmonary features including manifestations that cannot be demonstrated by echocardiography.

  10. Hyperglycemia as an Effect of Cardiopulmonary Bypass: Intra-operative Glucose Management

    Najmaii, Samira; Redford, Daniel; Larson, Douglas F.


    Cardiopulmonary bypass (CPB) is associated with surgical stress, hypothermia, hyperoxia, enhancement of neuroendocrine outflow, and administration of glucogenic catecholamines that are associated with glucogonolysis and glucogenesis that result in hyperglycemia. The hyperglycemic state during CPB has been associated with adverse outcomes, such as infection, neurological impairment, cardiac dysfunction, prolonged hospitalization, and higher mortality rates. This report justifies vigilant monit...

  11. Buprenorphine pharmacokinetic parameters during coronary artery bypass graft surgery.

    Amani, A; Joseph, T; Balasaraswathi, K


    The pharmacokinetic parameters of buprenorphine (BN) after a single bolus dose of 10 microg/kg i.v. was investigated in 6 male patients whose age averaged 59+/-9.8 years and body weight of 65.8+/-5.7 kg undergoing coronary artery bypass graft surgery (CABG). The unbound BN plasma concentrations were detected using ultrafiltration and high performance liquid chromatography/electro-chemical detection (HPLC/ECD) method. During cardiopulmonary bypass (CPB) there was a fall in BN plasma concentrations, observations similar to reports on fentanyl, sufentanil and alfentanil. This is probably due to haemodilution, hypothermia and hydrophobic sequestration of drug on to the CPB tubing. After CPB the concentrations rose to values higher than during CPB, though it did not attain pre CPB concentrations. These variations were not statistically significant indicating that plasma levels were adequately stable during CPB. The plasma concentration time curves were biexponential and the pharmacokinetic parameters obtained were : distribution half-life 37.24+/-6.57 min, elimination half-life 482.69+/-79 min, clearance 1221.97+/-209.42 ml/min, and volume of distribution 736.46+/-71.25 L. BN in the dose used follows the pharmacokinetic pattern of other commonly used narcotics during CABG. The mean +/- SEM plasma BN concentration during CPB was 0.51+/-0.03 ng/ml which was adequate for the maintenance of analgesia and anaesthesia, as none of our patients expressed the signs and symptoms of awareness during surgery. Further, unlike the other narcotics muscle rigidity was absent. Thus BN is a safe and good alternative to other narcotics for patients undergoing CABG.

  12. Transaortic Intra-Aortic Balloon Pump Catheter Insertion through a Separate Saphenous Vein Graft in Patients with Severe Aortoiliac Disease

    Faruk Toktas


    Full Text Available Background. Intra-aortic balloon pump (IABP is the most widely used mechanical assist device for hemodynamic support in high risk patients undergoing cardiac surgery. The aim of our study was to confirm whether transaortic route is a suitable alternative to allow IABP insertion in patients with severe aortoiliac diseases. Methods. This study included 7 consecutive patients undergoing coronary artery bypass grafting for severe coronary artery disease associated with severe aortoiliac disease. These patients could not be weaned from cardiopulmonary bypass and required the IABP support, which were placed through the ascending aorta. IABP catheter was inserted indirectly through a separate saphenous vein graft anastomosed to the ascending aorta by an end-to-side manner under a partial occluding clamp and advanced to the desired position in the descending thoracic aorta and exteriorly brought into the subcutaneous tissues in the jugulum. Results. The procedure was successfully performed in all the patients. The mean duration of IABP support was 54.0±13.4 hours. There were no in-hospital mortality and complications related to transaortic route. IABP removal did not require repeat sternotomy. At postoperative 6th month, multislice CT examination showed thrombotic occlusion at the remnant of the saphenous vein graft. Conclusions. This technique is a simple, reliable, and reproducible option in patients with severe aortoiliac disease in whom retrograde femoral route is not possible.

  13. Hybrid Graft Anterior Cruciate Ligament Reconstruction: A Predictable Graft for Knee Stabilization.

    Alvarez-Pinzon, Andres M; Barksdale, Leticia; Krill, Michael K; Leo, Brian M


    Trauma to the anterior cruciate ligament (ACL) is a season-ending injury and involves months of activity modification and rehabilitation. The annual incidence of ACL tears in the United States is approximately 200,000, which allows for a broad range of individualized treatment options. Various surgical techniques, including transtibial and independent tunnel drilling, allograft and autograft tissue, and various implants, have been described in the literature. This article describes the indications and technique for a hybrid soft tissue graft for ACL reconstruction. Autologous grafts eliminate the risk of disease transmission and have recently been shown to have a lower rerupture rate, particularly in younger, active patients; however, the harvesting of autologous hamstring grafts carries a risk of donor-site morbidity, iatrogenic injury of the graft, and inadequate graft size. In contrast to a traditional autologous soft tissue graft, the hybrid graft allows for graft size customization for a desired reconstruction, especially in cases where autograft hamstrings may be iatrogenically damaged or of inadequate size when harvested. The goal of a hybrid graft ACL reconstruction is to provide a favorable-sized graft with clinical outcomes comparable with autologous soft tissue grafts. In contrast to a traditional autologous soft tissue graft, this technique provides another option in the event of unforeseen deficiencies or complications associated with harvesting and preparation of the autologous gracilis and semitendinosis soft tissue graft.


    HUANG Hui-min; KONG Xiang; WANG Wei; ZHU De-ming; ZHANG Hai-bo


    Objective To study if using autologous lung as a substitute of oxygenator in cardiopulmonary bypass is better than the conventional cardiopulmonary bypass with artificial oxygenator in pulmonary preservation.Methods Twelve piglets were randomly divided into two groups ( n = 6). The isolated lung perfusion model was established. The experimental animals underwent continuous lung perfusion for about 120 min. While the control animals underwent 90 min lung ischemia followed by 30 min reperfusion. Another 12 piglets were randomly divided into two groups ( n =6). The experimental animals underwent bi-ventricular bypass with autologous lung perfusion.While control animals underwent conventional cardiopulmonary bypass with artificial oxygenator. The bypass time and aortic cross clamping time were 135 min and 60 min respectively for each animal. The lung static compliance ( Cstat), alveolus-artery oxygen difference ( PA-aO2 ), TNF-α, IL-6 and wet to dry lung weight ratio (W/D) were measured. Histological and ultra-structural changes of the lung were also observed after bypass. Results After either isolated lung perfusion or cardiopulmonary bypass, the Cstat decreased, the PA-aO2 increased and the content of TNF-α increased for both groups, but the changes of experimental group were much less than those of control group. The lower W/D ratio and mild pathological changes in experimental group than those in control group were also demonstrated. Conclusion Autologous lung is able to tolerate the nonpalsatile perfusion. It can be used as a substitute to artificial ogygenator in cardiopulmonary bypass to minimize the inflammatory pulmonary injury caused mainly by ischemic reperfusion and interaction of the blood to the non-physiological surface of artificial oxygenator.

  15. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery

    Rabie Soliman


    Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.

  16. Twist and its effect on ACL graft forces

    Arnold, MP; Blankevoort, L; ten Ham, A; Verdonschot, N; van Kampen, A


    Graft tension is a controversial topic in anterior cruciate ligament (ACL) surgery. Evidence suggests a narrow range of graft tensions, which allow the graft to remodel to a stable and mature neoligament. In previous cadaver experiments, we showed that twisting the graft could modulate the graft for

  17. Twist and its effect on ACL graft forces.

    Arnold, M.P.; Blankevoort, L.; Ham, A. ten; Verdonschot, N.J.J.; Kampen, A. van


    Graft tension is a controversial topic in anterior cruciate ligament (ACL) surgery. Evidence suggests a narrow range of graft tensions, which allow the graft to remodel to a stable and mature neoligament. In previous cadaver experiments, we showed that twisting the graft could modulate the graft for

  18. Experimental study on regeneration of ascending tract after spinal cord injury with predegenerated peripheral nerve graft and NGF infusion


    Objective:To explore the effects of predegenerated peripheral nerve graft (PPNG) combined with nerve growth factor (NGF) infusion on ascending sensory tract regeneration after spinal cord injury.Methods: Fifty female SD rats were randomly divided into 5 groups. Group A was treated with PPNG and NGF infusion, group B with PPNG, group C with NGF infusion, group D and group E were blank and normal control, respectively. Horseradish peroxidase-labled (HRP) tracing method was employed to evaluate the regeneration of injured nerves after 8 weeks. The extent of regeneration in and beyond the nerve graft was determined by counting the number of HRP-labeled fibers intersecting imaginary lines perpendicular to the axis of the graft and cord. For the sake of convenience, according to the relation of the PNG and spinal cord, 6 model zones were divided, including caudal of spinal cord, caudal transition zone, caudal zone in graft, rostral zone in graft, rostral transition zone and rostral of spinal cord. Results: On the transverse section of caudal zone in graft, rostral zone in graft, rostral transition zone, the fibers in group A were significantly higher than that in group B and C (P<0.05). Conclusion: PPNG combined with NGF may significantly promote the regeneration of ascending long tract after spinal cord injury. The regenerative fibers can penetrate the 2 graft-host interface scars.

  19. Neuroprotective role of Batroxobin in cardiopulmonary resuscitation rabbits

    Zhoujun Kang; Hui Cao; Bing Mei


    BACKGROUND: Batroxobin has been found to have protective effect on cerebral ischemia-reperfusion,and cardiopulmonary resuscitation (CPR) is the common cause of global brain ischemia-reperfusion.OBJECTIVE: To observe the effect of Batroxobin on the morphological results of cerebral cortex and hippocampus in rabbit models of CPR, and the changes of serum concentration of tumor necrosis factor alpha (TNF- α) after CPR.DESIGN: A randomized controlled observation.SETTING: Laboratory of the Department of Burns, Changhai Hospital affiliated to the Second Military Medical University of Chinese PLA.MATERIALS: Thirty healthy New Zealand rabbits of 2.5 - 3.0 kg, either male or female, were used. Kits for TNF- α determination were provided by LIFEKEY BioMeditech Company (USA).METHODS: The experiments were carried out in the laboratory of Department of Burns, Changhai Hospital from February 2001 to January 2002. The 32 rabbits were randomly divided into sham-operated group (n=8),conventional resuscitation group (n=12) and Batroxobin-treated group (n=12). The animals in the conventional resuscitation group and Batroxobin-treated group were anesthetized, then induced into modified Pittsburg's model of mechanical ventricular fibrillation. Sham-operated group was discharged on the chest wall, which did not cause ventricular fibrillation. Conventional resuscitation group and Batroxobin-treated group were exposed to 6 minutes of cardiac arrest induced by ventricular fibrillation, then the resuscitation began. A dosage of 0.3 Bu/kg of Batroxobin was administered to the rabbits in the Batroxobin-treated group at the beginning of resuscitation. Blood sample was collected at 4 and 12 hours after CPR to determine the concentration of TNF- α in serum. After the second blood collection, brain tissue was taken out immediately,and the forms of nerve cells in cerebral cortex and hippocampal CA1 region were observed under light microscope.MAIN OUTCOME MEASURES: ① TNF-α concentration in

  20. Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study.

    Ong, J C Y


    The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects.

  1. Aortic outflow cannula tip design and orientation impacts cerebral perfusion during pediatric cardiopulmonary bypass procedures.

    Menon, Prahlad G; Antaki, James F; Undar, Akif; Pekkan, Kerem


    Poor perfusion of the aortic arch is a suspected cause for peri- and post-operative neurological complications associated with cardiopulmonary bypass (CPB). High-speed jets from 8 to 10FR pediatric/neonatal cannulae delivering ~1 L/min of blood can accrue sub-lethal hemolytic damage while also subjecting the aorta to non-physiologic flow conditions that compromise cerebral perfusion. Therefore, we emphasize the importance of cannulation strategy and hypothesize engineering better CPB perfusion through a redesigned aortic cannula tip. This study employs computational fluid dynamics to investigate novel diffuser-tipped aortic cannulae for shape sensitivity to cerebral perfusion, in an in silico cross-clamped aortic arch model modeled with fixed outflow resistances. 17 parametrically altered configurations of an 8FR end-hole and several diffuser cone angled tips in combination with jet incidence angles toward or away from the head-neck vessels were studied. Experimental pressure-flow characterizations were also conducted on these cannula tip designs. An 8FR end-hole aortic cannula delivering 1 L/min along the transverse aortic arch was found to give rise to backflow from the brachicephalic artery (BCA), irrespective of angular orientation, for the chosen ascending aortic insertion location. Parametric alteration of the cannula tip to include a diffuser cone angle (tested up to 7°) eliminated BCA backflow for any tested angle of jet incidence. Experiments revealed that a 1 cm long 10° diffuser cone tip demonstrated the best pressure-flow performance improvement in contrast with either an end-hole tip or diffuser cone angles greater than 10°. Performance further improved when the diffuser was preceded by an expanded four-lobe swirl inducer attachment-a novel component. In conclusion, aortic cannula orientation is crucial in determining net head-neck perfusion but precise angulations and insertion-depths are difficult to achieve practically. Altering the cannula tip

  2. Regional myocardial shortening in relation to graft-reactive hyperemia and flow after coronary bypass surgery

    R.W. Brower (Ronald); P.W.J.C. Serruys (Patrick); E. Bos (Egbert); J. Nauta (Jan)


    textabstractExtent of regional shortening of myocardium in areas newly perfused by bypass grafting was determined in 56 patients by a new technique employing four to six radiopaque markers sutured in pairs to the epicardium near the coronary anastomosis. Paradoxical systolic expansion (PSE) was mani

  3. Non-isothermal cephalexin hydrolysis by penicillin G acylase immobilized on grafted nylon membranes

    Mohy Eldin, M.S.; Santucci, M.; Rossi, S.; Tramper, J.; Janssen, A.E.M.; Schroën, C.G.P.H.; Mita, D.G.


    A new catalytic membrane has been prepared using a nylon membrane grafted by -radiation with methylmethacrylate (MMA) and using hexamethylenediamine (HMDA) as spacer. Penicillin G acylase (PGA) and cephalexin were employed as catalyst and substrate, respectively. Cephalexin hydrolysis was studied in

  4. Successful rescue from cardiac arrest in a patient with postinfarction left ventricular blow-out rupture: "extra-pericardial aortic cannulation" for establishment total cardiopulmonary bypass.

    Ohira, Suguru; Yaku, Hitoshi; Nakajima, Shunsuke; Takahashi, Akihiko


    We report a quick and simple technique to establish cardiopulmonary bypass (CPB) in a left ventricular (LV) blow-out rupture. A 74-year-old woman with a diagnosis of acute myocardial infarction suddenly collapsed and lost consciousness. A venous-arterial extracorporeal membrane oxygenation (ECMO) device was inserted by femoral cannulation. Emergent median sternotomy was performed. The pericardium was not opened first, and the thymus was divided to expose the ascending aorta just above the pericardial reflection. After placing two purse-string sutures on the distal ascending aorta, a 7-mm aortic cannula (Terumo, Tokyo, Japan) was inserted. The pericardium was then incised. A large volume of blood was expelled from the pericardial space, and CPB was initiated with suction drainage. A two-stage venous drainage cannula was then inserted from the right atrial appendage without hemodynamic collapse. After cardiac arrest, closure of ruptured LV wall and concomitant coronary artery bypass grafting were performed. The patient was weaned from CPB with an intra-aortic balloon pump (IABP) and the previously inserted venous-arterial ECMO. Extra-pericardial aortic cannulation is an effective and reproducible method to prepare for CPB in emergent cases of LV rupture.


    S. Termnak; K. Sintasanai; T. Amomsakchai; T. Nipithakul; D. Triampo


    The scanning force microscopy (SFM)/chemical force microscopy (CFM) were used to study the growth of grafted polyacrylamide (PAM) chains onto polyethylene (PE)-film with varying grafting time. Results from the CFM reveal reduced interaction between the probe and areas with grafted-PAM on the surface. The topography and the friction trace-minus-retrace (TMR) images are complementary to one another resulting from the reduced interaction of the probe that has specificity to chemical domains.

  6. Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients

    Schmelter, Christopher, E-mail:; Raab, Udo, E-mail: [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany); Lazarus, Friedrich, E-mail: [Klinikum Ingolstadt, Department of Nephrology (Germany); Ruppert, Volker, E-mail: [Klinikum Ingolstadt, Department of Vascular Surgery (Germany); Vorwerk, Dierk, E-mail: [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)


    PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft was the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.

  7. Information Literacy and Employability

    O'Keeffe, Colin


    Information Literacy (IL) and its relationship to third level graduates’ employability has gained more attention in recent years. This article examines how IL has evolved from skills initially associated with academic libraries into a key workplace skill set of the knowledge economy. It outlines the challenges interviewees encounter when selling IL to employers, how IL can be utilised when preparing for upcoming interviews and suggests a distinction between workplace IL and employability IL. ...

  8. Histological evaluation of the influence of magnetic field application in autogenous bone grafts in rats

    Ponzoni Deise


    Full Text Available Abstract Background Bone grafts are widely used in oral and maxillofacial reconstruction. The influence of electromagnetic fields and magnets on the endogenous stimulation of target tissues has been investigated. This work aimed to assess the quality of bone healing in surgical cavities filled with autogenous bone grafts, under the influence of a permanent magnetic field produced by in vivo buried devices. Methods Metal devices consisting of commercially pure martensitic stainless steel washers and titanium screws were employed. Thirty male Wistar rats were divided into 3 experimental and 3 control groups. A surgical bone cavity was produced on the right femur, and a bone graft was collected and placed in each hole. Two metallic washers, magnetized in the experimental group but not in the control group, were attached on the borders of the cavity. Results The animals were sacrificed on postoperative days 15, 45 and 60. The histological analysis of control and experimental samples showed adequate integration of the bone grafts, with intense bone neoformation. On days 45 and 60, a continued influence of the magnetic field on the surgical cavity and on the bone graft was observed in samples from the experimental group. Conclusion The results showed intense bone neoformation in the experimental group as compared to control animals. The intense extra-cortical bone neoformation observed suggests that the osteoconductor condition of the graft may be more susceptible to stimulation, when submitted to a magnetic field.

  9. The autologus graft of epithelial tissue culture

    Minaee B


    Full Text Available With the intention of research about culture and autologus graft of epithelial tissue we used 4 french Albino Rabbits with an average age of 2 months. After reproduction on the support in EMEM (Eagle's Minimum Essential Medium we used this for graft after 4 weeks. This region which grafted total replaced. After fixation of this sample and passing them through various process, histological sections were prepared. These sections were stained with H & E and masson's trichrome and studied by light microscope. We succeeded in graft. We hope in the near future by using the method of epithelium tissue culture improving to treat burned patients.

  10. Off - Pump Coronary Artery Bypass Graft Surgery: A Safe Method For Complete Revascularization

    Mirkhani S. H


    Full Text Available In recent years off-pump coronary artery bypass surgery (OPCAB has emerged as preferred method for revascularization of coronary arteries in relatively selected group of patients. Considering patients receiving incomplete revascularization need significantly higher postoperative catheterization and re-intervention (PTCA or CABG, we performed this study to identify safety and feasibility of this technique for total revascularization in nearly all patients requiring coronary artery graft surgery."nMaterials and Methods: In this study, 150 consecutive patients underwent OPCAB by one surgeon. Octopus device used for regional wall stabilization. Vascular control achieved by ethibond loops, occluder, and shunts. Situations such as cardiomegaly, poor ventricular function, advanced age, hemodynamic instability, and small coronary arteries were not considered contraindications to OPCAB."nResults: Of 150 OPCAB cases, 146 (97.3 percent were completely off-pump. The mean number of grafts per patient was 4.1 (range, 2 to 6. Total 595 distal grafts anastomosed to LAD (140 diagonals (140, right coronary artery (145, left circumflex (164. Thirty-day mortality and myocardial infarction were 0.6 percent and 3.3 percent respectively OPCAB patient experienced lesser postoperative bleeding had shorter stay at surgical intensive care unit and extubated earlier. Conduits used were left internal mammary artery, radial artery and greater saphenous vein."nConclusion: OPCAB is a safe method for complete revascularization in nearly all patients. The OPCAB patients experience less complications, have shorter hospital stay, absolute contraindication for OPCAB other than severe, diffuse coronary artery disease with poor run-off which is better treated by cardiopulmonary bypass.

  11. Novel block, graft and random copolymers for biomedical applications

    Javakhishvili, Irakli; Jankova Atanasova, Katja; Tanaka, Masaru;

    roles for this [2]. An artificial lung (oxygenator), already in use, is coated with high MW PMEA prepared by radical polymerization with AIBN [2]. To broaden the possibilities for designing biomedical devices [3] and inspired from these findings we first prepared homo polymers of MEA and their block...... copolymers with MMA [4] utilizing ATRP. Here we present other block, graft and random copolymers of MEA intended for biomedical applications. These macromolecular architectures have been constructed by employing controlled radical polymerization methods such as RAFT and ATRP....

  12. Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass

    Temucin Noyan Ogus


    Full Text Available Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution.

  13. Computational fluid dynamics evaluation of the cross-limb stent graft configuration for endovascular aneurysm repair.

    Shek, Tina L T; Tse, Leonard W; Nabovati, Aydin; Amon, Cristina H


    The technique of crossing the limbs of bifurcated modular stent grafts for endovascular aneurysm repair (EVAR) is often employed in the face of splayed aortic bifurcations to facilitate cannulation and prevent device kinking. However, little has been reported about the implications of cross-limb EVAR, especially in comparison to conventional EVAR. Previous computational fluid dynamics studies of conventional EVAR grafts have mostly utilized simplified planar stent graft geometries. We herein examined the differences between conventional and cross-limb EVAR by comparing their hemodynamic flow fields (i.e., in the "direct" and "cross" configurations, respectively). We also added a "planar" configuration, which is commonly found in the literature, to identify how well this configuration compares to out-of-plane stent graft configurations from a hemodynamic perspective. A representative patient's cross-limb stent graft geometry was segmented using computed tomography imaging in Mimics software. The cross-limb graft geometry was used to build its direct and planar counterparts in SolidWorks. Physiologic velocity and mass flow boundary conditions and blood properties were implemented for steady-state and pulsatile transient simulations in ANSYS CFX. Displacement forces, wall shear stress (WSS), and oscillatory shear index (OSI) were all comparable between the direct and cross configurations, whereas the planar geometry yielded very different predictions of hemodynamics compared to the out-of-plane stent graft configurations, particularly for displacement forces. This single-patient study suggests that the short-term hemodynamics involved in crossing the limbs is as safe as conventional EVAR. Higher helicity and improved WSS distribution of the cross-limb configuration suggest improved flow-related thrombosis resistance in the short term. However, there may be long-term fatigue implications to stent graft use in the cross configuration when compared to the direct

  14. Investor Sentiment and Employment

    M. Montone (Maurizio); R.C.J. Zwinkels (Remco)


    markdownabstract__Abstract__ We find that investor sentiment should affect a firm's employment policy in a world with moral hazard and noise traders. Consistent with the model's predictions, we show that higher sentiment among US investors leads to: (1) higher employment growth worldwide; (2) lower

  15. Supported Employment in Spain.

    Verdugo, Miguel Angel; Borja, F.; de Urries, Jordan; Bellver, Fernando; Martinez, Salvador


    Supported employment is growing in Spain, assisted by models from other countries and national legislation. The Spanish Association of Supported Employment is providing a framework for program development. The field must deal with the lack of systematic evaluation and with funding problems. (SK)

  16. Listening to Employers

    Machalski, Jan; Riley, Alison; Aubrey, Karl


    Various government initiatives have highlighted the importance of employer engagement in schools, further education and higher education. However, speaking as a team of lecturers in HE the authors have found that there is a tension between the perceptions of government and those of employers. Clearly, it would be a good thing if, particularly in…

  17. Employment and Training Programs.

    Minnesota State Office of the Legislative Auditor, St. Paul. Program Evaluation Div.

    This report examines the effectiveness of employment and training programs in Minnesota and discusses the impact of the 1985 Jobs Bill state legislation. Chapter 1 provides an introduction to Minnesota's programs and to studies of employment and training programs conducted nationwide. Chapter 2 studies the use of Job Training Partnership Act funds…

  18. Nanotribological study of grafted polymer

    Bouhacina, T.; Aimé, J. P.; Attias, A. J.


    The frictional forces between grafted layers, organosilanes and polymer, on silica and a nanotip have been investigated as a function of the tip velocity. From the interpretation of these results and one gets a step forward for more quantitative information. Les forces de friction entre des couches greffées sur silice et une nanopointe ont été étudiées en fonction de la vitesse de la pointe. À partir de l'interprétation de ces résultats on s'avance vers plus d'infor mations quantitatives.

  19. Design and development of multilayer vascular graft

    Madhavan, Krishna


    Vascular graft is a widely-used medical device for the treatment of vascular diseases such as atherosclerosis and aneurysm as well as for the use of vascular access and pediatric shunt, which are major causes of mortality and morbidity in this world. Dysfunction of vascular grafts often occurs, particularly for grafts with diameter less than 6mm, and is associated with the design of graft materials. Mechanical strength, compliance, permeability, endothelialization and availability are issues of most concern for vascular graft materials. To address these issues, we have designed a biodegradable, compliant graft made of hybrid multilayer by combining an intimal equivalent, electrospun heparin-impregnated poly-epsilon-caprolactone nanofibers, with a medial equivalent, a crosslinked collagen-chitosan-based gel scaffold. The intimal equivalent is designed to build mechanical strength and stability suitable for in vivo grafting and to prevent thrombosis. The medial equivalent is designed to serve as a scaffold for the activity of the smooth muscle cells important for vascular healing and regeneration. Our results have shown that genipin is a biocompatible crosslinker to enhance the mechanical properties of collagen-chitosan based scaffolds, and the degradation time and the activity of smooth muscle cells in the scaffold can be modulated by the crosslinking degree. For vascular grafting and regeneration in vivo, an important design parameter of the hybrid multilayer is the interface adhesion between the intimal and medial equivalents. With diametrically opposite affinities to water, delamination of the two layers occurs. Physical or chemical modification techniques were thus used to enhance the adhesion. Microscopic examination and graft-relevant functional characterizations have been performed to evaluate these techniques. Results from characterization of microstructure and functional properties, including burst strength, compliance, water permeability and suture

  20. Radiation resistivity of polyacenaphthylene-grafted polyethylene

    Hayakawa, Kiyoshi; Kawase, Kaoru; Yamakita, Hiromi

    Thin poly (ethylene-g-acenaphthylene) films prepared by the vapor-phase grafting method were subjected to the γ-irradiation in air, and various changes in tensile and structural properties of the film were investigated by comparing with those of the untreated or crosslinked polyethylene film. Polyethylene got to lose its inherent necking property by oxidative degradation and to be brittle-fractured by the irradiation dose less than 100 Mrad in air. The polyacenaphthylene-grafted polyethylenes (extent of grafting, ˜ 54 by {100( P-P°) }/{P°}), however, kept their ductility up to 200 Mrad or more, and the rate of increase in elastic modulus as well as yield strength with the increasing irradiation dose was considerably lower than that of untreated or crosslinked polyethylene. The effect of the grafting extent, and that of the irradiation dose-rate on the fracture energy were also examined. The weight increase of polyethylene due to the oxygen consumption and the resulting formation of carbonyl group which proceeded proportionally with the irradiation dose were remarkably suppressed by the grafting, whereas the double bond formation seemed to be unaffected by it. The grafted film held the original content of gel fraction unchanged during the irradiation in air, but the average molecular weight of the sol fraction decreased gradually. Meanwhile, the gel fraction of the crosslinked polyethylene was degenerated by a small dose of irradiation. The analysis of gaseous products revealed the formation of water, methanol, acetaldehyde and so forth from the irradiated grafted film. The grafting procedure and the subsequent irradiation of the grafted film did not affect the degree of crystallinity of the backbone polyethylene. The role played by the grafted polyacenaphthylene for endowing the radiation resistivity to polyethylene and its inherent limitation in effect were discussed from the structural point of view of the grafted film.

  1. Filtration of activated granulocytes during cardiopulmonary bypass surgery : A morphologic and immunologic study to characterize the trapped leukocytes

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W


    Cardiopulmonary bypass surgery induces an inflammatory reaction among others by activation of granulocytes. Leukocyte filtration has been shown to reduce the postoperative morbidity mediated by activated granulocytes. However, little is known about the mechanism of filter-leukocyte interaction, This

  2. Biodegradability of poly(3-hydroxybutyrate) film grafted with vinyl acetate: Effect of grafting and saponification

    Wada, Yuki [Department of Biological and Chemical Engineering, Faculty of Engineering, Gunma University, 1-5-1 Tenjin-cho, Kiryu, Gunma 376-8515 (Japan)]. E-mail:; Seko, Noriaki [Environment and Industrial Materials Research Division, Quantum Beam Science Directorate, Japan Atomic Energy Agency, 1233 Watanuki-machi, Takasaki, Gunma 370-1292 (Japan); Nagasawa, Naotsugu [Environment and Industrial Materials Research Division, Quantum Beam Science Directorate, Japan Atomic Energy Agency, 1233 Watanuki-machi, Takasaki, Gunma 370-1292 (Japan); Tamada, Masao [Environment and Industrial Materials Research Division, Quantum Beam Science Directorate, Japan Atomic Energy Agency, 1233 Watanuki-machi, Takasaki, Gunma 370-1292 (Japan); Kasuya, Ken-ichi [Department of Biological and Chemical Engineering, Faculty of Engineering, Gunma University, 1-5-1 Tenjin-cho, Kiryu, Gunma 376-8515 (Japan); Mitomo, Hiroshi [Department of Biological and Chemical Engineering, Faculty of Engineering, Gunma University, 1-5-1 Tenjin-cho, Kiryu, Gunma 376-8515 (Japan)


    Radiation-induced graft polymerization of vinyl acetate (VAc) onto poly(3-hydroxybutyrate) (PHB) film was carried out. At a degree of grafting higher than 5%, the grafted films (PHB-g-VAc) completely lost the enzymatic degradability that is characteristic of PHB due to the grafted VAc covering the surface of the PHB film. However, the biodegradability of the PHB-g-VAc films was recovered when the films were saponified in alkali solution under optimum conditions. Graft chains of the PHB-g-VAc film reacted selectively to become biodegradable polyvinyl alcohol (PVA). The biodegradability of the saponified PHB-g-VAc film increased rapidly with time.

  3. Biodegradability of poly(3-hydroxybutyrate) film grafted with vinyl acetate: Effect of grafting and saponification

    Wada, Yuki; Seko, Noriaki; Nagasawa, Naotsugu; Tamada, Masao; Kasuya, Ken-ichi; Mitomo, Hiroshi


    Radiation-induced graft polymerization of vinyl acetate (VAc) onto poly(3-hydroxybutyrate) (PHB) film was carried out. At a degree of grafting higher than 5%, the grafted films (PHB-g-VAc) completely lost the enzymatic degradability that is characteristic of PHB due to the grafted VAc covering the surface of the PHB film. However, the biodegradability of the PHB-g-VAc films was recovered when the films were saponified in alkali solution under optimum conditions. Graft chains of the PHB-g-VAc film reacted selectively to become biodegradable polyvinyl alcohol (PVA). The biodegradability of the saponified PHB-g-VAc film increased rapidly with time.

  4. Influence of ischemia before vein grafting on early hyperplasia of the graft and the dynamic changes of the intima after grafting

    Zou RongJiang


    Full Text Available Abstract Background To investigate both the influence of ischemia before grafting on early hyperplasia of the vein grafts, and the dynamic changes of the intima after grafting in a rabbit model of vein graft disease. Methods We performed paired vein graft experiments under different ischemic conditions (15 vs. 60 min; 15 vs. 90 min in the neck of the rabbits and compared the differences between the grafts. Clopidogrel, an anti-platelet agent, was administered before and after surgery. Twenty-eight days after the grafting procedure, the veins were evaluated microscopically. The dynamic changes of the intima after grafting were evaluated by scanning electron microscopy over time. Results The vein grafts subjected to 60- or 90-min ischemia exhibited no differences compared to those subjected to 15-min ischemia in terms of the mean thickness of the intimal, medial, and adventitial layers of the graft. Similarly, there was no difference in the Ki-67 labeling index (proliferation marker between the vein grafts. Vein grafts with 15-min ischemia lost endothelial cells (ECs but healed by 3 days post graft, whereas vein grafts with 90-min ischemia suffered serious EC loss, which was restored with new ECs during days 2 to 14 post graft. Conclusions Ninety-minute ischemia before vein grafting can cause serious EC loss, but does not increase early intimal hyperplasia when clopidogrel is administered. Protecting the vein from ischemia and reperfusion injury preserves ECs.

  5. Ethylene vinyl acetate based radiation grafted hydrophilic matrices: Process parameter standardization, grafting kinetics and characterization

    Chaudhari, C. V.; Mondal, R. K.; Dubey, K. A.; Grover, V.; Panicker, L.; Bhardwaj, Y. K.; Varshney, L.


    A transparent, elastomeric, grafted matrix for several potential applications was synthesized by single-step simultaneous radiation grafting of methacrylic acid onto ethylene vinyl acetate (EVA). CuSO4 was found to be the most suitable homo-polymerization inhibitor among different inhibitors tried. The grafting kinetics was found to be a strong function of dose rate (D) and monomer content (M) and an equation relating grafting rate Rg=Kg [M]1.13D0.23 was deduced. Crystallinity of the grafted matrices as assessed from XRD and DSC measurements indicated decrease in crystalline content with increase in grafting yield, suggesting crystalline domain of EVA get disrupted on grafting. Elastic modulus increased linearly with the increase in grafting yield, though elongation at break decreased precipitously from 900% to 30% at even ~9% grafting. Thermo-gravimetric analysis showed three step weight loss of the grafted EVA matrix. The grafting of MAA resulted in increase in surface energy mainly due to enhanced polar component.

  6. A novel initiating system for wool grafting

    Magdy Kandil Zahran


    Full Text Available This paper describes a new method for the grafting of methacrylic acid (MAA and other acrylic monomers onto wool fabric in aqueous medium. The novelty principally concerns the chemical approach of the redox grafting reaction that was carried out in the presence of sodium perborate (SPB initiator. Before the grafting reaction was started, the wool fabric was treated first with a freshly prepared ferrous ammonium sulfate (FAS solution. The so-treated fabric formed, with SPB, an efficacious redox system capable of initiating grafting of methacrylic acid (MAA and other acrylic monomers onto the wool fabric. The effect of the polymerization conditions on the polymer criteria, namely, graft yield (%GY, homopolymer (%HP, total conversion (%TC, and grafting efficiency (%GE, was studied. These polymer criteria were found to depend spaciously upon concentrations of the Fe2+ ion (activator, SPB (initiator, and MAA, pH of the polymerization medium, duration and temperature of polymerization. The graft copolymerization reaction has also been carried out in the presence of polymerization activators (e.g. reductant transition metal ions and an inhibitor (e.g. hydroquinone. A suitable mechanism for the grafting processes has been suggested, in accordance with the experimental results.

  7. Multimodality imaging of coronary artery bypass grafts

    Salm, Liesbeth Pauline


    This thesis describes multiple imaging modalities to examine coronary artery bypass grafts, and the research which was performed to further develop noninvasive imaging techniques to detect stenoses in native coronary arteries and bypass grafts in patients who experienced recurrent chest pain after c

  8. Coaxial electrospinning multicomponent functional controlled-release vascular graft: Optimization of graft properties.

    Yin, Anlin; Luo, Rifang; Li, Jiukai; Mo, Xiumei; Wang, Yunbing; Zhang, Xingdong


    Small diameter vascular grafts possessing desirable biocompatibility and suitable mechanical properties have become an urgent clinic demand. Herein, heparin loaded fibrous grafts of collagen/chitosan/poly(l-lactic acid-co-ε-caprolactone) (PLCL) were successfully fabricated via coaxial electrospinning. By controlling the concentration of heparin and the ratio of collagen/chitosan/PLCL, most grafts had the heparin encapsulation efficiency higher than 70%, and the heparin presented sustained release for more than 45 days. Particularly, such multicomponent grafts had relative low initial burst release, and after heparin releasing for 3 weeks, the grafts still showed good anti-platelet adhesion ability. In addition, along with the excellent cell biocompatibility, the fabricated grafts possessed suitable mechanical properties including good tensile strength, suture retention strength, burst pressure and compliance which could well match the native blood vessels. Thus, the optimized graft properties could be properly addressed for vascular tissue application via coaxial electrospinning.

  9. Phase Transition and Micellization of Temperature Responsive Dextran-graft-poly (N-isopropylacrylamide) Polymers


    Phase behavior and micellization of dextran-graft-poly (N-isopropylacrylamide) (PNIPAAm) polymers in aqueous solution are investigated in this paper using DSC and AFM methods. It is found that with the increase of grafting (G%) of the copolymers the endothermic enthalpy during the phase transition increases significantly and the transition temperature decreases slightly. The phase transition behavior of the copolymers is scanning rate dependent. Micelles are formed whenever the solution temperature is raised above the LCST of the copolymers. It is proposed that by using this thermal responsive property of the copolymers, drugs could be incorporated into the micelles without employing any organic solvent.

  10. Autogenous vein graft thrombosis following exposure to calcium-free solutions (calcium paradox).

    Nozick, J H; Farnsworth, P; Montefusco, C M; Parsonnet, V; Ruigrok, T J; Zimmerman, A N


    The morphological and functional effects of calcium-free and calcium-containing solutions on canine jugular vein intima were examined under conditions which closely resemble those techniques currently employed in peripheral vascular and aortocoronary bypass surgery. Veins that had been exposed only to calcium-containing solutions remained patent for the duration of the experimental period. Vein perfusion with a calcium-free solution, however, resulted in disruption of the jugular vein intima once calcium ions were reintroduced. Autogenous as a femoral arterial graft became thrombosed within 60 minutes. It is therefore suggested that vein grafts of autogenous origin be irrigated with calcium-containing solutions to prevent intimal damage and thrombosis.

  11. Polyethylene oxide hydration in grafted layers

    Dormidontova, Elena; Wang, Zilu

    Hydration of water soluble polymers is one of the key-factors defining their conformation and properties, similar to biopolymers. Polyethylene oxide (PEO) is one of the most important biomedical-applications polymers and is known for its reverse temperature solubility due to hydrogen bonding with water. As in many practical applications PEO chains are grafted to surfaces, e.g. of nanoparticles or planar surfaces, it is important to understand PEO hydration in such grafted layers. Using atomistic molecular dynamic simulations we investigate the details of molecular conformation and hydration of PEO end-grafted to gold surfaces. We analyze polymer and water density distribution as a function of distance from the surface for different grafting densities. Based on a detailed analysis of hydrogen bonding between polymer and water in grafted PEO layers, we will discuss the extent of PEO hydration and its implication for polymer conformation, mobility and layer properties. This research is supported by NSF (DMR-1410928).

  12. Graft Take-Rates After Tympanoplasty

    Andersen, Steven Arild Wuyts; Aabenhus, Kristine; Glad, Henrik;


    , technique, graft material, and revision surgery) for tympanoplasty type I were studied. A comparison with the graft take-rates for tympanoplasty types II to IV and/or cholesteatoma was made. RESULTS: A user-friendly ear surgery database with fast data entry and direct import of audiometric data......OBJECTIVE: To present a prospective ear surgery database and investigate the graft take-rate and prognostic factors for graft take-rate in tympanoplasty using the database. STUDY DESIGN: Prospective database study. SETTING: Tertiary referral center. PATIENTS: A total of 1606 cases undergoing...... tympanoplasty types I to IV were registered in the database in the period from February 2004 to November 2013. INTERVENTION: A total of 837 cases underwent myringoplasty/tympanoplasty type I. MAIN OUTCOME MEASURE: Graft take-rate and prognostic factors (age, discharge at time of surgery, tuba function...

  13. [Tension pneumomediastinum and tension pneumothorax following tracheal perforation during cardiopulmonary resuscitation].

    Buschmann, C T; Tsokos, M; Kurz, S D; Kleber, C


    Tension pneumothorax can occur at any time during cardiopulmonary resuscitation (CPR) with external cardiac massage and invasive ventilation either from primary or iatrogenic rib fractures with concomitant pleural or parenchymal injury. Airway injury can also cause tension pneumothorax during CPR. This article presents the case of a 41-year-old woman who suffered cardiopulmonary arrest after undergoing elective mandibular surgery. During CPR the upper airway could not be secured by orotracheal intubation due to massive craniofacial soft tissue swelling. A surgical airway was established with obviously unrecognized iatrogenic tracheal perforation and subsequent development of tension pneumomediastinum and tension pneumothorax during ventilation. Neither the tension pneumomediastinum nor the tension pneumothorax were decompressed and accordingly resuscitation efforts remained unsuccessful. This case illustrates the need for a structured approach to resuscitate patients with ventilation problems regarding decompression of tension pneumomediastinum and/or tension pneumothorax during CPR.

  14. Rhythm recognition is accountable for the majority of hands-off time during cardiopulmonary resuscitation

    Hansen, Lars Koch; Brabrand, Mikkel


    . Rhythms were presented to physicians who identified whether they were shockable and whether they would defibrillate. We measured time to stated decision. Thirty-five doctors participated, 32 had completed advanced life support training. The mean time to make a decision on whether to defibrillate......Cardiopulmonary resuscitation guidelines are constantly optimized to increase survival. Keeping hands-off time brief is vital. Our hypothesis is that rhythm recognition is time-consuming during cardiopulmonary resuscitation. A Laerdal Sim-Man simulated three shockable and four nonshockable rhythms...... or not was 3.4 s [95% confidence interval (CI): 2.8-3.9] for shockable and 4.4 s (95% CI: 3.6-5.3) for nonshockable rhythms (Ptime was 4.0 s (95% CI: 3.5-4.5). Of all shockable rhythms, 95.2 % were correctly diagnosed as shockable, compared with 88.6 % of nonshockable rhythms...

  15. Critical incidents during prehospital cardiopulmonary resuscitation: what are the problems nobody wants to talk about?

    Hohenstein, Christian; Rupp, Peter; Fleischmann, Thomas


    We wanted to identify incidents that led or could have led to patient harm during prehospital cardiopulmonary resuscitation. A nationwide anonymous and Internet-based critical incident reporting system gave the data. During a 4-year period we received 548 reports of which 74 occurred during cardiopulmonary resuscitation. Human error was responsible for 85% of the incidents, whereas equipment failure contributed to 15% of the reports. Equipment failure was considered to be preventable in 61% of all the cases, whereas incidents because of human error could have been prevented in almost all the cases. In most cases, prevention can be accomplished by simple strategies with the Poka-Yoke technique. Insufficient training of emergency medical service physicians in Germany requires special attention. The critical incident reports raise concerns regarding the level of expertize provided by emergency medical service doctors.

  16. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

    Mastenbroek, Mirjam H; Sant, Jetske Van't; Versteeg, Henneke


    -defibrillator (mean age 65 ± 11; 73% male) underwent echocardiography and cardiopulmonary exercise testing (CPX) before implantation (baseline) and 6 months after implantation. At baseline, patients also completed a set of questionnaires measuring mental and physical health. The association between echocardiographic......BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time CRT...... response (left ventricular end-systolic volume decrease ≥15%) and a comprehensive set of CPX results was examined. Echocardiographic responders (54%) demonstrated higher peak oxygen consumption and better exercise performance than nonresponders at baseline and at 6-month follow-up. Furthermore, only...

  17. Increased post-operative cardiopulmonary fitness in gastric bypass patients is explained by weight loss

    Lund, M. T.; Hansen, M.; Wimmelmann, C. L.


    Roux-en-Y gastric bypass (RYGB) leads to a major weight loss in obese patients. However, given that most patients remain obese after the weight loss, regular exercise should be part of a healthier lifestyle. The primary aim of this study was to investigate the cardiopulmonary fitness in obese......-perceived physical fitness increased after RYGB. Self-reported low- and high-intensity physical activity did not change. With weight loss, self-rated fitness level increased and the limitations to perform exercise decreased in RYGB patients. Nevertheless, as shown by the lower absolute VO2max, RYGB patients do...... patients before and after RYGB. Thirty-four patients had body composition and cardiopulmonary fitness (VO2max) assessed and completed questionnaires regarding physical activity and function twice before RYGB (time points A and B) and 4 and 18 months after surgery (time points C and D). Weight loss was 37...

  18. Arterial pressure and deltoid muscle gas tensions during cardiopulmonary bypass in man.

    Stanley, T H


    The results of this study demonstrate that standard techniques of conducting cardiopulmonary bypass produce low muscle oxygen and high muscle carbon dioxide tensions and, thus, little perfusion of skeletal muscle. Our findings also show that PmO2 and PmCO2 do not return to pre-bypass levels until the mean arterial blood pressure exceeds 12 kPa (90 torr) during bypass and that utilization of vasopressor drugs during bypass maintains the pressure; but at the expense of muscle blood flow. The data indicate that both high mean blood pressure and high flow are necessary during bypass to ensure skeletal muscle perfusion and suggest, when combined with preliminary animal findings, that this type of bypass perfusion may prove to be superior to standard techniques in hastening recovery after cardio-pulmonary bypass.

  19. Retail Employment Trends


    Robert Walters, one of the world’s leading professional specialist recruitment consultancies, has recently released a report on employment opportunities in China’s consumer goods retail industry in the first half of this year. Excerpts follow:

  20. Development of the Roller Pump for Use in the Cardiopulmonary Bypass Circuit

    Cooley, Denton A.


    In 1937, John Gibbon proposed his concept of extracorporeal circulation as an aid to cardiac surgery. Subsequently, a number of different types of pumps were tried in the extracorporeal circuit. Today, the pump used most often is a positive displacement twin roller pump, originally patented by Porter and Bradley in 1855. The rotary pump has undergone some minor modifications prior to its use in clinical cardiopulmonary bypass. Cardiovascular surgeons owe much to Porter and Bradley for an inve...

  1. Influence of Cardiopulmonary Bypass on the Interaction of Recombinant Factor VIIa with Activated Platelets

    Kjalke, Marianne; Runge, Marx; Rojkjaer, Rasmus; Steinbruchel, Daniel; Johansson, Pär I


    Recombinant factor VIIa (rFVIIa) interacts preferentially with coated platelets characterized by a high exposure of phosphatidyl serine (PS), FV, FVIII, FIX, and FX binding, and fibrinogen. Cardiopulmonary bypass (CPB) is known to impair platelet function. In this study, the influence of CPB on formation of coated platelets and the interaction of rFVIIa with the platelets were studied. Blood was either exposed to a closed CPB circuit or obtained from patients undergoing CPB-assisted cardiac s...

  2. Mechanical compression of coronary artery stents: potential hazard for patients undergoing cardiopulmonary resuscitation.

    Windecker, S; Maier, W; Eberli, F R; Meier, B; Hess, O M


    Mechanical compression of coronary artery stents may be associated with a fatal outcome as the result of refractory myocardial ischemia. We present the history of an 83-yr-old patient, who died owing to hemorrhagic shock 3 days after stent implantation, despite immediate cardiopulmonary resuscitation (CPR). Postmortem examination showed stent compression, probably due to mechanical deformation during CPR. This complication has been reported in two other cases in the literature, suggesting that CPR may be hazardous to patients with coronary artery stents.

  3. Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients


    Outcomes of cardiopulmonary resuscitation (CPR) in hospitalized patients with ESRD requiring maintenance dialysis are unknown. Outcomes of in-hospital CPR in these patients were compared with outcomes in the general population using data from the Nationwide Inpatient Sample (NIS; 2005–2011). The study population included all adults (≥18years old) from the general population and those with a history of ESRD. Baseline characteristics, in-hospital complications, and discharge outcomes were compa...

  4. Deficiency of employability capacity

    Pelse I.


    Full Text Available Young unemployed people have comprised one of the significantly largest groups of the unemployed people in Latvia in recent years. One of the reasons why young people have difficulty integrating into the labour market is the “expectation gap” that exists in the relations between employers and the new generation of workers. Employers focus on capacity-building for employability such individual factors as strength, patience, self-discipline, self-reliance, self-motivation, etc., which having a nature of habit and are developed in a long-term work socialization process, which begins even before the formal education and will continue throughout the life cycle. However, when the socialization is lost, these habits are depreciated faster than they can be restored. Currently a new generation is entering the labour market, which is missing the succession of work socialization. Factors, such as rising unemployment and poverty in the background over the past twenty years in Latvia have created a very unfavourable employability background of “personal circumstances” and “external factors”, which seriously have impaired formation of the skills and attitudes in a real work environment. The study reveals another paradox – the paradox of poverty. Common sense would want to argue that poverty can be overcome by the job. However, the real state of affairs shows that unfavourable coincidence of the individual, personal circumstances and external factors leads to deficit of employability capacity and possibility of marked social and employment deprivation.

  5. A failure mode effect analysis on extracorporeal circuits for cardiopulmonary bypass.

    Wehrli-Veit, Michel; Riley, Jeffrey B; Austin, Jon W


    Although many refinements in perfusion methodology and devices have been made, extracorporeal circulation remains a contributor to neurological complications, bleeding coagulopathies, use of blood products, as well as systemic inflammatory response. With the exposure of these adverse effects of cardiopulmonary bypass, the necessity to re-examine the safety of extracorporeal circuits is vital. A failure mode effect analysis (FMEA) is a proven proactive technique developed to evaluate system effect or equipment failure. FMEA was used to evaluate the six different types of extracorporeal circuits based on feedback from five clinical experts. Cardiovascular device manufacturers, the Veteran's Administration National Center for Patient Safety, and the Joint Commission on Accreditation of Healthcare Organizations recommend the use of FMEA to assess and manage risks in current and developing technologies and therapies. This analysis investigates the safety of six types of extracorporeal circuits used in coronary revascularization, including the newer miniaturized extracorporeal circuits. The FMEA lists and ranks the hazards associated with the use of each cardiopulmonary bypass extracorporeal circuit type. To increase the safety of extracorporeal circuits and minimize the effects associated with cardiopulmonary bypass, perfusionists must incorporate FMEA into their clinical practice.

  6. Effect of carotid and aortic baroreceptors on cardiopulmonary reflex: the role of autonomic function

    T.L. Fernandes


    Full Text Available We determined the sympathetic and parasympathetic control of heart rate (HR and the sensitivity of the cardiopulmonary receptors after selective carotid and aortic denervation. We also investigated the participation of the autonomic nervous system in the Bezold-Jarish reflex after selective removal of aortic and carotid baroreceptors. Male Wistar rats (220-270 g were divided into three groups: control (CG, N = 8, aortic denervation (AG, N = 5 and carotid denervation (CAG, N = 9. AG animals presented increased arterial pressure (12% and HR (11% compared with CG, while CAG animals presented a reduction in arterial pressure (16% and unchanged HR compared with CG. The sequential blockade of autonomic effects by atropine and propranolol indicated a reduction in vagal function in CAG (a 50 and 62% reduction in vagal effect and tonus, respectively while AG showed an increase of more than 100% in sympathetic control of HR. The Bezold-Jarish reflex was evaluated using serotonin, which induced increased bradycardia and hypotension in AG and CAG, suggesting that the sensitivity of the cardiopulmonary reflex is augmented after selective denervation. Atropine administration abolished the bradycardic responses induced by serotonin in all groups; however, the hypotensive response was still increased in AG. Although the responses after atropine were lower than the responses before the drug, indicating a reduction in vagal outflow after selective denervation, our data suggest that both denervation procedures are associated with an increase in sympathetic modulation of the vessels, indicating that the sensitivity of the cardiopulmonary receptors was modulated by baroreceptor fibers.

  7. Protective effects of hypovolemic hypotension preconditioning on cardiopulmonary function after myocardium ischemia/reperfusion injury

    陈雪君; 王昕; 夏中元; 罗涛; 涂仲凡


    Objective: To identify the protective effects of hypovolemic hypotension preconditioning on cardiopulmonary function after myocardial ischemia/reperfusion injury and to explore the possible mechanism.Methods: Twenty-four male white rabbits were randomly assigned to two groups. In the control group, ischemia/reperfusion animals(Group I/R, n=10) were subjected to thirty-minute occlusion of left anterior descending coronary artery and two-hour reperfusion. Animals in hypovolemic hypotension preconditioning group (Group HHP, n=14) experienced brief systemic ischemia preconditioning through blood withdrawl to lower blood pressure to 40%-50% of the baseline before myocardial ischemia/reperfusion. Hemodynamic parameters were recorded. Blood sample was taken to measure superoxide dismutase (SOD), malondialdehyde (MDA) and nitrogen monoxide (NO) changes with blood gas analysis. Myocardium specimens were sampled to examine apoptosis-related gene interleukin-1 beta converting enzyme (ICE) mRNA. Results: Cardiac mechanical function and lung gas exchange remained stable in Group HHP with a significant increase in NO level; while in Group I/R without preconditioning, cardiopulmonary dysfunction was present after 2 h reperfusion associated with a significant reduction in NO formation and an increase in MDA (P<0.001). There was negative expression of ICE mRNA in the two groups.Conclusions: Hypovolemic hypotension preconditioning significantly improves cardiopulmonary function and increases NO formation and the protective benefit associated with hypovolemic hypotension preconditioning of the heart may be regulated through NO mediated mechanism.

  8. Animation shows promise in initiating timely cardiopulmonary resuscitation: results of a pilot study.

    Attin, Mina; Winslow, Katheryn; Smith, Tyler


    Delayed responses during cardiac arrest are common. Timely interventions during cardiac arrest have a direct impact on patient survival. Integration of technology in nursing education is crucial to enhance teaching effectiveness. The goal of this study was to investigate the effect of animation on nursing students' response time to cardiac arrest, including initiation of timely chest compression. Nursing students were randomized into experimental and control groups prior to practicing in a high-fidelity simulation laboratory. The experimental group was educated, by discussion and animation, about the importance of starting cardiopulmonary resuscitation upon recognizing an unresponsive patient. Afterward, a discussion session allowed students in the experimental group to gain more in-depth knowledge about the most recent changes in the cardiac resuscitation guidelines from the American Heart Association. A linear mixed model was run to investigate differences in time of response between the experimental and control groups while controlling for differences in those with additional degrees, prior code experience, and basic life support certification. The experimental group had a faster response time compared with the control group and initiated timely cardiopulmonary resuscitation upon recognition of deteriorating conditions (P < .0001). The results demonstrated the efficacy of combined teaching modalities for timely cardiopulmonary resuscitation. Providing opportunities for repetitious practice when a patient's condition is deteriorating is crucial for teaching safe practice.

  9. Reference values for cardiopulmonary exercise testing in healthy volunteers: the SHIP study.

    Koch, B; Schäper, C; Ittermann, T; Spielhagen, T; Dörr, M; Völzke, H; Opitz, C F; Ewert, R; Gläser, S


    Cardiopulmonary exercise testing (CPET) is a widely applied clinical procedure. The aim of the present study was to acquire a comprehensive set of reference values for cardiopulmonary responses to exercise and to evaluate possible associations with sex, age and body mass index (BMI). A standardised progressive incremental exercise protocol on a cycle ergometer was applied to 1,708 volunteers of a cross-sectional epidemiologic survey, called "Study of Health in Pomerania". Individuals with cardiopulmonary disorders, or echocardiographic or lung function pathologies, were excluded. The influence of potential confounding factors, such as smoking, taking beta-blockers, hypertension, diastolic dysfunction, BMI and physical activity, were analysed for their influencing power. Reference values of CPET parameters were determined by regression analyses. Of the volunteers, 542 current smokers and obese individuals were excluded for not being representative of a healthy population. The final sample size was 534 (253 males), with age 25-80 yrs. The current study provides a representative set of reference values for CPET parameters based on age and weight. Sex and age have a significant influence on exercise parameters. While addressing the problem of a selection bias, the current study provides the first comprehensive set of reference values obtained in a large number of healthy volunteers within a population-based survey.

  10. [Graft reconstruction of flexor tendons].

    Pauchard, N; Pedeutour, B; Dautel, G


    The improvement of primary flexor tendon repair has limited the indications of secondary repairs to neglected initial wound care and deficiencies in the surgical technique or rehabilitation. The surgical and rehabilitation care is complex and prolonged, requiring full cooperation of the patient. That is why the surgeon must evaluate patient's ability to integrate instructions and to comply with a long and demanding protocol. The functional needs of the patient are important in treatment decisions and the surgeon should not hesitate to use an appropriate surgical alternative (tenodesis, arthrodesis, tendon transfer, etc.). After a brief historical review, the authors discuss the indications, technical procedures and finally the results of one-stage and two-stage flexor tendon graft, which despite mixed results keep a real place in our current armamentarium.

  11. Grafted dopamine neurons: Morphology, neurochemistry, and electrophysiology.

    Strömberg, Ingrid; Bickford, Paula; Gerhardt, Greg A


    Grafting of dopamine-rich tissue to counteract the symptoms in Parkinson's disease became a promising tool for future treatment. This article discusses how to improve the functional outcome with respect to graft outgrowth and functions of dopamine release and electrophysiological responses to graft implantation in the host brain striatal target. It has been documented that a subpopulation of the dopamine neurons innervates the host brain in a target-specific manner, while some of the grafted dopamine neurons never project to the host striatum. Neurochemical studies have demonstrated that the graft-induced outgrowth synthesize, store, metabolize and release dopamine and possibly other neurotransmitters such as 5-HT. Furthermore, the released dopamine affects the dopamine-depleted brain in areas that are larger than the graft-derived nerve fibers reach. While stem cells will most likely be the future source of cells to be used in grafting, it is important to find the guiding cues for how to reinnervate the dopamine-depleted striatum in a proper way with respect to the dopamine subpopulations of A9 and A10 to efficiently treat the motor abnormalities seen in Parkinson's disease.

  12. Authenticity in Employment Relations

    Tackney, Charles Thomas

    This research takes up the concept of authenticity as a criterion variable for theology of the workplace analysis, a domain which explores employment parameters in light of religious teaching on the social question at national, organizational or firm-specific levels. Following a review of the con......This research takes up the concept of authenticity as a criterion variable for theology of the workplace analysis, a domain which explores employment parameters in light of religious teaching on the social question at national, organizational or firm-specific levels. Following a review......, it becomes possible to specify employment relations parameters between the indirect and direct employer and employees in a manner that will ensure working conditions consistent with these traditions, substantially enhancing the prospect of authenticity in employment relations. This theology of the workplace...... analysis should complement and support corporate social responsibility, management spirituality, authentic leadership / authentic follower, and other secular research by offering a research methods bridge between empirically grounded theology and secular studies, with the common goal of improving workplace...

  13. Ionic polymer-metal composite actuators obtained from radiation-grafted cation- and anion-exchange membranes.

    Park, Jong Hyuk; Han, Man Jae; Song, Dae Seock; Jho, Jae Young


    Two series of ionic polymer-metal composites (IPMCs), one cationic and one anionic, are designed and prepared from radiation-grafted ion-exchange membranes. Through examination of the properties of the membranes synthesized from the two grafting monomers and the two base polymers, acrylic acid-grafted poly(vinylidene fluoride-co-hexafluoropropylene) and quarternized 4-vinylpyridine-grafted poly(ethylene-co-tetrafluoroethylene) with the appropriate amount of ionic groups are employed for the fabrication of cation and anion IPMCs, respectively. The bending displacement of the cation IPMC is comparable to Nafion-based IPMC under direct- and alternating-current voltage, but back-relaxation is not observed. The actuation performance of the anion IPMC is highly improved over those reported earlier in the literature for the other anion IPMCs.

  14. Plasma-grafted alkaline anion-exchange membranes based on polyvinyl chloride for potential application in direct alcohol fuel cell

    Hu, Jue; Zhang, Chengxu; Cong, Jie; Toyoda, Hirotaka; Nagatsu, Masaaki; Meng, Yuedong


    Plasma grafting is employed to prepare alkaline anion-exchange membranes in this study. The attenuated total reflection Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy and thermo gravimetric analysis demonstrate that the benzyltrimethylammonium cationic groups are successfully introduced into the polyvinyl chloride matrix via plasma grafting, quaternization and alkalization. The plasma-grafted alkaline anion-exchange membrane exhibits a satisfactory ionic exchange capacity (1.01 mmol g-1), thermal stability, mechanical property, ionic conductivity (0.0145 S cm-1) and methanol permeability (9.59 × 10-12 m2 s-1), suggesting a great potential for application in direct alcohol fuel cells. The open circuit voltage of air-breathing ADAFC using plasma-grafted alkaline anion-exchange membrane is 0.796 V with 1 M EtOH solution at ambient temperature.

  15. Can the Cardiopulmonary 6-Minute Walk Test Reproduce the Usual Activities of Patients with Heart Failure?

    Guimarães Guilherme Veiga


    Full Text Available OBJECTIVE: The 6-minute walk test is an way of assessing exercise capacity and predicting survival in heart failure. The 6-minute walk test was suggested to be similar to that of daily activities. We investigated the effect of motivation during the 6-minute walk test in heart failure. METHODS: We studied 12 males, age 45±12 years, ejection fraction 23±7%, and functional class III. Patients underwent the following tests: maximal cardiopulmonary exercise test on the treadmill (max, cardiopulmonary 6-minute walk test with the walking rhythm maintained between relatively easy and slightly tiring (levels 11 and 13 on the Borg scale (6EB, and cardiopulmonary 6-minute walk test using the usual recommendations (6RU. The 6EB and 6RU tests were performed on a treadmill with zero inclination and control of the velocity by the patient. RESULTS: The values obtained in the max, 6EB, and 6RU tests were, respectively, as follows: O2 consumption ( 15.4±1.8, 9.8±1.9 (60±10%, and 13.3±2.2 (90±10%; heart rate (bpm 142±12, 110±13 (77±9%, and 126±11 (89±7%; distance walked (m 733±147, 332±66, and 470±48; and respiratory exchange ratio (R 1.13±0.06, 0.9±0.06, and 1.06±0.12. Significant differences were observed in the values of the variables cited between the max and 6EB tests, the max and 6RU tests, and the 6EB and 6RU tests (p<0.05. CONCLUSION: Patients, who undergo the cardiopulmonary 6-minute walk test and are motivated to walk as much as they possibly can, usually walk almost to their maximum capacity, which may not correspond to that of their daily activities. The use of the Borg scale during the cardiopulmonary 6-minute walk test seems to better correspond to the metabolic demand of the usual activities in this group of patients.

  16. Implementing public employment policy

    Larsen, Flemming; Bredgaard, Thomas

    disciplining of the unemployed (work first) (cf.Bredgaard & Larsen, 2005; Sol & Westerweld, 2005). It is, however, remarkable that in the research field there seems to be a division of labour so that changes in public administration and changes in the substance of employment policies are dealt with separately....... But there is an interesting question to investigate here: whether and if so how, NPM-inspired reforms are related to changes in employment policy towards a work-first approach? Are changes in public management systems created as deliberate policy changes, or do they bring about more indirect and unintended policy changes...... an intended policy shift, there seems to be very little public discussion about them. Far-reaching policy changes become politically invisible and de-politicized. Our empirical case is the contracting out of the public employment services in Australia, the Netherlands and Denmark. The main question is what...

  17. Hemodynamics Simulation of Stenosed Coronary Bypass Graft

    LIU You-jun; QIAO Aike; DU Jian-jun


    By means of FEM, the physiological blood flow in coronary bypass graft is simulated. The stenosis in coronary artery is involved in the graft model,and the deformation of graft end to allow the surgical suture with a smaller diameter coronary is taken into consideration. The flow pattern, secondary flow and wall shear stress in the vicinity of anastomosis are analyzed. It is shown that a zone of low wall stress and high wall stress gradient exists downstream the toe. The floor opposed to the anastomosis is an area of high wall stress and high wall stress gradient. Both the toe downstream and the anastomosis bottom floor are prone to intimal hyperplasia.

  18. Flow characteristics in narrowed coronary bypass graft

    Bernad, S. I.; Bosioc, A.; Bernad, E. S.; Petre, I.; Totorean, A. F.


    Tortuous saphenous vein graft (SVG) hemodynamics was investigated using computational fluid dynamics (CFD) techniques. Computed tomography (CT) technology is used for non-invasive bypass graft assessment 7 days after surgery. CT investigation shown two regions with severe shape remodelling first is an elbow type contortion and second is a severe curvature with tortuous area reduction. In conclusion, the helical flow induced by vessel torsion may stabilize the blood flow in the distal part of the SVG, reducing the flow disturbance and suppressing the flow separation, but in the distal end of the graft, promote the inflammatory processes in the vessels.

  19. An innovative design for cardiopulmonary resuscitation manikins based on a human-like thorax and embedded flow sensors

    Thielen, Mark; Joshi, Rohan; Delbressine, Frank; Bambang Oetomo, Sidarto; Feijs, Loe


    Cardiopulmonary resuscitation manikins are used for training personnel in performing cardiopulmonary resuscitation. State-of-the-art cardiopulmonary resuscitation manikins are still anatomically and physiologically low-fidelity designs. The aim of this research was to design a manikin that offers high anatomical and physiological fidelity and has a cardiac and respiratory system along with integrated flow sensors to monitor cardiac output and air displacement in response to cardiopulmonary resuscitation. This manikin was designed in accordance with anatomical dimensions using a polyoxymethylene rib cage connected to a vertebral column from an anatomical female model. The respiratory system was composed of silicon-coated memory foam mimicking lungs, a polyvinylchloride bronchus and a latex trachea. The cardiovascular system was composed of two sets of latex tubing representing the pulmonary and aortic arteries which were connected to latex balloons mimicking the ventricles and lumped abdominal volumes, respectively. These balloons were filled with Life/form simulation blood and placed inside polyether foam. The respiratory and cardiovascular systems were equipped with flow sensors to gather data in response to chest compressions. Three non-medical professionals performed chest compressions on this manikin yielding data corresponding to force–displacement while the flow sensors provided feedback. The force–displacement tests on this manikin show a desirable nonlinear behaviour mimicking chest compressions during cardiopulmonary resuscitation in humans. In addition, the flow sensors provide valuable data on the internal effects of cardiopulmonary resuscitation. In conclusion, scientifically designed and anatomically high-fidelity designs of cardiopulmonary resuscitation manikins that embed flow sensors can improve physiological fidelity and provide useful feedback data. PMID:28290239

  20. Governing EU employment policy

    Sørensen, Eva; Triantafillou, Peter; Damgaard, Bodil


    In the European Union (EU), employment policy is a prerogative of the member states. Therefore the EU's ability to govern in this area depends on its capability to involve national governments and relevant stakeholders in a collaborative effort to formulate and implement shared policy objectives....... Drawing an analytical distinction between cooperation, coordination and collaboration, the article analyses the formulation and implementation of EU employment policies. It concludes that while the formulation of policy objectives and the discussion of national policy approaches do involve elements...

  1. Implementing the employability agenda

    Lee, Donna; Snaith, Holly Grace; Foster, Emma


    This article draws on research commissioned by the Higher Education Academy (HEA) and conducted during 2013. It interrogates the ways in which the employability agenda has been fed through to the level of individual politics departments. The project was particularly concerned with establishing...... whether, and how, colleagues in politics and international relations (IR) had taken ownership of student employability at the level of the curriculum. In the article, the key findings of the research are summarised. There is also discussion of the (sometimes troubling) professional implications...

  2. Employment certificates on HRT

    HR Department


    As part of the ongoing drive to simplify and streamline administrative procedures and processes, the IT and HR Departments have made employment certificates available on a self-service basis on the HRT application, in the main menu under "My self services". All members of the personnel can thus obtain a certificate of employment or association, in French or in English, for the present or past contractual period. The HR Department’s Records Office remains responsible for issuing any special certificates that might be required. IT-AIS (Administrative Information Services) HR-SPS (Services, Procedures & Social) Records Office – Tel. 73700

  3. Grafting as a method for studying development in the filamentous fungus Podospora anserina.

    Silar, Philippe


    While grafting and transplant experiments have extensively been used to study development in animals and plants, they have seldom been employed to study fungal development. Here, grafting is used to study the interplay between mycelium and multicellular fruiting bodies during maturation in the model ascomycete Podospora anserina. Data indicate that grafts need a competent mycelium to continue their ripening. Vegetative incompatibility does not prevent transplanted fructifications to undergo development. Grafting onto mutant mycelia confirmed a previous model stating that the NADPH oxidase PaNox1 is required in the developing fruiting bodies, while the MAP kinase cascade PaMpk1 is required in the mycelium. Data also show that the IDC1 protein is required not only in the developing fruiting bodies but also in the mycelium, likely because of its role in anastomosis. Finally, entry inside the grafted fruiting bodies of a ribosomal protein tagged with GFP could be detected, suggesting that cellular components are imported from the underlying mycelium during maturation.

  4. Three-dimensional computer-aided human factors engineering analysis of a grafting robot.

    Chiu, Y C; Chen, S; Wu, G J; Lin, Y H


    The objective of this research was to conduct a human factors engineering analysis of a grafting robot design using computer-aided 3D simulation technology. A prototype tubing-type grafting robot for fruits and vegetables was the subject of a series of case studies. To facilitate the incorporation of human models into the operating environment of the grafting robot, I-DEAS graphic software was applied to establish individual models of the grafting robot in line with Jack ergonomic analysis. Six human models (95th percentile, 50th percentile, and 5th percentile by height for both males and females) were employed to simulate the operating conditions and working postures in a real operating environment. The lower back and upper limb stresses of the operators were analyzed using the lower back analysis (LBA) and rapid upper limb assessment (RULA) functions in Jack. The experimental results showed that if a leg space is introduced under the robot, the operator can sit closer to the robot, which reduces the operator's level of lower back and upper limbs stress. The proper environmental layout for Taiwanese operators for minimum levels of lower back and upper limb stress are to set the grafting operation at 23.2 cm away from the operator at a height of 85 cm and with 45 cm between the rootstock and scion units.

  5. Immunohistochemical localization of IAA in graft union of explanted internode grafting


    The dynamic changes of IAA in graft union of explanted internode autografting of Cucumber (Cucumis sativus Linn.) have been investigated using the immunohistochemical localization technique.It is shown that the efficiency of IAA fixation using lyophilization-gas fixation is higher than that using liquid chemical fixation.In contrast to few silver particles and no significant changes during the development of graft union cultured in hormone-free medium,more silver particles in graft union and significant changes of IAA related to graft union development have been found when graft union was cultured in medium supplemented with appropriate hormones.The fixation procedure of plant hormones and the roles of IAA in graft union are discussed.

  6. Employability through covenants

    Korver, T.; Oeij, P.R.A.


    How can a sustainable employment insurance system be guaranteed as a major element of the ESM? First a summary overview of the Lisbon targets and their impact on the policies of and in the member states of the European Union is given. Then follow data and problems associated with the target of enhan

  7. Shifting employment revisited

    Cremers, Jan; Gramuglia, Alessia


    The CLR-network examined in 2006 the phenomenon of undeclared labour, with specific regard to the construction sector. The resulting study, Shifting Employment: undeclared labour in construction (Shifting-study hereafter), gave evidence that this is an area particularly affected by undeclared activi

  8. Employment Relations in Denmark

    Madsen, Jørgen Steen; Due, Jesper Jørgen; Andersen, Søren Kaj


    Jørgen Steen Madsen, Jesper Due og Søren Kaj Andersen har skrevet et kapitel om udviklingen i dansk arbejdsmarkedsregulering til bogen International and Comparative Employment Relations, redigeret af Greg Bamber, Russell Lansbury og Nick Wailes. Bogen indeholder bidrag, der præsenterer og...

  9. A Stochastic Employment Problem

    Wu, Teng


    The Stochastic Employment Problem(SEP) is a variation of the Stochastic Assignment Problem which analyzes the scenario that one assigns balls into boxes. Balls arrive sequentially with each one having a binary vector X = (X[subscript 1], X[subscript 2],...,X[subscript n]) attached, with the interpretation being that if X[subscript i] = 1 the ball…

  10. Employer Engagement in Education

    Mann, Anthony; Dawkins, James


    The subject of this paper is employer engagement in education as it supports the learning and progression of young people through activities including work experience, job shadowing, workplace visits, career talks, mock interviews, CV workshops, business mentoring, enterprise competitions and the provision of learning resources. Interest has grown…

  11. Industrialisation, Exports and Employment.

    Sabolo, Yves


    After reviewing trends in industrial production, exports, and employment in the Third World since 1960, the author discusses industrialization strategies based on the local processing of raw materials for export. Such processing has proved to be a major factor in job creation. (Author/SK)

  12. Vietnamese Students Employability Skills

    Tuan, Nguyen Minh


    This paper attempts to investigate if the International University (IU) students' core competencies can meet the requirements set by employers, what are the differences in core competencies in final year students (or undergraduates), and how they view themselves compared with ex-students after one or two years in working environment, how…

  13. Compliance Study of Endovascular Stent Grafts Incorporated with Polyester and Polyurethane Graft Materials in both Stented and Unstented Zones

    Ying Guan


    Full Text Available Compliance mismatch between stent graft and host artery may induce complications and blood flow disorders. However, few studies have been reported on stent graft compliance. This study aims to explore the deformation and compliance of stent graft in stented and unstented zones under three pressure ranges. Compliance of two stent grafts incorporated with polyurethane graft (nitinol-PU and polyester graft (nitinol-PET materials respectively were tested; the stents used in the two stent grafts were identical. For the circumferential deformation of the stent grafts under each pressure range, the nitinol-PET stent graft was uniform in both zones. The nitinol-PU stent graft was circumferentially uniform in the stented zone, however, it was nonuniform in the unstented zone. The compliance of the PU graft material was 15 times higher than that of the PET graft. No significant difference in compliance was observed between stented and unstented zones of the nitinol-PET stent graft regardless of the applied pressure range. However, for the nitinol-PU stent graft, compliance of the unstented PU region was approximately twice that of the stented region; thus, compliance along the length of the nitinol-PU stent graft was not constant and different from that of the nitinol-PET stent graft.

  14. Enrichment of autologous fat grafts with ex-vivo expanded adipose tissue-derived stem cells for graft survival

    Kølle, Stig-Frederik Trojahn; Fischer-Nielsen, Anne; Mathiasen, Anders Bruun


    Autologous fat grafting is increasingly used in reconstructive surgery. However, resorption rates ranging from 25% to 80% have been reported. Therefore, methods to increase graft viability are needed. Here, we report the results of a triple-blind, placebo-controlled trial to compare the survival...... of fat grafts enriched with autologous adipose-derived stem cells (ASCs) versus non-enriched fat grafts....

  15. Treatment of gingival recession in two surgical stages: Free gingival graft and connective tissue grafting.

    Henriques, Paulo Sergio Gomes; Nunes, Marcelo Pereira; Pelegrine, Andre Antonio


    This report describes a clinical case of severe Miller Class II gingival recession treated by two stages of surgery that combined a free gingival graft and connective tissue grafting. First, a free gingival graft (FGG) was performed to obtain an adequate keratinized tissue level. Three months later, a connective tissue graft (CTG) was performed to obtain root coverage. The results indicated that the FGG allows for a gain in the keratinized tissue level and the CTG allows for root coverage with decreased recession level after 16 months. Therefore, for this type of specific gingival recession, the combination of FGG and CTG can be used.

  16. Resolution of severe graft steatosis following dual-graft living donor liver transplantation.

    Moon, DeokBog; Lee, SungGyu; Hwang, Shin; Kim, KiHun; Ahn, ChulSoo; Park, KwangMin; Ha, TaeYong; Song, GiWon


    Although severely steatotic liver grafts are not suitable for transplantation, they have been used when other, more optimal donors were not available, especially for living donor liver transplantation (LDLT) using two liver grafts. Here we present two cases of dual-graft LDLT in which the recipients showed rapid and complete clearing of fat from livers with previously severe steatosis. In the first case, two left lateral segment grafts were used, one of which was 70% steatotic. Preoperative and posttransplant two-week liver-to-spleen computed tomography-value (L/S) ratios were 0.48 and 1.25, respectively. A liver biopsy taken two weeks after transplantation showed that the fatty changes had almost disappeared. The second case used one left lobe and one left lateral segment graft, the latter of which was 80% steatotic. Preoperative and two-week L/S ratio were 0.58 and 1.34, respectively, and a liver biopsy taken two weeks after transplantation showed less than 3% steatosis. The two donors of the severely steatotic liver grafts recovered uneventfully. These findings show that the fat content of the liver grafts was rapidly removed after transplantation. This observation is helpful in understanding the recovery sequences following transplantation of steatotic liver grafts, as well as expanding the acceptability of steatotic liver grafts.

  17. Polyethylene glycol-grafted polystyrene particles.

    Meng, Fenghua; Engbers, Gerard H M; Feijen, Jan


    Densely pegylated particles that can serve as a model system for artificial cells were prepared by covalently grafting amino polyethylene glycol (PEG, molecular weight 3400 or 5000) onto carboxyl polystyrene particles (PS-COOH) using carbodiimide chemistry. PEG-modified particles (PS-PEG) were characterized by determination of the PEG surface concentration, zeta-potential, size, and morphology. Under optimized grafting conditions, a dense "brush-like" PEG layer was formed. A PEG surface concentration of approximately 60 pmol/cm2, corresponding with an average distance between grafted PEG chains of approximately 17 A can be realized. It was shown that grafting of PEG onto PS-COOH reduced the adsorption of proteins from human plasma (85 vol %) in phosphate-buffered saline up to 90%.

  18. Fluorescent Bioactive Corrole Grafted-Chitosan Films.

    Barata, Joana F B; Pinto, Ricardo J B; Vaz Serra, Vanda I R C; Silvestre, Armando J D; Trindade, Tito; Neves, Maria Graça P M S; Cavaleiro, José A S; Daina, Sara; Sadocco, Patrizia; Freire, Carmen S R


    Transparent corrole grafted-chitosan films were prepared by chemical modification of chitosan with a corrole macrocycle, namely, 5,10,15-tris(pentafluorophenyl)corrole (TPFC), followed by solvent casting. The obtained films were characterized in terms of absorption spectra (UV-vis), FLIM (fluorescence lifetime imaging microscopy), structure (FTIR, XPS), thermal stability (TGA), thermomechanical properties (DMA), and antibacterial activity. The results showed that the chemical grafting of chitosan with corrole units did not affect its film-forming ability and that the grafting yield increased with the reaction time. The obtained transparent films presented fluorescence which increases with the amount of grafted corrole units. Additionally, all films showed bacteriostatic effect against S. aureus, as well as good thermomechanical properties and thermal stability. Considering these features, promising applications may be envisaged for these corrole-chitosan films, such as biosensors, bioimaging agents, and bioactive optical devices.

  19. Prevention of grafted liver from reperfusive injury

    Kai Ma; Yang yu; Xian-Min Bu; Yan-Jun Li; Xian-Wei Dai; Liang Wang; Yang Dai; Hai-Ying Zhao; Xiang-Hong Yang


    @@ INTRODUCTIONThe incidence of primary non-function(PNF)of grafted liver in the early postoperative stage is 2%-23%[1-4],its main cause is the ischemic-rechemic injure[5,6].In this experiment,anisodamine was added into the preserving fluid and the grafted liver was rewarmed at different temperatures to protect the cell membranc and prevent ischemic-reperfusive injury.

  20. Grafting of a LLDPE using gamma irradiation

    Catari, E. [Centro de Quimica, Laboratorio de Polimeros Instituto Venezolano de Investigaciones Cientificas (IVIC) (Venezuela); Albano, C. [Centro de Quimica, Laboratorio de Polimeros Instituto Venezolano de Investigaciones Cientificas (IVIC) (Venezuela) and Universidad Central de Venezuela, Facultad de Ingenieria, Escuela de Ingenieria Quimica (Venezuela)]. E-mail:; Karam, A. [Centro de Quimica, Laboratorio de Polimeros Instituto Venezolano de Investigaciones Cientificas (IVIC) (Venezuela)]. E-mail:; Perera, R. [Departamento de Mecanica, Universidad Simon Bolivar (Venezuela); Silva, P. [Centro de Fisica, Laboratorio de Fisica de la Materia Condensada, Instituto Venezolano de Investigaciones Cientificas (IVIC), Caracas (Venezuela); Gonzalez, J. [Departamento de Mecanica, Universidad Simon Bolivar (Venezuela)


    In this investigation, the grafting of a commercial linear low-density polyethylene (LLDPE) with different concentrations of diethyl maleate (DEM, 5 and 15 wt.%) was carried out at different absorbed doses from a cobalt-60 source of gamma rays (0, 15, 30, 50, 100, 200 kGy). This process was performed in a decalin solution at 10% w/v to obtain a homogeneous dispersion of the monomer into the polyethylene matrix. The grafting degree was estimated by means of FTIR using a calibration curve reported in literature. Thermal properties of the functional polymers were studied by thermogravimetric analysis (TGA). Melt flow index (MFI) values were also taken. The results found indicate that the grafting degree increases as the concentration of DEM in the reaction mixture and the absorbed doses are increased upto 100 kGy, as expected. However, the behavior at higher doses is attributed to secondary reactions such as long-chain branching and/or crosslinking, which are faster than radical reactions responsible for the grafting of the DEM onto the polymeric chain. This fact was ascertained by the decrease of the MFI values as the applied irradiation was increased, irrespective of the quantity of DEM used in the grafting reaction. Therefore, in order to obtain a high grafting degree, the absorbed dose should be estimated carefully. Initial degradation temperatures of the grafted PEs decreased when the gamma irradiation dose was higher than 100 kGy. This indicates that the thermal stability decreases as higher doses are applied to the material, which is associated to branching and crosslinking. The grafting degree never exceeded 0.3 mol%, which demonstrates the low efficiency of the functionalization procedure here presented.

  1. DNA nanosensor surface grafting and salt dependence

    Carvalho, B. G.; Fagundes, J.; Martin, A. A.; Raniero, L.; Favero, P. P.


    In this paper we investigated the Paracoccidoides brasiliensis fungus nanosensor by simulations of simple strand DNA grafting on gold nanoparticle. In order to improve the knowledge of nanoparticle environment, the addiction of salt solution was studied at the models proposed by us. Nanoparticle and DNA are represented by economic models validated by us in this paper. In addition, the DNA grafting and salt influences are evaluated by adsorption and bond energies calculations. This theoretical evaluation gives support to experimental diagnostics techniques of diseases.

  2. Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk

    Lotfi, S., E-mail:; Clough, R. E.; Ali, T. [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom); Salter, R. [Guy' s and St. Thomas' NHS Trust, Interventional Radiology (United Kingdom); Young, C. P. [Guy' s and St. Thomas' NHS Trust, Cardiac Surgery (United Kingdom); Bell, R.; Modarai, B.; Taylor, P., E-mail: [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom)


    Hybrid repair constitutes supra-aortic debranching before thoracic endovascular aortic repair (TEVAR). It offers improved short-term outcome compared with open surgery; however, longer-term studies are required to assess patient outcomes and patency of the extra-anatomic bypass grafts. A prospectively maintained database of 380 elective and urgent patients who had undergone TEVAR (1997-2011) was analyzed retrospectively. Fifty-one patients (34 males; 17 females) underwent hybrid repair. Median age was 71 (range, 18-90) years with mean follow-up of 15 (range, 0-61) months. Perioperative complications included death: 10 % (5/51), stroke: 12 % (6/51), paraplegia: 6 % (3/51), endoleak: 16 % (8/51), rupture: 4 % (2/51), upper-limb ischemia: 2 % (1/51), bypass graft occlusion: 4 % (2/51), and cardiopulmonary complications in 14 % (7/51). Three patients (6 %) required emergency intervention for retrograde dissection: (2 aortic root repairs; 2 innominate stents). Early reintervention was performed for type 1 endoleak in two patients (2 proximal cuff extensions). One patient underwent innominate stenting and revision of their bypass for symptomatic restenosis. At 48 months, survival was 73 %. Endoleak was detected in three (6 %) patients (type 1 = 2; type 2 = 1) requiring debranching with proximal stent graft (n = 2) and proximal extension cuff (n = 1). One patient had a fatal rupture of a mycotic aneurysm and two arch aneurysms expanded. No bypass graft occluded after the perioperative period. Hybrid operations to treat aortic arch disease can be performed with results comparable to open surgery. The longer-term outcomes demonstrate low rates of reintervention and high rates of graft patency.

  3. Neurological complications and risk factors of cardiopulmonary failure of EV-A71-related hand, foot and mouth disease.

    Long, Lili; Xu, Lin; Xiao, Zhenghui; Hu, Shixiong; Luo, Ruping; Wang, Hua; Lu, Xiulan; Xu, Zhiyue; Yao, Xu; Zhou, Luo; Long, Hongyu; Gong, Jiaoe; Song, Yanmin; Zhao, Li; Luo, Kaiwei; Zhang, Mengqi; Feng, Li; Yang, Liming; Sheng, Xiaoqi; Fan, Xuegong; Xiao, Bo


    From 2010 to 2012, large outbreaks of EV-A71-related- hand foot and mouth disease (HFMD) occurred annually in China. Some cases had neurological complications and were closely associated with fatal cardiopulmonary collapse, but not all children with central nervous system (CNS) involvement demonstrated a poor prognosis. To identify which patients and which neurological complications are more likely to progress to cardiopulmonary failure, we retrospectively studied 1,125 paediatric inpatients diagnosed with EV-A71-related HFMD in Hunan province, including 1,017 cases with CNS involvement. These patients were divided into cardiopulmonary failure (976 people) group and group without cardiopulmonary failure (149 people). A logistic regression analysis was used to compare the clinical symptoms, laboratory test results, and neurological complications between these two groups. The most significant risk factors included young age, fever duration ≥3 days, coma, limb weakness, drowsiness and ANS involvement. Patients with brainstem encephalitis and more CNS-involved regions were more likely to progress to cardiopulmonary failure. These findings can help front-line clinicians rapidly and accurately determine patient prognosis, thus rationally distributing the limited medical resources and implementing interventions as early as possible.

  4. Polypeptide Grafted Hyaluronan: Synthesis and Characterization

    Wang, Xiaojun [ORNL; Messman, Jamie M [ORNL; Mays, Jimmy [ORNL; Baskaran, Durairaj [University of Tennessee, Knoxville (UTK)


    Poly(L-leucine) grafted hyaluronan (HA-g-PLeu) has been synthesized via a Michael addition reaction between primary amine terminated poly(L-leucine) and acrylate-functionalized HA (TBAHA-acrylate). The precursor hyaluronan was first functionalized with acrylate groups by reaction with acryloyl chloride in the presence of triethylamine in N,N-dimethylformamide. 1H NMR analysis of the resulting product indicated that an increase in the concentration of acryloylchoride with respect to hydroxyl groups on HA has only a moderate effect on functionalization efficiency, f. A precise control of stoichiometry was not achieved, which could be attributed to partial solubility of intermolecular aggregates and the hygroscopic nature of HA. Michael addition at high [PLeu- NH2]/[acrylate]TBAHA ratios gave a molar grafting ratio of only 0.20 with respect to the repeat unit of HA, indicating grafting limitation due to insolubility of the grafted HA-g-PLeu. Soluble HA-g-PLeu graft copolymers were obtained for low grafting ratios (<0.039) with <8.6% by mass of PLeu and were characterized thoroughly using light scattering, 1H NMR, FT-IR, and AFM techniques. Light scattering experiments showed a strong hydrophobic interaction between PLeu chains, resulting in aggregates with segregated nongrafted HA segments. This yields local networks of aggregates, as demonstrated by atomic force microscopy. Circular dichroism spectroscopy showed a -sheet conformation for aggregates of poly(L-leucine).

  5. Entrepreneurship and Employment Stability

    Failla, Virgilio; Melillo, Francesca; Reichstein, Toke


    are identified and empirically explored: (i) job matching, (ii) labour market value, and (iii) personal commitment. Entrepreneurs appear to be more productive and thus better matched compared to wageworkers. However, they also appear to be locked in entrepreneurship because of their anticipated lower value......This paper challenges the conventional belief that entrepreneurship is an unstable career path. Using longitudinal matched employer–employee data from Denmark, the analysis reveals that a transition to entrepreneurship decreases individual's employment turnover tendency. Three explanations...... in the labour market and because of their personal attachment to the venture. The counter-intuitive finding – entrepreneurship yields greater employment stability – only holds with respect to subsequent transitions to wagework and not for new venture founding. The results have implications for our understanding...

  6. Rebirth through supported employment.

    Strickler, David C


    In this column, the author describes how supported employment was a conduit for employment for him, and allowed for a remarkable journey of recovery, involving discovery and empowerment, incorporation, purpose, and belonging. After two decades of unemployment or underemployment, he began to see that work was possible through supported education at college, where he excelled. Federal and state grants paid for two thirds of his college education. He periodically met with a vocational rehabilitation counselor, who was very encouraging. He also had a case manager through a private psychiatric organization who provided support. The author concludes that the root of his problems was the lack of supports to help him become incorporated into society-a lack that ushered in a host of problems, probably similar to what others experience. When supports were given, many of those symptoms disappeared.

  7. Small business & employment

    Lieshout, Harm van


    Understanding SMEs is essential to our aspired succes as an economic partner. Small enterprises are not small big enterprises, and differ substantially among them The key ingredient to our help from education remains the education of a new highly skilled generation of workers … and entrepreneurs. Entrepreneurs do not necessarily want to be employers, and are not necessarily good at it. But to ensure a healthy life in a healthy business, they need to be.

  8. Languages and Employability



    This report reviews evidence regarding the foreign language competences of European citizens and presents new findings about the relationship between foreign language skills and the likelihood of being in employment. In view of providing research evidence that can inform European Union (EU) policy initiatives, it reviews studies that frame knowledge of languages as a form of human capital, presents descriptive statistics about language knowledge and investigates whether this knowledge is rela...

  9. Soldiers’ employment attitude and employability: An exploratory study

    Peng Gao


    Full Text Available Purpose: Nowadays it is very difficult for Chinese retired soldiers to find proper jobs, and the primary reason is the significant gap between job requirements and soldiers owned job skills. Therefore, it is very important to improve the soldiers’ job skills and enhance their understanding of employment.Design/methodology/approach: This paper expands the study scope from the soldiers’ job skills to the employability, initiatively introduces the employment attitude which has obvious impact on the employment of soldiers, and analyses the influence that employment attitude can play on employability. At last, this paper develops statistical method to find the relationship between soldiers’ employment attitude and employability.Findings: The empirical analysis shows that soldiers’ employment attitude has the positive linkage with employability, which makes the employment attitude a measurable variable for the employability rather than an absolute standard.Research limitations/implications: According to the research purpose, more variables should be considered in the model, consequently, there are only three indicators to describe solders’ employment attitude and four indicators to describe solders’ employability.Originality/value: This paper takes research on soldiers’ employability in a new perspective. The soldiers’ employment attitude is served as the entry point, showing the influence that soldiers’ employment attitude has on employability.

  10. Grafting-responsive miRNAs in cucumber and pumpkin seedlings identified by high-throughput sequencing at whole genome level.

    Li, Chaohan; Li, Yansu; Bai, Longqiang; Zhang, Tieyao; He, Chaoxing; Yan, Yan; Yu, Xianchang


    Grafting is an important agricultural technique widely used for improving growth, yields and tolerance of crops to abiotic and biotic stresses. As one type of endogenous, non-coding small RNAs, microRNAs (miRNAs) regulate development and responsiveness to biotic and abiotic stresses by negatively mediating expression of target genes at the post-transcriptional level. However, there have been few detailed studies to evaluate the role of miRNAs in mediation of grafting-induced physiological processes in plants. Cucumis sativus and Cucurbita moschata are important vegetables worldwide. We constructed eight small RNA libraries from leaves and roots of seedlings that were grafted in the following four ways: (1) hetero-grafting, using cucumber as scion and pumpkin as rootstock; (2) hetero-grafting, with pumpkin as scion and cucumber as rootstock; (3) auto-grafting of cucumbers and (4) auto-grafting of pumpkins. High-throughput sequencing was employed, and more than 120 million raw reads were obtained. We annotated 112 known miRNAs belonging to 40 miRNA families and identified 48 new miRNAs in the eight libraries, and the targets of these known and novel miRNAs were predicted by bioinformatics. Grafting led to changes in expression of most miRNAs and their predicted target genes, suggesting that miRNAs may play significant roles in mediating physiological processes of grafted seedlings by regulating the expression of target genes. The potential role of the grafting-responsive miRNAs in seedling growth and long-distance transport of miRNA was discussed. These results are useful for functional characterization of miRNAs in mediation of grafting-dependent physiological processes.

  11. ACL Revision in Synthetic ACL graft failure

    Etcheto, H. Rivarola; Zordán, J.; Escobar, G.; Collazo, C.; Palanconi, M.; Autorino, C.; Salinas, E. Alvarez


    The development of synthetic grafts as an alternative to biological grafts for reconstruction of the anterior cruciate ligament dates from 1980. The interest is awakened due to the potential advantages of: The absence of morbidity associated with donor site, and early return to sport. However, this surgical technique has had multiple complications associated with graft: mechanical failures (synthetic graft failure, loss of fixation), synovial foreign body reaction, recurrent stroke, recurrent instability and ultimately, early osteoarthritis. Objectives: We describe the synthetic graft failure LCA, intraoperative findings and details of surgical technique. Methods: Patient 35 years old, with a history of ACL reconstruction four years of evolution in another health center, consultation with the Service knee arthroscopy for acute knee pain left knee during secondary sporting event to a rotation mechanism with fixed foot. On physical examination, presents and positive Lachman maneuver Pivot. Radiografia in a widening of the tibial tunnel is observed. NMR shows a discontinuity of fibers of synthetic graft. Results: First time arthroscopic revision where synthetic plastic LCA identifies with Disruption fiber pattern. Intraoperatively, hypertrophic chronic synovitis localized predominantly in intercóndilo is observed. debridement thereof is performed, and proceeds to the extraction of the synthetic ligament. Then he was made prior cruentado and revival of the edges of the tunnel, filling them with non-irradiated structural bone allograft. At four months as planned and after confirmation by studies incorporating bone graft was performed the second time with the new plastic ACL. It was planned like a primary graft surgery with autologous hamstring prepared in fourfold form, and fixation with modified transtibial technique Biotransfix system proximal and distal screw Biocomposite (arthrex®). A quadruple graft 9 mm was obtained, making good positioning of tunnels and stable

  12. Cardiopulmonary Resuscitation in Microgravity: Efficacy in the Swine During Parabolic Flight

    Johnston, Smith L.; Campbell, Mark R.; Billica, Roger D.; Gilmore, Stevan M.


    INTRODUCTION: The International Space Station will need to be as capable as possible in providing Advanced Cardiac Life Support (ACLS) and cardiopulmonary resuscitation (CPR). Previous studies with manikins in parabolic microgravity (0 G) have shown that delivering CPR in microgravity is difficult. End tidal carbon dioxide (PetCO2) has been previously shown to be an effective non-invasive tool for estimating cardiac output during cardiopulmonary resuscitation. Animal models have shown that this diagnostic adjunct can be used as a predictor of survival when PetCO2 values are maintained above 25% of pre-arrest values. METHODS: Eleven anesthetized Yorkshire swine were flown in microgravity during parabolic flight. Physiologic parameters, including PetCO2, were monitored. Standard ACLS protocols were used to resuscitate these models after chemical induction of cardiac arrest. Chest compressions were administered using conventional body positioning with waist restraint and unconventional vertical-inverted body positioning. RESULTS: PetCO2 values were maintained above 25% of both 1-G and O-G pre-arrest values in the microgravity environment (33% +/- 3 and 41 +/- 3). No significant difference between 1-G CPR and O-G CPR was found in these animal models. Effective CPR was delivered in both body positions although conventional body positioning was found to be quickly fatiguing as compared with the vertical-inverted. CONCLUSIONS: Cardiopulmonary resuscitation can be effectively administered in microgravity (0 G). Validation of this model has demonstrated that PetCO2 levels were maintained above a level previously reported to be predictive of survival. The unconventional vertical-inverted position provided effective CPR and was less fatiguing as compared with the conventional body position with waist restraints.

  13. Cardiopulmonary response during whole-body vibration training in patients with severe COPD

    Richter, Petra; Winterkamp, Sandra; Pfeifer, Michael; Nell, Christoph; Christle, Jeffrey W.; Kenn, Klaus


    Several studies in patients with chronic obstructive pulmonary disease (COPD) have shown that whole-body vibration training (WBVT) has beneficial effects on exercise capacity. However, the acute cardiopulmonary demand during WBVT remains unknown and was therefore investigated in this study. Ten patients with severe COPD (forced expiratory volume in 1 s: 38±8% predicted) were examined on two consecutive days. On day one, symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer. The next day, six bouts of repeated squat exercises were performed in random order for one, two or three minutes either with or without WBVT while metabolic demands were simultaneously measured. Squat exercises with or without WBVT induced comparable ventilatory efficiency (minute ventilation (VE)/carbon dioxide production (V′CO2): 38.0±4.4 with WBVT versus 37.4±4.1 without, p=0.236). Oxygen uptake after 3 min of squat exercises increased from 339±40 mL·min−1 to 1060±160 mL·min−1 with WBVT and 988±124 mL min−1 without WBV (p=0.093). However, there were no significant differences between squat exercises with and without WBVT in oxygen saturation (90±4% versus 90±4%, p=0.068), heart rate (109±13 bpm versus 110±15 bpm, p=0.513) or dyspnoea (Borg scale 5±2 versus 5±2, p=0.279). Combining squat exercises with WBVT induced a similar cardiopulmonary response in patients with severe COPD compared to squat exercises without WBVT. Bearing in mind the small sample size, WBVT might be a feasible and safe exercise modality even in patients with severe COPD. PMID:28326310

  14. Attitude and skill levels of graduate health professionals in performing cardiopulmonary resuscitation

    Gebreegziabher Gebremedhn, Endale; Berhe Gebregergs, Gebremedhn; Anderson, Bernard Bradley; Nagaratnam, Vidhya


    Background Cardiopulmonary resuscitation (CPR) is an emergency procedure used to treat victims following cardiopulmonary arrest. Graduate health professionals at the University of Gondar Teaching Hospital manage many trauma and critically ill patients. The chance of survival after cardiopulmonary arrest may be increased with sufficient attitude and skill levels. The study aimed to assess the attitude and skill levels of graduate health professionals in performing CPR. Methods A hospital-based cross-sectional study was conducted from May 1 to 30, 2013, at the University of Gondar Teaching Hospital. The mean attitude and skill scores were compared for sex, original residence, and department of the participants using Student’s t-test and analysis of variance (Scheffe’s test). P-values attitude scores of nurse, interns, health officer, midwifery, anesthesia, and psychiatric nursing graduates were 1.15 (standard deviation [SD] =1.67), 8.21 (SD =1.24), 7.2 (SD =1.49), 6.69 (SD =1.83), 8.19 (SD =1.77), and 7.29 (SD =2.01), respectively, and the mean skill scores were 2.34 (SD =1.95), 3.77 (SD =1.58), 1.18 (SD =1.52), 2.16 (SD =1.93), 3.88 (SD =1.36), and 1.21 (SD =1.77), respectively. Conclusion and recommendations Attitude and skill level of graduate health professionals with regard to CPR were insufficient. Training on CPR for graduate health professionals needs to be given emphasis.

  15. Reproducibility of cardiac power output and other cardiopulmonary exercise indices in patients with chronic heart failure.

    Jakovljevic, Djordje G; Seferovic, Petar M; Nunan, David; Donovan, Gay; Trenell, Michael I; Grocott-Mason, Richard; Brodie, David A


    Cardiac power output is a direct measure of overall cardiac function that integrates both flow- and pressure-generating capacities of the heart. The present study assessed the reproducibility of cardiac power output and other more commonly reported cardiopulmonary exercise variables in patients with chronic heart failure. Metabolic, ventilatory and non-invasive (inert gas re-breathing) central haemodynamic measurements were undertaken at rest and near-maximal exercise of the modified Bruce protocol in 19 patients with stable chronic heart failure. The same procedure was repeated 7 days later to assess reproducibility. Cardiac power output was calculated as the product of cardiac output and mean arterial pressure. Resting central haemodynamic variables demonstrate low CV (coefficient of variation) (ranging from 3.4% for cardiac output and 5.6% for heart rate). The CV for resting metabolic and ventilatory measurements ranged from 8.2% for respiratory exchange ratio and 14.2% for absolute values of oxygen consumption. The CV of anaerobic threshold, peak oxygen consumption, carbon dioxide production and respiratory exchange ratio ranged from 3.8% (for anaerobic threshold) to 6.4% (for relative peak oxygen consumption), with minute ventilation having a CV of 11.1%. Near-maximal exercise cardiac power output and cardiac output had CVs of 4.1 and 2.2%, respectively. Cardiac power output demonstrates good reproducibility suggesting that there is no need for performing more than one cardiopulmonary exercise test. As a direct measure of cardiac function (dysfunction) and an excellent prognostic marker, it is strongly advised in the assessment of patients with chronic heart failure undergoing cardiopulmonary exercise testing.

  16. Quantitative blood flow measurements in the small animal cardiopulmonary system using digital subtraction angiography

    Lin Mingde; Marshall, Craig T.; Qi, Yi; Johnston, Samuel M.; Badea, Cristian T.; Piantadosi, Claude A.; Johnson, G. Allan [Department of Radiology, Center for In Vivo Microscopy and Department of Biomedical Engineering, Duke University Medical Center, Box 3302, Durham, North Carolina 27710 (United States); Division of Pulmonary and Critical Care Medicine and Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Box 3823, Durham, North Carolina 27710 (United States); Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Box 3302, Durham, North Carolina 27710 (United States); Department of Radiology, Center for In Vivo Microscopy and Department of Biomedical Engineering, Duke University Medical Center, Box 3302, Durham, North Carolina 27710 (United States); Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Box 3302, Durham, North Carolina 27710 (United States); Division of Pulmonary and Critical Care Medicine and Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Box 3823, Durham, North Carolina 27710 (United States); Department of Radiology, Center for In Vivo Microscopy and Department of Biomedical Engineering, Duke University Medical Center, Box 3302, Durham, North Carolina 27710 (United States)


    Purpose: The use of preclinical rodent models of disease continues to grow because these models help elucidate pathogenic mechanisms and provide robust test beds for drug development. Among the major anatomic and physiologic indicators of disease progression and genetic or drug modification of responses are measurements of blood vessel caliber and flow. Moreover, cardiopulmonary blood flow is a critical indicator of gas exchange. Current methods of measuring cardiopulmonary blood flow suffer from some or all of the following limitations--they produce relative values, are limited to global measurements, do not provide vasculature visualization, are not able to measure acute changes, are invasive, or require euthanasia. Methods: In this study, high-spatial and high-temporal resolution x-ray digital subtraction angiography (DSA) was used to obtain vasculature visualization, quantitative blood flow in absolute metrics (ml/min instead of arbitrary units or velocity), and relative blood volume dynamics from discrete regions of interest on a pixel-by-pixel basis (100x100 {mu}m{sup 2}). Results: A series of calibrations linked the DSA flow measurements to standard physiological measurement using thermodilution and Fick's method for cardiac output (CO), which in eight anesthetized Fischer-344 rats was found to be 37.0{+-}5.1 ml/min. Phantom experiments were conducted to calibrate the radiographic density to vessel thickness, allowing a link of DSA cardiac output measurements to cardiopulmonary blood flow measurements in discrete regions of interest. The scaling factor linking relative DSA cardiac output measurements to the Fick's absolute measurements was found to be 18.90xCO{sub DSA}=CO{sub Fick}. Conclusions: This calibrated DSA approach allows repeated simultaneous visualization of vasculature and measurement of blood flow dynamics on a regional level in the living rat.

  17. Coronary artery bypass grafting in a patient with active idiopathic cryoglobulinemia: revisiting the issue

    Hafiz Abdul Moiz Fakih


    Full Text Available Background: Cryoglobulinemia is a cold-reactive autoimmune disease. It is of distinctive importance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass (CPB. Cryoglobulins, which activate at variable levels of hypothermia, can cause precipitation during surgery leading to possibly severe leukocytoclastic or necrotizing vasculitis, clinically manifested as ischemic events, such as cutaneous ulcerations, glomerulonephritis, arthritis, or peripheral neuropathies among the most reported associated comorbidities. Management of CPB and systemic protection in this rare but unique scenario requires individualized planning. We report the case of a patient with active cryoglobulinemia who was preoperatively managed with plasmapheresis. He underwent hypothermic coronary bypass with no precipitation and flare during and after surgery. Case presentation: We describe the case of a 59-year-old Caucasian male with clinically significant idiopathic cryoglobulinemia and history of recurrent skin lesions and toe amputations secondary to cold exposure. He presented with 2-h duration of chest pain and new onset atrial fibrillation. After cardiac catheterization, a diagnosis of three-vessel coronary artery disease was established and coronary artery bypass grafting (CABG was scheduled. Because of a high risk of flare-up during surgery, the patient was preemptively treated with two sessions of plasmapheresis before bypass. He then underwent hypothermic CABG. The pre- and perioperative course was unremarkable without any clinical evidence of precipitation. The patient was discharged on day 6 postoperatively without any complications. Conclusion: Preoperative plasmapheresis before hypothermic coronary bypass can prevent fatal cryoglobulinemia-related complications in patients with active disease.

  18. Coronary artery bypass grafting in a patient with pseudothrombocytopenia: case report.

    Kaplan, Mehmet; Düzyol, Cagri; Kemal Gur, Ali; Olsun, Adlan; Tosun, Remzi


    A 53-year-old female patient with coronary arterial disease who had been diagnosed with conventional coronary angiography was scheduled to undergo elective coronary artery bypass grafting surgery. Preoperative routine evaluations of the whole blood count revealed severe thrombocytopenia (6000/mm3). The patient received a consultation by the internal medicine clinic. With an initial diagnosis of pseudothrombocytopenia, the patient's operation was delayed, and she was referred to a hematology clinic for further diagnosis. The thrombocyte count in heparinized whole blood was in the normal range. A smear of a fresh, nonheparinized blood sample revealed thrombocytes in aggregations of 5 to 14, which confirmed the diagnosis. The patient underwent operation with cardiopulmonary bypass with normal heparinization, and no unexpected postoperative complications, including bleeding, occurred in the early postoperative period. She had an uneventful recovery and was discharged from the hospital on the seventh postoperative day. Later routine polyclinic control evaluations showed no complications. We think the possibility of pseudothrombocytopenia should be discussed with patients. With the correct diagnosis, such patients can be safely given the chance of operation with no more than the usual risks of coronary bypass surgery.

  19. Employment opportunities for the disabled

    Delsen, L.W.M.


    Policy makers in the OECD Member States have developed quite different programmes and institutional arrangements to create and promote employment opportunities for the disabled. These policy approaches include legal interventions, employment support services, financial support of open employment and

  20. Interleukin-27 as a Novel Biomarker for Early Cardiopulmonary Failure in Enterovirus 71-Infected Children with Central Nervous System Involvement

    Huang, Mingyuan; Du, Wenjing; Liu, Jun; Zhang, Haiyang; Cao, Longbin; Yang, Weiqing; Zhang, Hui; Wang, Zhiyong; Wei, Pei; Wu, Weiquan; Huang, Zhulin; Fang, Ying; Lin, Qiling; Qin, Xingwen; Zhang, Zhizhong; Zhou, Keyuan


    Enterovirus 71 (EV71) is a major pathogen for severe hand, foot, and mouth disease (HFMD), which leads to severe neurological complications and has high morbidity and mortality. Reliable biomarker for the prediction of deterioration in EV71-infected children with central nervous system (CNS) involvement may reduce the cardiopulmonary failure and mortality. Here, we found that serum IL-27 levels were significantly higher in stage III EV71-infected HFMD patients with early cardiopulmonary failure and strong correlation with CRP levels. IL27p28 polymorphisms (rs153109, rs17855750, and rs181206) did not influence IL-27 production, and these three SNPs were not associated with EV71 infection risk and clinical stage. IL-27 can be used as an prediction indicator for early cardiopulmonary failure in EV71-infected children with CNS involvement. PMID:27403033

  1. Combined use of phenoxybenzamine and dopamine for low cardiac output syndrome in children at withdrawal from cardiopulmonary bypass.

    Kawamura, M; Minamikawa, O; Yokochi, H; Maki, S; Yasuda, T; Mizukawa, Y


    The combined use of phenoxybenzamine and dopamine was applied in infants and children when it was difficult to come off cardiopulmonary bypass for low cardiac output. The rationale of this method is to prevent the alpha-adrenergic action of dopamine by phenoxybenzamine and to encourage the beta-adrenergic and direct specific action of dopamine. Dopamine was used in dosage of 10 to 30 micrograms/kg per min after the additional administration of a half of the initial dosage of phenoxybenzamine; this was infused by drip always in a dosage of 0.5 to 1.0 mg/kg during the first half of cardiopulmonary bypass. It was possible to come off cardiopulmonary bypass with a stable haemodynamic state (mean arterial pressure more than 60 mmHg and total peripheral vascular resistance less than 2000 bynes s cm-5) and a good urinary output.

  2. Impact of bone graft harvesting techniques on bone formation and graft resorption

    Saulacic, Nikola; Bosshardt, Dieter D; Jensen, Simon S;


    formation and graft resorption in vivo. MATERIAL AND METHODS: Four harvesting techniques were used: (i) corticocancellous blocks particulated by a bone mill; (ii) bone scraper; (iii) piezosurgery; and (iv) bone slurry collected from a filter device upon drilling. The grafts were placed into bone defects...

  3. A pilot study of effects of cardiopulmonary resuscitation training on participants' self-concepts.

    Elliott, T R; Byrd, E K


    The administration of cardiopulmonary resuscitation (CPR) was taught to a group of 12 adults. The Tennessee Self-concept Scale Form-C and the Fundamental Interpersonal Relations Orientation-Behavior Scale (FIRO-B) were administered before and after their training. A control group of 12 was administered both scales twice with one day between administrations. Analysis indicated both groups showed significant differences between the pre- and posttest administrations on expressed affection on the FIRO-B. However, participants in a brief CPR course did not score significantly differently from a control group on these measures, as expected.

  4. [Chronic atrophic polychondritis and renal and cardiopulmonary amylosis: a case report and literature review (author's transl)].

    Lambrozo, J; Baubion, D; Brodaty, Y; Leclerc, J P


    Glomerular lesions with a nephrotic syndrome and impaired renal function developed secondary to a chronic atrophic polychondritis confirmed by auricular biopsy. In the absence of renal histology data, the possibility of an iatrogenic complication or a renal lesion specific to the affection itself were successively eliminated. Pos-mortem histological examination demonstrated renal and cardiopulmonary amylosis, the latter being clinically asymptomatic. The probable autoimmune origin of the chronic atrophic polychondritis has to be discussed in parallel with the dysimmunity mechanism responsible for the amyloid lesions, but no relationship between them was demonstrated.

  5. Portal venous gas and cardiopulmonary arrest during pneumatic reduction of an ileocolic intussusception.

    Ryan, Mark L; Fields, Jonathan M; Sola, Juan E; Neville, Holly L


    We present the case of an 8-month-old infant with a small bowel obstruction secondary to an ileocolic intussusception without a pathologic lead point. During pneumatic reduction, the patient went into cardiopulmonary arrest, at which point portal venous gas (PVG) was visualized on radiography. Here we present-to our knowledge-the first reported case of PVG secondary to pneumatic reduction of an intussusception along with a review of the literature regarding known complications of pneumatic reduction and the etiologies of PVG.

  6. European nursing organizations stand up for family presence during cardiopulmonary resuscitation: a joint position statement.

    Moons, Philip; Norekvål, Tone M


    Empirical evidence suggests that family presence during cardiopulmonary resuscitation (CPR) has beneficial effects. Although many American professional organizations have endorsed the idea of family presence, there is less formal support in Europe. In addition, the attitude of nurses from Anglo-Saxon countries, such as United Kingdom and Ireland, is more positive toward family presence than the attitude of nurses of mainland Europe. In order to support existing guidelines and to stimulate health care organizations to develop a formal policy with respect to family witnessed CPR, 3 important European nursing organizations have recently developed a joint position statement.

  7. Emergent cardiopulmonary bypass for a 180 kilogram patient: support with a single oxygenator.

    Hunter, Kyler T; Lopez, Angela R; Yun, Kwok L


    As obesity increases in prevalence, so will cases in which patients present at the boundaries of care. We report the support of a class III obese man, having a body mass index of 60.8 kg/m2 and in acute renal failure, with a single Trillium-coated Affinity NT Hollow Fiber oxygenator in cardiopulmonary bypass for an emergent aortic valve replacement secondary to infective endocarditis. A maximum oxygen delivery of 807.51 mL of oxygen per minute is reported for this oxygenator in this case report.

  8. First notification in Italy of cardiopulmonary filariosis (heartworm disease) in a wolf (Canis lupus).

    Pascucci, Ilaria; Fico, Rosario; D'Angelo, Anna Rita; Serini, Sabrina; Cammà, Cesare


    The authors report on the first notification of filariosis (heartworm disease) caused by Dirofilaria immitis in a wolf (Canis lupus) in Italy. On account of this exceptional finding, the parasite was typed not only using traditional methods, such as stereomicroscopic examination, but also using highly innovative diagnostic methods, such as scanning electron microscope and molecular identification with the application of various recently developed methods (polymerase chain reaction and sequencing). Certain aspects regarding the epidemiology of the disease are discussed in the light of this first case in Italy that occurred in an area in which cardiopulmonary filiariasis had not previously been reported in wild or domestic carnivores.

  9. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures.

    Hargrove, M


    The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed.

  10. Acute Mallory-Weiss syndrome after cardiopulmonary resuscitation by health care providers in the emergency department

    Dae Hee Kim; Dong Yoon Rhee; Seon Hee Woo; Woon Jeong Lee; Seung Hwan Seol; Won Jung Jeong


    A report of a 62-year-old female patient with severe Mallory-Weiss syndrome after successful cardiopulmonary resuscitation (CPR) by health care providers in the emergency department is presented. The bleeding continued for five days, and the patient’s total blood loss was estimated to be approximately 3 000 mL. After 7 days, the patient died due to respiratory distress syndrome. Severe Mallory-Weiss syndrome afterCPR may occur and should be considered as a potentially serious complication afterCPR.

  11. Hyperglycemia as an effect of cardiopulmonary bypass: intra-operative glucose management.

    Najmaii, Samira; Redford, Daniel; Larson, Douglas F


    Cardiopulmonary bypass (CPB) is associated with surgical stress, hypothermia, hyperoxia, enhancement of neuroendocrine outflow, and administration of glucogenic catecholamines that are associated with glucogonolysis and glucogenesis that result in hyperglycemia. The hyperglycemic state during CPB has been associated with adverse outcomes, such as infection, neurological impairment, cardiac dysfunction, prolonged hospitalization, and higher mortality rates. This report justifies vigilant monitoring of blood glucose levels and a rational protocol for the treatment of hyperglycemia of all open heart surgical patients that may improve post-CPB surgical outcomes.

  12. Physical properties of agave cellulose graft polymethyl methacrylate

    Rosli, Noor Afizah; Ahmad, Ishak; Abdullah, Ibrahim; Anuar, Farah Hannan [Polymer Research Centre (PORCE), School of Chemical Sciences and Food Technology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, 43600 Bangi Selangor (Malaysia)


    The grafting polymerization of methyl methacrylate and Agave cellulose was prepared and their structural analysis and morphology were investigated. The grafting reaction was carried out in an aqueous medium using ceric ammonium nitrate as an initiator. The structural analysis of the graft copolymers was carried out by Fourier transform infrared and X-ray diffraction. The graft copolymers were also characterized by field emission scanning electron microscopy (FESEM). An additional peak at 1732 cm{sup −1} which was attributed to the C=O of ester stretching vibration of poly(methyl methacrylate), appeared in the spectrum of grafted Agave cellulose. A slight decrease of crystallinity index upon grafting was found from 0.74 to 0.68 for cellulose and grafted Agave cellulose, respectively. Another evidence of grafting showed in the FESEM observation, where the surface of the grafted cellulose was found to be roughed than the raw one.

  13. Physical properties of agave cellulose graft polymethyl methacrylate

    Rosli, Noor Afizah; Ahmad, Ishak; Abdullah, Ibrahim; Anuar, Farah Hannan


    The grafting polymerization of methyl methacrylate and Agave cellulose was prepared and their structural analysis and morphology were investigated. The grafting reaction was carried out in an aqueous medium using ceric ammonium nitrate as an initiator. The structural analysis of the graft copolymers was carried out by Fourier transform infrared and X-ray diffraction. The graft copolymers were also characterized by field emission scanning electron microscopy (FESEM). An additional peak at 1732 cm-1 which was attributed to the C=O of ester stretching vibration of poly(methyl methacrylate), appeared in the spectrum of grafted Agave cellulose. A slight decrease of crystallinity index upon grafting was found from 0.74 to 0.68 for cellulose and grafted Agave cellulose, respectively. Another evidence of grafting showed in the FESEM observation, where the surface of the grafted cellulose was found to be roughed than the raw one.

  14. 2007 Veterans Employability Research Survey

    Department of Veterans Affairs — The 2007 Veterans Employability Research Survey (VERS) was conducted to determine the factors that impact veterans' employability resulting from participation in the...

  15. Coronary artery bypass grafting and sensorineural hearing loss, a cohort study

    Ashraf Omer


    Full Text Available Abstract Background Sudden sensorineural hearing loss is routinely encountered by the otologist. The etiology is varied and often identifiable. One of the relatively less frequent causes is surgery. Apart from being an established entity with otological surgeries, sensorineural hearing loss has also been known to occur after non-otological procedures under general anesthesia. Commonest amongst these procedures is cardiopulmonary bypass, an association that has long been recognized. However, despite the proposition of diverse hypotheses in the past, the pathophysiology remains unclear. Methods The study is a prospective matched cohort study that will be carried out in Aga Khan University Hospital, Karachi, Pakistan. Participants among exposed would include all those patients who would be undergoing coronary artery bypass surgery in the hospital who fall under the criteria for inclusion. Unexposed group would comprise of patients undergoing a non-bypass procedure of similar duration under the same type of anesthesia who meet the selection criteria. Both these groups will undergo audiometric testing at our hospital on three different occasions during the course of this study. Initially before the procedure to test the baseline hearing capacity; then one week after the procedure to assess any changes in hearing ability following the surgery; and finally a third audiogram at six weeks follow-up to assess further changes in any hearing deficits noted during the second phase of testing. Certain variables including the subjects' demographics and those concerning the procedure itself will be noted and used later for risk factors analysis. A detailed past medical and surgical history will also be obtained. Data analysis would include calculation of relative risk and significance of the results, by running the chi-square test. Other statistical tests like Fisher exact test may then be employed to facilitate data interpretation. Continuous scale may then be

  16. Self-deploying shape memory polymer scaffolds for grafting and stabilizing complex bone defects: A mouse femoral segmental defect study.

    Baker, Richard M; Tseng, Ling-Fang; Iannolo, Maria T; Oest, Megan E; Henderson, James H


    Treatment of complex bone defects places a significant burden on the US health care system. Current strategies for treatment include grafting and stabilization using internal metal plates/screws, intramedullary rods, or external fixators. Here, we introduce the use of shape memory polymer (SMP) materials for grafting and adjunct stabilization of segmental defects. Self-deploying SMP grafts and SMP sleeves capable of expanding and contracting, respectively, under intraoperative conditions were developed and evaluated in a mouse segmental defect model in vivo. Integration between grafts/sleeves and native bone was assessed using x-ray radiography, microcomputed tomography, and torsional mechanical testing. We found that SMP grafts were able to integrate with the native bone after 12 weeks, maintain defect stability, and provide torsional mechanical properties comparable to an allograft alone treatment; however no gross de novo bone formation was observed. SMP sleeves did not inhibit bony bridging at the margins, and limbs treated with a sleeve/allograft combination had torsional mechanical properties comparable to limbs treated with an allograft alone. In vitro torsional and bending tests suggest sleeves may provide additional torsional stability to defects. Incorporation of shape memory into synthetic bone graft substitutes and adjunct stabilization devices is anticipated to enhance functionality of synthetic materials employed in both applications.


    Valentina VASILE


    Full Text Available In consideration of the Lisbon Agenda, the Romanian Government drew up the National Programme for Reform for 2007-2010, which established national priorities, and ways and tools to achieve economic reform and growth. Transition in Romania implied a complex and extensive system of regulations and institutions for stimulating employment and creating a flexible system of social protection. The new regulations were focused on harmonisation with the Community labour law. Increasing investment in human capital is essential for a competitive and dynamic economy. Besides, labour market policies were formulated for correcting labour market imbalances.

  18. Challenging Scandinavian employment relations

    Ibsen, Christian Lyhne; Larsen, Trine Pernille; Madsen, Jørgen Steen


    and employment relations in the Danish, Norwegian and Swedish public sector. In this paper, we argue that although differences exist across the Scandinavian countries, it is evident that they have managed to adopt and implement NPM-inspired reforms without dismantling their universal welfare services and strong......Building on the convergence/divergence approach, this paper examines whether recent new public management (NPM) inspired reforms entailing inter alia cutbacks in the public sector, marketisation and management by performance measures have had significant implications for service provision...... traditions of collective bargaining in the public sector. However, this restructuring is taking its toll on the work environment....

  19. Employment without Growth

    Nørgaard, Jørgen

    Employment is a central argument for economic growth in the Western world. But environmental problems like global warming points towards limits to growth. The presentation outlines the history of what has lead to this dilemma. Fortunately citizens attitudes now points towards a preference for less...... more work. There are no indication that growth at Western economies increases satisfaction or happiness. A new look at the full economy divides it into professional economy and amateur economy, and it is suggested that a reversal of the trend hitherto to draw still more of the whole economy...

  20. Graduate Employability: A Conceptual Framework for Understanding Employers' Perceptions

    Cai, Yuzhuo


    This study provides a conceptual framework for understanding what employers think about the value of graduates with similar educational credentials in the workplace (their employability), using insights from the new institutionalism. In this framework, the development of employers' beliefs about graduates' employability is broken into a number of…

  1. Acute graft versus host disease

    Vogelsang Georgia B


    Full Text Available Abstract Acute graft-versus-host disease (GVHD occurs after allogeneic hematopoietic stem cell transplant and is a reaction of donor immune cells against host tissues. Activated donor T cells damage host epithelial cells after an inflammatory cascade that begins with the preparative regimen. About 35%–50% of hematopoietic stem cell transplant (HSCT recipients will develop acute GVHD. The exact risk is dependent on the stem cell source, age of the patient, conditioning, and GVHD prophylaxis used. Given the number of transplants performed, we can expect about 5500 patients/year to develop acute GVHD. Patients can have involvement of three organs: skin (rash/dermatitis, liver (hepatitis/jaundice, and gastrointestinal tract (abdominal pain/diarrhea. One or more organs may be involved. GVHD is a clinical diagnosis that may be supported with appropriate biopsies. The reason to pursue a tissue biopsy is to help differentiate from other diagnoses which may mimic GVHD, such as viral infection (hepatitis, colitis or drug reaction (causing skin rash. Acute GVHD is staged and graded (grade 0-IV by the number and extent of organ involvement. Patients with grade III/IV acute GVHD tend to have a poor outcome. Generally the patient is treated by optimizing their immunosuppression and adding methylprednisolone. About 50% of patients will have a solid response to methylprednisolone. If patients progress after 3 days or are not improved after 7 days, they will get salvage (second-line immunosuppressive therapy for which there is currently no standard-of-care. Well-organized clinical trials are imperative to better define second-line therapies for this disease. Additional management issues are attention to wound infections in skin GVHD and fluid/nutrition management in gastrointestinal GVHD. About 50% of patients with acute GVHD will eventually have manifestations of chronic GVHD.

  2. A phenomenological contact model: Understanding the graft-tunnel interaction in anterior cruciate ligament reconstructive surgery.

    Salehghaffari, Shahab; Dhaher, Yasin Y


    In this paper, we sought to expand the fidelity of a validated model of the anterior cruciate ligament reconstruction (ACL-R) procedure by incorporating a stick-slip contact model with linear pressure-overclosure relationship at the interface. The suggested model is characterized by three unknown parameters, friction coefficient, shear stress softening and contact stiffness. In the absence of any isolated experiments exploring the graft-tunnel interactions during an aggregate joint load, the calibration data used in this study are derived from a reported biomechanical study. A Bayesian calibration procedure was employed to find the unknown probability distribution function (PDF) of these contact parameters. Initially, the response surface approximations of the predicted graft forces from laxity test simulations was adopted to estimate the likelihood of noisy experimental data reported in the literature. Then, the wide domain of contact parameters was sampled sequentially based on the Marcov Chain Monte Carlo (MCMC) method with acceptance-rejection criteria to search for population of samples in significantly narrower domain of unknown parameters that are associated with the highest occurrence likelihood of noisy experimental data. Our simulations with calibrated contact parameters indicate that pre-tensioning applied at 30° of flexion leads to larger graft force after the joint is fully extended compared to the graft force when the same pre-tensioning force is applied at full extension. Moreover, regardless of the pre-tensioning force, the graft-tunnel contact pressure is larger when the fixation of the graft is performed at full extension, increasing with the pre-tensioning force.

  3. Internal inguinal ring closure by laparoscopy using homologous pericardium grafts in horses

    Julio David Spagnolo


    Full Text Available ABSTRACT: The occlusion of inguinal ring is the treatment to avoid the inguinal hernia in horses. The aim of this study is evaluate the efficacy of homologous pericardium grafts for internal inguinal ring closure in horses, comparing mechanical or manual laparoscopic suture. Cross over study, using six healthy intact male Mangalarga breed horses aged between 3 and 12 years. Horses were operated under general anesthesia in 25º Trendelenburg position. Five laparoscopic portals were employed. Pericardium grafts measuring 4x5cm were anchored covering the left and right internal inguinal rings using either manual intracorporeal suture or laparoscopic stapler. Horses were followed-up during 11 weeks when were submitted to a laparoscopic control. Surgical time, trans and postoperative complications and effectiveness of internal inguinal closure were evaluated and statistically analyzed. The level of significance was set at 5% P<0.05. The procedures were realized without complications and the mean time required for manual and mechanical suture procedures differed significantly (67.8±15.3 and 14.1±2.1 min respectively; P<0.05. All manually sutured grafts remained in place and partial suture dehiscence with incomplete occlusion of the internal inguinal ring was observed in two stapled grafts. Non-severe complications were observed trans or postoperatively. One synechiae and three omental adhesions were observed by laparoscopic control on day 77, but without clinical relevance in the evaluated period. The use of homologous pericardium grafts was effectiveness to internal inguinal ring closure by laparoscopy. Mechanical suture was faster to perform than manual, but provided less satisfactory results concerning safety of graft fixation.

  4. Life Sciences and employability

    Wynand J. Boshoff


    Full Text Available This article addresses unemployment in rural areas. South Africa is also characterised by skills shortage and high unemployment figures, especially in rural areas as compared to urban areas. The institutional reality of education is that every rural village hosts a high school which is primarily engaged in preparing learners for further studies, whilst the Further Training Colleges (previously known as technical colleges are mainly located in the larger centres. It is with this scenario as a backdrop that the possible role of high schools to alleviate the problem is being argued. It is clear that rural employers do not expect from school leavers to be in possession of applicable knowledge, but rather to be in possession of the ability as well as certain personal characteristics that would make them employable. Unfortunately, however, this is not always found in young persons who have completed their schooling successfully. Life Sciences educators can render a valuable service should certain nontraditional approaches be incorporated into the teaching practice. This will enable them to contribute to solving one of South Africa’s serious problems.

  5. Synthesis of grafted phosphorylcholine polymer layers as specific recognition ligands for C-reactive protein focused on grafting density and thickness to achieve highly sensitive detection.

    Kamon, Yuri; Kitayama, Yukiya; Itakura, Akiko N; Fukazawa, Kyoko; Ishihara, Kazuhiko; Takeuchi, Toshifumi


    We studied the effects of layer thickness and grafting density of poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) thin layers as specific ligands for the highly sensitive binding of C-reactive protein (CRP). PMPC layer thickness was controlled by surface-initiated activators generated by electron transfer for atom transfer radical polymerization (AGET ATRP). PMPC grafting density was controlled by utilizing mixed self-assembled monolayers with different incorporation ratios of the bis[2-(2-bromoisobutyryloxy)undecyl] disulfide ATRP initiator, as modulated by altering the feed molar ratio with (11-mercaptoundecyl)tetra(ethylene glycol). X-ray photoelectron spectroscopy and ellipsometry measurements were used to characterize the modified surfaces. PMPC grafting densities were estimated from polymer thickness and the molecular weight obtained from sacrificial initiator during surface-initiated AGET ATRP. The effects of thickness and grafting density of the obtained PMPC layers on CRP binding performance were investigated using surface plasmon resonance employing a 10 mM Tris-HCl running buffer containing 140 mM NaCl and 2 mM CaCl2 (pH 7.4). Furthermore, the non-specific binding properties of the obtained layers were investigated using human serum albumin (HSA) as a reference protein. The PMPC layer which has 4.6 nm of thickness and 1.27 chains per nm(2) of grafting density showed highly sensitive CRP detection (limit of detection: 4.4 ng mL(-1)) with low non-specific HSA adsorption, which was improved 10 times than our previous report of 50 ng mL(-1).

  6. Vascularized tail bone grafts in rats.

    Sempuku, T; Tamai, S; Mizumoto, S; Yajima, H


    A new experimental model for vascularized corticocancellous bone grafts was established by investigation of vascular anatomy of the tail in 15 adult Fischer 344 rats and determination of the viability of vascularized tail bone grafts into the abdominal wall in 22 7-week-old rats. The tail bones of 40 rats were then raised on the pedicle of the caudal artery and its venae comitantes, transferred to a resected portion in the femur, and observed for 16 weeks. The vascularized graft showed marked reactive periosteal bone formation during the first and second weeks following transfer, and thereafter, the graft continued to show active bone formation. In transverse section, the sharp processes became rounded. In the cancellous bone, both bone resorption and bone formation were noticeably activated early after transfer, although resorption predominated and the amount of the cancellous bone consequently diminished. The nonvascularized grafts showed "creeping substitution." The results suggest that morphologic adaptation occurs if living (i.e., vascularized) tail bones are transferred to long-bone femurs.

  7. Bone graft substitutes: past, present, future.

    Parikh S


    Full Text Available Bone grafts are necessary to provide support, fill voids, and enhance biologic repair of skeletal defects. They are used by orthopaedic surgeons, neurosurgeons, craniofacial surgeons, and periodontists. Bone harvested from donor sites is the gold standard for this procedure. It is well documented that there are limitations and complications from the use of autograft, including the limited quantity and associated chronic donor site pain. Despite the increase in the number of procedures that require bone grafts, there has not been a single ideal bone graft substitute Scientists, surgeons, and medical companies, thus, have a tremendous responsibility to develop biologic alternatives that will enhance the functional capabilities of the bone graft substitute, and potentially reduce or eliminate the need for autograft. This article is an attempt to review the past and existing bone graft substitutes, and future directions of research. The historical data was extracted after thorough review of the literature. The data for the current concepts and future directions was compiled from the Internet, and from direct correspondence with medical companies. Since many products are undergoing clinical trials, and are yet not commercially available, their data cannot be found in literature. The main purpose of this article is to give the reader an idea about the existing market products and products likely to be available in near future.

  8. Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses

    Clairton Marcos Citolino Filho


    Full Text Available Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%, the lack of harmony (77.6% or stress of any member of staff (67.3%, lack of material and/or equipment failure (57.1%, lack of familiarity with the emergency trolleys (98.0% and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1% are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

  9. Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

    Daniela Aparecida Morais


    Full Text Available OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%, "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%, "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%, and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%.CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest.

  10. Effect of Prior Cardiopulmonary Resuscitation Knowledge on Compression Performance by Hospital Providers

    Joshua N. Burkhardt


    Full Text Available Introduction: The purpose of this study was to determine cardiopulmonary resuscitation (CPR knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest. Methods: This cross-sectional study evaluated the CPR knowledge and performance of medical students and ED personnel with current CPR certification. We collected data regarding compression rate, hand placement, depth, and recoil via a questionnaire to determine knowledge, and then we assessed performance using 60 seconds of compressions on a simulation mannequin. Results: Data from 200 enrollments were analyzed by evaluators blinded to subject knowledge. Regarding knowledge, 94% of participants correctly identified parameters for rate, 58% for hand placement, 74% for depth, and 94% for recoil. Participants identifying an effective rate of ≥100 performed compressions at a significantly higher rate than participants identifying <100 (µ=117 vs. 94, p<0.001. Participants identifying correct hand placement performed significantly more compressions adherent to guidelines than those identifying incorrect placement (µ=86% vs. 72%, p<0.01. No significant differences were found in depth or recoil performance based on knowledge of guidelines. Conclusion: Knowledge of guidelines was variable; however, CPR knowledge significantly impacted certain aspects of performance, namely rate and hand placement, whereas depth and recoil were not affected. Depth of compressions was poor regardless of prior knowledge, and knowledge did not correlate with recoil performance. Overall performance was suboptimal and additional training may be needed to ensure consistent, effective performance and therefore better outcomes after cardiopulmonary arrest.

  11. Problems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection

    Kambiz Alizadeh


    Full Text Available Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB. Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB andmyocardial protection requires individualized planning. We describea case of MV repair and CABG in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.Normothermic CPB and continuous warm blood cardioplegia weresuccessfully used.

  12. Coordination of heart and lung co-development by a multipotent cardiopulmonary progenitor.

    Peng, Tien; Tian, Ying; Boogerd, Cornelis J; Lu, Min Min; Kadzik, Rachel S; Stewart, Kathleen M; Evans, Sylvia M; Morrisey, Edward E


    Co-development of the cardiovascular and pulmonary systems is a recent evolutionary adaption to terrestrial life that couples cardiac output with the gas exchange function of the lung. Here we show that the murine pulmonary vasculature develops even in the absence of lung development. We have identified a population of multipotent cardiopulmonary mesoderm progenitors (CPPs) within the posterior pole of the heart that are marked by the expression of Wnt2, Gli1 and Isl1. We show that CPPs arise from cardiac progenitors before lung development. Lineage tracing and clonal analysis demonstrates that CPPs generate the mesoderm lineages within the cardiac inflow tract and lung including cardiomyocytes, pulmonary vascular and airway smooth muscle, proximal vascular endothelium, and pericyte-like cells. CPPs are regulated by hedgehog expression from the foregut endoderm, which is required for connection of the pulmonary vasculature to the heart. Together, these studies identify a novel population of multipotent cardiopulmonary progenitors that coordinates heart and lung co-development that is required for adaptation to terrestrial existence.

  13. Observations on some cardiopulmonary effects of midazolam, xylazine and a midazolam / ketamine combination in the goat

    G.F. Stegmann


    Full Text Available Xylazine, midazolam and a midazolam / ketamine combination were administered to 6 goats in a randomised 3-way block design. All goats received all treatments with at least a 7-day interval between treatments. Statistically significant (P < 0.05 changes were observed in some of the measured cardiopulmonary variables for xylazine and midazolam/ ketamine. Xylazine administration resulted in statistically significant decreases in minute volume, arterial partial pressure of oxygen, heart rate andmeanarterial blood pressure. The increase in arterial partial pressure of carbon dioxide was not statistically significant. For the midazolam / ketamine combination, the decrease in tidal volume was statistically significant, but not the decrease in minute volume and increase in arterial partial pressure of carbon dioxide. The decrease in the arterial partial pressure of oxygen was also statistically significant. The mean arterial blood pressure for the combination was statistically significantly higher compared to xylazine. The changes in cardiopulmonary variables after midazolam administration were not statistically significant, such as tidal and minute volume, arterial partial pressure of oxygen and carbon dioxide. However, clinically significant effects such as hypoventilation and hypoxia were observed after its administration. The change in mean arterial blood pressure was minimal.

  14. Protective Effect of Heparin-coated Circuits on the Platelets during Cardiopulmonary Bypass

    张凯伦; 胡志伟; 杨运海; 黄如清; 范慧敏; 孙宗全


    To observe the protective effect of heparin-coated circuits (HCC) on the platelet function during cardiopulmonary bypass (CPB). 23 patients with heart valve replacement were studied. The system heparin dose was 3 mg/kg in the control group (n= 15) and heparin-coated circuits in the HCC group (n = 8). Platelet count, α-granule membrane protein-140 (GMP-140) concentrations were determined before CPB, at 60 min of CPB, 30 and 60 min after protamine administration, first 12 h after CPB, respectively. At end of CPB the arterial filters in the circuits were observed by electron microscopy. The amount of first 12-h postoperative blood loss was measured. There was significant reduction in platelet loss during and after CPB in the HCC group in contrast to the control group during CPB (P<0.05). During the first 12 h, postoperative blood loss was reduced in the HCC group as compared with that in the control group (218±61 ml, vs. 332±118 ml, P<0.05). Electron microscopy showed that in the HCC group the filter meshes and their fringes were clear and fragments of floccules were occasionally seen, without adherent cells or only few adherent cells on their surfaces, whereas several cellular and fibrous components were found to adhere to the surfaces of the filter meshes in the control group. This study indicates that heparin-coated circuits might reduce the platelet loss and activation during CPB and improve hemocompatibility of cardiopulmonary bypass equipment.

  15. Cardiopulmonary Profile in Streptozotocin-Induced Type 1 Diabetic Rats during Systemic Endotoxemia

    Ching-Hsia Hung


    Full Text Available This study was designed to determine the severity of cardiopulmonary dysfunction during systemic endotoxemia in type 1 diabetes. Thirty-two adult male Wistar rats were randomly assigned to a control group or to a group treated with streptozotocin (STZ to create an animal model of type 1 diabetes. Survival time and cardiovascular parameters were continually monitored in urethane anaesthetized animals receiving intravenous infusion of endotoxin (lipopolysaccharide (LPS or saline. We also determined arterial blood gases, lung injury, and tumor necrosis factor-alpha (TNF-α levels in serum and bronchoalveolar lavage fluid. Before LPS administration, the mean arterial pressure in STZ rats was significantly higher than that in normal rats. After LPS injection, the heart rate drop significantly in STZ rats than that in the control group. Also, the increased levels of TNF-α in serum and lavage fluid after LPS treatment were significantly higher in STZ rats than those in normal rats. Survival time in STZ rats was shorter than that in normal rats after LPS application. Albumin content, wet/dry weight ratio of lung, and lung injury were indistinguishable between STZ and normal rats. These results indicate that the cardiopulmonary change which occurs during LPS-induced endotoxemia is minor in STZ-induced diabetic rats.

  16. A review of cardiopulmonary research in Brazilian medical journals: clinical, surgical and epidemiological data.

    Serrano, Carlos; Rocha e Silva, Mauricio


    Research in the field of cardiopulmonary disease in Brazil has been very active in recent decades. The combination of PUBMED, SCieLO, open access and online searching has provided a significant increase in the visibility of Brazilian journals. This newly acquired international visibility has in turn resulted in the appearance of more original research reports in the Brazilian scientific press. This review is intended to highlight part of this work for the benefit of the readers of "Clinics." We searched through PUBMED for noteworthy articles published in Brazilian medical journals included in the Journal of Citation Reports of the Institute of Scientific Information to better expose them to our readership. The following journals were examined: "Arquivos Brasileiros de Cardiologia," "Arquivos Brasileiros de Endocrinologia e Metabologia," "Brazilian Journal of Medical and Biological Reviews," "Jornal Brasileiro de Pneumologia," "Jornal de Pediatria," "Revista Brasileira de Cirurgia Cardiovascular," "Revista da Associação Médica Brasileira," Revista da Escola de Enfermagem U.S.P." and "São Paulo Medical Journal." These journals publish original investigations in the field of cardiopulmonary disease. The search produced 71 references, which are briefly examined.

  17. Marginally effective medical care: ethical analysis of issues in cardiopulmonary resuscitation (CPR)

    Hilberman, M; Kutner, J; Parsons, D; Murphy, D J


    Outcomes from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR outcomes literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposal for selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the outcomes are harmful or usage inappropriate. Additionally, policies which usurp good clinical judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. Justice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation should be performed when justified by the extensive outcomes literature; not performed when not desired by the patient or not indicated; and performed infrequently when relatively contraindicated.

  18. Vitamin D Status After Cardiopulmonary Bypass in Children With Congenital Heart Disease.

    Abou Zahr, Riad; Faustino, Edward Vincent S; Carpenter, Thomas; Kirshbom, Paul; Hall, E Kevin; Fahey, John T; Kandil, Sarah B


    Deficiency in 25-hydroxyvitamin D (25OHD) is associated with increased morbidity and mortality in the critically ill. Children who underwent surgery for congenital heart disease under cardiopulmonary bypass (CPB) are typically deficient in 25OHD. It is unclear whether this deficiency is due to CPB. We hypothesized that CPB reduces the levels of 25OHD in children with congenital heart disease. We conducted a prospective observational study on children aged 2 months to 17 years who underwent CPB. Serum was collected at 3 time points: immediately before, immediately after surgery, and 24 hours after surgery. 25-Hydroxyvitamin D, 1,25-dihydroxyvitamin D, 1,25(OH)2D, vitamin D binding protein, and albumin levels were measured. Levels were compared using repeated measures analysis of variance. We enrolled 20 patients, 40% were deficient in 25OHD with levels Vitamin D binding protein and albumin levels did not significantly change. Cardiopulmonary bypass decreases 25OHD by reducing the free fraction. Current investigations are geared to establish whether vitamin D deficiency is associated with outcomes and if treatment is appropriate.

  19. Impaired microcirculatory perfusion in a rat model of cardiopulmonary bypass: the role of hemodilution.

    Koning, Nick J; de Lange, Fellery; Vonk, Alexander B A; Ahmed, Yunus; van den Brom, Charissa E; Bogaards, Sylvia; van Meurs, Matijs; Jongman, Rianne M; Schalkwijk, Casper G; Begieneman, Mark P V; Niessen, Hans W; Baufreton, Christophe; Boer, Christa


    Although hemodilution is attributed as the main cause of microcirculatory impairment during cardiopulmonary bypass (CPB), this relationship has never been investigated. We investigated the distinct effects of hemodilution with or without CPB on microvascular perfusion and subsequent renal tissue injury in a rat model. Male Wistar rats (375-425 g) were anesthetized, prepared for cremaster muscle intravital microscopy, and subjected to CPB (n = 9), hemodilution alone (n = 9), or a sham procedure (n = 6). Microcirculatory recordings were performed at multiple time points and analyzed for perfusion characteristics. Kidney and lung tissue were investigated for mRNA expression for genes regulating inflammation and endothelial adhesion molecule expression. Renal injury was assessed with immunohistochemistry. Hematocrit levels dropped to 0.24 ± 0.03 l/l and 0.22 ± 0.02 l/l after onset of hemodilution with or without CPB. Microcirculatory perfusion remained unaltered in sham rats. Hemodilution alone induced a 13% decrease in perfused capillaries, after which recovery was observed. Onset of CPB reduced the perfused capillaries by 40% (9.2 ± 0.9 to 5.5 ± 1.5 perfused capillaries per microscope field; P perfusion, which cannot fully explain impaired microcirculation following cardiopulmonary bypass. CPB led to increased renal injury and endothelial adhesion molecule expression in the kidney and lung compared with hemodilution. Our findings suggest that microcirculatory impairment during CPB may play a role in the development of kidney injury.

  20. Sport climbing with pre-existing cardio-pulmonary medical conditions.

    Kuepper, T; Morrison, A; Gieseler, U; Schoeffl, V


    Over the past 25 years sport climbing has developed from an elite extreme sport subculture pursued by few into a mainstream recreational sport enjoyed globally by climbers of all ages, climbing abilities, and with pre-existing health conditions. As the demands and grades of climbing difficulty have increased over this period, most scientific literature on sport climbing focused on acute injuries and overuse syndromes, or performance physiology in healthy adult males. The physiological response to sport climbing is more similar to that of resistance training (i.e., body building) rather than a predominantly aerobic sport (i.e., running, cycling), so that heart rate and blood pressure during a climb will be disproportionately high relative to the 'exercise' of climbing, and breathing may be irregular. Therefore this review sought evidence-based recommendations for recreational sport climbing participation by those individuals with pre-existing cardiopulmonary medical conditions including coronary heart disease, chronic heart failure, cardiac dysrhythmia, pulmonary diseases (i.e., asthma) or hypertension. This review defines the criteria that must be fulfilled for safe sport climbing by those with pre-existing cardiopulmonary conditions or those with hypertension.

  1. Vitamin D is associated with cardiopulmonary exercise capacity: results of two independent cohorts of healthy adults.

    Kaul, A; Gläser, S; Hannemann, A; Schäper, C; Nauck, M; Felix, S B; Bollmann, T; Ewert, R; Friedrich, N


    Vitamin D has an important role in calcium homeostasis and is known to have various health-promoting effects. Moreover, potential interactions between vitamin D and physical activity have been suggested. This study aims to investigate the relationship between 25-hydroxyvitamin D (25(OH)D) and exercise capacity quantified by cardiopulmonary exercise testing (CPET). For this, 1377 participants from the Study of Health in Pomerania (SHIP-1) and 750 participants from the independent SHIP-TREND cohort were investigated. Standardised incremental exercise tests on a cycle ergometer were performed to assess exercise capacity by VO2 at anaerobic threshold, peakVO2, O2 pulse and peak power output. Serum 25(OH)D levels were measured by an automated chemiluminescence immunoassay. In SHIP-1, 25(OH)D levels were positively associated with all considered parameters of cardiopulmonary exercise capacity. Subjects with high 25(OH)D levels (4th quartile) showed an up to 25% higher exercise capacity compared with subjects with low 25(OH)D levels (1st quartile). All associations were replicated in the independent SHIP-TREND cohort and were independent of age, sex, season and other interfering factors. In conclusion, significant positive associations between 25(OH)D and parameters of CPET were detected in two large cohorts of healthy adults.

  2. Exercise and NO production: relevance and implications in the cardio-pulmonary system

    Alexei V Nosarev


    Full Text Available This article reviews the existing knowledge about the effects of physical exercise on nitric oxide (NO production in the cardiopulmonary system. The authors review the sources of NO in the cardiopulmonary system; involvement of three forms of NO synthases (eNOS, nNOS, and iNOS in exercise physiology; exercise-induced modulation of NO and/or NOS in physiological and pathophysiological conditions in human subjects and animal models in the absence and presence of pharmacological modulators; and significance of exercise-induced NO production in health and disease. The authors suggest that physical activity significantly improves functioning of the cardiovascular system through an increase in NO bioavailability, potentiation of antioxidant defense, and decrease in the expression of reactive oxygen species-forming enzymes. Regular physical exercises are considered a useful approach to treat cardiovascular diseases. Future studies should focus on detailed identification of (i the exercise-mediated mechanisms of NO exchange; (ii optimal exercise approaches to improve cardiovascular function in health and disease; and (iii physical effort thresholds.

  3. Employment in the Public Sector.

    Organisation for Economic Cooperation and Development, Paris (France).

    This report synthesizes the findings from several areas of work undertaken to assess what impact public sector employment has had on both the level and structure of employment. It also examines the impact of the public sector as employer on the labor market from two viewpoints: the level and share of public sector employment and the structure of…

  4. Employability Skills Assessment Tool Development

    Rasul, Mohamad Sattar; Rauf, Rose Amnah Abd; Mansor, Azlin Norhaini; Puvanasvaran, A. P.


    Research nationally and internationally found that technical graduates are lacking in employability skills. As employability skills are crucial in outcome-based education, the main goal of this research is to develop an Employability Skill Assessment Tool to help students and lecturers produce competent graduates in employability skills needed by…

  5. Employability. NIACE Briefing Sheet 88

    National Institute of Adult Continuing Education, 2009


    Employability skills are central to gaining and keeping employment (e.g. whether paid or unpaid, as an employee or self employed) as well as career progression. The lack of such skills is regularly referred to as one reason for the United Kingdom's often cited long tail of underachievement. Employability skills are at the forefront of government…

  6. Novel anterior cruciate ligament graft fixation device reduces slippage.

    Lopez, Mandi J; Borne, Allen; Monroe, W Todd; Bommala, Prakash; Kelly, Laura; Zhang, Nan


    Clinically significant laxity occurs in 10%-30% of knees after anterior cruciate ligament reconstruction. Graft slippage and tension loss at the hamstring graft tibial fixation site during and after reconstruction surgery contribute to postoperative joint laxity and are detrimental to long-term knee stability and graft properties. Limiting graft slippage will reduce associated complications. We sought to compare the in vitro mechanical properties and in vivo joint stabilization, postoperative limb use, and graft incorporation of the novel GraftGrab™ (GG) device designed to reduce hamstring graft tibial fixation slippage with the commercially available bioabsorbable Bio-Post™ and spiked washer (BP). Mechanical testing was performed on canine tibia-hamstring graft constructs to quantify initial fixation properties. In vivo joint stabilization, postoperative limb use and graft incorporation of hamstring graft reconstructions were determined in a canine model. Outcomes included tibial translation and ground reaction forces preoperatively and 4 and 8 weeks postoperatively, three-dimensional graft and bone tunnel dimensions at the latter two time points, and graft-bone microstructure, as well as mechanical properties 8 weeks after implantation. Immediately after fixation, all grafts slipped from the BP constructs versus about 30% of GG constructs. In vivo limb use remained low, and tibial translation increased with time in the BP cohort. These results together confirm that initial graft slippage is lower with GG versus BP extracortical hamstring graft tibial fixation. In addition, postoperative recovery and joint stability are more consistent with the GG. This information supports the GG as an alternative to extracortical tibial hamstring graft fixation that has procedural advantages over current implants and reduces graft failure from slippage.

  7. Employment Trajectories Beyond Retirement.

    Burkert, Carola; Hochfellner, Daniela


    Within the political and academic debate on working longer, post-retirement employment is discussed as an alternative to maintain older workers in the labor market. Our article enhances this discussion by studying determinants of transitions into post-retirement jobs within differing work environments of birth cohorts 1940-1942. We estimate proportional subhazard models accounting for competing risks using unique German social security data linked to pension accounts. Our findings suggest that individuals' preferences to take up post-retirement jobs are not mutually exclusive. Our study provides evidence that taking up post-retirement jobs is related to seeking financial security, continuity, and work ability, suggesting that public policy has to develop target-oriented support through a public policy mix of different measures aligned to the different peer groups in the labor market.

  8. Quantitative evaluation of cardiopulmonary functional reserve in treated patients with pulmonary embolism

    YAN Wen-wen; WANG Le-min; CHE Lin; SONG Hao-ming; JIANG Jin-fa; XU Jia-hong; SHEN Yu-qin; ZHANG Qi-ping


    Background There is no research,either at home or abroad,focusing on assessing the cardiopulmonary functional reserve and exercise tolerance in patients with pulmonary embolism (PE),but the benefits of early exercise are well recognized.The goals of this study were to assess cardiopulmonary functional reserve in treated PE patients using the inert gas rebreathing method of the cardiopulmonary exercise test (CPET),and to compare it with traditional methods.Methods CPET on the bicycle ergometer were performed in 40 patients with age,gender,body mass index,systolic blood pressure,and pulmonary function matched.The first group was the PE group composed of 16 PE patients (5 male,11 female) who were given the standard antithrombotic therapy for two weeks.The second group was composed of 24 normal individuals (10 male,14 female).Both groups were evaluated by cardiac ultrasound examination,6-minute walking test (6MVVT),and CPET.Results (1) Right ventricular systolic pressure (RVSP) in the PE group increased significantly compared to the control group,(34.81±8.15) mmHg to (19.75±3.47) mmHg (P <0.01).But neither right atrial end-systolic diameter (RASD) nor right ventricular end-diastolic diameter (RVDD) in the PE patients had changed when compared with the controls.The 6-minute walk distance was significantly reduced in the PE patients compared with normal subjects,(447.81±79.20) m vs.(513.75±31.45) m (P <0.01).Both anaerobic threshold oxygen consumption (VO2AT) and peak oxygen consumption (VO2peak) were significantly lower in patients with PE,while CO2 equivalent ventilation (VE/VCO2 slope) was higher;VO2AT (9.44±3.82) ml·kg1.min-1 vs.(14.62±2.93) (P <0.01) and VO2peak (12.26±4.06) vs.(23.46±6.15) (P <0.01) and VE/VCO2 slope 35.47±6.66 vs.26.94±3.16 (P <0.01).There was no significant difference in resting cardiac output (CO) between the PE and normal groups,whereas peak cardiac output (peak CO)and the

  9. Meshed split skin graft for extensive vitiligo

    Srinivas C


    Full Text Available A 30 year old female presented with generalized stable vitiligo involving large areas of the body. Since large areas were to be treated it was decided to do meshed split skin graft. A phototoxic blister over recipient site was induced by applying 8 MOP solution followed by exposure to UVA. The split skin graft was harvested from donor area by Padgett dermatome which was meshed by an ampligreffe to increase the size of the graft by 4 times. Significant pigmentation of the depigmented skin was seen after 5 months. This procedure helps to cover large recipient areas, when pigmented donor skin is limited with minimal risk of scarring. Phototoxic blister enables easy separation of epidermis thus saving time required for dermabrasion from recipient site.

  10. Dermal graft correction of extraordinary chordee.

    Kogan, S J; Reda, E F; Smey, P L; Levitt, S B


    Severe degrees of primary chordee and persistent or recurrent chordee following previous surgical attempts at correction present a challenging problem. Inadequate resection of involved tissues, which may involve all layers of the penile investiture, or recurrent scarring of the ventral skin, Buck's fascia and tunica albuginea is usually the cause. Reoperation to achieve penile straightening often is unsuccessful unless all chordee-bearing tissue is resected extensively. Excision of large segments of tunica albuginea or wide separation of the margins creates a defect that tends to heal by dense scarring unless the defect is bridged by a graft. Various autogenous materials have been used, including blood vessel, fascia, free fat graft, dermis and tunica albuginea, as well as prosthestic materials, such as polytetrafluoroethylene, with varying results. A series of patients with extensive chordee is presented in whom tunical resection was necessary to achieve penile straightening. The results of free dermal graft replacement of the tunica are reported.

  11. Autologous Fat Grafting for Whole Breast Reconstruction

    Benjamin H. L. Howes, MBBS


    Full Text Available Summary: This is the first reported case of a patient who had a single-stage large-volume breast reconstruction with autologous fat grafting, following rotation flap approach (RoFA mastectomy. The purpose of this case study was to evaluate the viability of reconstruction of the breast by autologous fat grafting alone, in the context of RoFA mastectomy. The hypothesis was that there would be minimal interval loss of autologous fat on the whole breast reconstruction side. Right RoFA mastectomy was used for resection of an invasive primary breast cancer and resulted in the right breast skin envelope. Eleven months later, the patient underwent grafting of 400 ml of autologous fat into the skin envelope and underlying pectoralis major muscle. Outcome was assessed by using a validated 3D laser scan technique for quantitative breast volume measurement. Other outcome measures included the BREAST-Q questionnaire and 2D clinical photography. At 12-month follow-up, the patient was observed to have maintenance of volume of the reconstructed breast. Her BREAST-Q scores were markedly improved compared with before fat grafting, and there was observable improvement in shape, contour, and symmetry on 2D clinical photography. The 2 new techniques, RoFA mastectomy and large-volume single-stage autologous fat grafting, were used in combination to achieve a satisfactory postmastectomy breast reconstruction. Novel tools for measurement of outcome were the 3D whole-body laser scanner and BREAST-Q questionnaire. This case demonstrates the potential for the use of fat grafting for reconstruction. Outcomes in a larger patient populations are needed to confirm these findings.

  12. Culture of graft-infiltrating cells from cryopreserved endomyocardial biopsies

    G.A. Patijn (G.); L.M.B. Vaessen (Leonard); W. Weimar (Willem); F.H.J. Claas (Frans); N.H.P.M. Jutte (Nicolet)


    textabstractGraft-infiltrating cells can be cultured from fresh endomyocardial biopsies (EMB) taken after heart transplantation to determine their growth patterns, phenotypic composition, and functional characteristics for clinical or scientific purposes. In this study we investigated whether graft-

  13. Sulfonated hydrocarbon graft architectures for cation exchange membranes

    Nielsen, Mads Møller; Jankova Atanasova, Katja; Hvilsted, Søren


    A synthetic strategy to hydrocarbon graft architectures prepared from a commercial polysulfone and aimed as ion exchange membrane material is proposed. Polystyrene is grafted from a polysulfone macroinitiator by atom transfer radical polymerization, and subsequently sulfonated with acetyl sulfate...

  14. Graft patency in off-pump and conventional coronary artery bypass grafting for treatment of triple vessel coronary disease

    胡盛寿; 王小启; 宋云虎; 吕锋


    Objective To compare graft patency in off-pump and conventional coronary artery bypass grafting by using the transit time flow meter in the treatment of triple vessel coronary artery disease. Methods Between June 2000 and April 2001, 60 patients with triple vessel coronary artery disease underwent coronary artery bypass grafting. They were divided into two groups: off-pump and conventional coronary artery bypass. All completed grafts were tested intraoperatively using Transit Time Flow Measurement (TTFM). Preoperative and postoperative variables of the two groups were also compared. Results There were no significant differences in sex, age, weight, acute or remote myocardial infarction, hypertension, diabetes and type of bypass grafts between the two groups. The number of bypass grafts and the assisted respiratory time of the off-pump coronary artery bypass grafting (OPCAB) group were significantly less than those of the conventional coronary artery bypass grafting (CCABG) group. The flow and pulsatile index (PI) of the left anterior descending artery bypass grafts and the right coronary artery bypass grafts were not significantly different between the OPCAB and CCABG groups. The flow of OM in the CCABG group with the multiple anastomosis site of sequential grafts was higher than that in the OPCAB group. Diffused narrow coronary artery bypass grafts in both groups had less flow.Conclusion No signficant differences in graft patency were observed in patients with triple vessel coronary artery disease who had undergone OPCAB or CCABG.

  15. Patency rates and the role of newer grafts in coronary artery bypass grafting.

    Rai, Mridula; Rustagi, Tarun


    Coronary artery bypass grafting (CABG) was one of major surgical advances of the 20th century and it has proven to be one of the most effective and long-lasting therapies in the treatment of ischemic heart disease. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. We seek to review the emerging role and patency rates of newer arterial grafts in comparison with the traditional saphenous vein grafts.

  16. Study of cross-linking process in grafted polyethylene and ethylene based copolymer using a phase resolved photoacoustic method

    Dias, D. T.; Medina, A. N.; Baesso, M. L.; Bento, A. C.; Porto, M. F.; Muniz, E. C.; Rubira, A. F.


    In this work, the phase resolved photoacoustic method has been employed to monitor water saturated vapor cross linking in both copolymer and grafted polyethylene. The overtone bands and stretching frequencies combinations of the -Si-OH, =CH2, -CH3, and -CH2-CH3 were monitored and analyzed accordingly to a 32 factorial design with nine samples. The results showed that the cross-linking processes were more efficient when the samples were prepared at 80 °C with the catalyst in the concentration range between 3% and 5% for grafted PE, while 70 °C was the best temperature to obtain copolymer.

  17. Synthesis of Graft Copolymers Based on Poly(2‐Methoxyethyl Acrylate) and Investigation of the Associated Water Structure

    Javakhishvili, Irakli; Tanaka, Masaru; Ogura, Keiko;


    Graft copolymers composed of poly(2‐methoxyethyl acrylate) are prepared employing controlled radical polymerization techniques. Linear backbones bearing atom transfer radical polymerization (ATRP) initiating sites are obtained by reversible addition–fragmentation chain transfer copolymerization...... of 2‐methoxyethyl acrylate (MEA) and 2‐(bromoisobutyryloxy)ethyl methacrylate (BriBuEMA) as well as 2‐hydroxyethyl methacrylate and BriBuEMA in a controlled manner . MEA is then grafted from the linear macroinitiators by Cu (I)‐mediated ATRP. Fairly high molecular weights (>120 000 Da) and low...

  18. Design of cationic graft copolymers as a potential inducer of B-Z transition.

    Shimada, Naohiko; Kano, Arihiro; Maruyama, Atsushi


    Biological roles of transition from B form to Z form of DNA (B-Z transition) have recently received attention. The B-Z transition was also employed as driving machinery of a nano-mechanical DNA device. However, there are little reports of effective inducer of the B-Z transition. We previously reported that poly((L)-Lysine)-graft-dextran induces B-Z transition and grafted dextran plays an important role for the B-Z transition. In this report, we designed cationic graft copolymer as a potential inducer of B-Z transition. Series of the copolymers consisting of poly((L)-Lysine) backbone and abundant of dextran (Dex) or poly(ethylene glycol) (PEG) side chains were prepared. The B-Z transition of poly(dG-dC)/Poly(dG-dC) were observed in the presence of these copolymers. The copolymers having higher content of Dex or PEG effectively induced the B-Z transition compared to that having lower content. The result indicated that not only electrostatic interaction between DNA and the poly((L)-Lysine) backbone but also hydrophilic graft chains play a role for the B-Z transition. We speculated that Dex- or PEG-enriched environment is favorable for Z form.

  19. Graft polymerization of styrene initiated by covalently bonded peroxide groups on silica.

    Bachmann, Stefan; Wang, Hongyu; Albert, Klaus; Partch, Richard


    The graft polymerization of styrene initiated by immobilized peroxide groups was investigated. Three different types of modification reactions were used to introduce peroxide groups which are directly attached onto the surface of two different silica supports. Silanol groups were chlorinated using thionyl chloride or tetrachlorosilane. In another reaction pathway 1,3,5-benzenetricarbonyl chloride enabled the introduction of free acid chloride residues bonded onto the surface of silica. tert-Butyl hydroperoxide (TBHP) was used to transform the chlorosilyl and the acid chloride groups into peroxide residues. In a further reaction step the covalently bonded peroxides initiated the polymerization of styrene to form grafted polystyrene directly attached onto the silica support. Solid-state 13C CP/MAS NMR spectroscopy, and thermogravimetric and scanning electron microscope measurements enabled a clear structure and property elucidation of the different bonded phases. The highest amount of grafted polystyrene was achieved employing the acid chloride synthesis pathway with silica-gel, whereas modification of spherical silica only led to minor amounts of grafted polymer. The results contribute to the evolving need to understand particle surface modifications and may have positive impact on development of new HPLC stationary phases for improved elutant resolution.

  20. Nitroxide mediated and atom transfer radical graft polymerization of atactic polymers onto syndiotactic polystyrene

    M. Abbasian


    Full Text Available 'Living' radical graft polymerization was employed to prepare graft copolymers with nitroxide-mediated arylated syndiotactic polystyrene as the backbone and polystyrene (PS, poly(p-methylstyrene (PMS and poly(methylmethacrylate (PMMA as branches. A two-stage process has been developed to synthesize the macroinitiator. First, syndiotactic polystyrene (sPS was modified by the Friedel-Crafts reaction to introduce chlorine; second, the chlorine groups were converted to nitroxide mediated groups by coupling with 1-hydroxy-2,2,6,6-tetramethyl-1-piperidinyloxy (TEMPO-OH. The resulting macroinitiator (sPS-TEMPO for 'living' free radical polymerization was then heated in the presence of styrene and p-methylstyrene to form graft and block copolymers. We used the obtained copolymer and N-bromosuccinimide as brominating agent to achieve polymers with bromine groups. This brominated copolymer was used as a macroinitiator for polymerizing methyl methacrylate in the presence of the CuBr/bpy catalyst system. The formation of the graft and block copolymers was confirmed by DSC, ¹H NMR and FTIR spectroscopy. This approach using macroinitiators is an effective method for the preparation of new materials.

  1. Nitroxide mediated and atom transfer radical graft polymerization of atactic polymers onto syndiotactic polystyrene

    Abbasian, M. [Department of Basic Science, Payame Noor University, Tehran (Iran, Islamic Republic of); Shoja, S. Esmaeily [Lab. of Materials, Faculty of Engineering, Islamic Azad University, Bonab (Iran, Islamic Republic of)


    'Living' radical graft polymerization was employed to prepare graft copolymers with nitroxide mediated arylated syndiotactic polystyrene as the backbone and polystyrene (PS), poly(p-methylstyrene) (PMS) and poly(methylmethacrylate) (PMMA) as branches. A two-stage process has been developed to synthesize the macroinitiator. First, syndiotactic polystyrene (sPS) was modified by the Friedel-Crafts reaction to introduce chlorine; second, the chlorine groups were converted to nitroxide mediated groups by coupling with 1-hydroxy-2,2,6,6-tetramethyl-1-piperidinyloxy (TEMPO-OH). The resulting macroinitiator (sPSTEMPO) for 'living' free radical polymerization was then heated in the presence of styrene and pmethylstyrene to form graft and block copolymers. We used the obtained copolymer and N-bromosuccinimide as brominating agent to achieve polymers with bromine groups. This brominated copolymer was used as a macroinitiator for polymerizing methyl methacrylate in the presence of the CuBr/bpy catalyst system. The formation of the graft and block copolymers was confirmed by DSC, {sup 1}H NMR and FTIR spectroscopy. This approach using macroinitiators is an effective method for the preparation of new materials. (author)

  2. Water transport and clustering behavior in homopolymer and graft copolymer polylactide

    Du, An; Koo, Donghun; Theryo, Grayce; Hillmyer, Marc A.; Cairncross, Richard A. (Drexel); (UMM)


    Polylactide is a bio-based and biodegradable polymer well-known for its renewable origins. Water sorption and clustering behavior in both a homopolymer polylactide and a graft copolymer of polylactide was studied using the quartz crystal microbalance/heat conduction calorimetry (QCM/HCC) technique. The graft copolymer, poly(1,5-cyclooctadiene-co-5-norbornene-2-methanol-graft-D,L-lactide), contained polylactide chains (95 wt.%) grafted onto a hydrophobic rubbery backbone (5 wt.%). Clustering is an important phenomenon in the study of water transport properties in polymers since the presence of water clusters can affect the water diffusivity. The HCC method using the thermal power signals and Van't Hoff's law were both employed to estimate the water sorption enthalpy. Sorption enthalpy of water in both polymers was determined to be approximately -40 kJ/mol for all water activity levels. Zimm-Lundberg analysis showed that water clusters start to form at a water activity of 0.4. The engaged species induced clustering (ENSIC) model was used to curve fit sorption isotherms and showed that the affinity among water molecules is higher than that between water molecules and polymer chains. All the methods used indicate that clustering of water molecules exists in both polymers.

  3. Electrical Properties of n-Butyl Acrylate-Grafted Polyethylene

    Lee, C.R.; Oh, W.J.; Suh, K.S. [Korea University (Korea, Republic of)


    The electrical properties of n-butyl acrylate-grafted polyethylene (PE-g-nBA) were investigated. In PE-g-nBA, hetero charge founded in LDPE slightly increased due to the nBA grafting. Conduction currents decreased with the increase of nBA graft ratio. AC breakdown strength increased and water treeing length decreased with the increase of graft ratio in PE-g-nBA. (author). 4 refs., 6 figs.

  4. Hemocompatibility of Chitosan/poly(acrylic acid) Grafted Polyurethane Tubing

    Lee, Hyun-Su; Tomczyk, Nancy; Kandel, Judith; Composto, Russell J.; Eckmann, David M.


    The activation and adhesion of platelets or whole blood exposed to chitosan (CH) grafted surfaces is used to evaluate the hemocompatibility of biomaterials. The biomaterial surfaces are polyurethane (PU) tubes grafted with an inner poly(acrylic acid) (PAA) and an outer CH or quaternary ammonium modified CH (CH-Q) brush. The CH, CH-Q and PAA grafted layers were characterized by ellipsometry and fluorescence microscopy. Material wear tests demonstrate that CH (CH-Q) is stably grafted onto PU tu...

  5. Striatal grafts in a rat model of Huntington's disease

    Guzman, R; Meyer, M; Lövblad, K O;


    Survival and integration into the host brain of grafted tissue are crucial factors in neurotransplantation approaches. The present study explored the feasibility of using a clinical MR scanner to study striatal graft development in a rat model of Huntington's disease. Rat fetal lateral ganglionic...... eminences grown as free-floating roller-tube cultures can be successfully grafted in a rat Huntington model and that a clinical MR scanner offers a useful noninvasive tool for studying striatal graft development....

  6. Plasma Induced Grafting of PMMA onto Titanium Dioxide Powder

    Zhong Shaofeng; Meng Yuedong; Ou Qiongrong; Xu Xu


    Grafting of polymer of methyl methacrylate (PMMA) onto titanium dioxide powder is investigated in this paper. The graft polymerization reaction is induced by dielectric-barrierdischarge produced N2 plasma treatment of titanium dioxide surfaces. IR, XPS and TGA results show that PMMA is grafted onto the surfaces of titanium dioxide powder. And crystal structure of the titanium dioxide powder observed with XRD spectra is unchanged after plasma graft polymerization.

  7. Health effects and time course of particulate matter on the cardiopulmonary system in rats with lung inflammation

    Ulrich, M.M.W.; Alink, G.M.; Kumarathasan, P.; Vincent, R.; Boere, A.J.F.; Cassee, F.R.


    Recent epidemiological studies associate health effects and particulate matter in ambient air. Exacerbation of the particle-induced inflammation can be a mechanism responsible for increased hospitalization and death due to cardiopulmonary events in high-risk groups of the population. Systems regulat



  9. Clinical Effectiveness of Centrifugal Pump to Produce Pulsatile Flow During Cardiopulmonary Bypass in Patients Undergoing Cardiac Surgery

    Gu, Y. John; van Oeveren, Willem; Mungroop, Hubert E.; Epema, Anne H.; den Hamer, Inez J.; Keizer, Jorrit J.; Leuvenink, Ron P.; Mariani, Massimo A.; Rakhorst, Gerhard


    Although the centrifugal pump has been widely used as a nonpulsatile pump for cardiopulmonary bypass (CPB), little is known about its performance as a pulsatile pump for CPB, especially on its efficacy in producing hemodynamic energy and its clinical effectiveness. We performed a study to evaluate w

  10. Acute and Subacute Effects of Urban Air Pollution on Cardiopulmonary Emergencies and Mortality: Time Series Studies in Austrian Cities

    Daniel Rabczenko


    Full Text Available Daily pollution data (collected in Graz over 16 years and in the Linz over 18 years were used for time series studies (GAM and case-crossover on the relationship with daily mortality (overall and specific causes of death. Diagnoses of patients who had been transported to hospitals in Linz were also available on a daily basis from eight years for time series analyses of cardiopulmonary emergencies. Increases in air pollutant levels over several days were followed by increases in mortality and the observed effects increased with the length of the exposure window considered, up to a maximum of 15 days. These mortality changes in Graz and Linz showed similar patterns like the ones found before in Vienna. A significant association of mortality could be demonstrated with NO2, PM2.5 and PM10 even in summer, when concentrations are lower and mainly related to motor traffic. Cardiorespiratory ambulance transports increased with NO2/PM2.5/PM10 by 2.0/6.1/1.7% per 10 µg/m³ on the same day. Monitoring of NO2 (related to motor traffic and fine particulates at urban background stations predicts acute effects on cardiopulmonary emergencies and extended effects on cardiopulmonary mortality. Both components of urban air pollution are indicators of acute cardiopulmonary health risks, which need to be monitored and reduced, even below current standards.

  11. Comparative Cardiopulmonary Toxicity of exhausts from Soy-Based Biofuels and Diesel in Healthy and Hypertensive Rats

    Increased use of renewable energy sources raise concerns about health effects of new emissions. We analyzed relative cardiopulmonary health effects of exhausts from (1) 100% soy biofuel (B100), (2) 20% soy biofuel + 80% low sulfur petroleum diesel (B20), and (3) 100% petroleum di...

  12. An In Vitro Model for Studying Neutrophil Activation During Cardiopulmonary Bypass by Using a Polymerase Chain Reaction Thermocycler

    Tang, Min; Zhao, Xiao-Gang; Gu, Y. John; Chen, Chang-Zhi


    The accurate temperature control of a polymerase chain reaction (PCR) thermocycler was exploited in developing an in vitro model to study neutrophil activation during cardiopulmonary bypass. Neutrophils from 12 volunteers underwent temperature changes in a PCR thermocycler (37 degrees C for 30 minut

  13. Platelet Function in Stored Heparinised Autologous Blood Is Not Superior to in Patient Platelet Function during Routine Cardiopulmonary Bypass

    Huet, Rolf C. G. Gallandat; de Vries, Adrianus J.; Cernak, Vladimir; Lisman, Ton


    Background: In cardiac surgery, cardiopulmonary bypass (CPB) and unfractionated heparin have negative effects on blood platelet function. In acute normovolemic haemodilution autologous unfractionated heparinised blood is stored ex-vivo and retransfused at the end of the procedure to reduce (allogene

  14. Efficacy analysis of intravenous thrombolysis after cardiopulmonary resuscitation for patients with acute myocardial infarction and cardiac arrest



    Objective To explore the clinical value of intravenous thrombolysis in the treatment of patients with acute myocardial infarction(AMI)and cardiac arrest after cardiopulmonary resuscitation.Methods 120 patients with AMI and cardiac arrest admitted in our hospital from Mar2009 to Mar 2013 were divided into thrombolytic group(n=50)and control group(n=70)according to the

  15. High-Dose Intravenous Methylprednisolone for Hantavirus Cardiopulmonary Syndrome in Chile: A Double-Blind, Randomized Controlled Clinical Trial

    Vial, Pablo A.; Valdivieso, Francisca; Ferres, Marcela; Riquelme, Raul; Rioseco, M. Luisa; Calvo, Mario; Castillo, Constanza; Díaz, Ricardo; Scholz, Luis; Cuiza, Analia; Belmar, Edith; Hernandez, Carla; Martinez, Jessica; Lee, Sang-Joon; Mertz, Gregory J.


    We conducted a double-blind, placebo-controlled clinical trial to evaluate the efficacy of intravenous methylprednisolone for hantavirus cardiopulmonary syndrome in Chile between 2003 and 2010. Sixty of 66 enrollees had hantavirus confirmed. We observed no significant difference in primary efficacy or safety outcomes between the groups.

  16. Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

    McCaul, Conán


    Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.


    Rubina Khan; Tazin Aziz Chaudhury


    Abstract: This paper presents a brief summary of a study which was carried out to investigate how employers representing major employment sectors in the Bangladeshi Industry view the skills and English proficiency level of the current employees. Opinions were also solicited on what skills are required for fresh recruits. Semi-structured interviews were conducted with 30 employers representing the major employment sectors in Bangladeshi Industry. Results revealed the importance of English as a...

  18. Revascularisation of fresh compared with demineralised bone grafts in rats

    Solheim, E; Pinholt, E M; Talsnes, O


    Revascularisation of bone grafts is influenced by both the anatomical origin and the pre-implantation processing of the graft. We investigated the revascularisation by entrapment of 141Ce (cerium)-labelled microspheres in large, fresh and demineralised syngeneic grafts of predominantly cancellous...




    Collagen-based skin substitutes are among the most promising materials to improve regeneration of full-thickness wounds. However, additional meshed grafts or cultured epidermal grafts are still required to create epidermal regeneration. To avoid this, we substituted collagen-based split grafts, i.e.

  20. Superhydrophobic bio-fibre surfaces via tailored grafting architecture.

    Nyström, Daniel; Lindqvist, Josefina; Ostmark, Emma; Hult, Anders; Malmström, Eva


    Superhydrophobic bio-fibre surfaces with a micro-nano-binary surface structure have been achieved via the surface-confined grafting of glycidyl methacrylate, using a branched "graft-on-graft" architecture, followed by post-functionalisation to obtain fluorinated brushes.




    To evaluate the potential of a supporting, compliant, biodegradable prosthesis to function as a temporary protective scaffold for autologous vein grafts in the arterial circulation, we implanted vein grafts into the carotid arteries of rabbits, either with (composite grafts) or without (control graf

  2. 21 CFR 872.3930 - Bone grafting material.


    ...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3930 Bone grafting material. (a) Identification... “Class II Special Controls Guidance Document: Dental Bone Grafting Material Devices.” (See § 872.1(e) for... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bone grafting material. 872.3930 Section...

  3. Primary Adenocarcinoma in an Oesophageal Gastric Graft – Case Report

    Dranka-Bojarowska Daria


    Full Text Available Primary adenocarcinoma in the esophageal gastric graft is a rare complication diagnosed in patients with long-term survival. Most data concerning the diagnosis and treatment of patients with metachronic cancer in esophageal grafts is derived from Japan and South Korea. The diagnosis of cancer in esophageal gastric grafts in the European countries is rare.

  4. Disability and Supported Employment: Impact on Employment, Income, and Allowances

    Germundsson, Per; Gustafsson, Johanna; Lind, Martin; Danermark, Berth


    In this article, we examine supported employment and its impact on the level of employment, disposable income, and sum of allowances, targeting a group of individuals with disabilities. We have particularly focused on individuals with psychiatric disabilities. Supported employment is a vocational rehabilitation service with an empowerment approach…

  5. A Conceptual Understanding of Employability: The Employers' View in Rwanda

    Bamwesiga, Penelope Mbabazi


    Many governments believe that investing in human capital should increase citizens' employability, which is why it is often presented as a solution to the problems of knowledge-based economies and societies, rising unemployment rates and economic competiveness. The aim of this study is to understand employers' views regarding the employability of…

  6. Preparation and Mechanical Properties of Solid-phase Grafting Nanocomposites of PVC/Graft Copolymers/MMT

    ZHOU Dunbai; CAI Changgen; JIA Demin


    In order to improve the mechanical properties of PVC, by solid-phase grafting reaction, grafting on and nano-modifying the PVC process synchronously, acrylic monomers not only graft on PVC, but also are intercalated into the layers of MMT in the heating process. Blending PVC and the MMT-PVC grafting copolymers, we can get nanocomposites of PVC/ grafters/ MMT, and the mechanical performance of the material is improved.

  7. Activation of NTS A(1) adenosine receptors inhibits regional sympathetic responses evoked by activation of cardiopulmonary chemoreflex.

    Ichinose, Tomoko K; Minic, Zeljka; Li, Cailian; O'Leary, Donal S; Scislo, Tadeusz J


    Previously we have shown that adenosine operating via the A(1) receptor subtype may inhibit glutamatergic transmission in the baroreflex arc within the nucleus of the solitary tract (NTS) and differentially increase renal (RSNA), preganglionic adrenal (pre-ASNA), and lumbar (LSNA) sympathetic nerve activity (ASNA>RSNA≥LSNA). Since the cardiopulmonary chemoreflex and the arterial baroreflex are mediated via similar medullary pathways, and glutamate is a primary transmitter in both pathways, it is likely that adenosine operating via A(1) receptors in the NTS may differentially inhibit regional sympathetic responses evoked by activation of cardiopulmonary chemoreceptors. Therefore, in urethane-chloralose-anesthetized rats (n = 37) we compared regional sympathoinhibition evoked by the cardiopulmonary chemoreflex (activated with right atrial injections of serotonin 5HT(3) receptor agonist phenylbiguanide, PBG, 1-8 μg/kg) before and after selective stimulation of NTS A(1) adenosine receptors [microinjections of N(6)-cyclopentyl adenosine (CPA), 0.033-330 pmol/50 nl]. Activation of cardiopulmonary chemoreceptors evoked differential, dose-dependent sympathoinhibition (RSNA>ASNA>LSNA), and decreases in arterial pressure and heart rate. These differential sympathetic responses were uniformly attenuated in dose-dependent manner by microinjections of CPA into the NTS. Volume control (n = 11) and blockade of adenosine receptor subtypes in the NTS via 8-(p-sulfophenyl)theophylline (8-SPT, 1 nmol in 100 nl) (n = 9) did not affect the reflex responses. We conclude that activation of NTS A(1) adenosine receptors uniformly inhibits neural and cardiovascular cardiopulmonary chemoreflex responses. A(1) adenosine receptors have no tonic modulatory effect on this reflex under normal conditions. However, when adenosine is released into the NTS (i.e., during stress or severe hypotension/ischemia), it may serve as negative feedback regulator for depressor and sympathoinhibitory reflexes

  8. Complications in skin grafts when continuing antithrombotic therapy prior to cutaneous surgery requiring skin grafting

    Jarjis, Reem Dina; Jørgensen, Lone; Finnerup, Kenneth


    studies were of prospective and retrospective design. Most of the reviewed studies suggest that the use of antithrombotic therapy can increase the risk of bleeding complications in skin grafts. These complications are only wound threatening and not life threatening. Therefore, this is of concern mostly...... in terms of hemostasis by the surgeon and good pressure dressings. Care should be taken when operating on anticoagulated patients undergoing cutaneous surgery requiring skin grafting. However, graft failure is rare and, given the risk of thrombotic events, the reviewed studies recommend continuing all......Abstract The risk of postoperative bleeding and wound healing complications in skin grafts among anticoagulated patients undergoing cutaneous surgery has not been firmly established. The objective was to examine the literature and assess the risk of postoperative bleeding or wound healing...

  9. A decision tree for soft tissue grafting.

    Leong, Daylene Jack-Min; Wang, Hom-Lay


    Periodontal plastic surgery is commonly performed for esthetic and physiologic reasons, such as alleviating root sensitivity, root caries, and cervical abrasion and facilitating plaque control at the affected site. Currently, there is a lack of information regarding the most appropriate treatment method for the various clinical situations encountered. The aims of this paper are to review and discuss the various clinical situations that require soft tissue grafting and to attempt to provide recommendations for the most predictable technique. Using MEDLINE and The Cochrane Library, a review of all available literature was performed. Papers published in peer-reviewed journals written in English were chosen and reviewed to validate the decision-making process when planning for soft tissue grafting. A decision tree was subsequently developed to guide clinicians to choose the most appropriate soft tissue grafting procedure by taking into consideration the following clinical parameters: etiology, purpose of the procedure, adjacent interproximal bone level, and overlying tissue thickness. The decision tree proposed serves as a guide for clinicians to select the most appropriate and predictable soft tissue grafting procedure to minimize unnecessary mistakes while providing the ultimate desired treatment outcome.

  10. Tissue Engineering: Creating Living Cardiovascular Grafts

    Muylaert, D.E.P.


    When heart valves or coronary arteries fail, the surgical implantation of a replacement structure can be a life-saving operation. Right now, replacement vessels for bypass grafting are harvested from the leg or chest of the patient, which is an additional and invasive procedure. Similarly, heart val

  11. Polyethylene glycol-grafted polystyrene particles

    Meng, Fenghua; Engbers, Gerard H.M.; Feijen, Jan


    Densely pegylated particles that can serve as a model system for artificial cells were prepared by covalently grafting amino polyethylene glycol (PEG, molecular weight 3400 or 5000) onto carboxyl polystyrene particles (PS-COOH) using carbodiimide chemistry. PEG-modified particles (PS-PEG) were chara

  12. Endothelialized ePTFE Graft by Nanobiotechnology


    The Apparatus for Processing the Tubular Graft Modification Will be Designed and Evaluated.; The On-site Capturing of the Endothelial (Progenitor) Cells by Peptide-mediated Selective Adhesion in Vitro and in Vivo Will Also be Elucidated.; The Patency Rate of ITRI-made Artificial Blood Vessels Will be Evaluated by the Porcine Animal Model.

  13. Cellular grafts in management of leucoderma

    Mysore Venkataram


    Full Text Available Cellular grafting methods constitute important advances in the surgical management of leucoderma. Different methods such as noncultured epidermal suspensions, melanocyte cultures, and melanocyte-keratinocyte cultures have all been shown to be effective. This article reviews these methods.

  14. Grafted silane monolayers: reconsideration of growth mechanisms

    Ivanov, D. A.; Nysten, B.; Jonas, A. M.; Legras, R.


    Chemical force microscopy is a new technique devised to image chemical heterogeneities on surfaces. It requires the chemical modification of Atomic Force Microscopy (AFM) tips in order to create chemical probes. In this respect, self-assembled monolayers (SAM) of alkylchlorosilanes are particularly interesting as modifying agents for AFM tips. We report here our results on the kinetics of silanization and on the structure of such SAM's grafted on model surfaces (hydroxylated Si(100) wafers). AFM, contact angle measurements, X-ray reflectivity and X-ray photoelectron spectroscopy were used to characterize SAM's of octadecyltrichlorosilane (OTS) and octadecyldimethylchlorosilane (ODMS) grown from hexadecane and toluene solutions. The mechanism of grafting of OTS follows two stages. The first rapid stage corresponds to the nucleation and growth of island-like monolayer domains. The second slower stage is related to the densification of the monolayer. SAM's of ODMS were found to form thinner layers as compared to OTS, due to their lower grafting density probably resulting in a more disordered state of grafted alkyl chains. We also address the problems concerning the relationships between the quality of final SAM structures and the water content as well as the nature of the solvent used for silanization.

  15. Naevus depiomentosus treated with suction blister grafting

    Ravikumar B


    Full Text Available Naevus depigmentosus is a congenital hypomelanotic condition in which the off white lesions are permanent and cosmetically embarassing. There has been no effective treatment reported so for for this condition. Here we are reporting a patient of naevus depigmentosus on whom we performed suction blister grafting and the resultant pigmentation was satisfactory

  16. Dynamics of solvent-free grafted nanoparticles

    Chremos, Alexandros


    The diffusivity and structural relaxation characteristics of oligomer-grafted nanoparticles have been investigated with simulations of a previously proposed coarse-grained model at atmospheric pressure. Solvent-free, polymer-grafted nanoparticles as well as grafted nanoparticles in a melt were compared to a reference system of bare (ungrafted) particles in a melt. Whereas longer chains lead to a larger hydrodynamic radius and lower relative diffusivity for grafted particles in a melt, bulk solvent-free nanoparticles with longer chains have higher relative diffusivities than their short chain counterparts. Solvent-free nanoparticles with short chains undergo a glass transition as indicated by a vanishing diffusivity, diverging structural relaxation time and the formation of body-centered-cubic-like order. Nanoparticles with longer chains exhibit a more gradual increase in the structural relaxation time with decreasing temperature and concomitantly increasing particle volume fraction. The diffusivity of the long chain nanoparticles exhibits a minimum at an intermediate temperature and volume fraction where the polymer brushes of neighboring particles overlap, but must stretch to fill the interparticle space. © 2012 American Institute of Physics.

  17. Femoral revision surgery with impaction bone grafting

    B.L.E.F. ten Have (Bas); R.W. Brouwer (Reinoud); F.C. van Biezen (Frans); J.A.N. Verhaar (Jan)


    textabstractThe purpose of this prospective study was to evaluate the long-term clinical and radiological outcomes of revision of the femoral component of a total hip replacement using impaction bone grafting. Femoral revision with an impacted allograft was performed on 29 patients (31 hips). In all

  18. Experimental vascular graft for liver transplantation

    Kobori, L; Nemeth, T; Nemes, B; Dallos, G; Sotonyi, P; Fehervari, [No Value; Patonai, A; Slooff, MJH; Jaray, J; De Jong, KP


    Hepatic artery thrombosis is a major cause of graft failure in liver transplantation. Use of donor interponates are common, but results are controversial because of necrosis or thrombosis after rejection. Reperfusion injury, hypoxia and free radical production determinate the survival. The aim of th

  19. Surface Grafting of Thermoresponsive Microgel Nanoparticles (Postprint)


    particles, made of temperature- responsive polymers, have been widely researched for carrying out separations, as substrates for bioreactors, for enzyme ...Corporation (Model PDC-32G) plasma cleaner /sterilizer was used in the current study to treat PVDF fibers and tungsten wires prior to the grafting. To

  20. Fatal Saccharomyces Cerevisiae Aortic Graft Infection

    Meyer, Michael (Technical Monitor); Smith, Davey; Metzgar, David; Wills, Christopher; Fierer, Joshua


    Saccharomyces cerevisiae is a yeast commonly used in baking and a frequent colonizer of human mucosal surfaces. It is considered relatively nonpathogenic in immunocompetent adults. We present a case of S. cerevisiae fungemia and aortic graft infection in an immunocompetent adult. This is the first reported case of S. cerevisiue fungemia where the identity of the pathogen was confirmed by rRNA sequencing.

  1. Skin flaps and grafts - self-care

    ... Regional flaps - self-care; Distant flaps - self-care; Free flap - self-care; Skin autografting - self-care; Pressure ulcer ... your wound To care for the graft or flap site: You may need to rest ... around it clean and free from dirt or sweat. DO NOT let the ...

  2. Nasal bone grafts from the removed hump used as overlay grafts to camouflage concave lateral crura.

    Kubilay, Utku; Erdogdu, Suleyman; Sezen, Ozan Seymen


    Alar cartilage consists of a medial crus, middle crus and lateral crus. The lateral crus is an important aesthetic and functional structure of the nose. A 32-year-old male patient with concave lateral crura was operated by the authors. An open rhinoplasty with a dorsal approach to the septum is preferred. The nasal bones harvested from the hump, which is an autogenous graft trimmed and sutured on both concave lateral crura as an overlay camouflage grafts. Satisfactory result was achieved.

  3. Noninvasive, near infrared spectroscopic-measured muscle pH and PO2 indicate tissue perfusion for cardiac surgical patients undergoing cardiopulmonary bypass

    Soller, Babs R.; Idwasi, Patrick O.; Balaguer, Jorge; Levin, Steven; Simsir, Sinan A.; Vander Salm, Thomas J.; Collette, Helen; Heard, Stephen O.


    OBJECTIVE: To determine whether near infrared spectroscopic measurement of tissue pH and Po2 has sufficient accuracy to assess variation in tissue perfusion resulting from changes in blood pressure and metabolic demand during cardiopulmonary bypass. DESIGN: Prospective clinical study. SETTING: Academic medical center. SUBJECTS: Eighteen elective cardiac surgical patients. INTERVENTION: Cardiac surgery under cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: A near infrared spectroscopic fiber optic probe was placed over the hypothenar eminence. Reference Po2 and pH sensors were inserted in the abductor digiti minimi (V). Data were collected every 30 secs during surgery and for 6 hrs following cardiopulmonary bypass. Calibration equations developed from one third of the data were used with the remaining data to investigate sensitivity of the near infrared spectroscopic measurement to physiologic changes resulting from cardiopulmonary bypass. Near infrared spectroscopic and reference pH and Po2 measurements were compared for each subject using standard error of prediction. Near infrared spectroscopic pH and Po2 at baseline were compared with values during cardiopulmonary bypass just before rewarming commenced (hypotensive, hypothermic), after rewarming (hypotensive, normothermic) just before discontinuation of cardiopulmonary bypass, and at 6 hrs following cardiopulmonary bypass (normotensive, normothermic) using mixed-model analysis of variance. Near infrared spectroscopic pH and Po2 were well correlated with the invasive measurement of pH (R2 =.84) and Po2 (R 2 =.66) with an average standard error of prediction of 0.022 +/- 0.008 pH units and 6 +/- 3 mm Hg, respectively. The average difference between the invasive and near infrared spectroscopic measurement was near zero for both the pH and Po2 measurements. Near infrared spectroscopic Po2 significantly decreased 50% on initiation of cardiopulmonary bypass and remained depressed throughout the bypass and

  4. Employment relations, flexibility and risk

    Jensen, Carsten Strøby

    Employment relations literature often distinguishes between social democratic/corporatist models of employment relations and liberal models of employment relations as they are seen as opposite or at least different ways of organizing labor markets. They are often characterized as having very...... different risk profiles in terms of relationships between employees, employers, and the state. Low levels of labor market regulation very often characterize the liberal models of employment relations as we know them from, for instance, the USA and the UK. This means that employment conditions are very often...... insecure and that the burden of unemployment risk mostly lies with the employees rather than the employer. Corporatist – or social democratic – employment relations models are, in contrast to the liberal models, often characterized by stricter regulation of the labor market and by high standards...

  5. Office of Disability Employment Policy

    ... OF LABOR Facebook Twitter RSS Email Office of Disability Employment Policy (ODEP) Menu About ODEP About ODEP ... Youth in Transition Publications for Order and Download Disability Statistics October 2016 Disability Employment Statistics Ages 16 ...

  6. Single-employer Pension Plans

    Pension Benefit Guaranty Corporation — This spreadsheet lists the active single-employer pensions plans insured by PBGC. Plans are identified by name, employer identification number (EIN) and plan number...

  7. Employability of nursing care graduates:

    Donik Barbara; Pajnkihar Majda; Bernik Mojca


    Starting points: In Slovenia, the higher education institution for nursing started exploring employability opportunities in nursing care in connection with the achievement of competencies from students and employers point of view. This article highlights the importance of monitoring nursing graduates employability. Its aim is to examine the employability of nursing care graduates based on the self-evaluation of competences obtained during the last study year and to establish a link between th...

  8. Infrarenal abdominal aortic aneurysm. Endovascular repair with stent grafts; Infrarenales Bauchaortenaneurysma. Endovaskulaere Stent-Graft-Therapie

    Wagner, M.; Voshage, G.; Landwehr, P. [Klinik fuer Diagnostische und Interventionelle Radiologie, Gefaesszentrum Hannover, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover (Germany); Busch, T. [Klinik fuer Gefaesschirurgie, Gefaesszentrum Hannover, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover (Germany)


    As an alternative to surgery, endovascular therapy with stent grafts has become the second main treatment option for infrarenal abdominal aortic aneurysms. Unlike surgery, endovascular treatment with stent grafts is also applicable in patients unfit for open repair. Despite current improvements in endovascular repair devices, significant anatomic barriers still exclude this technique for a large number of patients. Computed tomography, magnetic resonance imaging, and ultrasound are essential for diagnostics, preintervention planning, and postintervention follow-up of abdominal aneurysms treated with stent grafts. This review covers etiology, pathology, and diagnostic aspects. Materials and methods for endovascular treatment of abdominal aortic aneurysms are presented in detail, and clinical results and complications are discussed. (orig.) [German] Die endovaskulaere Therapie des infrarenalen Bauchaortenaneurysmas hat sich als Alternative zur offenen chirurgischen Versorgung etabliert. Im Gegensatz zu Letzterer ist die Aneurysmatherapie mittels Stent-Grafts auch bei schwerkranken, nicht operationsfaehigen Patienten moeglich, wobei der Nutzen kontrovers diskutiert wird. Im Gegensatz zur klassischen transabdominellen Operation ist die Stent-Graft-Technik anatomischen Einschraenkungen unterworfen, die aber kuenftig aufgrund bereits abzusehender technischer Weiterentwicklungen eine geringere Rolle spielen werden. Die Diagnostik, die Entscheidung fuer eine endovaskulaere Therapie, die praeinterventionelle Planung und die Nachsorge erfordern den Einsatz bildgebender Verfahren, v. a. der Computer- und Magnetresonanztomographie sowie der Sonographie. Die fuer die endovaskulaere Aneurysmabehandlung relevanten Aspekte der Diagnostik werden dargestellt. Auf die Technik, die Materialien, die Ergebnisse und die Komplikationen der Stent-Graft-Behandlung wird ausfuehrlich eingegangen. (orig.)

  9. Modulation of graft architectures for enhancing hydrophobic interaction of biomolecules with thermoresponsive polymer-grafted surfaces.

    Idota, Naokazu; Kikuchi, Akihiko; Kobayashi, Jun; Sakai, Kiyotaka; Okano, Teruo


    This paper describes the effects of graft architecture of poly(N-isopropylacrylamide) (PIPAAm) brush surfaces on thermoresponsive aqueous wettability changes and the temperature-dependent hydrophobic interaction of steroids in silica capillaries (I.D.: 50 μm). PIPAAm brushes were grafted onto glass substrates by surface-initiated atom transfer radical polymerization (ATRP) that is one of the living radical polymerization techniques. Increases in the graft density and chain length of PIPAAm brushes increased the hydration of polymer brushes, resulting in the increased hydrophilic properties of the surface below the transition temperature of PIPAAm at 32 °C. More hydrophobic surface properties were also observed on surfaces modified with the block copolymers of IPAAm and n-butyl methacrylate (BMA) than that with IPAAm homopolymer-grafted surfaces over the transition temperature. Using PBMA-b-PIPAAm-grafted silica capillaries, the baseline separation of steroids was successfully achieved by only changing temperature. The incorporation of hydrophobic PBMA chains in grafted PIPAAm enhanced the hydrophobic interaction with testosterone above the transition temperature. The surface modification of hydrophobicity-enhanced thermoresponsive polymers is a promising method for the preparation of thermoresponsive biointerfaces that can effectively modulated their biomolecule and cell adsorption with the wide dynamic range of hydrophilic/hydrophobic property change across the transition temperature.

  10. Fluxometria da artéria torácica interna esquerda na revascularização da artéria descendente anterior com e sem circulação extracorpórea Flowmetry of left internal thoracic artery graft to left anterior descending artery: comparison between on-pump and off-pump surgery

    Filinto Marques de Cerqueira Neto


    Full Text Available INTRODUÇÃO: A cirurgia de revascularização do miocárdio (RM sem circulação extracorpórea (CEC é uma técnica amplamente utilizada. A fluxometria coronariana é a técnica mais usada para avaliação dos enxertos, porém, poucos estudos comparam os dados fluxométricos na RM com e sem CEC. O objetivo deste estudo foi comparar as variáveis fluxométricas dos enxertos de artéria torácica interna esquerda para a artéria descendente anterior em pacientes submetidos à RM com e sem CEC. MÉTODOS: Entre março e setembro de 2010, foram analisados retrospectivamente 35 pacientes consecutivos, não randomizados, submetidos à RM. Foram alocados 10 pacientes no grupo A (com CEC e 25 no grupo B (sem CEC. O fluxo médio do enxerto (FME, o índice pulsátil (PI e a porcentagem de enchimento diastólico (ED foram obtidos por meio da fluxometria por tempo de trânsito. Foi utilizado o teste exato de Fisher e Mann-Whitney, sendo considerado estatisticamente significante PBACKGROUND: Off-pump coronary bypass grafting (OPCAB has become a widely used technique. Coronary flowmetry is the most common method employed to assess graft patency, nevertheless, few studies compare flow patterns between ONCAB and OPCAB surgery. The objective of this study was to compare flowmetry data in left internal mammary artery grafts bypasses to the left anterior descendent artery. METHODS: From March to September of 2010, thirtyfive consecutive, non-randomized patients underwent CABG and were retrospectively evaluated. Ten patients were located on group A (On Pump, and twenty-five on group B (Off Pump. The mean graft flow (MGF, pulsatile index (PI and diastolic filling (DF were obtained using Transit Time Flowmetry (TTFM. The Fisher exact test, and Mann Whitney test were used, and a P value of < 0.05 was considered to indicate statistical significance. RESULTS: There were no deaths, AMI, re-interventions or PTCA in a 30-day period. The number of bypasses performed per

  11. Poly(amide-graft-acrylate) interfacial compounds

    Zamora, Michael Perez

    Graft copolymers with segments of dissimilar chemistries have been shown to be useful in a variety of applications as surfactants, compatibilizers, impact modifiers, and surface modifiers. The most common route to well defined graft copolymers is through the use of macromonomers, polymers containing a reactive functionality and thus capable of further polymerization. However, the majority of the studies thus far have focused on the synthesis of macromonomers capable of reacting with vinyl monomers to form graft copolymers. This study focused on the synthesis of macromonomers capable of participating in condensation polymerizations. A chain transfer functionalization method was utilized. Cysteine was evaluated as a chain transfer agent for the synthesis of amino acid functionalized poly(acrylate) and poly(methacrylate) macromonomers. Low molar mass, functionalized macromonomers were produced. These macromonomers were proven to be capable of reacting with amide precursors to form poly(amide-g-acrylate) graft copolymers. Macromonomers and graft copolymers were characterized by gel permeation chromatography (GPC), Fourier transform infrared spectroscopy (FTIR), nuclear magnetic resonance (NMR) spectroscopy, elemental analysis (EA), inductively coupled plasma (ICP), and differential scanning calorimetry (DSC). The second part of this research involved poly(dimethacrylate) dental restorative materials. Volumetric shrinkage during the cure of these resins results in a poor interface between the resin and the remaining tooth structure, limiting the lifetime of these materials. Cyclic anhydrides were incorporated into common monomer compositions used in dental applications. Volume expansion from the ring opening hydrolysis of these anhydrides was shown to be feasible. The modified dental resins were characterized by swelling, extraction and ultraviolet spectroscopy (UV), and density measurements. Linear poLymers designed to model the crosslinked dental resins were

  12. Maternal employment and birth outcomes

    Wüst, Miriam

    selection of mothers between pregnancies drives the results, I focus on mothers whose change in employment status is likely not to be driven by underlying health (unemployed mothers and students). Given generous welfare bene ts and strict workplace regulations in Denmark, my findings support a residual...... explanation, namely, that exclusion from employment may stress mothers in countries with high-female employment rates....

  13. Employment Impact of Electronic Business.

    Hecker, Daniel E.


    Electronic business is stimulating employment in some sectors across industries, such as computer-related and customer service occupations, and diminishing employment in others, such as administrative support and marketing/sales. Similarly, employment impacts will vary by industry. (Contains 56 notes and references.) (SK)

  14. Prognostic value of electroencephalography (EEG) for brain injury after cardiopulmonary resuscitation.

    Feng, Guibo; Jiang, Guohui; Li, Zhiwei; Wang, Xuefeng


    Cardiac arrest (CA) patients can experience neurological sequelae or even death after successful cardiopulmonary resuscitation (CPR) due to cerebral hypoxia- and ischemia-reperfusion-mediated brain injury. Thus, it is important to perform early prognostic evaluations in CA patients. Electroencephalography (EEG) is an important tool for determining the prognosis of hypoxic-ischemic encephalopathy due to its real-time measurement of brain function. Based on EEG, burst suppression, a burst suppression ratio >0.239, periodic discharges, status epilepticus, stimulus-induced rhythmic, periodic or ictal discharges, non-reactive EEG, and the BIS value based on quantitative EEG may be associated with the prognosis of CA after successful CPR. As measures of neural network integrity, the values of small-world characteristics of the neural network derived from EEG patterns have potential applications.

  15. [Training program on cardiopulmonary resuscitation with the use of automated external defibrillator in a university].

    Boaventura, Ana Paula; Miyadahira, Ana Maria Kazue


    Early defibrillation in cardiopulmonary resuscitation (CPR) receives increasing emphasis on its priority and rapidity. This is an experience report about the implementation of a training program in CPR using a defibrillator in a private university. The training program in basic CPR maneuvers was based on global guidelines, including a theorical course with practical demonstration of CPR maneuvers with the defibrillator, individual practical training and theoretical and practical assessments. About the performance of students in the practical assessment the mean scores obtained by students in the first stage of the course was 26.4 points, while in the second stage the mean was 252.8 points, in the theoretical assessment the mean in the first stage was 3.06 points and in the second 9.0 points. The implementation of programs like this contribute to the effective acquisition of knowledge (theory) and skill (pratice) for the care of CPR victims.

  16. Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass

    Toft, P; Tønnesen, Else Kirstine; Zülow, I


    Open-heart surgery with cardiopulmonary bypass (CPB) and abdominal surgery are associated with lymphocytopenia. We measured a panel of adhesion and activation molecules on lymphocytes to clarify possible association of CPB with increased expression of these molecules. Eight patients undergoing open......-heart surgery and eight with abdominal surgery were studied. The adhesion molecules CD11a/CD18 (LFA-1_, CD11c/CD18 and CD44 and the activation molecules CD25, CD69, CD71 and MHCII were measured, using monoclonal antibodies and flow cytometry. Lymphocytopenia was observed during CPB and for some hours after both...... open-heart and abdominal surgery. The proportion of CD11a/CD18-positive lymphocytes rose from 67.6 +/- 8% to 86.4 +/- 3% after aortic declamping (p

  17. Continuation of cardiopulmonary resuscitation in a Chinese hospital after unsuccessful EMS resuscitation

    Xiao-Bo Yang; Yan Zhao; Fei Wang


    Objective To evaluate the efficacy of the continuation of cardiopulmonary resuscitation (CPR) following transportation to the emergency department in a Chinese hospital after unsuccessful emergency medical services (EMS) CPR. Methods From January 2002 to December 2007, emergency records of non-traumatic patients who were transported to a tertiary teaching hospital after unsuccessful EMS CPR were reviewed. Results Eigty-five patients were included, and 13 patients (15%) accomplished restoration of spontaneous circulation in our emergency department. Resuscitative possibility reached zero at around 23 minutes. One patient was discharged with a favourable neurologic outcome. Conclusions This study shows that the continuation of CPR is not futile and may improve outcomes. The outcomes should be re-evaluatad in the future when prehospital information can be combined with in-hospital information.

  18. Stenting of critical tracheal stenosis with adjuvant cardio-pulmonary bypass

    Himanshu Bhardwaj


    Full Text Available Severe and critical central airway obstruction causing impaired ventilation and/or oxygenation can impose tremendous challenges on the interventional pulmonologist. Near total airway obstruction can rapidly evolve into potentially fatal complete airway occlusion during bronchoscopic airway manipulation under moderate sedation; as well as during the induction of the general anesthesia. Although there are currently interventional pulmonary procedures available to tackle the critical airway obstruction in extreme situations, cardio-pulmonary bypass should be considered prior to the intervention to maintain the adequate gas exchange during the procedure. Orotracheal intubation with mechanical ventilation in this situation can be fatal itself if the obstructing airway lesion functions as a “one way valve” allowing air to follow distally during inspiration but impeding expiratory flow leading to gas trapping, high intrathoracic pressure, tension pneumothorax, and ultimately a cardiac arrest.

  19. What people with Down Syndrome can teach us about cardiopulmonary disease.

    Colvin, Kelley L; Yeager, Michael E


    Down syndrome is the most common chromosomal abnormality among live-born infants. Through full or partial trisomy of chromosome 21, Down syndrome is associated with cognitive impairment, congenital malformations (particularly cardiovascular) and dysmorphic features. Immune disturbances in Down syndrome account for an enormous disease burden ranging from quality-of-life issues (autoimmune alopecia) to more serious health issues (autoimmune thyroiditis) and life-threatening issues (leukaemia, respiratory tract infections and pulmonary hypertension). Cardiovascular and pulmonary diseases account for ∼75% of the mortality seen in persons with Down syndrome. This review summarises the cardiovascular, respiratory and immune challenges faced by individuals with Down syndrome, and the genetic underpinnings of their pathobiology. We strongly advocate increased comparative studies of cardiopulmonary disease in persons with and without Down syndrome, as we believe these will lead to new strategies to prevent and treat diseases affecting millions of people worldwide.

  20. Disseminating cardiopulmonary resuscitation training by distributing 35,000 personal manikins among school children

    Isbye, Dan L; Rasmussen, Lars S; Ringsted, Charlotte


    BACKGROUND: Because most cardiac arrests occur at home, widespread training is needed to increase the incidence of cardiopulmonary resuscitation (CPR) by lay persons. The aim of this study was to evaluate the effect of mass distribution of CPR instructional materials among schoolchildren. METHODS......,140 from the second tier (mean, 2.5 persons per pupil; 95% confidence interval, 2.4 to 2.5). The teachers had used a mean of 64 minutes (95% confidence interval, 60 to 68) for preparation and a mean of 13 minutes (95% confidence interval, 11 to 15) to tidy up. Incidence of bystander CPR in the months after...... the project did not increase significantly compared with the previous year (25.0% versus 27.9%; P=0.16). CONCLUSIONS: CPR training can be disseminated in a population by distributing personal resuscitation manikins among children in primary schools. The teachers felt able to easily facilitate CPR training...

  1. Differences in displayed pump flow compared to measured flow under varying conditions during simulated cardiopulmonary bypass.

    Hargrove, M


    Errors in blood flow delivery due to shunting have been reported to reduce flow by, potentially, up to 40-83% during cardiopulmonary bypass. The standard roller-pump measures revolutions per minute and a calibration factor for different tubing sizes calculates and displays flow accordingly. We compared displayed roller-pump flow with ultrasonically measured flow to ascertain if measured flow correlated with the heart-lung pump flow reading. Comparison of flows was measured under varying conditions of pump run duration, temperature, viscosity, varying arterial\\/venous loops, occlusiveness, outlet pressure, use of silicone or polyvinyl chloride (PVC) in the roller race, different tubing diameters, and use of a venous vacuum-drainage device.

  2. Management of a case of left tracheal sleeve pneumonectomy under cardiopulmonary bypass: Anesthesia perspectives

    Aman Jyoti


    Full Text Available The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB. Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization from the extensive vascular raw area left after pneumonectomy. Meticulous peri-operative planning and optimal post-operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.

  3. Some aspects of the mitochondrial oxidative metabolism in human atrial tissue during cardiopulmonary by-pass.

    Corbucci, G G; Gasparetto, A; Antonelli, M; Bufi, M; De Blasi, R A


    Following previous research on the hypoxic cell in human circulatory shock, the present work has investigated some mitochondrial oxidative aspects in atrial biopsies taken during cardiopulmonary by-pass. Cardioplegic solution and hypothermia were administered to 10 patients and the atrial samples were collected before and after aortic clamping. The results show a cellular protective effect of cardioplegia and hypothermia on the electron-transport chain, even if the enzymes with high KmO2 appear to be more sensitive to ischaemia. The results suggest a metabolic injury rather than an oxidative damage due to the induced ischaemia, alterations to fatty-acid beta-oxidation being especially notable. Because of the unchanged oxidative capacities, the oxyradical generation and the peroxidative damage appear to be irrelevant in the ischaemic period and during the course of reperfusion. Further studies are needed to elucidate the metabolic damage and the therapeutic implications due to the induced ischaemia in the myocardial cell during the aortic clamping.

  4. Canine and feline cardiopulmonary parasitic nematodes in Europe: emerging and underestimated.

    Traversa, Donato; Di Cesare, Angela; Conboy, Gary


    Cardiopulmonary nematodes of dogs and cats cause parasitic diseases of central relevance in current veterinary practice. In the recent past the distribution of canine and feline heartworms and lungworms has increased in various geographical areas, including Europe. This is true especially for the metastrongyloids Aelurostrongylus abstrusus, Angiostrongylus vasorum and Crenosoma vulpis, the filarioid Dirofilaria immitis and the trichuroid Eucoleus aerophilus (syn. Capillaria aerophila). The reasons of this emergence are little known but many drivers such as global warming, changes in vector epidemiology and movements in animal populations, may be taken into account. The purpose of this article is to review the knowledge of the most important heartworm and lungworm infections of dogs and cats in Europe. In particular recent advances in epidemiology, clinical and control are described and discussed.

  5. Histophilus somni biofilm formation in cardiopulmonary tissue of the bovine host following respiratory challenge

    Sandal, Indra; Shao, Jian Q.; Annadata, Satish


    Biofilms form in a variety of host sites following infection with many bacterial species. However, the study of biofilms in a host is hindered due to the lack of protocols for the proper experimental investigation of biofilms in vivo. Histophilus somni is an agent of respiratory and systemic...... diseases in bovines, and readily forms biofilms in vitro. In the present study the capability of H. somni to form biofilms in cardiopulmonary tissue following experimental respiratory infection in the bovine host was examined by light microscopy, transmission electron microscopy, immunoelectron microscopy...... haemagglutinin (FHA), predicted to be involved in attachment. Thus, this investigation demonstrated that H. somni is capable of forming a biofilm in its natural host, that such a biofilm may be capable of harboring other bovine respiratory disease pathogens, and that the genes responsible for biofilm formation...

  6. Analysis of red blood cell aggregation in cardio-pulmonary bypass (CPB) surgery.

    Graaff, R; Gu, Y J; Boonstra, P W; van Oeveren, W; Rakhorst, G


    Not much is known about red cell aggregation during cardio-pulmonary bypass surgery (CPB). Blood samples from 19 patients undergoing CPB were anticoagulated with EDTA. Hematocrit was adjusted to 40%. A red blood cell aggregometer (LORCA) measured changes in light reflection from each blood sample after cessation of the rotation, and calculated an aggregation index (AI). Reflection measurements were stored. Because LORCA software failed for 87 of 171 samples, we developed new software, and applied it to the stored reflection measurements. This software failed only in 7 out of 171 cases and showed that all LORCA failures occurred for AI CPB and recovered to 37.1 +/- 13.5 at day 1. It is concluded that the new software can be used to study decreased red cell aggregation during CPB.

  7. The quantitative and qualitative responses of platelets in pediatric patients undergoing cardiopulmonary bypass surgery.

    Ignjatovic, Vera; Than, Jenny; Summerhayes, Robyn; Newall, Fiona; Horton, Steve; Cochrane, Andrew; Monagle, Paul


    This prospective, single-center study aimed to evaluate the platelet response during cardiopulmonary bypass (CPB) surgery in a large cohort of children up to 6 years of age. Blood samples were drawn at four time points: after induction of anesthesia, after initiation of the CPB, before protamine, and immediately after chest closure. The study recruited 60 children requiring CPB for surgical repair of congenital heart defects. The platelet count decreased throughout CPB surgery, but during the same period, platelet activity increased. The more pronounced decrease in platelet count observed in children younger than 1 year compared with that of children 1 to 6 years of age was not associated with an age-specific change in platelet activity. The overall increase in platelet function observed in this study could provide a mechanism that compensates for the decrease in platelet count. This study provides a new foundation for future studies investigating requirements of platelet supplementation in the setting of pediatric CPB surgery.

  8. Canine and feline cardiopulmonary parasitic nematodes in Europe: emerging and underestimated

    Conboy Gary


    Full Text Available Abstract Cardiopulmonary nematodes of dogs and cats cause parasitic diseases of central relevance in current veterinary practice. In the recent past the distribution of canine and feline heartworms and lungworms has increased in various geographical areas, including Europe. This is true especially for the metastrongyloids Aelurostrongylus abstrusus, Angiostrongylus vasorum and Crenosoma vulpis, the filarioid Dirofilaria immitis and the trichuroid Eucoleus aerophilus (syn. Capillaria aerophila. The reasons of this emergence are little known but many drivers such as global warming, changes in vector epidemiology and movements in animal populations, may be taken into account. The purpose of this article is to review the knowledge of the most important heartworm and lungworm infections of dogs and cats in Europe. In particular recent advances in epidemiology, clinical and control are described and discussed.

  9. Pulmonary artery perfusion versus no pulmonary perfusion during cardiopulmonary bypass in patients with COPD

    Buggeskov, Katrine B; Sundskard, Martin M; Jonassen, Thomas;


    INTRODUCTION: Absence of pulmonary perfusion during cardiopulmonary bypass (CPB) may be associated with reduced postoperative oxygenation. Effects of active pulmonary artery perfusion were explored in patients with chronic obstructive pulmonary disease (COPD) undergoing cardiac surgery. METHODS: 90...... starting CPB and longitudinally in a mixed-effects model (MEM). Secondary outcomes were tracheal intubation time, serious adverse events, mortality, days alive outside the intensive care unit (ICU) and outside the hospital. RESULTS: 21 hours after starting CPB patients receiving pulmonary artery perfusion...... with normothermic oxygenated blood had a higher oxygenation index compared with no pulmonary perfusion (mean difference (MD) 0.94; 95% CI 0.05 to 1.83; p=0.04). The blood group had also a higher oxygenation index both longitudinally (MEM, p=0.009) and at 21 hours (MD 0.99; CI 0.29 to 1.69; p=0.007) compared...

  10. Psychophysiologic effects of Hatha Yoga on musculoskeletal and cardiopulmonary function: a literature review.

    Raub, James A


    Yoga has become increasingly popular in Western cultures as a means of exercise and fitness training; however, it is still depicted as trendy as evidenced by an April 2001 Time magazine cover story on "The Power of Yoga." There is a need to have yoga better recognized by the health care community as a complement to conventional medical care. Over the last 10 years, a growing number of research studies have shown that the practice of Hatha Yoga can improve strength and flexibility, and may help control such physiological variables as blood pressure, respiration and heart rate, and metabolic rate to improve overall exercise capacity. This review presents a summary of medically substantiated information about the health benefits of yoga for healthy people and for people compromised by musculoskeletal and cardiopulmonary disease.


    黄惠民; 丁文祥; 苏肇伉; 张伟忠


    The deficiency of platelet function is the main defect of hemostatic mechanism during cardiopulmonary bypass (CPB), which attributed to the postoperative bleeding complication to a great extent. The proteinase inhibitor aprotinin was reported to have preserving effect on platelet adhesion during CPB. In this clinical reserch we found that CPB caused plasma alpha 2-antiplasmin decreasing, indicating the fibrinolytic system activation. Meanwhile, the ristocetin-induced aggregation declined to 39.6% and platelet GPIb decreased to 50% of preoperative value. However, by treatment with aprotinin, the plasma alpha 2-antiplasmin during CPB did not change, platelet aggregation was improved and platelet GPIb was preserved, and consequently resulted in a 46% lower blood loss postoperatively. These results confirmed that aprotinin could inhibit the fibrinolysis during CPB, and thus relieve the platelet damage and improve the postoperative hemostatic mechanism.

  12. Superior Cardiac Function Via Anaplerotic Pyruvate in the Immature Swine Heart After Cardiopulmonary Bypass and Reperfusion

    Olson, Aaron; Hyyti, Outi M.; Cohen, Gordon A.; Ning, Xue-Han; Sadilek, Martin; Isern, Nancy G.; Portman, Michael A.


    Pyruvate produces inotropic responses in the adult reperfused heart. Pyruvate oxidation and anaplerotic entry into the citric acid cycle (CAC) via carboxylation are linked to stimulation of contractile function. The goals of this study were to determine if these metabolic pathways operate and are maintained in the developing myocardium after reperfusion. Immature male swine (age 10-18 days) were subjected to cardiopulmonary bypass (CPB). Intracoronary infusion of [2]-13C-pyruvate (to achieve a final concentration of 8 mM) was given for 35 minutes starting either during weaning (Group I), after discontinuation (Group II) or without (Control) CPB. Hemodynamic data was collected. 13C NMR spectroscopy was used to determine the fraction of pyruvate entering the CAC via pyruvate carboxylation (PC) to total CAC entry (PC plus decarboxlyation via pyruvate dehydrogenase). Liquid chromatography-mass spectrometry was used to determine total glutamate enrichment.

  13. Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass.

    Ševerdija, Ervin E; Vranken, Nousjka P A; Teerenstra, Steven; Ganushchak, Yuri M; Weerwind, Patrick W


    Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A total of 52 adult patients who underwent cardiac surgery using pulsatile CPB were included in this prospective explorative study. Cerebral tissue oxygen saturation (SctO2) was measured in both the left and right cerebral hemisphere. Intraoperative events, involving interventions performed by anesthesiologist, surgeon, and clinical perfusionist, were documented. Simultaneously, in-line hemodynamic parameters (partial oxygen pressure, partial carbon dioxide pressure, hematocrit, arterial blood pressure, and CPB flow rates) were recorded. Cerebral tissue saturation was affected by anesthetic induction (p retractor (p cardiac surgery. Future studies are needed to identify methods of mitigating periods of reduced cerebral saturation.

  14. What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools?

    Zinckernagel, Line; Malta Hansen, Carolina; Rod, Morten Hulvej;


    of the study was to explore barriers to implementation of CPR training in Danish secondary schools. DESIGN: A qualitative study based on individual interviews and focus groups with school leadership and teachers. Thematic analysis was used to identify regular patterns of meaning both within and across...... teachers acquired the CPR skills which they considered were needed. They considered CPR training to differ substantially from other teaching subjects because it is a matter of life and death, and they therefore believed extraordinary skills were required for conducting the training. This was mainly rooted......OBJECTIVE: Cardiopulmonary resuscitation (CPR) training in schools is recommended to increase bystander CPR and thereby survival of out-of-hospital cardiac arrest, but despite mandating legislation, low rates of implementation have been observed in several countries, including Denmark. The purpose...

  15. Humidity Sensing Properties of Pre-irradiation Grafted HDPE Membranes

    Zheng Jiao; Qun Fu; Xiang Geng; Zhen Li; Haijian Zhong


    Grafted high density polyethylene (HDPE) films have been prepared by grafting sodium styrene sulfonate (SSS) and acrylic acid (AA) onto HDPE using preirradiation method. The structure and surface morphology of both grafted and ungrafted HDPE films were observed by FTIR spectroscopy and scanning electron microscope (SEM), respectively. The humidity sensing properties of grafted HDPE films were investigated. The results show that the impedance of the film decreases with increasing of relative humidity (RH). The films display high sensitivity with nearly three orders of magnitude change in the resistance during the relative humidity variation from 5% to 98%. Grafted HDPE films exhibit excellent properties as humidity sensors.

  16. Stretch Polytetrafluoroethylene Grafts for Hemodialysis Angioaccess: Three-year Experience

    Al Dayel Adel


    Full Text Available We report the results of 90 stretch polytetrafluoroethylene (PTFE grafts in 78 chronic renal failure patients over a 3-year period from 1995-1998. The grafts were used as primary access in 15% of the patients. The cumulative patency was 63.3% and there were no complications in 48.8% of the cases. Infection was encountered in 15.5% and thrombosis in 31.1% of the grafts. Intimal hyperplasia, venous anastomotic stenosis, improper puncture technique and subclavian vein stenosis were the major causes of failure of grafts. We conclude that stretch PTFE grafts as angioaccesses may provide good patency and durability.

  17. Significance of the carboxyhemoglobin level for out-of-hospital cardiopulmonary arrest

    Youichi Yanagawa


    Full Text Available Background: At low concentrations, carbon monoxide (CO can confer cyto and tissue-protective effects, such as endogenous Heme oxygenase 1 expression, which has antioxidative, anti-inflammatory, antiproliferative, and antiapoptotic effects. The level of carboxyhemoglobin in the blood is an indicator of the endogenous production of CO and inhaled CO. Aim of study: To investigate the significance of the value of carboxyhemoglobin for out-of-hospital (OH cardiopulmonary arrest (CPA. Materials and Methods: This study involved a medical chart review of cases treated from January to December 2005. The inclusion criteria included a patient who was transported to this department due to an OH CPA. The exclusion criteria included a patient who did not undergo blood gas analysis on arrival and who experienced CPA due to acute carbon monoxide intoxication. The subjects were divided into two groups based on their final outcome of either survival or non-survival. Results: There was no significant difference associated with the sex, age, frequency of witness collapse, bystander cardiopulmonary arrest, electrocardiogram at scene, cause of CPA, value of PCO 2 , HCO3 - , and methemoglobin. The frequency of OH return of spontaneous circulation and the value of pH, PO 2 , base excess, and carboxyhemoglobin in the survival group were greater than those values in the non-survival group. There were no subjects whose carboxyhemoglobin level was 0% on arrival in the survival groups. Conclusion: There appeared to be an association between higher carboxyhemoglobin levels and survival in comparison with non-survival patients.

  18. Echocardiography integrated ACLS protocol versus con-ventional cardiopulmonary resuscitation in patients with

    Chardoli Mojtaba


    Full Text Available 【Abstract】Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA cardiac arrest and pre-dicting the resuscitation outcomes. Methods: In this prospective interventional study, pa-tients presenting with PEA cardiac arrest were randomized into two groups. In Group A, ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity, right ventricle dilation, left ventricle function, peri-cardial effusion/tamponade and IVC size along with the ad-vanced cardiac life support (ACLS protocol. Patients in Group B solely underwent ACLS protocol without applying echocardiography. The presence or absence of mechanical ventricular activity (MVA and evidences of PEA reversible causes were recorded. The return of spontaneous circulation (ROSC and death were evaluated in both groups. Results: One hundred patients with the mean age of (58±6.1 years were enrolled in this study. Fifty patients (Group A had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR. Among them, 7 pa-tients (14% had pericardial effusion, 11 (22% had hypovolemia, and 39 (78% were revealed the presence of MVA. In the pseudo PEA subgroup (presence of MVA, 43% had ROSC (positive predictive value and in the true PEA subgroup with cardiac standstill (absence of MVA, there was no recorded ROSC (negative predictive value. Among patients in Group B, no reversible etiology was detected. There was no significant difference in resuscitation results between Groups A and B observed (P=0.52. Conclusion: Bedside echocardiography can identify some reversible causes of PEA. However, there are no sig-nificant changes in survival outcome between the echo group and those with traditional CPR. Key words: Heart arrest; Echocardiography; Car-diopulmonary resuscitation

  19. Changes in cardiopulmonary variables and platelet count during anesthesia for total hip replacement in dogs.

    Otto, K; Matis, U


    Changes in cardiopulmonary function and platelet count were determined in 22 dogs of various breeds that underwent total hip replacement with cemented femoral prostheses. In 11 dogs (group I) polymethylmethacrylate (PMMA) was inserted without venting the reamed and lavaged femoral canal. In a second group of 11 dogs (group II) a urethral catheter (ID: approximately 2.7 mm) was placed into the medullary cavity before the insertion of PMMA. The application of PMMA resulted in a decrease in end-tidal carbon dioxide tension (PETCO2) until 5 minutes after insertion of bone cement. Increases in arterial to end-tidal pCO2 gradient [P(a-ET)CO2] and physiological dead space (VD/VT) were recorded between 2 minutes before and 5 minutes after insertion of PMMA in 12 dogs. A significant decrease in platelet count occurred in both groups of dogs. Decreases in arterial pO2 (PaO2), arterial/alveolar oxygen tension ratio (PaO2/PAO2), and percent O2 saturation of hemoglobin in arterial blood (SaO2) were not statistically significant. No significant differences could be detected between data obtained from both groups of dogs. An increase in femoral intramedullary pressure caused by the insertion of PMMA and subsequent pulmonary microembolism by medullary contents has been considered the most likely cause for changes in pulmonary function. The lack of statistically significant differences in cardiopulmonary variables and platelet count between the two groups of dogs could have been related to inefficient pressure reduction by the method used.

  20. Progress of cardiopulmonary exercise testing%心肺运动试验研究进展

    蔡永前; 苏建奎; 桂星雨; 王芳利; 李建国; 王二鹏


    Cardiopulmonary exercise testing (CPET) provides a global assessment of the integrative exercise responses involving the pulmonary and cardiovascular systems by testing the gas exchange in airway. CPET is commonly used to evaluate the presence and severity of coronary ischemia, as well as exertional symptoms, heart rate and blood pressure responses and estimated aerobic capacity. CPET has become an important global clinical detection tool, while fewer related researches are carried out in China. The parameters, methods, exercise protocol, equipment, cardiopulmonary function evaluation and clinical application of CPET are introduced in this review.%心肺运动试验(CPET)是在一定运动负荷下,通过检测代谢与生理指标反映心、肺储备能力以及2者的协调性,进而同步、整体评估运动状态下呼吸系统、心血管系统、神经系统、骨骼肌肉系统等多器官、系统的功能。 CPET综合各种工程及医学技术,具有相对无创、客观定量等优点,目前已成为国际上用于评价心肺储备能力和心肺协调性水平的普遍且重要的临床检测手段,但我国的相关研究较少。从测量参数、试验方法、运动方案、试验设备、评价指标及临床应用等方面对CPET作一综述。