Cold Blood Research Articles

Modified del Nido versus blood cardioplegia in congenital cardiac surgery.

Lactated Ringer-based del Nido cardioplegia has been reported to be safe for acquired cardiac surgery. The original Plasma-Lyte-based solution has been proved for congenital cardiac surgery but its modification has not been adequately examined. We compared the clinical outcomes of congenital cardiac surgery using lactated Ringer-based del Nido cardioplegia versus cold blood cardioplegia. Between September 2018 and November 2020, 116 consecutive patients with congenital heart disease undergoing operations with cardioplegic arrest performed by a single surgeon at Faculty of Medicine Siriraj hospital; 66 with modified del Nido solution and 50 with institutional's blood cardioplegia. The patient risk profiles, operative details, mortality rates, care durations, inotrope use, blood transfusion and complications were compared. Preoperative characteristics were similar between groups, including median age (2.5 vs. 3.1 years; p = 0.49), size, and gender. The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score of 3 to 5 was more prevalent in the del Nido group (24.2% vs. 10%; p = 0.049). There were 4 deaths in the modified del Nido group (risk category score of 4) but none in the cold blood group (p = 0.13). There was no significant difference in median intubation duration, length of intensive care unit stay, and vasoactive medications immediately and 24 h after the operation. The del Nido group required 70 to 100 ml less blood transfusion (p = 0.04). All complications were similar between the two groups. Clinical outcomes of lactated Ringer-based del Nido cardioplegia were comparable to those of blood cardioplegia in congenital cardiac surgery.

Effect of storage on survival of infectious Treponema pallidum spiked in whole blood and platelets.

Blood donations must be tested for evidence of syphilis, a transfusion-transmitted infection. Screening blood for syphilis-related antibodies greatly reduced the risk of transfusion-transmitted syphilis (TTS). It is commonly believed that Treponema pallidum (Tp), the bacterium causing syphilis, does not survive in blood during cold storage-suggested as one reason why no cases of TTS have been recognized in the United States for many years. Some have suggested that routine syphilis screening of blood donations is no longer needed. To address the effect of storage, we investigated the survival of Tp experimentally spiked into blood and platelets stored under conventional conditions. We spiked fresh human blood products with high concentrations of Tp and inoculated samples at intervals into rabbits, a sensitive assay detecting infectious Tp. We tested whole blood (WB) stored refrigerated (1-6°C) for 9 days and platelets stored at room temperature for 7 days or refrigerated for 14 days. We assayed sera of the rabbits collected at intervals for seroconversion using two different tests and assessed orchitis. Rabbits were considered infected if one or both serological test results became positive. Viable Tp survived 7 days in WB and 6 days in platelets stored at both ambient and cold temperatures. Tp at concentrations much higher than those possibly present in an infected blood unit survived in cold blood products longer than previously reported and, thus, storage conditions cannot be relied upon to eliminate T. pallidum from blood or platelets. TTS remains a topic of concern for public health.

Moxibustion with different doses for primary dysmenorrhea of cold congelation and blood stasis type: A randomized controlled trial: 不同灸量艾灸治疗寒凝血瘀型原发性痛经:随机对照试验

ObjectiveTo explore the clinical effect differences of moxibustion with different doses on primary dysmenorrhea with cold congelation and blood stasis type. MethodsA total of 60 patients of primary dysmenorrhea were randomized into an intensified dose group and a conventional dose group. All of the patients were treated with moxibustion. In the intensified dose group, the treatment was given three times daily (once every morning, afternoon and at bedtime successively) and during the trial, 1 case was dropped out and 29 cases were included in the statistical analysis finally. In the conventional dose group, the treatment was given once daily and 1 case was dropped out during trial and 29 cases were included in the statistical analysis. The score of visual analogue scale (VAS) at the worst painful time point, the score of dysmenorrhea symptoms and recurrence rate were observed and compared before and after treatment in the patients between the two groups. The clinical therapeutic effects were observed in the two groups too. ResultsVAS difference value (D-value) and dysmenorrhea symptoms D-valuebefore and after treatment in the intensified dose group were higher than those in the conventional dose group respectively (both P < 0.05). The recurrence rate was 14.29% in the intensified dose group, lower than 42.31% in the conventional dose group, with the statistical significance (P < 0.05). The total clinical effective rate was 96.55% in the intensified dose group, higher than 89.66% in the conventional dose group, with the statistical significance (P < 0.05). ConclusionCompared with the conventional dose moxibustion, moxibustion with intensified dose achieves satisfactory therapeutic effect on primary dysmenorrhea of cold congelation and blood stasis type. This therapy is low in recurrent rate and convenient in manipulation, thus it deserves to be promoted in clinical application.

Love in Cold Blood: Are Reptile Owners Emotionally Attached to Their Pets?

ABSTRACT A growing number of reptiles are being kept as companion animals in private households, and this has resulted in a concomitant rise in welfare concerns. Poor welfare has been linked to a lack of the emotional attachment in other groups. The aim of this study was to investigate owner attachment to pet reptiles, grouped as lizards, snakes, and tortoises. The Lexington Attachment to Pets Scale (LAPS) questionnaire was administered online to a self-selected sample of 2,992 adult reptile owners, including 1,281 owners of both reptiles and dogs. The latter responded first for reptiles and then for dogs. Findings revealed evidence of an emotional attachment toward reptiles that was within the range of those observed in traditional pets. In addition, owners had a stronger attachment to lizards than snakes or tortoises and were also more attached to snakes than tortoises. Owners with both dogs and reptiles showed significantly higher attachment scores to their dogs than to reptiles. However, attachment scores for dogs were higher than those found in other studies. This work reveals strong evidence for a human–reptile attachment and suggests that instances of poor welfare may not result from a lack of attachment but rather a lack of knowledge.

Comparative Study Between Custodiol® versus Cold Blood Cardioplegia for Myocardial Protection in Double Valve Replacement Surgery

&#x0D; &#x0D; Background: Several cardioplegic solutions are available for myocardial preservation. The superiority of intracellular over extracellular cardioplegia is still debated. Our study aimed to compare the results of Custodiol® and blood Cardioplegia for myocardial protection in double valve replacement surgery.&#x0D; Methods: This is a prospective study that included 301 patients. We grouped the patient into; Group A (n= 135) had Custodiol® cardioplegia, and Group B (n= 166) had cold blood cardioplegia. We included patients who had double valve surgery and excluded redo, emergency procedures, and patients who had concomitant coronary artery bypass grafting.&#x0D; Results: Patients in Group A were significantly younger (43 ±9 vs. 47 ±10, P&lt;0.001). There were 72 females (53.3%) in Group A and 71 (43.4%) in Group B (P= 0.09). The total bypass time was higher in group B (217± 40 vs. 179± 35 min, P&lt; 0.001). The cross-clamp time was comparable between groups (90± 31 vs. 85± 29 min, P= 0.15). The duration of mechanical ventilation (7 ± 1 vs. 12 ± 2 h, P&lt; 0.001), ICU stay (3± 0.7 vs. 4± 0.9, P&lt; 0.001) and hospital stay (8± 1 vs. 13± 3, P&lt; 0.001) were shorter in Group A. Postoperative wound seroma (5 (26.6%) vs. 60 (36.1%), P&lt; 0.001) and mortality (2 (1.5%) vs. 11 (6.6%), p= 0.042) were lower in Group A.&#x0D; Conclusion: Custodiol cardioplegia could be safe during double valve surgery. A larger randomized trial is required to confirm our findings.&#x0D;

Modified Technique for Retrograde Cerebral Perfusion during Hemiarch Aortic Replacement.

Background Uncertainty remains regarding the optimal method of brain protection for procedures that require repair or replacement of the aortic arch. We examined the early outcomes of a technique for brain protection in patients undergoing partial aortic arch (hemiarch) replacement that involves deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) of cold blood from the superior vena cava toward the end of the arrest interval. Methods During a recent 15-year interval, 520 patients underwent elective or urgent/emergent ascending aortic and hemiarch replacement as an isolated (47 patients) or combined (473 patients) procedure employing DHCA (mean nasopharyngeal temperature at circulatory arrest, 17.1°C and mean duration, 19.3 minutes) supplemented with RCP of cold blood from the superior vena cava toward the end of the arrest interval (mean, 6.7 minutes). The mean age of the patients was 59.5 years, and 65% were male. Results The in-hospital and 30-day mortality rates were 1.2% (six patients). Seven patients (1.4%) sustained a stroke and 19 patients (3.7%) had transient neurologic dysfunction that completely resolved by the time of hospital discharge. Four patients (0.77%) developed postoperative renal failure requiring dialysis. Twenty-one patients (4%) required ventilator support for >48 hours and five patients (0.96%) required a tracheostomy. The median hospital length of stay was 6 days. Conclusion DHCA with a brief interval of RCP is a safe and effective technique for brain protection during hemiarch aortic replacement. RCP reduces the duration of brain ischemia and permits removal of particulate matter and air from the arterial circulation.

Cardioprotection with Adenosine during Coronary Revascularization

Background: Postoperative cardiac dysfunction is a common cause of mortality and morbidity associated with CABG Surgery. Adenosine enhances tolerance of the myocardium to ischemic arrest. Therefore, the study on adenosine pre-treatment as an adjunct to cardioplegia in patients undergoing CABG will definitely help to provide better myocardial protection for better postoperative outcome.&#x0D; Methods: Quasi experimental study was done in the Department of Cardiac Surgery, NICVD during July 2012 to June 2014 with patients who underwent conventional CABG surgery. Patients were divided in two groups. Group A: Patients received at regular institutional high-potassium ([K+] = 20 mol/ l) cold (12 °C) blood cardioplegia. and Group B: Patients received 250 μg /kg bolus dose of adenosine pre-treatment, which was immediately followed by high-potassium cold (12 °C) blood cardioplegia after clamp-on. Patients were followed up to evaluate the degree of myocardial damage by measuring perioperative Troponin I, amount of inotropic support, time of assisted ventilation, arrhythmia and mortality.&#x0D; Results: Most of the patients in each group belongs to 51-60 years of age range. There was no difference regarding operative parameters in two groups. Time to arrest was significantly shorter in group B compared to group A, indicating that adenosine has the potential to enhance the efficacy of cardioplegic arrest. Plasma level markers of myocardial damage: cardiac Troponin I (cTnI) obtained from serial venous blood samples post-operatively were significantly lower in group B than group A (p&lt;0.05). There was significantly decreased requirement of inotrope in group B during first 24 hrs (p &lt;0.05).&#x0D; Conclusion: Decreased level of cardiac enzymes and lower inotropic requirement suggests that an optimal myocardial protection with less cellular damage is obtained with adenosine pre-treatment as adjunct to cold blood cardioplegia.&#x0D; Cardiovasc. j. 2021; 13(2): 128-134

Warm versus cold cardioplegia in cardiac surgery: A meta-analysis with trial sequential analysis

ObjectiveThis meta-analysis aimed to compare clinical outcomes of warm and cold cardioplegia in cardiac surgeries in adult patients, with trial sequential analysis (TSA) used to determine the conclusiveness of the results. MethodsElectronic searches were performed on PubMed, Medline, Scopus, EMBASE, and Cochrane library to identify all studies that compared warm and cold cardioplegia in cardiac surgeries. Primary end points were in-hospital or 30-day mortality, myocardial infarction, low cardiac output syndrome, intra-aortic balloon pump use, stroke, and new atrial fibrillation. Secondary end points were acute kidney injury, hospital length of stay, and intensive care unit length of stay. Prespecified subgroup analyses were performed for (1) studies published since publication of Fan and colleagues in 2010, (2) randomized controlled studies, (3) studies with low risk of bias, (4) coronary artery bypass graft surgeries, and (5) studies with cold blood versus those with cold crystalloid cardioplegia. TSA was performed to determine conclusiveness of the results, using on all outcomes without significant heterogeneity from studies of low risk of bias. ResultsNo significant differences were found between post-operative rates of mortality, myocardial infarction, low cardiac output syndrome, intra-aortic balloon pump use, stroke, new atrial fibrillation, and acute kidney injury between warm and cold cardioplegia. TSA concluded that current evidence was sufficient to rule out a 20% relative risk reduction in these outcomes. ConclusionsConcerning safety outcomes, current evidence suggests that the choice between warm and cold cardioplegia remains in the surgeon's preference.

Modeling and Simulation of an Invasive Mild Hypothermic Blood Cooling System

Nowadays, mild hypothermia is widely used in the fields of post-cardiac arrest resuscitation, stroke, cerebral hemorrhage, large-scale cerebral infarction, and craniocerebral injury. In this paper, a locally mixed sub-low temperature device is designed, and the cold and hot water mixing experiment is used to simulate the human blood transfer process. To set a foundation for the optimization of the heat transfer system, the static characteristics are analyzed by building the mathematic model and setting up the experimental station. In addition, the affection of several key structure parameters is researched. Through experimental and simulation studies, it can be concluded that, firstly, the mathematical model proved to be effective. Secondly, the results of simulation experiments show that 14.52 °C refrigeration can reduce the original temperature of 33.42 °C to 32.02 °C, and the temperature of refrigerated blood rises to 18.64 °C, and the average error is about 0.3 °C. Thirdly, as the thermal conductivity of the vascular sheath increases, the efficiency of the heat exchange system also increases significantly. Finally, as the input cold blood flow rate increases, the mass increases and the temperature of the mixed blood temperature decreases. It provides a research basis for subsequent research on local fixed-point sub-low temperature control technology.

Patient-reported symptoms during dialysis: the effect of pre-dialysis extracellular water and change in extracellular water post-dialysis

BackgroundQuality of life for haemodialysis (HD) patients may be affected by symptoms during dialysis treatments, and patient groups have highlighted the need to improve post-dialysis fatigue and dialysis-related symptoms. As changes in extracellular water (ECW) may lead to cramps and other symptoms, we wished to determine whether there was an association between ECW and intra-dialytic symptoms.MethodsWe reviewed the hospital records of HD patients who completed a self-reported intra-dialytic symptom questionnaire, using a visual analogue scale, who had contemporaneous pre- and postdialysis bioimpedance ECW measurements adjusted to height (aECW).ResultsWe studied dialysis sessions of 506 patients, 314 (62.1%) male, 226 (44.7%) diabetic, mean age 64.6 ± 15.7 years, weight 69.9 ± 17.4 kg, and duration of dialysis treatment 26 (9.6–60.1) months. We divided patients into three groups according to pre-dialysis aECW, and total dialysis symptom scores were greater for those in the lower tertile (25 (10–41) vs middle 18 (8.5–34) vs upper 20 (7–31), p < 0.05). Only feeling cold, dizziness, and low blood pressure were statistically different between the three pre-dialysis aECW groups, and there was no difference in post-dialysis recovery times.We analysed the effect of the fall in aECW pre-to post-dialysis. Patients in the group with the greatest fall in aECW did not report more intra-dialytic symptoms or longer recovery times.ConclusionWe found that patients starting dialysis with lower relative ECW were more likely to report intra-dialytic symptoms than those with greater amounts of fluid to remove, and most commonly reported symptoms were associated with intra-vascular volume depletion.

Effects of cold and hot temperature on metabolic indicators in adults from a prospective cohort study

BackgroundPrevious studies have found that exposed to low and high outdoor temperature was associated with cardiovascular diseases morbidity and mortality. The risk factors for cardiovascular disease include high blood lipid, high uric acid (UA) and high fasting plasma glucose (FPG). However, few studies have explored the effects of low and high temperature on these metabolic indicators. ObjectiveTo explore the effect of low and high temperature on metabolic indicators in adults from northwest of China. MethodsBased on a prospective cohort study, a total of 30,759 individuals who participated in both baseline and first follow-up from 2011 to 2015 were selected in this study. The meteorological observation data and environmental monitoring data were collected in the same period. Associations between cold and hot temperature and blood lipid (total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein-cholesterol (HDL-C)), UA and FPG were conducted with mixed effect models after adjusting for confounding factors. ResultsA nonlinear relationship between outdoor temperature and metabolic indicators was found. For the cold effects, each 5 °C decrease of mean temperature was associated with an increase of 5.07% (95% CI: 3.52%, 6.63%) in TG and 2.85% (95% CI: 2.18%, 3.53%) in UA, While a decrease of 3.38% (95% CI: 2.67%, 4.09%) in HDL-C and 1.26% (95% CI: 0.48%, 2.04%) in LDL-C. For the heat effects, each 5 °C increase in mean temperature was associated with 1.82% (95% CI: 0.89%, 2.76%), 0.56% (95% CI: 0.11%, 1.00%), 5.82% (95% CI: 4.58%, 7.06%), 9.02% (95% CI: 7.17%, 10.87%), 0.20% (95% CI: 0.01%, 0.40%), and 1.22% (95% CI: 0.19%, 2.24%) decrease in TC, TG, HDL-C, LDL-C, UA and FPG. Age, smoking, drinking, high-oil diet and hyperlipidemia might modify the association between mean temperature and metabolic indicators. ConclusionThere was a significant effect of cold and hot temperature on metabolic indicators in a high altitude area of northwestern China. These results provide a basis for understanding the underlying mechanism of the influence of temperature on metabolic diseases.

Effect of Cardioplegia for Myocardial Protection in Pediatric Cardiac Surgery: A Network Meta-Analysis

Cardioplegia has been widely used to reduce myocardial injury during pediatric cardiac surgery; however, which cardioplegia solution has the best protective effect has not been established. Thus, we compared the myocardial protective effects of different cardioplegia solutions used in pediatric cardiac surgery. Seven databases were searched to identify the relevant randomized controlled trials. A network meta-analysis with a Bayesian framework was conducted. The outcomes included the following biochemical and clinical outcomes: serum concentrations of the creatine kinase-myocardial band at 6 h postoperatively; cardiac troponin I (cTnI) at 4, 12, and 24 h postoperatively; spontaneous beating after declamping; postoperative arrhythmias; inotropic support percentage and duration; mechanical ventilation hours; intensive care unit stay in days; hospital stay in days; and mortality. The group treated with cold crystalloid cardioplegia (cCCP) was chosen as the control group. The 22 studies involved 1529 patients. Six types of cardioplegia solutions were described in these studies, including cold blood cardioplegia, cCCP, del Nido, histidine-tryptophan-ketoglutarate (HTK), terminal warm blood cardioplegia, and warm blood cardioplegia (wBCP). The serum concentrations of the 24-h cTnI with wBCP (MD = −2.52, 95% CI: −4.74 to −0.27) was significantly lower than cCCP. The serum concentrations of the 24-h cTnI with HTK (MD = 4.91, 95%CI: 2.84–7.24) was significantly higher than cCCP. There was no significant difference in other biochemical and clinical outcomes when compared to cCCP. In conclusion, wBCP may have a superior myocardial protective effect with lower 24-h cTnI levels postoperatively and similar clinical outcomes after pediatric cardiac surgery.

Custodiol versus extracellular crystalloid cardioplegia in mitral valve replacement in patients with low ejection fraction

Background The use of cardioplegia solution is aimed to avoid myocardial muscle damage, leading to poor contraction and abnormal increased release of cardiac biomarkers enzymes during cardiac arrest. It remains the primary method for myocardial protection against ischemia–reperfusion injury during cardiac surgery. Cardioplegia was first presented as an agent for hypothermic hyperkalemic arrest. Blood was then introduced as a vehicle to convey potassium to the heart. Histidine–tryptophan–ketoglutarate solution is safe and used as a single dose that can last for up to 3 h. Comparison between custodiol cardioplegia and cold blood cardioplegia still remains a big debate till now. Objective To compare the clinical outcomes of custodiol solution with cold blood cardioplegia in mitral valve replacement (MVR) with cardiac ejection fraction less than 45%. Patients and methods This single‑center randomized prospective study was carried out from January 2018 till June 2019 at Ain Shams University hospitals. Overall, 65 patients with poor left ventricular function undergoing mitral valve replacement were divided randomly according to type of myocardial protection into two groups: group A included 30 patients who received custodiol cardioplegia, and group B included 35 patients who received cold blood cardioplegia. Data from each group were collected and compared with each other. Results Baseline demographic and intraoperative data showed no significant difference between the two groups. The need for inotropic support, length of mechanical ventilation, and ICU stay were statistically nonsignificant between the two groups. There was a statistically significant difference regarding the rhythm upon declamping [ventricular fibrillation (VF) in 17 (56.7%) cases in group A and nine (25.7%) cases in group B (P=0.016)], and also there was a significant difference in times of defibrillation cardioversion (DC) shock given after declamping (P=0.005). Overall mortality shows a statistically nonsignificant difference. There is a significant difference in postoperative echo assessment for both groups [ejection fraction in group A: 53.17±7.73 compared with 49.06±7.170 in group B (P=0.031)], and there is also a difference in hemoglobin postoperatively, with 10.35±0.843 in group A compared with 10.88±0.798 in group B (P=0.013). Conclusion Cardiac arrest using custodiol cardioplegia is a good choice in mitral valve replacement with the advantage of giving only one dose of cardioplegia without interruption of the operation, and also it gives good postoperative echo results than cold blood cardioplegia. Its disadvantages are lower hemoglobin levels postoperatively and hyponatremia during bypass in comparison with cold blood cardioplegia.

Historicising David Attenborough’s nature: nation, continent, country and environment

ABSTRACT Recognising his association with Australia over the course of decades, this essay explores how Sir David Attenborough’s programmes ‘remake’ Australian nature for global audiences. It examines not only Attenborough himself, but offers equal weight to the human and nonhuman world he brings to audiences. Offering an examination of ‘blue chip’ natural history programming and the two series that bookend Attenborough’s work as a presenter ‘in’ and ‘of’ Australia – Quest Under Capricorn (1963a, 1963b, 1963c and 1963d) and Life in Cold Blood (2008a, 2008b), it is attuned to historical and contemporary cultures of colonisation and how these are located within the values and practices of blue-chip natural history programming.

Relation between Exercise Performance and Blood Storage Condition and Storage Time in Autologous Blood Doping.

Simple SummaryAutologous blood doping (ABD) refers to sampling, storage, and re-infusion of one’s own blood to improve circulating red blood cell (RBC) mass and thus the oxygen transport and finally the performance capacity. This illegal technique employed by some athletes is still difficult to detect. Hence knowledge of the main effects of ABD is needed to develop valid detection methods. Performance enhancement related to ABD seems to be well documented in the literature, but applied study designs might affect the outcome that was analyzed herein. The majority of recent studies investigated the effect of cold blood storage at 4 °C, and only few studies focused on cryopreservation, although it might be suspected that cryopreservation is above all applied in sport. The storage duration—the time between blood sampling and re-infusion—varied in the reported literature. In most studies, storage duration might be too short to fully restore the RBC mass. It is thus concluded that most reported studies did not display common practice and that the reported performance outcome might be affected by these two variables. Thus, knowledge of the real effects of ABD, as applied in sport, on performance and associated parameters are needed to develop reliable detection techniques.Professional athletes are expected to continuously improve their performance, and some might also use illegal methods—e.g., autologous blood doping (ABD)—to achieve improvements. This article applies a systematic literature review to investigate differences in the ABD methods and the related performance and blood parameters owing to different storage conditions—cryopreservation (CP) and cold storage (CS)—and different storage durations. The literature research resulted in 34 original articles. The majority of currently published studies employed CS during ABD. This contrasts to the applied storage technique in professional sports, which was mainly reported to be CP. The second outcome of the literature research revealed large differences in the storage durations applied, which were in the range of one day to 17 weeks between blood sampling and re-infusion, which might affect recovery of the red blood cell mass and thus performance outcome related to ABD. Data revealed that performance parameters were positively affected by ABD when a minimal storage duration of four weeks was adhered. This article identified a need for further research that reflect common ABD practice and its real effects on performance parameters, but also on related blood parameters in order to develop valid and reliable ABD detection methods.

Myocardial Protection by Retrograde Application of HTK Solution Compare with Cold Blood Cardioplegic Solution during Heart Valve Surgery

Objective: Cardioplegic solution is one important principle for adequate myocardial protection in cardiac surgery. Bretschneider’s histidine-tryptophan-ketoglutarate (HTK) solution is an intracellular solution while blood cardioplegia solution is an extracellular solution. Both have been used to preserve the myocardium. The present study compared between the two cardioplegic solutions for incidence of ventricular fibrillation after aortic clamp removal in double valve replacement (DVR) and tricuspid annuloplasty (TVA) to assess the effectiveness for myocardial protection. Materials and Methods: A retrospective study was conducted among patients who underwent DVR with TVA operations between January 1, 2013 and June 30, 2017 and divided in two groups at Queen Sirikit Heart Center of the Northeast. The medical records were searched for detailed demographics, preoperative status, operative technique, and post-operative hospital course. Results: Thirty-six patients were included in the present study, 18 patients received HTK solution, the others received blood cardioplegia. The demographic data presented no statistical difference between the two groups. Incidence of ventricular fibrillation after aortic clamp removal occurred in 10 patients (55.6%) in the HTK group, which was more than the cold blood group [five patients (27.78%)]. Cardiopulmonary bypass (CPB) and aortic cross clamp time in the cold blood group was significantly longer than in the HTK group (p&lt;0.001). The peak of Trop-T and CK-MB within six hours after surgery tended to be downward after 24 hours and was not related to perioperative myocardial ischemia in the HTK group. No statistically difference was observed in postoperative outcome, ICU stay, or hospital stay. Conclusion: The use of HTK solution has no significant different outcome compared to conventional cold blood cardioplegia via retrograde route in DVR with TVA operation. There was no significantly different incidence of ventricular fibrillation and there was no evidence of postoperative myocardial infarction. CPB and aortic cross clamp time in the HTK group were shorter than in the cold blood cardioplegia significantly. Keywords: Cardioplegia, HTK, Custodiol, Ventricular fibrillation

Hybrid coronary revascularization with endoscopic closed-chest arterial coronary bypass technique (endo-CABG)

Abstract Introduction Treatment of three-vessel coronary disease in minimally invasive manner could be complex in some cases. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) gives good patency rates which outlive vein grafts. The hybrid approach, combination of PCI with minimally invasive endoscopic coronary artery bypass graft (endo-CABG), might be a valuable option for treatment of multivessel coronary disease. Hereby we describe our series of patients undergoing arterial revascularization of the anterior and/or lateral wall combined with PCI of the right coronary artery or a marginal branch. Methods From March 2013 until December 2019, 208 patients (82.2% males, mean age: 66.69±10.44 years) underwent hybrid coronary revascularization for multivessel disease. Patients with multivessel disease suitable for hybrid approach were accepted at the heart team. All patients received total arterial revascularisation by endo-CABG. The PCI was prior or after the endo-CABG. There was no discontinuation of dual platelet therapy. Uni or bilateral internal mammary artery (IMA) harvesting was performed through three 5mm endoscopic ports in the 2nd, 3rd and 4th intercostal space. Cardiopulmonary bypass was established using a minimally invasive extracorporeal circulation (MiECC) with groin cannulation. Transthoracic aortic cross-clamping was followed by antegrade administration of a single shot cold mixed blood cardioplegia. A utility port of three centimeter was used for direct vision anastomosis. Results The procedure was successful in all patients, requiring no conversion to full sternotomy. Mean cross-clamping and cardiopulmonary bypass times were 44.38±28.33 and 91.75±37.97 minutes, respectively, with a mean of 2.1±0.91 bypasses for each patient. All patients received total arterial revascularization. The mean ICU and hospital length of stay were 62.5±39.74 hours and 8.80±4.64 days, respectively. Average postoperative blood loss over 24 hours was 555.20±859.19 mL. There were 8 re-interventions on the target vessels (3.8%) and 2 patients suffered from a stroke (1%). The 30-day mortality rate was 0.5%. Conclusion Minimally invasive hybrid arterial coronary revascularization is a safe and valuable alternative to coronary artery bypass grafting in many patients with multivessel coronary artery disease. The endo-CABG is a safe and feasible technique without compromising operative morbidity and providing good postoperative results. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Jessa Hospital

COMPARISON STUDY: INTERMITTENT ANTIGRADE WARM CARDIOPLEGIA VERSUS ANTIGRADE COLD INTERMITTENT BLOOD CARDIOPLEGIA FOR MYOCARDIAL PROTECTION DURING ELECTIVE ON PUMP CORONARY ARTERY BYPASS GRAFTING IN EARLY POST-OPERATIVE PERIOD

Background: Defending the heart against potential damage during cross-clamping is the most important and vital step to ensuring a successful surgical outcome(1). The creation of cardioplegia solutions was one of the major advances in cardiac surgery that allowed surgeons to conduct complicated surgical procedures to avoid myocardial injury (14). Treating cardioplegia at a cool temperature would be a significant factor in lowering myocardial metabolism. However, the reduction in myocardial metabolism due to hypothermia, compared with that achieved by diastolic arrest, is usually very negligible. Since Normothermias enzymatic and cellular processes work better (7). Owing to the propensity of the heart to resume electrical operation during normothermia, however, this must be administered consistently or only with short interruptions (4). Terminal warm blood cardioplegia (hot shot) is normally done just before the elimination of the aortic cross-clamp since it has been demonstrated that myocardial metabolism is increasing (23). Methods: A prospective controlled randomised study (200 hundred patients aged 40 to 65 years of both sexes underwent elective CABG pump surgery) will be included. They will be divided into three groups of patients: Group I:includes 100 Patients who received intermittent cold blood cardioplegia. Group II:includes 100 Patients who received intermittent warm blood cardioplegia with controlled reperfusion for 3 minutes before aortic unclamping. Study made from January, 2019 to August, 2020, at National Heart Institute.All patients were thoroughly evaluated preoperatively, intraoperatively, and postoperatively. Results: We hypothesized that in our patient cohort, warm blood cardioplegia could be as successful as or even better than the conventional antegrade cold blood cardioplegia. Patients were randomised into two similar blocks, each of which consisted of 100 patients, each of whom obtained one of the two cardioplegic solutions. Our analysis did not indicate a statistically important difference in the post-operative release of myocardial biomarkers (Troponin I) &amp; CK in both classes. This finding did not significantly reflect the clinical outcome of our patient, which may indicate similar myocardial protection in primary low-risk CABG patients for both cold and warm blood cardioplegia. Conclusion: During the time of cardiac arrest, both methods tend to enable an equal and adequate approach for myocardial defence. To attain improved myocardial defence, warm blood cardioplegia needs a shorter administration interval. Therefore, the choice between one type of cardioplegia and the other remains at the discretion of the surgeon. The statistically minor variation found in the release of myocardial enzymes did not translate into distinct clinical results.

Mercury levels in pregnant women in Japanese general population and child birth size

In Japan, approximately 80-90% of human mercury (Hg) exposure is derived from fish consumption. In Japan, a methyl-Hg (MeHg) poisoning due to intake of contaminated fish, Minamata Disease occurred in 1956. Since then, Japanese government established environmental standards and emission reduction and guidelines to maintain fish intake. Consequence, MeHg intake remained unchanged since 1994, as mean levels of 8.4 µg/person/day among Japanese general population. In this presentation, we introduce birth cohort studies conducted in Japan, and discuss their association to children’s birth size.We have conducted the Hokkaido study on Environment and Children’s Health: Sapporo cohort. Pregnant women were enrolled in 2002 to 2005, with total 514 agreement. The maternal hair Hg levels of 1.41 µg/g at delivery. Prenatal exposure to MeHg has no association with newborn anthropometric measurements, although the incidence of babies born small-for gestational age by weight may reduce with higher concentrations of Hg in hair. Fish is the main exposure source of Hg but also of long-chain polyunsaturated fatty acids. High frequency of fish consumption may mask the adverse effects of MeHg on birth size with the beneficial effect of essential nutrition. Other studies in Japan are 1. Tohoku region of Japan with 486 infants in 2001-2003. Median total Hg in whole cold blood is 10.1 ng/g and found no association with a reduction of birth weight among all infant. 2. Japan Environment and Children’s Study with approximately 100,000 mothers enrolled from 2011-2014. Total Hg in maternal blood were median 3.66 ng/g. Only slight association was found that compared to infants of lowest maternal Hg quartile, infants of highest maternal Hg quartile had a reduced birth head circumference. Consider as a whole, the results suggest that there are no associations with prenatal Hg exposure and birth size at this level.

O nonfiction novel em paralaxe: duas leituras possíveis de In Cold Blood, de Truman Capote

Este artigo busca, através de uma discussão sobre a dupla natureza discursiva da obra In cold blood (1965), de Truman Capote, apontar para duas leituras feitas do gênero ícone do jornalismo literário estadunidense: a primeira desvela os traços que fariam do gênero um legítimo “romance de não-ficção”, tal como sugeriu Capote; a outra sonega esta nomenclatura. Valemo-nos de uma análise da obra segundo as premissas da Reader-Response Criticism, avaliando as relações de texto, contexto e leitura, conforme advoga Richard Beach (1993), exame cujos traços salientam as nuances de caráter sócio-histórico e a estrutura dos elementos referenciados. Esses traços serão pensados de acordo com a atmosfera de produção da obra, relacionados, ainda, com os tipos de abordagem que alguns analistas elucidaram sobre o gênero. Nesse âmbito, buscamos problematizar, a partir da avaliação de duas leituras da obra, o desacordo em termos de gênero. Propomos um estudo metodologicamente pautado nas observações de Beach (1993), mas também nos serão de grande utilidade as leituras do romance feitas, primeiro, por Jesse Brady (2006), e, posteriormente, por Philip K. Thompkins (1968), Gerald Clarke (1989) e Ralph Voss (2011).