Is 300 Seconds ACT Safe and Efficient during MiECC Procedures?

Introduction The recommended minimum activated clotting time (ACT) level for cardiopulmonary bypass (CPB) of 480 seconds originated from investigations with bubble oxygenators and uncoated extracorporeal circulation (ECC) systems. Modern minimal invasive ECC (MiECC) systems are completely closed circuits containing a membrane oxygenator and a tip-to-tip surface coating. We hypothesized that surface coating and the “closed-loop” design allow the MiECC to safely run with lower ACT levels and that an ACT level of 300 seconds can be safely applied without thromboembolic complications. The aim of this study was to investigate the potential risks during application of reduced heparin levels in patients undergoing coronary surgery. Methods In this study, 68 patients undergoing coronary artery bypass grafting with MiECC were randomized to either the study group with an ACT target of 300 seconds or the control group with an ACT of 450 seconds. All other factors of MiECC remained unchanged. Results The study group received significantly less heparin and protamine (heparin [international units] median [min–max], Red_AC: 32,800 [23,000–51,500] vs. Full_AC: 50,000 [35,000–65,000] p < 0.001; protamine [international units], Red_AC: 18,000 [10,000–35,000] vs. Full_AC: 30,000 [20,000–45,000] p < 0.001). The ACT in the study group was significantly lower at the start of MiECC (mean ± standard deviation: study group 400 ± 112 vs. control group 633 ± 177; p < 0.0001). Before termination of CPB the ACT levels were: study group 344 ± 60 versus control group 506 ± 80. In both groups, the values of the endogenous thrombin potential (ETP) decreased simultaneously. None of the study participants experienced thromboembolic complications. Conclusion Since no evidence of increased thrombin formation (ETP) was found from a laboratory standpoint, we concluded that the use of MiECC with a reduced anticoagulation strategy seems possible. This alternative anticoagulation strategy leads to significant reduction in dosages of both heparin and protamine. We can confidently move forward with investigating this anticoagulation concept. However, to establish clinical safety of ACT below 300 seconds, we need larger clinical studies.

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Pretreatment with Methylprednisolone Improves Myocardial Protection during On-Pump Coronary Artery Bypass Surgery

The Heart Surgery Forum ◽

10.1532/hsf.1367 ◽

2015 ◽

Vol 18 (4) ◽

pp. 171 ◽

Cited By ~ 1

Author(s):

Tolga Demir ◽

Mehmet Umit Ergenoglu ◽

Hale Bolgi Demir ◽

Nursen Tanrikulu ◽

Mazlum Sahin ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Myocardial Protection ◽

Troponin T ◽

Artery Bypass ◽

Control Group ◽

Study Group ◽

Cabg Surgery ◽

Anti Inflammatory ◽

Pump Coronary Artery Bypass

Background: This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). Methods: Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time. Results: A comparison of patients between both groups revealed significantly high levels of IL-6 in the control group at T2, T3, and T4 with respect to T1 (T2: P < .001; T3: P < .001; T4: P < .001). IL-10 levels were significantly higher in the study group at T2 compared with the control group (P = .007). CK-MB levels were significantly lower in the study group than in the control group at T4 (P = .001). The increase of cTnT was higher in the control group at T3 and T4 compared with the study group (T3: P = .002; T4: P = .001). Conclusions: This study demonstrates that methylprednisolone is effective for ensuring better myocardial protection during cardiac surgery by suppressing the inflammatory response via decreasing the levels of IL-6 and by increasing anti-inflammatory activity through IL-10.

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Dynamic thiol/disulphide homeostasis metrics as a risk factor for peripheral arterial disease

Vascular ◽

10.1177/1708538120947245 ◽

2020 ◽

pp. 170853812094724

Author(s):

Ufuk Turan Kursat Korkmaz ◽

Ahmet Yuksel ◽

Ayhan Cetinkaya ◽

Yusuf Velioglu ◽

Erhan Renan Ucaroglu ◽

...

Keyword(s):

Oxidative Stress ◽

Risk Factor ◽

Peripheral Arterial Disease ◽

Laboratory Data ◽

Arterial Disease ◽

Control Group ◽

Study Group ◽

Total Thiol ◽

Peripheral Arterial ◽

Study Participants

Objective To examine dynamic thiol/disulphide homeostasis metrics as a novel risk factor of oxidative stress in patients with peripheral arterial disease. Methods One hundred patients with lower extremity peripheral arterial disease (a study group) and 100 control subjects were included in this prospective case–control study. Participants’ baseline clinical characteristics and laboratory data including some oxidant/antioxidant status parameters such as albumin, ferroxidase and myeloperoxidase, and thiol/disulphide homeostasis parameters such as native thiol, total thiol and disulphide, as well as native thiol/total thiol, disulphide/native thiol and disulphide/total thiol ratios were all recorded and then compared between the groups. Results Mean albumin and ferroxidase, and median myeloperoxidase levels were found to be significantly higher in patients with the peripheral arterial disease than in control group ( p = 0.045, p = 0.000 and p = 0.000, respectively). Mean native thiol and total thiol, and median disulphide levels were found to be significantly lower in the study group as compared with the control group ( p = 0.000, p = 0.000 and p = 0.037, respectively). According to the results of logistic regression analysis, systolic blood pressure, ferroxidase and myeloperoxidase levels were detected to be the independent predictors of peripheral arterial disease. Conclusion Our report is the first one in the literature investigating dynamic thiol/disulphide homeostasis metrics as a novel risk factor of oxidative stress in peripheral arterial disease. Dynamic thiol/disulphide homeostasis metrics may be used as a valuable risk factor of oxidative stress in patients with the peripheral arterial disease since it is readily available, easily calculated and relatively cheap.

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Haemolysis during cardiopulmonary bypass: how to reduce the free haemoglobin by managing the suctioned blood separately

Perfusion ◽

10.1177/026765910101600612 ◽

2001 ◽

Vol 16 (6) ◽

pp. 519-524 ◽

Cited By ~ 21

Author(s):

A Pierangeli ◽

V Masieri ◽

F Bruzzi ◽

E De Toni ◽

G Grillone ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Control Group ◽

Study Group ◽

Artery Bypass Graft ◽

Operative Field ◽

Free Plasma Haemoglobin ◽

Free Plasma

During cardiopulmonary bypass (CPB) the collection of the patient’s blood from the operating area is of fundamental importance. This blood is collected in the cardiotomy reservoir using field suckers and can be managed in different ways. It can be filtered in the cardiotomy reservoir and redirected to the venous reservoir, then oxygenated and returned to the patient, or it can be managed separately: collected in the cardiotomy reservoir, treated at the end of the operation and only after this, returned to the patient. The aim of this study is to determine in vivo the effect of a separate management of the suction blood from the operative field, using the Avant D903 oxygenator (Dideco, Mirandola, Italy). Twenty-one patients undergoing coronary artery bypass graft surgery with CPB were selected and put into two groups at random. In the control group ( n 10) the suction blood in the cardiotomy reservoir was filtered and immediately redirected into the venous reservoir, oxygenated and returned to the patient. In the study group ( n 11) the suctioned blood was collected in the D903 Avant’s (Dideco) cardiotomy reservoir and returned to the patient only after having been washed at the end of the operation, using a Compact Advanced (Dideco), as required. Clinical data demonstrated that while in the study group it was possible to keep the free plasma haemoglobin (FPH) concentrations the same as at the beginning, in the control group there was a significant increase in FPH from 5.0 3.5 mg/dl (baseline) to 37 16.7 mg/dl (120 min after CPB).

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Study The Overprescription Of Proton Pump Inhibitors And Their Relation With Recurrent Community Aquired Infections In Outpatient Refilled Prescriptions Of Chronic Diseases Patients

European Scientific Journal ESJ ◽

10.19044/esj.2016.v12n6p116 ◽

2016 ◽

Vol 12 (6) ◽

pp. 116

Author(s):

Aysha Abedalhameed Alkhalaylah ◽

Maisan Mahmoud Hayajneh ◽

Shireen Imad Hijazeen ◽

Tahanie Ali Alqhewii ◽

Eva Raji Haddad ◽

...

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

Neutrophil Count ◽

Inflammatory Biomarkers ◽

Control Group ◽

Study Group ◽

Study Participants ◽

And Control ◽

The Relationship

Background: proton pump inhibitors are widely used worldwide and studies have demonstrated that the use of PPIs to be associated with various diseases such as several types of infection. Study objectives: to explore the effect of using PPIs on patients through studying some inflammatory biomarkers including WBC, neutrophil count, ESR, CRP, and IL-6. Methods and subjects: a retrospective study design was followed to collect data from study participants. The study included 62 patients receiving PPIs and 60 persons without being prescribed for PPIs. A working sheet was created for each patient and included the following information: age, WBC, neutrophil count, ESR, CRP, and IL-6. Data analysis was carried out using SPSS version 20. The relationship between variables was tested using independent T test. Significance was considered at alpha level < 0.05. Study findings: age was not varied significantly between study group and control group. All inflammatory biomarkers under study were significantly elevated in study group compared with control group. Conclusions: the findings of the present study showed that the use of PPIs was associated significantly with increased inflammatory biomarkers. We think that health settings should pay much attention to the role of pharmacists and pharmacy doctors to increase the awareness about the use of PPIs.

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Handwriting in Children with Attention Deficient Hyperactive Disorder: Analyzing by graphology

10.21203/rs.2.14541/v2 ◽

2019 ◽

Author(s):

Rony Cohen ◽

Batia Cohen-Kroitoru ◽

Ayelet Halevy ◽

Sharon Aharoni ◽

Irena Aizenberg ◽

...

Keyword(s):

Diagnostic Tool ◽

Control Group ◽

Study Group ◽

Adhd Group ◽

Children With Adhd ◽

Blinded Study ◽

Adhd Children ◽

Children And Adolescence ◽

The Mean ◽

Study Participants

Abstract Objective: Handwriting difficulties are common in children with attention deficient hyperactive disorder (ADHD). The aim of our study was to find distinctive characteristics of handwriting in children with ADHD by using graphology to analyze physical characteristics and patterns, and to evaluate whether graphological analysis is an effective ADHD diagnostic tool for clinicians. Method: The study group included 21 (43%) males and 28 (57%) females, with 15 (71.4%) males and 7 (25%) females diagnosed with ADHD. A graphologist analyzed handwriting text from 49 patients, 22/49 previously diagnosed with ADHD, aged 13-18 years, in a randomized, single-blinded study. All study participants wrote a story in Hebrew in 10-12 lines, on a blank paper with a blue pen, during a period of twenty minutes. A licensed graphologist was given the papers, without details, for characterization analysis. The graphologist suggested a profile of a person with ADHD based on graphology theory for ADHD, and gave patients one point for each ADHD handwriting characteristic, up to 15 points. Patients with 9-15 points were considered to have ADHD, based on their graphology evaluation. Results The mean graphology score in the DSM based ADHD group was significantly higher than in the control group (9.61+3.49 vs. 5.79+4.01, p=0.002, respectfully). Using score of 0 as a cutoff point graphology-based ADHD score had an 80% specificity (95% CIs [59.2-92.8]), and a sensitivity of 71.4%. Conclusion: Handwriting in ADHD children and adolescence has specific characteristics, thus graphological analysis could be a useful tool to help clinicians in the diagnosis of ADHD.

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Outcome Improvement and Cost Reduction in an Increasingly Morbid Cardiac Surgery Population

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253206289009 ◽

2006 ◽

Vol 10 (2) ◽

pp. 171-175 ◽

Cited By ~ 13

Author(s):

Scott M. Goldman ◽

Francis P. Sutter ◽

Mary Ann C. Wertan ◽

Francis D. Ferdinand ◽

Candace L. Trace ◽

...

Keyword(s):

Cardiac Surgery ◽

Artery Bypass ◽

Clinical Effectiveness ◽

Cerebral Oximetry ◽

Control Group ◽

Study Group ◽

Bypass Grafting ◽

Off Pump ◽

Prolonged Ventilation ◽

Pump Coronary Artery Bypass

Two studies assessed initiatives to improve the quality and the cost-effectiveness of cardiac surgery. The first evaluated a system for access and stabilization (SAS), with coronary stabilization, and a clinical effectiveness quality initiative (CEQI) in off-pump coronary artery bypass grafting. The SAS + CEQI cohort showed significantly lower mortality, a lower percentage of patients requiring prolonged ventilation, and a shorter mean postoperative length of hospital stay than the pre-SAS cohort who underwent on-pump coronary artery bypass grafting. The second study assessed the potential for noninvasive cerebral oximetry to reduce strokes related to all cardiac surgery by optimizing cerebral oxygen delivery. The incidence of permanent stroke was significantly lower in the cerebral oximetry group than in an earlier control group in which cerebral oximetry was not used, despite the fact that the study group had a significantly greater number of patients in New York Heart Association classes III and IV. The proportion of patients requiring prolonged ventilation was significantly lower, and the length of postoperative hospital stay was significantly shorter in the study group than in the control group. The incidence of cerebrovascular accident in the study group was 0.97%, compared with 2.03% in the controls. This translated to a potential avoidance of 12 cerebrovascular accidents and approximately $254 214 in direct costs and more than $425000 in total costs. The results show that specific measures can improve outcomes and reduce costs in cardiac surgery. Therefore, the use of a clinical effectiveness quality initiative and cerebral oximetry in all cardiac surgery, with the SAS system for off-pump surgery, should be advocated.

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Relationship between Sleep Bruxism, Perceived Stress, and Coping Strategies

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16173193 ◽

2019 ◽

Vol 16 (17) ◽

pp. 3193 ◽

Cited By ~ 2

Author(s):

Klara Saczuk ◽

Barbara Lapinska ◽

Paulina Wilmont ◽

Lukasz Pawlak ◽

Monika Lukomska-Szymanska

Keyword(s):

Coping Strategies ◽

Perceived Stress ◽

Sleep Bruxism ◽

Stress And Coping ◽

Control Group ◽

Study Group ◽

Positive Coping ◽

Brief Cope ◽

And Coping ◽

Study Participants

Sleep bruxism (SB) is a common phenomenon defined as a masticatory muscle activity during sleep. Untreated severe SB can have significant dental and orofacial consequences. SB has often been linked with stress and maladaptive coping strategies. Therefore, in this study, a potential correlation between SB, perceived stress and coping strategies was evaluated. A total of 60 adults were enrolled into this study. Participants underwent a detailed intra- and extraoral exam focused on detecting bruxism symptoms. Additionally, the overnight Bruxism Index was recorded using the Bruxoff device. A total of 35 participants with symptoms of bruxism were assigned to the study group, whereas 25 asymptomatic participants were assigned to the control group. The Perceived Stress Scale (PSS-10) was used for stress assessment and Brief-COPE for coping strategies. Results showed that the higher the PSS-10 score, the higher the Bruxism Index was in the study group. Positive coping strategies were chosen most frequently in the control group, while maladaptive ones were chosen in the study group. It can be concluded that there is a relationship between perceived stress and sleep bruxism. Moreover, the type of coping strategies used by participants may have an impact on sleep bruxism, but the relationship should be further investigated.

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Indirect Electroimpulse Myostimulation and Its Role in Treatment of Patients with Shin Bone Fractures

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201522421-25 ◽

2015 ◽

Vol 22 (4) ◽

pp. 21-25

Author(s):

V. N Obolenskiy ◽

A. V Karpenko ◽

N. V Zagorodniy

Keyword(s):

Bone Fractures ◽

Plate Osteosynthesis ◽

Controlled Study ◽

Control Group ◽

Study Group ◽

Thromboembolic Complications ◽

Randomized Controlled ◽

Electric Muscle Stimulation ◽

Venous Thromboembolic

Prospective randomized controlled study to evaluate the efficacy of electric muscle stimulation (EMS) of calf muscles in prevention of venous thromboembolic complications (VTEC), shortening of treatment and rehabilitation terms in patients with shin bones fractures was performed. The study included 60 patients, aged 19-67 years, with isolated shin bones fractures. All patients were admitted at early (from 0.5 to 3 hours) terms after injury. For final fixation either intramedullary or plate osteosynthesis were used. All patients were on anticoagulant therapy for VTEC prevention. In the study group ( n =30) 2 séances of EMS, 3 hours each, were performed daily from the first day of hospitalization. In 30 patients from the control group EMS was not performed. It was shown that application of EMS ensured the shortening of treatment and rehabilitation terms, better quality of life and enabled to avoid VTEC development. Achieved preliminary data are indicative of the expediency of EMS application in traumatologic patients at early hospital stage.

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Handwriting in Children with Attention Deficient Hyperactive Disorder analyzing by graphology

10.21203/rs.2.14541/v1 ◽

2019 ◽

Author(s):

Rony Cohen ◽

Batia Cohen-Kroitoru ◽

Ayelet Halevy ◽

Sharon Aharoni ◽

Irena Aizenberg ◽

...

Keyword(s):

Diagnostic Tool ◽

Control Group ◽

Study Group ◽

Adhd Group ◽

Children With Adhd ◽

Blinded Study ◽

Adhd Children ◽

Children And Adolescence ◽

The Mean ◽

Study Participants

Abstract Objective Handwriting difficulties are common to children with attention deficient hyperactive disorder (ADHD). The aim of our study was to find distinctive characteristics of the handwriting of children with ADHD by using graphology to analyze physical characteristics and patterns of their handwriting, and to evaluate whether graphological analysis is an effective ADHD diagnostic tool for clinicians.Method A graphologist analyzed handwriting text from 49 patients, 22/49 previously diagnosed with ADHD, aged 13-18 years, in a randomized, single-blinded study. All study participants wrote a story in Hebrew in 10-12 lines, on a blank paper with a blue pen, during a period of twenty minutes. A licensed graphologist was given the papers, without details, for characterize evaluation. The graphologist suggested a profile of a person with ADHD, and every patient received one point for each ADHD handwriting characteristic, up to 15 points. Patients with 9-15 points were considered to have ADHD, based on their graphology evaluation.Results The study group included 21 (43%) males and 28 (57%) females, with 15 (71.4%) males and 7 (25%) females diagnosed with ADHD. Overall, the mean score in the ADHD group (9.6, SD=3.49) was significantly higher ( p =0.002) than in the control group (5.79, SD=4.01).Conclusion Handwriting in ADHD children and adolescence has specific characteristics, thus graphological analysis could be a useful tool for clinicians in diagnosis of ADHD.

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The Efficacy of Inpatient vs. Home-Based Physiotherapy Following Coronary Artery Bypass Grafting

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15112572 ◽

2018 ◽

Vol 15 (11) ◽

pp. 2572

Author(s):

Aleksandra Szylińska ◽

Mariusz Listewnik ◽

Iwona Rotter ◽

Aleksandra Rył ◽

Katarzyna Kotfis ◽

...

Keyword(s):

Cardiac Surgery ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Control Group ◽

Study Group ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Home Based

Background: Intensive post-operative physiotherapy after cardiac surgery helps to reduce the number of complications, accelerating convalescence and decreasing peri-operative mortality. Cardiac rehabilitation is aimed at regaining lost function and sustaining the effect of cardiac surgery. The aim of this study was to compare the efficacy of inpatient and home-based phase II physiotherapy following coronary artery bypass grafting, and inpatient phase II post-operative physiotherapy based on the analysis of the spirometry results. Methods: A prospective observational study included 104 adult patients of both sexes undergoing planned coronary artery bypass grafting and were randomized to one of the two groups—inpatients (InPhysio) and home-based (HomePhysio) at a 1:1 ratio. All patients had undergone spirometry testing prior to surgery (S1) and on the fifth day after the operation (S2), i.e., on the day of completion of the first phase (PI) of physiotherapy. Both the study group (InPhysio) and the control group (HomePhysio) performed the same set of exercises in the second phase (PII) of cardiac physiotherapy, either in the hospital or at home, respectively, according to the program obtained in the hospital. Both groups have undergone spirometry testing (S3) at 30 days after the operation. Results: The demographic and peri-operative data for both groups were comparable and showed no statistically significant differences. An analysis of gradients between the results of spirometry tests before surgery and at 30 days after the surgery showed a smaller decrease in forced vital capacity (FVC) in the study group than in the control group (p < 0.001). The results at five and 30 days after the surgery showed a greater increase in FVC in the study group than in the control group (680 mL vs. 450 mL, p = 0.009). There were no statistically significant differences in other parameters studied. Conclusions: The advantage of inpatient over home-based physiotherapy was evidenced by much smaller decreases in FVC between the initial and final tests, and greater increases between the fifth day after surgery and the final test. Our analysis showed greater efficacy of inpatient physiotherapy as compared with home-based exercises and raises concerns about patient adherence.

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