Continuous Blood Research Articles

Effect of baicalin and glycyrrhizin on enrofloxacin in vivo in crucian carp (Carassius auratus gibelio)

Cytochrome P450s(CYPs) widely distribute in the liver of aquatic organisms and play a key role in drug metabolism.CYPs catalyze the N-deethylation of Enrofloxacin(ENR) to Ciprofloxacin(CIP).However,there is limited information regarding the action of CYPs in ?sh.We evaluated the metabolism of ENR following oral administrated of baicalin(100 mg/kg) and glycyrrhizin(100 mg/kg) in crucian carp,Carassium auratus gibelio.We measured the enzymatic activity of cytochrome P450 1A(CYP1A) and 3A(CYP3A) in liver microsomes.In addition,we documented the pharmacokinetics of ENR by continuous blood sampling.The absorption of ENR decreased significantly over time and both Cmax and AUC also deceased.AUC and t1/2z decreased signficantly whereas CL inceased after oral administrated of baicalin and glycyrrhizin,suggesting that ENR elimination was accelerated.The Cmax CIP/Cmax ENR was 1.48% and 2.22% for the BL and GZ groups,respectively(control: 0.95%).The AUC0-t-CIP/AUC0-t-ENR was 2.16% and 1.76% for the BL and GZ groups,respectively(control: 1.7%).Thus,BL and GZ contributed to induce N-deethylation of ENR.Pretreatment with BL and GZ was associated with a significant(P0.05) incease in ethoxyresorufin-O-deethylation(EROD) and erythromycin-N-demethylation(ERND) activity,the specific probes for CYP1A and CYP3A,respectively.In summary,BL and GZ accelerated the elimination of ENR.Furthermore,production of the ENR metabolite was related to the induction of CYP1A and CYP3A enzymatic activity.

Continuous flow blood pumps: the new gold standard for advanced heart failure?

Consider the familiar phrase ‘cardiac transplantation sets the gold standard for the treatment of severe heart failure’. Does this still ring true? For the advanced heart failure (AdHF) patient, the primary objective is to provide symptomatic relief from intolerable breathlessness, lethargy and fatigue [1]. The secondary aim, conditional upon the primary objective being met, is to extend life. Neither is accomplished easily in refractory Stage D heart failure (New York Heart Association (NYHA) IV). Conventionally, at this stage, only cardiac transplantation or palliative care options remain. The former may offer symptomatic relief and extended life for a carefully selected minority [2]. In contrast, opiates or inotropes may accelerate death for the great majority. These patients typically experience at least three periods of hospitalization during their last 6 months of life. The costs of dying are considerable, and the end-of-life/dying trajectory notoriously difficult to predict for any individual [3].

Successful use of a novel continuous intra-arterial blood glucose monitoring device under development in ICU patients following cardiac surgery

Successful use of a novel continuous intra-arterial blood glucose monitoring device under development in ICU patients following cardiac surgery

1C14 連続流血液ポンプ内部を想定した非定常せん断流中での赤血球変形の解析(GS19-2:人工臓器(2))

1C14 連続流血液ポンプ内部を想定した非定常せん断流中での赤血球変形の解析(GS19-2:人工臓器(2))

Effect of Continuous Arterial Blood Flow of Intra-Aorta Pump on the Aorta - A Computational Study

In this study, a computational fluid dynamics (CFD) study based on a finite element method (FEM) was performed for the human aorta with four different flow time patterns (healthy to full intra-aorta pump support). Fully coupled fluid-solid interaction (FSI) simulation was used to investigate the flow profiles in the aortic arch and its branches where the maximum disturbed and non-uniform flow patterns, and the wall shear stress profiles on the same areas. The blood flow was assumed as a homogeneous, incompressible, and Newtonian fluid flow. Flow across four inlets of aortas was derived from a lumped parameter model (LPM). The inlet flow rate waveforms were divided by different blood assist index (BAI), and were calculated with the physiological information of a heart failure patient.

Continuous Cardiac Stroke Volume Monitoring Leads to Early Detection of Cardiac Tamponade in the Percutaneous intracardiac Intervention

Background: Cardiac tamponade is one of the major complications which can result from catheter-based cardiac management, and if its detection or treatment is delayed, it can be fatal. Detecting cardiac tamponade in the earliest possible stages is crucial for preventing its development into a life threatening condition. Methods and results: In this study, an internal blood pressure reading was conducted as part of catheter ablation, cardiac electro physiologic study, and bi-ventricular pacing treatments, and this blood pressure wave form was used along with a FloTrac system to produce a continuous estimate of cardiac output. These data were then retrospectively analyzed to determine whether the FloTrac cardiac output showed changes prior to the onset of declining blood pressure, which is the typical indicator used to diagnose cardiac tamponade. The study was conducted on 213 subjects who were undergoing catheter ablation, cardiac electrophysiologic study, and bi-ventricular pacing treatments. Out of this group, 4 (1.9%) were diagnosed with cardiac tamponade. The FloTrac data for all of these cardiac tamponade subjects showed a decline in stroke volume and cardiac output, with the onset of these changes coming an average of 15.5 ± 6.2 minutes and 8.7 ± 1.0 minutes respectively in advance of the onset of declining blood pressure measurements from the internal blood pressure readings. Conclusion: Continuous cardiac output measurements can be used to detect cardiac tamponade at an earlier stage than continuous internal blood pressure readings, and this could enable accelerated treatment of these complications.

The significance of ecthyma gangrenosum in early diagnosis of pseudomonas aeruginosa sepsis in chidren

Objective To summarize the characteristics of ecthyma gangrenosum and explore its significance in early diagnosis of pseudomonas aeruginosa sepsis in children.Methods We retrospectively reviewed the medical records of 11 children with ecthyma gangrenosum who were hospitalized at Guangzhou women and children's medical center between May 2008 and Apr 2011.Results Eight cases were male and 7 were less than twelve months,the oldest was 2 years old,all of them were diagnosed as Pseudomonas aeruginosa spesis.Two patients had a single lesion,and the others had multiple lesions.Ecthyma gangrenosum located on the trunks in 7 cases,on anogenital areas in 5 cases,on extremities in 5 cases and on faces in 3.The lesions appeared on day 2 to day 10.On average,they developed on day 5.Seven patients developed ecthyma gangrenosum before admission,the course of the illness before admission was 6 days.Fever and multiple organ dysfunction occurred in all the patients and their cultures grew pseudomonas aeruginosa,blood cultures were positive in 8 cases,the others were isolated psudomonas aeruginosa from tissue of the lesion,discharge,ascites,pleural effusion,respectively.The time of ecthyma gangrenosum appeared was earlier than the time of the culture results reported.All of the patients were started empiric antibiotics therapy on admission,the initial antibiotic regimen was appropriate in 9 patients,8 needed surgical intervention,4 were treated with continuous blood purification.Ten patients survived and 2 died,the hospital stay was from 1 to 63 days,the average was 30.Conclusion Ecthyma gangrenosum is a known cutaneous manifestation of pseudomonas aeruginosa sepsis,which is helpful for early diagnosis and treatment,and then the outcome will be improved. Key words: Ecthyma gangrenosum ; Pseudomonas aeruginosa; Sepsis; Children

Accuracy of continuous glucose monitoring system during exercise in Type 2 Diabetes

a b s t r a c t The concordance of continuous glucose monitoring system (CGMS) and finger-stick blood glucose (FSBG) was assessed in patients with type 2 diabetes during daily activities and two different exercise sessions. Agreement between FSBG and CGMS becomes weaker during exercise, but more than 90% of the CGMS readings are within acceptable range.

Effect of Long-Term Circulatory Support on Arterial Wall: Comparison of Histological Findings in Pulsatile and Continuous Flow Blood Pump Recipients

Effect of Long-Term Circulatory Support on Arterial Wall: Comparison of Histological Findings in Pulsatile and Continuous Flow Blood Pump Recipients

Development of a Treatment Agent for Mass Casualty Smoke-Cyanide Exposure

Smoke inhalation is the major cause of death in fire victims. Combined cyanide and carbon monoxide poisoning is frequent in smoke inhalation victims, and mortality correlates more closely with cyanide levels than carbon monoxide exposure levels. There is currently no available treatment for mass casualty cyanide exposure, since treatment of individual victims requires administration of intravenous antidotes, and some antidote agents are contraindicated in smoke inhalation. We are developing a novel cyanide antidote, cobinamide, which could be administered intravenously or intramuscularly in mass casualty cyanide poisoning scenarios. Because cyanide antidotes cannot be tested for efficacy in humans, animal studies must be performed to demonstrate effectiveness of this agent in combined smoke-cyanide inhalation for FDA approval.METHODS: Six ventilator-supported New Zealand white rabbits were exposed to cold smoke breaths until toxic carbon monoxide levels were achieved (~30%), concurrent with intravenous cyanide infusion (0.167mg NaCN in 0.9% NaCl/min for 60 minutes). Animals were monitored with continuous gas exchange, hemodynamics, blood gases, cyanide levels, and diffuse optical spectroscopy, providing tissue oxy-and deoxyhemoglobin and cytochrome c oxidase measures in vivo. Intravenous cobinamide was administered in treatment arm animals and compared to control responses.RESULTS: Intravenous cobinamide reversed cyanide toxicity in these animals in the face of smoke induced carbon monoxide exposure, without evident adverse effects.CONCLUSIONS: Intravenous cobinamide shows promise as a potential antidote for cyanide poisoning in smoke inhalation victims, and an intramuscular formulation could potentially be administered in mass casualty exposure scenarios. Further validation and safety studies will be required for FDA approval of this promising agent.CLINICAL IMPLICATIONS: Treatment of fire smoke inhalation victims.DISCLOSURE: The following authors have nothing to disclose: Sasan Sani, Jangwoen Lee, Rene Patino, David Mukai, David Yoon, Sari Mahon, Gerry Boss, Steve Patterson, Matthew BrennerNo Product/Research Disclosure InformationBeckman Laser Institute, Irvine, CA. Language: en

Anemia, heart failure and exercise training

We read with interest the recent article by Wang et al. in which theauthors evaluated in anemic patients with heart failure whether exer-tionalperiodicbreathing influences rheological/hemodynamicfunctions[1]. For this purpose, the authors performed an incremental exercisetestusing a bicycle ergometer. In this regard, it has been generally assumedby some researchers, exercise physiologists and scientists that the incre-ment in blood hemoglobin (Hb) content is among the main hematolog-ical adaptations to endurance exercise training. This misconception isbased in the data published in diffe rent studies carried out severalyearsago [2].Inarecentmanuscript byBakeretal. [3],theauthorsdem-onstrated that endurance exercise training increases hematopoiesis,enhancing skeletal muscle hematopoietic cytokine expression, and mo-bilizing medullary hematopoietic stem and progenitor cell content. Themainconclusionofthisstudywasthatendurancetrainingshouldbecon-sidered as a strategy for blood donor preconditioning. The authors alsosuggestthatitwouldbeusefulasaphysiologicaladjuvantforautologousbonemarrowtransplantationorasa first-steptherapyforsomeformsofanemia. In our opinion, and in accordance with the results showed byWangandcollaborators,theseassumptionsarequestionableandagainstthe vast majority of experimental evidence.For instance, in 2000, Bojadjiev and Taralov found that continuous(formorethanoneyear)high-intensitysportstrainingcausedadecreasein blood Hb concentration in pubescent boys and girls [4].Twoyears

Abstract 222: Combination of Blood Cardioplegic and Strategic Reperfusion Period Leucodepletion During Cardiopulmonary Bypass Preserves the Cardiac and Pulmonary Function: A Prospective Randomized Controlled Study

Objectives: Leucocytes activation during cardiopulmonary bypass (CPB) contributes to postoperative organ dysfunction. We compared the outcomes of various leucodepletion strategies in patients undergoing coronary artery bypass grafting (CABG). Methods: One hundred-twenty low-risk patients undergoing first time CABG were prospectively randomized to six groups: 1 non-leucodepletion arterial filtration; 2 continuous arterial leucodepletion; 3 reperfusion period leucodepletion; 4 leucodepletion of blood cardioplegia; 5 combination of continuous arterial and blood cardioplegic leucodepletion; 6 combination of blood cardioplegic and reperfusion period leucodepletion. Blood samples were taken 5 min before CPB, 5 and 30 min on CPB, 5, 60 min after aortic X-clamp removal and 6 h post-CPB. Activated leucocytes were identified with Nitroblue Tetrazolium staining. Exhaled nitro oxide (NO) was measured pre- and post-CPB using real-time chemiluminescense analyzer. Respiratory index (alveolar-arterial oxygenation index, AaOI) was calculated 5 min before CPB and 5 min on CPB, 1, 2, 4, 8 and 18 h post-CPB. Results: Activated white cell counts were similar before CPB in all groups, but reduced significantly 5, 60 min following aortic X-clamp removal, and 6 h post-CPB in groups 2, 3, 5 and 6, compared with group 1 (ANOVA p=0.02). Post-CPB, NO increased in all groups (p<0.05) except in Group 6 (3.17±0.64 vs. 3.63±0.79 ppb/s, p=0.22). Group 6 exhibited a lower AaOI than group 1 over all time points post-CPB (ANOVA, p=0.02). Postoperatively, there was a significant reduction in inotropic requirement, ventilation time and atrial fibrillation in group 6 (p=0.045, 0.04 and 0.043, respectively). There was no difference in chest drain output, length of ICU and hospital stay among all groups. Conclusions: Combination of blood cardioplegic and reperfusion period leucodepletion appeared to be most effective in attenuating activated leucocytes during CPB, which was associated with better preservation of cardiac and pulmonary function compared with other leucodepletion strategies.

Vasovagal syncope: poorly understood, but well handled

This editorial refers to ‘Cardiac autonomic disturbances in patients with vasovagal syndrome: comparison between iodine-123-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability’ by G. Kochiadakis et al ., on page 1352 In this issue of the Journal, Kochiadakis and co-workers from Heraklion University Hospital in Athens report on autonomic regulation in patients with vasovagal syncope (VVS) diagnosed with tilt table testing.1 They measured heart rate variability (HRV) and assessed cardiac sympathetic innervation using 123-I-meta-iodobenzylguanidine (MIBG) scintigraphy. The main finding of this study was that adrenergic cardiac innervation showed defects in the left ventricle in patients with VVS. This finding was not associated with the type of response (cardioinhibitory or vasodepressor) during tilt table testing. However, the study critics may object that the infrequent blood pressure measurements rather than continuous non-invasive blood pressure measurement during tilt table testing did not allow the accurate classification of the response. In contrast to this finding, HRV, as a marker of the resulting efferent vasomotor activity at the level …

Influence of demographic factors, basic blood test parameters and opioid type on propofol pharmacokinetics and pharmacodynamics in ASA I–III patients

The aim of the study was to examine population pharmacokinetics (PK) and pharmacodynamics (PD) of propofol (CAS 2078-54-8) during total intravenous anesthesia monitored by spectral frequency index (SFx). Twenty-eight patients of ASA physical status I-III (ASA: American Society of Anesthesiologists) scheduled for laparoscopic cholecystectomy were included. In group I an anesthesia was induced with a bolus of propofol (2 mg/kg) and remifentanil (CAS 132875-61-7) (1.0 microg/kg), followed by a continuous infusion of remifentanil. In group II, an alfentanil (CAS 71195-58-9) (10 microg/kg) bolus dose was followed by a continuous infusion of alfentanil. The general anesthetic technique included propofol, opioid and muscle relaxant. During anesthesia, the propofol infusion rate (3-8 mg/kg/h) was adjusted to the SFx value. Venous blood samples were collected from the patients during 240 min after termination of the infusion. A two compartment model was used to describe propofol PK. A standard effect compartment model was used to describe the delay between the effect and the concentration of propofol. The SFx index was linked to the effect site concentrations through a sigmoidal Emax model. The influence of continuous (body weight, age, blood pressure, heart rate and blood oxygenation, serum protein, the erythrocyte count, hemoglobin and hematocrit, serum creatinine and creatinine clearance) and categorical (gender and the type of opioid) covariates on the pharmacokinetic and pharmacodynamic parameters was investigated. PK/PD analysis was performed using NONMEM. All the screened covariates did not influence propofol PK and PD, except of the opioid type. The central compartment volume of propofol was larger in the presence of remifentanil than in the presence of alfentanil.

The T-Line TL-200 system for continuous noninvasive blood pressure measurement in medical ICU patients

The T-Line TL-200 (Tensys Medical Inc., San Diego, CA, USA) is a noninvasive arterial blood pressure (BP) monitoring system allowing continuous beat-to-beat monitoring of systolic arterial pressure (SAP), mean arterial pressure (MAP), and diastolic arterial pressure (DAP). It provides a real-time BP waveform like that obtained using an arterial catheter for BP monitoring. The aim of this study was to compare BP measurements obtained using the T-Line TL-200 system with simultaneous invasive BP measurements using a femoral arterial catheter in unselected critically ill medical patients.

A Design of Pulse-Wave Data Collection System

In this paper, a newly design of pulse-wave data collection system continuously and non-invasion by using the means of clip-on transmission oxygen sensor for getting information of pulse-wave, using the wave can calculate a number of important parameters of blood, it may solve the problem of real-time, continuous and dynamic blood flow monitoring in clinic, This design use sensor to get photoelectric volume pulse wave then the signal through amplification and filter circuit ,after then it is sent to A / D converter and DSP. The powerful instruction functions and fast processing speed DSP makes this design can quickly and easily detect the pulse wave signal. This design not only used for clinical care, but also can be used for community or family health care on detection of cardiovascular blood flow. This design can make the telemedicine care ture by DSP and the PC communication, It provides a simple and easy method to monitor the pulse-wave signal .

Hybrid treatment of an aortic arch aneurysm in a patient with a patent right and left internal mammary graft

The aim of this report is to describe a known hybrid surgical and endovascular technique for aortic arch aneurysm repair in a special setting of a patient with previous coronary mammary bypass. We present a case of aortic arch aneurysm in a 66-year-old man with previous coronary bypass. He underwent a hybrid endovascular and surgical repair. All supraaortic vessels were debranched, keeping a continuous antegrade blood flow through the left and right internal mammary arteries to avoid myocardial ischemia. Endovascular treatment of aortic arch aneurysms is associated with less mortality and morbidity as compared with open surgery. The hybrid procedure with surgical debranching of the supraaortic vessels is the most commonly used method. In cases of previous coronary bypass with mammary arteries, care must be taken to maintain constant flow through the grafts during debranching.

Stroke volume variation obtained with Vigileo/FloTrac™ system during bleeding and fluid overload in dogs

Stroke volume variation (SVV) is a parameter for estimating fluid responsiveness. Recently, the Vigileo™ and the Flo-Trac™ sensor (Edwards Lifesciences, Irvine, CA, USA) were made available for clinical use to estimate SVV. The aim of this study was to investigate the relationship between the circulating blood volume and SVV, measured by the Vigileo-FloTrac™ system (SVV-FloTrac) or by central venous pressure (CVP), during a dynamic change in circulating blood transfusion volume, using a continuous constant bleeding and fluid-overload model in dogs. Ten anesthetized and mechanically ventilated beagles were used. SVV-FloTrac and CVP were measured during a bleeding period (2ml/kg/min, 15min), a stabilization period (15min), a blood transfusion period (2ml/kg/min, 15min), and a 6% hydroxyethyl starch solution overload period (2ml/kg/min, 15min). SVV-FloTrac changed significantly when more than 8ml/kg blood was withdrawn or when more than 8ml/kg blood was transfused. The change in SVV-FloTrac directly reflected the circulating blood volume change during continuous bleeding and blood transfusion. CVP decreased significantly when more than 4ml/kg blood was withdrawn or when more than 10ml/kg was infused, and this indicated that the CVP change did not directly reflect the level of the circulating blood volume change. During the stable circulating blood volume period after blood withdrawal, SVV-FloTrac changed significantly but CVP remained constant. During the fluid overload period, CVP, but not SVV-FloTrac, changed significantly. SVV-FloTrac is a sensitive indicator of the dynamic circulating blood volume change during both bleeding and transfusion, but not during either the stable circulating blood volume period after blood withdrawal or the fluid-overload period, in mechanically ventilated dogs.

Precision and accuracy of a new device (Nexfin) for continuous non-invasive blood pressure monitoring: Comparison with invasive arterial pressure during general anesthesia

Precision and accuracy of a new device (Nexfin) for continuous non-invasive blood pressure monitoring: Comparison with invasive arterial pressure during general anesthesia

A device for continuous therapeutic blood purification using ultra-strong target-specific nanomagnets

A device for continuous therapeutic blood purification using ultra-strong target-specific nanomagnets