Search

Background and Objectives: The relationship between histidine–tryptophan–ketoglutarate (HTK)-induced hyponatremia and brain injury in adult cardiac surgery patients is unclear. This study analyzed postoperative neurological outcomes after intraoperative HTK cardioplegia infusion. Materials and Methods: A prospective cohort study was conducted on 60 adult patients who underwent cardiac surgery with cardiopulmonary bypass. Of these patients, 13 and 47 received HTK infusion and conventional hyperkalemic cardioplegia, respectively. The patients' baseline characteristics, intraoperative data, brain injury markers, Mini-Mental State Examination (MMSE) scores, and quantitative electroencephalography (qEEG) data were collected. Electrolyte changes during cardiopulmonary bypass, the degree of hyponatremia, and any associated brain insults were evaluated. Results: The HTK group presented with acute hyponatremia during cardiopulmonary bypass, which was intraoperatively corrected through ultrafiltration and normal saline administration. Postoperative sodium levels were higher in the HTK group than in the conventional cardioplegia group. The change in neuron-specific enolase levels after cardiopulmonary bypass was significantly higher in the HTK group (p = 0.043). The changes showed no significant differences using case–control matching. qEEG analysis revealed a significant increase in relative delta power in the HTK group on postoperative day (POD) 7 (p = 0.018); however, no significant changes were noted on POD 60. The MMSE scores were not significantly different between the two groups on POD 7 and POD 60. Conclusions: HTK-induced acute hyponatremia and rapid correction with normal saline during adult cardiac surgeries were associated with a potential short-term but not long-term neurological impact. Further studies are required to determine the necessity of correction for HTK-induced hyponatremia. [ABSTRACT FROM AUTHOR]

Background: We sought to investigate the differential impact of EVAR (endovascular aneurysm repair) vis-à-vis OSR (open surgical repair) on ruptured AAA (abdominal aortic aneurysm) mortality by sex and geographically. Methods: We performed a retrospective study of administrative data on EVAR from state statistical agencies, vascular registries, and academic publications, as well as ruptured AAA mortality rates from the World Health Organization for 14 14 states across Australasia, East Asia, Europe, and North America. Results: Between 2011–2016, the proportion of treatment of ruptured AAAs by EVAR increased from 26.1 to 43.8 percent among females, and from 25.7 to 41.2 percent among males, and age-adjusted ruptured AAA mortality rates fell from 12.62 to 9.50 per million among females, and from 34.14 to 26.54 per million among males. The association of EVAR with reduced mortality was more than three times larger (2.2 vis-à-vis 0.6 percent of prevalence per 10 percentage point increase in EVAR) among females than males. The association of EVAR with reduced mortality was substantially larger (1.7 vis-à-vis 1.1 percent of prevalence per 10 percentage point increase in EVAR) among East Asian states than European+ states. Conclusions: The increasing adoption of EVAR coincided with a decrease in ruptured AAA mortality. The relationship between EVAR and mortality was more pronounced among females than males, and in East Asian than European+ states. Sex and ethnic heterogeneity should be further investigated. [ABSTRACT FROM AUTHOR]

BACKGROUND: The increasing prevalence of end-stage renal disease (ESRD) imposes a substantial economic burden on public health-care systems. Hemodialysis (HD) is a pivotal treatment modality for patients with ESRD. However, prolonged use of HD vessels may result in stenosis, thrombosis, and occlusion due to repeated daily punctures. Thus, early detection and prevention of the dysfunction of dialysis routes are crucial. OBJECTIVE: In this study, we designed a wearable device for the early and accurate detection of arteriovenous access (AVA) stenosis in HD patients. METHODS: A personalized three-dimensional (3D) printed wearable device was designed by combining the phonoangiography (PAG) and photoplethysmography (PPG) techniques. The capability of this device to monitor AVA dysfunction before and after percutaneous transluminal angioplasty (PTA) was evaluated. RESULTS: After PTA, the amplitudes of both PAG and PPG signals increased in patients with arteriovenous fistulas and those with arteriovenous grafts; this might be due to increased blood flow. CONCLUSION: Our designed multi-sensor wearable medical device using PAG, PPG, and 3D printing appears suitable for early and accurate detection of AVA stenosis in HD patients. [ABSTRACT FROM AUTHOR]

Chest x‐ray (CXR) examination is a common first‐line, non‐invasive, and rapid screening method in clinical examinations. The posteroanterior (PA) and anteroposterior (AP) view modes can both be used to detect related cardiopulmonary diseases, such as pneumonitis, tuberculosis, pulmonary fibrosis, lung tumors, and cardiomegaly. Compared with cardiac computed tomography and cardiac magnetic resonance imaging methods, CXR examination has a short scanning duration and costs less, and is suitable for routine and follow‐up health examinations. Cardiomegaly is an asymptomatic disease in the early stage and cannot be detected through electrocardiography measurements. Thus, early cardiomegaly classes detections, such as cardiac hypertrophy and ventricular dilatation, can help make decisions regarding drug treatments and surgeries. In addition, an automatic assistive tool is required to differentiate between normal individuals and those with cardiomegaly to address the problem of manual inspection and labor shortage. Hence, PA view‐based CXR classification is used to develop a deep learning (DL)‐based high‐dimensional multiple regression analysis (MRA) model for CXR image classification in rapid cardiomegaly screening. This multilayer network model uses a two‐channel three‐layer convolution‐normalization‐pooling process with two‐dimensional (2D) multi convolution operations to enhance images and to extract feature patterns; and then a one‐dimensional feature conversion is used to estimate the four coordinate points of the maximal horizontal cardiac diameter (MHCD) and maximal horizontal thoracic diameter (MHTD), which can be used to estimate cardiothoracic ratio and detect cardiomegaly. For experimental tests, the training and testing datasets are collected from the National Institutes of Health CXR Image Database (Clinical Center, USA), and 10‐fold cross‐validation was used for model evaluation in terms of precision (%), recall (%), accuracy (%), and F1 score. These indexes are used to evaluate the feasibility of the proposed MRA estimator. In addition, the performances of the proposed model are compared with those of conventional DL‐based multilayer classifiers. [ABSTRACT FROM AUTHOR]

There is no consensus regarding the terminology, definition, classification, diagnostic criteria, and algorithm, or reporting standards for the disease of infective native aortic aneurysm (INAA), previously known as mycotic aneurysm. The aim of this study was to establish this by performing a consensus study. The Delphi methodology was used. Thirty-seven international experts were invited via mail to participate. Four two week Delphi rounds were performed, using an online questionnaire, initially with 22 statements and nine reporting items. The panellists rated the statements on a five point Likert scale. Comments on statements were analysed, statements revised, and results presented in iterative rounds. Consensus was defined as ≥ 75% of the panel selecting "strongly agree" or "agree" on the Likert scale, and consensus on the final assessment was defined as Cronbach's alpha coefficient >.80. All 38 panellists completed all four rounds, resulting in 100% participation and agreement that this study was necessary, and the term INAA was agreed to be optimal. Three more statements were added based on the results and comments of the panel, resulting in a final 25 statements and nine reporting items. All 25 statements reached an agreement of ≥ 87%, and all nine reporting items reached an agreement of 100%. The Cronbach's alpha increased for each consecutive round (round 1 =.84, round 2 =.87, round 3 =.90, and round 4 =.92). Thus, consensus was reached for all statements and reporting items. This Delphi study established the first consensus document on INAA regarding terminology, definition, classification, diagnostic criteria, and algorithm, as well as reporting standards. The results of this study create essential conditions for scientific research on this disease. The presented consensus will need future amendments in accordance with newly acquired knowledge. [ABSTRACT FROM AUTHOR]

The aorta, including the thoracic and abdominal aortas, distributes blood from the heart to the upper and lower circulatory systems. Abdominal aortic sclerosis can cause abdominal aortic aneurysm. When the diameter of the aorta increases by more than 1.5 times its normal size (e.g., ≥4−5 cm, mean diameter in an adult is 2−3 cm), the risk of aneurysm rupture gradually increases. Aneurysm rupture and its associated bleeding have high mortality rates. Hence, the prediction of large diameter aortic aneurysms is an important issue with great clinical implications. In computed tomography angiography (CTA) imaging examination, an assistive tool for automatic image segmentation must be developed to help cardiologists and radiologists evaluate the risk of rupture progression and make appropriate treatment decisions. In this study, two‐dimensional (2D) spatial convolution operations (corner detection) and a multilayer machine vision classifier enabled the automatic segmentation of the luminal region, vascular intima, and calcified plaques in the abdominal aorta. The 2D spatial convolution operations can efficiently increase focus, remove unwanted noise in the convolutional layer, and segment calcified plaques and the vessel border by using a general regression neural network (GRNN)‐based classifier. The classifier's outputs can also be visualized in color presentation (red, green, and blue color series) to identify vessel borders and calcified plaques. Luminal change rate (LCR), calcified plaque rate (CPR), and ellipse ratio (ER) can be defined as criteria for evaluating changes in the luminal region and locating calcified plaques, which can be used to identify the locations of cross‐sectional shape changes and calcified plaques. Based on the collected CTA images from the clinical case studies, the proposed multilayer classifier has promising results for the intended medical purpose. With the LCR index, the correlation coefficients (R2) for manual image segmentation and automatic image segmentation is >0.90 in positive correlation for vessel borders segmentation. The proposed method is an adaptive learning scheme with potential clinical applications in automatic CTA image segmentation for further abdominal aortic aneurysm (AAA) risk evaluation. © 2022 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Patent ductus arteriosus (PDA) is a common cardiovascular complication that complicates clinical care in the intensive care of premature infants. Prenatal and postnatal infections and the inflammation process can contribute to PDA, and intrauterine inflammation is a known risk factor of PDA. A variety of inflammatory biomarkers have been reported to be associated with PDA. Chorioamnionitis induces the fetal inflammatory process via several cytokines that have been reported to be associated with the presence of PDA and may have a role in the vascular remodeling process or vessel dilation of the ductus. On the other hand, anti-inflammatory agents, such as antenatal steroids, decrease PDA incidence and severity in patients born to those with chorioamnionitis. Proinflammatory cytokines, which are expressed more significantly in preterm neonates and chorioamnionitis, are associated with the presence of PDA. In this review, we focus on the pathogenesis of PDA in preterm infants and the role of biomarkers associated with the perinatal inflammatory process. [ABSTRACT FROM AUTHOR]

Valvular heart diseases or chronic valvular dysfunctions are widely treated by percutaneous pulmonary valve implantation (PPVI) in cases requiring prosthetic pulmonary valve implantation and replacement. Commercial pulmonary valve stents (CPVS), sucas Epic™ valved stents or mechanical heart valves, are available to improve narrowed pulmonary valves or address problems of blood flow regurgitation in the right ventricle to pulmonary artery conduit. However, these commercial valve stents have limited availability of different sizes and diameters. Currently, the customized handmade trileaflet‐valved conduit (HTVC) is a novel surgical strategy being used in young adults and children. The HTVC can be designed witdifferent optimal parameters and can be reconstructed as expanded polytetrafluoroethylene (ePTFE)‐valved conduits for PPVI clinical applications. To verify the availability and durability of the HTVC, we validated its hemodynamic and functional performances using a mock circulation system in an in vitro study. At different heart rates and blood flows, we used the forward stroke flow (systolic period) and regurgitation flow (diastolic period) to calculate the pulmonary regurgitation fraction (RF) and ejection efficiency (EE) to evaluate the HTVC performances. We also observed its dynamic behaviours using an endoscopic camera in a pulsatile experimental setting. In addition, we used a Duffing–Holmes‐based chaotic synchronization system to track the trajectories of pulmonary artery pressure waveforms of the HTVC and CPVS, whiccan synchronously obtain the dynamic self‐synchronization errors for quantifying the HTVC's performance. Througin vitro laboratory experiments, the comprehensive dynamic errors were found to be positively correlated witthe RFs and EEs. The experimental results indicate that the results obtained by the HTVC are promising, including a decrease in the RF and an increase in the EE, as compared witCPVSs. Therefore, the dynamic errors can be used to obtain rapid quantitative indications of the performance quality of HTVCs under different hemodynamic conditions for RV‐PA reconstruction. [ABSTRACT FROM AUTHOR]

To develop a tissue-engineered vascular graft, we used pericardial effusion-derived progenitor cells (PEPCs) collected from drained fluid after open-heart surgery in children with congenital heart diseases to repopulate a decellularized porcine pulmonary artery. The PEPCs were compared with human fibroblasts (HS68) and human umbilical vein endothelial cells (HUVECs) in cell growth and migration. They were cultured with the matrices via an inner approach (intima), lateral approach (media), and outer approach (adventitia). PEPCs grew and migrated better than the other two cells 14 days after seeding in the decellularized vessel. In immunofluorescence assays, PEPCs expressed CD90 and CD105 indicating a vascular differentiation. PEPCs grew in a decellularized porcine pulmonary artery matrix may have the potential for producing tissue-engineered vascular grafts. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is employed to treat critical patients for one to a few days of life support in intensive care units. Venovenous (VV) and venoarterial (VA) ECMO configurations are the most commonly used rescue strategies for temporary cardiac and respiratory function support. However, both ECMO modes sometimes cannot meet a patient's demands because of (a) less oxygenated blood in either the upper body or lower body, or (b) a deterioration in the patient's hemodynamic status. Veno-Venoarterial (VVA) ECMO is an upgraded system that provides sufficiently oxygenated blood to the systemic and pulmonary circulation systems. Drainage cannulas and gas flow exchanges are determined to provide the maximum drainage blood flow required by the patient through a servo-regulator that adjusts the motor speed. A generalized regression neural network (GRNN) based estimator is created to automatically estimate the desired pump speed and then provide sufficient drainage flow for temporary life support. To achieve stability flow in an ECMO circuit, a bisection approach algorithm (BAA) is employed to improve the performance of transient responses in step controls and steady state controls. Experimental studies are used to validate the proposed model and it is compared with conventional controllers to indicate good performance in clinical VVA ECMO applications. [ABSTRACT FROM AUTHOR]

Abstract We present a case of 58-year-old woman with underlying diabetes mellitus, hepatitis C virus-related liver cirrhosis, and total hysterectomy for uterine myoma 11 moths ago, who was diagnosed ruptured aortic arch mycotic pseudoaneurysm after a certain period of survey for her unknown fever cause. After emergent surgery with prosthetic graft interposition, all her blood cultures and tissue cultures revealed pathogen with Bacteroides fragilis. Although mycotic aneurysms have been well described in literatures, an aneurysm infected solely with Bacteroides fragilis is unusual, with only eight similar cases in the literature. Here we reported the only female case with her specific clinical and management course and summarized all reported cases of mycotic aneurysm caused by Bacteroides fragilis to clarify their conditions and treatments, alert the difficulty in diagnosis, and importance of highly suspicious.

Background Coronary artery bypass grafting (CABG) is frequently performed in patients with end-stage renal disease (ESRD) together with severe coronary artery disease, after which, patients with ESRD have higher surgical risk and poorer long-term outcomes. We report our experience in patients with ESRD who survived in CABG and identify predictors of long-term outcomes. Methods We retrospectively investigated 93 consecutive patients with ESRD who survived to discharge after isolated CABG between January 2005 and December 2016 at our institution. Long-term outcomes, including all-cause mortality after discharge, readmission due to major adverse cardiac events, and reintervention, were evaluated. Predictors affecting long-term outcomes were also analyzed. Results The rates of freedom from all-cause mortality after discharge in 1, 3, 5, and 10 years were 92.1, 81.3, 71.9, and 34.9%, respectively. The rates of freedom from readmission due to major adverse cardiac events in 1, 3, 5, and 10 years were 90.7, 79.1, 69.9, and 55.6%, respectively. The rates of freedom from reintervention in 1, 3, 5, and 10 years were 95.3, 86.5, 79.0, and 66.6%, respectively. Postoperative β-blocker and statin use significantly improved overall long-term survival (β-blocker, p = 0.013; statin, p = 0.009). After case–control matching, patients who received statins showed better long-term survival than those without statins. The comparison of long-term survival between patients with and without β-blockers showed no significant difference after matching. Conclusions After CABG, dialysis patients who survived to discharge had acceptable long-term overall survival. Post-CABG statin use in dialysis patients is a predictor of better long-term survival. [ABSTRACT FROM AUTHOR]