Venous Levels Research Articles

Screening of idiopathic epiretinal membrane using fundus images combined with blood oxygen saturation and vascular morphological features.

PurposeTo achieve an accurate diagnosis of idiopathic epiretinal membrane (iERM) through analyzing retinal blood vessel oxygen saturation (SO2) and vascular morphological features in fundus images.MethodsDual-modal fundus camera was used to obtain color fundus image, 570-nm, and 610-nm images. As iERM affects the macular area, a macular-centered semicircle area as region of interest (MROI) was selected and analyzed SO2 and vascular morphologies in it. Eventually, random forest (RF) and support vector machine (SVM) were as classifiers to diagnose iERM patients.ResultsThe arterial and venous SO2 levels of the iERM group were significantly higher than that of the control group. There were significant differences in the vessel density and fractal dimension on the artery for vascular morphology, while the tortuosity had a significant difference in the vein. By feeding the SO2 and the vascular morphological features into classifiers, an accuracy of over 82% was obtained, which is significantly better than the two separate inputs for classification.ConclusionSignificant differences in SO2 and vascular morphologies between control and iERM groups confirmed that the occurrence of iERM may affect blood supply and vascular structures. Benefiting from the dual-modal fundus camera and machine learning models, accurate judgments can be made on fundus images. Extensive experiments proved the importance of blood vessel SO2 and vascular morphologies for diagnosis, which is of great significance for clinical screening.

The relationship between venous insufficiency and serum magnesium level

Magnesium is the second most common cation in the cell. In addition to its role as a cofactor in many enzymatic pathways in physiological processes, it is necessary for the regular functioning of vascular smooth muscle cells. Magnesium deficiency has been associated with exacerbation of inflammation, which plays a role in the aetiopathogenesis of many diseases. To investigate the potential relationship between serum magnesium level and the development of chronic venous insufficiency by comparison with healthy individuals. The study included 394 patients with venous insufficiency based on physical examination findings and colour Doppler ultrasonography, and 206 controls without venous insufficiency. Venous insufficiency was defined by colour Doppler as reflux lasting 0.5 seconds or more in superficial veins, and longer than one second in femoral and popliteal veins. Clinical, haematological and biochemical parameters, including serum magnesium level and indicators of inflammation, were compared between groups. A total of 600 participants were included. There was no significant difference between the groups in terms of age and gender. In total, 187 (47.46%) patients with chronic venous insufficiency and 105 (50.97%) of the control group were male (p=0.414). The median age of the patients with chronic venous insufficiency was 48 (min-max: 41-49), and the median age of the control group was 49.00 (min-max: 45.00-60.25) (p=0.064). Serum magnesium level was found to be significantly lower in the group with chronic venous insufficiency compared to the control group; 1.90 mg/dL (min-max: 1.82-2) versus 2.1 mg/dL (min-max: 2-2.2) (p<0.001), respectively. Low serum magnesium levels may pose a potential risk for the development of chronic venous insufficiency, which is common in the community.

VE53 - Identification of neoplastic venous thrombus level thanks to 3D augmented reality technology during robotic radical nephrectomy

VE53 - Identification of neoplastic venous thrombus level thanks to 3D augmented reality technology during robotic radical nephrectomy

P435 Evaluation of remote triazole capillary blood testing to facilitate remote therapeutic drug monitoring (TDM): A validation study

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMBackgroundThe advent of COVID-19 has meant that patients with chronic diseases needed to shield, however, investigations were needed to guide continual management of their disease. Remote monitoring options were evaluated to ensure the standard of care is not compromised.Purpose and HypothesisThe aim was to validate remote (return-posted) capillary triazole blood testing and evaluate the potential role of remote TDM in chronic antifungal therapy.Materials and MethodsA single-center prospective cross-sectional study of remote finger prick capillary blood testing compared with gold standard venesection was performed. Remote finger prick capillary blood testing was validated compared to local standard venesection using comparative statistical analysis Comparative statistical analysis: Paired t-test, correlation and Bland-Altman were used to determine if there was agreement or association between the sampling methods.ResultsA total of 66 patients receiving triazole therapy were recruited and 57 pooled pairs of remote capillary and venous triazole concentrations and metabolites were prospectively analyzed, with the rest of the blood samples not being analyzed due to insufficient sample, hemolysis, or undetectable triazole level of <0.2 mg/l. There was a significant difference in the comparison of the two methods of sampling with paired t-test at P <.0001. Bland-Altman analysis yielded wide bias (−49.07%) and wide limits of agreement (−85.5% to −12.64%). On average capillary triazole, concentrations were 37% lower than venous concentrations (Fig. 1). There was however a very strong correlation between capillary and venous tests (Pearson's correlation coefficient r = 0.9219, P <.0001, Fig. 2).ConclusionsRemote capillary triazole sampling does not appear interchangeable with venous sampling, but being strongly correlated and on average 2/3rd of the venous value, could be a predictor of venous triazole level, or be useful for intra-patient longitudinal monitoring. When incorporated into an outpatient clinical pathway it can improve shared decision-making and patient experience. Further research is required to determine appropriate target reference ranges if the new lower capillary levels can be used routinely, especially in the climate of COVID-19 where social distancing measures limit patient access to hospitals and clinics for routine investigations.

Cerebral metabolic rate of oxygen (CMRO2) changes measured with simultaneous tDCS-MRI in healthy adults

BackgroundTranscranial direct current stimulation (tDCS) is a safe and well-tolerated noninvasive technique used for cortical excitability modulation. tDCS has been extensively investigated for its clinical applications; however further understanding of its underlying in-vivo physiological mechanisms remains a fundamental focus of current research. ObjectivesWe investigated the simultaneous effects of tDCS on cerebral blood flow (CBF), venous blood oxygenation (Yv) and cerebral metabolic rate of oxygen (CMRO2) using simultaneous MRI in healthy adults to provide a reference frame for its neurobiological mechanisms. MethodsTwenty-three healthy participants (age = 35.6 ± 15.0 years old, 10 males) completed a simultaneous tDCS-MRI session in a 3 T scanner fitted with a 64-channels head coil. A MR-compatible tDCS device was used to acquire CBF, Yv and CMRO2 at three time points: pre-, during- and post- 15 minutes of 2.0 mA tDCS on left anodal dorsolateral prefrontal cortex. ResultsDuring tDCS, CBF significantly increased (57.10 ± 8.33 mL/100g/min) from baseline (53.67 ± 7.75 mL/100g/min; p < 0.0001) and remained elevated in post-tDCS (56.79 ± 8.70 mL/100g/min). Venous blood oxygenation levels measured in pre-tDCS (60.71 ± 4.12 %) did not significantly change across the three timepoints. The resulting CMRO2 significantly increased by 5.9 % during-tDCS (175.68 ± 30.78 µmol/100g/min) compared to pre-tDCS (165.84 ± 25.32 µmol/100g/min; p = 0.0015), maintaining increased levels in post-tDCS (176.86 ± 28.58 µmol/100g/min). ConclusionstDCS has immediate effects on neuronal excitability, as measured by increased cerebral blood supply and oxygen consumption supporting increased neuronal firing. These findings provide a standard range of CBF and CMRO2 changes due to tDCS in healthy adults that may be incorporated in clinical studies to evaluate its therapeutic potential.

Effects of Elamipretide on Autophagy in Renal Cells of Pigs with Metabolic Syndrome.

Autophagy eliminates excessive nutrients and maintains homeostasis. Obesity and metabolic syndrome (MetS) dysregulate autophagy, possibly partly due to mitochondria injury and inflammation. Elamipretide (ELAM) improves mitochondrial function. We hypothesized that MetS blunts kidney autophagy, which ELAM would restore. Domestic pigs were fed a control or MetS-inducing diet for 16 weeks. During the 4 last weeks, MetS pigs received subcutaneous injections of ELAM (0.1 mg/kg/day, MetS + ELAM) or vehicle (MetS), and kidneys were then harvested to measure protein expression of autophagy mediators and apoptosis. Systemic and renal venous levels of inflammatory cytokines were measured to calculate renal release. The function of isolated mitochondria was assessed by oxidative stress, energy production, and pro-apoptotic activity. MetS slightly downregulated renal expression of autophagy mediators including p62, ATG5-12, mTOR, and AMPK vs. control. Increased mitochondrial H2O2 production accompanied decreased ATP production, elevated apoptosis, and renal fibrosis. In MetS + ELAM, mito-protection restored autophagic protein expression, improved mitochondrial energetics, and blunted renal cytokine release and fibrosis. In vitro, mitoprotection restored mitochondrial membrane potential and reduced oxidative stress in injured proximal tubular epithelial cells. Our study suggests that swine MetS mildly affects renal autophagy, possibly secondary to mitochondrial damage, and may contribute to kidney structural damage in MetS.

Tissue Oxygenation Measurement in Patients with Sepsis Compared to the Lactate Levels and Hemodynamical Monitoring

&#x0D; &#x0D; &#x0D; Near-infrared spectroscopy (NIRS) is a noninvasive method for measuring tissue oxygenation. The method allows for monitoring tissue perfusion in shock by revealing tissue hemoglobin oxygen saturation (StO2). The current study aims to compare tissue oxygenation levels with hemodynamical monitoring and lactate levels in patients in severe shock. Study encompasses 19 patients treated in intensive care unit (ICU) at Alexandrovska University Hospital. Ten of the patients cover the criteria for severe sepsis, the remaining nine patients have no data for septic condition. In both groups of patients tissue oxygenation levels measured with INVIOS monitor, mean arterial pressure (MAP), oxygen saturation in mixed venous blood (SvO2) and lactate levels within 72 h of intensive care unit admission are compared. The patients with severe sepsis have significantly lower levels of StO2 in comparison with patients without sepsis. Tissue oxygenation levels correspond to the mean arterial pressure levels, oxygen saturation in mixed venous blood. StO2 levels in the current study do not correlate significantly with the lactate levels in patients with sepsis. Near-infrared spectroscopy as StO2 levels correlate with the hemodynamical monitoring in patients with severe sepsis, but do not correlate significantly with the severity of the disease. This data might indicate that tissue oxygenation monitoring has clinical significance in patients with sepsis. Further profound studies are necessary for assessing the role of tissue oxygenation monitoring in the early phase of resuscitation in septic patients.&#x0D; &#x0D; &#x0D;

Relationship between iliofemoral venous stenting and femoropopliteal deep venous reflux

ObjectiveSevere presentations of chronic venous insufficiency can result from reflux or obstruction at the deep venous, perforator, or superficial venous levels. Iliofemoral venous stenting can be used to address central venous obstruction; however, its effects on deep venous reflux (DVR) have remained unclear. The purpose of the present study was to evaluate the effects of iliac vein stenting on femoropopliteal DVR with the hypothesis that ultrasound evidence of DVR would remain absent or would have improved after iliac vein stenting. MethodsThe present study was a retrospective review of patients who had undergone iliofemoral venous stenting from 2013 to 2018. The patients were divided into two cohorts according to the preprocedural presence (group A) or absence (group B) of femoropopliteal DVR. Baseline patient variables were collected, including age, gender, CEAP (clinical, etiologic, anatomic, pathophysiologic) class, presence of concomitant superficial or perforator reflux, deep vein thrombosis history, and additional venous interventions. The primary outcome evaluated was the persistent absence or resolution of DVR on the latest venous duplex ultrasound at follow-up. Other outcomes included the follow-up CEAP classification and the need for secondary deep venous interventions. ResultsA total of 275 consecutive patients had undergone iliofemoral venous stenting. Of the 275 patients, 58 had presented with DVR (group A). A comparison of groups A and B revealed that group A had had a greater likelihood of prior deep vein thrombosis (P = .0001) and a higher frequency of superficial venous ablation. The remaining demographic variables did not differ significantly between the two groups. Of the 58 patients in group A, DVR had resolved at follow-up in 17 (P = .0001). When stratified by level, 7 of these 17 patients had had isolated popliteal reflux. In group B, DVR had developed at follow-up in 6 of the 217 patients. The CEAP class had improved from before intervention (C0, 1.1%; C1, 0.4%; C2, 1.8%; C3, 41.4%; C4, 24.9%; C5, 5.9%; C6, 24.5%) to the latest follow up (C0, 4.9%; C1, 1.9%; C2, 5.7%; C3, 34.2%; C4, 22.8%; C5, 17.1%; C6, 13.3%). Significant improvement had occurred in C6 disease within both groups (group A, 16 of 58 [27.6%; P = .0078]; group B, 19 of 217 [8.8%; P = .0203]). ConclusionsFor patients who undergo iliofemoral venous stenting, DVR could improve if present initially and is unlikely to develop if not present before stenting. A cohort of patients had experienced persistent DVR and warranted further evaluation. Prospective studies are required to corroborate the safety, efficacy, and durability of iliofemoral venous stenting for patients with DVR.

Computed Tomography Embolus Texture Analysis as a Prognostic Marker of Acute Pulmonary Embolism.

Texture analysis is a quantitative imaging analysis that provides novel biomarkers beyond conventional image reading. Our aim was to use texture analysis of pulmonary emboli derived from thoracic computed tomography for prediction of mortality and prognosis of acute pulmonary embolism (PE). Overall, 216 patients (116 female, 53.7%) were included in the analysis. Texture analysis was calculated on axial slices of the contrast enhanced pulmonary angiography of the proximal embolus. Clinical scores, serological parameters, need for intubation, intensive care unit (ICU) admission and mortality was assessed and correlated with the texture features. In the correlation analysis, there were several associations with mortality in days, the highest for the parameter S(0,5)SumVarnc (r = -0.43, P < 0.001). Another parameter, S(3,-3)AngScMom correlated with sepsis-related organ failure assessment score (SOFA)-score (r = 0.31, P < 0.001). Several texture features correlated with venous lactate and glucose levels. In discrimination analysis, there were significant differences in regard to texture features between survivors and non-survivors and between patients with and without the need for ICU admission (P = 0.02, respectively). These results highlight the potential clinical benefit of texture features in patients with acute PE as novel imaging biomarkers. Further studies are needed to validate these results.

Roux-en-Y gastric bypass alters intestinal glucose transport in the obese Zucker rat.

IntroductionThe gastrointestinal tract plays a major role in regulating glucose homeostasis and gut endocrine function. The current study examines the effects of Roux-en-Y gastric bypass (RYGB) on intestinal GLP-1, glucose transporter expression and function in the obese Zucker rat (ZR).MethodsTwo groups of ZRs were studied: RYGB and sham surgery pair-fed (PF) fed rats. Body weight and food intake were measured daily. On post-operative day (POD) 21, an oral glucose test (OGT) was performed, basal and 30-minute plasma, portal venous glucose and glucagon-like peptide-1 (GLP-1) levels were measured. In separate ZRs, the biliopancreatic, Roux limb (Roux) and common channel (CC) intestinal segments were harvested on POD 21.ResultsBody weight was decreased in the RYGB group. Basal and 30-minute OGT plasma and portal glucose levels were decreased after RYGB. Basal plasma GLP-1 levels were similar, while a 4.5-fold increase in GLP-1 level was observed in 30-minute after RYGB (vs. PF). The increase in basal and 30-minute portal venous GLP-1 levels after RYGB were accompanied by increased mRNA expressions of proglucagon and PC 1/3, GPR119 protein in the Roux and CC segments. mRNA and protein levels of FFAR2/3 were increased in Roux segment. RYGB decreased brush border glucose transport, transporter proteins (SGLT1 and GLUT2) and mRNA levels of Tas1R1/Tas1R3 and α-gustducin in the Roux and CC segments.ConclusionsReductions in intestinal glucose transport and enhanced post-prandial GLP-1 release were associated with increases in GRP119 and FFAR2/3 after RYGB in the ZR model. Post-RYGB reductions in the regulation of intestinal glucose transport and L cell receptors regulating GLP-1 secretion represent potential mechanisms for improved glycemic control.

Comparison of Continuous Real Time Blood Glucose Measurement With Venous Laboratory Blood Glucose Level in Neonates During Perioperative Period

To compare the continuous real time blood glucose (CG) measurement with venous laboratory blood glucose (LG) level in neonates during perioperative period. Glucose levels were measured simultaneously by CG, glucometer glucose (GG) and LG at 40 time points in ten neonates during perioperative period. Intraclass correlation coefficient (ICC) and Bland Altman analysis were used for comparison. Correlation between CG and LG was excellent (ICC= 0.953; P<0.001), and average difference was 23.8 (95%CI 52.9 to -5.3) mg/dL, showed better reliability than at hyperglycemic state (ICC=0.653; P=0.006). The GG-LG showed excellent reliability with ICC = 0.985; P<0.001 and average difference of 15.4 (95% CI 30.7 to 0.1) mg/dL. CG at euglycemic state (ICC= 0.880; P<0.001). CG measurement is reliable for blood sugar estimation in neonates; but has lower reliability for hyperglycemia. The continuous trend of glucose measurement by CG is helpful for timely diagnosis of hyperglycemia during perioperative period in neonates.

Neural Network-based Estimation of Microbubbles Generated in Cardiopulmonary Bypass Circuit: A Clinical Application Study.

The cardiopulmonary bypass system used in cardiac surgery can generate microbubbles (MBs) that may cause complications, such as neurocognitive dysfunction, when delivered into the blood vessel. Estimating the number of MBs generated, thus, is necessary to enable the surgeons to deal with it. To this end, we previously proposed a neural network-based model for estimating the number of MBs from four factors measurable from the cardiopulmonary bypass system: suction flow rate, venous reservoir level, blood viscosity, and perfusion flow rate. However, the model has not been adapted to the data collected from actual surgery cases. In this study, the accuracy of MBs estimated by the proposed model was examined in four clinical cases. The results showed that the coefficient of determination between estimated MBs and the measured MBs throughout the surgeries was R2=0.558 (p<0.001). We found that the surgical treatments, such as administration of drugs, fluids and blood transfusions, increased the number of measured MBs. The coefficient of determination increased to R2= 0.8762 (p<0.001) by excluding the duration of these treatments. This result indicates that the model can estimate the number of MBs with high accuracy under the clinical environment.

End-tidal Carbon Dioxide Measurements in Unintentional Non-fire-related Carbon Monoxide Poisoning

Background: Poisoning with carbon monoxide occurs occasionally worldwide, and the gold diagnostic standard is to measure carboxyhemoglobin level in the blood. This study investigated the correlation between carboxyhemoglobin and the end-tidal carbon dioxide levels in 50 patients with carbon monoxide poisoning. Methods: We recruited 50 volunteer patients who had been admitted to the Emergency Services of Istanbul Medipol University Hospital between January 2017 and January 2018. They had been diagnosed with carbon monoxide poisoning unrelated to fire accidents. The arterial and venous blood gases, and other blood and clinical parameters were also measured. The patients’ end-tidal carbon dioxide levels were measured from the nose and mouth air, using a Capnostream 20p bedside monitor. Pearson’s correlation analyses were performed and the results were compared with the end-tidal carbon dioxide, carboxyhemoglobin and oxygen saturation in the arterial and venous blood samples. Results: The Mean±SD age was 33.98±10.89 years. The Mean±SD arterial and venous carboxyhemoglobin values were 18.05±7.10 and 12.11±9.67, respectively. There were no statistically significant differences between the oxygen saturation, and the arterial and venous blood levels of carboxyhemoglobin (P=0.870, P=0.950), respectively. Also, no statistically significant correlations were found between the end-tidal carbon dioxide, and the arterial and venous carboxyhemoglobin levels (P=0.529, P=0.601), respectively. Conclusion: The results from the blood analyses demonstrated that there was no statistically significant difference between the end-tidal carbon dioxide and the carboxyhemoglobin levels in these patients who had been earlier diagnosed with carbon monoxide poisoning, unrelated to fire accidents.

Serum periostin as a predictor of early recurrence of atrial fibrillation after catheter ablation

Catheter ablation is an effective method of rhythm therapy for atrial fibrillation (AF). AF recurrence is a common problem after catheter ablation. The aim of this study was to investigate influence factors of early recurrence after catheter ablation for AF. One hundred and three consecutive patients with AF were enrolled and underwent catheter ablation. Venous blood (Marked as A) was collected before ablation and left atrial blood (Marked as B) was collected after successful atrial septal puncture to detect serum periostin. After 3months of follow-up, statistical analysis was made based on the recurrence of AF. 27 (26.2%) patients had a recurrence of atrial arrhythmia after catheter ablation. Patients with recurrent atrial arrhythmia had a larger left atrial volume (162.31 ± 47.76 vs. 141.98 ± 41.64,p = 0.039), and higher serum periostin levels (periostin A. 99.71 ± 16.475 vs. 90.36 ± 13.63, p = 0.005; periostin B. 103.95 ± 13.09 vs. 94.46 ± 15.85, p = 0.006) compared with the non-recurrent group. The numbers of patients with left atrial low-voltage areas (LVAs) were more in the recurrence group (p < 0.001). Left atrial volume, serum periostin and left atrial LVAs were included in univariate and multivariate COX regression analysis. It showed that left atrial LVAs (HR3.81; 95% CI 1.54 to 9.44; p = 0.004) and serum periostin A (HR1.07; 95% CI 1.02 to1.13; p = 0.008) were the independent predictors of AF recurrence. The cut-off value of serum periostin A was 87.95ng/ ml (AUC, 0.681; sensitivity 88.9% and specificity 53.9%). Kaplan-Meier survival curve showed that the recurrence rate of AF was higher in patients with left atrial LVAs and higher serum periostin. The venous serum periostin level and left atrial LVAs were independent predictors of early recurrence of AF after catheter ablation.

Evaluating risk factors for catheter-related infections in hemodialysis patients

Introduction: Catheter-related infection in the patients with end-stage renal disease (ESRD) is one of the leading causes of death. Identifying risk factors for infection, including patients’ iron profile, plays an important role in preventing this complication. Objectives: In this study, we aimed to determine the risk factors of catheter-related infections among the ESRD patients in Qazvin, Iran. Patients and Methods: In this observational study, 41 patients with hemodialysis venous catheter-related infection (case group) and 42 patients without catheter-related infection ( control group) in Qazvin educational and medical centers were studied. The definition of functional iron deficiency anemia included ferritin &lt;500 ng/mL and serum iron/total iron-binding capacity (TIBC) &lt;30%. The laboratory evaluation method was based on enzyme-linked immunosorbent assay method. Definition of catheter-related infection in this study consisted of two positive results of the three cultures from blue and red catheter lines and blood at the same time with the same microorganism. Results: In studying iron parameters, a significant difference between serum iron levels and transferrin saturation in the two groups was detected (P values of 0.0016 and 0.003, respectively). Both parameters were higher in the control group. The most common microorganism causing the infection was Staphylococcus aureus (43.9%) and most of the catheters used were of temporary internal jugular vein types. The most important risk factors in the incidence of catheter infection were diabetes mellitus (OR = 5.059) and high serum iron levels (OR = 1.053). Decreased transferrin saturation levels reduced the risk of infection (OR = 0.825). Conclusion: There was a relationship between iron profile and diabetes mellitus and the increased risk of catheter-related infections. To prevent infection, patients with ESRD undergoing hemodialysis with venous catheters, blood sugar and serum iron levels need to be monitored carefully and iron overdose should be prevented in these patients.

Abstract #1157747: Pseudohypoglycemia Secondary to Leukocytosis in a Leukemic Patient

Recognition of pseudohypoglycemia secondary to leukocytosis can prevent false diagnosis of hypoglycemia. A 73-year-old male with history of chronic myeloid leukemia (CML), end-stage renal disease (ESRD), hypertension, and hypothyroidism was admitted for a hip fracture after a mechanical fall associated with lethargy. He had no associated lightheadedness or syncope. Laboratory testing on admission revealed a venous serum glucose level of 88mg/dL. The following day, his venous glucose was 58mg/dL, but a follow-up point-of-care capillary glucose was 77mg/dL. On examination, he appeared cachectic, but was alert and fully oriented. He denied palpitations, tremor, diaphoresis, headache, visual disturbances, syncope, lightheadedness, or confusion. He denied any use of antihyperglycemic medications and had no history of diabetes. Subsequent venous glucose levels over the next days were in the lower limit of normal, ranging from 65 to 85mg/dL, with discrepantly higher capillary glucose values checked within two hours of phlebotomy. On the fourth day of admission, venous glucose level dipped to 40mg/dL. Follow-up capillary glucose was 65mg/dL. Patient appeared unchanged on examination and continued to deny acute symptoms. He received 25cc of dextrose 50% without any change in symptoms. Endocrinology was consulted for evaluation of hypoglycemia. Other than suboptimal food intake, further history and examination was unrevealing. Laboratory testing was significant for leukocytosis, ranging from 43,360 to 69,300/uL, secondary to CML. Although poor carbohydrate intake and diminished gluconeogenesis from ESRD could lead to hypoglycemia, the lack of any hypoglycemic symptoms was inconsistent with the reported severity of hypoglycemia. Given the severe leukocytosis, consistent discrepancy between venous and capillary glucose levels, and lack of hypoglycemic symptoms, the most convincing diagnosis was pseudohypoglycemia due to leukocytosis. Diagnosis of hypoglycemia in a person without diabetes is defined by Whipple’s Triad: 1) blood glucose level less than 55mg/dL, 2) symptoms of hypoglycemia, and 3) improvement of symptoms with correction of blood glucose. Pseudohypoglycemia presents a challenge in accurately diagnosing hypoglycemia. Pseudohypoglycemia is a phenomenon of falsely low glucose level due to glucose consumption by blood cells in vitro during the interval time between phlebotomy and laboratory processing. This phenomenon has been reported in cancers of the blood with high red or white blood cell count, such as polycythemia vera and leukemia. In this case, leukocytosis likely affected the accuracy of venous glucose results. Pseudohypoglycemia may be difficult to recognize in patients with concurrent critical illness that causes true hypoglycemia, such as sepsis, malnourishment, and hepatic, renal, or cardiac failure. One actionable step to distinguish true hypoglycemia from pseudohypoglycemia is minimizing the time between phlebotomy and laboratory processing.

Relationship between carbon dioxide combining power and the short-term prognosis in acute ischemic stroke patients after thrombolysis

To investigate the effect of venous blood carbon dioxide binding capacity (CO2-CP) on the short-term prognosis of patients with acute ischemic stroke (AIS) after thrombolytic therapy. A total of 86 AIS inpatients who received thrombolytic therapy in the emergency department of Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from April 2019 to May 2021 were analyzed retrospectively. According to the venous blood CO2-CP levels at admission, the patients were divided into two groups: low CO2-CP group (CO2-CP < 23 mmol/L, n = 52) and high CO2-CP group (CO2-CP ≥ 23 mmol/L, n = 34). The CO2-CP levels and changes between the two groups before and after thrombolytic therapy were compared. The National Institutes of Health Stroke scale (NIHSS) score was used to evaluate the improvement rate of patients after thrombolytic therapy [NIHSS score at admission-NIHSS score at discharge)/NIHSS score at admission ×100%] and in-hospital death was also recorded. The correlation between CO2-CP levels and prognosis of patients with AIS during emergency visit was analyzed, the receiver operator characteristic curve (ROC curve) was drawn and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of CO2-CP in the prognosis of AIS patients. The CO2-CP levels of low CO2-CP group and high CO2-CP group after thrombolytic therapy were significantly higher than those before treatment (mmol/L: 23.08±2.34 vs. 20.46±1.51, 25.24±2.16 vs. 23.94±1.07, both P < 0.05). The differences of CO2-CP before and after treatment in low CO2-CP group were significantly higher than those in high CO2-CP group (mmol/L: 2.62±0.83 vs. 1.30±1.09, P < 0.05). The improvement rate of CO2-CP levels in the high CO2-CP group (NIHSS improvement rate > 45%) was significantly higher than that in the low CO2-CP group [85.29% (29/34) vs. 23.08% (12/52)], while the mortality in the low CO2-CP group was significantly higher than that in the high CO2-CP group [11.54% (6/52) vs. 0% (0/34), P < 0.05]. The AUC of CO2-CP for the prognosis of patients with AIS thrombolysis was 0.820, the 95% confidence interval (95%CI) was 0.727-0.924, P = 0.000 1. AIS patients with CO2-CP levels less than 23 mmol/L have a poor short-term prognosis, which has certain predictive and clinical reference value for choosing thrombolytic time in emergency stroke patients.

Overcoming perioperative inflammation as a hurdle for successful preclinical orthotopic cardiac xenogeneic transplantations - particular in regard of the mandatory use of heart-lung machines.

After orthotopic cardiac xenotransplantation, the combination of both the inflammatory responses to the exposure of a recipient to the xenogeneic organ and the use of cardiopulmonary bypass has been assumed to cause detrimental side effects. These have been described not only to affect the transplanted organ (heart) itself, but also the recipient's lungs. In this article, we summarize how these possible detrimental processes can be minimized or even avoided. Data from eight pig-to-baboon orthotopic cardiac xenotransplantation experiments were analyzed with a special focus on early (within the first week) postoperative organ dysfunction and systemic inflammatory responses. Non-ischemic heart preservation and the careful management of the heart-lung machine were deemed essential to guarantee not only the immediate function of the transplanted xenogeneic organ but also the prompt recovery of the recipient. After weaning from cardiopulmonary bypass, very low catecholamine amounts were needed to ensure an adequate pump function and cardiac output. Central venous oxygen saturation and serum lactate levels remained within normal ranges. All animals were successfully weaned from ventilation within the first postoperative hours. Serum parameters of the transplants and native kidneys and livers were initially slightly elevated or always normal, as were hemoglobin, LDH, and platelet measurements. Markers of systemic inflammation, C-reactive protein, and IL-6 were slightly elevated, but the reactions caused no lasting damage. Consistent short-term and long-term results were achieved after orthotopic cardiac pig-to-baboon transplantation without detrimental inflammatory responses or signs of multiorgan failure. In comparison to allogeneic procedures, non-ischemic heart preservation was important for successful immediate organ function, as was the management of the heart-lung machine. Thus, we believe that genetically modified porcine hearts are ready for use in the clinical setting.

Changes in Oxygen Consumption and Metabolomic Profiles in the Kidney of Sprague‐Dawley Rat fed a High‐Salt Diet

The metabolism of oxygen and substrates in the kidney under normal conditions and in salt‐sensitive hypertension is still not well understood. A novel method was developed to collect renal arteriovenous blood and urine from conscious freely moving rats, while measuring renal blood flow (RBF) and blood pressure (BP). As such, global renal O2 consumption and metabolic profiles can be studied in response to various stimuli such as changes in salt diet. We report here changes observed in male Sprague‐Dawley rats (SD; 10 wk age) before and after 21 days switching from a 0.4% NaCl (LS) diet to a 4.0% NaCl diet (HS). Rats were surgically instrumented with a renal ultrasonic artery flow probe (Transonic), a femoral arterial catheter, and a renal venous catheter and placed in a movement response caging system. After 7 days recovery, control levels of RBF and BP (24 hr/day) were obtained, and arterial and renal venous blood were sampled. Rats were then switched to the HS diet and blood sampled at days 7, 14 and 21 while RBF and BP were recorded continuously throughout the study. Blood O2 content was measured by radiometer immediately after blood collection and plasma samples frozen for global metabolomic analysis by the Jackson laboratory. The metabolomic analysis (Thermo Q‐Exactive Orbitrap coupled to a Vanquich UPLC system) was performed in 4 modes (C18 positive, C18 negative, HILIC positive and HILIC negative). Average 24 hr mean arterial pressure (MAP) of the SD rats increased slightly over the 21 days of the HS diet from 111 ± 2 to 119 ± 5 mmHg (p&lt;0.05; n=7). Average 24 hr RBF rose from 9.2 ± 0.6 to 11.7 + 0.6 ml/min (p&lt;0.05). O2 consumption increased significantly from 0.17 ± 0.03 to 0.26 ± 0.03 ml/min (p&lt;0.05) as did O2 extraction which increased from 10.8 ± 1.1 % to 15.0 ± 1.2 % by Day 21 of HS diet. Of a total 1205 named metabolites detected, we present here those that differed between arterial and renal venous blood by more than 2‐fold and significantly (p&lt;0.05; Benjamini‐Hochberg corrected). At the time of this report, in rats fed the LS diet, 33 compounds were found more abundant in arterial blood than in venous blood. 10 compounds were found more abundant in venous blood. The HS diet increased the arterial / venous ratio of some compounds progressively throughout the 21 days while others decreased. No evidence of anaerobic respiration was obtained with lactate, pyruvate, glutamate and TCA cycle related metabolites remaining unchanged throughout the study. Interestingly, some gut microbiome generated compounds were found to differentially altered by the HS diet. Despite no changes in arterial concentrations, a progressive reduction was observed in Triethylamine in the renal venous blood at each time point, while a progressive elevation was observed in Hexanoic acid. Venous levels of Cis‐4‐Decenedioic acid and Succinylacetone, known to be altered in some metabolic diseases were significantly increased by the HS diet. Urine measurements and cortical and outer medullary tissue measurements are currently under way which together with the RBF will enable calculation of metabolic fluxes of these various metabolites. We conclude that a high‐salt diet increases oxygen consumption and alters the metabolomic profiles of the kidney.

The Cerebral Collateral Cascade: Comprehensive Blood Flow in Ischemic Stroke.

Robust cerebral collaterals are associated with favorable outcomes in patients with acute ischemic stroke due to large vessel occlusion treated by thrombectomy. However, collateral status assessment mostly relies on single imaging biomarkers and a more comprehensive holistic approach may provide deeper insights into the biology of collateral perfusion on medical imaging. Comprehensive collateralization is defined as blood flow of cerebral arteries through the brain tissue and into draining veins. We hypothesized that a comprehensive analysis of the cerebral collateral cascade (CCC) on an arterial, tissue, and venous level would predict clinical and radiologic outcomes. This was a multicenter retrospective cohort study of patients with acute stroke undergoing thrombectomy triage. CCC was determined by quantifying pial arterial collaterals, tissue-level collaterals, and venous outflow (VO). Pial arterial collaterals were determined by CT angiography; tissue-level collaterals were assessed on CT perfusion. VO was assessed on CT angiography using the cortical vein opacification score. Three groups were defined: CCC+ (good pial collaterals, tissue-level collaterals, and VO), CCC- (poor pial collaterals, tissue-level collaterals, and VO), and CCCmixed (the remainder of the patients). Primary outcome was functional independence (modified Rankin Scale score 0-2) at 90 days. Secondary outcome was final infarct volume. A total of 647 patients met inclusion criteria: 176 CCC+, 345 CCCmixed, and 126 CCC-. Multivariable ordinal logistic regression showed that CCC+ predicted good functional outcomes (odds ratio [OR] 18.9 [95% CI 8-44.5]; p < 0.001) compared with CCC- and CCCmixed. CCCmixed patients likely had better functional outcomes compared with CCC- patients (OR 2.5 [95% CI 1.2-5.4]; p = 0.014). Quantile regression analysis (50th percentile) showed that CCC+ (β -78.5, 95% CI -96.0 to -61.1; p < 0.001) and CCCmixed (β -64.0, 95% CI -82.4 to -45.6; p < 0.001) profiles were associated with considerably lower final infarct volumes compared with CCC- profiles. Comprehensive assessment of the collateral blood flow cascade in patients with acute stroke is a strong predictor of clinical and radiologic outcomes in patients treated by thrombectomy.