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Background: The aim of this study was to evaluate the impact of intravenous palonosetron compared to ondansetron on hypotension induced by spinal anesthesia in women undergoing cesarean section. Methods: Fifty-four women scheduled for elective cesarean section were, randomly allocated to ondansetron group (n = 27) or palonosetron group (n = 27). Ten minutes prior to the administration of spinal anesthesia, participants received an intravenous injection of either ondansetron or palonosetron. A prophylactic phenylephrine infusion was initiated immediately following the intrathecal administration of bupivacaine and fentanyl. The infusion rate was titrated to maintain adequate blood pressure until the time of fetal delivery. The primary outcome was total dose of phenylephrine administered. The secondary outcomes were nausea or vomiting, the need for rescue antiemetics, hypotension, bradycardia, and shivering. Complete response rate, defined as the absence of postoperative nausea and vomiting and no need for additional antiemetics, were assessed for up to 24 hours post-surgery. Results: No significant differences were observed in the total dose of phenylephrine used between the ondansetron and palonosetron groups (387.5 μg [interquartile range, 291.3–507.8 μg versus 428.0 μg [interquartile range, 305.0–507.0 μg], P = 0.42). Complete response rates also showed no significant differences between the groups both within two hours post-spinal anesthesia (88.9% in the ondansetron group versus 100% in the palonosetron group; P = 0.24) and at 24 hours post-surgery (81.5% in the ondansetron group versus 88.8% in the palonosetron group; P = 0.7). In addition, there was no difference in other secondary outcomes. Conclusion: Prophylactic administration of palonosetron did not demonstrate a superior effect over ondansetron in mitigating hemodynamic changes or reducing phenylephrine requirements in patients undergoing spinal anesthesia with bupivacaine and fentanyl for cesarean section. [ABSTRACT FROM AUTHOR]

Aims: The clinical benefits of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) for profound cardiogenic shock are well known. However, peripheral VA‐ECMO increases the left ventricular afterload, thus compromising myocardial recovery. Recent studies have revealed the benefit of left ventricular unloading using various methods applied at different times. The EARLY‐UNLOAD trial compares the clinical outcomes of early left ventricular unloading and conventional approach after VA‐ECMO. Methods and results: The EARLY‐UNLOAD trial is a single‐centre, open‐label, randomized trial that recruited 116 patients with cardiogenic shock undergoing VA‐ECMO. Patients meeting the inclusion criteria were randomized in a 1:1 ratio to two groups: routine left ventricular unloading via intracardiac echocardiography‐guided transseptal left atrial cannulation within 12 h of VA‐ECMO initiation or conventional approach that indicates rescue left ventricular unloading if clinical signs of an increased left ventricular afterload are present. The primary endpoint is the cumulative incidence of all‐cause death within 30 days, and patients will be followed‐up for 12 months. A key secondary endpoint is a composite measure of all‐cause death and rescue transseptal left atrial cannulation in the conventional group (suggestive of VA‐ECMO treatment failure) within 30 days. The enrolment of patients was finished in September 2022. Conclusions: The EARLY‐UNLOAD trial is the first randomized controlled trial to compare early left ventricular unloading and conventional approach after VA‐ECMO using the same unloading modality. The results could impact clinical practice to overcome the haemodynamic issues associated with VA‐ECMO. [ABSTRACT FROM AUTHOR]

Angiogenesis, the formation of new blood vessels from existing vessels, has been associated with more than 70 diseases. Although numerous studies have established angiogenesis models, only a few indicators can be used to analyze angiogenic structures. In the present study, we developed an image-processing pipeline based on deep learning to analyze and quantify angiogenesis. We utilized several image-processing algorithms to quantify angiogenesis, including a deep learning-based cell nuclear segmentation algorithm and image skeletonization. This method could quantify and measure changes in blood vessels in response to biochemical gradients using 16 indicators, including length, width, number, and nuclear distribution. Moreover, this procedure is highly efficient for the three-dimensional quantitative analysis of angiogenesis and can be applied to diverse angiogenesis investigations. [ABSTRACT FROM AUTHOR]

We investigated the association of insulin administration method with the achievement of mean glucose ≤ 180 mg/dL and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors who had hyperglycemia after the return of spontaneous circulation. From a multicenter prospective registry, we extracted the data of adult OHCA survivors who underwent targeted temperature management (TTM) between 2015 and 2018. Blood glucose levels every 4 h after initiating TTM were obtained for 72 h. We divided insulin administration methods into three categories: subcutaneous (SQI), intravenous bolus (IBI), and continuous intravenous (CII). We calculated the mean glucose and standard deviation (SD) of glucose. The primary outcome was the achievement of mean glucose ≤ 180 mg/dL. The secondary outcomes were the 6-month neurological outcome based on the Cerebral Performance Category (CPC) scale (good, CPC 1–2; poor, CPC 3–5), mean glucose, and SD of glucose. Of the 549 patients, 296 (53.9%) achieved mean glucose ≤ 180 mg/dL, and 438 (79.8%) had poor neurological outcomes, 134 (24.4%), 132 (24.0), and 283 (51.5%) were in the SQI, IBI, and CII groups, respectively. The SQI (adjusted odds ratio [aOR], 0.848; 95% confidence intervals [CIs], 0.493–1.461) and IBI (aOR, 0.673; 95% CIs, 0.415–1.091) groups were not associated with mean glucose ≤ 180 mg/dL and the SQI (aOR, 0.660; 95% CIs, 0.335–1.301) and IBI (aOR, 1.757; 95% CIs, 0.867–3.560) groups were not associated with poor neurological outcomes compared to the CII group. The CII (168 mg/dL [147–202]) group had the lowest mean glucose than the SQI (181 mg/dL [156–218]) and IBI (184 mg/dL [162–216]) groups. The CII (45.0[33.9–63.5]) group had a lower SD of glucose than the IBI (50.8 [39.1–72.0]) group. The insulin administration method was not associated with achieving mean glucose ≤ 180 mg/dL and 6-month neurological outcomes. [ABSTRACT FROM AUTHOR]

Background: Multiple studies have investigated the association between hyperoxaemia following cardiac arrest (CA) and unfavourable outcomes; however, they have yielded inconsistent results. Most previous studies quantified oxygen exposure without considering its timing or duration. We investigated the relationship between unfavourable outcomes and supranormal arterial oxygen tension (PaO2), commonly defined as PaO2 > 100 mmHg, at specific time intervals within 24 h following CA. Methods: This retrospective observational study included 838 adult non‐traumatic patients with CA. The first 24 h following CA were divided into four 6‐h time intervals, and the first 6‐h period was further divided into three 2‐h segments. Multivariable logistic regression analyses were conducted to assess associations of the highest PaO2 and time‐weighted average PaO2 (TWA‐PaO2) values at each time interval with unfavourable outcomes at hospital discharge (cerebral performance categories 3–5). Results: The highest PaO2 (p =.028) and TWA‐PaO2 (p =.022) values during the 0–6‐h time interval were significantly associated with unfavourable outcomes, whereas those at time intervals beyond 6 h were not. The association was the strongest at supranormal PaO2 values within the 0–2‐h time interval, becoming significant at PaO2 values ≥ 150 mmHg. During the first 6 h, longer time spent at ≥150 mmHg of PaO2 was associated with an increased risk of unfavourable outcomes (p =.038). The results were consistent across several sensitivity analyses. Conclusion: Supranormal PaO2 during but not after the first 6 h following cardiac arrest was independently associated with unfavourable outcomes. [ABSTRACT FROM AUTHOR]

The use of carbon fiber-reinforced plastics (CFRP) is markedly increasing, particularly for the manufacturing of automotive parts, to achieve better mechanical properties and a light weight. However, it is difficult to manufacture multi-material products because of the problems due to the adhesive between CFRP and steel. The prepreg compression molding (PCM) of laminated CFRP can reduce the production time and increase the flexibility of the manufacturing process. In this study, a new manufacturing process is proposed for CFRP reinforcement on a hot stamped B-pillar using PCM. A finite element (FE) simulation of the hot stamping process is conducted to predict the dimensions of the B-pillar. The feasibility of PCM manufacturing is explored by the simulation of the thermoforming of a CFRP set on a shaped B-pillar. The temperature conditions of the CFRP and B-pillar for the PCM are determined by considering the heat transfer between the CFRP and steel. Finally, the PCM of the B-pillar consisting of steel and CFRP was performed to compare with the analytical results for verification. The evaluation of the B-pillar was conducted by the observation of the cross-section for the B-pillar and interlayer by scanning electron microscopy (SEM). As a result, a steel/CFRP B-pillar assembly could be efficiently manufactured using the PCM process without an additional adhesive process. [ABSTRACT FROM AUTHOR]

We evaluated the performance of cardiac arrest-specific prognostication scores developed for outcome prediction in the early hours after out-of-hospital cardiac arrest (OHCA) in predicting long-term outcomes using independent data. The following scores were calculated for 1,163 OHCA patients who were treated with targeted temperature management (TTM) at 21 hospitals in South Korea: OHCA, cardiac arrest hospital prognosis (CAHP), C-GRApH (named on the basis of its variables), TTM risk, 5-R, NULL-PLEASE (named on the basis of its variables), Serbian quality of life long-term (SR-QOLl), cardiac arrest survival, revised post-cardiac arrest syndrome for therapeutic hypothermia (rCAST), Polish hypothermia registry (PHR) risk, and PROgnostication using LOGistic regression model for Unselected adult cardiac arrest patients in the Early stages (PROLOGUE) scores and prediction score by Aschauer et al. Their accuracies in predicting poor outcome at 6 months after OHCA were determined using the area under the receiver operating characteristic curve (AUC) and calibration belt. In the complete-case analyses, the PROLOGUE score showed the highest AUC (0.923; 95% confidence interval [CI], 0.904–0.941), whereas the SR-QOLl score had the lowest AUC (0.749; 95% CI, 0.711–0.786). The discrimination performances were similar in the analyses after multiple imputation. The PROLOGUE, TTM risk, CAHP, NULL-PLEASE, 5-R, and cardiac arrest survival scores were well calibrated. The rCAST and PHR risk scores showed acceptable overall calibration, although they showed miscalibration under the 80% CI level at extreme prediction values. The OHCA score, C-GRApH score, prediction score by Aschauer et al., and SR-QOLl score showed significant miscalibration in both complete-case (P = 0.026, 0.013, 0.005, and < 0.001, respectively) and multiple-imputation analyses (P = 0.007, 0.018, < 0.001, and < 0.001, respectively). In conclusion, the discrimination performances of the prognostication scores were all acceptable, but some showed significant miscalibration. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review and network meta-analysis was to determine the analgesic effectiveness of peripheral nerve blocks (PNBs), including each anatomical approach, with or without intrathecal morphine (ITMP) in cesarean delivery (CD). All relevant randomized controlled trials comparing the analgesic effectiveness of PNBs with or without ITMP after CD until July 2021. The two co-primary outcomes were designated as (1) pain at rest 6 h after surgery and (2) postoperative cumulative 24-h morphine equivalent consumption. Secondary outcomes were the time to first analgesic request, pain at rest 24 h, and dynamic pain 6 and 24 h after surgery. Seventy-six studies (6278 women) were analyzed. The combined ilioinguinal nerve and anterior transversus abdominis plane (II-aTAP) block in conjunction with ITMP had the highest SUCRA (surface under the cumulative ranking curve) values for postoperative rest pain at 6 h (88.4%) and 24-h morphine consumption (99.4%). Additionally, ITMP, ilioinguinal-iliohypogastric nerve block in conjunction with ITMP, lateral TAP block, and wound infiltration (WI) or continuous infusion (WC) below the fascia also showed a significant reduction in two co-primary outcomes. Only the II-aTAP block had a statistically significant additional analgesic effect compared to ITMP alone on rest pain at 6 h after surgery (−7.60 (−12.49, −2.70)). In conclusion, combined II-aTAP block in conjunction with ITMP is the most effective post-cesarean analgesic strategy with lower rest pain at 6 h and cumulative 24-h morphine consumption. Using the six described analgesic strategies for postoperative pain management after CD is considered reasonable. Lateral TAP block, WI, and WC below the fascia may be useful alternatives in patients with a history of sensitivity or severe adverse effects to opioids or when the CD is conducted under general anesthesia. [ABSTRACT FROM AUTHOR]