Clinical application of a new ternary polymer, SEC-1 coat™, for pediatric cardiopulmonary bypass circuits: a prospective randomized pilot study

Objective: The use of biocompatible materials to reduce the systemic activation of inflammation and coagulation pathways is expanding rapidly. However, there have been few clinical studies of biocompatible circuits for pediatric cardiopulmonary bypass. This pilot study aimed to preliminarily evaluate the biocompatibility of SEC-1 coat™ (SEC) for cardiopulmonary bypass circuits in pediatric cardiac surgery. Methods: Twenty infants undergoing cardiac surgery for isolated ventricular septal defects at Kobe Children’s Hospital were assigned randomly to an SEC-coated (SEC group, n = 10) or heparin-coated (control group, n = 10) circuit. Perioperative data and the following markers were prospectively analyzed: platelet counts and interleukin-6, interleukin-8, C3a, β-thromboglobulin, and thrombin–antithrombin complex levels. Results: Neither patient characteristics nor postoperative clinical outcomes differed significantly between the SEC and control groups. Platelet counts markedly decreased during cardiopulmonary bypass in both groups, but were significantly better preserved in the SEC group. Fewer patients needed postoperative platelet transfusions in the SEC group. After cardiopulmonary bypass termination, serum levels of β-thromboglobulin and thrombin–antithrombin complex were significantly lower in the SEC than in the control group. Although the differences were not statistically significant, serum levels of interleukin-6, interleukin-8, and C3a had a tendency toward being lower in the SEC group, with good preservation of leukocyte counts, fibrinogen, and antithrombin III. Conclusion: SEC-1 coat™ for cardiopulmonary bypass circuits have good biocompatibility with regard to platelet preservation and in terms of attenuating inflammatory reaction or coagulation activation during pediatric cardiac surgery. It can be beneficial in pediatric as well as adult cardiac surgery.

Download Full-text

Cytokine profile in adolescent girls with candidal vulvovaginitis

Kazan medical journal ◽

10.17816/kmj1797 ◽

2013 ◽

Vol 94 (6) ◽

pp. 817-820 ◽

Cited By ~ 1

Author(s):

U Kh Ziyadullaev

Keyword(s):

Inflammatory Response ◽

Adolescent Girls ◽

Interleukin 6 ◽

Serum Levels ◽

Interleukin 8 ◽

Yeast Cells ◽

World Health ◽

Vaginal Candidiasis ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group

Aim. To establish the pathogenic value of serum cytokine (interleukin-6 and interleukin-8) production in patients with candidal vulvovaginitis to optimize diagnostic and therapeutic approaches. Methods. 74 adolescent girls suffering from candidal vulvovaginitis aged from 12 to 19 years were examined. The diagnosis of candidal vulvovaginitis was verified according to the international classification of World Health Organization (ICD-X codes B37.3 and N77.1). At the stage of clinical examination, medical and general history was analyzed, general and gynecological examination was performed. The diagnosis of candidiasis was confirmed by the presence of vegetative forms of Candida spp. (budding yeast cells, pseudomycelium and/or mycelium) in Gram-stained smears from the mucous membranes of the vulva, urethra. The control group consisted of 20 healthy patients of appropriate age and sex. Serum levels of interleukin-6 and interleukin-8 were measured by enzyme-linked immunosorbent assay using «ELISA interleukin-6» and «ELISA interleukin-8» test systems (ZAO «Vector-Best», Russia). Results. The study has shown increased serum levels of interleukin-6 in adolescent patients with candidal vulvovaginitis. Interleukin-6 level in peripheral blood was significantly higher in patients with candidal vulvovaginitis (21.7±2.4 pg/ml) compared to controls (9.4±1.5 pg/ml, p 0.02). Serum interleukin-8 level was also significantly higher (51.2±2.1 pg/ml) in patients with candidal vulvovaginitis compared to controls (23.9±1.04 pg/ml, p 0.01). Conclusion. The revealed features of interleukin-6 and interleukin-8 production may be used as additional objective criteria of the orientation of the inflammatory response in patients with various forms of vaginal candidiasis. The changes of the studied parameters might reflect the state of the immune system and the severity of the inflammatory response.

Download Full-text

Cerebral oxygenation in 45-degree trendelenburg position for robot-assisted radical prostatectomy: a single-center, open, controlled pilot study

BMC Urology ◽

10.1186/s12894-020-00774-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Clemens Wiesinger ◽

Dominik Stefan Schoeb ◽

Mathias Stockhammer ◽

Emir Mirtezani ◽

Lukas Mitterschiffthaler ◽

...

Keyword(s):

Pilot Study ◽

Cerebral Oxygenation ◽

Preoperative Assessment ◽

Patient Characteristics ◽

Rank Test ◽

Control Group ◽

Robot Assisted ◽

Clinical Trial Registry ◽

Trendelenburg Position ◽

Signed Rank Test

Abstract Background Within the last decade, robotically-assisted laparoscopic prostatectomy (RALP) has become the standard for treating localized prostate cancer, causing a revival of the 45° Trendelenburg position. In this pilot study we investigated effects of Trendelenburg position on hemodynamics and cerebral oxygenation in patients undergoing RALP. Methods We enrolled 58 patients undergoing RALP and 22 patients undergoing robot-assisted partial nephrectomy (RAPN) (control group) in our study. Demographic patient data and intraoperative parameters including cerebral oxygenation and cerebral hemodynamics were recorded for all patients. Cerebral function was also assessed pre- and postoperatively via the Mini Mental Status (MMS) exam. Changes in parameters during surgery were modelled by a mixed effects model; changes in the MMS result were evaluated using the Wilcoxon signed rank test. Results Preoperative assessment of patient characteristics, standard blood values and vital parameters revealed no difference between the two groups. Conclusions Applying a 45° Trendelenburg position causes no difference in postoperative brain function, and does not alter cerebral oxygenation during a surgical procedure lasting up to 5 h. Further studies in larger patient cohorts will have to confirm these findings. Trial registration German Clinical Trial Registry; DRKS00005094; Registered 12th December 2013—Retrospectively registered; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005094.

Download Full-text

Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-020-04809-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Thiago Augusto Azevedo Maranhão Cardoso ◽

Gudrun Kunst ◽

Caetano Nigro Neto ◽

José de Ribamar Costa Júnior ◽

Carlos Gustavo Santos Silva ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Controlled Trial ◽

Artery Bypass ◽

Bypass Graft ◽

Volatile Anesthetic ◽

Serum Levels ◽

Randomized Controlled

Abstract Background Recent experimental evidence shows that sevoflurane can reduce the inflammatory response during cardiac surgery with cardiopulmonary bypass. However, this observation so far has not been assessed in an adequately powered randomized controlled trial. Methods We plan to include one hundred patients undergoing elective coronary artery bypass graft with cardiopulmonary bypass who will be randomized to receive either volatile anesthetics during cardiopulmonary bypass or total intravenous anesthesia. The primary endpoint of the study is to assess the inflammatory response during cardiopulmonary bypass by measuring PMN-elastase serum levels. Secondary endpoints include serum levels of other pro-inflammatory markers (IL-1β, IL-6, IL-8, TNFα), anti-inflammatory cytokines (TGFβ and IL-10), and microRNA expression in peripheral blood to achieve possible epigenetic mechanisms in this process. In addition clinical endpoints such as presence of major complications in the postoperative period and length of hospital and intensive care unit stay will be assessed. Discussion The trial may determine whether adding volatile anesthetic during cardiopulmonary bypass will attenuate the inflammatory response. Trial registration ClinicalTrials.gov NCT02672345. Registered on February 2016 and updated on June 2020.

Download Full-text

Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Perfusion ◽

10.1177/0267659117701562 ◽

2017 ◽

Vol 32 (7) ◽

pp. 547-553 ◽

Cited By ~ 12

Author(s):

Elena Bignami ◽

Marcello Guarnieri ◽

Marina Pieri ◽

Francesco De Simone ◽

Alcira Rodriguez ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Cardiac Troponin ◽

Troponin I ◽

Myocardial Necrosis ◽

Perioperative Period ◽

Cardiac Surgical Procedures ◽

Control Group ◽

Volatile Anaesthetics ◽

Volatile Agents

Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

Download Full-text