Target blood pressure management during cardiopulmonary bypass improves lactate levels after cardiac surgery: a randomized controlled trial

Background Hyperlactatemia is associated with a poor prognosis in cardiac surgery patients. This study explored the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate levels after cardiac surgery. Methods Adult patients undergoing cardiac valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital were enrolled. The patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n = 20 for each. Norepinephrine was titrated only during CPB to maintain MAP at the target level. Blood lactate levels in the two groups were detected before the operation (T0), at the end of CPB (T1), at the end of the operation (T2), 1 h after the operation (T3), 6 h after the operation (T4) and 24 h after the operation (T5). The primary outcome was the blood lactate level at the end of the operation (T2). The secondary outcomes included the blood lactate level at T1, T3, T4, and T5 and the dose of epinephrine and dopamine within 24 h after the operation, time to extubation, length of stay in the ICU, incidence of readmission within 30 days, and mortality within 1 year. Results Forty patents were enrolled and analyzed in the study. The lactate level in the H-MAP group was significantly lower than that in the L-MAP group at the end of the operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at the end of CPB and 1 hour after surgery. The dose of epinephrine within 24 h after the operation, time to extubation and length of stay in the ICU in the L-MAP group were significantly higher than those in the H-MAP group. Conclusions Maintaining a relatively higher MAP during CPB deceased the blood lactate level at the end of surgery, reduced epinephrine consumption, and shortened the time to extubation and length of stay in the ICU after surgery. Trial registration This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 8/1/2020 with the registration number ChiCTR2000028941. It was conducted from 20/1/2020 to 30/6/2020 as a single, blinded trial in Shanghai Chest Hospital.

The Immediate Effect of COVID-19 Vaccination on Anticoagulation Control in Patients Using Vitamin K Antagonists

Background: In January 2021, the Dutch vaccination programme against SARS-CoV-2 was started. Clinical studies have shown that systemic reactions occur in up to 50% of vaccine recipients. Therefore, COVID-19 vaccination could affect anticoagulation control, potentially leading to an increased risk of thrombotic events and bleeding complications. Aims: To investigate whether the BNT162b2 vaccine affects anticoagulation control in outpatients using Vitamin K antagonists (VKAs). Methods: A case-crossover study was performed in a cohort of outpatient VKA users from four Dutch anticoagulation clinics who received a BNT162b2 vaccine. INR results and VKA dosages before the first vaccination, the reference period, were compared with those after the first and second vaccination. Results: A total of 3148 outpatient VKA users were included, with a mean age (standard deviation (SD)) of 86.7 (8.7) years, of whom 43.8% were male, 67.0% used acenocoumarol and 33.0% phenprocoumon. We observed a decrease of 8.9% of INRs within range in the standard intensity group (target INR 2.0-3.0). There was both an increased risk of supratherapeutic [OR=1.34 (95% CI 1.08-1.67)] and subtherapeutic levels [OR=1.40 (95% CI 1.08-1.83)] after first vaccination. In the high-intensity group (target INR 2.5-3.5), the risk of a supratherapeutic INR was 2.3 times higher after first vaccination [OR=2.29 (95% CI 1.22-4.28)] and 3.3 times higher after second vaccination [OR 3.25 (95% CI 1.06-9.97). Conclusion: BNT162b2 was associated with an immediate negative effect on anticoagulation control in patients treated with vitamin K antagonists, so it is advisable to monitor the INR short after vaccination, even in stable patients. Figure 1 Figure 1. Disclosures Kruip: Daiichi Sankyo: Research Funding; Bayer: Honoraria, Research Funding.

Comparison of the Effects of Normocapnia and Mild Hypercapnia on the Optic Nerve Sheath Diameter and Regional Cerebral Oxygen Saturation in Patients Undergoing Gynecological Laparoscopy with Total Intravenous Anesthesia

Cerebral hemodynamics may be altered by hypercapnia during a lung-protective ventilation (LPV), CO2 pneumoperitoneum, and Trendelenburg position during general anesthesia. The purpose of this study was to compare the effects of normocapnia and mild hypercapnia on the optic nerve sheath diameter (ONSD), regional cerebral oxygen saturation (rSO2), and intraoperative respiratory mechanics in patients undergoing gynecological laparoscopy under total intravenous anesthesia (TIVA). Sixty patients (aged between 19 and 65 years) scheduled for laparoscopic gynecological surgery in the Trendelenburg position. Patients under propofol/remifentanil total intravenous anesthesia were randomly assigned to either the normocapnia group (target PaCO2 = 35 mmHg, n = 30) or the hypercapnia group (target PaCO2 = 50 mmHg, n = 30). The ONSD, rSO2, and respiratory and hemodynamic parameters were measured at 5 min after anesthetic induction (Tind) in the supine position, and at 10 min and 40 min after pneumoperitoneum (Tpp10 and Tpp40, respectively) in the Trendelenburg position. There was no significant intergroup difference in change over time in the ONSD (p = 0.318). The ONSD increased significantly at Tpp40 when compared to Tind in both normocapnia and hypercapnia groups (p = 0.02 and 0.002, respectively). There was a significant intergroup difference in changes over time in the rSO2 (p < 0.001). The rSO2 decreased significantly in the normocapnia group (p = 0.01), whereas it increased significantly in the hypercapnia group at Tpp40 compared with Tind (p = 0.002). Alveolar dead space was significantly higher in the normocapnia group than in the hypercapnia group at Tpp40 (p = 0.001). In conclusion, mild hypercapnia during the LPV might not aggravate the increase in the ONSD during CO2 pneumoperitoneum in the Trendelenburg position and could improve rSO2 compared to normocapnia in patients undergoing gynecological laparoscopy with TIVA.

In vitro and in vivo comparative study of a novel 68Ga-labeled PSMA-targeted inhibitor and 68Ga-PSMA-11

Abstract68Ga-radiolabeled small molecules that specifically target prostate-specific membrane antigen (PSMA) have been extensively investigated, and some of these tracers have been used in the diagnosis of prostate cancer via 68Ga-positron emission tomography (68Ga-PET). Nevertheless, current 68Ga-labeled radiotracers show only fair detection rates for metastatic prostate cancer lesions, especially those with lower levels of prostate specific antigen (PSA), which often occurs in the biochemical recurrence of prostate cancer. The goal of this study was to design and synthesize a new PSMA-targeted radiotracer, 68Ga-SC691, with high affinity for prostate cancer cells and excellent pharmacokinetics. To this end, structural optimization was carried out on the bifunctional group, target motif, and linker while the high affinity targeting scaffold remained. To explore its potential in the clinic, a comparative study was further performed in vitro and in vivo between 68Ga-SC691 and 68Ga-PSMA-11, a clinically approved tracer for PSMA-positive prostate cancer. SC691 was radiolabeled to provide 68Ga-SC691 in 99% radiolabeling yield under mild conditions. High uptake and a high internalization ratio into LNCaP cells were observed in in vitro studies. In vivo studies showed that 68Ga-SC691 had favorable biodistribution properties and could specifically accumulate on PSMA-positive LNCaP xenografts visualized by micro-PET/CT. This radiotracer showed excellent PET imaging quality and comparable, if not higher, uptake in LNCaP xenografts than 68Ga-PSMA-11.

Target blood pressure management during cardiopulmonary bypass improves lactate level after cardiac surgery: A randomized controlled trial

Background：Hyperlactacidemia seriously affects the prognosis of cardiac surgery patients. This study was to explore the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate level after cardiac surgery. Methods: Enrolled in this study were patients≧ 18 years who were scheduled for cardiac valve surgery between January 1, 2020 and June 30, 2020 at Shanghai Chest Hospital. The enrolled patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50-60mmHg) and a high mean arterial pressure (H-MAP) group (target MAP between 70-80 mmHg). Norepinephrine was titrated during CPB to maintain MAP at the target level.Blood lactate levels in the two groups were detect before operation (T0), at the end of CPB (T1), at the end of operation (T2), 1 h after operation (T3), 6 h after operation (T4) and 24 h after operation (T5) as the primary outcome. The secondary outcome was the dose of epinephrine and dopamine within 24 h after operation, at the time of extubation, during ICU stay, at the time of readmission within 30 days, and mortality in 1 year. Results: There was no significant difference in blood lactate level between the two groups at T0, T4 and T5. The lactate level in H-MAP group was significantly lower than that in L-MAP group (1.68±0.73, 2.33±0.93 and 2.90±1.09 mM;L-1 vs. 2.29±1.12, 3.63±1.86 and 4.60±2.24 mM;L-1) at T1, T2 and T3. The dose of epinephrine within 24 h after operation, at the time of extubation and during ICU stay in L-MAP group was significantly higher than that in H-MAP group. Conclusions: Target MAP management in patients with relatively high levels of MAP during CPB could decrease the blood lactate level, reduce epinephrine consumption, and shorten the time of extubation and length of ICU stay after surgery, thus improving the prognosis of cardiac surgery patients. Trial registration: This single-center single-blind RCT has completed the registration of the Chinese Clinical Trial Center with the registration number ChiCTR2000028941.

The Method of Operational Planning of Group Actions of Aircraft in the "Air Taxi" Mode

The article is devoted to the development of algorithms for operational planning of routes for a group of aircraft (AC). We consider group actions of small and unmanned aircraft in the "air taxi" mode, when there is no regular flight schedule between the points of destination, and requests are received "on call" for flights to points whose composition is unknown in advance and is of a random nature. The multicriteria task of planning a group flight in the "air taxi" mode is being solved. The solution to this problem is proposed using the apparatus of the queuing theory, according to which the system under consideration belongs to the class of multichannel queuing systems with waiting. A method for solving the problem of operational planning of aircraft actions is proposed. An algorithm for group target distribution of new claims between aircraft is developed on the basis of a modified minimax criterion for assigning the nearest aircraft for an object with a maximum service time. The developed algorithm is based on the following four main operations: in the first operation, priority unserved targets are selected according to the criterion of assigning a dynamic priority; in the second operation, the formed list is ranked according to another criterion, taking into account the importance and total distance of each ground object from the aircraft group, in three this operation selects the object with the maximum rank, and for it the task of assigning "own" aircraft is solved according to the third criterion of maximum proximity, in the fourth operation the conditions of non-intersection of the group flight routes are checked. A computer model of the system for servicing requests in the air taxi mode has been developed. The developed model makes it possible to analyze various scheduling algorithms, as well as to determine at each step the number of free claims and the number of free and busy aircraft. A comparison is made between the well-known in the theory of queuing and the proposed minimax approaches. It is shown that, in comparison with the known variants of scheduling in the queuing theory, on the basis of the proposed approach, the optimal number of used aircraft is achieved.

Comparison of efficacy of injection ferric carboxymaltose and iron sucrose in moderate anaemia in pregnancy

Background: Prevalence of anaemia in pregnant women is 14% in developed and 58-89.6% in pregnant Indian women. Parenteral iron is seems to be an option in the treatment of moderate iron deficiency anaemia which allow high doses of iron to be administered rapidly, in those who are intolerant to oral iron, have poor compliance to oral iron or gastrointestinal disorder. The objective was to compare the efficacy of newer drug, inravenous ferric carboxymaltose (FCM) with intravenous iron sucrose.Methods: Group A were given injection FCM and group B were given injection iron sucrose. FCM was given in one or two sittings depending on iron requirement and iron sucrose was given in divided doses. Haemogram was done at baseline and on day 3 and 21 and at 12 weeks. All the observations were tabulated and analysed.Results: The mean rise in haemoglobin values from baseline in the FCM group was 0.20±0.06 at 3rd day, 2.03±0.47 at 3 weeks, 3.86±0.53 at 12 weeks compared to iron sucrose group, which was 0.11±0.08 at 3rd day, 1.51±0.39 at 3 weeks, and 3.22±0.54 at 12 weeks, which was statistically significant and showed that the haemoglobin levels were increased more in FCM group. Target haemoglobin was achieved in 92% women in FCM group and 78% women in iron sucrose group.Conclusions: Women in the FCM group achieved significantly higher haemoglobin level than in iron sucrose group. It was given in fewer sittings, hence was more convenient with better efficacy.

ОСОБЛИВОСТІ ВИЗНАЧЕННЯ ВИТРАТИ СНАРЯДІВ І СПОСОБУ ОБСТРІЛУ КОЛОН ПРОТИВНИКА

Columns, which are highly maneuverable targets and any other targets, return the damage to the opponents. As a result of the shelling, the enemy column was informed about the systematic study and deployment of its reserves, management violations, and unfavorable conditions were created for the use of effective types of fire by other means of destruction. The result of artillery fire reveals a mathematical combination of irreversible damage and delay time of the enemy column or Woz, which is characterized by damage to the group counteracting due to the delayed columns and the adjustment of its irreversible damage.The article consists of the following sections:1. Indicators of effectiveness during the defeat of enemy columns;2. The dependence of the consumption of shells and the method of firing at the target on the conditions of the fire task;3. Dependence of projectile consumption on the required level of firing efficiency;4. The dependence of the consumption of shells on the method of determining the installations for firing on the defeat and the size of the group target;5. The dependence of the consumption of shells on the number of fire means used to hit the target, and the firing range;6. Dependence of projectile consumption on the characteristics of the impressive action of ammunition and the method of firing at the target;7. The dependence of the method of firing at the target from various factors.In the article mathematical dependences for definition of indicators of efficiency of defeat of columns, expense of shells, a way of firing of columns are considered. The probability of covering a column on the basis of the law of uniform scattering is considered. The sizes of zones of uniform scattering on the basis of a dispersion of the most favorable scattering are received.The article shows the dependences of the cost of shells and the method of firing at the target from the conditions of the fire task, based on the requirements of achieving a given degree of damage (the required level of efficiency). The issues of the dependence of projectile consumption on the required level of the rate of effectiveness of firing at the damage, and the method of determining the installations for firing at the damage and the size of the group target. The questions of dependence of shell consumption on the conditions of the fire task are considered.

Group Target Tracking Based on MS-MeMBer Filters

This paper presents a new group target tracking method based on the standard multi-sensor multi-target multi-Bernoulli (MS-MeMBer) filter. In the prediction step, the group structure is used to constrain the movement of the constituent members within the respective groups. Specifically, the group of members is considered as an undirected random graph. Combined with the virtual leader-follower model, the motion equation of the members within groups is formulated. In the update step, the partitioning problem of multiple sensors is transformed into a multi-dimensional assignment (MDA) problem. Compared with the original two-step greedy partitioning mechanism, the MDA algorithm achieves better measurement partitions in group target tracking scenarios. To evaluate the performance of the proposed method, a simulation scenario including group splitting and merging is established. Results show that, compared with the standard MS-MeMBer filter, our method can effectively estimate the cardinality of members and groups at the cost of increasing computational load. The filtering accuracy of the proposed method outperforms that of the MS-MeMBer filter.